An administrative study of the Los Angeles County Department of Charities
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AN ADMINISTRATIVE STUDY OP THE LOS ANGELES COUNTY DEPARTMENT OF CHARITIES
A T h e s is P re s e n te d to t h e F a c u l t y o f t h e S c h o o l o f P u b liG A d m i n i s t r a t i o n The U n i v e r s i t y o f S o u th e r n C a l i f o r n i a
In P a r tia l F u lfillm e n t o f t h e R e q u ire m e n ts f o r th e D eg ree M a ste r o f S c ie n c e i n P u b l i c A d m in is tr a tio n
by E u g e n e R o b e r t 1E r i c k s o n Ju n e 1950
UMI Number: EP64482
All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion.
Dissertation Publishing
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This thesis, written by
............. EUGME..HOBEHT . ERI.CKS OE.................. under the guidance of k%3.... Faculty C om m ittee, and a p proved by all its members, has been presented to and accepted by the Council on Graduate S tu d y and Research in partial fulfill ment of the requirements fo r the degree of
MASTER OF SCIENCE IN PUBLIC ADMINISTRATION T........................................... H. J ♦JD eue1.,. J r ..................
D ean ____________
Faculty Committee
'hairman
TABLE OF CONTENTS CHAPTER I*
PAGE
THE PURPOSE, D EFIN ITIO N S, ORGANIZATION AND SOURCES OF DATA
.
* •
The p u r p o s e ........................................................• • . . . . S ta te m e n t o f th e p u rp o se
•
.
I
............................
1
I m p o r t a n c e o f t h e s t u d y .......................... D e fin itio n s
1
o f t e r m s u s e d ..........................
3
P u b l i c h o s p i t a l a n d m e d i c a l c a r e .....................
3
P u b l i c a s s i s t a n c e .................................................. •
4
P u b lic w e lfa re .
II.
I
• •
..................... ♦ ....................................
4
O r g a n i z a t i o n o f t h e t h e s i s * .....................................
5
S o u r c e s o f d a t a ........................................................................
6
PHILOSOPHICAL AND LEGAL BASIS FOR PUBLIC WELFARE.............................................................................................
8
D e v elo p m en t o f p u b l i c w e l f a r e i n E n g la n d • •
8
B re a k d o w n o f p r i v a t e a n d c h u r c h w e l f a r e
sys-
. t e r n s ...................................
8
E n g l a n d a n d t h e E l i z a b e t h a n P o o r Law *
.
10
g ro w in g A m erica
• •
12
L ocal a d m in is tra tio n of p u b lic w e lfa re
• •
12
W e lfa re i n c o lo n ia l and
.
F a c to rs in f lu e n c in g p u b lic w e lfa re d e v e lo p m e n t ........................................................................................ S ta te
su p e rv isio n of lo c a la d m in is tra tio n .
14 17
iii CHAPTER
PAGE F ed eral p u b lic a s s is ta n c e in c e n tu ry .
.
th e t w e n t i e t h
.......................................................................
F ed eral h o s p ita ls
19
i n th e tw e n tie th c e n tu ry
S ta te and lo c a l p u b lic a s s is ta n c e tw e n tie th c e n tu ry .
•
in th e
....................................................
P u b lic a s s is ta n c e f o r c h ild r e n P u b lic a s s is ta n c e f o r
27
. . . . . .
th e a g ed , b lin d
p o o r
28
and
• • • •
30
f o r t h e b l i n d .........
31
P u b l i c a s s i s t a n c e f o r t h e a g e d .........
33
P u b lic a s s is ta n c e
P u b lic a s s is ta n c e f o r th e p o o r • • • • • • S ta te and lo c a l h o s p ita ls
34
in th e tw e n tie th
c e n t u r y ....................................................................................... III.
24
34
HISTORY AND ORGANIZATION OF THE ’ DEPARTMENT OF CHARITIES...................................................................... H i s t o r i c a l d e v elo p m e n t
• • • • •
A d m in is tra tiv e a c t i v i t i e s of C h a ritie s
3-9 39
o f th e D e p artm en t
. . . • • • • • • . • • •
C h a ritie s a d m in istra tio n
♦
• • • • • • • • •
54
B u r e a u o f H o s p i t a l s ......................................................... B ureau o f H o s p i t a l s : G en eral H o s p ita l
49
56
L os A n g e l e s C o u n t y
• • • • . «
..........................
57
B ureau o f H o s p i t a l s :
R a n c h o L os
A m ig o s.
•
B u reau o f H o s p i t a l s :
O l i v e V iew
S a n a to riu m
59 60
iv CHAPTER
PAGE B ureau o f H o s p i t a l s :
Los A n g e le s C o u n ty
H arbor G en eral H o s p ita l. B ureau o f H o s p i t a l s :
• • • • • • • •
Los A n g e le s C o u n ty
L o n g B e a c h G e n e r a l H o s p i t a l ............................... B u reau o f H o s p i t a l s : C a m p s.
IV .
THE
61
62
A c t o n a n d W arn S p r i n g s
• • • • ..............................................................
63
B u r e a u o f P u b l i c A s s i s t a n c e .....................................
64
B ureau o f R e s o u rc e s a n d C o l l e c t i o n s .
66
. . .
B u reau o f M e d ica l S o c i a l S e r v ic e
.....................
67
B ureau o f A d o p tio n s .
• • • • •
68
..........................
B ureau o f P h y s i c a l l y H a n d ic a p p e d C h ild re n *
68
PO LITICS OF PUBLIC WELFARE.....................................
70
P u b lic w e lfa re I n t e r e s t g ro u p s
•• • • • • •
70
R e l a t i o n o f th e D e p a rtm e n t o f C h a r i t i e s w ith g o v e r n m e n t a l g r o u p s .........................................................
73
N a t i o n a l a g e n c i e s ..............................................................
73
S ta te of C a lifo rn ia :
th e G o v e rn o r’ s o f f i c e
74
S ta te of C a lifo rn ia :
le g isla tu re .
75
S ta te
s t a t e a g e n c ie s
of C a lifo rn ia :
C o u n ty o f Los A n g e le s :
. . . . . . .
77
B o ard o f S u p e r
v iso rs
78
C o u n ty o f L os A n g e le s :
o th e r d e p a rtm e n ts.
79
C o u n ty o f L os A n g e l e s :
G rand J u r y • • • .
80
R e l a t i o n o f t h e D ep artm en t o f C h a r i t i e s w ith
V
CHAPTER
PAGE n o n g o v e rn m e n ta l g ro u p s . • • • • • • • • •
80
N e w s p a p e r s a n d m a g a z i n e s ..........................................
80
T a x p a y e r s * g r o u p s ..............................................................
82
P ro fe ss io n a l g ro u p s.
83
.
.
.........................................
R e l a t i o n o f th e D e p artm en t o f C h a r i t i e s w ith o rg a n iz e d c itiz e n s * C a lifo rn ia C itiz e n s*
In stitu te
g r o u p s ......................... .
o f S o c ia l W e lfa re
• .
87 87
S p e c i a l C o m m itte e o n C o m m u n ic a b le
D i s e a s e . .............................. R e l a t i o n o f th e D ep artm en t
88 of C h a ritie s
w ith a d v is o r y b o a rd s a n d c o m m itte e s. B oards s e r v e d by p h y s i c i a n s .
. . .
89
• • • • • • •
89
C o m m itte e s s e r v e d by p r o f e s s i o n a l a n d l a y p erso n s. V.
........................................................................
92
AN EVALUATION OF THE DEPARTMENT OF CHARITIES ADMINISTRATION . .
.
....................................................
H o s p ita l c a re and p u b lic a s s is ta n c e iz e d in th e
96
c e n tra lr
sam e d e p a r t m e n t ...................................
96
S h o u ld Los A n g e le s C o u n ty a d m i n i s t e r p u b l i c a ssista n c e ? .
...................................................................
101
H as L o s A n g e l e s C o u n t y a d e q u a t e l y p r o v i d e d p u b lic h o s p ita l
f a c i l i t i e s ? ..............................
.
10 8
BIBLIOGRAPHY..................................................................................................
117
LIST OF TABLES TABLE I*
O r g a n i z a t i o n C h a r t , L o s A n g e l e s C o u n ty D e p artm en t o f C h a r i t i e s
. . . . . .
CHAPTER I THE PURPOSE, D E FIN ITIO N S, ORGANISATION AND SOURCES OF DATA T h ro u g h , t h e y e a r s t h e D e p a r t m e n t o f C h a r i t i e s o f t h e C o u n t y o f L o s A n g e l e s h a s g r o w n , b e c a u s e o f n ew f u n c t i o n s th a t have been added and a s a r e s u l t o f p o p u la tio n in c r e a s e s i n t h e C o u n t y , y e t n o s t u d y h a s b e e n m ade o f t h e a d m i n i s t r a tiv e p ra c tic e s of th is
D e p artm en t w i t h I t s
e x te n siv e a c t iv i t ie s *
P u b l i c w e l f a r e a g e n c i e s i n o t h e r j u r i s d i c t i o n s h a v e m ade e x h a u stiv e a n a ly se s o f a d m in is tra tiv e o p e ra tio n s , and th e re
is
a n e e d f o r a m anagem ent s t u d y o f th e D e p a rtm e n t o f C h a r i t i e s * I*
THE PURPOSE
S ta te m e n t o f th e p u r p o s e * stu d y
It
Is
th e p urpose o f th is
(1 ) t o d e te rm in e on w hat p h i l o s o p h i c a l and l e g a l b a s e s
p u b lic w e lfa re i s a d m in is te re d to d a y , p a r t i c u l a r l y A n g e le s C o u n ty ;
(2 ) t o p r e s e n t th e d e v e lo p m e n t o f th e D e p a r t
m ent o f C h a r i t i e s and th e ran g e tie s a t p re se n t;
i n Los
(3 ) t o
of i t s a d m in istra tiv e a c tiv i
show p o l i t i c a l a n d p u b l i c r e l a t i o n s
i n f l u e n c e s i n h e r e n t I n p u b l i c w e lf a r e a d m i n i s t r a t i o n ; a n d (4 ) to
e v a lu a te
th e e f f i c a c y o f c e r t a i n a d m i n i s t r a t iv e p ro g ram s
o f t h e D e p a rtm e n t o f C h a r i t i e s a n d t h e C o u n ty o f Los A n g e les* Im p o rta n c e o f
th e s tu d y *
p u b lic w e lfa re p ro g ram s i s
A d m i n i s t r a t i o n o f t h e m any
one o f t h e m a j o r f u n c t i o n s o f
g o v ern m en t t o d a y , e s p e c i a l l y a t t h e s t a t e an d l o c a l l e v e l s * I n C a l i f o r n i a , w here p u b lic w e lf a r e i s a d m in is te r e d e n t i r e l y by c o u n tie s ,
th e f in a n c in g and o p e r a tio n o f th e s e program s
h a s becom e a n a c u t e b u rd e n t o L o s A n g e le s C o u n ty i s n in e o f th e s t a te s m any s t a t e s
lo c a l ta x p a y e rs * la r g e r i n p o p u la tio n th a n t h i r t y -
in th e n a tio n .
T he C o u n ty s t a n d s a b o v e
i n w e a l t h , a n d i n v a l u e o f a g r i c u l t u r a l a n d m anu
fa c tu r e d goods p ro d u ced .
A d m in is tra tio n of p u b lic w e lfa re
by th e D e p artm en t o f C h a r i t i e s
is,
in d e e d ,
" b ig b u s in e s s * "
N e a r l y h a l f o f t h e t w e n t y - t w o t h o u s a n d C o u n t y e m p l o y e e s w o rk i n t h i s D e p a rtm e n t.
Of 2 1 8 m i l l i o n s a p p r o p r i a t e d f o r a l l
C o u n t y p u r p o s e s d u r i n g t h e f i s c a l y e a r 1 9 4 8 - 4 9 , som e 117 m illio n s ,
o r f i f t y - f o u r p e r c e n t , w as e x p e n d e d b y t h e D e p a r t
m ent o f C h a r itie s * ^ One o f t h e n a t i o n ’ s a u t h o r i t i e s s ta te d , in
1938, th a t
on p u b l i c w e l f a r e
"Pew f e d e r a l o r s t a t e p u b l i c w e l f a r e
a g e n c i e s e m p lo y a s m an y p e r s o n s a n d p e r f o r m a s m any f u n c t i o n s p a s d o e s t h e L os A n g e le s C o u n ty D e p a rtm e n t o f C h a r i t i e s * " B e cau se o f th e i n c r e a s e d C o u n ty p o p u l a t i o n an d f u n c t i o n s t h a t h a v e b e e n a d d e d s i n c e 1 9 3 8 , t h e num ber o f e m p lo y e e s to d ay i s a t h i r d g r e a t e r .
**■ L o s A n g e l e s C o u n t y . A u d ito r. C o u n ty B u d g e t. 1 9 4 9 1950 (L os A n g e le s : B o ard o f S u p e r v i s o r s , 1 9 4 9 ) , pp* 2 7 - 2 9 . 2 M a r ie tta S te v e n so n , P u b lic W elfa re A d m in is tr a tio n (New Y o r k : The M a c m i l l a n C o m p an y , 1 9 3 8 ) , p . 9 6 .
3 I n v iew o f t h e a c c e p t e d im p o rta n c e o f p u b l i c w e l f a r e i n th e n a ti o n to d a y , and b e c a u se o f i t s
s ig n ific a n t f is c a l
e f f e c t s on a l l
is
a b le
l e v e l s o f g o v e rn m e n t, i t
th e re fo re d e s ir
to u n d e r s ta n d t h e f u n c t i o n s a n d r e a l i z e
a d m in istra tiv e a c t i v i t i e s T oo f e w c i t i z e n s
o f th e D ep artm en t o f C h a r i t i e s *
h a v e a k n o w le d g e o f o u r c o m p re h e n s iv e p u b l i c
w e l f a r e p r o g ra m s to d a y * n ia by th e
T h is was w e l l I l l u s t r a t e d
in C a lifo r
l e t h a r g i c a c c e p t a n c e o f t h e flM c L a in M a c h i n e ,f i n
1 9 4 8 , f o llo w e d by i t s
f o r c e f u l r e c a l l In 1949— b u t n o t u n t i l
ill- in f o r m e d ta x p a y e rs had lo s t m illio n s It
th e sco p e o f
i s hoped t h a t th is
a d m in istra tiv e ro le
of d o lla rs*
s tu d y w i l l h e lp to
c la rify
th e
o f th e D e p a rtm e n t o f C h a ri t i e s — i t s
p a s t and p r e s e n t p u b lic w e lfa re s e rv ic e to
t h e C o u n ty o f
Los A n g e les* II.
DEFINITIONS OF TERMS USED
P u b lic h o s p i t a l and m ed ica l c a r e * an d m e d ic a l c a re i s d e fin e d to
P u b lic h o s p ita l
in c lu d e ta x su p p o rte d i n s t i
tu tio n s and o u t- p a tie n t c l i n i c s p ro v id in g a l l h o s p i t a l a n d m e d ic a l c a r e to in c o m e g r o u p s .
The c u r r e n t
ty p es o f
t h e i n d i g e n t a n d t h o s e i n lo w tre n d i s
to d e v e lo p th e g e n e r a l
h o s p i t a l w h ic h f u r n i s h e s i n t e g r a t e d
s e r v ic e s f o r a l l ty p e s
of p a tie n ts.
fo llo w in g t h i s p re s e n t
L os A n g e le s C o u n ty i s
News i t e m i n t h e L o s A n g e l e s E x a m i n e r * N o v e m b er 2 7 ,
4 p a tt e r n In th e e s ta b lis h m e n t o f g e n e ra l h o s p i t a l s . lo c a litie s ,
h o w ev er, c o n tin u e t o u t i l i z e
ty p e s o f i n s t i t u t i o n s , c u lo s is , a c u te ,
Many
th e sp e c ia liz e d
se g re g a tin g th e c a re g iv e n , a s ,
c h ro n ic , m a te rn ity ,
P u b lic a s s is ta n c e .
tu b e r
c o n ta g e o u s , and m e n ta l.
T h ro u g h o u t t h i s
s tu d y th e te rm
”p u b l i c a s s i s t a n c e ” i s u s e d a s m e a n i n g t h e g r a n t i n g o f m a te ria l r e l i e f
to
th o se p e rso n s
th e s t a tu t e s o f n a tio n a l, f o r such r e l i e f , fro m f e d e r a l ,
o r l o c a l g o v e rn m e n ts .
and c o sts o f a d m in istra tio n , a re
Funds
d e riv e d
s ta te and lo c a l ta x e s .
P u b lic w e lfa r e . a l l p u b lic
sta te
i n n e e d who q u a l i f y u n d e r
P u b l i c w e l f a r e i s d e f i n e d a s m e a n in g
h o s p i t a l an d m e d ic a l c a r e , and p u b lic a s s i s t a n c e .
J u risd ic tio n s
th ro u g h o u t th e n a ti o n v a ry i n th e f u n c tio n s
a s s ig n e d to p u b lic
w e lfa re a g e n c ie s .
Some i n c l u d e a l l w o rk
t h a t eom es u n d e r p u b l i c h e a l t h , p a r k s a n d r e c r e a t i o n , a n d p u b lic h o u sin g a g e n c ie s .
T h is s t u d y , h o w ev er, h a s l i m i t e d
t h e t e r n to encom pass t h o s e s e r v i c e s p r o v id e d by th e L os A n g e le s C o u n ty D e p a rtm e n t o f C h a r i t i e s . h o s p i t a l , m e d ic a l an d r e l i e f c a r e .
T hese a r e , p r i m a r i l y ,
They a l s o
In c lu d e a
c e m e te ry f o r b u r i a l o f i n d i g e n t s , a p la c e m e n t u n i t f o r ad o p t i o n o f c h il d r e n and a program f o r c a re o f p h y s i c a l l y h a n d i capped c h ild re n .
5 I ll.
ORGANIZATION OF THE THESIS
The s e c o n d c h a p t e r o f t h i s
stu d y p re s e n ts th e p h ilo
so p h ic a l and le g a l b a s is fo r p re s e n t-d a y a d m in is tra tio n of p u b lic w e lfa re .
H i s t o r i c a l d e v e lo p m e n ts a r e
t r a c e d from
b e g in n i n g s o f p u b l i c p o o r r e l i e f i n E n g la n d w h ic h h a v e p r o v id e d t h e f o u n d a t i o n f o r m odern p u b l i c h o s p i t a l an d p u b l i c a s s is ta n c e p ro g ram s.
More s p e c i f i c a l l y ,
fro m i n i t i a l
ste p s
i n E n g la n d , t h e e v o l u t i o n o f w e l f a r e a s a p u b lic f u n c t i o n is
fo llo w e d t o
tiie A m e ric an c o l o n i e s , a n d t h e n a s i t
in
th e e x p a n d in g n a t i o n .
grew
S ta r tin g w ith th e tw e n tie th c e n tu ry
i n t h e U n i t e d S t a t e s , a m o re d e t a i l e d
stu d y i s
m ade o f
n a t i o n a l p u b lic m e d ic a l and p u b lic a s s is ta n c e - p ro g ra m s, a s w e ll a s th e
sy ste m s a d o p te d b y s t a t e a n d c o u n ty j u r i s d i c t i o n s .
P a r t i c u l a r e m p h a sis i s g i v e n ,
of co u rse,
to d ev elo p m e n ts i n
C a l i f o r n i a a n d Los A n g e le s C o u n ty . The n e x t c h a p t e r i s c o n c e r n e d w ith u n f o l d i n g w h ic h to o k p l a c e
th e h i s t o r i c a l
I n Los A n g e le s C o u n ty a s p u b l i c
w e l f a r e d u t i e s w ere a ssu m e d , b e g in n i n g fro m t h e C o n g ress a d d e d C a l i f o r n i a a s t h e t h i r t y - f i r s t S ep tem b er 9 , 1850 up to t h e p r e s e n t t i m e .
tim e t h a t
sta te
on
S tru c tu re o f th e
D e p artm en t o f C h a r i t i e s to d a y i s d e s c r i b e d , p r e s e n t i n g th e e x te n s i v e a d m i n i s t r a t i v e a c t i v i t i e s w h ic h a r e p e rf o r m e d . b r i e f e x p o sitio n o f c u rre n t o p e ra tio n s o f each d iv is io n in t h e D e p artm en t I s a l s o p r o v i d e d .
A
6 R a m ific a tio n s o f p o l i t i c a l and p u b lic r e la ti o n s fa re agency a re
in flu e n c e s ,
p o l i c y m a k in g
i n t h e a d m i n i s t r a t i o n o f a p u b l ic w e l
th e s u b je c t o f th e fo llo w in g c h a p te r .
The
r e l a t i o n s o f t h e D e p a rtm e n t o f C h a r i t i e s a n d t h e C o u n ty o f L o s A n g e le s w i t h g o v e rn m e n ta l g r o u p s on a n a t i o n a l , and lo c a l le v e l a re d e s c rib e d .
s ta te
In c lu d e d , in a d d itio n ,
is
a d i s c o u r s e i n r e g a r d t o r e l a t i o n s b e tw e e n t h e D e p a rtm e n t an d n o n -g o v e rn m e n ta l g r o u p s , b o th p r o f e s s i o n a l an d c it i z e n s * o rg a n i z a ti ons • The f i n a l c h a p t e r a t t e m p t s t o
e v a lu a te th e e f f e c ti v e
n e s s o f p u b l i c w e l f a r e a d m i n i s t r a t i o n i n L os A n g e le s C o u n ty fro m th e v ie w p o in t o f t h e ta x p a y e r a n d o f th o s e i n need* I n s t e a d o f s t u d y i n g a n d e v a l u a t i n g a g r e a t m an y p r o b l e m s in
t h i s c h a p te r , o n ly c e r t a i n o u ts ta n d in g q u e s tio n s w i l l be
c o n sid e re d * IV .
SOURCES OF DATA
In fo rm a tio n f o r th e
c h a p t e r on th e p h i l o s o p h i c a l a n d
l e g a l b a s e s f o r p u b l i c w e l f a r e w as o b t a i n e d p r i m a r i l y f r o m b o o k s w h o se a u t h o r s a r e w e l l - k n o w n a u t h o r i t i e s
in th e f ie ld s
o f p u b lic h o s p ita l and p u b lic a s s is ta n c e a d m in is tra tio n . D a ta r e l a t i n g
t o l e g a l d e v e lo p m e n ts i n C a l i f o r n i a was p r o
c u re d fro m t h e v a r i o u s s t a t u t e
books.
S o u rces m a te r ia l f o r
th e c h a p te r s d e a lin g w ith th e o r g a n iz a tio n and o p e ra tio n o f t h e D e p a rtm e n t o f C h a r i t i e s was a lm o s t e n t i r e l y p r i m a r y ,
b a s e d on p e r s o n a l i n t e r v i e w s ,
d o c u m e n ts a n d r e c o r d s .
M ost
o f t h e i n f o r m a t i o n on p o l i t i c s a n d p u b l i c r e l a t i o n s i n w e l f a r e a d m i n i s t r a t i o n was o b t a i n e d fro m p e r s o n a l i n t e r v i e w s w ith i n d i v i d u a l s , b o th w ith in and o u ts id e th e D e p a rtm e n t.
CHAPTER I I PHILOSOPHICAL AND LEGAL BASIS FOR PUBLIC WELFARE When t h e A m e r i c a n c o l o n i e s a l o n g t h e e a s t e r n w ere e s t a b l i s h e d ,
seab o ard
th e y a d o p te d , a lo n g w ith th e E n g lis h
common l a w , a m e t h o d o f c a r i n g f o r t h e i n d i g e n t a n d s i c k p o o r t h a t h a d b e e n e n a c t e d d u r i n g t h e r e i g n o f Q u e en E l i z a b e t h , k no w n a s t h e E l i z a b e t h a n P o o r L aw .
T h is sy ste m o f
p u b l i c w e l f a r e r e m a i n e d w hen t h e U n i t e d S t a t e s w a s f o r m e d , c o n t i n u i n g i n t h e g ro w in g n a t i o n i n a n am ended f a s h i o n . T hese p r i n c i p l e s
s t i l l a r e fo llo w e d to a c e r t a i n e x te n t i n
th e a d m i n i s tr a t io n o f p u b lic h o s p i t a l s and p u b lic a s s i s t a n c e i n A m e r i c a , a n d t h e y lfh a v e r e m a i n e d l a r g e l y u n c h a n g e d i n som e s t a t e s
even to
th is
d a y . 11’**
W hat b r o u g h t a b o u t t h i s m e t h o d o f p u b l i c w e l f a r e a d m i n i s t r a t i o n t h a t h a s come do w n t h r o u g h t h e y e a r s ?
For
w hat r e a s o n s , on w hat p h i l o s o p h i c a l a n d l e g a l g ro u n d s , d o es it
e x is t?
I n o r d e r t o p r o v id e a n u n d e r s ta n d in g o f t h e m anage
m ent o f w e lfa re a s a p u b lic to b r ie f ly
fu n c tio n to d a y , i t
tr a c e th e s ig n if ic a n t h i s t o r i c a l
is d e sira b le
d e v e lo p m e n ts and
th e reaso n s f o r t h e i r o ccu ran ce. I.
DEVELOPMENT OF PUBLIC WELFARE IN ENGLAND
B re a k d o w n o f p r i v a t e a n d c h u r c h w e l f a r e s y s t e m s .
A
•** M a r i e t t a S t e v e n s o n , P u b l i c W e l f a r e A d m i n i s t r a t i o n (New Y o r k : T he M a c m i l l a n C o m p a n y , 1 9 3 8 ) , p . 4 .
num ber o f f a c t o r s w e re r e s p o n s i b l e f o r t h e e n a c tm e n t o f t h e E l i z a b e t h a n P o o r Law i n E n g l a n d . i n th e m id d le a g e s . e sta te s,
P r o p e r t y was h e l d i n l a r g e l a n d e d
ow ned b y f e u d a l l o r d s a n d w o r k e d b y t h e common
p e o p le o r s e r f s .
T he r e l a t i o n s h i p b e t w e e n l o r d a n d s e r f m ade
one re s p o n s ib le f o r th e fo o d ,
The b e g in n i n g t o o k p l a c e
o th e r.
C o n se q u e n tly , v a s s a l s r e c e iv e d
c lo th in g and s h e lte r in r e tu r n fo r t h e i r
t h e y becam e s i c k ,
la b o rs.
If
th e l o r d s o r f r i e n d s c a r e d f o r th em .
At
t h e sam e t i m e , t h e c h u r c h a n d m o n a s t e r i e s , w i t h t h e i r a d j o i n i n g a l m s h o u s e s , c a r e d f o r t h e p o o r i n t h e i r v i c i n i t y who d i d n o t re c e iv e th e p r o te c tio n o f a fe u d a l lo r d . E v e n t u a l l y , th o u g h , t h e f e u d a l sy ste m b e g a n to d i s in te g ra te .
E a c t o r s w h ic h t e n d e d t o
c a u s e t h e b reak d o w n w ere
t h e g r o w t h o f t h e e c o n o m ic w o r l d , i n c r e a s e d f a c i l i t i e s c o m m u n ic a tio n a n d d e v e lo p m e n t o f a b o u r g e o is c l a s s . w ere th ro w n o u t o f w o rk .
fo r
S erfs
T h e m o n k s h e l p e d m any b y f u r n i s h
in g fo o d , s h e l t e r a n d m e d ic a l c a r e .
D u rin g th e R e fo rm a tio n
a n d t h e r e i g n o f H enry V I I I , h o w ev er, th e c h u rc h e s and m o n a s te r ie s l a r g e l y w ere d i s s o l v e d .
W ith t h e s e
two m a i n
s o u r c e s o f s u p p o r t , t h e f e u d a l s y s t e m a n d t h e c h u r c h e s , now gone,
th o u sa n d s o f i d l e
w o rk e rs w an d ered o v e r th e E n g lis h
c o u n try sid e
in s e a rc h o f fo o d , c lo t h i n g , s h e l t e r an d m e d ic a l 2 c a r e f o r th e m se lv e s an d t h e i r f a m i l i e s . As a n e c e s s a r y
2 A r t h u r E . l i n k , T h e F i e l d o f S o c i a l Work (New Y o r k : H e n r y H o l t a n d C o m p an y , 1 9 4 2 ) , p . 5 .
10 m e a s u r e , m an y t u r n e d t o t h i e v e r y a n d o t h e r c r i m e #
M o st
o f th e m b e g g e d c o n s t a n t l y # In o rd er to a lle v ia te p a s s e d a law i n
th is
1536 d e c r e e in g
c o n d itio n , P a rlia m e n t
t h a t a lm s w ere t o b e c o l l e c t
ed f o r t h e Im p o te n t an d s i c k p o o r , a n d t h a t th e s e fu n d s w ere to be a d m in is te r e d by lo c a l o f f i c i a l s * r e l i e f p r o v i d e d w as f a r f r o m a d e q u a t e ,
Even th o u g h th e tti t
s ig n a liz e d th e
t r a n s i t i o n o f p o o r r e l i e f fro m an u n r e g u l a te d d is p e n s in g o f a i d by t h e C hurch t o t h e b e g in n in g s o f a i d b y th e s t a t e • E n g l a n d a n d t h e E l i z a b e t h a n P o o r Law #
C o n d itio n s
f i n a l l y becam e so a c u t e a s u n e m p lo y m en t i n c r e a s e d t h a t Q aeen E l i z a b e t h a n d th e s t a te s m e n o f t h e tim e w ere f o r c e d , i n t o e n a c t a law w h ereb y t h e a g e d an d i n f i r m f o r b y t h e f,o v e r s e e r s o f t h e p o o r # 11 tim e i n E n g la n d ,
th e p r i n c i p l e
1572,
sh o u ld be c a re d
T hus, f o r th e f i r s t
o f p u b lic p ro v is io n f o r th e
d e s t i t u t e w a s m ade a r e s p o n s i b i l i t y o f l o c a l g o v e r n m e n t u n d e r 4 a n e s t a b l i s h e d t a x sy ste m # T h i s l a w h e l p e d i n some m e a s u r e , b u t i t w as n o t u n t i l 1 6 0 1 t h a t t h e f a m o u s E l i z a b e t h a n P o o r Law w a s e n a c t e d t o f u r n i s h c o m p r e h e n s i v e a i d # o f g o v ern m en t e x te n d e d a i d by i n c l u d i n g
5
Local u n its
th e p o o r a s a g ro u p ,
3 Ib id .. p . 6. E d i t h A b b o t t , P u b l i c A s s i s t a n c e . V olum e I , A m e r i c a n P r i n c i p l e s an d P o l i c i e s (C h ica g o ; The U n i v e r s i t y . o f C h ica g o P r e s s , 1 9 4 0 ) , p • 3# 5 E l i z a b e t h 2 , 1 572#
11 c o s t s b e in g b o rn e by c i t y a n d c o u n ty ta x p a y e r s * w ere,
f o r th e f i r s t
c la im f o r r e l i e f *
The i n d i g e n t s
tim e , re c o g n iz e d as a c la s s w ith a le g a l A id t h a t w as a f f o r d e d i n
t h o s e tim e s was
f a r d i f f e r e n t from w hat th e p o o r r e c e i v e i n th e U n ite d S t a t e s to d ay *
I n th e e a r l y
s e v e n t e e n t h c e n t u r y i n E n g la n d , i t was
th e p o p u la r concept th a t own f a u l t ,
” t h e p o v e r t y o f t h e p o o r was t h e i r
and t h a t th e y m u st be s e v e r e l y d e a l t w ith t o
p r e v e n t th e m f r o m l i v i n g i n i d l e n e s s a t t h e e x p e n s e o f »7
w o r k e r s who p a i d t a x e s • ”
T h is a t t i t u d e I s n o t e n t i r e l y
a b s e n t ev en to d a y * T h e r e w as v e r y l i t t l e
h o s p i t a l d e v e lo p m e n t i n E n g la n d
o r i n any o f th e P r o te s ta n t c o u n trie s u n t i l w e ll I n to th e e ig h te e n th c e n tu ry *
T hose c o u n t r i e s i n w h ic h th e C a th o l i c
c h u r c h w as d o m i n a n t h a d c a r e o f t h e o rd ers*
s ic k p ro v id e d by r e l i g i o u s
T h i s s y s t e m w as c a r r i e d i n t o
F ren ch and S p a n ish m is s io n a r ie s * w h a t i s now t h e
t h e New W o r l d b y t h e
M issio n s e s t a b l i s h e d in
so u th w e st p a r t o f th e U n ite d S t a te s p ro b a b ly
w ere th e f i r s t i n t h i s
c o u n try to p ro v id e f o r c a r e o f th e
Q
s ic k and u n fo rtu n a te * 0 M a r i e t t a S t e v e n s o n , “ P u b l i c W e l f a r e , ” ( M a r g a r e t B* H o d g e s , e d i t o r , S o c i a l W ork Y e a r B o o k * 1 9 4 9 * New Y o r k : R u s s e l l S a g e F o u n d a t i o n , 1 9 4 9 ) , p . 404* ^ L e w i s M e r ia m , R e l i e f a n d S o c i a l S e c u r i t y ( W a s h i n g t o n , D*C*: T he B r o o k i n g s I n s t i t u t i o n , 1 9 4 6 ) , p . 8* o H o s p i t a l C a r e i n t h e U n i t e d S t a t e s * C o m m is s io n o n H o s p i t a l C a r e ( New Y o r k : T h e C o m m o n w ealth P h n d , 1 9 4 7 ) , p * 4 3 f f *
12 II.
WELFARE IN COLONIAL AND GROWING AMERICA
L ooal a ( M in is tra tio n o f p u b lic w e lfa re .
In th e
a c t i v e f r o n t i e r o f t h e - A m e r i c a n c o l o n i e s , t h e r e w as l i t t l e need fo r in s t it u t io n a liz e d p o o r r e l i e f .
M ost p e r s o n s w ere
a b l e t o p r o v i d e f o r t h e m s e l v e s , a n d t h e r e was a m u t u a l b o n d o f “h e l p
th y n e ig h b o r• "
E x c e p t f o r a few w id e ly s c a t t e r e d
b e d s, h o s p ita ls d id n o t e x is t.
I t was n o t u n t i l 1751 i n
P h i l a d e l p h i a t h a t t h e f i r s t h o s p i t a l i n a m o d e r n s e n s e w as fo u n d ed i n N o rth A m e ric a . o f 3 0 ,0 0 0 a t th e
9
New Y o r k C i t y , w i t h a p o p u l a t i o n
tim e o f t h e
sig n in g o f th e D e c la ra tio n of
In d ep e n d en c e , had no h o s p i t a l u n t i l a p r i v a t e i n s t i t u t i o n was e s t a b l i s h e d i n t h a t y e a r .
The f i r s t p u b l i c h o s p i t a l o f
New Y o r k C i t y , w h i c h w a s t h e b e g i n n i n g o f t h e w o r l d - r e n o w n e d B e lle v u e H o s p i t a l o f t o d a y , was n o t s t a r t e d u n t i l By 1 8 0 0 o n l y a s c o r e o f h o s p i t a l s o f a l l g o v e rn m e n ta l, h ad b een e s t a b l i s h e d ,
1 8 1 6 .^
ty p e s, p riv a te
and
a n d m o s t o f t h e s e c am e
i n t o e x i s t e n c e when t h e i r n e e d w a s m ade a p p a r e n t d u r i n g t h e R e v o l u t i o n a r y W a r.
T h is c o n t r a s t s w ith th e 6 ,1 6 0 h o s p i t a l s
in th e U n ite d S ta te s a t
th e p r e s e n t tim e .
11
G ra d u a lly , as th e p o p u la tio n o f th e n a tio n began to
9 Ib id . . p . 52. M a lc o lm T . M a c E a c h e r n , H o s p i t a l O r g a n i z a t i o n a n d M a n a g e m e n t ( C h i c a g o : P h y s i c i a n s * R e c o r d C o m p any, 1 9 4 6 } , p . 15 . ^
H o s p ita ls . 2 3 :2 2 , P a r t I I ,
Ju n e, 1949.
13 grow , c i t i e s
a n d c o u n t i e s w e r e f o r c e d , b y t h e dem and o f
so c ia lly -m in d e d c it i z e n s , p rin c ip le
t o e s t a b l i s h m o re a l m s h o u s e s .
The
of lo c a l r e s p o n s ib ility f o r th e w e lfa re of c itiz e n s
was a d o p t e d fro m t h e E l i z a b e t h a n P o o r Law . w hen t h e U n i t e d S t a t e s w as f o r m e d ,
T h is c o n tin u e d
th e in d iv id u a l s t a te s
a ssu m in g a c c o u n t a b i l i t y f o r t h e w e l f a r e o f t h e i r i n h a b i t a n t s . T he s t a t e s ,
in
t u r n , p a s s e d t h i s r e s p o n s i b i l i t y on to t h e
l o c a l g o v e rn m e n ts.
Two o t h e r E l i z a b e t h a n p r i n c i p l e s w e r e 5 th a t r e c ip ie n ts of a id had to be r e s id e n ts of
e sta b lis h e d : a ju ris d ic tio n
f o r a d e f i n i t e p e rio d o f tim e , and th a t r e l a t i v e s
who c o u l d a s s i s t
t h e n e e d y w e r e c a l l e d u p o n t o do s o .
12
P r e s s u r e by r e l i g i o u s and o th e r g ro u p s eh eo uraged th e p r o v is io n o f f a c i l i t i e s o f th e im p ro v id e n t. th e h i l l
to
f o r th e c are o f c e r ta in
c la s s e s
As a r e s u l t , t h e a g e d w e re " s e n t o v e r
th e p o o rh o u se o r c o u n ty f a r m .”
w e r e m ade t h e
O rp h a n a s y l u m s
"hom es” f o r d e p e n d e n t c h i l d r e n . 13 c e r t a i n t y p e s o f p a t i e n t s w ere e s t a b l i s h e d .
H o s p ita ls f o r M o st o f t h e
p u b lic w e lfa re o f th is e r a , and u n t i l th e tw e n tie th c e n tu ry i n A m e ric a , was " i n d o o r r e l i e f , ” o r p u b l i c a s s i s t a n c e i n 14 ~ in s titu tio n s . I t h a s b e e n m a i n l y d u r i n g t h e l a s t tw o d e c a d e s
^
S te v e n s o n , P u b lic W e lfa re A d m i n i s t r a t i o n , o p . c i t . .
^
P i n k , op* c i t . ,
p* 5 . p . 11.
P r a n c e s C ahn a n d V a le s k a B a ry , W e lf a r e A c t i v i t i e s o f F e d e r a l . S t a t e , a n d L o c a l G o v e rn m e n ts i n C a l i f o r n i a . 1 8 5 0 1934 IB e rk e le y : U n iv e r s ity o f C a lif o r n ia P r e s s , 1 9 3 6 ), p . 141.
14 th a t
" o u td o o r r e l i e f , ” o r a i d i n t h e c l i e n t f s hom e, h a s b e e n
th e a c c e p t e d fo rm o f a d m i n i s t r a t i o n . F a c to rs in f lu e n c in g p u b lic w e lfa re d e v e lo p m e n t.
P u b lic
h o s p ita l e v o lu tio n , and p u b lic a s s is ta n c e to a g r e a t d e g re e , have b een in flu e n c e d i n th e U n ite d S ta te s by sev en im p o rta n t fa c to rs .^ ®
E ach o f th e s e w i l l be c o n sid e re d b r i e f l y .
F irst,
"T h e b a s i c c h a r a c t e r o f h o s p i t a l s e r v i c e w a s m o l d e d f r o m t h e 16 e le m e n ts o f e a r l y r e l i g i o u s d o c t r i n e s . " A b a sic p r in c ip le o f m ost r e l i g i o n s i s
c a re o f th e
m ent o f ch u rch h o s p ita ls and a id
s i c k and p o o r , a n d e s t a b l i s h so c ie tie s
s p u rre d th e reco g
n i t i o n o f g o v e rn m e n ta l r e s p o n s i b i l i t y f o r th o s e i n n e ed o f m e d ic a l c a r e , fo o d and s h e l t e r . Second, w a rs, f o r tu n a te ly and u n f o r tu n a te ly , have p r e s e n te d a need f o r a d e q u a te m e d ic a l c a r e . tio n a ry ,
D u rin g th e R e v o lu
t h e C i v i l a n d S p a n is h A m e ric an W ars, a n d e s p e c i a l l y
d u r i n g W o r l d W ars X a n d I I ,
th e n a tio n has re c o g n iz e d th e
p r e s s in g u rg en c y o f in c r e a s e d m ed ica l f a c i l i t i e s .
P o st-w a r
p e r i o d s h a v e r e s u l t e d i n t h e o p e n in g o f v e t e r a n s 1 h o s p i t a l s a s a g o v e rn m e n ta l r e s p o n s i b i l i t y , a lo n g w ith v e te r a n s * p ro g ram s o f one ty p e o r a n o th e r .
Such p ro g ram s s tim u la te d
i n t e r e s t In h o s p ita ls and p u b lic a id f o r n o n -v e te ra n s.
^ H o s p i t a l C a r e i n t h e U n i t e d S t a t e s , oj5. c i t • , p p . 43 f f . 16 I b i d . . p .
43.
a id
15 T h ird ,
”t h e c h i e f im p e tu s to im p ro v e d h o s p i t a l c a r e 17 h a s come f r o m a d v a n c e s i n m e d i c a l s c i e n c e * “ T he p u b l i c g a in e d c o n fid e n c e i n th e h o s p i t a l , a f a c t o r t h a t f o s t e r e d th e d e v e lo p m e n t o f a l l
ty p e s o f h o s p ita ls *
V ita l advances in
m e d ic in e o f g r e a t e s t im p o rta n c e in c lu d e d : o f p r e v e n tiv e and c u r a tiv e m e d ic in e ; m a te rn a l m o r ta lity ; g e ria tric s ;
re d u c in g in f a n t and
g a i n i n g new k n o w l e d g e i n
th e s c ie n c e o f
in tro d u c in g a n ti s e p ti c and a s e p tic p ro c e d u re s;
im p ro v in g a n e s t h e t i c s ; la st
m a k in g a s c i e n c e
a n d i n a u g u r a t i n g m odern n u r s i n g — t h e
t h r e e f a c t o r s m ak in g m o d ern s u r g e r y p o s s i b l e *
In d ire c tly ,
th e s e h o s p i t a l a d v an c es hav e re d u c e d th e num ber o f p e rs o n s on th e p o o r r o l l s , f o r a f t e r a d e q u a te m e d ic a l a t t e n t i o n m any a g a i n a r e a b l e t o p r o v i d e f o r t h e m s e l v e s * I t Is
d iffic u lt
to o v e re m p h a s iz e t h e f a c t t h a t m odern
n u r s i n g , u n d e r t h e i n i t i a l g u i d a n c e o f- F l o r e n c e N i g h t i n g a l e , Mh a s b e e n o n e o f t h e s t r o n g e s t i n f l u e n c e s i n t h e i m p r o v e m e n t 18 o f h o s p ita l se rv ic e * ” T h ro u g h h e r w ork, a n d t h a t o f t h o s e tra in e d u n d er and a f t e r h e r, ra d ic a lly
c o n d i t i o n s i n h o s p i t a l s w ere
changed*
F o u rth ,
e d u c a tio n ,
e s p e c ia lly In th e tw e n tie th c e n tu ry ,
was e x t e n d e d t o I n s t i t u t i o n s th e n a tio n *
o f h ig h e r le a r n in g th ro u g h o u t
M e d ic a l e d u c a t i o n ,
17 I f e i d . • P . 4 5 . 18 I b i d . . p . 4 7 .
in a l l
i t s p h a s e s , becam e
16 s p e c i a l i z e d a n d s t a n d a r d s w ere r a i s e d . w ere o v e r a h u n d re d m e d ic a l s c h o o ls i n v e r y few w ere a c c r e d i t e d . In th e f i e l d
B e f o r e 190Q t h e r e th e U n ite d S t a te s , b u t
Today th e s i t u a t i o n i s r e v e r s e d .
of p u b lic a s s is ta n c e ,
sp e c ia liz e d
tra in in g fo r
s o c i a l w o rk h a s b e e n d e v e l o p e d , p a r t i c u l a r l y i n t h e p a s t tw o 19 decades. A ll o f th e s e ad v an ces i n e d u c a tio n have h e lp e d t o e s t a b l i s h m e d ic in e a n d s o c i a l w ork a s r e c o g n i z e d p r o f e s s i o n s , t h u s l a y i n g t h e g r o u n d w o rk f o r g o v e r n m e n t a l p a r t i c i p a t i o n i n th e s e p ro g ram s. The f i f t h f a c t o r h a s b e e n t h a t o f s o c i a l o r g a n i z a t i o n . The I n d u s t r i a l R e v o l u t i o n i n t r o d u c e d t h e m a c h in e a g e a n d , lik e
th e d i s i n t e g r a t i o n o f t h e f e u d a l sy ste m i n E n g la n d ,
f o r c e d m an t o
change fro m a r u r a l to u r b a n ty p e o f l i v i n g .
T h is h a s b r o u g h t a b o u t cro w d ed c o n d i t i o n s w h ich h a v e con tr ib u te d to p o v e rty .
th e sp re a d o f d is e a s e .
U n e m p lo y m e n t c r e a t e d
P ro b le m s o f p u b l i c h e a l t h w ere b r o u g h t t o t h e f r o n t ,
r e s u l t i n g i n a t t e n t i o n b e in g p la c e d on th e im p o rta n c e o f h o s p ita ls .
In d iv id u a ls
p o o r and i l l sy ste m s.
in te re s te d in so c ia l
by in f lu e n c in g
At f i r s t ,
refo rm h e lp e d th e
th e e s ta b lis h m e n t o f p u b lic w e lfa re
th e s ic k and p o o r a li k e
w ere th ro w n t o
g e t h e r i n a p u b l i c a lm sh o u s e ; b u t a s m e d ic a l s c i e n c e d e v e lo p e d , s e p a r a t e i n s t i t u t i o n s w ere c r e a t e d .
I n som e I n s t a n c e s , d e m a n d s
^ B e n j a m i n E . Y o u n g d a h l , " S o c i a l Work a s a P r o f e s s i o n , 11 ( M a r g a r e t B. H o d g e s , e d i t o r , S o c i a l Work Y e a r B o o k . 1 9 4 9 . New Y o r k : R u s s e l l S a g e F o u n d a t i o n , 1 9 4 9 ) , p p . 4 9 7 - 5 0 6 .
17 by groups to
s e p a ra te c e r t a i n c l a s s e s , a s th e aged an d depend
e n t c h ild r e n , b ro u g h t a b o u t th e e s ta b lis h m e n t o f in d ep e n d en t h o m es a n d h o s p i t a l s * S ix th ,
e c o n o m ic c o n d i t i o n s h a d a d e c i d e d e f f e c t o n t h e
g ro w th o f g o v e rn m e n ta l h o s p i t a l s . a lw a y s p r o v i d e d f a c i l i t i e s
fo r c h a rity cases*
y e a r s , h o w ev er, a n d e s p e c i a l l y 1929, i t
P riv a te h o s p ita ls have
s in c e th e f in a n c ia l c ra sh of
has been in c re a s in g ly d i f f i c u l t
in d iv id u a l w e a lth ,
D u rin g th e
to am ass g r e a t
th u s c u ttin g p o s s ib le p h ila n th ro p ic
m e n ts o f v o l u n t a r y h o s p i t a l s . p ro v id e m e d ic a l f a c i l i t i e s
endow
G overnm ent h a s s t e p p e d i n t o
f o r t h o s e who a r e n o t a b l e t o p a y ,
a lth o u g h v o lu n ta ry h o s p i t a l s
s till
o f f e r m uch f r e e
care*
L a s t l y , p u b l i c a p p r e c i a t i o n o f t h e w o rk p e r f o r m e d b y h o s p i t a l s h a s in f lu e n c e d t h e i r d e v e lo p m e n t, r e a l l y fro m t h e o t h e r s i x f a c t o r s *
A lth o u g h i t
stem m in g
is d iffic u lt
to
u n d e r s t a n d to d a y , f o r h u n d re d s o f y e a r s h o s p i t a l s w ere l i t t l e m ore t h a n p l a c e s w h ere p e o p l e w e n t to
d ie*
The e v o l u t i o n o f
m odern m e d ic a l te c h n iq u e h a s h a d t h e g r e a t e s t e f f e e t on h o s p i t a l g ro w th .
P u b lic h e a l th d e p a rtm e n ts , a lo n g w ith
o f f i c i a l a n d n o n - o f f i c i a l a g e n c i e s , h a v e c o m b in ed t o dem and b e t t e r h o s p ita l f a c i l i t i e s , b o th p r iv a te and p u b lic . S ta te
su p e rv isio n of lo c a l a d m in is tra tio n *
L ocal u n its
o f g o v ern m en t i n th e n i n e t e e n t h c e n t u r y c o n tin u e d to a d m i n i s t e r p u b l i c w e l f a r e i n a v a r i e t y o f w ays, seld o m m e e tin g t h e n e e d .
18 The s i t u a t i o n f i n a l l y becam e so s e r i o u s t h a t s o c i a l o r g a n i z a t i o n s , a n d p u b l i c dem and i n g e n e r a l , b r o u g h t a b o u t s t a t e s u p e r v i s i o n o f l o c a l a d m i n i s t r a t i o n o f w e l f a r e law s* c h u s e t t s , i n 1 8 6 3 , was t h e f i r s t b o ard o f s o c ia l w e lfa re in i t s
su b d iv isio n s.
to
s ta te
M assa
to c r e a te a s t a t e
s u p e r v is e and e n fo rc e s ta n d a r d s
W ith in a few y e a r s ,
O h i o , New Y o r k ,
I l l i n o i s , N o rth C a r o l i n a , P e n n s y lv a n ia a n d Rhode I s l a n d e sta b lis h e d
s i m i l a r d e p a rtm e n ts*
20
B efo re th e tu r n o f th e
c e n tu ry th e g r e a t m a jo r ity o f s t a t e s had fo llo w e d t h i s p a tte rn .
A lth o u g h t h e s e b o a r d s w e re w eak a d m i n i s t r a t i v e l y ,
a t l e a s t a s te p had b een tak en in th e r i g h t d i r e c t i o n . im p o rta n c e o f i n i t i a t i n g
th is
tre n d in s ta te
The
su p e rv isio n ,
w h ic h was t o h a v e s u c h a p r o f o u n d i n f l u e n c e i n f u t u r e y e a r s , w as s u c c i n c t l y
s t a t e d by an o u ts ta n d in g a u t h o r i t y i n
th e
f i e l d o f p u b lic w e lfa re : . . . L o c a l r e s p o n s i b i l i t y h a s m e a n t a good sy s te m o f r e l i e f i n one c o u n ty i n a s t a t e a n d a w re tc h e d s y s t e m i n a n o t h e r c o u n t y i n t h e sam e s t a t e ; i t h a s m eant a d e q u a te r e l i e f i n one to w n sh ip a n d d i s g r a c e f u l l y i n a d e q u a t e r e l i e f i n a n o t h e r t o w n s h i p i n t h e sam e c o u n t y . L o c a l r e s p o n s i b i l i t y h as l e d to c o r r u p tio n and g r a f t am ong p e t t y o f f i c i a l s a t t h e e x p e n s e o f t h e d e s t i t u t e . I t h a s m ean t t h e u s e o f d e t e r r e n t m eth o d s i n t h e g iv in g o f r e l i e f , such a s th e p u b lic a tio n o f th e nam es o f t h o s e r e c e i v i n g r e l i e f i n th e l o c a l new spaper, d e p riv in g th e p e rs o n r e c e iv in g a id o f th e r ig h t to v o te , th e h u m ilia tio n and d e g ra d a tio n
20 p. 9.
S te v e n s o n , P u b lic W e lfa re A d m i n is tr a tio n , o p . c i t . ♦
19 o f u n f o r t u n a t e m e n , women, a n d c h i l d r e n .
21
D u rin g th e l a t t e r p a r t o f th e n i n e t e e n t h
c e n tu ry , a
n u m b e r o f a t t e m p t s w e r e m ad e t o o b t a i n n a t i o n a l p a r t i c i p a t i o n in s ta te
and lo c a l w e lfa re p ro g ram s.
The g e n e r a l a t t i t u d e
o f t h e p e r i o d was e x p r e s s e d b y P r e s i d e n t G ro v e r C l e v e l a n d : "T hough t h e p e o p l e s u p p o r t t h e g o v e rn m e n t, sh o u ld n o t s u p p o rt th e p e o p le ."
th e g o v ern m en t
A lth o u g h th e n a t i o n a l
g o v e r n m e n t d i d n o t c o o p e r a t e , som e i m p r o v e m e n t o f p u b l i c w e l fare It
s y s t e m s w as b e i n g m ade b y s t a t e a n d l o c a l j u r i s d i c t i o n s .
re m a in e d , h o w ev er, f o r th e f i r s t h a l f o f th e t w e n t i e t h
c e n tu ry to b r in g ab o u t by f a r th e g r e a te s t p ro g re s s o f any c o m p a ra b le p e r i o d o f t im e . III.
FEDERAL PUBLIC ASSISTANCE IN THE TWENTIETH CENTURY The n a t i o n a l g o v e rn m e n t f i r s t b e g a n t o
ta k e a n a c t iv e
p a r t i n p u b l i c a s s i s t a n c e p r o g r a m s w h en P r e s i d e n t T a f t c a l l e d t h e W h ite H ouse C o n f e re n c e o n t h e C a re o f D e p e n d e n t C h i l d r e n 22 in 1909. As a r e s u l t o f t h i s c o n f e r e n c e , t h e U n i t e d S t a t e s C h i l d r e n ’ s B u r e a u w as c r e a t e d b y A c t o f C o n g r e s s i n 1 9 1 2 "to in v e s tig a te and re p o rt
. . .
on a l l m a t t e r s p e r t a i n i n g
to th e w e lfa re o f c h ild r e n and c h ild l i f e
am ong a l l
c la ss e s
E d i t h A b b o tt, " A b o lis h t h e P a u p e r L a w s ,” S o c i a l S e r v i c e R e v ie w . V I I I , M arch, 1 9 3 4 , p p . 1 0 -1 1 . 22 S te v e n so n , P u b lic W e lfa re A d m in is tr a tio n , o p . c i t . , p. 17.
20
o f our p e o p le ."
23
O u t s t a n d i n g w ork h a s b e e n d o n e b y t h i s
o r g a n iz a tio n a s a consequence o f t h is
in itia l
ste p
ta k e n by
t h e n a t i o n a l g o v e rn m e n t* N o t h i n g w a s d o n e f o r o t h e r d e p e n d e n t g r o u p s u n t i l tw o decades la te r*
The s t o c k m a r k e t c r a s h o f 1929 p r e c i p i t a t e d
a r e l i e f lo a d on th e
sh o u ld e rs o f lo c a l and p r i v a t e
g ro u p s--a re s p o n s ib ility
re lie f
t h e y s o o n f o u n d c o u l d n o t b e m e t*
W ith t h e em erg en cy b r o u g h t a b o u t by m i l l i o n s o f u n e m p lo y e d , P re s id e n t H e rb e rt H oover i n th e n a t i o n a l g o v ern m en t i n t o
th e r e l i e f b u s in e s s f o r th e f i r s t
tim e by p r o p o s in g l e g i s l a t i o n C o n s t r u c t i o n A c t*
sum m er o f 1 9 3 2 l e a d t h e
f o r t h e E m ergency R e l i e f a n d
T h is law p r o v i d e d l o a n s t o
th e s t a t e s a t
t h r e e p e r c e n t i n t e r e s t fro m th e R e c o n s tr u c ti o n F in a n c e C o rp o ra tio n .
A d m i n i s t r a t i o n was e s s e n t i a l l y i n a c c o r d w i t h t h e
E l i z a b e t h a n P o o r L aw , w i t h d o l e g i v e n o u t b y l o c a l u n i t s o f g o v e rn m e n t* S o o n a f t e r P r e s i d e n t F r a n k l i n D e l a n o R o o s e v e l t w as i n a u g u r a te d i n 1 9 3 3 , a d d i t i o n a l f u n d s , a s a n em ergency m e a s u re , w e r e m ade a v a i l a b l e b y C o n g r e s s u n d e r t h e F e d e r a l E m e r g e n c y R e l i e f A c t*
R a t h e r t h a n l o a n i n g m oney t o
m easure p ro v id e d f o r d i r e c t g r a n ts to
th e s t a t e s ,
th e s ta te s *
th is
" T h i s w as
th e f i r s t re c o g n itio n o f d ir e c t fe d e ra l r e s p o n s ib ility f o r
23
t e a O. L u n d b e r g , " C h i l d W e l f a r e , " ( M a r g a r e t B. H o d g e s , e d i t o r , S o c i a l W ork Y e a r B o o k * 1 9 4 9 * New Y o r k : R u s s e l l S a g e F o u n d a t i o n , 1 9 4 9 ) , p . 103*
21 a ssistin g to
th e s ta te s in fin a n c in g and a d m in iste rin g r e l i e f 2 4 '** t h e u n e m p lo y ed * " W it h t h e a d o p t i o n b y C o n g r e s s i n
N o v e m b e r , 1 9 3 3 o f t h e C i v i l W orks A d m i n i s t r a t i o n , g o v e rn m e n t m ade i t s o f a r e l i e f p rogram *
th e n a tio n a l
b e g in n in g a t a lm o s t c o m p le te m anagem ent T h e C*W.A. w a s C o m p l e t e l y o p e r a t e d a n d OR
9 0 $ f i n a n c e d b y t h e F e d e r a l G o v e r n m e n t . 11
Then, i n
P r e s id e n t R o o s e v e lt, a d d r e s s in g th e C on gress s a id s F e d e r a l G overnm ent m u s t a n d s h a l l q u i t t h i s • • .
.
1935, f,T h e
b u sin e ss o f r e l i e f
He a s k e d t h a t j o b s b e p r o v i d e d f o r t h o s e who w e r e
a b l e t o w o r k , a n d t h e P u b l i c W orks A d m i n i s t r a t i o n w a s f o r m e d th e
same y e a r .
U nder t h i s program a lm o s t a l l o f th e
t u r e s w ere f o r s a l a r i e s a n d w a g e s .
e x p e n d i
The a i d w as a d m i n i s t e r e d
b y a n ew m e t h o d w h e r e b y j o b s w e r e p r o v i d e d i n l o c a l j u r i s d i c t i o n s a n d p a y m e n t w as i n c a s h i n s t e a d o f k i n d , a s i t w i t h m any e a r l i e r p r o g r a m s . if
had been
R e c i p i e n t s w ere t r e a t e d j u s t a s
t h e y w e r e g o i n g t o w o rk e a c h d a y f o r a p r i v a t e
co n cern *
T h i s p l a n , d e v i s e d b y H a r r y H o p k i n s , b r o u g h t a n ew p h i l o s o p h y re g a rd in g a id
to th e u n fo rtu n a te *
As a r e s u l t o f a s t u d y m ad e b y t h e C o m m i t te e o n E c o n o m ic S e c u r i t y , c o m p o s e d o f e x p e r t s a n d r e p r e s e n t a t i v e s o f t h e
24
S te v e n s o n , P u b lic W e lfa re A d m in is tr a tio n . o p . c i t . ,
p * 29 • 25
R o b e r t E . S h e r w o o d , R o o s e v e l t a n d H o p k i n s . An I n t i m a t e H i s t o r y (New Y o r k s H a r p e r a n d B r o t h e r s , 1 9 4 8 ) , p * 53* 26 I b i d . . p . 6 6 .
22
g e n e r a l p u b l i c , C o ng ress p a s s e d th e S o c ia l S e c u r ity A ct o f 19 3 5 #
27
I t was a n o u t s t a n d i n g p i e c e o f s o c i a l l e g i s l a t i o n #
As e n a c t e d a n d p u t i n t o
e ffe c t,
th is
a c t p ro fo u n d ly changed
Mt h e s c o p e o f p u b l i c w e l f a r e i n t h e U n i t e d S t a t e s , n o t o n l y i n t h e f e d e r a l g o v e r n m e n t , b u t down t h r o u g h t h e
s ta te s to th e
m o st i n s i g n i f i c a n t u n i t o f l o c a l g o v ern m en t p a r t i c i p a t i n g i n 28 t h e p r o g r a m # 11 T he S o c i a l S e c u r i t y A c t p r o v i d e d ,ff o r t h e g e n e r a l w e l f a r e by e s t a b l i s h i n g a sy ste m o f F e d e r a l o ld - a g e b e n e f i t s , a n d by e n a b lin g th e s e v e r a l s t a t e s
t o m ak e m o re
a d e q u a te p r o v is io n f o r ag ed p e r s o n s , b lin d p e r s o n s , d ep en d en t and c r ip p le d c h ild re n , m a te rn a l and c h ild w e lfa re , p u b lic h e a lth ,
an d t h e a d m i n i s t r a t i o n o f t h e i r u n em p lo y m en t com pen
s a t i o n l a w s # ” 29 S e c tio n s o f th e S o c ia l S e c u rity A ct im p o rta n t i n t h i s stu d y a r e :
T itle
I,
w h i c h p r o v i d e s g r a n t s t o s t a t e s f o r O ld
A ge A s s i s t a n c e ; T i t l e I V , w h i c h p r o v i d e s g r a n t s t o s t a t e s f o r A id t o D e p e n d e n t C h i l d r e n ; T i t l e V, w h ic h p r o v i d e s g r a n t s t o s ta te s
f o r M a t e r n a l a n d C h i l d W e l f a r e ; a n d T i t l e X, w h ic h
p ro v id e s g ra n ts to s t a te s
f o r A id t o t h e
B lin d #
T h e S o c i a l S e c u r i t y A c t i s now a d m i n i s t e r e d u n d e r j u r i s d i c t i o n o f t h e F e d e r a l S e c u r i t y A gency#
C e rta in re q u ire -
7 4 t h C o n g r e s s , 1 s t s e s s i o n , 6 2 0 , ch ap # 531 (A u g u st 1 4 , 1935)# S te v e n s o n , P u b lic W e lfa re A d m in is tr a tio n , o p # c i t # , p# 35# S o c ia l S e c u rity A c t, 1935, op * c i t #
25 m e rits , c o n t a i n e d i n t h e la w , m u st b e a d h e r e d t o by t h e s t a t e s in o rd e r to p a r tic ip a te
in th e g ra n ts*
A d m in is tra tio n o f th e
a i d m ay b e c a r r i e d o u t e i t h e r b y a s i n g l e a g e n c y o f t h e
s ta te
o r b y l o c a l j u r i s d i c t i o n s u n d e r “t h e s u p e r v i s i o n o f t h e s i n g l e s ta te agency.
E ach s t a t e m ust have a " p la n ” o f a d m i n i s t r a t io n
a p p ro v e d by th e
F e d e ra l S e c u r ity A gency.
T he p l a n i n s u r e s
t h a t th e p ro g ram w i l l be e f f e c t e d i n a l l s ta te .
ju ris d ic tio n s
o f th e
An i m p o r t a n t g e n e r a l p r o v i s i o n w h i c h h a s b e e n v i t a l
in fo ste rin g
im p ro v e m e n ts i n a l l
l e v e l s o f g o v ern m en t i s
th e
r e q u i r e m e n t t h a t a l l a i d b e a d m i n i s t e r e d b y e m p l o y e e s who a r e u n d e r a n a p p ro v e d m e r i t sy ste m .
If
s t a t e s d e v i a t e fro m
th e a p p ro v e d p l a n o f i n s u r i n g a t o t a l m e r it sy ste m , n a t i o n a l funds a re
su sp en d e d p e n d in g a d h e re n c e to t h i s
One o f t h e m o s t r e c e n t i n s t a n c e s w a s t h a t C a lifo rn ia
re q u ire m e n t.
e x p e rie n c e d i n
e a r l y i n 1 9 4 9 w h en f e d e r a l m o n ey w a s w i t h h e l d *
T h e F e d e r a l S e c u r i t y A g e n c y d e t e r m i n e d , am ong o t h e r t h i n g s , th a t n o n -e iv il se rv ic e
sta te
e m p lo y e e s h a d b e e n g i v e n a d m in
istra tiv e
re s p o n sib ilitie s
i n t h e S t a t e D e p a rtm e n t o f S o c i a l
W e lfa re .
F e d e r a l g r a n t s - i n - a i d w ere r e l e a s e d upon c o n f o r m ity
b y t h e s t a t e w i t h n a t i o n a l law s*
R e g u la r in s p e c tio n s a r e
m ade b y n a t i o n a l r e p r e s e n t a t i v e s
in o rd e r to in s u re a h ig h
l e v e l o f a d m i n i s t r a t io n o f th e S o c ia l S e c u r ity A c t. P a s s a g e o f t h e S o c i a l S e c u r i t y A c t m a r k e d a new e r a in
th e w e lfa re f i e l d .
T he n a t i o n a l g o v e r n m e n t e s t a b l i s h e d
a p e rm a n e n t sy ste m o f c o o p e r a t i o n w ith s t a t e s ,
in ste a d of
24 t h e te m p o ra ry an d em ergency m e a su re s t h a t had b e e n u s e d b e fo re * In d e c la rin g
th e A ct c o n s t i t u t i o n a l in 1937,
C o u rt s a i d , i n p a r t ,
t h e S u p re m e
"N eeds t h a t w ere n a rro w o r p a r o c h i a l a
c e n t u r y a g o m ay b e i n t e r w o v e n i n o u r d a y w i t h t h e w e l l - b e i n g o f th e n a tio n IV .
* .
.
, l!^
FEDERAL HOSPITALS IN THE TWENTIETH CENTURY
I t h a s b e e n s e e n how , I n A m e ric a , p u b l i c w e l f a r e was f i r s t a lo c a l r e s p o n s ib ility , a n d , i n som e c a s e s , p u b lic a s s is ta n c e ,
s ta te
fo llo w e d by s t a t e
a d m in is tra tio n .
care f o r in d ig e n ts,
W it h r e g a r d t o h o s p i t a l
is
th a t th e C o n s titu tio n does
In c lu d e p u b lic a s s i s t a n c e and m e d ic a l c a re
a s a f u n c t i o n o f t h e n a t i o n a l g o v e rn m e n t; n o t g ra n te d
of
th e n a t i o n a l g o v ern m en t h a s done v e ry
The r e a s o n f o r t h i s
not s p e c ific a lly
In th e f i e l d
n a t i o n a l p a r t i c i p a t i o n h a s b een d e v e lo p e d
l a r g e l y d u r i n g t h e p a s t tw o d e c a d e s .
little .
su p e rv isio n
th e re fo re ,
"pow ers
to th e n a t i o n a l g o v ern m en t a r e
se rv e d to th e
sta te s
o r th e p e o p le
w as e x p r e s s e d I n a C a l i f o r n i a
s p e c ific a lly re31 th ere o f* " T h is p h ilo s o p h y
c o u r t c a s e w h ic h h e l d t h a t
m e d i c a l c a r e f o r t h e I n d i g e n t s i c k w as a r e s p o n s i b i l i t y o f 32 th e s ta te and i t s s u b d iv isio n s.
30 H e l v e r l n g v . jB a v ia . 301 U .S . 619 ( 1 9 3 7 ) . 31
M e r ia m ,
o jd .
c i t . . p* 19*
^ C o u n ty o f S a c ra m e n to v . C h am b ers. 33 C a l i f . App. 148 (1 9 1 7 ).
25 T h e n a t i o n a l g o v e r n m e n t h a s m a i n t a i n e d m an y t y p e s o f h o sp ita ls
sin c e i t
e s ta b lis h e d
th e f i r s t
in s titu tio n
in 1798.
T hese m e d ic a l u n i t s have b een p r i m a r i l y f o r tre a tm e n t o f s e a m e n , m e m b e rs o f t h e a r m e d f o r c e s a n d v e t e r a n s o f t h e s e v e r a l w ars.
In a id in g c iv ilia n v e te ra n s ,
h a s, o f c o u rse,
i n d i r e c t l y h e lp e d lo c a l p u b lic h o s p i t a l s
by re d u c in g t h e i r b u rd e n . a id to In d ia n s.
th e n a t i o n a l g o v ern m en t
T h e sam e h a s b e e n t r u e o f f e d e r a l
E x t e n s i v e p r o g r a m s o f m any k i n d s a r e c a r r i e d
o u t b y d i f f e r e n t a g e n c i e s o f th e n a t i o n a l g o v ern m en t t h a t a r e in
th e n a tu re o f p u b lic h e a lth m easu res.
a r e p r o v id e d , how ever,
No g r a n t s - i n - a i d
to h o s p ita ls f o r c a re o f in d ig e n t s ic k .
B e tw e e n 1 9 3 3 a n d 1 9 4 1 t h e n a t i o n a l g o v e r n m e n t , t h r o u g h t h e W ork s P r o g r e s s A d m i n i s t r a t i o n , b u i l t h o sp ita ls,
a n d im p ro v e d f a c i l i t i e s
o v e r tw o h u n d r e d new
in
som e 2 , 2 0 0 m o r e .
”A11
n ew h o s p i t a l s b u i l t u n d e r t h e WPA p r o g r a m w e r e ow ned a n d 33 o p e r a te d by l o c a l o r s t a t e g o v e rn m e n ta l u n i t s . ” In o rd e r to p l a c e a l l p u b l i c h e a l t h a n d w e l f a r e a c t i v i t i e s u n d e r one head,
t h e F e d e r a l S e c u r i t y A g e n c y w as e s t a b l i s h e d i n 1 9 3 9 .
A n u m b e r o f c h a n g e s h a v e b e e n m ade s i n c e t h a t t i m e , u n t i l now a l m o s t a l l u n i t s
o f th is k in d a re
in th e F ed eral S e c u rity
A gency. T he P u b l i c H e a l t h S e r v i c e i s and c o o p e ra te s w ith s t a t e
a p a r t o f t h i s A gency
a n d l o c a l g o v e rn m e n ts i n e s t a b l i s h i n g t
33
H o s p it a l C are i n th e U n ite d S t a t e s . o p . c i t . . p .
532.
26 pro gram s o f a h e a l th n a t u r e .
One s u c h m e a s u r e w a s t h e
L an ham A c t p a s s e d b y C o n g r e s s i n J u n e ,
1941.
Funds d u rin g
t h e w ar y e a r s w ere p r o v i d e d to a i d c o n s t r u c t i o n o f b o th p r i v a t e a n d p u b l i c h o s p i t a l s w h e re t h e i r n e e d was e s s e n t i a l to th e w ar e f f o r t .
34
A c u r r e n t m a jo r a c t i v i t y
in re g a rd to
l o c a l h o s p i t a l s i s a d m i n i s t r a t io n o f th e H o s p ita l S urvey and C o n s t r u c t i o n A ct o f 1946*
35
T h is law p r o v i d e s
t h a t th e
H o s p ita l F a c i l i t i e s D iv is io n o f th e P u b lic H e a lth S e rv ic e i s a u t h o r i z e d t o m ak e g r a n t s t o
s ta te s fo r c o n stru c tio n o f
p u b lic and p r iv a te h o s p ita ls , h e a lth c e n te rs and r e la te d fa c ilitie s . h o sp ita ls,
F u n d s a r e p r o v i d e d o n a m a t c h i n g b a s i s f o r new and f o r e x p a n sio n an d r e p a i r o f p r e s e n t f a c i l i t i e s .
P r o v i d e d t h e h u s b a n d o r p a r e n t w as a n e n l i s t e d m an o f t h e arm ed f o r c e s i n o n e o f t h e f o u r lo w e s t p a y g r a d e s , g e n e r a l m e d i c a l a s s i s t a n c e was a u t h o r i z e d f o r h i s w i f e a n d i n f a n t , d i r e c t l y b e fo r e and a f t e r c h ild b i r t h .
T h is E m erg en cy
M a t e r n i t y a n d I n f a n t C a re p ro g ra m becam e e f f e c t i v e
i n M arch,
1943, c o n tin u in g u n t i l
I s e stim a te d
th e end o f h o s t i l i t i e s .
It
e i g h t y p e r c e n t o f a l l e l i g i b l e w iv e s to o k a d v a n ta g e o f t h e p ro g ram ,
th e r e b y r e d u c in g th e b u rd e n on a l a r g e
c la s s of
p e o p le .
34 I b i d . . p . 534. 3 5 7 9 th . C o n g r e s s , P . L . 7 2 5 ( A u g u s t 1 3 , 1 9 4 6 ) . 36 H o s p i t a l C a r e i n t h e U n i t e d S t a t e s , op,* c i t . . p .
551.
27 W i t h l o c a l t a x a t i o n b e c o m i n g s o h e a v y t o d a y , m an y s t a t e and lo c a l o f f i c i a l s
hope f o r f e d e r a l g r a n t s - i n - a i d f o r c a re
o f th e in d ig e n t s ic k . w o rk w o u l d l i k e
O t h e r s who a r e
to see such a program , f o r n a tio n a l p a r t i c i
p a t i o n w o u ld b e f o r t h c o m in g o n l y i f w ere m e t.
s tu d e n ts o f s o c ia l
e s ta b lis h e d h ig h sta n d a rd s
T h u s , h o s p i t a l c a r e f o r t h e n e e d y w o u ld be i n s u r e d
th ro u g h o u t th e n a ti o n , j u s t a s p u b lic a s s i s t a n c e f o r th e p o o r w a s i m p r o v e d w hen t h e n a t i o n a l g o v e r n m e n t e n a c t e d t h e S o c ia l S e c u rity la w . a t th e
It
sh o u ld b e
s a i d , h o w ev er, t h a t
Mg r a s s r o o t s ” o p p o s e f e d e r a l g r a n t s .
have th e c o n v ic tio n th a t in c re a s e in th e
some
T hese p e rs o n s
s u c h m o n ey w o u l d i n v o l v e a h e a v y
t a x b u r d e n a n d , i n a d d i t i o n , w o u ld r e l i e v e
t h e i n d i v i d u a l o f " b a s i c * 1 r e s p o n s i b i l i t y f o r h i s own h e a l t h and w e lfa re . V.
STATE AND LOCAL PUBLIC ASSISTANCE I N THE TWENTIETH CENTURY
S ta te d e p a rtm e n ts o f s o c ia l w e lfa re w ith e x te n s iv e c o n t r o l b e g an to be c r e a t e d i n th e t w e n t i e t h c e n t u r y , u n t i l to d ay a l l
s t a t e s have such an a g e n c y .
a d d itio n to d ir e c tin g th e pow er to
T hese d e p a rtm e n ts , in
s t a t e w e lfa re p ro g ram s, have been g iv en
su p e rv ise p r iv a te and p u b lic w e lfa re fu n c tio n s .
T h e f i r s t a d o p t e d w as t h e D e p a r t m e n t o f P u b l i G W e l f a r e o f th e S ta te o f I l l i n o i s ^ and 53,
Illin o is
in 1917.
*57
I n 1919 a s i m i l a r a g e n c y
C iv il A d m in is tra tiv e Code, S e c s. 3, 5, 6 ,
28 w as e s t a b l i s h e d i n M a s s a c h u s e t t s , C a l i f o r n i a , M i c h i g a n , New Y o r k , in g to n .
soon fo llo w e d by o th e r s in
O h i o , P e n n s y l v a n i a a n d W ash
P r e s s u r e f r o m a c t i v e c i t i z e n g r o u p s , w h en t h e i n a d e
q u a c y o f l o c a l u n i t s was r e a l i z e d , o f th e se s t a te
d e p a rtm e n ts*
38
b ro u g h t ab o u t th e c re a tio n
T h is , in tu r n ,
e m p h a siz e d th e
f,r e c o g n i t i o n o f w e l f a r e a s a n i m p o r t a n t f u n c t i o n o f g o v e r n m ent T w e n tie th c e n t u r y p u b l i c w e lf a r e d e v e lo p m e n ts an d i n f l u e n c e s i n C a l i f o m i a w i l l b e show n, a l o n g w ith a b r i e f e x p la n a tio n o f such e v e n ts in th e s t a t e p r i o r to P u b lic a s s is ta n c e f o r c h ild r e n *
1900*
C a l i f o r n i a h a s a lw a y s
b e e n one o f th e m ost p r o g r e s s i v e
s t a t e s w ith r e s p e c t to
a ssista n c e
i n t h a t no p u b l i c
to d e p e n d e n t c h il d r e n
in s titu
t i o n s f o r d e p e n d e n t, norm al c h il d r e n hav e been m a in ta in e d * In ste a d ,
th e
sta te ,
in 1855, s t a r te d a p la n of s u b s id iz in g
a n d s t a n d a r d i z i n g c a r e o f th e c h i l d i n h i s hom e, i n a b o a rd i n g home o r i n a p r i v a t e o r p h a n a g e .
T h is p r a c t i c e b e g a n
b e c a u s e o f t h e em ergency c o n d i t i o n s w h ic h e x i s t e d a t o f C a l i f o r n i a fs a n n e x a tio n * in
th e tim e
S u b s t a n t i a l n um bers o f c h i l d r e n ,
th e r a p i d l y g ro w in g p o p u l a t i o n o f th e m id d le n i n e t e e n t h
c e n tu ry ,
3 ft
l o s t on© o r m o re p a r e n t s a n d w e r e w i t h o u t hom es*
S te v e n s o n , P u b lic W e lfa re A d m i n i s t r a t i o n , o p . c i t * .
p* 8* 39 X b l d . . p . 1 3 .
29 T h e r e w a s n o t t i m e e n o u g h t o b u i l d i n s t i t u t i o n s f o r them * The s u b s i d y p l a n w a s, t h e r e f o r e , a d o p t e d a s t h e o n l y a l t e r n a tiv e .
H ere,
th e p r in c ip le
o f o u t d o o r r e l i e f b y s t a t e a d m in
i s t r a t i o n w as e s t a b l i s h e d i n C a l i f o r n i a f o r t h e f i r s t a lth o u g h " s p e c if ic
s ta tu a to ry p ro v isio n fo r i t
tim e ,
w as n o t m ad e
u n t i l 1 9 1 3 . "40 In 1888 o n ly n in e o f th e c o u n ti e s ,
Los A n g e le s b e in g
o n e , had a w e lfa re ag en cy c h a rg e d w ith th e d u ty o f a d m in is te r in g p u b lic a id
to c h ild r e n .
U n t i l 1 9 0 3 w hen t h e S t a t e
B o a r d o f C h a r i t i e s a n d C o r r e c t i o n s w as o r g a n i z e d , no s t a t e
t h e r e w as
s u p e r v i s i o n o f th e p e r f u n c t o r y m anagem ent o f m o st
c o u n ty a g e n c i e s .
T h e B o a r d w as g i v e n p o w e r t o
s t a t e a n d c o u n ty i n s t i t u t i o n s .
su p e rv ise a l l
I n 1 9 2 5 , t h e B o a r d w as s u c c e e d e d
b y t h e S t a t e D e p a rtm e n t o f P u b l i c W e lf a r e , w h ich i n
t u r n was
r e p l a c e d by th e p r e s e n t S t a t e D e p a rtm e n t o f S o c ia l W e lf a r e , in 1927, a l l
c h a n g e s a t t h a t t i m e b e i n g i n name o n l y *
C r i p p l e d c h i l d r e n w e r e g i v e n t h e sam e t y p e o f c a r e a s a ll
o th e r dependent c h ild re n u n t i l
1920 w hen, m a in ly th r o u g h
th e in f lu e n c e o f th e S h rin e and R o ta ry o r g a n iz a tio n s , th e y w ere p r o v i d e d s p e c i a l a s s i s t a n c e ,
som e b e i n g p l a c e d i n p r i v a t e
h o sp ita ls* S i n c e 1 8 6 0 , t e n y e a r s a f t e r C a l i f o r n i a was a d m i t t e d t o th e U n io n , s p e c i a l s t a t e
i n s t i t u t i o n s have been m a in ta in e d
40 C ahn, o p . c i t . . p .
365*
30 f o r d eaf and b lin d
c h ild re n ,
som e b e c o m i n g i n m a t e s f o r l i f e .
P u b l i c sy m p a th y h a s a lw a y s b e e n s t r o n g f o r s p e c i a l t r e a t m e n t o f such c h ild re n *
O th e r s t a t e
i n s t i t u t i o n s have been e s ta b
l i s h e d f o r h a n d ic a p p e d c h il d r e n o f a l l
ty p e s, and fo r d e lin
q u en t c h ild re n * T h e A i d t o N e e d y C h i l d r e n l a w , 4 '*' i n s t i t u t e d
in C a lifo r
n ia b e fo re p a ssa g e o f th e S o c ia l S e c u rity A c t, p ro v id e s f o r a ssista n c e
to th e c h ild in i t s
hom e, o r a p p r o v e d s u b s t i t u t e ,
and th e a v e ra g e g r a n t in C a lifo rn ia i s in th e U n ite d S t a te s .
now t h e s e c o n d h i g h e s t
T he p a s s a g e o f A s s e m b l y B i l l 4 0 i n t h e
1949 L e g i s l a t u r e a m p l i f i e d t h e C a l i f o r n i a law t o i n c l u d e m ore c h i l d r e n *
As a r e s u l t , t h e
sta te
law a n d t h e S o c i a l
S e c u r i t y A c t now d e f i n e a d e p e n d e n t c h i l d
in
e x a c t l y t h e sam e
term s* P u b lic a s s i s t a n c e f o r th e a g e d * b l i n d a n d p o o r * in stitu tio n a l
c a r e f o r t h e a g e d , b l i n d a n d p o o r w as c o n d u c t e d
a s one p ro g ra m i n f o r m an y y e a r s * a fte r
N on-
th e s t a t e
th e b e g in n in g i n C a l i f o r n i a ,
c o n tin u in g
R e l i e f f o r t h i s g ro u p becam e a p ro b le m j u s t jo in e d
th e U n io n , b r o u g h t a b o u t by t h e r a p i d
i n f l u x o f p o p u la tio n d u rin g th e g o ld r u s h days*
S ta rtin g
w i t h t h e e n a c t m e n t o f t h e P o o r Law i n 1 8 5 5 , a n d c o n t i n u i n g u n t i l 1883, th e l e g i s l a t u r e p la c e d r e l i e f in th e hands o f
^
P a l* S ta ts .
(1 9 3 5 ), chap. 804.
31 th e c o u n ty b o a rd s o f s u p e r v i s o r s ,
em p o w erin g th em t o r a i s e
th e n e c e s s a r y fu n d s by p o l l o r p r o p e r t y ta x e s o r b o th *
42
So g r e a t a b u r d e n w a s p l a c e d o n t h e g r o w i n g l o c a l g o v e r n m e n t s t h a t i n 1883 th e
sta te
began h e lp in g c o u n tie s by p ro v id in g
§100 a y e a r f o r each r e l i e f
re c ip ie n t*
43
T h i s p l a n w as s o o n
d r o p p e d , h o w e v e r , f o r tw o r e a s o n s — 11t h e r e p e a t e d c h a r g e s th a t
t h e law was b e in g a b u s e d a n d t h e c o n t i n u a l dem ands 44
f o r e c o n o m y * 11
So, b e g in n in g i n 1895,
th e c o u n tie s a g a in
assum ed f u l l
r e s p o n s i b i l i t y f o r th e a d m in is tr a tio n and 4S fin a n c in g o f r e l i e f * I n 1 9 0 1 t h e I n d i g e n t A c t , com m only
know n a s t h e P a u p e r A c t , w a s p a s s e d b y t h e s t a t e
l e g i s l a t u r e * 46
T h is law p r o v id e d t h a t c o u n t i e s s h o u ld s u p p o r t a l l p e r s o n s n o t p r o v i d e d f o r b y t h e i r own m e a n s , b y r e l a t i v e s o r by s t a t e
or p riv a te
in s titu tio n s *
or frie n d s,
The la w w as f u r t h e r
a f f i m e d a n d c h a n g e d s l i g h t l y i n 1 9 2 7 47 a n d a g a i n i n 1 9 3 1 * 4 8 P u b lic a s s is ta n c e f o r th e b lin d *
T he b l i n d w e r e
s e p a r a t e d fro m t h e a g e d a n d p o o r by a n a c t o f 1919* 42 C a l . S t a t s . 43 I b i d .
(1 8 5 5 ), c h a p . L V II, s e c .
( 1 8 8 3 ) , c h a p . X C V I, s e c .
44 C a h n , o p . c i t . . p .
1.
373.
4 3 C a l . S t a t s . “( 1 8 9 5 ) , c h a p . 1 2 , s e c . 1 . 46 I b i d .
( 1 9 0 1 ) , c h a p . CCX.
47 I b i d .
(1 9 2 7 ), ch ap . 239, se c . 2 .
■, 4 ® I b i d .
(1 9 3 1 ), ch ap . 110, s e c s .
2, 4.
49 I b i d .
(1 9 1 9 ), chap. 144, s e c s .
1, 4.
49
Much
1, 2, 6, 7 , 8.
32 o f t h e c r e d i t f o r t h e m o v em en t t o g i v e s p e c i a l c a r e t o t h e b lin d in C a lifo rn ia and o th e r s ta te s
is
d u e t o t h e w o rk o f
t h e L i b r a r y o f C o n g r e s s , w h ic h e s t a b l i s h e d a w e l f a r e
c e n te r
f o r t h e b l i n d i n W a s h i n g t o n , D. C* a n d h e l p e d i n f o u n d i n g 50 s i m i l a r u n i t s t h r o u g h o u t A m erica* The 1919 law p r o v i d e d t h a t p e n s io n s be g r a n te d th e b l i n d i n t h e am ount o f $150 p e r y ear,
w h i c h was, i n c r e a s e d t o $ 1 8 0 p e r y e a r i n
1921*^
T he g o v e r n o r o f C a l i f o r n i a a p p o i n t e d a c o m m i t t e e t o s tu d y c o n d i t i o n s o f t h e b l i n d i n 1 9 2 6 , re c o m m e n d a tio n s o f w h ic h b r o u g h t a b o u t p a s s a g e o f a law i n 1929 a sy s te m o f s t a t e an d c o u n ty a i d b o th j u r i s d i c t i o n s ,
to
th a t e sta b lis h e d
th e b lin d ,
su p e rv ise d by th e s t a t e ,
fin a n c e d by
w h ile im m e d ia te
i n v e s t i g a t i o n o f t h e a p p l i c a t i o n s o f b l i n d p e r s o n s was d e l e g a t e d to
th e c o u n tie s * ^
I n 1935 t h e l e g i s l a t u r e am ended t h e a c t o f 1929 i n 53 c o n f o r m a n c e w i t h t h e S o c i a l S e c u r i t y Law* S in c e t h i s tim e , a f t e r t h e n a t i o n a l g o v ern m en t a p p ro v e d t h e
sta te
Mp l a n , ,r t h e
S t a t e D e p artm en t o f S o c i a l W e lfa re h a s s u p e r v is e d th e p r o gram , w h ile a c t u a l a d m i n i s t r a t i o n h a s b e e n c o n d u c te d by th e c o u n tie s *
I n 1 9 4 1 a n o t h e r s e c t i o n o f t h e b l i n d l a w w as a d d e d
C ah n , o p * c i t * , pp* 1 8 3 -4 * 51 C a l * S t a t s * ( 1 9 2 1 ) , c h a p * 5 1 0 , s e c * 1 . 52 I b i d .
(1 9 2 9 ), chap . 845, s e e .
53 C a l . S t a t s .
(1 9 5 5 ).
chap. 703.
1.
53 to
th e W e lfa re and I n s t i t u t i o n s
C bde p r o v i d i n g f o r flA i d
to th e P a r t i a l l y S e lf-S u p p o rtin g
B l i n d , 11 a p r o g r a m w h i c h i s
u n iq u e w ith C a l i f o r n i a a n d i s n o t f i n a n c i a l l y
s p o n s o re d by
th e n a t i o n a l g o v e rn m e n t.
encouraged to
e sta b lis h
th e m se lv e s i n
B lin d r e s i d e n t s a r e
some t y p e o f o f o c c u p a t i o n ,
w ith a hope
o f e v e n t u a l l y b e c o m in g s e l f - s u p p o r t i n g . P u b lic a s s is ta n c e f o r th e ag ed.
An a t t e m p t w as m ad e
i n 1925 to s e p a r a t e r e l i e f o f t h e a g e d fro m t h a t o f th e p o o r i n g e n e r a l w hen t h e l e g i s l a t u r e p a s s e d a n o l d a g e p e n s i o n 54 a c t w h ic h was v e to e d b y t h e g o v e rn o r* A s i m i l a r m easu re w as i n t r o d u c e d d u r i n g t h e 1927 l e g i s l a t i v e
s e s s io n , but
a c t i o n w as d e la y e d p e n d in g a n i n v e s t i g a t i o n o f o l d a g e law s w h ich h a d b e e n e n a c te d i n o t h e r s t a t e s . .
A f te r th e re p o rt 56 w a s r e c e i v e d , a n o l d a g e s e c u r i t y l a w w as p a s s e d i n 1 9 2 9 . The s t a t e a n d c o u n t i e s w ere t o
sh are e q u a lly th e c o s ts ,
a d m i n i s t r a t i o n w as t o b e a c o u n t y r e s p o n s i b i l i t y .
w h ile
A maximum
p a y m e n t o f # 3 0 p e r m o n t h was p r o v i d e d . As i n t h e
case
of b lin d a id , th e l e g i s l a t u r e
i n 19 3 5
c h an g e d t h e o l d ag e s e c u r i t y la w to co n fo rm w i t h t h e S o c i a l 57 S e c u rity A c t. T h is w as a s im p le m a t t e r , f o r t h e C a l i f o r n i a
^
Cahn, op. c i t . , p . 179.
55 Ii2 c .
c it.
56 C a l . S t a t s *
(1 9 2 9 ), chap. 530, s e c s ,
^
(1 9 3 5 ), ch ap . 633.
C a l. S t a ts .
1 -3 .
34 la w a l r e a d y was v e r y s i m i l a r i n a d m i n i s t r a t i o n t o t h e n a t i o n a l la w , and th e s t a t e
’' p l a n 1* w a s s o o n a c c e p t e d *
H ere, a s w ith
t h e b l i n d la w , C a l i f o r n i a was a h e a d o f m o st s t a t e s
in th a t
s o u n d b l i n d a n d a g e d l a w s h a d b e e n e n a c t e d som e y e a r s b e f o r e p a ssa g e o f th e S o c ia l S e c u rity A c t. little
W ith t h i s
e x p e rie n c e ,
d i f f i c u l t y w as e n c o u n t e r e d i n c o n f o r m i n g w i t h r e q u i r e
m en ts o f f e d e r a l a g e n c i e s . P u b lic a s s is ta n c e f o r th e p o o r. who do n o t q u a l i f y u n d e r t h e
R e li e f f o r th o se p e rs o n s
" c a te g o r ic a l a id s " — th o se p ro
v i d e d f o r i n t h e S o c i a l S e c u r i t y A c t , n a m e ly A id t o N eedy C h i l d r e n , A i d t o N e ed y B l i n d , a n d O ld A ge S e c u r i t y — i s fin a n c e d and a d m in iste re d e n tir e ly by th e c o u n tie s . T h i s w as 58 p r o v i d e d f o r i n t h e I n d i g e n t A c t o f 1901 and has c o n tin u e d , w i t h m i n o r c h a n g e s , u n t i l t h e p r e s e n t t i m e , now u s u a l l y c a l le d G en eral R e l i e f .
The am o u n t o f a i d w h ic h i s
v a r ie s w ith th e needs o f th e in d iv id u a l.
g ra n te d
I n g e n e r a l, h ow ever,
g ra n ts a re n o t as
la rg e as
c a te g o ric a l a id s ;
a n d G e n e r a l R e l i e f h a s n e v e r b e e n know n
p o p u la rly a s a
“p e n s i o n , " w h i c h t e r m h a s o f t e n b e e n u s e d a s
a m isn o m e r i n r e g a r d t o V I.
th o se p ro v id e d f o r .u n d e r th e
th e c a te g o r ic a l a i d s .
STATE AND LOCAL HOSPITALS IN THE TWENTIETH CENTURY M ost o f t h e g r e a t p r o g r e s s i n
58 I b i d .
( 1 9 0 1 ) , c h a p . OCX.
s t a t e and c o u n ty m e d ic a l
35 c a r e f o r t h e p o o r w a s m ade d u r i n g t h e f i r s t h a l f o f t h e tw e n tie th c e n tu ry .
E ven th o u g h la w s r e q u i r e d t h a t su c h c a r e
be g iv e n th e in d ig e n t, a u t h o r i t i e s h ad , i n g e n e r a l, p ro v id e d v e ry in a d e q u a te s e r v ic e .
P u b lic o p in io n dem anded e s t a b l i s h
m ent o f th e e x c e e d in g ly h ig h s ta n d a r d s o f m e d ic a l s e r v i c e 59 t h a t a r e fo u n d to d a y . ^h en th o u s a n d s o f p e o p l e w ere p o u r i n g i n t o
San F ran
c i s c o a n d S a c ra m en to d u r i n g t h e m id d le o f th e n i n e t e e n t h c e n t u r y , o n e o f t h e o u t s t a n d i n g n e e d s o f C a l i f o r n i a w as 60 s h e lte r and h o s p ita l care fo r th e s ic k . I n 1850 a f e d e r a l h o s p i t a l was e s t a b l i s h e d i n San F r a n c i s c o w h ic h h e l p e d a l l e v i a t e th e s i tu a tio n .
T h i s sam e y e a r t h e l e g i s l a t u r e m ade p r o v i s i o n
f o r a h o s p i t a l i n San F ra n c is c o , a p p r o p r ia tin g fu n d s a ls o o th e r h o s p ita ls fo llo w . sta te
to b e c o n s tr u c te d i n
B ecause i t
th e im m e d ia te y e a r s
w as f o u n d t h a t m any o f t h e p a t i e n t s
fo r to
in
h o s p i t a l s w ere c o u n ty c h a r g e s , a n d b e c a u s e th e g r e a t
d r a i n on th e s t a t e
t r e a s u r y c o u ld n o t be c o n tin u e d ,
th e l e g i s
l a t u r e m ad e p r o v i s i o n i n 1 8 5 5 t o a p p r o p r i a t e m o n e y t o
each
c o u n ty f o r c a re o f th e i n d ig e n t s i c k .
c o u n tie s
w e r e e m p o w e re d t o
l e v y p o l l o r a d v a lo re m t a x e s to r a i s e
fu n d s f o r c a re o f th e
59
In a d d itio n ,
sic k p o o r.
M ost s t a t e s u p t o
E d i t h A b b o ttj P u b l i c A s s i s t a n c e , o p .
60 C ahn, o p .
c it.,
G a l. S t a t s .
p.
(1 8 5 5 ),
th is
o th e r tim e
c i t . . p . 387.
137. e h ap . L V II, s e c s .
1, 2, 6, 7, 8 .
gave c a re i n c o u n ty h o s p i t a l s b e in g r e q u ire d to p a y . o n ly in d ig e n ts
to a l l p e rs o n s , n o n - in d ig e n ts
C a lifo rn ia
c o u ld be a d m i t t e d ,
s p e c i f i e d , h ow ever, t h a t e x c e p t i n t h e c a s e o f em er
g e n cy o r on c o n t r a c t i n g a c o n ta g e o u s d i s e a s e . o rn ia
law s h o l d e v en to d ay * Many o f t h e e a r l y
gave ho s e r v ic e th e re fo re , a rie s
c o u n ty h o s p i t a l s
t o women a n d c h i l d r e n .
h i r e d n o women a n d
The l e g i s l a t u r e ,
i n 1869 a u t h o r i z e d c o u n t i e s to
so t h a t a l l p e o p le In o rd er to
and to
T hese C a l i f
e s ta b lis h in firm 62 c o u ld be c a r e d fo r*
o b t a i n u n i f o r m i t y am ong t h e
c o u n ty h o s p i t a l s ,
a d v is e th e s t a t e
on m a t t e r s o f m e d ic a l c a r e , th e 63 C a l i f o r n i a B o a rd o f H e a l t h w as c r e a t e d i n 1870* T hrough t h e w ork o f t h i s
B o a rd , a n d a s a n econom y m e a s u r e , t h e I n d i g e n t 64 o r P a u p e r A c t o f 1 9 0 1 w as p a s s e d b y t h e l e g i s l a t u r e * T h is law r e d e f i n e d t h e r e s p o n s i b i l i t y
o f th e c o u n ty f o r a l l
in d i
g e n t s i c k , a n d p r o v i d e d t h a t o n l y r e s i d e n t s w ere e n t i t l e d t o a id * S u p e r v i s i o n o f c o u n t y h o s p i t a l s w a s m ade a f u n c t i o n o f t h e S t a t e B o a r d o f C h a r i t i e s a n d C o r r e c t i o n s c r e a t e d I n 190 3 * T h is a g e n c y was n o t t o e s t a b l i s h s t a n d a r d s i n
62 I b i d *
(1 8 6 0 ) , chap* 2 4 7 ,
63 I b i d .
( 1 8 7 0 ) , c h a p . C C X X V III, s e c s . 1 ,
64 C a l. S t a t s . 65 I b i d .
secs*
re s p e c t to
1 , 12*
( 1 9 0 1 ) , c h a p . CCX, s e c s .
2.
1 -7 .
( 1 9 0 3 ) , c h a p . C C C L X III, s e c s . 1 ,
3.
65
37 m e d ic a l c a r e , b u t to
s o c ia l p o lic y *
66
S t u d i e s a n d re c o m m e n d a
t i o n s w e r e m ad e r e g a r d i n g t h e i m p r o v e m e n t o f s e r v i c e a n d c o n d i t i o n s am ong t h e v a r i o u s c o u n t y h o s p i t a l s * i n 1904 t h a t a l l b u t t h r e e th em , h ad i n s t i t u t i o n s
I t was fo u n d
c o u n t i e s , Dos A n g e le s b e i n g one o f
t h a t “s e rv e d th e d o u b le p u rp o se o f a
h o s p i t a l f o r t h e i n d i g e n t s i c k a n d a n a lm sh o u se f o r th e a g e d 67 o r h e lp le s s poor*" The S t a t e B o ard o f C h a r i t i e s a n d C o r r e c t i o n s w orked t o im p ro v e c o u n ty h o s p i t a l s y ears.
I t s nam e w a s c h a n g e d i n 1 9 2 5 t o t h e
o f P u b l ic W e lf a r e , a n d i n 1927 to
th ro u g h th e
S t a t e D ep artm en t
th e p r e s e n t S t a t e D e p a rtm e n t
o f S o c i a l W elfare * S u p e r v i s i o n o f c o u n ty h o s p i t a l s i s m a i n t a i n e d by t h r e e a g e n c ie s to d a y . tin u e s i t s
The S t a t e D e p a rtm e n t o f S o c i a l W e lf a r e co n
w ork i n r e g a r d t o g e n e r a l c o n d i t i o n s a n d s e r v i c e .
In sp e c tio n o f f a c i l i t i e s tu tio n s is H y g ie n e .
f o r m e n ta l p a t i e n t s
i n c o u n ty i n s t i
c a r r i e d o u t b y th e S t a t e D e p a rtm e n t o f M e n tal M a tte rs i n r e g a r d to h o s p i t a l c o n s t r u c t io n and
c o m m u n ity h e a l t h a r e
s u p e r v i s e d by t h e S t a t e D e p artm en t o f
P u b lic H e a lth . As t h e U n i t e d S t a t e s e v o lv e d , i t s
in te re s t
o f th e in d iv id u a l in c re a s e d a s a r e s u l t o f th e
in w e lfa re
c o n c e n tra te d
“p u b l i c o p i n i o n " p r e s s u r e s g r a d u a l l y f o r c i n g i m p r o v e m e n t o f b o th m e d ic a l and r e l i e f
67
I b id .. p .
147
sy s te m s.
I t h a s b e e n s h o w n how
38 v a rio u s f a c t o r s b ro u g h t ab o u t th e p r e s e n t- d a y p h ilo s o p h y and l e g a l b a s i s f o r th e o p e r a tio n o f p u b lic w e lfa re a g e n c ie s# In flu e n c e d ,
to o , by f e d e r a l and s t a t e a g e n c ie s ,
c o u n ty and
c i t y h o s p i t a l and p u b lic a s s i s t a n c e p ro g ram s g e n e r a l l y m eet th e
n e e d s o f th e in d ig e n t an d s ic k p o o r a d e q u a te ly #
o f th e se
c o m p re h e n siv e s y s te m s i s
T y p ic a l
t h a t w h ic h h a s b e e n e s t a b l i s h e d
i n t h e C o u n ty o f L o s A n g e le s u n d e r t h e D e p a rtm e n t o f C h a r i t i e s # Its
h is to r y and a d m in is tr a tiv e
d e ta il#
fu n c tio n s w ill be d e sc rib e d in
CHAPTER I I I HISTORY AND ORGANIZATION OF THE DEPARTMENT OF CHARITIES A f t e r a c e n t u r y o f p u b l i c w e l f a r e d e v e lo p m e n t i n Los A n g e l e s C o u n t y , a i d i s now a d m i n i s t e r e d b y t h e D e p a r t m e n t o f C h a ritie s•
T h i s o r g a n i z a t i o n h a s g r o w n t o b e co m e a d e p a r t
m e n t now e m p l o y i n g 1 0 , 0 0 0 p e r s o n s a n d s p e n d i n g some 1 2 0 m i l lio n d o lla r s a n n u a lly in a d m in is te rin g a id o f v a rio u s k in d s t o 2 4 0 ,0 0 0 c l i e n t s a n d p a t i e n t s *
W ith a p o p u l a t i o n o f a b o u t
4*3 m i l l i o n , L o s A n g e le s C o u n ty i s ,
th e re fo re ,
im a te ly f iv e and a h a lf p e rc e n t o f i t s w ith p u b lic a s s is ta n c e I*
in h a b ita n ts
e ith e r
or h o sp ita l c a re .
HISTORICAL DEVELOPMENT
H o s p ita l c a re has been p ro v id e d in s ic k p o o r sin c e
a id in g ap p ro x
som e f o r m f o r t h e
th e e s t a b l is h m e n t o f t h e C o u n ty , b u t i n d i g e n t
r e l i e f was i n e f f i c i e n t l y o r g a n i z e d a n d v e r y l i m i t e d i n i t s scope u n t i l th e g r e a t d e p re s s io n of th e C oncern f o r th e
e a r l y 1 9 3 0 1s .
i n d i g e n t s i c k was s t r e s s e d
e a rly in
t h e C o u n t y ’ s h i s t o r y w h e n , i n 1 8 5 5 , tw o p h y s i c i a n s p e t i t i o n e d t h e B oard o f S u p e r v i s o r s f o r e s t a b l i s h m e n t o f a p u b l i c h o s p i t a l •***
The B o a r d a p p o i n t e d a c o m m i t t e e t o
c o u n ty
stu d y th e
**• L o s A n g e l e s C o u n t y , B o a r d o f S u p e r v i s o r s , M i n u t e s * May 1 4 , 1 8 5 5 •
40 m a t t e r a n d m ake r e c o m m e n d a t i o n s , b u t n o t h i n g i m m e d i a t e l y cam e o f t h e i r f i n d i n g s .
The S u p e r v i s o r s d i d , h o w e v e r,
c re a te
t h e o f f i c e o f t h e C o u n t y P h y s i c i a n , who b e g a n r e n d e r i n g a l l care
to
th e in d ig e n t sic k *
w ere t r e a t e d by i n d i v i d u a l
Up t o t h i s
tim e t h e s i c k p o o r
d o c t o r s who s u b m i t t e d c l a i m s t o
t h e C o u n t y f o r c o s t o f c a r e g i v e n , a maximum o f $ 5 0 b e i n g a llo w e d f o r each p a t i e n t . I n 1 8 7 4 t h e C o u n t y P h y s i c i a n w as r e q u e s t e d b y t h e B oard t o
s u b m i t a r e p o r t o n i n d i g e n t s who h a d b e e n a n d w e r e
b e in g c a re d f o r . up i n
d e ta il.
2
M e d ica l c a r e r e g u l a t i o n s w ere th e n s e t
. T h i s w as t h e b e g i n n i n g o f e s t a b l i s h i n g r u l e s
w ith re g a rd to c h a r ity a d m in is tr a tio n . One o f t h e f i r s t p r o v i s i o n s
f o r th o se o t h e r th a n th e
s i c k w as m a d e i n © e c e m b e r , 1 8 7 4 w h en m i n u t e s o f t h e B o a r d o f S u p e rv iso rs d ir e c te d
t h a t b o a r d a n d c a r e f o r tw o c h i l d r e n
b e a u t h o r i z e d a t a t o t a l c o s t o f $24 p e r m o n th .3 t h i s p e r i o d was c o n t i n u e d a t t h e
A id d u rin g
^ p le a s u re o f th e B o ard,
and in v e s tig a tio n o f th e need o f p e rso n s r e q u e s tin g r e l i e f w a s m ad e b y i n d i v i d u a l S u p e r v i s o r s . U n til th is
d a t e m uch o f t h e B o a r d f s t i m e h a d b e e n
o c c u p ie d in p ro v id in g c a re f o r ~ th e in d ig e n t s ic k .
2 I b i d . . May 5 , 1 8 7 4 . ® I b i d . . D ecem ber 1 5 , 18 7 4 . 4 I b i d .. A p ril 3 ,
1878.
R e a liz in g
41 t h e g ro w in g n e e d , a n d i n f l u e n c e d b y t h e C o u n ty P h y s i c i a n a n d p ro m in e n t c i t i z e n s ,
t h e B oard o f S u p e r v i s o r s p u r c h a s e d , i n
J u n e , 1878, 3 7 .7 2 a c r e s
o f la n d a t th e s i t e
o f th e p re s e n t
C o u n t y G e n e r a l H o s p i t a l f o r t h e sum o f $ 7 , 5 4 4 .
A tw o -sto ry
s t r u c t u r e w ith a c a p a c i t y o f one h u n d re d p a t i e n t s w as o p ened on O c to b e r 1 0 , 1 8 7 8 .
When t h e C o u n t y H o s p i t a l a n d P o o r Harm
was r e a d y f o r o c c u p a n c y , f o r t y - s e v e n p a t i e n t s w e re t r a n s f e r r e d to i t
fro m p r i v a t e c o n t r a c t h o s p i t a l s .
It
is
in te r
e s tin g to n o te t h a t th e c o s t o f c o n s tr u c tin g and o u t f i t t i n g t h e o r i g i n a l i n s t i t u t i o n was o n l y $ 8 , 0 0 0 .
To e r e c t a o n e
h u n d r e d b e d m o d e r n h o s p i t a l t o d a y , t h e sum o f 1 * 5 m i l l i o n d o lla rs,
o r $ 1 5 ,0 0 0 p e r b e d , w o u ld b e r e q u i r e d .
An i l l u s t r a t i o n
o f th e changed a d m in is tr a tiv e p h ilo s o p h y
b e t w e e n t h a t d a y a n d now i s
sh ow n b y t h e f a c t
t h a t no fe m a le
n u r s e s w ere h i r e d f o r c a r e o f C o u n ty p a t i e n t s u n t i l T h e new p o i n t o f v i e w w a s i n f l u e n c e d b y a p e t i t i o n to
1885. s u b m itte d
t h e B o a r d b y t h e Women’ s C h r i s t i a n T e m p e r a n c e U n i o n .
A
b e g i n n i n g w a s m ade w h e n o n e m a t r o n w a s h i r e d t o c a r e f o r 7 women p a t i e n t s . B u ria l o f th e In d ig e n t dead had b een a p u b lic resp o n sib ility
s i n c e th e f o u n d in g o f th e C o u n ty .
I n t e r m e n t w as
L os A n g e le s C o u n ty G e n e r a l H o s p i t a l r e c o r d s . 6 7
Loc.
G it .
L os A n g e le s C o u n ty , B oard o f S u p e r v i s o r s , June 1 1 , 1885.
M in u te s.
42 p e rfo rm ed by p r i v a t e
c o n c e r n s , a c o n t r a c t , a s w ith a l l C o u n ty
b u s in e s s , g o in g to th e lo w e st b id d e r* was $12*00 i n 1 8 7 7 , f a l l i n g c e m e te ry and
The c o s t p e r b u r i a l
t o $ 3 * 7 4 i n 1 885 *
c r e m a t o r y w as e s t a b l i s h e d
A C o u n ty
soon a f t e r an d i s
o p e r a t e d to d a y * D u r in g t h e m id d le o f t h e 1 8 8 0 f s i t was r e a l i z e d t h a t fa c ilitie s at
t h e C o u n ty H o s p i t a l w ere n o t a d e q u a t e a n d t h a t
e x p a n s i o n was n e c e s s a r y *
I n o r d e r t o m ake ro o m f o r new
b u i l d i n g s w h ic h w ere t o b e e r e c t e d t o h o u se a d d i t i o n a l p a t i e n t s a t t h e C o u n t y H o s p i t a l , t h e P o o r F a r m w a s m o v ed t o t h e p r e sent s ite
o f R a n c h o L o s A m ig o s a t H ondo*
w e r e a d m i t t e d t o t h e P o o r F a rm i n
1888.
a t t i t u d e re g a rd in g such i n s t i t u t i o n s
8
P lr s t p a tie n ts As t h e p u b l i c f s
c h a n g e d , t h e nam e l a t e r
b e c a m e t h e flC o u n t y F a r m , 11 a n d f i n a l l y
“R a n c h o L o s A m i g o s • “
T he o f f i c e o f t h e S u p e r i n t e n d e n t o f C h i l d r e n ’ s a n d Women’ s Work w a s e s t a b l i s h e d t h e sa m e y e a r i t
in Ju n e , 1891, and in A ugust o f
cam e t o b e c a l l e d
a n d Women’ s W ork i n
t h e “O f f i c e o f C h i l d r e n ’ s
t h e C o u n ty o f L os A n g e le s * " ^
o f t h e o r d i n a n c e w as f o r t u t e women a n d c h i l d r e n
“th e c a r e and a s s i s t a n c e • • •
P ro v isio n of d e sti
The o r d in a n c e f u r t h e r
Q
R a n c h o L o s A m ig o s r e c o r d s * ^ L os A n g e le s C o u n ty , B oard o f S u p e r v i s o r s , A u g u s t 5 , 1 891* L o c* c i t *
M in u te s *
43 sta te d
t h a t t h e p u r p o s e was “t o p r o t e c t a l l
y o u n g , women f r o m e v i l a s s o c i a t e s th e f a lle n
• • .
«
.
such c h ild re n o r
• • and g e n e ra lly u p l if t
T h i s O f f i c e w a s l a t e r a b a n d o n e d w hen
th e In d ig e n t I n s p e c to r to o k o v er such d u t i e s . I n J u l y , 1 8 9 3 t h e O f f i c e o f I n d i g e n t I n s p e c t o r w as 12 c re a te d * A i d w a s m ade a v a i l a b l e i n t h e f o r m o f b o a r d a n d ro o m a n d m e d i c a l a t t e n d a n c e t o d e n t s o f th e C o u n ty i f
“d e s e r v i n g ” u n e m p lo y ed r e s i
t h e y w o u l d ”w o r k o f f ” t h e i r r e l i e f
b e n e f i t s , a s w as r e q u i r e d u n d e r t h e E l i z a b e t h a n P o o r Law* I n t h i s way, r e c i p i e n t s
“a p p r e c i a t e d ” t h e a i d r e c e i v e d ,
i t w a s f e l t t h e y w o u ld m ak e e v e r y e f f o r t
and
t o f i n d e m p lo y m e n t
o f f t h e C o u n ty r o l l s * To show t h e c h a n g e i n a t t i t u d e r e g a r d i n g t h e a d m i n i s tra tio n o f jo b
of c h a rity , title s
It
is
in te re s tin g
to fo llo w
of p u b lic a s s is ta n c e w o rk ers.
nam e o f ”I n d i g e n t I n s p e c t o r ” w a s c h a n g e d t o C h a ritie s" in 1895.
th e e v o lu tio n
The i g n o m i n i o u s “I n s p e c t o r o f
T h is p o s i t i o n l a t e r becam e " H e l d I n
v e s t i g a t o r ” a n d was u s e d u n t i l t h e p r e s e n t in n o c u o u s t i t l e of
“ S o c i a l C ase W o rk er" was a d o p te d *
The S t a t e P a u p e r A c t o f 1901 p r o v i d e d t h a t t h e C o u n ty 13 was r e s p o n s i b l e f o r c a r e o f i t s in d ig e n t s * A d m in is tra tio n
Loc* c l t * 12 Los A n g e le s C o u n ty , B o a rd o f S u p e r v i s o r s , Ju ly 8 , 1893. 13 C a l. S t a t s .
( 1 9 0 1 ) , C h a p . OCX, s e e s .
1 -7 .
M in u te s.
44 and fin a n c in g o f p u b lic a s s is ta n c e and h o s p ita l m ade a l o c a l b u r d e n .
A c t u a l l y , L os A n g e le s C o u n ty h a d b e e n
p e rfo rm in g th e s e s e r v i c e s , changes lo c a lly .
c a r e was
so t h e a c t b r o u g h t a b o u t few
The la w w as a im e d p r i m a r i l y a t c e r t a i n
o th e r c o u n tie s o f th e s t a t e fo r th e ir
w h ic h w ere n o t p r o p e r l y c a r i n g 14 in d ig e n t and s ic k p o o r.
D u rin g th e e a r l y p a r t o f th e
t w e n t i e t h c e n t u r y , m an y
o r g a n i z a t i o n s th ro u g h o u t th e U n ite d S t a te s an d Canada had b een se n d in g in d ig e n t p e rs o n s w ith tu b e r c u lo s is f o r tre a tm e n t,
to C a lif o r n ia
b u t m ak in g no p r o v i s i o n f o r t h e i r c a r e .
T he
s i t u a t i o n becam e s u c h a p r o b le m , t o b o t h t h e C o u n ty a n d p r i v a te a g e n c ie s ,
t h a t o n M arch 9 , 1909 t h e C h a r i t y C o n f e r e n c e
C o m m i t te e o f L o s A n g e l e s m e t t o
stu d y th e q u e stio n *
T h is
C o m m itte e , com posed o f t h i r t y - t w o c h a r i t a b l e a n d p h i l a n t h r o p i c s o c i e t i e s , a d o p te d a r e s o l u t i o n w h ic h was e n d o r s e d b y t h e B o a r d o f S u p e r v i s o r s o n M a r c h 2 2 , 19 0 9 * sta te d
t h a t th e
15
T he r e s o l u t i o n
se n d in g o f t u b e r c u l a r p e rs o n s c a u se d su ch a
b u r d e n t h a t t h e C o u n ty w o u ld p r o m p t l y r e t u r n p a tie n ts
to th e p la c e
such in d ig e n t
from w h ic h t h e y w e re ^ e n t , ”
16
The
14
l o a n e e s Cahn a n d V a l e s k a B a ry , W e l f a r e A c t i v i t i e s o f F e d e r a l , S t a t e , a n d L o c a l G o v e rn m e n ts i n C a l i f o r n i a , 1 8 5 0 1 9 5 4 *(B e r k e l e y : U n i v e r s i t y o f C a l i f o r n i a P r e s s , 1 9 3 6 ) , p p . 14 6 -7 . 15 L o s A n g e l e s C o u n t y , B o a r d o f S u p e r v i s o r s , M a rc h 2 2 , 1 9 0 9 . L oc. c i t .
M in u te s,
45 C o u n t y l o n g h a s h a d t o b e w a t c h f u l o f *t r e n d s a s t h i s , b e c a u s e o f th e a t t r a c t i o n s
of th e
" G o l d e n S t a t e . 11
C a lifo rn ia a s s is ta n c e g ra n ts
N e v e rth e le ss,
t o d a y a r e am ong t h e n a t i o n ’ s
h ig h e s t, and p u b lic h o s p ita l f a c i l i t i e s
a r e a d e q u a te .
The p r e s e n t L o s A n g e le s C o u n ty C h a r t e r w e n t i n t o e f f e c t i n J u n e , 1913#
17
At th is
tim e th e o f f i c e o f th e 18 S u p e r i n t e n d e n t o f C h a r i t i e s w as c r e a t e d * The S u p e r i n t e n d e n t
was g i v e n c h a r g e o f t h e C o u n ty H o s p i t a l a n d C o u n ty P o o r P hrm , a s w e ll a s th e In d ig e n t t h e pow ers an d d u t i e s
R e l i e f D ep artm en t*
D e fin itio n s of
o f th e B oard o f S u p e r v is o r s i n
to c a re o f th e in d ig e n t s ic k and
reg ard
d e p e n d e n t p o o r w ere g iv e n
u n d e r S e c t i o n 4 0 4 1 . 1 6 o f t h e C a l i f o r n i a P o l i t i c a l C o d e , now fo u n d i n S e c tio n s 2 0 0-207 o f th e C a l i f o r n i a 19 I n s t i t u t i o n s C ode*
W e lfa re and
A t t h e tim e o f a d o p t i n g t h e C o u n ty C h a r t e r , r e s i d e n c e was r e q u i r e d i n o r d e r t o except fo r
em ergent c a s e s .
o b ta in p u b lic
one y e a r ’ s
w e lfa re ,
R e l i e f was o f f e r e d I n k i n d .
When
c a s h w a s n e c e s s a r y , h o w e v e r , t h e g r o c e r y o r d e r g i v e n w as m a d e f o r a l a r g e r a m o u n t, a n d th e g r o c e r a d v i s e d t o g i v e c a s h t o th e c l i e n t
17
over th e c o s t o f th e r e g u la r g ro c e ry o r d e r .
C h a r t e r , C o u n ty o f L os A n g e l e s .
18 I b i d . . A r t i c l e
IV , S e e . 1 4 .
W e lfa re a n d I n s t i t u t i o n s C ode. S t a t e o f C a l i f o r n i a (S a c ra m e n to : C a l i f o r n i a S t a t e P r i n t i n g O f f i c e , 1 9 4 7 ) , 356 p p .
46 T he D e p a r t m e n t o f C h a r i t i e s w a s c r e a t e d b y a n o r d i n a n c e 20 o f t h e B o a rd o f S u p e r v i s o r s on N ovem ber 2 4 , 1914* A ll pub lic
c h a r i t i e s w h ic h h a d b e e n s u p p o r t e d o r m a i n t a i n e d by Los
A n g e le s C o u n ty , Los A n g e le s C i t y o r th e o t h e r c o u n ty m u n ic i p a l i t i e s w ere i n t e g r a t e d i n t o
th e D e p artm en t u n d e r th e d i r e c
tio n o f th e S u p e rin te n d e n t o f C h a r itie s . d iv is io n s
th e n in c lu d e d :
The D e p a r t m e n t ’ s
t h e C o u n ty H o s p i t a l , C o u n ty F arm ,
C o u n ty C e m e te ry , a n d C o u n ty O u td o o r R e l i e f ,
t h e l a t t e r w h ic h
h a d fo rm e rly b een th e I n d ig e n t R e l i e f D e p artm en t.
T h i s sam e
y e a r t h e P s y c h o p a t h i c U n i t w as o p e n e d a t t h e C o u n t y H o s p i t a l . I n 1915 t h e s t a t e
le g isla tu re
e n a c te d a law a u t h o r i z i n g
sta te
g ra n ts to c o u n tie s f o r c a re o f tu b e rc u la r p a tie n ts i f 22 c o u n tie s had sa n a to riu m f a c i l i t i e s . B e c a u se o f t h e g ro w in g t u b e r c u l o s i s p ro b le m ,, t h e B oard o f S u p e r v i s o r s l a t e r a d v a n ta g e o f t h i s c o n stru c tio n
to o k
a c t by p u rc h a s in g la n d and a u th o r iz in g
of a tu b e rc u lo s is
sa n a to riu m .
O l i v e V iew T u b e r
c u l o s i s S a n a to r iu m n e a r t h e C i t y o f San F e r n a n d o was o p e n ed O c to b e r 2 7 , 1 9 2 0 , a t t h a t tim e c o n s i s t i n g o f f o u r w ard s w ith 23 a t o t a l p a t i e n t lo a d o f n i n e t y - f i v e . U n til th is d a te , t u b e r c u l o s i s p a t i e n t s w ere g iv e n c a r e v e ry s i m i l a r t o
th a t
^ L os A n g e le s C o u n ty , O rd in a n c e No. 380 (N . S . ) , Novem ber 2 4 , 1 9 1 4 . ^
L o s A n g e le s C o u n ty G e n e r a l H o s p i t a l r e c o r d s . CaX. S t a t a .
23
21
(X 9X 5), e tia p . 7 6 6 , s e e . 3 .
O l i v e V iew S a n a t o r i u m r e c o r d s .
47 affo rd ed a ll
i n d i g e n t s , a n d i n t h e sa m e h o s p i t a l s *
A new u n i t ,
th e - O s t e o p a t h i c H o s p i t a l , w a s e s t a b l i s h e d 24 a t t h e C o u n t y G e n e r a l H o s p i t a l i n 1 92 7 * T h is h o s p i t a l was s e t up a t
t h e dem and o f D o c t o r s o f O s te o p a th y a n d c i t i z e n s
who w i s h e d t o b e t r e a t e d b y t h e s e p h y s i c i a n s . U n it i s p h y s ic a lly
s e p a ra te d an d m e d ic a lly in d e p e n d e n t o f t h a t
p a r t o f t h e G e n e r a l H o s p i t a l Tnhieh i s M e d ic in e .
T he O s t e o p a t h i c
se rv e d by D o c to rs o f
T he O s t e o p a t h i c H o s p i t a l t o d a y c o n s i s t s o f t h e
o l d b u i l d i n g s w h i c h f o r m e r l y m a d e u p t h e w h o l e G e n e r a l H o s p i t a l , w h i l e t h e h u g e n ew u n i t c o m p l e t e d i n 1 9 3 3 i s u s e d o n ly by D o c to rs o f M e d icin e a n d t h e i r p a t i e n t s .
Xn t h e
a g g r e g a t e t h e tw o a r e c a l l e d t h e L os A n g e le s C o u n ty G e n e r a l H o sp ita l*
The s e p a r a t i o n o f h o s p i t a l s w as a r e q u i r e m e n t o f
t h e A m e ric a n C o l le g e o f S u rg e o n s a n d t h e A m e ric an M e d ic a l A s s o c ia tio n i n o rd e r to b r in g a b o u t r e c o g n itio n o f th e G en eral 25 H o s p ita l by th e s e o rg a n iz a tio n s * B e g i n n i n g i n 1 9 3 0 i m p r e s s i v e s t r i d e s w e r e m ad e i n b r i n g i n g a c c e p t e d p r i n c i p l e s o f m anagem ent i n t o p u b l i c a s s i s t ance a d m in is tra tio n .
Expanded p ro g ram s o f r e l i e f ,
in by n a tio n a l,
a n d l o c a l g o v e rn m e n ts , r e q u i r e d g r e a t e r
s ta te
e f f i c i e n c y a n d a n ew p h i l o s o p h y . t o g row tr e m e n d o u s ly , a n d t h e r e
24 25
p a rtic ip a te d
These p la n s have c o n tin u e d is
no i n d i c a t i o n t h a t t h e y
L o s A n g e le s C o u n ty G e n e r a l H o s p i t a l r e c o r d s .
P e r s o n a l i n t e r v i e w w ith A r t h u r J . W i l l , Los A n g e le s C o u n ty S u p e r i n t e n d e n t o f C h a r i t i e s , D ecem ber 2 2 , 1949*
48 w ill
ev er d ecrease# Im p ro v ed b u s i n e s s m eth o d s i n t h e D e p a rtm e n t o f C h a r i t i e s
w ere i l l u s t r a t e d ,
in
1 9 3 5 , b y th e e s t a b l i s h m e n t o f t h e B ureau
o f R esources and C o lle c tio n s .
In v e s tig a tio n
of reso u rces
o f a p p lic a n ts f o r r e l i e f and h o s p ita l c a r e , and c o lle c tio n of b ills
fo r se rv ic e s
ren d ered ,
q u ire s re so u rce s a t a l a t e r
I f a n d w hen a n i n d i g e n t a c
d a te , a re a l l
c e n tra liz e d in th is
o n e u n i t i n s u r i n g m o re e c o n o m i c a l a n d e f f e c t i v e a d m i n i s t r a t i o n # D em ands o f p r o m i n e n t c i t i z e n s , la y in d iv id u a ls , in flu e n c e d th e o f A d o p tio n s i n
1949#
b o th p r o f e s s i o n a l and
c r e a t i o n - o f t h e C o u n ty B u re au
The B u r e a u w as c a r e f u l l y o r g a n i z e d
a n d h a s w o rk ed s lo w ly i n a ssu m in g i t s
ro le .
T e c h n iq u e s and
p r o c e d u r e s a r e now w e l l - e s t a b l i s h e d , a n d a d o p t i o n s a r e e f f e c t ed fre q u e n tly . R e c e n t I n c r e a s e s i n C o u n ty p o p u l a t i o n h a v e b r o u g h t about a need f o r a d d itio n a l h o sp ita l f a c i l i t i e s . p ita ls , ed i n
Two h o s
t h e L os A n g e le s C o u n ty H a rb o r G e n e r a l H o s p i t a l f o u n d
1946 a n d t h e Los A n g e le s C o u n ty L ong B each G e n e r a l
H o s p i t a l o p en ed i n 1 9 4 8 , h av e h e lp e d to m ee t dem ands f o r tu b e r c u lo s is , a c u te and c h ro n ic b ed s. C h a ritie s i s
fo llo w in g th e n a tio n a l tr e n d in th e e s ta b lis h m e n t
of g en eral h o s p ita ls , Qg
The D e p a rtm e n t o f
in ste a d of in s titu tio n s
fo r sp e c ia liz e d
P e r s o n a l I n t e r v i e w w i t h B e r y l E . C ox, D e p u ty S u p e r i n t e n d e n t o f C h a r i t i e s , L o s A n g e l e s C o u n t y , M a rc h 1 4 , 1950.
49 . t r e a t m e n t o n ly * Two m o u n t a i n s a n a t o r i a , A c t o n a n d Warm S p r i n g s G am ps, b o t h f o m e r l y p a r t o f R a n c h o L o s A m ig o s , w e r e m ade i n d e p e n d e n t u n i t s ' i n 1949* lo d g in g to h o te ls,
s i n g l e , u n e m p l o y e d men a t
l!S k i d Row11 c a f e s a n d
th e B ureau o f P u b l i c A s s i s t a n c e
i n d i g e n t s t o t h e cam ps* p lin e d
I n s t e a d o f p r o v id in g m e a ls a n d
s e n d s m any o f t h e s e
I n a h e a lth f u l c lim a te and d i s c i
s u r r o u n d i n g s t h e p a t i e n t s , m o s t o f whom a r e a l c o h o l i c s ,
r e c e iv e th e c a r e and t r e a tm e n t n e c e s s a r y , a n d a t a lo w e r c o s t to th e
tax p a y er*
An e x a m i n a t i o n w i l l b e m ad e o f t h e p r e s e n t - d a y D e p a r t m e n ta l s t r u c t u r e , an d a d m i n i s t r a t iv e a c t i v i t i e s p e rfo rm e d by th e
v a rio u s d iv is io n s w i l l be b r i e f l y
e x p la in e d i n th e f o l
lo w in g s e c t i o n . II.
ADMINISTRATIVE A C T IV IT IE S OF THE DEPARTMENT OF CHARITIES When t h e C o u n t y C h a r t e r w a s a d o p t e d I n J u n e , 1 9 1 3 ,
S e c t i o n 22 s e t o u t t h e d u t i e s o f t h e S u p e r i n t e n d e n t o f C h a r itie s
a s fo llo w s: The S u p e r i n t e n d e n t o f C h a r i t i e s s h a l l b e u n d e r t h e d i r e c t i o n o f th e B o ard o f S u p e r v i s o r s , a n d s h a l l e x e r c is e a g e n e ra l s u p e rv is io n o v er, and en fo rce r u le s a n d r e g u l a t i o n s f o r th e c o n d u c t a n d g o v ern m en t o f th e c h a r i t a b l e i n s t i t u t i o n s o f th e c o u n ty . He s h a l l p e r f o r m s u c h o t h e r d u t i e s a s may b e p r e s c r i b e d b y t h e B o a r d o f S u p e r v i s o r s o r b y la w * ™
27
L os A n g e le s C o u n ty , C h a r t e r , A r t i c l e
V I , S e c . 22*
50 L a t e r th e D e p a rtm e n t o f C h a r i t i e s was c r e a t e d , d u tie s o f th e S u p e rin te n d e n t o f C h a r itie s a re
28
and th e
to d a y d e s ig n a te d
i n t h e L os A n g e le s C o u n ty A d m i n i s t r a t i v e C ode: S u b je c t t o th e d i r e c t i o n o f th e B oard o f S u p e r v is o r s an d r u l e s a n d r e g u l a ti o n s a d o p te d by th e b o a rd , th e S u p e rin te n d e n t o f C h a r itie s s h a ll be th e head o f and i t s h a ll be h is d u ty to d i r e c t , s u p e rv is e , and c o n tro l a l l a c t i v i t i e s o f t h e D e p a r t m e n t o f C h a r i t i e s • He s h a l l e n f o r c e r u l e s a n d r e g u l a t i o n s f o r t h e c o n d u c t and g ov ern m en t o f th e v a r i o u s b u r e a u s o f th e D e p artm en t o f C h a r i t i e s . 29 T h e A d m i n i s t r a t i v e C o de f u r t h e r s t a t e s w h a t t h e v a r i o u s u n i t s o f th e D e p a rtm e n t s h a l l b e : T h e D e J p a rtm e n t o f C h a r i t i e s s h a l l c o n s i s t o f t h e B u re a u o f H o s p i t a l s , t h e B ureau o f P u b l i c A s s i s t a n c e , th e B u re au o f M e d ic a l S o c i a l S e r v i c e , t h e B ureau o f R e so u rc e s a n d C o l l e c t i o n s , a n d th e B ureau o f A d o p tio n s . S a i d D e p a r t m e n t s h a l l b e g o v e r n e d 0a c c o r d i n g t o t h e r u le s and r e g u la tio n s fo llo w in g ♦ D e ta ile d in s tr u c tio n s a re
l a i d out in th e A d m in is tra tiv e
C ode w i t h r e g a r d t o a d m i n i s t r a t i v e m a t t e r s o f t h e D e p a r t m e n t 31 w h ic h th e B o ard o f S u p e r v i s o r s c o n s i d e r s n e c e s s a r y . T hese r u l e s a n d r e g u l a t i o n s a r e p r o m u lg a te d when deem ed a d v i s a b l e . They a r e b a s e d on s t a t e
law s i n t h e ? fe lf a r e a n d I n s t i t u t i o n s
Code, th e p rim a ry p r o v i s i o n f o r
c o u n ty a d m i n i s t r a t i o n o f
p u b lic w e lfa re b e in g :
S u p ra, p . 46. 29
L os A n g e le s C o u n ty , A d m i n i s t r a t i v e IX , S e c . 1 5 0 .1 . 30 I b i d . . A r t i c l e
Code. A r t i c l e
IX , S e c . 15 0 .
I b i d . . A r t ic l e IX , S e c s . 1 5 0 .2 - 1 5 0 .6 8 .
51 E v ery c o u n ty an d e v e ry c i t y an d c o u n ty s h a l l r e l i e v e an d su p p o rt a l l in c o m p e te n t, p o o r, in d ig e n t p e rs o n s and th o se in c a p a c ita te d by a g e , d is e a s e , o r a c c id e n t, l a w f u l l y r e s i d e n t t h e r e i n , w hen s u c h p e r s o n s a r e n o t su p p o rte d and r e lie v e d by t h e i r r e l a t i v e s o r f r i e n d s , o r b y t h e i r own m e a n s , o r b y S t a t e h o s p i t a l s o r o t h e r S t a t e o r p r i v a t e i n s t i t u t i o n s * 52 I n a d d i t i o n t o L o s A n g e le s C o u n ty , Cook C o u n ty , I l l i n o i s is
th e o n ly o t h e r h e a v i l y p o p u la te d c o u n ty i n t h e U n ite d
S t a t e s w h ich a d m i n i s t e r s p u b l i c w e l f a r e .
I n m ost o t h e r
l a r g e u r b a n a r e a s , a s New Y o r k a n d B o s t o n , c i t i e s a d m i n i s t e r ' w e lf a r e , w h ile s t a t e
g o v e rn m e n ts p e rf o r m t h e
fu n c tio n in
m any j u r i s d i c t i o n s * I n a d d i t i o n t o c o u n ty m anagem ent o f p u b l i c w e l f a r e , a num ber o f o th e r a d m i n i s t r a t i v e p r i n c i p l e s
e sta b lis h e d under
t h e E l i z a b e t h a n P o o r Law i n E n g l a n d a r e f o u n d i n L o s A n g e l e s C o u n ty to d a y *
One o f t h e s e p r i n c i p l e s
Is
th a t a p erso n , in
o r d e r to r e c e iv e c o u n ty a i d , m ust n o t b e a b le
to p ro v id e f o r
h im s e lf , an d o n ly su ch in d ig e n ts a re e n t i t l e d to c o u n ty f a c i l i t i e s .
c a r e from
T h e A d m i n i s t r a t i v e C ode s p e c i f i e s
th a t
" n o p e r s o n s h a l l be c o n s i d e r e d t o b e a p a u p e r o r p o o r o r I n d ig e n t p e rs o n , so a s to b e e n t i t l e d to fa c ilitie s w ise a b le
32
c a r e fro m a n y o f th e
o f t h e D e p a r t m e n t o f C h a r i t i e s , who s h a l l b e o t h e r 33 t o p r o v i d e f o r s u c h c a r e * 11
T he o n l y e x c e p t i o n i s
S t a te o f C a l i f o r n i a , W e lfa re and I n s t i t u t i o n s C ode*
S e c * 25 0 0 * 33 '
Los A n g e le s C o u n ty , A d m i n ls tr a t lv e C o d e* A r t i c l e Sec* 1 5 0 .1 4 *
IX ,
52 t h a t i n d i v i d u a l s m ay b e t r e a t e d
i n c o u n ty h o s p i t a l s i f
th ey
a r e a f f l e c t e d w i t h t u b e r c u l o s i s o r a n o t h e r c o m m u n ic a b le d i s 34 e a s e , o r i n c a s e o f em erg en cy . A n o th e r law a d o p te d e a r l y i n E n g la n d w as t h a t c e r t a i n c lo s e r e l a t i v e s if
o f t h e i n d i g e n t w ere to p r o v id e a s s i s t a n c e
su c h r e l a t i v e s w ere a b l e .
t i v e C ode s t a t e s t h a t
One s e c t i o n o f t h e A d m i n i s t r a
o u t-o f-sta te
t a c t e d i n a n e n d ea v o r to
re la tiv e s
s h a ll be con-
o b ta in a s s is ta n c e f o r th e a p p lic a n t,
35
w h ile a n o th e r s e c tio n s p e c if ie s
t h a t t h e sam e s h a l l b e d o n e 36 w ith r e l a ti v e s r e s id in g in C a lif o r n ia . I t i s n o t m a n d a to ry th a t
o u t - o f - s t a t e k in h e lp s u p p o rt th e in d ig e n t p e rs o n , b u t
th o s e i n C a l i f o r n i a , b y la w , m ust a i d a p p lic a n t i f
in p r o v id in g f o r th e
th e y a r e a b le .
R e sid e n c e i n a c i t y o r c o u n ty f o r a s p e c i f i e d p e r io d o f t i m e w a s a n i n i t i a l r e q u i r e m e n t d u r i n g Q jieen E l i z a b e t h ' s re ig n .
T he g e n e r a l p r o v i s i o n i n t h e C a l i f o r n i a W e l f a r e a n d
In stitu tio n s
C o de r e g a r d i n g r e s i d e n c e i s
o th e rw ise p ro v id e d in t h i s e n title d
to a id ,
th a t
c h a p t e r , a p e r s o n , i n o r d e r to be
s h a l l b e a r e s i d e n t o f th e s t a t e and o f th e
c o u n ty w h e re in a p p l i c a t i o n
i s m a d e ." * ^ -
R e sid e n c e re q u ire m e n ts
34 I b i d . .
A r t i c l e IX , S e c . 1 5 0 .5 6 .
55 I b i d . .
A r t i e l e IX , S e c .
36 I b i d . .
A r t i c l e IX , S e c . 1 5 0 .1 9 .
3^ S ta te Sec. 2550.
"except a s
1 5 0 .1 8 .
o f C a l i f o r n i a , W e lfare a n d I n s t i t u t i o n s C ode.
53 v a ry w ith th e
ty p e o f a i d w h ic h i s g i v e n .
N o n -re sid e n ts r e
q u i r i n g em ergency a i d a r e p r o v id e d p u b l i c a s s i s t a n c e f o r a s h o r t p e r io d o f tim e , a n d , u n d e r c e r t a i n c irc u m s ta n c e s , a re g iv e n t r a n s p o r t a t i o n to
th e c o u n ty , s t a t e
o r c o u n t r y w here
t h e y do h a v e r e s i d e n c e . ^ A f i n a l i m p o r t a n t p r i n c i p l e p a s s e d down f r o m t h e E n g l i s h P o o r Law i s
th a t
" th e t o t a l
o f m o n th ly p u b l ic
a ssista n c e ,
t o g e t h e r w ith a l l o t h e r in c o m e , f o r a n y f a m i ly o r p e r s o n , m ay n o t e x c e e d a t o t a l w h i c h i s
$ 5 .0 0 l e s s th a n t h e lo w e s t 39 b e g i n n i n g w a g e f o r c o u n t y e m p l o y e e s . • . . !t The B oard o f S u p e r v i s o r s m ay, h o w e v e r, a u t h o r i z e h i g h e r g r a n t s i n e x tra o rd in a ry c irc u m s ta n c e s .
m ak e p u b l i c a s s i s t a n c e tio n
le ss a ttra c tiv e
th an
la w was t o
e m p lo y m e n t.
A p p lic a
o f t h e la w i s i n r e g a r d to G e n e r a l R e l i e f w h ic h i s
fin a n c e d e n tir e ly p a id
T he p u r p o s e o f t h i s
from c o u n ty f u n d s .
B ecause th e lo w e st
c o u n t y e m p lo y ee r e c e i v e s $ 1 3 1 p e r m o n th ,
g ra n t,
w hen e x c e p t i o n s a r e n o t m a d e , i s $ 1 2 6 .
g o ric a l a id s
f o r th e. a g e d ,
g o v ern m en t p a r t i c i p a t e s ,
c h il d r e n and b l in d
t h e maximum U nder th e c a te th e f e d e r a l
s o maximum g r a n t s t o a p e r s o n o r
f a m i l y a r e n o t r e g u l a t e d b y t h e C o u n t y 's $126 l i m i t . In th e
s e c tio n s fo llo w in g , a s h o rt a n a ly s is
of th e
D e p a rtm e n ta l s t r u c t u r e and a d m in is tr a tiv e a c t i v i t i e s
■ZQ
of each
Los A n g e le s C o u n ty , A d m in is tr a tiv e C o d e. A r t i c l e S e c . 1 5 0 .5 1 . 39 I M d . . A r t i c l e
IX , S e c .
1 5 0 .4 6 .
IX ,
5.4 u n i t w ill b e p re se n te d *
40 0
C h a r itie s A d m in is tra ti on* te n d e n t of C h a r itie s ,
The o f f i c e
o f th e S u p e rin
M r. A r t h u r J . W i l l , a n d t h e E x e c u t i v e
A s s i s t a n t S u p e r i n t e n d e n t o f C h a r i t i e s , Mr* W i l l i a m A . B a r r , is
c a lle d
" C h a r i t i e s A d m i n i s t r a t i o n . 11
W ith a s t a f f o f f o u r
p e r s o n s who a c t i n t h e c a p a c i t y o f a d m i n i s t r a t i v e a s s i s t a n t s and a n a ly s ts ,
c o n tr o l i s m a in ta in e d ov er th e v a s t a c t i v i t i e s
o f th e D e p a rtm e n t.
P ro b le m s r e l a t i n g
to
th e D e p a rtm e n t an d
o th e r d e p a rtm e n ts and j u r i s d i c t i o n s , a s w e ll a s q u e s tio n s b e tw e e n v a r i o u s b u r e a u s o f th e D e p a rtm e n t i t s e l f , by t h i s
sta ff.
a re stu d ie d
T he S u p e r i n t e n d e n t k e e p s a s t r i c t b u d g e t a r y
c o n t r o l o v e r a l l b u r e a u s t h r o u g h m o n th ly r e p o r t s w h ich a r e su b m itte d to
h im .
On t h e C h a r i t i e s A d m i n i s t r a t i o n s t a f f i s
a m ed ica l
d o c t o r who a d v i s e s t h e S u p e r i n t e n d e n t o n a l l m a t t e r s o f a m e d ic a l n a tu r e . re p re se n ta tiv e
T h is p h y s i c ia n a l s o
s e r v e s a s a D e p a rtm e n ta l
on th e m e d ic a l a d v is o r y b o a rd s*
Two o t h e r s m a l l u n i t s a r e d i r e c t l y u n d e r t h e m a n a g e m ent o f C h a r itie s A d m in is tra tio n :
th e p e rs o n n e l d i v is io n and
t h e C o u n t y C e m e te r y * The p e r s o n n e l d i v i s i o n w as e s t a b l i s h e d i n i t s fo rm i n 1 9 4 3 .
p resen t
A s t a f f of tw e n ty -fiv e p e rso n s p ro c e ss e s a l l
40 See T a b le I , O r g a n i z a t i o n C h a r t , Los A n g e le s C o u n ty D e p artm en t o f C h a r i t i e s .
TABLE
I
ORGANIZATION CHART LOS ANGELES COUNTY DEPARTMENT OP CHARITIES
SUPERINTENDENT OF CHARITIES MEDICAL ADVISOR
ADMINISTRATIVE STAFF
EXECUTIVE ASSISTANT SUPERINTENDENT OF CHARITIES
BUREAU OF RESOURCES AND COLLECTIONS
BUREAU OF PUBLIC ASSISTANCE
BUREAU OF ADOPTIONS
ACTON CAMP
LOS ANGELES COUNTY HARBOR GENERAL HOSPITAL
RANCHO LOS AMIGOS
LOS ANGELES COUNTY GENERAL HOSPITAL
COUNTY CEMETERY
BUREAU OF PHYSICALLY HANDICAPPED CHILDREN
BUREAU OF MEDICAL SOCIAL' SERVICE
OLIVE VIEW SANATORIUM
LOS ANGELES COUNTY LONG EEACH GENERAL HOSPITAL
WARM SPRINGS CAMP
CJ!
Cl
56 a c c e ssio n s,
s e p a r a tio n s and e f f i c ie n c y r e p o r t s , and m a in ta in s
ite m c o n t r o l c a r d s on th e 1 0 ,0 0 0 e m p lo y ees o f t h e d e p a rtm e n t* In d iv id u a l p e rs o n n e l s e c tio n s have been c re a te d in a l l b u rea u s and h o s p ita ls , b u t o v e r- a ll
su p e rv isio n i s
c a r r ie d o u t by th e
p erso n n el d iv is io n o f f ic e . C r e m a tio n o f t h e r e m a in s o f i n d i g e n t s w hose b o d i e s a r e u n c la im e d by f r i e n d s o r r e l a t i v e s , u n a b le to p ro v id e f o r p r i v a t e C o u n ty C e m e te ry .
o r w hose r e l a t i v e s a r e
in te rm e n t, i s
th e
T h o se b o d i e s w h ic h c a n n o t b e c r e m a t e d
because of re lig io u s
t e n e t s a re b u r ie d a t c o u n ty e x p e n se a t
t h e H o ly C r o s s C e m e te ry .
E c o n o m ic c o n d i t i o n s
m in e t h e num ber o f c r e m a t i o n s .
g re a tly d e te r
E ven th o u g h th e c o u n ty po p u
l a t i o n h a s in c r e a s e d tre m e n d o u sly s in c e o f c re m a tio n s i n
c o n d u c te d a t
1 9 3 8 -3 9 , t h e num ber
t h a t y e a r w a s 1 2 0 1 , ^ifoile i n
1948 -49 t h e r e
w ere o n ly 6 4 7 . ^ B ureau o f H o s p i t a l s . t h e B ureau o f H o s p i t a l s i s
F ro m t h e v i e w p o i n t o f p e r s o n n e l , f a r th e
la r g e s t of th e b u re a u s.
T h e re i s no h e a d o f th e B u re a u o f H o s p i t a l s a s s u c h , th e S u p e rin t e n d e n t o f C h a r it i e s and h i s E x e c u tiv e A s s i s t a n t h a v in g d ir e c t
c o n t r o l o v e r e a c h h o s p i t a l and cam p.
t a l s , p ro v id in g a l l
F iv e h o s p i
t y p e s o f m e d i c a l c a r e , a n d tw o c o n v a l e s
c e n t c a m p s m ake up t h e B u r e a u o f H o s p i t a l s .
Each o f th e s e
A n n ual R e p o r t , D e p artm en t o f C h a r i t i e s , and 1 9 48 -4 9.
1 9 38-39
57 u n i t s w i l l toe d i s c u s s e d b e lo w * B ureau o f H o s p i t a l s : H o s p ita l*
Los A n g e le s C o u n ty G e n e ra l
T he l a r g e s t a n d o l d e s t h o s p i t a l i n
sy ste m i s t h e G e n e ra l H o s p ita l* ill,
th e c o u n ty
I n d i g e n t s who a r e a c u t e l y
a n d a n y i n h a b i t a n t who h a s a c o n t a g i o u s d i s e a s e , a r e
r e c e i v e d h ere*
F our m e d ic a l u n i t s ,
M e d ic in e , a r e p r o v id e d :
A c u te , P s y c h o p a th ic ,
a n d C o m m u n ic a b le D i s e a s e *
T u b e rc u lo sis
In a d d i t i o n , one O ste o p a th ic U n it
s t a f f e d toy D o c t o r s o f O s t e o p a t h y , i s a d m in is tra tio n of a l l
s e r v e d toy D o c t o r s o f
in c lu d e d .
N o n -m ed ic al
s e c tio n s of th e G en eral H o s p ita l i s
f u r n i s h e d toy a c e n t r a l o f f i c e .
The p r e s e n t a r r a n g e m e n t o f
c e n t r a l i z a t i o n o f a d m i n i s t r a t i v e and h o u se k e e p in g f u n c t i o n s , w i t h th e M e d ic a l a n d O s te o p a th ic U n i t s u n d e r d i f f e r e n t r o o f s , re s u lts
I n e c o n o m i c a l a n d e f f i c i e n t m a n a g e m e n t* 42 F o r th e f i s c a l y e a r 1 949-50, to ta l sta ffin g at
G eneral H o s p ita l i s
4 ,5 0 0 .
T h i s i n c l u d e s 50 0 s t u d e n t s ,
a s in te r n s , n u rse s, p h y sic a l la b o ra to ry te c h n ic ia n s .
and o c c u p a tio n a l
B udget a llo w a n c e s,
f o r s a l a r i e s an d w ages a r e
in
11 m i l l i o n d o l l a r s ;
and o p e ra tio n , o r g e n e ra l o p e ra tin g ex p en ses, th ir d m illio n ; m e n t, $ 7 5 ,0 0 0 .
4P
and fo r c a p ita l
th e such
th e ra p is ts ,
and
ro u n d f i g u r e s , f o r m a in te n a n c e th re e and a
o u tla y , o r n o n -e x p e n d a b le e q u ip
In a d d itio n , c a p ita l p ro je c t a p p ro p ria tio n s ,
D a ta r e l a t i n g to b u d g e t a llo w a n c e s f o r t h e f i s c a l y e a r 1 9 4 9 -5 0 o b t a i n e d fro m th e Los A n g e le s C o u n ty B u d g e t. F i s c a l Y ear 1 9 4 9 -1 9 5 0 .
58 o r e x p e n d i t u r e s f o r new s t r u c t u r e s a n d r e p a i r s
to e x i s t i n g
fa c ilitie s ,
T o ta l c o s ts
cam e t o o v e r tw o m i l l i o n d o l l a r s .
f o r th e y e a r a r e b u d g e te d a t 16*4 m il l io n s * The a c u t e u n i t ,
o r t h a t p a r t o f th e
G en eral H o s p ita l
s e rv e d by D o c to rs o f M e d ic in e , i s b u d g e te d f o r a n i n - p a t i e n t lo a d o f 3 ,0 0 0 , and th e
o ste o p a th ic u n it f o r 300.
A n o th e r
f a c t o r w h i c h a c c o u n t s f o r m uch o f t h e h o s p i t a l ^ is
th e num ber o f o u t - p a t i e n t v i s i t s *
n e a r l y 5 0 0 ,0 0 0 v i s i t s d u r in g th e
It
w o rk -lo a d
w as e s t i m a t e d t h a t
w o u l d b e m ad e t o t h e v a r i o u s
1949-50 f i s c a l y e a r .
T hese c l i n i c s
c lin ic s
red u ce c o sts
o f c a r e , i n t h a t u n i t e :x p e n d itu re s f o r o u t - p a t i e n t are le ss
th a n
th o se f o r
ta g e of th e c lin ic s
is
in -p a tie n t
se rv ic e s.
tre a tm e n t
A n o th e r ad v an
t h a t b e d s a r e m ade a v a i l a b l e
to p e rso n s
n e e d in g a c u te c a r e . T he o n l y n e w f a c i l i t i e s
o r a d d i t i o n a l b e d s w h ic h a r e
b e in g p ro v id e d f o r th e f u t u r e a t th e
G en eral H o s p ita l a r e
t h e P s y c h o p a t h i c a n d C o m m u n ic a b le D i s e a s e U n i t s .
C o n stru c
t i o n o f th e 275 bed P s y c h o p a th ic H o s p ita l i s
c o m p le te d
a n d w i l l be read y f o r occupancy i n 1951.
h a lf
P l a n s f o r t h e 4 00
b e d C o m m u n ic a b le D i s e a s e H o s p i t a l h a v e b e e n p l a c e d f o r b i d , w ith c o m p le tio n o f th e s t r u c t u r e 1952.
sc h e d u le d f o r
t h e sum m er o f
To t h e l a y m a n t h e s e a u x i l i a r y f a c i l i t i e s
la rg e , b u t th is t h a t th e
is
q u i c k l y d i s c o u n t e d w hen i t
la rg e s t p riv a te
is
may n o t
re a liz e d
h o s p i t a l i n Los A n g e le s C o u n ty ,
Q ueen o f A n g e ls , h a s b u t 502 b e d s .
seem
59 B ureau o f H o s p i t a l s :
R ancho Los A m ig o s.
R ancho Los
A m ig o s, f o r m e r l y , th e C o u n ty P o o r F arm , t o d a y i s a h o s p i t a l f o r c h ro n ic and c o n v a le s c e n t p a t i e n t s o f a l l
ages,
tra n sfe r
r e d fro m o t h e r h o s p i t a l s i n t h e D e p a rtm e n t f o r p o s t - a c u t e care*
T h is i n c l u d e s e x te n d e d tr e a tm e n t o f
se v e rly p a ra ly z e d
p o s t - p o l io m y e li t is , m e d ic a l and o rth o p e d ic c a s e s , a s w e ll a s th o s e w ith m e n ta l d is e a s e s *
Much o f t h e f o o d c o n s u m e d a t
R a n c h o L o s A m ig o s i s p r o v i d e d b y g a r d e n c r o p s g r o w n o n t h e g r o u n d s , m ilk from a h e r d o f co w s, a n d e g g s a n d p o u l t r y fro m s e v e r a l th o u s a n d c h ic k e n s * shop f o r r e p a i r s p rin t
to
O th e r f a c i l i t i e s
sh o es o f a m b u la to ry p a t i e n t s ,
a r e a shoe and a
s h o p t f i i c h d o e s w o rk f o r a l l b u r e a u s a n d h o s p i t a l s
of
t h e D ep artm en t* F o r t h e 1 9 49-50 f i s c a l y e a r ,
1 , 0 5 0 c i v i l s e r v i c e em
p l o y e e s w ere a ll o w e d b y th e B oard o f S u p e r v i s o r s , a lo n g w ith 6 0 0 p a t i e n t s who e a r n a s m a l l h o u r l y o r d a i l y p e n d i t u r e s w ere b u d g e te d a t :
stip e n d .
Ex
s a l a r i e s and w ages, 2 .8 m illio n
d o l l a r s ; m a in te n a n c e a n d o p e r a t i o n , n e a r l y $ 7 0 0 ,0 0 0 ; a n d c a p i t a l o u t l a y , $ 1 0 0 ,0 0 0 . e s tim a te d a t $ 9 3 4 ,0 0 0 .
C a p i t a l p r o j e c t e x p e n d i t u r e s w ere
T o ta l b u d g et a llo w a n c e s f o r th e y e a r
w ere n e a r l y 4 . 5 m i l l i o n s * P a t i e n t d a y s w ere b u d g e te d a t 2 ,6 0 5 f o r t h e 1949-50 fis c a l y ear.
In a d d itio n to
p ro v id e d f o r i n p r iv a te
th e se p a ti e n t s ,
355 o t h e r s a r e
s a n a t o r i a a n d r e s t h om es*
E x p a n sio n o f f a c i l i t i e s f o r in f ii s a a r y p a t i e n t s i s
now
60 a lm o st c o m p le te d .
T he t o t a l p a t i e n t l o a d a t R a n c h o L o s
A m ig o s w i l l n o t b e c h a n g e d , h o w e v e r> f o r a m b u l a t o r y m a l e p a tie n ts
a r e t o b e m oved i n t o
th e o ld in firm a ry b u ild in g s ,
and th e s tr u c tu r e s
t h a t w ere u s e d by t h e a m b u la to r y in m a te s
w i l l be r a z e d .
i s n o t a n tic ip a te d th a t bed c a p a c itie s a t
It
R ancho w i l l be i n c r e a s e d i n
th e n e a r f u t u r e , b u t a lo n g -ra n g e
p ro g ram o f re p la c e m e n t o f o ld ,
in a d e q u a te
e x is tin g
s tru c tu re s
h a s b e e n l a i d o u t* B ureau o f H o s p i t a l s :
O l i v e V iew S a n a t o r i u m .
f u n c t i o n o f O l i v e V iew S a n a t o r i u m i s a f f l i c t e d w ith t u b e r c u lo s is . i n s u f f i c i e n t to h a n d le a l l ed in p r iv a te
sa n a to ria
The
to c a re f o r p erso n s
B ecause th e bed c a p a c ity i s
c o u n ty p a t i e n t s , o t h e r s a re
or in
tre a t
t h r e e o f t h e o t h e r C o u n ty h o s
p ita ls .
O l i v e V iew h a s l o n g b e e n r e c o g n i z e d a s o n e o f t h e
n a t i o n 's
o u tsta n d in g h o s p ita ls f o r tu b e rc u la r
tre a tm e n t.
A llo w a n c e s f o r t h e 1 9 4 9 -5 0 b u d g e t p r o v id e d f o r a s t a f f i n g o f 825 c i v i l
s e r v i c e e m p lo y e e s, a n d an a d d i t i o n a l
35 p a t i e n t h e l p e r s - - a
to ta l
of 860.
S a l a r i e s an d w ages w ere
b u d g e te d a t o v e r 2 .2 m i l l i o n d o l l a r s ; m a in te n a n c e an d o p e ra t i o n a t n e a r ly one m il l io n ; m illio n s ;
c a p ita l
o u t l a y e q u ip m e n t a t 3 .3
an d c a p i t a l p r o j e c t e x p e n d itu re s a t $ 1 6 ,0 0 0 .
O liv e
V i e w ' s t o t a l b u d g e t f o r t h e f i s c a l y e a r 1 9 4 9 - 5 0 w a s som e 6 . 5 m illio n s . T h e B o a r d o f S u p e r v i s o r s b u d g e t e d O l i v e View f o r a n a v e r a g e d a l l y p a t i e n t l o a d o f 1 ,2 0 0 d u r in g th e
1 9 4 9 -5 0 f i s c a l
61 y ear#
A dded t o t h i s w ere 386 p a t i e n t s c a r e d f o r i n p r i v a t e
c o n tra c t sa n a to ria #
T o ta l p a t i e n t s w ere, th e r e f o r e ,
a n tic i
p a t e d t o n um ber 1 ,5 8 6 # E x c e p t f o r e n c l o s i n g a few o p e n p o r c h e s t o p r o v i d e a s m a ll num ber o f a d d i t i o n a l b e d s , no o t h e r f a c i l i t i e s b e i n g p l a n n e d a t O liv e V ie w . S u rv ey F o u n d a tio n i s
are
T he L o s A n g e l e s C o u n t y X -R a y
c u rre n tly g iv in g x -ra y s
t h r e e m i l l i o n c o u n ty r e s id e n ts #
to , i t
is
hoped,
T h is su rv e y w i l l i n d ic a t e
w h e th e r o r n o t t h e r e i s a n e e d t o i n c r e a s e C o u n ty t u b e r c u l o s i s fa c ilitie s# B ureau o f H o s p i t a l s : H o s p ita l#
Los A n g e le s C o u n ty H a rb o r G e n e r a l
One o f t h e n e w e s t a d d i t i o n s t o
t h e B u r e a u o f H o s
p ita ls
i s H arb o r H o s p ita l in T o rra n c e , e s ta b lis h e d
1946#
The h o s p i t a l w as e r e c t e d a s a te m p o r a r y s t r u c t u r e
t h e Army d u r i n g W o r l d W ar I I , a t a fra c tio n of i ts
Ju ly 24, by
a n d was s e c u r e d b y t h e C o u n ty
o r i g i n a l c o st#
E ven th o u g h e x te n s iv e
im p ro v e m e n ts h a v e b e e n m ade, t h e i n v e s tm e n t p e r b e d i s
far
b e l o w w h a t t h e c o s t o f b u i l d i n g , a new h o s p i t a l w o u ld b e # N ext to
th e G en eral H o s p ita l,
o f a l l i n s t i t u t i o n s in th e
B ureau o f H o s p i t a l s , H a rb o r H o s p it a l i s m o st n e a r l y a g e n e r a l a c u te u n i t , is
in th a t a ll
ty p e s o f s u r g i c a l and m e d ic a l c a re
o ffered # B u d g e te d f u n d s f o r t h e 1 9 4 9 -5 0 f i s c a l y e a r w e re : s a l
a r i e s a n d w ag es, 2*1 m i l l i o n d o l l a r s ; m a in te n a n c e a n d o p e ra t i o n , $ 7 0 0 ,0 0 0 ;
c a p i t a l o u t la y , $ 7 0 ,0 0 0 ; a n d c a p i t a l p r o j e c t s ,
62 $ 2 6 5 ,0 0 0 #
T h e t o t a l b u d g e t f o r t h e y e a r w a s som e 3 * 1 m i l l i o n s #
E m p lo y ee s num ber 8 5 0 . I t w as e s t i m a t e d t h a t t h e i n - p a t i e n t l o a d a t H a r b o r H o s p i t a l w o u ld b e
755 d u r in g th e
1949-50 y e a r .
T h is i s
a
g r e a t e r n u m b e r t h a n w as p r o v i d e d f o r t h e y e a r b e f o r e , a n d i t is
e x p e c te d t h a t m ore t h a n 755 w i l l b e b u d g e te d f o r i n th e
1 9 5 0 -5 1 f i s c a l y e a r .
R e m o d e lin g a n d e x p a n s io n i s n e a r l y
c o m p le te d a t H a rb o r.
T hus, th e p la n
A d m in is tra tiv e
d e v is e d by th e C h ie f
O f f ic e r an d th e S u p e rin te n d e n t o f C h a r itie s i s
a p p ro a c h in g i t s
c u lm in a tio n , and r e s i d e n t s i n
th e g ro w in g
s o u th w e s t p a r t o f t h e C o u n ty w i l l b e n e f i t fro m t h i s tra liz a tio n
of h o sp ita l f a c i l i t i e s .
B ureau o f H o s p i t a l s ; G en eral H o s p ita l.
L os A n g e le s C o u n ty L ong B each
The m o st r e c e n t g e n e r a l h o s p i t a l a d d i t i o n
t o th e D e p artm en t o f C h a r i t i e s i s opened in
Ju n e, 1948.
th e Long B each H o s p i t a l ,
C o m p a re d t o t h e o t h e r i n s t i t u t i o n s
t h e C o u n ty s y s te m ,' t h e Long B each H o s p i t a l i s its
decen
bed c a p a c ity i s
tw o h u n d r e d .
s m a ll i n
th a t
Two t y p e s o f p a t i e n t s a r e
m a in ly c a re d f o r h e r e :
tu b e r c u la r and c h ro n ic .
p u rp o se i n
th e h o s p i t a l o r i g i n a l l y w as to
e sta b lis h in g
in
T he p r i m a r y ta k e
t h e o v e r - l o a d o f s u c h p a t i e n t s fro m t h e o t h e r C o u n ty i n s t i t u t i o n s , b u t Long B each H o s p i t a l i s g r a d u a l l y b e c o m in g a g e n e ra l h o sp ita l. u n i t w as a l s o
As w as th e
c a se w ith H arb o r H o s p ita l, t h i s
b u i l t f r o m s u r p l u s Army s t r u c t u r e s , a n d a t a
fra c tio n of i t s
r e a l w o rth .
65 For th e as fo llo w s:
1 9 49-50 f i s c a l y e a r ,
s a l a r i e s a n d w a g e s , $ 6 5 0 ,0 0 0 ; m a in te n a n c e an d
o p e r a t i o n , $ 2 0 0 ,0 0 0 ; je c ts ,
b u d g e t a ll o w a n c e s w ere
$ 1 0 0 ,0 0 0 .
c a p i t a l o u t l a y , $ 9 ,0 0 0 ; and c a p i t a l p r o
T he t o t a l w a s , t h e r e f o r e ,
som e $ 9 5 9 , 0 0 0 .
S ta f f in g f o r th e y e a r t o t a l e d 254. Beds t o be p r o v id e d d u r i n g th e a t 520.
1 9 4 9 -5 0 y e a r w ere s e t
M oney f o r e x p a n s i o n p u r p o s e s h a s b e e n u s e d e l s e
w h e re , ho w ev er, a n d th e e n la rg e m e n t t h a t i s
b e in g c a r r i e d
o u t a t t h e p r e s e n t tim e w i l l f i n d t h e t o t a l num ber o f b e d s a t a little
o v e r 200 a t th e en d o f th e f i s c a l y e a r .
tio n a l f a c ilitie s a p p e a rs to be a w ith re g a rd to
Some a d d i
w i l l b e p r o v i d e d a t Long B each i f need.
th e re
M o s t o f t h e n ew w o r k , t h o u g h , w i l l b e
im p ro v in g e x i s t i n g
s tru c tu re s .
As p a r t o f
t h e d e c e n t r a l i z a t i o n p r o g r a m , L o n g B e a c h H o s p i t a l now h e l p s t o m eet t h e m e d ic a l n e e d s o f i n d i g e n t s and em ergency p a t i e n t s in i t s
v ic in ity . B ureau o f H o s p i t a l s :
A c t o n a n d Warm S p r i n g s G am ps.
A c t o n C am p, n e a r P a l m d a l e , a n d Warm S p r i n g s Cam p, l o c a t e d t e n m ile s e a s t o f C a s ta ic , a r e a lm o st i d e n t i c a l i n i n th e ty p e o f tre a tm e n t o f f e r e d .
s iz e and
B o th o f t h e s e f a c i l i t i e s
f u r n i s h c a r e f o r c h r o n i c a n d c o n v a l e s c e n t a d u l t , m a l e , am b u la to ry p a tie n ts .
M o st o f t h o s e a t t h e cam ps a r e a l c o h o l i c s
who a r e p r o v i d e d s u c h t r e a t m e n t a s a s u b s t i t u t e f o r m e a l s an d lo d g in g
in th e c ity .
A f e w o f t h e s e men a r e r e h a b i l i t a t e d ,
b u t m an y o f t h e m , h a v i n g n o f a m i l i e s a n d n o p r o f e s s i o n
or
64 tra d e ,
f a l l back in to t h e i r o ld p a tte r n
l e a v e t h e camp#
of liv in g i f
A s m a l l s t i p e n d i s p a i d t h o s e who w i s h t o
w o r k , m o s t o f th e m d o i n g so i n c id e n ta l expenses.
o rd e r to
o b t a i n m oney f o r i n
The p h y s i c a l f a c i l i t i e s
at
a r e m u ch l i k e
a n a iro y c a m p , w i t h m en s l e e p i n g
and e a tin g in
a c e n tr a l d in in g h a l l .
B ecau se o f t h e p a t i e n t h e lp w h ich i s a re o n ly s ix te e n
c iv il se rv ic e
a t Warm S p r i n g s . a t th is
th e y
th e
cam ps
in b arrack s
a v a ila b le ,
th e re
e m p lo y e e s a t A c to n a n d f i v e
Few er a r e n eed ed a t th e l a t t e r ,
camp a r e i n b e t t e r p h y s i c a l c o n d i t i o n .
fo r p a tie n ts
E ach o f th e
cam ps h a s a b e d c a p a c i t y o f 3 7 5 . F o r t h e 1 9 4 9 -5 0 f i s c a l y e a r t h e t o t a l b u d g e t a t A c to n w a s $ 3 8 3 , 0 0 0 , a n d $ 1 7 6 , 0 0 0 a t Warm S p r i n g s .
M ore e x t e n s i v e
o p e r a t i o n s w ere c o n d u c te d a t A c to n , w h ich a c c o u n ts f o r th e h ig h e r b u d g e t.
I t is
n o t a n t i c i p a t e d t h a t Warm S p r i n g s
Camp w i l l b e e x p a n d e d , b u t A c t o n w i l l b e d o u b l e d i n d u rin g
t h e n e x t tw o . y e a r s ;
f o r camp c a r e i s m o re e c o n o m i c a l
t h a n p r o v i d i n g b o a r d a n d ro o m f o r s u c h m en i n t h e B ureau
o f P u b lic A s s is ta n c e .
em p lo y e e s i n t h e B u reau o f H o s p i t a l s B ureau o f P u b lic A s s i s t a n c e ,
th e
fo r m a te ria l r e l i e f
c ity .
A lth o u g h th e num ber
of
is
th e
f a r g r e a t e r th a n
l a t t e r b u reau
spends v a s t l y
l a r g e r sums a n d c a r e s f o r m any t i m e s m o r e p e r s o n s . have se e n e a r l i e r ,
siz e
As we
th e B ureau o f P u b lic A s s is ta n c e p r o v id e s o f f a m ilie s and s in g le p e rs o n s in t h e i r
own h o m e s a s d i s t i n g u i s h e d f r o m m e d i c a l c a r e a n d t r e a t m e n t
I n th e h o s p ita ls * ic a l a id s
T h is B ureau a d m i n i s t e r s th e
th re e
s e t up u n d e r th e S o c ia l S e c u r i t y A c ts
c a te g o r
O ld Age
S e c u r i t y , A id t o N eedy C h i l d r e n a n d A id t o N eedy B lin d * th r e e p ro g ram s a r e p a r t i c i p a t e d s t a t e a n d c o u n ty g o v e rn m e n ts*
T hese
in f in a n c ia lly by th e n a tio n a l, A n o th e r ty p e o f r e l i e f
is
th e
A id to th e P a r t i a l l y S e lf - S u p p o r tin g B lin d , p r o v id in g f i n a n c ia l
h e lp
to
t h o s e b l i n d who m ay b e c o m e s e l f - s u p p o r t i n g ,
and p a id f o r by th e ty p e o f a id i s
s t a t e a n d c o u n ty g o v e rn m e n ts*
G eneral R e l i e f , f in a n c e d e n t i r e l y
The l a s t fro m c o u n ty
funds* E s t im a te s , f o r th e num ber o f p e r s o n s a id e d and th e c o s t o f such r e l i e f , If
w i l l b e f o r t h e f i s c a l y e a r 1950-51*
th e 1 949-50 f i g u r e s w ere u s e d , a p r o p e r i n d i c a t i o n o f th e
C o u n ty ’ s a d m i n i s t r a t i v e
r e s p o n s i b i l i t y w o u ld n o t b e show n;
f o r d u r i n g m uch o f t h i s
l a t t e r y e a r , th e s t a te has been
a d m in iste rin g aged and b lin d r e lie f * t h i s w i l l b e d o n e b y t h e C o u n ty *
Now, a n d i n t h e f u t u r e ,
C ase lo a d a v e r a g e s p e r
m o n th f o r 1 9 5 0 -5 1 w i l l p r o b a b l y b e :
O ld Age S e c u r i t y ,
1 2 0 ,0 0 0 p e r s o n s a i d e d ; A id to N eedy C h i l d r e n , 2 3 ,0 0 0 c a s e s a i d e d ; A id t o N eedy B l i n d , 4 ,8 0 0 p e r s o n s a i d e d ; A id t o t h e P a rtia lly
S e lf-S u p p o rtin g B lin d ,
G en eral R e lie f ,
265 p e r s o n s a i d e d ; a n d
2 9 ,0 0 0 c a s e s a id e d *
o f c a se s t h a t w i l l be c a re d f o r i s
T h u s, th e t o t a l num ber e x p e c t e d t o b e some
1 7 7 ,0 0 0 . E x p e n d itu re s f o r th e v a rio u s ty p e s o f a id i s
b u d g e te d ,
66 f o r th e 1 9 50-51 f i s c a l y e a r , a t :
O ld A ge S e c u r i t y ,
m i l l i o n s o f d o l l a r s ; A id t o N eedy C h i l d r e n , A id t o
N eedy B l i n d ,
31*3 m i l l i o n s ;
4 .7 m i l l i o n s ; A id t o t h e P a r t i a l l y
S u p p o rtin g B lin d , $ 2 7 0 ,0 0 0 ; a n d G e n e ra l R e l i e f , The r e l i e f e x p e n d itu r e s w i l l , t h e r e f o r e , m illio n d o lla rs .
100*8
Of t h i s
S e lf-
1 7 .7 m i l l i o n s .
t o t a l som e 1 5 4 . 8
su m , 3 4 . 5 m i l l i o n s w i l l b e p a i d f o r
b y Los A n g e le s C o u n ty p r o p e r t y
ow ners; w h ile th e re m a in d e r
o f 1 2 0 .3 m i l l i o n s w i l l b e f i n a n c e d fro m g r a n t s - i n - a i d from th e n a tio n a l and s t a t e
g o v e rn m e n ts .
- I n t h e B ureau o f P u b l i c A s s i s t a n c e em p lo y ee s, l o c a t e d i n tric t
o ffic e s
y ear,
e x p e n d itu re s*
th e c e n tr a l o f f ic e an d in
th ro u g h o u t th e C o u n ty .
e stim a te d to b e :
e le v e n d i s
F o r t h e 1 9 5 0-51 f i s c a l
o th e r th an th e a id s g iv e n above, a r e
s a l a r i e s a n d w a g e s, 1 1 .3 m i l l i o n d o l l a r s ;
m a in te n a n c e and o p e r a tio n , $ 4 5 0 ,0 0 0 .
t h e r e a r e 2 ,9 5 3
1 .3 m il l io n s ;
and c a p ita l o u tla y ,
T o ta l e x p e n d i tu r e s o t h e r th a n t h e a i d s am ount
to n e a r ly 1 3 .1 m i l l i o n s .
Of t h i s
su m , 7 . 6 m i l l i o n s w i l l
b e f in a n c e d b y t h e C o u n ty , w h ile g r a n t s - i n - a i d fro m th e n a tio n a l and s t a t e
g o v e rn m e n ts f o r a d m i n i s t r a t i v e c o s t s w i l l
am ount t o 5 .5 m i l l i o n s . t u r e s o f th e B ureau o f
I n s u m m a ry , t h e n ,
e x p e n d i
P u b lic A s s is ta n c e f o r a id s and a d m in i
s t r a t i o n w i l l b e some 1 6 7 . 9 m i l l i o n s . p a id :
th e t o t a l
T h is am ount w i l l be
Los A n g e le s C o u n ty , 4 2 .1 m i l l i o n s , a n d
fro m t h e n a t i o n a l a n d s t a t e
g ra n ts -in -a id
g o v e rn m e n ts , 1 2 5 .8 m i l l i o n s .
B u reau o f R e s o u r c e s a n d C o l l e c t i o n s .
The f u n c t i o n o f
67 th e B ureau o f R e s o u rc e s a n d C o l l e c t i o n s i s
to re c o v e r fu n d s
e x p en d e d a s i n d i g e n t , c a t e g o r i c a l o r m e d ic a l a i d fro m r e c i p i e n t s who a c q u i r e a b i l i t y its e lf,
in
to pay*
T h is B ureau p a y s f o r
th a t re c e ip ts are f a r in
ex ce ss o f c o sts*
u s in g a l l p o s s ib l e m eans, a n a tte m p t i s a ll
m ade t o
By
c o l l e c t fro m
r e c i p ie n t s o f a id f o r s e r v ic e s ren d ered * One h u n d r e d a n d s i x t y - f i v e
B u reau .
e m p l o y e e s w o rk f o r t h e
F or th e f i s c a l y e a r 1 9 4 9 -5 0 , a llo w a n c e s f o r b u d g e te d
ite m s w ere:
s a l a r i e s an d w a g e s, $ 4 2 6 ,0 0 0 ; m a in te n a n c e a n d
o p e r a t i o n , $ 7 1 ,0 0 0 ; a n d c a p i t a l
o u t la y , $ 7 ,0 0 0 .
no a llo w a n c e f o r c a p i t a l p r o j e c t s . w as $ 5 0 4 ,0 0 0 * a ssista n c e
T h e r e w as
T hus, th e t o t a l b u d g et
E v e n t h o u g h m an y m o re p e r s o n s r e c e i v e p u b l i c
t h a n h o s p i t a l c a r e , a m uch g r e a t e r p a r t o f t h e
B u r e a u f s w o rk i s
w ith r e c i p i e n t s o f m e d ic a l tr e a tm e n t.
T h is
l a t t e r g ro u p , a f t e r re g a in in g t h e i r h e a lth , r e t u r n to jo b s a n d p a y t h e d e b t owed t h e C o u n t y .
In a d d itio n , p erso n s of
m i n o r i t y g r o u p s who a r e a b l e t o p a y a r e
o fte n n ot p e rm itte d
e a r e i n a p r i v a t e h o s p i t a l , a n d C o u n ty i n s t i t u t i o n s a r e
th e
o n ly re c o u rse * B ureau o f M e d ic a l S o c i a l S e r v i c e *
T he B u r e a u o f
M e d ic a l S o c ia l S e r v ic e i n v e s t i g a t e s a p p l i c a n t s 1 e l i g i b i l i t y f o r m e d ic a l c a r e o r p la c e m e n t i n C o u n ty H o s p i t a l s , an d p r o v i d e s m e d i c a l c a s e w ork s e r v i c e s t o a l l p a t i e n t s c a r e u n d e r th e D e p artm en t o f C h a r i t i e s * M e d ic a l a i d d i s t r i c t s
re c e iv in g
m ed ica l c a r e p ro g ra m s.
have been e s ta b lis h e d , and t h i r t e e n
68 o ffic e s are
l o c a t e d th r o u g h o u t t h e C o u n ty i n
d e c e n tra liz e d In th e w ere s e t u p :
se rv ic e
o rd er to o f f e r
to a p p l i c a n t s f o r a id *
1 9 4 9 - 5 0 b u d g e t , t h e f o l l o w i n g a m o u n t s o f m o ney s a l a r i e s a n d w a g es, $ 8 3 0 ,0 0 0 ; m a in te n a n c e a n d
o p e r a t i o n , $ 2 0 0 ,0 0 0 ; a n d $ 3 ,0 0 0 f o r c a p i t a l t o t a l w as $ 1 ,0 3 3 ,0 0 0 .
o u tla y *
T he
The s a l a r i e s a n d w ages p r o v i d e d f o r a
s t a f f i n g o f 323 e m p lo y e e s. B ureau o f A d o p tio n s * A d o p tio n s i s tio n s ;
e x a m i n e , a n d m ake r e p o r t s u p o n
f o r a d o p tio n f i l e d
p e r i o r C o u rt.
B ureau o f
to p e rfo rm th e h o m e -fin d in g an d p la c e m e n t fu n c
and to i n v e s t i g a t e ,
p e titio n s
T he p u r p o s e o f t h e
i n t h e L o s A n g e l e s C o u n t y S u
The B u re a u a l s o h a s t h e f u n c t i o n s to a c t a s a
p la c e m e n t agency i n th e p la c e m e n t o f c h il d r e n f o r a d o p tio n , t o a c c e p t r e lin q u is h m e n ts f o r a d o p tio n s , an d to p e rfo rm such o th e r ta s k s i n c o n n e c tio n w ith a d o p tio n a s th e S ta te D e p a rt m e n t o f S o c i a l W e lf a r e deem s n e c e s s a r y . B u d g e ta ry a llo w a n c e s f o r th e f i s c a l y e a r 194 9 -5 0 w e re : s a l a r i e s a n d w ages, $ 1 6 0 ,0 0 0 ; m a in te n a n c e a n d o p e r a t i o n , $ 1 8 4 ,0 0 0 ; a n d c a p i t a l o u t l a y , $ 8 ,0 0 0 .
T o ta l a p p ro p ria tio n s
f o r t h e y e a r w ere $ 3 5 2 ,0 0 0 .
57 e m p l o y e e s i n t h e
T h ere a r e
B u r e a u o f A d o p t i o n s , m ad e u p o f s o c i a l w o r k e r s a n d c l e r i c a l sta ff* B ureau o f P h y s i c a l l y H and!capped C h ild r e n * o f P h y s i c a l l y H a n d ica p p ed C h ild r e n i s
The B u re a u
j u s t now b e i n g e s t a b -
69 lis h e d .
The C a l i f o r n i a H e a l t h a n d S a f e t y Code
t h a t c o u n t i e s may g i v e s e r v i c e s
AT*
p ro v id e s
to h a n d ic a p p e d c h i l d r e n ,
when t h e p a r e n t o r g u a r d i a n g i v e s h i s c o n s e n t i n w r i t i n g . T h ro u g h th e S t a t e D e p artm en t o f P u b lic H e a l t h , L os A n g e le s C o u n ty w i l l
re c e iv e g r a n ts - in - a id to
h e lp i n
th e fin a n c in g
o f t h i s p ro g ram . T h is c h a p te r h as p r e s e n te d a re v ie w o f th e s t r u c t u r e and a d m in is tra tiv e a c t i v i t i e s U n d e rsta n d in g t h i s ,
o f t h e D e p a rtm e n t o f C h a r i t i e s .
we s h a l l now e x a m i n e p o l i t i c a l r e m i f i c a -
tio n s in th e a d m in istra tio n
of p u b lic w e lfa re , in c lu d in g r e
la te d to p ic s.
S ta te o f C a li f o r n ia , H e a lth and S a fe ty C ode. S ec. 268.
CHAPTER IV THE PO LIT IC S OF PUBLIC WELFARE I.
PUBLIC WELFARE INTEREST GROUPS
T h ro u g h o u t th e U n ite d S t a t e s - - i n in s ta te
c a p i t a l s and i n
th e n a tio n * a c a p i t a l ,
l o c a l j u r i s d i c t i o n s — some i n t e r e s t
g ro u p s a r e w o rk in g f o r , w h ile o t h e r s a r e f i g h t i n g a g a i n s t , d i f f e r e n t a n d m ore c o m p r e h e n s iv e p u b l i c w e l f a r e l a w s .
At
t h e sam e t i m e , m an y o t h e r o r g a n i z a t i o n s h a v e a s i g n i f i c a n t i n f l u e n c e on p u b l i c w e l f a r e d e v e lo p m e n ts . Y o r k * s PM^ s h o c k e d t h e n a t i o n w i t h i t s
Two y e a r s a g o New
expose e n t i t l e d
"T he
Shame o f t h e S t a t e s " w h i c h t o l d o f t h e u n b e l i e v a b l e o v e r 2 c ro w d in g a n d n e g l e c t i n s t a t e h o s p i t a l s . E x te n siv e "sh ak eu p s" o c c u rre d th ro u g h o u t th e c o u n try a s a r e s u l t . N ew spap ers, a l s o ,
have h e lp e d th e c a u se o f sound p u b l i c
a s s is ta n c e a d m in istra tio n . C a lifo rn ia
in
n ew sp ap ers I n n o to rio u s
T h is was w e l l e x e m p l i f i e d i n
1 9 4 9 b y t h e u n t i r i n g w o rk d o n e b y a l m o s t a l l th e s t a t e ,
w h ic h p r e c i p i t a t e d
th e o u s te r of th e
" M c L a in M a c h i n e . "
G roups o f l a y c i t i z e n s h a v e h a d a v i t a l r o l e
i n im -
^ Now t h e New Y o r k S t a r . ^ A l b e r t D e u t s c h , T he Shame o f t h e S t a t e s H a r c o u r t , B r a c e a n d C o m p an y , 1 9 4 8 ) , 1 8 8 p p *
{New Y o r k s
71 p ro v in g p u b lic
w e lfa re .
serv ed as a tte n d a n ts p o ss ib le
to h ire
3
D u rin g
i n m e n ta l h o s p i t a l s
tra in e d p e rso n n e l.
a t c o n d itio n s in th e s e h o s p ita ls in
W o r l d W ar I I a g r o u p o f men w hen i t
was n o t
T h i s g r o u p w a s so s h o c k e d
t h a t th e y w ere i n s t r u m e n t a l
fo rm in g t h e N a t io n a l M e n tal H e a lth F o u n d a tio n , a n o n
p r o f i t o rg a n iz a tio n o f c itiz e n s .
T he F o u n d a t i o n h a s h a d a
p ro fo u n d e f f e c t i n im p ro v in g h o s p i t a l p r a c t i c e s and e d u c a tin g 4 th e p u b lic . P r o f e s s i o n a l o r g a n i z a t i o n s h a v e d o n e m u ch t o r a i s e sta n d a rd s:
in th e h o s p ita l f i e l d ,
t h e A m e ric an H o s p i t a l
A s s o c i a t i o n , th e A m e ric an C o lle g e o f H o s p i t a l A d m i n i s t r a t o r s a n d th e A m erican M e d ic a l A s s o c i a t i o n ; i n fie ld , to
th e p u b lic a s s is ta n c e
t h e A m e ric an P u b l i c W e lf a r e A s s o c i a t i o n .
th e se h o s p ita l and p u b lic
dozens o f o th e r a c tiv e
In a d d itio n
a s s is ta n c e g ro u p s, th e re a re
o r g a n i z a t i o n s th ro u g h o u t th e
L earn ed s o c i e t ie s In th e
s o c ia l sc ie n c e s,
c o u n try .
such a s th e
R u s s e l l S a g e F o u n d a t i o n , t h e C o m m o n w ea lth F u n d a n d t h e B ro o k in g s I n s t i t u t i o n
and,
lo c a lly ,
t h e H aynes F o u n d a tio n ,
® News i t e m i n t h e L o s A n g e l e s T i m e s , M a r c h 2 7 , 1 9 5 0 . R e c e n t l y a c i t i z e n s 1 g r o u p c a l l e d t h e uS t a t e C o m m i t t e e on A d o p t i o n s ” w as f o r m e d , w i t h t h e a i m o f i m p r o v i n g a n d e x t e n d in g a d o p tio n and r e l a t e d s e r v ic e s i n C a lif o r n ia . 4 M a ry S w a in R o u t z a h n , " P u b l i c R e l a t i o n s i n S o c i a l W o r k , 11 ( M a r g a r e t B. H o d g e s , e d i t o r , S o c i a l W ork Y e a r B o o k . 1 9 4 9 , New Y o r k : R u s s e l l Sage F o u n d a tio n , 1 9 4 9 ), p . 3 9 8 . ® F o r e x a m p l e , L e w i s M e r ia m , R e l i e f a n d S o c i a l S e c u r i t y (W a sh in g to n , D .C .: The B r o o k in g s I n s t i t u t i o n , 1 9 4 6 ) , 912 p p .
72 h a v e m ade f u n d a m e n ta l c o n t r i b u t i o n s
to
th e
stu d y of p u b lic
w e lfa re * A lo n g w ith t h e
a b o v e g ro u p s w h ic h , g e n e r a l l y , a r e
p r e s s i n g f o r e x te n d e d p u b l i c w e l f a r e p ro g ra m s o r m ak in g n e u tr a l o b je c tiv e a n a ly se s, t i o n s w h ic h p r i m a r i l y
th e re are
o th e r i n te r e s t a s s o c ia -
"keep t h e i r eye on th e p u b l i c p u r s e * "
Such o r g a n i z a t i o n s h e lp
to d e v e lo p
p u b lic w e lfa re l e g i s l a t i o n .
th e d e m o c ra tic b a la n c e in
T he r e s u l t i s b r o u g h t a b o u t b y
t h e sa m e a g e - o l d j o c k e y i n g t h a t P r o f e s s o r P f i f f n e r p o i n t e d t o w h en h e s a i d t h a t m any c i t i z e n s ,
a s w e ll a s p re s s u re
g r o u p s , c r y o u t a g a i n s t e x p a n s io n o f g o v e rn m e n ta l a c t i v i t i e s ; y e t w hen t h e e n l a r g e m e n t o f a p a r t i c u l a r agency i s sc rib e
to th e b e n e f it of a g ro u p , i t
a d m in istra tiv e "w ill h e a r tily
t o t h e m o v e m e n t* " G o v e rn m e n tal a d m i n i s t r a t i v e a g e n c i e s a t a l l
a
sub-
p ro fo u n d a f f e c t on p u b lic w e lfa re p ro g ram s.
le v e ls have
L e g isla tiv e
e n a c tm e n ts m u st, o r s h o u ld , o u t l i n e i n g e n e r a l te rm s th e p u rp o s e and sco p e o f th e a c t , l e a v i n g d e t a i l s tio n to th e o p e ra tin g u n i t s . d ire c to r sa id th a t
".
of a d m in istra
An o u t s t a n d i n g p u b l i c w e l f a r e
• * i n a dem ocracy a p u b lic a d m i n i s t r a
t o r m ust have a w e ll-d e v e lo p e d s e n s e o f p u b lic r e l a t i o n s
T h e s e i n c l u d e , C h a m b e r s o f C o m m e rce , t a x p a y e r s * g ro u p s and c e r t a i n n ew sp ap ers and p e r i o d i c a ls * 7 J o h n M. P f L f f n e r , P u b l i c A d m i n i s t r a t i o n ( r e v i s e d e d i t i o n ; New Y o r k : T h e R o n a l d P r e s s C o m p an y , 1 9 4 6 ) , p . 5 5 6 .
73 w h ich, e n a b l e s h im n o t o n l y t o i n t e r p r e t h i s p r o g r a m b u t t o k e e p a b r e a s t o f t h e s o c i a l a n d e c o n o m ic c h a n g e s a b o u t h i m . " T h is p r e s e n t c h a p te r e x p lo re s th e r e l a t i o n
8
of th e
D e p a rtm e n t o f C h a r i t i e s a n d t h e C o u n ty o f Los A n g e le s w ith i n t e r e s t g ro u p s o f a l l ty p e s - -g o v e r n m e n ta l and n o n -g o v e rn m e n t a l*
An a t t e m p t i s m ad e t o p r e s e n t t h e e x t r a - d e p a r t m e n t a l
r a m ific a tio n s o f a d m in is te rin g a la rg e p u b lic II.
w e lfa re agency*
RELATION OF THE DEPARTMENT OF CHARITIES WITH GOVERNMENTAL GROUPS
N a tio n a l a g e n c ie s *
P ra c tic a lly
th e o n ly n a tio n a l
a g e n c y w i t h w h i c h t h e D e p a r t m e n t o f C h a r i t i e s now h a s r e l a tio n s i s
th e F e d e ra l S e c u r ity A gency.
T h is f e d e r a l o f f i c e
d i r e c t s w ork o f t h e n a t i o n a l g o v e rn m e n t w i t h r e s p e c t t o p u b lic a s s is ta n c e , p u b lic h o s p ita ls and c h ild w e lfa re s e r9 v ic e s. D u r i n g W o r l d W ar I I t h e S u p e r i n t e n d e n t o f C h a r i t i e s w o r k e d w i t h m an y t e m p o r a r y a n d p e r m a n e n t n a t i o n a l a g e n c i e s i n o rd e r to p ro v id e h o s p ita l f a c i l i t i e s and in te rn e d Jap an ese, to
f o r d e fe n se w o rk ers
o p e ra te a c e n te r f o r tre a tm e n t of
8 F r e d K. H o e h l e r , " I n t r o d u c t i o n , 11 ( M a r i e t t a S t e v e n s o n , e d i t o r , P u b l i c W e l f a r e A d m i n i s t r a t i o n * New Y o r k s The Mac m i l l a n C o m p an y , 1 9 3 8 ) , p . x* Q
News I t e m I n t h e L o s A n g e l e s T i m e s . M a rc h 1 9 , 1 9 5 0 * D u rin g t h e 1949 f i s c a l y e a r , m a jo r g r a n t s - i n - a i d to C a l i f o r n i a th r o u g h t h e F e d e r a l S e c u r i t y A gency w e re : o ld age a s s i s t a n c e ( l a r g e s t i n th e n a t i o n ) , $ 7 2 ,3 8 7 ,0 0 0 ; a i d to d e p e n d e n t c h i l d r e n ( s e v e n t h ) , $ 8 ,2 1 0 ,0 0 0 ; and a i d to th e b l i n d ( l a r g e s t ) , $ 2 ,9 5 5 ,0 0 0 .
74 s o c i a l d i s e a s e s , and to a i d d e s t i t u t e
se rv ic e m e n an d t h e i r
fa m ilie s*
Many a c u t e p r o b l e m s a r o s e w i t h som e o f t h e s e
p ro g ram s.
I t was o n ly t h r o u g h e f f e c t i v e p u b l i c
and m e e tin g s w ith f e d e r a l o f f i c i a l s
la rg e r
re la tio n s
i n W a s h i n g t o n , D» C* o r
i n f i e l d b ra n c h e s t h a t th e S u p e rin te n d e n t of C h a r it i e s , th ro u g h h is p e rs o n a l to
reach a
c o n t a c t s a n d a g g r e s s i v e n e s s , w as a b l e
so lu tio n .
More r e c e n t l y , o f C h a ritie s
th e E x e c u tiv e A s s i s t a n t S u p e rin te n d e n t
s p e n t a w e ek i n W a s h i n g t o n , D . G. c o n f e r r i n g
w ith F e d e r a l S e c u r i t y A gency o f f i c e r s , tiv e s o f la rg e p u b lic and p r iv a te
and w ith r e p r e s e n ta
m ed iG a l a n d a s s i s t a n c e
a g e n c ie s th ro u g h o u t th e U n ite d S ta te s * T h is e n a b le d th e E x e c u tiv e A s s i s t a n t to p r e s e n t a firs t-h a n d p ic tu re
o f th e o p e ra tio n o f p u b lic w e lfa re program s
i n Los A n g e le s C o u n ty to th e f e d e r a l r e p r e s e n t a t i v e s . a ls o
e n a b l e d h im t o
s e c u r e ^ I n f o r m a t i o n fro m o t h e r o p e r a t i n g
o f f i c i a l s w h ic h c o u ld be u t i l i z e d p o lic ie s
It
i n th e d e v elo p m e n t o f
I n th e l o c a l agency*
S ta te of C a lifo rn ia :
T h e G o v e r n o r 1s O f f i c e .
th e S u p e rin te n d e n t o f C h a r itie s
is
B ecause
ch arg ed w ith a d m in is te r
in g p u b l i c w e lf a r e i n a c o u n ty c o n ta in in g n e a r l y h a l f o f th e s t a t e ’s i n h a b ita n ts , he i s
f r e q u e n t l y c a l l e d o n b y t h e Gov
e r n o r ’ s O ffic e to o f f e r c o u n s e l on v a r io u s m a t t e r s .
One o f
t h e S u p e r i n t e n d e n t ’ s m o st r e c e n t a s s i g n m e n t s was a r e q u e s t fro m t h e G o v e rn o r t o
re c o m m e n d a n i n d i v i d u a l a s t h e new
75 D ir e c to r o f th e
S t a t e D e p a rtm e n t o f S o c i a l W e l f a r e , w h ic h
b r o u g h t a b o u t t h e a p p o i n t m e n t o f M r. C h a r l e s I , S ta te o f C a lif o r n ia :
L e g isla tu re .
g o v e rn m e n ta l p u b l i c w e lf a r e b u d g e ts a r e of annual a p p ro p ria tio n s, S u p e rv iso rs r e a l i z e s r e p re s e n te d d u rin g som e y e a r s n o w ,
B ecause l o c a l
such a
le g isla tiv e
sh o u ld be a b ly
se s s io n s .
s p r i n g o f 1950 d u r i n g th e
s e s s io n , th e S u p e rin te n d e n t, o ffic ia ls,
T hus, fo r
th e S u p e rin te n d e n t o f C h a r i t i e s h as been
a c t i v e i n S a c ra m en to d u r i n g a g r e a t p a r t o f a l l In th e
la rg e p e rc e n ta g e
t h e Los A n g e le s C o u n ty B oard o f
t h a t C o u n ty i n t e r e s t s
s ta te
S c h o t t l a n d . 10
s e s s io n s .
le g is la tu r e ’s f i r s t
"b u d g et* 1
t o g e t h e r w ith o t h e r C o u n ty
sp e n t s i x w eeks o f f e r i n g
te c h n ic a l p u b lic w e lfa re
c o u n s e l a n d , a c t i n g f o r th e B oard o f S u p e r v i s o r s , p r e s s i n g f o r b u d g e ta r y e n a c tm e n ts t h a t w o u ld b e n e f i t t h e t a x p a y e r s o f Los A n g e le s C o u n ty .
c i t i z e n s and
T he S u p e r i n t e n d e n t b e l i e v e s
t h a t b e ca u se o f h i s w e lf a r e e x p e r ie n c e he can b e n e f i t th e c o m m u n ity a n d t h e
s t a t e a n d t h a t he s h o u ld t a k e a n a c t i v e
p a r t in fo rm u la tin g p u b lic w e lfa re l e g i s l a t i o n . c o n tra ry to
th e
T h is i s
v i e w s o f t h e n ew D i r e c t o r o f t h e S t a t e
D e p a rtm e n t o f S o c i a l W e lfa re who, on a num ber o f o c c a s i o n s , has s a id :
”1 w o n ’t b e d o in g a n y p o lic y - m a k in g .
My j o b w i l l b e
t o a d m i n i s t e r th e d e p a rtm e n t i n a c c o r d a n c e w i t h t h e la w s o f t h e
^ M r. S c h o t t l a n d i s a n a c t i v e m em ber o f t h e A d o p tio n C o m m itte e f o r t h e D e p a r tm e n t o f C h a r i t i e s .
c itiz e n s 1
76 L e g isla tu re * "^ *
The D i r e c t o r w i l l no d o u b t b e c a l l e d by t h e
l e g i s l a t u r e f o r a d v i c e on p u b l i c w e l f a r e m a t t e r s , b u t h e i s n o t g o i n g t o t h a t b o d y o n h i s own a c c o r d t o h e l p f o r m u l a t e l a w s , a s d o e s t h e Los A n g e le s C o u n ty S u p e r i n t e n d e n t o f C h a ritie s* One o f t h e p r i m a r y o b j e c t i v e s f o u g h t f o r b y t h e S u p e r in te n d e n t d u rin g th e 1950 l e g i s l a t i v e o f th e re lie f*
" re la tiv e
s e s s i o n w as a b o l i s h m e n t
r e s p o n s i b i l i t y " c la u s e in r e g a r d to a g e d
He f e l t t h a t f r o m a c o u n t y t a x p a y e r s 1 p o i n t o f v i e w
and a s a m oral I s s u e , r e l a t i v e s , and p a r t i c u l a r l y
12
c h ild re n ,
o f an a g ed p e rs o n sh o u ld h e lp s u p p o rt th e r e l i e f a p p li c a n t , 13 I f th e r e l a t i v e s a r e a b le * One n e w s p a p e r c o m m e n te d : "A rth u r W ill, (S a c ra m e n to )
su p e rin te n d e n t of c h a r i ti e s to
• • • i s up h e re
h o ld th e f o r t a g a i n s t s l a s h in g o u t th e
tiv e s re s p o n sib ility
c la u se
• * .
.
re la
A rth u r w ill f in d o u t
11 News i t e m I n t h e L o s A n g e l e s T i m e s , F e b r u a r y 2 2 , 1950. News i t e m i n t h e L o s A n g e l e s T i m e s , M a rc h 1 1 , 1 9 5 0 . T he L o s A n g e l e s C o u n t y S u p e r i n t e n d e n t o f C h a r i t i e s e x p r e s s e d t h e o p i n i o n t h a t w e l f a r e c o s t s I n C a l i f o r n i a w o u ld b e I n c r e a s e d b y 58 m i l l i o n d o l l a r s a n n u a l l y i f t h e r e l a t i v e r e s p o n s i b i l i t y c l a u s e w a s a b a n d o n e d . A f i g u r e o f b u t 35 m i l l i o n s w a s e s t i m a t e d b y t h e W ey b ret C a l i f o r n i a S e n a te c o m m itte e * 13 News i t e m i n t h e L o s A n g e l e s T i m e s , M a r c h 1 0 , 1 9 5 0 . O th e r i n f l u e n t i a l g ro u p s h ad s i m i l a r v ie w s. One w as e x p r e s s e d b y t h e R t . R e v . M s g r . T h om as J . 0 fD w yer o f t h e C a t h o l i c C h urch a n d d i r e c t o r o f th e d e p a rtm e n t o f h e a l t h a n d h o s p i t a l s o f th e A rc h d io c e s e s o f Los A n g e le s. A c o rre sp o n d in g s ta te m e n t w as m ad e i n a n e d i t o r i a l i n t h e L o s A n g e l e s T i m e s . A p r i l 1 , 1950.
77 th is
i s a v ery p o l i t i c a l p i c n i c . ”
v o te d to a b o l i s h
th e r e l a t i v e s
th e -S ta te S e n a te r e t a i n e d i t In th is
14
T he S t a t e A s s e m b l y
re s p o n sib ility
in a s lig h tly
c la u s e , b u t
l i b e r a l i z e d fo rm .
r e g a r d J o h n M. P f i f f n e r h a s sh o w n t h a t a d m i n
i s t r a t i v e a g e n c ie s ,
such a s t h e B o a rd s o f S u p e r v i s o r s a n d t h e
D e p artm e n ts o f C h a r i t i e s ,
have s u f f i c i e n t num ber and e n e rg y
to p la y d e c is iv e - r o le s in
c e rta in p ressu re
situ a tio n s.
f u r t h e r i n d i c a t e d t h a t m any a l a r m i s t s f e a r t h e s in g le b u re a u c ra tic v a rie ty
and f u n c tio n s in v o lv e d i n th e p u b lic
u n lik e ly th a t th e re is
d e v e lo p m e n t o f a p u b l i c
sm a ll o n e s ,
r e a l d a n g er of th e
c o u n te rp a rt o f i n d u s t r i a l u n io n is m .”
T h is l a s t s t a t e m e n t seem s t o b e t r u e , fig h t
c o m in g o f a
s u p e r - l o b b y some d a y , b u t t h a t ” t h e
of ju ris d ic tio n s
s e r v i c e m akes i t
He
fo r la rg e
c o u n tie s
a n d r u r a l c o u n t i e s o p p o s e t h o s e w h ic h a r e
e s s e n tia lly u rb an .
I n a s i m i l a r way, one o f t h e p r im a r y
d i f f i c u l t i e s w ith th e U n ite d N a tio n s to d a y i s t h e c o n f l i c t b e tw e e n c o u n t r i e s o f d i f f e r e n t s i z e s an d t y p e s . S ta te o f C a lif o r n ia :
S ta te a g e n c ie s.
The t h r e e m ain
C a l i f o r n i a a g e n c i e s w i t h w h ic h t h e D e p a rtm e n t o f C h a r i t i e s w orks a r e
th e S t a t e D e p artm e n ts o f S o c ia l W e lfa re , P u b lic
H e a l t h an d M e n tal H y g ie n e .
14
News I t e m i n
T hro ug h c lo s e
t h e L o s A n g e l e s D a i l y N e w s. M a rch 7 ,
1950. P fiffn e r,
c o o p e ra tio n w ith
op> c i t . . p . 5 4 9 .
15
78 th e se
sta te
o r g a n i z a t i o n s a n d b y u n d e r s t a n d i n g t h e i r a im s
and o b je c tiv e s , re la tio n s. c e rta in
th e D e p a rtm e n t o f C h a r i t i e s h a s h a d e x c e l l e n t
F o llo w in g p e r i o d i c
changes o r a d d itio n s
i n s p e c t i o n s by s t a t e
to f a c i l i t i e s
a g e n c ie s,
or se rv ic e s have
b e e n m ad e a s re c o m m e n d e d * C o u n ty o f Los A n g e l e s ; p u b lic w e lfa re
B oard o f S u p e r v i s o r s *
B ecause
i s by f a r th e l a r g e s t e :x p e n d itu re i n c o u n ty
g o v e rn m e n t, an d b e c a u s e c h a r i t y h a s a lw a y s b e e n a " h o t ” issu e ,
t h e r e m ust be a n d i s a s u p e r i o r w o rk in g r e l a t i o n s h i p
b e tw e e n th e B o ard o f S u p e r v i s o r s an d th e D e p a rtm e n t o f C h a ritie s.
The B o a r d h a s t o h a v e c o m p l e t e c o n f i d e n c e i n
a d m in istra tiv e a b il i ty The S u p e r i n t e n d e n t ,
th e
o f th e S u p e rin te n d e n t o f C h a r it i e s .
o f n e c e s s i t y , m ust h av e a g r e a t d e a l o f
in f lu e n c e w ith th e B oard.
It
is
e s s e n t i a l t h a t he b e a
m a s t e r o f h u m an r e l a t i o n s i n o r d e r t o know w h e n c e r t a i n m a t t e r s can b e b ro u g h t b e fo re th e
B oard a t
t h e i r w e e k ly m e e tin g s .
S h o u ld t h e m em bers, g e n e r a l l y , b e i n a n u n r e c e p t i v e m ood, t h e S u p e r i n te n d e n t m ust
sense t h i s ,
d e fe rrin g a l l b u t u rg en t
b u s in e s s u n t i l a su b seq u e n t m e e tin g . W ith r e g a r d t o p u b lic ,
if
th e B oard a d o p ts a r e s o l u t i o n f a v o r i n g o r o p p o s in g
a p a r tic u la r m a tte r, th e
sam e p o s i t i o n ,
v ie w s.
w e l f a r e i s s u e s w h ic h a r e b e f o r e th e
th e S u p e r in te n d e n t m ust l ik e w i s e a c c e p t
ev en th o u g h i t
R e c e n tly th e
m ay b e o p p o s i t e t o
h is
B oard e x p r e s s e d i t s e l f a s b e in g i n
o f a c o u n ty s a l e s t a x i n o r d e r to
h e lp f i n a n c e m o u n tin g
fav o r
79 r e l i e f c o sts*
16
The S u p e r in te n d e n t*
th e S ta te L e g is la tu r e
a c tin g fo r
th e B o ard a t
d u rin g th a t tim e , u rg e d t h a t
e n a b lin g
l e g i s l a t i o n be e n a c te d * C o u n ty o f Los A n g e l e s : to c a rry out a d m in is tra tiv e
o th e r d e p a rtm e n ts*
re s p o n sib ilitie s,
it
In o rd er is
n ecessary
t h a t th e S u p e rin te n d e n t of C h a r itie s m a in ta in s a t i s f a c t o r y r e l a t i o n s w i t h o t h e r L o s A n g e le s C o u n ty d e p a r t m e n t s . is p a rtic u la rly
tru e
of se rv ic e u n its ,
c h ie f a d m in is tra tiv e o f f ic e r , m e c h a n ic a l d e p a rtm e n t,
c iv il
T h is
su ch a s th e a u d i t o r ,
se rv ic e
c o m m issio n ,
and p u r c h a s in g a n d s t o r e s — a s w e ll a s
t h e h e a l t h d e p a r t m e n t o n m a t t e r s o f c o u n t y h e a l t h a n d com m u n ic a b le d i s e a s e .
F r e q u e n t c o n f e r e n c e s b e tw e e n th e S u p e r
in te n d e n t o f C h a r itie s and h e ad s o f th e s e d e p a rtm e n ts i s an im p o rta n t f a c t o r i n th e f o i m e r 's in stru m e n t o f th e
e ffe c tiv e n e s s as an
o f e f f i c i e n t m an a g em en t.
c h ie f a d m in is tra tiv e
o ffic e r,
a lm o s t a lw a y s s u p p o r te d b y t h e B o a rd .
E sp e c ia lly is f o r he i s ,
th is tru e
of n e c e ssity ,
T he c h i e f a d m i n i s t r a
t i v e o f f i c e r fs w id e r e s p o n s i b i l i t y a n d a u t h o r i t y
w as p r e
s c r i b e d b y t h e B o a r d w hen h e w a s g i v e n c h a r g e o v e r f,a l l p a rtm e n ts,
se rv ic e s,
in s titu tio n s ,
and d i s t r i c t s
de
o f th e
c o u n t y f o r whom o r f o r w h i c h t h e B o a r d o f S u p e r v i s o r s o f t h e C o u n ty i s
^
b y l a w r e q u i r e d t o a d o p t a n a n n u a l b u d g e t « • • * ,f
News i t e m
17
i n t h e L o s A n g e l e s T i m e s . M a rch 2 2 , 1950*
^ Los A n g e le s C o u n ty , B o a rd o f S u p e r v i s o r s , No* 3 1 7 5 (N . S . ) , s e c . 2 , p t . 1 .
O rd in an c e
80 It
is,
th e re fo re ,
o b v io u s t h a t
th e S u p e rin te n d e n t h o ld th e
c o n fid e n c e o f th e C h ie f A d m in is tra tiv e O ffic e r* C o u n ty o f Los A n g e le s : a g ran d ju ry i s g r e a tly a d m in istra to rs*
G rand J u r y *
In any ju r is d ic tio n
r e s p e c t e d a n d f e a r e d by p u b l i c
A h ig h c a l i b e r o f m anagem ent i s
S h o r t l y a f t e r W o r l d W ar I I
en co u rag ed *
t h e Los A n g e le s C o u n ty G ran d
J u r y i n v e s t i g a t e d t h e cro w d ed a n d u n d e s i r a b l e c o n d i t i o n s o f th e p s y c h o p a th ic u n i t a t th e G e n e ra l H o s p ita l* ho w ev er,
It
w as f o u n d ,
t h a t t h e S u p e r i n t e n d e n t o f C h a r i t i e s w as n o t g u i l t y
o f n e g lig e n c e ,
but th a t
th e s i t u a t i o n was m e r e ly a r e s u l t o f
a m u sh ro o m in g p o p u l a t i o n d u r i n g t h e w ar y e a r s *
As a r e s u l t ,
a b o n d i s s u e was s u b m i t t e d t o
t h e C o u n ty v o t e r s i n N ovem ber,
1948 on re c o m m e n d a tio n o f t h e
G rand Ju ry *
The i s s u e was
a p p r o v e d , a n d a l a r g e , m odern p s y c h o p a t h i c u n i t i s e r e c t e d a t th e
G en eral H o s p ita l*
how i n a d e q u a t e f a c i l i t i e s
now b e i n g
When t h e G r a n d J u r y sa w
w ere a t th e p s y c h o p a th ic u n i t ,
t h e S u p e r i n t e n d e n t o f C h a r i t i e s h e l p e d s t i r th e m t o t h e a c t i o n o f p r o p o s in g a bond i s s u e b ^ p o i n t i n g to p a rtic u la rly III.
th e n e c e s s i t y , an d
t h e u r g e n c y , f o r e r e c t i o n o f a new s t r u c t u r e * RELATION OF THE DEPARTMENT OF CHARITIES WITH NONGOVERNMENTAL GROUPS
N ew apapers and m ag a z in e s*
A d e c a d e ago
of C h a ritie s
o fte n in c u rre d th e i l l - f e e l i n g
t h e C o u n ty *
I t was fo u n d t h a t
th e D e p a rtm e n t
o f new spap ers in
th e p rim a ry re a s o n la y I n th e
81 f a c t th a t th e p re s s had d i f f ic u lt y in a c tiv itie s. w ard i n
If,
f o r e x a m p l e , a r e p o r t e r w as t o t e l e p h o n e a
th e G en eral H o s p ita l to
n e w s-w o rth y p a t i e n t , c o m p le te r e p l y .
le a r n in g o f d e p a rtm e n ta l
le a rn
th e
c o n d itio n of a
a busy n u rs e -m ig h t o f f e r a c u r t ,
in
The S u p e r i n t e n d e n t o f C h a r i t i e s h a s s i n c e
g iv e n a f o r m e r n ew spaperm an i n C h a r i t i e s A d m i n i s t r a t i o n th e c o l l a t e r a l d u ty o f a c t i n g a s an in f o r m a tio n c e n t e r f o r th e p re s s and r a d io .
T h is e m p lo y ee knows a l l n e w s p a p e r r e p o r t e r s
on th e g o v ern m en t
Mb e a t M a n d u n d e r s t a n d s t h e i r p r o b l e m s .
In
a d d i t i o n , t h e o p e r a t i n g u n i t s a r e n o t b o t h e r e d w i t h n u m ero u s i n q u i r i e s from th e v a r i o u s p a p e r s . re s u lte d fo r a l l
c o n c e r n e d .* * ^
P u b lic a tio n s a re , m e n ts a c tiv itie s was t h e
A m ic a b le r e l a t i o n s h a v e
of co u rse,
fro m tim e t o
tim e .
c r i t i c a l o f th e D e p a rt T he B u r e a u o f A d o p t i o n s
t a r g e t o f s tin g in g new spaper c r i t i c i s m
g iv in g d ay.
T he B u r e a u h a d r e m o v e d two b o y s f r o m f o s t e r
p a r e n t s w here th e c h i l d r e n h a d l i v e d s in c e b irth .
l a s t T hanks
sh o rtly a fte r
S e p a r a t i o n w as p r o p e r a c c o r d i n g to a d o p t i o n r u l e s
b e c a u s e t h e f o s t e r p a r e n t s w ere n e a r s i x t y y e a r s o f a g e . A lth o u g h th e th e b o y s,
18
s o c ia l w o rk ers w ere a c tin g
c o rre c tly
i n re m o v in g
t h e t i m i n g a n d p r e p a r a t i o n f o r r e m o v a l w as b a d .
The
A num ber o f a r t i c l e s v e r y f a v o r a b l e to th e D e p a r t m ent h ave a p p e a r e d i n a l l l o c a l n e w sp a p e rs d u r in g th e p a s t tw o y e a r s . S e e , f o r e x a m p l e , 11*M e d i c i n e f o r M i l l i o n s 1 G e n e ra l H o s p it a l M o tto ,” Lps A n g e le s M i r r o r , O c to b e r 6 , 1949.
S u p e r i n t e n d e n t o f C h a r i t i e s was h i g h l y e m b a r r a s s e d b y t h e p u b lic ity and s a id th a t h is
e m p lo y e e s h a d u s e d b ad ju d g m e n t
a n d t h a t he w o u ld p e r s o n a l l y I n v e s t i g a t e m a g a z in e l a t e r b r o u g h t m ore a t t e n t i o n
th e case*
A n a tio n a l
to th e in c id e n t,
by
t a k i n g o n ly one s e n t e n c e , a n d q u o tin g th e S u p e r in te n d e n t a s sa y in g :
“H i s a g e n t s h a d b e e n
's tu p i d l y
i n d i s c r e e t 1 t o w a lk
o f f w ith t h e c h i l d r e n on T h a n k s g iv in g e v e * ”^ a r t i c l e p o in te d to
T h is m ag a zin e
t h e i n c i d e n t a s b e i n g a n “e x t r e m e I n s t a n c e ,
a n d a s a n e x am p le o f t h e
g r o s s In c o m p e te n c e o f a d o p ti o n
agency a d m in istra to rs* E r r o r s i n ju d g m en t a r e c e r t a i n t o i n any p r i v a t e o r p u b lic agency*
occur o c c a sio n a lly
E ven a s i n g l e e r r o r o r
u n i n t e l l i g e n t a c t by a s u b o rd in a te can b r in g a g r e a t d e a l o f em b arrassm ent to th e a d m i n i s t r a t iv e s t a f f * T ax p ay ersy g ro u p s*
One o f t h e m o s t o u t s p o k e n a n d
e ffe c tiv e c r itic s
o f p u b lic w e lfa re a c t i v i t i e s
tax p ay ers*
20
groups*
a re th e v a rio u s
T hese l o c a l o r g a n iz a tio n s , su ch a s th e
C a l i f o r n i a T a x p a y e r s * A s s o c i a t i o n a n d t h e P r o p e r t y O w ners* A s s o c i a t i o n , a r e w e ll-k n o w n t o t h e D e p a rtm e n t, a n d I n f o r m a t io n
^ A l b e r t %* Mai s e l l , “ Why You C a n ' t A d o p t a Baby,** Woman1s Home C o m p a n i o n , 7 7 : 3 1 , M a r c h , 1 9 5 0 * ^ News I t e m i n t h e L o s A n g e l e s T i m e s , May 2 6 , 19 4 7 * As a n e x a m p l e , t h e S o u t h e r n . C a l i f o r n i a T a x C o m m i t t e e o f t h e C a l i f o r n i a C h a m b e r o f C om m erce v o i c e d o p p o s i t i o n t o t h e “M c L a in P l a n , " w h i c h w a s l a t e r a d o p t e d a n d t h e n r e p e a l e d *
83 is
r e a d i l y m ade a v a i l a b l e
t o them *
R e l a t i o n s b e tw e e n t h e s e
a s s o c i a t i o n s a n d th e D e p a rtm e n t o f C h a r i t i e s a r e on a h ig h p la n e ;
f o r ta x p a y e rs *
p u b lic a s s is ta n c e and, a id *
o p p o sitio n u s u a lly l i e s
w ith e x te n d e d
to a sm a lle r d e g re e , p u b lic h o s p ita l
B ecause n i n e t y p e r c e n t o f p u b lic a s s i s t a n c e
n o n -a d m in is tra tiv e ta x p a y e rs *
and d e te rm in e d by th e s i z e
c o sts a re
of r e l i e f checks,
g r o u p s a r e m ore c o n c e rn e d w ith l e g i s l a t i v e
b o d ie s
w h e r e t h e v o lu m e a n d r a n g e o f s u c h g r a n t s a r e d e t e r m i n e d * The S u p e r i n t e n d e n t t r i e s a lw a y s t o t h i n k o f t h e t a x p a y e r on one hand a n d th e w e l f a r e r e c i p i e n t on th e o th e r* reaso n ,
For th is
s o c i a l w o r k e r s m ay f e e l t h e S u p e r i n t e n d e n t d o e s n o t
u n d e r s t a n d hum an s u f f e r i n g a n d n e e d , a n d t a x p a y e r s * b e lie v e he does n o t have th e ta x p a y e rs* P ro fe ss io n a l g ro u p s*
groups
i n t e r e s t s a t h e a rt*
Of t h e d o z e n s o f p r o f e s s i o n a l
o r g a n i z a t i o n s w ith w h ic h th e D e p a rtm e n t h a s r e l a t i o n s ,
fo u r
m ain o n e s a r e
S ta te
S u p e rv iso rs*
c o n s id e r e d b e lo w . A s s o c ia tio n i s
F irst,
th e C a lifo rn ia
a c tiv e in fo s te rin g w e lfa re
l e g i s l a t i o n w h ic h w i l l be a d v a n t a g e o u s t o c o u n t i e s *
21
H eads
o f th e D e p a rtm e n t o f C h a r i t i e s b u re a u s a n d h o s p i t a l s a r e o fte n c a lle d upon to a d v is e
c o m m itte e s o f th e A s s o c ia tio n *
The B u reau o f P u b l i c A s s i s t a n c e d u r in g t h e
21
l a s t y e ar has
An e d i t o r i a l i n t h e L o s A n g e l e s T i m e s * A p r i l 4 , 1950, r e f e r r e d to th e A s s o c ia tio n a s "an a l e r t , p o w e rfu l and p o l i t i c a l l y m i n d e d a g g r e g a t i o n o f p u b l i c o f f i c i a l s who a r e i n d u s t r i o u s i n l o o k i n g a f t e r t h e i r own a f f a i r s . 1*
84 f u r n i s h e d m u ch i n f o r m a t i o n a n d h e l p p u b lic a s s is ta n c e S e c o n d ly ,
law s i n
in re g a rd to th e
ch an g in g
th e s ta te *
th e e x e c u tiv e s t a f f has fre q u e n t d e a lin g s
w ith l a b o r u n io n s*
T hese g ro u p s a r e p a r t i c u l a r l y a c t i v e
i n h o s p i t a l s w i t h m e m b e rs o f t h e t r a d e s a n d w i t h e m p l o y e e s on lo w wage s c a l e s . fa irly
In a d d itio n ,
s tro n g u n io n s u p p o r te r s .
s o c i a l c a se w o rk ers a r e Some u n i o n a c t i v i t i e s a r e
w ith r e g a r d t o w o rk in g c o n d i t i o n s o f e m p lo y e e s. tia tio n s ,
h o w ev er, have b een c o n c e rn e d w ith jo b c l a s s i f i c a
tio n s and pay s c a l e s . annual sa la ry
B ecause w ages a r e d e te rm in e d by an
s u r v e y w h ich r e s u l t s
i n c o u n ty e m p lo y ee s b e i n g
p a i d a n am ount c o m p a ra b le t o p r i v a t e little
M ost n e g o
e n te rp ris e , th e re
t h e S u p e r i n t e n d e n t c a n do i n e f f e c t i n g
w age r a t e s .
He h a s h e l p e d t o r a i s e
ch a n g in g c l a s s i f i c a t i o n s
is
changes in
s t a n d a r d s , h o w e v er, by
o f c e r t a i n g ro u p s o f e m p lo y ees a n d
d e m a n d i n g m o re s k i l l e d p e r s o n n e l , w i t h t h e r e s u l t
th a t
s a l a r i e s h a v e b e e n i n c r e a s e d , c o m m en su rate w i t h h i g h e r q u a lific a ti ons• T h ird , th e E x e c u tiv e A s s is ta n t S u p e rin te n d e n t o f C h a r itie s , w ith lin e
re s p o n sib ility
B ureau o f P u b l i c A s s i s t a n c e , i s
f o r o p e ra tio n o f th e
a c t i v e w i t h t h e A m erican
P u b lic W e lfa re A s s o c ia tio n and r e l a t e d g ro u p s . tio n s ,
a l o n g w i t h s c h o o l s o f s o c i a l w o rk a t
v e rs itie s , w o rk ers.
have p re s s e d f o r p r o f e s s io n a l
T hese a s s o c ia
th e v a rio u s u n i
sta n d in g of s o c ia l
S e v e r a l y e a r s ag o t h e s e g ro u p s w ere i n s t r u m e n t a l
85 in p e rsu a d in g
th e C a lif o r n ia L e g is la tu r e to
p ro v id in g f o r th e r e g i s t r a t i o n have been r e g is te r e d
of s o c ia l w o rk ers, as n u rse s
f o r m an y y e a r s •
a p la n o f su p e rv isio n , and r e g is te r e d annual fee
of fiv e d o lla r s .
e n a c t a la w
T he S t a t e
e sta b lis h e d
s o c ia l w orkers pay an
When t h e l a w w as p a s s e d , h i g h
s t a n d a r d s w e r e s e t u p , r e q u i r i n g c o l l e g e g r a d u a t i o n a n d tw o y e a r s o f g r a d u a t e w ork t o becom e a r e g i s t e r e d s o c i a l w o rk e r* U n i v e r s i t i e s o f f e r d e t a i l e d c o u rs e s i n s o c i a l c a s e w ork, a l l o f w h ic h i s
e x c e lle n t fo r p riv a te
s o c i a l w o rk a g e n c i e s .
In
Los A n g e le s C o u n ty , h o w e v er, a l l b u t a s m a ll p e r c e n ta g e o f r e lie f cases a re
th e r e s p o n s i b i l i t y o f th e B ureau o f P u b lic
A s s is ta n c e , and th e m a jo rity o f th e s e c a se s r e q u ir e l i t t l e
or
no s o c i a l c a s e w o rk , b u t r a t h e r a d e t e r m i n a t i o n o f e l i g i b i l i t y - m a in ly a c l e r i c a l o p e r a tio n .
T h is p o i n t w as b r o u g h t o u t a t
a n a t i o n a l m e e tin g o f t h e A m e ric an P u b l i c W e lf a r e A s s o c i a t i o n when i t
was s t a t e d t h a t
“m o s t o f t h e s o c i a l w o r k e r s c h o o l s
in u n iv e r s itie s and c o lle g e s a re n o t tu rn in g
out so c ia l
w o r k e r s e q u ip p e d t o go t o w ork I n p u b l i c w e l f a r e a g e n c i e s . ” B ecause th e B ureau o f P u b lic A s s i s t a n c e m e n ta l, n o t a p r i v a t e ,
is
a g o v ern
r e l i e f a g e n c y , m any f e e l t h a t t h e
p a y e r s h o u l d p a y f o r a m inim um o f s e r v i c e . s ta n d a rd s have b e en a d o p te d ,
ta x
Y et p r o f e s s io n a l
w h ic h h a v e b r o u g h t a b o u t h i g h e r
s a l a r i e s a n d m ore tim e b e in g s p e n t on “c a s e w o r k ,” w i t h th e
pp 1947 .
22
News i t e m i n t h e L o s A n g e l e s T i m e s . D e c e m b e r 6 ,
86
ta x p a y e r' c a rry in g th e in c re a s e d b u rd en .
In a p a n e l d isc u ssio n
a t t h e a n n u a l c o n f e r e n c e o f th e A m erican P u b lic W e lfa re A s so c ia tio n ,
o n e o f t h e w e l f a r e w o r k e r s m ade a p l e a f o r m o re
c a s e w ork t o d e t e r m i n e m ore a d e q u a t e l y t h e n e e d s o f r e l i e f c lie n ts.
M r. W i l l i a m A. B a r r , E x e c u t i v e A s s i s t a n t S u p e r i n
t e n d e n t o f C h a r i t i e s i n L os A n g e le s C o u n ty , r e t o r t e d , h o w ev er, by sa y in g :
f!L e t me s u g g e s t t h a t w h a t we h a d b e t t e r b e d o i n g
is
g iv in g a l i t t l e „23 p ay ers. n F o u rth , te re sts
is
m ore t h o u g h t t o t h e n e e d s o f t h e t a x -
one o f t h e S u p e r i n t e n d e n t ’ s m o st a c t i v e
in
t h a t o f th e A m e ric an H o s p i t a l A s s o c i a t i o n a n d i t s
re g io n a l and s ta te a f f i l i a t e s .
He h a s s e r v e d o n c o m m i t t e e s
w i t h t h e s e g r o u p s , a c t i v e l y d e v e l o p i n g new p u b l i c h o s p i t a l a d m in is tra tiv e p ro c e d u re s and p ro g ram s.
In th is
re g a rd he
i s a n a d v i s o r t o t h e I m p e r i a l C o u n ty G e n e ra l H o s p i t a l , r e g u la r ly c o n fe r r in g th e r e w ith o f f i c i a l s
i n im p ro v in g m ed i
c a l care a d m in istra tio n . T h e S u p e r i n t e n d e n t w as f o r m e r l y d i r e c t o r o f O l i v e V iew T u b e r c u l o s i s S a n a t o r i u m a n d h a s d o n e e x t e n s i v e w o rk w i t h n a tio n a l and lo c a l h o s p ita l o rg a n iz a tio n s in le s s e n in g to ll
th e
of th is d read d is e a s e . T h ere a r e
s c o re s of o th e r p r o f e s s io n a l w e lfa re gro u p s
w i t h w h i c h t h e S u p e r i n t e n d e n t h a s w o r k e d o r i s now t a k i n g a n
^
News i t e m i n t h e L o s A n g e l e s T i m e s . D e c e m b e r 7 ,
1947.
87 a c tiv e p a rt in
fo s te rin g p ro g re ssiv e ch an g es•
r e q u i r e m e n t o f h i s p o s i t i o n t h a t he f u l f i l l ro le ,
I t is
not a
such an a c tiv e
b u t h i s k n o w le d g e t h u s g a i n e d h a s m e a n t b e t t e r a d m in
istra tio n
f o r th e D e p a rtm e n t o f C h a r i t i e s a n d im m e a su ra b le
g o o d w i l l f o r Los A n g e le s C o u n ty . IV .
RELATION OF THE DEPARTMENT OF CHARITIES WITH ORGANIZED CITIZENS* GROUPS
C a lifo rn ia I n s titu te
of S o c ia l W e lfa re .
T hro u g h t h e
y e a rs C a lif o r n ia h as been p la g u e d w ith v a rio u s w e lfa re 24 schem es. T he C a l i f o r n i a I n s t i t u t e o f S o c i a l W e l f a r e , p r e se n t-d a y o rg a n iz a tio n o f th e
" M c L a in M a c h i n e ” a n d now a n a t i o n
w id e g r o u p , a d v o c a t e s p u b l i c a s s i s t a n c e p ro g ra m s w h ic h a r e fe lt
to b e e c o n o m ic a lly u n so u n d an d to o b u rd en so m e on th e
ta x p a y e r.
A lth o u g h th e
S u p e r i n te n d e n t a n d t h e B ureau o f
P u b l i c A s s i s t a n c e g e n e r a l l y do n o t o p e n ly f i g h t
24
such g ro u p s,
25
An i n i t i a t i v e t o l e g a l i z e g a m b l i n g i n C a l i f o r n i a w i l l a p p e a r o n t h e b a l l o t i n N o v e m b e r, 1 9 5 0 . One o f t h e p r i m a r y a r g u m e n t s i n f a v o r o f t h e p l a n i s t h a t v a s t sum s w i l l b e o b t a i n e d b y t h e s t a t e g o v e rn m e n t w i t h w h ic h t o p a y m o u n t in g r e l i e f c o s ts . P r o m o t e r o f t h e s c h e m e i s W i l l i s A l l e n who h a s d e v e lo p e d o t h e r p l a n s w h ich w ere n o t a c c e p t e d by t h e v o t e r s : ”$ 3 0 E v e r y T h u r s d a y , ” ”Ham * n f E g g s ” a n d " B i l l o f R i g h t s . ” 25 . News i t e m i n t h e L os A n g e l e s T i m e s . May 2 6 , 1 9 4 7 . B e f o r e t h e " M c L a in P l a n ” w a s a d o p t e d b y t h e v o t e r s a s A r t i c l e XXV o f t h e S t a t e C o n s t i t u t i o n (w h ic h was l a t e r r e p e a l e d b y A r t i c l e X X V II), A r t h u r J . W i l l , L os A n g e le s C o u n ty S u p e r i n t e n d e n t o f C h a r i t i e s , w a r n e d a t a x c o m m i t t e e o f t h e C a l i f o r n i a S t a t e Cham b e r o f Com merce t h a t " t h i s p r o p o s a l i s g o i n g t o r e p e a l a l l t h e s a f e g u a r d s we h a v e o n , o l d - a g e a s s i s t a n c e , " a n d u r g e d t h e S t a t e C h a m b e r t o ” do e v e r y t h i n g y o u c a n ” t o d e f e a t t h e m e a s u r e .
88
t h e y do o f f e r f a c t s p la n s.
t o n e w s p a p e r s a n d o t h e r s who o p p o s e s u c h
Im m e d ia te ly b e f o r e th e
ffM c L a in M a c h i n e " w as o u s t e d
i n N o v e m b e r , 1 9 4 9 , t h e S u p e r i n t e n d e n t m ad e n o p u b l i c u t t e r a n c e s w ith r e g a r d to
th e p l a n b e c a u s e o f t h e f a c t t h a t th e B o ard
o f S u p e rv is o rs had fo u n d i t p o l i t i c a l l y
e x p e d ie n t n o t to
o p p o se o r s u b s c r i b e to t h e p ro g ram * C i t i z e n s * S p e c i a l C o m m i t t e e o n C o m m u n ic a b le D i s e a s e * The s o n o f a p r o m in e n t c i t i z e n ,
M r. Don H a r t m a n , w as s t r i c k e n
w i t h p o l i o m y e l i t i s d u r i n g t h e e p i d e m i c o f 1948* was s h o c k e d b y t h e he fo u n d a t
th e
Mr* H a r t m a n
o v e r- c r o w d e d , d a n g e ro u s c o n d i t i o n s w h ich
c o m m u n ica b le d i s e a s e u n i t o f t h e G e n e r a l
H o s p i t a l w hen h e w e n t t h e r e
to v i s i t h is
son.
The s t r u c t u r e
w as o l d a n d h a d b eco m e i n a d e q u a t e b e c a u s e o f t h e r a p i d g ro w th i n p o p u l a t i o n d u r in g th e p r e v io u s d e c a d e .
Mr. H a r t m a n
c a l l e d on th e S u p e r i n te n d e n t o f C h a r i t i e s an d th e B oard o f S u p e r v i s o r s d e m a n d i n g t h a t a n ew h o s p i t a l b e b u i l t .
B ecause
no p r i v a t e h o s p i t a l w i l l a d m it p a t i e n t s w ith a c o n ta g e o u s d ise a se ,
th e S u p e rin te n d e n t a g re e d w ith th e n e c e s s ity o f
a c q u irin g
such a h o s p i t a l and to o k th e
o p p o rtu n ity to
M r. H a r t m a n * s a n g e r f u r t h e r , w h i c h r e s u l t e d f o r m i n g t h e t w e n t y - f i v e m em ber C i t i z e n s * o n C o m m u n ic a b le D i s e a s e . C o m m itte e ,
in
sp ark
th e l a t t e r * s
S p e c i a l C o m m i t te e
T h ro u g h t h e u n t i r i n g w ork o f t h i s
a b o n d i s s u e w as p l a c e d o n t h e N o v e m b e r, 1 9 4 9
26 T h e C o m m i t t e e r a i s e d $ 1 0 , 0 0 0 b y s o l i c i t a t i o n s ,
th e
89 b a llo t.
T hen, by u s in g a l l
t y p e s o f c o m m u n ic a tio n ,
th e
p u b l i c w a s i n f o r m e d o f t h e u r g e n c y o f b u i l d i n g a n ew com m u n ic a b le d is e a s e u n i t .
T h e b o n d i s s u e p a s s e d , a n d a new
f o u r hu nd red bed h o s p i t a l w ill be re a d y i n V.
1952.
RELATION OP THE DEPARTMENT OF CHARITIES WITH ADVISORY BOARDS AND COMMITTEES
The S u p e r i n t e n d e n t o f C h a r i t i e s h a s o b t a i n e d t h e se rv ic e s
o f c i t i z e n s a n d fo rm ed sev en a d v is o r y b o a rd s and
c o m m itte e s. p h y s ic ia n s
B a sic a lly ,
th ey a r e
o f tw o t y p e s :
th o s e w ith
o n l y , a n d t h o s e w ith p r o f e s s i o n a l a n d l a y m em bers.
B o ard s s e r v e d by p h y s i c i a n s . w h ic h o n ly p h y s i c i a n s
serv e,
th e
Of t h e f o u r b o a r d s on
la rg e st is
th e G en eral
H o s p i t a l M e d i c a l A d v i s o r y B o a r d , m a d e u p o f D o c t o r s o f M e d i c in e .
A n o th e r g roup i s
s e r v e d by D o c to rs o f O ste o p a th y and
is
c a lle d
th e O s te o p a th ic M e d ic a l A d v is o ry B o a rd .
is
com posed o f D o c to r s o f M e d ic in e a n d l o c a t e d a t H a rb o r
H o s p i t a l , known a s
A th ird
th e -H arb or M e d ic a l A d v is o ry B o a rd . . E ach
o f th e s e b o ard s se rv e s th e
same p u r p o s e i n t h e i r r e s p e c t i v e
j u r i s d i c t i o n s a t m o n th ly m e e ti n g s .
The p r i m a r y f u n c t i o n s
m oney b e i n g u s e d t o h i r e a p u b l i c i t y m an. S e r v i c e s w ere d o n a te d by n ew sp ap ers f u r n i s h i n g e d i t o r i a l s and f e a t u r e s t o r i e s , a n d r a d i o s t a t i o n s o f f e r i n g s p o t a n n o u n c e m e n ts . A m o v ie s h o r t , m ad e a n d d i s t r i b u t e d i n t h e C o u n t y , a l l e n t i r e l y g r a t i s , s t a r r e d C a r y G r a n t a n d w as d i r e c t e d b y M r. D on H a r t m a n , a m o tio n p i c t u r e d i r e c t o r .
90 a r e t o e s t a b l i s h m e d i c a l p o l i c y a n d t o a p p o i n t m e m b e rs o f th e a tte n d in g
sta ff.
P o s i t i o n s on t h e a t t e n d i n g s t a f f a r e
h i g h l y s o u g h t a f t e r b e c a u s e o f t h e w id e r a n g e o f t r e a t m e n t o ffe re d to
th e th o u s a n d s o f p e rs o n s a t c o u n ty h o s p i t a l s .
T h e s e d o c t o r s m ay p r e s s f o r a b e t t e r q u a l i t y o f s e r v i c e f o r p a t i e n t s , b o t h from a h u m a n i t a r i a n p o i n t
o f v ie w , and a l s o
b e c a u s e o f th e f i n e r e x p e r i e n c e w h ic h w i l l b e a f f o r d e d th e p h y sic ia n s.
The r e s u l t i s a g r e a t e r
c o s t to c o u n ty ta x p a y e r s ,
w h i c h t h e S u p e r i n t e n d e n t c a n do l i t t l e
about w ith o u t a ro u s in g
t h e a n i m o s i t y o f t h e p h y s i c i a n s who r e n d e r s e r v i c e s f r e e C o u n ty e x p e n s e .
T h e S u p e r i n t e n d e n t m ay o r may n o t a g r e e
w ith chan ges p ro p o se d by th e a d v is o ry b o a rd s . a re,
of
T hese b o a rd s
h o w ev er, an e x c e l l e n t a d m i n i s t r a t i v e t o o l f o r o b ta i n in g
o u ts ta n d in g c o u n s e l, y e t th e y a re
a n o th e r so u rce of p o l i t i c a l
i n f l u e n c e w i t h w h ic h t h e S u p e r i n t e n d e n t m u st w o rk . A n o th e r f u n c tio n o f th e m e d ic a l a d v is o r y b o a rd s i s fu rn ish
to
e x p e r t te s tim o n y r e g a r d i n g h o s p i t a l p r a c t i c e s w h ic h
m ay b e a t t a c k e d a s b e i n g i m p r o p e r .
In 1948, a p a tie n t,
w h ile r e c e iv in g tre a tm e n t i n th e O s te o p a th ic U n it, d ie d . B ecause c irc u m s ta n c e s th is
s u r r o u n d i n g t h e c a s e w ere s u c h t h a t
d e a t h m i g h t “b a c k f i r e , "
th e
S u p e rin te n d e n t o f C h a r itie s
i n v e s t i g a t e d a n d was c o n v in c e d b y o u t s t a n d i n g o s t e o p a t h i c p h y s ic ia n s t h a t n o th in g i r r e g u l a r had o c c u rre d . te n d e n t,
th e re fo re ,
c a l l e d a m e e tin g i n h i s
T he S u p e r i n
o f f ic e , a sk in g
w e ll-k n o w n p h y s i c i a n s , a s w e ll a s m e d ic a l p e r s o n n e l c o n c e rn e d
91 in
th e m a tte r ,
to a tte n d #
R e p r e s e n ta ti v e s fro m n ew sp ap ers
i n Los A n g e le s C o u n ty w ere i n v i t e d #
F a c ts o f th e
situ a tio n ,
and te s tim o n y o f th e d o c to r s , a s s u re d th e p r e s s t h a t e s ta b lis h e d 27 m e d ic a l p r a c t i c e s had been fo llo w e d i n t r e a t i n g th e d e c e a se d . E v e n t h o u g h t h e n e w s p a p e r s m ay n o t h a v e b e e n p e r s u a d e d t h a t a l l m e d ic a l p ro c e d u re s had b een p r o p e r , t h a t th e y c o u ld n o t o f f e r a s c i n t i l l a
th e p re s s re a liz e d
o f e v id e n c e com pared
t o t h e v o lu m e o f t e s t i m o n y t h a t t h e m e d i c a l p r o f e s s i o n w o u l d pro d u ce f o r t h e i r c a s e . g u ilty of m a lp ra c tic e
W h e th e r o r n o t th e d o c t o r s w ere
in th is
in sta n c e ,
o r in hu ndreds of
th o u sa n d s o f o th e r c a s e s i n b o th p r i v a t e and p u b lic no one o u t s i d e
th e m e d ic a l p r o f e s s io n can s a y .
h o sp ita ls,
M ost a s s u r e d l y
s t u p i d b l u n d e r s h a v e b e e n m ade a n d t h e m i s t a k e s b u r i e d #
Y et
e r r o r s i n ju d g m e n t a r e c o m m itte d d a i l y by p e r s o n s o f a l l p ro fe ssio n s. p h y sic ia n ,
I f a s u i t o f n e g lig e n c e i s b ro u g h t a g a in s t a
o th e r d o c to rs in v e s tig a te .
S h o u ld i t
be found
t h a t m a lp ra c tic e had been p e rfo rm ed , th e g u i l t y p h y s ic ia n u su a lly s e ttle s For th is
out of c o u rt,
reaso n , i f
and th e case I s k e p t q u ie t.
th e a c tio n i s
b rought to
tria l,
th e
d o c to r i s u s u a lly e x o n e ra te d . A n o th e r g ro u p ,
t h e T u b e r c u l o s i s A d v is o r y C o m m itte e ,
m e e t s o n c e a m o n th a n d f o r m u l a t e s m e d i c a l p o l i c y I n r e g a r d
27
P e r s o n a l i n t e r v i e w w i t h G e r t r u d e S c h u c k e r t , Head A d m i n i s t r a t i v e A s s i s t a n t , L os A n g e l e s C o u n ty D e p a r t m e n t o f C h a r it ie s , A p r il 3 , 1950. .
92 to
th is
ty p e o f care*
W e ll-k n o w n t u b e r c u l o s i s
i n t h e C o u n t y m ak e u p t h e m e m b e r s h i p o f t h i s w o rk in g w ith t h e s e p h y s i c i a n s , a b le
th e
s p e c ia lists
C o m m itte e .
By
S u p e rin te n d e n t has b een
to d e v e lo p one o f th e n a ti o n * s f i n e s t s a n a to r iu m s ,
s u ltin g in w ith th is
re
th e m ost r a p i d ty p e o f c u re f o r th o s e a f f l i c t e d d ise a se *
C o m m itte e s s e r v e d by p r o f e s s i o n a l a n d l a y p e r s o n s * T h ere a r e
th re e
c o m m i t t e e s m ad e u p o f p r o m i n e n t c i t i z e n s
th e C o u n ty --p ro fe s s io n a l, th ro p ic .
One. i s
b u sin e ss,
of
i n d u s t r i a l and p h i la n
t h e C i t i z e n s 1 A d v i s o r y C o m m i t te e o n P u b l i c
A s s is ta n c e o rg a n iz e d in 1941.
T h is g roup o f t h i r t e e n
in d iv i
d u a l s , m e e t s o n c e a m o n th t o
d isc u ss
c o m m u n ity p r o b l e m s r e
la tin g ' to p u b lic a s s is ta n c e
and to e s t a b l i s h g e n e ra l p o lic y *
I t w as p r i m a r i l y a s a r e s u l t o f t h e C o m m i t t e e f s w o rk t h a t t h e S t a t e L e g i s l a t u r e p a s s e d t h e R e l i e f A c t o f 1 9 4 5 , w h ic h t
*
p ro v id e d f o r s t a t e p a r t i c i p a t i o n
in g en eral r e lie f
when w i d e - s p r e a d u n e m p lo y m en t w e re t o a n em erg en cy w as d e c l a r e d . i n 1943 a n d 1944 to p a te d . a ro u se
strik e
i f and
C a lif o r n ia and
T he C o m m i t te e h a d m e t r e g u l a r l y
s tu d y p o s tw a r c o n d i t i o n s t h a t w ere a n t i c i
T hey recom m ended t h a t t h e
B oard o f S u p e r v i s o r s
s ta te - w id e and n a tio n a l c o n sc io u s n e ss o f t h i s
in g p ro b lem
28
• .
28
and th e group i t s e l f
”. . .
im p en d -
a c tiv e ly p a rtic ip a te d
L e t t e r t o t h e Los A n g e le s C o u n ty B oard o f S u p e r v i s o r s fro m t h e C i t i z e n s * A d v i s o r y C o m m itte e on P u b l i c A s s i s t a n c e , June 2 7 , 1 944, p . 9 .
93 I n g a in in g p a ssa g e o f th e R e lie f A ct o f 1945. T h e C o m m i t te e a l s o h e l p s b y s t u d y i n g q u e s t i o n s a n d reco m m en d in g a c t i o n t o t h e B u reau o f P u b l i c A s s i s t a n c e on v a rio u s m a tte rs
c o n n e c te d w ith c o u n ty - f in a n c e d g e n e r a l r e l i e f .
I n t h i s w ay " h e a t ” i s
rem o v ed fro m t h e D e p a r tm e n t, n o t o n ly
b e c a u s e t h e C o m m itte e I s
c o n v in c e d t h a t t h e i r a c t i o n s a r e
w a rra n te d , b u t th e y se rv e i n
in te rp re tin g
g en eral p u b lic and p a r t i c u l a r l y to g a n iz a tio n s.
th e pro g ram to
th e
i n t e r e s t e d c o m m u n ity o r
An e x a m p l e o f t h e i r a c t i v i t y
h a s b een to h e lp
i n t h e e s t a b l i s h m e n t o f a b a 's ic f o o d b u d g e t f o r g e n e r a l r e lie f re c ip ie n ts, d ie titia n , sto re s
d e te rm in e d f i r s t a s to
and s e c o n d ly by p r i c i n g
th ro u g h o u t th e
" c o n t e n t ” by a
th e fo o d ite m s in r e t a i l
c o u n ty i n a r r i v i n g a t a t r u e
c o st.
A n o t h e r g r o u p w h i c h w as f o r m e d tw o y e a r s a g o i s
th e
A d o p t i o n s C o m m i t t e e , m ad e u p o f e i g h t e e n m e m b e rs who m e e t s e v e r a l tim e s a y e a r .
As w as show n a b o v e , t h e
h a n d lin g o f
c h i l d r e n who a r e b e i n g p l a c e d f o r a d o p t i o n i s
a m a t t e r w h ic h
can e a s ily
T h is C o m m itte e ,
c re a te a g re a t d eal of c ritic is m .
m ade u p o f d o c t o r s , p r o f e s s o r s , p ro m in e n t c i t i z e n s , secu res
s o c ia l w o rk ers and o th e r
d e c id e s on p o l i c y i s s u e s and g e n e r a l l y
th e a p p ro v a l o f i n t e r e s t e d p a r t i e s . A f i n a l c o m m itte e i s
p erso n s,
o n e m ade u p o f o u t s t a n d i n g l a y
i n c l u d i n g t h e fam ous s c i e n t i s t ,
I t w o rk s w i t h c o u n ty h o s p i t a l s H o s p ita l in p a r t i c u l a r .
D r. R o b e rt M i l li k a n .
in g e n e ra l,
b u t th e G en eral
T h i s H o s p i t a l A d v i s o r y C o m m i t te e o f
94 n i n e m e m b e rs m e e t s o n c e a m o n th # c r e a t i n g t h i s C o m m i t te e w a s " t o
The o b j e c t i v e
sought in
s e c u r e c o m p e te n t a n d d i s i n
t e r e s t e d a d v ic e on th e m anagem ent o f th e H o s p it a l a n d to p ro te c t i t
from a n y p o s s i b l e u n d e s i r a b l e p o l i t i c a l a tm o s p h e re
and to a s s u r e i t s
sc ie n tific
#29 and e f f i c i e n t o p e ra tio n # ”
T he
G en eral H o s p ita l, th e S u p e rin te n d e n t o f C h a r itie s and th e B oard o f S u p e r v i s o r s a r e tre a tin g p a tie n ts
at
o c c a s io n a lly ch arg ed w ith n e g le c t i n
c o u n ty h o s p i t a l s .
E rro rs,
of co u rse,
can
b e m a d e , a n d t h e H o s p i t a l A d v i s o r y C o m m i t te e i n v e s t i g a t e s such in s ta n c e s and r e p o r ts
to
t h e B oard a n d th e p r e s s #
One o u t s t a n d i n g e x a m p l e t o o k p l a c e l a s t y e a r #
A
p a t i e n t d ie d fo llo w in g an o p e ra tio n a t th e
G en eral H o s p ita l#
N ew spapers c h a rg e d m a l p r a c t i c e a s a r e s u l t
of in fo rm a tio n th e y
o b t a i n e d f r o m a p h y s i c i a n who w as f o r m e r l y e m p l o y e d i n t h e 'V ;.
C o u n ty C o r o n e r 's o f f i c e # o b ta in e d a l l
The H o s p i t a l A d v i s o r y C o m m i t t e e
re c o rd s , and in te rv ie w e d s u r g ic a l s p e c i a l i s t s .
A t a s p e c i a l m e e t i n g o f t h e B o a rd o f S u p e r v i s o r s , C o m m itte e m e m b e rs a n d p h y s i c i a n s t e s t i f i e d
th a t,
i n t h e i r o p in io n ,
ev ery p r e c a u tio n had b een ta k e n to p ro v id e a c c e p te d s ta n d a rd s of tre a tm e n t.
T he f a m i l y o f t h e d e c e a s e d w a s c o n v i n c e d t h a t
t h e r e h ad b e e n no n e g lig e n c e
on t h e p a r t o f t h e h o s p i t a l ,
L e t t e r t o a l l n e w s p a p e rs i n L os A n g e le s C o u n ty f r o m A* B# R u d d o c k , C h a i r m a n , H o s p i t a l . A d v i s o r y C o m m i t t e e , N o v e m b er 6 , 1 9 4 5 , p . 1#
95 a n d c h a r g e s w ere d ro p p ed * In c o n sid e rin g
30
th e p o l i t i c s
of p u b lic w e lfa re ,
th e re
i s a b r o a d a n d d i v e r s i f i e d a r e a o f w h ic h t h e .w e l f a r e a d m in i s t r a t o r m u st a t a l l t im e s b e m i n d f u l , r a n g i n g fro m th e s i n g l e c lie n t
to th e
b o d ie s.
la rg e ta x p a y e rs 1 o rg a n iz a tio n s and le g is la tiv e
T h e a d m i n i s t r a t o r m u s t re m e m b e r t h a t
som e a r e
s e n t a t i v e o f m ore t h a n one g r o u p , f o r e x a m p le , t h a t sib le
r e l a ti v e s ” a re a ls o
rep re
"resp o n
" ta x p a y e rs .”
I t h a s lo n g b e e n r e c o g n iz e d t h a t th e w e lf a r e p ro g ram w h i c h t h e c o m m u n ity h a s i s i t s e l f d e sire s,
is p o s s ib le ,
in
In so far as
t h e d e v e lo p m e n t o f p o l i c y o r i n m ak in g changes,
C h a r i t i e s m u st a lw a y s c o n s i d e r t h e is
s u b je c t to
e c o n o m ic a n d p o l i t i c a l .
re c o m m e n d a tio n s f o r l e g i s l a t i v e
p erso n s i t
c o m m u n ity
and th e a d m in is tr a tiv e agency i s
m an y p r e s s u r e s — s o c i a l , it
o n ly t h a t w h ic h t h e
e x p e c te d to
t h e D e p a rtm e n t o f
w e lfa re and needs o f
s e rv e , and th e a b i l i t y
and w illin g
n e s s o f t h o s e who m u s t p r o v i d e f i n a n c i a l s u p p o r t .
It
f o r e b e h o o v e s t h e o p e r a t i n g a g e n c y t o be a l e r t a s t o c h a r a c t e r o f t h e c o m m u n i ty a n d t h e t e n o r o f i t s
th e re th e
c itiz e n s,
so t h a t a p r o g r e s s i v e a n d so u n d m e d ic a l a n d a s s i s t a n c e p r o g r a m m ay n o t o n l y b e a s s u r e d b u t a c c e p t e d *
30
P e r s o n a l i n t e r v i e w w i t h Jam es A • R o b i n s o n , J r . , A d m i n i s t r a t i v e A s s i s t a n t , L os A n g e l e s C o u n ty D e p a r tm e n t o f C h a r i t i e s , March 9 , 1 9 5 0 .
CHAPTER V AN EVALUATION OP THE DEPARTMENT OP CHARITIES ADMINISTRATION I n s t e a d o f e v a l u a t i n g n u m e r o u s f u n c t i o n s o f t h e De p a rtm e n t o f C h a r i t i e s , d e a lin g o n ly b r i e f l y w ith e a c h ,
th is
c h a p te r w i l l c o n s id e r th r e e o f th e m a jo r a d m i n i s t r a t iv e q u e stio n s . tu re --th e
One i s w i t h r e g a r d t o c e n tra liz a tio n
ta n c e in th e p o sitio n
th e a d m in is tra tiv e
stru c -
o f h o s p i ta l care and p u b lic a s s i s
sam e d e p a r t m e n t .
The s e c o n d a n a l y s i s i s
th e
o f Los A n g e le s C o u n ty a s t h e a d m i n i s t r a t i v e u n i t f o r
t h e v a s t p u b l i c a s s i s t a n c e p r o g r a m , a s co m p ared w i t h c i t y s t a t e m an a g em en t.
T he f i n a l s u b j e c t i s
o f th e D e p a rtm e n t o f C h a r i t i e s
or
an e v a lu a tio n o f e f f o r ts
to m eet th e need f o r p u b lic
h o s p i t a l c a r e i n th e C o u n ty . I.
HOSPITAL CARE AND PUBLIC ASSISTANCE CENTRALIZED IN THE SAME DEPARTMENT A lm o st w i t h o u t e x c e p t i o n i n
th e U n ite d S t a te s , p u b lic
h o s p i t a l an d a s s i s t a n c e p ro g ra m s , a t a l l g o v e rn m e n ta l l e v e l s , a r e a d m i n i s t e r e d b y s e p a r a t e d e p a r t m e n t s o r u n i t s . ’*’
The one
o u t s t a n d i n g e x a m p le o f a g o v e r n m e n ta l u n i t w h ic h c e n t e r s , a s d o e s Los A n g e le s C o u n ty , b o t h p u b l i c
a s s is ta n c e and m e d ic a l
^ M a r i e t t a S t e v e n s o n , P u b l i c W e l f a r e A d m in i s t r a t i o n (New Y o r k : The M a c m illa n Com pany, 1 9 3 8 ) , p . 7 .
97 care in th e
same h i e r a r c h i c a l
stru c tu re
i t y A gency o f t h e n a t i o n a l governm ent..
is
th e F ed eral Secur
At one tim e
the U n ite d
S t a t e s P u b lic H e a lth S e r v i c e , w hich c o n t r o l s m e d ic a l c a r e , an d th e n a t i o n a l B ureau o f P u b lic A s s i s t a n c e w ere in d e p e n d e n t o f one a n o t h e r .
I t was d e t e r m i n e d t h a t a l l w e l f a r e f u n c t i o n s
s h o u l d , h o w e v e r , b e t o g e t h e r i n t h e sa m e d e p a r t m e n t , a s r e c o m mended i n 1937 by t h e P r e s i d e n t s C o m m ittee on A d m i n i s t r a t i v e 2 M anagem ent. T he r e s u l t w a s t h e e s t a b l i s h m e n t o f t h e F e d e r a l 3 S e c u r i t y Agency u n d e r t h e R e o r g a n i z a t i o n P la n o f 1939. T his n a ti o n a l agency has a d m in is te re d b o th h o s p i t a l and a s s is ta n c e program s s in c e t h a t tim e .
The l o c a t i o n o f t h e s e f u n c t i o n s i n
t h e same d e p a r t m e n t , a s f a r a s r e l a t i o n s
w ith th e D epartm ent
of C h a r itie s has been concerned, has proved a d m in is tr a tiv e ly 4 d esirab le. The C a l i f o r n i a
s t a te w elfare a g en c ie s,
D epartm ent of S o c i a l W elfare
e s p e c ia lly the
su p erv isin g p u b lic a s s is ta n c e
and t h e D e p a rtm e n t o f P u b l i c H e a l t h m anaging h o s p i t a l a re indep en d en t d e p artm e n ts, resp ectiv e
task s.
sa tisfac to rily
care,
carry in g out th e ir
W ith b o t h t h e n a t i o n a l a n d s t a t e
a g en cies,
p
P r e s i d e n t s C om m ittee on A d m i n i s t r a t i v e M anagem ent, R e p o r t w ith S p e c i a l S t u d i e s . (W a sh in g to n , D .C .: Governm ent P r i n t i n g O f f i c e , 1 9 3 7 ), 382 p p . 5 53 S t a t . 4
5 6 2 , 5 U. S . C . A . . A p r i l 3 ,
1939.
I n t e r v i e w w i t h G e r t r u d e S c h u c k e r t , Head A d m i n i s t r a t i v e A s s i s t a n t , L o s A n g e l e s C ou n ty D e p a r tm e n t o f C h a r i t i e s , March 3 0 , 1 9 5 0 .
98 how ever, i t
i s n o t a s i m p o r t a n t t h a t t h e y be i n t e g r a t e d i n t o
one a g e n c y ,
f o r th ey e x ercise p rim a rily su p erv iso ry c o n tro l,
not d ire c t ad m in istratio n .
P a rtic u la rly is
a s s i s t a n c e d e p a r tm e n ts w hich m e re ly i s s u e co o rd in a te and su p e rv ise and s ta te
lo cal
th is
g r a n ts -in - a id and
ad m in istratio n ;
h o s p ita l a g en cies a c tu a lly
t r u e o f the
w hile n a tio n a l
o p erate h o s p ita ls .
Because t h e D epartm ent o f C h a r i t i e s a d m i n i s t e r s b o th a s s is ta n c e and h o s p i t a l c a re , clie n t.
b e tte r serv ice is
o ffe re d the
T h e r e i s a much c l o s e r w o r k i n g r e l a t i o n b e tw e e n t h e
B ureau o f P u b lic A s s i s t a n c e a n d th e Bureau o f H o s p i t a l s th a n th ere is
betw een e i t h e r o f t h e s e b u re a u s an d , s a y ,
H e a lth D epartm ent.
th e C ounty
The S u p e r i n t e n d e n t o f C h a r i t i e s
in fo rm a l w orking r e l a t i o n s h i p s
e stab lish es
w i t h i n h i s D ep artm en t w hich
o f f e r more e c o n o m ic a l and e f f i c i e n t m anagem ent.
If,
f o r exam
p l e , a n i n d i g e n t r e c e i v i n g so m e t y p e o f p u b l i c a s s i s t a n c e in need of h o s p ita l care,
sim p le p r o c e d u r e s have been s e t up
so t h a t M e d ic a l S o c i a l S e r v i c e r e c e i v e s and he i s
is
e x p e d itio u s ly ad m itted .
t h e p a t i e n t Ts r e c o r d ,
I t may b e c l a i m e d t h a t
s u c h a t r a n s f e r c o u l d j u s t a s e a s i l y b e e f f e c t e d b e tw e e n two s e p a r a t e d e p a r t m e n t s ; b u t su c h w ould n o t be th e c a s e , a s w i t n e s s e d by th e d i f f i c u l t y o f t e n e n c o u n te re d betw een the D e p a r t ment o f C h a r i t i e s an d th e A u d i t o r o f P u r c h a s in g D ep artm en t on r e l a t i v e l y
ro u tin e n e g o tia tio n s.
A sim ple i n t e r - d e p a r t
m e n t a l t a s k may t a k e d a y s t o a c c o m p l i s h , w h i l e i n t r a - d e p a r t m ental m a tte rs a re
com pleted i n a s h o r t tim e , i n p a r t b e c a u se
99 know ledge o f p o o r c o o p e r a t i o n w i t h i n t h e D e p a rtm e n t w i l l be p a s s e d up t h e h i e r a r c h i c a l
ladder* 5 o f th e D epartm ent o f C h a r i t i e s is
best p rin cip le s
The,o rg an izatio n chart n o t in a c c o rd w ith th e
o f m anagem ent, an d i t m ig h t i n d i c a t e
th at
t h e m any h o s p i t a l s a n d b u r e a u s g e th e r--b u t i t
co uld n o t f u n c tio n w e ll t o 0 w o rk s , a n d works w e l l l Im provem ents can and
a r e b e i n g m ad e r e g u l a r l y ,
a s . w i t h any dynam ic p r i v a t e o r
p u b lic agency. A nother im p o rta n t c o n s id e r a tio n I n k eep in g p u b lic assistan ce
in
t h e same d e p a r t m e n t i s
p la n s a re developed and j o i n t l y S e c u r i t y Agency, m aking i t
the f a c t
th at fed eral
supervised by th e F ed eral
d e s i r a b l e from th e v ie w p o in t o f
c o o r d i n a t i o n o f th e n a t i o n a l p u b l i c w e lf a r e p ro g ram s to have lo c a l a d m in istratio n sim ila rly c e n tra liz e d . 6 0 0 0 now b e f o r e C o n g r e s s w o u l d m ake t h i s fo r th e b i l l
House R e s o l u t i o n
e v e n more n e c e s s a r y ;
su g g ests a lt e r i n g
th e S o c ia l S e c u rity Act to p ro 7 v id e m edical care f o r th o se r e c e iv in g p u b lic a s s i s t a n c e . A s t u d y was m a d e b y t h e A m e r i c a n P u b l i c ¥ / e l f a r e A s s o c ia tio n
in c o n ju n c tio n w ith th e m edical and a l l i e d p r o f e s s io n s ,
w ith the c o n clu sio n t h a t m edical and p u b lic a s s is ta n c e p ro 5
Supra, p .
55.
0 I n t e r v i e w w i t h W i l l i a m A. B a r r , E x e c u t i v e A s s i s t a n t S u p e r i n t e n d e n t o f C h a r i t i e s , Los A n g e le s C o u n ty , A p r i l 7 , 1950. ^ S o c ia l L e g i s l a t i o n B u l l e t i n , W elfare C o un cil o f M e t r o p o l i t a n Los A n g e l e s , No. 1 , 1950 S e r i e s , p . 5 .
100 gram s s h o u l d b e c a r r i e d o u t j o i n t l y .
One o f t h e i r 8 o f O r g a n i z a t i o n a n d A d m i n i s t r a t i o n 11 w a s :
c ip les
"P rin -
To b e e f f e c t i v e m e d i c a l c a r e m u s t b e a p a r t o f a n a d e q u a te program o f a s s i s t a n c e . P u b lic m edical c a re m u s t, t h e r e f o r e , be p la n n e d i n r e l a t i o n t o , and c l o s e l y i n t e g r a t e d w ith a g e n e r a l a s s i s t a n c e program p r o v i d in g ad eq u ate food, s h e l t e r , c lo th in g , and o th e r e s s e n tia ls of lif e . F o r th e in d iv id u a l p a t i e n t m edical and s o c i a l t r e a t m e n t s h o u l d be c l o s e l y c o r r e l a t e d . I t m ay b e a r g u e d t h a t t h e a d m i n i s t r a t i o n o f p u b l i c assistan ce
s h o u ld be in d e p e n d e n t,
and p u b lic h e a l t h c a r e ,
the l a t t e r
w hile h o s p i t a l tre a tm e n t o ffe rin g p u b lie h e a lth
n u r s i n g a n d s o c i a l work c o n d u c t e d b y t h e C ou nty H e a l t h D e p a r t m ent,
s h o u ld be t o g e t h e r i n one a g e n c y .
in g of th e m edical and p u b lic
The j o i n t f u n c t i o n
h e a l t h a g e n c i e s w ould e l i m i n a t e
d u p lic a tio n o f m ed ical and s o c ia l r e c o r d s , and a d im in u tio n o f t r a v e l tim e a n d e x p e n s e would r e s u l t . scope o f t h i s
study to
It
i s beyond th e
c o n s id e r the u n lim ite d r a m i f ic a t i o n s
o f such a p o s s i b i l i t y , y e t t h i s p r o p o s a l m ig h t be g iv e n s e r i ous c o n s i d e r a ti o n . g ratio n
To c a r r y i t
f u r t h e r , why l i m i t t h e i n t e
to th e h o s p i t a l s and p u b l i c h e a lth , f u n c tio n s ?
o r d e r to b r in g alm ost a l l
co un ty a g e n c ie s
In
concerned w ith
a d m i n i s t r a t i o n o f program s c o n t r o l l e d by th e F e d e ra l S e c u r ity Agency u n d e r c e n t r a l i z e d
resp o n sib ility ,
it
w ould p e r h a p s be
m ore e f f i c i e n t t o j o i n t h e D e p a r tm e n t o f C h a r i t i e s a n d t h e
O
O r g a n ! z a ti o n a n d A d m i n i s t r a t i on o f Tax- S u p p o rte d M edical C a re (C h ic a g o : A m erican P u b l i c W e lfa re A s s o c i a t i o n , 1939), unbound, p . 5.
C o u n ty H e a l t h D e p a rtm e n t i n o r d e r t o o b t a i n more e c o n o m ic a l and sound a d m i n i s t r a t io n # II.
SHOULD LOS ANGELES COUNTY ADMINISTER PUBLIC ASSISTANCE? T h e r e a r e m an y f a c e t s i n t h e c o n s i d e r a t i o n o f w h e t h e r
or not a d m in is tra tio n of p u b lic a s s is ta n c e t e d by Los A n g eles C o u n ty . are
evaluated h e re .
d escrib es
It
sh o u ld be conduc
Only a few o f t h e m a j o r i s s u e s
has been sa id th a t
the p r e s e n t s t a t e
"chaos a c c u ra te ly
o f c o u n ty governm ent i n t h e U n ite d
S t a t e s , " and t h a t c o u n tie s e v ery sound p r i n c i p l e a d m in istratio n ,
" v io la t e alm ost w ith o u t e x c e p tio n , a of o rg a n iz a tio n ." S tu d en ts of p u b lic
how ever,
concede t h a t th e a d m i n i s t r a t io n o f
c o u n ty governm ent i n Los A n g e les i s
o ne o f t h e n a t i o n ' s b e s t .
T he m a t t e r o f r e l i e f a d m i n i s t r a t i o n b y c o u n t i e s o r c ities
has o fte n been d isc u sse d ,
but I t
t h a t th e form er should perform t h i s to c ity ag en c ie s,
it
i s m u ch m o r e l o g i c a l
fu n ctio n ;
w o u l d be n e c e s s a r y t h a t
for,
in ad d itio n
th e county p r o
v id e such s e r v ic e s f o r u n in c o rp o ra te d a r e a s T h e
same
d u p l i c a t i o n i s f o u n d t o d a y w i t h m any c i t y a n d c o u n t y f u n c t i o n s law e n f o r c e m e n t a g e n c i e s ,
lib ra rie s,
p u b lic h e a lth departm ents
^ A. P. M acD o n ald , A m e r ic a n S t a t e G o v e rn m e n t a n d Admin i s t r a t i o n (New Y o r k : Thomas Y . C r o w e l l C o m p a n y , 1 9 4 5 , s e c o n d e d it i o n ) , p . 294. ^ I n t e r v i e w w i t h B e r y l E . Cox, Los A n g e l e s C o u n ty D eputy S u p e r i n t e n d e n t o f C h a r i t i e s , A p r i l 5 , 19 5 0 .
102 and o th e r s . th is
An o u t s t a n d i n g ^ a u t h o r i t y i n p u b l i c w e l f a r e h a d
to say :
"At t h e p r e s e n t t i m e e x p e r t s i n b o t h t h e
and s o c ia l w e lfa re f i e l d s u n it--th e
f a v o r t h e developm ent o f th e l a r g e r
c o u n ty --fo r lo cal a d m in istra tio n ."
The m a in q u e s t i o n l i e s assistan ce
a d m in istratio n .
th at
S t a t e m a n a g e m e n t can- b e a s e f f i as
e v i d e n c e d b y m an y w e l l -
throughout
co u n ty o p e r a tio n i s b e t t e r ,
a t hand.
"Its a c tiv itie s
11
i n co unty v e rs u s s t a t e p u b lic
c i e n t as cou nty a d m i n i s t r a t i o n , o rg an ized s t a t e ag en cies
affect
the n a t i o n .
Many f e e l
f o r ad m in istratio n is
clo se
the c i t i z e n
and
d ire c tly ,
h i s i n f l u e n c e c a n b e b r o u g h t t o b e a r q u i c k l y on I t s tio n s and o ffic e rs * " when c i t i z e n s v iso rs
th at
R e lief.
An e x a m p l e o f t h i s
13
in th e ir
cago:
occurred re c e n tly
em ployable i n d i g e n t s w ere r e c i p i e n t s therefore,
t o be draw n u p ,
o f G eneral
o r d e r e d a "no work— no r e l i e f "
h ereb y
su c h a i d .r e c i p i e n t s w ould
h a v e t o l a b o r on c o u n t y work p r o j e c t s relief.
opera-
i n d i g n a n t l y c o m p la in e d t o t h e Board o f S u p e r
The B o a rd ,
ordinance
12
h ealth
in
o rd er to
receiv e
T a x p a y e rs1 groups and new spapers a r e e s p e c i a l l y s tr o n g support of lo c a l
a d m in istratio n of p u b lic a s s is ta n c e .
^ G r a c e A b b o t t , From R e l i e f t o S o c i a l S e c u r i t y The U n i v e r s i t y - 'O f ^ C h ic a g o P r e s s , 1 9 4 1 ) , p . 3 7 3 .
(C hi
12
A b r a h a m H o l t z m a n , L o s A n g e l e s C o u n t y C h i e f A dm in i s t r a t i v e O f f i c e r : Ten Y e a r s 1 E x p e r i e n c e (Los A n g e l e s : U n i v e r s i t y o f C a l i f o r n i a , Bureau o f G overnm ental R e s e a r c h , 1948), p . 2 . 13
Los A n g e le s C ounty B oard o f S u p e r v i s o r s , M in u te s , A p ril 11, 1950.
103 An e d i t o r i a l
i n t h e Los A n g e l e s Tim es e x p r e s s e d t h i s v i e w ,
w h i l e d i s c u s s i n g a s t u d y w h ic h h a d b e e n made b y a t a x c o m m itte e o f t h e L o s A n g e l e s C h a m b e r o f Commerce i n r e g a r d t o a g e d a n d b l i n d a i d : 14 E x p e r i e n c e s h o w s t h a t w h en we t r a n s f e r a f u n c t i o n from l o c a l g o v e rn m e n ts t o b i g g e r u n i t s o f g o v e rn m e n t, n o t o n l y d o we g e t f a r t h e r a w a y f r o m l o c a l c o n t r o l b u t we a l s o r a i s e a d d i t i o n a l p r o b l e m s o f f i n a n c e . I f the c o u n tie s l o s e c o n tr o l o f th e a d m i n i s t r a t io n o f th e aged and b lin d program s, i n th e long run i t w ill c o s t th e t a x p a y e r s o f t h e S t a t e more t o s u p p o r t i t a t t h e S t a t e le v e l o r th e n a tio n a l le v e l th an i t w ill a t the lo c a l lev el . . . P a r t o f t h i s a r g u m e n t i s no d o u b t a h o l d o v e r fro m t h e E l i z a b e t h a n P o o r Law e r a when a s s i s t a n c e w a s a d m i n i s t e r e d b y lo cal ju ris d ic tio n s .
15
The C a l i f o r n i a T a x p a y e r s f A s s o c i a t i o n
has o fte n ex p ressed th e o p in io n th a t lo c a l a d m in is tr a tio n was p r e f e r a b l e
to
th ey s ta te d th a t
s t a t e m a n a g e m e n t , a n i n s t a n c e b e i n g w hen "home r u l e h a s a l w a y s b e e n b a s i c
ad m in istratio n of r e l i e f . "
W i t h "home r u l e , "
t o a humane
of course,
t h e A s s o c i a t i o n a n d o t h e r g ro u p s w ould have m ore i n f l u e n c e on w e l f a r e m anagem ent. The c o n s e n s u s a p p e a r s t o be t h a t c o u n t y a d m i n i s t r a -
14
E d i t o r i a l i n t h e Los A n g e l e s T im e s , D ecem ber 2 9 ,
1949. M a r i e t t a S t e v e n s o n , " P u b l i c W e l f a r e , " ( M a r g a r e t B. H o d g e s , e d i t o r , S o c i a l Work Y e a r B o o k . 1 9 4 9 . New Y o r k : R u s s e l l Sage F o u n d a tio n , 1 9 4 9 ), p . 4 04. ^ 2 7:295,
" V o t e Y e s On P r o p o s i t i o n No. 2 , ” T h e T a x D i g e s t » Septem ber, 1949.
104 tio n w ith s t a t e o rg an izatio n .
su p erv isio n i s
17
A ll s t a te s ,
th e m ost e f f i c i e n t ty p e o f
s p u r r e d by f e d e r a l re q u ire m e n ts
u n d e r t h e S o c i a l S e c u r i t y A c t , now r e c o g n i z e t h e n e c e s s i t y o f program i n t e g r a t i o n a t th e
sta te
lev e l.
P e rh ap s th e m ost
v a l i d argum ent f o r l o c a l a d m i n i s t r a t i o n of p u b l i c a s s i s t a n c e serv ices o p eratin g
c e n t e r s a ro u n d t h e t r e m e n d o u s ly wide v a r i a t i o n i n c o n d itio n s found w ith in th e a re a of a s t a t e a s
larg e as C a lifo rn ia .
W ith a d m i n i s t r a t i v e
c e n te r e d i n l o c a l gov ern m en tal u n i t s ,
resp o n sib ility
lo cal situ a tio n s w ill
a u to m a tic a lly be giv en c a r e f u l c o n s id e ra tio n . upon lo c a l f a c to r s of s ta te tiv e s
should,
o f c o u r s e , be p r e v e n t e d by a ty p e
s u p e r v i s i o n w hich w i l l
of a ll
Undue e m p h a sis
s a f e g u a r d t h e min im um o b j e c
sound p u b l ic a s s i s t a n c e p ro g ram s.
-v. . I n 1 9 4 8 t h e S t a t e D e p a r t m e n t o f S o c i a l W e l f a r e made a n e x te n s iv e stu d y of p u b lic a s s i s t a n c e a d m i n i s t r a t i o n i n Los A ngeles C ounty.
One o f t h e i r f i n d i n g s w a s t h a t
o f f i c e s and u n i t s
of th e
the d i f f e r e n t
B ureau o f P u b l i c A s s i s t a n c e w ere n o t
fam ilia r-en o u g h w ith th e fu n c tio n in g of o th e r u n its *
T O
W ith
46$ o f a l l C a l i f o r n i a p u b l i c a s s i s t a n c e a d m i n i s t e r e d i n Los A n g eles C ounty,
o n e c o u l d i m a g i n e how much m o r e t h e
w o u ld become c o n f u s e d i f
17 18
situ atio n
a d m i n i s t r a t i v e u n i t s were s p r e a d
G race A b b o t, p p .
c i t .. p . 374.
A d m i n i s t r a t i v e S tu d y o f L os A n g e l e s C o u n t y ' s Admin i s t r a t i o n o f P u b lic A s s is ta n c e (Sacram ento: C a lifo rn ia S tate D epartm ent o f S o c ia l W e lfa re , 1 9 4 8 ), p . 152.
105 over the s t a te .
The A m e ric a n P u b l i c W e l f a r e A s s o c i a t i o n
s t u d y o f w e l f a r e s e r v i c e s made t h e r e c o m m e n d a t i o n t h a t t h e n a tio n a l and s ta te
governm ents sh o u ld o f f e r t e c h n i c a l and
fin an c ia l a ssista n ce ,
b u t t h a t a d m i n is t r a t io n should be s e t
up a s a n " o r g a n i z a t i o n on a c o u n t y - w i d e b a s i s , 19 o f c o u n t i e s on a r e g i o n a l b a s i s , " th e l a t t e r sary in the
o r o f a group being n e c e s
c ase o f sm a ll c o u n ti e s w hich w ish to e s t a b l i s h
a common o r g a n i z a t i o n t h a t w i l l a f f o r d e c o n o m i c a l a n d e f f i c ie n t r e l i e f a d m in istra tio n . B ecau se o f t h e a t t r a c t i o n o f Los A n g e le s C o u n ty , a n d c e rta in o th er C a lifo m ia load is lic
c arried .
C o u n t i e s , a h e a v y G-eneral R e l i e f
In k eeping th e a d m in is tr a tio n of a l l pub
a s s is ta n c e a t the lo c a l l e v e l ,
th e n a t i o n a l governm ent a s w e l l ,
th e
sta te
governm ent, and
should p a r t i c i p a t e
fin a n c in g o f G eneral R e lie f j u s t a s the l a t t e r t i o n s now p r o v i d e f u n d s f o r
in the
two j u r i s d i c
the C a te g o r ic a l A id s.
A ssem bly
m a n G l e n n A n d e r s o n h a s i n t r o d u c e d A s s e m b l y B i l l 62 i n t h e cu rren t sessio n of th e p a rticip a tio n of to ta l
S ta te L eg islatu re
to p ro v id e s t a t e
in G eneral R e lie f c o s ts of to
co u n ty e x p e n d itu r e s .
20
The S t a t e
e ig h ty p ercen t S u p erv iso rs1
A s s o c ia tio n has su p p o rte d the m easure; f o r w ith c o u n tie s
'
19 O r g a n i z a t i o n a n d A d m i n i s t r a t i o n o f T a x - S u p p o r t e d M edical C a re , o p . c i t . , p . 5 . 20
1950.
—
News i t e m i n t h e n o s A n g e l e s D a i l y N e w s, A p r i l 6 ,
106 now h e l p i n g t o f i n a n c e t h e C a t e g o r i c a l A i d s ,
th e grow ing
G e n e r a l R e l i e f l o a d i s b e c o m in g t o o g r e a t a b u r d e n on l o c a l governm ent.
A situ atio n
s im il a r to
t h a t w hich o c c u r r e d i n
t h e e a r l y 1 9 3 0 * s i s a g a i n b e g i n n i n g t o d e v e l o p , when t h e c o u n ty p r o p e r t y owners w ere n o t a b l e t o
support a l l r e l i e f
e x p e n d i t u r e s , an d f i n a n c i a l h e l p was p r o v i d e d b y t h e s t a t e and n a t i o n a l governm ents. Some g r o u p s a r e n o t i n f a v o r o f s t a t e f o r G eneral R e lie f . burden i s w ill
It
is f e lt
by th e m t h a t
fin a n c ia l a id i f p a r t of the
t a k e n from t h e B oards o f S u p e r v i s o r s ,
s p e n d t h e m o n ey e l s e w h e r e .
th a t th ere is
In a d d itio n ,
the
it
is
la tte r said
bound t o b e a t t r i t i o n when m ore h a n d l i n g i s
in v o lv ed .
lfAs t h e d o l l a r s move f r o m o n e t r e a s u r y t o a n o t h e r , 21 some o f t h e m t r i c k l e o f f o u t o f s i g h t . 1* Yet c o u n ty f i n a n
c in g o f G e n e ra l R e l i e f i s becom ing a n a c u t e p ro b le m , a n d sta te it:
s u p p o r t m ust be f o r t h c o m i n g . " I f you d o n ’t l i k e
it,
As o n e n e w s p a p e r p u t
w hat w ould you d o ? " ^
The B u r e a u o f P u b l i c A s s i s t a n c e i s g e n e r a l l y c o n s i d e r e d to b e a n exam ple o f e f f i c i e n t a d m i n i s t r a t i o n , out its
assig n ed fu n ctio n s w e ll.
in w elfare has s a id ,
21 22
1950.
carry in g
An o u t s t a n d i n g a u t h o r i t y
" p r o b a b l y Los A n g e le s C o u n ty , w i t h i t s
E d i t o r i a l i n t h e Los A n g e les T im e s♦ A p r i l 5 , News i t e m i n
1950.
t h e L os A n g e l e s D a i l y News, A p r i l 6 ,
107 com m unity b u i l d i n g s i n w h ic h • • • p u b l i c s o c i a l a g e n c i e s a re housed, has u t i l i z e d g a n izin g
county-w ide
co u n ties." iste rs
its
0*2
It
t h e com m unity a s
th e b a sis fo r o r
s e r v i c e s more c o m p l e t e l y t h a n o t h e r
i s r e c o g n i z e d t h a t Los A n g e le s C o u n ty adm in
r e l i e f p r o g r a m more e c o n o m i c a l l y t h a n t h e S t a t e
D e p artm en t o f S o c i a l W e lfa re managed ag ed an d b l i n d a i d d u r i n g t h e l a t t e r f s s h o r t a d m i n i s t r a t i o n u n d e r A r t i c l e XXV o f t h e C a l i f o r n i a C o n s t i t u t i o n i n 1949 and t h e e a r l y p a r t o f 24 1950. W hereas t h e C ounty a d m i n i s t e r e d a l l c a t e g o r i c a l a i d s and G en eral R e l i e f w ith e le v e n d i s t r i c t S t a t e D epartm ent had tw e n ty - t h r e e d i s t r i c t th re e reg io n al
o ffices
o ffices,
o f f ic e s , p lu s
i n Los A n g e le s C o u n ty , t h e s e r e g i o n a l
o f f i c e s b r in g in g ab o u t a h ig h e r overhead c o s t . of the s ta te
the
S ta ffin g
o f f i c e s was m u ch h i g h e r t h a n t h a t f o u n d i n
co u n ty o f f i c e s ,
even though th e s t a t e a d m i n i s t e r e d o n ly
ag ed and f l i n d a i d
w h i c h r e q u i r e s m uch l e s s
s o c i a l work
t h a n do t h e two a i d s m a n a g e d b y t h e C o u n t y — A i d t o 25 C h ild re n and G eneral R e l i e f .
Needy
The p r a g m a t i c t e s t o f w h ic h w orks b e t t e r s h o u l d b e t h e
^ G r a c e A b b o t t , op,, c i t . , p . 5 7 6 . 24 D u r in g t h e f i r s t s e v e n m onths o f s t a t e a d m i n i s t r a t i o n , r e l i e f c o s t s w e re 46 p e r c e n t h i g h e r t h a n u n d e r C ou nty m anagem ent. " V o t e Y e s o n P r o p o s i t i o n No. 2 , ” o p . c i t . , p . 2 9 5 . ^ Each s o c i a l w o rk er o f th e B ureau o f P u b lic A s s i s t a n c e c a r r i e d 487 e a s e s , a s a g a i n s t 325 i n t h e S t a t e D e p a r t ment o f S o c i a l W e l f a r e .
108 d eterm in in g fac to r#
G iven a few y e a r s o f e x p e r i e n c e ,
a d m in is tra tio n of p u b lic e ffic ie n t,
o r more s o ,
lo ca l,
a s s i s t a n c e w ould p r o b a b l y becom e a s
t h a n C o u n ty m anagem ent#
cent experience of s t a te
sta te
relief
o p eratio n ,
From t h e r e
and th e n e c e s s a ry
r e g i o n a l a n d h e a d q u a r t e r s o f f i c e s t h a t w ould be m ain
tain ed ,
it
is
i n d i c a t e d , how ever, t h a t s t a t e a d m i n i s t r a t io n 26 w ould n o t be a s e c o n o m ic a l. A lth o u g h th e C ounty a n d s t a t e ag en cies fu n c tio n w e ll, tratio n
th e sc a le s
tip in fav o r of adm inis
o f r e l i e f p ro g ra m s i n t h e h an d s o f th e Los A n g e le s
C ounty Bureau o f P u b l i c A s s is ta n c e # III.
HAS LOS ANGELES COUNTY ADEQUATELY PROVIDED PUBLIC HOSPITAL F A C I L I T I E S ?
P u b l i c h o s p i t a l f a c i l i t i e s a r e made a v a i l a b l e resid en ts,
reg ard less
c i t i e s and co u n ties
o f r a c e o r econom ic c l a s s ,
of the U n ited S ta te s .
It is
i n m ost p rim arily
t h e l a r g e r c o m m u n ities w hich a d m it o n ly i n d i g e n t s , b e i n g t h e C oo k C o u n t y I l l i n o i s
to a l l
exam ples
G eneral H o s p ita l and B ellev ue
H o s p i t a l o f New Y o r k C i t y , a l o n g w i t h t h e L o s A n g e l e s C o u n t y p u b lic h o sp itals# w hether i t
is
27
T here a re argum ents p ro and con a s to
d esirab le
to adm it o th e r th a n m edical
in d ig en ts
"What i f P r o p o s i t i o n No# 4 i s R e p e a l e d ? ” T h e T a x D i g e s t , 27:136, A p r i l , 1949. 27
I n t e r v i e w w i t h R# B. F u l c h e r , A d m i n i s t r a t i v e A s s i s t a n t , L o s A n g e l e s C o u n ty G e n e r a l H o s p i t a l , A p r i l 4 , 1 950 #
109 i n t o C ounty h o s p i t a l s .
A w ell-know n a u t h o r i t y
on h o s p i t a l
a d m i n i s t r a t i o n co n d u cted a stu d y o f both p u b l ic and p r i v a t e h o sp ital f a c ilitie s m endation t h a t
i n Los A n g e les C o u n ty , m aking th e recom
"all h o sp itals
econom ic c l a s s e s , w h e th e r t h e m en t." th at
28
sta te
ow nership i s p r i v a t e
The r e a s o n i n g b e h i n d h i s
"u su a lly th e
su lt in
sh o u ld adm it p a t i e n t s
of a ll or govern-
c o n c l u s i o n was t h e f a c t
s e g r e g a t i o n by econom ic c l a s s d o e s n o t r e
the p ro p e r q u a li t y of c a re f o r th e p o o r . " ^
law , a s w e ll a s a C ounty o r d i n a n c e ,
30
Because
g en erally p ro h ib it
t h e t r e a t m e n t o f p e r s o n s o t h e r t h a n i n d i g e n t s i n County in stitu tio n s,
th e D epartm ent o f C h a r i t i e s m ust c o n tin u e i t s
p re se n t a d m ittin g p o l ic i e s .
Los A n g eles C ounty a n d th e
D epartm ent c o u ld , how ever, p e rh a p s in f lu e n c e l e g a l changes so t h a t
the p lan
o f m ost j u r i s d i c t i o n s a n d th e recom m endations
o f t h e H a m ilto n S u rv e y w ould be f o llo w e d . The num ber o f
governm ental and p r i v a t e
p i t a l beds th a t sh o u ld be p ro v id ed i n th e been d is c u s s e d by h o s p i t a l a d m i n i s t r a t o r s . fa c ilitie s
g e n eral hos
C ounty h a s o f t e n Some o f t h e s e
a re f u r n i s h e d by v o lu n ta r y h o s p i t a l s ,
o th e r s by
28
James A. H a m il t o n , A H o s p i t a l F l a n f o r Los A n g e le s C ounty C a l i f o r n i a , b o o k le t., 1947, p . 6. ^ 30
Loc. c i t .
Los A n g e le s C o u n ty , A d m i n i s t r a t i v e C o d e, A r t i c l e IX , s e c . 1 5 0 .5 6 . Those o t h e r th a n i n d i g e n t s s h a l l n o t be a d m i t te d to C ounty h o s p i t a l s e x c e p t i n c a se o f em erg en cy , q u a r a n t in e or p u b lic d is a s te r .
the p u b lie
in stitu tio n s.
The r a t i o
o f 3 .0 1 beds p e r th o u san d
o f p o p u l a t i o n e x i s t e d i n Los A n g e le s C ounty i n 1947, a s
com
p a r e d w ith- 4 . 7 b e d s i n 1942 i n m e t r o p o l i t a n c o u n t i e s i n t h e 31 U n ited S ta te s . The D e p a r t m e n t o f C h a r i t i e s e s t i m a t e s t h a t t h i r t y - f i v e p e r c e n t o f s u c h b e d s s h o u l d b e m ad e a v a i l a b l e b y 32 t h e C ounty. An a p p r a i s a l o f h o s p i t a l s made b y t h e H a m i l t o n Survey i n
19 4 7 s h o w e d t h a t 8 , 0 3 6 a d d i t i o n a l g e n e r a l h o s p i t a l
b e d s s h o u ld be p r o v i d e d i n Los A n g e le s C ounty by 1950;
33
but
b e c a u s e t h e C o u n t y p o p u l a t i o n now h a s i n c r e a s e d m o r e t h a n was a n t i c i p a t e d a t t h a t t i m e ,
612 m ore b e d s w ould b e n e e d e d ,
o r a t o t a l of 8 ,6 4 8 .
num ber, t h e n , t h i r t y - f i v e
p ercen t,
o r 3 ,0 2 7 ,
Of t h i s
s h o u ld be g o v ern m en tal f u r n i s h e d by th e
D epartm ent o f C h a r i t i e s . by t h e Bureau o f H o s p i t a l s
N early 1,000 beds have been added s in c e 1947, b u t , a c c o rd in g to th e
H a m i l t o n S u r v e y , som e 2 , 0 0 0 a r e y e t t o b e p r o v i d e d . E f f o r t s a r e now b e i n g made b y t h e D e p a r t m e n t o f C h a r i t i e s a n d t h e Los A n g e l e s B o a rd o f S u p e r v i s o r s t o
o b tain
f e d e r a l h o s p i t a l s i n t h i s a r e a w hich have been d e c la r e d s u r 34 p lu s: McCornack G e n e r a l H o s p i t a l i n P a s a d e n a w i t h 700 b e d s
31
Through lo n g s tu d y and e x p e r ie n c e , A rth u r J . W ill, Los A n g eles C ounty S u p e r i n te n d e n t o f C h a r i t i e s , h a s fo u n d t h i p e rc e n ta g e to be q u ite a c c u ra te . 32 Jam es A. H a m i l t o n , p p . c i t . , p p . 2 3 - 4 5 . 33 I b i d . . p . 4 . 34
Los A n g e le s C ounty B oard o f S u p e r v i s o r s , F ebruary 7, 1950.
M inutes,
Ill Long Beach N aval H o s p i t a l w ith 1 ,5 0 0 b e d s ; N aval H o s p i t a l w i t h 650 b e d s*
and th e Corona
These I n s t i t u t i o n s ,
w hich p o s
s i b l y can be p u r c h a s e d a t a f r a c t i o n o f t h e i r r e a l w o r th , w ill
s a tis f y th e needs fo r a d d itio n a l h o s p ita l f a c i l i t i e s
for
t h e C ounty o f Los A n g e le s , a n d a t a v a s t s a v i n g to p r o p e r t y o w n e r s who c a r r y t h e a d v a l o r e m t a x b u r d e n .
In fa c t,
th is
num ber o f b eds m ig h t be beyond t h a t w hich i s n e e d e d f o r p u b l i c in d ig en t care;
b u t few v o l u n t a r y h o s p i t a l b e d s have b e e n added
s i n c e 1947 a n d n o t many a r e b e i n g c o n s t r u c t e d a t p r e s e n t * The p r o g r a m o f e x t e n s i v e p l a n n i n g f o r a n d a c q u i s i t i o n o f p u b l i c h o s p i t a l f a c i l i t i e s was e x p l a i n e d b y A r t h u r J . W i l l , Los A n g e le s C ounty S u p e r i n te n d e n t o f C h a r i t i e s , to
in a le tte r
th e Board of S u p e r v i s o r s : W hile t h e H a m ilto n s u r v e y m a i n t a i n e d t h a t t h e con s t r u c t i o n an d o p e r a t i o n o f g e n e r a l h o s p i t a l s sh ould be t h e f u n c t i o n o f v o l u n t a r y h o s p i t a l s , i t i s becom ing In c re a s in g ly ap p aren t th a t v o lu n ta ry ag en cies a re not g o i n g t o b u i l d them w i t h o u t a s s i s t a n c e b y g o v e r n m e n t , of e it h e r su b sid y o r c o n s tru c tio n . T ax -supported i n s t i t u t i o n s m ust ta k e th e l e a d in a n sw e rin g th e n e e d , a s have ta x -s u p p o rte d c o lle g e s to m eet th e e d u c a tio n a l
n e e d .^ * N o n -g o v e rn m e n tal h o s p i t a l s i n Los A n g e les C ounty h a v e , a s com pared w ith l a r g e u r b a n a r e a s I n o t h e r p a r t s S ta te s, g en erally been p r o f it
in stitu tio n s;
of the U n ited
a n d ,-th e re fo re ,
t h e i r p a t i e n t - d a y r a t e s h av e b e e n beyond t h e means o f t h e common m a n .
35
I n a d d i t i o n , b e c a u s e t h e Los A n g e l e s a r e a
"grew
L e t t e r t o t h e L o s A n g e l e s C o u n ty B o a r d o f S u p e r v i s o r s , March 1 , 1 9 4 8 .
1X2 up l a t e , ” t h e r e a r e few l a r g e
endowm ents w h ich f u r n i s h i n e x
p en siv e p r iv a te h o s p ita l c are.
I t is necessary,
th e D epartm ent o f C h a r i t i e s p r o v id e , a s
th en ,
th at
th e only rem ain in g
a g ency l a r g e enough to assum e t h e r e s p o n s i b i l i t y , h o s p i t a l b ed s w hich a r e n e e d e d .
I t m u st b e re m e m b e re d t h a t many p e r s o n s ,
a lth o u g h n o t d e s t i t u t e ,
a r e c o n s i d e r e d “m e d i c a l l y i n d i g e n t , ”
and e l i g i b l e f o r c a r e in th e C ounty’ s h o s p i t a l s . same w a y , m a n y e m p l o y e d v e t e r a n s a r e
In the
t r e a t e d by i n s t i t u t i o n s
of th e V eterans* A d m in is tra tio n . The H a m i l t o n S u r v e y r e c o m m e n d e d t h a t o t h e r t y p e s o f C ounty h o s p i t a l f a c i l i t i e s , a n d com m unicable d i s e a s e ,
such a s c h ro n ic , p sy c h o p a th ic
sh o u ld n o t be expanded.
36
It
re m a in s f o r r e s u l t s o f th e p r e s e n t C ounty-w ide x - r a y su rv e y to d e te rm in e w hether o r n o t f a c i l i t i e s o f t u b e r c u l o s i s sh o u ld be expanded.
fo r th e treatm en t
Beds f o r t h i s
type of
c a re have b e e n added by th e D epartm ent o f C h a r i t i e s s in c e th e w ar.
B e c a u s e o f a d e c r e a s i n g i n c i d e n c e a n d m ore r a p i d
p a t i e n t r e c o v e r y due to ad v an c em en ts i n m e d ic a l s c i e n c e , D epartm ent f e e l s om ical to t r e a t
t h a t , a s a long ran g e p la n ,
it
the
i s m ore e c o n
t h e s m a l l n u m b e r o f p a t i e n t s who c a n n o t b e
accom m odated b y t h e B ureau o f H o s p i t a l s ’ f a c i l i t i e s
in p riv ate
s a n a t o r i a a t C ounty e x p e n s e . I t m ig h t a p p e a r t h a t t h e D epartm ent sh o u ld view w ith
Jam es A. H a m i l t o n ,
op., c i t . , p .
10.
1 13 alarm th e f a c t
t h a t t o d a y o n l y some t w e n t y p e r c e n t o f t h e
a d d it i o n a l beds have been p ro v id e d t h a t o f 1947 showed w ould b e n e e d e d i n 1 9 5 0 . h o sp ital f a c ilitie s in itia tiv e ,
th e H am ilto n Survey As l o n g a s m o r e
a re n o t b ein g e s ta b lis h e d by p r iv a te
a c u r s o r y a p p r a i s a l w ould i n d i c a t e t h a t p u b l i c
a u t h o r i t i e s sh o u ld c lo s e th e gap by im m e d ia te ly s u p p ly in g m ore b e d s .
The B u re a u o f H o s p i t a l s
th e need i s not p re s s in g .
has found,
how ever,
th at
The C o u n ty h o s p i t a l s h a v e s h o r t e n e d
th e a v e ra g e s t a y p e r p a t i e n t from n e a r l y tw e n ty days i n 1935, t o 1 7 . 5 d a y s i n 1 9 4 5 , down t o
o n ly 1 3.1 d ay s f o r th e f i s c a l
y e a r 1948-49. T h e r e a r e m any f a c t o r s w h i c h a c c o u n t f o r t h i s 37 drop, b u t o n l y t h r e e wi 11 b e d i s c u s s e d . One i s e a r l y ambu latio n ,
a new m e d i c a l p r a c t i c e w h i c h i n c r e a s e s t h e
o f b e d s a n d m akes more o f them a v a i l a b l e In lin e
w ith t h i s ,
turnover
to a c u te p a t i e n t s .
an e x t e n s i o n o f o u t - p a t i e n t f a c i l i t i e s
th e v i s i t i n g n u rs e program have p ro v id e d f o r p o s t - a c u t e i n t h e home.
and
care
I n a d d i t i o n , p la c e m e n t wards a r e b e in g u s e d
m ore f r e q u e n t l y , w h e re b y , i f
re c o v e ry w i l l be ex ten d ed over
a long p e rio d of tim e, p a t i e n t s
are e ith e r p u t In a non-acute
w a r d i n t h e G e n e r a l H o s p i t a l w h e r e o n l y a m in im u m o f s e r v i c e n eed be re n d e re d , o r s e n t A second reaso n f o r
37
t o Rancho Los A m igos. sh o rter p a tie n t
stay is
the d isc o v ery
I n t e r v i e w w i t h R. B. F u l c h e r , A d m i n i s t r a t i v e A s s i s t a n t , L os A n g e le s C ou n ty G en er a l H o s p i t a l , A p r i l 4 , 1 9 5 0 .
1X4 a n d d e v e lo p m e n t i n t h e l a s t few y e a r s o f t h e v a r i o u s a n t i b i o t i c s , w hich have re d u c e d th e
l e n g t h o f tim e n e ed e d f o r
t r e a t m e n t o f m any a i l m e n t s , o f t e n b y a s m uch a s n i n e t y p e r 38 cen t. A t h i r d im p o r ta n t f a c t o r w hich a c c o u n ts f o r a d e c re a s in g need f o r a c u te and g e n e ra l h o s p ita l beds i s e sta b lish m e n t in the
l a s t decade of
i c a l and h o s p ita l p la n s ,
the
e x t e n s i v e v o l u n t a r y m ed
such a s B lue C ro ss and R oss L o o s,
a s w e l l a s th e o p e n in g o f many s m a l l n e ig h b o r h o o d m e d i c a l b u i l d i n g s w h e r e p e r s o n s may b e e a s i l y t r e a t e d f o r v a r i o u s illn e sse s.
Such f a c i l i t i e s
o f f e r e a r ly d ia g n o s is and in ex
p e n s i v e t r e a t m e n t w hich p r e v e n t s ,
i n m an y c a s e s ,
m ent o f m ore e x t e n s i v e o r s e r i o u s i l l n e s s e s . w ith t h i s
l a s t p o in t,
the
develop
In co n ju n ctio n
a n o th e r c o n s i d e r a t i o n h a s been the
h i g h c u r v e o f t h e econom ic c y c l e d u r i n g t h e l a s t t e n y e a r s . It
i s a p p a r e n t t h a t t h e D epartm ent o f C h a r i t i e s i s
a d eq u a te ly supplying th e needs f o r p u b lic h o s p ita l f a c i l i t i e s i n Los A n g e le s C o u n ty . recen tly , u a lly th is
F o r many y e a r s ,
and u n t i l r e l a t i v e l y
th e re had been a long w a itin g l i s t f o r beds. list
n eeding b ed s.
has been d is s ip a te d u n t i l The s u r g i c a l w a i t i n g l i s t
to d ay th e r e a re
In terv iew t i v e A s s i s t a n t , Los 39 In ter v iew f o r th e Los A n g e le s 2 3 , 1950.
few
has been reduced to
what p h y s i c ia n s c o n s id e r a norm al am ount, 5
■Z O
G rad
Good s e r v i c e
w i t h Jam es A. R o b in s o n , J r . , A d m i n i s t r a A ngeles D epartm ent o f C h a r i t i e s , A p r il 6 , w i t h Howard W e s t , M. D . , M e d ic a l A d v i s o r C o u n ty D e p a r tm e n t o f C h a r i t i e s , F e b r u a r y
1950.
115 I s p rovided a t the
Bureau o f H o s p i t a l ^
fa c ilitie s,
w ith th e burden t h a t ta x p a y e rs can b e a r. i n t h e com m unity a r e
eith er
com m ensurate
The b e t t e r d o c t o r s
on, o r a tte m p tin g
to be p la c e d on,
th e v ario u s a tte n d in g
staffs
because of th e v a st tr a in in g and
exp erien ce a ffo rd e d .
One l o c a l h o s p i t a l a d m i n i s t r a t o r w a s o f
t h e o p in io n t h a t Los A n g e le s C ounty p r o v i d e d t h e f i n e s t p u b l i c h o s p ita l care i n th e U nited S ta te s ,
and t h a t t h i s was t h e 40 g e n e r a l c o n s e n s u s am o n g h o s p i t a l a u t h o r i t i e s . At l e a s t , th e D epartm ent of C h a r i t i e s a p p e a rs to be f u l f i l l i n g
its
ro le
of a d e q u a te ly a d m in is te rin g h o s p ita l c a re to th e s ic k poor o f Los A n g e le s C o u n ty . The D e p a r tm e n t o f C h a r i t i e s h a s b e e n t h e t a r g e t o f 11s h a r p - s h o o t i n g 11 b y v a r i o u s g r o u p s o f c i t i z e n s
who h a v e
a tta c k e d the v a st a n n u al e x p en d itu re s f o r p u b lic w e lfa re . T h is has r e s u l t e d from t h e i r co n cern a s to
th e amount of
money s p e n t , w i t h o u t a n a n a l y s i s o r e v a l u a t i o n o f t h e s e r v i c e s f o r w hich th e
fu n d s were p r o v i d e d .
A lthough p u b lic w e lfa re
i s n o t n e w , t h e r e r e m a i n m an y i n d i v i d u a l s a n d o r g a n i z a t i o n s t h a t a d h e r e t o th e o l d E l i z a b e t h a n m ethod o f o f f e r i n g m e d ic a l c a re and a s s i s t a n c e
o n t h e b a s i s t h a t t h o s e who a p p l y t o t h e
“ c o u n t y ” a r e r e s p o n s i b l e f o r t h e i r own d e p e n d e n c y , a n d t h e r e -
40 istrato r, 1950.
I n t e r v i e w w i t h R o b e r t E . H e n w o o d , A s s i s t a n t A d m in C ed ars o f L ebanon H o s p i t a l , Los A n g e le s , A p r i l 4 ,
X16 for© s h o u ld be c a r e d f o r i n a l i m i t e d a n d r e s t r i c t e d f a s h i o n . The g e n e r a l a t t i t u d e serv ices,
tow ard w e lfa r e
h o w e v e r , d e n o t e s a more c o n s t r u c t i v e p h i l o s o p h y i n
th e a p p ro a c h to m eeting bers of so c ie ty .
th e n e e d s o f the- l e s s
C om m unities, th r o u g h l o c a l ,
n a tio n a l ag en cies, w e lfa re program . u n til
o f m ost c i t i z e n s
f o r t u n a t e mem s t a t e and
a r e s e e k in g a com prehensive and i n t e g r a t e d 11G o v e r n m e n t a l f u n c t i o n s h a v e b e e n e ^ a n d e d
th ey to u ch p r a c t i c a l l y
every a sp e c t of our l iv e s .
D uring th e p a s t dozen y e a rs th e p ro c e s s has b een a c c e l e r a t i n g u n til
so ciety , actin g c o lle c tiv e ly ,
a r a n g e o f human a f f a i r s and w orld tr a d e to
th at
h a s become c o n c e r n e d w i t h
e x te n d s from i n t e r n a t i o n a l
the in tim a te and p e rso n a l d e t a i l s
fin an ce
of ch ild
w e l f a r e . 11^ P ro g ress in p u b lic w e lfare throughout the n a tio n i s k e y n o te d i n t h e Los A n g e le s County D e p a rtm e n t o f C h a r i t i e s since i t
i s p r o v i d i n g , w i t h i n th e fram ew ork o f f e d e r a l ,
and lo c a l s ta tu te s ,
th e m ed ical and a s s i s t a n c e
p e c t e d and dem anded by t h e com m unity i t sa m e t i m e i t
is
sa fe g u a rd in g the
sta te
program s ex
s e rv e s , w hile a t
the
in te g r ity of p u b lic funds.
J a r l e L e i r f a l l o m and M ajor R u s s e l l P . D ra k e, O rgan i z a t i o n and A d m in is tr a tio n of L o cal P u b lic W elfare S e rv ic e s (C hicago: A m erican P u b lic W e lfa re A s s o c i a t i o n , 1 9 4 3 ), p . 6 .
BIBLIOGRAPHY
BIBLIOGRAPHY A.
BOOKS
A bbott, E d ith , P u b lic A s s is ta n c e , C hicago: o f C hicago P r e s s , 1940, 894 p p .
The U n i v e r s i t y
A b b o t t , G r a c e , Prom R e l i e f t o S o c i a l S e c u r i t y . C hicago: The U n i v e r s i t y o f C h ic a g o P r e s s , 1 9 4 1 . 388 p p . _________ , The C h ild and th e S t a t e . C hicago: o f C hicago P r e s s , 1938. 700 p p . A n g le , G race M ., " F e d e r a l A g e n c ie s B . H o d g e s , e d i t o r , S o c i a l Work R u s s e l l Sage F o u n d a t i o n , 19 4 9 .
The U n i v e r s i t y
i n S o c ia l W ork.” M a rg are t Y ear Book. N ew .York: p p . 197-206.
A s h b u r n , P . M ., A H i s t o r y o f t h e M e d ic a l D e p a r tm e n t o f t h e U n i t e d S t a t e s Army. B oston: H o u g h to n M i f f l i n Company, 1929. 448 p p . Baehm eyer, A r t h u r C ., a n d G e rh a rd H artm an, e d i t o r s , T r e n d s a n d D e v e l o p m e n t s , 1 9 4 9 - 1 9 4 6 . New Y o r k : C o m m o n w e a lth F u n d , 1 9 4 8 . 819 p p .
H o sp ital The
Bondy, R o b e r t E . , " N a t i o n a l A s s o c i a t i o n s i n S o c i a l W ork." M a r g a r e t B. H o d g e s , e d i t o r , S o c i a l Work Y e a r B o o k . New Y ork: R u s s e l l Sage F o u n d a tio n , 1949. p p . 3 3 2 -3 3 8 . Cahn, F ra n c e s , and V alesk a B ary, W elfare A c t i v i t i e s o f F e d e ra l S t a t e . and L o c a l G overnm ents i n C a l i f o r n i a , 1850- 1 9 5 4 . Bureau o f P u b lic A d m i n i s t r a t i o n , U n i v e r s i t y o f C a l i f o r n i a . B erkeley: U n iv e r s ity of C a lif o r n ia P re s s , 1936. 422 p p . D e u t s c h , A l b e r t , The Shame o f t h e S t a t e s . B r a c e a n d C o m pany , 1 9 4 8 . 188 p p .
New Y o r k :
H arcourt
F a u ri, F . -F . , "P u b lic A s s is ta n c e ." M a r g a r e t B. H o d g e s , e d i t o r S o c i a l Work Y e a r B o o k . New Y o r k : R u s s e l l Sage F o u n d a tio n 1949. p p . 370-381. F i f i e l d , James C l a r k , e d i t o r , A m e ric a n a n d C a n a d ia n H o s p i t a l s . M in n eap o lis: M i d w e s t P u b l i s h e r s C o m p an y , 1 9 3 3 . 1560 p p . F i n k , A r t h u r E . , The F i e l d o f S o c i a l W ork. H o l t a n d Company, 1 9 4 2 . 518 p p .
New Y o r k :
H enry
11 8 H a m il t o n , Jam es A*, A H o s p i t a l P l a n f o r Los A n g e le s C o u n ty , C a lifo rn ia , B ooklet. [n . n . ), 1947, 51 p p . H a y t , E m anuel, a n d L i l l i a n R. H a y t, L e g a l -A s p e c t s o f H o s p i t a l P ractices. New Y o r k : H o s p i t a l T e x t b o o k Company, 1 9 3 8 . 239 p p . H o d g e s , M a r g a r e t B . , e d i t o r , S o c i a l Work Y e a r B o o k . Y ork: R u s s e l l Sage F o u n d a tio n , 1949. 714 p p .
New
H o ltzm an , Abraham , Los A n g e le s C ounty C h i e f A d m i n i s t r a t i v e O f f i c e r : Ten Y e a r s f E x p e r i e n c e . Bureau o f G overnm ental R e s e a r c h , U n i v e r s i t y o f C a l i f o r n i a , Los A n g e l e s . Los A ngeles: U n iv e r s ity o f C a lif o r n ia , 1948. 77 p p . H o s p ita l C are i n th e U n ite d S t a t e s . w e alth Fund, 1947. 6 3 1 ’p p .
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Lapp, John A ., and D o ro th y K etcham , H o s p i t a l Law. The B ru ce P u b l i s h i n g Company, 1 9 2 6 . 557 p p .
M ilw aukee:
L e i r f a l l o m , J a r l e , an d M ajor R u s s e l l P. D rak e, O r g a n iz a t i o n and A d m in is tra tio n o f L ocal P u b lic W elfare S e r v ic e s . C hicago: A m erican P u b lic W elfare A s s o c i a t i o n , 1943. 63 p p . L u n d b e r g , Emma 0 . , " C h i l d W e l f a r e . ” M a r g a r e t B . H o d g e s , e d i t o r , S o c i a l Work Y e a r B o o k . . New Y o r k : R u s s e l l Sage F o u n d atio n , 1949. p p . 98-109. M a c D o n a l d , A u s t o n F . , A m e r i c a n S t a t e Gov e m i n e n t a n d A d m i n i s t r a .t i o n . T h i r d e d i t i o n ; New Y o r k : T hom as Y . C r o w e l l C om p an y , 1945. 655 p p . M a cE a ch e rn , M alcolm T . , H o s p i t a l O r g a n i z a t i o n a n d M anagem ent. C hicago: P h y s i c i a n s * R e c o r d Company, 1 9 4 6 . 1052 p p . Manual o f H o s p i t a l S t a n d a r d i z a t i o n . A m erican C o l l e g e o f Surgeons. C hicago: P h y s i c i a n s * R e c o r d Company, 1 9 4 2 . 112 p p . M e r i a m , L e w i s , R e l i e f a n d S o c i a l S e c u r i t y . W a s h i n g t o n , D. C . : The B r o o k i n g s I n s t i t u t i o n , 1 9 4 6 . 912 p p . M i l l s , A lden B . , H o s p i t a l P u b l i c R e l a t i o n s . C hicago: P h y s i c i a n s * R e c o r d Company, 1 9 3 9 . 361 p p . M i l l s p a u g h , A r t h u r C . , P u b l i c W e l f a r e O r g a n i z a t i o n . W ash i n g t o n , D. C . : The B r o o k i n g s I n s t i t u t i o n , 1 9 3 5 . 700 p p .
11 9 O rg a n ! z a tlo n and A d m i n is tr a t io n o f T a x -S u p p o rte d M edical C a r e * Pam phlet* C hicago: A m erican P u b l ic W e lfa re A s s o c i a t i o n , .1949* 7 pp. P f i f f n e r , J o h n M*, P u b l i c A d m i n i s t r a t i o n * R e v i s e d e d i t i o n ; New Y o r k : The R o n a l d P r e s s C o m p a n y , 1 9 4 6 * 621 p p . P r o c e e d i n g s o f t h e N a t i o n a l C o n f e r e n c e o f S o c i a l Work* 7 4 th a n n u a l m eeting* New Y o r k : C olum bia U n i v e r s i t y P r e s s , 1948. 512 p p . R e p o r t w i t h S p e c i a l S t u d l e s * P r e s i d e n t s C o m m ittee on A d m i n i s t r a t i v e M anagem ent. W a s h i n g t o n , D* C * : Government P r i n t i n g O f f i c e , 19 37* 382 p p . R o u t z a h n , Mary S w a i n , “P u b l i c R e l a t i o n s i n S o c i a l W o r k . ” M a r g a r e t B. H o d g e s , e d i t o r , S o c i a l Work Y e a r B o o k . .New Y ork: R u s s e l l Sage F o u n d a tio n , 1 949. p p . 397-403. Sherwood, R o b e r t £ . , R o o s e v e lt a n d H opkins * H arper and B ro th e rs , 1948. 9 79 p p .
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S m i t h , I . E v e l y n , " A d o p t i o n . ” M a r g a r e t B* H o d g e s , e d i t o r , S o c i a l Work Y e a r Book. New Y o r k : R u s s e l l Sage F o u n d a tio n . 1949. p p . 22-27. S tevenson, M a rie tta , "P u b lic W e lfa re ." M a r g a r e t B. H o d g e s , e d i t o r , S o c i a l Work Y e a r B o o k * New Y o r k : R u s s e l l Sage F o u n d atio n , 1949. p p . 403-414. _________, P u b l i c W e l f a r e A d m i n i s t r a t i o n . M a c m illa n Company, 1 9 3 8 . 352 p p .
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Y o u n g d a h l , B e n j a m i n E . , " S o c i a l Work a s a P r o f e s s i o n . " M a r g a r e t B. H o d g e s , e d i t o r , S o c i a l Work Y e a r B o o k . New Y o r k : R u s s e l l Sage F o u n d a tio n , 1 9 4 9 . p p . 497-506. B.
PERIODICAL ARTICLES
A b b o t t , E d i t h , " A b o l i s h t h e P a u p e r L a w s , " The S o c i a l S e r v i c e R ev iew . V I I I (M arch, 1 9 3 4 ), 1 0 -1 1 . H o s p ita ls . 23:22, P a rt I I ,
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M a i s e l , A l b e r t Q . , "Why You C a n ' t A d o p t a B a b y , ” Woman' s Home C o m p a n i o n . . 7 7 : 5 1 . M a r c h , 1 9 5 0 .
120 S o c ia l L e g i s l a t i o n B u l l e t i n , W elfare C o uncil of M e tro p o lita n L o s . A n g e l e s , 1 : 5 , 1 95 0 s e r i e s * “V o t e . Y e s on P r o p o s i t i o n No* 2 , " T h e T a x D i g e s t , 2 7 : 2 9 5 , S e p t e m b e r , 1949* “What i f P r o p o s i t i o n No. 4 i s R e p e a l e d , " T h e T a x D i g e s t , 27:136, A p r i l , 1939. C.
GOVERNMENT HJBLICATIONS
C alifo rn ia* G a l. S t a t s * ( 1 8 5 5 ) , Chap. L V II, s e c . 1 , 2 , 6 , 7 , 8 ; ( 1 8 6 0 , C h a p . 2 4 7 , s e c s . 1 , 1 2 ; ( 1 8 7 0 ) , C h a p . CCXXVIII, s e c s . 1 , 2 ; ( 1 8 8 3 ) , C h a p . XCVI, s e c . 1 ; ( 1 8 9 5 ) , C h a p . 1 2 , s e c . 1 ; ( 1 9 0 1 ) , C h a p . CCX, s e c s . 1 - 7 ; ( 1 9 0 3 ) , C h a p . CCCLXIII, s e c s . 1 , 3 ; ( 1 9 1 5 ) , C hap. 7 6 6 , s e c . 3 ; ( 1 9 1 9 ) , Chap. 144, s e c s . 1, 4; (1 9 2 1 ), Chap. 510, s e c . 1; (1 9 2 7 ), Chap. 239, s e c . 2 ; ( 1 9 2 9 ) , C hap. 5 3 0 , s e c s . 1 - 3 ; and Chap. 845, se c . 1 ; ( 1 9 3 1 ) , Chap. 110, s e c . 2, 4; (1 9 3 5 ), Chaps. 633, 703, 804. C a lifo rn ia .
C o n stitu tio n .
C a lifo rn ia . C o u n t y o f S a c r a m e n t o v . C h a m b e r s . 3 3 C a l i f . Ap p . 148 (19175 C a lifo rn ia . D epartm ent o f S o c ia l W e lfa re . A d m in istrativ e S t u d y o f L o s A n g e l e s C o u n t y 1s A d m i n i s t r a t i on o f P u b l i c A ssistan ce. Sacram ento: C alifo rn ia S ta te P rin tin g O ffic e , 1948. 199 p p . C a lifo rn ia . H e a l t h and S a f e t y Code. Sacram ento: S ta te P r i n t in g O ffic e , 1947. 692 p p . C a lifo rn ia . W elfare and I n s t i t u t i o n s Code. C a li f o r n ia S ta te P r i n t i n g O f f ic e , 1947.
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Sacram ento: 356 p p .
C i t i z e n s 1 A d v i s o r y C om m ittee on P u b l i c A s s i s t a n c e , L e t t e r t o t h e Los A n g e le s C ounty B o ard o f S u p e r v i s o r s . June 27, 1944, p . 9. Illin o is.
Illin o is
Los A n g eles C o u n ty .
C i v il A d m in is tra tiv e Code. A u d ito r.
B u d g ets.
Los A n g e l e s .
Los A ngeles C ounty. Board o f S u p e r v i s o r s . C ode. Los A n g e le s , 1949. 59 p p .
A d m in istrativ e
121 Los A n g e le s County* Board o f S u p e rv is o rs * A n g eles, 1949, a n n o ta te d . 69 p p *
C h arter*
Los
L os A n g e le s County* Board o f S u p e rv is o rs * M inutes. May 1 4 , 1 8 5 5 ; May 5 , 1 8 7 4 ; D e c e m b e r 1 5 , 1 8 7 4 ; A p r i l 3 , 1 8 7 8 ; J u l y 1 1 , 1 8 8 5 ; A u g u s t 5 , .1 8 9 1 ; J u l y 8 , 1 8 9 3 ; March 2 2 , 1 9 0 9 ; F e b r u a r y 7 , 1 9 5 0 ; A p r i l 1 1 , 1 9 50 * Los A n g e les C o u n ty . B oard o f S u p e rv iso rs* 3 8 0 ( N . S . ) ; Wo. 3 1 7 5 (W. S . ) . Los A n g eles C ounty. Los A n g e le s .
O rdinance *
D epartm ent of C h a r i t i e s .
Wo.
Annual R e p o r t .
Los A n g e l e s County* D epartm ent o f C h a r i t i e s . L e tte r. A r t h u r J* W i l l , S u p e r i n t e n d e n t o f C h a r i t i e s , t o L o s A n g e le s C ounty B oard o f S u p e r v i s o r s . Los A n g e l e s , M arch 1, 1948. R uddock, A. B . , C h a irm a n , H o s p i t a l A d v is o r y C o m m itte e , L e t t e r t o a l l n e w s p a p e r s i n L o s A n g e l e s C o u n t y * Wovember 6 , 1 9 4 5 , p . 1# U n ited S ta te s . 7 4 th C ongress, (A ugust 14, 1 9 3 5 ).
1st se ssio n ,
U n ited S ta te s .
79th C ongress,
P . L . 725
U nited S ta te s .
H e l v e r i n g v . D a v i s . 3 0 1 U . S . 619 ( 1 9 3 7 ) .
U nited S ta te s . 3, 1939).
53 S t a t * 5 6 2 ,
D.
620 c h a p .
531
(A ugust 13, 1 9 4 6 ).
5 U . S* C . A * , s e c .
133 (A p ril
NEWSPAPERS
The L o s
A n g e l e s D a i l y News, M a r c h 7 ,
1950; A p ril 6,
The Los
A n g e l e s E x a m i n e r . W ovember 2 7 ,
1950.
1949.
T he L o s A n g e l e s T i m e s . May 2 6 , 1 9 4 7 ; D e c e m b e r 6 , 1 9 4 7 ; Decem b e r 7 , 1 9 4 7 ; . December 2 9 , 1949; F e b r u a r y 2 2 , 1950; . M arch 1 0 , 1 9 5 0 ; M arch 1 1 , 19 5 0 ; M arch 1 9 , 1 9 5 0 ; March 2 2 , 1950; A p r i l 1 , 1950; A p r il 4 , 1950; A p r i l 5 , 1950.
122 E.
PERSONAL INTERVIEWS
B a r r , W i l l i a m A*, E x e c u t i v e A s s i s t a n t S u p e r i n t e n d e n t o f C h a r i t i e s , Los A n g e l e s C o u n ty D e p a r t m e n t - o f C h a r i t i e s # Cox, B e r y l E # , D eputy S u p e r i n t e n d e n t o f C h a r i t i e s , A n g e le s C ounty D ep artm en t of C h a r i t i e s #
Los
P U lc h e r , R. B , , A d m i n i s t r a t i v e A s s i s t a n t , G e n e ra l H o s p i t a l , Los A n g e le s C ounty D e p a rtm e n t o f C h a r i t i e s * Henwood, R o b e r t E . , A s s i s t a n t A d m i n i s t r a t o r , C e d a r s o f L eb an o n H o s p i t a l , Los A n g e les# R o b in s o n , Jam es A#, A d m i n i s t r a t i v e A s s i s t a n t , County D e p a rtm e n t o f C h a r i t i e s #
Los A n g e les
S c h u c k e r t , G e r t r u d e , Head A d m i n i s t r a t i v e A s s i s t a n t , Los A n g e le s County D e p a rtm e n t o f C h a r i t i e s # W e s t , H o w a r d , M# D # , M e d i c a l D i r e c t o r , L o s A n g e l e s C o u n t y D epartm ent o f C h a r i t i e s # W ill, A rth u r J . , S u p erin ten d en t of C h a r itie s , C ounty D epartm ent o f C h a r i t i e s #
University of S o u th e rn C al.fo rn l, U b » 0
Los A ngeles