COMMUTATION IN LIEU OF RATIONS FOR PATIENTS, NURSES, AND OTHER EMPLOYEES. The CHAIRMAN. We overlooked the first one. You are also asking Including also allowances, to be prescribed by regulations approved by the Presi- Dr. STIMPSON. That is a provision for the Public Health Service Dr. MORRIS. At the present time in the Public Health Service it hospital will forward to the Surgeon Ceneral the number of rations for which commutation is to be raid and the total amount that will be paid to the medical officer in charge at a regular rate, which will be prescribed by the Secretary of the Treasury from time to time, according to the fluctuation in the market value of subsistence. This legislation would not involve any additional cost to the Covernment at all; it would simply enable the medical officers in charge of hospitals to purchase subsistence without sending bills to Washington for rayment. The CHAIRMAN. At present the officers in charge of hospitals are allowed rations for ratients, nurses, and other employees? Dr. STIMPSON. Yes, sir. The CHAIRMAN. And you want to have that changed so that they will be allowed commutation in lieu of rations? Dr. STIMPSON. Yes, sir; commutation given to the medical officer in charge to buy the subsistence. That is what is done in the Army and in the Coast Guard. Dr. MORRIS. This would result in a saving to the Government of a great many dollars, because the subsistence could be purchased in the market for cash at cheaper rates. In a great many cases dealers refuse to sell subsistence to hospitals on account of the great delay in the payment of their bills, all of the bills having to go to Washington for payment. I understand that the Army had a great deal of trouble, and that was the reason why this method was adopted in the Army. In 1898 they adopted the method of having a hospital fund, the hospital fund being derived from the commutation which is paid for the rations of patients. It gave them a fund whereby they could purchase all of the necessary subsistence without the necessary authorization from Washington. The CHAIRMAN. But still the patients might not purchase the rations at all; they might spend the money for something else? Dr. MORRIS. The money never gets to the patients; it goes to the commanding officer; he is the custodian of the fund and he is the only one who can expend the fund. Then there are proper safeguards thrown around the hospital fund, because it is audited on the first day of every month by a board of officers appointed for the purpose, and a statement of the condition of the hospital fund at the end of the month is sent to Washington for approval, and with that statement is sent a receipted voucher from every dealer to cover every bill that was incurred. Then those bills are carefully checked here. That is the method which is in use in the Army; they are checked just the same in Washington, so that every expenditure is checked up as it is under the present system. It results in a saving to the Government and it has been found to be a saving in the Army because the medical officer in charge can take advantage of market conditions. It has another advantage. Under the present system of making purchases of articles other than subsistence it is necessary to get those approved too; they all have to be sent to Washington, but under this method, if the medical officer in charge, the commanding officer of the hospital, finds it necessary to get medical or surgical supplies or instruments, or anything like that, in a hurry for a patient he always has this fund on which he can draw. A dealer will come along and say "I can not get my bills paid by the Government; here I have been two or three months getting this money." And that dealer may have prices which are a great deal lower than the prices of the man with whom the commanding officer has contracted for his supplies, but if he had a hospital fund he could go out and purchase to advantage and always get things cheaper. Dr. STIMPSON. Because he pays cash? Dr. MORRIS. At the end of the month, or he can pay cash down. The CHAIRMAN. It will cause a great deal more expense in bookkeeping and auditing the accounts? Dr. MORRIS. No, sir; it will simplify all of that. If a statement is sent to Washington under this method, every bill incurred at the particular hospital would be attached to the statement and everything would be listed on the statement, whereas they come in loosely now, one after another and at no definite time, and all have to be approved separately. It really simplifies the work all around and it is a saving to the Government. The CHAIRMAN. Suppose this method were adopted for the Government hospitals; would a patient have to take his meals in the hospital as under the present method? Dr. MORRIS. Yes; he would do that just the same as he does now. There is no change whatever except that the medical officer in charge has the money right there to take advantage of every fluctuation in the market and buy cheaper. That is absolutely the only difference there is in it. Dr. STIMPSON. Under the present method the medical officer must send an estimate every three months for the Surgeon General's approval, and bills can only be incurred after that authorization is received; when they come in they have to be compared with this authority; they all have to be audited and then checks sent out for each single bill, which makes a great deal of work. It was all right when we only had a few small hospitals. The CHAIRMAN. But in this case, if I understand it correctly, the commanding officer could say to Sam Smith, who is a patient, You can go across the street and get your board"? Dr. MORRIS. Oh, no; not at all. Dr. STIMPSON. Because he is a patient in the hospital. Dr. STIMPSON. The patient does not get the money; he only gets the food; but the doctor instead of incurring a bill and sending that bill to Washington for payment is given so much money with which he buys these necessary supplies and then he sends an account of it to Washington at the end of the month. The CHAIRMAN. Can not the superintendent of a hospital buy canned corn and canned tomatoes? Dr. STIMPSON. He can not buy any unless he has adequate authority from Washington. The CHAIRMAN. Then, where does he get such things? Dr. STIMPSON. He makes a contract every three months. Dr. MORRIS. Then, somebody else comes along later and offers subsistence much cheaper than the contract price, but he can not buy and take advantage of the lower price. Mr. BYRNES. In other words, you are fixed to your three months' supplies? Dr. MORRIS. Yes. Mr. BYRNES. The superintendent of the hospital having made a contract with a man to furnish supplies for three months? Dr. MORRIS. Yes. The CHAIRMAN. This will enable the superintendent of a hospita to take advantage of the market and buy things as he needs them? Dr. STIMPSON. Yes, sir. The CHAIRMAN. Rather than to enter into contracts for things he may never need? Dr. STIMPSON. Yes, sir. Dr. LAVINDER. It would be like a doctor in charge of a hospital near the country; he could take a motor car and drive out in the country a mile or two and buy fresh eggs cheaper than he could buy store eggs in the city, but as the matter now stands he must buy store eggs because he is forced to buy under contract. SERVICE IN ARMY, NAVY, ETC., TO BE RATED AS SERVICE IN PUBLIC HEALTH SERVICE IN COMPUTING LONGEVITY PAY. The CHAIRMAN. You are asking for additional language as follows: And officers of the Public Health Service shall be credited with service in the Army, Navy, Marine Corps, and Coast Guard, in computing longevity pay. Dr. STIMPSON. When officers come into this service from the reserves, from the Army, the Navy, and the Marine Corps we can not give them the longevity pay they are receiving in the Army because there is no authority in law for it. The provision for crediting service in the Army and Navy in computing longevity pay for officers is inserted as a matter of justification to these medical officers, now with the Public Health Service, who served their country in the war with Germany, either in the Army or Navy. If this provision is not made, these officers who have rendered patriotic service will also lose the longevity credit to which it is believed they are entitled. Some of them have been in the Army for 10 years and they are entitled to two fogies but if they come into this service they lose them. At present there is a reciprocity as to longevity service between the Army and the Navy, but not in this service. This amendment would remove the discrimination which operates to penalize medical officers who have rendered Government service in the Army and Navy. It is just to put them on a parity. The CHAIRMAN. How much will this cost? Dr. STIMPSON. I do not believe it will cost very much. Dr. Morris, do you know how many reserve officers we have in the service? Dr. MORRIS. I do not know how many we have in our service at the present time. I think Dr. Rawls can answer that better than I can. Dr. RAWLS. I should say that the officers we have in the service have not had more than two years service in the Army, so that the cost could not be very much at this time. Dr. MORRIS. I have only had two years' service and I am not entitled to it at all. The CHAIRMAN. Just what is the present law with regard to longevity pay to which this provision would apply? Dr. STIMPSON. There is no longevity pay for the reserves. Dr. LAVINDER. A 10 per cent increase for every five years of service up to 40 per cent. The CHAIRMAN. When does it commence? Dr. LAVINDER. At the end of five years a man gets his first fogy of 10 per cent. The CHAIRMAN. At the end of five years he is entitled to an increase of 10 per cent of his salary? Dr. LAVINDER. Yes, sir. The CHAIRMAN. Then for the second five years? Dr. LAVINDER. He is entitled to another 10 per cent. The CHAIRMAN. And for the third five years? Dr. LAVINDER. He gets an increase up to 40 per cent, provided the law does not restrict the pay of his grade so that he can not draw the last fogy. The CHAIRMAN. Have you not made an estimate as to what it would cost? Dr. LAVINDER. I have not, but I know it would not be much, because most of these men have only been in the Army for a short time. Dr. MORRIS. At the present time it will cost very little because there is hardly anybody who has served more than two years. The CHAIRMAN. Suppose you should appoint a district surgeon who has had 20 years' service in the Army? Dr. LAVINDER. Then he would get 40 per cent. The CHAIRMAN. Then everybody from the Army would get this? Dr. LAVINDER. No; very few would get that, because there are very few who have had 20 years' service in the Army. Dr. MORRIS. But even in that case he would already have drawn his longevity pay from the Army appropriation and this would simply be giving him the same as he had in the Army. Dr. LAVINDER. It is simply a piece of justice to the men we have taken in. The CHAIRMAN. Have you not made any calculation as to what it would cost? Dr. STIMPSON. It would take some time to do that, because we would have to write to each man and find out how long the service had been in the Army or Navy. The CHAIRMAN. I wish you would put in the record a statement as to the number of officers you now have who would come within this provision if it were applied and what the cost would be to the Government at the present time. Dr. STIMPSON. Very welt. MEMORANDUM RELATING TO LONGEVITY PAY OF OFFICERS. BUREAU OF PUBLIC HEALTH SERVICE, Commissioned officers of the Army, Navy, Marine Corps, Coast Guard, and Public Health Service under the present law receive an additional compensation of 10 per cent of their annual salaries for each five years' service, but not to exceed in all 40 per cent. There are at present about 260 officers assigned to active duty in the Reserve Corps of the Public Health Service. Many of these officers held commissions in the Reserve Corps of the services mentioned during the war with Germany. Approximately 2 per cent have had 5 years' service, or more; about 2 per cent have had 10 years' service; and less than I per cent over 10 years. At the present time an additional expenditure of about $5,000 a year would be involved if these officers were credited with former service in computing longevity pay. At the present rate of increase in reserve officers of the Public Health Service, it is estimated that in a year the expenditure would be two or three times the amount stated. |