WORK OF THE PURCHASING COMMITTEE DURING THE YEAR

The Commission has devoted a great deal of attention to the work done by the purchasing committee during the past year and is firmly of the belief that its activities will result in a great saving to the State. The question of purchasing coal at a reduced rate is one of the greatest importance, owing to the large amount of fuel which is used by the various institutions. It has been suggested that coal should be purchased on what is known as the "B. t. u." basis. The price paid for the coal in accordance with this plan depends entirely on the number of heat units furnished, so that heat units are paid for rather than tons of coal. Heretofore the different hospitals have purchased coal from sources which proved the most available under the circumstances and which varied largely with local conditions. The purchasing committee has devoted considerable time during the past year to this important question and, after consulting various authorities and studying the specifications used by the United States government, the city of New York, the Superintendent of State Prisons and the Fiscal Supervisor, prepared a set of specifications which it was thought would result in a material improvement over existing conditions. Unfortunately, the bids on these specifications were obtained at a time when a serious coal strike was impending and the committee's plans were accordingly not subjected to a test which was entirely a fair one. It was found, however, that the producers, in the form of the large coal companies, which have furnished the hospitals with their fuel heretofore, would not bid on these specifications, owing to the fact that they provided for a certain limitation as to the number of British thermal units contained in the coal supplied. Unquestionably the B. t. u. basis represents the most scientific method of purchasing fuel which is known to-day. Unfortunately, however, the coal situation is practically entirely in the hands of the large companies, which refuse to submit to any such restrictions. The plan adopted by the Commission on the recommendation of the purchasing committee and the various engineers and other authorities consulted has not resulted in any material advantage. There has been no improvement in the standard of coal furnished and no material saving in the amount

expended for fuel. In view of these facts the Commission is inclined to the belief that no economy can be exercised by the purchase of coal under joint contract through the medium of the purchasing committee.

extras.

After a careful study of the situation, and after repeated consultations with the representatives of the State Department of Agriculture, the committee recommended the purchase of butter by joint contract. It was thought that it would be wise to purchase large quantities of butter of the grade known to the trade as extras, when this quality could be purchased at a low price, for storage. The Agricultural Department was of the opinion, which has been amply confirmed by past experience, that it was not practicable to store butter of any lower grade than creainery The butter known as firsts is of a satisfactory quality for immediate use, but cannot be satisfactorily stored during the winter months without deteriorating to a considerable degree. The plan of purchasing butter by joint contract has been tried before by the representatives of the Commission. On this occasion, however, Western butter was purchased in the open market on New York quotations. The Agricultural Department recommended the purchase of New York State creamery butter in view of the requirements of the law that products of this State, other things being equal, should be given first consideration. The butter, to the extent of 600,000 pounds, was purchased by the committee from the creameries of northern New York on Boston quotations at a slight differential. This butter was carefully inspected by representatives of the State Department of Agriculture and stored in large quantities at convenient points for future use. As a result of this method it has been estimated by the purchasing committee that the saving will amount to fully $28,000 and a much better grade of butter has been rendered available for use in the hospitals than has been possible heretofore.

The committee has extended its activities very largely during the past year and its purchases have included the following: Flour, cereals, sugar, meats, butter, dried fruits, canned goods,

baking soda, cream of tartar, leather, rubber goods, cottons, dry goods, surgical rubber, plated ware, iron pipe and fertilizers.

The report of the Committee will be found in full under a separate heading.

NEW SCHEDULE OF SALARIES FOR MEDICAL OFFICERS

The Commission has for years been firm in its belief that the compensation of the medical officers in the various State hospitals was inadequate. Considerable difficulty has been experienced in inducing properly qualified recent graduates to make application for appointment to medical positions. After a careful consideration of the report as submitted in November, 1911, by the committee of superintendents appointed in October for that purpose, the Commission addressed the following communication to the Governor of the State on February 28, 1912:

Hon. JOHN A. Dix, Governor of the State of New York, Executive Chamber, Albany, N. Y.:

DEAR SIR. For many years the question has been carefully considered of increasing the salaries of the medical officers in the State service. The following resolutions were submitted to the State Commission in Lunacy by the committee of superintendents appointed at the Binghamton conference, October, 1911, to prepare amendments to the Insanity Law, and to submit recommendations regarding the salary and wage schedules of the State hospitals:

Whereas, The present salary schedule covering State hospital positions in the medical service has been in operation many years without change, notwithstanding the great increase in the size of the State hospitals and a corresponding increase in the work required of medical officers;

Whereas, The salaries now paid are not sufficient to induce properly educated and qualified physicians to enter the State hospital service, or to retain them if they enter such service;

Whereas, The vacancies on the medical staffs of the several State hospitals now existing are very numerous and, as shown by recent civil service examinations, cannot be filled by qualified candidates for appointment at the salarics now paid;

Whereas, The existing provisions for promotion are indefinite. and uncertain and allowances for maintenance are inadequate; 'Resolved, That it is the sense of this committee that the proper care of the patients in our State hospitals requires and demands

a revision of the salary schedule which shall provide higher compensation for the physicians, assurance of promotion after qualifications are established by proper examinations, and improved conditions as regards maintenance. Be it further

Resolved, That the schedule of salaries affixed hereto and forming a part of this report, be recommended to the State Commission in Lunacy for adoption, and that the Commission be asked to take immediate action as regards the approval of this schedule, and, in view of the fact that no legislation is required to make this schedule effective, to request the proper State officers to approve the same so that it may be made effective January 1, 1912." The schedule of salaries recommended by the committee of superintendents is that now recommended by the Commission for adoption.

The following statement sets forth the principal reasons for the proposed increases which the Commission now recommends: There are at the present time 186 resident medical officers in the fourteen State hospitals for the insane, and there are eighteen vacancies which the superintendents have not been able to fill with properly qualified men. During the year ending September 30, 1911, there were sixty-two appointments to positions on the medical staff in the various institutions, fifty-five promotions, twenty transfers and fifty-seven resignations. The resignations amounted to over 30 per cent. of the total number of officers. The difficulty in inducing properly qualified medical men to take the entrance examinations required for the service is shown by the fact that in an examination held a short time ago for one of the medical positions, twelve out of seventeen failed. An examination was recently held for admission to the service, when six men appeared for the examination, whereas several years ago twenty-eight were examined by the same committee for this position. Of those who were admitted to this examination, two failed, two made percentages which were barely sufficient to allow them. to pass, and the remaining two received very creditable marks.

The increase during the period from July 1 to September 30, 1912, which will be made necessary by the proposed schedule, if adopted, will amount to $9,349. The increase for the year beginning October 1, 1912, and ending September 30, 1913, will amount to $36,190.75. The expenditures for officers' salaries during the current year will amount to approximately $305,000, so that the change in the new schedule will result in an expenditure of about $341,000 for this purpose during the next fiscal year.

The salaries of medical officers have not been changed in any way since 1896. The physician entering the service as a medical interne receives but $600 per annum at the present time; junior

physicians receive from $900 to $1,200; assistant physicians from $1,200 to $1,500; second assistants from $1,500 to $2,000; first assistants from $2,000 to $2,500; and superintendents from $3,500 to $4,500. These officers are allowed maintenance in addition to these salaries. With the exception of superintendents, first assistant physicians and stewards, no resident officers are allowed maintenance for their families.

It should be remembered that the great majority of those in the service rank as assistant physicians, only a comparatively small number reaching the higher grades of first and second assistant physicians. Since this schedule was originally adopted, the cost of medical education has increased probably 50 per cent. The educational qualifications are much higher than formerly, many of the medical colleges requiring a college degree prior to entrance.

In 1904 the employees of the institutions received an increase in wages amounting to approximately 20 per cent. The provisions of the Phillips bill, recently introduced, will, if adopted, result in another increase of about 18 per cent. It would seem only fair and proper that some increase should be made in the salaries of medical officers. The salaries paid by the State hospitals are so much lower than those offered by the United States Army, Navy and Public Health and Marine Hospital services, and other departments of the public service, that it is only with exceeding difficulty that properly qualified men can be induced to interest themselves in the care of the insane.

The nature of the specialized work required is such that it does not offer many attractions to men entering the profession. As a result of the salaries offered, it has been impossible to retain men in the service for any great length of time, and this has materially affected the efficiency of the institutions. The proper understanding of the modern methods of caring for the insane can only come after years of experience in the large institutions, and the numerous changes which were mentioned above have made it difficult to maintain an adequate number of properly trained men. The lack of room which has been rendered unavoidable by the crowded condition of our large institutions has made it impossible to provide the medical officers with proper living quarters. As a result of this, the majority of them have found it necessary to leave the service in the event of their becoming married or having any family to maintain. Those who are married have been required to pay maintenance for their wives and have had very inadequate facilities for the maintenance of a family. All of these circumstances have made it very difficult