In the case of student nurses, we estimate 99. We also take into consideration meals that will not be served due to annual and sick leave. That comes down to a net number of meals that we serve to each category of employees, and that it what the total is. Also in that figure are dietetic aides that are required to take one meal at the hospital. That includes kitchen help and dietitians and the like. Senator THYE. Do you say they are compelled? Mr. BAIRD. They are compelled by law to have at least one meal taken from their salaries. Those are food handlers. CONTRACTS WITH NEIGHBORING POLITICAL SUBDIVISIONS Senator THYE. Have you had any difficulty with the agreements or contracts that you have with outside political subdivisions, which you discussed a year ago and from which source you anticipated revenue? Mr. BAIRD. Yes, sir; very much so. We have had a great deal of difficulty. Senator THYE. In which respect? Mr. BAIRD. As of July 1, 1952, we have had actually two contracts in hand, they being from Arlington and Fairfax Counties, Va. As of February 28, from those two areas, we have collected and have deposited in the Federal Treasury $126 for the care of indigent patients. The largest bulk of our indigents come from Prince Georges County, Md. On July 21, 1952, we received a communication from a Mr. C. Calvert Lancaster, attorney for Prince Georges County, in which he stated that the county would not enter into any agreement with the Federal Government for the reimbursement of indigent patients at Freedmen's Hospital. The problem is this: Prince Georges County patients are still coming to us. We have emergency cases that come to us. We have to take care of them. The elective cases, since the receipt of this letter, July 21, have been sent back to the county for care in their own hospital. It is my understanding that they do not have full facilities in Prince Georges County to take care of the Negro population. As a result, some of the elective cases are streaming back to us. I presume, although I don't know, that some of them are being taken care of. But I don't believe, honestly, that they can take care of the full load there. And as of this date, we have two contracts which are renewed each year, they being in Arlington and Fairfax. In the total picture, they represent the smaller of our patient load as far as indigent care from the States is concerned. Senator THYE. If you have difficulty in making collections there, what do you propose to do about it in the future? Mr. BAIRD. As I said before, the only thing that we can do is what we are doing now, sending the electives back to the county, hoping that they are receiving medical care. We have to accept the emergency cases when they come to us. We could not turn them away. That has been our practice. We have had cases of emergency admissions. ESTIMATED AMOUNT DUE Senator THYE. What do you feel that they owe you? Mr. BAIRD. We honesly feel that they owe us the reimbursement that is due the Federal Government. Senator THYE. How much would that be? Mr. BAIRD. I believe that all reimbursements should be actual cost of operation. The contract that we have with Fairfax and Arlington has been at $9 a day, which was the established rate that the District of Columbia has reimbursed us, and they felt they should reimburse us no higher than anyone else. Senator THYE. How much do you think they owe? Mr. BAIRD. Even at the $9 rate, I believe that it would be approximately Senator THYE. I mean if they have failed to pay for your care of patients, how many patients do you think you have taken care of and how many dollars does it represent that you have not been reimbursed? Mr. BAIRD. I can get that figure. It would have to be an estimated figure. Senator THYE. In other words, here is a county that is sending its patient load to the District of Columbia and then asking the Federal Government to carry the bill; is not that it? Mr. BAIRD. That is it. Senator DWORSHAK. Has the county refused to make the payment? Mr. BAIRD. Yes, sir. I have a letter here on that. Senator DWORSHAK. Over how many years has that practice been invoked? Mr. BAIRD. I would say prior to 1951 it was the practice of all counties to send patients to Freedmen's Hospital, and no reimbursements were made. Two or three years ago the Congress directed us to make attempts to make collection. Since that time, through the cooperation of the legal branch of the Public Health Service, we have been trying to negotiate contracts with the various counties that sent patients to Freedmen's. I would say it dates back practically from the beginning of Freedmen's Hospital. Senator DwORSHAK. What does it amount to annually? Mr. BAIRD. I don't have that with me now. Senator THYE. But you can supply us with that on an estimated basis, for the record; is that right? Mr. BAIRD. Yes. (The information referred to follows:) FREEDMEN'S HOSPITAL-FEDERAL SECURITY AGENCY ESTIMATE OF FREE PATIENTS, BY PATIENT-DAYS, RECEIVING CARE IN FREEDMEN'S HOSPITAL FROM MARYLAND AND VIRGINIA In accordance with the request made by the chairman of the Labor-Federal Security Subcommittee of the Senate Committee on Appropriations on the total estimated cost of free care rendered to Maryland and Virginia residents in Freedemen's Hospital, the following data is furnished. It should be noted that the estimated patient-days developed herein are based on indigency criteria of the hospital and would not necessarily meet the criteria for indigency that exists in the various localities shown in this estimate. Also, these estimates are based on a sampling from statistics compiled in fiscal year 1952. 1 Included in this figure are patients living in the District of Columbia who have not established legal residence in the District. ESTIMATE OF COST OF FREE SERVICE RENDERED TO MARYLAND AND VIRGINIA PATIENTS The actual consolidated (general and tuberculosis hospitals) per diem cost for fiscal year 1952 in Freedmen's Hospital was $16.46 a day. The estimated free cost rendered Maryland and Virginia based on the hospital's actual per diem cost of operation is as follows: Maryland: 31,729 patient-days, at $16. 46 per day---- $522, 259.34 158, 641. 48 Estimated reimbursement using rate established for the District of Columbia : $285, 561.00 86, 742.00 Senator THYE. Senator Dworshak, have you any further questions on this? Senator DwORSHAK. I am sorry that I missed some of the testimony. Senator THYE. We are through with this particular item now. FACILITIES PLANNING Senator DwORSHAK. I was interested in the contractual service request for $50,000, on page 22. Has that been explained? Mr. BAIRD. No, sir. Senator DwORSHAK. Can you very briefly state what you intend to do with that money if you get it? Mr. BURBRIDGE. The money is for the purpose of making a survey in order to develop a program for any necessary facilities planning that we might have at Freedmen's Hospital; also to determine the role of the hospital in regard to its relationship to the District of Columbia and also to Howard University College of Medicine. Senator THYE. I think there is some question about that phase of the budget which may be still under consideration in the Bureau of the Budget, and that is one reason why we have not discussed it, or no questions have been asked about it. That is my understanding of it, that the Budget Bureau is taking another look at this particular item. Mr. STEPHENS. That is right. Senator THYE. Therefore, we thought that inasmuch as the Budget Bureau is giving it another look, that we would not take either the time, nor would we try to develop the record on it. Senator DwORSHAK. Will it come up later? Senator THYE. If some recommendation should come to us on this question, we will take it up at some future hearing. That covers the item, gentlemen, and thank you. We will proceed with the next item. ST. ELIZABETHS HOSPITAL STATEMENTS OF WINFRED OVERHOLSER, SUPERINTENDENT, ST. ELIZABETHS HOSPITAL; ADDISON DUVAL, FIRST ASSISTANT PHYSICIAN; S. B. WILSON, MAINTENANCE OFFICER; C. G. DUNLAP, BUDGET OFFICER; AND M. A. STEPHENS, BUDGET OFFICER, FEDERAL SECURITY AGENCY APPROPRIATION ESTIMATE Salaries and expenses: For expenses necessary for the maintenance and operation of the hospital, including purchase of one passenger motor vehicle for replacement only, clothing for patients and cooperation with organizations or individuals in scientific research into the nature, causes, prevention, and treatment of mental illness, [$2,520,000] $2,428,500. NOTE.-Reimbursements from non-Federal sources above are from the District of Columbia for care of indigent patients and miscellaneous items such as cafeteria sales, sales of scrap, and receipts for officers' board (32 D. C. Code 401-416). Senator THYE. The next item is the appropriation for salaries and expenses, St. Elizabeths Hospital, for which the budget estimate is $2,428,500, a reduction of $91,500 from the current year's appropri- The hospital will also have available in 1954 from reimbursements $10,407,644, an increase of $131,434 over the amount expected to be derived from reimbursements in the current fiscal year. I believe it would be well to have in the record at this point pages 9 and 10 of the justifications, which contain the reimbursement de- Those pages will appear in the record at this point. |