Mr. DODD. We pay for hospitalization or medical care rendered by private hospitals and physicians to the extent of our appropriations. Mr. O'NEAL. Is that more expensive or less expensive than to care for them in your own hospitals? Dr. TOWNSEND. It is much more expensive. Mr. RICH. Do you have any trouble in providing hospital facilities for them at private hospitals or public hospitals owned by municipalities? Dr. TOWNSEND. No; we can generally place our patients in private hospitals on a per-diem basis. We have to pay for them, of course. Mr. RICH. Do those hospitals not enjoy an economic advantage in caring for these patients, just as the Government is benefited from an economic standpoint in having them in those hospitals? Dr. TOWNSEND. No, sir. We can run our own hospitals cheaper than we can hire contract services on the outside, because we have to pay for the operations and we have to pay for the cost of the anesthetic and the cost of the attendants. Mr. RICH. What do you pay for those operations? Dr. WHITE. We pay $75 for an uncomplicated appendicitis operation. Complicated cases run as high as $150; in the extreme Northwest is where we have the highest price to pay. COST PER DAY PER PATIENT IN HOSPITALS. Mr. FITZPATRICK. What is the cost per day per patient in your hospitals? Dr. TOWNSEND. It varies. Mr. FITZPATRICK. That is a very important question. It bears on Mr. Rich's statement as to whether or not it is costing the Government more to maintain its own hospitals than if they had those patients treated on the outside. Dr. WHITE. We have one hospital which is 168 miles from the railroad, and there the per-diem cost is high, because you have to transport everything from Flagstaff. Mr. FITZPATRICK. What is your average cost? Dr. WHITE. Something in the neighborhood of $4 is our highest. At the Tacoma Hospital in Washington, it costs $2.34. Mr. O'NEAL. That is just the cost of operation? Dr. WHITE. No; that includes the average running cost of the patients in this hospital, including all the surgical work done. Mr. JOHNSON. What is the average cost at the Kiowa Indian Hospital? That is one of your newer hospitals, and, I think, one of the best in the Service. Dr. WHITE. $2.50 a day. Mr. JOHNSON. $2.50? Dr. WHITE. Yes. You could not get that out at Lawton. Mr. FITZPATRICK. That $2.50 a day includes the cost of operations and everything? Dr. WHITE. Yes; it includes everything, anæsthetics, building maintenance, nursing service, medicines, food and so forth. Mr. RICH. What are the items of expense in connection with that average patient cost per day? What goes to make up that $2.50? Dr. WHITE. The surgical fee, the subsistence of the patient, the clothing that we furnish to him in the way of pajamas, and things of that kind, the regular ward surgeon fee, the nursing fee, and at. " goes with it. The upkeep of the hospital, including electricity, pas and everything of that kind. Mr. RICH. But you do not charge any depletion on the cost f construction of the hospital nor for insurance and things like ti Dr. WHITE. It includes the cost of the upkeep of the hospitaka is painted during the year, all of that is charged to it. Mr. RICH. You make no charge against the cost of constract. " Dr. WHITE. No. Mr. RICH. No charge of that kind would be involved? Dr. WHITE. No. Mr. RICH. You make no charges for insurance, taxes, or t that kind? Dr. WHITE. No. Mr. O'NEAL. Is there anything furnished to the hospital a not charged to this expense? Dr. WHITE. No; all of the equipment that is bought for the h during the year goes in with it though. Mr. O'NEAL. Anything like sheets and pillow cases and tl.: that kind goes into that cost? Dr. WHITE. Yes, that cost is included. That cost is arrived at .. taking the vouchers that have been submitted for payment dang year, and adding them together. That is where we get this comi Mr. LAMBERTSON. There are 1,000 Indians in my two counties i there is no hospital on any of the three reservations there do you treat those patients? Dr. WHITE. They have been paid for at Haskell Institute, at the rate of $2 per day per patient. We send them over there and burse the school for the service. Mr. RICH. I am interested in seeing whether the Indian or the people in those localities are trying to gouge the Govern because these Indians are wards of the Government to know that. Dr TOWNSEND. What happens is that your superintendent has to authorize the expenditure unless it is an emergency to ss. Then, if it is authorized, the fee is reviewed by the medical pers There have been times when the fee has been cut I think large, the fees that we have been paying are reasonable Of it is to our interest to get that work done as cheap as possible our own appropriation. Mr. RICH You could have a lot of influence on people to challenging them when they tell you that is the fee, and the Gment ought to pay it. I want to assume my share of the responsibility and have tis brought down if that is the case. Mr COLLIER What about the Veterans' Bureau rate” Dr WHITE. For an uncomplicated appendicitis operation the $75, and if there are compacations with it, there is an soditi For instance, if the appendix is ruptured or if peritonitis set in have to pay an additional cost. Mr. Rich. Is this table or schedule furnished by the Vetera Bureau Dr. WHITE Yes Sometimes we get bills where the amo large. We return it to the superintendent and ask to bave Take the clinic at Missoula, in western Montana. They have o do our work there for the rate they charge their ordinary patients, ninus 10 percent. They always send in a reasonable bill. At a umber of other places we have a special schedule cheaper than applied o white people. Dr. TOWNSEND. Many of the bills are sent back to the field for -echecking. Dr. WHITE. Yes. Mr. FITZPATRICK. How about your maternity cases out there; are hey expensive? Dr. WHITE. Where we have had them outside, we have had them down as low as $20, and we have paid as high as $50. The mileage rate is what counts on that. If they have to do a maternity case right in the home, they charge a dollar a mile, one way. OPERATION OF NEW HOSPITALS Mr. DODD. $212,500 is requested for part of a year's operation of new hospitals that are now under construction. Mr. RICH. It says for new hospitals. Is that for construction of new hospitals? Mr. DODD. No; this is for the operation of hospitals that are being constructed with Public Works funds now available to us; the construction is under way. Mr. RICH. Where is that on the detailed statement? Mr. DODD. It is on page 194 of the justification. Mr. RICH. That is just for 4 months' and for 6 months' operation; next year, that will just double, practically? Mr. DODD. Yes; in the case of those operating 6 months, the expense will double, and, in the case of those operating 4 months, the expense will treble. Mr. JOHNSON. These estimates were prepared last year, were they not? Mr. DODD. Yes, sir. Mr. JOHNSON. Áre all of these hospitals opening as you anticipated? Mr. DODD. Yes, sir. In the case of the Fort Defiance building we estimated about 500 days for construction. That hospital actually will be completed within 250 days from the date of notice to proceed. The amount for 4 months' operation in that case will be low. In some of these contracts, however, there are delays due to weather conditions, and delays in delivery of material, and so forth, which justify an extension of time. Rather than to say here that we need $75,000 or $100,000, we will wait until we get the hospital in operation, and if there is need for a deficiency we will present it at that time. All of the others were under contract at the time these estimates were prepared, and we knew the completion dates, or approximately so, and took that into account. TRANSFERS FROM TRIBAL FUNDS We are proposing an increase of $90,000 for the transfer from tribal funds of the amount needed to operate the hospitals in Minnesota at Cloquet, Cass Lake, White Earth, and Red Lake. As we have already explained in this hearing, the tribal funds of the Chippewa Indians have reached a point where no further expenses can be charged against them. INCREASE FOR EXISTING HOSPITALS The last item of $47,300 covers miscellaneous small increases in a number of existing hospitals, the details of which are found at the bottom of page 196. I would invite your attention to the tabulation appearing on page 186 of our justifications which gives the capacity of all of the hospitals supported by this appropriation, the average daily patient attendance. the number of dispensary treatments, and then the appropriation for 1937 and the increase requested for 1938. Mr. O'NEAL. You get no income whatsoever from any of these hospitals; is that correct, Mr. Dodd? Mr. DODD. That is correct. Mr. O'NEAL. You are furnishing $3,332,220 worth of service from which you get no return? Mr. DODD. That is correct. Mr. O'NEAL. Undoubtedly some of those that are treated there are able to pay a part of their cost? Mr. DODD. Yes. How many we do not know. I think that covers all that we have in connection with the "Conservation of health" item. CONSTRUCTION OF SIOUX SANATORIUM AND EMPLOYEES' QUARTERS, SOUTH DAKOTA Mr. JOHNSON. The next item is "Sioux Sanatorium and employees quarters, South Dakota." Mr. DODD. The justification in support of this item is as follows: Regular appropriation, 1937 act (reappropriation) Reappropriation, Second Deficiency, 1935.. Total appropriations, 1937. Deduct nonrecurring and other items not required in 1938: Project under contract. $29,875 337,500 367, 375 367, 373 Base for 1938_.. Total estimate, 1938.. This structure is to be erected on land included in the reserve occupied by the former Rapid City Indian Boarding School. The site is about a mile outside the city limits of Rapid City. Plans and specifications were prepared by the Construction Division of the Indian Service, after careful field studies, both as to location for the new building and utilization of some of the structures formerly used for boarding-school purposes. A contract was awarded to W. C. Smith, Inc., of Duluth, Minn., on September 30, 1936, for the erection of the new building. This structure, modern in every respect, will accommodate 111 patients. It will be completed about September 1. 1937. Other work to be accomplished with the money now available involves remodeling of an old dormitory to provide a nurses' home, repairing other structures to accommodate hospital personnel, improvements to the heating and sewer systems, and, if funds are sufficient, the conversion of the old classroom building into facili ties for ambulatory patients. Inasmuch as the contractor will not complete the new building before the close of the fiscal year, and much force-account work may also remain incompleted be cause of adverse building weather, we propose a continuation of the available funds until June 30, 1938. As stated, however, we expect the new institution to be ready for occupancy about September 1, 1937. Mr. O'NEAL. How far have they progressed with the work? Mr. DODD. They have the steel work up and the brick work up past the first floor. Mr. JOHNSON. There has been an unusual amount of delay in the construction of this hospital; what is the cause of it? Mr. DODD. The funds were appropriated in the Appropriation Act for 1932. There was a request made for the Indian Service to make savings in the appropriations that had been made to it. We had plans for this institution 75 percent complete. They were on the drafting boards at the time. We put a stop order on it. The next year the funds were still held in an impounded status, savings were desirable, so we held off. The thing ran on until about 2 years ago when Senator Norbeck revived the appropriation, which had lapsed, by inserting an item in a deficiency bill, over in the Senate. In conference that language was changed so that it compelled the Secretary of the Interior to make a study as to the location. After a study was made, it was determined to locate the building at Rapid City on land within the former Rapid City Boarding School campus. We then went ahead with the completion of the plans and entered into a contract. Mr. RICH. We have gone ahead with this proposition far enough now that anything you did to stop the appropriation would be wasting money, would it not? Mr. DODD. Absolutely; yes, sir. Mr. RICH. And it is for the purpose of a sanatorium or a school? Mr. DODD. It is to provide sanatorium facilities principally for the Sioux Indians in North and South Dakota, where we do not have any sanatorium facilities at the present time. Mr. FITZPATRICK. What was the total amount appropriated? Mr. FITZPATRICK. How much have you spent to date? Mr. DODD. I would judge about $60,000. Mr. FITZPATRICK. Then you have an unexpended balance now? Mr. DODD. Yes; but it is under contract, and, therefore, the appropriation is obligated. Mr. FITZPATRICK. Yes; but it is not appropriating new money out of the Treasury; it is appropriating money you have now that is unspent, is it not? Mr. DODD. That is all it is. CLINICAL SURVEYS AND GENERAL MEDICAL RESEARCH Mr. JOHNSON. The next item on page 218, is for clinical surveys. Mr. DODD. This item for clinical surveys and general medical research has been discussed in connection with the item appearing at page 209. We have consolidated this appropriation with the general health funds. There is no saving in money, but this work can easily be done as a part of the general conservation of health program. SUPPORT OF HOSPITALS, CHIPPEWAS IN MINNESOTA Mr. JOHNSON. The next item appears on page 219, and involves the operation of hospitals for the Chippewa Indians in Minnesota. Mr. DODD. I submit the following statement for the record. The present balance in the Chippewa tribal funds is only $438,756. during the last year from all sources was only $5,723. Because of the depleted condition of trust funds, it was necessary to transfer a portion of the charges Income |