The only Public Health Service hospital facility now available to seamen in the Great Lakes area is the hospital located in Detroit, Mich. The Public Health Service hospital in Chicago has already been closed. Medical and dental care for merchant seamen have been provided by the Public Health Service since 1798. The experience gained by the Service over the ensuing years has certainly resulted in an understanding and appreciation of the problems peculiar to seamen. They should not now be made secondary citizens by turning responsibility for their care and treatment over to the Veterans' Administration, the primary mission of which is to care for the veteran.

It is true that many of the Public Health Service hospitals are outmoded, but you do not solve this problem by eliminating the service or transferring the function to the Veterans' Administration. It hardly seems reasonable to believe that seamen would receive the same consideration and care in a Veterans' Administration hospital as from the Public Health Service system.

The proposed restriction of the Public Health Service system is viewed as inimical to the already hard-pressed Great Lakes vessel industry, and is further evidence of a lack of interest by the Federal Government in this important segment of the American merchant marine. As far as the Great Lakes are concerned, the proposed discontinuance of the Detroit Public Health Service hospital can only result in less skillful attention to the medical needs of the seamen.

It is difficult to understand why the Department proposes to maintain facilities on each of the three sea coasts but withdraw those same facilities entirely from the Great Lakes. Such a drastic step should not be taken without appropriate congressional approval. For this reason, Lake Carriers' Association endorses S. 1917 and urges its

enactment.

Senator BARTLETT. Mr. Meyers, please?

STATEMENT OF THOMAS L. MEYERS, WASHINGTON REPRESENTATIVE, SEAFARERS INTERNATIONAL UNION, WASHINGTON, D.C.

Mr. MEYERS. Mr. Chairman, we have filed a written report for the record and I will try to confine my remarks to what has been left unsaid here or my observations on certain comments made earlier. Senator BARTLETT. When you say "we," you mean the Seafarers International Union of North America?

Mr. MEYERS. Yes. I am speaking for them, sir.

The question arises in my mind, sir, as to whether the Public Health Service remarks regarding their responsibility should be interpreted as being merely physical. We would assume, or we would hope the interpretation placed upon the responsibility, as referred to in their statement, means medical responsibility. We fail to see where the transfer of seamen to veterans hospitals constitutes a continuation of medical responsibility for the care of American merchant seamen. We would hope, sir, that adequate facilities and services are made available for seamen, whether they are referred to the veterans hospitals or to community hospitals, in the event that VA facilities are not available to them.

We are particularly concerned in view of the General Accounting Office interpretation of the legality of treating seamen at veterans

hospitals. If it is finalized that the treatment of seamen at veterans hospitals is not legal, we fail to see how the seamen can be properly administered to, when they become ill, because we question very much the fact that with the high cost of community hospital services for individuals, that a continuing use of the community hospital at rates of about $60 a day in place of the $27 to $28 a day charge in Government facilities will be continued.

In my own particular knowledge, from the southern California. area, where there was no public health service hospital in the Los Angeles area, we found that they were very adverse to treating seamen in community hospitals, unless they were dire emergency cases. They preferred to put them on a waiting list for the San Francisco Public Health Service Hospital and this waiting list extended 3 to 4 weeks beyond the time that they made the original application.

Now it is well-known, of course, that all of the VA hospitals are highly crowded at the moment, and reference was made earlier today before the Appropriations Committee of the Senate to the Houston Hospital, which has a bed capacity of 1,200 beds. This hospital is now 95.8 percent crowded, or being utilized to the extent of 95.8 percent. We think it is going to be utilized even further as a result of the aging of the veterans, and I would like you to keep in mind, sir, that there are now 16 million veterans of the Korean war and World War II, and with the Government VA hospital capacity of 125,000 beds and we feel in the next 5 to 10 years the hospitals will be overcrowded and we fail to see how they will take care of the seamen.

In Galveston, the Public Health Service hospital there has 139 merchant seamen as a daily load. They propose to put these men into the Houston hospital, which as I say is 95.8 percent occupied today and the American Medical Association and all competent medical people state that no hospital should have more than 80 to 85 percent occupancy and anything in excess of that creates an inefficient operation.

Constant reference has been made by the Public Health Service to the cross servicing arrangements they have with the other agencies. Now we feel that wholesale cross servicing is no longer cross servicing, it is a transfer of the function of the Public Health Service to another agency.

We question the legality of that particular interpretation. As I say as to cross servicing, we have no argument to cross servicing as such, where it is used in an occasional case, but wholesale cross servicing or transfer of functions to another Government agency is not in our opinion proper. I have no argument, of course, with the people from Public Health Service, but the statement of Mr. Kelly this morning representing the Public Health Service we feel, of course, is a result of pressure put upon the Health, Education, and Welfare Department by the Budget Department.

They make reference to the fact that the closing of these hospitals will provide more accessible service to the patients needing medical care. They fail to make reference to the fact that there are 1,900 beds in the Public Health Service, in five remaining Public Health Service hospitals which will be left at the end of the period when

the seven hospitals will be closed. They state that they anticipate an expanded capacity of about 2,400 beds or an increase of approximately 20 percent.

I would like to call the committee's attention to the fact that the Public Health Service now has 3,000 beds, and a curtailment to 2,400 beds is certainly not an increase of facilities of 20 percent, but rather it is a drop of 20 percent.

I could go on through this report, I think a close analysis of it would prove that many of these facts are not in line with the true picture. I thank you, Mr. Chairman, and I hope this S. 1917 is approved by the Senate.

Senator BARTLETT. Mr. Meyer, do you consider that a sword is dangling over our heads, as it were, following the testimony of the Bureau of the Budget?

Mr. MEYER. I most certainly do. And one fact I didn't mention, which I should bring at this time, Mr. Chairman, is the fact that I know that all members of this committee dealing with maritime affairs are aware that at the present time we are in a period of negotiation on contracts and I most definitely feel that the maritime unions will certainly have to protect the interests of their members and negotiate some kind of clause that in the event the facilities for the seamen, these hospital facilities for seamen, that these should be abandoned or curtailed by the Government, they will certainly have to work this into the contract where the shipowner will have to pick up the tab.

We don't wish to contribute to the additional costs of the shipowner, but we would certainly have to protect the interests of our members and negotiate something like this in these contracts. When you say a "sword dangling over our heads," I assume you mean with reference to the medical care for the seamen, and the possibilities of this thing being abandoned altogether; is that the reference you meant?

Senator BARTLETT. At least the bill being vetoed.

Mr. MEYER. I am afraid it will be, sir, but we must go on record and fight in every way we can. We would hope it would not be, in consideration for what is just and fair for our people, but I would certainly hope it will pass and be OK'd by the time it reaches the White House.

Senator BARTLETT. Mr. Foster?

Mr. FOSTER. No questions.

Senator BARTLETT. Mr. Kenney?

Mr. KENNEY. No questions.

Senator BARTLETT. Your prepared statement will be printed in the record.

(Mr. Meyer's statement follows:)

STATEMENT OF THE SEAFARERS INTERNATIONAL UNION OF NORTH AMERICA, AFLCIO, ON S. 1917

My name is Thomas L. Meyer. I am the representative in Washington for the Seafarers International Union of North America, AFL-CIO, whose membership of 80,000 includes seamen on the Atlantic, gulf, and Pacific coasts, the Great Lakes, and on the inland waters of the United States.

The Department of Health, Education, and Welfare's anomalous announcement of January 19, 1965, of its plans for far-reaching changes in the general hospital system operated by the Public Health Service came as a profound shock

to American seamen, the trade unions which represent them, the management which employs them, and to all others who are concerned with the maintenance of the high quality of medical care and treatment that are available through the Public Health Service marine hospitalization program.

In announcing its plans, the Department stated that 7 of the 12 remaining public health hospitals would be closed. The plans say that a system would be provided which will permit "many Public Health Service beneficiaries" to obtain care at facilities of the Veterans' Administration, after the closing of the Public Health Service hospitals in Boston, Norfolk, Savannah, Galveston, Memphis, Chicago, and Detroit. This ill-conceived program apparently stems from pressures by the Bureau of the Budget, which has made a systematic effort to terminate the Federal program of medical care for seamen and the other public health hospital beneficiaries. It appears that the Public Health Service hospital service is slated for abandonment as a result of the Bureau's campaign of attrition over the past 10 years or so.

The plan to destroy this very vital service is at once both shocking and inconsistent in light of the special functions performed by the Public Health Service, the top quality of its services, and the absolute need in our Nation today for developing and increasing medical care and facilities rather than to diminish and liquidate them.

Since 1798, when the Congress established the marine hospitals-as the U.S. Public Health Service hospitals were called formerly-merchant seamen and other Federal beneficiaries have been eligible for a program of medical care and treatment which has been necessitated by the peculiar nature of their employment. The program of marine hospitalization was shaped to meet the special requirements and character of maritime employment. The considerations which led to the establishment of the Federal program of marine hospitalization under the Public Health Service still exist today. Merchant seamen, who are certified for their employment by a Federal agency-the U.S. Coast Guard-must work without the availability of medical care and treatment while on the job at sea. Their work is transient. They are subject to limitations of time in port, to the very flexible schedules of ship arrival and sailings and the need for meeting precise physical requirements before obtaining clearance to ship. They require the availability and accessibility of hospital and medical care after protracted periods at sea, and because they may require such care at any port in which their vessel may call or sign on and pay off, the maximum possible number of strategically located facilities is essential. These required services have been available to merchant seamen-and to the other Federal employees, who also are eligible for Public Health Service treatment-at the Public Health Service hospitals and clinics. However, this availability has been on a diminishing basis over the years as a result of the periodic closings of a number of these institutions inspired by pressures from the Bureau of the Budget.

The quality of medical care and treatment in the Public Health Service hospitals has been excellent. Staffed as they are by dedicated doctors, technicians, and other staff people, the Public Health Service hospitals have functioned with a uniformly high degree of competence, devotion, and understanding. Complaints or grievances against Public Health Service facilities by merchant seamen and the maritime unions representing them are virtually nonexistent a rare condition when you consider the manifold grievances in regard to hospital and medical care generally today.

Perhaps the most shocking aspect of the Government plan to close the seven Public Health Service hospitals and to attempt to divert patients to the Veterans' Administration is the utter incongruity of liquidating established Federal medical hospitals universally respected for their high quality, comprehensive medical care and treatment, research and clinical facilities at a time when the administration has expressed determination for a "Great Society" to include expanded medical care, increased hospital and clinical facilities, and greater research efforts under Federal aegis. In fact, it is obvious to everyone that the Government is working completely in this direction because it is acutely aware of the Nation's hospital and medical needs.

Those responsible for the plan to close the Public Health Service facilities and to ultimately dissolve the very effective and useful contribution to the wellbeing of Americans by this highly respected service are either uninformed of the medical care and research goals set by the administration or they are indifferent to the needs of our society. They certainly did not pay any attention to the President's Commission on Heart Disease, Cancer, and Stroke when it recommended in December 1964 that "the Division of Hospitals of the Public

Health Service be appropriated funds for the renovation and the development of research space in existing facilities and for increased research and training activities."

The President's Commission also recommended that the "still significant Public Health hospital system, which has taken promising steps toward an increased research and training program in recent years, be supported in the development of its full potential for research and training as well as patient care."

The Health, Education, and Welfare Department's announced plan for redueing the Public Health Service hospitals from 12 to 5 disregards the Commission's sound recommendations and evidences an absolute lack of the compassion and feeling that is fundamental to any successful program of medical care and treatment for American citizens. The plans of the Bureau of the Budget and the Department are fraught with flaws and unwarranted and misleading projections, both from the standpoint of continued availability of the marine hospitalization program for seamen and from the dollars and cents standpoint. Such plans certainly should not be permitted to influence judgments which affect the well-being of American citizens and which were made on the basis of sound social and human considerations.

The Department of Health, Education, and Welfare's summary of its plans for the closing of the seven Public Health Service hospitals and to use the Veterans' Administration's facilities as a substitute, and its assertion that it would save money thereby, is hardly the basis for such drastic and irreparable action which in the long run can only result in increased costs. The assertions made in support of the program are little more than an attempt to rationalize the untimely and ill-conceived scheme to wipe out a vitally necessary service. As a matter of fact, the Department's program does not deal in any specifics, but rather submits a series of generalized objectives, which are highly contradictory and misleading.

The Health, Education, and Welfare Department says in very unspecific terms that its plan will provide a system for Public Health Service beneficiaries to be cared for "by utilizing cooperative agreements with the Veterans' Administration and the Department of Defense for the use of their medical facilities” (Department of Health, Education, and Welfare, "Summary of Plan,” p. 1). It would be quite impossible to accommodate seamen in VA hospitals that do not have beds available for veterans. In this connection it must be noted that VA hospitals are all operating over the 80 percent bed-load capacity universally accepted as the maximum for operating efficiency. In the administration of hospitals, 80 percent of bed occupancy is considered most practical. The remaining 20 percent is the margin accepted for emergencies and other contingencies In the VA facilities, in the same, or nearest, areas to the seven Public Health Service hospitals slated for closing, the percentage of bed utilization ranges from 85.9 to 99.3. Across the Nation most VA hospitals are operating at over 90 percent. These figures certainly indicate that the VA hospitals are already operating over the proper limit and are concerned, themselves, with obtaining more space for veterans.

The Health, Education, and Welfare Department plan is not only jeopardizing medical care and treatment for seamen, it is also causing concern among yeterans over the future of the VA hospital system for veterans. The National Commander of the American Legion, Donald E. Johnson, has testified on Jaunary 28, before the Senate Subcommittee on Veterans' Affairs that the Legion was unable to ascertain the extent to which the referment of seamen to Veterans' hospitals would decrease the ability of the VA to care for war veterans. said that the American Legion "fears the VA hospital system, as established by Congress, is in jeopardy." At its Fifth Annual Washington Conference last month the Legion went on record to oppose the plan.

He

The Commissioned Officers Association of the U.S. Public Health Service concurs in the position of the American Legion in these words: "It is difficult to understand how the patients from the PHS hospitals can be cared for by the VA hospital system when many of the VA hospitals that these patients are to be referred to are already operating at maximum patient capacity and have long waiting lists for those veterans with non-service-connected disability.” (Statement of Commissioned Officers Association of the U.S. Public Health Service on the "Closing of Seven PHS Hospitals," February 1, 1965.)

The Health, Education, and Welfare Department certainly must know that its assertion that seamen would be accommodated at VA hospitals is more myth