B-160604, JANUARY 19, 1967, 46 COMP. GEN. 616

B-160604: Jan 19, 1967

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THE FACTS AND CIRCUMSTANCES GIVING RISE TO THE PROBLEM ARE SET FORTH BELOW. LYONS VETERANS ADMINISTRATION HOSPITAL WAS BUILT IN 1930 IN AN ISOLATED AREA OF BERNARD TOWNSHIP. PUBLIC TRANSPORTATION WAS AVAILABLE TO AND FROM THE HOSPITAL BUT WAS DISCONTINUED BY THE CARRIER. THE CLOSEST PUBLIC TRANSPORTATION IS NOW LOCATED ABOUT 2 MILES FROM THE HOSPITAL AT THE GLADSTONE BRANCH OF THE ERIE LACKAWANNA RAILROAD. THE SCHEDULE OF THE RAILROAD IS. THE CLOSEST BUS FACILITIES ARE LOCATED AT PLAINFIELD. WHICH IS APPROXIMATELY 10 MILES AWAY. THERE ARE APPARENTLY NO TAXICABS OPERATING IN THE VICINITY OF THE HOSPITAL. MANY RELATIVES OR OTHER VISITORS ARE UNABLE TO VISIT THE VETERAN-PATIENTS. THERE ARE PRESENTLY MANY INDUSTRIES IN NEARBY COMMUNITIES WHICH WOULD PARTICIPATE IN SUCH A PROGRAM IF TRANSPORTATION WERE AVAILABLE.

B-160604, JANUARY 19, 1967, 46 COMP. GEN. 616

VETERANS ADMINISTRATION - CONTRACTS - TRANSPORTATION SERVICES - AUTHORITY TO SUBSIDIZE TO OVERCOME THE LACK OF AVAILABILITY OF PUBLIC TRANSPORTATION TO A VETERANS HOSPITAL LOCATED IN AN ISOLATED AREA, THE VETERANS ADMINISTRATION TO ASSURE THE CONTINUATION OF VISITS TO VETERAN PATIENTS NECESSARY FOR THE COMPLETE MEDICAL AND HOSPITAL CARE PRESCRIBED BY 38 U.S.C. 4101 (A) MAY ENTER INTO A SUBSIDY-TYPE AGREEMENT WITH A PRIVATE CARRIER UNDER THE AUTHORITY OF 38 U.S.C. 213 FOR REGULARLY SCHEDULED TRANSPORTATION SERVICES TO THE HOSPITAL AT A GUARANTEED SUM PER ANNUM, LESS THE AMOUNT OF FARES--- FARES COMMENSURATE WITH COMMON CARRIER FARES--- COLLECTED FROM VISITORS AND EMPLOYEES, THE ADMINISTRATION TO ESTABLISH ADEQUATE CONTROLS TO INSURE A PROPER ACCOUNTING BY THE CARRIER OF THE FARES COLLECTED.

TO THE ADMINISTRATOR, VETERANS ADMINISTRATION, JANUARY 19, 1967:

YOUR LETTER OF DECEMBER 27, 1966, CONCERNS A TRANSPORTATION PROBLEM INVOLVING THE VETERANS ADMINISTRATION HOSPITAL IN LYONS, NEW JERSEY. YOU ADVISE THAT THE PROBLEM, IF ALLOWED TO CONTINUE, COULD SERIOUSLY INTERFERE WITH THE CARE AND TREATMENT BEING PROVIDED HOSPITALIZED VETERAN-PATIENTS.

THE FACTS AND CIRCUMSTANCES GIVING RISE TO THE PROBLEM ARE SET FORTH BELOW.

LYONS VETERANS ADMINISTRATION HOSPITAL WAS BUILT IN 1930 IN AN ISOLATED AREA OF BERNARD TOWNSHIP, NEW JERSEY. UNTIL THE LATTER PART OF 1964, PUBLIC TRANSPORTATION WAS AVAILABLE TO AND FROM THE HOSPITAL BUT WAS DISCONTINUED BY THE CARRIER, DUE TO A LACK OF SUFFICIENT INCOME TO COVER THE COSTS OF OPERATION. THE CLOSEST PUBLIC TRANSPORTATION IS NOW LOCATED ABOUT 2 MILES FROM THE HOSPITAL AT THE GLADSTONE BRANCH OF THE ERIE LACKAWANNA RAILROAD. THE SCHEDULE OF THE RAILROAD IS, HOWEVER, NOT COMPATIBLE WITH THE TRANSPORTATION NEEDS OF THE HOSPITAL. THE CLOSEST BUS FACILITIES ARE LOCATED AT PLAINFIELD, NEW JERSEY, WHICH IS APPROXIMATELY 10 MILES AWAY, AND THERE ARE APPARENTLY NO TAXICABS OPERATING IN THE VICINITY OF THE HOSPITAL.

BECAUSE OF THE TRANSPORTATION PROBLEM WHICH NOW EXISTS, MANY RELATIVES OR OTHER VISITORS ARE UNABLE TO VISIT THE VETERAN-PATIENTS. THIS HAS RESULTED IN A DETERIORATION OF PATIENT MORALE. IT HAS ALSO RESTRICTED THE PATIENT CARE PROGRAM IN OTHER WAYS, SUCH AS THE FOLLOWING:

(A) HAMPERS THE USE OF NIGHT HOSPITAL WORK-OUT PROGRAMS TO PROMOTE THE VOCATIONAL REHABILITATION OF PATIENTS. THERE ARE PRESENTLY MANY INDUSTRIES IN NEARBY COMMUNITIES WHICH WOULD PARTICIPATE IN SUCH A PROGRAM IF TRANSPORTATION WERE AVAILABLE.

(B) SERIOUSLY LIMITS MOBILITY OF PATIENTS FOR VARIOUS COMMUNITY ACTIVITIES, SUCH AS EMPLOYMENT, ORIENTATION VISITS, ETC., AS STEPS TOWARD CONSTRUCTIVE COMMUNITY PLACEMENT PLANS. RELATIVES FREQUENTLY GIVE LACK OF TRANSPORTATION AS A REASON FOR THEIR INABILITY TO VISIT THE HOSPITAL, THUS MAKING IT EXCEEDINGLY DIFFICULT TO INVOLVE THEM IN DISPOSITION PLANNING FOR PATIENTS.

(C) REDUCES THE ACCESSIBILITY OF THE HOSPITAL FOR OUTPATIENT TREATMENT PROGRAMS.

(D) LIMITS THE ASSIGNMENT OF STUDENTS AND TRAINEES TO THE HOSPITAL TO THOSE FEW WHO CAN AFFORD TO PURCHASE CARS.

(E) MAKES THE HOSPITAL INACCESSIBLE TO A SIGNIFICANT PERCENTAGE OF POTENTIAL EMPLOYEES IN AREAS IN WHICH THERE IS A CRITICAL SHORTAGE.

YOU ADVISE THAT THE PATIENT CARE PROGRAM IS INDIRECTLY AFFECTED BY STAFFING DIFFICULTIES AND EMPLOYEE MORALE PROBLEMS, WHICH IN SOME CASES CAN BE ATTRIBUTED TO TRANSPORTATION DIFFICULTIES. YOU POINT OUT THAT ALTHOUGH THE RECENTLY ENACTED PROVISIONS OF 38 U.S.C. 233 (B) AUTHORIZE THE UTILIZATION OF GOVERNMENT VEHICLES TO TRANSPORT EMPLOYEES TO AND FROM THEIR HOMES AND THE HOSPITAL WHERE IT IS DETERMINED THAT SUCH ACTION IS NECESSARY TO KEEP FROM ENDANGERING YOUR MEDICAL CARE PROGRAM, THIS AUTHORITY WOULD NOT SOLVE THE TRANSPORTATION PROBLEMS OF NONEMPLOYEE RELATIVES AND VISITORS.

AFTER CONSIDERING ALL ASPECTS OF THIS PROBLEM AND BEING COGNIZANT OF THE THERAPEUTIC BENEFIT ACCRUING TO VETERAN-PATIENTS AS A RESULT OF VISITS BY THEIR RELATIVES, IT WAS DETERMINED BY YOUR MEDICAL PERSONNEL THAT THE FURNISHING OF TRANSPORTATION FACILITIES TO ASSURE THE CONTINUATION OF THESE VISITS WAS, IN FACT,"NECESSARY FOR A COMPLETE MEDICAL AND HOSPITAL SERVICE," AS THAT TERM IS USED IN 38 U.S.C. 4101 (A). BASED UPON THIS DETERMINATION, YOU EXPRESS THE VIEW THAT IT WOULD APPEAR PROPER TO FURNISH THE NEEDED TRANSPORTATION EITHER BY USING GOVERNMENTAL TRANSPORTATION FACILITIES, OR, IN THE ALTERNATIVE, BY ENTERING INTO AN AGREEMENT (AS AUTHORIZED BY 38 U.S.C. 213) WITH A PRIVATE OR PUBLIC AGENCY OR PERSON.

AFTER CONSIDERING THE VARIOUS POSSIBILITIES, HOWEVER, YOU FIND IT WOULD BE LESS EXPENSIVE IF YOU COULD ENTER INTO A SUBSIDY-TYPE ARRANGEMENT WITH A PRIVATE CARRIER, RATHER THAN CONTRACT OUTRIGHT FOR THE NECESSARY TRANSPORTATION SERVICES. IT HAS BEEN DETERMINED THAT A PRIVATE CARRIER, THE PUBLIC SERVICE COORDINATED TRANSPORT, WILL PROVIDE TRANSPORTATION ON A REGULAR SCHEDULE BETWEEN NEWARK, NEW JERSEY, AND THE LYONS HOSPITAL FOR A GUARANTEED SUM OF $47,545 PER ANNUM. YOU ADVISE THAT THIS IS APPROXIMATELY $20,175 LESS THAN WHAT IT WOULD COST TO PROVIDE THE SAME SERVICE UTILIZING GOVERNMENT EQUIPMENT AND EMPLOYEES. MOREOVER, YOU STATE THAT THE COST WOULD BE REDUCED STILL FURTHER BY OFFSETTING AMOUNTS RECEIVED AS FARES. INASMUCH AS THE FACILITIES TO BE USED WOULD NOT BE GOVERNMENTAL FACILITIES, YOU ARE CONSIDERING ALLOWING EMPLOYEES TO UTILIZE THE FACILITIES, AND WOULD AUTHORIZE CHARGING ALL RECIPIENTS OF THE SERVICE.

SINCE THERE SEEMS TO BE AN ABSENCE OF PRECEDENT FOR USING A SUBSIDY CONTRACT AS A MEANS OF SECURING PUBLIC TRANSPORTATION TO MEET A GOVERNMENTAL NEED, YOU FEEL THAT PRIOR TO NEGOTIATING THE ACTUAL CONTRACT, THE MATTER SHOULD RECEIVE OUR CONSIDERATION. ACCORDINGLY, OUR ADVICE IS REQUESTED AS TO THE EXPENDITURE OF APPROPRIATED FUNDS FOR THE SUBSIDY-TYPE CONTRACT BEING PROPOSED AS A MEANS OF MEETING THE TRANSPORTATION PROBLEM NOW EXISTING AT THE LYONS VA HOSPITAL. IF APPROPRIATED FUNDS MAY BE USED UNDER THESE CIRCUMSTANCES, OUR ADVICE IS ALSO REQUESTED CONCERNING THE PROPOSAL TO CHARGE ALL PASSENGERS WHO WOULD UTILIZE THE FACILITIES, AND CONCERNING THE FISCAL PROCEDURE TO BE FOLLOWED IN OFFSETTING AMOUNTS COLLECTED FROM PASSENGER FARES AGAINST THE AMOUNT GUARANTEED TO THE CARRIER.

SECTION 233 (B), TITLE 38, U.S.C. PROVIDES THAT:

(B) THE ADMINISTRATOR, WHEN HE DETERMINES THAT AN EMERGENCY SITUATION EXISTS AND THAT SUCH ACTION IS NECESSARY FOR THE EFFECTIVE CONDUCT OF THE AFFAIRS OF THE VETERANS' ADMINISTRATION, MAY UTILIZE GOVERNMENT-OWNED, OR LEASED, VEHICLES TO TRANSPORT EMPLOYEES TO AND FROM THEIR PLACE OF EMPLOYMENT AND THE NEAREST ADEQUATE PUBLIC TRANSPORTATION, OR, IF SUCH PUBLIC TRANSPORTATION IS EITHER UNAVAILABLE OR NOT FEASIBLE TO USE, TO AND FROM THEIR PLACE OF EMPLOYMENT AND THEIR HOME. THE ADMINISTRATOR SHALL ESTABLISH REASONABLE RATES TO COVER THE COST OF THE SERVICE RENDERED, AND ALL PROCEEDS COLLECTED THEREFROM SHALL BE APPLIED TO THE APPLICABLE APPROPRIATION.

SECTION 4101 (A) OF THE SAME TITLE READS AS FOLLOWS:

THERE SHALL BE IN THE VETERANS' ADMINISTRATION A DEPARTMENT OF MEDICINE AND SURGERY UNDER A CHIEF MEDICAL DIRECTOR. THE FUNCTIONS OF THE DEPARTMENT OF MEDICINE AND SURGERY SHALL BE THOSE NECESSARY FOR A COMPLETE MEDICAL AND HOSPITAL SERVICE, INCLUDING MEDICAL RESEARCH, AS PRESCRIBED BY THE ADMINISTRATOR PURSUANT TO THIS CHAPTER AND OTHER STATUTORY AUTHORITY, FOR THE MEDICAL CARE AND TREATMENT OF VETERANS.

ALSO, 38 U.S.C. 213 PROVIDES---

THE ADMINISTRATOR MAY, FOR PURPOSES OF ALL LAWS ADMINISTERED BY THE VETERANS' ADMINISTRATION, ACCEPT UNCOMPENSATED SERVICES, AND ENTER INTO CONTRACTS OR AGREEMENTS WITH PRIVATE OR PUBLIC AGENCIES OR PERSONS, FOR SUCH NECESSARY SERVICES (INCLUDING PERSONAL SERVICES) AS HE MAY DEEM PRACTICABLE.

FURTHER, SECTION 501 OF THE INDEPENDENT OFFICES APPROPRIATION ACT, 1952, PROVIDES (QUOTING FROM 5 U.S.C. 140 (1964 ED.)

IT IS THE SENSE OF THE CONGRESS THAT ANY WORK, SERVICE PUBLICATION, REPORT, DOCUMENT, BENEFIT, PRIVILEGE, AUTHORITY, USE, FRANCHISE, LICENSE, PERMIT, CERTIFICATE, REGISTRATION, OR SIMILAR THING OF VALUE OR UTILITY PERFORMED, FURNISHED, PROVIDED, GRANTED, PREPARED, OR ISSUED BY ANY FEDERAL AGENCY (INCLUDING WHOLLY OWNED GOVERNMENT CORPORATIONS AS DEFINED IN THE GOVERNMENT CORPORATION CONTROL ACT OF 1945) TO OR FOR ANY PERSON (INCLUDING GROUPS, ASSOCIATIONS, ORGANIZATIONS, PARTNERSHIPS, CORPORATIONS, OR BUSINESSES), EXCEPT THOSE ENGAGED IN THE TRANSACTION OF OFFICIAL BUSINESS OF THE GOVERNMENT, SHALL BE SELF SUSTAINING TO THE FULL EXTENT POSSIBLE * * *.

IN LIGHT OF ALL THE FACTS AND CIRCUMSTANCES SET FORTH ABOVE CONSIDERED TOGETHER WITH THE TENOR OF THE STATUTES QUOTED ABOVE, WE WOULD HAVE NO OBJECTION TO THE EXPENDITURE OF APPROPRIATED FUNDS FOR THE SUBSIDY-TYPE CONTRACT YOU PROPOSE, IN THE INSTANT CASE, PROVIDED THE CARRIER IS REQUIRED THEREUNDER TO CHARGE ALL PASSENGERS FOR THE SERVICE FURNISHED. IN OTHER WORDS, IN THE INSTANT CASE, WE WOULD HAVE NO OBJECTION TO THE VETERANS ADMINISTRATION ENTERING INTO A CONTRACT WITH A PRIVATE CARRIER WHEREBY THE CARRIER WOULD PROVIDE TRANSPORTATION ON A REGULAR SCHEDULED BASIS BETWEEN NEWARK, NEW JERSEY AND THE LYONS HOSPITAL, AND THE VETERANS ADMINISTRATION WOULD PAY THE CARRIER A GUARANTEED SUM PER ANNUM LESS THE AMOUNT OF THE FARES THE CARRIER WOULD BE REQUIRED TO CHARGE AND COLLECT FROM ALL PASSENGERS. WE ASSUME, OF COURSE, THAT THE FARES ESTABLISHED WILL BE COMMENSURATE WITH THOSE CHARGED BY COMMON CARRIERS FOR SUCH SERVICE.

CONCERNING THE FISCAL PROCEDURE TO BE FOLLOWED, AS INDICATED ABOVE, PAYMENTS BY THE VETERANS ADMINISTRATION TO THE CARRIER, IF ANY, SHOULD BE ON A NET BALANCE BASIS, SUBJECT TO ADJUSTMENT IF MADE OTHER THAN ON AN ANNUAL BASIS. THAT IS TO SAY THE CONTRACT SHOULD PROVIDE THAT THE VETERANS ADMINISTRATION WILL PAY THE CARRIER THE DIFFERENCE, IF ANY, BETWEEN THE TOTAL AMOUNT OF THE FARES COLLECTED DURING THE YEAR BY THE CARRIER AND THE SUM GUARANTEED BY VETERANS ADMINISTRATION PER ANNUM. ADEQUATE ADMINISTRATIVE CONTROLS SHOULD BE ESTABLISHED TO INSURE A PROPER ACCOUNTING BY THE CARRIER OF THE FARES COLLECTED.