A-90099, FEBRUARY 16, 1938, 17 COMP. GEN. 653

A-90099: Feb 16, 1938

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IS AS FOLLOWS: THERE IS SUBMITTED A LETTER FROM COLONEL O. A COPY OF WHICH IS ATTACHED. THE BOARD HAS RULED THAT THIS RATE FOR THE FISCAL YEAR 1937 WAS ALL INCLUSIVE. WAS A PATIENT AT THE RAILROAD HOSPITAL FOR A TOTAL OF 81 DAYS. DURING WHICH TIME PROFESSIONAL SERVICES WERE RENDERED THIS PATIENT BY DR. DOCTOR ROMIG IS UNDER CONTRACT WITH THE HOSPITAL TO RENDER SERVICES OF THIS CHARACTER. WERE DISALLOWED BY THE SIGNAL CORPS. A CHECK FOR $486 WAS SUBMITTED BY IT TO THE RAILROAD HOSPITAL TO COVER THE 81 DAYS OF HOSPITAL SERVICE AT $6 PER DAY. THIS DISALLOWANCE WAS BASED UPON THE CONTENTION OF THE SIGNAL CORPS THAT THE RATE OF $6 PER DAY WAS ALL INCLUSIVE. THERE IS SUBMITTED FOR CONSIDERATION IN THIS CONNECTION.

A-90099, FEBRUARY 16, 1938, 17 COMP. GEN. 653

MEDICAL TREATMENT - ALASKA RAILROAD HOSPITAL - CHARGES FOR PATIENTS OF OTHER GOVERNMENT AGENCIES A RESOLUTION OF THE FEDERAL BOARD OF HOSPITALIZATION FIXING A SPECIFIED PER DIEM RATE TO BE CHARGED BY THE ALASKA RAILROAD HOSPITAL FOR HOSPITALIZATION OF PATIENTS OF OTHER GOVERNMENT AGENCIES, MAY NOT PRECLUDE THE CHARGING OF SUCH OTHER AGENCIES WITH THE EXTRA EXPENSE OF THE SERVICES OF A SURGEON PAID BY THE HOSPITAL ON A CONTRACT FEE BASIS, OR OF A SPECIAL NURSE FURNISHED IN ADDITION TO REGULAR HOSPITAL ATTENDANTS.

ACTING COMPTROLLER GENERAL ELLIOTT TO THE SECRETARY OF THE INTERIOR, FEBRUARY 16, 1938:

YOUR LETTER OF OCTOBER 30, 1937, IS AS FOLLOWS:

THERE IS SUBMITTED A LETTER FROM COLONEL O. F. OHLSON, GENERAL MANAGER, THE ALASKA RAILROAD, ANCHORAGE, ALASKA, OF OCTOBER 1, REGARDING THE CHARACTER OF HOSPITAL SERVICE TO BE RENDERED BY THE ALASKA RAILROAD HOSPITAL TO OTHER GOVERNMENT AGENCIES, DURING THE FISCAL YEAR 1937, UNDER RESOLUTION OF THE FEDERAL BOARD OF HOSPITALIZATION DATED APRIL 13, 1936, APPROVED BY THE PRESIDENT APRIL 31 (21), 1936. THIS RESOLUTION, A COPY OF WHICH IS ATTACHED, CONTINUED IN EFFECT DURING 1937, A SIMILAR RESOLUTION FOR THE PREVIOUS YEAR, APPROVED BY THE PRESIDENT AUGUST 30, 1935, AUTHORIZING THE RAILROAD HOSPITAL TO CHARGE $6 PER DAY FOR HOSPITALIZING PATIENTS OF OTHER AGENCIES.

THE BOARD HAS RULED THAT THIS RATE FOR THE FISCAL YEAR 1937 WAS ALL INCLUSIVE, AND COVERED NOT ONLY BED, BOARD, AND NURSING, BUT IN ADDITION, SUCH ITEMS AS PROFESSIONAL SERVICES OF PHYSICIANS, X-RAY TREATMENTS, AND ALL OPERATING ROOM CHARGES.

DURING JANUARY, FEBRUARY, MARCH AND APRIL, 1937, A MEMBER OF THE UNITED STATES SIGNAL CORPS, WAR DEPARTMENT, WAS A PATIENT AT THE RAILROAD HOSPITAL FOR A TOTAL OF 81 DAYS, DURING WHICH TIME PROFESSIONAL SERVICES WERE RENDERED THIS PATIENT BY DR. HOWARD G. ROMIG OF THE HOSPITAL STAFF, HIS BILL FOR THE SERVICES BEING $362. DOCTOR ROMIG IS UNDER CONTRACT WITH THE HOSPITAL TO RENDER SERVICES OF THIS CHARACTER, FOR WHICH HE RECEIVES 75 PERCENT OF THE FEE CHARGED THE PATIENT, AND THE HOSPITAL RECEIVES 25 PERCENT. IN ADDITION TO THESE PROFESSIONAL SERVICES, DOCTOR ROMIG ORDERED THE HOSPITAL TO EMPLOY A SPECIAL NURSE FOR THE PROPER CARE OF THIS PATIENT, THE COST OF THIS NURSING SERVICE BEING $240.

THEREAFTER, THE RAILROAD HOSPITAL SUBMITTED A BILL TO THE SIGNAL CORPS FOR $1,224.50, WHICH INCLUDED A CHARGE OF $6 PER DAY FOR THE PERIOD MENTIONED; ALSO THE FEE OF $362 CHARGED BY DOCTOR ROMIG, AND $240 FOR SPECIAL NURSING. THE CHARGES FOR PROFESSIONAL SERVICES AND THE SPECIAL NURSE, HOWEVER, WERE DISALLOWED BY THE SIGNAL CORPS, AND A CHECK FOR $486 WAS SUBMITTED BY IT TO THE RAILROAD HOSPITAL TO COVER THE 81 DAYS OF HOSPITAL SERVICE AT $6 PER DAY. THIS DISALLOWANCE WAS BASED UPON THE CONTENTION OF THE SIGNAL CORPS THAT THE RATE OF $6 PER DAY WAS ALL INCLUSIVE, AND WOULD NOT PERMIT ADDITIONAL PAYMENTS FOR PROFESSIONAL AND SPECIAL NURSING SERVICES.

THERE IS SUBMITTED FOR CONSIDERATION IN THIS CONNECTION, A COPY OF THE CONTRACT ENTERED INTO ON AUGUST 14, 1936, BY THE ALASKA RAILROAD WITH DOCTOR ROMIG UNDER WHICH HIS PROFESSIONAL SERVICES IN THIS CASE WERE RENDERED; ALSO A COPY OF THE STATEMENT OF THE RAILROAD HOSPITAL DATED SEPTEMBER 13, 1937, COVERING ITS PRESENT CLAIM AGAINST THE SIGNAL CORPS, INDICATING A BALANCE OF $511.50 STILL DUE THE HOSPITAL. IN ADDITION, THERE IS ENCLOSED A COPY OF CONTRACT ENTERED INTO ON DECEMBER 31, 1936, BY THE ALASKA RAILROAD WITH DOCTOR P. L. HEITMEYER AS CHIEF OF STAFF OF THE HOSPITAL; ALSO A COPY OF ITS CONTRACT OF JULY 10, 1937, WITH DOCTOR R. L. WORKS AS PHYSICIAN AND SURGEON, WHICH SPECIFY THE CONDITIONS OF EMPLOYMENT OF THESE MEMBERS OF THE MEDICAL STAFF.

IT IS REQUESTED THAT AN OPINION BE RENDERED AT THE EARLIEST PRACTICABLE DATE AS TO WHETHER THE RESOLUTION OF THE FEDERAL BOARD OF HOSPITALIZATION FOR 1937 IS ALL INCLUSIVE, AS RULED BY THE BOARD, OR WHETHER THE ALASKA RAILROAD HOSPITAL SHOULD BE REIMBURSED IN EXCESS OF $6 PER DAY TO COVER THE COST OF A SPECIAL NURSE AND THE PROFESSIONAL SERVICES OF A PHYSICIAN.

THE SECRETARY OF WAR REPORTED ON THE MATTER BY LETTER DATED DECEMBER 14, 1937, AS FOLLOWS:

REFERENCE IS MADE TO YOUR LETTER OF NOVEMBER 18, 1937 (A-90099), RELATIVE TO THE CLAIM OF THE ALASKA RAILROAD FOR HOSPITALIZATION OF PRIVATE FIRST CLASS ERLING A. HELDE, SIGNAL CORPS.

THE RECORDS OF THIS DEPARTMENT SHOW THAT AN ACCOUNT OF THE ALASKA RAILROAD FOR HOSPITALIZATION OF PRIVATE HELDE JANUARY 28TH TO APRIL 19, 1937, IN THE AMOUNT OF $486.00 (81 DAYS AT $6.00 A DAY), WAS APPROVED IN FULL AND FORWARDED TO THE FINANCE OFFICER, THIS CITY, FOR PAYMENT ON AUGUST 13, 1937, WHO ADVISES THAT PAYMENT WAS MADE AUGUST 31, 1937, ON F.O. VOUCHER NO. 9157, FOR AUGUST 1937. NO FURTHER CHARGES FOR TREATMENT OF THIS SOLDIER WHILE A PATIENT IN THE ALASKA RAILROAD HOSPITAL DURING THE PERIOD INDICATED HAVE BEEN RECEIVED.

THE ACCOUNT FOR $486.00 WAS AT THE RATE OF $6.00 A DAY, AS PER RESOLUTION, ADOPTED BY THE FEDERAL BOARD OF HOSPITALIZATION, APRIL 13, 1936, AND APPROVED BY THE PRESIDENT ON APRIL 21, 1936, THIS RESOLUTION COVERING RATES FOR THE FISCAL YEAR 1937. IN VIEW OF THIS RESOLUTION, A COPY OF WHICH IS INCLOSED, THE WAR DEPARTMENT IS UNABLE TO AUTHORIZE PAYMENT TO ADDITIONAL CHARGES FOR THE MEDICAL ATTENDANCE AND NURSING SERVICES REFERRED TO.

THERE IS INCLOSED A COPY OF A RESOLUTION BY THE FEDERAL BOARD OF HOSPITALIZATION ADOPTED JUNE 4, 1937, AND APPROVED BY THE PRESIDENT ON JUNE 21, 1937, FOR THE FISCAL YEAR 1938, WHICH AUTHORIZES A RATE FOR THE ALASKA RAILROAD HOSPITAL OF $6.00 PER DAY FOR BED, BOARD AND NURSING PLUS THE ACTUAL CONTRACT CHARGES FOR NECESSARY PROFESSIONAL SERVICES.

IN VIEW OF THE APPARENT DISCREPANCY IN THE LETTERS JUST QUOTED AS TO THE BILLING OF THE WAR DEPARTMENT FOR THE AMOUNT OF THE PROFESSIONAL AND SPECIAL NURSING SERVICES AND THE REPORTED REJECTION OF THIS PORTION OF THE CLAIM, AN EXAMINATION WAS MADE OF THE VOUCHER COVERING PAYMENT OF THE $486, WHICH VOUCHER IS SIGNED AND CERTIFIED BY THE CHIEF OF STAFF, BASE HOSPITAL, ANCHORAGE, ALASKA, AND SUCH EXAMINATION DISCLOSES THAT THE WAR DEPARTMENT WAS BILLED ONLY FOR THE AMOUNT OF $486 CHARGED FOR GENERAL HOSPITALIZATION. HOWEVER, IN THE LETTER FROM THE GENERAL MANAGER OF THE ALASKA RAILROAD, DATE OCTOBER 1, 1937, TRANSMITTED WITH YOUR SUBMISSION, IT IS STATED:

UNDER DATE OF AUGUST 25, 1937, THE FOLLOWING LETTER WAS RECEIVED FROM HOWARD G. ROMIG, M.D.:

"EARLY THIS YEAR THE WAR DEPARTMENT WAS BILLED BY THE BASE HOSPITAL FOR $1,224.50 ON ACCOUNT OF MR. ERLING HELDE, U.S. SIGNAL CORPS, ANCHORAGE, ALASKA. OF THIS SUM $362.00 WAS FOR MY PROFESSIONAL SERVICES. UNDERSTAND THAT THE ACCOUNT WAS REBILLED TO THE WAR DEPARTMENT IN THE AMOUNT OF $486.00, ATTACHED TO WHICH WAS A CLAIM FOR THE BALANCE UP TO $1,224.50.

"I HEREBY CERTIFY THAT MY BILL FOR PROFESSIONAL SERVICES IN THE AMOUNT OF $362.00 IS JUST AND CORRECT, AND THAT PAYMENT THEREFOR HAS NOT BEEN RECEIVED. AS THE RAILROAD IS RESPONSIBLE FOR COLLECTION OF THIS ACCOUNT, I WOULD APPRECIATE A REPLY INFORMING ME WHEN I MIGHT EXPECT PAYMENT OF THIS FEE FOR SERVICES RENDERED.'

A RESOLUTION ADOPTED BY THE FEDERAL BOARD OF HOSPITALIZATION, DATED APRIL 13, 1936, AND APPROVED BY THE PRESIDENT APRIL 21, 1936, PROVIDES A RECIPROCAL RATE OF $6.00 PER PATIENT DAY FOR THE ALASKA RAILROAD HOSPITAL AT ANCHORAGE, ALASKA, FOR THE FISCAL YEAR 1937. IT HAS BEEN RULED BY THE BOARD THAT THE RATE OF $6.00 SHALL BE ALL INCLUSIVE, THAT IS, SHALL, IN ADDITION TO NURSING, BED, AND BOARD, INCLUDE SUCH ITEMS AS PROFESSIONAL SERVICES RENDERED BY PHYSICIANS, OPERATING ROOM CHARGES, X-RAY, LABORATORY, AND ELECTROTHERAPY.

FOR THE FISCAL YEAR 1937 NO EXCEPTION IS MADE IN THE RESOLUTION TO INCLUDE EXTRA ITEMS LISTED ABOVE AND NO FURTHER QUESTION WILL BE RAISED BY THIS OFFICE CONCERNING THESE ITEMS, EXCEPT FOR PROFESSIONAL SERVICES RENDERED BY PHYSICIANS UNDER CONTRACTS WITH THE RAILROAD.

DURING JANUARY, FEBRUARY, MARCH, AND APRIL 1937, ERLING A. HELDE, A MEMBER OF THE U.S. SIGNAL CORPS, WAS HOSPITALIZED AT THE RAILROAD HOSPITAL 81 DAYS. DURING THIS PERIOD DR. HOWARD G. ROMIG, AS STATED IN HIS LETTER QUOTED ABOVE, ATTENDED THE PATIENT AND ACCRUED PROFESSIONAL CHARGES AMOUNTING TO $362.00. UNDER AUTHORITY OF ARTICLE 3 OF CONTRACT I-3ARR- 1824, DATED AUGUST 14, 1936, A BILL WAS RENDERED THE U.S. SIGNAL CORPS, IN WHICH WAS INCLUDED THE ITEM OF $362.00 PROFESSIONAL SERVICES AND $240.00 FOR SPECIAL NURSING. BOTH ITEMS WERE DISALLOWED BY THE SIGNAL CORPS, IT BEING THEIR CONTENTION THAT THE RECIPROCAL RATE OF $6.00 PER DAY WAS ALL INCLUSIVE AND WOULD NOT PERMIT ALLOWANCE OF THE PROFESSIONAL AND SPECIAL NURSING CHARGES.

HOWARD G. ROMIG IS A DOCTOR OF MEDICINE AND SURGEON PRACTICING IN THE CITY OF ANCHORAGE, AND IS NOT OBLIGATED TO PERFORM FREE SERVICES FOR THE UNITED STATES. HE IS NOT CONNECTED WITH THE RAILROAD EXCEPT THAT UNDER CONDITIONS AS OUTLINED IN CONTRACT I-3ARR-1824, DATED AUGUST 14, 1936, HE IS PERMITTED TO HOSPITALIZE HIS PATIENTS AND UTILIZE THE OPERATING ROOM AND OTHER FACILITIES OF THE RAILROAD'S HOSPITAL.

ARTICLE 3 OF CONTRACT I-3ARR-1824 MAKES IT MANDATORY FOR THE RAILROAD TO BILL FOR AND COLLECT FROM PATIENTS THE FEES CHARGED FOR SAID PROFESSIONAL SERVICES AND PAY TO THE PARTY OF THE FIRST PART 75 PERCENT OF THE PROFESSIONAL FEES COLLECTED ON ACCOUNT OF HIS SERVICE, THE RAILROAD RETAINING 25 PERCENT FOR ITS SERVICE. BY THIS PROVISION THERE APPEARS NO LEGAL BASIS FOR THE EXCLUSION BY THE SIGNAL CORPS OF THE CHARGE FOR PROFESSIONAL SERVICES IN ITS ENTIRETY. POSSIBLY THE EXCLUSION OF 25 PERCENT OF THE PROFESSIONAL CHARGE, THE AMOUNT TO BE RETAINED BY THE RAILROAD, IS PROPER. SEE COMPTROLLER GENERAL DECISION A-29130, DATED FEBRUARY 3, 1930--- (9 C.G. 332).

IN CONNECTION WITH THE HOSPITALIZATION OF HELDE, THE RAILROAD, UPON ORDER OF THE ATTENDING PHYSICIAN, EMPLOYED SPECIAL NURSES, THE COST OF WHICH AMOUNTED TO $240.00. AS SPECIAL NURSING SERVICES ARE NOT FURNISHED IN THE ORDINARY HOSPITALIZATION OF PATIENTS, BUT ARE AN ADDITIONAL EXPENSE, IT IS BELIEVED ONLY JUST THAT THE RAILROAD BE REIMBURSED TO THIS EXTENT.

A CHECK ON THE TREASURY OF THE UNITED STATES, NUMBERED 399,155 IN THE AMOUNT OF $486.00, DATED AUGUST 31, 1937, AND SIGNED BY E. C. MORTON, OVER SYMBOL 20-249 REPRESENTING 81 DAYS HOSPITALIZATION AT $6.00 PER DAY FOR HELDE WAS RECEIVED, AND TAKEN INTO ACCOUNT SEPTEMBER 14, 1937. THIS CHECK PURPORTS TO BE FULL SETTLEMENT OF OUR BILL.

TWO COPIES OF BILL NO. H-9671 ARE ENCLOSED STATED AS FOLLOWS: 81 DAYS HOSPITALIZATION AT $6.00 ($486.00) 75 PERCENT OF PROFESSIONAL CHARGE OF $362.00 ($271.50) AND SPECIAL NURSING ($240.00), TOTAL $997.50, LESS PAYMENT OF $486.00, LEAVING A BALANCE OF $511.50 DUE THE RAILROAD, OF WHICH AMOUNT THE RAILROAD WOULD PAY TO DR. ROMIG, ON DISBURSEMENT VOUCHER, $271.50 AS HIS PORTION OF THE PROFESSIONAL CHARGE AND THE BALANCE OF $240.00 COVERS AMOUNT PAID BY THE RAILROAD TO THE SPECIAL NURSES.

DURING THE FISCAL YEARS 1936 AND 1937, BILLS WERE RENDERED THE SIGNAL CORPS (ON ACCOUNT OF HOSPITAL SERVICES) IN WHICH WERE INCLUDED CHARGES FOR PROFESSIONAL SERVICES RENDERED, SAID PROFESSIONAL SERVICES HAVING BEEN DISALLOWED BY THE SIGNAL CORPS AT THE TIME OF PAYMENT FOR THE REASON STATED IN THE INSTANT CASE. THE DOCTORS PERFORMING PROFESSIONAL SERVICE IN THESE CASES WERE EMPLOYED BY THE RAILROAD, UNDER CONTRACT, BUT WERE NOT OBLIGATED TO FURNISH FREE SERVICES TO OTHER BRANCHES OF THE GOVERNMENT. BILL IN DUPLICATE LISTING THESE CASES IS ENCLOSED.

IT IS RESPECTFULLY REQUESTED THAT THIS MATTER BE REFERRED TO THE ACTING COMPTROLLER GENERAL FOR DECISION, BEARING IN MIND THE FACT THAT THE RAILROAD INCURRED EXTRA NURSING EXPENSE IN THE AMOUNT OF $240.00 IN THE CARE OF HELDE, AND THAT THE DOCTOR IN NONE OF THESE CASES IS OBLIGATED UNDER HIS CONTRACT TO PERFORM FREE SERVICES TO OTHER BRANCHES OF THE GOVERNMENT.

RESOLUTION ADOPTED BY THE FEDERAL BOARD OF HOSPITALIZATION DATED JUNE 4, 1937, AND APPROVED BY THE PRESIDENT JUNE 21, 1937, STATES: "* * * AND THAT THE REIMBURSEMENT RATE FOR GOVERNMENT HOSPITALIZATION IN THE ALASKA RAILROAD HOSPITAL AT ANCHORAGE FOR THE FISCAL YEAR 1938 BE ESTABLISHED AT $6.00 PER DAY PER PATIENT FOR BED, BOARD, AND NURSING, PLUS ACTUAL CONTRACT CHARGES FOR NECESSARY PROFESSIONAL CHARGES.'

MR. E. K. BURLEW IN LETTER OF JUNE 25, 1937, STATED THAT THE ABOVE LANGUAGE AS INTERPRETED BY THE HOSPITALIZATION BOARD WOULD INCLUDE THE USE OF THE SURGICAL ROOM, LABORATORY ANALYSIS, AND SUCH IN THE $6.00 PER DIEM RATE FOR BED, BOARD, AND NURSING. THE RAILROAD HAS NEVER CONSIDERED USE OF SURGERY, LABORATORY, AND X-RAY WORK AS INCLUDED IN THE PER DIEM CHARGE MADE TO PRIVATE PATIENTS AND INCLUDES IN THE REGULATIONS CHARGES FOR THESE ITEMS CLOSELY APPROXIMATING THE ACTUAL COST, WHICH ARE ASSESSED IN ADDITION TO THE PER DIEM CHARGES FOR BED, BOARD, AND NURSING.

AS THE HOSPITAL REGULATIONS OF THE RAILROAD PROVIDE FOR A CHARGE FOR THESE SERVICES IN ADDITION TO THE PER DIEM RATE, AND AS THE HOSPITALIZATION BOARD DO NOT SPECIFICALLY INCLUDE THEM IN THE RESOLUTION, IT IS RESPECTFULLY REQUESTED THAT THE ACTING COMPTROLLER GENERAL BE REQUESTED TO DECIDE THIS MATTER AND ADVISE IF THE RAILROAD SHOULD CHARGE THE OTHER GOVERNMENT AGENCIES FOR USE OF SURGERY, LABORATORY, AND X-RAY WORK AT RATES AS ESTABLISHED BY THE ALASKA RAILROAD'S HOSPITAL REGULATIONS IN ADDITION TO THE $6.00 PER DIEM AUTHORIZED BY THE FEDERAL BOARD OF HOSPITALIZATION. IT IS MY UNDERSTANDING THAT THE CHARGES FOR PROFESSIONAL SERVICES WILL BE 75 PERCENT OF THE REGULAR FEES PRESCRIBED BY THE RAILROAD HOSPITAL REGULATIONS, THIS AMOUNT TO BE PAID TO THE DOCTOR AFTER COLLECTION BY THE RAILROAD.

ONE COPY EACH OF CONTRACT I-3ARR-1824 DATED AUGUST 14, 1936, WITH HOWARD G. ROMIG, NOT EMPLOYED BY THE RAILROAD, I-3ARR-1888 DATED DECEMBER 31, 1936, WITH P. L. HEITMEYER, EMPLOYED AS CHIEF OF STAFF AND I-3ARR-1959, DATED JULY 10, 1937, WITH R. L. WORKS, EMPLOYED AS PHYSICIAN AND SURGEON, ARE ENCLOSED. ATTENTION IS INVITED TO ARTICLE 3 OF DR. ROMIG'S CONTRACT AND ARTICLES 2 AND 3 OF THE OTHER CONTRACTS. AN EARLY DECISION WILL BE APPRECIATED IN ORDER TO PROPERLY RENDER HOSPITAL BILLS AGAINST OTHER FEDERAL AGENCIES DURING THE BALANCE OF THIS FISCAL YEAR.

REGULATIONS FOR THE MANAGEMENT OF THE ALASKA RAILROAD HOSPITAL AT ANCHORAGE, ALASKA, WERE ESTABLISHED UNDER EXECUTIVE ORDER NO. 2414, OF JUNE 30, 1916. THE JOINT RESOLUTION OF MARCH 3, 1927 (PRIVATE NO. 6, 69TH CONG., 2D SESS.), 44 STAT. 1845, AUTHORIZES THE PAYMENT OF FEES TO HOSPITAL SURGEONS OF THE RAILROAD UNDER ANY AGREEMENTS RELATING TO THE COLLECTION OF FEES, AND EXECUTIVE ORDER NO. 4618 OF MARCH 19, 1927, SPECIFICALLY AUTHORIZES THE GENERAL MANAGER OF THE ALASKA RAILROAD TO ENTER INTO CONTRACTS OF EMPLOYMENT ON A FEE BASIS FOR HOSPITAL SURGEONS SUCH AS IS INVOLVED IN THE PRESENT CASE.

EXAMINATION HAS BEEN MADE OF THE RESOLUTION ADOPTED BY THE FEDERAL BOARD OF HOSPITALIZATION DATED APRIL 13, 1936, FIXING UNIFORM PER DIEM RATES OF REIMBURSEMENT FOR GOVERNMENT HOSPITALIZATION DURING THE FISCAL YEAR 1937, AND PROVIDING THAT THE ALASKA RAILROAD HOSPITAL AT ANCHORAGE BE EXCEPTED FROM THE PROVISIONS OF THE RECIPROCAL AGREEMENT APPROVED BY THE PRESIDENT ON MARCH 30, 1935, AND BE PERMITTED TO CHARGE A RATE OF $6 PER DAY FOR HOSPITALIZING PATIENTS OF OTHER FEDERAL AGENCIES. WHILE THIS $6 RATE APPARENTLY WAS TO COVER ALL CHARGES FOR HOSPITALIZATION FURNISHED DURING 1937, THE BOARD OF HOSPITALIZATION DERIVES ITS AUTHORITY FOR ITS ACTIONS SOLELY FROM AN AGREEMENT BETWEEN THE VARIOUS SERVICES TO COOPERATE. SUCH CIRCUMSTANCES SAID BOARD HAS NO STATUTORY AUTHORITY TO REQUIRE ANY AGENCY TO FURNISH SERVICES TO ANOTHER AGENCY AT LESS THAN COST. IN THE PRESENT MATTER, SINCE THE SURGEON'S SERVICES ARE PAID FOR ON A FEE BASIS AND AS A SPECIAL NURSE WAS FURNISHED IN ADDITION TO REGULAR HOSPITAL ATTENDANTS, THE $6 PER DAY CHARGE APPARENTLY DID NOT COVER SUCH EXTRA EXPENSES. THE BOARD HAS EVIDENTLY RECOGNIZED THIS AND HAS AMENDED THE REGULATIONS FOR THE FISCAL YEAR 1938 AUTHORIZING SUCH EXTRA CHARGES. ANY EVENT THE 1937 REGULATIONS MAY NOT BE CONSTRUED AS PRECLUDING PAYMENT FOR EXTRA SERVICES SUCH AS INVOLVED HERE AS SUCH CONSTRUCTION IN EFFECT WOULD NOT ONLY NULLIFY CONTRACTS WITH HOSPITAL SURGEONS SANCTIONED BY STATUTE AND THE EXECUTIVE ORDER OF MARCH 17, 1927, SUPRA, BUT WOULD BE IN CONTRAVENTION OF SECTION 3678, REVISED STATUTES, AS THE REVENUES OF THE ALASKA RAILROAD ARE SPECIFICALLY APPROPRIATED FOR ITS EXPENSES AND NOT TO FURNISH MEDICAL AND NURSING SERVICES TO PATIENTS OF THE WAR DEPARTMENT.

ACCORDINGLY, IN VIEW OF ALL THE CIRCUMSTANCES, THE LAW AND THE EXECUTIVE ORDERS THEREUNDER PROMULGATED, IT MUST BE HELD THAT THE ALASKA RAILROAD IS ENTITLED TO RECOVER FROM THE WAR DEPARTMENT, PURSUANT TO THE CONTRACT WITH THE HOSPITAL SURGEON, 75 PERCENT OF THE SURGEON'S FEES FOR SERVICES RENDERED IN THE CASE OF PVT. ERLING A. HELDE, $271.50, PLUS THE CHARGES FOR SPECIAL NURSING ORDERED BY THE CONTRACT SURGEON, $240, OR AN ADDITIONAL SUM OF $511.50.

THE SECRETARY OF WAR IS BEING FURNISHED A COPY OF THIS LETTER FOR HIS INFORMATION AND GUIDANCE.