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The original documents are located in Box 1, folder "Pocket Veto - 12/25/70 S3418 Family
Practice of Medicine (2)" of the White House Records Office: Legislation Case Files at the
Gerald R. Ford Presidential Library.
Copyright Notice
The copyright law of the United States (Title 17, United States Code) governs the making of
photocopies or other reproductions of copyrighted material. Gerald R. Ford donated to the United
States of America his copyrights in all of his unpublished writings in National Archives collections.
Works prepared by U.S. Government employees as part of their official duties are in the public
domain. The copyrights to materials written by other individuals or organizations are presumed to
remain with them. If you think any of the information displayed in the PDF is subject to a valid
copyright claim, please contact the Gerald R. Ford Presidential Library.
Exact duplicates within this folder were not digitized.
Digitized from Box 1 of the White House Records Office Legislation Case Files at the Gerald R. Ford Presidential Library
Calendar No. 1079
91sT CONGRESS
SENATE
REPORT
2d Session
No. 91-1071
THE FAMILY PRACTICE OF MEDICINE ACT OF 1970
AUGUST 5, 1970.-Ordered to be printed
GERALD FORD LIBRARY
Mr. YARBOROUGH, from the Committee on Labor and Public Welfare,
submitted the following
REPORT
[To accompany S. 3418]
The Committee on Labor and Public Welfare, to which was referred
the bill (S. 3418) to amend the Public Health Service Act to assist
medical schools and hospitals in establishing special departments and
programs in the field of family practice and otherwise to encourage
and promote the training of medical and paramedical personnel in
the field of family medicine and for other purposes, having considered
the same, reports favorably thereon with amendments and recom-
mends that the bill, as amended, do pass.
NECESSITY FOR LEGISLATION
S. 3418 would provide for the encouragement of the training of
family practitioners. In public hearings on the bill the Health Sub-
committee of the Senate Labor and Public Welfare Committee heard
a wide variety of witnesses testify to the very great need to supple-
ment this country's highly specialized medical manpower with phy-
sicians who have a more broadly based educational program.
Additionally, the bill enables the Secretary of HEW to assist
medical schools, graduate schools, universities, hospitals, and other
public or private institutions in more effectively dealing with the
problems of malnutrition. The bill authorizes activities intended to
advance medical knowledge in the causes and effects of malnutrition,
provide for the early detection and effective treatment of malnutrition,
and enhance student assistance programs in the field of malnutrition.
HEARINGS
Public hearings were held by the Health Subcommittee of the
Senate Labor and Public Welfare Committee on July 8 and 9, 1970.
48-010
2
In addition to the substantial number of statements which were
filed with the committee, a wide range of witnesses gave testimony
to the subcommittee. In substantial measure they cover the spectrum
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of agencies, associations, and individuals who would be affected by
the proposed legislation.
SUMMARY OF S. 3418
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TITLE I
Title I of the bill would authorize professional and technical training
in the field of Family Medicine. It would provide for the making of
grants to public and private nonprofit medical schools, including schools
of osteopathy to: (1) operate, as an integral part of their medical edu-
cation program, separate and distinct departments devoted to provid-
ing teaching and instruction (including continuing education) in all
phases of family practice; (2) construct such facilities as may be
appropriate to carry out a program of training in the field of family
medicine whether as a part of a medical school or as separate out-
patient or similar facility; (3) operate, or participate in, special
training programs for paramedical personnel in the field of family
medicine; and (4) operate, or participate in, special training programs
to teach and train medical personnel to head departments of family
practice or otherwise teach family practice in medical schools.
It would further provide for grants to public and private nonprofit
hospitals, which provide training programs for medical students,
interns, or residents to: (1) operate, as an integral part of their medical
training programs, special professional training programs (including
continuing education) in the field of family medicine for medical
students, interns, residents, or practicing physicians; (2) construct
such facilities as may be appropriate to carry out a program of training
in the field of family medicine whether as a part of a hospital or as a
separate outpatient or similar facility; (3) provide financial assistance
(in the form of scholarships, fellowships, or stipends) to interns, resi-
dents, or other medical personnel who are in need thereof, who are
participants in a program of such hospital which provides special
training (accredited by a recognized body or bodies approved for such
purpose by the Commissioner of Education) in the field of family
medicine, and who plan to specialize or work in the practice of family
medicine; and (4) operate, or participate in, special training programs
for paramedical personnel in the field of family medicine.
In order to carry out the purposes of title I, the committee's bill
authorizes the appropriation of:
$50 million in fiscal year 1971,
$75 million in fiscal year 1972,
$100 million in fiscal year 1973,
$100 million in fiscal year 1974, and
$100 million in fiscal year 1975.
For the purpose of assisting medical schools and hospitals to plan
or develop programs or projects for the purpose of carrying out one
or more of the purposes set forth in title I of the bill, the Secretary
of HEW is authorized to make planning and developmental grants.
Not more than $10 million of funds appropriated in each fiscal year
may be utilized for these planning and development grants.
3
Title I of the bill further provides that the Secretary shall appoint
an Advisory Council on Family Medicine. The Council shall consist
of 12 members, four of whom shall be physicians engaged in the prac-
tice of family medicine, four of whom shall be physicians engaged in
the teaching of family medicine, and four of whom shall be repre-
sentatives of the general public. The Council shall advise and assist
the Secretary in the preparation of regulations for, and as to policy
matters arising with respect to, the administration of title I. The
Council shall consider all applications for grants under title I and
shall make recommendations to the Secretary with respect to approval
of applications for and of the amounts of grants.
TITLE II
Title II of the bill authorizes the Secretary of HEW to:
1. Make grants-in-aid to and enter into contracts with medical
schools, appropriate graduate schools, and nursing schools to assist
such schools in establishing courses dealing with malnutrition, its
causes and effects, means for its early detection, and effective treat-
ment of malnutrition and conditions resulting therefrom;
2. Make grants-in-aid and enter into contracts with universities,
medical schools, hospitals, laboratories, and other public or private
institutions, and individuals and groups of individuals for research
into malnutrition, its causes and effects, means for its detection, and
into the effective treatment of malnutrition and conditions resulting
therefrom;
3. Establish special projects designed to provide to students of
courses in malnutrition practical training and experience in the field
of malnutrition; and
4. Provide fellowships and otherwise financially assist students to
encourage and enable them to pursue studies and engage in activities
in poverty areas relating to malnutrition.
In order to carry out the purposes of title II there are authorized
to be appropriated:
$32,000,000 in fiscal year 1971,
$32,000,000 in fiscal year 1972,
$32,000,000 in fiscal year 1973,
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$32,000,000 in fiscal year 1974, and
$32,000,000 in fiscal year 1975.
COMMITTEE VIEWS
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TITLE I-FAMILY MEDICINE
1. Separate departments of family medicine-
The committee heard a variety of points of view concerning the
requirement in the bill that in order to be eligible for assistance a school
of medicine (or osteopathy) must either have established or be in
the process of establishing a separate and coequal department of
family medicine. The committee feels the requirement is both sound
and necessary. It is persuaded by those who testified that unless such
a requirement does in fact exist, there is little or no incentive for the
already financially beleaguered schools of medicine to establish a new
4
organizational entity. This point of view was cogently presented by
the President of the Academy of General Practice who testified:
Advances in medical science have opened new medical
horizons and made feasible the practice of medicine in many
specialized areas. At the same time, medical schools have
focused much of their attention on research aimed at dis-
covering new horizons.
The medical school curriculum has been geared to accom-
modate research, with the result that few, if any, of the
medical school faculty have been general practitioners with a
primary interest in training family doctors.
It is only natural that faculty surgeons would tend .to
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support programs which would improve the training of
surgeons, just as faculty internists would tend to support
programs to improve the training of internists. Once the
emphasis switched to research, the trend toward limited
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specialization became self-perpetuating.
He further testified:
We in the general practice area have gone down the blind
alley of trying to produce family doctors in a nonspecialty
department. We have had much experience showing that it
does not work, because the department is set out in a corner
of the medical school. It does not work.
But we do have experience in the last 15 months with
schools setting up primary areas of family practice. The
student interest is tremendous. The interest on behalf of
new teachers of family medicine is tremendous.
2. Role of Advisory Council
The committee carefully considered the proposed role of the Ad-
visory Council. Its consideration included the necessity that the Coun-
cil be in a position to advise and assist the Secretary of Health, Edu-
cation, and Welfare on the issues of major policy which will inevitably
arise as well as be able to make recommendations to him with regard to
the approval of request for grant assistance. At the same time the com-
mittee is fully aware of the need to avoid the stultifying effect on pro-
gram administration that might result from an overly zealous Council.
The committee believes that an appropriate balance between these
two positions can be found in the operation of the National Advisory
Council on Regional Medical Programs, established under title IX of the
Public Health Service Act. Accordingly, it has reported language for
the Council on Family Medicine, which closely parallels that of the
Regional Medical Programs Council. In SO doing the committee
intends that the Council herein established will function with respect
to policy formulation and grant review in essentially the same way as
the RMP Council has functioned.
3. Planning and Development Grants
The committee, while being strongly persuaded that a separate
and coequal department of family medicine is essential in order to
achieve the purposes of title I, nevertheless well recognizes that most
medical schools do not yet have such departments, though many are
or are about to begin planning for a separate department.
5
For reasons of equity and commonsense, therefore, the committee
has authorized planning and development grants in order to give
assistance and encouragement to this trend.
4. Continuing Education of Physicians
The committee believes that the value of the specialty of family
medicine is by no means limited to the initial, graduate, or immediate
postgraduate training of physicians. In point of fact both educational
and practical activities in the area of family medicine are highly
relevant to the practicing physician. Accordingly, the committee has
explicitly included continuing education activities as eligible for sup-
port under title I.
5. Osteopaths and Schools of Osteopathy
Osteopaths and Schools of Osteopathy have and are making a
significant contribution to family medicine through their patterns of
practice and their curriculums. Their full participation in the programs
authorized by this bill is both desirable and essential. Since the com-
mittee understands that HEW defines "schools of medicine" to
include schools of osteopathy for purposes of qualifying for grant
assistance, the committee did not feel the necessity of identifying
them by name in the bill. Additionally, no specification of osteopaths
was made with regard to the membership of the Advisory Council,
though clearly there are many eminent osteopaths whose contribution
to the Council would be invaluable.
6. Maintenance of effort
The committee intends that section 765(c) of title I which states
"The Secretary shall not approve any grant under this part unless the
applicant therefore provide assurances satisfactory to the Secretary
that funds made available through such grant will be SO used as to
supplement and, to the extent practical, increase the level of non-
Federal funds which would, in the absence of such grant, be made
available for the purpose for which such grant is requested" shall not
be constructed SO as to exclude the hospitals of the Veterans' Adminis-
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tration, the Public Health Service or other Federal agencies from
&
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competing for such grants when they meet all other requirements
under title I.
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7. Construction of facilities
Title I of the bill includes authority for the construction of facilities
appropriate to training programs in family medicine whether as a
part of a medical school, hospital, separate outpatient facility, or
similar facility. The committee encourages the use of this authority in
innovative and experimental ways. For example, a medical school or
hospital might wish to construct a facility in an area of severe economic
blight, regardless of its immediate proximity to that medical school
or hospital, in order to provide training in family medicine while
providing high quality services.
TITLE II.-MALNUTRITION
The committee is deeply concerned that we set the seal of urgency
on a national commitment to put an end to malnutrition in America
and accept as a nation the problem of malnourishment as a national
responsibility.
6
In his message to the Congress last year, the President, Mr. Nixon,
clearly testified to the very real need for action in this area. He stated:
We have long thought of America as the most bounteous
of nations. In our conquest of the most elemental of human
needs, we have set a standard that is a wonder and aspira-
tion for the rest of the world. Our agricultural system pro-
duces more food than we can consume, and our private food
market is the most effective food distribution system ever
developed. So accustomed are most of us to a full and bal-
anced diet that, until recently, we have thought of hunger
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and malnutrition as problems only in far less fortunate
i
countries.
But in the past few years we have awakened to the dis-
tressing fact that despite our material abundance and agri-
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cultural wealth, many Americans suffer from malnutrition.
Precise factual descriptions of its extent are not presently
available, but there can be no doubt that hunger and mal-
nutrition exist in America, and that some million may be
affected.
Dr. Arnold Schaefer, the man in charge of the National Nutri-
tional Survey, has made this forceful observation:
We have been alerted by recent studies that our popu-
lation who are "malnutrition risks" is beyond anticipated
findings, and also that in some of our vulnerable population
groups-preschool children, the aged, teenagers, and the
poor-malnutrition is indeed a serious medical problem.
Although we do not know just how many Americans are actually
hungry and how many suffer from malnutrition-who don't eat
enough and who don't eat the right things-we do know there are
too many Americans in both categories.
Testimony before the Select Committee on Nutrition and Human
Needs has indicated that our medical schools have not been adequately
preparing their students for detecting and treating malnutrition and its
related illnesses. Even though many of our medical schools do have
courses in which some attention is given to malnutrition few make the
study of malnutrition an identifiable part of their curriculum. We
have learned that too few doctors have a background which equips
them to recognize and treat malnutrition as it exists in our poverty
areas. For too long, the study of malnutrition has been given secondary
attention in our medical, graduate, and nursing schools to the shame
and dismay of us all. The final report of the White House Conference
on Food, Nutrition, and Health stated: "The teaching of nutrition in
schools of medicine, dentistry, and nursing is most inadequate at the
present time; in some schools it is almost nonexistent.
The num-
ber of specialists in nutrition among physicians, dentists, and nurses is
very limited; a few hundred persons would be an optimistic estimate."
To overcome this deficiency, the committee authorized grants-in-aid
and contracts to be provided to medical schools, appropriate
graduate schools, and nursing schools to assist such schools in estab-
7
lishing courses dealing with malnutrition, its causes and effects, means
for its early detection, and effective treatment of malnutrition and
conditions resulting thereform.
Among the recommendations set forth in the final report of the
White House Conference on Food, Nutrition, and Health are those of
its "Task Force VI C-2" which recommended funds be provided for:
"Continued research, both basic and applied, on specific nutritional
needs of the population and the fundamental causes of malnutrition."
To meet this need the committee authorized grants-in-aid and
contracts to be provided for research into malnutrition, its causes and
effects, means for its detection, and into the effective treatment of
malnutrition and conditions resulting therefrom.
A national program must have its ultimate focus at the community
level, where the citizen must be served. The nutritionist's laboratory
should be the home and the community in which the person lives as
well as the traditional basic research laboratories, The White House
Conference on Food, Nutrition, and Health report states:
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More emphasis should be given to applied nutrition, not
only in the classroom but through field experience in hospi-
tals, clinics, and the community. Students of today are more
GERALD
LIBRARY
socially conscious and community oriented than in the
past,
To achieve this objective the committee authorized financial
assistance be provided to establish special projects designed to provide
to students of courses in malnutrition practical training and ex-
perience in the field of malnutrition.
Only with a major increase in committed and competent man-
power in the field can a national program be established to deliver
needed health and nutritional services to people. There is substantial
evidence to document the effects of poverty and the enhanced risks
to mental and physical development from severe malnutrition during
the first few years of life. This enhanced risk extends into the period
of pregnancy when the expectant mother is unable to provide the
infant with sufficient nutrients.
To meet this need the committee authorized the provision of
fellowships and other financial assistance to students to encourage
and enable them to pursue studies and engage in activities in poverty
areas relating to malnutrition.
To meet these grave challenges, curriculum development, research,
practical experience, and student assistance in all facets of the field
of malnutrition, with its emphasis on poverty, the committee au-
thorized $32 million to be appropriated for each of 5 fiscal years
beginning with fiscal year 1971.
CHANGES IN EXISTING LAW
In compliance with subsection 4 of rule XXIX of the Standing
Rules of the Senate, changes in existing law made by the bill are
shown as follows (existing law proposed to be omitted is enclosed in
black brackets, new matter is printed in italic, existing law in which
no change is proposed is shown in roman):
8
PUBLIC HEALTH SERVICE AcT
*
TITLE VII-HEALTH RESEARCH AND TEACHING FACILI-
TIES AND TRAINING OF PROFESSIONAL HEALTH
PERSONNEL
*
[PART D-CENTERS FOR RESEARCH ON MENTAL RETARDATION
AND RELATED ASPECTS OF HUMAN DEVELOPMENT
[AUTHORIZATION OF APPROPRIATIONS
[SEC. 761. There are authorized to be appropriated $6,000,000
for the fiscal year ending June 30, 1964, $8,000,000 for the fiscal year
ORD
ending June 30, 1965, and $6,000,000 each for the fiscal year ending
June 30, 1966, and the fiscal year ending June 30, 1967, for project
grants to assist in meeting the costs of construction of facilities for
research, or research and related purposes, relating to human develop-
ment, whether biological, medical, social, or behavioral, which may
assist in finding the causes, and means of prevention, of mental
retardation, or in finding means of ameliorating the effects of mental
retardation. Sums SO appropriated shall remain available until ex-
pended for payments with respect to projects for which applications
have been filed under this part before July 1, 1967, and approved by
the Surgeon General thereunder before July 1, 1968.
[APPLICATIONS
[SEC. 762. (a) Applications for grants under this part with respect
to any facility may be approved by the Surgeon General only if-
[(1) the applicant is a public or nonprofit institution which
the Surgeon General determines is competent to engage in the
type of research for which the facility is to be constructed; and
[(2) the application contains or is supported by reasonable
assurances that (A) for not less than twenty years after comple-
tion of construction, the facility will be used for the research, or
research and related purposes, for which it was constructed;
(B) sufficient funds will be available for meeting the non-
Federal share of the cost of constructing the facility; (C) sufficient
funds will be available, when the construction is completed, for
effective use of the facility for the research, or research and
related purposes, for which it was constructed; and (D) all
laborers and mechanics employed by contractors or subcon-
tractors in the performance of work on construction of the center
will be paid wages at rates not less than those prevailing on
similar construction in the locality as determined by the Secretary
of Labor in accordance with the Davis-Bacon Act, as amended
(40 U.S.C. 276a-276a-5); and the Secretary of Labor shall have,
with respect to the labor standards specified in the clause (D)
the authority and functions set forth in Reorganization Plan
Numbered 14 or 1950 (15 F.R. 3176; 5 U.S.C. 133z-15), and
section 2 of the Act of June 13, 1934, as amended (40 U.S.C.
276c).
9
[(b) In acting on applications for grants, the Surgeon General shall
take into consideration the relative effectiveness of the proposed fa-
cilities in expanding the Nation's capacity for research and related
purposes in the field of mental retardation and related aspects of
human development, and such other factors as he, after consultation
with the national advisory council or councils concerned with the field
or fields of research involved, may by regulation prescribe in order to
assure that the facilities constructed with such grants, severally and
together, will best serve the purpose of advancing scientific knowledge
pertaining to mental retardation and related aspects of human de-
velopment.
[AMOUNT OF GRANTS; PAYMENTS
[SEC. 763. (a) The total of the grants with respect to any project
for the construction of a facility under this part may not exceed 75
per centum of the necessary cost of construction of the center as
determined by the Surgeon General.
[(b) Payments of grants under this part shall be made in advance
or by way of reimbursement, in such installments consistent with
construction progress, and on such conditions as the Surgeon General
may determine.
[(c) No grant may be made after January 1, 1964, under any
provision of this Act other than this part, for any of the four fiscal
years in the period beginning July 1, 1963, and ending June 30, 1967,
for construction of any facility described in this part, unless the
Surgeon General determines that funds are not available under this
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part to make a grant for the construction of such facility.
[RECAPTURE OF PAYMENTS
[SEC. 764. If, within twenty years after completion of any con-
struction for which funds have been paid under this part-
[(1) the applicant or other owner of the facility shall cease to
be a public or nonprofit institution, or
[(2) the facility shall cease to be used for the research pur-
poses, or research and related purposes, for which it was con-
structed, unless the Surgeon General determines, in accordance
with regulations, that there is good cause for releasing the ap-
plicant or other owner from the obligation to do so,
the United States shall be entitled to recover from the applicant or
other owner of the facility the amount bearing the same ratio to the
then value (as determined by agreement of the parties or by action
brought in the United States district court for the district in which
such facility is situated) of the facility, as the amount of the Federal
participation bore to the cost of construction of such facility.
[NONINTERFERENCE WITH ADMINISTRATION OF INSTITUTIONS
[SEC. 765. Except as otherwise specifically provided in this part,
nothing contained in this part shall be construed as authorizing any
department, agency, officer, or employee of the United States to
exercise any direction, supervision, or control over, or impose any re-
quirement or condition with respect to, the research or related pur-
poses conducted by, and the personnel or administration of, any
institution.
10
[DEFINITIONS
[SEC. 766. As used in this part-
[(1) the terms "construction" and "cost of construction"
include (A) the construction of new buildings and the expansion,
remodeling, and alteration of existing buildings, including archi-
tects' fees, but not including the cost of acquisition of land or
off-site improvements, and (B) equipping new buildings and
existing buildings, whether or not expanded, remodeled, or
altered;
[(2) the term "nonprofit institution" means an institution
owned and operated by one or more corporations or associations
ONL
no part of the net earnings of which inures, or may lawfully
inure, to the benefit of any private shareholder or individual.]
PART D-GRANTS To PROVIDE PROFESSIONAL AND TECHNICAL
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TRAINING IN THE FIELD OF FAMILY MEDICINE
DECLARATION OF PURPOSE
SEC. 761. It is the purpose of this part to provide for the making of
grants to assist-
(a) public and private nonprofit medical schools—
(1) to operate, as an integral part of their medical education
program, separate and distinct departments devoted to providing
teaching and instruction (including continuing education) in
all phases of family practice;
(2) to construct such facilities as may be appropriate to carry
out a program of training in the field of family medicine whether
as a part of a medical school or as separate outpatient or similar
facility;
(3) to operate, or participate in, special training programs
for paramedical personnel in the field of family medicine; and
(4) to operate, or participate in, special training programs
to teach and train medical personnel to head departments of
family practice or otherwise teach family practice in medical
schools.
(b) public and private nonprofit hospitals which provide training
programs for medical students, interns, or residents-
(1) to operate, as an integral part of their medical training
programs, special professional training programs (including
continuing education) in the field of family medicine for medical
students, interns, residents, or practicing physicians;
(2) to construct such facilities as may be appropriate to carry
out a program of training in the field of family medicine whether
as a part of a hospital or as a separate outpatient or similar
facility;
(3) to provide financial assistance (in the form of scholar-
ships, fellowships, or stipends) to interns, residents, or other
medical personnel who are in need thereof, who are participants
in a program of such hospital which provides special training
(accredited by a recognized body or bodies approved for such
purpose by the Commissioner of Education) in the field of
family medicine, and who plan to specialize or work in the
practice of family medicine; and
11
(4) to operate, or participate in, special training programs
for paramedical personnel in the field of family medicine.
AUTHORIZATION OF APPROPRIATIONS
SEC. 762. (a) For the purpose of making grants to carry out the pur-
poses of this part, there are authorized to be appropriated $50,000,000
or the fiscal year ending June 30, 1971, $75,000,000 for the fiscal year
ending June 30, 1972, and $100,000,000 for the fiscal year ending
June 30, 1973, and for each of the next two succeeding fiscal years.
(b) Sums appropriated pursuant to subsection (a) for any fiscal year
shall remain available for the purpose for which appropriated until the
close of the fiscal year which immediately follows such year.
GRANTS BY SECRETARY
SEC. 763. (a) From the sums appropriated pursuant to section 762,
the Secretary is authorized to make grants, in accordance with the pro-
visions of this part, to carry out the purposes of section 761.
GERALD
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(b) No grant shall be made under this part unless an application
therefor has been submitted to, and approved by, the Secretary. Such
application shall be in such form, submitted in such manner, and contain
such information, as the Secretary shall have prescribed by regulations
which have been promulgated by him and published in the Federal Register
not later than six months after the date of enactment of this part.
(c) Grants under this part shall be in such amounts and subject to
such limitations and conditions as the Secretary may determine to be
proper to carry out the purposes of this part.
(d) In the case of any application for a grant any part of which is to
be used for major construction or remodeling of any facility, the Secre-
tary shall not approve the part of the grant which is to be so used unless the
recipient of such grants enters into appropriate arrangements with the
Secretary which will equitably protect the financial interests of the United
States in the event such facility ceases to be used for the purpose for which
such grant or part thereof was made prior to the expiration of the ten-year
period which commences on the date such construction or remodeling is
completed.
(e) Grants made under this part shall be used only for the purpose for
which made and may be paid in advance or by way of reimbursement, and
in such installments as the Secretary may determine.
ELIGIBILITY FOR GRANTS
SEC. 764. (a) In order for any medical school to be eligible for a grant
under this part, such school-
(1) must be a public or other nonprofit school of medicine; and
(2) must be accredited as a school of medicine by a recognized body
or bodies approved for such purpose by the Commissioner of Education,
except that the requirement of this clause (2) shall be deemed to be
satisfied if, (A) in the case of a school of medicine which by reason of
no, or an insufficient, period of operation is not, at the time of appli-
cation for a grant under this part, eligible for such accreditation, the
Commissioner finds, after consultation with the appropriate accredi-
tation body or bodies, that there is reasonable assurance that the school
will meet the accreditation standards of such body or bodies prior to
the beginning of the academic year following the normal graduation
12
date of students who are in their first year of instruction at such school
during the fiscal year in which the Secretary makes a final deter-
mination as to approval of the application.
(b) In order for any hospital to be eligible for a grant under this part,
such hospital-
(1) must be a public or private nonprofit hospital; and
(2) must conduct or be prepared to conduct in connection with its
other activities (whether or not as an affiliate of a school of medicine)
one or more programs of medical training for medical students, interns,
or residents, which is accredited by a recognized body or bodies,
FORD
approved for such purpose by the Commissioner of Education.
&
APPROVAL OF GRANTS
SEC. 765. (a) The Secretary, upon the recommendation of the Council,
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is authorized to make grants under this part upon the determination that-
(1) the applicant meets the eligibility requirements set forth in
section 764;
(2) the applicant has complied with the requirements of section 763;
(3) the grant is to be used for one or more of the purposes set forth
in section 761;
(4) it contains such information as the Secretary may require to
make the determinations required of him under this section and such
assurances as he may find necessary to carry out the purposes of
this part;
(5) it provides for such fiscal control and accounting procedures
and reports, and access to the records of the applicant, as the Secretary
may require (pursuant to regulations which shall have been pro-
mulgated by him and published in the Federal Register) to assure
proper disbursement of and accounting for all Federal funds paid to
the applicant under this part; and
(6) the application contains or is supported by adequate assurance
that any laborer or mechanic employed by any contractor or sub-
contractor in the performance of work on the construction of the
facility will be paid wages at rates not less than those prevailing on
similar construction in the locality as determined by the Secretary of
Labor in accordance with the Davis-Bacon Act, as amended (40
U.S.C. 276a-276a5). The Secretary of Labor shall have, with respect
to the labor standards specified in this paragraph, the authority and
functions set forth in Reorganization Plan Numbered 14 of 1950 (15
F.R. 3176; 65 Stat. 1267), and section 2 of the Act of June 13, 1934,
as amended (40 U.S.C. 276c).
(b) The Secretary shall not approve any grant to-
(1) a school of medicine to establish or operate a separate depart-
ment devoted to the teaching of family medicine unless the Secretary
is satisfied that-
(A) such department is (or will be, when established) of
equal standing with the other departments within such school
which are devoted to the teaching of other medical specialty
disciplines;
(B) such department will, in terms of the subjects offered
and the type and quality of instruction provided, be designed
to prepare students thereof to meet the standards established for
specialists in the specialty of family practice by a recognized
body approved by the Commissioner of Education; or
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(2) a hospital to establish or operate a special program for medical
students, interns, or residents in the field of family medicine unless
the Secretary is satisfied that such program will, in terms of the type
of training provided, be designed to prepare participants therein to
meet the standards established for specialists in the field of family
medicine by a recognized body approved by the Commissioner of
Education.
(c) The Secretary shall not approve any grant under this part unless
the applicant therefor provides assurances satisfactory to the Secretary
that funds made available through such grant will be so used as to supple-
ment and, to the extent practical, increase the level of non-Federal funds
which would, in the absence of such grant, be made available for the purpose
for which such grant is requested.
PLANNING AND DEVELOPMENTAL GRANTS
SEC. 766. (a) For the purpose of assisting medical schools and hospitals
(referred to in section 761) to plan or develop programs or projects for the
purpose of carrying out one or more of the purposes set forth in such sec-
tion, the Secretary is authorized for any fiscal year (prior to the fiscal year
which ends June 30, 1975) to make planning and developmental grants in
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such amounts and subject to such conditions as the Secretary may determine
to be proper to carry out the purposes of this section.
(b) From the amounts appropriated for any fiscal year (prior to the
fiscal year ending June 30, 1975) pursuant to section 762(a), the Secre-
tary may utilize such amounts as he deems necessary (but not in excess of
$10,000,000 for any fiscal year) to make the planning and developmental
grants authorized by subsection (a).
ADVISORY COUNCIL ON FAMILY MEDICINE
SEC. 767. (a) The Secretary shall appoint an Advisory Council on
Family Medicine (hereinafter in this section referred to as the 'Council').
The Council shall consist of twelve members, four of whom shall be
physicians engaged in the practice of family medicine, four of whom shall
be physicians engaged in the teaching of family medicine, and four of
whom shall be representatives of the general public. Members of the Council
shall be individuals who are not otherwise in the regular full-time employ
of the United States.
(b) Each member of the Council shall hold office for a term of four years,
except that any member appointed to fill a vacancy prior to the expiration
of the term for which his predecessor was appointed shall be appointed
for the remainder of such term, and except that the terms of office of the
members first taking office shall expire, as designated by the Secretary at
the time of appointment, three at the end of the first year, three at the end
of the second year, three at the end of the third year, and three at the end of
the fourth year, after the date of appointment. A member shall not be
eligible to serve continuously for more than two terms.
(c) Members of the Council shall be appointed by the Secretary without
regard to the provisions of title 5, United States Code, governing appoint-
ments in the competitive service. Members of the Council, while attending
meetings or conferences thereof or otherwise serving on business of the
Council, shall be entitled to receive compensation at rates fixed by the
Secretary, but not exceeding $100 per day, including traveltime, and
while so serving away from their homes or regular places of business they
14
may be allowed travel expenses, including per diem in lieu of subsistence,
as authorized by section 5703 of title 5, United States Code, for persons in
Government service employed intermittently.
(d) The Council shall advise and assist the Secretary in the preparation
of regulations for, and as to policy matters arising with respect to, the
administration of this title. The Council shall consider all applications for
grants under this part and shall make recommendations to the Secretary
with respect to approval of applications for and the amounts of grants
under this part.
DEFINITIONS
SEC. 768. For purposes of this part-
oan
(1) the term "nonprofit" as. applied to any hospital or school of
medicine, means a school of medicine or hospital which is owned and
operated by one or more nonprofit corporations or associations, no
part of the net earnings of which inures, or may lawfully inure, to the
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benefit of any private shareholder or individual;
(2) the term "family medicine" means those certain principles and
techniques and that certain body of medical, scientific, administrative,
and other knowledge and training, which especially equip and prepare
a physician to engage in the practice of family medicine;
(3) the term "practice of family medicine" and the term "practice",
when used in connection with the term "family medicine", mean the
practice of medicine by a physician (licensed to practice medicine
and surgery by the State in which he practices his profession) who
specializes in providing to families (and members thereof) compre-
hensive, continuing, professional care and treatment of the type
necessary or appropriate for their general health maintenance; and
(4) the term "construction" includes construction of new buildings,
acquisition, expansion, remodeling,- and alteration of existing
buildings, and initial equipment of any such buildings, including
architects' fees, but excluding the cost of acquisition of land or offsite
improvements.
*
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*
TITLE III-GENERAL POWERS AND DUTIES OF PUBLIC
HEALTH SERVICE
PART A-RESEARCH AND INVESTIGATION
*
*
*
*
*
SEC. 310c. (a) In order to reduce the incidence of malnutrition in the
United States, to advance medical knowledge in the causes and effects of
malnutrition, and to encourage and facilitate the provision of early detec-
tion and effective treatment of malnutrition and the conditions which result
therefrom, the Secretary is authorized, out of funds available for carrying
out the purposes of this section, to:
(1) make grants-in-aid to and enter into contracts with medical
schools, appropriate graduate schools, and nursing schools to assist
such schools in establishing courses dealing with malnutrition, its
causes and effects, means for its early detection, and effective treat-
ment of malnutrition and conditions resulting therefrom;
15
(2) make grants-in-aid and enter into contracts with universities,
medical schools, hospitals, laboratories and other public or private
institutions, and individuals and groups of individuals for research
into malnutrition, its causes and effects, means for its detection, and
into the effective treatment of malnutrition and conditions resulting
therefrom;
(3) establish special projects designed to provide to students of
courses in malnutrition practical training and experience in the
field of malnutrition; and
(4) provide fellowships and otherwise financially assist students
to encourage and enable them to pursue studies and engage in activities
in poverty areas relating to malnutrition.
(b) In selecting schools and institutions to carry out the purposes
referred to in paragraphs (1) and (2) of subsection (a), priority shall be
accorded to those schools and institutions which are located in poverty
areas.
(c) For the purpose of carrying out the provisions of this section, there
are hereby authorized to be appropriated $32,000,000 for the fiscal year
commencing with the fiscal year ending June 30, 1971, and for each of
the next four fiscal years thereafter.
91sT CONGRESS
HOUSE OF REPRESENTATIVES
REPORT
2d Session
No. 91-1601
FORD
ASSISTANCE FOR PROFESSIONAL AND TECHNICAL
GERALD
TRAINING IN THE FIELD OF FAMILY MEDICINE
OCTOBER 13, 1970.-Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
Mr. PICKLE, from the Committee on Interstate and Foreign Commerce,
submitted the following
REPORT
[To accompany H.R. 19599]
The Committee on Interstate and Foreign Commerce, to whom was
referred the bill (H.R. 19599) to amend the Public Health Service
Act to provide for the making of grants to medical schools and
hospitals to assist them in establishing special departments and pro-
grams in the field of family practice, and otherwise to encourage and
promote the training of medical and paramedical personnel in the
field of family medicine, having considered the same, report favorably
thereon without amendment and recommend that the bill do pass.
PRINCIPAL PURPOSE OF LEGISLATION
The reported bill would provide for the establishment of training
programs at medical schools and teaching hospitals for the training
of medical students to serve as family physicians, and for the training
of auxiliary personnel to aid in the practice of family medicine.
HEARINGS: COST
Hearings were held before the Subcommittee on Public Health and
Welfare on September 29 and 30, and October 1, 1970. The bill was
considered in executive session by the Subcommittee on Public
Health and Welfare, and unanimously reported to the full committee,
which unanimously ordered the bill reported to the House. Similar
legislation (S. 3148) was considered by the Senate Labor and Public
Welfare Committee, and unanimously passed the Senate September
14, 1970.
The appropriation authorizations contained in the bill are: $50
million for fiscal year 1971, $75 million for fiscal year 1972, and $100
million for fiscal year 1973.
48-006-70-1
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assist the Secretary in the preparation of regulations for, and as to
EXPLANATION OF THE BILL
policy matters arising with respect to, the administration of the
l'amily medicine is a new specialty recently created by the medical
program. The Council shall consider all applications for grants under
profession to describe physicians formerly referred to as general
the program and shall make recommendations to the Secretary with
practitioners. The number of persons serving as general practitioners
respect to approval of applications for and of the amounts of grants.
has been steadily declining in recent years as a result of increased
ISSUES PRESENTED BY THE BILL
specialization in the medical profession. The purpose of this bill is to
attempt to halt this trend and possibly reverse it by encouraging
1. SEPARATE DEPARTMENTS OF FAMILY MEDICINE
medical students to take up family medicine for their professional
careers.
The committee heard a variety of points of view concerning the
The bill would authorize professional and technical training in
requirement in the bill that in order to be eligible for assistance a school
the field of family medicine. It would provide for the making of
of medicine (or osteopathy) must either have established or be in
grants to public and private nonprofit medical schools, including
the process of establishing a separate and coequal department of
schools of osteopathy to: (1) operate, as an integral part of their
family medicine. The committee feels the requirement is both sound
medical education program, separate and distinct departments
and necessary. It is persuaded by those who testified that unless such
devoted to providing teaching and instruction (including continuing
a requirement does in fact exist, there is little or no incentive for the
education) in all phases of family practice; (2) construct such facilities
already financially beleaguered schools of medicine to establish a new
as may be appropriate to carry out a program of training in the field
organizational entity.
of family medicine whether as a part of a medical school or as separate
outpatient or similar facility; (3) operate, or participate in, special
2. ROLE OF ADVISORY COUNCIL
training programs for paramedical personnel in the field of family
medicine; and (4) operate, or participate in, special training programs
The committee carefully considered the proposed role of the Ad-
to teach and train medical personnel to head departments of family
visory Council. Its consideration included the necessity that the Coun-
practice or otherwise teach family practice in medical schools.
cil be in a position to advise and assist the Secretary of Health, Edu-
It would further provide for grants to public and private nonprofit
cation, and Welfare on the issues of major policy which will inevitably
hospitals, which provide training programs for medical students, in-
arise as well as be able to make recommendations to him with regard to
terns, or residents to: (1) operate, as an integral part of their medical
the approval of request for grant assistance. At the same time the com-
training programs, special professional training programs (including
mittee is fully aware of the need to avoid the stultifying effect on pro-
continuing education) in the field of family medicine for medical
gram administration that might result from an overly zealous Council.
students, interns, residents, or practicing physicians; (2) construct
The committee believes that an appropriate balance between these
such facilities as may be appropriate to carry out a program of training
two positions can be found in the operation of the National Advisory
in the field of family medicine whether as a part of a hospital or as a
Council on Regional Medical Programs, established under title IX of
separate outpatient or similar facility; (3) provide financial assistance
the Public Health Service Act. Accordingly, it has reported language
(in the form of scholarships, fellowships, or stipends) to interns, resi-
for the Council on Family Medicine, which closely parallels that of the
dents, or other medical personnel who are in need thereof, who are
Regional Medical Programs Council. On so doing the committee
participants in a program of such hospital which provides special
intends that the Council herein established will function with respect
training (accredited by a recognized body or bodies approved for such
to policy formulation and grant review in essentially the same way as
purpose by the Commissioner of Education) in the field of family
the RMP Council has functioned.
medicine, and who plan to specialize or work in the practice of family
medicine; and (4) operate, or participate in, special training programs
3. PLANNING AND DEVELOPMENT GRANTS
for paramedical personnel in the field of family medicine.
For the purpose of assisting medical schools and hospitals to plan
The committee, while being strongly persuaded that a separate
or develop programs or projects for the purpose of carrying out one
and coequal department of family medicine is essential in order to
or more of the purposes set forth in title I of the bill, the Secretary
achieve the purposes of the bill, nevertheless well recognizes that most
of HEW is authorized to make planning and developmental grants.
medical schools do not yet have such departments, though many are
Not more than $5 million of funds appropriated in each fiscal year
or are about to begin planning for a separate department. Therefore,
may be utilized for these planning and development grants.
the committee has authorized planning and development grants in
The bill further provides that the Secretary shall appoint an
order to give assistance and encouragement to this trend.
Advisory Council on Family Medicine. The Council shall consist
of 12 members, four of whom shall be physicians engaged in the prac-
4. CONTINUING EDUCATION OF PHYSICIANS
tice of family medicine, four of whom shall be physicians engaged in
the teaching of family medicine, three of whom shall be representatives
The committee believes that the value of the specialty of family
of the general public and one of whom shall, at the time of his appoint-
medicine is by no means limited to the initial, graduate, or immediate
ment, be an intern in family medicine. The Council shall advise and
postgraduate training of physicians. In point of fact both educational
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5
and practical activities in the area of family medicine are highly
Based upon an approximate cost of $300,000 for estab-
relevant to the practicing physician. Accordingly, the committee has
lishing a department of family practice in a medical school
explicitly included continuing education activities as eligible for sup-
or teaching hospital, 40 medical schools and 130 hospitals
port under the bill.
could establish programs during the first year for which
funds are authorized. This would cost $51 million.
5. OSTEOPATHS AND SCHOOLS OF OSTEOPATHY
The cost of maintaining these programs would drop to
Osteopaths and schools of osteopathy have and are making a
$250,000 after the first year. Although construction costs will
significant contribution to family medicine through their patterns of
not exist after the first year, additional residents would be
practice and their curriculums. Their full participation in the programs
added to the programs, thereby making the net decrease in
authorized by this bill is both desirable and essential. Since the com-
funds only $50,000. To maintain the original 170 programs
mittee understands that HEW defines "schools of medicine" to
during the second year would cost $421/2 million. Twenty new
include schools of osteopathy for purposes of qualifying for grant
medical school programs and 80 new hospital programs could
assistance, the committee did not feel the necessity of identifying
be added the third year at a cost of $30 million. Total costs
them by name in the bill. Additionally, no specification of osteopaths
for the second year would be $72½ million.
was made with regard to the membership of the Advisory Council,
During the third year, it would cost $67½ million to main-
though clearly there are many eminent osteopaths whose contribution
tain the 270 existing programs. Fifteen new medical school
to the Council would be invaluable.
programs and 90 new hospital programs could be added the
third year at a cost of $31½ million. Total costs for the year
would be $99 million.
6. MAINTENANCE OF EFFORT
The committee intends that the proposed section 765(c) which
AGENCY REPORTS
states "The Secretary shall not approve any grant under this part
unless the applicant therefore provide assurances satisfactory to the
The reported bill is a clean bill, introduced after the conclusion of
Secretary that funds made available through such grant will be SO used
the hearings, and therefore no agency reports have been received on
as to supplement and, to the extent practical, increase the level of
the bill. Reports on H.R. 15793 and H.R. 13063, however, deal with
non-Federal funds which would, in the absence of such grant, be made
the subject matters covered by the bill, and are therefore set forth
available for the purpose for which such grant is requested" shall not
below:
be constructed so as to exclude the hospitals of the Veterans' Adminis-
EXECUTIVE OFFICE OF THE PRESIDENT,
tration, the Public Health Service or other Federal agencies from
OFFICE OF MANAGEMENT AND BUDGET,
competing for such grants when they meet all other requirements
Washington, D.C., July 9, 1970.
under the bill.
Hon. HARLEY O. STAGGERS,
7. CONSTRUCTION OF FACILITIES
Chairman, Committee on Interstate and Foreign Commerce, House of
Representatives, Rayburn House Office Building, Washington, D.C.
The bill includes authority for the construction of facilities appro-
DEAR MR. CHAIRMAN: This is in response to your request for the
priate to training programs in family medicine whether as a part of
views of the Office of Management and Budget on H.R. 15793, a bill
a medical school, hospital, separate outpatient facility, or similar
to amend the Public Health Service Act to provide for the making
facility. The committee encourages the use of this authority in inno-
of grants to medical schools and hospitals to assist them in estab-
vative and experimental ways. For example, a medical school or
lishing special departments and programs in the field of family
hospital might wish to construct a facility in an area of severe economic
practice, and otherwise to encourage and promote the training of
blight, regardless of its immediate proximity to that medical school
medical and paramedical personnel in the field of family medicine.
or hospital, in order to provide training in family medicine while
In a report being furnished to your committee, the Department of
providing high quality services.
Health, Education, and Welfare states its reasons for recommending
against the enactment of H.R. 15793.
JUSTIFICATION OF COSTS
We concur in the views of the Department of Health, Education,
and Welfare, and, accordingly, recommend that your committee not
During the hearings, Dr. Edward J. Kowalewski, president of the
give favorable consideration to H.R. 15793.
American Academy of General Practice, stated with respect to the
Sincerely,
authorizations contained in the reported bill, as follows:
WILFRED H. ROMMEL,
I would now like to touch upon the amount of funds which
Assistant Director for Legislative Reference.
would be authorized by these bills. I should preface my
remarks with the statement that the figures which I will be
using are estimates which are subject to many variables in
different situations.
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6
Methods of achieving the goal of personalized and unfragmented
DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE.
care for each individual-including not only diagnosis and treatment
OFFICE OF THE SECRETARY.
of illness but also preventive and rehabilitative services-are in a state
Washington, D.C., July 7, 1970.
of experimentation and change. A variety of terms is used to describe
Hon. HARLEY O. STAGGERS,
the kind of care or practice, or the type of practitioner, that is wanted:
Chairman, Committee on Interstate and Foreign Commerce, House of
family practice, general practice, personal medicine, primary care,
Representatives, Washington, D.C.
first-contact physician, generalist, comprehensive medical care.
DEAR MR. CHAIRMAN: This letter is in response to your request of
A number of schools of medicine and osteopathy and their teaching
February 13, 1970, for a report on H.R. 15793, a bill to amend the
hospitals have used, or have indicated their intention to use, at least
Public Health Service Act to provide for the making of grants to
a portion of their formula grants or their special project grants under
medical schools and hospitals to assist them in establishing special
the health professions educational assistance program to support the
departments and programs in the field of family practice, and other-
teaching of continuity, primary, or family-oriented care through a
wise to encourage and promote the training of medical and para-
variety of means. Some schools are gearing their entire educational
medical personnel in the field of family medicine.
program to the production of family physicians; some are establishing
The bill would authorize a new 5-year program of grants to medical
separate departments of family practice or family medicine; others are
schools—
developing family practice or "primary care" programs on an inter-
(1) To operate separate departments devoted to teaching and
departmental basis.
instruction in all phases of family practice;
Among the medical schools that have been awarded special project
(2) To construct facilities appropriate to carry out family
grants for expansion of enrollment (including physician augmentation
practice training programs whether as a part of a medical school
projects) under the health professions educational assistance program,
or as a separate outpatient or similar facility;
a number will give additional emphasis to the teaching of family
(3) To operate or participate in special training programs for
medicine in the course of achieving the goal of increased output.
paramedical personnel in the field of family medicine; and
The health professions educational assistance program has aided in
(4) To operate or participate in special training programs for
the construction of facilities for all teaching purposes in medical
medical personnel to head departments of family practice or
schools including their affiliated hospitals. We are trying to remove
otherwise teach family practice in medical schools.
artificial barriers to sound planning and construction of the institution
The bill would also authorize grants to public or private nonprofit
as a whole, rather than create them through categorical construction
hospitals which train medical students, interns, or residents—
aid.
(1) To operate special professional training programs in family
Several other legislative authorities already exist under which activ-
medicine for medical students, interns, or residents;
ities related to the field of family medicine as contemplated under
(2) To construct facilities appropriate to carry out these pro-
H.R. 15793 may be aided. Authority for Federal support of training of
grams whether as part of a hospital or as a separate outpatient or
physician assistants and other new types of paramedical personnel
similar facility;
exists under the allied health professions personnel training authority
(3) To provide scholarships, fellowships, or stipends to interns,
for developmental grants (sec. 794, Public Health Service Act) and
residents, or other medical personnel in need of such assistance,
under the new health professions educational assistance special project
who are participants in accredited training programs in the field
grant authority which went into effect July 1, 1969.
of family medicine and who plan to specialize or work in the
A number of projects involving the preparation of nurses to play a
practice of family medicine; and
role in the provision of family-oriented medical care have been con-
(4) To operate or participate in special programs for training
ducted under nurse training and public health training authorities.
paramedical personnel in the field of family medicine.
These have included, among others, projects to plan and evaluate
For the purpose of making the grants to medical schools and to
experimental training programs for such clinical nursing specialists as
hospitals, the bill would authorize appropriations of $50 million for
pediatric nurse practitioners.
fiscal year 1971, $75 million for fiscal year 1972, and $100 million
The Hill-Burton medical facilities construction program provides
each for fiscal years 1973, 1974, and 1975.
support for the construction and modernization of private, nonprofit
We are in full accord with the objective of encouraging and promot-
medical facilities, including ambulatory care facilities of the type re-
ing the training of physicians and paramedical personnel to help to
quired for family medicine teaching programs.
meet the needs of each patient for personalized and unfragmented
At the level of internship and residency training, concern for the
care for all of his health needs as an individual in a particular family
need for more training in the provision of personalized or family-
in a given community at a particular time. At a time of increasing
oriented continuing medical care is reflected in the recent creation of
specialization and with a variety of types of personnel and facilities
family practice as a new medical specialty. There is pressure also for
often contributing to the care of a single patient, educational pro-
increased emphasis on training in continuous, comprehensive patient
grams for health manpower at all levels must emphasize this aspect
care in other specialty training programs such as internal medicine,
of training.
pediatrics, and obstetrics. The costs of interns' and residents' salaries
8
9
(and to a somewhat lesser extent, teaching costs for these training
programs) now are met largely out of payments for services, including
Under the existing program, two types of improvement grants, that
reimbursements for care under medicare and medicaid.
is, basic institutional and special project grants, may be made to schools
In view of the evolving character of the concept of family medicine,
of medicine. Basic institutional grants are formula grants based on
there are advantages to aiding activities in this field under broad,
student enrollment and may be used for any purpose, other than those
flexible legislative authorities such as those contained in the Health
prohibited by regulations, which each school determines will most
Professions Educational Assistance Act. This type of authority permits
effectively advance the quality of its educational program. Special
the support of alternative approaches to training in the provision of
project grants are to be used among other things in meeting the cost
comprehensive and continuing care to individuals and families, pend-
of special projects to plan, develop, and establish new programs or
ing further evaluation of the various mechanisms for educating
modifications of existing programs of education.
personnel and organizing medical services in this field. It also allows
The proposed program in the area of family medicine could possibly
aid for training in family medicine to be provided in conjunction with
be undertaken under the existing program. Therefore, the committee
aid directed toward another purpose such as expansion of enrollment
may wish to consider the relationship of the grants to be authorized
of medical schools.
under this bill to the grant programs already authorized under part E
of title VII.
The health professions educational assistance authority is due to
expire on June 30, 1971. Because of the close relationship between the
It is not clear from the language in the proposed section 761 whether
family medicine activities proposed in the instant bill and the health
or not it was intended that grant funds could be made available to
professions educational assistance programs, we recommend that
finance the construction of facilities. We believe that the language of
action on that bill be deferred until the recommendations on the
the bill should be clarified in this respect by substituting the word
Health Professions Educational Assistance Act have been completed.
"construction" for "development" in line 10, page 2. We note that
In any event, however, we would strongly oppose the enactment of
part B of title VII of the Public Health Service Act already authorizes
another categorical grant authority, such as that embodied in the
a program of grants to medical schools for construction and initial
bill, which would duplicate authorities or mechanisms already existing
equipping of teaching facilities for medical personnel.
to achieve the purpose of this legislation.
The bill does not provide for a review of grant applications by a
We are advised by the Office of Management and Budget that there
National Advisory Council. The legislation authorizing the previously
is no objection to the presentation of this report from the standpoint
cited program, and most other grant programs administered by the
of the administration's program.
National Institutes of Health, require the Secretary of HEW to
Sincerely,
consult. with a National Advisory Council before approving or dis-
ELLIOT L. RICHARDSON, Secretary.
approving any grant application. The committee may wish to provide
a similar requirement in this bill.
The proposed part D does not contain an access to records and audit
authority for the Comptroller General of the United States. We rec-
COMPTROLLER GENERAL OF THE UNITED STATES,
ommend that the bill be amended to include such authority. This
Washington, D.C., September 4, 1969.
could be accomplished by omitting the proposed subsection 762(c)(4)
B-74254.
and substituting the following language:
Hon. HARLEY O. STAGGERS,
"(4) Each recipient of assistance under this part shall keep such
Chairman, Committee on Interstate and Foreign Commerce, House of
records as the Secretary of Health, Education, and Welfare shall pre-
Representatives.
scribe, including records which fully disclose the amount and disposi-
DEAR MR. CHAIRMAN: By letter dated July 25, 1969, you requested
tion by such recipient of the proceeds of such assistance, the total
our comments on H.R. 13063, a bill to amend the Public Health Serv-
cost of the project or undertaking in connection with which such
ice Act to provide grants to develop training in family medicine.
assistance is given or used, and the amount of that portion of the
The bill would authorize funds to be appropriated over a 3-year
cost of the project or undertaking supplied by other sources, and such
period for grants to medical schools to assist in meeting the costs of
other records as will facilitate an effective audit;
special projects to plan, develop, or establish new programs or modifi-
"(5) The Secretary of Health, Education, and Welfare and the
cations of existing programs of education in the field of family medi-
Comptroller General of the United States, or any of their duly
cine, and including the development and equipment of appropriate
authorized representatives, shall have access for the purpose of audit
facilities.
and examination to any books, documents, papers, and records of the
We note that the proposed program is similar in many respects to an
recipients that are pertinent to the assistance received under this part."
existing grant program administered by the Department of Health,
Similar provisions are contained in various acts relating to health
Education, and Welfare (HEW), which.is authorized under part E of
programs. See sections 280b-11(b), 291d(11), 299i(b), 2697(b), and
title VII of the Public Health Service Act under the caption "Grants
2956-5 of title 42, United States Code.
To Improve the Quality of Schools of Medicine, Dentistry, Osteopathy,
Under section 202 of the Integovernmental Cooperation Act of
Optometry, and Podiatry."
1968, Public Law 90-577, 82 Stat. 1101, the Comptroller General and
heads of Federal agencies have access to records pertaining to grants-
10
11
in-aid received by the States. However, section 202 does not cover
similar construction in the locality as determined by the Secretary
political subdivisions of States or beneficiaries other than States,
of Labor in accordance with the Davis-Bacon Act, as amended
which are grant recipients.
Sincerely yours,
(40 U.S.C. 276a-276a-5); and the Secretary of Labor shall have,
with respect to the labor standards specified in the clause (D) the
R. F. KELLER
authority and functions set forth in Reorganization Plan Num-
(For the Comptroller General of the United States).
bered 14 of 1950 (15 F.R. 3176; 5 U.S.C. 133z-15), and section
CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED
2 of the Act of June 13, 1934, as amended (40 U.S.C. 276c).
[(b) In acting on applications for grants, the Surgeon General
In compliance with clause 3 of rule XIII of the Rules of the House
shall take into consideration the relative effectiveness of the
of Representatives, changes in existing law made by the bill, as re-
proposed facilities in expanding the Nation's capacity for research
ported, are shown as follows (existing law proposed to be omitted is
and related purposes in the field of mental retardation and related
enclosed in black brackets, new matter is printed in italics, existing
aspects of human development, and such other factors as he, after
law in which no change is proposed is shown in roman):
consultation with the national advisory council or councils con-
cerned with the field or fields of research involved, may by regulation
PART D OF TITLE VII OF THE PUBLIC HEALTH SERVICE Act
prescribe in order to assure that the facilities constructed with such
grants, severally and together, will best serve the purpose of ad-
[PART D-CENTERS FOR RESEARCH ON MENTAL RETARDATION AND
vancing scientific knowledge pertaining to mental retardation and
RELATED ASPECTS OF HUMAN DEVELOPMENT
related aspects of human development.
[authorization OF APPROPRIATIONS
[AMOUNT OF GRANTS; PAYMENTS
[SEC. 761. There are authorized to be appropriated $6,000,000 for
[SEC. 763. (a) The total of the grants with respect to any project
the fiscal year ending June 30, 1964, $8,000,000 for the fiscal year
for the construction of a facility under this part may not exceed
ending June 30, 1965, and $6,000,000 each for the fiscal year ending
75 per centum of the necessary cost of construction of the center
June 30, 1966, and the fiscal year ending June 30, 1967, for project
as determined by the Surgeon General.
grants to assist in meeting the costs of construction of facilities for
(b) Payments of grants under this part shall be made in advance
research or research and related purposes, relating to human develop-
or by way of reimbursement, in such installments consistent with con-
ment, whether biological, medical, social, or behavioral, which may
struction progress, and on such conditions as the Surgeon General may
assist in finding the causes, and means of prevention, of mental
determine.
retardation, or in finding means of ameliorating the effects of mental
[(c) No grant may be made after January 1, 1964, under any pro-
retardation. Sums so appropriated shall remain available until ex-
vision of this Act other than this part, for any of the four fiscal years in
pended for payments with respect to projects for which applications
the period beginning July 1, 1963, and ending June 30, 1967, for con-
have been filed under this part before July 1, 1967, and approved by
struction of any facility described in this part, unless the Surgeon
the Surgeon General thereunder before July 1, 1968.
General determines that funds are not available under this part to
make a grant for the construction of such facility.
[APPLICATIONS
[RECAPTURE OF PAYMENTS
[SEC. 762. (a) Applications for grants under this part with respect
to any facility may be approved by the Surgeon General only if-
[SEC. 764. If, within twenty years after completion of any construc-
[(1) the applicant is a public or nonprofit institution which
tion for which funds have been paid under this part-
the Surgeon General determines is competent to engage in the
[(1) the applicant or other owner of the facility shall cease to
type of research for which the facility is to be constructed; and
be a public or nonprofit institution, or
[(2) the application contains or is supported by reasonable
[(2) the facility shall cease to be used for the research pur-
assurances that (A) for not less than twenty years after comple-
poses, or research and related purposes, for which it was construc-
tion of construction, the facility will be used for the research, or
ted, unless the Surgeon General determines, in accordance with
research and related purposes, for which it was constructed;
regulations, that there is good cause for releasing the applicant or
(B) sufficient funds will be available for meeting the non-
other owner from the obligation to do so,
Federal share of the cost of constructing the facility; (C) sufficient
the United States shall be entitled to recover from the applicant or
funds will be available, when the construction is completed, for
other owner of the facility the amount bearing the same ratio to the
effective use of the facility for the research, or research and
then value (as determined by agreement of the parties or by action
related purposes, for which it was constructed; and (D) all
brought in the United States district court for the district in which
laborers and mechanics employed by contractors or subcontrac-
such facility is situated) of the facility, as the amount of the Federal
tors in the performance of work on construction of the center
participation bore to the cost of construction of such facility.
will be paid wages at rates not less than those prevailing on
12
13
[noninterference WITH ADMINISTRATION OF INSTITUTIONS
personnel who are in need thereof, who are participants in a program
[SEC. 765. Except as otherwise specifically provided in this part,
of such hospital which provides special training (accredited by a
nothing contained in this part shall be construed as authorizing any
recognized body or bodies approved for such purpose by the Com-
department, agency, officer, or employee of the United States to
missioner of Education) in the field of family medicine, and who
exercise any direction, supervision, or control over, or impose any
plan to specialize or work in the practice of family medicine; and
requirement or condition with respect to, the research or related pur-
(4) to operate, or participate in, special training programs for
institution. poses conducted by, and the personnel or administration of, any
paramedical personnel in the field of family medicine.
[DEFINITIONS
AUTHORIZATION OF APPROPRIATIONS
[SEC. 766. As used in this part-
SEC. 762. (a) For the purpose of making grants to carry out the
[(1) the terms "construction" and "cost of construction"
purposes of this part, there are authorized to be appropriated $50,000,000
include (A) the construction of new buildings and the expansion,
for the fiscal year ending June 30, 1971, $75,000,000 for the fiscal year
remodeling, and alteration of existing buildings, including
ending June 30, 1972, and $100,000,000 for the fiscal year ending
architects' fees, but not including the cost of acquisition of land
June 30, 1973, and for each of the next two succeeding fiscal years.
or off-site improvements, and (B) equipping new buildings and
(b) Sums appropriated pursuant to subsection (a) for any fiscal year
altered; existing buildings, whether or not expanded, remodeled, or
shall remain available for the purpose for which appropriated until the
close of the fiscal year which immediately follows such year.
[(2) the term "nonprofit institution" means an institution
owned and operated by one or more corporations or associations
GRANTS BY SECRETARY
no part of the net earnings of which inures, or may lawfully
inure, to the benefit of any private shareholder or individual.]
SEC. 763. (a) From the sums appropriated pursuant to section 762,
the Secretary 18 authorized to make grants, in accordance with the provi-
PART D-GRANTS To PROVIDE PROFESSIONAL AND TECHNICAL
sions of this part, to carry out the purposes of section 761.
TRAINING IN THE FIELD OF FAMILY MEDICINE
(b) No grant shall be made under this part unless an application
therefor has been submitted to, and approval by, the Secretary. Such
DECLARATION OF PURPOSE
application shall be in such form, submitted in such manrer, and contain
such information as the Secretary shall have prescribed by regulations
SEC. 761. It is the purpose of this part to provide for the making of
which have been promulgated by him and published ir the Federal Register
grants to assist-
not later than six months after the date of enactment of this part.
(a) public and private nonprofit medical schools-
(c) Grants under this part shall be in such amounts and subject to such
(1) to operate, as an integral part of their medical education
limitations and conditions as the Secretary may determine to be proper
program, separate and distinct departments devoted to providing
to carry out the purposes of this part.
teaching and instruction in all phases of family practice;
(d) In the case of any application for a grant any part of which is to be
(2) to construct such facilities as may be appropriate to carry
used for major construction or remodeling of any facility, the Secretary
out a program of training in the field of family medicine whether as
shall not approve the part of the grant which is to be so used unless the
facility; a part of a medical school or as separate outpatient or similar
recipient of such grant enters into appropriate arrangements with the
Secretary which will equitably protect the financial interests of the United
(3) to operate, or participate in, special training programs for
States in the event such facility ceases to be used for the purpose for which
paramedical personnel in the field of family medicine; and
such grant or part thereof was made prior to the expiration of the twenty-
(4) to operate, or participate in, special training programs to
year period which commences on the date such construction or remodeling
teach and train medical personnel to head departments of family
as completed.
practice or otherwise teach family practice in medical schools.
(e) Grants made under this part shall be used only for the purpose for
(b) public and private nonprofit hospitals which provide training pro-
which made and may be paid in advance or by way of reimbursement, and
grams for medical students, interns, or residents-
in such installments as the Secretary may determine.
(1) to operate, as an integral part of their medical training pro-
grams, special professional training programs in the field of family
ELIGIBILITY FOR GRANTS
medicine for medical students, interns, or residents;
(2) to construct such facilities as may be appropriate to carry out
SEC. 764. (a) In order for any medical school to be eligible for a grant
a program of training in the field of family medicine whether as a
under this part, such school-
part of a hospital or as a separate outpatient or similar facility;
(1) must be a public or other nonprofit school of medicine, and
(3) to provide financial assistance (in the form of scholarships,
(2) must be accredited as a school of medicine by a recognized body
fellowships, or stipends) to interns, residents, or other medical
or bodies approved for such purpose by the Commissioner of Educa-
tion, except that the requirements of this clause (2) shall be deemed
14
15
to be satisfied, if (A) in the case of a school of medicine which by
reason of no, or an insufficient, period of operation is not, at the
(1) a school of medicine to establish or operate a separate depart-
time of application for a grant under this part, eligible for such
ment devoted to the teaching of family medicine unless the Secretary
accreditation, the Commissioner finds, after consultation with the
is satisfied that-
appropriate accreditation body or bodies, that there is reasonable
(A) such department is (or will be, when established) of egual
assurance that the school will meet the accreditation standards of such
standing with the other departments within such school which
body or bodies prior to the beginning of the academic year following
are devoted to the teaching of other medical specialty disciplines;
the normal graduation date of students who are in their first year of
(B) such department will, in terms of the subjects offered and
instruction at such school during the fiscal year in which the Secre-
the type and quality of instruction provided, be designed to
tary makes a final determination as to approval of the application.
prepare students thereof to meet the standards established for
(b) In order for any hospital to be eligible for a grant under this part,
specialists in the specialty of family practice by a recognized
such hospital-
body approved by the Commissioner of Education; or
(1) must be a public or private nonprofit hospital; and
(2) a hospital to establish or operate a special program for medical
(2) must conduct or be prepared to conduct in connection with its
students, interns, or residents in the field of family medicine unless
other activities (whether or not as an affiliate of a school of medicine)
the Secretary is satisfied that such program will, in terms of the type
of training provided, be designed to prepare participants therein to
one or more programs of medical training for medical students,
interns, or residents, which is accredited by a recognized body or
meet the standards established for specialists in the field of family
bodies. approved for such purpose by the Commissioner of Education.
medicine by a recognized body approved by the Commissioner of
Education.
(c) The Secretary shall not approve any grant under this part unless
APPROVAL OF GRANTS
the applicant therefor provides assurances satisfactory to the Secretary
SEC. 765. (a) A grant under this part may be made only if the applica-
that funds made available through such grant will be 80 used as to supple-
tion thereof is recommended for approval by the Advisory Council on
ment and, to the extent practical, increase the level of non-Federal funds
that- Family Medicine and is approved by the Secretary upon his determination
which would, in the absence of such grant, be made available for the
purpose for which such grant is requested.
(1) the applicant meets the eligibility requirements set forth in
section 764;
PLANNING GRANTS
(2) the applicant has complied with the requirements of section 763;
(3) the grant is to be used for one or more of the purposes set forth
SEC. 766. (a) For the purpose of assisting medical schools and hospitals
in section 761;
(referred to in section 761) to plan projects for the purpose of carrying
(4) it contains such information as the Secretary may require to
out one or more of the purposes set forth in such section, the Secretary is
make the determinations required of him under this section and such
authorized for any fiscal year (prior to the fiscal year which ends June
30, 1975) to make planning grants in such amounts and subject to such
part; assurances as he may find necessary to carry out the purposes of this
conditions as the Secretary may determine to be proper to carry out the
(5) it provides for such fiscal control and accounting procedures
purposes of this section.
and reports, and access to the records of the applicant, as the Secretary
(b) From the amounts appropriated in any fiscal year (prior to the
may require (pursuant to regulations which shall have been promul-
fiscal year ending June 30, 1975) pursuant to section 762(a), the Secre-
gated by him and published in the Federal Register) to assure proper
tary may utilize such amounts as he deems necessary (but not in excess of
disbursement of and accounting for all Federal funds paid to the
$5,000,000 for any fiscal year) to make the planning grants authorized
applicant under this part; and
by subsection (a).
(6) the application contains or is supported by adequate assurance
that any laborer or mechanic employed by any contractor or sub-
ADVISORY COUNCIL ON FAMILY MEDICINE
contractor in the performance of work on the construction of the
SEC. 767. (a) The Secretary shall appoint an Advisory Council on
facility will be paid wages at rates not less than those prevailing on
Family Medicine (hereinafter in this section referred to as the "Council").
similar construction in the locality as determined by the Secretary of
The Council shall consist of twelve members, four of whom shall be physi-
Labor in accordance with the Davis-Bacon Act, as amended (40
cians engaged in the practice of family medicine, four of whom shall be
U.S.C. 276a-276a5). The Secretary of Labor shall have, with respect
physicians engaged in the teaching of family medicine, three of whom
to the labor standards specified in this paragraph, the authority and
shall be representatives of the general public, and one of whom shall, at
functions set forth in Reorganization Plan Numbered 14 of 1950
the time of his appointment, be an intern in family medicine. Members of
(15 F.R., 3176; 65 Stat. 1267), and section 2 of the Act of June 13,
the Council shall be individuals who are not otherwise in the regular full-
1934, as amended (40 U.S.C. 276c).
(b) The Secretary shall not approve any grant to-
time employ of the United States.
(b) (1) Except as provided in paragraph (2), each member of the Council
shall hold office for a term of four years, except that any member appointed
16
to fill a vacancy prior to the expiration of the term for which his pred-
ecessor was appointed shall be appointed for the remainder of such
term, and except that the terms of office of the members first taking office
shall expire, as designated by the Secretary at the time of appointment,
three at the end of the first year, three at the end of the second year, three
at the end of the third year, and three at the end of the fourth year, after
the date of appointment.
(2) The member of the Council appointed as an intern in family medi-
cine shall serve for one year.
(3) A member of the Council shall not be eligible to serve continuously
for more than two terms.
(c) Members of the Council shall be appointed by the Secretary without
regard to the provisions of title 5, United States Code, governing appoint-
ments in the competitive service. Members of the Council, while attending
meetings or conferences thereof or otherwise serving on business of the
Council, shall be entitled to receive compensation at rates fixed by the
Secretary, but not exceeding $100 per day, including traveltime, and while
so serving away from their homes or regular places of business they may be
allowed travel expenses, including per diem in lieu of subsistence, as
authorized by section 5703 of title 5, United States Code, for persons in
Government service, employed intermittently.
(d) The Council shall advise and assist the Secretary in the preparation
of regulations for, and as to policy matters arising with respect to, the
administration of this title. The Council shall consider all applications
for grants under this part and shall make recommendations to the Secretary
with respect to approval of applications for grants under this part.
DEFINITIONS
SEC. 768. For purposes of this part-
(1) the term "nonprofit" as applied to any hospital or school of
medicine means a school of medicine or hospital which is owned and
operated by one or more nonprofit corporations or associations, no
part of the net earnings of which inures, or may lawfully inure, to
the benefit of any private shareholder or individual;
(2) the term "family medicine" means those certain principles
and techniques and that certain body of medical, scientific, adminis-
trative, and other knowledge and training, which especially equip
and prepare a physician to engage in the practice of family medicine;
(3) the term "practice of family medicine" and the term "prac-
tice," when used in connection with the term "family medicine",
mean the practice of medicine by a physician (licensed to practice
medicine and surgery by the State in which he practices his profes-
sion) who specializes in providing to families (and members thereof)
comprehensive, continuing, professional care and treatment of the
type necessary or appropriate for their general health maintenance;
and
(4) the term "construction" includes construction of new buildings,
acquisition, expansion, remodeling, and alteration of existing build-
ings, and initial equipment of any such buildings, including archi-
tects' fees, but excluding the cost of acquisition of land or offsite
improvements.
91sT CONGRESS
}
HOUSE OF REPRESENTATIVES
REPORT
2d Session
No. 91-1668
TRAINING OF FAMILY PHYSICIANS
DECEMBER 3, 1970.-Ordered to be printed
BERALD FORD LIBRARY
Mr. STAGGERS, from the committee of conference
submitted the following
CONFERENCE REPORT
[To accompany S. 3418]
The committee of conference on the disagreeing votes of the two
Houses on the amendments of the House to the bill (S. 3418) to
amend the Public Health Service Act to provide for the making of
grants to medical schools and hospitals to assist them in establishing
special departments and programs in the field of family practice, and
otherwise to encourage and promote the training of medical and
paramedical personnel in the field of family medicine, and to alleviate
the effects of malnutrition, and to provide for the establishment of a
National Information and Resource Center for the Handicapped,
having met, after full and free conference, have agreed to recommend
and do recommend to their respective Houses as follows:
That the Senate recede from its disagreement to the amendment of
the House to the text of the bill and agree to the same with an amend-
ment as follows:
In lieu of the matter proposed to be inserted by the House amend-
ment insert the following:
TITLE I-FAMILY MEDICINE
SEC. 101. Part D of title VII of the Public Health Service Act is
amended to read as follows:
"PART D-GRANTS To PROVIDE PROFESSIONAL AND TECHNICAL
TRAINING IN THE FIELD OF FAMILY MEDICINE
"DECLARATION OF PURPOSE
"SEC. 761. It is the purpose of this part to provide for the making of
grants to assist-
48-006
2
3
"(1) public and private nonprofit medical schools-
"(c) Grants under this part shall be in such amounts and subject to
"(A) to operate, as an integral part of their medical education
such limitations and conditions as the Secretary may determine to be
program, separate and distinct departments devoted to providing
proper to carry out the purposes of this part.
teaching and instruction (including continuing education) in all
"(d) In the case of any application for a grant any part of which is to
phases of family practice;
be used for major construction or remodeling of any facility, the Secretary
"(B) to construct such facilities as may be appropriate to carry
shall not approve the part of the grant which is to be so used unless the
out a program of training in the field of family medicine whether as a
recipient of such grant enters into appropriate arrangements with the
part of a medical school or as separate outpatient or similar facility;
Secretary which will equitably protect the financial interests of the United
"(C) to operate, or participate in, special training programs for
States in the event such facility ceases to be used for the purpose for which
paramedical personnel in the field of family medicine; and
such grant or part thereof was made prior to the expiration of the twenty-
"(D) to operate, or participate in, special training programs to
year period which commences on the date such construction or remodeling
teach and train medical personnel to head departments of family
is completed.
practice or otherwise teach family practice in medical schools; and
"(e) Grants made under this part shall be used only for the purpose
"(2) public and private nonprofit hospitals which provide training
for which made and may be paid in advance or by way of reimbursement,
programs for medical students, interns, or residents-
and in such installments, as the Secretary may determine.
"(A) to operate, as an integral part of their medical training pro-
grams, special professional training programs (including continuing
"ELIGIBILITY FOR GRANTS
education) in the field of family medicine for medical students,
interns, residents, or practicing physicians;
"SEC. 764. (a) In order for any medical school to be eligible for a
"(B) to construct such facilities as may be appropriate to carry
grant under this part, such school-
out a program of training in the field of family medicine whether as
"(1) must be a public or other nonprofit school of medicine; and
a part of a hospital or as a separate outpatient or similar facility;
"(2) must be accredited as a school of medicine by a recognized
"(C) to provide financial assistance (in the form of scholarships,
body or bodies approved for such purpose by the Commissioner of
fellowships, or stipends) to interns, residents, or other medical
Education, except that the requirements of this clause shall be
personnel who are in need thereof, who are participants in a program
deemed to be satisfied, if (A) in the case of a school of medicine
of such hospital which provides special training (accredited by a
which by reason of no, or an insufficient, period of operation is not,
recognized body or bodies approved for such purpose by the Com-
at the time of application for a grant under this part, eligible for such
missioner of Education) in the field of family medicine, and who
accreditation, the Commissioner finds, after consultation with the
plan to specialize or work in the practice of family medicine; and
appropriate accreditation body or bodies, that there is reasonable
"(D) to operate, or participate in, special training programs for
assurance that the school will meet the accreditation standards of such
paramedical personnel in the field of family medicine.
body or bodies prior to the beginning of the academic year following
the normal graduation date of students who are in their first year of
"AUTHORIZATION OF APPROPRIATIONS
instruction at such school during the fiscal year in which the Secretary
makes a final determination as to approval of the application.
"SEC. 762. (a) For the purpose of making grants to carry out the
"(b) In order for any hospital to be eligible for a grant under this
purposes of this part, there are authorized to be appropriated $50,000,000
part, such hospital-
for the fiscal year ending June 30, 1971, $75,000,000 for the fiscal year
"(1) must be a public or private nonprofit hospital; and
ending June 30, 1972, and $100,000,000 for the fiscal year ending June 30,
"(2) must conduct or be prepared to conduct in connection with
1973.
its other activities (whether or not as an affiliate of a school of medi-
"(b) Sums appropriated pursuant to subsection (a) for any fiscal
cine) one or more programs of medical training for medical students,
year shall remain available for the purpose for which appropriated until
interns, or residents, which is accredited by a recognized body or
the close of the fiscal year which immediately follows such year.
bodies, approved for such purpose by the Commissioner of Education.
"GRANTS BY SECRETARY
"APPROVAL OF GRANTS
"SEC. 763. (a) From the sums appropriated pursuant to section 762,
"Sec. 765. (a) The Secretary, upon the recommendation of the
the Secretary is authorized to make grants, in accordance with the pro-
Advisory Council on Family Medicine, is authorized to make grants
visions of this part, to carry out the purposes of section 761.
under this part upon the determination that-
"(b) No grant shall be made under this part unless an application
"(1) the applicant meets the eligibility requirements set forth in
therefor has been submitted to, and approved by, the Secretary. Such
section 764;
application shall be in such form, submitted in such manner, and contain
"(2) the applicant has complied with the requirements of section
such information, as the Secretary shall have prescribed by regulations
763;
which have been promulgated by him and published in the Federal Register
"(3) the grant is to be used for one or more of the purposes set
not later than six months after the date of enactment of this part.
forth in section 761;
H. Rept. 91-1668
H. Rept. 91-1668
4
5
"(4) it contains such information as the Secretary may require to
in such section, the Secretary is authorized for any fiscal year (prior to
make the determinations required of him under this section and such
the fiscal year which ends June 30, 1973) to make planning and develop-
assurances as he may find necessary to carry out the purposes of
mental grants in such amounts and subject to such conditions as the
this part;
Secretary may determine to be proper to carry out the purposes of this
"(5) it provides for such fiscal control and accounting procedures
section.
and reports, and access to the records of the applicant, as the Secre-
"(b) From the amounts appropriated in any fiscal year (prior to the
tary may require (pursuant to regulations which shall have been
fiscal year ending June 30, 1973) pursuant to section 762(a), the Secre-
promulgated by him and published in the Federal Register) to assure
tary may utilize such amounts as he deems necessary (but not in excess
proper disbursement of and accounting for all Federal funds paid
of $8,000,000 for any fiscal year) to make the planning and develop-
to the applicant under this part; and
mental grants authorized by subsection (a).
"(6) the application contains or is supported by adequate assurance
that any laborer or mechanic employed by any contractor or subcon-
"ADVISORY COUNCIL ON FAMILY MEDICINE
tractor in the performance of work on the construction of the facility
will be paid wages at rates not less than those prevailing on similar
"SEC. 767. (a) The Secretary shall appoint an Advisory Council on
construction in the locality as determined by the Secretary of Labor
Family Medicine (hereinafter in this section referred to as the 'Council').
in accordance with the Davis-Bacon Act, as amended (40 U.S.C.
The Council shall consist of twelve members, four of whom shall be
276a-276a5). The Secretary of Labor shall have, with respect to
physicians engaged in the practice of family medicine, four of whom shall
the labor standards specified in this paragraph, the authority and
be physicians engaged in the teaching of family medicine, three of whom
functions set forth in Reorganization Plan Numbered 14 of 1950
shall be representatives of the general public, and one of whom shall, at the
(15 F.R. 3176; 65 Stat. 1267), and section 2 of the Act of June 13,
time of his appointment, be an intern in family medicine. Members of the
Council shall be individuals who are not otherwise in the regular full-time
1934, as amended (40 U.S.C. 276c).
"(b) The Secretary shall not approve any grant to-
employ of the United States.
"(1) a school of medicine to establish or operate a separate depart-
"(b) (1) Except as provided in paragraph (2), each member of the
ment devoted to the teaching of family medicine unless the Secretary
Council shall hold office for a term of four years, except that any member
is satisfied that-
appointed to fill a vacancy prior to the expiration of the term for which his
"(A) such department is (or will be, when established) of
predecessor was appointed shall be appointed for the remainder of such
equal standing with the other departments within such school
term, and except that the terms of office of the members first taking office
which are devoted to the teaching of other medical specialty
shall expire, as designated by the Secretary at the time of appointment,
disciplines; and
three at the end of the first year, three at the end of the second year, three at
"(B) such department will, in terms of the subjects offered
the end of the third year, and three at the end of the fourth year, after the
and the type and quality of instruction provided, be designed to
date of appointment.
prepare students thereof to meet the standards established for
"(2) The member of the Council appointed as an intern in family
specialists in the specialty of family practice by a recognized
medicine shall serve for one year.
body approved by the Commissioner of Education; or
"(3) A member of the Council shall not be eligible to serve continuously
"(2) a hospital to establish or operate a special program for medi-
for more than two terms.
cal students, interns, or residents in the field of family medicine unless
"(c) Members of the Council shall be appointed by the Secretary without
the Secretary is satisfied that such program will, in terms of the type
regard to the provisions of title 5, United States Code, governing appoint-
of training provided, be designed to prepare participants therein to
ments in the competitive service. Members of the Council, while attending
meet the standards established for specialists in the field of family
meetings or conferences thereof or otherwise serving on business of the
medicine by a recognized body approved by the Commissioner of
Council, shall be entitled to receive compensation at rates fixed by the
Education.
Secretary, but not exceeding $100 per day, including traveltime, and while
"(c) The Secretary shall not approve any grant under this part unless
80 serving away from their homes or regular places of business they may be
the applicant therefor provides assurances satisfactory to the Secretary
allowed travel expenses, including per diem in lieu of subsistence, as
that funds made available through such grant will be 80 used as to supple-
authorized by section 5703 of title 5, United States Code, for persons in
ment and, to the extent practical, increase the level of non-Federal
Government service, employed intermittently.
funds which would, in the absence of such grant, be made available for
"(d) The Council shall advise and assist the Secretary in the preparation
of regulations for, and as to policy matters arising with respect to, the
the purpose for which such grant is requested.
administration of this part. The Council shall consider all applications
"PLANNING AND DEVELOPMENTAL GRANTS
for grants under this part and shall make recommendations to the Secretary
"SEC. 766. (a) For the purpose of assisting medical schools and
hospitals (referred to in section 761) to plan or develop programs or proj-
ects for the purpose of carrying out one or more of the purposes set forth
H. Rept. 91-1668
H. Rept. 91-1668
6
7
with respect to approval of applications for, and of the amount of, grants
and promote the training of medical and paramedical personnel in the
under this part.
field of family medicine and to provide for a study relating to causes and
"DEFINITIONS
treatment of malnutrition. And the House agree to the same.
"SEC. 768. For purposes of this part-
HARLEY O. STAGGERS,
"(1) the term 'nonprofit' as applied to any hospital or school of
JOHN JARMAN,
medicine means a school of medicine or hospital which is owned and
PAUL G. ROGERS,
operated by one or more nonprofit corporations or associations, no
TIM LEE CARTER,
part of the net earnings of which inures, or may lawfully inure, to
JAMES F. HASTINGS,
the benefit of any private shareholder or individual;
Managers on the Part of the House.
"(2) the term 'family medicine' means those certain principles and
RALPH W. Yarborough,
techniques and that certain body of medical, scientific, administrative,
HARRISON A. Williams,
and other knowledge and training, which especially equip and prepare
EDWARD M. KENNEDY,
a physician to engage in the practice of family medicine;
GAYLORD NELSON,
"(3) the term 'practice of family medicine' and the term 'practice',
THOMAS F. EAGLETON,
when used in connection with the term 'family medicine', mean the practice
ALAN CRANSTON,
of medicine by a physician (licensed to practice medicine and surgery by
HAROLD E. HUGHES,
the State in which he practices his profession) who specializes in providing
PETER H. DOMINICK,
to families (and members thereof) comprehensive, continuing, professional
JACOB K. Javits,
care and treatment of the type necessary or appropriate for their general
GEORGE MURPHY,
health maintenance; and
WINSTON PROUTY,
"(4) the term 'construction' includes construction of new buildings,
WILLIAM SAXBE,
acquisition, expansion, remodeling, and alteration of existing buildings
Managers on the Part of the Senate.
and initial equipment of any such buildings, including architects' fees,
but excluding the cost of acquisition of lands or offsite improvements."
TITLE II-MALNUTRITION
SEC. 201. (a) The Secretary of Health, Education, and Welfare shall
conduct a study, in cooperation with schools training health professional
manpower, of the feasibility and desirability of establishing at such
schools courses dealing with nutrition and problems related to mal-
nutrition, and of establishing research programs and pilot projects
in the field of nutrition and problems of malnutrition.
(b) The Secretary is authorized to make grants to health professional
schools, in connection with the study provided for by subsection (a),
for the planning of programs at such schools, and for the conduct of
pilot projects at such schools, to assist such schools in the establishment
of courses dealing with nutrition and problems related to malnutrition.
(c) The Secretary shall report to the President and to Congress by
July 1, 1972, the results of such study, together with such recommendations
as he deems advisable.
(d) There is authorized to be appropriated $5,000,000 to carry out
the purposes of this section.
And the House agree to the same.
That the Senate recede from its disagreement to the amendment of
the House to the title of the bill and agree to the same with an amend-
ment as follows: Amend the title SO as to read: An Act to amend the
Public Health Service Act to provide for the making of grants to medical
schools and hospitals to assist them in establishing special departments
and programs in the field of family practice, and otherwise to encourage
H. Rept. 91-1668
H. Rept. 91-1668
9
The House amendment contained no comparable provision. The
conference substitute authorizes the Secretary of Health, Education,
and Welfare to conduct a study, in cooperation with health profes-
sional manpower schools of the feasibility and desirability of establish-
ing courses at such schools in the fields of nutrition and problems
STATEMENT OF THE MANAGERS ON THE PART OF THE
relating to malnutrition. $5,000,000 is authorized for such grants, and
HOUSE
for planning of programs and pilot projects, with a report being
required to the President and to the Congress before July 1, 1972,
The managers on the part of the House at the conference on the
together with such recommendations as the Secretary deems advisable.
disagreeing votes of the two House on the amendments of the House
HARLEY O. STAGGERS,
to the bill (S. 3418) to amend the Public Health Service Act to pro-
JOHN JARMAN,
vide for the making of grants to medical schools and hospitals to
PAUL G. ROGERS,
assist them in establishing special departments and programs in the
TIM LEE CARTER,
field of family practice, and otherwise to encourage and promote the
JAMES F. HASTINGS,
training of medical and paramedical personnel in the field of family
Managers on the Part of the House.
medicine, and to alleviate the effects of malnutrition, and to provide
for the establishment of a National Information and Resource Center
O
for the Handicapped, submit the following statement in explanation
of the effect of the action agreed upon by the conferees and recom-
mended in the accompanying conference report:
The House amendment struck out all after the enacting clause of the
Senate bill and substituted a new text. The conference agreement is a
substitute for both the text of the Senate bill and the House amend-
ment.
Except for technical, clerical, clarifying, and conforming changes,
the differences between the House amendment and the conference
substitute are as follows:
The Senate bill provided specific authority for programs of con-
tinuing education in the field of family medicine, and the conference
substitute is the same in this regard as the text of the Senate bill.
The Senate bill authorized a five-year program, at total authoriza-
tions of $425,000,000, and the House amendment was limited to three
years, at a total authorization of $225,000,000. The conference sub-
stitute is the same in this regard as the House amendment.
The Senate bill authorized not to exceed $10,000,000 for any fiscal
year for planning and developmental grants for the purpose of
assisting medical schools and hospitals to plan or develop programs or
projects for the purposes of carrying out training in the field of family
medicine. The House amendment limited the sums to $5,000,000 a
year, and did not specifically cover developmental grants.
The conference substitute authorizes $8,000,000 for planning and
developmental grants. The purpose of these grants is to assist medical
schools and hospitals in actually getting programs and projects under-
way, and is intended to expedite the development of programs at
schools and hospitals for the training of family physicians.
The Senate bill contained a provision authorizing grants and con-
tracts to universities, medical schools, graduate schools, hospitals,
laboratories, and other public or private institutions, and individuals
for research into malnutrition. This provision also authorized the
establishment of courses at medical schools, graduate schools, and
nursing schools in malnutrition, and would have authorized fellow-
ships and other financial assistance to students in this area.
(8)
H. Rept. 91-1668
H. Rept. 91-1668
U.S. DEPARTMENT OF LABOR
OFFICE OF THE SECRETARY
WASHINGTON
DEC 15 1970
Honorable George P. Shultz
Director, Office of Management and
Budget
GERALD FORD LIBRARY
Washington, D. C. 20503
Dear Mr. Shultz:
This is in response to your request for my views on S. 3418,
an enrolled bill, "To amend the Public Health Service Act to
provide for the making of grants to medical schools and
hospitals to assist them in establishing special departments
and programs in the field of family practice, and otherwise
to encourage and promote the training of medical and para-
medical personnel in the field of family medicine and to
provide for a study relating to causes and treatment of
malnutrition.'
I have no objection to the President taking favorable action
on this enrolled bill.
Sincerely,
ZoHoogson
0 EDUCATION PREMIUM AND
HEALTH
DEPARTMENT OF HEALTH, EDUCATION. AND WELFARE
U.S.A.
R.FORD
DEC 17 1970
Honorable George P. Shultz
Director, Office of Management
GERALD
LIBRARY
and Budget
Washington, D. C. 20503
Dear Mr. Shultz:
This is in response to Mr. Rommel's request of December 14, 1970,
for our recommendations on enrolled bill S. 3418 "To amend the
Public Health Service Act to provide for the making of grants to
medical schools and hospitals to assist them in establishing special
departments and programs in the field of family practice, and
otherwise to encourage and promote the training of medical and
paramedical personnel in the field of family medicine and to provide
for a study relating to causes and treatment of malnutrition."
The bill would authorize a new three-year program, beginning in
the current fiscal year, of grants (1) to medical schools to operate
departments devoted to instruction in family practice; to conduct
special training programs for paramedical personnel in the field
of family medicine; to conduct training programs to prepare medical
school personnel to head departments of family practice and to
train medical school teachers of family practice; and for the
construction of facilities for training in family medicine; and
(2) to hospitals to train medical students, interns, residents, or
practicing physicians in family medicine; to provide their students
of family medicine with scholarships, fellowships, or stipends
to the extent of their need; to operate programs to train para-
medical personnel in the field; and to construct family medicine
training facilities. Grants would be authorized only upon the
recommendation of an Advisory Council on Family Medicine established
by the bill.
Authorizations for these purposes are set at $50 million for fiscal
year 1971, $75 million for fiscal year 1972, and $100 million for
fiscal year 1973. Up to $8 million of the sums appropriated may be
granted to medical schools and hospitals, in each of these fiscal
years, to plan or develop programs or projects to carry out one or
more of the bill's purposes. The bill also authorizes a separate
$5 million appropriation for a study of the feasibility of establishing,
at schools training health professional manpower, courses dealing with
nutrition and problems related to malnutrition, and for planning and
pilot project grants in connection with that study.
In the Department's report on this bill to the Senate Committee on
Labor and Public Welfare, which was cleared by your Office, we cited
Page 2 - Honorable George P. Shultz
the Health Professions Educational Assistance program, the Allied
Health Professions Personnel Training authority, and the Hill-Burton
medical facilities construction program as currently existing legislative
authorities under which we may now support activities related to the
field of family medicine. Apart from the duplication of authority that
S. 3418 would therefore entail, it was our judgment that, because the
concept of family medicine was still evolving, activities in the field
were best aided under existing programs, such as those contained in
the Health Professions Educational Assistance Act, in which our
authority was broad and flexible. This would permit the support of
alternative approaches in the training of health professions personnel
to provide comprehensive and continuing care to individuals and
families, and would allow aid for training in family medicine to be
provided in conjunction with aid directed toward other purposes, such
as expansion of medical school enrollment.
Although our earlier report recommended that action on S. 3418 be
deferred until we had completed the development of recommendations
on the Health Professions Educational Assistance Act (currently
being prepared as part of a broader departmental health options
study), it nevertheless "strongly oppose[d] the enactment of another
categorical grant authority
which would duplicate authorities
or mechanisms already existing to achieve the purpose of this
legislation."
We continue to believe that our position on the bill is sound. We
therefore recommend that the bill be disapproved. If, as may be the
case, the Congress is to adjourn within ten days (Sundays excepted)
of the day upon which the bill was presented to the President, we
propose that the President not sign the bill, in which case it will,
of course, fail to become law. Should the Congress not so adjourn,
we recognize that there is considerable likelihood that a veto will
be overridden. (The bill passed the Senate by a vote of 64 to 1,
and a similar bill passed the House by a vote of 346 to 2. The
Conference report was agreed to in both bodies without objection.)
Nevertheless, we would find any course other than disapproval difficult
to reconcile with our consistently expressed opposition to the proposal,
both in the House and in the Senate, and with this Administration's
strong opposition to further proliferation of categorical grant
programs. A draft Memorandum of Disapproval is included for your
use.
Sincerely,
GERALD FORD LIBRARY
Secretary
Enclosure
FORD
MEMORANDUM OF DISAPPROVAL
GERALD
LIBRARY
I have withheld my approval of S. 3418, entitled "An Act to amend
the Public Health Service Act to provide for the making of grants to
medical schools and hospitals to assist them in establishing special
departments and programs in the field of family practice, and otherwise
to encourage and promote the training of medical and paramedical
personnel in the field of family medicine and to provide for a study
relating to causes and treatment of malnutrition."
I take this action with regret because the principal purpose of the
bill--to strengthen the practice of family medicine--is one which I
would be pleased to see achieved. However, S. 3418 duplicates
currently existing legislative authorities directed at the same
purpose--the Health Professions Educational Assistance program, the
Allied Health Professions Personnel Training authority, and the Hill-
Burton medical facilities construction program. The concept of
family medicine is still evolving. Activities in the field are best
aided under these existing programs, particularly those contained
in the Health Professions Educational Assistance Act, in which the
authority of the Secretary of Health, Education, and Welfare is broad
and flexible. For example, the instant bill would lay stress on the
establishment, by medical school grantees, of separate and distinct
departments devoted to the teaching of family practice. Current law,
in contrast, permits the support of alternative approaches in the
training of health professions personnel to provide comprehensive
and continuing care to individuals and families. Moreover, current
law would allow aid for training in family medicine to be provided
in conjunction with aid directed toward other purposes, such as
expansion of medical school enrollment. Given the authorization
levels of the bill, which are in excess of budget projections for
adequate Federal support of the activities encompassed, the contrary
approaches of S. 3418 and existing law would compete with each other
for limited funds.
Beyond these considerations, I again call to the attention of the
Congress the increasingly chaotic and unmanageable grant-in-aid
system of the national government. The proliferation of narrowly
categorical grant programs runs counter to the need for grant
simplification and consolidation. S. 3418 furthers this proliferation.
Finally, I again remind the Congress that enactment of new legislative
authorities, and authorization of new appropriations, by themselves
accomplish nothing. It takes the appropriation of funds and the
efficient and effective administration of legislation to accomplish
the objectives. In times of stringent fiscal constraints, the
enactment of such authorities and the authorization of such appro-
priations which largely duplicate existing, broader, authorities
can only serve to create expectations which cannot be realized, in
addition to confusing and complicating administration.
It is for these reasons that I have withheld my approval of this
enrolled bill.
EXECUTIVE OFFICE OF THE PRESIDENT
OFFICE OF SCIENCE AND TECHNOLOGY
WASHINGTON, D.C. 20506
17 December 1970
FORD
MEMORANDUM FOR
GERALD
LIBRARY
Wilfred H. Rommel
Assistant Director for Legislative Reference
Office of Management and Budget
Subject:
S. 3418, an Act "To amend the Public Health
Service Act to provide for the making of grants
to medical schools and hospitals to assist them
in establishing special departments and programs
in the field of family practice, and otherwise to
encourage and promote the training of medical
and paramedical personnel in the field of family
medicine and to provide for a study relating to
causes and treatment of malnutrition."
This Act provides funds to establish departments of family
medicine in medical schools. "Family medicine" is defined as "those
certain principles and techniques and the body of medical, scientific,
administrative, and other knowledge and training which especially
equip and prepare a physician to engage in the practice of family
medicine. 11 The practice of family medicine is defined as "the practice
of medicine by a physician
who specializes in providing to families
(and members thereof) comprehensive, continuing, professional care
and treatment of the type necessary or appropriate for their general
health maintenance. "
This office recommends that S. 3418 be vetoed.
In considering the nature of medical practice in the United States,
a panel of the President's Science Advisory Committee (Panel on
Biological and Medical Science) made the following comments:
"In our estimation the need for emphasis on the
production of a large corps of "primary physicians"
has not been demonstrated at this time and it is
unrealistic to make this a major goal of medical
education. It is, therefore, the opinion of this panel
-2-
that current government planning and financial
support for medical education should not imply
an obligation or commitment to the production of
a specific type of general physician such as that
described by Millis and his colleagues. Research
into methods for delivery of health care and for
the utilization of different types of physicians and
other health professionals should be encouraged.
FORD
&
In attacking the complex problems of reorganization
GERALD
LIBRARY
of our health care delivery system, we must avoid
the mistake of seizing on attractive panaceas such
as the concept of the "primary physician" in the
absence of evidence of effectiveness or relevance. "
The purpose of S. 3418 is to develop our national capacity to
provide primary medical care to the inhabitants of this country.
Despite the emotional appeal of the concept of family medicine,
reasoned analyses of this problem have indicated that physicians
in the broad specialties of medicine, namely internal medicine
and pediatrics, will become the primary physicians of the future.
It is felt that physicians of this type, working in the framework of
group practice such as is envisioned in the concept of health
maintenance organizations (an Administration initiative) would
provide a higher level of family medicine than would the type of
primary physician who would be generated by S. 3418.
Since there is room for debate on the nature of the primary
physician needed for the future, it seems inappropriate for the
Federal Government to institutionalize a particular approach,
especially when that approach has not yet been evaluated and
demonstrated to be effective. Moreover, the philosophy underlying
S. 3418 seems to depend on solo practice of medicine and it appears
to be the policy of the Administration that the Federal Government
will encourage the development of more efficient forms of practice
such as health maintenance organizations.
In summary, because the effectiveness of the type of
practitioner that will be produced under S. 3418 has not been
evaluated and demonstrated, because S. 3418 would institutionalize
-3-
the family medicine approach and give it the endorsement of the
Federal Government, and because S. 3418 constitutes a major
intervention by the Federal Government in determining the kind
of practitioner that will be available in abundance in the future,
we recommend that the Act be vetoed. It would be better to
direct funds to the medical schools in a manner that would allow
them to determine whether indeed departments of family medicine
will be important to the country in the years ahead, and to examine
other options for providing primary care to families.
GERALD FORD LIBRARY
Edward E. David, Jr.
Director
STATES DEPARTMENTOR DEPARTMENT GRICULTURE
DEPARTMENT OF AGRICULTURE
OFFICE OF THE SECRETARY
WASHINGTON, D. C. 20250
December 78 1970
Honorable George P. Shultz
Director
Office of Management and Budget
Executive Office Building
Washington, D. C. 20503
Dear Mr. Shultz:
This is in response to your request for a report on the enrolled
bill S. 3418. S. 3418 amends the Public Health Service Act to
provide for the making of grants to medical schools and hospitals
to assist them in establishing special departments and programs
in the field of family practice, and otherwise to encourage and
promote the training of medical and paramedical personnel in the
field of family medicine, and to alleviate the effects of malnu-
trition, and to provide for the establishment of a National
Information and Resource Center for the Handicapped.
This department has no objections to the President signing this
enactment.
Sincerely,
J. Phil Campbell
Under Secretary
IDENT
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checking
DEC 21 1970
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Dear
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Last Day for Action
December 25, 1970 - Friday
GERALD FORD LIBRARY
Purpose
Authorizes a three-year program of grants to medical
schools and hospitals to assist them in establishing
special departments and programs to encourage training
of personnel in the field of family practice; provides
for a study of malnutrition.
Agency Recommendations
Office of Management and Budget
Disapproval (Veto
message attached)
Department of Health,
Education, and Welfare
Disapproval (Memorandum
of disapproval
attached)
Office of Science and Technology
Disapproval
Department of Labor
No objection
Department of Agriculture
No objection
Description of the Bill
S. 3418 originated in the Congress and passed both Houses
with overwhelming majorities, despite Administration
opposition. Its main objective is to have the Federal
Government provide targeted funds for planning and operat-
ing programs, construction, and student assistance
designed to increase the number of medical personnel in
the field of family practice.
THE WHITE HOUSE
WASHINGTON
December 22, 1970
MEMORANDUM FOR THE STAFF SECRETARY
FROM:
EDWARD L. MORGAN
SUBJECT:
Enrolled Bill S-3418 -- Family Practice of Medicine
LOG NO. 4489
I recommend disapproval of this bill for all of the reasons set forth
by OMB, HEW and OST.
My only reservation about the draft veto message is the reference in
the fifth paragraph, "The medical profession is itself divided as to how
best to organize and train personnel
11
They may well divide over
our proposals next year, so perhaps we ought to soften that reference.
GERALD R. LIBRARY FORD
THE WHITE HOUSE
ACTION MEMORANDUM
WASHINGTON
LOG NO.: 4489
Date: December 22, 1970
Time: 10:30 a.m.
FOR ACTION: E. Morgan
CC (for information):
B. Timmons
K. KeogH8/22
FROM THE STAFF SECRETARY
DUE: Date: December 22, 1970
Time:
5:00 P. M.
SUBJECT:
Enrolled Bill S. 3418 Family Practice of Medicine.
FORD i LIBRARY
ACTION REQUESTED:
For Necessary Action
X For Your Recommendations
Prepare Agenda and Brief
Draft Reply
For Your Comments
Draft Remarks
REMARKS:
Do you recommend approval or disiapproval of this bill?
If you recommend disapproval please comment on the
veto message attached at Tab A.
Mr. Keogh: Please approve or revise the veto message
at Tab A.
PLEASE ATTACH THIS COPY TO MATERIAL SUBMITTED.
If you have any questions or if you anticipate a
delay in submitting the required material, please
K. R. COLE, JR.
telephone the Staff Secretary immediately.
For the President
THE WHITE HOUSE
WASHINGTON
December 23, 1970
ACTION
White House log. #4489
MEMORANDUM FOR:
FORD i LIBRARY GERALD
THE STAFF SECRETARY
FROM:
WILLIAM E. TIMMONS
E
SUBJECT:
Enrolled Bill S. 3418
Family Practice of Medicine
I recommend disapproval of this bill by a pocket veto during
the current recess of the Congress.
Although Congress is on record as having overwhelmingly approved
S. 3418 (by a Senate vote of 64 to 1 on September 14, 1970 and
a House vote of 346 to 2 on December 1, 1970), the President
has subsequently made clear his intention to propose to the
next Congress new initiatives aimed at attacking health problems
on a comprehensive basis. In view of this stated intention and
the impossibility of a veto override vote, I believe the President
can safely disapprove this bill through a pocket veto and protect
his health image through the issuance of a statement - - not a veto
message -- similar to that attached in Tab A.
ASSISTANT ATTORNEY GENERAL
Department of Justice
GERALD FORD LIBRARY
Mashington, D.C. 20530
December 23, 1970
MEMORANDUM FOR THE HONORABLE JOHN W. DEAN, III
Counsel to the President
Re: Availability of Pocket Veto During Current
Adjournment of Congress.
You have inquired as to whether or not the President
may "pocket veto" a bill passed during the session of
Congress which was adjourned on Tuesday, December 22, 1970.
Article I, section 2, clause 2 of the Constitution provides
for two methods by which the President may make effective
his disapproval of a bill:
(1) By returning it within the defined ten-day
period with his objections "to the House in
which it originated";
(2) When the "Congress by their adjournment pre-
vent its [the bill's] return" within the
ten-day period, by simply failing to sign
it.
The second method described above is traditionally referred
to as a "pocket veto".
In the Pocket Veto Case, 279 U.S. 655, the Supreme
Court held that the "adjournment" referred to in the Consti-
tution was not only the sine die adjournment of a Congress,
but included also adjournments within a session. The Court
there decided that if, upon the expiration of the ten-day
period granted the President by the Constitution to con-
sider a bill, Congress had adjourned so that the House in
which the bill had originated was not sitting and available
to receive the returned bill, the President's withholding
his signature had the effect of vetoing the law, rather than
the effect of its becoming law without his signature.
- 2 -
The later case of Wright V. United States, 302 U.S. 583,
while troublesome in different situations than this, does
not impinge in any way on the validity of the Pocket Veto
Case reasoning as applied to the situation now confronting
the President. In that case, a majority of the Court held
that where only one House had adjourned, and the adjournment
of that House was for a period of only three days, "Congress"
as that term is used in the Constitutional provision had
not adjourned, and therefore a pocket veto would not be
available to the President.
Since in this case, both Houses have adjourned, and the
final day for the President's consideration falls during
the adjournment, the conditions of the Pocket Veto Case are
met; since the adjournment is for longer than three days,
and is not merely an adjournment of one House, the negative
implications of the Wright case suggest no reason why the
pocket veto would not be available in this situation.
The resolution of adjournment passed by both Houses
of Congress on December 22, 1970, and found in the Congres-
sional Record for that date at page S. 21119, contains nothing
more than the bare bones of an adjournment resolution. It
does not provide, as previous adjournment resolutions have,
that officials of the two Houses shall be authorized to
receive communications and messages from the President
during the adjournment. While, in my opinion, in light of
the language in the Pocket Veto Case, such additional
language would not deny to the President the right to use
the pocket veto if otherwise available to him, those who
would argue otherwise would be deprived of at least this
argument during the present adjournment.
GERALD FORD LIBRARY
William H. Rehnquist
Assistant Attorney General
Office of Legal Counsel
2. life. MO KET OF VETO 12/24/170 1° int
THE WHITE HOUSE
WASHINGTON
SSUED BATED 12/26
December 23, 1970
ACTION
MEMORANDUM FOR:
THE PRESIDENT
BERALD FUND LIBRARY
FROM:
JOHN EHRLICHM
SUBJECT:
Disapproval of Enrolled Bill S. 3418
Family Practice of Medicine
S. 3418 authorizes a three-year program of grants to medical
schools and hospitals to assist them in establishing special
departments and programs to encourage training of personnel in
the field of family practice. The bill also provides for a study
of malnutrition.
S. 3418 originated in the Congress and passed both Houses with
overwhelming majorities, despite Administration opposition.
Disapproval of this bill is recommended for the following reasons.
First, this Administration strongly opposes further proliferation
of categorical grant programs. This bill provides for a new and
duplicatory health manpower grant program which is undesirable.
Second, the effectiveness of the family medicine practitioner
has not been evaluated and demonstrated yet this bill would
institutionalize the family medicine approach and give it the
Federal government's endorsement. The government should not
be in the position of legislating the internal structure of medical
schools.
Disapproval of S. 3418 is recommended by the Office of Management
and Budget, the Office of Science and Technology, HEW, Ed Morgan
and Bill Timmons. Jim Keogh has revised the Memorandum of
Disapproval.
RECOMMENDATION
That you pocket veto S. 3418 and sign the Memorandum of Disapproval
attached at Tab A.
some
m
GERALD LIBRARY P. FORD
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THE WHITE HOUSE
WASHINGTON
JOHN,
Decision been
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FORD i LIBRARY 9ERALD
MEMORANDUM OF DISAPPROVAL
1
I am witholding my signature from S. 3418, a bill designed to promote
training in family medicine. The authority provided in this bill is un-
necessary and represents the wrong approach to the solution of the nation's
health problems.
In my press conference on December 10, I stated that a health
program will be one of the highest priority proposals I will submit to
the Congress next year. We will propose a broad pattern of reforms to
deal with the nation's health problems and needs on a systematic and
comprehensive basis. In contrast, the piecemeal bill I am rejecting
today simply continues the traditional approach of adding more programs
to the almost unmanageable current structure of Federal Government
health efforts.
The Federal Government already has at least four programs on the
books that provide funds which can be used to promote the training of
family medicine practitioners. Moreover, the entire concept of American
medicine is in an evolutionary stage. There are differing opinions on how
best to organize and train personnel to provide comprehensive and con-
tinuing care to individuals and families.
Under these circumstances, I do not believe it wise to place heavy
emphasis on the establishment of separate departments of family medicine
in medical schools, as S. 3418 would do. This is only one -- and not
necessarily the most efficient -- method of achieving our national health
care objectives, and should not be fixed in law.
GERALD LISBERT FORD
THE WHITE HOUSE,
FORD' is LIBRARY 076830
TO THE SENATE OF THE UNITED STATES:
I am returning without approval S. 3418, a bill designed to promote
training in family medicine. The authority provided in this bill is unnecessary
and represents the wrong approach to the solution of the nation's health
problems.
In my press conference on December 10, I stated that a health
program will be one of the highest priority proposals I will submit to
the Congress next year. We will propose a broad pattern of reforms to
deal with the nation's health problems and needs on a systematic and
comprehensive basis. In contrast, the piecemeal bill I am rejecting today
simply continues the traditional approach of adding more programs to the
almost unmanageable current structure of Federal Government health
efforts.
The Federal Government already has at least four programs on the
books that provide funds which can be used to promote the training of
family medicine practitioners. Moreover, the entire concept of American
medicine is in an evolutionary stage. There are differing opinions on how
best to organize and train personnel to provide comprehensive and con-
tinuing care to individuals and families.
Under these circumstances,
I do not believe it wise to place heavy
emphasis on the establishment of separate departments of family medicine
in medical schools, as S. 3418 would do. This is only one -- and not
necessarily the most efficient method of achieving our national health
care objectives, and should not be fixed in law.
THE WHITE HOUSE,
MEMORANDUM OF DISAPPROVAL
BERALD FORD VIBRARY
J. am withholding my signature from S. 3418, a bill designed to promote
training in family medicine. The authority provided in this bill is un-
necessary and represents the wrong approach to the solution of the nation's
health problems.
In my press conference on December 10, I stated that a health
program will be one of the highest priority proposals I will submit to
the Congress next year. We will propose a broad pattern of reforms to
deal with the nation's health problems and needs on a systematic and
comprehensive basis. In contrast, the piecemeal bill I am rejecting
today simply continues the traditional approach of adding more programs
to the almost unmanageable current structure of Federal Government
health efforts.
The Federal Government already has at least four programs on the
books that provide funds which can be used to promote the training of
family medicine practitioners. Moreover, the entire concept of American
medicine is in an evolutionary stage. There are differing opinions on how
best to organize and train personnel to provide comprehensive and con-
tinuing care to individuals and families.
Under these circumstances, I do not believe it wise to place heavy
emphasis on the establishment of separate departments of family medicine
in medical schools, as S. 3418 would do. This is only one -- and not
necessarily the most efficient -- method of achieving our national health
care objectives, and should not be fixed in law.
Richt Ne:
THE WHITE HOUSE,
December 24, 1970.
[ THE SENATE
JK
I am witholding returning without my approval S. 3418, a bill
SigNature FRom Signature FROM
designed to promote training in family medicine.
I take this action because the authority provided
in this bill is unnecessary and represents the wrong
approach to the solution of the nation's health problems.
In my press conference on December 10, I stated
that a health program will be one of the highest priority
proposal programs I will submit to the Congress next year. We
will propose a broad pattern/ program of reforms which deal with
to
the nation's health problems and needs on a systematic
and comprehensive basis. In contrast, the piecemeal
bill I am rejecting today simply continues the traditional
approach of adding more programs to the almost unmanage-
able current structure of Federal Government health
efforts.
FORD LIBRARY is 9ERALD
programs
The Federal Government already has at least four
programs on the books that provide funds which can be
used to promote the training of family medicine
practitioners.
Moreover, the entire concept of American medicine
There are differing opinions
is in an evolutionary stage. The medical profession is
ON
itself divided as to how best to organize and train
personnel to provide comprehensive and continuing care
to individuals and families. Under these circumstances,
I do not believe it wise to place heavy emphasis on the
establishment of separate departments of family medicine
2
in medical schools, as S. 3418 would do. This is only
one -- and not necessarily the most efficient -- method
of achieving our national health care objectives,
and should not be fixed in law.
GERALD FORD LIBRARY
THE WHITE HOUSE
December , 1970
Public Law 91-696
91st Congress, S. 3418
December 25, 1970
An Act
To amend the Public Health Service Act to provide for the making of grants to
medical schools and hospitals to assist them in establishing special depart-
ments and programs in the field of family practice, and otherwise to encourage
and promote the training of medical and paramedical personnel in the field of
family medicine and to provide for a study relating to causes and treatment
of malnutrition.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
Family
medicíne;
TITLE I-FAMILY MEDICINE
malnutri-
tion.
Sec. 101. Part D of title VII of the Public Health Service Act is
amended to read as follows:
"PART D-GRANTS To PROVIDE PROFESSIONAL AND TECHNICAL TRAINING
IN THE FIELD OF FAMILY MEDICINE
"DECLARATION OF PURPOSE
"SEC. 761. It is the purpose of this part to provide for the making of 42 USC 295.
grants to assist-
"(1) public and private nonprofit medical schools-
'(A) to operate, as an integral part of their medical edu-
cation program, separate and distinct departments devoted
to providing teaching and instruction (including continuing
education) in all phases of family practice;
FORD
"(B) to construct such facilities as may be appropriate
to carry out a program of training in the field of family med-
icine whether as a part of a medical school or as separate out-
patient or similar facility;
GERALD
LIBRARY
"(C) to operate, or participate in, special training pro-
grams for paramedical personnel in the field of family
medicine; and
"(D) to operate, or participate in, special training pro-
grams to teach and train medical personnel to head depart-
ments of family practice or otherwise teach family practice
in medical schools; and
"(2) public and private nonprofit hospitals which provide
training programs for medical students, interns, or residents—
(A) to operate, as an integral part of their medical train-
ing programs, special professional training programs
(including continuing education) in the field of family medi-
cine for medical students, interns, residents, or practicing
physicians;
(B) to construct such facilities as may be appropriate to
carry out a program of training in the field of family med-
icine whether as a part of a hospital or as a separate out-
patient or similar facility;
"(C) to provide financial assistance (in the form of schol-
arships, fellowships, or stipends) to interns, residents, or
other medical personnel who are in need thereof, who are
participants in a program of such hospital which provides
special training (accredited by a recognized body or bodies
approved for such purpose by the Commissioner of Educa-
tion) in the field of family medicine, and who plan to spe-
cialize or work in the practice of family medicine; and
84 STAT. 2080-1
Pub. Law 91-696
- 2 -
December 25, 1970
December 25, 1970
- 3 -
Pub. Law 91-696
"(D) to operate, or participate in, special training pro-
following the normal graduation date of students who are in their
medicine. grams for paramedical personnel in the field of family
first year of instruction at such school during the fiscal year in
which the Secretary makes a final determination as to approval of
"AUTHORIZATION OF APPROPRIATIONS
the application.
(b) In order for any hospital to be eligible for a grant under this
42 USC 295a.
"SEC. 762. (a) For the purpose of making grants to carry out the
part, such hospital-
purposes of this part, there are authorized to be appropriated
"(1) must be a public or private nonprofit hospital; and
$50,000,000 for the fiscal year ending June 30, 1971, $75,000,000 for the
"(2) must conduct or be prepared to conduct in connection with
fiscal year ending June 30, 1972, and $100,000,000 for the fiscal year
its other activities (whether or not as an affiliate of a school of
ending June 30, 1973.
medicine) one or more programs of medical training for medical
"(b) Sums appropriated pursuant to subsection (a) for any fiscal
students, interns, or residents, which is accredited by a recognized
year shall remain available for the purpose for which appropriated
body or bodies, approved for such purpose by the Commissioner
until the close of the fiscal year which immediately follows such year.
of Education.
"APPROVAL OF GRANTS
"GRANTS BY SECRETARY
"SEC. 765. (a) The Secretary, upon the recommendation of the 42 USC 295d,
42 USC 295b.
"SEC. 763. (a) From the sums appropriated pursuant to section
Advisory Council on Family Medicine, is authorized to make grants
762, the Secretary is authorized to make grants, in accordance with
under this part upon the determination that-
the provisions of this part, to carry out the purposes of section 761.
"(1) the applicant meets the eligibility requirements set forth in
Applications,
(b) No grant shall be made under this part unless an application
section 764;
Publication
therefor has been submitted to, and approved by, the Secretary. Such
"(2) the applicant has complied with the requirements of section
in Federal
Register.
application shall be in such form, submitted in such manner, and con-
763;
tain such information, as the Secretary shall have prescribed by reg-
"(3) the grant is to be used for one or more of the purposes set
ulations which have been promulgated by him and published in the
forth in section 761;
Federal Register not later than six months after the date of enactment
"(4) it contains such information as the Secretary may require
of this part.
to make the determinations required of him under this section
"(c) Grants under this part shall be in such amounts and subject to
and such assurances as he may find necessary to carry out the
such limitations and conditions as the Secretary may determine to be
purposes of this part;
proper to carry out the purposes of this part.
"(5) it provides for such fiscal control and accounting proced-
"(d) In the case of any application for a grant any part of which
ures and reports, and access to the records of the applicant, as
the Secretary may require (pursuant to regulations which shall
Publication
is to be used for major construction or remodeling of any facility, the
in Federal
Secretary shall not approve the part of the grant which is to be so used
have been promulgated by him and published in the Federal Reg-
Register.
unless the recipient of such grant enters into appropriate arrangements
ister) to assure proper disbursement of and accounting for all
with the Secretary which will equitably protect the financial interests
Federal funds paid to the applicant under this part; and
of the United States in the event such facility ceases to be used for the
"(B) the application contains or is supported by adequate assur-
purpose for which such grant or part thereof was made prior to the
ance that any laborer or mechanic employed by any contractor
expiration of the twenty-year period which commences on the date such
or subcontractor in the performance of work on the construction of
construction or remodeling is completed.
the facility will be paid wages at rates not less than those prevail-
"(e) Grants made under this part shall be used only for the pur-
ing on similar construction in the locality as determined by the
pose for which made and may be paid in advance or by way of reim-
Secretary of Labor in accordance with the Davis-Bacon Act, as
bursement, and in such installments, as the Secretary may determine.
amended (40 U.S.C. 276a-276a5). The Secretary of Labor shall
have, with respect to the labor standards specified in this para-
"ELIGIBILITY FOR GRANTS
graph, the authority and functions set forth in Reorganization
Plan Numbered 14 of 1950 (15 F.R. 3176; 65 Stat. 1267), and
5 USC app.
42 USC 295c.
"SEC. 764. (a) In order for any medical school to be eligible for a
section 2 of the Act of June 13, 1934, as amended (40 U.S.C. 276c).
II.
grant under this part, such school-
(b) The Secretary shall not approve any grant to-
"(1) must be a public or other nonprofit school of medicine; and
(1) a school of medicine to establish or operate a separate
(2) must be accredited as a school of medicine by a recognized
department devoted to the teaching of family medicine unless
body or bodies approved for such purpose by the Commissioner of
the Secretary is satisfied that-
Education, except that the requirements of this clause shall be
(A) such department is (or will be, when established) of
deemed to be satisfied, if (A) in the case of a school of medicine
equal standing with the other departments within such school
which by reason of no, or an insufficient, period of operation is not,
which are devoted to the teaching of other medical specialty
at the time of application for a grant under this part, eligible for
disciplines; and
such accreditation, the Commissioner finds, after consultation with
"(B) such department will, in terms of the subjects offered
the appropriate accreditation body or bodies, that there is reason-
and the type and quality of instruction provided, be designed
able assurance that the school will meet the accreditation standards
to prepare students thereof to meet the standards established
of such body or bodies prior to the beginning of the academic year
for specialists in the specialty of family practice by a recog-
84 STAT. 2080-3
84 STAT. 2080-2
Pub. Law 91-696
- 4 -
December 25, 1970
December 25, 1970
- 5 -
Pub. Law 91-696
nized body approved by the Commissioner of Education; or
erning appointments in the competitive service. Members of the Coun-
Compensation,
"(2) a hospital to establish or operate a special program for
cil, while attending meetings and conferences thereof or otherwise
medical students, interns, or residents in the field of family medi-
serving on business of the Council, shall be entitled to receive com-
cine unless the Secretary is satisfied that such program will, in
pensation at rates fixed by the Secretary, but not exceeding $100 per
terms of the type of training provided, be designed to prepare
day, including traveltime, and while so serving away from their homes
participants therein to meet the standards established for special-
or regular places of business they may be allowed travel expenses,
ists in the field of family medicine by a recognized body approved
including per diem in lieu of subsistence, as authorized by section 5703
by the Commissioner of Education.
of title 5, United States Code, for persons in Government service,
"(c) The Secretary shall not approve any grant under this part
employed intermittently.
unless the applicant therefor provides assurances satisfactory to the
"(d) The Council shall advise and assist the Secretary in the prep-
Secretary that funds made available through such grant will be so used
aration of regulations for, and as to policy matters arising with
as to supplement and, to the extent practical, increase the level of non-
respect to, the administration of this part. The Council shall consider
Federal funds which would, in the absence of such grant, be made
all applications for grants under this part and shall make recom-
available for the purpose for which such grant is requested.
mendations to the Secretary with respect to approval of applications
for, and of the amount of, grants under this part.
"PLANNING AND DEVELOPMENTAL GRANTS
"DEFINITIONS
42 USC 295d-1.
"SEC. 766. (a) For the purpose of assisting medical schools and
hospitals (referred to in section 761) to plan or develop programs or
"SEC. 768. For purposes of this part-
42 USC 295e.
projects for the purpose of carrying out one or more of the purposes
"(1) the term 'nonprofit' as applied to any hospital or school of
set forth in such section, the Secretary is authorized for any fiscal year
medicine means a school of medicine or hospital which is owned
(prior to the fiscal year which ends June 30, 1973) to make planning
and operated by one or more nonprofit corporations or associa-
and developmental grants in such amounts and subject to such condi-
tions, no part of the net earnings of which inures, or may lawfully
tions as the Secretary may determine to be proper to carry out the
inure, to the benefit of any private shareholder or individual;
purposes of this section.
"(2) the term 'family medicine' means those certain principles
"(b) From the amounts appropriated in any fiscal year (prior to the
and techniques and that certain body of medical, scientific, admin-
fiscal year ending June 30, 1973) pursuant to section 762(a), the Secre-
istrative, and other knowledge and training, which especially
tary may utilize such amounts as he deems necessary (but not in excess
equip and prepare a physician to engage in the practice of family
of $8,000,000 for any fiscal year) to make the planning and develop-
medicine;
mental grants authorized by subsection (a).
"(3) the term 'practice of family medicine' and the term 'prac-
tice', when used in connection with the term 'family medicine',
"ADVISORY COUNCIL ON FAMILY MEDICINE
mean the practice of medicine by a physician (licensed to practice
medicine and surgery by the State in which he practices his pro-
42 USC 295d-2.
"SEC. 767. (a) The Secretary shall appoint an Advisory Council on
fession) who specializes in providing to families (and members
Family Medicine (hereinafter in this section referred to as the 'Coun-
thereof) comprehensive, continuing, professional care and treat-
Membership.
cil'). The Council shall consist of twelve members, four of whom shall
ment of the type necessary or appropriate for their general health
be physicians engaged in the practice of family medicine, four of whom
maintenance; and
shall be physicians engaged in the teaching of family medicine, three of
"(4) the term 'construction' includes construction of new build-
whom shall be representatives of the general public, and one of whom
ings, acquisition, expansion, remodeling, and alteration of existing
shall, at the time of his appointment, be an intern in family medicine.
buildings, and initial equipment of any such buildings, including
Members of the Council shall be individuals who are not otherwise in
architects' fees, but excluding the cost of acquisition of lands or
the regular full-time employ of the United States.
Term.
offsite improvements."
(b) (1) Except as provided in paragraph (2), each member of the
Council shall hold office for a term of four years, except that any
TITLE II-MALNUTRITION
member appointed to fill a vacancy prior to the expiration of the term
for which his predecessor was appointed shall be appointed for the
SEC. 201. (a) The Secretary of Health, Education, and Welfare shall
Feasibility
remainder of such term, and except that the terms of office of the
study.
members first taking office shall expire, as designated by the Secretary
conduct a study, in cooperation with schools training health profes-
42 USC 295
at the time of appointment, three at the end of the first year, three
sional manpower, of the feasibility and desirability of establishing at
note.
at the end of the second year, three at the end of the third year, and
such schools courses dealing with nutrition and problems related to
three at the end of the fourth year, after the date of appointment.
malnutrition, and of establishing research programs and pilot projects
'(2) The member of the Council appointed as an intern in family
in the field of nutrition and problems of malnutrition.
(b) The Secretary is authorized to make grants to health profes-
Grants,
medicine shall serve for one year.
"(3) A member of the Council shall not be eligible to serve contin-
sional schools, in connection with the study provided for by subsec-
uously for more than two terms.
tion (a), for the planning of programs at such schools, and for the
"(c) Members of the Council shall be appointed by the Secretary
conduct of pilot projects at such schools, to assist such schools in the
$ USC 101 et
without regard to the provisions of title 5, United States Code, gov-
establishment of courses dealing with nutrition and problems related
to malnutrition.
seq.
84 STAT. 2080-4
84 STAT. 2080-5
Pub. Law 91-696
- 6 -
December 25, 1970
Report to
(c) The Secretary shall report to the President and to Congress by.
President
and Congress.
July 1, 1972, the results of such study, together with such recommenda-
tions as he deems advisable.
Appropriation.
(d) There is authorized to be appropriated $5,000,000 to carry out
the purposes of this section.
[Note by the Office of the Federal Register.-The foregoing Act, having
been presented to the President of the United States on Monday, December 14,
1970, for his approval and not having been returned by him to the House of
Congress in which it originated within the time prescribed by the Constitution
of the United States, has become a law without his approval on December 25,
1970, in accordance with the decision of the United States Court of Appeals
for the District of Columbia Circuit, Kennedy v. Sampson, et al., Nos. 73-2121
and 2122(D.C. Cir., Aug. 14, 1974).]
LEGISLATIVE HISTORY:
HOUSE REPORTS: No. 91 1601 accompanying H.R. 19599 (Comm. on
Interstate and Foreign Commerce) and No. 91 1668
(Comm. of Conference).
SENATE REPORT No. 91 1071 (Comm. on Labor and Public Welfare).
CONGRESSIONAL RECORD, Vol. 116 (1970):
Sept. 14, considered and passed Senate,
Dec. 1, considered and passed House, amended, in lieu of
H.R. 19599.
Dec. 8, House agreed to conference report.
Dec. 10, Senate agreed to conference report,
WEEKLY COMPILATION OF PRESIDENTIAL DOCUMENTS, Vol. 6, No. 52:
Dec. 24, 1970, President's memorandum of disapproval.
Kennedy V. Sampson, et al,
Nos. 73-2121 and 2122 (D. C. Cir., Aug. 14, 1974).
84 STAT. 2080-6
amormed 12/16/70
FOR IMMEDIATE RELEASE
DECEMBER 26, 1970
Office of the White House Press Secretary
THE WHITE HOUSE
GERALD R.FORD LIBRARY
MEMORANDUM OF DISAPPROVAL
I am withholding my signature from S. 3418, a bill designed to promote training
in family medicine. The authority provided in this bill is unnecessary and
represents the wrong approach to the solution of the nation's health problems.
In my press conference on December 10, I stated that a health program will
be one of the highest priority proposals I will submit to the Congress next
year. We will propose a broad pattern of reforms to deal with the nation's
health problems and needs on a systematic and comprehensive basis. In
contrast, the piecemeal bill I am rejecting today simply continues the traditional
approach of adding more programs to the almost unmanageable current structure
of Federal Government health efforts.
The Federal Government already has at least four programs on the books that
provide funds which can be used to promote the training of family medicine
practitioners. Moreover, the ontire concept of American medicine is in an
evolutionary stage, There are differing opinions on how best to organize and
train personnel to provide comprehensive and continuing care to individuals
and families.
Under these circumstances, I do mt believe it wise to place heavy emphasis on
the establishment of separate departments of family medicine in medical
schools, as S. 3418 would do. This is only one -- and not necessarily the
most efficient -- method of achieving our national health care objectives, and
should not be fixed in law.
/S/ RICHARD NIXON
The White House
December 24, 1970
#
#
#
Number
Received
Referred
Returned
Action
Filed with
Announced
Number of
Archives
Law
POCKET VETO
Budget
eff. Midnight
S. 3418,
12/14/70
12/14/70
12/21/70
12/25/70
16-80225-1
GPO
S. 3418, An Act to amend the Public Health Service Act to provide for the making of
grants to medical schools and hospitals to assist them in establishing special
departments and programs in the field of family practice, and otherwise to
encourage and promote the training of medical and paramedical personnel in
the field of family medicine and to provide for a study relating to causes and
treatment of malnutrition.
MEMORANDUM OF DISAPPROVAL (Dated: 12/24/70) ISSUED : 12/26/70
FORD j LIBRARY GERALD
91-2
FOR THE RECORD:
it the time of this pocket veto the Senate was in
recess from December 22, 1970 to December 28, 1970.
This is the only example found in which a bill was
bocket vetoed while a house of Congress was gone
for only a short period of time.
FORD & LIBRARY GERALD
GERALD FORD LIBRAR,
Number
Received
Referred
Returned
Action
Filed with
Announced
Number of
Archives
Law
POCKET VETO
Budget
eff. Midnight
S. 3418,
12/14/70
12/14/70
12/21/70
12/25/70
16-80225-1 GPO
S. 3418, An Act to amend the Public Health Service Act to provide for the making of
grants to medical schools and hospitals to assist them in establishing special
departments and programs in the field of family practice, and otherwise to
encourage and promote the training of medical and paramedical personnel in
the field of family medicine and to provide for a study relating to causes and
treatment of malnutrition.
MEMORANDUM OF DISAPPROVAL (Dated: 12/24/70) ISSUED : 12/26/70
91-2
Some items in this folder were not digitized because it contains copyrighted
materials. Please contact the Gerald R. Ford Presidential Library for access to
these materials.
1, 1071
THE WASHINGTON POST
Justice Dept. Cites Pocket Veto Precedente
By Ken W. Clawson
Court decisions, Mr. Nixon's
ident Nixion announced he
after 10 days plus Sundays if
Washington Fost Staff Writer
veto was appropriate and "en-
was refusing to sign the Fam-
Congress is still in session.
The Justice Department con-
tirely consistent with that of
ily Practice of Medicine Act,
But Congress was in the midst
ends that President Nixon fol-
preceding
administrations
which was intended to pro-
of a six-day Christmas vaca-
owed "well established histor-
which have considered the
mote training of more family
tion when Mr. Nixion an-
cal practice" in exercising a
question."
doctors. The White House said
nounced the pocket veto of
ocket veto of a $225 million
Kennedy, Sen. Ralph Yar-
it was a veto because Congress
the doctor bill.
octor-training bill that some
borough (D-Tex.) and Sen.
was not meeting when the
Kennedy argued in his lct-
Democrats claim is already
Sam Ervin (D-N.C.) contend
10th day had passed after the
ter to the Justice Department
1W.
that a pocket veto is valid only
President received the bill
that the pocket veto was in-
William H. Rehnquist, an as-
if Congress is in adiournment
from the Capitol
istant atiorney general
FOND
Senate
(Proceedings of the Senate continued from the Record of Thursday, December 31, 1970)
THE POCKET VETO
that the Supreme Court's decision in the
though the Senate itself was in a brief
Mr. KENNEDY. Mr. President, 2 days
pocket veto case has expressly rejected
3-day recess, the President was not "pre-
my view that the pocket veto provision
vented" from returning the vetoed bill
ago, I wrote to Attorney General
is intended only to apply in sine die ad-
with his objections to the Senate, within
Mitchell requesting clarification of the
administration's interpretation of the
journment situations.
the meaning of the pocket veto clause,
Indeed, the specific holding of the
since the Secretary of the Senate was
pocket veto clause of the Constitution.
pocket veto case is clearly in accord
available to receive the President's veto
The President sought to use the pocket
with my view. The House of Representa-
message. In other words, it may be ar-
veto power last week to disapprove
tives had adjourned sine die. Therefore,
gued, there are two requirements before
S. 3418, the Family Practice of Medicine
it was impossible for Congress to act to
the pocket veto clause comes into play-
Act, thereby preventing Congress from
override the veto. Under the Constitu-
first, Congress must be in adjournment,
having the opportunity to override the
veto. This action by the President has
tion, a two-thirds majority in both the
and, second, the adjournment must pre-
Senate and the House is required to over-
vent the return of the vetoed bill to
raised extremely serious questions about
ride a veto. Since the House had ad-
Congress.
the distribution of power under the Con-
journed sine die, it was clear that the
If a 3-day recess of the Senate did not
stitution between Congress and the exec-
House could not act to override the veto,
prevent the return of & vetoed bill in the
utive branch in the enactment of Federal
and the fact that the Senate's adjourn-
Wright case, it is difficult to believe that
legislation, and it was for this reason
ment was not sine die was irrelevant.
the 5-day adjournment of the Senate in
that I sought. clarification of the ad-
This is the precise situation in which the
the present case prevented the return of
ministration's position.
Founding Fathers intended the pocket
the vetoed Family Practice of Medicine
Today, I have received a reply from
veto clause of the Constitution to apply.
Act.
Assistant Attorney General William H.
Where there is no opportunity for Con-
One additional point is worth noting.
Rehnquist, of the Office of Legal Coun-
sel in the Department of Justice, ex-
gress to override a veto by the President,
In his letter, Mr. Rehnquist states that
the Constitution resolves the question of
not only was the President authorized to
plaining the position of the administra-
the status of legislation enacted within
exercise a pocket veto on the present
tion on this issue. Although a substantial
the 10-day period before adjournment by
legislation, "but if he wished to disap-
area of disagreement continues to exist
specifying, in effect, that the bill does
prove it at all, he very probably had no
over Mr. Rehnquist's interpretation of
not become law unless approved by the
choice as to the form of veto."
the clause and my own interpretation, I
President. In other circumstances, of
Surely, if the President wishes to dis-
am delighted by both the thoughtful-
course, where a sine die adjournment of
approve a bill in such a situation, he can
ness and the promptness of his reply,
Congress does not intervene, a bill be-
return it to Congress with his veto mes-
and "I commend the Attorney General,
comes law even without the approval of
sage in the usual fashion. Even if such
the Assistant Attorney General, and the
the President, unless the President acts
a return of the legislation is invalid be-
Department of Justice for their con-
positively to veto it, and thereby triggers
cause Congress is in adjournment, as Mr.
structive approach to the legal questions
the opportunity for Congress to override
Rehnquist appears to be arguing, the
raised by the controversy that has
the veto.
President will still be in the position of
erupted over the pocket veto.
Strong additional support for my view
not having signed the bill. In other
The principal difference between us is
is contained in Wright V. United States,
words, even if a formal veto is invalid,
over the interpretation of the Supreme
302 U.S. 583 (1938), which was decided
a pocket veto can still apply, since the
Court's precedents on the pocket veto
almost a decade after the pocket veto
bill has not been signed. Moreover, the
clause of the Constitution. The Assistant
case, and which substantially clarified
language of the Wright case may be
Attorney General relies heavily on the
the Supreme Court's earlier decision. In
easily read as implying that the court
Pocket Veto case, 279 U.S. 655, which
the Wright case, which was decided
will sustain the validity of 2 return of
was decided in 1929 and which contains
6-2 by the Court, the majority opinion
legislation when Congress is in a brief
dicta apparently giving extremely broad
by Chief Justice Charles Evans Hughes
adjcurnment within a session.
leeway to the President in the exercise
discusses the holding in the pocket veto
To be sure, as Mr. Rehnquist's letter
of the pocket veto power.
case as turning on the question of
shows, there is a sporadic practice of
It is clear, however, that these dicta
whether there has been a sine die ad-
pocket vetoes by the President during
of the Supreme Court were not essential
journment. As the opinion states:
relatively brief adjournments of Con-
to the holding of the case, which in-
In the Pocket Veto Case, the Congress had
gress. In large part, however, the prac-
volved an adjournment sine die at the
adjourned. The question was whether the
tice is a tribute to the difficulty of chal-
end of a session of Congress. I believe
concluding clause of paragraph 2 of $7 of
lenging a pocket veto in the courts,
that sine die adjournments-either at
article I was limited to a final adjournment
rather than a tribute to the validity of
the end of a Congress or at the end of
of the Congress or embraced an adjournment
administration's reasoning. Now that 2
a session of Congress-are the only sit-
of the Congress at the close of the first regu-
substantial legal controversy has begun,
uations in which the pocket veto clause
lar session. The Court held that the clause
of the Constitution was intended to ap-
was not so limited and applied to the Intter.
it is my hope that this difficulty in
[Emphasis in original.] 302 U.S. 583, at 593.
mounting an appropriate challenge can
ply. I also believe that this is all that the
be overcome. It is my understanding that
Supreme Court's decision in the pocket
The Court's holding in the Wright case
a private bill was also subject to a pocket
veto case holds on this issue. As Mr.
appears to be two-pronged. First, the
veto by the President during the Christ-
Rehnquist's letter expressly recognizes,
Court clearly held that-since the House
mas recess. Since questions of standing
the pocket veto case did in fact involve
of Representatives was still in session,
are less likely to thwart the jurisdiction
a sine die adjournment at the end of a
even though the Senate had adjourned
of the courts in cases involving private
session of Congress-albeit a sine die
for a brief period-there was no "ad-
bills, it may be possible for the claimant
adjournment of only one House. In the
journment" of Congress within the
under the recent private bill to challenge
circumstances of that case, the House
meaning of the pocket veto clause of
the pocket veto of his bill, and thereby
of Representatives had adjourned sine
the Constitution. Therefore, the Court
obtain a court test that would be squarely
die, and the Senate had adjourned for
held, the pocket veto clause was com-
applicable to the vetoed Family Practice
several months to a date certain.
pletely inapplicable.
of Medicine Act.
It is difficult, therefore, to understand
Second, the Supreme Court appears to
Finally, it is worth pondering the im-
the logic of Mr. Rehnquist's assertion
have held in the Wright case that, even
plications of the administration's posi-
S 21817
S 2181S
CONGRESSIONAL RECORD-SENATE
January 2, 1971
tion. Nothing in the Constitution sug-
tribution of power under the Constitution
veto":
If any bill shall not be returned
gests any stopping point for the admin-
between Congress and the Executive Branch
by the President within ten days (Sundays
istration's logic. In the present case, in-
with respect to the enactment of Federal
excepted) after it shall have been presented
volving the brief 5-day Christmas ad-
logislation. Surely, contrary sporadic practice
to him, the same shall be a law. in like man-
notwithstanding, the Pocket Veto provision
ner as if he had signed it, unless the Con-
journment by Congress, the President is
of the Constitution-Article I, Section 7,
gress by their adjournment prevent its re-
already close to pushing the pocket veto
Clause 2-was intended to apply only in cir-
turn, in which case it shall not be a law."
power to the limit of its logic. If the
cumstances involving an adjournment sine
(Art. I, §7. United States Constitution.)
pocket veto clause applies to a 5-day
die at the end of a Congress or at the end
The bill which was pocket-vetoed by
adjournment, why should it not also ap-
of a session of Congress, and was not in-
President Coolidge in the Pocket Veto Case
ply to an adjournment of 3 days, or 1 day,
tended to apply to brief adjournments of
had been presented to him on June 24, 1926,
or even overnight?
Congress during a session such as the recent
and the adjorrament of Congress took place
The 10-day constitutional period for
Christmas period. This Is all that the lead-
on July 3rd. The Court said:
the President's consideration of legisla-
ing decisions of the Supreme Court appear
"The specific question here presented is
to have held. See Wright V. United States,
whether, within the meaning of the last sen-
tion presented by Congress expires on
302 U.S. 583 (1938); Pocket Veto Case, 279
tence-which we have italicized-Congress
midnight of the 10th day. Since Congress
U.S. 655 (1029). Indeed, in Wright 2. United
by the adjournment on July 3rd prevented
is virtually always in adjournment at
States. the Supreme Court expressly sug-
the President from returning the bill within
midnight, the reductio ad absurdum of
gested that the Pocket Veto provision might
ten days, Sundays excepted, after it had
the administration's logic is that vir-
not be applicable in a case involving a brief
been presented to him. If the adjournment
tually every piece of legislation is subject
adjournment within a session.
did not prevent him from returning the bill
to a pocket veto, in spite of the clear
In light of the discrepancy between the
within the prescribed time. it became a law
contrary language of the Constitution.
theory and practice involving the Pocket
without his signature; but, if the adjourn-
Veto provision, I would be grateful to receive
ment prevented him from so doing, it did
Conceivably, the Supreme Court might
a clarification of the Administration's posi-
not become a law. This is unquestioned." 279
attempt to establish a "rule of reason" to
tion on this issue.
U.S. at 674.
resolve the pocket veto controversy, un-
Sincerely,
The Court went on to say that the term
der which the pocket veto clause might
EDWARD M. KENNEDY.
"adjournment" as used in the constitutional
be applicable in cases involving rela-
provision authorizing pccket vetces did not
tively long adjournments during a ses-
DEPARTMENT OF JUSTICE,
refer only to the final adjournment of Con-
Washington, D.C., December 30, 1970.
gress. It pointed out in support of this con-
sion of Congress, in addition to cases in-
Hon. EDWARD M. KENNEDY,
clusion that the word "adjournment" is used
volving sine die adjournments. Even by
U.S. Senate,
both in section 5 of Article I in reference to
this standard, however, it seems clear
Washington, D.C.
the power of a smaller number than the
that the 5-day adjournment involved in
DEAR SENATOR KENNEDY: The Attorney
majority of each House to "adjourn" from
the present case would be far too short
General has asked me to reply to your letter
day to day, and in the fourth clause of the
to trigger a pocket veto.
to him of December 29 relating to the pocket
same article, in reference-to the prohibition
To me, it is much more likely that the
veto of S. 3418, inasmuch as I had given the
that neither House during the session of
advice to the White House that under the
Congress shall, without the consent of the
Court will decline to be drawn into any
effort to set an arbitrary time period for
circumstances a pocket veto by the Presi-
other, "adjourn" for more than three days.
adjournments during a session, beyond
dent would be appropriate.
The Court then stated:-
In your letter you state that the pocket
"We think that under the constitutional
which a pocket veto would be valid. By
veto "was intended to apply only in cir-
provision that the determinative question in
drawing a clean dividing line at adjourn-
cumstances involving an adjournment sine
reference to an 'adjournment' is not whether
ment sine die, the Court can avoid the
dis at the end of a Congress or at the end
it is a final adjournment of Congress or an
ambiguities inherent in a "rule of rea-
of 2 session of Congress, and was not in-
interim adjournment, such as an adjourn-
son" approach and clear up the contro-
tended to apply to brief adjournments. of
ment of the first session, but whether it is
Congress during a session such as the recent
one that 'prevents' the Fresident from re-
versy entirely.
Christmas period." You also state that "in
turning the bill to the House in which it
In closing, let me emphasize again the
Wright v. United States, the Supreme Court
orginated within the time allowed. It is clear,
importance of the issue raised by the
expressly suggested that the pocket veto pro-
and as we understand, it is not questioned,
President's recent exercise of the pocket
vision might not be applicable in a case in-
that since the President may return a bill
veto. The President has challenged one
volving a brief adjournment within a ses-
at any time within the allotted period, he
of the most basic perrogatives of Con-
sion." Suggesting a "discrepancy between the
is prevented from returning it, within the
gress. His action has vital implications
theory and practice involving the pocket veto
meaning of the constitutional provision, If
provision", you have requested a clarification
by reason of the adjournment it is Impos-
for the checks and balances in our con-
stitutional form of government between
of the Administration's position on this issue.
sible for him to return it to the House in
The position of this Administration on the
which it originated on the last day of that
the legislative branch and the executive
"pocket veto" issue is, as nearly as I can de-
period." 279 U.S. at 630.
branch, and I hope that we will make a
termine, entirely consistent with that of
The Court then concluded that since Con-
thorough exploration of this area in the
preceding Administrations which have con-
gress had adjourned prior to the expiration
92d Congress.
sidered the question. The two decided Su-
of the ten day period given President Cool-
premo Court cases, both of which are cited
Idge by the Constitution in which to decide
Mr. President, I believe that my ex-
change of correspondence with Mr.
in your letter, have, with one exception,
whether or not to veto the particular bill
pretty well marked out the boundarles of the
there involved, the pocket veto provision te-
Rehnquist will be of interest to all Mem-
pocket veto power, and in my opinion the
came operative. It seems clear to me that
bers of Congress, and I ask unanimous
President's exercise of that power in declin-
the Court's decision did not turn on the
consent to have it printed in the RECORD.
ing to sign S. 3418 conforms both to these
length of the adjournment, any more than
There being no objection, the corre-
Judicial precedents and to the consistent
on its finality, but that it turned instead on
spondence was ordered to be printed in
practice or other Presidents during the last
the fact that the adjournment commenced
the RECORD, as follows:
quarter century.
within the ten day period allotted the Presi-
The Pocket Veto Case, 279 U.S. 655 (1029),
dent by the Constitution to decide whether
WASHINGTON, D.C.,
December 20, 1970.
decided by 3 unanimous Court, seems to me
or not to veto the measure in question.1
to have expressly rejected your contention
The most recent formal expression on the
Hon. JOHN N. MITCHELL,
Attorney General, Department of Justice,
that the pocket veto provision was intended
pocket veto provision appears in the opinion
Washington, D.C.
to apply only in circumstances involving
an adjournment sine die at the end of a Con-
1 The Court in that case also said (though
DEAR MR. ATTORNEY GENERAL: As you
gress or at the end of a session of Congress.
the statement does not appear to have been
know, on December 26 it was announced
Although the adjourament of Congress there
necessary to Its holding) that even though
that the President would not sign S. 3418,
involved was for 3 period of several months,
one or both Houses of Congress were to au-
the "Familly Practice of Medicine Act," and
it was neither an adjournment at the end
thorize an agent to receive messages from the
that the bill would therefore be subject to
of the session nor at the end of the Con-
President, "the delivery of the bill to such
a "pecket veto," under which Congress
gress, since the Senate adjourned on July 3rd
officer or agent
would not comply with
would have no opportunity to reconsider the
until November 10th, while the House ad-
the constitutional mandate." 279 U.S. at 681.
logislation in 11ght of the President's ch-
journed on July 3:d sinc dis. Notwithstand-
While dicta Is not entitled to the same
Joetions.
ing the difference in length of time of ad-
weight-as is a holding. the fact that the lan-
Whatever the merits of this particular
Journment between that case and the altua-
guage is subscribed to by a unanimous Stt-
bill-and I strongly supported it in the Sen-
tion respecting S. 3418, the Court in the
preme Court, and the fact that It Is found in
ate-the President's action raises extremely
Pocket Veto Case was required to interpret
cno of the only two cases from that Court
serious questions that far transcend the bill
the following language from the constitu-
dealing with the question, make it the best
itself and that 60 to the heart of the dis-
tional provision authorizing the "pocket
available authority on the point.
January 2, 1971
CONGRESSIONAL RECORD-SENATE
S21819
of Attorney General Biddle of July 16, 1943.
The Court in Wright summarized its ruling
position taken In your latter, I:believe it is
40 Op. A.G. 274. The Attorney General after
in these words:
consistent both with the decided cases and
reviewing the cases and the historical prac-
"We hold that where the Congress has not
with quite well established historical prac-
tice, advised President Roosevelt that an ad-
adjourned and the House in which the bill
tice.
journment of Congress within 2 session was
originated is in recess for not more than
Yours very truly.
an occasion for a pocket veto.
three days under the constitutional permis-
WILLIAM H. REHNQUIST,
In the memorandum on the same subject
sion while Congress is in session, the bill
Assistant Attorney General,
transmitted to the White House in Novem-
does not become a law if the President has
Office of Legal Counsel.
ber, 1965. by my predecessor in this office,
delivered the bill with his objections to the
the precedents then existing were summar-
appropriate officer of that House within the
Ized in this language:
prescribed ten days and the Congress does
TRIBUTE TO SENATOR GORE
"The experience of the past quarter of the
not pass the bill over his objections by the
requisite votes." 302 U.S. at 598.
Mr. KENNEDY. Mr. President, when
century discloses the following practice. If
the tenth day (Sundays excluded) after the
In the situation confronting President
the 92d Congress convenes next month,
presentation of the bill fell into a period in
Nixon with respect to his disapproval of S.
none of our colleagues will be missed
which neither House was in session, Presi-
3418, both Houses of Congress had adjourned
more deeply or more affectionately than
dents uniformly exercised their pocket veto
for a period of longer than three days-the
the distinguished senior Senator from
power, even if the period of adjournment
Senate from December 22nd to December
Tennessee. For 32 years, 18 of them in
were short, or if Congress reconvened on the
28th, and the House from December 22nd
to December 29th-and by their adjourn-
the Senate, covering one of the most im-
day following expiration of the constitutional
ment had prevented the President from hav-
portant eras in the history of the Nation,
period."
The following Instances were relied upon
ing the full ten day period allotted him under
ALBERT GORE has graced the U.S. Senate
in support of this statement:
the Constitution to decide whether or not
with his extraordinary gifts of /intelli-
(1) In the spring of 1944, the Congress ad-
to veto in the ordinary manner the bill in
gence, persuasion, eloquence, and wit.
journed from April 1st to April 12th. A pri-
question. In my opinion, therefore, on these
Time and again, his insights and percep-
vate bill had been presented to the Presi-
facts the general rule of the Pocket Veto
tions have been translated into signifi-
dent on March 30, 1944. 90 Cong. Rec. 3380.
Case, rather than the exception to that gen-
The tenth day (Sundays excepted) follow-
eral rule carved out in the Wright case, gov-
cant and far-reaching legislation. Time
ing the day of presentation was April 11, 1944,
erned, and the President was not only
and again where others drifted with ex-
i.e., the day preceding the reconvening of
authorized to exercise a pocket veto, but If
pediency, Senator GORE has stood on
the Congress. On that day, President Roose-
he wished to disapprove it at all, he very
principle. Time and again, where others
velt signed a memorandum of disapproval.
probably had no choice as to the form of
were content to follow, Senator GORE
The bill was considered to have been pocket-
veto.³
has chosen to lead, and the Nation is the
vetoed. 90 Cong. Rec. 3408.
You state in your letter that the Presi-
richer for service.
(2) In the spring of 1956, both Houses of
dent's action raises extremely serious ques-
Historians will catalog the full rich-
Congress adjourned from March 20th to
tions far transcend the bill itself and that
April 9th. A private bill had been presented
go to the "heart of the distribution of power
ness of his long and remarkable career
to the President on March 22nd, and the
under the Constitution between the Con-
in public service, and his/major contri-
tenth day following the day of presentation
gress and the Executive branch with respect
butions in foreign relations and domestic
was therefore April 3, 1956. President Eisen-
to the enactment of federal legislation".
affairs. His association with my family
hower withheld his approval from the bill,
While I believe that the President was on
in the Senate goes back many years. In-
and it was considered to have been thereby
very firm legal ground in taking the action
deed, ALBERT GORE and John Kennedy
pocket-vetoed as of April 3, 1956. 102 Cong.
he did, there is no doubt that the use of
came to the Schate together in 1952.
Rec. Index 732.
the pocket veto power has been a bone of
(3) In the summer of 1964, both Houses
Later, Senator Kennedy preceded Sena-
contention between the President and the
of Congress adjourned from August 21 to
Congress throughout the years. Indeed, the
tor GORE as the chairman of the Sub-
August 31 during the Democratic presiden-
Pocket Veto Case, supra, apparently resulted
committee on Africa and they shared
tial nominating convention. A private bill
from an effort on the part of the House of
many common interests together in the
had been presented to the President on Au-
Representatives to repudiate the traditional
Senate.
gust 14, 1964, and the tenth day following
interpretation of the pocket veto clause-by
In many ways, however, the 91st Con-
the day of presentation was August 26, 1964.
then more than a century old-and to limit
President Johnson signed a memorandum of
gress itself has been a microcosm of the
the exercise of that form of veto to the final
disapproval on August 24, 1964, which was
adjournment of Congress. This effort on the
ALBERT GORE we love and respect, and
communicated to the House of Representa-
part of the House was, of course, unsuccess-
we will carry away many warm recollec-
tives on September 2, 1964. 110 Cong. Rec.
ful. Again in 1940, Congress passed .a bill,
tions of recent months to inspire us:
21409.
H.R. 3233, 76th Congress, which purported to
In the fall of 1969, he was among the
Most recently, in the summer of 1968,
repeal as of the date of their "enactment" all
President Johnson pocket-vetoed a bill re-
first to challenge the secret American
bills and joint resolutions which prior to the
lating to cotton importation during an ad-
military involvement in Laos, and to be-
beginning of the 76th Congress had been
journment of both Houses of Congress of
pocket-vetoed, during an adjournment of
gin the critical examination of the extent
approximately one month. 4. Weekly Comp.
the Congress other than a final adjournment.
to which the military establishment has
Pres. Docs. 1222.
President Roosevelt vetoed the bill on the
been determining the foreign policy of
Similar precedents may be found going
ground that it was inconsistent with the
the United States.
back a good deal further than the quarter
century period covered in the memorandum
constitutional practices going back to Presi-
His votes against the confirmations of
described above. Those which occurred prior
dent Adams, as well as with the Supreme
Judge Haynsworth and Judge Carswell
to 1923 are collected in House Doc. No. 493,
Court's interpretation of the Constitution in
to the Supreme Court rank with the
70th Cong., 2d Session. They include pocket
the Pocket Veto Case. 86 Cong. Rec. 8024. The
veto was sustained.
greatest profiles in political courage in
vetoes during Christmas adjournment of
our history
Congress by Presidents Andrew Johnson,
Thus, while the Administration's position
Benjamin Harrison, and Grover Cleveland.
with respect to presidential use of the pocket
His leadership against the ABM in
In Wright V. United States, 302 U.S. 583
veto provision is largely at odds with the
1969 put Him in the forefront of those in
(1938). a majority of the Court held that
the Senate determined to shift our na-
where only one House had adjourned, and
text, could be said to undercut the reason-
tional priorities and begin to attack the
the adjournment of that House was for a
ing in the Pocket Veto Case, the fact that
overriding domestic issues of our day-
period of only three days, "Congress" as that
the Wright Court reserved the question of
issues like poverty and unemployment,
term is used in the constitutional provision
the effect of an adjournment of even one
health and education, the problems of
authorizing pocket vetoes, had not ad-
House alone for more than three days would
journed, and therefore a pocket veto was
the elderly, and all the other urgent is-
indicate that its language is to be confined
not available to the President in that situa-
to the fact situation there presented.
sues we face.
tion. The Court's majority declined to specu-
*There is undoubtedly a legal "gray area"
Many of Senator GORE'S victories in
late on the result If one House had ad-
with respect to the question reserved in the
the Senate were single-handed triumphs
journed for more than three days.²
Wright case-whether a pocket veto is ap-
of his legislative skill. A striking example
propriate during an adjournment for more
of his outstanding success was in the Tax
The Court majority in Wright rejected
than three days by one House of Congress.
Reform Act of 1969, where, after days of
the argument that because the originating
Advice from this office in the past has been
House was the one which had adjourned for
to the effect that in this situation, without
debate on the Senate floor, he persuaded
three days, the President was prevented from
any controlling judicial decision to guide
us to rewrite the crucial tax reduction
returning the bill within the meaning of the
him, the President ought to disapprove a
provisions, in order to give a far greater
constitutional language. While some of its
bill by the normal veto message and return,
measure of tax justice to the ordinary
reasoning, in so doing. if lifted out of con-
rather than by the pocket reto.
taxpayer.
WASHINGTON POST 8/13/73
Nixon's 1970 Pocket Veto
Pocket Veto
In Recess
During Recess Held Illegal
VETO, From A1
Senate Subcommittee
on
Waddy also- rejected that
Ruled Illegal
ments to encourage the prac-
Health and a cosponsor of the
ing the order sought by Keni
bill, had indicated earlier that
tice of family medicine.
nedy "requires no action- by
he was prepared to carry his
the President
- It was approved in the Sen-
argument to the Supreme
By Donald P. Baker
ate by a vote of 6+ to 1 and in
Court if necessary.
Named 23 defendants in the
Washington Post Staff Writen
the House by 340 to 2. and
He had- called the bill the
action were Arthur F. Sample
A pocket veto by President
presented to the President on
most important piece of legis-
son acting administration or
during a congressional
Dec. 14, 1970. On Dec 22; Con-
lation' ever to be pocket ve-
the GSA, and Thomas MO
Christmas recess- in 1970 was
gress adjourned for five days
toed and the five day recess
Jones. chief of White Hous
uled unconstitutional yester-
for the Christmas holidays
the shortest in which a pocket
records The court's order
by U.S. District Court
Two days Later, Mr. Nixon is
veta had been used.
quires: Jones to turn over
sued a mémorandum of disap
In arguing his own case;
Sampson the papers necessar
udge Joseph C. Waddy.
proval; announcing that he
Kennedy said Presidents have
for GS to publish the bill
The President's action had
was withholding his signature
exercised their pocket veto 24-
law
challenged by Sen-Ed-
Waddy ruled that the Presi-
thority- approximately 70
M Kennedy (D-Mass);
dent's action did not fall
times, and that 90 per cent of
ho personally argued the
within the bounds of Article-F
them have occurred since
Section 7, Clause 2 of the Con-
World War II, and then primar
Hit-Run Canine
before Judge Waddy last
28
stitution, which provides for a
ily for private or minor bills.
Fells Tourist
Waddy ruled on the narrow
so-called pocket veto. The
Waddy, saying his court
the Presi
packet vote in intended to ---
"dealines to suim in
Reuter
Evening Star 12/30/70
'Pocket Veto' by Nixon
Brings Hill Challenge
By JAMES DOYLE
courage more general practi-
Star Staff Writer
tioners.
President Nixon may have
The President announced Sat-
acted illegally when he used the
urday that he was withholding
"pocket veto" on a medical edu-
his signature from the legisla-
cation bill during Congress'
tion because, he said, it would
Christmas recess.
add to "the almost unmanagea-
ble current structure of federal
That is the opinion of Senate
and House proponents of the bill,
government health efforts." He
said his own health proposals
who promise a move in the next
Congress to defy the President's
would receive high priority in
action and to define the limits of
his 1971 legislative program.
He acted under a provision of
VETO
Nixon's Action Challenged
Continued From Page A-1 power "should be one of the first cess "has grave implications for
to Congress with his objections
priorities of the 92nd Congress,"
the balance of power between
any bill that he disapproves.
Kennedy said. The same view
the legislative and executive
Then a two-thirds vote of both
was taken by several other legis-
branches.' He called it "this lat-
houses is required to override
lators, including the bill's House
est effort by the President to
the veto.
sponsor, Rep. Fred B. Rooney,
undermine congressional pow-
D-Pa.
er."
Passed Overwhelmingly
Sen. Sam Ervin, D-N.C., sug-
Senate parliamentarians noted
In the case of the "family
gested that Congress should
that President Johnson used the
practise of medicine" bill, it is
challenge the President's action
pocket veto on an agricultural
by appropriating the $225 million
act amendment in August 1968,
CORRECTED SHEET
S. 3418
Ainety-first Congress of the United States of America
AT THE SECOND SESSION
Begun and held at the City of Washington on Monday, the nineteenth day of January,
one thousand nine hundred and seventy
LIBRARY
FORD
An Act
To amend the Public Health Service Act to provide for the making of grants to
medical schools and hospitals to assist them in establishing special depart-
ments and programs in the field of family practice, and otherwise to encourage
and promote the training of medical and paramedical personnel in the field of
family medicine and to provide for a study relating to causes and treatment
of malnutrition.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
TITLE I-FAMILY MEDICINE
SEC. 101. Part D of title VII of the Public Health Service Act is
amended to read as follows:
"PART D-GRANTS To PROVIDE PROFESSIONAL AND TECHNICAL TRAINING
IN THE FIELD OF FAMILY MEDICINE
"DECLARATION OF PURPOSE
"SEC. 761. It is the purpose of this part to provide for the making of
grants to assist-
"(1) public and private nonprofit medical schools-
(A) to operate, as an integral part of their medical edu-
cation program, separate and distinct departments devoted
to providing teaching and instruction (including continuing
education) in all phases of family practice;
'(B) to construct such facilities as may be appropriate
to carry out a program of training in the field of family med-
icine whether as partof medical school Cr a3 separate out-
patient or similar facility;
"(C) to operate, or participate in, special training pro-
grams for paramedical personnel in the field of family
medicine; and
"(D) to operate, or participate in, special training pro-
grams to teach and train medical personnel to head depart-
ments of family practice or otherwise teach family practice
in medical schools; and
"(2) public and private nonprofit hospitals which provide
training programs for medical students, interns, or residents—
(A) to operate, as an integral part of their medical train-
ing programs, special professional training programs
(including continuing education) in the field of family medi-
cine for medical students, interns, residents, or practicing
physicians;
(B) to construct such facilities as may be appropriate to
carry out a program of training in the field of family med-
icine whether as a part of a hospital or as a separate out-
patient or similar facility;
"(C) to provide financial assistance (in the form of schol-
arships, fellowships, or stipends) to interns, residents, or
other medical personnel who are in need thereof, who are
participants in a program of such hospital which provides
special training (accredited by a recognized body or bodies
approved for such purpose by the Commissioner of Educa-
tion) in the field of family medicine, and who plan to spe-
cialize or work in the practice of family medicine; and
LIBRARY
FORD
017839
S. 3418-2
"(D) to operate, or participate in, special training pro-
grams for paramedical personnel in the field of family
medicine.
"AUTHORIZATION OF APPROPRIATIONS
"SEC. 762. (a) For the purpose of making grants to carry out the
purposes of this part, there are authorized to be appropriated
$50,000,000 for the fiscal year ending June 30, 1971, $75,000,000 for the
fiscal year ending June 30, 1972, and $100,000,000 for the fiscal year
ending June 30, 1973.
"(b) Sums appropriated pursuant to subsection (a) for any fiscal
year shall remain available for the purpose for which appropriated
until the close of the fiscal year which immediately follows such year.
"GRANTS BY SECRETARY
"SEC. 763. (a) From the sums appropriated pursuant to section
762, the Secretary is authorized to make grants, in accordance with
the provisions of this part, to carry out the purposes of section 761.
(b) No grant shall be made under this part unless an application
therefor has been submitted to, and approved by, the Secretary. Such
application shall be in such form, submitted in such manner, and con-
tain such information, as the Secretary shall have prescribed by reg-
ulations which have been promulgated by him and published in the
Federal Register not later than six months after the date of enactment
of this part.
"(o) Grants under this part shall be in such amounts and subject to
such limitations and conditions as the Secretary may determine to be
proper to carry out the purposes of this part.
"(d) In the case of any application for a grant any part of which
is to be used for major construction or remodeling of any facility, the
Secretary shall not approve the part of the grant which is to be SO used
unless the recipient of such grant enters into appropriate arrangements
with the Secretary which will equitably protect the financial interests
of the United States in the event such facility ceases to be used for the
purpose for which such grant or part thereof was made prior to the
expiration of the twenty-year period which commences on the date such
construction or remodeling is completed.
"(e) Grants made under this part shall be used only for the pur-
pose for which made and may be paid in advance or by way of reim-
bursement, and in such installments, as the Secretary may determine.
"ELIGIBILITY FOR GRANTS
"SEC. 764. (a) In order for any medical school to be eligible for a
grant under this part, such school-
(1) must be a public or other nonprofit school of medicine; and
(2) must be accredited as a school of medicine by a recognized
body or bodies approved for such purpose by the Commissioner of
Education, except that the requirements of this clause shall be
deemed to be satisfied, if (A) in the case of a school of medicine
which by reason of no, or an insufficient, period of operation is not,
at the time of application for a grant under this part, eligible for
such accreditation, the Commissioner finds, after consultation with
the appropriate accreditation body or bodies, that there is reason-
able assurance that the school will meet the accreditation standards
of such body or bodies prior to the beginning of the academic year
S. 3418-3
following the normal graduation date of students who are in their
first year of instruction at such school during the fiscal year in
which the Secretary makes a final determination as to approval of
the application.
"(b) In order for any hospital to be eligible for a grant under this
part, such hospital-
"(1) must be a public or private nonprofit hospital; and
"(2) must conduct or be prepared to conduct in connection with
its other activities (whether or not as an affiliate of a school of
medicine) one or more programs of medical training for medical
students, interns, or residents, which is accredited by a recognized
body or bodies, approved for such purpose by the Commissioner
of Education.
"APPROVAL OF GRANTS
"SEC. 765. (a) The Secretary, upon the recommendation of the
Advisory Council on Family Medicine, is authorized to make grants
under this part upon the determination that—
"(1) the applicant meets the eligibility requirements set forth in
section 764;
(2) the applicant has complied with the requirements of section
763;
"(3) the grant is to be used for one or more of the purposes set
forth in section 761;
"(4) it contains such information as the Secretary may require
to make the determinations required of him under this section
and such assurances as he may find necessary to carry out the
purposes of this part;
"(5) it provides for such fiscal control and accounting proced-
ures and reports, and access to the records of the applicant, as
the Secretary may require (pursuant to regulations which shall
have been promulgated by him and published in the Federal Reg-
ister) to assure proper disbursement of and accounting for all
Federal funds paid to the applicant under this part; and
"(6) the application contains or is supported by adequate assur-
ance that any laborer or mechanic employed by any contractor
or subcontractor in the performance of work on the construction of
the facility will be paid wages at rates not less than those prevail-
ing on similar construction in the locality as determined by the
Secretary of Labor in accordance with the Davis-Bacon Act, as
amended (40 U.S.C. 276a-276a5). The Secretary of Labor shall
have, with respect to the labor standards specified in this para-
graph, the authority and functions set forth in Reorganization
Plan Numbered 14 of 1950 (15 F.R. 3176; 65 Stat. 1267), and
section 2 of the Act of June 13, 1934, as amended (40 U.S.C. 276c).
(b) The Secretary shall not approve any grant to—
"(1) a school of medicine to establish or operate a separate
department devoted to the teaching of family medicine unless
the Secretary is satisfied that-
"(A) such department is (or will be, when established) of
equal standing with the other departments within such school
which are devoted to the teaching of other medical specialty
disciplines; and
(B) such department will, in terms of the subjects offered
and the type and quality of instruction provided, be designed
to prepare students thereof to meet the standards established
for specialists in the specialty of family practice by a recog-
S. 3418-4
nized body approved by the Commissioner of Education; or
"(2) a hospital to establish or operate a special program for
medical students, interns, or residents in the field of family medi-
cine unless the Secretary is satisfied that such program will, in
terms of the type of training provided, be designed to prepare
participants therein to meet the standards established for special-
ists in the field of family medicine by a recognized body approved
by the Commissioner of Education.
(c) The Secretary shall not approve any grant under this part
unless the applicant therefor provides assurances satisfactory to the
Secretary that funds made available through such grant will be so used
as to supplement and, to the extent practical, increase the level of non-
Federal funds which would, in the absence of such grant, be made
available for the purpose for which such grant is requested.
"PLANNING AND DEVELOPMENTAL GRANTS
"SEC. 766. (a) For the purpose of assisting medical schools and
hospitals (referred to in section 761) to plan or develop programs or
projects for the purpose of carrying out one or more of the purposes
set forth in such section, the Secretary is authorized for any fiscal year
(prior to the fiscal year which ends June 30, 1973) to make planning
and developmental grants in such amounts and subject to such condi-
tions as the Secretary may determine to be proper to carry out the
purposes of this section.
"(b) From the amounts appropriated in any fiscal year (prior to the
fiscal year ending June 30, 1973) pursuant to section 762(a), the Secre-
tary may utilize such amounts as he deems necessary (but not in excess
of $8,000,000 for any fiscal year) to make the planning and develop-
mental grants authorized by subsection (a).
"ADVISORY COUNCIL ON FAMILY MEDICINE
SEC. 767. (a) The Secretary shall appoint an Advisory Council on
Family Medicine (hereinafter in this section referred to as the 'Coun-
cil'). The Council shall consist of twelve members, four of whom shall
be physicians engaged in the practice of family medicine, four of whom
shall be physicians engaged in the teaching of family medicine, three of
whom shall be representatives of the general public, and one of whom
shall, at the time of his appointment, be an intern in family medicine.
Members of the Council shall be individuals who are not otherwise in
the regular full-time employ of the United States.
(b) (1) Except as provided in paragraph (2), each member of the
Council shall hold office for a term of four years, except that any
member appointed to fill a vacancy prior to the expiration of the term
for which his predecessor was appointed shall be appointed for the
remainder of such term, and except that the terms of office of the
members first taking office shall expire, as designated by the Secretary
at the time of appointment, three at the end of the first year, three
at the end of the second year, three at the end of the third year, and
three at the end of the fourth year, after the date of appointment.
(2) The member of the Council appointed as an intern in family
medicine shall serve for one year.
"(3) A member of the Council shall not be eligible to serve contin-
uously for more than two terms.
"(c) Members of the Council shall be appointed by the Secretary
without regard to the provisions of title 5, United States Code, gov-
CORRECTED SHEET
S. 3418-5
erning appointments in the competitive service. Members of the Coun-
cil, while attending meetings and conferences thereof or otherwise
serving on business of the Council, shall be entitled to receive com-
pensation at rates fixed by the Secretary, but not exceeding $100 per
day, including traveltime, and while SO serving away from their homes
or regular places of business they may be allowed travel expenses,
including per diem in lieu of subsistence, as authorized by section 5703
of title 5, United States Code, for persons in Government service,
employed intermittently.
'(d) The Council shall advise and assist the Secretary in the prep-
aration of regulations for, and as to policy matters arising with
respect to, the administration of this part. The Council shall consider
all applications for grants under this part and shall make recom-
mendations to the Secretary with respect to approval of applications
for, and of the amount of, grants under this part.
"DEFINITIONS
"SEC. 768. For purposes of this part-
"(1) the term 'nonprofit' as applied to any hospital or school of
medicine means a school of medicine or hospital which is owned
and operated by one or more nonprofit corporations or associa-
tions, no part of the net earnings of which inures, or may lawfully
inure, to the benefit of any private shareholder or individual;
"(2) the term 'family medicine' means those certain principles
and techniques and that certain body of medical, scientific, admin-
istrative, and other knowledge and training, which especially
equip and prepare a physician to engage in the practice of family
medicine;
"(3) the term 'practice of family medicine' and the term 'prac-
tice', when used in connection with the term 'family medicine',
mean the practice of medicine by a physician (licensed to practice
medicine and surgery by the State in which he practices his pro-
fession) who specializes in providing to families (and members
thereof) comprehensive, continuing, professional care and treat-
ment of the type necessary or appropriate for their general health
maintenance; and
"(4) the term 'construction' includes construction of new build-
ings, acquisition, expansion, remodeling, and alteration of existing
buildings, and initial equipment of any such buildings, including
architects' fees, but excluding the cost of acquisition of lands or
offsite improvements."
TITLE I1-MALNUTRITION
SEC. 201. (a) The Secretary of Health, Education, and Welfare shall
conduct a study, in cooperation with schools training health profes-
sional manpower, of the feasibility and desirability of establishing at
such schools courses dealing with nutrition and problems related to
malnutrition, and of establishing research programs and pilot projects
in the field of nutrition and problems of malnutrition.
(b) The Secretary is authorized to make grants to health profes-
sional schools, in connection with the study provided for by subsec-
tion (a), for the planning of programs at such schools, and for the
conduct of pilot projects at such schools, to assist such schools in the
establishment of courses dealing with nutrition and problems related
to malnutrition.
S. 3418-6
(c) The Secretary shall report to the President and to Congress by
July 1, 1972, the results of such study, together with such recommenda-
tions as he deems advisable.
(d) There is authorized to be appropriated $5,000,000 to carry out
the purposes of this section.
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.
THE WHITE HOUSE
WASHINGTON
June 8, 1972
NOBLE:
The attached ltr and attachment was delivered to
Don Leonard of my office by someone apparently from
Senator Kennedy's office when they appeared at the
EOB mail room at approx 11 am today and stated that
they had to deliver it to either me or someone from
my office.
Quite obviously it is not something which should
have been addressed to me.
FORD & LIBRARY GERAÇO
Also quite obviously it is something which should
be taken care of by John Dean's office.
To be of assistance I have attached the bill report
on the bill.
Also, this was handled in part by Mr. Hopkins and
if memory serves us correctly, he in turn had some
dealings with Ken Cole and John Campbell on the
matter.
In addition, Mr. Hopkins wrote on the bill report
that John Dean would be furnishing a Justice memo
in support of the pocket veto. This memo has never
been seen by this office.
Tom Jones
long time. "Not this month
will it be over, not this year,"
Kenneth Rush
he said in response to a ques-
FOR
tion.
Treasury Secretary William
their regular exec
E. Simon was even gloomier
jobs-would not b
in his appearance before a
OMB director 4
Senate Finance subcommittee.
House Banking
predicting that the rate of in-
that giving an
Associated Press
flation in the United States
will remain high for two to
poena powers m
Sen. William Proxmire, right, greets I. W. Abel as the latter arrives to testify.
five years.
that subsequentl
Wash. Post 8/15/74
The House Banking Com-
force would gain
2
mittee is scheduled to vote to-
impose mandator
Court Rules President Nixon
day on a bill establishing an
price curbs.
executive task force that can
He said experie
focus public attention on wage
that wage and pr
and price developments but
which expired Ap:
"mistake." It is "
Made Improper Pocket Veto
can't subpoena witnesses for
emphasize that th
public hearings or suspend or
roll back excessive wage or
price boosts.
By Timothy S. Robinson
tor." Judge Tamm continued.
threatened by an invalid veto,
While some members of the
Washington Post Staff Writer
In a concurring opinion,
but also, in the circumstances,
committee are in favor of giv-
Heal
The U.S. Court of Appeals
Judge Fahy agreed.
to protect his own interest as
ing the agency more powers
"As a United States senator
a national legislator in the bill
and others are fearful the
ugheld a lower court ruling
he represents a sovereign
for which he voted," Fahy
monitoring task force is a
yesterday that former Presi-
said.
prelude to a reimposition of
HEALTH, F
state' whose people have a
dent Nixon improperly in-
deep interest in the act and
The effect of the ruling is to
wage and price controls, 28 of
Mills said he h
voked a pocket veto during a
look to their senators to pro-
order the $225 million Family
the 40 members, including
to President For
"congressional Christmas re-
tect that interest; and he, as
Practice of Medicine Act into
Chairman Wright Patman (D-
idea and stressed
cess in 1970.
senator, it seems to me, has a
law. A token appropriation of
Tex), have cosponsored a
merely a suggest