B-39432, MARCH 18, 1944, 23 COMP. GEN. 694

B-39432: Mar 18, 1944

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1944: REFERENCE IS MADE TO YOUR LETTER OF JANUARY 12. IT WAS NOTIFIED BY THE SURGEON GENERAL THAT ITS APPLICATION HAD BEEN APPROVED AND AN ALLOCATION OF $89. THIS WAS DEPOSITED IN THE " SPECIAL DEPOSITS ACCOUNT" IN THE TREASURY PENDING CLARIFICATION OF QUESTION CONCERNING APPLICATION OF THE FUNDS AS AFFECTS THE HOSPITAL. IT HAS BEEN ADMINISTRATIVELY DETERMINED BY THE SURGEON GENERAL OF THE PUBLIC HEALTH SERVICE THAT THE ALLOTMENTS MADE UNDER THE BOLTON ACT ARE AVAILABLE AS OF JULY 1. THE SAINT ELIZABETHS PLAN WAS SUBMITTED PRIOR TO THAT DATE. THE ITEMS WHICH PARTICIPATING INSTITUTIONS ARE REQUIRED TO FURNISH STUDENT NURSES UNDER APPROVED PLANS ARE SET FORTH IN SECTION 2 OF THE BOLTON ACT.

B-39432, MARCH 18, 1944, 23 COMP. GEN. 694

APPROPRIATIONS - AVAILABILITY OF NURSE TRAINING PROGRAM FUNDS TO FEDERAL INSTITUTIONS FUNDS APPROPRIATED BY THE ACT OF JUNE 15, 1943, AS AMENDED, AUTHORIZING A GRANT OF FEDERAL FUNDS TO INSTITUTIONS PARTICIPATING IN THE NURSE TRAINING PROGRAM PARTIALLY TO COMPENSATE FOR EXPENSES INCIDENT THERETO, MAY NOT BE ALLOTTED TO ST. ELIZABETHS HOSPITAL OR OTHER FEDERAL INSTITUTIONS OPERATED WITH APPROPRIATED MONEYS.

COMPTROLLER GENERAL WARREN TO THE FEDERAL SECURITY ADMINISTRATOR, MARCH 18, 1944:

REFERENCE IS MADE TO YOUR LETTER OF JANUARY 12, 1944, AS FOLLOWS:

THE NURSING SCHOOL OF SAINT ELIZABETHS HOSPITAL SUBMITTED TO THE SURGEON GENERAL OF THE UNITED STATES PUBLIC HEALTH SERVICE A PLAN FOR PARTICIPATION IN THE NURSE TRAINING PROGRAM PROVIDED BY THE ACT APPROVED JUNE 15, 1943 ( P.L. 74--- 78TH CONGRESS) GENERALLY KNOWN AS THE BOLTON ACT. ON SEPTEMBER 11, IT WAS NOTIFIED BY THE SURGEON GENERAL THAT ITS APPLICATION HAD BEEN APPROVED AND AN ALLOCATION OF $89,171.00 HAD BEEN MADE. ON OCTOBER 15, IT RECEIVED A CHECK FOR THE FIRST QUARTER IN THE AMOUNT OF $18,640.00. THIS WAS DEPOSITED IN THE " SPECIAL DEPOSITS ACCOUNT" IN THE TREASURY PENDING CLARIFICATION OF QUESTION CONCERNING APPLICATION OF THE FUNDS AS AFFECTS THE HOSPITAL. IT HAS BEEN ADMINISTRATIVELY DETERMINED BY THE SURGEON GENERAL OF THE PUBLIC HEALTH SERVICE THAT THE ALLOTMENTS MADE UNDER THE BOLTON ACT ARE AVAILABLE AS OF JULY 1, FOR INSTITUTIONS WHICH SUBMITTED APPROVABLE PLANS PRIOR TO SEPTEMBER 1. THE SAINT ELIZABETHS PLAN WAS SUBMITTED PRIOR TO THAT DATE.

THE ITEMS WHICH PARTICIPATING INSTITUTIONS ARE REQUIRED TO FURNISH STUDENT NURSES UNDER APPROVED PLANS ARE SET FORTH IN SECTION 2 OF THE BOLTON ACT, SUPPLEMENTED BY THE REGULATIONS ADOPTED THEREUNDER. FED. REG. TITLE 42, PART 28, JULY 9, 1943. SECTION 3 OF THE ACT SPECIFIES THE ITEMS WITH RESPECT TO WHICH PAYMENTS SHALL BE MADE TO EACH PARTICIPATING INSTITUTION "TO COMPENSATE SUCH INSTITUTION" FOR THE ITEMS FURNISHED STUDENT NURSES.

THE ALLOTMENT TO SAINT ELIZABETHS HOSPITAL WAS ACCORDINGLY MADE WITHOUT DEDUCTION ON ACCOUNT OF ITEMS FOR WHICH THE GENERAL APPROPRIATION FOR THE HOSPITAL IS AVAILABLE. THUS, THE ALLOTMENT INCLUDES AN AMOUNT OF MAINTENANCE DURING THE FIRST 9 MONTHS OF STUDY; THE GENERAL APPROPRIATION IS AVAILABLE TO FURNISH MAINTENANCE THROUGHOUT THE ENTIRE PERIOD OF TRAINING AT THE HOSPITAL, AND SUCH MAINTENANCE IS CONSIDERED A PART OF THE COMPENSATION. THE ALLOTMENT ALSO INCLUDES AMOUNTS EQUAL TO THE MINIMUM RATE OF STIPEND ($15 AND $20 PER MONTH) WHICH PARTICIPATING INSTITUTIONS ARE REQUIRED TO PAY FOR THE FIRST 9 MONTHS OF STUDY AND FOR THE ENSUING 15 -21 MONTHS PERIOD OF COMBINED STUDY AND PRACTICE; THESE AMOUNTS ARE LESS THAN THE CASH COMPENSATION OF $43 PER MONTH, INCLUDING OVERTIME, PAID TO ALL STUDENT NURSES AT SAINT ELIZABETHS. YOUR DECISION OF DECEMBER 14, 1943 (B-38665) INDICATES THAT SUCH PAYMENTS TO STUDENT NURSES EMPLOYED BY SAINT ELIZABETHS, INCLUDING THOSE WHO ENROLL AS CADETS UNDER THE PLAN, MAY BE CONTINUED. THE ALLOTMENT INCLUDES ALSO AMOUNTS FOR ITEMS WHICH ARE NECESSARY FOR THE TRAINING PROGRAM AND WHICH, UNDER SECTION 2 OF THE BOLTON ACT, MUST BE FURNISHED WITHOUT CHARGE TO STUDENT NURSES UNDER THE PLAN, THE COST OF WHICH, HOWEVER, IS CUSTOMARILY CARRIED BY THE STUDENT NURSES THEMSELVES. THESE INCLUDE SUCH ITEMS AS TEXT BOOKS, LABORATORY FEES, AND UNIFORMS.

THE REGULATIONS ISSUED UNDER THE BOLTON ACT REQUIRE THAT THE FISCAL OFFICER AUTHORIZED BY THE GRANTEE INSTITUTION SHALL KEEP AN ACCOUNT OF FUNDS PAID UNDER THE ACT SEPARATE AND DISTINCT FROM THOSE OF ANY OTHER FUNDS, LOCAL OR FEDERAL.

IN VIEW OF THE FOREGOING, YOU ARE REQUESTED TO ADVISE:

(1) SHOULD THE BOLTON ACT FUNDS RECEIVED BY SAINT ELIZABETHS BE SET UP UNDER A SUITABLE TITLE AND SYMBOL ON THE BOOKS OF THE TREASURY?

(2) MAY OR MUST FUNDS RECEIVED UNDER THE BOLTON ACT BE USED FOR ALL ITEMS FURNISHED CADET NURSES IN ACCORDANCE WITH THE PLAN APPROVED UNDER THE BOLTON ACT, TO THE EXTENT THAT SUCH FUNDS ARE AVAILABLE THEREFOR?

(3) TO THE EXTENT THAT THE GENERAL APPROPRIATION HAS BEEN, OR MAY BE, USED TO PAY FOR ITEMS FOR WHICH FUNDS HAVE BEEN MADE AVAILABLE UNDER THE BOLTON ACT, SHOULD THE GENERAL APPROPRIATION FOR THE HOSPITAL BE REIMBURSED FOR SUCH ITEMS?

(4) SHOULD SUCH REIMBURSEMENT BE MADE EFFECTIVE FROM JULY 1, 1943 OR FROM SEPTEMBER 11, 1943 THE DATE OF NOTIFICATION OF APPROVAL OF THE PLAN SUBMITTED UNDER THE BOLTON ACT?

SECTIONS 1, 2, AND 3 OF THE ACT OF JUNE 15, 1943, 57 STAT. 153, 154. PUBLIC LAW 74, PROVIDE AS FOLLOWS:

THAT FOR THE PURPOSE OF ASSURING A SUPPLY OF NURSES FOR THE ARMED FORCES, GOVERNMENTAL AND CIVILIAN HOSPITALS, HEALTH AGENCIES, AND WAR INDUSTRIES, THERE ARE HEREBY AUTHORIZED TO BE APPROPRIATED SUMS SUFFICIENT TO CARRY OUT THE PURPOSES OF THIS ACT: PROVIDED, THAT THERE SHALL BE NO DISCRIMINATION IN THE ADMINISTRATION OF THE BENEFITS AND APPROPRIATIONS MADE UNDER THE RESPECTIVE PROVISIONS OF THIS ACT, ON ACCOUNT OF RACE, CREED, OR COLOR. SUCH SUMS SHALL BE USED FOR MAKING PAYMENTS TO SCHOOLS OF NURSING OR OTHER INSTITUTIONS WHICH HAVE SUBMITTED, AND HAD APPROVED BY THE SURGEON GENERAL OF THE PUBLIC HEALTH SERVICE (HEREINAFTER REFERRED TO AS THE SURGEON GENERAL), PLANS FOR NURSES' TRAINING, FOR MAKING PAYMENTS UNDER SECTION 4, AND FOR ALL NECESSARY EXPENSES OF THE PUBLIC HEALTH SERVICE IN ADMINISTERING THE PROVISIONS OF THIS ACT.

SEC. 2. A PLAN FOR TRAINING OF NURSES MAY BE LIMITED TO STUDENT NURSE TRAINING, OR TO POSTGRADUATE OR REFRESHER-NURSING COURSES, OR MAY INCLUDE BOTH. A PLAN SUBMITTED BY AN INSTITUTION MAY BE APPROVED ONLY IF IT PROVIDES---

(A) THAT NO STUDENT OR GRADUATE NURSE WILL BE INCLUDED UNDER THE PLAN UNLESS IN THE JUDGMENT OF THE HEAD OF THE INSTITUTION SUCH NURSE WILL BE AVAILABLE FOR MILITARY OR OTHER FEDERAL GOVERNMENTAL OR ESSENTIAL CIVILIAN SERVICES FOR THE DURATION OF THE PRESENT WAR, AND SUCH NURSE SO STATES IN HER APPLICATION FOR INCLUSION UNDER THE PLAN;

(B) THAT NURSES UNDER THE PLAN WILL BE PROVIDED COURSES OF STUDY AND TRAINING MEETING STANDARDS PRESCRIBED BY THE SURGEON GENERAL;

(C) THAT THE INSTITUTION WILL FURNISH STUDENT NURSES UNDER THE PLAN (WITHOUT CHARGE FOR TUITION, FEES, OR OTHER EXPENSES) COURSES OF STUDY AND TRAINING, UNIFORMS, INSIGNIA, AND MAINTENANCE IN ACCORDANCE WITH REGULATIONS OF THE SURGEON GENERAL;

(D) THAT THE INSTITUTION WILL PAY STUDENT NURSES UNDER THE PLAN A STIPEND AT NOT LESS THAN THE FOLLOWING MONTH RATES: $15 FOR THE FIRST NINE MONTHS OF STUDY; $20 FOR THE FOLLOWING FIFTEEN TO TWENTY-ONE MONTHS OF COMBINED STUDY AND PRACTICE, DEPENDING UPON THE CURRICULUM OF SUCH INSTITUTION;

(E) THAT THE INSTITUTION WILL EITHER AFFORD STUDENT NURSES UNDER THE PLAN AN OPPORTUNITY TO COMPLETE THEIR COURSE OF TRAINING UNTIL GRADUATION AT SUCH INSTITUTION AND WILL PAY SUCH STUDENT NURSE A STIPEND AT A MONTHLY RATE NOT LESS THAN $30 FOR THE PERIOD FOLLOWING THE PERIOD OF COMBINED STUDY AND PRACTICE AND PRIOR TO GRADUATION, OR WILL TRANSFER SUCH STUDENT, AFTER COMPLETION OF THE PERIOD OF COMBINED STUDY AND PRACTICE AND PRIOR TO GRADUATION, FOR TRAINING IN SOME OTHER INSTITUTION, BUT ONLY IF SUCH TRAINING MAY BE CREDITED TOWARD GRADUATION, AND THE INSTITUTION TO WHICH THE NURSE IS TRANSFERRED AGREES TO PAY HER A STIPEND AT A MONTHLY RATE OF NOT LESS THAN $30 UNTIL GRADUATION; AND

(F) THAT WHERE EXTRAMURAL CREDIT TOWARD GRADUATION CAN BE GIVEN UNDER THE LAW OF THE STATE IN WHICH THE INSTITUTION IS LOCATED, SUCH INSTITUTION WILL MAKE TRANSFERS TO FEDERAL HOSPITALS, UNDER THE CONDITIONS SPECIFIED IN SUBSECTION (E), IN ANY CASE WHERE A STUDENT NURSE DESIRES SUCH TRANSFER AND APPROPRIATE REQUEST FOR SUCH TRANSFER IS MADE ON BEHALF OF SUCH HOSPITAL.

SEC. 3. FROM THE SUMS APPROPRIATED THEREFOR THE SECRETARY OF THE TREASURY SHALL PAY EACH INSTITUTION, WITH A PLAN APPROVED UNDER SECTION 2-

(1) WITH RESPECT TO ITEMS FURNISHED STUDENT NURSES THEREUNDER, AMOUNTS DETERMINED BY THE SURGEON GENERAL TO COMPENSATE SUCH INSTITUTION FOR---

(A) REASONABLE TUITION AND FEES FOR THE COURSES OF STUDY AND TRAINING;

(B) REASONABLE MAINTENANCE PROVIDED PURSUANT TO SECTION 2 FOR THE FIRST NINE MONTHS OF THEIR COURSE OF STUDY AND TRAINING, TO THE EXTENT THAT SUCH MAINTENANCE IS NOT COMPENSATED FOR BY THE VALUE OF THEIR SERVICES DURING SUCH PERIOD;

(C) UNIFORMS AND INSIGNIA, PROVIDED IN ACCORDANCE WITH SECTION 2; AND

(D) THE MINIMUM RATE OF STIPEND SPECIFIED IN SECTION 2 FOR PERIODS PRIOR TO COMPLETION OF THE COURSE OF COMBINED STUDY AND TRAINING REFERRED TO IN SUCH SECTION; AND

(2) WITH RESPECT TO ITEMS FURNISHED GRADUATE NURSES THEREUNDER, AMOUNTS DETERMINED BY THE SURGEON GENERAL TO COMPENSATE SUCH INSTITUTION FOR REASONABLE TUITION AND FEES FOR POSTGRADUATE AND REFRESHER COURSE OF STUDY, AND REASONABLE MAINTENANCE FOR GRADUATE NURSES UNDERTAKING POSTGRADUATE COURSES, OR SUCH PORTION OF SUCH AMOUNTS AS MAY BE DETERMINED IN ACCORDANCE WITH REGULATIONS OF THE SURGEON GENERAL.

IT IS UNDERSTOOD FROM YOUR LETTER OF NOVEMBER 29, 1943, WHICH FORMED THE BASIS FOR DECISION TO YOU OF DECEMBER 14, 1943, B-38665, 23 C.G. 436, THAT ST. ELIZABETHS HOSPITAL OPERATES A SCHOOL OF NURSING THROUGH USE OF APPROPRIATED FUNDS AND THAT STUDENT NURSES OR TRAINEES IN SUCH SCHOOL ARE EMPLOYEES OF THE UNITED STATES OBTAINED AND APPOINTED UNDER REGULAR CIVIL SERVICE PROCEDURES. APPARENTLY IT IS CONTEMPLATED THAT SUCH STUDENT NURSES, AND ADDITIONAL ONES WHICH MIGHT BE OBTAINED AND APPOINTED IN THE SAME MANNER, BE PERMITTED TO ENROLL IN THE UNITED STATES CADET NURSE CORPS, SUCH ENROLLEES TO RETAIN THEIR STATUS AS GOVERNMENT EMPLOYEES, AND RECEIVE THE SAME COURSES OF STUDY, ETC., AS STUDENT NURSES EMPLOYED BY THE INSTITUTION WITH THE USE OF APPROPRIATED FUNDS WHO DO NOT ENROLL IN THE SAID CORPS. IN OTHER WORDS, THE DISTINCTION BETWEEN ENROLLEES IN THE UNITED STATES CADET NURSE CORPS AND STUDENT NURSES IN THE REGULAR SCHOOL OF NURSING WOULD BE ONE IN NAME OR DESIGNATION, ONLY. WHETHER IT BE INTENDED TO ENLARGE THE REGULAR SCHOOL OF NURSING BY EMPLOYMENT OF A CONSIDERABLE NUMBER OF ADDITIONAL STUDENT NURSES IS NOT CLEAR BUT, OBVIOUSLY, UNLESS THAT BE DONE THE MERE TRANSFER OF PRESENT STUDENTS TO THE CADET NURSE CORPS WOULD NOT FURTHER PROGRAM CONTEMPLATED BY THE ACT OF JUNE 15, 1943, AS AMENDED.

IRRESPECTIVE OF THE FOREGOING, I FIND NOTHING IN THE ACT OF JUNE 15, 1943, SUPRA, WHICH WOULD AUTHORIZE A GRANT OF FUNDS TO FEDERAL INSTITUTIONS FOR THE PURPOSE OF CARRYING OUT THE PROVISIONS OF THE STATUTE. WHILE IT MAY BE THAT FEDERAL INSTITUTIONS ARE NOT SPECIFICALLY EXCLUDED FROM THE STATUTE, NEVERTHELESS, THE PROGRAM, THE PROVISIONS OF THE STATUTE, AND THE PRESCRIBED MANNER OF ITS OPERATION ARE INCONSISTENT WITH THE IDEA OF PARTICIPATION BY FEDERAL INSTITUTIONS WHICH MAINTAIN NURSING SCHOOLS, OR TRAIN NURSES, WITH FUNDS APPROPRIATED FOR THAT PURPOSE. ALTHOUGH THE TERM ,INSTITUTION" IS NOT DEFINED IN THE ACT THERE IS NOTHING IN THE LEGISLATIVE HISTORY OF THE ACT, OR IN ANY OF ITS PROVISIONS, WHICH INDICATES AN INTENTION THAT THE TERM SHOULD INCLUDE A FEDERAL HOSPITAL. ON THE OTHER HAND," FEDERAL HOSPITALS" APPEAR TO BE DISTINGUISHED FROM OTHER INSTITUTIONS IN SECTION 2 (F) OF THE STATUTE. ALSO, IT IS PROVIDED IN SECTION 3 OF THE ACT THAT INSTITUTIONS PARTICIPATING IN THE PLAN WILL BE COMPENSATED BY THE GOVERNMENT FOR "REASONABLE TUITION AND FEES FOR THE COURSES OF STUDY AND TRAINING," AND OTHER ITEMS. OBVIOUSLY, THERE WOULD BE NO REASON, NEED OR SOUND BASIS FOR PAYING A FEDERAL HOSPITAL, OPERATED WITH APPROPRIATED MONEYS,"TUITION AND FEES" FOR TRAINING STUDENT NURSES. IN PRACTICAL EFFECT, AN ALLOTMENT OF FUNDS UNDER THE ACT HERE INVOLVED TO ST. ELIZABETHS HOSPITAL WOULD SIMPLY AMOUNT TO AN AUGMENTATION OF THE APPROPRIATION MADE FOR MAINTAINING AND OPERATING THE NURSING SCHOOL THEREIN.

THE AMENDMENT OF THE ACT OF JUNE 15, 1943, SUPRA, BY THE ACT OF MARCH 4, 1944, 58 STAT. 111, PUBLIC LAW 248, IS ENTIRELY INCONSISTENT WITH THE VIEW THAT THE TERM "INSTITUTION," AS USED IN THE FORMER, INCLUDES FEDERAL HOSPITALS. THAT AMENDMENT AUTHORIZES TRANSFERS OF STUDENT NURSES TO FEDERAL HOSPITALS UNDER SUBSECTIONS (E) AND (F) OF SECTION 2, AN AUTHORIZATION ENTIRELY UNNECESSARY IF FEDERAL HOSPITALS BE CONSIDERED AS ELIGIBLE FOR GRANTS UNDER THE ORIGINAL STATUTE. ALSO, WITH RESPECT TO STUDENT NURSES OBTAINED BY TRANSFER, UNDER THE AMENDMENT, IT IS PROVIDED THAT THE STIPEND TO BE PAID THEM, AUTHORIZED TRAVEL EXPENSES, MAINTENANCE, LAUNDRY, MEDICAL AND HOSPITAL CARE, ETC., SHALL BE PAID FROM "APPROPRIATE APPROPRIATIONS OF THE AGENCIES CONCERNED," AND THAT SUCH NURSES SHALL BE ENTITLED TO THE BENEFITS PROVIDED FOR CIVIL EMPLOYEES OF THE UNITED STATES BY THE ACT OF SEPTEMBER 7, 1916, AS AMENDED, 5 U.S.C. 751-793. FURTHERMORE, A CONCLUSION THAT THE ACT IS APPLICABLE TO FEDERAL HOSPITALS WOULD CREATE THE ANOMALOUS SITUATION OF HAVING REGULAR STUDENT NURSES OF A FEDERAL HOSPITAL ENROLLED IN THE CORPS IN A DIFFERENT STATUS, WITH DIFFERENT RIGHTS, AND MAINTAINABLE FROM A DIFFERENT FUND THAN THOSE TRANSFERRED TO A FEDERAL HOSPITAL UNDER THE AMENDMENT OF MARCH 4, 1944. OBVIOUSLY, NO SUCH SITUATION WAS INTENDED OR PROVIDED. IN THIS CONNECTION IT APPEARS THAT THE SPONSOR OF BOTH THE ORIGINAL ACT AND THE AMENDMENT, CONGRESSWOMAN BOLTON APPEARS TO HAVE REGARDED THE ORIGINAL ACT AS INAPPLICABLE TO FEDERAL HOSPITALS. AT THE HEARINGS FEBRUARY 2, 1944, ON THE BILL WHICH BECAME THE ACT OF MARCH 4, 1944, SHE STATED, IN RESPONSE TO AN INQUIRY AS TO WHICH FEDERAL SERVICES WERE EXCLUDED UNDER THE ORIGINAL ACT, THAT " ALL ARE EXCLUDED AT THE MOMENT.' IN VIEW OF THE FOREGOING IT MUST BE CONCLUDED THAT GRANTS OF FUNDS TO FEDERAL INSTITUTIONS ARE NOT AUTHORIZED UNDER THE ACT OF JUNE 15, 1943, SUPRA, AS AMENDED, WHICH MAKES UNNECESSARY CONSIDERATION OF THE SPECIFIC QUESTIONS PRESENTED IN YOUR LETTER OF JANUARY 12, 1944.