TOTAL RECEIPTS AND EXPENDITURES OF THE HOSPITAL

Mr. O'NEAL. Does there appear in last year's hearings or any other place a statement of the total income and the total outgo of the hospital and from what sources these moneys came?

Mr. SANGER. Yes, sir.

Mr. O'NEAL. In other words, this year we are being asked to appropriated $1,149,750. Of course, that is not enough to operate the entire hospital.

Mr. SANGER. We have that statement. If you will turn to the last page, you will see it, page 533 of the bill.

Mr. LAMBERTSON. It is all itemized in the justification.

Mr. O'NEAL. It shows here $3,755,174. Is that the total of the operations?

Mr. SANGER. Yes, sir.

Mr. O'NEAL. You have certain amounts allocated to you by the District of Columbia for their patients?

Mr. SANGER. Yes. We enumerate that just following that $3,700,000. You will see it there.

Mr. O'NEAL. These are your net obligations-$1,149,750?

Mr. SANGER. Just ahead of that, do you see those items? There are a few items there.

Mr. O'NEAL. But then you have the total net obligations as $1,149,750. That is what we are appropriating?

Mr. SANGER. That is what you are appropriating for.

Mr. O'NEAL. And the total of the sums mentioned in the column above

Mr. SANGER. That is what we receive from other sources.

Mr. O'NEAL. That is contributions that you receive from other sources?

Mr. SANGER. Yes.

COST TO OTHER AGENCIES

Mr. O'NEAL. There is another question that I want to ask you: What have you to do with determining how much service you are rendering and the cost of it to the District of Columbia or other agencies? You justify that, do you?

Mr. SANGER. Yes. We figure what the total cost is to operate, including ordinary repairs to buildings and grounds. That includes the full pay roll and maintenance of the institution for the benefit of the patients, such as feeding, clothing, furnishing everything pertaining to the ambulance service, heating, lighting, and everything else; and we divide that by the total number of hospital beds.

Mr. O'NEAL. Has the pro-rata cost increased from 1937 over 1936? Mr. SANGER. No.

Mr. O'NEAL. Do the other agencies contribute a greater amount pro rata than they did in the other fiscal years?

Mr. SANGER. Not since 1935. In 1935 it was somewhat less, because there was a 5-percent reduction from the pay rolls. We increased that in 1936.

We have tried to economize in some other way-by increasing the output from our dairy, increasing the products from the fresh pork

139751-37-pt. 1- -47

that we raise there, and from the shoe factory, to offset any increase in supplies and to maintain the same level.

Mr. O'NEAL. Even though the cost of living has gone up, by better management and better production and better operation of your institution you have managed to keep the pro-rata cost on the same level? Mr. SANGER. That has been our effort.

Mr. LAMBERTSON. That is a very commendable effort.

FARMING ACTIVITIES

Mr. LAMBERTSON. How much milk do you buy outside of what is produced by the institution?

Mr. SANGER. We do not buy any fresh milk. We receive about 875,000 gallons from our herd. We do buy some canned milk for cooking purposes and in the bakery. When the demand is greater, we add to the amount required for cooking purposes.

We hesitate to introduce purchase of milk into our supply. Our herd is tuberculin tested. It is one of the largest accredited herds, care being taken to prevent the incubation of mastitis and garget, and we do not want any other milk mixed with ours if we can avoid it. Mr. LAMBERTSON. Hog production and gardening are expensive, are they?

Mr. SANGER. The gardening grows a little less. Each time we build a building we are taking up some of the land formerly used for farming and gardening. Also we have to keep on an even level the amount of ground devoted to silage and forage, as it is difficult to purchase economically feed of that class for the dairy herd.

Mr. LAMBERTSON. Those farms are mainly down the river a little farther?

Mr. SANGER. Yes. That is one of the biggest farms.

But in a hospital of that size it would be ideal, to get the greatest amount of benefit to the patient and do it most economically, to have an acre to a patient.

Mr. O'NEAL. Where is the money appropriated to operate your dairy?

Mr SANGOR. It all comes out of this one fund.

Mr. O'NEAL. It comes out of this fund here?

Mr. SANGOR. "Forage and other supplies for animals", and then "Materials not specifically allocated for purchase" item 029, at the foot t'ere.

Mr. O'NEAL. Do you use a good many of the inmates in work of this el aracter?

Mr. SANGER. Practically 1,200 to 1,300 inmates are used for various activities around the hospital grounds. If you include those who work just on the wards, it would probably be larger than that.

MAINTENANCE AND REPAIR OF MOTOR VEHICLES

Mr LAMBERTSON. $25,000 pays for the maintenance, repair, and equipment of all kinds of cars?

Mr. SANGER. Yes, sir; that includes ambulances and all passenger

cars

Mr. LAMBERTSox Including two new cars?

Mr. SANGER That is to replace worn-out ones which have been in use 7 or 8 years.

ESCAPES

Mr. LAMBERTSON. How many escapes did you have during this last current year?

Mr. SANGER. We probably had about between 140 and 150 altogether.

Mr. LAMBERTSON. You have a little fund here to take care of that, and get them back, do you?

Mr. SANGER. Yes; but we don't use that whole fund. You know how we arrange that. We don't give a reward. That is what it is named, but we offer to those who return a patient $5 for their expenses in bringing them back. That has proved the most economical way to handle it.

PAYMENTS BY PATIENTS FOR SERVICE

Mr. O'NEAL. Doctor, is there any payment made by any of your wards tkat are financially able to do so, for the service rendered to them; or is it all charity?

Mr. SANGER. That must be answered in two ways. The only money that the hospital receives directly for service is from Army and Navy officers, a dollar a day, which they must pay for food in any Government hospital.

Mr. O'NEAL. Is that turned into the Treasury?

Mr. SANGER. That goes into "Miscellaneous receipts."

In addition to that, for the District patients, all who are indigents, if the District government finds that the people can afford to pay, they collect the cost of maintenance, and that goes into the District of Columbia receipts.

Mr. O'NEAL. But you get no part of it?

Mr. SANGER. We get no part of it.

Mr. O'NEAL. If you divide the cost with the District of Columbia, why should you not share in the payment for the service?

Mr. SANGER. We charge them full for the cost, and they reimburse themselves for something that we have already charged them. Mr. O'NEAL. That is taken care of? Mr. SANGER. That is taken care of.

CONTINUOUS-TREATMENT BUILDING

Mr. LAMBERTSON. I see you have some language in here for the construction and equipment of a continuous-treatment building, $250,000.

Mr. SANGER. Yes. The justification for that item states:

One continuous-treatment building, including preparation of plans and specifications, advertising, supervision of construction, and equipment, to remain available until used, $250,000.

In 1926, when the Comptroller General of the United States surveyed the hospital, there were 4,600 patients in the institution. The report of the Comptroller General to Congress showed that he considered the hospital 1,000 patients overcrowded. Under these conditions it would seem that to comfortably fill all the beds the hospital could provide it could accommodate 3,600 patients.

Since 1926, when the report was made, additional beds have been provided as follows:

Female receiving building.

Total additional beds_

Continuous-treatment building (authorized in act of June 22, 1936).

Total number of beds in the hospital when building at present authorized is completed.

Beds

200

80

320

400

300

160

1,460

5,060

The present number of patients in the hospital is 5,500. Estimated for 1938, 5,636. With 5,500 in the hospital at the present time, there is an overcrowding of 440 and 136 additional beds to carry the average estimated for 1938. Included in the buildings at present in use are seven semipermanent buildings, each arranged for 72 beds, or 504 beds in all. These were erected in 1918, of s semipermanent character, with an estimated life of 15 years. They have now been in use for a period of 18 years, are in more or less of a semidilapidated condition, of wooden construction covered with stucco, which can hardly be considered fireproof material, and should be replaced. They cannot be replaced with the present population and under the future estimates unless additional beds are provided. The continuous-treatment building, with the estimated capacity of 160 beds, requested is to in part meet this shortage and provide additional beds. If this building is authorized there will be a total of 5,220 beds, which still would leave the hospital in a crowded condition. If authorized, before this building is completed, there would probably be upward of 5,700 patients to provide for.

The continuous-treatment class of buildings, with 160 beds each, at a cost of $250,000 each, is the cheapest class of construction that probably could be provided to house the patients. The estimate is based on the rate of $1.562.50 per bed, which would include preparation of plans and specifications, advertising. supervision of construction, and equipment. The buildings would be of fireproof construction and economical in maintenance.

This building would fit around a central kitchen which was erected in such a manner that would permit all six such buildings to be fed from the same kitchen, with little or no additional equipment.

Mr. LAMBERTSON. What was the complement or duplicate of that that was finished last year? What do you call that?

Mr. SANGER. One was authorized last year, on which we opened bids; and the lowest price so far was $264,000. So far we have not been able to enter into a contract, as we have an estimate with the Bureau of the Budget which we hope will be in the next deficiency for $40,000 additional.

But at the present time we are about six or seven hundred beds short of what we should have; and we have one series of buildings, which I mentioned as semipermanent, with 500 beds, which will have to be replaced in a few years.

Mr. LAMBERTSON. I think there is no question but what you need it. Where are the buildings going to be placed in regard to the remainder of the men's receiving ward?

Mr. SANGER. The two continuous-treatment buildings would be placed where they would be accessible to a kitchen, which is built in such a manner that we can fill out on each side, two on each side, all feeding from that same kitchen.

Mr. LAMBERTSON. This kitchen is not built?

Mr. SANGER. It is built.

Mr. LAMBERTSON. In the men's receiving?

Mr. SANGER. Back of the men's receiving, or practically south of it. Mr. LAMBERTSON. It would be south and east, then, of the men's receiving building?

Mr. SANGER. Yes. You have seen this men's receiving building, have you not, Mr. Lambertson?

Mr. LAMBERTSON. Yes. The female receiving building was the last to be constructed, was it not?

Mr. SANGER. That is the last one completed. Yes.

Mr. LAMBERTSON. What was the cost of that?

Mr. SANGER. The women's receiving building cost $750,000. That is a five-story building.

Mr. LAMBERTSON. That is a big, fine building.

Mr. SANGER. Yes.

This class of building that we are now asking for will probably be a cheaper type of construction. We can get this for 190 beds for practically $1,100 a bed, while the receiving building cost $2,500 a bed. Mr. LAMBERTSON. It is a two-story building?

Mr. SANGER. Yes. A two-story building.

Mr. LAMBERTSON. With basement?

Mr. SANGER. With basement. Yes.

Mr. LAMBERTSON. What was the cause of the delay in the securing of bids on that?

Mr. SANGER. The bids were secured.

Mr. LAMBERTSON. But they were too high?

Mr. SANGER. Yes.

As to the delay, we first had to have the architect draw up the plans. Then we had to secure the approval of the printer to have the specifications sent out, and then give 90 days. We opened them several months ago, about November; but we have not been able to get a deficiency since that time.

On the new buildings that delay will be avoided, because similar specifications will be used to the ones that we have already drawn up.

DRIVEWAY UNDER NICHOLS AVENUE AND TUNNEL BETWEEN C AND M

BUILDINGS

Mr. LAMBERTSON. I see you have a little item here in the bill reading:

To furnish a driveway under Nichols Avenue, connecting two parts of the hospital, and four tunnels between C and M Buildings, for conveying food, $56,000.

Mr. SANGER. Yes. Our justification for that is as follows:

Most

To furnish a driveway under Nichols Avenue, connecting two parts of the hospital, and for tunnel between C and M Buildings, for conveying food, $56,000. St. Elizabeths Hospital occupies land on both sides of Nichols Avenue. of the older buildings are on the right hand, or west side, while the newer buildings are on the left hand, or east side. In 1903 a subway was erected under Nichols Avenue, connecting both sides of the hospital grounds for more efficient, economic, and safer transportation and traffic between the two sides of the institution. When this subway was built no consideration was given to motor transportation. In addition, the growth of the hospital has resulted in an increase in the number of patients on that part of the institution where the newer buildings are being erected, until at the present time about 2,000 patients are being quartered in such new buildings. Traffic in the subway by patients and employees, also relatives and friends visiting patients, has increased very materially. Motor vehicles can not pass each other in this subway, and it is dangerous for the patients to go back and forth while vehicles are coming through. The height of this subway is such that it not only prevents loaded trucks of the hospital from coming through but altogether stops the passage of any fire apparatus. A survey has been made by an engineer of the Public Works Administration, and in his report he stated that