A-67796, MARCH 5, 1936, 15 COMP. GEN. 757

A-67796: Mar 5, 1936

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MEDICAL TREATMENT - PRIVATE - ARMY OFFICER A WARRANT OFFICER OF THE ARMY WHO VOLUNTARILY SELECTS AS HIS RESIDENCE A PLACE BEYOND THE LIMITS OF A METROPOLITAN AREA FIXED AS HIS DUTY STATION WITHIN WHICH MEDICAL SERVICE IS PROVIDED IN KIND. PERSONNEL WERE ADVISED THAT GOVERNMENT MEDICAL ATTENDANCE COULD NOT BE FURNISHED OUTSIDE OF DESCRIBED AREAS. 1936: THERE WAS DULY RECEIVED YOUR LETTER OF SEPTEMBER 28. SUBMITTING FOR DECISION WHETHER PAYMENT IS AUTHORIZED THEREON. LINNEY WAS ON DUTY AT HEADQUARTERS. HE "WAS FEELING SO BADLY THAT HE REPORTED AT THE DISPENSARY AT THE ARMY BASE FOR TREATMENT AND WAS ADVISED IN EFFECT TO GO HOME AND GO TO BED.'. THERE SEEM TO HAVE BEEN NO GOVERNMENT QUARTERS AVAILABLE FOR ASSIGNMENT TO WARRANT OFFICER LINNEY AT THE ARMY BASE AND HE WAS BEING PAID RENTAL ALLOWANCE.

A-67796, MARCH 5, 1936, 15 COMP. GEN. 757

MEDICAL TREATMENT - PRIVATE - ARMY OFFICER A WARRANT OFFICER OF THE ARMY WHO VOLUNTARILY SELECTS AS HIS RESIDENCE A PLACE BEYOND THE LIMITS OF A METROPOLITAN AREA FIXED AS HIS DUTY STATION WITHIN WHICH MEDICAL SERVICE IS PROVIDED IN KIND, MAY NOT BE REIMBURSED FOR COST OF CIVILIAN MEDICAL TREATMENT AT THE EXPENSE OF THE UNITED STATES, PARTICULARLY WHERE, BY GENERAL NOTICE GIVEN, PERSONNEL WERE ADVISED THAT GOVERNMENT MEDICAL ATTENDANCE COULD NOT BE FURNISHED OUTSIDE OF DESCRIBED AREAS, NOTWITHSTANDING A GOVERNMENT MEDICAL OFFICER CALLED AT HIS RESIDENCE AND FOUND NO REASON FOR HOSPITALIZING HIM AT THAT TIME AND LATER DEVELOPMENTS PROHIBITED TRANSPORTATION OF THE OFFICER TO GOVERNMENT FACILITIES.

ACTING COMPTROLLER GENERAL ELLIOTT TO MAJ. F. E. PARKER, UNITED STATES ARMY, MARCH 5, 1936:

THERE WAS DULY RECEIVED YOUR LETTER OF SEPTEMBER 28, 1935, SUBMITTING FOR DECISION WHETHER PAYMENT IS AUTHORIZED THEREON, VOUCHERS IN FAVOR OF ROBERT E. ROSS, M.D., $43, WEYMOUTH HOSPITAL, $78, AND ELLEN CRAIG, R.N., $35, COVERING MEDICAL, HOSPITAL, AND NURSING SERVICES RENDERED WARRANT OFFICER JOHN T. LINNEY, UNITED STATES ARMY, FEBRUARY 6 TO 14, 1935, IN THE CIRCUMSTANCES HEREAFTER DESCRIBED.

MR. LINNEY WAS ON DUTY AT HEADQUARTERS, FIRST CORPS AREA, ARMY BASE, BOSTON, MASS., AND APPARENTLY ASSIGNED FOR DUTY AS THE STENOGRAPHER FOR THE CORPS AREA INSPECTOR GENERAL, WHEN, ON FEBRUARY 4, 1935, HE "WAS FEELING SO BADLY THAT HE REPORTED AT THE DISPENSARY AT THE ARMY BASE FOR TREATMENT AND WAS ADVISED IN EFFECT TO GO HOME AND GO TO BED.' THERE SEEM TO HAVE BEEN NO GOVERNMENT QUARTERS AVAILABLE FOR ASSIGNMENT TO WARRANT OFFICER LINNEY AT THE ARMY BASE AND HE WAS BEING PAID RENTAL ALLOWANCE. HE HAD SELECTED HIS RESIDENCE AT BRAINTREE, OUTSIDE THE CITY LIMITS OF BOSTON, ALTHOUGH IT SEEMS TO BE CONTENDED, WITHIN THE METROPOLITAN AREA OR WITHIN "GREATER BOSTON AND VICINITY," AND 5 3/4 MILES BEYOND THE GEOGRAPHICAL LIMITS IN WHICH THE MEDICAL OFFICERS ATTACHED TO THE GENERAL DISPENSARY, BOSTON, MASS., UNDER THE CORPS AREA COMMANDER'S ORDERS, WERE REQUIRED TO MAKE CALLS TO VISIT PATIENTS IN THEIR QUARTERS. ON TELEPHONE REPORT BY HIS WIFE ON THE 5TH TO THE GENERAL DISPENSARY, IT WAS SUGGESTED THAT A CIVILIAN PHYSICIAN BE PROCURED AND IF, IN HIS OPINION, HOSPITALIZATION WAS NECESSARY, ARRANGEMENTS WOULD BE MADE TO SEND AN AMBULANCE TO TRANSPORT WARRANT OFFICER LINNEY TO THE HOSPITAL AT FT. BANKS, ADJACENT TO THE CITY OF BOSTON BUT SOME 18 MILES FROM BRAINTREE. ALTHOUGH THE CIVILIAN PHYSICIAN IS REPORTED TO HAVE EXPRESSED THE VIEW MR. LINNEY SHOULD BE HOSPITALIZED, A MEDICAL OFFICER ATTACHED TO THE GENERAL DISPENSARY CALLED AT HIS RESIDENCE ON THAT DAY, AND AS MR. LINNEY HAD SHOWN SOME EVIDENCES OF IMPROVEMENT, FOUND NO REASON FOR HOSPITALIZING HIM. THE ILLNESS BECAME MORE ACUTE, DEVELOPED PNEUMONIA, AND THE PATIENT THEN BEING DESCRIBED IN MEDICAL TERMINOLOGY AS "NONTRANSPORTABLE," THE CIVILIAN PHYSICIAN HAD MR. LINNEY ADMITTED TO THE WEYMOUTH HOSPITAL AT SOUTH WEYMOUTH, A DISTANCE APPARENTLY OF ABOUT 1 1/2 MILES FROM HIS HOME.

THE MATTER OF WHETHER PAYMENT OF THE BILLS BY THE GOVERNMENT IS AUTHORIZED HAS BEEN GIVEN EXTENDED CONSIDERATION BY ARMY AUTHORITIES AND THE VIEW IS EXPRESSED THAT 17 COMP. DEC. 472 IS NOT APPLICABLE TO THIS CASE. IN THE CITED CASE IT WAS HELD THAT AN OFFICER WHO CHOOSES TO PLACE HIMSELF BEYOND THE REACH OF THE MEDICAL SERVICE PROVIDED FOR HIM AT HIS DUTY STATION MAY NOT BE FURNISHED CIVILIAN MEDICAL TREATMENT AT THE EXPENSE OF THE UNITED STATES. THE BASIS FOR THE VIEW THAT THAT DECISION IS NOT APPLICABLE IS FIRST, BECAUSE THE CITED CASE WAS THAT OF AN OFFICER OF THE NAVY, AS TO WHOM THERE IS APPLICABLE SECTION 1586, REVISED STATUTES, THAT EXPENSES INCURRED BY AN OFFICER OF THE NAVY FOR MEDICINES OR MEDICAL ATTENDANCE SHALL NOT BE ALLOWED UNLESS THEY WERE SECURED WHEN THE OFFICER WAS ON DUTY AND MEDICINES COULD NOT HAVE BEEN OBTAINED FROM NAVAL SUPPLIES OR THE ATTENDANCE OF A NAVAL MEDICAL OFFICER COULD NOT HAVE BEEN HAD; AND, SECOND, THAT THE FACTS OF THIS CASE TEND TO DISTINGUISH IT, APPARENTLY BECAUSE A MEDICAL OFFICER FROM THE GENERAL DISPENSARY IN THE CITY OF BOSTON IN FACT VISITED MR. LINNEY.

AS HAS BEEN HERETOFORE POINTED OUT, SOME CONFUSION OF THOUGHT SEEMS TO ARISE IN THE MINDS OF SERVICE PERSONNEL AS TO PAYMENT BY THE GOVERNMENT FOR MEDICAL SERVICE BECAUSE MEDICAL SERVICE SEEMS TO BE LOOKED UPON AS AN ALLOWANCE. WHILE IT HAS SOME ASPECTS OF AN ALLOWANCE IN THAT WHEN FURNISHED IT REDUCES THE EXPENDITURES OF SUCH PERSONNEL, IT IS IN FACT NOT STRICTLY AN ALLOWANCE CONVERTIBLE TO A MONEY PAYMENT, UNITED STATES V. JONES, 18 HOW. 92 (SEE 7 COMP. GEN. 314), BUT IS A SERVICE IN KIND BY THE PROVISION OF A MEDICAL DEPARTMENT OF THE ARMY AND, IN SOME CIRCUMSTANCES, UNDER APPROPRIATIONS MADE THEREFOR, OTHERWISE.

IN THIS CASE, HOSPITAL AND MEDICAL SERVICE WERE AVAILABLE FOR MR. LINNEY AT HIS STATION AND THEY BECAME UNAVAILABLE TO HIM IN HIS ILLNESS ONLY BECAUSE OF HIS VOLUNTARY RESIDENCE AT SUCH A DISTANCE THEREFROM THAT FOR PRACTICAL PURPOSES ADEQUATE MEDICAL SERVICE COULD NOT BE FURNISHED BY THE ARMY MEDICAL PERSONNEL AT HIS DUTY STATION. THE QUESTION IS WHETHER THE APPROPRIATION CONTAINED IN THE ANNUAL ARMY APPROPRIATION ACT IS AVAILABLE TO PAY THE EXPENSES OF CIVILIAN MEDICAL, HOSPITAL, AND NURSING SERVICE DURING HIS ILLNESS. THE ARMY APPROPRIATION ACT FOR MANY YEARS HAS CONTAINED UNDER THE HEADING "MEDICAL DEPARTMENT--- ARMY--- MEDICAL AND HOSPITAL DEPARTMENT" (FOR THE YEAR IN QUESTION, ACT OF APRIL 26, 1934, 48 STAT. 628) AN APPROPRIATION---

FOR MEDICAL CARE AND TREATMENT NOT OTHERWISE PROVIDED FOR, INCLUDING CARE AND SUBSISTENCE IN PRIVATE HOSPITALS OF OFFICERS, ENLISTED MEN, AND CIVILIAN EMPLOYEES OF THE ARMY, * * * WHEN ENTITLED THERETO BY LAW, REGULATION, OR CONTRACT: PROVIDED, THAT THIS SHALL NOT APPLY TO OFFICERS AND ENLISTED MEN WHO ARE TREATED IN PRIVATE HOSPITALS OR BY CIVILIAN PHYSICIANS WHILE ON URLOUGH; * * *

ARMY REGULATIONS 40-505, ENTITLED "MEDICAL ATTENDANCE--- GENERAL PROVISIONS," PROVIDE:

2. FOR WHOM AUTHORIZED.--- UNDER THE CONDITIONS INDICATED THEREIN THE ARMY WILL, USUALLY THROUGH ITS OWN FACILITIES, PROVIDE MEDICAL ATTENDANCE TO THE PERSONNEL ENUMERATED IN A, B, AND C BELOW:

A. GENERAL.--- ANY PERSON ADMITTED TO AN ARMY HOSPITAL UNDER THE PROVISIONS OF A.R. 40-590, 40-605, OR 40-610 WHILE UNDERGOING TREATMENT IN SUCH HOSPITAL.

B. MILITARY.

(1) OFFICERS, WARRANT OFFICERS * * * WHILE IN ACTIVE FEDERAL SERVICE, EXCEPT THOSE NOT IN A DUTY STATUS WHILE ABSENT FROM THEIR PROPER STATION OR COMMAND WITH OR WITHOUT AUTHORITY, * * *

3. CIVILIAN MEDICAL ATTENDANCE FOR MILITARY PATIENTS.--- A. WHEN MEDICAL ATTENDANCE IS REQUIRED BY AN OFFICER, WARRANT OFFICER * * * ON DUTY WITH ANY COMMAND OR DETACHMENT * * * AND CANNOT OTHERWISE BE HAD, THE COMMANDING OFFICER MAY EMPLOY THE NECESSARY CIVILIAN SERVICE, AND JUST ACCOUNTS THEREFOR WILL BE PAID BY THE MEDICAL DEPARTMENT. WHEN THE * * * WARRANT OFFICER * * * IS ON DUTY WHERE THERE IS NO OFFICER, HE * * * MAY ARRANGE FOR THE REQUIRED SERVICE, * * *

IT WILL BE NOTED THE SUBSTITUTED CIVILIAN SERVICE IS AUTHORIZED ONLY WHEN ON DUTY AND WHILE IN SOME CIRCUMSTANCES AN OFFICER NECESSARILY LIVING AT A DISTANCE FROM THE PLACE OF PERFORMANCE OF HIS DUTIES MAY-- FOR THE PURPOSE OF MEDICAL TREATMENT--- BE "ON DUTY" AT HIS RESIDENCE DURING THE HOURS WHEN ACTUAL PERFORMANCE OF DUTY IS NOT REQUIRED (SEE 10 COMP. GEN. 377), WHEN THE OFFICER VOLUNTARILY RESIDES AT A DISTANCE FROM HIS DUTY STATION HE CANNOT TRANSFER TO THE UNITED STATES THE COST OF CIVILIAN MEDICAL SERVICE WHEN HIS VOLUNTARY ACTION HAS MADE UNAVAILABLE THE MEDICAL SERVICES PROVIDED IN KIND BY THE GOVERNMENT AT HIS DUTY STATION. TREATMENT BY THE MEDICAL DEPARTMENT OF THE ARMY IS PRIMARILY WHAT IS GRANTED, AND CIVILIAN MEDICAL SERVICES AT THE EXPENSE OF THE UNITED STATES MAY NOT BE SUBSTITUTED THEREFOR BY THE VOLUNTARY ACTION OF THE INDIVIDUAL.

ARMY REGULATIONS 40-550, MAY 16, 1924, ENTITLED "DISPENSARIES--- GENERAL PROVISIONS," PROVIDE:

4. B. GENERAL DISPENSARIES.

(1) A GENERAL DISPENSARY IS PROVIDED TO SERVE THE NONHOSPITAL NEEDS OF MILITARY PERSONNEL LOCATED IN A LARGE CITY, MILITARY DISTRICT, OR PRESCRIBED MILITARY AREA, AND NORMALLY TREATS OUT-PATIENTS FROM LARGE MILITARY HEADQUARTERS, SMALL DETACHED UNITS, AND MISCELLANEOUS DETACHED PERSONNEL FOR WHOM NO OTHER DISPENSARY SERVICE, AS REGARDS JURISDICTION AND DISTANCE, IS AVAILABLE.

(2) A GENERAL DISPENSARY WILL BE ADMINISTERED UNDER THE DIRECT CONTROL OF THE CORPS AREA, DEPARTMENT, DISTRICT, OR TACTICAL COMMANDER UNDER WHOM IT MAY BE SERVING.

C. LIMITATIONS REGARDING OUT-PATIENT SERVICE.

(1) IT IS INTENDED THAT PERSONS DESIRING OR NEEDING TREATMENT SHOULD PRESENT THEMSELVES AT THE DISPENSARY OR BE TRANSPORTED THERETO RATHER THAN THAT MEDICAL OR DENTAL ATTENDANCE SHOULD BE FURNISHED THEM IN "QUARTERS," AT THEIR HOMES, OR ELSEWHERE. ONLY IN EMERGENCIES, OR WHEN HOSPITALIZATION OR TRANSPORTATION OF THE PATIENT, IN THE OPINION OF THE COMMANDING OFFICER OF THE GENERAL DISPENSARY OR, IN OTHER INSTANCES, OF THE SURGEON OF THE COMMAND, IS NOT PRACTICABLE, WILL MEDICAL OR DENTAL ATTENDANCE BE FURNISHED PERSONS IN QUARTERS.

(2) IN THE CASE OF A GENERAL DISPENSARY THE TERRITORIAL COMMANDER UNDER WHOSE JURISDICTION IT IS OPERATING, WILL PRESCRIBE THE GENERAL POLICY AS TO THE LIMITATIONS OF THE GEOGRAPHICAL AREA WITHIN WHICH CALLS TO VISIT PATIENTS IN QUARTERS SHOULD BE RESPONDED TO BY THE DISPENSARY PERSONNEL.

STAFF MEMORANDUM NO. 5 A.G. 701 (GEN.) HEADQUARTERS, FIRST CORPS AREA, OFFICE OF THE CORPS AREA COMMANDER, ARMY BASE, BOSTON, MASS., FEBRUARY 12, 1934, IN PARAGRAPH 2 DEFINES CERTAIN AREAS WITHIN THE BOSTON AREA, ALLOCATES AVAILABLE MEDICAL FACILITIES FOR MEDICAL ATTENTION TO ARMY PERSONNEL RESIDING WITHIN SUCH AREAS, CERTAIN AREAS BEING ALLOCATED TO THE SURGEON, FORT BANKS, OTHERS TO THE SURGEON AT WATERTOWN ARSENAL, AND OTHER AREAS TO THE GENERAL DISPENSARY, AND IN PARAGRAPH 6, IT IS PROVIDED:

6. THE LIMITED FACILITIES OF THE GENERAL DISPENSARY HAVE MADE IT NECESSARY FOR THE CORPS AREA COMMANDER TO REDUCE THE GEOGRAPHICAL LIMITS WITHIN WHICH CALLS TO VISIT PATIENTS IN QUARTERS WILL BE MADE. THERE IS NO AUTHORITY AT LAW FOR THE PAYMENT FROM APPROPRIATED FUNDS OF CIVILIAN PHYSICIANS FOR SERVICES RENDERED OUTSIDE THE AREAS DESIGNATED AS THE PATIENT'S PLACE OF DUTY. THEREFORE, OFFICERS AND SOLDIERS WHO CHOOSE FOR THEIR OWN CONVENIENCE TO RESIDE OUTSIDE THE GEOGRAPHICAL LIMITS OF DISPENSARY SERVICE AS PRESCRIBED IN PARAGRAPH 2 A, B, AND C, AND MEMBERS OF THEIR HOUSEHOLDS (PAR. 2 C, (4), AR 40 505), CAN OBTAIN MEDICAL TREATMENT ONLY BY PERSONAL VISITS TO THE GENERAL DISPENSARY, WATERTOWN ARSENAL, OR FORT BANKS. THEIR TREATMENT BY CIVILIAN PHYSICIANS CANNOT BE PAID FOR FROM PUBLIC FUNDS.

THIS IS THE GENERAL POLICY PRESCRIBED BY THE CORPS AREA COMMANDER. THOSE LIVING WITHOUT THE AREA INDICATED IN THIS MEMORANDUM WERE PLACED ON NOTICE THAT MEDICAL ATTENDANCE COULD NOT BE FURNISHED OUTSIDE OF THE DESCRIBED AREAS AND THAT MEDICAL ATTENDANCE PROCURED BY THEM WOULD BE AT THEIR OWN EXPENSE. THEY WERE AT LIBERTY TO COME TO THE GENERAL DISPENSARY PERSONALLY AND PROVISION WOULD BE MADE FOR THEIR PROPER CARE.

THERE SEEMS TO BE AN IMPRESSION THAT THE FACT THE GENERAL DISPENSARY WAS NOTIFIED OF MR. LINNEY'S ILLNESS, AND THAT, ALTHOUGH HE LIVED OUTSIDE THE AREA WITHIN WHICH MEDICAL OFFICERS FROM THE GENERAL DISPENSARY WOULD MAKE HOUSE VISITS, A MEDICAL OFFICER FROM THE GENERAL DISPENSARY DID IN FACT VISIT HIM--- HIS RIGHTS WERE IN SOME MANNER MODIFIED. THE MEDICAL OFFICERS ON DUTY AT THE SAME HEADQUARTERS PROPERLY WERE INTERESTED IN THE WELFARE OF MEMBERS OF THE COMMAND AND TO THE EXTENT PERMITTED BY THEIR DUTIES MIGHT PROPERLY VISIT IN THEIR PROFESSIONAL CAPACITY SUCH PERSONNEL RESIDING BEYOND THE AREA WITHIN WHICH THEY WERE REQUIRED TO MAKE HOUSE VISITS. THE ,GENERAL POLICY" IN LIMITING THE GEOGRAPHICAL AREA WITHIN WHICH CALLS TO VISIT PATIENTS IN QUARTERS SHOULD BE RESPONDED TO WAS NOT DESIGNED TO PROHIBIT MEDICAL OFFICERS FROM MAKING VISITS TO SUCH PERSONNEL IF THEIR DUTIES PERMITTED, BUT THE FACTS OF SUCH VISITS IN NO WAY CHANGE THE RIGHTS OF THE INDIVIDUAL SHOWN SUCH CONSIDERATION. MR. LINNEY VOLUNTARILY RESIDED BEYOND THE AREA WITHIN WHICH MEDICAL SERVICE COULD PRACTICABLY BE FURNISHED, CONSIDERING THE NUMBER OF INDIVIDUALS COMPOSING THE COMMAND, THE AREA INVOLVED, AND THE NUMBER OF MEDICAL OFFICERS AVAILABLE. HE WAS ON NOTICE THAT ADEQUATE MEDICAL SERVICE COULD NOT BE AFFORDED HIM BY THE ARMY MEDICAL DEPARTMENT AND THAT EXPENSES RESULTING FROM HIS ILLNESS AND TREATMENT BY A CIVILIAN PRACTITIONER AND IN A CIVILIAN HOSPITAL COULD NOT BE REIMBURSED FROM PUBLIC FUNDS. UNDER THE REGULATIONS, MR. LINNEY WAS NOT ENTITLED TO MEDICAL TREATMENT IN THE CIRCUMSTANCES DESCRIBED AT THE EXPENSE OF THE UNITED STATES AND THE APPROPRIATION IS ACCORDINGLY NOT LEGALLY AVAILABLE FOR THE PAYMENTS PROPOSED. PAYMENT OF THE VOUCHER, THEREFORE, IS NOT AUTHORIZED. THE PAPERS WILL BE RETAINED IN THIS OFFICE.