25-723 0743 Assistant Bureau Director (and Small Staff of 5-6) for Each Program Authorized by Legislation ATTACHMENT NO. 6 CONGRESS OF THE UNITED STATES, DEAR COLLEAGUE: It is the intention of the Department of Health, Education, and Welfare to administratively reorganize the Health Services and Mental Health Administration into the Health Resources Administration and the Health Services Administration. These proposed administrative changes, as outlined very broadly on page 18260 of the Federal Register of July 9, 1973, would seem to set the stage for what Dr. Arthur Lesser, in his statement of resignation as program director for Maternal and Child Health Care, protested would amount to, ". . . the first step in the elimination of categorical programs. It is another disregard for the intent of Congress." Please see my remarks on Page H. 5773 of the June 30, 1973 Record (2d column, last paragraph, et seq.), for further particulars on this issue and the protest resignation of this highly respected, veteran health professional. As the attached letter to Secretary Weinberger spells out, this "reorganization" would effectively deprive six categorical programs of their immediate support, program and administrative personnel. It would further seem to be in conflict not only with funding and personnel accountability contained in present law, but with the very recent intent of the Congress in providing an extension of specific program funding for Title V Maternal and Child Health Care programs-extension of a categorical, not formula method of fund distribution. It is my hope that you will be able to join with me in this letter to Secretary Weinberger, asking for clarification of the Department's specific intentions with regard to Maternal and Child Health Care, and other categorical programs being lumped together for purposes that may be "efficient" but which have been condemned by deeply worried health care professionals as destructive of the health care goals the Congress intended in creating them. The specifics of this letter and the attached have the strong endorsement of the American Academy of Pediatrics. Should you wish to join in this letter please call Miss Golden on ext. 54105 by noon Friday, July 20, 1973. Sincerely, HUGH L. CAREY, M.C. ATTACHMENT NO. 7 Hon. CASPAR WEINBERGER, Secretary, Department of Health, Education, and Welfare, DEAR MR. SECRETARY: The lack of current information regarding the proposed reorganization of Health Services and Mental Health Administration into the Health Resources Administration and the Health Services Administration is causing anxiety, and it is hoped that your response to this inquiry might convey Administration proposals as they might affect the effective achievement of program goals directed by the Congress. Specifically, concern is mounting that the new organizational structure will be incapable of fulfilling the purpose for which each individual program had been initially established. The organization proposed reflects a new Bureau of Community Health Services comprised of Maternal and Child Health, Family Planning, Migrant Health, Neighborhood Health Centers, National Health Service Corps and Health Maintenance Organization. The director of each of these programs will become an Assistant Bureau Director. It appears that each program will be treated similarly regardless of whether they are equal in scope, history, funding, accomplishments, expectations or mandate. In addition, while the Director of Maternal and Child Health Service for example, maintains apparent responsibility for the program, he has no line authority over employees justifiably employed with Title V funds, since the personnel are redistributed among the various offices, save five or six employees who will work on the Assistant Bureau Director's immediate staff, primarily as apologists. This reorganization plan, unlike previous plans, appears to dismantle the maternal and child health program components rather than merely give them new administrative superiors. This appears as not only unsound health policy and unwise administrative practice, but a disregard for the populations to be served and the compassionate mandate which established and maintains the MCH program. This reorganization fails to assure that programs will advance at the accelerated pace which is so vital. The Congress maintains a very active interest in maternal and child health programs, as manifested by the strong support Title V project extension received recently in both Houses. The maternal and child health program has been established for 38 years, and has continued through the years marked by distinguished accomplishment. The proposed reorganization is not a solution for the problems of the program, which admittedly may exist, nor would it provide improvement for the program. The anxiety of the Congress with the new reorganization plan has intensified recently with press accounts regarding the resignations of Arthur Lesser and Dr. Gordon Macleod, two highly regarded program directors. Each official has stated that his resignation stems from the incompatibilty of reorganization and program objectives. Dr. Lesser has stated, "This is the first step in the elimination of categorical programs. It is another disregard for the intent of Congress." In light of the seriousness of this issue, and the relative scarcity of information, it would be appreciated that your response include comment on these questions: 1. Why has no revised appropriations request been submitted to reflect the reorganization? 2. Are there plans to change program allottees as required by Section 36799 of the Revised Statutes and the HEW Accounting Manual Chapter 2-10 (6/26/ 67)? 3. How will each allottee be able to maintain supervision and accountability of personnel working in other offices? 4. Will each office have assigned staff to work exclusively on each of the programs, or will there be an "equivalent time" arrangement to assure that programs receive staff support proportionate to appropriations for direct program operations? 5. What recourse is available to the Assistant Bureau Director when offices are not responsive? 6. What are the long range plans since five of the programs are operating under one year extensions and maternal and child health program is under permanent authority? Is it the ultimate intention to phase out these six categorical programs? 7. Might the Department initiate this reorganization July 1, 1974, after the Congress decides upon the future of these categorical programs? 8. When will the details of the plan be available for public review? 9. Will comments on the plan be solicited and considered before it is initiated? 10. When might the Congress expect to be fully informed of administrative plans? 11. Will Congressional approval be sought? The Committee on Ways and Means and, indeed, the entire Congress, would prefer to leave administrative organization and detail to the Executive. However, when administrative changes seem imminent, and these changes appear to run counter to the policy intent of the law, it becomes incumbent to the Congress, and even more so on the Executive, to engage in a dialogue which protects the intent of the Congress, maintains the integrity of the programs under discussion, preserves true administrative flexibility, and permits the Executive department in question to retain the confidence of the Congress in like matters. It is our concern that the Department of Health, Education and Welfare administer all programs mandated to it by the Congress in the most efficient manner consistent with the program goals determined by the Congress. However, it is equally our concern that various categorical and other programs not be done to death through administrative legerdemain-a process that deprives programs of adequate fiscal and administrative support and strong professional leadership and then declares to the Congress that these starving and stumbling programs are clearly ineffective and surely inefficient, and should be terminated or blended with an even more amorpheous administrative unit, which itself is earmarked for destruction. Your early response to both the specific questions and the larger philosophical one is appreciated. Advance communication through this informal means would seem to be preferable to repeated last minute legislative resuscitation by the Congress action necessarily less well designed than is desirable. Sincerely, HUGH L. CAREY, ATTACHMENT NO. 8 [Press Release: July 23, 1973-From Congressman Hugh L. Carey] CAREY QUESTIONS POSSIBLE ILL-EFFECTS OF HEW REORGANIZATION PLAN WASHINGTON.-Congressman Hugh L. Carey (D-N. Y.), was joined today by 34 of his House Colleagues in requesting an explanation from HEW of an administrative reorganization that Carey believes will have very serious ill-effects on Maternal and Child Health Care programs throughout the Nation. Carey's letter to Secretary Weinberger was prompted by the continued HEW assault on Health and other programs the Department is supposed to foster and see successful. The Congressman is increasingly dismayed at seeing the present Secretary of Health, Education and Welfare destroying progressive, human-needs programs passed by the Congress and administered in the recent past by such distinguished men as Abraham Ribicoff, Anthony Celebrezze, Wilber Cohen and John Gardner. In a letter to HEW Secretary Weinberger, Carey asks, in eleven specific questions, for clarification of the Department's intentions with regard to Maternal and Child Health Care, and other categorical health programs being lumped together for purposes that may be "efficient", but which have been condemned by deeply worried health care professionals as destructive of the health care goals the Congress intended in creating them. "The anxiety of the Congress with the new reorganization plan has intensified recently with press accounts regarding the resignations of Drs. Arthur Lesser and Gordon McLeod, two highly regarded directors of affected programs. Each official has stated that his resignation stems directly from the incompatibility of reorganization and program objectives. Dr. Lesser stated, "This is the first step in the elimination of categorical programs. It is another disregard for the intent of Congress." The Congressman, further declared, "It is the concern of the Congress that the Department of Health, Education and Welfare administer all programs mandated to it by the Congress in the most efficient manner. However, it is equally our concern that various categorical programs not be done to death through administrative legerdemain-a process that deprives programs of adequate fiscal and administrative support and strong professional leadership and then declares to the Congress that these starving and stumbling programs are clearly ineffective and surely inefficient, and should be terminated or blended with an even more amorphous administrative unit, which itself is earmarked for destruction." In closing, Carey stated that if the Department of HEW expects to regain the confidence of the Congress and retain authority in administrative reorganizations affecting policy goals set by the Congress, "Advance and thorough communication would seem to be preferable to repeated last-minute legislative resuscitation by the Congress.' The following Congressmen have added their names to the letter sent by Congressman Carey: Mr. ROGERS. Thank you, Mr. Carey, for an excellent statement. I think the points you have made are very well taken and I am sure this committee will adhere to your admonitions. |