OVERNMENT

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MEDICAL CARE FOR SELF-EMPLOYED SEAMEN

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.z>e>hM 4^/8 H E A R I N G S

BEFORE A

SUBC OMM ITTE E OF THE

COMMITTEE ON

INTERSTAT E AND FOREIGN COMMERCE 

HOUSE OF REPRESENTATIV ES

___ EI GH TY -EIG HT H CONGRESS

~ ~ ~ □ FIR ST SESSION

M S o N

B 3 H.R. 2108, H.R. 2669, H.R. 3338, H.R. 3873,

S = 10 H.R. 7002, S. 978

□

—---- □ BIL LS TO PROVIDE MEDICAL CARE FOR CERTAIN PERSO NS

ENGAGED ON BOARD A V ESSEL IN THE CARE, P RESERVATION,

~ ~ ~ h OR NAVIGATION OF SUCH VESSEL

OCTOBER 14 AND 24, 1963

KSU LIBRARIES

Prin ted for the use of the

Committee on Interstate and Foreign Commerce

31-833

U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON : 1964
-M .at:.

COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE

OR EN HARRI S, Ark an sa s, C hair m an

JO HN BELL WILLIAM S, M issis sip pi 

KENNETH A. RO BE RT S, Alaba ma 

HA RLE Y O. STAG GE RS, W es t V irgi ni a 

W ALTE R RO GE RS, Tex as 

SA MUE L N. FRIE D EL, M ar yl an d 

TO RBERT I I. MAC DON ALD, M as sa ch use tts 

GE OR GE M. RH OD ES , Pen ns yl van ia 

JO H N JARM AN , Ok laho ma 

LE O W. O’BR IE N, New York 

JO H N E. MOSS, Cal ifor ni a 

JO H N D. DI NG EL L, Michiga n 

PA U L G. RO GE RS , Flo ri da 

RO BER T W. H EM PH IL L, Sou th Car ol in a 

DAN RO ST EN KO WSK I, Il lino is 

JA M ES C. HE AL EY , New York 

HO RA CE It. KORNEGAY, N or th Car ol in a 

W. R. HU LL , J r„ Miss ou ri 

G IL L IS W. LON G, Lou isia na

LIO N EL VAN DEER LI N, C al if orn ia

/ r *. ■*

W. E. Wil liam so n, C le rk

Ken net h J. P aint er, A s s is ta n t C le rk

P ro fe ss io n a l S ta ff

A ndr ew Ste ve ns on Sam G. Spa l

Kurt Bor ciiardt George W. P erry

JO HN B. BE NNET T, M ichiga n 

WILLIAM L. SP RIN GER , Illin oi s 

PA UL F. SC HE NC K, Oh io 

J. AR TH UR YO UN GE R, C al if or ni a 

MILTON W. GL EN N, Ne w Je rs ey 

SAMU EL L. DEVIN E, Oh io 

AN CH ER NEL SE N, M in ne so ta 

HA ST IN GS K E IT H , M as sa ch us et ts 

W IL LA RD S. CU RT IN , Pen ns yl va ni a 

AB NE R W. SIBA L, Con ne ct ic ut 

GL EN N CU NN INGH AM , Neb rask a 

JA MES T. BR OY HI LL , N ort h Car ol in a 

DON ALD a . BR OTZM AN , Co lor ado

Subcommittee on P ublic Health and Safety

KENNET H A. RO BE RT S, Alaba ma, C hair m an

GE OR GE M. RH OD ES , Pen nsy lv an ia PA UL F. SC HE NC K, Ohio

LE O W. O’BR IE N, New Yo rk AN CH ER NEL SE N, M in ne so ta

PA U L G. RO GE RS, Flo ri da DONA LD G. BROTZM AN , Co lor ado

II...........
Text of—

H.R. 2108.................... ......... ..................... ........... ..................................

H.R. 2669______________ ______ ____________ ______ _____ ___

H.R. 3338...................... ................. ............... ........... ................................

H.R. 3873______________ ___________ ______ __________ ______

H.R. 7002_________ _______ _____ _______ _____ ______ ______

S. 978................ ............. ....... ......................... ......... ............... ...................

Report of—

Bureau of th e Budget on H.R. 2108 and II.R . 3873-----------------------

Commerce Department on H.R. 2108___________________________

Health, Education, and Welfare Departme nt on H.R. 3873________

Interior Departme nt on H.R. 3873_____________________________

Navy Dep artm ent on H.R. 2108_______________________________

Treasury Department on H.R. 2108____________________________

Statem ent of—

Clark, Earl W., codirector, Labor-Managemen t Maritim e Committee, 

AFL -CIO Maritim e Committee, and American Merchan t Marine 

Insti tute__________________________________________________

Edelman, Sidney, Assistant Chief, Public Hea lth Division, Office of 

General Counsel, Departme nt of Health, Education, and We lfare..

Ellenbogen, Theodore, Deputy Chief, Legislation Division, Office 

of General Counsel, Departme nt of Health, Education, and Welfare______________________________________________________

Finnegan, David, atto rney, Legislative Division, Dep artm ent of the 

Interior___________________________________________________

Hansen, Hon. Julia Butler, a Representative in Congress from the 

State of Washington_______________________________________

Kibre, Jeff, Washington representa tive, Internatio nal Longshoremen’s & Warehousemen’s Union_____________________________

McIntire, Hon. Clifford G., a Representative in Congress from the 

Sta te of Maine____________________________________________

McKernan, Donald L., Director, Bureau of Commercial Fisheries, 

Departm ent of the Inter ior ___ ______________________________

Miller, Dr. Mryon D., Chief, Division of Hospitals, Public Health 

Service, Dep artm ent of Health, Educatio n, and Welfare_________

I’ellv, Hon. Thomas M., a Representative in Congress from the State 

of Washington____________________________________________

Pike, Hon. Otis G., a Representative in Congress from the State of 

New York________________________________________________

Price, Dr. David E., Deputy Surgeon General, Public Health Service, 

Departm ent of Health, Education, and Welfare_______________

Rivers, Hon. Ralph J., a Representative in Congress from the State of 

Alaska___________________________________________________

Stolting, Walter, Chief, Branch of Economics, Bureau of Commercial 

Fisheries, Department of the Inter ior _______________________

Tollefson, Hon. Thor C., a Representative in Congress from the State 

of Washington____________________________________________

Van Deerlin, Hon. Lionel, a Representative in Congress from the 

State of Califo rnia_________________________________________

Wedin, John H., secretary, Committee for Restoration of Marine 

Hospital Services for Self-Employed Seam en_________________

Westland, Hon. Jack , a Representative in Congress from the State of 

Wash ington_______________________________________________

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in
IV CONTENTS

Additional information subm itted for the record by— Hagre

American Medical Association, lett er from Dr. F. J. L. Bla singam e.. 50 

Association of Wives of Commerical Fishermen, telegram from Mrs.

Thomas L. Warren, president_______________________________ 49

Bassett, Mrs. Robert, letter fro m______________________________ 50

Fishing Vessel Owners Association, telegram from _______________ 49

Health, Education, and Welfare Departmen t:

Letter from Wilbur J. Cohen, Assistant Secretary, tran smitting

additional information__________________________________ 73

Medical care for seamen and certain other persons, from the

Federal Register_______________________________________ 60

Opinions from Office of General Counsel d ated—

October 12, 1951____________________________________ 56

October 30, 1951.......... 58

December 29, 1953___________________________________ 59

October 25, 1954____________________________________ 59

Interio r Departm ent, letter from Robert M. Paul, Deputy Assistant

Secretary, transm itting proposed language for S. 978____ ______ 38

Woolfey, Lloyd, telegram from______ __________ _____________ 49
MEDICAL CARE FOR SELF-EM PLO YED SEAMEN

MONDAY, OCTOBER 14, 1963

H ouse of R ep re se nt at iv es ,

Sub co mmitte e on P ub lic H ea lt h an d S af et y

of t h e C om mit te e on I nt er st at e an d F oreig n C om mer ce,

W ashing ton, D.G.

The subcommittee met at 10 a.m., pursuant to call, in room 1334, 

Longworth Building, Hon. Kenneth A. Roberts (chairman of the 

subcommittee) presiding.

Air. Roberts. The subcommittee will please come to order.

We are holding hearings today on six bills: H.R. 2108, introduced 

by our colleague, Mr. Rivers of Alaska; H.R. 2669, introduced by our 

colleague, Mrs. Hansen; H.R. 3338, introduced by our colleague, Mr. 

Pelly, a former member of this committee; H.R. 3873, introduced by 

our colleague, Mr. P ike; H.R. 7002, introduced by our colleague, Mr. 

Mc Intire; and S. 978, a bill which has passed the other body.

These bills are designed to restore to owner-operators of small 

vessels the righ t to public health service which they enjoyed prio r 

to an administrative rulin g of the Departm ent of Health, Education, 

and Welfare, in 1954, which interpreted sections 2(h) and 322 of the 

Public Health Service Act as not authorizing such services for such 

owner-operators.

The purpose of the bills is to remove an inequity in present practices 

by amending the act to include certain self-employed seamen among 

those who have the privilege of receiving medical care in Public Health 

Service hospitals.

At this point in the record, the text of the bills and the agency 

reports thereon will be inserted.

(Thebills and reports follow:)

[H.R. 2108, 88th Cong., 1st sess.]

A BILL To provide medical care for certain persons engaged on board a vessel in the care, 

preservation, or navigatio n of such vessel

Be it enacted by the Senate and House of Representatives of the United

Sta tes of America in Congress assembled, Th at section 2( h) of the Public Health 

Service Act (42 U.S.C. 201(h)) is amended by striking out “any person 

employed on board” and inserting in lieu thereof “any person employed or engaged on board.”

Sec. 2. Section 322(a) (1) of such Act (42 U.S.C. 249(a) (1 )) is amended by 

inserti ng immediately after “employed” the following: “or engaged”.

1
2 MEDICAL CAKE FOR SELF-EMPLOYED SEAMEN

[H.R. 2669, 88th Cong., 1st sess.]

A BILL To provide medical care for certain persons engaged on board a vessel in the care, 

preservation, or navigation of such vessel

Be it enacted by the Senate and House of Repre sentatives of the United States

of America in Congress assembled. That section 2 (h) of the Public Health Service 

Act (42 U.S.C. 201(h )) is amended by striking out “any person employed on 

board” and inserting in lieu thereof “any person employed or engaged on boa rd”.

Sec. 2. Section 32 2(a)(1) of such Act (42 U.S.C. 24 9( a) (1 )) is amended by 

inserting immediately after “employed” the follow ing: “or engaged”.

[H.R. 3338, 88th Cong., 1st sess.]

A BILL To provide medical care for certain persons engaged on board a vessel in the care, 

preservation, or navigation of such vessel

Be it enacted by the S enate and House of Representatives of the United States

of America in Congress assembled, Th at section 2 (h) of the Public H ealth Service 

Act (42 U.S.C. 201(h)) is amended by striking out “any person employed on 

board ” and inserting in lieu thereof “any person employed or self-employed on 

boa rd”.

Sec. 2. Section 32 2(a)(1) of such Act (42 U.S.C. 24 9( a) (1 )) is amended by 

inserting immediately after “employed” the follow ing: “or self-employed”.

[H.R. 3873, 88th Cong., 1st sess.]

A BILL To amend section 322 of the Public Health Service Act to permit certain owners 

of fishing boats to receive medical care and hospitalization with out charge at hospitals 

of th e Public Health Service

Be it enacted by the Senate and nouse of R epre sentative s of the United States

of America in Congress assembled, Th at subsection (a) of section 322 of the 

Public Hea lth Service Act (42 U.S.C. 249) is amended by striking out “and ” a t 

the end of p aragraph (6), by striking out the period at the end of paragraph (7) 

and inse rting in lieu thereof “ ; a nd”, and by adding at the end thereof the following new pa ra gr ap h:

“ (8) Persons who own vessels registered, enrolled, or licensed under the ma ritime laws of the United State s, who are engaged in commercial fishing nitra tio ns , 

and who accompany such vessels on such fishing operations, and a substan tial 

pa rt of whose services in connection with such fishing oi>erations are comparable 

to services performed by seamen employed on such vessel or on vessels engaged 

in sim ilar operations.”

[H.R. 7002, 88th Cong., 1st sess.]

A BILL To provide medical care for certain persons engaged on board a vessel in the care, 

preservation, or navigation of such vessel

Be it enacted by the Senate and House of Repre sentatives of the United States

of America in Congress assembled, T hat subsection (h) of section 2 of the Public 

Health Service Act (42 U.S.C. 20 1( h) ) is amended to read as follow s:

“ (h) The term ‘seam an’ includes any person employed or self-employed on 

board in the care, preserv ation, or navigation of any vessel, or in the service, on 

board, of those engaged in such care, preservation, or navigation

Sec. 2. Section 32 2( a) (1 ) of such Act (42 U.S.C. 24 9( a) (1 )) is amended by 

inserting immediately after the word “employed” the following: “or selfemployed”.

[S. 978, 88th Cong., 1st sess.]

AN ACT To provide medical care for certain persons engaged on board a vessel in the care, 

preservation, or navigation of such vessel

Be it enacted by the Senate and House of Representativ es of the United States

of America in Congress assembled, Th at subsection (h) of section 2 of the Public 

Health Service Act (42 U.S.C. 201(h) ) is amended to read as follows:

“ (h) The term ‘seamen’ includes any person employed or self-employed on 

board in the care, preserva tion, or navigation of any vessel, or in the service, on 

board, of those engaged in such care, preserva tion, or navigation
MEDICAL CARE FOR SELF-EMPLOYED SEAMEN 3

Sec. 2. Section 32 2( a)(1 ) of such Act (42 U.S.C. 24 9( a) (1 )) is amended by 

inserting immediately after the word “employed” the following: “or selfemployed”.

Passed the Senate May 28,1963.

A ttes t:

Felton M. J ohnston,

Secretary.

Executive Office of the President,

Bureau of the Budget, 

Washington, D.C., August 2, 1963.

Hon. Oren Harris,

Chairman, Committee on Int ersta te and Foreign Commerce,

House of Representatives, Washington, D.C.

Dear Mr. Chairman : This is in response to your letter of February 22. 1963, 

in which you requested the views of the Bureau of the Budget regarding 1I.K. 

3873, a bill which would make certain owners of fishing vessels eligible for free 

medical, surgical, and dental treatm ent and for free hospitalization now provided 

seamen. These services would be provided by the Public Health Service to 

owners of vessels registered, enrolled, or licensed under U.S. maritime laws 

(1) who accompany such vessels on commercial fishing operations, and (2) a 

sub stan tial pa rt of whose services in connection with such operations are comparable to those performed by seamen employed on such vessels engaged in similar 

operations.

Your le tte r of Feb ruary 14,1963, also asked us to comment on II.K. 2108. This 

bill goes beyond H.R. 3873 in th at it amends section 2(h) of the Public Health 

Service Act (42 U.S.C. 201(h)) to provide care not only to fishing boat owners, 

but also to any person who may be employed or engaged on board the vessel in 

its care, preservation, or navigation.

The Bureau of the Budget recognizes tha t self-employed seamen and fishing 

boat owners are undoubtedly engaged in the same general type of duties and 

activities as the men classed as seamen who a re now eligible for free hosp ital and 

medical care. They are similarly transient and are subject to the same injuries 

and diseases. The major distinction between self-employed seamen and fishermen and other seamen is that the self-employed individual assumes the business 

risks of an e ntre preneur in the expectation of income in the form of profits rather 

than wages. In the United States such individuals normally bear their owrn costs 

for medical care. The sta tute tre ats the owner-operator as an entrepreneur for 

this purpose.

It is estim ated th at there are roughly 6.000 owTner-o perators of commercial 

fishing vessels who would be affected by H.R. 3873. Although patients from this 

group might, at the beginning of an expanded program, be cared for in Public 

Health Service hospitals and clinics with an out-of-pocket cost only for food and 

supplies, experience indicates th at the increased patient loads would soon require the employment of additional staff and oth er expenses. Thus, the cost to 

the Government of providing free medical c are in Public He alth Service hospitals 

and clinics to the group covered by the bill could soon reach a level of $1 to $1.5 

million annually. In addition, capital improvements might be required to enable 

specific hospitals and clinics to handle the increased workloads, with a resulting 

increase in program costs.

The Burea u’s principal concern, however, with an extension of benefits as contemplate d by II.K. 3873 and H.R. 2108, lies with the proposed furth er dei>arture 

from the fundame ntal principle followed in financing the program from 1798 to 

1905. This principle is that the seamen or the industry should bear the e ntire 

cost of special programs of medical care provided by the Federal Government. 

This principle lies behind the tonnage tax still levied today. However, since 

1905 the cost of medical care for seamen has increased until approximately $5 

million in ann ual tonnage tax revenue now covers only about 20 percent of the 

costs of the program.

The dire ct operating expenses incurred by the Public Health Service in providing this care are estim ated at $25 million. In addition, another $5 to $6 

million is attrib uta ble to the indirect costs of the program such as depreciation, 

self-insurance, and Public Health Service overhead, plus deferred capital expenditures as high as $30 to $50 million for modernizing or replacing hospitals. 

As a result, the d irect and indirec t costs to the Federal Government of providing 

such care are not appreciably different from the estim ated $33 million it would
4 MEDICAL CARE FOR SELF-EMPLOYED SEAMEN

cost to provide comprehensive medical and dental care coverage through health 

insurance plans fo r the estimated 119,000 currently eligible seamen.

In view of these considerations, the Bureau of the Budget believes that benefits should not he extended as proposed in either H.R. 3873 or H.R. 2108, without 

a retur n to the principle th at all or a substantial pa rt of the cost of providing 

medical care for merchant seamen should be paid by the industry or by th e seamen themselves. Two altern ative means for accomplishing this would be a substa ntial increase in the tonnage-tax rates or the establishment of a user charge 

for hospital and outpatient care furnished individual seamen.

With regard to the second alternative, it should be noted th at the maritime 

ind ustry has, to a varying extent, already establish ed welfare plans financed by 

employer contributions which provide medical and den tal care for sea farers 

an d/or the ir dependents. These welfare plan s could provide a mechanism fo r 

reimbursing the Federal Government for all or a sub stantial pa rt of the cost of 

care furnished members of the employee organizations. It should be recognized 

th at this approach would probably increase the amou nt of Federal subsidy now 

paid to certain ship operators, since an estim ated 20 percen t of the seamen curren tly eligible for medical care from the Public Health Service a re employed on 

subsidized vessels. However, such an increase would be pref erab le to atte mpting 

to distinguish between seamen on subsidized and nonsubsidized ships.

There exists a special additional problem in connection with H.R. 2108 and a 

somewhat similar bill, S. 978, passed by th e Senate on May 28, 1963. The wording in both H.R. 2108 and S. 978 would extend coverage not only to the owneroperators of fishing vessels who devote a sub stantial portion of their time to seamen duties (as provided in H.R. 3873) but also to owner-operators of other types 

of vessels, such as tugs, ferries, and barges engaged in local traffic, su bjec t only 

to the requirement th at such persons be engaged in the care, prese rvation, or 

navigation of the vessel. The language proposed in H.R. 2108 tends to so broaden 

the definition of seamen that vessel owners, passengers, guests, or others on board 

could claim benefits on the basis of minimal partici pation in the care, preserv ation, or navigation of the vessel.

To summarize, the Bureau of the Budget would have no objection to enactment of H.R. 3873, if amended to provide for recovery of the cost of providing 

medical care for seamen, both employed and self-employed, eith er through an increa se in the tonnage tax or, preferably, through the establish ment of user 

charges. In the absence of any justificatio n for extending eligibility for medical 

care to o thers tha n the owner-operators of fishing vessels, the Bu reau would prefe r the language of II.R. 3873 to that of S. 978, and would recommend against 

the broade r authoriza tion of H.R. 2108.

Sincerely,

Ker mit Gordon, D ir ec to r.

Genera l Cou nsel of th e Depar tm en t of Commerce,

Washington, D.C., October 1,1968.

Hon. Oren H arr is,

Chairman, Committee on Inter sta te and Foreign Commerce,

House of Representatives, Washington, D.C.

Dear Mr. Cha irman : This is in furth er reply to your request for views of 

thi s Departm ent with respect to H.R. 2108, a bill to provide medical care for 

cer tain persons engaged on board a vessel in the care, preservation, or n avigation 

of such vessel

Section 322(a) of the Public Health Service Act (42 U.S.C. 24 9( a) (1 )) 

authorizes that Service to provide medical, surgical, and dental treatm ent and 

hospitalization without charge at hospitals and oth er sta tions of the Service to 

seamen “employed” on vessels of the United States registered, enrolled, and 

licensed under the maritim e laws thereof, other than canalboats engaged in the 

coasting trade. Section 2 (h) of the Public Health Service Act (42 U.S.C. 201(h) ) 

presently defines the term “seamen” as including any person “employed” on 

board in the care, prese rvation, or navigation of a ny vessel, or in the service, on 

board, of those engaged in such care, preservation, or navigation.

H.R. 2108 would extend th at authority to persons “engaged” on board such 

vessels in the care, preservation, or navigation of the vessel.

We understand th at the purpose of the bill is to restore to owner-operators of 

small vessels the right to public health services which they enjoyed prior to an 

adm inistra tive ruling of the Department of Health, Education, and Welfare in
MEDICAL CARE FOR SELF-EMPL OY ED SEAM EN 5

1954 which interprete d the sta tut e as not auth oriz ing such services for such 

owner-operators. We look with favor on thi s purpose. The bill, however, 

might be construed more broadly than this. It migh t be construed to apply to 

passengers, guests, and othe rs abroad the vessel who provide only some incidental service relating to the care, preserva tion, or navigation of the vessel. 

We recommend favorable consideration of the bill if it is amended so as to be 

limited to the foregoing purpose and to exclude those who furnish only incidental services.

The Bureau of the Budget advises there is no objection to the submission of 

this report from the stan dpoint of the adm inistration’s program.

Sincerely,

Robert E. Giles.

Department of the Navy,

Office of the Secretary,

Washington, D.C., October 29,1968

Hon. Oren Harris,

Chairman, Committee on In terstate and Foreign Commerce,

House o f Representatives, Washington, D.C.

My Dear Mr. Chairman : Your requ est for comment on H.R. 2108, a bill “To 

provide medical care for certain persons engaged on board a vessel in the care, 

preservation, or navigation of such vessel,” has been assigned to thi s Depar tment by the Secretary of Defense fo r th e prep ara tion of a rep ort thereon expressing the views of the Departm ent of Defense.

This bill would amend sections 2( h) and 32 2( a)(1 ) of the Public Health 

Service Act so as to include among the persons entitled to medical care in P ublic 

Hea lth Service facilitie s persons engaged on board American merchant vessels 

in the care, prese rvation, or navigation of the vessel. These sections as presently 

worded limit this medical care to persons “employed” in these activities.

As this bill does not rela te to persons entitled to medical care in milita ry 

medical facilities , the Departm ent of Defense defe rs to other inte rested depar tments and agencies.

This report has been coordinated w ithin the Dei>artment of Defense in accordance w ith procedures prescribed by the S ecre tary of Defense.

The Bureau of the Budget advises tha t, from the stan dpo int of the administra tio n’s program, there is no objection to the presentation of this repo rt for the 

consideration of the committee.

Sincerely yours,

C. R. Kear, Jr.,

Captain, U.8. Navy, Deputy Chief

(F or the Secretary of the Navy).

The General Counsel of the Treasury,

Washington, October 15,1968.

Hon. Oren Harris,

Chairman, Committee on Interstate and Foreign Commerce,

House of Representative s, Washington, D.C.

Dear Mr. Chairman : Reference is made to the request of your committee for 

the views of this Department on H.R. 2108, “To provide medical care f or certain 

persons engaged on board a vessel in the care, preservation, or navigation of such 

vessel.”

The proposed legislation would exten d the benefits of the Pu blic Health Service Act to c erta in persons not now entitled to such benefits because they ha ve not 

been considered as being “employed” on board vessels. The bro ade r term “engaged” used in the bill would include individuals serving on board who contrib ute to the vessel’s operation.

Since the subject ma tter of the bill is not of primary intere st to the Tre asu ry 

Department, we make no recommendation as to its enactment.

The Departm ent has been advised by the Bureau of the Budget t ha t there is no 

objection from the stand point of the adm inistration’s program to the submission 

of this report to your committee.

Sincerely yours,

G. d’Andelot Belin, General Counsel.

31 -83 3— 64-------2
6 MEDICAL CARE FOR SELF-EM PLOY ED SEAM EN

Depa rtme nt of th e I nterior,

Off ic e of th e Secretary,

D.C., A vgu st 1 2, 196J. Hon. Oren H arr is,

Chairman, Committee on Interstate and Foreign Commerce,

House of Representatives, Washington, D.C.

Dear Mr. H arris : Your committee has requested this Dep artm ent's report on 

H.R. 3873, a bill “To amend section 322 of the Public Health Service Act to permit 

certain owners of fishing boats to receive medical care and hospitaliz ation 

without charge a t hospitals of the Public H ealth Service.”

While we agree w ith the objectives of H.It. 3873, we believe th at these can best 

be accomplished through our dr af t bill enclosed herein. Accordingly, we recommend the enactment of H.It. 3873 in the form of our suggested dr aft bill.

Section 322 of the Public Health Service Act, as amended (42 U.S.C. sec. 249) 

authorizes the Public Health Service to provide medical care and treatm ent of 

certain persons, including seamen “employed” on vessels of the United States. 

Prior to 19.»4 self-employed fishermen were eligible for medical care in hospitals, 

outpatien t clinics, and other medical facilities of the Public Hea lth Service. An 

adm inistra tive ruling of that agency in 1954 held th at the term “employed” as 

used in the Public Health Service Act, supra, may not be reasonably interpre ted 

as synonymous w ith “occupied” or “engaged in.” but must be understood to refe r 

to services rendered in an employee status under a con tract of hire, eith er expressed or implied. Subsequently, section 32.1(d) of the Public Hea lth Service 

regulations (42 CFR sec. 32.1(d)) was amended to exclude the owner or join t 

owners of a vessel or the spouse thereof from receiving such medical benefits. 

Thus, section 32.1(d) of the regulations defines the term “seamen” to include 

“* * * any person employed on board in the care, preservation, or navigation of 

any vessel, or in the service, on board, of those engaged in such care, prese rvation, 

or navigation, hut does not include the owner or j oint owners of a vessel or the

spouse of any such owner ;”. [Italic supplied.]

Generally, owner-fishermen perform the same duties and engage in the same 

activities as do employee fishermen under a con trac t of hire, either expressed or 

implied. They face the same dangers and are subject to the same injuries and 

sicknesses as employee fishermen. Frequently, adeq uate community hospital 

fac ilities are not available to them because of th e transi ent natur e of their work 

which takes them away from the ir home community health and welfare facilities. 

The Atla ntic menhaden fishery, for example, extends from New England to 

Florida and such fishermen frequently follow the schooling fish, often landing 

their catch in ports dis tan t from their home ports. The Gulf of Mexico shrimp 

fishermen extend the ir operations to waters off the coast of Mexico; and on the 

west coast, the tuna vessels, while based principally in San Diego, fish as far 

south as Peru. The la tte r put into ports frequently in foreign countries to 

obtain licenses, supplies and other materials.

The legislative history of the hospital and medical care program for seamen 

suggests th at the participation of the Federal Government in providing medical 

care to seamen r ests primarily on a national inte res t in a ssuring an effective labor 

force which is necessary for an adequate merchant marine. Self-employed fishermen also add to this maritime labor force, since they ha ve developed maritime 

skills necessary to all good seamen.

H.R. 3873 would expand the authority of section 322 of the act. supra, to 

inclu de commercial fishing vessel owners who accompany the ir vessels on fishing 

operations and substan tially perform services comparable to seamen employed on 

such vessels or on vessels engaged in similar operations. We believe that the 

provisions of th is bill are too restrictive. The bill would limit the benefits of the 

act to commercial fishermen alone and not include other self-employed persons 

who may be engaged on board a vessel in the care, preservation, or navigation 

thereof. Fur ther. II.R. 3873 would require a finding tha t the self-employed person 

is engaged substan tially in the care, preservation, or navigation of a vessel before 

receiving the benefits of the act. We believe that, such a test would be difficult 

to meet in every instanc e and even more difficult to administer.

Our proposal would amend subsection (h) of section 2 of the act (42 U.S.C. 

sec. 201(h)) in a manner th at would clearly provide th at “seamen” include 

owners or jo int owners of vessels. Section 2 o f our draft bill would amend section 

32 2( a) (1 ) of the act. supra, to include “self-employed” seamen among those 

eligible presently to receive medical benefits under the act. supra. Thus, the 

prin cipal effect of our proposal, and we believe the intended purpose of H.R.
MEDICAL CARE FOR SELF-EM PLOY ED SEAM EN 7

3873. is to resto re to all self-employed seamen the medical benefits enjoyed prior 

to 1954. Accordingly, we again recommend the enactme nt of H.R. 3873, if 

amended as provided herein.

The B urea u of the Budget h as advised that there is no objection to the presentation of this report from the stan dpoint of the adm inistration's program. 

Sincerely yours,

F rank P. Brigg s, 

Assistant Secretary of the Interior.

A BILL To provide medical care for certain persons engaged on board a vessel in the care, 

preservation, or navigation of such vessel

Be it enacted by the Senate and House o f Representatives of the United States

of America in Congress assembled, That subsection (h) of section 2 of the 

Public Health Service Act (42 U.S.C. 201(h )) is amended to read as follows:

“(h) The term 'seamen’ includes any person employed or self-employed on 

board in the care, prese rvation, or navigation of any vessel, or in the service, 

on board, of those engaged in such care, preservation, or navigation

Sec. 2. Section 322(a) (1) of such Act (42 U.S.C. 249(a) (1 )) is amended by 

inserting immediately after the word “employed’’ the following: “or selfemployed”.

D ep artm en t of H ea lth, E du ca tion , an d W el fa re ,

Washington, Septe mber 12, 1964.

H o n . Oren H arris,

Cha irman, Committee on Int ers tate and Foreign Commerce,

House o f Representatives, Washington, D.C.

D ea r Mr. Ch a ir m a n : This letter is in response to your requests for reports 

on II.It. 3873, a bill to amend section 322 of the Public Health Service Act to 

permit certain owners of fishing boats to receive medical care and hospitalization 

without charge at hosp itals of the Public Health Service, and II.It. 2108, a 

bill to provide medical care for certain persons engaged on board a vessel in 

the care, prese rvation, or navigation of such vessel.

Under present law seamen employed on vessels registered, enrolled, and 

licensed under the maritim e laws of the United States, other than canal boats 

engaged in the coasting trade, are entitled to medical, surgical, and dental trea tment and hosiptalizatio n without charg e at hosp itals and other stations of the 

Public Health Service (Public Health Service Act, sec. 2( h) , 322, 42 U.S.C. 201, 

240). In view of the use of the term “employed” in the definition of “seamen” 

we have interpre ted these provisions to limit entitlem ent to medical care to 

those who are employees and to exclude those who are self-employed even when 

they are engaged in the care, preservation, or navigation of the vessel.

The legislative history of this program suggests that the participa tion of 

the Fed eral Government in providing medical care to merchant seamen rests primarily on a national interest in assuring the effectiveness of the labor force 

requ ired for an adeq uate American merchant marin e. A self-employed owner 

who performs duties rela ted to the care, preservation, or navigation of a documented vessel of the United States is, in effect, fulfilling the same purpose as 

the employed seamen on board the vessel. Since such i»ersons are in fact 

applying their maritime skills, they are essentially adding to the maritime 

labor force.

Although sta tistics are not available on the additional number of persons who 

would come within the provisions of the law under the present bills, we believe 

th at neither the number nor cost would significantly affect the present program, 

and that enactme nt of the legislation with the revisions suggested below would 

pose no serio us difficulties fo r this Depa rtment as a provider of services.

The purpose of the bills, as we understa nd it, is to remove an ap parent inequity 

in present practice by amending the act to include a ce rtain class of self-employed 

seamen who formerly, de facto, enjoyed the privilege of receiving medical care 

in Public Health Service hospitals, and not to expand the program in any substan tia l manner. Speaking solely as a provider of services, this Depa rtment 

has no objection to the passage of appropriate amendments to tha t end.

We have certain reservations, however, as to the limitation of H.R. 3873 to 

self-employed fishermen, a limitation that would create a new inequity by discrim inating against self-employed seamen other than fishermen. If the legislati on is favorably considered, we would therefore p refe r the language of S. 978, 

now pending before your committee, which would simply broaden present law to
8 MEDICAL CARE FOR SELF-EMPLOYED SEAMEN

include self-employed persons as seamen if they perfo rm the same task s as are 

performed by seamen within the meaning of the present law.

We also have reservations concerning the language of H.R. 2108, which, by 

extending entitlement to medical care to all persons engaged on board a vessel 

in its care, preservation, or navigation, seems b road enough to include even p assengers and guests who may perfo rm on board some useful service rela ted to the 

care, preservation, or navigatio n of the vessel, though this was probably not 

intended by the bill’s author. Here, again, amendment of the bill so as to conform to the language of S. 978—which simply extends the definition of “seamen,” 

and the operative provision conferring entitlem ent to medical care, under the 

Public Hea lth Service Act to self-employed seamen—would render the bill unobjectionable from the viewpoint of this Departmen t.

We are advised by the Bureau of the Budget th at there is no objection to the 

presenta tion of this report from the standpoint of the administration’s program. 

Sincerely,

Welbub J. Cohen, 

Assistant Secretary.

Mr. Roberts. Our first witness tod ay will be ou r colleague, Re presenta tive R alph J. Rive rs of Alaska.

I believe, Mr. Cle rk, the statem ents have been passed up to the 

members.

Mr. Riv ers.

STATEMENT OF HON. RALPH J. RIVERS, A REPR ESENTATIVE IN 

CONGRESS FROM THE STATE OF ALASKA

Mr. Rivers. Mr. Ch air man an d members of th e c omm ittee, I a pp recia te the op po rtu nity to be heard here in behalf of S. 978, which is 

sim ila r to my own bill, H.R. 2108, also un de r con sidera tion by th is 

committee, bu t I w ish to ind icate t ha t I am su pp ortin g t he Se nate bill.

Th e pur pose of th is legisla tion is to enable fish ing vessel owneropera tor s who work aboard their vessels to receive the same med ical 

benefits as are affo rded by the Public Hea lth Service to seamen emplo yed on lx>ard in the care, pre ser vat ion , or na viga tio n of any vessel.

As the members o f this comm ittee will r eca ll, the need fo r th is leg islatio n arose in 1954 when the Sur geo n General of the Un ite d State s 

ruled in resp ect to med ical benefits th at the Pu blic Hea lth Service A ct 

appli es only to fishermen holdi ng a co ntr act o f employment on a fishin g vessel. Th e Surge on Gen eral based his decision on the definition 

of the ter m “seamen'’ whi ch is set ou t in the Pu blic He alth Service 

Ena bl ing Act. Th ere a “seaman ” is defined as “* * * any p erso n em ­

ployed o n board in the care, pre ser vat ion , or n aviga tio n of a ny vessel 

* * *.” From this definition, the Surge on Gener al reasoned th at un ­

less a seaman held a contr act of employme nt, he was precluded fro m 

being a bene ficia ry of the Public Hea lth Serv ice benefits. Thus, since 

1954, a n ow ner-operator working a bo ard a vessel on a self-employ ed 

bas is has been den ied fre e care at Pu blic Hea lth Serv ice facilities.

In Alaska alone there a re more th an 2,000 sma ll fishing boato wne rs, 

most of whom —in the course of rang in g hu nd red s of miles from 

home—ea rn less th an $5,000 per annum, and occasionally mak e no 

pro fit at all. These owner -op era tors are as much in need of car e in 

Pu blic H ea lth Service fac ilities d ur ing voya ges as are employees who 

work aboard th eir vessels. Thus, the very reason which led to in ­

clus ion o f boat owner-operators in the benefits o f the pro gra m, dur ing 

all those years p rio r to 1954 still pertains.
MEDICAL CARE FOR SELF-EMPL OY ED SEAM EN 9

As was brought out in the hearings before this committee last year, 

the legislation now under consideration would restore to self-employed 

fishermen the eligibility for care in Public Health Service facilities 

which they enjoyed prior to 1954.

I am pleased to note that S. 978 is supported bv the Department of 

Health. Education, and Welfare, the Bureau of Commercial Fisheries 

of the Department of the Interior, the Alaska State Legislature, and 

various maritime organizations and fishermen’s associations.

I urge tha t the measure be approved.

I might state that I have kept my remarks brief because many of my 

colleagues who are conversant with the subject are here to testify 

along with specialists in this field, and I thank you, Mr. Chairman.

Mr. Roberts. Thank you, Mr. Rivers.

If I recall correctly, one of the witnesses who appeared in favor of 

this bill was the late Clem Miller, of California, and one of the bills 

we considered, I believe, was introduced by him. Is tha t no t correct?

Air. Rivers. That is correct, and I was associated wTith him in 

hearings before this committee last year on the same legislation.

Air. Roberts. It seems tha t the trouble arises here with an administrative ruling on section 2(h) where the term “seamen” under tha t 

definition—and I am reading from the Public Health Service Act. as 

amended—includes:

* * * any person employed on board in the care, prese rvation, or navigation 

of any vessel, or in the service, on board, of those engaged in such care, preservation, or navigation.

Wha t the Senate bill did was to add to that subsection (h) the 

words “or self-employed.”

I believe tha t is the change t ha t the Senate made which they believe would include these owner-operators.

Mr. Rivers. That is correct, Air. Chairman.

Air. Roberts. I believe t hat is clear enough and I appreciate your 

appearance.

I have no questions except to compliment you on your support of 

this legislation.

Any questions, gentlemen ? Air. Schenck.

Air. Schenck. I just have two questions, Air. Chairman.

I would like to ask our colleague, and I do so as a matter of developing information, what is the basic justification for Public Health 

Service facilities being available to either seamen employed or owneroperators of boats any more than any other field of commercial 

activity ?

Air. Rivers. I would say to my colleague th at this is historical. It 

is a matter of policy. Seamen lead topsy-turvy lives, and travel on 

voyages a long, long way from home plying the seven seas. As a 

matter of policy and to encourage Americans to be seamen, our forefathers decided to extend Federal health benefits as one of the fringe 

benefits of being a seaman. Fishing vessels are also frequently taken 

for use in time of war to bolster our merchant marine. Seamen a 

long way from home without much money or credit often need to be 

taken care of when injured in the course of their hazardous occupation.

The thing is that this whole thing has pertained to seamen for 

a century and a half and whether or not you wish to include fishermen, who are included right now as long as they are working as em-
1 0 MEDICAL CAKE FOR SELF-EM PLOY ED SEAM EN

ployees of the skipper of the fishing boat, is another policy consideration, and whether you want to include the skippers of these small 

vessels who barely make a living any more than their employees do, 

is also a matter of pol icy.

I am supporting the policy as stated.

Mr. Schenck. I would like to say to my colleague that I did not 

ask the question critically but 1 felt that it might be very helpful 

to have some background information in the record because, as you 

have indicated, this has been a long lime and perhaps many who are 

now considering it are not aware of that background.

Mr. Rivers. I would say that I was not planning on making the record very complete from my own testimony. T am here primarily to 

express my suppport of the bill. The specialists present from the 

Bureau of Commercial Fisheries, and the Public Health Service, will. 

I am sure, answer fhe gentleman’s questions.

Mr. Sciienck. I just wanted to get that in the record and I also 

wondered, Mr. Chairman, who might give an estimate of cost.

Mr. Rivers. There is one in the Senate report here. It says $1,733,- 

000 per year.

Mr. Schenck. Tha t is all the questions I have, Mr. Chairman.

Mr. Roberts. I would like to add at this point—I would like the 

staff to correct me if I am wrong—I think this was probably the first 

piece of legislation tha t brought the Public Health Service within 

the jurisdiction of this committee. It was advocated, I believe, bv 

President Adams. I think tha t is correct.

If I could find that with the help of our able staff member. I 

will try to insert tha t in the record.

Mr. Roberts. I might observe the Senate has a report which is 

available and gives quite a bit of the background.

Mr. Rogers of Florida ?

Mr. Rogers of Florida. Mr. Chairman, I do not have any particular questions at this time.

I will wait until we have other witnesses. I just want to say it is 

always good to see our distinguished colleague from Alaska here. 

We are always delighted to have his testimony.

Mr. Roberts. I would like to say tha t our chairman’s wife has 

just gone out the door.

Mrs. Harris, we are pleased that you would come to our meeting 

this morning and would be glad if you cared to stay.

Mr. Nelsen ?

Mr. Nelsen. 1 thank my colleague from Alaska for his testimony.

I wondered, Ralph, if you recall any real reason why this act was 

changed. Prior to 1954, the owner of the vessel, as I recall, was 

covered.

Was there any controversy that developed that led to fhe change, 

to your recollection ?

Mr. Rivers. Yes, sir. From the history tha t I have read to refresh 

my memory, the Suregon General in 1954 interpreted the provision 

of the act referred to by the chairman to the effect that to be a seaman 

one had to be employed as such under a contract of employment, and 

could not qualify for the purpose of care at Federal health facilities 

if self-employed.
MEDICAL CARE FOR SELF-EMPLOYED SEAMEN 11

Th us the owner -op era tors got exclude d on the Surge on Ge neral ’s 

admi nis tra tiv e rulin g after sh aring the benefits in questio n fo r 125 

ye ars or so.

Mr. N else n, Wo uld the owner of the vessel th at goes ou t fo r king 

cra b be co nsid ered a fisherman ?

Mr. Rivers. Yes, he would.

Mr. Nelse n. Because I wan t to be sure they are covered.

Mr. Rivers. Th is all app lies to bei ng away from home ports, and 

with respec t to the fisherm en th at are fishing fo r kin g cra b 20 miles 

off t he coast of Ko dia k, their neare st po rt is th eir home po rt, so I do 

not suppose th at they would be include d.

Mr. Nelse n. I am sure that you wou ld have no obje ction if I re ­

ferred to the king cra b a t H om er, Alaska. 1 rememb er b ein g u p there, 

Mr. Ch air man, a nd king crab when stretc hed out were about t hat long 

[in dica tin g] . Th ey looked as if they would be tou gh to wrestle 

wit h. Tha nk yo u very m uch.

Mr. Rivers. Th an k you for the honor able mentio n of the great 

king crab o f A laska.

Mr. Roberts. Th an k you, Mr. Riv ers.

Mr. Rivers. Tha nk you.

Mr. Roberts. Our next witness will be our colleague from 'Washing ton , Con gressm an Tollefson.

STATEM ENT OF HON. THOR C. TOLLEFSON, A RE PR ES EN TA TIVE IN 

CONGRESS FROM TH E STATE OF WASHINGT ON

M r. T ollefson. Mr. Cha i rm an and mem bers of the subcom mittee, I 

appre cia te this op po rtu nity to testi fy in sup port of II.R . 2108 an d the 

sim ila r House an d Sen ate hills.

The com mittee heard testimo ny on sim ila r hills in the last Congress 

and is famili ar with the obje ctives which the chairma n of the committee sta ted at the outset. I have men tioned these purpo ses in my 

statem ent. There is no reason f or repe at ing them.

It seems a little odd to me that because of the interpretatio n of a 

mere word a catego ry of people hav e been t hro wn out of the privilege s 

of medical car e un de r the Public I lea lth Service Act.

As has alr eady been stated , the Surge on Gen eral ap pa rently based 

his ru lin g upo n the in terp retatio n of the word “seam an," and under 

the orig ina l act, a seaman was one who was employed in the care, preserv ation, or n aviga tion of a vessel and, ap pa rently, the Sur geo n Ge nera l felt that because the self-employ ed did not have a co ntr act of 

em ployment he was not entitled to benefits of the act. It is th at simp le 

a th in g and these bills are seeking to restore the privilege s that these 

people had prior to 1954.

I tr us t th at th e committee will tak e the same kind o f ac tion it did last 

year and approv e the bill.

Th an k you very much.

Mr. Roberts. Th an k you, Congressm an. I appre cia te very much 

yo ur a ppear ance here.

Mr. T ollefson. I )o you ha ve any quest ions ? _____ __

With ou t objection, your statem ent may be/

£m t7M mb <L rec ord .

Mr. T ollefson. Th an k you.
12 MEDICAL CARE FOR SELF-EMPLOYED SEAMEN

(The statement referred to follows:)

Statement of Thor C. Tollefson, Representative in Congress From the State

of Washington

Mr. Chairman and members of th e subcommittee, I appreciate this o pportunity 

to testify in support of H.R. 2108 and the sim ilar House and Senate hills which 

are being considered this morning. The members will recall the hearings on 

similar bills in the last Congress and are fam iliar with the ir objectives. They 

seek to resto re medical and hospital care to owners, or pa rt owners, of fishing 

boats who, prio r to 1954, received such care in Public Health Service hospitals. 

This class of persons was ruled ineligible for such care by adm inistra tive action 

following an opinion by legal counsel in the Department of Health, Education, and 

Welfare. Historically, prior to this action, these people had been eligible for 

and received such care. The ruling of the Surgeon General deprived them of 

the services, and these bills seek to restore their historic privileges.

The Surgeon General based his decision on the definition of the term “seaman” 

which is set out in the Public Health Service Enabling Act. A seaman is there 

defined as “* * * any person employed on board in the care, prese rvation, or 

navigation of any vessel * * The Surgeon General apparen tly reasoned tha t 

unless a seaman held a contract of employment, he was not entitled to receive 

Public Health Service benefits. The owner-operator of a vessel not having a 

contract of employment was excluded.

There are a gre at many small fishing boat owners whose annual income is 

relatively small. At the earlie r hearings, it was testified that in Alaska alone 

there were 2,500 small boat owners whose income was less than $4,000 per year. 

With such small income they are as much in need of care in Public Health 

Service facilities as are their employees. Indeed, prior to 1954 no distinction 

was made as to whether persons working aboard the vessel owned or held a 

pa rt interest in the vessel. These self-employed fishermen essentially fulfill 

tli same purpose as employed seamen on the vessels, and should receive the same 

health benefit. They should not be excluded by a mere technical inte rpretation 

of a word.

I urge the subcomm ittee to act favorably on the proposal pending before it. 

In doing so you would only be restoring a tradition al and historic right.

Mr. Roberts. Our next witness is our colleague from California and 

a member of the Committee on Interstate and Foreign Commerce, the 

Honorable Lionel Van Deerlin. Mr. Van Deerlin, we will be glad 

to hear you at this time.

STATEMENT OF HON. LIONEL VAN DEERLIN, A REPRESENTATIVE 

IN CONGRESS FROM THE STATE OF CALIFORNIA

Mr. Van Deerlin. Mr. Chairman, I am happy to join my colleagues from the Pacific Northwest in support of IT.R. 2108, for extending medical benefits to self-employed fishermen.

This measure, if enacted, will close a serious gap in the protection 

of men engaged in hazardous, yet extremely important work. As 

the world’s nutritional needs turn our attention evermore to the oceans 

for protein, we must strive to make fishing a desirable occupation. 

Medical protection and a cushion against disabling injury are vital to 

that end.

While at sea, owners skippering their own vessels perform the same 

duties as crewmen, and are exposed to the same perils. Thus they 

appear to come within the intended meaning of the law on public 

health coverage from which an administrative ruling excluded them 

9 years ago.

II.R. 2108 has support of the American Tunaboat Association, representing a great southern California industry. In recent international disputes over territorial fishing rights, the various segments of
MEDICAL CARE FOR SELF-EMPLOYED SEAMEN 13

American commercial fishing have been drawn together as never 

before. And though the tuna fleet characteristically operates with 

fewer owner-crewmen than some other branches of fishing, its organization feels strongly the need for this legislation.

Mr. Chairman, 1 hope the subcommittee will give approval to this 

legislation, and tha t its enactment into law will follow quickly.

Mr. Roberts. Are there any questions? If not, we appreciate your 

appearance and testimony, Mr. Van Deerlin.

Mr. Van Deerlin. Thank you, Mr. Chairman.

Mr. Roberts. Congressman Pelly, I believe I will call Mrs. Hansen 

next, because I believe you wanted to introduce a witness.

Mrs. Hansen, the gentlelady from Washington.

STATEMENT OF HON. JU LIA BUTLER HANSEN, A RE PRESENTATIVE 

IN CONGRESS FROM THE STATE OF WASHINGTON

Mr. Hansen. Mr. Chairman and members of the committee, it is a 

real pleasure to appear here this morning and I want to express my 

appreciation for the courtesy.

I had the pleasure of appearing last year and I think my remarks 

are still before you and are just as tru e today as they were a year ago.

I do want to join my very distinguished colleagues from the west 

coast and from the east coast who are supporting S. 978 and some of 

our own bills.

I come from a district, pa rts of which are largely made up of fishing 

people and this historic right, which was the privilege which was given 

to the shipowners throughout the years, I feel should be restored. I 

am sure tha t you realize that the fishing industry has been severely 

hurt and crippled during the last few years. There has been a scarcity 

of runs.

We have a great deal of difficulty with some international problems 

on fisheries and these have all increased the problems, and I think this 

is one place where we might rectify an injustice, and certainly the shipowners, the masters of the vessels, are competent seamen and are on 

the same par as their employees, so I do urge the committee's favorable 

action on behalf of the bill.

Mr. R oberts. Thank you very much, Mrs. Hansen. We appreciate 

your statement.

Any questions, gentlemen ?

Thank you again for your appearance.

Mrs. Hansen. Thank you, sir.

(Mrs. Hansen’s statement follows:)

Statement of H on. J ulia Butleb Hansen, a Representative in Congress

From the State of Washington

Mr. Chairman, it is a p leasure to submit to you and the members of the subcommittee this statement in supp ort of the bills before you today, which include my 

bill, H.R. 2669. All have been introduced for the purpose of correcting an 

injustice to the fishing boatowners of our country.

The district I represent includes a larg e number of fishing boatowners who 

serve on board their vessels, along with the men they employ. I know, because 

I have been on these boats many times. "They fish in the Columbia River, in 

the waters of Grays Harbor, and all the way up to Alaska. Their skill as 

seamen is a source of gre at pride to these men. Theirs is a demanding way of 

making a living, and the owners share the duties and the hardships equally 

with th eir employees.

31-833—64-----3
14 MEDICAL CARE FOR SE LF-EM PLOY ED SEA ME N

The men employed on board fishing vessels have been eligible for medical and 

hospital care at Public Health Service facilities, without question and without 

inte rrup tion, from 1798 to the present. Yet the shipowners, who trav el as far 

from their home ports as the men they employ, face the same dangers, and are 

prey to the same illnesses and injuries, were denied eligibility by administrative 

ruling in 1954. My bill, H.R. 2669, and the other bills under consideration by 

thi s subcommittee today are intend ed to restore eligibility to the owners, thus 

ending the unfair discrimination to which they have been subject for the past 

9 yea rs and restoring their historic right to the medical and hospital services 

of the Public Hea lth Service.

I would like to quote from some typical letters I have received from consti tue nts of my dis trict in supp ort of this legislation. One writes, “The 

American fishing industry is an important one to our country and should be 

protected in every way that can make it profitable, but the opposite has been 

true. * * * Our self-employed seamen don’t have a pension or unemployment 

benefits.”

Another wrote, “The boatow ners have been hit wth diminishing return s 

of fish and foreign competition and would appreciate the retu rn of eligibility 

for medical care.”

The fishing industry is a most important one to the economy of the country 

and to that of distric ts like mine, as these letters point out. In addition to its 

prim ary function, the fishing fleet provides an imp orta nt source of experienced 

seamen in times of national crisis. In the ir day-to-day work the owners and 

crews provide valuable services to the Government. These men, therefore, deserve every encouragement and incentive to ply the ir trade and to buy the ir own 

boats, eith er individually or as co-owners, as they a re able.

The legislation I have sponsored seeks only to reestablish fair and equitable 

treatm ent for the fishing vessel owner-operators. It does not seek coverage for 

any other groups. I feel sincerely tha t these men deserve the favorable consideration of the committee in this m atte r, as it seems appa ren t to me that the original 

inte nt of Congress was th at they should be included. The fact that they enjoyed 

entitlem ent to Public Hea lth Service care for 156 y ears is convincing evidence in 

their behalf.

Tha nk you for this opportunity to speak in behalf of this legislation.

Mr. Roberts. Next I would like to call our dis tin guish ed colleague 

fro m Maine, the Ho norab le Clifford G. M cIn tire. We sh ift f rom one 

coast, to another.

STATEMENT OF HON. CLIFFORD G. McINTIRE, A REPRESENTATIVE 

IN CONGRESS FROM THE STATE OF MAINE

Mr. McI ntire. Mr. Ch airma n and mem bers of the committee, I ask 

unani mo us consent th at m y statement may be filed fo r the record,

Mr. R oberts. W ith ou t objection.

(T he sta tem ent referred to follo ws :)

Statement of Hon. Clifford G. McI ntire, a Representative in Congress From

tiie State of Maine

Mr. Chairman, my bill. H.R. 7002, would restore to self-employed boat-owning 

fishermen and other self-employed seamen eligibility for medical care in hospitals, 

as well as other medical facilities of the Public Health Service, these in the event 

of illness or injury incurre d while engaged in at-sea operations.

For some 156 years—from 1798 to 1954—such eligibility did exist. During th is 

period the Federal Government recognized that the fisheries industry is made up 

large ly of fishermen who own fishing craft individually or jointly and who sha re 

the same toil and dangers at sea as do those working with them and receiving 

wages.

This eligibility, however, ceased to exist in 1954. At t ha t time an adm inistrative ruling differentiated between wage-earning fishermen and their coworkers 

who held ownership or pa rt ownership in the cr afts they used f or fishing. Under 

this ruling, medical benefits form erly enjoyed by workmen fishermen were retained, but those th at had been extended to fishermen who owned their own 

fishing boats a nd were self-employed were discontinued.
MEDICAL CARE FOR SE LF -EMPL OY ED SEA ME N 15

Such a ruling imposes a present or poteutial hardship on p erha ps as many as 

10,000 indu strio us men who—in their own or cooperatively owned small craft— 

gain a livelihood from the sea. The pertinent ruling poses as an inequity th at 

should be corrected, and my legislation would serve to accomplish this end.

In addition, my legislation would provide a very valuable assist for th e American fishing industry. Restoring these pre-1954 benefits to self-employed fishermen and seamen would have the effect of furnishing an inducement for vessel 

ownership. Many who are now employed as fishermen and seamen would aspire 

to acquiring and owning vessels, thereby adding strength and dimension to the 

American fishing fleet in particular and the fishing industry in general.

We are all mindful, of course, that legislation similar to th at which is before 

this committee was passed by the Senate in the las t Congress; however, it was 

not brought to a vote in the House of Representatives.

Some Members of the House of Representatives registere d a concern over the 

definition of the term “seamen” in th at Senate-passed legislation, wondering 

whether it migh t not be so broad in scope as to include o ther than bona fide selfemployed fishermen and seamen.

I wan t to make it clear for the record th at my principal intere st is centered 

in extending to owner-operator fishermen and other self-employed seamen the 

medical benefits th at had been provided them prior to 1954 through the Public 

Health Service.

I would like the record of hearings on thi s legislation to show clearly th at it 

was not the design of my legislation to encompass either passengers or others 

aboard vessels who provide only some incide ntal service relating to the care, preservation. or navigation of the vessel. Neither do I feel that these benefits should 

be provided for those associated with vessels employed in local traffic, such as 

tugs, ferries, and barges.

I wan t to say. too, t ha t I would h eartily concu r with any change in legislative 

language that would establish clearly and precisely th at this legislation had application only to fishing boat owners and self-employed seamen.

I would not, however, favor any amendment of this legislation which would 

provide for recovery of the cost of providing medical c are for seamen and fishermen, either through an increase in the tonnage tax or through the establishm ent 

of user charges.

Mr. Chairman. I want to say th at I deeply appreciate having the opportunity 

of presenting my testimony to the members of this committee.

Mr. McI ntire. There is little more perhaps that I could add except 

to say tha t this legislation has a very deep bearing to the east coast in 

our fishing industry, as well as to the interests of the west coast. The 

same principles apply; the same traditions are th ere; and I am happy 

to join with my colleagues this morning in urging the committee’s favorable consideration of the legislation. I appreciate the opportunity 

to appear and I am pleased tha t the committee is taking this matter, 

which has already passed the other body, under legislative consideration this morning.

Mr. Roberts. Would you consider the Senate bill to do the job? 

Would that be your recommendation ?

Mr. McI ntire. Indeed I do.

Mr. Roberts. Very well.

Any questions, gentlemen ?

Thank you, sir.

Mr. McIntire. Thank you very kindly.

Mr. Roberts. Our next witness is our colleague from New York, the 

Honorable Otis G. Pike.

Mr. Pike, we are glad to have you before the subcommittee, and you 

may proceed.
16 MEDICAL CARE FOR SELF-EM PLOY ED SEAM EN

STAT EMENT OF HON. OTIS G. PIKE , A RE PR ES EN TA TIVE IN 

CONGRESS FROM TH E STATE OF NE W YORK

Mr. Pike. Mr. Chairman, I appreciate (he opjx>rtunity to make a 

brief statement in support of the proposal to provide medical care for 

fishing boat owners. This bill is designed to restore to the self-employed fishermen of this country a right which our forefathers saw 

fit to gran t them over 150 years ago—and which, by administrative 

ruling 9 years ago, was taken away.

While this ruling was promulgated to eliminate certain abuses— 

and it probably has—it has at the same time denied medical benefits 

to a large segment of our commercial fishing industry, the owners or 

part-owners who perform the same hazardous work as their employees.

Fishing is a very important factor in the economy of my district— 

located in Suffolk County, at the east end of Long Island, and almost 

the entire industry is made up of small fishing vessels, owned in whole 

or in part, by one or two of the working fishermen, and frequently 

operated exclusively by the owners without any other crew. In mv 

opinion there is no real distinction between employees and the selfemployed in the commercial fishing industry. For one classification 

(the employee) to be eligible for Public Health Service benefits, and 

to deny these same benefits to the other (the owner-fishermen) is 

inconsistent.

We are well aware of the problem currently facing the commercial 

fishing industry in this country. The enactment of this legislation 

would be an indication tha t the Congress recognizes the significant 

contribution this small but important segment of our working population contributes to the national welfare.

This legislation is designed to correct an inequity. The departmental reports are favorable. I recommend enactment of this legislation and am in agreement with the language contained in S. 978, as 

passed by the Senate.

Mr. Roberts. Thank you, Mr. Pike. Any questions? Thank you 

again, Mr. Pike.

Mr. P ike. Thank you, Mr. Chairman.

Mr. Roberts. The next witness is another colleague of ours, the 

Honorable .lack Westland from the State of Washington.

Mr. Westland, we are happy to have you before the subcommittee, 

you may proceed.

STA TEM ENT OF HON. JACK WESTLAND, A RE PR ES EN TA TIVE IN 

CONGRESS FROM TH E STATE OF WASHINGTON

Mr. Westland. Mr. Chairman, thank you for this opportunity to 

present, this statement in support of TI.R. 2108 and similar bills which 

would restore to self-employed fishermen their eligibility for certain 

medical benefits through the Public Health Service.

This is elgislation tha t has bipartisan support. It is legislation with 

a history of little if any opposition. As you recall S. 367 was passed 

by the Senate without a dissenting vote last year. Unfortunately, the 

House did not have the opportunity to consider the bill before adjournment. Nevertheless, I lielieve an overwhelming number of Members 

in the House would vote for this legislation if given an opportunity.
MEDICAL CARE FOR SELF-EMPLOYED SEAMEN 17

Those of us who are familiar with the fisheries of the Pacific Northwest and my State of Washington know that the self-employed fishermen, that is the fishermen who own their own boats, in practice carry 

out the duties and functions similar to those engaged in bv employed 

crewmembers. I emphasize this point because the administrative 

ruling that that excluded them from eligibility was based on language 

in the law that required eligible seamen to be employed on board in the 

care, preservation, and navigation of a vessel. These- are the duties 

that self-employed fishermen are engaged in. These duties and functions expose them to the same perils at sea as their crewmembers. I 

believe that the self-employed fisherman is fulfilling the same purpose as an employed seaman on board a vessel.

Anyone who has sailed the waters around the Aleutians, has crossed 

the Gulf of Alaska, or has weathered the sudden winds of the Inland 

Passage and Puget Sound recognizes the dangers involved in fishing 

these waters.

Mr. ('hairman, such dangerous work necessarily mean that insurance 

rates are high for the self-employed fisherman. It is common knowledge that many boatowners and self-employed fishermen fail to survive the economic blows sustained when they become ill or have an 

accident.

The precedent for this legislation is obvious. Between 1798 and 

1954, a period of 15G years, self-employed fishermen received benefits 

of medical care through the Public Health Sendee. Then, afte r all 

these years, an administrat ive order put an end to their eligibility. I 

think it istim efo rth e Congress to restore that eligibility.

Mr. Roberts. Thank you, Mr. Westland.

Are there any questions? If not, thank you again, Mr. Westland.

Mr. Westland. Thank you, Mr. Chairman and gentlemen.

Mr. Roberts. Mr. Pelly.

Congressman Pelly, it is a pleasure to welcome you back to the 

commit tee which you served on for some time. We are always happy 

to have you and to have your contribution.

STA TEM ENT OF HON. THOMAS M. PEL LY, A RE PR ES EN TA TIVE IN 

CONGRESS FROM TH E STA TE OF WA SHINGTON

Mr. Pelly. Thank you, Mr. Chairman. It is a real privilege for 

me to appear again before this great committee to reaffirm my support for this legislation and, with my colleagues, 1 support the Senatepassed bill, S. 978, in lieu of any of the other bills. It is quite similar 

to my own. I think to save the committee's time, I will ask that my 

statement be placed in the record and then, if I may have the priv ­

ilege, I would like to present one of my constituents who has come 

from Seattle to testify in favor of this bill. He is Mr. John Wedin, 

the editor of the Fishermen’s News, a well-known fishing paper on the 

West Coast.

I would like then to present him to the committee, if I may, and I 

think tha t he represents probably the most objective and broad viewpoint of the fishing industry itself.

Mr. Roberts. Without objection, I will be happy for your statement to be filed for the record and would be glad for you to introduce 

Mr. Wedin.
18 MEDICAL CAKE FOR SELF-EMPLOYED SEAMEN

(The statement referred to follows:)

Statement of Hon. Thomas M. Pelly, a Representative in Congress

From the State of Washington

Mr. Chairman, it is a privilege to again app ear before your subcommittee in 

supp ort of my bill, H.R. 3338, as well as rela ted or sim ilar bills under consideration, which would provide medical care for certain persons engaged on board 

vessels, who are engaged in the care, preservation, or navigation of such vessels.

The Senate has alre ady passed a bill, S. 978, which is almost identical to 

my bill, and which I understand is also being considered at this time. Inasmuch 

as the Senate-passed version, S. 978, car ries the recommendations of various 

inte rested Government agencies, including an enthusiastic endorsement from 

the Department of the Interior, I would hope th at this subcommittee would 

accept the Senate version, in the inte rest of expediting enactment of this sorely 

overdue legislation.

In this connection, it will be recalled that I testified before this committee in 

August of 1962 in supp ort of a similar bill. Unfortunately, time ran out on 

this legislation in the 87th Congress, and I sincerely hope that it will not meet 

a similar misfortune in the 88th Congress. As you know, the purpose of the 

legislation is to restore the historic health benefits to those seamen who had them 

taken away by Executive orde r in 1954. Specifically, the legislation would extend hospital, medical, and denta l benefits to persons who are on board fishing 

and other small vessels which are registered, enrolled, and licensed under the 

maritime laws of th e United States.

Certain seamen were eliminated from these benefits due to their reclassification as owners or part owners under the Executive order of 1954. It is conceded that under existing law, the executive ruling is certainly in orde r and it 

would require specific legislation to rectify it. This Executive orde r denies 

owner-masters of fishing vessels the use of Government maritim e care and facilities, reserving this service solely to seamen employed aboard ship—this in 

spite of the fact that such fishing vessel owners perform the same duties, as defined in 42 U.S.C. 201 (h ).

Mr. Chairman, there is little tha t can be added to the exhaustive testimony 

rela tive to this legislation which was subm itted to thi s subcommittee last year. 

Consequently, I shall sum up by reaffirming my stro ng support of H.R. 3338, or 

any similar legislation to accomplish the same purpose, and reemphasize my 

previous recommendation that in the intere st of time, the Senate-passed bill, 

S. 978. be reported out by this subcommittee. In conclusion I wish to thank 

the subcommittee for allowing me to present my views a t this time.

Mr. Pelly. Mr. Chairman, I think you may remember tha t Mr. 

Wedin was back here and appeared liefore the committee last year.

Mr. Roberts. We are happy to have you again here, sir.

Mr. Pelly. He is very well thought of in our community on the 

west coast.

STATEMENT OF JOHN H. WEDIN, SECRETARY, COMMITTEE FOR

RESTORATION OF MARINE HOSPITAL SERVICES FOR SELFEMPLOYED SEAMEN

Mr. Wedin. Mr. Chairman, I know your committee is a busy one 

and I know there is no particular reason in going through the statement of last year, but I think it is important to note the fact that the 

representation which we have here today, as far as the Pacific coast 

and, as a matter of fact the Nation, on this particular legislation is 

quite extensive. It is very seldom on fishery legislation that we have 

this unanimity of thinking. This applies not only to the people who 

would lie covered by this bill but also, for example, to the crewmen, 

the Alaska Fishermen's Union here, who perhaps would not benefit, 

and many other groups who now enjoy this facility and who see no
MEDICAL CARE FOR SELF-EMPLOYED SEAMEN 19

reason why the captain of the vessel who serves in exactly the same 

manner as the crewmen, or very much so the same at least, is denied 

this since the administrative ruling.

I would like to say something very briefly about the kind of conditions we have out in the North Pacific right now.

We are inclined to feel th at as far as our vessels are concerned, we 

are competing with the Russians; we are competing with the Japa ­

nese.

We feel th at we are entitled to whatever sort of support possible to 

try to compete properly with them.

The Japanese and Russians, as you know, are certainly covered from 

the standpoint of hospitals, from the standpoint of subsidy, and all 

sorts of things, and we have to go out and try to do the same things 

tha t they do and make a living at it.

In another sense, our people are in the business and are required to 

make a profit. For example, the king crab fishery up north is 

limited by conservation measures placed upon it by the United States. 

We are not able to use the same kind of gear which might be more 

efficient in the taking of the fish of the North Pacific and certainly 

in this manner we are limited.

We feel that the American fishing industry is an important one, 

not only from the standpoint of producing food, but also from the 

standpoint of defense, and I think that if the Coast Guard were 

testifying here today, they would certainly go along with the statement that we are perhaps the first line of defense—at least as f ar as 

the waters are concerned in the North Pacific—and I think perhaps 

this maybe true throughout the United States, throughout the 

perimeters.

Fishermen on small vessels comprise very often one- and two-man 

vessels. Here is one man who is allowed marine hospitalization, 

whereas the captain of the vessel, and you certainly can’t say the 

captain is not a seaman, is denied marine hospital privileges.

We are running into a thing from time to time in an industry th at 

is sort of on the edge of bankruptcy in many cases, where there is 

very little desire on the pa rt of a crewman to become a boatowner, 

and on the question of losing marine hospitalization—which he would 

if he became a boatowner, he would automatically then lose his marine hospital privileges—this might be enough to keep him from 

wanting to be a boatow’ner, and this actually happens.

We have people working on vessels who have the experience necessary—and this is not the kind of a business where a farmer, for 

example, or a worker in a manufacturing plan t can suddenly step 

on a boat and go out and make a living—w’ho fall into this category. 

It is something tha t you have to learn. It takes time. A crewunan 

here suddenly decides tha t he wants to become a boatowner and he 

weighs all of these things and the first thing you know he goes to the 

bank and the bank says, “No, because you are in an industry w’hich 

is certainly not productive or has had a good financial return at 

this time.” And then he takes a look at the fact that he suddenly 

loses his marine hospital privileges, and I think in many cases our 

crewmen are not going into tha t for that same simple reason.

I have wanted to just, brief my statement. I have a formal statement here for the record, and I think this is sufficient at this time, 

unless you have questions.
20 MEDICAL CARE FOR SE LF-EMP LO YE D SEAM EN

Mr. Roberts. Thank you, Mr. Wedin. I think your statement is 

fully adequate.

I would like to ask just one or two questions.

You mentioned the main competitors of the fishing industry. For 

instance, let us pick out the Japanese.

Wha t are some of the advantages which they enjoy tha t the selfemployed owners would not enjoy ?

Mr. Wedin. Advantages, did you say ?

Mr. Roberts. Yes.

Mr. Wedin. First of all, I am not only refer ring to hospitalization, 

but, of course, in our overall fishing industry problems we look a t the 

question of markets, and certainly as far as the Japanese are concerned it is very difficult for us to compete.

I think you recognize as far as the Russian fleets are concerned that 

up in the North Pacific today it is very difficult for us to compete.

If a Russian seaman is injured, it doesn’t make any difference 

whether he is a captain or a crewman, we certainly turn out the very 

finest facility we can; we fly planes out there and take care of him and 

return him immediately to a hospital. If one of our skippers becomes 

ill in the North Pacific, let’s say, Adak or somewhere, I don’t think we 

would enjoy that same courtesy and privilege.

Mr. Roberts. Is it also true tha t in the case of the corporate-owner 

ship, the officers and crewmembers aboard tha t type of vessel would 

automatically be covered by benefits tha t are not enjoyed by the selfemployed operators?

Mr. Wedin. Mr. Chairman, I believe that is true.

I personally represent some G5 trawl vessels, bottom-fish draggers, 

who fish off the coast of Washington and off the west coast of Vancouver Island, and in these cases if these vessels were to incorporate the 

captain would become an employee. Then he would perhaps be 

eligible under the act, but it doesn’t seem quite proper to me tha t they 

should have to do this in order to become eligible for something for 

which they are qualified.

Certainly during the last war, there is no question our people came to 

the front. Our vessels entered war service.

I think it is fairly obvious where our fish were coming from. For 

example, J apa n was not available a t that time and we provided the 

fish and it just seems only fair somehow or other tha t consideration 

should be given for past service.

Mr. R oberts. Tha t is all I have.

Mr. Rogers?

Mr. Rogers of Florida. Mr. Chairman, just a question or two.

As I understand it, Mr. Wedin, this change was brought about by 

an administrative ruling. Why is it that you cannot go back to HEW 

now and ask that that rulin g be changed? Have you tried this?

Mr. Wedin. Mr. Rogers, if we went back and restored by administrative ruling the privilege tha t we enjoyed before, then we would once 

again be subject to another administrative ruling, and it seems like 

legislation is necessary to get the proper interpretation.

I mean th at is our feeling, that we would rather do it thas way.

Mr. Rogers of Florida. Does this just pertain to fishing boats?

Mr. Wedin. Commercial fishing vessels.

Mr. Rogers of Florida. What about captains who own their boats 

and take fishing parties out?
MEDICAL CARE FOR SELF-EMPLOYED SEAMEN 21

Mr. Wedin. Mr. Ch air ma n, I do n't believe the law would apply. As 

I interp ret it, at least, it would no t ap ply to sport s ch ar ter vessels. 

All we hav e sought to do here is no t to increase the traffic in ma rin e 

hospitals, bu t merely to res tore th e people th at were rem ove d by the 

ad minist rativ e rulin g, which were the ca ptain s in th is p ar ticu la r case, 

the captain s who also own par t of the vessels. In othe r words, the y 

have been discr imina ted a gai nst.

If you were a capta in of a vessel (an d we have many of those in ou r 

fleet, who merely opera te the vessel from their experience and ab ility 

bu t do not have an owner ship) you would be eligible, an d sud den ly a 

man a cqu ires an o wnership in a vessel an d he is no lo nger elig ible, and 

this doesn’t seem quite fai r.

Mr. Rogers of Florida. Why would you distinguis h betw een the 

capta in of a c ha rter boat and th e c ap tain of some other kind of fishing 

boat ?

Mr. W edi n. Con gressman R oge rs, I am n ot sure what so rt of cha rte r 

boa t you are talk ing about, bu t in ou r country , and I am speak ing 

abo ut the Pacific No rth we st right now, a ch arter boat op erator is one 

who is op erating inshore or no t a gr ea t distance off the coast. He is 

taki ng people out for hire.

Our tr aw lers are out fo r 10-day trip s and the y are out catch ing fish 

and prod ucing food from the sea, and the y are in a position, fro m the 

defe nse sta nd po int, for example—certa inly this would ap ply to the 

king crab fisheries way up off Ada k and in areas of t his kind —where 

the y are in con tac t with foreig n vessels.

I t is a good deal different.

Take ch ar ter boat out of W estport, Wa sh., fo r exa mple, and the y 

are fine people and most of them are ex-commercial fishermen who 

could n’t stay in t he business. I tal ke d to one the other day in Seattle. 

I asked him, “W hy aren ’t you sti ll in th e troll sa lmon fishing business ?”

He said, “I can ’t affo rd to tro ll and I have to take ”—and I won't 

use t he wor d he used—bu t you hav e t o tak e these p eople ou t to do this 

sort of t hi ng because you can’t afford to sta y in the trol lin g business, 

li e can stil l fish crab, bu t even th at has become alm ost uneco nomical 

today. It is a different kind of circumstance entirely.

Mr. Rogers of Florida. W ha t is the disti ng uish ing fea ture? Is it 

the size of the bo at, or is it en tirely the activ ity ? Must it be one th at 

goes out and stays overn igh t, or fo r a week ? How do you d isting uis h 

the type of vessel th at would hav e its employees qualified here?

Mr. W f.din . I think we go in th is p ar ticu la r case to wh at we call 5- 

ton vessels, in other words, a docu mented vessel, which isn’t a q uestion 

of size, len gth, or how m any days the y may sta y out.

set u p in th e bill, 5 ton.

Mr. Rogers of Florid a. Five ton ?

Mr. Wedi n. I believe so.

Mr. Rogers of F lorid a. As com mercial fishing ?

Mr. W edin. Yes, sir.

Mr. R ogers of Fl orida. Th an k you, Mr. C hairm an.

Mr. Roberts. Tha nk you, Mr. Ro gers.

Th an k you, Mr. "Wedin.

Mr. W edin. Th an k you.

Mr. Roberts. Yo ur statem ent may be filed fo r the rec ord wi tho ut 

objection.

Mr. W edin. Th an k you.

3 1- 83 3—-64----- 4
22 MEDICAL CARE FOR SELF-EM PLOY ED SEA MEN

(The statement referred to follows:)

Sta teme nt of J oh n H. Wed in, Secretary, Com mittee for Restoration of Marine H osp ital Services for S elf-E mployed Seam en

My name is John Wedin, I am appearing today as secretary of the Committee 

for Restoration of Marine Hospital Services for Self-Employed Seamen. I also 

serve as legislative represe ntative for the Fishermen’s Marketing Association 

of Washington, a member of this specific group. Other members in supp ort of 

the Senate-passed bill, S. 978, include the following:

Purse Seine Vessel Owners Marketing Association, Inc., representing 225 vessel 

owners in the States of Washington and Alaska.

Humboldt Fisherme n’s Marketing Association of California representing 145 

fishing vessel owners.

Fishermen’s Cooperative Association, Seattle, represen ting 1,720 Pacific coast 

member vessels.

Petersburg Vessel Owners Association, Petersburg, Alaska, representing 65 

vessel owners.

Fishermen’s Marketing Association, Inc., Eureka, Calif., representing 90 trawl 

vessel owners.

Bay Fish Exchange, Seattle, representing independent troll salmon vessel owners 

of Washington, numbering approximately 350 boats.

Association of Pacific Fisheries, Seattle, represen ting 33 member canning firms 

on the Pacific coast.

Puge t Sound Canners Association, representing 11 salmon cann eries in the State 

of Washington.

Fishermen’s Marketing Association of Washington, Inc., representing 65 traw l 

vessel owners.

Halibut Producers Cooperative, Seattle, Wash., representing 250 Pacific coast 

fishing vessel owners.

American Tunaboa t Association, San Diego, Calif., represen ting 05 fishing vessel 

owners.

Fishermen’s Marketing Association of Oregon, Inc., represen ting 25 fishing vessel 

owners.

Fishermen’s Cooperative Association of San Pedro, Calif., representing 85 member vessel owners.

Washington Crab Producers, Inc., representing 50 member vessel owners, Westport, Wash.

Wash ington Crab Association, representing 80 member vessels, Westport, Wash. 

Alaska Fishermen’s Union, 2,700 members, residents in the Pacific Coast States 

with h ead qua rters in Seattle, Wash.

Jun eau Halib ut Fishermen’s Association, 30 fishermen and vessel owners, Juneau,

Alaska.

Ronald W. DeLucien, director, Fisheries Products & Program, National Canners Association, Washington. D.C.

I.L.W.U.. Local 33, San Pedro, Calif.. 400 members.

Seine & Line Fisherme n’s Union, AFL-CIO, San Pedro, Calif.. 400 members.

San Pedro Independent Fishermen’s Union. 250 members, San Pedro, Calif. 

National Fisheries Institu te, Washington, D.C., 500 firms throughout the United 

States.

California Fish Canners Association, representing 10 canneries which produce 85 

percent of the Nation’s t una requirements, in addition to mackerel and other 

species.

Bu tts & Pattison, La Push. Wash., individually, and represen ting 45 fishermen. 

43 Boat Operators, Ilwaco, Wash.

18 Independent Boat Operators, Seattle, Wash.

Mr. Chairman, it is a plea sure to represe nt such a widespread list of organizations in beha lf of the marine hospital legislation for self-employed seamen. 

There are. of course, many othe rs who would willingly partic ipate in suppo rt of 

this needed legislation.

As we stated before the Senate Commerce Committee on April 24 of this 

yea r and in August of 1962 before this subcommittee, this is not new legislation 

in a sense. Rather, it is designed to correct an injustice caused by the 1954 

adm inistrative ruling by the Departm ent of Health, Education, and Welfare.
MEDICAL CARE FOR SELF-EMPLOYE D SEAMEN 23

The working captains of the U.S. fishing fleets work in the same manner 

as crew members—who are eligible for marine hospital care—aboard the ir 

vessels. They sha re the conditions, the hazards, and uncertainties along with 

the crew. As such, we feel they are entitled to be rein stated to equal hospital 

privileges. For 20 years or more prio r to the 1954 ruling by the General Counsel of the 

Department of Health, Education, and Welfare, self-employed seamen or those 

who had financial interests in the vessels had been entitled to medical care at 

the facilitie s of the U.S. Public Health Service. This medical care was given 

to all persons working on board these vessels irrespective of whether they were 

working for themselves as owners or pa rt owners of vessels or whether they 

were employees working for others ju st as long as they were employed in the 

“care, prese rvation, or navigatio n of any vessel, or in the service, on board, of 

those engaged in such care, preservation, or navigation.” The word “employed” 

in this connection was given a broad interp retation similar to the word “used.”

In May 1954, the General Counsel of the Departm ent of Health. Education, 

and Welfare issued an opinion stating th at the term “employed” would the rea fter 

be interpre ted in the narrow sense to mean only those persons working for 

someone else in an employer-employee relationship.

This inte rpretation had the effect of denying medical care to the thousand s of 

self-employed seamen all over the country, par ticula rly in the fishing industry. 

It had the effect of dividing the crews on these vessels into two p art s: one 

consisting of those who had no ownership in a vessel and who were eligible for 

medical care at facilitie s of the Public Health Service, and the other consisting 

of those who had an intere st in the vessel no ma tter how small and who were 

excluded from receiving medical care at the Public Hea lth Service facilities.

There was no justification for this ruling. It should be corrected as soon a s 

possible. The hosp itals of the U.S. Public Hea lth Service, or marine hosp itals as seafaring people call them, have long performed an extremely useful service for 

the U.S. maritim e industry. The justification for providing medical facilitie s 

for seamen is well established in our history. Some of the reaso ns why these 

facilitie s were provided are as follows:

1. The roving na ture of the seam an’s work requ ires special consideration. 

The seaman finds himself often in d istan t parts of the world where he is out of 

touch with the medical facilities to which the shoreworker has easy access.

2. The hazardous natur e of his work merits prim ary attention. The seaman 

is often exposed 24 hours a day to exceptional haz ards due to extraord ina ry 

wea ther conditions not faced by the shoreworker or from which the seaman 

cannot escape as can the worker on land.

3. The seam an’s work is seasonal. This seasonality is often caused by decisions of the U.S. Government. The marine worker is affected to a gre ate r 

degree by actio ns of the Government tha n is his land counterpart.

4. The seafaring industry provides an outp ost for the United States of value 

for military purposes. Seamen are usua lly the first to provide surveillan ce for 

their country in time of crisis.

5. The sea faring industry is characterized by economic insecurity due to its 

transient natur e and to its seasonal cycles. Again this insecurity is caused in 

large pa rt by governmental decision.

6. The seafaring industry is of extreme impo rtance to the Nation in times of 

crisis. It provides trai ned and experienced personnel for the Navy and merchant marine In wartime.

7. The Government is dependent upon the m aritim e industry in so m any ways 

th at the Government has a special obligation in the in terests of its own secu rity 

to see to it that the m aritime industry is kept in hea lthy condition at all times.

8. The seamen in our maritim e ind ustry litera lly work elbow-to-elbow with 

workers from foreig n lands, giving the ir occupation an intern ational cha rac ter 

deserving of the same conisderation as th at given seamen of oth er coun tries 

by their governments.

9. The maritim e industry, and this is especialy tru e of the fishing fleet, serves 

as an auxiliary to the U.S. Coast Guard and performs many of the tasks carried 

on by the Government-supported service. Were it not for the vessels of the 

fishing fleet, the cost of operating the U.S. Coast G uard would be much higher.
24 MEDICAL CAKE FOR SELF-E MPLOYED SEAMEN

10. The maritime industry vastly extends the economic a nd political influence 

of the United States into are as where the ordinary protection enjoyed by the 

shore citizen is not found.

The justification for providing medical facilities for seamen apply with equal 

force to self-employed seamen. The self-employed seam an must, of necessity, 

be on a small vessel, fo r a larg e vessel is usua lly operated by a corporation, and 

in such cases all men on board including officers are entitle d to Marine hospital 

benefits.

On these small vessels, the self-employed seaman works under exactly the 

same conditions as do the employed seamen. The hours are the same. The 

roving natur e of the employment, the hazards, the seasonal condition of the work, 

the economic insec urity and all the other conditions are exactly the same. In 

some cases, the economic insecurity of the self-employed seaman is gre ater than 

th at of the employed seaman when cyclical conditions are unfavorable. In such 

cases, the self-employed seaman is bound to his vessel and employment and 

saddled with insurance, depreciation, and oth er main tenance costs which go on 

no ma tter how unprofitable the operation of his vessel may be.

S. 978 is needed to give presen t seamen an opportunity and incentive to improve 

their status. Vessel o perators must come from the ran ks of crewmen. No one 

can successfully operate a deep sea fishing vessel witho ut first serving his apprenticeship as a crewmember. Crewmembers today hesitate to become self-employed operators as they lose the ir hospital benefits when they do. The effect 

of th is condition is to contribute to the weakening of the American fishing fleet.

Our indu stry today has powerful competitors in its area of operation. Our 

American fishermen-seamen are working lite rally side by side with fishermen 

from these competing countries. Those in the North Pacific at the present time 

are from Canada, Jap an, and Russia. The situatio n in the North Paciflfic, the refore, m erits atte ntion from the standpoint of S. 978.

First, let us look a t o ur neighbors, the Canadians. Their vessels are like ours 

in the main. They are the same size for all intents and purposes and operate 

under more or less the same conditions. In Canada, however, the vessels may 

pay to the Canadian Government’s Sick Mariners Fund a sum comparable to the 

tonnage tax charged American merchant vessels and which up to a few years ago 

was also charged American fishing vessels. But, for this Canadian charge, the 

crews of the Canadian vessels, including any self-employed seaman on board, are 

entitled to medical and hospita l benefits without fu rth er charge.

The Japanese vessels are quite unlike ours. They are mostly owned by large 

companies and, as fa r as I now, have no self-employed persons on board. It is 

presumed that all i>ersonnel on board are furn ishe d medical services.

The Russian vessels are large and modern and in a class by themselves. They 

ar e government owned and operated and their number is being expanded rapidly. 

Cost apparen tly is not a fac tor in their operation or deployment. With out 

doubt the crews on Russian vessels, who are government employees from every 

standpoint, receive full medical and hospital care.

These are the vessels among whom our fishermen-seamen are working and 

with whom our seamen are attempting to compete. It is an unequal struggle. 

Fo r its own welfare our Government should set about to improve the competitive 

position of its marine industry, including both large and small vessels.

These vessels in this atomic age could become indispensable in the event of 

atomic w arfa re. With land are as and our population centers the targ et of enemy 

attack , and with our food supply from our agricultura l hea rtland contaminated 

by the byproducts of atomic war. the merchant marine of the country, including 

the fishing fleet, could well become a means of survival for many of our citizens 

through the movement of people out of danger areas and for production of food 

from the sea.

It is our considered opinion that if the U.S. fishing industry is to survive, it 

must have assistance from the U.S. Government. Our priv ate industry cannot 

compete with fishing fleets oi>erated as arm s of foreign governments or subsidized by them. S. 978 is not the sole solution to the dilemma, hut its adoption 

is a step in the right direction. We urge its passage with utmost haste.

Mr. Roberts. Our next witnesses are Dr. David E. Price, Deputy 

Surgeon General, and Dr. Myron D. Miller, Chief, Division of Hospitals. Public Health Service.

I assume you gentlemen want to appear together ?
MEDICAL CARE FOR SELF-EMPLOYE D SEAMEN 25

STATEMENTS OF DR. DAVID E. PRICE, DEPUTY SURGEON GENERAL,

AND DR. MYRON D. MILLER, CHIEF, DIVISION OF HOSPITALS,

PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

I)r . P rice. Th an k you very m uch, Mr. Ch airma n.

I do n ot have a p repa red statem ent . I could rea d the repo rt which 

the De pa rtm ent has sen t to the com mittee if you wish and the n Dr. 

Mille r and I w ould be pleased to atte m pt to a nsw er any questions you 

may have.

Air. Roberts. Has the De pa rtm en t ap pro ved thi s bill ?

Dr. P rice. Yes.

Air. Roberts. I was going to say th at is filed fo r the record under 

our pro cedure, a nyway, so if y ou ju st wa nt to make some comments, I 

think the comm ittee would be int ere ste d in the cost fac tor, if you h ave 

any figures on that.

Dr . P rice. In the Dep artm en t’s repo rt on this bill, sir, we ha ve said 

th at sta tistic s are no t ava ilab le on the ad ditio na l numb er of pers ons 

who would come wi thin the pro vision s of law un de r thes e bills, bu t 

we believe th at ne ith er the numb er no r the cost wou ld significantly 

affect the present prog ram and th at the ena ctm ent of the leg islation, 

such as th at o f S. 978, would pose no serious difficulties fo r t he D ep ar tment as a pr ov ider of services.

I believe th e best basis for an estim ate of the possible cost of this 

is pro vid ed in the testimony which was g iven to t he Senate by repr esen tatives of the Bu rea u of Com mercial Fis herie s whe n it was estima ted th at no t more than 10,000 ad dit ion al fishermen who are 

ow ner-oper ato rs on doc umented vessels wou ld become eligible under 

the enactm ent of this bill.

If one ascribes to them the same pe r ca pita cost fo r these services 

th at one as cribes t o the me rch ant seamen f or whom we now a re caring, 

it wou ld ap pe ar th at the maxim um cost would be $1,733,210 per 

annum.

Air. R oberts. Tha nk you, D r. P ric e.

Dr. Aliller, do you have a ny thing to add ?

Dr. AIiller. Th an k you, sir. I hav e no thing fu rthe r to add .

Air. R oberts. Any questions, gentlem en?

Air. Schenck. I have no questions.

Air. Roberts. Air. Rogers?

Air. Rogers of Fl orida. Yes.

Dr. Price , I wa nt to see i f yo ur in terp retatio n of some of t he questions I asked is the same as the pre vio us witn ess, and I presum e you 

heard the questions I asked.

Do you have an y co ntrary views ?

Dr. P rice. AVith respect to the typ e of beneficia ry ?

Air. Rogers of Florida. Yes.

Dr. P rice. I t is my un de rst an din g, sir , th at un de r the lan gu ag e of 

the Senate bill, the addit ion al beneficiarie s wou ld no t be solely fish ermen, bu t th at any indiv idual who was se lf-employed on a docum ented 

vessel w ould be covered.

Air. R ogers o f Fl or id a. So it w ould be a ny typ e vessel th at th e ma n 

owns who w ork s on i t ; is that correc t ?

Dr . P rice. Yes.
26 MEDICAL CARE FOR SELF-E MPLOYED SEAMEN

Air. Rogers of Florida. Any kind of activity ?

Dr. Price. This is correct. The way in which the act now defines 

“seamen” it includes any person employed on board in the care, preservation, or navigation of any vessel, or in the service, on board, of 

those engaged in such care, preservation, or navigation, and the term 

“vessel” includes every description of watercraft or other artificial 

contrivance used or capable of being used as a means of transportation 

on the water, exclusive of a ircraft and amphibious contrivances.

Mr. Rogers of Florida. Does it have a 5-ton limitation ?

Dr. Price. This is the limitation which I understand is the factor 

which determines the documentation of the vessel, 5 net tons.

Mr. Rogers of Florida. So you feel that the interpretation, if this 

were passed, would be quite a bit more broad than the previous witness 

had indicated ?

Dr. Price. I believe it would be considerably broader than just 

commercial fishermen. T might say, sir, tha t prior to the ruling of 

1954, all individuals of this class had been included as eligible for care 

for a very great many years and so at the time the 1954 ruling was 

made by our General Counsel, we excluded not only the fishermen 

owner-operators but a variety of other individuals who had been beneficiaries prio r to this time.

Mr. Rogers of Florida. What type of vessel, for instance, would 

you say ? Cargo ?

Dr. P rice. Any kind of vessel, sir.

Mr. Rogers of Florida. As long as he was an owner and actually 

worked the vessel himself?

Dr. Price. That is correct.

Mr. Rogers of Florida. Are you in favor of this legislation ? Is the 

Department in favor of this legislation?

Dr. P rice. The Department feels that the legislation would correct 

an inequity which was created at the time of the 1954 ruling.

Mr. R ogers of Florida. Has the Department done anything to correct it themselves ?

Dr. Price. There is nothing we feel tha t the Department could do 

other than to propose a modification o f law, and the Department has 

not seen fit to propose a legislative remedy.

Mr. Rogers of Florida. I understood th at this change was brought 

about not by an act of Congress but by an interpretation made by your 

General Counsel. Is tha t true?

Dr. Price. That is correct, sir.

Mr. Rogers of Florida. Why could tha t change not be brought 

about by a single ruling made by him at any time? It could, could 

it not?

Dr. Price. I am sure that it could have been. However, we were 

confronted with a situation at the time this ruling was made where 

there were two specific cases seeking to demonstrate eligibility, one 

on the basis of ownership of a pleasure yacht, and the other on the 

basis of residence on a houseboat, in which case it was alleged that 

duties comparable to those of a seaman were rendered by the necessity for turning the navigational lights off and on at night, and it 

was when the eligibility of these cases was explored that the General Counsel of our Department concluded that the terms of the act 

required th at there be a bona fide employment relationship.
MEDICAL CARE FOR SE LF-EM PLOY ED SEAM EN 27

Mr. Rogers of Florida. W ha t if we pass thi s leg isla tion ? Would 

th at allow th ose people to come in and qualify ?

I)r. P rice. We believe th at it w ould.

Mr. Rogers of Florida. Th e two cases you j us t cited?

Dr . P rice. No; I beg your pa rdo n, sir.

No ; we are certain th at it would not include such individuals. 

Mr. Rogers of Florida. Why wou ld it not? W ha t wou ld be the 

disti ng uish ing fac tor th at keeps them from being included?

Dr. P rice. Because the y are no t self-employed doi ng the work of 

seamen.

Mr. Rogers of F lorid a. You mean if a man keeps h is own houseboat 

there and keeps it u p and th at is all he does, he does not hav e a seaman 

on it, he wou ld n ot be incl uded ?

Dr . P rice. We would not consider this, sir.

Air. R ogers of Florida. Tha t would still be an in terp retatio n of 

the Genera l Counsel, would it n ot ?

Dr . P rice. Dr. M iller, cou ld you answer th at question ?

Mr. Rogers of Fl orida. Do you have your counsel here ?

Dr. P rice. No, sir; we are no t accompanied by counsel this morning.

Mr. Rogers of Florida. Wh o makes the decisions? Is it in your 

Dep artm en t ? Do you make the recommendations on this, or do you 

leave in to the counsel, or who ?

Dr . Miller. Th e in terp retatio n of the Gen eral Coun sel was based 

strictly on the d efinition of “em ploy ed seamen.’’

Mr. Rogers o f Florida. I un de rst an d t ha t. I am a sking who makes 

these decisions at the De partm ent. Is it up to you ? Are you head 

of this p ar ticu la r D epartm ent ?

W ha t is your position, Dr. Mil ler?

Dr. Miller. I am the Chief of the Division of Ho spita ls, which 

opera tes th e m arine hos pitals.

Th e Ge ner al Counsel in its decision said th at the law as existed 

pr ior to 1954 and as now exists did not ap ply to seamen othe r tha n 

those who were employe d aboard a vessel; an d the law as is stated 

does no t identifv an ow ner-o perator as an emp loye d seaman.

Mr. Rogers of Florida. I un derst and th at. Th is is the in terp re tatio n of your Gener al Counsel in 1954. W as th at br ou gh t about 

throug h a recommen dati on fro m your De pa rtm en t in ask ing for a 

ru ling on th at, or w hat ?

Dr. Miller. Th e Gener al Coun sel still feels th at th ei r in terp re tatio n is correc t and th at the inequity can be corr ected only by a cor ­

rec tion o f the legislation th at now exists.

Mr. R ogers of Florida. How would th is cha nge the law as it existe d p rior to the r uling in 1954 ?

Dr . Miller. By defining the owner -op era tor as a self-employed 

seam an, it will br ing him wi thin the scope of the legislation, whereas 

now where it r efers to those employed, and no t self-employed it will 

no t incorporate the ow ner -op era tors and th ei r spouses.

Mr. R ogers of F lorid a. You do not think th at yo ur G eneral Cou nsel cou ld in terp ret the word “em ployed” as “self-employed” ?

Dr. Miller. No, sir; the interpretatio n of th e Gen eral Counsel was 

th at t he o wn er-opera tor w as no t employed in the sense th at othe r seamen aboard vessels are employe d, but with the addit ion of the term 

“se lf-employed,” it would br ing them within the scope of t he legisla-
28 MEDICAL CARE FOR SELF-EMPLOYED SEAMEN

Mr. Rogers of F lrida. I do not want to get into a ease of semantics 

here, but it seems to me if he made an interpretation in one instance 

where he changed the law, in effect, the way is was administered, he 

could put it back in the same status simply by changing it, if you 

really want to do it.

Mr. Roberts. Will the gentleman yield ?

Mr. Rogers of Florida. Yes.

Mr. Roberts. I think there is more than one executive department 

involved. I think that is what you get into.

The next witness is accompanied by the attorney for the Legislative 

Division. I think he might be in a better position to answer your 

question.

Mr. Rogers of Florida. I just thought it was done through the General Counsel of this Department. Tha t was my understanding. 

Perhaps we can also question him. If the Department feels this 

change is necessary, I do not know why the General Counsel cannot 

make this change and see how it works. Then if you needed the law, 

come up and do something about it, but I am surprised that the Department thinks an inequity has been done but does not take any 

administrative action to change it when it was administrative action 

that brought the injustice.

Mr. Roberts. The chairman does not believe tha t Dr. Price or Dr. 

Miller would tell the General Counsel what he had to do.

Mr. Rogers of Florida. But I would think the gentlemen might 

request the General Counsel to do it if it is in his own department. 

Someone has to initial it.

Mr. Roberts. I think the General Counsel is independent in his 

rulings on these particular cases.

Mr. Rogers of Florida. I agree with that.

Mr. Roberts. And tha t they could probably not in their request 

cover all the cases that would arise, so, therefore, I think there lias to 

bo clarification by legislation because you get into the question of 

pleasure craft owners, charter boats, houseboats.

As I understand it, the thing that controls here is whether or not 

they are engaged in commercial fishing.

Mr. Rogers of Florida. I beg to differ with the gentleman just 

from the testimony these two gentlemen have given. They say it does 

not apply to commercial fishing alone.

That is the point I am making. They just testified to this.

Mr. Roberts. I will say this. I think we could very well handle 

the interpretation of what it does apply to by the report*.

Mr. Rogers of Florida. I would like to find out—that is what I 

want to question about—what the Department interprets this to be, 

and if we want to confine it I think we had better know ahead of time 

what they are going to interpret it to be, and they are giving us the 

interpretation. I do not know whether they are giving us the General Counsel’s interpretation, or the Department’s interpretation, or 

where it came from.

Mr. Roberts. I would suggest that in order to expedite this hearing 

we request the General Counsel to come up and testify.

Mr. Rogers of Florida. I think th at is a good suggestion.

I just think, as the chairman says, it might be helpful.
MEDICAL CARE FOR SELF-EMPLOYED SEAMEN 29

I)r. Miller. Mr. Chairman, the administrative action that was 

taken was based on the decision of the General Counsel, and this has 

been discussed with the General Counsel, who feels that the only way 

in which the administrative decision could be reversed would be 

through a correction of the existing legislation.

Mr. Roberts. Mr. Brotzman.

Mr. Brotzman. Thank you, Mr. Chairman. I have one question.

I know that when my distinguished colleague from Florida asked 

you if you opposed or favored this legislation, your answer was tha t 

you thought it corrected an inequitable situation, which is not precisely 

responsive to the question that was asked you.

My question is, Are you in favor of this legislation?

Dr. Brice. Sir, if I had been permitted to read the Department’s 

report, I believe I might have covered this point somewhat more 

specifically.

The Department stated that if the legislation should be favorably 

considered, we would prefer the language of S. 978 now pending 

l>efore your committee, which would simply broaden present law to 

include self-employed persons as “seamen," if they perform the same 

tasks as are performed by seamen within the meaning of the present 

law.

The report does not state that the Department favors this legislation, but rather that if the House bill were amended to conform to the 

language of S. 978, which simply extends the definition of “seamen." and the operative provision conferring entitlement to medical 

care under the Public Health Service Act to “self-employed” seamen, 

it would render the bill objectionable from the viewpoint of this 

Department.

Mr. Brotzman. This sounds kind of like some of the witnesses I 

used to have in law practice. I listened very carefully but I could not 

get the answer.

I was going to say from the tenor of your remarks it would sound 

to me like you are not in favor of the House bill.

I just want to be sure the record is clear as to what your position is. 

That is my only reason for asking this question.

Dr. P rice. The Department reported on onlv two of the House bills, 

sir, H.R. 3873 and H.R. 2108.

The Department had not been asked to comment on other House 

bills which are worded essentially in the same way as S. 978.

Mr. Brotzman. I will ask the question another way. Are you in 

favor of any of the bills as they are written? Is the Department in 

favor?

Dr. P rice. Yes.

Mr. Brotzman. Tell me the number.

Dr. Price. The Senate bill 978, and H.R. 3338, and H.R. 7002. 

These are essentially the same in broadening the eligibility, to restore 

eligibility to self-employed seamen.

Mr. Brotzman. These are the ones that you do favor?

Dr. Price. Yes, sir.

Mr. Brotzman. Thank you very much.

Mr. Roberts. Thank you, Dr. Price.

Any further questions, gentlemen ?

Mr. Rogers of Florida. No questions.
30 MEDICAL CARE FOR SELF-EM PLOY ED SEA ME N

Mr. R oberts. Th ank you, Dr. Miller.

Dr . Miller. Th ank you, sir.

Mr. Roberts. Ou r next witn ess is Dr. Do nald L. Mc Kernan, Direc tor of the Burea u of Com mercial Fis heries, Dep artm en t of the 

In terior , accompanied by Mr. W alter Stoltin g, C hie f, Branch o f Economics, Burea u of Com mercial Fisheries, and Mr. Da vid Finn egan, 

att orney, Legislati ve Division.

STAT EMENT OF DONALD L. McKERNAN, DIRECTOR, BUREAU OF

COMMERCIAL FI SH ER IE S; ACCOMPANIED BY WA LTER STOLTING,

CH IEF, BRANCH OF ECONOMICS, BUREAU OF COMMERCIAL FI SH ­

ERIE S; AND DAVID FIN NEGAN, ATTORNEY, LEGIS LATIV E DIV ISION, DEP ARTMENT OF TH E INTE RIOR

Mr. M cKernan. Mr. C hairm an, I broug ht Mr. F inne gan here to the 

witn ess stand with me and , as you men tion ed, I hav e Mr. St oltin g 

also, who are p rep ared to assist in ans wering detailed q uestions shou ld 

the committee desire.

I wish to th an k you fo r th is op po rtu nity to ap pe ar before your 

committee in supp ort of II.R. 3873, a bill to pro vid e medical care for 

cer tain persons engaged on b oard a vessel in the care, pre ser vat ion , or 

navig ation of such vessel. As indicated in ou r re po rt, our D epart me nt 

agrees with the objectives of II.R. 3873, but believes that these can 

best be accomplished t hrou gh the dr af t bill enclosed in our sta tem ent.

I would like to review briefly the fac ts rega rd ing the s tatus of selfemp loye d fishermen and th ei r eligib ilit y fo r medical care, denta l, and 

hospitalization services pro vid ed by the U.S . Pu blic He alth Service.

Th e Fe deral Government provides free med ical care and ho sp ita liza tio n to seamen, pr im arily because o f the nat ion al inte rest in ma inta in in g an effective lab or force necessary for an adequate me rchant 

ma rin e.

Section 322 of the Publi c Hea lth Serv ice Act pro vid es that seamen 

employed on vessels of th e Un ite d State s reg istere d, enrolle d, and 

licensed under the ma ritim e laws the reo f, oth er than canal boats engaged in the coastal tra de, are entitled (o medical, surgic al, and dental 

tre atmen t, and hospita liz ati on wit hout charge.

Mo st comm ercial fishermen are also seamen because of the natur e 

of th e work oth er th an the fishing ope ration performed on a fishing 

vessel relatin g to the navig ation and ma intena nce of such a vessel, 

pa rtic ul ar ly when goi ng to and from fishing grounds. Histo ric all y, 

th e Publi c Hea lth Ser vice held the view th at any fisherman on a 

docume nted fishing vessel, who could qu ali fy as a seaman, was eligible 

fo r fre e medical care and hospitalization as a seaman.

In 1954, however, because of a case which arose out of claims fo r 

medical car e in 1951 b y own ers of pleasur e yachts and by a housewife 

liv in g abo ard a houseboat who was “em ploy ed on board in the care, 

pre ser vatio n, or nav igation "’ o f the vessel to the ex ten t of turning on 

th e navig ation lig hts each evening, th at agency rul ed th at the Publi c 

Hea lth Service Act appli ed on ly to persons un de r a contract of employ ­

me nt, expressed or implied, on a vessel.

Th is decision stric tly i nterpreted the term “ seam en” as it is defined 

in th e act as “ any perso n employe d on b oard in the care, preserv ation, 

or n aviga tio n of any vessel * *
MEDICAL CARE FOR SELF-EMPLOYED SEAMEN 31

Consequently, fishing vessel own ers who go out on th eir boats, 

tho ugh the y wo rk as seamen, are no t con side red seamen because the y 

are not employees, and are thus excluded from the medical care an d 

hospitalization benefits of the act.

An illus tra tio n of the na ture of fishermen’s wo rki ng relatio ns hips 

will po int out the inconsistencies resu lti ng from t hi s rulin g. Fis her ­

men may chan ge th ei r sta tus in a rel atively sh ort p eri od of time from 

an employee fisherman to th at of a self-employ ed fisherman or a pa rt 

owner of a fish ing vessel. These cha nges may occur in rev erse ord er, 

and the y may no t reflect a ny mate ria l cha nge in fina ncial sta nd ing of 

the ind ividual. For exam ple, a fish erm an may be engag ed early in 

the season as an em ployee fishe rman an d th ere fore be eligib le for Pub lic 

He alt h Ser vice benefits as a seam an e mployed on a vessel un de r a contra ct of employmen t, e ith er expressed or implied. Lat er in th e season 

he may p artic ip ate in fishing o perat ion s in a diffe rent fishery as a p ar t 

owner of a sma ll vessel and con sequently be ineligib le fo r Publi c 

Hea lth Service benefits tho ugh lie still con ducts a ctivities as a se aman.

It becomes ap pa re nt th at the re is no real distinction between employees and fishing vessel o wners in the p rac tical world of commercial 

fishing.

Ev en on the larg er fishing vessels whe re the ma jority of t he fishe rmen are employed as crewmembers, vessel owners often pa rti cipa te in 

fishing trip s and perform the same du tie s on bo ard the vessel in its 

care, pre ser vat ion , or navig ation as other fishermen. Suc h ownerfisherm en or self-e mployed fishermen are in fact a pp lying th ei r m ar itime skil ls as seamen a nd conseque ntly a re co ntr ibuti ng to th e maintenance of an effective ma riti me lab or forc e req uired in the natio nal 

inte rest.

Elig ib ili ty f or free medical, surg ica l, and den tal tre atmen t a nd hospit alization fo r pers ons emp loye d in the fishing indu str y is sta ted in 

th at section of the Public Hea lth Service Ac t which lists among the 

typ es of eligible persons “Se ame n emp loyed on vessels o f th e United 

State s reg istere d, enro lled, and licen sed un de r the ma ritime laws 

the reo f, other th an canal boats engaged in the coastin g trad e.”

Abo ut 32,000 employee fishermen servi ng abo ard such docume nted 

fishing vessels are now conside red to be elig ible fo r th ese benefits.

Ab out 80,000 owner-fishermen and employee-fisherm en serve on un ­

documented vessels of lim ited fish ing rang e and are no t eligible fo r 

free medical benefits fro m the Public He al th Service.

Sho uld th e pro posed leg islation become law, approx im ate ly 10,000 

addit ion al own er-fishermen on doc umented fishing vessels would be 

eligible.

Mr. Ch air ma n, th is concludes my statem ent . I will be glad to tr y 

to an swer an y questions of the committee.

Mr. Roberts. Tha nk you, Doctor.

I note th at you say th at the objectives of H.R. 3873 can best be 

accomplished throug h the d ra ft bill enclosed in your statem ent. You 

mean the dep artm en tal statem ent , I believe.

Mr. McKern an. Yes, Mr. Ch airma n.

Mr. Roberts. An d I am advised th at your dra ft bill is liij^S *mate 

bill, S. 978. " / '

Mr. McKern an. Yes, Mr. Ch airma n.

Mr. Roberts. I s that correct? £ *1

10 5
32 MEDICAL CARE FOR SELF-EM PLOY ED SEAM EN

Mr. McKernan. Yes.

Mr. Roberts. Relative to a question th at lias been raised here as to 

the adminis trative ru lin g in 1954, is it yo ur opinion th at legislation 

is necessary to correct th is r uling?

Mr. McKernan. Yes, Mr. Chairman.

Mr. Roberts. How do you arr ive at th is opinion, Doc tor?

Mr. McKernan. Mr. Ch airma n, it is my un de rstand ing th at the 

Gen eral Counsel of He alth, Ed ucation, and W elfare has interpreted 

the law in th is esse ntia lly new way in 1954 and unless the Gen eral 

Counsel of the De pa rtm en t of He alth, Ed uc ation, and W elf are deter mined that they h ad misinte rpr ete d the law this wou ld u ndoubte dly 

rule in such a case. I am inform ed by ou r counsel, and he is here to 

comment fu rther sho uld the cha irm an or members of the committee 

so desire, th at it is our un de rst an din g th at the Gener al Counsel does 

no t now believe t hat he mi sin terprete d the law in 1954. There for e, if 

some inter pretation othe r than th at now used in the De partm ent of 

Hea lth , Ed ucati on , and W elf are were decided to be in the nat ion al 

int ere st, this would req uire legi slation and th at as a res ult the pre sen t 

leg islat ion is befo re th is committee.

Mr. Roberts. I s this the firs t time that the De partm ent of the In ­

te rior has a pprov ed this legislation ?

Mr. McK ernan. No; we app roved essentially this same type of 

leg islation las t year, Mr. C hairman.

Mr. Roberts. I might dire ct this question to Mr. Fin negan. As ­

sum ing , as has been men tioned here, th at the General Counsel of th e 

Dep artm en t of Hea lth , Ed ucation, and W elf are might reverse his 

ru lin g, would th at necessarily control yo ur De partm ent?

Mr. Finn egan. Th is De partm ent wo uldn 't have any direct concern. If th e Pu blic Hea lth Service were to c han ge their ru lin g to include s elf-employ ed fisherm en, this w ould, of course, obviate the necessit y of th is legislation.

However, the problem stil l exists in th at a late r Gene ral Counsel 

could decide diff erently , if he so desired.

Mr. Roberts. I do not know th at this is pr op er and you may no t 

wan t to ans wer the question, but do you see any different set of ci rcum stances th at migh t lead the Gen eral Counsel to give an opinion 

in which he would say th at he misinte rpreted the law in 1954?

Mr. F inn egan. No, si r; I do not a t the mo ment.

Mr. R oberts. Do you believe, Doc tor, th at un de r S. 978 there w ould 

be any difficulty in d ete rm ini ng the person s entitled to benefits of P ub ­

lic Hea lth Service tre atmen t under the Senate bill ?

Mr. McKernan. No, Mr. Chairm an, I d on 't believe there will be any 

gr ea t difficulty in d ete rm ining those eligible.

I am not ce rta in th at I have considered all of tho se who m igh t, righ t 

at th e mom ent, b ut to my know ledg e I t hi nk this could be a relatively 

easy determ ina tion.

Mr. R oberts. Do you think , Mr. Finn eg an , t hat we could wr ite in to 

the repo rt o r b rin g out in debate certa in leg islative intent t hat would 

deny these benefits to pleasu re boat owners, and ch arter boats, and 

peo ple of th at kin d, and say it is int ended pr im arily for the benefit 

o^comm ercial fishermen ?

Mr. F innega n. Yes, sir.

; Mr. Roberts. Mr. Rogers ?

- Mr. Rogers of Florida. Th ank you, Mr. Chairma n.
MEDICAL CARE FOR SELF-EMPLOYED SEAMEN 33

I was interested in your statement that you felt there was no change 

now that might permit the General Counsel to make a different ruling.

Wha t change in the circumstances was there that brought about his 

basis for ruling in 1954?

Mr. Finnegan. Maybe, sir, I didn’t quite make myself clear.

Up to 1954, self-employed fishermen were included.

Mr. Rogers of Florida. In other words, he had interpreted the word 

“employed” to also mean “self-employed"; did he not?

Mr. Finnegan. Well, as far as I know there had not been any 

interpretation as such by the General Counsel until 1954.

Mr. Rogers of Florida. What I mean is those people were receiving 

benefits, were they not ?

Mr. Finnegan. Tha t is right, sir.

Mr. Rogers of Florida. So 1 assume there was no interpretation to 

deny them that.

Mr. F innegan. That is right, sir. Apparently the question had not 

really come up, sir. until 1954 when circumstances—the factual situation I am not exactly familiar with—did come up at tha t time.

Mr. Rogers of Florida. Is it not true that in any event the General 

Counsel is going to be called upon in certain circumstances to make 

rulings even if we pass this? He is going to have to determine tha t 

certain people are self-employed, will he not ?

Mr. Finnegan. That is right, sir.

Mr. Rogers of Florida. You would still have to go to the General 

Counsel for interpretation of specific cases, would you not?

Mr. F innegan. No, sir; if the legislation is clear, and this is what 

is intended by S. 978 and our draft bill on II.R. 3873, 1 think there 

wouldn’t be any problem as far as interpretation with the General 

Counsel. Ilis problem presently is the interpretation of what is 

meant by the word “employed” and he said that this did not include 

“occupied or engaged in,” hut it had to refer to persons who were 

under a contract of hire, and this did not include self-employed 

persons.

Mr. Rogers of Florida. 1 realize that, but I am saying if anyone 

makes a claim and the Department contested it, it still will have to 

go to the General Counsel for determination, will it not ?

Air. Finnegan. That is right, sir.

Mr. Rogers of Florida. Now, Mr. McKernan, do you interpret this 

as to apply only to commercial fishing boats?

Mr. McKernan. No.

Mr. Rogers of Florida. You do not ?

Mr. McKernan. No.

Mr. Rogers of Florida. It would apply to any boats? Is your 

view consistent with the testimony we heard from the Department of 

Health, Education, and Welfare ?

Mr. McKernan. Yes. It would apply to self-employed men who 

are operating vessels over 5 net tons; tha t is, documented vessels. For 

example, it would apply to the charter boat fishermen who were operating as seamen. For example, charter boats, out of Florida, if these 

vessels were, over 5 net tons.

Mr. Rogers of Florida. What would you have to do with the administration of this law were it to pass?

Mr. McKernan. We would not have anything to do with the administration directly, Mr. Rogers. Of course, we are extremely anx-
34 MEDICAL CAKE FOR SELF-EMPLOYED SEAMEN

ious to promote the general welfare of the fishing ind ustry of the 

Un ite d States.

We feel, as has been presen ted by the other witnesses before this 

committee, th at there is an inequity here; th at a gr ea t many small 

op era tors an d owners who have exactly the same problem s as emplo yed fishermen are elim ina ted fro m these services at the present 

time.

We think th at this is not good and th at it would actua lly help the 

indu stry i f t his were correc ted a nd corrected as sp eedily as possible.

Mr. Rogers of Florida. Tha nk you very much.

Tha nk you, Mr. Ch airma n.

Mr. Roberts. Mr. Schenck?

Mr. Sche nck. Mr. Ch air ma n, I un de rst an d fro m the discussion 

here th at th is is not confined to just comm ercial fish ing boats.

Mr. McKernan. I t is no t in the bill which passed the Senat e and 

it is no t in the dra ft b ill prepared by the Dep artm en t o f the I nterior. 

I t is confined to commercial fishing vessels in H.R. 3873. I t confines 

this to commercial fishermen in th at bill.

Mr. S ciienck. Wh o is a commercial fisherman ?

Mr. McKernan. I beg yo ur pardo n ?

Mr. Sche nck. Wh o is a commercial fisherman? W ha t are the 

guidelines?

Mr. McKerna n. A man who fishes and sells the re sults of his labors 

on the marketpla ce.

Mr. Sciienck. An d it is not one who takes oth ers out fo r pleasure 

fishing, trawl ing , and so fo rth ?

Mr. McK ernan. No, he would not be considered a commercial 

fisherman.

Mr. Sciienck. W ha t is m eant by a documented vessel o f 5 net tons ?

Mr. McKernan. The Coast Gu ard reg ula tio ns r equir e th at all vessels of 5 n et tons and over be documented and we call—an d this is a 

m atter of simp ly histor ical practic e—vessels less than 5 net tons fishing boa ts an d vessels of 5 ne t tons and over vessels.

Mr. Schenck. W ha t is meant by the term “ 5 net to ns” ?

Mr. McKernan. Th is is the carry ing capacit y of the vessel itself 

and it is one of t he ton nage figures which is comm only used by Coast 

Gua rd and by Ma ritim e people.

Mr. Schenck. So 5 net tons then refers to the fact th at a vessel can 

saf ely car ry 5 tons of fish or of an ything ?

Mr. McKernan. Tha t is correct.

Mr. Schenck. T hat is all, Mr. Ch airma n.

Mr. R oberts. Mr. Br otzm an ?

Mr. Brotzman. I hav e no questions, Mr. Ch airma n.

Mr. Roberts. I would like to ask you one question that trou bles me 

a great, deal.

I have ju st been read ing the bud get rep ort. They point out tha t 

the re exists a special addit ion al problem in connection with IT.R. 2108 

and a somewhat sim ila r bill, S. 078, which is the bill th at you say you 

are f or and the De partm ent app roves, passed bv the Sen ate on M av 28, 

1063.

The wording in both H.R. 2108 and S. 978 would extend coverage not only to 

the owner-operators of fishing vessels who devote a sub stantial portion of their 

time to seamen duties (as provided in H.R. 3873) but also to owner-operators of
MEDICAL CARE FOR SELF-EMPLOYED SEAMEN 35

other types of vessels, such ns lugs, ferries, and barges engaged in local traffic, 

subject only to the requirement that such persons be engaged in the care, preservation, or navigation of the vessel.

Is that your interpretation, or do you disagree with that ?

Mr. McKernan. I do not disagree with it, Mr. Chairman. That is 

my interpretation.

Mr. Roberts. 1 cannot believe that this committee would want to 

extend legislation to these other types of vessels. 1 recognize that 

there may be and undoubtedly is valuable work performed by this type 

of vessel, but we are primarily concerned here with trying to correct 

an administrative ruling which we believe would serve to strengthen 

people engaged in commercial fishing in competition with the Russians,

(Canadians, J apanese, and others.

It seems to me th at Inte rior’s approval of that proposition would 

certainly run us into a tremendous amount of money, a lot more than 

is contemplated by the approach which you mention at first, I believe, 

H.R.3873.

Mr. McKernan. Mr. Chairman, may I comment on this?

Mr. Roberts. Yes, sir.

Mr. McKernan. Our approval of S. 978 and our draft bill which is 

similar simply envisages including those people who were included 

before the 1954 interpretation by HEW . Essentially what that bill 

does and what Inte rior’s re port says is tha t those people who were 

covered before will again be covered except that it excludes vessel 

owners, passengers, guests, or others who are not partic ipating in the 

actual operation of the fishing vessels.

Now, there is one question which hasn’t arisen here, but I am sure 

it is one that one thinks of, and tha t is, What is wrong with H.R. 3873 ?

Mr. Roberts. Yes, sir.

Mr. McKernan. Our problem here was the interpretation of “a 

substantial part of whose services in connection with such fishing 

operations are comparable.’’ In other words, substantiality of fishing 

was the thing that bothered us.

If this committee chooses to limit participation to owner-fishermen 

engaged in commercial fishing, then perhaps an interpretation of the 

word “substantial” in the bill which is being heard before this committee today might well take care of the problems which Inte rior had 

with this bill.

Mr. Roberts. If the budget is correct in its interpretation of the bill 

that you endorse, I think this committee would certainly not desire, or 

at least this is my personal feeling—I am not speaking for the other 

members—to extend this to tugs, ferries, and barges engaged in local 

traffic.

That certainly would not be in my opinion a thing that this committee would want to lend itself to.

If you feel th at the budget is wrong in this interpretation and you 

would like to amend your statement to cover this situation, I would be 

glad to have you supply it for the record.

Mr. McKernan. I didn’t understand your last statement, Mr. 

Chairman.

Mr. Roberts. I would not think that your Department would want 

to approve a bill tha t would extend it to vessels engaged in local traffic.

Mr. McKernan. Mr. Chairman, the Departm ent’s position here was
36 MEDICAL CARE FOR SELF-E MPLOYED SEAMEN

th at we w anted it extended to cover co mmercial fishing vessel owners 

in docum ented vessels.

The resu lt of ou r suggestion, it is true , e xtends it to all of tho se people who had such coverage befo re 1954. I t is true th at the Dep ar tme nt’s suggestion h as t ha t effect also.

W ha t t he effect of ou r reco mmendation was was simply to pu t this 

hack where it was before 1954. In doing so, it also does include some 

other gro ups of peop le, and the Dep artm en t’s inte rest, of course, is 

confined to owner-fishermen. Sho uld the committee wish to lim it it 

to those people the y could quite easily do so, eit he r by prov idi ng 

gr ea ter lim ita tio n to S. 978 or by perhap s a ra th er simple a lte ratio n to 

the bill which is before you here.

Mr. Roberts. Of course, I know t ha t the re are s eagoing tugs and it 

could be th at a vessel bu ilt to be a tug could be con vert ed into a fishing 

vessel. Is th at no t true ?

I do not know o f any fer rie s t hat p ossibly could be en gaged in comme rcial fishing. I guess th at would be possible, but, gen erally s peaking, I do not know of any fer ries th at are so engaged. If the re are 

some th at you know abo ut, I would be glad to hear abou t it.

Mr. Rogers of Florid a. Mr. Chairma n.

Mr. Roberts. Mr. Rogers.

Mr. Rogers of Florida. I would be hopef ul th at the various govern me nta l de pa rtm en ts would get together so we will know wh at 

th is le gislation will do. I realiz e you have an inter est in j us t th e commercia l fishing, but if th is bill goes fa rt her th an that, I would hope 

yo ur counsel would also be awa re of this . I presum e lie is.

Also, now, do you tak e a sim ilar view as the budget does t hat th ere 

should be addit ion al use r cha rges or addit ion al ton nage cha rge?

What is the D ep artm en t’s view on that, sir?

Mr. McKern an. No ; we do not tak e th at poi nt of view. In oth er 

wor ds, the De partm ent feels th at this is in essence a different prob ­

lem, t hat if Congress wishes to consider this m atter, this perh aps should 

be considered in the whole a rea, th at is, th is policy o f h elp ing or assisting in the medical car e of seamen. In o ther words, the De partm ent’s 

position on this is as sta ted in their subm ission to thi s comm ittee, tha t 

we have n’t specifica lly studie d this pa rti cu la r problem, bu t we feel 

th at it is not the qu estion which is before us in this legislation.

Mr. Rogers of Fl orida. You hav e no t considered wh eth er it will 

pu t an addit ion al tax or tonnage tax to tak e car e of thi s even tho ugh 

the B udget ha s recomm ended it ?

Mr. McKern an. Tha t is true, Mr. Rog ers, we have not considered 

th at in connection with this legislation because we f elt th at th is partic ular matter is a matter which wou ld ap ply clear across the board 

as a matter of g enera l public policy as to wh eth er or not the country 

shou ld, in a sense, su pp ort medical car e to seamen in gen eral.

It is the Dep artm en t’s position th at th is leg isla tion deals with an 

inequity, that fishermen a nd small vessel own ers have n ot been tre ated 

the same way that, other seamen and fishermen employees hav e been 

treate d.

We are inte rested righ t at the m oment in att em pting to see th at that 

is corrected.

Mr. Rogers. I thou gh t yo u just told me now th at t his proposed legislation also goes bey ond th at.
MEDICAL CAKE FOR SELF-EMPLOYED SEAMEN 37

Mr. McK erxax. Th is proposed leg islation does include------

Mr. Rogers of Fl orida. Ad ditio nal people.

Mr. McKerxax (co ntinuing ). Some o ther people, th at is corr ect.

Mr. Rogers o f F lorid a. What is go ing to be the effect on com mercial 

fishing if you hav e to raise rat es here to pay fo r this as recommended 

by the Bu rea u of the Bu dget? Is th at going to affect yo ur people 

or not?

Mr. McK erxan. Th at wou ld affect ou r people if they took ad ­

vanta ge of those servic es; yes.

Mr. Rogers of Florida. Should th at be conside red by you and should 

we know what effect your De pa rtm ent thinks it would hav e on commercial fishing to h ave increased rat es?

Mr. McK ernax. Ul tim ate ly if th at pa rtic ul ar problem comes up, 

our Dep artm en t certa inly would want to ascertain what effect this 

would have on the i ndividual fishe rman.

Mr. Rogers of Florida. Ha s yo ur counsel checked with the Burea u 

of the Bu dget fo r th eir views on t his ?

Mr. McK erxax. Xo: we ha ven't been asked abou t th at pa rticul ar 

facet of th is problem.

Would you like f ur th er comme nt from th e counsel ?

Mr. Rogers of Florida. Do you coord ina te? In other words, it is 

confu sin g to the committee, it seems to me—it is to me—to have one 

de pa rtm en t come in and not be concerned with any othe r problem 

and vet it may affect your De pa rtm ent. I do not know why you cannot get coo rdinated here and let us hav e a view where you hav e conside red all of these t hings. Th at is th e point I was making.

Mr. McK erxax. Mr. Ch air ma n, in the de partm ental re po rt we indic ate tha t we feel that thi s is a no ther prob lem , pe rhaps an im po rta nt 

one, but it is anoth er prob lem. It is not the prob lem before us here 

and so, in con sidering t his, we considered th at what we would like to 

do is to resolve th is p artic ular problem first.

When legisla tion is proposed to change, for example, the cha rge of 

seamen, an d in this case fishermen as well, for t he ir med ical and d ental 

expenses, then obviously the vario us depa rtm en ts of Government 

should coo rdinat e any re po rt th at comes forw ard to th is com mittee 

on th at questio n.

Mr. Rogers o f Florida. How ever, where the Bu rea u of the Bu dget 

made a pos itiv e recommendation tying it into the co nsider atio n of this 

legislation as the only way to hav e it appro ved, then T th ou gh t you 

might have co nsidered it. T hat ’s the point I was making.

Mr. McK erxax. We di d con sider it, M r. Rogers, but we co nsid ered 

rea lly it was n't very germane to th is p ar ticu la r question. We w anted 

to correct an inequity .

Mr. Rogers of Florida. How we p ay for it is not germa ne?

Mr. McK ernax. Well, no: I wo uld n't want to say th at , but we felt 

that first we wan ted to correct an inequity and then if the Congres s 

felt that seamen and fishermen should pay for this the n, obviously, 

the re would have to l>e very carefu l and con side red stu dy of tha t pa rtic ­

ul ar problem.

Mr. Rogers of Flori da. Wo uld it l>e y ou r Dep artm en t’s fe eling th at 

this should lie confined to commercial fishing o peration s?

Mr. McK erxax. The inte rest of ou r De partm ent is in co rre cti ng 

this inequity in comm ercial fishe rmen, vessel own ers, so the answer 

to your question, then , is “Y es.”
38 MEDICAL CAKE FOR SELF-EMPLOYED SEAMEN

M r. R ogers of F lorid a. You w ant it confined to th at ?

Mr. McK ernan. We have n’t specifically said so in our presen t repo rt, hut our interest is in comm ercial fishermen.

Mr. R ogers of Florid a. Th an k you very much.

Th an k you, Mr. C hairm an.

Mr. Roberts. Th an k you, Mr. Rogers.

An ything furth er, gentleme n ?

Mr. Brotzman. No fu rthe r questions.

Mr. Roberts. Th an k you very much , gentlem en, for yo ur sta tements.

(The followi ng inf orma tio n was later sub mitted fo r the reco rd:)

Department of the I nterior,

Office of the Secretary, 

Washington, D.C., November 8, 1963.

Hou. Kenneth A. Roberts,

Chairman, Subcommittee on Public Health and Safety, Committee on Interstate

and Foreign Commerce, House of Representatives, Washington, D.C.

Dear Mr. Chairman : We have had an opportunity to review the proposed

amendments to sections 1 and 2 of S. 978 which recently passed the Senate and 

the proposed explanation of these amendments, both of which were prepared by 

the Department of Health, Education, and Welfare with the assistance of the 

committee staff. A copy of the se proposals is enclosed herein.

In our opinion, these changes would accomplish the objectives of this Department which are to restore to self-employed commercial fishermen the benefits they 

enjoyed prior to 1954.

Sincerely yours,

Robert M. Paul,

Deputy Assistant Secretary of the Interior.

Proposed Language for I nclusion in Committee Report on S. 978

The committee amendments strike out the words “or self-employed” in sections 1 and 2 of the bill and insert in lieu thereof, “ (or, in the case of a commercial fishing vessel, self-employed)”.

The purpose of this bill, as modified by the committee amendments, is to resto re to owners and coowners of U.S.-flag commercial fishing vessels, who perform seamen’s services onboard, the eligibility for medical care in hospitals, 

outpatient clinics, and other medical facilities of the Public Health Service which 

was provided to them before a 1954 amendment to the regulations under the 

Public H ealth Service Act.

An opinion of the Office of the General Counsel of the Department of Health, 

Education, and Welfare, issued in 1951, had inte rpre ted the term “employed” 

in section 2(h) and section 322(a) (1) of the Public Health Service Act* as excluding persons who a re self-employed. After the General Counsel’s Office, upon 

request for reconsideration, had adhered to its earlier opinion, the regulations 

were amended in 1954 so as to exclude from the term “seamen” “the owner or 

joint owners of a vessel [and] the spouse of any such owner” .

Under the committee amendments, self-employed indiv iduals engaged onboard 

a commercial fishing vessel in the types of activity described in section 2(h) of 

the Public Health Service Act will be considered “seamen,” whether or not they 

are owners or coowners of the vessel. At the same time, self-employed persons 

on pleasure boats and other vessels tha t are not commercial fishing vessels would 

he excluded from coverage, whether o r not such vessels are owned or chartered 

by such persons. Thus, self-employed persons on vessels used for spo rt fishery, 

even th ought the vessel be one owned by a person commercially engaged in c ha rterin g such vessels to sport fishermen or taking sport fishermen on fishing trips 

for pay, would be excluded. The phrase “commercial fishing vessel” is, on the

1

 Sec. 2 (h ) defines “s ea m en ” as in clud ing “a ny pe rson em plo yed onboard in the care, 

pr es er vat io n, or nav ig at io n of an y vessel, or in th e service , on bo ard, of thos e eng aged in 

su ch care, pr es er vat io n, or na vig at io n.” Sec. 3 2 2 (a )( 1 ) pr ov ides th a t “Sea men employ ed 

on vessels of th e U ni te d S ta te s registered , en rolle d, an d lic en se d un de r th e m ar iti m e laws 

th er eo f, oth er th an ca na l boat s engaged in th e co as ting tr ad e” shall in ac co rdan ce wi th 

re gula tions be en titled to medica l, surgical, an d de nt nl tr eatm en t and ho sp ital iz at io n fro m 

th e Servi ce.
MEDICAL CARE FOR SELF-EMPLOYED SEAMEN 39

other hand, intended to include vessels engaged in the gathering of any form of 

eith er fresh water or marine animal life for commercial purposes, and will thus 

include vessels engaged in the commercial catch ing or harvesting of shrimp, 

lobsters, oysters, etc., as well as fish, if, as required by section 322(a) (1) of the 

Public Health Service Act, the vessel is a U.S.-ttag vessel “registered, enrolled, 

and licensed under the maritime laws of the United States, other tha n canal 

boats engaged in the coasting trade.” (The bill would not enlarge the coverage 

of section 322(b) of the Public Health Service Act which authorizes medical, 

surgical, dental, and hosp ital services to seamen on foreign-flag vessels on a 

user-charge basis.)

Mr. Rogers of Florida (presiding). The next witness will be Mr. 

J efi Kibre.

STATEMENT OF JE FF KIBRE, WASHINGTON REPRESENTATIVE,

INTERNATIONAL LONGSHOREMEN’S AND WAREHOUSEMEN’S

UNION

Mr. Kibre. Mr. Chairman, my name is Jeff Kibre. 1 am the Washington representative of the International Longshoremen's and Warehousemen’s Union, and I appear here today in behalf of our fisheries 

division, comprising some 3,500 west coast fishermen and related 

workers.

I welcome the opportunity to support legislation to restore to selfemployed fishermen eligibility for medical care benefits under the 

Public Health Service Act.

This legislation does not call for breaking any new ground. It 

would simply return to a particular class of fishermen a service they 

were accorded from 1798 to 1954, a period of 156 years. The interruption of medical and hospital care in 1954 came as the result of an 

administrative ruling which was directed primarily at persons other 

than the fishermen in question.

Employee fishermen were not affected by the 1954 ruling. They 

have continued to receive Public Health Service care. What we are 

concerned about, then, is the denial of service to self-employed fishermen—a work force of some 10,000 men. This group, of course, feels 

that they are the victims of an obvious inequity.

Legislation to cure the problem passed the Senate last June. Similar bills were subsequently considered by this subcommittee. The 

legislation failed to move furthe r largely because of an objection—as 

I understand the situation—over the definition of the term “seamen.” 

That objection, I am sure, has been corrected in S. 978, the bill that 

recently passed the Senate.

Considering the legislative history, we definitely favor S. 978. 

This bill, in our judgment, meets most precisely the inequity created 

by the 1954 ruling.

The facts involved in the proposed amendment were substantially 

developed in the hearing of last August 13. I merely want to review 

the highlights of my previous testimony, which may be found on 

pages 34 to 36, inclusive, of the printed record.

Under existing provisions of the act, medical services are available 

to fishermen employed on board documented vessels if they are substantially engaged in the care, preservation, or navigation of the 

vessel. The great majority of the fishermen I represent meet these 

qualifications and, therfore, enjoy the services of the marine hospitals.
40 MEDICAL CAKE FOB SELF-EM PLOY ED SEA ME N

Th e need for the ame ndm ent arise s from the fact tha t many fishermen are owner -op era tors of fishing cr af t, and are held to be selfemployed. Th is is pa rti cu larly tru e on small boa ts where one or 

more fishermen sha re owner ship of a boat. Al thou gh these men may 

technically be defined as self-employed, the y pe rfo rin the same essention seamen services as employee fishermen. Ex ce pt for the elem ent 

of ownership in a vessel, they cannot be dis tin guish ed fro m employee 

fisherm en. It is ma nif estly un fa ir, the ref ore, th at the y be ba rre d 

from Public H ea lth Service care.

S. 978 would res tore this service by expand ing the definitio n of 

the ter m “seamen.” Th e existing lan guage refers only to pers ons 

“em ployed’' on boa rd a vessel in the care, prese rva tion, or na viga ­

tio n of such vessel. The ame ndm ent would extend the defin ition to 

include p erso ns “self-employed” on board a vessel.

Th e effect of this change would be quite modest. It would only 

mak e eligible for service those self-employed fishermen who are 

engaged in the care, pre ser vat ion , or navig ati on of a vessel, or in 

the service of those engaged in such care, p res erv ation, or naviga tion. 

Th e door would not be opened for those persons ag ains t whom the 

1954 ru lin g was pr im arily directed—casual fishermen, owners of 

pleasure yac hts, or women liv ing abo ard houseboats.

One oth er point bears mention. In the Senat e Comm erce Com ­

mittee hearing, the Burea u of the Budg et rais ed the question of a 

user charge, not only with reg ard to self -em ployed fishermen bu t 

also for all such service to seamen gen erally.

We feel th at such an issue is hig hly im prop er at this time. The 

sub ject of congressional policy tow ard the financ ing of the medical 

care prog ram for seamen is not at s take here. We are dealing solely 

wi th an amend ment which strike s at an inequity arising out of the 

1954 ad mi nis tra tiv e rulin g. Th is ame ndm ent, there for e, should not 

be used as a vehicle to change a lon gstan din g policy of Cong ress, a 

policy in effect since 1905.

One final con sideration should be taken into account in ap praisin g 

th is legisla tion. Th e N ation’s fishing fleet, f or a vari ety of reasons, has 

been ha rd hi t du rin g the las t decade. The det ails need ha rd ly be re ­

cite d. Suffice it to say th at th e average fisherman despe rately needs a 

lit tle encouragement from his Governm ent, from this Congress.

Spe edy acti on in ap prov ing S. 978 will be more th an welcomed by 

tho usa nds of fishermen, on small and big boa ts alike. It would be 

tak en as a sign th at they are not forgotten, th at the y are remembered 

fro m time to tim e as men who fulfill an im po rta nt service fo r th eir 

cou ntry.

Mr. Rogers of Fl orida. Th an k you very much, Mr. Kibre .

An y questions ?

Air. Brotzman. Mr. Kibre , just one question : W ha t is the specific 

longsta nding polic y of Congress that von allu de t o ?

Mr. K ibre. I allude to this fact: Th at since 1884, as I recall, the re 

has been no use r cha rge as such app lied to seamen and since 1905 the 

cost o f o pe ratin g th e m arine h osp itals ha s been m et an nu all y o ut of a pprop ria tio ns fo r t hat specific purp ose. In othe r words, as fa r back as 

1884, Congress removed the so-called head tax whi ch had previously 

ap pli ed to seamen and su bstitu ted a tonnag e tax.
MEDICAL CARE FOR SELF-EMPLOYED SEAMEN 41

The tonnage tax, however, was revised in 1905 and direct appropriations were substituted for the financing of the marine hospitals.

Of course, the tonnage tax does continue, but it goes into the Treasury as a part of the general receipts.

Mr. Brotzman. With regard to this original determination in 1884, 

what was the purpose of Congress or what is the legislative history 

behind the provision for this medical care, as you understand it?

Mr. Kibre. As I understand it, medical care for the merchant 

marine, which was first provided for in 1798 was directed toward serving the nat ional interest.

The national interest at tha t time was defined as having a strong 

merchant marine, and in order to preserve a substantial work force 

in the merchant marine, it was felt that the Government should provide medical service.

As I recall, th at was the original basis for the national policy.

Mr. Brotzman. This is a general question. Does the same need 

exist today, as far as taking care of the national interest, that calls 

for this particular medical assistance to be provided ?

Mr. Kibre. Yes; I think that the same basic national interest prevails at the present time. Certainly it has been said time and time 

again that it is in the national interest to have a strong, healthy 

merchant marine, and, of course, the seamen are an integral part of 

tha t merchant marine and fishermen who are regularly employed 

aboard vessels or self-employed are certainly a part of the merchant 

ma rine. This has been historically so.

Mr. Brotzman. I take it from your comment that you predicate this 

statement upon the basis that at that time this was a fringe benefit 

or something to attr act people to enlist in or become a part of the 

merchant marine. Would that be correct ?

Mr. Kibre. I wouldn’t describe it as a fringe benefit.

Mr. Brotzman. ITow would you describe it ?

Mr. Kibre. I would describe it as an integral part of the service 

that, was essential to having an effective body of seamen.

Bear in mind that the seaman employed aboard a vessel is not in the 

same situation as a person living or employed ashore. He is generally 

away from his home, goes long distances, and when he needs medical 

care he may be in a strange place and he needs tha t care quickly. It 

is important then to provide this extra sendee for the merchant marine 

in order to have and attract the men necessary to operate the merchant 

marine.

Mr. Brotzman. Let us assume you have a merchant marine that is 

on a ship. Would he be able to get service any more rapidly because 

he got it under the auspices of the Public Health Service than he 

would from some other source?

Mr. Kibre. That would depend on circumstances.

Mr. Brotzman. Obviously, he would have to find a doctor or medical care whether it comes from the Public Health Service or from 

some private source, is that not correct?

Mr. K ibre. That would be substantially correct.

Mr. Brotzman. So that, in fact, it does not assist him in getting 

medical assistance any more rapidly—the mere fact that it comes under 

the Public Health Sendee Act?

Mr. Kibre. It might under some circumstances.
42 MEDICAL CARE FOR SELF-EM PLOY ED SEA ME N

Mr. Brotzman. How would that occur ?

Mr. Kibre. It might help him to get the kind of expert medical 

care that he needs.

Mr. Brotzman. I said it would not help him get it any more 

rapidly, would it ?

Mr. Kibre. It might not. Under present circumstances, it might 

not, not necessarily.

Mr. Brotzman. Logically, it seems to me th at you have to find a 

doctor and it does not make much difference whether he comes from 

the Public Health Service or from some private source, is that not 

correct?

Mr. Kibre. That would be generally true.

Mr. Brotzman. You seem to have some reservation in your answer 

that I do not understand. I mean, is that not true?

Mr. Kibre. The point is this, sir; that a man is hurt or he becomes 

sick; he is in need of quick medical care; he is in a strange port; he 

has to go shopping around for a doctor or he has to go shopping 

around for a hospital.

If the marine hospital is available, a hospital which has been caring 

for merchant marine people, which understands a number of their 

disabilities, he then certainly is going to get expert care immediately 

without having to shop around.

Air. Brotzman. How many of these hospitals are there?

Air. Kibre. They are located in the principal ports.

Air. Brotzman. So th at he does not have to find a doctor. He can 

go to that specific place. Is tha t what you are saying?

Air. Kibre. Precisely. He is always aware tha t that marine hospital 

is there.

Air. Brotzman. It puts it up to the seaman, then. Wha t you are 

saying is tha t he has to find a doctor like everybody else does and it 

makes it more difficult for him to find a doctor?

Mr. Kibre. I am sure th at you are generally aware, sir, tha t if you 

are in a strange city, locating a doctor in whom you have confidence 

might sometimes be a problem.

Air. Brotzman. I suppose the same thing applies to very other 

citizen of this country.

Air. Kibre. Exactly.

Mr. Brotzman. Is that not right?

Air. K ibre. Th at’s true.

Mr. Brotzman. If you have doctors in every town t hat you are going to visit on the t rip , it might be nice in the event you got sick, but 

tha t is not the way our country really operates.

Let me ask you this. I think my first question of you was, “Is this 

a fringe benefit tha t w’ould attract people to being in the merchant 

marine,” and I think, as you said, to preserve the national interest.

Mr. Kibre. That is correct.

Mr. Brotzman. You seemed to disagree with my choice of terminology when I said “fringe benefit.” You said it is an integral part. 

Let me ask you this question: Is it your position tha t the national 

interest would suffer because we would not have a merchant marine 

if the Public Health Service medical care was not provided?

Air. Kibre. I think it has been well established tha t the national 

interest would suffer if our merchant marine would wither away or 

if it becomes inefficient. I think this has been well established.
MEDICAL CARE FOR SE LF-EMP LO YE D SEA ME N 43

Mr. Brotzman. Let us go back now. The point I asked you was, 

“Do you th in k they would not become merch ant marines if the y did 

not have t his Pu blic H ea lth Service entitlem en t?”

Mr. K ibre. I certa inly cou ldn’t give a flat answer to th at , bu t I 

would say th at the existence and the av ail ability of the mari ne hos ­

pitals certain ly helps to keep the men in th e merchant marine.

I know th at i t is an imjio rta nt elem ent in t he th inking of the average 

fisherman.

I am much b etter acquainted with the fishermen th an I am with the 

mem bers of the me rch ant marine, th at is, the seagoing men.

Mr. Brotzman. There is one m ore questio n I have, and I was lea ding up to this. In y ou r statement you say you feel th at such an issue 

is hig hly im prop er at this time. Tha t mean s how to pay fo r it ; is 

th at correct?

Mr. K ibre. Le t me put it this w ay: W ha t we are d ealing with, as I 

say here , is wi th the question of serv ice th at was pro vid ed to a par ­

tic ular class of fishermen fo r 156 y ears an d which was removed bv an 

ad minist rativ e ru ling in 1954.

W ha t we a re de aling with here is th e question of res tor ing th at service, re sto rin g the situatio n th at prevailed p rior to 1954.

If the question of use r cha rges is going to come up, it seems to me 

th at it sho uld come u p as a se parat e issue deali ng with t he broad prob ­

lem of financ ing of the Pub lic Hea lth Service care fo r seamen.

Mr. Brotzman. All rig ht. Let us tak e y ou r thesis as being correct. 

Do y ou think th at the question of how to pay for this shou ld come up 

as an issue?

Mr. Kibre. It seems to me th at Congress has alr ead y resolved that 

question.

If Congress w ants to reopen it, cert ain ly it can always be reopened.

Mr. Brotzman. 1 do not think it has been resolved as to the ad ­

dition al grou p of people th at m igh t come un de r the t erm s of t he act; 

has i t?

Mr. Kibre. Th is amend ment brings in pr im arily a class of fishermen who w ere un de r the act p rior to 1954. It mi ght, as th e discussion 

indicated a few mom ents ago, br ing in some self-employ ed seamen 

aboard othe r vessels.

As to how man y, no figures can be adva nce d, b ut in th e m ain th e bill 

takes in a class o f fishermen or a class of seamen beneficiaries who were 

covered prior to 1954.

Mr. Brotzman. Th an k you very much.

Mr. Rogers of Florid a. Th ank you v ery much, Mr. K ibre.

Mr. Kibre. Th an k you.

Mr. Rogers of Fl orida. We a pp recia te it.

Mr. Kibre. Th an k y ou, sir.

Mr. Rogers of Florida. Ou r nex t witnes s is Mr. E ar l W. Clark .

Mr. Clark , we are glad to hav e you b efo re th e com mittee.

STAT EMENT OF EAR L W. CLARK, CODIRECTOR, LABOR-MANAGEMEN T MA RITIME COMMITTEE, AFL-C IO MA RITIME COMM ITTEE,

AND AMERICAN MERCHA NT MA RINE IN ST ITUT E

Mr. Clark. Th an k you, Mr. Ch airma n.

Mr. Rogers of Florida. Wo uld you like to file yo ur sta tem ent fo r 

the record, Mr. C lar k ?
44 MEDICAL CAKE FOK SELF-EMPLOYED SEAMEN

M r. Clark. Yes ; I would.

I testified at l ength fo r th e g rou p I rep res ent both in the Sen ate and 

in the House last year and testified at len gth in the Sen ate thi s year, 

and I think , to save the com mittee's tim e, 1 w ould lik e to file it and th en 

comment, please.

Mr. Rogers of Florida. Th ank you very much.

W ith ou t objection, the statem ent by Mr. Cl ark will be made a par t 

of the reco rd I this po int, and we are delig hte d to hav e yo ur comments, M r. C lark.

(The statem ent re ferre d to follows :)

Sta te men t of t h e L abor-Managem en t Ma r it im e Co m m it tee, A F L -C IO Maritim e Com m it tee an d A mer ic an Merchant Ma rin e I nst it u te on S. 978 and

Compa ni on H ou se Bil ls

The Labor-M anagement Maritime Committee, representing some of the major

American-flag steamship lines and seagoing labor unions, the AFL-CIO Maritime Committee, consisting of the largest segment of maritime unions within the 

AFL-CIO, and the American Merchant Marine ins titu te, comprising a broad 

membership in the maritim e industry, desires to jointly suppo rt the general intent and purpose of S. 978 and companion House hills. We believe that Public 

Health Service hospital and medical care should he made available to a certain 

class of seamen-fishermen now denied this service because they are owners, or 

pa rt owners, of fishing vessels.

It should be pointed out tha t, prio r to 1954, this class of persons was receiving 

such hospital and medical care, but was excluded during that year following a 

legal opinion by the General Counsel of the Departm ent of Health. Education, 

and Welfare. We understand the occasion for such ruling arose in 1951 out of 

claims for medical care by certain parties occupying resid ential yachts and 

houseboats. The claims were based on the general language of the law. In the 

cases in point, the attem pt was to include even a housewife, who was allegedly 

engaged in the care or preservation of the vessel und er the literal wording of 

the act. Tt seems obvious th at such persons were not intended to fall und er the 

classification of seamen a s set forth in 42 U.S.C. 201 (h ).

In November of 1953 Public Health Service officials referred the ma tte r to the 

General Counsel of that agency for review and advice. His opinion resulted in 

the issuance of regulations which had the broad effect of barring, among c erta in 

other beneficiaries, the owners, or part owners, of small fishing vessels to whom 

such medical and hospital care bad been tradition ally extended. The new regulations were first published in the Federal Register on March 24, 1954, revised 

and republished on May 26, 1954, and became effective Jun e 26, 1954.

While no one could qua rrel with the necessity for proper inte rpretation of the 

law and its app ropriate application to the tyj>e of cases giving rise to the new 

regulations, the net effect upon certain of those in the fishing trade was unfortunate.

Seamen employed on vessels registered, enrolled, or licensed under the maritime laws of the United States are now entitled to Public Health Service care. 

This is clearly establish ed in 42 U.S.C. 24 9( a) (1 ). The essence of the term 

“seamen” as defined in the sta tute is found in the words “care, preservation, 

or navigation” of vessels.1

 Fishermen are not entitled to Public Health Service 

medical and hospital care by virtue of being fishermen—quite the contrary. 

They are not covered under the sta tute at all unless the ir activities encompass 

the care, prese rvation, or navigation of vessels. In such case, they qualify 

because they are, in fact, seamen, and not because they may also engage in fishing. Fishing is incidental to eligibility for medical and hospital care and is not 

governing.

The fac t that a person enjoys an ownership, or pa rt ownership, of a small 

fishing boat in which he pursues his occupation does not appear to change the 

complexion of his occupation as a seamen-fisherman. Furth ermore, his occupation is for the most p art comparable to the many other types of seamen. In fact, 

many of these seamen-fishermen have been readily a djusted to other types of seamen's duties during wartime, or in periods of national emergency. Certainly.

1

 42 U.S.C. 201(h ).
MED ICAL CARE FOR SE LF -EMPL OY ED SEAM EN 4 5

the ir normal duties on board a vessel are not changed by v irtue of the fac t that 

they have an intere st in some fishing boat.

We subscribe to modification of the law to the extent that it can be int erpreted to reinstate, as recipients of Public Health Service hospital and medical 

care, owner-operators of fishing boats (documented under the laws of the 

United Sta tes ).

The wording of S. 978, and companion House bills, includes the language “any 

person employed or self-employed on board in the care, preservation or navigation of any vessel.” (42 U.S.C. 201 (h), italic supplied.) The use of the word 

self-employed is new and would reinst ate the owners of fishing boats to Public 

Health Service medical and hosp ital care, from which they were excluded on 

Jun e 26, 1954.

The repo rt of the Public Health Service, submitted on S. 978 this year, contains 

the following language:

“The legislative history of this program suggests that the participation of the 

Federal Government in providing medical care to merchant seamen rests primarily on a national intere st in assurin g the effectiveness of the labor force required for an adequate American merchant marine. A self-employed owner who 

performs duties rela ted to the care, preservation, or navigation of a documented 

vessel of the United States is, in effect, fulfilling the same purpose as th e employed 

seamen on board the vessel. Since such persons are in fac t applying the ir maritime skills, they a re essentially adding to the maritim e labo r force.

“Although statistics are not available on the a dditional number of persons who 

would come within the provisions of the law und er the present bill, we believe 

that neither the number nor cost would significantly affect the prese nt program, 

and that enac tmen t of this bill would pose no serious difficulties for this Department as a provider of services.

“The purpose of the bill is to remove a n app are nt inequity in present practice 

by amending the act to include a certain class of self-employed seamen who 

formerly enjoyed the privilege of receiving medical care in Public Health Service 

hospitals, and not to expand the program in any sub stantial manner. Speaking 

solely as a provider of services, this Department has no objection to the enac tment of the hill.”

The insertion of the word “self-employed” in section 32 2(a)(1) of the Public 

Hea lth Service Act (U.S.C. 249(a) (1 )) , is chiefly for the purpose of making this 

section consonant with 42 U.S.C. 201 (h).

We support S. 978, and companion House bills, for several reason s:

(а) The bill mainta ins the inte grity of the term “seamen” as defined in 

current statutes.

(б) The bill will not floodgate the Public Health Service by unduly increasing the number of recipients othe rwise not entitled to its service.

(c) The bill reinstates only those who legitimate ly should receive medical 

and hosp ital care and who were excluded by a legal interp retation based on 

technicalities of the law. rather tha n upon the merits.

This is appropriate legislation and should be passed by the Congress.

Mr. Clark. Thank you, sir.

1 would like to state that the filing of this document covers the 

position taken by the Labor-Management Maritime Committee, which 

is composed of major shipping lines and seagoing unions.

It is also subscribed to by the AF L-CIO Maritime Committee, of 

which Mr. Haddock is a codirector and who is here present.

It is subscribed to by the American Merchant Marine Institute 

through its vice president, Mr. Alvin Shapiro.

These three bodies comprise the great bulk, I would say, of shipping 

in this country, both of labor and management, so that the position 

is well supported from private industry.

Since I am filing this statement on behalf of these committees, I 

should like, with the permission of the Chair, to address myself to some 

of the problems that have been raised here today.

I think you will find that the persons on tugboats and barges who 

are engaged in the care, preservation, and navigation of vessels are a lready covered and, therefore, are not involved with this legislation.
46 MEDICAL CARE FOR SELF-EM PLOY ED SEA ME N

I would like to say with reference to the Burea u of the Budget 

sta tem ent on user cha rges o r tonnage taxes t hat no tonnag e taxe s hav e 

been levied again st fishing vessels, so th at th at problem here would 

seem to be separate fr om the one tha t is bein g considered .

W ha t is being con side red here is the eli mination of an ine quity to 

these people who were taken out of the prog ram in 1954, not the ton ­

nage tax , and I think th at fal ls perha ps un de r a com pletely differen t 

catego ry.

I w ould say fo r t he grou ps tha t T rep res ent we do not fav or th e impos itio n of a ton nage tax on the fishing boat indu str y in connection 

with this bill.

To nnage taxes hav e been levied again st ship s in the foreig n commerce and in the domestic commerce of this c ountr y since 1884. He re 

you have a very high degree of commercial en ter prise dea ling with 

larg e ship s which ca rry large am ounts of car go for this cou ntry.

In the case o f thes e lit tle fishing b oat op era tors the y may hav e just 

a small lit tle boat. Most of them do no t earn a larg e am ount of income. They do not hav e a large amoun t of capit al invested, and a 

gr ea t many of the m I think have a strug gle to get a long.

You are dealing with an entirely different pro position here than 

you are dea ling wi th in rel ati onship to broader pha ses o f the foreign 

an d domestic commerce o f the United States.

I t is an entirely different prob lem, an d to levy a tax again st these 

people when it has no t been tra ditio na l to do so, I t hink would be un ­

reaso nable .

I just wa nt to comm ent as t o the g ene ral proposi tion which I believe 

you rea d in the comm ents of the Bu rea u of th e Bu dget which implied 

th at the whole question of ton nage taxe s, no t only fo r seamen bu t 

across the boa rd, m ight be inv olve d here.

I would like to say th at this, aga in, is an entirely diff eren t matter 

fro m the subject t hat is being b roug ht up. Th is came up in the last 

three sessions of the C ongress, and points u p some of the thing s which 

the s hipp ing ind ustry is up a gainst.

Th e shipp ing indu str y is an ind ustry unique in itself with reg ard 

to this problem. Le t me say th at no indu str y in th is country is u nder 

th e type of r egulati on and law o r t he e xte nt o f reg ula tio n an d law as 

is t he m erc hant marine.

Und er the ad mira lty clause of the Co nstituti on seamen are con sidere d wards of the sta te. Th ey are tr ea ted differently from ot her types 

of employees a nd they have been treated by the courts differently down 

th ro ug h the y ear s in the claims which devo lve upo n the sh ipping in ­

du str y.

We have other sta tutes, such as the sta tutes requ iri ng maintenance 

an d cure on the par t of th e opera tors fo r seamen all over the world 

who become sick at sea and who have to be k ep t on a ce rtain allowance 

by the shipp ing lines un til they recover. Th ere is th e doctrine of unseaworthiness, the Jone s Act , and all of th e other laws th at apply, so 

the shipp ing indu str y is co ntr ibuti ng it s s hare t hrou gh the application 

of a nu mb er of m ari tim e law s.

The presu mp tion of the Bu rea u of the Bud ge t here would be th at we 

are like any other nor mal indu str y and, the ref ore, we should have an 

imp osition of use r cha rges to accomplish this.
MEDICAL CARE FOR SELF-EMPLOYE D SEAMEN 47

Gentlemen, let me say this with all clue respect. We feel in our industry tha t the Bureau of the Budget is leading in the direction of 

wanting to do away with these marine hospitals. If they succeed in 

this thing it will be one of the worst things tha t has happened to the 

merchant marine of this country in its ability to help defend this 

Nation in case ol' war.

I think tha t the gentleman who testified before me made a very 

good point, Mr. Wedin, in connection with these fishing boats, when 

he said, and I will turn to his statement:

The seafaring industry provides an outpost for the United States of value 

for military purposes. Seamen are usually the first to provide surveillance for 

their country in time of crisis.

He also made the p oint tha t the maritime industry, and this is especially true of the nshing boats, serves as an auxiliary to the Coast 

Guard, and related tha t to the present Russian fishing problem.

I am certain tha t if some of things which are known in this industry 

could be made available, and which can’t, perhaps, because of security 

regulations, you would find that there is a close tie between the fishing 

boats and the defense of this country.

When you come to the overall merchant marine, we are the only 

industry in this country tha t is taken over, lock, stock, and barrel 

when war is declared. All our ships are taken over. They are operated for Government account and our shipping lines run their 

operations for Government account.

At the Normandy invasion, these ships backed up General Eisenhower. They were all running under Government account. After 

the war is over ships of the American merchant marine are returned 

back into private hands.

Some folks have said, “Well, we are no different from United States 

Steel, and a lot of other corporations.”

This is not so. The Merchant Marine Act of 1936, section 101, 

provides tha t it is the policy of the Congress of the United States and 

of this country tha t we have seamen capable of serving as an auxiliary 

force to the m ilitary in case of war and they must be trained and e fficient at all times. No other industry must keep its men fit at all 

times, ready for immediate conflict. So I offer this to show tha t the 

Government itself has a stake in the health of seamen. It is not 

aside from the question, gentlemen; it is rig ht to the point, w ith reference to the Bureau of the Budget’s proposal, when we forget th at the 

Government has a great stake in this merchant marine. The Government is paying out millions of dollars to keep it alive and the steamship lines are putting up over two and a half billion dollars within 

the next several years in order to replace all th eir fleets and every one 

of those ships has to meet the Nation’s defense purposes.

Let it not be said that the merchant marine, including these fishing 

boats, is just another industry and the Government has no interest 

in the health of seamen. The very Government policy under which 

the Congress is now supporting the m erchant marine and which has 

existed since 1936, sets forth clearly the position of th e U.S. Government on it, and I think the Bureau of the Budget is far afield on 

this. I think if its proposal ever gets to the Congress, we will want 

certainly to speak out very decidedly upon it.
48 MEDICAL CARE FOR SELF-EM PLOY ED SEAM EN

I think it is a mistake to raise it in connection wi th these little 

fishing boats. The y do n’t make a whole lot of money. I know a 

lot of those people who have lit tle boats. Some of the m just eke out 

an existence. To thr ow a ton nag e charge on the m is im proper. You 

migh t as well thr ow a tax upon the Coast Gu ard, and the Coast and 

Geodetic Survey , and the othe r recipient s of th e public care in the 

Publi c He alth Serv ice hospitals. The y are in the re, too, and I am 

fo r them, but there are some thing s here that do n't meet the eye unless 

they are bro ught out. 1 hope what I hav e said may be of some 

benefit to the com mittee.

I think the Gover nment 's intere st tra nscen ds ju st the mere matter 

of who gets pub lic care. Ce rta inl y, I say to you it is not a fring e 

benefit and we don’t consider it so.

Th e indu str y is put ting up mon ey; the Governm ent is pu tti ng up 

money. Ea ch p uts it up on t he basis of its ow n inter est in the m atter 

of keepi ng a strong, healt hy merchant ma rin e, and, as the act says, 

not only to ca rry a substan tia l portio n of the commerce of this 

country , bu t also to serve this Nation in case of defense, and we are 

usu ally t he first to be called.

I wou ld like to ju st c larify one ot her thi ng .

A question was asked by one of the gentlem en about the num ber of 

hospitals. Th ere are 12 general service Pu blic Hea lth Serv ice hospital s in the country. They are located on the coa stline with three 

exceptions—D etr oit, M emp his, and Chicago.

In addition to those 12, there, are th ree special hospitals, one located 

at Lexin gto n, K y., one at F ort Wort h, Tex., and one at Carville, La.

Aside from th at , there are 25 o utpa tie nt clin ics in the country and 

115 o ut pa tie nt offices. These are offices to car e fo r p eop le th at a re fa r 

dista nt from th e h ospit als an d, also, to tak e c are o f the overload in the 

are a of the hos pitals.

As fa r as the lega l interp retatio n by the Gen eral Counsel of the 

Pu blic He alth Service or the He alt h, Edu catio n, and W elf are Dep ar tme nt is concerned, the recommendation of the g roups th at I rep res ent 

would be t h is : Un less yo u pass this legisla tion you w ill have no assurance t h at t his will be c arr ied o ut. I myself used to be in the Government. I was in the Mari tim e Ad ministratio n fo r a numb er of years, 

dur in g the Ko rea n war. I have the hig hest degree of r espect fo r the 

Fe de ra l service. I could n’t have worked fo r it as lon g as I did b efore 

I we nt into private employme nt if I h ad n’t, bu t I kno w the re are c erta in overall policies th at ema nate from the B ureau of the Budget. An d 

these Government p eople who testified before you here tod ay have to 

reconcile th eir answers in terms of th at ove rall policy.

I oppose some of these o verall policies, as I th in k a grea t many people 

do.

I have mad e comm ents on the essential issues th at h ave been raised 

with t he t ho ug ht th at I might be helpful to y ou r thinking . I should 

like to leave it the re and if you have any questions, I will be happy 

to respond .

Mr. R ogers of Fl orida. Th an k you ve ry m uch, Mr. Cla rk.

Some of th e points you have made hav e been most he lpf ul.

Any questions ?

Mr. B rotzman. No questions.

Mr. Rogers of Fl or id a. Ju st one question. I notice th at the B urea u o f the Bu dg et again differs with you one th e e xtension of coverage
MEDICAL CARE FOR SE LF -EMPL OY ED SEAM EN 49

and I think it might be helpful if you could furnish the committee 

with information about present coverage on tugs and this sort of thing, 

if you could just submit it to the committee.

Mr. Clark. I would be glad to do this.

Mr. Rogers of Florida. I think it would be helpful in our further 

consideration.

Mr. Clark. I would be happy to do that.

(The information referred to follows:)

Statement for th e Record

The statem ent th at “Persons on tugboats and barges who are engaged in 

the care, preservation, and navigatio n of vessels are already covered” by medical and hosp ital care in the Public Health Services hosp itals is correct and 

refe rred to the employees on such vessels which are engaged in local traffic. It 

was not inten ded to refer to owner-operators of such vessels. If the context of 

the Bureau of the Budget’s reference was solely to owner-operators of such 

vessels, the reference would be correct, and such owner-operators, not now 

eligible, would be covered under the provisions of S. 978, if engaged in the care, 

prese rvation, and navigation of th e vessels.

Mr. Rogers of Florida. All right.

Thank you very much for giving us the benefit of your views, Mr. 

Clark. You have been most helpful.

Mr. Clark. I thank the committee.

Mr. Rogers of Florida. At this point in the record, I have a few 

statements and communications received by the committee (hat will 

be placed in the record.

(The documents referred to follow :)

Seattle, Wash ., October I.}, 1963.

Representative Kenn eth A. Roberts.

Chairman, Subcommittee on Public Health and Sa fety,

House Office Building, Washington, D.C.:

We strongly urge you and your committee to please accept S. 978, marine 

hospitalization bill, favorably.

Association of Wives of Commercial F ish er me n, 

Mrs. T homas L. Warren, President.

Seattle, Was h., October 13,1963.

Re presen tat ive Kenn eth Roberts,

House Office Building,

Washington, D.C.:

Pacific Northwest fishing industry urges you to supi>ort Senate hill 978 now 

before Public Health and Safety Committee. This or similar House bill needed 

to correct previous injustice when longstanding medical care for self-employed 

seamen was terminated and to give supi>ort to U.S. fishing industry now str ug ­

gling for existence in hand-to-hand comi»etition with vast Japane se and Russian 

fishing fleets whose fleets have complete support from the ir governments. Your 

support will be ap preciated.

F ishi ng Vessel Owners Association.

Anacortes, Wash ., October 13,1963.

Representative Kenneth Roberts,

Washington, D.C.:

I am in favor of restoring rights .of self-etoitioved commercial fishermen to tl 

marine hospital. X

Boat “Fritzie Marie,” 

Lloyd Woolfey.
50 MEDICAL CARE FOR SELF-E MPLOYED SEAMEN

October 10, 1903.

Representative Kenneth A. Roberts,

Chairman.

Dear Sir : Would be most grateful for your support on the bill S. 978. I am 

a fisherman’s wife and the res t of them in the industry are waiting for the 

restoration of Public H ealth Service benefits.

Sincerely,

Mrs. Robert Bassett,

Boat “Astrid."

American Medical Association,

Chicago, III., October 1Ih 1968.

Hon. Kenneth A. Roberts,

Chairman, Subcommittee on Public Health and Safety, Committee on Interstate

and Foreign Commerce, House of Representatives, Washington, D.C.

Dear Congressman Roberts : I should like to take this opportunity on behalf

of the American Medical Association to submit respectfully fo r your consideration 

our views on II.R. 210,8, S. 978, and related bills of the 88th Congress which are 

now being considered by the Subcommittee on Public Hea lth and Safety of the 

Committee on In ter sta te and Foreign Commerce.

It is our understanding that th e proposed bills would amend the Public Health

Service Act in such manner so as to provide th at self-employed individuals on 

board commercial fishing vessels and other ships of U.S. registry would be 

eligible for medical, surgical, and denta l treatm ent and hospitalization without 

charge a t Public Health Service hosiptals.

Although we shall not comment on the fundame ntal issue of provision of 

medical care to merchan t seamen as a matter of public policy, I would like to 

direct your atte ntio n to certain portions of the 1955 Hoover Commission Task 

Force Report on Federal Medical Services, which stated, in p a rt:

“It is difficult to understand what substan tial reasons may be advanced today 

to supp ort the sing ular claims of seamen for medical services at Government 

expense. * * * Though the actual beneficiaries of the medical services are the 

seamen themselves, this practice is, nonetheless, a form of subsidy for the 

shipping industry. As such it is a precedent th at might well inspire similar 

demands from employees of other industries. * * * Merchant seamen as an 

identifiable group with in the Nation’s tota l population are insurable. * * ♦ 

Voluntary health insuranc e can provide medical and hosp ital care for merchan t 

seamen to the same extent and degree as it does for employees of other 

industries .”

The master or owner aboa rd a commercial vessel is an entrepreneur. The 

legislative history of the program whereby seamen are furnished medical and 

dental services at tax payers’ expense suggests th at the participation of the 

Federal Government in providing medical care to merchant seamen rests pri ­

marily on a national intere st in assuring the effectiveness of the labor force 

requ ired for an adequate American merchant marin e. The extension of this 

doctrine to self-employed indiv iduals and owners of documented vessels is 

not, in our opinion, in the public interest nor a necessary or desirable expenditur e of public funds. These are individuals who can. and should, as do millions 

of other Americans who are self-employed in other indu stries, provide for the ir 

medical and dental care and hospitalization from the ir own resources or through 

the purchase of one of a myriad of plans of pr ivate health insurance.

The American Medical Association, as spokesman for th is country’s physicians, 

believes, as a ma tter of policy, that personal medical care is prim arily the 

responsibility of the individual. It is only when the individual is unable to provide such care for himself th at payment for such care may become a public 

responsibility. The proposals embodied in the legislation before your subcommittee to provide medical and dental care to the self-employed is not justified 

by eith er need or any special relationship to the Federal Government. Such 

owner-seamen are not wounded in the service of our Nation as are veterans with 

service-connected dis abilitie s; they are not employees of the Federal Government, 

participating in a voluntary, contributory hea lth insurance program, as are 

civil service employees; they are pot members of the Armed Forces or their 

dej>endents, who have voluntarily , or by command of the Government, reli nquished for a period of time the ir right of movement from job to job.
MEDICAL CARE FOR SELF-EMPLOYED SEAMEN 51

Accordingly, we respe ctfully request that this proposal now before your subcommittee not be given favorable consideration. We urge that the subcommittee 

and the Congress jealously guard against unwa rra nte d expe nditures of public 

funds for individuals who are capable of providing for their own needs and who 

cannot be classified as wards or employees of our Nation’s Government.

Thank you for this opportunity of presenting the views of the Nation’s physicians on this legislative proposal pending before your subcommittee. I respectfully request that this statement be made a pa rt of the record of your hearings 

on this bill.

Sincerely yours,

F. J. L. Bla sin g a m e, M.D.

Mr. Rogers of Florida. The committee will now stand in recess 

subject to the call of the Chair to hear further testimony from the 

General Counsel of HEW .

(Whereupon, at 12:10 p.m., the subcommittee recessed subject to 

the call of the Chair.)

MEDICAL CARE FOR SELF-EMPLOYED SEAMEN

THURSDAY, OCTOBER 24, 1963

H ouse of Repr esenta tives,

S ubc omm itte e on P ub lic H ealth and Safety

of the Com mittee on I nter stat e and F oreign Commerce

D.C.

The subcommittee met at 10 a.m., pursuant to call, in room 1334, 

Longworth Building, Hon. Kenneth A. Roberts (chairman of the 

subcommittee) presiding.

Mr. R oberts. The subcommittee will please be in order.

We are meeting today to hear from the Department of Health, 

Education, and Welfare. With reference to certain language in Senate bill 978 and related bills with reference to providing medical care 

for certain persons engaged onboard a vessel in the care, preservation, 

or navigation of such vessel.

At the last meeting we had several of our colleagues testify on these 

bills and the representative, T believe from the Department of the In ­

terior, testified th at under the language of S. 978 the benefits sought 

to be derived under these bills could be extended to persons engaged in 

the care, preservation, or navigation of such vessels as ferries, tug ­

boats, houseboats I believe, and some other charter boats, and this interpretation gives this subcommittee a great deal of trouble.

It is our understanding th at p rior to the 1954 administrative ruling 

which eliminated owner-operators, these benefits were not extended 

to these classes, but tha t probably one thin g that brought about that 

ruling, I believe, was the fact that the wife of a houseboat owner 

sought these benefits at a Public Health Service hospital. Therefore, 

this morning we had set aside for hearing the representatives of the 

Department of Health, Education, and Welfare, and it is my pleasure 

to welcome Mr. Sydney Edelman, assistant chief, Public Health Division, Office of the General Counsel.

IVe are glad to have you, Mr. Edelman. We would be happy to 

have your comments.

STATEMENT OF SIDNEY EDELMAN. ASSISTANT CHIEF. PUBLIC

HEALTH DIVISION; ACCOMPANIED BY THEODORE ELLENBOGEN,

DEPUTY CHIEF, LEGISLATION DIVISION, OFFICE OF GENERAL

COUNSEL, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Mr. E df.lm an . Thank you, Mr. Chairman.

As the chairman just said, the question of the employment status 

of persons living on houseboats came up prior to 1954. If the act 

is amended as proposed by S. 978, it will include individuals who are 

self-employed aboard documented vessels of the United States as sea53
54 MEDICAL CARE FOR SELF-EM PLOY ED SEAM EN

men if they perforin the customary activities of a seaman in the care, 

preservation, or navigation of the vessel.

Mr. Roberts. You agree then with the opinion of the witness for 

the Department of the Interior?

Mr. Edelman. Yes, sir. I read that in the record and I agree 

with it.

Mr. Roberts. Let me ask this further question: Do you think it 

would take an amendment of an exclusive nature to cure this situation and to limit it to fishing vessels engaged in commercial fishing, 

tha t is, exclude charter boats, exclude ferries, excluding tugboats, 

possibly by naming those types of vessels th at the committee would 

desire to exclude ? Would it be your recommendation that language in 

the form of an amendment would be the proper way to cure it, or do 

you think we could cure it by spelling out the legislative intent in the 

form of a report ?

Mr. Edelman. Mr. Chairman, I think the question of spelling out 

legislative intent in a report is always a hazardous operation. The 

language of the statute is so broad tha t the legislative intention as 

expressed in a report may not be sufficient to furnish a legal basis 

for restriction.

I think if the committee intends to restrict the remedial effect of 

this amendment to a category of seamen it should specify in the bill 

exactly what kind of restriction it intends to be applied.

Mr. Roberts. May I suggest then tha t the Department submit 

language to us th at would acomplish the exclusion of the group that 

you say would be excluded in the broad language of the Senate 

bill ?

Air. Edelman. Do I understand it is the intention of the committee to restrict the effect of this amendment to owner-operators of commercial fishing vessels?

Air. Roberts. Tha t is correct.

Air. Edelman. AVe will be glad to prepare such an amendment 

for the committee.

Air. Roberts. Thank you, Air. Edelman.

Air. Schenck?

Air. Schenck. Aly only question, Air. Chairman, is tha t it would 

be confined then entirely to fishermen on fishing vessels whose pu rpose is to sail and work in the collection of fish for sale on the open 

market and not a pleasure boat or pleasure vessel ?

Air. Edelman. If this is the intention of the committee, I think 

language can be drafted to accomplish that purpose, though I would 

like to offer my personal views. It would be very difficult to draft 

a definition which will include only vessels actually engaged, because 

vessels do tie up for repairs and they do have crews aboard, even 

though they are not actually engaged in fishing operations, but I 

thin k the language can be drafted to accomplish this purpose.

Air. Schenck. Well, the purpose, as I understand the chairman’s 

idea, is that it be confined to only those vessels which are engaged in 

commercial fishing, not just when they are engaged, but which are so 

engaged full time except when being repaired as th eir reason of operation, and not any commercial type charter boat service which takes 

people out for pleasure fishing. Can that be done f
MEDICAL CARE FOR SELF-EMPLOYE D SEAMEN 55

Mr. Edelman. I think we can put the words together to accomplish 

that, Mr. Schenck.

Mr. Roberts. Mr. Nelson?

Mr. Nelson. No questions. Thank you.

Mr. Roberts. One other question, Mr. Edelman. I ask this for 

Mr. Rogers of Florida, who is really the one who originated th is line 

of inquiry. Have there been any requests fo r reconsideration of the 

1954 opinion?

Mr. E delman. Yes, Mr. Chairman, there was a request and I would 

like to just briefly go back and give the chronology of this. Two 

opinions were written in 1951 in the month of October, one dealing 

with the owner of a vessel in Florid a who was listed as the master.

The vessel had been tied up in port for 5 years. The woman 

worked in town at Food Fair and various grocery stores and said she 

was engaged every night and weekends in the preservation of the 

vessel in order to get it ready for navigation, bu t because of the lack 

of time she was fallin g behind and the vessel was falling into a worse 

and worse state of preservation, and it looked as though she would 

never be able to get it out to navigate it.

The other one involved a houseboat in Washington where the wife 

of the owner of the boat came in for medical care. In both those 

cases we held in the light of the legislative history tha t Congress 

intended tha t the medical services be available only to seamen who 

occupied the status of employees.

In 1953 we were asked to reevaluate tha t opinion by the Public 

Health Service to determine whether there was any basis for changing 

our views. At th at time, on December 29,1953, we advised the Service 

in writing th at we had reexamined the previous opinions and saw no 

reason to change our views. We suggested tha t if there wras any 

confusion it might be desirable to amend the regulations in order to 

specify tha t individuals who were not actually employed as employees 

were not eligible.

This was done by a notice of proposed rulemaking published in the 

Federal Register on March 24, 1954. Thi rty days notice was given. 

No comments or protests of any kind were received. The regulation 

was then promulgated and went into effect 30 days afte r publication 

on May 26, 1954, so the interpretation of the provision is now embodied in regulations.

I have a copy which I will submit. It is section 32.1(d) of the 

Public Health Service Regulations, as amended, which contains the 

definition of “seaman.’'

This now has the force and effect of law. It has never been challenged in court. No one has ever brought a suit contending tha t 

he had been denied care illegally because the regulation was invalid 

or beyond the authority of the Surgeon General and the Secretary to 

promulgate. As far as the Office of General Counsel is concerned, 

we have from time to time informally been asked whether our views 

have changed or are subject to change, and each time we have reviewed 

the original opinions and have indicated that we saw no basis for a 

change in our views.

Mr. Roberts. That answers the question that I thin k Mr. Rogers 

of Florida would like to have in the record. Also, without objection, 

the regulation which you submitted will be included in the record.
56 MEDICAL CARE FOR SELF-EMPLOYED SEAMEN

Mr. Edelman. T have copies of the opinions referred to, Mr. Chairman, if you would like them to be submitted for the record.

Mr. Roberts. I would like to have those opinions too, please.

(The information referred to follows:)

Federal Secu rity Agency,

Office of th e Adminis tra tor,

Office of tiie Gener al Cou ns el ,

October 12,1951. Office memorandum—U.S. Government.

To: Mr. Robert T. Hollinger. Chief. Regulations and Procedures Section, Division of A dministrative Management, BMS.

From : Office of the General Counsel.

Subject: Medical services—Eligibility for medical care of owner of vessel— 

Mrs. Hermia Sobraski.

Your memorandum of August 14 on the above case forw ards a copy of a 

memorandum from the Medical Officer in Charge of the Outpatien t Clinic, 

Miami, Florida, concerning the eligibility of Mrs. Sobraski for treatm ent as a 

sta tutory beneficiary of the Service and requests our views on the subject.

It appears that Mrs. Sobraski is the mas ter and owner of the “Virginia Dare.” 

a vessel documented under the laws of the United States. The vessel, however, 

has been tied up for the past five years and has been used as Mrs. Sobraski’s 

home while she has been employed ashore. Apparently she ret urns to the 

vessel each evening and, according to h er stateme nt, engages in the preservation 

and care of the vessel for the balance of the evening. The questions presented 

are whether, under these facts, Mrs. Sobraski is a “seam an” and whether the 

vessel is “tem porarily laid up in port” within the meaning of Pa rt B, Chapter I, 

section 2.22 of the Division of Hospitals Operation Manual.

It is unnecessary to answer these specific questions as we have concluded 

th at Mrs. Sobraski as owner of the vessel is not “employed on board” such 

vessel and is therefo re not entitled to benefits under the Public Health Service 

Act.

Section 2(h) of the Act defines the term “seamen” as including “any person 

employed on board in the care, preservation or navigatio n of any vessel, or in 

the service on board of those engaged in such care, preservation or navigation.” 

(Em pha sis added.) This definition has been retained withou t substan tial 

change since its original enactment in 1875 (18 Stat. 485). app arently in 

response to recommendations by the Supervising Surgeon? Prior to 1875 the 

term “seamen” had not been defined in the s tatu te.

Under section 32 2( a)(1 ) of the Act, applicable to Mrs. Sobraski’s claim, 

medical c are is authorized for seamen "employed on vessels of the United States 

. . .” [Emphasis added.]

In orde r to be eligible for medical benefits in accordance with the provisions 

of the statute, therefore, an individual must not only be a “seaman,” but must 

also be “employed” aboard a vessel as such. The term “employed” as used in 

the statutory language quoted above may not, in the ligh t of legislative history, 

reasonably be interp reted as equivalent to “occupied” or “engaged in” but must 

be taken to refer to services rendered in an employment relationship under a 

con trac t of hire, ex press or implied?

The history of the provisions for the medical care of seamen discloses tha t, 

ap art from any question as to the na tur e of the duties which bring an individual 

with in the class of persons considered as seamen, the sta tut e was intended to 

benefit those merchant seam an who received an economic ret urn for their 

services in the form of wages (not as a profit on an investment of cap ital), 

and thus fell into a generic classification of “employees.” One of the purposes 

of th e early sta tutes here discussed was to provide means for the relie f of seamen 

“by withdrawing a small fund from time to time from their maritim e earn ings.” 

Seamen were tradition ally considered a reckless and “improvident class of men” 

who would not make provision for the ir futur e needs unless compelled to do so?

1

 A definition was recommended to assist in the collection of hospital dues and the determination of eligibility for care. United States Marine Hospital Service, Annual Reports 

1873, p. 14 ; 1874, p. 7.

2

 In view of the requirement of section 322 (a) (1) quoted above, i t is immaterial in this 

case whether the definition of the term “seaman” in section 2 (h) is to be considered as an 

open or restrictiv e definition. See our memorandum of August 5, 1944 on the eligibility 

of lunchroom employees of ferry concessions.

8

 Reed v. Canfield, 20 Fed. Cas. 426 (1832).
MEDICAL CARE FOR SELF-EMPLOYED SEAMEN OZ

Th e li m itat io n of be ne fits to in di vi du al s wh ose m ar itim e ea rn in gs w er e de rive d 

from th eir se rv ices re nd er ed as em ploy ee s is ac co rd in gly under st an dab le “i n 

th e li ght of th e misch ie f to be co rr ec te d and th e e nd to be att ain ed .” * 4

The fi rs t Fed er al legi slatio n pr ov id in g m ed ical care fo r se am en (1 S ta t. 

603, Ac t of 1798 ) en titled “An Ac t fo r th e re li ef of sick an d di sa bl ed se am en ” 

re quir ed th e “m as te r or ow ne r of ev er y sh ip or vessel of th e U ni te d S ta te s” to 

pa y to th e co lle ctor 20 ce nt s per mon th fo r ev er y se am an “em ploy ed on bo ar d 

su ch ve ssel, ” which sum he was auth ori ze d “t o re ta in out of th e wag es of su ch 

se am an .” [E m ph as is ad de d.] T h at th e se am an ’s sta tu s a s an e mpo lyee w as o ne 

of th e elem en ts on which liab ility fo r th e ta x de pe nd ed is mad e ev en cl eare r by 

th e Ac t of Ju n e 29, 1870 (16 Sta t. 16 9). T hat Act ra is ed th e ho sp ital du es to 

40 ce nt s pe r mon th fo r ev ery se am an “em ploy ed on sa il ve ssel” and au th ori ze d 

th e m as te r or ow ne r to “co lle ct an d re ta in [suc h su m ] from th e wag es of sa id 

em ploy ee s." [E m pha si s ad de d.] Si gn ifi ca ntly , se ction 5 of th e Act of 1870, th e 

fo re ru nner of section 322 (a ) of th e pre se nt ac t, pr ov id ed fo r th e di sb urs em en t 

of th e fu nd so co lle cte d fo r th e “c are and re li ef of sick and di sa bl ed seam en 

em ploy ed i n . . . ve ssels of t he U ni ted S ta te s. ” [E m phas is ad de d.]

At th e tim e th e de fin iti on of “se am an ,” re fe rr ed to e ar li er , w as ad op te d by th e 

Act of 1873, th e fu nds fo r th e m ai nte na nce of w hat w er e th en kn ow n as th e 

M ar in e H os pi ta ls were st il l de rive d from ta xes la id up on th e wag es of se am en 

em ploy ed on ve ssels of th e U nited Sta te s. T h a t Ac t, which agai n aut hor iz ed 

th e w ith ho ld in g of ho sp ital du es from "e ac h se am an ’s w ag es ,” al so prov ided a 

pe na lty fo r th e fa il ure to keep ac cura te re co rd s of se am en “empl oy ed ” on bo ar d 

ve ssels sub je ct to th e pa ym en t of hos pi ta l du es.

Th e st atu te s ha ve th us un ifor m ly reco gn ized and re quir ed as a n es se nt ia l 

elem en t fo r liab ility fo r th e hos pi ta l ta x and fo r el ig ib ility fo r be ne fit s th a t th e 

se am en he re c on side re d be “emp loye d” on ve ss els or, as s ta te d in th e Act of 1870, 

su pr a, be “emp loye es.”

By th e Act of Ju ne 26, 1884 ( 23 Sta t. 37) al l pr ov isio ns fo r th e as se ss m en t 

an d co lle cti on of a ho sp ital ta x fo r seam en w er e re pe al ed an d it w as prov id ed 

th a t th e ex pe ns e of m ai nta in in g a M ar in e H os pital Se rvice w as th ere aft er to be 

bo rne by th e U ni ted S ta te s out of th e re ce ip ts of duties on to nn ag e. Th e 

st atu te , ho wev er, bo th in it s de fin iti on of se am en (now se ction 2 ( h ) ) an d in 

its co nd itio ns of elig ib ility fo r ca re , (n ow se ct io n 322 ( a ) ( 1 ) ) co nt in ue to 

re quir e th a t th e seam en be “e mploy ed ” on ve ssels of th e U ni te d Sta te s.

The curr ent re gul at io ns of th e Pu blic H ea lth Se rvice, in ac co rd an ce w ith sec ­

tion s 2 (h ) an d 32 2(a ) (1 ) of th e Pu blic H ea lth Se rvice Act, mak e pl ai n th a t th e 

eco nomic sta tu s of a se am an as an em pl oy ee 5

 is a ne ce ss ar y elem en t fo r hi s 

cl as sifica tio n as a i>erson en titled to be ne fits under th e Pu blic H ea lth Se rvice 

Act. Sp ecifically, se ction 32.14 re qu ires , am on g oth er th in gs , ev iden ce th a t th e 

ap pl ic an t “h as been em plo yed on a * * * vessel of th e United S ta te s. ” Ag ain , 

section 32.13 re fe rs t o th e el ig ib ility of sea m en ta ken sic k or in ju re d a sh ore “ while 

ac tu ally em ploy ed o n a ve ssel. ” Fin al ly , th is e conomic de pe nd en ce o f th e se am an 

on th e bu sine ss of oth ers is un de rs co re d by se ction 32.17 which pr es er ve s th e 

el ig ib ility of a se am an whe re m ore th an 90 d ay s ha ve el ap se d sin ce h is la st serv ice 

if. am on g oth er thin gs , su ch laps e of tim e was “d ue to cl os ur e of nav ig at io n or 

econo mic co nd itio ns re su ltin g in de cr ea se d sh ip pi ng w ith co ns eq ue nt lack of op ­

port unity to sh ip .” “La ck of op po rtun ity to sh ip ” in th is co nt ex t is m ea ni ng fu l 

on ly to an em ploy ee look ing fo r em ploy men t and no t to an em pl oy er wh o per ­

form s s er vice s o n hi s ow n vessel.

In th e ligh t of th is disc us sion , th e de cisive qu es tio n in th is ca se is not th e 

co nd iti on of th e ve ssel o r th e natu re of th e wor k do ne by Mr s. So br as ki , but 

w het her sh e is “employ ed ” ab oa rd th e ve ssel ow ned by he r. I t see ms to us th a t 

whe re an in di vi du al is th e sole ow ne r of a vessel, as a m att er of law he ca nnot 

be sa id to be “employ ed ” ab oa rd su ch ve ssel as a se am an , re gar dle ss of w het her 

he a ctu ally pe rf or m s th e serv ices tr adit io nall y re nd er ed by seam en . The e mploy ­

m en t re la tion sh ip , in cl ud in g em ploy men t as a se am an , is e ss en tial ly a contr actu al 

one, eit her ex pr es s or im plied,’ and an in di vid ual ca nnot c ontr act w ith hi m se lf so 

as to m ak e hi m se lf hi s ow n em plo yee . Acc ordin gly, sin ce Mr s. So br as ki is th e 

ow ne r of t he Virgi ni a Da re, she is no t “employ ed ” ab oar d su ch ve ssel w ithin th e 

mea ni ng of th e Pub lic H ea lth Se rvice Act, an d sh e is no t th ere fo re enti tl ed to 

benefits u nder th a t Act.

Sidney E delman.

« W arn er v. Goltra, 293 U.S. 155 ; H.L .R.B . v. He ars t Pu blications, 322 U.S. I l l : U.S. v Silk. 331 U.S. 704.

5

 Cf. Barte ls v. Bir mingham. 332 U.S. 126. 130, United St at es v. Si lk, 331 U.S. 704, 712 8

 48 Am. Ju r. Shipping 140 ; 56 C.J. 93 1; the Joseph B. Thom as, 148 F 762.
58 MEDICAL CARE FOR SE LF-EMP LO YE D SEA MEN

F ederal Secu rity Agency,

Office of th e Administr ator,

Off ice of th e Gen eral Cou nsel,

October 30,1951.

Office memorandum—U.S. Government.

T o: Mr. Robert T. Hollinger, Chief, Regulations & Procedures Branch, Division 

of Adm inistrative Management, BMS.

Fro m : Sidney Edelman.

Sub ject: Medical services—Eligibility for medical care of spouse of owner of 

vessel—Mrs. Claude C. Ham.

The material transm itte d w ith your memorandum requesting our views on the 

eligibility of Mrs. Ham supplies a basis for finding the following fa ct s:

Mrs. Claude C. Ham claims sta tus as a seaman entitle d to medical care because 

of services performed by h er aboard the “Suzy Too,” a vessel documented under 

the laws of the United States. The “Suzy Too” is owned by Mrs. Ham’s husband, who is also the ma ster of the vessel, and is used by them as the ir home. 

Mr. Ham has been a full-time employee of the Department of the Army for the 

past year, while Mrs. Ham is employed full time by the Veterans’ Adm inistration. The vessel is docked at 1300 Maine Avenue, Washington, D.C., and has not 

been used in trad e or fishing for over six months. There is no evidence th at the 

owner uses the vessel for anything other tha n a residence, except the ma ster’s 

certificate submitted by Mrs. Ham, dated Jul y 27, 1951, which states th at the 

vessel is used “for the coastal trade and mackerel fisheries.” On J uly 31, 1951, 

the Bureau of Medical Services advised Mr. Ham that his wife was not eligible 

for medical care as a seaman beneficiary of the Service and agreed to consider any 

additional evidence submitted.

In suppo rt of the claim for benefits, Mr. Ham then furnished the additional 

inform ation1 that on weekends and evenings, Mrs. Ham engages in work connected with the care and preservation of the vessel, such as preparation and 

serving of food aboard, cleaning, painting, maintenance of records and charts 

and the handling of correspondence rela ting to the vessel. According to h er hus ­

band, Mrs. Ham maintains “a constant watch over the cr af t” to protect against 

loss or damage, stan ding “ten to twelve hours of watch service everyday.” He 

adm its that her watch period “includes the time normally devoted to sleep” but 

ass erts that “asleep or awake she is ale rt to conditions affecting the vessel’s 

welfare .” There is no evidence that Mr. Ham paid or agreed to pay his wife 

for these services.

It is unnecessary to determine whether, on the basis of these facts, Mrs. 

Ham is a “seaman,” as that term is defined in section 2 (h ) of the Public Hea lth 

Service Act, as we have concluded that she is not “employed on board” the 

vessel and is therefo re not entitled to benefits under the Public Hea lth Service 

Act.2

The services performed by Mrs. Ham, such as cleaning, painting, cooking, 

handling of correspondence and records relating to her home, and watchfulness 

to protect her home against harm, are duties tradition ally incid ent to the 

ma rita l relation, whether performed by the wife on a vessel used as a home or 

ashore in a more conventional home. In the absence of statute, a wife cannot 

con tract with her husband for the performance by her of services incident 

to the marita l status. It would, indeed, be a rare case in which a claim could 

successfully be made on alleged contract of employment between a wife and 

her husband for the performance of domestic duties in their home.’

In this case, however, no claim is made th at Mrs. Ham’s services were performed under a con tract of employment nor has any evidence been submitted 

which would tend to support such a claim if one were made. Under the facts 

submitted, it may reaso nably be found th at Mrs. Ham ’s services were not rendered in “employment” but as an incident to the ma rita l relation, and that she 

was not, therefore, “employed on board” the vessel as required by the Public 

Health Services Act. Accordingly, we concur in the holding of the Bureau 

of Medical Services that Mrs. Ham is not eligible for benefits under section 

322 (a )(1) of the Public H ealth Service Act.

1

 Letter dated Aug. 2, 1951.

a

 See our memorandum of Oct. 12, 1951, entitled, "Medical Services—Eligibility for Medical Care of Owner of Vessel—Mrs. Hermia Sobraski.”

s Cf. In re Stra ta’s Estate, 275 N.W. 919; Frame v. Frame, 36 S.W. (2d) 152; see also 

sec. 3, “Property Rights of Husband and Wife,” Selected Essays on Family Law, pp. 441-502.
MEDICAL CARE FOR SELF-EMPLOYE D SEAMEN 59

December 29, 1953.

Office Memorandum—U.S. Government.

T o: Mr. Robert T. Hollinger, Legislative Legal Liaison Officer, BMS.

Fr om : Office of the General Counsel.

Subje ct: Division of Hospitals—Medical care for seamen—Eligibility of masterowner and spouse of owner as “seamen.”

Reference is made to y our memorandum of November 19, 1953, which requests 

our review of the conclusions expressed in our memoranda of October 12 and 

October 30, 1951.

In our memorandum of October 12, 1951,1

 we concluded th at “where an individual is the sole owner of a vessel, as a matt er of law he cann ot be said to be 

‘employed’ aboa rd such vessel as a seaman 1

 rega rdless of whether he actually 

performs the services trad itio nally rendered by seamen.”

Our memorandum of October 30, 1951,3

 dealing with the eligibility of the spouse 

of the owner of a vessel, advised that where it could reasonably be found (as 

the facts submitted to us in that ease indicated), th at the services rendered by 

the wife “were not rend ered in ‘employment’ but as an incident to the ma rital 

relation, . . . she was not . . . ‘employed on board’ the vessel as requ ired by 

the Public Hea lth Service Act.”

We have reexamined the rationa le of these opinions, and upon such reexam ination, our conclusions are reaffirmed. It is our view, as we stated in our memorandum of October 12,1951:

“In order to be eligible for medical benefits in accordance with the provisions 

of the statute, therefore, an individual must not only be a ‘seaman,’ but must 

also be ‘employed’ aboa rd a vessel as such. The term ‘employed’ as used in 

the sta tutory language quoted above may not, in the ligh t of legislative history 

reasonably be interprete d as equivalent to ‘occupied’ or ‘engaged in’ but must 

be taken to refer to services rendered in an employment relationship under a 

con trac t of hire, expressed or implied.”

The present regu lations of the Service are, as pointed out in our memo randa 

refe rred to above, consisten t with this view. It may, however, be desirable, if 

adm inistrative decisions in the past are not in accord with our conclusion, to 

clar ify the ma tte r by an appropriate revision of the regulations. We shall be 

pleased to discuss th is question with you a t y our convenience.

Darrell T. Lane, 

Ass ista nt General Counsel.

October 25,1954.

Office memorandum—U.S. Government.

To: Mr. R. T. Hollinger, Legislative Legal Liaison Officer, BMS.

From : Office of the General Counsel.

Sub ject: Medical care— Seamen—Eligibility of coowners employed on vessel 

leased to employer.

Your memorandum of October 19 requests our advice with respect to the 

eligibility for medical care as a seaman of a coowner of a diving boat which 

has been leased to the Pacific American Fisheries and for the period of the lease 

was being opera ted by the coowners, a husband and wife, as employees of the 

lessee.

We have concluded th at the owners under the circu mstances you set forth 

would be eligible for medical c are under section 322(a) (1) of the Public Hea lth 

Service Act, as amended, even though the regulation (sec. 3 2.1(d)) was amended 

June 1954 to exclude the owner or joint owners of a vessel.

You will note th at the st atute declares seamen eligible if “employed on” certain 

vessels. The amendment to the regulation which excluded owners or join t owners 

was based on the assum ption th at such an owner when actu ally engaged in the 

operation of his own vessel would necessarily also be the employer of the crew 

and the entrep ren eur of the enterprise. On such an assumption, he could not 

possibly have been “employed” since as employer he could not be his own 

employee.

The situ atio n you present, however, makes quite clea r th at an owner can also 

be an employee w ith respe ct to the operation of his own vessel for the period of

1

 “Medical services—Eligibility for medical care of owner of vessel—Mrs. Hermia So1jt* 0 sici

a

 Section 2(h ) of the Public Health Service Act defines the term “seamen” as including 

“any person employed on board In the care, pres ervatio n or navigation of any vessel or in 

the service on board of those engaged in such care, preservation or navigation.”

• “Medical services—Eligibility for medical care of spouse of owner of vessel—Mrs. Claude 

C. Ham.”
60 MEDICAL CAKE FOR SELF-EMP LO YE D SEA ME N

tim e in which co ntro l of th e v esse l is ve ste d in anoth er pe rs on eit her by chart er, 

lea se, or ot her co ntr act if th e oth er pe rson wh o th us ac qu ired co ntro l of th e 

ve ssel en te rs in to an em ploy men t re la tion w ith th e ow ne r to ope ra te it. Su ch 

ow ne r then bec omes in fa ct “emp loy ed on ” th e ve ssel w ithi n th e mea ni ng of th e 

st atu te . Sin ce th e re gu la tion wo uld be lega lly que st io na bl e if it were co ns true d 

to mak e ineligible an y pe rs on s cl ea rly eli gible by th e te rm s of th e st atu te , we 

th in k th e re gu la tion shou ld be c on stru ed as no t in te nd in g to deny ca re to ow ne rs 

if th ey a re in f act e mp loyed on b oa rd a s in th e c ase you pr es en t.

The re gu la to ry ex clus ion of th e spou se of an ow ne r invo lves a sl ig ht ly di ffer ­

en t as pe ct of th e same prob lem . Th e sp ou se 's di sq ua lifica tion sh ou ld re st no t 

mer ely on being th e spou se of th e ow ne r bu t fi rs t on be ing th e spou se of th e 

allege d em ploy er an d sec on d on pe rfor m in g se rv ices th a t re la te to th e m atr imon ial or fa m il ia l duti es ra th e r th an thos e of a bo na tid e em ploy men t re la ti onsh ip. In th e p art ic u la r ca se yo u pr es en t, be ing spou se of an ow ne r does no t 

pr ev en t th e wife hav in g a bona tide em pl oy men t re la tionsh ip w ith th e Pa cif ic 

American F is her ie s an y more th an being a co- ow ner.

I t wo uld be appro pri at e to issu e a cl ar if yin g m em or an du m to you r fa ci lities 

on th e pr op er in te rp re ta ti on of th e re gu la tion an d to sche du le th is prov ision fo r 

earl y revisio n. We w ill be gl ad to review an y pr op os als alon g th es e lines.

E dward J. Rou rke.

[HE W-P HS- SO—PHS regulations, pt. 32]

P art 32—Medical Care for Seame n and Cert ain Oth er P erso ns

De f in it io n s Sec.

32.1 Meaning of terms.

BENEFICIARIES 32.6 Persons eligible.

AMERICAN SEAMEN 32.11 Use of Service facilities.

32.12 Use of othe r than Service facilities.

32.13 Application for trea tme nt.

32.14 Evidence of eligibility.

32.15 Sickness or inju ry while employed.

32.16 Seamen from wrecked vessels.

32.17 Lapse of more tha n 90 days since las t service.

32.18 Procedure in case of doubtful eligibility.

32.19 False document evidencing service.

32.20 Treatmen t durin g voyage ; treatme nt when not arranged for.

32.21 Injury while committing breach of peace.

32.22 Communicable diseases.

32.23 Certificate of discharge from treatment.

SEAMEN ; EMPLOYEES OF THE UNITED STATES THROUGH WAR SHIPPING

ADMINISTRATION

32.41 Conditions and extent of treatment.

SEAMEN ; STATE SCHOOL SH IP S AND VESSELS OF THE UNITED STATES GOVERNMENT

32.46 Conditions and extent of treatment.

SEAMEN : MI SSISS IPP I RIVER COMMISSION

32.51 Conditions and extent of treatment.

SEAMEN ; FIS H AND WILDLIFE SERVICE

32.56 Conditions and extent of treatment.

MARITIME SERVICE ENROLLEES AND MERCHANT MARINE CADETS

32.61 Use of Service facilities.

32.62 Use of other than Service facilities.

32.63 Inju ry while committing breach of peace.

32.64 Communicable diseases.

32.65 Absence w itho ut leave.

CADETS AT STATE MARITIME ACADEMIES OR ON STATE TRAINING SHIPS

32.76 Conditions and extent of t reatm en t

FIELD EMPLOYEES OF THE PUBLIC HEALTH SERVICE

32.81 Use of Service facilities.

32.82 Use of other than Service facilities.
MEDICAL CARE FOR SELF-EMPLOYED SEAMEN 61

PE RSON S AFF LICTED WITH LEPROS Y

32.86 Admissions to Service facilities.

32.87 Diagnostic board for arriving p atients.

32.88 Detention or discharge according to diagnosis.

32.89 Exam inations and treatment.

32.90 Restrictions on movement within reservation.

32.91 Isolation or res traint.

32.92 Discharge.

32.93 Notification to health authorities regarding discharged patients.

SEAM EN ON OTH ER FOREIGN -FLAG VE SS EL S

32.106 Conditions and e xtent of tr ea tm en t; r ate s; burial.

NO NB EN EFICI AR IES ; TEMPORARY TR EATM ENT IN EMERGENCY

32.111 Conditions and exte nt of treatm ent.

RED CROSS PE RSON NE L

32.116 Emergency medical care when serving w ith United States Coast Guard.

Autho rity: §Sj 32.1 to 32.116 issued under sec. 215, 58 StaL 690, as amen dment: 42

U.S.C. 216. Inter pret or apply sec. 322, 58 Sta t. 696, as amended ; 42 U.S.C. 249. Other 

statutory provisions interpre ted or applied are cited to tex t in parentheses.

DEFINITIONS

§ 32.1 Meaning of terms. When used in th is p a rt:

<a) “Act” means the ac t approved July 1,1944, 58 Stat. 682, entitled “An ac t to 

consolidate and revise the laws relatin g to the Public Health Service, and for 

other purposes” ;

(b) The term “Service” means th e Public Health Service;

(c) The term “Surgeon General” means the Surgeon General of the Public 

Hea lth Service;

(d) The term “seamen” includes any person employed on board in the care, 

preservation or navigatio n of any vessel, or in the service, on board, of those 

engaged in such care, preservation, or navigation, but does not include the owner 

or jo int owners of a vessel or the spouse of any such ow ner;

(e) The term “vessel” includes every description of wa ter craft or oth er 

artificial contrivance used, or capable of being used, as a means of tr anspo rtation 

on water, exclusive of aircraft and amphibious contrivance s;

(f) “Medical relief statio n” mean a first-, second-, third-, or fourth-class 

station of the Serv ice;

(g) “First-class statio n” means a hosp ital opera ted by the Service;

(h) “Second-class station” means a medical relief facility, other tha n a hospital of the Service, under the charg e of a commissioned officer;

(i) “Third -class sta tio n” means a medical relief facility, other tha n a hospita l of the Service, under the charge of an acting ass istant sur geon;

(j) “Fourth-class station” means a medical relief facility, other tha n a first-, 

second-, or third -class station, under the charge of an auth orized Government 

rep res entat ive ;

(k) “Active duty”, with respect to an enrollee of the United Sta tes Maritime 

Service, means th at the enrollee is on the activ e list of th at service, as distinguished from being on inactive status, and includes absence on authorized leave 

or liberty.

(Secs. 2, 321, 58 Stat. 682, ns amended, 695, as amended; 42 U. S. C. 201, 248)

BENEFICIARIES

§ 32.6 Persons eligible, (a) Under this pa rt of the following persons are 

entitled to care and treatm ent by the Service as hereinaf ter prescribed:

(1) Seamen employed on vessels of the United States registered, enrolled, or 

licensed under the maritim e laws thereof, oth er tha n canal boats engaged in the 

coasting trade, her ein after designated as American seamen ;

(2) Seamen employed on United States or foreign flag vessels as employees of 

the United S tate s through the War Shipping Adm inistration ;

(3) Seamen, not enlisted or commissioned in the military or naval esta blishments, who are employed on State school ships or on vessels of the United 

States Government of more th an five tons’ b ur de n;

(4) Seamen on vessels of the Mississippi R iver Commission;

(5) Officers and crews of vessels of the Fish and Wildlife S erv ice ;

(6) Enrollees in the United States Maritime Service on active duty and members of th e Merchant Marine Cadet Corp s:
62 MEDICAL CAKE FOR SELF-EMPLOYED SEAMEN

(7) Ca de ts a t S ta te m ar itim e aca de m ies o r on S ta te tr ain in g sh ip s ;

(8) Em plo yees an d noncom mi ssion ed officers in th e field serv ice of th e Pu blic 

H ea lth Service whe n in ju re d o r tak en si ck in lin e o f d uty ;

(9) Pe rson s afflicted w ith leprosy.

(10) Se am en on fo reign-fla g ve ssels oth er th an th os e seam en em ploy ed on 

for eig n-f lag ve sse ls s pecified i n su bp ar ag ra ph (2 ) of this p ar agra ph ;

(11 ) Non be ne flc iarie s fo r te m po ra ry tr eatm ent an d car e in ca se of em ergency.

Note : § 32.6 does not list all the persons entitled to care and treatm ent by the Public 

Health Service.

<b) Sep ar at e re gula tions go ve rn : (1) The med ical ca re of cer ta in pe rson ne l, 

an d th eir d ep en de nt s, of t he C oa st G ua rd, Coa st a nd Ge od eti c Su rvey , an d Pu blic 

H ea lth Se rvice (s ee P a rt 31 of th is ch apte r) ; (2 ) ph ys ic al an d m en ta l ex am in atio ns o f al ie ns (see P a rt 34 of th is c hap te r) ; (3) car e an d tr eatm ent of na rc ot ic 

ad di ct s (see P a rt 33 of th is ch ap te r) ; an d (4 ) Me dic al C ar e fo r In di an s. (See 

P a rt 36 of th is c h ap te r. )

(c) W hile re gula tions of th e Pub lic H ealth Se rvice are no t re qu ired w ith 

re sp ec t th er et o, cir cula r in st ru ct io ns by th e Se rvice co ve r th e ca re an d tr eatm ent 

or p hy sica l e xam in at io n of th e fo llow in g:

(1) Per so ns no t oth er w is e eligib le fo r tr eatm ent, fo r pu rp os es of st u d y ;

(2 ) Per so ns det ai ned in a cc or da nc e w ith quara nti ne la w s ;

(3) Per so ns det ai ned by th e Im m ig ra tion an d N at ura li zati on Service , fo r 

tr eatm ent a t th e req ues t o f t h a t S er vic e;

(4) Per so ns en ti tl ed to tr eatm ent unde r th e Em ploy ee s’ Com pe nsation Commiss ion Act an d ex te ns io ns t h e re o f;

(5) Be ne fic iarie s o f oth er Fed er al age nc ies on a re im bu rs ab le b a sis ;

(6) Medica l e xam in at io ns o f :

(i ) Em ploy ees of th e A lask a R ai lroa d an d em ploy ees of th e Fe de ra l Gov ernmen t for re ti re m ent p u rp o ses;

(i i) Em ploy ee s in th e Fed er al cla ssified service , an d ap pl ic an ts fo r apj>ointme nt, as re qu es te d by th e Civil Service Co mm iss ion fo r th e pu rp os e of p ro m otin g 

hea lth and effici en cy ;

< i ii) Se am en f or pu rp os es of q ua lify in g f or c er tifica te s of se rv ic e; an d

(iv) Em ploy ees eli gible fo r benefits under th e Lon gs ho remen ’s an d H arb or 

W or ke rs ’ Com pe ns ation Act, as am ende d, as re qu es te d by an y de pu ty co mm issi on er th er eu nd er .

AMERICAN SEAMEN

§32.11 Use of Se rv ic e fa ci lities . American se am en (h ere in aft er re fe rr ed to 

in §§ 32.11 to 32.23, inclus ive, as s ea men ) sh al l, on pr es en ting evide nc e of e lig ibility , be entitled to med ical, su rg ical, an d den ta l tr eatm en t an d ho sp ital iz at io n a t 

med ical re li ef sta ti ons of th e Service.

§32 .12 Use of ot he r th an Se rv ice fa ci lities , (a ) W he n a se am an re qu ires 

me dical, su rg ic al , or den ta l tr eatm ent or hos pi ta liza tion an d th e ur ge nc y of th e 

si tu ati on does no t p erm it tr eatm ent a t a med ical re lief stat io n, ar ra ngem en ts f or 

ne ce ss ar y tr eatm en t or hos pi ta liza tion a t th e ex pe ns e of th e Se rvice from pu blic 

or p ri vate m ed ical or hosp ital fa ci lities oth er th an th os e of th e Se rvice may be 

ma de by th e officer in ch ar ge of a medica l re li ef st ati on or a quara nti ne st at io n 

or by th e dir ec to r of a Se rvice dis tric t. W he n su ch e me rgen cy tr eatm ent is nec essa ry pr ef er en ce sh al l be give n to ot he r F ed er al me dical fa ci lities whe n reason - 

ab ly a va ilab le a nd whe n co nd iti on s pe rm it.

(b ) If el ig ib ility ca nno t be es ta bl ishe d a t th e tim e of ap pl ic at io n by th e se amen or by th e pe rs on wh o ap plie s in his be ha lf, th e ap plica nt sh al l be notifi ed 

th a t th e auth ori zati on fo r tr eatm ent is co nd itio na l an d th a t th e pa ym en t of 

re as on ab le ex pe ns es by th e Se rvice fo r such tr eatm ent sh al l be su bj ec t to pr oo f 

by e lig ibili ty.

(c ) In ev ery su ch ca se of em ergency tr eatm en t or hos pi ta liza tion , au th or iz ed 

ei th er co nd iti on al ly o r un co nd itio na lly, a fu ll re port sh al l be su bm itted pr om ptly 

by th e au th ori zi ng offic er to th e Su rgeo n G en eral. Th e au th ori zi ng officer sh al l 

kee p him se lf in fo rm ed re gard in g th e pr og re ss of th e ca se to th e en d th a t tr e a tme nt or ho sp ital iz at io n sh al l no t be un du ly an d un ne ce ss ar ily prolon ged. As 

soon as pr ac tica bl e, un le ss th e in te re st s of t he p ati en t or th e Gov ernm en t re qu ire 

othe rw ise , tr eatm en t or hosp ital iz at io n sh all be co nt in ue d a t a med ical re lief 

st at io n o r a t an oth er ap pro pri ate F ed er al med ical fac ility.

(d ) Ex pe ns es fo r co nsu ltan ts or sp ec ia l serv ices, or fo r den ta l tr eatm ent 

ot he r th an em erge nc y m ea su re s to re lie ve p ain, sh all no t he all ow ed ex ce pt wh en 

au th or iz ed in ad va nc e by th e hea dquart ers of th e Se rvice or, in extr aord in ary
MEDICAL CARE FOR SELF-EMPLOYED SEAMEN G3

cases, when subsequently approved by such hea dqu arters upon receip t of report 

and sati sfactory explanation as to th e necessity and urgency therefor.

(e) Certified vouchers on proper forms covering expenses for emergency trea tment or hospitaliz ation shall be forw arded to the Surgeon General by the 

author izing officer, and each such voucher shall contain a statem ent of the 

facts necessitating the treatm ent or hospitalization.

§ 32.13. Application for treatment. A sick or disabled seaman, in orde r to 

obtain the benefits of the Service, must apply in person, or by proxy if too sick 

so to do, at a medical relief station or to a n olficer of the Service as specified in 

§ 32.12 and must furnish satisfac tory evidence of his eligibility for such benefits.

§32.14. Evidence of eligibility, (a) As evidence of his eligibility an applican t must present a properly executed ma ste r’s certificate or a continuous discharge book or a certificate of discharge showing th at he has been employed on a 

registered, enrolled, or licensed vessel of the United States. The certificate of 

the owner or accre dited commercial agent of a vessel as to the fac ts of the employment of any seaman on said vessel may be accepted in lieu of the ma ster’s 

certificate where the la tte r is not procurable. When an applican t cannot furnish 

any of the foregoing documents, his certification as to the facts of his most recent 

(including his las t) employment as a seaman, stating names of vessels and dates 

of service, may be accepted as evidence in supp ort of his eligibility. Documentary evidence of eligibility, excepting continuous discharge books and certificates of discharge, shall be filed at the station where application is granted. 

Where continuous discharge books and certificates of discharge are submitted as 

evidence of eligibility, the pertinen t information shall be abs trac ted therefrom, 

certified by th e officer accepting the application, and filed at the station.

(b) Except as otherwise provided in §§ 32.11 to 32.23, inclusive, documentary 

evidence of eligibility must show that the applica nt has been employed for 60 

days of continuous service on a registered, enrolled, or licensed vessel of the 

United States, a part of which time must have been during the IX) days immediately preceding application for relief. There may be included a s a pa rt of such 

60 days of continuous service as a seaman time spent in training as (1) an active 

duty enrollee in the United States Maritime Service, (2) a member of the Merchant Marine Cadet Corps. (3) a cadet at a Sta te maritime academy, or (4) a 

cadet on a State training ship. The phra se “60 days of continuous service” shall 

not be held to exclude seamen whose pape rs show brief intermissions between 

short services that aggregate the requ ired 60 days: Provided, That any such intermission does not exceed 60 days. The time during which a seaman has been 

treated as a patient of the Service shall not be reckoned as absence from vessel 

in determining eligibility. When the seamen’s service on his las t vessel is less 

than 60 days, his oath or affirmation as to previous service may be accepted.

§32.15. Sickness or inju ry while employed. A seaman taken sick or injured 

on board or ashore while actu ally employed on a vessel shall be entitled to care 

and treatm ent without regard to length of service.

§ 32.16. Seamen from wrecked vessels. Seamen taken from wrecked vessels of 

the United States and returned to the United States, if sick or disabled at the 

time of the ir arr iva l in the United States, shall be entitled to c are and trea tment 

without regard to length of service.

§32.17 Lapse of more than 90 days since last service. Where more than 90 

days have elapsed since an applicant’s la st service as a seaman and he can show 

tha t he has not definitely changed his occupation, such period of time shall not 

exclude him from receiving care and treatm ent (a) if due to closure of navigation or economic conditions resulting in decreased shipping with consequent lack 

of opportunity to ship or (b) in the event the applican t has been receiving trea tment at oth er than Service expense.

§ 32.18 Procedure in ease of doubtful eligibility . When a reasonable doubt 

exists as to the eligibility of an applicant for care and trea tme nt, the ma tter 

shall be referre d immediately to the headquarters of the Service for decision. 

If. in the opinion of the responsible Service officer, the app lica nt’s condition is 

such that immediate care and treatm ent is necessary, temp orary care and trea tment shall be given pending receipt of the decision as to eligibility.

§ 32.19 False document evidencing service. The issuance or presentation of a 

false document as evidence of service with intent to procure the tre atm ent of a 

person as a seaman shall be immediately repo rted to the hea dqu arters of the 

Service.

§ 32.26 Trea tment during voyage; trea tment when not arranged for. The 

Service shall not be liable for the expense of caring for sick and disabled seamen
64 MEDICAL CAKE FOR SELF-EM PLOY ED SEA MEN

incurred during a voyage, no r when the care of a seaman has not been arra nge d 

for by a responsible officer of the Service.

§32.21 In jury while committing breach of peace. Seamen inju red in street 

braw ls or while otherwise committing a breach of the i»eace shall not receive 

trea tment at th e expense of the Service while in jail or in a hospital other than 

a hospital belonging to our u nder c ontract with the Service.

§32.22 Communicable diseases. The Service shall not be liable for the expense of carin g for seamen who are suffering from communicable diseases and 

who, in accordance with Sta te or municipal health laws and regulations, are 

taken to quarantin e or other hospitals under charge of ha-al health auth orities, 

unless such patients were adm itted at the time at the requ est of a responsible 

officer of the Service.

§32.23 Certificate of discharge from treatment. A certificate of discharge 

from trea tment may, at the discretion of the officer in charge, be given to a hospital patie nt, but such certificate, when presented at ano ther medical relief sta ­

tion, shall not be take n as sufficient evidence of the app lica nt’s eligibility for 

car e and treatment, but may be considered in connection with other documentary 

evidence submitted by the seamen.

s e a m e n ; em pl oye es of t h e uni te d st ate s th rough wa r s h ip p in g

ADM INIS TRA TION

§ 32.41. Conditions and extent of treatment. Seamen employed on United 

States- or foreign-flag vessels as employees of the United States through the 

Wa r Shipping Adm inistration shall be entitled to care and treatm ent by the 

Service under the same conditions, where applicable, and to the same extent as 

is provided for American seamen.

s e a m e n ; st at e sc ho ol s h ip s and ve ss el s of t h e unit ed st at es go ve rn me nt

§ 32.46. Conditions and extent of treatment. Seamen, not enlisted or commissioned in the military or naval establishments, who are employed on State 

school ships or on vessels of the United States Government of more than five 

ton s’ burden, shall be entitled to care and treatm ent by the Service under the 

same conditions, where applicable, and to the same extent as is provided for 

American seamen.

SE AM EN ; M IS SI SS IP PI river commission

§ 32.51 Conditions and exten t of treatment. Seamen on vessels of the Mississippi River Commission shall be entitled to care and trea tment by the Service 

und er the same conditions, where applicable, and to the same extent as Is provided fo r American seamen.

SEAMEN ; FI SH AND WILDLIF E SERVICE

§ 32.56 Conditions and ext ent of treatment. Seamen on vessels of the Fish 

and Wildlife Service shall be entitled to care and treatm ent by the Service 

und er the same conditions, where applicable, and to the same extent as is provided for American seamen.

MA RIT IME SERVICE ENROLLEES AND MERCHANT MA RIN E CADETS

§ 32.61 Use of Service facilities. Enrollees in the United States Maritime 

Service on activ e duty and members of the Merchant Marine Cadet Corps shall, 

upon written request of the responsible officer of the station or training ship 

to which such enrollees or cadets are attached, identifying the applicant, be 

entitled to medical, surgical, and dental treatm ent and hospitalization at medical relie f stations of the Service. Whenever an enrollee or cadet applies for 

relief without the above-mentioned written request and in the opinion of the 

responsible Service officer the applicant’s condition is such that immediate 

car e and treatm ent is necessary, temporary care and trea tment shall be given 

pending verification of the applicant’s stat us as an enrollee or cadet.

§ 32.62 Use of other than Service facilities, (a) When an enrollee on active 

duty or a cadet requ ires medical, surgical, or dental treatm ent or hospitilization for an emergency condition and the urgency of the situation does not jiermit 

treatm ent at a medical relie f station or at a Maritime Service medical facility, 

arra nge ments for necessary trea tment or hospitalization at the expense of the
MEDICAL CAKE FOR SELF-EMPLOYED SEAMEN 65

Service from public or private medical or hospital facilities other than those 

of the Service may be made by the officer in charge of a medical relief station 

or a quarantine station, by the director of a Service district, or by the responsible officer of the Service assigned to a Maritime Service station, to a Merchant 

Marine Cadet Corps school, or to a State maritime academy. When such emergency treatment is necessary preference shall be given to other Federal medical 

facilities when reasonably available and when conditions permit.

(b) If eligibility cannot be established at the time of application by the enrollee or cadet or by the person who applies in his behalf, the applicant shall be 

notified that the authorization for treatment is conditional and tha t the payment of reasonable expenses by the Service for such treatment shall be subject 

to proof of eligibility.

(c) In every such case of emergency treatm ent or hospitalization, authorized 

either conditionality or unconditionally, a full report shall be submitted promptly 

by the authorizing officer to the Surgeon General. The authorizing officer shall 

keep himself informed regarding the progress of the ease to the end tha t 

treatment or hospitalization shall not be unduly and unnecessarily prolonged. 

As soon as practicable, unless the interests of the patient or the Government 

require otherwise, treatment or hospitalization shall be continued at a medical 

relief station or a t another appropriate Federal medical facility.

(d ) Expenses for consultants or special services, or for dental treatment 

other than emergency measures to relieve pain, shall not be allowed except 

when authorized in advance by headquarters of the Service or, in extrao rdinary cases, when subsequently approved by such headquarters upon receipt of report and satisfactory explanation as to the necessity and urgency therefor.

(e) Certified vouchers on proper forms covering expenses for emergency trea tment or hospitalization shall be forwarded to the Surgeon General by the 

authorizing officer, and each such voucher shall contain a statement of the 

facts necessitating the treatm ent or hospitalization.

§ 32.63 Injury while committing breach of peace. Enrollees on active duty 

or cadets injured in stre et brawls or while otherwise committing a breach of the 

peace shall not receive treatment at the expense of the Service while in jail 

or in hospital other Ilian a hospital belonging to or under contract with the 

Service.

§ 32.64 Communicable diseases. The Service shall not be liable for the 

expense of caring for enrollees on active duty or cadets who are suffering from 

communicable diseases and who, in accordance with State or municipal health 

laws and regulations, are taken to quarantine or other hospitals under charge 

of local health authorities, unless such patients were admitted at the time at 

the request of a responsible officer of the Service.

§ 32.65—Absence without leave. Enrollees on active duty or cadets who are 

absent without leave shall not be entitled to receive treatment by the Service 

except at a medical relief station.

CADETS AT STATE MA RITIM E ACAD EMIE S OR ON STATE TRAIN ING SH IP S

§32.76 Conditions and extent of treatment, (a) Cadets at State maritime 

academies or on State training ships while they are enrollees in the U.S. Maritime 

Service shall be entitled to care and treatment by the Service under same conditions and to the same extent as is provided for enrollees in the U.S. Maritime 

Service on active du ty: Provided, however, Tha t the written request of the 

superintendent or other responsible officer of an academy, including the master of 

a training ship, shall be acceptable in lieu of the written request of the responsible officer of the Maritime Service.

(b) Cadets at State maritime academies or on State training ships when 

not enrolled in the U.S. Maritime Service shall be entitled to care and treatment 

by the Service under the same conditions, where applicable, and to the same extent as is provided for American seamen: Provided, however, That the written 

request of the superintendent or other responsible officer of an academy, including the master of a training ship, shall be acceptable in lieu of the documentary evidence of eligibility required of Ajnerican seamen.

FIELD EMPLOYEES OF THE PU BL IC HEA LT H 8ERVICE

§ 32.81 Z7«e of Service facilities. Employees and noncommissioned officers in 

the field service of the Public Health Service when Injured or taken sick in line 

of duty shall, upon presentation of satisfactory evidence of their status, be en-
66 MEDICAL CAKE FOK SELF-EMPLOYED SEAMEN

ti tl ed to me dic al, su rg ical, an d den ta l tr eatm ent an d hosp ital iz at io n a t med ical 

re li ef st at io ns .

§32.8 2 Use of ot he r th an Se rv ic e fa ci lities , (a ) Em ploy ee s and no ncom ­

missio ne d officers in the field se rv ic e of th e Pu bl ic H ea lth Se rv ice wh en in ju re d 

or ta ke n sick in lin e of dut y sh al l be en titled to th e same ca re an d tr eatm ent 

unde r th e same co nd iti on s an d to th e same exte nt as is pr ov id ed fo r American 

se am en in § 32.12.

(b ) When emplo yees or noncom miss ion ed officers in th e field se rv ice of th e 

Pu bl ic H ea lth Se rvice on dut y in an y foreign plac e are in ju re d or Lik en sick in 

line of du ty, th e officer in ch ar ge sh al l mak e th e ne ce ss ar y ar ra nge m en ts fo r 

tr eatm ent or ho sp ital iz at io n. If th e pati ent him se lf is th e only em ploy ee o r 

no nc om miss ione d officer of th e Se rvice on dut y a t a fo re ig n pla ce, th e tr eatm ent 

or ho sp ital iz at io n ma y be ob ta in ed by or on beh al f of th e pat ie nt. In ev ery su ch 

ca se , a fu ll re port sh al l be su bm itte d to th e Su rgeo n G en er al by th e officer in 

ch arg e or by th e pati ent hi m se lf whe re th er e is no su per io r on du ty a t th e fo reign pla ce. In al l oth er re sp ec ts th e pr ov isions of § 32.12 sh al l go ve rn w her e 

ap plicab le.

PE RSO NS AF FL IC TE D W IT H LE PR OS Y

§ 32.86 Adm ission s to Ser vi ce fa ci lities . Any pe rson afflicted w ith lepr os y 

who pr es en ts him se lf fo r ca re , de tent ion, or tr eatm ent o r wh o may be appre ­

he nd ed purs uant to re gu la tions pr es cr ibed unde r section 332 or 361 of th e ac t 

a n d an y pe rson afflicted w ith lep ro sy wh o is du ly co nsigne d to th e ca re of th e 

Se rv ice by th e pro pe r hea lth auth ori ty of an y Sta te , T err it ory , or th e D is tr ic t 

o f Co lum bia sh al l be received in to the Se rvice ho sp ital a t Carville , Lou isia na , or 

in to an y oth er h os pital of th e Se rvice wh ich has been de sign at ed by th e Su rgeo n 

G en er al as be ing su itab le fo r th e tem po ra ry ac co mmod ation of pe rson s afflicted 

w it h lep rosy.

(Sec. 331, 58 St at. 698, as am en de d; 42 U. S. C. 255)

§32 .87 Diagn os tic board fo r ar riving pa tien ts. At th e ea rl ie st pr ac tica ble 

date , aft e r th e arr iv al of a pati ent a t th e Se rv ice ho sp ital a t Carville , Lou isia na , 

th e med ical officer in ch ar ge s hal l convoke a bo ar d of n ot less th an th re e med ical 

officers of th e Servi ce, wh o sh all con firm or di sa pp ro ve th e diag no sis of lep rosy. 

(Sec. 332, 58 S ta t. 698 ; 42 U. S. C. 256)

§32.8 8 D et en tion or discha rge accordi ng to diag no sis . If th e diag no sis of 

lepr os y is confi rmed, th e pati ent sh all be de ta in ed in the hos pi ta l as prov ided in 

th is p a r t ; if th e di ag no sis is not con firme d, th e pati en t sh all be disc ha rg ed .

(Sec. 332, 58 St at. 698 ; 42 U.S.C. 256)

§32.8 9 E xa m in ati ons an d tr ea tm en t. P ati en ts sh al l un de rg o th e us ua l ro uti n e cl in ic al ex am in at io ns whi ch ma y be re qui re d fo r th e di ag no sis of pri m ar y 

o r se co nd ar y co nd iti on s, a nd su ch tre at m en t a s may be presc rib ed .

(Sec. 332, 58 St at. 698 ; 42 U.S.C. 256)

§32.9 0 R es tr ic tions on m ov em en t w it hin re se rv at io n. No pati ent sh al l be 

allo wed to proc ee d beyo nd th e lim its se t as id e fo r th e de te ntion of p ati ents su ffe ri ng from lepr os y ex ce pt up on au th ori ty fr om th e headquart ers of th e 

Se rvice and under pr es cr ib ed co nd iti on s ap pl ic ab le to th e in di vidu al pat ie nt. 

Sh ou ld an y p ati en t vio la te his in st ru ct io ns in th is re ga rd , he sh al l up on his 

re tu rn , be pr op er ly sa fe guar ded to pr ev en t a re pe tition of th e offe nse, or, a t th e 

di sc re tion of t he m ed ic al officer in c ha rge, b e pe rm itte d to g ive bo nd to t he United 

S ta te s of America in a pe na l sum no t ex ce ed ing $5,000 co nd iti on ed up on his 

fa it h fu l ob se rv an ce o f t his par t.

(Sec. 332, 58 St at. 698 ; 42 U.S.C. 256)

§ 32.91 Is ol at io n or re st ra in t. The re sh al l be prov ided th e ne ce ss ar y accommod ation, w ithin th e lim its se t as id e fo r pe rs on s afflicted w ith ac tive lep rosy, 

fo r isol at io n or re str a in t of p ati ents wh en in th e ju dgm en t of th e med ica l officer 

in ch ar ge su ch ac tion is ne ce ss ar y fo r th e pr ot ec tio n of them selves or othe rs. 

Th e med ical officer in ch ar ge sh al l m ai nt ai n a se para te re gis te r in wh ich sh al l 

be reco rd ed th e na m es of p ati en ts w ho h av e been plac ed in isol at io n or re str ain t, 

an d all ci rc um stan ce s a tt e n d a n t upon su ch isol at io n or re str ain t.

(Sec. 332, 58 St at. 698 ; 42 U.S.C. 256)

§ 32.92 Di scha rg e. Th e med ical officer in ch ar ge of th e Service ho sp ita l at 

Ca rvill e. Lou isia na , sh al l convoke, fr om tim e to tim e, a bo ard of th re e medica l 

officers fo r the pur pose of ex am in in g p ati ents w ith a view to recomme nd ing
MEDICAL CARE FOR SELF-EM PLOY ED SEA ME N 67

the ir discharge. When in the judgm ent of the board a pat ien t may be regarded 

as no longer a menace to the public health, he may be discharged, upon approval 

of the hea dquar ters of the Service, as being either cured or an arrested or late nt 

case.

(Sec. 332, 58 Stat. 698 ; 42 U.S.C. 256)

§ 32.93 Notification to health authorities regarding discharged patients. Upon 

the discharge of a patient the medical officer in charge shall give notification of 

such discharge to the proper health officer of the State, Territory, Dis trict of 

Columbia, or other jurisdiction in which the discharged pat ien t is to reside. 

The notification shall also set for th the clinical findings and other essential 

fac ts necessary to be known by the health officer rela tive to such discharged 

patient.

(Sec. 332, 58 Stat. 698 ; 42 U.S.C. 256)

SEAMEN ON OTHE R FLAG VESSELS

§32.106 Conditions and extent of treatment; rates; burial, (a) Exce pt as 

provided in § 32.41 for seamen on certain foreign flag vessels, seamen on foreign 

flag vessels may, when suitable accommodations are available and on application of the master, owner, or agent of the vessel, be hospitaliz ed at first-class 

stations or furnished out-patient treatment, including physical exam inations, 

at first-, second-, and third-class station s at rates prescribed by the Surgeon 

General with the approval of the Administrator.

(b) Upon similar application, hospitalization of such seamen or private 

services in connection with their trea tment may be arrang ed for at secondand third -class stations, with the understa nding th at all expenses shall be paid 

directly to the vendors by the master, owner, or agent of the vessel. For any 

professional services which may be furnished by Sendee personnel in connection with such hospitaliz ation or treatment, the rates charged shall be those 

presc ribed by the Surgeon General with the approval of the Adm inistrator.

(c) If any such seaman dies while receiving treatm ent by the Service, the 

expenses of burial shall be paid direc tly to the vendors by the master, owner, 

or agent.

NONBE NEF ICIA RIES J TEMPORARY TREATM ENT IN EMERGENCY

§32.1111

 Conditions and exten t of tre atmen t; charges.

(a) Persons not entitled to treatm ent by the Service may be provided temporar y care and treatm ent by the Service in case of emergency as an act of humanity. Such temporary care and treatm ent shall be limited to hospitalization at 

first-class stations and to outpatient trea tment at firs- and second-class stations.

(b) Persons refer red to in par agr aph (a) of this section who, as determined by 

the medical officer in charge, are able to defray the cost of their care and trea tment shall be charged for such care and treatm ent a t the following rates (which 

shall be deemed to constitute the entire charge in each instance) : In the case 

of hospitalization, at the curre nt interdepa rtm ental reimbursable per diem rate 

as established by the Bureau of the Budget; and, in the case of outpatient 

treatm ent, at rates esta blisheJ by the Surgeon General.

( Sec. 215, 58 Stat. 690, as amended; 42 U.S.C. 216. Interpret or apply sec. 321, 

58 Stat. 695, as amended, sec. 32 2(d ), 58 Sta t. 696, as amended, sec. 501, 65 S tat. 

290 ; 42 U.S.C. 248, 42 U.S.C. 249 (d), 5 U.S.C. 140).

RED CROSS PERS ONN EL

§ 32.116 Emergency medical care when serving with United States Coast

Guard. Red Cross uniformed personnel serving with the United States Coast 

Guard may be admitted upon proper evidence of their sta tus with the United 

States Coast Guard to hosp itals and second-class medical relie f stations of 

the Public Health Service for emergency medical care and treatment. Hospita lization will be furnish ed at Service hosp itals only and, provided suitable 

accommodations are available, at a per diem charg e to each patient admitted 

under this regulation equivalent to the uniform per diem reimbursem ent rate 

for Government hospitals as approved by the Preside nt for each fiscal year.

’ Sec. 32.111 amended December 15, 1959, 24 FR 10108, app lica ble to pa tie nts admitted 

on or af te r Ja nu ary 15, 1960.
68 MEDICAL CARE FOR SELF-E MPLOYED SEAMEN

Mr. Roberts. Mr. Schenck h as a no the r question.

Mr. Sciienck. Mr. Ch airma n, in view of counsel’s comment on this 

vessel which was tied up f or an e xtended per iod of tim e, how can you 

reach th at problem of the extended period of the ino per ation of the 

boa t or the vessel ?

Mr. E delman. Th is is one of the reasons, Mr. Congres sman, th at 

I said there were some difficulties in restric tin g it to vessels which are 

act ually engaged.

Th e problem is one of a vessel l aid up fo r an appre ciable period of 

time. He re I th in k it becomes a question of fact of wheth er there is 

eve r any intentio n to return th at vessel to the trad e of commercial 

fishing.

Mr. Sciienck. Such as some evidence a s to w ha t rep airs were being 

done and wh at othe r action was being tak en to prepare the vessel, is 

th at righ t ?

Mr. E delman. Th is would be p ar t of the p ict ure on which a de terminatio n would hav e to be made. I would an tic ipate th at questions 

of thi s kin d would be r are , but I think it is possible th at they may occur 

and each one of these cases will have to be determ ine d on its own facts.

Mr. Sche nck. Tha nk you very much.

Mr. Rogers of Florida. Mr. Edelm an, I am sorry I am a lit tle late 

here and have n ot he ard all of yo ur tes timony. I t is yo ur int er pr etatio n the n th at this bill does cover more than ju st comm ercial fishing 

boats?

Mr. E delman. Yes, sir.

Mr. Rogers of Florida. An d did you define wh at it would cover 

in y our opinion ?

Mr. E delman. I t would cover every pers on aboar d a reg istere d, 

enrolled, or licen sed vessel of the United States who perfo rm s the 

duties of a seam an on board , and a vessel of the U nited State s wou ld 

include any vessel which is so reg istere d, wh eth er it is a pleasu re 

ya ch t, a houseboat, or any con triv ance cap able of floatin g on water.

Mr. Rogers of Florida. So it is no t confined to fishing by any 

mea ns ?

Mr. E delman. No, sir.

Mr. Rogers of Florida. Is there any reason why you can’t change 

th e form er opinion th at was render ed by the Counsel of H EW to 

have the law inter preted as it had been before if you t hink t hat is th e 

way the law should be i nte rpret ed?

Mr. E delman. Air. Congressman, if we were convinced as law yers 

th at the earlier opinions weren’t correc t we would have no difficulty 

in revers ing them. We have conside red the question for a period 

of about 12 years and ou r continu ed conside ration of it has c onvinced 

us th at leg ally the 1951 opinions are sound.

Mr. Rogers of Fl orida. How l ong had the law been a pplied previous 

to th at time?

Mr. E delman. Well, th e o rigina l act f or the m edical care o f seamen 

was enacted in 1798, as I recall, a nd there it p rovid ed fo r a tax upon 

the wages of seamen emp loyed on board vessels of th e Un ited Sta tes, 

so since 1798 med ical service has been ren dered t o seamen.

Air. Rogers of Fl orida. W ha t I was th inki ng abo ut was the interpr etation t ha t was more bro ad than the chang e in 1951.
MEDICAL CARE FOR SELF-EMPL OY ED SEAM EN 69

Mr. Edelman. Tha t is difficult to say, Mr. Congressman, but I 

would think that the possibility of the application of a broader interf

>retation existed since about 1885 because prior to tha t time the Pubic Health Service took the view tha t only those seamen who were subject to the withholding tax on wages were eligible fo r medical care.

Now, in 1884 the withholding tax was repealed and therefore it 

would be possible since 1885, when the regulations were changed, that 

self-employed persons might have been given care by the Service. 

Mr. Rogers of Florida. Is this in fact true? What is the history ? 

Mr. E delman. I understand that certainly within the recent past, 

that is, prior to 1951, self-employed persons were given care by the 

Service.

Mr. Rogers of Florida. What made tha t opinion wrong? What 

made it necessary to change it ?

Mr. Edelman. I don’t know th at there was an opinion at th at time.

I think it was something tha t just happened. In 1951 the Service was 

confronted with two situations which raised the question in its mind 

as to whether the people involved were entitled to care under the law.

They asked the Office of the General Counsel for legal advice and 

we advised them tha t in these two cases the individuals were not entitled under the law.

Mr. Rogers of Florida. Is tha t a sufficient reason to change the 

whole application of the law on two specific cases ?

Mr. Edelman. The question of whether these two cases were sufficient reason is a difficult one to answer. All I can say, Mr. Congressman, is tha t the legal advice we gave in these two cases could not 

be confined to the facts in these two cases alone, but involved a broader 

interpretation of the law and what it meant when it said “employed 

on board.”

Mr. Rogers of Florida. Had Congress made any change in the law 

tha t brought th at interpretation about ?

Mr. Edelman. No, sir.

Mr. Rogers of Florida. What brought the Department to change 

the interpretation, if it had been interpreting the law in such a way, 

so broadly ? Why did you change it so broadly ?

Mr. E delman. Perhaps the best way to answer that, Mr. Congressman, is th at there was no official interpretation p rior to 1951.

Mr. Rogers of Florida. Other than the application of the law itself? 

Mr. E delman. Other than the fact that individuals were treated. 

Mr. Rogers of Florida. Well, tha t is all they are asking for now, I 

think, to have individuals treated, isn’t it?

Mr. E delman. I guess tha t is w hat they are asking for, Mr. Congressman.

Mr. Rogers of Florida. Well, there is no point in us getting into 

this. The Department does not feel it can change administratively 

what it did change administratively before? Is that the position of 

the Department ?

Mr. Edelman. Speaking as a member of the Office of General Counsel, I would say that the Office of General Counsel is not prepared to 

advise the Department th at its legal opinion was wrong, and I unde rstand that the Department is not willing to overrule the legal advice 

it has received from the Office of General Counsel.
70 MEDICAL CARE FOR SELF-EM PLOY ED SEA ME N

Mr. Rogers of F lorid a. Now, this makes me wonder, Mr. C hairm an, 

if we had n’t b ett er look into some of th e legal opinions th at have been 

rendered, because it seems to me th at very broad ad ministrativ e 

changes are coming abo ut witho ut leg islative ap prov al, th at this is 

over the dam now, bu t I think we be tte r look into this some because 

th is causes me concern to have a law th at is b ein g administered completely changed by admi nis tra tiv e in terp retatio n yea rs af te r it has 

been a pplied in an oth er mann er.

I can un de rst an d how in specific cases you could say, “Well, you 

don’t fall withi n this in terp retatio n,” bu t to mak e bro ad, sweepin g 

changes is a little beyond admi nis tra tiv e in terp retatio n of the law 

af te r it has been adminis tered for so many yea rs, I would think.

How ever, let me ask you spe cifically: Wo uld the Depar tment submit 

to the committee change s in the leg isla tion th at would comply with 

wh at is hoped to be done ?

Mr. E delman. Th e c hairm an ha s asked that the D epartme nt sub mit 

lan guage which would insure that, if an am endm ent were made to includ e self-employed seamen, such amendment be restric ted to the 

owner -op era tors of comm ercial fishin g vessels, and we ha ve agreed to 

do tha t.

Mr. Rogers of Florida. What did yo ur previo us rep ort say to the 

committee f rom the D epartme nt ?

Mr. E delman. The report on the legislation ?

Mr. Rogers of F lorid a. Yes.

Mr. E delman. On which of the b ills, Mr. Con gressm an? As I recall , we reported only on tw o bills.

Mr. Roberts. S. 978. Th at is the one th at gives us the trou ble.

Mr. E delman. As I recall, the De partm ent took the position, if T 

may consult with Mr. Elle nbo gen , th at we did not object to S. 978. 

Is tha t correct ?

Mr. Ellenbogen. Yes, s ir. As I recall ou r r eport, it inclu ded S. 978 

as well as the House bills pending before yo ur committee and, as I 

recall, we d id no t object to t he inclusion of self-em ploy ed seamen insofa r as our De pa rtm en t was concerned.

It did seem to us th at if self-employed seamen were to be included 

it would be ineq uita ble to disting uis h between seamen who w ere fishermen and seamen who were not, but, of course, we would defer to the 

wisdom of th e com mittee on that question.

Mr. Rogers of F lorid a. Has the histo ry been since the interp retatio n 

of 1951 tha t it was confined to fishermen ?

Mr. E llenbogen. I do n’t think so. Th ere would be no legal basis, 

would you agre e, Mr. Edelm an, th at if self-employ ed seamen were 

covered u nd er exi sting law—if it were so int erpreted —for dra wing any 

dis tin ction between fisherm en an d others?

Mr. E delman. Xo, si r; there would not. Th e req uirem ent th at a 

seam an be employe d on boa rd in the sta tus of an employee would be 

equ ally app lica ble to all persons regard less of the na ture of th eir 

calling .

Mr. Roberts. Would the gentleman yield ?

Mr. Rogers of Fl orida. Yes, sir.

Mr. Roberts. Th at sort of an interpretatio n, wi th the vast increase 

in pleasu re c raft th at we have seen in i he last few yea rs, man y o f them 

oceango ing types, it seems to me would be a verv expensive opera tion 

for the Public He alt h Service, would it not, Mr. Edelm an?
MEDICAL CAKE FOR SELF-EMPLOYED SEAMEN 71

Mr. E delman. 1 have no idea of the numb er of m aster ow ners th at 

wou ld be involved, because this would ju st involve the ques tion o f the 

•owner of t he vessel.

If it were e xtende d lieyond the com mercial fish ing indu stry I have 

no idea how many people would be involved .

Mr. Roberts. Th ere would be a tremendo usly larg er numb er than 

would be invo lved if you res tricte d it to ships or boats engag ed in 

fishing, would t here not?

Mr. E delman. Undoubted ly, I think it wou ld be much lar ger.

Mr. Rogers of F lorid a. I th ou gh t yo u said you were n ot now in te rpr etin g th e law an d co nfining i t to fishing vessels?

Mr. E delman. Tha t is correct, sir. We ap ply it to all vessels regardless of the pur pose f or whic h they a re used.

Mr. Rogers of Florida. Rig ht now th is is true ?

Mr. E delman. Tha t is r ight.

Mr. R ogers of Florida. So th at anyone who works on a vessel of 

wha t size w ould be included ?

Mr. E delman. Well, a vessel mu st be reg istere d which is 5 t ons or 

over.

Mr. Rogers of Florida. One on any t yp e o f vessel now may receive 

free med ical services?

Mr. E delman. If he is a seaman em ploy ed on board as an employee.

Mr. Rogers of Florida. So there is no presen t res tricti on to commercial fishing vessels?

Mr. E delman. Tha t is rig ht , sir.

Mr. Rogers of Florida. As I un de rst an d it the n, the De pa rtm en t 

doesn’t th ink the re s hould be any di stinction?

Mr. E delman. I think on th at I wou ld like to rea d fro m th e Depa lame nt’s official rep ort which comments on H.R. 3873, an d which 

does mak e a d isti nct ion. We said :

We have cer tain reservations, however, as to the limitation of H.R. 3873 to 

self-employed fishermen, a limitation th at would create a new inequity by discrim inating against self-employed seamen other th an fishermen.

If the legislation is favorably considered we would, therefore, pre fer the language of S. 978 now pending before your committee which would simply broaden 

present laws to include self-employed iiersons as seamen if they perform the 

same tasks as are perform ed by seamen within the meaning of the p ersent law.

Mr. R ogers of Florida. Does the De pa rtm en t hav e any est imate of 

how m any people would be affected ?

Mr. E delman. T un derst and the re was testim ony before this committee by Dr. Price which ind ica ted th at if t he bill were r estricte d to 

comm ercial fisheries-----

Mr. Rogers of Florida. You are no t recommending th at , as I un ­

derstand. I know that. I th in k we know th at figure. I am say ing 

how ma ny would be affected un de r wh at the Dep artm en t is reco mmending?

Mr. E delman. Mr. Ch air ma n, if the m igh t just say, I did n ot partic ipate in the leg isla tive reco mm end atio n on this. I have no idea 

how many people would be affected if the position take n on S. 978 

were ado pted.

Mr. Rogers of Florida. Is anyone from the De pa rtm ent here who 

might ?
72 MEDICAL CARE FOR SELF-E MPLOYED SEAMEN

Mr. E delman. There are oth er people fro m the De partm ent here, 

bu t they hav e no idea either. I think we can arrive at an estimate if 

you would like it.

Mr. Rogers of Florida. I f you could fu rnish the committee with 

an estima te of how man y and the ap roximate cost of what would be 

involved here, we would aprec iate it.

Mr. Ellenbogen. Mr. Ch airma n, if I may say so, our report did 

say , I believe, th at the extension of coverage un de r anv of the bills 

would not substan tially affect the cost in th e opinion of the service.

Mr. R ogers o f Fl orida. I think it might lie goo d to have some thin g 

a lit tle more specific than th at, because if all of these pleasu re boats 

are goin g to be covered I would think th is could result in quite a l arg e 

sum o f money.

Mr. E delman. Mr. Congressman, I would like to suggest that the 

question of pleasu re boa ts has to be conside red in the light of the 

lim ita tio n on ent itle me nt. A person must no t only be a sea ma n; 

he mu st be employed on a vessel of 5 tons o r m ore which is r egi stered , 

licensed, or en rolled.

I have no idea how ma ny plea sure boats fit into that catego ry. I 

imagi ne the y wou ld be ra th er large vessels beyond the reach o f the 

avera ge person.

Mr. Rogers of Florida. I think it would be good for us to have the 

numb er and appro xim ate cost subm itted.

Mr. Roberts. I think th at possibly there could be some consider atio n give n to the fact th at gen erally in tim e of natio nal emergency 

we bring vessels into the service of the Coast Gu ard and Na vy ; th at 

is, most all of these vessels a re s eaw orth y and we ju st bla nket them into 

th e service.

That is the w ay we d id it in Worl d W ar I I. Th ere migh t possibly 

be some consideration given to peop le on t hat score, bu t it would seem 

to me th at wh at we are inte rested in pr im arily in th is com mittee is 

tr yin g to restrict this p re tty much to fishing opera tions.

I t is recognized facet of the juris dicti on of th is committee, as has 

been poi nted out, since 1798, and I think th at the idea o f tryi ng to 

exten d it to seamen on pleasure craft and ch ar ter boats and tug s and 

ferries would gr ea tly increase the cost of this th in g beyond any hope 

of ge tti ng the bill thr ou gh .

The figure t hat I recall, and I would like to be checked on it b y some 

depa rtm en tal witnesses, was th at if we res tricte d to vessels engaged 

in fishing opera tions the add itio nal cost wou ld probably he abo ut 

$1,700,000 a yea r. Tha t is the figure th at I h ad in mind .

Mr. Edelman. Tha t is my recollection, Mr. Chairma n.

Mr. Roberts. I don’t know which witn ess gave that testimony. It 

seems like i t was somebody from HEW .

Mr. E delman. I th in k i t was Dr. P rice, sir.

Mr. R oberts. T hat was my recollection.

Mr. R ogers of F lorid a. Mr. Edelm an, wh at is the D ep artm en t’s view 

on the Bu rea u of the Bu dg et’s suggestion o f an ad ditio na l ta x ?

Mr. E delman. I will have to ask Mr. Ellenb ogen to speak to th at , 

sir.

Mr. Ellenbogen. In so fa r as the seam en’s medical care p rogram as 

a whole is concerned, we are still stu dy ing the re po rt of the Budge t 

Bu reau on these bills as well as a sim ila r repo rt the Budget Bu rea u
MEDICAL CARE FOR SELF-EMPLOYED SEAMEN 73

made in commenting on S. 978 when it was pending before the Senate 

committee. As our report indicates, we do not condition our no-objection position on this bill on a basic change in financing the medical 

care program for seamen. This is what in my opinion the Budget 

Bureau’s report amounts to.

As I understand the Budget Bureau’s report, it amounts to a statement that they would not object to the extension of coverage of the law 

to self-employed fishermen, if at the same time user charges were imposed on all seamen or the tonnage tax were increased to cover the cost 

of the whole medical care program for all seamen.

We do not believe th at this bill needs to be tied into the question of 

financing for the whole medical care for seamen program, and so we 

are not in agreement with the Budget Bureau th at the consideration 

of this bill involves the other question.

Mr. Rogers of Florida. You are not in agreement with the Bureau 

of the Budget ?

Mr. Ellenbogen. On this question.

Mr. Rogers of Florida. Yes. All right. Thank you, Mr. Chairman.

Mr. Roberts. Anything further, gentlemen ?

Mr. Nelsen. No questions.

Mr. Roberts. Then the subcommittee will be in recess, subject to the 

call of the Chair and we wish to thank you, Mr. Edelman, and your 

associates, for your attendance here today.

Mr. Edelman. Thank you, sir.

(The following information was submitted for the record:)

Department of Health, Education, and Welfare,

December 11,1963.

Hon. Kenneth A. Roberts,

Chairman, Subcommittee on Health and Safety, Comm ittee on Inter sta te and

Foreign Commerrce, House of Represen tatives, Washington, D.C.

Dear Mr. Chairman : Enclosed here with is dr af t language for committee

amendm ents to S. 978 as r<*quested at the recent hea ring before your subcommittee on th at bill and certain House bills.

There are also enclosed herewith an explana tion of the bill as thus amended 

and, in accordance with a request made at the hearing, estimates as to the 

cost of e xtending eligibility to owners and coowners of vessels. The figures are 

broken down as between owners of fishing boats and owners of o ther boats. 

Sincerely yours,

Wilb ur J. Cohen, Assistant Secretary.

E nclosure 1

Proposed Committee Amendments to S. 978

On line 6, strike out “or self-employed’’ and ins ert in lieu thereof “ (or, in the 

case of a commercial fishing vessel, self-employed)”.

On line 11, strike out “ ‘or self-employed’ ” and ins ert in lieu thereof “ ‘(or, in 

the case of a commercial fishing vessel, self-employed)’ ”.

E nclosure 2

Explanation of Proposed Committee Amendments to S. 978

The proposed committee amendm ents would str ike out the words “or selfemployed” in the first section and section 2 of the hill and ins ert in lieu thereof, 

in each section “ (or, in the case of a commercial fishing vessel, self-employed)” .

The purpose of this bill, as modified by the proposed committee amendments, 

is to restore to owners and coowners of U.S.-flag commercial fishing vessels, who 

perform seamen’s services on board, the eligibility for medical care in hospitals,
74 MEDICAL CAKE FOR SE LF-EMP LO YE D SEA MEN

outpatient clinics, and other medical facilitie s of the Public Health Service 

which was provided to them, de facto, before a 1954 amendment to the regulations under the Public Health Service Act.

An opinion of the Office of the General Counsel of the Departm ent of Health, 

Education, and Welfare; issued in 1951, had interprete d the term “employed" in 

section 2(h) and section 322(a) (1) of th e Public Hea lth Service Act1

 as excluding persons who are self-employed. Afte r the General Counsel’s Office, upon 

requ est for reconsideration, had adhered to its ear lier opinion, the regulations 

were amended in 1954 so as to exclude from the term “seamen” “the owner or 

joint owners of a vessel [and] the spouse of any such owner."

Under the proposed committee amendments, self-employed individuals engaged 

on board a commercial fishing vessel in the types of activity described in section 

2( h) of the Public Health Service Act will be considered “seamen," whether or 

not they are owners or coowners of the vessel. At the same time, self-employed 

persons on pleasure boats and other vessels th at are not commercial fishing 

vessels would be excluded from coverage, whether or not such vessels are owned 

or charted by such persons. Thus, self-employed persons on vessels used for 

spo rt fishery, even though the vessel be one owned by it person commercially 

engaged in cha rtering such vessels to sport fishermen or taking sport fishermen 

on fishing trips for pay, would be excluded. The phra se “commercial fishing 

vessel” is, on the other hand, intended to include vessels engaged in the gathering of any form of either fresh water or marine animal life for commercial purposes, and will thus include vessels engaged in the commercial catching or hair 

vesting of shrimp, lobsters, oysters, etc., as well a s fish, if. as required by section 

32 2(a)(1) of the Public Health Service Act, the vessel is a U.S.-flag vessel 

“registered, enrolled, and licensed under the maritime laws of the United 

State s, other than canal boats engaged in the coasting trade.” (The bill would 

not enlarge the coverage of section 322(b) of the Public Health Service Act which 

authorize s medical, surgical, dental, and hospital services to seamen on foreignflag vessels on a user charge basis.)

October 28,1903; U.S. Government memorandum.

To : Mr. Robert T\ Hollinger, legislative legal liaison officer.

From : Acting Chief, Division of Hospitals.

Sub ject: Estim ated cost of providing medical and denta l care to self-employed 

seamen.

In accordance with your request, attached is an analysis of the estimated 

additio nal patient load and cost of providing medical and dental care to selfemployed seamen of commercial fishing boats and self-employed seamen of other 

tha n commercial fishing boats.

Mr. W alter H. Stolting, of the Bureau of Commercial Fisheries. Depa rtment of 

the Interio r, was contacted for an estimate of the number of self-employed 

seamen of commercial fishing boats. The 10.0(H) self-employed seamen of commercial fishing boats estim ated by Mr. Stolting differs from the 11,000 previously estimated in that the 11,000 included noncommercial fishing boats.

Mr.-.Clem Freeman, of the Bureau of Customs, was contacted for an estimate 

of all other self-employed seamen. He indicated that it was impossible to make 

an estimate of the number of self-employed seamen. He stated that there are 

aprpoxim ately 54,000 documented Ameriean-flag vessels (including fishing bo ats). 

He agreed that a figure of 5,000 self-employed seamen of other than commercial 

fishing boats appeared to be reasonable. Based on the above, the estimated patie nt loads and costs should be looked upon as only very rough estimates.

C. Dudley Miller, M.D., Medical Director.

1

 Sec. 2(h) defines “seamen” as including “any person employed on board in the care, 

preservation, or navigation of any vessel, or in the service, on board, of those engaged in 

such care, preservation, or navigation.” Sec. 32 2(a)(1) provides that “Seamen employed 

on vessels of the United States registered, enrolled, and licensed under the maritime laws 

thereof, other than canal boats engaged in the coasting trade” shall in accordance with 

regulatio ns be entitled tn-medical. surgical, and dental treatm ent and hospitalization from the Service.
MEDICAL CARE FOR SELF-EMPLOYED SEAMEN 75

E stimated Cost fob th e Medical and Dental Care of Sel f-E mployed Seame n

SELF-EMPLOYED SEA MEN OF C OMM ERCIAL FI SH IN G BOATS

It is estim ated that there are 10,000 self-employed seamen of commercial fishing boats. If these 10,000 self-employed seamen are made eligible for medical 

and dental care in Public Health Service hosp itals and outpatient facilitie s, the 

number of American seamen I’HS beneficiary group would increase from 117,500 

to 127,500. The additional cost for the ir care would amount to $1,824,200. The 

following table shows the estim ated increased patient load and cost which would 

result from the additional 10,000 self-employed seamen of commercial fishing 

bo ats:

Fa cilit y

Fis cal ye ar 

1963 seam en 

load

Add ition al 

sea me n load 

(selfem plo yed

com me rcial

fishermen)

Fis cal y ear 

1963 cost per 

un it

To tal 

ad ditio na l 

an nu al co st

In patient (average da ily p at ie nt load ):

PH S gen eral ho sp ita ls. . .. . ______ ____ 1.520

241

34

37

130

20

3

3

$27.81

11.02

25.00

50.17

$1,319,600

80.400

27.400 

54.900

PH S ne urop sy ch iatri c ho sp ita ls........ ............

Fe deral h os pitals_______________________

No n-Fe de ral h os pitals. ______ __________

Su bt ot al_____________________________ 156 1.482.300

O ut pa tie nt visits:

PH S ho spita ls__________________________ 282,491 

189.120 

38,647

24.000 

16.100 

3,300

7.90 

7.51 

9.50

189,600 

120,900 

31.400

PH S clin ics............................. . .........................

PH S offices____________ ____ __________

Su bt ot al........................................................ 43.400 341,900

Tota l.............................. .......... ....................... 1,824.200

SELF-EM PLOY ED SEAMEN OF OTH ER TH AN FI SH IN G BOATS

There is no information available as to the number of owners of vessels documented as American-flag ships and, therefore, it is very difficult to estimate the 

number of self-employed seamen on vessels other tha n commercial fishing boats. 

Based on a discussion with a represe ntative of the Bureau of Customs, it is believed that a figure of 5,000 would be reasonable. The table below shows the e stimated increase in patient load and cost which would result from the additional 

5,000 self-employed seamen of other than commercial fishing b oa ts:

Fa ci lity

In patient (averag e da ily p at ie nt load):

PU S general ho sp ita ls............ ..........

PU S ne urop sy ch iatri c hospitals-....

Fe de ral h os pitals____________ . .. .

No n-Fe de ral hos pi ta ls ................

Subto ta l______________________

O ut pa tien t visits:

PH S hosp ita ls__________________

PH S clinics____________________

PH S offices_____________________

Sub to ta l______ ____ __________

Tota l..................................................

Add ition al 

sea me n load 

(selfem plo yed 

ot he r th an 

comm ercial 

fisherme n)

Fiscal yea r

1963 c ost 

per un it

To tal

ad di tio na l

cost

65 $27.81 $659.800

10 11.02 40.200

1 25.00 9.100

1 50 17 18,300

77 727.400

12.000 7.90 94.800 8.000 7.51 60.100

1.600 9.50 15.200

21.600 170,100

(Whereupon, at 10:55 a.m., the subcommittee recessed subject to 

the call of the Chair.)

O