New York State Dept.of Health 
Allegany County Health Service ALLEGANY COUNTY HEALTH SERVICE 
A Report to the Board of Supervisors 
on the Establishment and Coordination of 
County Health Department 
County Public Health Laboratory 
County General Hospital 
Services 
NEW YORK STATE DEPARTMENT OF HEALTH 
and the 
JOINT HOSPITAL BOARD 
of the 
POSTWAR PUBLIC WORKS PLANNING COMMISSION 
February 1947 ALLEGANY COUNTY HEALTH SERVICE 
A Report to the Board of Supervisors 
on the Establishment and Coordination of 
County Health Department 
County Public Health Laboratory 
County General Hospital 
Services 
NEW YORK STATE DEPARTMENT OF HEALTH 
I *• 
and the 
JOINT HOSPITAL BOARD 
of the 
POSTWAR PUBLIC WORKS PLANNING COMMISSION 
February 1947 FOREWORD 
A committee of the staff of the Hew York State De- 
partment of health and of the Joint Hospital hoard has Pre- 
pared this prospectus for the organization and development of 
% 
coordinated health services in Allegany County. 
I he proposed plan r; presents an unusual opportunity 
to promote public health and related laboratory and hospital 
facilities and services in a sound and effective manner m 
A. LI e.gany County. 
There are assembled in the prospectus, as a guide 
for further consideration and detailed Planning, such facts, 
laics, regulations, and sources, of materials as. may seem rele- 
vant, There arc also presented broad objectives, that should 
be considered in such planning. Consideration is. given, in- 
sofar os current conditions will permit, tc the mere important 
matters, of procedure and cost, and steps are suggested for the 
further consideration and clearance of plans as they are de- 
veloped. 
Tne establishment .and ievelopment of the services as 
recommcndea would definitely place Allegany County in the van- 
guard of national and state progress. CONTMTS 
Page 
5Toreword 1 
Table of Contents 2 
Introduction 3 
Characteristics of Allegany County 5 
The County Health Department 7 
The Public Health Laboratory 15 
The County General Hospital 18 
Recapitulation of Costs 27 
Sequence of Steps 28 
Appendix 30 INTRODUCTION 
Throughout the State and the Nation, there are evidences of a 
growing public interest and concern in matters relating to the provision 
of adequate public health and medical services. In consequence, there 
has been an accompanying increase in proposals for state and national 
surveys, studies by commissions, and legislation. Much of this has been 
of a controversial nature, but two distinct trends have taken shape and 
appear to be meeting with public acceptance and the general support of 
the professional groups concerned. These are: 
(l) the establishment of full-time health departments 
operated as county units or large city units, as 
recommended by the American Public Health Associa- 
tion and supported in principle by the American 
Medical Association and the New York State Medical 
Society; 1J 
(2) national and state sponsored surveys of hospital 
needs seeking to bring about an orderly development 
of hospital and related health services which have 
been given impetus by recent federal legislation, 
namely, the Hospital Survey and Construction Act, 
Public Law 725 (Appendix E), This measure 
provides financial aid administered by the state for 
hospital and health center construction. It has 
the support of.the American Medical Association as 
well as the American Public Health Association and 
the American Hospital Association, 
There are other related trends of national signifiaance, such 
as the rapid-growth of voluntary hospital insurance plans and voluntary 
medical care insurance plans, which provide a partial answer for certain 
groups to some of the economic problems of hospital and medical care; 
the interest in and growth of the principle of paying hospitals on an 
operating cost basis for patients hospitalized at public expense, as 
has been established in. connection with the Federal Emergency Maternity 
ly New York State Journal of Medicine, July 15> 19*+o, page lb08. 
Journal of the American Medical Association* July h, page 811. 
American Journal of Public Health, December page 1^+21. and Infant Care program; and the widespread recognition the advantages 
of group medical practice in its several forms, including the affiliation 
of outlying hospitals with medical centers in the interest of establishing 
and maintaining an improved quality of medical care. 
Without exception, these national trends have had their counter- 
parts in New York State, Great encouragement for the development of full- 
time county and city health departments has been given by the state aid 
provisions of Chapter 1000 of the Laws of 19*+6 (Appendix A-l) and by other 
important legislation, such as Chapter 999 the Laws of 19*+6 establishing 
a greatly accelerated program for the control of tuberculosis. Recognition 
in New York State of the other raggor trends is reflected in the establish- 
ment of the Joint Hospital Board which has been conducting a survey of hos- 
pital and health center facilities (Appendix E); by the establishment of the 
Interdepartmental Health Council composed of the State Commissioners of 
Education, Health, Mental hygiene and Social Welfare with the advisory ser- 
vices of the chairman of the Health Preparedness Commission of the New York 
State Legislature; by the increasing operation of medical and hospital in- 
surance plans; by the planning for the care of the chronically ill being 
undertaken by the Health Preparedness Commission; by the development of a 
plan for regionalization of medical services promoted by this same commis- 
sion and serving as a basis for state-wide planning; 1] and by the studies 
of the New York State Legislative Commission on Medical Care. 2J 
Throughout the development -and planning of these activities in 
New York State, particular emphasis has been placed upon the importance of 
maintaining local authority and responsibility to the highest degree com- 
patible with economical and efficient health and medical cafe services. 
Under such a. policy, the establishment of facilities and services compre- 
hensive in scope and yet sensitive to the needs and situations prevailing, 
in the communities concerned may be expected to result. 
Tj Planning for the care of the Chronically 111 in the New York State - 
Regional Aspects, New York State Commission to Formulate a Long Range 
Health Program, also known as New York State Health Preparedness Com- 
mission, Legislative Document (l9*+5) Ho, 7'g A,. 
2/ Medical Care for the People of New York State.- Report of the New York 
State Legislative Commission on Medical Care, February 15, 19^6, CHARACTERISTICS OF ALLEGANY COUNTY 
Allegany County is essentially rural in character. In 
eighty-five per cent of its population lived in areas classified by the 
U, S, Bureau of the Census as rural, i.e*, outside cities or other in- 
corporated places having 2,500 or more inhabitants. Only Wellsville 
village, population is classified as urban. Other incorporated 
villages with more than 1,000 inhabitants are Cuba (1,699)* Bolivar 
Andover (1,290), Friendship (l,lUg), and Belmont (l,1^6). 
There has been little change in the total population of the County since 
1900 when the population was Ul,501. There was a decrease to in 
1920, followed by an increase to 38.025 in 1930, and a further slight in- 
crease, to 39*681 in the following decade. The estimate is 39*821.1J 
Agriculature, which in engaged one-quarter of the employed 
workers in the County, is the most common occupation of Allegany County 
residents. An additional thirteen per cent of the workers are employed 
in manufacturing, and eleven per cent in the production of crude petrol- 
eum and natural gas, 2j 
Essential public health services are provided at present through 
part-time local health officers serving the county's 32 local health dis- 
tricts, and by the full-time staff of the district state health officer at 
Hornell, which serves Allegany, Chemung, and Steuben counties. Public 
health laboratory service is provided by the approved county laboratory at 
Belmont, The county employs, under state aid, three public health nurses 
who provide public health nursing services under the general supervision 
of the district state supervising nurse; two registered nurses, who have 
not had public health training, are employed by the New York State Depart- 
ment of Health under the supervision of the District State Supervising 
Nurse and supplement the work of the public health nurses by providing 
bedside nursing care; twelve school nurses provide service only to school 
children in limited areas within the county. Tuberculosis hospitalization 
is provided by the Mt, Morris State Tubersulosis Hospital at Mt. Morris* 
Livingston County, 
The infant mortality rate, which is considered as one of the 
best available single indices of health conditions, is approximately Uo 
per 1000 live births in Allegany County (Average annual rate, to 
Appendix F), This is 13 per cent higher than the infant mortality 
1J New York State Department of Health, Vital Statistics Review, Volf 27* 
No, 1, March 19^6, 
• / 
2/ U, S* Bureau of the Census, Characteristics of the Population (New 
York State), 19^-0, rate for the -upstate area and nine per cent higher than that for the rural 
population in the state as a whole. Five per cent of all births in Allegany 
County, or between 35 er-b per year, are premature and these premature in- 
fants should have long periods of hospital care. Although infant mortality 
has been declining gradually in Allegany County during the past several years, 
as in other parts of the state, the Allegany County rate has continued to re- 
main at a somewhat higher level than the average for upstate. It is pertinent 
to note in this connection that the proportion of births occuring in hospitals 
in Allegany County (90 per cent) is third lowest of the eleven counties in 
the so-called Rochester region. 
The death rate from all causes, 11,9 per 1000 of the population 
also has remained at a higher level than that for upstate New York and re- 
flects to some extent the slightly older age distribution of the population 
in Allegany County, Even when allowances are made for age differences, how- 
ever, the death rate is slightly higher in Allegany County than the rate for 
upstate New York, In striking contrast is the death rate from tuberculosis. 
Allegany County, which has been served for the last ten years by one of the 
state tuberculosis hospitals, has one of the lowest, if not the lowest, 
tuberculosis death rates in the state. THE COUNTY HEALTH DEPARTMENT 
A frequently quoted definition of public health is that of 
Dr. C.-E, A. Winslow, editor of the American Journal of Public Health 
and formerly Dean of the Yale School of Public Health: 
"Public health is the science and art of preventing 
disease, prolonging life and promoting physical 
health and efficiency through organized community 
effort for the sanitation of the environment, the 
control of community infections, the education of 
the individual in the principles of personal hygiene, 
and the organization of medical and nursing service 
for the early diagnosis and preventive treatment of 
disease; organizing these benefits in such fashion 
as to enable every citizen to realize his birthright 
of health and longevity," 
The functions of the health Department, some of which are 
described below, can only be carried out with the cooperative effort 
of official (tax-supported) and non-official agencies, doctors, hospi- 
tals, nurses, and the people themselves. 
Constant effort is necessary to prevent the spread of dis- 
eases such as typhoid and dysentery through contamination of water and 
food supplies, and through improper disposal of human wastes. The 
health department is the agency which is responsible, through its spe- 
cially trained sanitation personnel, for inspecting water supplies, 
milk-producing herds, pasteurization plants, and the manner in which the 
milk and cream are handled from the cow to the consumer, restaurant and 
other food-handling establishments, certain hotels and boarding houses, 
farm labor camps, children’s camps, and swimming pools and bathing 
beaches, and assisting in correcting any practices or conditions which are 
a menace to the public. 
Such inspections can only be conducted properly if a sufficient 
number of trained workers are made available locally. As a necessary 
part of this inspection service these workers must have readily available 
a laboratory to analyze the samples which they collect so as to determine 
if contamination has occurred or if some purification process has been 
performed properly, Por'exanrple, a milk sample cannot be sent a long 
distance to a laboratory, as changes will occur during the time spent in 
travel which will make the laboratory examination worthless. 
These sanitation examinations and inspections aro principally 
to prevent communicable diseases. The control of communicable diseases 
is helped by other procedures performed by the health department,. Phy- 
sicians are required to report promptly acute communicable diseases which they diagnose in their patients. These reports are watched carefully by 
the county health officer and if they suggest that an epidemic is start- 
ing he investigates immediately so as to determine the source of the in- 
fection and to take steps to prevent further spread. For example, a 
group of scarlet fever case reports may be received all at one time by 
the county health officer, Bach of the physicians reporting these cases 
may have seen only one or two cases and not be aware that there is any- 
thing unusual, but the county health officer, noticing that all of these 
patients have become ill within a few days of each other, realizes that 
it is unusual, and he and his staff will be competent to make a proper 
investigation. This investigation may trace the outbreak to infected 
milk, and prompt action would be taken to prevent more cases, thus elimi- 
nating much unnecessaiy suffering- and deaths. Time is extremely important 
in such a situation; adequate health services immediately available in the 
county will save time in recognizing and controlling such an outbreak. 
In certain other diseases, such as typhoid fever, every case re- 
ported is carefully investigated to determine the source and prevent ad- 
ditional cases occurring from that source. Here again the availability 
locally of properly trained full-time personnel and availability of ade- 
quate laboratory service to help in these investigations may mean the 
prevention of much unnecessary suffering and premature death. 
An ounce of prevention, of course, is worth a pound of cure, and 
the health department will devote much of its time in'preventing communi- 
cable tdiseases rather than putting into effect control measures after such 
diseases have 'already appeared in the community. This in addition 
to the sanitation services already outlined, emphasis on specific iramuniza-r 
tion against diphtheria, smallpox, and whooping cough, as well as against 
other diseases under special circumstances. This means a constant campaign 
on the part of the health department to inform the people of the need for 
such immunization, to persuade them to take their children and themselves 
to their physicians to be immunized, and to conduct clinics for such im- 
munization of those individuals who will not go to their own physicians 
for this purpose. 
There are one or two commimicable diseases which are particularly 
important because of the large number of cases which occur in every community 
and the seriousness of these diseases. Tuberculosis is one of them. It is 
a serious, "catching" disease, but it can be cured if discovered early, and 
its spread to others can be prevented if each infectious case is found early, 
goes to a hospital promptly, and stays there until he is no longer infectious. 
Prompt hospital care thus is best for the patient himself and for everyone 
else in the community. The trouble is that in the early -stages- there are 
no symptoms, or they are so slight that the individual does not know that 
he has tuberculosis. 
In order to detect such cases, all individuals who are known to 
have been exposed to a person with tuberculosis must have chest x-rays 
periodically; and a new development is providing free chest x-rays to all adults in a community, so-called "mass x-ray surveys". Although the State 
Department of Health, because of the size and the cost of the program, 
necessarily must take the lead in much of this tuberculosis control program, 
it will be successful only if there is wholehearted assistance locally in 
arranging for groups to be x-rayed, arranging for people who are found to 
have tuberculosis to receive hospitalization and arranging for members of 
their families who have been exposed to be examined periodically. The per- 
sonnel of a county health department are trained to do this job. 
The other special communicable diseases are the so-called 
"venereal" diseases, principally syphilis and gonorrhea. If a person has 
one of these diseases, and he is treated early and adequately by the new 
methods recently made available, not only is he promptly made incapable 
of spreading the disease to others but he will not develop later the ter- 
rible crippling and even fatal after-effects which often occur in a non- 
treat ed case. Thus, here again prompt diagnosis and prompt and adequate 
treatment are best, both for the patient with the disease and the people 
in the community. And once again, to do a proper control job there should 
be properly trained public health physicians and nurses working every day 
in the county to see that patients receive treatment pronptly; to see that 
they stay under treatment until they are no longer infectious and are not 
likely to relapse; to see that those who have been exposed to them are 
examined to find out if they have caught the disease, and if so, to arrange 
for them to receive medical treatment; to make readily available expert 
help in diagnosis in cases in which it is difficult to tell whether or not 
the patient is suffering from the disease; and to cooperate with the local 
police authorities in closing and keeping closed houses of prostitution, 
which are such prolific sources of these particular infections. Here, too, 
readily available adequate local laboratory service is essential to doing 
a good job. 
There is nothing quite so tragic as the death of a mother in 
childbirth. Here again organized community effort can help reduce the 
frequency of such tragedies. They may be reduced through having the 
expectant mother come under the care of a physician early in pregnancy 
and continue under such care throughout pregnancy, and by having delivery 
take place in a properly equipped and maintained hospital or maternity 
home. The health department public health nurses can assist in having 
the pregnant woman place herself under the care of a physician early and 
report to the physician in accordance with the schedule which he outlines. 
The public health nurse will also assist the mother in evaluating 
symptoms which occur during pregnancy and in deciding whether or not they 
need to be brought to the attention of the physician before the next regular 
visit. She is able to be of great help to the mother in assembling and 
making clothes and other materials she will need for the care of the baby 
after it arrives. 
Maternity homes will be regularly inspected by a staff member of 
the health department to bo certain they arc being,conducted safely and properly, (Hospitals in most instances are inspected by representatives 
of the State Department of Social Welfare and the American College of 
Surgeons, Even here, however, the qualified staff of a county health 
department can often give helpful advice as to the best procedures to 
be followed in the maternity wards and new born nursery, as well as in 
the communicable disease isolation wards and elsewhere in the hospital.) 
"As the twig is bent so grows the tree", thin a relatively 
few years, the nature of the population of a community is changed through 
the children which have been born into it and their growing up into 
adults. If these new citizens are given every opportunity for the best 
possible growth and development - physically, mentally and morally - the 
community will be a much more happy and prosperous one than if such op- 
portunities are not provided. This actually goes back to before birth, 
since birth is merely an incident in the development of a person. Thus 
proper prenatal care of the expectant mother, through proper nutrition 
and skillful delivery in a properly equipped hospital or maternity home, 
not only reduces the chances of a fatal outcome in the mother but in- 
creases tremendously the possibility of a coupletely normal infant at 
birth who is off to a good start in life. 
However, assistance is also needed by the mother throughout the 
infant, childhood and adolescent stages of development in the child. Here 
again, organized community effort, represented by the health department 
(particularly by the public health nurses), the physicians in the community, 
and other groups and agencies, can be of great help in giving this needed 
assistance. Infants and young children need to be examined periodically by 
qualified physicians to be sure that they are developing properly, and to 
correct any defects,while they can still be corrected and before doing 
permanent damage. 
The mother needs advice with regard to feeding the family so as 
to assure optimum growth through proper nutrition, and this will be obtain- 
ed to a large extent through the local public health nurses who, in turn, 
will have received expert advice from qualified nutirtionists made available 
through the State Department of Health, 
Regular dental inspection with proper treatment of the teeth 
when indicated is an important part of this program. The crippled child, 
whether due to infantile paralysis, cerebral palsy or some other condition, 
is particularly in need of help, as well as his family, and special ser- 
vices and financial assistance are available, provided by the State De- 
partments of Health and Education in cooperation with the county Judges 
of the children’s courts. Here again, however, it is not possible for a 
community to take full advantage of these services unless it has an ade- 
quately staffed health department to develop them in accordance with the 
needs of that community. 
Many other very important activities could be mentioned, such as 
the early detection and proper treatment of cancer, and the prevention of 
accidents in the home and on the farm, but these few examples show the kind 
of public health service every community is entitled to, and which can be given best through a county health department adequately staffed with 
specially trained workers. 
The work of a county health department may vary from year to 
year or from day to day according to the particular needs or desires 
of the communities which it serves. The gains in improving the health 
of the public in the past have been achieved largely through the com- 
bined efforts of health ofiicers, public health nurses, sanitarians, 
laboratory technicians, health educators and others. Actually, a team 
of workers such as these, each trained in his special field, makes up 
the personnel of the health department. As individuals and as a team 
they should be a part of the community and constantly alert to the 
health needs of its people. 
They should be easily accessible and ready to turn their at- 
tention to any problem concerning the health of the nubile, whether it 
be the prevention of epidemics, stopping epidemics if and when they get 
started, saving the lives and improving the health of mothers and chil- 
dren, arranging for people with cancer, rheumatic fever, or other con- 
ditions to receive proper care at a time when they may be cured and 
resume normal lives, or promoting other facilities and resources for 
meeting the health needs of the poqple. 
The organization of such a team for each individual village 
and town is not practical, since a small community cannot afford nor 
does it have a sufficient volume of work to Justify the employment of 
these full-time properly trained workers. Therefore, over the past 
years, the state has found it necessary to supplement local service by 
employing and assigning certain trained personnel to district offices to 
provide health services which should have been provided locally. This 
has not been entirely satisfactory, however, since the number of state 
personnel available could not possibly provide the amount of service re- 
quired for a good and effective local public health service. Generally 
speaking, the county is the optimum governmental unit for providing 
such services, through a county health department. 
In order to assist the counties in providing lor these ser- 
vices an amendment has been made in the public health law to provide 
for state aid for county and part-county health departments to the 
extent of 75 Per cent of the first $100,000 expended for approved pub- 
lic health work (Appendix A-l), Expenditures above $100,000 are reim- 
bursable on a 50 per cent basis. State aid for county health work in 
counties not organized as county health departments is continued on the 
same 50 Per cent basis as heretofore. Towns and villages are not eligible 
for state aid for public health work. 
Under the public health law, the retention of boards of health 
and health officers' of the individual towns and villages is permitted when 
local opinion so directs. Such health officers continue to be paid by the 
local municipality rather than by the county, although they become deputies 
of the county health officer and perform such duties as may be delegated to 
them in the towns or villages which they serve. As regards Allegany County, the minimum public health person- 
nel required to staff the county health department and the estimated 
cost thereof would be as follows: 
Personnel 
Annual Salary Range 1/ 
xlealtn commissioner 
Clinic physician fees 
Director of Public 
Health Nurses 
8 Public Health Nurses 
at $2,280 - $2,880 2/ 
Public Health Engineer 
Sanitary Inspector 
Milk Sanitarian 
Veterinarian, part-time 
Dentist, part-time 
2 Dental Hygienists at 
$2,000 - $2,500 
Health Educ at 0 r 
Office Manager 
4 stenographers or clerks 
at $1,200 - $1,700 
Total 
$6,000 $7,000 
2.500 2,500 
3,360 4,020 
18,240 23,040 
4.500 5,500 
2,400 3,000 
3.600 4,350 
1.600 2,000 
1.600 2,000 
4,000 5.000 
2,600 3,225 
2,520 3,120 
4,800 6,800 
$57,720 $71,555 
Annual Maintenance and Operating Costs 
Total 1/ 
14,300 14,300 
$72,220 $Sb,055 
If It is difficult to recommend definite salaries because of the 
rapid changes in the cost of living and corresponding salary 
levels. These ranges are suggested as those currently in force 
for public health personnel. It is recognized that some modi- 
fications may be indicated in a particular county to provide 
salaries in line with local salary levels. 
2/ This does not provide for sufficient instructive bedside nursing 
care of the sick nor sufficient school nursing. If it is planned 
to increase this service additional nursing personnel will be re- 
quired as described on page 13. 
3/ The cost of original equipment is not included in this estimate, 
since the amount required would be dependent on an evaluation of 
existing equipment which might be ;used. If these salaries are accepted, the annual cost for salaries 
and maintenance and operation will vary between a minimum of $72,220 
and a maximum of $86,055* 2or preliminary planning purposes, $75»OQO 
is suggested. State aid reimbursement on expenditures of this amount 
would be $56,250, leaving $18,750 as the amount to be raised by county 
taxation. Of this amount, $6,025 is already provided for as the 
county’s share of the cost of nursing service, exclusive of the pun- 
chase of new cars, in the budget. Therefore the net estimated 
increase in the total budget would be $12,725» or 19 cents per $1000 
over the county tax rate of in 1J 
There is much to recommend the combination of school medical, 
school dental, and school nurse teacher services with the general 
health program of the county health department. Such an integrated 
service would be not only in the interest of econoraft, but also would 
result in an improved opportunity for continuity of health work as the 
preschool child passes into school age, or as the school child is 
found in need of health services or related medical care, which can, be 
provided through the public health program* 
"There the school health service is administered as part of 
the general health program of the county, the program must be planned 
in conjunction with the school authorities and the work in each par- 
ticular school district must be approved ty the appropriate school 
authorities under the provisions of the Education Lav/ and under the 
regulations prescribed pursuant thereto, 
Nursing care for the sick is an important service related 
to public health nursing. The purpose of such service is to teach 
a responsible member of the family or a practical attendant the pro- 
cedures of home nursing care and the methods of carrying out the 
treatment ordered by the private physician. Visits for this purpose 
average about one hour in length .and are spaced in accordance to the 
needs of the patient. Calls for the nurse may be received from 
physicians or families, but the nurse only gives her services where 
there is a physician in attendance whose orders for treatment are 
followed. 
This is a worthwhile and popular service and has economic 
values to the individual citizen and to the public budget. It is 
directly related to efficient use of hospital facilities. 
Where it is planned as pant of the public health nursing 
service, registered professional nurses should be employed part-time 
or full-time to assist the public health nurse. It has been determined 
that a population of 5000 would need, on an average, one public health 
nurse assisted by a registered professional nurse for sickness care 
and for certain aspects of clinic work, A practical nurse as an extra 
assistant to the public health nurse may be thought of later wherever 
the care of chronics is included and where the case load is heavy. 
ly Proceedings of the Board of Supervisor of Allegany County, 19^5»P«2d8 Since public health laboratory services constitute an essential 
part of a comprehensive health program, it is preferable that such ser- 
vices be included in the county health department. Under the existing 
Public Health Law, Sections 20-c to 20-h, (Appendix A-2) - separate pro-* 
vision is made for state aid for public health laboratory services. This 
supersedes the general provisions for state aid for county health ser- 
vices previously referred to. This unit of service must, therefore, be 
financed separately. 
In addition to the services of the county health department for 
which provision is made above, certain supplemental specialized public 
health services would be provided on a cooperative basis by the state. 
These would deal with specialized or advisory functions in which the re- 
quirements of Allegany County would be insufficient to justify the full- 
time employment of highly tr ined technical personnel. Examples of the 
service which might be provided by the state are orthopedic nursing ser- 
vice, specialized consultation and diagnostic service in orthopedics, 
obstetrics, pediatrics, tuberculosis, the venereal diseases and other 
communicable diseases, and consultation services in nutrition and medi- 
cal social service, but it is hoped that in the future counties may find 
it possible to employ the part-time services of some of the foregoing 
speciali sts, THE COUHTY PUBLIC HEALTH LABORATORY 
Adequate laboratory services are a fundamental of good 
medical care and a public health program. They are essential as 
an aid to diangosis, to communicable disease control, to certain 
forms of therapy, and to the practice of preventive medicine. No 
plan can be considered complete that does not make ample and ade- 
quate provision for such. 
Under the provisions of the Public Health Law, Sections 
20-c — 20-h, inclusive (Appendix A-2), the board of supervisors 
of any county is empowered to establish therein a laboratory or 
laboratories which shall serve the whole or part of the county. 
Under certain conditions specified in the law, they may apply for 
state reimbursement of 50 per cent of the cost of maintaining each 
laboratory in an amount not to exceed $7,500 per annum. In addition 
state aid may be received not to exceed $2,500, toward the initial 
installation and equipment of each laboratory. Laboratories re- 
ceiving such aid must fully meet the standards of the Commissioner 
of Health for approval as a public health laboratory. 
As far as Allegany County is concerned, an ideal oppor- 
tunity presents itself to develop further and operate the publis 
health laboratory as a part of the coordinated county hospital and 
health department plan. It is suggested that the main county lab- 
oratory be located in the proposed general hospital at Wellsville 
with branch facilities at Cuba, and the present county laboratory 
in Belmont be discontinued* 
The two laboratories at Cuba and Wellsville should be ' , 
under one qualified Director who would be a competent pathologist 
and would be available for.consuitat ion in the laboratory phases 
of medical problems. The estimated annual budget and method of financing for the 
laboratory service is as follows: 
JLxpenses 
Personnel 
Director $9000 
Wellsville 
Assistant bacteriologist 2500 
Senior technician 2200 
Junior technician 150n 
Helper 1200 
Secretary 2000 
' Cuba 
Senior technician • 2200 
Junior technician 1500 
Total $22,100 
Supplies and maintenance 3*900 
Total $26,000 
Method of Financing 
Income from fees paid by private patients 8,000 
State aid reimbursement (50 per cent of 9*000 
$26,00 less income from fees received 
from private patients) 1/ 
Net cost to county 9, OOP 
Total $26,000 
The floor space recommended for the laboratories to serve the 
two hospitals as well as the county laboratory would be 1500 square feet 
at Wellsville and 500 square feet at Cuba. Since it is recommended that 
the laboratories be housed in the proposed county general hospitals, the 
additional expense would be that of supplying an additional 1500 square 
1/ Up to maximum of $7,500 for each of the two proposed laboratories. feet of construction to the Wellsville plant and an additional 500 square 
feet to the Cuba general hospital plant. Provision has beep made for this 
in the estimated cost of construction of the county hospitals in Section IV 
of this prospectus. 
The equipment now in the laboratory at Belmont could be transferred 
to one of the proposed new laboratories. Additional equipment would be need- 
ed, however, for which an additional $2500 of state funds would be available 
under the provisions of 20-h of the public health law. THE COUNTY GENERAL HOSPITAL 
This plan is developed upon the premise that in the public in- 
terest the preventive, diagnostic, and curative fields of medicine must 
be readily available to all members of the community. The provision of 
such services and facilities, particularly in rural areas, is recognized, 
however, as one of the major problems confronting the country. 
There has been a continuing decline in the number of physicians 
in rural areas. While economic conditions are in large measure responsible 
for this situation, they are not the only factor. The young physician has 
been educated and trained to use and depend upon the modern hospital and 
laboratory as essential tools for the use of his scientific knowledge and 
skill in a manner satisfying to him in discharging his obligation to his 
patients. Furthermore, in his training he has become aware of the advan- 
tages of consultations with specialists in problem cases, and such readily 
available consultation service is provided in the modern hospital. Thus, 
the medical school graduate of today will not elect to go to rural areas 
without adequate hospitals and laboratories. Therefore, the community 
that wishes to have adequate medical services must have the foresight to 
provide the physical equipment that will attract the efficiently trained 
physician. 
INTEGRATION OF PUBLIC HEALTH AND HOSPITAL SERVICES 
In recent years, there has "been a growing realization that there 
can he no hard and fast lines between the health of the mass of the people, 
such as sanitation and quarantine (public health), and the health of the 
individual, In the past, the general hospitals have been thought of en- 
tirely as places where acutely ill individuals were taken to get well* 
Health department activities, on the other hand, have dealt primarily with 
the prevention of disease in large groups of people. 
The prevention of disease and maintenance of good health begins 
with the individual and it is important for the physician to give much of 
his attention to preventive measures and to the maintenance of optimum 
health of his patients. Large opportunities erist for the collaboration 
of the physicians, hospitals, and public health authorities in the conduct 
of effective health education, collection and analysis of mortality and 
morbidity statistics, case-finding and control in tuberculosis and the 
venereal diseases, and other health services. In fact, it may be said 
that only through such combined action can there be developed an adequate 
health service for the people,, 
Except for statistics that can be compiled from reports of cases 
of communicable diseases and cancer, death statistics provide the only re- 
liable guide we have today regarding the general health of the public. It appears highly desirable for hospitals, which serve over one-tenth of the 
population annually, to assist in the development of a system of sickness 
reporting. Such data would furnish a much more reliable basis upon which 
to measure the health of the people and the effectiveness of health measures 
than those which are now used. This problem, like most others, would be 
handled for the greater benefit of the public if hospitals and health de- 
partments integrated their facilities in a coordinated program. 
Hospitals are in a strategic position for the dissemination of 
reliable health information. If a program of health education were de- 
veloped by the hospitals, they would become the focal points for health 
activities in the community. In view of the fact that so large a propor- 
tion of the population (patients, their relatives and friends) are passing 
through these institutions each year, a large opportunity exists for hos- 
pitals to share more extensively in health education work. Education in 
matters of health is notoriously of little interest to healthy people; but 
when they fall ill, their curiosity as to cause, cure, and prevention is 
aroused, end they together with their relatives and friends, show an avid 
eagerness for knowledge. Hospitals and health authorities have an excellent 
opportunity for collaboration in this field. 
It would be advantageous also if the public health nurses were 
responsible for follow-up of patients discharged from the hospitals to the 
care of private physicians and patients receiving out-patient service. 
This would require the formulation of a plan by the physicians, hospitals, 
and health department for the referral of patients, transfer of records, 
and other pertinent information to provide continuity of nursing care in 
accordance with patients’ needs. The hospitals also should be available 
as centers for refresher courses and instruction for the field nurses as 
well as their own nursing staffs* They would serve as the centers for 
the clinical practice and mobilization of volunteers, auxiliary nursing 
aides, and practical nurses in an integrated program of community service. 
There would also be an opportunity for interchange between the hospital 
nursing staffs and the field nursing staffs which would prove of great 
value and represent a potential economy in case of emergency. 
AFFILIATION WITH MEDICAL TEACHING- CENTERS 
The affiliation of smaller hospitals and health facilities with 
larger institutions in which comprehensive and competent service in the 
special fields of medicine are available has been proposed in order to 
maintain a proper standard of service in the smaller hospitals and provide 
for the continuing education of the physicians practicing at these in- 
stitutions* It has been suggested that the facilities of the medical 
schools and the teaching hospitals be sufficiently augmented so that quali- 
fied instructors and consultants could regularly visit these outlying in- 
stitutions to assist the local staff, provide postgraduate instruction, 
and be available upon call for consultation services to the local physi- 
cian, If we are to be successful in improving medical services in rural and small urban areas, it is believed necessary that such a system of 
affiliation be arranged. This action would provide for a more inter- 
esting and satisfying medical career for the rural and small urban 
physician and allow for a larger number of patients to be cared for at 
their community hospital. Under a system of affiliation it should be 
possible for the small urban and rural hospitals to develop through 
their attending physicians the indicated staff of specialists and to 
provide for the establishment of competent well-organized services in 
the several departments of medicine and surgery. Affiliation should 
do much to strengthen the quality of services and bring about full 
local support of the public. 
The consultation and advisory services obtained through the 
type of affiliation proposed fall intv. two broad categories, each of 
which would be financed differently: (l) Consultation and advisory 
services to the hospital as a whole, such as regularly scheduled con- 
ferences with the hospital staff on x-ray problems, surgery, medicine, 
obstetrics, pediatrics, hospital administration and nursing, which 
would be services to the entire medical staff, with payment probably 
considered a part of the operating cost of the hospital and reflected 
in the daily charge to patients or in the operating deficit, (2) 
Specialist consultation service rendered in emergencies or in the 
treatment of individual patients apart from the regularly scheduled 
conferences, which would be obtained-on an individual case basis and 
charged to the individual patient. 
CHRONIC DISEASE HOSPITAL CARE 
One of the major problems in medicine today is the control of 
chronic disease* As a part of long-term planning, consideration should 
be given in the development of community hospital facilities for the pro- 
vision of public diagnostic, treatment, and follow-up services for those 
suffering from chronic diseases as a part of a coordinated health and 
hospital service. The chronic disease facility should be expected to 
operate at a lower patient day cost than the general hospital proper, 
FEDERAL AND STATE AID 
The regulations pertaining to state aid provided through the 
State Department of Health (Public Health Law, Article II-B; Appendix 
A-l) in the amount of 50 per cent of the cost of construction and main- 
tenance of a county general hospital are given in Appendix C. In ac- 
cordance with the provisions of the law, the Commissioner of Health is 
expected to establish standards for the construction and operation of 
such hospitals. These are currently under review, but, in general, will 
be similar to those required for approval by the American College of 
Surgeons (Appendix C), Federal aid to the extent of one-third of the cost of con- 
struction is administered by the Joint Hospital Board of the Postwar 
Public Works Planning Commission in accordance with regulations 
promulgated by the Surgeon General of the United States Public Health 
Service and the Stale Agency (Appendix E). 
EXISTING HOSPITAL FACILITIES 
There are at present three general hospitals in Allegany 
County v/ith a total bed capacity of 85 beds. The 15-bed hospital at 
Fillmore (Genesee Country Memorial Hospital) and the U2-bed hospital 
at Wellsville (Jones Memorial Hospital) are non-fire resistive and 
were not originally constructed to be used as hospitals. In reality, 
the county has only one hospital of modern fire-resistive construction. 
That is the Cuba Memorial Hospital at Cuba with a bed capacity of 28, 
The Cuba Memorial Hospital operated with an average daily 
patient census 66 per cent of its capacity during which is 
slightly above the normal percentage occupancy expected for a hos- 
pital of its size. The Genesee Country Memorial Hospital operated 
during the same year with an average daily census of only 32 per cent 
of its capacity. The Jones Memorial Hospital, on the other hand, 
operated at 103 per cent of its normal capacity and found it necessary 
to establish 13 additional beds to meet the demands for its facilities 
in recent years, 
v- 
The geographic distributions of patients are available for 
the hospitals in Cuba and Wellsville in Of the 729 patients 
discharged from the Cuba Memorial Hospital in that year, 295 were resi- 
dents of Cuba; 337 were from the rest of the county; and 97 were from 
outside the county or the state. Of the I865 patients discharged from 
the Jones Memorial Hospital at Wellsville in the same year, 655 were 
residents of the village of Wellsville; 925 were from the rest of the 
county; were from other counties and 204 were from outside of the 
st at e. 
ESTIMATED NEEDS 
The number of available general hospital beds in Allegany 
County is considered inadequate. The formula based on births and deaths 1/ 
which is currently recommended as an index of general hospital needs, 
indicates that the average daily general hospital census of Allegany 
County residents alone might be expected to be 169, Allowances for the 
referral of patients to the larger medical centers in Buffalo or Roches-* 
ter and for periods of increased demands because of seasonal or epidemic 
1j HospitalSurvey News Letter, Commission on Hospital Care, Chicago, 
Illinois, July 19*+6, increases in illness, emergencies, etc., indicate a final estimated 
need of 183 general hospital beds in Allegany County, determined as 
follows: 
Expected average daily census 169 
l 
Number of additional beds needed to 
meet seasonal and other fluctuations 
in demands. U6 
Total 215 
Allowance for referral of patients 
to larger medical centers for specializ- 
ed care, 32 
Estimated total number of general hospi- 
tal beds needed in Allegany County, 183 
Of this number, as stated above, a total of 85 beds are already 
available but 57 are in buildings which are not fire-resistive and were 
not constructed to be used for hospital facilities, leaving only 28 beds 
that are suitable and safe for use at the present time. Therefore, there 
is a need for 155 new general,hospital beds, or replacements in Allegany 
County, 
The determinant ion of the best size of hospital is a difficult 
problem in rural areas. Hospital facilities should be accessible to 
those in the most distant points in the community. Yet, each hospital 
should be large enough to make it possible to maintain adequate stand- 
ards and efficient operation. 
The construction and operation of a general hospital of less 
than 50 "beds is not considered good modern practice from a financial or 
medical staff standpoint. As hospitals decrease in size below 100 beds, 
it is increasingly difficult to provide the necessary balanced medical 
staff of specialists. If hospital care of high standards is provided, 
there will be a sharp increase in the patient-day cost, and the per- 
centage occupancy possible during normal periods will be materially re- 
duced* In other words, smaller hospitals will have a larger proportion 
of vacant beds for longer periods if they are planned to meet peak loads. 
The present.trend in design is toward a compact multi-storied 
plan, since such a structure is less expensive to build, operale, and 
maintain. Because of hospital insurance and the rise in living standards 
thfere is a trend today Which indicates that the future public demand will 
be for more semiprivate facilities and fewer ward-type facilities than in 
the past, (See Appendix D for reference) The ideal hospital plan for Allegany County would be one 150 
bed hospital preferably located at Wellsville and containing the physical 
facilities for the activities of the full-time county health department 
and the county laboratory. Because of the existing facilities and inter- 
ests, however, the alternative of a 100-bed hospital at Wellsville to 
replace the existing non-fire resistive plant and an expansion of the Cuba 
Memorial Hospital to 50 beds is suggested. 
It is suggested that these projects should be carried out at 
the earliest opportune date and that consideration be given in future 
planning to modern replacement of the Genesee Country Memorial Hospital 
at Fillmore to serve as a branch unit of the Wellsville hospital. The 
branch unit should have interchange with and supervision from the 
wellsville Hospital so far as administrative facilities and1 services 
are concerned. 
The plan for the Jones Memorial Hospital at Wellsville should 
include facilities for the main office of the county health department 
and facilities for its activities, including clinic and health education, 
A branch of the county health department is suggested for the Cuba Hospi- 
tal, The county laboratory also should have its headquarters at the 
Wellsville hospital with a branch at the Cuba hospital. 
Cuba Memorial Hospital 
The plan for a 5£i~tied.hospital and health center would require 
a total of approximately square feet of floor space, ij including 
the existing plant. This would provide ten one-bed private rooms, 12 
two-bed semiprivate rooms and four four-bed wards, plus two single isola- 
tion rooms and a nursery with eight bassinets. It would provide two op- 
erating rooms, one delivery and one labor room, 2/ 
The floor space of square feet would be apportioned as 
follows: 27,750 square feet, or 555 square feet per bed for hospital 
facilities and approximately 15,250 square feet for public health admin- 
istration, public health clinics, laboratory, social service, and related 
activities. If it appears desirable, certain out-patient services and 
T/ Exclusive of office facilities for lease to private physicians who 
are members of the attending staff. 
2j Eor the details of requirements in floor space for the various branches 
of hospital service* reference should be made to "Planning Suggestions 
and Demonstration Plans for Acute General Hospitals" by 'MacDonald and 
Schaffer, reprinted from HOSPITALS, July • follow-up clinical services could be held in the clinical spaces of the 
branch health department wing. If it is desired not to have a branch of 
the County Health Department at Cuba, the estimated square footage for 
the floor plans given above can be decreased accordingly. 
Jones Memorial Hospital at Wellsville 
The city might consider turning the present plant over to the 
county hut a complete replacement of the plant should he considered with 
a capacity of 100 beds including housing facilities for the county health 
department and for the county laboratory service. 
Por a 100-bed hospital there would be required square feet 
of floor space apportioned as follows: U6,700 square feet for hospital 
facilities 1j and approximately 15, 250 square feet for public health ad- 
ministration, public health clinics, laboratory, social service, and re- 
lated activities. 
The new hospital should be planned to provide for one-third of 
the beds on a private basis, one-third semiprivate, and one-third in four- 
bed wards. It would be necessary for the present hospital to function 
during the period of new construction so that the selection of an addition- 
al site might have to be considered. 
1j For the details of requirements in floor space for the various branches 
of hospital service, reference should he made to "PI;arming Suggestions 
.and Demonstration Plans for Acute General Hospitals", hy MacDonald and 
Schaffer, reprinted from HOSPITALS, July 19^3* ESTIMATED COST AND SUGGESTED METHOD OF FINANCING THE CONSTRUCTION PROGRAM 
Co st 
It is very difficult to arrive at a sound estimate of the cost, 
in view of the uncertain conditions of material and labor. The following 
figures are conservative and are based on pre-war costs plus one-third. 
Since the project is of considerable scope, the county should not under- 
take construction at a time when high existing costs would place an ex- 
cessive expense upon the taxpayers. 
a. 
Replacement of Wellsville hospital, 100-bed 
capacity estimated at $7,500 per bed, in- 
cluding standard equipment, health center, 
health department, and county laboratory. 
$750,000 
be 
25-bed addition to the Cuba Memorial Hospi- 
tal at $7,500 per bed 1 /, including stand- 
ard equipment and branch facilities for the 
county health department and laboratory. 
187,500 
v937, 500 
Method of Financing 
3 ✓ 
Federal grant through the State under provisions of 
Public Law 725, Federal Hospital Survey and Construc- 
tion Act, (one-third of total cost - Appendix E) 
$312,500 
• 
State aid for architectural planning through the 
Postwar Public Works Planning Commission (50 per 
cent of cost of preparing plans, specifications 
and estimates, but not to exceed two per cent of 
the total cost of construction.) 
v 13.750 
State aid for construction under provisions of 
Article II-B, Section 19, Public Health Law - 
50 per cent of total cost less federal ©id and 
state aid for architectural planning (Appendix A-l) 
303-. 125 
Cost 
aid) 
to county 2/ (total cost less federal and state 
303,125 
Total 
$937,500 
1J It is anticipated that certain changes would be necessary in the cen- 
tral services of the hospital to provide for the increased capacity. 
2/ It would be possible for. both existing hospitals to undertake a-sub- 
scription drive and turn the proceeds over to the County Treasury for 
the purpose of meeting the planned hospital construction costs.. Like- 
wise, any endowments available through the Board of Trustees of the 
Cuba Memorial Hospital could be handled accordingly. Hospital Operating Deficit 
It is assumed that the cost of caring for patients approved for 
care by the public welfare officials would not be charged back to the 
county, towns, or villages, and that such costs would be cared for as 
part of the annual operating deficit which would be eligible for 50 per 
cent state aid through the State Commissioner of Health. Based on the 
average operating deficit of State aided hospitals of a similar size to 
that which is recommended for Nellsvilie and Cuba, a reasonable estimate 
might be as follows: 
Cuba Memorial Hospital, 50 beds 
$36,300 
The Jones Memorial Hospital, Wellsville, 
100 beds 
37.^00 
Total Estimated Annual Operating Deficit 
$73,700 
50 per cent State aid to the county 
36.350 
Estimated Annual Operating Deficit Cost to 
the County 
$36,350 
No cost has been included for a branch emergency hospital at 
Fillmore* This is a project which might receive consideration at some 
future date. 
CONCLUSION 
The above is a brief outline for co-ordinated health and medi- 
cal care facilities and services for Allegany County, a ruraJ. county of 
39,585 population. It is expected that considerable savings can be ef- 
fected through such a Joint medical care and public health undertaking, 
and at the same time supply needed services to the public and the medical 
profession* 
It would appear desirable for the recommended facilities to 
affiliate with the Rochester Regional Hospital Council, for the provision 
of specialised medical, surgical, and pathological diagnostic and thera- 
peutic services which are not available in the county. Such arrangements 
should make it possible for certain patients who must now go to Rochester 
or Buffalo for their hospitalization to remain near their own homes. RECAPITULATION OF COSTS 
Sgurce of Funds 
Hospital construction l/ 
Total Cost 
Federal State 
County 
Replacement of 100 beds at 
Wellsvilie and 25 "bed ad- 
g/ 
• 
dition at Cuba 
$937,500 
$312,500 ¥321,275 
$303,125 
Annual maintenance and operation 
County health department 
75.000 
56.250 
12.750 
Hospital operating deficit 
73,700 
36,850 
36.850 
Laboratory operating deficit 
18,000 
9,000 
9,000 
Total 
$166,700 
$102,100 
$6U,6oo 
TJ Including floor space for the county health department and laboratory, 
but exclusive of new equipment and offices for lease to private phy- 
sicians who are members of the attending staffs of the hospitals. 
2/ Two per cent through the Postwar Public Works Planning Commission for. 
architectural planning plus $0 per cent through the State Department 
of Health toward the total cost of construction less federal aid and 
state aid for architectural planning. SUGGESTED SEQUENCE OF STEPS RECOMMENDED 
IN PLANNING AND OBTAINING STATE APPROVAL 
, The following suggested steps are intended to clarify what may 
seem to be a complicated and confusing process of clearance. Certain 
State approval is required under the law for the construction of the pro- 
posed general hospital facilities. Other types of clearance or approval 
also are required in obtaining state aid. 
Under existing law and administrative regulations, the three 
chief elements of service concerned, i.e, the establishment of the county 
general hospitals, county health department and the expansion of county 
public health laboratory, need not all be undertaken at once. However, 
in the interest of an efficient and economical medical and health service 
for the county, all three are strongly recommended, and the steps recom- 
mended are based on such an integrated program* 
It would be possible to establish a county health department 
alone and to obtain state aid. Similarly, it would be possible to expand 
the county laboratory service alone and obtain state aid within the liraitar* 
tions prescribed. Under the existing regulations, however, it is no longer 
possible to obtain state aid for the construction and operation of the 
county general hospitals except as they are a part of, or closely coordin- 
ated with, the services of a full-time county health department. This 
restriction, however, does not apply to the possibility of obtaining feder- 
al assistance under the Federal Hospital Survey and Construction Act, 
RECOMMENDED STEPS 
1, State assistance up to 50 per cent of the cost of preparing plans, 
specifications* and estimates for 'building programs by counties but not 
to exceed two per cent of total cost of the project, is available through 
the Postwar Public Works Planning Commission. Application should be address- 
ed to that agency. Governor Alfred E. Smith State Office Building, Albany, 
New York, 
2, Before construction is undertaken, the county is required to 
submit its plans for the hospital to the State Department of Social Welfare 
for approval (Appendix A-U), This should be done through the Rochester 
Area office, U5 Exchange Street, Rochester U, New York, 
3, If assistance through Federal funds (Public Law 725) f°r the 
hospital construction is to be requested, application for approval of the 
project and plans should be filed with the Postwar Public Works Planning 
Commission, since such approval is requisite to the granting of Federal 
funds. This approval is in the interest of good overall State planning „ and integration of hospital services. Procedures for application for 
Federal funds are not available as yet but will be released within the 
next few months. 
4* If state aid under Article II-B, Section 19, of the Public 
Health Law is to be requested, the following steps should be taken: 
a. A county health district must be established. Assistance 
and advice in the necessary steps will be provided by the 
District State Health Officer, Dr. D, P, McMahon, Federa- 
tion Building, *42 Broadway, Hornell, New York, This county 
health district must embrace the entire area of the county. 
For the approved expenditures of such a county health de- 
partment, the county may receive reimbursement in the amount 
of 75 Per cent of the first $100,000 spent annually and 50 
per cent of any amounts expended in excess of $100,000, 
b. A county general hospital may then be established in ac- . 
cordance with the provisions of Sections 126 to 133 °f the 
General Municipal Law (Appendix A-3). If the hospital is 
so established and operated that it meets with the regula- 
tions and standards established by the Commissioner of 
Health and is operated as a part of, or is satisfactorily 
coordinated with the county department of health (Appendix 
C), the county may apply for state aid of 50 per cent for 
moneys expended in the construction and operation of such 
hospital. If such state aid is to be requested, clearance 
with the District State Health Officer through all stages 
of organization and planning is desirable in order to pro- 
tect the interest of the county, 
5* The county public health laboratory must, under the current 
provisions of law (Appendix A-2), be financed as an independent unit 
since separate application for state aid must be macLe to the State Com- 
missioner of Health, vThe District State Health Officer can advise and 
assist with this, 
6, Should the county be in receipt of voluntary contributions for 
the construction and/or operation of the county general hospital and 
health department facilities, such moneys, if expended by the county, 
may be considered as county funds and are creditable for establishing 
a claim for State reimbursement, provided such funds are accepted and 
appropriated by the county board of supervisors. 
It would be highly desirable for the powers and duties of the 
Board of Managers of the county laboratory to be conferred upon the 
county board of health as permitted under paragraph 8, Section 20-b, 
(Appendix A-2) of .the Public Health Law, Early revision of the law to 
permit the greater unification cud coordination of all three boards, 
i,e, the Board of Health, the Board of Managers of county general hos- 
pitals and the Board of Managers of public health laboratories is being 
considered by the legislature currently in session. APPEND I X 
APPENDIX A 
1. Public Health laws relating to county health districts and state 
aid to counties for public health work. 
2. Public health laws relating to public health laboratories and 
state aid for public health laboratories. 
3* General municipal law relating to the establishment and operation 
of public general hospitals. 
U, Social welfare law relating to inspection and supervision of hos- 
pitals. 
APPENDIX B 
Effective Units for Health Service in New York State 
by V, A. Van Volkenburgh, M,D» 
APPENDIX C 
1, Official notice to boards of supervisors on state aid for 
public health purposes. 
2. New York State Department of Health rules for state-aided county 
general hospitals. 
3* Standards for approval of hospitals by the American College of 
Surgeons. 
APPENDIX D 
References on hospital and health center planning and construction. 
APPENDIX E 
1. Abstract of the Federal Hospital Survey and Construction Act. 
2. New York State Plan for Survey of Hospital Facilities and Program 
for Regional Hospital Planning for Postwar Hospital Construction, 
New York State Postwar Public Works Planning Commission Joint Hos- 
pital Board, 
3. Hospital Survey and Planning in New York State, 
by John J, Bourke, M,D. 
APPENDIX E 
Map showing average annual Infant Mortality Rates by counties, New 
York State exclusive of New York City, 19^0-19^+, MTEHDIX A- 
LAWS OF NEW YORK.—By Authority 
CHAPTER 1000 
AN ACT to amend the public health law, in relation to state aid for public 
health, work and the organization, establishment and operation of certain 
health districts 
Became a law April 24, 1946, with the approval of the Governor. Passed, 
three-fifths being present 
The People of the State of New York, represented in Senate and Assembly, 
do enact as follows: 
Section 1. The article heading of article two-b of chapter forty- 
nine of the laws of nineteen hundred nine, entitled ‘ ‘ An act in rela- 
tion to the public health, constituting chapter forty-five of the con- 
solidated laws,” such article having been added by chapter six 
hundred sixty-two of the laws of nineteen hundred twenty-three, is 
hereby amended to read as follows: 
ARTICLE 2-B 
State Aid for Public Health Work1 
§ 2. Section nineteen of such chapter, as added by chapter six 
hundred sixty-two of the laws of nineteen hundred twenty-three and 
last amended by chapter seven hundred twenty-two of the laws of 
nineteen hundred thirty, is hereby amended to read as follows: 
§ 19. State aid to counties and certain cities2 engaging in public 
health work. 1. As used in this article: 
(a) “County” means any county of the state other than one 
wholly embraced within a city. 
(b) “City” means each city of the state having a population of 
fifty thousand or more, according to the last preceding federal 
census, but does not include any such city which is included as a 
part of a county health district pursuant to section twenty-b of 
this chapter. 
(c) “Municipality” means a county or city. 
(d) “Governing body” means the board of supervisors of a 
county or the common council, city council or other legislative body 
of a city.3 
2. Whenever the board of supervisors of any county shall appro- 
priate and expend moneys for the construction, establishment or 
maintenance by such county of a county, community, or other public 
hospital, clinic, dispensary or similar institution, or for the purpose 
of defraying the expenses of such county in any public enterprise or 
activity for the improvement of the public health, or any public 
health work undertaken by such county, within limits to be pre- 
scribed by the state commissioner of health, such county shall 
receive state aid in the manner and subject to the conditions pre- 2 
scribed in this article unless state aid is otherwise specifically pro- 
vided for any such purpose by this chapter or any other law/ 
3. Whenever any city shall appropriate and expend moneys for 
the purpose of defraying the expenses of such city in any public 
enterprise or activity for the improvement of the public health, or 
any public health work undertaken by such city, within limits to be 
prescribed by the state commissioner of health, such city shall 
receive state aid in the manner and subject to the conditions pre- 
scribed in this chapter unless state aid is otherwise specifically 
provided for any such purpose by this chapter or any other law.8 
§ 3. Section nineteen-a of such chapter, as added by chapter six 
hundred sixty-two of the laws of nineteen hundred twenty-three and 
amended by chapter two hundred seventy-eight of the laws of nine- 
teen hundred twenty-four, is hereby amended to read as follows: 
§ 19-a. Approval of state commissioner of health. It shall be the 
duty of the state commissioner of health to formulate standards of 
construction, equipment, service, administration and work which 
must be complied with by such municipalities6 in order to be 
entitled to state aid, and no state aid shall be given to any 
municipality unless the state commissioner of health, after inspec- 
tion and examination by him or his representative, shall make 
his certificate that such construction, equipment, service, administra- 
tion or work is necessary to the public health and conforms to the 
standards so established therefor, and to the limits prescribed by 
him as required by section nineteen of this chapter, 
§ 4. Section nineteen-b of such chapter, as added by chapter six 
hundred sixty-two of the laws of nineteen hundred twenty-three and 
last amended by chapter seven hundred thirty-two of the laws of 
nineteen hundred forty, is hereby repealed, and such chapter is 
hereby amended by inserting therein in lieu thereof a new section, 
to be section nineteen-b, to read as follows: 
§ 19-b. Amount of state aid; procedure. 1. The board of super- 
visors of each county or the common council or other body exercis- 
ing similar powers of each city desiring to make application for state 
aid under this article shall on such dates as may be fixed by the 
state commissioner of health submit to him the request of such 
county or city for such state aid and shall support such request with 
such information as the state commissioner of health may require. 
The state commissioner of health shall prescribe the form in which 
such information shall be submitted. 
2. State aid reimbursement shall be granted under the provisions 
of this article in accordance with the following schedule: Fifty per 
centum of the amount of money expended or to be expended by a 
county not organized as a county department of health; fifty per 
centum of the amount of money expended or to be expended by a 
department of health of a city having a population of fifty thousand 
or more, according to the last preceding federal census; where a city 
or cities each having a population of fifty thousand or more, accord- 
ing to the last preceding federal census, contained in a county 
which is organized as a county health district exclusive of such city 
or cities as specified in section twenty-b of this chapter, takes or take 3 
joint action with such county for the establishment of an integrated 
health service, such city or cities and such county shall each be 
entitled to receive reimbursement in the amount of seventy-five per 
centum of the first one hundred thousand dollars expended or to be 
expended by each for such health service, and in the amount of fifty 
per centum of all money so expended in excess of one hundred thou- 
sand dollars; on account of money expended or to be expended by a 
county department of health, reimbursement in the amount of 
seventy-five per centum of the first one hundred thousand dollars 
and fifty per centum of all money expended in excess of one hundred 
thousand dollars. 
3. Reimbursement of the state’s share of expenditures made by 
counties prior to the first day of January, nineteen hundred forty- 
seven shall be made in accordance with the provisions of former 
section nineteen-b of this chapter as it existed immediately prior 
to such date. 
§ 5. Section twenty-b of such chapter, as added by chapter five 
hundred nine of the laws of nineteen hundred twenty-one, as 
amended, is hereby amended to read as follows:7 
§ 20-b. County and part-county health districts. 1. Definitions. 
Whenever used in this section the term “county health district” 
shall mean a health district comprising the entire county heretofore 
or hereafter established pursuant to the provisions of this section; 
the term “part-county health district” shall mean all that part of a 
county outside of a city or cities having a population of fifty 
thousand or more heretofore or hereafter established as a health 
district pursuant to the provisions of this section; the term “county 
department of health ’ ’ shall mean that division of the county gov- 
ernment having jurisdiction over the public health of a county or 
part-county health district; the term “board of health” shall mean 
the board of health of such county or part-county health district; 
the term “county health commissioner,” shall mean the executive 
officer of such county department of health; and the term ‘ ‘ health 
district”, unless otherwise designated, shall mean either a county 
health district or a part-county health district. 
2. The board of supervisors of any county, with the approval of 
the state commissioner of health, shall have power to establish 
a county or part-county health district and in such event shall 
appoint a board of health for such county or part-county health 
district. No city or any part thereof shall be included as a part of 
any such health district unless the mayor and common council of 
such city or the officials exercising similar powers shall have con- 
sented thereto and, in respect of cities having a population of fifty 
thousand or more, according to the last preceding federal census, 
unless the supervisors representing that part of the county outside 
such city shall have consented thereto. 
In a county containing one or more cities having a population of 
fifty thousand or more, according to the last preceding federal cen- 
sus, which are not to be included in a county health district, the 
supervisors representing that part of the county outside of such 
city or cities may petition the board of supervisors to establish such 4 
part of the county as a part-county health district and, upon receiv- 
ing such petition, the board of supervisors shall forthwith file a 
certified copy of such petition with the state commissioner of health. 
If after a reasonable period of time following such petition to the 
board of supervisors, a part-county or county health district has 
not been established in such county, which district, in the opinion of 
the state commissioner of health, meets the standards of administra- 
tion, service and work necessary to qualify for state aid, he may 
refuse state aid reimbursement of expenditures made by such city 
or cities until such a part-county or county health district has 
been established or until such petition has been withdrawn. 
Whenever the provisions of this section shall have been proposed 
to be adopted in any county, and proceedings have been taken to 
establish a county or a part-county health district within any such 
county, the board of supervisors shall notify the state commissioner 
of health in writing of the proposed establishment of such county or 
part-county health district, and in such notice shall state the extent 
of the territory intended to be included within such district. The 
consent of the state commissioner of health to the establishment of 
any such health district shall be evidenced by a certificate, setting 
forth the approval of the state commissioner of health to the estab- 
lishment of such health district and such certificate shall be filed 
with the clerk of the board of supervisors. 
3. The county or part-county board of health shall consist of 
seven members, except that each city which becomes a part of the 
health district shall be entitled to one additional representative 
on the board of health to be appointed by the board of supervisors 
from a list of three persons submitted by the mayor or other 
administrative head of such city and which city representative so 
appointed shall have all the powers and duties conferred upon 
other members of said board and whose term of office shall be six 
years. The members of the board of health shall be residents of 
the health district, one of whom shall be a member of the board of 
supervisors selected by the board of supervisors, and at least three 
of whom shall be licensed to practice in the state of New 
York. The county medical society of the county in which a health 
district is established may submit to the board of supervisors a list 
of physicians from which the board of supervisors may choose the 
medical members of the board of health. The term of office of each 
appointive member of said board of health shall be six years, 
and the term of one of the members shall expire annually, 
The first appointments shall be made for the respective terms d 
six, five, four, three, two and one years. Vacancies shall be filled 
by appointment for the unexpired terms. 
4. The members of the board of health shall receive for attend- 
ance at meetings of the board a per diem compensation which 
shall be fixed by the board of supervisors and in addition thereto 
they shall be allowed actual and necessary traveling expenses, to be 
audited and paid in the same manner as other expenses of such 
hoard of health. 
5. In counties having a county auditor or county comptroller, all 5 
charges and other expenses of such district shall be audited and paid 
in the same manner as other charges against the county. In coun- 
ties not having a county auditor or county comptroller, all accounts, 
charges, claims and demands of such health district shall be 
presented to and audited by the board of health and paid by the 
county treasurer upon warrants of the board of health within the 
limits of the appropriation made therefor. 
6. Upon the establishment of a board of health as herein pro- 
vided it shall exercise all the powers and perform all duties of 
local boards of health, and such board of health may formulate, 
promulgate, adopt and publish rules, regulations, orders and direc- 
tions for the security of life and health in the health district which 
shall not be inconsistent with the state sanitary code. Every rule, 
regulation, order and direction adopted by a board of health shall 
state the date on which it takes effect and a copy thereof signed by 
the county commissioner of health or his deputy shall be filed as a 
public record in the state department of health, the county or part- 
county department of health and in the office of the county clerk 
and shall be published in such manner as the board of health may 
from time to time determine. Such rules, regulations, orders and 
directions shall be known as the sanitary code of such health 
district. The county commissioner of health or his deputy shall 
furnish certified copies of such code and its amendments for a fee 
of one dollar and such certified copies shall be received in evidence 
in all courts or other judicial proceedings in the state. The pro- 
visions of such sanitary code shall have the force and effect of law. 
Any violation of or non-conformance with any provision of such 
sanitary code or of any rule, regulation, order or special direction 
duly made thereunder shall constitute a misdemeanor punishable 
by a fine of not more than fifty dollars or by imprisonment for not 
more than six months or by both such fine and imprisonment. 
7. Such board of health shall elect annually one of its number 
as president and another as vice-president. It shall also appoint 
a county health commissioner, who, in addition to his duties as 
health commissioner may be designated by the board of health 
to act as secretary without extra compensation. Such county 
health commissioner shall possess such qualifications for office as 
shall have been approved by the public health council. He shall 
serve for a term of six years and shall not be removed during the 
term for which he shall have been appointed, except upon written 
charges after a hearing and upon notice. He shall devote his whole 
time to the duties of his office and shall receive such compensation as 
the board of health shall determine within the limits of the 
appropriations made by the board of supervisors. He shall, 
within his district, possess all the powers conferred upon and per- 
form all the duties required of local health officers. Local health 
officers who continue to hold office as herein provided after the 
establishment of a health district shall be deputies of the county 
health commissioner, who may require any such local health 
officer to perform within his local jurisdiction any such duty. 
The county health commissioner may, upon the authorization of 6 
the board of health and within the limits of the appropriations 
therefor, appoint such additional deputies, assistant deputies and 
other employees as may be required to fulfill in the health district 
the purposes of this section. Such deputies and assistant deputies 
shall have the qualifications prescribed for health officers by 
regulation of the public health council. 
The county health commissioner may designate in writing a 
deputy to whom shall be delegated all the powers and duties of 
the county health commissioner when such county health commis- 
sioner is unable to act by reason of absence or disability. 
The board of health shall have the power to remove the health 
officer of any local health district included within such county or 
part-county health district or any deputy or assistant deputy of 
the county health commissioner for cause, upon charges, and after 
such health officer or deputy or assistant deputy has, with due 
notice, been given an opportunity to be heard. The proceedings in 
connection with such removal shall be subject to review by the 
state commissioner of health, who within thirty days of the receipt 
of an order of a board of health removing such local health officer, 
may revoke such order whereupon such order shall be void. 
8. Local health districts within the area of any county or part- 
county health district shall continue to exist as subdivisions of such 
health district, and the local boards of health shall continue to exist 
and to retain their powers and duties subject to the rulings and 
regulations of the board of health, and may continue to appoint 
local health officers for such local health districts as provided by 
law. 
The governing authorities of any city, village or town or the 
board of health of any consolidated health district may abolish 
such city, village, town or consolidated health district as a local 
health district, whereupon all the powers and duties of the local 
board of health of such local health district shall devolve upon 
the health board and aid the powers and duties of the local health 
officer of such local health district shall devolve upon the county 
health commissioner. The governing authorities of a town or 
village, the local board of health of which has been abolished pur- 
suant to the provisions of this section, when authorized by a 
proposition submitted and adopted in the manner provided by law, 
may employ a public health nurse or public health nurses, qualified 
as provided by regulation of the public health council, and make 
the necessary appropriation therefor. Such public health nurse, 
or nurses, shall work under the direction of the county health com- 
missioner. 
The governing authorities of any city which has consented to 
be included in a health district, may, at any time after three years 
shall have elapsed since such city has been included in a health 
district, by resolution adopted by said authorities, provide for 
the withdrawal of such city from a health district. Before such 
action is taken an opportunity shall be given for a public hearing 
before such governing authorities. Public notice shall be given 
and the health board shall be notified in writing, at least thirty 7 
days in advance, of the time and place of such hearing. Such 
action by the said governing authorities shall become effective at a 
time to be stated in the resolution, which said time shall be not less 
than thirty days from the date of the adoption of said resolution. 
Upon the date when such resolution shall become effective, the local 
health district of such city shall be reinstated and it shall have all 
the powers of a local health district as though such city had not been 
included in the health district pursuant to the provisions of this act. 
If a county or part-county health district as heretofore or here- 
after established by a board of supervisors shall by its terms con- 
tain a portion of any village which lies partly within said county 
and partly within some other county, said village, without regard 
to population, shall continue its local health district organization 
in the same manner as before, in which case its health officer acting 
within the county or part-county health district shall be a deputy 
of the county health commissioner with reference to acts performed 
within said county or part-county health district. Provided, how- 
ever, said village may, by resolution of its village board, limit its 
local health district to that portion of the village lying in the 
county outside of the county or part-county health district, in 
which event the compensation of the local health officer shall be 
based upon the number of inhabitants in the reduced village health 
district, and the residents of that portion of the village lying 
within the county or part-county health district shall not be taxed 
by the village for the support of such reduced local health district. 
9. The health officer of each city, village, and consolidated health 
district included as part of any county or part-county health dis- 
trict, shall transmit daily all original reports of communicable 
disease cases, and all registrar’s reports of deaths from communi- 
cable disease, to the county health commissioner. The county 
health commissioner shall transmit the original reports of com- 
municable disease eases, within twenty-four hours after he receives 
them, to the state health department. 
10. Annually the board of health shall prepare an estimate of 
the necessary expenses of such county or part-county health district, 
for the ensuing fiscal year which shall be transmitted to the board 
of supervisors of the county within such period of time as shall 
enable the board of supervisors to inquire into the necessity for the 
items of such estimate. The board of supervisors shall levy a tax 
upon the taxable property within the county or part-county 
health district, sufficient to provide such sums as the board of 
supervisors may deem necessary to meet the expenses of such 
health district. In preparing the items of any estimate of the 
expense of a county or part-county board of health, the board of 
supervisors may lawfully include therein and approve all items 
of expenses wffiich may in any degree tend to promote the efficiency 
of the administration of the provisions of the public health law 
and other regulations adopted pursuant to the authority thereof. 
11. The board of supervisors of any county in which a county 
health district has been established, the boundaries of which are 
soterminous with the county, shall have power to abolish the board 8 
of managers of the county laboratory of such county, established 
and operated under the provisions of sections twenty-c to twenty-f, 
both inclusive, of this chapter, and to confer the powers and duties 
of such board of managers of such county laboratory upon the 
county board of health. The board of supervisors of any such 
county, with the approval of the state commissioner of health, may 
abolish the board of managers of the county tuberculosis hospital 
established and operated in such county under the provisions of 
sections forty-five to forty-nine-e, both inclusive, of the county law, 
and confer the powers and duties of such board of managers upon 
the county board of health. 
12. The board of supervisors of any county in which a county 
or part-county health district has been or may be established, with 
the consent of the supervisors representing that part of a county 
included in the district in respect to a part-county health district, 
may abolish such district at any time after three years shall have 
elapsed following its establishment, provided, however, that before 
such action may be taken an opportunity shall be given for a public 
hearing. Public notice shall be given and the state commissioner 
of health shall be notified in writing, at least thirty days in advance, 
of the time and place of such hearing. Such action by the board 
of supervisors shall become effective thirty days after the adoption 
of the resolution to abolish such health district, and at the end 
of such period the terms of office of the members of the board of 
health and of the county health commissioner shall terminate. 
§ 6. This act shall take effect immediately, except section four, 
which shall take effect January first, nineteen hundred forty-seven, 
and except that state aid reimbursement authorized by the amend- 
ments to the public health law made by this act shall be effective 
and accrue to the benefit of counties and cities on and after January 
first, nineteen hundred 
State of New Yobk, I . 
Department of State.) 
I have compared the preceding with the original law on file in this office, and 
do hereby certify that the same is a correct transcript therefrom and of the 
whole of said original law. 
THOMAS J. CURRAN, 
Secretary of State Appendix A-2» p. 1 
PUBLIC HEALTH LAW 
Sections 20-c to 20-h 
Section 20-c, Laboratories 
The hoard of supervisors of any county may establish therein a 
laboratory or laboratories which shall serve the whole or part of the 
county. In the resolution of the board of supervisors establishing such 
laboratory they shall define the area which it is intended to serve, which 
area from time to time may by resolution be altered. Provided, however, 
that in defining such area the territory included in a town shall not be 
divided and provided further, that no city or any part thereof shall be 
included in the area so defined, unless theiiayor and the common council, 
or the officials exercising similar powers, shall have consented thereto. 
The services of such laboratories shall be rendered at a moderate charge 
or free. 
If, however, it is the intention of the board of supervisors to apply 
for state aid for such proposed laboratory, under the provisions of section 
twenty-h of this article, an application for such state aid for such pro- 
posed laboratory shall be transmitted by the board of supervisors to the 
state commissioner of health. On or before January first of each year the 
state commissioner of health shall file with the governor a statement of 
the aggregate amount of such applications for state aid for proposed new 
laboratories in addition to the aggregate amount of applications for state 
aid for laboratories already established. 
Such sums, as revised in the discretion of the governor, shall be the 
estimate of state aid under this article to be used in the preparation of 
the executive budget. 
Subsequent to enactment of the appropriation by the legislature the 
state commissioner of health shall revise such applications for state aid 
as necessary to bring the aggregate of all applications within the total 
appropriations available. 
The board of supervisors may, in lieu of the establishment of a 
laboratory and with the approval of the state commissioner of health, 
provide for laboratory service by contracting with an established labora- 
tory which is conveniently located and when such service shall have been 
provided, shall be entitled to such state aid as would be provided for 
under this act if the amount expended for service were expended for 
maintenance and operation of a laboratory established in accordance with 
the provisions of this act. 
Upon the petition signed by two hundred or more taxpayers of the 
county or district to be served by such a laboratory, the governing body 
of that county or district at the next date for filling an elective office 
shall hold a referendum urion the question of establishing a laboratory the 
construction of which is to be financed by taxes levied for the fiscal 
year in which the expenditures therefore are to be made. If a majority of 
the votes cast are in favor of establishing such a laboratory it shall be 
mandatory upon the governing body of that county or district to take the Appendix A-2, p. 2 Public Health Law cent. 
steps necessary for the establishment and maintenance of such a laboratory 
as provided for by this act. Nothing contained in this section shall be 
construed to prevent the financing of any expenditure, in whole or in part, 
pursuant to the local finance law. 
Section 20-d. Powers of boards of supervisors in relation to laboratories. 
The board of supervisors, when they shall have determined to establish 
such a laboratory shall have the following powers: 
1, To acquire by purchase, exchange or otherwise, necessary real prop- 
erty, building or rooms or to erect necessary buildings. 
2. To cause to be assessed, levied and collected in the same manner as 
other charges against the county, such sums of money as it shall deem nec- 
essary for laboratory purposes. Provided, however, that where a laboratory 
is intended to serve less than a whole,county the expenditures made in con- 
nection therewith shall be assessed only against the area served by the lab- 
oratory. 
3. To accept and hold in trust for the county any grant or device of 
land or any gift or bequest of money or other personal property or any dona- 
tion to be applied, principal or income, or both, for the benefit of said 
laboratory. 
U-, To appoint a board of managers for the laboratory which shall 
consist of at least five members, two of whom shall be physicians duly 
licensed to practice in the state of New York, The county medical society 
may present to the board of supervisors a list of physicians residing in the 
county from which the board may choose the medical members of the board of 
managers. The board of managers shall hold a meeting at least four times 
in each year, and at such other times as it may deem necessary and each 
member attending meetings shall receive his actual and necessary expenses 
incident thereto, to be audited and paid in the same manner as other ex- 
penses of the laboratory. In counties having a comity board of health 
and a county health officer, the president of the county board of health 
and the county health officer shall be members of the board of managers 
ex-officio• The members of such board, with the exception of the members 
ex-officio, shall first be appointed so that the term of one member shall 
expire within one year from the first day of January of the year in which 
he shall have been appointed, the term of another member shall expire 
within two years of the first day of January of the year in which he shall 
have been appointed, the term of another member shall expire within three 
years of the first day of January of the year in which he shall have been 
appointed, the term of another member shall expire within four years of 
the first day of January of the year in which he shall have been appointed, 
and the term of another member shall expire within five years of the first 
day of January of the year in which he shall have been appointed. There- 
after the terms of membership shall be made for five years from the first 
day of January of the year in which the appointment is made. Nothing in 
this act shall be construed to repeal or amend any provision of law not in- 
consistent herewith relating to laboratories in counties or to abrogate any 
powers of boards of supervisors relating thereto. 
Section 20-e. Powers of boards of managers of laboratories. 
The board of managers of each laboratory shall have the following 
nowers and duties; Public Health Law cent. Appendix A-2, p. 3 
1, To elect a chairman, vice-chairman and a secretary. 
2, To appoint a director or a bacteriologist in charge of the 
laboratory. Any person appointed as such director shall comply with 
such qualifications as may be prescribed by the public health council. 
3# To fix the salaries of the director of the laboratory and all 
other employees within the limits of the appropriation made therefor by 
the board of supervisors. 
U, To exercise general management and control of said laboratory, 
of the grounds, buildings, rooms, employees and of all matters relating 
to the government, discipline, contracts and fiscal concerns thereof. 
5. To make such rules and regulations as may be necessary in rela- 
tion to the administration of the laboratory and the fees to be charged 
for laboratory service, not inconsistent with the provisions of this act. 
6. Notwithstanding any other general or special law, to erect all 
additional buildings found necessary after the laboratory has been placed 
in operation and make all necessary improvements and repairs within the 
limits of the appropriations made therefor. 
7* To make to the board of supervisors annually at such time as said 
supervisors shall direct a detailed report of the operation of the 
tory during the calendar year, the number and kind of specimens examined 
and the results of such examinations, together with suitable recommendations 
and such other matters as may be required of then and full and detailed 
estimates of the appropriations required during the ensuing year for all 
purposes including maintenance, erection of buildings, repairs, renewals, 
extensions, improvements, betterments or other necessary purposes. 
8, To establish branch laboratories if the area to be served by the 
laboratory is so large, if its topography is such as to make access to the 
laboratory difficult, or for any other reason such action seems reasonable 
or desirable. 
Section 20-f, Powers of the director of a laboratory. 
The director or the bacteriologist in charge of such laboratory, 
subject to the board of managers, shall: 
1, Equip the laboratory with all necessary furniture, appliances, 
fixtures and other needed facilities for the conduct of laboratory work and 
purchase all necessary supplies within the appropriations made therefor. 
2, Have general supervision and control of the internal affairs and 
work of the laboratory. He may make and enforce such rules, regulations 
and orders as he may deem necessary, not inconsistent with law or with the 
rules and regulations of the board, of managers. 
3, Appoint employees of the laboratory within the limits of his appro- 
priations, and remove them. 
Cause to be kept proper accounts and records of the business and 
operation of the laboratory, including such records relating to specimens Appendix Ar*2, p. U Public Health Law cent* 
examined and render such reports as may be required by law or by the regu- 
lations of the state commissioner of health; certify all bills and accounts 
including salaries and wages, and transmit them to the board of supervisors 
which shall provide for their payment in the same manner as other charges 
against the county. The board of supervisors of a county not having a pur- 
chasing agent may make an appropriation for the maintenance of such labor- 
atory and direct the county treasurer to pay all bills, accounts, salaries 
and wages which are approved by the director of the laboratory within the 
amount of such appropriation, subject to such regulations as to the payment 
sind audit thereof as the board of supervisors may deem proper. 
Section 20-g. Laboratories in cities. 
Nothing contained in section twenty-e to twenty-f hereof inclusive, 
shall be construed to repeal or amend any provision of law under which any 
health function or activity may be carried on in any city, or to transfer 
or affect any authority in relation to health activities now being exer- 
cised in any city by any public board or officers. Provided, however, that 
any public board or officers of a city now exercising health functions may, 
with the approval of the mayor, contract with the board of managers of any 
laboratory for the purpose of cooperation and to join and share facilities. 
If a city desires to avail itself of the state aid provided for in section 
twenty-h of this act, the common council or any body exercising similar 
powers in any city with the approval of the board of estimate, if such 
exists, shall have the power to establish a laboratory in such city. Upon 
the establishment of such laboratory by such city, all the powers and duties 
of the board of supervisors, in relation to laboratories hereinbefore pro- 
vided for, shall devolve upon the common council or other body exercising 
similar powers, except that the mayor shall, appoint-the board of managers 
of such laboratory and that the salaries of the director and other employees 
of the laboratory, and contracts to be £kade for, by, or on behalf of the 
laboratory and appropriations for the acquisition of eites and buildings 
and for maintenance, shall all be under the control of the same officials 
as now have control of similar Items and shall be governed by the same 
provisions of law. In cities when more than one' laboratory is established, 
but one board of managers shall be appointed, which shall have jurisdiction 
over all the laboratories established or operating under this act in said 
city. In cities of the second and third class the president of the local 
board of health, if such office exists, and the local commissioner of health 
or health officers shall be ex-officio members of the board of managers of 
the laboratory. 
Section 20-h, State aid. 
Where a laboratory as hereinbefore provided for shall have been 
established, the state, through the legislature, shall provide the follow- 
ing aid: a grant of an amount not to exceed one-half of the actual cost of 
maintenance of the laboratory or laboratories not in excess of seven thousand 
five hundred dollars per annum for each laboratory and of twenty-five hundred 
dollars toward the initial installation and equipment of such laboratory. 
The salaries and traveling expenses of employees of the state-depart- 
ment of health engaged in supervision or Inspecting laboratories unless 
otherwise provided for and other expenses necessarily incurred by the state 
department of health in the execution and enforcement of this act shall be 
paid from the sum appropriated toward maintenance and operation of laboratories 
as hereinbefore specified. Public Health Law cont. Appendix A-2, p. 5 
The board of supervisors of any county or the common council or 
other body exercising similar powers of any city which has heretofore 
established and is maintaining a laboratory or which is already provid- 
ing laboratory service by contract with another laboratory may apply for 
state aid in maintaining and operating such laboratory or in otherwise 
providing such laboratory service and upon complyirg with the provisions 
and requirements of this act, shall be entitled to such state aid, pro- 
vided however, that in the event that the total amount appropriated for 
state aid is not sufficient to pay in full the state aid and other ex- 
penses hereinbefore provided for, counties or cities establishing labor- 
atories or providing laboratory service under this act shall be given 
precedence and any balance remaining of moneys appropriated under this 
act, after the payment of full state aid to such counties or cities, 
shall be allotted to such counties or cities as have heretofore estab- 
lished and are now maintaining laboratories or are providing laboratory 
service by contract and have applied for state aid. 
The work of all laboratories, except in the city of New York, estab- 
lished or receiving aid in accordance with the provisions of this act 
shall be inspected and standardized by the state department of health, 
and no state aid shall be given to any laboratory under the provisions 
unless the area of the district, site, design and construction of the 
buildings, equipment, work and conduct of such laboratory shall be first 
approved in writing, after inspection, by the state commissioner of 
health or his representative. 
The comptroller after receiving the written approval of the state 
commissioner of health, hereinbefore provided for, shall determine the 
amount due in any one year to the various laboratories in the state 
under this act, and shall draw his warrant upon the state treasury in 
favor of the county treasurer of each county or the city treasurer of 
each city for the total amount to be paid to each laboratory in such 
county or city or in consideration of laboratory service contracted for 
in such county or city as shall be determined by him and shall indicate 
the amount to be paid to each laboratory or to each county or city in 
consideration of laboratory service contracted for. The county or 
city treasurer shall pay out such amount in the same manner and upon the 
same vouchers and proof as all other moneys devoted to such laboratory. 
The board of managers of a laboratory may appeal from any decision 
of the comptroller or of the state commissioner of health or any refusal 
to furnish the written approval herein provided for to the governor, and 
the action of the governor shall be final and conclusive and his approval, 
if granted, shall be accepted by the comptroller in lieu of the certificate 
of the commissioner of health herein nrovided for. 
Laboratories established or receiving aid under this section, 
except in the city of New York, shall be under the supervision of the 
commissioner. Appendix Ar-3» p. 1 
GENERAL MUNICIPAL LAW 
SECTIONS 126 to 133 
Section 126* Establishment of public general hospitals. 
The governing board of any county, town, city or village may by 
resolution determine that there shall be in said county, town., city or 
village a public general hospital for the care and treatment of the sick 
and in any county not having a tuberculosis hospital established under 
sections forty-five to forty-nine-e, both inclusive, of the county lav/, 
said public general hospital may include a pavilion or other provision 
for the care of tuberculosis patients. In any city in which a board of 
estimate and apportionment or other board is required to approve appro- 
priations for public purposes, the resolution of the governirg board to 
establish a public general hospital shall be effective only after the 
necessary appropriation for lands and buildings for such public general 
hospital shall have been approved by said board of estimate and appor- 
tionment or other board, in the same manner and by the same vote by 
which it is required by law to approve other appropriations for public 
purposes. When the governing board of any county, town, city or village 
shall have voted to establish a public general hospital, such govern- 
ing board shall have the following powers: 
1, To purchase and lease real property therefor, or acquire such 
real property and easements therein by condemnation proceedings in the 
manner prescribed in the condemnation law, in any locality within the 
jurisdiction of such governing board. 
2, To cause to be assessed, levied and collected such sums of 
money as shall have been approved as hereinabove provided for suitable 
lands and buildings, and as it shall deem necessary for equipment and 
improvements for said hospital, and for the maintenance thereof, and 
for all other necessary expenditures therefor; or such governing board 
may finance expenditures for the erection of such hospital and for the 
purchase of a site therefor pursuant to the provisions of the local 
finance law, and may transfer such moneys so appropriated to the treasurer 
of such hospital, subject to such regulations as to audit thereof by 
such governing board as it may deem proper when such of managers 
have appointed a treasurer as hereinafter provided for. 
3. To accept and hold in trust for the county, town, city or 
village of which it is the governing board, any grant or devise of land, 
or any gift or bequest of money or other oersonal property, or any dona- 
tion to be applied, principal or income, or both, for the benefit of said 
hospital, and apply the same in accordance with the terms of the gift. 
U, Such governing board may also adopt a resolution authorizing the 
board of managers of such hospital to elect a treasurer, who shall be bond- 
ed, and who shall establish an account in a bank or banks in the name of 
such hospital and deposit in such account all money received or collected 
by such hosuital and pay therefrom all bills, accounts, and salaries and 
wages, when approved by the board of managers of such hospital, within the Appendix A-3» p. 2 General Municipal Law cont. 
budget limits, by resolution subject to such regulations as the govern- 
ing board may deem proper, provided, however, that the proceeds, inclu- 
sive of premiums, from the s?~le of bonds, bond anticipation notes, 
capital notes or budget notes shall be deposited in a special account in 
a bank or trust company located and authorized to do business in this 
state, shall not be commingled 'with other funds, and shall be expended 
only for the object or purpose for which such obligations were issued. 
Section l?6-a. Joint hospitals for cities, towns or villages. 
Two cities in the same county or adjoining counties, or a city and 
one or more villages located within the seme county or adjoinirg counties 
or two or more villages located within the same county or adjoining 
counties or two or more towns in the same county or adjoining counties 
or a city and one or more towns located within the same county or adjoin- 
ing counties or one or more towns and one or more villages (including a 
village or villages within one or more of such towns) located within the 
same county or adjoining counties, subject to approval at a general 
county, town, city or village election in each of said counties, towns, 
cities or villages, by a majority of the voters qualified to vote and 
voting upon the proposition therefor, may Jointly acquire real property 
by purchase, lease or condemnation for the purpose of this article and 
establish, construct, equip, maintain and operate for such municipalities 
Jointly in accordance with the provisions of this article, a public 
general hospital for the care and treatment of the sick, and by appro- 
priate resolution and subject to like approval by the voters as provided 
in this section, any two cities, towns or villages as above specified, 
may be appropriate action of the governing board, create a Joint hospital 
for such cities, towns or villages as above specified of any existing 
hospital, established, constructed, equipped and operating by one of 
such cities, towns or villages and enlarge or add thereto. 
The ordinance or resolution providing for such Joint action, either 
in the establishment of a new Joint hospital or the creation of a Joint 
hospital or addition thereto, of one already existing by one of such 
cities, towns, and villages, shall be adopted by the local governing 
board of a city, town or village of each municipality and the board of 
trustees as specified in section one hundred twenty-seven hereof shall 
be corn-nosed of members appointed by the supervisor of the town, the 
mayor of the city, or the president of board of trustees of the village 
of each of said cities, towns or villages in proportion to the ratio of 
the assessed value of each of the cities, towns, or villages to the other. 
The ordinance or resolution may specify matters as to which the action of 
the board of trustees shall require the Joint approval of such governing 
bodies or boards. The ordinance or resolution also shall prescribe the 
proportions of the cost of such project to be borne by the municipalities 
respectively, based upon the ratio of the assessed value of each city, 
town or village to the whole. In a town, wholly or partly containing 
a village or villages Joining with it for the purposes of this section, 
the proportion of the cost of such project to be borne by such town may, 
however, be based upon the ratio that the assessed valuation of such 
town outside such village or villages bears to the whole. The moneys 
to be mid shall be provided in the same manner as hereinbefore prescribed 
in this article. The ordinance or resolution of the governing board may 
be amended from time to time with the concurrence of each of such govern- 
ing board of each of said cities, towns or villages, A Joint hospital 
established under this article, shall be within the county in which the 
city, town or village, or one of them is located. General Municipal Law cent, Appendix A-3, p, 3 
Whenever two or more cities, towns or villages shall establish a 
joint hospital as herein provided, all other provisions of this article 
respecting hospital, if applicable, shall apply to such joint hospital. 
Two or more cities, towns or villages as hereinbefore specified, 
may under the provisions of this article by appropriate resolution of 
the respective boards of said city, town, or village, and subject to like 
approval by the voters as provided in this section, provide for the 
joint operation and management only of an already existing hospital in 
one of such cities, towns or villages. 
Section 127. Appointment and terms of office of managers. 
1, Except as provided in subdivision two, when a governing board 
of a county, town, city or village shall have determined to establish 
a public general hospital for the care and treatment of the sick, the 
board of supervisors of the county, the supervisor of the town, the 
mayor of the city or the president of the board of trustees of the 
village shall appoint not less than five and not more than fifteen 
citizens of the county, town, city or village, respectively, who shall 
constitute a board of managers of the said hospital. The term of 
office of each member of said board shall be five years, and the term 
of one of such managers shall expire annually; the first appointments, 
however, being made for the respective terms of five, four, three, two 
and one years. Appointments of successors shall be for the full term of 
five years, except that the appointment of a person to fill a vacancy 
occurring by death, resignation or cause other than the expiration of a 
term shall be made for the unexpired term. 
?, When the board of supervisors of any county having a population 
of more than six hundred thousand but less than one million shall have 
determined to establish a public general hospital for the care and treat- 
ment of the sick, the board of supervisors of such county shall appoint 
seven citizens of the county who shall constitute a board of managers of 
such hospital. The members of such board first appointed shall be appoint, 
ed for terms of office as follows: one for a term of one year, two for 
terms of two years each, one for a term of three years, two for terms of 
four years each, and one for a term of five years. Their successors shall 
be appointed for terms of five years each. Vacancies occurring by death, 
resignation or cause other than the expiration of a term shall be made for 
the remainder of the unexpired term. 
3. Failure of any manager to attend three consecutive meetings of 
the board shall cause a vacancy in his office, unless said absence is 
excused by formal action of the board of managers. The managers shall 
receive no compensation for their services, but shall be allowed their 
actual and necessary traveling and other expenses, to be audited by the 
governing board, and paid in the same manner as the other exoenses of the 
hospital. Any manager may be removed from office at any time by the 
appointing authority after having received notice in writing of the cause 
of the proposed removal and after an opportunity to be heard thereon. 
Unless a treasurer for the hospital is appointed as herein provided the 
treasurer of the county, town, city or village by which the hospital is 
maintained shall be treasurer of the hospital. Appendix A-3» p* General Municipal Law cont. 
Section 128, General powers and duties of managers. 
The hoard of managers shall; 
1. Elect from among its members annually a president, a vice- 
president, and a secretary. It shall appoint a superintendent of the 
hospital, who shall not be a member of the board of managers, and who 
shall hold office at the pleasure of said board. 
2. Erect all necessary buildings; make all necessary improvements 
and repairs and alter any existing buildings, for the use of said 
hospital, provided that all expenditures for new buildings or altera- 
tions, other than ordinary repairs, shall first be authorized by the 
governing board of the county, town, city or village and the plans 
therefor approved by the state board of charities. 
3. Fix the salary of the superintendent and the number and 
salaries of all other employees, within the limits of the appropriation 
made therefor by the governing hoard, and such salaries, together with 
maintenance when provided, shall he compensation in full for all services 
rendered. The hoard of managers may determine the amount of time re- 
quired to he spent at the hospital by said superintendent in the discharge 
of his duties, and may also determine in what cases maintenance shall he 
provided for nurses and other employees of the hospital. 
Provide for the medical care and treatment of all persons admitted 
to the hospital; and shall appoint and may at pleasure remove resident, 
visiting and consulting physicians and surgeons; establish rules 
and regulations governing the service thereof. 
5. Have the general superintendence, management and control of the 
said hospital and of the grounds, buildings, officers, employees*and in- 
mates thereof; and of all matters relating to the government, discipline, 
contracts and fiscal concerns thereof; and make such rules and regulations 
as may seem to them necessary for carryirg into effect the purposes of 
such hospital; and may designate the purchasing agent of any municipality 
as the purchasing agent of said board for the purchasing of all necessary 
furniture, appliances, fixtures and other needed facilities for the care 
and treatment of patients and for the use of officers and employees there- 
of, and all necessary supplies, and said purchasing agent shall render a 
monthly report of his activities to said board. 
6. Maintain an effective inspection of said hospital, and keep itself 
informed of the affairs and management thereof; shall meet at the hospital 
at least once in every month, and at such other times as may he prescribed 
in the by-laws; and shall hold its annual meeting at least three weeks 
prior to the meeting of the governing hoard at which appropriations for the 
ensuing year are to he considered. 
7, Keep in a book provided for that purpose a proper record of its 
proceedings, which shall be open at all times to the inspection of its 
members, of the members of the governing board and of duly authorized 
representatives of the state board of charities. 
8, Certify all bills and accounts, including salaries and wages, 
and transmit them to the governing board, who shall provide for their General Municipal Law coat. Appendix A-3, p. 5 
payment in the same manner as other charges against the county, town, 
city or village. The board of supervisors of a county not having a 
purchasing agent or auditing commission may make an appropriation for the 
maintenance of such hospital and direct the county treasurer to pay all 
bills, accounts, salaries and wages, which are approved by the board of 
managers, within the amount of such appropriation, subject to such reg- 
ulations as to the payment and audit thereof as the board of supervisors 
may deem proper. When authorized by resolution of the governing board 
the board of managers may appoint a treasurer in the manner provided in 
subdivision four of section one hundred twenty-six. The treasurer shall 
pay the bills and accounts, including salaries and wages, anproved by 
resolution of the board of managers and at least once each month shall 
transmit to the governing board an itemized statement thereof. 
9. Make to the governing board of the county, town, city or 
village by which the hospital is maintained, at such times as said board 
shall direct, a detailed annual renort of the operations of the hospital, 
the number of patients received, the methods and results of their treat- 
ment, and such other matters as may be required, of them. Such renorts 
shall include full and detailed estimates of the appropriations required 
during the ensuing year for all purposes, including maintenance, erection 
of buildings, repairs, improvements and other necessary purposes. 
Section 129* General powers and duties of super!ntendent. 
The superintendent shall be the chief executive officer of the 
hospital and, subject to the by-laws, rules and regulations thereof, and 
to the general control of the board of managers, shall: 
1, Equip the hospital with all necessary furniture, appliances, 
fixtures and other needed facilities for the care and treatment of patients 
and for the use of officers and employees thereof, and nurchase all nec- 
essary supplies, unless the board of managers shall designate the purchas- 
ing agent of a municipality as the purchasing agent of said board as pro- 
vided in subdivision five of section one hundred twenty-eight, 
2. Have general supervision and control of the records, accounts, 
and buildings of the hospital and all internal affairs, and maintain 
discipline therein, and enforce comt)liance with, and obedience to, all 
rules, by-laws, ana regulations adopted by the board of managers for the 
government, discipline and management of said hospital, and the employees 
and inmates therebf. He shall make and enforce such further rules, reg- 
ulations and orders as he may deem necessary, not inconsistent with law, 
or with the rules, regulations and directions of the board of managers. 
3. Appoint such enrnloyees as he may think proper and necessary for 
the efficient performance of the business of the hospital, and prescribe 
their duties; and for cause stated in writing, after an opportunity to be 
heard, discharge any such emnloyee at his discretion. 
d, Cause proper accounts and records of the business and operations 
of the hospital to be kept regularly from day to day, in books and on forms 
provided for that narcose; and see that such accounts ard records are 
correctly made up for the annual renort to the governing board, as re- 
quired by subdivision seven of section one hundred and twenty-eight of Appendix A~3» p. b General Municipal Law cent. 
this chapter, and present the same to the board of managers, who shall 
incorporate them in their annual report to the said governing board. 
5, Receive into the hospital, under the rules established by the 
board of managers, any person in the county, town, city or village who 
is sick or mained or injured and who is in need of hospital care, 
irrespective of whether such person is able to pay for his care or not; 
and may also receive persons from without the county, town, city or 
village, provided there is a vacancy in the hospital, and provided the 
reception of such person does not interfere with the proper care and 
treatment of persons received from the county, town, city, or village. 
6, Cause to be kept proper records of the admission of all 
patients, their name, age, sex, color, marital condition, residence, 
occupation, place of last employment and the names and addresses of 
their nearest relatives or friends. He shall also cause a careful ex- 
amination to be made of the physical condition of all persons admitted 
to the hospital; and shall cause a record to be kept of the condition 
of each patient when admitted, and from time to time thereafter. 
7# Discharge from said hospital any patient who is found to have 
recovered from his illness sufficiently to be no longer in need of hos- 
pital care, or who shall wilfully or habitually violate the rules there- 
of, or who for any other reason is no longer a suitable patient for treat- 
ment therein; and shall make a full report thereof at the next meeting 
of the board of managers. 
8, Collect and receive all money due the hospital, keep an accurate 
account of the same, report the shine at the ensuing monthly meeting of the 
board of managers, and transmit the same within tefrdays after such meeting 
to the treasurer of the county, town, city or village by which the hospital 
is maintained. When a treasurer has been appointed as herein provided, all 
moneys collected and received by the superintendent shall be transmitted 
to the treasurer who shall deposit the same in a bank or banks in the name 
of the hospital and he shall also at least once in each month transmit to 
the governing board an itemized statement thereof. 
8-a, Establish and maintain, out of any moneys received by him, a 
fund, not to exceed two hundred dollars at any time, as a revolving petty 
cash fund for the payment of small emergency debts and to account to the 
board of managers at each monthly meeting for all expenditures made during 
the preceding month from such fund. 
9* Give a bond before entering upon the discharge of his duties, in 
such sum as the board of managers may determine, to secure the faithful 
performance of such duties. 
10, To accept and hold in trust for the county, town, city or village 
of which it is the governing board, any grant or devise of land, or any 
gift or bequest of money or other personal property, and to apply the 
principal or income, or both, for the benefit of said hospital, in accord- 
ance with the terms of the gift. 
Section 130. Admission and maintenance of patients. 
Whenever a patient shall have been admitted to such hospital, the 
superintendent shall cause to be made such inquiry as he may deem nec- 
essary, relative to the ability of such patient, or of the relatives of General Municipal Law cont. Appendix A-3, p. 7 
such patient legally liable for his support, to pay for his care and 
treatment. If he finds that such patient, or said relatives, are able 
to pay for his care and treatment in \diole or in part, an order shall 
be made by the superintendent directing such patient, or said relatives, 
to pay to the treasurer of such hospital for the support of such patient 
a specified sum per week, in proportion to their financial ability, but 
such sum shall not exceed the actual cost of maintenance. The superin- 
tendent shall have the same power and authority to collect such sums 
from tiie patient, or his relatives legally liable for his supnort, as is 
possessed by an overseer of the poor in like circumstances. If the 
superintendent finds that such patient, or his said relatives, are not 
able to pay, either in whole or in part, for his care and treatment in 
such hosoital, the unpaid cost of his maintenance shall become a charge 
unon the county, town, city or village Iy which the hospital is maintain- 
ed; provided, however, that in case such patient is not a resident of 
said county, town, city or village, the cost of his maintenance shall be 
a charge upon the civil division of the state upon which he would be a 
charge as a poor person. No employee of such hosnital shall accept from 
any patient thereof any fee, payment or gratuity whatsoever for his 
service. 
Section 131. Training school for nurses. 
Subject to the provisions of the education law the board of mana- 
gers of any hospital under this article may establish and maintain in 
connection therewith and as a part of the public hospital a school of 
nursing. The board may, in its discretion, appoint an advisory board 
for such training school and define the functions of such advisory board. 
Section 132* Hoorn for detention and examination of persons who ere 
suspected of being insane. 
The board of managers may provide a suitable room for the temporary 
detention, observation and care of persons who are suspected of being 
insane and shall do so upon the direction of the governing board or of 
the department of mental hygiene; provided, however, that such department 
before making such direction shall give to both the board of managers and 
the governing board due notice and opoortunity to be heard thereon. 
Section 133* Visitation and inspection. 
Members of the board of managers shall be admitted to every part of 
the hospital and premises, and shall have access to all books, papers, 
accounts and records pertaining to the hospital and shall be furnished 
with copies, abstracts and reports whenever required by them. All hos- 
pitals established or maintained under the provisions of sections one 
hundred and twenty-six, one hundred and twenty-seven, one hundred twenty- 
eight, one hundred and twenty-nine, one hundred and thirty, one hundred 
and thirty-one, one hundred and thirty-two, one hundred and thirty-three, 
and one hundred and thirty-four of this act shall be subject to inspection 
by any duly authorized representative of the state board of charities, of 
the state department of health, of the state charities aid association, 
and of the governing board of the county, town, city or village by which 
the hospital is maintained; and the resident officer in charge shall 
admit such representatives into every part of the hospital and premises, 
and give them access on demand to all records, reports, books, papers 
and accounts pertaining to the hospital. Appendix A-U 
SOCIAL WELFARE LAW 
Section 21. Visitation, inspection and supervision. 
The hoard (Social Welfare) 
3, shall establish and may alter and amend rules concerning records, 
buildings, and equipment and standards of care vhich shall apply in the 
care of destitute, delinquent, abandoned, neglected or dependent children; 
in the operation of any hospital, infirmary, dispensary, clinic,or home, or 
institution for convalescent, invalid, aged or indigent persons, or lying- 
in asylum where women may be received, cared for or treated during pregnancy 
or during or after delivery, and in the or boarding-out of 
children. 
Section 22. Information to be sought on visits or inspections. 
Upon visitation or inspection of any institution under this article, 
inquiry may be made to ascertain: 
1, Whether the objects of the institution are being accomplished, 
2, Whether the laws and the rules of the board and regulations of 
the department, applicable to it, are fully complied with, 
3, Its methods of and equipment for industrial and scholastic 
education and for moral training, and whether the same are 
best adapted to the needs of its inmates or beneficiaries. 
Its methods of government and discipline of its inmates or 
beneficiaries, 
5. The qualification and general conduct of its officers and 
employees, 
6. The condition of its grounds, buildings and other property. 
7. The sources of public moneys received by any institution in 
receipt of public funds and the management and condition of 
its finances generally, 
8. Any other matter connected with or pertaining to its useful- 
ness and good management or to the interests of its inmates 
or beneficiaries. ;appmdix 3 
Reprinted from The Massachusetts Health Journal, Vol. 27, No. 4, December, 1946. Published by the 
Massachusetts Tuberculosis League, 1148 Little Building, Boston 16, Mass. 
Effective Local Units for Health Service in New York State 
V. A. VAN VOLKENBURGH, M.D., DR.P.H.* 
Assistant Commissioner, Local Health Administration, New York State Department 
of Health, and Secretary to the Public Health Council of the State of New York 
During the past years, much has 
been said and a great deal written 
as to what constitutes an efficient, 
economical unit of government to 
provide basic local public health 
services. A brief review of the past 
indicates that this subject has been 
a part of and frequently empha- 
sized at the Annual Conferences of 
Health Officers and Public Health 
Nurses of New York State in ad- 
dresses by New York State Gov- 
ernors, State Health Commission- 
ers, Presidents of the State Medical 
Society, and outstanding public 
health leaders. 
Health publications are replete 
with articles in which local health 
services are discussed, and of spe- 
cial interest is the volume Public 
Health in New York State pub- 
lished in 1932, representing the re- 
port of a Special Health Commis- 
sion charged with the duty of mak- 
ing a comprehensive survey of the 
entire subject of public health as a 
governmental function both state 
and local. 
In reviewing these many sources 
one is impressed with the almost 
complete unanimity of professional 
opinion endorsing the county as 
the most practical, efficient, and 
economical unit of government to 
provide basic local public health 
services. 
In view of this weight of in- 
Perhaps by examining the prob- 
lem together it may he possible to 
bring to light some of the factors 
which have caused New York State 
to run counter to trends in other 
states as well as to the collective 
opinion of national and state medi- 
cal societies and of specialists in 
public administration. As a result 
of our probing, perhaps it may be 
possible to venture a fair opinion, 
after having examined the facts 
and made up one’s mind, as to 
whether basic local health services 
should continue to be provided un- 
der existing conditions in which 
the State has progressively taken 
over more and more the responsi- 
bility for direct local health serv- 
ices, or whether these obligations 
should be cared for by a suitable 
local unit of government in which 
the personnel are adequate in num- 
ber, have no conflicting obligations, 
and possess the knowledge and 
ability to do the work adequately. 
Analysis of Existing Facilities 
To analyze the problem, certain 
fundamental facts are necessary. 
The answers to the following ques- 
tions should provide most of them; 
namely, what does the job consist 
of; what personnel are now avail- 
able to do the job; what type of 
local health organization is pro- 
vided; how well is the work being 
done. 
IP hat Constitutes Present 
Health Services? 
Let us first consider the job. In 
New York State, public health 
activities of a primary nature com- 
prise at present: (1) the discovery, 
investigation, and control of com- 
municable diseases, including tu- 
The problem of providing local health 
services in the United States has re- 
ceived much attention from time to 
time and has recently been emphasized 
anew by the appearance in 1945 of 
the Commonwealth Fund publication 
LOCAL HEALTH UNITS FOR THE 
NATION, prepared by Dr. Haven Emer- 
son as Chairman of the Sub-committee 
tee on Administrative Practice of the 
on Local Health Units of the Commit- 
American Public Health Association. 
Public h ealth workers in Massachusetts 
have not overlooked the need of extend- 
ing adequate health services of high 
standard so that all areas and all per- 
sons are reached. But such a program 
is not put into operation quickly with- 
out preliminary organization, planning, 
and state-wide education. 
Accordingly, the MASSACHUSETTS 
HEALTH JOURNAL has published 
articles which would interest its readers 
in the subject of local health services. 
This address, given by Dr. Van Volken- 
burgh at the Annual Conference of 
Health Officers and Public Health 
Nurses of New York on June 25, 1946, 
describes the problems encountered in 
providing local health services in New 
York State and urges the establish- 
ment of county health departments 
with state financial assistance as the 
only alternative to the assumption by 
the state of additional responsibility 
for and control of local health serv/ces. 
formed and impersonal opinion, it 
might well he asked what is the 
need to discuss the subject further. 
The question is, of course, rhetori- 
cal since we all are aware that only 
six* of New York State’s fifty-seven 
countiest are organized as county 
departments of health. For this and 
other reasons it would seem worth 
while to explore briefly the situa- 
tion as it exists today. 
*Dr. Van Volkenburgh has held 
many important positions. He was 
Special Staff Member of the Intei- 
national Health Division of the Rocke- 
feller Foundation; Epidemiologist for 
the John J. Abel Fund for Research on 
Upper Respiratory Diseases; Assist- 
ant Physician at the Johns Hopkins 
Hospital; Research Associate and 
Associate at Johns Hopkins Univer- 
sity; and District Health Officer, New 
York State Department of Health. 
* Since giving this address, four ad- 
ditional counties have established 
county health departments. 
fThe five counties comprising great- 
er New York City are excluded. herculosis and syphilis; (2) the 
hygiene of maternity and infancy 
and the promotion of the health 
of children of preschool age; (3) 
the discovery of physically handi- 
capped children and alleviation of 
their condition; and (4) the dis- 
covery and control of cancer. 
Activities which are mainly sup- 
portive, hut equally important, in- 
clude health education of the gen- 
eral public; pre-service and in- 
service training of public health 
personnel; public health labora- 
tory services; the compilation, in- 
terpretation, and use of vital statis- 
tics data; environmental sanitation 
including milk, milk products, pub- 
lic eating places and summer camps 
and hotels; instruction in nutri- 
tion; dental hygiene and dental 
corrective services; various diag- 
nostic and immunization clinics; 
research; local and state tubercu- 
losis sanatorium care; state-aided 
county general hospital services, 
and state cancer and orthopedic 
hospital care. More recent arrivals 
receiving public health attention 
include accident prevention, blood 
bank services, and mental hygiene 
clinics undertaken in cooperation 
with the Department of Mental 
Hygiene. Looming on the horizon 
are rheumatic heart disease, cere- 
bral palsy, and the degenerative 
diseases. 
This is a formidable list, yet it 
is not complete. It represents most 
of the activities in effect today 
provided through state and local 
public health units, although their 
provision is not uniform through- 
out the State. It represents activi- 
ties which reflect the application 
of the ever-increasing newer dis- 
coveries in the field of preventive 
medicine. It represents services ex- 
pected by the public. It is, in 
short, an attempt to apply to the 
business of being born, of growing 
up, and of growing old the best 
health services which human wis- 
dom now makes possible. 
When we ask ourselves, there- 
As a matter of fact, health con- 
servation services reach but a frac- 
tion of the public since the staff 
now employed at the various gov- 
ernmental levels is insufficient to 
meet known needs. For example, 
the minimum number of public 
health nurses necessary for basic 
public health services is at least 
one per 5,000 population. Using 
this standard, there should he em- 
ployed in the State, exclusive of 
New York City, at least 1,250 such 
nurses. As of recent date, the total 
number of these positions for 
which appropriation had been 
made by city, county, township, 
village, and consolidated health 
districts totaled 734. Obviously, in 
this most important and basic serv- 
ice position, considerable is lack- 
ing. 
Services at Various Governmental 
Levels—- 
At tins point it would seem ad- 
visable to examine the administra- 
tive facilities limiting our consid- 
eration to counties not having a 
county health department and ex- 
cluding cities of 50,000 population 
or more. Just how are these mul- 
tiple services and the various types 
of service personnel both official 
and unofficial coordinated? Where 
does leadership originate, who de- 
termines public health needs, pro- 
vides technical and administrative 
direction, assesses quality and 
quantity of the work, provides 
stimulation, guidance and disci- 
plinary control? In short, what 
makes this public service taken as 
a whole “click?” 
—(1) By Local Boards of Health 
Perhaps if we examine a speci- 
men county, it may he possible to 
visualize the situation. In such a 
county there is a sizable number 
of part-time local health officers 
employed by the local hoards of 
health of the individual townships, 
villages, consolidated health dis- 
tricts, and small cities. A public 
V. A. VAN VOLKENBURGH. M.D. 
fore, what unit of local organiza- 
tion is best adapted to present-day 
needs, it is essential that we con- 
sider the health service not as an 
organization concerned with the 
control of the ordinary communi- 
cable diseases and rudimentary 
sanitation problems, but as an or- 
ganization whose prime concern is 
to bring to the people of the State 
the latest and best available meth- 
ods of health conservation. 
Present Staff Inadequate 
The stalf now employed at state 
and/or local levels to service the 
foregoing public health program 
represent numerous specialties. To 
mention a few: There are health 
officers, both full time and part 
time; sanitary engineers; sanitary 
inspectors; milk sanitarians; pub- 
lic health nurses; dental hygien- 
ists; dentists; health educators; 
bacteriologists; pathologists; nutri- 
tionists ; tuberculosis specialists; 
radiologists; orthopedists; physical 
therapeutists; syphilologists; pedi- 
atricians, etc. The employment of 
the various types of personnel is 
dependent on the need of the par- 
ticular health projects provided. 
They should he supplied in an 
amount no greater than is neces- 
sary to meet adequately the local 
need. health nurse may similarly be em- 
ployed by the more populous local 
health districts. All do their best 
to discharge their duties hut of 
necessity act independently of each 
other because their authority and, 
therefore, their interest is limited 
hy the boundaries of their specific 
health jurisdiction. 
Although the part-time health 
officer has had rudimentary train- 
ing in civilian public health prac- 
tice, it cannot be expected nor 
should it he necessary that he have 
the qualifications or provide the 
services of the specialists in public 
health practice. It would he im- 
possible for him independently to 
place in effect the broad plan of a 
general public health program 
limited as he is, in all hut a few in- 
stances, hy the small population 
served and consequently hy the 
funds available. Moreover, since 
only a small fraction of specialized 
services is necessary for these small 
population health jurisdictions, it 
would he impractical if not impos- 
sible to make them available on an 
independent basis. 
Considered collectively, these 
part-time health officers, sometimes 
referred to as the general prac- 
titioners of public health, serve a 
very useful purpose. They are close 
to the people in their jurisdiction, 
frequently sense needs and discover 
health hazards, enforce control 
measures for the ordinary com- 
municable diseases, and place in 
effect rudimentary environmental 
sanitation measures. Some perform 
duties far in excess of that which 
the community could reasonably 
require of them for the small com- 
pensation they receive. There are 
others, however, whose work is 
negligible. 
—(2) Other Local Services 
In addition to these health offi- 
cers and nurses serving multiple 
units of small population, we find 
a number of school medical in- 
spectors and school nurses em- 
ployed by individual school hoards 
on a school district basis. They 
are not concerned with other 
health problems in the home nor is 
there much effective coordination 
between them and other public 
health agencies. 
There also exist small municipal 
water plants and pasteurizing 
plants serving limited areas. 
visors. Similarly, there may be a 
county tuberculosis sanatorium 
with its own separate board of 
managers, a few employing a tu- 
berculosis visiting nurse. Other 
health agencies having some official 
status are the County Nutrition 
Committee, the County Health 
Preparedness Committee, etc. 
—(4) County Voluntary Agencies 
The unofficial county health or- 
ganizations are also active, have 
separate committees, and some em- 
ploy full-time workers. Such 
agencies are the Tuberculosis and 
Public Health Committee, the Red 
Cross, the Foundation for Infan- 
tile Paralysis, and the Women’s 
Field Army. Many local organi- 
zations of a broad nature include 
health conservation among their 
primary aims. Examples are the 
4-H Club, Home Bureau, Rural 
Policy Committee, Community 
Council, various service clubs, the 
Federation of Women’s Clubs, etc. 
Coordination Lacking Where 
County Health Department 
Is Lacking 
To summarize the situation ex- 
isting in a typical New York State 
county lacking a county health de- 
partment, it is apparent that local 
health services are provided 
through a multiplicity of agencies 
of limited capacity with an over- 
lapping of effort, each acting in- 
dependently and at times in con- 
flict with one another. Adminis- 
tratively, there is no systematic 
plan of development of the work 
in the county as a whole. There 
is no local director to head up such 
a program and, therefore, no pro- 
vision for unity of direction or 
proper coordination of activities, 
and no adequate machinery for 
efficient utilization of the services 
already existing or the develop- 
ment of needed services. 
Public Health Nurse 
Demonstrates Baby's Bath 
—(3) Official Services at County Level 
Pyramiding these independent 
“grass-root” services, we find em- 
ployed by the county board of 
supervisors a variable but usually 
insufficient number of public 
health nurses. County funds are 
also made available for a limited 
amount of clinic services, mainly 
for venereal disease, child health, 
and dental hygiene. Local super- 
vision is provided by a county pub- 
lic health committee meeting for 
a few hours once every two months. 
It can hardly he expected that such 
a committee could alone provide 
the necessary technical and admin- 
istrative direction or coordination 
required for the day-to-day func- 
tioning of a service of this type. 
Existing independently of other 
local health services is a county 
public health laboratory under the 
direction of a hoard of managers 
appointed by the hoard of super- State Department Has Helped—- 
That complete chaos does not 
exist in such counties is largely due 
to services provided by State De- 
partment of Health personnel, its 
district health officers, sanitary en- 
gineers, milk sanitarians, supervis- 
ing nurses and orthopedic nurses, 
as well as its central office staff of 
consultants in specialty fields. In 
order to knit together the unor- 
ganized local health facilities and 
to provide direct services which are 
beyond the limitation of local 
personnel in the expanding field of 
public health practice, it has been 
necessary for the State to take over 
responsibilities which cannot be 
cared for locally. 
—(1) Guidance and Technical Advice 
I refer to the guidance and 
technical advice, on a voluntary 
basis, given by State personnel to 
county public health committees 
and the various other official and 
unofficial agencies. The purpose 
lias been to assist in determining 
the health needs of the county; 
in laying plans to meet those needs, 
including coordination of all 
health agencies; in obtaining local 
funds or State services to secure 
the necessary specialized personnel 
and equipment to service the pro- 
gram, and in organizing the work 
to obtain the best degree of effi- 
ciency. 
—(2) Assumption of Some Local 
Responsibility 
I refer to the State’s assumption 
of local responsibility for tubercu- 
losis, venereal disease, and cancer 
control work, including the follow- 
ing up of cases and contacts, be- 
cause of lack of proper local or- 
ganization. I refer to the inspec- 
tion and permitting of farm labor 
camps, children’s camps, summer 
camps and hotels, and pasteuriz- 
ing plants. 
—(3) Other Work 
I refer to the personal epidemio- 
logical investigation of communi- 
cable disease outbreaks by State 
personnel, to the immediate super- 
vision of public health nurses lack- 
ing local supervisory facilities, and 
to the many supportive actions pro- 
vided part-time local health offi- 
cers. These are all duties which 
a full-time, capable county health 
department staff should handle. 
The State representatives should 
not he expected to function in this 
fashion. 
The Road Ahead 
Counties Have Not Organized 
Health Departments 
The reluctance of New York 
State counties to employ a full-time 
health officer trained in the 
specialty of public health and to 
develop their own adequate 
modern health conservation serv- 
ice is said to he somewhat of a 
puzzle to professors of public 
health administration. Since 1921 
when legislation was first enacted 
to permit formation of county 
health districts, only six counties 
have elected to do so, the last being 
Nassau County in 1938.* Despite 
concerted hut admittedly sporadic 
drives to influence counties to ac- 
cept their own responsibilities, the 
result has been obviously negli- 
gible. 
What are some of the reasons 
for this negative response? Do 
they exist now? It was at the sug- 
gestion of Governor Dewey that 
thought was given recently toward 
removing any legislative handicaps 
that might exist and providing ad- 
ditional financial inducements to 
counties to establish county health 
departments. 
Local Boards of Health 
May Continue 
One of the handicaps lias been 
the requirement for abolishing 
local health districts of towns and 
villages of less than 3,000 popula- 
tion when the county establishes 
a county health department. This 
requirement has been stricken out 
in the new law, effective January 
1, 1947. The matter is left to the 
discretion of all local governing 
authorities as to whether or not the 
boards of health shall continue to 
exist and employ a local health 
officer. If continued, his salary 
and expenses under the law would 
be met by the municipality, not the 
county. 
It has already been shown that 
most part-time local health officers 
serve a useful purpose. It is be- 
lieved they should be of material, 
although necessarily limited, as- 
sistance to a county health officer. 
Retention should also serve to 
maintain local interests. The con- 
tinuance of local boards of health 
would similarly strengthen such 
interests since the boards may con- 
tinue to enact local health regula- 
tions not inconsistent with the 
county and state sanitary codes. 
Home rule is further preserved by 
legal requirements as to the mem- 
bership of the county board of 
health. All cities are entitled to a 
representative on such a hoard. 
Towns and villages may he repre- 
sented through the physician and 
supervisor appointees. 
Large Cities Need Not Be In 
County Health Department 
In some instances failure to form 
a county health department has 
been due to the unwillingness of 
the supervisors of a dominant city 
to support such a measure even 
though it did not include the city 
and did not affect its taxes. A pro- 
vision in the new law relating to 
part - county districts authorizes 
petitioning the county hoard of 
supervisors by the supervisors of 
the area lying outside of cities of 
50,000 or more to form a part- 
county unit. If not granted by the 
hoard of supervisors acting as a 
whole within a reasonable time, 
State aid for such cities may be 
jeopardized. 
*There are now ten counties. APPENDIX b 
Conversely, opposition has come 
from supervisors outside of such 
large cities who were opposed to an 
organization which included the 
city. Some cities provide in their 
health budgets for services for 
which the remainder of the county 
might have little use and it was 
felt the latter should not he ex- 
pected to share the expense. In the 
amended law, the area outside of 
the cities of 50,000 or more now 
can vote to exclude cities from the 
county health district, if this is 
their determination. 
It is recommended, however, 
that, where expedient, cities of 50,- 
000 population or more be a part 
of the county health district. Ad- 
ministratively, this is sound, will 
provide a unified service, and avoid 
conflicts and overlapping of func- 
tions. Moreover, population sta- 
tistics show that, with few excep- 
tions, from 50 to 80 per cent of 
the population living outside of 
cities having a population of 50,- 
000 or more reside within ten miles 
of such a city. In Schenectady 
County the percentage is 95.5. 
Although residing outside of the 
city, most of these people shop, 
work, and obtain much of their 
recreation within the city. They 
are as much a part of the city popu- 
lation as those dwelling within the 
city boundary. 
State Aid Increased 
Some counties of a mercenary 
turn of mind and failing to see 
that conservation of health would 
save the county money expended 
for care of the indigent may have 
felt that State aid provisions were 
niggardly. The amended law in- 
creases the amount of State aid 
for county and part-county health 
departments to 75 per cent on the 
first $100,000 expended for general 
public health work. Expenditures 
above $100,000 are reimbursable 
on a 50 per cent basis. Consider- 
ing each of the fifty-six counties 
as a whole, inclusive of all cities, 
calculations show that the cost* of 
establishing and operating a very 
efficient county health department 
for general public health services 
would be less than $100,000 in 
thirty-three counties. In seven, 
it would range from a little over 
$100,000 to $125,000. In six it 
would range from over $125,000 to 
$200,000, and would amount to 
over $200,000 in the remaining ten, 
seven of which are counties con- 
taining a city or cities of more than 
50,000 population. The cost on a 
per capita basis, using the average 
of the cost of all 56** counties, is 
only $1.52 per annum. In a county 
expending $100,000, the local per 
capita tax cost under state aid 
would amount to 38c per annum. 
There would seem to be no ques- 
tion of the ability of counties to 
afford such a health service under 
the new state aid provisions. 
State Forced to Assume Some 
Local Services 
Another deterrent to county 
health department formation is 
said to be a fear of State domina- 
tion. In this connection it should 
be remembered that by Taw the 
State Commissioner of Health is 
charged with the enforcement of 
the public health law and the sani- 
tary code, is responsible for the 
security of life or health and the 
preservation and improvement of 
public health in the State, and 
must exercise general supervision 
over the work of all local health 
authorities. 
1 have already shown that failure 
on the part of counties to provide 
adequately for a modern health 
*Excludes public health laboratory 
service, tuberculosis hospitalization 
and medical rehabilitation hospital, 
clinic and appliance costs for which 
separate state aid provision is made. 
Also: industrial hygiene services, men- 
tal hygiene clinics and hospitalization, 
and school health service in all but a 
few small population counties wherein 
it might seem desirable for the school 
board to contract with the health de- 
partment for such services; these 
services are the responsibility of other 
governmental agencies in New York 
State. 
**Hamilton County because of its 
small population (3,433) has been 
omitted from the calculations. 
Immunization Clinics discussed by health officer and public health nurse. conservation program has forced 
the State to take over many of the 
local health services which should 
be provided by an adequate county 
health department service. Because 
of this fact, it was necessary over 
the years for the State department 
to augment its field staff and to in- 
crease the number of State health 
districts to twenty until each such 
district comprises no more than 
two to four counties each. In ef- 
fect, there exists today in the State 
twenty multiple-county health de- 
partments in which State personnel 
hold the key positions and are 
directed in their work by the State. 
To me this represents State con- 
trol of local health services. It 
has come about because counties 
have failed to organize an efficient, 
adequate, up-to-date health con- 
servation program under the direc- 
tion of a qualified full-time staff. 
If State domination is not desired, 
then the alternative is establish- 
ment of a local county health de- 
partment. 
Adequate Service Should 
Be Provided Locally 
As stated previously, it is not the 
policy of the present State adminis- 
tration to provide basic local 
health services through a state 
agency. Such State services would 
he contrary to the concept of home 
rule and is the reason behind re- 
cent amendments to the public 
health law. To conform with this 
policy, adequate health services 
should be provided locally, utiliz- 
ing the county or large city as a 
base, each having been accepted 
by public health administrators as 
efficient and economical units of 
government to provide basic local 
health services. 
State Ready to Assist 
The State is ready to do its part. 
Qualifications for public health 
personnel already exist and mini- 
mum standards have been issued to 
guide the district state health of- 
ficers in helping local authorities 
prepare statements of required 
personnel, scope of work, and costs 
for each of the counties. It is 
hoped that suitable counties, main- 
ly those of limited population, may 
consider establishing a state-aided 
county general hospital which will 
also house the county health de- 
partment and county laboratory. 
Plans have also been made to 
divide the State into six super- 
visory state health regions and, as 
county health departments are es- 
tablished, the existing smaller state 
health districts would correspond- 
ingly be decreased in number. The 
duties of the staff of the regional 
state offices, as stated by Dr. E. S. 
Godfrey, Jr., State Commissioner of 
Health, “will be advisory and ob- 
servational; to assist in local plan- 
ning; to note deficiencies and ex 
ceptional accomplishments; to visit 
the central office frequently and 
keep it in touch with conditions 
in the field, and keep the field in 
close touch with the State health 
department’s objectives.” The 
multiple direct health services 
now provided most counties 
through the district state offices 
would he discontinued and become 
the function of the county health 
department. 
Conclusion 
It would seem apparent that a 
fork in the road had been reached. 
If the branch road is taken, local 
communities would assume their 
responsibility for providing ade- 
quate and modern health conser- 
vation services through establish- 
ment of a county health depart- 
ment with state financial assistance. 
If the present road is followed, the 
State would he required to absorb 
additional local responsibility, in- 
crease its staff, and more than 
double the number of its present 
district offices to provide equiva- 
lent local health services. The 
choice of the road should be of 
immediate concern to the affected 
localities. The decision cannot be 
delayed much longer if the people 
of the State are to receive the type 
of health conservation services they 
have every right to expect. Form Adm. 22 
NEW YORK STATE DEPARTMENT OF HEALTH 
ALBANY, N. Y. 
Edward S. Godfrey, Jr., M. D. 
Commissioner 
Official Notice to Boards of Supervisors 
Applications for State Aid for Public Health Purposes 
Notice is hereby given that pursuant to the provisions of Article 2-B of the Public Health Law, 
I will consider applications for grants of state aid for the year 19 for the following purposes: 
1. COUNTY HEALTH DEPARTMENTS * 
Seventy-five per centum of the first one hundred thousand dollars and fifty per 
centum of amounts in excess of one hundred thousand dollars of the cost of establishing 
and operating county departments of health. 
2. COUNTIES NOT ORGANIZED AS COUNTY HEALTH DEPARTMENTS 
Fifty per centum of the salaries and expenses of public health nurses, dentists, 
dental hygienists, physicians, milk inspectors and sanitary inspectors. 
Fifty per centum of the cost of establishing and operating clinics for maternity 
and child hygiene, venereal diseases, dental hygiene, tuberculosis, preventive 
inoculations, etc. 
3. MENTAL HYGIENE CLINICS 
Subject to the joint approval of the commissioner of mental hygiene, reimburse- 
ment in accordance with Item 1 above for the cost of establishing and operating 
mental hygiene clinics as a part of the budget of a county health department. 
4. COUNTY GENERAL HOSPITALS** 
(a) Fifty per centum of the cost of construction, and/or fifty per centum of the 
operating deficit for maintaining and operating county general hospitals, subject to 
the following conditions: 
1. The county shall have had a population of less than fifty 
thousand at the last federal census. 
2. The county shall have a demonstrable need for additional or 
improved hospital services. 
3. The county shall have established a county health department 
which shall include the total area of the county. 
Effective January I, 1947. 
Fifty per centum reimbursement allowable during 1946 inclusive of the cost of operating expenses of county tuberculosis sanatoria receiv- 
ing state aid for this purpose during the county fiscal year 1945-1946. 
** Copies of Rules established by the State Health Commissioner governing Stale-aided County General Hospitals may be obtained from 
the State Department of Health. 
(OVER) 4. The plans for a county general hospital to be constructed, 
established or maintained shall be approved by the state 
commissioner of health and shall provide suitable quarters 
and facilities within the hospital for the county health 
department staff and for the efficient performance of its 
services. 
5. Provision shall be made for the proper coordination of the 
services of the hospital and the county health department. 
(b) Fifty per centum of the operating deficit for maintaining and operating 
county general hospital facilities for which state aid was paid during the county 
fiscal year 1945-1946. 
6. ADULT POLIOMYELITIS: Remedial Care 
Fifty per centum of the cost of remedial care and treatment (including hospital- 
ization, surgery, and appliances) of poliomyelitis or its aftereffects in persons 
twenty-one years of age and over for whom such care cannot otherwise be provided. 
Such care must'be authorized by the local health officer and approved by an authorized 
representative of the State Department of Health. Individual applications must be 
submitted for each case. 
6. OTHER COUNTY PUBLIC HEALTH PROGRAMS 
Other county public health programs may be submitted for consideration, the 
decision as to approval depending on the merits of the individual proposal. 
Where services are rendered by health agencies to children of school age, such services must be 
made available to all children irrespective of the schools they attend. 
It will be necessary in making applications for state aid to supply a detailed budget of proposed 
expenditures, indicating not only titles for personnel but the subdivisions of the department to which 
they are attached. The initial application must be accompanied by a narrative statement of the functions 
of the various subdivisions of the department. The narrative statement in subsequent years should explain 
all major proposed changes in the budget but so far as functions of the department are concerned, it need 
indicate only changes from the original descriptive statement which accompanied the initial application. 
The applications for state aid for 19 must be received at the office of the State Department 
of Health on or before the first day of December 19 
Dated: 
$&***/ft 
Commissioner Appendix C-2 
NSW YORK STATS 
RULES FOR STATS-AIDSD COUNTY GENERAL HOSPITALS 
(in effect as of July 1, 19^6) 
Pursuant to the provisions of Article II-B of the Public Health 
Law, the following rules are promulgated for the operation of county 
general hospitals established under Article 6 of the General Municipal 
Law when such hospitals are receiving State aid: 
1, The hospital shall he operated and maintained in accordance 
with the provisions of law (the important provisions of law 
which are applicable to county general hospitals are listed 
in the attached sheet). 
2, The professional standards in the hospital shall meet the 
minimum requirements established by the American College of 
Surgeons for an approved hospital. (Copy of these rules is 
appended.) 
3, There shall be a medical staff to which all registered physi- 
cians residing in the county shall be eligible for membership. 
U, Under regulations of the board of managers approved by the 
state commissioner of health the medical staff from their own 
number shall nominate for election by the board of managers 
a medical board of not less than five members, 
5. The medical board, subject to the approval of the board of 
managers and the state commissioner of health shall: 
a) prepare rules and regulations for the conduct of the pro- 
fessional work of the hospital, 
b) formulate whatever by-laws it deems necessary for the ef- 
ficient conduct of tiie business of the staff and the med- 
ical board., 
c) recommend appointment for the surgical, medical, special 
and nursing services of the hospital, 
d) supervise and control all of the professional service of 
the hosnital. STANDARDS FOR APPROVAL BY THE AMERICAN COLLEGE OF SURGEONS 
Minimum Standard for Hospitals 
1. That physicians and surgeons privileged to practice in the 
hospital he organized as a definite medical staff. Such organiza- 
tion has nothing to do with the question as to whether the hospital 
is open or closed, nor need it affect the various existing ty£es of 
medical staff organization. The word staff is here defined as the group 
of doctors who practice in the hospital inclusive of all groups, such 
as the active medical staff, the associate medical staff, ani the 
courtesy medical staff. 
2, That membership upon the medical staff he restricted to physi- 
cians and surgeons who are a) graduates of medicine of approved medical 
schools, with the degree of Doctor of Medicine, in good standing, and 
legally licensed to practice in their respective states or provinces; 
h) competent in their respective fields; and c) worthy in character and 
in matters of professional ethics; that in this latter connection the 
practice of the division of fees,.under any guise what soever,he pro- 
hibited. 
3* That the medical staff initiate and, with the approval of the 
gove ning hoard of the hospital, adopt rules, regulations , and policies 
governing the professional work of the hospital; that these rules, reg- 
ulations,, and policies specifically provide a) that medical staff meetings 
he held at least once each month; h) that the medical staff review and 
analyze at regular intervals their clinical experience in the various 
departments of the hospital, such as medicine, surgery, obstetrics, and 
the other specialties; the medical records of patients, free and pay, to 
he the basis for such review and analysis. 
U, That accurate and complete medical records he written for all 
patients and filed in an accessible manner in the hospital, a complete 
medical record being one which includes identification data; complaint; 
personal and family history; history of present illness; physical ex- 
amination; special examinations, such-as consultations, clinical lab- 
oratory, x-ray, and other examinations; provisional or wsrking diagnosis; 
medical or surgical treatment; gross and miscroscopical pathological find- 
ings; progress notes; final diagnosis; condition on discharge; follow- 
up; and, in case of death, autopsy findings. 
5, That diagnostic and therapeutic facilities under competent med- 
ical supervision he available for the study, diagnosis, and treatment of 
patients, these to include at least a) a clinical laboratory providing 
chemical, bacteriological, serological, and pathological services; b) an 
Xp-ray department providing radiographic and fluoroscopic services. 
Fundamental Principle* 
1, A modern physical plant, free from hazards and properly equipped 
for the comfort and scientific care of the patient. 
2, Clearly stated constitution, by-laws, rules and regulations set- 
ting forth organization, duties, responsibilities, and relations. Appendix C-3, p. 2 
3* A carefully selected governing board having complete and 
supreme authority for the management of the institution. 
4, A competent, well trained executive officer or administrator 
with authority and responsibility to carry out the policies of the 
institution as authorized by the governing board, 
5* An adequate number of efficient personnel, properly organized 
and under competent supervision, 
6, An organized medical staff of ethical, competent physicians for 
the efficient care of the patients and for carrying out the professional 
policies of the hospital, subject to the approval of the governing board, 
7. Adequate diagnostic and therapeutic facilities with efficient 
technical service under competent medical supervision, 
8, Accurate and complete medical records, promptly written ar*i 
filed in an accessible manner so as to be available for study, refer- 
ence, follow-up, and research, 
9. Group conferences of the administrative staff and of the medical 
staff to review regularly and thoroughly their respective activities in 
order to keep the Service and the scientific work on the highest plane of 
efficiency, 
10, A humanitarian spirit in which the best care of the patient is 
always the primary consideration. Appendix D 
REFERENCES ON HOSPITAL AND HEALTH CENTER 
PLANNING AND CONSTRUCTION 
"Planning Suggestions and Demonstration Plans for Acute 
General Hospitals", by Neil P< MacDonald and Marshall Shaffer 
(Material prepared by the Hospital Facilities Section of the U, S. 
Public Health Service) published in Hospitals, July 15^3* 
"Planning for Integrated Service: The District Hospital", 
by the Hospital Facilities Section of the U. S. Public Health Ser- 
vice, published in Hospitals, September, 19^5* 
"Planning for Integrated Service: A 50-bed P.ural Hospital 
and Health Center", by the Hospital Facilities Section of the U. S* 
Public Health Service, published in Hospitals, July 19^5* 
"Public Health Centers, Architectural Building Types 
Study No, 67", published in Architectural Record, July 19^2. 
t • . 
"Hospitals, Architectural Record's Building Types Study 
No. by the Hospital Facilities Section of the U, S, Public, 
Health‘Service, published in Architectural Record, August 19^5- 
"Planning for Integrated Service: A Health Center Unit", 
by the Hospital Facilities Section of the U, S, Public Health Ser- 
vice, published in Hospitals, May 19^5* APPBNDES 1 
ABSTRACT 
Public Law 725 79th Congress 
FEDERAL HOSPITAL SURVEY AND CONSTRUCTION ACT 
(Hill-Burton Bill S 191) 
This Act is title 6 of the Public Health Service Act, Part A, 
"Part A - DECLARATION OF PURPOSE 
Purpose is to assist the several states — 
(a) To inventory their existing hospitals. 
(b) To survey the need for construction of hospitals# 
(c) To develop programs for construction of such public and other 
non-profit ho sp it als, 
(d) To construct public and other non-profit hospitals. 
"Part B - 
(l) $3,000,000, authorized to be appropriated to assist the States 
in carrying out PART A, and to remain available ’until expended. 
"STATE APPLICATIONS 
(a) to be approved a State application for funds for carrying out 
the purposes of Survey and Planning, 
"(l) designate a single State agency as the sole agency for 
carrying out such purposes; 
"(2) provide for the designation of a State advisory council; 
"(3) provide for making an inventory and survey and for de- 
veloping a state hospital program; 
"W provide for submission of such'reports as are required 
by the Surgeon General of the United States Public Health 
Service, 
"ALLOTMENTS TO STATES 
Allotment to the States for survey and planning shall be such proportion of 
the Federal appropriation as the States population bears to the population 
of the United States# Each State shall be entitled to receive 33-1/3 Per 
cent of its expenditures subject to the limitation of the State allotment. 
Any funds paid to the State under this Section and not expended for the pur- 
pose for which paid shall be re-paid to the Treasury of the United States. 'Part C - CONSTRUCTION OR HOSPITALS AND RELATED FACILITIES 
"AUTHORIZATION OF APPROPRIATIONS 
In order to assist the States in carrying out the purpose of Hospi- 
tal construction there has been authorized to be appropriated for the 
fiscal year ending June JO, 19*+7 and for each of the four succeeding 
fiscal years the sum of $75»000, 000, for the construction of public and 
non-profit hospitals. 
NOTE: While the Act authorized the appropriation, no actual 
appropriation has been made for the present fiscal 
year; nor can one be made until the Congress convenes. 
The suras appropriated shall be used for making payments to the States 
which have submitted and had approved by the Surgeon General State plans 
for carrying out the purposes of construction and for making payments to 
the political subdivisions and public or other non-profit agencies in such 
St at es. 
NOTE; Chapter 666 of the Laws of 19*+6 for New York State provides 
that the State of New York can accept such funds and that 
they shall be administered by the New York State Postwar 
Public Works Planning Commission or any other agency so 
designated by the Governor; in order to meet the Constitu- 
tional restrictions on the allocation of lump sums to non- 
profit agencies, the above State Law provides for the setting 
up of a special fund by the State Department of Taxation 
and Finance. This Act makes it unnecessary for the Federal 
Government to make payments direct to local agencies in New 
York State, 
GENERAL REGULATIONS 
Within six months after the enactment, the Surgeon General with the 
approval of the Federal Hospital Council and the Social Security Adminis- 
tration shall, by general regulation prescribe: 
(a) the number of general hospital beds required to provide adequate 
hospital services to the people residing in the State and the 
general method or methods by.which such beds shall be distributed 
among base areas, intermediate areas and rural areas. 
provided, that the total of such beds for any State shall not exceed 
*+,5 beds per one'thousand population except in those States sparsely popu- 
lated. In any areas (as defined in the regulations) within the State there 
are more beds than required by the standards prescribed by the Surgeon Gen- 
eral. The excess over such standards may be eliminated in calculating this 
maximum allowance. APPENDIX E 
(b) The number of beds required to provide adequate hospital ser- 
vices for tuberculosis patients, mental patients and chronic 
disease patients in a State and the general method or methods 
by which such beds shall be distributed throughout the State. 
Provided, that the total number of beds for tuberculosis patients 
shall not exceed 2-*l/2 times the average annual deaths from tuberculosis 
in the State over the five year period from to inclusive, the 
total number of beds for mental patients shall not exceed 5. per thousand 
population and the total number of beds for chronic disease patients shall 
not exceed 2. per thousand population. 
(c) The number of public health centers and general method of dis- 
tribution of such centers throughout the State which for the 
purpose of this title shall not exceed one per thirty thousand 
population except in the more sparsely populated states. 
(d) The general manner in which the State agency shall determine 
the priority of projects based on the relative need of differ- 
ent sections of the population and of different areas lacking 
adequate hospital facilities, giving special consideration to 
the hospitals serving rural communities and areas with relative 
small financial resources. 
(e) General standards of construction and equipment for hospitals 
of different classes and in different types of location. 
(f) That the State plan shall provide for adequate hospital facil- 
ities for the people residing in a State without discrimination 
on account of class, creed or color, and shall provide for ade- 
quate hospital facilities for persons unable to pay therefore. 
(g) General methods of administration of the plan by the designated 
State agency, subject to limitations set forth in the next sec- 
ti on (a) ( 6) and (8). 
''STATE PLAITS 
(A) After such regulations have been issued, any State desiring to 
take advantage of this part may submit a State plan for carrying out the 
purposes of construction. Such St ate plan must t— 
(l) designate a single State agency as the sole agency for super- 
vising and/or the administration of the plan. 
(2) contain satisfactory evidence that the State agency designated 
in accordance with paragraph (l) hereof will have authority to 
carry out such plan in conformity with this part; 
(3) provide for the designation of a State advisory council. (4) set forth a hospital construction program. 
(a) which is based on a statewide inventory of existing hos- 
pitals and survey of need, 
(b) which conforms with the regulations as prescribed by the 
Surgeon General (a) (b) and (c), 
(c) which in the case of a State which has developed a pro- 
gram of construction, conforms to the program so develop- 
ed, except for any modification required in order to com- 
ply with regulations (a) (b) and (c), and except for any 
modification designated pursuant to paragraph (l) of this 
section and approved by the Surgeon General, 
(d) which meets the requirements of the Surgeon General’s 
regulations under (f) above, i.e,, race, color, creed 
and medical indigency* 
(5) Set forth the relative need in accordance with the regulations 
prescribed under section (d) for the several projects included 
in such programs and provide for the construction, in-so-far as 
financial resources available., therefore and for maintenance and 
operation make possible, in order of such relative need. 
(6) Provide such methods of the administration of the State plan in- 
cluding methods relating to the establishment and maintenance of 
personnel standards on a merit basis (except that the Surgeon 
General shall exercise no authority with respect to the selection 
tenure of office, or compensation of any individual employed in 
accordance with such methods) as the Surgeon-^fienera! prescribes 
under paragraph (g) and (h)* 
(7) Provide minimum standards (to be fixed in the discretion of the 
State) for the maintenance and operation of hospitals which re- 
ceive Federal aid under this part; 
(8) Provide for affording to every applicant for a construction pro- 
ject an opportunity for hearing before the State agency; 
(9) Provide that the State agency will make such reports as the 
Surgeon General may from time to time reasonably require, and 
give the Surgeon General, upon demand, access to the records upon 
which such information is based; 
(10) Provide that the State agency will from time to time review its 
hospital construction program and submit to the Surgeon General 
any modifications which it considers necessary. 
(P) The Surgeon General shall approve any State plan or any modifi- 
cation thereof which complies with the sub-section (A) above. APPWDTX Pi 
If any such plan or modification is disproved by the Surgeon General, 
the Federal hospital council shall upon request of the State agency afford 
it an opportunity for hearing. 
If the council determines that the plan or modification complies with 
the provisions of sub-sect ion (a), the Surgeon Genera]., shall thereupon ap- 
prove such plan or modification. 
(c) No changes in the State plan shall be required within two 
years after initial approval thereof, or within two years 
after any change thereafter required by reason or any. change 
in the regulations of the Surgeon General, except with the 
consent of the State, 
(d) If any State, prior to July 1, has not enacted legis- 
lation providing compliance with minimum standards of 
maintenance and operation shall be required in the case of 
hospitals which shall have received Federal aid under this 
title, such State shall not be entitled to any further 
allotments for construction. 
MALLOTMENTS TO STATES 
Each State for which a State plan has been approved prior to or during 
a fiscal year shall be entitled for such year to an allotment of a sum bear- 
ing the same ratio to the sums authorized to be aopropriated for construction 
for such year as the product of (a) the population of such State and (b) the 
square of its allotment percentage (as defined in section 631, paragraph (a) 
bears to the sum of the corresponding products for all of the States, The 
amount of the allotment to a State shall be available for payment of 33""T/3 
per cent of the cost of approved projects within such States. Sums alloted 
to a State for a fiscal year for construction and remaining unen combe red at 
tha end of such year shall remain available to such State for such purposes 
for the next fiscal year (and for such year only), in , addition to the sums 
alloted for such State for the next fiscal year. 
"APPROVAL OF PROJECTS AND PAYMENTS FOR CONSTRUCTION 
(a) For each project for construction pursuant to a State plan, approv* 
ed under this part, there shall he submitted to the Surgeon General through 
the State agency an application by the State or a political subdivision there- 
of or by public or other nonprofit agency. Such application shall set forth: 
(1) a description of the site for such project, 
(2) plans and specifications therefor in accordance with the regulations 
prescribed by the Surgeon General under paragraph (e). 
(3) reasonable assurance that title to such site is or will be vested solely 
in the applicant. (U) reasonable assurance that adequate financial support will be available 
for the construction of the project and for its’ maintenance and opera- 
tion when completed, 
(5) reasonable assurance that the rates of pay for laborers and mechanics 
engaged in the construction of the project will be not less than the 
prevailing local wage rates. 
The Surgeon General shall approve such application if sufficient funds 
to pay 33-1/3 per cent of the cost of construction of such projects are avail- 
able from the allotment to the State and if the Surgeon General finds: 
(A) that the application contains such reasonable assurance as to title, 
financial support and payment of prevailing rates of wages, 
(33) that the plans and specifications are in accord with the Surgeon Gener- 
al’s regulations, 
(C) that the application is in conformity with the approved State plan and 
contains an assurance that the applicant will conform to the applicable 
requirements of the State plan and to the Surgeon General’s regulations, 
(D) that it has been approved and recommended by the State agency and is 
entitled to priority within the Stale in accordance with the Surgeon 
General’s regulations. No application shall be disapproved until the 
Surgeon General has afforded the State agency an opportunity for hearing. 
u(b) Upon approving an application under this section, the Surgeon Gen- 
eral shall certify to the Secretary of the Treasury an amount equal to 33-1/3 
percent of the estimated cost of the project and designate the appropriation 
from which it is paid. Such certification shall provide for payment to the 
State except that if the State is not authorized by law to make payments to 
the applicant the certification shall provide for payment direct to the 
applicant, 
NOTE: The latter is not necessary in this State, 
Upon certification by the State agency based upon inspection by it, that 
work has been performed upon a project, or purchases have been made, in ac- 
cordance with the approved plans an.d specifications, and that payment of an 
installment is due to the applicant, the Surgeon General shall certify such 
installment for payment by the Secretary of the Treasury, If the Surgeon 
General has ground to believe that a fault has occurred, he may, upon giving 
notice of hearing, withhold certification. 
(c) Amendment of any .approved application shall be subject to ap- 
proval in the same manner as an original application. 
(d) Funds paid under this section shall be used solely for carrying 
out projects as so approved., 
(e) If any hospital for which funds have been paid under this section 
shall be sold or transferred to .any person, agency, or organization 
which is not qualified for benefits under this Act or if it cease 
to be a non-profit hospital, the United States shall be entitled to 
recover 33~l/3 per of the current value of such hospital. APPENDIX E 
"Part D - MISCELLANEOUS 
"DEFINITIONS - For the purposes of this title — 
(a) the allotment percentage for any State shall be 100 per centum 
less that percentage which bears the same ratio to 50 Per centum 
as the per capita income of such State bears to the per capita 
income of the continental United States (excluding Alaska), except 
that; 
1, the allotment percentage shall in no case be more than 
75 Per cent or less than 33~l/3 Per cent, 
2, the allotment percentage for Alaska and Hawaii shall be 
50 per cent each and the allotment percentage for Puerto 
Hico shall be 75 per cent, 
"(b) allotment percentages shall be promulgated by the Surgeon General 
between July 1 and August 31 of each evennurabered year, 
"(c) population of the several States shall be determined on the basis 
of the latest figures certified by the Department of Commerce, 
"(d) the term ’State1 includes Alaska, Hawaii, Puerto Rico, and the 
District of Columbia, 
"(e) the terra ’hospital’ includes public health centers and general, 
tuberculosis, mental, chronic diseases and other types of hospitals 
and related facilities such as laboratories, out-patient depart- 
ments, nurses’ home and training facilities and central service 
facilities operated in connection with hospitals and does not in- 
clude any hospital furnishing primarily domiciliary care, 
"(f) the term 'public health center’ means a publicly owned facility 
for the provision of public health services including related 
facilities such as laboratories, clinics and administrative offices 
operated in connection with public health centers. 
"(g) the term 'non-prof it'hospital ’ means any hospital owned and operat- 
ed- by a corporation or association, no part of the net earnings of 
which inures, or may inure lawfully, to the benefit of any share- 
holder or individual,. 
"(h) the term 'construction' includes construct!on of new buildings, 
expansion, remodeling, and .alteration of existing buildings ail’d 
initial equipment of such buildings including architects fees and 
excluding the cost of off-site improvements and, except with re- 
spect to public health centers, the cost of the acquisition of lancfr 
"(i) the term *cost of construction’ means the .amount found by the 
Surgeon General to be necessary for the construction of a project. "WITHHOLDING OF CERTIFICATION 
Whenever the Surgeon General, after reasonable notice and opportunity for 
hearing to the State agency, finds that the State is not complying substantial- 
ly with the intent and regulations of the Act, he may withhold further certifi- 
cations, If the Surgeon General refuses to approve any application, the State 
agency through which the application was submitted, or if any State is dis- 
satisfied with the Surgeon General's action, such State may appeal to the ap- 
propriate United States Court of Appeals, The findings of fact by the Surgeon 
General, unless substantially contrary to the weight of the evidence, shall be 
conslusive, but the court, for good cause shown, may remand the case to the 
Surgeon General to take further evidence. The court shall have jurisdiction 
to affirm the action of the Surgeon General or set it aside in whole or in 
part. The judgment of the Court shall be subject to review by the Supreme 
Court of the United States upon certiorari or certification as provided in 
sections 239 and. of the Judicial Code, as amended. 
"FEDERAL HOSPITAL COUNCIL 
"(a) The Surgeon General is authorized to make such administration 
regulations and perform such other functions as he finds nec- 
essary to carry out the provisions of this title. Any such 
regulations shall be subject to the approval of the Social 
Security Administrator. 
"(b) In administering this title, the Surgeon General shall consult 
with a Federal Hospital Council consisting of the Surgeon General, 
who shall serve as 'Chairman ex-officio, and eight members appoint- 
ed by the administrator. Four of the eight appointed members shall 
be persons who are outstanding in fields pertaining to hospital and 
health activities, three of whom shall be authorities in matters 
relating to the operation of hospitals and the other four members 
shall be appointed to represent the consumers of hospital service 
and shall be persons familiar with the need for hospital services 
in urban and rural areas. Appointees shall hold office for a term 
of four years subject to the usual regulations of new appointees 
and appointees for vacancies, The Council shall meet as frequently 
the Surgeon General deems necessary but npt less than once ea,ch 
year. Upon the request of three or more members* the Surgeon Gen- 
eral shall call a meeting of the Council, 
"CONFERENCES OF STATE AGENCIES 
The Surgeon General shall call conferences of the agencies designated by 
the States to carry out this Act as needed bub at least once annually. Upon 
application of five or more State agencies, the Surgeon General shall call a 
conference of representatives of all State Agencies, "STATE CONTROL OF OPERATIONS 
Except as otherwise specifically provided, nothing in this title shall 
be construed as conferring on any Federal officer or employee the right to 
exercise any supervision or control over the administration, personnel, 
maintenance, or operation of any hospital with respect to which any funds 
have been qr may be expended under this title. 
Abstracted by! 
Joint Hospital Board 
Postwar Public Works Planning 
Gommi ssion 
Commissioner Robert T, Lansdale, 
Chairman 
John J, Bourke, M, D. 
Survey Director appendix e 
HEW YORK STATE PLAN FOR SURVEY OF HOSPITAL FACILITIES 
AND 
PROGRAM FOR REGIONAL HOSPITAL PLANNING 
FOR 
POSTWAR HOSPITAL CONSTRUCTION 
NEW YORK STATE POSTWAR PUBLIC WORKS PLANNING COMMISSION 
JOINT HOSPITAL BOARD 
Robert T. Lansdale, Chairman 
John J. Bourke, M.D. 
Survey DIrector 
State Office Building 
Albany, New York APPENDIX E 
PLAN FOR SURVEY OF HOSPITAL FACILITIES AND REGIONAL PLANNING FOR 
POSTWAR HOSPITAL CONSTRUCTION 
In order to meet the requirements of the proposed Hill-Burton Bill, S-191, and 
to more efficiently plan for postwar hospital construction, the Postwar Public Works 
Planning Commission, through its Joint Hospital Board, is inaugurating an intensive 
survey of existing facilities and an appraisal of needed hospital construction. 
To secure the assistance and advice available through individuals and groups 
responsible for the construction, operation and use of hospitals, the work is to be 
approached on a regional basis. 
For the purpose of facilitating the completion of the survey and for postwar 
hospital construction planning, the State will be provisionally divided into hospi- 
tal regions and primary and secondary service districts within each region. 
Representatives from each of the primary and secondary hospital service dis- 
tricts will bechosen at regional meetings to which will be invited all hospital ad- 
ministrators and others with interest and responsibility for hospital care. With 
the hospital service district re presentat Ives as a nucleus of t he me mbe rs h I p, Region- 
al Hospital Planning Councils will be established in each of the regions. 
This joint local and state action should result In an orderly and intelligent 
solution to the problem of meeting the needs for additional hospital and related fa- 
cilities for the care of the sick. 
The following is a resume of the plan adopted by the Joint Hospital Board: 
I PURPOSE OF THE JOIWT HOSPITAL BOARD OF THE NEW YORK STATE POSTWAR PUBLIC WORKS 
PLAHNIMG COMMISSION 
(1) To inventory the existing hospitals of every character. 
(2) To survey the need for the construction of hospitals. 
(3) To develop programs for the construction of such public and non-profit hos- 
pitals as will afford, in conjunction with existing facilities, the neces- 
sary physical facilities for furnishing adequate hospital clinic and simi- 
lar service to all of the people. 
I I STATE ORGAHIZATI OH 
( |) The Governor has designated the Hew York State Postwar Public Works Planning 
Commission to act as the sole state agency. The Joint Hospital Board, con- 
sisting of the Commissioners of Health, Mental Hygiene and Social Welfare, 
is to assist and cooperate. 
(2) A State Advisory Council to the Postwar Public Works Planning Commission is 
being appointed and will be under the chairmanship of Assemblyman Lee B. 
Mailler, who has been designated by the Governor as advisor to the Joint Hos- 
pital Board. appendix e 
I I I REGIONAL HOSPITAL PLAN FOR THE STATE 
(A) PURPOSE 
1. To provide a decentralized method of completing the survey of hospitals. 
2. To make available the results of the Survey to the local individuals and 
groups with responsibilities for hospital care. 
3. To provide, through Regional Hospital Planning Councils, appraisals of ex- 
isting facilities for hospital care. 
i|. To secure regional recommendations regarding the need for additional faci- 
lities. 
5. To assist hospitals in their plans for expansion by co-ordinated regional 
hospital planning and to enhance working relationships between individual 
hospitals and services. 
• 
6. To take advantage of the position of the four up-state medical teaching in- 
stitutions for improving facilities for undergraduate and postgraduate med- 
ical, public health and nursing education and for the provision of an ade- 
quate distribution of medical services requiring specialty training. 
7. Through the work of the Regional Hospital Planning Councils, to assist the 
Joint Hospital Board and the New York State Postwar Public Works Planning 
Commission in meeting its responsibilities. 
(B) ORGAN IZATION 
1. The provisional division of the state, (exclusive of New York City) into 4 
major hospital regions a nd 2 smaller regions fort he extra metropolitan area. 
2. The provisional division of each region into primary and secondary hospital 
service districts. (See map attached) 
3. The Hospital Council of Greater New York, with its Postwar Hospital Planning 
Committee, and with the co-operation of the Greater New York Hospital Asso- 
ciation, will act as the clearing house for New York City, 
Establishment of Regional Hospital Planning Councils in each of the up-state 
regions. Regional Hospital Planning Councils shouId be composed of the hos- 
pital administrators, acting as representatIves of the primary and secondary 
hospital districts, representatives of the New York State Hospital Associa- 
tion and its local hospital councils, boards of trustees of hospitals, re- 
presentatives of the medical and nursing professions, the medical school and 
representatives of Pub 1ic Health, Public Welfare, Agriculture, Labor and In- 
d ustry. APPENDIX e 
5. The appointment of a competent hospital administrator, on a full or part 
time basis, for a temporary period, for each of the Regional Planning Coun- 
cils to act as secretary to Reg IonaI Planning Councils and to assist in com- 
pleting the hospital Inventory schedules. State funds will be available to 
cover this service and travel expenses. 
6. One local hospital administrator from each of the hospital districts will be 
asked to volunteer as the representative of his hospital service district 
and to assist the local hospitals in completing the inventory schedules. 
This will mean that no one volunteer would be responsible for more than 10 
or 12 institutions. These district representatives w 111 receive instruction 
concerning the Interpretation of the inventory schedules from the secretar- 
ies of the Regional Hospital Planning CounciIs a nd the Joint Hospital Board. 
(C) OPERATION OF THE PLAN 
1. The 22 page Inventory schedule will be sent directly to each of the hospi- 
tals of more than 25 bed-capacIty. 
Hospitals of less than 25 beds will receive a Short 9 page inventory sched- 
ule in duplicate. 
Two copies of the schedule are to be completed, the hospital will retain one 
for its own use, the second copy will be turned over to the representative 
of the hospital service district, who will review it with the hospital su- 
perintendent, If necessary. 
The secretaries to the Regional Planning Councils will meet with the hospi- 
tal service district representative, check the schedules for the several 
hospitals within the district, and forward them to the Joint Hospital Board 
at Albany. 
The Hospital Council of Greater New York will distribute the inventory sched- 
ules and complete the contacts with hospitals In New York City. Inventory 
schedules for maternity homes, nursing homes and related Institutions will 
be completed with the ass Istance ofthe several state departments concerned. 
2. The completed Inventory schedules will be forwarded to Chicago, where the 
Commission on Hospital Care has volunteered to perform the coding, prepara- 
tion of punch cards and preliminary tabulations. 
The statistical tabulations and completed Inventory schedu les a nd punch cards 
will then be returned for appraisal and planning uses In New York State. 
3. Shortly after the I nventory schedules have been mailed to the hospitals, or- 
ganizational meetings will be held In each of the regions. To these meet- 
ings will be invited representatives of the New York State Hospital Associa- 
tion and its local Councils, trustees and superintendents of hospitals In 
the regions, representatives of the medical and nursing professions, the 
Deans of the medical schools and representatives of public health and soc- 
ial welfare, agriculture, labor and Industry. APPENDIX E 
At the regional organization meetings, the Regional Hospital Planning Coun- 
cils are tobe established, a secretary appointed and the survey Inaugurated. 
Each Regional Hospital Planning Council should be composed of the hospital 
service district representatives and representat I ves of the groups enumera- 
ted above. 
4. Subsequent meetings of the Regional Planning Councils are to be arranged 
through Itschalrman, as neces sa ry and by request of the Joint Hospital Board. 
The Joint Hospital Board will make available to each of the Regional Hospi- 
tal Planning Councils, Information secured through the survey and data per- 
taining to the social and economic factors In hospital planning. APPENDIX E 
Based on data relative to existing hospitals, medical schools, 
trade areas and highways. 
Adapted from material prepared by New York State Health Preparedness Commission 
Trade area data adapted from MARKETING MAP OF NEW YORK published by Hearst 
Magazines, Inc., for 1942. 
PROVISIONAL DIVISION OF NEW YORK STATE 
INTO 
HOSPITAL REGIONS AND PRIMARY AND SECONDARY 
HOSPITAL SERVICE DISTRICTS 
FOR 
THE PURPOSES OF SURVEY AND PLANNING, & 
POSTWAR CONSTRUCTION 
BOUNDARIES OF HOSPITAL REGIONS 
BOUNDARIES OF SECONDARY HOSPITAL DISTRICTS 
SECONDARY HOSPITAL DISTRICTS SERVED BY 
PRIMARY CENTERS 
OTHER SECONDARY DISTRICTS 
PRIMARY CENTERS 
SECONDARY CENTERS 
POSTWAR PUBLIC WORKS PLANNING COMMISSION 
JOINT HOSPITAL BOARD Appendix E-3 
mMM 
JJJfa 
EDWARD 5 GODFREY. JR, M 0. 
. COMMISSIONEP 
I B. R. RICKARDS. S S 
U 101 TOR 
• A iiaCA AT ALBANY. H Y. 
»y NEW YORK STATE DEPARTMENT OF HEALTH 
Vol. 23 
July 29, 1946 
No. 30 
Hospital Survey and Planning in New York State 
Among the many controversies concerning a health 
program, perhaps the foremost is whether or not any 
adequate plan for medical care need be compulsory. 
Too often compulsion has stifled inspiration and 
progress. To my mind this is not the most important 
problem; The first essential of any sound and effective 
plan for extended service is that it provide individual 
initiative, encourage improvement, and advance and 
provide medical and hospital facilities of high quality 
where needed. 
Hospitals once established are apt to operate as 
isolated institutions and there is very little coordination 
between them. Too frequently small hospitals, espe- 
cially in areas lacking wealth and population and the 
necessary medical and surgical staff, attempt to furnish 
all types of care as a self-sufficient unit. Under such 
an arrangement, the public does not receive care in 
keeping with modern medicine and the medical care 
standards of the locality tend to remain static or to 
depreciate. Moreover, physical separation between 
hospital and health departments tends to perpetuate the 
custom under which preventive and curative services, 
figuratively speaking, operate in different worlds rather 
than in relation to the same individual. 
Fundamentals in Planning 
In any discussion regarding the development of a 
functional plan for the administration of hospital and 
health services, several fundamental criteria should be 
constantly kept in mind. 
There is ample evidence of the relationship between 
low economic income and illness. This implies volun- 
tary or governmental subsidy. 
Areas on a low economic level generally are less 
likely to have professional and hospital facilities. The 
well-trained physicians whom the medical schools are 
providing today need hospital facilities with special 
diagnostic and consultation services and, frequently, 
therapeutic assistance in the fields of medicine and 
surgery requiring special postgraduate education and 
experience. The tendency of recent graduates to locate 
predominantly in proximity to the teaching type of 
hospital center is ample evidence that they seek the 
intellectual stimulation found in these centers and that 
they desire a progressive career. 
Progress in medical science dictates a continuing 
educational program for physicians. New methods of 
diagnosis, treatment and prevention emanate from the 
research and teaching centers. Rural physicians espe- 
cially have been isolated from advances in modern 
medical science and technology. 
In planning it should be kept in mind that the gen- 
eral practitioner is the key person in community medical 
care. New patterns and procedures should supplement 
and assist rather than supplant him. To transport all 
seriously ill patients fifty or one hundred miles or more 
to the nearest medical center would weaken the stand- 
ard of medical practice and eventually deprive the 
community of full and comprehensive health services. 
At the other extreme, it would be economically unsound 
and inadvisable to have hospital or health center facili- 
ties in every hamlet. 
Relatively few communities have the economic, pro- 
fessional, and medical equipment and resources required 
to provide modern medical services which should be 
available to all people today. Experience shows that 
the population must be sufficient to support the services 
of a physician qualified in one of the specialized 
branches of medicine. 
Affiliation a Prerequisite 
Obviously, a system of affiliation is needed between 
hospitals of various sizes, the medical profession, the 
medical schools and the official health agencies if pre- 
ventive and curative services of high quality are to 
be provided on an economical basis. Further, these 
affiliations are necessary in order to narrow the gap 
between scientific achievement and actual practice. 
Analysis of the location of physicians, qualified 
specialists, and teaching centers, especially in New 
York State, leads to the belief that regional and district 
hospital planning offers much hope in meeting the aims 
* Abstract of paper presented by John J. Bourke, M.D., survey director, 
Joint Hospital Board, New Yoik State Postwar Public Works Planning Com- 
mission, at the Annual Conference of Health Officers and Public Health 
Nurses, Saratoga Springs, New Voik, June 25, 1946 
Stop Accidents Before They Stop Yon HEALTH NEWS 
July 29, 1946 
for better service. This is not a new idea; it involves 
an unselfish approach in the development of inflow and 
outflow services between the teaching center and the 
institutions which might be referred to as satellite 
hospitals. 
and nursing professions, of official public health and 
public welfare departments, boards of supervisors, 
mayors of cities, and deans of medical schools within 
the region and other interested persons with responsi- 
bility for the establishment, operation, support and use 
of the hospitals. 
About the first of September, these councils will be 
supplied with the results of the hospital survey and with 
other pertinent data of social, economic and health 
nature which are currently being assembled. It is 
believed that with this information, the regional coun- 
cils can formulate basic recommendations of great 
importance to the State and localities as to needs for 
new construction and expansion of existing facilities 
and the desirability of certain amalgamations and affili- 
ations between hospitals of various types and sizes and 
health centers. 
The Regional Concept of Hospital Service 
The regional concept of hospital service has much to 
merit its widespread adoption. I believe that the medi- 
cal schools and larger hospitals of high quality wish to 
extend their influence and assistance in raising the 
standards of hospital care. Further, hospitals in rural 
and small urban areas appear eager to have the assist- 
ance which these teaching centers offer. The medical 
and nursing professions should receive much benefit. 
The larger institutions will have to assure the smaller 
hospitals and the medical profession that affiliation is 
not a competitive program designed to deprive the 
rural hospitals and physicians of patients but rather a 
method of improving medical care and medical educa- 
tion. This should make it possible ultimately for more 
patients to obtain care at their community hospital. 
On the other hand, the local hospital and the local prac- 
ticing physician will have to subject themselves to a 
critical analysis of the scope of their abilities for the 
best interests of the patient. 
It is with the previously mentioned points in mind 
that the Joint Hospital Board, under the chairmanship 
of State Commissioner of Social Welfare, Mr. Robert 
T. Lansdale, and comprising the State Commissioners 
of Health and Mental Hygiene,. Dr. Edward S. 
Godfrey, Jr., and Dr. Frederick MacCurdy, has 
attempted to meet its responsibility for state hospital 
survey and planning. Assemblyman Lee B. Mailler 
has been appointed by the Governor as advisor to the 
Joint Hospital Board and is chairman of the State 
Advisory Council on Hospital Survey and Planning. 
The responsibilities of the Board are to “inventory the 
existing hospitals of every character in the State of 
New York, and to survey the need for construction of 
such public and other nonprofit hospitals, as will afford 
in conjunction with existing facilities, the necessary 
facilities for furnishing adequate hospital clinic and 
similar services to all the people.” 
For the purpose of survey and planning, the State 
has been provisionally divided into five regions. Each 
region has a primary hospital service center associated 
with a medical school and several secondary hospital 
centers where there are hospitals of 100-bed capacity 
or more. The nuclei of regional planning councils have 
already been completed. The councils are active in the 
completion of the hospital survey and include compe- 
tent hospital administrators from each of the primary 
and secondary centers. The Joint Hospital Board 
plans to assist the local councils in expanding their 
membership to include representatives of the medical appendix 5 
AVERAGE ANNUAL DEATH RATES, 1940 — 1944 
4-5 AND OVER 
40 44-. 9 
RATE 
33.3 
31 .2 
35.7 
34.7 
37 .3 
34.7 
36 .7 
INFANT MORTALITY 
NEW YORK STATE 
NEW YORK CITY 
REST OF STATE 
URBAN 
RURAL 
PLACES OVER 10,000 
PLACES UNDER 10,000 
30 34-.9 
35 39.9 
UNDER 30