Texas Medicine patient day, including equipment and ,salaries. And, Hurst added, costs are not exactly helped by the fact that hospitals are necessarily forced to do a tremendous amount of charity housing. He said that 422 shortterm members of the Texas Hospital Association reported doing $30,000,000 charity service last year for 612,364 patients. Medical Districts Though $30,000,000 is a sizeable hand-out, many Texans are concerned that the state has not consistent and comprehensive program for taking care of its indigent patients, especially in the rural areas. For at least a dozen years, Texas doctors have been trying to get rid of the antiquated medical aid program for rural poor folks which really isn’t an aid program at all, but so far the legislature hasn’t responded to their recommendations. What many doctors hope for eventually is a state divided into medical districts, with perhaps 30 counties in a district, and each county contributing to the upkeep of a central medical center to which they could send their indigent patients. The operation of such districts in terms of assessments and help, ironically enough, would be based on the old economic theory: “From each according to his abilities, to each according to his need.” As things stand now, each county in the state goes its own way, with the result that indigent patients Nvho have the misfortune to live and get sick in a por county also have a pretty good chance of dying there. In 1960, county governments live and get sick in a poor county spent $521,000,000 on indigent medical care in Texas, but only 6.7 percent of this was scattered over the 247 counties with populations of less than 100,000 per county. Paupers So long as the care of the pauper is left up to the commissioners court in each county, as i t now is, the situation will probably be chaotic. Just about everybody in the medical profession seems agreed on that, but not all are agreed as to why. Some say that medical direction should be taken away from the commissioners court because with local-level politicians medical care too quickly becomes a political football. Others are less concerned with such speculation than they are with the fact that there are no rules for the game as played in Texas. Dr. Emerson K. Blewett of Austin, chairman of the Committee on Hospital Care of the Rural Medically Indigent, explains it this way: While Article 2351 and Article 4438, Revised Civil Statutes of Texas, 1925, would seem to vouchsafe medical care for all paupers at county expense, the commissioners courts have ways of sidestepping their duty. In the first place, he explained, i t is up to them to decide who is a pauper, and an attorney general’s opinion clouded that point, saying “all paupers are indigent persons” .. . but “whether or not en indigent person is a pauper will be determined by the degree of his nigency.” There is no legal or consistent method for determining pauperism. Each court has its own arbitrary method. Is a man with only two shirts and no socks a pauper? Or must he have only one shirt and no shoes? It’s up to each court to THE TEXAS OBSERVER Page 3 Jan. 14, 1961 say, and no one can challenge them. Once it is settled that a patient is a .pauper, the commissioners court is legally bound to provide help for him, and if there is no hospital in that county to do the job, the court is empowered to contract with one of the surrounding county hospitals. But, says the law, it is strictly up to the commissioners court to say how much it will pay, or even if it will pay anything at all. Under these arrangements, says Dr. Blewett, where “either no tax money or an insignificant amount is spent for hospitalization of the indigent,” one of the following is usually the outcome: Either the pauper doesn’t receive any hospital care, or he is sent to the nearest urban tax-supported hospital, or he treated at a local private hospital at an increased cost to the paying patient, or he is shipped out to a state-supported teaching hospital. Brackenridge Hospital, operated by Austin and Travis County, is a typical urban hospital, and each year it spends thousands of dollars taking care of patients who wander in from surrounding counties where they could not get treatment. Blewett is quick to point out, h o w e v e r, that commissioners courts that fail to do their duty by their paupers are not always activated by cautious conservatism alone. They are handicapped by the state constitution that prohibits their levying a tax specifically for hospital care for paupers. While he feels the legislature could pass a law requiring the commissioners courts to set aside a specific portion of the general fund for this purpose, he doubts that the legislature would want to interfere in this way with another law-making body, and therefore Blewett pins his hopes on a constitutional amendment permitting a hospital-aid tax. School Vacancies -Numerically, Texas is not faced with a present shortage of doctors, although, the distribution of its doctors might be greatly improved. The ratio of doctors to potential patients in Texas cornpares well with national averages. Nationally, there are vacancies for 15,000 new interns each year in all hospitals. The nation’s 84 SAN ANTONIO San Antonians, always sprite players in controversial political dramas, perhaps got as much mileage out of a $1.75 poll tax as any other group of citizens in the state over the past voting year. This week they rounded out the old poll tax year by approving a $10,500,000 bond issue. All four propositions passed. The storm center of the election, a Northside expressway, s ti rr ed up one of the most determined and emotional campaigns in the history of the city. Passage of the Northside freeway was aided by vocal support from the city council, numerous public figures and officials, and both San Antonio newspapers. Opposed were the San Antonio Conservation Society; the Citizens’ League; the West and East Sides, led mainly by County Commissioned Albert Pena Jr.; and organizations like the Save Our Parks Committee, organized specifically for the occasion. AFB access road and U.S. Highway 90 West freeway, totaling Guadalupe street overpass, $900,a $500,000 improve medical schools turn out less than half that number. Proportionately this holds true for Texas. Directors of the Galveston medical school have cut the number of incoming freshmen in recent years. Lincoln Williston, secretary of the Texas Medical Association, explained the reasons why: “Well, they say they don’t have the clinical equipment necessary to train the number of third and fourth-year students they used to have. They figure they need four patients per advanced student, and they haven’t been getting enough patients. The John Sealy Hospital is so deep at one end of the state it has a hard time drawing patients from all over, and advanced students need patients to work on. But I want to say that TMA feels very bad about that cut in admissionsin the last three or four years the freshman class has dropped from about 165 to about 140.” While it is sometimes difficult to get into medical school as a freshman because of the large number of applications, there are usually vacancies in the medical school at the third and fourth year level because of drop-outs. In the United States currently, there are between 500 and 600 vacancies on the upperclass levels. There are vacancies in Texas’ medical schools at the thirdand fourth-year levels, although , exactly how many will not be known until the end of this month. This ‘is one reason why the TMA is pushing not only for another four-year medical school in Texas, but also for a two-year basic science school, whose graduates could take up the slack created by the drop-outs. These drop-outs constitute about eight per cent of G freshman-to-senior class. Medical officials in the state feel fortunate that they can hold the number of drop-outs to eight per cent. The quality of the average student entering medical school in recent years has declined, Williston said. “Talk to any Texas medical educator,” he said. “You’ll find out he feels we are not getting the quality students we would like to have and ought to have. Now you can be a high-C student and get in medical school. Right after the war, there were four GOOD applicants for every va ment issue for parks and recreation areas. The latter issue was considered by many bonds opponents to have been added to induce support from the Conservation society. Spearhead of the Northside freeway opposition was the Conservation Society. Led by Mrs. James Graves, president of the society, and assisted vocally by other conservationists such as Mrs Maury Maverick Sr. and Miss Mary Green and Miss Sibyl Browne, representatives of the Conserve Our Parks committee, the ladies pushed the fight all the way. Leading proponent for the entire bond issue for the city !council was Councilman W. W. McAllister Sr., chairman of the Committee for Parks and Expressways. At one stage McAllister suggested the Conservation Society was being used as a “cat’s paw by vested property interests who do not live in San Antonio,” referring to the North Side suburbs. Points of contention concerning the freeway included whether the Sunken Garden next to Brackenridge Park would be destroyed, whether the zoo would be wiped out, whether the Omos Basin set AUSTIN Jerry Holleman, one of the three Assistant Secretaries of Labor in the Kennedy Administration, was born and spent the first 20 years of his life on a cotton farm in the Texas Panhandle. He went to Cameron College,,a branch of Oklahoma A&M, and then took a job as a union electrician. In World War II he was a lieutenant with the Army Engineers in Italy. He became business manager of his local electricians’ union in Lubbock after the war, rose to president of the Lubbock labor council, and moved to Austin as an official in the Texas State Federation of Labor. After 18 months as company commander with the Army Engineers in Korea, Holleman became, in 1953, the effective chief eration. He was elected president of the Texas AFL-CIO upon the merger in 1957 and holds that job now. Holleman is a liberal, but also a believer in organizational discipline within the labor movement. His religion is Church of Christ, and he thinks of his thoroughgoing liberalismon labor, civil rights, the-welfare state, valuing the peopleas applied Christianity. He is generally a grave, quiet man. Graying at his temples at 41, he is heavy in frame. As the Texas labor chief he has played a conspicuous role among the leadership of the Texas liberal Democrats. He has on occasion joined in criticism of Speaker Sam Rayburn and Sen. Lyndon Johnson in contests betken conservatives and liberals for state party control, but he has done this with some reserve. He helped hold back a bolt of Texas liberals against Johnson’s presidential candidacy at Los Angeles; but when offered a delegate’s seat by the cancy. Of course, that’s not a happy situation either, because you lose too many excellent prospects.” One of the main reasons medical schools aren’t getting the first-rank students they used to get, he said, is that “the rockets are pulling them away”meaning that other sciences, especially physics, now hold enough glamor and money to take away the s cholastic ere.am that used to rise toward medicine. aside for flood control would be affected, and whether severe damage would be done to the Incarnate Word College campus. The Conservation Society distributed handbills at the Societysponsored “Los Pastures,” the traditional Christmas play in Spanish: “They tried to TEAR DOWN the Alamo! “The people said ‘No’. “They tried to PAVE the San Antonio River! “The people said ‘No’. “They tried to DESTROY the grounds of San Jose Mission! “The people said ‘No’. “They tried to CUT THROUGH Brackenridge Park! “The people said `No’.” Among the side-br issues of the controversy was the cutting off of Pena’s water for failure to pay his sewer tax, dubbed “sewerola” by city hall critics. Pena claimed the action was taken , because of his stand on the bonds. “Because of my opposition to the unplanned, controversial north freeway, I have been subjected to an insiduous conspiracy to cut off my water,” he said. JIM PRESLEY Johnson forces, he declined it. As Majority Leader, Johnson on occasion complained that he could sit down and get along with George Meany and Walter Reuther in Washington, but Holleman and Fred Schmidt, the executive secretary of Texas AFL-CIO, were always off somewhere with his liberal Texas critics. Holleman and Schmidt undertook to explain to their Washington associates in labor the Texas situation in which they felt obliged to side with liberals against frequent conservative-moderate coalitions supported and led by Johnson and Rayburn. When the crisis arrived at the May, 1960, state convention in Austin, Washington labor leaders feared an open labor-assisted bolt against Johnson in Texas, believing his influence could be contained at Los Angeles. Holleman and Schmidt recommended in Austin that labor take no stand as a group on bolting on a party loyalty question, and the bolt which did occur was unsuccessful. New Ground As president of the AFL-CIO in the state he has broken new ground for labor on many issues, including non-labor ones. For instance, he has advocated abolition of capital punishment and the enactment of state personal and corporate income taxes. On labor issues he has supported a legalized union shop, a state labor relations act, industrial safety legislation, and higher maximums and more liberal policies on unemployment and workmen’s compensation. He has sought improved farm worker ‘standards. He told the 1959 state labor convention, “We have been trying for several years to secure for our domestic farm laborers the same housing and health standards, wages and guarantees that we give to the Mexican nationals who are contracted to work here as braceros.” During his tenure as president, state laobr has advocated abolition of the bracero program. His appointment is not likely to please the
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