Mr. CONTE. I am vitally interested in that problem. I am going to ask the doctor that question when he testifies. Maybe he can clarify it. Thank you very much.

TESTIMONY OF DR. OAKLEY SAUNDERS, COMMISSIONER, COMMU NITY ACTION COMMISSION, CAP, BALTIMORE, MD.

Dr. SAUNDERS. I am Dr. Oakley Saunders, a pediatrician in Baltimore City, in the target area. As a matter of fact, directly across the street from one of the drugstores that probably has been represented this morning.

Mr. POTVIN. Can you identify that drugstore?

Dr. SAUNDERS. Keystone Pharmacy, across the street from my office-probably part of the association that was represented this morning.

First I would like to thank you for permitting me to join in these proceedings, since it has been a rather amiable thing to this point, at least.

I would like to take exception to the statement of Mr. Kaufman who I believe implied that certain of the pharmacists were being villified by the proponents of the on-site pharmacy. The case really was not quite like that, Mr. Kaufman. I think that the people who produced these facts just produced them like they saw them. It might have been some of the pharmacists who have been sensitive after they looked at the facts. But I suppose I ought to go on and say that when the project first was proposed, the physicians in the Provident Hos pital staff had some misgivings initially. But after it was explained, these physicians practicing in the inner city were extremely en thusiastic and I think excited is not too strong a word--because it represented a rather radical departure from the traditional ultraconservative image that most physicians have. We have been accused of sitting idly by waiting for the stream of patients to come drifting into our offices and not being directly and immediately involved.

This seems like a rather existing concept, that for once we were go ing to do something direct and aggressive in reaching these people who were in their miasma of misery, and recognized they had many periph eral and paramedical problems as well as the traditional medical things.

You know Baltimore is No. 2 in the Nation for tuberculosis. This is not just a pure medical problem as such, because you can have all the antituberculant drugs in the world-but if you have bad housing and bad food and crowded conditions you'll have a high rate of tuberculosis. Baltimore still has a lot of rat bites every year. I won't dwell on that too much.

Baltimore has a lot of children die every year from lead toxicity from chewing paint, cheap paint on tenement houses, off window sills. These are the paramedical problems which we face as physicians in the inner city.

Now, even I, I must confess, had some misgivings when a block and a half away from me-and I am in pediatrics-there was a comprehen sive pediatrics center opened about 18 months ago. I wondered if this would affect my practice adversely with title 19 patients. Peculairly enough, a year and a half later I'm now seeing 15 percent in my prac

tice instead of 8 percent formerly. In other words, a 100 percent increase where my total patient load has increased 20 percent. I think the pharmacists will have the same kind of experience if they are competitive in regards to quality, prices, courtesy, et cetera.

You know the old American principle of free enterprise.

I must go back to Mr. Kaufman, because he had such a beautiful presentation for the association this morning that I was nearly turned around in my thinking. But then as his clients followed him to the microphone, I found there were certain glaring inconsistencies which made me believe I was on the right track after all when I was in favor of this pharmacy on the premises.

For example, his first client talked about the fact that being in the 800 block of North Avenue he would have competition from a center which was down on Freemont Avenue and Shroder Street. But knowing the city as I do, and I am sure you do, Mr. Kaufman, you recognize it's about 20 blocks from his pharmacy down there, and there are probably 20 to 25 blocks for him to get over to Johns Hopkins.

Now, Johns Hopkins Hospital has a comprehensive pediatric center with a pharmacy, the same types of services that we are proposing now. The University Hospital has a comprehensive pediatric center, same type of services.

Mr. PoTVIN. Let me ask you this question. Are any of these hospital pharmacies that you are referring to Government-financed, or with access to VA supplies?

Dr. SAUNDERS. In the case of Hopkins, this was a direct grant. It did not come through OEO. So this is a Federal grant. I believe the Children's Bureau.

Mr. POTVIN. The answer is they probably do have access.
Dr. SAUNDERS. Yes-mainly Federal funds.

To go on-the second client was Mr. Fedder. Now, I notice the counsel has been very specific in his questions, and wanted specific answers at times, I would like to ask if Mr. Fedder would supply this committee with the percentage of the pharmacists in the ghetto who have family record cards, how many in actual numbers. I would like to know how many of them have engaged in innovated health programs for these people that they purport to serve. How many have been speakers at health affairs. How many have had scholarships granted to people in the inner city in the health field? How many have taken people under their wing to train them in their pharmacies and perhaps in the pharmacy school at a later time-actual numbers of people and numbers of ways they have done it and talked to people.

You see, at one point, sir, one of the pharmacists said very explicitly he was a professional, too, and he was intelligent, too, and he sort of resented this base canard that maybe he was not quite up to par. Now if he is a professional he does not have to be stimulated to do the right thing for the people he serves; he knows what needs to be done and he does it.

Mr. POTVIN. I think there is a point here. The rather detailed offer made by the pharmacy association was prospective in nature. I think Mr. Kaufman would concede that this has caused stirrings and rustlings and, perhaps I could say on the first day of spring, a reawakening on the part of his people.

This, too, is all to the good. But I think that you should exhibit some charity there in the hope that there might be redemption for all of us, and if some of them have indeed been remiss in some respects, I think they are entitled to be considered as acting in good faith when they come and say, "We are going to do these things"-until proven other wise, I think you have to assume they are asserting that in good faith. I don't think they are saying, "We all do this now."

sir.

Dr. SAUNDERS. I am not completely lacking in Christian charity,

Mr. POTVIN. I didn't mean that.

Dr. SAUNDERS. But I am suggesting it's a bit late for crocodile tears when these obvious lapses in community responsibility have been made evident because this did not happen overnight.

We talk about drug prices. There's been developed by a Mrs. Johnson of the Urban League Consumer Protection Program a comparison of drug prices in Baltimore City, inner city, target area, as compared to the suburban area. We will send this to you--because it conclusively shows not only prescription items, but sundries

Mr. POTVIN. Would this be applicable through the vendor system, where they sell at their wholesale cost plus a professional fee?

Dr. SAUNDERS. I cannot answer that specifically. It has been my experience when a patient carries a prescription into a drugstore, even if he is medicare and doesn't have to pay out of his own pocket, he will also maybe buy a bottle of alcohol or a bottle of shampoo or lotion and pay 15 to 20 to 25 percent more than someone on the periphery of the city. This is a fact proven conclusively.

Mr. CONTE. Would this come from a drugstore of comparable size! You have this problem all over the country. Some of your large chains sell below cost.

Dr. SAUNDERS. I'm not talking about the chain-type pharmacy, sir. I'm talking about the private pharmacy.

Lastly I would like to touch on something that is an obvious conflict between what Mr. Kaufman, Mr. Fedder and Mr. Patz said on the one hand, and Mr. Taisch said on the other.

The first group of men had spoken to the point of innovating and producing changes in reaching people, and supplying them with drugs and health services. Mr. Taisch, however, has stated that the main thing without frippery was to get medicine to the people.

But as Dr. English, I believe it was, has already clearly stated, and it has been supported by studies in Baltimore-and we will get a copy of this report to you if you wish-it's not enough to put medicine in the hands of people if they have not been sufficiently motivated to take the medicine with a sense of mutual responsibility between patient and physician.

And so I feel that part of this at least is the educational process part of this is the mutual area of respect for each other. It's not enough to drape the arm lovingly around the shoulder in a paternalistic sense and say, "I'm on your side, Buddy, here's your medicine." It's just as bad I feel on the one hand as the exploitative concept on the other. And I feel that some attitudes have to be changed, and I feel that the attitudes that have been exhibited by the members of the pharms ceutical association here today do not indicate that they have the kind

of awareness to be responsible for the development of the program

at this stage.

I think there is a place for them, yes. But I don't think they should be trusted with the responsibility of the developing program.

Mr. CONTE. Doctor, I realize this is going far afield from what these hearings are all about, but for my own edification do you know any pharmacies in Baltimore that are distributing pep pills or narcotics to juveniles?

Dr. SAUNDERS. No, sir, I cannot honestly say that I do. If I did, I am sure this would be a matter of approach to the proper authorities. This is a difficult thing. I would not dare even to suggest that I do if I could not prove it.

Mr. CONTE. It is a very serious problem, and one that will take the cooperation of all of us to stop.

Mr. Mitchell, do you want to wrap it up?

Mr. MITCHELL. Yes, sir. I said I would try to rebut specifically some of the points raised earlier. I don't need to do this, I don't think. I believe that many of the witnesses that have spoken to the committee have rebutted some of the statements that were made by Mr. Kaufman this morning.

Just two items in conclusion, if you please.

The first-we spoke earlier today about the ironical situation of one Federal agency apparently working at cross purposes with another. Even more ironic, even more deplorable is this situation, where we are trying to get women off of the welfare rolls to go to work. As we try to get them off of the welfare rolls to go to work-and this is national studies have disclosed that because of poor health, bad diet, lack of proper medical services, lack of proper pharmaceutical services, these women, although they want to work, are deemed unfit physically because of this terrible thing that we have done to inner city residents. The last point that I want to make is that in our community action program we have two neighborhood councils made up of committee members from various neighborhood centers. One is in East Council and one is in West Council. Altogether those councils are embracing approximately 600 or 700 people, and speaking for many more than that number.

I wanted to just submit to you and read for you, if you will, the letter submitted by Mr. John Herbert, the chairman of the West Baltimore Advisory Council. I think he sums up very well what our position is.

This letter was addressed to Dr. Frankel.

DEAR DR. FRANKEL: It is the general consensus of the West Baltimore Advisory Committee that the present plan for the Provident Hospital comprehensive plan be accepted. We are of the opinion that this present plan should definitely include a pharmacy in the center. Omission of a pharmacy would certainly impose undue hardships on the residents involved in such a program. After discussing this problem at length with the West Baltimore Advisory Council, we find that many of the problems we are trying so hard to eliminate would continue to plague us in the future. We assure you that the situation now confronting us is not a pleasant one. Many of us have had very unpleasant experiences that we feel can certainly be corrected by the addition of a pharmacy in the comprehensive program. In our area we are constantly faced with the fluctuation of prices of prescriptions and in many instances we do not have a choice of to what pharmacy we would like to go. There is an ever-present time factor that should also be included here. One often finds that a prescription

should be filled immediately. This cannot always be done under the present circumstances. A center pharmacy would surely eliminate this problem. By further viewing this problem, we find very often that pharmacies that we go to may be out of a particular drug and will substitute another for us. We found even though this comprehensive center would be in West Baltimore, we have the support of the East Baltimore Advisory Council. They feel in conjunction with us that a pharmacy must be present in the plans of the center. Evaluating the situation, we certainly hope that you will take favorable action on our pressing problem.

Sincerely,

JOHN HERBERT.

We have no other statements to make. We are prepared to answer any additional questions.

Mr. CONTE. Thank you. Counsel has a question.

Mr. POTVIN. Mr. Chairman. Mr. Mitchell, on August 7 you wrote Mr. Nathan I. Gruz, executive secretary of the Maryland Pharmaceu tical Association, saying that you had recommended to Dr. Saunders, as chairman of the health committee, that the representative from the Maryland Pharmaceutical Association serve on that committee, and you go to say in a general way this is going to be taken up by the health committee and as soon as there has been a ruling you will let them know. Was any follow-through done on that, sir, and what was the result?

Mr. MITCHELL. Dr. Saunders will speak to the follow-through. I will simply indicate that this was a continuing effort. We consulted the Provident Hospital people, and they said they would be delighted to have a pharmacist serve on the board of the in-house pharmacy for the health center.

Mr. POTVIN. Was Mr. Gruz informed of this?

Dr. SAUNDERS. As chairman of the health committee I must confess that the Community Action Commission was reorganized, and the health committee was simply absorbed into a so-called programs com mittee. This was primarily a committee, which was concerned with liaison between the Commission and the OEO office.

When we had established some of the initial guidelines, we the turned most of the operations over to the director of the project and his staff. So this was the reason this gap existed.

Mr. MITCHELL. Mr. Gruz was apprised of this at a meeting November 2, 1967, at which Mr. Gruz, Mr. Kaufman, Mr. Lachma and others were present. The entire pharmaceutical association apprised of it on November 6, 1967.

Mr. POTVIN. In brief, it was done verbally.

Mr. MITCHELL. That's right.

Mr. POTVIN. That explains the vacuum in my file.

Mr. Mitchell, could you submit at your convenience for the co mittee such documents that you may have in your possession th show or tend to show the sort of consultation that you did in t context of the guidelines prior to the submission? We are a little fogg in that point.

Lastly, Mr. Chairman, I have a rather brief list of written question which I would like to submit to Dr. English for reply to the commit within such time as the chairman will see fit to designate.

Mr. CONTE. Without objection, the questions and answers will accepted for the record.

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