i@l Planning r'or Hospital And Health vacilities JOHN W. CRONIN, M. D.- WASHI',q,GTON, D. C. Each hour, each moment we stand on popularly as the Hill-Burton Program, -the threshold of the unknown. This state- was designed basically to assist the states n-ent holds true for each of us as indi- to provide needed hospital and health fa- 'd.uals and also for all of us as a Nation. cilities in needy areas. These areas were v, It is in times such as these that our real primarily rural. The mechanics of this worth as free men becomes manifest. Act have proven it to be one of the most soundlv conceived statutes ever enacted The foundation upon which all of our I vreat progress as a Nation has been. built by Congress in providing for local, state and Federal cooperation in providing hos- nas been our ability to plan for the future. pital services. It is administered on the In isolated instances the planning has state level with the local community re- been done by a single individual, but in . . . the vast majority of times the planning taining the incentive for local initiative has been the result of the work of many and local operation of the completed non- profit, non-discriminatory, conununity individuals, competent in many skills, get- service type of facility. An inventory Iand ting together, working together, sharing analysis by the state of the existing facili- trials and tribulations, but ever pushng forward to achieve the common goal for @es @nd definition of the need for addi- the betterment of all. That is democracy zionai facilities is required !before Federal in action. funds become available on a matching All planning is based on recognition of basis for construction purposes. need. One of the greatest needs in our The State establishes the percentage of whole country today is adequate health Federal funds to be made available an- services for our people. We need to main- nually for each project in its borders. The tain and improve the quality of our health total amount of Federal funds granted to services. Equally as important we must the respective States is determined by a formula in the Law. The controlling fac- extend the:scope of these services so that tors. however, are population and they will be available to, those in need or capita income of the State. per them. ., This is true in time of peace, but in time of potential war-hot or cold-it In 1949 the basic law was amended to is imperative that the health resources of include Federal aid for research in the the 'Nation be mobilized to meet an field of hospital services. An appropria- y cataitrophe-great, or small. Today atomic, tion to implement the amendment: was -bacteriological, - radiological cat@stro@ies under consideration at the outbreak of are a concern of many of our communi- the hostilities in Korea. With the in- .ties. Those of'us who deal with services creased demands on the distribution of to our fellow men in time of illness have Our Federal funds there has been no ap- an even greater duty during the prepara- propriation made available for this type tion for the defense of our Country. of research. It is well to take stock of some of the As of July 31, 195@l a total of 467.5 mil- -important aids avail'able to the Nation' in lion dollars has been appropriated for. hos- building up our health resources. pital and health center construction. This In 1946, by the action .of the 79th Con- has made possible the approval of l@600 gress and the President, Public Law 725 projects which will provide 77,000 addi- established the Hospital Survey and Con- tional hospital beds. An analysis of all struction Program. This program, known the State plans shows that there are in -2xistence today approximately 1,100,000' *Chief, Division of Hospital Facilities, Public H@ith acceptable hospital beds and a deficit of SerAce@ nearly 830,000. In other words we have Presented at the Christian County ModicaI @ety, iiop. -,- kin@lle, Ky. 6@@,.,about 54 percent of our needed hos- pital plant in this country at this time. Ow,Tnsboro, these projects provide Of the 1600 approved projects, 475 are completely new facilities. corr@-oleted and rendering a community The orovision in the Act zervice. @-000 are -@inc'Ler ,cns,,rLiclon ancL :or Survey, @-nd pianning Has pr,,,,,,iTect -,,,) )e 125 are still in -he olanning stage. Total one of the soundest features of the ia@@!. construction costs are estimated at slight- Each community fits into a pattern of ly more than I billion, two hundred mil- service as outlined in the State Plan. The lion dollars. The Federal share is about community must determine the size of the 36 percent of this amount. facility that can be supported and the ervices to be include . T e local com- Of all the projects approved, nearlv s munity planning features are one of the three-fourths are for general hosvital@. Tajor reasons why the Public Health This includes new hospitals as well as ad- bervice believes that a pro-ram for what ditions, alterations or remodeling of ex- isting hospitals. Next in order are pubiic we now call defense impacted areas, with health centers-about 15 percent; then increased populations, should follow the mental hospital projects-about five per- Hill-B.urton concept. Service at the local cent; tuberculosis projects-3 percent. level.is the objective of the pro-ram for with only about 1 percent for chronic dis' war impacted areas. Therefore, advice ease facilities. from the communities where the affected people live is essential. Conversely, State It is apparent that most of the emphasis and Federal advice to local planning has been on general hospital facilities. groups is important if the planning is to About @55 percent of the general hospital be re-T-Ily effective. Those involved at all projects are for completely new hospitals. levels should take part in it, not simply Most of the new hospitals are being built be brought into the program after the in small towns and in the smaller cities; olans are made. nearly 61 percent of the new general hos- ' In addition to the Hill-Burton Program, pitals are located in towns of less than 4th its obvious limitations for hospital 5,000 population. Only 7 percent are in wi cities of more than 50,000 people. construction in war impacted areas there are several action pro-grams designed to Th-s to %me points up the Providential provide assistance. nature of the Hill-Burton Program at this The Federal Civil Defense Act does not time. There is a duality o-@ purpose noted. contemplate the makin of grants for hos- I pose the question, "Can not these Hill- 9 Burton Hospitals be regarded as evacua- pital construction. It does provide for the tion destinations for our potential target incorporation of shelter areas or other areas." I hope we will never be called construction designed to provide protec- upon to put this statement to a test, out tion of the occupants against enemy at- wa may -be. It certainly was not our orig- tack. Funds, however, are very, very inal purpose. limited. The bill sponsored by Senator Maybank Of the total Federal funds made avaii- of South Carolina and Representative able $15,551,132 has been allocated to Ken- Spence of Kentucky known as the De- tucky. State aid to communities has also fense Housing and Community Facilities been granted. To date 47 projects have and Services Act was passed by this 82nd been approved. 23 are for general hos- Congress and signed by the President. pitals of which half are completely new Title III of this Act relates to Community facilities. The balance is made up o@ Facilit-es and resembles in some respects projects that provide for the replacement 1 of old buildings, or for additions or- alter- the Lanham Act of World War II. The ations to existing general hospitals. Six provisions of this Act include hospital projects are located in tuberculosis sani- facilities and services for the care of the toria, and four provide additional Psy- sick, as well as facilities for water, sew- chiatric facilities. Seven health centers age, sanitation and other community facil- have been constructed, three of which are ities. Federal funds in the amount of 60 combined with new general, hospitals. million dollars are provided for the con- struct,.on, maintenance or operation of Two of the projects are located in Hop- community facilities. In the case of as- kinsvflle and others in this section are at sist@ance for hospital construction these Clinton, Cadiz, Princeton, Owensboro an@ funds will be available only if funds are Leitchfield. With the exception of not available under the Hill-Burton Act. This legislation also provides that main- pital is beina constructed in Clarksville, b tenance and operation pavments will no+ Tennessee, which may provide for patients L exceed the portion of t@e maintenance rom this area if adequate arrangements and operation expenses attributable to the are made. Data should alsc) lie abtainej -@a'L@lonai @Defense -@c,,i.,,rities ;n -he area." )n -.he crovisions needed l'or mental, -Lhe -@cl,- also specifies 'hat the f@unction, 'c,,,erculosis and chronic disease patiei"-z. ,,owers and duties with respect to health, The Public Health Service in CGope-- reFuse disposal, sewage treatment, and tion with Commissioner Bruce Underwood water purification shall be exercised by of the Kentucky State Health Department and vested in the Surgeon @General of the made a survey for the Atomic Eneray Public Health Service. This latter proviso Commission in February 1951 and recom- properly relates the health activities to mended that 80 hospital beds and an ad- those existing in regard to the Hill-Bur- d4,tional nurses' residence were needed to ton program. The success of this legisla- care for the influx population in Pa- 'Lion depends entirely upon 7@ocal, State and ducah. These beds we'-e proposed in c.-'- Federal cooperation and coordination of dition to the expansion planned for River- hospital and health services-the kind of side Hos-oital under tha- Hill-Burton Pro- cooperation which has proven so em-inent- gra-L-n. It is possible that a 100 bed Bap- ly effective to date. tist Hospital, begun some years ago, may The communities in western Kentucky be completed. If the 'Lund drive for tho are affected by the defense activities cur- Baptist Hospital is successful and it is r,@n.tly taking place at Paducah, Camp erscted, will there be@a need for addition- Breckenridge, Camp Campbell, Fort Knox al beds, and if so, how many? and in the T.V.A. areas. It -is important These are typical questions for which that plans be made at once for health re- answers must be sou,-ht,by the local com- sources in this general area. Based on rnunities. successful planning on other areas this Third, bring to the attention of local com- Tr,.ay be accomplished as follows: munity professional and lay groups for First, form a Planning Committee. the joint study and solution of the prob- Community health planning has many lems and for the correlation of all pro- facets. There is need for teamwork among grams and services affecting health- mEny groups. The key groups are the preventive, therapeutic, environmental. rr@edical societies and the trained and ex- One successful method of filling in gaps perienced local public health officials. in hospital services is by coordination and BUT thc-se cannot do the job alone. The cooperation among hospitals. There is .'@',.team must have representatives of volun- good evidence that -the small hospital can- teer health a-encies, other professional not-by itself-provide all of the services 0 and educational -groups, organizations needed by the people it serves. A solution concerned with fields related to health, is to develop relationships among hos- and all those groups which might be call- pitals whereby the larger and more com- ed consumers of health services. pletely equipped can provide the smaller Second, gather factual data on existing with the needed services. resources and need. The concept of a regional hospital co- lt is estimated that the peak popula- ordination system includes many lines of tion influx is expected to increase the affiliation and sharing among hospitals. Po-oulation of affected communities in this For example, such a system envisions in- secti.on of Kentucky by about 50 percent. terne and resident physician services on a Hopkinsville has already had at least a 12 ro.tating basis to hospitals which other- percent increase. Problems in sanitation, wise would not have the advantage of tuberculosis and venereal disease control such services; (internes for small hos- have already arisen. Hopkinsville has apitals are a rare commodity today); the sanitary land fill system of refuse dis- pr,4s:on of consultation and part time p!--sal but other communities in this area specialist services, including radiology, have less adequate systems. pathology and other diagnostic services to- small institutions; clinical conferences iii Such mat-ters as the rol6'--of insects as small community hospitals; educational disease carriers and their.control must al- courses for all classes of hospital per- ways be considered. sonnel; postgraduate training of physi- Resources across state lines must be cians from small communities; provision considered. For example, a 125 bed hos- for the search for knowledge related to m:;--'ern hospital practice in administra- Filth, develop xnethods of effective im- ';,on .-.qd @-,',Inical ser,.Tlces,, stinuiation ana' oie--@cn,-@ation of the plan. o' 'nforration on ;,nproved The best method to assure this ;s losp4@@Lal @-dm,@'nis@@rat,;L,,7e methods; group through education of all the people in the purchasing; uniform medical records and community of the need for it. Planned Lookkeeping systems; joint Planning of publicity of the educational type, com- hospital and public health programs. All bined with planned public relations 'Of a these are directed toward better patient high order, are of great value. care and when combined with a proper The objective of community planning and adequate hospital licensure law will should be to make available -to every in- accomplish better -atient care. Coo dividual the curative and preventive bene- t rdina- tio@i o-@ -,Iacil;.t;.es and services indicates the fits of medical science at its best. Pre- ,ieed -or a regional planning committee ventive medicine is a function of every co.m,posed of representatives from each of physician and every hospital. Diagnosis, t'--e community planning bodies. treatment, restoration to health, rehabili- Out--@at@ient departments may be used tat;-on, prevention of disease and health as a means. of alleviating hospitalization promotion and health maintenance are the 4-n communities where the demand for obligations assumed by every physician. beds exceeds the supply. Home care pro- The hospital should be the health center grams have aided in this regard. Out-pa- of the community. It is the mobilization tient service provides one of the best de-oot of modern medical science. The -means -For hospital participation in pre- practice of medicine should not be con- ventive medicine, particularly in the fused with the business of medicine by fields of mental illness, venereal disease the physician or the hospital administra- and tuberculosis. Rehabilitation services tor; however, the relationships must be started early and adequately conducted understood. shorten@ hospital stay and permit return @- community health program which of the individual to an economically corn- combines curative and preventive aspects petTnt-s@.at-as. The results of this @ype of to attain health promotion and health -service pay b' dividends,, especially in maintenance will be not only of inesti- ig state and, other governmentally support- mable value to the defense effort but also ed institutions. will pay great dividends to the sick and Fourth, interpret the find ngs to the pu' the well at any time. The accomplish- @i D. ment of this objective will require dy- lic. namic leadership, imagination and coop- Con,.gtant efforts. should be made to in- erative effort of the highest order. crease public participation in planning. In closiniz I think it is appropriate to re- In this way valuable health education call the official m,otto of this great indus- may be accomplished-relative to, the prop- trial and agricultural State "United We er use of existing' services and@ facilities. Stand, Divided We Fall." Epprinted From' The Journal of the Kentu@ @te Nledictl Asgociation,, J,,tniiarv, 1952. . . i . I