Part 26

In making the above statement, we do not wish to be misunderstood. We all know that we have among our patients in the Veterans’ Hospitals some of the best type of men anywhere to be found; some of the most ambitious; some who are exceedingly anxious to have their health restored and be returned to an earning status in life at the earliest possible moment; but, unfortunately, this does not apply by any manner of means to all the patients whom we are hospitalizing. Out of the disabled arising from an army of nearly five million men, naturally there will bob up representative types of every manner of man in existence. As representatives of Veterans’ Hospitals we owe to our Government as well as to our patient our best efforts to help, not only toward the rehabilitation of every soldier who can be rehabilitated but we are also obligated to help develop this program upon the most economical basis without sacrificing efficiency and the most satisfactory constructive results.”

MR. BURKE: stated that the subjects were now open for discussion, and called on Colonel Patterson for a few words.

COLONEL PATTERSON, of the U.S. Veterans’ Bureau,: stated that it had been a great personal loss to him that he had been unable to attend all of the meetings. He then spoke on the policy of the Veterans’ Bureau with respect to the utilization of contract hospitals and Government institutions. He stated that the Bureau has been for some months endeavoring to take the beneficiaries of the Bureau out of contract institutions and put them into Governmental institutions for several reasons—first, the law says we must utilize to the maximum extent the Government facilities in existence. Another reason is that the majority of contract hospitals are unsatisfactory from the treatment standpoint, if from no other reason, as many of these contract hospitals are purely boarding houses which originated merely for the purpose of making money out of the Government, by taking care of beneficiaries of the Veterans’ Bureau. Of course there are many contract hospitals in which this is not true, but it has been determined that better treatment at least equal cost can be obtained in the Government hospital. Another reason is that the civilian hospital is not particularly interested and does not desire to make the necessary reports. He also mentioned discipline. The contract hospitals do not like to discipline a man because it may lead to the loss of that patient. He stated that every time the Hospital Section of the Medical Division recommends the closing of a contract hospital the Bureau is immediately bombarded by letters from Congressmen, Senators, the American Legion, United Veterans, and other organizations, but the Veterans’ Bureau has been trying to stand firm.

The next subject he took up was the fact that a beneficiary gets more compensation while he is in a hospital. This, however, cannot be changed except by Act of Congress, and the Medical Division has recommended to the Director that the man’s compensation be reduced while he is in the hospital.

He took up next disciplinary regulations. With regard to payment of transportation, he stated that this money could not be deducted from the man’s compensation without Congressional action.

He spoke also on the fact that under the Vocational Rehabilitation Act a man discharged with a disability not connected with the service, who has been denied compensation, can get training even if his disability is the direct result of his own misconduct, and that he is entitled to treatment for any disease contracted while taking training if it interferes with the continuance of his training. The Medical Division recommended some time ago that Section 3 training be discontinued and that no man be given training unless his disability is the result of service or aggravated thereby.

He said he hoped that the gentlemen present would express their opinion as to whether or not meetings similar to this one should be held annually.

With regard to the attitude of the Veterans’ Bureau towards the various Services, he stated that when allegations are made all the Veterans’ Bureau can do is to send them to the Head of the Service, asking him to take the usual steps to find out whether or not those things are true. On the other hand, if there is a charge a man is mistreated, the Veterans’ Bureau must investigate it. It is a very peculiar situation for one Department to investigate something conducted in another Department.

Regarding complaints, he cited one case. A letter was received from an insane man in the west Roxbury Hospital, who signed the letter “All the patients in the hospital”, and complained about everything in the institution. A letter was immediately received from a Congressman, then another, and one from a Senator. The institution had been inspected only ten days previous and the Veterans’ Bureau was sure the allegations were not true, but sent out another man to investigate the matter. Later the Bureau received copies of similar letters which the insane man had sent to President Harding, King George and the Prince of Wales. He mentioned this as an illustration of what the Veterans’ Bureau has to put up with.

Speaking about coordination and cooperation, he mentioned the fact that the Public Health Service is represented in the Veterans’ Bureau by Dr. Guthrie, Dr. Lloyd and Dr. Long, the Navy by Commander Garrison and Commander Boone, and the Army by Colonel Brooke and Colonel Hutton. In this way the Bureau benefits by the advice of these men, and friction between the Departments is avoided.

Another thing he took up was the situation in Arizona. Attempts have recently been made to get the Bureau to put hospitals in two towns, Phoenix and Tucson, both of which he stated were so hot that everybody would have to get out in the summer. There are 431 vacant beds at Prescott, within 400 miles, and in a few months 422 more will be available. Transportation has been offered these men to these hospitals but many have refused to go. He believed that the Veterans’ Bureau could do more than this, but wanted an expression of opinion on the subject.

MR. BURKE: asked for further discussions on the questions raised by Colonel Patterson.

DR. KLAUTZ: stated that he would like to ask Col. Patterson whether the question of furloughs has been taken up in connection with disciplinary regulations.

COLONEL PATTERSON: informed him that length or frequency of furloughs had not been determined, but permission to be absent will be obtained from District Managers under policies issued by the Central Office from time to time. He asked for an expression of opinion on this subject.

DR. KLAUTZ: stated in regard to the situation in Arizona that probably all the hospitals available there were situated in an altitude of 5000 ft.

COL. PATTERSON: informed him that Camp Kearny is lower than this. He stated that the policy of the Veterans’ Bureau in regard to tuberculosis has the backing of the National Tuberculosis Association, and that the men asking for hospitalization had been offered transportation to Kearny or Prescott.

DR. KLAUTZ: offered the suggestion that somewhere in the mountains North of Tucson there might be places which were not too high and would be good all the year round.

COL. PATTERSON: reported that there are already at Prescott 131 vacant beds and within four months will be 432 additional. Why should we go to additional expense when we have these other hospitals?

DR. LONG: took up the subject of the speeding up of patients in hospitals, which is necessary for two reasons—first, in the interest of the man himself, and, second, in the interest of economy. The average man was about 25 years of age when he entered the service, and it should be taken into consideration that his character had not been formed, and that keeping him in a hospital tends to destroy still further his initiative, so the sooner a man gets out of the hospital the better it will be for him. As for economy, it costs about $240 a month to keep a man in a hospital. He stated that dispensaries are now being established in the district and sub-offices, where treatment can be obtained, thus a man should be discharged as soon as he has reached the maximum improvement. He cited the case of Palo Alto, where arrangements had been made with Dr. Wheate that when a man had reached the maximum hospital improvement such further treatment as was needed should be obtained in the out-patient office. In about six weeks the total number of patients was reduced from 540 to 417.

DR. ELLIOTT: took up the question of furloughs, stating that at the Naval Hospital in Washington at Christmas time many Veterans’ Bureau patients asked for leave, and pursuant to advice from the District Manager they were given the same amount of leave that the other Naval patients received, from 5 to 10 days.

DR. DEDMAN: spoke on economy. He said he understood a certain rate per diem was to be established for the care of patients, and wanted to call attention to several things in this connection. First, the environment. Some hospitals have central heating plants; others have stoves. He said that his hospital was an old cantonment hospital, with a unit heating system which required the employment of about 45 stokers.

Another thing, some hospitals Are a great distance from markets; also, prices may be higher. All those things make quite a difference in the average cost of the care of a patient per day.

With regard to General Order 27, he called attention to the clause which gives the Medical Officer in charge the privilege of giving the man his transportation back to his home, and mentioned the case of a man who come to the hospital from Oteen, where he had been discharged for disciplinary reasons. The hospital could not admit him, but authority was obtained from the Veterans’ Bureau to admit him for examination, and, if active, to hospitalize. The man was examined and found to be inactive. He then complained to the American Legion because they did not hospitalize him, and he had no way to get home. However, in this particular case, transportation was later received from the Veterans’ Bureau. General Order 27–A now gives the Medical Officer authority to pay transportation.

He then asked whether a man who had been discharged for disciplinary reasons and was very sick should be hospitalized.

COL. PATTERSON: informed him that General Order 27 has ample authority for emergency cases.

CAPT. BLACKWOOD: expressed his appreciation of the opportunity to attend the conference, and of the great value it had been.

He mentioned the fact that the word “discipline” carries with a feeling of dread. Discipline is purely and simply obedience, and when you have obedience you have discipline. Orders should be issued in such away that no antagonism will be created. He gave an example: In the Naval Hospital the patients are all supposed to stand at attention, if able, when the Commanding Officer comes thru the wards. The Veterans’ Bureau patients objected most seriously to this, so an order was issued that they should sit down, and now you couldn’t make them sit down.

He stated that with regard to the question of absence of a patient over leave for seven days, under G.O. 27 a man can now stay away six days without any action other than minor punishments, which he said is absolutely ridiculous. He thought some other form of punishment, should be devised, as reduction of compensation would not affect many of the patients who are not receiving compensation, and believed the Commanding Officer should be allowed to assign these minor punishments. He did not believe the patient should be discharged, as in that case he would only go to another hospital.

Another thing he suggested, with reference to medical records, was that a skeleton record, at least, of the history of a man’s treatment, his examination and diagnosis, should be made to follow him around from place to place. This would save a great deal of work and give the hospital a line on what has been done for the man in the past. He said patients had been hospitalized anywhere from one to thirty-five times prior to coming to his hospital, and it was impossible to get a history of their previous hospitalization.

HON. CHARLES H. BURKE: I happen to be, as some of you may know, at the head of the Bureau of Indian Affairs.

In listening to the discussion this morning by Mr. Madden and by General Dawes, I have had brought to my notice that there are some things in connection with hospitalization that compare in some respects with some of the things I have to come in contact with in connection with the administration of the affairs of the Indians.

Mr. Madden referred to the politicians and the harm they may do by criticism and comment and so forth. I don’t think he meant when he said politicians, the men who may participate in politics. I think he had in mind these demagogues and agitators and sources of propaganda that are doing more harm in the Government service,—I know it is true of the Indian Bureau,—than anything else or everything else all put together; and I think something of that applies to the hospitalization question. Agitators, I call them. Some of them are perhaps interested in the Indians and in their purposes, supersensitive, possibly. Others have selfish motives that they desire to serve; others are just ordinary trouble makers.

So, in the Indian Service, one of the things that we are handicapped by is this aggregation that I have just described, that are criticizing and finding fault with practically everything that is being done. One of the things that they contend for more than anything else is that the Federal Government, in supervising and administering the affairs of the Indians should, before they put into operation any policy for their uplift and their advancement, have the consent of the Indians. What an absurd proposition! When you contemplate sending your boy to some educational institution, are you going to permit him to dictate and say to you what you shall do, or, when he selects a certain institution and tries it for a few weeks, say that he does not like it and is going to try some other institution? How far would a father get with a son if he permitted him to dictate and dominate the situation?

So it seems to me that this question of hospitalization and caring for the ex-service man is very largely a medical question and it ought to be administered with a view to what will be most productive in rehabilitating and restoring these men to full health; and so it occurred to me that before this meeting adjourns, and because possibly the impression may have been given this morning that the principal question was one of economy, that we should, just for a moment, consider this other question of what can be done and what should be done for the best interests of these ex-service men. It will require regulations; it will require legislation.

If you have not been repaid in the other sessions of this Conference until this forenoon, I think every one of you who has come from some distance will feel that he has been fully compensated in listening to the discussion by General Dawes and Mr. Madden with reference to what the Government, under our present Chief Executive, is endeavoring to accomplish in the matter of administering Government. And so we have this hospitalization proposition and all of the Departments having to deal with that subject. We have this Federal Board of Hospitalization made up of representatives or the heads of these different departments.

Now what I want to ask you gentlemen, and I am talking to you now as experts, as men who are in the field in charge of hospitals, in a position to see this Question from every angle,—what can you do now that will help the situation. This is what I want to bring to your attention: that is, that each and every one of you, through your proper officers, communicate freely and from time to time what you believe ought to be done to strengthen and improve this service; and then, these suggestions coming from every part of the country and all of those different institutions and services will be concentrated and ultimately have consideration by the Federal Board of Hospitalization, and a regulation will be prepared where needed and necessary legislation will be suggested to Congress in the interest of better caring for and administering these different hospitals throughout the United States.

My opinion, gentlemen, is this: that when a man goes into a hospital he is presumed to be ill and should be governed by such regulations and by such control as will best enable him to recover from his disability at the earliest practicable time; and if he ought to have considerable money and if he ought to be permitted to go his way, let him go; but if, on the contrary, he should be required to live within certain reasonable discipline as to his personal conduct, if he should be limited in the amount of money that he should have to spend as he desires he should be limited by you, who are expert and who have no possible thing in mind except the welfare of these men.

Now don’t get the impression that you can get all the legislation that you think perhaps you ought to have. I am not going to speak of the Congress as constituted now, because a person in the administrative side of the Government and in a bureau is not supposed to talk about the Congress and so I am not going to say anything about the present Congress; but up to about six years ago and for a period of many years, I happen to know that there were men in Congress that don’t measure up to what my friend, Mr. Madden, said a member of Congress ought to be. There used to be members of Congress who kept their ears very close to the ground listening constantly for any criticism, for any comment on any part of the Government service, perhaps through a magazine or newspaper; and they rose on the floor in their might to denounce some policy or administrative action on the part of the Government simply because they lacked the courage of their convictions.

Mr. Madden does not come within that class of members of Congress. He is a man who has always been known to have the courage of his convictions. Perhaps the entire body is now made up of that type of members, but such was not the case up to 1915.

These agitators that I have spoken of, these demagogues, have learned what you can do with a scared member of Congress, and we used to say that the thing that emphasized most a scared Congressman was two. We don’t have them I think any more.

My friends, let us hope that Congress is so constituted at the present time, and we will assume that it is, that it will courageously and fearlessly and without any regard as to what the results may be to themselves, rise up and respond to what you gentlemen, through the heads of these various Departments and the Federal Board of Hospitalization may indicate and will enact into law such legislation, and if there are any in the Congress who may have any fears about the results if they do so act, I would say to them they have less to fear by keeping courageous and standing for what is right, regardless of the comment at the time, or the criticism that may come from certain sources.

Gentlemen, I thank you for the privilege of these few words and I hope that all of you and each of you will be generous and diligent in communicating, whenever you have any suggestions to make with reference to bettering this service, in order that they may have the consideration of these co-ordinating Departments that were so ably described this morning by General Dawes. I thank you.

GEN. SAWYER: General Ireland, have you anything to say?

GEN. IRELAND: I don’t believe I have. I think it is time well spent and I trust that there will be further meetings of this kind.

ADMIRAL STITT: I can only repeat what General Ireland has said. I have learned a great deal from this Conference and feel sure that everyone agrees that we should have a similar Conference, possibly every year.

GENERAL CUMMING: I have nothing to say except to express what I know is the appreciation of everybody here to you as Chairman of the Board for having inaugurated such a Conference, and, secondly, I think we owe something to Colonel Forbes as an agent for having brought us all together.

COL. MATTISON, N.H.D.V.S.: I can voice the sentiments just expressed. I expected this meeting to be exceedingly valuable and it is vastly more so than I had ever anticipated. I am very glad indeed to have had this opportunity.

DR. WHITE: I want to express my personal appreciation for having had the opportunity of coming into personal contact with all of you men who are engaged in this work. I have long felt that one of the very great values of a congregation of this sort is that resulting from personal contact with men who are doing the same work.

I have listened to all of the discussions. I don’t know what I have learned, but I feel, as I go back to my desk, that during the coming year I will, in my various decisions, hark back to something that has been said here that will help me solve the questions of the day. The real things that one learns on occasions of this sort it is almost impossible to formulate in one’s mind at the moment but they are always brought up and proven valuable day by day. Thank you very much, gentlemen, for the privilege of meeting you and I am going to ask you to come out to St. Elizabeths and visit with us.

COL. PATTERSON: I have already occupied a great deal of time and so I can only voice the sentiments expressed by the previous gentlemen. I know those of us in the Bureau have learned a great deal and I hope that it will be possible to let us have the benefit of a similar Conference next year. We in the Bureau will be in a much better condition to profit by your suggestions than we are this year and we will know better where we stand than we do at present. Most of us are rather new to the job and are in a very receptive mood.

In passing I would like to tell Captain Blackwood that the new order, G.O. 27, covers most of the things he brought up. Some of the other suggestions as to the way patients got into hospitals I fear will take some time to rectify. We are in the hands of our agents in the field. Many of them are not up to the standard. We hope to rectify that. As far as the hospital question is concerned, I think you understand that the Medical Bureau is with you and I hope you will take to heart what Commissioner Burke has said and give us in writing the benefit of your opinions and send them in through your chiefs. I hope you will give that your attention and let us have the benefit of your advice. We want constructive criticism and we need your help.

GENERAL SAWYER: How many of the Commanders present are accompanied by their wives. Those that are, please stand. (Six stood up) I want to say furthermore that the reception at the White House is at 8:30; entrance by the North Portico. I feel sure that I can predict for you a very pleasant evening.

In summarizing, just in a few words, I would like to give you something of an idea of the impressions that have come to me and I believe that you will agree that they are fair and that you should accept the same impression for yourself.