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Assembly Bill No. 1059

PUBLIC HEARING before ASSEMBLY EDUCATION COMMITTEE on ASSEMBLY BILL NO. 1059 - combines the Rutgers Medical School and the New Jersey College of Medicine and Dentistry to be known as the College of Medicine and Dentistry of New Jersey.

Held May 12, 1970
Assembly Chamber
State House
Trenton, New Jersey

MEMBERS OF COMMITTEE PRESENT

  • Assemblyman John J. Ewing (Chairman)
  • Assemblyman Thomas J. Costa
  • Assemblyman Karl Weidel
  • Assemblyman S. Howard Woodson

Also:

  • Senator Wayne Dumont, Jr.
  • Senator William T. Hiering
  • Assemblyman Kenneth T. Wilson
  • Assemblywoman Millicent H. Fenwick

[Obtained by Robert L. Trelstad, MD, from a copy of the document housed in Fireston Library, Princeton University, under: New Jersey, Legislature, General Assembly, Committee on Education. Digitized and proof read by Robert L. Trelstad. Pagination: The page numbers on the original text are inserted as [Page ##]. The text above the insertion belongs to that page. The pages after 81 and after the lunch recess begin with 1A and end with 103A. The page

I N D E X

  • Ralph A. Dungan 2
    Chancellor of Higher Education
  • Dr. Mason Gross 16
    President, Rutgers, The State University
  • Dr. John Cooper 43
    President, Association of American Medical Colleges
  • Dr. Carl Kaysen 58
    Director of Advanced Study, Princeton
  • George F. Smith 65
    Chairman, Board of Trustees, New Jersey College of Medicine and Dentistry
  • Dr. Daniel Adler 70
    Associate Secretary, National Office American Association of University Professors
  • Dr. Robert R. Cadmus 76
    President, New Jersey College of Medicine & Dentistry
  • Dr. Norman Reitman 1A
    Board of Trustees, Rutgers
  • Dr. Rulon Rossin 9A
    Dean of Medicine, New Jersey College of Medicine and Dentistry
  • Dr. Haydn Nicholson 13A
    American Medical Association
  • Dr. Ian Bennett 19A
    Dean of Dentistry, New Jersey College of Medicine and Dentistry
  • Dr. DeWitt Stetten, Jr. 28A
    Dean, Rutgers Medical School
  • Dr. Carroll Leevy 43A
    President, Faculty of the New Jersey College of Medicine
  • John Adams 48A
    Student, Rutgers Medical School
  • Larry Pizzo 57A
    President, Student Body, New Jersey College of Medicine & Dentistry
  • Dr. James MacKenzie 64A
    Chairman, Department of Surgery, Rutgers Medical School
  • Dr. William S. Wilson 71A
    Chairman, Department of Medicine, Rutgers Medical School
  • Dr. Paul Jordan 78A
    Staff, Martland Medical Center
  • Dr. George Bird 79A
    Professor of Chemistry, Rutgers
  • Dr. Richard Cross 85A
    Associate Dean in charge of Student Affairs, Rutgers
  • Harold G. Logan 89 A
    Administrator, Proposed Rutgers Psychiatric Institute and Community Health Center
  • Michael E. Pichichero 94A
    Pre-Medical Student, Rutgers
  • Dr. Ben Rush 100A
    Chairman, Department of Surgery, New Jersey College of Medicine & Dentistry
  • Letter to Assemblyman Ewing from Alvin N. Geser, 105A
    Executive Officer, New Jersey Pharmaceutical Association

[Page 1]

ASSEMBLYMAN JOHN J. EWING (Chairman): Good morning, ladies and gentlemen. I am Assemblyman John Ewing from Somerset County, District 8, Chairman of the Assembly Education Committee, conducting the hearing today which will pertain to Assembly Bill No. 1059 concerning medical and dental education in the State of New Jersey.

For the benefit of those who have not been here before, there are ladies' and men's rooms out in the corridor to the left; there's a water fountain down here to the right; in the annex building, you go all the way through the corridor, there is a cafeteria; also out in the hall is a small snack shop. You are permitted to smoke and move around.

I ask each and every one of you to speak to the particulars of the hearing which is on the bill itself. If anybody would like a copy of the bill, you may come up here and obtain one.

We originally started this more or less as a so-called private hearing and we decided to move it upstairs to these Chambers so that the Press could attend and other interested citizens.

We will go, first of all, through the lists of individuals which have been given to me by Dr. Gross, Dr. Stetten and Dr. Cadmus. Should we have time, we will hear others from the audience, but we are trying to get at the main points from those

[Page 2]

people whom we feel are representing groups that have been set forth by these people I just mentioned.

The first person I would like to call on is Mr. Ralph Dungan, Chancellor of Higher Education for the State of New Jersey.

On my left is Senator Hiering, Chairman of the Senate Education Committee; and on my right is Assemblyman Costa, a member of the Assembly Education Committee. How many other members will be here today, we cannot say. There will be a couple more coming in that I know.

Chancellor Dungan.

RALPH A. DUNGAN: Thank you, Mr. Chairman, Senator Hiering, Assemblyman Costa, it is my pleasure to appear here this morning before this Committee on behalf of the Administration to discuss Assembly Bill No. 1059, which has as its essential purpose the creation of a new administrative entity to administer the two existing medical education facilities in the State of New Jersey which are publicly supported.

I want to stress at the outset, Mr. Chairman, that the sole purpose of this bill is to create a board of trustees, an eleven-man public board of trustees, to administer the existing public medical and dental education facilities and to plan and operate those facilities and any other facilities that might be built in the future.

[Page 3]

We are not here, I submit, Mir. Chairman, to discuss, however important, some of the issues associated with the question of the creation of this board, which was alluded to in the Governor's recent message on medical education.

Before we talk about the bill, or before I address myself to the bill, Mr. Chairman, I think it would be useful to very briefly review the history of the State's involvement in medical education which began, I believe, in 1965. Since I was not here, I may be slightly rusty on precise facts. I think the essential facts to keep in mind are that the State initially began the development of the Medical School at Rutgers, the State University, - I think that was in 1965. Subsequently, pursuant to the recommendation of a specially created commission, the State took over, absorbed the Seton Hall Medical School, which was at that time located in Jersey City.

In short, in the period 1965-1966, the State committed itself to the construction and operation of two self-contained medical and dental education complexes, one to be located, as it subsequently turned out, in Newark, and the other on the campus of the State University in New Brunswick.

Much has happened from the time the Legislature made that initial judgment and today. Most notably, costs of construction, as everyone knows, has escalated

[Page 4]

precipitously and, indeed, the other costs associated with education, particularly medical education, have gone up considerably. But perhaps of equal significance, there has come about a more widespread realization that the current mode of delivering medical services and of providing the medical education in support of those services has broken down. I think most people in this room and the members of the Committee, among other articles they may have read, may have seen the series in the January 1970 issue of Fortune. If you haven't read it, I strongly suggest that you do, not only with respect to what it says on medical education but what it also says about the health care delivery system and the sad shape in which it is.

Back to the history of the two schools. When the Legislature established or took us on the course of running two independent and self-contained medical complexes, it very wisely observed that this was likely to be a difficult and probably an inefficient operation to run in this way and, therefore, it set up what was known as the Council on Medical and Dental Education.

The Council on Medical and Dental Education was a temporary commission which expired by law in January of this year. It was composed of citizen members as well as representatives of the existing schools. The principal function of that council or commission was to make recommendations to the Governor

[Page 5]

and to the Legislature regarding - these are my words, not the words of the statute - the joint administration or a rational administrative structure for medical and dental education in the State.

This legislation creating the Council, I might say parenthetically, was enacted before the creation of a department in the Board of Higher Education, and, consequently, the Council and the Board, during this period from 1966 until 1970, had overlapping jurisdiction, as I see it, over medical and dental education. In effect, the Board of Higher Education deferred to the Council since it had prior existence and since, in any event, it went out of existence in January of this year.

The Council, when it made its recommendations to the Governor and the Legislature, suggested that -- in effect, avoided the central question which, as I understand it, the Legislature asked them to concentrate on when the Council was created, and that is, How do we best provide an administrative and operational supervisory structure over medical and dental education in the future?

In effect, what it did was to say let us continue on the course on which we have embarked over the past years, continuing two independent schools with their independent boards and continue with the planning which has gone on to construct two complexes.

[Page 6]

So that's where the situation was when the present Governor assumed office.

What the Council did not make clear, I might say, in its final report was what the financial situation was with respect to the two planned schools, both on the capital and the operating side. The plain fact of the matter, depending on how you count, is that there is a deficit of some $170 million for the currently planned facilities at the two individual locations.

Now I know that there will be persons who will dispute those figures. It depends on what your estimates are as to Federal contributions, private donations, cost escalation, and so forth, But certainly I do not believe that the present plan, at either site, can be completed, in my opinion, for anything less than $170 million, roughly $170 million, on top of the Federal grants and State appropriations which are currently in hand, may be counted on.

So the Governor was faced with $171 million capital deficit, In the meantime, the estimates that are available on the cost of operating the two medical schools suggest a steeply ascending curve. I hesitate, myself, to give the gentlemen of this Committee a firm estimate on operating costs because there are many, many elements that go into calculating that cost which are very difficult to tie down at this

[Page 7]

point. For instance, if one continues at New Brunswick in the current course, the question would be how many clinical faculty members one would add even if one were going to continue and cut off the training at that facility at the two-year mark. If one were going on to provide clinical training for a limited number of young students, as has been proposed, then those costs would go up rather significantly.

In short, and by way of summary, when the Governor was faced, in January of this year, with a report of a Council which did really not address itself to the administrative question, and with the kind of cost questions which I have just briefly summarized, and with knowledge, at least in some quarters, of some appreciable, if you will, revolutionary changes in the way medical education is conducted, and with the knowledge that he and others have of the sad situation of the delivery systems for medical services, it caused him to revise all of his thinking in this drastic and important field of medical education.

The results of that thinking emerged in his message of last week.

I want to repeat, however, whatever the conversations we have here today or that are had subsequently about the mode of medical education or dental education, or about the cost figures to which I have alluded, or about the record of the Council,

[Page 8]

the central issue before the Legislature and before this Committee and before all of us is how medical and dental education are to be managed and supervised in the State of New Jersey.

There are two choices clearly before us - one, we can create a single administrative entity, not implying a complex, a physical complex, at one or any other location in the State; or, two, we can proceed on the present course which is to construct two independent non-coordinated medical schools and one with a dental school attached to it. They are the two choices, it seems to me, that are before us.

Now may I talk briefly to the principal advantages as I see them to a single administrative board, a single administrative entity.

First of all, I can tell you from my own experience, and I think any of my colleagues who serve on the Board who will be testifying before you today, on either of the Boards, can tell you that medical education and dental education are extremely complex and expensive businesses these days. It requires the proper supervision by a lay board, requires a full attention to the problem of medical and dental education. We cannot be concerned or interrupted in our discussions with the range of disruptions, physical and otherwise, or diversions, which occur in a board which has a multiplicity of

[Page 9]

responsibilities, educational and otherwise. It is an important, large, critically important to the community, enterprise and deserves the full attention of a lay board.

Secondly, I would say that a consolidated, central board, operating board, over both of these entities is the only way - I repeat, the only and the best way to secure optimum use of resources. And I suggest, gentlemen, that if you have any doubt on this question you look at the history of the past three and four years in New Jersey, and you look at it, scrutinize it, very carefully in detail.

Third, I would say that the kind of a board which is proposed in this bill provides a flexible, progressive, look-to-the-future kind of administration, oriented toward and addressed to the solution not only of the medical education problem, as such, but also of the very serious health delivery system problem which all of you share with all of us. I submit to you that there is hardly any issue in American life which is as important as the solution of the care delivery system, and I think all of my colleagues, professional and otherwise, would agree on that.

Fourth, I do believe that a board of the character suggested in this bill would be better able to relate to a wide variety of clients in the medical

[Page 10]

education business, When I say "clients," I'm talking about the people who need care in the first instance, I'm talking about other professional groups - nurses, x-ray technicians and others; in other words, a board which has the kind of membership that this one has can reach out to a whole variety of clients, including, I might say, the Legislature, and relate to the needs of the community as they see them.

Once again, as I will any time I have the opportunity, gentlemen, I want to underscore what this bill does. Essentially, what the bill does is to create an independent or quasi autonomous board to supervise public medical and dental education. It does nothing else. And I think it would be very important for us to concentrate on that point. It is an administrative reorganization that we are talking about here, not a whole series of philosophic and educational questions.

Finally, gentlemen of the Committee, I want to underscore what in my mind and I think in the minds of many people much more qualified to observe on this question, you cannot divorce the kind of medical and dental education which young men and women are getting from a larger question of what kind of care, medical care, the American people have received and are receiving currently.

I think there is no profession, no occupation

[Page 11]

that can remain immune from criticism if it fails to perform as it advertises it will perform. And I submit to you on the record, as currently organized and without some very, very substantial changes, medical delivery systems are not responsive to the needs of the bulk of the American people, black and white, rich and poor, upper and middle and lower class; we are just not getting the amount of service for which the public is paying.

I submit to you that it is time that responsible public officials look at the delivery system and the educational system which is behind it. By saying this I mean to impute or imply no criticism of the fine professionals who have given us the tremendous advances we have had in medical knowledge, particularly over the past decade.

I do think, however, that we have new priorities and new frontiers in the area of medical education and delivery systems which it is incumbent on the profession of medical educators to begin exploring with a seriousness of purpose that I submit we have not seen up until this time.

One of the purposes of the creation of this board, in addition to some of the other purely managerial and administrative ones, is to insure that in the State of New Jersey public education begins to get oriented toward the needs of the community. And

[Page 12]

I submit it is an extremely important consideration for all of you to bear in mind.

Finally, Mr. Chairman, I simply want you to concentrate with my colleagues, who are directly connected with the schools, the consequences of delay in making a decision on this administrative matter which is before you in the form of A-1059. The fat is in the fire, so-to speak; the issue has been joined; the question has been raised. If it is not resolved, and resolved promptly, many people, professionals in the schools, accrediting agencies and others, will be concerned about what the posture of New Jersey is with respect to medical education.

I submit that it is in all of our interests, the Legislature's, the citizenry, the faculty and students of the school, to resolve the issue, up or down. I've given you my arguments why I believe it ought to be resolved along the lines of A-1059, and I would be happy, Mr. Chairman, to answer questions which you or your colleagues may wish to put to me.

ASSEMBLYMAN EWING: I would just like to introduce Assemblyman Woodson, on my left, from Mercer County; and Assemblyman Weidel, also from Mercer County; both members of the Assembly Education Committee. Are there any questions?

SENATOR HIERING: Chancellor, I think that you have made your position absolutely clear in unequivocal

[Page 13]

terms. I just want to pursue one matter and that is, this bill in setting up the Board of Trustees gives wide control in the conduct and the management and the administration of the college, and I assume that you believe that this is as it should be, that there should be no amendments, for instance, to this bill which would put conditions upon the Board of Trustees or put legislative limits upon what they could do, as far as whether it's the location of a college or what it might be, or take any other discretionary powers away from this bill. Am I correct in that assumption?

CHANCELLOR DUNGAN: That's correct, Senator. I think the bill is substantially okay. There may be technical questions of drafting changes but no substantial changes, in my opinion, and certainly on the issue of any legislative impedance of the freedom of the Board to act as it sees the best interest, subject, of course, to the appropriations process.

SENATOR HIERING: Thank you.

ASSEMBLYMAN EWING: Chancellor, there has been some question about the Board of Higher Education having control of the curriculum as stated in the bill.

CHANCELLOR DUNGAN: Yes. Mr. Chairman, that issue has been raised by one of my colleagues - at the bottom of page 2. I don't think it's a substantial issue. Frankly, the role of the Board of Higher Education vis-a-vis this Board and this institution,

[Page 14]

would be similar to the role that it enjoys under its own statute at the present time over all institutions, public institutions, of higher education. It is a very general supervisory role and, by law as well as by brief custom, the Board exercises a good deal of restraint in meddling around in any details of program or curriculum. So the anxiety that has been raised about this section seems to me is not warranted in substance. There may be some technical drafting errors that could clarify this and I am certain that the Administration would be perfectly happy to make them.

ASSEMBLYMAN EWING: As far as the terms for the new board, what would your feeling be if it were increased say from three years to five years to give it a greater continuity?

CHANCELLOR DUNGAN: Well I don't believe that the three-year term suggested in the bill, or in the bill, is a disaster. It is true that most of the boards in higher education in this State have terms somewhat longer than this. I think this is a fielder's choice, so to speak.

ASSEMBLYMAN EWING: Would you be opposed to it?

CHANCELLOR DUNGAN: No, sir, I would not.

ASSEMBLYMAN EWING: Another question. In the first page of the bill where it says "shall be combined into a single entity to be known as the College of Medicine and Dentistry of New Jersey," do you feel your Department

[Page 15]

would have any aversion to including a Rutgers division and a Newark division? In other words, pointing out that there will be two separate divisions?

CHANCELLOR DUNGAN: Well, I'm sorry, Mr. Chairman, I can't concur in that. I think you better bite the bullet if you're going to bite it and decide whether we're going to have one medical college in New Jersey or whether you are going to have two or more. And I think anything that fudges on that issue ducks it to everyone's dissatisfaction.

ASSEMBLYMAN EWING: I have another purely technical one. I notice also that the monies to be disbursed -- it evidently is planned that the new medical college would keep the monies received for tuitions and fees and they would not come back into the State Treasury and be reappropriated.

CHANCELLOR DUNGAN: Yes, sir. That's characteristic, as you know, of the State University practice at the present time. It is not at the State Colleges.

Well, it's an interesting bookkeeping arrangement which, to me, doesn't have any very great practical effect because the dollars that are retained by the Institution are dollars that you don't have to appropriate, and vice versa, dollars that are turned in by an institution to the Treasury, then you just appropriate them back out. So it is an in and out

[Page 16]

proposition.

ASSEMBLYMAN EWING: Any further questions? All right, thank you.

CHANCELLOR DUNGAN: Thank you.

ASSEMBLYMAN EWING: We will next hear from Dr. Mason Gross, President of Rutgers.

DR. MAS0N GR0SS: Mr. Chairman, Senator Hiering, gentlemen. I have not been able in the time allotted me to prepare a written speech. I would, therefore, like your permission to have this tape recorded by my neighbor here so we can have a full recording of what I say.

ASSEMBLYMAN EWING: Fine.

DR. GROSS: Thank you very much.

I should start my remarks by reading to you a resolution passed by the Board of Governors of Rutgers, the State University, on Friday, May 8:

"The Board of Governors believes that there has been insufficient time properly to consider Assembly No. 1059 and its implications. It also believes that a matter of such great importance to the future of the State, its medical education and the health of its people, should be submitted in detail for adequate public consideration. Therefore, the Board opposes enactment of A-1059 at this time and suggests that a representative body be appointed by the Governor to study the solutions available and

[Page 17]

to recommend specific plans for the future organization of state-supported medical and dental education in New Jersey. This plan should be fully discussed at Legislative hearings and otherwise before legislation is enacted applicable to the 1971-1972 academic year. Meanwhile, the present administrative arrangements should be continued."

That is the resolution adopted by the Board, all voting members voting for it. I might add that only one member of the Board was absent on that occasion.

Now, Mr. Chairman, the Chancellor has made a great point of the fact that this bill is concerned only with a new mode of administration. I think that if you read even the second paragraph you will realize that we proceed at once with the implications of this new mode of administration because it says that in furtherance of such new policy, public policy, "the School of Medicine heretofore established by Rutgers, The State University, hereinafter called the Rutgers Medical School, and the New Jersey College of Medicine and Dentistry shall be combined into a single entity to be known as the College of Medicine and Dentistry of New Jersey."

Later on, of course, the bill assumes that this has been established, the college has been authorized to negotiate with Rutgers for the acquisition of its

[Page 18]

property. This is all iffy - in other words, if this college is established and so on. And the Rutgers concern obviously is what seemed to be the direct implications of the wording in this first paragraph. In other words, one would not go out to set up a new administrative setup without having certain many, many more important implications brought along with it. And I feel that in passing this bill now, we have to face immediately all of these implications and what they could mean. And we find that they are serious even to the point of being possibly destructive of much that is very valuable in the University and in our Medical School.

I don't really understand the argument which the Chancellor has just put forward to the effect that one board should be required to take care of medical education because any university board has too much else to do. This, I suppose, could apply to any group of men on any occasion. But I can't help thinking of places like Harvard, Pennsylvania, Columbia, Chicago, Stanford--in fact, all but six of the going medical schools, six or seven--are in fact universities now, run by the boards of the universities, and have established a rather good reputation for medical education. I just can't see even the slightest ground for that argument at all. I would grant that we ought to have advisory boards on medical education specifically,

[Page 19]

and so on, and get the best advice that we can. But ultimately I think the central administration the central board of the university can and will take care of adequate administration. This is not a valid argument and all of the history of medical education in this country seems to me to prove that.

Now I might just add also a comment. I wasn't going to say much about this but - I'll reserve that point for a little later.

We are really concerned, as the Board of Governors' resolution shows, with making sure that this whole matter is thoroughly studied before any irrevocable steps are taken. We want to know this before the Governors - as a group of Trustees with properties and monies in their trust are not to be asked to turn over these things, having been committed to this one administrative board, without thoroughly knowing what the implications are. After all, they are trustees, they're trustees of many monies given already to the medical school, and if the proposal here is that ultimately these shall be turned over, then the Trustees, as Trustees, must know that the monies will be handled in the proper manner for medical education. This we do not know.

There are so many questions that come in our minds that we cannot possibly deal with them in the short time that has been available to us or before

[Page 20]

this bill might pass. This has been hurry-up legislation and we really don't understand what it's all about.

The notion that we ought to have unified planning for medical education in New Jersey is a perfectly valid notion. It does not, however, necessarily mean a single administrative core. There seems to be no implication there at all.

Back in 1964 when the first hearings were held or the first discussions were held on the matter of acquiring Seton Hall Medical School and appropriating monies for the Rutgers Medical School, the notion then was that after this five-year period somehow we would be brought together into a single system. I think the Joint Council felt that the establishment of the State Board of Higher Education took a long step in the direction of that central organization, and we were hoping that through that machinery, as we got over certain very crude stages, this could be worked out. However, that hasn't come to pass either. The State Board has not really made any move in this direction at all.

Now the further notion, which was argued this morning by the Chancellor was the tremendous costs that face us all, $170 million. I am not absolutely clear. That's the capital cost under the present plans. Presumably it includes $91 million which we estimate

[Page 21]

as the cost for the teaching hospital at Rutgers. This particular item, however, has been put on the shelf, at least for the moment. We have stopped the architects in their drawing and paid them off and that $91 million is not part of our existing plan. We think that for the time being, as I will show you a little later, we can get along without that and just simply wait to see whether New Jersey does not really need teaching hospitals of that size and magnitude both in Newark and in New Brunswick.

Let me make it quite clear that nothing that I'm saying this morning has anything to do with the programs of the New Jersey College of Medicine and Dentistry. I have nothing against them, I am not arguing for them, I am simply addressing ourselves to our own situation at Rutgers.

Now the program here calls for - again in paragraph two - "preparing greater numbers of students for the general practice of medicine and dentistry." I'm still not quite clear, even if the $70 million figure should be valid, how we are going to prepare greater numbers for less money. This I think, again, has got to be spelled out. Are you going to curtail your programs of education? Does general practice mean something specific, is it just general language? We don't know. And, until we get an answer to that, we do not know whether we're being asked to turn over

[Page 22]

our property, or will be asked to turn over our property, to a program which might not be worth anything. Because, obviously, you get what you pay for and if you are going to be very economical here and at the same time turn out students, more students, who are better prepared, then this ought to be spelled out, we ought to know how it's going to be done and certainly would not have any opposition to a program with that result.

The suggestion is made by the Chancellor that we can improve education of the medical profession. I notice that he said we shouldn't get philosophical, so I won't, I will just introduce myself that element of philosophy which he introduced, namely, all the questions that come along about better health delivery and what-not. All of these are being explored all the time. They don't seem, to me, to have much relevance right now because we must have all kinds of professional aid in doing this. You and I can't sit here and decide this is the way to do it. We don't know. And we certainly ought to take a year's time to study this very carefully and we would promise ourselves to do so before we venture into such an unknown area.

There are implications in the Governor's message, which introduced this bill, that monies for research should be stopped, that lots of people who

[Page 23]

have diseases who don't need research and they ought to be cured. Well, I certainly hope they will be cured. But we did start in this Country, some time back, a long program of study in the fields of heart disease, cancer and stroke, and, again, I would agree with the Chancellor that these diseases are not respecters of persons, they come to all classes of people in all orders of society. Progress there, and in related diseases, will come about through research, extensive research, and to turn our backs on research at this time is to move back into the middle ages somewhere. We must not curtail that in any way; we mustn't be extravagant with it either; we must get all of the help we can from the Federal Government which has extensive programs of research in and through the National Institutes of Health. We can't turn that kind of a thing down and still have a medical school.

Now some of the questions that the Board of Governors has got to consider. The proposal apparently calls for taking over four buildings on the Rutgers Campus. Of these buildings one, of course, is the recently completed building for the two-year Medical School, the first two years of the medical school. That building cost $18,300,000. Of that money, $6 million was appropriated by the State of New Jersey; $8.3 million was appropriated in two grants by the Federal Government through the Department of Health, Education

[Page 24]

and Welfare; and the remainder, the remaining amounts of something over $4 million were provided by monies which we secured from private sources, individuals and foundations. We are disturbed about the reaction of both the Federal Government and the individual donors as to what will happen if we simply calmly say, "Thanks for all of that money, we will now give the building away." This could cause a great deal of bad feeling; it could also close off future sources of financing.

I think buildings number two and three refer to the laboratories where the two classes of 16 students have been educated during these past few years while the main building was being built.

Of these buildings, one building was provided entirely by the Federal Government, originally for the pharmaceutical study -- I've forgotten the exact name of it. When that closed down, we started up the medical program in that building. That took care of one class. We then went to our friends in industry and raised the money from them to build another small building to accommodate another laboratory for 16 students, and we have been able to function in those with these small classes while the building was being built.

I think I'm correct in saying there is not one nickel of State money in either of those buildings.

[Page 25]

And finally, the fourth building seems to be the converted warehouses on the Camp Kilmer tract which we have from the Federal Government and to which the title comes if as and when we use those buildings for educational purposes. I don't know what the disposition of that would be, what interest the government would have. We do not have, at the present moment, any clear title. The title is contingent upon our use of the land for educational purposes.

Now these are some of the physical problems. We have also problems of moral commitments. Together with a Committee of the Faculty, I joined in trying to find the best Dean we could. We think we did just that. Then with the Dean we proceeded to get the key people to head the various different departments for the purpose of planning the curriculum, planning the building, and drafting more recruits and getting the program under way. All of these people came, as I believe some of them are going to tell you today, in the conviction that we were going to have a University Medical School operated under the highest possible standards. That's been our commitment all along.

We have enrolled students and these students have done quite brilliantly. Their records in the last two years in the colleges to which they have gone have shown they rank very high among the medical

[Page 26]

students in this Country. We are proud of them and we feel we have a commitment to them too. And again, we don't feel that we can turn this out and give it up unless we know what it is all about. We really don't know what the new plan is. We hear that there may not be a proper teaching hospital. We hear that there might be a division of clinical sciences in one place and basic sciences in another, which we think would be catastrophic. We are worried about the implications for research. We are worried about being able to retain a faculty, at least a faculty of the quality we have. There are so many undetermined questions here, all of which I think we can receive much more and greater clarity on. And, in fact, we are very much concerned with trying to answer the question who really would benefit by this kind of a change. Are we at all sure that they are going to get better education or that there will be more students? We do not think so. But instead of taking a position of opposition at the moment to that, we are opposing only its passage at this time. We think there has been much too much hurrying up on the whole thing.

Well, let me just say now what I think we would like to propose to you as our plan for the future if this can be delayed for the moment. As I say, we have given up the plans for the $91 million hospital right now because we recognize the financial situation. I

[Page 27]

say it was said in the newspapers the other day, it was reported as some State official saying that this money could not be provided without a bond issue. Well, having worked through several bond issues for larger sums than this, that doesn't frighten me. I think if we again can tell the story right, there is no reason why we couldn't float a bond issue in order to provide the highest quality of medical education in New Jersey. This doesn't frighten me at all.

However, we could proceed now with our program, and it would be costing the State relatively little, if two things which have been discussed could be brought about. One is to build the psychiatric institute. The psychiatric institute, you may recall, was designed originally for Skillman, the voters in 1964 approved approximately $6 million building and it was to come under the general Department of Institutions and Agencies. The Department discovered they could not get Federal support for this building, which was planned to be much larger than $6 million, -- they couldn't do it unless it was associated with a university or a university hospital. Therefore, legislation was passed by this Legislature transferring these funds from I&A to Education for the purpose of building the building on the Rutgers Campus. With the idea that we were going ahead, we cut down, we

[Page 28]

got the architect to revise his drawings to provide an efficient but much less expensive building, we went to the Federal Government where we received an award of something over $1 million and then Mrs. Pearl Buck, through her organization called Aims has promised us another million dollars to carry forward with this program. We have the money, we have the plans, we went after bids, the bids came in just about on the budget and we were all set to go when, because of this general problem coming up, we had to freeze. We would like to see this go forward. A psychiatric institute of this sort for both inpatient care, research, connections with the hospital and also community health programs for a catchment area of 200,000 people, this is a program which would be valuable to all people and should go forward in connection with the Medical School as now constituted.

The other thing that has been proposed is that the University or the State might take over for the University's use the Raritan Valley Hospital in your County, sir. We understand -- I don't know the details on this -- that the building can be acquired if we simply take over the mortgage of $4 million. We would have to put between $2 and $2.5 million into it to make it appropriate for a teaching hospital. This would enable us to accommodate, initially cat least, some 30 students for the third and fourth years; it

[Page 29]

would give our faculty a place to practice their skills, as well as to teach; and we feel that this is a very small sum of money to go ahead with.

So if you add the appropriation of about $6 million, or $5.5 million as it is now, which has already been approved to the two grants that we have, for a total of about $7.5 million, and then you add the $4 million mortgage and roughly $2.5 million to put it into shape, you will see that we can be operating a four-year medical school with a first-rate faculty in New Brunswick using fully the building which we have already built for a sum of, I would say roughly, $14 million.

Now this is a short way from $170 million, which I wouldn't want to talk about, but this figure ought to be introduced into your thinking too. I do not know anything about the plans as approved for the Newark College but this can put us into good shape and we can be operating then, and I hope cooperating also with whatever may go on in Newark.

Now I think our basic point is that we firmly believe -- and there are plenty of quotations which will be submitted by other people, I believe, -- that the right place for a medical school is in a university. We have so many other schools which cooperate, as one of the submissions will show you, -- so many other schools and colleges which cooperate with a medical

[Page 30]

school in their programs. The faculty of the medical school are parts of the university faculty. They work in university sections. They are an inspiration in many ways to the college, but they are very, very good colleagues too. And with so many other schools there, we feel that this complication is unnecessary, to have an alien group running a couple of buildings on our Campus. We feel this would add to all kinds of complications. For example, we have built, of our program, very well thought through, -- we have built and it's now nearing completion --immediately adjoining the medical school we have a Library of Science and Medicine. This was designed as a place to bring together the graduate students and the undergraduates in sciences at the University Heights Campus with the medical students so that there would be more exchange amongst the graduate students, the scientists, the basic scientists and the medical students than is possible at many institutions. If the units here are divided, it's impossible to figure out who is going to run that library, who is going order the books, who is going to pay for them, who is going to budget them, just all kinds of administrative details like that will make this life very much more complicated.

I should add also that this has caused something of a panic in New Brunswick because if by an act of

[Page 31]

this sort the Medical School can be separated out and joined up with somebody else outside the University, why not the Law School, why not the College of Pharmacy, why not any one of these other schools which could be separated for some kind of purpose. And this destruction of a University, this almost systematic tearing apart of a University is something too horrible to contemplate. It absolutely reverses all the course of history in this Country and we are all worried and disturbed. We feel that any suggestions of this sort violate the whole spirit of the Act of 1956 by which we became fully the State University of New Jersey and we feel it would be a betrayal of all the people who have put so much of their lives into trying to build a great university for the glory of the State of New Jersey.

So, gentlemen, we really think these questions are of tremendous importance, that they must be considered. We must get expert approval. We must consult with all kinds of people before we make this kind of a very, very, very drastic change. This is not a simple administrative matter. This is a matter of very grave consequence to the nature and the health of a whole university as well as to the progress of medical education in this State. And I plead with you, therefore, to take the resolution of our Board of Governors seriously and don't rush pell-mell into

[Page 32]

something the consequences of which we haven't even begun to think through.

Thank you very much,

ASSEMBLYMAN EWING: Dr. Gross, don't you feel that the new board of trustees would be able to delve into these questions that you raise and come up with the answers and decide whether the Rutgers complex should continue as well as the Newark complex?

DR. GROSS: I would have no objection to the board of trustees being considered as an advisory board to study these matters before they actually took over, took over anything. But I think really to take over and then think is not the right order of things. I think you think, you plan, you study, you research, you get all the best opinions you can. I'm sure the board the Governor would appoint would be a first-class board and it could do this, but I don't really see, if we pass this bill, telling what the trustees are supposed to come up with before we've even appointed the trustees. This does not seem to be the right order of things.

ASSEMBLYMAN EWING: The single board would coordinate whatever medical education would be ongoing in the State and they certainly would consult these other groups, whoever they might be, to determine what avenues they should take. This bill is simply setting up a single board.

[Page 33]

DR. GROSS: Yes, but the intent is to set up a single school.

ASSEMBLYMAN EWING: The intent really lies with the board itself.

DR. GROSS: You can't read that into either the Governor's message or this bill itself, even in paragraph number two. The intent is to bring the two schools together.

Now I have no objection. This does not again seem to be totally impossible, but I want to know how it's going to work. I don't construe the two schools as necessarily being built in one location but if you do have two schools in two different locations that really provides administrative problems which ought to be thought through before you have your board. There are plenty of people around here who have been working on this thing and can advise such a board and study with them. And what is the hurry? Certainly no great tremendous economies are going to be effected next year. What is the hurry? Why can't we think things through? Why can't we plan? Why can't we realize this is such a tremendously important move and take the time to effect it? It just seems to me folly to rush into this thing. I grant you the bill that has been presented here looks smaller - I looked at it and it looks enormous. On concentration we can make it smaller and perhaps the terrible awe is not quite

[Page 34]

as appalling as it seems. Perhaps this can be worked out under the existing organization. But these questions should be answered.

ASSEMBLYMAN WOODSON: Dr. Gross, how long do you think it would take the University itself to come to some very definite conclusions as to the impact of these changes that are proposed in this bill?

DR. GROSS: Well, Mr. Woodson, that would have to be a question of whether we're just talking about one administration or whether we're talking about all the implications that seem to be spelled out as to what could happen.

ASSEMBLYMAN WOODSON: Well, I mean from all the implications that are spelled out. I think things that you have discussed this morning.

DR, GROSS: We would ask for a year's delay.

ASSEMBLYMAN WOODSON: A year's delay.

DR. GROSS: Yes.

ASSEMBLYMAN COSTA: Dr. Gross, didn't you say that we should have more time to plan?

DR. GROSS: Yes, sir.

ASSEMBLYMAN COSTA: Well, as I understand it, in 1965, July of 1965, it was agreed that the State would take over this institution under a new name within five years, after five years. What have we been doing in the last five years?

DR. GROSS: I can't answer that question. If

[Page 35]

you want me to say mea culpa, I must, because I was on that Commission. You will notice that we were assigned several duties, including managing the budgets and seeing that they didn't get out of line. We did do that. We did not address ourselves to the other problem. But I don't really think, sir, that errors in the past are justification for errors in the future.

ASSEMBLYMAN COSTA: The only reason why I raise this question is that if nothing was done in the last five years, what guarantee do we have that any improvements will be made in the next five years?

DR. GROSS: I can't give you any guarantee, sir. I am sure if you will give this thing full run what we're asking now is the Board of Governors of the University to move in. This other board was perhaps not the right kind of board to set

ASSEMBLYMAN COSTA: Dr. Gross, you also said that if you had a new psychiatric institute and if we were to purchase the Raritan Valley Hospital, we would have a better complex at which, to work. Is that correct?

DR. GROSS: Yes, sir, We would have a good complex in which to work, better than what we have now.

ASSEMBLYMAN COSTA: Now if we had one single entity, as was suggested by the Chancellor, why couldn't they acquire both of these institutions that you speak of?

[Page 36]

DR. GROSS: I don't quite follow. I was addressing myself there to the cost involved and I think the cost here is so slight that it shouldn't be considered only in terms of $170 million, that some items could be much less expensive and, therefore, the crisis isn't before us.

ASSEMBLYMAN COSTA: Well, what makes you think that if we had one entit,y this new board of trustees would not follow the statement that you just made, that we do have a psychiatric institute and that we also consider the advisability of purchasing the Raritan Valley Hospital?

DR, GROSS: Well, sir, I wasn't trying to say that a new board might not do the same thing; I was very much in hope that it would, because that would be an intelligent thing to do. But I am just simply pointing out that we mustn't be rushed into this thing on the grounds of overwhelming expenses, when really we can do a satisfactory job with far less. I would compare this $14 million, for example, with our $91 plus the psychiatric or nearly $100 million at Rutgers. We now think we can work this thing out for vastly less than that and, therefore, I believe that the fiscal urgency is not as great as it was presented as being. That was the point of that.

SENATOR HIERING: Dr. Gross, getting back to the basic merits of this bill, and it's a simple bill,

[Page 37]

as I see it, because what we're doing we're combining our two schools and putting them under one board of trustees. Don't you feel that once the new board of trustees is appointed that they can take care of and meet all of these implications that you are concerned about? You're talking about turning over the property, you're worried about retaining faculty, and so forth. It seems to me that we should have enough confidence in a new board of trustees that they would adequately take care of these things and in consultation with yourself and in consultation with the other school, so to speak. Don't you feel these matters could be worked out with a new board of trustees?

DR. GROSS: I think that you put me in a difficult position because you are asking me an if question. Since I don't know who the new board of trustees is, I don't know. I assume they are going to be a fine group of people, but I don't know. I mean, this is a pig-in-a-poke business, isn't it? We are asking to more or less go along with the program. The program is spelled out in here even if it's only iffy. The program is spelled out as to what's to happen here. And you say, don't I think a bunch of angels couldn't do this right. Well, I still say it's the wrong thing to take them out of the University.

[Page 38]

SENATOR HIERING: In other words, you oppose the concept of one board of trustees to administer the program of medicine and dentistry in this State as opposed to two boards?

DR. GROSS: Sir, I'm not here to oppose anything, I'm here to ask for time to study it. And I think to rush in ahead of time with your board and the bill here which really tells the board what to think about, if nothing else.

SENATOR HIERING: Well, the bill that's before us gives the board wide discretion. There are no limitations as to what they can do anymore than there is with Rutgers or the present board we have of Medicine and Dentistry.

DR. GROSS: Well, what do you construe it to mean, sir, when it suggests that this board might think about the possibility of acquiring all the buildings and property at Rutgers? Is that just a chance thought that there is something they might talk about? Isn't that a pretty clear indication of what the intent of this bill, the direction of this bill is? And we don't know that that can be done yet. We've got to study it.

SENATOR HIERING: Well, perhaps this is a question that we don't know whether it should be done or not. Isn't this a question that the new board of trustees can make that determination?

[Page 39]

DR. GROSS: I think it's also a very important question for our Board of Governors to decide where their responsibilities as trustees of those buildings and those funds end, what's involved in them. They've got to think these things through. They have a legal responsibility,

SENATOR HIERING: Well do you see any - do you basically object to having this one board control medicine and dentistry in our State?

DR. GROSS: I would suggest very much that until we work this thing out, we spend a year studying how it would work, and appoint your board to study it first, with a notion that if the plan is approved, then they become the administrative board. But we've got to have time somewhere along the way. This is altogether too quick.

ASSEMBLYMAN WEIDEL: Dr. Gross, when I heard Chancellor Dungan speak; the question he posed to this Assembly was, how is medical education in New Jersey to be managed in the future. That's the basic intent of this bill. I mean that's the question that he posed to us. Now those of us who may be for one segment of medical education at Rutgers and those that may think it should be someplace else - all the things that you propose, I don't know why you would be concerned, because if you are as convinced as you sound and if yours is the proper way for it to be

[Page 40]

done, the Administration Board, which this bill proposes, would follow your recommendations, it would have to come to you, it would have to discuss and seek out and look at what you've done, what you've spent, why you've done it, where it should be, how it should be.

DR. GROSS: Apparently the intent of this bill as written out here is to bring together the New Jersey College of Medicine and Dentistry and the Rutgers Medical School into a single entity with a name all its own. That does not seem to me to be a proposal; that's law if that goes through. The fat is in the fire, to put it in my words. And I would think before we enact that, we have got to have some more information as to how this is going to work. I think it's a smokescreen to say that this is nothing but an administrative detail here at all. There is the plain statement, one entity, and that one entity our part of that would be taken out from the University.

ASSEMBLYMAN WEIDEL: It would be taken out of the University as administered by the University. It would be administered by this new board for the College of Medicine and Dentistry of New Jersey, but it might very practically be located in New Brunswick.

DR. GROSS: Well, it's already there to the extent of $18.3 million and I hope it will stay.

ASSEMBLYMAN WEIDEL: Pardon?

[Page 41]

DR. GROSS: It' s already there to the extent of $18.3 million. And I don't mind building anywhere else, either, for some other schools.

ASSEMBLYMAN WEIDEL: We are just starting now and we probably will be here for a long, long time. It seems to me that so far the Chancellor is speaking of one college of medicine and dentistry and you're speaking of Rutgers. Now I suppose there will be people speaking of other institutions. The problem that we have as Legislators and the problem that we're trying to solve by this bill is how is this to be done. Should we continue the way you have already started or should we continue under one college someplace in New Jersey, administered by somebody and some board, the board of which we do not even know the makeup -- most likely it might be people from this room.

DR. GROSS: Sir, at the present moment both of these medical schools are under the direction of the State Board of Higher Education, both of them, because the University is in accordance with the Higher Education Bill. I see no reason why the State Board of Higher Education cannot be requested or directed to conduct during the next 12 months a study of the administration of medical education in New Jersey and to secure the full cooperation of both of the existing medical schools including all of the

[Page 42]

University too. I would pledge you our fullest cooperation in that. You have an existing board now which has got this kind of responsibility right smack in its existing authority and I see no reason why that can't be done without creating a new board at this point, an administrative board which, after it has administered for a while, will plan what it's going to do. This doesn't seem to me to make any sense. I'm asking for time. I think this is a way in which we can move forward, and it's all in existing law and it requires nothing more than we have now.

ASSEMBLYMAN EWING: I want to welcome Assemblyman Wilson from Essex County who is Chairman of the Air, Water Pollution and Public Health Committee.

ASSEMBLYMAN WILSON: Dr. Gross, do you think there is need for coordination between the programs that are being offered at Rutgers Medical School and also at the New Jersey College of Medicine and Dentistry ?

DR. GROSS: I don't know exactly what you mean by coordination. I would like to see closest cooperation and obviously the removal of any unnecessary duplications, and so on. Is this what you mean?

ASSEMBLYMAN WILSON: Well, yes. As far as duplication and also the fact of having somewhat similar courses, because they are training the dentists and we 'hope the future doctors of our State. So,

[Page 43]

therefore, there should be close, very close, coordination. Would you agree to that?

DR. GROSS: But you know essentially you have that now, yes. We can't introduce new departments and things of that sort. We have to justify our budget to the State Board of Higher Education, which overviews both of them. That State Board of Higher Education was not in existence when the legislation of 1965 went through. It is in existence now. It does have this kind of power. And, again, we are cooperative.

ASSEMBLYMAN EWING: Thank you, Dr. Gross. I would just like to remind people, I am going to have to cut down a little bit on the time because we do have so many people who do want to appear today. And also please try to stick to the pertinent facts that are contained in the bill, of having a single board look into and run the medical education in New Jersey

I would like to call on Dr. John Cooper, President of the AAMC.

DR. JOHN COOPER: Thank you very much, Mr. Chairman. I am very pleased to appear before this Committee to testify on the bill entitled Medical and Dental Education Act of 1970, which you are considering today.

I have been asked by both the New Jersey College of Medicine and Dentistry and the Rutgers

[Page 44]

Medical School to testify.

I understand that this bill has only been recently introduced into the Legislature and an with these broad implications of this bill warrants very careful study and evaluation.

As President of the Association of American Medical Colleges, I am very interested in providing whatever assistance you desire in this study and evaluation.

The Association which I head was founded almost a hundred years ago to promote a then much needed reform in medical education. Over the years the Association has continued to promote the advancement of medical education and for this purpose it has undertaken work with all of the educational institutions involved in the education of professionals and in carrying out biomedical research and training.

At the present time the membership of this Association includes all of the 105 medical schools of this Country that have been established or are in development. It also includes 34 very distinguished academic societies which represent the faculty of these medical schools, and 360 of the Nation's largest teaching hospitals. Both Rutgers and the New Jersey College of Medicine and Dentistry are institutional members of the Association and their Deans, Dr. Rossin and Dr. Stetten are members of our Council of Deans.

[Page 45]

The Association works in very close cooperation with the American Medical Association for the continued improvement of medical education and educational standards. We have had a very long-standing committee, a liaison committee on medical education with the Council on Medical Education. This liaison committee has a policy statement on the functions and structures of a medical school. I think that a part of the chapter on organization and structure is pertinent to the consideration of this bill which is under discussion, and I quote:

"A medical school should be incorporated as a non-profit institution, if possible as part of a university, since the university can so well provide the milieu required by a modern medical school. If not a component of a university, a medical school should have a board of trustees composed like that of a university of public-spirited men or women having no financial interest in the operation of the school or its associated hospitals. The trustees should serve for fairly long and overlapping terms.

The relationships of a medical school to the university are becoming increasingly important as medicine and the medical sciences become more complex. University departments can assist and strengthen the medical school in meeting its responsibilities and vice versa. For example, the physical and biological

[Page 46]

sciences are making important contributions to the understanding of living processes and the changes effected by disease. Engineering can contribute to an understanding of the complex living system and in the development of medical technology to make it more effective and efficient. We already have many examples across the country of biomedical engineering groups which have been formed by the faculties of medical schools and schools of engineering to address themselves to this matter.

Social sciences can also contribute to research and innovation and demonstration in new approaches in the delivery of health services which will make more effective the use and training of scarce health professionals and reduce the need for expensive facilities.

The competence and expertise in operations research, systems and management, available in engineering and business schools can also make important contributions in the rationalization of our health care systems.

As pointed out in Governor Cahill's statement, the medical school should lead the way in development of better systems for the delivery of health care. They are already undertaking this responsibility across the Nation and in many cases they can do this most effectively using the total resources of the university.

[Page 47]

Through the Liaison Committee on Medical Education with the American Medical Association we are involved in the accreditation of medical schools. The Liaison Committee is recognized by the National Council on Accreditation as the official agency for accrediting medical education.

The New Jersey College of Medicine and Dentistry was last accredited in 1967. The College was resurveyed recently. The final recommendations on the resurvey are pending action by the Liaison Committee and the parent councils.

The Rutgers State University Medical School was accredited in 1968. It is due for an accreditation survey in 1971.

I would like to make it very clear that the actions proposed in the bill would not in themselves call into question the accreditation of the two medical schools. If the action, however, resulted in drastic reorganization of the schools and a change in the nature of the program, this would have to be taken into account and a careful study of the situation undertaken. If the reorganization did bring about a loss of competence of the faculty and students in either of these institutions, it would be necessary to reconsider their present status.

It is most gratifying to find the informed interest in the support of medical education in the

[Page 48]

political leadership of New Jersey. The awareness of the critical needs of the health delivery systems and the hospitals and communities of the State and a desire to take positive action is to be highly commended. But undergraduate medical education is only one segment of the total problem. Well supported, well staffed hospitals and clinics are also necessary to attract and keep the numbers and quality of house officers and physicians which New Jersey needs and deserves.

The excellent beginnings which have been achieved in mounting programs in biomedical research at both institutions must be extended to contribute new knowledge which is essential if we are to meet society's expectations for help within any reasonable limits of trained personnel and extensive facilities, for it is through research that empirical, palliative medicines can be replaced with effective diagnosis and treatment, that disease can be prevented from taking its toll of human life and suffering.

In closing, I would like to suggest certain questions present themselves in considering this bill.

1. Has there been adequate opportunity for discussion with the Administration, Faculty and Students of the Schools involved on the impact of the legislation on the institutions?

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2. Has due consideration been given to alternative proposals that might more effectively achieve the purposes desired and that would retain and extend the advantages of present arrangements? Have the opinions of national leaders in medicine, medical education and university administration been sought to have the best possible advice on this very far-reaching issue?

3. Have the effects of bringing the two schools under a single administration -- the effects on federal grants of bringing the two schools under a single administration been adequately considered? Under some Federal programs there might be a reduction in the funds received.

4. Will the three-year term proposed for the board of trustees be long enough to assure adequate continuity of policy and programs and permit the members to maintain freedom of action to promote the best interests of the institution and its educational program?

Again, I would like to thank the Committee for this opportunity to appear before you. I can assure you that the Association of American Medical Colleges stands ready to help in any way possible in your efforts to meet the health care needs of the people of New Jersey.

Thank you.

[Page 50]

SENATOR HIERING: Dr. Cooper, you seem to put a great deal of emphasis upon the advantages of university affiliation. I think most of us on this Committee agree with that, that it would be most helpful. But couldn't we get exactly the same thing through the cooperation of the Board of Governors of Rutgers and the new board under this proposed bill? In other words, by cooperation and operation of the facilities at Rutgers, couldn't we through cooperation have the same affiliation?

DR. COOPER: I think that I may have gotten into the philosophical aspects which the Chancellor said we probably shouldn't concern ourselves with this morning.

I think that there are probably a variety of ways in which cooperation could be achieved. There are a great number of institutions in New Jersey in which these kinds of interrelationships between the medical schools, which are becoming much more complex and much more dependent upon the broad spectrum of expertise, ability and education of the faculties of universities, and I think that there could be a number of ways explored in which this kind of cooperation, this kind of assistance from those who are not directly related to medicine are addressing themselves to the medical problems today, could be attained. That was the suggestion that maybe some of

[RLT note: compare Cooper's prepared and spontaneous testimony. Then consider that Gross had nothing prepared. Incoherence is the order when you think on your feet]

[Page 51]

these ought to be explored.

SENATOR HIERING: Another thing. On the Federal grants, you mentioned the possibility of perhaps getting less federal money. Now wouldn't you say that we have two medical colleges, two medical setups competing for federal funds, that we have the possibility of duplication and perhaps the possibility of getting less federal grants?

DR. COOPER: Well, the bill is not clear about whether this would be a single institution or would be two institutions. I'm not clear, from reading the bill, what is actually proposed. I think there are some of the federal programs, especially those related to capitation support of operating budgets in which there is a specific amount of money granted to each institution as a separate institution. And, of course I think the consideration of many of the federal agencies has to do with the overall programs of the institutions and would not be affected by either action, retaining the present situation or converting this into a single institution. But this is a matter which I think should be explored.

SENATOR HIERING: I might say, for your information, the bill does call for this to be a single entity, known as the College of Medicine and Dentistry.

ASSEMBLYMAN WOODSON: Doctor, as it was stated earlier that this was a very simple bill, I gather from

[Page 52]

your remarks that you do not feel that this is a simple bill, that there are implications in this bill which call for a great deal more study than we presently have before us.

DR. COOPER: Well, I think that certainly the bill proposes to make some rather substantive changes in the present organization of these two medical schools, And from that point of view, I think it may not be a simple bill, especially taking into account, the kinds of reactions and viewpoints that might be expressed by the faculty and students of the two institutions. And in this time when it is very difficult to obtain faculty and where student opinion is very important, I think that these matters ought to be given serious consideration by this Committee,

ASSEMBLYMAN WOODSON: You have heard, I presume, Dr, Gross' statement prior to your statement?

DR. COOPER: Yes.

ASSEMBLYMAN WOODSON: Would you support the thought that he had of a longer period of study for a bill of this nature so that the University and all concerned might be able to give far more expert opinion about it in regard to its implications?

DR. COOPER: Well, as I stated, I think that under the circumstances and with, I think, very little time to consider a very important problem, that it might be to the advantage both of this Legislature

[Page 53]

and the institutions and the State Higher Education to gave due consideration and more consideration to the implications and the reactions. I think the Committee will have to determine for itself whether these hearings and the other kinds of inputs that they have had are adequate in their view to make the decision which ultimately, of course, rests with you gentlemen.

ASSEMBLYMAN EWING: Well also, the new board can go into a much more detailed study, though. Nothing is going to change with the new board taking over if this bill goes into effect. And they can take a year or two years, if they wish, or three years in coming up with the final solution.

DR. COOPER: I think that from my reading of the bill, and I'm not an expert on the bill, but in reading the bill it does appear as though a proposal is made to join these two institutions under a board and in essence remove Rutgers from its present Board and constitute a new board for the one which now governs New Jersey College of Medicine and Dentistry. So I think the action on this bill will imply that some changes will be made on the basis of the language in the bill, although I'm not an expert, as I say, on the bill.

ASSEMBLYMAN EWING: Generally is there a greater preponderance of teaching medical facilities

[Page 54]

oriented with universities or separate?

DR. COOPER: Yes. We have relatively few institutions that are separate institutions. One of these, of course, and one which is a fully accredited member of the Association is one in the State of New Jersey which originally, as you know, was started as a part of a university. But there are only some eight medical schools out of the 105 in the country which are not directly governed and under the direction of a university.

ASSEMLBLYMAN EWING: Well, is the tendency increasing toward not having them connected with universities or is this an old way of doing it and now they are --

DR. COOPER: Most of the schools that are independent were founded more than fifty years ago with a couple of exceptions, and these exceptions have to do with medical schools that were related to church-affiliated schools and these schools found, in some cases, some difficulties in receiving federal support and public support for their programs on the basis of this close affiliation. For example, Baylor Medical School in Houston is now a separate entity and was at one time a part of Baylor University. The Marquette Medical School in Milwaukee, which was originally a part of Marquette University, is now a separate entity. But these are the two - and, of

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course, in the case of New Jersey College, it was originally a part of Seton Hall and when the State took over it became a separate entity.

But the tendency - most of the new schools that have been founded in this Country are State-supported public schools, and in most cases they have been formed as integral parts of a university.

ASSEMBLYMAN EWING: When was the most recent one formed? How many years ago, approximately?

DR. COOPER: Well, both Marquette and Baylor are within -- the separation or the formation?

ASSEMBLYMAN EWING: The formation of a brand-new school tied in with a university?

DR. COOPER: Well, there are a great number that have come on board. Connecticut, Arizona, New Mexico, the University of California, Davis; there was sort of a new school at Irvine in California, it was transferred from an osteopathic school into a full medical school; the University of California at San Diego; the University of Texas at San Antonio.

ASSEMBLYMAN EWING: Are these all recent ones?

DR. COOPER: Yes, within the past four or five years.

ASSEMBLYMAN WILSON: Dr. Cooper, are there advantages to having a medical school affiliated with a college? Would you say? You did not comment as to whether there were advantages or disadvantages in your

[Page 56]

testimony.

DR. COOPER: I think that both in the statement which is the joint statement of Council on Medical Education of the American Medical Association and the Association of American Medical Colleges that it does point out that it is the preferable situation, although the schools which we have which are fully accredited, which are producing medical students, as independent institutions are certainly looked upon in the same way that other schools are with regard to their output of physicians.

It is felt by both of our parent bodies that medical education is a university discipline and that the interrelationships between this educational program and medicine are becoming closer and not more disparate than they were in the past. We had a long period before 1910 when there were a great number of independent schools, many of them proprietary, which have closed as the result of a very intensive study which was carried out by Dr. Abraham Flexner which brought about at that time the gradual disappearance of proprietary schools and most of the independent schools that remained did become parts of universities, with the exceptions that I have told you.

The interrelations, the scholarly atmosphere, the ability to call upon confreres in other parts the university in meeting the problems which now face

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medical education and medical care is very important. And the social sciences certainly will make great contributions, as I have said, in the rationalization and in the making more effective and efficient our medical care system because we do need the kinds of advice, input, background, that these people have to really deliver the quantity, quality and equality of medical care which this affluent nation deserves.

ASSEMBLYMAN WILSON: Dr. Cooper, that means then that there are no advantages to having a college or a school of medicine being independent? I mean, you could not find these same sources of interrelationship among the faculty members which are oriented into the development of competent doctors and dentists in our State?

DR. COOPER: No, sir, I would not say that that follows. I would say that it is much more likely you have the interactions between two groups of faculties if they really sort of belong to the same institution. But this is not necessarily true. Certainly some of the independent institutions have worked with institutions in their area to develop programs between the faculties of two institutions. I just think it becomes more difficult as you have separation of administration and purpose.

ASSEMBLYMAN EWING: Thank you, Dr. Cooper.

DR. COOPER: Thank you.

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ASSEMBLYMAN EWING: I would like to call Dr. Carl Kaysen, Director of Advanced Study at Princeton.

DR. CARL KAYSEN: Mr. Ewing and gentlemen. I have been asked to express my views on the bill before you. Let me say that professionally I am an Economist; I'm not a physician and I am not a biologist. I have become familiar with matters related to the organization of medical education as a member of the Carnegie Commission on Higher Education.

This Commission, which has been sitting for two years now and which will be sitting for a while longer, is trying to make an overall survey of colleges, universities, professional education in the United States; its finance; its organization; what its future growth might be; what changes would be desirable.

It's a long Commission. I won't go through the whole list of names. The Chairman of it is Clark Kerr, who was President of the University of California. It includes among its membership: Nathan Pusey, President of Harvard University; David Henry, President, of the University of Illinois; William Friday, President of the University of North Carolina; Stanley Heywood, President of Montana State College; David Riesmann, Professor of Sociology at Harvard; Kenneth Keniston, Professor of Psychiatry in Yale University Medical School; myself -- I'm giving you

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the academic members - Katharine McBride, President of Bryn Mawr College. It also includes a number of businessmen who have had experience as trustees of colleges and universities: Clifton Phalen who was Chairman of the Board of Trustees of the State University of New York is Vice President of Marine Midland Bank; Ralph Besse, President of the Cleveland Electric Illuminating Company, had a lot of experience as a college trustee; Norton Simon of the University of California; Governor Scranton, former Governor of Pennsylvania. That gives you some flavor of the Commission.

Now let me make it clear, while I'm speaking here in response to your invitation because of my experience with the work of the Commission, I am not speaking for the Commission. I am not here to represent the views of the Commission. Indeed, as I will explain to you in just a minute, it would be inappropriate for me to do so.

The Commission has under consideration now a report on medical education. It will come out in about a month or a little more than a month, entitled Higher Education and the Nation's Health. That report is being prepared by the staff members of the Commission with the advice of a group of doctors and deans of leading medical schools. Amongst the people who have been consulted, whose advise has been weighed heavily,

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are Robert Ebert, Dean of the Harvard Medical School; Phillip Lee, Dean of the University of California Medical School in San Francisco; many others.

Like all commissions of this sort, we don't sit as experts, we sit as concerned, intelligent, experienced laymen; we listen to what the experts have to say and we try to evaluate it.

Now since we have not produced a final report and since only the report can speak for the Commission, I want to emphasize again that I am giving you such knowledge and wisdom as I have, which may not be very much, in the light of my experience as a member of this Commission, not as a representative of it.

Now we have had a draft report on medical education before us; we've met in a session and discussed it for a day -- that session took place at the Harvard Medical School; we had the Dean of the Medical School, we had several of his colleagues who are particularly concerned with the organization of medical training, the finance of medical research and related questions, and we have given a lot of thought to that.

Now I think it's further useful for me to say to this body that I had a conversation on these subjects with Chancellor Dungan, an old friend of mine with whom I have had a close and good relationship for many years, but this was as a result of a chance encounter. He told me some of the things that he was thinking of and

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I responded by saying, "That's very interesting, Ralph. You know we're working on a report on medical educaticn and a lot of what we are saying goes along the same lines."

I want to make it clear that my own thoughts were drawn from my experience in the Commission and Mr. Dungan's thoughts were drawn from sources that he can tell you better than I can, but they converged independently, they didn't necessarily borrow from each other.

One of the recommendations of the Commission -- it's a recommendation particularly addressed to new medical schools, ones that are either yet to be created or in the early stages of creation -- is that strong consideration be given to the notion that the pre-clinical training in the medical school be offered in the university rather than at the medical school. What is equivalent in the conventional curriculum of many medical schools today of the first two years of laboratory work, anatomy, physiology, and the like, can just as well be taught in the university rather than in the medical school proper, especially if the medical school proper is conceived of as being closely related with a group of hospitals and closely connected with clinical training and clinical research.

The basis of this recommendation involved a number of factors. One was the desire that medical

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educators, many medical educators have, and a desire that's shared and, in fact, you might even say is felt much more strongly by academic administrators, by Legislators, by people who are concerned with paying for the high and increasing costs of medical education -- this was the question of, can the program be shortened? is it possible to turn out well trained and competent physicians in a shorter period of time than we are doing it now?

There was a good deal of testimony amongst people we heard, papers we've read, that it was possible to do so. There are a variety of experiments now being undertaken in different states looking toward this end. One experiment - and the Commission doesn't suggest, we didn't suggest in our first draft report and I do not believe we will suggest in our final report, which I haven't yet seen, that this is the only road to that goal, but we do think a road to the goal is trying to put the first two years of medical training, as it is now organized, and the four years of premedical training, into five years, the site of which would be the college or university, and the last two years cf which would be a heavy emphasis on the laboratory sciences that are basic to clinical training.

Then the notion is that a student would transfer from that kind of an institution to a medical school proper at what is the equivalent of the third year and start his clinical training.

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Other experiments are possible. Some others have been training. If I may, Mr. Ewing, I will read a paragraph from the draft report which indicates another experiment that is now going on in Illinois.

"The Illinois Board of Higher Education has recently approved the plan for the reorganization of the College of Medicine at the University of Illinois which, among other changes, would establish two types of schools. One, schools of basic medical sciences at the Medical Center Campus in Chicago - and it's the University's Urbana-Champaign Campus - and two schools of clinical medicine. The schools of basic medical sciences will promote basic knowledge and understanding of sciences relative to preparation for careers in dentistry, medicine, nursing, pharmacy, and associated medical fields. It is anticipated that the typical basic science curriculum for medical students will be one year." Now, note, that's different from what I was previously talking about. "Schools of clinical medicine would be established to offer to students transferring from the schools of basic medical sciences a three-year curriculum to complete the work for the MD degree. The third year would correspond with the present internship year.

Now that's a very substantial change in the organization of medical education that is already approved and will be under way starting next year.

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And I may say that David Henry, the President of the University of Illinois, who is deeply involved in this change, is a member, as I said earlier, of the Commission.

Now, I think I will finish my statement, Mr. Ewing, by saying that we recognize that these are matters that are not matters on which all well-informed people agree; they're matters of controversy, they are matters of weighing conflicting considerations. My own judgment, and the judgment of a number of members of the Commission, - and, again, I don't think l should and can say more until we have a report which reflects our agreed judgment, but my own judgment and the judgment of a substantial number of members of the Commission is that the need for accelerating the production of doctors and the increasing pressure, the high cost of presently organized modes of producing doctors, both justify a good deal of experimentation with any method that offers a reasonable promise, as evaluated by competent and knowledgeable people, of cutting the time and thereby cutting the cost.

Thank you.

ASSEMBLYMAN EWING: Thank you very much, Dr. Kaysen.

I would like to call on Mr. George Smith, Chairman of the Board of Trustees, Newark.

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GEORGE F. SMITH: Mr. Chairman and gentlemen of the Committee: My name is George F. Smith. I am now the Chairman of the New Jersey College of Medicine and Dentistry and have acted in that role from the very beginning in 1965. Interestingly enough, prior to that I was Chairman of a Fact-Finding Committee which was established by Governor Hughes to determine what to do about the Seton Hall College of Medicine and Dentistry which was close to coming to an end. That committee consisted of some distinguished people: Governor Driscoll, Governor Meyner, Jack Connor, Former Secretary of Commerce. In our deliberations as a Seton Hall Fact-Finding Committee, we had two charges: One was to determine whether Seton Hall was worth preserving and, if so, what to do with it. It is a rather interesting situation in the light of the discussion this morning that the first choice of that committee was to turn over the administration of Seton Hall to Rutgers. In fact, Mason Gross and I had conversations. And finally it was determined by the Committee that the position of Rutgers was that it could only take over Seton Hall, if virtually immediately it be effected, with no more entries into the school and the phasing out very rapidly to put them into the college.

Following that, we chose as our second choice discussion with the Newark College of Engineering, which took the position after some consideration that it would rather devote all of its energies to engineering education.

One of the reasons behind the position of Rutgers was and I don't blame them because it looked as bad to me as it

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did to some of them - that it was impossible to develop a worthy medical and dental school in the atmosphere where it was in Northern New Jersey.

However, in the meantime with a very great deal of hard work and notwithstanding almost every imaginable obstacle, the college is now fully accredited, and has been for some years, and has turned out 860 graduates since 1965, increased every class, and recently, as the gentleman who preceded me said, we have been studying ways too, as have other medical schools, on how to shorten the medical college training period.

Today we have approximately 140 in the entering class and in our plans for improvement in respect to the enrollment, we contemplate with the completion of the permanent facilities now held up that we will presumably, if we go ahead immediately, within a few years have an entering class of more than 300 students in medicine and dentistry.

Among other things that is very interesting is that, having first considered Rutgers as the repository for the Medical School, and when we were faced with the only practical choice, namely, to establish a new institution as an agency of the State, the closer we got to the advantages and disadvantages, it was increasingly clear that our role should be where the people were -- in other words, supply the medical care for those most in need.

When we made that decision we realized, but not fully, the many problems that were ahead of us. But notwithstanding

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that and in all the years we have suffered through a variety of situations, the Board of Trustees of our college feels more strongly today than it did in the beginning that our role was to be where the action was, where we could do the most good for the most people who need it.

The program that we have developed has come, interestingly enough, from the addition of faculty people, some of them coming from -- well, less trouble-free situations -- in universities usually. In one of my first interviews with some of those being considered, I was rather happy to find typical of many of the men in medicine, they choose instead of an ivy tower situation to be where the action was, where most of the people could be served.

It seems to me the problem before us is not the question alone of the State's position in respect to medical and dental education. I hope there is no question about the need, the urgent need, to complete the facilities of the New Jersey College of Medicine in New Jersey. Our working drawings are virtually all complete. We are ready to move as soon as the necessary additional funds are found. And if that is not done, I think we have before us, among other things, the question of whether this college which has been built to a position -- our college, the New Jersey College of Medicine and Dentistry -- has been built to a position, I wouldn't say as yet first rank, but one of which the State can be proud -- I think the question, and I would be inclined to agree with Mason Gross that the disposition

[Page 68]

of the question, "What about Rutgers?" is whether or not at this time the Rutgers College of Medicine should be continued until further studies have been completed as a two-year medical school, which is about to be its role. They have had a pilot plan in operation with 16 students in temporary facilities. The new building, the new Medical School at Rutgers, is now approaching completion, It should be ready before the end of the year. Except for planning largely and some faculty, it is still what it started off to be and it has been done quite admirably. The question really before us, as I see it, is whether Rutgers at this time should launch upon a concrete program for a four-year school if this interferes with the completion of the facilities of the New Jersey College of Medicine and Dentistry.

Let me remind you - I think most of you know -- in the beginning, going back to 1965, we had rented facilities in Jersey City. We had woefully inadequate facilities. We had nothing of our own in the way of physical means and since then we have moved to Newark and in passing, it is interesting that we acquired for one dollar the Martland Hospital, which has a lot to be done with it, but in addition to that we have an underwriting by the City of Newark of 7.4 million dollars annually against operating funds, an unusual and very comfortable situation from the standpoint of finance.

We are today in temporary facilities, which can be construed as only that, and in a nut shell unless we are able to proceed while a study is being made of what is to be done with Rutgers, we are definitely in trouble from the

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standpoint of accreditation and every other way. Because the basic fact is there is not enough money to undertake both the Rutgers' four-year program and to complete the job which I think has been well done over the last five years, we are in favor of the bill under question and are perfectly willing as far as I am concerned, talking now as an individual, to put for second consideration the future of Rutgers Medical School.

SENATOR HIERING: Mr. Smith, did I understand you correctly that in the beginning when this study was made and the Medical College was set up, at that time you were tempted to put this into Rutgers or elsewhere?

MR. SMITH: The Fact-Finding Committee had two charges -- one to determine whether the Seton Hall College of Medicine and Dentistry was worth saving and, if so, what to do with it.

In our determination, the first choice we made was to have it assigned to, administered and carried out on one very important condition and that was that there be no lack of continuity. Basically the problem was at that time Rutgers took the position if it took it over, it would be with a number of conditions. One was that there be no new entrants into the college and that the reminder of the programs, so far as those then already enrolled, would be phased out--within, as I recall it, two years.

SENATOR HIERING: So at that time it was your opinion and the opinion of your committee and your board that this

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should be under one school?

MR. SMITH: That would have been the effect of it.

Mr. Chairman, may I ask, if it meets with your approval, that other members, the two Deans, for example, and the President of the New Jersey College of Medicine, be permitted to make their points to supplement mine?

ASSEMBLYMAN EWING: There are going to be many more called on the list here.

MR. SMITH: Any more questions?

ASSEMBLYMAN EWING: I don"t believe so. Thank you.

Dr. Daniel Adler, the Executive Secretary of the National Office, AAUP.

DR. DANIEL ADLER: Mr. Chairman and members of the Hearing Committee: Let me reidentify myself as Dr. Daniel Adler, Associate Secretary of the National Office of the American Association of University Professors.

I have prepared a quite brief, but I hope quite pertinent, statement.

The American Association of University Professors, together with the American Council on Education and the Association of Governing Boards of Universities and Colleges, has strongly encouraged the concept of appropriately shared responsibility and cooperative action among all components of the academic institution, its responsible students, its faculty, its administration and governing board.

The Association's interest in the proposed Medical And Dental Education Act stems particularly from its

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recognition of the special benefits to be derived from faculty participation in the planning and decision-making needed to effect changes in an institution of higher education.

Let me develop this point for a moment in the context of this act. There does appear to be consensus among all concerned with regard to the objectives of the proposed legislation, namely, to provide for the State of New Jersey a viable medical training facility which will meet the large and growing need for medical practitioners and trained ancillary personnel within the limits of available or potential funding.

It would appear, however, that in moving toward the implementation of these objectives, opportunity has not been amply provided for the input of alternate ideas from a most critically important source, the teaching and clinical faculties. Their subject matter expertise, their up-to-date contacts with developments in medical education, and their awareness of history-making changes in the relationships between medical faculties and the community argue strongly for encouraging their counsel before enacting legislation which may crystallize the future perhaps too adamantly.

The Association which I represent, having amassed experience over a period of 55 years on more than 1200 campuses, reflecting the academic lives of some 90,000 faculty members, has come to recognize some early warning signals of institutional problems in the making. Notable among these, particularly in publicly-supported institutions, is

[Page 72]

the makeup of the governing board, the terms of office of its members, and their governing relationship to the institution.

With respect to these items, the Assembly Bill under consideration contains explicitly or implicitly some basic ingredients for future difficulty. For example, Article 4 (a) providing for a three-year turnover of board constituents on a staggered basis, not only provides the temptation of political changes geared to successive holders of the governorship, but more importantly within the first two years of the board"s existence it could have a change of eight of its eleven members during this critical formative period.

Further Article 6 (a) and Article 6 (b) vest in what could become a completely lay board, the responsibility for determining the medical curriculum and the development of the college. Surely these are the critical areas in which faculty participation and interdependence among faculty components are essential and deserving of explicit provision in an act so important to the state of medical education in New Jersey.

Finally, may I call to your attention the minimal detail provided in Article 30 (c) in assuring the protection of faculty rights. Although this assurance extends to the tenure rules, it raises questions but does not seem to answer them with respect to the overlap of faculties in two adjoining institutions. It may create problems which may be eventually called to the attention of the Association with regard to the

[Page 73]

termination of contracts of individuals who serve perhaps overabundantly in the joining of the institutions.

My last remark is not obviously intended as an indictment but rather a citation of potential danger. In separating a portion of an operating and functioning faculty from its larger host, the institution, the university, there is the danger that in not consulting with the constituents, all of them, the academic freedom of these individuals will have been endangered.

Thank you for permitting me to make this statement.

ASSEMBLYMAN WILSON: Dr. Adler, your statement concerning the faculty problem if you consolidate the schools, this is not a basic problem. In. any type of consolidation, everybody looks out for what is going to happen to them, what is going to be their position in the hierarchy, etc. No matter what you consolidate, whether you consolidate, say, two factories or you consolidate high schools or you consolidate police departments, you have the same concerns. So this is nothing that would be different, would it?

DR. ADLER: I am happy to say, however, a faculty is not a police department and it is not a factory squad, but it does generally consist of dedicated members of the profession whose objective is besides earning a salary to educate and to do so at the highest level of their expertise. It is true that each professor -- and I can count myself among them -- has hoped for a raise in rank, a promotion, but I think the important feature I was referring to was the likelihood

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that a proportion of such individuals who enter an institution by choice, along with the invitation, may now find themselves in danger not of their choosing but because of an external relationship that will lop off x number from one faculty and y number from another. And the question of how this may reasonably, legitimately be done is, I consider, of greatest importance.

ASSEMBLYMAN WILSON: Yes, but this is a basic concern of all educators when you talk about consolidation of school districts. This has been discussed, has it not?

DR. ADLER: I deal primarily with higher education. In my experience some very sad examples have occurred where two institutions, in one instance, by the way, a medical coalition of schools, has resulted in the release of faculty members without consideration of even their minimal rights vested in tenure.

I think that in this area, it is cavalier to indicate that the interest of the faculty is simply in maintaining its position. I think the welfare of the institution, the morale factors, are equally important. And when each man feels that maybe he will be lopped off next, not merely because of a lack of expertise but the possibility of not having built up enough seniority or because a certain number must go alone, is a dangerous factor for institutions, particularly those of medical institutions.

ASSEMBLYMAN WILSON: With regard to your statement concerning staggered terms, do you think that the Governor of

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this state or any state would appoint an individual to such a position as a member of the medical board and not reappoint him -- just appoint him for one year?

DR. ADLER: I don't see in the bill any provision, and I presume in its absence it permits reappointment. I think my emphasis, however, had to do with a quite reasonable possibility that reappointments might not occur for a variety of reasons, including, I presume, political, although this is not an implication -- it is a possibility.

ASSEMBLYMAN WILSON: Also, Dr. Adler, how else do you start staggered terms? When you start a new board, whether it is an authority or any type of board, you have to stagger them.

DR. ADLER: I do agree that the staggering principle is superior to putting them on and taking them off in one fell swoop. There is the possibility, hinted at in the early portion of my statement, that other devices for amplifying the medical opportunity of the public through the training of medical practitioners might be sought other than through this particular arrangement. I suggested the encouragement of faculty participation in attempting to do so.

ASSEMBLYMAN EWING: Thank you, Dr. Adler.

We will have one more speaker and then we will break for lunch.

Dr. Cadmus would you like to speak as the President?

DR. CADMUS: Mr. Smith spoke for the College of Medicine, but I will be glad to elaborate.

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Assemblyman Ewing. Go right ahead.

DR. R0BERT R. CADMUS: Mr. Chairman and members of the Committee, I would be delighted to just amplify a few remarks, particularly to make a few comments concerning some of the things which we have perhaps heard this morning.

Just a quick reference to Federal grants -- we were privileged to have a site visit by a group of Federal authorities with us last week, at which time they saw the Governor, talked about this bill. They expressed no difficulty with Federal funding, although I recognize Dr. Cooper's concern. We feel that there is no threat in Federal funding from any consolidation.

[RLT: is this true. What was the site visit. Who was there on the site visit team. What was the grant. Was there a discussion of this issue. Is he lying or telling the truth?}

I also have a feeling that there is an impression that by virtue of an affiliation with a university, there is something that is gained in academic relationships which is not possible with other types of affiliation. Although Dr. Cooper mentioned that, I think the impression was that most of these medical schools are contiguous and right next to their parent university. Many of these institutions are not. The new institution at Hershey is a long way from State College in Pennsylvania, over a hundred miles. Cornell is a very good example. He mentioned Connecticut. Connecticut in Farmington is on the west side of Hartford; the university at Storrs is far east of Hartford. We could go through many of these schools to show that there is not a geographical but only an administrative connection.

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We in Newark have enjoyed four State-supported institutions: The Newark College of Engineers, Rutgers - Newark, the Community College and ourselves. We already have joint faculty appointments. We already have joint programs with bio-engineering. We already have joint catalogs of holdings in our libraries. We can show that there is a real ability to affiliate with other academic institutions. And most of us who have had experience in both types of systems find that at times we used to go outside of our own university to get help because we did not want to be limited by the expertise of our own faculty but rather we wished to have the expertise, the consultation, of individuals who for some reason or another were located in other universities. So I would not like to have the group feel that the only way that a university family communicates is through an administrative structure, quite to the contrary. University people get together with university people whether it is in their own university or not. The fact that they have to be connected is real. The fact that they have to be connected by personnel policies, purchasing procedures, administrative things is not.

I would also like to mention the fact of one board of trustees. We have been pleased to note that our board of trustees has met two times a month for about three hours throughout this period of five years. I know of no university board that has been able to put that many hours, including Rutgers' board, I would imagine, to put that many hours

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on just the one subject of medical and dental education. I think if medical and dental education in this State is to go forward, there is no question that we need the constant attention of a board of trustees to the many complex problems which it faces. I would think a board which has no other problems than medical and dental education could supply that attention rather than a board which has many requirements to handle.

I would feel that the New Jersey College of Medicine and Dentistry is a going concern. We have a problem, as Mr. Smith said, of our immediate future. We have cleared land. We have people waiting for us. We have the largest Federal grant that was ever given to any college in the United States. It was given to the New Jersey College of Medicine and Dentistry for matching funds for our physical facilities the sum of over $35 million. They believe in Newark. They believe in us. And I think that we have to move along and that a delay in the creation of a combined board we would hope would in no way create the delay in these two schools moving forward. Thank you.

ASSEMBLYMAN EWING: Dr. Cadmus, at the present time, how much coordination or cooperation is there between the Rutgers Medical School and your medical school? Is there an interchange of professors, etc.?

DR. CADMUS: Yes, sir. We are trying to work that constantly. After all, these are our friends. We are trying to do this constantly and have. This is not two

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groups of opposing forces, but quite to the contrary. The faculties are, as you know, much more bound to their American Association of Bio-Chemists, etc. They are much more bound by their academic ties than by their administrative ties.

ASSEMBLYMAN EWING: Is there an actual interchange of professors back and forth, I mean, some teaching some class in Newark and some in New Brunswick?

DR. CADMUS: There has been less of that. There have been some seminars planned and such. But there has been nothing of that kind. There is more in Newark because the relationship has been established for that.

ASSEMBLYMAN COSTA: How do the faculty and the students of your college feel about this possible merger into one entity?

DR. CADMUS: I think our faculty and students have had considerable discussion. I think there is sufficient vagueness in this bill to create apprehension in any group. There are always fears. We have the groups here. We have our Alumni Association. We have the President of our student organization. We have a number of our Faculty Senate and both Deans. They can speak for themselves. I would say that they are more concerned about the quality of medical education and the financing and support of that education than they are about the mechanisms by which it comes about. But they support the bill and have gone on record as supporting it. But, as I say, their concern is that there be strong

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relationships between the basic sciences and the clinical sciences, that there be adequate support of medical and dental education and that we have programs of high integrity.

ASSEMBLYMAN COSTA: Do you feel that by having one entity there is any chance of endangering the nature of the program?

DR. CADMUS: No, sir. Let us look at our neighboring state, the State of New York. They have a university which operates, incidentally, three medical campuses at Syracuse, Buffalo and Brooklyn downstate. It also operates other academic institutions. We also know that on the private campus of Cornell there are some State University operations - the Veterinarian School, the Forestry School, the Agricultural School. These are operated by the state on a private university campus. I think there are many more examples of alternates than we have heard this morning. Therefore, we feel that the combining of these boards will do nothing but enhance the opportunity to appeal to the Governor and to the Legislature for strong support for medical education as one united voice. We look at not insecurity of faculty members; we look at adequate budgets to hire more and to grow. There is no question we need additional support to turn out additional physicians and additional dentists. Therefore, I think this board could help medical and dental education in New Jersey and present that voice.

ASSEMBLYMAN COSTA: Thank you.

ASSEMBLYMAN EWING: Thank you.

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We will take a break for lunch now and we will reconvene at one o'clock.

[Recess for Lunch]

[Page 82 1A]

NB: The pages in the afternoon started with 1A and ended with 103A. In order to keep some coherence in page numbering, the sequence established in the morning session is also continued and is the first number presented. In the official records, the second number is the correct page number used.]

Afternoon

ASSEMBLYMAN EWING: Ladies and gentlemen, will you come to order, please. I would like to call Dr. Norman Reitman, Board of Trustees -- Will you give your position, Dr. Reitman, please?

DR. NORMAN REITMAN: Mr. Chairman, I come here as a practitioner in the State of New Jersey. I have been closely affiliated with Rutgers University and am serving at the present time as a member of the Board of Trustees at Rutgers, and am Chairman of the Advisory Committee on the Medical School to the Board of Trustees at Rutgers, the State University.

Let me say that I entirely sympathize with the Legislature's concern in this matter of medical education. Likewise, I know that you are marking the course that medical education in New Jersey will take for the next few decades. I appreciate the pressures and the problems that you face in making this most important decision.

All the evidence points to the best medical school being that which is university-based and controlled. Our strongest medical institutions have followed this mold. The few which remain non-university affiliated are not among our most distinguished institutions. Indeed, most of them are looking for some type of university affiliation at this moment. As an example, the Mount Sinai School of Medicine in New York City, an outgrowth. of one of the most prestigious hospitals

[Page 83 2A]

in the United States, required an affiliation with the City University of New York, in order to become a fully-accredited and recognized medical school. As you well know, this is one of the strongest institutions in our country and it still required a university affiliation in order to function properly. It is of interest to note that only 6% of our medical schools are non-university affiliated. Therefore, to leave the university and establish an independent medical school seems to go against the current medical thinking. Back

There are many reasons set forth in the Evans and Coggeshall reports which clearly indicate the necessity of a medical school being part of the University community rather than existing as a separate administrative entity. I am sure that you are well aware of the information in these most important reports, as well as a recently-expressed view by Dr. Milton Eisenhower, formerly president of Johns Hopkins University. "A quality medical center should be an integral part of the University. Medical schools in the United States were once independent; they were mere proprietary institutions. When most of them became units of universities, medical science flourished with increasingly high standards in medical education and patient care."

The concern for increasing medical student

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population in New Jersey is most laudable. I could not agree more. However, there is another factor in medical schools beside students, bricks and mortar. I am referring to the faculty -- those people who are the driving force behind any medical school. Unless we can attract and keep teachers of the highest quality, our State Medical School will deteriorate with a most precious commodity -- our faculty -- leaving in droves. We have attracted an outstanding faculty which have performed wonders in the early years of medical education at Rutgers. Our record speaks for itself. We rank fifth in the medical schools in the United States in the basic science examinations given by the National Board of Medical Examiners. This type of quality training will deteriorate, I fear, under an independent medical educational authority.

Unless we have a strong medical center serving all the people of the State, I fear for the future of our community hospitals. We do have outstanding community hospitals scattered throughout our State, but these differ substantially from the function of a hospital devoted to teaching medical students.

I have been engaged in the practice of medicine in New Jersey for the past 32 years. I have had an opportunity to study New Jersey medicine from many vantage points, that of a practitioner, State society committee member, officer in several State medical organizations and as an active staff member of three

[Page 85 4 A]

community hospitals, one of which I presently serve as chief of staff. I have also had a close opportunity to work with the faculty of the Rutgers Medical School and have attempted to develop meaningful clinical affiliations at two of our hospitals, It has been my conclusion that the community hospital, no matter how excellent, can never serve in the capacity of a primary teaching hospital, although there are many areas where clinical affiliation can help both parties. One must recognize that the mission of the community hospital and that of the university hospital, although parallel, are not the same. The community hospital exists primarily to render patient care. The university hospital serves its prime purpose in education and research.

For the medical school to work in a community hospital, it must control the beds as well as the program if the faculty is to discharge its educational responsibility. In a community hospital where beds are at a premium and so many operate at capacity or even above, this is clearly impossible. Shall we deny admission to a patient brought to the hospital in shock from a bleeding ulcer, heart attack or drug abuse because there is a clinical study being conducted whereby these beds are needed for teaching and research purposes? Of course not. The community hospital must serve the community and is geared to this

[Page 86 5 A]

responsibility. The teaching hospital has a much different role -- education and research -- and its cost, needs, equipment and personnel are distinctly different from that of a community hospital.

Therefore, I strongly urge that the Legislature realize the need of a university teaching hospital as a prime facility for the education of undergraduate medical students, interns and residents as well as the source for postgraduate medical education for the practitioners in the State. In such a milieu the community hospital can serve a distinct purpose by attracting graduates of our medical schools for intern and resident training.

I recognize the responsibility of the full-time teacher as well as that of the full-time practitioner. These responsibilities cannot be met by a half-time approach. The practitioner, devoted to patient care, can help in a teaching program for medical students and the academic physician can offer help to the practitioner in a study of medical problems, but one is not a substitute for the other.

It is not fair to our students who need the discipline of an organized medical curriculum, no matter how innovative, to ask the practitioner to undertake this added responsibility.

I do not mean for an instant to decry the medical profession in New Jersey. Individually and

[Page 87 6 A]

as a group we are as good or better than any. However, I feel strongly that our community hospitals have suffered from the lack of a strong academic influence which only a fine medical school can offer. In New Jersey we have had to look elsewhere for such guidance and our individual and hospital efficiency has suffered thereby. We must establish in New Jersey a strong academic medical center. In my opinion such a medical center must be an integral part of the State university. The study and practice of medicine demands the very best in us. It is only fair that the State give its best as well.

A medical school is an educational institution. As such it belongs with its sister schools and colleges within the university. To cut the medical school adrift would complicate many multi-disciplinary programs such as biomedical engineering, psychosociologic factors in disease, teaching responsibilities in different faculties within the university, but most important would be the loss of the stimulation to education and research which every school gets from its parent university.

Experiments in curriculum, means of increasing our output of medical students, new ways of delivering health care to our communities, are problems all institutions are facing today. The resource to solve these problems must come from the entire community,

[Page 88 7 A]

not from an isolated medical authority.

I also note the Governor's concern for the great need for general practitioners in New Jersey. I would like to submit that the orientation of the medical school will not influence the students' decision to enter general practice. There are as many specialists and research physicians graduating from our clinically oriented institutions as from our research-oriented schools. It is of passing interest that 70 percent of the Harvard Medical School graduates enter clinical practice. What we need in New Jersey is not more general practitioners per se, but more well-trained practitioners in all fields.

Considering these factors, gentlemen, I must recommend that the bill before you receive full, careful and comprehensive review before such a far-reaching decision is made.

Thank you.

ASSEMBLYMAN EWING: I forgot to announce that Senate Wayne Dumont of the Senate Education Committee is on my extreme left. ~

SENATOR DUMONT: Doctor, what percentage did you say of the medical schools are not university affiliated?

DR. REITMAN: About six percent. I believe there are eight out of 105 that are non-university affiliated.

[Page 89 8 A]

SENATOR DUMONT: This is throughout the nation?

DR. REITMAN: That's right.

SENATOR DUMONT: Now why do you think that the faculty will leave in the event that the Board of Trustees should be combined?

DR. REITMAN: I think frankly we are dealing with a buyers' market. I think people who are teaching in medical schools today want to belong to part of the university. The overall attraction of the university is there. They feel the strength of the university adds a great deal to the strength of the medical school. They want to be part of an academic community. There are opportunities for professors, assistant professors, and instructors to move on to other institutions. A great many people who are on the faculty at Rutgers have received substantial offers and I feel that we will deteriorate in the quality of our faculty if this bill is enacted.

SENATOR DUMONT: Do you believe that there will be then only part-time teachers and not full-time faculty members in the event there is a combination of the boards?

DR. REITMAN: I don't know, but I think, sir, that the trend is for full-time academic positions as primary teachers in our medical schools both at the basic science level and the clinical science level. However, on that point, I don't believe that the practitioners of our State should be given the responsibility of primary

[Page 90 9 A]

education of our undergraduate medical students. This is a full-time academic position's responsibility.

SENATOR DUMONT: You mentioned that you fear that under a single medical authority that it will be isolated, as I recall it, to use your words. Now why do you think that would be true?

DR. REITMAN: Well, I feel that the medical school separate from its university will become isolated. It will operate as an independent authority; it will be able to cooperate with other agencies, but in the long run it will weaken the strength of the medical school because of its position being cut apart from the parent university.

SENATOR DUMONT: Are you fearful that if there were one board instead of two separate ones as it is today, you wouldn't have the contact as frequent or as close as you have with your own board?

DR. REITMAN: I feel this is true, sir.

SENATOR DUMONT: Thank you.

ASSEMBLYMAN EWING: Thank you, Doctor. I will call Dr. Rulon Rossin, Dean of Medicine, Newark.

DR. RUL0N R0SSIN: Gentlemen, my name is Ruon Rossin and I am Dean of Medicine at the New Jersey College of Medicine and Dentistry. Our faculty, students and alumni have agreed on the following statement:

We support the concept of one governing board for medical and dental education for New Jersey providing:

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This board a) unifies health education and establishes adequate and equitable support of all public medical and dental educational programs in New Jersey.

This board b) after appropriate consultation with State and national leaders in health education, responds to the State's need for quality medical and dental education.

This board c) moves as promptly as possible in establishing priorities for capital expenditures to meet the needs for medical and dental education.

It is our opinion that the State of New Jersey's needs for physician manpower are critical. To meet these needs at least two complete medical schools are needed.

If quality medical education is to be offered, we cannot separate pre-clinical instruction from clinical teaching.

Our own faculty has been striving for some time to develop an integrated, coordinated, shortened curriculum and at the present time we do integrate the teaching in the pre-clinical years with clinicians participating in the teaching of the pre-clinical sciences or basic sciences, and the pre-clinical scientists or basic scientists participating with the clinicians in teaching multi-disciplinary conferences clinical topics.

Both medical schools we believe should have some university association, This is not inconsistent with the concept of one governing board. For example, the State University of New York has one board of trustees overseeing several university centers, colleges of arts

[Page 92 11 A]

and sciences, statutory colleges, and medical centers.

The State University of New York operates at Cornell University in Ithaca, New York Colleges of Agriculture, Industry and Public Relations, Home Economics, and Veterinary Medicine.

The State University of New York also operates medical schools at Brooklyn (Downstate Medical Center), at Syracuse (the Upstate Medical Center), at Buffalo and is now preparing to operate one at Stony Brook.

We feel that deferral of action would be acceptable only if the Board of Trustees of the New Jersey College of Medicine & Dentistry is re-constituted and this Board is authorized by the State to move ahead with the building program for which plans are nearly complete.

We have been asked what our response would be if the New Jersey College of Medicine and Dentistry were placed under the aegis of Rutgers University, and our response to this is that this is a decision which should only be made after careful study by the proposed new Board of Trustees i.n consultation with medical and dental academicians 'from within and from without the State of New Jersey.

SENATOR DUMONT: I have a couple of questions if I may. Doctor, do I understand your position to be that. if there were one board, that board should have a direct affiliation with the university and thus be in control of the two medical schools?

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DR. ROSSIN: My reaction would be that that board should be a board overseeing the University of New Jersey - the State University of New Jersey - that that University might have branches at several places in the State of New Jersey, that it might also have medical colleges under its jurisdiction - again as a part of the State University.

SENATOR DUMONT: Thank you.

ASSEMBLYMAN EWING: Doctor, to get it clear in my mind: You are saying that the single board should be the State University Board or this new board that is talked about in the bill?

DR. ROSSIN: This is what I would prefer if I had my choice.

ASSEMBLYMAN EWING: The new board, or the State University Board?

DR. ROSSIN: I would have a State University Board probably large enough to have set aside one large segment to oversee health education,

ASSEMBLYMAN EWING: You do not go along with the concept as in A-1059 as a separate board by itself then, do you?

DR. ROSSIN: I stated that that would be acceptable to us if we could realize these objectives. I think it would be more desirable to have a board of trustees for the State University of New Jersey with several branches.

SENATOR HIEKING: As I understand it, Doctor,

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you do prefer the concept in Assembly Bill 1059 as compared to the present concept of two boards.

DR. ROSSIN: I think it is desirable to have one board that looks at the needs of the entire State, not at the needs of one institution.

ASSEMBLYMAN EWING: Thank you, Dr. Rossin.

I will call Dr. Haydn Nicholson, American Medical Association.

DR. HAYDN NICH0LS0N: Thank you, Mr. Chairman. I would like to express my appreciation and the appreciation of my organization for the opportunity to appear before this group in relation to the problems of medical education in the State of New Jersey.

I am Dr. Haydn Nicholson and I am Director of the Department of Undergraduate Education of the American Medical Association. However, I am appearing before you now more in my capacity as Secretary of the Liaison Committee on Medical Education. This morning Dr. Cooper referred to the Liaison Committee.

The Liaison Committee on Medical Education for a good many years has been the official accrediting body for medical education in the United States. It represents jointly the Association of American Medical Colleges and the American Medical Association.

The Liaison Committee has an administrative custom by which the chairmanship and the secretaryship of the

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committee alternative annually between the American Medical Association and the Association of American Medical Colleges. I happen to be the secretary this year.

The Liaison Committee not only concerns itself with formal accreditation actions but is interested in the development and maintenance of sound programs in medical education. The role of the Liaison Committee is not primarily a punitive one. On the other hand, it tries to aid existing medical schools and agencies or organizations contemplating the establishment of new schools with advice and guidance regarding the problems they are encountering or may expect to encounter. The Committee is concerned that the programs of the schools be sound from an educational point of view and that they be developed in recognition of the changing needs of our society.

The Committee recognizes that there is no one pattern of organization that must be followed by every medical school Conditions and needs vary from institution to institution and what is appropriate in one institution may be quite inappropriate in another.

A publication of the Liaison Committee entitled "Functions and Structure of a Modern Medical School" contains the following paragraph:

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I believe that Dr. Cooper quoted the same paragraph this morning.

"Governing Body --A medical school should be incorporated as a non-profit institution, if possible as a part of a university since a university can so well provide the milieu and support required by a modern medical school."

Of the one hundred or so medical schools in the United States, by far the majority are parts of universities. Of those that are not integral parts of universities, some are parts of university systems and systems of higher education in the State, and some are completely independent. There is no one acceptable pattern of university relationship for a medical school. The Liaison Committee does not attempt to impose upon a State an organizational structure for medical education.

If in any accredited medical school there occur basic changes in its organization or structure, it is necessary for the Liaison Committee to evaluate the effect that these changes are having on the school's educational program. One can think of various factors in addition to the school's organizational structure that might impair its educational program. Curtailment of financial support is an obvious one. Any development in a school which fundamentally alters the school/s educational program would call for evaluation by the Liaison Committee,

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The concern of the Liaison Committee with the soundness and the adequacy of medical educational programs in the United States impels us to be deeply interested in the health of the two medical schools in New Jersey,

As we all know, New Jersey has been somewhat of a laggard in the field of medical education. believe it was only 15 years or so ago that the first medical school in New Jersey was established and in the intervening 15 years a great deal of progress has been made in medical education in the State in spite of a series of rather serious and difficult obstacles, I hope that any changes that are made in connection with the organization of medical education in the country will not seriously affect in any respect or deteriorate the quality of medical education or the progress that these schools have made in the past.

I would emphasize one other point and that is that the education of physicians should be looked upon as higher education, a form of higher learning, and a medical school must be thought of as an institution of higher education. and not a trade school,

By that remark I do not cast any reflection on the importance of education for the trades, but the education of physicians is a form of higher education and I had hoped that any organizational change would

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not result in an appreciable change or at least a deterioration or degradation of the philosophy of education of physicians.

Thank you very much.

ASSEMBLYMAN EWING: Are there any questions?

SENATOR DUMONT: Doctor, do you agree with Dr. Reitman that only about six to eight percent of the medical schools in the United States are not university-affiliated?

DR. NICHOLSON: Yes, there is no question about that. That is a fact, it's not just an expression of opinion.

SENATOR DUMONT: Where do you live, Doctor?

DR. NICHOLSON: I live in Chicago.

SENATOR DUMONT: Are you advancing any position here from your experience with regard to whether you think this is a good trend in this legislation, or how do you feel about it?

DR. NICHOLSON: Well, I would say that, as has been pointed out repeatedly, there are a number of medical schools that are not affiliated with a university. There are about half a dozen that are completely independent and there are a number of others that are parts of the State higher education system. Offhand I can't think of another example of a medical school that has started as a university school being separated from

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the university except a couple of instances that Dr. Cooper mentioned this morning involving medical schools that were parts of sectarian universities and they felt it was necessary that they become independent if there was any possibility of their receiving State financial support.

So I certainly would not imply that it isn't possible in a non-university medical school to provide a good quality of medical education.

SENATOR DUMONT: Well, now, as between the two concepts - the one in this bill where there would be a single board of trustees not directly affiliated with the university, or a single board as preferred by Dr. Rulon Rossin, who testified just before you, affiliated with the university, which do you think is the better?

DR. NICHOLSON: I don't believe I should express a preference there. I might say that, if I understood him correctly, Chancellor Dungan this morning said that the question before the Committee and before the Assembly is between a single school under unified control or two completely autonomous and uncoordinated institutions. I don't believe he meant it exactly that way but I believe that is what he said. I believe it should be possible to obtain a relatively high degree of coordination, a fairly effective coordination, without the two institutions becoming one.

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I might point out also that there are some advantages - it's a complicated problem - but there are some advantages of two medical schools over one medical school, even though the one medical school is twice as large as either of the two. It is a complicated matter but there are certainly some distinct advantages in two separate schools, but I certainly agree on the importance of a degree of coordination between them, especially when they are both State schools and derive their financial support from the State.

SENATOR DUMONT: Thank you.

ASSEMBLYMAN EWING: Dr. Ian Bennett, Dean of Dentistry of Newark.

I would like to remind everyone that we do want to stick completely to A-1059, exactly what the bill stands for - the formation of a single board.

DR. IAN BENNETT: Thank you, Mr. chairman, and members of the Committee. I would like to briefly bring to you the position of the students and faculty of the Dental School of the New Jersey College of Medicine and Dentistry.

Essentially they support this legislation, recognizing of course that the results of it will depend very much on the calibre and interest of the Board of Trustees that are appointed.

[Page 101 20 A]

Our students and faculty I think are much more concerned about the present uncertainties than they are about the consequences of this legislation. I think they are also very unconcerned about any danger of say we say - losing their positions. They know very well that they are in a strong seller's market in terms of employment of them and their skills and I would say are very unconcerned about this. And in fact the effect of the uncertainties I referred to tend to lead to other institutions wanting to steal our faculty rather than any effect of the faculty being let go because of a consolidation.

I think the position of the Dental School on a university affiliation, and perhaps my own personal position, would be that certainly an academic affiliation is very desirable. The ability to meet with and exchange views with and to cooperate with faculty members and other disciplines is extremely useful. However, we take the position that often if this academic affiliation is associated with an administrative affiliation, the cumbersomeness of this arrangement is often very unproductive. It leads to a lack of administrative convenience.

I think, too, as an example of the calibre of education that is possible in an institution as we are now, a non-affiliated institution, I might quote the position of the present graduating dental class who came first in the nation in the basic science

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portion of the dental national boards. This is the first time in many, many years that Harvard has been displaced from this position and, fortunately for us, it is also the last time because with this class they have stopped reporting who came first. So we have the happy advantage of not having to repeat that because it was the last time it happened.

I think one brief comment about the interrelation of the basic science instruction and the clinical instruction as it relates to dentistry should be made. The dental curriculum has rather less basic science than the medical and in balance rather more time in dental subjects. We essentially divide our curriculum into pre-clinical dentistry and clinical dentistry. Much of the early years of dental education is made up in learning the concepts and techniques that go into the practice of dentistry essentially in a laboratory rather than on patients themselves. From the patients' point of view this is a very fortunate arrangement.

The time this goes on is essentially indigitated with the basic science portion of the curriculum. So our pre-clinical dental curriculum and our basic science curriculum run in parallel essentially in the first two years of the four-year program.

It would be of extreme disadvantage to us if the basic science portion were removed from this and

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particularly if they were geographically separated. I can speak from rasher bitter experience right now., We are in fact functioning in this way, and when the medical school moved to Newark, the dental school's clinical program and pre-clinical program remained in Jersey City because the expense of re-locating dental facilities was judged to be too great to justify the move into temporary quarters. So we are-presently functioning with our basic science instruction approximately eight to nine miles away from clinical and preclinical instruction. This leads to many problems and one of the reasons for the faculty's feeling of urgency about this legislation is the problems which this separation causes and their concern to get back together with our medical school and particularly with our basic science departments so that we might avoid the tremendous disadvantages we are now working under with this separation geographically.

Thank you, Mr. Chairman.

ASSEMBLYMAN COSTA: You said the students were more concerned about the present uncertainties. Could you elaborate on what you meant by that?

DR. BENNETT: I think perhaps they are slightly concerned about the administrative arrangements but much more concerned with the facilities which we will have for their instruction. We are now operating with

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an entering freshman class of 58 students in a facility that was designed for a maximum of 50. At the time it was designed the class was supposed to be 40, so they built in a little expansion potential up to 50 students in the present facility we have. Added to this have been the consequences of the separation of the basic science departments from us which led to a reduction of space, and so our students are concerned about the kind of clinical facilities that they will have available to them when these larger classes get into the clinical years.

Now this is further compounded by the very present problem we have. Our attrition rate has changed markedly over the last few years. Our present graduating class, for example, is 43 students. They started as 55 four years ago. This loss of more than 10 students from a group of 55 was common in those years. However, the calibre of students we are accepting nowadays increasing so that we are losing less and it looks if, for example, the present sophomore class, which was accepted at 56, has lost one student in its first year, will lose none in its second year, so we will have, going into the clinical years, which puts the greatest pressure on our facilities, a larger number of students to be absorbed by the antiquated facilities we have. So I would say that the major concern relates to

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construction of dental school facilities.

ASSEMBLYMAN EWING: Thank you. Senator Dumont?

SENATOR DUMONT: Doctor, apparently you believe then that your facilities are going to improve substantially, that they will be consolidated, there will be new ones, etc. Do you attribute that all to the concept in this bill, or would it happen otherwise?

DR. BENNETT: No, not necessarily. I think the same things could happen with separate boards of trustees for two medical schools. Essentially we are a little uninvolved in the discussion going on between the medical schools because we are the only dental school involved in this and so in a sense we are not in competition with anyone else's funds. However, I think the uncertainty surrounding the future of medical and dental education in this State can do nothing but delay the decisions which have to be made to give both dental and medical education the facilities they sorely need. I am thinking about capital expenditures. So we feel that this bill if it is passed, will let things begin to move forward again rather than that this is the only possible solution to New Jersey's medical and dental education problem.

SENATOR DUMONT: Do you have any gross figures on what it will take to provide the necessary capital facilities that you need?

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DR. BENNETT: Well the specific cost of the new dental building we have planned, which is included in the complex to be built in Newark - the latest estimates bring it in at about $16,000,000. Now this facility does not include the provision for basic science instruction of dental students nor does it include any classroom space because this was all programmed to be included in an adjacent building with a common wall, which is the medical school essentially which has in it the basic science space and the lecture room space for dental students. It was felt at the time the buildings were designed that it would be more convenient this way and, in fact, it works out very well. The design of the facility is good.

SENATOR DUMONT: Now the construction of that building in Newark would then consolidate the entire dental school in Newark is that right?

DR. BENNETT: Yes, with the construction of that we would be able to move to Newark and be with our medical school and particularly its basic science departments.

SENATOR DUMONT: What is your feeling as to the facilities you are still using in Jersey City? Are they bad, good, or indifferent?

DR. BENNETT: They were designed by Seton Hall

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in 1956. They were equipped with obsolete equipment at that time because Seton Hall could afford nothing better. They are old fashioned in the sense that the concept of dental practice has changed and was changing back then fourteen years ago, but it has changed markedly now and we are not able in these facilities to produce a practitioner who is up-to-date in the sense of his ability to deliver care in modern ways. We do a fairly good job I think with the facilities we have, but we would do much better with up-to-date facilities, and much more.

SENATOR DUMONT: How about the equipment in Jersey City? Has that been updated?

DR. BENNETT: No. With a few minor exceptions we are still functioning with equipment which went out of production in some cases 30 years ago.

SENATOR DUMONT: Thank you.

ASSEMBLYMAN WOODSON: Doctor, you said that an academic affiliation is advisable or useful. Are you speaking in terms of its being a part of a university system? Would that be a useful vehicle? Is that what you're speaking of?

DR. BENNETT: I think that is one way to get an academic affiliation. However, I think we can get it another way.

ASSEMBLYMAN WOODSON: I guess you have some questions in your mind with regard to your being under

the Rutgers Board per se. In other words then, you are

[Page 108 27 A]

speaking in terms more of a board of trustees that would be separate and apart from the Rutgers Board in terms of administration?

DR. BENNETT: My personal preference would be not to be administered by a board of trustees which has the problems of the whole university. I have been involved in other institutions where we dealt with, as we called it there, the main campus. I find that the present arrangement we have with our own Board of Trustees which are much more responsive to our needs, although I must confess are not able to produce all we need to do our job effectively in terms of money:- I guess that's part of the problem - but they are much more available, we can talk to them more easily, and get their response more quickly and they spend more time on our problems, and this essentially is what you need from trustees - time spent on your problem.

ASSEMBLYMAN COSTA: Doctor, don' t you think if you had one board of trustees, you would have a better chance of getting your fair share of the money than if you had two fighting for the same money?

DR. BENNETT: Yes, I do.

ASSEMBLYMAN COSTA: Doctor, I want to commend you on your class being Number 1 with the bad equipment and bad facilities. If you had good equipment and good 'facilities I guess you would go international-

DR. BENNETT: Fortunately the advantage came in

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the basic science portion of the curriculum. Our facilities there are a little better than they are in the clinical portion of the curriculum, where we don't do as well. But I won't tell you how we do there.

ASSEMBLYMAN EWING: Thank you, Doctor.

Dr. DeWitt Stetten, Dean of Rutgers Medical School.

DR. DeWITT STETTEN, JR.: Mr. Chairman, gentlemen: A plan for medical education is developed in a message dated May 4, 1970, by Governor Cahill, and in an act, Assembly No. 1059. In the act it is stated, "The school of medicine heretofore established by Rutgers and the New Jersey College of Medicine and Dentistry shall be combined into a single entity to be known as the College of Medicine and Dentistry of New Jersey." The purpose of this action is elsewhere stated and is "to avoid duplication of facilities and of effort."

I am happy to follow the last speakers because I find myself in complete agreement with some of the points which were clearly made; namely, that those of us involved in medical and dental education are apparently quite in agreement that a separation of basic and clinical teaching and research, a physical separation, is poor business.

A careful examination of the duplications that might be avoided leads to the inference that what is probably intended is that basic medical sciences shall

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be housed and taught at New Brunswick while clinical sciences shall be housed and taught at Newark. Such a plan is not to be compared, in my opinion, with the experiments mentioned earlier by Dr. Kaysen, proposed but as yet untried at Indiana or Illinois wherein an old, large, and securely established school - a state medical school in each case - assume responsibility for peripheral satellites to its teaching programs. In New Jersey we do not have at this time an old, secure, and well-established medical school. The schools in Illinois and Indiana date from 1903 in one case, and I think about 1880 in the other. They have been there a long time; they are old, the are secure, they now are ready to grow and they choose to grow by adding columns in other towns. We are not in that situation at all.

The economy, the avoidance of duplication here envisioned is a divorce of the two complementary aspects of medical science and, apparently from what has been said, of dental science and is therefore diametrically opposed to the overwhelming mass of informed opinion. In fact, much effort in medical curricular reform and in our own curriculum is directed to break down the largely artificial barriers between the basic sciences such as physiology and pharmacology and the cliniical sciences such as medicine or psychiatry. There two kinds of subjects are really parts of the same thing and should be taught concurrently and coincidentally. Once it is agreed that separation of clinical and basic sciences is bad teaching, and it

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seems in this house as though most of the teachers who have testified so far do agree - then the prospects for economy, by elimination of duplication, it seems to me, disappear and the functions of the newly-proposed Board of Trustees would seem to decrease in significance.

I tried to catch a quotation from Dr. Rossin a moment ago and with his permission I'll quote it out of context: "At least two complete medical schools are needed," he said. With this statement I am in complete and total accord.

I should now like to talk about the separation of Rutgers Medical School from Rutgers, the State University: and I would point out that this is indeed authorized by the Act, although it is not specifically dictated by Assembly No. 1059 provides among other things that the on-going school which is now Rutgers Medical School shall be transferred to the Board of Trustees of the presently non-existent College of Medicine and Dentistry of New Jersey. In the opinion of the faculty and students of Rutgers Medical School, such an action would be retrogressive. Against the threatened separation of Rutgers Medical School from its parent university, the faculty and students, acting in concert and voting unanimously have cited the following arguments: And I quote from their resolution:

1. There is no environment and no administration more favorable than a university for the growth and high quality of a medical school:

2. The medical school serves the university in mutually advantageous programs and in its out-reach

[Page 112 31 A]

into the community.

3. The precedent of separation of a medical school from its university is menacing, not only to the medical school but indeed to all other specialized areas of university activity. If any one professional school can be separated with impunity, why should not other such separations follow, leading to dismemberment of the university?

4. When it undertook to establish a medical school, the Board of Governors of Rutgers assumed certain responsibilities toward its faculty and its students. These responsibilities can only be discharged by the continued surveillance of the medical school by the Board of Governors.

In addition, the university's continuity of purpose favors the long-range planning needed in a growing medical school. Such continuity is demonstrably lacking in the ever-changing policies of State government, and I would like to mention that we have, incidentally, in the last two years received mandates -one, that there should be two complete medical schools in New Jersey; two, that there shall be three complete medical schools in New Jersey, and as of this bill, that there shall be one medical school on New Jersey. It is very difficult to make long-term plans when even in these fundamental issues it is hard to get a continuing focus.

Mention was made by Dr. Kaysen of curricular experiments and indeed we are very much interested

[Page 113 32 A]

as I think most medical educators are, in curricular experiments. It is certainly clear that we have yet to find the best possible way of teaching medicine if indeed there is one best possible way. However, his comment led me to jot down the names of the schools of medicine in which curricular experimentation is presently going on in the most interesting fashion.

The names that occurred to me were Duke, Dartmouth, Western Reserve, Northwestern, Boston University, Stanford, Pennsylvania, Hopkins and Brown. Each of these universities are engaged at present in a thoroughly dramatic experiment involving real change in the methods of teaching medicine. Some of these involve shortening the program, as Dr. Kaysen said. One of them, the one at Stanford, involved lengthening the program. There is much argument as to what the proper length of the program should be. I think my faculty are inclined to think it can be shortened, and we would like to have an opportunity to try it.

On the other hand, those unaffiliated schools, schools that are not connected with universities, are under considerable restraint when it comes to tampering with curricula. They cannot easily ask their undergraduate college to teach biochemistry or physiology because they don't have an undergraduate college, and I would mention that Woman's, Hahnemann, New York Medical College and Chicago Medical College have not been engaged in any interesting curricular experiments, at least that have come to my attention.

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I should like now briefly to address myself to the question of immediate capital construction costs and plans. These have been mentioned earlier. There has been much misinformation in the public press concerning the costs involved in making a full or four-year program out of the present two-year program at Rutgers Medical School. Whereas the projected and planned 428-bed teaching hospital is confessedly expensive, this part of our program, as Dr. Gross mentioned earlier, has been temporarily tabled and we have repeatedly proposed a far less expensive interim plan.

Chancellor Dungan mentioned earlier a figure of $170 million deficit; we have seen numbers in the newspapers ranging all the way from $230 million down.

It seems to be almost anybody's game. The plan that we have proposed, however, is quite simple. It involves two components - the Psychiatric institute and the Raritan Valley Hospital. The construction of the Psychiatric Institute is fully planned, fully funded, and fully bid. Its construction requires at this time merely a release from a freeze on contracting imposed on January 22, 1970, by Mr. Walter Wechsler. Into this building will go about $5.4 million already transferred by law by this legislature in 1967 from the Department of Institutions and Agencies to Rutgers University, $1.065 million committed by the National Institute for Mental Health and $1 million as mentioned by Dr. Gross coming from the American Institute for Mental Studies.

[Page 115 34 A]

The last two of these sums, more than two million dollars, will be lost to New Jersey permanently if the planned building is not built. This facility, when in operation, will serve the psychiatric needs of a catchment area of 200,000 persons, an area in which there are at present no psychiatric beds, will train medical students, will train psychiatric residents, and will generate we project ten board eligible psychiatrists annually once in operation, in addition to training paramedical personnel in those fields related to psychiatry. The Institute will work together with other parts of the University such as the Center for Alcohol Studies, the Department of Psychology and the Graduate School of Social Work toward the advancement of psychiatric knowledge and skills.

The Raritan Valley Hospital is stated to be for sale for a probable price of about $4 million. Even this, however, we are told probably need not be paid outright. Title might be transferred by the assumption of a mortgage in that amount. With some enlargement and improvements projected as costing about $2.5 million, this could be developed into an operational, if small, teaching hospital, Some consideration has been given to the possible enlargement of this hospital and we do not have any precise cost figures on this. This could be done if funds were available. This purchase, together with the Psychiatric Institute, would assure, at minimal cost and in the shortest possible time, a complete medical school in the New Brunswick area. I would point out

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that in order to achieve this goal, it would seem to me that no new board is needed, that no separation of Rutgers University from Rutgers Medical School is needed, and that indeed this latter action, which would cause a great deal of difficulty and a great deal of trauma, has yet so far at this hearing or in previous discussions a single virtue. No one thus far to my knowledge has come forward with any asset to be gained by divorcing Rutgers Medical School from Rutgers University.

If we do this we can start generating physicians, M.D.'s locally in central New Jersey who might, and hopefully would, in some numbers intern, train, and practice locally, fulfilling thereby the very need for physicians which Governor Cahill and all thinking citizens of New Jersey now recognize. Thank you.

ASSEMBLYMAN EWING: Dr. Stetten, if Raritan Valley was taken over as a clinical facility, what would the cost be of operating that? Would you be able to take all the graduates from your basic courses?

DR. STETTEN: We project that if Raritan Valley Hospital is kept at its present size, which is 128 beds, if I recall correctly, we could accommodate 30 or 32 students into a third or a fourth year class. Our first year class will be about 80 students as we project it, and therefore we would still be in a position of having to place perhaps 50 students in other third-year classes around the country.

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The cost of operation depends for every hospital upon its bed occupancy. Raritan Valley Hospital is for sale for the reason that it apparently has not caught on with the physicians of the community. Its bed occupancy rate has been low. Our experts, Eugene Rosenfeldt Associates - an expert is someone who comes in and gives you an answer from outside - tell us that if the occupancy rate gets up to 85 per cent, which would not be remarkable for a hospital in this neighborhood, then if the mortgage is paid off initially, we would be in balance, and if the mortgage is not paid off but is amortized we would still have an operating mortgage deficit of about $410,000 per year. A portion of this can be recaptured, we are told, out of Blue Cross fees collected from patients.

ASSEMBLMAN EWING: Still, your costs there would be a lot higher than if you had a complete clinical hospital, wouldn't they. I mean a large scale one.

Being small- Raritan Valley being small, it is going to create a much higher cost.

DR. STETTEN: It has elements of poor economy about it - there's no doubt about that. It could be enlarged incidentally. Its foundation it is said will take two more stories of construction.

ASSEMBLYMAN EWING: At the present time is there an interchange of faculty between your basic courses and Rutgers University itself?

DR. STETTEN: Oh, yes, sir.

ASSEMBLYMAN EWING: How many professors do you have

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that teach at Rutgers that teach over in your temporary quarters ?

DR. STETTEN: I would guess between a third and a half of my faculty have contact with the graduate programs at Rutgers University~

ASSEMBLYMAN EWING: They teach at Rutgers also besides -

DR. STETTEN: Yes, sir. Our biochemistry department offers courses in the graduate biochemistry program. Our microbiologists are involved in teaching in the graduate programs in microbiology.

ASSEMBLYMAN EWING: So therefore your budget is lower because they are absorbing part of the cost -

DR. STETTEN: No, we salary these people.

ASSEMBLYMAN EWING: You what?

DR. STETTEN: Their salaries come out of the Medical School budget.

ASSEMBLYMAN EWING: And you give their time the University then? So the University makes on it.

DR. STETTEN: Well, the University gives us time from other people also. That's the beauty of the university, sir. It all comes ultimately out of one pocket.

ASSEMBLYMAN EWING: I believe I asked Doctor Cadmus the same thing: Is there much liaison between your faculty and your group down there and yourself with the group in Newark?

DR. STETTEN: We meet from time to time. I see Dr. Rossin and I speak to him on the phone I would

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guess every other week maybe about one thing or another. In some departments this has developed the Department of Pathology, for instance, exchange teaching exercises. Dr. Brady from their department teaches in our school and I believe Dr. Morrison from time to time goes up and teaches in their school.

ASSEMBLYMAN EWING: Has Dr. Cadmus been down to your basic science building? Did he see that while it was going up or anything?

DR. STETTEN: Dr. Cadmus has visited the science building a few days ago. He said he was going to, and I gather he did.

ASSEMBLYMAN EWING: I mean prior to that. During the design stage or anything like that; I mean was there any exchange of ideas back and forth between -

DR. STETTEN: I don't recall that we discussed that at that time, no, sir. I don't remember discussing it.

ASSEMBLYMAN EWING: And if they come down to you during their design stage in Newark -

DR. STETTEN: I have never seen their plans. I have seen a photograph of their model, but I have not seen their plans.

ASSEMBLYMAN EWING: We have all seen the photograph.

DR. STETTEN: I have not seen the blueprints or any plans or architect's drawing that I can recall.

SENATOR HIEKING: Doctor, as I understand it, the Medical School at Rutgers was authorized to start in 1965.

DR. STETTEN: May I correct that?

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SENATOR HIERING: Surely.

DR. STETTEN: I believe the Board of Governors authorized it. I am not sure what you mean by authorization. Well before that - I was hired in November of 1962 so it must have been authorized before that time by the Board of Governors I would assume, otherwise I was illegally retained.

SECTOR HIERING: What was the first year you had students in your Medical School?

DR. STETTEN: September 1966 we admitted students.

SENATOR HIERING: How many students do you have today?

DR. STETTEN: We have 16 students in each of two classes at this time, in these temporary buildings which were described and which were built out of gifts chiefly from the pharmaceutical industry who wanted us to get started,

SENATOR HIERING: And what is your cost per pupil this current year for operating.

DR. STETTEN: Well, it's high. I'm afraid I can't give you that off the top of my head. It's high because we are a growing school. It will be a great deal less this next year because next year we are more than doubling the size of our student body. The year after that it goes up again.

SENATOR HIERING: Well, I realize in the beginning you have started at cost which causes a problem.

DR. STETTEN: Our State budget this past year was just under three million dollars.

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SENATOR HIERING: But I understand that your cost per pupil was somewhere around $95,000 per year per pupil.

DR. STETTEN: That figure, sir, is only meaningful if you assume the only thing we have to do is to teach medical students, which is not the case.

SEBIATOR HIERING: Well, what is the national average per pupil cost in medical schools, do you know? Approximately.

DR. STETTEN: I would give about thirty thousand a head but I am not sure of that. I think it runs twelve million dollars for the average school which has an average of 400 students.

SENATOR HIERING: Well, can you estimate when you might come within this realm from $95,000 per pupil down to -

DR. STETTEN: In local 1970 dollars that is likely to happen. In 1975 dollars I really wouldn't know that.

SENATOR HIEKING: How about your ratio of faculty to students at Rutgers? What is that now?

DR. STETTEN: At the present time we have a faculty of about 60 and a student body of 32. We have roughly two faculty per student,

SENATOR HIERING: How many faculty?

DR. STETTEN: Roughly two - 60 total roughly. It varies. This is high, but we are preparing for a larger class. We have to make these preparations.

SENATOR HIERING: What do you contemplate, for instance, for the next three years as to the size of

[Page 122 41 A]

your class ?

DR. STETTEN: If we stay as a -

SENATOR HIERING: You have 32 pupils now.

DR. STETTEN: Next year we have admitted 53 and we project to admit 80 the year after that. By that time we will be up to 160 students and the faculty will be on the order of 80, I would guess. So we will be close to the national average, which is at present 1.7 students per faculty member. I believe that was the national figure for this last year.

SENATOR DUMDNT: Did you say, Doctor, that you have joint appointments on your faculty and also the faculty of the New Jersey College of Medicine and Dentistry?

DR. STETTEN: No, sir, I don't know of any of those.

SENATOR DUMONT: They are completely separate appointments.

DR. STETFEN: As far as I know, they are completely separate. There may be some of the clinical professors who are also clinical professors elsewhere but there are no regular salaried faculty.

SENATOR DUMONT: You don't have any regular meetings then, I take it, with Dr. Cadmus?

DR. STETTEN: No, sir - irregularly, but not regularly. My counterpart, sir, is Dr. Rossin.

SENATOR DUMONT: When did you say you thought you could reduce your operating costs from about $95,000 per student to the national average of around $30,000?

DR. STETTEN: As the student body goes up. Up to this time we have had no space for more than 16 students

[Page 123 42 A]

in a class.

SENATOR DUMONT: Well, when it goes up to what? 400?

DR. STETTEN: When it goes up to 160, which will be in 2 years or 3 years.

SENATOR DUMONT: And are you getting the physical facilities by degrees that will enable you to take care of that many students in two or three years?

DR. STETTEN: The building - to whose dedication I trust you have been invited - will be ready for occupancy during the summer and we will start teaching in that building in September of 1970.

SENATOR DUMONT: So how many students then are you going to admit in September?

DR. STETTEN: We are admitting for next year's class 53, and the following year we expect to admit 80.

SENATOR DUMONT: You haven't had people at Rutgers Medical School long enough to determine, I presume, whether or not as they leave there for their third and fourth years, how many of them are going to return to New Jersey, have you?

DR. STETTEN: No, sir. Our first class is getting their M.D. in a few weeks. As far as I know, none of them have applied for internships in New Jersey. They have all that I have heard of secured first-class internships in teaching institutions. I have heard from approximately eight, I would guess, of the 15 that we graduated in our first year. They have all done very well, incidentally.

[Page 124 43 A]

SENATOR DUMONT: Were all of those sixteen New Jersey residents?

DR. STETTEN: The first year about half were New Jersey residents and in subsequent years it has run more. I believe this year there were 14 out of 16 who were New Jersey residents. New Jersey seemed to look upon us with suspicion when we started.

SENATOR DUMONT: You don't have any particular requirements as to how many should be from New Jersey in a particular class, or do you?

DR. STETTEN: No, we do not have a statutory requirement. I have steered clear of that, as has the Law School and as has the Graduate School.

SENATOR DUMONT: Thank you, Doctor.

ASSEMBLYMAN EWING: Dr. Carroll Leevy from the Newark College.

DR. CARR0LL LEEVY: Mr. Chairman, I am President of the Faculty of the New Jersey College of Medicine. This is the first year we have had this organization. I have been with the College of Medicine since it began in Seton Hall. Prior to this time, I was practicing in the Jersey City area. We found that with the development of the Medical School, the practice of medicine was completely changed in this environment.

Since this time the faculty of medicine, as you know, has moved as has a great deal of harassing situations related to its being transferred from Seton Hall University to the New Jersey College of Medicine and the subsequent moving from there to Newark. Since

[Page 125 44 A]

this time a number of individuals have been recruited including all of the present administration and most of the chairmen of the .major departments in the medical school, They have come because they have had faith in the potentiality that the Medical School located in a very highly-urbanized disadvantaged area could do three things: First, it could produce physicians who were highly needed in the State of New Jersey; secondly, it could contribute to health care, and thirdly that it could improve on health care by doing clinical and basic investigations necessary to improve our general knowledge.

The Faculty Senate or the Faculty Council of the New Jersey College of Medicine met with the faculty., the executive faculty, of Rutgers University. We share the common belief that one of the terrible things that has happened in New Jersey is that we don't have an outreach kind of program which is going to insure continuity.

We believe sincerely that the State of New Jersey must devote the time and the energy of governmental and private support to be certain that we have quality medical education and are able to take care of the large number of citizens who do not get proper care at this moment because we don't have the proper facilities. It is our belief that it is essential that as of this moment the New Jersey College of Medicine, and we share this with Rutgers, move ahead in this general area. The faculty does not really feel bad in terms of the possibility that they will not have activities elsewhere because there is such a shortage of trained educators and clinicians. On the other hand, we sincerely believe

[Page 126 45 A]

and we have devoted ourselves to the State and its needs and we would like to see this move forward. It is our belief that most of the things which are being discussed, and we have no control, but we would like very much if the legislature would move toward implementing those things which really initially began when Seton Hall began its medical school and secondly which have been initiated with Rutgers beginning its medical school, and the things which have been expressed already to you in a letter from the faculty, students and alumni.

Thank you.

ASSEMBLYMAN WOODSON: Do I gather, Doctor, that you are supporting the proposition in this bill which is the setup proposed by Assembly Bill 10597

DR. LEEVY: I am supporting it within the context of what has been expressed; in other words, as we would understand it, if one is going to insure a quality education, preservation of the two medical schools, proper financing - this is what the faculty wish.

ASSEMBLYMAN WOODSON: Speaking in terms of the preservation of the two medical schools, are you speaking in terms of there being two separate schools - one at Rutgers, the State University, and then the College of Medicine in Newark, or are you speaking of their coming under one board and operating as one unit?

DR. LEEVY: I believe that if one starts at the legislative and financial area, the input has to be in the medical education. What device is had to garner

[Page 127 46 A]

that I think one needs to work administratively in the best area. We were told originally when Seton Hall and Rutgers were started there was one higher board of education that would control the two institutions.

I think that one has to have this kind of format in order for one not to have chaos.

ASSEMBLYMAN WOODSON: What is your feeling with regard to a university affiliation? Several of the prior speakers testified that it would be highly desirable to have a university affiliation?

DR. LEEVY: Well, my own personal view - I think since I have labored 14 years as such, first with Seton Hall and now without, that it is the desirable thing to belong to a parent university. I think it was suggested when we moved in the middle of Newark that one would consolidate the Newark College of Engineering and other things and create Essex University. At least I saw this in the newspaper,

So obviously, from an educational point of view, this would have all of the advantages that have been spoken about by these other educators.

I think on the other hand, a medical education I understood that President Eisenhower said, when he was at Columbia, that the next time he was going to be President of a university he would not like to have a medical school there. Medical education has to be specially funded with special areas and even if it is under the university, whether it is Essex University or Rutgers University or whatever, one has to have adequate

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funds and a special kind of device which would permit this, because a medical school I think provides a climate for excellence in patient care and excellence in health delivery. This requires then that you educate physicians, dentists, paramedical people, and it also requires that you do the kind of research so that you would know what is new and whether it is useful and discard those things which are old. All of this requires a lot of money. More important, every community hospital in this State will benefit by having the kind of service which is provided by this. We feel that in all probability one will need to ultimately educate 400 medical students, and so that in the sense that one needs special money and special funding, I think this ought to have some sort of unity so that it can come freely from the governing body of the State.

ASSEMBLYMAN EWING: Thank you, Doctor.

I will call Mr. Jack Owens, Executive Director of the New Jersey Hospital Association. (not present)

Mr. John Adams, of the First-year class at Rutgers.

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J0HN ADAMS: My name is John Adams. I am a first year student at the Rutgers Medical School and a resident of Princeton.

First I would like to say to the Committee that we are very grateful that the Committee does see fit hear from students on a matter which is vitally important to us and which we are very greatly concerned

This bill, as we see it, does indeed set up one board. But to us the most important aspect of this bill is the direction it gives that board to separate Rutgers Medical School from the University.

There are other provisions of the bill which we may find questionable but this, to us, is an essential matter.

We see this as a most undesirable possibility. Indeed, we find it alarming. We in the Medical School, as students, find the contacts with the other faculties of the University very encouraging, very invigorating, and a vital part of our education. We feel that this is the best use that can be made of the University. Indeed, to separate the Medical School from the University would be to take the University away from where the action is.

The separate board, it has been said, could, of course, establish relationships with the University. However, I think it's quite clear that these relationships would be contrived, difficult to establish, and

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very much weaker than the current strong bonds that we have within the University.

It seems to me that all people in this room are in agreement that there probably should be some board, some body of men, who would coordinate and oversee the development of medical education in New Jersey, its financing, its direction and its future. However, the instrument that we have before us now, this bill, has been posed to us as the only alternative, it's either this or stick where we are. And I think it's quite clear now that that's not quite true. There are a variety of possibilities. Many states, as I understand it, have a variety of boards which do work in coordination with their university system to coordinate medical education. As I understand it, Utah, California, New York, all have such arrangements.

If I were a student of law, I would have gone to my law library and found these statutes and tried to prepare some concrete alternatives to present to you here today. As it is, we have had only four days since this bill appeared in print, hardly enough time for us, as lay people, and I think even for yourselves as professionals, to adequately deliberate on the variety of alternatives that are available to us to solve the problem. It seems clear that there is a solution that would satisfy the interests of parties involved and it would seem to us a great

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tragedy for the State to move ahead in an effort to avoid a few months of uncertainty into a mistake when, with a certain amount of deliberation, of working together and considering the possibilities, we could come up with a good law. Thank you.

ASSEMBLYMAN EWING: Mr. Adams, why couldn't the rapport with the Rutgers teaching staff, professors, etc., still go on even though the Rutgers Medical School would come under a different board? What's to stop you? I certainly hope that all of those connected with education throughout our whole State are trying to do everything for everybody and not just say, well I only belong here, I'm not going to talk to you because you're with another group, or anything. I think this would be hideous.

MR. ADAMS: Well we, the students, prepared a statement to cover that and I hope I will be allowed--I don't know what is customary in hearings of this kind--but I do hope I will be allowed to include it in the record so that you people can study it. But right now let me give you specific examples.

Neighboring institutions will do each other favors but when times get difficult and time is difficult for anyone on a teaching staff of a university, time is precious, one does have to set priorities.

And your first priority, your first duty is to members

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of your own institution and not favors that you are doing for a neighbor. And I think it is quite clear that while some relationships could continue in one way or another, many relationships would be weakened, damaged, in fact in some cases be altogether unworkable. If, however, the faculties of our institutions remain a part of the University, they do set common educational policies, they could arrange some of these experiments which have been proposed, of shortening the time from high school to the MD. These could not be done conveniently or well. Why make something difficult that is at present simple and, in fact, could be continued in its present simplicity and strength under a good board which would oversee the financing, the future and the development of medical education in this State ?

ASSEMBLYMAN EWING: I certainly would not envision, if a new board is put into effect, that. I should think that they would try to strengthen the rapport between the Rutgers Medical School and the Rutgers University, as well as strengthen the rapport with the professional staff up in Newark.

MR. ADAMS: Unfortunately, the bill as it reads, or at least my interpretation of the words there, is that the relationships as they exist would immediately come to an end. It separates the Medical School from the University. It says so, or I may be paraphrasing

[Page 133 52 A]

the meaning of it. But that's the meaning, as I take it directly, that this separation is to occur immediately. You rend this fabric and then you ask to stitch it back together you will get a seam but it will be a very poor one.

SENATOR DUMON: Mr. Adams, As you know; we have to be concerned about cost here too and the fact that apparently costs now $95,000, or thereabouts, to educate a medical student at Rutgers and about $27,000 in the New Jersey College of Medicine and Dentistry, it's bound to be of some concern to us and to you too. Now I understand, through Dean Stetten, that this will gradually come into better focus as you increase your enrollments.

You indicated that you live in New Jersey, I believe you said in Princeton --

MR. ADAMS: Yes, sir.

SENATOR DQIMONT -- what are your plans or do you have any plans yet where you might practice in the event that you have to complete your third and fourth year at a medical school elsewhere than in New Jersey?

MR. ADAMS: Well, I think that depends a great deal on what I can expect to find when I come back. It's fairly clear now that I must leave the State to complete my third and fourth year, and the decision about where I would go and I think this is true of most of my

[Page 134 53 A]

fellow students, would depend on the nature of the medical community that I would be seeking when I come back. I can speak for myself personally. I would very much like to be in practice near a good university medical center, not so much that I would necessarily be a member of the faculty but I do think this would add a great deal of strength to my own practice. When I came to a problem that I would not be able to handle personally, I would know that there would be experts in every field available to consult or to refer my patient to. I think this strength to an entire state that would come from a good university medical center is the sort of thing that would attract me to an area to practice medicine.

SENATOR DUMONT: You don't think that such a medical center will be created or, if it now exists, will remain under the concept of this bill with a new board of trustees?

MR. ADAMS: Because this bill does clearly separate medicine from the University, I don't think you can get the sort of thing that I have in mind, no, sir.

SENATOR DUMONT: Do you think that if the board of trustees were at Rutgers, as suggested, I think, by Dr. Rulon Rossin, where you have only one board but it operates out of the 'State University with branches in different locations, would that fit

[Page 135 54 A]

your idea of a medical center more than what you think this bill would create?

MR. ADAMS: I think that would be closer to it, though, as I said earlier, I don't think all of the possibilities have yet been explored. Some were mentioned - have a very large board, a portion of which would devote its attention to medicine or perhaps even within the university structure have a separate board devote its entire attention to medicine. I think there are a great variety of possibilities that the Legislators and we should explore and examine the merits of the various possibilities. It doesn't seem to me that this is the best one. I can't say that I have properly examined all alternatives but I think we should take time to carry out this examination before we take any action, or you gentlemen take action.

SENATOR DUMONT: Do you have any specific alternative today that you would want to offer?

MR. ADAMS: Well, as I said, with the matter of four days since the bill appeared in print, I was unable to devise a bill to my liking but I think in a matter of months, with proper help from legal authorities, one could be drafted by me or by anyone who is genuinely interested and consults all the parties involved, that would satisfy the needs of New Jersey and the interests of the medical students, the medical faculty and the patients of New Jersey,

[Page 136 55 A]

ultimately I think it could be done.

SENATOR DUMONT: Have any of the graduates of Rutgers Medical School gone on in their third and fourth years to the New Jersey College of Medicine and Dentistry?

MR. ADAMS: I am not sure of those facts. As far as I know that's not true but I am not absolutely sure. I don't recall any.

SENATOR DUMONT: Thank you.

ASSEMBLYMAN WEIDEL: Mr. Adams, did you complete your undergraduate studies at Rutgers?

MR. ADAMS: I was an undergraduate at Princeton, actually.

ASSEMBLYMAN WEIDEL: You said you lived in Princeton?

MR. ADAMS: I live there now.

ASSEMBLYMAN WEIDEL: And YOU advocate the personal relationship in your statement between the Medical School being associated .with the University.

MR. ADAMS: As a part of the University.

ASSEMBLYMAN WEIDEL: As a part of the University. Do you live in Princeton or do you live in New Brunswick?

MR. ADAMS: No, I actually, physically live in Princeton and commute up now, as a matter of fact.

ASSEMBLYMAN WEIDEL: Well, would you give me an example--you live in Princeton, you graduated from Princeton, you are in a Medical School in New Brunswick--would you give me a personal example where this inter-

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relationship of the Medical School being a part of the University has affected you?

MR. ADAMS: Yes, sir, I would be glad to.

As I was working earlier this year on a small research problem and there was a question of mathematics which came up which I didn't understand. I have friends who are graduate students at the University in Princeton and they referred me to a Mathematics Professor at Princeton, they said this gentleman might know something in the field and be able to help you. So I called him up and he said he simply didn't have time to consult me about it. I did exactly the same thing with a Mathematics Professor in the University at Rutgers and he welcomed me. He was very interested in the problem, He wanted to know how his talents could be put to use in helping us in the medical school. It was a rather obscure problem and for him it was rather trivial, for me it was very profound.

ASSEMBLYMAN WEIDEL: Are you suggesting then what with a separate board, which this bill calls for, this Professor would deny you that if you are physically there at New Brunswick?

MR. ADAMS: If I'm physically there, just as I was physically present in Princeton, yet I'm a member of another institute, I don't think we would have the same relationship. I think that is quite clear Neighbors are not the same as family members, good

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though your relations may be.

ASSEMBLYMAN EWING: Thank you, Mr. Adams.

MR. ADAMS: Thank you, sir.

ASSEMBLYMAN EWLNG: Is Mr. Larry Pizzo here, President of the Student Council in Newark?

LARRY PIZZO: My name is Larry Pizzo. I'm a third-year medical student and President of the Student Body at New Jersey College of Medicine and Dentistry.

To answer the Chairman's question, if I had to make a yes or no decision my answer would be yes, I endorse the bill. However, I plead guilty with reservations. I endorse it because I feel the future of the New Jersey College of Medicine and the future of the third and fourth year classes, as now constituted, would be best served by having a unified board.

This is the first year since the State of New Jersey has taken over the Medical School formerly run by Seton Hall that we have full time chairmen of all the clinical departments. And most of them came with the vision that there would be a new university medical center that they would be able to be chairman over and be able to have a referral hospital to which they could have patients from all over the State come.

Now in terms of the third-year students presently at the New Jersey College of Medicine, we invest our

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future and our time seeking an internship and residency program.

The New Jersey College of Medicine, through the constant efforts of the administration has uninterruptedly graduated 80 senior medical students and about 50 dental students since 1960, well, since Seton Hall gave it up and we've taken it over. There are over 900 alumni of New Jersey College of Medicine and Dentistry. A good number are still in the service and residency training. But because of the lack of a university hospital, most of them are out of the State of New Jersey. And you are well aware of the figures that most of the students leave New Jersey to seek greener pastures in New York or Philadelphia, wherever there are established university hospitals.

Now back to the reason why I am endorsing this bill. Someone said this morning that perhaps we should postpone it one year. One year is too late. We are still recruiting faculty members. As a junior student I am looking toward an internship and I'm looking right now. For example, I have to be sure that that residency program will exist two or three years from now. And with the lack of commitment and the lack of both financial and emotional commitment, I'm not sure of that. And it's very easy to get in internship programs.

Now back to the question of the university hospital affiliations. Every morning in the mail I get

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three brochures from very green pastures, community hospitals located on the edges of hundred acre parks that provide apartments and whatnot. Yet fully 75%, at least students from our senior class, go on to university hospitals or university affiliated hospitals for much less money and very often located in the ghettos. So there is no doubt that university hospitals are what are attractive.

Secondly, the internal residence staff are the true faculty in terms of everyday contact, The clinical faculty that's hired by the medical school certainly run the program and teach the residents and interns. The medical students live with residents and interns. It is necessary to have a strong postgraduate medical training program in terms of internship and residency programs. And because this is a bias market, we can look elsewhere very easily. People are just not coming back to New Jersey to practice because most people settle where they do their residency. I'm a resident of Essex County but if I spend five years in training to be a surgeon, let's say in Boston, I make contacts there, I find people in community hospitals that I can deal with and indeed we get offers to have private practice with, and we would most certainly settle there, in addition to having your wife and family there.

So, all in all, I think we vote yes because the progress at the New Jersey College of Medicine is

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made, it's truly dramatic and we have to continue its progress rather than stymie it or postpone it even for one year.

SENATOR DUMONT: I gather that you think a single board is going to help to continue this dramatic progress which you say you have already experienced actually with the New Jersey College of Medicine and Dentistry and a separate one at Rutgers.

MR. PIZZO: Yes. However there is a point that one of you gentlemen raised about two groups asking for the same number of dollars, which I feel prompted the Governor into starting this whole business in the first place, that there were parallel demands and, not being a medical educator, he did not know. So he is asking for this board who can seek the advice of medical educators.

Secondly, I do understand Rutgers' position and I fully agree that I can't see the logic of taking them out from the university but it's not my decision, it's purely an administrative decision that has to be made by this board. And we have to, with great hopes and prayer, put some faith in this Committee, although I do share their understanding. And although I would vote for this if this is a referendum, I fully intend to help work with Rutgers University in getting their medical center established because, as everyone agrees, we need more than two

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medical centers. The Chancellor of Education has chided us for our non-delivery of health care but in the next breath we're told that they are only willing to support one medical school. Well that doesn't follow one from the other. I think continual effort has to be made in all parts.

SENATOR DUMONT: Do you think you have suffered in any way as a student by not having a university affiliation?

MR. PIZZO: Well, in terms of not direct suffering. There is a graduate school of biomedical science at the Newark Campus, which was chartered in 1965 and has since produced 12 PhD's. So our basic science faculties do teach a graduate program. We do not participate in undergraduate education, yet having gone to - I went to undergraduate school at New York University, a very large university, and there are definite ties both in terms of student body, in terms of social development of physicians, which is underestimated in our scientific communities, is definitely fostered between the two of them.

SENATOR DUMONT: How many of your graduates, having completed four years of medical or dental schooling, remain in New Jersey?

MR. PIZZO: Well, it's a hard figure to give to you. From our graduating seniors only 7 are staying on at Newark City Hospital; another 5 are staying on

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at Beth Israel. So there are 12 of our graduates staying on in Newark. The other fellows are going to various university programs throughout the country.

SENATOR DUMONT: Now you are talking about 12 out of how many?

MR. PIZZO: Eighty. However, let me make this point. The graduating class now is now a product of a divided school - basic science in Jersey City, they have been spread all over, including New York City hospitals to do their clinical work. They have no either affection or style of life attached to the medical school. My class is really the first that has had a continuous medical education in the New Jersey College of Medicine. And I think my class will definitely show a difference if we are confident that our residency programs will be stable and continuous over a period of years, and that would require the building of a medical center in all due haste.

SENATOR DUMONT: Thank you.

ASSEMBLYMAN EWING: While in Newark, have you made use of any. of the other facilities there in the education field?

MR. PIZZO: Well, not academically- We have used Rutgers, Newark, for various social and sports. We have a basketball league, etc.

ASSEMBLYMAN EWING: But not academically.

MR. PIZZO: No.

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ASSEMBLYMAN EWING: Have you found the need for it, though?

MR. PIZZO: No, I haven't.

ASSEMBLYMA EWING: Do you think any of your other classmates have?

MR. PIZZO: Well, right now many of them are taking elective within the basic science departments, There are various electives offered by the people that also teach our graduate school oriented toward research and there are also many electives in the first years that are oriented toward clinical sciences. But, no, there aren't any active affiliations or active switching of faculty or forces with any of the other colleges in the area.

ASSEMBLYMAN EWING: Well, if you felt you needed academic help from some other facility that was in Newark that wasn't part of the Medical School, would you have a hesitancy to go there and ask help or seek help?

MR. PIZZO: No, I wouldn't, I wouldn't have any hesitancy. Although I haven't had the experience that Mr. Adams has had.

ASSEMBLYMAN EWING: Thank you very much.

Dr. James MacKenzie, Chairman of the Department of Surgery at Rutgers.,

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D R. JAMES MacKENZIE: Mr. Chairman and members of the Committee on Education, I should say that I am a Teacher of Clinical Surgery. My particular field of interest is surgery of the heart and lungs. For the past ten years I have been on the full-time staff of medical schools in two other states.

When I was offered the opportunity to come to New Jersey to develop a Department of Surgery at Rutgers Medical School, you may be sure that I looked very carefully into the school, its administration, future plans, and, most particularly, its accomplishments.

Because I investigated these programs of Rutgers Medical School and because I had nothing to do with their development or implementation, my opinions may have some objectivity.

Furthermore, as a surgeon at University hospitals, I have seen a number of new surgical procedures developed and described. Some of these are no longer used. For this, as well as for other reasons, I have a healthy skepticism of promises without performance.

It is, of course, exceedingly difficult to evaluate a medical school. Each of us brings his own biases to the evaluation, and yet there are certain criteria which can be used. Among the ways used to evaluate medical schools are the accreditation visits sponsored by the Liaison Committee described today.

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Copies of these reports are given to the medical school and the university. Prior to coming her I read these reports. I should like to quota from the last visit of the Liaison Committee to Rutgers Medical School. This visit took place from May 14 to May 16, 1968. "The team was greatly impressed with (the) remarkable progress since the last survey. In fact, it was the unanimous consensus that the faculty, programs, and even the temporary facilities were of excellent quality. The only concern was related to the progress toward the four-year program. Among the specific comments made in the Summary of comments of this Committee was one that impressed me.

"The significant and extraordinary development of staff, educational budget, and research programs during the past two years all merit commendation. They reflect the high level of leadership provided by the dean and his staff."

In support of this evaluation of the academic accomplishments of the basic science faculty which Dr. Stetten had assembled, it should be noted that represented on the faculty were either editors or members of the editorial boards of ten scientific journals.

[Page 147...66 A]

I hope that these recognitions by their peers of the accomplishments of faculty of the first two years of Rutgers Medical School are impressive to you, and they were meant to be. I am equally sure that they do not answer the fundamental question, "Well, what about teaching?" Prior to coming here I spent four years on the Education Committee of another medical school. It was an active group. We spent many hours investigating new developments in medical education. The pilot teaching laboratories at Rutgers Medical School with chair multi-disciplinary approach to basic medical science teaching are recognized as classics. The principle of these laboratories is that the students remain in one laboratory and the teaching materials and teaching staff are brought to them. Not only does this provide better instruction but it does it at less cost than having students rotate to different laboratories for each of their basic science courses.

One may well ask, "Why the concern of a surgeon about the quality of the basic science instruction offered in the medical school?" I can only say that although it is possible to develop a strong department of surgery without the support of excellent basic science departments, it is difficult to do so.

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One of the real problems facing medical educators is how to evaluate their most important end product, the fledgling physician. One of the ways to do this is to require that graduates take medical licensure examinations. The granting of a license to practice medicine is a privilege of each state. Many states, I believe the number is now 46, will accept the examination score given by the National Board of Medical Examiners. For this reason many medical students take the National Board examinations. In 1969, 72 medical schools had 25 or more of their second year students take the Part I examinations which are customarily given at the end of second year of medical school. It was a source of some pride to us when it was reported that the students from the Class of 1969 of Rutgers Medical School placed fifth in this group. I would not wish to overemphasize this performance, but I think when one considers that the courses at Rutgers are designed to teach the basic sciences and not just to pass an examination, this is really a remarkable record for such a new school.

With legitimate concern over the cost of services furnished by the state government and in particular with the cost of medical education, it seems to me certain facts should be stressed. The operational aspects of the excellent programs planned and developed at Rutgers Medical School have been well supported by a

[Page 149 68 A]

generous legislature. It should be clear that up to this date, however, no capital funds from State sources have been invested in Rutgers Medical School. The basic science facilities and the teaching laboratories will be dedicated this month. The State of New Jersey will then have an excellent facility capable of instructing in the basic sciences classes of at least 80 medical students. Only 6 million dollars of the State of New Jersey's capital funds are invested in this new 18 million dollar building. I think the people of New Jersey have received a bargain.

In summary then, it seems to me that by all the criteria I can find, planning at Rutgers Medical School has been sound, programs have been both innovative and well thought out, and the results impressive. I sincerely doubt that they could have been developed as rapidly or as well under the administrative organization proposed in this bill. Thank you.

SENATOR DUMONT: Doctor, does $6 million represent the total capital money that has come from the State Treasury toward the Rutgers Medical School?

DR. MacKENZIE: I can't speak for Rutgers Medical School but it is my strong understanding that this is true. This is the only State capital money invested in Rutgers Medical School, will be when this new building is dedicated.

[Page 150 69 A]

SENATOR DUM0NT: But the $6 million is all in that one building.

DR. MacKENZIE: Yes, sir.

SENATOR DUMONT: Thank you.

ASSEMBLYMAN WOODSON: I gather that you also believe that a university affiliation is entirely desirable.

DR. MacKENZIE: I think, without question, that the university affiliation has been an integral part of the rapid development of Rutgers Medical School to this time and it is highly desirable.

ABSSEMBLYMAN WOODSON: And you would foresee that with the establishment of this autonomous and separate board that that affiliation would be curtailed, if not altogether cut off?

DR. MacKENZIE: If I read the bill correctly, it implies the actual release of the Medical School from Rutgers University. I think this is the intent of the bill as I read it and I think this would only have deleterious effects.

ASSEMBLYMAN WOODSON: You would not feel that this new board of trustees could work out some form of relationship with the University?

DR. MacKENZIE: This, of course, is speculation.

ASSEMBLYMAN WOODSON: Yes, I understand.

ASSEMBLYMAN EWING: I failed to introduce Assemblywoman Millicent Fenwick from Somerset County.

[Page 151 70 A]

ASSEMBLYWOMAN FENWICK: Dr. MacKenzie, do you feel that beyond the psychological impact of having a university attached to the medical school, or the medical school attached to a university, there is a practical academic need for having university facilities? Is there a real academic need or is it a psychological impact as being part of a great university?

DR. MacKENZIE: I'm sure the psychological impact must be part of it but there are very real practical reasons. Some of these have been commented upon before. The development of cooperative programs with schools of engineering, schools of sociology, schools of business administration, is facilitated greatly by this formal affiliation rather than having to rely on sort of personal relationships which may well be transient.

ASSEMBLYMAN EWING: Thank you, Doctor.

We will take a short seventh inning stretch now for a Coke or something and come back in six or seven minutes.

(Recess)

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[After Recess ]

ASSEMBLYMAN EWING: Will the hearing please come to order.

Dr. William Wilson, Chairman of the Department of Medicine at Rutgers, please.

D R. WILLIAM S. WILS0N: Mr. Chairman and members of the Medical Education Committee: My name is Wilson. I teach Medicine and Physiology at Rutgers.

I have a few brief comments to make about the clinical program at Rutgers.

As you have heard, we have presented some evidence to indicate that Rutgers is now a two-year school of some quality. The only point I want to make, my main point, is that we now have a program for the future which will preserve and enhance quality while at the same time serving economy. In other words, in the event this bill, 1059, doesn't pass, it will not leave Rutgers in a vacuum.

I would like to describe this program briefly. Our immediate plans call for two important simultaneous moves. I will summarize this very quickly since it has been brought up before.

The first is to occupy the soon-to-be-completed pre-clinical science building. As you know, our classes thus far have been limited to 16 because of the space available. This building will allow us to quickly reach our goal of increased number of students going through our two-year program. This new building will permit us to increase

[Page 153 72 A]

our class size by approximately five times in two years and if we are going to list cost per pupil the way I would like to list the cost, we are going to decrease tremendously in the next two years and I think that may be a more realistic way of looking at it since new schools are inherently expensive schools. You have to have the teachers before you get the students. You can't wait for the students to get there and then hope to get the teachers.

Our second immediate goal is to develop a clinical program to serve the following needs:

a. an introduction to medicine for our first and 2nd year students.

b. a clinical program for our 3rd and 4th year students, producing M.D.s.

c. an internship and residency program to attract graduates of American schools.

d. a postgraduate education system to serve our practicing physicians since they make up by far the largest pool of educable people, much, much larger than the current pool of medical students-

e. development of affiliations with the community hospitals of the area so that we can utilize these educational resources more effectively.

This second goal - the development of a clinical program - brings us at once to our current problem and to our proposed solution.

The problem is, as you well know better than I, that

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the Federal and State money is not available now for our long-awaited university campus hospital. These plans have been shelved. Times have changed since these plans were made several years ago.

Because of this we proposed near the end of 1969 that Rutgers be authorized to purchase a community hospital, already mentioned in this hearing. This would give Rutgers a small university hospital and permit the school to mount an effective clinical program.

Now I am going to repeat some figures that were mentioned before because I think they deserve emphasis. The cost of this program would be moderate when compared with other plans that have been mentioned almost daily in the press. The hospital is something around $4 million. Renovations and additions would be $2.5 million in that range.

If two floors were added to the hospital, the Medical School of Rutgers, the State University, might graduate as many as 80 to 100 M.D.'s per year in the near future.

I will close by restating my point. The Rutgers Medical School is now a 2-year school of good quality. We have a plan for the future which will preserve and enhance quality and at the same time serve the interests of economy.

I hope we will be given an opportunity to implement this plan. Now almost any administrative system will work. I don't think that's the question, whether anything will work. I prefer to think of it as to what is most likely to work and in

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my opinion, the chance of success will be much higher if we follow the example of most of the rest of the nation by permitting the School of Medicine to remain within framework of Rutgers University,

It comes to something called continuity and which New Jersey has not had in medical education. Personally. I would like to see the State of New Jersey have a medical school with the same name for over a decade. It might give the illusion. of stability to the rest of the country,

Now to be positive about it - and I don't want to be negative - it seems to me that we are talking about one school or two schools. Many states have two medical schools and it is perfectly reasonably, I think most will agree, have some coordinating board to make some sense and plan for the future in medical education.

This current bill is possible; as I say, anything will work. It seems to me it is the least likely to work of a wide series of alternatives.

I would like to suggest another alternative. The New Jersey College of Medicine, has, I think, performed admirably and Rutgers has had some modicum of success. I think if these schools were properly funded, and I am sorry but I don't see any way around that and I am sure you don't if these schools were properly funded and if there were a central coordinating board within the state to provide planning, but if we kept two schools as they are now, I think it would serve as a compliment to the people of the

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New Jersey College of Medicine, telling them in effect, "Well, done," and perhaps some indication of confidence in what has been done at Rutgers so far.

So the alternative I would like to present, and I think it is premature to become fixed to that alternative, is what amounts to the status quo, one complete medical school, a good one, that has really grown under many adverse conditions, and another fledgling school that seems to be doing all right. If these two schools could be coordinated with a central coordinating committee, then I think we would be in a position to serve the State of New Jersey the way it should be served.

Because of these factors and others that have been mentioned today, I would like, and I am very pleased to have the opportunity, to express my opposition to Bill 1059. Thank you.

ASSEMBLYMAN EWING: Dr. Wilson, should this bill go through and should a single board be put into being and the Rutgers Medical Section would continue, how much harm would it do them if they didn't get their clinical hospital for some time, say, there was a postponement in that particular phase of it?

DR. WILSON: Well, I don't think a two-year school can survive long in this environment.

I must ask you for a point of information. It is my understanding, as a naive layman in these matters, that if this bill does go through, Rutgers Medical School no longer

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exists but is indeed a part of the College of Medicine of New Jersey.

ASSEMBLYMAN EWING: That is correct. The way the bill is written, that is right. But still the graduates could go to some other area for their clinical training until such a clinical setup was established at what is now known as the Rutgers Medical School campus.

DR. WILSON: I think you are right. It is absolutely true. It is possible to educate students for their first two years on the grounds that were formerly the Rutgers Medical School. As I say, almost anything will work but I think there is unanimous agreement in medical education circles that this is probably not the best way to do it. I understand perfectly it may be necessary but I actually find that hard to conceive.

ASSEMBLYWOMAN FENWICK: Dr. Wilson, do you know of any medical school, two-year medical school, that operates separated from a university and without a hospital?

DR. WILSON: No, I don't know one, but there may be one. There are, as has been said several times, six or eight medical schools without a university affiliation. I don't think there is a two-year one, no.

ASSEMBLYWOMAN FENWICK: -- and without a hospital. How do you organize the education of medical students in the absence of a hospital?

DR. WILSON: This is a very difficult problem and will become much more difficult and perhaps, as I think you are

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implying, impossible when the class size increases to 53. Now we have it pretty good. We have 16 students. They are all good. It is hard for us to ruin them. With 16 students we have developed teaching units in 6 community hospitals which have served us well for these 16 students, I doubt if it would be possible to do this and maintain quality that you would like when we go to 53 and then the next year to 80.

ASSEMBLYWOMAN FENWICK: Thank you.

SENATOR HIERING: Doctor, just one thing - we do want quality in our medical school certainly and still we want to produce doctors to meet a very sincere need. I notice for the past 3 years, the '67-'68 year, '68-'69 year and '69-'70, that you have maintained a constant 32 pupils. How is it that you haven't increased the number of entrants in your school?

DR. WILSON: There are 32 chairs.

SENATOR HIERING: Pardon ?

DR. WILSON: There are 32 chairs. I don't mean to be facetious but if you would come and visit, we would show you the square footage available. I can't give you the square footage. But you cannot squeeze more than two 16-man labs in it.

SENATOR HIERLNG: So this is strictly a space problem?

DR. WILSON: Yes, sir.

ASSEMBLYMAN EWING: Thank you, Doctor. I

DR. WILSON: Thank you.

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ASSEMBLYMAN EWING: Dr. Paul Jordan of the staff of Martland Medical Center.

DR. PAUL J0RDAN: I am Dr. Paul Jordan from Jersey City, New Jersey.

I am an alumnus of the New Jersey College of Medicine, representing the 1100 alumni. I am also President of the Internes and Residents Association.

I think most of what I feel and the alumni of the New Jersey College of Medicine feel and also the house officers of Martland has been more than adequately expressed by Mr. Smith, Dr. Cadmus, Dr. Rossin and the other representatives of the New Jersey College of Medicine. And I would just like to echo their remarks and say that I think the Assembly Bill should be passed for the simple reason that medical education in New Jersey has been in limbo much too long and I think the needs for medical education in New Jersey are too great for any further delay in this matter. I think this is our principal emphasis.

In my years in the Medical School - I have been with the school since 1963 either as a student or as an interne or resident. I was there in those horrible days in Jersey City when the Dean announced precipitously that we be distributed throughout the State and I have seen the New Jersey College of Medicine make a slow but steady climb-back up to the level at which we are currently where all departments have chairmen, which was not always the case. We have a Dean, which was not always the case. And I see us hanging on the

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edge of greatness, if you will, in Newark and in the area of medical education. I feel that as frequently as signals are changed on this particular direction, we run the risk of going back into limbo again, going back to the Jersey City situation where our faculty dispersed, our students were disenchanted, our house staff went to other hospitals.

So on behalf of the two organizations that I represent here today, I urge you to approve this bill with all due haste. Thank you.

ASSEMBLYMAN EWING: Thank you very much.

Dr. George Bird, Professor of Chemistry at Rutgers.

DR. GE0RGE BIRD: Gentlemen, I am grateful for the privilege of speaking to you.

Let me qualify myself. I would like to speak to you as one of the people who could support a medical school.

I would like to speak to you as a former manager of scientists. I was for 11 years a manager of the Physical Chemical Department of Polaroid Corporation. I would like to speak to you as a scientist who in the past has been active in a medical center, specifically the Boston Complex and my particular part of it, the Children's Cancer Research Foundation, where in toto over a period of some 10 years, I actually spent a working time of about 3 years. And finally, let me speak to you from the position of a scientist who has recently and happily been lured to New Jersey, specifically last September. And, incidentally, please understand that my remarks have no pertinence to the New Jersey College of

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Medicine and Dentistry. From everything that I have heard today, I can only salute them. I haven't been here long enough to meet any of their faculty or visit their campus. I hope to do so in due course of time. So the remarks that I will make to you this afternoon have only to do with what I have been seeing on the University Heights Campus of Rutgers and what I have seen at the new Medical School.

The University Heights Campus was a rather thrilling thing to me when I first looked at it and I was honored and delighted to become a member of it, not just of the Chemistry Department but of a place where people are beginning to talk to each other. You know, there is a joke about how the physicists never walk over to the chemistry building. This is ceasing to be true and I have been waiting for the time when someone would walk over from the Medical School to talk with me. Now it hasn't happened yet but I know it is going to happen sooner or later because I have a laboratory which in effect I inherited with $75,000 worth of apparatus in it. It is not mine; it is the department's. In fact, it is Rutgers'. But I have charge of it and I keep it going and I know that that apparatus has medical implications. have seen it used for medical purposes and I have consulted with people at the Harvard Medical School who are using such apparatus and wanted my advice. So up until now I have been delighted with the progress that the Rutgers Medical School has been making.

Now in one week I received an invitation to the

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dedication of the new building. I read the student newspaper and I find that the Rutgers medical students ranked fifth in the country in some of their qualifying exams and I discover that the Rutgers Medical School is about to be taken away from Rutgers.

I think that this bill, 1059, commits one of the classic blunders of the management of scientists. I say this on the basis of 11 years experience because I have had to manage scientists and I have seen managers commit this same blunder over and over again of hastily moving large groups of scientists who are already functioning well and creatively, doing their best, and moving them abruptly without any consultation or any choice. When you deal with people who take a year or two to get moving to collect their apparatus together and to begin their work, you just can't afford to give them the feeling that they can be moved in this way like nuts and bolts. Nuts and bolts they are not and you antagonize them by this kind of approach.

Let's think about what a medical school or medical schools ought to provide in New Jersey. Let's throw this on a more creative, positive tone. Let's think about it. I recognize and salute the preoccupation of these two schools, one with clinical problems and one with basic medical problems. I think we need both of these. We have to recognize that the doctors who are being trained now, if they are trained from the philosophy of technicians to do operations pure and simple, will be obsolete in about ten years' time. I am

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not a medical authority but I make that prediction on the basis of what happens to chemists who don't read the literature and stay up, It is utterly essential that a man coming through a medical school be given enough feeling for the research that is going on so he will know that he has to stay abreast of it. He has to read and inquire and learn and learn and learn. There is no end to this process. So you need this balance,

I see you here in New Jersey needing something else which I will call quid pro quo. I will wager a guess that the same thing happens here in New Jersey as happens in Massachusetts. I have seen it in operation there. I had concern a few years ago for a relative undergoing a malignancy operation and I wondered whether to leave this relative in a Cape Cod Hospital or transport her abruptly to Massachusetts General Hospital a hundred miles away. What I happily discovered was that the Cape Cod Hospital and the Massachusetts General Hospital were the same thing, that a program existed by which the Chief Pathologist of the Cape Cod Hospital and the Pathologists of many others took their most puzzling samples twice a week and travelled the 50 or 100 miles or whatever to Massachusetts General Hospital and there they met with the Pathologist there who held simultaneously faculty positions on the Harvard Medical School, the Tufts Medical School and so on, and there they had it out. So the best of modern medicine reached into the little towns of Massachusetts. -'

I would warrant right now that those of your doctors

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in New Jersey who are doing that are travelling to New York and to Philadelphia. And that can go on for a while, but I shouldn't need to tell you of this committee that there is no such thing as a free lunch. Eventually you have to give as good as you get. I am not saying that the State of New Jersey ought to enter into competition with Sloan-Kettering and Rockefeller Institute, far from it. We are a relatively small state. But we ought to do some thing well so that some people will come to us so when we come to other people, they will not have the frame of mind, "Why should we do anything for you?" I think this is vital.

There is another function that hasn't been discussed here today. We have talked about losing New Jersey physicians, people who have been trained in either the New Jersey College of Medicine and Dentistry or the Rutgers Medical School. Let's throw that in a positive vein and think about luring some people, some medical counterparts of myself, here. How shall this be done? The answer is - it shall be done by having facilities like the Massachusetts General Hospital which act as points of reference where a physician can come with his worst and most troublesome problems. We don't have that now and the best internes in any given medical year are now opting, I think, not to come to New Jersey for just that reason. It is very simple.

Finally, and this is really the most troublesome thing of all and I am not even remotely competent to talk to you about it, but nobody else has, this State has a large

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and very active pharmaceutical industry. I think that pharmaceutical industry is here because of the long-time strength in chemistry in this State. But the pharmaceutical business has changed. It isn't just chemistry any more. It moved from chemistry to micro-biology and you are well aware of the micro-biology institute at Rutgers and the Nobel Prize in Medicine won by Professor Oxman (sic..Waksman) and it is now moving more and more in the direction of the drawing together of chemistry, biology, micro-biology and medicine. I fear and I fear very seriously that this bill will create a climate somewhat hostile to the pharmaceutical industry and I think you have to consider that very seriously. Thank you.

ASSEMBLYWOMAN FENWICK: I wonder if you could explain - I should have asked Dr. Wilson perhaps - 1059, if that fails to pass, why is there an element of delay? Do you know why people would feel delay in the development of these schools of medicine if 1059 failed to pass?

DR. BIRD: I am not really competent to answer that. But let me simply say that you have here two fine medical schools, both straining at the bit, and they don't want to go through an interim period where everything will be tied in knots.

ASSEMBLYWOMAN FENWICK: Let me put it another way. Why would the passage of 1059 accelerate the process?

DR. BIRD: My own thought is it would hinder it. From my point of view as a potential supporter of both these medical schools, a man who might help the students and

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the doctors to do their investigations and a man who has in the past been in the same sort of thing, I might say that I think the amount of administrative hindrance and the amount of confusion and the amount of ill-will that hasty action will generate will make it very hard for me to perform this function. It isn't that it will be impossible; it will just be very difficult and if it gets x (sic) difficult, I will do something else instead which is more productive.

ASSEMBLYWOMAN FENWICK: Thank you.

ASSEMBLYMAN EWING: Thank you, Dr. Bird.

Dr. Richard Cross, Associate Dean at Rutgers.

DR. RICHARD CROSS: Mr.. Chairman, I am Dr. Richard Cross, a member of the-faculty at Rutgers. I am also Chairman of the Admissions Committee and Associate Dean in charge of student affairs.

I had intended starting off with evidence of how good our students are and how well we have educated them. I think this has already been brought out and with your leave I will move on. I will be happy to answer questions about the students if this should arise.

It seems to me that we are concerned today not with the past but with the future. Specifically, what effect will passage of Assembly Bill 1059 have on our educational program and our students? Certain things are definite. If I read the bill correctly, our students will not receive degrees from Rutgers University. They will not attend an institution called Rutgers Medical School. It may be

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asked, "What's in a name?" The answer is, I think, a good deal. Our faculty and students have worked hard to create on the banks of the Raritan an educational institution of excellence. With all due modesty, I believe that facts already brought out indicate that we have succeeded. Rutgers Medical School is highly regarded throughout the nation, and our reputation cannot help but be of value to New Jersey. We are proud of what we have accomplished, we are proud of our name and we are reluctant to lose it.

Lest there be any misunderstanding, I would like to make it quite clear that I do not wish to imply that the name of Rutgers Medical School is more deserving of praise than that of the New Jersey College of Medicine and Dentistry. Over the five years that I have been here, I have had many close contacts with members of the faculty of that school. I am well aware of the Herculean problems they have faced and have been amazed at the skillful way in which these problems have been dealt with. I have the highest regard for my colleagues at the New Jersey College. Their problems are different from ours, but they are just as deserving of your full support.

Along with the change in name will come certain other changes. Rutgers medical students have heretofore had priority on scarce housing facilities on the University Heights Campus. Not only will this priority be lost, but I fear that all possibility of having any medical student in University housing will vanish, since Rutgers students would

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hardly tolerate the allocation of this scarce space to outsiders.

This may seem like a minor issue. But I assure you it is a serious problem for a student who has no automobile and has to commute several miles in an area where no good public transportation is available.

As has been indicated by others, many members of our faculty came in part because they prize a University affiliation. If this bill passes, many of them will leave. In any such turnover, one inevitably loses first those who are most easily able to obtain jobs elsewhere. The irony is that I fear we will lose many capable individuals who are dedicated to the sort of community relationships the Governor seeks to encourage.

The above consequences seem quite predictable; many other possibilities cause concern. To recount the anxieties and fears of our faculty and students any further would occupy far more time than is allotted to me here. As has been indicated, faith in the new board and its administrative appurtenances is an important ingredient here. I suggest that the manner in which this bill is being pushed through is hardly calculated to inspire such faith. I have great sympathy for many of the objectives voiced by the Governor in his Special Message of May 4. There are many ways in which these objectives might be implemented, each of which has far-reaching impact on medical education, on medical practice, on hospitals and on higher education generally.

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To seize upon a single solution and to seek its passage without adequate consultation with all the many individuals involved suggests an arbitrary and high-handed approach which, in my opinion, augurs ill for medical education in New Jersey.

Since I have spent 40 years of my life as a resident of New Jersey, I hope I am wrong in my gloomy predictions, but right or wrong I urge that time be taken to study the many ramification of this complex piece of legislation. With a few months to explore other possibilities, I am sure that ways can be found to meet the needs of New Jersey without catastrophic damage to either of its medical schools. Thank you.

ASSEMBLYWOMAN FENWICK: Dr. Cross, again not to belabor the point, but I am a little confused by this;. What is the element of delay that failure to pass 1059 would involve or how would the passage of 1059 accelerate the process of developing medical education in the State?

DR. CROSS: Mrs. Fenwick, speaking for my school, I believe that passage of the bill would delay our progress and I cannot see that its passage would in any way accelerate it. I think the delays would arise through loss of key faculty- through confusion which will arise as we wait to see what this board is, how it operates, what it does. The bill leaves our future, in my opinion. very uncertain. I am not clear whether there is to be one school or two. If here is one school, is it to have two campuses? Are we

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to have basic sciences one place and clinical sciences in another? These are all things which are totally unclear at the present time.

ASSEMBLYWOMAN FENWICK: In your opinion, Dr. Cross, is it possible to have clinical sciences in one place and basic sciences in the other?

DR. CROSS: Yes, it is possible, but I think highly undesirable. Modern medical education is leaning more and more towards mingling the two and working them together and this is further emphasized by the current trend towards improved community relationships.

ASSEMBLYWOMAN FENWICK: Do you know any place where it is being done in the United States?

DR. CROSS: Not in the United States. The only two schools that I know of where they are isolated are in North and South Dakota, but even here there are hospital relationships that have been worked out.

ASSEMBLYWOMAN FENWICK: I see. Thank you.

ASSEMBLYMAN EWING: Thank you, Dr. Cross.

Mr. Harold Logan, Rutgers Psychiatric Institute.

HAR0LD G. L0GAN: Mr. Chairman and members of the Committee: I am Mr. Harold G. Logan, the administrator of the proposed Rutgers Psychiatric Institute and Community Mental Health Center.

Our program of mental health care for the people of New Jersey must be upgraded and expanded in scope. This is a matter of utmost urgency. In July 1966, in working toward

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this goal, the Board of Control of the Department of Institutions Agencies, following extensive exploration, decided to ask Rutgers University and its associated Medical School to build and operate Psychiatric Institute. They chose to bring the Psychiatric Institute into the University family because they believed it was essential

treatment and care programs that new methods of delivery of service, be developed and that many more physicians be trained to provide psychiatric care. In October 1966. the Board of Control voted ask the Legislature to transfer the necessary funds ($5.6 million) to Rutgers, The State University, to build and to operate a Psychiatric Institute which would include as its treatment component a Community Mental Health Center. On March 13, 1967, a bill (S-25) transferring this money was passed unanimously by the Senate (27-0). On April 17, 1967, the bill was passed by the Assembly (42-3) and was signed into law.

At this point in time, May 1970, the need for increased psychiatric services is even greater. Mental illness remains the No. 1 cause of disability in the State of New Jersey and in the nation. In 1968, New Jersey was 22% below the national average for psychiatrists in practice. The statistics for psychologists, social workers, occupational therapists and other mental health workers showed even a greater shortage. In a recent study of 101 consecutively hospitalized patients in the New Jersey State Hospital at Marlboro conducted by the Department of Psychiatry of Rutgers Medical School and the Bureau of Economic Research of Rutgers University, it was found that the loss to the State from the continued disability of these patients would be over $7 million.

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Looking at the figures from Middlesex County, in which the Rutgers Community Mental Health Center is to be built, we find that there is not a single psychiatric bed to serve a population of close to 700,000. At the present time there are four mental health clinics functioning in the county, only one of which specializes in the treatment of disturbed children. There are no facilities for partial hospitalization and no special facilities for children who are so disturbed that they cannot stay at home.

The Rutgers Psychiatric Institute and Community Mental Health Center was designed with the goal of making a major impact on many of these problems. The Institute will contain 150,000 gross square feet, over 70% of which are dedicated to the Mental Health Center and the remainder to administrative offices and faculty areas. The Center will contain 76 beds for adults and children, partial hospitalization and out-patient areas as well as occupational and recreational therapy facilities. It is estimated that 1,250 in-patients and 1,250 partial hospital patients will be admitted each year. Out-patient visits willnumber approximately 37,000 each year.

The Mental Health Center staff has been working closely with the staffs of various community and social agencies in order to develop a comprehensive and relevant approach to the problems which confront us. We have begun to develop working relationships with the Middlesex County Economic Opportunity Corporation, the Middlesex County Visiting Nurse Association, the Middlesex County Family Counselling Agency, the Special Education Divisions of the Departments of Education of the various towns in our service

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area, as well as with a number of other agencies, including the Raritan Bay Mental Health Center. The architectural for the Psychiatric Institute have been completed, the construction bids received and accepted. The award of contracts was held up by Governor Cahill pending his study of the system of medical education in New Jersey. This hold order is still in effect.

The only service and training facility of the Rutgers Psychiatric Institute and the Department of Psychiatry of the Rutgers Medical School is the Rutgers Community Mental Health Center. In this facility, no distinction will be made between any patient, rich or poor, black or white. The National Institute of Mental Health, with whom we have been in constant contact during all of our planning, has indicated that we, as a University Center, have a major responsibility to study and to implement new methods of delivery of service which might serve as models to other community mental health centers. They believe that we have an ideal opportunity as a University-affiliated department to bring all of the resources of a major university to bear on solving the myriad of problems which surround the care of mentally ill patients. During the past 18 months we have been carrying out this mandate and have been developing working relationships not only with the community outside of the University, but with numerous departments and schools within the University proper. These include the Graduate School of Social Work, the Bureau Of Community Affairs, the Bureau of Economic Research, the

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Extension Service of the School of Agriculture and Environmental Science, the Graduate Division of Psychiatric Nursing, the Graduate School of Psychology, the Graduate School of Education, and the new Livingston College.

It has been the goal of the Community Mental Health Center as well as the goal of the entire Medical School that our efforts in the development of this program should be as inclusive of all the University community as possible. We believe that the University and Medical School setting is unmatched in providing the rare skills and experiences necessary not only in the education of medical students and other health professionals, but, at the same time, they provide a medium in which the skills of the many University people can be used in evaluating the results of educational and treatment programs and in the designing of new techniques for the prevention, diagnosis, and treatment of mental illness. Thank you very much, Mr. Chairman.

ASSEMBLYWOMAN FENWICK: There is one question I would like to ask. Mr. Logan, as I understand it, the Psychiatric Institute would be a part of the Medical School.

MR. LOGAN: Yes, that is correct.

ASSEMBLYWOMAN LOGAN: So that the passage of 1059 would in effect sever the Psychiatric Institute from the University.

MR. LOGAN: That is the implication that we take from our interpretation of the law.

ASSEMBLYWOMAN FENWICK: I see. Thank you.

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ASSEMBLYMAN EWING: But you can still have a separate Psychiatric Institute there if the money is given to Rutgers.

ASSEMBLYWOMAN FENWICK: Yes, but not part of the University.

MR. LOGAN: This is one of the many vague features of the bill that we have not been able to determine and so I am not able to answer that at this point.

ASSEMBLYMAN EWING: Thank you.

Mr. Douglas Lubra, a pre-med student at Rutgers.

MR. PICHICHERO: Mr. Chairman, Mr. Lubra has allowed me to speak for the people we represent.

ASSEMBLYMAN EWING: What is your name, please ?

MICHAEL E. PICHICHERO: My name is Michael E. Pichichero. I am from Mount Holly, New Jersey. Sarry T. Parker is my representative.

I am a pre-med student at Rutgers College. I am very concerned about this bill, 1059, because I think it directly affects all pre-medical students in the State of New Jersey. I have come here to voice the opinion of these pre-medical students as I have talked to them.

My comments are directed about Rutgers Medical School because I am directly associated with Rutgers Medical School. I know nothing about the New Jersey School of Medicine in Newark and therefore I wish to emphasize that fact that I am only speaking in reference to Rutgers Medical School.

I feel that New Jersey has formed a-great Medical

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School at Rutgers. 'We have heard many facts - fifth in the country in the boards. All of these seem to indicate that the State has formed what many consider across the country as one of the excellent schools.

Now this committee by this bill wishes to destroy it. I say this because if we will read in lines 13 through 16 "The New Jersey College of Medicine and Dentistry shall be combined into a single entity to be known as the College of Medicine and Dentistry of New Jersey." That seems to indicate to me that there will be one school, not Rutgers Medical School. It is not simply the implementation of a Board of Trustees. We will only have one school.

You have a fine reputation in Rutgers Medical School. You have a fine faculty. I feel and the students whom I represent feel that this will be lost by the combination of the two schools.

Economically, you consider all the facts. But can we consider economics in this issue? We are talking about lives, gentlemen. If you are on the operating table, I wonder if you will question whether you spent $1.2 million or $1.3 million. I don't think that is an issue. Your life is the issue. We want to train qualified, high-caliber doctors here in the State of New Jersey. I wonder if this will be the case under the new system. Do we know? Can we not think about this thing? Can we not survey the possibilities? Why must this bill be rushed through ,the Assembly? Have all the different aspects been considered?

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Many of the people who have spoken today are directly affiliated with Trenton - with the State. I as a student have no obligation and therefore will speak about the different topics which have been evaded. I am talking about how the different speakers have said, "Well, there is implied in this bill. . . There is implied in I want to speak about what is implied in this bill. Now the Governor in his speech on May 4th stated that he wanted the local clinicians In the various hospitals across the State to assume the role of faculty for this new school called the College of Medicine and Dentistry of New Jersey. In talking to the various faculty members of Rutgers Medical School, they have stated that they believe that the American Association of Medical Colleges will not accredit this new experiment in medicine. If this is the case, where does that leave us, the pre-med students? It leaves us shut into New Jersey or trying to get out.

What happens if New Jersey puts into effect this plan and it is not approved by the American Association cf Medical Colleges? No out-of-starer will want to come into New Jersey or he probably won't even be allowed to because of the shortage of space. Governor Cabill on May 4th told us that only 1 in 20 are admitted to New Jersey medical schools What about the other 19 pre-medical students? Where do we If you have a good cumulative average which counts so much, if you have all the good qualities which the medical schools are looking for, you will go out of state to a private

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school and you will get the education that you want and you deserve. Now if you don't have this high cumulative, the qualifications that the good medical schools are asking for, you will be forced to stay in New Jersey at this unaccredited school. Out-of-staters won't come in. There will be no reciprocal trading which somehow in some way we understand to exist. If so many go to New York, so many are supposed to come here to Rutgers and the various medical schools in New Jersey. That leaves the other 19 stranded. If they don't have the qualifications, they can't get into state schools which are easier to get into. They are left here in New Jersey. There is only one space for 20. What happens to the other 19?

Now this Assembly is considering providing an inadequate education, I feel and the pre-medical students feel whom I have talked to, by implementing this new Board of Trustees which will overlook a new college without a reputation, with a faculty, I feel, that may not be the one you have now. You have an excellent faculty at Rutgers Medical School. Dr. Stetten has formed a group of the most brilliant minds, I feel, in the country. What is going to happen if these people leave as they are threatening to do? I hear it in the halls of Rutgers Medical School. I think they are going to leave. They say they are going to leave. What happens then? You are going to have to bring in a lower caliber faculty because who wants to come to an unaccredited school?

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Speaking for a moment regarding the mothers whom I have talked to, they say, "Who wants to take their children to doctors who are inadequately trained, the low-caliber doctor that will be produced under this new system?" The mothers don't like it. They were going to march here. They did not march here but they are interested. I wonder if representatives know they are interested. This bill is being rushed through and they haven't had time to talk to the people they represent.

The doctors of the Burlington County Memorial Hospital whom I have spoken are against this bill. They feel if the doctors produced are of poor quality, then they will be considered poor quality. They do not want to be associated with a state that is known for poor quality physicians.

This, gentlemen, is a bill concerned with life, I feel. It is concerned with the lives of everyone in the State of New Jersey because doctors save those lives. Why is it being rushed through? Why is this bill being considered so rapidly without considering all of the alternatives, all of the implications? I feel that the time has come for this Assembly to study what is happening in medical education here in New Jersey. The time has come for New Jersey not to step back to the Middle Ages, as I have heard quoted here today, but to go forward in education. Thank you, gentlemen.

ASSEMBLYMAN EWING: I would just like to ask you one question, isn't the medical school in Newark accredited now?

MR. PICHICHERO: As I understand it, Mr. Chairman, the Medical School in Newark is accredited on a year-to-year

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basis.

ASSEMBLYMAN EWING: But it is accredited.

MR. PICHICHERO: On a year-to-year basis, I will repeat.

DR. CADMUS: I challenge that. That is incorrect. We have full accreditation.

ASSEMBLYMAN EWING: So we do have an accredited medical college in the State and students could always go there.

ASSEMBLYMAN WEIDEL: You made the assumption that this college isn't going to be accredited. Who said that the enactment of this bill or the non-enactment of this bill is going to change medical education? Who told you that ?

MR. PICHICHERO: It seemed to be implied in Governor Cahill's address on May 4th "-

ASSEMBLYMAN WEIDEL: Excuse me. Governor Cahill is interested in raising the quality of education to provide more young people with opportunity to go into medical school to have a larger medical school and more facilities than you have now - and you come here almost, speaking of the Assembly and speaking to me, questioning my honesty, by some of your statements that we are interested in lowering the quality of education. I would be the first one to get up and walk out.

MR. PICHICHERO: Sir, I do not ---

ASSEMBLYMAN WE IDEL: Sorry.

MR. PICHICHERO: I do not wish to do what you are

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saying I am doing. I simply ask the Assembly to consider what the implications of this bill are. I do not question the Governor's intentions. I do not question your intentions. I only question the studies which have been made about this bill. I apologize if I have in any way been disrespectful to this Assembly.

ASSEMBLYMAN EWING: Thank you.

Dr. Rush of the Martland Hospital Executive Committee.

DR. BEN RUSH: I am Dr. Ben Rush, Chairman Of the Department of Surgery at the New Jersey College of Medicine and Chairman of the Executive Committee of the Clinical Staff of the Martland Hospital.

I would like to address myself to a portion of the bill which I think has troubled our clinical staff perhaps more than any other part and that is the statement that there will be one college of medicine in the State of New Jersey.

I think a good deal of the conflict that has occurred in previous testimony today relates to how one interprets the charge to the common board or common board of trustees described by the bill. Are there to be two schools under one board or one school under one board? I think many of us would accept the first alternative and most of us would reject the second.

Certainly the State of New Jersey needs, as we have heard many tell us today, many students, perhaps 400 a year, to satisfy its needs. And we feel that quantity alone is not

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enough, that we want quality physicians for our State. One possibility which was testified to earlier was that if we were to have one school, it might be a divided school with half of the teaching being done in the so-called basic sciences at New Brunswick and one-half, the clinical years, being taught in Newark.

We feel that half a school in New Brunswick and half a school in Newark really is not one school and that such a division between the two halves of the school would really not substitute for the functions of two complete schools in either area. If one is to prophetize such a division, one might well imagine that it would not attract the same quality of student, it would not attract the same quality of teacher and that ultimately what one would see would be the acquisition of clinical staff in New Brunswick and basic science staff in Newark to make two complete schools. But that after all, gentlemen and lady, is what we are trying to do now.

So if the implication of the bill is one school under one board, then certainly the clinical staff at the Martland Hospital is against it. Thank you.

ASSEMBLYWOMAN FENWICK: Did I understand correctly that you are Chairman of the Department of Surgery at the New Jersey College of Medicine and Dentistry?

DR. RUSH: That ' s right.

ASSEMBLYWOMAN FENWICK: Could you tell me in your view this: Would the passage of 1059 accelerate the development of medical education' in the State?

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DR. RUSH: I think what I have directed my remarks to is the interpretation obviously of this bill.

ASSEMBLYWOMAN FEN'WICK: Well, the interpretation, Dr. Rush, if you will forgive me, seems to be almost inescapable because from line 12 through 16 on page 1, "a single entity. to be known as. . ." -- Now there is nothing clearer than the words "a single entity."

DR. RUSH: All right. If we were to change that to the "colleges of New Jersey" instead of the "college of New Jersey," I think I would accept it.

ASSEMBLYWOMAN FENWICK: -- as you have testified. Could I ask you something? I don't know anything about this field. What savings when people speak of the expense - what are the financial savings that might be achieved through the passage of 1059? Are there any that you know of?

DR. RUSH: I can think of no professional savings. I have been told that there may be administrative savings and there may be circumstances where a common board may reduce the competition between the two schools and may supervise the endeavors, the ambitions, the requests and perhaps coordinate them. I can see an advantage in that. I cannot see advantage obviously in changing the direction of movement of these two schools.

ASSEMBLYWOMAN FENWICK: You don't think there might be a possibility of increased expense if you had two separate schools and then above that a whole other administrative body with its own needs and bureaucracy, forgive the word?

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DR. RUSH: Well, this is speculative. I think it depends on how good your board is. I think the charge to the board concerns us perhaps more than the construction.

ASSEMBLYWOMAN FENWICK: What did you say?

DR. RUSH: -- the charge to the board, the directions to them.

ASSEMBLYWOMAN FENWICK: I see. Thank you, Dr. Rush.

ASSEMBLYMAN EWING: Thank you very much.

That brings the hearing to a conclusion. I certainly appreciate everyone coming down here and giving of their valuable time and information. If anybody wants to hand in a written statement, we will be willing to accept it.

[Hearing Concluded]

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