. i @ i I i !1!1 ii;iil i . i ii@i i ill) 1 1 i !I 11 !,! 1 i I i i it ! .. li@iii iiii liiii liiii 4iiii @ li" i iI1 1 @ii! i@ . . i ; ! ?! 1. ,I "I I I l@i I. ' "i- ' *EOO 1 31 * DEPARTMENT OF HEALTII, E D U C A T I 0 N A N D W E L F A R E flealth Services and M6--ntal Healtli AdnAnistration Division of Regional Mc-dical Programs National Advisory Council on Regional Medical Programs Minutes of the Meeting July 28-":Ig, 1970 Parklaiqn Building Confeience Rooni G/ql OIP lb."AfjrII3 AND *-;It@ARE National Advisory Council on f@ei-,Io@-il. Medical Programs Minutes of the Twentieth Meeting 1/ 2/ July 28-29, 1970 The National Advisory Counci'@ on Reri.oiial ".Iedical Programs convened for its twentieth meeting, at 8:30 a.m., @esday, July 2 , 1970 in Conference Room Czlf-f of the Parl@laein Buildi.ri@@, Rockville, Maryland. Dr. Harold @brgulies, Acting Director, !-',egional- Medical Programs Ser,vice presided over- the meeting. i7-ie Council members present were: Dr. Bland W. Cw-mori I),,. @.und D. Pellf7ino Dr. Fdwin L. Crosby (7/28 only) Dr. Alfred M. Popma Dr. Michael E. Eullakey (7/'19 only) Dr. Russell B. Roth Dr. Bruce W. Ever-ist Dr. i-lack I. Slianholtz Dr. William f@. Iftitit Mrs. F'--orence R. Wyckoff Dr. Alex,-tnder, M. McP]ieciran A listing Of HMP staff members, and others attending is appended. I. CATI, TO ORDER AND OPENING FO,@S 'I'he metinf,, was called to order at 8:30 a.m. on July 28 by Lh,. l@ld Mareulies. TI. X4NOUNCF,',,T@,NT@9 '1'he Council members were welcomed to tilie new Conference facilities in the Pai,klavRi Buildirv., and the LTeiiei,a.t arrwif-,emzits for the conduct of the meeting in these facilities wa,'3 explained. Dr. Marpulies announced his plans for wi executive session with the Council at the close of the first dav of the meeting. 1/ Proceedi@,s of meetings are i,@stt,!(@ted unless cleared by the Office of the Administrator, IISNUTA. The r,ez3'Lli@ictioti relates to all material submitted for discussion at the meetings, the supplemental material, and all other official documents, including the aicnla. For the recor@d, it is noted that absent themselves from the meetiW., when the Council is ctiscussirij-, applications: (a) from their @@pective institutions, or (b) iii which a conflict of interest night occur. 'this procedure ioes riot,, of ap@)-i-y to en bloc acti.ons oilly Nation application is Llfl(jei, discussion. III. I@Zfliol)UCTION OF T L@, 4 Pbi,fnilies introduced two new c)t' the Council who were in attetidai-ice for tl-iis iTioet I i-q,. 'They ai,e: WI. I I..!.Lun II. I funt, M.D. , a Coiiiiiissionei@ of the Cowity of Allf-@t-@it,iiy In Pennsylvania and medical practitioner in McKeesport, Pennsylvwiia; wid Alexander M. McPliedran, M.D., Associate Professor of Internal Medicine (Neurology), Emory University School of Medicine . Atlanta. 'Die recent appointflient of i@. C. Robert Ogden was also m-iounced. Mr. Ogden is President of the North Coast Life I,,isu,.,aiice Co@@.o@r in Spokine, Wisliir,,f.-ton and Chai. of the Washington/ Alaska Regional Advisory Group. fie will begin his regular attendance at the next meeting. IV. RL,:GIONAL ICDICAL PROGRAMS AS A Pigr OF IfilL ]Ei!AL'Ill SERV'LCES AND %'U@ Vernon Wilson In his first @etinEr, with the.Council as Administrator of the Health Services and t4ental Hedltli A@nisti@atl.on., Dr. Wilson recalled his long interest and first-l-iand involvement in the cleveloprTent of Regional Medical Program . fie assured the Council of his strong support of Regional Medical Programs as a part of' the broader efforts of HS@ He expressed ',iis endorsement of the t)i@iiicil)les of decentralization of the adudnl.stration of IISPillA activities generally, and his belief that the concept of Regional @4edical Prof-@ams can relate well to these principles. Altliouf-rh the mchanisiiis will be worked out slowly, he is confident that this can take place without dilution of effort,, either in the Regions or in the head@lti@-tei-s office. In recok,7iition of the very formidable @)roblt@ins facing Regional Medical Programs Service, Dr. Wilson expi@,,.ii(,d re@t that he was not able at the present tinie to resolve the staffirifr problems. He assi-tred the Council this has v@ry liii@i priority oi-i his working agenda and the fact that fie is as yet utizabl(? to report does not iridiqiate that he is not actively viorking toward a solution. Dr. Wilson asked the Council to meet with Iiiiii again in approximately six to eirjit weeks, in a special otio@,-iy session. At that tin-e he Is assured he will be able to discuss his plans, as they are based on those of Secretary ]Ucliardsc)n, for the organization and administration of the Department's efforts to sti@erip,,tlieri and increase the nation's capacity to deliver health services. fie indicated also that by that tire he would have iiiore definitive I)Ian.,@ for the staf.fing and organization of the Regional Medical Progr3nis Seiv'@Lce. AltlioLVji his plans will include a @,,eticral outline of the I'@ssion" of Regional Medical rt.oF@@amo as a part of the tl,'3MiA effort,, Dr. Wilson .said that It-le would rely heavily on the advice and guidance of the Council for developing the policies arid detailed program directions that would to even raise Off,:I("Lerit (Effective cooperative ai@rar.-ements le between the private sectors, wliic-ti they rept@e,,@erit-1, -ind the Federal effort. Dr. Wilson told the-Council of the resignation of iMr. Irving Lewis as. Deputy Administrator of and about ';Ir. Lewis' appointment a@ Professor in-the Department of Community Medicine at Albert Einstein College of D4edicine in New York. :4r. Lewis addressed the Council briefly, stating again his faith in the Regional, ',4edical -@t of'true regia.-ialization Programs as, representing "the only conce of health services that can be expected to work" in the United States. @. Lewis expressed his thanks to the Council for the many pleasant working relationships he had had with them. f@s. Florence Wyckoff responded for the Council, expressin- their appreciation for his assistance to them., especially in helping them to understand the principles of Federal financing of health care and in the area of health economics generally. V. CONFIRMATION OF P4,,L7TIkIG 'DATES Council was apprised of the necessity for reverting to a system of four meetings per year in order to accommodate the changeover to Anniversary Review. Two new Council dates were set: November 9 and 10., 1970 and February 2 and 3, 1971. In addition, September 30 1970 was set for the special meeting requested by Dr. Wilson. The.Cowicil accepted the invitation of Dr. Edwin Crosby to hold this meeting at the American hospital Association headquarters in'Chicago. 'Iliis will enable more of the members to travel to and return home from the meeting in a single day. VI. CONS@' ERATIOIJ OF TI-E, MIIIU@ OF ri7lL @,ILRcli 31-APRIL 1, 1970 PIEETI14G The Council unanimously recommended approval of the minutes of the meeting of the Council on ',%Iarcli 31-Api@il 1, 1970. 'V-l I .A RE-POW FROM Tf-fl-" DIRECTOR - Dr. @-t,old Margulies A. Progress of l@R 17570 and S3355 Dr. 14argulies reviewed the contents of the twc Bills very briefly and referred the Council members to wi analysis prepared by staff which compares the Bills to one another uad to the present legislation. This was included in the agenda materiafs. B. Appropriations for Fiscal Year 1971 Status of the Appropriation Bill was reviewed and the Council was reminded of the various circumstances which impinge on the tota-'L amount of "new" funds to be available for major expansion of Regional Dledical @,ofTafiis in FY lg"ll. Among these ii-e the $1.9 million earmarked for I'@iodel Cities activities; the 1% reserve of' funds to be used for evaluation e possibility of activities at DHL,W, HSi@, and RMPS levels; th administrative "e I,,ing" of some funds for @4P participation in comprehensive regional kidney disease programs; all in addition to a total amount slightly in excess of $77 million required to meet minimal continuation requirements of ongGing regional activities. C. Funding Strategy Dr. Marpi-ilies made abrief introduction of a new mana ement information 9 system being implemented by @S. Ile also noted the effect of the 1969-70 strategy of permitting Regions almst unlimited rebudgetitig of unexpei-ided balances for program expansion. Dr. Nlm,gulies stated Iiii intention to begin to apply more stringently guidelines to this kind of rebudgetinp, and to recapture some of these balances for reallocation among the Regional Medical Programs In response to evidence of successful regionalization apd program development. D. The FAST Recommendations In a brief review of the recommendations of the Federal Assistance Streamlining Task Force and his plan for responding to them, Dr. Margulies emphasized the "liaison" role of the DHLIW Regional Offices in the developmnt of IIS,"@ programs Generally, and in helping to relate Regional Medical Programs to both publicly and privately-funded programs in the area served; but with the retention of the principal mana,r,ement responsibility in the Re@ional Medical Programs Service at the national level. Ile also mentioned especially the Service's concern, antedati@, the Task Force study, for better delineation of the multiplicity of activities now covered by the core budget in Regional Medical Program grants. Dr. ?4argulies explained the intent of TIMPS in placing, a Program Representative in each of the tei-i Dlil,@@l lief,-Iorial. Offices and described what he sees as the service role of these individuals. VIII. PROGRESS DIO'I'ES FROM STAFF A. Contracts under Section 907 - fx,. Margaret Sloan Dr. Sloui gave a brief review ani r,eport on the three contracts made by the fuqrs under the terms of ction 907 of Title IX of the- Public Health Service Act, which deals with the 11 ... list or lists of facilities in the United States equipped and staffed to provide the most advanced @tliods and techniques in the diagnosis and treatment of heart disease, cancer, and stroke.... LT Llie contract 7qit@ti. the t i@,,@ociat-ioll in support of the Intersociety Commission for Heart Disease Resources, has begun serial -publication of its report and will continue .to do so throughout the period of the contract. The Joint Committee for Stroke Facilities, supported by a contract with the American Dleurolop;ical Association, has chosen to withhold publication of-its r@port until it is entirely completed. . The report of the Special Advisory Committee on Cancer Care Facilities of' the Cancer Commission of the American College of Surgeons, which was supported under a contract now completed, has been reviewed by the Regional Medical Programs Service and was received by the National A@visory Council at the April 1970 meeting. Negotiations between the American College of ')urfr ,eons and the RMPS, preparatory to completion and RMP approval of this report, are now underway. (This was discussed in more detail with Council during the Y@ecutive Session). B. Multi-Prograrn Services Project Grants - Mrs. Martha Phillips Authorized under Section 910 of Title IX of the Ilublic Health Service Act, this program of project grants will be implemented for the first time early in FY 1971. @e Council was reminded of its original role in the development of the basic guidelines and operating policies for these grants. They were assured that these are reflected in the final edition of the program documents which are now'in clearance. The Council expressed its persistent concern about the potential effect of the funding of these grants on the total funds available for Section 904 grants (operational support to Regions). Dr. Margulies said that he expected to be able to present to the Council at its next meeting, a ' plan for allocation of grant funds that would take into consideration an appropriate distribution of the available dollars between these two major grant activities. C. Regional Medical @ograms In Model Cities - Mr. Cleveland Chw&.liss The Council was reminded of ttlE@ administrative e@ king of $1.9 million of l@4P PY 71 grant funds for use in projects which have direct impact on certain designated Model Cities neighborhoods. Mr. Chainbliss outlined the procedure for determining the degree of such impact and obtaining the certification of Model Cities officials in this regard. Although this procedure includes endorsement of DI@ Regional officials, Mr. Chwnbliss assured the Council that the procedure would entail no authority for further review and approval- of these projects beyond the local Regional Advisory Group and the National- Advisory Council. Also in i,os@@onse to s@)ecific q),Iestio@-i@,, i@i@ ex@)lai@.,ied that Regional Medical PropTams which are planning arid subnLittirg projects to 6 serve urban populations need not plan them exclusively for Model Cities areas and need not seek any endorsement or concurrence beyond their own review and approval mechanism. D. Senior Clinical Traineeships - Mrs. Martha Phillips Mrs. Phillips recalled to the Council :he circumstances leading to the Departmental decision to place responsibility for the Senior Clinical Tt,aineeship program in Regional Medical, Programs Service. She also reported to the Council on,the selection of the first group of.@aineeships to be awarded'under liMPS sponsorship. 'Iliis selection process was carried out by panels of hon-P'edepal experts in the cancer field and was chaired by Dr. Michael @ennan, to whom the-Council delegated authority for the selection of individual trainees to the total extent of $300,000 of FY 1970 funds. Thirty trainees were selected from among 80 applicants, and represent t.ie disciplines of medicine, gynecology, pathology, pediatrics, radiology, and surgery. T"ne training will be done in @or medical centers throughout the United States. E. G@uidelines for Instructional TeclinoloLV - Miss Cecilia Conrath A second edition of these Guidelines was before the Council for tlie:-r consideration. Dr. Pellegrino, who served as Chiirman of the Subcommittee to prepare these guidelines, expressed his belief that they are now ready for publication arid -implementation, with certain rewriting. This is being done by @4PS staff, incorporatir@- Dr. Pc-Ilegrino's suggestions. revaluation Activities - Mr. Roland Peterson In reporting to the Council, Mr. Peterson mentioned the final sunmtioh aiid distribution of the Regional ProF ,less Summaries which resulted from the questionnaire developed and tabulated by his staff; on the Regional Medical Program Evaluation Conference to be held at the University of - Chicago Conference Center in September; and on his plans for evaluation activities in Fy 71 which will be chargeable to the evaluation earmark. rIThis earmark was explained to the Council by both Mr. Peterson and Dr. Margulies as a 1% administrative reserve to be used for evaluation activities not only at the program level, but also at the level of fISMLA, and DHFW. It is anticipated that something slightly under- $1 million could be set aside under these circumstances and could be used by contract or by the Section 910 grant mechanism, at the discretion of . ) w portions of the total withheld for HS@IA ind DIL7W evaluative activities. 'n-ie entire matter of evaluation sparked considerable discussion in the Council. It was the consensus that in order for these funds to be effectively utilized, a much broader concept of evaluation must be developed. '@re was a good d eal of discussion of the contract with Arthur D. Little, Inc. and expression of considerable doubt as to the real value of any find--ngs being reported. Several of'. the Council have @d'i.iadiv,-dual experience ct activities and feel that the@have not with the conduct of the contra alw),y,s been handled in the best interests of the Program. There was unanimous agreemnt-with the suggestion, made by Dr. Roth and Dr. Cannon, that interim reports on the progress of such undertakings, either this current one or any future such contracts., be required and that they be made available to the Council for review affd-disclission. The Council requested a more definitive report from the staff on the results of the contract, particularly as it relates to the purposes for which the contract was originally let. They also asked to see the final report from the Artliur@ D. Little' 15 Inc. as soon as it is received by RMPS. In swruToi@izing the discussion,, Dr. Pellegrino suggested that all evaluation activities should, in the loii e to test h@e vi-abil@ s they ai,@(, ie.v are not. IX. KTDNI,',Y DISEASE ACTIVITIES IN REGIONAL Iq@'i)ICAL PROGRAMS Dr. Marf,,ulles reviewed for the Cotiricil the circumstances leading to the addition, in both the House and Senate versions of the continuation legislation, of kidney disease as one of' the specific disease categorical targets of Regional Medical Prc)Uams. fie asked l'or guidance of the Council In the development of a. responsive and effective policy for Regional Medical Programs participation in comprehensive regional kidney disease programs throughout the Nation. Ile is aware that the final . definition of such a policy, especially as it would apply to the @ediate future, will not be possible until after CorZi,essional action, on both the continuation legislation and the appropriations, is complete. In order to provide some background foi, their deliberation, Dr. Margulies Oxplained that he had asked the staff to prepare some basic information and to draft some suFj-,ested policy guidelines. These were part of the agenda materials presented to the Council-. lie then introduced Dr. George Schreiner, Chief, Nephrolof-,y Section, Department of Medicine, Georgetown University and Di,. Richard 13. Freeman, Department of Medicine (Neplu-oloEW), University of Rochester ,,',cliool of Medicine, whom he had invited to the meeting to provide expei@,t reference to the Council in their deliberations. Dr. Schreiner made a detailed presentation of the "state of the art" of the @-ageinent of chronic kidney disease. fie incl,-Ided resume of the techniques and methodologies of screeiiiii,(r. diagilLosis and therapy; and the shortcomings as well as successes in prevention, treatment, and rehabilitation. Nepl lot id a ri(@i,4 area of specialization. As iro V is, Dr. Schreiner sa such it has the disadvantage of a severe shortage of trained specialists; but has the advantage of having, few established traditions, and is in the enviable petition of able to from the niistat@es made in establishing resources for open nearly sui,@r(2i,y, high voltage radiotherapy, e'l-c. 8 organization for the delivery of servies to patients with kidney disease, Dr. Schreiner believes, lends itself so ideally to regionalization that the,development of such a program can and will serve as a framework for regionalization of' services in other more traditionally established disciplines. Ap,ain, as in nearly all their past discussions of kidney disease, the Council expressed concern about the apparent lack of emphasis on prevention as part of an overall kidti(-,y disease program. Dr. Schreiner and Dr. @(-em-qn believe that the only li(.)[)e for real prevention will come via prenatal care and "Frenetic tieering" and although work in these areas is progressing, it will riot have any significant impact for fifty to sixty years. 'ITioy also believe that the more traditional approaches to prevention generally will not be seen to be effective for at least 20 years. Both Dr. Schreiner and Dr. Freemn spoke to the issue of the cost of developing regionalized kidney disease services; and the way in which the,enormous numbers often used in this regard have been misleading and discouraging to institutions and coranunities. Both agreed that the $15 million mentioned in the pending I.e@,isl.ati.on could make a significant difference in the extension of services of' existing kidney disease centers or in the establishment of some smaller, nurrber of entirely new ones. Dr. Marpulles reminded the Council that the $15 million to which the Bill makes reference, is recomeiided as a maximum assignment of Regional Medical Program grant funds to kidney disease efforts, and in no way e ks or limits any dollars exclusively for this purpose; nor does it provide, or even recommend the provision, of funds over and above the grant funded, to be otherwise available for purposes of Regional Medical ProFTains. Dr. I-Iverist raised the question of the mechanics of incorporating kidney disease programs into the 55 Regional Medical Pro@ams if the principle of local autonomy and decisiori-makii-Vr is to be maintained. It is his belief that unless and until l'o-ions with appropriate existing facilities can be "seduced" into affording higJi regional priority to kidney disease control, it will be necessary to use t e Section 910 authority, so that national directives rpay be used to develop 'sensible prof;rains in sensible places." AcceptirT, the apparently inevitable laiT time before the results of a planned program of prevention can be t'(@it, Dr. Pellegrino asked for the advice of Dr. Schreiner and Di,. @@c,,eman on vihat immediate impact Regional Medical Progpajns could reasc)i-iib.ly have, considering the - provisions of the proposed legislation and within the amunt of funds that are likely to be available within the next two or three years. Responding first, Dr. Schreiner recon3ilt,t-id@--3 the stre @., herii@-r of existi@-, facilities, particularly those which have co@tted themselves to outreach beyonJ the confines of tli-@@ center within which exist; and identifying those t,@iis group that lend them- 9 S?Ives to further interlinkage to provide a multiplying rather than cimply an additive effect. Dr. Freernan recommends the support of the f completion and extension to full services of a small number o centers which can be developed on the basis of existing, although perhaps not entirely complete, resources;--the use of R,4P funds for support of planning, particularly in regard to increased effective utilization of expensive resources; and the training of personnel., principally physicians, who can serve to train others (other physicians and paramedical personnel). The Coundil. strongly endorsed Dr. McPliedi,an's point regarding the @ortance of thoughtful integration of a kidney disease program nto an existing Regional Medical Prograni; particularly in T,lanning, sub-regionalization, continuing education, and inter-professional comnunlcation activities. In a subsequent discussion on the second day, the Council members reflected on the recommendations of Di,. l,reen-an and Dr. Schreiner as well as on the goals, objectives, mid the basic operational concepts which guide Regional Medical Programs at the present time. Since these proscribe against the use of futi(Js f(i,the direct provision of patient services, and the total amount of funds likely to be available will proscribe against making @jor contributions toward the establishment of facilities, the Council agreed that the major focus of @.IP involvement will be (a) the encouragement of better and more effective cooperate ve arrangements amng carefully selected institutions and resources which together might form @i "decentralized center" and (b) in the stre@, hening of existing institutional resources competent and willing to develop outreach, both in the demonstration of service and the training of personnel. Both of the above requii@e national as well as regional plarniitT,. In summary, the Council endorsed the general plan presented by the staff; they also agreed, however, that to develop a workable overall policy it will be necessary tc) have basic data concerning the resources in, and available to, each of the lj'3 Regional Medical Programs. This should include (a) presently ,:-,elf-contained centers, (b) institutions which have the capability of becoming an integral part of such a center, at-id (c) institutions and resources which might participate in an inter- rec,iorial arrangement for the provision of kidney disease services. An CD assessment of the "size and sl-iape" of' the kidney disease problem in each of the Regions would provide the other essential piece of basic information. IX,. Nlargulies agreed to provide these data based on the existing geographic pattern of the 55 Regional Aeclical Program. X. RL,VIE@4 OE,' AFPLICATIONS A. Issues Identified 14@D 1. In the matter of- FW suPL)ol-,t of' s@loi,t-totili t the Council considered the history provided them by stat'@.', ana a nuniuei@ of l'O 'fic projects included in the apl,licat@,oiis under review at this spec -L Meeting. 'Phey be'.ieve that tinder iiiost cii@curpstances'i-t is not necessary or appropriate for Regional @,ledical ProtTams grant funds to be used to cover the full costs of both the presentation of short-term training projects and of stipends and expenses of the participants. 'rhe majority of projects in this category provide opportunities for up- p,radinp, and development of new skil.Is in special techniques or procedures and are directed to individuals pr(@.,;eritlv employed in health care institutions. Under the circumstances these institutions should, and -in rnc)st cases do, make regular provision for'tlils kind of training for their staffs. 'life Council therefore recomended the following changes in policy guidelines Payments to participants in continuing, education and tr@airiiii- projects (as defined j.r) the Guidelines Addendum, February 1970, page 13) which are- supported by Regional i',Iedical Prograin grant funds. Regional Medical Pi,oi _Tam grant, funds ma,.v not be @sed for the payment of stipends, either directly oi- on the Maintenance of income principle," to participants in short-term continuing education and training projects. 'L'Iii,,s does not include training for new careers for new types of T)eisonnel. . Otliei, allowable costs of parti.cip@itit's support may be calculated accoiU-Lr4,- to the exist !.like fLlidel-'unos. Regional Medical l@ogra.rn @wit funds nay be request.(@@.1 and awarded for per them and travel- to the extent of 5OZ of the tcftal airiount so derived. The awarded funds nay then be paid to t,l)c, enrolled trainees as considered appropriate by the project personnel, depending on the participants' ability to provide these costs for t-li(,riiselves and/or the willingness of their employers to provide them. @lo shift _,le individual may receive per them or travel allowance ,it a rate higher than that prescribed by the present Guidelit-ies. TIP funds iiiay not be rebti(iget(@l, t'rorn within or without the project budget, to Increase the total airiowit awarded for per diein and travel above the 50/'O level. 2. 'ilie Council considered the present, (iiii(ielines regarding ef-rional ',It . @ilcal Contain f'@idir@, of projects o'.' torij@-tetin post-doctoral training, at the senior resident -tnd L)ost-t,et3l(ierit, levels, z)ai,ticularly in the clinical sub-sDecialtie,,@ of iiiipoi@tanc(-, ir-i patient n@agement in the diseases tai,reted by I'vef-,ionil Mc@dica-1. As has been pointed out by both the Review CoriuiLittee and the (outicil i'@quests for support for@ training of this kind are appearing There and ni(,)i,,e frequently in Regional Medical applications; of' lul-ic, critical but also 'Lt@cause cf' tiae drastic reduction in NIH funding which has previously been available for this purpose. f maintaining the training 'Die Council unarlimusly agrees on the -importance o out the nation. prop,rams in these fields in the major teaching centers through They also agree that funding throuyli l@egional '.qedical Programs would serve these centers of' clinical form the .rarr.ework of cg_o@@ttye @@in@erLtp which - E. ft is recognized, however, of which they are a par that the allocation of an amount of funds large enough to make a siFi-iificant impact, if provided from the present 1. @4P appropriation, would create a serious and inappropriate. imbalance in the -.@ efforts to meet more their varied comprehensive troals. 'L'@ie @'ouricil, therefore, requested the @.,IPS staff to forward to both liSt ndat on that ai,r, e made , o pr@oi e to clinical departments in IlWor, teaching centers to off., ducation distinct from osts,i en ifi( -,iei-it serv:ces of iie III-al-rit(--'riance of t@.ieii- clinica- Residency training -iegional that fundinp.,,, ovei@ an( current C-. AccordinE,,ly, the Council recommends, tt@--t until such funds are added to the annual appropriation, the Regional @4edical Program Guidelines for operational grants under Section 90)1 ol' 'Pitle IX of the PliS Act be changed to exclude the payment of stipends a-rid other participant costs for long-term training at the post-doctoral level. 3. The Council is keenly aware of tli(-, potentially crippling effect on Refr,ional Medical Propxams of contiri(-)tis investment in p@o,jects which were initiall for deiiiotistr@atioti ot in, new techniques an essential service to Patients. woul e LMWise and indeecL il.y including or excluding e iVPS staff to work closely o be certain that other sources of support for maintenance of' the sei,vice involved be well in hand before such a project is initiated; and also to encourage i3egions to carefully investigate every possibility of capturing the fees paid for the service Involved, for reinvestment in the project. B. NOHPfif@'A'O'FPI-@IN O]IIO RF,,GIONAL Nlf@",)ICAI, In response to a special appeal for reconsideration of previous action on Project #7 (A Comprehensive (@t-patient Stroke Rehabilitation- f)enioristration), the Council considered the additional information submitted and recommended that the project be approved as requested. 01- $118,233 -.)76 0) -o,i .03 $26, flAVIAII RECTIONAL D/EDICAL PROGRAM RM 00001 7/70.1 - Operational Supplenieit Approval Project #21- - Approval I Project #22 - Approval I 01 - $202,7113 02 $99,168 03 $108 3252 ILLINOIS @'GIONAL @'U-"I)ICAL PROGRAP4 @,,i ooo6l 7/70.2 - Approval with specific conditions. Project # 9- Noti-approval II with the recoinmeridations for revision suEZested by the lit@view Cor@ttee. Project #10 - Approval I Project #11 --,-Approval Iwith the conditions specified by the Review CoiiaiLittee. Project #12- Approval I Project #13- Approval Iwith (,,(-)nditi,ons specified by the Review Comm-ittee; with secoti(-l and third year funding contingent upon proFres s in tire first year to be assessed by the Council on the bis-i,,, of a progress report3 continuation application, and tli(@ report of the technical site visit to be held soa)et.iiii,-@ toward the end -of the first year. 01 - $587,412 o,? - @,661.%237 03 - $341,883 INDIANA Pd@:(31ONAT, IVF.DICAL PROGUM RNI 000113 7/70.1 -Operational Supl)leiiriit - Non-appi@oval Project #19 -Tloii-appi-k)val T inappropriateness for f@vIP funding based on the Councills decision to defer@ approval of pro'ects proposing tilie cl.-iri.!,(.@al application of C,,eiietic counselling, pending further, sci(?titific validation of the clinical uses of this technique. ,Project #20 -Noti-cip[)T-ova.L ].I with the recorrrwndations for revision suiyp,ested by the Review Coniniittee. I@KRMO@ITAIN REGIONAL, H-I'DICAI- I!FUCIWI RM 00015 7/70.1 - C@er,ational Suppl(@rliet-it Return for Revision Project #2'[ - 1,4oii-appi,ov,,:il il t' I,,e t,,-@ccituTiericiatioris for revision she sted by ttio i'@('?'vi(,w Coiiuriittee. NO DS REGIO@IAL @'4,LDICAL PROGK-vl Thd National Advisory Council considered a request for the initiation of interim support to the Diabetes Detection and Education Center in !4inneapolis with the understanding that (a) these furds will be 7ade available from the Region's unexpencied bdlance:g and (b) that this approval does not in any sense indicate co@tment to approve the forthcoming application for RT participation in the long-range basic 'support of this Center. VIRGINIA REGIONAL P)EDICAL PROGM4 In reoard to Project #14 (Stroke in a Simall Rural Cormunity the Counci concurred in the staff Is recommendation for a waiver of the restrictions @osed as a condition of the original. approval of this project, subject to the satisfaction of HVIPS that the purposes of the project are being adequately achieved. WE,-,= NEW YORK RL,GIONAL DEDICAL I@R()(.',FiAM In regard to Project #10 (Vlestern New York 'ilumr Registry) the Council concurred with the Review Committee's reconrnc-ndation for continuation of the project as amended. C. Recomwndatioi-is for Action 'Ehe Council recorded their recommendations in t)ie forffiat which was adopted in the previous review cycle (Appendix I). ALBANY 13FGTO14AL ,')U@'DICAI, PROGFL*L PIA 000011 7/70.1 - Operational Suppleiiic-iital - Approval with specific conditions. Project #7A(R) - Approval I with the conditions specified by tne Review CoiT3Tdttee. Project #7B(R) - Approval I with the conditions specified by the Review Conunittee. Project #18 - Non-approval II - Revision Required. 01 " $36,930 02 - $36,930 03 - $0 1/ All amo@ts are direct costs only arid unless otherwise specified refer to a 12-month period. 'I'he designation 01, O'C', etc. i@(-Iate5 to the first, second, etc. , budget periods of the subject aplication, not necessarily the budget periods that will actually be suppiemntect. 14 T CAFTlt).V41,A L@IONAI, @D,"D-CAL PRXjfM Project #56 Approval I Project #60 Approval I in the reduced amunt approval I 01 - $107,307 02 - $117,248 03 $121,393 CENTRAL NEW yoRK REGjotJAL MEDICAL PROGRAIL M 00050 '@/'(0. 1 - Operational Supplettiorit- Conditional approval. Project #15 - Approval I at a reduced level with the conditions specified by the lieView Committee. ol - $4o.,OOO 02 - $50,000 03 - $53,000 COLO@/14YOMIN@-T FT-,GIONAL ML,'DICAL PliOGRNil RP4 000110 7/70.1 - Operational @uppleiiierit - Return for Revision. Project #13,ri - Non-approval II. Return for revision with the clarification requested by the Review Co@ttee. FLORIDA RdiPxIOI@IPL ML,DICAL PROGRAM RM 000211 7/70.1 - Return for revision. Pro,iect #36 - Non-approval II with recomendations for revision as suggested by the Review Comdttee. GFTORGTA ff,]GIONAL @U@:DICAL PR@,QAM R@,l 000)46 7/70.1 - Conditional approval. Projects #31 and #32 - Approval in the reduced amount of $100,000 to be used for the initiation of,both projects as seen fit by the C.--eorFI,a FMP. Project #33 - @lori-approval I. 01 - $100,000 02 - $100.1000 03 - $0 GIT-ATE-R DELAVIARE, VALLL,'Y RFGIONAL @,a,,DICAL PROGRAM Rl,l 00026 7/70.1 - Dis oval - inappropriate for funding. Project #19 - Non-approval I 16 KAII.SAS REGIOIJAL D)EDICAL PROGRAM RM 00002 7/70.1 - Operational Supplerrent -.Return for Revision Project #39 - 14on-approval II with the recommendations for revision suggested by the Review Committee. LOUISIINA REGIODIAL jNU;',DICAL PROGRX.,L @TI 000.-33 "(/70.1 - Approval- with spcciCic conditions. Project # 8 - lqon-al)proval II with the recommendations for revision suf-i,,,osted by the li(-vlew Coimdttee. Project # 9 - Approval I in a amount and with the conditions specified by the 13(-@view ConrLittee. Project #10 - Approval I Project #11 - Approval .1. I ,Project #12 - llori-appy-oval. II with the recoTffnendations for revision sur,gested by the vieview Co@ttee. Project #13 - Approval II ol $147,532 O"-' - $'17,2112 03 - $79,342 i@TiYLAND REGIONAL DR@'DICAL PROGRA2,1 Pu'4 0001111 7/70.1 and 7/70.2. - C)peratioi-ial Suppleiyp-nts Approval with specific conditions. Projects #25 and #26 - Approva-1. I with both projects to be combined at a reduced ainowit and with the conditions specified by the Review Coinnittee. -Project //27 - Approval I Project 928 - Noii-appi-ova-L IT with the reco,,niiendations for revision suggested by the !',Oview Conudttee. PIoject #'C'9 - Noti-appi-ova--L I Project #-'O - Noti-approval- I oi - $914,975 o') - $11111 1175 03 - $145,975 NU,-t4PIiIS REGIONAL @@ICAL Pf:,'OG,,-aM RM 00051 7/70.1 --Operationil @ilDpleii?ot-it - Disapproval. Inappropriate for ITM funding. Project #2'7 - i%'()ti-appi,oval T. ';Ilio iAr@is in a,-.reernent vritli the Hc?view Co,,i@[Litt(.,e ill ri...)ti-al)pi@c)val for the Peripheral Vascul.ai, Clinic Pi@oject. 'Itley wish, however, 17 'Fg,lli[PIIT"' FiiBIONAL ICA PROGIW,,'l (COT-"i'). to be certain that the project personnel and the Monphis FFIP under,.,t,@..-@ that the reconmndation in no way reflects a (11; a@@-eTwnt with the inherit service value of the Clinic nor suF@, sts lack of confidence in the st@iff and Institution. The action does not preclude i@stibmission of a request for R,T funding for the continuing education aspects of this project at such tiii)3 as these are niore thoroughly planned and ready to be iiTplemented. Project #28 Non-approval I .@7FROI@LI'FAN klASlIT14G'L'ON, D.C. RI@,CIONAL i@,D.--Il)ICAL PROGRAM P@4 00031 7/70.1 - 1 Suppleiiierit - Approval- with specific conditions. Project #36 - lqoii-,qpproval I I JOCT #37 - Approval I at the ie(-Iuced level and with the It #3( conditions specified by the l@,evi(-,w Cormdttee. ol - $38.%1177 o'.1 - $Iio,618 03 - $44,928 @MICHTGAN RFGTOt4AL NILDTCAL PR@)CtRA14 RM 00053 7/70.1 - nperatioonnaali LSuuDplltefil@@t@i@t' - Approval with specific conditions. Project #16H Approval I r iect #2-( Approval I with the conditions specified by the Review '-'o@ttee. In concurring with all of the reconmndations of the Review CoiTnLitteel the Council urged the Ri'TS staff to work closely in the development of this project with the hope that it will come closer to a demonstration of comprehensive care., as proirdsed by its title, than it would presently appear to be. Project #28 - Nori-approvcil II with the recormiendations for revision slif, ew Coifnittee. @, sted by the fievi ol - $550,970 02 - $ii5)1,574 03 - $1477,459 MTSSISSIPPI @,,'GIONAL iNIU!DlCAL PliOG13A@.'t R-1 00057 7/70.1 --C@eration I Su@)ple[Tent - Approval with specific conditions. Project #2r, - Approval in the reduced airount for 18-months with the conditions specified by the Review Coiirdttee and with .the understan(iiiii, ti-i@it this will represent the teriTLi-nation ol@ R@T @)f a,-, i v:@ t y 19 N-n,,l NEXICO REGIONAL @@'EDICAL PROGRA:@I (C'OlVi') -Project #111 - Approval I in the 1401-iLICed amount ar-ci with the conditions specified by the Review CoimLittee. Project #15 -Approval I with the conditions specified by the Review Comittee. 01 - $923-100 o@, - $99,900 03 - $101,765 H Al ;r) RPJ .,W YORK vU.,7ffiOF'OI,I'I.'AN TU,',GIONAL I'l G .I fIM 000'),'i '(/70.1 ind 7/'(0.2 - Operational Supplernents - Approval 'Arith specific conditions. Project #16 -Non-approval 11 with the r,ecotmi@-,t-idations for revision sup-,gc@sted by the li(@vi(@w Coiiinittee and with the advice that the Region (ief'(,t, further pl-anninf-, for R",IP participation in kidii(-y disease services in the New York Metropolitan area until they receive the National policy i7,uidelines wlilcli are in preparation. Project #17 Approval I. 'flee Coui-icil based its recommendation on the findings of the site visit team wh--ch had visited the project on the advice of the Review Coranittee. Project #18 -.14oii-appr-oval I- Project #19 - Approval I 01 - $117631)17-) o-11 " $4911,@)65 03 - $3501000 NOI'A'Ill ('AROLINA IU@',GTO@IAL [VUOI@ IIRC@Gl@14 fi4 oooo6 7/70.1 - operational Sup[)lt-,rik?iit - Approval with specific conditions.. Project #31@ - Approval I Project #26 - No Action 'Paken. Site visit required. Oi - $89,908 o.,, - $62,550 03 - $@2,3o6 NOIT[li DAFC(PA IU,:CIONKL @.IE-DICAL PROGI@M RNI 00060 7/70.1 - Operational-,')itl)pleiii@,tit- - Approval with specific conditions. Project #5 - Approval I - Approval 1'. Altliotit,ii (,outi(-Il was in E,,ericral agree@nt with the Review Cc)iiaTilt,tee (Concerning the shortcomings of this pik)ject, it w@i-:, ti)(,Ii, (-)piri:lon, based on first-hand laiowle@i@',C'. of' 'Lllit, and pet@sofiriej- -@n@,o.Lved in tlic,. project and oti thin, experience in site visiting this 18 MI,O)SISOOIPPI REGIONAL K-,DICAL PROCM@R! Project #13 -.Approval t Project #14 - Noti--approval II tvit li tiie rccorm)etaclat.Lon thM the Fiec-ion be requested to r@,cc)li.3i(lei, their prori,ani in the liffjit of the National t'ol, R.@, participation in coirpi-ehensive kidney disease pr-oFrains. Council further r-ecoi@iided that tiie fief-,iori be afforded direct help by the staff of RMPI) in iiulcing their decision in this .T@-gai,d and in a revision if such is to be proposed. 01 - $213,llc-_'O O;) $125,gli6 03 - $39,455 ,@iisll;omi IZLCIot@AL @/U,"DICAL PICGPAII f?4 00009 7/70-1. and 7/70.2 - 0-perat-,!-oi-i,@I1 SuT),pleirient - Approval with specific conditions. Project #60 - 14ori-approval II Project #bl - Nori-approval II. Altliougji the Cow-icil agreed with the f-,eview CormLLttee limit these-,, two projects, as presented, are unacceptable Coi, Regional Medical Programs support, they recalled the i@-coimrendati.ons of the recent indepth site visit to Mol@IP ,ixici suW ed that with staff help ,(-st from both RMPS a-rid i@lo,@Ill these ifoutreact-i" projects could be developed into i@ortant components of the Program. Project #62 - Approval I in a reduced aitioutit and with the conditions specified by the lieview CoiiiTdttee. Project #63 - Noii-approval II - qhe Council recommends that this project be iritef-t,,it'e(i into the Qegion's overall continuing education effort in the preparation of the Region's Anniversary Revi.cw application. 3 01 $33031'.1 O:-' -@;36 984 03 $"D"-),165 @40LJtZ,PAIN STX-Pf-,@) F@,GIONAL Pli,'DICAL I,]-',OGM'vl RM 00032 7/70.1 - Operational Supp-ietix2nt - Approval Project #12 - Approval I Project #13 - Approval I ol $i84,976 O;) $191.1117 03 $197-,8011 Nl,,'W YU,'XTCO TU@IONAL, fT;-'DTCAL PF@(,]iANI 101 000@)14 '(/70.1 - 01)(-)Patioiiai Al-')PI'Oval- ,iiuli specific conditions Project #13 - Noti-appi,oval. 'Fl 10 iNDiMi DAKOTA REGIOIJAL @,IEDICAL PROGRAI@ (CONT) Region, that the approval of this project is essential for further development of the North Dakota Regional @,ledi--al Programs. In recomending approval, Council strongly urged RMPS staff to work with the Region and with personnel involved in this project to correct sorne of the deficiencies and get it off to a good start. Project #7 Approval I for essentially the same reasons given above. The Council believes that the implementation of this project is essential to regional development and sue.-,@sted ti-iit it be approved at $35,000 (dco) for one year only with cotit@Li-itie(-t support contingent upon revision of the pi,oje(,@t with staff assistance, and reapplication to the Council. Project #8 - Non-approval I Project #9 - Approval I 01 - $115,383 O,' - 'p79,'@'(2 03 $79,549 Oill'O fld,:G-l'ol@IAL [/ga)I(AL it@l 0006-3 7/70.1 and 7/70.2 - Operational Supplenetits - Approval with specific conditions. Project #01-S - Non-approval I Froject Pli -Non-approval II witli the i,ecorrrneridations for revision suggested by the lieview Coiiinittee. Project #14 -Approval with the conditions specified by the @@eview Cotriiiittee ,for one year only. Project #15 -Approval I. Al-ttioLij, @i the Council recognized this as another of' the "COLItICil for@ Continuing l@ucation" projects which have been -,-@LibiriLtteci by the Ohio State tiegion and action upon wliicli been deferred pending the outcome of the initially funded one. The Council accepted the advice of the site visitors that the project is of ci@itical J-jiiportrance to the Northwest Ohio l@ef,-ioi-kil NIE-,@ll.cal. Pi,of,,i@ain -u-id probably has an excellent chance of success under t,lic,, leadership proposed. Project #16 -to be incoi-poi,at-lo@t with project #111. E@jCct #IT' -Approval in the t,edLiced @)jiiottrit and with the conditions specified by the lieview Co@.-ttee. ql-ie Council (,6risl(lered the findings of the site visit tea'TI r(@@ )ti a@ a @,iliol(@; it,@ organization, ajid iDlaris. It is their recommendation tl)at the ii(,t:-,ion be urged to seek stronger leadership but tlit, (owic-1-1 a@-! ed that aiiv specific re- _,re conrw-ndation ref);ii@ilrie; personnel would be inappropriate. 21 NO.-@YtIVIF-,ST OHIO lif@,GTONAL MEDICAL PRO(iPiX@l. (COI\FP) 'nie value of -in asst.@ssinent visit as recorrnT?ended by the visitors was qLi(-,,@,tioried since it would probably do no more than t@e-i,,ientify the pr)blern. Council suggested that per,lia@)s direct and L'requent assistance from RMP staff' and consultants would be more helpful than further investigations of the situation. oi $lli5,830 02 - $70,525 03 - $21,250 OffIO BE-GIONAL MF.DICAL PROGIWI f@,l 00022 7/70.1 and 7/70.2 - Opei,ati@)t@:tl Renewal Tid Suppletneiit - Al@proval with specific conditions. Project #lfZ -Approval I at tli(, t,e(-Iuced level and with the conditions specified by he(, lieview CoiTn-d.ttee I)ioject q8fi -Approval I in the t@(,dticed amount iid with the conditions spel-if'ied by tiit, l@ev'L(@w Coinrnittee. Pro,j(@et #22 -Approval I I)i,(),ject was considered by the Council in the previous Y@vic-,w cycle and action was deferred at that, tiiic-@). Prollect #211 -Non-approval ]-I with the recommendations for revision suf, bhe iieview Com-Littee. .,@sted by 01 - $714>07@) 03 - $847,944 ,)IIIO VALd-J@:y FJ,)G-T.O[\IAL tU ICAT, .@Al 000218 7/70.1@ Operational- Suppleirerit - Approval with specific condit ons. @@oject #12 -Approval I in the reduced amount i,econytiended by the expert technical reviewer,. Project #13 - Approval 1. '-Pc) be ftiiided only if riot@d by other Federal resources. Project #14 - Approval IT Project #Icj - Approval I @,Oi e6t #16 - Non-approv,-tl 11 with the t@coraiiendations for revision ,@est(@(A b as suF @y tti(, [-'review CornTiittee. Pmj ect #17 - Noti-al)pl,ovil. Tl- with the i,ecormiendat@Lons for revision st47,c,ste(i I)y the lieVit-'W COITtnittee. - Project #18 - t'-Jori-appr-ovil I 01 -@$273 1)116 02 - $--,96 215 03 $327,657 23 TF-,XAS RL,GIONAL i'EDICAL PAOGRA[4 FJ4'00007 7/70.1 Operational Supplerlietit Approval with specific conditions. Project #8R - Approval I contingent upon the satisfaction of a technical s te visit tean-rreg,,arding four specific points set forth by the Review Co@ttee., Project #1@R - Approval I with conditions specified by the Review Comdttee. Project #15R - Approval. I Project #118 - inoti-approval I Project #IJ9 - Noti-approval I ol - $li6o,6'io OP - $;,96,595 03 - $2)40,386 ':'RI-&PA'I'T,, P)FTTO,'4AL @U@ )ICPF, P130GHM4 RM ;00062 7/70.1 - @)oratioi-kal Stip@)lotii(,,rit, Approval Project #9 - Appi@oval I in a r-e(fLicett wTiow-it and with the conditions specified by the Review CoitirLittee. 01 - $105,300 0-@) - $85,6oo 03 - $63,000 VT-:IGINIA RL,(',IO14AL TU@TCAL Pa)GM@l fl%l 00049 7/70.1 - Operational Stipr)lcnieiit - Approval with specific conditions. Project #10 - Approval I with the conditions specified by the Revi.ew CoiiriLttee. I'ti discussing this project the Council wished to stress the. importance of the condition for approvai- of' this project alid urges great care on the part of the start.' iii a,-Ijusti.rig the second and third year amounts of l@,11' support by utilizing patient revenues to offset costs of the project. 01 - $268,552 02 - $1180%li79* 03 - $533,504* 'fo be negotiated downward WI-'.STE;Ol NT-,IQ YORK RI,7C'@IONAL @lF@)TCAI, rli'O(j'l@l IDI 00013 7/70.1 Operational @')Ilf)[)I(@rilent - Approval witli specific conditions.. Project #15 Approval T in the r@c-,,(Iuced amount and with the conditions specified. Pro-iect #16 Approval I in tii(, wiic)t.trits :uid witli t@-ie conditions sp&cified by tti(, liev@L(@,w Cornnittee. Council expressed its willingness to callow the f@egioii to increase the funding 24 WES@ NEW YORK REGIOIIAL MEDICAL P@RP24 (COITI') of this project to a maximum of $100,000, providing such a level of funding would be required to maintain this valuable regional resource. Project #17 -Non-approval I 01. $350,000 02 - $3@10 000 03 - $350,QOO WES"iY,@l PENNSYLVANIA REGIONAL H@'D.'rCfd, PPOGHAIL RM 000111 7/70.1 - Operational Sup !iierit Approval Project #9 - Approval I ol - $43,911 02 - :I;Ilii 81@DO 03 - $li6,995 WISCO14SIti PJ-,:GIO14AL n,,DICAL PROCj!W-.l "4 t) "2--- Opei,atioiial P 003'( 7/70.1 and 7/70. Approval with specific conditions. Pro ct #13A (R) - Approval 11. Pro rbval-I Pro Non-approval I Pro @Jon-approval I Pro tlon-approval I Pro ect 1 Nori-approval I. Cowicil based this recoimendati-on on the findings of a collateral. review of the project by the staff of maternal and Child Health Service, IISL@, which was requested at the suggestion of the Review Co@ttee. Pro.lect #20 Approval I Project #21 Nori-appi@oval I le Approval I ct #2 0, Iect 2 Approval I in tli(-, reduced amount and with the conditions specified by the l@eview Coiiimittee. 01 $2923815 oo $16,(,807 03 $172,395 XI. ADJOUFNMU The meeting was adjourned at 11:30 a.m. on july 29, 1970 I hereby certify that) to the best of ing minutes nty igiowled,@, the fDrc-190 are accurate and complete. tki,) Acting Direct ReC ,ional Medical Progr@ Service 22 O@i',CION M@X',IONAL, @T-"D]'CAL PROCzl3N4 i-e,l 0001,' '@/70.1 - op(,-ritiona. Approval Project #12R - Approval I Project #lb-- Approval I 01 - $59,375 02 $28JI829 03 $14-*843 PL)T,'I-M@ fii:CO RJDTONAT, @IT.-:DTCAL PfiCVjMl iim ooo65 7/70.1 @ierationaJ@ SUPP.I.eliK.'tlt - Approval with specific conditions. Project # 9 - Approval I -Lnthe r@edticeci amount al-id with the conditions specified by the Review Co @ ttee. Project #11 - Approval I with the conditions specified by the Review Com@l,ttee. 01 - $320,936 Ol-I $,)27,)136 03 $233,636 ,SOMI CA'@3OLIi'iA Pd-IiIOlqi@ t@ @' ICAL RDl 00035 7/70.1 C)perational Suppl-eiiic--iit, - 14on-approval.. Project #35 lion-approval T.[ wine t,lie recomei-idations for revision i stif7,,ested by the %'eview Coitirlittee. Project #36 14o action taken. ,')ite visit is indicated. Project #37 Nlori-approva.1 I S'@J.SQtJl-"ILA.@-,Iti-A VALLI,:Y TUrilONAL P/D-.])TCAI, ]DI 000c@9 '@,/'@0.1 Operational ",tippleinetit - Approval with specific conditions. Project #'@10 @lon-appr-oval I Project #21 Approval I in the reduced @urit to reflect the newly adopted policy on training project participants. Pi@,i ect tlon-approva'L T Prt-)j ect #2@3 i4oi-i-approval T Project #211 llon-appioval IT with the i@cormienditions for revision suf-Zested by the Review CoiTuiiittee. Project #25 Non-approval II. 'me Council was in general agreement with the Review Coiiiiiittee regarding the specifics o project but believe ttiat further development of this project along with #,'211 Is in the b(..st Interest of the the ReFioia md has i@e(Itiesteci that the iDT.S staff offer 'c(-) tl)e in this Project #26 - Approval I oi - $gc--"1311 02 03 - $83,29LI 26 CC)!Il"n.@, tc) t'lic-@ -@Ly ai-ij capably l@e,,tslble utidei, Uri@t,-,)pi-ov,-tble on tecl-ii-i--'tcal. p,-L I iicl T Acid-i@tll()ijl-il- fLl)l(]:-; Ap- IT l@-o - foi, - I-lo @tct-,.,Lon tall,cii - Noocl sitc, Ncc,cl Couiac@.@i.'L Ar)prc),,7, tl fOt-' F-,CV!@-,-!Otl foi, f Lil ](If I II'; .1 ot-i,,il A(lv-i,@oi, t,c) (A.,-, by tlic@ Lt,t,@@o ol, lo I, L)! 27 NA'I'TO,'I.@r, fil)@rT';O@@iY COIY,@( Ol'i IIIIE'4NP,14, Michael J., M.D. (72) MIILIY@Q, Clark If... M.D. (72) President, L',IichiC,@in Cancer Foundation Consultant in Neurology 4811 John R Street @layo Clinic Detroit, ,@iic,lli,,,an li8201 Rochester, Minnesota 55902 Professor of..@-dicine OGDE@',N, D@-. C. Robert (70) Wayne State University President and Geriei,,@il Counsel North Coast Lifc@ Iiisurince Coapany CANNON, Bl,@cl lq. , I.I.D. (73) Spokane., WashinfLton 99201 91.0 4adison Avenue Menpliis, Tennessee 38103 Plil-L'Gf-'JN.O, food D., M.D. (70) Vice President for the Health Division of' ',Ieur-osurfreiy Sciences and Director of the Center University of 'iemessee College State University of New York of 'Aedicine Stony Brook, New York 11790 -ed 14. CROSBY, I!'A,,iin L., M.D. (71) POPP.IA, Al. fi M.D. (70) l@ecutive Vice President and Director Regional Director A@ricai-i hospital Association ,.loLtiitc@ri States PT,.._r Chicago, Illinois 60611 525 West Jefferson Street Boise Idaho 83702 D-,BAKr,,Y I-lichael E., M.D. (7") President ii-id C,,iie f' !,'executive Officer ROilll, Russell B. I M.D. (73) Baylor Collei-7,e of .lccilcine 2110 West 41st Street Houston, Texis 7702-) Eric, Pennsylvania 16508 Professor and Chai-ii,,iiri Vice Soeal@er of the House D-opai@tm,@nt of Su-i-i7,erv of De@eFcites, @@IA Colle,ge of D.'L-dicine S@l\nioLqlz, Crack I... M.D. (70) r State Stealth Cc,,LiLissioner F,VE!iTST, 9i@uce W., @.I. D. (71) of 17 Chief of Pediatri.cs State @,part!@,i@-,Yat -iealth Green Clinic Rici@iici, Vii@Cinia 2 3.,7 'L 9 Ruston., @uisio-na 71270 .Ir. Curtis (71) IRRIP3 Wil-l-i@iri R., I.I.D. (71) Dii,c,@ctol@, Petisioi-i T-id Insurance Daznl 1-1 lbw,d of Cc),iz,,nssi,oriex,s United I"@Ll@)bez,., Cor.1c, Linole-ILM, County of All,@rjier)y and Plastic l@lori@ers of tj.@@,rica 101 coult;iou@,e Akron, Ohio 443o8 Pittsbur!ji, Peruisylv,-ulia 15219 VNCY,Or,F, IIrs. Florence R. (72) McP!E@',IA'4, Al,e,,,aii,,Jei.- M., M.D. (73) @)13 Cori,@,itos ',load Rnory LJr)iv,,?r,@l-ty Clinic Watsonville, California 95076 1365 Clifton Road, II.E. Atlanta, Gcorgia 30.)e- Dr. Vernon l@:. Wilcl;ori 5C)OO 20C)52 Rockville, i:u ATMOANCE AT TTE NATIONAL ADV@RY COUNCTT, Ju@-.y 28-29, 1970 ReS STAFF, ATMOING Miss Rhoda Abrams Dr. Marion E. Leach Mr. H. Earle Belue Gregory Lewis Dr. Edward T. Blomquist Ray Maddox Mr. J. Edgar Caswell Miss Elsa Nelson Dr. Donald R. Chadwick Mr. Roland Peterson Y[r. Cleveland R. Chambliss Mrs. Martha L. Phillips Mr. Clyde Couc@ niss Leah Resnick Dr. Sam Fox., III Mr. Donald @Riedesel Mr. Edward @@edlander INIrs. Jessie Salazar Mr. Sam 0. @il-nier Mrs. Sarah Silsbee P4r. Charles Hilsenroth Dr. Margaret Sloan ;Miss Dona Houseal Mr. James Smith I,lr. Frank Icliniowski Mr. Dan Spain Dr. Anthony Komaroff Mr. Lee Teets Mrs. Lorraine Kyttle 14r. l@ancis Van Hee, Jr. Mr. John M. Korn Jr. Mr. Lee Van'Wi@,le Mr. Frank Zizlavsky OTHERS A ING Dr. ;Maurice @nder, OS Dr. J.H.U. Brovm., IIIGiV-,,14III Dr. John Ca@an, CL-LS, @ISI.TIA Mr. Jwws Dunlop, A.D. Little, Inc. Miss Sylvia Kesi@rer, CIFS, HSYUFA Dr. Richard @vinson, Vetei@ans AdrTLI.iiisty-ation D4r. Wendall P@l-addrey, 1,JCHS-R&D, li'@NULA 14rs. Sylvia Payirer, NCI, 14IH ,Nlr,. No ilucker Blirl,:Mr, NIfi Dr. T. M. Ilal.ega, NTAMD, NIH Dr. Williani zllukell l@I&LI, NII-F