Additional material-Continued Carey, Hon. Hugh L., a Representative in Congress from the State of No. 2-Letter dated April 19, 1973, from Secretary Weinberger No. 3-Letter dated June 15, 1973, from Congressman Carey to No. 4-Floor remarks of June 30, 1973, by Congressman Carey No. 5-Organizational chart showing the proposed disposition No. 6-Letter dated July 17, 1973, from Congressman Carey to No. 7-Letter from Congressman Carey to Secretary Weinberger No. 8-Press release dated July 23, 1973, from Congressman Health, Education, and Welfare Department: Health authorization and appropriation levels, fiscal year 1973 Memorandum dated February 20, 1973, from Dr. Edwards to Organization charts and brief explanation of mission and function Health Services Administration___ Indian Health Service.-- Federal Health Programs Service__ Bureau of Community Health Services- 52, 53, 54, 57 Report dated April 5, 1973, prepared for the Assistant Secretary of Health and entitled, "Review of Programs and the Organization of Health Services and Mental Health Administration". 203 National Council of Community Mental Health Centers, statement.. New York City Health and Hospitals Corp.: Analysis and discussion of the 1972 amendments to the Social Application for medical assistance forms___ 200 91 108, 117 107 Memorandum from President English, New York City Health Regional Medical Program Coordinators, J. Gordon Barrow, M.D., 87 199 REORGANIZATION OF HEALTH PROGRAMS IN HEW MONDAY, JULY 30, 1973 HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON PUBLIC HEALTH AND ENVIRONMENT, COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE, Washington, D.C. The subcommittee met at 10 a.m., pursuant to notice, in room 2322, Rayburn House Office Building, Hon. Paul G. Rogers, chairman, presiding. Mr. ROGERS. The subcommittee will come to order. This morning the subcommittee is conducting oversight hearings on the recent reorganization of the Department of Health, Education, and Welfare. The Department of Health, Education, and Welfare derives its authority to operate programs from the Congress, and thus it is accountable to the Congress for the performance of its programs. The reorganization of the "H" portion of HEW is thus of great interest to this subcommittee, which has written much of the health program authority for HEW. Today's hearing will focus on the effect of the reorganization on the programs developed by this subcommittee, as well as its effect on the maternal and child health programs. This subcommittee has nothing against reorganization. Indeed, few would argue that HEW does not need a reorganization in the health field. However, if the effect of the reorganization is to retard programs developed by this subcommittee, then we will consider legislative action to reverse decisions which retard the proper functioning of those programs. We will be hearing testimony on this from Dr. Charles Edwards, Assistant Secretary for Health of the Department of Health, Education, and Welfare. Our first witness this morning, is the Honorable Hugh Carey, a member of the House Ways and Means Committee. Before we have witnesses today I think Dr. Roy, as I understand, may have some remarks he would like to make before we get into witnesses and the Chair would recognize the gentleman. Mr. Roy. Thank you, Mr. Chairman. I very much appreciate the fact that today we are going to have hearings on the reorganization of the Health Division of the Department of Health, Education, and Welfare. Mr. Chairman, these hearings are held, as you so well expressed, on national TV this morning at a difficult time in the history of Federal health programs. At the present time programs designed by the Congress to meet the health needs of the people of this Nation are under unprecedented attack. While the officials of this administration pay lip service to and hold propaganda conferences about the importance of Federal programs (1) designed to improve the health and health care of the people of this Nation, their performance has been diametrically opposed to that position. If we follow John Mitchell's admonition to "watch what we do, not what we say," hardly a worse situation could be imaginedMr. CARTER. Mr. Chairman. Mr. Roy. Within the past year this administration has twice vetoed Department of HEW appropriation bills carefully worked out within the Congress to provide adequate, but not extravagant, funds for health and educational programs. The administration has submitted a budget request for fiscal year 1974 for health programs which, if we include inflation, provide 16 percent less funds for health programs than was appropriated in fiscal year 1972. And perhaps most serious of all, this administration has illegally impounded-or at least left unspent $1.1 billion of health funds in 1973. It should be stressed that this attack is not merely an attack on Federal health programs, but it is also an attack on the Congress and the very constitutional basis for our Government. The funds impounded-or as I said, at least not spent in fiscal year 1973 were legally authorized and appropriated and according to the provisions of section 601 of the Public Health Service Act, which was adopted by an override of a Presidential veto in 1970, funds appropriated pursuant to the Public Health Service Act must be spent. The impoundment or nonspending of health funds in fiscal year 1973 is a clear example of the administration's considering itself above the law. Subsequent to this unprecedented attack on both Federal health programs and the constitutional powers of Congress, the Department of Health, Education, and Welfare began a reorganization of the administration of health programs in February of this year. This reorganization was from the beginning unmistakenly a part of the attempt to reduce and abolish a number of health programs. The first line of the charge to the committee on the reorganization states, "The administration has made a number of policy decisions on the direction of Federal programs for health services." This reorganization is then unmistakenly a political reorganization. A political reorganization is without basis in legislation, either authorizing or appropriations legislation, a political reorganization whose basis, "administration policy decisions," has been, in fact, explicitly rejected with the passage of Senate 1136 and House Joint Resolution 636 by both the authorizing and Appropriation Committees of the House and Senate of the United States. In recent days we have heard much from this administration about this administration's illegal activities and subsequent attempts to cover up certain activities. We have heard about burglaries and subsequent payoffs to the burglars. We have heard about illegal bombing raids and subsequent falsification of reports, so in health we know well of the illegal impoundment of $1.1 billion in fiscal year 1973 moneys. Today we prepare to hear testimony on an attempt to cover up the impoundment by the so-called reorganization of the health division of the Department of Health, Education, and Welfare. Thank you, Mr. Chairman. Mr. ROGERS. Dr. Carter, you may say something. Mr. CARTER. Mr. Chairman, I do wish to say something. I am distressed to see this committee, which has been organized to legislate on health and environment, sink to the lowest depths of politics. I regret it very much. As every man on this committee knows, and as Dr. Edwards and his staff know, I have supported every worthwhile piece of health legislation for the past 8%1⁄2 years, and have opposed all cuts in appropriations. It is with extreme regret that I see this committee made a political forum to launch the campaign of the gentleman for the Senate in Kansas. I regret this. I had hoped that we wouldn't sink to politics on this committee. Now, Mr. Chairman, if we want to do some reorganization, and this Committee has suggested that we do that, I want to remind you that there is a bill before you which would establish legislation providing funds for different diseases for research, treatment, and so on, for different diseases according to the mortality, morbidity, and economic impact of such diseases. For instance, since heart disease has the greatest mortality, morbidity, and economic impact in our country, then most of our funds should be devoted in this area. Second, since the cancer is the second greatest killer, then the second amount of funds should be devoted to research and treatment in this area. This bill which has been introduced before this House for the past 2 years has not been given a great deal of consideration. Instead of that this committee has time after time taken up little bills which have political impact, such as Cooley's anemia. I am a physician, and of many years, but I have never even seen a case of Cooley's anemia. It is a very rare bird. If the legislation which I had proposed basing appropriations on authorizations on morbidity, mortality, and economic impact, had been in effect it would have been unnecessary to have had a hearing on diabetes last week because it would have received the funds which were necessary for it. This is not done. Instead of that this committee has chosen to take a political attitude and even insinuate that it would ask for the resignation of one of the most capable Secretaries of HEW we have ever had, Mr. Caspar Weinberger. I regret that in some cases perhaps funds have been impounded, but I want to tell you that in many others it has been necessary. In mental health, in particular-and I am one of the men who have developed that bill. In fact, every piece of health legislation which has been enacted in the past 8 years I have been part of. But we have seen mental health. I have checked it thoroughly, and I have investigated the State of Kentucky. The Executive Secretary, Mr. Asher Tulles, called on me and told me that administration should be cut at least 50 percent. Mr. Weinberger has seen fit to cut in this area, and the reason, the basis of Mr. Tulles' recommendation, was the fact that too much was being spent on administration in this area. Now the services, the part in which people are helped, was not to be cut. I will give you a specific instance. In one area in Kentucky the regional director was found to have embezzled $6,000 or $8,000, and only left an IO U in his desk. This man had been guilty before of taking funds, and before this time the regional board, as the record shows, had increased his salary so that he could pay back that money. In Louisville, Ky., we have what is called a crisis center under mental health, and hundreds of thousands of dollars are spent each year on this crisis center. Not a physician is present, but as many as 10 of 15 people are in this crisis center, and when a man who is a potential suicide comes there, the answer given as to his treatment is that they "rap" with him. I think that this is absolutely and totally not the proper treatment. He should see a psychiatrist immediately and be treated by a psychiatrist. In Lexington, Ky., we had the very same, or something of the same nature happen. Judge Monihan, the Federal judge in that district, told the district attorney, Mr. Eugene Siler, to get to the depths of the dirty treatment and the dirty methods of treatment that were going on in the Lexington unit. This is a matter of record today in the Federal Court of Eastern District of Kentucky. So I wish to commend the Secretary of HEW for his grit in doing something about the waste of money in mental health. That is being done, and I think is eminently justified. We want to give every cent that is needed in all these areas, and to say that these things are illegal, absolutely illegal, is to say that Thomas Jefferson also violated the law because we know that he began impounding funds during his administration. I think I came here today not realizing that we would have a political forum on which to impeach members of the party or in which to say all manner of evil against the Secretary of HEW and others. I can't do that. I deeply regret to see this committee, which has done so much for health in the past few years, sink to a low level, and I thank the distinguished chairman for yielding. Mr. Roy. Mr. Chairman, may I have a word, please? I made two accusations: No. 1, that funds have been illegally not spent. Like I say, I don't want to use the word "impounded" because it has certain technical meanings. I base that in part on the President's veto message, and the third paragraph of that states the following: "One of the most unacceptable provisions of this bill is in section 601. Here the Congress insists that funds appropriated for any fiscal year through 1973 to carry out the programs involved must be spent." The veto was overridden. I think the President has stated this very clearly, has admitted that which was provided in that bill. And here, of course, we have a list that is public knowledge. Everyone knows that there has been $1,095 million that have not been spent on these programs. Now, the second charge I made was that the reorganization is a coverup of the failure to make a health effort within the administration, and I would like to go to page 20 of the study perspective and one of the major items in caps, underlined, is "The new organization must provide for the phaseout of major health service activities.' I submit to my friend, Dr. Carter, whom I respect greatly, and who has done an exceptional job in health, that we have not at this time. authorized the phaseout of major health service activities. Now, I am privileged to sit on this committee, and I am very open to consideration of restructuring of our health programs, and phasing out some programs and bringing others together, but I would submit to you that as we study this reorganization, which I have over the past 2 or 3 weeks, we'll see that by administrating a fiat they intend to do |