Planning For Hospital And Health Facilities
JOHN W. CRONIN, M. D.*
WASHINGTON, D. C.

Each hour, each moment we stand on
‘the threshold of the unknown. This state-
ment holds true for each of us as indi-
viduals and also for all of us as a Nation.
It is in times such as these that our real
worth as free men becomes manifest.

The foundation upon which all of our
great progress as a Nation has been built
has been our ability to plan for the future.
In isolated instances the planning has
been done by a single individual, but in
the vast majority of times the planning
hes been the result of the work of many
individuals, competent in many skills, get-
ting together, working together, sharing
trials and tribulations, but ever pushing
forward to achieve the common goal for
the betterment of all. That is democracy
in action.

All planning is based on recognition of
need. One of the greatest needs in our
whole country today is adequate health
services for. our people. We need to main-
tain and improve the quality of our health
services. Equally as important we must
extend the.scope of these services so that
they will be available to those in need of
them. . This is true in time of peace, but
in time of potential war—hot or cold—it
is imperative that the health resources of
the ‘Nation be mobilized to meet any
catastrophe—great or small. Today atomic,
‘bacteriological,- radiological catastrophies
are a concern of many of our communi-
‘ties. Those of us who deal with services
to our fellow men in time of illness have
"an even greater duty during the prepara-
tion for the defense of our Country.

It is well to take stock of some of the
important aids available to the Nation in
‘building up our health resources.

In 1946, by the action of the 79th Con-
gress and the President, Public Law 725
established the Hospital Survey and Con-
struction Program. This program, known

 

*Chief, Division of Hospital Facilities, Public Health
Service, ‘

‘kinsville, Ky.

Presented at the Christian County Medical Society, Hop: “«~
Y.

popularly as the Hill-Burton Program,
was designed basically to assist the states
to provide needed hospital and health fa-
cilities in needy areas. These areas were
primarily rural. The mechanics of this
Act have proven it to be one of the most
soundly conceived statutes ever enacted .
by Congress in providing for local, state
and Federal cooperation in providing hos-
pital services. It is administered on the
state level with the local community re-
taining the incentive for local initiative
and local operation of the completed non-
profit, non-discriminatory, community
service type of facility. An inventory and
analysis by the state of the existing facili-
ties and definition of the need for addi-
tional facilities is required before Federal
funds become available on a matching
basis for construction purposes.

The State establishes the percentage of
Federal funds to be made available an-
nually for each project in its borders. The
total amount of Federal funds granted to
the respective States is determined by a
formula in the Law. The controlling fac-
tors, however, are population and per
capita income of the State. -

'. In 1949 the basic law was amended to

include Federal aid for research in the
field of hospital services. An: appropria-
tion to implement the amendment was
under consideration at the outbreak of
the hostilities in Korea. With the in-
creased demands on the distribution of
our Federal funds there has been no ap-
propriation made available for this type
of research,

As of July 31, 1951 a total.of 467.5 mil-
lion dollars has been appropriated for. hos-
pital and health center construction. This
has made possible the approval of 1600
projects which will provide 77,000 addi-
tional hospital beds. An analysis of all
the State plans shows that there are in
axistence today approximately 1,100,000 °
acceptable hospital beds and a deficit of
nearly 830,000. In other words we have
ony. about 54 percent of our needed hos-

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pital plant in this country at this time.

Of the 1600 approved projects, 475 are
completed and rendering a community
service, 1000 are under construction and
125 are still in the olanning stage. Total
construction costs are estimated at slight-
ly more than 1 billion, two hundred mili-
lion dollars. The Federal share is about
36 percent of this amount.

Of all the projects approved, nearly
three-fourths are for general hospitals.
This includes new hospitals as well as ad-
ditions, alterations or remodeling of ex-
isting hospitals. Next in order are public
health centers—about 15 percent; then
mental hospital projects—about five per-
cent; tuberculosis projects—3 percent,
with only about 1 percent for chronic dis-
eas2 facilities.

It is apparent that most of the emphasis
has been on general hospital facilities.
About 55 percent of the general hospital
projects are for completely new hospitals.
Most of the new hospitals are being built
in small towns and in the smaller cities;
nearly 61 percent of the new general hos-
pitals are located in towns of less than
5,000 population. Only 7 percent are in
cities of more than 50,000 people.

This to me points up the Providential
nature of the Hill-Burton Program at this
time. There is a duality of purpose noted.
I pose the question, “Can not these. Hill-
Burton Hospitals be regarded as evacua-
tion destinations for our potential target
areas.” I hope we will never be called
upon to put this statement to a test, but
we may be. It certainly was not our orig-
inal purpose.

Of the total Federal funds made avail-
able $15,551,132 has been allocated to Ken.
tucky. State aid to communities has also
been granted. To date 47 projects have
een approved. 28 are for general hos-
pitals of which half are completely new
facilities. The balance is made up of
projects that provide for the replacement
of old buildings, or for additions or’ alter-
ations to existing general hospitals. Six
projects are located in tuberculosis sani-
toria, and four provide additional psy-
chiatric facilities. Seven health centers
have been constructed, three of which are
combined with new general hospitals.

Two of the projects are located in Hop-
kinsville and others in this section are at
Clinton, Cadiz, Princeton, Owensboro and
Leitchfield. With the exception foi

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Owensboro, these projects will provide
completely new facilities.

The provision in the Hill-Burtoen Act
for survey and planning has oroved to %e
one of the soundest features of the iaw.
Each community fits into a pattern of
service as outlined in the State Plan. The
community must determine the size of the
facility that can be supported and the
services to be included. The local com-
munity planning features are one of the
major reasons why the Public Health
Service believes that a program for what
we now call defense impacted areas, with
increased populations, should follow the
Hill-Burton concert. Service at the local
level is the objective of the program for
war impacted areas. Therefore, advice
from the communities where the affected
people live is essential. Conversely, State
and Federal advice to local planning
groups is important if the planning is to
be reelly effective. Those involved at all
levels should take part in it, not simply
be brought into the program after the
plans are made.

In addition to the Hill-Burton Program,
with its obvious limitations for hospital
construction in war impacted areas there
ere several action programs designed to
provide assistance.

The Federal Civil Defense Act does not
contemplate the making of grants for hos-
pital construction. It does provide for the
incorporation of. shelter areas or other
construction designed to provide protec-
tion of the occupants against enemy at-
tack. Funds, however, are very, very
limited.

The bill sponsored by Senator Maybank
of South Carolina and Representative
Spence of Kentucky known as the De-
fense Housing and Community Facilities
and Services Act was passed by this 82nd °
Congress and signed by the President.
Title III of this Act relates to Community
Facilities and resembles in some respects
the Lanham Act of World War II. The
provisions of this Act include hospital
facilities and services for the care of the
sick, as well as facilities for water, sew-
age, sanitation and other community facil-
ities. Federal funds in the amount of 60
million dollars are provided for the con-
struction, maintenance or operation of
community facilities. In the case of as-
sistance for hospital construction these
funds will be available only if funds are
not available under the Hill-Burton Act.
This legislation also provides that main-
tenance and operation payments will not
exceed the portion of the maintenance
and operation expenses attributable to the
“National Defense Activities in -he area.”
The Act also specifies that the function,
Fowers and duties with respect to health,
refuse disposal, sewage treatment, and
water purification shall be exercised by
and vested in the Surgeon General of the
Public Health Service. This latter proviso
properly relates the health activities to
those existing in regard to the Hill-Bur-
ton program. The success of this legisla-
tion depends entirely upon local, State and
Federal cooperation and coordination of
hospital and health services—the kind of
cooperation which has proven so eminent-
ly effective to date.

The communities in western Kentucky
are affected by the defense activities cur-
rently taking place at Paducah, Camp
Breckenridge, Camp Campbell, Fort Knox
and in the T.V.A. areas. It is important
that plans be made at once for health re-
sources in this general area. Based on
successful planning on other areas this
may be accomplished as follows:

First, form a Planning Commiitee.
Community health planning has many
facets. There is need for teamwork among
meny groups. The key groups are the
medical societies and the trained and @X-
perienced local public health officials.
, BUT these cannot do the job alone. The

“= team must have representatives of volun-

teer health agencies, other professional
and educational groups, organizations
concerned with fields related to health,
and all those groups which might be call-
ed consumers of health services.

Second, gather factual data on existing
resources and need.

It is estimated that the
tion influx is expected to increase the
Fopulation of affected communities in this
section of Kentucky by about 50 percent.
Hopkinsville has already had at least a 12
percent increase. Problems in sanitation,
tuberculosis and venereal disease control
have already arisen. Hopkinsville has a
sanitary land fill system of refuse dis-
pesal but other communities in this area
have less adequate systems.

Such matters as the role:of insects as
disease carriers and their control must al-
ways be considered.

Resources across state lines must be
considered. For example, a 125 bed hos-

peak popula- -

pital is being constructed in Clarksville,
Tennessee, which may provide for patients
from this area if adequate arrangements
are made. Data should also be obtained
on the provisions needed for mental, *:-
serculosis and chronic disease patients.

The Public Health Service in coope: 2-
tion with Commissioner Bruce Underwood
of the Kentucky State Health Department
made a survey fer the Atomic Energy
Commission in February 1951 and recom-
mended that 80 hospital beds and an ad-
ditional nurses’ residence were needed to
care for the influx population in Pa-
ducah. These beds were proposed in ¢7-
dition to the expansion planned for River-
side Hospital under the Hill-Burton Pro-
gram. It is possible that a 100 bed Bap-
tist Hospital, begun some years ago, may
be completed. If the fund drive for the
Baptist Hospital is successful and it is
erected, will there be-a need for addition-
al beds, and if so, how many?

These are typical questions for which

answers must be sought by the local com-
munities.
Third, bring to the attention of local com-
munity professional and lay groups for
the joint study and solution of the prob-
lems and for the correlation: of all pro-
grams and services affecting health—
preventive, therapeutic, environmental.

One successful method of filling in gaps
in hospital services is by coordination and
cooperation among hospitals. There is
good evidence that the small hospital can-
not—by itself—provide all of the services
needed by the people it serves. A solution
is to develop relationships among hos-
pitals whereby the larger and more com-
pletely equipped can provide the smaller
with the needed services.

The concept of a regional hospital co-
ordination system includes many lines of
affiliation and sharing among hospitals.
For example, such a system envisions in-
terne and resident physician services on a
rotating basis to hospitals which other-
wise would not have the advantage of
such services; (internes for small hos-
pitals are a rare commodity today); the
provision of consultation. and part time
specialist services, including radiology,
pathology and other diagnostic services to
small institutions; clinical conferences in
small community hospitals; educational
courses for all classes of hospital per- .
sonnel; postgraduate training of physi-
cians from small communities; provision
for the search for knowledge related to
mccern hospital practice in administra-
tion and clinical services: stimulation and
exchange or information on improved
hospital administrative methods; group
purchasing; uniform medical records and
bookkeeping systems; joint planning of
hospital and public health programs. All
these are directed toward better patient
care and when combined with a proper
and adequate hospital licensure law will
accomplish better patient care. Coordina-
tion of facilities and services indicates the
need for a regional planning committee
composed of representatives from each of
the community planning bodies.

Out-ratient departments may be used
as a means. of alleviating hospitalization
in communities where the demand for
beds exceeds the supply. Home care pro-
grams have aided in this regard. Out-pa-
tient sérvice provides one of the best
means for hospital participation in pre-
ventive medicine, particularly in the
fields of mental illness, venereal disease
and tuberculosis. Rehabilitation services
started early and adequately conducted

shorten hospital stay and permit return -

of the individual to an economically com-
pet?nt status. The results of this type of
‘service pay big dividends, especially in
state and. other govérnmentally support-
ed institutions.

Fourth, interpret the findings to the pub-
lic.
Constant efforts. should be made to in-
crease public participation. in planning.
In this way valuable health- education
“tay be accomplished-relative to. the prop-
er use of existing services and: facilities.

Fiith, develop methods of effective im-
plementation of the plan.

The best method to assure this is
through education of all the people in the
community of the need for it. Planned
publicity of the educational type, com-
bined with planned public relations of a
high order, are of great value.

The objective of community planning
should be to make available to every in-
dividual the curative and preventive bene-
fits of medical science at its best. Pre-
ventive medicine is a function of every
physician and every hospital. Diagnosis,
treatment, restoration to health, rehabili-
tation, prevention of disease and health
premotion and health maintenance are the
ooligations assumed by every physician.
The hospital should be the health center
of the community. It is the mobilization
depot of modern medical science. The
practice of medicine should not be con-
fused with the business of medicine by
the physician or the hospital administra-
tor; however, the relationships must be
understood.

A community health program which
combines curative and preventive aspects
to attain health promotion and health
maintenance will be not only of inesti-
mable value to the defense effort but also
will pay great dividends to the sick and
the well at any time. The accomplish-
ment of this objective will require dy-
namic leadership, imagination and coop-
erative effort of the highest order.

In closing I think it is appropriate to re-
call the official motto of this great indus-
trial and agricultural State “United We
Stend, Divided We Fall.”

Reprinted’ From’ The Journal of the Kentucky State Medical Association, January, 1952.