A-10994, NOVEMBER 9, 1925, 5 COMP. GEN. 340

A-10994: Nov 9, 1925

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MEDICAL TREATMENT - VETERANS' BUREAU BENEFICIARIES IN PRIVATE HOSPITALS WHERE A PRIVATE HOSPITAL IS AUTHORIZED BY THE VETERANS' BUREAU TO FURNISH MEDICAL TREATMENT TO A VETERAN OF THE WORLD WAR. SAID HOSPITAL IS ENTITLED TO PAYMENT FOR THE COST OF REASONABLE AND NECESSARY TREATMENT FURNISHED. NOTWITHSTANDING THE VETERAN MAY HAVE. IS LIMITED TO THE NECESSARY AND AUTHORIZED PERIOD OF TREATMENT. 1925: THERE IS FOR CONSIDERATION THE REQUEST OF THE MAYO CLINIC FOR REVIEW OF SETTLEMENT NO. 027064. THAT SUBSEQUENTLY HIS HOSPITALIZATION AND TREATMENT AT ROCHESTER WERE AUTHORIZED BY THE VETERANS' BUREAU AND HE WAS ADMITTED TO TREATMENT BY THE MAYO CLINIC AT ROCHESTER. THE DECISIONS OF THIS OFFICE DISALLOWING PAYMENT OR REIMBURSEMENT FOR MEDICAL AND HOSPITAL TREATMENT AT PRIVATE HOSPITALS BECAUSE THE BENEFICIARIES HAD REFUSED TREATMENT AT GOVERNMENT HOSPITALS WERE NOT INTENDED TO.

A-10994, NOVEMBER 9, 1925, 5 COMP. GEN. 340

MEDICAL TREATMENT - VETERANS' BUREAU BENEFICIARIES IN PRIVATE HOSPITALS WHERE A PRIVATE HOSPITAL IS AUTHORIZED BY THE VETERANS' BUREAU TO FURNISH MEDICAL TREATMENT TO A VETERAN OF THE WORLD WAR, SAID HOSPITAL IS ENTITLED TO PAYMENT FOR THE COST OF REASONABLE AND NECESSARY TREATMENT FURNISHED, NOTWITHSTANDING THE VETERAN MAY HAVE, AT A PRIOR DATE, REFUSED TO ACCEPT TREATMENT AT A GOVERNMENT HOSPITAL. PAYMENT, HOWEVER, IS LIMITED TO THE NECESSARY AND AUTHORIZED PERIOD OF TREATMENT, AND THE HOSPITAL MAY NOT BE REIMBURSED FOR TREATMENT FURNISHED DURING THE TIME THE VETERAN ELECTED TO REMAIN IN THE HOSPITAL AFTER BEING AUTHORIZED BY THE ATTENDING PHYSICIAN TO RETURN HOME.

DECISION BY COMPTROLLER GENERAL MCCARL, NOVEMBER 9, 1925:

THERE IS FOR CONSIDERATION THE REQUEST OF THE MAYO CLINIC FOR REVIEW OF SETTLEMENT NO. 027064, OF JULY 6, 1925, DISALLOWING ITS CLAIM FOR REIMBURSEMENT FOR AMOUNTS PAID THE COLONIAL AND KAHLER HOSPITALS FOR SERVICES RENDERED STUART LAKE, BENEFICIARY OF THE UNITED STATES VETERANS' BUREAU, DURING THE PERIOD SEPTEMBER 7, 1922, TO APRIL 6, 1923.

IT APPEARS FROM THE RECORD THAT IN A LETTER OF JUNE 27, 1922, THE BENEFICIARY REFUSED TREATMENT BY GOVERNMENT HOSPITALS OR SURGEONS, BUT THAT SUBSEQUENTLY HIS HOSPITALIZATION AND TREATMENT AT ROCHESTER WERE AUTHORIZED BY THE VETERANS' BUREAU AND HE WAS ADMITTED TO TREATMENT BY THE MAYO CLINIC AT ROCHESTER, MINN., BY DIRECT AUTHORIZATION OF THE MEDICAL OFFICER IN CHARGE OF THE DISTRICT 12 STATION, UNITED STATES VETERANS' BUREAU, SAN DIEGO, CALIF.

THE DECISIONS OF THIS OFFICE DISALLOWING PAYMENT OR REIMBURSEMENT FOR MEDICAL AND HOSPITAL TREATMENT AT PRIVATE HOSPITALS BECAUSE THE BENEFICIARIES HAD REFUSED TREATMENT AT GOVERNMENT HOSPITALS WERE NOT INTENDED TO, AND DO NOT, APPLY TO CASES IN WHICH THE TREATMENT BY PRIVATE HOSPITALS HAD BEEN DULY AUTHORIZED BY THE VETERANS' BUREAU. THE TREATMENT IN THIS CASE, HAVING BEEN FURNISHED UNDER AUTHORITY OF THE VETERANS' BUREAU, THE CLAIMANT IS ENTITLED TO PAYMENT THEREFOR IN SO FAR AS SUCH TREATMENT WAS WITHIN THE SCOPE OF THE AUTHORIZATION. IT APPEARS FROM THE RECORD THAT THE MAYO CLINIC DOES NOT MAINTAIN ITS OWN HOSPITALS BUT TREATS ITS PATIENTS AT OTHER HOSPITALS, AND THAT THE HOSPITALS INVOLVED IN THE PRESENT CLAIM HAVE BEEN PAID BY THE MAYO CLINIC, AS EVIDENCED BY RECEIPTED BILLS.

WITH RESPECT TO THAT PORTION OF THE CLAIM INVOLVING PAYMENT TO THE KAHLER HOSPITAL, THE FOLLOWING STATEMENT, DATED JULY 18, 1924, HAS BEEN FURNISHED BY THE DOCTOR OF THE MAYO CLINIC WHO AUTHORIZED THE TRANSFER OF THE PATIENT FROM THE COLONIAL TO THE KAHLER HOSPITAL:

I BELIEVE THE ONLY REMAINING POINT YOU WISH INFORMATION FROM ME ON CONCERNING STUART LAKE IS THE DIFFERENCE IN RATES BETWEEN THE COLONIAL AND THE KAHLER HOSPITALS. THE SITUATION IS THIS: MR. LAKE WAS TOLD HE COULD GO HOME, BUT HE ASKED PERMISSION TO GO OVER TO THE KAHLER FOR POSSIBLY TWO OR THREE WEEKS BEFORE LEAVING, SO THAT HE COULD GET MORE STRENGTH AND FEEL BETTER. ACCORDINGLY, I DISMISSED HIM FROM THE COLONIAL AND HE WENT OVER TO THE KAHLER HOSPITAL, * * *.

MY REASON FOR GIVING PERMISSION FOR MR. LAKE TO CHANGE FOR THE PERIOD MENTIONED FROM THE COLONIAL TO THE KAHLER WAS THAT HE HAD BEEN SO LONG A TIME AT THE COLONIAL, WAS DISSATISFIED WITH THINGS IN GENERAL, AND AS HE BEING THE TYPE OF INDIVIDUAL HE WAS, AN EDUCATED MAN GREATLY DEPRESSED FROM HIS EXPERIENCE IN THE WAR AND BY HIS FAILURE TO OBTAIN UNION IN THE FRACTURE, I FELT THAT HE WAS ENTITLED TO SOME SPECIAL CONCESSION. I AM FRANK TO SAY THAT I WOULD NOT HAVE GIVEN PERMISSION IN THE MAJORITY OF INSTANCES, BUT IT SEEMED TO ME THAT MR. LAKE'S CASE IS DIFFERENT FROM THE AVERAGE ONE.

IT THUS APPEARS THAT THE HOSPITALIZATION AT THE KAHLER HOSPITAL AFTER THE PATIENT'S CONDITION WAS SUCH THAT HE HAD BEEN TOLD BY THE MEDICAL OFFICER IN CHARGE OF HIS CASE THAT HE COULD GO HOME WAS NOT A REAL NECESSITY IN CONNECTION WITH THE AUTHORIZED TREATMENT. THE TREATMENT OR HOSPITALIZATION AT THE KAHLER HOSPITAL NOT BEING NECESSARILY INCURRED BUT DUE MERELY TO THE PERSONAL DESIRES OF THE PATIENT, CAN ONLY BE CONSIDERED AS A PERSONAL LIABILITY OF THE PATIENT AND NOT AS CREATING ANY LIABILITY ON THE PART OF THE GOVERNMENT THEREFOR. THE DISALLOWANCE AS TO THAT PORTION OF THE CLAIM MUST BE AND IS ACCORDINGLY SUSTAINED.

THE TREATMENT OR HOSPITALIZATION IN THE COLONIAL HOSPITAL WAS APPARENTLY A NECESSARY PART OF THE TREATMENT AUTHORIZED BY THE VETERANS' BUREAU, AND THAT PORTION OF THE CLAIM HAS BEEN REDUCED BY ADMINISTRATIVE AUDIT TO $1,993 AND FORWARDED TO THIS OFFICE "FOR CONSIDERATION UNDER DECISION OF APRIL 21, 1925.' SAID DECISION OF APRIL 21, 1925, A-8834, CONTAINED THE FOLLOWING:

CLAIMS OF INDIVIDUAL PHYSICIANS AND CONTRACT HOSPITALS FURNISHING MEDICAL AND HOSPITAL TREATMENT TO PERSONS NOT WITHIN THE TERMS OF THE CONTROLLING STATUTES SENT THEM BY THE PROPER OFFICIALS OF THE VETERANS' BUREAU, WHERE THE INDIVIDUALS OR HOSPITALS ACTED IN GOOD FAITH WITHOUT ANY KNOWLEDGE OF ADMINISTRATIVE IRREGULARITY, ARE FOR SUBMISSION TO THE CONGRESS FOR LEGISLATION, OR, IN EXCEPTIONAL CASES INVOLVING EMERGENCIES OR AN ERRONEOUS CONSTRUCTION OF DOUBTFUL PROVISIONS OF LAW, FOR PRESENTATION TO THIS OFFICE FOR CONSIDERATION AND DIRECT SETTLEMENT WITH ADMINISTRATIVE REPORT AND RECOMMENDATION.

THE PRESENT CASE DOES NOT INVOLVE THE TREATMENT OF A PERSON NOT ENTITLED TO THE BENEFITS OF THE WORLD WAR VETERANS' ACT. THE REFUSAL OF THE BENEFICIARY TO ACCEPT TREATMENT AT GOVERNMENT HOSPITALS WOULD NOT FOREVER BAR HIM FROM TREATMENT AT GOVERNMENT EXPENSE IF AND WHEN OTHERWISE AUTHORIZED BY PROPER OFFICIALS OF THE VETERANS' BUREAU, THE METHOD AND PLACE OF TREATMENT OF LAWFUL BENEFICIARIES OF THE BUREAU BEING PRIMARILY A MATTER FOR DETERMINATION BY THE DIRECTOR OF THAT BUREAU.