ii 1 i !II' ' i !If li ii.i ii i.i I i I I,'i 1. i i.Iiiii;lil i@ !! iil * ("30 1 61 f-).@ T.7klANSCE.IPT OF PII.OCEEDINGS A,.@iD WELFPRE DIVISION 0,P! t;:,FOICAL PFIIOGRAMS AD HOC EFVT W CO@",L,'IITTEE a r y n Pp-res 183 t--u 4'fg HOOVER REPORTING COMPANY, INC. Olficial Reporters Wasbington, D. C. 546 6666 R 3 P-1@,-PAT@TI, -7,7 'T 01' @'k'EAT@TT-T j-,DUr'-ATIO' i@,TD 1,7FLPAP OF AD T @IOC CO'ISIJLTY@ITS Pj',VIM17IIT(, P,7,CIOIIPJ,) !4r,,DICPL PRO(';PMi APPLICATIO@IS Conferenc.-e RooTn I-T 'Pe.rkl.a.@-in PiiilOincT 5600 Fisbers Lane Rockvill.(-., @-laryla:n(-l 20P,52 Thursda,,, May 23, 1974 Panel B conveneO at 9:40 o'clock, a.ir,. l@ir. 'Pet@- rson Chai.rma.n, r)re--,iclincr. (A-, liereto-'7ore notnC-.) 1'0'4-A C 0 117 T r. @T- T 9- (Continiaprl) ar5e 7 !Medical Plan for I'Tec;tern 'Oenn-,yl.vania 33C) @loti.on for recommendation 350 Virginia R@@rional lieclic-al Pro(-rz,,m 35 5 motion for recorr,,en0ation 367 T.,],,@n for tie ti@ T@c7ket; @rei motion f(j-- recormene8tion .3 M') Motion for -r, c c c T-,T,@ c n (I. ac) n 40(, I- TE'v7 Rec7it-,nal "eoical- TIrorrrE,,.rp for t-ie State of ,@lar,,/Ic-inO, 14 illc)tion for rp-ccmr@,on-@z-tion Al.6 H.7W Rcc7io-ial @',e@ica"L T)I.an for tho Di-,tri-ct of Coli-ir-i@ia 4 2 'lotion for recor,.-,men0ation 431) 1T-'T@,7 Reciional ',Ileeical Plan for Lonc-T Isl.an(4, ',Ie@,7 York anO. Suffoll-, Counties 443 Motion for reco!rr,,(--ne,-.tion @55 TIF"t7 Rei7,ional !Ilan for Susciiehanna 461 notion for rccop.,Lr,,en0ation 4 7 2 P R 0 C E E D I N G S -- - - - - - - - - - iy 23 [Thc-, B P-ATiel @,ias called to order at 8 90 a.m. by Session a. L, Peterson, the Chairman.] CIIP,III-I)L@@ PETErSO-@i- We are still missing a coulnle of peonle, I took some stuff home last night and this is just to ive vou an idea of -vThat .,7e did yesterday. [Indicatinq the 9 blacl-,boarO..,] on iihich was inscribed P@,ec Pund- Overall Item ing in Ks %Rea % Tard,ot Alban,.7 (1) SU-? 3.0 1.066 100 70 i.@aine Sun 2.9+ 1,600 80 120 1 P-A S C,-) 2.5 7 0 0 67 52 C,j-) Valleii Al@ 2.5 2 , 3 0 0 82 83 C'-,l York Aug 1.8 615 77 61 ila,raiit Aucr 1.8 irioo 70 7n, Ariz (1) Blk 1.7 360 64 50 Conn BA Poon 1.6 510 30 22 $3,751 c 80 70 Ti,'.L CIIAIP-',,L@T It seemed to me clie rcaions fell out into about four nice rTroups. The first column indicates that sort of overall ratind- that reviewers aave "Su-)erior", "-@ove AveracTe", "Bel.o@,i Averaae", or "T)oor. " Now the second colurin is sort of an itemization. You will recall that you vrere asked to chec,,-, 'IC-,ood", "Average LUU I -!I 2 "Belo@.7 ,@@veracTell -- and I sort of 1.7ej-cThted that as "3"p "2" rind li,,, and didn't count in where peonle said there @.ias insufficient basis for judgment. And again, it seems to me those scores, that itemized kind of scoring is roucthlv consistent with the i verbal score. And then I indicated @.71-iat your recommended funding i levels i@7cre, in thousands. And the list t@,.7o c the percentage of that olumns are recor,,i-,(-,nO..ation vis-a-vis the recTuest in the first column; -vis the -Tct ficTure or level for L.,.a overall tar, at and vis-a rerTion. .ie do have -m "IT So arl-led disTDari.,L--ics @.aine , ..or e:@annl-- if -,rou -.,i-ll recall, t,icirs is onl-,7 coming in now (1) Connecticu@@ is at the very bottom of the lisL-.. @-S I it ha-.oponed, heir initial reuuest was really quite it,,odcst compared to what @-ic were exnectina. But this is nothing authoritative or final, but I thought vou might be interested in just sort of secina one T,!a@7 of cuttincT, ho%@7 thincfs came out yesterday. It did see-r.. to r-,e thev sort of fell out into four equal arouses, rather ti-ian t-.,"O small ones and then the middle we don't have a bell s'-,Iapeo. ,.i,iich I guess is something ::urve vet, that educators are ex- tre-melv interested in. DR. TESCIIA@,L - That's because tl'iev are saving money .1 For the nrogram. 187 t 3 Tlyr, CIIAIr,',,'@.JI: Well --yes. Those are rou(Th nercentacf@s at the bottom. You reco-v,,ended about 80 nercent of the requests in the acarcoate, and about 70 percent of the target figures -- on the eight regions we looked at yesterday. Tell, I'm not sure that we reallv @,7ant to wait on Bill and Joe. '.,7e @,,7ere aoinrt to take up Puerto Tlico first, and. both of those are Puerto Rico.pcople. DP.,. McCALI,: lio@,7 al)out taking 1-7cst virainia first? TIIE '%'7ell. r)r otherwise You haven't had your coffee vet, Sister Ann, @,7ould you mind if we go to @7est Vircfiriia? OtherT,7i-se, I was gci,-I(-, to'@ o to Orecion. She ,,,as the onlv 7oerson @@7e didn't aet to%--sterc@,ay 9 -- and, t@-iat @,iarn't entirely accidental, there @@,ar, a @i ir,.Ilan. It r,.7as r)art of the little collusion wit, ti-ie c'@ia' 1 noverient. (Lau 'iter.) eclaraenica q cbn't we start Haiti T,-@'est VircTinia, then, and let Sister IZinn drink her coffee -- and riaN7!De then bv that tir@ie Bill Thurman and Joe %,7ill be here. If thev aren't, the,.,'ll have two black T,-arks apiece thevlve alread@7 cTot one. And on l,"'cst Virginia, @7e have Paul Tcscllan and Chari@-s 'IcCall and you neonle have colluded or do vou ,@,Tant to fli- a coin? DR. TE-SCI,'@'q: !lo. r)r. I!cCall, I vield the floor i,,litli pleasure to Tiy senior colleague; from Texas. 188 t 4 -HE No@-7 if N-7e -:ire going to get into these Senate type protocol-, x,,7e're not going to ctc-lt fourteen regions don,---todav. [Laughter.] DR. !'JlcCALL: I'm not sure whether I accept the floor under those circumstances. I'm sorrv Bill is not here-. I wanted to point out to him that I find another "Superior" region, but that I'r@, olification, not one that cari.(,- in with t,,,70 volums of elaborate am,. T 1-le onnoslLe. quarter inch, non- .)er se -- but just t' bound, non-color, blaclir, and,@,7hi-te application that is one of t7,ie s jr,.o IV lest, clearest--, rio-@t concise aonlications that I e r.@ad and it's siiaple for a lot of reasons: One, is the state, itself, and thev the-k7 Have devel-o-)e--' the procrran, b 't also because this application is u a request for suoport for and onlv t,,7o continuation projects 7.7ith the plan to come in for all of ti@ir new nrograms in July. And that is clearl,7 as stated here, it is a region that car-,e in rather late in terTis of the overall -- 56 allies tha'L- ultimately @,7as our pealz -- so that they came in, developed their orogram based on the neeris of the recion, developed their Priorities, stuck with them, haven't had to shift them they have a strong.staff and region advisory grouT) leadership and an integrated program that has been consistent, right along. 189 t 4 A-rid I have already mentioned that it's reall-,7 a staff Lge 4A ,iarily -- just t@.7o continuation projects -;ust ?roposal, prir Some- tliin(Ts continued in other funds. I think the feasibility of their accomiDlishj-ncT, in the' of r,,ihat they say her(,. @.7hat they have done in the past, is excellent and @,.ihile there is not a lot of information on :7@..P relationships there is nothing that indicates there is no,.@i there, at all. r.@hc,7 are reauestil-irf, no-,,,, 663,132. The onlv thing 1 qould noi-nt out there is that there is a significant indirect ::ost in this that has come up before, about 130 some odd -- or 136,663 wlaic-i rias indirect cost but that is an establ-is'@iec@ L'-hi-,ig that @.7c couldn't do anything about at this ooink-- in tiT-e. it to 170u.- attention. 1 merely call -1 In I think i'll ston there. -Lhe regional -@,dvisorv rroun is a little hea,,r7 on tl-ic_ Drof,2ssional me.,=Crshj.n, but it's there I don't think it's 3erious Droblem. TIIE Cil@,I 71,iul? DR. m.11SCil.Yi: "l'ile have no reason to disagree ..7ith an,%7- :hing that ha- been said. It's a pleasure to read a proaram --hat has not onlv been able to carry not onl-,7 been able to accumulate funds currentl,7, and arranqe ongoing fundinc, -- ':)ut @,hd is able to accumulate funds concurrently in multiples @.e., %,!here the,,,ill put in half a Billion and they @,yill c igo running about a t7.,,o to tiirce million dollar program 5 that ,.7ho-n T?j4P vias going to -,)hasc out, the (.',ovo-rnor and the State Government were readv to take the staff on. it looks as if they are as far along becoming tic follow I operation of PLIP as anv re(Tion that i-7e have come across. @'.Ie have kno@,7n Charlie, in operation of @,lest !7irginia, because it's a mer@oership in the Southeastern Groun, and have been a%.,,are of this development in the general direction, un to.no@-7. rL"hev seem to accorqnlish more interaction, and starting of more services and develo-oincT of manpower, fe-iier dollars than almost any group T.,i(@ are a@@.,are of. So my recommendation -- if I can nreerqot the dignil@-v of my Predecessor I @,7ould reco,@,,cnd fundin(7 as requested. I'll second that. TT,!E C.tIAIP21A-;.,T: O.-T,\. Before .7p@ or)en that u-) as Charlie did indicate, this is a verv, in one sense, a verv modest adolication a continuation of -,)rocTrarq staff with funding a slight expansion in viei-7 there and a couple of projects so that it totals "1663,000.00 in round nu,-L',-L@rs. They do anticipate cor-.ina in with a major su,,oplemental-, application ini ,ulv for $1.2 million. DR. @l.cCALL: But that, added to this, would out then' above the target. i,le're recognizing that. But I ti.iinl-, we are in a Dosition to let them make igi the judgment of what they do come in with, in their new coiii-nittee. THE CIIAIP-1",@14: All we-, kne@i -- this is one of the reasons -- this is one of maybe eight or ten, where the initial application is, indeed, restricted to continuation and to program staff -- and all of their new activities will be reflected in the July submission. O.N., !\Torm, are there any comments regarding C-AP or this matter I recall T,!est @.,Iirginia has at least considered, overl I the years, some Dossibility of disassociation from the University but I'm not sure @..?he,--Iier that ever got much d sort of NOR!,L-X@l A-'IDETI S O'L@, AnNi AgOnc,7 Director isa I'ller,@,er. of ti-ie LecTal 2%dvisor-,,r rroup a nd thev did recor,)@Tend annroval of this Darticular anolication. And as I said, it I has been previously approved by the aqenc-,i, since the @vorl,,: is continuing on schedule. The major thrust of the uroaram we can anticipate ini the ne--,t application, @7ill be on the State-wide basis,' as opposed to the individual project, or community basis. l,lo,,7 I thin],, it urobably will be the size that thev will get. DR. @mESCIlPa,7: They have helped build P.NC aaencies in an area. rrOM THE CIIAII?J.LAJ.,l do you have anv particular insic,-..- 192 r@t 7 linto this as regards West Virginia? MR. SIMONDS: Well I think Norm summed it up very well. That's a pretty good state. THE CHAIRMAN: Most of West Virginia is still that way, I know. We do have a recommendation but are there additional comments, questions, observations. MR. BARROWS: I would like to ask a question, just as ia matter of my own information: What qualities, as you fellows I see it, accounts for this marvelous support on the part of their constituency? DR. McCALL: The usual fact of strong, capable Ileadership involving MR. BARROWS: On the part of the coordinator, or do they have a good RAG too? DR. McCALL: I think it goes on further than that. MR. NASH: The coordinator, the university, and the force of the medical society They started off with -- had the RAGs to start with and they haven't had to shift. They have been right on target throughout. MR. BARROWS: The university and the medical society &re united -- i.e. -- they both agree. Now, I didn't ilsay the relationship was good between the medical society and !the university, but both units support the PM POOVER REPORTING CO, INC. 320 t4.3ssachusetts Avenue, N.,-,. 'Olaship.Mon, D C. 2,jOO2 193 t 8 DR. TESCHAN: There's a very important phrase about ihalf of one line in the application that says that, in working with the medical societies in the health delivery area, they have restricted their activities to their legislative franchise. And then the thing goes on. Well, anybody who reads English in the context that we have all experienced it, will know exactly what they mean. That says that Charley's been very careful as a non-MD, he's been very careful and he's working with full understanding with the people who might otherwise take umbrage. MR. NASH: That's right. THE CHAIRMAN: I think I've observed something this isn't 'ust West Virginia -- it does seem to me that in 3 those states which have, perhaps less in the way of health resources, institutionally and otherwise (and Maine falls into that category certainly) and during the phaseout period, they seem a little more, for whatever reasonsi anxious to preserve at little they've got, including the RMP, than some states here there is almost an embarrassment of riches, in one sense. I don't know that that's an axiom, but I have that impression. tha-E in places like Maine and West Virginia, they eem to be, or to have been willing -- and I think they ha,7e ad good programs there, to try and preserve the RMP with tate and other fuhds, moreso than had it -jDeen Michigan or HOOVER REPORTING CO, tt'C. i, 320 M@assachusetts Aveni,,, N-E V@ash;ln,,ton, D @C. 20002 194 Illinois, necessarily. t 9 DR. McCALL: But I think also, in addition to that the good leadership, good program a lot of needs relative to the resources. THE CHAIRMAN: Yes. DR. McCALL: But also, a rather homogenous noncomplex region, too. You know there has been a lot of competing institutions and people, so that they were able from the beginning to focus it, and then have not only the need to recognize their function but they were productive in it -- and therefore, you can rally when the legislation gets shot out from under you. People come in and say: This is a worth while thing, and MR. NASH: There's a motion. THE CHAIR14AN: Yes, there is a motion, but are there any other questions or comments? If not, we have a motion to recommend approval of the amount requested, $663, 000.00 which has been seconded. I call for the question. [Approval of the amount requested was put to vote and carried unanimously.] HOOVER REPORTING CO, INC. 320 tA3ssachusetts Avenue, N.',. 195 still short Bill wt 10 THE CHAIRMAN: 'O.K., again we are Thurman. He's got three black marks now -- but he can afford it,'he's a dean of a medical school and he's got enough major insecurities without worrying about black marks from the Chairman. [Laughter.] I wonder, Sister Ann, since Bill isn't here, if we could again improvise, and ask you to review Oregon? This is a region where we only do have a single reviewer, Sister Ann, since Dr. James is not here. SISTER ANN: There is a staff person here. THE CHAIP2.,IAN: Yes, there is a staff person here, Dick Russell, and he's just coming up here. OREGON SISTER ANN: Oregon is presently at the $767,000i level and they are asking for $1.2 million. They are bringing in three new activities, and a total of eight projects, and they plan to come in, in the July review for a project at the cost of $200,000. The program, from what I can read, and I -questioned a few people who were there on a site visit, and apparently it has been a good program over the years. From the material that is presented in the book I was able to identify a strong program leadership, with staff, with the regional group, that has a good review process and apparently it functions adequately. .40OVER REPORTING CO, INC. 320 Mass2chusetts Avenu@, N.',. 'Nashingto6, D.C. 20002 19b The Regional Advisory Board select projects and wt 11 '!I assign priorities, and they do this through three standing committees, by which this is accomplished. It was interesting to me that the coordinator of the program is really in control of three projects with a total of $360,000. You might want to comment on this, this is rather interesting it kind of indicates the style of leader- 1 ship in this'program. MR. RUSSELL: Yes. SISTER ANN: There are eight professional staff and there are three vacancies that they hope will be filled. Credentials could indicate that the staff is well qualified. Their job descriptions are well written, and if they operate within that framework, they should be able to do a good job. In the past, they have had adequate technical review, problem analysis, and documentation of need and technical soundness. They have also addressed themselves to efficiency and containment of costs and this would appear to be on an ongoing basis. The project, submitted in two ongoing projects (approved but unfunded projects due to phaseout directions) and the new activi@s not reviewed by the Board -- the methodology for achieving the goals listed on page 42 of the project -- and I won't read it -" if the methodology is 40OVER REPORTING CO, INC. 320 Ma-.sach@e,,ts Aveflue, iN.L Washir,gion, D.C. 20002 198 wt 12 followed, it's very adequate. The three priorities are ones that were established lby the Federal Government -- the availability and accessibility and improvement of following, and containment of reduction of costs -- it would appear that they would be able to carry out the projects in the allotted period of time. And the CHP relationships appear to be good although as I looked at the letters and concurrence on the last project, I noticed that there was no return on about 50 percent of them, which kind of conflicted v&h some of the other impressions that I got. And these are the main things that I picked up. THE CHAIRMAN: I think Sister Ann was the only reviewer, but I think perhaps you will want to elaborate on this MR. RUSSELL: Well, let me respond to Sister Ann's quest--ions, because 1 think they are very pertinent questions: The one that you didn't quite understand the 50 percent return -- was this of letters? SISTER ANN: Yes, that's right. MR. RUSSELL: 0. K. This is a matter of procedure as part of the Oregon structure. They have a CHP subcommittee and all the project applications come through that subcommittee so they do have input there. HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, N@'@. Washi,,igton, D.C. 20002 igg wt 13 And in the applications for Oregon, I think it was only nine of those did not respond formally. But the CHP relationships are SISTER ANN: Yes, that is very good. MR. RUSSELL: Now in terms of the staff, they do show two professional vacancies. Now those vacancies have been filled. They, you know, knowing that it is sometimes difficult Ito recruit just on short time, they are using interns from the Ten WICHIE program -- The Western States Commission for Higher Education. And these young men are on board. SISTER ANN: I think ther w e ere five they were going to bring in -- is that right? MR. RUSSELL: Well there were only two vacancies Ion page 53 SISTER ANN: Yes, but five interns were going to be hired into those vacancies. MR. RUSSELL: No, I think there were only two as I understood it, and those two are filled. Now the three projects which Sister Ann referred to which show the coordinator as project director -- which, I believe would be a CHP priority as 1, if I remember correctly. The other is an emergency medical service consul'ca- ition. Yet he is not project director, per se it's that 40OVER REPORTING CO. INC; 32OMassachusett@Avefiu@ N,',. l@these funds are controlled through the Program Staff budget Olaship,gton, D.C. 20002 200 and all of that money will be subject to Regional Advisory wt 14 Board review, and approval. You are right, the Regional Advisory Board is aware of them I sat with them for their four-hour meeting to look at the applications, and they have been very much involved, and it has been a very strong program. DR. TESCHNI: How many of the new activities are going to be processed through, or managed by the University I of Oregon? Just in round numbers -- one out of ten, or ten out of ten or -- there are a number of these projects who will be managed through the University. MR. RUSSELL: Very few, if I remember. DR. TESCHA.N: Wiall, when I se6. the list here look@ it looks as if they were managed somewhere else. "A hundred thousand dollars to CHP priority" was the, title, and I was interested in what it was. SISTER ANN: But that, then, is when it was under [Dr. Rhineschmidt] and that --.is under staff $900,000 and then ther6ls another $150,000 somewhere itis total $360,000 under his direction, so he keeps it in the program,hi@se DR. TESCHAN: What do they plan to do with that? Can you tell from that? SISTER ANN: No, I can't tell from the application, but apparently the staff is going to address itself to the HOOVER REPORTING CO, INC. 320 Massahusetts Ay,, r,,ue. 'Na@ington,D.C.20002 201 management of it, but I would think that CHP is going to be wt 15 involved in the planning, and I think the various agencies in the area- are going to be involved in providing the services. MR. RUSSELL: What this is -- this is, you know, in keeping with the emphasis being placed on the particular relationship DR. TESCHAN: That signal, I got. I wanted to know the content -- I can read this myself. MR. RUSSELL: And they have a number of.activities that now are in the developmental stage. These will come in as projects -- go through the advisory group interview, and then will be approved and awarded to individual CHP agencies. DR. TESCHAN: I gather the decision is exactly what the content would be -- it's open ended. They wanted to get some staff resource to move in that direction and to have it earmarked for committee for that purpose, to get the signal to you all and to the rest of us on that. (Reads from the document.] what they are saying, you see, the law is that 'they have to do this and most CAPs or many, would say: This in our experience has not been ready because they didn't have the basis to make the judgment. SISTER ANN: I got the impression that the majority lof the funds for these programs, that it's really kind of a ithrust into the future as well beginning in the present, and HOOVER REFORTl.4G CO, INC. 320 ti'ia@chusettsAverlue, Vjithinartnn D C- 2@)3,&2 202 f link '-hese programs iit really would be very difficult to kind 0 wt 16 together in the kind of a model that their Federal Government talks about at the present time. Is that right? Does that reflect MR. RUSSELL:- Yes. THE CHAIRMAN: Paul, with respect to the University of Oregon and the Medical School, I recently, on a flight, was sitting next to somebody from the University of '.Oregon', and I had the -- apparently, you know Oregon is a "different" state you see in many respects. They are trying to keep people out, and they led the way in gas rationing -- but also, its University is one that they are at the end of the line in feeding at the Government trough They get less money in terms of Federal grants percentage-wise, than any other medical school in the country. And the Dental School won't even accept percapitation grants and that, you know, is almost unheard of. So it isn't surprising in one sense that despite the fact that the University is a grantee here, that very many W4P a'6tivi-Ei'es now, or in my recollection in the past, has been university-sponsored. DR. TESCIIAN: You really must have a first rate coordinator out there too. MR. RUSSELL: Not too long ago there was a management. ,Ias@sessment this was by a management program -- and the best 4iOOVER REPORTING CO, @NC. 320 lv'iac@sach,,isetts Avent- V-Iaship,gton, D.C. 20002 203 wt 17 I can remenlber, the only recommendation was that the grantee ought to buy some curtains for the RMP Office. MR. SIMONDS: Well, that's a little exaggeration. [Laughter.] DR. HEUSTIS: Well, while you folks feel sorry for the university, I know that they are getting $163,000.00 in indirect costs.-- MR. RUSSELL: I didn't say I was feeling sorry for it, Al. THE CHAIRMAN: I seldom have bled for a university. SISTER ANN: But you know, for a university grantee, they get the lowest amount. DR. TESCHAN: What's their rate? .SISTER ANN: Oh, I think it goes up to 60 percent in some cases DR. TESCHAN: And how low MR. RUSSELL: 40 percent for salaries and wages. THE CHAIRMAN: Well, this is an application for, again, in round numbers $1.2 million. They have estimated that they will be in with a very small supplemental, roughly $200,000.00 in the July request but this is their major request. The total of those would bet again, almost their target level- figure of 102 percent by our calculation. HOOVER REPORTING CO, INC. 320 t@assarhusetts Avenu@, fit. Washington, DC. 20002 204 wt 18 Any other questions, or any other comments? Sister wt 18 Ann? SISTER ANN: I recommend that they get the amount ,that they are asking br $1.2 million. Their target is just 102 percent. I believe in rewarding good programs. DR. HESS: Was that a motion? SISTER ANN: Yes. DR. HESS: I'll second it. THE CHAIRMAN: We have a motion and a second, to approve, or recommending the funding at the level requested, $1.2 million. Is -there any further discussion, comments, questions? In that case, the question. DR. HESS: Let's Vote. [The motion was properly put to vote and carried unanimously.) HOOVER REPORTING CO' .1,iG. 320 klassachusetts Avepie ti.L. Washington, D.C. 20002 205 THE CHAIRMAN: Again, unanimous we re just wt 19 continuing the complacency of yesterday afternoon. DR. HEUSTIS: I think the Chairman should find a better word than "complacency." THE CHAIRMAN: Everything, in the eyes of the beholder, Al. Well, we are still missing Bill Thurman, so we're going to continue to extemporize. DR. HEUSTIS: If they ever subpoena these tapes, I would just hate to have anybody think we were complacent. THE CHAIRMAN: Well I don't think they will find very many explicatives, or, on my part, many "inaudible" portions. As long as we are on the West Coast, and if John and Al feel up to it, we might want to take one tenth of our MP, namely, California, which in terms of population, past funding, has roughly come out that way. Al, do you want to lead off? Or John? Again, I don't know DR. HIRSCHBOECK: No, Al does. [Laughter.] DR. HEUSTIS: You see, I have a voice problem, this morning. CALIFORNIA DR. HEUSTIS: Well, california is submitting two Ilapplications for this year, and the one that you have before you @40OVER REPORTINC- CO, INC. 320 Mas@Achusetts Avenue, N.'- ,Nas@.ir.gton, D.C. 20002 206 is for approximately $8.3 million, of which about $1.6 million wt 20 is for the program staff. And they would estimate that with the July application they would come to $14 million and you can note, if you care to look on your white sheet that the RMP are prorated figures at $12.5 -- so there are approximately $1.5 million ahead of what they were advised to do. They.served the area of California with two regional offices, both of them (note) located near major airports, one in the northern part of the state and one in the southern part of the state. The Regional Advisory Group has established si4,goals and six program elements, and the will implement these. y The goals are to be implemented through six programs, and they have assigned a percentage of funds, and have determined their priorities in this way to each of the majbr goals. The percentages are the largest, they held manpower at some 25 percent and the least is 4 percent with others ranging in between. The RAG is strong, stable, and very interested and this is judged by the attendance which has a very well- known committee structure. In addition to the Executive Board, there are three standing committees on program development, one on program .1review and one on evaluation -- and then they have what I like, HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, OVashington, D.C. 20002 20 wt 21 the program element committees in each of the areas and their charge is to develop programs and to monitor programs. Here, again, it seems to me that real guidance is provided to people that would request money, in what the money should be requested for. It came through strong and clear to me that the RMP Central Staff plays an extremely important role in actually coming up with the projects and trying to define what our RMP role ought to be in each of the general areas -- and trying to define what kind of applications they ought to address themselves to, and they actually have pretty well defined criterias for the program development and provide actual guidance and request preparation I don't know whether they actually write the requests or not, that wasn't stated. It was stated that the nine RMP Area Committees that formerly existed, had been phased out and that the program elements committees had replaced these, and that the they were well satisfied with the fact that the volunteers were now doing -- at least I got the impression from the ,Work, that they were now doing a better job than the good job they previously thought that the staff had been doing. The final budget, as requested, has been approved by the RAG, and first of all, apparently in the process the reports of the Program Area Committees goes to an Executive; HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, ti.E. 'tVas,6,ington, D@C. 20002 2o8 Board, and the Executive Board reconunends a division of the wt 22 Ili funds among the Program Ar@-as and then the RAG makes the decision as far as the -- within that context, with regard to the applications. I think they have a really well defined review and approval process, which is adequately described and interestingly -- and before I reviewed this, I didn't know that this was exclusive. They used technical experts, apparently from outside the region -- but the technical. experts work under the supervision of the Review Committee. The one matter that I felt was defective, and yet I I am extremely understanding, because California is a pretty complex state -- and other large states have been having similar problems -- and that is: First of all, who speaks for CHP? And how do they effectively communicate what they think, to RMP? I gathered that RMP has, what I would consider an arms length" relationship with CHP and that RMP was extremely strong, relatively, and CHP was relatively extremely weak and there was no described CHP development or input into the preparation of requests prior to the RAG action, except for I the legal review and comment -- and that seemed as though at minimal, CHP ought to in some way formally be consulted about what they thought their needs and priorities were. IIOOVER REPORTING CO, INC. 320 M3ssachusetts Avenue, N.'@. Oiastiington, D.C. 20002 209 hey don't h @t 23 Of course, the whole problem may be that t ave any need for priorities that have as yet been developed but that is rather reading between the lines rather than reading what's there. I DR. TESCHAN: Well, they have had seven years time to acquire DR. HEUSTIS: The staff is well seasoned and exper- t ienced, although substantially cut. They used to have approximately 50 percent of the total awards that went to staff@ and it's now down to 12 percent. The past results that I found, seemed to be impressive both with regard to the numbers trained and, I guess I have to interpret some of these figures, I'm not quite certain how meaningful some of this is, as far as the meaningfulness. We talked about new medical power resources created or new medical people power resources created" and the number wasn't really very impressive. I think it was a little better than 2,000. But the access to care -- it seemed as though the two major provider systems that had been started and now were expanding with other funds -- they have given attention to and they have done some work with the Iurban Indians, California Council of Free Clinics -- all helping the under- iprivileged. HOOVER REPORTING CO, INC. 320 M,3ssachusctt@ Avenue, N.[. 210 ojects without cord of continuations, the pr The re d that out of 76 ongoing 24 RMP funds, was impressive. They sai s that had terminated since projects, or a total of 81 project rcent had continued with other funding July, 1960 -- 70 pe sources. In the first year, it said that following the RMP discontinuance, the projects that had previously been funded over three years fot a total of IUAP funds, in the amount of $7 million - in the first year of going along with other funds -- the people came up with $4.5 million to continue what was going on. I thought that that was rather an impressive figure. The continuations supported by all kinds of money, including voluntary funds, university funds, hospital funds, State Governmental funds In the proposed program, they are trying to set u@ a network of what they call "Health Services, Educational Activities" to cover the entire state -- and yet some 14 of these formed ten of them are incorporated and four are developing -- and these are supposed to improve the quality of health care for coordinated state-wide system for health, manpower, training utilization and health education. And again, it mentioned that over a hundred colleges and 120 hospitals(seemed low) and clinics involved in this with some 200 people on the boards of 211 of directors of these organizations. wt 25 In high bloodpressure control programs, they have a state-wide plan, and I thought it was interesting that of the 36 applications that had been received, the project said that sixteen were selected for funding. Then I think the others were, of course, pretty much there. Again, as I indicated before, the thing that probably bothers me the most, and yet probably shouldn't bother me too 'much, knowing what the facts of life are -- are the relationships between CHP and the Regional Medical Program. THE CHAIIUMN: Oh, I think Staff may have something to contribute to that -- we spent four days in California DR. HEUSTIS-. It is very difficult for a person with just the information we have, to evaluate the real meaning- fulness of the CHP comments -- whether they are just bemoaning the fact that they haven't been recognized and watt to say some things, or whether they really have a beef and maybe the staff could be helpful there. But before we get to that, as far as my assessment was concerned, I have rated on the Review Sheet, all of the items from -- on the first page, program leadership, program staff, the RAG and the performance and objectives in the "good" to "excellent" category. HOOVERREPORTINGCO,14C. 320 Massarhusetts Avent,.,, N.',. Wasiiin@ton, D.C. 200OZ wt 26 on the second page, I had to break down the three items in the proposal, thinking that they were congruent and that they were addressed to areas of emphasis, and because I didn't know about the CHP input of plans, and because there were criticisms, I rated that down to "Above Average." And then on CHP relationships, I thought these were very I couldn't make the determination, and if I had to vote I would have to vote that these were certainly "Poor." But the column that I checked was the "Insufficient Data' and then the overall assessment of the program was "Above AVerage." And the recommendation was made that as far as the funding level, that we ought to know more about CHP. And tnen, I should say after that that we need to have staff comments. THE CHAI.@'4AN: Well, thank you. You have raised the matter of CHP. Perhaps I would comment on that before we ask John, and then Rebecca can complement some other things, as relates to California region. Relationships with CHP there, are uneven, but even i CHP relationships one to another, are uneven. Let me explain that: There are twelve B agencies in California and I think the relationship of the California PDAP, with most of the medium-moderate sized ones (Fresno and the northern counties, Empire Valley, which is Sacramento) we met with, during the HOOVER.IEPORTING CO, INC. 320 laassachtisetts A,4enue, N.',. Viashingtoii, D.C. 20002 213 Icourse of our four-day visit, Rebecca and Sandy and I, met at 27 !with six B Agency Directors and the A Agency Director. !The relationships -- I would describe those agencies as "Fair to Excellent." Much of this has been as a result of the Health Service Educational activities where the State is blanketed by those which have been sponsored by the California RMP tagain, the development has been somewhat uneven, but in many instances, one finds that these health service educational 11 activities, most of which are now incorporated as private non- lprofit groups, are in a very real sense, the health planning arm, or at least an important adjunct of the local CHP agency. Relationship, on the other hand, with the three maDor CHPs in terms of Population areas -" Bay Area, Los Angeles, and Sany)iogo -- are arms length to "awful." MRS. SADIN: Well, LA was all right THE CHAIRMAN: Well, yes, LA -- at least the word we got was that LA wasn't doing anything, so that they weren't getting into anybody's way. But some of that is a matter of personalities, I think. We found, for example, that in the Bay Area, the Director of the CHP (and that's sort of a federated CHP, as there are nine counties, and each of them with one exception I believe)-- DR. HEUSTIS: Yes, but it seemed to me that in HOOVER REPORTING CO, INC. 320 assac@iusettsAvenue,ti.'i-. Viashington, D.C. 20002 214 wt 28 addition to the B Areas, that every county had its own CHP, and to kind of sort out the comments it became very complicated. THE CHAIRMAN: Well, the Bay area is an interesting CHP -- certainly the most vocal, outspoken, bidder, director we ran into, that was Don Ardell in the Bay area. He was having problems with his eight County Directors, and they sort of meet apart from him. Correspondingly, those B A@encies, and perhaps the B Agencies in general, but certainly the larger ones -- I'm not sure it's constructive, I think there was some destructive tension going on presently between the A Agency and the area wide agencies out there. I think the @IP has, on the while, pretty good relationships with the A Agency. Now part of that may be the fact that the A Agency is, comparatively speaking, poor So that it has been getting some money from the State EMS Office, or from the RMP, to do some of the things that it really hasn't been able to get State funds or State positions for. But the picture is a mixed one, but certainly based on our site visit, Rebecca has thrust in front of me here both our report to Dr. Paul and our feedback letter to Paul Ward -- while we did have some recommendations about their HOOVER REPORTING CO,.Il'v'. 320 Massachusetts Aver;ie, N-1. ;.,- @@ 0 innni 21 5 relationships, I think there are more that have to do with wt 29 details, that they really ought to do a better job in insuring ithat the letter, as well as the spirit of the law is followed. If for no other reasons, the defensive purposes. They were kind of sloppy in logging in things, and showing that they you know somebody wants to get you over a barrel But we felt that on balance, that the requirements for CHP reviewing comment were largely being met in substance as well as technically. We did, also, have a chance to witness at the RAG meeting we attended, that there.are several CHP representatives on there -- one from the State CHP and the area-wide agencies have a California Conference of CHPs -- it's kind of their "trade union" and they have a representative on the RAG and at the RAG meeting we attended an alternate member was sitting the fellow from San Diego -- and they certainly,, not only spoke out, and they had some objections, but the RAG took them under advisement to the extent that they deferred -- they were going to look into the matter and either accept them in whole or ignore them and I think, you know, that even that slight demonstration suggested to us that in the RAG councils they have the ability to make themselves heard. So it's kind of an uneven picture, Al, I don't HOOVER REPORTING Co, :,','C. 320 Massachusetts Aven,te, N.'@. i&'ithinoinn f) C 7(jDO2 216 at least from what we've wt 30 DR. HEUSTIS: From what you have said previously what comes up with what I get out of the thing -- I had written down a summary of the comments that had been made, and that was marked in red -- and I admitted that the ones that I thought were important, and I had imported negative comments from six of the twelve areas -- at least what I thought were impor- tant negative comments of the six MR. BARROWS: I don't think we can charge them with the responsibility for resolving these intramural conflicts within the CHP. THE CHAIRMAN: Oh. no. MR. BARROWS: But we can grade them on their effort to relate to CHP -- and would you regard that effort (and this should be a positive one) as "Good" "Average" "Weak?" THE CHAIRMAN: I would have to ask for Rebecca to comment too. My judgement, I guess, would be "Atrerage" to "Good." I think there are some situations where my impression is that California RMP feels that it has walked the last mile. For example, when the Area Offices are abolished, that was a kind of a structured cross-over situation., When they abolished all their area offices and with them the area advisory committees, and came up with the Program Element Committees as a substitute -- there became a number of vacancies HOOVER REPORTING CO,:.ic. 320 Mamchusetts Avenk@@. N.'@ Olashin@iton. D.C. 20002 217 on various B Agencies you know our slots targeted for the wt 31 RMP, we found in the Bay Area that an issue of longstanding the B Agency Director wants an RMP person, but he wants a consumer. But it just so happens that in that part of California Paul has only got some providers on his RAG, and you know, I think there is a real personality kind of conflict. But I think on the whole -- and one of the suggestions we have in our feedback letter, was that they should consider the possibility of having a fairly senior staff person as kind of a liaison with the Conference of the Aqencies -- they have met with them, and again, this is not a monochromatic picture at all DR. HEUSTIS: Have we any kind of a written agreement that has been either tried, or achieved, as to what each of them have thought they were supposed to be doing and what their responsibilities were DR. TESCHAN: The answer to that is: Yes, as I recall. Now whether it is current or not is more to the point, but I recall that there was circulated to the coordinators some two to three years ago -- and this was the first example of a written memorandum of agreement as to what RMP and CHP roles were going to be and how each would interact wlth them. I'm quite sure Paul Ward was HOOVER REPORTING CO, INC. 320 Massnhuretts Avenue, N.[. 'tiashis.igton, D.C. 2COfJ2 218 DR. TESCHAN: I thought it was a marvel. As a wt 32 matter of fact, when we got around to signing a statement in Tennessee, we used that as one of the bases of ours. MRS. SADIN: But I think it's uneven -- the relationships are uneven. The only suggestion I could think of and we discussed this -- I think we need a Rabbinical Council -- you know, you mediate. just need it, to i'm awfully sorry, Sister Ann. (Laughter.] I You know, in the old days, they didn't need lawyers both parties just went to the local Rabbi, and I kind of thought that's what they needed.. [Laughter.] They are doing, you know, the legal part of it and getting the review in comments and submitting the things, etc, etc,, etc, but it's a relationship thing that's the proble,7, in some areas. They are now logging in, as you can see in their applications, all of the comments that are sent out and all 76 projects DR. HEUSTIS: 76? MRS. SADIN: well 75 not that's a lot of projects@ for review and comment -- and they just sent me another whole batch from the LA -- and this is all just LA CHP (Displaying a dossier.] DR. HEUSTIS: That came in late. HOOVER REPORTING CO, l'IC. 320 Massactiusetts Avenu,, N.". WashinRton. D.C. 20002 219 MRS. SADIN: Yes, that came in late. [Laughter.] wt 33 So it is -- you know, one of the things we suggested and this is the letter sent back to Paul Ward -- and one of the things that we suggested is that they have a senior staff person as liaison, to spend more time and pay more attention to that problem. DR. HEUSTIS: Well I am satisfied from what I have heard, that I would change my recommendation from "Insufficient Data" to at least a "Satisfactory" relationship. THE CHAI@IAN: Correct..me, Rebecca -- but most of the program elements committee do have a CHP representative on them. This is really their program development thrust. Now DR. HEUSTIS: Yes, it is pretty good. THE CHAIRMAN: Well, I wonder if we want to hold withhold other staff comments, and let John as a second reviewer, take a look at California -- we have spent an awful lot of time with CHP but given the fact that they are probably 10 percent of the CHP in California, also. At least, in terms of family, I wouldn't think that was far off. DR. HIRSCHBOECK: Well, I won't repeat the comments which Al made because I think they hit the target right along the line in most instances. I am troubled in one way that in reading this over, I didn't see what really happened when the areas were dissolved HOOVER REPORTING CO, INC. 1020 Massachusetts Avenue, N.' . WashinRton, D.C. 20002 220 wt 34 and they were put into two. Is CHP, again, is it moving into the area-wise approach here that existed with@ the regional setup? I think that because of this, maybe this is one of the reasons for some of the problems that they are encounL@-e--- ing there in relating to the CHPS. The other point that bothered me is this enormous ll'project that Dr. White is in charge of -- it's how many millions? Altogether, I guess he's asking for a state-wide consortium of colleges and universities and hospitals and this enormous arrangement seems to me really going too far. At the practical level, I don't know how they are going to work this out, but if this is the way to go in California, maybe it should he allowed, but I have my druth6rs about that enormous approach to dealing with area- wide health education aspects. MR. BARROWS: Resolving that at Berkeley DR. HIRSCHBOECK: I guess so. [Laughs.] I have made several visits, site visits, to other agencies in the California region, and there is one for the California RMP and one in their Review Team consulting visits, and the thing that impresses me out there is that things are HOOVER REPORTING CO, INC. 320 Massachusett-- Avpnue@ 221 wt 35 @i so different in different parts of the State that to try to resolve a problem on a state-wide basis becomes extremely difficult and this is recognized initially by their setting up a CAP region. And now that this has gone, I am uncomfortable. It's like setting up a Regional Idedical Program for a whole nation, and doing it in one'-- as a sub-set of another nation. I don't think DR. McCALL: That is difficult to do. We tried it. [Laughter.] DR. HIRSCIIBOECK: So that my overall evaluation is: Sure, the leadership is good. The problems are difficult. The program and staff is good. The Regional Advisory Group I might differ a little with Al on all these he has perhaps read it in a little different way. I had the feeling at least that the Regional Advisory Group- was@ not really involved in the actual process of evaluation as much as other Rk4Ps are. In other words, they take the word of others very readily, without being, themselves, directly involved. Now I may be all wrong on that but I sort of sensed that HOOVER REPORTING CO, 14C. 320 Massachusetts Avenl,,,,, N.[. Washington,D.C.20002 222 wt 36 Past performance and accomplishments ... objectives and priorities -- I think these are well defined. Feasibility -- here, again, the whole idea of true regionalization on a state-wide basis, I think, is very difficult. In general, I would say "Average" or "Good." "A,v3rage" would be my overall evaluation. MR. BARROWS: Let me ask a question: One of the things -- California, as you both pointed out, is not only vast, but extremely complex. One of the very unique complexities is the strength of the foundation movement. Now nobody has commented on how this program relates to the practices of the community which happens to be an unfortunate bias of mine -- have they been relating to these foundations at all? This is including the interplay between DR. HIRSCHBOECK: Well some of their projects are involved in the quality insurance. DR. HEUSTIS: They mentioned particularly some of the foundations have picked up the check for some of the projects which had gone on THE CHAIP24AN:: Great. DR. HEUSTIS: Now how extensive this is, I don't know@ HOOVER REPORTING CO. iii 320 Massachusetts Averl:e N.[. ik;t,.hintrtnii DC 20002 223 11 or how wide. MR. BARROWS: Good well- boy, that's the acid wt 37 test to this hard-earned DR. HEUSTIS: Whether this was two foundations or twenty foundations I couldn't -- I believe my notes are not clear. FROM THE FLOOR: Could you tell roughly how mahy grantees there are, other than their sponsoring grantees programs? DR. HEUSTIS: You would have to help me there. DR. HIRSCHBOECK: Let's see the agencies other than central staff that are handling the money -- as grantees. MRS. SADIN: They have subcontractors -- or contracted, that is, most -- for instance, all of the health service activities are contracted to the independent facilities. They are calling their shorts And almost all of what they have, when they develop a program element, they have sent out RMPS, you know, throughout the state, and in which they really outline what they want and then they contract it out. They have in their access, which is going to be coming in in July, they have had something like -- from their RMP they have something like 250 isn't it? I think it's 250 letters of intent, which is the, way they go about this libusiness. HOOVER RENRTING CO, INC. '120 filassachusetts Avenue, N.' . 2211 wt 38 In answer to some of.your questions on the definitions of area offices -- one of the things the CHP -- or some of them, told us was that well now that they don't have the area offices in California, that we could kind of take their place in terms of local input. And when-we mentioned that to Dr. Mitchell, he said ';Yes, do you think this is the first time I have heard it>" They have never communicated this to us. (Laughter.] Some said that they missed the area offices and some of the agencies said they were glad they were gone. You know, it was kind of a 50/50 kind of thing, almost through- out the state. The result of the definition of area offices really you know they had something like a three-months visit when H7--,',' audited them and this was the latter part of 172 "- that was a fact that one of the strongest recommendations was that they not have all of the area-- offices. And I think Paul Ward took the opportunity to follow the advice of the HEW auditors, and they now have a northern field -- it isn't just a central office, they have a northern field office and a southern field office. THE CHAIRDIAN: Yes, but these are quite different from the old areas. These are essentially administrative HOOVER REPORTING CO, INC, 320 Massachusetts Avenue, N.[. 225 wt 39 or for program development, and monitoring purposes. MRS. SADIN: Right. DR. HIRSCHBOECK: One@ wonders whether they shouldn't really make two RMPs instead. MR. BARROWS: Right. From a management point of view this is too damn big for one MRS. SADIN: Right but MR. BARROWS: But we can't do anything about it. THE CHAIRMAN: I think that represents, though, a very conscious, deliberate, decision made at the time Pj4P came along and involving what, at that time, were a lot of the influential people in California. At that time you will remember, Breslow was the State Health Officer, and Brown was the Governor, and they made a conscious decision and they wanted a "state-wide" PIIP even though it might be juggled. They came out exactly the o posite from N'ew York, which now has six or seven P14Ps. p So they didn't blunder into it, and I'm sure, like any decision, it had both then and in retrospect both its plus and minus qualities. MR. BARROWS: Well, there's not much we can do about history now. What's the recommendations SISTER ANN: I was interested in your comment where you said the technical experts work under the direction of the IOOVER REPORTING CO, teiC. 320 Massachusptts Aver,@@e, N.I@ W,,iqhington. D.C. 20002 226 IReview Committee of would this be inhibitory to the technical experts? wt 40 DR. HEUSTIS: Are you talking to me? SISTER ANN: Yes, you indicated in the report, that the technical experts work under the direction of the review committee. What's the purpose of bringing in these technical experts? DR. HEUSTIS: Well, I think the purpose of bringing in the technical experts, as I understood it from a person that made a site visit too, with me one time when we got into this discussion -- is that this is to get rid of the local bias and the local conflicts of interest and the local antagonisms between the centers from which the experts come. SISTER ANN: Then you said that they work under the direction of DR. HEUSTIS: Well, the "direction" -- perhaps if I said the overall direction or overall supervision DR. HESS: Or "they report to" MRS. SADIN: I started in on that -- to review particularly the manpower, and they do bring in top experts and they have to counteract the ones in California -- and I think what was meant was that the recommendations go into a review -- but it isn't DR. HIRSCHBOLCK: But this is exactly the point I was@ tryingto make a little while ago. I think that the distance 40OVER REPORTING CO, INC. 320 klassachl-,sett., Av@-fiue, N.',. 227 wt 41 between the RAG and that technical review process, is at least at the time that I was out there it seemed to be a larger gap than really should be. That the RAG should be much more closely involved in the actual review of the project itself and not just take the report with the badge of an expert pinned onto it. MRS. SADIN: I don't know if they changed it since Twelve been there, but they now have a member of that RAG Represent at every one of these -- which helps tremendously, and @i he reports back. THE CHAIRMAN: They have two standing committees. A review -committee, and; An evaluating committee. Under the Review Committee, the technical experts operate in a panel fashion, sort of. They look at the new projects. The Evaluation Committee, on the other hand, doesn't have that close line of the smaller committees, and they are the ones who look at and then forward to RAG. And then, both of these standing committees are RAG people, on continuation, so that they have that kind of relationship And what goes through RAG, if it's a continu- ation of the Evaluation Committee -- if it's new, it goes to the technical panel. So it's the overall "umbrella" supervision HOOVER REPOPTING CO, INC. 320 Maszchusetts Avenue, N,@L. 228 of the Review Committee. wt 42 SISTER ANN: And then @re, too, on page 3 of the Staff Comments, they have 70 requiring surveys, four kinds of positions -- they are adding the 19 but one of the concerns is the proposals are not being monitored and evaluated on a systematic basis. And here, I just wondered if adding more and more people would complicate the issue. MRS. SADIN: There is some urgency to this. In fact, they have added evaluations to their staff, and they are asking -- part of the 70 is for more. But we had, after their supplemental application we sent an advice letter back to Mr. Ward. We had suggested that such a vast program would merit that they spend more time on surveillance and monitoring. And when we were there in April -- if anything, they had gone the other way. They are sending the people in the Southern Field Office to the Northern Field Office and require a monthly progress report. So if anything, they have gone overboard. So they are monitored all their people in their Field Offices are monitored -- every single contract -- and' this is the contracts mostly, so that they have a condition written into the contract. HOOVER REPORTING CO,'NC. 320 Massachusetts '@iaship,gton, D.C. 20002 229 wt 43 DR. HESS: I see. DR. TESCIIAN: I would like to say that the evaluation effort of what public accountability of funds really means in terms-of output benefit -- that whole concept was jelled for all of the RMPs in the country by the initiative of Paul Ward and that staff in California. And a good deal of some of the numbers you are,seeing, John, and all the rest of us are aware of how that ultimately became generalized in order to get the data together, to show to various critics what the numerical impact of these activities was. I am interested that you consider that some of it became a little bit more compulsive than others -- but I understand the atmosphere in which such compulsion can be generated so that I even have some tolerance for that as we 1 l.. MRS. SADIN: In terms of the H.E. Doctor, you asked a question about the manpower. When we said "supplemental funding" in July of 172 California of course as usual, got the most money in the supplemental funding for manpower control -- they started out with something like 10, plus the Central Coordinating one. They now have something like 15 and they just about cover the state. Some are in the planning stage but most are now independents consortium with independent boards. HOOVER REPORTING CO, "IC. 320 Mamc-husetts AvenL,, N.@'. Washinaton, D@C. 20002 230 It's interesting though, that at conferences like wt 44 the schools of Allied Health Protection -- and they have had some -- there's a national conference in Boston this year they had Dr. White speaking in some of the consortia of the directors. The people at the conference were so excited about it that they then sponsored their regional California conferencEs they have done some exciting things. But it is a lot of money, though. DR. HIRSCHBOECK: Well, I would like to see it sometime, to see how it functioned. It sounds good on paper but I would like to DR. TESCHAN: Well, John, the thing that bothered us is that each one of their nine regions was about as big as one-point-some million as most of the other RMPs we are talking about -- and to see Paul Ward, in one application, with a dissolution of area offices, jus-. boggles my mind. And Ken's point of "management, how do you get ahold of it?" I am surprised at the HEW Audit. We know a little bit about the origin of that, or have suspected some of the origin of it, and I'm wondering whethe: acceeding to it -- the fact that it has some budgetary require- ,Iments isn't a "giving in" to what would in Ken s view be sound management since we would have insufficient data to mark HOOVER REPORTING CO, INC. ',120 M@,@@s;ichusetts Ayepue. N.[. 231 wt 45 11 or to be able to make that judgment from here. MRS. SADIN: Well, some of the things Dr. [Hirschfeld] has-said -- nobody knows this is going to happen -- they had more than a norm -- they recognized that -- perhaps not DR. HESS: You are dealing with a state of some twenty million people, and $2 million for health, education though it seems a lot in one lump sum, is not a disproportionate amount for the population. THE CHAIRMAN: Al, you've been trying to DR. HEUSTIS: Yes, I've been trying to push and I would like to make a motion. THED CHAIRMAN: Fine. We have a request here for a little over $8 million and we have an indication that California will be in -- and this is a request just for continuation and program staff. Roughly, they are at the $6 million level for all new activities in July. That would total, if my figures are correct, almost $14 million. DR. HEOSTIS: If you would then look at another column you would note that if they did that, they would then come to 111 percent of the amount that you requested for them. And because both John and I have rated this as "Above Average" it seems as though, in conformity with our HOOVER IREPOPTING CO, INC. 32OMass,,chusettsAveiiue,N.',. ;Vashin-7tr;n, D.@. 20002 232 wt 46 policy of rewarding the people that do well, and taking away from the people that don't INDEX I would therefore, move that it be funded at the MOTION requested level, some $8,170,374.00 (Th6 motion was properly seconded.] THE CHAIRMAN: All right, we have had a motion to approve at the requested level of $8.170,000 DR. HEUSTIS: 374. -- it's a separate item. THE CHAIP24AN: $8,170,374. Are there any further comments, or any additional questions? SISTER ANN: Excuse me. Are there any things that you feel we should look at, or that you think should be looked at, serious enough t at-- by reducing this funding (since they are coming in in July) might be an impetus for them to look at the funding? Are there any points or things that bother you about the region that maybe could be looked at? DR. HESS: But the point is, there is no time for them to look at anything. DR. HEUSTIS: I guess the answer, as far as I'm concerned, Sister, is that I thought it was a good program with good management and that the CHP situation bothered me HOOVER REPOPTING CO, INC. 320 Ma@chus@tts Avenue, li.',. rlr. @fICif)2 233 but that has been resolved satisfactorily for the moment wt 47 they still ought to work on that, but at this time I think I would say no" to your question. SISTER ANN: As I read those notes here and the Staff Summary, I'm not all that impressed with the good management, and I think part of it is because it is such a difficult region and as I have heard it reviewed from time to time and the management hasn't been its strong point. But as Dr. Hess says, there is nothing that can be done about it now except in terms of a recommendation. MR. BARROWS: I feel as you do. We can't reverse history. I would certainly not recommend this as a model program for the new House Resources Agency -- it's too monstrous. SISTER ANN: Well now I would think thatwould have to dome through -- it would make me much more comfortable if that came through as a :--recommendation. MR. BARROWS: But I don't know what -- it's bigger than both of us. MRS. SADIN: The target that's figured though, you knowi which is, I guess, less than what they less than the $14 million they have communicated over the telephone and they have allocated percentages to each program analysis -- and' of course if that came down to -- say $12 million instead of 11$14 million -- the man had written 25 percent of 12, etc HOOVER REPORTING CO,;.'iC. 320 Ma@chusetis Avep,:e 14.',. THE CHAIRMAN: They have pretty well -- you know, I wt 48 assume there is some ability to make adjustments at the tail &49 end.of the process. But they have gone through a process lby which the RAG has said in effect: One way of expressing priorities is that we'll put essentially 25 percent of our money into the access program -- now whether that is X-plus $2 million or X-minus $2 million -- so I do think we have a notion both here and looking at a new application, of what the or where the cuts would come. DR. THURMAN: Yes. Question. THE CHAIRMAN: All those agreeing with the recommend- ation to fund at the level requested indicate. i [The motion was properly put to vote and passed "by a vote of 6 in favor and 3 opposed.] THE CHAIP-IIAN: In that case, I guess that's by default. I can't think of any better solution. There should The one, but I can't think of it. O.K. for California. HOOVER REPORTING CO, INC. 320 Massic@usett-, AverueT N.E,1 1 1 i Viashin?ton, Dk,. 20002 (202) 5A,6-6666 235 THE CHAIRMAN: O.K., Bill, since you guaranteed us, wt 50 last night, that you could dispose of Puerto Rico in ten minutes, we'll take you up on that. And then after Puerto Rico, we'll see if the group wants to take some coffee. You and Joe -- I'll call on you first, since you are on the site visit -- well Maybe you were too, Joe, were you? COMMENT: No. PUERTO RICO DR. THURMAN: Just a reminder of the fact that a site visit was asked for by Council, as to whether or not Puerto Rico would get any money at all -- whether they should be discontinued. Mr. Nash was on the site visit with us and the most important thing about the site visit was that we had a multi" lingual team, and I think that resolved all our questions because in our meeting with the Puerto Rican groulD the Coordinator now, he was the Associate Coordinator before he has the respect for the program and control of the people. They continue to have real translation problems, even during the site visit and even though we were multilingual. Some of the concerns that came out were onl handled y by a girl who was even more fluent than the Site Team was. The RAG is very strong. It's very representative despite the differences involved with Puerto Rico, and poor HOOVER REPORTING CO, INC. 320 Wash@@ggton, D.C. 20002 236 wt 51 transportation and despite the phaseout as concerned that 11 part of the program in toto, the RAG has continued to work quite well. The real strength of the program as far as the future is concerned, is that 70 percent of all health services in the island are public, and the grantee being the University I of Puerto Rico which is also a public agency has forced the staff to flow from agency to agency, but nevertheless, has worked quite well. I think the most eloquent thing that we heard was several testimonials that came from cnnsumer groups about what Puerto Rico and the medical program had meant -- the delivering of health services to the underprivileged groups in the continuing organizations. Therrojects were just superb, when you really under- stood them (which is not true on paper, and this has been out problem the whole time.) They have an operational VSRO which is phenomenal in every sense of the word. They have a very good plan for their EMS and they are working hard at the geographical spread. I think that this program, having gone down there thinking it wasn't worth supporting for another day -- the Site Team came away totally satisfied that it was an excellent program, and I would recommend approval of their request. HOOVER REPORTING CO, INC. ,120 filassaChdSetts Avenue, 237 wt 52 DR. TESCHAN: Second. THE CHAIRMAN: Joe. MR. de La PUENTE: Well I have many good things to say about them. I have discussed with friends of mine who lived there and who have been living with the government structure, which is quite monstrous and they speak of Puerto@ iRico P14P as La creme de la cr6me" as far as entered into l'our conversations -- with living over there. And under the circumstances I have written I @,lwrote a lot that has already been said, but in summary, this application represents tenacity in the face of austerity in that a viable program is being presented. It is possible to enhance the staffing pattern with the introduction of a physician who possesses some training in the field of epidemiology, and this is tremendous. It is apparent that the Regional Advisory Group ihas continued their efforts towards program development and review. Their track record in terms of the number of programs that are eventually adopted by the community appears to be better than average. Most of the present priorities appear to coincide with the needs of the Island. Special attention should be paid to assuring the dissemination and application of findings for additional sites lin Puerto Rico. HOOVER REPORTING CO. INC. 238 wt 53 But I certainly, strongly concur with the present recommendation. THE CHAIRMAN: Thank you. Yes, Al. DR. HEUSTIS: I am impressed by what was said. In fact I was so impressed by what was said that I looked over into the next to the last column on this tabular sheet, and I noticed that Puerto Rico is one having the honor or distinction (or otherwise) for requesting the lowest amount of the allocated funds, for any group. THE CHAIRMAN: Yes, the lowest percentage of that so- icalled target figure. DR. HEUSTIS: Yes, the lowest percentage. THE CHAIRMAN: Yes. DR. HEUSTIS: Now, with the obvious need, and I say "obvious" need, it's from what you have said after a one- week visit -- and whan I was there under different circumstances and not for RMP and quite sometime ago Is this because they were tired, or because they were:, discouraged, or because there was a lack of understanding on the part of what RMP was looking for? Why this low figure? DR. HESS: I don't think that's a good measure, lat all. HOOVER REPORTING CO, INC. 320 Massachusetts Aver;ue, t4.F. Vloshing.ton. D.C. 20002 239 wt 54 DR. THURMAN: I think I had better respond to that. I agree with you, I don't really think it is. It's not a matter of being tired, it's not a matter of being fed up, or anything else. This program has been going and again, we didn't understand how well it worked with all the other health affairs and activities. Now th ey have wanted to avoid an outward appearance of affluence, and that's why they were so well accepted, as Joe points out. Again, I would just emphasize that -- not in talking to people who are getting anything out of it, but in talking to the little people -- and these people were able to speak in Spanish to the people involved -- it really is the cream of the program and they felt that they can use this money wisely and not jeopardize the future of anything else -- and they would only ask for the money they think they can use well. DR. HEUSTIS: Now in view of this, do you not wish to retract the statement that you made yesterday about the people "always asking for more than they need?" DR. THURMAN: No, these people have asked for more than they need. I would never retract a statement, like that. [Laughter.] HOOVER REPORTING CO,:,iC. 32OMa.-@husettsAvepue N.,. Ar-hi.ainn ri P. 9,llf@fl9 24c) tit 55 DR. HEUSTIS: For the moment I thought I had you, but I couldn't go further DR. THURMAN: No, I am going to defend the sheet, a little later on, with the fact that.I think it's useless, so I only bring that up No, the only place that -- the place that I would criticize their budget, if you still look at the core of the staff program -- as to what was indicated earlier -- they just pick up all the staff, and they didn't really, physically pick them up, they just moved them to other budgets within the medical science campus, and try to find a place for them and then they kind of flow them back. And that "flow" is very worth while for the very reason you bring up -- that these people will be able to do an awful lot with a very little bit of money. So that we are approving more money than they can truly use right now, because they are funded through other mechanisms. So that I'm not defending my very dogmatic statement too much. [Laughter.] DR. HESS: The point is: How many people are there ilin Puerto Rico? DR. THURMAN: Higher than New York City per squarer HOOVER REPORT!Ni'3 CO, INC. 320 4@,lassachusptts Avenue, f4.' - ViashinW@r,, D.C. 2O,,jO2 24i. foot it's the most densely populated region in the United wt 56 States. MR. NASH; About 2.5 million I guess. DR. THURMAN: But a higher density than New York City, per square foot of ground. And yet the most of the island, you couldn't set foot on if you wanted to, because of the trees and the water. MR. NASH: Dr. Heustis, that figure may change -- 69 percent -- depending on what comes out of their application that they will submit. DR. HEUSTIS: I didn't care to explore that any more but it just seems as though where there was need -- was there a language problem. But I think my question has been satisfactorily answered. MR. NASH: All right. THE CHAIRMAN: We do have a motion, and a second, on this one -- to approve in the amount requested, which is $696,862.00. Is there any additional discussion'? All those in favor [The motion was regularly put to vote and carried unanimously.] HOOVER REPORTING CO, INC. 320 Ma-@-lhu-.etts Avenue, N.[ ,,Vaship@gton, D,C. 242 (IT wt 57 THE O.K., it's ten o'cl.oci-,. T;,,Ih a t i stLi c Pleasure of the qrouT)? Do @ie @,7ant to take on another one or do %@7o- want to break for fifteen minutes and have a cu-o of Cofi@ce? Do @.7c have anot@i@r ten minute one? How about the Tloul-it@-ain States of Idaho, I'llontana, 1,7yortinq, and Nevada? '-"O'i,IEI,TT: Is that c-ilT.-;ca,,7s that same four rtates? It's al%.7ak7s been a little unclear in m,,, mind'. @-7"lat i'vp- read nor,.., suc-rgcsts it's sort of a northern ir-7,7 half of omin,@ -@ it doesn't really make much difference as "7,701"i.na has been "I-IlPs "P-oland" there arc three .7Z.'!Ps @L. 0 -olot over; in the mountains: Colora6o, !,7yominq, and -- the mountain states THE 1.10@-iTAIN STATES DR. 1@!cCALL: They have cot a tableLof staff and a pri-oritv aroun, and a Priority setting on a ori-oritv basis, they have handled that in a hiah, mcditip., and lo-@.,7 c@,roun,-nq in this application -- @,7hic,-i is a good application -- clear and I think it n@-esents a picture of the recion Pretty ,@7ell. Tliev have had rcction review certification visit and management assessment visits ii7hich came out as, I think prett-,), much all "nlu@,cs" from that rcaion. Assessment of their Past performance and accomplish-, ment has also been T)rcttv (-,,nod. 243 d with -vit 58 The current pronozal8 seem to be in accor their stated objectives and priorities, and I thin]-, thev are feasible. The C@'!P there are four A Agencies and sevenB @lgeiicies that have to be dealt i,7it'L-1 by this -,2,cgional "-Icdical Program, and thev have received in this application, comments '%gencies, and fo gcncies from all fourA ur of the seven B A are included. The ICia@o A Aaencv disapproved one of the T)rojects the physical assessment field -- nurses and the D .7\-ccncv hE,.d nec@ative cc-iiqcnts on about four -)ro]ccts -- but @.7cre no an in (fto--,oth stt,,-Iv or criti.ql-,e of t.iosc it @.,,a!3 just on(,-. sentence co-L-,ionts. I state that to sav tiat I C@on't have ant7 T17,1@7 to evaluate the auali-.tv of the CliP reviexi and relations'@i4--)s th2ra but these were --- t@-ie extent of the necativo tv-De co@--,@nL---. L,,Iat would neee deali.nc, by the and from the applications, I ,votild -feel Seasonal comfortable, all@-houch I @-iould ,-7arn the Sta-Ff to comment on these if 4--liev @70uld wis.-i to deal -,,i4-th them. This application contains 27 orojects. 11 of these are for continuation, and 16 are new,-- makina uD in dollars an eleven continuation of about $1.5 riillion; and the sinteen new ones, at $640,000 -- the staff buduct being some c7uarter of a million dollars -- the total recuest $2.4 million. 244 -liey intend to aniolv'for aaipplement of some 59 $220,000.00 in iulv. I rated this "Above Avo-racre." CI"AIPJ-@--',l Thank you, Charlie, and Joe. DR. IIESS: I generally concur with that. It is evidence to ri@ that the people @.7ho t)ut this iTDplication toac-@thc!@- thin]-, clearl@7, concisely, and are v7ell organized, and are using apiDronria-IL-.c Procedures. They have atterinted to reach out and nrovi(,c c-ood service to all four states, and they havc,,@ offices in each of the four states, and seem to have aood @7otkinc relationships %,7ith the state Governments, and the CHP and so on. Just to comment on that one oroject that @Te ave ne",atiVe comments on -- aivon a little TDri.ority in the list;-nc, so I think that -ia,-l be a result of the Cl-!P 7(-,vie@,,,. CT@p I t'i-link'the- comments on that Particular one Zero relevant but t.,Iat ,vas ta'i',en account of. The onl@r real- (-Iue-sti-on I had about t'li,2 bu@cet @.;as, the rather larce amount of mone,l goina into Elt4s from ?--,IP. I leave no doul:)t t.iat in that area of vast distances -ind so on that an @-!IS system is an important element to aet orc-anj-zed and goina. But there has been a substantial increas in money goincT into that and I su-,)nose that it @,iould be ap proor4 a--@ to sort of flaa that as an issue and ask them to take a close 245 wt lool@ at that when thev ce'k-- their arcint a@-,,ard. it ,.;oul-d be anprooriate to have DR. @cCALL: a staff comment on that. D'P,. IIESS: Yes, I was goincT to sav, that i@.7as sometninr I meant to point out -- and because of the distance, of course, it miaht v7ell be justified, but vou can't tell. r',.IHT:,' Cl-LAII@'L@l: Yes. Some of- the -- N@,,Iiile a good nart of this is continue, ation, some of that continuation is really oxnansion, and it's'. larcfelv in the Y,@.i-S area. Dic@, T don't 1-nO7.'7 @,71-iother vou 1.@@ould i-7an- to co:7,j,,ien+- k- on this, or arc, any police,, issues. @t tills 7DOi.nt til@ere are no notice,, do.@s not annear to 17)c .in-,,, T-ol.ic,,7 flagged this to raake douL)I.v sure,. I.,i terms of the 7"',-S nrocTrFt,-@a in t'@@ic @lountai.n States area, all of those nroara-.is starl--@C, cut 1-iit.i assistance f-ro.@. ,,Iauntain States in terms of vor@;, small. contract-,. Like, 7!@-vada, for instance, started out @@7it",l and as a result --,jou can see. @lontana, is the same @@7aV. Idalio. So this is one of their big, major Program we do have some concerns about that larger DR. 1IT7SS: This is one of the things that impressed 246 me about their management techniques; and that is that thev Tt 61 used the contract mechanism as a device for getting thin(7F-, done that they have identified and perceived as a means and thc,,7 ',.iavc, i7"jnc-,Oiiately tal,--cn the initiative -- as opposed to ,..7aitino for it to come in. And I -tlaink tlliis reflects very sound, sor,,'-ii-,ticatc-(2 inanac,o@i,,,.l.ent on the part of 71?1'P. @@c(7ALI,: Just one other tA-ii.nq, one Point ti-la-i@- I thinir, L--i-ie Stz.,.ff might 1,7(.int to on, too. L It is no@ecq- that thev clearly clio@.7 the allocation o-T- -7,oll-rs ObV40 anr,@ rrograrLs -- and L U there is a strong stiL--F, and t'liev have generated and involved in a lot of znr-!. sc-cr.-, to be involved with An-,. T!I.entionc(l in tl.,iesc,, oro3ecL,-s the grantee auencv. In -.anv of the activities, I -)rctt,'/, t"lat ,-,o-.L-.bodv kne-,.7 the rcaion I)ctter than I did, m,7sel-@ -- and that was accentible @.7ithin the re-Tion it @,7asn't too much generation. Is "-his IT'.'!S exr)onditur-c, -For i-)r@-.nara",@,-, for a system. for the purchase of hard@,.7aro> @iR. RUSSI@LL: It's preparation of -- rat,@ier than the T.)urcl-lasc. THE C I I,@ IL%,-. ISandy Flythe, and D4C]Z RUSSCIJ were both out in the !Iountain States, I quess this -.7aF, -larch, or carlisli, on a review verification of th(,, management. l@ 247 6 2 I goes it @@7a.9 combinccl: neview Verification of @"ana.cTer,,cnt 7%ssessr,-Lent --- p @-iould a\r(-, some o T3erliap@3 Sandy an(!/or Dicl: comments as it relates snocifically to CHP and also the abilit,7 to manaae projects under the accis of -oroQrar-@ staff which I train}:. I heard Charlie raise a ctucstion a,'@out. Sandv. is. ILYTHE: Basicall@,, the CITLP rclationshin within the region are qood. T'l-lore is one nroblem, 7-)crliaT)s, but they are i@.7orli-inci i at worked out -- but general-1,7, the on t,iat, trying to get th t 4 rela -Lors'-:iins are cTood. C'IP is in fact, 'IP "las generated. some iDrojc-,ct@, ,.7itil.j-n t-,ic- rcc-3-on rel,-tion---I-iip@-, are basically @ood. T.,@q i C Iis I just really, the graitcc-@ tl' cv ',-ve no responsibility T jhatsoever as 7ar a.s the projccts arc co@icern Staff and T3roqrapi staffs, 1.)asicall,7 arp- r--Snc,@n sible for monitoring that sort of t,,iincr which is just grantee. 11". PUf'DSELL: I would you know, we spent reall-,;, la whole week anu covered, I think at least t@,,,o counties evorNr day, and this is @,,,i-iat it takes. Before i-7e went out, we had some concern, really because @-,,e didn't understand that program that well -- as to how one -,anacted the program in four state!--, from that P.,ecTional Officc-,, -- and v(--i-%7 Y@-iuch ir,,,@rcsseci @,7ith the cormuni-cat,.cll:l@ among the staff and the whole setulo. We kept loolzing, and wt 63 lool-,incr, and looking for somethin(7, \%7rona and we really couldii'j, find it. And I talked with Pod @ll-,erck-er, @,,7ho had the @@lanicTcmcnc. Assessment -- and his impressions we-re nretty much the same as ours. DP,. FIF.SS: I ended un, based on what I read in i here, givina them "(-,ood" and "@.'.xcel.lent" ratincts-in near]--,, everv cateaory and I think it @@7as one of the best orcranizc-,C.@ and managed IT.lPs. M@,. BAR7'0@,,',S l,"4'hat's the nur-l-)cr? 'TiE @,'Icll, the numl)cr is our in t' case of the Ilountain S,"-ates t'Licv are asi@i-icr for @2.2 i@-Lillion no, I m sorry -- 6'2.4 million. i Thev did indicate, as thin! one of the r evic@iers said, that they will be in for a vc@rv (')v comparison modest-- sunT)le-mcntal additional amount of @200,000. DP.' !!cCALL: I recommend $2.1 million. D',2,. IIESS I had written do@qn $2.2 rLauc-ihter-I So @,7e are prettv close. T)R. TESCI@-N: $2.lr--. (Lauchtcr.] TIIE CIIAITZPIAN: @le have a motion of recommended func-ti.@,-- level of $2.15 million. Is there a second? [Th(-, motion @l,ar, pro-)erly seconded.] 249 DR. TTIIU-T,@@l: ilav we discuss this? 6 4 THE CH.NIRTtTd4: Certainlv. !)R. TILIURI@@T: I have no disagrecricnt with everyti-li-.n@,7 that both of them ilave said about the manacr(--ment. But on some of these projects and the funds for them are absolutely unreal. "To@ -icet here I 4 if vou i@yill turn back to the Staff SI in our little grey bool@-. and we have already heard the concern expressed about and I share that concern $181,000.00 for @,Tevada @,,7hic-h is for @iorkina on the E@IS Program on which thev have been ,,ior3,,ing for ten years. Now E?-.IS in P'llontana and Idaho both, make un to $350,000.00 not to mention Nevada's share. But look at some of these other projects. Area- wide, thev would simply scare you to the tune of $270,000 and as I listened to this motion, @,,,c are talking abojl,-- a L-.Ie o lit4 ver 8,000 nersons at the r,,osl- ITo@,i vou figure that 8,000 births -- and vou are going to have rouahlv 120 children that may need intens3-v@- care a year -- and you divide that by the two hundred some thousand dollars and it's an astronomical figure4 Well, Nie move on doi-7n to the breast cancer @:hich regionally continues to be funded at $30,676.00 and thatlt an old nroject, again. 250 65 And the TleQional medical audit system develor--ient project, $177,000.00. Let's see, there is one other herc- that rocked my ,)oat, but I've forgotten @.7'@-iich one it @,7as But 1 just, I really have no disagreciient i,,ith the management anc@ I knov7 the difficulties of communications and orqai-ilze.tion -- but the fun(,'tiiici of these TDro3-cct.-j, I thin)?,- I am qoiicT to move to a mountain state nb,,@7 and [Lauqhter-I T,T'IE Thev need a medical school. DP.. Thev really need one. Sounds like the staff and the ib%G i are a,,,7full,,7 T,T:ll" Joe, I thinl,, @7ou intent to !7,,:a,,r something. T P. FESS: ITell, I @,7as _7oin,.i to sa,,. that one judg7,p-nt here a"@)out nun@-)ers of T)eoole has to be modified bv the distances and the distribution of i-)oTDulation in thoce irc-,--c-z and it's m@7 judament or estimate, that @-7ith the T-)o-oulati_uii spread out the wav they are, it's going to be more costly per person, to act some of this more sophisticated services organized and available than it @,7ould he in a denselv ovulate region. So I would make some allowance in my mind for the geographical distribution of the population, vou know. so that doesn't unsct -L--oo much. 251 SISr,,,E have a comment to made on the Use i t 6 6 L 11 ALI-i.l:I I of medical services -- because the regions intending to being in Salt La]-,e rial@it near the University of Utah, @,7here i the, I-lave funds for the Recional @,@,cdical Program for lust the same kind of service and are cryiiaq for, you I-,noii, people to use the service. P,ncl for an ,-ir- tran@i-)ort bein(T available in terms of this service,-and -.,,ith the birth rate aoi-ncy down think that is a ver@7 -- if @.7c, jest ho-@,7 this program ovf,-rla-.)-)ecl 1-7i-th the other nrorra!ns. But this one nroaraia, I 'r,,nO@-7 IS CToin(T to @l-)e com,,-)cti- tive and neither of the--i are c.,ciha to be a!Dle to use their funds effectively. DR. TIIUR'I-7%.!.I: coul(a alrios-t buv each i-Dao,,- a plane for this r@one'7, and let's fl,7 them in. [Lauchter ,.,P. @-hat's a 1--ouj. thincT @ut you're oneninq a @,71iole ne@,7 thing there @.ihen you 3tart tall@incT about numbers of neople and t'@ic- other T)r(,,-,leris. But in connection @,iith t,iese costs, is it true, or is it not true, that these peonle have further to cio in these things and-thek7 don't have the TDresent resources thai- many other rcaions do? DR. IIFSS 1,7ell, no "(,,dical school in the irt@n nor in the re ion and they are trvincT to relate -- Vou kno@.,I-- 2 @@2 wt 67 they are trying to relate you they are trying to build up their secondary terciary resources in the region. But for raedical schools, thev tried to relate to Utah, to Oregon, Seattle and to T)enve-r. Those are the four, I guess. DR. THUP2,L@-,I: They none have a medical school for associates ,)P. IIT.ISS: TI@ierets one developing there, -,)Ic--s and that's the first one in the region, and it's just gerund qoincT. m-mchts @-7ell, @,7o'vo- heard sorAe co rec-,ardina 'oudcet 4un&s, and narticulariv as it relates to n,@-o-i natal nrojects. Dici@? -4R. -PUSS"LL: I ,,ould. like to resoonO. to Sister concerns about the Salt 'Liake inter-mountain nroqramt. !7e have, we in ')Ir!P, have sort of n u the sc@-,@77S to i t'ne inter-rec-,ional e,,ecutive council -- the three coc,--IlinaL-cr-, you kno,17, that Council was formed to avoid ti-le tvr)c of you are tall-,inq a!Dout, during the nhasebut, for some reasons, it just 6iOn't aet off the ground. It's bacl-, in action, no@v. have a comnlete listina that came in just a counle of days ago, of every T 7c, community listed, and which RMP is programmed there. i are very concerned about the effectiveness of that ccmr,,,3ttce I 253 and i-7e think v7e are cToj-ncr to see some improvement in t-(--re, 6 8 in their action. DTIDI. Yes, ind vou I-Ino@,7 T'IR. RUSSELI,: In terms of transportation there, @@7e have found on t,io trips, that to clet to T7.elena, "Tontan,-i, one must ao to Portland, Oregon and spend the night. '@"hat's @.'Doul- the onl-,7 @@7a@7 -%,,ou can get @L.here. IT 7, S- Ac @- ii a 1 1 @7 , ,.7hit k@-liev are trvinci to do is -.Ti'-'@ this @ll',000.00 is C.@@-v-elo-cD local resources and train I Peor)le on trip. local level to I)<-@ able to T)rovide the hiqqer I lov,--3. 04 DR. @ut t','Iat's a criticism of manactei!l@-nt. ljl-- should, -@116 tlic-,rc ancq. @207 on our sheet -- and 117 else that difference is that piece of iDancr and riT Irincr it t.,.,ie @-e3-lo,.7 You are I.oo, L'CTT71-'l DR. TE,., Could this be a typocranhi-cal error? DT@Z. T"-IU@'LM: it %@7ould be less tiian a hun,@',r@', babies at the rost it @@7oul-d !)c 1','O Keith 8,000 e-l-nected births in this bonulati-on and that .@.,ould, of course, not i be every ba',D,,,. II,', CITI%Ill'.@"L7'@T: .navbe @!ie have -- I don't kno@@7 Diclc and I @,7ere huddling here mi@7be, @@ic have an ariti@.,:naticzil- error -- 'out the sheet ..7!iich you have in Nrour boo,',: ancl. ,,7hich I alather T)r. @hurrLian @l!as lookincf it, is a staff ou--out. 254 t 6 9 DR. THTJ'P,@l-@q: And Imlooking at this too it does sho@.@i 116. THE CHAIPZ@@N: Yes. DR. TIIU@4PII: But even at 116, this project is glittering in gold because have intensive care over all the country and DR. "'cCALL: Pind they can cret intensive care every place else, too. DP,. T7111TR'-lT,@l: But il you lool,: at a lot of this is -if -,.lou looli@ at the staff s'.ice@, and cTet hung u-P on that, voti are tal'ling about $1.5 million for continuation of eleven projects and some of those -- the last time this came un for revie@@7 @,7ere DR. lIcCALL: @,600,000 for the eleven THE CHYIIR:l@l: You're tali'-,ing, about the continual.-io,- DP,. TIIUTI@?,' L@Tl in the continuation they are askincT fo- 'el.5 million for that. THE CHAIR-PLZV4: If there are no more comments or questions, the notion on the floor is to aonrove $@/-.15 millions for Mountain States. All those in favor. .7as regularly, put to vote and 0 r@'Lotioni (Th carrie(l, %,;itl.-i 6 in favor and 3 opposed.] 2 5 70 TIIT-' CIT-AI IT'," i@',l i thii-ii: it v7oul.d be good, if the concensus of tiie groun, thoiiah, in reporting your recommendation to Council and assuming tliev agree in the feedback to the !,Iountain States @-,IP -- that to indicate that there @@7as some concern @%7ith the dollars invested in some of ilo-se ,Dro@ectq and singling out neonatal, among others, as a aooci example of ti.'Iat. DR. TI-1,SCTI71,j'.,I: I @L-hinl@ we ought to have a decision n o@@.@i a s to @7!iat the actual ni-inber is. Tf there are three or four -- v7e have several differ2-- read4j-iics and there oucht to b(-- a @7ay to tell the DR. TTEOI[-,, I tiiin), @@o;. have to acc--T)t theira@,nlicati,,-.-i as the DR. TESCII,@,-T: Tii,cre ire t,,,7o T)laces in the a-o-ilicatioi. One is the 16 that vou are lool,,,ii-icT at and I ,.,7ant to j@no@,,7 TIIE CIIP.IiVIA,.I: 1,7cll no@,7 I can see -- 16 shoN,7s $234,000.00 and that includes indirect costs. DR. THUILNW.,I: They mtiltiT)lv one vear bv ti,7(-). ,'L "R. RUSSELL: T,@7here are you getting the 116 from? l,rnat pacTe is that on? DR. IIESS: Paqe 105 DR. THU@.IPil: Tmd page 199. ,:TOT,7 I don't mean to get hung up on the intensive carol 256 104- of 71 There are an artful lot of high nriced and an awful continuing projects, and I thought I would just go along @%,ith the advice -- DR. FESS: I%Tell again, th@-s is an area-wiclo thing that covers four states -- and that's roughly, $ 25,000.00 Der state for developing this care -- and I don't think tha t is excessive at all. there is some incongruity, I thing, bet@,7cen the ar)nlication they have prepared and the fi-aures on the Form 15 and 16 -- @,7hici-i obviously don't agree. 'L'he figure that @,,,c have translated to the nrint- out here is the !Porri 16 fi.cTure. DR. TT ,.IUP@ ,LW,I: Yes L: I'll see if I can find it on the RUSSEL other sheet .7hen . . . (Lauqhter.] THE Ilell are thev askincT for t@@@o @,-ears? DR. THUPJW.,T: !,To -7lPx. RUSSELL: If I could call your attention to page 21, Consolidated Budget Request -- 21 of the At)plication.@ Because I think this shows how I-lountain States Programs it's right in the middle of the page. The 116 - 231 is budgeted as a discreet nroject activi-tv -- and add to that $91,738.00 which is the rest of tl-e Peaional Program -- the cost of that. 257 @it 72 That brings the cost u,,) -to 207. DR. TICCALL: That is what I Questioned. That was the additional budget allocation, on the staff -- looked like about 45 percent of program activities THE Well., I think that one of the things we have seen, or at least I have seen, and I susnect this is ti n Ilountain "tal-es: Some of the more sophisticated .ie case i J. rerTions (if that's the adjective to use) in California certainl-,7 in tlii@, cl-aF@-@ at this juncture, from the manauer.@ent stan,-',,-)oint -- California i.@, ;,)udqcting a aood deal of nroc,rr.i,i a!-, sort of c). -)rojec-L, i-tc!rq and each of the at froii m@,, -First hand observation r e , a rcasonEt'!-)le form of nroc@-ran. buclc-f-cti.-ir' k--iaat seeriECt to b- so that a Chuck @@@-ho F,-)enOs, if not 4ull. tir.,-?, a r-alor -)ortion of ",is ti-c on health services educational 4- activities and and one or @.70 oti@ler neon3.e -.7ilo ar(? tire T-7a'7 arc 3ct u@), the people T-7iio 1-I'loni-.,@-or a nar-,ic,,ilar nro@ra,-n element the-,7 are sort of the cost of that -.,oroaran@ element -- as a separate nroject -- and there --a@7 be 90rie of that here, also. There ma,,7 be some of that. I don't think it is thOU(T;I. -h is i@, ti-ie case: say, for examnle, that t!iev are going out into a Programmed area and they will call a T)roject like "a:cea i,,idE-- neonatal voii I:no%,7 -- that is a r)rbcfran. thrust 258 that's a project -- thev roay have two or three funded activities t 7 3 a contract, or an agreement etc -- affiliations So to save title, they have budget set aside like you know, if thev need to support a Governor s Confercn@c-@ on neonatal or @,.7hatever, then that monev is considered a "reaional" budqet rather than tacking it onto an individual project. DR. THU-Pl.Uli: But I think I hear @.,hat vou art,- sr-i,,,7 "L n (7f 1 but that sa,,7s that they have act $54,000.00 -" if vou go all the .,,a@, 'reach-., to ao to consultants to nut on the regional oroaram. nut vou cet hung uo on one nrourar,,, or one and that shoulon't "De. it's the am S,,Dcakinq acainst, to do overfuno@.ina of loro4ec-@s -@or i,7hich there is n o vi I and the over-fanding of continuation t)ro-icc s. @l..5 -Pj-llion of the l,,2.1 or the @2.4 that tieN;, i-iav,-- requesteo for continuation nrolects -- some o-F @@ihich are six and seven -,7ears aao -- anO that is not cTobd management. T )id vou move that the staff and that th,--v should pa\7 Particular attention to this? llr.. RUSSELL: Yes, @-le N,,iill clcirif-,, this bo.--Fore it aoes to Council. !)P. IT',@,TSTIS: I @-.7ill sunnort th-L S . cl,.iri-f@7 this. O.K.? TI@IE 0. 1,. 7@nd this is a prize item for it did vote a Council, that the @-7t 74 of 2.15 -- it had Some cicTnif3-cant concern in this regard and -ie Council ,,7ith some lior,eful.1,7 reacheO. out and -)rovicles ti ad-itiona'!. clarification so tli@,it they might talz(-- a critical ci looj,-, at recTion, nerh,--).r)s (lifferentlv than they for most, 1-@--caiise -L-heN7 are accc-,pt3-i-ic,- ,,our rc,@corn-,,ncnOation. DR. The amount of money for each of thesel activities it @,,,oulci be hel--j--r-tal to tiic-, determination as to accurci@o or not. ether @USS--ILL: Yes, T-jell I think I @-lould have to r)oil-i- out '@.lere thatn I-oo@ed at of tlicse activities, it lia@> CIS e- continuation and t,iis i-,r--,ans tTiat thev are I contin.tiina in that nro7rari area. T ut "I t@7 la+- ',,cC.@LL: ycc@, 1, sai-c actinii 3 T) P.USS!'ILL: '-.Tc), no, does not !-,ean the sa7,e activ@-t@7. 7@-re ,Te on ti-iat 'oreF.,'I: vet? TliT" Yes. [Lauqliter.] I,et's nlease he bacl- i)-,7 a (-uarter of eleveni c to o more re,7@-ons @,ould certainl- Dolis@i off at 1 c a s t t,.@i- before lunch. [The assei@Dl@, recessed for cbr-fee at-10:31 a.r@i.] [Proceedings Caere resumed at 10:501 wt 75 TIJE; CIIAIPIITIIT: I tt-ic)ii@4lit @.7c N,,,ould jumn to tire "@.ri- State, at this juncture -- that will talze care of the last of the regions @.,here Dr. @IcCall is a reviewer, and that ,,7ill let hi-,i, without anv problems, cTet a%.ia@7 bi midafternoon for per his earlier understanding. So @-7e have 1-7ister Tnn and Charlie on this one. I don't 1,@,noT@7 @rou t@,:o have -- I s lj, a@,,, @,,ou hud@. at coffee --- I don't I-,no%,7 @,7'@-iether vou had aarced as to i,7ho @..,,as cToinc@ to lead off, or T @@l TTITI Chirlic Massachusetts, Island, and Hamos'L@i-i-r,@. DT'. '!c",T:,LL: 71,icht. T:iis is three states 4r(-;-,L 7-1/2 @,illi-on iDconlc -- and 'D.C) of that 7.5 million "Joint ,irc! ana 11151), in '!assac'@iusc--,tt,7,-, 7,1,',,')Of) in o d T s !an(]-. i,xnd at the outset, I tl-,inll--l I @,,,ould also noint out in this T)articular a-,),n]-ication, as far as additional no@@.r -T activities, "lamT)shire is not in this aT)r)licati-on, buL'- t, iiey @7ere a little qlo%,,cr in getting tiieir revi(--@.7 and t7,iincTs in -- and olan to come in the -u-,)nlernent -- .7'liich ,7ill Le tate" is reallv, in the Julv I annlicati-on. F)o the "tri s as far as this is concerned, a "bistate"' of ,,Iapsachusetts and ,7.hoae Island for this particular aT)nlication. 261- 7 6 o a 1-1 t 1 c I-) i t 11 1 -f u initially to loolr a 'Little !--it at tho, Iiistor,,7 of t,i s rccrion, because in ri-, in ad(liti.oi-i to a col-i-r)lc o:i@ oolic,/ @.,ucstions, it's not (-)tr tied r,,,Ftjor cTu(--,,;t-i-on is not s much as t',@C ,ioi-nci to le (Ti),alit@,- of staff ii-icl r)r(,)oraT,,i, ci func@inq level anCt it'-- i-n rc,@3.on @@7hi.ch @.7e'vc-, had a ra-,@_licr c-,,T-)onentiall-,7 risinrT of fi:,n(.-).i.ng from one 1.2 .@ill-ion to 1.,?, to 2 train irtr@,7DincT to mi3.1i.C)-', in lc"73, )ri-or tot le T,-,,ith a current six r@@.ont@is I aiicsi; tha@'s a si-- current level of 1.@ months level c, I;o that at th,-2 -",(-,n t t 7-i O@ o n u z i n t 1 i -2 c@ o n',- r,7@, c@i i n ra2-@-'[).er t t' zn@ at curr@n4- @L b @'L-- t e rncrs-)cc-.1 @7e. l@L. ric-ans t'.iat have hid c-c)ocl,, e:@nerienc@d at ti@ s-L-a c s a f , E,, @-, I me n t i on L .7ac- a --a@-h----@r ':)4L(-T r--,taf--- in 173 !)u@. -',-t 'ias ',,)ccoTi-c a ra@@l-@cr s;,-,-all staff at this point in ti--c-, @:ith si,-: full time r)rof--f,-si-on,@-,- aiic' five T-.ar'L -@ i:,n -And t',aere lies also a -)oi.i-it t" at ,77c mav Giant to focus on a little bit in of -it aas come u-o u i-,., --1,7 ..-,Iiat n,-irc: tii:ie- r o f L@ i n s and 1 @62 of sa-ric@ t 77 The nec o.. r,-@ c c, iir vj,,, _so !:,,v I-'-,-ie @Dtaff. l-,an,-,cei--@nt as,@c-,9F3 T Tlaci-r TDroc@rarq anO.. aoalr3 of o@Djectives are l@i.nd of interesting. Ihc@i are verv cancer, in 1-)oj.ntin(7 ou'L-, as 'C sa"7 resr.)ond to nation 1 70rioy-i.tieF, @-ocv,.,@ ,-in,, to match tliesc to collic t', iria-k7 @DO E',. little @,lorc c-trateT,, is not c@i lnal.,7si-:, o--F Ca,@a fro,-.i the rcuio-,, ncr se. But it scc-,T-"s to I,,-- cct,,.r@t@r't:)alancc c)-r is th@,t as @,ou a-@L. @,ro- ver@,r c, is the t ti C,.7 C, Li sa,7 tl)at I as r(.--sT-)on(7. to national t'-c dollar do d,,3al it n a r a s,,D n,,i",,'Le, r.@ -.he,@ use this .-ien Area-,. lo-': -Ij- There are a C-0t, 4 n t,ic icatio, F-,, t,'-.ere are- a@ le@i@)- one or t-:,'O TDOli---'7 i S S 0 r z,, "holi are rec-ucst-Lnc in tli@ ")udaet, so,-ae -T 0 $2 10 , 0 0 0 to bont_T-act @o,,- t'@,@ n@,anac,,eTro-nt anc7, -r@.-@onit in 1976. no,.,7, t,i@,@t CTT7" I @,taff a,,ic. --cc (-,7i that. 2'0- 3 ncc,@df7, to 7L') an@i. ti-iit had-> to (fp-al,t. with. Nc),,..T ,,7h,-,t is C,,- -:ICti Vj 4-V '7( and 1).avi.ncr the (Trzintc-,,c.-c or in 1 dissolve a contract @,7ith to r,,,onitor the contii-iliiri@l activi- @,o as .,,@-n(i the T),cvic@@': (-'nnTrittee needs to I-lee-o in r-.iiid -that re,7,iie.qt is for $210,000.00 -- and it could cTo one. i@7a-,7 or anotiior dc,@,@ndin(- on 1.7",'Iat t'@-@e T)olic@, decision is. T-ind the other is, not onl@, @,zit@-ii-n monitoring 'L-,",-Iat ro-queE@t of a little over @200,000 -- it' s for a fourth @,ear of fundin,,T of an f-@VIEX] a --.hode Island !T--cilt@i SCi(2T-,(-_C !',JU(7-citiorial Council, ma,ibe state wide in Phode Islan,@,.. And @.,Ir. La@,7on, -.Former Denutv Coo.-di.nali--or, has returned to Rhode Is]-and as the Direc't--or of 1; -,:nar- C@r4- 4. C, Iar nroc-r@.-.@ 7@tE-@te-,, a n in scc)no. o --"c- Coord4-nal-l-or L@cr tn@ @-riS@-a@u-e at a l@, )@@rcrz2n"" art as onc of the na there. So -h-Lni-, that nc--@s to he focused unon. it sceis to ir,,e that this thin(-, -,7a7, founded is t,-ic-, second Vear of its funeL-Inc-@ it Tias funded ini-tiall-7 at S600,000.00 'i)ut oot off to a sloT@7 start, and 1 -@hin)- this is a s i rT,,'i if 4-cant a-,T -iount of mone-,7 %,,'@lich is left in that, t'i,-lt thc@7 are. ii,,iincr at the monciit. the comments in -,io-tir ,;ta-Ff you micT'at V4 F- indicate in one -L. t, ,7a!-, c.ijc-stion o@ @t@, i i of-fec-ti.v!.2ness of tiie %,,7a@7 tiis @@7a.9 c I nd -,7et sitic,2 that - joi..ncT -- a - i I I i i i i i I i 2o@ 4 7) 4-ho c:t@ this one rial@c a. con!-," ,ooint t'!i,@re. F.) o tho7,c, t@,7o of- til@ r-ontractiiic for Ltnd That fourth @7ear of that f7,tZ@,tC -1'7i(lo TDroject oil that lev@,l of '11000,000 thin', %.7c)ul(-'L t o a ti It sc-e-,-rl.7, clear t,.-iat T 1-@,,nd 'i-la@d sc,, Vit i-n i-id :the F%, 4 --,I -o@cther so @,ye.11 i h 4 a 4.- 4L-. a Ion'4-. '.role 4L@ a TD r r i t h t u@ r F. 4- far one has a r@ro---,c-L T @Tivcn -,-e a co@-! o 1-@ a 'L c i IL- i, --ccr@'4na,-or, T.7j-t"l anei it secr,,r-,C, @n@ ';-!ad to do I.,7it'ji @.'.ac@ recti-onali--ati-on of ne,@.7 born car-2 [LaucThtc-r. -,2d to car to Dr. attention. (Lauc:,T-.it,@l-. DR. -T!,TJ"T 7: Cc)o@@L tlij-ng I'T-. not -)arino@(@. i)@TI. I lcC,@ LL: And 1.3 -@@(-7@ncy that voted ('is- ra-'u-cc' as one ar),nro.7ial of the t-,'.ii-nc, 0 e ai)T)rovcil o@L 71 roject 1,i 3 t r) tlii- 13 ad i 1- 4- I,ia-d !Dcen involvcc' bV a particular cot,,rit.-,7 ,)eon -Fact the c--, o'n, )@,,j t t' a t ha@ t'. it. not to be include, to b r@ in @,7 j- t. @u-- in an-7 event, it ha7, r(@,-qov(-d no@,, Lind f---ror.-i ti.e bur"@c,,c@t, @-;-i-i,ch i.iivc)lvec@ ti-i,-it i)art-icu',Laa- cc)@-ant-, 7 c', the ot'lier area o@,c iie(-ati resnonse voi! aca to do a c,?,rdionulr-,oi,,a-,_-@7 ),nd of-: c-c)r-linetic,- @7-i for rc3u:-,,-,ita 4c. and t,.-)@-s @,,-@s n --.,.,n t j. 7, in tili.F. ,'n@.. I L--hin@: T f,@el /c nccCi more E,:t:a-f-!' co ..,.:.-nts @-T I 'n, -@, --- -n,@-7- -@ @- -L.@@7 t'irf-@e -nc- t'ie ceo(.7ra of the n,,r:,;- and no@ -eall,,7 un 0 -F o- tho C,,@-c7rce of o@ 0- - r_ I 0 L. a,-. n 0 I r e v c c c i c--, n t I Flrl SC14-iS' ;@d the@, !:)einc-i cl ealt a n@ havt:, no reaF@on to -1-irec states @,70 c, n 7,'i i.,D the uld 1--,e un@3a'L-isj',icL--or@7 but if I not correct, T v,.7oi,]-d lik4-- for to the !7)tclff cor--@-,c+- t'-iat ir,,-,Drc,@,@3ion. T,-icro- arc C,,q of tj ,c-se in 266 i negative comments b-,7 sho@@,-i-@ia that they had, in this annli-catio".t wt 81 erroneously sent in a letter -- and I belie-,re it @%Tas a neqat-.,,.%"@ one ijhen in actuality, it @,ias part of a project iil-iich @,Tas removed. They are also I-lurphv has, as a result Of the Revievi @roccss, nut on a CIIP renresentative on the Executive Board. Ile has funded a $93,.OO@0.0@ A 2NcTenc,7 project in T T -ilre 2%nd so b,i and large, i think the A and T3 a cf n c,,,7 renrenenta@@iVef-, arc going alon7 nrn@@,--t,7 ,7ell. I T"cr(,- vou th-ouah, Cliarlie? DR. "'!cC2-1-1,L: Yc7,, @L am, TIIE )crians can c,!e@ i i @-in's re-,-riew of this roc- .,..on, -T .,ion. @,n @.1 t,, corl,--z,.inl,,;, col,l-Lnrl ba--"-. to the r)ol-ic,7 issucs aron(.T o--her I thin',: t'-Ia-. haic "-o7ne auiaancc, an@ so@,,- idea of -,!head .,e are up to on that one. SISI-1-1", P.,NN: I really don't have anvthinq to add to that at this point. TIIE CI-IAILl.,@,l: You @,,,cre on the last site visit STST-:]I'@ 71-NIT: ilio, I @,7asn But,I just likc-,, to kinel, of see ho,,., soi,,e of nroble-..@, I have heard over, in(I over ar 2.een jain, have resolved. T@-jell, i'll- leave the nrobl@-,r@, resolu'-L 'I (7 r 4-c)l,ov. cc)- on 32 i-n (-@@'-ct, to all of trip c. D n c),@i to sea 1 Or'- c e c c), c c n t r C-1 @to fvndr, o'DlicTattcl -for l@75. r (-,jcct hcrc--, nii.@,c],17 c-, i!7) on,@ @,tl(7,i r, t 1, e f our @-'-i o o @)Ol i@C@7, tc) 0 r (D-@ C) 1: i o, I c7 c --r t c::! r; c-- -io 7c are !7-. t to form "O@ or 'L-', -@.Do rccc,--- 11-iii7, @roun to,,-,'a,,, 4,-.' a @u'@ a c,, a c) -1- cl o n t'-, untj-'@ ccin T'- to t'--iore role FirjoncT @,c)r@o r,'L-- E.,, f f n d n t,,, r-oiTi(-T tc) sce ac@L-.ivitc.-,, at I.--a@@,t a 4-. at -l-,@a@,t r)c)inz 268 8 3 ,,7e are not ai.lo,,@iin-, any rro(!,r Even not considering net activities, %,7ere t,.-ier,-- thincrs contracted for that lona, that there's cToin@, to have 2 yt 84 to 1.)e lyic),,)3'-torj-nc., o@, rc(7,arcllc,,f-,s 0-c clone 1-tere? T-1 E C T T T or (,c.,rrv can '-iat qu@-sj-ic) don't-. IrnoT,7. n of nonc, I)Nr excerit T"ITi,')EC t',ie onl@,r one li@-3.n(Tina on ST,'-)' OV: the -nCiituro;,s are nc,@ i,nii of TDro-iected mon-L@'ily (@@:@i-)en reac'i,,lng a po @liture ral-c an,,@ t' once to c.-irr,7 thcri over to the ne@;, so TI(l n ",!.i r - '-t i d d th c r,@v t'@,inir tl-i,@ ans,..Tcr is -@4 lol- o@ r@c)nc2-%7 T) r c) (.,ever f red t 7 '7 r @@-0"7 rl@Cil i,,,a7, tha@l-? 0 O,> @,z-cnt @;201) -- i little 200 so it at 59-@, a '--le lc,,,-,s than 40,I),OOO tc)l--' r --ic-v %,?antc-,Ct t'ie O'@)O . 00 for a -F- -,ca-, o,4!':4-c,@r, a a socrct,@r,7 and an evaluator the,, nee(aed soT-@e sun-,Dlic5, some travel, fri.n(,-c !)cnefits for tho--- grou,,--)s a.nc@, t'iere is a i-)u(9gct cchedulc-. coordinator -,,'.,o,.nted, -i,ilien (7,irciiL-,sincf this ,i@@-h @o, Has very @-)ractic@ll @qc said), !,lion they qct t@icii.- - i I i i I I 270 a@.7ard notice, half of the Council meets in August." 85 T@.L(,,rc-, is "x" number of months for these T)rojects to be VLable. If the grantee, which is a free stand, has to clcse, he reallv has to terminate his projects around February, for him to close shop in June. So it hurts the project, and at the same time it @-iould not be Practical unless they could find out 1,71.iether the free standing grantee SIs,,-7Ep\ is this goina to be I-,ina of an e-z..cE-r)t--ion in this cas(--? or is this the beginning of a net.7 "ASI'-,: T701.1 cis I sav -- all the free statdina cornoraL@ions TDrobabl%, @ace the same thi.,nrr. -LIIJ-', CHAI !P-ll: mLhe-,,r are the only ones that have -oroooser-I to deal xyith it this @,.7ay, and as I ;aid., Olis-tcr 71,.nn 4 Ln staff, after some agon3-zyn7 discussion to date, 't7oU ',.-.n OT@7,that t' it nrobler, 1-7OUld have to be .1 handled in some ,,7av. 1,3ut that v7e ,.,,ould permit, on the one hand, proaram activities to continue bevond that point in time. I t'iiinl@l, you ',,:no-,@7, this is an issue quite anart fro,@,.l tile LUISOttlCd POli.CV -- @-7ill- it be oermitted is somethina that the arou,-) can address itself to. T 7 not have -- as a result of the deci@-j-on, t,7e C M ,aV may not iiave any o@tion, it ria-,, be -)rccludc(-@,. On tile otior 271 lianO,, the aroup may have vie-,is unon the Oesire,'L)ilitv of it in any case, I Con't I:no@@,,. i don't think there's much eisDute i in some cases. T don't knoT,,7 @,7he@tlier those are the anoror)riat(@, ones or not, but there ;7ill @)c a legitimate need for conti-nued-i monitoring b(@@'ond the life of the nroqram, and there should. lie a reasonable mechanisms for dealing @,7ith that. Does anybody feel differently al@,out that' @-To@@7 @ii'icti-ior these T.)rc@,c@nt a legitimate need for continued monitoring or %,j'lieth(--r this is the best r,,@,@clianism, I ju@,L-- Con't kn()@.,7. '.ilat's ei'liat has been the @@!ith '-he O@iio proc,-ram that Islas, out -- then of their .ic@@ivitics ll)eina monitored r T,1"17, Cl.L AI I (zon't 'J",no-,7 if aii@,t"linc7 -- I c,@.n't sr),-ak: to it, 7ohn -- one of t,ic-,- nhio zictivitcs, for ti ,iere ;7as an activj-t, J. u-,n in the ClevelF@.ncl- ,.,7hich .ias continued a@fter the -,.;r)rtl-ieast Ohio @,,7as nh,@seei o,,i-t- it @7as continued under allr9lO arant, ,.Tith fu-i&s coincr directed, I T A .1 , @C" to t',ie I assurie, ')ut don't realIN7 kno@,i, that the r.,-onitorincr that has tal@en place in that instance has been essentially,,, sta4@ rionitorin(T. you l@no,..7, from. here. There is not a .,IorIL--i-ieast O.,-li-o !Z'@14,P, I don't think [Case -,,"'eastern 'Z(--!3crvc] .7!iic'i -v7a,.; the grantee in t.-i(-, ol,-l Ohio cast 272 an@, r loncr sllado@,.7s over t,L-iat. t 87 14ASII: No, they are d.oin(T the evaluations frc,,,,n. that activity. B,,, the @,yciv, @@7e i,7ill se-- that activity in a later a,@,TDlicati.on in I-Testern P.A. j--r @-io- get to it todav. "'HE i,7(- have heard from iiAF)IT: 1"),@cuse ric. In vie@@.7 of the "IIT,.'Sr,,C thizir-T @,,'-,,iich concerns r-,@ ri little i-'--roi,l Staff -- the fact t@ia4L. @7e have it.)out 401),r),00. le-@t over fror,@i tiie first tT.io years anO, @.,-ie-v are aslz4-nj for @").00,000. T-,",orc -- I don't j-,no@7 t'--at concerns anv of @),oii necolc, or not, but T)'?. ,!cCALT@ it does T'r!E CIT I-,ring to tic attention -- nerha-)s ,7ou ?ant to elaborate. There ,.Tar, a staff visit and this is pre-7-a@,7ton involved, I believe -,),ou ;aiO, T)r. [@lar(-Ilulu@;] anci. @7,@s the of the proura,-.i, is that r4.r,,ht? !T.I\SII: Yer,. J..Le c,,,-iest-Loned as to @,71,ic-ther that T)ro(7ram N.%ias on tarcTet or not. He fell, they 7ere rToinr,, bacj'z into the traditional sort of Health manT)o,.7er activities rather than follo@.,7in(-T the concept. -So nerl,.,ins .-7ith La,.,7ton there, the,.7 can get the th4-ncT back on traci: but I jur@t ,.",oy-idor if thev rcallv need '--,iat muc'l iionev. SISTR@T' I @,7aE, just looliin(7, at this 6.n here 2 7 on the line-here and the 1.4 next ,ica,r and you Should ju@-L- t 8 8 @-.i-nCt of I,,no@,-7 that t'tie,7 @7or(,- ovcrfunding. S-)eal@.incT of L'u-IeLincT, I have a concern: Pi-ori t"ic@,e caption descriptions, the real ,7erit,,; ar--@t clear -- at least in the Countrk7 nuicle -- but here lo 7 t@ ve got n-rolcc 3 ,- r t,iev are aF7,lrj.n(-.T almost a 4- t lic-il@' million '@)ucl-@, -- aof ii(--altli nolic,,,- in "aFscic@-ILISO-@ 'I .1-or @?230U,000. -L'call.th services in tiT!,.e of 6-,-onomic trans!-ti-o-I 2 5 0 0 '7 o,-7 1 rion't !,,no,.@? @,7]iit t'iev Are like, but sicTht unseen I l@7oul.d li',r:o to take those on, on an entrepreneurial basis. DR. 7@cCAT,L: Anc7 tiie onc-,, that naval 'jase in -PI-Lode I7,la.-id D '@n, . TT@ U, -7@' @L@ -i Bo careful no@,, t,io're qoinq to call @,7ou a "T',-cri-@an" if @,oi-i're not c,,ireF-,.il. [Lau(7'i-itcr. T, I c7.on"L- -,,,ant to annc-ar c@,,nicc@l or arce'-@L 1 1 Fi,' C'.T o ar the snonsors? I"n STn-Lr)@l: rOhe rovernor of @ode lo]-and snonsors Phoac Island one; th and ".orri,,[,)onnaliucl, t'lie -Forrc-@r Pr--si-C-,ent o-@- tie '-7tate L(@uislatur,-- and no7..7 @%7ith the T'niv,-@r@,i-t-,r ,@as ciske(-! to looli,: at the -i transition to the legislation. state policies issue a,.F, c,-uc,3tion staff rai.E,,e(I in reference to ioO,-@ Island -- ind called tl(-, T'!:','7 "C-Igional r)ficicc toa 274 better handle on it -- @.ias the need for this in @hod-c island 8 9. for t@,o counties in -,'@iode Island -- but the Staff told us that one out of every ten T)o-oT)le in P,,iiode Island Caere ui-ierqT)lo,7 as i result of the D--f(--n!7,e -niillout, and in the ti-7o counties one out of every five jo@)S T.-7o-re hit as a result of this. And half of tiie jo')s %,,,ere "I("Ivv and tl-ic other half @;ar, for 4 .,an sunnort of- the @civy installations. And the C-c)vernor is bri-nainq ne,@7- industry into the area, and there is a vacuLim i-7itiiin t,iat area of the hcaltl serv4ccs it 'De later -)erforT@Lcd b-,,;, I',"O or -)repaid h@-alt'i -)racticrz-, or sorietlj.liii(-T I.il-le that. TIU- they felt that this Has an area :[or focusi on at this tiTic. to this nolic-,r s ttid@ in assacfiuf7,etts, mv,ctuestion @.7ould @,c: I,,That in tile hel-1 r@ Cl:.'LP @nd '-',"-T) l@)een doinc7 'or t'-,e T:)ast six or seven -,,e,@rs i -F it's croinc- to talzr-, @2@@8,'-)OO ';-,uci-s to come u@n @,,ith tl-lat. I ould thin.'-, that ..7ould have been the crul--s of @il,-iat thev had been doing. THI@ rcrr,,7, do @7ou have any 'ili,T?. STOLOV: VjTell, I can only say that if you read the CIIP reports, both the A and B, they do sunport the nroject, the,7 feel it's a necessary niece of unfinished business that t,',iov need in the health T)lannina transition. Tliov did question @-ii-let'lier the U of ',!ass @,ias the 275 (-:.ncv or a governj--icntal- acency, sin,.(-- the rrovornr,,,cntal Drol or acT 9 0 the @li.cy is beina made. But agency is clos-@- to @,iliere they did support. This came from the anO B -- and PIIIST.'C -- T,7ell I hoar Questions, @@eing raised at least !)v Barroi@,,f-,, about t,.,io of these- larcTe studv nro@octs. I car-, onlv speculate, -'out liavina sat in I t@iat closing of tire '-@aval. !:)aso. at '@7,c@@7r-ort, there literally f-iill -)aco ads in botli of the Tlar,'@'lin@tc-,n oi-,Dors over a ncrj.bd of I su,,-)nose -i month not ever-,,- 0,Ei,,7 "ou @l:no@,?, sort of )ubli.c ad@, nleadin(- -,io- @resido-nt not to clo e the '@ase at cK,,t--ntuF,11,4I done,, of course. @xicl no coast it had a vcr,,, c coffee,c i r.,-) a c .,-knd also, Ialso acinncnc(', to that t"ic of @iocle Island is tie Cliai-rrian oil ti (',nvcrnors' "c-i@r-rence you know the Conference of r@overnor@, held a cor.,jnittr-,e .-- he testified in t"lat capacitor I)--for,2 "(@,nate on the 1ealth ,Tl@sotirces Plan2aina lecTir@leti-on. r.i',iosc are just facts L. @,)ut Niou knoT,l the nressure I ar., sure for qettinq as manv Federal dollars to fill that !'4avy vacuum in 7'iode island, you know the 7oolitical anO. otlier ,)ressures, 1 suspect, have I)een verv fierce. l@'ilel-1, I sort of read the ou@stion 276 as: lio@,l vou spend ,i quarter of a million dollars in a k7ear, and get something out that is north a quarter of a million? And studies in cTeneral, tend to be T)ublished and never read.. this is the type of tliina don't kro-,7, "C can't resolve it -- I)Ut T don't kno,.7 Conarcss can intelliaentl@7 evaluate E,,n,,,tl-iinc @,7hen t,,ie-v c-ot ti'iir@ @,ic3-le,,r !IOU-,e stuff. are, deali-na Keith t-,'-iis (qisister oro---,IL-7i @,;ith a re@ional medical i-)rc)@raii mechanism -- usina t'--Iis. to treat that o, this is T-iorclv T)t,ittincT -i T-),ai--@-Aid TIT'S C' on it. DR. -!IcCALL: Exactlv. a quarter of a million !Ducl,-,s is just oone. @l@ - S"'OLOII: I dir, d. ti-ii.s with ['Ir. '.-7alkor] c "Is @ c T,7ho is the neNi I-oordinator o4 -hodo island, or @.-ill he t"-.e nc@i Coordinator, and I mentioned "iirnh@,- s stud-\7 o--F the .$1.40 ner canita goina into PJicde Island, as onposed to 45@ in @iass, and 75@ in Ilampshire -- and although this is an economic disaster area, uThen you look at the @,7!iole state of -Rhode Island, it is a large project and i,a@,7ton 277 N,7t 9 2 said: X@7e @.7ill be lookina at it, not only froin the t@,%7o counties, but T)ossiblv utilizing it for the State But this is sort of off the record, but the question has been raised, at least to Tic. '-"I P, .BAP,@O"IS: To me it loc)]-,s lil@e t@7o professional staff goodies. rPT-Tr CT17@l@7,1'A@ But to get ba.cl@ -- sorrv 1)7@? '17T -).n I refresh m@r m(--mory, c 1, SITS: C@ an I have r..l.y r-or,,or-,,r refreshed? TIIP, ro ahead, Is the -- is t,i.is the same -nroject as has t'@ic healt'i nl,@n e@i-icat.4-on T)ro@nct that alrcic7,.@,7 ;,.ac; @,400,000.00? MT Cl@ 7, , that's their activity, There there is annarently a carr,7over annroac-@iii-).rT 8400,000.00 from -Dric)r a@..7a-@df-@ so are til"3'-na aiDout rouchl,7 for t-.,,,o for that activitv. r-"h i. sis lec-al -- just jes, or no ,k4T3 OT,Oll Ye@, . The i-,one@7 is o!Dlicateel. DR. 111',SS: Could we -(--t a description a little bit Tiiore? I think it's very, v,@rv difficult to mak6 an,i kiftc! of C!7,-,ential juda,-,iont on a one line stateT,-,.cnt of a title of a project amid I 'L-.'iiin,-, it ,,.Tould bc-, hf,-lT)-Irul, to r-.c at lE@a@,t, to kno-,-7 @.7her(-- to fit in this tikiing if @,TC could hear a little 2'78 more description as to @-7h,-.t these t@,7o r)ro4r@,ctr, are wt 93 the science and (Scic-ncc,- Council) an(. the health services in time of economic transition. DR. 1,@cCALL: The I'@.ea.ltli Science -@(.I.ucation,,,l Council@. takes in -- the r-,erbershin includes all educational liealt)i services institutions tlirou(Tli the State -- pu,'Dlic and T)rivate consortium -!iolde(i into a data @,a!-,e which couolcci the sophisticated de-termination of their needs and result o--F iaan-c@17or su-)-)I@r and distribution c.@ianqes ':)one f it. S-necificall.y, t':iis Dronosal is ask!-na fc,-@ i four-l"-i-l DP ESS: is the roncv used 'or? DR. ',"cCALL: I ,Ion't I-.no!7. !IESS: I kno@@7 these one-nacte summaries are ri t very e-.,-r)licit al@Dout these. for e;,.amTDle, is this to some of it T E,.Ill sure, is for administrative niir,,Doses, or -- is it to na y for facult,7 or for conferences, or T)artl-,,, su@-)oortive ,T)R. "ICCALL: OIL the @200,000 re(-udst, 123,000 is salaries and i,7acTes, In that request is 5,000 consultants, 813,000 rent @5,000 communications 279 ,.?t 9 4 $7,500 corqDuter clita r)roc@Fsii-icT. And of course I ',save nothina at all concerning the $400,000.00 carryover. P,nd navl)e -- I have not I)eian to the region at all so I reall@r can'-L. -- @l]-, SS: T' , o@.1 -DR. Tnanv schools are involved in this DR. :!cCALI,: The nUT-"-)--rf7, arei-i't in the sui-,mar@, list at all.. @,11 the institutions in Iceland MTT- r..an@7 are there? .1; @@rn @..n@, ar@ cor,,-,.munit-,7 colLec,-,c,.s Ei@, Tell, in Tiho(7,-@ Island, and La,,@7@-on' f--, letter T-,iay 'oe snecific -" it c'@oes snell out-- P,s to the $400,000 fiourc@ treat @,7as as of a fe-@@ r,,lontA,is ago -- so t@iic sr)on@,,incT rate at the end of this fiscal vear nro;Dablv @,!ould be reduced They do -Dlan to do a lot of subcontracting locallv and if -,iou T-7anted to comment on that, Dr. 'IcCall, as to ivhether DR. lIcCALL: -.his letter is dated @'llay 10th, from 'lob Lar,7ton to Jorrv -- say s that . . . interests of -@.ode Tsland in terms of 280 recTionalizin( o@,7(--r and the continuing wt 95 its .'Icalth i-,ianp. education of health nrofessi-onalc,, lies in a fourth year of sunr)ort for ITESIC" (Or whatever it is) In its developmental i--)criod. TI-iis is the nrocl.uct -oart of a. slo7- st -i is nerhans not so in art, ,7hic.L unusual considering tire difficult of establishing a via'-@le and coordinated consortium of many forces. ","irr,-t I @.7ould and m,,7 r)resnnce here is t,. I C- 7,Droof of tili,,, t,-icit the conco-)t -r'I',.S"C c@,nd t'@,e of the T)u'@llic and nrivate nartners to its :@ITIS"C success is still excellent. The elc?(-ance of C@csi-CT]l Still !)e pro(fucti-ve of its nro(-ram. joCt4 "So7.c of t-ic a n (-I -,T) c, c ic or@ -L @7@- -1,,7 crystallized, ar,-- -'ic, 'ollo@@,,in(-,: neT.. "The development of criteria for neec', in t@c r-a-;or health nrofcssions. Tii!-, is essential to deter.".inincT the gaps after the completion of a current inventory of active professionals, nor in process. consider a difficult and r)ioneeri.na, but necessar@7 effort. "2., A riajor exploration and develonraent of a positi,-@- 4- on TDlivsician e::ten@,ors of all ].-.inds :ind t,io-ir ccrtifica@-,--. -,,-cntorV of tl-ic or licensure. %7ill include an in authorized and informal extenders, T)lus a detbrininati,on of the nee(-Is for tlac,,-q, ",)y type-. 3. The annlicat4-on of a successful deciaii of core curriculum incl career ladder, alread@,, develoncd ex-)erii-nentall,7 for inhalation therapists, to other nrofes8ions. "4 17@ coordinateCt nroaram for continuing education of -rhy7:,icians siriilz,,r to the 'com-,-)actl siiccersA4ul1v develoned in 71orida. 115 .7\ effort for the continuing education of idliarmacists, and nurses on tli(, of c@rur., interaction. !To-,, c,@n 7c)tj tell- --FroT,-, thissi c-@ t or hO-7 MUC@N the collcis-)or@it-i-nct institutions are contril;)uk--i-ncf to this overall Y)ro4--ct? DP,. @.,@lo, tl,is in not sho@t7n T DP,. IT.ESS: '.,,o mone@, is sho@,,,n DT2. @.IcCZ-@LL: ilo money is -,ho,!,in as comincT fro.,:i o-L"I-ier' sources, on the record that I have. Dit. !IESS: In some of this there is a legitimate concern of the educational institutions, and I can see %,?here RIIP can form a linl-.in@, a coordinating function. But -,;,ou no7li , Nrou knoT Ithe hard @,ioric of doing this is basicall-,7! an institutional resT)Onsi,@ilitv. DI',. Ti']SCiT,.@,l: You don't have to provide them @,,,ith. a linl-, DR. lij"@,SS: Yc:-@ 282 ,,@7t 9 7 L@ 'I- E c i'll d@. I1-@, In response to vour other question tire @@250,000.00 study health services in a time of economic transition -- skipping throu@l@i here, this is in the Office of t'iqc Coverhor of 7Z'@iode Island -- but some of tj'-ie specific activities -- and I am readin(-,I: "7@nti-cinatp- that durii-ic-T the fiindina -,@@(,-riod, include an assessment of the j-rinict of 'oa@e closinar, on the deliver-,, and financing of- health care in the affected coii=,,uni-tv. A fo--cccircil-na of sun,,:)l@,,-dc-,-,nand relationships for health services resulting from information o.)ta 4, e)ed in the assessment, formation of nolicy options and t'ie coordination of variou7, planning efforts State nlaiis a,-id resources . . . and L-.'Ien -@he-@,7 cTo on to tal.lz a',,)out economic anC. ot',Ier i,!.a@14-- siio-nose susf-ect @-hat th(--rc-,'.-, an a@.7full lot of economic as @7ell as health in that -- but again, I can't that'f3 a bac@lzdron. DTZ. Do ,,ou have to (Tet doT,7n to 'DraF@s tac'@:cll) ',7e don't have enough in-Eornit-i-on here to get aliold of this one in the 'I-,in(i of d--tail that "7otilc3 justij7ll nutting a half million into so,-.1.,@thincT @,,,e don't kn@,7 @,7,-iat. It looks lil":Ol a -oic-5 in a nol-,c situation. 'I, site visit @-@ould he in order, a d seems to n 283 since @,?e are- no@,.7 site visiting 56 nrograr.,.s, or 53, T'ii@Tht 1,7t 9 a as site visit this one. SISTEP@, At this time, at this T.)oint in time, i,,re have a demonstration project that can't be completed in the demonstration time -- so their @,,,Iiole T)rojcct system needs to be looked at in the i-jay thcy@ve desiaiied these. 11 i ,,.,nd then t'ilere's one here "for regionalization and maternity for ne@..,born care in PiiFsachusetts" And th' hasn't @-)(-,en broii,@',lt uo @,7itlil neoDle are (7oing to be til-C Dtoviders and the consumers and there ';--)e some emotional issues, Tle could stir uo a horiict's nest if t,iev are not ready to use this. S 0 I @-.7ould concur t'-lat this this seems to r@ a oroarai-a that needs to be loo",@c-d at, it this point in if ,7c are- qoincT to givr2 funds. TT 10 is TIIE tl-ie cu,,@ the actic,-i i.1 this aroun? D P,, TESC.Ti.T@,-: Thurman. (Laur-T',ito-r. TIIE Socr"ts to rne that r,,or@- than almost an,,7 r(-,cT-i-on -.7c have lool,,cd at, i have heard a lot of concern e:,@nresse@- about individual TDrojects @@,,hich I-)-,7 an larae, in terms of dollars, are significant. @io studies, each a quarter of a million, the continuation of 'Rhode Islane, -i, if you @-iill lool,, at the carrvover funds, is at least iic'@ a half a million. 284 So those are certainl,7 -- and beti-yeen the three wt 99 or among the three is getting and I don't mean to be because I think the neonatal one is around $80,000.00 about $600,000 out of an application at this point of $1.9 or roughly one third of the project -- the group has some serious concern with and I think we need to flag that for the Council. i@IDEX DR. Hj@,T@TSTIS: I move we approve it at a million dollars. DR. THUPIIA@L: Second Second. I don't mean to com-,)ete @,7ith @7,@'Ll@ but ',,7e have a motion and a secoT-i(l, to an-,)rove at a rillio n. Chu c')'@- , Ithink I sa@-7 a little strain DTZ. T'cC.ALL: Excuse me, I think @,7e haven't 'ic,@rd from Sitter .@-nn on this SI.@lm.ER @IN: '@,lo, I'm DP,. HF@,TTSTIS: I J4 M'7 motion is nreriature I'Tn. DR. @lc('--',%LL: I assume that @.7ith the tire restraints it may not be Practical, at least in numbers, to have a site visit. 1'rLi not sure. If it I would stit)nort that But if T .7c are not going to be able in these unii!-,,Liil circiiri7,tances, to have one and @.,!clvo c,roL-- to come uT) @jith :i figure and it's certain; that ,7hatever T.-@e recomrena -- zeroing in on all these concerns' 1.7t 100 -- specifically -- so that if @,7o- took the @,1600,000 back that i,7ould leave almost $1.3 million and surely it s not t]-iat@ .,imr.)le in rise mind I @7as thinkina about $1.4 million as a recommendation. BA@-RO@,7S I think that is reflecting the ,.7 lole .)attern of their anproach. If ',70U Caere to describe this as you do meat, this has more fat in it than anv cut @7e have seen to date, and T)robai-)1%7 ever DR. Can @-To @,T)eal@ to the issues raised' "o@z7 June ank' TUJI,7 are not bad months to et t-,ie citations raised if there are availal-)Ic T)ersonnel. Can @@,,e advise Council that this -oroc!ram, !)ccause of all t,ie things that have been discussed ',-iere this morninc, badly need-, crui-ck site visit T H E C',- I,". I @'T 1, @lini-sitc visit There mav even be the Possibility, althoucjli 1 can't VOUC.'L for this, that one could mount a mini-site visit bet,,ieen I 1,T net and the Counci cetin(j, @-.7hich one of the Council @Ic,-@crs might a one-dav sort of thina DR. @@cCALL: I think that's highly desirable. DR. Because I certainly couldn't su@cort this figure -- Ilrti havinc-T difficulty supporting a million. DR. !IJ',T]STIS: I agree. 286 @@.R. BARROT @qS agree, yes, I'm ,%Titll vOu. N-,It 10 1 DR. IIEUSTIS: I'd like to get this in as soon as possible, I guess DR. HESS: I think you have to recognize that currently funded at an annual rate of about $2.7 million Joe, -,7ou @,iell l-,no@%, that we have never discussed this nrogram -- but everybody has said that it has been overfun(-IeO,.' T 1,;Iell, is the suaqestion one of reallv trvin7 to count aP,,ini-site visit, either l@)cfore the C(')iii-icil convenes or certainly immcOiatel,i after before a fundinQ decision is -)aclr@, to really,, sha-,)(@ the recoi-Ticndaticn as to the funding level? Or do you ..,7ant to put a base fundincT rc-cc)nn@@@-nO@ati@,n in an--' DR. '-!-cCALL: I @@7ou,,t lil-le to -,ee us cro tIFiat --b@,te of the mini-site visit before, prefetra,,-)lv before tic Council DP,. Could I ma,,:e an alternate, substitute rqotion suggestion or Whatever -vie really @,7ant? If Vou read Stan's first pAcrc here, they are as]-lincT for 1896 two continuation projects, and elevei ne,.@7 T)rojects -- that dives them a .)rogram before the $671,1@oo. and if you add :'?324,00 to continue the t%vo projects for a 287 neriod of time, vou do cor.'.e up ,,7itla a base of a million, ,.it 102 And so I thin]-,, i,71,iy not let's -- this 671 ficure they don't currently have those people now -- T,,.7hy not let's arrive at ei-c-ht, or a million, ,,:ith an understanding that the :7,@.te visit %.iould either add to or subtract from-- I') pos-Dibl(L, rllii-thout -- ut no l'ianO,4n(- !Vnd no continuation fund.i-na- I just to ,,@a@,.e sure i understand @7ou no,.17 -- no continuation 7 lund4-,n@j ne-,t Oscar the @200,000. for the until ti.lat. @AOO R. T'@7,- UT@7,L have 000 no@7, so it -,.,c,,nt hurt at all. T' C;.Il,@I@l@. TTOUld 70U -1 -I i. :,CC(-,.Ot @-!,,iat as a "T o ,I' s t i motion? T once, I didn't tin@c-,rstand tiat liou vc c@@, it an'7 -except to add the site visit @T7 L,_ : Tl- t) R. T U --Il not rc!all,.r. o@ 4 I saiO,, aoinc, !)acl;- to the f act that @,7e @7c there an,,,,,L--hincf, in L@-1-iat sense of the word, for iealti.@ sc:Lence council- because the@7 are carr,iin(- this money for-.,arc!. 1 ,.,ac-! shootina for @,'U'00,000, which really wouldn't hi.i.rt them by the time @.ie ran the site v4-si.t here. DR. IIEUSTIS: l,',Ioiild you c@lange a million to DR. THU,7-!@',-7\2.,@: Yes. 288 DR. IIE@TS'@IS: I @,7oiild su-p.port that. SCTT,@-"T: t 1 0 3 DTZ. T@r I second that also. 0. l@. @ihat I have heard. have then, if I understand it, is a minimal, interi-a or not "minimal" necessarily 1.)ut interim fun(-ling level r,@com- riendation of $OJOO,000.00 a strong recommendation that I IOML I ()@T some of a mini-site vi-F-,j--t !)o made to -ri-statc, lool,,in(-l a-i@ sbr.,,e of these n--,,.., activities, and also the. [.Hitachi-] to Cotcrinine ..i'.iother that r-igurc should li:)e uo-p,--d, and if so r -- or i.nO-e(--c@, that it rii,71 t even b@ lo@,7crc-,cl,. @uch if-@ that rou,(7"ilv sense of the rLotion, 7@ill? DT. @TT@@-IIISTIS: :)(.)es ti-lat include tiic, '@200,0@00 for monitoring activates? p . -lo that t'@.iat out. DT@'@. ITEUSTIS: You. arc,, cli.i-.,,i-riatinc-T that. n. DP,. T E cj C'lI ,-,,e @@7otild love to .'@zno-v7 -licit the har, been thin]-linct. -'4.11. Ni%SI71: the PAG dic,n't really anDrov-c I don't believe. TIIE CT@Ajrjj!,@l: Tle ri-) is here, let's tr@, tii,; i-C,--a on hill, to see if this is reasonable the TZogional NASII': Ile'll be sorr,@ he Totaled in on this at this tire. TIIE CHAIR'@L@l: 1-lerb, @,ic ave s-,)cnt a good deal of tine @.7ith Tri.stat@-, ro-centl@.,,. @,.Ie are concluding no@,,,, and 289 perhans more than anv other reoion, serious (7,ucLtions have 104 been raised about a sr,,iall number of projects -- several nev@7 ones that total half a million -- continuation of that -@@-f-iode island @"i7l-C@'\ for @,7hich an additional $200,000.00 is being asl,,Od, but for ,,7hich there is so,-,IO $400,000.00, or r@ia@7be $300,000.00, in carryover fundr,. And the crou-)'s recommendation, @@ihicli hasn't 7:)ecn voted on, but .,7hicli is on the ta@-lc no@-i, is to recommend an interi,-.-, --f-'tinaincr level of silnnl,7 $nOO,000.00 in tire place of -Trillion request -- ..7ith a strona re a rcu@,.@il,,7 cor@-i-,nclation I that fine, of mini- on-c-da,,7 site visit be made to IL--r@@L8L-ate to loo'@-. at several of these large, no@7 stud,,,,-lilpr-, activities @,.cit are boina oroposed, as x,!ell as the -oroqrcsp, and needs -- future neectL-, for the nhode Island-F.,-", - T- !@.C is a s'aori-. ti-T-.e c@@Ta?- IC c-,it. r '--)cfore (,oun,--il @@7hich or a',Ilout -L..-rec or less than t',arcc .,,oeks; or he'Lor@.a tile final fundinc-, decision is -,,,ade. this is the first-- tiT-.o @-ic have come to ai-i,., ki,.-ic' of a recommendation. I think tlicre are enouaii serious concerns about sT)ecific activities, and Questions Pl\.,Ill,: lj7cll @-le, of course, have not been site visitinq other regions, ')Ut T tl-ii.ni: it's an unusual set of circumstances, in something lil-,e this, there is no reason that couldn't accor.,noclate that recommendation. 2 0,0 But would much Dref-@r to have the site visit @,yt 105 prior to Council ',IcetincT 'than -ifter Council TIIE CHAIPI-1.@,l: @d includi.na rome@.)odv from Council '4 P@,IL: Somebodv from Council and liaison. I think the Tristate one, particularly, has given us soT-.e questions, internally? also, and this certainly reflects, nerhans a little bit more emol-liaticallv the issues that have come to rv attention. lie can acco,--L@-,ioclat(,- that recommendation, and I.Tr, act on can't accommodate rianv site visits '-')ecau@.e of the tir,.c ini7olv,@O., cert.ainl-,,7 in unusual circumstances call. I' 7' 17clI t'iis ncee,. is dramatic, @-oo. T ,7c-- do leave a motion to t@-iat '-then let's call for the cuest@.ioii if there's no fur4L-.-er discussion. 7'ill those in favor rohe Tiotion ,-ias T)roperl,,7 out to vote and carried unanimous!-v.] T 1 C T T,7% Paul. O.T Drl,. TESI-'T-T-@,.,@: I,,,Tell, the '-IeT@i Jors(.-.-,7 application is a little longer than 1-7ert Virainia, but 'iias about the- same Qeneral qualities in ')eina able to describe simply and in relationship to the rcgion's needed c ,joals and their shorter term, objectives @,Thic,li have been arrived at by explic@-t@ process, so that -,7ou can follo@,i it. rlrlherc -are cor@orate Grantees -- -t.ie Program serves 7.2 milli-on neonle. Thev have established sixteen profession al.s and some ciaht clerical noonle anproximatelv, and they are asl@ing a nrogram staff sunDort to the tune of @825,000.01@. They have ciaht projects, as far as I see it, an@ this spans, reall,,,, the entire set of @als relating to access, sun-oort of categorical. -- sunnort of cTual-i.tv assurances activities and sor,.--- efforts in the area- nov..7 of cost contain- ment, and a beginning exploration as to ho@,,, the CITP and the develbd,@ient in the T"!P -,nav be setting ready for the ne..@ legislative activities. The,7 also function on the contractual svstc-m. fLn.-,Llev have a large contractual Yjudaet -- that's essentially ho@@7 they are functioning. '7hev have tincr staff organization so that an interes in addition to the usual essential min@i@crs, that is the fiscal., development and evaluation tipc-- thing, they also have 292 a I)roa-ra@-,,,, aeveloT.)T,.ient @,7]io has aon-line, full time 107 r..-Lanac-ter that ias to do -,.7itl-i the ri-i@)ject matter -- so that there i-7, somcbo(qv free -- and -,o -,7ou q(-,t the sense that there is a ver-,,- discrete pror-iram ,is-,i(-,ncd responsibility for the conduct of these affairs throughout the -region and sort of a ticht, ei,,nlicit @-7av. if you read a c','I,-xrt -rsta are Droceedina. ,You can unci nd c-,:actl-,7 ho,,,T the,@7 Our i,-)ast O-.,,ncrience is coherent @,7ith the i(-I.o-a that t'ie annears,to I:)c e-tr(--T-c2li, (.-xnlicit and active, and hot, so,-,e of the :-,ost ef4-c-,,-,tj-v@ T-.eor)le i.ncludina one of the T'@oi-j)erF, of this (7.ouncil in t.-ie other opiiel this co7n]-ttee on tric ptin(:-]- -- v7ho hi!--, not only c-,;,'.tr(--mely able, ;Ijulk-- verv articulz,-Lc a'@)oiat the nrocra,,.i in nresen4--,;.il(-.T _Tp ho7,-,, t' e @@I should be .7or,@in(-T in cif--voloiDing not only Cil cai-)z,b,-litics, ',,)ut the nrojr--cts in virt-uall@,7 all tiic- areas. I am interested that there are t-,.7,,-nt@7 cTr,:int,@ef', a@-nrT-c ti-le 41-hirt,7 so-.e nroj(--Ct@,. r-7-1-iey had 3(i operational -rolects 't-lut not all of then are current, I miuh-u add -- and 7 developmental ones. So that ariona t.,iat entire aroup there are quite a number of Grantees Prince air)arentl-,7 ire the recipients of the contractual funds -- Dririarily boeratinq out of Prog--ar.,. Staff. So t;lat it's not either centrally managed or qrante6 r-anacfed, or an,7thin@ of the sort you oet the feelinc7 there that there's a good clisscmi,-iition of rcsidonsi- irorTram. bilitv in the oncration of the 2 -Q3 One of the fascinating thina@, about Tc-r.,@ey has I-,ccn the @,7ay thev have been on too of so rqan-,7 of the ne@,,7 issues in terms of better access emergency medical services -- cTualitv care insurance including assistance in nS?,-O develon,,nent but also, more explicitly than ali',Ios anv other )roqrai@n I I:no,,,,, al@')out, touch the Staff -may kno@-,7 better than 1, of course, for good reasons. But the Post ---nco- I 'liav(-, had in settinc-,T t;c-andcird--; for e.-.nelicit cyner4, cualit@7 for certificate o-F- nee(!. tvne activities -- i.e. the technical rev-'LeT,.7 arou-Ds, or ti-Le coTTii.ttccs, hatle T)ut to(-, standards of excellence, or standards of aua,-it--V care, in a @.71,-iole varic-,t,! or -;i-)eci,:,,!.Ize(l@ anC. @(--rvicc--s 4--nd one cfathers from till- narrative, that t;-Iese have, in fact, been u5c@, in certificate of need and that the @l,"P Cc,,Tl@.,-'Ii-ttce@, have been used 'I-)y certificate of need type activities for advice on the basis of standards -- i-)ut not onlv the Y CT-,TL standards have been amended but the staff has Dartici.@ated in the reviews,, of certificate of need and given the otofessior@al and technical advice to '-'I'LP Oelil)or- ation-@. !,low that's rcall,7, one of the. first e,",-Dlicit CTTD exa.m,-)les in my experience ti-iat in fact, 1-.. has used 7.TP te @@:av. I t'iinl-.' it's i real credit to t" c in an ay)t)ronria l@iisto--,i of that d(@-velor)-,i(,-nt. 294 i,loT,l tire -final thinc. I @,7an@@ed to ao into 1.7t 109 t'@ic,,rr--Is a fair amount of detail But t'!,Ic- other thincT I %,7anteci to mention -,,,7as a good deal of i-)acle: and forth Ci@,cuf7,@,-I-on, epnociallv -in one set of correspondence %.,,hich Frank has (-Tot a nice cov@ri-no- letter on -- from a7,@paro-ntl-,r the "':."Iorti,@rn T.-To@,7 7p-rse-v Con-Ference of Clinical Coi-inci.l" I can't tell @@7i-ictlicr it's an A or B MITI' C 'ITI'T'.7 are, It's r, T@ C' r'TT@,l: An,,-l tl- ec@i.!-,cu@si-on of @'c letter of t,qe -m@,cotj-vc-, ")ircc-tc)r of the 7, lll.(7cnc-,7, is sort of a c,-,ntan.k.@r,7 buckshot tvne of vi-tunerati.on, ,@.,to ,.7hich, t@-iere is one of the rrot ID--au@uiful res-nontcs ti@lat T have ever had the of rea(3ina. P,l [T'lori.nl '-,iciE-@ Krone, in -five pa(Tcs, to the histor-7 of hoT7 Cll'-O existence in is a result of @-!-'-D effort, through <,-cncrations of e,c2cutivc di-rectors and he takes each of the issues relative to each of the projects, and @),--autifullv t'@Ie@A in some verv sir,-.nle, clear lanouaoe, in a hi@'i y ,Drofcssional and ',-ii(-hl,, unvitiincrative and une.,-iotiona i,7ay civin(-T It--he facts of the case. You kno@7, this little correspondence file, to met is one of tll,.e most beautiful pi--cc@-c.; of exchange that i've had the pleasure of reading., I'm just delighted that i-7c 2 9r, %7 j-, at(--ria-I it's the )DaFi.:3 of @.iad this for suDpl@,.entar 'I 1,7 t 1 1 really a more acneral reco,-,-xicndat4-on that I lil7.e to leave ,,7ith you all, and that is that -- not in my o,@.,n feelina --- is that recognizing the legislative mandate of recoani--in@,- the relations the regulations of nl-'IP -For interaction -- I feel that @-ye should recommend to Council, for Council iDolic-,7, that scivs that- urge that (-'oLin(Ilil l-,rin(@ to 'Ir. [Pavell?] anc@ ot-i.--r anoro-)riate noonl.e's attention, that interaction is a reciprocal nroc--ss and t.,iat @.,,e should have mandated regulation suite isiOc from lec-fi.r:,lation reciprocal intera,ct@o n and mutual respons@!Dili-t%,, directed fro.-" the !-amid of -L.'Io- Cilp Agency, here, to call 7, @art-i.cular!N,,, @7hat thev do i t,-L the @-is is a different of course, and it's uT) to them. Secondl,,, tiat so far as our raclibcrations in this Col@"IM4-ttee and in Council, that i-7e should ic@nor,-- c nec,,a4L-.ive C"-!P co,-j-,cnts, c:,Icept as (a) number one, the -P, :,%aenc@,-7 informs the local of their criteria and reviei in corm@on orocess nrecisel,7 as our T-1-@"D incomes, the B @genc@7 of the reviev7 of coiri@,ion T)roj--cts -- total reciprocity. (b) nur,-bcr tNqo, that the 13 Agency shall furnish to t,-ie TI-@@T? z).cTcncv, e:,.,nlicit-- staterionts of the ol3jectives and Priorities and as need statements, against @,ihic,li 296 t,,rclc@ts (lc-,velo@r.,Ient. ,7t So mNi feeling is, yes, we reco,7,nize and feel entirely appropriate the should respond to CIIP -- ju7.t c-xactl@,, as sai@l -- no argument. i.@@ut that it needs to 0 r ssional, level to which is ,I -1 Ore @t the same T'Drofc c 0 l@r, @ll i-4 T-) bein<-, called. ,"hat needs to be established as a simple issue of basic intecrity bot@,7cen the tl.,70 T)rocTrams .-nar@,i-cularl,i if t'@'lcv are (Toinc, to be 1(--gi.slated into o m ki-'I@l of rclations'il-In. that's a -irorr-,al recorlinencl,-:ition I N,,7ould lillt-- to 'iavc, t,-iir, (7roun discuss and at !-,olne T)oint. it'3 @t Cic-@rcss-ion froi,), t.-ic current thinking ind .@nd no,,7 T,,,,7 final-, to sum it un, I t.iin',@ this is a beautiful -oroaram,, a ton level operation. Our feelina is that r,7e i.,ouleL nroba,)l,,, r(--cor.-mc-,nct fuiic@incT 15 to 20 te------nt above t',ac current (--ar(-@t hut r@,inzis cl..@O'il@ is clue about 7ul-,7 lst and tLnat co-,.os out to be al)out million. he -)e conctrat- .@nd that ti -.ecion -,Fcntiall@@ si oiil(ft ,,ilat,-a(i for ti-ie i,7a-,, !lave -oroc--c-,cOecl. T-) -@'. IlEiiSl@IIC,: @That @.7as ,7our fi@,ure icrain, nlease? DT ,Z @17SCTY,@- . L , .1 , : D-TZ. TIEUSTIS: And t'- cn @,ou're qoina to 1 nocl- them do,.in by a million? i@,\Sll Tiiis an,,Dlir-ation is 3.9. 297 @.7t 11@2 BARTZO,-@'IS: Ye-,, @,,,e ire knocl@,ing them do@qn hv million bucks. D R. TESCTIIIN: I thought that the recommended j'unO..,j-n@ r(--].ates to the target, about 15 to 20 T)erce-nt above the target, minus about @601),O,00.00 in Jul-,7. The.v are over target b%T some I forget izhat D@-,'@. 11-@SS: Tliov are currentl,7 fundel" R T,-, S C H And I thought that from 1.6 to 2.9 it's a substantial rise and it allo@,7c a little iioiie,,7 for Julv 1 Council situation, and it bi-inap, it a little closer in line ,.7hat the ficurec, a@nT-,car to be, ,.7hich ar2 availa-.".@l -2 for the nroclran. ITioulOt -It.@vc no election sor-,e.@od,7 L- 0 fully or in some larger amount, @,,ou kno@,,. @,,Ie OUCfht to, since "r. Barrc,,,--- Ti"P Cil, @,7as the other rev-Le,@.,,er on this, hear from him before .le carr@! the matter of funding level, or other comments or observations further. MR. BARROWS: P;.v revie,,7 is T)rettv much a reflection of just what Paul has said. In short, the program leadership ranks, participation, I thought, @.ias sunerb. In fact, overall. I came out @7ith the impression that this T,7as particularly in death, the type of nro(Tram I @,7ould recommend. Period. r@"he relevance of their nast activities and the 298 oronosed activities in the !-)road, mission, @.7as just @.7t 113 ton notch, and more than tl-iat, t@lev are rel.(@vant to the needs of tl.,ieir area -- T.Darticularlk7 tlic uneLc,@rserved, seemed to he jtist riaht on tar-et. I .7as cleenl@7 i.r.)nressecl.. harl another attril)zi-l@-c, T,,,i'licli .ias outstanding and this to me, and really this is maybe a -nl,.Iilosor-,'iical matter @,7j-th @.7]ii-ch vou r-a-,7 not all cicirc,@e; !-,le need t',-ie ideas, the c,@:-,ortise oil ac;nd,@r-,iii and '1;7e need the sunnort of the r,over,rip.-,r@,-it if @,?r3 are real-117 croincT to (-,t@t anvt' incT reall@7 done in t?ic n@.ainstreaT. of ironrovina. It's set to come frc:7, the )rofessional I .I @ - 0. T)ra.c@ tl-cv have doni-- t':,@.,@n anNi nro-ra--.i 1 have to c,,,-2t the TDracticin@r @rof@@,si-C,'ni @@-'Iat, I cz,.@o out ji-irt t'.-l.is tc)@-) ral@-i-nr- ane, I di,sr@issed the ('!,IT-3 t-iina a@i a ventilation of pique il4-c',l ha@ no r-.crj-t. T.!a,,71)e T C)U(@-11@ to ask 77ranl:. I think .7c an issue tlaat is resolved here, Fran'," on tie M- @.STT: You rcei,-i on the CEP? iT 71, "@"ilil C"r.@ I 7i T .@Ll Yes, rj-cT,.t. of course T-)r. hu Man i7, (-(--rtainlll,, accurate in his de@,crintion of the letter Dr. [Ford? I 's af f air -- it 1-7a,; ll)ei.uti,f ul. z@,nCi T i-iavc @,inc '.ic,-ard from the recTion, that the ,,,7t 114 B Y7-1.gency Board an-oroveO, I i,@ican, recoTriin"-,i-id(--d aTDproval of t'@iis application -- so I thin],, ti-iit this )Dit of "@,r)leE--n vcnt4-nc,," ]Dv t@ie CIT@P Director @..7i-io '@-ias onl-,, ;Dcen on the board about five r,,ont'.,3 in -that z:)articular a(fc--,ncy an@7a@,r , is TIE T Ti Lavc@ -,You cTot anv more insights on ti.Ic- -,@@7arf are in Jcrsev, 7ersev, Tom? ITE T FLOO-P,: That's not Pay I)ailiwick. oh, oh, t-iat's ri ht. Jersev co.@-,olit. (T,aiiaht(-,r. T'm @iast cal.lin,-T -for fairii(-,E-.-, an@ (--Cru,alit-r C 1 T,@.! TI",@ that i:-, a t"-i@ letter @,7a a Director's l@tter, !-)ut tr)(,- 1,oard -- under duress or r,ro--nt-od h@;, %,lh,-it rea@,on, cli.d ta"e iction O-),@OS4@-te to that, annrovinCT the @7,--rsev aT,.nlica-"ion. I realize -,7ou're just as!@incT for fairness anO,. cc,-ualit,,r '!R. '@-7.AS IT "o repeat, @-re i@-.av hive a oolicv (-,ueE-,t@on in this Particular region. one of their Dronosals is to estaljlio'i 3 PS,rOs and I don't l@no,.@7 @,7hetiier !,7c can ur;e our mone-7 for the act,,ial of iSPos or not @47. BAIIT@IOTi-'S Is that to he established, or just to nrovi-de the T)rcnaration ictivit;@es? eAi I'm not sure, it'@, I)ackun sup-nort. 300 t actual Eupport here, t 1 1 Z') It I)e an issue that @,,,e want to flaq, though, and get into sor,@,e consultation, if @@,,c haven't, with the anoropriato-E-IST3,0 staff here, and deTDenOinc uT)on the outcome of- that, we mav, or mpv not, want to hiqhlicf',.I-, soiti-tl@iinci for Council. I lia-,,,e the same question in iav mind. It co-rtainl,7 is, ill one sense I ver,7 consistent v,7iL--Ii the kind of 14. c-,ua assurance activities ancl st--anO-ar(q.-, @,ettinrT -- or standards d@velo,,D@-@,nt, t'-,iat ha-, characterized one riajor thrurti of-. On the ot'@,icr ',7anc@, '@)tircaucrat:7, heave a of to h,--lnincT the Y.,,@dical cTet rcicl,,, for this T)rcc-,rE.,m and ITT7' -7ant to C",-ieck uT) r, a staff, I ti-iinl-, in an,., case just so that !-.eor)le Oon't '@,iave their noses out o-r joint arounr-l here. D'@Z. @7;SCIT@'T: -'-ie '-a@,ic fundin7, of the PS@O comes i from, ti@,,-c nrocessinc-i of the !;:)uziness -- so ,?ou l-,no@.7, it isi-i't goin(- to taize -- tile actual fi-rianci.nry of the PSTIO is not a Droblem. 'IP PAIIL: '@"ICV %-7ant to r)rovi(-Ie the same t@,,rDc,- of cun@ort @)tat it'-, a a@oncv. '@OTl cir(-, there aii,,7 ot -ip-r matters or 201 or comments or @,uic@,tions o-f- the t@@7o rovi-(-7,7c-r@,, or of t]-ie %..7t staff, for tl'lit that rc,.I.ate to @7o-rsey j)P. I.F,,T,,S"-TS: 1)(i @7c)ii tqinl,, ilarro@?:7, @,7ill acirce- ivit.ri the monev figure? !IP,. R)ARP cll I i-7as a little rore generous. ,OTIS W 11-m not as good at r)icl,:ina @igures out of the air as vou are -- but I @,,,ould Fa,@.7 that ,,Yind u.n, this should in the cate-(-,or,,7 --- ver@7 cle,-irlv in t.1 I "2 cate@,or-,7. -.1o@,7, Share thi- fi<-riirc, iT,, :1. don't ITT- T-7n CT the,, are a@@l,--in as aul ii, arc r t' in a@-)@.nlicition al-oct "4 'i-iavo air that Coes not in,cll.u.-@-- a,@,7 3-n one senior, soTa-@- nc,,,7 ,D,--oc,--ra-@ :7,ta-Ff activi-t,7, 1 and conic-- and -ic@7 T@7ill '--@e in, a i-ru',7 cir),Dlication that J-- at ly'C@)00,000. rT'17'1: T'lell lil-.e I I avc- no o,)j(-'ction L to unnin7, that ante, but I jii-,k-- (liCn't know to do it. D L@ i-:!E SS Let r,:tc as!: you a cou--le of questions: one: @,.'iiat'p, the -population of the recTi-on? DrZ. Seven and a li@-1f. 7.2, rcill-,7. T T:l D P,. ,%,n@ i.@, tqis ju:7,t the, state of -i .-,T-rso-,? 302 r" ITIE Pig'at, it foll@,is the state line. %,it- 117 There i-s some overl,-iD ,.7iti-i Treater r)ela@,7cirp- @lalle.V in the Southern and less T)ooulated -- PI-iilad(--lphia and Camd,,@n area, and the Cran]Dc-,rr-,,,'Lloqc, and the resorts But T thin), certainl,7 ileT.i @-Ter@ey has defined itself as the entire state and, indeed, have conducted activities throualliout'i the state. _7. 11.7@Sll: 'hear sent a staff nerson do@in to Southern 7o-rse@7, anc, TDairl the salary and all expenses for a ,,ear in est,-@'. lisliinu the Jorsev CAII actencN7. ll.'hev consider ther@selves a state-iqide nrograin. liod Tlur,@nhy? CTTI O'll, Y---s, T.Od laterally;, is -Oee-.v from a Management visit to .Ter:-,ev earlier t',,'l 1 7 e @,4R. @IE-lt',CKER: I -,,Dent 1.1unscla,,7 and the Proara.-@n Staff of the k-)Ier-:,ev Reaional. ',Iedical ProcTrar.-i and tiic'-r i,.anacemont is e:-cellcnt@-. The nrocrai-. .-.@anaCTcrip-nt in :)@-irti-.ular -- they arc, in the -oroc5@f,-s of ta']-,iii(T (@)-i --FU,Ll corporate resnonsibilitv -frori -the -2nivor--,it,., t!IC,. Tjl-ii vcrsi- IL-- ,,.',(-,dical Sc,-iool and thcl --iavo developed the additional nolic basis for this, but thev still have some administrative Tianaaement nolicies to dovelon. But their nroarai-a manaaeTqent was ru,)erL-1. have a T@ia-,,r of- operatinc- hv health snecialt-,7 ar(-,a!7,, their f7@taf-, 303 meyqbers interact extensive-l@7 ind effectively @@,ith the @,7t 118 -projects. It verv, vor,7 Lmnrcs,,4-ve. T T.L r-H7kIR)IL7@T I don't think @@7c hive -- unless the Chair,-qan rqissed it -- a formal recor,-onendation on It]-le floor to -- of course a ficure ,ias mentioned, but I didn't ask for it, nor did I hear a second. !1,7,. B.7'@p,.RO-@"7s I'll second that. Ti beclinn-na to (-,ar a conccnsiis @.)ecau53c- if have a 7.2 -- and it's on a ner capita basis -@e tal'j:i.n(-T about 3.6. @?our motion? Tire -i rcvisi-nq f I @ raising the Question. I ,.,(-),uld !)e rore comfortable @,7it'-i so -life 3, or 4, or 5. 2.9, 3.4, 3.6, 3.5 @,7'-iat do I ,Near ne-@t? (Lauc, Oc La 1,7ell, in vic,.,7 01@ @@7,qat 1 have iiearO,, and in vic@,7 of the @-)uelact that I havc- seen, and -Ln views., of @.7iiatever I I-,no-,Ij of the '."@C@-7 Jerse-,,7 iDrocTram, and in vie-,.,7 of t.-ie other sucfr--@@F@tions that have been r,-,ade durin(,- this session, 1 think that $1 million do@-in from tire fiaure they ',Llave requested is too much. So I @,7ould cTo along @,7itl-i 'Tr. Barrm-7s. Til'IE C"IAIMla'j4: Sister, you liavk-- better connections than do -- ..i'at do -,-7ou sa@7? 3o4 ,7t S I S Tr, P, Barro%,7s, there is one thing I 119 haven't N-7orked out, and that is the process of di.scorn-@,ient. (Laucjhter.] DR. TIIUPJIIIP@lli: @fter T,7',,IaLt Joe just said, I acTree @vith this, and I an certain that all of us x,7ho have seen Jc-,rse@l, are very, vo-r,,, pleased Tiith the !,7a@l, it runs. But are ta,!]!.-.inci about i recTion right no@@i t.,iat is gettingl@1.4 Tqillion -- and then %@ic are talking about sudd.enl@,7 lea-,)incf to $3.4 million. @io, @, 3. 6. On CO'll!7-@--TT: the other f-,heet. T',.,--n I bac'@ to my criticism c)-c DIZ. 7o s,-icet. ,3ut on the other hand, i think theit's an unreal lean into @-,,Toll, @.7ould ,cu buy @3.2? DR. i @.,ould cTo bacli@-, to 2. S I S R ,Y, 1',-q And I cfo back to $'-).9 too that's SCTIAIT: I,,rjiv not riovf-- for $2.9? DR. TE Ilo@.7 that's Keith the point that this is the su@erlat-j_-;-:-@ story, and if the Council felt di.snosed to increase still further, that the T'loview Committee @)7ould take no unL'Drac,-e of that. DR. IIESS: I @@iould like to just make a Doint hbre: 305 120 I hate to see us undulv influenced bv a region that ii I comes in with a huge recuest and grant a lot o4 funds, just because they ask for a lot of money. In other @7ords, @,7e loo'j,, at Puerto TZico -- a toT,) notch program, that comes in @.;ith a modest request -- and ,,,ou ]!,no@.,7, i)rett-%i close to ,7het w(:- think theV can use- and v7e c-i-ve them that. '@1,4oi7 this is a first rate -nrociram, but they come 1 'LI @-7ay over -- vou ]:none? -- @7hat thcv have preViouF,]..@7 '.-.)een cTetti-na in -the last vear of funding. And Foricho@i, that just doesn't sit ri(-ht. t DR. TITT Could I add sor,@ethina again? CIIAI7-"IP--,T: Cert,@i-nlv, Bill. T "L@l: Tio voil see an d for an extra )@TZ. TTIU@@ n e c r@li.ig of none@,, for them to carr,7 out their corporate tn3nc,? I?CT A modest su,,i of monev. Thev havc@ requested an added accountant to the staff. TTT 0 I second the motion for .2.9. r"jlr CT 0.1'. @-ie have a motion to reco@.-cn funding ',"el-7 k-,--rsey on this annlication of @,2.9, with the sense, I believe, of the groun that certainly it reflects a favorable task to,.;ard the region and otesumablv (but aaaiii, one'nas to see the proposal, their supplemental oronosal should be loo'@:ed at in Iulv this c-irou-)) in a quite :ravora'@,,,-@, 306 light. That should be around'@600,000.00 y@t 121 Is that essentially the sense of the motion? 7 DP,. FESS: e s . BAPRO@7S: Yes. TIIF, Is there any more comment on t.,iis? If not all those in favor [r.Plie motion was regularly put to vote and passed favoral)lv by and un f avo r.@l-) l@ 1 vote. I TIJE it's (a!7, they siy in l'oll@!i,,,Ood) 12 2 llili.(TIl !,7oon" and I thin'j-, 11-7ith the concurrence of t.@le @roti.-D, this is about the busiest time in the Cafeteria and I ti-iinl,l ,,ie do have time for DR. TESC-TI@-1.11: T@,7o more. r.",-TLE C.L-IP-I Two more? T@7oll then, @lou will have to !-lelT) me identify the eas7i ones. -Pochester has been -suggested is that one on @..,hi-c- you are not t'i(? revlp,.7er, Joe? D'2,. TTT,](,;S -Ilell, I couldn't -mal:e the ju@cTment il@ I @.!erenit Lau-T-@lr '-IIE- Oh, i clon'-'L-- DT JITI T The hur@,,or is q--ttin(T strona. ITII@ C@lp"j T, t'li.nl@ Ile are goina to !,ia-,@c to c,--"-- in about half an hour, thinas are c.,ettina out of hanl-". @@7liv don't just lead off ,,7ith @oclier-,tc-r and ask Joe to lead off. DR. Vii-,SS: !less volunteers. TiOCill',ST-T"P, DR. T,-Ij@ISS @-7ell, this is the third anolication we have discussed this morning in i-71-iicli there is an inverse relationship bet,qeen the size of the -- the amount of nancr and the quality of i,?Iiat's on it, at least in ry estiriaL.'@ on. 3o8 In terms of the overall orci--i.,.-iization of the 12 3 tliev seer,-, to be well organized in terms of their overall goals and o'Djectives, and they are consistent with the national goals and objectives. Their revie@,7 process is clear and well defined. ,,-@s near as I can tell from the ar)olication, the leadcrr,l i-P on the .Dart o' the T3roc7rar-, staff, seems to be hiq"-, c.Tualit@7. They have identified .,7ithin their recTion the areas of need -- the@,, lia@7e ci-,)narcntlv done sor,.c (7ood ':)ac!,,-crrou-i-id .,or',,. in of '@-h(,- identification, and c-,ot a '-Ic-,r.74-onal Plan out dis'. la-,;,@- it clearl@7 an-'- on a man in teris of their or undcrsurvevs and t-i(-- nec,-9. -)i-in@ar@7 care, and that tvne of one oil -he thinc-,:; @@!hich -I enforcer a,-,out third -'cat-ion annlL the-:7 have tli-2i r coals, and t,-ien at the ac" thev have their @jec@@ives of the nrolects rela@@e@ to goals -- and the 'undincr is disnla@,,eift ri(@l.it alon(T i t'-i i t [T)is,Dla@?-s a Oocur,.cnt.] ;',fear overall 7oal ii-erc, and listed in nriori@li,7 order the i-7aN7 tl-,c,7 nr,-ori7 e t' F, the T-ione-,,, ti ic nroDcct .,iat goes it. Tnc@ then the cll,-iulative total that .,ill spent on that particular aoal. @.0"7 this T)arti cular i,')I)licai---'Lon is onlv )'or a continuation of a core staff, a small increment -- i-)lu'73 309 ,1.7t 12 4 @,,7o small increment -- t,,..7o small 7,)roj(--cts -- and the rest of i,7hat we see listed here under "goals" @,.Yill be coming in in the form of projects in July. So that basically, all we are asked to do here, is to proof the cumulation of a relatively small corns staff an& t@io small T)rojectc., and this is communicated in such a @,.7ell orc5anizee. 'Las.@-iion that it just 53@eT@is to me tliev got their tocTother in that r(--,g ion prett,7 well --- and T favora,Dllz im-)rc-,sred and I see no reason i,7i-iv ,.7e shouldn't give the,@i t'.Icy T.7ant. D@. Is L@h@---o- i-.ore co,-,inc7 in 7u!,tr@ tTi@-,j are coi-.iii-ici in a bia increment corin(- in in 'L--.',ic ,,)roD@oct,3. '7ou c z-,, n -aad%7 sce clca .1 al. rl,7 T,' at t,-io@,e T)rojcct-, -ire going to be and ho,;:, t'@,i e,i T-iill relate to -Eric cToal. '@o I have rated ti.acii on either "Satisfcicto--@," or "E.--.cellcnt" in evn-r,@, catcaorN/,. --'Ji(@re @.7cre justt.,o that I nut "Satisfac-or@7" on I'lo7,7cver, @,!it' ,i i,,ore in.:.-orration D -c r.@l aT3s at staff level, ti-ic,/ mial,.t ,.7ell be categories of excellence -- and overall, based on ,,7hat I see here, I have rated it as a "Su@n--rior" region. P@Tll,: 1-7hat's t:-Ie CITP ? D H U Ed Lane he sent in a nice letter sav,incT ',-ic,- su@nT3orted the @,7hole thinri. 310 Til- CIT.Nj@llpl-1: You have a region hr@re, an T, 125 @@7hich geoqranhically is clefined in cxactl-,,r the same configuration as the sin@tle arc,,a-@,,7ide B ,%cTency (,@-nesc-@e they have, I think, good relationships, and I think 7.@vle nav even have an incestuous re]-ati.onslii-c) d(,-velo-r)incr in the sense that I believe Peter ',Iarkl.,@ brother nay become the B T,gcncy Director, T, 'alter s retirement this sun,-Tne r. '@,,Ic)T,@7 this r,.iay not help -- havina kno-,,7n other brothers, but DR. TIIU-,@'-@@l: '-,lo sisters? ',3ill, -,Iou @7cre the other rcv@-.c@@7@r on CIT annlication it is a ver@,7 modest one in -- bok--"-@ in amount and in it is are -,)ronos3-nc, noi.@7. --ut @..ic" Ir-@ -n oT@7 T3re'Ltv %.Tell ,,,hak'- t"l--ir -',]-.4 million annliceti-on is cToi-niz to lobK like in terms of speci4ic activities. DP,. Joe said cv@2r'%,7thincT thaL--.! @-oialo,. ha,,7'o said aoout those -Dri-orities -- @.7ell orcrani-z@-c'., rTrant-3e situation is a separate from the s@andnol-rt of CT' never liavinc.T had a real evaluation group; an(!, the voted unanimously to recommend approval of the annlication and sent a vcrv cood letter. So that i @,7oul(-l su-or3ort ev(,-rv,t,-iina he said and recommend the absolute figure of @Y361,437.00. -to also bring uT) t,ic ou@@stion i 4- T'f -ki n tieir i-),)l@cL L'@O thou-TI'll that t@,icy have r)ut out an @,PP of Sentember 1, '74 June 30th, '76, in the 'T"P that t'-, cy ilave distributed all 311 the @,7ay do@@?.n -- this is the health care Oeli.ver@7 oroarain and al-..,7ays has )een "1,300,000 126 ilhat @7ou are sayina, I think, is LTuly that @.7e may see a nura:,Dcr of activities Y_DroDosed in the a,-),,)lication, run I)eyond the end of nel DR. TIIURMAN: All of us are building in develop- 9 10 ment costs. 11 We are being reimbursed for Medicare for organ 12, procurement, tissue typing and dialsysis right now, and we 13 have the lousiest system in the country out there. I was under the impression that none of these 14 1 15 types of programs were going to be funded, other than that by July 1. I(; 17 DR. TESCHAN: One of the projects is to reimburse the institution for the procurement of unused kidneys. 18 1 You know, that is not, so far as I know, in the 19 Medicate reimbursement. You get reimbursed for the ones you 20 use and transplant. 21 One of the projects talks about reimbursing for 22 the cost of the harvest of the unused. 23 DR. HEUSTIS: But isn't it built into the cost of 24 the ones you used? 25 HOOVER REPORTI@NG CO, INC. 4-39 hv@,!3-13 You divide the total cost by the total number of patient days served, and that is it. 3 DR. THUP-@ I didn't mean to get us off here. 4 Let me say again I am in support of the two re- 5 viei-,7ers. 6 DR. HEUSTIS: Can we hear again where you rate 7 this program in terms of average, above average, or below 8 averztcre, from the two reviewers? @- DR. HESS: The first time I read it I checked it l@o in the above average. 11 The next time I read it I went through and looked 12. a little more carefully, and I put it on a line between the two, so in looking and thinking of its past history instead 13 14 of being on a plateau, I think this program is on an upward curve, and because of that I am willing to extrapolate a 15 little bit and give them the benefit of the doubt based on 17 recent past performance. 18 With that in mind I would like to propose a level I!) of $1.1 million. They are currently at $1,756,000. They 20 asked for $1.27 million. 21 As I look at their priority ranking and their programs there is one, the pulmonary diseases for $65,000, 22 and assistance to CHP's of $132,000, it seems to me that the CHP's should be able to stand on their own two feet now, and 24 I don't see why RMP should need to support that, to that 25 HOOVERIEFORTiN'GCO,IriC. 41-10 hws-14 tune. 2 for $200,000 right there. They seem That accounts to be z,,oving in the right direction. 4 There is an area of substantial need, and so forth; 5 Mr. Chairman. 6 I would make that as a motion. 7 DR. HEUSTIS: This is the full yearly HEW pro- s rated amount, your $1.1 trillion? It is 100 percent of the 9 targeted available funds now in Column C? 10 You see, what I was getting at in my other ques- 11 tion was they are going to ask between this application and 12, the next application for a 50 percent increase over their 13 money that they have right now. 14 DR. HESS: They are going to ask for another 15 $500,000. DR. HEUSTIS: Or a total of $1.7 million, and their 17 targeted allocation is $1.1 million. 18 If we give them more, then we have to take it away from somebody else. I!) 20 DR. HESS: I don't think we need to worry about 21 that for the moment, because that is not a target type figure, 22 and I think this -- I don't know the population, but my guess is it is probably in the neighborhood of two million people. 23 241 MR. PETERSON: I am glad you asked that question. DR. HESS: It is an urban area. 25 HOOVER Rr'PDqTING Go, ltiC. 32,0 Nias@husetts Avenue, N.'L. 441 MR. PETERSO!I: It is a little over two million 211! peonle, 2.1 million. The District of Columbia, I think, has just under 4 one million people, but you have two big bedroom areas in the! 5 suburbs. 6 DR. HESS: There it seems to me the management is - there is an area of need. picking up now, and that DR. THURMAN: I second the motion. MR. PETERSON: There is a motion of $1.1 million, 9 1 I 0 and we have a second. Any further discussion? 12 MR. de la PUENTE: I just wanted to add I hate to 13 limit them on the CIIP that much. 14 MR. PETERSON: I don't think I hoard Joe say he (7) was going to cut it out. 15 I(; DR. HESS: We ate going to issue the money. MR. de la PUENTE: Is there any way we can put in 17 a recommendation there, phasing out as many of the kidney 18 19 activities as soon as the self-support is available? DR. HESS: Some of these they have listed. They 20 state no additional funds requested on there. 21 They have already phased out some: 22 MR. PETERSON: These are the residue of a number 23 of kidney activities, but even these are continuations, and I 24 am assuming, and I have not looked at the application that 25 HOOVER REPORTING CO, INC. 320 Massachusetl,sAvenue, N.E. l,',,'ashin ton. D.'U. 20002 4 @t2 hws-16 I- close, that most of 'k--hese will really have come to ai-i end 2 someti-nie during the next year. 311 DR. HESS: They have a prior4-ty 1 ranking, so we 0 4 can't go in on a line item and scratch out something they have 5 on Priority 1. 6 I just don't think we can do much with that, Mr. 7 Chairman. 8 MR. de la PUENTE: Then I have no objection. 9 MR. PETERSON: We have a $1.1 million recommenda- 10 tion. 11 Any further discussion or question? 12. All right, those in favor raise your hands. (Showing of lia,@lds.) 13 MR. PETERSON: It is unanimous. 14 15 17 18 20 21 2 2il 24 25 HOOVER REPORTING Co, INC. 320 tAa@chusetts Avenue, N.[. It L-L Li K hws-17 HEW REGIOIIiiL l@EDICi@ PLAN FOR LONG ISLAND, NEW YORK AND NASSAU-SUFFOLK 2 COUNTIES 3!1 MR. PETERSON: Well, we are down to two Rngions, 411 5 and it is a quarter to five. I think we are going to switch gears and touch 6 7 upon Long Island of New York and Nassau and Suffolk. 8 Do you want @lo lead of f on this? DR. IIIRSCHBOECK: This was to be the model combin- 9 10 ation, twin agencies, and it was split off from the Metro- 11 politan New York, and put under the aegis of Stoneybrook for a while, at least. 12. 13 With the phase out of RI@IFJ the Nassau Regional Medical Program lost its Coordinator and I believe mush of 14 its staff, at least there are a lot of vacancies here, and 15 there was a shift from this program priorities. Incidentally, the Nassau-Suffolk Medical Program 17 and the Comprehensive Planning Council jointly produced the 18 priorities for the Region. 1!) With the split, with the phaseout of the PIMP 20 resulting in the split, all of the planning projects were 21 deleted from the RllP priorities, and the remaining ones have 22 to do with increasing health manpower availability, increasing 2,,3 coordination, cooperation, resource sharing, instituting new 24 preventive health measures, innovative improvements in 25 HOOVER REPORTING CO, INC. 320 Yassachusetts Avenue,,4.1. hws-18 professional continuing education aid priority number 5 deve3.cping within the purview of 801-239 R@IP legislation, 2 ambulatory care services. This seems to be the project that they have put 41 the most emphasis on in terms of their priorities and planning 5 6 for the future. 7 Also the PSM project is underway, and a kidney 8 ,;:Oject. 9 One gets the impression that this application, when 10 he reads it, is really dealing with the broad plan worked 11 out prior to the departure of the Coordinator, Dr. Hastings, and there is hot much room projected here, other than a data 12 base development for ambulatory care in Suffolk CoiLnty. 13 Everything else apparently is a holdover from the 14 grand design of the previous activity and programing. 15 As far as the leadership is concerned, the staff Dr. Hastings has, it is extremely weak. 17 Everybody on the project is at a Master's degree 18 level, including the Coordinator. Those proposed for employment are mainly from 20 social work, and then there is a serious question in my mind 2 1 as to whether this staff is going to be able to follow through 22 with the project in terms of leadership and evaluation as 23 described in the document. 24 The relationship with the CHP agency, one gets the 25 HOOVER REPORTING CO, ii'@C,1 320 tla-@&ichusetts Aver..,je, N.E. 45 hws-19 fec-lii-ig that CIIP is so@L. of taking over. 2 The Regional r-idvisory Group is still a discreet entity. 4 The CHP agency has endorsed everything in one 5 letter. 6 The projects that are being proposed are contin- 7 uation projects, except for one, that is the data base con- 8 tract for ambulatory care. 9 They do expect, however, to bring in six projects 10 in July, new ones, and there are some continuations, so that 11 I th,,nk we ought to hear from staff about the real state of 12, affairs that exists between the CIIP and the MIP there as to 13 whether there is any prospect of this staff being improved 14 back to what it originally was. 15 Doctor Hastings is the Coordinator. 1(; MR. PETERSON: Do we want to ask Paul to present 17 his review first, or would you want us -- well, I don't know 18 to what extent the staff has any comment. We really are down in one sense, and not only did 20 Glen Hastings leave, but Harrison Owens, who had been in many 21 ways,, I don't recall it was hit name, but he certainly was 9-2 functioning as Glen's deputy. He was acting for a period of 23 what, six months? 24 Harrison has left, and went to NIH. The present Coordinator who has been there a couple of years, he was 25 HOOVER REPORTING CO, INC. 't?R Mi@",hi!,Ptt@ Avpniif- N 1,@i 41.,6 hws-20 i their evaluation person. lie. is an East Indian. 211 I site visited Nassau-Su.4folk. I was on the last visit. I had some contact with Persade. My impression of 4 him would be that maybe he holds a few things together, but I don't see, for a variety of reasons, his background, and 6 what have you, by that I don't mean the fact that he is an 1, Indian, but he is a numbers man by and large. 8 I think he is fairly new to the health field, and 9 I certainly wouldn't see a great deal of positive, imagina- 10 tive leadership coming out at least through his person, and 11 I think the other staff there have some problems as relates 121 to the grantee. 13 MR. NASH: Why don't we hear from the second 14 reviewers 15 DR. TESCH@N: In reading the document it is put 16 together with a good deal of mental confusion on the part of 17 the author, or the Committee didn't talk to each other, or 18 was put together at different times with interruptions. 1!) It is hard to follow with groups of projects they 20 are talking about and what the status of the projects that 21 are being described are. so there are some projects-that are 22 not described in the narrative, or their rationale developed in the overview, and there are som ethat are described 231 1 241 several times, or more than..once,, in different ways,, so you 25 can't tell whether they are talking about a rejuvenation of 110OVER REPOR.Til@l-,G CO, ltic. , I Stan D (.1 2 I)r@f@9 1-i47 hws-21 of an old project, or a new -Droject, or the relationship 2 between them. There is a minor confusion point here to tidy 4 minds in the sense that in the one form, the 158, there are the progress reports that relate to 1971-73, and the proposal 6 relates to 1974--75. 7 There is a one year's gap in the situation, which 8 doesn't.overly distress in-a, but it sounds as if there is a 9 problem in terms of accounting for what happened to the 10 projects in the meantime, and how do we now ask for new funds@l 11 if, in fact, in the meantime either the project died com- 12 pletely, or survived with other funds since then. 13 Should we not be over on new funding altogether? i 14 Why do we recur after a year's absence? 15 Now, that may be just a technical question on how the numbers appear. It may be an administrative type staff 17 thing, but I don't understand it, and it doesn't make any sense. The priority statements, these things are two or three years old. 20 I was on a site visit when Glen was still there, 1 21 and I remember distinctly the long discussion how they got 22 the priority, and this is really Castings' work, and it hasn't', 23 been revised since, and you get the sense, the end of review 1-14 process is sort of a Xeroxing of something. 25 HOOVER REPORTING CO, triC. 320 Ma@-@,hLsetts Avenue N.[. 41!r8 hws-22 DR. HEUS'J'IS: This is what I wanted to convey. 2!! DR. TESCfl7@: I get the feeling that if this docu- ment is reflecting sort of the state of affairs then it says 4 that 66 members of the RAG have been asleep. 5 It says the grantee has been asleep, and it says, I don't see a focus a 6 tha4 round which you can organize a next 7 step. 8 1 don't know where to turn to fish for that focus i 9 of the new entrepreneur relationship that is needed in the 10 thing, because one thing on the CHP business, the two agencies 11 say they are going to reexplore what the lesson is from the 12. experience they have had. 13 If the document is any indication, I can't tell if i 14 there has been any. Well, in view of this, I think that we are tending 15 ](; to go somewhere between a below average and a poor situation, 17 and one where I don't see where there is viability. 18 I frankly don't know what to do about a funding 19 recommendation on it. I think maybe we ought to hear from staff, and maybe 20 we will be a little more illuminated than I am at the moment. 1 21 22 MR. PETERSON: Jerry, you have any comment that 2t3 speaks specifically to the point? To put the question crudely, how bad is the situ- 1, 124 ation? 25 IIOOVER REPORTITIG CO, iNC. hws-23 MR. STOLOV: We have members from Grant's manage- ment here. We are about in the fourth recite of their bylaws 41, and PAG grantee relationships. 5 When we tried to review their process, their RAC, 6 was rally dominated by the corps in terms of numbers, and we 7 asked that there be a change in numbers, and they did adjust 8 that change. 9 The auditors were out there for ten weeks, and their 10 came up with a whole pot ppuri of items which represented to 11 Dr. Paul, Mr. Silbus and operations people. 12. They felt, though, the RAG was do minating the corps, but this is only a sideline to what they did find. 13 14 They did look into some of the projects you have 15 mentioned, as to the gaps in time, the Nassau-Suffolk believes they can reinstate from all indications. 17 DR. TESCHAN: I did have one more comment on the 18 project, that there are two kidney projects, the relationship 1() between which is unclear, and we don't, or they don't seem to 20 have a lot of content and don't have a specified relationship. 21, I am a little less critical of the same situation in the EMS story, because the counties appear to be big enough, and the divergency between them sufficient, and the location of the population centers sufficient to justify two separate operations in that case. 21 HOOVER,IEPORTING CO, INC. 320 @hssachusetts Avenue, N.'L. 0 hws-24 Thc- 1-idney gaiT,.e is differc@yit, because both o f' tllp 11-1 21!11 talk about relationships to Metropolitan New York and the biq! eastern consortium, so there is reason for more coordination 4;1 than I f in d. 5 MR. STOLOV: Could I just ask that we get to the 6 issues that staff looked at? 7 MR. PETERSON: That is what we want to get to. 8 MR. STOLOV: EMS Communication Project. We touche@ 9 base with Region 2 Office, and the same people applying for 10 the equipment dollars were the same people applying under Mr. Rearden's program and HSA under the new law. 12@ This was almost the identical proposal, even more 13 dollars to them. 14 Well, it was briefly presented. We asked the- El-I 15 Communication Specialists to look at it, and we consequently heard from Region 2 that they turned it down. 17 One could draw a grey line between whether they did mention communications in their original proposal. How- ever, we were asked to highlight it because of the magnitude 20 of the dollars. That is where we stand in EMS. 21 22 In Kidneyi we asked the Region, before they sub- 23 initted their project, to have it reviewed by outside consult- ants. 24 They got one consultant, got one one night in the 25 HOOVER REPORTit@G CO, ItiC. 320 Massachijsptts Avenue, N.C. D.C. 20002 hwfj-25 Kidney Meeting in Chicago, and,he dictated something over thei 2 phone, and we called him 'today to get h,-s impression, and he agrees with Dr. Tesclian, that the two projects should be 4 brought together into one, P,3.id this shows supporting two 5 institutions rather than getting a new thrust. 6 DR. TESCHAII: He shows no CIIS function, and it 7 shows no RMP coordination, so it is a total bust, no matter 8 which way you look at it. 9 MR. STOLOV: In terms of the proposed staffing 10 pattern and the present staffing pattern I think we asked then 11 Region, and they only sent in they were allowed to budget 12, the $6.9 million, and they elected to put into staff, so, 13 prior to this application what they actually sent in was whati 14 they were budgeting into. 15 We haven't seen the new coordinator function. Thel i(i 111,AG had a committee, and they have 70 applications to con- 17 sider, soma from the nearby regions, et cetera, and other 18 people. Well they chose their own man for the job. We 19 1 1 20 have not seen him function. We did ask him to expand on the 21 organization chart, and he had four health analysts reporting to a girl who was in the program since it started, for four 22 and a half years. 8he was the grant's management gal, and 23 did a good job at it, and we were concerned the poor people 24 reporting to her, she has a BA, and she has four and a half 25 [IGOVER REPORTING CO, INC. 320fil,a5 chusettsAvenue,t4.1. 2 likes 2 6 1 of experience, &nd her experience was another factor years 2 he looked at in the decision, bu-i-- the organizational cha--ti t has changed. 4 He has sent in a new one, having two report to 5 his evaluator, and two reporting to tier. 6 Again, we ques tioned the decision, but haven't 7 seen it in operation. 8 The seven vacancies are social workers, as you sai.r-,, 1 9 Dr. Ilirschboecl@. 10 MR. PETERSON: Tom, did we have a management 11 assessment visit at the same time as the review verification 12, visit this year? 13 MR. SIMONS: I have almost lived with that Region. 14 I have a very hardnosed View. I think Frank better talk before I do. 1,5 MR. NASH: I think it was over two years ago it i 17 was recognized that the structure and relationships between 18 the grantee institution and the Board of Directors of the RAG I!) of this program there was something very much wrong there. 20 I think they had a 25 member Board, each of whom 21 was also a member of the RAG. 22 The normal procedure for the Board is to meet., dis-, 2.3 cuss the business. They would adjourn, and 30 minutes later 241 they would convene a RAG meeting, and most of the time some of the RAG members didn't show up. All the Board meii,,bers 25 HOO'IER REPORTING CO, IN,-. 320'@l,as.@chusettsAv,,'flLie, t4.E. hws-27 were there, so the clear dominance of the RAG in the whole 2 11 decision making process was by the Board grantee institution. I This gave us a lot of concern. They were ad-,rised 0 they should be concerned about this. They would send us backi 5 letters assuring us that they would do this. 6 Then they would get involved in phaseout, and so 7 from our part we didn't follow up on it until we got the one 8 year's extension. 9 We have been after them again to straighten out 10 this situation, and that is why we are now looking at their 11 revised bylaws, and I think Tom's later review of those indi- 12. cates there is still the possibility of dominance of the RAG 13 by the Board. 14 I don't know how we will straighten this situation 15 out. Does that cover part of it? 17 MR. SIMONS: Yes. 1 don't think it has come out 18 that Rt,!P and CHP has separated. MR. PETERSON: Yes it has. 20 MR. SIYIONS: There was mention of the HEW audit 21 that has been up there ten months. 22 They came in and met, and had a very long report 23 on the Region. They selected five projects that ran when they first went in, based strictly on the time the project 124 25 occurred, and the dollar volume, and they traced it from therd i HOOVER PEPORTING CO, INC. -0 t@'@@assachuselts Averue, N.[. n r 454 11 b-28 1 from the time it started up until it was complete. 21 Now, all five of them they considered a dismal 31' qement by the program staff. 11 failure because of the poor mana 4 They now ask them to select two more teams, to giv 5 it to them. 6 MR. NASH: The audit report doesn't bother me 7 quite so much, because this is a reflection of what went on 8 in the past. 9 The question that concerns me is what is the future 10 for thisprogram. 11 MR. SIYIONS: I,have two more points I would like 12. to make, 13 I think the philosophy of that region, the three 14 or four times I have been up there, seems to be we are going 15 to do what we want to do. We will try to write it to make P,1,4P's and the 17 Councils believe we are going to do what they say,, but we are 18 still going to do the things we want to do here. As far as the domination of the program by the l@) 1 20 corps, as Frank said, I don't know how we are ever going to 21 get them to stop that. 22 The climate is still ripe for the corps to domin- 23 ate, the bylaws still provide for domination by the corps. 24 The only way that they are ever going to change is a very hard approach from here. 25 HOOVER REPORTING CO, INC. 320 Massichusetts Avenue, N.[. Washingto,-i, D.C. 20002 hws-29 1 I think the recommendation you made for Maryland would be a little kind to them. 21 i DR. TESCHAN: You made the funding contingent on 311 their compliance, either get with it or ship out. 4 5 MR. STOLOV: The letter from Dr. Paul said exactly 6 that. Unless those bylaws are changed to meet our conforma..--, 7 and the Region -- 8 MR. SIMONS: No ifs, ands, or buts. 9 DR. THUP14AN: I move that we approve this program 1, for a level of approximately $150,000 for staff phaseout. 10 DR. TESCHAN: I second. 11 MR. PETERSON: The motion, if I understood it 12, correctly, was $250,000 for staff phaseout. 13 DR. HEUSTIS: Aren't you rather generous,> 14 DR. HESS: I don't see how that is consistent 15 with the decision you fellows made on Maryland. Then I am missing something. DR. TESCHAN: 17 DR. HESS: I wasn't ready to vote with you for or 18 against it. But it seems to me, from all that we have heard, i 20 that this program in New York in nearly every dimension is 21 worse off than Maryland, and the vote, as I remember, it was 9-2 to recommend termination for Maryland. 23 Now, if Maryland deserves that kind of vote, I 24 don't see how you, in any consistency, can vote any money 25 HOOVER REPORTING CO, INC. 320 Massachusetts Avenue,'I.E. Washin2ton.. D.C. 20002 456 hi,is-30 1 here. 2 DR. TIIURMAN: That is not what my word was. I don't think we ought to fire these people tomorrow by term- 4 inating all funding, and $240,000 will carry them until their 5 staff can find other jobs. 6 DR. HESS: You didn't make that proviso with 7 Maryland. 8 DR. THURMAN: Yes we did. We said terminate it 9 with adequate time. 10 DR. HESS: Okay, the same general language. DR. THURMAN: Except to make it worse in Maryland. 12, How is that? 13 DR. HEUSTIS: I thought the motion we voted on 14 before was we recommended termination, and left it up to the 15 good judgment of the Council to bring about an orderly term- ination, without out getting involved. 17 DR. THURMAN: I will rephrase my motion, and let's 18 make it the same as Maryland, but a little worse. In that way we will have the same terminology, 19 because I think the program ought to be terminated. 20 DR. HESS: I call for the question. 21@ MR. PETERSON: Let me be sure that I have the 22 motion correct. 23 The motion is termination at the earliest possible 24 moment. 25 HOOVER REPORTING CO, 14C. 320 filassachusetts Avent@, N.I. 457 hws-31 1 DR. HEUSTIS: No, just the termination. 2 MR. PETERSON: Termination with only such funding 3.i as may be necessary to provide for'the orderly termination. 4 DR. HEUSTIS: But you didn't do that for Maryland.1 6 MR. PETERSON: I think what we are hearing now is 6 we are really acting on a kind of generic motion that we will 7 rephrase the Maryland one accordingly. 8 MR. BARROWS: Funds sufficient for an orderly 9 termination. 10 MR. PETERSON: It may require slightly more funds 11 than one or the other for the orderly termination, but that 12, is a minimal amount of funds, really. 13 DR. HEUSTIS: Why cannot we, as a review committee, 14 recommend to the staff, as I understand it, we recommend 15 termination, and the staff, under whatever it deems best,, make whatever it thinks is a proper recommendation to the 17 Advisory Council? 18 MR. PETERSON: As to funds? 19 DR. HEUSTIS: It puts us firmly on the record as 20 far as termination, and what you do with it is the orderliness. 21 MR. PETERSON: Termination with such funds as staff 22 finds necessary to make that an orderly process. That is poorly phrased. We don't know. 23 24 MR. NASH: The Department would insist on this, 25 any way. HOOVER REPORTING CO, INC. 458 hws-32 1 DR. HEUSTIS: With such funds as are necessary. 2 MR. PETERSON: I want to make sure whether it is 3 in the motion or not that we have the sense of that. 4 Termination is i guillotine. 5 DR. HEUSTIS: There has been so much pussyfooting 6 around on this thing, I would like to use language so nobody 7 misunderstands what we say. 8 What they do with the language after that, after. 9 I understand it, is fine. 10 MR. PETERSON: I think I understand the lanquaae. DR. HEUSTIS: I am glad you do, but do you have a 12. vote on the Council? 13 MR. PETERSON: No, I don't. 14 DR. I-IEUSTIS: I would like to be sure the Council 15 understands what we say. MR. PETERSON: I will reduce the motion to one word which will be "termination," and we will supply appropriate 17 parentheticals. Again, I am just trying to get a sense here. 20 MR. BARROWS: It is very important to avoid an 21 appearance of capriciousness and arbitrariness on our part that this termination be provided with whatever is necessary 22 for an orderly termination. 23 MR. PETERSON: Early, orderly termination. 24 Termination with only such funds as is necessary. 25 HOOVER REPORTING CO, INC. 320 Massachusetts Avet-@ue. N.[. 459 hws-33 1 MR. NASH: Any program that I have ever seen in 211 IIEW that has been terminated, the Department insists on an .3 orderly termination. 4 MR. BARROWS: We should mention that. 5 MR. RUSSELL: RMP would go to any RMP and say sendi, 6 us your plans for going out of business. 7 DR. TESCHAN: They will either roll over and die, 8 or scream and come in here with all kinds of important reso- 9 lutions. 10 I wouldn't mind July 1 in that sort of situation 11 to review if they have more life than we hava seen in two 12. years. 13 MR. PETERSON: On both Maryland and Nassau-Suffolk 14 I have a sheet of paper in front of me, I am filling in the 15 last few figures on, in both cases I am showing the figure of equal to or greater than zero. 17 There is a motion now. 18 All those in favor of the motion raise your hands. 1!) (Showing of hands.) MR. PETERSON: It is unanimous. 20 21 MR. BARROWS: This will include the proposition we faced on the impact on the new program. 22 DR. HEUSTIS: This has the same reasons Maryland 2,,3 had. 24 MR.-PETERSON: The set of problems are not all that 25 HOOVER REPORTING CO, 114C. 320 Mn,,sachusetts AvenL,-. N.E. @!.6o hws-34 d i fe rr@- n 211 Grantee Number 1 is of a different order. It is not a Johns Elopki.ns with a grantc.,c! domination vis-c,-vis the RAG, questionable leadership, and certain results of no 5 signif icance. 6 Well, we are down to the wire now with just the 7 Susquehanna Valley, which is the central part of Pennsylvania. 8 Let us move ahead. 9 Joe, you were one of the reviewers here. I wonder 10 if you wanted to lead off. 11 12, 13 14 15 17 18 I!) 20 21 22 2,3 24 25 HOOVER REPORTII@G CO, INC. 320 Ma@,sag-h-is-tts Avenue, N.L@ 46.L hws-35 HEW REC@LONAL ZIEDICPJ, PI,7-@ FOI@ THE SUSQTJEI',At4NA VAI.,LEY 2 MR. de la PUENTE: This is an application for $721,606. 4 On July 1 they are going to come in for $1,05,000. 5 They have 14 positions, including three physicians devoting i 6 25 percent of their time to staff functions following the 7 8 recommendation of management. 9 They have been successful in filling three addi- tional kev positions with former IUIP staff who are rejoining 10 11 the program. The present request is for a fully viable prdaram. 12. Their activities are addressing thcrnselves to the Rec@,ional 13 what the Board concedes as need in the primary health care 14 availability of services for room area and accessibility to 15 the urban service. They are with the Pennsylvania Medical Society, 17 which is providing excellent physical management sources. 18 The staffing pattern coincides with their program. I!) Many parts of their program are grants. The grants, 20 present an opportunity for realigning their staff pattern in 21 a manner which coincides with their new plan. 9-2 The present application is for support of their 23 positions from July, 1974 to June 30, 1975, as well as two 24 months of support. 25 HOOVER PEFORTING Co, INC. Aventie N.E. 462 hws-36 Their July 1 application will emphasize project 2 support. At that time they will present approximately 18 1 4 1 1 projects presently under review by their Regional Advisory 5 Board. 6 While they represent present activities, their 7 application does not include comprehensive updating of their 8 plans. 9 I have not seen anything as to how they are up- 10 dating their plans. They intend to continue the AHEC activity in South 12. Central Pennsylvania, as well as the Area Health Education 13 System in North Central Pennsylvania, and the ambulatory 14 patient dialasis is also going to be continued. 15 What they are going to do as far as new activity Iii is concerned, is to facilitate the development of Regional 17 Health Authorities, and adequately address the need of inte- 18 grated functions of health plans, implementation, and regula- 19 tions. 20 As they develop their plans they will have active 21 participation of the B agencies in the Susquehanna Valley 22 Region. One of the major concerns regarding this Region is 23 the evaluation of their activities. 2,4 This is the problem I have with this Region, how i 25 HOOVER REPORTING CO, INC 120 Mi-@rhij,,,tt@ Avenue. N.[. 463 hws-37 do they evaluate what they are going to do, and how do they 21 decide what they are going to do next, and what are their priorities. 4 SISTER JOSEPHINE: I have some of the same problems 5 that Joe has. As I looked over the proposal I got the impression 7 that they got on the bandwagon very quickly to phase out the 8 program, and they ended up with three people from 22. 9 Then they hired, and they are at a level of 14 now,! 10 and they propose to build it up to the original level, and 11 they realize when they get the whole group in they are going 1 12, to need to develop them to have some program to work on. 1.3 All they are going to do now is to tie up for a 14 poor staff and a development program which is the only thing, 15 a development to develop that corps staff so they will be it; able to identify some projects, but there are no plans for 17 how they are going to implement the projects, or how they are 18 going to develop the project. This creates a real problem for me. 20 MR. de la PUENTE: Maybe sta can e p us. 21 What was the story? 22 SISTER JOSEPHINE: Another thing here, too, their 23 past performance, there are three things that they identify, 24 and one- is that they have been able to elicit grassroots 25 involvement, but you don't know. HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, N.E. hws-38 They talk about the coronary units which %@7ere one of the- first types of tliiric s, which b,,@g,-iti wlic-,n the program first evolved. There were five, Now there are 30. 0 They had a management consultant firm come in and 5 help them learn how to develop a program. I feel they are very much in the same place as 7 when they first started the program. 8 MR. BARROWS: Sister, you better be careful. You 9 are going to acquire a reputation of a hanging judge. 10 DR. TESCHAN: She is helping us to be one. 11 SISTER JOSEPHINE: This is the way I have to read 12@ it. They are going to ge$-- the kiss of death any how. 13 MR. STOLOV: I thought maybe Tom would comment 14 since he was on the management assessiiian My visit was the last visit, where the RAG met on 15 this application. I could supplement maybe what the reviewerl 17 had to say. 18 MR. SIIIIONS: We were up there in January. There I!) were two people at that time, plus the secretary. 20 There was the Acting Coordinator, the Fiscal man, who has been there since the day one, I suppose, and the 21 2 secretary. They had sDent the entire year of the phaseout doing absolutely nothing, just s itting there reading the newsJ, 24 papers. 25 HOOVER REPORTING CO, lt4C. DC, 2r,@iP,2 465 hws-39 MR. PETERSON: In I-Iarrisburg? 211 MR. SI14,@ONL-): They were reluctant to hire people 3 because the Coordinator had almost a paternalistic attitude, 41 although some of the staff wanted to come back. He didn't 5 think they were fair to themselves to want to come back. But 6 now with more money, they will come back, he thinks. 7 This was just a very inactive operation. 8 MR. PETERSON: You were at the PNG meeting when 9 this application was considered. 10 What kind of life did you see? 11 MR. STOLOV: I attended not only the RAG meeting, 12, but the Executive Committee meeting. 13 The first thing that impressed me was that it was I 14 at the Pennsylvania Medical Society Headquarters, which is in 15 Camp Hill, and the grantee is an ex officio member of the Executive Committee, so most of the people in attendance at ,the Executive Committee meeting were physicians, and if you 17 are in the medical Society building, which is quite impressivei 18 but there was adequate participation in the Executive Com- I 20 mittee. 21 This was around April 17, so one of the physicians 22 just paid his taxes, so he was carrying the torch at that meeting, and he was trying to question the Coordinator as to 23 dollar expenditures. 24 Most of them,, I still believe, are similar to one 25 HOOVER REPoRTitiG CO, ItiC. Ave tiue, N, hws-40 of the cor@,,,-nts we made in another r@c@gion, that this is a fun@- ing strategy rather than a prouram Strategy that at this 2 due to the conservatism -- well, they just appointed a D4 t meeting. He was Actin @ro-ctor at tha g Director, so there 5 was a sort of sitting on the fence sort of attitude there, 6 as well as due to low salaries that the grantee has in this 7 structure. This was a negative- force. However, the Executive 8 9 Committee is behind the Coordinator, and the RAG was well attended at this meeting. It was a well attended R-kG meeting. 10 11 They had minority representation there, and people made their voices known, and after the RAG meeting, and they 12. reviewed the arthritis applications, as well, and we did note 13 some positive progress. 14 The Chairman was also well liked, and is a good 15 Chairman. Staff went just like Nassau-Suffolk staff. They 17 were at the position where you are today, because this Region 18 wanted to put its rebudgeting into staff at that time, and they sent us their staffing pattern, and we asked them to link 20 it to their goals, objectives and priorities, but I think, as 21 Tom mentioned, they are very slow to move, and have to ave the dollars in hand before they will move, and I think this was a negative point to them. As to evaluation, this last Saturday they had an 25 HOOVER @IEPORTING CO, INC. 467 hws-41 I I evaluation. One of the reasons was one was just appoin4- -ed a inenLber on the staff. They evaluated the two AREC's there 4 with outside consultants, and they were at a point i,.,Iaere thevi 5 were Handicapped because of the dominance of this medical 6 clinic, and one of the physicians in charge is on the Executix, 7 Committee as well, and up to this point they were really 8 handicapped by not performing an evaluation. 9 However, they did conduct evaluations on Saturday, and the eval 10 uation report will go to RAG. 11 They did, however, use their outs,4.de consultants and staff, and this is the first time they have probably 12. (8) 13 evaluated something on a scale like they did. MR. BARROS: It seems to me, from what you have 14 15 -,aid, what we are dealing with here is essentially a rebuild- ing of the budget. 17 Do you think that is going to bear fruit? MR. STOLOV: I think that we iden tify about $142,000 18 in vacancies in this budget, and the question is when you readi 1!) 20 their narrative, and realize what they went through in the steps they have to take, this is one thin , but they were 21 9 quite honest to say that they mav not fill all of these 22 positions, yet their R7iG and Executive Committee gave them 2 t3 1 authority to go ahead with the strategy. DR. HESS: Can you tell us more about Chad Holmes? 25 iOOVER REPORTING Co, INC. 320 Massachusetts Avenue, f,,L. 4'c) 8 hws-42 1 Apparently lic- has beer, appointed in May of 1974. That is 2 this month. MR. NASH: That is as Coordinator. 411 MR. PETERSON: Maybe I could offer a little 5 historical impression of this Region. 6 One of the first times I visited I spoke to the 7 RAG in the early days of the program, and while I have not 8 been a frequent visitor, I have sort of kept an eye on it. 9 It seems to me this is a program which is in a sense almost 10 like three distinct faces to it. 11 In the early days when the Pennsylvania Medical. Society was still the grantee, but in the early days the first 12. Coordinator was McKenci.e, and I don't recall the first name, 13 who had been an employee, I think he had been the Executive 14 Director, and at that time there was indeed, a great deal of 15 pulling and tugging between the grantee and the RAG, that was trying to make itself felt, but did not have a great deal 17 18 of, it seems to me, moxie behind it in there individually, and certainly collectively. Well, that issue began to get clouded. There is 20 the new medical school over at Hershey, Pennsylvania. I 2 1 don't recall if the Dean is still there, but despi te the 22 fact that the medical school at Hershey was put in the business 2 t3 of training primarily physicians, some of the impressions I i 24 got, &rid I can remember a Dutch uncle talked about that, 25 HOOVER REPORTING CO, INC. ,20 'i',a@sachusetts Aveno,@, N.C. hws 4 3 1 that Harold rolled with so7rie of the pE-,opl.e from Susquel-ip,,-Ina 21' Valley. The medical scl-iool',-! interest was to get some m-oney to do some things that were @.)retty, at least some peoi:)Ie @-iP@o knew better than I, was certainly exotc, and totall-, in- 5 congruous with any total prirctary care. It sort of shifted from the iledical Society and 6 got clouted by the medical school, and as a result of that Dutch uncle talk they did bring in a Docto-- Ector, who was 8 9 from Philadelphia, axid I think he started working in trying 10 to build some sort of program objectives which had never really existed before, but really got caught up -- well., I 11 don't think he had been in the post more than ten or 12 months,@ 12, before the phaseout order came and I don't know what his 13 motivation was. He didn't stay around ver long. 14 y Since that time, Chad Holmes has been first Acting,'; 15 and now he has been recentl.y confirmed as a Coordinator, but they not only have looked forward to a fairly rapid phase- 17 out, but I think it does sort of reflect a Region which prob- 18 ably never did have much momentum or sense of direction. There was not too much to reach back to, and Holmes:, 20 he was job hunting actively for a while, but with his con- 2 1 firmation as Coordinator, I guess he stopped doing that. 22 DR. HESS: Was he the fellow sitting around 2!3 twiddling his thumbs? 24 MR. PETERSON: I assume so. 25 HOOVER REPORT[T@G CO, INC. 320 Massachusetts Avenue@ if.[. ordin-I hws- 44 well, any way, they got dcAvn to the Actii)t:j Co 2@i ator or Finance Officer to close the books, and the secretary!, to do the typing, and they all read the newspaper, according to Tom. 5 Holmes was there the whole time. 6 DR. IIELJSTIS: Is there anything there worth 7 salvaging? 8 DR. HESS: No point in trying to gear up a program 9 for a phaseout. 10 MR. PETERSON: Do we have any idea? 11 Susquehanna Valley has indicated they are asking 12. for a little over $700,000 now, which is about their current 13 level, and they have indicated they are going to care in. with 14 another $700,000 package. 15 Any idea of what it specifically looks like? I(; MR. de la PUENTE: They talk about improving the 17 quality, the high quality care in the Valley Region. 18 The Second Reqion is to improve the high quality health care, and then they speak of each mission, and how the 1!) 20 are going to do it, so I think in here an awful lot depen s 21 on what they come up with in the other application. 22 How they do that I just don't know. MR. STOLOV: There are some plusses, when they star@le( 23 getting.rejuvanated that they have supported the B agency 24 directors at one of the B's Previously not supported, and his 21 HOOVER REPORTING CO, 1,NC. 3@'@ Avenue, t@.E. -T I 4 5 h-vis- 1 name is in, referred to by the budget staff. 2 The second point is 'ch,-- Region is in the State Capital area, actually, @iiid therc is a need in that arca to I coordinate with the th,--ee unidei-i-I.-ified B agencies, and the i RMP. 6 I believe this Coordinator can do it. He has thc! 7 personality. He has a Master's in Theology. He calls it 8 theracit medicine. 9 Any way, he is well liked, and the other point I 10 want to mention is the RAG Chairman is a specialist in cardi- 11 ology, quite devoted and a good leader, and he has the RAG 12. support at this go around. 13 MR. BARROWS: Would it be fair to say at the mini- 14 mum this will be a built-in block for the transition if we keep this program going? 15 it; MR.. STOLOV: I would ask the Committee to encourage, 17 that. When Doctor Ecort left, prior to his leaving they 18 were going to come in for a triannual. They actually had 20 100 applications in-house. This is an indication of some 21 identity in the community. What they plan to do is to try to bite on some of 22 those back applications. 23 MR. BARRO;QS: Let--s give them a reasonable budget i 24 and see what they come up with in their ne),.t one. 25 HOOVER REPO RTING CO, INC. 320hiass"husettsAvenue,N.C. 4 6 hws DR. TESCIII',,i4: That soux,ids except what I 2 think I have heard up u,,iti). no-v7, until you just said what you just said up to now we are going to need a couple of 4 Dutch uncles. 5 One did not carry very far here, so it seems to ii,,P- 6 that the Chairman and the Coordinator, or whatever else needs 7 to be invited down here has to come, and you have to line 8 up and lay it on in terms of what needs to be done up there. 9 MR. BARROWS: Could you give them a transcript 10 of this discussion? 11 MR. PETERSON: I prefer not to do that. 12. DR. THURMAN: As you look at their budget, what 33 they have proposed is $498,000 in staff, $95,000 in definitive, 14 projects, and $127,000 in grantee administrative costs. 15 Going along with what Mr. Barrows said, why not i(i think about $95,000 for the definitive projects, because 17 most of them are transitional projects for a few agencies, 18 and added to that, $250,000 for program staff. l@) I am making a motion that we not terminate, but 20 we ought not to commit this kind of money until we see what is going on. 21 22 MR. BARROWS: Your recommendation makes a lot of sense. 2,3 We have a good Coordinator. We have a good RAG 24 ii guy UP there. I think the two give you a ray of hope. 25 HOOVER REPOPTiliG CO, tNC. 320 tla@chus,,it. Ave,,,.tie, i@I.E. hws- 47 MR. STOLOV: iffid the grantee follows the f i.na-licicil practices as to their philosophy and their whole sala@r,,, is something else. 0 4 DR. TESCHATI: You will need a bellows in Condition i 5 to the dollars to get them started. 6 DR. HESS: In- circumstances like this I wonder if 7 mp,,be I am just thinking here, if he could somehow learn a i 8 little something from the fellow in Rochester Peter IIott, as judged by the grant application, and I never met the man, 9 10 except I like the way he thinks, as represented in the appli- 11 cation, that organization that is there, and the way he got 12, that thing lined out, I wonder if a little apprenticeship with a first rate Coordinator, and looking at what a first 13 14 rate Coordinator does with an application, if it would not be helpful saying, you know, much more than you have to do 15 better. He needs some direction as to how to do better. I gather from what you say he has the interest'. 17 and motivation. 18 MR. STOLOV: Ile did expand from three to 14, and 19 a lot of his staff are following him. 20 He does have some leadership that did come to 21 work for him. 9-2 MR. PETERSON: Let me make sure what figure you 23 were coming up with, Bill, and what the basis for it was. 24 You said leave the $95,000 in projects? 25 HOOVER REPOPTit,G CO, ltiC. 320 Masvchtisetts Avenue, 4'@ 48 rains staff activit-,.,:;@ hws DR. TliUl@,IALN: $250,000 in prog' 2 which would also bring then $60,000 in grantee administrativei 31:, costs which is $310,000 and $95,000 they have asked for in the-."! 4 projects they have, which is $405,000, so why not $00,000? 5 That will not make him lay off any of the 14. 6 It will give him some room for expansion in that 14. This 7 will carry his projects, and pay his overhead. 8 MR. PETERSON: And try and see what their July 9 application looks like in terms of any hint of A program 10 there. 11 MR. BARROWS: Is there any way of getting the 12. reasoning to them? 13 Could you do that, Jerry? 14 MR. STOLOV: We have to send a policy feedback to 15 the Coordinators, but we expect whatever domes out of this DR. IIEUSTIS: There are only about three or four instances in all of these discussions we have thought there 17 18 might be some real value to get some information back reason- Ably soon. 1!) Would it be possible for the staff to discuss this 1 20 with the higher ups, to see whether or not, in a very small 21 number of cases an exception to the general rule could be 22 made, and that maybe some of these people could go? 23i DR. TESCHAN: I have a question. 24 Our recommendation is to Council who has charged 25 IIOOVER REPORTING Co, I!I;C. 320 Massa,:husptt@, Avenue, N.[. 4 9 4'(5 hws- us, and it seems to me if Coiu-icil. says we don't want any part 2 of that'-, we will do this. DR. HESS: I recommend staff do that. 41 MR. PETERSON: Your recommendation is for a feed- 5 back? 6 DR. HESS: No, officially. 7 DR. THURMAN: That letter you signed made us report 8 to the Council. 9 MR. PETERSON: You have an official legal status 10 now. You are legal. 11 DR. HEUSTIS: Shouldn't they give us a copy of 12. that letter to make it legal? 13 DR. TESCH@L: It is a little techinical point, and 14 we might be overridden by Council. 15 DR. THURM.U Staff has the option to ask if Council approves, ask somebody to go with them to explain all of this. 17 The staff can ask about that. 18 MR. NASH: If Council approves this, and of course, this information goes to the Advisory Letters, you know. 20 MR. PETERSON: I thought I heard Al say something 21 different. Here and in a few other instances we won't have Council action until the 14th or 15th. I don't know-if it 23 makes any difference, but I,thoiaght I heard Al suggesting if 24i it is agreed at a higher level. 25 IIOOVER PEPORTING CO, l@iC. ."?O filissachuselts Av -6 1 hws- 50 DR. HEUSR.OIS I gather from the discussion there 2 was no great enthusiasm for the suggestion I made, so forget i 3 DR. HESS: There was, indeed. 5 DR. HEUSTIS: My suggestion is, as soon as I)ossibli 6 after this meeting, that in a very small number.of iii.-,Lances 7 where you believe it important, that the staff seek the 8 approval of a higher level in this organization to at least' 9 informally discuss with the local people what we have talked 10 about in those instances where it will be thought to be bene- 11 ficial to the program. 12. DR. THUR@IAN: I second. 13 MR. BARROVIS: I move it. 14 MR. PETERSON: In this instance if it is concurred 15 in by Dr. Paul that we would get back to, I hope, if tl,.a RAG i(i Chairman is an impossible i-,iover, indicate to them in frank 17 terms the Review Committee's recommendation will still have to be looked at by the Council, That we have serious reser- vations about the Susquehanna Valley program, but would be 20 looking at their July application largely in terms of whether 21 there is any indication of some kind of program being performe 22 there, and they need to keep that in mind. I don't think they are going to generate any new 2t3 projects, but it may make a difference in terms of their 24 25 priorities, and how they present what they have in the pipeline HOOVER REPORTItiG CO, INC. 1,20 taassahusett@ Avenue. N.[. L@77 hws-51 now. 21 DR. HEUSTIS: When is the deadline? MR. PETERSON: July 1, but for most Regions this 4 means their RAG's are going to be looking at things. @lost of 5 them are scheduling meetings in mid-June, or early June. 6 MR. RUSSELL: We have a precedent and can handle 7 this and accommodate the concerns of this group. 8 What I hear this group saying is that there should 9 be a staff visit. 10 MR. PETERSON: Maybe we ought to ask Ho mes. 11 MR. BARROWS: Let's clarify this thing. 12@ We are not preempting the role of the Councilo or 13 reporting decisive actioni but we do feel under some obliga- 14 tiot to help the programs. 15 We think it would be in their best interest to 1(; know some of the concerns and some of the reasoning that went 17 into this discussion. 18 What they do with it is their own business, and we 19 are not reporting any definitive action. DR. TESCHAN: The site visit isn't the term. 20 MR. RUSSELL: It is a staff visit. 21 22 MR. PETERSON: I think in some ways it is particularly more effective since we are not that far away. Harrisburg 23 is a little over a two hour drive, and let's see if we can't 24 get the Chairman and Dr. Holmes to come down for a half day 25 HOOVER REPORTifiG CO, INC. 320 A,@etiue, i@.E. 4'1/ 0 hws-52 visit. 2 Sometimes the direction in which you move is most 3 helful. 4 DR. THURMAN: Excellent. 5 I call the question. 6 MR. PETERSON: The question is on a $400,000 recom 7 mendation for Susquehanna Valley with the communication to 8 Holmes, the Chairman, that he meet here as soon as possible. 9 Does that meet with your concurrence? 10 DR. HEUSTIS: The appropriate division of that 11 within program staffs and projects. MR. PETERSON: All in favor raise your hands. i2. 13 (Showing of hands.) MR. PETERSON: The vote is unanimous. 14 15 MR. NASH: Remind them of the confidentiality of deliberations particularly in the case of Maryland. MR. PETERSON: Yes, particularly Maryland and 17 Nassau-Suffolk Counties. 18 Are we agreed then that we will try to get together at 8:30 tomorrow? 20 I will have something in some kind of rough shape 2 1 to pats around then. 22 We are planning, according to the last communica- tion I got from the other side of the wall, to reconvene as 24 ii a single group, or as a whole, between nine and 9:30 tomorrow. 25 HOOVER REPORTiliG CO, INC. 320f,la@chusettsAvenue,N.E. 79 hws-53 One final thing, if- there are any of.these, partic..!! 2 ularly as they relate to Nassau-Su.ffolk and Maryland tlia@ have not been turned in, please let me have them back. 4 We will meet again at 8:30 tomorrow morning. 5 (Whereupon, at 5:50 p.m., the meeting adjourned, 6 to reconvene at 8:30 a.m., the following day.) 7 - - - 8 9 10 11 12! 13 14 15 it; 17 18 19 20 21 22 2@3 24 25 OOVER REFORTlt%G CO, INC. ?O,Nlamc@usetts Avefl'Lie. N.r L D.C. 2OfjO2