we were speaking of. We have a responsibility for the whole District government, with certain exclusions, of providing physical examinations to employees entering on duty. To be sure we do not hire persons who are disabled, who will be unable to perform their duties properly, or, from the standpoint of the dollar, will increase or advance premature retirement rates among the number of employees. We have only the one doctor and a clerk to do this and obviously that one doctor cannot begin to handle all of the District government. Fortunately, the hospitals have their own facilities. The Police and Fire Departments have facilities, and we handle primarily the schools and as many other employees as we can with the staff we have.

We put on a crash program, you might say, by pulling doctors from all over the place, sometimes to try to catch up on a backlog, but that is not the proper way to conduct an organized program. We feel that the addition of these two people still will not enable us to do everything but certainly we will do twice as good a job as we are doing with the one doctor, particularly with the health nurse.

PERSONNEL INCREASE IN PAST 5 YEARS

Mr. NATCHER. At this point in the record we would like for you to insert a chart showing the increase in personnel in the Department of Public Health for the past 5 years.

Dr. HEATH. Yes, sir.

The Department of Public Health?

Mr. NATCHER. The Department of Public Health.

Dr. HEATH. All right.

(The requested information follows:)

District of Columbia Department of Public Health-Increase in number of personnel,

Mr. NATCHER. We next turn to the "Health of mothers and children" that appears on page 22-29 of the justifications.

You are requesting $2,226,917, which is an increase of $253,607.

You are requesting 21.6 new positions in this section.

We shall insert pages 22-29 and 22-43 in the record at this point.

1 Percentage distribution, see "Medical care" for detailed breakdown.

Mr. NATCHER. Before we proceed with this item, Mr. Rhodes, do you have questions?

POLICE AND FIRE CLINIC

Mr. RHODES. As you just mentioned, there is a Police and Fire Clinic which is not part of the Department of Health. This subcommittee has, from time to time, felt this was a duplication of effort and perhaps public money could be saved if there were a consolidation or at least a joint use of facilities and personnel.

Would you care to comment on whether or not the Department of Health would be able to take over the work of the Police and Fire Clinic?

Dr. HEATH. Yes, sir.

So far as the Department of Public Health is concerned, if it is decided that it should be transferred to our Department we would accept it, but we would have to accept it in a so-called orderly manner. By that I mean our first concern would be assurance to the Members of Congress, and to the Police and Fire Departments, that there would not be any decrease in the quality of the service which they are now receiving.

Conceivably, there might be some improvements in it.

In order to avoid a disruption of the service and conflicts which would naturally result, any changes must be effected with careful deliberation and action. If we were given this responsibility without anything else, that is, without any additional funds or personnel or facilities, at this point it would be an extremely difficult thing to do. If it is felt that we should have it, then we could probably work out an arrangement if the funds, facilities, and personnel would be transferred to the Department of Public Health.

We would be able to continue operating the program and make a program evaluation and study and then we would know which way changes would be made.

Mr. RHODES. Dr. Heath, let me put it this way: Do you feel there would be a saving of public money over the long pull if this clinic were put under the Department of Public Health?

Dr. HEATH. After we get the central core of the hospital finished and would have adequate facilities, I could see there would be some areas where there could be some savings.

Mr. RHODES. It would be your thought that if the consolidation were made, the location of the clinic should be in the District of Columbia Hospital?

Dr. HEATH. Eventually. There is no room for it over there now. Mr. RHODES. I am certainly aware of that, but after the proper construction program had been completed?

Dr. HEATH. Yes, sir.

Mr. RHODES. Do you see any great difficulties involved in taking over this clinic provided it is done in an orderly fashion, as you have described?

Dr. HEATH. Of course, there will always be some difficulties until people are adequately oriented and informed of the way that it will be operated, but I think we would be able to maintain the quality of service they are now getting.

We would have to have some help and, as I say, with facilities and money because, for example, we do not have physicians who could go to a two-alarm fire. The hospital clinics are not designed for the activities such as the routine physical and preemployment examination; mostly hospital clinics are designed around the concept of diagnosis and treatment of patients which require just a little different approach.

Mr. RHODES. That is all.

Mr. NATCHER. Now justify the request for the 21.6 new positions.

INFANT AND PRESCHOOL SERVICES

Dr. HEATH. Eight of the positions are in the infant and preschool activity shown on pages 21-36. Basically the program is the supervision of the child in its infancy and preschool years and seeing that it is having a proper diet and corrections made for any deficiency or disease and the correction of any orthopedic defects, as well as adequate immunization to prevent communicable diseases.

These clinics we have are now 12 in number, located in various sections of the city. They are well patronized and, in fact, they are extremely overcrowded.

Mr. NATCHER. Doctor Heath, at this point, would your request for the eight new positions mean the establishment of a new clinic with these eight in charge?

Dr. HEATH. It would not mean the establishment of another geographic location. It would be increasing some clinic sessions in some of the existing locations.

Mr. NATCHER. Proceed.

Dr. HEATH. We pointed out that this will help greatly and that in 1961 in the clinics we now have, there were 114,316 patient visits. There will be 40,000 patients registered in these various clinics, approximately, and this has continuted to climb over a period of years. In the future, it is expected that there will be a greater number of patients registered.

We felt at this point we would increase the number of clinic sessions at some of our locations. The clinics are not operating every day, both morning and afternoon, due to the limited amount of personnel. This team would help to increase these sessions in various locations.

Mr. NATCHER. Do you need this medical officer, GS-12?

Dr. HEATH. Yes, sir; because this is the team that you need, and it is felt that this is a portion of the personnel it takes to conduct an activity of that type.

Mr. NATCHER. Do you need one public health nurse or three? Could you get along with one?

Mr. BOWMAN. No, sir.

Mr. NATCHER. Could you get along with two?

Dr. HEATH. We felt we needed three and that is why we put three in our request.

Mr. NATCHER. What about this one medical aid, GS-3?

Dr. HEATH. Yes, sir; everyone has a specific function in this type of activity.

MEDICAL AID DUTIES

Mr. NATCHER. What are the differences in the duties performed by a GS-3 and a GS-2 medical aid, Dr. Heath?

Dr. HEATH. I do not have that at hand. I cannot tell you at this time.

Do you wish it for the record?

Mr. NATCHER. Can any one of you give me the difference in the duties of these two particular assignments?

Mr. BOWMAN. These aids also perform clerical duties and the grade 3 serves as an aid, plus being a record clerk, control clerk, and other miscellaneous duties. They are the people with these clerical skills.

Mr. NATCHER. What would you do with one GS-1, Mr. West? Mr. WEST. That varies in terms of a particular clinic and function. There is need in a clinic to have available clean linen, clean instruments, formula, and that sort of thing. The lower grade clerk is the one who washes up the material and the next level of clerk would be working in association with the physician who is handling the infant and having things available for the physician.

The grade 3 clerk would be one, as Mr. Bowman explained, involved in recordkeeping and having mothers come in with their infants to register with the clinic and keeping track of the patients and parents.

The nurses are important in terms of explaining to the mothers of new infants what the infants need. This is essentially a clinic which is not unlike that of a private pediatrician's office where you have a physician and his nurse or aid, and his office girl who controls these patients. The big difference is that we are doing this on a volume basis and we need more of these helping people than you do in a physician's office where you do one in a half hour or so.

Mr. NATCHER. Do you have any additional comments concerning the need for these eight positions?

Dr. HEATH. I think I covered the highlights of that, Mr. Chairman. Mr. NATCHER. Let us take up the other additional positions requested and I believe that is 21.6 total.

You have discussed eight of them and now let us take up the balance. Dr. HEATH. The remaining positions are for dental health, audiometric screening, and public health nursing.

Mr. NATCHER. What page are you on now?

DENTAL HEALTH

Dr. HEATH. This starts on page 22-38.

In the dental activity of the school health program, we operate 14 different clinic locations. We do not have dental assistants at all of these installations, but only at half of them. The dental assistant and the help she gives in this activity to the dental clinic are very important. It relieves the dentist of keeping records and other sig nificant nonprofessional details around the dental office. It allows him to devote more of his time to the professional aspects of his work. I think it was estimated that it increases the dentist's productivity at least 20 to 30 percent by having this type of assistance. These seven positions would equip each dental clinic with a dental assistant. There is one position requested for a secretary to the Assistant Chief of the Bureau and for the entire Bureau they have only one secretary and a clerk.

The amount of paperwork, records, and so forth that need to be kept, because they operate in so many schools and with a large number of children, the keeping up of followup records, that additional assistant is necessary.

There are two other things on the dental aspect and there is an item of $7,500 for replacement of dental equipment. Much of the dental equipment we have was, to start with, old surplus equipment and some of it is 30 to 40 years old.

Some of it we obtained already in a reconditioned state and it is in bad need of repair. This money would not replace all of it but