A-18084, MAY 3, 1927, 6 COMP. GEN. 719

A-18084: May 3, 1927

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IT IS DISCLOSED THAT THE DIAGNOSIS BY THE BUREAU WAS ERRONEOUS AND THAT THE TREATMENT AT THE EXPENSE OF THE GOVERNMENT WOULD NOT HAVE BEEN AUTHORIZED. THAT EMERGENCY TREATMENT WAS GIVEN FOR OTHER CAUSE. THE COST OF SUCH TREATMENT IS A CHARGE AGAINST THE ALLOTMENT MADE TO THE NAVY DEPARTMENT FROM THE VETERANS' BUREAU APPROPRIATION FOR MEDICAL AND HOSPITAL SERVICES. WHICH IS RESPONSIBLE FOR HIS ADMISSION TO THE NAVAL HOSPITAL. THE PARTICULAR CASE PRESENTED IS THAT OF JOHN GOVENLOCK. A CANADIAN EX-SERVICE MAN WHO WAS FURNISHED HOSPITALIZATION AT THE UNITED STATES NAVAL HOSPITAL. AS FOLLOWS: THE RECORDS OF THE BUREAU SHOW THAT HOSPITALIZATION OF THE BENEFICIARY FOR PHYSIOTHERAPY TREATMENT FOR SCIATIC NEURITIS WAS AUTHORIZED BY THE REGIONAL MEDICAL OFFICER OF THE BUREAU REGIONAL OFFICE AT RICHMOND.

A-18084, MAY 3, 1927, 6 COMP. GEN. 719

MEDICAL TREATMENT - VETERANS' BUREAU BENEFICIARIES FURNISHED TREATMENT IN NAVAL HOSPITALS WHERE, SUBSEQUENT TO THE ADMISSION OF A BENEFICIARY OF THE VETERANS' BUREAU IN A NAVAL HOSPITAL BY PROPER AUTHORITY OF THE BUREAU, WITHOUT ANY NOTICE TO THE NAVY DEPARTMENT OF ANY ADMINISTRATIVE IRREGULARITY, IT IS DISCLOSED THAT THE DIAGNOSIS BY THE BUREAU WAS ERRONEOUS AND THAT THE TREATMENT AT THE EXPENSE OF THE GOVERNMENT WOULD NOT HAVE BEEN AUTHORIZED, BUT THAT EMERGENCY TREATMENT WAS GIVEN FOR OTHER CAUSE, THE COST OF SUCH TREATMENT IS A CHARGE AGAINST THE ALLOTMENT MADE TO THE NAVY DEPARTMENT FROM THE VETERANS' BUREAU APPROPRIATION FOR MEDICAL AND HOSPITAL SERVICES, RATHER THAN TO THE APPROPRIATION FOR MEDICAL TREATMENT PROVIDED UNDER THE NAVY DEPARTMENT.

COMPTROLLER GENERAL MCCARL TO THE SECRETARY OF THE NAVY, MAY 3, 1927:

CONSIDERATION HAS BEEN GIVEN TO YOUR REQUEST OF APRIL 6, 1927, FOR DECISION UPON THE FOLLOWING QUESTION:

* * * WHEN A PATIENT HAS BEEN PROPERLY TRANSFERRED TO AND ADMITTED INTO A NAVAL HOSPITAL FOR TREATMENT FOR A "SERVICE CONNECTED DISABILITY" AND SUBSEQUENT TO SUCH ADMISSION AND WHILE IN SAID HOSPITAL HE DEVELOPS OTHER OR CONCURRENT OR SEQUELAE CONDITIONS REQUIRING TREATMENT, SHOULD THE COST OF HOSPITALIZATION, UNDER CHANGED DIAGNOSIS, PROPERLY FALL ON THE U.S. VETERANS' BUREAU, WHICH IS RESPONSIBLE FOR HIS ADMISSION TO THE NAVAL HOSPITAL, OR ON THE BUREAU OF MEDICINE AND SURGERY OF THE NAVY DEPARTMENT?

THE PARTICULAR CASE PRESENTED IS THAT OF JOHN GOVENLOCK, C-G-441 REGT. NO. 2626952, A CANADIAN EX-SERVICE MAN WHO WAS FURNISHED HOSPITALIZATION AT THE UNITED STATES NAVAL HOSPITAL, NORFOLK, A., DURING THE PERIOD MARCH 13 TO MAY 6, 1925, INCLUSIVE.

THE NAVY DEPARTMENT CHARGED THE COST OF THE TREATMENT, $198.54, AGAINST THE FUNDS ALLOTTED TO THE NAVY DEPARTMENT FROM THE VETERANS' BUREAU APPROPRIATION FOR MEDICAL AND HOSPITAL SERVICES UNDER AUTHORITY OF ANNUAL APPROPRIATION ACTS (F.Y. 1925, SEE ACT OF JUNE 7, 1924, 43 STAT. 532). UNDER DATE OF FEBRUARY 1, 1927, THE VETERANS' BUREAU ADDRESSED THE BUREAU OF MEDICINE AND SURGERY, NAVY DEPARTMENT, AS FOLLOWS:

THE RECORDS OF THE BUREAU SHOW THAT HOSPITALIZATION OF THE BENEFICIARY FOR PHYSIOTHERAPY TREATMENT FOR SCIATIC NEURITIS WAS AUTHORIZED BY THE REGIONAL MEDICAL OFFICER OF THE BUREAU REGIONAL OFFICE AT RICHMOND, VA., ON AUTHORITY OF CENTRAL OFFICE, AND THAT THE EX-SOLDIER WAS EXAMINED ON THE DAY HE WAS ADMITTED AND THE DIAGNOSIS CHANGED TO ACUTE APPENDICITIS, THAT HE WAS OPERATED ON THAT NIGHT AND GIVEN THE USUAL POST-OPERATIVE TREATMENT AND AFTER CARE FOR HIS AILMENT.

THE RECORDS FURTHER SHOW THAT THE TREATMENT WAS NOT FOR A SERVICE CONNECTED DISABILITY AND WAS NOT AUTHORIZED BY THE COUNTRY UNDER WHOSE FLAG THE EX-SOLDIER SERVED NOR BY AN OFFICIAL OF THIS BUREAU. THEREFORE, THE EXPENSE IS NOT A PROPER CHARGE AGAINST THE BUREAU ALLOTMENT.

THE FACT THAT THE TREATMENT WAS CONSIDERED EMERGENCY TREATMENT DOES NOT WARRANT REIMBURSEMENT FOR THE REASON THAT THERE IS NO PROVISION OF LAW OR REGULATION UNDER WHICH AN ALLIED EX-SERVICE MAN MAY BE FURNISHED EMERGENCY TREATMENT FOR OTHER THAN A SERVICE-CONNECTED DISABILITY.

IT IS REQUESTED THAT THE SUM OF $198.54, THE AMOUNT CHARGED FOR THE SERVICE IN QUESTION, BE RETURNED TO THE ALLOTMENT FROM WHICH IT WAS DEDUCTED AND THE BUREAU ADVISED WHEN THIS ACTION IS TAKEN IN ORDER THAT THE RECORDS MAY BE COMPLETED.

THE BUREAU OF MEDICINE AND SURGERY CONTENDS AS FOLLOWS:

1. UNDER EXISTING LAW AND AGREEMENT, VETERANS' BUREAU PATIENTS ARE ADMITTED TO NAVAL HOSPITALS ON THE REQUEST AND RESPONSIBILITY OF AND WITH THE DIAGNOSIS DETERMINED BY, THE OFFICIALS OF THAT BUREAU. AFTER ADMISSION, HOWEVER, AND DURING THE PERIODS SUCH PATIENTS ARE RETAINED IN THE NAVAL HOSPITALS, THEY ARE CARED FOR, NECESSARILY, ACCORDING TO THE AILMENTS WITH WHICH THEY MAY BECOME AFFLICTED. IT IS IMPRACTICABLE IN THE HUMANE AND PROPER HOSPITAL TREATMENT OF SUCH CASES TO AVOID GIVING TREATMENT FOR OTHER CONDITIONS (THAN ORIGINALLY DIAGNOSED) THAT INDEPENDENTLY ARISE AS CONCURRENT CONDITIONS OR THAT NATURALLY FOLLOW AS SEQUELAE.

2. IN THE CASE IN QUESTION IT MIGHT PERHAPS BE THAT THE "SCIATIC NEURITIS" FOR WHICH THE MAN WAS ADMITTED, AND THE "ACUTE APPENDICITIS" FOR WHICH HE WAS IMMEDIATELY TREATED WERE DIFFERENT MANIFESTATIONS OF THE SAME STREPTOCOCCEMIA CONDITION, AND THAT THE TREATMENT GIVEN THE APPENDICITIS RELIEVED THE NEURITIS FOR WHICH HE WAS ADMITTED.

3. UNDER THE CIRCUMSTANCES HEREIN CONSIDERED, HOWEVER, IT IS NOT IMPORTANT (AND IT IS NOT CONTENDED) WHETHER THE DIAGNOSIS OF THE VETERANS' BUREAU (SCIATIC NEURITIS) WAS CORRECT OR INCORRECT; IT IS ADMITTED THE PATIENT WAS LEGALLY TRANSFERRED TO THE NAVAL HOSPITAL WITH A DIAGNOSIS OF A "SERVICE-CONNECTED DISABILITY" AND WAS SO RECEIVED. UPON ADMISSION, HOWEVER, IT WAS FOUND THAT A MORE IMMEDIATELY EXIGENT CONDITION EXISTED THAN THAT FIRST DIAGNOSED, NAMELY, APPENDICITIS, AND FOR THE PURPOSE OF THE OPERATION THE DIAGNOSIS WAS ACCORDINGLY CHANGED.

THE COST OF MEDICAL AND HOSPITAL TREATMENT RENDERED IN AN EMERGENCY TO A BENEFICIARY AFTER HAVING BEEN REGULARLY ADMITTED TO A GOVERNMENT HOSPITAL, FOR A DISEASE OR DISABILITY OTHER THAN THE ONE FOR WHICH ADMITTED, IS PROPERLY CHARGEABLE TO THE APPROPRIATION FOR MEDICAL AND HOSPITAL SERVICE, VETERANS' BUREAU. THE AUTHORITY TO USE ALLOTMENTS REGULARLY MADE TO OTHER BRANCHES OF THE GOVERNMENT, INCLUDING THE NAVY DEPARTMENT, FOR DIRECT EXPENDITURE FOR TREATMENT OF BENEFICIARIES OF THE VETERANS' BUREAU WOULD BE NO DIFFERENT IN THIS RESPECT. WHERE THE SITUATION MAKING THE TREATMENT IN THE NAVAL HOSPITAL NECESSARY IS A DIRECT RESULT OF THE ACTION OF THE VETERANS' BUREAU, THE APPROPRIATION AUTHORIZED UNDER THE VETERANS' BUREAU AND ALLOTTED TO THE NAVY DEPARTMENT IS EXCLUSIVELY CHARGEABLE WITH THE COST OF SUCH TREATMENT.

IF, IN SUCH A CASE, THERE IS NO EMERGENCY, AND THE NAVY DEPARTMENT DIAGNOSIS DIFFERS FROM THAT OF THE VETERANS' BUREAU, NO TREATMENT SHOULD BE GIVEN IN A NAVAL HOSPITAL UNTIL THE MATTER HAS BEEN REVIEWED BY THE VETERANS' BUREAU AND ITS DIAGNOSIS CONFIRMED OR CORRECTED. IN SO FAR AS THE RIGHT TO TREATMENT AT THE EXPENSE OF THE VETERANS' BUREAU APPROPRIATION IS CONCERNED THE FINAL DIAGNOSIS OF THE VETERANS' BUREAU SHOULD CONTROL.

IT IS UNDERSTOOD THAT IN THE CASE OF JOHN GOVENLOCK, IF THE DIAGNOSIS OF THE VETERANS' BUREAU HAD BEEN CORRECTED AND TREATMENT GIVEN ACCORDINGLY, THE ALLOTMENT MADE TO THE NAVY DEPARTMENT FROM THE APPROPRIATION FOR MEDICAL AND HOSPITAL SERVICE, VETERANS' BUREAU, WOULD HAVE BEEN CHARGEABLE WITH THE COST OF THE TREATMENT UNDER AUTHORITY OF SECTION 202 (14) OF THE WORLD WAR VETERANS' ACT DATED JUNE 7, 1924, 43 STAT. 621. IT IS UNDERSTOOD ALSO THAT THE TREATMENT GIVEN BY THE NAVY DEPARTMENT WAS CONSIDERED AS NECESSARY IN AN EMERGENCY. THE ERROR OF THE VETERANS' BUREAU, IF SUCH THERE WAS, MAY NOT BE CONSIDERED AS OBLIGATING APPROPRIATIONS PROVIDED FOR MEDICAL AND HOSPITAL TREATMENT DIRECTLY UNDER THE NAVY DEPARTMENT. ACCORDINGLY THE CHARGING OF THE COST OF THE TREATMENT AGAINST THE NAVY DEPARTMENT ALLOTMENT FROM THE VETERANS' BUREAU APPROPRIATION FOR MEDICAL AND HOSPITAL SERVICES, RATHER THAN TO THE APPROPRIATION PROVIDED UNDER THE NAVY DEPARTMENT, WAS AUTHORIZED. THE DIRECTOR OF THE VETERANS' BUREAU HAS BEEN ADVISED ACCORDINGLY.