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neering effort. All interests must be coordinated into a working team if best results are to be achieved. Mud slinging and distrust of motives between groups working toward a common goal, does not advance the best interests of the handicapped individuals in our Nation. It is to be hoped that all groups, associations and individuals interested in providing effective services to handicapped persons will subscribe to these principles in their efforts to promote constructive legislation.


RELATIONS, AMERICAN OSTEOPATHIC ASSOCIATION Mr. Chairman and gentlemen of the committee: I am Dr. Chester D. Swope, engaged in private practice as an osteopathic physician with offices in the Farragut Medical Building, Washington, D. C. This statement is submitted in my capacity as chairman of the department of public relations of the American Osteopathic Association.

At the outset may I express the appreciation of the association for the opportunity of commenting on H. R. 3095 cited as the “Federal Aid to the Physically Handicapped Act” and H. R. 5577 cited as the “National services for disabled persons amendments of 1949,” now pending before this committee.

Title II of H. R. 3095 creates a Federal Commission on Services for the Physically Handicapped, to which is assigned the functions of the Office of Vocational Rehabilitation now located in the Federal Security Agency, “maintaining the present relation with the States, with such additional functions which may be granted by this act.”

The first purpose listed in the bill is “provide for maximum extension of medical services.” If this purpose is to be effectuated, it will require an amendment to the bill to clarify the meaning of the term "corrective surgery or therapeutic treatment” as used in section 3 (a) (3) (A) of the Vocational Rehabilitation Act of 1920, as amended.

The Vocational Rehabilitation Act, as amended, provides for State plans for vocational rehabilitation and confers on the Administrator (which will be the Commission established under H. R. 3095) the right to determine standards of rehabilitation services involving corrective surgical or therapeutic treatament with which the States must comply in order to obtain Federal approval of State plans. In exercise of that right, the Federal agency prescribed a Manual of Policies, section VI of which relates to minimum Federal requirements for physicians participating in the State programs, including the following:

“1. The medical diagnosis and treatment of disabled persons under the care of a State board of vocational education or State agency for the blind shall be limited to physicans licensed to practice medicine and surgery and otherwise qualified by training and experience to perform the specific services required.”

The requirement of a license “to practice medicine and surgery” prevents most of the States from utilizing the services of licensed osteopathic physicians or surgeons for the benefit of the physically handicapped. For example, some States do not license osteopathic physicians to perform major operative surgery. Quite obviously in those States they could not perform physical restoration services involving major operative surgery. But there are many physical restoration services of vital importance which do not involve major operative surgery. Yet, the Federal agency takes the position that unless an osteopathic physician is licensed to do everything he cannot be utilized by the State agency to do anything for effecting the purposes of the program.

During the Seventy-ninth Congress I appeared before the House. Committee on Labor in connection with a bill, H. R. 3922, relating to services for crippled children under State plans to be approved by the Federal Security Administrator. At that time I pointed out that the Federal agency had adopted a policy in connection with requirements for State plans for services for crippled children which prohibited the States from utilizing the services of licensed osteopathic physicians. Whereupon, this committee on July 25, 1946, favorably reported the bill (too late for enactment during that Congress), including the following provision :

"Nothing in this Act shall be deemed to prohibit the inclusion in State plans of provisions for osteopathic services furnished by duly licensed practitioners of osteopathy within the scope of their practice as defined by State law, or for purchase of care from osteopathic hospitals meeting standards established under the State plan.”

For equally cogent reasons, we now ask this committee to insert that provision in H. R. 3095 under title XI, in order that it may be applicable throughout the bill including titles II and IV which involve State plans for medical examination, treatment, and hospitalization.

For the same reasons, in the event H. R. 5577 receives favorable action by this committee, we respectfully suggest that H. R. 5577 be amended on page 45, after line 21, as follows:

(-) By inserting after subsection (b) of section 2 thereof a subsection (c) to read as follows:

“(c) Nothing in this Act shall be deemed to prohibit the inclusion in State plans of provisions for osteopathic services furnished by duly licensed practitioners of osteopathy within the scope of their practice as defined by State law, or for purchase of care from osteopathic hospitals meeting standards

established under the State plan." All States license osteopathic graduates.

Osteopathic services are being used in all the States by the Bureau of Employees' Compensation in the Federal Security Agency for the rehabilitation of injured or occupationally ill Federal civil employees, pursuant to the United States Employees' Compensation Act of September 7, 1916, as amended, including the following provision :

"The term “physician' includes surgeons and osteopathic practitioners within the scope of their practice as defined by State law.

“The term 'medical, surgical, and hospital services and supplies includes services and supplies by osteopathic practitioners and hospitals within the scope of their practice as defined by State law.” (U. S. C., 1940 ed., title 5, sec. 790).

Osteopathic services are also being used in all the States for rendering outpatient rehabilitation services for veterans with service-connected disabilities, under the laws of the Veterans Administration (Public Law 293, 79th Cong. ; 59 Stat. 676; 38 U. S. C. A. 15).

We respectfully submit that it will serve the public interest and advance the objectives of the pending legislation to permit the States, in accordance with our proposed amendment, to utilize the licensed professional services of osteopathic physicians or surgeons and osteopathic hospitals for the benefit of the physically handicapped under this program.



I present this statement to the committee as a private citizen, a member of the National Rehabilitation Association, presenting what is, we have reason to believe, the unanimous point of view of executives of agencies for the blind and professional workers in that field.

I direct my remarks particularly toward certain provisions in H. R. 3095.

In passing, may I solicit your support of H. R. 5370 and H. R. 5577, particularly the first.

The objectives sought in H. R. 3095 are indeed worthy, and it is to be hoped that your committee may incorporate salient features of all three bills mentioned in legislation to be enacted either under social security or under vocational rehabilitation.

The establishment of a commission for the handicapped as contemplated under H. R. 3095 would appear to be a serious blow against the specialization for which workers for the blind have always striven. Bitter experience has shown that when services for the blind are consolidated with services for the mentally and physically handicapped work for the blind always suffers. The seriousness of the handicap, the greater cost in solving problems, combined with the relatively small number of persons affected, hare always placed this specialized area at a disadvantage.

The Office of Vocational Rehabilitation over 5 years has developed certain experiences in dealing with blind people that should not at this time be sacrificed to changes in organization.

The number of handicapped persons to be served and the variety of conditions to be met will be vastly increased under H. R. 3095, and the possible attention given to blindness is likely to be reduced.

The administrative pattern represented by a commission for the handicapped, while it is commendable as a concept, appears to be out of step with the modern trend in the field of administration, and would appear to make uncertain the future assignment and disposition of this area of service. The assignment of the Office of Vocational Rehabilitation to social security, as it is at present, seems sound administratively.

The relationship of the Commission for the Physically Handicapped and the several States would appear to require more careful definition in order to avoid legal complications. Putting rehabilitation commissions in the business of distributing assistance—in many States reserved to other boards—will doubtless give rise to numerous problems.

It would seem preferable for financial assistance to be made part of socialsecurity legislation rather than legislation on rehabilita on. In this connection, it should be borne in mind that the basis for distributing assistance under H. R. 3095 is definitely different from that under present aid to the blind under social security. This is likely to be a complicating factor if the bill is passed in its present form.

If we assume as seems probable that aid to the handicapped will in due course be made a part of the social-security legislation it would appear that H. R. 3095 would accomplish little that progressive and enlightened administration of the existing legislation on rehabilitation and the changes that are provided for in H. R. 5577 and H. R. 5370 would not provide for. The two last bills in question would have the advantage of holding the gains made through experience under existing procedures and would not involve the uncertainties of changes in legislation.

Commendable as the proposed provisions are in H. R. 3095, they are costly. If ample funds could be made available under existing legislation and the changes recommended by the Office of Vocational Rehabilitation, I believe most of the good which supporters of H. R. 3095 expect for the physically handicapped would be forthcoming.

It seems unclear from the reading of H. R. 3095 whether its terms apply as fully to the mentally handicapped as to the physically handicapped. The problem of rehabilitating the mentally handicapped is so far reaching in its implications and its relations to the needs of the physically handicapped that the question as to whether the mentally deficient are included should be made crystal clear.

In summary, may I say

1. The administrative pattern of a commission seems an unstable substitute for the existing status of the Office of Vocational Rehabilitation.

2. The broad area contemplated by the commission's service under H. R. 3095 appears to require a more careful tying-in with rehabilitation commissions and commissions for the blind on the State level.

3. There should be more careful reconciliation of the provisions of financial assistance to the physically handicapped and existing financial assistance for the blind.

4. Financial aid as provided in H. R. 3095 would seem to be more appropriately included in social security, and other commendable provisions of that bill combined in amendments to existing legislation contemplated in H. R. 5577 and especially H. R. 5370.

STATEMENT OF JAMES G. PATTON, PRESIDENT, NATIONAL FARMERS UNION I regard it as a privilege to be able to appear before this committee today in support of H. R. 3095. It is a blot upon our record as a Nation that we have not moved earlier to take better care of the disabled and physically handicapped. The annual accident toll in the United States is staggering, and the proportion of those seriously or totally disabled for useful employment should give us pause. In manufacturing, on the highways, in agriculture, even in the home, there are heavy daily additions to the roster of Americans disabled in one way or another. It is high time that we as a Nation began to do something about this problem.

It seems to me that H. R. 3095, a bill that has evolved over a long period of years from the efforts of devoted workers in this cause, is admirably adapted to meet the need. I therefore strongly urge its approval by the Education and Labor Committee and its passage by the House.

As the president of a farm organization, I am naturally much concerned with the extension of assistance to those injured in the pursuit of farming. It is not generally realized that farming is a hazardous business. It is not necessary to burden the record in this hearing with additional statistics in an effort to prove this statement, if indeed sufficiently accurate figures exist. Nevertheless, those of us who have contact with agriculture and with farming know that

I nearly every day farmers are subjected to some risk, either minor or major, in the ordinary conduct of their farming operations.

H. R. 3095 will be of the very greatest assistance to those who already have been injured in the course of attempting to earn a living from the land. I note with special interest, for example, that section 302 of the bill calls for the extension of no less than 25 percent of all loans made from the fund to establish cooperative enterprises for the handicapped shall be made in rural areas. The National Farmers Union is particularly gratified that such a definite provision is carried in the bill in recognition of the special stake of agriculture in legislation such as this.

Title III, which would'authorize a $10,000,000 appropriation in the first year and $5,000,000 thereafter for five years to establish and maintain special in. dustries for physically handicapped persons, is of course one of the several major provisions of H. R. 2095. We feel that these sums, far from being too large, are the very minimum necessary to deal with the problem of financing work projects for physically handicapped persons who are primarily in the group classed as “unfeasible for rehabilitation.” Such individuals of course require special conditions of employment and training. These funds, with the 25-year loan repayment provision and the provision for loans to finance some projects which are not self-liquidating, will go a long way toward meeting one of the gravest of our situations.

We also endorse heartily the title IV program for the allocation for Federal grants to the States for aid to the totally disabled ; Those who are unable to maintain themselves and are without means of livelihood and support. Such a system of Federal assistance to the States, it seems to us, provides the best practical method of assisting the totally disabled in those States which are unable to finance adequate programs from their own treasuries. We approve, moreover, the requirement for the submission of a State plan for the use of such funds before the funds are made available. Such a requirement should guard against wasteful expenditure of Federal moneys and also provide some salutary uniformity among State systems of aid.

The third major fiscal provision of the bill is of course that contained in title VI, which carries a $10,000,000 authorization for the establishment of a “Federal services to handicapped revolving loan fund.” Here again provision is made that not less than 25 percent of the loans must be used by the States in the extension of loans for vocational rehabilitation in rural areas.

The essential purpose of this fund is the replenishment of State funds for vocational rehabilitation insuring that State programs will be carried on without interruption because of exhaustion of money. The provision of this type calling for payment of a 2 percent interest rate by the States to amortize cost and for repayment within 30 days of adjournment of State legislatures would seem to provide adequate protection to the interest of Federal Government.

In conclusion, I cannot refrain from paying tribute to the magnificent work that has been done down through the years by Paul Strachan, president of the American Federation for the Physically Handicapped, in forcing upon the attention of Congress and the general public the needs and claims of this large group of our citizens. One of the disabled himself, Paul Strachan has become a symbol of the very best in this movement. He has never asked favors or special consideration, and in his work and in this bill it seems to us that this spirit remains. The disabled must be treated as first-class citizens who desire no more than an equalization of opportunity and the chance to do for themselves. We believe that H. R. 3095 moves a long way in this direction.

JULY 20, 1949. The PRESIDENT, The White House,

Washington, D. O.: H. R. 3095, a bill to establish a Federal Commission on Services for the Physically Handicapped now before a subcommittee of the House Committee on Education and Labor has the support of a large number of organizations, including the labor groups. In my judgment H. R. 3095 is superior to the so-called Administration bill and its enactment will in no way work against your program. I therefore respectfully request you to support H. R. 3095 and advise the House Committee accordingly.

H. W. FRASER, President, Order of Railway Conductors.


New York 19, N. Y., July 12, 1949. Hon. AUGUSTINE B. KELLEY, Chairman, Subcommittee on Education and Labor,

House of Representatives, Washington, D. C. MY DEAR CONGRESSMAN KELLEY: I had planned to attend your committee hearings on bills for the handicapped, but when I heard that the clerk of the committee had explained that more people wanted to testify than could be heard, I decided to send you this communication in the hope that it will be acceptable to you and your committee.

From a very long experience in the care of the tuberculous, I feel that I can testify that we have neglected a very important phase of the care of the handicapped, the readjustment to useful, productive life. To care for the tuberculous at the sanatorium and to neglect the second phase of treatment, is wasteful. Millions of dollars are spent in the care of the tuberculous. A very substantial number, on their discharge, are told that they may look forward to an apparent cure of their disease, only to break down again, return to the hospital for further treatment, with their chances for recovery greatly diminished. It is true that in many hospitals it costs $8 to $12 a day per patient, but the social waste, the demoralization in the family whose hopes for a normal life are destroyed, is as important as the economic. Also, this renewed activity again presents the danger of spread of tuberculosis.

You probably know that although the deaths from tuberculosis have continued to decrease, the number of new cases in some States is greater than it was 7 years ago. The most challenging fact is that it has been proven conclusively that many of these break-downs after successful treatment can be prevented and the patients can be returned to useful, productive lives, often becoming completely self-supporting again.

Our own experience of over 35 years has demonstrated the value of aftersanatorium care and the place of the sheltered workshop with the auxiliary medical, psychiatric, social, and economic services. Serving largely the moderately advanced and far-advanced cases of tuberculosis (85 percent and over of the patients at the Altro Work Shops are in these categories) we have demonstrated that this kind of care pays substantial dividends. A careful study of the Altro Work Shops has shown that the graduated of the workshop have the life expectancy of men and women of their own age in the general population.”

The most neglected group among the tuberculous is the employable good chronics. These patients who may become social and financial assets are, through neglect, permitted to become a drain and a threat to themselves, as well as to the community. Based on some research made in England a few years ago, I have hazarded the guess that we have in the United States about 60,000 employable good chronics. These are the patients whose disease, usually after a long period of treatment, has become quiescent, they no longer require treatment, but often spend years in hospitals after their disease has reached the quiescent stage, demoralizing the new patient, disrupting the service, for at many VA and civilian hospitals they have been there longer than the manager or the medical director.

I tried to urge consideration of these patients in an address made before the State directors of rehabilitation. I pointed out some startling experiences with two of the first patients of this type who started toward the end of World War I, and have been working ever since. We have one man who started at the age of 48, who will be 70 early next year, and does a creditable day's work at the workshop.


We are now in the second year of an experimental project in the employment of cardiac patients. The experiment, though limited in time and the number of patients served, leads us to believe that we will demonstrate that many cardiacs, prematurely thrown on the junk heap, can be restored to useful productive lives, even though they may be more limited in the kind and amount of work they may do, than our tuberculous patients.

As you can appreciate, I am in complete agreement with the bills before your committee providing for the establishment and further use of sheltered work

1 Objectives of Sheltered Workshops by Edward Hochhauser. 2 Clinical Evaluation of the Rehabilitation of the Tuberculous, by Dr. Louis E. Siltzbach. 3 Providing Rehabilitation Service to the Tuberculous.

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