A-71263, APRIL 6, 1936, 15 COMP. GEN. 874

A-71263: Apr 6, 1936

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MEDICAL TREATMENT - PRIVATE PHYSICIANS - EMPLOYMENT WITHOUT ADMINISTRATIVE AUTHORIZATION PRIVATE PHYSICIANS MAY NOT BE PAID FOR SERVICES SECURED BY THE COMMANDING OFFICER OF A NAVAL HOSPITAL IN CONNECTION WITH A DIAGNOSIS AND OPERATION ON A CIVILIAN CONSERVATION CORPS ENROLLEE WHERE THE EMPLOYMENT WAS NOT AUTHORIZED BY THE NAVY DEPARTMENT AS REQUIRED BY APPLICABLE ADMINISTRATIVE REGULATIONS. 1936: THERE ARE FOR CONSIDERATION CLAIM OF DR. WAS ADMITTED TO THE UNITED STATES NAVAL HOSPITAL. IT IS STATED THAT HIS CASE WAS DIAGNOSED AS AN ABSCESS ON THE BRAIN. THAT IT WAS DEEMED ADVISABLE AND NECESSARY BECAUSE OF THE UNUSUAL CHARACTER OF THE SYMPTOMS TO CONSULT A SPECIALIST. THAT AN OPERATION WAS DECIDED UPON.

A-71263, APRIL 6, 1936, 15 COMP. GEN. 874

MEDICAL TREATMENT - PRIVATE PHYSICIANS - EMPLOYMENT WITHOUT ADMINISTRATIVE AUTHORIZATION PRIVATE PHYSICIANS MAY NOT BE PAID FOR SERVICES SECURED BY THE COMMANDING OFFICER OF A NAVAL HOSPITAL IN CONNECTION WITH A DIAGNOSIS AND OPERATION ON A CIVILIAN CONSERVATION CORPS ENROLLEE WHERE THE EMPLOYMENT WAS NOT AUTHORIZED BY THE NAVY DEPARTMENT AS REQUIRED BY APPLICABLE ADMINISTRATIVE REGULATIONS.

DECISION BY ACTING COMPTROLLER GENERAL ELLIOTT, APRIL 6, 1936:

THERE ARE FOR CONSIDERATION CLAIM OF DR. ORMAN C. PERKINS, IN THE SUM OF $50, AND CLAIM OF DR. E. JEFFERSON BROWDER, IN THE SUM OF $300, FOR MEDICAL SERVICES RENDERED JOSEPH LINCOLN BREINER, CIVILIAN CONSERVATION CORPS ENROLLEE ON OCTOBER 16, 1935, AT THE UNITED STATES NAVAL HOSPITAL, BROOKLYN, N.Y.

THE REPORT SHOWS THAT JOSEPH LINCOLN BREINER, CIVILIAN CONSERVATION CORPS ENROLLEE NO. 2-164762, WAS ADMITTED TO THE UNITED STATES NAVAL HOSPITAL, BROOKLYN, N.Y., FROM COMPANY NO. 1278, C.C.C., CAMP S-58, HOPE, N.J., ON SEPTEMBER 21, 1935. IT IS STATED THAT HIS CASE WAS DIAGNOSED AS AN ABSCESS ON THE BRAIN; THAT IT WAS DEEMED ADVISABLE AND NECESSARY BECAUSE OF THE UNUSUAL CHARACTER OF THE SYMPTOMS TO CONSULT A SPECIALIST, DR. ORMAN C. PERKINS, WHO CONFIRMED THE DIAGNOSIS; THAT AN OPERATION WAS DECIDED UPON, AND AS IT WAS CONSIDERED TO BE OF A SPECIAL NATURE BEYOND THE SKILL OF THE STAFF AT THE NAVAL HOSPITAL, THE COMMANDING OFFICER OF THE NAVAL HOSPITAL, ACTING ON HIS OWN RESPONSIBILITY IN VIEW OF THE CIRCUMSTANCES IN THE CASE, CALLED IN SPECIALISTS WITHOUT REFERRING THE MATTER TO THE BUREAU OF MEDICINE AND SURGERY, NAVY DEPARTMENT, FOR AUTHORITY FOR THE EMPLOYMENT OF SPECIALISTS, AND THAT DR. E. JEFFERSON BROWDER WAS REQUESTED TO PERFORM THE OPERATION, WHICH HE DID ON OCTOBER 16, 1935, DRAINING THE ABSCESS. THE PATIENT DIED OCTOBER 20, 1935.

THE CHIEF OF THE BUREAU OF MEDICINE AND SURGERY STATES IN FOURTH ENDORSEMENT OF DECEMBER 5, 1935, THAT WHILE THE ACTION OF THE COMMANDING OFFICER OF THE NAVAL HOSPITAL IN SO SECURING THE SERVICES OF THE SPECIALISTS IS QUESTIONABLE FROM AN ADMINISTRATIVE STANDPOINT, IN VIEW OF ALL THE CIRCUMSTANCES, INCLUDING THE GRAVE CONDITION OF THE PATIENT, THAT BUREAU CONSIDERS THE EMPLOYMENT OF SPECIALISTS WAS NECESSARY AND PROPER AND RECOMMENDS THAT THE BILLS BE PAID. THE BILL SUBMITTED BYDR. PERKINS IN THE SUM OF $50 IS FOR CONSULTATION SERVICES, AND THAT OF DR. BROWDER IN THE SUM OF $300 FOR PERFORMING THE OPERATION (BRAIN ABSCESS) ON THE ENROLLEE.

THE ACT OF MARCH 31, 1933, 48 STAT. 22, FOR THE RELIEF OF UNEMPLOYMENT PROVIDES AS FOLLOWS:

* * * THE PRESIDENT IS FURTHER AUTHORIZED, BY REGULATION, TO PROVIDE FOR HOUSING THE PERSONS SO EMPLOYED AND FOR FURNISHING THEM WITH SUCH * * * MEDICAL ATTENDANCE AND HOSPITALIZATION, * * * AS MAY BE NECESSARY, DURING THE PERIOD THEY ARE SO EMPLOYED, * * *

THE AUTHORITY OF THE PRESIDENT UNDER THE PROVISIONS OF THAT ACT WAS EXTENDED TO AND INCLUDING MARCH 31, 1937, BY SECTION 14 OF THE JOINT RESOLUTION OF APRIL 8, 1935, 49 STAT. 119, WHICH RESOLUTION ALSO PROVIDED THAT OF THE FUNDS APPROPRIATED THEREIN THERE SHALL BE AVAILABLE FOR THE CIVILIAN CONSERVATION CORPS THE SUM OF $600,000,000.

WAR DEPARTMENT REGULATIONS, RELIEF OF UNEMPLOYMENT, CIVILIAN CONSERVATION CORPS, DATED MAY 15, 1935, PROVIDE AS FOLLOWS:

93. MEDICAL ATTENDANCE AND HOSPITALIZATION.--- A. A DULY ENROLLED MEMBER OF, OR ACCEPTED APPLICANT FOR ENROLLMENT IN, THE CIVILIAN CONSERVATION CORPS WILL BE FURNISHED NECESSARY MEDICAL ATTENDANCE AND HOSPITALIZATION FOR INJURY OR DISEASE NOT THE RESULT OF HIS OWN MISCONDUCT. * * * MEDICAL CARE WILL NOT INCLUDE DEFINITE TREATMENT FOR LONG-CONTINUED CASES, ELECTIVE SURGICAL OPERATIONS, OR DENTAL WORK OTHER THAN EMERGENCY. WHEN HOSPITALIZATION IS REQUIRED, ARMY, NAVY, UNITED STATES PUBLIC HEALTH, INDIAN, AND VETERANS' ADMINISTRATION HOSPITALS WILL BE USED IF AVAILABLE AND IN THE VICINITY OF CIVILIAN CONSERVATION CORPS CAMPS. IF SUCH HOSPITALS ARE NOT AVAILABLE, HOSPITALIZATION AND MEDICAL ATTENDANCE, EXCEPT WHEN THE INJURY OR DISEASE IS DUE TO MISCONDUCT, WILL BE ARRANGED FOR BY CORPS AREA COMMANDERS IN CIVILIAN HOSPITALS AT THE EXPENSE OF EMERGENCY CONSERVATION FUNDS ALLOCATED TO THE SURGEON GENERAL.

THE REGULATIONS ESTABLISHED UNDER THE AUTHORITY OF THE ACT OF MARCH 31, 1933, THEREFORE, PROVIDE FOR MEDICAL TREATMENT FOR ENROLLEES OF THE CIVILIAN CONSERVATION CORPS IN THE ARMY, NAVY, UNITED STATES PUBLIC HEALTH, INDIAN, AND VETERANS' ADMINISTRATION HOSPITALS, IF AVAILABLE. UNDER THESE REGULATIONS THE HOSPITAL SERVICE TO BE FURNISHED IN THIS CASE WAS IN THE NAVAL HOSPITAL TO WHICH THE PATIENT WAS ADMITTED AND SUBJECT TO THE ORDINARY RULES FOR THE CONDUCT OF THAT HOSPITAL. IF THE MEDICAL OFFICERS ON DUTY THERE WERE NOT SUFFICIENTLY SKILLED TO FURNISH THE REQUIRED SERVICE, THE COMMANDING OFFICER HAD NO AUTHORITY, WITHOUT APPROVAL OF THE NAVY DEPARTMENT, TO EMPLOY OTHERS IN HIS OPINION MORE SKILLED. PARAGRAPH 1189 (4), NAVY REGULATIONS, 1920 (PAR. 3163 OF THE MANUAL FOR THE MEDICAL DEPARTMENT OF THE NAVY, 1927, MERELY REPEATS THE CITED PARAGRAPH OF THE REGULATIONS) IS ADDRESSED TO THE RIGHT OF AN OFFICER OF THE NAVY TO THE SERVICES OF A SPECIALIST WHEN THE SERVICES OF A NAVAL MEDICAL OFFICER ARE AVAILABLE, AND REQUIRES THE APPROVAL OF THE MEDICAL OFFICER IN CHARGE, THAT IS, A DETERMINATION BY THE OFFICER IN CHARGE THAT IN HIS OPINION HE IS NOT SUFFICIENTLY SKILLED TO PROPERLY TREAT THE AFFECTION AND, ALSO,"THE PRIOR AUTHORITY OF THE CHIEF OF THE BUREAU OF MEDICINE AND SURGERY.' IF SUCH PRIOR AUTHORITY OF THE BUREAU OF MEDICINE AND SURGERY IS REQUIRED TO PROCURE THE SERVICES OF A SPECIALIST IN THE CASE OF AN OFFICER, INVOLVING AS IT DOES A DETERMINATION THAT MEDICAL OFFICERS OF THE NAVY AVAILABLE ARE NOT SUFFICIENTLY SKILLED, EQUAL AUTHORITY IS REQUIRED FOR THE NAVY TO EMPLOY SPECIALISTS FOR PATIENTS PROPERLY ADMITTED TO NAVAL HOSPITALS FROM OTHER BRANCHES OF THE GOVERNMENT SERVICE.

THE MEDICAL DEPARTMENT OF THE NAVY IS NOT MAINTAINED TO PROVIDE MEDICAL OFFICERS TO SELECT CIVILIAN SPECIALISTS FOR THE TREATMENT OF PATIENTS IN NAVAL HOSPITALS BUT IS MAINTAINED TO FURNISH MEDICAL AND SURGICAL SERVICES TO THE PATIENTS PROPERLY ADMITTED THERETO. IF IN ANY CASE OF AN OBSCURE AFFECTION OR UNUSUAL SYMPTOMS THE SERVICES OF A SPECIALIST ARE BELIEVED TO BE NECESSARY, THE MATTER IS ONE FOR CONSIDERATION BY THE NAVY DEPARTMENT. IN THIS CASE THERE SEEMS TO HAVE BEEN NO QUESTION OF EMERGENCY NOT PERMITTING REFERENCE OF THE MATTER TO THE NAVY DEPARTMENT IN WASHINGTON AS THE PATIENT WAS ADMITTED SEPTEMBER 21, 1935. THE SERVICES OF THE PHYSICIANS WHOSE CLAIMS HAVE BEEN SUBMITTED HAVING BEEN SECURED WITHOUT LEGAL AUTHORITY THEREFOR, THE CLAIMS NECESSARILY MUST BE DISALLOWED.