STATEMENT REGARDING THE POSSIBLE CONVERSION OF THE ARMY AND NAVY HOSPITAL AT HOT SPRINGS, ARK., FOR USE AS A REHABILITATION CENTER FOR THE DISABLED CITIZENS OF ARKANSAS AND SURROUNDING STATES

By Frank H. Krusen, M.D., Mayo Clinic, Rochester, Minn.; Member of the National Advisory Council on Vocational Rehabilitation

On October 28 and 29, 1958, at the request of Miss Mary Switzer, Director of the Office of Vocational Rehabilitation in the Federal Department of Health, Education, and Welfare, I joined a survey team in Hot Springs, Ark., to consider the possibility of converting the facilities of the Army and Navy Hospital in Hot Springs for use as a rehabilitation center for the disabled citizens of Arkansas and the surrounding States. This survey team consisted of the following persons:

Mr. Don W. Russell, director, Arkansas Vocational Rehabilitation Service, Little Rock, Ark.

Mr. Curtis O. Little, supervisor of technical services, Arkansas Vocational Rehabilitation Service, Little Rock, Ark.

Dr. Frank H. Krusen, Mayo Clinic, Rochester, Minn. (member, National Advisory Council on Vocational Rehabilitation).

Mr. Frank O. Birdsall, Woodrow Wilson Rehabilitation Center, Fisherville, Va. Mr. James Burrows, Institute for the Crippled and Disabled, 400 First Avenue, New York, N.Y.

Mr. Herbert Carleton, North Georgia State Trade School, Clarkesville, Ga.

Mr. Gerald Clore, executive director, Goodwill Industries, 2511 Elm Street, Dallas, Tex.

Mr. Ralph Bryan, architect, U.S. Public Health Service, Department of Health, Education, and Welfare, Dallas, Tex.

Mr. Eugene C. Spratt, director, regional hospitals, State health department, Little Rock, Ark.

Mr. Robert E. Thomas, associate regional representative, Office of Vocational Rehabilitation, Department of Health, Education, and Welfare, Dallas, Tex. Some of the conclusions reached by our committee were as follows:

The entire Army-Navy Hospital post consists of approximately 19 acres and approximately 20 buildings. The principal building-that is, the hospital itself— was completed in 1934. Some of the supporting buildings are much older; some are newer. One or two have been condemned and can be used for limited purposes only. The main building is a 500-bed hospital, although during World War II the hospital and attached annex housed nearly 2,000 patients. The building is in excellent physical condition and would require little or no physical rehabilitation to make it usable for appropriate functions. It is undoubtedly one of the best physical facilities in the Army's hospital system.

The facility is located in downtown Hot Springs, immediately off the principal business street. The buildings are fairly close together, set on beautifully landscaped hilly terrain. Considerable climbing is necessary in moving from one building to another.

In addition to the main hospital building there is a 32-story structure which serves as nurses' quarters. It has a capacity for approximately 100 persons. The group of maintenance buildings, plumbing, carpentry, woodworking shops, etc., are well suited to industrial workshops or vocational training shops. These are from 50 to 100 yards distance from the main hospital building, located on ground somewhat above the main hospital.

A number of buildings are now occupied by military personnel as living quarters; these would be available for occupancy by rehabilitation center staff. Three commercial type buildings are located across Reserve Avenue. These are suitable for a wide variety of purposes; however, they will be without water and heat in the near future when the adjoining old Eastman Hotel Annex will be razed. It will cost an estimated $16,000 to get water and heat across Reserve Avenue for these buildings. It is also estimated to cost $16,000 to install separate heating and water systems in these buildings in case it is decided not to tie on to the utilities of the main hospital.

The Army-Navy Hospital also has a camp site on Lake Hamilton with several acres use for recreational purposes. This has a rather large lodge with a few cabins, with boat docks, etc. It may or may not go with the main facility.

The facility is now more than adequately equipped for use as a hospital serving a limited number of patients. Much of the built-in equipment which would go with the building is not of value to a rehabilitation center. There are some exceptions, such as the kitchen equipment, cold storage equipment, and Hubbard tanks.

THE PRINCIPAL BUILDING

The main hospital building has a total of 234,544 square feet. Exclusive of corridors, stairways, and other nonusable spaces it provides 192,000 square feet. The building in its entirety goes for five floors. The sixth floor sets back so that it has about half the area of each of the first five floors. The seventh, eighth, and ninth floors form the tower. A total of four passenger elevators and one freight elevator serve the hospital; one goes to the ninth floor and the other three go only to the seventh floor. The adequacy of the elevators should be given further study. The principal building contains seven large wards, each of which measures approximately 38 x 175 feet. The remaining areas are divided into rooms of smaller size.

The ninth floor is used at the present time for radio broadcasting facilities. This area is suitable for office space.

The eighth floor consists of rooms with adjoining baths, diet kitchen, utility rooms, and two Chrysler Air Temp air conditioners for the area.

The seventh floor contains the physiotherapy department. This area is air conditioned by an individual Chrysler Air Temp unit. The X-ray department is also located on this floor. These areas are suitable for office space, and examining rooms.

The sixth floor contains the sterile supply department. It is equipped with stainless steel appointments throughout. A library and conference room located here provide space for about 50 chairs. Two large surgery rooms are located on this floor. From the sixth floor one can walk out onto the sun deck, which is above the fifth floor wings. On one wing an outdoor theater has been set up for motion pictures. The other deck area is vacant. The major surgery room would probably not be usable for other purposes. The other areas on this floor could be used for offices, laboratory, and treatment rooms.

The first five floors are all the same size, extending throughout the wings on either side of the hospital. The third, fourth, and fifth floors are approximately the same. In the central portion of the building-roughly the tower/rotunda area-are located various clinics, such as dental and E.E.N.T., libraries, diet kitchens, nurse rooms, and storage closets. Also located in this central area are approximately 12 or 13 rooms which would be available for clients' living quarters; these, on an average, could accommodate 25 or 30 clients per floor. Seven large wards are located on these floors; each of these wards measures 38 x 175 square feet; each is air conditioned, with full washroom facilities at both ends of the ward. The large wards could be used either for living quarters for clients, therapy rooms, classrooms, or shop areas.

The first floor includes the entrance hallway and elevators. Around the lobby/rotunda are the offices for the commanding and executive officers and such staff assistants as those for finance, personnel, and fiscal. One wing of this floor housed the bathhouse; this consisted of a large tiled area with individual standing tubs on one side of the wing and rubdown cubicles directly opposite. This portion would not be suitable for office space, but possibly could be converted for therapy areas.

The basement area consists of (a) water control rooms, (b) the morgue, (c) PX, and (d) outpatient department.

The principal secondary building is the bachelor officers quarters, which is now used by the nurses. It is made up largely of single and double bedrooms. Most of the rooms are double size with a bath connecting between two rooms. The capacity is about 100. There are also a kitchen, dining room, and parlor.

CONCLUSIONS

The preliminary survey indicates that the buildings might be used for a Vocationally oriented rehabilitation center serving between 250 and 450 clients. The present nurses' quarters would house 100 clients and some 200 to 300 more could be housed in the miscellaneous rooms in the central portion of the building and in the two wards which already have been converted into patient bedThe seven large wards could be used for vocational training shops. Each 41414-59-3

rooms.

would easily accommodate two training areas. The central wing of the building (immediately behind the rotunda area) would probably be more suitable for treatment areas and other miscellaneous purposes. The maintenance buildings might be used for certain training shops (such as auto mechanics) provided the trainees are not in wheelchairs. They could also be held in reserve for the establishment of sheltered workshops or for specialized demonstration and research projects involving client activities. The three buildings across Reserve Avenue are suitable for a wide variety of uses. They might be available for sheltered workshops or possibly made available to a local group for the establishment of an independently operated sheltered workshop. It is assumed that the present buildings used as residences could be used as staff quarters. The barracks buildings now used for enlisted men would probably remain vacant. The estimated total cost of operating the facility, just for utilities and maintenance, is about $200,000 per year.

The survey team of ten nationally and regionally known experts in the field of rehabilitation concluded, in its report of December 5, 1958, that

(1) Facilities for providing comprehensive services to the disabled are inadequate in all sections of the Nation.

(2) Small centers and facilities are needed in most States and these are being established in many places. It is professionally and economically unsound, however, to attempt the establishment of a comprehensive center in each State.

(3) There is urgent need to establish a few regional centers which are large enough to meet all the needs of the disabled in the area of medical, psychological, social, and vocational evaluation and services. The establishment of one such center, with Federal-State participation, would serve as a pilot project.

(4) The physical plant and equipment of the Army-Navy Hospital in Hot Springs are well suited for use as a comprehensive rehabilitation center. Conversion can be made at a very low cost. If the facility is declared surplus, a facility would thereby be available which would require millions of dollars to construct at present prices. Every effort should be made to utilize the facility to the best advantage.

(5) The Arkansas Vocational Rehabilitation Service should administer and operate the center, accepting disabled clients on a nationwide basis.

It was our opinion that with proper financial support this very fine facility could be organized so that it would provide an outstanding facility for the rehabilitation of handicapped persons. It is, therefore, recommended that S. 1616 be considered favorably by the United States Senate Committee on Government Operations.

The CHAIRMAN. We propose to hear from several witnesses this morning, and at the conclusion of oral testimony, there will be inserted in the record statements and other material relating to the bill. The Chair desires to state further for the record, that the facility or property sought to be conveyed from the Federal Government to the State of Arkansas, is a 500-bed modern hospital that is located on the National Park Reservation in the city of Hot Springs, Ark.

This hospital was originally authorized and constructed about 1882. It was subsequently rebuilt in about 1929 or 1930, and then, about 7 or 8 years ago, it was remodeled, modernized, and brought up-todate. I think it was in the fall of 1953 that the Army decided that it no longer needed the facility. The military population had moved away from that area, and there wasn't sufficient patient load in the vicinity to support or to justify operation of the hospital on an economic basis.

It was proposed that the hospital be closed or deactivated or placed in a standby status. It was estimated that it would cost some $200,000 to $250.000 a year to maintain it in that condition, for that purpose and, therefore, we from Arkansas, and particularly with the cooperation and assistance of other members of the Arkansas delegation, opposed the closing or deactivation of the hospital. In the

meantime, we were able to keep it from being closed and have been able to keep it operating up until now in the hope that we might persuade some other Government agency to find a use for it, so they could occupy it and use it and not have to have the facility become a loss and a burden to the Government for maintenance and upkeep while not performing any service to the Government.

We have repeatedly made that effort, through various agencies of the Government, without success. No agency has been willing to take it, and use it or to claim to have any need for it, and the Congress has, by direction in the appropriations bills from year to year, forced the Army to keep the hospital open and operating until now.

Recently the idea developed, that it could be utilized for a vocational rehabilitation center to serve not just the people of Arkansas, but the people of the entire southwest area. Under existing law the Department of Health, Education, and Welfare does have authority to make contributions for the maintenance and operation of that type of service. The State of Arkansas, therefore, has proposed to operate such a center, and has enacted legislation; Act No. 34 approved February 13, 1959, to authorize the establishment and operation of a rehabilitation center and workshop, to provide for expanded services in the rehabilitation of the physically and mentally impaired, including those who can benefit from independent living services and for other purposes.

I will place in the record, at this point, a copy of the enabling act, entitled the "Rehabilitation Act of Arkansas" No. 34, which was approved on February 13, of this year.

(The document referred to follows:)

S. B. No. 60-MILUM

Approved Feb. 13, 1959

ACT 34

"A BILL for an Act to Amend Sections 1, 2, 3, 4, 5, 6, 7, 8. 10, 12, 15, 16 and 17 of Act 43 of the Acts of the General Assembly of the State of Arkansas for 1955; to Authorize the Establishment and Operation of Rehabilitation Centers and Workshops: to Provide for Expanded Services in the Rehabilitation of the Physically and Mentally Impaired, Including Those Who Can Benefit From Independent Living Services; and for Other Purposes."

Be It Enacted by the General Assembly of the State of Arkansas: SECTION 1. Section 1 of Act 43, Arkansas Acts of 1955 [Ark. Stats. (1947) Setcion 80-2540] is hereby amended to read as follows:

"Section 1. SHORT TITLE. This Act may be cited as the 'Rehabilitation Act of Arkansas.'"

SECTION 2. Section 2 of Act 43, Arkansas Acts of 1955 [Ark. Stats. (1947) Section 80-2541] is hereby amended to read as follows:

"Section 2. POLICY AND SCOPE OF REHABILITATION. It is hereby declared to be the policy of the State of Arkansas to provide rehabilitation services to the extent needed and feasible, to eligible disabled and handicapped individuals throughout the State, to the end that they may engage in useful and remunerative occupations to the extent of their capabilities, and in rehabilitating handicapped individuals who, as a result of such rehabilitation, may be expected to achieve such ability of independent living as to dispense with, or largely dispense with, the need for institutional care or, if not institutionalized, to dispense with, or largely dispense with, the need for an attendant, thereby increasing the social and economic well being of themselves and their families and the productive capacity of the State and reducing the burden of dependency on families and taxpayers.

"Pursuant to such policy, rehabilitation services shall be provided to citizens throughout the State and the rehabilitation plan adopted pursuant to this Act shall be in effect in all political subdivisions of the State."

SECTION 3. Section 3 of Act 43, Arkansas Acts of 1955 [Ark. Stats. (1947) Section 80-2542] is hereby amended to read as follows:

"Section 3. DEFINITIONS:

"(a) 'State Board' means the State Board for Vocational Education; "(b) 'Service' means the Rehabilitation Service established by this Act; "(c) 'Director' means the Director of the Rehabilitation Service who may, at the discretion of the State Board, be designated Executive Officer for the Rehabilitation Service;

"(d) 'Employment handicap' means a physical or mental condition which constitutes, contributes to, or if not corrected, will probably result in a substantial impairment of occupational performance;

(e) Disabled individual' means any person who, as a result of a physical or mental disability, (1) has a substantial employment handicap and who may, through receiving vocational rehabilitation services, be fit into remunerative employment, or (2) may achieve such ability of independent living, through receiving rehabilitation services, which will enable him to dispense with, or largely dispense with, the need for institutional care or attendant care in the household; "(f) 'Remunerative employment' includes employment in the competitive labor market, practice of a profession, self employment, homemaking, farm or family work where payment is in kind rather than cash, sheltered employment, home industry or other homebound work of a remunerative nature;

"(g) Rehabilitation' and 'rehabilitation services' means any service, provided directly or through public or private instrumentalities, found by the Director to be necessary to compensate a disabled individual for his employment handicap and to enable him to engage in a remunerative occupation, or to achieve independent living; including, but not limited to, medical and vocational diagnosis, vocational guidance, counseling and placement, training, physical restoration, transportation, occupational and business licenses, equipment, initial stocks and supplies, maintenance, and training books and materials. The term covers the establishment and operation of workshops, rehabilitation centers, home industries and small business enterprises for the blind and severely disabled.

"(h) 'Rehabilitation training' means all necessary training provided to a disabled individual to compensate for his employment handicap, including, but not limited to pre-vocational, vocational and supplementary training and training provided for the purpose of developing occupational skills and capacities;

"(1) 'Physical Restoration' means any medical, surgical or therapeutic treatment necessary to correct or substantially reduce a disabled individual's disability within a reasonable length of time, including prosthetic appliances but excluding curative treatment for acute or transitory conditions, excepting treatment of medical complications and emergencies as may arise during the rendering of rehabilitation service;

"(j) Maintenance' means money payment not exceeding the estimated cost of subsistence during the provision of rehabilitation services:

"(k) The term 'rehabilitation facility' is a facility operated for the purpose of assisting in the rehabilitation of disabled persons, which provides one or more of the following types of services: (1) testing, fitting, or training in the use of prosthetic devices; (2) pre-vocational or conditioning therapy; (3) physical corrective or occupational therapy: (4) adjustment training, or evaluation or control of special impairments; or, in which a coordinated approach is made to the physical, mental, and vocational evaluation of impaired persons and an integrated program of physical restoration and pre-vocational or vocational training is provided under competent professional supervision and direction:

(1) The term 'workshop' means a place where any manufacture or handwork is carried on and which is operated for the primary purpose of providing remunerative employment to severely disabled persons who cannot be readily absorbed in the competitive labor market;

"(m) The term 'non-profit'. when used with respect to a rehabilitation facility or workshop, means a rehabilitation facility or a workshop owned and operated by a corporation or association, no part of the net earnings of which inures, or may lawfully inure, to the benefit of any shareholder or individual and the income is exempt from taxation under Section 101 (6) of the Federal Internal Revenue Code:

"(n) Establishment of a workshop or rehabilitation facility means: (1) In the case of a workshop, the expansion, remodeling or alteration of existing buildings to adapt them to workshop purposes or to increase employment opportunities, and the acquisition of initial equipment; and (2) in the case of a