39-52. COMPREHENSIVE HEALTH PLANNING AND PUBLIC

GOVERNMENT HEALTH SERVICES AMENDMENTS OF 1966

Storage

H E A R I N G

BEFO RE T H E

I COMM ITTEE ON

INT ER STAT E AND FO RE IGN COMMER CE

HOUSE OF RE PR ES EN TA TI VE S

EIGH TY -NI NT H CONGRESS

SECOND SES SIO N

ON

, H.R. 18231, H.R . 18232, S. 3008

JS H IN G CO MP REHE NSIVE PLANNIN G FO R 

ICE S AND AU TH OR IZING PR OJE CT GRANTS 

GRA NTS FO R HE AL TH SERV ICE S TO TH E 

STA TES

OCT OBE R 11, 11X56

Serial No. 89-52

Print ed fo r th e use o f the

on In te rs ta te an d Fo rei gn Comm erce

70-050

U.S . GO VE RN MEN T PR IN TIN G O FFIC E 

WAS HI NG TO N : 196 6
' • : ; . . .

4

. a.

■ r ' S r

.ssrJ

COMMITTEE ON INTERSTA TE AND FOREIGN COMMERCE

HA RL EY O. STAG GE RS , W es t Virginia, C hair m an

W AL TE R RO GE RS, Tex as

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

TO RB ER T H. MACDO NALD, M as sa ch use tts 

JO HN JARM AN , Ok laho ma

LE O W. O’BR IE N, New York

JO HN E. MOSS, Cal ifor ni a

JO HN D. DI NG EL L, Michiga n

PA UL G. RO GE RS, Flo ri da

HO RA CE R. KORNEGAY, N ort h Car ol in a 

LIO NEL VAN DEE RLI N, C al if or ni a 

J. J. PI CK LE, Te xa s

FRED B. ROONEY, Pen ns yl va ni a 

JO HN M. MU RPHY , New York 

DA VID E. SA TTERFIE LD II I, Virgi nia 

DANIE L J. RONAN, Illin oi s 

J. OL IVA HU OT , New Ham ps hi re 

JA M ES A. MACKAY, Ge orgia 

JO HN J. GILL IG AN , Ohio 

CH AR LE S P. FA RN SL EY , Ken tuck y 

JO HN BELL W ILLIAM S, Missis sip pi 

BR OC K ADA MS, W as hi ng to n

W. E. Wil li am so n, Cleric

Ken neth J. P ain te r, A s s is ta n t Cleric

P ro fe ss io n a l S ta ff

Andrew Ste ve nson J am es M. Men ge r, J r.

Kur t Borc hardt Wil li am J. Dixo n

W IL LIA M L. SP RI NGER , Illin oi s 

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

SA MU EL L. DEV IN E, Ohio 

AN CH ER NE LS EN , M inne 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 

GL EN N CU NN ING HA M, Neb rask a 

JA M ES T. BR OY HI LL , N or th Car ol in a 

JA M ES HA RV EY , Michiga n 

ALBERT W. WA TSON , Sou th Car ol in a 

TIM L EE CA RT ER , Ken tuck y
C O N T E N T S

Text of— Bage

H.R. 13197 -,__________ 2

H.R. 18231________________ 9

S. 3008____________________________________________ 17

Rep ort of—

Civil Service Commission_____________________________________ 29

General Accounting Office____________________________________ 27

Health, Education, and Welfare, Department o f__________________ 27

Statem ent of—

Boggs, Mrs. Fitzhugh W., former president, National Association for

Reta rded Children_________________________________________ 90

Brindle, James O., president, Health Insurance Plan of Greater

New York________________ ________________________________ 73

Donelan, Paul R. M., atto rne y, legislative departm ent, American

Medical Association________________________________________ 57

Hiscock, William, Deputy Chief, Division of Public Health Methods, 

Surgeon General’s Office, Dep artm ent of Health, Education, and 

Welfare_____________________________________ _____________ 30

Hudson, Dr. Charles L., president, American Medical Association___ 57

Kimble, Sam A., Associate Chief for Grants, Bureau of State Services,

Dep artm ent of Health, Education, and Welfare_______________ 30

Lee, Dr. Philip, Assistant Secretary for Health and Medical Affairs,

Dep artm ent of Health, Education, and Welfare_______________ 30

O’Connell, Brian, executive director, National Association for Mental

Health, Inc_______________________________________________ S8

Peavy, Dr. James E., Texas State commissioner of health_________ 55

Peters, Dr. Henry B., representing the American Optometric Association___________________________________________________ 83

Peterson, Harry N., atto rney, legislative departm ent, American

Medical Association________________________________________ 57

Stewart, Dr. William H., Surgeon General, Public Health Service,

Department of Health, Education, and Welfare________________ 30

Venable, Dr. Joh n H., director, Georgia Departme nt of Health, representing the Association of State & Territorial Health Officers_____ 55

Additional material subm itted for the record by—

Allegheny County (Pa.) Health Departme nt, letter from E. Jane

Fleming, M.D., with attachm ents____________________________ 121

American Dental Association, letter from Joh n B. Wilson, D.D.S.,

chairman, Council on Legislation_____________________________ 113

American Insti tute of Planners, statem ent o f____________________ 90

American Nurses’ Association, Inc., letter from Judit h G. Whitaker,

R.N., executive dire ctor____________________________________ 115

American Public Health Association, Inc.:

Letter from Dr. Berwryn F. Mattison, executive direc tor_______ 112

Statem ent of Emil T. Cha nlett, chairm an, Radiological Health

Section_______________________________________________ 94

American Public Health Association, Western Affiliates: Resolution

adopted at annual meeting, May 23-27, 1966________________ 119

Association of Schools of Public Hea lth, telegram from Dr. Ray E.

Trussell, presiden t___________________________________________ 98

Association of S tate and Territorial Hea lth Officers, statem ent of Dr.

Bernard Bucove, presiden t__________________________________ 72

Chautauq ua County (N.Y.) Departm ent of Health, letter from Dr.

Lyle D. Franzen, health commissioner_______________________ 121

Farnum, Hon. Billie S., letter from _____________________________ 116

in
IV CONTENTS

Additional material subm itted for the record by—Continued

Health, Education, and Welfare, Depar tment of (Public Health

Services): Comparison of appropriation auth orizations in S. 3008 Page

and Il.R. 18231 (table )____________ ________________________ 34

Hea lth Insurance Plan of Greater New York: Proposed amendments

to S. 3008________________________________________________ 70

Jorris, Dr. E. II., Wisconsin S tate health officer, letter from_______ 118

Kraenzel, Prof. Carl F.:

Letter dated April 29, 1966________________________________ 99

Statem ent in regard to cost of spa ce________________________ 99

National Association for Retard ed Children, statem ent of Thomas A.

Tucker, president__________________________________________ 91

National Association of Counties, lett er from Bernard F. Hillen brand, •

executive dire ctor__________________________________________ 116

National Association of Sanitarians, sta tem ent of Nicholas Pohlit,

executive director______________________________________ ___ 9S

National Association of Sta te Men tal Health Program Directors,

statem ent of Dr. William E. Schumacher, preside nt___________ 93 “

National Catholic Welfare Conference:

Letter dated October 11, 1966, from the Most Reverend Paul S.

Tanner, general secreta ry_______________________________ 105

Statem ent on Government and birth control, presented August

24, 1965____________________ _________________________ 106

New Jersey State Departm ent of Health, letter from Dr. Roscoe P.

Kandle, commissioner of he alt h_____________________________ 118

Atta chment A—Letter sent to New Jersey Representatives____ 119

Palm Beach County (Fla.) Association for Retarded Children, Inc.,

telegram from Irwin L. Langbein, president___________________ 98

Public Health Services, Department of Health, Education, and Welfare: Comparison of appropriation authorizations in S. 3008

and H.R. 18231 (tab le)_____________________________________ 34

Rolvaag, Hon. Karl, Governor of Minnesota, letter from __________ 117

South Carolina State Board of Health, lett er from Malcolm U.

Dantzler, M.D., assistan t Sta te health officer__________________ 120

Southeastern Michigan Task Force on Comm unity Health Services,

letter from Alfred M. Pelham, cha irm an____________________ 117

Utah State Department of Health, letter from G. D. Carlyle Thompon,

M.D., direc tor of public hea lth______________________________ 121

Wisconsin State Board of Health, letter from E. H. Jorris, M .D., State

health office______________________________________________ 118

• • ’ i -u

t

if f'
COMPREHEN SIVE HEALTH PLANNING ANI) PUB LIC 

HEALTH SER VIC ES AMENDMENTS OF 1966

TUESD AY, OC TO BE R 11, 19 66

H ouse of R epr esenta tives,

Com mit tee on I nterstate and F oreign C omm erce,

Washington, D.C.

The committee met, pu rsuant to notice, at 9 a.m., room 2123, Rayburn House Office Building, Hon. Ilarley O. Staggers (chairman) 

presiding.

The Chairman. The committee will come to order.

The hearings today are on II.R. 13197 and S. 3008, II.R. 18231, and 

H.R. 18232, bills establishing comprehensive planning for health 

services and authorizing project grants and formula grants for health 

services to the States.

H.R. 13197 and S. 3008, as introduced, were recommended by the 

administration as part of the President's health message.

S. 3008 was amended substantially and passed the Senate on October 3. As passed by the Senate, the bill provides a 4-year program 

for grants for comprehensive health planning conducted by the 

States, and a 4-year program of project and formula grants for health 

services.

The bill contains authorization of over $1 billion for these programs. It is very late in this session—too late I am afraid—for our 

committee to be able to conduct the extensive hearings which this 

subject deserves, although much background information concerning 

the problems with which this bill deals was developed in hearings 

held by the Special Subcommittee of this Committee on Investigations of the Department of Health, Education, and Welfare, chaired 

by the gentleman from Florida, Mr. Rogers.

It therefore seems best to me to schedule hearings on a much more 

limited bill, with the view in mind of going into the subject in some 

depth next year. Therefore, the gentleman from Florida and I have 

worked out a revision of S. 3008, which he and I then introduced on 

Thursday, October 6, as H.R. 18231 and H.R. 18232.

These bills authorize a total of $44 million over a 3-year period for 

new, and continuation of, existing programs of comprehensive p lanning for health services on the State and local levels.

In addition, the bill authorizes a program of project and formula 

grants for the fiscal year 1968 and 1969, totaling $125 million for each 

fiscal year, which represents a slight increase over the appropriation 

levels currently contained in the health, education, and welfare appropriation bill. The hill would modify existing law in the same 

fashion as S. 3008 by eliminating the so-called categorical formula 

grants so as to provide added flexibility in the conduct of State 

programs.

1
2 PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66

The committee decided last week th at we would hold hearings on 

this bill and it is inte nde d to complete these hearings tod ay. I hope 

th at the witnesses will keep th is in mind, because time is very sho rt.

At this point in the record the re will be included the text of the 

bills and the agenc y re ports thereon .

(H .R. 13197, U.R . 18231, S. 3008, and agency rep orts thereon 

fo llo w:)

[H .R . 13197,, 89 th Cong., 2d sess.]

A B IL L To am en d th e Pu blic H ea lth Se rv ice Ac t to pr om ote an d as si st in the ex tens ion 

an d im pr ov em en t of co mpreh en siv e hea lth pla nnin g an d pu blic he al th se rvice s, to 

prov ide fo r a mo re effect ive use of av ai la bl e Fed er al fu nds fo r su ch pl an nin g an d 

se rvice s, an d fo r oth er pu rp os es

li e it enacted by th e Se na te an d Hou se of R ep re se nta tive s of the United Sta te s

of A mer ica in Co ngres s a ssem bled . T h at th is A ct may be cite d as t he “C om preh en ­

sive H ea lth P la nn in g an d Pu bl ic H ealth S ervice s Amen dm en ts o f 1966”.

FI NDI NGS AN D DECLARATION OF PUR POSE

Sec. 2. (a ) The Co ng ress dec la re s th a t fu lfillm en t of ou r N at io na l pu rpos e 

de pe nd s on pr om otin g an d as su ri ng th e hi gh es t lev el of hea lth att ain able fo r 

ev ery pe rson , in an en vi ro nm en t which cont ri but es po sitiv ely to hea lt hfu l in divid ua l an d fa m ily li v in g ; th a t att ain m en t of th is go al de pe nd s on an eff ective 

par tn er sh ip , invo lving close in te rg ove rn m en ta l co lla bo ra tio n, official an d vo lunta ry e ffo rts , an d part ic ip at io n of ind iv id ual s an d org an iz at io ns; an d th a t Fed er al 

fina nc ial as si st an ce mus t lx* dir ec te d to su ppo rt th e m ar sh al in g of all he al th 

reso ur ce s— N atio na l, Sta te , an d lo ca l—to ass ure co mpr eh en sive hea lth serv ice s 

of hi gh q ual it y fo r e ve ry person.

(b ) To carr y ou t such pu rpos e, an d reco gn izing th e ch an ging chara cte r of 

he al th prob lem s, th e Co ng res s fin ds tha t, co mpr eh en sive pla nn in g fo r hea lth 

service s, he al th man po wer, an d hea lth fa cil it ie s is es se nt ia l a t ev ery level of 

gov er nm en t; th a t de si ra bl e adm in is tr ati on re quir es st re ngth en in g th e le ad er ­

sh ip an d ca pa ci tie s of S ta te hea lt h agencie s; an d th a t su pp or t of hea lth serv ices 

prov id ed pe op le in th eir co mm un iti es s ho uld be br oa de ne d an d mad e more flex ible.

Sec. 3. Secti on 314 o f t he P ub lic H ea lth Se rvice Ac t (42 U .S.C. 246) is am en de d 

to rea d as follo ws :

“grants for comp rehensive he al th pl an ning and public he al th services

“G ra nts to S ta te s f or Com preh en siv e S ta te H ea lth Pla nn in g

“S ec. 314. (a )(1 ) Aut ho riz at ion.—I n ord er to ass is t th e S ta te s in co mprehe ns ive an d co nt in ui ng pla nn in g fo r th eir cu rr en t an d fu tu re hea lth needs, th e 

Su rgeo n Gen eral is au th ori ze d duri ng th e pe riod be ginn ing Ju ly 1, 1966, an d en ding Ju ne 30, 1972, to mak e g ra nts to S ta te s which ha ve su bm itt ed , an d ha d 

ap pr ov ed by th e Su rgeo n Gen eral, S ta te pl an s fo r co mpr eh en sive S ta te he al th 

plan ning .

“ (2 ) State plan s for co mp rehe ns ive stat e he al th pl ann in g.—I n o rd er to be 

ap pr ov ed fo r pu rp os es of th is su bs ec tio n, a S ta te pl an fo r co mpr eh en sive Sta te 

hea lt h pla nn in g m us t—

“ (A ) de sign ate, or pr ov id e fo r th e es ta blish m en t of, a sin gle S ta te ag ency 

as th e sole ag en cy fo r ad m in is te ri ng or su pe rv isin g th e ad m in is tr ati on of t he 

S ta te ’s he al th p lann in g fu nc tion s un de r th e p lan ;

“ (B ) prov id e fo r th e es ta blish m en t of a Sta te hea lt h pl an ni ng coun cil, 

which sh al l includ e re pre se nta tives of S ta te an d loc al ag en cies an d nongover nm en ta l or ga ni za tion s an d gr ou ps con ce rned w ith he al th , an d of con su mers 

of healt h serv ices, to ad vise su ch S ta te agen cy in carr yin g ou t it s fu nc tion s 

under th e p la n ;

“ (C ) se t fo rt h policies an d pr oc ed ur es fo r th e ex pe nd itur e of fu nd s un de r 

th e plan , which , in th e ju dg m en t of th e Su rgeo n Gen eral, are de sign at ed to 

pr ov id e fo r co mpr eh en sive S ta te pla nn in g fo r hea lth serv ices (b ot h pu blic 

an d p ri v ate ), incl ud in g th e fa ci lities an d pe rson s re qu ired fo r th e prov isi on 

of su ch serv ices, to mee t th e hea lth ne ed s of th e peopl e of th e S ta te ;

“ (D ) pr ov id e fo r en co ur ag in g co op er at iv e ef fo rts am on g go ve rn m en tal or 

no ng ov er nm en ta l ag en cie s, org an iz at io ns , an d gr ou ps co nc erne d w ith he al th 

serv ices, fa ci lities , or man po wer, an d fo r co op er at ive ef fo rts be tw ee n such
PUBLIC HEA LTH SERVICES AMENDMENTS OF 19 66 3

agencies, organizations, and groups and similar agencies, organizations, and 

groups in the fields of education, welfare, and r eh ab ilitatio n;

“ (E) contain or be supported by assu rances satisfactory to the Surgeon 

General tha t the funds paid under this subsection will be used to supplement 

and to the extent practicable, to increase the level of funds t ha t would otherwise be made available by the State for the purpose of comprehensive health 

planning and not to su pplant such non-Federal f un ds ;

“ (F) provide such methods of administration (including methods relating 

to the estab lishm ent and main tenance of personnel standard s on a merit 

basis, except that the Surgeon General shall exercise no autho rity with 

respect to the selection, tenure of office, and compensation of any individual 

employed in accordance with such methods) as are found by the Surgeon 

General to be necessary for the proper and efficient operation of the pla n;

“ (G) provide that the Sta te agency will make such reports, in such form 

and containing such information, as the Surgeon General may from time to 

time reasonably require, and will keep such records and afford such access 

thereto as the Surgeon General finds necessary to assure the correctness and 

verification of such repo rts ;

“ (H) provide that the Sta te agency will from time to time, but not less 

often than annually , review its State plan approved under this subsection 

and submit to the Surgeon General app ropriate modifications th er eo f;

“ (I) provide for such fiscal control and fund accounting procedures as 

may be necessary to a ssure proper disbursement of and accounting for funds 

paid to the State under this subsection; and

“ (J ) contain such additional information and assurances as the Surgeon 

General may find necessary to carry out the purposes of this subsection.

“ (3) (A) State allotments.—From the sums appropriated for such purpose 

for each fiscal year, the several States shall be entitle d to allotments determined, 

in accordance with regulations, on the basis of the population and the per capita 

income of the respective Sta te s: except that no such allotment to any State 

for any fiscal year shall be less than 1 per centum of the sum appropriated for 

such fiscal year pursu ant to p ara gra ph (1). Any such allotment to a State for a 

fiscal ye ar shall rema in available for obligation by the State, in accordance with 

the provisions of this subsection and the Sta te’s plan approved thereunder, until 

the close of the succeeding fiscal year.

“ (B) The amount of any allotment to a Sta te under subparagraph (A) for any 

fiscal year which the Surgeon General determines will not be required by the 

State, during the period for which it is available, for the purposes for which allotted sha ll be available for reallotment by the Surgeon General from time to time, 

on such date or dates as he may fix, to other States with respect to which such 

a determination has not been made, in proportion to the original allotments 

to such States under subp arag raph (A) for such fiscal year, but with such proportionate amount for any of such other Sta tes being reduced to the extent it 

exceeds the sum the Surgeon General estim ates such State needs and will be able 

to use during such perio d; and the total of such reductions shall be similarly 

reallotted among the States whose proportionate amounts were not so reduced. 

Any amount so reallotted to a State from funds appropriated pursua nt to this 

subsection for a fiscal year shall be deemed part of its allotment under subparagraph (A) for such fiscal year.

“ (4) Payments to states.—From each Sta te’s allotm ent for a fiscal year 

under this subsection, the State shall from time to time be paid the Federal 

sha re of the expenditures incurre d during th at y ear or the succeeding yea r pursua nt to its State plan approved under this subsection. Such payments shall be 

made on the basis of estim ates by the Surgeon General of the sums the State 

will need in order to perform the planning under its approved State plan under 

this subsection, but with such adjustments as may be necessary to take account 

of previously made underpayments or overpayments. The ‘Federa l sha re' for 

any Sta te for purposes of th is subsection shall be all, or such part as the Surgeon 

General may determ ine, of the cost of such planning, except that in the case 

of the allotmen ts for the fiscal year ending Jun e 30, 1970, and for each of the 

next two fiscal years, it shall not exceed 75 per centum of such cost.

“Projec t Grants for Areawide Hea lth Planning

“ (b) The Surgeon General is authorize d, during the period beginning July 1. 

1966, and ending Jun e 30. 1972, to make, with the approval of the Sta te agency 

adm inistering or supervising the administratio n of the Sta te plan approved under
4 PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66

su bs ec tio n (a ), pr oje ct g ra nts to an y oth er pu blic or no np rofit pri vate ag en cy or 

or ga ni za tion to co ve r no t to ex ceed 75 per ce ntum of th e co sts of pr oje ct s fo r de ­

ve loping (a nd from tim e to tim e re vi sing ) co mpr eh en sive regi on al m et ro po lita n 

ar ea , or ot he r loc al are a pl an s fo r co or di na tion of ex is ting and pla nn ed hea lth 

service s, in cl ud ing th e fa ci lities an d pe rs on s re qui re d fo r prov ision of su ch se rv ­

ic es ; ex ce pt th a t in th e ea se of pr oj ec t g ra n ts mad e in an y S ta te pri or to Ju ly 1, 

1968, ap pr ov al of such S ta te ag en cy sh al l be re qui re d only if su ch S ta te has such 

a S ta te p lan in effect a t th e ti me o f s uc h g ra nts .

“P ro je ct G ra nts f or Tra in in g, St ud ies, an d D em on st ra tion s

“ (c ) The Su rgeo n Gen eral is also au th orize d, duri ng th e pe riod be ginn ing 

Ju ly 1, 1966, an d en ding Ju ne 30, 1972, to mak e g ra n ts to an y pu blic or no np rofit 

p ri vate agency, in st itution, or oth er or ga niz at io n to co ve r al l or an y p art of th e 

co st of pr oj ec ts fo r tr ai ni ng, stud ies, or dem ons trat io ns loo king to w ar d th e de ­

ve lopm en t of im prov ed or mo re effecti ve co mpr eh en sive hea lth pl an ni ng th ro ughout th e Nati on .

“G ra nts for C om preh en siv e Pu bl ic H ea lth Se rvices

“ (d )(1 ) Autho riz ation of ap prop ria tio ns.—T he re are au th ori ze d to be appro pri at ed fo r th e fiscal yea r en ding Ju ne 30. 1968. an d ea ch o f th e nex t fo ur fiscal ye ar s such su ms as may be ne ce ss ar y to en ab le th e Su rgeon Gen eral to 

mak e g ra nts to S ta te hea lth or m en ta l hea lth auth ori ti es to ass is t th e Sta te s in 

es ta bl is hi ng a nd m ai nta in in g a deq uat e pu blic hea lth service s, incl ud in g th e tr a in ­

ing of pe rson ne l fo r S ta te an d loca l hea lth work. The sums so ap pro pri at ed 

sh al l be used fo r mak in g pa ym en ts to S ta te s which ha ve su bm itt ed , an d ha d 

ap pr ov ed by th e Su rgeo n Gen eral, S ta te pl an s fo r prov ision of pu blic hea lth 

service s.

“ (2 ) State pl an s for provision of public he al th services.—In ord er to be ap pr ov ed un de r th is subs ec tio n, a S ta te pla n fo r pr ov ision of pu blic hea lth se rv ­

ice s m us t—

“ (A ) pr ov ide fo r ad m in is tr ati on or su pe rv isio n of ad m in is tr ati on by th e 

S ta te hea lth auth ori ty or, w ith re sp ec t to m en ta l hea lth service s, th e S ta te 

m en ta l healt h a u th o rit y ;

“ (B ) se t fo rt h th e po lic ies an d pr oc ed ur es to be follo we d in th e ex pe nd itu re of t he fu nd s pai d und er th is su bs ec tio n ;

“ (C ) co nt ai n or be su pp or ted by as su ra nce s sa ti sf acto ry to th e Su rgeon 

G en er al th a t (i ) th e fu nd s pa id to th e S ta te un de r th is su bs ec tio n will be 

used to mak e a sign ifi ca nt co nt ri bu tion to w ar d pr ov id in g an d stre ngth en in g 

pu blic healt h serv ices in th e var io us po litica l su bd iv isio ns in ord er to im ­

prov e th e he al th of th e pe op le; (i i) su ch fu nd s will be mad e av ai la bl e to 

ot her pu blic or no np ro fit pri vate ag en cie s, in st itutions, an d or ga ni za tion s, 

in ac co rd an ce w ith cri te ri a which th e Su rgeo n Gen eral det er m in es are de ­

sig ne d to se cu re max im um par ticip ati on of loc al, re gion al, or m et ro po lita n 

ag en cies an d grou ps in th e pr ov ision of such se rv ic es ; an d (i ii ) su ch fu nd s 

wi ll be used to su pp lemen t an d, to th e exte nt pra ct ic al , to in cr ea se th e leve l 

of fu nd s th a t wo uld ot he rw ise be mad e av ai la ble fo r th e pu rpos es fo r wh ich 

th e Fed er al fu nd s are prov ided an d no t to su ppl an t such no n- Fe de ra l fu nds;

“ (I )) prov ide fo r th e fu rn is hin g of pu blic hea lth serv ices und er th e S ta te 

pl an in ac co rd an ce w ith such pl an s as ha ve been develop ed purs uant to su bsection (a ) an d, eff ectiv e Ju ly 1, 1970, prov id ed th a t ex ce pt t o th e ex te nt per ­

m itte d in re gu la tion s, such se rv ices wi ll be prov ided th er eu nder only to th e 

exte nt includ ed in an d in ac co rd an ce w ith th e pl an s so dev el op ed ;

“ (E ) pr ov id e th a t pu blic hea lth serv ices fu rn is hed un der th e plan wi ll 

be in ac co rd an ce w ith st andard s pr es cr ib ed by re gu la tion s, includ ing st andard s as to th e sco pe an d qual ity o f s uch serv ices ;

“ (F ) pr ov ide su ch metho ds of ad m in is tr ati on (inc lu di ng metho ds re la ting 

to th e es ta blish m en t an d m ai nte nan ce of pe rson ne l st andard s on a m er it 

ba sis, ex ce pt th a t th e Su rgeo n Gen er al sh al l ex ercise no auth ori ty w ith re ­

spec t to th e selecti on , te nure of office, an d co mpe ns ation of an y in di vi du al 

em ploy ed in ac co rd an ce w ith su ch m et ho ds ) as are foun d by th e Su rgeo n 

Gen er al to be ne ce ss ar y fo r th e pro pe r an d efficie nt op er at io n of th e p la n ;

“ (G ) pr ov id e th a t th e Sta te hea lt h au th o ri ty or, w ith re sp ec t to m en ta l 

hea lth serv ices, th e S ta te m en ta l healt h auth ori ty , wi ll from tim e to tim e, 

bu t no t les s oft en th an an nu al ly , re vi ew its S ta te pla n ap pr ov ed un de r th is
PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66 O

subsection and submit to the Surgeon General app ropriate modifications 

thereo f;

“ (II) provide that the State health autho rity or, with respect to mental 

health services, the State mental health authority, will make such reports, 

in such form and containing such information, as the Surgeon General may 

from time to time reasonably require, and will keep such records and afford 

such access thereto as the Surgeon General finds necessary to assure the 

correctness and verification of such re po rts;

“ (I) provide for such fiscal control and fund accounting procedures as 

may be necessary to assure the proper disbursement of an accounting for 

fund s paid to the State under this subsection : and

“ (J ) contain such additional information and assu rances as the Surgeon 

General may find necessary to carry out the purposes of this subsection.

“ (3) State allotments.—From the sums app ropriated to car ry out the provisions of this subsection the several States shall be entitled for each fiscal year 

to allotmen ts determined, in accordance with regulations, on the basis of the 

population and financial need of the respective States.

“ (4) (A) Payments to states.—From each Sta te’s allotment under this subsection for a fiscal year, the State shall be paid the Fed eral share of the expenditur es incurred during such yea r under its State plan approved under this subsection. Such payments shall be made from time to time in advance on the basis 

of estimates by the Surgeon General of the sums the Sta te will expend under the 

Sta te plan, except that such adjustments as may be necessary shall be made on 

account of previously made underpayments or overpayments under this subsection.

“ (B) For the purpose of determin ing the Fe deral sha re for any State, expenditures by nonprofit private agencies, organizatio ns, and groups shall, subject to 

such limitations and conditions as may be prescribed by regulations, be regarded 

as expenditures by such S tate or a political subdivision thereof.

“ (5) Federal share.—The ‘Federal sha re’ for any State for purposes of this 

subsection shall be 100 per centum less that i>ercentage which bears the same 

ratio to 50 per centum as the per cap ita income of such State bears to the per 

capita income of the United St at es ; except th at in no case shall such i>ercentage 

be less tha n 33% per centum or more than 66% per centum, and except th at the 

Federal share for the Commonwealth of Pue rto Rico, Guam, American Samoa, 

and the Virgin Isla nds shall be 66% per centum.

“ (6) Determination of federal shares.—The Federal shares shall be determined by the Surgeon General between July 1 and September 1 of each year, on 

the basis of the average p er capita incomes of each of the States and of the United 

States for the most recent y ear for which satisfa ctory data are ava ilable from the 

Departm ent of Commerce, and such dete rmin ation shall be conclusive for the 

fiscal year beginning on the next July 1. The populations of the several States 

shall be determined on the basis of the latest figures for the population of the 

several States available from the Department of Commerce.

“ (7) Allocation of funds wit hin the states.—At leas t 15 per centum of a 

State ’s allotment under thi s subsection shall be a vailable only to the State mental 

health autho rity for the provision under the Sta te plan of mental health services. 

At lea st 70 per centum of such amount and a t leas t 70 per centum of th e rem aind er 

of a Sta te’s allotmen t under this subsection shall be available only for the 

provision under that State plan of services in the communities of the State. 

“Project G ran ts for Hea lth Services Development

“ (e) There are authorized to be appropriated for the fiscal yea r ending 

Jun e 30, 1968. and each of the next four fiscal yea rs such sums as may be necessary for gra nts to any public or nonprofit private agency, institution, or organization to cover pa rt of the cost of (1) providing services to meet hea lth needs 

of limited geographic scope or of specialized regional or n atio nal significance, (2) 

stim ulating and supporting for an initial period new’ programs of health services, 

or (3) und erta king studies, demonstrations, or training designed to develop 

new’ methods or improve existing methods of providing health services. Such 

grants may be made pursu ant to clause (1) or (2) of the preceding sentence 

with respe ct to projects involving the furn ishing of public health services only if 

such services are provided in accordance with such plans as have been developed 

pursuant to subsection (a) and. effective Jul y 1, 1970. except to the extent permitted in regulations, only to the extent such services are included in and are 

furnish ed in accordance with plans so developed.
6 PUBLIC HEA LTH SERVICES AMENDMENTS OF 19 66

“In te rc han ge of Per so nn el W ith Sta te s

“ ( f ) ( 1 ) F or th e pu rp os es of th is su bs ec tio n, th e te rr a ‘St ate ’ mea ns a Sta te 

or a po litica l su bd iv isio n of a Sta te , or an y agen cy of eit her of th e forego ing 

en ga ge d in an y ac ti vit ie s re la te d to hea lth or des ig na te d or es ta bl ishe d purs uant 

to su bpar ag ra ph (A ) of para gra ph (2 ) of su bs ec tio n (a ) ; th e te rm ‘Se cr et ar y’ 

mea ns (e xc ep t w he n used in para gra ph (3 )(D ) th e Sec re ta ry of H ea lth , 

Edu ca tion , an d W elf are ; an d th e te rm ‘De par tm en t’ mea ns th e D ep ar tm en t of 

H ea lth, E du ca tion , a nd W elfa re .

“ (2 ) The Sec re ta ry is au th or iz ed , th ro ugh a gr ee m en ts or o ther wise, to a rr an ge 

fo r as si gn m en t of officers a nd em ploy ees of S ta te s to th e D ep ar tm en t an d as sign ­

men t to S ta te s of officers an d em ploy ees in th e D ep ar tm en t en ga ge d in wo rk 

re la te d to hea lth, fo r work which th e Sec re ta ry de te rm in es will aid th e D epart ­

men t in mor e eff ective di sc ha rg e of it s re sp on sibi lities in th e field of he al th as 

auth ori ze d by law , incl ud in g co op er ation w ith S ta te s an d th e prov ision of tech ­

ni ca l or oth er as sistan ce . Th e pe riod of as si gn m en t of an y offic er or emplo yee 

under an a rr an gem en t s ha ll n ot e xc ee d t w o ye ar s.

“ (3 ) (A ) Officers an d em plo yees in th e D ep ar tm en t as sign ed to an y Sta te pursu ant to th is su bs ec tio n sh al l be co ns idered , du ring such as sign m en t, to be (i) 

on det ai l to a re gula r wor k as si gn m en t in th e D ep ar tm en t, or (i i) on lea ve 

w ith ou t p ay from t heir po sitio ns in th e D ep ar tm en t.

“ (B ) Per so ns con side red to b e s o de ta iled s hal l re m ai n as officers o r emplo yee s, 

as th e ca se may be, in th e D epar tm en t fo r al l pu rp os es , ex ce pt th a t th e su per ­

vis ion of th eir du ties du ring th e pe riod of det ai l may be go ve rned by ag re em en t 

betw ee n th e D ep ar tm en t a nd th e S ta te involv ed.

“ (C ) In the ca se of perso ns so as sign ed and on leav e w ithou t p ay —

“ (i ) if th e ra te of co m pe ns atio n (inc lu di ng allo wan ce s) fo r th ei r em ­

ploy men t by th e S ta te is les s th an th e ra te of co mpe ns ati on (inc ludi ng 

allo wan ce s) th ey wo uld be re ce iv in g had th ey co ntin ue d in th eir re gu la r 

as sign m en t in th e D ep ar tm en t, th ey may rece ive su pp le m en ta l sa la ry pa ymen ts from th e D ep ar tm en t in th e am ou nt co ns id ered by th e Sec re ta ry to 

be ju stified, but no t a t a ra te in ex cess of th e diffe renc e be tw ee n th e Sta te 

ra te a nd t h e D ep ar tm en t r a t e ; a nd

“ (i i) they may be gra nte d annual le av e an d sic k leav e to th e ex te nt 

au th or iz ed by law , bu t on ly in ci rc um st an ce s co ns id ered by th e Sec re ta ry to 

ju st if y ap pr ov al of su ch leave .

Such officers an d em plo yees on leav e w itho ut pa y sh all, notw ithst an din g an y 

•th e r prov ision of law , be en titled —

“ (i ii ) to co ntinu at io n of th eir in su ra nce und er th e Fed er al Em ploy ees’ 

Group Life In su ra nce Ac t of 1954, arid co ve rage un der th e Fed er al Em ­

plo yees H ea lth Be ne fits Act of 1959, so lon g as th e D ep ar tm en t co nt in ue s to 

co lle ct th e em ploy ee’s co nt ri but io n from th e officer or em plo yee involv ed 

an d to tr ansm it fo r tim el y de po sit in to th e fu nd s cr ea te d un der suc h Acts 

th e am ou nt of th e em ploy ee’s co nt ribu tions an d th e Gov ernm en t’s contr ib uti on fro m a ppro pri at io ns of the D ep art m en t; an d

“ (i v) ( I) in th e ca se of commiss ione d officers of th e Servi ce, to ha ve th eir 

serv ice duri ng th eir as sign m en t tr eate d as prov ided in section 21 4( d) for 

such officers on leav e w ith ou t pa y, or ( I I) in th e case of oth er officers an d 

em plo yees in th e D ep ar tm en t, to cre dit th e pe rio d of th eir as sign m en t un de r 

th e ar ra nge m en t un de r th is su bs ec tio n to w ar d pe rio dic or long ev ity step 

in cr ea se s an d fo r re te ntion an d leav e ac cr ua l pu rpos es, an d, upon pa ym en t 

in to th e civil serv ice re ti re m en t an d dis ab ility fu nd of th e pe rc en ta ge of 

th eir S ta te sa la ry , an d of th eir su pp le m en ta l sa la ry pa ym en ts, if an y. wh ich 

wo uld ha ve b een de du cted from a like Fed er al sa la ry fo r th e pe rio d of such 

as si gn m en t an d pa ym en t by th e Sec re ta ry in to such fu nd of th e am ou nt 

which wo uld ha ve been pa ya bl e by him duri ng t he p erio d of such as sign m en t 

w ith re sp ec t to a lik e F ed er al sa la ry , to tr e a t (n otw ithst an din g th e pr ov ision s of th e In de pe nd en t Offices A pp ro pr ia tio n Act, 1959, under th e he ad 

‘Civil Se rvice R et ir em en t an d D isab ility F und’) th e ir serv ice duri ng such 

pe riod as serv ice w ith in th e m ea ni ng of th e Civ il Se rvice R et irem en t A c t: 

ex ce pt th a t no officer or em ploy ee or his be ne fic iary may re ce iv e an y benefits 

under th e Ci vil Se rvice R et ir em en t Act. th e Fed er al Em ploy ees H ea lth Be nefits 

Act of 1959. or th e F ed er al Empl oy ee s’ Group Life In su ra nce Ac t of 1954. based 

on se rv ice duri ng an as sign m en t her eunder fo r which th e offic er or em plo yee or 

if he di es w ithout m ak in g such elec tio n) his b en eficiary elec ts to rec eive benefits, 

un der an y S ta te re ti re m ent or in su ra nce la w or pr og ra m , which th e Civ il Se rvi ce 

Co mm ission de te rm in es to be si m ilar . The D ep ar tm en t sh al l de po sit cu rr en tly
PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66 7

in th e fu nds cr ea te d under th e F edera l Em ploy ee s’ G ro up Life In su ra nce Act of 

1954, th e F ed er al Em ploy ees H ealth Be ne fit s Ac t of 1959, an d th e ci vi l se rv ice 

re ti re m ent an d di sa bility fu nd , resp ec tiv ely, th e am ou nt of th e Gov er nm en t's 

co nt ribu tion un der th es e Acts on ac co un t of se rv ice w ith re sp ec t to which em ­

plo yee co ntr ib ut io ns are co lle cte d as prov id ed in su bpara gra ph (i ii ) an d th e 

am ou nt of th e G ov er nm en t’s co ntrib ut io n un de r th es e Acts on Se rvice R eti re ­

m en t Act on ac co un t of se rv ice w ith re sp ec t to whi ch pa ym en ts (o f th e am ou nt 

which wou ld ha ve been de du cted und er th a t Act) re fe rr ed to in su bpar ag ra ph 

(i v) are m ad e to su ch civil se rv ice re ti re m ent an d dis ab ility fu nd .

“ (D ) An y su ch officer or em ploy ee on leav e w ithout pa y (o th er th an a com ­

mission ed officer of th e Se rv ice) wh o su ffer s dis ab ility or death as a re su lt of 

pe rs on al in ju ry su st ai ned w hile in th e pe rfor m an ce of his d ut y duri ng an as si gn ­

m en t he re un de r, sh al l be tr eate d, fo r th e pu rp os es of th e F edera l Em ploy ee s’ 

Com pe ns ation Ac t, as th ou gh he w er e an emplo yee , as defin ed in su ch Act, wh o 

ha d su st ai ned su ch in ju ry in th e per fo rm an ce of du ty. W he n such pe rson (o r 

hi s de pe nd en ts, in ca se of death ) en ti tl ed b y re as on of i nju ry or d eath to be nefits 

un der th a t Ac t is also en ti tl ed to benefits from a S ta te fo r th e same in ju ry or 

de ath, he (o r hi s de pe nd en ts in ca se of death ) sh al l elec t whi ch be ne fit s he will 

rec eiv e. Su ch elec tio n sh al l be mad e w ithin one year a ft e r th e in ju ry or de at h, 

or su ch fu rth e r tim e as th e Sec re ta ry of Lab or may fo r goo d ca us e all ow , an d 

whe n mad e sh al l be irre vo ca bl e un less ot he rw ise pr ov id ed by law .

“ (4 ) Assig nm en t of an y officer or em plo yee in th e D ep ar tm en t to a S ta te 

under th is su bs ec tio n may be mad e w ith or w ith ou t re im burs em en t by th e S ta te 

fo r th e co mpe ns atio n (o r su pp le m en ta ry co m pen sa tion), tr avel an d tr an sp o rt ation ex pe ns es (to or from th e plac e of as si gn m en t) , and allowan ce s, or an y p a rt 

th er eo f, of su ch officer or em plo yee duri ng th e pe riod of as sign m en t, an d an y 

su ch re im bu rs em en t sh al l be cr ed ited to th e ap pro pri at io n ut iliz ed fo r pa yi ng 

su ch co mpe ns ation, tr avel or tr ansp ort ati on ex pe nses, or allowa nc es.

“ (5 ) A pp ro pr ia tio ns to th e D ep ar tm en t sh al l he av ai la bl e, in ac co rd an ce 

w ith th e st an da rd iz ed Gov ernm en t tr av el re gu la tion s or. w ith re sp ec t to commission ed officers of th e Se rvice, th e jo in t tr av el re gu la tion s, th e ex pe ns es of 

tr avel o f officers an d em ploy ees as sign ed to S ta te s und er an arr an gem en t un de r 

th is su bs ec tio n on eit her a det ai l or leav e- with ou t-p ay ba sis an d, in ac co rd an ce 

w ith ap pl ic ab le law , or de rs , an d re gu la tion s, fo r exi>enses of tr ansp ort ati on of 

th eir im m ed ia te fa m ilie s an d ex pe ns es o f tr ansp ort ati on of th eir ho us eh old goods 

an d pe rs on al eff ects, in co nn ec tio n w ith th e tr avel of su ch officers an d em plo yees 

to th e lo ca tion of th eir po st s of as sign m en t an d th eir re tu rn to th eir official 

st at io ns .

“ (6 ) Officers an d em ploy ees of S ta te s wh o are as sign ed to th e D ep ar tm en t 

under an ar ra ngem ent under th is su bs ec tio n may (A ) be give n ap po in tm en ts in 

th e D ep ar tm en t co ve rin g th e pe riod s of su ch as sign m en ts, or (B ) be co ns idered 

to be on de ta il to th e D ep ar tm en t. A pp oi ntm en ts of pe rs on s so as sign ed may 

be mad e w ith ou t re ga rd to th e civ il se rv ice laws. Per so ns so ap po in te d in th e 

D epar tm en t sh al l be pai d a t ra te s of co mpe ns atio n de te rm in ed in ac co rd an ce 

w it h th e Class ifi ca tio n Ac t of 1949, an d sh al l no t be co ns id er ed to be officers or 

em ploy ee s of th e Se rvice fo r th e pu rp os es of (A ) th e Civil Se rvice R et ir em en t 

Act, (B ) th e Fed er al Em ploy ee s’ Group Li fe In su ra nce Act of 1954, o r (C ) 

un le ss th eir ap po in tm en ts re su lt in th e los s of co ve rage in a gr ou p healt h benefits pl an w hose p remium has b een pa id in w ho le or in p a rt by a S ta te c ont ribu tion , 

th e F ed er al Em ploy ees H ea lth Be ne fits Ac t of 1959. S ta te officers and e mp loy ees 

wh o are as sign ed to th e D ep ar tm en t w itho ut ap po in tm en t sh al l not be co nsidered 

to be officer s or em ploy ees of th e D ep ar tm en t, ex ce pt as pr ov id ed in su bs ec tio n 

(7 ), no r sh al l th ey be pai d a sa la ry or wag e by th e Se rvice duri ng th e pe rio d 

of th eir as sign m en t. The su pe rv isio n of th e du ties of such pe rson s duri ng th e 

as si gn m en t may be go ve rn ed by ag re em en t betw ee n th e Sec re ta ry an d th e S ta te 

inv olv ed.

“ (7 ) (A ) Any S ta te offic er or em plo yee wh o is as sign ed to th e D ep ar tm en t 

w ithout ap po in tm en t sh al l nev er th el es s be su bj ec t to th e pr ov isions of sections 

203, 205. 207, 208, an d 209 o f t it le 18 o f t he U nited S ta te s Code.

“ (B ) An y S ta te officer or em plo yee who is give n an ap po in tm en t w hi le assig ne d to th e D ep ar tm en t, or who is as sign ed to th e D ep ar tm en t w ithout ap ­

po in tm en t, un de r an a rr an gem en t un de r th is sub se ction, a nd w ho s uf fe rs d is ab ility 

or de at h as a re su lt of pe rs on al in ju ry su st ai ne d w hile in th e pe rf or m an ce of bi s 

duty duri ng such as sign m en t sh al l be tr ea te d, fo r th e pu rp os e of th e Fed er al 

Em ploy ee s’ Com pe ns ation Act, as th ou gh he wer e an em plo yee, as defin ed in 

such Ac t, wh o ha d su st ai ne d su ch in ju ry in th e pe rf or m an ce of du ty . W he n 

such pe rson (o r his de pe nd en ts, in ca se of death ) en ti tl ed by re as on of in ju ry
8 PUBLIC HE AL TH SER VIC ES AM ENDM ENTS OF 1966

or de at h to be ne fits und er th a t Act is also entitled to be ne fits from a S ta te fo r 

th e same in ju ry or de at h, he (o r his de pe nd en ts, in ca se of dea th ) sh al l ele ct 

which be nefits he wi ll receive. Su ch elec tio n sh al l be mad e w ithi n one yea r 

a ft e r th e in ju ry or de at h, or su ch fu rt h e r tim e as th e Sec re ta ry of Lab or may 

fo r good ca us e all ow , an d wh en mad e sh al l be irre vo ca bl e un less oth er w is e pro ­

vid ed by law .

“ (8) The ap pro pri at io ns to th e D epar tm en t sh al l be av aila bl e, in ac co rd an ce 

w ith th e st an dar diz ed Gov ernm en t tr avel re gu la tion s, duri ng th e pe riod of 

as si gn m en t an d in the case of tr av el to an d from th eir plac es of as sign m en t or 

ap po in tm en t, fo r th e pa ym en t of ex pe ns es of tr avel of pe rs on s as sign ed to, 

or give n ap po in tm en ts by, th e Se rvice unde r an arr an gem en t un de r th is 

su bs ec tio n.

“ (9 ) All ar ra ngem en ts un de r th is su bs ec tio n fo r as sign m en t of officers or em ­

plo yees in th e D ep ar tm en t to S ta te s or fo r as si gn m en ts of officers or em plo yees 

of Sta te s to th e D ep ar tm en t sh al l be mad e in ac co rd an ce w ith re gu la tions of th e 

Sec re ta ry .

“G en er al

“ (g )(1 ) All re gu la tion s and am en dm en ts th er et o w ith re sp ec t to gra nts to 

S ta te s un de r subs ec tio n (a ) sh al l be mad e a ft e r co ns ul ta tion w ith a co nferen ce 

of th e Sta te he al th plan ni ng ag en cies de sign at ed or es ta bl is he d purs uant to su bpar agra ph (A ) of para gra ph (2 ) of su bs ec tio n (a ). All re gula tions and am en dmen ts th er et o w ith re sp ec t to g ra n ts to S ta te s und er s ub secti on (d ) sh al l be mad e 

a ft e r co ns ul ta tion w ith a co nf er en ce of S ta te hea lth auth ori ti es an d. in th e case 

of re gu la tion s an d am en dm en ts which re la te to o r in an y way affect g ra n ts fo r 

se rv ices or oth er ac ti vit ie s in th e field of m en ta l he al th , th e S ta te m en ta l hea lth 

au th ori ti es. In so fa r as pra ct ic ab le , th e Su rgeo n G en eral sh al l ob ta in th e ag re emen t, pri or to th e issu an ce of su ch re gul at io ns or am en dm en ts, of th e S ta te 

auth ori ti es or age nc ies w ith wh om su ch c on su ltat io n is requ ired .

“ (2 ) Th e Su rgeo n Gen eral, a t th e re qu es t of an y re ci pi en t of a g ra n t under 

th is secti on , may re du ce th e pa ym en ts to such re ci pi en t by th e fa ir m ar ket va lue 

of an y eq uipm en t or su pp lie s fu rn is hed to such re ci pi en t an d by th e am ou nt of 

th e pa y, allowan ce s, tr av el in g ex pe ns es, an d an y oth er co sts in co nn ec tio n w ith 

th e de ta il of an officer or em plo yee to t he re ci pi en t whe n su ch fu rn is hin g or such 

de ta il, as th e case may be, is fo r th e co nv enien ce of an d a t th e re qu es t of such 

reci pi en t an d fo r th e pu rp os e of carr yin g ou t th e S ta te pl an or th e pro je ct w ith 

re sp ec t to which th e g ra n t unde r th is se ction is ma de. The am ou nt by which 

su ch pa ym en ts are so re du ce d sh al l be av ai la ble fo r pa ym en t of su ch co sts (i nclud in g th e co sts of su ch eq ui pm en t and su pp lies ) by th e Su rgeo n Gen eral, bu t 

sh al l, fo r pu rp os es o f de te rm in in g th e F ed er al sh ar e un de r su bs ec tio n (a ) or (d ), 

be dee med to ha ve been p ai d to th e Sta te .

“ (3 ) W he ne ve r th e Su rgeo n Gen eral, a ft e r re as on ab le no tic e and opp or tu ni ty 

fo r he ar in g to th e hea lth au th o ri ty or, whe re ap pro pri at e, th e m en ta l hea lth 

auth ori ty o f a S ta te or a S ta te healt h pl an nin g ag en cy de sign at ed or es ta bl ishe d 

purs uant to su bp ar ag ra ph (A ) of para gra ph (2) of su bs ec tio n (a ), fin ds th at, 

w ith resp ec t to mo ney pa id to th e S ta te ou t of ap pro pri at io ns und er su bs ec tio n 

( a ) or ( d ) th er e is a f ail ure to co mp ly su bst an tial ly w ith eit her—

“ (A ) th e ap plic ab le pr ov isions o f th is section ;

“ (B ) th e S ta te pl an s ub m itte d u nd er suc h su bs ec tio n ; or 

“ (C ) ap pl ic ab le r eg ul at io ns u nder this sec tio n : 

th e Su rgeo n G en eral sh al l notify su ch S ta te hea lth auth ori ty , m en ta l he al th 

auth ori ty , or he al th pl an ni ng ag en cy , as th e ca se may be, th a t fu rt h er pa ym en ts wi ll no t be mad e to th e S ta te from appro pri at io ns under such subsection (o r in his di sc re tion th a t fu rt h e r pa ym en ts wi ll no t be mad e to th e 

S ta te from su ch ap pro pri at io ns fo r ac ti vit ie s in wh ich th er e is su ch fa il u re ), 

until he is sa tis fied th a t th ere wi ll no lo ng er be such fa ilure . U ntil he is 

so sa tis fie d, th e Su rgeo n Gen er al sh al l mak e no pa ym en t to such S ta te fro m 

appro pri at io ns unde r such subs ec tio n, or sh al l lim it pa ym en t to ac tivitie s 

in wlii'-h th ere is no such f ai lu re .

“ (4 ) F o r th e pu rp os es of th is s ec tio n—

“T he te rm ‘no np ro fit’ as ap pl ie d to any pri vate agency, in st itution, or

org an iz at io n m ea ns one whi ch is a co rp or at io n or as so ciatio n, or is ow ned 

an d oper at ed by one or more co rp or at io ns or as so ciatio ns , no p a rt of th e 

ne t ea rn in gs of which inur es , or may la w fu lly in ur e, to th e benefit of an y 

pri vat e sh ar eh old er o r in d iv id u al: an d

“ (B ) Th e te rm ‘State ’ incl ud es th e Com mon we alth of Puer to Ric o. Gu am , 

American Sa moa , th e Virg in Is la nds, and th e D is tr ic t of Co lum bia , an d,
PUBLIC HEA LT H SER VIC ES AM EN DM EN TS OF 19 6 6 9

ex ce pt w ith resp ect, to para gra phs (5 ) an d (6 ) of su bs ec tio n (d ), th e te rm 

‘Un ite d S ta te s’ m ea ns a ll suc h Sta te s. ”

Sec. 4. Ef fective Ju ly 1. 1967, section 309 of th e Pu bl ic H ealth Se rvice Ac t is 

am en de d by ad di ng a ft e r su bs ec tio n (b ) th e following new s ub se ction :

“ (c ) Ther e are also au th ori ze d to be ap pro pri ate d $5,000,000 ea ch fo r th e 

fiscal year en ding Ju ne 30, 1968, an d th e fiscal yea r en di ng Ju ne 30, 1969, to 

en ab le th e Su rgeo n G en er al to mak e gra nts , under such te rm s an d co nd iti on s as 

may be pr es cr ib ed by re gu la tion s, fo r pr ov ision, in pu blic or no np rofit pri vate 

sch oo ls of pu blic hea lth ac cr ed ited by a body or bo dies reco gn ized by th e S urgeo n Gen eral, of co mpr eh en sive pr of es sion al tr ain in g, sp ec ializ ed co ns ul ta tive 

serv ices, an d tech ni ca l as si st an ce in th e fields of pu blic hea lth and in th e ad ­

m in is tr ati on of S ta te or loc al pu blic hea lt h pr og ra m s, ex ce pt th a t in al lo ca ting 

fu nd s mad e av ai la ble und er th is su bs ec tio n am on g such sch oo ls of pu bl ic 

he al th , th e Su rgeo n G en eral sh al l giv e pri m ar y co ns id er at io n to th e nu m be r of 

fe de ra lly spo ns ored s tu den ts a tt en din g e ac h su ch s chool.”

Sec. 5. Ef fective Ju ly 1, 1967, section 311 of th e Pub lic H ealth Se rvice Act 

is am en de d by ad di ng at th e en d th er eo f th e follo wing ne w se nte nce : “T he 

Su rgeo n G en er al is also au th ori ze d to tr a in pe rs on ne l fo r S ta te an d loc al hea lt h 

wor k. ”

Sec. 6. The am en dm en ts mad e by section 3 sh al l becom e eff ectiv e, an d secti on 318 of th e Pu blic H ea lth Se rvice Ac t sh al l be re pe al ed as of Ju ly 1, 1966, 

ex ce pt th a t th e pr ov isions of section 314 of th e Pu bl ic H ealth Se rvice Ac t as in 

eff ect pri or to th e en ac tm en t of th is Act sh al l be effecti ve until Ju ly 1. 1967. in 

lie u of the pr ov isions o f su bs ec tio ns (d ) an d te ). an d th e p ro vi sion s of su bs ec tio n 

(g ) in so fa r as th ey re la te to su ch su bs ec tio ns (d ) an d (e ), of se ction 314 of th e 

Pub lic H ea lth Se rvice Ac t a s am en de d by th is Act. Ef fective Ju ly 1, 1967, section 

316 of th e Pub lic H ealth Se rvice A ct is re pe al ed .

[H .R . 18231, 89 th Cong., 2d se ss.]

A B IL L To am en d se ction 314 of th e Pub lic H ea lth Se rvice Act to pr om ot e an d assi st in 

th e ex tens io n an d im pr ov em en t of co mpr eh en siv e hea lt h pla nnin g an d pu bl ic he al th 

se rvice s, to pr ov ide fo r a mo re effective use of av ai la ble Fed er al fu nds fo r su ch pl an ni ng 

an d service s, an d f o r oth er pu rp os es

Be it en ac ted by the Sen ate an d Hou se of Rep re se nta tive s of th e United Sta te s

o f Am er ica in Congres s assemb led. T h at th is A ct may be cite d as th e “C om pre ­

he ns iv e H ea lth Pla nni ng an d Pu blic H ea lth Se rvices Amen dm en ts of 1966”.

FINDING S AND DECLARATION OF PURPOSE

Sec. 2. (a ) Th e Co ng ress de cl ar es th a t fu lfillm en t of our nati onal pu rp os e 

de pe nd s on pr om otin g an d as su ri ng th e hig he st lev el of hea lth att ain ab le fo r 

ev er y pe rson , in an en vi ro nm en t which co ntr ib ute s po sitiv ely to healt hfu l in divi du al an d fa m ily livin g; th a t att ain m ent of th is goal de pe nd s on an effecti ve 

par tn ers hip , invo lving close in te rg ov er nm en ta l co llab or at io n, official and vo lu nta ry effo rts , and part ic ip ati on of in di vi dua ls an d org an iz at io n’s ; th a t F ed er al 

fina nc ial as si st an ce m us t be direc te d to su pport th e m ar sh ali ng of al l healt h 

re so ur ce s— na tion al . Sta te , an d loca l—to ass ure co mpr eh en sive hea lth se rv ices 

of high qual it y fo r ev er y prison , but w ithout in te rf ere nce w ith ex is ting p att ern s 

of pri vat e pr of es sion al pra ct ic e of m edici ne, den ti st ry , an d re la te d he al in g art s.

(b ) To carr y ou t su ch pu rpose, an d reco gn izing th e ch an gi ng chara cte r of 

he al th prob lem s, th e Co ng ress finds th a t co mpr eh en sive pl an ni ng fo r hea lth 

service s, hea lth man po wer, an d hea lth fa ci li ti es is es se nt ia l a t ev er y lev el of 

go ve rn m en t; th a t de si ra bl e ad m in is tr ati on re quir es st re ngth en in g th e le ad ers hip 

an d ca pa ci ties of Sta te hea lth ag encie s; an d th a t su pport of healt h se rv ices pro ­

vide d peop le in th eir co mm un iti es sh ou id be br oa de ne d an d m ad e mor e flexib le.

GRANTS FOR COMPREHENSIVE HEALTH PLANNING AND PUBLIC HEALTH SERVICES

Sec. 3. Se cti on 314 of th e Pub lic H ea lth Se rvice Ac t (42 U.S .C. 246 ) is 

am en de d to r ea d as fo llo ws :

“ GRANTS FOR COMPREHENSIVE HEALTH PLANNING AND PUBLIC HEALTH SERVICES

“G ra nts to S ta te s fo r Com preh en siv e S ta te H ealth P la nnin g

“Sec. 314. (a ) (1 ) Aut ho riza tio n.—In ord er to ass is t th e S ta te s in co mpr ehe ns ive an d co nt in ui ng pl an ni ng fo r th eir cu rr en t an d fu tu re healt h ne eds, th e
10 PUBLIC HEA LT H SER VIC ES AM ENDM ENTS OF 19 6 6

Su rgeo n G en eral is au th or iz ed duri ng th e pe rio d be ginn ing Ju ly 1, 1966, an d 

en ding Ju ne 30, 1969, to mak e g ra nts to S ta te s which ha ve su bm itted, an d ha d 

ap pr ov ed by th e Su rgeo n Gen eral, S ta te pl an s fo r co mpr eh en sive S ta te he al th 

plan ni ng . F or th e pu rp os es of carr yin g ou t th is subs ec tio n, th er e are he reb y 

au th or iz ed to he appr opr ia te d $2,500,000 fo r th e fiscal yea r en ding Ju n e 30, 1967, 

$5,000,000 fo r th e fiscal yea r en ding Ju ne 30, 1968, an d $7,500,000 fo r th e fisc al 

yea r en ding J une 30 ,19 69.

“ (2 ) State pl an s for comp rehe ns ive stat e he al th pl an ni ng .—I n ord er to he a pp ro ve d fo r pu rp os es o f t h is sub se ction, a S ta te p la n fo r co mpr eh en sive S ta te 

hea lth p la nn in g mus t—

“ ( A) de sign ate, or prov ide fo r th e es ta blish m en t of. a sing le S ta te agency, 

which may be an in te rd epart m enta l agency, as th e sole ag en cy fo r ad m in ­

is te ri ng or su pe rv isin g th e adm in is tr ati on of th e S ta te ’s healt h pla nn in g 

fu nc tion s un de r th e p la n ;

“ (B ) pr ov id e fo r th e es ta blish m en t of a S ta te hea lth pl an ni ng coun cil, 

which sh al l in clud e re pre se nta tives of S ta te an d loca l ag en cies an d no ngovern m en ta l or ga ni za tion s an d gr ou ps co nc erne d w ith he al th , and of consu m ers of hea lth serv ices, to ad vi se su ch S ta te ag en cy in ca rr yin g ou t its 

fu nc tion s unde r t he p la n ;

“ (C ) se t fo rt h po lic ies an d pr oc ed ur es fo r th e ex pen di tu re of fu nds und er 

th e pl an , wh ich , in th e ju dg m en t of th e Su rgeo n Gen eral, are de sig ne d to 

prov ide fo r co mpr eh en sive S ta te pl an nin g fo r he al th serv ices (both pu blic 

an d p ri v ate ), incl ud in g th e fa cil it ie s and pe rs on s re quired fo r th e prov isi on 

of s uch serv ices, to m ee t th e healt h n ee ds o f t h e i>eople of t he S ta te ;

“ (D ) pr ov id e fo r en co ur ag in g co op er at iv e effo rts am on g go ve rn m en tal or 

no ng ov er nm en tal ag en cies, org an iz at io ns and grou ps co nc erne d w ith hea lth 

serv ices, fa ci lities , or man po wer, an d fo r co op er at iv e ef fo rts be tw ee n such 

ag en cies, or ga ni za tion s, an d gr ou ps an d si m ilar agencie s, or ga ni za tion s, an d 

gr ou ps in t he fields of ed uc ation, w el fa re , a nd r e h a b il it a ti o n ;

“ (E ) co nt ai n or be supi>orted by as su ra nc es sa ti sf acto ry to th e Su rgeo n 

G en er al th a t th e fu nds pa id unde r th is su bs ec tio n will be us ed to su pp lemen t an d, t o th e e xte nt pra ct ic ab le , to in cr ea se t he lev el of f unds th a t wo uld 

ot he rw is e be mad e av ai la ble by th e S ta te fo r th e pu rp os e of co mpr eh en sive 

healt h pl an ni ng an d no t to su ppla nt such non -F ed er al fu nds;

“ (F ) pr ov id e su ch metho ds of adm in is tr ati on (inc lu di ng metho ds re la ting to th e e st ab lish m en t an d m ai nt en an ce of pe rson ne l st andard s on a m er it 

ba sis, ex ce pt th a t th e Su rgeo n G en er al sh al l ex ercise no auth ori ty w ith 

re sp ec t to th e selecti on , te nure of office, an d co mpe ns ation of an y in divi du al em ploy ed in ac co rd an ce w ith such m et ho ds ) as ar e foun d by th e 

Su rgeo n Gen er al to be ne ce ss ar y fo r th e pro pe r an d efficie nt op er at io n of th e 

p la n ;

“ (G ) pr ov id e th a t th e S ta te ag en cy will mak e su ch re po rts, in such 

form an d co nt ai ni ng su ch in fo rm at io n, as th e Su rgeo n Gen er al may from 

tim e to tim e re as on ab ly re qu ire, and w ill ke ep such reco rd s an d affo rd such 

acce ss th er et o as th e Su rgeo n G en er al fin ds ne ce ss ar y to ass ure th e co rr ec tne ss an d ve rifica tio n of su ch r e p o rts ;

“ (I I) pr ov id e th a t th e S ta te ag en cy wi ll from tim e to tim e, but no t les s 

of te n th an an nu al ly , review it s S ta te pl an ap pr ov ed und er th is su bs ec tio n 

an d su bm it to th e Su rgeo n G en er al appro pri ate mod ifi ca tio ns th e re o f;

“ (I ) pr ov id e fo r such fiscal co nt ro l an d fu nd ac co un tin g pr oc ed ur es as 

may b e ne ce ss ar y to as su re p ro pe r dis bu rs em en t of a nd ac co un tin g fo r fu nds 

pai d to the S ta te u nd er thi s su bs ec tio n ; an d

“ (J ) co nt ai n su ch ad di tiona l in fo rm at io n an d as su ra nce s as th e Su rgeon 

G en er al m ay find ne ce ss ar y to carr y ou t th e pu rp os es of th is su bs ec tio n.

“ (3) (A ) State allotm ents.—F ro m th e su ms appro pri at ed fo r su ch pu rpos e 

fo r ea ch fiscal ye ar , th e seve ral S ta te s sh al l be entitled to al lo tm en ts de term in ed , 

in ac co rd an ce w ith re gu la tion s, on th e ba sis of th e po pu latio n an d th e pe r ca pita 

inc om e of th e re sp ec tiv e S ta te s: ex ce pt th a t no such al lo tm en t to an y Sta te 

fo r an y fiscal year sh al l be les s th an 1 per ce nt um of th e sum ap pro pri at ed fo r 

su ch fiscal yea r purs uant to para gra ph (1 ). An y such al lo tm en t to a S ta te fo r 

a fiscal yea r sh al l re m ain av ai la ble fo r ob lig atio n by th e Sta te , in ac co rd an ce 

w ith th e pr ov isions of th is su bs ec tio n an d th e S ta te ’s plan ap prov ed th er eu nd er , 

unti l th e close of the su cc ee ding fi sca l y ea r.

“ (B ) Th e am ou nt of an y al lo tm en t to a S ta te un de r su bpar ag ra ph (A ) fo r 

an y fiscal y ear which th e Su rgeo n Gen er al de te rm in es will no t be re qu ired by 

th e Sta te , duri ng th e pe rio d fo r which it is av ai la bl e, fo r th e pu rpos es fo r which 

allotted sh al l he av ai la bl e fo r re al lo tm en t by th e Su rgeo n G en eral from tim e
PUBLIC HEALTH SERVICES AMENDMENTS OF 1966 11

to time, on such d ate or dates as he may fix, to other States with respect to which 

such a dete rmin ation has not been made, in p roportion to the original allotm ents 

to such States under subparagraph (A) for such fiscal year, but with such proportionate amount for any of such oth er States being reduced to the extent it 

exceeds the sum the Surgeon General estimates such State needs and will be 

able to use durin g such period ; and the total of such reductions shall be simila rly 

reallotted among the States whose prop ortionate amounts were not so reduced. 

Any amount so reallotted to a State from funds appropriated pursuant to this 

subsection for a fiscal year shall be deemed pa rt of its allotmen t under subpar agr aph (A) for such fiscal year.

“ (4) Payments to states.—From each Sta te’s allotment for a fiscal year 

under this subsection, the State shall from time to time be paid the Federal share 

of the expenditures incurred during that year or the succeeding yea r pursuant 

to its State plan approved under this subsection. Such payments shall be made 

on the basis of estimates by th e Surgeon General of th e sums the State will need 

in orde r to perform the planning under its approved State plan under this subsection, but with such adjustments as may be necessary to take account of previously made underpayments or overpayments. The ‘Federal sha re’ for any 

State for purposes of this subsection shall be all, or such pa rt as the Surgeon 

General may determine, of the cost of such planning.

“Project G rants for Areawide Hea lth Planning

“ (b) The Surgeon General is authorized, during the period beginning July 1, 

1966, and ending Jun e 30, 1969, to make, with the approval of the Sta te agency 

administering or supervising the adm inistra tion of the State plan approved 

under subsection (a ), project grants to any other public or nonprofit priv ate 

agency or organization to cover not to exceed 75 per centum of the costs of 

projects for developing (and from time to time revising) comprehensive regional, 

metropolitan area, or other local are a plans for coordination of existing and 

planned health services, including the facilities and persons required for provision of such services; except th at in the case of project gra nts made in any 

State prio r to July 1, 1968, approval of such State agency shall be required only 

if such Sta te has such a State plan in effect a t the time of such grants. For the 

purposes of carrying out this subsection, there are hereby authorized to be appropriated $5,000,000 for the fiscal year ending Jun e 30, 1967, $7,500,000 for the 

fiscal year ending June 30, 1968, and $10,000,000 for the fiscal year ending Ju ne 30, 

1969.

“Pro ject Gran ts for Train ing, Studies, and D emonstrations

“ (c) The Surgeon General is also authorized, during the period beginning July 

1, 1966. and ending Jun e 30, 1969, to make grants to any public or nonprofit 

private agency, institution , or other organization to cover all or any pa rt of the 

cost of projects for training, studies, or demonstrations looking toward the 

development of improved or more effective comprehensive hea lth planning 

thro ughout the Nation. For the purposes of carryin g out this subsection, there 

are hereby authorized to be appropriated $1,500,000 for the fiscal yea r ending 

Jun e 30. 1967, and $2,500,000 each for the fiscal year ending June 30, 1968, and 

for the fiscal year ending Jun e 30,1969.

“Grants fo r Comprehensive Public Health Services

“ (d )( 1) Authorization of appropriations.—There are authorized to be appropriated $62,500,000 each for the fiscal yea r ending Jun e 30, 1968, and for the 

fiscal year ending June 30. 1969, to enable the Surgeon General to make gra nts 

to State hea lth or mental health autho rities to assist the States in establishing 

and maintaining adeq uate public hea lth services, including the training of personnel for State and local hea lth work. The sums so appropriated shall be 

used for making payments to States which have submitted, and had approved by 

the Surgeon General. Sta te plans for provision of public hea lth services.

“ (2) State plans for provision of public health services.—In orde r to be 

approved under this subsection, a State plan for provision of public health services must—“ (A) provide for adm inistra tion or supervision of adm inistra tion by the 

Sta te health autho rity or, with respect to mental health services, the State 

mental h ealth a ut ho rity ;

“ (B) set for th the policies and procedures to be followed in the expenditure of the fund s paid under this subsection ;
12 PUBLIC HEALTH SERVICES AMENDMENTS OF 196 6

“ (C) contain or be supported by assuranc es satisfactory to the Surgeon 

General that (i) the funds paid to the State under this subsection will be 

used to make a significant contribution toward providing and strengthening 

public health services in the various political subdivisions in order to improve the hea lth of the people; (ii) such funds will be made available to 

other public or nonprofit private agencies, institutions, and organizations, 

in accordance with cri ter ia which the Surgeon General determines are designed to secure maximum partici pation of local, regional, or metropolitan 

agencies and groups in the provision of such services; and (iii) such funds 

will be used to supplement and, to the extent prac tical, to increase the level 

of fund s that would otherwise be made available for the purposes for which 

the Federal funds are provided and not to supp lant such non-Federal funds ;

“ (D) provide for the furn ishing of public health services under the State 

plan in accordance with such plans as have been developed pursua nt to subsection (a) ;

“ (E) provide th at public health services furnished under the plan will 

be in accordance with standard s prescribed by regulations, including standard s as to the scope and qua lity of such services ;

“ (F) provide such methods of adm inistration (including methods relat ­

ing to the establishment and maintenance of personnel stan dar ds on a merit 

basis, except th at the Surgeon General shall exercise no authority with 

respect to the selection, tenure of office, and compensation of any individual 

employed in accordance with such methods) as are found by the Surgeon 

General to be necessary fo r the proper and efficient operatio n of the plan ;

“(G) provide that the Sta te hea lth autho rity or, with respect to mental 

health services, the State mental health authority, will from time to time, but 

not less often tha n annually, review and evaluate its State plan approved 

under this subsection and subm it to the Surgeon General appropriate modifications the reof ;

“ (H) provide th at the Sta te hea lth autho rity or, with respect to mental 

health services, the Sta te mental health authority, will make such reports, in 

such form and containing such information, as the Surgeon General may 

from time to time reasonably require, and will keep such records and afford 

such access thereto as the Surgeon General finds necessary to assu re the 

correctness and verification of such re po rts;

“ (I) provide for such fiscal control and fund accounting procedures as 

may be necessary to assure the proper disbursement of an accounting for 

funds paid to the State und er th is subs ection; and

“ (J ) contain such additional information and assurances as the Surgeon 

General may find necessary to carry out the purposes of this subsection.

“ (3) State allotments.—From the sums appropritaed to carry out the provisions of this subsection th e several States shall be entitled for each fiscal ye ar to 

allo tments determined, in accordance with regulations, on the basis of the population and financial need of the respective State s, except that no Sta te’s allotment shall be less for any year than the total amounts allo tted to such State 

und er formula g rants for cancer control, plus other allotments u nde r this section, 

for the fiscal year ending Jun e 30,1967.

“ (4) (A) Payments to states.—From each Sta te’s allotmen t under this subsection for a fiscal year, the State shall be paid the Federal share of the expenditures incurred during such year under its Sta te plan approved under thi s subsection. Such payments shall be made from time to time in advance on the basis of 

estimates by the Surgeon General of the sums the State will expend under the 

Sta te plan, except that such adjustments as may be necessary shall be made 

on account of previously made underpayments or overpayments under this subsection.

“ (B) For the purpose of dete rmining the Fed eral share for any State, expenditures by nonprofit private agencies, organizatio ns, and groups shall, subject to 

such limitations and conditions a s may be prescribed by regulations, be regarded 

as ex pend itures by such Sta te or a political subdivision thereof.

“ (5) Federal shake.—The ‘Federa l sha re’ for any State for purposes of this 

subsection shall be 100 i>er centum less that percentage which bears the same 

ratio to 50 per centum as the per capita income of such State bears to the per 

capita income of the United Sta tes ; except th at in no case shall such percentage 

be less than 33% per centum or more than 66% per centum, and except tha t the 

Federal sha re for the Commonwealth of Puerto Rico, Guam, American Samoa, 

and the Virgin Islands shall be 66% per centum.
PUBLIC HEA LTH SERVICES AMENDMENTS OF 19 66 13

“ (6) Determina tio n of federal sh ar es .—T he Fed er al sh ar es sh al l he d ete rmined by th e Su rgeo n G en eral be tw ee n Ju ly 1 an d Se ptem be r 1 of ea ch ye ar , on 

th e b as is o f th e av er ag e pe r cap it a inc om es o f e ac h of the S ta te s an d of th e United 

S ta te s fo r th e mos t re ce nt y ea r fo r whic h sa ti sf acto ry dat a a re a va ilab le from the 

D ep ar tm en t of Comm erce, an d su ch det er m in at io n sh al l he conc lusiv e fo r th e 

fiscal year be ginn ing on nex t Ju ly 1. The po pu la tion s of th e se ve ra l S ta te s sh all 

be de te rm in ed on th e ba sis of th e la te st figu re s fo r th e po pu la tion of th e se ve ra l 

S ta te s av ai la bl e fr om th e D ep ar tm en t of Co mm erc e.

“ (7 ) Allocation of fu nd s w it h in th e states.—A t le ast 15 per ce ntum of 

a S ta te ’s al lo tm en t un de r th is su bs ec tio n sh al l be av ai la ble on ly to th e Sta te 

m en ta l he al th auth ori ty fo r th e pr ov ision under th e S ta te pla n of m en ta l hea lth 

service s.

“P ro je ct G ra nts f or H ea lth Se rvices Dev elo pm en t

“ (e ) The re are au th ori ze d to he appro pri at ed $62,500,000 ea ch fo r th e fiscal 

ye ar en ding Ju n e 30, 1968, an d fo r th e fis cal yea r en ding Ju n e 30, 1969, fo r 

g ra nts to an y pu blic or no np ro fit pri vate agency, in st it uti on, or or gan iz at io n to 

co ve r p a rt of th e co st of (1 ) pr ov id in g se rv ices to mee t hea lth ne ed s of lim ite d 

ge og ra ph ic sco pe or of sp ec ializ ed re gi on al or nati onal sig nif ica nce, (2 ) st im ula ti ng an d su pp or tin g fo r an in it ia l pe riod ne w pr og ra m s of healt h service s, or 

(3 ) under ta kin g stud ie s, de m on st ra tion s, or tr ain in g de sign ed to develop new 

metho ds or im prov e ex is ting metho ds of pr ov id in g hea lth service s. Su ch g ra nts 

may b e mad e pu rs u an t to clau se (1 ) or (2) of the p rece di ng se nten ce w ith resp ec t 

to pr oj ec ts invo lving th e fu rn is hin g of pu blic hea lth se rv ices only if s uc h serv ices 

are prov id ed in ac co rd an ce w ith su ch pl an s as ha ve been de velop ed purs uant 

to su bs ec tio n (a ).

“I nt er ch an ge of Per so nn el W ith Sta te s

“ ( f )(1 ) F or th e pu rp os es of th is su bs ec tio n, th e term ‘St ate ’ m ea ns a Sta te 

or a po litica l su bd iv isio n of a Sta te , or an y ag en cy of eit her of th e forego ing 

en ga ge d in an y ac ti vit ie s re la te d to hea lth or des ig na te d or es ta bl is he d purs uant 

to su bpar ag ra ph (A ) of para gra ph (2) of su bs ec tio n (a ) ; th e term ‘Se cr et ar y’ 

mea ns (e xc ep t whe n us ed in para gra ph (3 ) ( D ) ) th e Sec re ta ry of H ea lth , 

Edu ca tio n, an d W e lf a re ; an d th e te rm ‘D ep art m ent’ mea ns th e D ep ar tm en t of 

H ea lth, Edu ca tio n, an d W elf are.

“ (2) The Sec re ta ry is au th or iz ed , th ro ugh ag re em en ts or ot he rw ise, to a rra ng e fo r as si gn m en t of officers an d em ploy ees of S ta te s to th e D epar tm en t an d 

as si gn m en t to S ta te s of officers and em ploy ees in th e D ep ar tm en t en ga ge d in 

wor k re la te d to hea lth, fo r wor k which th e Sec re ta ry de te rm in es will ai d th e 

D ep ar tm en t in mor e effecti ve di sc ha rg e of it s re sp on sibi lities in th e field of 

healt h as au th or iz ed by law , in cl ud in g co op er ation w ith S ta te s an d th e prov ision 

of te ch ni ca l or ot her as sistan ce . Th e pe riod of as si gn m en t of any offic er or em ­

plo yee u nde r an a rr an gem en t sh al l no t exceed tw o ye ars.

“ (3 ) (A ) Officers an d em plo yees in th e D ep ar tm en t as sign ed to an y S ta te pursu ant to th is subs ec tio n sh al l be co ns idered , duri ng su ch as sign m en t, to be (i ) on 

det ai l to a re gula r wor k as si gn m en t in th e D ep ar tm en t, or (i i) on leav e w ithout 

pa y fr om th eir po sition s in th e D ep ar tm en t.

“ (B ) Per so ns c on side red to b e so det ai le d sh all rem ai n as officers or emplo yees, 

as th e ca se may be, in th e D ep ar tm en t fo r al l pu rpos es, ex ce pt th a t th e su per ­

visio n of th eir duties du ring th e pe riod of det ai l may be go ve rn ed by ag re em en t 

be tw ee n th e D ep ar tm en t an d th e S ta te invo lved.

“ (C ) In the ca se o f per so ns so as sign ed a nd on le av e w ithout p ay —

“ (i ) if th e ra te of co mpe ns atio n (i nc lu di ng allo wan ce s) fo r th eir em ­

ploy m en t by th e S ta te is less th an th e ra te o f co mpe ns atio n (i nc lu di ng a llow ­

an ce s) th ey wou ld be re ce iv ing had th ey co nt in ue d in th eir re gula r as si gnm en t in th e D ep ar tm en t, th ey may rece iv e su pp le m en ta l sa la ry pa ym en ts 

fr om th e D ep ar tm en t in th e am ount co ns id er ed by th e Sec re ta ry to be ju sti ­

fied, but no t a t a ra te in ex ce ss of th e di fferen ce be tw ee n th e S ta te ra te an d 

th e D ep ar tm en t r a t e ; an d

“ (i i) th ey may be gra nte d annual leav e and sic k leav e to th e exte nt a u ­

th or iz ed by law , but only in ci rc um st an ce s co ns id er ed by th e Sec re ta ry to 

ju sti fy a pp ro va l of su ch leave.

Su ch officers an d em plo yees on leav e w ithout pa y sh al l, notw ithst andin g an y 

oth er p ro vision o f la w, be en titled —

“ (i ii ) to co ntinu at io n of th eir in su ra nce under th e F ed er al Em pl oy ee s’ 

Gr ou p Life In su ra nce Act of 1954, an d co ve rage und er th e F ed er al Em ­

plo ye es H ea lth Ben efits Ac t of 1959, so long as th e D ep ar tm en t co nt in ue s

70-0 50—66------ 2
14 PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66

to co lle ct th e em ploy ee’s co ntrib ut io n from th e offic er or em plo yee inv olv ed 

an d to tr an sm it f or tim ely de po sit in to t he f un ds cr ea te d un de r su ch Ac ts th e 

am ou nt of th e em ploy ee’s co ntr ib ut io ns and th e Gov ernm en t’s co nt ribu tion 

from a ppro pri at io ns o f t he D ep art m en t; a nd

“ (iv) (I ) in th e ca se of co mm iss ion ed officers of th e Servi ce, to ha ve th eir 

se rv ice du ring th eir as sign m en t tr eate d as prov id ed in section 214 (d ) fo r 

su ch officers on leav e w ithout pa y, or (I I) in th e case of oth er officers an d 

em ploy ees in th e D ep ar tm en t, to cre dit th e p er io d of th eir as sign m en t un de r 

th e ar ra ngem ent un de r th is su bs ec tio n to w ar d pe rio dic or long ev ity step 

in cr ea se s an d fo r re te ntion an d leav e accr ual pu rpos es, an d, up on pa ym en t in to th e civil serv ice re ti re m ent an d dis ab ility fu nd of th e pe rc en ta ge 

o f th eir S ta te sa la ry , an d of th eir su pp le m en ta l sa la ry pa ym en ts, if an y, 

which wo uld ha ve been de du cted from a like Fed er al sa la ry fo r th e pe rio d 

of such as sign m en t and pa ym en t by th e Sec re ta ry in to su ch fu nd of the 

am ou nt wh ich wo uld ha ve bee n pa ya bl e by him duri ng th e pe rio d of such 

as sign m en t w ith re sp ec t to a lik e Fed er al sa la ry , to tr e a t (n otw ithst an din g 

th e pr ov isions of th e In dep en de nt Officers A pp ro pr ia tio n Act, 1959, un de r 

th e he ad ‘Civil Se rvice R et ir em en t and D is ab ility F u n d ’) th eir s er vice d ur in g 

such pe riod as se rv ice w ithin th e mea ni ng of th e Civil Se rvice R et ir em en t 

A c t;

ex ce pt th a t no offic er o r e mp loy ee o r his ben eficiary m ay rece ive an y be ne fits un de r 

the Civil Se rvice R et irem en t Act, th e Fed er al Em ploy ees H ea lth Be ne fits Ac t of 

1959. o r t he F ed er al E mploy ee s’ Group L ife I nsu ra nce Act of 1954, ba se d on service 

du ring an as sign m en t he re unde r fo r which th e officer or em plo yee or (i f he dies 

w ith ou t mak in g such elec tio n) hi s be ne fic iary e lects to rec eive ben efits, un der a ny 

S ta te ret ir em en t or ins ur an ce la w o r pr og ra m , w hich t he Civ il Se rvice C om mission 

det er m in es to be si m ilar . Th e D ep ar tm en t sh al l de po sit cu rr en tly in th e fu nd s 

cr ea te d unde r th e F ed er al Em ploy ee s’ Group Life In su ra nce Ac t of 1954. th e 

Fed er al Em ploy ees H ealth Ben efits Ac t of 1959, an d th e civil serv ice re tire m en t 

an d di sa bi lity fu nd , resp ec tiv ely, th e am oun t of th e Gov ernm en t’s co nt ribu tion 

un de r th es e Ac ts on ac co un t of se rv ice w ith re sp ec t to wh ich em plo yee co ntr ibu tion s are co lle cte d as pr ov id ed in su bpar ag ra ph (i ii) an d th e am ou nt of the 

G ov er nm en t’s co ntrib ut io n unde r th e Civil Se rvice R et irem en t Ac t on ac co un t 

o f serv ice w ith re sp ec t to which pa ym en ts (o f th e am ou nt w hic h wo uld ha ve been 

de du ct ed unde r th a t Act) re fe rr ed to in su bpar ag ra ph (iv) are mad e to such 

ci vi l serv ice re ti re m ent an d dis ab ility fu nd .

“ (D ) An y such offic er or em plo yee on leav e w itho ut pa y (o th er t h an a comm ission ed officer of th e Se rvice) wh o su ffer s dis ab ility or de at h as a re su lt of perso na l in ju ry su st ai ned while in th e pe rf orm an ce of hi s duty duri ng an as si gn ­

m en t he re un de r, sh al l be tr eate d, fo r th e pu rp os es of th e Fed er al Em ploy ee s’ 

Co mpe ns ation Act, as thou gh he w er e an emplo yee, as defin ed in su ch Act, who 

had su st ai ne d su ch in ju ry in th e pe rf or m an ce o f du ty. W hen su ch pe rson (o r his 

de pe nd en ts, in ca se of death ) entitled by re as on of in ju ry or dea th to benefits 

under th a t Ac t is also en titled to be ne fits from a S ta te fo r th e same in ju ry or 

dea th , he (o r hi s de pe nd en ts in ca se of death ) sh al l elec t which be ne fits he will 

rec eiv e. Such elec tio n sh al l be mad e w ithi n one yea r a ft e r th e in ju ry or de ath, 

o r su ch fu rt h e r tim e as th e Sec re ta ry of Lab or may fo r goo d ca us e all ow , an d 

whe n mad e sh al l b e irrev oc ab le u nles s o th er w is e pr ov id ed by la w.

“ (4 ) Assignm en t of an y officer or em plo yee in th e D ep ar tm en t to a S ta te und er th is su bs ec tio n may be mad e w ith or w ithout re im bu rs em en t by th e S ta te 

fo r th e co mpe ns ation (o r su pp le m en ta ry co m pe ns at io n) , tr av el an d tr an sp o rt ation ex pe ns es (t o or from th e plac e of as si gnm ent) , and allowan ce s, or an y p art 

th er eo f, of su ch officer or em plo yee duri ng th e pe riod of as sign m en t, an d an y 

su ch re im bu rs em en t sh al l be cr ed ited to th e appro pri at io n utilize d fo r pa ying 

su ch c om pe ns ati on , tr avel or tra nsp ort ati on ex pe ns es, o r a llo wan ce s.

“ (5 ) A pp ro priat io ns to th e D ep ar tm en t sh al l be av ai la bl e, in ac co rd an ce with 

th e st andar diz ed Gov ernm en t tr avel re gula tions or. w ith re sp ec t to co mm issio ne d officers of th e Se rvice , th e jo in t tr av el re gu la tion s, th e ex pe ns es of tr av el 

of officers an d em plo yees as sign ed to S ta te s unde r an arr an gem en t un der th is 

su bs ec tio n on eit her a det ai l or leav e- witho ut -p ay ba si s an d. in ac co rd an ce with 

ap pl ic ab le law . or de rs , an d re gu la tion s, fo r ex pe ns es of tr ansp ort ati on of th eir 

im m ed ia te fa m ilie s an d ex pe ns es of tr ansp ort ati on of th eir ho useh old goods an d 

pe rs on al eff ects, in co nn ec tio n w ith th e tr avel of such officers an d em ploy ees to 

th e loca tio n of th eir po sts of as si gn m en t and th eir re tu rn to th eir official 

st at io ns.

“ (6 ) Officers an d em ploy ees of S ta te s wh o a re assign ed to th e D ep ar tm en t 

und er an arr angem ent unde r th is su bs ec tio n may (A ) be giv en ap po in tm en ts in
PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66 15

th e D ep ar tm en t co ve rin g th e pe rio ds of such as sign m en ts, or (B ) be co ns id ered 

to be on det ai l to th e D ep ar tm en t. A pp oi ntm en ts of pe rson s so as sign ed may be 

mad e w ithout re gar d to th e civil serv ice laws. Pe rs on s so ap po in te d in th e 

D ep ar tm en t sh al l be pai d a t ra te s of co mpe ns atio n de te rm in ed in ac co rd an ce 

w ith th e Class ifi ca tio n Act of 1949, an d sh al l no t be co ns id er ed to be officers or 

em ploy ees of th e Se rvice fo r th e pu rp os es of (A ) th e Civil Se rvice R et irem en t 

Act, (B ) th e F edera l Em ploy ee s’ Group Life In su ra nce Ac t of 1954, or (C ) unless th eir ap po in tm en ts re su lt in th e los s of co ve rage in a gr ou p hea lth benefits 

pl an who se pr em iu m has been pai d in wh ole or in p a rt by a S ta te co nt ribu tion , 

th e F ed er al Em ploy ee s H ea lth Be ne fits Ac t of 1959. S ta te offic ers a nd e mp loy ees 

who are as sign ed to th e D ep ar tm en t w ithout ap po in tm en t sh al l not be co ns idered 

to be officers or em ploy ees of th e D ep ar tm en t, ex ce pt as pr ov id ed in su bs ec tio n 

(7 ), no r sh al l th ey be pa id a sa la ry or wage by th e Se rvice duri ng th e pe riod of 

th eir as sign m en t. The su pe rv isio n of th e duties of su ch pe rson s duri ng th e 

as si gn m en t may be go ve rned by ag re em en t be tw ee n th e Sec re ta ry and th e Sta te 

inv olv ed.

“ (7 ) (A ) Any S ta te officer or em ploy ee wh o is a ss ig ne d to t he D ep ar tm en t w ithout ap po in tm en t sh al l ne ve rthe le ss be su bje ct to th e pr ov isio ns of se ction 203, 

205, 207, 208, a nd 209 of ti tl e 18 of th e United S ta te s Code.

“ (B ) Any S ta te officer o r em ploy ee w ho is given an a pp oi nt m en t w hile a ss ig ne d 

to th e D ep ar tm en t, or wh o is as sign ed to th e D ep ar tm en t w ithout ap po in tm en t, 

un der an arr angem ent un de r th is su bs ec tio n, an d wh o su ffer s dis ab ility or dea th 

as a re su lt of pe rs on al in ju ry su st ai ned w hile in th e pe rf or m an ce of hi s du ty 

duri ng su ch a ss ig nm en t s ha ll be tr ea te d, fo r th e pu rp os e of th e F ed er al E mpl oy ee s’ 

Com pe ns ation Act, as thou gh he w er e an emplo yee, as defin ed in such Act, wh o 

had su st ai ne d such in ju ry in t he per fo rm an ce o f du ty. W he n su ch pe rson (o r his 

de pe nd en ts, in ca se of dea th ) en titled by re as on of in ju ry or dea th to be ne fits 

un de r th a t Act is also en titled to be nefits from a S ta te fo r th e same in ju ry or 

de at h, he (o r hi s de pe nd en ts, in ca se of death ) sh al l elec t which benefits lie will 

receive. Such elec tio n sh al l be mad e w ithin on e year aft e r th e in ju ry or de at h, 

or such fu rt h e r tim e as th e Sec re ta ry of Lab or may fo r good ca us e all ow , an d 

whe n mad e sh al l b e irr ev oc ab le u nl es s o th er w is e pr ov id ed by la w.

“ (8 ) The appro pri at io ns to th e D ep ar tm en t sh al l be av ai la bl e, in ac co rd an ce 

w ith th e st andar diz ed Gov ernm en t tr avel re gu la tions, d uri ng th e p er io d of a ss ig nm en t an d in th e case of t ra vel to and from th eir plac es of as sign m en t or ap po intmen t, fo r th e pa ym en t of ex pe ns es of tr avel of pe rs on s as sign ed to, or giv en 

ap po in tm en ts by, th e Se rvice under an arr angem ent und er th is su bs ec tio n.

“ (9 ) All arr an gem en ts unde r th is su bs ec tio n fo r as si gn m en t of officers or 

em ploy ees in th e D ep ar tm en t to Sta te s or f or as si gn m en ts o f officers o r em plo yees 

of S ta te s to th e D ep ar tm en t sh al l be mad e in ac co rd an ce w ith re gula tion s of th e 

Sec re ta ry .

“G en eral

“ (g )(1 ) All re gu la tion s an d am en dm en ts th er et o w ith re sp ec t to g ra nts to 

Sta te s un der su bs ec tio n (a ) sh al l be m ad e a ft e r co ns ul ta tion w ith a co nferen ce 

of th e S ta te healt h pla nn in g ag en cies des ig na te d or es ta bl is he d pu rs u an t to subpara gra ph (A ) of para gra ph (2 ) of su bs ec tio n (a ). All re gu la tions an d am en dm en ts ther et o w ith re sp ec t to g ra n ts to S ta te s under su bs ec tio n (d ) sh al l be m ad e 

aft e r co ns ul ta tion w ith a co nferen ce of S ta te hea lth auth ori ti es an d, in th e case 

of re gu la tion s and am en dm en ts which re la te to or in an y w ay affe ct g ra n ts fo r 

serv ices or ot her ac ti vit ie s in th e field of m en ta l he al th , th e S ta te m en ta l hea lth 

au th ori ti es. In so fa r as pr ac tica bl e, th e Su rgeo n Gen er al sh al l obt ai n th e ag re emen t, pri or to th e issu an ce of su ch regu latio n's or am en dm en ts, of th e S ta te 

au th o ri ti es or ag en cies w ith wh om such co ns ul ta tion is re qu ired .

“ (2 ) Th e Su rgeo n Gen eral, a t th e re ques t of an y re ci pi en t of a g ra n t und er 

th is section, may re du ce th e pay m en ts to such re ci pi en t by th e fa ir m ar ket va lu e 

of an y eq ui pm en t or su pp lie s fu rn is hed to su ch re ci pi en t an d by th e am ount of 

th e pay. allowan ce s, tr av el in g ex pe nses, an d an y oth er co sts in co nn ec tio n w ith 

th e de ta il of an officer or em plo yee to th e re ci pie nt whe n such fu rn is hin g or su ch 

de ta il, as th e ca se m ay be. is fo r th e co nv enien ce of an d a t th e re ques t of su ch 

re ci pi en t an d fo r th e pu rpos e of carr yin g ou t th e S ta te pl an or th e pro je ct w ith 

re sp ec t to w hich t he g ra n t unde r th is s ec tio n is ma de. The am oun t b y which s uch 

pa ym en ts are so redu ce d sh al l be av ai la bl e fo r pa ym en t of such co sts (i nc lu di ng 

th e co sts of such eq ui pm en t an d su pp lies ) by th e Su rgeo n G en eral, but sh al l, 

fo r pu rp os es of de te rm in in g th e Fed er al sh ar e under subs ec tio n (a ) or (d ), be 

deem ed t o ha ve be en p ai d to th e Sta te .
16 PUBLIC HEA LTH SERVICES AMENDMENTS OF 19 66

“ (3) W he ne ve r th e Su rgeo n G en eral, aft e r re as on ab le no tic e an d op po rtun ity 

fo r he ar in g to th e hea lth auth ori ty or, whe re ap pr opr ia te , th e m en ta l he al th 

auth ori ty of a S ta te or a S ta te hea lth pla nn in g ag ency de sign ated or es tablishe d 

pu rs u an t to su bpar ag ra ph (A ) of para gra ph (2 ) of su bs ec tio n (a ), finds th at, 

w ith re sp ec t to mo ney pai d to th e S ta te ou t of appro pri at io ns und er su bs ec tio n 

(a ) or (d ), th ere is a fa il ure to comp ly su bst anti all y w ith ei th er —

“ (A ) th e ap pl ic ab le pr ov isions of th is section ;

“ (B ) th e S ta te p la n su bm itte d unde r such s ub secti on ; o r 

“ (C ) ap pl ic ab le re gu la tion s under th is se cti o n ; th e Su rgeo n Gen eral sh all 

no tify su ch S ta te he al th auth ori ty , m en ta l hea lth au th ori ty , or hea lth pla nni ng agency, as th e ca se ma y be, th a t fu rt h e r pa ym en ts wi ll no t be ma de 

to th e S ta te from ap pro pri at io ns under su ch subs ec tio n (o r in his disc re tio n 

th a t fu rt h er pa ym en ts wi ll no t be mad e to th e S ta te from such ap pro pri ation s fo r ac tivitie s in whic h th ere is such fa il u re ), unt il he is sa tis fied th a t 

th er e will no long er be su ch fa il ure . U ntil he is so satis fie d, th e Su rgeon 

Gen er al sh al l mak e no pa ym en t to such S ta te from ap pro pri at io ns un de r 

su ch subs ec tio n, or sh al l lim it pa ym en t to ac ti vit ie s in wh ich th ere is no 

such fa ilur e.

“ (4 ) F or th e pu rp os es of this sec tio n—

“ (A ) Th e te rm •nonpro fit’ as ap pl ie d to an y pri vate agency, in st itution, or 

or ga ni za tion m ea ns one which is a co rp or at io n or as so ciatio n, or is ow ned 

an d op er at ed by one or mo re co rp ora tions or as so ciatio ns , no p art of the 

ne t ea rn in gs of which inur es , or may law fu lly in ur e, to th e benefit of an y 

pri vat e sh ar eh old er o r in d iv id u al; a nd

“ (B ) The te rm ‘St ate ’ in clud es th e Co mmon we alth of Puer to Rico, Gu am , 

American Sa mo a, th e Virg in Is la nd s, an d th e D is tr ic t of Co lum bia an d th e 

te rm ‘Unite d S ta te s’ m ea ns th e fif ty S ta te s an d th e D is tr ic t of Colum bia.”

CON TIN UATION OF GRANTS TO SCHOOLS OF PUB LIC HE AL TH

Sec, 4. Ef fective Ju ly 1, 1967, se ction 309 of th e Pu blic H ea lth Se rvice Act is 

am en de d by ad di ng a ft e r su bs ec tio n (b ) th e follo wing new su bs ec tio n:

“ (c) The re are also auth ori ze d to be appro pri at ed $5,000,000 ea ch fo r th e 

fiscal yea r en ding Ju ne 30, 15)68, and th e fiscal yea r en ding Ju ne 30, 15)69, to 

en ab le th e Su rgeo n Gen eral to mak e gra nts , unde r such te rm s an d co nd iti on s 

as may be pr es cr ib ed by re gu la tion s, fo r pr ov ision, in pu blic or no np ro fit pri vat e 

sch oo ls of pu blic hea lth ac cr ed ited by a body or bodie s rec og nized by th e Surge on 

Gen eral, of co mpr eh en sive pr of es sion al tr ai nin g, sp ec ializ ed co ns ul tiv e service s, 

an d te ch ni ca l as si st an ce in th e fields of pu blic hea lth an d in th e adm in is trat io n 

of S ta te or loc al pu blic hea lth pr og ra m s, ex ce pt th a t in al lo ca ting fu nds mad e 

av ai la bl e un der th is su bs ec tio n am on g su ch sch oo ls of pu blic he al th , th e Su rgeon 

G en er al sh al l giv e pri m ar y co ns id er at io n to th e nu m be r of fe der al ly sp on so red 

st uden ts a tt en din g ea ch suc h sch ool.”

CON TIN UATION OF AUTHOR IZATION FOR TRAIN ING OF PERS ONN EL FOR STATE AND LOCAL 

HE AL TH WORK ; COOPERATION BETWEEN TH E STATES

Sec. 5. (a ) Ef fective Ju ly 1, 1966, section 311 of th e Pu bl ic H ea lth Service 

Ac t is am en de d by in se rtin g “ ( a ) ” a ft e r “311.” an d by ad di ng at th e en d of such 

se ction th e fo llo wing new subs ec tio n :

“ (b ) Th e Su rgeo n Gen eral sh al l en co ur ag e co op er at iv e ac ti vit ie s be tw ee n the 

S ta te s w ith re sp ec t to co mpr eh en sive and co nt in ui ng pl an ni ng as to th eir curre n t an d fu tu re hea lth needs, th e es ta bl is hm en t an d m ai nt en an ce of ad eq uat e 

pu blic hea lth serv ices, an d ot he rw is e ca rr yin g ou t th e pu rp os es of section 314.”

(b ) Ef fective Ju ly 1. 1967, section 311 of th e Pu blic H ea lth Se rvice Act is 

fu rt h er am en de d by ad di ng a t th e en d of subs ec tio n (b ) th er eo f th e follo wing 

new se nte nce: “T he Su rgeo n G en er al is also auth ori ze d to tr a in pe rson ne l fo r 

S ta te and lo cal hea lth w or k. ”

EFFE CTIVE DATE AND REPEALER

Sec. 6. The am en dm en ts mad e by se ction 3 sh al l bec ome eff ectiv e as of Ju ly 

1, 1966, ex ce pt th a t th e prov isions of se ction 314 of th e Pu bl ic H ea lth Se rvice 

Act, as in eff ect pri or to th e en ac tm en t of th is Ac t sh al l be eff ectiv e unti l Ju ly 

1. 15)67, in lie u of th e pr ov isions of su bs ec tio ns (d ) an d (e ), an d th e pr ov isions 

of su bs ec tio n (g ) in so fa r as th ey re la te to su ch su bs ec tio ns (d ) an d (e ). of 

section 314 of th e Pub lic H ea lth Se rvice Ac t as am en de d by th is Act. Ef fective 

Ju ly 1, 1967, se ctions 316 an d 318 of th e Pu bl ic H ealth Se rvice Act are repe aled .
PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66 17

REORGAN IZATIOX PLAN

Sec. 7. The provisions enacted by this Act shall be subject to the provisions 

of Reorganization Plan Numbered 3 of 1966.

[S . 300 8, 89 th Con g., 2<J se ss.]

AN AC T To am en d th e Pub lic H ea lth Se rvice Act to pr om ot e an d as si st in th e ex tens ion 

an d im pr ov em en t of co mpr eh en siv e hea lth pla nni ng an d pu blic hea lth services , to pr ovide fo r a more eff ective use of av ai la bl e F ed er al fu nds fo r such pl an nin g an d servi ces , 

an d fo r oth er pu rp os es

Be it enacted by the Senate and House of Represen tatives of the United States

of America in Congress assembled, That this Act may be cited as the “Comprehensive Health Planning and Public H ealth Services Amendments of 1966”.

FIN DING S AND DECLARATION OF PUR POSE

Sec. 2. (a) The Congress declares that fulfillment of our national purpose depends on promoting and assurin g the highest level of health atta inable for every 

person, in an environment which contributes positively to hea lthful individual 

and family liv ing; that attain me nt of this goal depends on an effective pa rtn ership, involving close intergovernm ental collaboration, official and volu ntary efforts, and partici pation of individuals and organiz ations; th at Federal financial 

assistance must be directed to supp ort the marshaling of all hea lth resources— 

national, State, and local—to assure comprehensive health services of high quality for every person, but without interference with existing pat terns of private 

professional prac tice of medicine, dentistry, and rela ted healing arts.

(b) To carry out such purpose, and recognizing the changing chara cte r of 

health problems, the Congress finds th at comprehensive planning for health 

services, health manpower, and health facilities is essential at every level of 

government; that desirable adm inistration requ ires strengthening the lead ership and capacities of State hea lth agencies; and th at su pport of h ealth services 

provided people in the ir communities should be broadened and made more flexible.

NATIONAL HE AL TH POLICY

Sec. 3. In order to assure planning and direction on the national level leading 

to the construction of a national health policy, the Surgeon General is au thorized 

during the period beginning Jul y 1, 1966, and ending Jun e 30, 1972, to conduct 

studies, research, and investigations to establish a coherent set of natio nal health 

goals and to formulate comprehensive guidelines to ass ist States in developing 

health plans consistent with the purposes of this Act.

GRANTS FOR COMPREHEN SIVE HE AL TH PL AN NI NG AND PUB LIC HE AL TH SERVICES

Sec. 4. Section 314 of the Public Hea lth Service Act (42 U.S.C. 246) is amended 

to read as follow s:

“ GRANTS FOR COMPREHEN SIV E HE AL TH PLAN NING AND PUB LIC HE AL TH SERVICES

“Grants to States for Comprehensive State Health Plan ning

“Sec. 314. (a )( 1) Authorization.—In order to assist the States in comprehensive and continuing planning for the ir current and future hea lth needs, the 

Surgeon General is authorized during the period beginning July 1, 1966, and 

ending Jun e 30, 1972, to make gra nts to States which have submitted, and had 

approved by the Surgeon General, State plans for comprehensive Sta te health 

planning. For the purposes of carryin g out this subsection, there are hereby 

authorized to be appropriated $2,500,000 for the fiscal year ending Jun e 30, 1967, 

$5,000,000 for the fiscal year ending Jun e 30. 1968, $10,000,000 each for the fiscal 

year ending Ju ne 30, 1969, and for the fiscal ye ar ending Jun e 30. 1970.

“ (2) State plans for comprehensive state health planning.—In order to 

be approved for purposes of this subsection, a State plan for comprehensive Sta te 

health planning must—

“ (A) designate, or provide for the establish ment of. a single State agency, 

which may be an inte rdepartme ntal agency, as the sole agency for adminis-
18 PU BLI C H EA LTH SE RVIC ES AM EN DM ENTS OF 19 66

te ri ng or su pe rv isin g th e ad m in is tr ati on of th e S ta te ’s h ealt h pla nn in g fu nc ­

tion s unde r th e p la n ;

“ (R ) pr ov ide fo r th e es ta blish m en t of a S ta te hea lth pla nn in g coun cil, 

which sh al l in clud e re pre se nta ti ves of S ta te an d loc al ag en cies an d no ngo ve rn m en tal or ga ni za tion s and gr ou ps co nc erne d w ith he al th , an d of consu m er s of he al th service s, to ad vise su ch S ta te ag en cy in carr yin g out its 

fu nc tion s under th e p la n ;

“ (C) se t fo rt h po lic ies an d pr oc ed ur es fo r th e ex pen di tu re of f un ds un de r 

th e plan , wh ich , in th e ju dg m en t of th e Su rgeo n Gen eral, a re de sig ne d to 

pr ov id e fo r co mpr eh en sive S ta te pl an nin g fo r he al th se rv ices (b ot h pu blic 

an d p ri v ate ), includ ing th e fa cil it ie s an d pe rson s re qu ired fo r th e prov isi on 

of su ch service s, to me et th e healt h ne ed s of th e people of t he S ta te ;

“ (D ) pr ov ide fo r en co ur ag in g co op er at iv e ef fo rts am on g go ve rn m en tal 

or no ng ov er nm en tal ag en cies, org an iz at io ns an d gr ou ps co nc erne d w ith 

hea lth service s, fa ci lities , or man po wer, an d fo r co op er at iv e ef fo rts be tw ee n 

su ch agencie s, or ga ni za tion s, an d gr ou ps an d si m il ar ag en cie s, or ga ni za tion s, 

an d gr ou ps in th e fields of ed uc at io n, w elfa re , are re h a b il it a ti o n ;

“ (E ) co nt ai n or be su pp or te d by as su ra nc es sa tisf acto ry to th e Su rgeon 

Gen er al th a t th e fu nds pai d under th is su bs ec tio n will be us ed to supp lemen t an d, to th e ex te nt pra ct ic ab le , to in cr ea se th e lev el of fu nds th a t wo uld 

ot he rw ise be mad e av ai la ble by th e S ta te fo r th e pu rp os e of co mpr eh en sive 

he al th pl an ni ng an d no t to su ppla nt su ch no n- Fed er al fu nds;

“ (F ) pr ov ide su ch metho ds of a dm in is tr ati on (i nc lu di ng m etho ds re la ting 

to th e es ta bl is hm en t an d m ai nt en an ce of pe rson ne l st an d ard s on a m er it 

ba sis, ex ce pt th a t th e Su rgeo n G en er al sh al l ex er ci se no au th o ri ty w ith re ­

sp ec t to th e selecti on , te nure of office, an d co mpe ns ation of an y in di vi du al 

em plo yed in ac co rd an ce w ith su ch metho ds ) as are foun d by th e Su rgeo n 

G en er al to be ne ce ss ar y fo r th e pro pe r an d efficient op er at io n of t he plan ;

“ (G ) pr ov id e th a t th e S ta te ag en cy will mak e such re po rts, in such form 

an d co nt ai ni ng such in fo rm at io n, as th e Su rgeo n G en eral may from tim e to 

tim e re as on ab ly re qu ire, an d will ke ep su ch reco rd s an d afford such acc ess 

th er et o as th e Su rgeo n Gen er al fin ds ne ce ss ar y to ass ure t he co rr ec tn es s an d 

ve rific ation of su ch re p o rt s;

“ (H ) pr ov id e th a t th e S ta te ag ency will fro m tim e to tim e, bu t no t les s 

of te n th an an nu al ly , review it s S ta te pl an ap prov ed under th is su bs ec tio n 

an d su bm it to th e Su rgeo n G en er al ap pro pri ate mod ifi ca tio ns th ere of;

“ (I) pr ov id e fo r su ch fiscal co ntro l an d fu nd ac co un ting pr oc ed ur es as 

ma y be ne ce ss ar y to a ss ure pro pe r dis bu rs em en t of a nd ac co un ting f or fu nd s 

pa id to th e S ta te u nde r th is sub se ction ; an d

“ (J ) co nt ai n such ad ditio nal in fo rm at io n an d as su ra nce s as th e Su rge on 

Gen eral may find ne ce ss ar y to carr y out th e pu rp os es of th is su bs ec tio n. 

“ (3) (A ) State allotm ents.—F ro m th e su ms ap pro pri at ed fo r su ch pu rpos e 

fo r ea ch fisc al ye ar , th e se ve ra l S ta te s sh al l be en titled to a llotm en ts de term in ed , 

in ac co rd an ce w ith re gu la tion s, on th e ba si s of th e po pu lation an d th e pe r 

ca pita incom e of th e re sp ec tiv e S ta te s; ex ce pt th at no su ch al lo tm en t to an y 

S ta te fo r an y fiscal yea r sh al l be less th an 1 per c en tum of th e sum ap pro pri at ed 

fo r su ch fisc al year purs uant to para gra ph (1 ). Any su ch allotm en t to a Sta te 

fo r a fiscal year sh al l remain av ai la ble fo r ob lig atio n by th e Sta te , in ac co rd ac ne 

w ith th e pr ov isio ns of t h is su bs ec tio n an d th e S ta te ’s pla n ap pr ov ed th er eu nd er , 

un til th e clo se o f th e succ ee ding fis cal y ea r.

“ (B ) Th e am ou nt of an y allotm en t to a S ta te unde r su bpar ag ra ph (A ) fo r 

an y fiscal yea r which th e Su rgeo n G en er al de te rm in es will not be re qu ired by 

th e Sta te , duri ng th e pe rio d fo r which it is av ai la bl e, fo r th e pu rp os es fo r 

which al lo tted sh al l be av ai la ble fo r re al lo tm en t by th e Su rgeo n G en eral fro m 

tim e to tim e, on su ch dat e or dat es as he may fix. to oth er S ta te s w ith resp ec t 

to which su ch a de te rm in at io n has not been ma de, in pr op or tio n to th e or ig inal 

al lo tm en ts to su ch Sta te s under su bpar ag ra ph (A ) fo r su ch fiscal yea r, bu t 

w ith su ch pro po rt io nat e am ou nt fo r an y of such oth er Sta te s be ing redu ce d to 

th e exte nt it ex ce ed s th e sum th e Su rgeo n G en er al es tim at es su ch S ta te needs 

an d will be ab le to us e duri ng su ch pe rio d : an d th e to ta l of such re du ct io ns 

sh al l be si m ilar ly re al lo tted am on g th e S ta te s wh ose pr oport io nat e am ou nt s 

w er e no t so redu ce d. Any am oun t so re al lo tted to a S ta te fro m fu nd s ap pr opri at ed purs u an t to th is su bs ec tio n fo r a fiscal year sh al l be deem ed p a rt of its 

al lo tm en t u nder s ubpar ag ra ph (A ) fo r such fi sca l y ea r.

“ (4) P ay men ts to stat es.—F ro m ea ch S ta te ’s al lo tm en t fo r a fiscal yea r 

un de r th is su bs ec tio n, th e S ta te s ha ll from tim e to tim e l>e pa id th e Fed er al sh ar e
PUBLIC HEALTH SERVICES AMEN DMENTS OF 19 66 19

of th e ex pe ndi tu re s in cu rr ed duri ng th a t year or th e su cc ee ding y ear p u rs u an t 

to it s S ta te pl an ap pr ov ed under th is su bs ec tio n. Su ch pay m en ts sh al l be mad e 

on th e ba sis of est im at es by th e Su rgeo n G en er al of th e s um s th e S ta te w ill need 

in or der to pe rfor m th e pl an ni ng under it s ap pr ov ed S ta te pla n under th is su bsecti on , bu t w ith su ch ad ju st m ents as may be ne ce ss ar y to ta ke ac co un t of 

pr ev io us ly mad e un de rp ay m en ts o r ov er pa ym en ts. Th e ‘Fe der al sh are ’ fo r an y 

S ta te fo r pu rp os es of th is su bs ec tio n sh al l be all. o r su ch p a rt as th e Su rgeo n 

G en er al may de term in e, of th e co st of su ch pla nn in g, ex ce pt th a t in th e ca se 

of th e al lo tm en ts fo r th e fis cal year en ding Ju n e 30. 1970, and fo r ea ch of th e 

ne xt tw o fiscal ye ar s, it sh al l no t ex ceed 75 per ce nt um of su ch cost.

“P ro je ct G ra nts f or Are aw id e H ea lth Pla nn in g

“ (b ) The Su rgeo n G en eral is au th or iz ed , duri ng th e pe rio d be ginn ing Ju ly 1, 

I960, an d en ding Ju n e 30, 1972, to mak e, w ith th e ap pr ov al of th e S ta te ag en cy 

ad m in is te ri ng or su pe rv isin g th e ad m in is tr ati on of th e S ta te pla n ap pr ov ed 

un de r su bs ec tio n (a ), pro je ct g ra nts to an y oth er pu blic or no np rofit p ri vate 

ag en cy or or ga ni za tion to co ve r not to ex ce ed 75 tie r ce nt um of th e co sts of 

pro je ct s fo r de ve loping (a nd fr om tim e to tim e re vi sing ) co mpr eh en sive re ­

gion al, m et ro po lita n ar ea , or oth er loca l are a pl an s fo r co or di na tion of ex is ting 

an d pl an ne d hea lt h service s, in cl ud in g th e fa cil it ie s an d pe rs on s re qu ired fo r 

prov ision of su ch se rv ic es; ex ce pt th a t in th e ca se of pro je ct g ra n ts m ad e in an y 

S ta te pri or to Ju ly 1, 1968, ap pr ov al of such S ta te agen cy sh al l be re quir ed only 

if such S ta te ha s su ch a S ta te pl an in effect a t th e tim e of su ch gra nts . For 

th e pu rp os es of ca rr yin g ou t th is su bs ec tio n, th ere are he reby au th ori zed to be 

appro pri at ed $5,000,000 fo r th e fiscal y ear en ding Ju ne 30, 1967, $10,000,000 

ea ch fo r th e fiscal yea r en ding Ju ne 30, 1968, fo r th e fiscal year en ding Ju n e 30,

1969, a nd f or th e fis cal y ear en ding June 30,1970.

“P ro je ct G ra nts fo r Tra in in g, Studi es , an d D em on st ra tion s

“ (c ) The Su rgeo n G en eral is also au th orize d, duri ng th e pe rio d be ginn ing 

Ju ly 1, 1966, an d en ding Ju ne 30, 1972, to m ak e g ra nts to an y pu blic or no np rofit 

p ri vate agency, in st it uti on, or oth er or ga niz at io n to co ve r al l or an y p art of 

th e co st of pro je ct s fo r tr ai nin g, stud ies, or dem ons trat io ns look ing to w ar d th e 

de ve lopm en t of im prov ed or mor e effecti ve co mpr eh en sive healt h pla nn in g 

th ro ughout th e nat io n. F or th e pu rp os es of ca rr yin g out th is su bs ec tio n, 

th er e are he re by au th ori ze d to be ap pro pri ate d $1,500,000 fo r th e fiscal yea r 

en di ng Ju n e 30, 1967, $5,000,000 ea ch fo r th e fiscal year en di ng Ju ne 30, 1968, 

fo r th e fiscal year en ding Ju n e 30, 1969, an d fo r th e fis cal year en di ng Ju ne 30,

1970.

“G ra nts fo r C om preh en siv e Pub lic H ealth S ervice s

“ (d ) (1 ) Autho riz ation of approp ria tio ns.—T he re are au th ori ze d to be appro pri at ed, $170,500,000 fo r th e fis cal y ear en di ng Ju ne 30, 1968, an d fo r each 

of th e nex t tw o fis cal yea rs $230,700,000 to en ab le th e Su rgeo n Gen er al to mak e 

g ra nts to S ta te hea lth or m en ta l healt h auth ori ti es to ass is t th e S ta te s in es ta blish in g an d m ai nta in in g ad eq uat e pu blic hea lth service s, in cl ud ing th e tr ain in g 

of pe rs on ne l fo r S ta te an d loca l hea lth work. Th e su m s so appro pri at ed sh al l 

be used fo r m ak in g pa ym en ts to Sta te s which ha ve su bm itte d, an d had ap prov ed 

by th e Su rgeo n Gen eral, S ta te pla ns fo r pr ov isio n of pu blic hea lth service s.

“ (2 ) State pl an s for provision of pu bl ic he al th ser vices.—I n ord er to 

be ap pr ov ed unde r th is subs ec tio n, a S ta te pla n fo r prov ision of pu blic he al th 

se rv ices m us t—

“ (A ) pr ov id e fo r ad m in is tr ati on or su pe rv isio n of adm in is tr ati on by 

th e S ta te h ealt h au th o ri ty or, w ith re sp ec t to m en ta l healt h serv ices, the 

S ta te m en ta l healt h auth ori ty :

“ (B ) se t fo rt h th e po lic ies an d pr oc ed ur es to be follo wed in th e ex pe nd itu re of th e fu nds p ai d und er this su bs ec tio n :

“ (C ) co nt ai n or be su pp or ted by as su ra nce s sa ti sf acto ry to th e Su rgeo n 

Gen er al th a t (i ) th e fu nds pai d to th e S ta te und er th is su bs ec tio n will be 

us ed to m ak e a sign ifi ca nt co ntr ib ution to w ar d pr ov id in g an d st re ngth en in g 

pu blic h ea lth ser vi ce s in th e v ar io us pol itic al s ub di vision s in o rd er to im prov e 

th e hea lt h of th e pe op le; (i i) su ch fu nds will be mad e av ai la ble to oth er 

pu blic or no np ro fit pri vate ag en cie s, in st it uti ons, an d or ga niz at io ns, in 

ac co rd an ce w ith cri te ri a which th e Su rgeo n G en er al de te rm in es are de ­

sig ne d to se cu re max im um part ic ip ati on of loc al, re gi on al, or m et ro polita n
20 PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66

age ncies and gro ups in the pro vision of such service s; (iii) such fun ds 

will be use d to sup ple me nt and , to the exten t practic al, to inc rea se the level 

of fund s th at would oth erw ise be made avail ab le for the purpos es for which 

the Fe de ra l fund s ar e pro vided and no t to supp lant such non-F edera l fu nds; 

an d (iv ) public he alth services un der the plan w ill be e sta bli shed and main ­

tain ed for ind ivi duals confined to institu tio ns fo r the menta lly ill and 

me nta lly reta rd ed;

“ (D )p ro vide for the fu rn ishing of pub lic he alth services un der the State 

pla n in acc ord anc e with such pla ns as have been developed pu rs ua nt to sub ­

section (a ) and, effective Ju ly 1. 1970, pro vide th at exc ept to the ex tent pe rmitted in reg ula tions, such serv ices will be provided thereu nd er only to the 

ex tent included in and in a cco rda nce w ith the plans so developed :

“ (E ) provide th at pub lic he alth serv ices furnish ed under the plan will 

be in acc ord anc e with stan da rd s prescribe d by reg ula tions, including 

sta nd ards as to th e scope a nd qu ality of suc h ser vi ce s;

“ (F ) provide such methods of ad minist ratio n (in clu din g methods re la ting to the estab lishm ent and ma int enance of person nel sta nd ards on a merit 

bas is, exc ept th at the Surgeon General shall exe rcise no au th or ity with 

res pect to the selection, tenu re of office, and com pensation of any indiv idu al 

employed in acc ord anc e with such me tho ds) as ar e fou nd by the Surgeon 

General to be necessa ry fo r th e prop er and efficient opera tion of the p la n ;

“ (G) pro vide th at th e State he alth au th or ity or, with respec t to me nta l 

he alth services, th e St ate me nta l he al th au thority , will fro m tim e to time, 

bu t no t less o ften than a nn ually , rev iew and eva luate i ts St ate pla n approved 

un der this subsection and subm it to th e Surgeon Gen eral ap pr op ria te modifica tion s th er eo f:

“ (I I) pro vid e th at the St ate he alth au th or ity or. with res pect to me nta l 

he alth services, th e Sta te me nta l he alth au thor ity , will ma ke such rep orts, 

in such for m an d contain ing such inf orm ation, as the Surgeon Gen eral 

may from tim e to tim e reasonably req uir e, and will keep such rec ord s and 

affo rd such access thereto as th e Surgeon General finds nec ess ary to assure 

the correc tne ss a nd verifi cat ion of such re po rts :

“ (I ) provide fo r such fiscal contr ol and fun d acc ounting pro ced ure s as 

may be nec ess ary to as su re the prop er dis burse me nt of an accoun ting for 

fund s paid to the St ate u nd er th is sub section ; and

“ (J ) contain such ad ditio na l inf ormati on and assurances as the Surgeon 

General ma y find necessa ry to ca rr y ou t the pur poses of this subsection. 

“ (3) State allotments.—Fro m th e sum s ap prop ria ted to ca rry ou t the pro ­

visi ons of this subs ection th e sev era l States shall be en tit led fo r each fiscal 

ye ar to all otm ents det erm ine d, in acc ord anc e with reg ula tions, on the bas is of 

th e popu lation and f inancial need of the resp ect ive S tate s.

“ (4) (A) Payments to states.—From eac h State’s allotm en t under this sub ­

section for a fiscal year, th e Sta te shall be pai d the Fe de ral sh ar e of the exi>endi ture s incu rre d durin g such ye ar un de r its St ate plan app rov ed un der this 

subsection . Such pay me nts shall be made from tim e to tim e in adv ance on the 

basis of estim ate s by the Surgeon General of the sums the State will expe nd 

under the St ate plan , exc ept th a t such ad justm en ts as may be nec ess ary sha ll 

be mad e on acc oun t of previo usl y made underpayme nts or overp ayme nts un der 

th is subsection.

“ (B) Fo r the purpose of deter mi nin g the Fe deral sh are for any Sta te, expe nd itu res by non pro fit pr ivate agencies, organiz ations, and gro ups sha ll, sub ject 

to such lim ita tio ns an d conditio ns as ma y be presc ribed by reg ula tions, be re ­

garded as expend itu res by such St ate or a po litica l subdivision thereof.

“ (5) F ederal share.—The ‘Fed eral sh ar e’ f or any State fo r purpo ses of this 

subsection shall be 100 pe r cen tum less th at per centa ge which bears the sam e 

ra tio to 50 pe r cen tum as the pe r ca pita incom e of such St ate bears to the per 

ca pita income of the United Sta te s; exc ept th at in no case shall such per cen tag e 

be less th an 33% per cen tum or more than 66% per centum, and except th at the 

Fe deral sh are fo r th e Com mon wea lth of Pu erto Rico, Guam , Am eric an Samoa, 

and t he Virgin I sla nd s sha ll be 66% per centum .

“ (6) Determination of federal sha res.—The Fe deral shares sha ll be de te rmine d by th e Surgeon General betw een Ju ly 1 and Sep tem ber I of each yea r, 

on the basis of th e average per ca pita incomes of each of the States and of the 

United States fo r the most rec ent ye ar fo r which sa tis factor y da ta ar e available 

from the De pa rtm ent of Commerce, and suc h deter mi na tio n shall be conclusive 

for the fiscal ye ar beg inning on the ne xt Ju ly 1. The populations of the sev eral
PU BLI C H E A L T H SE RVIC ES AM EN DM ENTS OF 19 66 21

S ta te s sh al l be de te rm in ed on th e ba si s of th e la te st fig ures fo r th e po pu lation 

of th e se ve ra l S ta te s a vai la ble fr om the D ep ar tm en t of C ommerce.

“ (7 ) Allo cat ion of fund s w it h in th e stat es.—At le ast 15 per ce nt um of a 

S ta te ’s al lo tm en t under th is su bs ec tio n sh al l he av ai la ble only to th e S ta te 

m en ta l healt h auth ori ty fo r th e pr ov isio n under th e S ta te pla n of m en ta l hea lth 

serv ices. A t le ast 70 per ce ntum of su ch am ount an d a t le ast 70 per ce nt um of 

th e re m ai nder of a S ta te ’s al lo tm en t under th is su bs ec tio n sh al l be av ai la bl e 

on ly fo r th e pr ov ision und er th a t S ta te pla n of se rv ices in th e co mm un iti es of 

th e St at e.

“P ro je ct G ra nts f or H ea lth Se rvices D ev elo pm en t

“ (e ) Ther e ar e au th ori ze d to be appro pri at ed $100,000,000 fo r th e fiscal yea r 

en di ng Ju n e 30, 1908, $125,000,000 ea ch fo r th e fiscal yea r en di ng Ju ne 30. 1909, 

an d fo r th e fiscal year en ding Ju ne 30, 1970, fo r g ra n ts to an y pu blic or no np rofit 

p ri vate ag en cy , in st it uti on, or org an iz at io n to co ve r p a rt of th e co st of (1 ) 

pr ov id in g serv ices to m ee t hea lth ne ed s of lim ite d ge og ra ph ic sco pe or of 

sp ec ializ ed re gi on al or national sig nif ica nce, (2) st im ula ting an d su pp ort in g 

fo r an in it ia l pe riod n ew p ro gr am s of hea lth serv ices, or (3) undert akin g stud ies, 

de m on stra tion s, or tr ain in g de sig ne d to de velop new metho ds or im prov e ex ­

is ti ng m etho ds of p ro vi di ng hea lth service s. Su ch g ra n ts may be mad e p urs uant 

to clau se (1 ) or (2) of th e pr ec ed in g se nten ce w ith re sp ec t to pro je ct s invo lvin g th e fu rn is hin g of pu blic hea lth serv ice s on ly if su ch se rv ices a re prov id ed 

in ac co rd an ce w ith such pl an s as h av e be en develop ed p urs uant to su bs ec tio n (a ) 

an d, eff ectiv e Ju ly 1, 1970, ex ce pt to th e exte nt perm itte d in re gu la tion s, only 

to th e exte nt su ch se rv ice s are incl ud ed in an d ar e fu rn is hed in ac co rd an ce 

w ith p la ns so dev elo ped.

“In te rc ha nge o f P er so nn el W ith Sta te s

“ (f )(1 ) F or th e pu rp os es of th is subs ec tio n, th e te rm ‘St ate ’ mea ns a S ta te 

or a po litica l su bd ivision of a Sta te , or an y ag en cy of ei th er of th e forego ing 

en ga ge d in an y ac ti vit ie s re la te d to healt h or des ig na te d or es ta bl is he d purs uant 

to su bpar ag ra ph (A ) of para gra ph (2 ) of su bs ec tio n (a ) ; th e te rm ‘Se cre ta ry ’ 

m ea ns (exc ep t wh en used in para gra ph (3) ( D ) ) th e Sec re ta ry of H ea lth , Edu ca ­

tio n, an d W e lf a re ; an d th e te rm ‘D ep art m ent’ m ea ns th e D ep ar tm en t of H ea lth, 

Edu ca tion , an d W elfa re .

“ (2 ) Th e Sec re ta ry is au th or iz ed , th ro ugh ag re em en ts o r ot he rw ise, to a rra ng e fo r as si gn m en t of officers an d em ploy ees of S ta te s to th e D epar tm en t an d 

as sign m en t to S ta te s of officers and em ploy ees in th e D ep art m ent en ga ge d in 

wor k re la te d to hea lth, fo r work which th e Sec re ta ry de te rm in es will ai d th e 

D ep ar tm en t in mor e effecti ve d is ch ar ge o f i ts r es po ns ib ilitie s in th e field of h ea lth 

as au th ori ze d by law , in cl ud in g co op er ation w ith S ta te s an d th e prov ision of 

te ch ni ca l or oth er as si stan ce . The pe riod of as si gn m en t of an y offic er or em ­

plo ye e u nder an a rr an gem en t sh al l no t e xceed t wo ye ars.

“ (3 ) (A ) Officers and em plo yees in th e D ep ar tm en t as sign ed to an y S ta te 

p urs uant to th is subs ec tio n sh al l be co nsidered , duri ng such as sign m en t, to be 

(i ) on det ai l to a re gula r work as si gn m en t in th e D ep ar tm en t, or (i i) on leav e 

w ithout p ay fr om t h eir p os iti on s in th e D ep ar tm en t.

“ (B ) Per so ns co ns id er ed to be so de ta iled sh al l re m ai n as officers or em ­

plo yees, as th e ca se may be. in th e D ep ar tm en t fo r al l pu rpos es, ex ce pt th a t th e 

su pe rv isio n of th eir dut ie s du ring th e p er io d of deta il m ay be go ve rn ed by ag re em en t b etwee n t he D ep ar tm en t a nd th e S ta te in vo lve d.

“ (C ) In the case of pe rs on s so a ss igne d an d on leav e w ithou t pa y—

“ (i ) if th e ra te of co mpe ns ation (inc lu di ng allo wan ce s) fo r th eir em ploy ­

m en t by th e S ta te is les s th an th e ra te of co mpe ns atio n (inc lu di ng 

allo wan ce s) th ey wou ld be rece iv ing had th ey co nt in ue d in th eir re gula r 

as sign m en t in th e D ep ar tm en t, th ey may re ce iv e su pp le m en ta l sa la ry pay ­

men ts from th e D ep ar tm en t in th e am oun t co ns id ered by th e Sec re ta ry to 

be ju stified, but not a t a ra te in ex cess of th e differen ce be tw ee n th e S ta te 

ra te and th e D epar tm en t r a t e ; an d

“ (ii') th ey may be gra nte d an nual leav e an d sic k leav e to th e exte nt 

au th or iz ed by law , b u t only in ci rc um st an ce s co ns id ered by th e Sec re ta ry 

to j u sti fy ap pr ov al of s uc h lea ve.

Su ch officer s an d em ploy ees on leav e w ithout pa y sh al l, notw ithst an din g an y 

oth er pr ov ision of la w, be e ntitled —

“ (i ii ) to co nt in ua tion of th eir in su ra nce und er th e F ed er al Em pl oy ee s’ 

Group Life In su ra nce Act of 1954, an d co ve rage under th e F ed er al Em -
22 PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66

ployees Health Benefits Act of 1959, so long as the Department continues 

to collect the employee’s contribution from the officer or employee involved 

and to transm it for timely deposit into the funds created under such Acts 

the amount of the employee's contributions and the Government’s contribuion 

from appropriations of the Department; and

"(iv) (I) in the case of commissioned officers of the Service, to have their 

service during their assignment treated as provided in section 214(d) for 

such officers on leave without pay, or (I I) in the case of other officers and 

employees in the Depa rtment, to credit the period of their assignment under 

the arrangeme nt under this subsection toward periodic o r longevity step increases and for retention and leave accrual purposes, and, upon payment 

into the civil service retirem ent and disability fund of the percentage of 

their State salary, and of their supplemental salary payments, if any, which 

would have been deducted from a like Federal salary for the period of such 

assignment and payment by the Secretary into such fund of the amount which 

would have been payable by him during the period of such assignment with 

respect to a like Fed eral sala ry, to trea t (notwithstanding the provisions of 

the Independent Offices Appropriation Act, 1959, under the head ‘Civil Service 

Retirement an d Disability Fund’) the ir service during such period as service 

within th e meaning of the Civil Service R etirement A ct;

except that no officer or employee or his beneficiary may receive any benefits under 

the Civil Service Retirement Act, the Federal Employees Hea lth Benefits Act 

of 1959, or the Federal Employees’ Group Life Insurance Act of 1954, based on 

service during an assignment hereunder for which the officer or employee or 

( if he dies without making such election) his beneficiary elects to receive benefits, 

under any State retirem ent or insurance law or program, which the Civil Service 

Commission determines to be similar. The Department shall deposit currently 

in the funds created under the Federal Employees’ Group Life Insu ranc e Act 

of 1954, the Federal Employees Health Benefits Act of 1959, and the civil service 

retirem ent and disability fund, respectively, the amount of the Government’s 

contribution under these Acts on account of service with resj>ect to which employee contributions are collected as provided in subp arag raph (iii) and the 

amount of the Government’s contribution under the Civil Service Retirement 

Act on account of service with respe ct to which payments (of the amount which 

would have been deducted under th at Act) referre d to in subparagraph (iv) 

are made to such civil service retirem ent and disability fund.

"(D) Any such officer or employee on leave without pay (other than a commissioned officer of the Service) who suffers disability or death as a result of 

personal injury sustained while in the performance of his duty during an assig nment hereunder, shall be trea ted, for the purposes of the Federal Employees’ 

Compensation Act, as though he were an employee, as defined in such Act, who 

had sustained such injury in the performance of duty. When such person (or 

his dependents, in case of death ) entitled by reason of injury or d eath to benefits 

under th at Act is also entitled to benefits from a State for the same inju ry or 

death, he (or his dependents in case of dea th) shall elect which benefits he will 

receive. Such election shall be made within one y ear after the injury or death, 

or such furth er time as the Secretary of Labor may for good cause allow, and 

when made shall be irrevocable unless otherwise provided by law.

"(4 ) Assignment of any officer or employee in the Depa rtment t o a State under 

this subsection may be made with or without reimbursement by the State for 

the compensation (or supplementary compensation), trav el and tran spo rtation 

expenses (to or from the place of assignm ent), and allowances, or any part 

thereof, of such officer or employee during the period of assignment, and any 

such reimbursement shall be credited to the appropriation utilized for paying 

such compensation, travel or transp ortation expenses, or allowances.

“ (5) Appropriations to the Department shall be available, in accordance with 

the standardize d Government trav el regulations or, with respect to commissioned officers of the Service, the join t travel regulations, the expenses of trav el 

of officers and employees assigned to States under an arrangement under this 

subsection on eith er a detail or leave-without-pay basis and, in accordance with 

applicable law, orders, and regulations, for expenses of tran spo rtation of their 

immediate families and expenses of transp ortation of their household goods and 

personal effects, in connection with the travel of such officers and employees to 

the location of the ir posts of assignment an d their return to their official stations.

“(6) Officers and employees of States who are assigned to the Department 

under an arra nge ment under this subsection may (A) be given appointments in
PU BLI C H EA LTH SE RVIC ES AM EN DM ENTS OF 1 9 6 6 23

th e D ep ar tm en t co ve rin g th e i>eriods of su ch as sign m en ts, or (B ) be co ns idered 

to be on det ai l to th e D ep ar tm en t. A pp ointm en ts of pe rs on s so as sign ed may 

he mad e w ith ou t re gar d to th e civi l se rv ice law s. Pe rs on s so ap po in te d in th e 

D ep ar tm en t sh al l be pa id a t ra te s of co m pe ns atio n de term in ed in ac co rd an ce 

w ith th e Class ifi ca tio n Act of 1949, an d sh al l no t be co ns id ered to be officers 

or em plo yees of th e Se rvice fo r th e pu rp os es of (A ) th e Ci vil Se rvice R eti re ­

men t Act, (B ) th e Fed er al Em ploy ee s’ Gro up Life In su ra nce Act of 1954, or 

(C ) un less th eir ap po in tm en ts re su lt in th e los s of co ve rage in a grou p he al th 

be ne fits plan wh ose pr em ium has been pai d in who le or in p a rt by a S ta te 

co nt ribu tion , th e Fed er al Em ploy ees H ealth Be ne fit s Ac t of 1959. S ta te officers 

an d em plo yees wh o are as sign ed to th e D epar tm en t w ith ou t ap po in tm en t sh al l 

no t be co ns id ered to be officers or em ploy ees of th e D ep ar tm en t, ex ce pt as provide d in su bs ec tio n (7 ), no r sh al l th ey be pai d a sa la ry or wag e by th e Se rvice 

duri ng th e pe rio d of th eir as sign m en t. The su pe rv isio n of th e duties of such 

pe rson s duri ng th e as si gn m en t may be go ve rned by ag re em en t be tw ee n th e 

Sec re ta ry an d th e S ta te inv olv ed.

“ (7 ) (A ) Any S ta te officer or em plo yee wh o is as sign ed to th e D ep ar tm en t 

w ithou t ap po in tm en t sh al l ne ve rthe le ss be su bj ec t to th e pr ov isio ns of sections 

203, 205, 207, 208, an d 209 of ti tl e 18 of th e U ni te d S ta te s Code.

“ (B ) Any S ta te officer or em ploy ee who is give n an ap po in tm en t while 

as sign ed to th e D ep ar tm en t, or wh o is as sign ed to th e D ep ar tm en t w ith out 

ap po in tm en t, under an arr an gem en t unde r th is subs ec tio n, an d wh o su ffer s di sab ility or de at h as a re su lt of pe rs on al in ju ry s ust ai ned while in th e p er fo rm an ce 

of hi s duty duri ng su ch as sign m en t sh al l be tr eate d, fo r th e pu rp os e of th e 

Fed er al Employ ee s’ Com pe ns ation Act, as tho ug h he were an e mp loy ee, as defin ed 

in su ch Act, wh o ha d su st ai ne d su ch in ju ry in th e pe rf or m an ce of du ty. When 

su ch pe rson (o r his de pe nd en ts, in ca se of death ) en titled by re as on of in ju ry 

or death to be ne fit s und er th at Ac t is also en titled to be ne fit s from a S ta te fo r 

th e same in ju ry or de at h, he (o r his de pe nd en ts, in ca se of death ) sh all elec t 

wh ich be ne fits he will rec eiv e. Such elec tio n sh al l be mad e w ithin on e yea r 

aft e r th e in ju ry or de at h, or su ch fu rt h e r tim e as th e Sec re ta ry of Lab or ma y 

fo r good ca us e all ow , an d wh en mad e sh al l be irre vo ca bl e un less oth er w is e 

prov ided by law .

“ (8) The appro pri at io ns to th e D ep ar tm en t sh al l be av ai la bl e, in ac co rd an ce 

w ith th e st an dar diz ed Gov ernm en t tr avel re gu la tion s, duri ng th e pe riod of 

as sign m en t an d in th e ca se of tr avel to an d from th eir plac es of as si gn m en t or 

ap po in tm en t, fo r th e pa ym en t of ex pe ns es of tr avel of pe rs on s as sign ed to, or 

giv en ap po in tm en ts by, th e Se rvice unde r an arr an gem en t und er th is subs ec tio n.

“ (9 ) All arr an gem en ts under th is su bs ec tio n fo r as sign m en t of officers or 

em plo yees in th e D ep ar tm en t to S ta te s or fo r as si gn m en ts of o fficers or em plo yees 

of Sta te s to th e D ep ar tm en t sh al l be mad e in ac co rd an ce w ith re gula tion s of 

th e Sec re ta ry .

“G en eral

“ (g ) (1 ) All re gu la tion s an d am en dm en ts th er et o w ith re sp ec t to g ra n ts to 

S ta te s unde r su bs ec tio n (a ) sh al l be mad e a ft e r co ns ul ta tion w ith a co nferen ce 

of th e S ta te healt h pl an ni ng ag en cies de sign at ed or es ta bl ishe d p urs uant to 

su bpar ag ra ph (A ) of para gra ph (2 ) of su bs ec tio n (a ). All re gula tion s an d 

am en dm en ts th er et o w ith re sp ec t to g ra n ts to S ta te s und er su bs ec tio n (d ) sh al l 

be mad e aft e r co ns ul ta tion w ith a co nferen ce of S ta te healt h auth ori ti es an d. 

in th e ca se of re gu la tions an d am en dm en ts which re la te to or in an y way affect 

g ra nts fo r serv ices or ot he r ac tivi ties in th e field of m en ta l hea lth, th e Sta te 

m en ta l healt h auth ori ties . In so fa r as pra ct ic ab le , th e Su rgeo n G en er al sh al l 

ob ta in th e ag re em en t, pri or to th e issu an ce of su ch re gul at io ns or am en dm en ts, 

of th e S ta te auth ori ti es or ag en cies w ith wh om su ch co ns ul ta tion is re qu ired .

“ (2 ) The Su rgeo n Gen eral, at th e re qu es t of an y re ci pi en t of a g ra n t unde r 

th is section, may re du ce th e pa ym en ts to su ch re ci pie nt by th e fa ir m ar ket 

va lue of an y eq ui pm en t or su pp lie s fu rn is hed to su ch re ci pi en t an d by th e 

am ou nt of th e pa y, allowan ce s, tr av el in g ex pe ns es, and an y oth er co sts in co nne ction w ith th e det ai l of an officer or em ploy ee to th e re ci pi en t whe n such 

fu rn is hin g or su ch det ai l, as th e ca se m ay be, is fo r th e co nv en ienc e of and at 

th e re ques t of su ch re ci pi en t an d fo r th e pu rp os e of carr yin g out th e S ta te 

plan or th e pr oje ct w ith resp ec t to which th e g ra n t under th is section is ma de. 

The am ou nt by which su ch pa ym en ts are so re du ce d sh al l be avai la ble fo r 

pa ym en t of su ch co sts (inc lu di ng th e co sts of su ch eq uipm en t an d su pp lies ) by 

th e Su rgeo n G en eral, bu t sh al l, fo r pu rp os es of det er m in in g th e F edera l sh are 

un de r su bs ec tio n (a ) or (d ), be deem ed to hav e been pa id to th e Sta te .
24 PUBLIC HEA LTH SERVICES AMENDMENTS OF 19 66

“ (3 ) W he ne ve r th e Su rgeo n Gen eral, a ft e r re as on ab le no tic e an d op po rtun ity 

fo r he ar in g to th e hea lth auth ori ty or, w he re ap pro pri at e, th e m en ta l hea lth 

au th ori ty of a Sta te or a S ta te he al th pl an ni ng ag en cy de sign ated or es ta bl ishe d 

p urs uant to su bp ar ag ra ph (A ) of para gra ph (2 ) of su bs ec tio n (a ), finds th at, 

w ith re sp ec t to mo ney pai d to th e S ta te out of appro pri at io ns unde r su bs ec tio n 

(a ) or (d ), th ere is a fa il u re to comp ly su bst anti all y w ith eit her—

“ (A ) th e a pp lic ab le provisio ns of t h is se ction ;

“ (B ) th e S ta te plan su bm itte d under su ch sub se ction ; or 

“ (C ) ap plic ab le re gu la tion s under th is se ct io n; th e Su rgeo n Gen eral 

sh al l no tify such S ta te he al th au th ori ty , m en ta l hea lth auth ori ty , or he al th 

pl an ni ng agency, as th e ca se may be, th a t fu rt h er pa ym en ts will no t be mad e 

to th e Sta te from ap pr opr ia tions und er such su bs ec tio n (o r in his disc re tio n 

th a t fu rt h e r pa ym en ts wi ll no t be mad e to th e Sta te from such appro pri ation s fo r ac ti vit ie s in wh ich th ere is su ch fa il u re ), unt il he is sa tis fied th a t 

th er e wi ll no long er be such fa il ure . Until he is so satis fie d, th e Su rgeo n 

Gen er al sh al l m ak e no pa ym en t to su ch S ta te fr om app ro pri at io ns und er 

su ch subs ec tio n, or sh al l lim it pa ym en t to ac ti vit ie s in which th ere is no 

such fa ilur e.

“ (4) For th e pu rp os es of th is sec tio n—

“ (A ) The te rm ‘no np ro fit’ as ap pl ie d to an y pri vate agency, in st itution, 

or o rg an iz at io n m ea ns one wh ich is a co rp or at io n or as so ciatio n, or is ow ned 

an d op er at ed by one or more co rp or at io ns or as so ciatio ns , no p art of th e 

ne t ea rn in gs of which inur es , or may la w fu lly in ur e, to th e benefit of an y 

pri vate s ha re hold er o r in d iv id u al; an d

“ (B ) The te rm ‘St ate ’ incl ud es th e Co nn on wea ltl i of Puer to Ric o, Gu am , 

American Samo a, th e Virg in Is la nds , an d th e D is tr ic t of Co lum bia an d th e 

th e ter m ‘Un ite d S ta te s’ m ea ns th e fi fty Sta te s an d th e D is tr ic t of C olum bia.”

CO NTINUATI ON OF GRANTS TO SCHOOLS OF PUBLIC HE AL TH

Sec. 5. Ef fective Ju ly 1, 1967, se ction 309 of th e Pu blic H ea lth Se rvice Ac t is 

am en de d by ad di ng a ft e r su bs ec tio n (b ) th e follo wing new su bs ec tio n :

“ (c ) The re are also au th ori ze d to be a ppro pri at ed $5,000,000 each fo r th e fiscal 

yea r en ding Ju ne 30, 1968, an d th e fis cal year en ding Ju n e 30, 1969, to en ab le th e 

Su rgeo n G en er al to mak e gra nts , unde r su ch te rm s an d co nd iti on s as m ay be pre ­

scrib ed by re gu la tion s, fo r pr ov ision, in pu blic or no np rofit p ri vate sch ools of 

pu blic hea lth ac cr ed ited by a body or bo dies reco gn ized by th e Su rgeo n Gen eral, 

of co mpr eh en sive pr of es sion al tr ain in g, sp ec ializ ed co ns ul tiv e service s, an d 

te ch nic al as si st an ce in th e fie lds of pu bl ic hea lth an d in th e ad m in is tr at io n of 

S ta te or loca l pu blic hea lt h p ro gr am s, ex ce pt t h a t in al lo ca ting fu nds mad e avail ­

ab le un der th is su bs ec tio n am on g su ch sch oo ls of pu blic he al th , th e Su rge on 

G en eral sh al l give pri m ar y co ns id er at io n to th e nu m be r of fe de ra lly si>onsored 

st udents attendin g ea ch such school.”

CONTINUATI ON OF AUTHOR IZATION FOR TRAIN ING OF PERSON NEL FOR STATE AND LOCAL 

HE AL TH WORK ; COOPERATION BETWEEN TH E STATES

Sec. 6. (a ) Ef fective Ju ly 1, 1966, se ction 311 of th e Pub lic H ea lth Se rvice Act 

is am en de d by in se rtin g “ ( a ) ” a ft e r “311 .” and by ad di ng a t th e en d of such 

se ction th e follo wing new su bs ec tio n :

“ (b ) Th e Su rgeo n Gen eral sh al l en co ur ag e co op er at iv e ac tivitie s betw ee n th e 

S ta te s w ith re sp ec t to co mpr eh en sive an d co nt in ui ng p lann in g as to t h eir c urr en t 

and fu tu re hea lt h ne ed s, th e es ta bl is hm en t an d m ai nt en an ce of ad eq uat e public 

healt h serv ices, an d ot he rw ise carr yin g out th e pu rp os es of se ction 314.”

(b ) Effec tiv e Ju ly 1, 1967, se ction 311 of th e Pu blic H ealth Se rvice Ac t is 

fu rt h e r am en de d by ad di ng a t th e en d of su bs ec tio n (b ) th er eo f th e follo wi ng 

ne w se nte nce : “T he Su rgeo n G en er al is als o au th ori ze d to tr a in pe rson ne l fo r 

S ta te a nd loc al h ealt h w or k. ”

EFFE CTIVE DATE AND REPEALER

Sec. 7. The am en dm en ts mad e by section 4 sh al l bec ome effective, an d section 

318 of th e Pub lic H ea lth Se rvice Act sh al l be repe aled , as of Ju ly 1. 1966, ex ce pt 

th a t th e pr ov isio ns of se ctions 314 of th e Pub lic H ea lth Se rvice Act as in effect 

pri or to th e en ac tm en t of th is Ac t sh al l be effecti ve until Ju ly 1, 1967, in lieu of 

th e pr ov isions of su bs ec tio ns (d ) an d (e ), an d th e pr ov isions of su bs ec tio n (g ) 

in so fa r as th ey re la te to su ch su bs ec tio ns (d ) an d (e ), of section 314 of th e
PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66 25

Pu blic Hea lth Serv ice Act as ame nded by th is Act. Effective Ju ly 1, 1967, section 316 of the P ublic He alth Service A ct is repea led.

GRANTS FOR IN IT IA TI NG SERVICES AT MENTAL RETARDATION FA CILITIES

Sec. 8. The Mental Ret ar da tio n Fa cilities an d Com mun ity Me ntal Health 

Ce nte rs Co nstruction Act is amend ed by addin g at th e end of title I, t he following 

new p art :

“P art D—Grants for Costs of I nitiating Services in Community Mental

Retardation Facilities

“authorization of grants

“Sec. 141. Fo r the purpos e of as sis tin g pub lic an d non-profit pr ivate agencies, 

org aniza tio ns, or in stitu tio ns to initi ate, extend, and improve services in facilities 

for the me nta lly re tard ed princ ipally designed to serve th e need s of th e pa rtic ula r com munity or com munities in or ne ar which the facilit y is sit ua ted, th e Secre ta ry may, in accord anc e with the provisio ns of th is pa rt, make gr an ts to mee t 

not to exceed 75 pe r cen tum of th e cos ts (de ter mine d pu rs ua nt to regu lat ion s 

un de r section 144) of pro vid ing servic es in suc h facilities fo r the me nta lly 

ret arde d.

“I n making such gr an ts a ft er J un e 30, 1968, the Se creta ry s ha ll give prefe ren ce 

to new or exp anded servic es par t of th e cos t of which will be borne out of St ate 

or local p ublic fun ds.

“applications and conditions for approval

“Sec. 142. Grants un de r this par t with res pect to a ny f ac ility fo r the me nta lly 

re tard ed ma y be m ade only upon application, a nd only if—

“ (1) th e ap plica nt is a pub lic or non pro fit pr iv at e agency, org aniza tio n, or 

in stitu tio n which ow ns o r o perates th e f ac ility ;

“ (2) the services to be provided by the faci lit y will pro vide pri ncipa lly f or 

per son s res idi ng in a pa rtic ul ar community o r com muniti es in or n ea r which 

such facil ity is sit ua ted, one or m ore of t he ty pes of services fo r t he m ental ly 

re tard ed which ar e deter mi ned by the Secreta ry to be bas ic and nec ess ary 

services fo r the m entally re ta rd ed;

“ (3) th e Se creta ry det erm ine s th at th e typ es of services to be sup ported 

ar e not sufficiently avail ab le in othe r facilities in said comm unitie s;

“ (4) the Se creta ry determines th at , with respect to th e par ticu la r typ e or 

typ es of service to be so assis ted Fe de ral financ ial assis tan ce is not, in fac t, 

avail able to th e ap plican t un der any othe r Act (o r po rtion thereo f) which is 

admini ste red by th e De pa rtm en t of He alt h, Ed uca tion, and We lfare.

“ (5) th e Se creta ry det erm ine s th at there is sa tis factor y assuranc e th at 

Fe de ral fund s made avail able un der this par t for any per iod will be so used 

as to sup plement and , to the ex tent pr actic al, inc rease th e level of Sta te, 

local, and othe r non-F edera l fund s for me nta l re ta rd at io n servic es th at 

wou ld in the absence of such Fe de ral fund s be made av ail ab le for the 

services describ ed in pa ra gr ap h (2) of this subsection , an d will in no eve nt 

supp lan t such Sate, local, and oth er non-Federal fu nds; and

“ (6) in the case of an ap plica nt in a St ate which ha s in exi stence a St ate 

pla n relatin g to th e pro vision of services fo r th e me nta lly retarded , the 

servic es to be pro vided by the facility ar e consistent with the plan .

“payments

“Sec. 143. Pa ym en t of gr an ts un der this par t ma y be made (a ft er nec ess ary 

ad justm en t on acc oun t of pre viously ma de overp ayme nts or underpay me nts ) in 

advance or by way of reimb urs em ent , and on such ter ms and con ditions an d in 

such ins tal lm ents, as the Se cre tar y may det erm ine .

“regulations

“Sec. 144. The Se creta ry sha ll presc ribe general regu lat ion s con cerning the 

eli gib ility of facilities un der this p art, de term inati on of eligible costs with res pect 

to which gr an ts may be made, and the ter ms an d con ditions (in clu din g tho se 

specified in section 142) for app rov ing appli catio ns un der this pa rt.
26 PU BLI C H EA LTH SE RV IC ES AM EN DM ENTS OF 1 9 6 6

“Payments under this part with respect to any project may be made for a 

period of not to exceed five years beginning with the commencement of the first 

fiscal year for which any payment is made.

“ AUTHORIZA TIO N OF APPROPRIA TIO NS

“Sec. 145. There are authorized to be appropriated $1,000,000 for the fiscal 

year ending Jun e 30. 1067, $7,000,000 for the fiscal year ending Jun e 30, 1968. 

$12,000,000 each for the fiscal year ending Jun e 30. 1069, and for the fiscal year 

ending Jun e 30, 1070, to enable the Secretary to make gra nts under the provisions 

of this part.”

DE FIN ITI ON OF CON STRUCT ION

Sec. 0. Subsections (e) and (f) of section 401 of the Mental Retardation 

Facilities and Community Mental Health Centers Construction Act of 1963, as 

amended, are amended to read as follow s:

“ (e) The term ‘construction’ includes construction of new buildings, acquisition of existing buildings, and expansion, remodeling, alte ration, and renovation 

of existing buildings, and initial equipm ent of such new, newly acquired, expanded, remodeled, altered, or renovated buildings.

“ (f) The term ‘cost of construction ’ includes the cost of architects’ fees and 

acquisition of land in connection with construction, hut does not include the cost 

of off-site improvements.”'

Sec. 10. The Mental Retardatio n Facilities and Community Mental Health 

Centers Construction Act of 1963 is amended by adding at the end thereof 

the following:

“TITLE V—TRAINING OF PHYSICAL EDUCATORS AND RECREATION

PERSONNEL FOR MENTALLY R ETARDED AND OTHER HANDICAPPED

CHILDREN

“ GRANT ; AUTH OR IZA TIO N OF APPROPRIA TIO NS

“Sec. 501. (a) The Secretary is authorized to make gra nts to public and other 

nonprofit institutions of higher learning to ass ist them in providing professional 

or advanced training for personnel engaged or preparing to engage in employment as physical educ ators or recreation personnel for mentally retarded and 

other handicapped children or as supervisors of such personnel, or engaged or 

prep aring to engage in research or teaching in fields rela ted to the physical 

education or recreation of such children.

“ (b) For the purpose of making the gra nts authorized under subsection (a), 

there is authorized to be appropriated for the fiscal year ending June 30, 1968, 

$1,000,000, fo r the fiscal year ending June 30, 1969, and for the fiscal year ending 

Jun e 30, 1970, $2,000,000 each. Any sums appropriated for any such fiscal year 

and not obligated before the end there of shall remain available for the succeeding 

fiscal year for the purpose for which appropriated .

“ RESE ARC H AN D DEM ONSTR ATION PROJECT S IN PH YSI CAL EDUCATION AN D RECREATION

FOR ME NT AL LY RETARDED AN D OTHER HA ND ICAP PE D CH ILD REN

“Sec. 502. (a )( 1) There is authorized to be appropriated for the fiscal year 

ending Jun e 30, 1968, $1,000,000, and for each of the two succeeding fiscal years, 

$1,500,000, to enable the Secretary to make gra nts to States, State or local 

educational agencies, public and nonprofit private institu tions of higher learning, 

and other public or nonprofit private educatio nal or research agencies and 

organizatio ns, for research or demonstration projects rela ting to physical education or recreation for mentally retarded, hard of hearing, deaf, speech 

impaired, visually handicapped, seriously emotionally disturbed, crippled, or 

other children with specific or serious learning disabilities, who by reason thereof 

require special or modified physical education and recreation activities to 

enhance their physical and mental development.

“ (2) Grants under paragraph (1) shall be made in installments, in advance 

or by way of reimb ursem ent, and on such conditions as the Secretary may 

determine.

“ (b) The Secretary shall from time to time appoint panels of expe rts who are 

competent to evaluate v arious types of research or demonstration projects under
PUBLIC HEALTH SERVICES AMEN DMENTS OF 196 6 27

this section, and shall secure the advice and recommendations of one such panel 

before making any grant under this section.

“ ADVISORY COMMITTEE

"Sec. 503. (a )( 1) The Secretary shall appoint an advisory committee which 

shall consist of fifteen members to advise him on ma tters of general policy 

rela ting to the adm inistration of this title. Seven members of such committee 

shall be individuals from the field of physical education, five members thereof 

shall be individuals from the field of recre ation, and three members thereof shall 

be individuals wtih experience or special i nte res t in the education of the me ntally 

retarded or other handicapped children.

*■ “ (2) The Secretary shall, from time to time, designated one of the members

of such committee to serve as the chairman thereof.

“ (b) Members of th e advisory committee and members of any panel appointed 

pursu ant to section 502(b), who are not regular full-time employees of the 

United States, shall, while serving on the business of such committee or such

• panel, be entitled to receive compensation at rates fixed by the Secre tary, but

not exceeding $100 per day, including travel time; and, while so serving away 

from their homes or regular place of business, they may be allowed tra vel expenses, including per diem in lieu of subsistence, as authorized by section 5 of 

the Adm inistrative Expenses Act of 1940 (5 U.S.C. 73b-2) for persons in the 

Government service employed intermittently.

“delegation of functions

“Sec. 504. The Secretary is authorized to deleg ate any of his functions under 

this title to any officer or employee of the Departme nt of Health, Education, 

and Welfare.”

REORGANIZATION PLA N

Sec. 11. The provisions enacted by this Act shall be subject to the provisions 

of Reorg anization Plan Numbered 3 of 1966.

Passed the Senate October 3,1966.

At test: FRANCIS R. VALEO,

Secretary.

Department of Health, Education, and Welfare,

Washington, D.C., March 25, 1966.

Hon. Harley O. Staggers,

Chairman, Committee on Int ers tate and Foreign Commerce,

House of Representatives,

Washington, D.C.

Dear Mr Chairman : This is in response to your request of March 7. 1966. 

for a report on H.R. 13197. the “Comprehensive Health Planning and Public 

Health Services Amendments of 1966”.

This bill embodies the provisions of a dr aft bill transm itte d by us to the 

Congress in order to carry out the recommendations for gra nts to States for 

comprehensive he alth planning and services contained in the President’s message 

to th e Congress on domestic health and education.

We urge th at your committee give favorable consideration to this bill and 

th at it be enacted by the Congress.

Sincerely.

Wilbur J. Cohen,

Acting Secretary.

Comptroller General of the United States,

D.C., April 13, 1966.

Hon. Harley O. Staggers.

Chairman, Committee on Inter sta te and Foreign Commerce,

House of R epresentatives.

Dear Mr. Chairman : Your lette r of March 7, 1966, requests our comments 

on H.R. 13197, which, if enacted, would be cited as the “Comprehensive Health 

Planning and Public H ealth Services Amendments of 1966.”
28 PUBLIC HE AL TH SER VIC ES AM ENDM ENTS OF 1966

The pu rp os e of th e bill is st ate d in it s ti tl e as be ing to pr om ote an d as si st in 

th e ex tens ion an d im prov em en t of co mpr eh en sive hea lth pl an ni ng an d publi c 

healt h serv ice s an d to pr ov ide fo r a mor e effecti ve us e of av ai la ble Fed er al 

fu nds fo r su ch pl an ni ng an d service s. We ha ve no spec ial in fo rm at io n on th e 

des ir ab ility of th e prop osed legi slatio n an d sin ce th e pu rpos e th er eo f ap pea rs to 

be a m att er of pol icy pri m ar ily fo r th e Co ng ress to de term in e, we ha ve no 

re co m men da tio ns to off er co nc erni ng th e m eri ts of th e bill. How ev er, we offer 

th e fo llo wing comm ents fo r co ns id er at io n of you r c om mittee .

Secti on 3 of th e pro po sed bi ll wou ld am en d se ction 314 of th e Pu blic H ea lth 

Se rvice Act to pr ov ide fo rm ul a an d pro je ct gra nts to Sta te s and oth er pu blic 

or no np rofit p ri vate ag en cies an d org an iz at io ns to be us ed fo r hea lth pl an ni ng 

an d es ta blish m en t an d m ai nt en an ce of ad eq uat e pu blic hea lth service s. In 

or de r to be eligible fo r fu nd s, S ta te s wou ld be re qu ired to su bm it S ta te pl an s 

fo r co mpr eh en sive Sta te hea lth p lann in g.

Secti on 314 (g )( 3 ) of th e Pu blic H ealth Se rvice Act as am en de d by th e bil l 

wo uld au th or iz e th e Su rgeo n G en eral, a ft e r re as on ab le no tic e to th e gr an te e, 

to w ith ho ld fu rt h er pa ym en ts from ap pro pri ate d fu nds if th ere is a fa il ure 

to su bs ta nt ia lly com ply w ith ap pl ic ab le legi slatio n, S ta te pl an s, or regu la tio ns .

A si m ilar prov ision is now co nt ai ne d in section 314 of th e Pu blic H ea lth 

Se rvice Act. We ha ve been in fo rm ed by Pub lic H ealth Se rvice officia ls th a t to 

th eir kn ow led ge th e Su rgeo n Gen er al has ne ve r ex ercise d hi s auth ori ty un de r 

th is prov ision to w ith ho ld pa ym en ts to th e S ta te be ca us e of no nc om plian ce w ith 

ap plicab le legi slatio n. S ta te plan s, or re gu la tion s. W e ha ve ob served , howe ver, 

th a t D ep ar tm en t of H ea lth . Edu ca tion , an d W el fa re au dit ors ha ve ta ken nu m er ­

ous ex ce ptions to ex pe nd itur es of F ed er al healt h gra nt fu nd s a s no t being in 

ac co rd an ce w ith ap pl ic ab le re qu irem en ts. We ha ve fu rt h er ob served th at p u rsu ant to th e D ep ar tm en t’s adm in is tr ati ve pr oc ed ur es , th e Sta te s ha ve not been 

re qu ired to eit her re pa y th e am ou nt of th e ex ce pt ions or to dem onst ra te th a t 

ot her ex pe nd iture s were mad e in ac co rd an ce w ith ap plicab le re qu irem en ts in 

th e sa m e ye ar in which th e gra nt fu nd s were pa id to th e S ta te s which could be 

rec og nized as su bst itute s fo r th e exi>endit ures to which ex ce ptions were take n.

Since, fo r th e mos t part , audit s by th e D ep art m ent’s audit ors of g ra n t fu nd s 

are mad e fro m one to th re e yea rs a ft e r th e g ra n t fu nd s ha ve bee n expe nd ed , th e 

Su rgeon G en eral does no t ha ve al l curr ent in fo rm at io n co nc erning no nc om plian ce 

by th e g ra n t re ci pi en t w ith ap pl ic ab le legi slatio n. S ta te pl an s, or re gul at io ns 

an d. th er ef or e, is no t in a po sition to ex er ci se hi s auth ori ty to w ith ho ld fu nd s 

a t th e tim e th e no nc om plian ce ex ists. In th e ligh t of th es e circ um stan ce s, th e 

co mm itt ee may wish to in clud e in th e hill lang ua ge which wo uld re quir e th e 

g ra n t recipient , to re pa y to th e U ni ted S ta te s th e am ou nt of Fed er al gra nt fu nd s 

whic h are de term in ed to ha ve been ex pe nd ed not in ac co rd an ce w ith ap plicab le 

legi slatio n, S ta te p lans , or re gu la tion s.

Th e bil l doe s no t prov ide cri te ri a to be us ed by th e Su rgeon G en er al in dete rmin ing th e Fed er al sh ar e of (1 ) fo rm ul a g ra nts fo r co mpr eh en sive S ta te he al th 

pl an ni ng un de r section 314 (a ) ; (2 ) pr oj ec t g ra n ts fo r ar ea w id e hea lth pl an ni ng 

un de r section 31 4( b) ; (3 ) pro je ct g ra nts fo r tr ai ni ng, stud ies, an d dem on st ra ­

tion s fo r co mpr eh en sive hea lth pl an nin g unde r section 31 4( c) ; an d (4) pr oj ec t 

gra nts f o r he al th se rv ices de ve lopm en t und er secti on 314(e ). Also , th e bill does 

no t prov ide cri te ri a to be used by th e Su rgeo n G en eral in th e al lo tm en t of gra nt 

fu nd s fo r pr og ra m s au th or iz ed by se ction 314(b ), (c ), an d (e ). The co mmittee 

may wish to includ e in th e bill specific cri te ri a to be used by th e Su rgeo n Ge ner al in de te rm in in g th e Fed er al sh are an d th e al lo tm en t of fu nds fo r th e 

af or em en tion ed pr og ra m s au th ori ze d by th e bill.

Se ctions 3 1 4 (a )(2 )( G ) an d 3 1 4 (d )(2 )(H ) of th e Pu blic H ea lth Se rvice Act 

as am en de d by th e bil l wo uld re quir e th e S ta te ag en cy to mak e such re po rts, in 

such form , an d co nt ai ni ng such in fo rm at io n as is re qu ired by th e Surge on 

Gen eral. Also, se ctions 314(a ) (I) an d 314 (d ) (2) (I ) wo uld re quir e such fisc al 

co ntro l an d fu nd ac co un tin g pr oc ed ur es as may be ne ce ss ar y to as su re th e pr op er 

di sb ur se m en t of an d ac co un ting fo r fu nd s pa id to th e St at es . How ev er, no pr ovis ion is m ad e in th e hil l w ith re sp ec t to th e oth er prop osed gra nt pr og ra m s 

re qui ring a gra nte e to keep ad eq uat e co st reco rd s of th e pro je ct s to which th e 

Fed er al Gov ernm en t mak es fina nc ial co nt ribu tion s, no r is th ere an y pr ov ision in 

th e bil l spec ifica lly auth or iz in g th e S ecr et ar y of H ea lth, Edu ca tio n, an d W el fa re 

or th e Com pt ro lle r G en eral to ha ve ac ce ss to th e gra nte e’s reco rd s fo r pu rp os es 

of au d it an d ex am in at io n. In view of th e in cr ea se in gra nt pro gr am s ov er th e
PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66 29

last several years, we feel that in order to determine whether gra nt funds have 

been expended for the purpose for which the gra nt was made, the grantee 

should be required by law to keep records which fully disclose the disposition 

of such funds. We also feel that the head of the agency as well as the General 

Accounting Office should be permitted to have access to the g rantee’s records for 

the purpose of audit and examination. We therefo re suggest that consideration be given to adding a new section to the bill including such requirements 

with respect to the proposed new gra nt program s. This could be accomplished 

by the following lan guage:

‘’records and audit

“ (a) Each recipient of assistance under this Act shall keep such records as 

the Surgeon General shall prescribe, including records which fully disclose the 

amount and disposition by such recipient of the proceeds of such grants, 

the tota l cost of the project or und ertaking in connection with which such funds 

are given or used, and the amount of th at portion of the cost of the project 

or und ertaking supplied by other sources, and such other records as will 

fac ilitate an effective audit. “ (b) The Secretary of Health. Education, and Welfare ami the Comptroller 

General of the United' States, or any of the ir duly au thorized rep resentatives, sh all 

have access for the purpose of aud it and exam ination to any books, documents, 

papers, and records of the recipients tha t are pertinent to the gra nts received 

under this Act.” Language similar to th at suggested above under other parts of the Public 

Health Service Act is codified in sections 280b-ll, 291d(10) and (11), and 299i 

of title 42. United States Code. There appears to be a typographical err or in lines 10 and 11, page 18 of the 

bill. Also, the word “Service” should either be defined or changed to “Public 

Health Service.”

Sincerely yours, Frank H. Weitzel,

Assistant Comptroller General of the United State s.

Civil Service Commis sion, 

Washington, D.C., May 13,1966.

Hon. Harley O. Staggers,

Chairman, Committee on Int ersta te and Foreign Commerce, House of Representatives.

Dear Mr. Chairman : This is in furth er reply to your request for the views 

of the Civil Service Commission on H.R. 13197, a bill “To amend the Public Health 

Service Act to promote and assist in the extension and improvement of comprehensive health planning and public health services, to provide for a more effective use of available Federal funds for such planning and services, and for other 

purposes.” This legislation would perm it closer collaboration among all levels of Government and private health resources to assure high qua lity comprehensive health 

services for our entire population. The Civil Service Commission supp orts thi s 

objective and is in agreement with the specific provisions of the bill.

Of particular inte rest to the Civil Service Commission is section 3 of the bill 

which amends section 314 of the Public Health Service Act. Section 3 authorizes 

gra nts to States to aid in comprehensive planning, health services and training, 

and sets the conditions under which gra nts may be made. An imp orta nt condition contained therein is that Sta te plans for comprehensive Sta te health planning, and for the provision of comprehensive public hea lth services must, if they 

are to receive F ederal funds, contain m erit system featur es which meet standard s 

set by th e Surgeon General.

To increase the effectiveness of joint Fed eral-State programs, the .bill authorizes temp orary interchanges of personnel between the Public Health Service 

and State hea lth jurisdictions. This fea tur e (subsection (f), beginning on page 

14, line 15) closely p arallels two interchange autho rities alre ady existing and of 

proven value—section 507 of P.L. 89-10 which provides for interchanges between 

the Office of Education and the States, and P.L. 84-918 which provides for 

intercha nges between the Department of Agriculture and the States.

7 0 -0 5 0 —Gi 3
30 PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66

The Civil Service Commission has long favored the interchange idea as a means 

of improving governmental service at all levels, and accordingly endorses this 

fea tur e of the bill.

With the steady rise in the number of joint Fed eral-State programs, the need 

for greater sharing of knowledge and skills by the various levels of Government 

is becoming increasingly apparen t. With this in mind the Commission is developing a legislative proposal which would apply generally and would authorize 

the head of any Federal agency to arrang e for the temp orary assignment of 

employees of his agency to a Sta te when work of mutual concern to his agency 

and the Sta te is involved, and when he determines that the arra ngemen t would 

,be beneficial to both.

The Commission has two technical points to mention: (1) on page 18, line 10. 

the words “these Acts on” should be, for purposes of accuracy, replaced by the 

words “the Civil” so th at sentence would r ead “. . . the Government’s contribution 

under the Civil Service Retirement Act . . .”, and (2) on page 24, line 19, an 

“ (A )” is apparen tly missing between the opening quotation marks and the first 

word of the paragra ph which begins on t ha t line, since the following paragraph, 

page 25, line 1, is preceded by “ (B )”.

The Bureau of the Budget advises that from the standpoint of the Administratio n’s program there is no objection to the submission of this report.

By direction of the Commission:

Sincerely yours,

J ohn W. Macy, Jr., Chairman.

The Chairman. We are happy to welcome as our first witness 

this morning Dr. William H. Stewart, the Surgeon General of the 

Public Health Service.

Di'. Stewart, you may proceed, and, as I have said, we will try 

to complete this hearing today; so, if you have a long statement, if 

you would put it in the record and summarize it, we would appreciate 

it.

STATEMENT OF DR. WILLIAM H. STEWART, SURGEON GENERAL ,

PUBLIC HEALTH SER VICE, DEPAR TMENT OF HEALTH, EDUCATION, AND WEL FA RE ; ACCOMPANIED BY DR. PH IL IP LEE, ASSIST ANT SECRETARY FOR HE AL TH AND MEDICAL AF FA IR S;

SAM A. KIM BLE , ASSOCIATE CH IEF FOR GRANTS, BUREAU OF

STATE SER VICES; AND WILLIAM HISCOCK, DEP UTY CH IEF , DIVISION OF PUBLIC HEALTH METHODS, SURGEON GENERAL’S

OFFICE

Dr. Stewart. Thank you, Mr. Chairman. I will submit the longer 

statement for the record and read a shorter summary of the statement.

Before I begin, I am accompanied, on my right, by Dr. Philip Lee, 

the Assistant Secretary for Health and Medical Affairs; on my immediate left, Mr. Sam Kimble, the Associate Chief for Grants of the 

Bureau of State Services, and on his left Mr. William Hiscock. the 

Deputy Chief of the Division of Public Health Methods in the Surgeon General’s Office.

Mr. Chairman and members of the committee, I am pleased to appear before this committee today to support the Comprehensive Health 

Plan ning and Public Health Services Amendments of 1966, introduced by the distinguished chairman, Congressman Staggers, and other bills 

before the committee, including H.R. 18232, introduced by Congress­ man Rogers.
PU BL IC H EA LTH SE RV IC ES AM EN DM ENTS OF 1 9 6 6 31

Pro vision s of these bills would revise the pa tte rn of rel ati onships 

and healt h gran ts, rev italize St ate and local healt h ad minist ratio n, 

and e ncourag e th e m ost effective p ursuit of health g oals t hrou gh pl an ­

ning as th e foundation for a ratio na l and efficient use of o ur resou rces 

fo r health, flex ibility to pu t the kind s and amoun ts of resources where 

they are needed most to serve the he alt h of the peop le in local communities, and th ird , develop ment to find new or be tte r methods of 

org anizi ng and delivering personal and e nvironm ent al healt h services.

He arings on Fe de ral-S tate rel ati onships whi ch this com mittee’s 

Subcom mittee on Investiga tio ns held early in th is session, pointedly 

docume nted some of the shortco min gs of the prese nt arrangeme nts. 

These include fra gm en tatio n bo th in he alth program s an d healt h or ­

gan izations, gaps in health service coverage, lack of coo rdination in 

healt h plan ning and servic es at the St ate and local levels, undue rigidity in the catego rica l financ ing of fed era lly assisted he alt h pro ­

gra ms, an d inab ility to use efficiently scarce pro fes sional he alt h 

personnel.

Mr. Ch airma n, I wou ld like to comment on the major differences 

between the several bills which you hav e un de r con sideration .

S. 3008, as passed by th e S ena te, is ba sically th e same as th e admi nis ­

trat io n bill when introd uced, with the exception of two ame ndm ents 

made by the Senat e committee.

Section 8 of the Senate-passed bill pro vides fo r gr an ts to assist 

staffing of com munity mental retard ation facilities; and section 10 

pro vides fo r the tra in in g of phy sical edu cators and rec rea tion perso nnel fo r menta lly retar de d and oth er handica pped children. We do 

not believe these ame ndm ents are necessary at this time .

Th e Pr es iden t’s Com mittee on Me ntal Re tardation will subm it a 

repo rt next year. At th at time, we will be bette r prep ared to assess 

the needs for the me nta lly retarded and request legisla tion to meet 

thes e needs.

Likewise, Secre tary Gardn er’s Ta sk Fo rce on the Han dicapp ed is 

now pr ep aring its final rep ort which will serve a s the basis fo r fu ture 

legislative proposals. In both cases we would pr ef er to have the 

op po rtu nity to study these repo rts carefully before we receive ad di ­

tional au thor ity to serve the menta lly retarded and handica pped.

En actment of 11.R. 13197, as introd uced, would be an ideal res ult, 

so fa r as we are concerned. It wou ld allow us to find needed he alt h 

services at an opt imum level. Th ere are activities, such as the program to control tuberculosis and venerea l disease, whi ch sho uld be 

exp and ed and which can not be exp and ed un der the autho riz ati on 

lim ita tio ns o f IT.R. 18231 and II.R . 18232.

We know, however, th at th e tim e remain ing in this session is short, 

and we sinc erely ap preciat e the com mittee’s holdi ng heari ngs now. 

We believe it is vitally im po rta nt, as the mem bers of th is committee, 

to move now to restr uc ture the catego rical healt h gran ts. Because 

we also believe it is essential to begin the plan ning process immediately, as a basis fo r any fu ture exp ansion of pub lic he alth activitie s 

in the Sta tes , we are willing to accept a more lim ited bill.

But in th at event, we will be prep ared to come back to the com ­

mittee next yea r, when there is more tim e fo r a fu lle r evalu ation
32 PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66

of the need for funding of State and local health activities, with legislation providing for the increased ceilings and, possibly, with other 

necessary measures. We sincerely believe that public health programs 

will be harmed if more funds are not made available in the future.

Mr. Chairman, I should note tha t the authorizations under existing 

law which would be replaced by this bill will expire on Ju ne 30, 1967. 

Therefore, it is critically important tha t this legislation’s enactment 

have a high priority among the remaining actions of the Congress.

Mr. Chairman, that completes my summary statement and I would 

be very happy to answer any questions.

(The prepared statement submitted by Dr. Stewart follows:)

Statement of Dr. William H. Stewart, Surgeon General, U.S. Public H ealth

Service

Mr. Chairman and members of the Committee, I am pleased to app ear before 

this Committee today to su pport the “Comprehensive Health P lanning and Public 

Hea lth Service Amendments of 19G6”, introduced by the distinguished Chairman, 

Congressman Staggers.

President Johnson, is his March 1st message on Health and Education, proposed legislation to deal with three vital are as of he al th : improved organization and delivery of health ser vices; modernization of obsolete health facilities; 

and training needed additional hea lth manpower. H.R. 13197, II.R. 18231 and 

H.R. 18232, which you are considering today, can stren gthen and improve the 

organization and delivery of health services in States and communities throughout the Nation. A companion bill (S. 3008) has already passed the Senate.

Mr. Chairman, our Nation is committed to promoting and assurin g the best 

level of health attainable for every person. The 88th and 89th Congresses have 

enacted landmark health legislation toward meeting this national goal. The 

setting for this commitment is one of gre at magnitude and complexity. The 

population of this Nation is growing rapidly—with a net increase last year of 

2.2 million for a tota l of 196.8 million. New knowledge, accelerating scientific 

and technological potentia l progressively add to our capabilities for preventing, 

diagnosing and curing disease. Our growing national wealth enables us to 

increase investment in the health of the Nation. But with the rise in our 

scientific and fiscal capab ilities must also come increased atte ntion to economy— 

economy not ju st of dollars, but of time, of talent and of organization.

To meet these challenges, to deploy our resources most effectively, and to 

fulfill our present national health potentia l requires that we stren gthen vital 

partnerships—private and public; local, Sta te and national; individual and 

organizational—in creative action for health. These kinds of partnerships are 

fostered by these proposals.

The provisions of these bills revise the pat tern of relationships and health 

grants, revitalize Sta te and local health adm inistration, and encourage the most 

effective purs uit of health goals through :

Planning, as th e foundation for a ration al and efficient use of our resources 

for he al th ;

Flexibility , to put the kinds and amounts of resources that are needed, 

where they are needed most to serve the health of people in local communities, and

Developement, to find new or better methods of organizing and delivering 

personal and environmental health services.

Hearings on Federal-Sta te relationships, which this Committee’s Subcommittee on Investigations held early in this Session, pointedly documented some 

of the shortcomings of the present arrangem ents. These include fragmentation 

both in hea lth programs and health organizatio ns, gaps in health service coverage, 

lack of coordination in health planning and services a t the State and local levels, 

undue rigidity in the categorical financing of Federally-assisted health programs, 

and inab ility to use efficiently scarce professional hea lth personnel.

One of the major problems in planning and delivering health services in the 

State arises from the tremendous and varied workload imposed on State agencies 

as a resu lt of new programs authorized during the past several years. State
PUBLIC HE AL TH SER VIC ES AM EN DM EN TS OF 1966 33

hea lt h de pa rtm en ts , espe ciall y, ha ve had to as su me ne w re sp on sibi lities in a var ie ty of fie lds w ithout a co rr es po nd ing st re ngt hen in g of th eir ca pa citie s. Acti on s ta ken by th e Co ng ress ha ve plac ed in cr ea si ng re sp on sibi lities fo r the de liv ery of hea lth se rv ice s an d fo r co nt ro llin g en vi ro m en ta l po llut io n on Sta te an d loca l he al th agencie s. A t th e same tim e, ho we ve r, S ta te an d loc al he al th 

de par tm en ts ha ve not been rece iv ing th e ki nd of su pp or t ne ed ed to m ak e them st ro ng adm in is tr ati ve or ga ni za tion s. T heir ca pa ci ty to carr y ou t th e new 

re sp on sibi lities th ey ha ve bee n giv en m ust b e st re ng th en ed . Th e fi rs t th ru st of th e hills is to st re ngth en S ta te an d loc al ca pac ity to de al w ith m yr ia d he al th prob lems an d reso ur ce s, by es ta blish in g a co nt in ui ng pro cess of co mpr eh en sive he al th plan ning . The bill wo uld au th ori ze F ed er al fina nc ial as si st an ce t o en ab le Sta te s to e st ab lish S ta te hea lth pla nn in g ag en cies an d re pre ­ se nta ti ve coun cil s, to de te rm in e hea lth ne ed s an d to develop pl an s fo r he al th serv ices, utiliza tion of he al th fa ci lities , an d hea lth m an po w er re qui re m en ts fo r m ee tin g th es e ne eds. It wo uld auth ori ze fina nc ial as si st an ce to ar ea w id e loc al hea lt h p lann in g ag en cies to ex pa nd t heir com mun ity a nd m et ro po lita n hea lth p la n­ ni ng effo rts an d fa cil it ate wi de co op er ation an d co or di na tion am on g pu blic an d pri vate ag en cies th ro ugh ou t th e St at e. It wo uld also auth ori ze fina nc ial ass is t­ an ce to im prov e he al th pla nn in g th ro ug h tr ain in g, st udie s an d de m on stra tion s. Th e bil l is no t de sign ed to su pp la nt w ith new S ta te hea lth pla nn in g agencie s th e ex is ting pl an ni ng m ec ha nism s in spec ializ ed p ro gr am s— (f or ex am ple, h os pi tal an d oth er hea lth fa ci lities co ns truc tion pr og ra m s, m en ta l re ta rd ati on pr og rams, or co ns truc tion of co mmun ity m en ta l healt h cente rs ). R at her, it is de sign ed to he lp br in g or der in to th e Sta te w id e hea lth pla nn in g process, which is no w sp ot ty an d fr ag m en te d. I t wo uld pr ov ide, fo r th e first tim e, re so ur ce s to m ea su re an d unders ta nd th e spec ial hea lth ne ed s of ea ch of th e Sta te s, an d wou ld mak e it 

po ssible to est ab lish pri orities f or m ee ting th es e needs. Com preh en siv e he al th pl an nin g is a pr oc es s which de pe nd s on, comp lem ents, an d link s up ex is ting an d var ie d hea lth pr og ra m pl an ni ng ac tivitie s. It is no t lim ited in tim e, or to a p art ic u la r se t of di se as e en tities , or to a se gm en t of the healt h serv ices syste m, or to a co lle cti on of healt h pr og ra m s. Thi s es se nt ia l 

proc ess pr ov ides th e mec ha nism th ro ugh which : All healt h pl an ni ng ca n be link ed and st re ngth en ed an d cle ar pu rpos e 

secu re d ; H ea lth st atu s can be m ea su re d, go als an d ob jectives def ine d, pri ori ti es set, 

and ac tion s pl an ne d f o r ; Servi ce, man po wer, an d fa ci lity ne ed s ca n be iden tif ied an d in te rr ela te d 

and pr og ra m ac co m plishm en ts assessed . P ro je ct g ra n ts fo r ar ea w id e healt h pl an nin g ac ti vit ie s wou ld st im ula te th e de ve lopm en t of e ss en tial pl an nin g ac ti vit ie s in are as w he re th e nee d is v er y gr ea t. H ealth prob lems do no t fit nea tly in to po litica l ju ri sd ic ti ons or subd ivisi on s. The pu blic an d pri vate ef fo rts to de al w ith them ar e not pr es en tly or ga ni ze d in a way which wo uld co ntr ib ute to th e m os t or de rly and efficient us e of scarce reso ur ce s. The se g ra nts wo uld ex te nd an d ex pa nd th e su cc es sful ar ea w id e pla nni ng exp er ienc es of the H ill -B ur to n pr og ra m. The sec ond th ru st of th e bi lls re dir ec ts Fed er al hea lth g ra n ts so th a t pr og ra m 

ac ti vit ie s wou ld be more clea rly focu se d on br in gi ng healt h se rv ices to peo ple, by pr ov id in g fle xible fo rm ul a g ra n t su pp or t. The eff ect of th is pr op os al wo uld be to e lim in at e ei ght ca tego rie s of fo rm ul a gra nts , an d to pr ov id e a sing le fo rm ul a g ra n t to S ta te s fo r co mpr eh en sive pu blic h ealt h serv ices. Eac h of t he b ills u nder co ns id er at io n wou ld cre at e a ne w section 314 (d ) of th e Pub lic H ealth Se rvice Ac t to prov ide fo rm ul a g ra n ts to S ta te s fo r co mpr eh en sive hea lth se rv ices wh ich wou ld repl ac e th e se ve ra l ca te go rica l pro gr am s no w carr ie d ou t al m os t wh olly und er th e pr es en t se ct ion 314, fo r which $55 million h as been re qu es ted in th e 

fis cal 1967 bu dg et. The prop os ed ne w se ction 314(e ), to pr ov id e pro je ct g ra n ts fo r hea lth serv ice de ve lopm en t wou ld repl ac e ex is ting au th o ri ti es in th e pr es en t section 316 an d annual ap pro pri at io n ac ts, fo r which $53 mill ion has been re qu es te d in th e fis cal 1967 bu dg et. In ad di tion , th e auth ori zati on f or ar ea w id e hea lt h f ac ility pla nn in g now foun d in section 318 (f o r which pre se nt ap pro pri at io ns w er e $5 mill io n) wou ld be co nt ai ne d in th e ne w pl an ni ng pr ov isions , and th e au th ori zati on fo r as si st an ce t o schools of pu blic he al th , w ith th e pre se nt $3.5 mill ion ap pr op ri at io n, 

wo uld be tr an sf err ed to s ec tio n 309 o f t he a ct. In su m m ar y, th ere is a to ta l of so m ew ha t m or e th an $116.5 m ill ion in th e 1967 bu dg et fo r th e ex is ting pro gr am s which wo uld be co ve red by th e pr ov isions
34 PU BLI C H EA LTH SE RVIC ES AM EN DM ENTS OF 1 9 6 6

of thi s hill plus $10 million in the budget for the new authorizations in H.R. 13197 fo r planning. A table comparing the authorizations under S. 3008 as passed by the Senate, and H.R. 18231 is being subm itted for the record.

Comparison of appropriation authoriza tions in S. 3008 and II.Ft. 18231

[In millio ns of dollars]

1967 1968 1969 1970

S. 3008 H .R .

18231

S. 3008 H .R .

18231

S. 3008 H .R .

18231

S. 3008 H .R .

18231

A. Pl an ning g ra nts ..

B. Hea lth service 9.0 9.0 20.0 15.0 25.0 20.0 25.0 .0 formu la gr an ts. .0 .0 170.5 62.5 230.7 62.5 230.7 .0 C. He alt h service

pro ject gra nts .. .0 .0 100.0 62.5 125.0 62.5 125.0 .0 D. Grants to

schools of pub ­

lic hea lt h_____ .0 .0 5.0 5.0 5.0 5.0 .0 .0 E. Men tal retardation ser vic es. . . 1.0 .0 7.0 .0 12.0 .0 12.0 .0 F. Re cre ation perso nn el__ _ . .0 .0 2.0 .0 3.5 .0 3.5 .0 To tal authoriz at io n......... 10.0 9.0 304. 5 145.0 401.2 150.0 396.2 .0 Difference (compared to S. 3008 as 

passed b y Sen ate , 

Oct. 3, 1966)_____ 1.0 159.5 251.5 396.2

N ot e.—Total difference, fiscal ye ar 1967-1970, $882,200,000.

Fiscal ye ar 1967 A pp ropriatio n Act (as pas sed by Senate) inc lud es $55,250,000 for categ orical gr an t ac tiv ­ itie s und er sec. 314 of the Public Hea lth Service A ct; $55,179,000 lor p roje ct gr an ts un de r sec. 316 an d annu al ap prop ria tio n acts; $5,000,000 for areawide health fac ility plan ning un de r sec. 318; a nd $3,750,000 for schools of p ub lic he al th —a to ta l of $119,179,000. In ad ditio n, th e fiscal ye ar 1967 bu dg et inc lud es $10,000,000 for th e new pla nn ing ac tiv ities authoriz ed by H .R . 13197.

The new formula gra nt program would strengthen the capabilities of State hea lth and mental agencies to car ry out increasingly complex leadership func­ tions w ithin States. It would extend and improve the quality and scope of local community public hea lth services. And it would focus these programs on the multiple problems of individuals and families living in communities throughout the Nation, rather than on n arro w disease categories.

Health problems vary from place to place, even with in the same community. As priority needs are identified and developed through the comprehensive health planning efforts, localities and States will have gre ater flexibility in using Federal assistance to meet their most imp ortant hea lth problems. Finally, the Health Services Development projects authorized by these bills would provide a means of supporting programs to meet health problems which are nationally imp ortant but not nationwide in incidence. Targ eted atta cks can be mounted on such problems as narc otics and drug abuse, alcoholism, and venereal diseases. This is an effective and economical way to develop new ap­ proaches to combatting par ticula r health problems, and better ways to organize and deliver hea lth services.

In addition to differences in the level of authorization, which are compared in the table we have submitted, the re are other imp ortant differences between the various bills.

S. 3008 as passed by the Senate is ba sically the same as when introduced, with the exception of two amendments made by the Senate Committee. Section 8 of the Senate passed bill provides for gran ts to assist staffing of Community Mental Retardation Facilities. Section 10 provides for the training of physical edu­ cato rs and recreation personnel for mentally retard ed and other handicapped children. The President’s Committee on Mental Retard atio n will report next year. At that time we will he better prepared to assess the needs for the mentally retard ed and request legislation to meet these needs. Likewise. Secre­ tar y Gardner’s Task Force on the Handicapped is now prep aring its final report which will serve as the basis for futur e legislative proposals. In both cases we
PU BLI C H E A L T H SE RVIC ES A M EN DM ENTS OF 1 9 6 6 35

would prefer to have the opportunity to study these reports carefully before our authority to serve the mentally retarded and the handicapped is broadened. Enactment of H.R 13197 as introduced would be an ideal result, so fa r as we are concerned. It would allow us to fund needed health services at an optimum level. There are activities, such as the programs to control tuberculosis and veneral disease, which should be expanded, and which cannot be expanded under the authorization limitations of H.R. 18231 and 18232. We know, however, tha t the time remaining in this session is short, and we sincerely appreciate the Committee’s holding hearings now. We believe it is vitally important, as the members of this Committee are aware, to move now to restructure the categorical health grants. Because we also believe it is essential to begin the planning process immediately—as the basis for any future expansion of public health activities in the States—we are willing to accept a 

more limited bill. But in tha t event we will be prepared to come back to the Committee next year, when there is more time for a fuller evaluation of the need for funding of State and local health activities. We sincerely believe tha t public health programs will be harmed if more funds are not made available in the future. And we will seek the opportunity next year to demonstrate the need for these 

funds. Our national health goals are but an expression of the justifiable expectation of the American people—that this country can and will provide the best in health care and protection to all is citizens. The fulfillment of this expecta­ tion will require that we plan and organize health resources efficiently; finance programs adequately to extend the availability and scope of public health serv­ ices ; use skilled health manpower economically; and effectively coordinate health activities through dynamic local-State-Federal partnership for health. In concluding my statement, Mr. Chairman, I should note that the authoriza­ tions under existing law to which I have already referred, and which would be replaced by this bill, will expire on June 30, 1967. Therefore, it is critically important tha t this legislation’s enactment have a high priority among the remaining actions of the Congress.

Mr. Chairm an. Th an k you very m uch, D r. Stew art .

I have ju st one question. Assum ing th at ou r com mittee decides to rep ort H.R . 18231, wh at wou ld be the Dep artm en t’s attitud e if the committee were to dele te fro m the bill the autho riz ati on fo r pro jec t gr an ts a nd form ula g rant s fo r the fiscal ye ar 1969. b ut lef t the r em ain de r of the bill int act ?

Dr. Stewart. Mr. Ch air ma n, you un de rst an d our basic position 

which I outlin ed in the statem ent, th at we would have preferred the origi nal ad mi nis tra tio n bills, b ut we r ealize th e time is short, and, as I mentio ned , we pla nned to come ba ck in the 1st session of the 90th Con­ gress wi th leg islation to provide for more ade qua te fun din g. Th ere fore, I do no t think th at it rea lly mak es too much difference wh eth er the 1969 year is the re or n ot, as fa r as our opinion goes, be­ cause we do inten d to come back next ye ar to examine in more detail 

the f un ding levels w ith the committee.

Th e Chairm an. I s yo ur 1968 fund ing—t h at would give you time 

the n?

Dr. Stewart. Th e 1968 fun ding , as you know, somewh at of an in ­

crease over the prese nt estimated 1967 levels. It will give us some flex ibility. I t is s till l imited, b ut we can p robably get alon g w ith th at , althou gh we wan t to examine t ha t, too, when we come back n ext year .

Th e Chairman. All r ight.

Mr. Rogers?

Mr. Rogers o f Fl orida. Th an k you, M r. Ch airma n.

Ju st a couple of points. I t may be well to call th is up when you come back ne xt year, but I just won dere d wha t was your feel ing about
36 PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66

in a State plan requiring that they submit some criteria or set forth 

some criteria for evaluating their programs as to what they are actually doing, if the program is doing some good, rather than just 

saying tha t they will keep a proper audit and make sure that the funds 

are spent righ t ?

Dr. Stewart. Well, Mr. Rogers, I think th at is implicit in the language now. We certainly would want that in the State plans.

Mr. Rogers of Florida. You have no obi’ection to a requirement like 

that?

Dr. Stewart. Not at all.

Mr. Rogers of Florida. I just wanted to ask one quick question 

about repeal, I guess of section 318.

How does that tie in now with the Council on Hill-Burton?

It is done all in one planning.

Dr. Stewart. Yes. The repeal of 318, but then it emerges again 

within the planning section of this present bill, at the same level it 

was at, and then it steps up into the future as it is now programed.

Mr. Rogers of Florida. As you know, we went into this whole type 

of approach in our hearings by our special committee, and all of the 

State offices and the Government wrere very much in favor of this 

type of approach that is embodied in this bill.

So, I congratulate the Department in looking forward in its dealing 

with the States in this problem, and I think this is an excellent 

approach.

Thank you, Mr. Chairman.

Dr. Stewart. Thank you, Mr. Rogers.

The Chairman. Mr. Springer.

Mr. Springer. Doctor, looking at this sheet here—do you have this 

sheet here ?

Dr. Stewart. Yes.

Mr. Springer. Under B, Health Service formula grants—what all 

is included in that $62.5 million ?

Dr. Stewart. This is a series of formula grants which are now authorized until 1967 that I want-----

Mr. Springer. Through 1967?

Dr. Stewart. Tha t is correct. This is the chronic illness and aged 

formula grants, the dental health formula grants, the general health 

formula grants, heart disease control formula grants, home health 

services formula grants, mental health formula grants, radiological 

health and TB control.

Mr. Springer. Well, now what is the difference between those and 

some of the legislation we have already passed on mentally retarded, 

heart, stroke, cancer ?

Dr. Stewart. Well, on the mentally retarded, there was a planning 

and the mental retardation programs, which was related to the development, of the facilities for the care of the mentally retarded in other 

legislation. It is not related to this formula grant at all.

Mr. Springer. What does the formula grant do ?

Dr. Stewart. Well, the formula gra nt is in the mental health field. 

The formula grant—these are all formula grants to States, they are 

matched by the States, and then they go for services within the State. 

Each State may choose a different way of using it within that category.
PUBLIC HEALTH SERVICES AMENDMENTS OF 196 6 37

Mental health money may go to stall mental health clinics somewhere, 

or it may go to train some more people.

Mr. Springer. Aren’t there mental health staffs—isn't there mental 

health staffing in mental hospitals ?

Dr. Stewart. It more likely will not be used for staffing mental 

hospitals. This is in the public health realm apa rt from, the hospital. 

We have one authority for improvement of mental health hospitals, 

which is in another piece of authorization.

Mr. Springer. Well, didn’t we have something in legislation last 

year or the year before that we could not use any funds which would 

diminish the State’s current liability for funds, for programs undertaken by the State? Nothing tha t these funds could be used to take 

away already existing responsibilities of the State. Tha t is what I am 

trying to find out is whether you are plowing new ground or whether 

we are going back over old ground.

Dr. Stewart. Well, you are going back over old ground, in effect. 

Mr. Springer. What I am trying to find out is what that old ground 

is.

Dr. Stewart. These are formula grants to the States for health 

services in the communities which have been in existence for some period of time and have been extended by the Congress the last couple 

of times. These provide for some staffing within the mental health 

authority, if there is a separate authority in the State or the Health 

Department if it is in the H ealth Department, training for people to 

work within the official health agency in the mental health field, 

some work in the various types of clinics. It may be a type of clinic tha t is not supported anywhere else. I 

think what you have in mind, Mr. Springer, was the mental health 

legislation which we had which had to do with the staffing of mental 

health clinics-----

Mr. Springer. Tha t is true.

Dr. Stewart (continuing). In which there was language which 

said, in effect, that you could not use other money at the same time, or 

something like that.

Air. Springer. You could not use this money to diminish already 

created responsibilities of the State-----

Dr. Stewart. That is right.

Mr. Springer. Which were in existence.

Dr. Stewart. Because the mental health staffing grant was one 

tha t went down over time, the Federal share went down over time, 

and I think you have reference to the fact tha t there was the nonreplacement of State and local money with the Federal money in the 

initia l staffing.

Air. Springer. That was a part of it, yes.

Dr. Stewart. T his is also contained in this bill.

Air. Springer. The same language.

Dr. Stewart. Very much alike.

Air. Springer. Can you point that out in this bill ?

Dr. Stewart. On page 5, in section (E ), the language is—

contain or be supported by assuranc es satisfa ctory to the Surgeon General th at the funds paid under this subsection will be used to supplement, and to the 

extent practicable, to incre ase the level of fund s th at would otherwise be made available by the Sta te for th e purpose of comprehensive hea lth planning and not 

to supplant such non-Federal funds.
38 PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66

T hat was relatin g to the plan ning functio n.

On page 11, starti ng with line 2—

such funds will be used to supplement and, to the extent prac tical, to increase 

(he level of funds th at would otherwise be made available for the purposes for 

which the Federal funds are provided and not to supp lant such non-Federal 

funds.

Th is relates to the form ula gra nts .

Mr. Springer. All rig ht. Now, let us go to (C) fo r just a moment. 

The $62.5 million fo r th at . What, is covered un de r Hea lth Service 

project g ran ts?

Dr. Stewart. Th ere is a serie s of pro ject gr an ts whi ch are covered 

und er th at tit le which T will ge t the list on, in ju st a minute. For 

1967, it covers the ex pir ing section 316 of the Pu blic He alth Service 

Act which are the pro jec t gr an ts fo r com munity healt h services. It 

also covers proje ct gr an ts fo r venereal disease control, t uberculosi s contro l, cancer con trol, mental retardation, neu rolo gica l and sensory dis ­

eases, which are con tain ed in ap prop ria tio n langua ge.

Mr. Springer. W ha t are such pro jects? Tha t is what I am try in g 

to get at.

I)r. S tewart. Well, in tuberculosis co ntrol, the proje ct may be made, 

say, to the City Hea lth De pa rtm en t of New Yo rk City, and because 

the y have an are a wi thin the city where the re is a high er incidence 

of tuberculosis, and they want to inte nsify control efforts in th at area, 

or in ma ny oth er cities or are as aro und the country where there is a 

con cen tration of tubercu losis. Th ey have been using it to stu dy the 

level of tuberculosis in th eir com munity to see wh eth er it is goi ng 

down.

Air. Springer. W ha t else besides tuberculosis?

Dr. S tewart. Well, in ven erea l disease co ntrol.

Mr. Springer. All righ t, go ahea d.

Dr. Stewart. Can cer control.

Mr. Springer. All rig ht. Ho w does cancer control work ?

Dr. Stewart. In many instance s, the cancer-control proje ct g rant s 

are used to develop and open up demo nstration clinics fo r the detection of cervical cancer, an d fo r the dete ction of oral cancer, and to 

exper iment with o ther methods o f dete cting cancer on a screenin g kind 

of basis.

These are now being develope d.

Mr. Springer. Those are three . Go ah ead to the ne xt one.

Dr. Stewart. Neurology and sensory diseases.

Mr. Springer. W ha t is th at , the nervous system ?

Dr . Stewart. Yes, ne rvous systems th at could be condition s th at lead 

to blindn ess, cond itions th at lead to neu rolo gical con ditions like de afness or speech defects, or som eth ing like this.

Mr. Springer. Any thing else?

Dr. S tewart. Pa rd on ?

Mr. Springer. Any th in g else?

D r Stewart. Th ere is one oth er, m ental retardation. Th is was an 

extension of the money which sta rte d as the mental retardation pl an ­

ning m oney t hat w as extend ed to the imple me nta tion phase, and now 

it is be ginn ing to su pp ort various typ es of stud ies and activities in 

men tal retardation.

Air. Springer. Pa rd on me. Ar e you t hrou gh ?

Dr. Stewart. Yes.
PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66 39

Mr. Springer. Under (B) and (C), give me a rough idea, under 

(B), how many grants—how long has this legislation been in 

existence ?

I)r. Stewart. Well, if you go back, it actually all started with the 

Social Security Act in 1935.

Mr. Springer. But the big money has been just in recent years.

Dr. Stewart. Well, I was just noticing some figures. We have a 

table. We had a total of $30 million in formula grants now in 1950. 

In 1936, it started with the Social Security Act, and the total was $3 

million. This is formula grants for the States. In 1950, it had gone 

to $30 million. It then dropped during the 1950’s, getting back to 

over $30 million in 1961, and the estimate for formula grants in the 

1967 appropriation is $55.2 million. At the present time that has been 

divided into general grants, and then the tuberculosis, heart, mental 

health and cancer, which started in later years, and as the categorical 

grants have been coming along in numbers and in amount, the general 

grant which is what the Health Department uses to support its laboratories, its public health nursing in general, has been going down, and 

almost from its inception.

Mr. Springer. How many grants did you make last year?

Dr. Stewart. These are to the States, so it would be-----

Mr. Springer. In other words, how many States participated?

Dr. Stewart. Fifty-four jurisdictions, all of them, including the 

Virgin Islands.

Mr. Springer. In other words, everybody, all 54 agencies, participated in the whole thing.

Dr. Stewart. They all participated, that is correct.

Mr. Springer. Well, then, you do not know how many grants there 

were. Does that come to you for final approval ?

Dr. Stewart. Mr. Springer, what they do is put together a State 

plan which covers not only these grants but the Children’s Bureau 

grants, every other year, and the regional offices review the State plan, 

negotiate, and finally they approve for the Surgeon General, and within that State is what they spend the money for.

Mr. Springer. All right.

Now, going to (C), do all 54 jurisdictions participate?

Dr. Stewart. The project grants may go to State health departments, but they may go to a local health department or a nonprofit 

agency.

Mr. Springer. They can go to any one of those three ?

Dr. Stewart. Yes, sir; it could go to a hospital, for example, starting one of these cancer clinics we are talking about.

Air. Springer. Does that gra nt go directly from you ?

Dr. Stewart. Yes, it does.

Mr. Springer. It does not go to a State agency ?

Dr. Stewart. In many instances we have, through just practice, 

gotten the recommendation from the State health department or the 

State agency as to what they think about it.

Mr. Springer. But tha t is a direct gra nt to you directly to the 

agency involved?

Dr. Stewart. That is correct.

Mr. Springer. Can you tell me again, have all 54 jurisdictions pa rticipated ?
40 PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66

Dr. Stewart. Has there been a grant in every State ?

Yes, there has.

Mr. Springer. Is the bulk of tha t money going to any particular 

State ?

Dr. Stewart. The distribution of the project grants by States is 

what you are asking ?

Mr. Springer. No, the distribution of the Health Service project 

grants.

Dr. Stewart. It is widely distributed around the country, but I 

would have to get the information as what has been the distribution 

State bv State, Mr. Springer.

Mr. Springer. I was trying to find out whether th at was being concentrated in any particular city or any particular State.

Dr. Stewart. Well, from my knowledge of what it is, I would say 

the answer is that it is not being, but I will have to get the information.

Mr. Springer. I s that a matching grant ?

Dr. Stewart. It is to pay part of the costs, but there is no set matching under the project grants.

Mr. Springer. All right.

How much is th at generally, about 10, 20, 30 percent from you ?

Dr. Stewart. I would say, we think that on the average the matching to the project gran t is about a thir d to two-thirds, on the average

now.

Mr. Springer. Your part is a third to two-thirds ?

Dr. Stewart. No, ours is two-thirds.

Mr. Springer. Theirs is one-third.

Dr. Stewart. One-third.

Mr. Springer. IIow about the health service formula grants; how 

are they determined ?

Dr. Stewart. The formula grants are 50-50 matching with the State 

and us. Actually, over the years, the States have put up more—over 

the years, the moneys have been overmatched by the States and localities.

Mr. Springer. I s there any reason—and this is my last question. Is 

there any reason why your health service project grants are so high, 

two-thirds ? Is there a reason for it ?

Dr. Stewart. Yes, I think so. In many instances here you are dealing with a community agency or a hospital or a local health department where a project is more delimited. He is trying out something, 

he has to bring in more people on a shorter-term basis. It is not a continuous kind of arrangement.

We are hoping, for example, in these cancer clinics tha t once it has 

been demonstrated, then the hospital will take it over or the health 

department will take it over. So, there is what you might call a little 

higher risk factor for the recipient of a project grant.

Mr. Springer. Jus t this last question, Doctor.

With this $154 million, I believe it is—or $159 million, under the 

chairman’s bill, you can do your job all right?

Dr. Stewart. Well, as I stated, Mr. Springer, in our statement, we 

recognize the time shortage, and we think the establishment of the 

principle of getting these grants so they are more flexible, getting the 

planning started, is very important, but we will be back next year to 

talk about the authorized ceilings tha t are in there.
PUBLIC HEALT H SERVICES AMENDMENTS OF 19 66 41

The $62.5 million in 1968 for the (B) and (C) is a slight increase over the estimate for 1967, but with the demands for increased work in tuberculosis, alcoholism, drug addiction, all the things tha t these moneys will be used for by State and local agencies, we will have very little flexibility in 1968. Well, actually, as we went into 1968, we will have decreased programs more than we have at the present time. Therefore, we think when the committee has more time we will be back, next year, to have a more thorough examination of the authorized ceilings.

Mr. Springer. Thank you, Mr. Chairman.

The Chairman. Mr. Kornegay.

Mr. Kornegay. Dr. Stewart, I would like to thank you and your colleagues for coming up and testifying in behalf of the bill this 

morning. I do not have any particular questions to ask, but I would like to call your attention to one defect in the bill which is an expression of concern from those in my district who are concerned with mental 

retardation and mental health in these bills. Now, inquiry on my p art causes me to believe th at they are not included in the bills. Is tha t correct ?

I)r. Stewart. No. One could provide mental retardation services 

under the formula grant if the State health department so chose to use the money for that purpose. Also the project grants would be available for projects for the mentally retarded, so it would be available. Now, within the limitations on the authorization, there is not very much flexibility, but then tha t is what we will address ourselves to 

next year.

Mr. Kornegay. Yes, you will do that specifically. Do you have any reason—do you have any knowledge as to why 

these people would be opposed to this bill ?

Dr. Stewart. Well, there is a great deal of interest in the persons who are concerned about the mentally retarded in the amendment th at was made to S. 3008 in the Senate which had to do with staffing of the mental retardation clinics. We recognized the growing number of clinics under our own construction program, that this is happening. But, as I stated in my short summary, the Committee on Mental Retardation is in session now, and it is going to report early in the ye ar; the Secretary’s Committee on the Care of the Handicapped is going to report soon, and we would like to take a look at these reports, study them, and see what legislative proposals are necessary in order 

to carry out adequate programs next year.

Mr. Kornegay. Thank you, sir.

Tha t is all, Mr. Chairman.

The Chairman. Mr. Younger.

Mr. Younger. Than k you, Mr. Chairman. Dr. Stewart, on the (A) planning grants, $9 million, do you have 

funds already in 1967 for that purpose ?

Dr. Stewart. Yes. There are $5 million of the $9 million contained in the estimates for 1967 under section 318. This is repealing tha t and inserting this in there; $5 million is there. The rest was con­ tained in the President’s budget under new legislation.
42 PU BLI C H E A L T H SE RV IC ES AM EN DM ENTS OF 1 9 6 6

Mr. Younger. Well, you mean there are only $5 million or $4 million of new money for 1967 ?

Dr. Stewart. Tha t is correct, for the planning portion of this, 1967.

Mr. Younger. And the other $5 million is money that is already 

appropriated?

Dr. Stewart. Well, it is in the estimate of 1967. We do not have 

an appropriation lawyer.

Mr. Younger. No, but some of the appropriations are still being 

acted upon. I appreciate that.

But I could not understand why, in all the other categories with 

the exception of (E) where the Senate added $1 million, and yet on 

(A) you added $9 million, which would be over and above what has 

beein already appropriated.

Dr. Stewart. Yes. S. 3008 repeals section 318 which is in the 

Hill-B urton Act, and moved it over to be a part of the planning grants 

section. That contains three parts. That portion that was in section 

318 was grants to areawide planning councils for, like, a metropolitan 

hospital council would get their money in this type of project grant.

It also includes the formula money to the States for their planning 

—this is new—$2.5 million of the $9 million, and then there is a 

million and a half dollars which would be for studies related to the 

planning and training of people to do the planning.

There is a scarcity of health planners in the country, and in embarking upon this State health planning agency, the States are going 

to have to train some people.

Mr. Y ounger. There is nothing in here whatsoever in regard to, 

that I could find, in regard to family planning. Is there any idea 

on your part or the Department's part to cooperate with the poverty 

program and provide, where requested, family planning as a project?

Dr. Stewart. ‘Well, Mr. Younger, within this formula grant, which 

would be part (B ), since we are now taking the categorical labels off 

and we are saying to the State: “What do you think are your real 

problems, this is the way to mold this money within the State health 

planning function as you have done?”

If they wish to embark upon family planning within this, it would 

certainly be appropriate under part (B), of the formula money; 

likewise, the project money could be used to initiate a program or do 

demographic studies or population studies that are necessary in order 

to understand the family planning problem. This would all be done 

in cooperation and in relationship to what the Office of Economic Opportunity, because it is within the context of the State health agency 

which is tryin g to relate all of these things, these various things, 

together.

In addition, there is the maternal and maternal care grants of the 

Children’s Bureau, which also would part of this putting together 

all these various facets that are occurring now into this State health 

plan and would relate family planning to it.

Now, since the increased authorization for 1968 or 1969 is not in, 

very greatly beyond what we have in, the estimate for 1967, until we 

have had an examination of the authorized ceilings next year, there 

is not much room to expand into anything, any additional programs, 

such as family planning or drug addiction or whatever else health 

problem the State would like to get into.
PUBLIC HEALTH SERVICES AMENDMENTS OF 19 60 43

Mr. Younger. As far as your Department is concerned, where there 

is a need and a request for embarking on a family planning project, 

tha t would receive your approval ?

Dr. Stewart. It certainly would. It is p art of a health program, 

and we think it is a very central part of a health program.

Dr. Lee. I might add, Mr. Younger, at the present time, we are scheduling a series of regional meetings. There will be nine regional meetings. The first one has been held in Roanoke on family planning, to inform the people in State and local agencies, particularly govern­ mental agencies, also in hospitals and physicians in private practice, about the Federal resources tha t are available to support local fam­ ily planning programs, and we feel it is a very important thing that this information get out, because despite the fact we have had a policy since January, there are many people in State and local agencies and physicians in private practice, and hospitals tha t are unaware of the fact that Federal funds are available now to support this. We do not have adequate funds to support it. We estimate tha t we will need at least $15 million next year to support requests that we are presently expecting, and that more will be needed in subsequent years. 

But we do have some funds currently available for this. A number of States have changed policy with respect to family planning, under their public assistance medical care programs. California is a good example. With a change in Federal policy, California now provides family planning services throug h the title 19 program for mothers, for ex­ ample, who are on aid to families with dependent children. These 

services were not provided before this year. So there has been a significant change and the States can carry out and can support family planning programs, purchase oral contracep­ tives or other contraceptives as needed under this program, and tha t is one that has not been used in many States yet, but California certainly has led the way in that regard.

Mr. Rogers of Florida. Would the gentleman yield ?

Mr. Younger. Yes.

Mr. Rogers of Florida. Actually, any of those programs instituted 

though would be done at the decision of the State or local facility.

Dr. Stewart. Yes, sir. Under the formula grants we are working 

with whatever the State has planned to use the funds for within broad 

guidelines of the public grant service.

Mr. Rogers of Florida. Thank you.

Mr. Younger. But you are conducting regional conferences on tha t 

subject now?

Dr. Lee. That is correct.

Dr. Stewart. Yes.

Mr. Younger. Thank you, Mr. Chairman.

The Chairman. Mr. Van Deerlin.

Mr. Van Deerlin. In establishing the State health planning councils, Dr. Stewart, do you think it might be wise to designate that the 

majority would be public or consumer members?

Dr. Stewart. Well, I think tha t I would see no objection to that. 

Consumers certainly have a great interest in the health developments in the country. Actually, our Hill-B urton Council, I think, is t ha t 

way at the present time.
44 PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66

Mr. Van Deerlin. There is a precedent for it in successful national 

health legislation.

Dr. Stewart. That is right.

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

The Chairman. Mr. Nelsen.

Mr. Nelsen. Thank you, Mr. Chairman.

I might preface any comments of mine by saying, calling attention 

to the fact, tha t Dr. Barr, from our State, called me and was very 

much, interested, and likewise Dr. DeBakey called, feeling tha t this 

area is something which needs some attention.

I understand the question was asked about whether it was in the 

budget, and the answer was “Yes,” as I understand it.

Dr. Stewart. That is correct.

Mr. Nelsen. And I am becoming a little bit sensitive about programs tha t roll by pretty fast, and then we fail to fund them, and 

when we fund them we are accused of raising the budget, so I want 

to be very sure that this is in the budget.

I notice a reference to the mental health, mental retardation, program in the Senate bill. It refers to staffing grants for mental 

retardation facilities, and while this has no relation to this bill particularly but the mental health, mental retardation, bill tha t we 

passed, throughout the hearings, in the discussion T made reference 

to the need for some community center for the training of the mentally retarded and day-care centers, and also used as an example a 

vacated, four-room brick school building, with playground, with toilet 

facilities, with heating equipment—everything there. All you need 

to do is buy it for $1, and it was my understanding from the hearings 

tha t under the terms of this bill, this facility could be put into operation, and certainly, to the betterment of the community, if it happened.

To this day, nothing has happened. The center is staffed, and has 

been put into shape by local voluntary contributions.

I have called the State by telephone, and I have written letters, and 

we completely miss the mark on something tha t I thought Congress 

acted correctly on, and it is my understanding now tha t there are 

priorities on which procedure develops in a State and this does not 

happen to have the prior ity tha t outranks some others.

Now, what good does research do, what good does conversation do, 

what good does talk do when here we have a facility available for 

nothing, for no charge, and we have money tha t I think Congress 

intended to go in that direction, and this is now 2 or 3 years ago when 

it started, and we have not gotten to it.

I know this is under your—it is not exactly something I can criticize 

you for, Doctor, but I think my point is to bring this out in the open 

for the record with the hope that we can get this thing off the ground.

I might mention tha t the local people have built a fence around 

there with local contributions. They have an instructor there, and 

the children are brought to this day-care center, and I think we will 

finally get this thing put together. But it takes some time. So, I 

want to be gracious in my criticism, if that is a proper way to express 

it. You may have some comment now that I have made my little 

pitch.

Dr. Stewart. Mr. Nelsen, we welcome criticism in not delivering 

services to people who need them.
PUBLIC HEA LTH SERVICES AMENDMENTS OF 19 66 45

If you will remember, the mental retardation construction program, 

the community retardation centers were modeled somewhat afte r the 

Hill-Burton Act.

Air. Nelsen. Yes.

I)r. Stewart. In which there is a State-developed plan, priorities, 

and they decide where the projects will go within the State, within 

the money that is allocated to the State.

So, it is actually for some reason or other the State has chosen to 

set up a prior system which has not gotten, as I understand, to this 

project tha t you had in mind.

Now, in addition to that, you also recall tha t we had initial staffing 

money for the community mental health centers. There was no similar provision for mental retardation centers. The amendment in the 

Senate was for that purpose, and, as I mentioned in my opening statement, that, with the President’s Committee on Mental Retardation 

reporting soon, and the Secretary’s Committee on the Handicapped 

reporting, we would prefer to get these reports and then to mold 

whatever seems to be the proper legislative proposals for next year.

Air. Nelsen. It is my feeling that there is a very wonderful building and a very quiet little community close to two of our larger towns 

in our county, and the service that could be provided there would be 

not only to one school district but several. I think it has a very 

strategic location, and I just wanted to mention it, because I have 

talked to one of the men from HEW at considerable length. They 

have been in contact with the State and have advised the President’s 

Commission about this, because, it would seem to me, that here is an 

opportunity, at no cost, to have a facility, no bricks and m ortar at all, 

and certainly was our intention on this committee—I remember Congressman O’Brien had a similar feeling—that this would be a nice 

thing to do. So, if there is anything we can do in this bill to implement these two ideas, of some center where children in rural areas 

who are mentally retarded can accept a certain amount of education 

and training, there is a great need, and I would go all out for everything we can do in that direction. Thank you very much.

Tlie Chairman. Air. Pickle.

Air. P ickle. Air. Chairman, I have no questions, other than to compliment Dr. Stewart here.

I have heard his remarks, and I assume that you attach a great deal 

of prior ity to this measure. Although it is not complete, it is the 

best we can live with under the conditions.

Dr. Stewart. Yes, sir; very much so.

The Chairman. Air. Curtin.

Air. Curtin. No questions, Air. Chairman.

The Chairman. Air. Alackay.

Air. AIackay. Thank you, Air. Chairman.

If this Congress does not adjourn, I am not likely to be able to 

help you in the 90th Congress, so I would like to do what I can to 

help you righ t now.

Dr. Venable, who is here to testify, has interpreted to me his 

judgment of the impact on our State health program if we fail to 

take some action at this session.

I would like for you to comment generally on the possible impact 

of our failure to act, because this bill is getting up before us so late

70- 05 0— 66------ 4
46 PUBLIC HEALTH SERVICES AMENDMENTS OF 196 6

in the session that the usual arg um ents sometimes that are effective: 

“W hy not let it go over to the next Congres s?” What do you think 

the cost of let tin g it go over would be, the possible cost ?

Dr. Stewart. Well, I th in k that we fail to captu re, a t least, a piece 

of the r esu lts o f a c lear examin atio n of a p roblem which we all un de rsta nd a nd all have a feel of now, and th at it badly needs solution.

If we were to delay unt il the next Congres s, we would not get the 

planning fun ction sta rte d.

I think the constan t cry of thi s mult ipl ici ty of pro gra ms th at are 

flowing into the State s and com munities at the present time unrelate d 

to one anoth er is evidence enough in itself for the need for pla nning .

But, more importa nt tha n th at I think, is the dem and for services 

of all typ es is increasing for a var iety of reasons, a nd we do not have 

unlim ited sup ply of resources.

We need to be able to know that when we invest into th at hos pital, 

(hat is the rig ht investment ra th er th an inv esting in this pa rti cu lar 

lab ora tory or this pa rti cu la r clinic, and we hav e no mechanism at 

the present (ime to do this at any level of gov ernm ent.

Secondly, we would go forw ard with the formu la gr an ts as we now 

have them , cate gorized into variou s narro w categories in which the 

State health offices, and pa rti cu larly Dr . Ven able can tell you, completely puts them into rig idity , and in which they can not have any 

flex ibility of th e Federal -ai ded program s they hav e t o rea lly meet the 

needs as they see th em in th eir area, and the needs do v ary from area 

to area.

In the project plan ning pro gra m there are many needs for project 

money now beyond disease-co ntrol pro gra ms . We need to exp erim ent 

with new ways to deli ver healt h services into rural areas. Th is is 

ge tting to be an increa sing problem in the countr y, and I am not sure 

th at we rea lly know how to solve the problem and we need to have 

experim ent ation whe re they are willing to do it.

Th is is the type of broadening. If we wait a year or 2 years, we 

are d uck ing th e problem.

Mr. M ackay. Doctor, I en thu sia stically support the princ iple of this 

bill and hope we can pass it at th is session.

As a recent mem ber of the Geo rgia Legis lature , I think thi s will 

help the rel ationship between the State leg islatu re and the State 

healt h departm ent, and between the St ate and the Fe de ral Government, because you often he ar the question : “W hy the se p rio rities when 

oth er prior ities look more logical ?”

I do not think it is fully und erstood th at the direc tor o f our State 

healt h departm ent is sort of locked up in a legal for mu la or legal 

arr angeme nts tha t do not give him flexibility.

So, I un derst and your an swer to be t hat t he re would be a loss really 

to the Nation if we do not pass this at th is time.

Dr. Stewart. I think it would be a serious loss if we did not 

esta blis h the plan ning process and the princ iple of flexibility.

I un de rst an d why th e autho riz ati ons m ust be a s they are, because we 

do not h ave tim e enough to really go int o it. Bu t I th in k it is t errib ly 

im po rta nt th at we hav e a serious look at the amount of money th at 

should be wi thin thes e progra ms nex t year.

Mr. Mackay. Th an k you.

No fu rthe r qu estio ns, M r. C hairm an.
PUBLIC HEALTH SERVICES AMENDMENTS OF 196 6 47

The Chairman. Mr. Watson.

Mr.W atson. Thank you, Mr. Chairman.

Doctor, I support this measure as introduced by our able chairman.

I can see only one disadvantage at this juncture, and that is the lateness 

of the hour in this session, but I am not deterred by th at particular 

factor.

Now, since it has come to us rather late, or at least the interest 

manifested itself rather late, 1 have not had an opportunity to study 

the two bills. So, if you could just help me to understand the difference between H.R. 13197, which, 1 understand, you say is the ideal 

solution or the ideal bill at this time-----

Dr. Stewart. Correct.

Mr. Watson. 1 notice in your chart your comparison of authorizations. You compare S. 3008 and H.R. 18231. So, I wonder if you 

could explain briefly the difference between H.R. 13197 and H.R. 

18231?

Dr. Stewart. Yes, sir.

Mr. Watson. Firs t, to start it off, there is a difference between 

$9 and $10 million, is th at not correct, in the amounts we authorized 

for these planning grants ?

Dr. Stewart. In H.R. 13197, which was the companion piece to 

S. 3008 introduced for the administration it was $10 million.

S. 3008, as it emerged from the Senate, had $9 million in the 

planning.

H.R. 18231 would contain the same $9 million.

I think, Mr. Watson, that we have a chart which compares 13197, 

S. 3008 and H.R. 18231, which I might provide for you, instead of—it 

is four pages long, and there are significant differences.

I think 1 might, point out that the major differences between 18231 

and 13197 are as follows:

The planning stays essentially the same except it is $1 million 

reduced.

The formula grant, the language stays essentially the same except 

in 13197 there was a provision tha t 70 percent of the funds in the 

formula gran t had to go to the local community.

In 18231, this had been struck out. The reasons for this were that 

by lowering the authorized ceilings to the levels to which they are 

lowered, there would be some States which would be embarrassed 

under the 70-percent requirement to the local area, because at the 

present time they have less than that. They would, in effect, have to 

decrease the State health department budget in order to carry out 

tha t function.

If the authorized ceilings had been as they were in the Senate bill, 

3008, as it emerged—the amount of money I mean—then there would 

have been enough flexibility to put that provision in.

It also provides for 1968 and 1969 authorized ceilings of $62.5 million which is in H.R. 13197. It was different from that.

In II.R. 13197 there were no authorized ceilings except for the 

planning, and in S. 3008, as it was introduced in the Congress.

Those are the essential changes, the 70 percent figure, the authorized 

ceilings of $62.5 million, and the 3 years—1967, 1968, and 1969.

There are a lot of other changes within this, I could ffive vou in this chart. & j ,
48 PUBLIC HEALT H SERVICES AMENDMENTS OF 19 66

Mr. Watson. Am I to understand at this juncture, though, tha t 

although you feel 13197 is the optimum bill-----

Dr. Stewart. Correct.

Mr. Watson (continuing). That you feel in the essence of practicality at this time th at you are favoring 18231, just the single 1-year 

appropriation?

Dr. Stewart. No. H.R. 18231 authorizes $9 million for the planning grants, 1967; $15 million in 1968, and $20 million in 1969 to the 

planning grants. But the formula grants, there is nothing in 1967, 

$62.5 million for each of 1968 and 1969, and the same with the project 

grants.

Then there is another element to this, the grants to the schools of 

public health which would continue an authorization they already 

have of $5 million. This would be what 18231 would authorize.

Our feeling is, as I have expressed, th at to establish the idea of the 

planning program and the principle of more flexibility for the State 

and local health departments, it is a terribly important thing to get 

underway, and while we would much have preferred 13197, we recognize the shortness of the session yet to remain and the inability of time 

to really examine the authorized amounts, and we intend to come back 

t o those next year.

Mr. Watson. Now, one final question. Am I to understand that 

the State or local health agency would be prohibited from using any 

of these grants for planning mental retardation ?

Dr. Stewart. No, sir.

Mr. Watson. They would not ?

Dr. Stewart. No, sir.

Mr. Watson. The reason th at tha t question is prompted is because 

I see a specific breakdown of $1 million for mental retardation services 

and $9 million for planning grants under the Senate bill, but I do not 

see such a breakdown under the House bill.

Dr. Stewart. The Senate amended S. 3008 to add the beginning of 

the staffing of the mental retardation clinics, and the $1 million was 

for that purpose in 1967.

Mr. Pickle. Will the gentleman yield ?

Mr. Watson. Yes; I will yield.

Mr. Pickle. There would be no prohibition of our State health commission to use planning funds for mental retardation.

Dr. Stewart. Tha t is correct.

Mr. Pickle. This would be for mental retardation planning and not 

for staffing. At what point, at what level, could the State do this under 

18231?

Dr. Stewart. Could they use the money for staffing ?

Nfr. Pickle. Use the funds appropriated for mental retardation 

staffing?

Dr. Stewart. Well, there is no specific provision within 18231 for 

the staffing of the mental retardation clinics as this was amended in the 

Senate.

Mr. Pickle. I understand it, “not specifically.”

Dr. Stewart. That is correct.

Mr. P ickle. But just in the general sense, whether it would be for 

tha t program, mental retardation, or whether it would be for tuberculosis.
PUBLIC HEALT H SERVICES AMENDMENTS OF 196 6 49

Dr. Stewart. It would be possible for the State health department 

within the $62.5 million authorized in 1968 to use some of that money 

within their plan for a mental retardation clinic if they so chose.

Mr. Pickle. This would be the fiscal year, I assume.

Dr. Stewart. In 1968.

Mr. Pickle. Thank you.

Mr. Watson. The gentleman has prompted another question on my 

part, Doctor.

As I understand it now, this is going to be a single formula gran t 

to the States and they will have the discretion of using this planning 

money as they see fit, in accordance with their health needs.

Dr. Stewart. Tha t is correct.

Mr. Watson. Tha t is correct?

Dr. Stewart. That is correct, sir.

Mr. Watson. You do not anticipate the issuance of any regulations 

or guidelines so as to put restrictions upon the making of these grants?

Dr. Stewart. Well, when the State health planning agency is operational, we would assume that the State plan, which is going to spend 

the formula gran t money would be related to tha t State health plan 

that has been developed 'by the State health planning agency, and we 

would review this within the Public Health Service, within very broad 

guidelines, and I think, as we do now, there would be discussion and 

debate as to how they see their priorities, and-----

Mr. Watson. But the final decision will be with the States. You 

know we have been a little concerned-----

Dr. Stewart. The State plan must be approved by the Surgeon 

General.

Mr. Watson. Yes. But, of course, your overall guidelines will place 

primary emphasis upon the needs of the State-----

Dr. Stewart. Definitely.

Mr. Watson. Bather than those needs as determined by the Surgeon 

General, as you have said.

Dr. Stewart. I think we are all trying to do the same thing.

Mr. Watson. I am sure of that.

Dr. Stewart. We are all trying to get services out to the people, 

and if there is any debate at all it is a question of which one is a little 

more important than the other in getting it to the people.

Mr. Rogers of Florida. Will the gentleman yield ?

Mr. Watson. Yes.

Mr. Rogers of Florida. The main purpose of this and the thrust 

of this is to allow flexibility to the State, tha t is the whole reason 

why we are doing it.

Dr. Stewart. Tha t is correct.

Mr. Rogers of Florida. And so I think the gentleman is correct, 

tha t this is to give the States the righ t to spend this money in those 

areas tha t they feel is necessary within those State borders. This 

is basically what we are trying to do.

Dr. Stewart. I s to give them flexibility within the formula grant 

to mold it to the priorities, as they see it through the State planning 

agency to work on it.

Mr.N elsen. Will the gentleman yield ?

Mr. Watson. Yes.
50 PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66

Mr Nelsen. I noted in y ou r statem ent, with refe renc e to th e Sen ate 

b ill, that the bill pro vid ed th at by ame ndm ent gr an ts to assist the 

staffing of a mental retardation fac ility— is this on a ma tch ing basis, 

the Senate bill ? ’

I)i. Stewart. Yes. It is sim ila r to the staffing gr an t pro vision in 

the mental health, w here it is a decr easing amount.

Mr. Nelsen. Yes.

Dr. Stewart. I have forgotten wh at the ma tch ing form ula is.

Mr. Nelsen. I t does no t rea lly matter . The po int is it is on a 

ma tch ing basis.

Dr. Stewart. Yes.

Mr. Nelsen. Now, wh at is the position of H E W rel ative to the 

Senate amendm ents ?

Did you tak e a position for—o r was there no position tak en on the 

amendmen ts ?

Dr. Stewart. I think the position is the one th at I sta ted in my 

ope ning sta tem ent, th at we are no t opposed to them.

Mr. Nelsen. Yes.

Dr. Stewart. Bu t with these variou s committee rep orts coming 

along, we would ra th er look at those first.

Mr. Nelsen. In refe renc e to the flexibility th at Congres sma n 

Rogers mentioned, I recall the W hite House Conference early in the 

session where the direction we seemed to be moving towa rd is more 

flexibility, because circum stan ces may v ary in m any States whe re th ere 

is m ore serious need than in an othe r, the re may be some local activity 

th at has met one need and not met ano the r.

So I think there is gr ea t merit in flex ibility and State deter mi nation in spite o f what I said earlier.

Th an k you.

Mr. W atson. Th an k you, Mr. C hairm an.

The Chairman. Mr. Jar m an .

Mr. J arman. I have one or two questions, Mr. Chairma n.

Doc tor, let me joi n in welcoming you and yo ur colleagues, yo ur associates who are here th is morning. We appre cia te the inf orm ation 

you have give n to us.

I am cer tainly in agreem ent an d su pp ort of the ove rall objectives 

of the bill befo re us, the need for an effective working pa rtn ersh ip 

at all levels in the hea lth field.

The concern th at I have is ove r expenditures, ove r costs, p artic ul arly 

in view of the costs o f so man y oth er thing s th at o ur F ed era l Government is tryin g to do.

Let me ask— and perha ps yo u hav e covered this, bu t let me ask you 

th is: I notice in the Senate committee rep ort th at accompa nied the 

Senate bill th at the figure given fo r fiscal 1970 w as $507.1 million. 

Then, in a comp ara tive lis tin g which you have giv en us, a comparison 

of the two bills, the S. 3008 figure shown is $392 million .

Was th at figure redu ced on the floor of the Senate when the bill 

was considered in th e Sena te ?

Dr. Stewart. Yes, it was.

Mr. J arman. As I say, you may have covered this, bu t wh at was 

dele ted, wh at was cut out, in the Sena te?

Dr. Stewart. Th ey took 1971 and 1972 off, and they pu t the 1970 

at the 1969 level, except for the plannin g. Does th at exp lain it?
PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66 51

Mr. J arman. Th ey pu t 1970 at the 1969 level except fo r th e p lann ing 

money ?

I)r . S tewart. That is rig ht.

Mr. J arman. We ll, I will not go into th is in any g reat detail in our 

short he aring this mo rning, alt hough I will be inte rested in much 

more detai l when we go into it with you ne xt yea r.

Le t me ask you t h is : A s o rig ina lly requested in wh at was an origin al 

request by the ad minist ratio n fo r a 6-year pro gra m, as I un de rst an d 

it, it would cost appro xim ate ly $2.4 billion o ver t ha t period.

Dr. Stewart. T hat was the ap pro xim ate figure we supplied the 

Se nate; yes,sir.

Mr. J arman. In th at request, the 1970 figure was a littl e over $500 

million in total—$507 m illion. Th e 1971 figure was $557 m illi on; the 

1972 figure was $545 million.

I do know, of course, th at in the heari ng s in the othe r body, th at 

Secre tary Cohen did indicate, in response to questions, th at these are 

yo ur Dep artm en t’s best estimates of wh at will be needed.

Dr . S tewart. That is corre ct.

Mr. J arman. T^et me ask ju st one more question the n.

Do you anticipa te, as we get into th is prog ram of Fe de ral-S tate 

coo peratio n goi ng ahe ad with the legisla tion th at is requ ested here— 

do you an tic ipa te the n the spe nding of t he Fe de ral sha re is going to 

run somewhere in the neighb orhood of $500 m illion a year, o r do you 

antic ipa te th at beyond th at 5- or 6-year period the cost is goi ng to 

mo unt and mount, as so man y Fe de ral prog ram s do?

Dr. Stewart. Mr. Ja rm an , I think, in orde r to accomplish the pr ogra ms th at we visu aliz e as bein g nece ssary, contr olling the diseases 

th at can be con trolled and prov idi ng t he services th at need to be pr ovided, and doing something abo ut drug abuse, doing something about 

alcoholism and f am ily pl an ning an d so on, a l ong, long list, of bu ild ing 

a str uc ture in th e country of St ate and local he alth departm ents th at 

can do th ese thing s respons ibly , efficiently a nd econom ically , it is go ing 

to ta ke th at kin d of money.

Mr. J arman. By “that kind ,’’ do you th in k Fe de ral expenditures 

will be held to that level ?

Dr . Stewart. I do n ot th in k I can pr ed ict th at f ar in advance , Mr. 

Ja rm an . I th in k th at we estimate a t t he pres ent time , as we p rovid ed 

here—Mr. Cohen gav e the figures—that th is wou ld be a level which 

we could be pr ov iding the kin ds o f services th at the people need.

Bey ond 1972, I t hi nk we would hav e to have some experience with 

an inc rea sin g am ount of fund s to know wh eth er there will be needs 

fo r more or wh eth er there will not. But I th in k th at th is was in 

rou gh e stim ate as to wh at it really will take.

We have at the present tim e $55 millio n in the form ula gr an ts fo r 

the enti re Nati on for all of these v arious a ctiv ities, and the needs gro w 

every day. But th is is the subject I am su re we will go into in gr ea ter 

de pth th is com ing year.

Dr. Lee. Mr. Ja rm an , if I could ju st add a word . Some of these 

pro gra ms , I think , do no t ju st cost money, the y save money ; and I 

think, if we ju st take one example of a program , such as fam ily p la nning with effective pro gra ms m aking services ava ilable to people who 

cu rre ntly do no t hav e the services ava ilab le, can result no t only in 

savings in terms of preven tin g things like mental retardation, reduc-
52 PUBLIC HEALT H SERVICES AMENDMENTS OF 19 66

ing infant mortality and maternal mortality, but reducing costs, for 

example, for school construction and a variety of other welfare costs 

through these programs. So that, they can, in fact, be investments 

as well as expenditures.

Mr. J arman. We certainly hope for those long-range results.

I might add th is: I am certainly not for a minute commenting in 

opposition to the objectives of the program. I think this is an area 

in which we should be participating, and I think it is unfortunate 

tha t we have so many other programs of high cost that it makes it 

necessary to look very carefully at any new program in terms of 

whether we can justify it as additional costs for the Federal 

Government.

Thank you, Mr. Chairman.

Mr. Friedel?

Mr. Friedel. First, I want to say tha t I am sorry I missed your 

opening statement.

I have two questions to ask, and each one has a three-part question. 

You might have answered these questions, I do not know, but these 

relate to the use of funds for voluntary family planning programs.

For the Health Service formula grants, can the States use Health 

Service formula grants for voluntary family planning under this 

program ?

Hr. Stewart. Tha t is good.

Mr. Friedel. Hoes HE W believe tha t voluntary family planning 

health services are properly part of a comprehensive State health 

program ?

Hr. Stewart. Yes.

Mr. Friedel. Would IIE W encourage the States to include such 

services in their comprehensive State plans?

Hr. Stewart. Yes; they would.

Mr. Friedel. Thank you very much.

Now, the other one is the Health Service project grants. Can 

Health Service project grants be used for voluntary family planning 

programs ?

Hr. Stewart. Yes; they could be.

Mr. F riedel. Can an application for such funds be made by a local 

government agency or a qualified private nonprofit corporation ?

Is the approval of the State health departm ent required?

Hr. Stewart. Tha t is right.

Mr. F riedel. Ho your potential needs for probable allocation of 

project gran t funds include funds for voluntary family planning?

Hr. Stewart. I do not quite understand tha t question.

Mr. Friedel. Hoes it include-----

Hr. Stewart. There is no allocation of funds under the project 

money. This would be competitive within various projects.

Mr. Friedel. It would be.

Hr. Stewart. But it certainly would compete just like anything 

else would compete.

Mr. Friedel. At what level of expenditures do you anticipate for 

voluntary family planning purposes for this fiscal year, 1968 through 

1970? Ho you have any plans for that, what level of expenditures?

Hr. Stewart. Well, no. As I stated earlier, recognizing why the 

authorized ceilings tha t are provided in the bill are the way' they
PUBLIC HEA LTH SERVICES AMENDMENTS OF 19 66 53

are, t hat this will give us very little flexibility and very little expansion into the family planning programs next year, but we do intend 

to come up next year with a new look at the authorized ceilings.

There is considerably more expenditures for family planning within 

the Department, though: The Child Health Institute in research, the 

Children’s Bureau programs in maternal and infant care, the MCII 

money tha t is being used by State health departments for family 

planning, the Office of Economic O pportunity title 19, and you can 

go down several others tha t I probably forgot.

Mr. F riedel. Thank you for the straightforward answers. I think 

it cleared up the record, so far as I am concerned.

Dr. Lee. I might just add one tiling on tha t, Mr. Friedel, in terms 

of the Department’s estimates of additional funds required for family 

planning services in 1968.

We have estimated, and these are very preliminary, that about $15 

million additional funds would be required based on the estimates 

tha t we have in from various States and local family planning organizations and other people that we are working with, both in terms of 

the Children’s Bureau and other programs.

Mr. F riedel. Would tha t be on a matching basis?

Dr. Lee. These are on a matching basis.

Mr. Friedel. Thank you, Mr. Chairman.

The Chairman. Mr. Satterfield.

Mr. Satterfield. No questions, Nfr. Chairman.

The Chairman. Dr. Carter.

Mr. Carter. You do not mean tha t this bill at the present time 

does include funds for family planning; is tha t true?

Dr. Stewart. It does not have funds specifically earmarked for 

family planning, but the formula grant money th at would be auth orized fo r 1968, and the project grant money could be used for family 

planning; yes.

Mr. Carter. Would it be used for family planning?

Dr. Stewart. I am sure it will be, if it is within the State’s or 

the locality’s plans to use it tha t way.

Mr. Carter. It is up to the States to do that.

Dr. Stewart. That is correct.

Mr. Carter. You are just a little bit hesitant about promulgating 

this at the present time; is th at true?

Dr. Stewart. No. I think we would try to encourage the States 

in the appropriate setting and the appropriate place to do family 

planning.

Mr. Carter. Certainly, this is something we should go into, I feel, 

and go into at once. It is quite a problem, as you know, and if this 

bill comes to committee for final consideration, I aim to place an 

amendment in for family planning beginning with this year. I believe it is necessary, because I do not think—I think we should go 

boldly into this field without hesitancy.

Dr. Stewart. Dr. Carter, I did not want to imply any hesitancy on 

our part. We will do everything we could, as I answered before, to 

encourage the States; the States can use the funds, and we will be 

trying to encourage them to.

Mr. Carter. Yes, sir. Thank you very much.

Tha t is all, Mr. Chairman.
54 PUBLIC HEA LTH SERVICES AMENDMENTS OF 19 66

Th e Chairman. Th an k you very kindly, Dr . Stew art , and all of 

yo ur colleagues here . We appre cia te yo ur coming up and giv ing us 

yo ur views, and we are hopeful th at we can ge t this bill ou t today. 

If we do not, it does not have much of a chance, I can tell you th at , 

if it does n ot get ou t today.

Th an k you.

We will go along with our next witn ess, if it is all righ t with you.

Dr. Stewart. Tha nk you, Mr. Ch airma n.

Th e Chairma n. I will call on ou r colle ague, the Ho norab le Jame s 

Mac kay, to introd uce the next witness. I believe he comes fro m his 

are a of the co untry. He will h ave the p riv ilege of intr od ucing him .

Mr. Mackay. Th an k you, Mr. Ch airma n.

I t is a p ar ticu la r p leasure for me to presen t Dr . Jo hn Venable, who 

is di rec tor of the Ge orgia D ep artm en t of H ea lth and who is also president-ele ct of th e Associa tion of St ate and Ter rito rial Hea lth Officers.

I know you have a way of com plime nting us to ou r con stituen ts, 

bu t I do no t th in k it will do any good, because Dr. Venable has been 

kno win g me since I was abo ut 14 years old, so I think an ything you 

mi gh t say fav ora ble to me w ould c han ge his op inio n which, I hope, is 

good.

But in a ny case, Dr. Venable is a g radu ate o f Emory Un ive rsity, and 

he was on the fa cu lty fo r 21 years, a nd he has been the hig hly respected 

head of o ur St ate h ealth d ep art me nt, w hich we th in k is one of the best 

in the Natio n.

I m igh t say th at the G eneral Asse mbly o f G eorgia, which is capable 

of being critic al of every part of th e executive bra nch of our State 

government, reg ard s this as one of th e best administered departm ents 

in our Sta te, and Dr . Venable has c ertainlv been helpful to me since 

I hav e been a mem ber of this com mittee in in terp retin g to me the 

Fe de ral, State, local, pu bli c-p riv ate relationships , and I tak e partic ular pride in pre senti ng this ou tst an ding Geo rgian, who is spe aking for th e State of Geor gia a nd also fo r t he association. Th an k you.

Th e Chairman. Dr. Venable, I ju st w an t to say you can be pro ud, 

too, of y ou r Repre sen tative here in Wash ing ton . He does a good job 

on th is committee as, I th ink , e very me mbe r of th e comm ittee does, but 

he has done an o utsta nd ing job.

A t t his time , I w ould like to c all on Mr. Pickle, our colle ague from 

Texas, to introd uce , I believe, the gen tlema n who is with you, Dr. 

Pea vy.

Mr. Pic kle ?

Mr. P ickle. Mr. C hairm an, at the witnes s table is D r. Jame s Pea vy, 

who is Com missioner of Hea lth of the St ate of Texas. I hav e not 

known him as lo ng as Dr. Venable has our colleague, Mr. Mackay, b ut 

alm ost, because we served toge ther in the St ate of Texas on man y 

comm ittees.

At one time , I was pa rt of the official St ate governm ent fam ily, 

and Dr . Peavy is a car eer public he alt h official in the finest sense of 

the word, and he made a real contr ibu tio n to the health needs of our 

State and gave us lea der ship on a national basis. So, I welcome the 

chance, also, to pres ent him to th is committee.

Th e C hairm an. I might say, as I di d abo ut Mr. Mackay, Dr . Peavy , 

th at y ou can be prou d of Ja ke Pic kle . He is one of our outstandin g 

mem bers, and we have 33 o utsta nd ing members—32, no t c ounting m yself—on th is committee.
PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66 55

So, I)r. Venable, if you will begin your presentation—I might say 

to you as I said to Dr. Stewart, we are trying to get through with this 

legislation today; so, if you have a long statement, if you will put it 

in the record, it will appear there, and you can summarize it.

STATEMENT OF DR. JOHN H. VENABLE, DIRECTOR, GEORGIA DEPARTMENT OF HEALTH, REPRESEN TING THE ASSOCIATION OF

STATE AND TERR ITORIAL HEALTH OFFICERS; ACCOMPANIED

BY DR. JAMES E. PEAVY, COMMISSIONER OF HEALTH, STATE OF

TEXAS

Dr. Venable. Thank you, Mr. Chairman and Mr. Mackay.

I have a very short statement.

I appear today representing both the State of Georgia and the Association of State and Territorial Health Officers of which I am the 

president-elect. On behalf of all your States’ health officers, may I 

express our appreciation for this opportunity to meet with you today.

It will not be news to any member of this committee when I say 

tha t all your State health officers are deeply interested in the legislation being considered. Many of us have spoken with our own Congressman Members—all of you have received communications from 

your home State explaining the reasons for our support of this remedial legislation. We regret tha t your heavy schedule of responsibilities precluded full hearing on H.R. 13197 and S. 3008. Assurance 

by Chairman Staggers tha t full consideration will be scheduled early 

next year is most gratifying. We believe it indicates the fact that you 

have concern, and we look forward to the opportunity to present to 

you the results of our studies over the past 4 years, during which time 

we have worked very closely with officials of the Public Health Service 

and the Secretary’s Office, Department of Health, Education, and 

Welfare.

We are aware, Mr. Chairman, of the situation presently confronting 

this committee in these closing days of the 89th Congress. I deeply 

appreciate the extraordinary efforts that you and your committee are 

making to resolve temporarily the precarious situation of the moment. 

As requested, these comments and recommendations are addressed to 

the identical bills, H.R. 18231 and H.R. 18232, introduced by C hairman Staggers and Congressman Rogers of Florida.

This new provision—the expression of Federal willingness to become a full partner in developing practical health plans, utilizing the 

joint efforts of all States health interests—is extremely important. It 

is essential if we are to b ring to those who need them the fruits of new 

medical knowledge in the most orderly, least confused fashion, utilizing to the optimum scarce available health personnel. These funds 

will enable each State to assess all its health needs, plan to meet them 

and continue an intelligent, realistic appraisal of progress and shifting priorities. We stanchly support this provision in the bills.

Current authority for the Federal formula categorical grants in 

section 314(c) and section 316 expires June 30, 1967. H.R. 18231 

would extend this authority through June 30, 1969, and would eliminate the disease categories presently included as was proposed in 

II.R. 13197 and S. 3008.
56 PUBLIC HEALT H SERVICES AMENDMENTS OF 19 66

We support this new approach to assisting State and local health 

departments which would allow to each sufficient latitude to meet 

their most serious health problems. We must, in candor, point out 

respectfully that removing the structures on the appropriations will 

only help solve our problem. The amount of funds provided must be 

increased significantly if the Federal Government is to become a 

partner in fact. The increase of but $6.5 million over present appropriations, distributed among 50 States, the District of Columbia, 

Puerto Pico, Guam, and the Virgin Islands will mean we can make no 

appreciable impact on greatly needed programs such as family planning, alcoholism, renal dialysis, home and traffic safety, retarded 

children and a host of others. In view of the obvious needs, we recommend that the authorization for formula health grants to States 

for 1968 be increased to $100 million and, because the committee will 

be making a thorough study of this problem in Jan uary 1967 tha t 

there is no apparent or compelling need for an authorization for 

fiscal 1969.

You are familiar with the purpose of the project health gran t— 

to more adequately deal with specific disease or health problems of 

unusual proportions in delineated geographical areas—so I shall not 

be repetitious. Our views here reasonably parallel those attendant 

to the formula grants, namely, that they be authorized for 1968 at 

a level of approximately 50 percent higher than at the present— 

$75 million.

We earnestly request your serious consideration of these views. 

Authorization to continue our collective efforts next year is vital to 

continued progress. Our recommended, temperate increases would 

elevate the rate of progress.

Thank you for this opportunity to appear before you.

Mr. F riedel (presiding). Thank you fo r your very fine statement.

Are there any questions?

Dr. Carter?

Mr. Carter. Tn your State, you have a program at the present 

time for family planning?

Dr. Venable. Yes, sir, we do.

Mr. Carter. Have you had any difficulty with tha t program?

Dr. Venable. Any program includes difficulties. We, I think, have 

a major difficulty of not sufficient funds to provide the materials 

necessary for the needs that people are demanding be met.

Mr. Carter. I s it widely accepted there?

Dr. Venable. It is widely accepted, and we are currently training 

counselors in the local welfare departments to counsel in this area and 

refer.

Mr. Carter. I want to congratulate you on that.

What about renal dialysis, your program for tha t at the present 

time?

Dr. Venable. Renal dialysis is just starting under a grant in Atlanta in the city hospital. It is just off the ground. I am not sure 

whether they have had their first patient at this moment, or not, but 

thev will very shortly if they have not already done so.

Mr. Carter. The mechanism for perform ing this, I understand, 

has become less complicated and less expensive, and could be of great 

help.
PUBLIC HEALT H SERVICES AMENDMENTS OF 19 66 57

Dr. Venable. One of the built-in features of this particula r project 

is to try to further a cheaper and mobile method that will enable this 

procedure to be done at home.

Mr. Carter. Thank you very kindly.

Mr. Friedel. Mr. Pickle?

Mr. Pickle. Thank you, Mr. Chairman.

Dr. Peavy, I assume you are in general agreement with the statement which has been made by Dr. Venable ?

Dr. Peavy. Yes, sir. We are in complete harmony all the way 

through.

Mr. Carter. That is all, Mr. Chairman.

Mr. Friedel. Thank you.

Mr. Watson. Doctor, we appreciate your statement. There is only 

one thing that disturbs me about it. You state on page 3:

The increase of but $6.5 million over present appropriations, distributed among 

50 states, the District of Columbia, Pue rto Rico, Guam, and the Virgin Islands will mean we can make no appreciable impact on greatly needed programs 

such as—

and then you enumerate some of the programs.

The thing that concerns me, I agree with you tha t it will not make 

an appreciable impact, but yet in your statement you say this will 

give the Federal Government full partnership. I do not believe in 

giving them partnership in such a meager amount. I appreciate your 

statement.

Dr. Venable. Thank you, sir.

Mr. F riedel. If there are no further questions, I want to thank you 

both.

Dr. Venable. Thank you.

Dr. Peavy. We appreciate the opportunity very much.

Mr. F riedel. Dr. Charles Hudson, president of the American Medical Association, accompanied by Mr. Harry Peterson and Mr. Paul 

Donelan.

Dr. Hudson if you want to briefly summarize your statement, your 

whole statement will be included in the record. We want to try to get 

all the witnesses in today.

STATEM ENT 0E DR. CHARLES L. HUDSON, PRESIDEN T, AM ERICAN

MEDICAL ASSO CIATION; ACCOMPANIED BY PAU L R. M. DONELAN

AND HA RR Y N. PETE RSON, ATTORNEYS, LEGISLATIVE DE PARTMENT STA FF, AMERICAN MEDICAL ASSOCIATION

Dr. Hudson. Thank you, Mr. Chairman and members of the committee.

I am Dr. Charles L. Hudson, president of the American Medical 

Association and a practicing physician from Cleveland, Ohio, where 

I have been in the practice of internal medicine for over 25 years.

Those accompanying me have already been introduced by you, Mr. 

Chairman.

I would like to abbreviate my report in the hopes that it will be recorded in full, including the summary and the recommendations at 

the end.

Air. F RI ED EL . Y e S .
58 PU BLI C H E A L T H SE RV IC ES AM EN DM ENTS OF 1 9 6 6

Dr. H udson. The le gislation, insofar as it is in tended to prov ide for 

greater use of a vailable fac ilities and manpower, avoid overl appin g o f 

existing p rog ram s and pro vide c oordinat ion among variou s prog ram s, 

and pe rm it gr ea ter flex ibility of pub lic he alt h gr an ts to meet t he p ar ­

tic ular problem s in a Sta te, has the supp ort of the Am erican Medical 

Association. How ever, we would like to co nsid er the various p ar ts of 

the bills separa tely, inas much as we believe that the legisla tion requires 

certain modifications.

One section of H.R. 13197 would provide a 6-year prog ram of fo rmu la gr an ts for comprehensive plan ning wi thin t he State fo r healt h 

services, both private and pub lic, and inc lud ing facilities and ma npower. Since duplication and ov erl appin g of p rog ram s can be costly 

in terms of healt h resources, inc lud ing scarce manpo wer, the AM A 

would endo rse the co ncep t o f com preh ensive pla nning . How ever, we 

recom mend th at certa in changes be m ad e:

(1) We believe th at the legisla tion , being concerned as it is with 

health prob lems in a Sta te, should provide fo r the ad mi nis tra tio n of 

the plan by the State healt h au thor ity or by an interagen cy comm ission composed of repr ese nta tives of St ate agencies or de partm ents concerned with he alth and rel ate d activities.

(2) We recommend th at the legislation req uir e the m emb ersh ip of 

the State healt h planning council to include repres entativ es of the 

State medical society, with the majority of the council bein g physicians, inc lud ing those in the p riv ate pra ctice of medicine.

(3) We also believe th at such a pl an ning council should be more 

than adv isory and , as in the case of the advisory councils un der the 

he art disease, cancer, and stro ke program , the State pla n should be 

appro ved b y the plan ning council. Fu rthe r, w here th e legisla tion requires a review of the State pla n, we believe th at thi s review should 

be m ade in con sultation with the p lann ing council and th at a ny m odifications of the St ate pla n should be appro ved by the council.

The significance of this legisla tion cannot be ove rstated as it will, 

if enac ted, hav e far -re aching effects on the provision of healt h care 

to the citizens within a Sta te. We believe th at the above suggested 

amendmen ts would str ength en the leg islation in ass uri ng the continu ed 

prov ision of adeq uate he alt h services, an d wi th these amendmen ts the 

AM A support s the prog ram of comprehensive State healt h pla nning .

The A MA has end orsed areawid e p lann ing on a v olun tar y basis, and 

we believe th at the leg isla tion would enc ourage vo lun tar y priva te 

agencies to pla y a substan tia l role in plan ning activities. Accordingly, we s up po rt the provisions of the legisla tion fo r areawide p lanning .

The com preh ensive public healt h services portion of H.R. 13197 

would pro vide fo r a 5-year prog ram of form ula gr an ts for com prehensive pub lic healt h services. The section embodies one of the pr in ­

cipal objectives of th is legi slation. At the present time, financial 

assistance is made ava ilable un de r the Publi c Hea lth Serv ice Act to 

State s and com mun ities, to assist them in dev eloping and prov idi ng 

pub lic healt h services. Th is asistanc e usually takes the form of separate catego rica l gran ts, eit he r formu la or pro jec t, ear ma rke d for use 

in meetin g a specific disease prob lem. Grants are p resently made for 

such prog ram s as gen eral pub lic healt h services, tube rculosis control, 

chronic disease services, he art disease con trol, cancer control, mental
PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66 59

healt h services, denta l healt h services, rad iological services, home 

healt h services, and also venereal disease control.

As a chara cte riz ati on of the type of services envisioned un de r this 

legisla tion, it was sta ted in the Senate heari ngs on S. 3008 th at the 

Fe de ral gra nt funds would be ava ilab le to State s on a nonca tegorical 

basis fo r the pro vision of “com preh ensive pub lic healt h serv ices’’ 

whi ch are focused on ind ivi du als and on fam ilie s in t he ir com munities 

ra th er than on separat e disease conditio ns. Dr. Leo J. Gehrig, 

De pu ty Surge on General, Publi c Hea lth Serv ice, tol d the Senate 

co mm ittee:

Through this flexible g ran t structur e comprehensive public health services will 

be developed, expanded, and supported to maintain physical and mental he al th ; 

to detect, prevent, control, or reduce the impact of diseases, injuries, and disa ­

bilities ; to maintain a hea lthful env iron ment; and, generally, to make available 

to all persons within the Sta te a continuum of public health services based on the 

most up-to-date scientific knowledge and techniques.

The testimony of ad mi nis tra tio n witnesses has m ade it c lear t hat the 

ter m “public healt h services” has lit tle res tricti ve meaning, if any. 

Th e increase in pro jec t ap prop ria tio ns ind icates a gr ea tly increased 

pro gra m, w ith no s tat ed li mi tat ion as to th e kind of services to be sup ­

ported. Th e Am erican M edical Associa tion would s up po rt pro gra ms 

prov iding “pu blic h ealth services,” which fo r the most p art have been 

rep res ent ed in the existing categorical gr an ts, such as fo r venereal 

disease, tuberculosis con trol , rad iological he alth gran ts, et cetera. 

We believe t hat th is legislation, in the absence of definitive langua ge, 

could rep res ent a f ar-re aching dep arture, o r ex pan sion, from the t ru ly 

pub lic he alt h servic es wi th which the Public Hea lth Serv ice has been 

cha rged.

The legislation pro vid es what appears t o be un lim ited he alth services, focused on ind ivi duals and on fam ilies ra th er than on sep ara te 

disease conditions. It brin gs w ith in the guise of “p ublic h ea lth ” services the med ical and he alt h services prese ntly being pro vid ed by the 

indiv idual physician to th e in div idual pati en t.

The Am erican Medical Associa tion believes t hat th is legislation, as 

described by witnesses at Senat e hearings, rep res ents a substan tial 

cha nge in activities of the Public Hea lth Service. We believe th at 

Congress should define “public he alth se rvices” un de r t his bill, so th at 

its int ention as to the fun ctions of the Pu blic Hea lth Service will be 

clea r, and so th at public healt h clinics will no t be fostered to replace 

private medical care. In the absence o f any li mita tio n, and where th e 

ap prop ria tio ns are no lon ger iden tified on a catego rica l basis, an un ­

lim ited ran ge of ac tivitie s appears to be th e result. Th is the Con gress 

refuse d to autho rize un de r the he art disease, cancer, and stroke pr ogram , and we believe th at the Con gress sho uld not autho riz e a carte 

bla nch e prog ram merely because it is un de r the bene ficient title of 

“public he alth services.” Exten sions of such a prog ram can have no 

oth er effect th an to interfe re w ith a system w hich has p rov ide d a h igh 

level of medical care. Inter feren ce w ith the priva te p rac tice of me dicine could also res ult from the pro vision au thorizing the Surge on 

Gener al to set sta nd ards as to the scope and qu ality of the services to 

be pro vided.

Th e Am erican Medical Ass ocia tion cannot end orse an und efined 

pro gra m. As an alt ern ati ve, or un til t he scope of the prog ram is pu t 

in p rope r “public health ” pers pec tive , we wou ld recom mend a continua-
60 PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66

tion of tlie present categorical grants, with the Surgeon General having discretion to permit a State to shift a portion of a categorical grant 

for use in other of the categorical programs as may be desired by the 

State. This would achieve the flexibility sought under the proposed 

legislation.

The section concerning project grants for health services development. would provide a 5-year program of project grants to public or 

nonprofit private agencies to cover part of the cost of :

(1) Providing services to meet the health needs of limited geographical scope or of specialized regional or national significance;

(2) Stimulating and supporting for an initial period new programs of health services; or

(3) Undertaking studies, demonstrations, or training designed to 

develop new methods or improve existing methods of providing health 

services.

These project grants are intended to assist the States with a par ­

ticular disease or health problem, and as we view it, would in effect 

retain the system of categorical grants—the elimination of which is 

one of the intents of the previous section of the bills discussed. Fu rther, it should be noted tha t this section no longer refers to “public 

health services” but is concerned with the development and providing 

of undefined “health services.”

Presently, project grants are made for cancer control, mental retardation activities, neurology and sensory disease activities, and continuing support of venereal disease and tuberculosis control activities, 

as well as the development of new or improved methods of providing 

out of hospital community health services.

An administration witness stated at the Senate hearings that project 

grants could continue under the proposed legislation for these same 

kinds of programs, as well as for program support, program development, and demonstration purposes in other health program areas 

such as heart disease control, dental health, injury control, urban 

health, family planning alcoholism, drug addiction, and rural health 

development.

Again, there is no limitation stated in the legislation as to the kind 

of health services which might be provided. The programs could be 

supported almost wholly by the Federal Government. And the categorical grants would not only be perpetuated but could in fact be increasingly diversified.

The American Medical Association would support grants for existing or new programs having a bearing on the public health. Assistance in proper Public Health activities to attack and control public 

health problems has unquestionable merit. However, this section of 

the legislation is vague and needs clarification as to its intent. There 

is need for definition and limitation of the services to be provided, and 

in its present form the association cannot support the project gran t 

provisions.

Other provisions of the legislation provide for interchange of personnel with States, grants for support of public health training, and 

training of personnel for State and local health work. We believe all 

these provisions to be salutary and recommend your support.

We would further suggest that the legislation should provide for 

the creation of a National Advisory Council, to the Surgeon General
PUBLIC HEALTH SERVICES AMENDME NTS OF 19 66 61

of the Public Health Service for implementing the provisions of this 

legislation, which Council would approve grants made to the States 

and approve changes made from time to time in the State plans. The 

Council should include representatives of national organizations which 

are represented on the State planning councils.

As a final addition we believe tha t a provision should be inserted 

in the legislation, similar to section 1801 of Public Law 89-97, to the 

effect tha t there shall not be any interference with the practice of 

medicine.

Having noted that I have not read the summary and recommendations, again, I would like to close and thank you for this opportunity 

to present the views of the American Medical Association on this legislation. We will be pleased to try to answer any questions which you, 

or the members of the committee, may have.

(The prepared statement submitted by Dr. Hudson follows:)

Statement of the American Medical Association by Charles L. Hudson, M.D., 

President

Mr. Chairman and members of the committee, I am Dr. Charles L. Hudson, 

president of the American Medical Association, and a prac ticing physician from 

Cleveland, Ohio, where I have been in the practic e of intern al medicine for over 

twenty-five years.

With me ar e Mr. P aul R. M. Donelan and Mr. Ha rry N. Peterson, atto rne ys on 

the Legislative Department staff of th e AMA.

The American Medical Association is pleased to have this opportunity to 

appear before you and present its views on H.R. 13197 and S. 3008, the Comprehensive Health Planning and Public Health Service Amendments of 1966.

All of us who are active in medicine are a ware of the gre at contribution being 

made by the Public Health Service in reaching the high level of hea lth care enjoyed in this country. As you know, the American Medical Association has 

cooperated with the Public Health Service and has supported legislation in 

the area of public health.

In general, the “Comprehensive Health Planning and Public Hea lth Service 

Amendments of 1966” has two principal divisions. One would provide grants 

to the States for comprehensive hea lth plan ning—statewide, regionally and 

locally—with respe ct to all are as of hea lth services, both public and private, 

and including hea lth facilities and manpower. The second would revise the 

present gra nt system under the Public Health Service Act which, at the present 

time, provides sep ara te categ orical gra nts—both on a form ula and project 

basis—and earmarked for use in meeting a specific disease problem. Under 

the legislation, certain present categorical gra nts would be consolidated into 

a single gra nt to the State for use in accordance wdth its State planning. In 

addition, special project gra nts would remain available to provide additional 

assistance to attack special needs of a limited geographic scope or of regional 

or natio nal significance.

The legislation, insofar as it is intended to provide for greater use of ava ilable facilities and manpower, avoid overlapping of existing programs and provide coordination among various programs, and perm it gre ater flexibility of 

public hea lth gra nts to meet the pa rticu lar problems in a State, has the supl>ort of the American Medical Association. However, we would like to conside r the various pa rts of the bills separately, inasm uch as we believe th at 

the legislation requ ires certain modifications.

Comprehensive Sta te Health Planning

One section of H.R. 13197 would provide a six-year program of formula 

gra nts for comprehensive planning with in the Sta te for health services, both 

priv ate and public, and including facilities and manpower. Since duplication 

and overlapping of programs can be costly in term s of health resources, including scarce manpower, the AMA would endorse the concept of comprehensive 

planning. However, we recommend that cer tain changes should be m ad e:

(1) We believe that the legislation, being concerned as it is with health 

problems in a State, should provide for the adm inistration of the plan by 

70 -0 50— 66------ 5
62 PUBLIC HEALT H SERVICES AMENDMENTS OF 19 66

the State hea lth autho rity or by an interagen cy commission composed of 

represen tatives of State agencies or departm ents concerned with health 

and rela ted activ ities.

(2) We recommend th at the legislation require the membership of the 

State Hea lth Planning Council to include represe ntatives of the State 

Medical Society, with the majority of the Council being physicians, including those in the private prac tice of medicine.

(3) We also believe th at such a Plan ning Council should he more than 

advisory and. as in the case of the advisory councils under the Heart 

Disease. Cancer and Stroke Program, the State plan should be approved 

by the Plan ning Council. Furth er, where the legislation requires a review 

of the Sta te plan, we believe th at this review should he made in consultati on with the Planning Council and that any modifications of the State 

plan should be approved by the Council.

The significance of this legislation cann ot he overstated as it will, if enacted, 

have far-reac hing effects on the provision of hea lth care to the citizens within 

a State. We believe that the above suggested amendments would strengthen 

the legislation in assuring the continued provision of adeq uate health services, 

and with these amendments the AMA supports the program of comprehensive 

State hea lth planning.

Area wide Planning

A second section is also concerned with planning, hut this time on an are awide basis. Under this portion of H.R. 13197, a six-year program of grants is 

authorized, under which the Surgeon General may make a gra nt (with approval 

of the State agency adm inistering the plan for comprehensive State health planning) to any other public or nonprofit private agency to cover up to 75% of 

the cost of projects for developing (an d for revising) comprehensive regional, 

metropolitan area, or other local area plan s for coordination of existing and 

planned health services, including the facilities and persons requ ired for such 

services.

The AMA has endorsed areawide planning on a voluntary basis, and we 

believe that the legislation would encourage volu ntary private agencies to 

play a sub stantial role in planning activities. Accordingly, we supp ort the 

provisions of the legislation for areawide planning.

Grants for Comprehensive Public Hea lth Services

The comprehensive public health services portion of H.R. 13197 would provide for a five-year program of formula gra nts for comprehensive public health 

services. The section embodies one of the prin cipal obectives of this legislation. 

At the present time, financial assistance is made available under the Public 

Health Service Act to States and communities, to assist them in developing and 

providing Public Health services. This assistance usually takes the form of 

sep ara te categorical grants, eith er formula or project, earm arked for use in 

meeting a specific disease problem. Gra nts are presently made for such program s as general public health services, tuberculosis control, chronic disease 

services, heart disease control, canc er control, mental hea lth services, denta l 

health services, radiological services, home hea lth services, and also venereal 

disease control.

As a cha racterization of the type of services envisioned under this legislation, 

it was stated in the Senate hearings on S. 3008 that the federal gra nt funds 

would be available to States on a noncategorical basis for the provision of 

“comprehensive public hea lth services” which are focused on indiv iduals and 

on families in their communities rather tha n on separate disease conditions. 

Dr. Leo J. Gehrig, Deputy Surgeon General, Public Health Service, told the 

Senate Committee: “Through this flexible gra nt structur e comprehensive public 

hea lth services will be developed, expanded, and supported to mainta in physical 

and mental he al th ; to detect, prevent, control, or reduce the impact of diseases, 

injuries, and dis abilitie s; to maintain a hea lthful env ironment; and, generally, 

to make available to all persons within the State a continuum of public health 

services based on the most up-to-date scientific knowledge and techniques.”

The testimony of Adm inistratio n witnesses has made it clea r th at the term 

“public hea lth services” has little restric tive meaning, if any. The increase in 

projected app ropriations indicates a greatly increased program, with no stated 

limitation as to the kind of services to be supported. The American Medical 

Association would support programs providing “public health services,” which 

for the most pa rt have been represented in the existing categorical grants, such
PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66 63

as for venereal disease, tuberculosis control, radiological health grants, etc. 

We believe th at thi s legislation, in the absence of definitive language, could 

represe nt a far-reac hing departu re, or expansion, from the truly public health 

services with which the Public Hea lth Service has been charged. The legislation 

provides what appears to be unlim ited health services, focused on individuals 

and on families rather tha n one sep arate disea se conditions. It brings with in 

the guise of “public healt h” services the medical and hea lth services presently 

being provided by the individual physician to the individual patient.

The American Medical Association believes th at this legislation, as described 

by witnesses at Senate hearings, represents a sub stantial change in activities 

of the Public Hea lth Service. We believe th at Congress should define “public 

hea lth services” under this bill, so t ha t its intention as to the functions of the 

Public Health Service will be clear, and so th at Public Health clinics will not 

be fostered to replace private medical care. In the absence of any limitatio n, 

and where the appropriations are no longer identified on a categ orical basis, an 

unlim ited range of activities appears to be the result. This the Congress refused to authorize under the He art Disease, Cancer and Stroke Program, and 

we believe th at the Congress should not authorize a car te blanche program 

merely because it is under the beneficent title of “public health services.” Extensions of such a program can have no other effect tha n to int erf ere with a 

system which has provided a high level of medical care. Inte rference with 

the private practice of medicine could also res ult from the provision authorizing 

the Surgeon General to set standar ds as to the scope and quality of the services 

to be provided.

The Amercian Medical Association cannot endorse an undefined program. As 

an alternative , or until the scope of the program is put in proper “public healt h” 

perspective, we would recommend a continuation of the present categ orical 

grants, with the Surgeon General having discretion to perm it a State to shift 

a portion of a categ orical gra nt for use in other of the categorical programs as 

may be desired by the State. This would achieve the flexibility sought und er 

the proposed legislation.

Project Grants fo r Health Services Development

The section concerning project gra nts for hea lth services development would 

provide a five-year program of p roject gra nts to public or nonprofit priv ate agencies to cover p art of the cost o f: (1) providing services to meet the h ealth needs 

of limited geographic scope or of specialized regional or n atio nal significan ce; (2) 

stim ulating and supporting for an initial period new programs of health services; or (3) underta king studies, demonstrations, or traini ng designed to develop new methods or improve existing methods of providing hea lth services. 

These project gra nts are intend ed to ass ist the States with a particular disease 

or health problem, and as we view it. would in effect retain the system of categorical grants—the elimination of which is one of the inte nts of the previous 

section of the bills discussed. Further, it should be noted th at thi s section no 

longer refers to “public hea lth services” but is concerned with the development 

and providing of undefined “health services”.

Presently, project gra nts are made for cancer control, mental retard ation 

activ ities, neurology and sensory disease activities, and contin uing support of 

venereal disease and tuberculosis control activities, as well as the development 

of new or improved methods of providing out of h ospital community health services. An Adm inistratio n witness stated at the Senate hearing s th at project 

gra nts could continue under the proi>osed legislation for these same kinds of programs, as well as for program support, program development, and demonstration purposes in other hea lth program are as such as he art disease control, den tal 

health, Injury control, urban health, fam ily planning, alcoholism, drug addiction , 

and rural health development.

Again, there is no limitation stated in the legislation as to the kind of hea lth 

services which might be provided. The programs could be supported almost 

wholly by the Federal government. And the categorical gra nts would not only 

be perpetua ted but could in fact be increasingly diversified.

The American Medical Association would supp ort gra nts for existing or new 

programs having a bearing on the public health. Assistance in prop er Pub lic 

Health activities to att ack and control public hea lth problems has unquestionable merit. However, this section of th e legislation is vague and needs clarification as to its intent. There is need for definition and limitation of the services 

to be provided, and in its present form the Association canno t support the p roject 

gra nt provisions.
64 PUBLIC HEA LT H SER VIC ES AM ENDM ENTS OF 19 6 6

O th er P ro vision s

O th er pr ov isions of th e le gi sl at io n pr ov id e fo r in te rc han ge of pe rson ne l w ith 

Sta te s, g ra nts fo r su pp or t of Pu bl ic H ealth tr ai nin g, an d tr ain in g of pe rson ne l 

fo r Sta te an d loc al he al th wo rk. W e be lie ve al l th es e pr ov isions to be sa lu ta ry 

an d rec om men d yo ur su pp or t. We wou ld fu rth e r su gg es t th a t th e legi slatio n 

sh ou ld pr ov id e fo r th e cr ea tion of a N at io nal Adv isor y Co un cil to th e Su rgeon 

G en er al of th e Pu blic H ea lth Se rv ice fo r im plem en tin g th e prov isions of th is 

legi slatio n, which Co un cil wo uld ap pr ov e g ra n ts mad e to th e Sta te s an d ap pr ov e 

ch an ge s mad e fro m tim e to tim e in th e S ta te pl an s. Th e Co uncil shou ld includ e 

re pre se nta tives of nat io nal org an iz at io ns which are re pr es en te d on th e Sta te 

Pla nn in g Co uncils.

As a fin al ad di tion we believe th a t a pr ov isio n shou ld be in se rted in th e leg islation , si m il ar to Se cti on 1801 of P.L. 89-97, to th e eff ect th a t th ere sh al l no t be 

an in te rf ere nce w ith th e pr ac tice of m ed icine.

Su m m ary

In su m mar y. Mr. C ha irm an an d mem be rs of th e Co mm ittee, th e Am erican 

Me dic al Assoc iatio n is ke en ly aw are of th e g re at co nt ribu tion to th e pu blic 

he al th mad e by th e Pu blic H ealth Se rvice . Th e prop osed legi slat io n wo uld 

broa de n th e ac ti vit ie s of th e Pub lic H ealth Se rvice , an d in so fa r as it wo uld 

prov ide fo r gre ate r us e of e xis ting fa cil it ie s an d man po wer, av oid ov er lapp ing of 

pr og rams, an d prov ide gre ate r flex ib ility of pu blic hea lth gra nts , it has ou r 

su pp or t. How ev er, we ha ve dir ec te d th e Com m itt ee ’s att enti on to th e spec ific 

prov isions o f t he b il l:

A. We rec om me nd th a t th e Com mitt ee su pp or t th e co mpr eh en sive Sta te 

he al th pl an ni ng prov isi on prov id ed th a t (1 ) th e ad m in is tr ati on of th e plan 

be by th e S ta te hea lth auth ori ty or by an in te ra ge nc y comm iss ion com pos ed 

of re pre se nta tives of S ta te ag en cies or dep ar tm en ts co nc erne d w ith he al th 

an d re la te d acti vit ie s; (2 ) th e m em be rshi p of th e Pla nni ng Co un cil inc lude 

re pre se nta tives o f th e S ta te M ed ica l So cie ty, w ith th e m aj ori ty o f th e Council 

be ing ph ys ic ians , includ ing th os e in th e pri vat e pra ct ic e of m ed ic in e; an d 

(3 ) th e Pla nn in g Co uncil sh ou ld ap pr ov e a S ta te plan , th e re vi ew of the 

pl an shou ld be mad e in consu ltat io n w ith th e Pla nnin g Co unc il, an d an y 

mod ifi ca tio ns of th e pl an shou ld be ap pr ov ed by th e Pla nni ng Counc il.

B. We rec om me nd you r su ppo rt of th e ar ea w id e pla nn in g pr ov isions an d 

th e e nc ou ra ge m en t of v olu nta ry ag en cies to play a s ubst anti ve role.

C. W e ur ge yo u to oppose th e prov isions , as now co nt ai ne d in th e legi slatio n, fo r Co mpreh en siv e Pub lic H ealth Se rvice s, in as m uc h as the y app ar en tly 

could pr ov ide fo r a fa r- re ac hi ng d ep art u re fro m tr uly Pu bl ic H ea lth Servi ces.

D. Si m ilar ly , we as k yo u to re je ct th e secti on on P ro je ct G ra nts fo r 

H ea lth Se rvices De velop me nt, sin ce w hat ap pea rs to b e pla nn ed is a pr og ram 

fo r th e de ve lopm en t an d th e pr ov id in g of a gr ou p of un de fin ed “h ea lth 

se rv ices .”

E. W e rec om men d th a t yo u ap pr ov e of thos e se ctions which prov ide fo r 

in te rc ha ng e of pe rson ne l w ith Sta te s, g ra nts fo r su pp or t of Pu bl ic H ea lth 

tr ai nin g, an d tr ain in g of perso nn el fo r S ta te an d loc al he al th w ork.

F. Fin al ly , we as k th a t th e hi ll in cl ud e prov ision fo r a N at io na l Adv iso ry 

Co uncil, includ e a pr oh ib itory cl au se st ati n g th a t th er e sh al l be no in te rfe re nc e w ith th e pr ac tice of med ici ne , an d de lete th e prov ision pr es en tly in 

th e legi slatio n, ou t of which in te rf ere nce could ar ise, th a t th e re gu la tion s 

pr es cr ib e th e sco pe and q uali ty of t he h ea lth se rv ices u nder a S ta te ’s plan .

F or your co ns id er at io n, we su gg es t th e follo wing mod ifi ca tio ns to th e

leg islation:

(1 ) In th e se ction co nc erni ng Co mpreh en siv e S ta te H ea lth P la nnin g:

(a ) pr ov id e th a t th e sin gle S ta te ag ency sh al l be th e S ta te hea lth 

auth ori ty or an in te ra ge nc y co mm iss ion com posed of re pre se nta tives of 

S ta te ag en cies or dep art m ents co nc erne d w ith healt h an d re la te d 

a c ti v it ie s;

(b ) pr ov id e th a t a S ta te H ea lth Pla nnin g Council sh al l incl ud e re pre ­

se nta tives of a S ta te Medica l So cie ty, w ith th e m ajo ri ty of th e Cou ncil 

be ing ph ys ic ians , in cl ud in g th os e in th e pri vate p ra ct ic e of m ed icine;

(c ) pr ov id e th a t a S ta te p la n m ust b e ap pr ov ed b y th e P la nni ng C ou ncil. th a t th e review o f th e p la n be m ad e in co ns ul ta tion w ith th e Council, 

and m od ifi ca tio ns be ap pr ov ed by th e Co uncil.

(2 ) C la ri fy t he sco pe of an y h ealt h se rv ices to be pr ov ided b y :

(a ) Add ing a de fin iti on of “p ub lic he al th se rv ices ” to in di ca te th at 

pu blic healt h is th e a r t an d scienc e of m ai nt ai ni ng , pr ot ec ting , an d im-
PUBLIC HEALTH SERVICES AMEN DMENTS OF 19 66 65

pro ving the he alth thr ough org anized com munity effo rts. Pu bli c he alth 

serv ices could inc lud e: vital st at is tics ; public he alth edu cat ion ; enviro nme nta l sa ni ta tion ; public he alth labo ratorie s (i f pr ivate facilities ar e 

un avail able) ; and hygiene of maternity, inf ancy an d childho od, if 

pr iv ate facilities ar e unavailable.

As an al tern at iv e to the provision fo r com prehensive pub lic he alth 

services, pe rm it the Surgeon General to allow , un der the ex ist ing categor ical gr an t pro gra ms, a St ate to sh if t a portio n of a categ orical gr an t 

fo r use in othe r of the categ ori cal pro gra ms as may be desired by the 

Sta te. Th is wou ld ach ieve the flexib ility which is sou ght un der the 

propose d legisla tion.

(b) Cl arify ing the pro gram of projec t gr an ts fo r he alth services 

deve lopment, by cha nging it to one re latin g to Pu bli c Hea lth wi thi n the 

concept of the p receding pa ra gr ap h (a ).

(3) Pro vid e f or th e cre ation of a N ati on al Adv isory Council to the Surgeon 

General of the Pu bli c Hea lth Service, fo r implementing th e pro vision s of 

this legisla tion. Th is cha nge should pro vide th at t he C ouncil wou ld app rov e 

gr an ts made to th e St ates and app rov e cha nges made from tim e to tim e in 

the St ate plans, an d th at the Council sho uld inc lud e represen tat ive s of 

na tio na l organiz ati ons which ar e represe nte d on the St ate Plan ning Councils 

(as co ns tituted in con formity with our rec om me ndations fo r membersh ip 

of the S ta te P lann ing Counc ils) .

(4) In se rt a pro vision in the leg islati on, sim ila r to Section 1801 of 

P.L. 89-97, which ind ica tes th at there shall not be any inter ference with 

the practice of medicine.

(5) Delete in the section con cerning com prehen sive public he alth servic es 

the provision th at the serv ices be accor din g to stan da rd s set by reg ula tions, 

inc luding st an da rd s as to th e scope an d qu ality of such services.

Mr. Ch airma n, in clos ing we than k you fo r this oppo rtu nit y to presen t the 

views of the Am erican Medica l Association on th is legisla tion. We will be 

pleased to tr y to an sw er any que stio n which you or members of the Com mittee 

may have.

Mr. F riedel. Th an k you very much fo r y our c ooperation.

Are the re any questions?

Mr. Younger ?

Mr. Younger. Docto r, on yo ur recom menda tion s beginn ing on pag e 

8 where you are op posed to provisio ns con tained in the legislation, are 

you re fe rrin g to the bill on pag e 9, b eginn ing wi th lin e 18 ?

Dr. 11 udson. May I look-see ? Whic h bill num ber, sir ?

Mr. Younger. Well, the one we ar e considering.

Mr. Donelan. T am M r. Donelan.

Mr. Younger. Th e bill we are co nsider ing, 18231.

Mr. Donelan. Th e problem , sir, was Dr. Hu dson was not able to 

ge t a copy of 18231, nor was the asso ciation, and his comments refer 

to 13197 which co nta ins sim ila r p rovisions, bu t th ey may be in a different par t o f th e bill.

Mr. Younger. We ll, I think the pro vision s pro bably are sim ila r 

except in th e am ount o f au tho riz ation.

Mr. Donelan. Ge nerally, th at is true, sir.

Mr. Younger. But under the heading “G ra nts fo r Com preh ensive 

Pu blic Hea lth Service s,” th at is the pro vision th at you are referri ng 

to ther e?

Mr. Donelan. That wou ld be the provision.

Mr. Younger. That w ould be the p rov isio n th at you oppose.

Mr. Donelan. Tha t is correct, sir.

Mr. Younger. Now, on (D ), you say the “P rojec t gr an ts”. Can 

you tell me what section of the bill you are re fe rrin g to the re? 1 do 

not, o ffha nd ------

Mr. D onelan. Tha t w ould be pag e 14, sir, line 20.
66 PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66

Mr. Younger. That is the allocation of funds within the states?

Mr. Donelan. No; project grants for health services development.

Mr. Younger. For which?

Mr. Donelan. Yes; health services development.

Mr. Younger. Project grants for health services development.

Mr. Donelan. Yes, sir.

Mr. Younger. It is that provision there that you-----

Mr. Donelan. (e).

Mr. Younger. That you object to.

But you do agree with the Department that the question of family 

planning ought to be included in this whole package.

Dr. Hudson. It certainly would not be excluded in view of the fact 

tha t this activity now goes on.

Mr. Younger. That is all, Mr. Chairman.

Mr. Friedel. Mr. Van Deerlin.

. Mr. Van Deerlin. Dr. Hudson, do you call for a majority of physicians to be represented on both the State and the National health 

planning councils? Do you intend by this recommendation to convey 

the idea that the planning councils involved in Hill-B urton legislation have been handicapped by the equal representation they have 

given to nonprofessional members?

Dr. Hudson. No, there is no reference to any of the council nor 

should you make inferences of that nature.

Mr. Van Deerlin. There would be, however, would there not, a 

similarity in the problems in the area of the purview of these respective councils, and that they are both related to comprehensive health 

planning?

Dr. H udson. I would think in the Hill-Burton perhaps there would 

be a wider range for diversity. But in the field of providing health 

services, and, as I interpret this personal health services, in many instances we do feel that we are expert in this particular field, traditionally have been carrying this out for many years.

Mr. Van Deerlin. Thank you.

Mr. F riedel. Mr. l ounger.

Mr. Younger. Would the gentleman yield? 1 think we have a 

provision in there, in one of the previous bills, that at least a majority 

should be composed of nongovernmental groups. Would you subscribe 

to that same theory that we have put into one other bill ?

Dr. Hudson. I would be more or less obliged to refer to my statement, sir.

Mr. ounger. To the effect of what? Repeat it.

Dr. Hudson. That we would like to have a majority of physicians. 

Mr. Younger. A majority of physicians.

Dr. Hudson. Including those in private practice.

Mr. Younger. Thank you, Mr. Chairman.

Mr. F riedel. Dr. Carter.

Mr. Carter. Dr. Hudson, I take it that one of your objections, 

main objections, to this bill is that in place of categorical grants they 

want just general grants and tha t their authority might invade the 

private practice of medicine; is that not true?

Dr. Hudson. This is a possibility.

Mr. Carter. Yes, sir.
PUBLIC HEA LTH SERVICES AMENDMENTS OF 19 66 67

Dr. Hudson. Our recommendation was that the flexibility could 

occur within the listed categorical grants. This would be an acceptable solution to the problem.

Mr. Carter. Tha t could be done through the Surgeon General’s 

approval or change in categorical g rants; is tha t not true?

Dr. Hudson. The difficulty, if I could summarize it, is th at we are 

uncertain as to what this means as one moves from listed categorical 

gran t activity into an open field, and then I suppose, from then on, it 

is subject to individual interpretation as to what tha t means. But I 

feel that in all of the interests of the health of the country, we would be 

better off' if that were defined.

Mr. Friedel. Doctor, would you yield ?

Mr. Carter. Yes.

Mr. F riedel. In II.B. 18231, on page 1, under “Findings and Declaration of Purpose,” and then you will notice on page 2, line 9:

To assure comprehensive health services of high quality for every person, but 

without interference with existing patterns of private professional practice of 

medicine, dentistry, and rela ted healing arts.

Isn ’t tha t clear enough there, Doctor?

Dr. Hudson. I think that is quite clear, personally, but the feeling 

of our counsel was that the recommendation we made was even more 

clear and more definitive.

Mr. Carter. Doctor, public health as we generally think of it is tha t 

branch of medicine which has to do with prevention of disease. You 

would have no objection to these rath er general diseases, but what 

you are objecting to is that they might enter into the practice of medicine, and so on; is tha t not true ?

Dr. Hudson. Prevention of disease, however, is not the exclusive 

prerogative of any departments, so far as I know. It is a part of the 

general practice of medicine.

I think that the easiest and most comfortable definition of “public 

health” has to do with environmental safety. If prevention of disease 

occurs under this connotation, yes, I think that is a proper function 

of the Public He alth Service.

We pick up bits here and there, hence: "We would just like to have 

a better definition of the intent of the expansion or of this kind of 

activity. It is not th at we are opposed to it in its proper sphere. We 

are accustomed to it, and we support it and collaborate with it, but 

it is just the uncertainty of the language of this bill that makes us feel 

it should not be passed in its present form b ut possibly could be with 

better definition.

Mr. Carter. Doctor, for my part, I think I understand, and certainly I would like to see the bill more clearly delineated. Thank you, 

sir.

Mr. Friedel. Any other questions?

Mr. Pickle. I would like to ask Dr. Hudson a question or two.

If I understand your testimony here, you would like the language 

to have more clear-cut definition as to what would be public health 

services; tha t is about it.

Now, when you make reference on page 8 in your testimony as to 

section—first, at the top of the page you say:

Comprehensive public health services is a far-reac hing departure from truly 

public health services.
68 PUBLIC HEALT H SERVICES AMENDMENTS OF 19 66

I do not quite understand what you mean there. That is a mighty 

fine-cut difference.

Are you saying tha t your idea of the difference would be on page 

9 of what you attempt to give the definition of what would be public 

health services ?

Dr. Hudson. Well, the word “comprehensive” is a very elusive word, 

in the first place, and I would not claim to know what the word “tr uly ” 

means in this particular context because I do think it needs definition.

I think almost everyone has a different opinion as to what it should 

include and, as we heard earlier a statement to the effect that we need 

to do something to the structure of the Public H ealth Service, I think 

there, too, we need to define and to make an evaluation of this alleged need, to make an evaluation of what we have already in the various fields that might be covered.

Mr. Pickle. Dr. Hudson, perhaps we are in general agreement. 

You are apprehensive about the word, “comprehensive”, and you suggest tha t we use the word “truly.” We are not any closer to a solution, are we? So we are trying to arrive at what would be a protection 

to the medical association.

Now, I assume when you make reference to, in the middle of the 

page, tha t there shall be no interference with the practice of medicine, 

tha t you are talking about the private practice of medicine?

Dr. Hudson. Yes, sir.

Mr. Pickle. And you also make reference that you are talking about 

public health service definition th at it could include these things you 

list, and when you say, “if private facilities are unavailable,” you are 

talking about private medical facilities or private practitioners are not 

avialable. What you really want to be sure of is what we do is in no 

way interferring with the private practice of medicine.

If you look at the bill, in both the bill tha t is S. 3008, and also this 

H.H. 18231, you will notice on page 2 in the purpose and intent, line 

10, tha t it says, “but without interference with existing patterns of 

private professional practice of medicine, dentistry, and related healing arts,” which, I assume, would be optometry and all the healing 

professions.

Does this satisfy you or the Medical Association on page 2 about the 

intent?

Dr. Hudson. Well, the line of the question makes it appear that 

we are extremely selfish, an extremely selfish profession, and what I 

would like to say, as an alternative answer to you, is tha t we now 

have the Public Health Sendee and the private sector working in 

good, harmonious relationships.

It seems to me the burden is on someone who proposes to change it, 

and so since the definition is lacking as to what health services, public 

health services are, a sort of open-end recommendation to be determined, perhaps, by the Surgeon General, using the words, “scope and 

quality” we feel tha t there is an opportunity to disturb the present 

relationships, not just our own private practice, but the whole system 

of providing good, high quality care for the people of the country, and 

this is the context I would like to leave it rather than I am fearful 

tha t my own operation will be disturbed and injured.

Mr. Pickle. Dr. Hudson, I think—I, for one, and I am sure the 

members of this committee comparably, do not want to pass any meas-
PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66 69

lire that would interfere with the private practice of medicine as we 

know it because this is the greatest in the world. But I assume tha t you are speaking as a representative of the AMA, and that as such you do not necessarily attempt to speak for every State. I say tha t because I have a feeling that in my State the physi­ cians within my State are in general accord with the language and ob­ jectives of this H.R. 18231 as proposed, and if you have different in­ formation than tha t which respect to my State or other States, why, then, I think you ought to say so. But you are speaking in the gen­ eral sense when you say you are representing the AMA. I do not 

think you necessarily represent the Texas view.

Mr. Donelan. Mr. Pickle, if I may add to what Dr. Hudson indi­ cated earlier with respect to this language on page 2, lines 10, 11, and 

12, that was in the Senate reported version, S. 3008. Also in that reported Senate version of S. 3008, there was language which gase us considerable concern. In the State plan for comprehen­ sive public health services there was a requirement tha t the State would have to provide public health services for all individuals with­ in the State regardless of income or resources, age, or place of 

residence. Now, here again public health services were indefined. But you can only do so much for everybody without intending the definition of public health services to be much greater th an is currently accepted. This is why we have our basic point, which is that, and we feel tha t in this particular point we are representing the overwhelming ma­ jority of physicians, that the definition of public health service would 

do much to clear up any confusion.

Dr. Hudson. Mr. Chairman, may I-----

Mr. P ickle. I believe two sections in S. 3008 have been eliminated.

Mr. Donelan. This provision tha t I mentioned was eliminated as 

soon as it came up on the Senate floor.

Mr. P ickle. On page 11 of S. 3008, they have deleted on line 11 all that follows, from lines 11 to 14, “public health services under the plan will be established and maintained for individuals confined to insti­ tutions for the mentally ill and mentally retarded,” and also on page 

18 through page 21. When you talk about the State plans, that has been eliminated. 

So tha t-----

Mr. Donelan. Tha t was eliminated. Our fear though, sir, was that this testimony was drafted at a time when this was the bill that 

was before us.

Mr. Pickle. I see. Tha t is all, Mr. Chairman.

Mr. Friedel. Mr. Watson.

Mr. Watson. Thank you, Mr. Chairman. Dr. Hudson, I should like to commend you and the American Medical Association for your helpfulness on this legislation. Now, I notice that your statement is aimed directly at your observa­ tions and recommendations relative to H.R. 13197; and, of course, I am sure there would have been some modification if you had had the opportunity to study 18231, which is probably the bill which would 

come out of this committee, if any does. I certainly agree with you on page 7 of your statement that we should add some provisions such as section 1801 of Public Law 89-97 that there shall be no interference with the practice of medicine.
70 PUBLIC HEALTH SERVICES AMENDMENTS OF 196 6

But one particular tiling that T noticed on page 2, you recommend 

tha t a majority of the council of State health planning be physicians; 

and, frankly, it appeals to me that you recommend on page 6 that we 

create a national advisory council to the Surgeon General of the Public Health Service for the implementation of the provisions of this 

legislation. However, you do not recommend there that a majority 

of the Council be members of the profession. I assumed that would 

be your recommendation ; is tha t correct ?

Dr. Hudson. I would have to revert to the statement. I could 

amplify it.

Mr. Watson. Well, your statement then—if you want to revert to 

that—your statement is the Council should include representatives of 

national organizations which are represented on the State planning 

councils. So we can naturally assume and conclude from that that 

your specific recommendation is that this National Council not include 

a majority of physicians.

Dr. Hudson. Tha t is correct.

Mr. Watson. Thank you.

Thank you very much, Doctor, for your contribution.

Mr. Friedel. Mr. Mackay.

Mr. Mackay. Thank you very much, Mr. Chairman.

Dr. Hudson, the nub of the problem, as T see it, and it would appear 

from your testimony, is your concern about who actually determines 

priorities. I am looking at S. 3008, page 4, starting on page 3, where 

it says:

In orde r to be approved for purposes of thi s subsection, a State plan for 

comprehensive Sta te Health plan ning must («) designate, or provide for the 

establish ment of, a single State agency, which may be an interdepa rtmental 

agency, as the sole agency for adm inistering or for supervising the adm inistration of the Sta te’s health planning function under this plan.

We have our State director, and I would just assume th at it would 

be the State board of health.

Dr. Hudson. I felt tha t it was not precise and specific enough in 

its language, and that we would like to have th at-----

Mr. Mackay. It is left up to the State though; is it not? I do 

not construe this to give the Surgeon General the power to say that 

you have got to configure the thing in a certain way.

Dr. Hudson. No ; that is right.

Mr. Mackay. And it seems to me that our common view would be 

that the State ought to have this authority to determine it.

Dr. Hudson. Yes.

Mr. Mackay. On the other hand, if you go further, I supported in 

the Georgia Legislature the position that the majority of the board 

of health ought to be professional people, not necessarily physicians, 

because we find veterinarians and many other people want to get into 

discussions of health policy.

For the Congress of the United States to say that a State has got 

to put a majority of physicians on there is a pretty stern use of congressional power in determining what we do at the State level, would 

you not say ?

Dr. Hudson. Yes.

Mr. Mackay. Well, T just recall working very pleasantly with the 

AMA on the heart, stroke, and cancer program in which we explicitly
PUBLIC HEA LTH SERVICES AMENDMENTS OF 19 66 71

provided for participation by the practicing physicians, and I want 

to report to yon that yon are certainly accurate when you said there 

was a division of opinion in your ranks, because I have been receiving 

splendid material from AMPAC on how to get reelected, and 

AMPAC is raising money to beat me, so I am really confused. Thank 

you.

Mr. Friedel. Any other questions ?

Mr. Adams. I have just one, Mr. Chairman.

Doctor, I gathered from your statement and from your testimony 

tha t you, representing the AMA, have no objection to the manner or 

the amount of funding as set forth in this bill, is tha t correct?

I)r. Hudson. I think I have not touched on i t in my statement.

Mr. Adams. I noticed there was nothing in it, but I gather from 

it that, therefore, that you have no opposition to the manner or the 

method of funding as is proposed in the bill ?

Dr. H udson. Let me refer to my compatriot here.

Well, your observation is correct, tha t we have not made any reference to it, and so any answer I think would have to be general. Our 

opposition is largely to the substance, th at is, the lack of definition 

of what is being proposed, and then amounts of funds, of course, 

relate to tha t subject.

If you have a project tha t is excellent, there cannot be a great 

argument against putting more funds into a good project. But we 

cannot discuss funding when we are uncertain as to what th is proposition is.

Mr. Adams. I have no further questions.

Mr. Mackay. I have one f urther question. I want to say tha t I 

was being a little facetious a while ago, and because I am in a campaign, I am not quite rational at this point, but I hope we can, particularly those of us on the Subcommittee on Health can, get into 

some real deep discussions of what we do mean by public health and 

where the lines of demarcation are.

But righ t in the area of Metropolitan Atlanta, where I am told the 

birth rate of the indigent poor, both white and Negro is nearly as 

great as tha t in India, we have a planned parenthood program that is 

being carried out down there by Dr. Thompson at Grady Hospital, 

which is one of the most fascinating and important activities tha t I 

know about in public health.

Yet, would you call an actual planned parenthood program an environmental program, or would you call tha t the practice of medicine, 

private medicine?

Dr. Hudson. I think it has to do with the total community. It 

is always presented that way.

Mr. Mackay. I am sure the environment helps create the problems.

Dr. Hudson. Yes; and the effects of the population explosion are 

on the total community, also.

Mr. Mackay. But I would just like to stress this, take this opportunity to stress to you, that I certainly do not have any doctrinaire 

views about what is public health and what is private medicine, and I 

need help in this area, and any information that the American Medical Association can furnish me will be appreciated and studied with 

great care.

Dr. Hudson. I would like, Mr. Chairman, to be permitted to add 

something that is, perhaps, tenuously related to the question.
72 PUBLIC HEA LTH SERVICES AMENDMENTS OF 19 66

I served on the National Comm ission fo r Comm unity Hea lth Se rvices, and in its tas k force th at tri ed to describe wh at com preh ensive 

personal healt h servic es would be and how the y migh t be org anized 

wi thin a com munity. I fou nd it very difficult to do it at the local 

level, and I would th in k th at to make this definition in an ascending 

scale to State and natio nal levels wo uld be inc rea sin gly difficult.

When I men tion thi s, I men tion the problem of fittin g the Pu blic 

Hea lth Serv ice into the tot al resources of a com munity and tryi ng to 

define wha t th eir role would be, and some of my hes itancy is personal 

in th at I feel with this knowledge, t he difficulty o f desc ribing it locally 

righ t whe re the peop le are, becomes inc rea sin gly difficult and makes 

the problem not only more difficult bu t more ur ge nt at the nation al 

level t ha t we m ake t his definitio n.

Mr. M ackay. Th an k you. No f ur th er questions.

Mr. F riedel. Th an k you.

Any oth er questions? I wa nt to th an k you, Dr. Hu dson, and your 

two colleagues there.

Dr. H udson. Tha nk you, sir.

Mr. Adams. Mr. Ch air ma n, jus t pr io r to the testim ony of t he nex t 

witness, I wonde r if I migh t be pe rm itted to make a unanim ous -consen t request. I have here the sta tem ent fro m Dr. Bucove, who is the 

pre sident of the Ass ocia tion of State and Ter rito rial Hea lth Officers. 

He also h app ens to l>e the head of the Wa shington S tate Pub lic Hea lth 

Serv ice, and I would like to incl ude a sta tem ent by him which is in 

supp ort, on beha lf of his organiz ation and of the Washin gto n State 

Medical Associa tion, of H.K. 13197, an d the su cceeding bill, 18231, and 

I ask una nim ous consent th at his sta tem ent might be include d in the 

record at th is point.

Mr. F riedel. If there is no objection it will be include d in the 

record at th is point.

(The statem ent of Dr. Berna rd Bucove follows:)

Statement of Bernard Bucove, M.D ., President, Association of State and

Territorial Health Officers

I wi sh to ex pr es s my own an d ou r A ss oc ia tio n’s th an k s to th e Ho use Com ­

merce Co mmittee , an d es pe cially to C hai rm an St ag ge rs, fo r yo ur fa vora ble 

resp on se to ou r plea s fo r ac tio n to co nt in ue F ed er al g ra nts fo r pu blic hea lth 

pr og ra m s. Hr. Ve na ble has sh ar ed w ith me th e st at em en t which he is pre se nting , an d I su bs cribe to it fully . I ha ve e ve ry confide nce he will be ab le to supp ly 

fu rt h e r in fo rm at io n thro ug h an sw er s to que stio ns w hich th e Com mitt ee m ay have.

I ha ve polled our Exe cu tive Co mmittee , an d our re co m m en da tio ns are unanimo us. The y a r e :

(a ) Sup po rt of th e pla nn in g gra nts pr ov isio ns of H.R. 18231 fo r 1967, 

1968, an d 1969.

(b ) As th e m in im um , su pp or t of th e fo rm ul a an d pro je ct he al th gra nts 

a t th e lev el of $62.5 mi llio n fo r 1968 only. T he mod es t in cr ea se su gg ested 

by Hr. Ven ab le is. in our view, mor e th an ju stified.

fc) W e are no t ab le to di sc ern an y reas on to au th ori ze fo rm ula an d 

pr oj ec t gra nts fo r 1969 in th e am ou nt prop osed in H.R. 18231.

(d ) Com plete heari ngs on th e ba sic pr op os al co nt ai ne d in H.R. 13197.

Th e ne w ch alle ng es to th e hea lth of our nati on’s peop le re quir e ne w vi ta l 

pr og ra ms, mor e hi gh ly tr ain ed pe rson ne l an d ad eq uat e fina nc ial su pp or t. Mu ch 

de fin iti ve in fo rm at io n will re su lt fro m nex t Ja n u a ry ’s he ar in g. Our fo ur -y ea r 

st ud y of how be st to mee t th e pu blic hea lth prob lems of to day an d of tomorrow 

conv inc es me th a t ultim ate ly a pr op os al si m il ar to H.R. 13197— S. 3008 will be 

en ac ted. It is ne ed ed —it is pra cti cal— it is ac ce pt ab le. W as hi ng to n’s S ta te 

Me dic al So cie ty, as was th e ca se w ith oth er sta te med ical socie tie s, ha d en do rsed 

th e prop os al. You r co nt in ue d in te re st is es se ntial to th e hea lth of th e na tion . 

T ha nk you.
PUBLIC HEALT H SERVICES AMEN DMENTS OF 196 6 73

Mr. F riedel. Our next witness will be Mr. James Br ind le, preside nt o f th e Hea lth Insuran ce Pl an of Greate r New York.

STATEMENT OF JAMES 0. BRINDLE, PRESIDENT, HEALTH 

INSURANCE PLAN OF GREATER NEW YORK

Mr. Brindle. Tha nk you, Mr. Ch air ma n.

Mr. F riedel. You may proceed.

Mr. Brindle. I hav e a wr itten sta tem ent which I would like includ ed in the record, Mr. Ch air ma n, if possible.

Mr. F riedel. Yo ur sta tem ent will be incl uded in the record.

Mr. B rindle. I wou ld l ike to m ake just a few brief rem ark s a bout i t.

Th e Hea lth Insuranc e Pl an , of which I am pre sid ent, conducts a 

comprehensive grou p pra ctice care pro gra m in New York. It covers 

appro xim ate ly 700,000 persons. Th ere are othe r program s of thi s 

kin d, notab ly the lar ge st one in the country , the Ka ise r Hea lth Pl an 

of Ca lifornia .

These program s over a period of yea rs have been in com petition 

wi th the most common method of fu rnishing pers onal healt h servic es 

in this cou ntry. Th e g ene ral p rac tice is a fee for service basis. They 

have organiz ations whi ch are in com petition with them , and it is not 

an exclusive program , and I would say the y have certa in economic 

and medical adv antage s.

Now, we are gen era lly in fav or, no t only these two pro gra ms I 

mentioned, bu t with the Group He alth Ass ociatio n of Am erica which 

represents a lar ge num ber of such plans—we are gen erally in fav or 

of the bills un de r con sideration here , and we have, because of our 

experience in opposition to, in a fre e-e nte rpr ise economy to, the typ e 

of org aniza tions we rep res ent, we hav e several specific suggestions.

One of them is prec isely the opp osit e from th at one just recommended by the Am erican Medical Associa tion.

We think , as a m atter of fac t, th at the pro posal sho uld inclu de a 

majority of rep res ent atives on these statew ide pl an ni ng councils to 

rep res ent the pub lic ra th er th an t he professions which are at inter est 

in this, and th is we have specific lan guage which we sug gest be included to this end.

Th e other point is since plan ning ofte n rea lly intru de s and pre ven ts 

experim entation , we wou ld sug gest th at some gen era l lan guage be 

included, and again we have specific suggestion s, which would enc ourage the develop men t of effective app roa che s to the o rganiza tio n delivery o f healt h services with view exte nsio n to experime nta l app roa che s 

and altern atives .

I th in k to say we have excellent person al medical servic es in the 

Un ite d State s is reall y alm ost irr ele vant. However good the y are, 

and the re are com parison s wi th othe r systems, and there are tr emendous differences inside them, we can all agree the y mu st be 

imp roved, and wh at we are s uggesting is the fact that we wa nt to see 

flex ibility towa rd experime nta tion, and we w an t to see th ese plan ning 

councils dom inated n ot by those wh o provide service b ut by those w ho 

are rep res entin g the gen era l public.

W ha t we are really tryi ng to get to here is to tak e eve ry possible 

effective action to see th at we get impro vem ent , however the level of 

services are, th at we get imp rovement, and we tr y vario us me tho ds
74 PUBLIC HEALT H SERVICES AMENDMENTS OF 19 66

by which we can further improve, no matter how excellent we are in 

personal health services in the United States, and that there is always 

room for improvement. Thank you, Mr. Chairman. I will be glad 

to answer any questions.

(The prepared statement of Mr. Brindle follows:)

Statement of J ames O. Brindle, P resident, Health I nsurance Plan of

Greater New York

Mr. C ha irm an an d mem be rs of th e co mmitt ee , my na me is Ja m es O. Brin dl e, 

pr es id en t of th e H ea lth In su ra nce Pla n of G re at er Ne w Yo rk, which co nd uc ts 

one of th e la rg es t pr ep ai d co mpr eh en sive grou p pra ct ic e he al th ca re pr og ra m s in 

th e U ni ted State s. At pre se nt our pr og ra m pr ov id es mo st of th e pr of es sion al 

serv ices fo r ap pr ox im at el y 700,000 pe rs on s in th e m et ro po lita n New York ar ea .

Th e regi on al pl an ni ng co ncept w as w ri tt en in to th e H ill -B ur to n law . Th e 

su bst an tial an d sig nific an t be ne fits which ha ve flow ed from H ill -B ur to n are well 

kn ow n an d widely pr ai se d, but th e re gi on al pla nni ng co nc ep t has no t bee n 

su cc es sfully im plem en ted .

H ealth fa ci lities an d se rv ices in th is co un try ha ve co nt in ue d to develop in a 

ra nd om an d di so rg an iz ed m an ne r. W e sh are th e in cr ea si ng co nc ern w ith pa tchwor k p att ern s of hea lth serv ices an d fa cil it y dis tr ib uti on—p att ern s which to 

som e ex te nt are resp on sibl e fo r our fa il u re to att ain op tim um uti liza tion of 

re so ur ce s de vo ted to hea lth service s. F ail u re s in ac hi ev in g op tim um dis trib ution 

of hea lth fa ci lities an d se rv ices ha ve oc cu rred in th e past an d will co nt in ue in 

th e fu tu re if di ve rs e in te re st s in de pe nd en tly p urs ue th eir v ar io us ob jectives i n an 

un co or di na te d an d un co op er at iv e m an ne r. W e stro ngl y su pport ef fo rts to fo st er 

ra ti onal plan ni ng .

Pe op le who ow n and oper at e hea lth fa cil it ie s ha ve a ve sted in te re st if not in 

m ai nta in in g th e st atu s quo, a t le ast in ass uring th a t fu tu re de ve lopm en ts will 

per m it them to m ai nta in th eir re la ti ve po sitio n in th e hea lth ca re econom y. 

Co nseq ue ntly, we are co nc erne d abou t att em pts to impo se ord er on ex is ting 

p att ern s wh ich may le ad to th e co ng ea lin g of th es e pat te rn s.

Plann in g, alth ou gh it offers th e ho pe of co her en t de ve lopm en t an d op tim um 

or ga ni za tion in th e dis tr ib uti on of healt h se rv ices , also poses a ve ry re al th re at 

of a nt ag on ism a nd re si st an ce t o in no va tion an d de ve lopm en t of a lt ern ati v e m ea ns 

of or ga ni zi ng an d dis tr ib uti ng he al th ca re serv ices. Thus we believe th a t an y 

legi slat io n ha vi ng to do w ith ho sp ital an d healt h fa ci li ty an d se rv ice pla nn in g 

sh ou ld co nt ai n a t le as t th e follo wing sa fe g u a rd s:

1. The pr in ci pa l de cis ion-mak ing ro le sh ou ld be re se rv ed to peop le wh o tr uly 

re pr es en t th e ge ne ra l pu blic as co ns um ers of hea lth service s, ra th e r th an people 

wh o mig ht be ex pe cted to ha ve mor e pa ro ch ia l view s of plan ni ng . U lti m at e 

re sp on sibi lity fo r reso lu tio n of br oa d qu es tion s of socia l polic y sh ou ld re m ain 

fr ee from id en tif ication w ith th e lim ited an d so metim es sp ec ializ ed in te re st of 

an y p art ic u la r healt h pr of es sion or th e pre vai ling ph ilo so ph y in th e ho sp ital 

“i nd u st ry ”.

2. An y pl an ni ng pr og ra m sh ou ld ass ure th a t pr om isin g alt ern ati ves to th e 

do m in an t metho ds fo r or ga ni zi ng an d dis tr ib uti ng hea lth car e se rv ices are giv en 

an op por tu ni ty fo r a fa ir tr ia l, an d, if th ey suc ceed, fo r co nt in ue d gr ow th.

THE IMPORTANCE OF ALTERNATIVES

The tr adit io nal and pr ev ai ling metho d of med ical pr ac tice in th is co un try 

al w ay s has bee n fee -for-service . T hi s metho d of pr ov id in g phy si ci an s’ serv ice s 

is as ra nd om and diso rg an ized as th e pre se nt la ck of system in dis tr ib uti ng 

hos pi ta l service s. T his st ate of aff air s has long been rec og nized.

In 1951 P re si den t T ru m an ap po in te d a Co mm iss ion to st udy an d re port on th e 

hea lth ca re ne ed s of th e nat io n. In it s 1952 re port en titled “B ui ld in g Amer ica’s 

H ealt h ” the Com miss ion o bserve d :

“T he ge ni us fo r or ga ni za tion , so ch ara cte ri st ic of American life in ge ne ra l, is 

co nspicu ou s in healt h se rv ices by it s ab senc e. By org an iz at io n is m ea nt th e 

proc es s of putt in g to get her people an d fa ci lities , and utilizi ng them in th e mo st 

efficie nt m an ner * * *.

“I n re ali ty mos t of th e American peop le gr op e th eir way th ro ug h a hap hazard 

a rr a y of h ea lth se rv ices * *

The st im ul us fo r pla nn in g stem s from a bel ie f th a t th e pre se nt syste m ( or l ac k 

of sy stem ) fo r or ga ni zi ng an d d is tr ib uti ng healt h car e se rv ices do es no t repr e-
PUBLIC HEALTH SERVICES AMENDME NTS OF 19 66 75

sent the best approach. Hench any planning program, if it is to result in improving present conditions, must assure a significant measure of flexibility by encouraging alternatives to the patterns whose inadequacies have stimulated the 

demand for planning. In 1959 the American Medical Association’s Commission 

on Medical Care Plans concluded th at: “The medical profession should assume a judicious, tolerant, and progressive 

attitude toward developments in the medical care field. The need for continued 

experimentation is recognized, and the profession should undertake, and actively 

participate in, the study and development of various mechanisms for the provision of medical care of high quality.”

However, if planning is left to people and institutions representing the traditional approach to organizing and distributing health care services, we fear tha t 

opportunities for experimentation and innovation may be severely restricted.

Group practice prepayment plans represent one alternative to the principal 

method of distributing health care services. Certainly this is not the only alternative and others may he developed in the future. Our belief in the importance 

of maintaining flexibility and providing opportunities for developing new techniques of organizing and distributing health care services would extend to any 

responsible approach.

Among possible alternatives, we are, of course, most familiar with the approach 

of our plan, which is a product of experimentation of the kind advocated by the 

American Medical Association’s Commission on Medical Care Plans. We believe 

that our plan represents a significant and proven alternative to the dominant p atterns of organizing and providing care, and the following discussion is offered 

not as a special plea for our approach, but only as illustrating the usefulness, 

and, if substantial progress in distributing health care services is to be realized, 

the necessity, of assuring opportunity for experimentation and innovation.

ONE ALTERNATIVE : DIRECT-SERVICE, GROUP PRACTIC E PREPAY ME NT PLAN S

A direct service plan receives dues from its membership and assumes direct 

responsibility for arranging health services for a fixed payment per member per 

month. Contrary to the prevailing system, which lacks any overall concern with 

organization, direct-service plans undertake to unite and coordinate the health 

care resources necessary to provide the patient with the care he needs. Directservice plans have built-in incentives for holding down costs and avoiding both 

unnecessary duplication of facilities and inappropriate utilization of services. 

These plans also provide a potential for significant economies by stressing preventive care and early disease detection.

The organization with which I am affiliated organizes prepaid medical care 

services for some 700,000 persons who reside in the greater New York area. 

These services are provided by 31 medical groups based at outpatient centers 

throughout the area. The major specialties of medicine, along with general 

practitioners, are represented in each of these groups. Community hospitals 

have been used to provide hospital care to the membership. Throughout the 20 

year history of our organization, we have found a persistent obstacle to fulfiling our commitment to provide comprehensive health services; namely, the 

physicians in the medical groups do not have free access to needed hospital beds. 

Furthermore, because the physicians in each medical group are unable to 

hospitalize their patients in the same hospital, it is difficult, and in many instances impossible, to focus all the talents of the group on a sick patient during 

the very period of his illness when consultation of physicians in different 

specialties is frequently most important.

Until this year HIP was not permitted under New York law to own and 

operate hospitals. The law was amended this year and we are now permitted to 

round out our program by developing a network of hospitals for our present and 

future members. We believe th at any significant planning effort should permit 

and encourage organizations such as the one I represent to implement the 

goal of providing comprehensive health services for a significant segment of 

the population which has demonstrated a desire to receive services through this 

type of program.

On the West Coast the Kaiser Program, which is similar to HIP in many 

respects, has always owned and operated its own hospitals. It has demonstrated the effectiveness of coordinated planning of health care services and 

facilities and is now providing health services to 1,400.000 people in California, 

Oregon, Washington, and Hawaii.
76 PUBLIC HEALTH SERVICES AMENDMENTS OF 196 6

A number of observers have noted the advantages, both in cost-savings and 

in quality, th at group practice can produce, particu larly when it is coupled with 

prepayment.

The first large-scale systematic app rais al of the organization of medical care 

services in the United States was conducted by the Committee of the Costs of 

Medical Care, which represented leading physicians, economists, hospital experts and allied professionals. In October of 1932 this Committee issued the 

28th and las t volume of its landmark study. The Committee’s first recommendatio n was that medical service “should be furnished largely by organized 

groups of physicians, dentists, nurses, pharmacists and other associated personnel”. In 1947 the American Hospital Association's Commission on Hospital 

Care stated : “It is generally recognized that the coordinated effort of a group of 

physicians can provide the individual patient more read ily with medical care of 

higher caliber tha n can equally skilled physicians working separately.” President Tru man’s Commission on the Hea lth Needs of the Nation concluded that 

“When group medicine is practiced in accordance with the highest stan dards, 

it provides excellent medical care at the lowest cost to the pat ien t and the 

community.” The President’s Commission also approved form ation of groups 

rend ering prepaid comprehensive service. Both Presidents Kennedy and Johnson 

advocated group prac tice of medicine in messages to Congress and the American 

Medical Association’s Commission on Medical Care Plans concluded th at “good 

medical care is being provided, within the scope of services offered” , by directservice plans. Others who have studied the subject have reached similar 

conclusions.

Again, we wish to make it clear that we refer to our plan, and to directservice prepayment plans in general, not with a view to seeking preferen tial 

treatm ent, but only to indic ate that there are meaningful altern atives to the 

prevailing methods for organizing and distrib uting hea lth care services, and 

in support of our belief th at any approach to planning should assure th at this 

and other altern ate approaches are provided an opportunity to develop so t ha t 

each individual is secured the right to choose from among significantly different 

approaches to distributing health c are services.

SUM M ARY

(1) We suggest that the dominant role in the planning process should be left 

to people representing the public as consumers of health care services. Adequate represen tation for special-in terest groups should be provided, but health 

professionals should be in a minority.

(2) We believe that assurin g the highest level of health attain able for every 

person will most likely be achieved through encouragement of flexibility and 

experim entation in the development of altern ative approaches to the provision 

of health services.

Proposed Amendments to S. 3008. Submitted by th e Health I nsurance

P lan of Greater New York

1. Sec. 2(a ), page 2. line 5, following the words “of individuals and organization s;”, ins ert the follow ing: "th at such collaborative effort should be directed

toward encouraging and supporting effective means of organising and delivering

health services, and should foster flexibility and expe rimentation in the development of alte rnative approaches to the provision of health services:”

2. Sec. 31 4(a)(2) (B), page 3, line 15. following the word “and ” at the end 

of line 15, ins ert the words "at least a m ajority comprised”.

3. Sec. 314(a) (2) (C), page 3. line 22 following the words “ (both public and 

pr iv at e) ”, insert the follow ing: "and to encourage development of effective

approaches to the organisation and delivery of health services (with due atte ntion to expe rimenta l approaches and altern atives)”

Mr. F riedel. An y que stions? Mr. Youn ger.

Mr. Younger. In rega rd to yo ur reco mm end atio n abo ut the majo rity o f the council, are you fa m ili ar w ith or do you have befo re you 

18231?

Mr. Brindle. I have a copy o f th e S ena te bill 3008. I th ink its contents are ap prox im ate ly the same.

Mr. Younger. I guess i t is th e same. I have not compared them.
PUBLIC HEA LTH SERVICES AMENDMENTS OF 196 6 77

The bill we are considering is 18231 and, as I understand before, in 

response to recommendations of the various health plans all over the 

country, we did include the expression that at least a m ajority composed of. Where would you put t hat expression in the bill, do you 

know, or can you advise us ?

Mr. Brindle. Well, we have a specific proposal which would put 

it in again—let me see if I can find it here—on page 4 in 2 (B) we 

would suggest tha t this be—and that is the same as the Senate version, righ t afte r line 13 “and” we would suggest the insertion “at 

least a majority comprised.”

Mr. Younger. Of the group concerned with health, is that what 

you would recommend?

Mr. Brindle. Yes, sir; and it would follow that line 13, and it 

would run “and at least a majority comprised of consumers of health 

services,” following line 13, between lines 13 and 14.

Mr. Y ounger. It is similar to the recommendation that the committee put in a previous bill.

Mr. Brindle. I think it is, sir.

Mr. Younger. Except we got a little confused, as I recall now, 

with the language. But-----

Mr. Brindle. Well, this is-----

Mr. Younger. The principle is the same.

Mr. Brindle. Yes, sir.

Mr. Younger. And in this council-----

Mr. Brindle. A majority to represent the consumers.

Mr. Younger. That a majority be composed of those tha t need or 

use the health services rather than the practitioners.

Mr. Brindle. Rather than those who furnish it; yes, sir.

Mr. Younger. Tha t is your recommendation, and it would come 

in this section (B).

Mr. Brindle. Section (B ) on page 4 afte r line 13.

Mr. Younger. On page 4 ?

Mr. Brindle. Yes.

Mr. Younger. Thank you very much.

Mr. Friedel. Mr. Van Deerlin.

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

Mr. Brindle, has your organization which represents, I take it, 

group care and prepayment plans, had some experiences tha t are 

unpleasant with what we might call the medical establishment?

Mr. Brindle. Well, I would say, I have to say, in all justice in the 

recent 3 or 4 years it has been much improved in New York. But over 

the history of the Health Insurance Plan, and I think from my involvement with other group practice prepayment plans like Kaiser Plan 

and those represented by the Group Health Organization, there has 

been consistent opposition to this plan on the part of the standard 

medical establishment. In New York it was necessary to go to the 

State and get a law passed to keep the hospitals from excluding 

physicians who were engaged in group practice from ge tting hospital 

privileges.

This last year we had to go for legislation to get permission for 

the Health Insurance P lan to move in the hospital field.

Lately, the hospital council which, in New York now must have a 

substantial representation from the consumers rath er than the pu rveyors of services, will have to be more sympathetic.

70- 050— 66-------6
78 PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66

I say lately the hospital planning council of both State and local 

in New York have been much more sympathetic, but still generally 

around the country you find opposition from these organizations 

which do represent hospitals and the established medical organizations, you find opposition from these groups to the group practice 

prepayment plans.

Mr. Y ax Deerlix. I see you put in a statement exclusion from 

established hospitals, I presume doctors who are associated with these 

plans ?

Mr. Brixdle. Yes, sir.

Mr. Y ax Deerlix. Not patients. Patients are not excluded as such, 

except you cannot take your own doctor in ; is that the idea ?

Mr. Brixdle. Well, a doctor has to admit a patient to a hospital. 

So if you blocked physicians out you effectively block th eir patient 

or force these patients to transfer to another physician.

Mr. Vax Deerlix. How are these staffs accredited ? Is this through 

membership in the State medical society, or licensed physicians? 

These are always licensed physicians we are talking about, are they 

not ?

Mr. Brixdle. These are licensed physicians, but the appointment 

to hospital staffs is controlled by the board of trustees of a hospital, 

and they act on the advice of the physicians on the staff there. Staffs 

customarily are organized into a medical board which appoints, recommends the appointment of physicians, and physicians are appointed 

to hospital staffs by the board of trustees of a hospital.

I do want to say the situation has improved in New York. But in 

many places you still find this discrimination against physicians in 

group practice prepayment plans on the part of local institutions and 

local agencies.

Mr. Van Deerlix. What about the Kaiser organization tha t you 

referred to in your statement ?

Mr. Brixdle. Well, the Kaiser organization has gotten around this 

difficulty by developing its own hospitals. But you find there tha t 

they have had experiences where even in the planning and erection of 

new hospitals they have had opposition from the establishment which, 

for instance, has dominated the planning programs, and so on.

In most areas you find these organizations tha t represent hospitals 

and physicians generally blocking the development, perhaps, of new 

institutions, new agencies or influencing negatively grants of money, 

money grants, toward the group practice plans.

Mr. Van Deerlix. This matter of admission to hospital staffs; is 

there any legal recourse that is possible ?

Mr. Brixdle. Well, yes; but it is extremely difficult, and you have 

to understand the problem of a good hospital. They want to restrict 

their staff to persons who are well qualified, and so it is extremely d ifficult, and some of the time the opposition and the blocking gets pretty 

subtle.

They also have the problem, most hospitals do, of pressure on beds, 

and when they run out of beds for their staff it is hard to get new 

people on, so you know you cannot define this precisely.

In New York it was so open and flagrant tha t we had a State law 

passed. Now this has not been resorted to in other places and, fortunately, Kaiser, with its resources of the Foundation Health Plan has 

been able to develop its own institutions.
PUBLIC HEA LTH SERVICES AMENDMENTS OF 19 66 79

Mr. Van Deerlin. Normally, would not a physician’s S tate license 

attest to his qualifications ?

Mr. Brindle. No. There are many other qualifications taken into 

consideration.

For instance, by a health plan like ours or the K aiser Plan or others 

or good hospitals, in determining who could practice in a hospital, and 

it would depend on the extent of practice.

For instance, many hospitals, quite properly, and agencies like ourselves, require much higher qualifications for train ing, for certain 

procedures. You cannot accept, for instance, the fact tha t a man is 

licensed, and bring him into an institution and let him do neurosurgery 

and do heart work. There are many gradations which are quite properly applied, and many other determinants of qualifications of a 

physician. So, you see, there is opportunity to be quite discriminatory, 

sometimes properly and sometimes improperly, and in gran ting hospital privileges.

Air. Van Deerlin. I note th at in your summary recommendations, 

the second one you ask for a m ajority on the State planning councils, 

of consumer, nonprofessionals.

Would you settle for h alf and half such as we have in Hill-Burton ?

Air. Brindle. I think that is an improvement, but I really believe 

that the majority would be a better solution to it.

Air. Van Deerlin. That is a precedent.

Air. Brindle. Tha t would be an improvement over the present language. I would urge that the majority be receivers, rather than the 

purveyors of services.

Air. Van Deerlin. I see the chairman is getting ready to use his 

gavel.

Air. F riedel. Dr. Carter.

Air. Carter. Air. Brindle, would you give me a little resume of your 

background, please, sir.

Air. Brindle. Yes, sir. I am president of the Health Insurance Plan 

of Greater New York. Prior to that I was director of the Social 

Security Department of the United Auto Workers, and I helped to 

develop a prepayment group, practice plan in Detroit there.

Before that, with the exception of 4 years in the armed services, 

durin g AVorld War II , I was director of public assistance in Pennsylvania, and there supervised the administration of welfare medical 

care in tha t State.

Air. Carter. Have you had professional training in this capacity ?

Air. Brindle. Not as a physician, no, sir.

Air. Carter. Well, as an administrator or supervisor, have you had 

college trainin g along those lines?

Air. Brindle. Yes, I have had college training and my professional 

background was in social work.

Air. Carter. Social work.

Air. Brindle. Yes, sir.

Air. Carter. Would you feel differently then if these councils should 

be composed principally of consumers, that they should direct the 

health departments; is tha t true ?

Air. Brindle. I do not think these councils should direct the health 

department. There are many technical areas in which you obviously 

need professionals and, as I indicated, I think the professions ought
80 PUBLIC HEA LTH SERVICES AMENDMENTS OF 19 66

to be represented, but just as I think you gentlemen must decide many 

important, overall policy decisions concerning operations of our health, 

and since we are primarily interested in the health of the people, not 

in the operation of the professions, I think it is perfectly proper to 

have an overall planning agency dominated by those who have the 

primary interests, the public interests.

Mr. Carter. You do not think the medical profession then has the 

primary interest in public welfare?

Mr. Brindle. I think it has a great interest in the public welfare, 

but I think-----

Mr. Carter. Yes, sir; I agree with you.

Air. Brindle. But I would not say its primary interest—well, its 

primary interest is in health care and providing it, but I would say 

that, as in other providers of service, it may have a little different 

approach and a little different objective from those who are receiving 

the care or those who are kind of neutral or disinterested therein.

Mr. Carter. Do you consider yourself better qualified to judge on 

capacities of physicians or as to what they should do in States and 

State departments of health rath er than what the physicians themselves should decide should be don e; is tha t true ?

Mr. Brindle. I do not know how’ you make the comparisons. There 

are many areas in professional and in administrative policy, although 

I would not think of trying to proceed without the advice and help 

of a physician, but I do not think th at it is necessary at all to have an 

organization of physicians be the persons who have voting control of a 

planning agency.

Mr. Carter. Yes, sir.

Would you say you were a member of the Automobile Workers 

Union; is that right ?

Mr. Brindle. No, sir, not a member. I was head of the ir Social 

Security Department. I came on there as an expert to deal with 

pensions and health insurance, and programs like that.

Mr. Carter. Yes, sir. And experts on pensions were in your group; 

is that right?

Air. Brindle. Yes, sir. We had actuaries in the group.

Air. Carter. In this group would you recommend tha t members of 

other professions should help decide problems concerning social 

security ?

Mr. Brindle. Yes. As a matter of fact, we had physicians in the 

organization to be concerned with this area. We worked with them.

Air. Carter. I suppose they were in the majority then?

Air. Brindle. No, sir; they were not.

Mr. Carter. They were not ?

Air. Brindle. That is right.

Mr. Carter. I see.

Air. Brindle. We were not dealing primarily with medical affairs 

either.

Air. Carter. Can you advocate th at they not be in the majority in 

something which affects them more greatly*than any other group ? *

Air. Brindle. I would disagree with you that health care affects-----

Air. Carter. In which they devote th eir lives to it ?

Air. Brindle. I would disagree with you tha t health care affects 

physicians more than it affects patients.
PUBLIC HEA LTH SERVICES AMEN DMEN TS OF 19 66 81

Mr. Carter. Well, I am in agreement with tha t insofar as the 

patient is concerned. But tha t is, of course, the great ideal of the 

physician is to help those who are ill and who are sick, and most of 

us, regardless of what people say, are devoted to tha t ideal of helping. Certainly I think tha t physicians should be represented on 

these councils.

Mr. Brindle. I do, too. We do not disagree on that. I agree they 

should be represented.

Mr. Carter. At least one half of the council should be composed 

of physicians and, of course, the other half should be extremely intelligent men although, perhaps, from different walks of life.

Mr. Brindle. I think we are just, differing on the proportion of 

the people. We would just recognize that the professions must be 

represented and the public, too.

Mr. Carter. You have also stated that you worked previously on 

the situation on which you worked, the majority of the group were 

the same type as you were, and I should think that positions or councils involving physicians as well as their patients should also have 

at least equal representation.

Mr. Brindle. Well, I do not know what kind of—I do not know 

how you envisage the place I last worked. I was a staff member, a 

technical staff member, with a staff of qualified persons. We had a 

couple of physicians on the staff, actuaries, we had insurance experts, 

and so on. We were not prim arily engaged—when we set up a health 

plan we pu t it under the direction of physicians, and when we had 

substantial representation of these physicians on the health plan, we 

obviously used physicians. My job was not to work primarily in 

the health area, and when we were in pensions we had an actuary. 

We were employees of an organization which hired us. We did not 

have a council.

Mr. Carter. Yes, sir. How many were in your group?

Mr. Brindle. In the United Auto Workers?

Mr. Carter. Yes, sir; this group you are talking about.

Mr. Brindle. At the time I went there about 1,600,000.

Mr. Carter. In your council or your commission you said there 

were two physicians.

Mr. Brindle. I had no commission, we had a diagnostic center which 

was operated by the union.

Mr. Carter. We are not gettin g anywhere on this.

Mr. Brindle. I had no council.

Mr. Carter. You were a member of a group, were you not?

Mr. Brindle. I was a member of the technical staff of the union.

Mr. Carter. A member of the technical staff. Now we are getting a little furth er. How many members were on this technical 

staff?

Mr. Brindle. We had about 11 people.

Mr. Carter. How many physicians were on this?

Mr. Brindle. There were two, but they worked-----

Mr. Carter. Two physicians, all right.

Mr. Brindle. But they worked in the health plan.

Mr. Carter. All right, sir, OK.

Xow, this applied to the Automobile Workers, I believe you stated, 

is that not right?
82 PUBLIC HEALTH SERVICES AMENDMENTS OF 196 6

Mr. Brindle. We did the negotiating with the corporations.

Mr. Carter. All right. Nine of those members were not physicians. Yet in a system which involves physicians directly yon want 

to limit the number of physicians to less than half, whereas on a 

different commission entirely, on your commission or on your group, 

they had a representation of only two.

Mr. Brindle. We were not primarily concerned with health programs; we were renegotiating pensions.

Mr. Carter. It all depends on whose ox is gored as to what number 

you would have on a council, it appears to me. Thank you, sir.

Mr. F riedel. Mr. Mackay.

Mr. Mackay. Mr. Chairman. I would just like to say this: Mr. 

Brindle, I will make the same point to you that I made to t)r. Hudson. 

Ibis law does not say what the State agencies shall be. It leaves this 

up to the State legislature, and if we had not achieved reapportionment I would be interested more in Congress defining this. But are 

you not willing to leave it up to the State legislatures to thrash out 

who shall be the agency ?

Mr. Brindle. Who should be the agency ?

Mr. Mackay. Yes. In planning, the planning agency. This law 

does not say.

Mr. Brindle. Well, my recommendation was th at we have a majority, tha t Congress act to provide a majority, represent the consumer rather than the provider.

Mr. Mackay. I) o you not think we can contribute to the vitality of 

the State as a political subdivision if we leave this type of policy 

question for experimentation and variety ?

Mr. Brindle. I think tha t if you leave it you are going to find in 

most places the majority will be, as in many past such activities will 

be, dominated by the providers of the services.

The other suggestion made that there be equal numbers would be 

better, I would think. But I should think I would recommend you 

put some standards in there on this subject.

Mr. Mackay. Thank you very much.

Mr. F riedel. Any other questions?

Mr. Pickle.

Mr. Pickle. Mr. Brindle when you offered to the committee your 

recommendations, amendments, the first and the third, it seemed to me 

tha t your key word was “experimentation.”

I assume th at in offering these two suggested amendments you are 

by th at wording hoping to put into the measure the intent of the bill 

to provide for group practice prepayment or group hospitalization 

tha t you have in New York ?

Mr. Brindle. Among other things. I think the experimentation 

should be broader than that: yes, sir.

Mr. Pickle. I, for one, do not agree, but I just want to be sure I 

pinpoint that.

Mr. Brindle. I am really speaking on behalf of the group practice 

prepayment, but I think there can be other possible and useful experiences, experiments.

Mr. Pickle. Tha t is all.

Mr. Friedel. Any other questions? Well, thank you very, very 

much, Mr. Brindle.
PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66 8 3

Our next witness will be Dr. He nr y B. Peter s, Unive rsi ty of Ca lifo rnia, Berkeley, Ca lif., fo r the Am erican Op tometr ic Associa tion.

Would you wish to summ ariz e yo ur statem ent ?

STATEMENT OF DR. HENRY B. PETERS, ASSISTANT DEAN AND

DIRECTOR, CLINIC, SCHOOL OF OPTOMETRY, UNIVERSITY OF

CALIFORNIA, REPRESEN TING THE AMERICAN OPTOMETRIC

ASSOCIATION

Dr. P eters. Tha nk you, M r. Chairma n.

I am Dr. Hen ry B. Peters, assistan t dean and direc tor o f the clinic 

of the Scho ol of Op tom etry of the Un iversity of Ca lif ornia in 

Berkeley.

I am a mem ber of the ad hoc prog ram and review council to the 

Ca lifornia med ical assistan ce prog ram and , among oth er thing s, a 

mem ber of the Am erican Pu blic H ea lth Association.

I t is as a membe r of the comm ittee on public he alt h and optom etric 

care th at I ap pe ar here tod ay in be ha lf of the Am erican Op tom etric 

Association.

The Am erican O pto me tric Association endorse s the purpo ses of th is 

legisla tion . I pa rti cu larly wan t t o com plim ent th is com mittee on its 

concern fo r th e pro fession of optom etry in pa st leg islation, and I 

hope th at it will extend th at concern to this.

I t has been my pri vil ege to sit on various plan ning c ommissions in 

the St ate of Ca lifornia , an d I believe the y perfo rm a vital fun ction.

It is safe to assum e th at funds will not be ava ilab le to p rov ide for 

the maxim um need s or even some of th e more u rg en t ones. It , therefore , will be nece ssary to cu rta il or pos tpone some of the suggested 

pro jects.

Vision care has not received the su pp or t or int ere st it merits. 

Th ere are no pr oject grants, no form ula g rant s to o pto me try for vision 

care. Testimo ny by members of th e optom etric pro fession before this 

com mittee has outlin ed the importance of visi on car e fo r all people 

of all ages in all walks of life. Va st unm et needs fo r vision care 

exists tod ay. F or example, vision screen ing among preschool and 

school a ge childre n, an area in which I have done conside rable r esearch , 

shows rep eated ly th at 12 to 20 perce nt of the child ren hav e uncorrected, unrea lized vision problems. A t every mo tor vehicle lice nsing 

office l arge num bers of ap pli cants fail because of uncorrected vision 

problems.

In du strial vision scre ening prog ram s regu larly show th at 25 pe rcen t or more of those cu rre ntly emp loyed hav e vision ina dequate for 

th ei r jobs. Multiface screen ing prog rams show a high er incidence 

of uncorrected visi on pro blems than any other he alth defect except 

denta l disease. Th e Arme d Force s have fou nd th at one of the majo r 

causes fo r rejecti ng m en is defective sig ht. Much of this could have 

been corrected if prop er visio n care had been obtained in childhood.

Th e full cost of neglected vision problems is impossib le to calculate . An estimated to tal mu st include the costs of highwa y acciden ts, indu str ial injuries , lost pro duction, school re tard ation, and 

dro pouts. A local upwa rd bound prog ram fo r stu dents conside red 

po ten tia l dropouts by the O EO in ou r com munity , fou nd th at 52 per-
84 PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66

cent of the children in this program considered potential dropouts 

had severe uncorrected and undetected vision problems.

Optometry is a national resource for sight conservation. The 

17,000 practicing optometrists, the Nation's thir d largest health profession, want to participate in the planning and implementation of 

vision care and sight conservation programs. They wish to eliminate 

the human and material waste caused by inadequate vision services.

But these problems are largely ignored by Federal, State, and local 

public health officers. Optometry, which serves the vision needs of 

the vast majority of the Nation's citizens, is not represented in any 

public health department concerned with health services—state or 

local. How then may optometry be represented in the health planning program proposed in this legislation ?

There are only two ways that we can see, and I would propose for 

your consideration two amendments. The first relates to the State 

health planning council, and the second relates to a specific provision 

for planning for sight conservation.

I compliment the committee on including in section 314 providing 

consumers on the Health Planning Council. Having served on just 

such a council under title 19 Medicare, I can assure you tha t the 

majority of consumers lends a welcome balance to the governing 

council.

There is no question that the language in the bill would permit the 

employment of duly licensed optometrists to the State planning 

council. But to make certain tha t Congress intends tha t representatives of the various health professions be included on these councils, 

we recommend that on page 3, line 16, after the word “health" there 

be inserted “duly licensed personnel in sciences related to health'5.

The term “sciences related to health,” has been used in several 

recent congressional enactments to include medicine, dentistry, optometry, pharmacy, osteopathy, and other health related sciences.

Our profession urges that when reported by this committee, the 

bill contain a provision which will assure that some of the authorized 

funds must be used for vision care planning.

Frankly, I am normally opposed to this kind of fragmentation, 

but. it is urgent tha t the Congress indicate its intent that some of 

the health planning funds be directed in this direction.

So we have suggested, Mr. Chairman, that at least 2 percent of 

the State’s allotment under this subsection shall be available only to 

the State vision authority for developing the State planning of optometric and related vision services.

We are grate ful for the opportunity, Mr. Chairman, to appear 

before you today. Our association wholeheartedly endorses the concept of this legislation and urges that the suggested amendments be 

incorporated into the bill when reported to the House.

If there are any questions, I will endeavor to answer them. If I 

do not have the information at hand it will be furnished to the committee promptly. Thank you, Mr. Chairman.

(The prepared statement of Dr. Peters follows:)

Statement of the American Optometric Association

Presented by Dr. Henry B. Peters. O.D.

Mr. Chairman and Members of the Committee. I am Henry R. Peters, Assistant 

Dean anti Directo r of the Clinic of the School of Optometry. University of Cali-
PUBLIC HEALT H SERVICES AMENDMENTS OF 19 66 85

fo rn ia . Berke ley. Cal ifor ni a. In 193S I gra duate d fro m th e Schoo l of Optom etry 

a t Berke ley an d su bs eq ue ntly ea rn ed a M as te r's de gr ee in E duca tional Psy ­

cholo gy. I am lic en sed to p ra ct ic e op tom etry in Cal ifor ni a.

C urr en tly I se rv e as Vice Pre si den t, Assoc iatio n of Schools and Co lleges of 

Optom etry ; me mb er, Amer ican Ac adem y of O pt om et ry Exe cu tive C ouncil: me mbe r, Amer ican O ptom etric Assoc iatio n Com mitt ee on Pu blic H ealth an d 

Optom etric C are ; an d me mb er, Ad Ho c Pro gra m an d Re view Co un cil of th e Cal ifo rn ia Medica l A ss istanc e Pro gr am . I se rv ed as a Navy lin e offic er du ring th e 

second wor ld w ar an d cu rr entl y ho ld a re se rv e co mmiss ion as an op to m et ri st in 

th e N avy Med ica l Se rvice C orp s.

I t is as a mem be r of th e Co mmitt ee on Pub lic H ealth an d O ptom etric Car e 

th a t I ap pea r her e to da y on be ha lf of th e Amer ican Opt om et ric Assoc iatio n. 

Th e Assoc iatio n is comp osed of op to m et rist s du ly lic en sed to pra ct ic e thenpr of es sion in one or mor e of th e fifty st ate s an d th e D is tr ic t of Co lum bia . Of 

th e 17,000 lic en sed opto m et ri st s in pra ct ic e to da y, clo se to 14,000 ho ld mem be rsh ip in o ur A ssoc iatio n.

Th e pu rp os e of II. R. 13197, as I unders ta nd it. Mr. C ha irm an , is to as si st in 

th e ex tens io n an d im pr ov em en t of co mpr eh en sive hea lth pla nn in g an d pu blic 

hea lth se rv ice as we ll as to pr ov id e a more effecti ve us e of av ai la ble fe de ra l 

fu nd s. W hen one co ns id er s th e vas t am ou nt o f fe der al mon ies av ai la ble to 

st ate s fo r pu blic healt h pr oj ec ts, th er e ca n be no qu es tio n th a t som e mo ney 

sh ou ld be al lo ca te d fo r plan ni ng . T hi s bill, whe n en ac te d in to law , will au ­

th or iz e th e U.S. Pu bl ic H ea lth Se rvice Su rgeo n G en er al to mak e g ra n ts to st ate s 

which ha ve su bm itte d pl an s fo r co mpr eh en sive st ate hea lth plan ni ng . Th e 

Amer ican O ptom etric Assoc iatio n en do rs es th e pu rp os es of th is legi slatio n.

It ha s been my pr iv ileg e to se rv e on var io us pla nn in g co mmiss ions in th e 

S ta te of C al ifor nia and I be lie ve th ey per fo rm a vital fu nc tio n. But in ord er 

to fulfi ll th e ir pu rpos e, fu nds m us t be al lo ca te d fo r th e pla nn in g wh ich shou ld 

be do ne by in di vi du al s kn ow led ge ab le ab ou t th e ne ed s of th e publi c, th e fa cil ities an d th e pe rson ne l av ai la ble to m ee t th es e ne ed s as well as th e re la tive 

m er its of ea ch su gg es ted plan . It is sa fe to as su m e th a t fu nds will not be 

av ai la bl e to pr ov ide fo r max im um nee ds; it th er ef ore will b e ne ce ss ar y to curt ail 

or po stpo ne som e of th e su gg ested pro je ct s. Thu s, in te llig en t pl an ni ng m us t be 

pr ov id ed to o bt ai n th e b es t re su lts .

Tes tim on y by mem be rs of th e op to m et ric pr of es sion be fore th is Com mittee 

has ou tlin ed th e im po rtan ce of visio n ca re fo re peop le of al l ag es in all w al ks 

of life. V as t un m et ne ed s fo r visio n car e exis t to da y. F or ex am ple, vis ion 

sc re en ing am on g pre-scho ol an d sch ool ag e ch ildr en , an are a in which I ha ve 

done co ns id er ab le re se ar ch , show s re pe at ed ly th a t 12 to 20 pe rc en t of th e ch ildr en 

ha ve un co rrec te d, un re al iz ed vis ion prob lem s. At. ev ery mot or ve hicle lic en sing 

office la rg e nu m be rs of ap plica nt fa il be ca us e of un co rr ec te d visio n prob lems. 

In d u str ia l visio n sc re en in g pro gr am s re gul ar ly show th a t 25 pe rc en t or mo re 

of th os e curr entl y em ploy ed ha ve visio n in ad eq uat e fo r th eir jobs . M ul tip ha sic 

sc re en ing pr og ra m s show a hig he r incide nc e of un co rr ec te d vision prob lems th an 

an y oth er hea lth de fe ct ex ce pt den ta l disease. Th e ar m ed fo rc es ha ve foun d 

th a t one of th e m aj or ca us es fo r re je ct in g me n is de fe ctive sigh t, mu ch of wh ich 

co uld ha ve been co rr ec te d if pro pe r visio n ca re had been ob tain ed in ch ild ho od .

The fu ll co st of ne glec ted vis ion prob lems is im po ssible to ca lc ul at e. An 

es tim at ed to ta l m us t in cl ud e th e co sts of hi gh w ay ac ci de nts, in d u str ia l in ju ri es , 

lo st pr od uc tio n, sch ool re ta rd ati on an d drop -o uts. A loc al upw ar d bo un d pro ­

gr am fo r st uden ts co ns id er ed pote ntial dr op -o uts fo un d th a t 52 j>ercent of the 

yo un g peop le ha d se ve re un co rrec te d an d un de te ct ed visio n prob lem s.

P re si den t Jo hn so n, in his message to Co ng ress w hich p ro vi de d a fo un da tion fo r 

th is bill st at ed , “A w in ni ng st ra te gy de m an ds wise an d we ll pl an ne d us e of 

man po wer. I t de m an ds co or di na te d us e of all th e re so ur ce s av ai la ble * * *. 

I reco mmen d to Co ng ress a pr og ra m to e na ble st ate s an d co mm un iti es t o plan the 

b ett er us e of man po wer, fa ci lities , an d fina nc ia l re so ur ce s fo r co mpr eh en sive 

hea lth s er vice s * *

Visio n is an ess en tial fa cto r in bo th healt h an d ed uc at io n. I t pl ay s an im ­

p o rt an t p a rt in th e batt le again st re ta rd ati on. In days gone by. people re fe rr ed 

to t h e “T hre e R ’s—re ad in . ’rit in an d ’rithm ati c.” The re is anoth er R comm on ly 

us ed w ith read in g, re m ed ia l re ad in g. The re m ed ia l m ig ht well be ap pl ie d to 

“ ’ri ti n ” an d also “ ’ri th m ati c”. A ch ild w ith de fe ct iv e visio n is al m os t su re to be 

re ta rd ed in ari th m ati c a nd w ri ti ng a s w ell a s in rea di ng .

In hi s me ssag e Pre si dent Jo hn so n also sa id , “F ew pr og ra m s ha ve ha d th e 

vi sibl e success of O pe ra tion H ead sta rt ”. The visible success is in p a rt du e to
86 PUBLIC HEALTH SERVICES AMENDMENTS OF 196 6

the work of the V olunteers for Vision, sponsored by the Auxiliary to the American 

Optometrie Association.

The Honorable Wilbur J. Cohen, Under Secretary of Health, Education, and 

Welfare, in his stateme nt before the Senate Committee on Labor and Public 

Welfare during hearings on the Senate companion bill to H.R. 13197 said, “It is 

designed to serve as a new legislative basis for expanding the capabilities of 

states and communities to plan, develop and provide public health services”. He 

went on to say th at th e principal objectives w ere: “Firs t to increase the capacity 

for continuing comprehensive planning for hea lth statew ide, regionally and 

locally, in partnership with the federal government * * *. Second, to redirect 

the focus of health grant programs to reactiv ate local and sta te health efforts 

and to focus program activities more c learly on bringing services to people”.

Optometry is a national resource for sight conservation. The 17,000 practicing 

optom etrists, the nation’s third largest hea lth profession, want to participate in 

the planning and implem entation of vision care and sight conservation programs. 

They wish to eliminate the human and ma terial waste caused by inadequate 

vision services.

But these problems are largely ignored by federal, sta te and local public 

health officers. Optometry, which serves the vision needs of the vast majority 

of the nation’s citizens, is not represented in any public health departm ent concerned with hea lth services—state or local. How then, may optometry be represented in the hea lth planning program proposed in thi s legislation? There are 

only two ways that we can see. I would propose for your consideratio n two 

amendments. The first rela tes to the sta te hea lth planning council and the 

second relates to a specific provision for planning for sight conservation.

First, section 314(a) (2) (B) requires that a state plan to be approved must 

provide for the estab lishm ent of a State Hea lth Planning Council, which shall 

include represe ntatives of state and local agencies in nongovernmental orga nizatio ns and groups concerned with health, and of consumers of hea lth services 

to advise such state agencies.

There is no question but th at the language of the bill would perm it the appointment of duly licensed health personnel to a state planning council. But 

to make certain that Congress inten ds th at representativ es of the various health 

professions be included on these sta te councils, we recommend that on page 3, 

line 16. after the word “health” there be inserted “duly licensed personnel in 

sciences rela ted to heal th”.

The term “sciences rela ted to health” has been used in several recen t Congressional enactm ents, one passed by the first session of this Congress known as the 

Medical Library Assistance Act of 1965, P.L. 89-291. The House Committee report in referrin g to th e term “sciences rela ted to Health” said, “This means th at 

the disciplines which may receive construction assistance under the health research facilitie s program are the same disciplines as will be included under the 

reported bill such as medicine, dentistry, optometry, pharm acy, osteopathy and 

other health rela ted sciences”. At the very least we hope this Committee will see 

fit to make a similar state ment.

Second, one of the provisions of this bill is : “At least 15 per centum of a State 

allotment shall be available only to the State Mental Health Authority for the 

provision under the Sta te plan of mental health services”. When hearings were 

held by the Senate Committee on the Senate companion bill, represen tatives of 

the dental profession requested that a provision similar to the mental health 

requirement be inc orjora ted in the bill with a minimum of five per centum 

for dental health planning.

Our profession urges that when reported by this Committee the bill contain 

a provision which will assure that some of the authorized funds must be used 

for vision care planning. We therefo re recommend th at an additional pa ragrap h l>e included on page 13 under sub-p aragraph 7 as follow s: “At leas t 2 

per centum of the State ’s allotment under this sub-section shall be available 

only to the Sta te Vision Authority for developing the Sta te planning of optonietric and related vision services”.

While we are hopeful that the s tate will utilize more tha n this minimum, the 

actio n of Congress in specifying some amount for vision will call the sta tes ’ 

atte ntion to the need for planning of optometrie and related vision services.

Mr. Chairman, and Members of the Committee, we are grateful for the opportunity to app ear today. Our Association wholeheartedly endorses the concept of this legislation and urges th at th e suggested amendm ents be incorporated 

into the bill when reported to the House.
PUBLIC HEA LTH SERVICES AMENDMENTS OF 19 66 87

If there are any questions, I will endeavor to answer them. If I do not have 

the information at hand, it will be furnished to the Committee promptly.

The Chairman. Mr. Pickle.

Mr. P ickle. I assume, I)r. Peters, since no provision has been made 

for a specific allotment to an individual group other than limitations 

with respect to mental health, tha t is, none is given to dentistry, and 

that you yourself would not prefer this fragmentation, I believe that 

is what you said there-----

Dr. P eters. That is correct.

Mr. Pickle (continuing). If the language and the intent were 

shown that we, through the legislation, were leaving to the States the 

determination of the distribution of these funds, and tha t it would 

be for duly licensed personnel in sciences relating to health, tha t this 

would, in general, take care of your concern ?

Dr. P eters. Yes, Mr. Pickle.

Mr. P ickle. I think it should be, and I think this is the in tent of 

the committee, and it would be better than to ask for an individual 

allotment. With that understanding, that would be satisfactory, you 

feel, to you or your group ?

Dr. P eters. Yes, sir.

Mr. Pickle. All right. Thank you.

The Chairman. Any further questions ?

Mr. Springer. This is the first time I knew this was in the bill, 

page 14, lines 15 to 19. I do not know how it got in there, but with 

respect to your first amendment, I think that is all right, and I think 

it will retain the amendment, if we retain the language of this bill, 

lines 15 through 19, but I do not like the “ friend” system where everybody comes in and they earmark this little special fund, and then this 

gets to be a habit year afte r year after year of allocating funds to a 

certain specific profession. I do not believe tha t this is a good way 

to start. I am glad you called it to my attention, because I think that 

health activities ought to have prior ity. In Alabama the priority 

is not going to be the same as in New York City, in my opinion, and 

there certainly ought to be flexibility, and a great deal of it. But if 

you are going to earmark 15 percent for this profession, 5 percent for 

that profession, and 2 percent for anybody else, pretty soon half the 

money is going to be used up in allocating it to a particu lar profession.

I do not believe that is a good way to legislate, because I think that 

your State and local authorities ought to have some discretion here on 

how they are going to allot the money based on the priorities you need 

in that community.

But I would say tha t if we retain this language then you will 

probably be protected. But I do not think I am going to support that 

language of allocating any money to any specific profession or any 

specific illness.

It seems to me that is not the way to legislate.

Dr. Peters. I agree.

Mr. Springer. The principle of the system has certainly fallen 

down by its becoming so antiquated over there now that they cannot 

change it because a profession comes in wanting its percentage, and 

then this becomes chronic year afte r year afte r year and then it is 

hard to change it. But I understand your situation and I can see 

why you are in here asking for 2 percent if somebody is in here asking 

for 15 or 5 percent.
PUBLIC HEA LTH SERVICES AMENDMENTS OF 19 66

Dr. Peters. I simply wanted to use this as a means of calling attention of the States to the problems th at are involved in the need for 

vision services. I could not agree with you more, Mr. Springer, about 

the fragmentation.

Mr. Springer. I worked for years with the Illinois Optometric 

Association, and I know it is a fact on the school system and on the 

roads and everywhere else that it surely is a safety factor. But this 

is ju st my opinion as of this moment, and I do not think I am going 

to change it, and if I get a chance to offer any amendent, I will.

The Chairman. Any further questions? If not, thank you very 

much.

Dr. P eters. Thank you.

The Chairman. Our next witness is Brian O’Connell, executive 

director, the National Association for Mental Health, Inc.

STA TEM ENT OF BR IAN O’CONNELL, EX EC UT IVE DIRECTOR, THE 

NAT IONA L ASSOCIATION FOR MENTA L HEALTH, INC.

M. O’Connell. Thank you, Mr. Chairman.

The Chairman. You may proceed.

Mr. O’Connell. Mr. Chairman, on behalf of the association there 

has been distributed a statement and I recognize the severe time limit. 

Suffice it then to say that the association supports the bill as reported 

out of the Senate, S. 3008, and would even go so far as to add to the 

funding for 1972 as originally proposed to the Senate, and as originally included in H.R. 13197, recognizing the advice of the chairman 

and of the committee of the problem of securing such legislation in 

the House at this late date, and we, at least, argue strongly for sufficient planning money and grants fo r 1 year, with the hope of returning 

early in the next session in order to lur ther discuss the longer term 

appropriations and legislation.

(The prepared statement of Mr. O’Connell follows:)

Statement of th e National Association for Mental Health

T he N at io na l Assoc iatio n fo r M en tal H ea lth is a nat io nal volu nta ry citiz en s 

org an iz at io n dir ec ting it s ef fo rts to th e pr ev en tion an d re du ct io n of th e incide nc e or im pa ct of m en ta l illnes s or di sa bi lity . We fa vor pa ss ag e of S. 3008, 

as p as se d by th e S en ate, w ith th e ex ce pt ions noted below.

W e vigo ro us ly su pp ort th is bil l be ca us e it wo uld (a ) ex te nd to pu blic he al th 

pro gr am s th e co nc ep t of co mpr eh en sive pla nn in g th a t has been eff ectiv ely use d 

in th e H ill -B ur to n pro gra m : (b ) st re ngt hen an d im prov e ex is ting pr og ra m s of 

gr an ts -i n- ai d an d pu blic hea lth se rv ic es ; an d (c ) pr ov id e fe der al as si st an ce fo r 

th e m en ta lly re ta rd ed a nd ot he r h an di ca pp ed c hi ld re n.

BACKGROUND

T he var io us fe dera l pro gra m s fo r su pp or t of pu blic healt h act iv itie s thro ug h 

gr an ts -in- ai d. no w to ta l 16 in as m an y ca tego rie s. I t is a m att er of in cr ea si ng 

co nc ern to Sta te s, co un ties an d citie s, be ca us e of ex pa nd in g re sp on sibi lities of 

pu blic hea lth, th a t th ere is a t pr es en t a lack of flex ibili ty in th e us e of pu blic 

fu nd s, sin ce fu nds appro pri at ed fo r ea ch of th e ab ov e specific ca te go ries may no t 

be tra n sf err ed .

S. 3008 pr ov id es fo r a fle xib le an d resp on sive pr og ra m of fin an cial as si st an ce 

fo r pu blic healt h ac ti vit ie s aim ed pri m ar ily a t th e prov ision of co mmun ity 

h ealt h service s.

comprehensive plan ning

W ith lim ited re so ur ce s of fu nd s an d man po w er to m ee t our cr itic al he al th 

ne ed s, it is ess en tial th a t we ap pl y as fu lly as po ss ible th e co nc ep t of ev al ua tin g
PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66 89

needs and establishing priorities based on the extent of need. During the past 

20 years the Hill-Burton program has demonstrated that comprehensive planning 

is essential to the most effective use of resources. There is no single category 

which would not benefit from comprehensive Statewide planning, partic ula rly 

today when the responsibilities of public hea lth departm ents are expanding.

We believe it essential th at this bill be passed so that fund s may become im ­

mediately available to the State s. There can be no delay in meeting the need 

for coordination resu lting from the many different sources of federal support for 

health program s a t the S tate and local level.

COMPREHEXSIVE PUB LIC HE AL TH SERVICES

The bill embodies a fundam enta l revision of the hea lth grant stru cture, by 

making fede ral gra nt fund s available to State s, and through them to their local 

communities, on a flexible basis for the provision of comprehensive public health 

services focused on individuals and on families in their communities rather tha n 

on separate disease conditions. Through this flexible str uctur e services will be 

supported to maintain physical and mental he al th : detect, prevent, control, or 

reduce the impact of diseases, injuries, and disabil ities; maintain a hea lthful 

environment, and generally make available to all persons in a Sta te public hea lth 

services rela ted to local needs.

The National Association for Mental Hea lth strongly supp orts this concept.

We are partic ula rly inte rested in the enactmen t of S. 3008, since it makes 

available funds, on a more realistic basis compared with known needs, for the 

development of mental hea lth services in communities. It provides that of a 

State ’s allo tment for comprehensive health services :

At least 15 percent of all funds allotted to a Sta te must be available to 

the Sta te mental health autho rity for Sta te and local community mental 

health services.

At least 70 p ercent of all funds available to th e State health autho rity and 

to the State mental health autho rity must be used to supp ort services in 

local communities.

Up to 30 percent of the fund s available to the State health autho rity and 

to the Sta te mental health autho rity may be used to strengthen the State 

health agency or S tate mental he alth agency.

We rega rd it as par ticula rly significant that this provision perm its specialized 

planning by the Sta te mental health autho rity to meet the mental health needs 

of the State, and at the same time rela tes the specialized planning to the 

comprehensive planning.

Earlier, we stated th at NAMH supports S. 3008 as enacted by the Senate with 

certain exceptions. We urge th at there be restored the deletions in the autho rizations. made when S. 3008 was passed, so th at the program extend through 

1072 with a total authorization of 10.0 million for 1067; 304.5 million for 1068: 

401.2 million for 1060 ; 507.1 million for 1070; 57.0 million for 1071; and 

545.0 million for 1072.

The NAMH believes S. 3008 to be the single most imp orta nt health bill to 

come before the second session of the 80tli Congress and, if passed, it would be 

one of only two major hea lth bills enacted during th at session. We believe 

that delay beyond thi s session of the Congress in enacting S. 3008 would 

seriously jeopardize the proposed program for extension and improvement of 

comprehensive health planning and public health services.

We urge tha t the House Committee on In terstate and Foreign Commerce 

repo rt this bill favorably in time for it to be voted on and passed by the 

80th Congress.

The Chairman. I want' to thank you very kindly for your statement, and your appearance here because, as you say, time is of the 

essence. We did not mean to keep you tha t short.

Mr. O’Connell. I would want to urge tha t I would be ha ppy to 

go on at some length, but I am impressed with your statement tha t 

if a bill is not reported out today we may not get anything.

The Chairman. Tha t is about r igh t; that is about the situation.

Any questions?

Mr. Springfjl I have none except on this question of the 15 percent. 

How did you arrive at that ?
90 PUBLIC HEA LTH SERVICES AMENDMENTS OF 19 66

Mr. O'Connell. Th is was not a figu re th at the Na tio nal Associa ­

tio n for Me ntal Hea lth arriv ed at. Th is was a figu re included in the 

original leg islation based on con sultation wi th the De pa rtm en t of 

Hea lth , Ed uc ati on , and Welf are, as a rea listic prop ortio n of total 

he alth spe nding which, at a minim um, sho uld go fo r me nta l healt h, 

mental retardation.

Th e Chairman. Th an k you again , an d yo ur sta tem ent will appear 

in t he reco rd in full.

We have one more witness, Mr. Thom as A. Tu cke r.

STATEMENT OF MRS. FITZHUGH W. BOGGS, FORMER PRESIDENT, 

NATIONAL ASSOCIATION FOR RETARDED CHILDREN

Mr s. Bogus. Mr. Tu cker was called to the W hite H ouse, and I will 

speak f or him, if I may.

Th e Chairman. You are Mrs. Bog gs and you are rep res entin g Mr. 

Tu cker on beha lf of the Na tio nal Associatio n fo r Re tarded Children .

Mrs. Boggs. I am a pa st p resid en t o f t he associatio n.

Th e C hairman. We ll, c ould you insert y ou r statem ent in th e record, 

please ?

Mrs. Boggs. I wou ld be del igh ted if y ou would. I am attend ing to 

yo ur time.

Th e Chairman. All right . Th an k you.

Mrs. Boggs. I am Mrs. F itz hu gh W . Boggs. T am rep res entin g Mr. 

Tucke r. Mr. Tu cker is a mem ber of the Pr es id en t’s Com mittee on 

Me ntal Re tardation which happened to be me eting to day, and when I 

asked him, to call over, as I tho ug ht, th e tim e was r un ning , h e told me 

th at th e g roup was jus t leav ing for a m eet ing at the W hite House, and 

he sends his apologies and reg rets.

We hav e presen ted our views in the testim ony which we have given 

in w rit ing, and I will no t read that.

I will use just a minute or two to say t hat whi le there is some fund 

fo r the servic es to the me nta lly retarded inc lud ed among the pro jec t 

gr an ts of th e P ublic H ealth S ervice as presently op era ted an d as would 

be a uth orize d u nd er 18231, the am ount is very sma ll, a nd th ere is a t the 

prese nt tim e an urge nt need to expand com munity fac ilities for the 

me nta lly ret ard ed.

In 1963 the Con gress autho rized con struction leg islation fo r commun ity fac ilities fo r the me nta lly retar de d, and also fo r com munity 

me nta l he alt h centers.

Recog nizing the need to augm ent th at with op erating fun ds, the 

Congress acted in 1965 with respec t to com mu nity me nta l health 

centers , bu t not with resp ect to com munity me nta l retardation facilities. Th e S ena te, in ad ding section 8 to the bil l S. 3008, has recognized 

th at deficiency.

Th e Surge on General has sa id th at th e De pa rtm ent prefers to aw ait 

the recommen dati on of the new Com mittee on Me ntal Re tardation 

ap po int ed by the Presiden t last sprin g. Th e pro posals in S. 3008 

which we are espousing a re rea lly an outcome of the activities of the 

Pr es id en t’s Panel on Menta l Re tardati on which was appoin ted in 1961, 

1962. We do not believe th at there rea lly can be a mo rat ori um on t ha t 

proceedin g in an o rderl y fashio n with the growt h of th is autho riz ation 

leg islation, and we would stron gly urg e th at the Senate amendments,
PUBLIC HEALT H SERVICES AMENDMENTS OF 19 66 91

as included in section 8 of S. 3008, be included in your bill as you 

report it out this year.

Failure to do so would cause a delay in the staging of this operation 

and will accentuate the kind of problem that Mr. Nelsen referred to 

earlier th is morning.

We are also in support of the two additional amendments, section 

9 and section 10, which were added in the Senate.

We concur with the view that has been repeatedly expressed here 

this morning tha t the authorizations in 18231 can only be regarded as 

stopgaps and are not adequate to the total program.

Thank you, sir.

(The prepared statement of Mr. Thomas A. Tucker follows:)

Statement op Thomas A. Tucker. President, National Association for

Retarded Children

The National Association for Retard ed Children supports and urge s passage 

of S. 3008, the Comprehensive Health bill, during thi s session of Congress. We 

urge passage of the bill as reporte d out by the Senate Committee on September 

29th.

It is late in the year, but, we contend, not too lat e for the members of this 

Committee to review the history of this legislation, its origins in thought and 

stud y begun in the early sixties by the Sta te and Te rritor ial Health Officers, 

the National Commission on Community Hea lth Services and the President’s 

Panel on Mental Retardation of 1961-1962. The documentation published some 

months ago in the Senate hearings is replete with justification. We urge the 

Committee, also, to consider the need for timely anticipation of the requirements 

of sta te legislatures, sta te agencies, local governments and non-profit voluntary 

agencies, to the end that those who will have the responsibility for matching 

these fund s and delivering the various services speedily and efficiently know in 

advance where they stand. Postponement of this legislation or substitution of 

an emascula ted bill will inevitably reduc e its effectivness.

Contrary to some impressions, this is not a c rash p rogram of the Great Society ; 

it is a logical and well staged development, building on existing experience and 

precedents. The attach ed table compares the authorized appropriations for S. 

3008 with authorizations for the House and Senate passed versions of this year’s 

Anti-Poverty and Elem enta ry and Secondary Education bills. The amount 

authorized for FY 1967 in S. 3008 is less tha n one percent of the 1967 authorization 

for anti-poverty funds and the 1968 authorization is 8.3 percent (Senate) and 

8.5 perc ent (House) of the 1968 authorization s for Elemen tary and Secondary 

Education. Thus, we can see that the authorized appropriations are modest 

when compared with the anti-poverty and education bills. Yet good health is 

basic to good education as well as f or the alleviation of poverty.

Comparison of authorised appropriations for antipoverty, elementary and

secondary educat ion amendments, and public health planning and services

bills

H ous e au th o ri zati o n (in m illions 

of d ol la rs )

S en at e au th o ri zati o n (in m illion s 

of d ol la rs )

1967 1968 1967 1968

E le m e n ta ry an d se co nd ar y ed ucati on am en d m en ts (S. 3046; 

H .R . 13161)________________ ____________ _________ _______ 2,18 7 3,553 2,716. 5 

1,750. 0 

10 .0

3, 649. 7

A n ti p o v ert y (S. 3164; H .R . 15111)___________ _______ ______ _ 1, 750

P u b li c healt h pla nnin g an d se rv ices (S. 3008 )__________________ 304.5

We respectfully point out th at S. 3008 as i t now stands holds the 1967 auth orizations to a token amount, $10 million for all purposes, and th at thi s is what 

the Adm inistration has alre ady budgeted. The total authorization for 1970 is 

alre ady below th e Adm inistration proposal. The totals authorized for 1968 and
92 PUBLIC HEA LTH SERVICES AMENDMENTS OF 19 66

1969 are less than 3% and 4% respectively, more than the Administration 

recommended.

Our particular interests in this legisla tion are s ixfo ld :

1. Pla nning

As an organization interested in children and adults with a chronic disab ility, whose needs for health services are extens ive, we are especially aware that, in recent years, the growth of public and priv ate health services has not been orderly or planfu l, nor, indeed, has the approach of the fede ral government been holistic. This bill enunciates a philosophy which recognizes the changes brought about in the health field as a result of scientific advances and of modifications in our social structu re and econ omy ; it recognizes the need for plannin g, and makes the means available to states to carry out this function more intensely in the next few years. Such plannin g, if it is indeed comprehensive, must redound to the advantage of the mentally retarded in the same measure as it affects 

other citizen s.

2. Pre ven tion

The prevention of mental retard ation in children yet unborn is a majo r ob­ jective of our organi zation. Such prevention will require action on many fronts. The proper organization and pursuit of many kinds of public health activities will contribute to this end—the control of cert ain diseases such as measles, viral encephalitides, and toxoplasmosis, the control of environmental hazards such as lead poisoning, the prevention o f accidents resulting in brain inju ry, the reduction of prematurity through improved prenatal care, the prompt dissemination of new findings relative to causation, and many other activ ities which are part of a broadly conceived and intelligen tly administered public health program. The formid able costs to society of mental retard ation are not widely under­ stood. Since mental retardation is genera lly speaking not “cu rable” in a medical sense, and usua lly results in some degree of continu ing disabilit y throughout life, the loss to the nation in costs of care and salvaged earning capa city can be realistic ally estimated as between one-quarter and one-half million dollars for 

each ind ivid ual who becomes seriously menta lly retarded but who could have 

been saved by preventive methods. Eac h year that passes now dooms some 50.000 infa nts to lives of dependency and distress, because of mental retardation (not countin g the milder forms which only reduce produc tivit y). The losses in costs to the taxpa yers for care and in potenti al earning capa city of these re­ tarded citizen s who w ill be born in 1967 is equivalent to 10% o f the e ntire federal budget anticipated for the same year. I f through intensification of public health measures, we could prevent only one out of every ten cases of serious 

mental retardation which will be caused in 1967, the savings in cost s of care

alone could balance the annu al expenditur es authorized under S. 3008 for all purposes for either 1969 or 1970. the years of maximu m author ization . Can we afford to postpone stepping up our acti vity in prevention for even one year?

3. Publi c He alt h Ser vices

Those who are. unfortunately, alrea dy retarded require various general and specialized health services within the framework of generic services. A small beginning has been made in developing this approach under exis ting autho riza­ tions. Howeve r, fail ure to autho rize increased appropriations in the years immediately ahead will put a ceili ng on efforts in all new or recently activat ed fields, and especially in the area of services affec ting the mentally retarded 

adult—a group which will be at least 50% larger in the next decade.

4. Ser vices in Com mun ity Fa cil iti es fo r the Me nta lly Retarde d

In addition to the attention which can and should be given to mentally re­ tarded children and adults within the general system of public health, there is at present a special need to provide funds to initiate, expand and improve specialized community services to the retarded which may run the gamut of the continuum of care, (exclusive of those forms of service which are now receivi ng federa l support through education or vocation al rehab ilitati on agen­ cies). Much enthusiasm has been generated throughout the country by the Ment al Reta rdat ion Facili ties Construction amendments. Many communities have not. however, been able to avail themselves of these funds because of lack o f capa city to launch the service when the buildi ng is ready to open. There is a need to autho rize this program now, so as to put mental retardation faci li­ ties on a comparable basis with community mental health centers, both in
PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66 93

states where these are being developed in a complementary fashion, and in 

States or communities where the two programs are sepa rately administered. 

Section 8 of S. 3008 provides a modest and well thought-out program which 

will meet this need and at the same time stim ulate State, county and local 

governments to share in these costs. In this same spirit the funding under 

this section would he available to initiate services in any community facility 

for the retarded regardless of whethe r it was constructed with federal funds.

5. Definition of Construction

Section 9 of S. 3008 modifies the definition of construction to include acquisition of land and of existing buildings. The language follows that of PL 

89-333 covering comparable situations in construction of sheltered workshops. 

The purpose is to offset the disadvan tage now suffered by sponsors of projects 

in built-up areas, where the most suitable location may be already in use and 

where the cost of land is a considerable parKof the total cost of the project. 

We understand that the Secretary would prefer net to have the present language 

of subsection (f) of Section 401 of PL 88-164 deleted. We have no objection to 

reta inin g the present language of subsection (f) if the sense indicated above 

is added.

6. Physical Education and Recreation for the Handicapped

The modest auth oriz atio ns in Section 10 would benefit all categories of physically and mentally handicapped children by stim ulating recruitmen t and trai ning of personnel in an area which has been largely overlooked. This effort 

will be complimented by a program of demonstration grants, through which 

new practic al knowledge may be gained.

We apprecia te the opportunity to be hea rd on behalf of America's six million mentally retard ed citizens and urge your prompt and care ful considera ­

tion of these matters.

The Chairman. Thank you, Mrs. Boggs. Well, tha t is entirely the 

intention of the committee that this will be just a stop gap piece of 

legislation, a holdover, and it appeared all of a sudden as an emergency last Saturday a week ago, and we were still in session on some 

other matters and had two or three packages to come off the floor, and 

other matters, so we gathered at the last minute here that it is an emergency, and we are tryin g our best to accommodate it in the time we 

have.

Mrs. Boggs. We recognize that both your committee and the Senate 

committee have been extraordinarily busy this year on various matters. 

It is unfortunate tha t health seems to be taking the squeeze.

The Chairman. I do not know about the Senate committee, but I 

can assure you that this committee is busy, and some of the members 

said they liked me all right, but they are g etting tired of looking at 

me, so I guess that is about it.

Mrs. Boggs. Thank you.

The Chairman. Jus t a moment. Are there any questions ? If not, 

we wish to thank you very kindly.

This concludes the hearings, and we will go into executive session 

on Thursday on this matter.

(The following material was submitted for the record:)

Statement by National Association of State Mental Health Pbogram

Directors. Presented by William E. Schumacher. M.D., President

Mr. Chairman, I am the director of the Bureau of Mental Health, Dept. of 

Mental Health and Corrections, State of Maine, and I am the preside nt of the 

Natio nal Association of State Mental Health Program Directors.

It is the position of the members of this association th at S. 3008, as amended 

by the Senate and passed by the body on October 3, will more effectively meet the 

public health needs of the states tha n the various altern ative proposals.

7 0 -0 5 0 — ■7
94 PUBLIC HE AL TH SER VIC ES AM ENDM ENTS OF 19 66

We have studied the various “Partn ers hip for Health” proposals and have 

determ ined that significant improvement in public health adm inistration 

(including m ental health and mental retard ation) can be provided only through 

adoption of the Senate-passed bill.

As Dr. John Venable told y our committee this morning, eliminating the disease 

categories in the present, gra nt program (as the compromise “Staggers bill”— 

H.R. 18231—does) is only a partial solution of the problem of providing improved 

public health services.

In addition, wh at is needed for a strong and effective partnership is a 

sub stan tial increase in the federal share. We consider the provisions in H.R. 

18231 as inadequate.

Government at present has a special responsibility to see th at the vastly 

increased expenditures of tax money and other fund s for health services are 

utilized efficiently w ith a minimum of dilution by bureau cratic distractions.

S. 3008 as passed by th e Senate fully meets this responsibility.

H.R. 18231 does not.

S. 3008 as amended may be considered a serious move by the Congress to 

require the federal government to get its own public health program in order, 

providing an effective partner'ship of the federa l government with the states and 

local resources in providing both leadership and financing of essential health 

services.

H.R. 18231 is a gesture in the right direction. It is not the full bold move 

called for.

Our members also support federal assistance for developing staffs in community mental retard ation facilities. H.R. 18231 fail s to trea t this problem.

There is one p articu lar issue, involving both S. 3008 and H.R. 18231. w ith which 

we especially w ant to trea t.

It is the m att er of allocating a minimum of 15 of the grants for comprehensive 

public health services for use in stat e mental he alth services.

This factor is in both bills and the history of the need for this clear and 

singular mandate is long and well-known.

Our members have asked me to express to you our strong feeling about the 

necessity for this provision.

It is our hope that it will not be altered in whatever final version emerges 

from the Committee.

In connection with this matter, back on August 31 we had occasion, at the 

request of Congressman Pau l Roger’s subcommittee staff, to submit to the Investigations Subcommittee some data on the relative size and importance of 

mental health and mental retard ation programs in the total public health picture 

in the state s.

In our August 31 stateme nt we showed a breakdown of tota l State expenditures for public hea lth in 1965 a s : $3,368,311,309.

Of this amount 69% was expended on mental health and mental retardatio n 

programs.

We urge your favorable consideration of S. 3008 as passed by th e U.S. Senate.

Statement of Emil T. Chanlett, Chairman, Radiological Health

Section, American Public Health Association

Chairman Staggers, on behalf of the Radiological Health Section of the 

American Public Health Association I am most appreciative of the opportunity 

to testify on H.R. 13197. As Chairma n of the Radiological Hea lth Section, I 

speak on behalf of a large number of practit ioners of radiological health protection working in State and local hea lth departments. Presently there are nearly 

1,060 men and women so engaged in the United States. About one-third of the 

funds for the ir work comes from a Public Hea lth Service categorical gra nt to 

the ir employing agency. In FY 65, about $4,000,000 was provided from State 

and local sources.

My name is Emil T. Chanlett. My home is at 622 Greenwood Road, Chapel 

Hill, North Carolina, where I am Professor of San itary Engineering of the 

University of North Carolina and Dire ctor of the Radiological Hygiene Program. 

I am a member of the North Carolina Atomic Energy Advisory Committee by 

gubernatorial appointment.
PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66 95

H.R. 13197 which we fully support provides for form ula gra nts and project 

gra nts for planning and services in public hea lth at the State, area-wide, and 

local level. This bill is of g rea t importance to sustain and to develop environmental health services. This bill is of particular intere st to radiological health 

as it is one of the several categ orical gra nts now made by Public Hea lth Service 

to States for specific services. Under the bill such categ orical provisions with 

the exception of mental health will be made pa rt of one allotm ent. For fiscal 

year 1966, $2.5 million were provided to the State and Territo ries to estab lish 

and to sustain radiological health services. A determined and inspired effort 

and effective activities were necessary to reach that high mark of national and 

sta te concern for managing the radiation exposure of our people.

The merits of this bill have been clearly delin eated by our foremost public 

health administrators and by the leader of the American Public Health Association. It is not the purpose of this statem ent to refute, det rac t or to demur 

from these sincere and well informed witnesses. The present $2.5 million for 

radiological health is slightly over 4% of th e total of approximately $57.5 million 

for present form ula grants to the States and Territories in fiscal year 1966. 

Perhaps it is the very fac t that we are small fish in big ponds that we seek the 

safe havens of identification before the House Committee. We ask that the 

record show our support for this bill and our und erstanding and the Committee’s 

recognition that the extant activities supported by formula gra nts shall continue to be nurtured under the Comprehensive Planning and Health Services 

legislation both in its conception and in its implementation. Further, that so 

long as these activities are worthy of their nur ture, these shall be vigorously 

encouraged to obtain gre ater support from State tax resources.

It is certain that there is nothing peculiar or special about the present radiological health formula grants. It is only our proximity and dependence upon 

these which makes it seem so. We are dedicated to protectin g each citizen and 

his surroundings from a cummulative dose an d contamin ation, in minute amounts 

by irrevocable small actions, beyond easy recall. There are two items tha t 

warrant mention.

The existing radiological hea lth formula gra nts have made it possible for 

the States to achieve a readiness and competence to meet the challenge the 

Congress so wisely set before the States to enter into executive agreements 

for the tra nsfer of the licensing power for radioisotope u sers from the U.S.A.E.C. 

to a State. As of July 1966, 13 States have met the issue, a heartening and 

real reminder that we are a fede ratio n of sovereign States bound to one another 

for the general good. Other than for a limited training activity, the U.S.A.E.C. 

has no funds for stren gthening a Sta te’s capa bility to meet AEC’s necessarily 

demanding criteria for the tra nsfer of its inspectional autho rity and responsibility to a State. Nor to my knowledge does it wish such funds. But the 

PHS form ula grants are a fac tual element in the hea lthy process under way. 

We look to the day when 50 States have met the unique opportunity to exercise 

this bit of their sovereignty, lest the scepter rust.

The second item is the reaffirm ation that government is a process of men and 

not adm inistrative schema, however handsome and colorful the organizatio n 

charts. Men respond to leadership, to friendship, to devotion and pride in their 

professional calling. The present system of multiple categorical formula grants 

is a colossal administra tive headache and hodge-podge, but it carries the personal 

identification of a common professional dedication and ambition. Incentives 

are a powerful American ignition. The broad adm inistrative structur e for 

activating H.R. 13197 m ust keep the lines of common professional goals strong 

and wide open. In radiological health these provide tlie energizing pulse from 

the top command of the Division of Radiological Hea lth of the PITS to the most 

dis tan t toter of the “Cutie-pie” and Geiger-Muller counter in the physician’s 

office in some ru ral village to check an Xray machine or in the field check of 

a “Hi-Vol” air sample in an urban center. It is not a one-way wire. It carries 

the intelligence surveillance information to safeguard our people, young, old, 

and unborn. Large plans and adm inistra tive structures must have the human 

dimension to produce a service to the root of our adm inistrative being, the 

taxp ayer. We suppo rt H.R. 13197. We wa nt the record to recognize the place of radiological health in the present supp ort system. We want the record to show that 

it is not the intent of this legislation to diminish the place of such activities 

as radiological health in the overall health protection services of our jieople.
96 PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66

Sta tem ent of t h e A mer ican I n st it u te of P la nn er s

The American Institut e of Planners is the professional society for city and 

regional planners in the United State s. Its 4,500 members account for the 

professional planning staffs in city, metropolitan and state comprehensive planning agencies, and in many housing and urban renew al agencies. Other members of the Institute, in priv ate practice, serve as consulta nts to local, sta te and 

federal agencies on problems of urba n growth. Thus, the profession is ^well 

qualified by experience and inte rest to comment on matters concerning urba n 

development and the federa l responsibility.

We hea rtily endorse the basic principles behind this legislation, which would 

greatly expand the scope and dolla r level of federal aid to the states for pubic 

health services, and would broaden and make more flexible the manner in which 

the funds are expended on the states and local levels.

This trend toward block-grants to state and local agencies for assistance in 

developing a wide range of planning for services is quite consistent with trends 

in other federal legislation, and we feel th at it will result in a more comprehensive approach in health facilitie s and services planning.

Our prim ary suggestion for improving this legislation would be to make specific 

reference to inte grating this health planning program with comprehensive planning underway in nearly all states and metropolitan areas, thus putting health 

planning in its proper perspective in relation to physical, social and economic 

goals.

To do this, we would suggest adding as Section (c) (2) (K) of the proposed 

amendments to Section 314 of the Public Health Service Act, the following 

lan guage:

“Provides, where comprehensive state-wide planning is being carried on with 

or without assistance under Section 701 of the Housing Act of 1954, for full 

coordination between the comprehensive sta te hea lth planning plan and other 

state-wide planning programs, and for assuranc es th at such health plans will 

be in conformity with the general development policy in such state.”

This language is similar to that which this and previous Congresses have 

enacted in such legislation as the Wa ter Resources Plan ning Act, the Mass 

Tra nsp ortatio n Act, the Land and Water Conservation Act, and the Highway 

Act of 1902. Its purpose is to rela te comprehensive health planning to tota l 

development planning for the jurisdictio n for which the services and facilitie s 

are to be provided.

Section 701 of the Housing Act, as administered by the Department of Housing and Urban Development, is the prim ary vehicle recognized by the Bureau 

of the Budget and federal law for coordinating functional plans into tota l community plans. Several examples will suffice. In the Senate hearings on S. 3008, 

several state health officers endorsed this legislation as providing more flexibility 

and comprehensiveness to hea lth planning. An example is Dr. G. D. Carlyle 

Thompson, Director of Public Health for the Utah State Department of Health, 

who wrote. “The nature of the work of state health agencies has always required 

and actually involved planning, especially with the impact of categorized federa l grants. But it is generally recognized that planning has been rarely adequate both as to extent or quality.” The agency for state wide comprehensive 

planning in Utah is the Sta te Planning Coordinato r in the Office of the Governor, 

who is authorize d to receive and adm inister 701 gra nts to coordinate health 

planning with economic development, recre ation, transp ortation and all the 

other factors affecting development an d government.

In another example, the Depa rtment of Housing and Urban Development has 

given a Section 701 gra nt to the New Jersey Division of State and Regional 

Plan ning to provide several planners to work specifically with the New Jers ey 

Sta te Health Department on fitting the New Jersey sta te health plan into the 

framework of the comprehensive state wide development plan.

This is the pat tern we hope would develop in every state—sufficient fede ral 

gra nts under Section 314 of the Public Health Service Act to the State Departments of Health to provide trul y adequate health planning—combined with funds 

under Section 701 of the Housing Act to the sta te planning agency to coordinate 

the state health plan with other functional plans being prepared by state agencies (many of them required by federal agen cies).

Professional comprehensive planners have long worked with health professionals in aiding communities to protect, design and engineer the total community 

for hea lthful human development. This coordination has taken four general 

form s: join t planning of community programs, inte rdisciplina ry research, ex-
PUBLIC HEA LTH SERVICES AMENDMENTS OF 19 66 97

ch an ge of kn ow led ge of pr of es sion al co nferen ce s, an d in te rd is ci plinar y tr ai nin g. Th e man y ex am pl es of effecti ve in te rr ela ti onsh ip s ar e, ho we ver, too of te n ov er ­ sh ad ow ed by a co mplete lack of co mm un ication about pr og ra m s of m utu al in te rest. T hi s is of te n att ri b u te d to th e fa ct th a t th er e is to da y se ve re f ra gm en ta tion of re sp on sibi lity fo r co mmun ity healt h pl an ni ng am on g a wi de var ie ty of org an i­ za tio ns , or els e a co mplete lack of pl an ni ng acti vit y fo r hea lt h a t bo th th e st ate 

an d loc al levels. I t is ag ain st th is ba ck gr ou nd an d w ith reco gn iti on of th e ne ed to st ri ve con­ ti nual ly to im prov e th e hea lth of th e co mm un ity th a t th e American In sti tu te of Pla nners stro ng ly en do rses th e go al in HR 13197 of im pr ov in g st at e, region al, m et ro po lita n are a an d loc al hea lt h pla nn in g ag en cies. We fu rt h e r specifically en do rse th e co ncept of in te rg ov er nm en ta l co or di na tion , co or di na tion am on g fu nct io nal pr og ra m in te re st s, an d the auth ori ty c on ta in ed in th e bil l which w ou ld m ak e it po ssible to tr a in pe rson ne l an d su pp or t st udi es an d dem onst ra tion s re la ­ tiv e to th e a rt an d scien ce of plan ni ng . The pa ss ag e of H R 13197 wo uld , in ou r opinion, re pr es en t a m aj or st ep to w ar d giving Amer ican co mm un iti es th e re sp on ­

si bi lity an d su pport ne ce ss ar y to pl an fo r th eir fu tu re so cial deve lopm en t. We wo uld rec om men d th a t th e “si ng le st ate ag en cy ” in th e am en de d Sec. 314 ( a ) (2 )(A ) m ig ht in som e ca se s be a sub-secti on of a gen er al st ate pl an ni ng ag ency resp on sibl e fo r ph ys ical, econo mic an d so cial pla nn in g if th e Gov erno r or th e le gis la tu re or th e st ate an d loc al officials wou ld so de sire. Si m ilar ly , th e region al, m et ro po lita n or ot he r loca l are a hea lth pl an ni ng ag en cy m ig ht we ll be a sub-secti on of a gen er al pl an ni ng agency. F or in stan ce , th e M et ro po litan W as hi ng to n Co uncil of Go ve rnors, which is a volu nta ry or gan iz at io n of m un ic i­ pa l an d co un ty go ve rn m en ts in th e W as hi ng to n are a, has a co mpr eh en sive hea lth pl an ni ng divi sion which wo uld be do ing th e pla nnin g unde r th is legi slatio n. How ev er, it is re la te d in th e same org an iz at io n to tr ansp ort ati on, open sp ac e 

an d eco nom ic de ve lopm en t plan ni ng . Furt her m ore , we wou ld rec om me nd th a t th e co mpr eh en sive region al, m et ro ­ po lita n or loca l are a hea lth pla nn in g or ga niz at io n de linea te th eir pl an ni ng are as to co rres po nd w ith pla nn in g ju ri sd ic ti ons fo r oth er co mmun ity fu nct io ns su ch as tr ansp ort ati on or la nd us e plan ni ng . Th e ve hicle fo r this, of c ou rse , is th e st ate 

pl an ni ng ag en cy a nd t he m et ro po lita n pla nn in g agency. We wou ld also rec om men d th a t th e tr ain in g and re se ar ch re so ur ce s of th e city an d st ate pl an ni ng pr of es sion sh ou ld be eli gible to part ic ip ate in tr ai nin g, 

re se ar ch an d de m on st ra tion pr oj ec ts which will im prov e th e a rt an d sci ence of hea lth plan ni ng . Th e U.S. Pu bl ic H ea lth Se rvice is alr ea dy en co ur ag in g th is par tici pa tion . A few ex am pl es of th e pr og ra m s fo r in te rd is ci pli nar y tr ain in g in sch oo ls of city pla nn in g are thos e es ta bl ishe d a t th e U ni ve rs ity of Pen ns yl ­ va ni a, U ni ve rs ity of N or th Carolin a, H ar var d, U ni ve rs ity of Cin ci nn at i, an d Co rnell Uni ve rs ity . Th e Pu bl ic H ealth Se rvices has fo r a nu m be r of yea rs bee n sp on so rin g sh or t-te rm tr ain in g c ou rses in en vi ro nm en ta l hea lth fo r ci ty plan ni ng . 

We wo uld l ik e to see this e xp an de d. We wo uld also rec om men d th a t thos e resp on sibl e fo r ad m in is te ri ng th es e 

pr og ra m s in th e U.S. Pu bl ic H ea lth Se rvice work w ith officials of ot her fe de ra l ag en cies resp on sible fo r ad m in is te ri ng g ra n ts to st ate an d loc al pla nn in g ag en cies in or der to fo st er th e enti re co or di na tion of pla nn in g act iv itie s on th e st ate an d loca l levels, to av oid du pl ic atio n a n d /o r co mpe tit ion of pla nn in g effo rts . Ma ny 

as pe ct s of en vi ro nm en ta l he al th pla nn in g an d pe rs on al hea lth ca re pl an ni ng can be under ta ken th ro ug h tr adit io nal ci ty pl an nin g pr og ra m s, incl ud in g ge ne ra l social serv ice pl an ni ng w ithi n th e co mmun ity re ne w al pr og ra m or spe cific urb an re ne w al pr oj ec t pl an ni ng an d Secti on 701 urb an plan ni ng . Thi s oppo rtun ity fo r 

co or di na tion wi ll, of co urse, be en ha nc ed un de r th e Citi es D em on st ra tion pro ­

gr am now p en ding b efor e th is C on gress In th is re sp ec t, th e Adv iso ry Co mmiss ion on In te rg over nm en ta l R el at io ns ha s prop os ed th a t “fed er al pl an ni ng a id s or urb an de ve lopm en t, in cl ud ing Se cti on 701 U rb an pl an ni ng as si st an ce an d co mpr eh en sive tr an sp o rt ati o n plan ni ng , sh ou ld specifically auth ori ze an d en co ur ag e econ om ic an d so ci al pla nni ng fo r th e com­ m un ity as a ba sic ju st ific at io n fo r ph ys ic al pl an nin g.” Thi s is ne ce ss ar y to br oa de n tr ad it io n al ph ys ical an d re gi on al pl an nin g to mak e it mor e vi ab le an d to re la te it mo re di re ct ly to th e ne ed s of peop le th ro ugh pl an ni ng fo r se rv ices 

as w ell a s fo r fa ci lities . W e under st an d th a t th e U.S. Pu bl ic H ea lth Se rvice is sp on so rin g tw o m aj or st ud ie s to de te rm in e th e co nt en t an d t ec hn iq ue o f co or di na tion b etwee n city pla nni ng ag en cies a nd healt h or ga ni za tion s. We loo k fo rw ard to p ub lica tion of t he se st ud ie s an d to th eir im pa ct upon mak in g our pl an nin g ac ti vit ie s m or e via bl e an d 

more us ef ul to loca l a re as .

70- 05 0— GO------ 8
98 PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66

Statement of Nicholas Pohl it, Executive Director, National Association of

Sanitarians

The Partn ers hip in Hea lth Bill is one of the more forward-looking pieces of 

legislation in the opinion of those of ns in executive positions in health professional organizations. Its implem entation should rival the beneficial effects 

of the now-famous Hill-Burton Act for, as that Act provided our Nation with 

a strengthened health facility posture, so this Bill would provide the Nation 

with a health-planning scheme that puts the expenditure of health resources on 

an objective output-oriented base rather than a base of pure emotion. Under the 

direction of such men as the Surgeon General, Dr. Stewart, and Assistan t Surgeon 

General Carruth J. Wagner, it would indeed move us to the point of the most 

productive use of our health resources direc ted toward the goal of assuring 

health services for every American rega rdless of his financial ability or social 

status.

The National Association of Sanitarians is vita lly interested in this Bill, 

not only for its general contribution to the health system of the Nation but 

because the sanitarian, by dint of his traini ng and experience, becomes a logical 

choice for a key health planner at every echelon of government and nongovernment program s. This second largest group of allied health professionals and 

the only group traine d at the undergradua te level for public health work, some 

14,000 strong, has for many years been an instrum ent of the health team who 

has insisted upon recognition of the final effects of h ealth effort as a pre-courser 

to request for support resources.

The National Association of S anitarians strongly urges tha t this Bill be passed 

during this Session of Congress to move us more rapidly to th at point in time 

when all health moneys will be directed toward specific health objectives regard ­

less of the field of endeavor.

(T el eg ra m ]

New York, N.Y., October 10, 1966.

Congressman Harley Staggers,

Chairman, House Committee on Inter sta te and Foreign Commerce, Rayb urn

House Office Building, Washington, D.C.:

Please enter in the record of your h earing on H.R. 18231 th e strong suppo rt of 

the Association of Schools of Public Hea lth for the objective of the proposed 

legislation on beha lf of the Association. I strongly urge the suppo rt of your 

Committee for the section contin uing the $5,000,000 a uthorization for gra nts to 

Schools of Public Health. These gra nts are vita l to the continued effort of the 

schools to meet the ever increasing demand fo r tr ain ing public health personnel— 

a demand greatly increased by th e passage of Medicare.

Ray E. Trussei.l, M.D.,

President, Association of Schools o f Public Health.

[T el eg ra m ]

West P alm Beach, Fla., October 10,1966.

Hon. Paul G. Rogers.

House of Representatives.

Rayburn House Office Building, Washington, D.C.:

I urge your assistance in passage of S. 3008 including mental retard ation funds, 

in preference to H.R. 18231 and 18232. This is on basis of demonstrated experience in your own community here in Palm Beach County, that sheltered workshop and evaluation and training services for retarded pay huge dividends to 

society f ar in excess of th eir cost.

At the Reh abilitation Center at John Prin ce Park in Lake Worth, on land 

donated by county and in buildings and equipm ent supplied entirely by community gifts, without any public money at all, the Palm Beach County Association for Reta rded Children in our first 4 years from 1959 through 1962 put back 

into perm anent employment in competitive industry over 30 people—average 

10 per year—who were unemployable until we developed the ir late nt abilities.

From 1962 through 1965 we got a tota l of $37,000 Federal and State assistance 

for additional staffing and equipment, and we increased our output of useful 

people to 100—average 30 per year.
PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66 99

At current minimum wage of $1.25 per hour our tota l 130 permanen tly placed 

trainees are thus earning minimum $325,000 per year, actually more, since some 

earn as high as $2.39. This compares with tota l less t han $90,000 current ann ual 

deficit now made up from public fund s and private donations. Our average 

employment in sheltered workshop of people who would otherwise be entirely 

unemployable public charges has also increased from average 25 to average 95 

for this same two successive periods.

Demand for our services is constantly increasing, and presently available 

funds, public and private, are grossly insufficient. We are turnin g people away 

who need us now, for insufficiency of diagnostic services, halfway-house fac ilities, and other resources tha t S. 3008 proposes.

Palm Beach County Association for Retarded Children, I nc. 

Irvin L. Langbein, Presiden t.

Montana State University, 

Agricultural Experiment Station,

Bozeman, Mont., A pril 29, 1966.

Dr. William H. Stewart,

Surgeon General, U.S. Public Hea lth Service, Department of Health, Education,

and Welfare, Washington, D.C.

Dear Dr. Stewart : At the request of Dr. John S. Anderson, State Health Officer 

of Montana, I have prepared the enclosed statement (attachm ent A) in regard 

to the cost of space. I will introduce myself only by saying I have studied and 

written extensively on the social and economic cost of space, most partic ula rly in 

the Great Plains.

The formula prepared by Dr. Anderson and sent to you on April 6, 1966 is a 

good one, particularly for allocation of money within the states. It certainly 

indicates the problem very well. It is my conviction, however, th at since there 

is such a low population density in the Western States as a whole, with the exception of California and Hawaii, a more equitable form ula will need to include the 

sparsity of the whole of the states. The fede ral law should also provide similarly for allocation within all the states to meet the problem more specifically 

described by Dr. Anderson, i.e. specifically more money to the are as with lesse r 

population, particu larly those under 50,000 population.

I most sincerely supp ort H.R. 13197 and S. 3008 in principle, but w itho ut some 

real weight given for the space factor, it will only inten sify the problem for th e 

more sparsely populated state s. While the average population density of the 

United States was 50.5 persons per square mile in 1960, this figure will rise in 

the futu re, and will need to be changed or will change the number and identity 

of the states involved in the sparsity category. The Great Plains and Rocky 

Mountain states will probably never be removed from the spa rsity category 

since gains will occur only in small amounts and only in the already existing 

larger towns and cities. The problem for these sparsely populated states will 

become more acute in the fu tur e in comparison with the rest of the United States, 

and th e problems within the sta tes will become more intense.

Respectfully,

Carl F. Kraenzel, 

Professor of R ura l Sociology.

Attachment A

The Social Cost of Space as a Criterion in the Distribution of Federal

Grants,

1 by Carl F. Kraenzee, Professor of Rural Sociology, and Frances

H. Macdonald, Research Assistant, Montana State University, Bozeman,

Mont.

Federal gra nts and aid programs have now been generally accepted as a way 

of equalizing certain basic services to people the natio n over. They are so 

extensive that distortions in the formula are likely to produce burdensome inequities that were intended to be corrected. Specifically, gra nts based on population and per capita gross income, such as the Public Health grants, discriminate

1

 P re par ed fo r pre se nta ti on to th e Su rgeo n Gen er al of th e U.S . Pub lic H en Ph Service , 

an d Dr. Jo hn An derso n, Exe cu tiv e Officer. M on ta na S ta te B oa rd of H ea lth, an d fo r Sen at ors 

an d Co ng ressmen fo r th e Up pe r G re at P la in s S ta te s re la tive to S. 300 8 an d H.R. 131 97; 

an d fo r a gra duat e st udent an d fa cu lt y se m in ar in A gri cu lt ura l Ec on om ics an d R ur al 

Sociology. Apr il 28, 1966 .
100 PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66

again st th e sp ar se ly se ttle d st ate s, chiefly in th e West. Thi s paper is in te nd ed 

to re port on th e social co st of sp ac e in th e less po pu la te d st ate s fo r wh ich ad ­

ju st m ents m ust he m ad e if th e pr in ci pl e of eq ui ty is to be fu lly ap pr ox im at ed . 

Th e so cial co st of spac e is so ex te ns iv e an d pe rv ad in g th a t it m us t be in clud ed 

as th e th ir d cr iter io n in th e fo rm ula fo r dis tr ib uti on of aid .

TH E ECONOMIC COST OF SPACE

I t is no t difficult to dem onst ra te th a t th ere is an econom ic co st of space, bo rn e 

an d pa id di re ct ly by th e in div id ual citiz en . The av er ag e M on tana n tr av el s 

pe rh ap s te n tim es fa rt h e r th an th e av er ag e Io w an an d per hap s fifty tim es 

fa rth e r th an th e av er ag e Ne w Y or ke r fo r goods an d service s, as in di ca te d in 

th e fo llo wing tab le.

Thi s is ba se d on th e as su m pt io n th a t th e re si de nts of ea ch are a mak e ab out 

an eq ua l nu m be r of t ri ps fo r ea ch ty pe of serv ice an d fo r si m ilar ty pe o f ser vic es. 

He nce, th e M on ta na n pa ys mor e in ou t-o f-p oc ke t ex pe ns e da ily an d yea rly ju s t 

fo r t ra ve l.

State

Are a

(square

miles)

Po pu latio n

(1960) Den sit y

Square

mile s

per

thou sand

pers ons

M on ta na ____________________________ ______ 147,138 674, 757 4. 6 218

Iow a ________________ __ _ _ _ ____ 56,290 2,757,537 49.0 20

New Y or k____________ . _____________ ____ 49, 576 16; 782,' 304 338.5 3

B ut even th is fig ure fa vors th e Io w an and th e New Yo rker. W he n face d w ith 

gre at di st an ce s an d w eat her ha za rd s, th e ri sk of g et ting th ere a nd b ac k is gre ate r 

th an wh en di st an ce s are sh ort er . I t is, th er ef or e, ne ce ss ar y to ha ve pri vat e 

stan d- by tran si>o rta tio n— tw o or mor e m ot or ve hicles ra th e r th an one, fo r ex ­

am ple ; w ith al l th e att en d an t in ve stm en t, fin an cing an d in su ra nce co st fo r th e 

se ve ra l vehic les . So metim es th is ex pr es se s it se lf as in ve st m en t an d up ke ep c osts 

fo r tw o home s, or offices, or sch oo ls ra th e r th an one. F or ex am ple, fo r man y 

fa rm ers an d ra nchers th is m ay mea n one ru ra l home an d on e town home nea r 

school, do ctor an d re cr ea tion serv ices. At. oth er tim es th is may ex pr es s itse lf 

as ad ditio nal co sts att en d an t on se nd in g ch ildr en to bo ar di ng plac es when in 

school.

I t is cle ar, then , th a t dis ta nce re pre se nts a gre ate r ou tlay of ex pe nditur es pe r 

unit of ser vic e. B ut th is is on ly on e sid e of th e co in—th e ex pe nditur e side fo r 

in di vi dua ls in te rm s of p ri vate an d pu blic ou tla y. Pe op le in re m ot e places also 

te nd to ha ve les s incom e—dis ta nce re su lt s in les s incom e. The pr ic e of w hea t 

or catt le te nds to be th a t es ta blish ed in th e ce ntr al m ark et plac es —Minne ap olis, 

St. Pau l, Buffalo, Ch ica go, Omah a an d St. Lo uis , fo r ex am ple. The re fo re , th e 

fa rm ers n ear thes e m ark ets ge t mor e incom e per u n it of pro du ct th an th e Monta n an s fo r th eir bu sh el of w hea t or po un d of b eef.* 2 3* The d iff er en ce is th e a m ou nt 

of th e fr eig ht no t only as a ra te pe r mi le (o ften lo wer whe n near th e m ar ket ) 

hut also as a to ta l bill. At th e sa m e tim e th e fa rm ers n ear M inne ap olis i«iy 

les s fo r th eir tr ac to rs , th eir fu el, th eir cars an d truck s, th eir fee d, an d mos t of 

th e oth er cost- of-living ite m s th a t ente r th eir op er at io n an d liv in g co st bu dg et. 

The oil field an d mi ne w or ke rs, th e fo re st w or ke rs an d oth er la bo re rs, an d th e 

bu sine ssmen and pr of es sion al w or ker s a re si m ilar ly dis ad van ta ged co mpa red 

w ith th eir fello w e arn ers in th e d en se ly p op ul at ed are as .

The re fo re , th e eco nomics of th e nat io n dis cr im in at es ag ain st th e re si den ts 

wh o liv e in d is ta n t an d re m ote p la ce s8

 on tw o co un ts at le a s t: (1 ) th ey pa y mo re 

to ge t th e se rv ic e; an d (2) th ey ha ve les s ne t inc om e to bu y th e service s. Th ey 

ha ve on ly one te m pora ry de fens e, eco nomic an d m an ag em en t w is e: th a t is to 

en la rg e th eir volum e of bu sine ss oi> eration s. By do ing th is they in te ns ify th e

3

 Se e Cor le y, Jo se p h R., C hangin g P a tte r n s o f Gra in T ra n sp o rta ti o n in M onta na, M a ste r’s 

D eg re e T hesi s, M o n ta n a S ta te U n iv e rs it y , B oze m an , M onta na. Ju n e, 19 64 , p. 16. Also see 

T ro ck , W arr e n L.. C a tt le F eedin g in th e N o rth e rn G re at P la in s, PhD . T hesi s, M o n ta n a

S ta te U n iv e rs it y L ib ra ry , B oze m an , M onta na, M ar ch , 19 63 , p. I l l ff. In so m e in sta n ce s 

fo r w h e a t an d c a tt le , p e r m ile ra te s a re h ig h e r fo r lo nger th a n fo r s h o rte r d is ta n ce s.

3

 F o r an a n aly sis of th e ec ono m ic a sp e c t of th e co st of sp ac e see K el so . M auri ce M..

“ C ost s of Spac e in th e W est” , in L a n d and W a te r Use, edit ed by W ay ne T horn e. AA AS

p u b li c a ti o n No . 73, W ashin gto n, D.C ., 19 63 .
PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66 101

ve ry dif ficult y th ey su ffer fro m— th ey c re ate m ore dis ta nce be tw ee n them se lv es a s 

ne ighb ors, em ploy ers an d emplo yees, bu ye rs an d selle rs, cl ie nts an d pr of es sion al 

men.

T H E SO CI AL COST OE SP AC E

Th e ab ov e dilemma has re su lted in one oth er w ay of coping w ith prob lems in 

th e sp ar se ly po pu late d are a—a so lu tio n no t ge ne ra lly ad ver tise d an d difficult to 

pro ve. Pe op le in th e sp ar se ly po pu late d are as ha ve rec eive d fe w er service s, 

ha ve a cc ep ted po or er q ual it y of service s, or ha ve h ad serv ices o nly in te rm it te ntl y, 

or ha ve h ad a co mbi na tio n of th es e de fic its ?

It is difficult to m ea su re quanti ty a nd quali ty di ff er en tial s fo r se rv ices betw ee n 

are as an d th e st at em en ts abov e st and larg el y un su pp or te d, ex ce pt by inferenc es. 

Th e w ri te rs know of li tt le re se ar ch th a t has m ea su re d th es e di ff er en tial s. 4 5 B ut 

a re fe re nc e to in fo rm at io n fo r M on tana will be off ered. The mo st re ce nt re port 

of th e Fac ilitie s an d Pla nn in g Divisi on of th e M on tana S ta te Boa rd of H ea lth 

has ju st been re leas ed . In re co gn iti on of th e in troduc tion of th e m ed ic ar e pr ogr am th is comi ng Ju ly , a stiffe r se t of st an d ard s of in sp ec tio n fo r hosp ital s an d 

nu rs in g home s has been ap plied, co mpa re d to th e st an d ard s em ploy ed as 

re ce nt ly as tw o year s ago. As a re su lt of ap pl yi ng th es e st iffe r an d mor e uniform st andard s, th e nu m be r of su itab le or ac ce pt ab le be ds in hosp ital s has 

bee n de cr ea se d from 84.6 pe rc en t of th e to ta l in 1963 to 35.8 per ce nt of th e to ta l 

in 1965. F or nu rs in g home s th e nu m be r of su itab le be ds de cr ea se d from 85.6 

pe rc en t of th e to ta l in 1963 to 77.9 pe rc en t of th e to ta l in 1965. T his lo wer 

de cr ea se fo r nu rs in g home s is ex pl ai ne d by an in cr ea se in new fa cil it ie s al m os t 

en tire ly . It sh ou ld be no ted th a t th e M on tana be d- po pu latio n ra ti os fo r bo th 

th e ho sp ital s an d th e nu rs in g ho me s are re la tivel y low by national st andard s, 

espe cially whe n co ns id er ing ac ce pt ab le beds. One mig ht ex pe ct a hi gher bed 

ra ti o in a sp ar se ly po pu late d are a be ca us e of hi gh er oc cu pa nc y ra ti os th a t 

att ends di st an ce an d sp ar si ty , a fa ct th at is a m ea su re o f th e social co st of spa ce. 

Th e f ollowing ta bl e g ives spe cific in fo rm at io n.

4

 F or a mo re de ta iled st ate m ent of th is soc ial co st as pe ct see Kraen ze l, Car l F., “A 

Direc t M ea sure of th e So cia l Co st of Sp ac e” , Pro ce ed inys of th e M on ta na Aca de my of

Scienc e, 14 : 82 -8 9, 1964 ; also “P il la rs of Se rv ice fo r th e Em er gi ng Co mmun ity of the 

P la in s” , Jo urn al of H ea lth an d H um an Beh av io r, Su mmer, Fal l, 196 4, Vol. 5, pp. 67—74.

5

 T he U.S . Pub lic H ea lth Se rvice itse lf ha s reco gn ize d th e ab se nc e of fu ll tim e pu blic 

hea lt h se rvices in sp ar se ly po pu la te d region s. To ge t at th is pro blem th e Se rv ice itse lf 

und er to ok a st udy to ge t a t th is problem . Th e re su lt s we re re po rted in T he H e a lt h S tu d y

of K it Ca rso n Cou nty, Colorado , U.S . D ep ar tm en t of H ea lth, Edu ca tion , an d W elfare, Pub ­

lic H ea lth Servi ce, Di visio n of Co mmun ity H ea lth Service s, Pub lica tion No. 844, 1962.
T a ble 1.— H osp ital and n urs in g ho me beds clas sifie d by total, 19 63 and 1965; accep tab le and no na cc ep table beds, and diffe re nc es between 19 63

and 19 65 ; and po pu la tion -b ed ra tio s fo r M onta na

[I—accep tab le beds; II—no na cceptab le bed s; III—tota l beds]

Beds Difference i n bed s Pe rcen t of—

1953 1965 Num be r Pe rcen t Ac cep tab le No nacceptab le

I II II I I II II I I II II I I II II I 1963 1965 1963 1965

Ho spita l bed s . ___________________ n^ot.al popij 1 at ion 2,830 517 3,347 701,000 

4.77

1,165 2,088 3,253 

739, 000

4. 4

-1 ,6 65 1, 571 -9 4 -4 1.2 403.9 -9 .7 84.6 35.8 15.4 64.2

Ratio 1 4 03 0 74 1. 58 2.83Nu rsing home be ds .. . . . . ___ . . 1,661 280 1,941 63,511 

3.06

2,045 580 2,625 384 380 684 123.1 207.1 135.2 85.6 77.9 14.4 22.1

P o p u la t io n B.S a n d o y p r 67, 018 

3.92 Ratio 1 2.62 0. 44 3.05 0.87

1 N um be r of be ds p er 1,000 to ta l po pu latio n in th e case of th e hosp ita ls an d an d pe r 1,000 aged (6.5 a nd over) in th e case of nu rsing hom es.

102 PUBLIC HEA LTH SERVICES AMENDMENTS OF 19 66

A
PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66 103

The re is no do ub t th a t alm os t all, if no t all, of th is di ff er en tial be tw ee n 1963 

an d 1965 is to be ex pl ai ne d by th e to le ra nc e of po or qual it y fa ci lities as mu ch 

as only tw o years ag o—th e po or er qual ity ac ce pt ed as th e re su lt of th e social 

co st of spa ce. Th e di ff er en tial is one im port ant m ea su re of th e social co st of 

space."

By do ing w itho ut or by ac ce pt ing lower qual it y service s, in clud ing th e po stpo ning of service s, man y people ha ve lowered th eir pote nt ia l fo r re tr ain in g an d 

job re hab ilitat io n, th eir ex pe rie nc e level, th e ir he al th level, an d th eir ge ne ra l 

adapta tion lev el whe n face d w ith ch an ge . Pre ve nt io n has been neg le cte d; an d 

cu re s or tr eatm ent are difficu lt to effect. The se as pe ct s ne ce ss ar ily are th e tr ue 

social co sts th a t fol low from th e fa ct of space— def er re d service s, co sts pa id 

by th e ta xpayer ra th er th an by th e in di vi du al , co sts re su ltin g in di m in ut io n of 

pr odu ct iv ity an d eco nomic and social eff ectiv eness, co sts m ea su re d in hu m an 

pa in an d suffe rin g.

Ofte n, fo r al l th es e reas on s, th er e has be en ou t-m ig ra tion of po pu latio n, a 

fa cto r co ntr ib uting to an in te ns ific at io n of th e prob lem of th e social co st of 

spa ce. Ev en ag ed adult s who had pl an ne d to mak e th e are a th eir home fo r th eir 

la st da ys r eso rt to m ig ra tio n.

SO ME PA RTI AL W AYS OF CO PIN G W IT H T H E SO CIAL COST OF SP AC E

In ad di tion to ou t-m ig ra tion an d th e lo wer in g of th e level of se rv ices or th e ir 

nu m be r an d type , th er e are som e adju st m ents of a ne ce ss ar ily te m po ra ry n atu re 

th a t ha ve com e in to be ing to cope w ith th e social cost of spa ce. Th ese, howe ver, 

ha ve lim its an d may ev en pe na liz e th e princ ip le of eq ua l serv ice ev en tually.

One ex am pl e has to do w ith high way s. The na tion is bu ild in g an ex tens iv e 

in te rs ta te hi gh way sy stem w ith 90 pe rc en t fe der al fin ancin g. Th e th ir te en 

w es te rn Sta te s, in cl ud ing H aw ai i an d A lask a, are k no wn as p ub lic do main St at es . 

Sp ar se ly po pu lated, it is an ac ci de nt al fa ct th a t th eir po rtio ns of fe der al ai d 

a re in cr ea se d beyo nd th e 90 pe rc en t spec ifica tio n by an am ou nt th a t re pre se nts 

th e pu blic do main inv olve men t. F or M on tana th e curr ent co st ra ti o is reix irt ed 

to be 91.27 pe rc en t fo r th e fe de ra l sh are an d 8.79 pe rc en t fo r th e Sta te . For 

A lask a th e ra ti os are re po rt ed a s 94.91 pe rc en t an d 5.09 p e rc e n t: an d fo r Nev ad a, 

95.0 pe rc en t an d 5.0 pe rc en t. * 7 Th e fo rm ul a fo r th e ABC ro ad sy stem allo ws a 

gre ate r fe der al match ing, m ea su re d by th e pro xi m ity an d ac ce ss to pu blic 

do main.

H er e th en is an ex am pl e of an ac ci de nt al adju st m ent fo r sp ars it y by vir tu e 

of pu blic do ma in. Th is, ho we ver, ap pl ie s to co ns truc tion only. F or m ai nte ­

na nc e of th e g re ate r ro ad mile ag e in th e sp ar se ly po pu la te d are a, th ere is no 

su ch rec og ni tio n of sp ac e c ost s.

The B ur ea u of Pub lic Roa ds is. ho we ver, an “Angel of Good Tid in gs” in th is 

re sp ec t co mpa red w ith th e ICC an d th e FAC. A look a t th e a ir tr ip co sts show s 

how th e sm all ai rl in es in the Yon lan d are as 8 m us t ch ar ge first clas s fa re s to 

su rv ive, while th e line s clo ser to cities wh ich also ha ve in te r-ci ty traffic, w ith 

high volum e, ha ve “econo my ” ru ns . ICC has se t a lon g his to ry fo r a su bs idy 

to th e cities in th is resp ec t, ba sed on such qu es tion ab le his to ri ca l ra tionali zati on 

as develop ed by Von Tliiinen an d Alfr ed W eb er.8

l ’rogr es s in curt ail in g th e bu rd en of th e social co st of sp ac e ca n come ab ou t 

in sp ar se ly po pu late d st ate s by lim itin g se ttle m en t an d co nseq ue ntly, comm un ity an d social serv ices, to cert ain are as only. In th e ari d w es te rn st ate s 

th is is ea si er to accompli sh. Po pu lation , incl ud in g ru ra l, is confi ned to ir ri gate d 

oa ses only. Man ca nn ot su rv iv e in th e non- ir ri gat ed ar ea s. R ura l an d urb an

8

 See M on ta na Sta te Pl an s fo r H osp ital an d Med ical Fa cilit ies Con stru ction fo r 1964

(19 63 d ata ) an d 1966 (196 5 dat a) pu blishe d by th e Di visio n of H osp ital Fac ilitie s, Mo nta n a Sta te B oa rd of H ea lth, Hele na , M on tana .

7

 R ep or ted to th e w ri te rs by wa y of te leph on e from th e S ta te Hig hw ay Office, He lena , 

M on tana . Th e ABC sy stem has referenc e to pr im ar y an d se co nd ary road s.

8

 By Yo nlan d th e w ri te r ha s re fe renc e to th e sm all to w ns an d sp ar se ly po pu la te d ar ea s 

ou t aw ay fro m th e se ttle d ar ea s of th e Pla in s. Th e Sutlan d ar ea s ar e th e more he av ily 

se ttl ed , st ri nglike re ta il an d wh oles ale are as in th e P la in s. Th es e so metim es ar e th e 

ir ri gate d ar ea s too an d ha ve r ea dy a cc es s to c om m un icatio n fa ci lities .

9

 The se th eo ri es ho ld th a t fo r reas on of ge og raph y, hi stor y, ac ci de nt or ot he r, po pu la ­

tion s beg in to co nce nt ra te in w hat become citie s. Lan d va lues , re nts an d pr ic es go up 

an d as si st th e de ve lopm en t an d offer ad va nta ges . Fro m th es e ce nt er s tr an sp o rt ati o n ex ­

pa nd s ou tw ar d, an d becom es mo re co stly. The re fo re , la nd va lu es go down as di stan ce 

incr ea se s, co sts go up, net inc om e goe s down . Th ese fa cts ex plain th e lo ca tio n an d gr ow th 

of in dust ry in lim ite d ar ea s. Th ese ar e ra ti onalizati ons per ha ps as much as ex pl an at io ns 

a t first, an d la te r ma y be ra tional iz at io ns chiefly .
104 PU BLI C H E A L T H SE RV IC ES AM EN DM ENTS OF 1 9 6 6

peo ple liv e re la tive ly close to ge th er . Th e socia l cost of spac e is lim ite d, in par t, 

fo rt unate ly by th e fa ct of ar id it y. How ev er, th e oa ses may he sm all an d ma y 

need to be knit te d to ge th er into a serv ice ar ea of ad eq ua te size.

B ut in th e sp ar se ly po pu lated se m i-a rid G re at Pla in s an d ot he r semi-a rid 

is la nd s of th e na tion , ru ra l fa rm an d ra nc h an d villa ge po pu lation s a re s ca tter ed 

al l ov er th e land , in th e fa sh io n si m ilar to th at of hu mid Am eri ca. Se rvice s 

ha ve been si m ilar ly disp erse d al l ov er th e land , w ith th e co nsequences de scrib ed 

by th e socia l co st of s pace. Ther e is gra dual ly em erging a he av ie r co nc en tratio n 

of th is po pu latio n in w hat is ca lle d Sutlan d ar ea s. But be ca us e of lack of 

zonin g, it wi ll ta ke a long tim e fo r th e Sut la nd to ac qu ire th e de gree of concentr at io n ty pi ca l of t he o ases in th e ari d region s. Nev ertheless, th is a dju st m ent 

is being recogn ize d as a ne ce ss ar y ad ap ta tion an d is bec om ing mo re pr ev al en t. 

As th e level of liv ing ris es, th e pre ss ur e fo r th is ki nd of ad ap ta tion will become 

gr ea te r.

Ther e is a th ir d kind of a dapta tion th a t is em erging . Thi s is th e po ss ibili ty of 

co or di na tion an d in te gra tion of se rv ices am on g se ve ra l ca ses an d be tw ee n Sutla nd an d Yo nlan d ar ea s. By st re ss in g fle xibilit y an d mob ili ty of se rv ices an d 

pr og ra ms, ra th e r th an self-sufficie ncy , an enti re are a can be or ga ni ze d into a spe ­

cial serv ice dis tr ic t an d ca n hav e mor e effecti ve serv ice s th an is now th e cas e. 

B ut t his r eq ui re s a hi gh er a nd mor e so ph istica te d de gr ee o f co op eration th an now 

pr ev ai ls in th e reg ion. Cos ts wo uld un do ub tedl y be hi gh er th an now , in man y 

in sta n ces; bu t serv ices wou ld be mor e ad eq ua te . Th e ta sk is to develop th e 

sp ec ial lo ya ltie s th a t m us t go w ith su pp ort in g th is kind of pr og ra m ra th er th an 

de stro yi ng th e co mmun ity by sh op ping ar ou nd . The re ar e isol at ed ex am ples 

of th is ki nd of de ve lop ment. Thi s re pre se nts a kind of co ns ol idation no t of ten 

pr ac tice d— one th a t en co ur ag es loc al su rv iv al of man y serv ices hu t ba ck -stopp ing 

by sp ec ia lists fro m la rg er plac es. It wo uld mea n th e ha nd -in -glove co op eration 

of th e gen er al is t a nd th e sp ec ia list.10

TH E NEED FOR INC LUD ING TH E SOCIAL COST OF SPACE IN TH E ALLOCATION FORMULA FOR 

FEDERAL AID

Fr om th e ev iden ce above it wo uld ap pea r th a t (1) in ad ditio n to gros s po pu latio n. (2) ad ju st ed fo r per ca pi ta inc om e re la ti ve to th e nat io nal av erag e, a th ir d 

cri te ri on in th e fo rm ul a sh ou ld be (3 ) an allo wan ce fo r th e socia l co st of spa ce. 

It is su gg es ted th a t H.R. 13197 and S. 3008 in clud e th is c rite ri on in th eir fo rm ul a 

fo r fin an cin g th e p ub lic h ea lth serv ices an d pro gr am s envis ion ed.

The on ly as pe ct su bj ec t to deb at e is th e specific am ou nt s to he all ow ed in th e 

fo rm ul a fo r th e soc ial co st of spa ce. In th e ab senc e of specific re se ar ch dat a at 

th is tim e, it i s prop osed, th a t th is b e a 100 per ce nt in cr ea se , w ithout m at ch in g re ­

qui re m en t fo r th e mo st sp ar se st ate s of th e na tion . Per hap s on ly yea rs of ex ­

pe rien ce w ill f err et ou t t he spe cific d eta il s f o r th e fo rm ul a am ou nt s. A dj us tm en ts 

w ill un do ub tedl y be re qu ired as tim e pr og re sses , as im prov em en ts ar e mad e an d 

as n ati onal policy g oa ls req ui re.

T he re fo re it is rec om me nd ed th a t all of lin es 18 th ro ug h 22 of p art B of page 

12 in H.R. 13197 be de leted an d th e follo wing be su b sti tu te d : “p er ca pi ta incom e 

of th e United S ta te s; e xc ep t th a t an ad ditio nal 100 pe r ce ntum of the to ta l th us 

co mpu ted sh al l be ad de d to al l st ate s wh ose po pu latio n de ns ity is les s th an fi ve; 

an ad ditio nal 80 pe r ce ntum o f th e t ota l th us co mp uted sh all be ad de d to all st at es 

wh ose po pu la tion de ns ity ra ng es from five to te n ; an ad ditio nal 60 pe r ce ntum of 

th e to ta l th us co mpu ted sh al l he ad de d to al l st ate s wh ose po pu latio n de ns ity 

ra ng es f ro m 10 to 37 ; an d an ad ditio nal 40 pe r ce ntum of th e to ta l th us compu ted 

sh al l be ad de d to all st ate s wh ose po pu latio n de ns ity ra ng es fro m 37 to 50.5 (the 

la tt e r be ing the nat io nal av er ag e in 1960) ; an d ex cept th at a lik e 100 pe r ce ntum 

sh al l be ad de d to th e sh are fo r th e Com mon we alth of Puer to Rico, Gu am , American Sa mo a, an d th e Virg in Is la n d s; an d ex ce pt th a t no ne of th is ad di tion of 

100 th ro ugh 40 pe r ce ntum sh al l re quir e m at ch in g by th e re sp ec tive st at es , an d 

on ly th e ori gi na l am ou nt s go ve rned by th e pe r ca pita an d incom e cri te ri a sh al l 

re quir e m at ch in g; an d ex ce pt th a t ev ery st ate sh al l itse lf dis tr ib ute th es e g ra n t 

fu nd s w ithin it s own st ate ac co rd in g to a fo rm ul a th at allo ws fo r th e socia l cost 

of space, us in g it s own de ns ity as th e ce ntr al cri te ri a fo r a diffe re nt ia l in a man ­

ner si m il ar to th e fe der al fu nd s her e al lo ca te d.”

10 T he se ni or w ri te r ha s em ph as ized th is in “P il la rs of Se rvice fo r th e Emerging Com ­

m unity of th e P la in s” , ibid .
PU BLI C H EA LTH SE RV IC ES AM EN DM ENTS OF 1 9 6 6 105

By way of ex pl an at io n it sh ou ld be st at ed th at, us in g 1960 de ns ity data , th is 

allo wan ce fo r th e social cost of sp ac e wo uld do th e fol low ing , na mely in cr ea se 

th e al lo w an ce : (1 ) by 100 pe rc en t fo r A lask a, Nev ad a. Wyo mi ng a nd M on tana ;

(2 ) by SO pe rc en t fo r New Mexico , Id ah o, So ut h D ak ot a an d N or th D ako ta ; (3 ) by 00 pe rc en t fo r U tah. Ariz on a, Co lorado , N eb ra sk a, Orego n, K an sa s, 

Oklah om a, Tex as , A rk an sa s, an d M ai ne ; (4 ) by 40 pe rc en t fo r W as hi ng ton, Minne so ta, Ve rm on t, Miss iss ippi, an d 

Io w a ; (5 ) by 100 p er ce nt fo r Puert o R ico, Gu am , American Sa moa an d the Virg in 

Is la nd s. Thi s same ki nd of socia l co st of sp ac e cr it eri on s ho ul d be in st it ute d fo r fe der al gra nt pr og ra m s in oth er are as su ch as el em en ta ry ed uc ation, ex pe rim en t st at io n 

su pp or t in ag ri cu lture , adult ed uc at io n effo rts , pu blic w el fa re an d s oc ial se cu rity 

pr og ra m s ge ne ra lly , an d fo r la bo r an d sm all bu sine ss pr og ra ms. The re is us ua lly an att em pt to co un te r th e ar gum en t of th e socia l co st of 

sp ac e w ith one po in ting up th e social cost of de ns ity , an d th us ar gue in fa vo r 

of th e st atu s quo . The auth ors ad m it th a t th ere is a co st of de ns ity, but th e la tt er ar gum en t ca n an d shou ld no t be us ed to re gat e or de stro y th e fo rm er. 

It is on ly ne ce ss ar y to po int ou t th a t people in a de nsely po pu late d plac e 

re pr es en t a gr ea t volum e, an d a sm all pa ym en t by ea ch pe rson pr od uc es a co ns id er ab le income. "S ta nd in g on th e corn er ” in a ci ty an d w at ch in g th e 

tra ffi c en te r a co vered par ki ng ar ea , an air port , or alm os t an y bu sine ss de mon ­ st ra te s th is fa ct . In th e sp ar se ly po pu late d are as th er e is no t th e vo lume of 

bu sin ess. Al mo st an y ch ar ge is too hi gh ex ce pt fo r th e bar e es se nt ia ls. S ta nd­ ing alon g a high w ay in Wyo mi ng or M on ta na an d at te m pti ng to hi tc h a rid e 

is a m ea su re of t his fac t. It shou ld be no ted th a t th e su gg ested fo rm ul a im po ses no pen al ty on de ns ity 

th at is prog essiv ely g re ate r th an th e national av er ag e by dec re as in g the fe der al 

aid below th e or ig in al allo ca tio n fo r pop ul at io n an d pe r capit a Income. It is conc lude d th a t th ere is no th in g in th e American tr adit io n th a t shou ld pe na liz e 

sp ar si ty . It wo uld ap pe ar to be in th e nat io nal in te re st to includ e th e socia l 

co st of spac e as th e th ir d dimen sio n in a fo rm ul a fo r fe der al aid .

Nati onal Ca th olic W el fa re Conf er en ce,

Washington, D.C., October 11, 1966.

II on. H arley O. Staggers,

Chairman, Committee on Inters tate and Foreign Commerce,

House of Representatives,

Washington. D.C.

Dear Mil Ch a ir m a n: As official spok esman fo r th e ge ne ra l body of Bishop s 

of the Ro man Catho lic Chu rch, sp ea ki ng th ro ugh th e N at io na l Catho lic W el fa re 

Co nfere nce, I wish to mak e se ve ra l ob se rv at io ns co nc erning legi slat io n cu rr en tly 

pe nd ing be fore y our Co mm ittee. It is my under st an din g th a t you r di stin gui sh ed Co mmitt ee is now co ns id ering 

II R 1S231 an d S. 3008, wh ich pr ov id e fo r th e ex tens ion an d im prov em en t of co mpr eh en sive hea lth pl an ni ng an d pu blic hea lt h service s. The bill re fe rr ed 

to yo ur Com mittee by th e Sen at e (S. 300 8) has dis tu rb in g legi slat iv e hi st or y, 

in di ca ting th at th e prop os ed legi slatio n ma y also be in tend ed to au th ori ze 

Fed er al fu nd s to pr om ot e la ng ua ge a uth ori zi ng such pr og rams. On pa ge 11 of th e Se na te Rep or t on S. 3008, th e follo wing la ng ua ge appears : “T he prop osed auth ori ty wo uld pe rm it pr oj ec t g ra nts fo r pr og ra m su pp or t, 

pr og ra m deve lopm en t an d de m onst ra tion pu rp os es fo r th es e ki nd s of ta rg et s, 

an d fo r ot her are as su ch as den ta l he al th , urb an hea lth, na rc ot ic s an d dru g 

ad dict ion, ru ra l hea lth service s, fa m ily pl an ni ng , an d alco ho lis m.” A dd iti on ally , a colloquy on th e Sen at e floor betw een Sen at or Tyd in gs of 

M ar yl an d an d Sen at or Hill of Alaba m a cl ea rly de m on st ra te s th at th is m ea su re 

is in te nd ed to be used as a mea ns of fin an cing fa m ily plan ni ng . (C on gr es sion al 

Re co rd. Oc tob er 3,1 96 6. pa ge 23789) N ei th er bi ll co nta in s la ng ua ge auth ori zi ng th e use of Fed er al fu nds fo r 

fa m ily plan ni ng . Our co ncern is th a t it may be am en de d or oth er w is e in ­

te rp re te d in th e Rejio rt of th e Co mmitt ee in such a way as to ap pr ov e F ed er al 

fu nd in g of bir th lim itat io n.
106 PUBLIC HEA LTH SERVICES AMENDMENTS OF 19 66

While there are grave moral considerations prompting our protest, there also 

are policy and legal arguments against government involvement in birth control 

programs beyond mere research. These are rele vant to the provisions of 

IIR 18321.

On an ear lier occasion, William B. Ball. Esquire, General Counsel to the 

Pennsylvania Catholic Conference, appeared before a Subcommittee of the 

Senate to urge rejection of other proposed legislation of sim ilar pur port to the 

immediate provision of concern to us. Mr. Ball’s sta tem ent had the approbation 

of the National Catholic Welfare Conference. In it the constitution al permissibility of the use of tax revenues for birth control programs was challenged 

because of the inevitability of interference with cherished personal liberties 

and unavoidable coercion of conscience in administration. The whole state ment 

is directly rela ted to our present concern. So th at your Committee may have 

before it for consideration in its cu rre nt deliberations the position of the National 

Catholic Welfare Conference on this issue. I am atta ching a copy of that sta tement (attachment A) althou gh it was drafted as comment on another bill.

The issue assumes additional gravity when it is considered in light of the 

provisions of S. 3008 authorizing th e establishment of a “National H ealth Policy” 

to be determ ined by the Surgeon General. The Catholic Bishops of the United 

States have previously taken a firm position aga inst th e inclusion of governmentsponsored birth control programs as an inte gral part of our national health policy. 

This position requires additional emphasis when broad autho rity is delegated to 

the Surgeon General to determ ine health goals including family limitation.

The implications of this question are too complex and far-reaching to handle 

in the indirect manner of the Senate approach or in a one-day hearing before a 

congressional committee. Exten ded hearings on a specifically defined and na rrowly limited legislative program should be an essential condition to any 

legislation involving the use of Federal funds for family planning.

Accordingly, I respectfully request that your Committee reject the implication 

that the bills before it may be utilized as a means of making birth control an 

inte gral part of health planning programs which, according to the language of 

the legislative proposals is designed primarily to promote better utilization of 

our health-caring agencies.

Respectfully submitted.

Most Rev. P aul S. T a n n er, D.D.,

General Secretary.

(Attachm ent A)

I ss ue d by t h e P re ss D epa rtm en t, Nati ona l Cath oli c W el fa re Con fe re nc e, 

W a sh in g to n, D.C., Augu st 24, 1965

[Following is a statement, on public policy and birth control presented 

August 24 by William B. Ball, general counsel of the Pennsylvania Catholic 

Welfare Committee, before the Subcommittee on Foreign Aid Expenditures of 

the Senate Government Operations Committee. Ball spoke on behalf of the 

PCWC and the National Catholic Welfare Conference.]

Gov er nm en t an d B ir th Control

I am William B. Ball, general counsel to the Pennsylvania Catholic Committee, 

an agency jointly created by the eight Roman Catholic dioceses of Pennsylvania. 

Let me express to you the committee’s appreciation at being permitted to present, 

through its attorney, testim ony respecting Senate Bill 1676 and the imp ortant 

public issues w’hich it brings into scope. I am authorized to say th at this 

statem ent has been reviewed by the National Catholic Welfare Conference and 

is submitted with its express approval.

It is said th at Senator Gruening. who introduced thi s bill, has been particularly interested in seeing that these public hearings advance the community 

diologue respecting the subject ma tter of S. 1676. We hea rtily agree with this 

laudable aim. and precisely for that reason we a re hopeful that many points of 

view will be brought to bea r upon the proposals made by this bill and the most 

varied and searching inqu iry be offered respecting the principles upon which the 

proposals are based.

My own commentary, upon beha lf of the Pennsylvania Catholic Committee, 

will be primarily from the viewpoint of constitutional law. And before coming 

to grips with some of the specifics of Senate Bill 1676 (as v eil as with testimony
PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66 107

already presented here interpreting it), I should like preliminarily to sketch the 

constitu tional scene upon which this bill arrives. Two feature s have marked the development of American law in our tim e: one, a development by the legislature in the broadening of social we lfare, the other, a development by the courts in the narrowing of the powers of government over individuals. While most of our people app laud each of these developments, some have alwa ys insisted th at the one must necessarily be at the expense of the other—th at is, that more social welfare must entail the shrinking of personal liberty, or th at the widening recognition of civil rights and individual liberties must necessarily be destructive of the welfare of the body politic. Yet, looking back upon three decades of acceleration in both of these develop­ ments’, we m ust judge these critics o f the American scene wrong. Social w elfare and individual liberty are flourishing in the I n ited States side by side. Big government and the individual seem to be getting along quite well together. Both 

are undoubtedly going to expand—government in its care for i>eople, individuals 

in the realization of civil freedom. And nothing is thre atened by this fact. Therefore, in presently raising questions about the things called “family planning” or “population control” or the various “programs” of which S. 1676 speaks, the Pennsylvania Catholic Committee and the National Catholic Welfare Conference in no wise question an expanding role for government in the care of people, the need vigorously to use public resources to promote health, to relieve poverty, to stim ulate learning and to help emerging n ations to a better economy 

and more stable order. Yet these things are not ends in themselves, to be achieved at any cost. As the NCWC and the PCWC are emphatic in pressing for the achieving of these things, they are equally emphatic in declaring that if they are sought without the finest sensitivity to personal liberty, they will have been achieved in vain, or not at all. At every moment must be kept in mind the inseparablenes s of social progress w’ith individual freedom. As Professor W alte r Gellhorn has st at ed : “Ind ividuals comprise the state . The state has no existence as an abstract entity, capable of demanding homage in its own right. It exists only as an amalgam of human beings, who are its blood, bones and sinew. The subo rdina­ tion of the individual and the exaltation of the sta te have always impressed Americans as obnoxious . . . Today, how-ever, too many administrators seek, and too often are given, powers that unduly obscure tradition al protections against 

expen dient invasions of individual righ ts.” 1

And therefore, as we contemplate the march to new horizons of mass better­ ment. we redouble our concern for the inte grity and individuality of persons, for the inviolability of the ir privacy, the freedom of the ir judgm ent, the libe rty of their conscience, the availab ility to them of untrammeled moral choice. The Supreme Court of the United States has long been engaged in setting up 

guideposts for the protecting of personal liberty, and especially in the past 30 

years which have witnessed greatly expanded roles for American government at all levels as well as critical intern al pressures, threatening the individual, w hich have been generated by a world in conflict. These guideposts are particularly rele vant to the ma tters w’e are discussing here today. They have pertained, in 

general, to

—freedom from governmental inquisition ;

—the related rig ht of privac y; —concern for the w’eaker members of society ;

—governmental coercion of mind and conscience. Governm ental inquisition. We willingly accept a great deal of information- taking by government today. The income tax return , pension forms, and Social Security applications are common examples of processes w’hich we recognize t ha t government must employ if it is to act responsibly and efficiently. At the same time, it may be hazarded th at a trend to set limits about governmental inquiry into the lives of indiv iduals is being sparked by recent Supreme Court decisions. Illumin atin g various provisions of the Bill of Rights, the cou rt has more narrowly defined what may be reasonable search and seizure,2

 more literally 

defined the self-incrim ination clause of the fifth amendment,3

 more tightly constricted the freedom of governmental bodies “to expose for the sak e of exp osure.” 4

1

 Ge llh orn. In di vid ual Fr eedo m an d G ov er nm en tal R est ra in ts . 46.

2

 Won g Su ng v. United Sta te s. 371 U.S . 471 (1 96 2) .

’ To wn se nd v. Sa in . 372 U.S . 293 (1 96 3) .

4

 P er W ar re n, C. J., in W atk in s v. United St ate s, 354 U.S . U.S. 178 (1 95 7) .
108 PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66

(and, impliedly, to inquire for the sake of inquiry). On the frontier of freedom 

from unreasonable governmental inqu iry lie those areas of governmental abuse 

recently described as helping render our society “nak ed” 5—not the least of these being the de facto non-confidentiality of tiles in which personal case histories of, 

for example, individuals on public assistance, are recorded.

The righ t of privacy. Closely rela ted to a freedom from governmental inquisition is the right of privacy so well elaborated by the Supreme Court in its 

recent decision in the Connecticut birth control case. Here the cou rt described 

the area of the marriage relationship as “lying within th e zone of privacy 

created by several constitutional gua rantees.” 6

 The particularly noteworthy opinion of Justice Goldl>erg, now Ambassador to the United Nations, decried 

the slightest experimentation in the area of the personal righ ts of citizens.7

Concern for the weaker memlterS of society. A th ird area of marked concern 

by the Supreme Court (and indeed in our decisional and statutory law tra ditionally) has been that, pertain ing to the weaker members of our society— 

children, mothers, the aged, for example. Most recently, this concern has been 

more emphatically extended to the criminally accused,8

 the alien,9

 the Negro,10

and the poor.11

Ksj>ecially with respect to the latte r two groups has our concern more and 

more become one tha t recognizes the ir human dignity, and less and less one that 

rega rds them jmternalis tica lly—fts wards to be fed in the name of peace and 

order. At the same time this concern recognizes the ease with which it is 

possible for the righ ts of the distressed members of society to be violated. Both 

the poor and the Negroes in our country—like the poor and the darker people 

in most parts of the world for the past two centuries—have been de facto 

“rightless.” that is to say, lacking in any power whatever to ass ert righ ts or 

realize liberties. And this, in our discussion, rela tes very direc tly to questions 

of governmental coercion.

Governmental coercion of mind and conscience. Of recent years our courts 

have tended ever more closely to examine relationships between government 

and individuals where questions of governmental compulsion might become 

material. Particu larly has this been so where the relationship involves matters 

pertaining to conscience, or to religion, or to lielief or outlook on life, to political 

creed, to familial relationships, to all th at we have long deemed “the personal”.

In its recent decisions on prayer and Bible reading in the public schools, the 

Supreme Court wrote into our constitutional law an extrem ely important body 

of doctrine upon the natur e of governmental coercion. In those cases these 

elements were present: (a) sponsorship by government of the prac tice in questio n; (b) these practices involving a ma tter in the area of the personal; (c) 

a weak member of society (the child) cast in a relationship with government 

(through the school) ; (d) a general attitude in the community favoring the 

practic es; (e) an exemption procedure available to the child upon the basis 

of conscientious objection. The Supreme Court, you will recall, found coercion 

to be inherent in the child-state relationship, even though the sta te’s role was 

almost wholly passive, even though the project was broadly considered good 

for children and needful for society, and even though the child could be exempt 

by claiming his privilege of non-participation.

To these four elements—pe rtaining to governmental inquiry, privacy, the weak 

members of society and coercion—must be added some other principles of 

constitutional protection with which the courts have historically restricted 

governmental action. For example, that if government may act at ail in m atters 

affecting liberty of mind and conscience, it must do so only within the confines 

of the most plainly stated stan dards. We do not, in the American system, 

provide government with blank checks where personal liberties are involved.

Again, there is the principle, well established in our law. that where government is to act in ma tters closely involved with personal liberty, the rationa l 

basis for its action must be firmly—not loosely—established. As Jus tice Goldberg stated this summer in Griswold v. Co nnecticut:

“In a long series of cases this court h as held that where fundamental personal 

liberties are Involved, they may not be ab ridged . . . simply on a showing that

8

 Packar d. The Naked Society.

8

 Griswold V. Con ne cticut ,------U .S .------- , 14 L. ed. 2d 510, 515 (19 65). • Id. at 522.

8

 V. Uni ted S tat ea, .377 U.S. 201 (1964) .

n

 B rown ell v. Tom We &hung. .352 U.S. 180 (1956). 10Bro wn v. Board of Educa tion, .349 U.S. 294 (19 55). 11 Gideon v. Wa inw rig ht, 372 U.S. .3.35 (19— ).
PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66 109

a regulato ry statu te lias some ratio nal relatio nship to the effectuation of a 

proper state purpose. ‘Where there is a signific ant encroachment upon per sonal 

liberty, the State may prevail only upon showing a subordinating interest which 

is compelling . . The law must he shown ‘necessary, and not merely rationa lly related , to the accomplishment of a permissible state polic y.’ ” 12

Hav ing thus stated some principles which have been developed in our constitutiona l law, let me turn particularly to S. 1676. In part, this bill calls for 

study and research respecting problems of population growth. Where such study 

and research can be conducted without intrusion by representatives of our 

nation ui>on the sensibilities and customs of other nation al communities, it is 

desirable that they be pursued.

Indeed, we have heard it said that that is all that S. 1676 is about and nothing 

more. We cannot, however, ignore the fac t that organized supporters of this 

bill, as well as several witnesses before this subcommittee, have described the bill 

as going well beyond study and research. In fac t, some comment upon the 

bill would lead one to believe that study and research are its lesser features. 

We think that lett er view of the bill correct and direct our comment to this 

reading of it.

Section 1( b) (1 ), for example, calls for such restru cturing of governmental 

organs as to enable the United State s “more effectively to deal with ’’ rapid 

population growth throughout the world. The subsection follo wing this would 

declare in the policy of the Congress tha t the Unite d Stat es should “a ssist” other 

nations, and groups and indiv idua ls in their efforts “to cope with problems 

aris ing out of rapid population growth.” Section 2(a ) (10) enjoins upon the 

Secretary of State the duty to make availabl e to recognized scientific and medical 

authoritie s in foreig n countrie s, upon request of the government thereo f, “a ssist ­

ance pertai ning to medical and othex- aspects of population growth problems.” 

The next e nsuing subsection contemplates programs of the United Stat es relating 

not only to population growth but to population “control.” Section 3(a ) makes 

it the duty of the Secretary of Hea lth, Educatio n, and Wel fare to review “h ealth 

and medical programs” of the department inso far as they relate to problems of 

population growth.

The repetition of the term “p opulatio n” throughout the text, the reference in 

the bill to population “control” coupled with an absence of -any indica tion of 

means other than population control as a solution to problems of imputation 

growth, and, finally, the proposed findings in Section 1( a) (3 ) that it is presumably the increase of population alone which causes hundreds of millio ns of 

parents to lie unable to provide for their fam ilies, leads us to the necessary 

conclusion that S. 1676 is, plain ly and simply, a bill for the establishing of a 

domestic and internatio nal birth control program and for the creat ing of 

permanent feder al governmental organs for the carryin g out of the same.

If we have been at some labor to prove this, it is no fau lt of the bill nor due 

any artific e of its sponsors in dra ftin g it, but only because there have been a 

few denials that it is any such bill. On the co nt ra ry : it is a completely frank 

and aboveboard proposal and its aim not at all a matter of doubt.

The term “birth contro l,” as witnesses before the subcommittee have noted, 

of course, refers prim arily to contraception. It also appears to have necessary 

reference to the somewhat more spacious term, “fa mily planning,” or program 

which take into account broader aspects of the lives of individuals who are 

recipients of birth control services.

At the time when the Congress contemplates embarking the nation upon so 

unprecedented a program, the Nati ona l Catholic We lfar e Conference and the 

Pennsylvania Catholic Committee feel it their duty to state their conviction that 

the public power and public funds should not be used for the providing of birth 

control services.

As noted, they do not oppose, but rathe r welcome, the furthering of research 

upon population growth. Moreover, they speak today with sensitive ap preciation 

of the anxie ties and motivations which have stimu lated the introduction of 

Senate Bi ll 1676. They believe, however, that the main featu res of the bill 

pose serious dangers to civi l libert y, while offering no genuine prospect of 

relieving the problems of poverty, crowding and disease which they purport 

to solve.

The distin guish ing feat ure o f S. 1676 is, of course, the use of the public power 

as the sponsor of birth control services. We feel that the implica tions of public

32 Griswold v. Connecticut, U.S . . 14 L. ed. 2d 510. 52.3 (1 96 5) .
110 PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66

intervention in this area have been scarcely considered and now require the most 

car efu l weighing . The action s of privately supported agencies in the promoting 

of education in birth control, the settin g up by them of clinics, and their fur nis hing of contraceptive mate rials are entirely protected under the law of the land. 

This appears clear ly in the recent decision of the Supreme Court in the Connecticu t case. Thus the sponsors of such programs have total freedom to get 

their ideas “accepted in the competition of the marke t” ,13 with the assurance 

that, in a free society, their ideas if sound, will in time win acceptance. Bu t it 

is a total ly different thing to a ttempt to shortcut the route to such acceptance by 

the use of subsidies, derived from the taxe s contributed by all.

We have pari cula r concern over this, because we believe that if the power and 

prestige of government is placed behind programs aimed at providing birth 

control services to the poor, coercion necessarily results and violations of human 

priva cy become inevitable.

It appears sufficiently from the statement of findings and declara tion of policy 

of S. 1676 that the programs in question are intended to be effected prima rily 

among the poor. In the Unite d States, cert ainly, the main target group in 

birth control programs has been the poor, as public assist ance programs at the 

Sta te level and the anti-poverty program at the federa l level demonstrate.

The statement of findings lays particular stress upon the underdeveloped 

countries and those whose population growth is extreme. The programs contemplated by S. 1676 for these foreign countries can have reference solely to an 

implementation among their poverty-stricken majo rities—or else it could not 

possibly be ventured tha t these programs would achieve the universal benefits 

claimed for them.

We have spoken of the poor as a class of “weaker members of society” , but we 

have not had reference merely to their lack of income or low economic standard 

of livin g. We refer, in addition, to facto rs revealed in the Cornell Univ ersit y 

department of psyc hiat ry study in 1963 o f New York Cit y : joblessness, ignorance, 

disrupted fam ily life , sickness. Mich ael Harr ingto n, in his perceptive study. 

The Other Amer ica, says of the poor:

“ The poor are subject to more mental illness than anyone else in the society, 

and their disturbances tend to be more serious than those of any other class.” 14

The encounter between government and the poor person, therefore, is an encounter in which the poten tial for coercion by government is at maximum. 

Wh at heightens the importance of the encounter where birth control or fam ily 

plann ing are introduced, however, is the potential for inquiry by government into 

the personal affa irs of the indi vidu al, data -taki ng respecting these, dictation 

concerning conduct, especia lly regarding sexual life or mar ital relationship (a 

thing described by the Supreme Cou rt as “ intima te to the degree of being 

sacred ” ).

It is very easy indeed to say tha t procedures can be created, governing such 

encounters, whereby “no coercion or pressure is exerted against indiv idua l moral 

choice ,” 15 but such prescription does little or anyt hing to relieve the encounter 

of its built-in coercive atmosphere. I f it is apparent to the “cl ient” that government has a role in the program, he is at once rendered more susceptible to government’ s suggestions.

Here , as where child confronts state in the school prayer situation, the 

ava ilab ility of an exemption means very litt le indeed. The procedure may not 

be com prehended; t akin g advantage of it may be feared. Espe cially is the latter 

true where one governmental program which one may refuse is intertwined with 

another—such as subsistence benefits—which one can scarcely refuse.

It hardl y need be s tated tha t for the Catholic a very special problem is raised 

in such encounter. He has been taug ht, as a moral precept, that “ sexua l power 

is generative by natur e and must be so respected whenever it is employed.” in

He has been given to unders tand, in other words, that any form of contraception 

is forbidden to him by the te achin gs o f his religion.

To this citizen a most serious problem, then, may be posed by the very fac t 

of his having to answer a question about his religious beliefs (even though the

i» Holme s. J. , in Ab ra ms v. Uni te d Sta te s, 25 0 U.S . 616, 630 (1 91 9) .

14 3

 32 15 H an le y Pr ob le m s of Pub lic Po lic y A ri sing Out of Tax -S un nn rted Fa m ily Pla nn in g, 

ad dre ss given be fore Fam ily La w Se ction of America n B ar As so ciation. Aug. 9. 1965 . 9.

w 1965 N at io nal Cat ho lic Al man ac . 11S. And see Po pe P au l VI. ad dr es s of .Tune 23. 

1964 • “B ut m ea nw hile we sa v fr anklv th a t so fa r we do not ha ve sufficie nt reason to 

re ga rd th e no rm s giv en bv Po pe Pin s X II (r ej ec ting th e co nt ra ce pt iv e use of drug s, pills 

or med icines ) in th is m att er as su rp as se d an d th er ef or e no t b in d in g : th ey m us t th er ef or e 

be co ns idered va lid . . .”
PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66 111

question may be asked solely to protect him in his religious beliefs). For some, 

undoubtedly, the sense of the caseworker’s question will seem to be thus : 

•‘Government (or your state, or city, or society itself, or this government-certified agency) has a birth control program. Do you wish to except to it? ” The 

same protective procedure, on the other hand, may impose upon the freedom 

of conscience of a person not a Catholic or who is a non-believer.

It is recognized, of course, th at birth control programs may be of many different sorts. They may cover a broad spectrum of efforts, ranging from a mass 

issuance of pills or devices with only the brie fest instruction to the case approach of “family planning,” where individual interviews, counsel, recordkeeping and follow-up are all involved.

We are told by proponents of publicly funded contraception that only the 

latte r sort of program promises effectiveness and indeed that failures which 

have been ascribed to birth control programs have been due to atte mpts to 

conduct them with techniques assimilated from mass immunization programs 

(without, therefore, any sort of casework). But it is precisely the casework 

type of prog ram—the genuine “family planning” program—which, as government 

or government-funded activ ity, opens widest the scope for thought control and 

conduct control and, in general, human engineering.

Inevitably, in casework, the ambit of inquiry is large. What is the client’s 

fam ilial situation? Histo ry of pregnancies? Frequency of sexual intercourse— 

within or outside of marriage? Experience in use of contraceptives? Fa ith ­

fulness in following advice previously given? Menstrual history? Sex-orfamily-re lated factors (e.g., drinking habits, treatm ent of partn er or children, 

health, income, etc .)? Data rela ting to mental hea lth? And where does the 

whole process end?

In this connection something needs to be said about interviewers since the irs 

is the exquisitely sensitive task (or so it should be deemed) of helping plan in 

the “family planning” (in fact, guiding it). Whether it is constitutionally possible or not, where governmental agencies are concerned, to set any sort of moral 

qualifications to be met by public servan ts charg ed with exploring the most 

intimate are as of the lives of the poor and the igno rant who will constitute the 

majority of the intended class of recipients of birth control services, moral 

qualifications of the highest sor t are plainly requisite.

Going beyond this, educational and professional qualifications would seem 

necessary. Yet the 1960 Survey of Salaries and Working Conditions of Social 

Welfare Manpower reveals that in 1960, 30 percent of all public assistance caseworkers were not college grad uates, while 10 percent had only high school 

training or less. While the Congress appears to contemplate a program of inter ­

national family planning, litt le seems to be said about who the plan ners are 

really to be. And yet their role will be the very marrow of the program.

Recalling the stateme nts of the Supreme Court respecting the constitu tional 

necessity of establishing, where civil liberties a re involved, a “necessary, and not 

merely ration al” relationship between a sta tut e and the accomplishment of state 

policy, one must furth er ask not what do the proponents of state-supported birth 

control predict will flow from their policies but what can they prove will flow 

therefrom? What is the experience, and where is the record of it, which demonstr ate s a tight cause-effect linkage between the proposed adve nture and the 

peace, health, relief of poverty and betterment of economies which, it is said, 

will resu lt? The astounding fact is that there is no such record and no such 

experience but at best a large scale effort in deductive logic.

It is easy indeed to be mesmerized by concepts of social planning, ju st a s it is 

natur al to want the le ast and shortest steps to solve th e worst and most complex 

of our problems. But we must remember th at the planning of families is a thin g 

radically different from the planning of highways, and the government control 

of birth may come close to being government control of life. We think th at this 

is no place for government.

While the Pennsylvania Catholic Committee and the National Catholic W elfare 

Conference feel that the question of civil liberty raised in this statement should 

be considerations of paramo unt interest to this subcommittee, we cannot but 

point to two questions of policy which appeare d to not have been discussed in 

the present hearings.

The first relates to the fact alre ady noted that population control means many 

things—and among th ese are ste riliz ation and abortion. There exists substantial 

evidence of a correlation between contraception and these two practices. Dr. 

Alfred C. Kinsey, in 1955, sta ted at a conference sponsored by Planned Parenthood 

Federation of America, I nc .:
112 PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66

“At the risk of being repetitiou s, I would remind t he group that we have found 

the highest frequency of induced abortion in the group which, in general, most 

frequently uses contraceptives.” 17

As sterilization and abortion so increase in a society respect for life decreases. 

Sterilization and abortion are not excluded, we may note, from a definition of 

population control in this .bill.

The second policy question has been raised by others hut. we feel, with insufficient emphasis. It pertain s to the note of racial eugenicism which is 

inescapable in th e proposal of S. 1676. It is known (and it is indeed whispered) 

that Negroes dominate in numbers our public assistance rolls. No one asserts 

th at it is the intention of the proponents of S, 1676 to limit the production of 

American Negro offspring, and no one can doubt th at de facto this will resu lt if 

large scale programs of government-supported birth control realize t heir intended 

goals.

Certainly, the members of this subcommittee should take pause .before asking 

the Congress to commit itself furth er to programs having this potential. In this 

hour of the painful emergence of our Negro brothers into the American society, 

surely this consideration should be weighed in the balance with the assumed hut 

unproved benefits of S. 1676’s birth control proposal.

A similar consideration should be weighed when the Congress contemplates 

bringing .birth control, as yet one more blessing of white civilization, to the 

countries of the black and brown and yellow peoples. They will, we suppose, 

be free to reject this American advice, but we do not think that the psychology 

of the “white man’s burden” ought to be furthe red today, particu larly in so 

vita l a matter.

To conclude—and with deep thanks for your gracious atte ntion—may I state 

that the Pennsylvania Catholic Committee and the Natio nal Catholic Welfare 

Conference believe, with respect to birth control, th at government should neither 

penalize nor promote it, but pursue a policy of str ict neutrality.

The American P ublic Health Association, I nc.,

Washington, D.C., October 10,1966.

Hon. Harley O. Staggers,

Chairman, House Committee on In terstate and Foreign Commerce,

Washington, D.C.

Dear Mr. Chairman : I wish to express to you the appreciation of the American Public Health Association for the action that you are taking on Tuesday, 

October 11, in considering amendm ents to the Public Health Service Act as they 

relate to formula and project grants to States for public health services, for 

gra nts to assist in planning for more efficient h ealth program s, and for continuation of the gra nts to schools of public health. Ju st as you are not unmindful 

of our deep interest an d concern relative to this legislation, we too are not unm indful of the tremendous pressures which have been upon you and your Committee 

during this year—the work that has been required of the Committee in long 

considerations of extrem ely important programs. We believe the action that 

you and the Committee are taking is due to the realization th at this is an extremely imp orta nt issue and that at least some temp orary means must be found 

in order that public health programs of the nation can continue to provide needed 

services. Please he assu red that the over 17,000 public health workers who are 

members of the APHA and the over 40 thousand additional members of State 

public hea lth associations will he apprised of this action which you are taking 

that is so esse ntial to co ntinuation of public health programs.

We are informed that the Committee will be considering on Tuesday, October 

11. only the proposed substitute to the original legislation which you had introduced some time ago, H.R. 13197. Because of this change. I shall address my 

remarks only to the substitute. H.R. 18231, as I und erstand it. Most certa inly 

the initial proposal, that which would provide for planning gra nts to States and 

to localities for regional and areawide planning, and which was contained in 

your original bill, is a concept w ith which we are in complete accord. There are. 

as you know, planning funds from Federal. Sta te and local sources which are 

utilized to bring about a much more orderly process in some health programs. 

Unquestionably, the best known of these is th e Hill-Burton planning gran ts which 

have proven to be a most effective way of b etter organizing these facilities. Not

17 C ald ero ne, Abo rti on in th e United Sta te s. 157.
PUBLIC HEALTH SERVICES AMENDMENTS OF 196 6 113

to disc ou nt a t all earn est an d co nscien tio us de sire s to ha ve hosp ital fa ci lities 

ju st as close as po ssible to ea ch pe rson , it is, no ne theles s, a fa ct of life th at, 

un less th er e are a minim um num be r of beds an d com mo n fa ci lities , th e ho sp ital 

does no t op er at e efficie ntly from th e st an dpoin t of f inances or fro m th e st an dpoin t 

of qu al ity of ca re which is prov ided to th e pa tien ts . Th e prop os al in yo ur hill 

wou ld en ab le th e S ta te s and co mm un iti es w ithi n th e Sta te s, w ith th e ad vice 

of al l of th e va ri ous hea lth in te re st s w ith in th e loca lit y or w ithin th e Sta te , to 

de cide fo r them se lv es th eir m os t se riou s hea lt h needs, es ta bl is h pri ori ti es to mee t 

th es e needs, an d pre par e to pr og re ss in an or de rly fa sh io n. O ur Assoc iatio n 

stro ng ly su pp or ts th is co nc ep t an d ur ge s th e ap pr ov al th er eo f by you r Co mmitt ee 

and b y th e Co ngres s.

As st ate d pr ev ious ly, our A ssoc iatio n is disa pp oi nt ed th a t it has n ot b een po ss ible fo r yo ur Com mittee to giv e fu ll co ns id er at io n to th e pr em ise an d th e prom ise 

of H.R . 13197. We are mos t ap pre ci at iv e of you r as su ra nc e, ho we ve r, th a t full 

hea ri ng s w ill be c on du cted on th is e ar ly i n th e 90tli Co ng res s, an d we lo ok fo rw ar d 

to m ak in g w hat co nt ribu tion we ca n a t th a t tim e. We are so m ew ha t pe rp lexe d 

by th e prop os al in you r bil l whi ch wo uld pr ov ide fo rm ula an d pro je ct gra nts 

to ta ll in g $125 mill ion ea ch fo r bo th 1968 an d 1969. It is ea sily unde rs to od why 

im m ed ia te ac tion is needed in re sp ec t to 1968, bu t w ith hea ri ngs to be he ld ea rly 

in 1967 we do no t see wh y it wou ld be ad va nt ag eo us to auth ori ze th es e g ra n ts 

th ro ug h 1969, espe cially a t th e minim um level wh ich is includ ed in the bill. It is 

th e co nv ictio n of ou r mem be rshi p th a t th e Fed er al Gov ernm en t has no t bee n 

as su m in g it s ri ghtf ul sh ar e of re sp on sibi lity fo r th e pu blic hea lth pr og ra m s of 

th e na tion . Ev en a cu rs or y co mpa riso n be tw ee n th es e pro gr am s an d th e level 

of Fed er al su pp or t fo r co ns truc tion of w as te tr eatm ent fa ci lities in th e w ate r 

po llu tion pr og ram, th e Fed er al g ra n ts f or high way s, fo r ag ri cult ure , fo r ed uc at io n 

an d fo r nu m er ou s oth er co mp let ely ju stifie d an d m uch ne ed ed pr og ra m s in di ca te s 

to us th a t th e Fed er al Gov ernm en t ha s no t re al ly as su m ed a tr ue hea lth p art n ersh ip rol e. It m ig ht bett er be de sc rib ed as th a t of a m in or stoc kh olde r. We hop e, 

th er ef or e, th a t ac tio n or a co mm itm en t fo r 1969 could he w ith he ld unti l yo ur 

Com mittee ha s ha d tim e to co ns id er fu lly all of th e prob lems th a t are att en d an t 

to th is si tu at io n. As a consequence, we are im pe lle d to rec om men d th a t ap pr ov al 

be giv en fo r co nt in ua tion of th e fo rm ul a g ra nts an d th e pro je ct g ra n ts th ro ugh 

1968. pr ef er ab ly a t a so m ew ha t in cr ea se d lev el, bu t th a t th ere no t be prov ision 

mad e fo r 1969 until you ha ve had an op po rtun ity to st udy th e si tu ati on more 

clo sely.

We ar e ce rt ai nly plea se d th a t you ha ve includ ed in you r bill a co nt in ua tion 

of th e Fed er al g ra nts to sch oo ls of pu blic he al th . Thi s has been an im port an t 

fa cto r in th e su ppo rt of th es e sch ools which , thou gh few in nu mbe r, m us t 

att em pt to sa tisf y th e ne ed s fo r pu blic he al th pr og ra m s th ro ughout th e en ti re 

na tion an d. in fa ct , mu ch of th e wo rld . As you may know , th er e is an in cr ea se d 

in te re st re la ti ve to in it ia ti ng addi tion al sch oo ls of pu blic hea lth, an d th is is a 

fa cto r which I be lie ve yo ur Com mittee will wish to loo k at ve ry clo sel y wh en 

yo u ha ve yo ur he ar in gs ea rl y in 1967. In th e in te rim , ho wev er, we ce rt ai nl y 

hope th a t you wi ll includ e in th e ac tio n ta ken by yo ur Com m itt ee auth ori za tion 

fo r th e co nt in ua tion of th es e g ra nts to th e schools of pu blic hea lth th ro ug h 

1968 an d 1969.

Ag ain , may I ex pr es s to yo u th e ve ry re al g ra ti tu d e of th e mem be rs of th e 

American Pu bl ic H ea lth Assoc iatio n who se vo ca tio n in th es e pu blic he al th 

pr og ra m s br in gs th em in to da y-to-day co nt ac t w ith th e peop le who ar e ben efltted th er eb y an d wh o ha ve an in tim at e kn ow led ge of th e fa ct th a t new . ex ci ting, vib ra nt pr og ra m s are ne ed ed in which yo u and you r Com mittee will ha ve 

an in te gra l part . I wo uld lik e to re qu es t th a t th is co mm un ication be mad e a 

p art of yo ur he ar in gs on Oc tobe r 11.

You rs tr uly ,

Berw yn F. Mat tis on, M.D., 

E xe cuti ve Dire ctor.

American Den tal Asso cia tio n, 

W as hi ng to n, D.C., Octob er 11, 1966.

Hon . H arley O. Staggers,

Chairman, Comm ittee on Inte rstate and Foreign Commerce,

TJ.8. House of Representatives,

Washington, D.C.

Dear Mr. Staggers : Th e American D en ta l Assoc iatio n w ishe s to su bm it th e 

follo wing bri ef co mmen ts on S. 3008, H.R. 18231 an d si m il ar bills which are

7 0 - 0 3 0 — -or,--------9
114 PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66

under co ns id er at io n by yo ur Com mittee an d re sp ec tful ly re qu es ts th a t th is 

le tt er he includ ed in th e rec ord.

As in di ca te d in te stim on y pr es en ted earl ie r th is year to th e Sen at e Co mmittee 

on Lab or an d Pu blic W elfa re , th e American D en ta l Assoc iatio n is in acco rd 

w ith man y of th e ob jectives of S. 3008 an d H.R. 18231. Th e Assoc iatio n rec og ­

nize s in p art ic u la r th e des ir ab ility of en co ur ag in g st ate s an d co mmun iti es to 

mak e co mpr eh en sive pla ns in ord er to me et in th e mos t efficie nt m an ne r th e 

healt h prob lems in th eir own ar ea s. It also is reco gn ized th a t st ate s an d 

co m m un iti es shou ld ha ve re as on ab le fle xibi lit y in im plem en tin g such plan s.

The Assoc iatio n has a m aj or concern , how’ever , w ith th es e pr ov isions of S. 

3008 an d H.R. 18231 wh ich wo uld mak e a fu ndam en ta l re vi sion of th e exis ting hea lt h gra nt st ru ctu re by ab ol ishi ng all di se as e ca te go ries ex ce pt men tal. 

A ft er man y ye ar s of di sh ea rten in g ex pe rie nc e w ith ge ne ra l he al th gra nts , th e 

Assoc iatio n is convinc ed th a t su pp or t fo r den ta l pu blic he al th ac tivitie s shou ld 

be specifica lly au thor ized .

U nl ike m an y ot he r afflictions which var y in incide nc e an d se riou sn es s from 

one st ate or c om mun ity to an ot he r, den ta l di se as e is pre val en t to t h e same ex te nt 

ev eryw he re. But w hile den ta l di se as e is un iv er sa l, his to ry de m onst ra te s th a t 

it do es no t rece ive th e em ph as is it de se rv es in pu blic healt h pr og ra m s. It 

simply is no t ab le to comp ete fo r su pp ort an d fu nds w ith th e mo re dra m at ic 

di se as es such as can ce r an d h eart dise ase.

Co ng ress rec og nize d th is prob lem th re e yea rs ago whe n it be ga n al lo ca ting 

spec ifica lly mod est am ou nt s ($1 mi llion in fiscal 1967) fo r gra nts to st ate s fo r 

den ta l publi c he al th ac tivi ties . Thi s w as done unde r th e auth ori ty of secti on 

31 4( c) of th e Pub lic H ealth Se rvice A ct which w ou ld b e re pe al ed b y en ac tm en t of 

S. 3008 an d H.R. 18231. W hile $1 mi llion is on ly a toke n am ou nt wh en compar ed w ith th e de nt al di se as e prob lem in th is co un try, it prob ab ly is more th an 

wo uld h av e b een a lloc ated w itho ut th e spec ific direc tion o f C ongre ss.

T hi s conclus ion received su bst an tiat io n in 1967 by th e H on or ab le W ilbu r J. 

Cohen wh o tes tified on be ha lf of th e D ep ar tm en t of H ea lth. Edu ca tion an d W elfa re be fore th e Se na te Com mittee on Lab or an d Pub lic W el fa re in su pp or t of 

legi slatio n cr ea ting a se para te gra nt -in- ai d pr og ra m fo r den ta l pu blic hea lth 

ac tivi ties . Am ong o th er th in gs , Mr. Cohen p oi nt ed o u t:

“In 1961. fo r exam ple, th e Pub lic H ea lth Se rvice mad e ge ne ra l hea lth gra nts 

of .$17 mi llion to st ate pu blic hea lth dep ar tm en ts . Yet th es e dep ar tm en ts 

allo ca te d to de nt al ac tivi ties on ly $125.000—ju st 0.7 pe rc en t of th e to ta l. . . . of 

th e mo re th an half a bil lio n dol la rs sp en t in 1961 on al l sta te hea lth prog rams, 

on ly $6.6 mi llion —a bo ut 1 per ce nt —w en t to den ta l he al th . T his p att ern of 

allo ca tio n of p ub lic fu nd s is in sh arp contr ast w ith th a t of p ri vate fu nd s, whe re 

$15 out of ev ery $100 sp en t fo r hea lth ca re goe s fo r th e purc ha se of den ta l 

service s.

“S o gre at a dis par ity ca nn ot be igno red, fo r th e curr ent allo ca tio n all ow s les s 

th an 4 ce nts per pe rson pe r yea r fo r al l st ate an d co mm un ity ac tivitie s in den ta l 

he al th . And 4 ce nts pe r pe rson a year sim ply is no t en ou gh . It doe s no t pe rm it 

pr og ra m s which ev en be gin to m ee t th e exis ting nat io nal ne ed .”

I t w as follo wing th is hea ri ng th a t Co ng ress es ta bl is hed a lin e ite m in the 

bu dg et fo r st ate de nt al pu blic healt h ac tivi ties . I t is su bm itted re sp ec tful ly 

th a t th e co ntinu at io n of spe cific au th o ri ty fo r Co ng ress to al lo ca te fu nds fo r 

den ta l he al th wo uld no t be in co ns iste nt w ith th e pu rp os e of S. 3008 an d H.R. 

18231. D en ta l he al th , like m en ta l hea lth, tr adit io nall y has been se par at el y 

iden tif ied in st ate he al th de pa rtm en ts . Pro fe ss io na l den ta l pe rson ne l ar e se pa ­

ra te ly lic en sed an d carr y on se para te pr og ra m s w ithout co nflic t or ov er lap w ith 

oth er st ate an d local hea lth pr og ra m s. Th us , spe cific allo ca tion of fu nds fo r 

den ta l he al th wo uld no t dis tu rb ex is ting re la tionsh ip s an d wo uld no t pr ev en t 

th e co or di na tion an d fle xibi lit y en visio ne d in S. 3008 an d H.R. 18231. T he Associ at io n reco mmen ds an al lo ca tion of 5 pe r ce nt of th e sum au th or iz ed in S. 

3008 an d H.R. 18231 fo r “G ra nts fo r Com preh en siv e Pu blic H ea lth Se rvices.”

The Am erican D en tal Assoc iatio n is plea se d w ith th e lang ua ge in S. 3008 

an d H.R. 18231 st ati ng th a t not hi ng may be done to in te rf ere “w ith ex is ting 

p att ern s of pri vat e pr of es sion al pr ac tice of med icine an d denti st ry an d re la te d 

he al in g a rt s.” It is as su m ed th a t th e in te nt of th is la ng ua ge is to mak e cl ea r 

th a t th e ac tivt ie s au th or iz ed are to be carr ie d ou t w ithi n th e fr am ew or k of 

w h at ha ve been tr adit io nall y co ns idered to be pu blic healt h service s. It is 

su gg es ted th at th is in te nt be em ph as ized in th e Com m itt ee ’s re port on th e bill.
PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66 115

W ith th is un der st an din g th e Assoc iatio n be lie ve s th a t th e pr ov isio ns of S. 

3008 an d H.R. 18231, if ad eq uat el y fu nd ed , ho ld co ns id er ab le pr om ise fo r 

im prov ing th e metho ds by whi ch pu blic hea lt h se rv ice pro gr am s are es ta bl ishe d 

an d im plem en ted in st ate s an d co mmun iti es .

Th e Amer ican D en ta l Assoc iatio n ap pr ec ia te s th is op por tu ni ty to pr es en t its 

views.

Si nc erely yo urs,

J ohn B. W il so n, D.D.S., 

Chairman, Council on Legislation.

American Nur se s’ Asso cia tio n, I nc.

jVeic York, N.Y., October 7,1966.

Ho n. H arley Staggers,

Chairman, Committee on Inter sta te and Foreign Commerce,

U.S. House o f Representatives,

Washington, D.C.

Dear Mr. Staggers : Th e American N ur se s’ Assoc iatio n wishe s to re co rd its 

su pp or t of yo ur bill H.R. 1.3197, to am en d th e Pu bl ic H ealth Se rvice Act to pr omote an d ass is t in th e ex te ns io n and im pr ov em en t of c om pr eh en sive hea lth pla nni ng and pu blic he al th service , to pr ov id e fo r a more effecti ve us e of av ai la ble 

Fed er al fu nd s fo r such pla nn in g an d serv ices, an d fo r oth er reas on s.

Our in te re st an d su ppo rt stem s from th e mem be rs’ deep co nc ern fo r th e pr ovisio n of a de qu at e healt h ser vi ce s fo r th e A merican p eop le. The s ys tem o f p ub lic 

healt h se rv ices ha s develop ed piec em ea l ov er th e yea rs to mee t cu rr en t prob lems 

w itho ut an as se ss m en t of th e ch an ging ne ed s of society fo r th es e service s. P ro ­

gr am s ha ve been bui lt ar ou nd an d on to p of ea ch othe r, cr eati ng an un wiel dy , 

ine fficie nt op er at io n. Lo ca l pr og ra m s ha ve develop ed on ly to th e exte nt th a t 

loc al pr es su re s will allow . Bo ld ac tion is in di ca te d if we are to mee t th e ne ed s 

of the cha ng in g tim es.

As in te re st in ea ch di se as e ca te go ry was stim ul at ed , pr og ra m s were est ab ­

lish ed to pr ev en t, an d co nt ro l th e p art ic u la r dis ea se. Eac h pr og ra m ha s grow n 

into a to ta li ty an d as th e pr og ra m s develop in de pth, they ha ve a tend en cy to 

become in cr ea sing ly ingr ow n. M ea ni ng fu l co or di na tion of th e m ul tipl e pr ogra m s is es se nt ia l fo r pl an ni ng fo r th e to ta l hea lth ne ed s of a co mmun ity .

Cat eg or ic al fu nd in g to re ac h a specific hea lth go al en ab led st ate s to giv e a tte nt io n to ne w o r lon g ne glec ted hea lth prob lem s. In th e pas t, it pr ov ed a 

us ef ul mec ha nism fo r en co ur ag in g ac tion in a giv en are a which mig ht ne ve r 

ha ve been un der ta ken ha d such fu nd in g no t bee n av ai la bl e. How ev er, a t th is 

tim e a di ff er en t ap pr oa ch is in di ca te d in ord er to develop a c om pr eh en sive hea lth 

pr og ra m o f p re ve nt ion, c ar e an d re hab ilitat io n.

C er ta in pr ac tice s as so ci at ed w ith ca te go rica l fu nd in g ha ve re su lted in fr ag ­

m en ta tion an d di sr upt io n of s ervice. Th es e includ e th e re qu irem en t of a ss ig ni ng 

staf f on a spec ializ ed ba sis, a co mpl icated sy stem of ac co un ting fo r fu nds an d 

th e focu sing of reso ur ce s on a sp ec ia l ne ed to th e ne glec t of more pres sing

pro blem s. H.R. 13197 wi ll prov id e a focu s fo r an in te gra te d g en er al iz ed pr og ram. H ea lth 

serv ice ne ed s fo r an y giv en are a may var y widely. Su ch fa ct ors as ag e an d 

ed uc at io n lev el of th e po pu latio n, th e eco nomy, an d th e topo gr ap hy inf lue nce 

th e ki nd s of pr og ra m which m us t be ta ilore d to su it ea ch co mmun ity . Fle xibility in th e us e of fe de ra l g ra nts will pr ov ide a st im ulu s fo r im ag in at iv e pla nni ng a nd red uc e th e em ph as is on d isea se -o rien te d pr og rams.

H.R. 13197 pr ov id es fo r th e de ve lopm en t an d im pr ov em en t of home hea lth 

service s. Th e pa ss ag e of th e H ea lth In su ra nce Be nefits Amen dm en ts to th e 

So cia l Se cu rity Act w ith th e prov ision fo r pa id home he al th serv ices as a be ne ­

fit, mak es it im pe ra tive th a t co mmun ity hea lt h serv ices be develop ed, ex tend ed

an d im prov ed . ____ .. ..

W e be lie ve th a t th ere is urg en t ne ed to en ac t H.R. 1319< so th at, as th e ti tl e

of th e bi ll st at es , pl an nin g fo r co mpr eh en sive hea lth se rv ices ca n become a 

re al ity.

Res pe ctfu lly , „

J ud ith G. W hit a ker, R.N .,

Execu tive Director.
116 PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66

National Association of Cou nt ie s,

W as hi ng to n, D.C. .Octo ber 11 ,1966.

Ho n. H arley O. Staggers,

Cha irm an , C omm itte e on In te rs ta te an d F or eign C om me rce ,

Hou se o f Rep re se nt at iv es ,

Was hing ton. D .C.

Dear Mil Ch a ir m a n: On be ha lf of th e N at io na l Assoc iatio n of Co un tie s, I 

sh ou ld lik e to ex pr es s ou r su pp or t of H.R. 13197, a hil l to impro ve co mpr eh en sive 

he al th pl an ni ng an d pu blic hea lth service s. The gr ow ing comp lex of prob lem s 

co nf ro nt in g loc al go ve rn m en ts ha s in man y in st an ce s been comp ounded by th e 

rigi di ty of th e fe de ra l pr og ra m s de sig ne d to as si st them . In our vie w H.R. 

13197 w ill as si st in co rrec ting this s it uat io n in th e im port an t are a of hea lth.

We wo uld s tron gly sugg es t t h a t th e bil l be a men de d to :

(a ) st re ng th en th e em ph as is of th e ro le of offic ial loc al hea lth ag en ci es ; 

an d

(b ) of a re aw id e pla nn in g be ing ca rr ie d ou t by ag en cies resp on sible to an d 

ap po inted by the part ic ip ati ng loc al go ve rn m en ts, vis -a-vis , no ng ov ernm en tal 

pri vate agency or org an iz atio n.

In or de r to obt ai n th e max im um benefit, hea lth pro gr am s shou ld be co or di na ted 

w ith one anoth er as we ll as man y oth er pr og ra m s be ing ca rr ie d ou t by ou r loc al 

go ve rnmen ts. Thi s ca n be st be done by ha vi ng th e ar ea w id e pla nn in g car ri ed ou t 

und er th e au sp ices of th e loca l go ve rnmen t. T hi s wo uld in no way pr ec lu de th e 

inclus ion of re pre se nt at io n from so ur ce s oth er th an go ve rn m en ta l on th e pla nning body.

Specifically, we sugg es t th a t th e prop os ed new Secti on 314(a ) (2 ) (B ) of Title 

I I I b e amen de d to r ea d a s f oll ow s:

“ (B ) pr ov id e fo r th e es ta bl ishm en t of a S ta te hea lth pl an ni ng council, 

wh ich sh al l includ e re pre se nta tives of S ta te an d loc al [official] ag encie s an d 

no ng ov ernm en tal or ga ni za tion s an d gr ou ps co nc erne d w ith hea lth, an d of 

co ns um ers of h ea lth service s, to ad vise such S ta te ag en cy in carr yin g ou t its 

fu nc tion s un der th e plan

We fu rt h er sugg es t th a t th e prop osed Secti on 314(a ) (b ), “Pro je ct G ra nts fo r 

Are aw id e H ea lth Pla nnin g” be am en de d to in clud e th e follo wing prov isi on :

“I n th e ab senc e of su bst anti al re as on s to th e cont ra ry . P ro je ct G ra nts un de r 

th is Secti on wi ll be mad e to pu blic ag en cies which are com posed of officials appo in te d by an d resp on sib le to th e part ic ip ati ng loca l go ve rn m en ts co mpr isi ng 

th e are a be ing p lann ed f or. ”

I t is ou r vie w th es e tw o am en dm en ts will no t co mplicate th e adm in is trat io n 

of th is pr og ra m, bu t ra th e r wi ll gre at ly fa cil it ate it s be ing su cc es sful ly im plemen ted. I shou ld lik e to th ank you in ad va nc e fo r you r co ns id er at io n of ou r 

co mm ents.

Ve ry tru ly y ou rs,

Bernard F . IIillenrra nd,

E xecuti ve D ire cto r.

H ouse of R ep res en ta ti ves , 

Was hing ton, D.C., June 15,1966. Hon . Harley O. Staggers,

Cha irm an , Hou se C om mitt ee on In te rs ta te a nd F oreig n Co mm erc e,

W as hi ng to n, D.C.

Dear Mr. Ch a ir m a n: I am w riting to giv e my su pp or t fo r H.R. 13197, th e 

Com preh en siv e H ea lth Pla nnin g a nd P ub lic H ealth Se rvices A men dm en ts of 1966.

At th e same tim e, I wou ld lik e to enclo se a cop y of a le tt er I rec eive d re ce nt ly 

from Alfr ed M. Pe lham , th e ch ai rm an of th e South ea st er n Mich iga n Tas k Fo rce 

on Co mmun ity H ea lth Service s. Mr. Pe lham has giv en a br ie f bu t ve ry per su asive d iscu ssio n of how im port an t H.R. 13197 is fo r my Sta te , an d I hope it can be 

incl ud ed in th e pe rm an en t reco rd of th e co m m ittee’s he ar in gs on th is im po rtan t 

prop os al.

T ha nk you v er y mu ch f or y ou r c on side ra tion a nd i nte re st .

Sinc erely ,

Bil li e S. F ar nu m, M.C.
PUBLIC HEALTH SERVICES AMENDMENTS OF 196 6 1 1 7

Sou theastern Michiga n T as k F orce

on Com mun ity H eat h Services,

Ann A rbor, Mich., June 3,11)66.

Ho n. Bil li e S. F ar nu m,

Hou se O ffice Build ing,

W as hing ton, D.C.

Dear Si r : At th e Ju ne 1, 1966, m ee tin g of th e South ea st er n Michiga n Tas k 

For ce on Co mmun ity H ea lth Se rvices, th e mem be rshi p reso lved to su pp or t 

Hou se Bi ll 13197 an d Sen at e Bill 3008, “C om preh en sive H ea lth Pla nnin g an d 

Pub lic H ea lth A men dm en ts o f 1966.”

The Sou th ea st er n Mich igan Tas k For ce has been st ud yi ng th e co mmun ity 

hea lth prob lems an d ne ed s in Sou th ea st er n M ichiga n an d th e w ay s in which 

th es e prob lems are me t. It is obvio us, th a t in th e co mmun ity hea lth ar ea, th er e 

is a gre at de al of co nfus ion as to who is do ing w hat or even wh o sh ou ld be 

do ing w ha t. Our data reve als, fo r ex am ple, th a t in Michiga n ele ve n di ffer en t 

st ate ag en cies are inv olved in th e prov ision of hea lt h service s. A re ce nt su rv ey 

by ou r st af f ha s reve aled th a t one of th e mo st urg en t ne ed s in th e co mmun ity 

hea lth are a is fo r co or di na tion an d co op er at io n of th e ef fo rts an d ac ti vit ie s of 

th e va riou s he al th ag en cies an d grou ps . All exper ts ag re e th a t in th e pu blic 

hea lth are a th er e is a la rg e ga p betw ee n w hat is kn ow n an d w hat is ap plied. 

Sen at e Bill 3008 an d Hou se Bill 13197 wi ll allow fo r m ea ni ng fu l pla nn in g an d 

th e or der dl y de ve lopm en t of co mpr eh en sive co mm un ity healt h se rv ices to al l 

citize ns in t he U nited St at es .

As C ha irm an of the South ea st er n Michiga n Tas k Fo rc e on Com mun ity H ea lth 

Se rvices an d on be ha lf o f th e mem be rshi p an d sta ff, I ur ge th a t yo u su ppor t th is 

ne ed ed le gi slatio n.

Si nc erely y ou rs,

Alfred M. P el ham, Ch airm an .

State of Minne so ta ,

E xecutive Off ic e,

St. Pa ul, M inn ., A pri l 7 ,1966.

Ho n. II ari.ey Staggers.

Hou se o f R ep re se nt at iv es ,

Was h ington , D.C.

Dear Cong ressma n Stagg ers: I w ant to ex te nd my co ngra tu la tions to you fo r 

th e ex ce lle nt pr op os al you ha ve mad e in H.R. 13197. th e Com preh en siv e H ea lth 

Pla nni ng and P ub lic H ea lth Se rvices A men dm en ts of 1966.

H er e in M inne so ta we ha ve mo ved fo rw ard w ith th e ap po in tm en t of a Go ve rnor’s Com mi ssion on H ea lth a nd R eh ab il it at io n w hich will c arr y th e b ro ad as si gn ­

m en t of p la nn in g hea lth an d re hab il it ati on se rv ices fo r th e im m ed ia te fu tu re an d 

long -ra ng e. Th e re sp on sibi lities of th e Comm ission , which is com posed of pr om inen t med ical an d lay le ad er s from ev er y co rn er of th e st at e, w ill incl ud e th e 

fo llow in g:

a. An ev al ua tio n of th e pr es en t Sta te vo ca tio na l re hab il it ati on pr og ra m 

an d th e pr ep ar at io n of a co mpr eh en sive st at ew id e pl an to mak e re h ab il it ation serv ices a va ilab le to e ve ry pe rs on w ho co uld b enefit th ereb y,

b. An an al ysi s of th e ov er al l qual it y of th e he al th of th e ci tize ns of th e 

S ta te of Minne sota, in cl ud ing an as se ss m en t of th e he al th an d ill ne ss sta ti stics a va ilab le in va riou s st ate a nd fed er al b ur ea us ,

c. A review of th e ex is ting healt h man po wer, in cl ud ing an an al ysi s of 

th e dis trib ution of hea lth man po wer, th e nu m be r of pe rson s in th e va riou s 

med ical an d pa ri-m ed ical pr of es sion s, an d th e re so ur ce s fo r ed uc at in g 

addi tion al h ea lth man po wer,

d. Th e or ga ni za tion of pu blicly fin anced an d oper at ed hea lth ca re pr ogr am s, includ ing an an al ysi s of th e S ta te -F ed er al re la tions hi p an d a review 

of th e qu al ity o f pub lic ly s up po rted h ea lth c ar e.

e. A review of th e ex is ting an d prop osed hea lth fa ci lities under the v a rious fe der al and s ta te c on st ru ct io n pr og ra ms,

f. An an al ys is of th e econom ics of hea lth ca re — th e exte nt an d qual ity of 

p ri vate an d pu blic hea lth ca re in su ra nce co ve rag e, an ex am in at io n of th e 

var ia ti on by region s in th e co st an d supp ly of hea lth ca re , an d th e po ss ibility of dev elo ping optim um u tili zati on of h ea lth c ar e service s.
118 PUBLIC HEA LTH SERVICES AMENDMENTS OF 19 66

It is a br oa d under ta kin g b ut th e n ee ds o f t he t im es re quir e it. Th e vo ca tio na l 

re habil it ati on pl an ni ng fu nd s will fin an ce th a t as pe ct of th e pr og ra m . Yo ur 

pr op os al wo uld be of gre at va lu e in pr ov id in g as si st an ce w ith th e co sts in cu rr ed 

in th e br oad er he al th pl an ni ng as sign m en t. I hope th at H.R. 1319“ will become 

law an d wo uld be ha pp y to be of as si st an ce in an y way possible . I am se nd ing 

a cop y of th is l ett er to th e M in ne so ta de lega tio n so th a t th ey may be fu lly aw ar e 

of th e im pl ic atio ns of II.R . 1319“ fo r th e im prov em en t an d mo re eff ective org ani za tion of h ealt h s ervice s in M inne sota.

W ith ki nd es t p er so na l r eg ar ds .

You rs ve ry t ru ly ,

Karl R olvaag. Go verno r.

T he State of Wis co ns in ,

State Roarii of H ea lt h. 

Ma dison, W is., A pri l 15, 1966.

Re H .R. 13197.

Ho n. H arley O. Staggers,

Hou se o f R ep re se nt at iv es ,

W as hing ton, D.C.

Dear Cong ressma n Staggers : The W isco nsin S ta te Boa rd of H ea lth is in 

fa vor in pr in cipl e w ith th e ob ject iv es of bil l H.R. 1319" an d its compa nion bil l 

S. 300S. W ith one am en dm en t it is believed th a t th es e bills wo uld ha ve gre at 

po ss ib ilities of st re ng th en in g co mpr eh en sive hea lt h pl an ni ng an d th e le ad er sh ip 

of official Sta te he al th agencie s.

The re is one de fect, ho we ver, which sh ou ld be co rrec ted to in su re th a t ju st 

th e op po sit e do es no t ha pp en . As th e bi lls a re now w ri tt en an y S ta te agency 

ca n be de sign ated as th e sole agen cy fo r ad m in is tr ati on of th e S ta te ’s he al th 

pl an ni ng fu nc tio ns . T hi s co uld re su lt in th e S ta te ’s official hea lth ag ency los ing 

it s le ad er sh ip ro le an d ju ri sd ic tion in policy de te rm in at io n in th e field of publi c 

healt h an d th us wea ke ning ra th e r th an st re ngt hen in g th e Sta te hea lth agency.

It is rec om me nd ed th at, on pa ge 3 of H.R . 13197, (2 ) (A ) be am en de d to re ad 

as fo llow s:

“ (A ) de si gn at e th e official S ta te pu blic he alth ag ency as th e sole ag ency fo r 

ad m in is te ri ng or su pe rv isin g th e adm in is tr ati on of th e S ta te ’s hea lth pl an ni ng 

fu nc tion s unde r th e plan

Thi s one ch an ge is ur ge d by th e in di vid ual mem be rs of W isco ns in ’s officia l 

S ta te Boa rd of H ea lth an d by me pe rs on ally as W isc on sin S ta te H ea lth Officer. 

Sinc erely yo urs,

E. H. J orris, M.I)..

S ta te He alth Officer.

State of New J ers ey, 

Depa rtm ent of H ea lt h. 

Tr en to n, N . J.. March 28. 1966.

Ho n. Harley O. Staggers.

Hou se o f Rep re se nt at iv es ,

W as hi ng to n, D.C.

Dear Cong ressman Staggers : A tta ch ed is a cop y of a le tt er (a ttachm ent A) 

se nt to all New Je rs ey Mem bers of th e Hou se of R ep re se nta tives re sp ec tful ly re ­

qu es ting th eir su pp or t of H.R. 13197.

You r co ns truc tive in te re st in public hea lth is comm endable . Th e prov isions 

of th e bill in trod uc ed by you will allow fo r mo st ne ce ss ar y an d im po rtan t ad ­

va nc es in th e pl an ni ng an d ad m in is tr ati ve proc esses ne eded to me et mo de rn day 

pu blic healt h de man ds .

Sinc erely ,

R oscoe P. Kandle, M.D..

Sta te Co mmiss ione r of Hea lth .
PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66 119

(A tt ac hm en t A)

State of New J ersey, 

Depa rtme nt of Hea lt h, 

Tr en to n, N.J., Ma rch 21,19 66.

H o n .--------------------,

Congress of the United S tates,

House of Repre sentatives,

Washington, D.C.

Dear Congressma n ---------: Yo ur att enti on is re sp ec tful ly in vited to H.R.

13197 in trod uc ed by th e Hon or ab le Mr. Sta gg er s on M arch 2, 1966 an d re fe rr ed 

to th e Com mittee on In te rs ta te an d For ei gn Comm erce.

Thi s bill am en ds th e pre se nt Pu blic H ea lth Se rvice Ac t an d pr ov id es f o r :

1. Com preh en siv e stat e- w id e hea lth pla nn in g to incl ud e th e co or di na tion an d 

in te gra ti on o f a re a- wid e plan ni ng .

2. Th e st re ng th en in g an d ex te nd in g of co mmun ity he al th se rv ices in a m an ­

ner which wou ld br in g ab ou t close in te rg ov er nm en ta l co llab or at io n an d wo uld 

allo w fo r a re al part ners hip of pu blic an d priva te , in di vid ual an d or ga niz at io nal , 

official and volu nta ry ef fo rts ne ce ss ar y to mee t th e co mpl ex iti es of mod ern da y 

pu blic he al th . Much of th is ability is no t now po ssible unde r th e ex is ting de ­

ta il ed c at eg or ic al g ra n t ap proa ch .

3. Sin ce t he ne ed s an d re so ur ce s of c om m un iti es an d sta te s var y widely , m ax imum flex ibili ty in adm in is tr ati on is ne ce ss ar y in ord er pr op er ly to pr ov id e fo r 

pu blic hea lth serv ice s of a var ie d an d di ff er en t scope. Such fle xibi lit y is im ­

po rt an t to in su re th a t loca l pro gr am s are de sign ed to me et loca l pro blem s. 

Su ch fle xibi lit y is no t now a va ilab le.

4. Th e co nt in ua nc e of pro je ct or de ve lopm en t g ra nts to mee t spe cific he al th 

prob lems of lim ited ge og raph ic scope, or of sp ec ializ ed re gi on al or nat io nal signific an ce ne ce ss ar y to st im ula te an d la un ch new hea lth pr og ra ms, an d to und er ­

ta k e s tu dies , de m on st ra tion s an d tr ain in g p ro gr am s.

5. Th e in te rc ha ng e of pe rson ne l w ith S ta te s and po litica l su bd iv isio ns of a 

S ta te so th a t max im um us e of sp ec ializ ed kn ow led ge co uld be mad e av ai la bl e 

in are as w he re ne ed ed w itho ut loss of be ne fit s to su ch in te rc ha ng ed pe rson s.

The m ea su re s in co rp or at ed in th is bi ll are mos t im port an t an d mos t necessa ry if we a re eff ectiv ely to mee t th e br oa d de m an ds of pu blic hea lth in th is 

S ta te a nd if we are e ffe cti ve ly t o se rv e th e citize ns of New Je rs ey . Publ ic h ea lth 

ca n no long er be co ns id er ed a si ng ul ar , sim ple, par oc hi al problem .

Thi s bil l, if pa ss ed w itho ut su bst an tive ch an ge , wo uld pr ov id e th e mea ns fo r 

an effecti ve part ners hip an d wo uld rem ov e cu rr en t ca te go rica l re st ri cti ons to 

effecti ve p lann in g an d op er ation.

I resp ec tiv ely re qu es t yo ur fa vo ra bl e co ns id er at io n an d supi>ort of th is b ill. 

Sinc erely ,

Roscoe P. Kandle, M.D.,

Sta te Commissioner of Health.

State of Mon tana,

State B oard of H ea lt h,

Helena, Mont., Ju ne 9, 1966.

Con gres sm an J am es B a t o n ,

House Office Building, Washington, D.C.

Dear Cong ressma n Ba to n : At th e annual m ee tin g of th e W es te rn Affiliates, 

American Pub lic H ealth Assoc iatio n, May 23-27, 1966, th e follo wing reso lutio n 

w as p assed :

“O rg an ized lo ca l Pu bl ic H ealth Se rvices are no ta bl y la ck in g in ru ra l, sp ar se ly 

po pu late d ge og raph ic a re as of the U ni te d St at es .

Fed er al fo rm ula gra nts to sta te s are adju st ed by to ta l po pu latio n an d pe r 

capit a inco me. To m ee t th e ne ed s of th e sp ar se ly po pu late d ar ea s, it wi ll be 

ne ce ss ar y to ta k e in to co ns id er at io n th e hig her pe r ca pita co st of r ea ch in g peo ple 

in t he se a re as an d m ak e ad ju st m ents o f for m ul a gra nts .

The Con fe de ra tion of W es te rn Affiliates, APH A, reco mmen ds th a t Co ng ress 

de velop a fo rm ula which will giv e st ate s w ith sp ar se po pu la tion s a gre ate r 

am ou nt of su bs idy fo r pu blic healt h pro gr am s th an wo uld be th e case if only 

to ta l po pu la tion a nd p er ca pita inc om e w er e used.
120 PUBLIC HE AL TH SER VIC ES AM ENDM ENTS OF 1966

The Con fe de ra tio n of W es te rn Affiliates, AI ’HA, also rec om me nd s th a t AP HA 

as sign an ap pro pr ia te co mm itt ee th e ta sk of de vising a su itab le fo rm ul a fo r dis ­

tr ib uti ng fe de ra l pu blic he al th fo rm ul a g ra n ts to s ta te s. ”

Thi s or ga ni za tion re pre se nts th e S ta te Pu bl ic H ea lth Assoc iatio n of the 

w es te rn st at es . You mig ht find th is an ad ditio nal en do rsem en t fo r adju st in g 

th e g ra n t fo rm ul a un de r S. 3008 a nd H .R. 13197.

Sinc erely yo urs,

J oh n S. Anderson, M.D.,

E xec utive Officer.

State Board of Hea lt h, 

Co lum bia , S.C., Oc tob er 7 ,1966.

Ho n. W illiam J en ning s Bryan D orn,

Hou se Office Bu ild ing,

W as hing ton, D.C.

Dear Congressman Dorn : We ha ve been info rm ed th a t th e Hou se In te rs ta te 

an d Fo reig n Comm erc e Com mitt ee has vo ted to ha ve a one-d ay hea ri ng on H.R. 

13197 an d S. 3008 (t he Com preh en siv e H ea lth Pla nnin g a nd Pub lic H ea lth Se rv ­

ice s Amen dm en ts of 1966). We re gre t th a t th e he av y load of work prec ed ing 

ad jo ur nm en t fo r th e yea r does no t allow addi tion al tim e fo r co ns id er at io n of 

th is co mplicated issue.

We ha ve also been ad vi se d th a t th e co mm itt ee is se riou sly co ns id ering au th o rizi ng on ly $62.5 mill ion pe r yea r fo r healt h se rv ice fo rm ul a gra nts duri ng th e 

fiscal ye ar s 1968 an d 1969 al th ou gh th e Se na te has ap pr ov ed an au th ori za tion of 

$170.5 mill ion fo r 1968 an d $230.7 mi llion fo r 1969.

We fe el th a t th e au th ori zati ons ap pr ov ed by th e Se na te wo uld tr uly allow fo r 

th e de ve lopm en t of co mpr eh en sive pu blic hea lth serv ice s in th e Sta te s while th e 

le ss er fig ures qu oted ab ov e are ab ou t th e sa m e as th e sum of the pre se nt cat ego rica l hea lth gra nts an d wou ld no t allow de ve lopm en t of serv ices bey ond the 

pre se nt in ad eq ua te lev el co ns id er in g th e rising co sts of al l commod ities an d 

service s.

If th e Ho use ca nn ot ac ce pt w ithout ad ditio nal tim e fo r st udy th e auth ori zation s pa ss ed by th e Sen at e on Octo lie r 3. we stro ng ly rec om me nd th a t th e pla nni ng g ra nts only be au th or iz ed a t th is tim e an d th a t add itio nal h ea ring s be sche duled fo r Ja n u ary 1967 whe n th ere will be more tim e av ai la bl e to es ta bl ish the 

ju st ific at io n o f a nd ne ed for a deq ua te form ula g ra nt s.

Sinc erely yo urs,

Malcolm U. Dant zler. M.D..

A ss is ta nt Sta te Hea lth Officer.

Uta h State Depa rtm ent of H ea lt h.

Sa lt L ak e Ci ty, Utah, Oc tob er 7 ,1966.

Ho n. H arley O. Staggers,

Ch airm an , Com m itte on In te rs ta te an d Fo re ign Co mm erc e, U.S. Hou se of Rep re ­

se nt at iv es , W as hing ton, D.C.

Dear Congressman Stagg ers: W ith re sp ec t to H.R. 13197 an d S. 3008 as it 

pa ss ed t he Sen at e an d will be be fore y ou r co mm itt ee for co ns id er at io n on Oc tob er 

11. I wo uld ap pr ec ia te yo ur re port in g to you r co mmitt ee th a t th e pr in cipl es an d 

ob jectives inv olved are of su ch im po rtan ce in solving nu m er ou s prob lems in ­

her en t in ex is ting legi slat io n which th es e bi lls will re pl ac e or su pp lemen t th a t 

th eir fa vo ra bl e co ns id er at io n at th is tim e is of th e high es t im po rta nc e.

W hile S. 3008 an d H.R. 13197 were co mpa nion bills when introd uc ed , th e bill 

as fin all y pa ss ed by th e Sen at e do es not d etr act in an y way fr om th e sig nific an ce 

of th is legi slatio n an d poses no ob jection to th e le gi sl at io n as it wou ld affect us 

in U tah.

The prov ision fo r im prov ing he al th pl an nin g has long been needed. Thi s is 

em ph as ized by tops y tu rv y de ve lopm en t of a gre at va ri et y of ca te go rica l gra nts 

in th e healt h field. Thi s prov isi on , alon g w ith th e sign ifi ca nt ch an ge from cat ego rica l g ra nts to ba sic co mpr eh en sive hea lth gra nts w ill pe rm it mo re eff ectiv e 

use of th e fu nds in th e s ta te s.

The ne ed fo r bett er hea lth pla nni ng in U ta h has b een re ce nt ly rec og nize d by a 

re port of th e Co mm ission on th e O rg an iz at io n of th e Exe cu tive B ra nch of th e
PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66 121

Gov ernm en t (L it tl e Hoo ve r Co mm iss ion R ep ort) which spec ifica lly rec om men ds 

th a t th e S ta te D ep ar tm en t of H ea lth es ta blish a division fo r pl an nin g an d 

re se ar ch .

It is no t on ly m os t im port ant but mos t tim el y th a t th e ne w er co nc ep t of 

Fed er al hea lth g ra nts to th e S ta te s as se t fo rt h in th es e tw o bi lls be en ac te d at 

th is ti m e so th at th e pr og ra m c an be ef fecti ve a s ear ly a s p ossib le.

Ma y I also ad d ap pr ec ia tion to you r sc he du lin g a hea ri ng on th es e bills du ring 

th is v ery bu sy t im e fo r y ou r co mm ittee.

Sinc erely yo urs,

G. D. Carlyle T ho mpson , M.D .,

Director of Public Health.

Cha ut au qu a County D epa rtm ent of H ea lt h,

Mayville, N.Y., September 29,1966.

Ho n. H arley O. Staggers,

Chairman of th e House Committee on Inter sta te ami Foreign Commerce,

House of Representatives,

Washington, D.C.

Dear Repr ese ntative Staggers : I under st an d th a t th ere is curr entl y a bill 

pe nd ing be fo re Co ng res s, entitled “C om preh en siv e H ealth Pla nnin g an d Pu blic 

H ealth Se rvices Amen dm en ts of 1966” (S . 300 8).

H ea ring s on th is b ill ha ve n ot lieen he ld in th e Hou se of R ep re se nta tives to my 

know led ge. Th e en d re su lt of th e bill— am en d th e Pu blic H ea lth Se rvice Ac t— 

wo uld be—

to pr om ote an d as si st in th e ex tens io n an d im pr ov em en t of c om pr eh en sive 

he al th p la nn in g an d pu blic hea lt h se rv ices : an d

to prov ide fo r a mo re effecti ve use of av ai la bl e Fed er al Fun ds fo r such 

pl an ni ng a nd se rv ice s an d fo r oth er p urpo se s.

The D ep ar tm en t o f H ea lth su pp or ts th is prop os ed legi slatio n an d re ques ts th a t 

you h old he ar in gs on it.

Res pe ctfu lly y ou rs,

Lyle D. Fra nzen, M.D.,

Health Commissioner.

Alleg heny County H ealth Depar tm en t,

Pittsburg h, Pa., September 16,1966.

Ho n. H arley Staggers,

H ou se Office Build ing,

Washington, D.C.

My Dear Mil Staggers : Ref er en ce is m ad e to Se na te Bill 3008 whi ch revises 

th e tra d it io n al c ateg or ic al fo rm ul a fo r h ealt h p ro gr am g ra nts to St at es .

Th e lack of ass ura nce in th is bil l to in su re ad eq uat e co ve rage of urb an hea lth 

ne ed s de sp ite it s st at ed in te nt “t h a t Fed er al fin an cia l as si st an ce m ust he di ­

re ct ed to su pp ort th e m ar sh al ling of all hea lth re so ur ce s— nat io nal . S ta te an d 

loca l—to ass ure co mpreh en siv e hea lth se rv ices of high qual it y fo r ev er y pe rs on ” 

w as an d is of m ajo r concern to th is dep ar tm en t.

T hi s co nc ern fo r th e lack of as su ra nce in thes e bi lls fo r urb an hea lth ne ed s 

lia s been co mm un icated to th e Co ng ressmen from Pen ns yl va ni a. Th e Hon or ab le 

Elm er J. H ol land has ad vise d th is depart m ent th a t a compa nion bill, II.R . 13197 

is be fo re th e In te rs ta te an d Fo reig n Co mm erc e Co mmitt ee an d as ye t th ere ha s 

lieen no sc he du lin g of he ar in gs . He fu rth e r ad vi se d th is dep ar tm en t th a t th e 

att ached co mm un ications ha ve been fo rw ard ed fo r yo ur at te nti on. It w as su gge sted by Co ng ressman Holland th a t th es e co mm un ications m ig ht be mad e p a rt 

of co mmitt ee heari ng reco rd . (S ee attachm ent A.)

Sen at e Bill 3008 an d co mp anion bil l H.R. 13197 will ha ve m ajo r im pa ct on th e 

pr ov isio n of co mpreh en siv e he al th se rv ices to urb an re side nt s. It is es se nt ia l, 

th er ef ore , fo r th e bill to spec ify th e mec ha nism by which th ere wo uld be loc al 

official invo lvem en t guar an te ei ng appro pri ate at te nti on to urb an hea lth service s.

Sinc erely yo urs,

E. J ane F le ming, M.D.,

Chief, Bureau of Planning, E valuation and Research.
122 PUBLIC HEALTH SERVICES AMENDMENTS OF 19 66

(A ttac hm en t A)

Allegheny County H ealth Depa rtme nt,

Pittsbu rg h, Pa ., Se pt em be r 7 ,1966. Ho n. E lme r J. H olland,

Hou se Office B uilding,

W as hi ng to n, D.C.

My Dear Mr. Holland : Ref er en ce is mad e to Sen ate Bi ll 3008 which revises 

th e tr ad it io n al ca te go rica l fo rm ula fo r co mpr eh en sive hea lth pr og ra m gra nts to 

st at es .

The lac k of as su ra nce in th is bill to in su re ad eq uat e co ve rage of urb an hea lth 

ne ed s de sp ite it s st ate d in te nt “t h a t Fed er al Fin an ci al as si st an ce mus t be di ­

re ct ed to su pp ort th e m ar sh al ling of all hea lth reso ur ce s— na tional , st ate an d 

loca l— to ass ure co mpr eh en sive healt h se rv ices of high qual ity fo r ev ery pe rs on ” 

w as and is o f m aj or co ncern to th is d ep ar tm en t.

On Ju ly 18, 1966 th is co nc ern w as co mm un icated by Dr . H er ber t R. Domke, 

th en D irec to r of th e Al leg heny Cou nty H ea lth D ep ar tm en t, in th e att ac hed le tt er 

to th e Co nferen ce o f May ors an d th e Con ferenc e of Ci ty H ea lth Officers (e xh ib it 

A) an d su bs eq en tly en do rsed by th e la tt e r org an iz at io n in its Se ptem be r ’66 C ity 

H ea lth Officer New s, Vol. 6, No. 9. F u rt h er, th is dep art m ent’s ne wly es ta bl ishe d 

B ure au of Plan ni ng , E val uat io n & R es ea rc h was ch ar ge d w ith th e resp on sibi lit y 

of co nt in ui ng effo rts to st re ngt hen an d im pr ov e S. 3008.

Th e im po rtan ce o f th is b ill a nd its pr of ou nd im plicatio n to hea lth pr og ra m m in g 

on loc al, st ate and n at io nal le vels de m an ds a m en dm en t to st re ng th en loca l go ve rnm en ta l hea lth adm in is trat io n, loc al go ve rn m en tal hea lth serv ices an d to as su re 

th a t loca l he al th officers are i nc lude d pr om in en tly in th e pla nn in g fo r loca l he al th 

prog ra mmin g.

I t is urge d, th er ef or e, th a t th er e be fu rt h e r opp or tu ni ty fo r review an d part ic ipa tion by loc al an d st ate pu bl ic hea lt h officials an d Co ng ressiona l co mmitt ee s 

pri or to fi nal C on gression al acti on .

Sinc erely you rs,

E. J ane F le mi ng, M.D.,

Ch ief , B ur ea u of Plan ning , Eva lu ation tf Re sear ch .

(E xhib it A)

Alleg he ny County H ealth Depa rtme nt,

Pittsbu rg h. Pa., Ju ly IS, 1966. J oh n J. Gunth er ,

E xecuti ve Dire ctor ,

Co nferen ce o f Mayors.

E dw in D. Lym an , M.D.,

Pre side nt,

Co nferen ce of C ity H ea lth Officers.

Gentlem en: The follo wing an aly si s of Sen at e Bill 3008, Pu blic H ea lth P la nni ng an d G ra nt s, is w ri tt en in resp on se to your re qu es t. I rec om me nd th a t th e 

Co nferen ce of M ay or s an d th e Con ferenc e of Ci ty H ea lth Officers ta ke ac tio n 

to ca ll to th e att enti on of Co ng ress th e ne ed fo r am en dm en t if th e Bill is to 

ac hiev e th e im pr ov em en t in urb an pu blic hea lth in te nd ed by it s spo nsors.

P re si den t Jo hn so n, mem be rs of Co ng ress an d th e ge ne ra l pu blic as we ll ha ve 

ex pr es se d concern th a t th e re su lts of th e m as sive med ical re se ar ch effo rt are no t 

ad eq ua te ly re ac hi ng th e in di vid ual in hi s co mmun ity . Th e adm in is trat io n ha s 

spon so red Sen at e Bill 3008 to he lp m ee t th is co nc ern an d it is to do so by re orga ni zi ng th e g ra n t mec ha nism to c ha nn el Fed er al fu nds to st ate an d loc al publi c 

hea lth a gencies .

Th e even gre ate r im po rtan ce of th e M ed icar e Act has di ve rt ed atten tion from 

S. 3008. No ne thele ss, th e re org an iz at io n of th e g ra n t sy stem shou ld be th e 

st im ulu s to re vi ta lize st ate an d loc al official ag en cy pr og ra ms. S. 3008, th er efo re , is a Bill which m us t be of m aj or co nc ern to st ate an d loca l hea lth ag encie s 

th ro ughout th e U ni ted Sta te s, an d to th e Co nferen ce of Mayors .

Th e P re si dent’s 1966 H ea lth Messag e giv es th e ba ck gr ou nd fo r S. 3008. Th e 

P re si dent cl ea rly rec og nizes an d ca lls fo r ac tio n to st re ng th en urb an hea lth 

serv ices. Thi s is es pe ciall y to be w elcom ed fo r th e official hea lth ag en cies a t the 

F ed er al level ha ve no t giv en sufficien t att enti on to th e hea lth ne ed s of our now
PUBLIC HEALTH SERVICES AMENDMENTS OF 196 6 123

preponderantly urbanized population. Certa inly, therefore, the Conference of 

Mayors and the Conference of City Health Officers should enthusiastically support the adm inistra tion’s efforts to give more atte ntion to the hea lth problems 

of American cities. In any and all of the following comments and criticisms, 

therefore, it should be understood th at the Adm inistration’s goals and basic 

philosophy a re supported.

The specific background for S. 3008 is given in the President’s message of 

March 1,1966 as follow s:

“The focus of our efforts is the individual and his family, living in the ir own 

community. To meet the ir hea lth needs, requires the cooperation of many 

agencies, institutions, and experts—of State and local government, of doctors, 

nurses and param edical personnel.

“These are the fron tline fighters in our battle aga inst disease, disability and 

death. As in military battle, a winning strategy demands wise and well planned 

tfse of manpower. It demands coordinated use of all the resources available.

“I recommend to Congress a program of gra nts to enable States and communities to plan the better use of manpower, facilities and financial resources for 

comprehensive health services . . .

“Our purpose must be to help redirect a nd reform fragmen ted programs which 

encourage inefficiency and confusion and fail to meet the total health needs of 

our citizens.

“I recommend a program to initiate new State formula gra nts for comprehensive public health services. This program would begin in fiscal 1968.”

Und ersecretary Cohen went on to say in the testimony on S. 3008:

“The imp orta nt point is that State and local health agencies must shoulder 

the major responsibility for assuring the availability of high quality public 

health services. The proposed legislation will provide the Sta te and local health 

departm ents with Federal financial supp ort with which to meet their responsibilities and provide the leadership and coordination th at is so urgently needed.

“S 3008 has two principal objective s: Fi rst to increase the capacity for continuing, comprehensive planning for hea lth—statewid e, regionally, and locally— 

in partnership with the Federal Government- . . . It will perm it expansion of 

regional and metropolitan h ealth planning . . .

“Second, to redirect the focus of hea lth-grant programs to revitalize local 

and Sta te health effort and to focus program activities more clearly on bringing 

services to people . . .”

There are many imp ortant features of S. 3008. These quotations were selected 

to show the adm inistration’s ap par ent in tent to strengthen urban hea lth services. 

Turning to the Bill itself, however, the stateme nt of purpose begins to modify 

the stated goals and important sections referri ng to urba n health depa rtments 

become ambiguous. The Bill states (Page 3, Line 10) :

“. . . the Congress finds that comprehensive planning for hea lth services, 

hea lth manpower, and health facilitie s is essential a t every level of governm ent; 

that desirable adm inistration requires strengthening the leadership and capacities of State hea lth agencie s; and tha t support of health services provided people 

in their communities should be broadened and made more flexible.”

The phra se that support for people in communities should be “broadened and 

made more flexible” is not the language of the President’s message. The Bill 

does not use the President’s language of “redirect and reform fragm ented program s.” The “flexibility” among many of the existing programs ha s been a principle factor to lead to the existing fragmentation.

Turning to the State Plan ning Council which is the key group to car ry out the 

provisions of the Bill, Page 4, Line 12, provides “for the estab lishm ent of a State 

hea lth planning Council, which shall include represen tatives of State and local 

agencies and nongovernmental organizations and groups concerned with health, 

and of consumers of health services, to advise such State agency in carryin g out 

its functions under the plan .”

Although the Department of HEW ’s recen t legislation for Mental Retardation 

Prevention administe red by th e Children’s Bureau provides explicitly for involvement of the official health agency, the section quoted here is typical of PH S legislation in refusing recognition to the sta te and local official health agency. The 

section would be much strengthened by the inclusion of the word “official” on 

Line 14 to read “sta te and local official agencies.”
124 PU BLI C H E A L T H SE RV IC ES AM EN DM ENTS OF 1 9 6 6

At th e Assoc iatio n of S ta te an d T err it o ri al H ea lth Officers mee tin g w ith th e 

Su rgeo n Gen eral in No vemb er 196.", th er e was vigo rous discus sio n on th is po int 

w ith man y S ta te hea lth officers ta kin g th e po sitio n th a t ex plicit as sign m en t to 

offic ial ag en cies sh ou ld he specified in th e legi slatio n. Rep re se nt at iv es of th e 

Co nferen ce o f Ci ty H ea lth Officers who were pr es en t spoke to mak e a re la tionsh ip 

to th e official st ate or loc al go ve rnmen t hea lth unit re qu ired . Th e S. 3008, ho wev er, does no t ta ke ac co un t of th es e discussio ns.

Th e Bill prov ides, (P ag e 14, Li ne 16 et seq.) th at, “a t le as t 70 pe r ce ntum . . . 

of a sta te ’s a llot m en t sh al l he av ai la bl e to co mm un iti es of th e Sta te .”

Thi s is fine, bu t th er e is no comm ent w ith re ga rd to allo ca tio n in pr op or tio n 

to po pu lation or an y oth er urb an or m et ro po lita n fa ct or . This prov ision cou ld 

ea sily re in fo rc e an ex is ting patt ern on th e p a rt of S ta te H ea lth D ep ar tm en ts to 

pr ov id e dir ec t ex pe ns ive serv ice to ru ra l are as leav in g th e ur ba ni ze d mun icipal 

are as to co nt in ue su pp or t fo r loc al hea lth pro gr am s from th eir own reso urce s.

Pa ge 8, Li ne 14 et seq. pro vid es:

“. . . th e Su rgeo n G en eral is au th orize d . . . to mak e . . . pr oj ec t gra nts to 

an y oth er pu blic or no np rofit pri vate ag en cy or org an iz at io n to cover no t to ex ­

ceed 75 pe rc en tu m of t he co sts of pro je ct s fo r deve loping (a nd from tim e to tim e 

re vi sing ) co mpr eh en sive re gi on al m et ro po lita n are a, or ot her loc al are a plan s 

fo r co or di na tio n of ex is ting an d pl an ne d hea lth service s, incl ud in g th e fa ci lities 

an d pe rs on s re qui re d fo r prov ision of s uc h serv ice s

If I unde rs ta nd th is section co rrec tly , it wo uld be po ssible fo r a nonofficial, 

no ng ov er nm en tal ag en cy to ta ke re sp on sibi lity fo r “com preh en siv e region al, 

m et ro po lita n are a or ot he r loc al are a pl an s. ”

In ge ne ra l, as il lu st ra te d by th e pr ov isions of th e Bill so fa r qu ote d, th e entire 

Bill will te nd to co nt in ue fr ag m en ta tion a t th e loc al leve l. Th e Bill pr ov ides 

(P ag e 10, Li ne 12, e t seq .) th a t fu nds will mak e a sign ifi ca nt co nt ribu tion to w ar d 

stre ngt hen in g pu blic hea lth serv ices in th e va riou s po lit ical su bd iv isio ns “. . . 

in ac co rdan ce w ith cri te ri a which th e Su rgeo n Gen eral de term in es . . .” N ei th er 

he re no r els ew he re, ho we ver, is th ere an y as su ra nce th at ur ba n he al th se rv ices 

wi ll receive ap pro pri ate at te ntion, an d th e PH S has no t giv en ad eq ua te reco gn itio n to ur ba n he al th pro blem s. It wo uld he des irab le fo r th e Bi ll to spec ify 

mec ha nism by which then* wo uld he loc al official invo lvem en t to review th e plan s 

or to as si st th e Su rgeo n Gen eral in de te rm in in g th e cri te ri a.

Su re ly th er e is ad eq ua te legi slat iv e pr ec ed en t bo th in an d ou t of II EW to pr ovid e fo r more eff ective m et ro po lita n healt h councils. I am no t sufficie ntl y in ­

fo rm ed ab ou t va riou s Co ng ressiona l ac tion s fo r m et ro po lita n in te gr at io n to cite 

man y ex am ples. In the field of tr ansp ort ati on an d high way s, howe ver, th er e is 

bett er pr ec ed en t th an th is Bill use s. S. 3008 pr ov ides an un us ua lly good op po rtu n it y to ad va nc e m et ro po lita n plan ni ng , but re al iz in g th is op po rtun ity will no t 

he as si st ed by Co ng res s if th e Bill keeps th e pr es en t va gu e lang ua ge . Thi s sec ­

tion wo uld gr ea tly be im prov ed if re w ri tten to re quir e co or di na tion of an d w ith 

th e m et ro po lita n go ve rn m en t co un cil s of th e ki nd s now develop ed b y loc al go ve rnmen ts. such as th e Su pe rv isor s In te r-Cou nt y Com mittee of th e D et ro it ar ea , th e 

So ut hw es te rn Pen ns yl va ni a Reg iona l Pla nn in g Co uncil of P itts burg h an d the 

Eas t-W es t Gatew ay Coo rd in at in g Co uncil of St. Lo uis .

In th es e ex am ples, th e pr in ci pa l ele cted officials are al w ay s re pr es en te d an d 

in a m ajo ri ty ; ot her mem be rs of th e Co uncil, if an y. are ap po in te d by loc al 

go ve rnmen t auth ori ties . In an y case, it is no ns en se to ex pect th at an y kind 

of eff ectiv e co mpr eh en sive m et ro po lit an pr og ra m in he al th ca n be deve lope d 

w ith ou t su pp or t of th e inv olv ed m un ic ip al itie s an d th eir official he al th agencie s.

It, pe rh ap s, shou ld be no ted als o th at th er e are fu nd s now av ai la bl e to med ica l 

schools in th e Reg iona l pr og ra m s fo r H ea rt , Strok e an d Can ce r (w hich als o 

ex clud e local hea lth or ele cte d officia ls) th a t prov id e opp or tu ni ty fo r med ica l 

sch ools to ex tend se rv ices on a regi on al ba sis. A ge ne ra l prov ision of th is kind 

in S. 3008, th er ef or e, cou ld du pl ic at e pr og ra m s develop ed un de r ot her legislation.

I hope th is Bill will be ab le to rece ive th e st af f’s clo se at te ntion. Thi s Bill 

an d th is le tt er are spe cific to he al th plan ni ng . The im plicatio ns are, ho we ver, 

no t re st ri cte d to th e he al th field. The same ki nd s of cr itic ism wo uld be no les s 

ju st ifie d ab ou t legi slatio n si m ilar ly ph ra se d fo r urb an pr og ra m s ot her th an 

he al th . A re ce nt ex am pl e com es from a St. Lo uis Pos t D ispa tch ed itori al en ­

titled . “W ho C ar es fo r C itie s? ”, wh ich conc lude d w ith th e follo wing p ara g ra p h :

“U rb an aid does no t de pe nd ab so lu te ly on a ra tional iz at io n of eit her th e 

adm in is tr ati ve o r th e co ng ress iona l set-u p, but i t ce rt ai nly w ould be mo re e ffe ctive
PUBLIC HEA LTH SERVICES AMENDMENTS OF 19 66 125

if it were un de r more in te gra te d di re ctio n. If W as hi ng to n were no t w or ki ng at 

cro ss-purpo ses, it could be more effecti ve in he lp in g urb an au th o ri ti es to me sh 

mor e clo sely.”

In su m mar y, S. 3008 pr ov ides a mec ha nism fo r gra nt dis trib ution which wi ll 

ha ve a pr of ou nd eff ect on st ate an d loca l pu blic hea lth op er at ion. The cr itic ism 

of th e Bill prov ided he re is th a t cert ain as pe ct s of its wor ding an d clau se s do 

no t ac hiev e th e pu rji os e in te nd ed fo r it ha s an ad m in is ta tion Bi ll. F u rt h e rmo re, it is cl ea r th a t th e Bill was develop ed w ith out th e ac tive par ticip ati on 

of an y loc al pu blic hea lth officia ls an d de sp ite ad ve rs e cr itic ism fro m m an y st ate 

hea lth officers.

In view of th e im po rtan ce of the Bill it wo uld seem high ly des irab le fo r Congr es s to pr ov ide fo r more ad eq uat e rev iew . It wo uld see m ve ry des ir ab le fo r 

th e Co nferen ce of M ay or s an d th e N at io nal Assoc iatio n of Co un ty Officers an d 

oth er in te re st ed gr ou ps be giv en th e op po rtuni ty to ca re fu lly co ns id er th is an d 

be giv en th e op po rtunity to pr ov id e th e Con gr es sion al co mm itt ee s ad vice to 

st re ngth en an d im prov e th e Bill.

Sinc erely yo urs,

H erbert R. Dom ke, M.D.,

Director.

(Whereupon, at 12 noon, the committee adjourned.)

O