B-94560, JUNE 16, 1950, 29 COMP. GEN. 507

B-94560, JUNE 16, 1950, 29 COMP. GEN. 507

APPROPRIATIONS - AVAILABILITY - PURCHASE OF CLOTHING FOR INDIGENTS DISCHARGED FROM PUBLIC HEALTH SERVICE HOSPITALS IN VIEW OF SECTION 341 OF THE PUBLIC HEALTH SERVICE ACT AUTHORIZING THE SURGEON GENERAL TO PROVIDE GENERALLY FOR THE CARE AND TREATMENT OF VOLUNTARY NARCOTIC PATIENTS, AND OF THE ADMINISTRATIVE OPINION THAT THE PROVISION OF CLOTHING CONSTITUTES A THERAPEUTIC DEVICE IN AID OF MEDICAL TREATMENT, APPROPRIATED FUNDS MAY BE USED IN REASONABLE AMOUNTS FOR THE PURCHASE OF CLOTHING FOR INDIGENT NARCOTIC PATIENTS, UPON DISCHARGE FROM PUBLIC HEALTH SERVICE HOSPITALS, AS A NECESSARY THERAPEUTIC DEVICE IN AID OF THEIR RECOVERY AND REHABILITATION, PROVIDED A MEDICAL DETERMINATION HAS BEEN MADE TO THAT EFFECT.

ACTING COMPTROLLER GENERAL YATES TO THE FEDERAL SECURITY ADMINISTRATOR, JUNE 16, 1950:

REFERENCE IS MADE TO LETTER DATED APRIL 14, 1950, FROM THE ACTING ADMINISTRATOR, IN WHICH ATTENTION IS CALLED TO THE PROGRAM FOR THE CARE, TREATMENT, AND REHABILITATION OF NARCOTIC ADDICTS, ESTABLISHED AT TWO HOSPITALS OF THE PUBLIC HEALTH SERVICE, LOCATED AT FORT WORTH, TEXAS, AND LEXINGTON, KENTUCKY, IN ACCORDANCE WITH SECTION 341 OF THE PUBLIC HEALTH SERVICE ACT, 58 STAT. 698 (42 U.S.C. 257), WHICH PROVIDES AS FOLLOWS:

SEC. 341. THE SURGEON GENERAL IS AUTHORIZED TO PROVIDE FOR THE CONFINEMENT, CARE, PROTECTION, TREATMENT, AND DISCIPLINE OF PERSONS ADDICTED TO THE USE OF HABIT-FORMING NARCOTIC DRUGS WHO VOLUNTARILY SUBMIT THEMSELVES FOR TREATMENT AND ADDICTS WHO HAVE BEEN OR ARE HEREAFTER CONVICTED OF OFFENSES AGAINST THE UNITED STATES, INCLUDING PERSONS CONVICTED BY GENERAL COURTS MARTIAL AND CONSULAR COURTS. SUCH CARE AND TREATMENT SHALL BE PROVIDED AT HOSPITALS OF THE SERVICE ESPECIALLY EQUIPPED FOR THE ACCOMMODATION OF SUCH PATIENTS AND SHALL BE DESIGNED TO REHABILITATE SUCH PERSONS, TO RESTORE THEM TO HEALTH, AND, WHERE NECESSARY, TO TRAIN THEM TO BE SELF-SUPPORTING AND SELF RELIANT.

THE ACTING ADMINISTRATOR CALLS ATTENTION TO CERTAIN SECTIONS OF THE PUBLIC HEALTH SERVICE ACT, SUPRA, WHICH PROVIDE THAT NARCOTIC ADDICTS WHO HAVE BEEN CONVICTED OF OFFENSES AGAINST THE UNITED STATES AND WHO HAVE BEEN TRANSFERRED TO PUBLIC HEALTH SERVICE HOSPITALS FOR TREATMENT PURSUANT TO THE ACT SHALL BE FURNISHED, UPON DISCHARGE, THE SAME GRATUITIES, INCLUDING CLOTHING, AS ARE AUTHORIZED TO BE FURNISHED OTHER FEDERAL PRISONERS, UPON THEIR RELEASE FROM FEDERAL PENAL INSTITUTIONS, GENERALLY. IT IS POINTED OUT THAT THE STATUTES, HOWEVER, DO NOT SPECIFICALLY AUTHORIZE THE PURCHASE OF DISCHARGE CLOTHING FOR VOLUNTARY NARCOTIC PATIENTS AND THE QUESTION IS RAISED AS TO WHETHER THE SURGEON GENERAL IS AUTHORIZED TO PURCHASE SUCH CLOTHING FOR INDIGENT PATIENTS FROM FUNDS APPROPRIATED FOR THE PURPOSE OF CARRYING OUT HIS FUNCTIONS UNDER SECTION 341 OF THE PUBLIC HEALTH SERVICE ACT, QUOTED ABOVE.

THE ACTING ADMINISTRATOR STATES THAT IT HAS BEEN OBSERVED WITH RESPECT TO SOME OF THE VOLUNTARY PATIENTS AT THE HOSPITALS WHO DO NOT POSSESS SUITABLE CLOTHING FOR DISCHARGE PURPOSES THAT THE SOCIAL ADJUSTMENT OF SUCH DISCHARGE PATIENTS IS SUBSTANTIALLY IMPAIRED BECAUSE OF THIS FACT, AND THUS THE RESULTS OF THE PAINSTAKING AND COSTLY PSYCHIATRIC TREATMENT PROVIDED BY THE GOVERNMENT ARE SERIOUSLY JEOPARDIZED, SOMETIMES CAUSING THE PATIENTS TO RETURN TO NARCOTIC SUPPORTS, AND A RAPID RECURRENCE OF DRUG ADDICTION. THE ARGUMENT IS ADVANCED THAT THE PROVISION OF ADEQUATE CLOTHING FOR DISCHARGE PURPOSES CONSTITUTES A THERAPEUTIC DEVICE IN AID OF THE MEDICAL TREATMENT OF A PATIENT, AND THAT, SINCE THE TREATMENT PROVIDED IN THESE HOSPITALS IS ESSENTIALLY PSYCHIATRIC, THE THERAPEUTIC DEVICES USED TO ACHIEVE THESE ENDS ARE NOT ALWAYS SIMILAR TO THE TECHNIQUE USED IN THE TREATMENT OF PHYSICAL AILMENTS. HENCE, IT IS CONCLUDED THAT THE PROVISION OF CLOTHING FOR DISCHARGE PURPOSES IN THOSE CASES WHERE MEDICAL BENEFITS CAN BE PROGNOSTICATED WOULD CONSTITUTE TREATMENT "DESIGNED TO REHABILITATE" THE PATIENTS IN QUESTION.

REQUEST IS MADE AS TO WHETHER THIS OFFICE WOULD BE REQUIRED TO OBJECT TO THE EXPENDITURE OF APPROPRIATED FUNDS FOR THE PURCHASE OF CLOTHING FOR INDIGENT VOLUNTARY NARCOTIC PATIENTS PRIOR TO DISCHARGE FROM THE HOSPITAL WHERE IT IS DETERMINED THAT THE PROVISION OF SUCH CLOTHING IS A NECESSARY THERAPEUTIC DEVICE IN AID OF THE PATIENT'S GENERAL RECOVERY AND REHABILITATION.

AS ABOVE INDICATED, WHILE THE STATUTES IN QUESTION EXPRESSLY PROVIDE FOR PAYING THE TRANSPORTATION COSTS, INCLUDING A SUBSISTENCE ALLOWANCE, TO INDIGENT VOLUNTARY PATIENTS UPON THEIR DISCHARGE FROM THE HOSPITAL, THE PURCHASE OF CLOTHING FOR VOLUNTARY NARCOTIC PATIENTS UPON DISCHARGE IS NOT EXPRESSLY AUTHORIZED, AS IN THE CASE OF PRISONERS WHO ARE DISCHARGED FROM HOSPITALS. HOWEVER, THE PROPOSAL ADVANCED BY THE ACTING ADMINISTRATOR TO CONSIDER THE PROVISION OF CLOTHING FOR INDIGENT VOLUNTARY PATIENTS AS A THERAPEUTIC DEVICE IN AID OF MEDICAL TREATMENT IS NOT WITHOUT PERSUASION. IN VIEW THEREOF, AND OF THE PROVISIONS OF SECTION 341 OF THE PUBLIC HEALTH SERVICE ACT, AS QUOTED ABOVE, AUTHORIZING THE SURGEON GENERAL TO PROVIDE GENERALLY FOR THE CARE AND TREATMENT OF VOLUNTARY NARCOTIC PATIENTS, NO OBJECTION WILL BE INTERPOSED BY THIS OFFICE TO THE USE OF APPROPRIATED FUNDS IN REASONABLE AMOUNTS FOR THE PURCHASE OF CLOTHING FOR INDIGENT NARCOTIC PATIENTS UPON DISCHARGE, WHERE A MEDICAL DETERMINATION HAS BEEN MADE TO THE EFFECT THAT THE FURNISHING OF CLOTHING IS A NECESSARY THERAPEUTIC DEVICE IN AID OF THE PATIENT'S RECOVERY AND REHABILITATION.