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Board of National Missions miners hospitals discussions, April 1963, tape 2.
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- speaker[Eugene Rosenfeld] You saw you saw it a moment ago in terms of numbers, but in terms of specialty
- speakerservices, with very few exceptions, of the sixty
- speakertwo doctors who are not on the staff of the hospital, about eight are specialists. All the
- speakerother specialists in the area, certified specialists, are on the staffs
- speakerof the Miners Memorial Hospital. So that in terms of services, specialty
- speakerservices, these people would have to be kept in the community or
- speakerreplacements recruited. Now under the conditions that exist nationally
- speakerin terms of the availability of physicians, recruitment today is going to be
- speakerextraordinarily difficult unless you could use the same techniques that
- speakerthe, that the Miners Memorial Hospitals use, and that is security, high
- speakerlevels of income, group practice. I think the
- speakerchurch might have another possibility, that would not be available to
- speakerother groups. And, that is that you might be able to recruit doctors with missionary interest,
- speakerin addition to those that might come in for other reasons. But the doctors who are presently there
- speakerare of two groups generally, one or the group of doctors
- speakerwho are devoted to a group practice concept of medical practice and the
- speakerother groups of ex-Federal physicians who were either in the
- speakerarmed forces or some other branch of the federal services and are used to a
- speakerkind of group practice and security of employment in the practice of medicine
- speakerand are retired from federal employment. These are generally the kinds of doctors that are
- speakerthere as specialists in the Miners program. Unless they're kept under
- speakersome arrangement that will it will interest them, I think that you're going to be
- speakerfaced with an almost insuperable problem of staffing. They can be
- speakerunder encouragement for group practice. They can't be otherwise, in my estimation.
- speakerThat doesn't mean that I am either in favor or against a method of
- speakerpractice of medicine. I think one has to be realistic about the situation as it presently exists.
- speakerNow this problem has been
- speakerevaluated for the five hospitals. I have not personally had the opportunity to evaluate it
- speakerfor the other five, although I've been told that there is a considerable amount of
- speakerinterest among the doctors in the other five hospitals in a similar approach.
- speakerMost of the doctors in Harlan--that's the hospital that has twenty six
- speakerspecialists--are prepared to stay under some practice of that type.
- speakerWe have worked up a budget for
- speakerthe medical group, an income and expense budget for the medical group. If they
- speakerwanted to reorganize themselves on that basis, and based upon
- speakerthe cost of operation at the levels of income that they enjoy at the present time,
- speakerand the same salaries paid to para medical personnel as are paid in the hospital,
- speakerand a reduced staffing pattern because they are a little bit too lavish. They can
- speakeroperate with a deficit in the region of perhaps sixty seventy
- speakerthousand dollars a year for the first year. And after that, they should be able to operate with no deficits at
- speakerall. So that there may be a need to supplement
- speakertheir earnings only for a period of a year, or at least give them some assurance that if they
- speakerdo run a deficit it can be met. After the first year, we think there is no possibility at all that
- speakerthey'll have to worry about deficit for the operation of their group. They should be able
- speakercompetitively to generate enough income from all sources to operate as a group
- speakerpractice arrangement. We projected this in
- speakerdetail in the report. And, you will see it when you get your final copies.
- speakerWe were
- speakerconcerned as to how the hospitals might operate from the point of
- speakerview of administration and management and trusteeship. And I would ask
- speakerMr Dinwiddie, if you don't mind, sir, to pass around to you
- speakera proposed organization chart for the
- speakerthe hospitals. It became apparent that there
- speakerwas little or no possibility that the hospitals could be operated
- speakeron the same level or even an approximate level of quality of service if an effort
- speakerwere made to operate them independently or by the local communities. We think that the
- speakeronly possibility of such an operation lies in a regional plan.
- speaker[Rosenfeld] You notice that the picture on the board, the map on the board, shows
- speakerthem as a regional group of hospitals. They were designed this way. Each hospital is
- speakernot a complete entity. And nor can any of them operate
- speakeralone without dependence upon the others. All ten get their
- speakermaintenance and central services from Williamson, which I
- speakerthink is in West Virginia. And all of them get a certain amount of
- speakercentral administration presently from Doctor Newdorp [Newdorp, John] and his staff in
- speakerWashington. None of the hospitals have facilities
- speakerto encompass all the specialties within their own walls. So that they are
- speakeran integrated group of hospitals. In many ways to continue them as an integrated group would
- speakerbe a great achievement because one of the prime problems nationally is
- speakerto find ways of regionalizing hospital services. And, here is a regional
- speakerplan already set up. And, it would be in a way a retrogression if
- speakerthis regionalization were not to be maintained. Also in terms of
- speakerboard trusteeship and leadership, we came to the conclusion that although there are
- speakerpeople in each of the counties and in the towns where
- speakerthese hospitals are located who could well serve on a regional board,
- speakerthere are not sufficient experienced numbers of people in each individual town to
- speakerconstitute an adequate board at this time, so that eventually this may be
- speakerpossible. There isn't time between now and the closing of the four hospitals to organize such
- speakerboards. It ought to be the long range objective of the church, if you take these
- speakerhospitals all over, to develop local trusteeship, but originally,
- speakerinitially, you should, in our estimation, approach this as a regionalization
- speakerprogram. And, for this reason we have made certain recommendations. And,
- speakerI'm going to resort to reading only in this one instance.
- speakerAnd that is that if it is your decision
- speakerto take on the obligations of keeping these hospitals open,
- speakerthen I think you ought to follow. It ought to accept the following
- speakerproposals. And, therefore I make these proposals to you on a step by step basis.
- speakerThat you acquire these hospitals on terms and conditions which are to be
- speakeroutlined separately. And that you create an
- speakerAppalachian Regional Hospital board of the Presbyterian Church. Now, I use that
- speakerterm. You can use any term you want. But I've used it here only to designate that the
- speakerhospital would be hospitals will be operated by a regional board. I think
- speakerthat this board would have to be nominated by the Board of National Missions to get it started.
- speakerAnd, it would have to be incorporated under such legislation as exists
- speakerin Kentucky and possibly in West Virginia and Virginia to operate these
- speakerhospitals. And, that you should choose for the board
- speakerleading members of the Presbyterian Synod in these states. Lay leaders, businessmen,
- speakereducators, labor leaders and local community representatives.
- speakerI think that this regional board to effectively operate should probably have no more than
- speakerthirty members with an executive of about seven. And I think that like most
- speakerboards in order to make it function well, it ought to have tenure, limited
- speakertenure, so that new leadership can come forward. And, we've made recommendations specifically on that
- speakerscore. This board would then create and set up
- speakera regional hospital executive and administrative structure
- speakerto operate the hospitals that you acquire. The
- speakerregional executive structure would have to have an executive director. And he would
- speakerthen develop a hospital administrative center. And we think the
- speakercenter should be in eastern Kentucky. It should be located with direct access to the
- speakerhospitals and not outside of the region. It's. This executive in
- speakerthe center would then employ staff or central purchasing, central records, central
- speakerstatistics, budgeting policy, accounts payables, payrolls, maintenance, public
- speakerrelations and program development. We think that in order to make these hospitals
- speakercommunity oriented. And to provide a community type of service since up to
- speakernow their service has been largely restricted for the fund
- speakerbeneficiaries that you should develop a series of community advisory councils. And,
- speakeryou'll notice the councils on this graph that's been given to you.
- speakerThese councils should be appointed from among leaders in the individual communities by the
- speakerAppalachian Regional Hospital board. And that. These
- speakercouncils then have membership to a regional advisory council to the board.
- speakerWe think also that in order to reflect the best
- speakerpossible quality of medical care and standards of medical care and to keep these
- speakerstandards ethical and within the concepts of
- speakerthe leading thinkers in medical education and medical organization that there ought to be a
- speakermedical and hospital regional advisory council available to the regional board.
- speakerAnd, that this council should be composed of representatives, that is
- speakerprofessional representatives, of medical schools, Blue Cross
- speakercommissions, the basic science and clinical educators, and of course
- speakerthe medical association in the states in which the hospitals are located. It should be
- speakeradvisory in a professional sense both to the Appalachian Regional Hospital board of the
- speakerchurch and to the medical staff organization of the hospitals as this medical staff organization
- speakerdevelops.
- speakerNow, as we've said, the doctors who are in the Miners Program today
- speakerwould presumably reorganize themself into a private practice group. Somebody
- speakerhas already dubbed this group the Daniel Boone medical group and you'll find that terminology in your
- speakercopy of the report. And, I will simply use it to designate
- speakerthis group of doctors. But they, together with
- speakerthe other doctors practicing in the region, would constitute the hospital staffs.
- speakerThese staff would then be coordinated, programs
- speakerdeveloped with emphasis upon regional specialty services,
- speakerthe development of preventive services, rehabilitation services, and community health services
- speakerthrough the staffs of these hospitals.
- speakerI think an affiliation can be worked out with the University of Kentucky School of Medicine.
- speakerThere has been some indication that they are interested in such an affiliation. And, this would help both
- speakeradministratively in terms of staffing and keeping quality of medical care at a high
- speakerlevel. I think that it's possible under this arrangement to develop a coordinated
- speakerprogram involving uniform employment policies, staffing patterns, budgeting procedures,
- speakerand the emphasis upon a high degree of local autonomy for the hospital medical staffs.
- speakerIt will be necessary simultaneously with these recommendations
- speakerthat the doctors in the area, both those in this Daniel Boone medical
- speakergroup and those outside of the group who give service to fund beneficiaries,
- speakerwork out some arrangement with the United Mine Workers Welfare and Retirement Fund for
- speakerreimbursement. And I'm assured that that can be done and that the
- speakerfund directors are interested in working out a reasonable arrangement with the doctors
- speakerNow among certain policy recommendations, which we think are important if this program is to
- speakersucceed, would be the following. That all licensed physicians in
- speakerthe service area of the several hospitals be accorded staff or courtesy privileges based upon
- speakerreasonable professional qualifications and willingness to abide by the rules and regulations of the
- speakerhospitals. That the hospital staff be organized. Rules
- speakerregulations by laws adopting adopted meeting the requirements of the Commission on Accreditation of the
- speakerAmerican Medical Association, American Hospital Association, American College of Surgeons.
- speakerWe think that you should not attempt the
- speakeracquisition, operation of the hospitals until you have assurances
- speakerfrom the Fund that the Fund will continue utilization of the several hospitals for
- speakerfund beneficiaries. And, this has been discussed with representatives of the fund. And, I
- speakerunderstand that certain assurances are forthcoming in this respect.
- speakerAnd finally, you cannot possibly operate the hospitals
- speakeron anything approaching a reasonable level of service unless there are some
- speakerassurances that the deficit of operation, representing care to the medically
- speakerindigent, can be met. The level required I've
- speakeralready given you. I think the encouragement by either a
- speakerregional hospital council or regional hospital board of community
- speakercouncils and advisory councils is important and will help to keep the quality of this
- speakerprogram high and will give it the status that it needs nationally that the church
- speakerwill in effect be creating and conferring upon it. Because up to this time that it's been
- speakera subject of a good deal of controversy, as you know. I think finally that
- speakeryour programs if you adopt it should look forward to about five years or so of
- speakeroperation during which time local leadership should be rising up through the advisory
- speakercouncils and the regional board so that eventually this will become largely a
- speakerlocal operation. At the present time I think that neither time nor
- speakerleadership is possible, is available, to carry on such a program at the level
- speakerof service that has been characteristic of the program up to this time.
- speakerWe have some assurance already that the Kentucky State
- speakerMedical Association is recognizing the difficulties inherent in
- speakerkeeping the staffs intact and are willing to cooperate in this respect.
- speakerI would say to you that the present situation in eastern Kentucky
- speakerin respect to the continued operation of the hospitals presents a challenge to both the
- speakermedical and lay leadership and to you folks to your missionary zeal,
- speakeras well as a challenge to the several governmental units concerned
- speakerto find a way of eliminating the resistance to the group
- speakerpractice programme of upon the part of local non Miners doctors, whose charges of
- speakercorporate practice medicine against the Miners original program has been the basis of continued bitterness in the
- speakerarea. The program we have outlined here is designed to provide a
- speakermethod of maintaining the benefits that have been brought to the community and
- speakerretaining especially services in the area while eliminating the corporate practice of medicine
- speakerand seeks to develop cooperation within the hospital staffs in the communities between these
- speakerdoctors practicing in an organized group and those practicing in solo
- speakerpractice. It is essential however in developing this necessary cooperation.
- speakerI've put them in the essential purpose however of developing this necessary cooperation is neither the demonstration
- speakerof its feasibility, as important as this may be, but rather the fact that in the absence of
- speakersuch a coordinated program and a continuation of the group practice principle, there is little
- speakerpossibility of the several hospitals can remain open and continue to provide adequate care of a reasonable
- speakerstandard. This is the basic purpose. I could go on with a
- speakerlot of detail but I think that.
- speakerIf you want detail you better ask me questions. I've attempted here to summarize
- speakerour findings and our recommendations. And to give you a basis for
- speakerconsidering whether this is a program that you can undertake. There is
- speakerone other aspect that I want to mention briefly and that is that we've recommended
- speakera development budget. Aside from the budgets of the hospitals and the central
- speakerbudget which would be maintained the central budget by the hospital's income. The
- speakercentral budget is included in the deficit projections but in addition to that we've made we
- speakerrecommended to you a developmental budget which would be about seventy five
- speakerthousand dollars a year not sustained through hospital operations or part of the
- speakerhospital deficit projections. This would be a budget that you would have to meet directly yourself
- speakerand with that. I'll be happy to attempt to answer any questions that you may have. [Neigh] Thank you, Dr. Rosenfeld.
- speakerOK You're not leaving? No sir. And you will be here to morrow or morning? If you
- speakerwish. I think that it probably is desirable
- speakerto get the whole picture. I've not
- speakerbeen able to deal either with the question of
- speakerthose funds involved in acquiring the hospital
- speakernor with the problems dealing with
- speakerthe operational deficit projected. And, I
- speakerthink that it. Probably as we get the picture before us,
- speakeris well for us to get those in front of us in addition to the
- speakerquestions you raise concerning the technical aspects of the
- speakeroperation of the hospital, together with the statement of the deficits. And if you
- speakercan, sir, I would hope if you would be able to stay
- speakerand be here tomorrow morning. This is a
- speakerUnited Presbyterian Church and I haven't the vaguest idea what will happen
- speakerto the schedule or left what the
- speakerrequirements will be.
- speakerDo you want anything to be said at this time about the capital acquisition? I think we need to do
- speakerthat later.
- speakerYes. And thank you very much for that portion of your
- speakerpresentation. Now, as we mentioned,
- speakerDr Rosenfeld indicated very pointedly, the
- speakerreal question of the operation of the hospitals centered around three points,
- speakerthe acquisition, the operational deficit and
- speakerthe ability to provide a staff. I think before
- speakeranything, and I know how easy it is for mis-
- speakerapprehension
- speakerbecome embedded in a document upon
- speakerwhich you will be discussing tomorrow
- speakerwill not be this. It will be a statement although this is an
- speakerembodiment of the, is in the statement of the
- speakeroperation. Now, the document for
- speakerconsideration, the mimeographed sheet that has been placed in your hands.
- speakerNow, some of us as we've gotten involved in this, have
- speakerbecome utterly amazed
- speakerat the sacrifices that
- speakermany people in very
- speakerbusy lives have been willing to make in order to do it.
- speakerTo see a way through it. And. The
- speakergovernor of Kentucky [Combs, Bert T.] is one of them.
- speakerWe felt that
- speakerno one could represent the position of the State
- speakerof Kentucky any more adequately than he. And
- speakerprobably without any more feeling. And, he has kindly consented to be
- speakerhere. I would like to present to you, those of you who haven't met him,
- speakerGordon Corbett, [Corbett, Gordon L.], who is the executive of the
- speakerSynod of Kentucky. Now, a lot of discussion about
- speakergrass roots, and the precincts and the administration of National Missions in
- speakerthis meeting. One of the strong administrators in the Board of National Missions,
- speakercarrying responsibility, not only for National Missions, but the total program of the United
- speakerPresbyterian Church, is Gordon Corbett, the Executive of the Synod of
- speakerKentucky, who, Heaven help us!, is a reconstructed
- speakerBaptist.
- speaker[Corbett] Dr. Neigh has
- speakerindicated to you that there are a number of just plain providential
- speakerthings in connection with this whole problem. In my judgment,
- speakerone of the very providential things was the employment of Dr Rosenfeld as a
- speakerconsultant. If you haven't been overwhelmed by this presentation, let me
- speakerassure you that having spent many days with him, I have been
- speakercontinually amazed by the breadth of his knowledge and his skill
- speakerand his compassion in studying this problem. And, we've been most fortunate
- speakerto have him working for us. Dr Neigh also indicated
- speakerthat there have been many times that we have ardently wished that we could
- speakerget such a firmly locked door in our faces that we could with a
- speakerclear conscience turn away from this problem. But
- speakerstrangely, week after week, one door at a time
- speakerhas opened. Now Dr Neigh was very blunt on the executive
- speakerofficers in talking to me and to Dr Barrie and saying. You
- speakercan talk about these hospitals as long as you make it plain
- speakerthat the United Presbyterian Church has no money to spend on acquisition
- speakerand no money to subsidize operation and surely in any
- speakersensible world that would have been enough to lock the door and let us out of this
- speakerthing.
- speakerBut these doors have opened.
- speakerOn Monday I spent all day with the staff of the governor's
- speakerthe governor's staff working on a proposal
- speakerwhereby the state government would undertake to
- speakerassure us that the cost of taking care of
- speakerindigent people would be assumed by the state government.
- speakerMonday night we met with the governor [Combs, Bert T.]. And, it was my
- speakerfirst meeting with the governor. And, I looked forward to it with a great deal of interest.
- speakerThe governor was brief. He was brusque. He told me the
- speakerfacts of life about dealing with the state legislature.
- speakerAnd, he will tell you about it. I [Corbett] recognized some of what he was saying
- speakerbecause I assured him that as a staff member, I had great respect for the Board of
- speakerNational Missions. And I know that no staff member ever dared to
- speakerpredict what this Board would do when it meets.
- speakerBut I was appalled. I could picture myself
- speakerstanding before you and trying to assure you that it seemed
- speakerreasonable that the state of Kentucky would
- speakertake care of this indigent load. And the governor in his honesty and
- speakerhis candor, left so many doors wide open that he could walk out of
- speakerand leave us holding the bag that I was scared.
- speakerNow Tuesday morning we met with representatives of the Union.
- speakerAnd they're an interesting group. Miss Roche [Roche, Josephine A.],
- speakerthe trustee, is a
- speakerlady of about seventy nine or eighty, with snapping black eyes,
- speakeran Irish girl,I believe, the granddaughter of a Methodist bishop
- speakerAnd she just laid the wood to us.
- speakerShe said these hospitals we made the commitment to close
- speakerthem last October and we face the fact that we've
- speakergot to send out the severance notices to our staff
- speakeron May first unless we know that someone is going
- speakerto take over these hospitals.
- speakerAnd I said I can't commit the United Presbyterian Church to take
- speakerthese until I know that the state government's going to assure us that we'll
- speakerhave the operating money. The governor says I can't call the state legislature to meet
- speakeruntil the first of June. and the A.R.A. man said and I can't promise any money
- speakeruntil I know the state will act. Miss Roche smiled. And, she said, "Yes,
- speakergentlemen, but we have to send out our notices on next Wednesday." And, we
- speakerwent round and round the room looking at each other. Who's going to break out of the
- speakercircle? And then we went back. Well we got up and left. There was
- speakernothing more to say. We went back to the governor's suite and sat
- speakerdown and talked a little about it. And it
- speakerbecame very apparent to me that we United Presbyterians are the
- speakerone people that have got to take the first step and it's a risky one.
- speakerBut we've got to make the step. And I said. "Governor,
- speakerI know you can't write a letter that would commit your legislature. It isn't
- speakerdone. Would you be willing to send some of your staff up and try to explain to the
- speakerBoard more effectively than I could?" And, with that
- speakerbrusqueness and brevity that many of us Kentuckians have come to admire
- speakervery much in our governor, he [Combs] said, "Would it help if I came and
- speakertalked to your Board?" Well, I said I'd have to ask
- speakerDr Neigh. And run it by him.
- speakerBut Governor Combs as a concerned dedicated man and I don't need
- speakerto describe him because you'll begin to catch that flavor as he speaks to you.
- speakerHe offered to come from Kentucky to meet with you to tell
- speakeryou what he can try to do and what he hopes to do.
- speakerAnd I'm [Corbett] very proud as the Synod Executive of the United Presbyterian Church in
- speakerKentucky and as a citizen of the Commonwealth to
- speakerintroduce the Honorable Bert Combs, the governor of Kentucky.
- speakerT. Oh
- speaker[Combs, Bert T. speaking]Thank
- speakeryou very much, Gordon [Corbett]. Mr Chairman, Mr. Rosenfeld,
- speakermembers of the Board, distinguished visitors. I suppose it is
- speakerappropriate that
- speakera reformed Baptist sent me to you. I happen to be the first Baptist governor of Kentucky in
- speakerone hundred years. And my Presbyterian and
- speakerMethodist friends never let me forget it.
- speakerUsually when I am presented, they tell this old
- speakerstory that many of you heard, of course. But being a Baptist,
- speakerwon't necessarily keep you from sinning. But sure as heck will keep you from enjoying it.
- speakerI'm glad you have the copy of Newsweek.
- speakerL. S. Grigsby is typical of the
- speakerresidents of this area. I think you would agree that
- speakerhe has a strong face. He has a face with character.
- speakerAnd, with the proper education,
- speakerwith an opportunity, he would be a
- speakerfine Kentuckian and a fine American.
- speakerThe "Miner's Lament"
- speakera scene from which you saw here is not
- speakerexaggerated. It's not minimized, but it's typical
- speakerof this area. I happened to
- speakerbe a product of this area. My
- speakerhome was in Clay County, close to Harlan, shown on the map here.
- speakerAnd I live now in Floyd County close to McDowell, where one of the
- speakerother hospitals is located. So
- speakerI know, I suppose, as much about these people, about their potential,
- speakerabout their weaknesses as almost anyone.
- speakerAnd, they do have a great potential. They have a great deal of
- speakercourage and determination and all that.
- speakerBreathitt County, close to Hazard on the map, was the only
- speakercounty in the United States in World War One
- speakerwhich did not have a single person drafted from it.
- speakerThey had more than their quota of
- speakervolunteers.
- speakerKentucky, for the most part, is prosperous.
- speakerThe Bluegrass Region is about one hundred miles from this area we ae talking about.
- speakerAnd today
- speakerin the bluegrass, they're running the Bluegrass
- speakerStakes, the preliminary to the Kentucky Derby, which will be run on the
- speakerfirst Saturday in May. And, the rich
- speakerand the influential in this country will be
- speakerat Keeneland racetrack today. And, except that I'm
- speakerhere, I would have presented the cup,
- speakerbut this is much more important
- speakerWe have accumulated in this region not any
- speakerspecific problem I suppose which is unusual but an aggravation
- speakerof most of the problems which beset America today.
- speakerThe unemployment rate is more than twice as much as the national average
- speakerWe have trouble getting new industry into the areas to take the place
- speakerof the dying coal industry.
- speakerAnd although we have built new parks in the area, although
- speakerwe have flood control projects, although we have reforestation projects, although we have spent
- speakera greater proportion of Kentucky's money in this area, especially since I've been governor
- speakerWe really have not begun to solve that problem. And
- speakerwhen we thought we at least were making a start,
- speakerjust a few weeks ago, the most devastating
- speakerflood which has ever occurred in Kentucky, hit this
- speakerarea. And before we had
- speakerdug out from the mud and debris left
- speakerby the flood,
- speakerwe were afflicted with a great many forest fires. And, they are raging today in this area. And, we
- speakerclose the forest by executive order a couple days
- speakerago. This area of course has been given
- speakerattention
- speakerby a great many people, a great many groups. The Appalachian Governors Conference
- speakerhas been formed, composed of about eight governors, Pennsylvania, West Virginia, Kentucky,
- speakerTennessee, and so on. I served as the chairman of that conference for two
- speakeryears and chairman now is Governor Barron[Barron, William Wallace] of West Virginia.
- speakerWe were in Washington recently
- speakerin a conference with, I believe, four Cabinet members and the President of the United
- speakerStates talking about the problems
- speakerof the Southern Appalachian region. And, the president has
- speakerappointed a task force to get a program going. An
- speakeroverall problem for this area.
- speakerThese hospitals are a symbol of
- speakera better way of life.
- speakerThey were constructed five or six years ago when the coal
- speakerindustry was much more prosperous and at a time when all of us thought
- speakerthe future look brighter. And the miners
- speakerparticularly have come to visualize these
- speakerhospitals as a symbol of a few of the
- speakergood things of life, at least adequate medical treatment.
- speakerIf these hospitals close, the whole program collapses. The President's [John F. Kennedy]
- speakertask force might as well stay in Washington.
- speakerThe program of the Appalachian Governors
- speakerConference will never get off the ground.
- speakerConditions couldn't be worse if these hospitals should fold, because
- speakera vestige of hope, almost the last vestige, perhaps
- speakerwhile these people
- speakerwill have been destroyed.
- speakerAnd I've been suggested that maybe these people all just move out of eastern Kentucky and West Virginia
- speakerSouthern Appalachian region, but they're just not going to do it.
- speakerand so all that is not the solution. They are going to stay there.
- speakerWe've built a modern four-lane highway in eastern
- speakerKentucky. And, I've been criticized some for that. A fellow said to me, "Why would you build a road up
- speakerthere? You've got nothing but people and people without any money at that." And I
- speakertold him the story about old Fess Whitaker, who lived in Letcher County, close to Hazard here.
- speakerOld Fess was the jailor for the county. And, every time he ran for re-election he would
- speakerharangue the people about what a great hero he'd been in the Spanish-American War, and how they should vote for
- speakerhim.
- speakerWell, he would say, "I was one of the real genuine bona fide heroes. I rode
- speakerin the great Teddy Roosevelt Roughriders." And say, "We rode up San
- speakerJuan Hill on our horses stirrup to stirrup, slaying the Spaniards as we went.
- speakerWe got to the top of the hill, looked over the plains and saw the Spaniards in the distance.
- speakerThere I sat on my horse, stirrup to stirrup with Teddy Roosevelt." He said, "Teddy
- speakerturned to me. And, he said Fess, "That we won the war. We'll be
- speakerfamous."
- speakerI said one of us will probably President. And Fess said, "I said to
- speakerTeddy. Teddy, you be president. All I want to be is the jailor of Letcher County,
- speakerKentucky."
- speakerAnd so, we can't move them out. They're going to stay. We have
- speakertried to improve the schools. We have passed a three percent sales tax in Kentucky with
- speakera great deal of protest as you might imagine. And I was introduced the
- speakerother day as
- speakerthe first Baptist governor, as I told you. Smart aleck up front. There's always one, you know. Said, "Yes,
- speakerand you'll be the last one in one hundred years if you don't do something about this sales tax." But
- speakersixty seven percent of that tax revenue goes for education.
- speakerAnd so given time, given an opportunity
- speakerthe younger
- speakerEllis Creek Spears will be educated and be
- speakercapable of taking their place in this world.
- speakerNow. The State Government of course cannot get in the hospital business. The medical
- speakerassociation wouldn't permit it.
- speakerAnd it is not a proper function of the state government.
- speakerBut given an opportunity a vehicle through which state government can
- speakerwork, the legislature of Kentucky. I'm entirely convinced
- speakerthat the legislature would not subsidize a
- speakerprogram, that wouldn't be the proper word, but
- speakerthe legislature, in my judgment, will pass
- speakerlegislation enacting a program into law
- speakerwhich will make it possible for these hospitals to be operated
- speakerwithout a deficit. And we can do that through the so called per meal fill
- speakerthen medical assistance program to indigent people.
- speakerAnd certainly nobody.
- speakerLon Rogers [Rogers, Lon B.] I see sitting back here lives in that area [Pikeville, KY] now.
- speakerNobody would deny that this would be a proper
- speakerfunction of state to make it possible for the government to
- speakerpay to indigent citizens enough of their medical bills
- speakerthat the program to be operated without a deficit
- speaker[Bert Combs] It's been suggested that might be seven hundred fifty thousand dollars per year.
- speakerBut, we can handle that much
- speakermoney. The legislature, in my judgment, would not hesitate to make a
- speakersufficient appropriation
- speakerto cover that. We cannot get the legislature into session
- speakerwith any hope of success before June first. We're
- speakerhaving a primary election in Kentucky. And, if you have heard about Kentucky elections, you would know
- speakerwhy we can't have a session of the legislature this month. But after
- speakerthe first of June, I repeat.
- speakerI'm thoroughly convinced that the legislature would
- speakerpass legislation making it possible for the state to contribute sufficient
- speakerfunds to prevent an operating deficit
- speakerNow I cannot say that to the papers, and I hope we have no reporters here. The only
- speakerreason in my judgment which would prevent a legislature from doing it, would be that they thought I had come up here and
- speakersaid they would.
- speakerAnd so, I don't want you to say that I said that when you get back home. Because
- speakeryou got one hundred thirty-eight members of that legislature. And each of them is a prima
- speakerdonna, a big wheel in his own right. and so the
- speakerreason they would pass it would be that we would say to them, the need is great. And we can keep the
- speakerhospital open if you do this. They do happen to
- speakerbe in a majority with the state administration. I
- speakerhappen to be a Democrat and most of the legislature are members of the same party so
- speakerI have some reason to think I can predict what they might do. Now, I
- speakerunderstand of course that one of the conditions here is subject to a grant
- speakerby the A.R. A. I'm not sure that anybody us here from the federal government
- speakertoday. I understand you perhaps have a letter or a message, and somebody else will report on that. But,
- speakerI have been in Washington recently. And, I have
- speakerdiscussed with some of the people of the possibility of making this grant possible
- speakerwhich would permit the acquisition of the hospital and without
- speakerattempting to anticipate him certainly I am encouraged by their
- speakerattitude. I think that there is a very definite possibility
- speakerthat they A.R.A. grant will be forthcoming, making it possible for
- speakeryour group to purchase the hospitals, conditioned on the
- speakerlegislature of Kentucky passing the necessary legislation, which I think
- speakerprobably could be done in the first part of June.
- speakerThe need is great. It's
- speakervery great. There is no other way in my judgment, by
- speakerwhich these hospitals can remain open.
- speakerI'm not going to attempt to minimize the problems. There are
- speakerproblems. But a great many Kentuckians,
- speakergreat many loyal Americans
- speakerwill be praying today that you will
- speakerundertake this task.
- speakerAnybody have any questions?
- speakerThank you very much.
- speaker[Kenneth Neigh] Governor, I know that your time is at a premium.
- speakerI hope that you will stay as long as you can, but please feel free to leave
- speakerat any time that it is
- speakerurgent for you to leave.
- speakerBob. I'm really naked without Bob, [Barrie, Bob]
- speakertoday. Dr. Neigh,
- speaker[Bob Barrie speaking] I think maybe it might be time to give you such word as we have from the Area Redevelopment
- speakerAdministration about the acquisition costs. I really don't mean to be
- speakeras dramatic as this is, but literally I didn't have the letter until after the governor started to speak.
- speakerI knew what was going to be in it because it had been read to me last night on the telephone and I would now like to
- speakerread it to you. It is on the letterhead of the United States
- speakerDepartment of Commerce Area Redevelop Administration. It is signed by the acting
- speakeradministrator for the Administration, Mr H. W. Williams. Dear Mr Barrie.
- speakerThe Area Redevelopment administration is prepared to receive
- speakerand give immediate attention to a request from the Presbyterian Board of
- speakerNational Missions or an appropriate community or area trust entity for a
- speakergrant under Section eight of the Area Redevelopment Act to finance the acquisition of
- speakerall or a group of the ten hospitals now owned and operated by the Miners Memorial
- speakerWelfare Association in the states of Kentucky, West Virginia and Virginia.
- speakerAmong the factors which would influence our decision are the following: one a
- speakernegotiation of a minimum purchase price for the hospitals; two, the assurance
- speakerthat adequate provisions have been made for the continued long term operation of the hospitals;
- speakerand three, a finding of compliance with our statutes and regulations.
- speakerNow, against the background of many conferences with the staff of the A. R. A. and a
- speakergreat number of telephone calls over the past few days,
- speakerin my personal judgment,
- speakerthis letter constitutes a virtual commitment to make it
- speakerpossible for us to acquire the hospitals without any expenditure of Board of
- speakerNational Missions funds.
- speaker[Kenneth Neigh] Mr. Chairman, may I add, Mr. President, two other
- speakergermane. At least it seems to me germane,
- speakerobservations. The first has to do with
- speakerthe matter of group practice. It has said,
- speakerand said I think a little too easily, that and
- speakerprobably inaccurately that what we are doing here is
- speakerde-socializing medicine. But, what we have attempted to do
- speakeris to create a program by which the best in group
- speakerpractice and best in the practice of
- speakermedicine that has been a part, a very great part,
- speakerof the success of these hospitals. With reference to that
- speakeron last Sunday afternoon, Mr Barrie
- speakermet with the. Was it the trustees, Bob, of the
- speakerKentucky Medical Association? And
- speakerwe don't have, I think, the original of this action
- speakerbut here are the actions as they
- speakercame to us from the Executive Secretary of the Kentucky Medical
- speakerAssociation. "Resolve: That the Kentucky State
- speakerMedical Association wishes to commend the Presbyterian Church for the
- speakerhumanitarian effort to keep these hospitals in operation.
- speakerResolved: Further, that we feel that the members
- speakerof the Kentucky Medical Association who provide medical
- speakercare to the patients in those hospitals."
- speakerAnd, then there are three provisions. Most of
- speakerthe three are. Have been
- speakeroutlined or have been discussed
- speakerby Dr Rosenfeld [Rosenfeld, Eugene D.] in his,
- speakerin his, statement and which,
- speakerI think, open the door almost
- speakercompletely or for the complete cooperation and understanding of
- speakerthe State Medical Association, subject to certain
- speakernegotiations about principle. Following, and then further.
- speaker"The Board of Trustees of the Kentucky Medical Society
- speaker[Kenneth Neigh] Jim [Gailey, James R.], this is like the Board of Christian Education. I could never understand what the initials mean.
- speakerK. S. M. A., which is the medical association, stands
- speakerready to cooperate in the future with the concerned parties in
- speakerimplementing this program in keeping with these policies."
- speakerThis would seem to say that the Kentucky
- speakerMedical Association. Well, it does say. We are congratulated
- speakeron the humanitarian effort to keep the thing in operation.
- speakerDr. Neigh, that has been confirmed, we just haven't been able to keep in communication fast
- speakerenough, but I do have a
- speakersign.