CHAPTER XIII
Changes in Policies andProcedures Affecting the Occupancy of Hospital Beds inthe Zone of Interior
An important feature of attempts to meet hospitalrequirements with limited resources was an extension of the practice begun on asmall scale during the early war years of keeping patients who did not actuallyneed hospital care from occupying beds. This could be done by limitingadmissions and shortening length of stay.
Problem of Limiting Hospital Admissions
More was done to shorten periods of patient-stay than tolimit admissions. Two factors worked against the latter: (1) the MedicalDepartment's practice of admitting patients to hospitals before performingcomplete diagnostic procedures and (2) policies of the General Staff governingdischarges from the Army. Normally, zone of interior patients were sent tohospitals after only preliminary examinations by dispensary physicians and werethen given more thorough examinations by hospital staffs. Early in the war, itwill be recalled, some hospitals had established diagnostic clinics for theexamination of patients before their admission to wards. This practice did notbecome general, and hospitals continued to admit patients first and to performdiagnostic procedures afterward.1 Some policiesof the General Staff tended to increase rather than to limit hospitaladmissions. In July 1943, for example, the Staff issued a directive, against TheSurgeon General's advice, to discharge from the Army men who did not meetminimum physical standards. This flooded hospitals with patients whosedisabilities had to be observed and evaluated before they could be givendisability discharges.2 Toward theend of 1943, when a manpower short-
1See above, p. 121. Annual reports of hospitals are silent, with few exceptions, on the establishment of diagnostic clinics. See also Federal Medical Services-A Report with Recommendations, prepared for the Commission on Organization of the Executive Branch of the Government [Hoover Commission] by the Committee on Federal Medical Services (Washington, 1949), pp. 20-21.
2(1) WD Cir 161, 14 Jul 43. (2) An Rpt, 1943, Ft Bragg Sta Hosp. HD. (3) William C. Menninger, Psychiatry in a Troubled World (New York, 1948), pp. 551-52.
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age developed, the Staff directed that men who could serve usefully inmilitary assignments, despite minor ailments, should be kept in the Army.3While this reduced the disability-discharge load, it increased the number of menwho returned to hospitals repeatedly with the same complaints and led to a tugof war between line officers and the Medical Department over whether those whowere not physically disabled but were noneffective should be given medical oradministrative discharges.4 The Staff finallyattempted to solve this problem by making it easier in the latter half of 1944for line officers to grant administrative discharges and by authorizing in thespring of 1945 the discharge at separation centers of all combat-woundedenlisted men in the limited service category.5To some extent these actions relieved hospitals of the care of men who didnot need actual treatment at a time when these installations were reaching theirpeak load.6
Measures to Shorten the Length of Patient-Stay
Shortening the time spent by patients in hospitals was another way oflimiting occupancy of beds to patients actually needing hospital care.Controlling the length of stay in an effort to limit the occupancy of beds topatients actually needing hospital care was a complicated and difficult process,for many factors affected it, some tending to increase and others to shorten it.Among them-aside from the seriousness of patients' wounds, injuries, andillnesses-were the speed with which patients were transferred to proper typesof medical installations, the degree of recovery they were expected to achievewhile in Army hospitals, the efficiency with which hospitals completed diagnosesand treatments, and the administrative problems that were encountered indisposing of patients after completion of treatment. Beginning in the fall of1943 the Surgeon General's Office devoted more attention than formerly tothese factors in particular and to the length of stay in general.
The attention given to the general problem is illustrated by studies made inthe Surgeon General's Office and letters sent to service commands. During 1944and 1945 the Facilities Utilization Branch and its successor, the ResourcesAnalysis Division, made monthly studies of the length of time differenthospitals kept patients before disposing of them. In the absence of morereliable data, the Branch measured the average duration of patient-stay by meansof an "activity index." This index was the ratio of total patient daysto the sum of hospital admissions and dispositions. Over a long period of time anumber twice the size of the activity index was considered a close approximationof the number of days that the average patient spent in a given hospital.7A low activity
3WD Cir 293, 11 Nov 43.
4(1) An Rpt, 1943 and 44, Ft Bragg Sta Hosp. HD. (2) An Rpt, 1944, Surg 7th SvC. HD. (3) Memo, SG for CG ASF, 1 Sep 44, sub: Disposition of Inapt and Inadaptable. SG: 300.3. (4) Memo, Dep SG for ACofS G-1 WDGS, 26 Sep 44, sub: WD Cir 370 (1944) II-EM. SG: 300.-5. (5) Memo, SG for CG ASF, 23 Mar 45, sub: Gen Hosp Program, ZI. SG: 322 "Hosp."
5(1) WD Cir 370, 12 Sep 44. (2) AR 615-368 and AR 615-369, 20 Jul 44. (3) WD Cir 71, 6 Mar 45.
6(1) Memo, Dir NP Consultants Div SGO for Dir Resources Anal Div SGO, 27 Nov 44, sub: Discharge of EM. SG: 220.811-1. (2) An Rpt, 1944, Surg 7th SvC. HD. (3) An Rpts, 1945, Baxter Gen Hosp and Ft Bragg Sta Hosp. HD.
7Draft article for ASF Monthly Progress Rpt, Sec 7, Health, entitled "The Disposition of Patients in Hospitals of Selected Size Groups [31 May 44]." HD: Resources Anal Div file, "Hosp."
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index was therefore an indication that a hospital was treating and disposingof patients promptly. Monthly announcements of hospitals' activity indiceskept before service command surgeons the importance of avoiding unnecessarilylong patient-stays.8 This indirectpressure upon hospitals seemed insufficient after the patient load began toincrease rapidly in the spring of 1945. In March, therefore, The Surgeon Generalurged general and convalescent hospital commanders, as well as service commandsurgeons, to accelerate dispositions.9 Thefollowing month he established tentative monthly quotas for the disposition ofpatients from convalescent hospitals.10Meanwhile, during the preceding year and a half, attention had been given tovarious individual factors which influenced the length of patient-stay.
One of these was the transfer of patients between hospitals. Failure totransfer patients promptly from station hospitals to better staffed and betterequipped hospitals, after it had been determined that they needed a higher typeof care than that afforded in station hospitals, retarded their recovery. On theother hand, unnecessary transfers of patients between hospitals of differenttypes consumed the time of hospitals involved, put an extra load on overburdenedtransportation facilities, and increased the time patients stayed on hospitalrolls by causing repetitive physical examinations and more administrative paperwork. Several steps were therefore taken to regulate the transfer of patients.In the fall of 1943 the Deputy Chief of Staff ruled that zone of interiorpatients need not be transferred from station to general hospitals merelybecause their injuries or illnesses were of particular types, provided stationhospitals were equipped and staffed to give them the care and treatment theyneeded.11 In the spring of 1944, when regionalhospitals were authorized, a policy was established under which patients were tobe transferred "without any more delay than is compatible with soundprofessional judgment" to the "nearest adequate medicalinstallations," regardless of their type-whether regional, convalescent,or general hospitals-and regardless of the command under which they operated.12To implement this policy, both the Air Surgeon and The Surgeon Generalapplied to regional hospitals the bed credit system which had been developedearlier to facilitate the transfer of patients from station to generalhospitals.13 Soon afterward TheSurgeon General established the Medical Regulating Unit (mentioned elsewhere) tocontrol the transfer to general hospitals of patients debarked at ports in theUnited States. This office, in turn, devised an elaborate system by whichgeneral and convalescent hospitals reported vacant beds and debarkationhospitals reported patients received, indicating by code their sex, rank, homeaddress, and disability.14 Theoretically thissystem assured the transfer of patients directly to hospitals staffed
8These letters are found in SG: 323.7-5 (each service command).
9Ltr, CG ASF (SG) to CGs all SvCs attn SvC Surg, and to COs all Gen and Conv Hosps, 24 Mar 45, sub: Furlough and Disposition Policy. Off file, Gen Bliss' Off SGO, "Med Clarification of Disposition Policy."
10Ltr, SG to CO Ft Story Conv Hosp, 12 Apr 45. Off file, Gen Bliss' Off SGO, "Med Clarification of Disposition Policy."
11See above, p. 183.
12WD Cir 140,11 Apr 44.
13(1) See above, pp. 35, 184-85. (2) The Planning and Oprs of ZI Hosps, Tab B to Memo, Dir Hosp Div and Dir Resources Anal Div SGO thru Chief of Oprs Serv SGO for Dir HD SGO, 18 Jun 45, sub: Add Mat for An Rpt for FY 1945. HD: 319.1-2.
14See below, pp. 346-49.
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and equipped to care for their particular ills and injuries but it was notcompletely successful.
A study by the Resources Analysis Division early in 1945 showed thatforty-five out of fifty-nine general hospitals were receiving patients whoshould have been sent to other medical installations. "Beyond adoubt," a report on the study continued, "there are a large number ofoverseas patients being transferred from the debarkation hospitals to thegeneral hospitals who need little or no further surgical or medical treatmentand could equally as well be cared for in convalescent hospitals. These casesconsume a large amount of time in the general hospitals in examination andworking up plus all the administration detail and the time involved indisposition."15
Another factor which affected the length of stay in Army hospitals was thedegree of recovery which patients were expected to attain before beingdischarged. Those returned to duty were expected to be able to do an effectiveday's work as soon as they rejoined their outfits. To shorten the convalescentphase of hospitalization, The Surgeon General emphasized during 1944 thereconditioning program initiated the year before. Although no statisticalstudies were made of the effect of this program on the average period ofhospitalization, many hospital commanders believed that it was shortened.16Patients who could not be reclaimed for military service could be transferred toVeterans Administration hospitals if they needed further care. In the early partof the war, it had been Surgeon General Magee's policy to transfer suchpatients as soon as the Medical Department determined that they could not berestored to duty, thus shortening the time they stayed in Army hospitals.17
During 1943 public pressure upon the Army to keep patients for finaltreatment, along with the inability of Veterans Administration hospitals toaccommodate large numbers of them18 caused achange in policy that tended to lengthen the period of patient-stay. In December1943 Army hospitals began to keep all patients whose disabilities were incurredin line of duty, except those who were tuberculous or psychotic, until theirdefinitive treatment had been completed.19 Asseriously wounded casualties began to fill hospital beds during 1944, thispolicy had to be clarified for it was difficult to know when the definitivetreatment of those with chronic disabilities was completed. In the fall of thatyear it was announced that such patients would be kept in Army hospitals untilthey had reached the "maximum degree of recovery."20In the following December, the President confirmed this policy and broadened itsapplication to include patients whose disabilities had not been incurred in lineof duty.21 Hospital commandersinterpreted this directive "very broadly," and by March 1945, as
15Memo, J. S. Murtaugh [Resources Anal Div, SGO] for Dr [Eli] Ginzberg, 16 Mar 45, sub: Summary of Replies to the Furlough and Disposition Study. Off file, Resources Anal Div, SGO.
16Richard L. Loughlin, [History of] Reconditioning [in the U.S. Army in World War II], (1946), pp. 198-208. HD.
17(1) See above, pp. 129-30. (2) AR 615-360, C4, 16 Apr 43.
18Ltr, Dep SG to Mr Donald C. Urquhart, Veterans of Foreign Wars of US, 24 Mar 44. SG: 220.-811-1.
19(1) WD AGO Form 026, prepared by Col William B. Foster, MC, SGO, 15 Nov 43, sub: Request and Justification for Publication. AG: 220.8 (2 Jun 42) (2) Sec 2. (2) AR 615-360, C 16, 15 Dec 43.
20(1) WD Cir 423, 27 Oct 44. (2) ASF Cir 374, 13 Nov 44.
21Ltr, Franklin D. Roosevelt to SecWar, 4 Dec 44. HRS: Hq ASF Control Div, 705 "Cutback in Gen and Conv Fac."
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the patient-load neared its peak, The Surgeon General concluded that theywere holding patients longer than necessary.22Two months later his Office attempted to define more precisely the term"maximum degree of recovery." This term, it was explained, referred tothe point in a patient's treatment when progress appeared to have leveled offand no further substantial improvement could be anticipated. Patients reachingthat point, even though they had not made full compensatory adjustment todisabilities, were not to be kept longer in Army hospitals.23
A third factor affecting the length of time patients stayed in hospitals wasthe efficiency with which hospital staffs made diagnoses and initiatedtreatment. In the fall of 1943 representatives of the Surgeon General's Officeand the ASF Control Division complained that hospitals were delaying diagnosesand treatment by having unnecessary laboratory work performed for each patient.24At that time The Surgeon General urged hospitals to insist upon itselimination. A few months later he suggested that service command surgeonsrequire hospitals to keep ward charts showing the duration of patient-stay, as areminder that unnecessary procedures should be avoided and requisite medicaltreatment given promptly. Some, and perhaps all, service commands accepted thissuggestion.25
A fourth factor affecting length of stay was the administrative work involvedin disposition of patients, either by return to duty or by separation from theservice. Their return to units or organizations from which they enteredhospitals created no problem, but the reassignment of others who were physicallyunqualified for duty with their former units or whose units had gone overseaswas fraught with delays. Reassignment was primarily an Army personnel procedure over which the MedicalDepartment had no control. It was complicated by the fact that patients belongedto different major commands (Ground, Service, and Air Forces), were qualifiedfor different types of duty (limited or full duty), came from different areas(theaters of operations or the zone of interior), and were of separate ranks(commissioned or enlisted). Because of these complications, directives governingthe reassignment of men and women who had been hospitalized were numerous,frequently changed, often obscure in meaning, and sometimes in conflict with oneanother. Attempts were made to correct this situation, but the general problemso far as it pertained to Ground and Service Forces personnel remained unsolvedthroughout the war.26 The Air Forces, on theother hand, adopted a system of assignment in the fall of 1944 that was simpleand effective. AAF headquarters placed liaison officers in some AAF regionalhospitals and, with the concurrence of ASF headquarters, in each general and ASFregional hospital.
22Memo, SG for CG ASF, 23 Mar 45, sub: Gen Hosp Program, ZI. SG: 322 "Hosp."
23Ltr, SG to CGs all SvCs attn COs Hosp Ctrs, Gen Hosps, and Conv Hosps, 28 May 45, sub: Med Clarification of Disposition Policy. HD.
24(1) Rpt of SGs Pers Bd, 3 Nov 43. HD. (2) Memo, Dr Eli Ginzberg, ASF Control Div for Chief Oprs Serv SGO thru Dir Control Div ASF, 30 Nov 43, sub: Surv of Gen Hosps. SG: 333.1-1.
25(1) SG Ltr 193, 30 Nov 43. (2) Ltr, SG (init A. H. S[chwichtenberg]) to Surg 2d SvC, 8 Feb 44, sub: Prompt Prof and Admin Practice in Army Hosps. SG: 705 (2d SvC)AA. Similar letters were sent to other service command surgeons. (3) Ltr, CG 5th SvC (Asst SvC Surg) to SG, 30 Mar 44, sub: Prompt Prof and Admin Practice in Army Hosps. SG: 705 (5th SvC)AA. (4) An Rpt, 1944, 2d SvC Surg. HD.
26(1) Mins, SvC Conf, Ft Leonard Wood, Mo, 27-29 Jul 44, p. 17. HD. (2) Memo, SG for CG ASF, 14 Mar 45, sub: Improvement in Hosp Admin Procedures. SG: 300.7. (3) History of Control Division, ASF, 1942-45, App, p. 199.
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These officers acted as representatives of the commanding general, Army AirForces, reassigning both commissioned and enlisted personnel of the Air Forces.Subsequently it was reported that they returned flying officers to duty in theFourth Air Force in 10 percent of the time formerly required.27
Aside from the necessity of securing reassignments, there was another causefor delay in returning patients to duty: the administrative procedure for thephysical reclassification of officers. In July 1943 the General Staff directedthat officers found by hospital disposition boards to be permanentlyincapacitated for full military service should appear before Army retiringboards instead of being returned to duty in limited service assignments.28This meant that such an officer had to be kept in a hospital while its commanderforwarded recommendations of his disposition board to service commandheadquarters; the service commander issued orders for the appearance of theofficer before a retiring board; the board assembled and considered the case,and sent its findings to Washington for review by The Surgeon General, TheAdjutant General, and the Secretary of War's Separation Board; and TheAdjutant General issued orders for the officer's disposition. In the fall of1944 the Surgeon General's Office, ASF headquarters, and the Adjutant General'sOffice attempted to find a way to avoid keeping such officers in hospitals aftertheir treatment had been completed. The Adjutant General proposed returning themto their previous stations or to replacement pools after appearance beforeretiring boards, to await there the decision of agencies in Washington.29The ASF proposal, which went further than this, was approved by the GeneralStaff. On 14 October 1944 a War Department circular authorized hospital andstation commanders to return to duty officers recommended for limited service bydisposition boards, without referring them, except in a few cases, to retiringboards.30 This change in procedure reduced thelength of stay in hospitals of officers in this category to such an extent thatit saved, according to the estimate of ASF headquarters, 1,000 hospital bedsannually.31
Improvements in Disability Discharge and Retirement Procedures
Officers and men whose physical disabilities prohibited return to duty wereeither retired or discharged from the service. Since both retirement anddischarge for disability were personnel as well as medical administrativeprocedures, they involved agencies other than the Medical Department. Theirsimplification was therefore a complicated process and some-
27(1) A History of Medical Administration and Practice in the Fourth Air Force (1945), vol. I, pp. 79-81. HD: TAS. (2) Ltr, CG AAF to CG ASF, 25 Aug 44, sub: Disposition of AAF Pnts in Gen Hosps and Certain ASF Hosps. AG: 705(25 Aug 44)(1). (3) ASF Cir 296, 9 Sep 44. (4) AAF Ltr 25-1, 21 Sep 44, sub: AAF Liaison with Hosp. SG: 211 (Surg, Flight). (5) An Rpts, 1944, Fitzsimons, Thayer, and O'Reilly Gen Hosps. HD.
28Rad, ACofS G-1 WDGS to SvC Comdrs, Retiring Bds, and all Named Gen Hosps, 10 Jul 43. SG: 334.6-1 Retiring Bds.
29Draft of WD Cir, incl to T/S APGO-S 210.85 (6 Sep 44), TAG to SG, 8 Sep 44, sub: Disposition of Offs Appearing before Retirement Bds, with lst ind, SG to TAG, 24 Oct 44. SG: 300.5 (WD Cir).
30(1) Memo, CG ASF for ACofS G-1 WDGS, 25 Sep 44, sub: Physical Reclassification of Offs. AG: 210.85 (25 Sep 44)(2). (2) DF WDGAP 210.01, ACofS G-1 WDGS to TAG, 7 Oct 44, same sub. Same file. (3) WD Cir 403, 14 Oct 44.
31Rpt, Economies Effected through Procedures Studies Made by or jointly with Control Div ASF, 13 Apr 45. HRS: Hq ASF Control Div file, "Est Admin Savings Resulting from Procedural Revisions."
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times slow, but for the Medical Department it was important because any delayin either procedure wasted beds by lengthening the stay of patients inhospitals.
Despite earlier attempts to remove causes for delays, the disabilitydischarge procedure took more time than was considered necessary and in the fallof 194332 both the Surgeon General's Officeand ASF headquarters began studies to simplify and standardize it. Because itsControl Division was engaged in a more general study of Army administrativeprocedures, ASF headquarters directed The Surgeon General to discontinue hisstudy. The ASF Control Division proceeded thereafter, with assistance from theSurgeon General's Office, to develop and test a revised procedure fordisability discharges.33 In March1944 this procedure was published in a tentative manual and each service commandwas directed to install it in one general and one station hospital for furthertesting. Reports from such tests were favorable, and on 24 July 1944 ASFdirected all of its hospitals to begin using the new procedure. Six months latera War Department manual made it official for use in hospitals of the Air Forcesas well as of the Service Forces.34
The new procedure for disability discharges covered actions taken withinhospitals themselves, since measures adopted earlier had reduced administrativeactions required by headquarters other than hospitals.35This goal was more completely achieved during 1944 when additional postcommanders delegated to hospital commanders their functions relative todisability discharges, and the War Department delegated to commanders ofregional and convalescent hospitals, as it had earlier to those of generalhospitals, authority to grant discharges without reference to higherheadquarters.36 Under the newprocedure, administrative actions within hospitals were simplified and speededup. Hospital commanders were permitted to request records of former physicalexaminations and medical treatments from the Adjutant General's Office andfrom other hospitals as soon as ward officers made a diagnosis indicatingeventual disability discharge, rather than after completion of treatment. Thismove was expected to eliminate delays in the consideration of cases by CDD(Certificate of Disability for Discharge) boards. To reduce the work of theseboards and of all officers who participated in the procedure, paper workrequired for disability discharges was simplified. Separate forms and lettersprevi-
32(1) Memo, Dr Eli Ginzberg, Control Div ASF for Chief Oprs Serv SGO thru Dir Control Div ASF, 30 Nov 43, sub: Surv of Gen Hosps. SG: 333.1-1. (2) Notes on Visit to McCloskey, O'Reilly, and Percy Jones Gen Hosps, 11 Dec 43, by Col Tracy S. Voorhees, Control Div SGO. Same file.
33(1) Memo, SG (Control Div) for Dir Control Div ASF, 29 Oct 43, sub: Delays in Discharging Pnts from Hosps. (2) Memo, SG (Control Div) for CG Army Med Ctr, 29 Oct 43, sub: Delays in CDD Procedure. (3) Memo, CG ASF (Control Div) for SG attn Dir Control Div, 5 Nov 43, sub: Delays in Discharging Pnts from Hosps. (4) Memo, Act Dir Control Div SGO for Brig Gen Edward S. Greenbaum, Off of UnderSecWar, 16 Feb 44, sub: Improvements in CDD Procedures. All in SG: 220.811-1. (5) An Rpt, FY 1944, Control Div SGO. HD.
34(1) History of Control Division, ASF, 1942-1945, App, pp. 345-46. HD. (2) Memo, CG ASF for CG 1st SvC, 17 Mar 44, sub: Estab of Pilot Instl Covering Discharges and Release from AD. SG: 220.811-1. Similar letters were sent to each service command. (3) Draft of Tentative Procedures-Discharge and Release from AD, Hq ASF, 5 Mar 44. AG: 220.8. (4) ASF Cir 217, 13 Jul 44. (5) TM 12-235, Enl Pers-Discharge and Release from AD (Other than at Separation Ctrs), 1 Jan 45.
35See above, pp. 124-30.
36(1) AR 615-360, C 19, 17 Mar 44. (2) An Rpts, 1944, Fts Jackson, Bragg, and Cp Shelby Regional Hosps. HD. (3) WD Memo 615-44, 17 Aug 44, sub: Discharge Auth. (4) AR 615-360, 20 Jul 44, and C 1, 1 Feb 45.
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ously used were eliminated or consolidated, and copies of different forms andthe number of signatures required on them were limited. All forms were set upaccording to standard typewriter spacing to facilitate preparation and, in someinstances, rubber stamp entries were authorized.37To insure speedy, well co-ordinated action by all hospital officers concernedwith discharges, a time schedule was established. It listed the actions taken byeach officer on the days following the admission of patients to hospitals, theday before the CDD board meeting, the day of the meeting, and the threefollowing days. Finally, the manual on the discharge procedure showedgraphically each step in a disability discharge.
Except in procuring adequate supplies of new forms, hospitals encounteredlittle difficulty in installing the new procedure. Their reaction was almostimmediately favorable. For example, by the end of 1944 one of them reported thatdisability discharges were "no longer a matter of concern."38The Surgeon General's Office likewise was pleased with the new procedure andwith the saving in hospital beds which it produced.39 According to anestimate of the ASF Control Division in April 1945, this saving amounted to anaverage of seventeen days for each disability discharge and to a total of6,205,000 hospital bed-days (the equivalent of seventeen l,000-bed hospitals)annually.40
As in the case of disability discharges for enlisted men, several agenciesbecame concerned in the fall of 1943 about the time used in retiring officersfor disability. Among them were the Adjutant General's Office, the SurgeonGeneral's Office, and ASF headquarters.41 During the next two years they workedtogether to speed the retirement process and thereby to shorten the period ofhospitalization of officers disabled for military duty. One method was toshorten the time that elapsed between completion of an officer's treatment andhis appearance before a retiring board. In the middle of 1943 the procedure forgetting an officer before a retiring board was complicated. After completion oftreatment, his case was reviewed by a hospital disposition board. If the boardrecommended retirement, its recommendation was sent to higher headquarters, suchas that of a service command, for review. If that headquarters approved therecommendation, it ordered the officer to go before a retiring board. At thatpoint, the hospital requested his personnel records from the Adjutant General'sOffice. After they arrived, the retiring board could consider the officer'scase. In the fall and winter of 1943 steps were taken to get records
37(1) TM 12-235, Enl Pers-Discharge and Release from AD (Other than at Separation Ctrs), 1 Jan 45. (2) History of Control Division, ASF, 1942-45, pp. 183-86, and App, pp. 345-46. HD.
38An Rpt, 1944, O'Reilly Gen Hosp. HD. Letters from hospitals reporting on the new procedure, dated May-June 1944, are filed in HRS: Hq ASF Control Div file, "Disability Discharge Corresp." See also: An Rpts, 1944, Fts Jackson and Bragg Regional Hosps and Ashford Gen Hosp. HD.
39An Rpt, FY 1944, Control Div SGO, and An Rpt, FY 1945, Hosp and Dom Oprs SGO. HD.
40Rpt, Economies Effected through Procedures Studies Made by or jointly with Control Div ASF, 13 Apr 45. HRS: Hq ASF Control Div file, "Est Admin Savings Resulting from Procedural Revisions."
41(1) T/S, Dir Control Div AGO to Chief Insp and Investigation Br AGO, 28 Aug 43, sub: Retirement Procedures Affecting Offs. AG: 210.85 (12-17-42) (1). (2) Memo, SG for Gen Malin Craig, Pres Army Retiring Bd, 30 Aug 43. SG: 334.6-1. (3) Memo, Dir Control Div SGO for Brig Gen Charles C. Hillman, SGO, 8 Sep 43, sub: Retiring Bd Procedures. Same file. (4) Memo, Lt Col Basil C. MacLean, SGO for Gen [Raymond W.] Bliss thru Col A. H. Schwichtenberg, 6 Nov 43, sub: Observations Based on Recent Visits to Gen Hosps. Off files, Gen Bliss' Off SGO, "Util of MCs in ZI" (19)#1
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from the Adjutant General's Office at an earlier point in the proceedings.In September, on The Surgeon General's recommendation, the General Staffauthorized hospitals to request records of officers as soon as dispositionboards recommended their appearance before retiring boards.42Later, on recommendation of the ASF Control Division, the Staff permittedhospitals to request these records as soon as it became obvious that officerswould be considered for retirement, even though their cases had not beenreviewed by disposition boards.43 Inthe latter half of 1944 another cause for delay was eliminated when the Staffauthorized hospital commanders to order officers to appear before retiringboards without reference to higher headquarters.44
Another method of speeding the retirement of officers was to prevent thedevelopment of backlogs of work for retiring boards. This could be done, in partat least, by increasing the number of such boards. Until the middle of 1943retiring boards were few in number and could be appointed only by the Secretaryof War.45 In June of that year the Secretarydelegated appointment authority to commanding generals of service commands anddirected them to establish retiring boards at all general hospitals. Four monthslater the commanding general of the Air Forces, receiving similar authority, wasdirected to set up a retiring board at each AAF convalescent center.46In the middle of 1944 the right to have retiring boards was extended toall convalescent and regional hospitals.47 Later, in October 1944, the number ofcases referred to such boards was limited when, in connection with the movementto shorten the period of hospitalization of officers being physicallyreclassified for limited duty only, retiring boards were relieved of theconsideration of such cases.48
An additional way of speeding officer retirements was to reduce the paperwork of retiring boards. In the latter part of 1944 the ASF Control Divisiondeveloped a standard form for such boards to use in reporting their proceedings.49Following the success of the new manual on disability-dischargeprocedures, the same Division developed and published in 1945 a technical manualon the retirement and reclassification of officers.50This manual, like that on the disability-discharge procedure, gave detailedinstructions in diagrammatic and other explanatory forms on the completion ofall administrative actions in the retirement process and established a timeschedule to be followed by officers concerned. As a result, according to ASFheadquarters, the period of hospitalization of officers awaiting disabil-
42(1) Memo SPMCH 300.3-1, Exec Off SGO for Publication Div AGO thru Procedure Br SGO, 7 Aug 43, sub: Proposed Change in AR 605-250. AG: 210.-85 (12-17-42)(1). (2) AR 605-250, C 1, 17 Sep 43.
43(1) Memo, Dir Control Div ASF for TAG, 18 Dec 43, sub: Request for Publication. AG: 210.85 (12-17-42)(1). (2) AR 605-250, C 5, 6 Jan 44.
44(1) T/S, Chief Insp and Investigation Br AGO to Dir Control Div AGO, 26 Jul 44, sub: Reasgmt of Pers Returned to Duty from Hosp. AG: 705 (5 Jul 44). (2) WD Cir 403, 14 Oct 44.
45AR 605-250, 1 Jun 43 and 28 Mar 44.
46WD Memo W605-28-43, 17 Jun 43, and WD Memo W605-41-43, 19 Oct 43, sub: Delegation of Auth to Appoint Retiring Bds. SG: 334.6-1.
47(1) AR 605-250, C 1, 22 Jun 44. (2) Mins, SvC Conf, Ft Leonard Wood, Mo, 27-29 Jul 44. HD.
48See above, p. 243.
49Memo, CG ASF (Dir Control Div ASF) for SG, 9 Oct 44, sub: Form for the Proceedings of Army Retiring Bds. SG: 315 "Gen."
50(1) Draft of Proposed WD Technical Manual, TM 12-245, Physical Reclassification and Retirement of Offs, 1 Jun 45. Off file, Physical Standards Div, SGO. (2) Tentative WD Technical Manual, TM 12-245, Physical Reclassification, Retirement, and Retirement Benefits for Offs, 1 Oct 45. Same file.
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ity retirements was reduced enough to save 4,700 bedsannually.51
The simplification and standardization of procedures fordisability discharges and retirements were the culmination of efforts begunearly in the war to limit the occupancy of hospital beds to persons actuallyneeding them. Earlier measures to reform these procedures affected actions takenoutside hospitals but were a necessary foundation for the later ones which weremainly intended to improve action within the hospitals themselves. Other effortsto restrict patients in hospitals to those needing medical and surgicaltreatment were less successful. Little if anything was done to screen patientsby physical examination before admission to hospitals. The reassignment of thosereturning to duty continued to cause difficulty and delays in disposition. Andthe policy of giving all patients "maximum hospitalization," whethertheir disabilities had been incurred in line of duty or not, tended to lengthenthe average period of hospitalization and hence to increase the occupancy ofbeds by men who could be of no further service to the Army.
51History of Control Division, ASF, 1942-45, App. pp. 481-83. HD.
