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medicine, dentistry, osteopathy, or optometry which has an approved application therefor and for which an application has been approved under section 771, if he determines that the requirements of subsection (b) are satisfied in the case of such applicant.
"(b) No special improvement grant shall be made under this section unless such grant is recommended by the National Advisory Council on Medical, Dental, and Optometric Education and the Surgeon General determines that such grant will be utilized by the recipient school (1) to contribute toward the maintenance of, or to provide for, accreditation, or (2) to contribute toward the maintenance of, or to provide for, specialized functions which the school serves.
"(0) No grant to any school under this section may exceed $100,000 for the fiscal year ending June 30, 1966; $200,000 for the fiscal year ending June 30, 1967; $300,000 for the fiscal year ending June 30, 1968; or $400,000 for the fiscal year ending June 30, 1969.
"Applications for grants
“SEc. 7'73. (a) The Surgeon General may from time to time set dates (not earlier than in the fiscal year preceding the year for which a grant is sought) by which applications for basic or special grants under section 771 or 772 for any fiscal year must be filed.
"(b) To be eligible for a grant under this part, the applicant must (1) be a public or other nonprofit school of medicine, dentistry, osteopathy, or optometry, and (2) be accredited by a recognized body or bodies approved for such purpose by the Commissioner of Education, except that the requirement of this clause (2) shall be deemed to be satisfied if, (A) in the case of a school which by reason of no, or an insufllcient, period of operation is not, at the time of application for a grant under this part, eligible for such accreditation, the Commissioner finds, after consulation with the appropriate accreditation body or bodies, that there is reasonable assurance that the school will meet the accreditation standards of such body or bodies prior to the beginning of the academic year following the normal graduation date of students who are in their first year of instruction at such school during the fiscal year in which the Surgeon General makes a final determination as to approval of the application, or (B) in the case of any other school, the Commissioner finds after such consultation and after consultation with the Surgeon General that there is reasonable ground to expect that, with the aid of a grant or grants under this part, having regard for the purposes of the grant sought, such school will meet such accreditation standards within a reasonable time.
"(c) The Surgeon General shall not approve or disapprove any application for a grant under this part except after consultation with the National Advisory Council of Medical, Dental, and Optometric Education (established by section 774).
“(d) A grant under this part may be made only if the application therefor—
“(1) is approved by the Surgeon General upon his determination that the applicant meets the eligibility conditions set forth in subsection (b) of this section;
“(2) contains or is supported by assurances satisfactory to the Surgeon General that the applicant will expend in carrying out its functions as a school of medicine, dentistry, osteopathy, or optometry, as the case may be, during the fiscal year for which such grant is sought, an amount of funds (other than funds for construction as determined by the Surgeon General) from nonFederal sources which are at least as great as the average amount of funds expended by such applicant for such purpose in the three fiscal years immediately preceding the fiscal year for which such grant is sought;
"(3) contains such additional information as the Surgeon General may require to make the determinations required of him under this part and such assurances as he may find necessary to carry out the purposes of this part; and
"(4) provides for such fiscal-control and accounting procedures and reports, and access to the records of the applicant, as the Surgeon General may require to assure proper disbursement of and accounting for Federal funds paid to the applicant under this part.
"(c) In considering applications for grants under section 772, the Surgeon General shall take into consideration the relative financial need of the applicant for such a grant and the relative effectiveness of the applicant's plan in carrying out the purposes set forth in clauses (1) or (2) of subsection (b) of section 772 and in contributing to an equitable geographical distribution of schools offering high-quality training of physicians, dentists, and optometrists.
"National Advisory Council on Medical, Dental, and Optometric Education
"SEC. 774. (a) There is hereby established in the Public Health Service a National Advistory Council on Medical, Dental, and Optometric Education consisting of the Surgeon General, who shall be Chairman, and twelve members appointed without regard to the civil service laws by the Surgeon General with the approval of the Secretary of Health, Education, and Welfare, and such appointments may be made for specified staggered terms. The appointed members of the Council shall be selected from among leading authorities in the fields of medical, dental, and Optometric education, respectively, except that not less than three of such members shall be selected from the general public.
“(b) The Council shall advise the Surgeon General in the preparation of general regulations and with respect to policy matters arising in the administration of this part and part F, and in the review of applications under this part.
"(c) The Surgeon General is authorized to use the services of any member or members of the Council in connection with matters related to the administration of this part or part F, for such periods, in addition to conference periods, as he may determine.
“(d) Appointed members of the Council, while attending conferences or meetings of the Council or while otherwise serving at the request of the Surgeon General, shall be entitled to receive compensation at rates to be fixed by the Secretary but not exceeding $100 per day, including travel time; and while away from their homes or regular places of business they may be allowed travel expenses, including per diem in lieu of subsistence, as authorized by section 5 of the Administrative Expenses Act of 1946 (5 U.S.C. 73b-2) for persons in the Government service employed intermittently.
“PART F—SCHOLARSHIP GRANTS TO SCHOOLS or MEDICINE, OSTEOPATHY, DENTISTRY, on OPTOMETBY
“SEC. 780. (a) The Surgeon General shall make grants as provided in this part to each public or other nonprofit school of medicine, osteopathy, dentistry, or optometry, which is accredited as provided in section 721 (b) (1) (B) or section 773(b) (2), for scholarships to be awarded annually by such school to students thereof.
“(b) The amount of the grant under subsection (a) to each such school shall be equal to $2,000 multiplied (1) for the fiscal year ending June 30, 1966, by one-tenth of the number of full-time first-year students of such school; (2) for the fiscal year ending June 30, 1967, by one-tenth of the number of full-time first-year students and secondyear students of such school; (3) for the
fiscal year ending June 30, 1968, by onetenth of the number of full-time first-year students, second-year students, and thirdyear students of such school; and (4) for the fiscal year ending June 30, 1969, by one-tenth of the number of full-time students of such school. For the fiscal year ending June 30, 1970, and for each of the two succeeding fiscal years, the grant under subsection (a) shall be such amount as may be necessary to enable such school to continue making payments under scholarship awards to students who inltially received such awards out of grants made to the school for fiscal years ending prior to July 1, 1969.
"(c) (1) Scholarships may be awarded by schools from grants under subsection (a)—
“(A) only to individuals who have been accepted by them for enrollment as full-time first-year students, in the case of awards from such grants for the fiscal year ending June 30, 1966;
“(B) only to individuals who have been so accepted, and individuals enrolled and in good standing as full-time second-year students, in the case of awards from such grants for the fiscal year ending June 30, 1967:
"(C) only to individuals who have been so accepted, and individuals enrolled and in good standing as full-time second-year or third-year students, in the case of awards from such grants for the fiscal year ending June 30, 1968;
"(D) only to individuals who have been so accepted, and individuals enrolled and in good standing as full-time students, in the case of awards from such grants for the fiscal year ending June 30, 1969; and
“(E) only to individuals enrolled and in good standing as full-time students who initially received scholarship awards out of such grants for a fiscal year ending prior to July 1, 1969, in the case of awards from such grants for the fiscal year ending June 30, 1970, or the two succeeding fiscal years.
“(2) Scholarships from grants under subsection (a) for any school year shall be awarded to students, particularly students from low-income families, on the basis of need for financial assistance in pursuing a course of study at the school for such year. Any such scholarship awarded for a school year shall cover such portion of the student's tuition, fees, books, equipment, and living expenses at the school making the award, but not to exceed $2,500 for any year, as such school may determine the student needs for such year on the basis of his requirements and financial resources.
“(d) Grants under subsection (a) shall be made in accordance with regulations prescribed by the Surgeon General after consultation with the National Advisory Council on Medical, Dental, and Optometric Education.
"(e) Grants under subsection (a) may be paid in advance or by way of reimbursement, and at such intervals as the Surgeon General may find necessary; and with appropriate adjustments on account of overpayments or underpayments previously made."
(b) Section 724 of such Act (containing definitions) is amended by striking out "As used in this part" and inserting in lieu thereof "As used in this part and parts C, E, and F"; and section 740(a) of such Act is amended by striking out "(as defined in section 724) ".
Mr. HARRIS (interrupting reading of the section). Madam Chairman, in view of the fact that this section 2, which starts on the bottom of page 14 where the Clerk started reading and goes to the middle of page 25, is an amendment to title VII of the Public Health Service Act, I ask unanimous consent that further reading of the section be dispensed with and that it be printed in the RECORD at this point.
The CHAIRMAN. Is there objection to the request of the gentleman from Arkansas?
There was no objection.
Mr. COHELAN. Madam Chairman, I move to strike the last word.
Madam Chairman, I take this time to clarify a couple of points in regard to the main arguments which we have been having here. In the heat of discussion we have overlooked some very important points.
Madam Chairman, I take this opportunity to supplement the remarks I made yesterday and in particular to provide additional information in support of my strong belief that the amendment of my good friend from Florida [Mr. ROGERS] which was added by the committee in executive session without any opportunity to have hearings, that it be deleted from this otherwise needed bill.
Mr. HARRIS. Madam Chairman, will the gentleman yield?
Mr. COHELAN. I yield to the gentleman from Arkansas.
Mr. HARRIS. I asked the gentleman to yield, and I will get him some additional time if I take too much of his time.
There has been a very clear reference to the fact that the committee has apparently included an amendment to the bill which did not belong there, one that was not germane, and one which those who are interested did not have an opportunity to consider.
I would like to allay that contention. Certainly it appears some people may have not been consulted, but the committee did not include anything that was not germane. This is an amendment to the Nurses’ Training Act of 1964. The committee, in my opinion, was within its rights in considering the amendment referred to. I did not want anyone to think that the committee has done something here without giving the proposal the consideration that the committee usually does.
Mr. COHELAN. I understand what the distinguished chairman is saying, but I wish as much time had been given for discussion of this subject in committee as has been generously granted on the floor yesterday and today.
Mr. HARRIS. I would like for the record to show that the committee did conduct hearings. It held extensive hearings on this entire subject matter, and afforded opportunity to anyone and anybody to discuss this matter as well as other provisions.
Mr. COHELAN. There was some misunderstanding about what the facts are in regard to this point. Let me finish, because I want to make the record in just the manner the chairman wanted me to yesterday.
As Members will recall, the Rogers amendment provides that in the field of nursing alone, of all the health professions, the accreditation of training programs would no longer be the responsibility of the recognized accrediting body within that profession. This, I believe, is a serious mistake, as I indicated in my remarks yesterday.
Madam Chairman, in response to several questions which have been raised, I would like to point out that since the
passage of the Nurse Training Act in August of 1964, a total of 167 programs have applied for reasonable assurance of accreditation, the step which makes a school eligible for funds under this act. Of these 167 applications, 49 came from junior colleges and of these 49 junior college applications, 32 were granted reasonable assurance. It is my understanding that an additional 49 programs, 23 of them junior college programs, have submitted materials for the review panels which will meet later this month. From this breakdown, I think it should be perfectly clear that junior colleges are in no way being slighted; that their applications for accreditation are being considered promptly and fairly.
Madam Chairman, I would also like to comment on the matter of accreditation fees since certain questions have been raised and certain inaccurate conclusions have been drawn on this point.
In order to secure reasonable assurance, institutions offering new nursing programs are charged an accrediting fee of $100, plus travel and per diem expenses of two visitors. Institutions offering established nursing programs are charged only the accrediting fee of $100 since in most cases no field investigation is required.
Now Madam Chairman, the question has been raised about the $1,500 fee which is charged to those junior colleges which are not members of the National League for Nursing. Initially I think we should point out that 26 junior colleges are members and they, of course, pay only the fees I have already mentioned. The others, those that are not members, pay the $1,500 to assist in defraying the cost of the visit, convening the board of review, processing the necessary materials, corresponding with the school and listing the program. This $1,500 is paid only once every 6 years at the time of accreditation. Member schools incidentally, those who pay $100 at the time of accreditation, also pay annual dues of $575 and these dues, in part, defer the cost of accreditation. It should also be noted that through 1967 the National League of Nursing is offering a special annual dues rate to junior colleges, a dues rate of only $285 which is, of course, half the regular amount.
Again, Madam Chairman, I think the facts speak clearly to the need and to the fairness of eliminating this unnecessary and harmful amendment.
Mrs. BOLTON. Madam Chairman, I move to strike out the last word.
Madam Chairman, I rise with a great deal of reluctance. I have worked in nursing and for nurses longer than some of you men have lived. I have watched the nursing profession pull itself out of apprentice training into educational training. I have helped them at every point. I have felt in recent years, that they have gone a little beyond where they should have gone. The pendulum usually swings too far when it starts swinging.
Madam Chairman, I do surprise myself to be standing here speaking in opposition to the League of Nursing accreditation program. But I know of one State where there were 38 schools of
nursing—small, but excellent schools. The girls who trained there went back to their own areas and nursed the sick. They did not just fill out papers. There are now only five schools in that State, because of the accreditation. There had to be M.A.’s as teachers or nurses with doctoral degree. You could not have just a nurse who knew nursing from top to toe teaching in that school.
Some of the schools that have been examined for accreditation have been informed that they would receive partial accreditation. What girl is going to go 3 years to a school when she cannot get a license to nurse when she has finished? To me these things are tragic.
In 1956 I introduced a bill in the House of Representatives when my very good friend and our former colleague, Mr. Priest, was chairman of the subcommittee at that time. I had studied the whole situation of why girls do not go into nursing in the numbers that we want them to and why they do not stay in the field of nursing when they are there. I was in touch with nearly 12,000 people in this country—doctors, nurses, patients and so on—and I happened to be one of the patients myself. I know hospitals inside out and upside down. We found many very interesting things. Most of them are matters that the nurse cannot talk to the hospital superintendent about nor to the board of trustees. She is taught not to. It takes lay people who are trained through experience to go to the boards of hospitals and to go to the various areas that have to do with nursing and make the changes happen. A great deal of research had been done by nurses—magnificent research—but it had never been pulled together and made to produce. We wanted to pull it together.
So I asked for a Presidential Commission. On that Commission I placed two laymen. They were the patients who, surely, should have been heard. The nurses killed it in committee. The hierarchy—way up here—of nursing—whom I know very well and whom I admire, would not have any of us laymen—nonprofessionals—on the scene.
So the bill was killed. There was a Commission appointed. It did an excellent job of its kind, but it has produced no more nurses. It has not made it easier for nursing schools to give real bedside nursing training.
The last time I had figures compiled, We were short 85,000 bedside nurses.
How are we going to staff the new hospitals? How are we going to take care of the people who are sick in the districts?
The practical nurse has been a boon. She has been a wonderful addition when she has had proper training. She has to be overseen also by registered nurses of the right caliber and of the right training.
I am surprised at myself, as I said at the beginning, that I agree with the amendment of the gentleman from Florida [Mr. ROGERS] and its having been made a part of the bill.
My one suggestion is that it is going to be desperately important to uphold the standards of nursing training, and this will have to be carefully watched. Standards in our 50 States vary. We cannot afford to have the high standards lowered. We must watch that with the utmost care and must find ways to lift the lesser ones. This, Madam Chairman, is an activity this subcommittee has assumed.
The CHAIRMAN. The time of the gentlewoman from Ohio has expired.
(By unanimous consent (on request of Mr. HARRIS), Mrs. BOLTON was granted permission to proceed for an additional 3 minutes.)
Mr. ROGERS of Florida. Madam Chairman, will the gentlewoman yield?
Mrs. BOLTON. I yield to the gentleman from Florida.
Mr. ROGERS of Florida. I wish to say that I certainly appreciate the very fine statement the gentlewoman just made. I believe it is an excellent one and puts the proper perspective on this problem.
No one wants to let down the standards of nursing. We want them raised all the time. But we do so badly need nurses for this country. The problem is being accentuated every day.
All we are trying to do is to get more nurses.
All of us who know of the wonderful work of the gentlewoman from Ohio in helping establish the great nursing profession in this country are grateful to her for her comments.
Mrs. BOLTON. I thank the gentleman. I do want to say one amusing thing. This work has given me the chance to get equal rights for men.
Mr. HARRIS. Madam Chairman, I move to strike the requisite number of words.
Madam Chairman, I hesitate to take any additional time on this subject, because I believe it has been thoroughly discussed. There has been a record of great importance made. That was what we had in mind yesterday as we talked about this subject.
I am very glad the gentlewoman from Ohio did take the floor and speak on this subject. From my personal observation, I know she has contributed much to the welfare of the nursing profession through her efforts to bring to the attention of the people of this country the public service performed by the nurses. She is to be commended—and I do compliment her—for her sustained and continued interest over the years in this field. She has given me a lot of help, advice, and counsel, and has sustained me and other members of the committee in our efforts to try to reach a solution to the problems of nurse shortages in our traditional way in this Nation.
I wish to thank the gentlewoman publicly for the marvelous contribution she has made over these years.
I realize that this is a highly contro— versial issue. We did realize that in the committee. As was explained by the sponsor of the amendment, the gentleman from Florida [Mr. ROGERS] the committee believed there was some substance to the contention that was made that there were problems faced by junior colleges. On the other hand, I have nothing but the highest admiration for the
National League for Nursing. The nursing organization has contributed much to the health and welfare of the people of this country.
I have only the highest commendation for them in their efforts to improve their own profession so as better to serve the people of this Nation.
In view of the fact that this issue has been brought up and in view of the fact that there are so many who are concerned with it, I reiterate what I said yesterday—namely, if the matter will go on to conference and we have an opportunity further to develop the facts in connection with this matter, it will be my purpose—and I am sure other mem— bers of the committee will join me in it— that we make every possible eifort to work this matter out satisfactorily in conference.
There have already been some suggestions made as to how it can be done. We do not want to lower the standards or the criteria in the nursing profession. We want to utilize all of the educational facilities that are interested in training nurses, including the junior colleges. We have provided programs of nurse training, including a program of associate degree nurses, or nurses with 2 years of junior college education, a program of baccalaureate degrees, a program of diploma nursing, and then, of course, graduate nursing. It seems to me with the record that has been made here and the interest that has been shown, when we get to conference, or maybe when it is considered in the other body, we should come to some satisfactory solution of the problem.
Again I want to assure you, my colleagues, as I did yesterday, that I will make every effort to try to work this matter out as satisfactorily as possible. We can do it better in that way than we can do it here on the floor of this House.
Mr. CUNNINGHAM. Madam Chairman, I move to strike out the requisite number of words.
Madam Chairman, I am pleased to hear from my distinguished chairman, that there is a problem here and it is not all black and white. As far as I am concerned, there is definitely a real problem. Reference has been made to the need for more nurses. There is not a member of this committee that does not realize we need more nurses. But we need qualified nurses, and you do not get qualified nurses under a 2-year program where the school has not been accerdited by the National League of Nursing.
I might say, as I have said before, that there are slightly more than 100 junior colleges that do have registered nurse training programs. When they graduate from these programs they have to take a State examination. The results of their examinations, in some instances, have been pitiful.
In conclusion I might say that we have this wonderful Nurse Training Act which we passed last year which was the administration bill. Now we have this bill, and we are in favor of all of the bill except this provision having to do with accrediting of nurses’ schools.
We had no hearings. This was put in in executive session. I know that when
you get into executive session you mark up a bill, but this was a major change from what we did last year. So I say we had no hearings, and it was not discussed at any length.
Madam Chairman, if this amendment of the gentleman from Florida [Mr. ROGERS] stays in the bill, I am convinced that it will scuttle the National Nurses Training Act passed last year.
Mr. MOSS. Madam Chairman, I move to strike out the requisite number of words.
Madam Chairman, I have just listened to an amazing display of absolute inaccuracy. We have in junior colleges been training nurses for more than 35 years. San Jose Community College has been training nurses, I believe, for 35 years. Sacramento Junior College was training nurses or giving nursing educa— tion when I was a student there a long, long time ago.
The associate degree program has been underway for about 15 years. Hundreds of nurses who attended our junior colleges for their training are today rendering outstanding service in nursing.
Another bit of misinformation is the allegation that only three junior colleges are accredited today because of their pitifully inadequate standards. Three are accredited today; but the relationship of the number accredited to the number nonaccredited has absolutely no bearing upon their qualifications. Some 32 additional junior colleges have certificates of probable certification from the nurses accrediting group. It would be a great disservice to let the record stand as obfuscated as it was at the conclusion of the remarks of the gentleman who spoke before me.
The results of those attending the 2-year course in the license examinations given in the three larger States in this Union indicate that they compare in every respect favorably with the baccalaureate graduates and with the diploma. graduates from the hospital schools of nursing.
The statement was made that no significant factor should be assigned to this matter of accreditation cost. I requested the staff of the subcommittee for a document setting forth the cost of accreditation supplied by the American Nurses Association themselves. What does accreditation cost? An accrediting fee for a nonagency member is $1,500 each 6 years.
There are annual dues of $285 for member institutions, agency members, for the years of 1965 through 1967 and in 1968 that fee goes up to $585.
Now, Madam Chairman, if an agency member seeks accreditation it must pay the fees covering the cost of visitors, and that appears to be significant, because in correspondence furnished to the gentleman from Florida [Mr. Rooms] by Sister Anne Joachim, of St. Mary’s Junior College, in Minneapolis, Minn, and I quote:
The cost of this visit—
Referring to an inspection visit— was $317. Added to our $600 payment to the NLN for our membership brings our payments themselves close to $1,000 for this year alone.
And, the good sister adds:
One is painfully reminded of the comments one frequently hears about the unreasonably high cost of the NLN visits and travel which are neither necessary nor fruitful.
Mr. KING of Utah. Madam Chairman, I move to strike the requisite number of words. I have taken this time to clear up one or two points.
I might say that I appreciated the very fair attitude of the distinguished chairman who is managing this bill, and approach this matter in the same spirit.
Madam Chairman, I believe some of the trouble into which we have run in discussing the matter of accreditation of nurses is due to the fact that we have become victims of what I might call a time fix. A time fix occurs when one develops a mental image, in the nature of a fixation, at a particular instance of time, relating to a particular set of circumstances. The circumstances then change, but the image lingers on, unchanged.
Some Europeans who go out to Utah, for example, are still looking for wild Indians running up and down our main street. They are disappointed when they do not find them. They are victims of a time fix.
And so many people still conceive of the role of nurses as essentially that of dressing wounds, washing bodies, taking pulse and temperature, and emptying bedpans. This is the image which became accepted 40 years ago. But today, Madam Chairman, we must call to mind the image of a lady who sits behind her work desk on which are lined up hundreds of bottles containing narcotics and medications of every description. These bottles carry with them life, or death, depending on how they are used. The lady with the lamp has now become the lady with the hypodermic needle, and woe unto the poor patient upon whom that needle is used improperly.
What I am saying is that the nurses today are professional women who are required to exercise judgment and skill in the highest sense of the word. So, when we emphasize the need for upholding nursing standards, our position is not something artificially contrived. It is in full accord with realities of modern life.
Now, I am a little distressed that so much of the debate on this subject has dealt with the question of whether or not junior colleges are competent to train nurses.
In my opinion this is not the issue. I am perfectly willing to concede for the sake of argument that many, perhaps most, of the junior colleges are quite competent to turn out excellent nurses. Since this may well be true, it seems to me all the more logical that they should be willing to accept the same standards as do other institutions.
If the junior colleges can turn out such good nurses, then why should they ask for special privileges? Why should we give them special treatment, which we do not accord to others?
Madam Chairman, the issue is not whether or not the junior colleges are competent to do the job. They are not on trial. The indispensable service which they offer the Nation is a matter
of public record. The issue is simply whether we shall have nationally enforced professional standards, to the end that those institutions which receive Federal funds shall be limited to those which are giving competent nursing instruction. By so doing, patients may have the assurance that they will receive the best care which training can provide.
This, it seems to me, is the issue, and everything else is irrelevant. For that reason, I reiterate, I feel that the best interests of this bill can be served by the conference committee going to conference with the intent of eliminating this language which jeopardizes the high standards that have been so successfully established.
AMENDMENT OFFERED BY IVIR. QU'IE
Mr. QUIE. Madam Chairman, I offer an amendment.
The Clerk read as follows:
Amendment offered by Mr. QUIE: On page 15, line 1, strike out all of part E from page 15, line 1 through line 11 on page 22.
Mr. QUIE. Madam Chairman, I offer this amendment to strike part E of the bill because to me it sets a new precedent that is going to affect all of the legislation that confronts us in the Committee on Education and Labor in the future in regard to education. This part E provides money for current operating expenses in medical schools. We have chosen not to do this in the Committee on Education and Labor for colleges and universities, in fact, in a previous Congress, there were efforts to include a sum of money to go toward current expenses whenever a Federal scholarship was granted. We felt that was unwise.
We did take a big step in the last Congress toward providing grant money for the construction of academic facilities. We felt that based on previous Federal assistance acts, the aid should go to both public and private institutions of higher learning we would not get into the constitutional question of church-state relationship, or into the question of the operation of the schools when we provided "bricks and mortar money” only.
We provided only construction money in the medical school bill in the last Congress as well.
Now, the Committee on Interstate and Foreign Commerce has in effect set a precedent. As I mentioned in yesterday's debate there are 13 of the 84 medical schools which are church-related, there are 11 of the 4'? dental schools which are church-related. I believe that whenever we assist any institution of higher learning, we should treat them all alike whether they are public or private church-related.
We have tried very carefully in all the areas of Federal assistance coming from the Education and Labor Committee in an effort to make certain that we kept it absolutely constitutional, and develop a national policy that we could live with in future years. If we, then. in our committee could point to the efforts that are being made now by the Committee on Interstate and Foreign Commerce to provide a substantial amount of money for the operation of medical, dental schools, schools of osteopathy, and so forth, for salaries, administrative costs, in the
medical schools of the country, as necessary as the committee claims it to be, we have little reason not to provide the same kind of money for the other colleges and universities in order that they may pay their salaries and meet their administrative costs. I just want you to know that the private colleges and universities are in as great a need as any other and I shall maintain when the time comes that all be equitably treated.
Many of the administrators of colleges and universities, especially public colleges and universities, have come to us and said—We are going to need more than scholarship money, more than tax credits for students and their families, and more than any of these other funds you are talking about on the Federal level. What they need is money for operating expenses. If the Federal Government would pay all the operating expenses, it would not cost the student anything to go to college. So here we see the first step being made, I believe, in a substantial change in Federal education policy in the country. It is true the institutions of higher learning do receive operating expenses, assistance in graduate education indirectly in research grants, and it amounts to better than 50 percent of all expenses of colleges and universities. However, in this case the universities and colleges util— ize the services of a researcher to spend part of his time teaching and they have drawn tremendous benefits from these research grants which, on the most part, are project-oriented research grants. However, this would be the first time it was done directly. I do not believe it is wise for us to set this precedent without thorough study for its total education implications. Medical, dental, osteopathic, pharmacy schools, and podiatry schools policy will affect all of our colleges and universities. I think this aid ought to be deleted from the bill and this question should be consid— ered by both the Committee on Education and Labor and the Committee on Interstate and Foreign Commerce. I believe the need is as great in many other disciplines as it is in medical schools. The need for our country is not only in the health field but also the other areas of knowledge. Our country does have a shortage of brainpower and we need to do everything we possibly can. However, I think this is an unwise step without at the same time looking at other colleges and other disciplines. I might point out if we do take that further step another year, using this as a precedent providing grant money for current operating expenses in all our colleges and universities, can we make certain that Federal influence and standardization will not be the outcome? So I just point this out to you. If you want to look down the pike a ways and want to spend a little bit more time in thorough study and analyzing what we ought to do I would hope you would support and adopt my amendment to delete part E and pass a bill with just the student assistance and construction money.
Mr. HARRIS. Madam Chairman, I rise in opposition to the amendment.
Madam Chairman, now the Committee on Interstate and Foreign Commerce has given the very best it has in developing a program to try to meet a very great need. There is no one in this country who will tell you there is not a very great need in this field. If you strike out this provision, you are going to take away the principal part of this bill which is designed to meet this need—the need for trained people in the health professions.
The gentleman talks about precedent. I remind you in the recent Higher Education Act of 1965, which passed the House last Thursday, August 26, there is authorized a 5-year program of project grants to institutions of higher education and to teaching fellows to assist in raising "the quality of developing institutions.” The college must, among other things, be “seriously hampered in its efforts to improve staff and services by lack of financial resources and a shortage of qualified personnel.” The main purpose of the legislation is to assist the institutions which for financial and other reasons are struggling for survival and are isolated from the main currents of academic life.
Two general mechanisms are provided for in strengthening developing institutions: First, project grants to support cooperative arrangements aimed at building up these colleges; and, second, a national teaching fellowship program to graduate students and junior faculty members to encourage them to teach at developing institutions.
What we have been trying to do with these programs is to do something about these medical institutions. There are some 12 medical schools that right now are dangling on the brink as to whether or not they are going to continue. This is not fiction. There are 10 of these medical schools that are in a serious situation as to what is going to happen to them. Madam Chairman, there are six of these medical schools that are not going to make it, if some way is not provided to help them. How can we say we are going to establish a program, as we are providing in this bill, to increase the number of medical institutions by at least 10 new schools and then permit a dozen old established medical schools to go by the way. It just is not practicable.
This is not a new precedent.
The precedent for Federal support of institutions serving a clear and pressing need of the people of this country was established long ago in relation to land grant colleges.
Every medical school serves in part as a national institution. Its graduates spread out to all parts of the country and serve the total range of needs for medical care. It is worthy of some emphasis that accomplishing the missions of the Department of Defense, the Public Health Service, and the Veterans’ Administration now requires the annual intake of about 3,900 physicians, or more than half as many as graduate from all the medical schools. They serve for an average of about 4 years, and about 22,000, or 12 percent of all the physicians in the country, are on full-time duty with these three agencies.
Improvement grants—basic or special—under the proposed legislation can be awarded only if the school “sets forth plans for using the grants which the Surgeon General finds give reasonable promise of strengthening and improving the school's faculty and curriculum.” Thus, expansion of the school alone will not entitle a school to aid.
There are several precedents for Federal grants to strengthen and improve teaching programs for professional health personnel:
Under section 314(c) of the Public Health Service Act, the Surgeon General is authorized to make grants for the support of graduate and specialized public health training in the Nation's several accredited schools of public health—— currently 12 in number. The current annual appropriation of $2.5 million for this purpose is divided among the schools as follows: One-third of the funds are allotted equally among eligible schools and the remaining two-thirds on a 3-year average of the number of federally sponsored students.
Under section 309 of the Public Health Service Act as amended, the Surgeon General is authorized to make project grants to any public or private nonprofit institution which provides graduate or specialized training in public health, for the purpose of strengthening or expanding graduate public health training. Appropriations for fiscal year 1965 for this purpose were $2.5 million.
Under the Nurse Training Act of 1964, the Surgeon General is authorized to make payments to diploma schools of nursing to defray a portion of the cost of training students of nursing whose enrollment in such schools can be reasonably attributed to the provisions of the act. Payments are determined on the basis of first, the increase in the fulltime enrollment for the current year over the average for the 3 preceding years; and, second, the number of students enrolled in the school who have received loans under the Nurse Training Act.
Under various sections of the Public Health Service Act, all of the Institutes of NIH make training grants to public and other nonprofit educational institutions to support graduate training leading toward careers in research in sciences relating to medicine and health or toward increased competence in the treatment of disease. The grants, awarded to establish, expand, or improve training opportunities, provide sums both for the support of the institution’s pro~ gram and for stipends to students.
So it can be seen that this is not really a new program—there are many precedents already established for Federal assistance to schools serving a national purpose.
Our medical schools serve a national purpose, and Madam Chairman, their needs are great.
We must face the fact that high operating costs and shortages of operating funds are jeopardizing our health professions educational system. Several underfinanced medical and dental schools are threatened with failure to meet educational standards. New schools are slow to start even when con
struction funds are available, due to lack of operating funds.
A strong system of medical education requires adequate financial support that is continuing and stable. Universities with budgets already under great stress will be unable to maintain, improve, or expand their existing medical programs or to establish new medical schools or new educational programs unless sources of additional operating funds are found. It is reasonable and proper that the Federal Government should provide together with other national and local sources the needed additional operating funds.
The medical schools of this country vary enormously, not only in age and location but also in strength and stability. At one end of the spectrum are a small number of schools so weak and poorly financed that it is doubtful they can continue to provide acceptable education without more institutional support. The grants proposed in this legislation will be enormously helpful to them. At the other end of the spectrum are 15 or 20 very fine, well-established institutions with large and complex programs. The grants proposed will be modest in relation to their total expenditures, but they will make it possible for these fine institutions to continue to pioneer in the development of programs in which newly developed knowledge offers great promise. In the middle are the majority of schools with hardly enough money to keep their present programs going and under great pressure to correct their known weaknesses, institute programs of proven value, and expand enrollments. The grants proposed will be of great help toward doing some or all of those things.
It may not be always realized, but there are some medical schools in this country at any given time, 10 to 15, who are in very serious financial difiiculty. They barely have enough money to keep going, and the strain is so great that their concern is as to whether they can continue or not. For institutions in this category the sort of institutional grants provided in this legislation will really be a lifesaver.
At the other end of the spectrum we are fortunate in having 15 or 20 medical schools that are very well established and very sophisticated and fine institutions. Institutional grants to those strong schools will be rather small compared to what they are already spending, but those are the schools who can pioneer in developing new programs where new knowledge makes it sensible and which pioneering can then be helpful to all schools.
The majority of medical schools are in between these extremes. They are finding it nip and tuck to have enough money to operate. This sort of grant can help them correct deficiencies that may exist and build strengths where they know they need it and can greatly help them meet the need to expand all of their activity. For example, Dr. F. J. Ebaugh, dean of the Boston University Medical School, testified before my committee that by 1966, this outstanding institution is expected to run a deficit of $113,000 and that by 1972 the deficit will increase to $152,000. Dr. Ebaugh stated that thus