Under the instructions that we have given him we are asking that he will keep in touch with the patients in these institutions because so many primarily enter the institution through his services, but not all of them-not all of them of course.

Senator BUSHFIELD. What relationship has this director, Dr. Coulter, to problems in the sanatoria that affect his control?

Dr. RUHLAND. Only this; that we will ask him to confer with the resident staffs at the institutions on matters of diagnosis or matters of discharging of patients, or matters that may persuade patients to try to leave the institution-this business of walking out that was referred to in yesterday's testimony.

Senator BUSHFIELD. As I understood you yesterday, Dr. Seckinger, who is your assistant, has immediate personal coordination.

Dr. RUHLAND. Dr. Seckinger was appointed by Congress when the institutional service was added to the health department, as Coordinator of Health and Hospitals, that is, to facilitate the transition of service from the field to the institution and from the institution back to the community again.

Senator BUSHFIELD. Going back for a moment to Dr. Coulter, to see whether I understood you completely or not, he does not have direct personal charge of any of these patients as to clinical supervision?

Dr. RUHLAND. Not in the institutions; no.

Senator BUSHFIELD. If the patients leave the hospital, like we were discussing yesterday, against advice, who has charge of getting them back?

Dr. RUHLAND. The Department of Health will naturally try to get in touch with the patient again, because if it is still an open case-as we technically call a patient who has a postive sputum-we try to get hold of the patient and try to bring him back under institution

treatments.

Senator BUSHFIELD. And that is done by persuasion, Doctor, is it? Dr. RUHLAND. That is done primarily through contact with the visiting nurse, bringing him to the clinic where he comes in contact with the physician, and at times, if it is a fractious patient, by the use of police power. That is the least desirable means to fall back upon, although it has been necessary.

Senator BUSHFIELD. Does the Director of the Bureau of Tuberculosis, who is Dr. Coulter, communicate directly with the superintendents of the sanatoria in the District?

Dr. RUHLAND. Yes.

Senator BUSHFIELD. In regard to complaints of patients, and so forth?

Dr. RUHLAND. That is the direction, to have an interchange of the problems, a discussion of the problems that affect tuberculosis.

Senator BUSHFIELD. To a certain extent then the efficiency with which these tuberculosis departments are conducted is up to the man who has charge of the departments, who is Dr. Coulter. Is that correct?

Dr. RUHLAND. No; we hold the individuals in charge of the institutions primarily responsible for the discipline and any patients while at the institution.

Senator BUSHFIELD. That is, Dr. Bocock would be at Gallinger, and whoever is in charge of Upshur?

Dr. RUHLAND. Yes; but more specifically, of course, Dr. Cake, who is the specialist in tuberculosis at Gallinger, and Glen Dale is entirely an institution for the tubercular, and of course that entire staff there is held responsible.

Senator BUSHFIELD. And now that I may more fully understand the mechanics of entrance into these various places, is there a permit issued from the Bureau of Tuberculosis to the individual to enter the tuberculosis ward at Gallinger?

Dr. RUHLAND. The procedure for the admission of any and all patients to the institution is through a permit of it.

Senator BUSHFIELD. Where is that office located?

Dr. RUHLAND. At the present time that office is located at 472 Indiana.

Senator BUSHFIELD. Does the patient get that permit by going to this office, or does he go to the hospital?

Dr. RUHLAND. He should present himself at this particular office, if he is able to present himself, and there he will be investigated as to eligibility-that means residence and economic status-that makes him a proper person for public assistance.

Senator BUSHFIELD. Let me illustrate: Suppose I went to this office and obtained a permit; what would I do, then; take the permit to Gallinger Hospital, for instance?

Dr. RUHLAND. That is right; if it calls for admission to Gallinger, and that would be presented at the time the patient arrives at Gallinger.

Senator BUSHFIELD. To whom would I present it?

Dr. RUHLAND. To the admitting officer.

Senator BUSHFIELD. That was the place we discussed yesterday? Dr. RUHLAND. The admitting officer at Gallinger.

Senator BUSHFIELD. And then he turns that patient over to Dr. Cake's department; is that correct?

Dr. RUHLAND. He refers them to that particular branch of the service there; if it is tuberculosis, to that particular branch of the service.

Senator BUSHFIELD. Do you have any nonresident patients in these tuberculosis places?

Dr. RUHLAND. That happens; yes. That happens in practically any of the branches because a person who becomes acutely ill obviously, for humane reasons, must be dealt with.

Senator BUSHFIELD. That is right.

Dr. RUHLAND. However, as soon as that fact is established, the institution, or the service, if you please, attempts to repatriate the individual back to the jurisdiction from where he comes, the particular State or municipality.

Senator BUSHFIELD. For instance, if a citizen of my State, South Dakota, were taken ill here and obtained a permit to go to Gallinger, then it would be the duty of Dr. Cake, or whoever is in charge there, to try to get him back to his own State of South Dakota?

Dr. RUHLAND. That is right.

Senator BUSHFIELD. These nonresidents, if they are taken into the District institutions, do they have to pay?

Dr. RUHLAND. If they are able to pay; yes. There is a sliding scale of fees that are being charged.

91033-43--S

sometimes a week passed by before the patient was in condition to respond to any treatment which might prove beneficial at St. Elizabeth Hospital.

My observations on Gallinger Hospital are being submitted because of my hope that conditions in that hospital will be improved.

Here is a more detailed statement of the treatment of this particular man:

When we entered the proper building the interviewing nurse asked my husband to sit by her desk so that she could ask him the routine questions.

I was horrified at two of the questions and noticed the crushing effect they had on my husband.

They were: Have you ever tried to kill yourself? Have you ever tried to kill anyone else?

When I regained a measure of self-control I told the interviewing nurse that I should like to be conducted through the ward so that I could observe conditions in the ward and that after my husband was taken to his room I wanted to see him so that I could be sure he was satisfied before I left him.

I was told that I could not enter the ward or see my husband until the following Sunday, April 4, and then for only 15 minutes.

Then I requested that interview with the doctor so that I could give him the case history. A man, whom I found out later was Dr. Silverman, was standing by the nurse when I made this request. He walked away without speaking to me and the nurse answered that the doctor had no time for a case history or for consultation and continued with her desk work.

When I commented that I thought it was terrible to expect a patient's relatives to be satisfied to leave him in a place where information as to his surroundings and treatment was refused, she said very nonchalantly, "Oh, they just give them a bath and put them to bed." I turned to the nurse and to our friend-understand, Doctor, this woman was paying the bill; she was not a charity patientupon consultation with my doctor and upon his stating that if I were dissatisfied about leaving my husband at Gallinger I could take him away by simply signing a request for release, my friend urged me to leave him and promised to ask Dr. Ruhland to see that good care was given to the patient.

At 7 o'clock in the evening I called the hospital to inquire about my husband's condition and to ask if he was contented. I was told that he was all right and not to worry. The next day I found out that at that very minute he was strapped to the bed.

The next morning I called at 9:45 a. m., and was informed by Dr. Silverman that he was critically ill, his blood pressure having dropped to 250. I told Dr. Silverman that I would come out immediately to take him to another hospital and he answered that I would probably be allowed to move him, but that he was not sure.

Then I called Dr. Ruhland to request that he remove any obstacles that might impede my transferring my husband to another hospital, and later I talked again with Dr. Ruhland after he had talked with Dr. Gilbert, the doctor in charge of the psychopathic ward.

Then Dr. Gilbert called me to tell me that he considered it unwise to move my husband. I told him that, after considering his advice, I would let him know my decision.

Dr. Gilbert also informed me that I might come out and see my husband for brief periods in the meantime, and that special nurses would be able to give him better care. I asked him to get two nurses immediately but he said he could not until I came out and signed for them. May I suggest that it would be a simple matter to have the person responsible for a patient's bills sign at the time of admission to the hospital a statement authorizing the calling of special nurses if necessary. In this particular case my husband had needed special nurses for approximately 22 hours before I was advised of this need.

Upon consultation with our doctor I decided to take my husband to Doctors' Hospital.

About 2 o'clock in the afternoon I arrived at the psychopathic ward and was admitted to my husband's room. I was aghast at the change in his appearance since I left him the preceding day. His lips were so parched that the outer layer of skin on each lip had separated.

I called for some water. My husband drank two cups without stopping. Evidently it had been an unduly long time since anyone had given him a drink of waterr.

Then I noticed that his arms were actually chained to the sides of the bed, and I was horrified. But that wasn't alt his ankies were bound together with & sheet, and the spread or the bed was tied down tightly at all four

corners.

Fron. talking with one of the attendants I gathered that he had been so chaier, and tied since the preceding afternoon. I think snel, & prnetice is noching less that torture and reeks of the Middle Ages.

At length: 1 succeeded in getting an orderly to unchulu my husband's arms and unitie his feet. There was a soiled piece of gauze under one of the leather arm bands, which I was told by an attendant had beer pinced there on the preseding day.

My husband's arms and ankles were rubbed raw and several blisters had hurt. Today, ♬ days after his removal from. Gallinger, those places, biere not howlod a The same attendam also told me that my hushanë lind yoðod & lo; during the nigh: and that he had given him water when he conlá. The sofforing he experienced will never be known.

I requested the attendant to ask a nurse to bring some of to rub on his arms and ankies, but she didn't return while I was there.

Then I went to Dr. Gilbert's office to make final arrangements for removal. He told me that if the commitment papers had been filed he would be unable to release the patient. A young woman, în the office was asked to see whether or not the papers had been filed and I went outside to wait.

In about half an hour Dr. Gilbert returned to tell me that he bað à report and that he would talk with our doctor when he arrived. I asked. "Have the papers been filed ?”

He answered that he preferred to talk with our doctor. I insisted on a reply to my question, and he finally admitted that the papers had not been filod.

I told Dr. Gilbert that the condition of the patient indiested gross neglect and mistreatment. He contended that chaining a patient's hands to the dod and binding his feet were good medical treatment. Yesterday I was informed by a doctor at St. Elizabeths Hospital that such methods were never used there, and that in the 5 years during which he had been on duty he had never found it necessary to restrain even with a sheet tied across the body, a patient of my husband's age.

When I requested Dr. Gilbert to go in with me at that moment and examine the terrible condition of my husband's arms and ankles, he refused.

Well, there is more of it of the same type.

Is that the customary practice in your ward of patients that come to you?

Dr. GILBERT. Well, the last case I recall, although it is not signed and I do not know the name, the patient was so terribly sick and I asked the wife to have a physician say that he would assume responsibility for the patient's care at Doctors' Hospital, which a doctor did, and he was discharged against advice, and not long afterward the patient came back in much worse condition than he went out, and he had to be committed at St. Elizabeths, and was committed as a temporary patient.

Senator BUSHFIELD. Were you here yesterday?

Dr. GILBERT. No, sir.

Senator BUSHFIELD. One lay witness testified that at least one or two attendants dearly loved to exhibit their physical prowess in roughly handling patients.

Do you know anything about that?

Dr. GILBERT. We have attendants of all types. During recent months and the last few years we have had to resort to about anything and everything we could possibly use on wards, our staff of ward personnel has been so furiously and badly depleted.

At times over the years I have been in charge of that department it is true we have found attendants who were not adaptable to the work, and when we found that was true they were promptly dismissed.

Furthermore, it should be understood that for certain types of the service as, for example, tuberculosis, the care in the psychopathic hospital and communicable-disease hospital, there we may take some pay cases.

Senator BUSHFIELD. What is the maximum charge for a nonresident?

Dr. RUHLAND. $4 a day.

Senator BUSHFIELD. Is Dr. Coulter in the room, Doctor?

Dr. RUHLAND. No, I do not see him; he is not here this morning.
Senator BUSHFIELD. That is all, Doctor. Thank you.
Senator BUSHFIELD. IS Dr. Ossen fort in the room?

Dr. OSSENFORT. Yes.

TESTIMONY OF W. F. OSSENFORT, ASSISTANT SURGEON GENERAL, UNITED STATES PUBLIC HEALTH SERVICE, IN CHARGE OF THE DIVISION OF MARINE HOSPITALS AND RELIEF

Senator BUSHFIELD. Doctor, will you give your name and official position-not your naval position-in the District?

Dr. OSSENFORT. W. F. Ossenfort, Assistant Surgeon General, United States Public Health Service, in charge of the Division of Marine Hospitals and Relief.

Senator BUSHFIELD. You were assigned to this committee, were you not, by the Board of Health?

Dr. OSSENFORT. I was assigned to cooperate with this committee, by the Acting Surgeon General, Warren F. Draper.

Senator BUSHFIELD. I have not had a chance, Doctor, to discuss this matter with you, but you requested to be heard this morning and you have a statement to make I wish you would proceed to make it without questioning.

if

I will state to the Senators that Dr. Ossenfort has to leave the city and that is the reason we are placing him on out of order.

Senator HOLMAN. I want to report to the committee that I had a conversation on the telephone with the Doctor-I have never personally met him-and have been awaiting his completion of his studies, when he was to advise me in personal conversation of his observations and recommendations.

Senator BUSHFIELD. You may proceed, Doctor.

Dr. OSSENFORT. I want to say in the beginning that I perhaps have the unusual distinction of having been a patient in a municipal hospital for 6 weeks myself, in a small town in Ohio, and I am alive today by virtue of the treatment I got there for an injury which I suffered and had some broken bones, but I am here to tell the story.

I have enjoyed the privilege of going to Gallinger for several days last week. I wish I had had more time to spend, but I did not.

The history of Gallinger is familiar to all of us and has to be taken into account in the present instant, it seems to me, or on any survey. The functions today of Gallinger are very broad, and I might state includes neuropsychiatric cases, contagious cases, medical, surgical, gynecologic, pediatric, and tuberculosis.

The physical plant is well known to all of us. crowding in the general facilities now.

There is no over

The tuberculosis facilities are overtaxed always. I was told that the day the new units was opened there were 60 more patients than