NOVEMBER 11, 1922, 2 COMP. GEN. 320

NOVEMBER 11, 1922, 2 COMP. GEN. 320

TREATMENT IN VETERANS' BUREAU HOSPITALS OF BENEFICIARIES OF EMPLOYEES' COMPENSATION COMMISSION IT IS WITHIN THE DISCRETION OF THE DIRECTOR OF THE VETERANS' BUREAU TO RECEIVE PATIENTS OF THE UNITED STATES EMPLOYEES' COMPENSATION COMMISSION INTO HOSPITALS UNDER HIS CONTROL WHENEVER IN HIS JUDGMENT THEIR RECEIPT AND TREATMENT WILL NOT INTERFERE WITH THE HOSPITALIZATION OF BENEFICIARIES OF HIS OWN BUREAU, SUCH TREATMENT TO BE WITHOUT REIMBURSEMENT OF THE VETERANS' BUREAU APPROPRIATIONS.

COMPTROLLER GENERAL MCCARL TO THE DIRECTOR UNITED STATES VETERANS' BUREAU, NOVEMBER 11, 1922:

I HAVE YOUR LETTER OF OCTOBER 23, 1922, SUBMITTING FOR DECISION THE FOLLOWING QUESTIONS:

(1) IS IT THE DUTY OF THE UNITED STATES VETERANS' BUREAU TO RECEIVE FREE OF CHARGE INTO ITS HOSPITALS FOR HOSPITALIZATION AND TREATMENT ALL BENEFICIARIES OF THE UNITED STATES EMPLOYEES' COMPENSATION COMMISSION WHO MAY BE ASSIGNED TO SUCH HOSPITALS BY SAID COMMISSION; AND IF SO, UNDER WHAT LIMITATIONS, IF ANY?

(2) IF YOU SHOULD HOLD THAT NOT ALL BUT SOME OF THE HOSPITALS UNDER THE CONTROL OF THIS BUREAU ARE OPEN TO ALL SUCH PATIENTS, PLEASE STATE WHICH HOSPITALS ARE SO OPEN.

(3) IF YOU SHOULD HOLD THAT NONE OF THE HOSPITALS UNDER THE CONTROL OF THIS BUREAU IS OPEN TO RECEIVE PATIENTS ASSIGNED TO THEM BY THE UNITED STATES EMPLOYEES' COMPENSATION COMMISSION, THEN CAN SUCH HOSPITALS RECEIVE SUCH PATIENTS IN CASES OF NECESSITY OR EMERGENCY; AND IF SO, PLEASE DEFINE THE LIMITS WITHIN WHICH SUCH PATIENTS MAY BE RECEIVED.

(4) IF AT THE TIME OF THE TRANSFER OF A HOSPITAL FROM THE UNITED STATES PUBLIC HEALTH SERVICE TO THIS BUREAU THERE SHOULD BE IN SUCH HOSPITAL ONE HOSPITALIZED UNDER THE REQUEST OF THE UNITED STATES EMPLOYEES' COMPENSATION COMMISSION, AND IF IT WOULD MATERIALLY IMPAIRTHE HEALTH OF SUCH PATIENT TO REMOVE HIM, SHOULD THIS BUREAU CONTINUE SUCH HOSPITALIZATION FREE OF CHARGE?

(5) IF AT THE TIME OF THE TRANSFER OF A HOSPITAL FROM THE UNITED STATES PUBLIC HEALTH SERVICE TO THIS BUREAU THERE SHOULD BE IN SUCH HOSPITAL ONE HOSPITALIZED UNDER THE REQUEST OF THE UNITED STATES EMPLOYEES' COMPENSATION COMMISSION, AND IF IT WOULD NOT MATERIALLY IMPAIR THE HEALTH OF SUCH PATIENT TO REMOVE HIM, SHOULD THIS BUREAU CONTINUE SUCH HOSPITALIZATION FREE OF CHARGE?

THE QUESTIONS SUBMITTED ARE PRIMARILY FOR CONSIDERATION AND DETERMINATION BY YOUR BUREAU. ONLY IN SO FAR AS TREATMENT OF PATIENTS OTHER THAN BENEFICIARIES OF THE VETERANS' BUREAU IN HOSPITALS OF THE BUREAU INVOLVES A QUESTION OF EXPENDITURE FOR SUCH TREATMENT OR AN ADJUSTMENT OF APPROPRIATIONS BECAUSE OF IT ARE THE QUESTIONS PROPERLY FOR DECISION BY THIS OFFICE.

IT HAS BEEN HELD THAT UNITED STATES HOSPITAL FACILITIES ARE FREE TO PATIENTS OF THE UNITED STATES EMPLOYEES' COMPENSATION COMMISSION WITHOUT REIMBURSEMENT OF THE APPROPRIATION MAINTAINING THE HOSPITAL FROM FUNDS OF THE COMMISSION. 23 COMP. DEC., 776. PATIENTS OF THE COMMISSION ARE AMONG THOSE ENTITLED TO TREATMENT IN PUBLIC HEALTH SERVICE HOSPITALS. PARAGRAPH 400 (10), REGULATIONS OF THE PUBLIC HEALTH SERVICE, 1920. ALSO, IT HAS BEEN HELD THAT THERE IS NO AUTHORITY FOR REIMBURSING APPROPRIATIONS OF THE VETERANS' BUREAU FOR HOSPITAL TREATMENT OF PERSONS OTHER THAN ITS OWN PATIENTS WHO MAY BE ENTITLED TO GOVERNMENTAL HOSPITAL SERVICE, AND THAT THE EXPENSE OF TREATING ANY SUCH PERSON MUST STAND AS A CHARGE AGAINST THE BUREAU APPROPRIATION. 1 COMP. EN., 230.

SECTION 9 OF THE ACT OF AUGUST 9, 1921, 42 STAT., 149, IMPOSES UPON THE DIRECTOR OF THE VETERANS' BUREAU RESPONSIBILITY FOR MEDICAL TREATMENT AND HOSPITALIZATION OF BENEFICIARIES OF THE BUREAU AND AUTHORIZES HIM TO UTILIZE FOR THAT PURPOSE THE THEN EXISTING OR FUTURE FACILITIES OF OTHER BRANCHES OF THE SERVICE HAVING HOSPITAL AND MEDICAL OFFICERS, AND DIRECTS SUCH GOVERNMENTAL AGENCIES TO FURNISH SUCH MEDICAL, SURGICAL, AND HOSPITAL SERVICES AS THE DIRECTOR MAY DEEM NECESSARY IN CARRYING OUT THE PROVISIONS OF THE ACT. THE SECTION FURTHER AUTHORIZES THE DIRECTOR TO SECURE ADDITIONAL HOSPITAL FACILITIES WHEN NECESSARY, AND AUTHORIZES THE PRESIDENT, SHOULD HE DEEM IT NECESSARY OR ADVISABLE FOR THE PROPER MEDICAL CARE AND TREATMENT OF VETERANS' BUREAU PATIENTS, TO TRANSFER TO THE DIRECTOR THE OPERATION, MANAGEMENT, AND CONTROL OF SPECIFICALLY DESIGNATED HOSPITALS THEN UNDER THE JURISDICTION OF THE PUBLIC HEALTH SERVICE, WITH A PROVISION THAT---

SUCH HOSPITALS WHEN TRANSFERRED SHALL BE USED EXCLUSIVELY FOR BENEFICIARIES UNDER THIS ACT, AND SHALL BE UNDER THE OPERATIVE CONTROL OF THE DIRECTOR FOR SUCH PERIOD OF TIME AS THE PRESIDENT MAY PRESCRIBE.

THE GENERAL PURPOSE AND EFFECT OF THESE PROVISIONS IS TO IMPOSE UPON THE DIRECTOR AUTHORITY AND RESPONSIBILITY FOR HOSPITALIZATION AND TREATMENT OF ALL BENEFICIARIES OF THE BUREAU AND TO OPEN TO HIM FOR THAT PURPOSE THE HOSPITALS OF OTHER BRANCHES OF THE SERVICE AS WELL AS THOSE UNDER HIS OWN OPERATION AND CONTROL. HOSPITALS UNDER THE CONTROL OF THE DIRECTOR HAVE BEEN PROVIDED PRIMARILY FOR HOSPITALIZATION OF PATIENTS OF THE VETERANS' BUREAU, AND ARE INTENDED TO BE USED FOR THAT PURPOSE TO THE EXCLUSION OF OTHER PATIENTS TO THE EXTENT THAT THE BUREAU'S NEEDS MAY REQUIRE. SO THE HOSPITALS OF THE PUBLIC HEALTH SERVICE ARE INTENDED PRIMARILY FOR THE USE OF OTHER CIVILIAN GOVERNMENT PATIENTS, AND SHOULD BE USED FOR THAT PURPOSE WHEREVER THEY ARE AVAILABLE.

PROPER USE OF THE VARIOUS HOSPITAL FACILITIES OF THE GOVERNMENT FOR HOSPITALIZATION OF THOSE INJURED CIVILIAN EMPLOYEES WHO ARE ENTITLED TO ADMISSION TO GOVERNMENT HOSPITALS IS A MATTER OF ADMINISTRATIVE RESPONSIBILITY. I MAY SAY, HOWEVER, THAT I THINK THERE IS NO STATUTORY BAR TO THE USE OF HOSPITAL FACILITIES OF THE VETERANS' BUREAU FOR THAT PURPOSE, TO THE EXTENT THAT SUCH FACILITIES ARE NOT NEEDED FOR BUREAU PURPOSES, AS CONVENIENCE AND ECONOMY OF ADMINISTRATION MAY REQUIRE. ANY USE OF GOVERNMENT HOSPITAL FACILITIES FOR PATIENTS OTHER THAN VETERANS' BUREAU PATIENTS MUST NECESSARILY REDUCE TO THE EXTENT OF SUCH USE THE ACCOMMODATIONS AVAILABLE FOR BUREAU PATIENTS. IT WOULD SEEM TO BE OF NO GREAT IMPORTANCE WHETHER OTHER PATIENTS OCCUPY SPACE IN OTHER HOSPITALS WHICH OTHERWISE WOULD BE AVAILABLE FOR BUREAU PATIENTS.

IT SEEMS TO BE WITHIN THE DISCRETION OF THE DIRECTOR OF THE VETERANS' BUREAU TO RECEIVE PATIENTS OF THE UNITED STATES EMPLOYEES' COMPENSATION COMMISSION INTO HOSPITALS UNDER HIS CONTROL WHENEVER, IN HIS JUDGMENT, SO RECEIVING THEM WILL NOT INTERFERE WITH HOSPITALIZATION OF BENEFICIARIES OF HIS OWN BUREAU FOR WHOSE USE THE HOSPITAL FACILITIES OF THE BUREAU HAVE BEEN PROVIDED. THERE SHOULD BE NO INCREASE OF BUREAU HOSPITAL FACILITIES TO CARE FOR PATIENTS OTHER THAN ITS OWN BENEFICIARIES, BUT I SEE NO REASON WHY VACANT ACCOMMODATIONS IN HOSPITALS SO PROVIDED AND NOT FULLY OCCUPIED MAY NOT BE UTILIZED FOR THESE OUTSIDE PATIENTS IN THE DISCRETION OF THE DIRECTOR. IF SO USED, HOWEVER, THERE MUST BE NO REIMBURSEMENT OF THE BUREAU APPROPRIATION.

TAKEN LITERALLY, SECTION 9 OF THE ACT OF AUGUST 9, 1921, PROVIDES THAT HOSPITALS TRANSFERRED BY THE PRESIDENT FROM THE PUBLIC HEALTH SERVICE TO THE VETERANS' BUREAU SHALL BE USED "EXCLUSIVELY" FOR THE BENEFICIARIES UNDER THAT ACT. THIS PROVISION MAY HAVE BEEN INTENDED AS A LIMITATION UPON THE TRANSFERS RATHER THAN UPON THE USE OF THE HOSPITAL AFTER ITS TRANSFER FOR THE AUTHORIZED PURPOSE. THIS OFFICE DOES NOT UNDERTAKE TO DIRECT ADMISSION TO VETERANS' BUREAU HOSPITAL, NOR TO DETERMINE THE CONDITIONS OF SUCH ADMISSIONS. IF PATIENTS OF THE EMPLOYEES' COMPENSATION COMMISSION ARE HOSPITALIZED BY THE VETERANS' BUREAU, IT MUST BE BY VIRTUE OF THE PROVISION IN THE EMPLOYEES' COMPENSATION LAW GIVING THEM HOSPITAL SERVICE TO BE"FURNISHED BY UNITED STATES MEDICAL OFFICERS AND HOSPITALS," AND, THEREFORE, MUST BE WITHOUT REIMBURSEMENT OF THE BUREAU APPROPRIATION.