WAR DEPARTMENT Office of The Surgeon General Washington 25>, D, C, MEDDD October 19^6 MEMORANDUM FOR Subject; Report of Conference of The Surgeon General with Commanders of Named General Hospitals 1. There is transmitted herewith for your information a copy of the report of the conference of The Surgeon General with commanders of named general hospitals on 22 - 23 August at The Pentagon, Washington, D, C* FOR THE SURGEON GENERAL; 1 Incl. Report of Conference W , * yj. S f tT ' "■ / GUY B. DENIT Brigadier General, USA Chief of Plans and Operations DISTRIBUTION; 2 copies, each, to commanders of named general hospitals A,B,C, CONFERENCE OF THE SURGEON GENERAL with COMMANDERS OF NAMED GENERAL HOSPITALS Washington, D. C. 22 - 23 August 19/4.6 INDEX Tab Subject, Page A Welcoming Address and Statement of Conference Aims ,,,. 1 B Army Hospitalization Program,,,.,. ..... h C Army Hospital Supply Program , 36 D Personnel Problems in Army Hospitals........ I4.7 E Dental Personnel in Army Hospitals 69 F Performance of Station Complement Functions at Class II Hospitals.,,.,,, 71 G Fiscal Problems in Army Hospitals ?8 H Training Activities in Army Hospitals.. 8I4 I Professional Administrative Problems in Army Hospitals. 95 J Preventive Medicine Problems in Army Hospitals, ........... 106 \ K General Discussion and Summary, 109 Inclosures 1 Hospitalisation Data, Ill 2 Patients Remaining in Army Hospitals...,,,.. 112 3 hospitalization Data by Type of Hospitals... 113 i; Number of Evacuees Remaining in General and Convalescent Hospitals, 111*. 5 Army Patients Evacuated to the United States 115 Inclosures Subject Page 6 Patients Received in Continental United States Each Week from Overseas,....... 116 7 Hospitalization Data - General and Con- vale s cent Hospitals , , , , , , , , ,. .- *• * • 117 8 Estimate of Patient Load in General-Con- valescent Hospital System, 113 9 Organization Chart of Physical Medicine Service and Convalescent Services Division. ........... 119 10 Building Maintenance Costs - Average Per Square Foot, FY 19l|6. ............ 120 11 Comparative Maintenance Costs.., 121 12 Status of Residencies in Amy General Hospitals122 13 The U.S. Amy Medical Department Educational School System for Officers (Proposed)... 123 ill Agenda for Conference....,............,,, 12A CONFERENCE OF THE SURGEON GENERAL with COMMANDERS OF NAMED GENERAL HOSPITALS Washington 2£, D. C, 22 - 23 August I9I4-6 The conference of The Surgeon General with commanders of named general hospitals was convened at 0900 hours, 22 August Room 2E U08, The Pentagon, Washington, D, C, The following were present: Office of The Surgeon General Major General Norman T, kirk, USA The Surgeon General Brigadier General Raymond W. Bliss, USA Deputy Surgeon General Brigadier General Guy B. Denit, USA Chief of Plans and Operations Commanders of Named General Hospitals Brigadier General George C. Beach, USA halter Reed General Hospital Washington, D. C, Brigadier General Charles Ct Hillman, USA Letterman General Hospital San Francisco, California Brigadier General Omar H« Quade, USA Fitzsimons General Hospital Denver, Colorado Colonel Clyde M. Beck, MC Pratt General Hospital Coral Gables, Fla. Colonel C. K, Berle, MC O'Reilly General Hospital Springfield, Missouri Colonel Paul Crawford, MC Wakeman General Hospital Cp, Atterbury, Indiana Colonel Cleon J, Gentzkow, MC Valley Forge General Hospital Phqenixville, Pa, Colonel John R, Hall, MC Bruns General Hospital Santa Fe, New Mexico • Colonel Robert M, Hardaway, MC Bushnell General Hospital Brigham City, Utah Colonel Maxwell G, Keeler, MC Madigan General Hospital Tacoma, Washington Colonel Paul A. Keeney, MC Murphy General Hospital Waltham, Mass. Colonel Floyd V. Kilgore, MC Cushing General Hospital Framingham, Mass. •Colonel* Henry L, Krafft, MC Mayo General Hospital Galesburg, 111. Asa Lehman, MC Army L Navy General Hospital Hot Springs, Ark, Colonel Hew B. McMurdo, MC Oliver General Hospital Augusta, Ga. Colonel Carl R. Mitchell, MC McCornack General Hospital Pasadena, Calif. Roary A, Murchison, USA Percy Jones General Hospital Battle Creek, Michigan * To replace Colonel Upshur as Commanding Officer, Array & Navy General Hospital, Representing Commanding General, Percy Jones General Hospital. Colonel Cleve C. Odom, MC Mason General Hospital Brentwood, LI, New York Colonel Charles A, Pfeffer, MC Old Farms Convalescent Hospital Avon, Conn. Colonel George TUT, Reyer, MC Wm. Beaumont General Hospital El Paso, Texas Colonel Edwin H. Roberts, MC Murphy General Hospital Waltham, Mass, Colonel Oramel J. Stanley, MC Halloran General Hospital Willowbrook, LI, New York Colonel Paul H, Streit, MC Brooke General nospital Ft. Sam Houston, Texas Colonel Samuel J. Turnbull, MC Tilton General Hospital Ft. Dix, N, J, Colonel Alfred E. Upshur, MC Army & Navy General Hospital Hot Springs, Ark. Colonel Dean F. Winn, MC Moore General Hospital Swannanoa, N. C, A, , WELCOMING' ADDRESS. i .Major General Norman T, Kirk STATEMENT OF CONFERENCE AIMS.,,,.Brigadier General Raymond w, Bliss Major General Norman T, Kirk, The Surgeon General, opened - the conference.at 0900 hours, 22 August I9U6 with a welcoming address to the hospital commanders. He then,called upon Brigadier General Raymond’ W, Bliss, The- Deputy Surgeon General to set forth the con- ference aims. General Bliss extended his greetings to the hospital commanders, and set forth,-the conference aims -in the following statements: " . • -.- r ... - This conference of hospital commanders is the first held since .certain Army medical facilities were designated as Class II . installations and placed them under direct control of The Surgeon General,' . ; . < ■ • Presently there are forty-six Class II installations with a total command strength of around 100,000. They, include, twenty-four general hospitals, ’. ‘ “e know that this meeting will be. mutually helpful. The program Has been arranged so that there will .be a chairman for each scheduled ' topic. After each subject'is presented there will be-:an informal 'discussion and we hope that the discussion will bring into- the open every matter of interest .to hospital commanders. - We--want ; ; all your problems brought out at this conference, . We will try to . find solutions that can be put immediately or take any .: necessary steps here .’in- Washington, ■ There are a few points which wd-. tmis.tr bear in’mind and which will be brought out in more de.tail during .the conference, 1. ’The Surgeon General wants-and expects our hospitals to be the best. We want them recognized as. such and theywiil only be-so recognized if they are, in fact, comparable with the best in ■ contemporary medicine and only if they constantly improve. Construc- tion must always be thought of not only1 as immediate but in terms of the future. Our equipment, likewise,7 must be up-to-date and the finest obtainable. • r, : s 2. .Our educational and 'training system must be kept at such a level that it meets the highest standards demanded by the professional groups in civilian life,- ' It is accepted and. recognized that patients receive the best care and treatment in hospitals which are teaching institutions. All of burageneral hospitals must be organized' along the lines of, and; be- thought of as teaching institutions. 3;. Commanding officers*must.consider themselves as representatives'of ;The 'Surgeon General and of medidine in: ■... their relations with other federal*'and state medical agencies, and with the. .civilian profession. It is essential that there be thel closest:•cooperation-'with civilian, medicine. Every opportunity should be. takeh ■'to encourage the. mutual exchange of available teaching, and prbfesSi'onal-facilities, ; ‘ " : Wd have -an.,immediate and-continuing problem in insuring adequate specialist.representation in our-hospitals. .We had the specialists for our needs during the war,.., During demobiliza- tion, we have,.separated to date some Ui,000 medical officers. Of necessity .this included a-large proportion of doctors of the various specialties* '.“"To/ provide ./replacements for these specially trained men we have planned as'follows-;.- .. . . ‘ • j. ,a. To train, retrain, or refresh Army medical officers who:had -been’on non-professional duties during the war years. .Some three hundred of■this.group have been-and are being exposed to pro- fessional medical practice and are currently-becoming;available for duty assignment. ' " b. To permit-selected ASTP students to continue in residency,: training -beyond their . internship. Of ..this group there are roughly'five hundred'senior, or twenty-seven-months' residents, and 1100,-junior,,*.or eighteen-months. residents i These officers are. now , available arid are assigned after completion of, their Army indoctrina- tion course at Brooke Army.-Medical Center* ‘Their .specialized- ability must be utilized to -the fullest. " ’ ■ -,r.. ; *■ - - c. To-provide consultants. Civilian consultants-are available for a].! general hospitals—-we-have-the authority to employ their services. A rational program must be-worked out -at' every general-hospital-to insure their proper integration into the. hospital activities* By the. intelligent use of:these three categories of specialized personnel,•• our .patients should be provided with superior me.dical .attention. ’ ■ •*•' • . . . • ’ • •' . ' •■d,There was one other method .of providing-rcont inning specialist attention and that*was by: . . •A ■ , • • - : rv;‘ Retaining in the service medical • officers • • -• . '-''.y.i -.with special MOS numbers classified as A, , •• ■ s.;B, or C specialists, ■ for a ’longer period • .7 , ' . ’ • vpf .service than'their brother officers. (>2),••.By.freezing for an indefinite period by . name, a limited number of essential specialists — for example, plastic surgeons. Of these two groups less than three hundred are now kept in the service. It.is.imperative- that every one of these highly qualified doctors be actually on duty commensurate with his specialized ability and that every step be taken to replace him by a qualified person at the earliest possible date. Hospital commanders must • consider this group as. an individual group, know who they are, and know that they are properly; assigned. Please, let them know that their services are appreciated and that constant effort is being made to release them at the earliest possible moment. Special consideration should be given in recommending promotions for them. Finally, we hope that you are familiar with TO Circular 138, I9U6, ■ and its supplement WD Circular 170, and that you have considered its implications so far as they apply to you. There is the divided responsibility in the working of this instrument. You must be familiar with the functions coming directly under. The Surgeon General and the functions for which the army commander is responsible, If you cannot come to a satisfactory agreement with the army commander on matters for which he is responsible and as a result any problem is unsolved, please advise the Office of The Surgeon General and we will make every effort to help,. . ■ ■ • ■ BV •■PH0GRAi4.:.:,.r.’..'. vi fvVLieutenant Colonel James { ‘ T' McGibony, Officers ’ arid Civilians 1. Hieyiew of. iigspitalizatiorb program, including present and ' ''V.projected :S.Vatus'; of general--hospital operation, Class II ‘ • 'hospitals at .Class I posts/ and future plans. Lt., Colone.l Names T, i/icGibpny, 'MC.,.-,..of the Hospital Division, Office' of-The: Surgeon- ’General, reviewed' 'briefly 'fhe-. patient load in zone ■’of interior, hospitals af the peak of-operation andfat present, with the gradual decrease .ip.,the general- - Convalescent hospital system, and gave ■the projected stat-ps of'general hospital’operation, . He made the following ■'statementsf;. :V Probably, the main point' of interest is the hospital cutback 'prOgraia.’withtydiich. most ,of you;.are familiar. Last September, following ■'tJ-Dayy, the' hospital patient -. load was more than 300,000, As we all knew, this■ was Vo decline. A general plan of cutback in hospital installations was prepared, A quarterly program was initiated which planned that the first group of hospitals would close in December, the next group in March, the next group in June, and so on. The load of patients has now dropped to about 70,000, The original schedule of closure has been followed pretty closely. As you know, the convalescent hospitals as such, went out at the end of June and we picked up convalescent annexes. The patient load coining in from the zone of interior was increasing rapidly, so con- valescent annexes were set up for all general hospitals, He believe y -‘-r patients cared for in this way will get back to duty quicker than under the older system. The slides I have here will give you a good idea as to why convalescent hospitals were closed and how we hope to have the regional hospitals out by September and revert to general and station hospitals. First slide (inclosure No, 1): Shows hospitalization data on all hospitals within the continental United States, including beds authorized, patients remaining, and beds occupied. It shows the effect of the various quarterly hospital cutback on the authorized bed capacity. Second slide (inclosure No. 2): Shows the total patients remaining in hospitals including non-Army, both in the United States and overseas, Third slide (inclosure No. 3): Shows the patient load in general hospitals proper, indicating the drop in peak load of the patients remaining. Fourth slide (inclosure No. A): Shows the peak load of patients evacuated from overseas and the diminution in the number of evacuees remaining. Fifth slide (inclosure No. 3): Shows the convalescent hospital system and why the convalescent hospitals were closed out. In June the patient load in these hospitals was down to where*- it was not economical to keep patients at these installations. Sixth slide (inclosure No* 3): Shows the regional hospital system which was in operation to take some of the load off the general hospitals during the war. These are being cutback and at the present time it is expected to have these hospitals 'out by the end of September and revert to the prewar general and station hospital system. Seventh slide (inclosure wo, 3): ‘Shows station hospital load which at the present time is running about 8,000 patients. Eighth slide (inclosure No. 5): Shows the number of Army patients evacuated to the United States by month; the peak month load being 59,000 patients. The number of evacuees has dropped down very rapidly to where we are receiving only about 1200 to 1500 patients and has re- sulted in a drop of-from twenty-seven to six hospital ships. Ninth :slide (inclosure No, 6); Shows the number of patients received in Continental United States each week from overseas by water and by air. ' : ' -• Tenth slide (inclosure No. 7): Shows the total final disposition-of patients. Eleventh slide (inclosure No. 7): Shows patients on sick leave and furlough. This number at one time exceeded some 80,000. This has now leveled off to about twenty-five percent. Twelfth slide (inclosure No, 7): Shows number of patients returned to duty" which at the present/ time is approximately seventy-five percent. ' • ' ; ■ Thirteenth slide (inclosure No. 7): Shows the number of patients given ODD. • Fourteenth slide (inclosure No, 8); Shows the estimate of patient load in general - convalescent hospital system, indicating the estimated load through September. The estimate for December is some 33*000 or 3A*000 patients remaining. A group of charts I have will give you some idea of what is in. mind for the uieitt group of closures. Of the sixty-five general hospitals at peak operation/we' are now- down, t o. twenty—two of which three will close' at the end of September, The original estimate called for at least seven hospitals to be closed by the end of September. : -At the present time, we will not be able'.to meet the- seven, but should be able to meet at least five of that number. The Veterans/Administration’has been slow to' accept TB patients which are now in three Army-hospitals, Th&fe’are some 3,000 TB patients in'Army hospitals at<.the. present’time, . ‘I;...; .... v< r First chart: Shows general hospital operation in dune and what :the, general thinking is on the December cutback. This December cut- back. has not yet been sent to .Aar .'Department for final- approval, ' It is;planned' that i-iason will go back to the btate of New fork; Hallpran wifi either go to the State of New fork or to the Veterans Administration.;,* Moore ■ will. go- to: the Veterans Administration; Aakeman will close due to the Closing;-of the ..post, and will close if the TB load can go into Beaumont, Valley Forge has been scheduled for closure, but nas at.present A12 plastic cases, ny keeping Valley Forge, we can'close ■haHoranf and Mason and at the same time take care of the plastic and NP load. * '-. • Second chart: Gives some idea of the* development of the general hospital"System after•the outbreak of the war and the distribution ;of these hospitals,. Third;chart; This is a copy of the slide which showed the general and convalescent patient load and the station'-.and regional patient load, together with the anticipated load: for the next few-,.-months, Fourth chart; Shows the cutback in the regional hospital system.with the closure of the hospitals. Fifth chart: elves an idea of what happened to the patients and patient load from June 19A5 to June*19A6 by the individual specialty. Sixth chart*;- Shows the drop-off in surgical patients, although plastic surgery; is at present still a major problem, Borden General Hospital is now closing and the deaf patients will be moved to halter'hoed. Hegarding the blind patients, there are forty at Valley Forge who will be sent to Old Farms, This raises the question as to whether Old Farms vd.ll be closed. At present there is a need for individual-treatment for the remaining blind patients. It was tentatively set for ■ closure-,,in October and is now tentatively set for March, depending on the patient, load in other hospitalsf v The prisoner-of-war problem is practically over. All Italian patients., all Japanese patients and thirty thousand German patients have been repatriated. Only a very few remain, 2, Physical medicine activities in Army general hospitals, Lt, Colonel Benjamin a, Strickland, MC, Chief of the Physical Medicine Consultants Division, Office of The burgeon General, was intro- duced by Colonel McGibony, Colonel otrickland reviewed the physical ■medicine activities in Army general hospitals, ■ He stated that a -number of questions had -been submitted concerning long-term reconditioning and that a number of questions were sent in regarding the new department of phvsd medicine. Before answering the questions, Lt. Col, Strickland explained the policies of this department and some plans for its future. He quoted a physician at the American medical Association convention recently, who believed that civilian hospitals. would do well to follow the lead of Array hospitals in reconditioning, physical therapy, and occupational therapy. The recent upswing in the reconditioning system was improved by Bernard Baruch’s donation to establish foundations for this purpose. Physical medicine is the combined use of physical therapy, occupational therapy, and reconditioning of convalescent patients, SGO Circular 53 gives the treatment‘program of convalescent patients in array- hospitals. In line *urgeon General's accomplishment;in getting this splendid, ..permanent hospital initiated during the-War. ■ .■ •; •.... 5. Maintenance, repair and utilities in -army hospitals. Brigadier General John E, Bragdon,CE, Chief of Construction, Office of the Chief of Engineers was introduced by General Bliss, he made the following statements: , i ..The vital mission of the medical Department lias been recog- nized by the Gprps of Engineers throughout the Ear.*- with the cessation of hostilities; tnis mission, has not diminished, nor have- the responsibilities of the Corps of Engineers in connection, with the execution of this mission diminished. Providing the finest medical care -for the sick and wounded in the best-equipped.hospitals is ap important responsibility of the -ir. Gifford spoke on the relationship to the Federal .hospitals. I understand that it was the desire to have an .informal talk on the relationship of the Bureau of the Budget with the general hospital program of the Federal Government and army hospitals in.particular, There are throe points to that title as you will see, I o ’understand the relation ship of the Bureau of the Budget to a hospital program under the Federal Government' and to.army hospitals in particular, it is best to begin with the relationship of the Bureau of the Budget and the Federal Government, The Bureau of the Budget originally was an executive office of the Presi- dent; It is a staff agency and its principal function is to act as a representative or agent to the Chief executive in problems of coordination and management * That means that the Bureau of the Budget is interested not only in hospitals but in all other management activities of the Federal Government, Hospitals themselves constitute such an important part of the entire Federal program that an entire section of the Hureau of the budget is devoted to that particular function. You will realize, of course, that in-handling the many problems that confront'us we have,to specialize, and in the matter of hospitals and medical programs we specialize functionally. In some other instances a group will handle an agency with all its activities* a number of groups combined into a section will concern them- selves' With a particular.function. You will see by the position of the Bureau' of the budget in,the Federal•Government and its relationship to the Chief'Executive that we have a wider field than' is sometimes assumed, I know that members of the staff of the ’bureau of' the budget are sometimes jokingly accused of having taken this or that away from some individual, but at the same, time wc have■a great many activities that come outside of the field of appropriation estimates and sometimes suggest that some things may not bp needed. Individual projects'are'welded into a harmonious pattern. That.implies management in a broad and general sense and we like to define our work in terms of the approach of management rather than in the more narrow accounts concept of going’at a budget* We do;-have-the responsibilities that .are ordinarily implied in budget-work and a good deal beyond'that* It is for that reason that vie set up in the bureau Of the Budget a section, that specializes in hospitals and medical.programs, The 'member's of ‘that: .section are keeping constantly in’touch with; the Federal hospital'program, Me- analyze the resources how the loads are being carried and must be prepared to answer all sorts'of questions that come in. Cur mission is varied indeed. If ■ someone on the outside writes a letter to the President concerning a hospital question it is likely to be answered in the Hospital eection, if it is a budget matter it comes to us for analysis and recommendation* If it is a proposal to build __ a new hospital we must be prepared to answer questions relating to its construction. Probably most of you are familiar with the figures of the hospital program,qf the Federal Government. I brought along a brief reference as to the number involved. I am speaking of what you call general hospitals — army named general hospitals omitting station hospitals and .the various dispensaries, .1 mean fully staffed general hospitals.• At the present time the,Veterans -administration is the largest Federal agency operating about 92,000 beds. That program is already planned for expansion of 150,000.beds by 1950. 1950 is the target date in making studies of Veterans administration needs. In round figures about 150,000 beds will be. needed at that time, k round figure of 300,000 beds is- in the Veterans plan. That is a‘ long way in the'distance.- It might never be reached. It is more an immediate goal according to the studies made thus far. Perhaps I960 or 1965 the Veterans Administration might be operating .more than 250,000 general hospital beds. The Veterans Administration will be the largest single hospitalizing agency for.-some time to come. The Army now holds second place with 56,000 bods and the Navy AA,000 beds. Then tnere are a group operating under the Public Health Service that includes marine hospitals, St, Elizabeth's Hospital, narcotic hospitals, and Freedman's Hospital. All are grouped together under1the Public Health Service, Together they comprise 17,500 bods, lastly, there are three small groups: Indian bervice hospitals. Bureau of Prisons ■ hospitals and the District of Columbia hospitals. These three together have about 7,900 beds at the present time. The agencies r have indicated account for about 220:,000 beds which are now being operated in general hospitals by the Federal Government, That is a large hospital program; so large'that we feel justified in treating it as a special function,- One of the principal management tools that the Bureau' of' the Budget usesj and of course everyone uses that tool in management, is exact information - statistics, I never did like that word ’’statistics". It implies something dry and more dusty than the figures that one uses in every day administration. We do get reports generally on a monthly basis. In operating hospitals over a period of years we have tried to get those reports on a uniform basis, for they are indispensable to us- and to you. Uniform definitions supply us with the information so that when we speak of patient load it will mean the same thing whether Army, Wavy,. Publis health service, or Indian Service, reports are on a monthly basis with an annual summary. These are the principal equipment in answering questions that arise in regard to hospitalization and in making recom- mendations to the President concerning hospital activities. We feel that in any management approach, material of that kind is indispensable,, Most of the reports that we get represent a summary of information that the agency has to prepare and keep current for its own use, i-t may be that some reports involve special work on the part of the agency. I don’t believe that very many of them do, Essentially, we need the same informa- tion to solve a problem relating, to a hundred hospitals as a group. The Federal hospital program divides itself into two parts* We treat them as separate parts. One is the location and construction of new. .hospitals• The other is the operation of hospitals'already in existence, faring the past six years the Federal Government has been engaged in a very active program of:hospital expansion* . It has been mostly an army and navy expansion*.. with the ending of the war the Veterans administration has expanded. Planning a hospital program from the stand- point of construction is- quite different from.the. operation of one* For one thing it is necessary to v;ork farther ahead. The target date is 1950, It is necessary to look quite ahead because of. the lag of time* First, there is the appropriation of.the,money and then the contracting and scheduling of the hospital for use. We saw plenty of that during the war and you,got much faster action.than is possible to get. now. ‘right now an agency such as the Veterans administration is trying to expand, hospitals are included in the budget now .being, prepared for the fiscal year 194-B, At the present rate of speed of construction,present hospitals will not be ready before. 1950, That is a long spread and complicates the; matter of planning,.' - ■'; ' - ■ ' •* : • ‘In solving problems regarding the' hospital construction program the bureau of the Budget has the assistance of the federal board of Hospitalization with which many of you are familiar,. It consists of heals of the'principal hospital operating agencies'.uAder*the chairmanship of the Director of the Bureau.of the Budget. All'proposals for new con- struction or expansion of existing facilities must be presented to that board, for analysis and recommendation. The Federal Hospitalization Board ha,s,been actively screening projects of this kind'particularly for the last, three years, The benefits-of-such a .screening process has been tremendous, 'When an agency /wants, to build a. hospital it' lias - to specify to the Board wiiere and what it will be and how large ahd of what type. It must be justified- before the ..-board. This has a very healthy effect on planning at'agency1level,; Another-great advantage has been that the Board has been able to review.the prpposals,of all the agencies and recommend coordinated- action,: There is no question in my’mind that the work of that board has saved the Federal covernraent hundreds of millions of dollars. And,, it appears from the experience wc have had the Federal Hospitalization Board can function without impairing any individual agency. Here is one little illustration of what can be done by coordinating the hospital resources of the Federal Government - turning over to the Veterans -administration surplus Array and Havy hospitals,. Up-to-date 28 Array and Navy hospitals have been transferred to the Veterans Adminis- tration. Those hospitals had a normal capacity of 4-5,000 beds and* were transferred fully equipped and stocked. The veterans Administration proposes to use 20,000 beds in the near future with 25,000 in reserve. At lease six ©f the above hospitals will form a permanent part of the Veterans Administration system. They are so located and constructed that they can be used permanently with little modification* In some casus the reservation and utilities of a temporary hospital will be put to permanent use with new hospital buildingsv Others «will eventually be replaced with new hospitals at other locations* The importance of this use of surplus hospitals can hardly be overestimated. without .'them the Veterans Administration could not possibly meet its present urgent demands while waiting for. its own hospitals to be built. In approaching the current operating problems of hospitals we realize that you have your'own particular difficulties, itapid demobilization of army personnel has caused serious dislocation of professional,and technical staffs at a' time when patient loads, continued at high levels. Perhaps the worst of that is over. *»e are very much alive, however, to the,fact that nobody sympathizes with an agency that has to contract. It takes Very careful planning to abandon certain hospitals and to keep others going. In approaching the operating problems of military hospitals we recognize something else, also, which does not apply to any hospitalizing organization, and that is that a system of military, hospitals has to be ready at all times for expansion. We recognize, too, that it is necessary to keep enough trained personnel in your general hospitals so that you can supply new -organizations. Those are peculiarities of military hospitals which-do not apply to-hospitals of some other agencies. Thus far I have said nothing about the dollar economy and I an not going to say anything about that because we feel that in approach- ing problems of Government from a sound standpoint the matter of economy in the military sense are tak6n care of. The matter of economy will take care of itself. It is only fair to warn you, however, that in tiie future the bureauof the Budget will scrutinize appropriation estimates for hospitals more closely than if did during the war. no realize that with a war in progress it was impossible to estimate patient load or personnel requirements or any other major facts that determine the size.of a hospital program, now that you are in a position to estimate those things more closely we shall ask more questions, I am sure you will see that your budget officer will be prepared to answer those questions. On one point you may be sure that we will be in complete agreement — the high standards of medical and hospital care must not be impaired. Thank you. Questions submitted by hospital commanders and referred to the hospital Division for answer were presented by Colonel LicGibony. QUESTION 1: Can general hospitals receive a six month notice as to future patient loads, with a breakdown by classification? DISCUSSION: For planning purposes, it is essential that future prospects regarding patient loads be known as far in advance as possible. The patients in a hospital can be assayed, but calculations are repeatedly upset by sudden transfers of large numbers of patients from other hospitals. The time is past when general hospitals can receive convoys such as were received during wartime, without advance planning in regards to bed space and medical- care, bix months would provide an adequate period for such planning. % ANSWER; Such-a long forecast would bo of doubtful value* a three month forecast has been distributed to each of the hospital commanders. QUESTION 2: ■Are•separate planning boards required for the post of Fort ‘-• Custer and Percy Jones 'General hospital in Battle Creek, -:dr -is ia single planning board'adequate to cover all activi- ■ ties-under the control of the Commanding ‘General, Percy • Gen’eral ilospital? ’ ‘ ,, . ” ’• . ..... DISCUSSION; .... - - ; . • ... ■ ■ ...••* .. V- Paragraph 3, AH 210-20 states that "Commanding Generals answer- able to .the -War Department will cause to be established at each post, damp or: station a permanent Post Planning Board.11 Prior to the deactiva- tion of .the Sixth Service Command and the change’in the status of this command, a single planning board existed, covering activities of Percy Jones hospital Center. Subsequently, the directive establishing such a board has been rescinded by the Commanding General, Fifth Army, with the substitution of -a new directive ordering the establishment of .a pew planning Board at "Fort Custer, Michigan", it is believed, however,', inasmuch as there are no activities at Fort' Custer, other than those of Percy Jones General Hospital, that single planning board, covering all hospital installations'would be both adequate and desirable, 1’his is not possible until the present confusion has. been eliminated1. (Submitted by; CG, Percy Jones-General Hospital.) .... ’ “ ’ _ , ANSWER; ■' The post is scheduled for continued use. Therefore, the Commanding General, Fifth Array is justified in establishing a planning board. Percy Jones General’Hospital should maintain an active planning board for the Battle Creek establishment only, irv accordance with AR 210-20. . The . Commanding General, Percy Jones Hospital should seek member- ship in the Fort Custer Board as having a primary interest there. He should invite representatives of, the Fort Custer Board to sit with the Percy Jones Board as associate members. QUESTION 3: Who has the responsibility for final approval'of construction projects at general hospitals, army headquarters or the Office of The Surgeon General? DISCUSSION: Both array headquarters and the Office of The burgeon General have asked for estimates and detailed information regarding construction projects at this installation, thus, creating uncertainty as to which of these agencies can furnish an authoritative decision regarding the status of a given project, (Submitted by: CG, Percy Jones General Hospital.) ANSbER: • a. References: * • .... WD Circular 343, 194-5. I© Circular 45, 1946 VJD Memo 100-46 , 4 March 1946. wD Memo 100-46 , 2 April 1946. TM 5-600 W Memo 100-70-1 b. Basically, all construction is approved by the bar Department except maintenance repair and.utilities projects costing less than 410,000, c. Commanding officers desiring to submit projects must secure authority for submission prior to directing local engineers to prepare them. This authority may come from either the array commander or The burgeon .General and may be written or verbal, d. New projects are processed through engineer channels, that is, district engineer,-then array engineer, to the Chief of Engineers, who obtains approval of The burgeon General with regard to planning and approval of the War Department with regard to expenditure. e. Repairs, alterations, conversions and extensions of existing buildings may be approved by array commanders • as a part of the housekeeping function provided the project cost does not exceed 410,000. Projects exceeding 410,000 in cost must be forwarded by array commanders thru the Chief of Engineers to the bar Department, It should be noted that post commanders no longer have 'authority to approve new construction projects costing ‘less than 41,000,- Alteration projects costing less than 41,000 continue to be approvable by post commanders• f. all construction must conform to bar Depart- ment construction policy. '> ■ g. Budgeting of new construction' a.V general hospitals is- handled by The Surgeon General, Estimates should be submitted directly to this oflice in the case of general hpspitals located on Class I,posts, information copies of this material should be ..furnished the army headquarters concerned. QUESTION 4: AR 210-20, 11 June 1946 provides for establishment of post planning boards at all stations, "that have been either tentatively or finally selected and designated, by the War Department as.being installations planned for permanent or prolonged retention,’1 Has McCornack General hospital been * selected or designated by the war Department for retention as noted above? If it has been so selected then why has not a planning board been established by proper authority? (Submitted by; CO, McCornack General hospital,” ... ANSIJER.: McCornack General hospital has just been designated a 1A station. As such, it should have a post planning board and proper instructions vd.ll be issued as soon as the re- classification notice is formally issued. QUESTION 5: Is the personnel allotment for post engineer based on requirements for maintenance, repair and operation only or does the personnel allotment allow for a percentage of hew work and alteration to be done by engineer personnel without deferring maintenance and repair? (Submitted by CO, McCornack General Hospital.) DISCUSSION Cost budget in relation to new work account, — Assuming the limitation of cost budget set by Sixth Army is for the purpose of rainiraiz~ ing the number -;of, mag or new work project, it would appear that revision of the definition of this account as contained in l/D TM 5—602, should be made in vievr of •■the., numerous recurring installations that are absolutely neces’sary, and-which must under present definition be costed to this account, nlnee this station,is.a hotel conversion minor installations are constantly'required .whicli under present procedure reflect distorted cost, in the new- work.account, Station estimate for present six months In this account-was; .^4,BOO*.00, Sixth army approved 42,000,00, An increase in this- account will not be approved unless detailed justification is shown, Detailed justification would- involve unjustified engineering analysis and cost•estimates• Examples of recurring new work costs; Installation of kitchen equipment, installation of electric outlets, installation of phone buzzers, installation of hasp and lock on door or cabinet, removal of light, fixtures, removal of partitions, windows or doors, Any job that is not classified as maintenance repair and operation is considered new work, All items are costed at prevailing date, i,e,, EM labor, free material, etc, ANSWER: The answer to this question is contained in a Yffl circular to be published, Tn general, new work should not be undertaken by the post engineer at the expense of deferred maintenance. •Efforts are being made to secure authority for post engineers to use purchase and hire on such jobs. QUESTION 6: Request that a definite directive as to the position of the ' ■ array in the channels of command in relation to Class II installations (especially named general hospitals), be issued (Submitted by: CO, Murphy General Hospital.) ANSVffiR: \tfD Circulars 13 B and 170, 194-6, cover this matter, QUESTION 7: At the present time there are approximately 130 to 140 cases of poliomyelitis residuals under treatment at this hospital. Special facilities.have been set up for their treatment, which is supervised by specially trained officers, nurses and physical therapists, however, when allocation of bods is-received from The Surgeon General, no mention is ever made of poliomyelitis, beds being allocated for arthritis, deep X-ray and radium therapy, Veterans Administration and Service Command only, (Submitted by: CO, Army and Navy General Hospital.) ANSWER: • The "number of cases is relatively small and no code was established. It will be the policy to transfer chronic residual polio eases to Army and Navy ueneral Hospital, QUESTION 8: It appears very difficult to effect various repair, mainten- ance and needed construction programs through the army head- quarters, formerly service command headquarters. The roofs of the two main wings of this-steel and concrete structure have been leaking for the past six or eight years. Since early in 194-6 the post engineer at this hospital has been attempting to get authorization- for the repair of these roofs without any definite action so far. Various so-called experts from Array headquarters advise different remedies, with the result that nothing is accomplished, (Submitted by: CO, army and Navy General hospital,) ANSVJER: In cases where inadequate engineering service is outained from army headquarters the following procedure is recom- mended: * a. Direct contact with the army surgeon enlisting his support in securing necessary service. b. Official report to The Surgeon General detailing the difficulties encountered. Such reports will be taken '••• \ " up with'the Chief of Engineers and concerted efforts 1- ‘ will be made to. secure the. desired service* QUESTION 9: This hospital follows the procedure outlined in AD Circular 215, 194-5, in forwarding officers’ clinical records and VA Form 326 to the Veterans administration. Further directives oh this subject are contained in AD ."Circular 474, 1944, AD Circular 36, 1946, and AD Circular 146, 1946, all these directives state that the Clinical Record and VA Form 326 will-' b'e’ forwarded to the Regional Veterans administration Office, However, it is the opinion .of this headquarters that V© Circular 36, 1946 and AvD .Circular 215, 1943 conflict somewhat, AD Circular 36 states; that VA Form 325 will be forwarded immediately following the officer's separation. AD'Circular 213 states that Va Form 526 will be forwarded with the clinical records after authority has been received from The adjutant General to forward ,the clinical record. Officers are appearing before an army, retiring board and •being.separated, then writing to this headquarters requesting that their application for pension, VA Form 526, be forward- ed to the regional Veterans administration office. This office is not forwarding 526-as they request, and. as is provided by AD Circular 36, but as holding it until authority is received from The' Adjutant General to forward the clinical record which is the procedure outlined in AD Circular 213, 1943, In a number, of cases it is several months.before The adjutant General authorizes this headquarters to release the clinical record, (Submitted by: CO army and Navy General Hospital),. : . ANSWER: The procedure outlined as .the one currently followed by the questioner with respect to forwarding of specified clinical records and VA Forms 526 to the Veterans administration is the'correct'procedure. In the case of officers being separated for disability. The adjutant General's Office desires that‘the clinical records.and other records required by tiie Veterans administration be held by the hospital until their release is authorized by.The adjutant General,. War Department Circular 36, 1946., on the one hand, and AD Circulars 474, 1944 and 215, 1945, on the other, are not in conflict since the latter ones pertain to officers separated for disability and the former (AD Cir 76, 1945) pertains to separations at separation centers and to separating enlisted men at other than separation centers. With respect to the occasional delay referred to in obtaining authority from The Adjutant General for release of the records in question, it is suggested that vigorous follow-up measures be initiated on unanswered requests. QUESTION 10: In spite of many letters to The Surgeon General reporting that fact, the Veterans administration continues to be throe or four months in arrears for payment of subsistence charges for veterans treated in hospitals. (Submitted by; CO, Arny & Navy General Hospital) ANSWER* Hospital Fund has alv/ays compensated for this by additional grants’. The Veterans Administration Fiscal Officer is familiar with this situation. QUESTION XI: In newly activated general hospitals is it advisable to set up full long range planning board activities without definite assurance that the installation is to be permanent? (Submitted by; CO* Hratt general Hospital.) ANSVIER: None of our general hospitals now classified 1A can be de- activated prior to 1949 according to present plans. Each such hospital should have an active planning board which can evaluate its construction and major alteration needs for the anticipated period of continued use. The burgeon General will in the immediate future issue to-'all-concerned a, definition of mission and of anticipated period of continued occupancy. QUESTION 12; what changes or modifications., if any, in Corps of Engineers policies and criteria for planning at post installations will be recommended by The Surgeon General to adapt such planning for named general hospitals? (Submitted by; CO, Pratt General Hospital) ANSWER: The burgeon General has asked all Class II commanders to submit comments on postwar planning criteria issued by the Office of the Chief of Engineers* These comments are welcome at all times and any inadequate or unapplicable criteria pointed out will be taken up with the Chief of Engineers in order that his manuals may be changed. QUESTION 13; Is it the policy of The Surgeon General to require-an emergency electric power plant installation in all general hospitals to back up the primary electric power supply from public utilities? (Submitted by: CO, Pratt General Hospital,) ANSWER: * ' Neither,the Office of The Surgeon General, nor the Office of Chief of Engineers has, a .fixed policy in this matter due to , the wide variation-in local conditions* In any case where power failure is- normally..expected. The Surgeon General and Chief of Engineers require stand-by generating equipment adequate, to-light■critical areas and to operate critical equipment such as elevators, boilers and pumps. ' • . . . • - • - • -• QUESTION 1A: Is it the,policy .of The Surgeon General to require separate post engineer establishments in general hospitals even though nearby army activity is already performing this function? • • ■ • War Department policy and common sense dictate the unifi- cation of maintenance facilities for adjacent stations. The .burgeon General strongly recommends- the assignment of a post .engineer liaison officer (or competent civilian engineer) to the hospital staff in those cases where general hospitals are, dependent upon other stations for post engineer service. The Chief of Engineers is sympathetic to this recommendation hut has not put it in effect in all cases due to personnel shortages. QUESTION15; Is approval of your office required for expenditures from hospital fund in excess of SI,000,00 for individual welfare projects for patients? (Submitted by: CG, Fitzsiraons General Hospital.) ANSWER; Ygs i Paragraph id, 1© Circular 214, 1945 is in effect, Approval formerly required from s'ervice command- for con- struction, maintenance, and purchase of furnishing for building and other facilities of over is now the responsibility of The burgeon General. QUESTION 16: What are the limitations imposed upon the hospital commander for the definitive surgical and medical care1-in treatment of Veteran Administration patients? ANSWER:’.. . .T he limitations are the same as the limitations on treat- ment of military personnel as outlined in Vffl Circular 12, 1946. QUESTION 17: What typo- Ojf.operative procedures, or medical procedures is he limited;to? ■ !. ANSWER: ' T he typo of operative oroGedures.. is listed in WD Circular 12, 1946. ■ ' QUESTION 18: What is the length of the.hospitalization that the Veterans Administration patients are going to be limited to? AHSlifflR: Length of hospitalization - Veterans .administration bed credits are not designated for domiciliary type cases and as a general policy the length of hospitalization would bo similar to the policy for military personnel as outlined in LD Circular 12, 194-6. QUK£5TIdN'-19: In what ways is the mess going to be reimbursed for rations; in turn, the hospital fund reimbursement. Will a ration allowance be the same for Veterans administration patients as it is for military patients? ANS1/ER: Authority for the admission in array hospitals of benefi- ciaries of the Veterans -administration is prescribed in Par. 6u, AR 40-590, Subsistence charges for such personnel are governed by the provisions of Par 12A (l) (b) 13, AR 40-590, with a footnote which is quoted as follows: “Subsistence, charges for these personnel will not be collected from the patients but either will be billed by the commanding officer of the medical installation concerned direct to The Surgeon General of the -army, or will be otherwise collected in accordance with instructions from time to; time issued by The Surgeon General," The above-cited .army Regulations are Currently implemented by SGO Circular 13 j 14 May 1946. Notwithstanding the fact that this directive was distributed only to general hospitals and hospital centers, the Fiscal division of this office advises that a copy of this circular is forwarded to an army hospital as soon as information has been received that the hospital concerned has been allotted beds for Veterans Administration patients. QUESTION 20; What are the limitations on the ‘dental treatment of veteran patients? ANSWER: The following concerning dental treatment for veterans who are in-patients in army hospitals has been coordinated with the interested divisions of the- Office of The burgeon General and the Veterans administration, however, to date, it has not been published, "Dental treatment for veterans who are in-patients in Army hospitals as beneficiaries of the Veterans Administration will, be furnished on the request of chiefs of hospital services following determination of need by the chief of dental service. This treatment will be the same as that furnished military personnel (see letter AG 703wl (4-16-42) MO—S—M, 2$ April 1942, Mental services during and for six ■ months after uar) except that patients will be held in the hpspital for .dental attendance only when it is for the treat- ment of Glass I conditions other than the replacement of missing teeth.. No outpatient dental treatment will be provided.” General Denit called the attention of the hospital commanders to,;the folder prepared for them. He spoke of an extract of questions and answers made'of the conference' of the Director of Service, Supply and Procurement Division, WDGS, 12 and 13 August 1946, which he believed contained a great deal of interesting information. The following is a question he wished to emphasize '’Question; V/hat recourse does the chief of technical services have when the maintenance and custodial services provided at Glass II installations by army commanders are reported unsatis- factory by commanding officers of the Class II installations? DISCUSSION-: ‘ Instances of this nature should bo called to the attention of the appropriate War Department General Staff Division for initiation of corrective'action, nowever, it is believed that the Glass II installation commander should report any such deficiencies to the array commander before reporting such facts to The Surgeon General, Undoubtedly, most of the unsatisfactory conditions could be worked out by mutual arrangements between the installation commander and the arrry headquarters * Action should be taken as follows; a. The installation commander should report the unsatis- factory conditions to the array commander and attempt to work out a- satisfactory solution, b. If corrective action is not forthcoming the installa- tion commander should report the conditions to the Chief of technical service who in turn should attempt- t-o work out a solution informally with the army commander, c. If the.above steps do not obtain results the chiefs of technical service should report the unsatisfactory condi- tions to the appropriate War Department General Staff division," General Denit stated that he quoted that question because . the matter had been discussed at the conference during the morning session. He stated further, that, there were many other questions pertaining to ■array commanders and commanders of Class II installations in the folder which are extremely valuable. . Colonel McGibony called the attention of the hospital commanders to the copy .of The -Bulletin of The Inspector General of the Army, the .August issue of which carries a practical check list for inspection of hospitals* He stated that he had been informed by the Inspector General's Office that if there is anyone not on the distribution list; he may write to that office and be placed‘on the mailing list to receive the monthly Issues of the Inspector General's Bulletin, AK 210-*2G,.i published:'.Uune-.of; this yean, provides for the ■ establishment-of -a-, permanent, installation planning .board at. those installa- tions which have -been" either tentatively-.or -firugUy selected, and., designated by* the hfer; Department as beingairistallations, ;planned .for permaneht -or prolonged retention;.- yihej, mission of these, planning boards fs .two-fold: (1) : the- preparation oof .a comprehensive and continuing plan arid program by which to ■-achieve-"the- orderly- and systematic,.;doyelqprAept. and improvement of the installation as a facility for its intended purpose; and, (2), the submission of consolidated and properly supported construction and long- range repairs and utilities programs and supporting data to the bar Depart- ment on which to base and fully defend military appropriation and authori- zation acts necessary to realize the objectives of the plans and program developed by the planning boards, at the present time, twelve general hospitals have been either finally or tentatively selected for retention. This means that plans and programs for each of these general hospitals should be included in the over-all master plans of tne planning boards of the installations concerned. It,therefore, becomes incumbent upon the commanding officer of each of these general hospitals to develop long-range plans for construction and repairs and utilities programs for his particular hospital and to insure their inclusion in the installation master plan. It would probably be helpful to clarify the relationships between the various field agencies in tiie repairs and utilities chain of responsibility, and the corresponding echelons in the chain of medical responsibility. Hie first point I wish to emphasize is that under wD Circular 138, 194-6, an army commander is responsible for the accomplish- ment of all repairs and utilities work at all Class I and II installations within his army area, he, with the advice and assistance of his engineer, holds the post, camp, station, or other installation commanders responsible, I'he post engineer is a technical staff officer of the post commander, but in addition, exercises a command responsibility over the carrying out of all repairs and utilities functions at the post, -at a Class I post wiiich has on it a general hospital, - a medical Department II installation- the post commander's responsibility for the accomplishment of necessary R & U work applies not only to the Class I part of his post, but to the general hospital as well, -*-t is his job to allocate funds made available to him to carry out his responsibility, so as best to accomplish his mission, Ihe charts I have shown you demonstrate that the general hospitals have not fared too badly. Unfortunately, however, occasions arise in which there is an honest difference of opinion as to whether the needs of the hospital are being met as well as are those of the rest of the post, buch differences are found to become more frequent as funds become less plentiful, un such cases, we should like to see the hospital commanders enlist the aid of the anry surgeon in an attempt to correct the difficulty by agreement with the army engineer at army level. The armies have additional funds, and they have complete responsibility for repairs and utilities at both Class I and Class II installations. It should be possible for nine out of ten such cases to be settled at army level before the Office of The burgeon General or the Office of Chief of engineers ever hears of them. Post commanders have authority to approve projects up to $1,000 within the funds made available quarterly, buch funds arc usually allotted to posts on the basis of square feet, of covered building space, acres of improved grounds, square yards of paving*, and other such factual criteria. They should be sub-allotted to the Class I and Class II portions of the posts on the same basis, or as directed by the army commander. Projects over 01,000 must be forwarded to higher authority for technical review and approval. An army commander has approval authority up to 010,000; every project over 010,000 must be forwarded to the Chief of Engineers for approval. In closing, I again repeat the mission of repairs and utilities is to provide a service coordinate with the mission of the installation concerned. Repairs and utilities, by maintaining to the maximum the higher maintenance standards already established at general hospitals, will do its part toward enabling the liedical Department to maintain the highest standards of hospitalization for the sick and wounded available anywhere. ‘DISCUSSION COLONEL REYER: There is a shortage of supplies and personnel to do repair work at William Beaumont General hospital. The hospital looks terrible; it is terrible. We can’t get such simple things as minor plumbing repairs or trash pickups, maintenance projects started ten weeks ago are not completed. Is completion in sight? My post engineer is a nice fellow, when I can catch him—but he has four pos-ts to handle and no help. We have two men to clean seven miles of corridors. GENERAL'BRaGDOU; There is atshortage of critical materials and the Veterans Administration has top priority on all of them, a check should be made to see if the post engineer is doing everything in his . power'.and going through channels. The post engineer can go to his regional engineer who in turn can go to the army engineer, and if he can't do anything, the post engineer should appeal to the of Engineers, a lot of the difficulty is a question of money, and we don t control the money. You, as commanding officers, should make sure you are''getting your full share from the post and the post commander should make sure that he is getting his full amount from the Army, *■ . MR, VINCENE, from the Office, Chief of Engineers; The Office of the Chief of Engineers has been advised of the conditions at Beaumont through.Lt, Colonel bonder's office, a representative from the Office, Chief of Engineers'was sent down to check on this almost a year ago. as a result of this investigation the post engineer was replaced. If the matter has still not been corrected it will be investigated again. LT. COLONEL SOUpSR: I suggest that the Office of I1 he Chief of Engineers acquaint the post- engineer with the proper procedure for getting assistance in requisitioning supplies, etc. It appears that array engineers either do not know how effective their service is in locating scarce supply or else fail to avail themselves of it. GENERAL BRAGDON: Perhaps the hospital commander is not receiving his full share of deferred maintenance. CONFEREES; "How do we know if we are getting our share of deferred maintenance?'* 0 GENERAL BRAGDON: You should go to the commanding officer of the post and inquire as to your share of deferred maintenance, fhe money for deferred maintenance is allocated according to square footage of the physical plant. General.hospitals v;ere the first installation that got money out of regular funds. GExjEIlAL BLISS; most of the problems appear to arise in Class II installa- tions on I posts. - General -fiss then called on General Hillman, Col, Streit, Col, Keeler, Col. Turnbull and finally General aeach. All except General Beach apparently experience the same problems. GENERAL BRAGDON; That, in general, seems true, however, V/D Circular 13b states that K U U for Class II installations is under the army. GENERAL HILLnAU; There seems to be a lack of enthusiasm to get things done,vat the post level, When other means fail, I put in a call to The surgeon General. He added that,•generally, he Was not complaining, but the difficulties at Letterman General hospital' seemed to have become more apparent since the Sixth Array took over. COLONEL STREIT; I have to go through three headquarters before •-the main- tenance people supposedly assigned, to me can'get off their bhairs and go to work, I can't issue work orders to them, The situation is-impossible. COLONEL TURNBULL; I am unable to get supplies, especially of small things, for example, door knobs, '■ - GENERAL BRAGDON; There is a ceiling on what you can have-in storage for repairs and utilities. .. COLONEL TURNBULL:. I have used medical personnel to perform engineer duties x have difficulty in getting a statement of expenditures and- L can't get it until a month after it is spent. I used local labor in painting the interior of the hospital. CuLONEL KEELER; At Radigan we have the same problem as neaumont, only more of them. GENERAL BRAGDON: I feel it would be beneficial if War Department would get out a regulation governing Glass II installations on Class I pqsts. I will look into the matter and see if separate or sub-post engineer establishments for Glass II hospitals on Class I posts are the answer. We shall propose them. GENERAL BEACH; We have no serious trouble at the army Medical Center, My post engineer;is always on the job and is able to anticipate most problems before they become serious. GENERAL BRAGDON; If my post commander were not giving me adequate engineer service I'd pound on his desk until he did. It is his responsibility. COLONEL: ST RE IT :• The post engineer is several miles away from my buildings and I have no one. to turn to for advice on engineer problems. The .only . way I.can get them studied is to ask the engineer to come over after I have discovered the problems. I'he engineer personnel won't work unless a work order is issued from the post engineer and that .takes considerable time inasmuch as the work order must go through channels. GENERAL BRAGDON; It might be a solution if a deputy post engineer ; could be established, but with the loss of many engineers through separations, etc., line officers have been appointed post engineers in many instances. COLONEL KEELER; Everything said thus far applies to Madigan,.. only, perhaps more so. The greatest difficulty at Madigan is to know how much money is allotted to the hospital. I find it particularly delaying to have to submi work orders through channels before the work can be accomplished. ■ My maintenance is weeks behind and it has been necessary in order for ray hospital to operate efficiently, to take medical Department personnel off their duties of caring for the sick and use them-for engineer duties, j. GENERAL BLIbS; What is the situation at Class II installations not on Class I posts? GENERAL BEACH; I am having no difficulty. GENERaL BRAGDON: I suggest three solutions to aid in this matter. 1, A deputy post engineer at the general hospital. 2, Have communicated to Class II installations, their proper snare of the money which is allocated to armies. 3. Continued prodding from the Chief of Engineers to the post engineers to maintain their efficiency despite the loss in numbers of good personnel. C. ARMY HOSPITAL SUPPLY PROGRAM Colonel Silas,B. Hays, MC Colonel Silas B, Hays, Chief of Supply, OSG, lead th.e. discussion on methods of handling supply, of nonstandard items, establishment o,f allowances and control of issue of, equipment-, and the hospital equipment modernization program. He made hhe following statements; I have a very ’’blue" picture to paint. It has been blue enough ■..in the last month or two. . In the last few days it has become a great • deal- "bluer11. You have heard something about the budget and the appropriation, and you will hear more again tomorrow. The situation : regarding supply money is something like this* We have about $17,000,000 .•ifOr supplies and‘equipment, in.the 1947 budget. That sounds like a lot -of money. Back before the war when the Army Was'running around 150,000 '■■troops we were always- living:on a hand-to-mouth’basis and we had : approximately $2,000,000 for supplies and equipment. The Army in 1947 is going to be ten times as big and our budget isn’t ten times as large. Looking at it,from another aspect, wrhen the budget was computed we used certain tropp' figures that . were prescribed, certain expectancy.:of hospital bed occupancy, and, we estimated prices to be paid for supplies,;! All three of those figures have been wrong, Neither the Army nor the hospital bed occupancy have gone down to the figures, used,,and prices on all supplies haye increased, which means that We will have to make the-money'that we had.-for supplies spread considerably. It may bo that General Kirk will find it necessary to take money originally allotted for supplies and use it to pay civilian personnel, Yf a deficiency appropriation is to be looked upon favorably by the War Department, the,Bureau of the- Budget, and The President, it,would still have to go to Congress, and Congress isn’t scheduled to meet until next year, I don’t see anyway that General Kirk can receive any assurance before next year that he will haVe any more money to spend than he no?/ has. I wanted to start off my remarks by giving you that picture because it is very very ’’blue”. It means that certainly for the next six months we are going to have to’get along on the barest essentials. It moans that the central purchasing office is,:going to • have to buy only replacements and essentials. On local purchases hospitals' will have to do likewise. I don’t know whether.We all realize or appreciate how much the cost of medical care has gone up. To give you an example, streptomycin this year is costing one and,one-half million dollars. That is just one small item as compared to a two million dollar appropriation for all supplies and equipment back in the years before the war. Even to give a do centra standard of .medical care it costs more. It is the desire of General Kirk and everyone in the office to equip and supply army hospitals with the best, that wo can get and make our hospitals equal to or better than other Government hospitals, and the best civilian hospitals. Until the money picture became so acute in the last -few weeks we had hoped that we would bo able to do a considerable amount of modernization of hospital equipment ‘this year. Vue may still be able to do some, but wo certainly are not going to be able'to in the first six months of this fiscal year. We plan to survey general hospitals and the large station hospitals this fall to determine what equipment is needed to bring them up to acceptable standards of equipment; and this year and next year do as much as we can to meet that need. The plan briefly is this: That a team will be established by The Surgeon General, the Job of which will be to determine standards of certain items of equipment (I am not speaking of surgical instruments, but of heavier types of equipment, such as the bedside tables, built-in-stainless-steel cabinets, shelves,, and things of *that nature) to decide Just what our standard will be. In determining that standard we will visit some of the best equipped civilian hospitals in the country. Then the team will go around to the various hospitals, and, working in conjunction with the commanding officers, determine what is needed and what the degree of urgency is. With our peacetime hospitals there are no two hospital plants the' same. Each one is different. A considerable amount of this equipment is going to have to be tailor-made, particularly tables, shelving and similar items, After we determine our modernization requirements, the equipment we will be able to furnish will bo entirely a question’of money. We are preparing at the present time the’’194-8 budget. We are putting in several million dollars for modernization. V/hother this- program will get by the various hurdles we do riot know but we will fight for it. Beginning-the first of July of this year we put into effect a new nonstandard allowance procedure. It has been in effect for about six weeks and I would- like to have your comments on v/hother it' is working satisfactorily and if not, what should be done to improve it, and also, a statement of your opinion as to ivhether the allowance you get is adequate or inadequate, ; DISCUSSION: COLONEL MITCHELL: I have a Sl>57$ quarterly allowance. My best figure would bo about $8,000 to take care of that enormous amount of supplies required by plastic surgeons. This money is for sponge material, dressings, etc., for use in connection1with skin grafting. GENERAL KIRK: Isn’t that too expensive? Why not use cotton waste? How much' do you- spend on it? COLONEL MITCHELL: We have about twenty-four or twenty-five cases per month. Only one place produces it. I don’t recall the name. COLONEL STREET: The plastic surgeon at Dibble did apt..like any,of the standard suture material,' He wanted a 5-0’and 3-0 which is not on the supply, table,: During my tour with him I bought oyer *15*000 worth of that material;for Him. It is very much finer and, no doubt is.better in .the -large number of sutures they use in stopping bleeding. They won’t use nylon since it tends to untie. Let them have what they want until the money run's out. : /. " ; GENERAL KIRK; -. lie are in the red. Vie must save a little on expenses and use; more standard material. Standard material..will work. COLONEL; HAYS: . I am interested'in two things. First* is the system satisfactory? ’That about the allowance - is it adequate or inadequate? COLONEL! KEELER: I'would say that the system is all right, I am beginning to get delivery on* things. I think the amount I have .is sufficient, which is $7,000 per quarter. COLONEL HAYS: Does anybody have any special problems? Do you need additional money for any particular item? COLONEL REYER: There is one problem - EKG machines. On the battery machines the batteries leak and we don’t always have them available, I don't know vhether this has come up before. Batteries are generally expensive; especially-ones made for these machines which do not leak. Otherwise* I think-we get ’along -at Beaumont. Vie have made some of our own instruments and things. I have a very handy man in the automobile maintenance school who does this work. He turns out some of the instruments required and designs them in accordance'with the wishes, of the surgeon. I might ask about these metal wheelchairs,-' Wien these fellows go homethey take the chairs with them. Every amputee takes them home - he is entitled to them'. GENERAL BEACH: I have 150 wheelchairs*j on order; received fifteen by freight the other day. COLONEL HAYS: The next thing I want to discuss is the supply .system during this coming year. The-basic Uar Department manual on station stock control is TM 38-220* which is undergoing revision at the present time, I haven’t been able to secure too much information as to Just how it will .come out. However* it mil be-referred to us again before it is published* for our concurrence or comment, I can give you briefly what we have already proposed on the revision and I would like any comments that you have as to whether the proposed revision is satisfactory or whether there are any changes that you would like to have. Basically, you are interested in where you get the supplies and what your allowance is. Our suggestion on the manual was that requisitions continue to go directly to the depot and not through army headquarters; that you be authorized to establish your own allowances for all items, with the exception of 150 to perhaps 250 costly items that will require approval of the Office of The Surgeon General. A replacement of one of those items will be a routine matter and would not come to this office, an increase of allowance would have to bo referred to this office. Initially, we would ask you to submit your suggested allowance for this group of 150 to 250 items - as to what you think you need to run your hospital. In practically every instance you will already have these allowances on hand. In some instances you will not have them on hand. Your recommendations will be reviewed here, in conjunction with the professional consultants, particularly, and the allowances approved or revised. After the allowances have been established, should it become necessary to increase the authorization for one of the 150-250 items mentioned, application should be made to this office for an increased authorization. On all other'items, both expendable and nonexpendable items (some 6,500 other items) it will be up to you to determine how many you need, the only control exercised being that of inspections that, will be made from time to time by the Army and this office to determine whether or not you are accumulating equipment and supplies you do not have need for. Question: Has it been found beneficial to keep on 60-day stock level rather than a 90-day level? COLONEL HAYS: Twice within the last year we have gone to the War Department asking for increased stock levels from 60 to 90 days. Our request was turned down in both instances. If the hospital commanders feel that this matter is important enough wo will go to the War Department again. Perhaps it would be advisable to ask for a 90-day level on certain items, only. Before we discuss this matter any further I would like to go back and get comments on the proposed authorization and supply system. Does anyone have any suggestions' on that? I can’t guarantee how it will come out, but unless you bring up something to change our minds, wo will fight for what I have just told you. If there arc no comments, I would like to discuss 60 and 90-day levels. From my own standpoint, previously I felt much stronger about raising to a 90-day level than I have in the last few months. In talking to the various hospital supply officers I find that in most instances they find the 60-day level adequate. COLONEL MURCHISON: We have had trouble at Percy Jones on some items such as ether and soap and have had to place emergency requisitions. GENERAL KIRK: Dogs your supply officer go and* see what is going oh? COLONEL HAYS: How long does it take- to get supplies from St.- Louis? COLONEL MURCHISON: We have a very good service* COLONEL’TURNBULL: We have a lot of supplies we don't need. I have no storage space for them, and it is difficult to take care of- these supplies. We have thousands of yards of gauze somebody has got to use in the next six months. If we don’t use it-, it will have to be declared surplus. LTWCOLONEL LOUIS F. WILLIAMS, Chief, Distribution Division, Office of Supply1: The Second Army Commander has done an" outstanding job of shifting supplies from one place to the other where they can be used. What: the surgeon of the Second Army attempted to do was to redistribute :that property within the Second Army Area to1 be'utilized within that command. • • • COLONEL TURNBULL: There a re-..chough; supplies: there! to list for years.. There should he some way of handling this•property at Binghamton Medical Depot. We don’t want to let it he turned in as salvage’and then used as junk. COLONEL HAYS: Naturaliy we have a great amount of excess property. The original Medical Department plan’ provided that when stations closed, the supplies and equipment would be’ returned to depots’ and there be declared surplus. However, about six months ago the War Department decided that all supplies and equipment now excess in posts, camps arid stations would be declared surplus locally'-except those items that‘are still required by -the- War Department. We how publish a monthly list Of required items which are to’ be returned to the depots. Everything over and" above that which becomes -excess"at the station level is-to'be declared surplus by the station.- ’-This--brings up the problem”of transferring ’supplies and equipment from-one’ hospital to another. Items not listed are carried in’ depots; in sufficient quantity for eighteen months anticipated issue. COLONEL TURNBULL; The point I 'wanted to make is‘-that this property may be surplus to my needs but not to someone else’s needs. COLONEL HAYS: If • it is not "On that list ii-is"to:be declared •surplus at the station level, because1 thO'Medical Department has adequate-depot stocks and does not need the material, ' ■ ■ ;,v pe re.- COLONEL TURNBULL: I have a warehouse full of property. It has been there for over a year. Maybe some 'of : that property may not be-surplus now. ‘When it is declared surplus there is nothing we can do “about-it. It is a lot of loss of property and somebody could use it if wo had a place to keep it. It takes a lot of personnel to sort it out and store it. COLONEL HAYS: What is it? COLONEL TURNBULL: Oh.’ Everything. . Electrocardiographs - we got some from England General Hospital, lie got two or three basal metabolism machines. The-re is lack of coordination on much of , this property. I have a smart supply officer. He, took a truck and picked out %vhat he wanted and brought it back to the hospital. 1/hatever we don’t need someone else can use. I can’t handle it because I don’t have the space. LT. COLONEL bTLLIAMS: Return it to the Binghamton Depot. COLONEL TURNBULL: Binghamton hasn’t the room to handle it. LT. COLONEL NILLIAMS: Yes, they have. All of our depots have space and wall receive returns of those items required to meet our issue demands. LT. COLONEL McGIBONY: Now about freezes. Sometimes before we can ship desirable property a freeze is put on the installation for the Veterans Administration, On other occasions when we know a freeze is imminent we ask commanding officers of hospitals to ship prior to our telling the bar Department that the installation is surplus. This is done on the items which we need badly and commanding officers should ship such property promptly in order that it can be saved for use by the Army. COLONEL ODOM; Equipment has been frozen at Mason, recently. Prior to that time I had ordered dayroom furniture. It is beautiful chrome leather type furniture, I want to figure out some way not to let it get frozen . — COLONEL HAYS: rIe are going to G-A and try to get a clear-cut decision on that. V/e have got to watch out for the Medical Department, I would like;to point out that the hospital commander is on the spot and wo hope that he does let us know if any of this material really should be retained and given to some other hospital. LT. COLONEL NTLLIAHS: If you have a piece of equipment that you think should be saved and time does not permit reporting it to this office, then-ship it to your distribution depot. In case you got a directive from this office to ship equipment, then freeze or not freeze, ship it and we will make explanation, if required. COLONEL TURNBULL; Has Binghamton storage facilities to handle this equipment? If they have, why wouldn't it be sensible to ship all the property, there and let them send it where it is needed, . LT. COLONEL 1 TILL LANS: There is no point in expending Government funds to needlessly transport surplus property. NT) Circular 34* .1946 directs. that. it bo'declared surplus' on the spot. Wo -have One other thing. A lot of expensive nonstandard equipment, WD Circular 34 keeps us from getting reports on nonstandard items. If you have nonstandard items which.in your■opinion should be saved, report them to this office, if time permits - if not,' ship them to the distribution depot. COLONEL HAYS; I would like to bring up the question,of medical supply officers in the -hospitals'. -If-ybu do not have' as good'a medical supply officer as you would like to have or think you should have, please lot mo know and I will do all I can to got you a better qualified man. We feel that the most likely place for the supply system to break is right in the. hospital between the supply ‘officer and- the professional man. The supply^officer may be prone to hold supplies on his shelves rather than get out and tell the professional man what he has. He should have’ them come down and take a look at the stock. It is no good on the shelves. '• Quite-frequently when a complaint does conic in aboqt one thing or another, it boils down to the fact that the supply officer in ■ the hospital is not- 'doing'his job. If you have supply officers with whom you are not satisfied>; Tet me know while you arc here. We will* do what we can to replace*the'mV- ' COLONEL .STANLEY;: My supply officer is ordered overseas. I have no replacement. COLONEL GENTZKOW; The-same thing':applies at Valley Forge. COLONEL HAYS; We will select a man for .each place right away. GENERAL:KIRKi How many hospitals are washing gauze? I see by this show of hands- that four hospitals are and the remainder arc not. 'It is a good economy procedure. Everybody has a laundry. It is very simple to get it washed. Also, it is good occupational therapy for the patients I think that on the supply business, if we are going to save money, we have got to save on these small things, I am satisfied that we can save • fifty percent on adhesive, dressings, bandages, and gauze. Likewise, for those nonstandard supplies. Watch the little things carefully. Those are the things that cause us to run out of thousands of dollars. We had better become economy minded, but not where it interferes with patient care. There are so many little things where it can be stopped. Fifty percent of what wo spend can be saved if supplies are properly dispensed. Instead of giving a patient a pint of medicine, give him two ounces. Ho isn’t going to take but two or three doses. Colonel Hays presented for discussion questions submitted by the hospital commanders: Question 1: Is there any further information concerning the moderniza- tion of ward kitchens? ♦ Answer : Standards have been set, requirements determined and "pilot" procurement initiated on equipment for ward diet kitchens including electric food carts, food cabinets, dish conveyors and several other items. It is now extremely doubtful whether any more than this pilot procurement4can be accomplished prior to the next session of Congress, in January *1947. The 1947 medical budget is inadequate to support the Medical Department except on the barest necessities. TVhother the T/ar Department will approve the submission of, and Congress pass, a deficiency appropriation is very questionable at this time. Question 2i Is the adoption of a standard ’Jar Department form possible for the use of all Medical Department installations for the purpose of requisitioning and purchasing nonstandard items, cither from the depot or by local purchase, when required for the immediate use of patients to prevent suffering and distress? Answer- ; This matter, as far as I know, has not been considered in this office. It sounds like an excellent suggestion. I would like to request the Commanding General of Percy Jones General Hospital to submit this suggestion in detail complete with sample forms and explanation of their use. If any other hospital commanders present have developed procedures and forms along this line, it is requested that they be submitted, also we can then have them tried out in other hospitals and if proved valuable, standardized as a new procedure. ■' Question 3: Is it possible to authorize named-,, -'-permanent general hospitals a four month supply of fast-moving, expandable items? Answer *' : Twice within the last year, this office has attempted to secure liar Department approval for increasing the supply level from sixty to ninety days, both times without success. If the hospital commanders present feel that this is worth another try,•this office-will be glad to try it again. However for this third attempt, it will be necessary, I believe for'us to secure substantiating data which the hospital commanders-will have to furnish. It might be advisable, also, to restrict our request to those items which are really causing trouble. I Would like to hear a discussion on this matter so that we can determine our course of action. Question 4i Is the modernization of such items as bedside tables, dressing carria'gas, instrument cabinets, etc., planned for named general, hospitals? ;. . : Answer t This question is answered in.1, above. Question. 5* Organization Chart:Til 8-2.62, under "Supply Division”, makes no mention of medical supply, which is a major supply function .-of,: tho.hpspital. ' In the experience of the commanding officerj medical supply officers arc usually much more competent' officers than*the quartermaster officers assigned to*general hospitals. ■ (Submitted by Commanding Officer, Army and Navy General Hospital.) Answer i The organization chart'pin TM 8-262 is predicated, I believe, on the maintenance of, a single supply stock record. I do not believe.that many, if any, hospitals are operating with a single stock record. The organization chart in TM 8-262 shows a Quartermaster Branch and Signal Branch. I would like to hear how other hospital commanders have solved this problem. I assume that they have established a Medical Branch and probably in a, hospital considered as a supply division itself with subsidiary branches. There is one point I would like to make and that is that where possible, it would appear advisable to make a Medical Depart- ment officer the director of; supply. Question 6: ' Why is’ Medical Department .equipment shipped to this hospital upon deactivation of other -stations mthoqt prior approve?! of this hospital? During recent weeks this hospital has received shipments of Medical Department' property from various discontinued statipns. Inmost instances these supplies are excess to our needs. When received 'at ' this station action must be taken to dispose of this excess, that is, either declare them surplus or ship them to the depot* There is- no space; available here for storage of excess equipment and supplies. Specific examples: Shipment •• from O'Reilly General Hospital, Springfield, Missouri, consisting of eight crates and boxes, total shipping weight 1293 pounds. Authority quoted on shipping document was: THK SGD TSG.USA Washington, 23 July 1946. However, this office did not receive a copy of this authority. This equipment was in excess of station requirements. Six or seven other'such shipments have been received, consisting of three to 148. boxes.- (Submitted by Commanding Officer, Army'and Navy General Hospital.) t . Answer : Dug to the necessity for removing property as quickly as possible in order to avoid it being "frozen" for some other agency, arbitrary decision as to its transfer must frequently be made. In this instance all of the property shipped from O'Reilly General Hospital was expendable occupational therapy supplies which over a period of time would readily be used by the.receiving station. It is not believed that any station is pressed for storage space. Almost all of them are contracting in size and unused wards and other buildings can be used for temporary storage. The increased stock can be retained by making temporary adjustments in station stock levels. This office has and will continue,to inform receiving stations by means of copies of the shipping directive forwarded at the time it is furnished the shipping station. Question 7: There is a need for replacement of victory type equipment with modern type equipment. Requisitions have boon forwarded to general depots for many such replacements; items which they have not as yet been able to furnish. Information is desired as to how such equipment may be obtained in the near future. It is the understanding that The Surgeon General desires.that the most modern equipment be made available for use in general hospitals, (Submitted by Commanding Officer, Pratt General Hospital.) Answer i See answer to Question 1. The Surgeon General desires that - the most modern equipment be made available for use in’all permanent hospitals. However, present indications are that budgetary restrictions during this fiscal year will curtail this program markedly. Several months ago this office instituted the "Lions": Program which called for the replacement of all inferior items which could be made with standard and desirable type. Again this program was put.into effect prior to the establishment of Pratt General Hospital. It is suggested that the Commanding Officer, Pratt General Hospital be instructed to submit a requisition .-direct to this-office for such items as he needs ip his--installation.- This office will ship all items available from Account- 18 and give consideration to procurement of -additional items. Question 8; Is it the plan,to dispense with old type wooden Balkan frames and replace them with a type of metal fracture frame such as arc made by the DuPuy and other companies? The presgnt Balkan frame is satisfactory and fulfills its purpose, but is unsightly in a modern General Hospital. Answer ; i ■"•■Theirq'/ls' no plan .at the moment: for the replacement of the ■ 1 old type wooden Balkan-frame with the metal fracture frame such as ar,e made by the DuPuy and other companies. Both types of Balkan frames are, functionally satisfactory but it is agreed that the wooden type frame is probably more unsightly than the,metal one. During the recent war, the metal typo frame, was.unavailable and the wooden type Balkan frame was, of necessity, procured. If it is the consensus of opinion of hospital commanders that the metal fracture frame is desirable,. it mil be considered for planning purposes to be implemented-when stocks of existing wooden frames are exhausted dr when the financial position of the Medical Department mil.allow such a change. Question- 9 j • There is a need at every general hospital for Stryker turning frames from time to time to be '-used in lieu of the standard Bradford. Advantage^--ore- that one person can turn a patient'with ease whereas about four people and two •Bradford frames are needed--fOt-hofwise. Can these frames be included on the. supply table?' ' ‘ ' • * Answer i Stryker turning frames were procured as nonstandard and furnished general hospitals and the majority of regional hospitals, .however, ..this was prior to the establishment of Pratt General Hospital, Some of these frames are available in the St. Louis Medical Depot-, having been turned in from hospitals which are closing. This office is instructing that depot to ship three of the frames and the cart for the frames to Pratt General Hospital, Question 10? Stryker motor-driven cast cutters should be on the supply table, ' Present hand operated cutter costs and is slow and tiresome to use. The Stryker cutter is safe, rapid: and easy to operate. Cost $85-00 on the retail market. Answer i The Stryker netor-driven.cast- cutter has recently been tested at Percy Jones General Hospital'and Walter Reed General Hospital, ,the,findings being that in its present state of development it ..is ,too light for the heavy duty required in army hospitals. This has been reported .to the manfacturer whom, I understand, is flow -developing a- heavier and more sturdy, cutter.- ~ r(\. D. PERSONNEL PROBLEMS IN ARMI HOSPITALS Col. Francis P..Kintz General Bliss opened the second morning’s session of the con- ference and 'turned the meeting ever to Colonel Francis P, Kintz, MC, Chief of Personnel, OSG, who acted as discussion chairman on the sub- ject of personnel problems in Army hospitals. Colonel Kintz made the following statements* The subject of this morning’s conference is personnel.problems in Array hospitals, the use of Medical Department specialists and expert consultants, with pertinent data concerning the■Central Officers' Assignment Groups the Amy integration and Apmy interne pro- officer and enlisted personnel' nursing, dietetic and physical therapy*personnel; civilian personnel; dental personnel; the perform- ance of station complement functions at Class' II hospitals, and the fiscal’problems in Army hospitals, including availability of funds and- proper charges against appropriated funds. In the conduct of this part of the conference program Colonel Kintz made a few general remarks and then called on the various branch chiefs and consultants to explain in detail their various personnel activities. "As you well know, personnel is the life blood of any organization, it*, has its fingers into everything and it is a constant and continuing function and responsibility. It goes on all the time. No commanding officer can afford to turn over the assignment, the classification nor the utilizatioh of his personnel, to a junior officer, and then forget' it," IFe-have been most fortunate here in the Office of The Surgeon General in having a Surgeon General and Deputy Surgeon General who have’ b’een'hxtremely personnel conscious, and I think that many of the advances that have been made by the Medical Department in the past few years have been the result of their personal interest in. handling personnel matters. We are fully aware of the magnitude of the personnel problem in your hospitals, YiTe are trying and will continue - to try to be a Personnel Service in fact as well as in name, and will continue to give you all the assistance we possibly can to assist you with this problem. Since VJ-Day, with the rapid demobilization amount- ing to practically a disintegration, we have been so busy plugging holes that much advance planning-has not been possible, .The situation was ~ too "fluid." We are now getting to a more stable situation and I feel quite sure that before long we will be able to plan assignments ahead of time and get orders*out so that we will:'not be continually disrupting the domestic and official situation of an officer. We are continuing to get many requests for transfers for personal reasons. While we try to personalize as much as' possible the requests for transfers for purely personal reasons,-’ add for like reasons, it-is obvious that many of these requests will-have to-, be disapproved as they materially, increase the walk in'every office. We would like to have these requests discouraged unless they are really justified. The Office of Personnel is set up with: two divisions, military and civilian. The Military Personnel Division is further divided into several branches as: the'Classification and Records Branch; Assignments .Branch, Procurement; Separations and Reserve Branch,the MAC, WAC, and Enlisted Branch, There are also the Nursing Consultants Division, the Dietetic Consultants Division, and the Physical therapists Consultants Division, These, divisions, while not assigned'to the Office of Personnel are physically located near personnel and ■a’fcl-activities and policies concerning personnel matters of these sections are coordinated by the Personnel Office, As to the functions of the Office of Personnel, General Kirk has said that the office acts somewhat as the Adjutant General for The Surgeon General, in implementing and coordinating the recommendations for assignments of officers as recommended by the Dental, Veterinary, Surgical, Medical, Neuropsychiatric, and Preventive Medicine Consultants, As Colonel Freer puts it, he recommends to us and we act as the mouth- piece in accomplishing the recommendations. I would like to speak a little here about refresher training. This will be discussed more fully by Training Division, but the Office of Personnel has to work so closely with training in the assignment of officers that it is not out of' place here., .. .Last August, it was decided that it was necessary to "reprofessionallze”- the Regular Corps, Prac- tically every man in the Regular Corps had.been,on administrative and staff assignments for the past five years, and if we were to avoid a professional vacuum, with the separation of the Reserve and AUS officers at hospitals, something had to be done to get the Regular Corps back on its feet professionally, A request was submitted to the Yfar Depart- ment to have 100 individuals returried from the various theaters and placed in refresher training in order that they might become chiefs of services and sections. This program was accepted by the Regular Corps with such enthusiasm and became such a tremendous morale factor that it was allowed to expand and it did expand to t-Ke: point -where any officer returning from overseas who requested refresher{training was placed in such training. We have had in refresher somewhere between 350 and 4-00 individuals. As Colonel Duke will tell you* the qualifications of these men vary from those who are practically-board men to those who have had practically no professional work. We are now’in the process of reassigning these individuals, getting them,back on the job in station and general hospitals. We mil continue, to. change the refresher- type program to the residency-type program which. Is laj.d. down in AR 350-1010. It is not plsiuifld that t he" ire fresher-typo program will be continued indefinitely as'such. We•receive'frequent requests from hospital commanders and personnel officers to assign permanently at a hctepital officers in 'refresher training. While we would like to comply with all such requests we have to evaluate each assignment from the overall standpoint, arid Colonel Freer and Colonel Cole, Medical and Surgical Consultants are1- constantly reviewing these people in refresher training. The mehe fact that an officer has reported and is on re- fresher training does not mean that it is an absolute justification for him to be assigned to any installation if he is needed in his Specialty somewhere else. General Kirk and General Bliss in their opening statments . called attention to WD Circular 229, 194-6. This circular is the result bf over a year of harrassing, driving, needling, cajoling, and personel effort oh the part of General Kirk which resulted in the document as finally published. It is certainly a step forward and we should take fall advantage of it and make it pay dividends. A regulation, AR 605-12 is Cbming out shortly, that revises Circular. 229 and adds a very inter- esting paragraph that implements one thing which is not included in the circular. To date we have promoted or recommended promotion on.a.total bf '242' individuals: forty-six from second to first lieutenant, one- hundred-forty-seven from first lieutenant to captain, and forty-eight from’captain to major. These were approved by The Surgeon General’s Promotion Board and forwarded to The Adjutant General, We have promoted one majon to lieutenant colonel. This officer was a former pnisoner- of war, who •was due and eligible for a one grade promotion. the recommendations as sent in, it is advisable that the man’s.'Correct MOS be shown. We-had a recommendation come in, recently, .with an-MOS of 3100. In the write-up of the individual he was described as chief of surgery in the hospital to .which he was assigned. He was a special- ist and was doing specialist .work. So, from a functional standpoint, the proper MOS should.be included on each individual. Concerning the *ASTP. students, we have taken in some 4,000 since April, Many have been processed and sent overseas after com-, pleting the training course at the Brooke Army Medical Center. Many have been assigned to hospitals. This is a most fertile source of Regular Army material. If properly assigned and properly handled these young men can be stimulated into coming in the Regular Corps, We would appreciate any information on the personality, ability, adaptability, etri., of these men. The Central Officers Assignment Group is a part of theold- office of G-l, War Department General Staff, Under, the Simpson ..Board Reorganization of the War Department, G-l-became the. Director of. Pei>- sohnel and Administration, WDGS,The Central Officers Assignment-Group (COAG) is a part of .that .office, pOAG consists, of achief,with a small"Control Branch, and representatives of the various technical serv- ices and major commands. COAG is charged with the career planning of officers and. with the permanent change of-^tatipn,on all officers, ■ As- the representative of The Surgeon General 'with; control of initiate all permanent change of station assignments on Medical Department officers, Wien this first came into effect, it was felt we:might lose, control .of our personnel. Under-this system The Surgeon General has not lost anyr of his prerogatives,. The system seems.to.be functioning a- very well. The armies object to orders at War Department level, but think it is too soon for the system to be turned, down without -trial. ; Colonel Cole and Colonel Freer will no doubt elaborate more fpliy .pn the specialist problem,. however, certain factors which re- quire-considerable action on the part of the Personnel Service should be mentioned here. In December 1945, it was quite evident that at the rate jof separation we would soon be without any qualified plastic or orthopedic surgeons, and there were still thousands of patients to. be taken -care of. Permission was obtained to: freeze a maximum of one hundred, of which eighty-five or ninety officers were frozen by name,.,and a one grade promotion secured to compensate them in some way; for their .retention in the service. Last spring,- we had to go to the. War Departiiien.t and get exemptions from demotion for these- men -*Tjrho were about rto .he. reduced in grade under the current demotion program, De- motion was. deferred until 1 September 1946, and the need- for these men was ev.al. -ted-* ■ We cannot release all of_them, A-certain number mil have to be. retained on active duty, and a certain number of them have received, notices that, they will be demoted. Information- froneG-l is to the effect, that these officers will not be., demoted, until January 1947, a.s requested by this office., ........ :. ... With the ceiling imposed on the-,,Office qf.The Surgeon,.General ; by t’he War Department Manpower Board,, and.the inability of the medical y installations to live within the sub-ceilings imposed, it was decided that a survey of installations was .indicated*:-.- Survey- teams have now practically completed their work. Major Murray,,will give you same of •• the facts on this survey,- This is about the best .thing we have: done recently. We now have .some real ammunition for going to the War Depart-, ment for.on increase.,i.n, ceiling,. ,V{e feel, .that hospitals and this ,office haye. very definitely from this survey* Some of the. officers. . on‘th.e survey teams .sai-.d-.t hey.were most happy to be in-.on it.because,, of the opportunity to visit other hospitals and see how they work, ? Considerable .discussion^has,.oo,rae..up in the office-from time to time , relative, tp, I would like to read the ;policy . given to vthe Secretary of.,.War’s -Personnel.Board by General Paul, Director of Personnel and ... I'-quote from memorandum for the. President,, .Secretary ,-of War’s. Personnel Boa^d>; subject: . ’’Palicy .Concerning, Acceptance of Resignation of; Regular Army, Officers:!’^ "1. It is desired that in considering an unconditional resig- nation submitted by a*Regular Army officer; the Secretary of War's Personnel Board be guided by the following policy: ’ ”a. For the duration of the emergency plus six months the unconditional resignation of a Regular Army officer will not be accepted unless: H(l) The officer has completed a period of com- missioned service equal to the period of total service which is, required to make an officer of the same branch or arm of service eligible for relief from q.ctive duty under Read jus tment Re gulations, ''Add n (2) Full consideration is given the recommendations of the Commanding General of, the Major Fo.rce or the Chief of the Service.’ bonderhed. Mb; f :iThe resignation of an officer cd’nfiriisslotted*J^pon' graduation’'from'-th¥'United States Military Academy vlll not\bd accepted unless He has’iofti^ieVed’four years commissioned service! ' * "c. Notwithstanding the above provisions, the.'resignation of an officer submitted with evidence that the officer’s military serv- ice is the cause of undue personal or family hardship will be reviewed by the Secretary of War’s Personnel Board and mil be accepted if the Board so recommends. ”d. The above policy will not be applied to resignations submitted in lieu of reclassification or trial by court martial. "2. Copies of this memorandum are being forwarded to the Commanding Generals of the Major Forces and the Chiefs of* the Services for their personel attention. /s/ w. s, Paul Major General, GSC Director* of Personnel and Administration” After World War I there were quite'a few resignatibris,' Through the Fiscal Year 1919 through 1926 the' following totals' were; recorded: 1919 'Medical.Corps . 28 1920 -• ' - • « •• 157 1921 tt n 49. 1922. it -r ■ ir •1 ' • 29 1923 - ’* it it 29 Total 302 The present strength of the. Regular A my, Medical Corps is as followsi . - I ■ > Major Generals 1 Majors 333 Brigadier Generals t 3 Captains 637 Colonels ,!' 246 1st Lieuts. 46 Lt* Colonels . 33 Total 1299, Medical Corps officers Since VJ-Day the losses for the Medical Corps through resignation have amounted to: Ninety-three resignations submitted, of which thirty-six are pending,_fifty-four have been approved and three have been dis- approved, The average age of those resigning from the Medical Corps' is thirty-three' years, Seventy of these were in Regular Army refresher training; twenty-three were not. In the Dental Corps, eighteen have submitted,resignations, ten'are pending and eight have been approved. In the•Veterinary Corps, onfy one resignation has been submitted and this one i? y;'Ih;!,the Phanjiacy Corps, six resignations have been submitted,; five are pending’ and one has been disapproved,,r At this point Colonel Kintz turned the conference over to Colonel Freer who spoke for the Consultants-divisions• of this office and Colonel Cole who answered the questions submitted to the Consultants by the.hospital commanders. 1, The use of Medical Department specialists and expert consultants. Colonel Arden Freer, MC, Chief, Medical Consultants Division, Office of The Surgeon General, discussed the use of Medical Department specialists and expert consultants. Colonel Freer made the following Statements; During World War II, The Surgeon General developed a system of utilizing professional consultants from which great benefit was derived. In order to insure the maintenance of the highest profes- sional standards and to provide close liaison with leaders in the medical profession at large, this system will be continued and ex- tended in the future. Professional consultants who are recognized experts in the medical and allied specialties will be designated by The Surgeon General, As representatives of The Surgeon General the professional consultants are concerned essentially with the maintenance of the highest standards of medical practice, • It is' their function to evaluate, promote and improve* further the quality of'medical care and sanitation by every possible means, to advise ih the formulation of the professional policies of The Surgeon General arid to aid in the implementation of these policies, " . ' /. ' _ ' Consultants are considered under three headings 1, The headquarters group-'"(SGO) 2, Army area consultants' ' ' 3, Hospital teaching consultants Allcare. appointed-by the Secretary of War upon recommendation of The Surgeon. General, . . The mission of the headquarters group is to perform special duty in the Office of The Surgeon General, or on trips from that office. That-’of the army area group is to visit any and all classes of hospitals in the zone of interior as was done duiing the war by the service command consultants. Names of these expert consultants will be furnished each army surgeon, who will arrange directly with .the consultant for such hospital inspection trips as are deemed advisable and submit vouchers to the Office of The Surgeon General for payment upon comple- tion of the'•mission. Reports of inspection will be submitted through technical channels, • ... Hospital Iteaching consultants'in medicine*and.surgery will be provided for all permanent' general hospitals and.'three AAF hospitals. Consultants in additional specialties' wall be provided for certain general hospitals in which sped.al residencies are approved,, such as pediatrics, dermatology, urology, neuropsychiatry/ and physical.medicine, These consultants are to further in 'every possible way the educational program for the advancement of medical officers, in the specialties and assist in maintaining the-highest standards on the professional.services of the installations to which- they are assigned. They are to be re- garded as members Of the professional staff, XCmmanding officers will arrange with them schedules which' are' mutually convenient', 'Additional details in this connection'are to be- found,in letters from the Office of The Surgeon General, subject:^'4"Civilian Expert Consultants’’. and "Expert Consultant Service and’Travel." t, -.'Inquiries have been received from some of the hospitals which are scheduled to close this year: relative to assignment of’consultants to those installations,- Requests have been’received, also, to have them assigned to some "dispensaries. The funds allotted by the War Department for these - consultants were approved on the basis of training. and the training program,: in this respect,, is planned only for. the per- manent general •_ and regional* station hospitals,- The question has been raised, .also, a,s to; whether army consultants are to visit'hospitals to which local teaching consultants are assigned. While there will be less need for visits by army consultants in such hospitals, there will be occasions when these visits will be indicated and proper. It is to be noted that nothing in this program changes the provisions of AR 40-505 "which authorized .the use of consultants for individual military patients at public expense, whenever and wherever indicated, • * . , . • :: . * • • ! References on. the subject of consultants are: . AR .3-50-1010$ AR 40- 505; WD Circular 101, 1946 and letters, Office of The. Surgeon General, subjects: "Civilian Expert Consultants" and "Expert Consultant Service and Travel," ...... At the conclusion of his remarks.. Colonel Freer called on the various Directors of the Consultants Divisions., . ..., Colonel Caldwell, MC, Director of the Neurop.sychiatric. Con- sultants Division,, .stated that, there was one thing, that, was, not exactly clear, and-that was the convalescent'annex and. the use- of such an annex. Patients-with a neurosis, who do; not require additional-psychiatric therapy on a general hospital level, should be sent), immediately, to the convalescent annex where their treatment, given in conjunction with the convalescent,.program, will be supervised .by a ..neuropsychiatrist. ■It is. considered that the best- treatment .for,.ther neurotic .patient, is not..in a. hospital. The general consensus of opinion in the-Army is that this type of patient should be treated on a convalescent level, and in uniform. This- treatment is being outlined: .and will be published in a War Department circular. ■ ,; .;iLt, ...Colonel; Strickland, MC, Director of the. Physical Medicine .Consultants ..Division, prefaced his remarks by-quoting a- saying of Elbert Hubbard, J'A ;person is usually-dawn .pn- that .on. which-he-.;is--not .up-.;on," # Particularly -is this true of any individual branch; .of-medicine. Still, there* is. much vague conception..,and some misconception about the .consultants in physical, medicine, . ,This-:office is -engaged•presently in obtaining the services of specialists in, physical ;medicine ,-for utili- zation in the consultant’s p*rogram. The services of these individuals will be;.made available., to .all general hospitals, -The-.use of medical officers who have*-had specialty.training in physical .medicine has. not been properly handled. Certain of the dootors- .who were, sent out to. general hospitals after,, a- short-.course, pf training Ip physical medicine were not. assigned .to.physical medicine divisions, and utilized to the best advantage. It is realized that these young doctors are not "cured11 specialists, but they are much better than a medical officer whose Interest lies in some other field. There must be a doctor between' an orthopedic surgeon and the female physical therapist, who is not trained in certain aspects of diagnosis and treatment. It must be remembered that, although of the greatest value, the female physical therapist is not a doctor. The use of the physical medicine consultants who will be made available should be to cd me into the hospital, survey the physical therapy department, take the individual officer assigned to the service, and make him more able by training him and working with him a certain number of days each month.' In physical medicine there is not an American Specialty Board, although reliable sources have indicated that in all probability an American Board will be established in February, There are over '650 doctors in this country who are specialized in the field of physical medicine, and there are two large societies for physicians who are interested in specializing in this field. Many of the consultants in physical who are being appointed are heads of departments in medical schools and are very competent to teach and to carry out the program which will be inaugurated. DISCUSSION: COLONEL McMURDO: At Oliver General Hospital we don’t have a bg.ard member in urology and I have taken our teaching consultant and have had him operate .once a week until all urologic cases could be -cleared tip; He works up his cases during the week and operates them on Friday, This procedure has worked out very s atisfactorily. GENERAL QUADE: Are funds ample for the use of consultants? MR. UPHOFF: I think the funds are ample, unless we exceed the total number of consultants. We have asked for 313 consultants and have enough money to cover these. GENERAL HILLMAN: The letters which came out from the Office of The Surgeon General spoke of using the consultants three days a week. Of course, many consultants can’t' give three days a Yreek, COLONEL FREER: Of course, this is a new thing with us. Generally speaking, hoiYever, it was thought that the need for consultants vrould vary with the patient load and the size of the installation. We thought if we would provide three or four names acceptable to you it would be possible for you to have a man- present a couple of times a week. This is not absolutely rigid. Some weeks you may need a consultant only one day, and other weeks you may have a need for him three or four--times, We must profit by experience as we go along. COLONEL "BECK; We; are just starting the use of consultants, but it becomes increasingly plain to me that Unless you have at least, three men you are not going- to 'get the work done. . ' COLONEL FREER: I have been asked, '“Why not provide six or seven consultants?” Well, matters of economy must be considered, and so there are limitations on the number,of consultants who can.,,be engaged. . Eventually the total number of consultants appearing on the roster will be cut. COLONEL REYER: . I have only one consultant in medicine- and none in ■surgery at William Beaumont General Hospital. COLONEL’FREER: Some hospitals are not conveniently located to- civilian medical 'centers and the availability of consultants is limited. COLONEL' COLE: We have been trying to get consultants, for Beaumont, The field there is very limited, and the same is true of some of the other hospitals, Percy Jones is another general hospital where it is difficult to get consultants because of the location of the hospital. Now, here is something I should like to bring up. The teaching consultants are furnished to your hospitals only for those subjects which the hospitals have been.designated to teach. We gst requests for. X-ray men from hospitals in 'which a course in X-ray therapy has npf been e stablished. There'has been.a little misunderstanding on the part of some of the hospital commanders that all hospitals should be teaphing institutions in all subjects. Economy measures prevent such a...system, and so we are setting up consultants for those subjects in which the hospital has been designated as a teaching institution. If you-.need a. consultant on a special'case you can always get him under AR 10-505. COLONEL ST REIT: How' many hours a day must a consultant be at the. hospital in order to draw his forty dollars? COLONEL FREER: The Veterans Administration decided very wisely,:X > . believe,.'that the situation would vary at times. If a consultant goes to a hospital for an hour or two, thereby interrupting his schedule and upsetting his plans, he may be paid the usual per diem of forty dollars, for the regulations state, "For a day or any part of a day,” A close watch wilj have to be kept, however, to see that one consultant doesn't consistently receive §>4-0,00 for an .hour's work while., another consultant works consistently a full day, . COLONEL*STREIT: j There is one consultant at Brooke!who is receiving twenty-five' dollars a day while the. other .consultants are receiving forty dollars a day. MR. UPHOFF: I think that was in the case of Dr. Page and that has now been cleared up. All consultants are now paid forty dollars a day. COLONEL MITCHELL: One of the consultants at McCornack General Hospital received a letter stating that his appointment’was for" ninety days. • ; Must he be reappointed after each ninety days? MR. UPHOFF: There must be some mistake in that case, inasmuch as all letters appointing consultants state that the appointment-is for a period of onb year', with the restriction that the consultant cannot- be paid for time in excess of ninety days. Some consultants have been previously appointed for five days or for ninety days, or for similar periods, but that was not under the present program. If you have to use a consultant in excess of ninety days, you must make special request to'the Secretary of War, Consultants have to be appointed each year, ’ COLONEL METCHELL: Can a consultant be used before notification of the consultant1s'appointment has been received. From the time the papers are sent:tbtlie Civilian Personnel Division and notification of appoint- ment received at* least ninety days will elapse. MR. UPHOFF: A consultant should not be used until he is officially appointed* COLONEL' COLE: The re is one other thing on the pay situation, and that is the case’ of the man who has been retired for physical disability by the Army and is being paid a retirement stipend. Such an individual cannot be paid the forty dollars a day, but can receive only that amount which will bring him to the maximum limit of the Government pay he is permitted to receive on his retired salary. GENERAL KIRK: There is 'something I would like to say about the con-y valescent facility for psychoneurotics and the question* of physical medicine. All doctors are interested in things other than those two. It took a year and a, half to get the convalescent program "going during the war, but it paid’great dividends — almost as much as did surgery in the line. Please get your shoulders behind these two things. The greatest improvement made during the was in the handling of the psychoneurotics, and in physical medicine, which now comprises physical therapy, occupational therapy And reconditioning. It is the general opinion that twenty to twenty-five percent of patients referred toy- physical medicine do not require physical therapy. Give them occupa- tional therapy. Please back these two younger agencies of medicine, An outstanding job was done during the war,' so do not, neglect these considerations, COLONEL UPSHUR; There is only one consultant, a surgical consultant, appointed thus far at* Army and-Navy General Hospital,-’1 There-is a scarcity of consultants in Hot Springs, Arkansas, • • 1 COLONS! FREER: There are some consultants on the way to Hot Springs* 2, DISCUSSIONS by branch chiefs. Office of Personnel. Colonel Kintz called on the various branch chiefs of the .Office of Personnel for discussion, starting with Mr, Uphoff, Chief ■of the Civilian Personnel Division. .-p Mr, Uphoff urged that hospital commanders give as much atten- tion to the training and welfare of civilian employees as to the military employees,- In civilian personnel administration be just as careful in making assignments as you are with military personnel. Civilian personnel is more of a problem and you should give more time to development of this personnel. Money is short and you will have to make one person do .the work of two and do it better* We do have money for training .civilian personnel and you should take advantage of it. Colonel Leech, MC, Chief of the Classification and Records Branch, Office of Personnel, called attention to a'draft of the new .active duty card which will be used for all Medical-Department officers. This card was developed after considerable study of cards that were used in the past, and is considered as complete, up-to-date, and modern.-a;.record that it is possible to obtain. It is felt that with the use of this card it will be. possible to have an accurate and current record of each Medical .Department officer,. which will make up in part for;-our not being able to interview and evaluate each officer personally-. The Office of Personnel is in the process of transferring information ■.contained on the old cards, the 66-1, and the 178-2 to these new cards, . :•• :In regard to the professional training evaluation form, Colonel Leech requested that this form be turned in:on each officer at the end of each ninety-day period of refresher training. The Professional training Committee is dependent to a great-.-degree nn the information contained in this' report. In some cases it-has been necessary to hold up. an; officer’s assignment because the info.imatioh'as to the progress of his training was not forthcoming, Colonel.Leech requested that the American Specialty Boards not be contacted in all cases, but that the educational committee of the. hospital survey the officer’s qualifica- tions and send an evaluation of his.status to the, boards, when it is considered that the officer is within a year of, obtaining his certificate. Colonel Leech‘requested, further, that information, concerning the patient load and type of patients be provided and that a statement be made as to the adequacy of the clinical material, for support of the training program, ;.I,. . '•i • ' a ; regard-to the overseas roster. Colonel Leech stated that there is in the Classification Branch, Office of The Surgeon General a roster containing all of the Regular Army, Category I, and volunteer officers lis.teckas follows: (1) Volunteers (2) Officers with no overseas service (3) Officers with less than six months overseas service (4) Officers with less than a year’s overseas service In choosing.an officer forioverseas assignments, officers having no'- overseas -service are chosen!irst, It is the intent of COAG that as many of these officers as possible be sent overseas. The date which is,.used, as a basis for overseas service is 7 December 1941* In regard to .the .classification of officers, Colonel Leech stated that the MOS of an officer can be found in TM 12-406, which outlines the procedure of -classification in detail. Officers should be evaluated constantly. The Technical Manual states there should be a re-evaluation of an officer in March of each year, however, re-evaluation should be done whenever- it is- considered ne cessary. The Office of Personnel is de- pendent on -subordinate headquarters for keeping the,.M0S-.pf each officer up-to-date,- • . -.cv. Lt, Colonel C. B, Perkins, Chief, Military JPersqnnel Division discussed the deferments of officers and, for the information of -the hospital commanders, stated that The Surgeon General is definitely com- mitted to meet all overseas theater requisitions.for personnel, and, to date, has done so. However, the question of deferments for so-called "key personnel" has become increasingly important^-and as a result the following policy has been established in regard to the deferment of officers: (1) Officers will be alerted as early as possible. (2) Replacements will be furnished when asked for,;.but officers alerted will not he deferred pending.. arrival of replacements,., (3) All officers who have not had overseas serviceor who have had a comparatively short tour of overseas service should have understudies who can take over cn short notice, . j;v : L (4) Closing hospitals- will be,.provided a. replacement.-. .. in .the -same :MOS m&s -the- officer alerted,, withe a •- c .minimum ;overlap.of two yreekswhen ; requested, i■ .. - i(5.;) The final,.depislop. as. to essentiality will rest with . T,he-. SuT’ge'gn> General, . , (6) Key personnel who have had no overseas service or who have had less than six months overseas service in - • World War II,. and for whom replacements are needed, may be; requested, in a special letter requisition, ■ Attention:•' MEDCM-A. Colonel Leech; here .-that volunteers have' a. number one priority for overseas-service. The reason these officers do not go just when they desire Is because they re. 11 choosy” about the theater of assignment. crM 1 ■. Lt, Colonel Ida Danielson of the Nursing Personnel Branch, OSG, •stated that the-War Department was in the process of recalling one thousand nurses to active duty. Already 600 letters have been sent out to, nurses from the Office of The Surgeon General. Nurses with dependents, married nurses, limited service nurses are not being accepted. Those nurses,who are recalled are asked to sign a Category I or a Category VIII statement. Overseas duty will still be on a volunteer basis provided the nurses are physically qualified. It is anticipated that -there will be no integration of nurses this year inasmuch as the Bill for the female corps has not yet been passed. The new Bill provides for 2500 Regular Army nurses. The maximum age limit for integration will be thirty-four years, except for a few nurses over thirty-four years of age with special MOS’s, such as anesthetists-and nurses with NP-training, Chief.nurses •are being asked to review, the MOS of their nurses in order to bring the nurse classifications up-to-date. The European,Theater of Operations wants at least forty anesthetists* Promotions fromfgrade of second to first lieutenant are still being made of nurses who haye •been in the grade of second lieutenant for eighteen months or more, provided they merit promotion. •••■ ,,.1 . •: •'" • Major Helen C, Bums of the Dietetic Consultants Division, OSG, asked that the hospital commanders urge the qualified dietitians in their hospitals who are; eligible for release to change to Category I or to one of the new categories. Most of the dietitians are now realizing that the Army has something! to offer and are anxious to continue on duty if their .services- are needed. Captain Olena H, Cole of the Physical Therapists Consultants Division, OSG, asked that the hospital commanders make every effort to keep their hospitals Oovered with qualified physical therapists. A number, of physical therapists .'are changing their categories to I and II and .are being, assigned to hospitals-, -. Where there are several physical therapists assigned to a hospital, it is best that the senior physical therapist, who is an experienced individual, supervise the work of the physical therapists in the various clinics. Rotation of physical thera- pists from the small clinics to the large clinics, so that the personnel will get we11-rounded training, is advisable. At the present time an attempt is being made to set up a civilian position for a physical . .therapy aide that is on the order of the nurse’s aide. This will fill a ereat need- Captain Beatrice I, Ringgold, MAC, WAC Personnel Officer of the Military Personnel Division, stated that, numerically speaking, the situation concerning the WAC’s in the general hospitals was not good*. There are, at present, 3100 WAC’s in general hospitals. By 30 September 1946 there will be approximately 1353 remaining. Many WAC’s are anxious to-get out of, the Army in order to take, advantage of the G.I, Bill.of Rights, because their future in the Army is uncertain* Most of those volunteering to stay in want to go, overseas. Unfortunately, there is no requisition for WAC medical technicians to serve in overseas areas . except in-Manama, In order to give them an opportunity to serve over- seas, . a clerk’s school has been established at Camp Lee, Virginia. Upon successful completion, of this school, the personnel will qualify as clerk-typists. All those with military occupational specialties other than 405.or 213 may have the opportunity to attend that school* Those with critical MOS’s will be applying. Basically, that is not sound,' but if non-volunteers.wish to attend the school specifically for the purpose of going overseas as typists, they may do so and thus be saved for service in the Army, The first class starts on 2 September 1946. A quota has been given to hospitals on the East Coast, This vsas due to the short amount of time in vdiich we had to fill our requisition. The West Coast will be taken care of later. • ; y< As .far-as. WAC officers are concerned, it ,is strongly recommended that, if they are worthy, they be detailed in the Medical Administrative Corps in order to be held for the Medical Department* The latest on the. wearing of civilian clothes, is .that Go.lopel Boyce, Director of the,.WAC, has requested permission for ,WAC’s to Wear civilian clothes.. The wearing of civilian clothes during off-duty hours would be a good morale factor for the fACs. DIS CUSS ION: COLONEL' MITCHELL: -Will there be any WAC replacements after ! September 1946? ... .• .. CAPTAIN RINGGOLD: Right now, it is very hard to tell,, because the ; enlis ted women who have not already;volimteered have until 31 October to decide, to‘stay iri:or;to.; be separated from the Army, We. can only promise to do the very best we can for you. COLONEL TURNBULL: 'What about specialized WAC’s and those who are' technicians? CAPTAIN RINGGOLD: If the WAC’s with critical MOS’s, according to IVD Circular 105* 1946, have volunteered to stay on duty after 31 October, they are not eligible to attend the clerks’ school. They are eligible, however, for direct assignments overseas provided we get requisitions for their MOS’s, Panama has sent in a.requisition for medical technicians. GENERAL HILLMAN: What procedure do you use in detailing a WAC officer in the MAC? CAPTAIN RINGGOLD;' A MAC who desires to be so detailed should write a letter to'the Office of The Surgeon General through channels. If you approve her request, we will do so. Major Bernard Aabel, MAC, discussed the Medical Adninistnative Corps officer situation. Major Aabel stated that out of a total of 22,500 MAC officers on duty during World War H, there are now approximate- ly 3,500 on duty. Amy-wide, Procurement authority has been obtained for recall of about’1,000 officers. Up until 23 August three hundred MAC officers had been recalled. Campaign applications have been sent by direct mail to officers Yrhose 201 files have been carefully scrutinized, A ten percent response has been obtained. An attempt to establish a three months officer candidate school was turned down by the War Department because of the new ruling of nine- months for officer candidate courses'. Overseas theaters have been able to appoint MAC officers direct and the pacific Area -has recommended and appointed one hundred such officers. Of the 492 Pharmacy- Corps officers integrated, approximately 125 were from civilian life,. The criteria for separation of MAC officers is to be lowered to twenty-four months as soon as possible. If there are some MAC officers who have not been overseas or who have had.less than six months of over- seas service, they can be expected to be ordered- overseas in the very near future. The B2nd Airborne Division is greatly in need of MAC officers for glider and parachute training. As to clinical psychologists, when the separation criteria is dropped to twenty-four months there will be a very acute shortage. lie are trying to get specialist MAC officers out of small hospitals and especially Sanitary Corps officers who are needed in the larger installations. Also, we are trying to get phychole- gists out of assignments other than psychology work. These officers are needed at disciplinary barracks and larger camps, MAC’S on other than Medical Department duties are being screened for possible transfer to. Medical Department duties, fo‘r which the need is much greater. Colonel Armstrong, MC, of the Office of Personnel was called upon. Colonel Armstrong made the following statements: "Personnel should be decentralized,"' Colonel Kintz has stated that personnel are the "lifeblood of any orgahization," I heartily agree with both these statements. Regardless of-how adequate the supplies and how fine the equipment, medical service cannot be rendered except with adequate personnel, especially medical officers. We cannot in this office personalize our entire personnel system; we must have your help, I recall an officer, whom I have known for over forty-years, who reported at one of his early stations with a fair basic training in general surgery. This was known to the commanding officer, who, in spite of it, rathe'r gleefully told him that he*would have the laboratory for about two weeks, after which he would be permanently assigned in medical supply. AH' df-you have had a similar experience, furthermore, you probably think that this situation was .obsolescent. Gentlemen, it is noti One of our young A3TP officers with a twenty-seven month residency in surgery reported to one of your executive officers and was assigned to dispensary duty in spite of his protests, without any explanation for the malassign- ment. General Kirk earlier made the statement that we have to get one thousand Regular Army officers from the ASTP group. Gentlemen, unless you-personally sell the Army to these young men we will be lucky if we get. fifty frdm the entire group, I cannot emphasize too strongly our desire that you personally interview each young officer who reports to you for duty and that you contact him again periodically, making every endeavor to see that he is properly assigned and given every opportunity to develop a sincere interest in entering the Army, Unless this is done, the future of the entire Medical Bepartment is threatened. DISCUSSION: Lt, Colonel C, B. Perkins, MC, Chief of the Military 'Personnel Division, OSG, presented for discussion the questions on personnel sub- mitted by the hospital commanders: Question 1; Hoy; 'are position vacancies to be determined in'dhits not covered by an approved table of organization and vtien allotments are not made by grade and arm or service (see Par 4y“WD'(}:ir 2-29, 194-6)? (Submitted by: CO, Fitzsimons General Hospital*) ' . Answer :: There has been no definite policy determined as to position vacancies in units not covered by approved tables of organization. However, in the past it Has been the policy that field grade officers should hold the positions of chiefs of service, chiefs of section, and assistant chiefs of■sebtibh When the individual hospital has been designated as a cehteh for a specific specialty. For example, if a hospital has-been designated as "ah orthopedic center the chie'f of service, qhief of section.and one or, two assistant chiefs of section,.-who.,are^-qualified, .have been promoted to' the .grade of. major or .higher diip to the responsibilities which’they , ' . ; . Question 2 s" ‘ Paragraph 6c, YW Circular 229, provides for promotion; of certain'specialists to grade of major, after twelve months Service and includes certain MQ.S’s for.Sanitary,Corps,, Are tiP.st lieutenants, Sanitary Corps holding such MOS’s- eligible for promt?tioh to Captain after twelve .months service? (Swbjiri.fte'd by: CO, Fitzsimons General. Hospital,) Answer • '"J: First''lieutenants in the Sanitary Corps .holding such. MOS's as outlined ih paragraph 6_c, YW Circular.229, do not come under the provisions of this circular.. : ft. appliesto■ Medical Corps officers only. The circular is .being amended to this effect, Question 3: Are officers, otherwise for promotion 'if Sick in hospital with possibility-of appearance before retiring board eventual disposition (see. .Par,. 7h, YW Cir 229, 194.6)? (Submitted by: : .CO, .Fi.tzgimons :General- Hospital;’)' ‘ , ...'V Answer : If an offiOef'is #not expected to :sejvei,.,,ar;rpaspnable length of 'time’,' six months ‘after hfs/jpromotion;,.; not'be piroriioted blit receive his promotion at tlie time of s epara t ion, .t n ■■ fvr ft Question 4: What is ;neant.,by a ’’manning table position1’ as used in paragraph 6c,;7ft!r Circular 2.29, 1346? ...(Submitted by:-; ; CO, i^lt2simonS General Hospital#) . .. .. • ■ Answer • The "manning table position" has not been definitely defined. The manning table .is a guide a.s to v^hether or not an officer is performing duties cominens,urate with the grade and responsibilities of a, major. To a large extent this should be left up to the judgment of,the commanding officer. This was done probably so that we could increase the number of field grade officers working in our general hospitals. Question 5: Is' it. necessary to use a, consultant a minimum amount of time even though his services are.not necessarily required? For example, the services of a pediatrician are not necessarily required at this general hospital at this particular time. Would it be possible to maintain the consultant on the apprpVed list and through local agreement, use his services when they aie required? (Submitted by: CO, Fitzsimons General Hospital,) Answer . : It is not necessary to use a consultant a minimum amount of time unless his services are actually required.' This does not prevent the consultant from remaining on the approved list and being available for call when and if his services are required. Question 6: Some ' confusion has bedn caused, particularly as regards personnel matters, over the apparent lack of a clearly de- fined line of demarcation over jurisdiction of the army and the technical services at Class II installations. Can functions bo more clearly defined in directives? Example: SG Circular 3, cs, states specifically that no critical officer specialist will be released from the service -without first sending a TWX to,the SGO for concurrence, Ltr, Hq Seventh Amy, file AJMFI) 210.3 dtd 12 July 1946, subject; "Criteria for Separation of Medical Department Officers," was'addressed to GO’S, Class‘I, II, and III installations within the Third Army Area and did not indicate in any way that prior concurrence of the SGO was necessary or even desirable in any case,’ Since the letter from Hq Seventh Army quoted a TWX from TAG it caused considerable confusion. It is believed that such confusion would be avoided if separation- directives on Medical Department■personnel were transmitted to general hospitals by the SGO only, quoting appropriate TWXfs from TAG. (Submitted by; CO’, Pratt General Hospital.) Answer : There are two Service Units at each Class II (general hospital) installation: a. Technical Service Units, the personnel of which is directly under the control of the Office of The Surgeon General. This includes all personnel assigned to Technical Service Units, both military and civilian. b. Army Service Unit, the personnel of which provides the housekeeping services. This personnel, although under the administration and supervision of the commanding officer of the Class II installation, is still army personnel, Requisitions and replacements for this type of personnel should be handled through array channels, • ' Question 7.; What is the plan for supplying highly trained specialists, such as the following,, to general hospitals where now these specialises, are not available? Electro-ehOephalograph 'Technician (56,4), Medical Equipment Maintenance Technician “(22) (Submitted by: ' CO, Pratt General Hospital.) Answer : The plan for supplying highly trained, specialists in such HOS*s,;as Electrd-encephalograph 'Technician (564.) and •Medical Equipment'-Maintenance Technician (22), is already in operation. There Is-a*school,at the present time at ’ Brooke to train Electro-encephalograph Technicians (564) and a school at St. Louis, Missouri' to train medical equipment maintenance technicians (22). Also,.the other ■ technical specialists are being trained at the Medical Department Enlisted Technicians Schools, It is true, at the present tifne, that the great portion of the graduates of these; schools -are being used as overseas replacements, but a ..Certain -number are' being diverted to zone of interior installatiohS-v ; ' . Question- 8-Do we plan on having internes. in army general hospitals? (Submitted by: .CO, Mayo'1 General’Hospital.) • • •... '*• • Answer It is planned to have • internes in army general hospitals commencing 1 July 19‘A7. ■ ’ . ' .... ; Question- 9* To•-what extent do we contemplate using ciyilion personnel in, the future? (Submitted bys CO* Mayo General Hospita.1) Answer At the present time, there are three survey teams in the Office of The Surgeon General,, which are making a survey of all named general hospitals. Part, of their study in- cludes a discussion of what positions in an army hospital can be satisfactorily filled by qualified civilians and- the minimum number of military personnel, required to operate the hospital in conjunction with the use of civilians. A definite answer on this subject cannot be given at the present time. Question 10: Will, enlisted personnel be trained and'occupy' key positions as in:the pre-war period? (Submitted by: CO, Mayo General Hospital.) Answer • Yes:,; Question 11; In the majority of cases, when Medical Department officers holding key positions are ordered for duty elsewhere, no response is. made to letters requesting their replacement. As a result the commanding officer is. le ft in the. dark -end -additional TWX*s, and phone calls have to be made. It. is: s.uigge.sted rt'hat the Personnel Section:,, at. the time detached;, notify, theCommanding Officer ■as,<.t.t^>Ttoheh;Iet‘ replacement,, fp’quote an example: The anesthesiologist at this hospital, whose services are ihighly important, was due for separation on 3 August 194-6, after voluntarily remaining on duty for two months beyond the due date. In spite of letters, TWX's, and phone calls, we are yet in the dark as to a replacement and have been without the services of an anesthesiologist for the past ten days. At the. same time, the operative program must go on without an experienced officer, (Submitted by: CO, Army and Navy General Hospital.) ■ Answer : This office concurs in the remarks as outlined in this paragraph, and in the future will endeavor to replace key- personnel prior to the departure of that personnel from the home station, and if this is impossible, which it will be at times, to keep the commanding officer informed as to the current developments in obtaining replacements. Question 12; We would like to be informed as to The Surgeon General's policy for assigning officers to foreign service. Some have made requests to go and haite been retained, while others who have no desire for foreign service are so assigned. At present our medical supply officer, a highly competent man, is alerted for foreign service. He is 57 years of age and completes 30 years service in 17 months, including enlisted service. Arriving as his replacement is an officer, age 28, anxious for overseas duty. (Submitted by; CO, Array and Navy General Hospital.) Answer : It is the policy of this office to send overseas, first, officers who volunteer for overseas service. The second group which we are sending overseas is made up of officers who have had no overseas duty since 1 September 1940, The third group is made up of officers who have been overseas during the war but only for a relatively short period of time, that is, for periods less than a year. Question 13: Personnel Problem: In allocating Medical Department civilian personnel it should be remembered that a hospital functions seven days a week, twenty-four hours a day. In some in- stances it costs the government more money to pay overtime than it would to hire additional personnel. (Submitted by: CO, Army and Navy General Hospital.) Answer ; Because this office realizes the difficulty that our general hospitals are experiencing in an attempt to operate under the present circumstances which exist in the field, The Surgeon; General, has designated three survey teams to visit all named general hospitals’.and render a report as to the ■number of personnel, as to the number type, grade ratings, etc1,, needed to operate these hospitals. This v/hole problem is now under exhaustive .study because it is realized that the -War■department figures based on the manning guide charts, are not (Satisfactory to operate hospitals in peacetimes " . E. DENTAL PERSONNEL IN ARMY HOSPITALS- Brigadier General Thomas L, Smith Brigadier General,Thomas L. Smith, Chief of the Dental Consultants Division,, OSG, discussed problems in regard to dental personnel in army hospitals.. ; . ’ General Smiths tated .that it is often hard to fill requisitions for dental officers when a,Specific MOS is asked for, as 3171, 3175, etc., due to the fact that usually the requisition asks for officers in company grade. Younger officers do not have enough experience to be classed as specialists, so It may be necessary to send in officers in the higher grades. In the recent integration of officers in the Regular Armyapprbximtely forty-three were integrated in the grade of major, however, nearly all the officers being procured through Selective Service and the ones transferred from the Navy are young officers, and many lack experience. DISCUSSION General Smith then discussed questions pertaining to dental personnel that .had been submitted by the hospital commanders. I Question 1: The system of classifying dental personnel does not seem to be comprehensive. Many dental laboratory technicians are not^strictly to be classified as 067, yet can do some laboratory work. It is suggested that the classification designation/ Dental Laboratory Technician (067) be broken down into various classes according;,to -the degree of -proficiency. As a suggestion, a man - 067A - could meet the requirements'of TM12-4-27; 067B - could be plaster of paris manipulator j 06'7C - Bridgework; 067D - Finisher,etc. Would such.a system be feasible? It is believed it would help greatly in requisitioning personnel. (Submitted by CO, Pratt General Hospital,) ■ ■ DISCUSSION-: The system of ■ classifying dental personnel does not seem to be comprehensive. Many dental laboratory technicians are not strictly to be classified as 067, yet can do some laboratory work. It is suggested that the. classification -designation Dental Laboratory Technician (067) be broken down into the various, closes according to the degree of proficiency. As a suggestion,, a man (067A) could meet the requirements of TM 12-427, (06’7B) could be a plaster of paris manipulator, etc, * ' : Answer : Classification of enlisted Dental laboratory Technicians (06?)r .in the classes of A,- B, C, D, E, etc,,• is a ve»y .practical suggestion. Civil Service has just completed, and had approved, new specifications for civilian dental laboratory mechanics, from SP-3 to S.P-85. inclusive, de- fending upon,:.;the' training and' experience of the technician, A system of classifying enlisted technicians could be worked out in a similar manner. In fact, it would be very desirable, and an effort will be made to have this done, both as an aid in‘-rrequisitioning personnel..and as a guide to establishing appropriate ratings for .the more experienced technicians,- ; * . .... . .. Question 2; When may general hospitals expect to'receive more experienced and better qualified dental personnel? ’(Submitted by CO, Percy Jones General Hospital1.- ' Discussion; With more cases requiring extensive treatment, it becomes '• ' increasingly important to have more experienced dental personnel in general hospitals. At this station, the operation of three clinics and the care of maxillo-facial patients with but one qualified oral surgeon, makes the assignment of two more, semi^'trained oral surgeons essential, .fhe'. snme problem exists in the 1 prosthetic section. Replace- ments to date have been youngsters,,i recently ..graduated and requiring the supervision of bide r’men',' Although qualified ; personnel have been requisitioned,' ‘uncertainty as to their arrival makes planning difficult. Answer : It is very difficult for-us to meet the requirements for officers in the specialized'branches of dentistry. We are at this tine in the process of releasing our older men who have, had experience in prosthesis and oral surgery, and replacing them, with' younger ASTP officers who have not had the opportunity nor time to gain experience in this line. So .it appears that this situation will become even worse, !’ Every effort is.made in this office to portion this type of personnel on an equitable basis to the stations as needed. The.more capable and promising younger officers will have to be put on the job and trained to handle these responsibili- ties, One suggestion might be offered in this respect, however. When requisitions are submitted for officers of the specialized.MOS numbers, it is suggested that they be placed in the higher grades rather than in the company grades with the idea of promoting them if they.are qualified. This is ordinarily the premises for whibh they have gained their promotion, and no doubt are older better qualified officers. The younger company grade officers have neither had the time nor the association to gain such qualifications. F. PERFORMANCE OF STATION COMPLEMENT. FUNCTIONS AT II INSTALLATIONS.....Major R. Murray, Jr. Major Russell Murray,'. Jr,, MAC, Chief, of Personnel Authorization Unit, OSG, discussed the following problems pertaining to the subject of the performance of station ‘complement functions at Class. II hospitals: Problem Is Clarification of responsibility for certain activities shown in 1VD Circular 138 as amended by Circular 170, 194-6 DISCUSSION: There appears to be many circumstances which have caused army commanders' to interpret the reorganization directives in such a manner and to direct hospital commanders to consider activities as the respon- sibility of The Surgeon General and vice versa. Our office has in some cases been appraised of such facts. Our personnel survey teams have attempted to indicate in the Survey reports, the exact disposition of controversial activities. The Mar Department General Staff may not agree on certain of these interpretations and as personnel authorizations and allocation of funds are' channeled through either The Surgeon General or the army commanders by the ’Tar Department General Staff on its interpretation of the directives it is vitally important that correct allocation and assignment of all pers’onnol be made.. Me ‘believe the survey teams have the'correct interpretations. Action: Such matters which remain controversial should be referred to the attention of Thie Surgeon General for appropriate action. Problem 2: Personnel authorizations made by army commanders to hospital commanders for the performance of station complement activities. DISCUSSION: The problem arising from the recent personnel authorizations must be considered in the over-all as one which is likely ,to remain constant until the Postwar period planned strength has been reached by Army and the then remaining allotments have been fairly and equally apportioned to all the major commands and in turn, to each installation. The review of the personnel problem must, take into- consideration the terrific drop in the size of the Army in the past year and the fact that many missions which wore being performed by -troop units *and field forces be’eame the 'continuing responsibility' of the chiefs of the technical services simply because the personnel in troop units no longer existed. Confusiop and delay in administrative actions occasioned by the reorganization of the liar Department' have added further problems to the matter of adequate' distribution of available’- pbrsomdi, Are Class II installation fiscal officers’authorized to request funds from the Chief of Chaplains under Project No, AA7 (Chaplain activities), for the purchase, of / . necessary7 religious supplies and equipment? (Submitted by CO, Army-Navy General Hospital,)' Answer ; Purchase of necessary religious supplies and equipment other than wafers will not be made locally except dn unusual, circumstances. In connection with the' supply of chapel equipment, attention is invited, to the1 provisions of V/D,Circular 159* 1946,. together with the following circulars which are. in the hands of the local chaplains only: OFC of Chaplains, Circular Letter- No* 301, 1 January 1916), "Addenda"; OFC ,of Chaplains, Circular Letter No. 311* If-Anguqt'-194-6, "Addenda"OFC of Chaplains Circular:,.,.22 August 1915, subject,, "Equipment aad Supplies for « Chapels and Chaplains"; Addenda C. 0. No. 30/+, which is an'extract of Section VII, WD Circular 383, 19A5, subject, "Non-appropriatod Funds." Information has been secured from the Office of the Chief of- Chaplains to the effect that it is desired that all worn and dilapidated chapel equipment be replaced. Requisitions should be submitted to the Quartermaster Depot, Alexandria, Virginia, through the Now Cumberland General Depot at New Cumberland, Pennsylvania. Request’s for funds for local purchase should be submitted directly to the Office of the Chief of Chaplains, liar Department, Washington 25, D, C. Y/here such requests v/ill be scrutinized. If such requests arc approved, funds will be made available directly by that office to the hospital-:concerned by means of a WD iDO Form 1-4—11A, subject, Obligation Authority,M Question 6J Are funds available under Project No. 510 (Equipment supplies, and other expenses for training), for the purchase of supplies and equipment for use of patients in training under the supervision of Occupational Therapist at general hospitals - such .as radio repair kits, tools, .small motors, etc. (Submitted by CO, Army— Navy General Hospital.) ' -No.;funds are available under project 510 for the purchase of -, supplies and equipment for use of patients in training under the’reconditioning program. Supplies and equipments for such activities are listed in Medical Supply Catalog under Class F* Question '7: Will funds continue to be allotted by SGO on a quarterly basis for the balance of the fiscal .year?' Some consideration has' been paid to the possibility of yearly allotments. (Submitted by CO, McCornack General Hospital.) Answer : Funds will not bo allotted by The Surgeon General for re- quirements in excess of one quarter with the possibility that it might become necessary to allot for smaller periods. The restriction by quarter is placed on the Medical Department by the budget officer for the 7ar Department and the Bureau of the Budget, Question 8: If quarterly .allotments are to be continued, will a prpccdure be set up whereby budget estimates are submitted quarterly, or does the teletyping of obligations through 15 August constitute a means of judging both what is needed for the balance of the current quarter and what will be needed for next quarter? (Submitted by CO, McCornack General Hospital.) Answer ; Quarterly budget estimates are acceptable if submitted in letter form, together with supporting information and justification. The obligations furnished as of 15 August constituted a one-time requirement only. Question 9• Should’requests for additional funds as needed be submitted in letter form or on the; old NSC Form 100? (Submitted by CO, KqCornaclr General Hospital.) - . * • *. ‘ *■ answer. /'I Request'for additional funds can bo submitted in the form of letters, radios, teletypes, or telephone conversations, depending upon the urgency. There is no requirement for using NSC Form 100 (Ninth Service Command Form.) .The,Fiscal Division, Office of The Surgeon General is anxious to be of all'possible assistance to the commanding officers of the general hospitals in working out their fiscal problems. Please do not hesitate.to call upon us. Thank you. H. TRAINING ACTIVITIES AT ARMY HOSPITALS.. Colonel R. E. Duke , . Brigadier General Denit introduced Colonel Raymond E. Duke, MC* Chief of Education and Training Division* 0SG* vdao discussed the professional graduate- training program* including interim refresher training* interne training* and the residency training programs. Colonel Duke, made the following statements; In discussing the subject of Medical Apartment training,'I would .like to give you first the details of our present refresher pro- fessional graduate training program; second to give you the details of the plan for pur permanent postwar residency program, and show you how we will progress from our present refresher training into the permanent residency program. -Then, I would’like, just briefly, to show you the details of the plan for our postwar. Medical Department school system, and to show you where the residency program fits into that system. As Colonel Kintz pointed out this morning* during the years of World War II* of necessity almost one hundred percent of the personnel in the Regular Army - Medical Corps officers - were assigned to staff* command and administrative positions. At the close of the war* and anticipating a rapid demobilization* it was evident that we had to get these Regular Army officers back into professional work. A Professional Training Committee was appointed here in the Office of The Surgeon General and about one year ago this program was begun. As officers were re- turned from overseas and could be relieved from their administrative or command assignments, they were placed in the general hospitals for professional training. Insofar as possible* and it was usually possible* they were given a choice of the specialty in which they wished to be trained. At that time AR 350-1010* "Professional Graduate Education for Medical Corps" was written and approved by the War Department. Likewise* SGO Circular 17* 1946* on The Surgeon General’s policy of assignment was written, and also, WD Circular 101, 194-6* which governs the consultants’ program. Somewhere between 370 and 380 officers have taken part or are taking part in the refresher training program. About ninety officers have been sent to civilian institutions for training. Different courses varying from three weeks up to six months in length have been set up. Educational committees were established in the general hospitals to assist the commanding officers and the Office of The Surgeon General in the evaluation of these officers in training and in selecting those who should be sent to civilian institutions* Some of these committees have functioned very very well; I am sorry to say that others have not. We would like for the educational committee to consider each one of these officers individually and to evaluate him in detail. What I have in mind is this. Occasionally we have an officer who will apply through channels for a course in a civilian institution. Vie feel' that the educational committee should consider the officer in training very carefully: What he has been doing, what the caliber of his work is, and what the estimate of-his capacity for proceeding on to Board certification is. -Such an indorsement should bo put on the letter to the Office of The Surgeon General. A letter often,times is received from an officer who has applied for or requested a course, and the only indorsement'on the letter is, "approved,” signed by the hospital commander. That does not help The Surgeon General’s Professional Training.Committee very much in evaluating the officer, nor in determining whether!or' not he. should be sent to the civilian institution; * In order that the training an officer receives counts towards his specialty board, and to raise the general standard of our training, the Teaching Consultants• Program was begun and is now in operation. In order to qualify the officers, especially those who were close to their board examinations, we have established review-courses in the basic sciences. For the time being, these are being given in civilian medical'schools. We have four such courses in operation now; we hope to have five in the very near future. These four courses are given, at the present time? at George Washington for Walter Reed; at Colorado University foV Fitzsimons; at the University of California, for most of the Letterman group, and at the University of Washington in Seattle for the group af Madigan General Hospital. The time has now come when it is becoming increasingly necessary to take officers out of the professional training program and give them assignments. We have lost our large group of AUS officers and the Medical Corps of the Army.is more and more consisting of regular officers and ASTP graduates.' These .are the younger individuals who have just graduated from medical schools. So, as the office of Personnel needs officers for key positions•such as'chiefs or assistant chiefs of services arid sections, and similar assignments, these officers must be pulled out. However, if'the assignment'is; in-a general‘hospital or largo station hospital, the man is still considered to be in training. We want the educational committee at the hospital to", continue to consider him so, and to continue sending in quarterly reports on the Individual, One other thing I would like to point out. Xri some;■■■instances'.'officers in the refresher training program have* been■assigned quarters, on the post and. they get the idea that they mil continue in training at that particular,hospital, or that permanent -assignment will be to,that hospital. This is not necessarily true, •.These -officers may be-moved elsewhere for a permanent assignment. This training, I feel, has been all the- way from excellent to poor,* At some of the- hospitals the officers have received a great deal of training. In other hospitals, and on some" of the services, it has only-been fair, and in some instances it has been poor. There are, many; reasons for this. In some instances, there has been an A US officer who; is chief of service and who has not beep interested' in training Army officers, especially, since he may be- only a major and the student a colonel., I think’the training has been largely in direct proportion to the interest and enthusiasm .shown by the. chiefs of service and the educational committee. , . From here I would like to go into the permanent residency program. While the refresher training program has been in progress this last year, there has been in the process of formulation a permanent residency program for the general hopsitals. Now this permanent structure is almost complete, as you will se on this chart (inclosure No. 14.) • We are establishing permanent internships and residencies in eight of the general hospitals. Also, we are attempting to establish residencies in internal medicine and general surgery at the eight larger station hospitals. This has not as yet been accomplished. To obtain approval of residencies we have to ask the American Medical Association to have their Council on Medical Education and Hospitals inspect the hospitals with regard to each residency. Their report goes to each of the fifteen American Specialty Boards for approval. It then goes back to the AMA which gives the final approval or disapproval. Our Personnel Division is. attempting to get individuals assigned to the residencies over and above the ceiling needed to operate the hospitals. We are now attempting to get this approved by the War Department, . On the chart the red dots indicate those residencies where we have permanent approval by the AMA and the American Specialty Board. You will notice we have internships approved in eight of the general hospitals. We will get our first internes July 1st of next.year. As it was pointed out this morning, we have authorization for one hundred internes as reserve officers, but we don't’ know,as yet how many will be accepted for next year. You will notice, likewise, that we have approval for mixed residencies in these eight general hospitals to cover six months on medicine, and six months oh surgery. The blue dots denote temporary approval. The AKA Board has given us temporary approval pending a final inspection. The black dots indicate those residencies which the AKA has recommended to the specialty boards for approval. However,* final approval is awaiting the action of each of the respective specialty boards. Not all of the hospitals have been inspectad. Brooke has been inspected but we' haven’t received the final report. Madigan has been inspected, but likewise we have not received the report. Oliver and Percy Jones have been inspected, and we have the recommendations. Walter Reed will be inspected 26 August. .¥.0 will gradually progress from our present refresher program training into the permrnont program. You rail -receive in two or three weeks the details of the program for mixed residencies. As other residencies are given final approval wo will forward detailed programs. Some of the officers in our present refresher training program will be assigned to those permanent residencies. Your educational committees should function in the permanent program just as they do at tpe present time. Via want these individuals evaluated every three months''as at present. The number of individuals assigned to a residency will depend on the number of admissions to that particular service. On an aye,rage it takes two hundred to four hundred admissions in the specialty to support one officer in that residency. Officers who came into the Regular Army in 1939-19A1 have had very little professional background will be assigned to mixed resi- dencies in preparation for further training in a specialty. Each will be given a chance to choose his specialty insofar as is consistent with requirements. The Medical Department will have a chance to evaluate the officer before his assignment to a residency. Those officers who have had seven to fourteen or fifteen years of service - in other words, those who-had quite a little professional background before* the war - will be assigned to the other residencies. "I.think it will take us about four to six months to completely progress, .from- our present refresher course into this training* program. The residency programs are being written and will be distributed at the time the formal residencies arc announced* This, gentlemen, is purely a competitive program. Keep.that in mind. If we have-an officer assigned,■dith6r"to;our refresher training or permanent specialty training •program, who drows by a lack, of skill or enthusiasm or willingness to put forth the required’amount of work and effort necessary to go on to board certification, he should be pulled out and put somewhere else, ¥e are dependent ’to a great extent upon your educational committee to give- us that information. The Regular Army is short of doctors right now, and we-are going to bq short for some time. You cannot interest a. young doctor in'the’Army from the financial standpoint, for it's a cinch he can make more money in civilian practice. If we can show him that his opportunities for professional advancement and training, on up to board certification, are as good or better in the Army as in civilian practice’T think' we . .. will interest some of them. Some individuals believe that if we . train., our’Regular officers on up-to board■certification that" they will resign. I believe that if we can set Up,lan;-‘educational system’- such ns''has".-, been proposed, we will have-plenty of doctors who are * eager ’to come into the Army. ¥e must pick our officers at a younger age and so plan.their careers so that their training and assignment lead "to•• , board certification. The only, way we "can do that is .to make’pur,, general hospitals teaching institutions, and wo should do all in our power to accomplish this. This responsibility will be largely yours as commanding officers of the general hospitals. .Now, just a. brief description of the postwar Medical Department school system.,, to show you where this residency program fits in. I realize that*'! am just a bit premature in presenting this, because it does.not have, bar Department approval, nor has it been submitted to The Surgeon General for his approval. It is just now being coordinated with the Army Ground Forces, the Array Air Forces, and the Army Medical Center .here at Washington. The bar Department has recently approved the GcroW: Sphool System for the Army. The Gcrow Board plan and the schools contemplated do not quite fit the. Medical Department and we are going .to ask, in submitting this to. the bar Department, to have- certain, exceptions made fo■the•Gcrow Board system. The Resources and Analysis Division of the Office of The Surgeon General has made an analysis of the' requirements for specialists.. This 'school system is planned and is so coordinated to- meet these requirements. (Showing chart, the Medical Department School System, inclosure No, 15*) The arrows merely indicate a general flow of officers. There will be exceptions to it. Every officer mil not follow a particular arrovf, but there is shown' the general flow of the bulk of officers. There will be certain training which; is now shown on”this chart. Medical supply will need a certain number of men highly trained, in depot operation, in storage and distribution, but that number is so small it does not pay to set up a school. These are the formal schools. Now, the Gerow Board requires three -schools. . It requires what..Is .■ re- called a basic officers' course, basic military training, band I.-will explain that in just a-moment. It requires, also, a basic branch course, and an advanced branch course. These are required by ’the '. Gerow Board of all officers.’ coming into the Army regardless of arm'or service. All officers willagb- to a common school.. They mil all be grouped together in one Basic Branch Immaterial School where" they will be taught all the things an officer should know about the Array .in general. Our doctors will be in that group, best Point graduates'are assigned to the same group. When we found that out, it became quite evident that you cannot taka a doctor and put him in with a group of West Point graduates. So, we hove askod G—3 to take all the doctors — tho chaplains, also, are included — that come in from civilian life, one month early, and send them to tho Basic Branch Immaterial School at Fort Riley for a one-month’s course in very basic military subjects. The medical officer will take a course and mil then be reedy for the four-months' course with the other officers* The Gerow Board provides that graduates of this first four*1- months1 course will be turned over to their respective branch; Infantry, Quartermaster, Artillery, etc., for a five-monthsC? basic branch course. For Medical Department officers this course will be conducted at the Medical Field Service School at the Brooke Army Medical Center, Fort Sam Houston. The very basic subjects will be eliminated from the course and more of the Medical Department subjects will bo given. At the present time a four-months' basic branch course is contemplated for Medical Department officers. After the officers first year in the Army we can see that this is a good time tp pick out Medical Service Corps officers-’who arc going to be adjutants, personnel officers, supply officers, ’and other officers to work in hospitals. We should give them a three- months 1 course in hospital administration before assigning them to duty. It is also a good time to pick men trained in medical equipment maintenance and send them to St. Louis for a course in medical equipment maintenance before assigning them to duty. A certain number of medical officers will go to the Air Corps .where they will take a basic aviation medicine course of ;ne-month’s duration before being assigned to duty. Between two duty periods they will be sent to aviation medicine course to become flight surgeons. TMie Gerow school system requires, next, that sometime between the third and tenth years of an officer’s career he will be ''given an advanced branch course. This course is designed to specialize individuals in their particular branch*. Certain common subjects are required to be taught to all officers attending the advanced A four-months' course is considered t'o be ample for the Medical Department, Based on the present planning policy for the size of the Medical Department, the size of classes would bo 170 to 190 officers. At this point or sooner, officer’s careers should be planned. There is a career planning policy being set up by the War Department and the Office of The Surgeon General. We should plan an officer's career very early and have his assignments and training working toward that goal. • Individuals going on in professional work for board certification should be sent to general hospitals for residency training. From the advanced branch course Some may go to civilian institutions, public health, or civilian hospitals for specialty courses. Some may go to the school for military neuropsychiatry, a four-months’- course. School of basic sciences is now taken care of in civilian medical schools,- We expect to have our oym course in basic-sciences soon. Laboratory medicine, a nine-months’ course, will fit in closely with basic sciences. In time we plan to set up our own course in preventive medicine, a couhse equal to or better than- the ones given in civilian institutions.' ’ W ; - ■ Also, we visualize a course in tropical and global medicine. This will be mostly research, and a portion of. the course will possibly be given in Panama, at-the Army School of Malariology, or in Puerto Rico. ■ y- .. . . - . Another branch of: the advanced course will .bo a course in hospital, administration for- commanding officers. .Possibly, we'could send a few Pharmacy Corps officers whom we would desire to train for executive officer duties. Then, to complete the advanced course, we ?dll, have advanced dental and the advanced veterinary courses. It is pla,nned-to :lockta-the courses as follows.; ;.,... Brooke Army Medical. .Center .u. ..... 5 ahirie- Basic Branch Course Advanced Course.. .. in. r v:; Hospital Administration C,qur§ea;-(bath basic and advanced) Optical Repair Course . —, .-, Military Neuropsychiatry ■ • . -a Army Medical Center {.--t ' Preventive Medicine Laboratory Medicine Basic Sciences • . vc,.f<.e ori? Tropical and Global Medicin.Gr Advanced Veterinary Course--> St* Louis Medical Depots Army and Navy Equipment Maintenance Course Qyarth¥master Depot, Chicago ; •Meat and Dairy Hygiene Course . Randolph Field Basic aviation Medicine; Advanced Aviation Medicine This, then, in general, is the plan for the Medical Department school,system. It is not yet firm arid is now .being coordinated with the various agencies-. Colonel Caldwell,Chief, Neuropsychiatric Consultants Division, OSG madcpthe following statements in'regard to training in neuropsychiatry; As you know there are some unusual features about training in neuropsychiatry, • I would like to state some of* the problems that -we are up against. In maintaining a 500,000 army, we need abput'130 psychiatrists. In a 800,000 army we need about 200 psychiatrists. 17c now have approximately twelve in the Regular Army not including those with-the Army Air Forces* Thirteen medical bfficors are assigned to. ho-spitals for residency training in neuropsychiatry. The Amy is concerned about what we are going to do next spring. We will need replacements, for ”B&C” men now in the service. * Where are we going to get these .130 psychiatrists? Wo will have to use officers for pro- fessional training in the Army from the present ASTP groups. Wo will not get many from the outside. There isn’t much inducement to come in'; on. the. next integration. .The Veterans Administration is bidding against us with'at least twenty-five percent increase in pay. We will have to train men from our own rank; train from eight to ten in each hospital. Requests are coming in for replacement for clinical psychiatrists. We do not have replacements for clinical psychiatrists, many are going out of service. Hospitals are hiring clinical psychiatrists. If your hospital has hired a clinical psycologist, write up his job sheet and send it to the Civilian Personnel' Division- for a rating. Vfc will continue to train neuropsychiatrists and nurses in nouropsychiatric nursing. We will need a number of nouropsychiatric technicians. Courses will be set up at Brooke for the training of these' technicians, also, for the training of.clinical psychologists and psychiatric social workers. DISCUSSIONi Colonel Duke discussed questions on education and training that had been submitted by hospital commanders. Question Is How many months will the medical officer trainee be at this hospital for training? This influences the training program vitally. If assurance could be given that when a trainee arrives at this hospital he will be here for a definite period of time, the training program could be adjusted in accordance and would enable the trainee to receive maximum benefit during!his training period. (Submitted by: CO, Pratt General Hospital.) Answer : Officers assigned to a general hospital for refresher training will remain at this hospital for at least six months. This is the minimum time* V/henover possible the time will be extended* However when the officer' s services are needed by the Personnel Division of The Surgeon General's Office for a duty assignment, it will be necessary to withdraw him from a training status and to assign him to duty* If this assignment is in a general or largo station hospital the officer will bo still considered to be in training and quarterly reports will be rendered on him by the educational committee* ■ These reports will continue until he has been certified by an American Specialty Board. Question 2i Is there a planned training program drawn up in the Training Division outlining the scope of training desired? Such master .program to be used as a guide in the.-.various hospitals. / (Submitted byr CO, Pratt General.Hospital.) Answer f .. For: the .refresher type training the training program is outlined in paragraph. 6, AR 350-1010, In the permanent residency training detailed training-programs are being , -drawn-up for each specialty. .In the. .near future as. ,, residencies are approved by the AMA and-American Specialty . the various hospitals these .programs will be .-. forwarded to the hospitalst,>., . , . . • .w A: •. • - ■ .... I. * i : I. ■ ... • ' ' • * * • • * • .... . Question. 3• The problem has .arisen at soma hospitals of not. having sufficient-wall-qualified medical officers on the staff to conduct both a competent program of professional service to the hospital and of training new officers in interim refresher courses, interne and residency training programs as well as the continuing program of training enlisted,.men and enlisted, women technicians. Will there be available in .the near future sufficient qualified medical officers to meet the needs mentioned? (Submitted .bv; CO, Pratt General.Hospital.). • Answer ; The Army has recently integrated .into -the,-.regular service about twenty-six board members. About thirty Regular Army officers will, become board withfn the next six months. It .is hoped that our present, educational program will in the near future make available more well qualified medical officers for the staffs of our hospitals.. Question 4-J Is It. .the policy of your office .to order regular officers undergoing, refresher training,'to civilian institutions for training in the basic sciences, required for board certification? (Submitted by: CG, Fitzsimons General Hospital. Coordination.: Office of Personnel.) Answer i It is the policy of The Surgeon General's Office to order Regular Army officers undergoing refresher training to civilian institutions for training in the basic sciences required for board certification. , Four such courses are now in progress and the fifth one is being established next month. These courses are being conducted at George ■Washington University, University of Colorado, University of Michigan, University of California and Washington University in Seattle. It is anticipated that additional such courses vd.ll be established from time to time. Officers who are nearing their examinations for the American Board .arc given preference to these schools. Question 5• Rotation of officers assigned for professional training on various services. For example, an officer is assigned for professional training in chest surgery at Fitzsimons General 'Hospital. In order t‘o properly prepare for his board in this field, it is noc'C'S'sary that he have training on general surgery. Do we have authority, in view of the way. the orders are written, to rotate such an officer for training in other sectipns of surgery, without requesting a' change in orders? (Submitted by: CG, Fitzsimons General Hospital.) Answer ; The answer to this question is., ”YGs3,r If training in other fields is required for. certification in a particular specialty the hospital is. authorised to assign the officer to meet these requirements. However, to completely change the o’fficer1 s .assignment from one specialty to another must be coordinated, with and be approved by The Surgeon General’s Office. Question 6; Does the Array plan on training and using their own specialists and expert consultants? (Question submitted by CO, Mayo General Hospital.) Answer : The Army definitely plans on training and using their own specialists and expert consultants* This is the very reason for our career planning policy and educational program* However, the accomplishment of this will require some time* Question 7: V/hon will T/O units bo adequately staffed to perform unit training tentatively scheduled at this station for 23 August 194-6? Officers presently assigned to these units are not qualified by training or experience to direct their units in such training activities. Despite T/0 authorizations, there arc no field grade officers assigned to any units in training at this installation. (Sub- mitted by: CO, Percy Jones General Hospital.) Answer : There is at present assigned or ordered into the General Reserve units about 2/3 of their authorized strength of MAC officers* Also a few Medical Corps officers have been and are being assigned. The highly qualified professional officers to be chief of services and sections will not bo assigned until movement is imminent, ’/herever there is not a qualified commanding officer assigned, this fact should bo made known to the Personnel Division, Surgeon General’s Office* Question 8; Viho will determine ?/ho$ ;T/0. units .are, qualified to proceed from MTP 8-1 to MTP 8-2,;-etc. ? Uncertainty exists as to whether this determination-may1 ;be .made by the c ommanding general and :director-; oftraining of.the installation at 'which they are, receiving their training or if it will be made by an inspection team from The Surgeon General’s Office*:.;:. (‘Submitted by; CO, Percy. Jones General Hospital.) Answer : The decision as to v/hen T/0,.units .are .qualified to proceed from MTP 0—1 to MTP 8-2 is given tv the Director of Military. Training, ■ ‘ /DGS-. The latest information received from that office -is -that -DTP 8—2. wilX.no t‘ be started until 15%> of the technicians in each,unit have finished their’ technical training, T/c, were told that a directive on training of General Reserve: units, was in the process of being published now. I.- PROFESSIONAL ADMINISTRATIVE PROBLEMS IN ARMY HOSPITALS Colonel A. N. Nylen Colonel A. N, Nylen, MC, Chief of the Physical Standards Division, OSG, introduced Major John II, Mollidajr, AGO, who discussed briefly essential changes in a proposed revision of NT) Circular 313, 1945, placed in immediate effect by AG letter, 22 August 1946, Subject: "Disposi- tion of officers subsequent to appearance before Army retiring Board": 1, Officers who are under orders for separation, or are eligible therefor, and officers ineligible for separation but who have beer found physically incapacitated for all types of military duty may elect to be retained bn active duty in a patient status, pending final War Depart- ment actiori bn their case. When the Army retiring board proceedings have been completed, the hospital commander will obtain a statement signed by the officer expressing his desires reference remaining in patient status, or relief from active duty, and take appropriate action as follows: a> If the officer desires immediate separation, he will be separated at the hospital under current procedures and copies of the relief order and the officer's statement declining retention in a patient status will be forwarded to the War Department together with-the Array-' retiring board proceedings* ufficers- found not incapacitated and who are eligible for separation will not be transferred to separation ■centers but will be processed at *the hospital, Records and pay accounts will be retained at the-hospital until officers revert to inactive status. ' ; • ; If the officer elects to be retained in patient status pending final War Department determination,; the hospital commander will include the officer's statement with the Army retiring board proceedings indicating that he is eligible for relief from active duty but desires retention in patient status pending War Department instructions. Hospital com- manders are authorized to grant sick leave in the amount they deem necessary. (1) If, as a result of War Department action, the officer is Considered qualified for temporary limited service,•The Adjutant General will so notify the hospital commander, who will ascer- tain the officer's desires regarding reassign- ment, Jin officer who elects to be- separated will be processed in accordance with paragraph la above, .an officer who elects to continue on active-duty for the period of temporary limited service recommended will be reported to the War Department, Attention: Central Officers Assignment Group * G Aepbfts will’include the following infor- mation: Name, Grade,' and' arm or brancji of servicef efficiency index; military occupational specialty;'-color; limitations as to type, of service and locality, if anydate officer’will report for re-examination; copy of 66-4.,, if available. * * P' -‘: • * • -- (2) Officers:who are found by the.Gar-Department to be V qualified for general service and' who!desirp con- . tinned active- duty will be processed .for -separation and be -informed-that' they should communicate with The .*djutant General's Office, regarding recall to active -duty. ' : 2. If, at the time of processing for relief from active duty, an officer is. ..found to be in a. temporary limited service status with instruj^tionp./tp-.return to a medical-facility for re-evaluation at the expiration pf ,the period of. temporary limited service, he vri.ll be cautioned that if.he, still; .desires re-evaluation after his separation from the service he should apply, to;!he;Adjutant General for written authority to enter an Army hospital.at,.the appropriate time, unless lie has received such authority. :r . • Lt., Holland, MG', • ol, ;th:e 'Physical Standards Division, OSG, discussed; policies of the Office,of The Surgeon General in handling the proceedings of.Army retiring boards* ’Copies of "Notes on Conference on Procedures Governing retirement of Officers for Physical Incapacity" held at the Pentagon earlier in the’year were distributed. These notes cover in detail policies in effect 'and usual causes for delay in processing. . • - DISCUSSION:- Colonel Hylen.discussed questions pertaining to professional administrative problems that had been submitted by hospital commanders. QUESTION 1: Can. a clear-cut policy be laid down for the disposition of all patients (detachment of patients unassigned status) of all services who are returned to a duty status? (Submitted by GO-, McCornack General hospital) ANSWER: It is believed the-'proposed revision of WD Circular 313, 1945, "Physical Reclassification of Officers", which should be out shortly, will adequately provide for the disposition of types of patients mentioned. QUESTION 2: How may line of duty be determined in the case of injuries received overseas when no board proceedings are available? DISCUSSION: In the case of many injuries received overseas, involving both officers and enlisted men, insufficient evidence is available to determine line of duty. This results in a considerable delay in completing the disposition of the patient. -*-t is recommended that hospital boards of officers be.permitted to determine line of duty from clinical and other records available and by personal interviews. This would prevent long delays in disposing of patients with doubtful line of duty status, (Submitted by; t)0, Hercy Jones General Hospital), ANSWER; AR 345-415 outlines the procedure in LOD cases. Where pro- ceedings of boards of officers which should have been convenec at the time of the injury are not available or obtainable, it is believed proper to’ convene a board to act on all infor- mation obtainable from records or interview and arrive at a decision, Ahe proceedings should show the result of effort made to obtain information from the individual's oversea station (concurred in by Legal Division, SGD)• army retiring boards may determine the LOD in any case before it independ- ently of any determination which may have been made previousI- QUESTION 3: Is it necessary for an officer to appear before a disposition board prior to appearing before an Army retiring board when he has a letter from The Adjutant General’s Office author- izing him to appear before an retiring hoard? Many officers, who' have been marked six months temporary limited service and who have been separated from the service, are reporting to this hospital at the end of the six months period with a letter from The -adjutant General's Office authorizing them to appear before an Army retiring board. In such cases it appears that* appearance before a disposition board as a prerequisite to appearance before an Army retiring board is superfluous and time wasted when the letter itself authorized the officer to appear before an Army retiring board, (Submitted by: CO, hratt General hospital) ANSWER: Any officer who is scheduled to appear before an Array retir- ing board should appear before a disposition board within 30 days, prior to his appearance before such board. This is considered to bo warranted inasmuch as the findings of the disposition board constitute valuable evidence for considera- tion . by the retiring board. QUESTION Ai Should such a transfer be made• by ■ a. hospital—without first coordinating with The Surgeon General? Even though that officer may be'-on-.a' civilian status?".' ;;i ■DISCUSSION: ■'■•■■' the case of AUS officers who v/ere put on six months temporary limited1 service.' John Doe, 1st Lt,,.'AUS,. met an retiring- board at Camp Blanding, Florida* ■ The•board- found .Lt• Doe.incapacitated and he was placed on terminal leave* The burgeon General did.not concur, with the findings of the -army retiring board, and recommended a six months period of temporary limited-service with re-examination .and..re-evaluation at the expiration of that period at a neurological center, -in the meantime, the hospital at Camp Standing closed* Subject officer is on a civilian status. The proceedings of the Array retiring board go back to The adjutant General hc Office for necessary action. Lt* Doe is recalled to active duty and ordered to a named general hospital nearest his home* xt so happens that It, Doe is spending his terminal leave in another section of the country, so requests permission from the hospital where he was ordered to enter a general hospital near where he is spending his leave. Thus, his papers are transferred to the- new station. ANSWER.; NT) Circular 313, 1945, provides that an; officer who has been ■found not permanently incapacitated;for active service and ■who has been placed on six months temporary limited service status and who has, prior to the. expiration of this prescribes period,- reverted to an inactive status, may, upon submission of his'written:request to The adjutant General's uffice, receive authorization to enter' the Army medical installation nearest his home-for appearance before another Army retiring board, If such an officer desires to enter the hospital nearest the place where he is spending his leave rather than the one nearest his home, he should submit a request to this ■effect to The Adjutant General, If- such an officer has been admitted physically to the arny general hospital nearest his home, it appears unwarranted to effect his transfer to the hospital nearest the place where he was spending his leave. If, however, this officer's papers.were merely transferred to the hospital nearest his home and he had not physically appeared at that hospital, then if he wishes to be admitted to-the hospital nearest his place of leave, he should submit a request to such effect to The Adjutant General's Office in writing,* The commanding officer of the hospital receiving an officer in the status of a civilian at the expiration of his TLS period should, if he believed that the case should be transferred to another hospital for correct management, submit a recommendation to this effect to The Adjutant General's Office, If, however, the officer in question has been- recalled to active duty upon the expiration of his TLS period, the hospital commander could effect his transfer to another hospital under the directives and policies now governing the transfer of patients from one hospital to another, j-t is believed that such transfers of patients from one hospital 'to another should bo governed by the medical indications in the case, . . r’ QUESTION 5: The 'officer was ordered to a hospital by The Adjutant General Office for# a '.purpose—probably because the general hospital was a neurological center. The new station*does not have a neurosurgeon to accurately evaluate the case* if the Army retiring board finds that man not incapacitated, then the officer can criticize the •n-rmy and probably bring political pressure to bear* (Submitted by: CO, rVatt General Hospital ANSWER: In cases where the services of a specialist, not available on the staff, are believed essential for the proper evaluation of a given case, consideration should be given to obtaining a consultation with a qualified civilian specialist or effecting transfer of patient to a hospital where such specialized service is available* It is not believed the thought of criticism alone should be the determining factor, but rather whether available personnel, can properly evaluate the case, /' . QUESTION”6: If the officer appears before an Army retiring board-and introduces his own medical witness, who is a neurosurgeon, and the witness, testifies to the effect that Diagnosis #1 was aggravated by military service, and Diagnosis ffU was of a severe nature, and the recorder of the Army retiring .board does not have available a neurosurgeon to represent the Government as a medical witness>or a consultant, what disposi tion should be made of the case? Should the recorder recom- mend to the board—in behalf of the’government—that subject officer be transferred to a neurological center? Should the board recommend the transfer? Gr should the board weigh the evidence given by the officer's medical witness and leave it up to the reviewing authority to make'the decision? (Submitted by; GO, Iratt General Hospital) DISCUSSION: An officer appeared before an Array retiring board. The board found the officer incapacitated by reason of:, ' 1, Post-traumatic cerebral syndrome, moderate, manifested by grand raal attacks, incurred following auto accident at _ age id, .. -- • .... 2*,, Pra,pt;ure, compound, complete, comminuted, left tibia at ... junction "-of • middle and upper third, incurred 8 April 1944, , at,,hew. Guinea> ’’in'jeep accident. 3, „. Compound, complete, comminuted, end of left fibula,.incurred as in 2 above. 4<» traumatic, chronic.-left common peroneal nerve, ' secondary -to 2 above, , ... The Surgeb'h 'General did not concur, with. the.-.findings of the Army retiring :board5 In that the four diagnoses-as Stad,ed,Lare’incidents of the service— .Diagnosis #1-was LOD ; No - EFTS. 11 #2 was healed, : 11 jf3 was healed, M nU The' board did, not state the severity. ;The>'Army retiring board reconvened for a rehearing ..and found the officer not incapacitated and recommended a period of six months temporary limited .service, ' The officer was authorized to enter a general hospital for ob- servation and' appearance before an Army retiring beard. The disposition board, recommended an,appearance before' ah Army .retiring board. ANSWER: A retiring board should always weigh .the evidence'"'given by every witness, whether he be one oil the appointed medical Witnesses; ,or ;a: wit ness called, on behalf of the officer before the . It, is- difficult to conceive how a post-traumatic cerebral syndrome, •• manifested.by grand mal attacks, incurred at, the, age:. of sixteen, could, possibly: be aggravated by mili- tary service several years la ter y, notwithstanding the testi- mony, 'and opinion of any neurosurgeon,..however, the neuro- .surgeon's opinions as to the severity of the traumatic 'neuritis should=be given considerable credence. But the medical members of the’ retiring board should require the neurosurgeon to demonstrate in. exactly what way this neuritis is severe and in what way it incapacitates the officer for military service. Having proceeded as just indicated, the board should then determine whether further observation in a neurological center is indicated for the proper disposition of the case, or whether it is prepared to render unequivocal findings as to whether or not subject officer is permanently incapacitated for active military service, The findings and recommendations of the board would be weighed, in the light of ail evidence, by the reviewers in'The'burgeon General's Office, and such recommendations would then be submitted as evidence at hand should warrant* QUESTION 7: Can a member of the detachment of patients at a general hospital be marked quarters for their convenience and reside with their families in town- at the discretion of the com- manding officer? May charges be made for rations? The advantage of this would be the release of beds in the hospital, (Submitted by GO, *ratt General Hospital), ANSVffiR; The change of status from hospital to quarters or quarters "to hospital would appear t'o be within the discretion of the hospital commander. Charge should not be made for subsis- tence while in a- quarters status. Care should be exercised in having individuals who may not be drawing an allowance for quarters understand this is a privilege and that claim for quarters allowance will not be considered. QUESTION 8: Why must officers appearing before disposition boards, whose appearance before a retiring board is not contemplated and who are not eligible for separation, or on terminal leave, be required to await action from the War Department before they can be Returned to duty? DISCUSSION; ' In the past, officers in this category were sent to reception centers for processing and reassignment as soon as the disposition board had completed action. Under the new system, a considerable delay takes place before officers can be dispositioned, fhe same problem exists for enlisted men, inasmuch as delay often results after army headquarters had been contacted since in many cases they seen uncertain as to where the enlisted men should be sent for duty. (Submitted by; CO, Percy Jones General hospital) ANSln/ER (TAG): Officers found not incapacitated by disposition boards should, in accordance with V1D Circular 87 as amended by V/D Circular 2AA be reported to TAG for assignment instructions if their previous commanding officers have not requested their return,. Officers recommended for temporary lifnit'ed service should also be reported to TAG under such- circumstances. A bar Department Circular is presently'being prepared which will include specific instructions as to disposition of such officers.., ■■ QUESTION 9: A recent directive states that an officer within the continen- tal. United States, .transferred to, an army general hospital will not bq returned to ,the station from .which admitted unless a written request is. fece.lyed to that effect from his command- ing officer'.;, otherwise, and' in'the case of an officer admitted from overseas,'report must1 be made to The Adjutant General fifteen days-,prior to the time „he is, ready, for. duty, from former experience,in requesting orders from The Adjutant Generaly it: is—dur opinion that this directive would result in the retention ,of many.,officers • in, hospitals for a consi- derable benefit. ' Also9 it is hot always easy to say fifteen days, .in advance when an .officer, will be ready for duty, (Submitted by;' CO Arny'i'Navy'General Hospital), {^NS\ffiR:(TAG)Under ..provisions.of TjiTD Circular‘ ‘24A, ’1946, officers* who are ..qualified ior return to general dutyJupon completion of ..hQspitali^atiph,will not:be returned to station from which admitted except upon written request from the CO of that ... station. All other cases, except cases involving officers , of the khF, will be reported to TAG for disposition instruc- tions. Under present policy such cases are being processed in .accordance with a newly established procedure, and it is anticipated that assignment instructions’will be'forthcoming more rapidly tiian in the past. QUESTION 10: Officers who have been separated from the service following appearance before a retiring board/ who are later recalled, with their own consent, for reappearance before a retiring board, should be informed of the length of time that such re- consideration .-will involve. . Many, come in thinking that they .will be away from home for a few. days and find that they are • retained for. three or four ...weeks,/.’ due to the necessity for obtaining their records from The Adjutant .General's Office, and. because of the pressure of work upon new medical officers with little experience In such matters'./ Recommend that when an officer is ordered to active duty 'for the purpose of meet- ing an army retiring'board, The Adjutant General automatically forward to the general hospital all necessary papers. (Submitted by: CO,.Army A Navy.General Hospital). ANSIffiR(TAG)Present policy .of The Ad jutant General is and has been since 1 June 194-6 to., either, authorize or'order an officer to enter a hospital from, an inactive status and immediately thereafter dispatch the medical records to the designated hospital. It is believed that at the present time and in future cases no should, be. experienced in disposing of an officer's case by reason' of failure to receive necessary records from The iidjutarit General's Office* ft is impossible for The Adjutant General to estimate the duration of an officer's stay in a hospital, however, whenever an inquiry is received as to the probable duration of such hospitalization he is requested to contact the commanding officer of the hospital,, QUESTION 11.; fte.commend that a general hospital be authorized to separate officers who have been ordered back to active duty for the purpose of rehearing, before an Array retiring board. At the present time they must be sent to a separation center and repeat a process they have once before gone through. (Submitted by; CO Army & Navy General Hospital), .ANSWER(TAG): a. Officers separated for reasons other- than physical dis- ability, admitted to an Array hospital either from terminal leave or who have been recalled.to active duty for Army retiring board action, Yfho are found incapacitated for active service by an Array retiring board, should be re- lieved from active duty by reason of physical disability by the hospital under authority of Circular 313 and need not be transferred to a separation center for reprocessing In cases of such officers who are admitted from terminal leave, who, after physical reclassification are found to be permanently incapacitated for active service the separation centers to which,the. officer had been pre- viously assigned, should be-, requested to transfer the officer to unassigned detachment of patients of the hospital involved and issue orders relieving him from active duty.for physical disability b* (1) Officers being separated for other than physical disability, who are admitted to a hospital from terminal leave and who are., found to be qualified for general service need.not be sent to a separation center,4 but will be restored to a terminal leave status and the separation center notified of the duration of the hospitalization in order that the officer's leave can be recomputed and his relief orders amended.- (See WD Giro 116, 194-6). (2) Officers recalled from inactive status to active duty.for the purpose of. appearing before Army re- tiring board, who,are found not incapacitated need ..not be sent to a, separation center for processing but may be separated at the hospital. (Instructions providing for, separation by the hospital of all personnel who are eligible; therefor will be forth- coming, in the near future)* v,- *• * — * • *• - ■ ..QUESTION12:.'foin 'the case 'of qfficera ordered into hospital by TAG from '".■terminal leaver for ; r>eccyisideration there--is a variation of ‘policy emanating;frpm fourth army Headquarters , from that published in various‘Mar Department Circulars, Illustration: 1st, Lt* Catton, ANC, was ordered-to Cushing General Hospital by TAG from terminal leave and'subsequently transferred by Cushing General Hospital to this hospital; upon completion of treatment here,.,returned to terminal--leave, in conformance to \iD Circular 116-; returned to her home ;in mass. at Her own expense; after her departure we were'advised by TAG to sep- arate her at this hospital. There are numerous other in- stances, .(Submitted by; ,00, Army & Navy General Hospital.) jj-'JJ|# prolusions of Tffl) Circular 116, 1945 are not applicable to officers who are ordered to‘proceed to an.hrmy hospital upon specific instructions -frora the War Department. " Further , 'it .‘does not apply to. officers who' are admitted to an Army hospital from terminal leave who are under orders for sep- aration for other than physical disability but, who, after necessary:-'hospitalisation : are determined to be physically disqualified for general military service. Such officers shbuld:-be transferred to detachment of patients and disposed Of ith'accordance with the 'provisionsdTUD Circular 313, 1945► (If-the dfficer had previously collected travel from the to his‘home he'-’should be required to re- imburse.the .'travel pay. collected under the original separation cieht%r)';fv.e' r. -■•‘Ucr.-;. T-" ;; . ;i ,.T-y-'':-‘h- QUESTION Yt■*fhe;;ih?iiira.ng:;bQard in cases of officers suffering with tuberculosis have'beeri’Vetlirned for reconsideration in some cases .-.with.. carnments.fr oin /The Surgeon General’s Office that are not :Well ..understood by. th®se officers conversant with these.cases’at General Hospital. Some of these cases diagnosed as active tuberculosis and some as apparently ..'arrested, as is well known, the term ’’apparently arrested”, ;at best, hazily describes the actual condition of the tuberculous - lesion. As a matter of fact, it is not intended to convey any final prognostic information. The term ordinarily applied in cases that have been active within recent months, Me know of no one recognized in the field of tuberculosis who would recommend any type of duty on such cases for an indefinite period of time. We have felt at Fitzsiraons, that a period of two to five years is necessary to establish the permanent stability of such lesions which have been recently active. Colonel XJong, recently, in a conversation with the Chief of Medical Service at Fitzsimons leneral Hospital, felt that five years should be the minimum period of a protected existence in such cases. ANSWER; The policy of The Surgeon General's Office in reference to .the.question stated above.13..outlined in the following para- graphs : (l) Cases of (a) pulmonary: tuberculosis, with or without pleural effusion,.(b) pleurisy with effusion without •pulmonary tuberculous infiltration, and (c) tuberculous lymphadenitis, will be hospitalized in accordance with the provisions of Section V, .V© Circular 122, 194-6. Patients with continuing active disease and patients with inactive disease moderately or far advanced in extent, will be retired. Patients with minimal tuberculosis who achieve apparent arrest of their disease, as determined by accepted criteria (see Diagnostic Standards of the Wational Tuberculosis association), if not eligible for separation, will be returned to limited duty, with pro- vision for chest x-ray observation in pulmonary and pleural cases each three months and careful medical re- evaluation each six months. Ultimately ‘(within two years of the period of apparent arrest) .such-cases may be ad- judged either active or apparently cured. If they have reached the latter state and are eligible for separation from the service they should be separated without re- tirement. (2) If, however, patients in the categories here considered have reached the state-of .arrest or apparent arrest only, and are eligible for separation-from the-service and elec- to be'separated, they will be separated under Section V, WD Circular 122, .194-6, which provides that officers with favorable prognosis may be hospitalized up to one year and that 'officers with inactive tuberculosis will not be retired. In such cases the retiring board should recom- mend -that the officer be found not permanently incap- acitated -for active service, and that he be placed on temporary limited service status for six -months, with re- examination and re-evaluation at the end of that time. Within the discretion of"the board, a second six months period may be recommended in order to allow sufficient time for the-apparently cured state to be reached. At the end of the first or second of these six months period it should be possible to determine if the disease in question is apparently -cured or':still active, and render a final'Opinion with reference tfd-incapacitation and retiranient, • ‘ •. r • . • J.,/''PREVENTIVE1 MEDICINE; PROBLEMS rJN-.,ARMI . ' 'HOSPITALS.,* * ,-,t .»>.,• .... .Colonel Torn-E.-Whayne ' F-. Whayne, Iv|C.,. Deput3r Chief of, .Preventive Medicine Division; Off Surgeon general, was introduced by General Kirk, Colonel• Whayne*tftsfcJ® aiflie‘ifallowing, .statements: There • is'-.not •■a:;gteat. deal ’in preventive medicine to come before the.meeting, but I. thought: itnecessary to’bring up two or three matters. '■T'X --Phe-1 -first'thing to. be referred, to is’WD Circular 138, There . seems tb'havO-been some variation-, in the interpretation of paragraph 6W, \which''designates :th©-: .commanders of Class II installa- tions within -.the As ?/e interpret it, commanders of Class II xnStallatibrls: are-.required.*to,(report ’problems with regard to preventive .medicine1,, sanitation.and hygiene., venereal disease control, nutrition and liaison with-civilian, public health agencies to the army commanders. The army commander - is’ responsible for his entire area with respect to these problems. It is; obvious that they must cooperate with civil agencies and coordinate- problems in a capacity that goes far beyond the confines at 'ftlass II installations themselves., One other minor matter is the routing- of Class II sanitary reports. A change is being made in Arfoy Regulations UO-275>; necessary concurrences have been.submitted. and permission to publish this regulation -.has;,been granted, :This change directs that ’sanitary reports from Class II 'installations will be submitted.to army commanders. This is necessary so pjbHat’ 'the -army commanderv.ua-a.make, a comprehensive sanitary report for the xarea of army jurisdiction,. ■ • . W l”' ; - ’Concerning- the program that was set up in-WD ; Circular 211, 1.926, Lieutenant Colonel1 Long will comment on that and give our reasons- for its •adoption,*’ Also, Colonel Long will comment •very briefly on influenza control. We: would like to ask your cooperation • in certain phases of the-influenza program for the coming year. Lieutenant Colonel Arthur P, Long, MC, Chief of the Infectious Disease Control Branch made the following statements in regard to in- fluenza and diphtheria control: We don’t know-if we are going to have influenza again this year or not, Fran the experience of the last twenty-two years, there may well be at least a moderate outbreak. There was no "sentinel outbreak" last spring. The decision has not as yet been made whether or not we will apply routine influenza vaccination in the Army again this year. What 1 would like to ask is that you commanding officers of army hospitals will have your chiefs of medical service -when, they have cases—-truly suspicious influenza cases—•submit acute and convalescent serum specimens on those cases for specific .diagnosis. We have only two laboratories manned to do this diagnosis.at this time. One is the Army Medical School the other is•the Sixth Army Laboratory at Monterey, Within the next few weeks or a month we hope to have at least one or two other laboratories equipped to do influenza diagnoses. You will be informed through proper channels of the availability of these laboratories. If you-find, anything that looks like influenza let us know and send in a few serum specimens. We don't want a lot of specimens—actually, a dozen or two dozen paired specimens from suspicious cases is 411 that is required, . '-As for diphtheria, most'of you recall that about a year ago an.ASF Circular set forth instructions for the immunization of all per- sonnel- -in general hospitals who might come in contact with this disease. At; that time .about, sixty-five percent of the diphtheria in this country was occurring-' in,.general hospitals. In July of this year all ASF Circulars were rescinded and WD Circular 211 came out with instructions that all hospital personnel likely to come in contact with diphtheria’ must be Immunized, We feel that this is still a good program. Diphtheria is be- coming quite a problem in the young adult group. Knowing that this-is a difficult procedure, it certainly can be done better in a hospital where there are people who can do this work. Because of reactions, it is a difficult thing to do in adults. For that reason, I think it can best be done in a good medical installation, . , ’ ■ • Another-thing, I would' suggest that you, don’t line up the whole staff of diphtheria immunization fat one time. Don’t do large segments all at one time-because you may get into trouble. Use the outline in TB Med 11b, ,-lt is. hot perfect-but you will have less trouble. Colonel. Whayhe stated that there are two questions oh laboratories relationship of army' area/-laboratories and- one question with regard to the chief of laboratory service'in-hospitals. He asked Lieutenant Colonel Cavenaugh to discuss these points. : Lieutenant‘Colonel Robert L, Cavenaugh, MC, Chief’ of the Laboratories Branch made the following statements: ' There are two points in regard to laboratories. One, the re- lationship of laboratories in general hospitals to the army area laborator- ies. The status of the army area laboratories is 3 little bit uncertain at the moment, A request has gone in for all six army laboratories to be transferred back to The Surgeon General as Class IT installations, just as are all the general hospitals. But regardless of whether they are Class II installations or are under the army commanders, we still want to have them considered as "general1’ in function, because they provide a general service to all the installations in the area, which includes ■‘general; hospitals. They-' provide.- laboratory service; of- therpreventive 'mddicine type to .general; hospitals. .Al&o,- it is. rdcognized that; the chiefs of these• laboratories, who are- selected nperi,; have a staff of trained: personnel to bd utilized as-laboratory. to help you in any laboratory .problem which come up,. Unfortunately, it :1s not'-possible to have an array area, laboratory ,,consultant in each -.area. So the chief of the, army laboratory in;each-area is your best-con- sultant, 1 In case you have a -call for: a more extensive type-Of laboratory consultation, there-'will be a few specialists of the' highest type working out of the Office of.The. Surgeon 'General, or on ‘call by The. Surgeon General. These specialists will’ be-’available to ■ serve you#: , . * ’ " • . ' Another means in which these army, area laboratories can be of service to the, general hospitals will :be .in evaluation-studies: t ions of, unknown specimens, in chemistry, serology, bacteriology, neto;.;,'; -sent, out to all the hospitals ,in. the area by the array laboratories, . this is to maintain the hospital laboratory work at the ■ hlghes.t fieyel of accuracy, and to obtain help in technical matters where ‘needed.. --We, ask' that your hospital laboratory cooperate actively with the requests of fpe area laboratories, . -They are of great value to you in maintaining your laboratory procedures at a high level of accuracy. DISCUSSION: COLONEL KEELER: ’’ Is .it planned to continue; .the laboratory at Fort Lewis? .LT, COLONEL CAVEKAUGH: :Yesl Approximately ajs it Is now. In other words, it functions as ah army area laboratory,.Tbut is under your control. Lt. Colonel Cavenaugh stated the other point he'wanted to bring up was "the question in Sanitary‘Corps officers .serving as chiefs of laboratories. This-has happended in a feW instances, It ..is not_a,desirable situation. If you want a reference to'it, paragraph 177, TM 8-260, directs that the senior medical officer assigned to the. • laboratory service be designated Chief of laboratory, ..Decisions and responsibilities as chief of labora- tory should be made by a* medical officer, and this will relieve the Sanitary Corps' officer of making such.decisions. It is a matter of checking, to see .that this directive is applied in your hospitals. K. GENERAL DISCUSSION AND SUMMARY Major General Norman T. Kirk Brigadier General R* W* Bliss Brigadier General Guy B# Denit Hospital Commanders brigadier General Guy’B, Denit, Chief of’ Plans and-Operations, Office of The .Surgeon General, complimented the hospital- commanders on the smoothness with which the change in control of general hospitals from service, commands to' control by The Surgeon General was made. . In. regard to the allocation of personnel to the armies by the War Department ..Manpower Board.for the performance of certain functions at Class II installations,“General Denit pointed out: that;the :concern of the hospital commanders.should be in the type of service 'provided— is ;|Lt; adequate ?--and not in the numbers of persoftrtel involved,': In the • bulk .'allotment .of personnel- to the armies, the Department Manpower Board includes a breakdown of personnel, whiQh* shows' "how the board arrived at the allotment.- ' This breakdown is merely for the information of the army and .does hot restrict an array commander in the utilization of his personnel, " h ■ • • . General Denit stated that he was very much impressed with what .Colonel Armstrong said about the proper utilization and assignment of medical personnel. He pointed out that we might do a better job of ."selling" the Medical Department to our younger men. The advantage of a'Regular Amy medical career-should be pointed out, and our younger officers should be informed of the measures that are being taken to make their careers attractive*"• He pointed out that he had a chance to talk to three.Regular Army Medical Corps officers who ‘wanted to resign, but ’who, after he had talked with them, were reassured and decided to stay in the Corps. • *;,fJ • * • <• - General Denit mentioned the recent conference; 6f The Surgeon General with the army surgeons, which was a profitable and splendid meeting. One of. tHe matters discussed at that Conference was the coordination of medical technical matters at Class II medical installa- tions by the army surgeon. This matter was presented to the 'War Department and approval given for The Surgeon General to call upon the army surgeons as his-technical; representatives in medical matters at Class II installations. General Denit closed his remarks by stressing the need for continued striving—even in the face of economy talk—to make our hospitals the finest in the country—the best physical plants and the finest equipment. ., yi Brigadier QeoeralURaymorid^Wi^Sliss> Deputy-burgeon General 4spoke Bliss stated that he was sure that if all the hospital: commanders were getting half as much from the conference as he..was, -the time.-was well-spent. General Bliss called upon Colonel Turnbull, Commanding Officer of Tilton General Hospital. -Colonel Turnbufl iagreed that ithe-rOonf ere nee'had been a very .profitable; one. .-H& stated that vhe .h'Scd!-r’found‘Out things that he had .wonderedyabput; fotr.olong months. He complimented those in charge for ,-fho- effici©ney>;,and-ccpmpetency, of everything that v£as‘fk3#he. Colonel Turnbull had one criticism to make, and that was in regard to messes, He:, -though-t that;-thls, subJe:ct-.,would have,-.been a verjk illuminating and sney,nai-ntf:*r v' * C ‘ ‘'l *.c-5“ oo or; i 3 arJ o::o heir: lee d . vm ; 1 •' vooa gf;jv'feigndie;r;,-General; Charles. rC;. Hillman, ‘Commanding General, and Colonel' Cleon J,- Ce’ritzkbw,' Commanding pff leery yValley;,Forge penbral Hospital,, spoke - next;-' ’They expressed the ir,‘.appreoi.artion •of 'the,; opportunity to. assemble as they had in conference,-, a-nd- the hope that conferences of‘this kind might be called more- of ten-, ; re'‘ioo i c- •" Major General Norman T, Kirk, The Surgeon General, concluded •>the conference*,;,: He-emphasized the esprit bf’-the:MedicalICorps, and ,,;the. continued;-striving ■ to-have the.ibest medicdl- service available. He stressed the need;‘for good public relations*- and; for -the utilization of-.£hp abundance of material available for the: training' of Medical .Department;:pergonnel,;.; He made particular reference'-to the® Technical Medical.-Bulletins • and-.the-many excellent'‘training films developed during the war. The TB Medsy’stated General' Kirk, lfAre "better than most, text books, on medicine, and a reference Set of:them' should be available in:-each hospital library. " ' • r*-; ;; -• • t * ♦ r- * General Kirk mentioned the efforts being made to increase ,vfhe .numher of- nurses, -anesthetists, from three‘"to five in general -t j hospitals, .and the ratio, of nurses-per 'beds from one to twelve to one .to ten, ' : . ' ' -The conference ended 1600 hours, 23 -August 19'U6, OFFICE OF THE SURGEON GENERAL MEDICAL STATISTICS DIVISION, HE ALTH REPORTS BRANCH BEDS AUTHORIZED PATIENTS REMAINING BEDS OCCUPIED HOSPITALIZATION DATA ALL TYPES OF HOSPITALS CONTINENTAL UNITED STATES Q UJ h- o cr i— (Si ■UJ cr OFFICE OF THE SURGEON GENERAL MEDICAL STATISTICS DIVISION, HEALTH REPORTS BRANCH PATIENTS REMAINING IN ARMY HOSPITALS US. AND OVERSEAS UNITED STATES OVERSEAS (INCLUDES BOTH ARMY AND NONARMY) OFFICE OF THE SURGEON GENERAL MEDICAL STATISTICS DI VI S I ON, HEALTH REPORTS BRANCH HOSPITALIZATION DATA BY TYPE OF HOSPITAL REGIONAL HOSPITALS I i STATION HOSPITALS BEDS AUTHORIZED PATIENTS REMAINING BEDS OCCUPIED GENERAL HOSPITALS PROPER CONVALESCENT HOSPITA1 S NUMBER OF EVACUEES REMAINING GENERAL AND CONVALESCENT HOSPITALS-END OF MONTH ALL ARMY PATIENTS EVACUEES OFFICE OF THE SURGEON GENERAL MEDICAL STATISTICS DIVISION, HEALTH REPORTS BRANCH ARMY PATIENTS EVACUATED TO THE UNITED STATES NUMBER OF PATIENTS ARRIVING EACH MONTH EVACUATED FOR DISEASE, NON-BATTLE INJURY, AND BATTLE WOUNDED I TOTAL DISEASE BATTLE WOUNDED NON-BATTLE INJURY OFFICE OF THE SURGEON GENERAL MEDICAL STATISTICS DIVISION, HEALTH REPORTS BRANCH TOTAL RECEIVED OTHER BY Al R DEBARKATION PATIENTS RECEIVED CONTINENTAL UNITED STATES OFFICE OF THE SURGEON GENERAL MEDICAL STATISTICS DIVISION, HEALTH REPORTS BRANCH HOSPITALIZATION DATA GENERAL AND ASF CONVALESCENT HOSPITALS GENERAL a ASF CONVALESCENT HOSPITALS GENERAL HOSPITALS ASF CONVALESCENT HOSPITALS i I TOTAL FINAL DISPOSITIONS PATIENTS RETURNED TO DUTY i I PATIENTS ON SICK LEAVE, FURLOUGH, ETC. 1 I PATIENTS GIVEN CDD HOSPITAL CAPACITY AND PATIENT LOAD IN THE GENERAL - CONVALESCENT HOSPITAL SYSTEM IN THE UNITED STATES Educational hecon-j 'ditioniag Br. *2 J Information c* Education fc—mmwimiiiiw n mi— wmmmmmmi »■ j Personal ail axrs 8 Branch Veterans “■ Auiiiinistrat ion j Cenva3.es cent "Services"j [ Division I 20 August 1946 NAMED (kRERAL* HOSPITAL ESTABLISHMENT OF PHYSICAL MEDICINE SERVICE AND CONVALESCENT SERVICES DIVISION ‘ _ Indicates Liaison) Special Services j Branch f j Classification eT| i Counseling Br**2 r *AGF a- AAF Liaison Officers Red Gross Commanding Officer . Convalescent Annex 3 Companies *1 A - Medical B - Surgical C - N. ?* , - If not sufficient beas authorised for 3 companies s 2 or one company may be organised ior administration with platoons for 3 professional specialties* *% - To be adsOr&ed by Education Officer, l&±: Branch, in the future. j Rseondi- | 1. tionjLiig Branch | Physical Medicine j Service j Occupational ! Therapy Branch i Physical Therapy Branch. BUILDING - MAINTENANCE-COSTS AVERAGE PER SQ_. FT, F.Y 1946 Ft.Bliss 2.54 cents 7.25 ■■ 3.29 ■■ 12.66 ■■ 6.34 ■■ 11,85 ■ 5.24 ■■ 17.04 • -Beaumont G.H. Presidio of Sf. -Letterman G.H Ft. Dix -Tilton G.H. Ft. Devens -Lovell G.H. OFFICE OF THE CHIEF OF ENGINEERS REPAIRS* UTILITIES DIVISION MAINTENANCE A REPAIR BRANCH BUILDING 4 STRUCTURES SECTION COMPARATIVE MAINTENANCE COSTS AVERAGE OF ALL CLASS I «. CLASS H INSTALLATIONS • COMPARED WITH GENERAL HOSPITALS PER ACRE 28 97656 ALL $ 11.38 IMPROVED GROUNDS GEN. HOSP. #125- 06 ALL }.SZ CENTS PER SQ.FT. GEN. H05P. 11 .52 CENT5 BUILDINGS STATUS OF RESIDENCIES p T PERMANENT APPROVAL [r] COUNCIL REC’MD TO AMERICAN BOARDS TEMPORARY APPROVAL notify following re changes 1. CHIEF, EDUCATION AND TRAINING DIVISION (o) Chief .Officer Branch 2, CHIEF, CLASSIFICATION, MILITARY PERSONNEL DIVISION fa_ fa. fa>. fa. fa. fa.. fa. fa% fa. fa. j ::js> Jk Jk. Jk Jk i RESIDENCI HOSPITAL /i i |/ A / J 17 | 7 i / £ £ / £ A v /i / i / $ M $/i '/ i if $ / i /$ Wl/ f / i A #A a7 ® / * / * / /« &/ / A / <0 / ia / & / Q> / £ / y / a; / /I /7l / / #/ 17 c / C / * / ? // r §/ $ /i !'/&/ / £ / S' / S 71 * / A A BASIC BRANCH COURSE 100% BROOKE ARMY MEDICAL CENTER (4 MO.) V y BROOKE ARMY MEDICAL CENTER FT SAM HOUSTON, TEXAS BASIC BRANCH COURSE HOSPITAL ADMINISTRATION (MC) ADVANCED BRANCH COURSE OPTICAL REPAIR HOSPITAL ADMINISTRATION (PC) MILITARY NEUROPSYCHIATRY ARMY MEDICAL CENTER, WASHINGTON, O.C. (ARMY MEDICAL RESEARCH 8 GRADUATE TEACHING CENTER) BASIC SCIENCES TROPICAL B GLOBAL MEDICINE LABORATORY MEDICINE ADVANCED DENTAL PREVENTIVE MEDICINE ADVANCED VETERINARY ST. LOUIS MEDICAL DEPOT. ST. LOUIS, MO, ARMY-NAVY MEDICAL EQUIPMENT MAINTENANCE SCHOOL OF MEAT B DAIRY HYGIENE CHICAGO QUARTERMASTER DEPOT, CHICAGO, ILLINOIS MEAT 8 DAIRY HYGIENE SCHOOL OF AVIATION MEDICINE, RANDOLPH FIELD. TEXAS BASIC AVIATION MEDICINE ADVANCED AVIATION MEDICINE ' BASIC OFFICER’S COURSE 100% FT. RILEY, KANSAS (4 MO.) y PREPARATORY COURSE (I MO ) TIME AND PLACE TOPIC FOR DISCUSSION - ACTIVITY DISCUSSION CHAIRMAN 22 August - Room 2E I4Q8, The Pentagon O83O - 0900 Register in Executive Office Room 2E-28U, The Pentagon 0900 - 0915 Welcoming Address Maj, Gen.N.T.Kirk 0915 - 0930 Statement of Conference Aims Brig. Gen.R.W,Bliss 0930 - 1030 Array Hospitalization Program: Lt. Col*J*T*McGibony Review of Hospitalization Program, including present and Projected Status of General Hospital Operation, Class II Hospitals at Class I Posts, and Future Plans 1030 - 1100 Long Range Hospital Construction Program, Lt, Col,J,Sender including activities of Post Planning Boards 1100 - 1115 Recess 1115 - llU£ Maintenance,Repair and Utilities in Representative,Ofc.C Engrs. Array Hospitals llii5> - 1215 Open Discussion Lt.Col.J.T.McGibony and Conferees Incl, #1IA AGENDA CONFERENCE OF THE SURGEON GENERAL with Commanders of Named General Hospitals August 19U6 22 August - Room 2E-qQ8 (Cont’d) 121$ - ll|00 Luncheon - Officersf Dining Room Lounge Corridor 10, 3rd Floor,between A and C Rings Army Hospitalization Program (Cont*d) lUOO - 1$00 The Federal Hospitalization Program, Representative,Bureau including Bureau of Budget Interests of Budget in Army Hospitalization Program - I63O Army Hospital Supply Program: Col,S.B.Hays Methods of Handling Supply of Non- standard of Allowances and Control of Issue of Equipment Hospital equipment Modernization Program 1900 - Reception and Dinner (Officers) - Officersf Club,Army Medical Center TIME AND PLACE - TOPIC FOR DISCUSSION - ACTIVITY DISCUSSION CHAIRMAN 23 August 194-6 - Room 2E-408, The Pentagon 0900 - 1130 Personnel Problems in Army Hospitals: Col.F.P.Kintz (0930 - 1045) Use of Medical Department Specialists Col.A.Freer and and Expert Consultants Col.F.L,Cole General Discussion of Personnel Problems, Col.F.P.Kintz, including Central Officer's Assignment Officers & Civilians Group; Army Integration and Army Interne Programs; Officer and Enlisted Personnel; Nursing, Dietetic and Physical Therapy Personnel; Civilian Personnel (104.5 * 1100) Recess (1100 - 1115) Dental Personnel * Brig. Gen. T.L.Smith (1113 - 1130) Performance of Station Complement Major R.Murray,Jr. Functions at Class II Hospitals 1130 - 1200 Fiscal Problems in Army Hospitals, Includ- Mr. N. Fogelberg _ ing availability of Pounds and proper Charges against Appropriated Funds. AGENDA CONFERENCE OF THE SURGEON GENERAL with Commanders of Named General Hospitals 22-23 August 194£ 0* ' 23 August 194-6 - Room 2E - 408 (Cont'd) 1200 - 1315 • Lunch - Officers' Dining Room - Lounge Corridor 10, 3rd Floor, Between A and C Rings 1 1315 - 1415 Training Activities at Army Hospitals: Col.R.S.Duke Professional Graduate Training Program, including Interim Refresher Training, Interne Training, and Residency Training Programs Training of General Reserve Units 1415 - 1500 Professional Administrative Problems in Col.A.N,Nylen Army Hosoitals, including Board Pro- cedures in connection with the Disposition of Patients 1500 - 1520 Preventive Medicine Problems in Army Col.T.F.Whayne Hospitals 1520 - 1630 General Discussion and Summary Maj.Gen.N.T.Kirk, Brig. Gen. R.l/j .Bliss, Brig.Gen.G.B.Denit and Hospital Commanders