@ i 0 @'i n I-\l)-,7uFt P,, T h c-, rp t n,-@ @%.r. r,, at 9 11 cA r. F)r TI,@rhert T' 'ri c t r P zi. A t,,) r) 1 v --3 n @AlzAH J. S' n c- r Fit o n,,@ a r, Development', DPMP, c, c,, u :i. c r z7s @r- i.aho. 19 T,.'@. FLO-ID, I:', Paso Tcxa@., C) @,T'A@'r,LTYJ"N 01- Y-@ c7 n @)3 D l@' P C E 1'7 I j,,' I:Z I,',, h n. c. D P,, P A U L A I T 7 -'f: 1). C 2 PRESENT (continued): I!JA@ TI(TNt3, New York, ilei%T York DR. Pr MI@,! l@7. 14)% C. POPFr.,t Iqpokane, Washington. 4 D-r, ANTI'LONY I,. KO@1A.ROFP, Boston, Massachutetts. f 15 l-@ICIT7',.r,,D JA@IrT@7AY, T,7i-nston-Salcm, North Carolina.', 6 Vi-6:@ :)TTA R. GORDON, Creat Rend, Yansas. 7 EDWT?@T C. HTROTO,'Los Angeles, Califotn3'.a. 8 MARIEL S. MORGAN, Albuci,uercfue, New Mexido. And Others. 17 18 20 !I 21 j; 24 3 p P, 0 C 1, N DR. l)2.@IIL: @,7ill r-11-acting pleas,@- come to order? 2 T-7 none all plu 'ged in, UT) at head table, and I think ..e are 3 with this of the I.'Iational -Advisory 4 .-an proceed 5 l,lost of you were here yesterday for the meeting of 6 the ad hoc @IP Review Committee, but I do wish to welcome to 7 the table '4rs. Gordon, and Dr. Ilaber, and @,ir. IIilli}@,on. @,le 8 1 are very pleased that you can re-arrange your summer schedules 9 10 and be here with us. As you know, this will be, or is expected to bet the 11 final meeting of the National Advisory Committee, called to 12 disoerse the remaining fiscal 73 funds, which have been relc-aqn( 13 as a result of the court order. All of the 197A fiscal furid--'i were obligated prior to the close of the fiscal year, June 30t 'Ili 15 And as of this state, @.;c- have approximately 23 to i 16 17 30 million dollars for making our awards following this AugLis 18 Council meeting. Now, we will be discussing more of that in few minutes, because we had a rather lengthy open session 19 yesterday. And many of the topics were discussed with both 20 the Council members sitting as observers, and the review com- 21 22 I liesitat3 to go over all of the material again, and@ 23 perhaps it miglit.be better as we gojinto the closed session tol 24 take up some specific Poiftts. If there are questions that bear@ 25 oh the points we discussed yesterday, but I thin),: 1 should mak@, one of two g@-n--ral comments. STiocificall,,r for -the benefit of the three 3 not be with us yesterday, lc-cause I ti-i-Lnl-, it is 4 the da s proceedings . I,'irst of al 1, l@Ir. P,-Libel diO -a':e a y 5 presentation and go over -Llie current status of the 6 and vie did provide, T bc-li eve, a hand-out, did we r4c"@-, 7 yesterday? 8 ZIR. B,@UM,: Yes. 9 DR. WAIIMOCK: @lo. 10 DR. P@.T.IL: !fell, it was intended to give a 11 out. Can we make sure that we get those now, toda@!. @l-IR. BAUPI: All right. 12 13 DR. PAIIL: 1,Thich summarizes the basic 6leren"-S O,: 14 the I.Touse bill that has been reported out by the fu.7L 1- c C 15 I won't go into all of that now. Because, really, I "I 16 that we still haverany steps to qo before we have 17 and by giving you our sum,-.iary statement, I believe, 18 understand what the main features are very quickly. 19 It is a long bill, some one hundred pages. It does certainly make provisions for a transition period, and 20 anticipate that the local regional medical oroqrams 21 with these CIIP age cies and experimental healti'l ser%,,i (f a! 2 n systems, and Ilill-Burton organizations ,,iill be given t-he 23 opportunity to become incorporated into the Proposed or@a-iza- 24 25 tions. is @prc,,T could is n t c--tainly y @@7,-IY 0 to perpetuate the ,-Irourari as @,ic I.Iiow it. youi 2 3 vlho have been following the lc- islation closely certainI 9 appreciate that. 4 5 I,.hen we have copies of.the floor bill we will tryi 6 to get them out to you, because I do believe that it will be faily close to what may be passed. And of course, the time i 7 table for enactment of legislation is unknown for good and sufficient reasons. 9 10 But it may well be passed later this fall. MR. BARROWS: You have just given me a note saying the 11 12 summary of the bill is attached to the Council agenda. MR. BA.Ul-,I. It's the item stapled. 13 DR. PAIIL: Oh, I thought it was a sepetate hand-out. 14 15 I see it. It's the next to the last item. There is a Nation 1 16 Council for Health Policy established v,,ithin DIIEW. 'i,7e do not!, 17 know at this time what relationship such council will have 18 with this council, or to the other legislatively mandated councils,- of the constituent programs. 19 T.10 MR. OCDEN tld it be appropriate for Tnb to speak 20 1-to this legislation at this point? 21 22 DR. PAIIL-. Yes, I believe it would be a good tire. @IR4 OGDETI: In reviewing Mr. rubells summary yesterday 23 24 and in thinking about the matter overnight, while I have not Yet.had an opportunity to read tl-ie summary ul y it is here. 25 6 I am greatly concern d that fil@ 16204, as @@7e h(-,ared it d,-scri!Dc-d sc@ems to ignore the role that PI.IP has played in the 2 health care environment in recent years. I would like to 3 read to this council and to those present at this session, the! 4 open session a letter from Senator PIagnusen who is chairman 5 of the.F>ubcommittee on Labor, lic;alth, T@,ducation and Welfare, 6 addressed to Senator 't,,c-nnedy. 7 And I am quoting. Dear Senator Kennedy. it has 8 been reported to me that the proposed le islative revision of t7ne Public Health Service Act in effect eliminates the Region 10 Medidal Programs. And would divert the appropriation that has 11 been used for rl,!P purposes to local planning agencies, as 12 I understand the present proposal. 13 Planning agencies would then be expected to develop 14 services in the same manner that PLIP has been doincT in recent 15 years. I am somewhat concerned whether planning agencies are i 16 4--h-- appropriate bodies to be engaged in the development of 17 18 services. From my experience with the Washington-Alaska R,--giona' 19 @'Ic-dical Program it seams to me that the development of servide 20 in this complicated undertaking demanding the skills of @,erson;3 21 experienced in the delivery of dare, and cohttadt planninc,- eLn--@ 22 pends almost entirely oft the determination of health care 23 needs 24 By an agency and staff which can attempt to mdtc.,l 25 the local demand for c;,@rvices ac@ainst resources, and ho,oefu2,1'-,,' 2 (-'@vcl.op a co7,-,T,)unit,,, Consensus as -t.-.o how to the z-eeds. It seems that few if any planning agencies '@,,ave a broad spectrum of nersons i-@itl-i the knowledge and e:@.@,Derience 4 necessary for the actual creations new services. ::cr does 5i it seem practical for the planning agencies to do so, since 6 it would create an unnecessarily large and cumbersum crganiza- 7 tion. 8 I would think that a planning board should ta@abla 9 Of expressing the communities will and the board of a devel@,- 10 T-.ent agency should be canable of making sound technical judg- ments about the best way to develop services at the ent level to meet the needs outlined by the Plannina agen--v. 14 These are tvio distinct activities @@.,hich r-'-.-@,iire -,"he involvement of boards and staff i@,,ith their efforts an@- different 15 skills. This is the way the successful PI@IP such as IkiA 16 17 are now Working. I am concerned that if we attempt to t r c t@@ both activities into the same structure, one of thln a@ i , '-s 18 t viti- will suffer, and it may very well be the quality of the services 19 developed in the function. 20 The medical school. faculty,, the medical sl:)6--iali--,ts 211 the medical idministrators and oti@iers who are basic llY int@. 22 Tested in the way care is delivered at the patient e-,rel ma,,, Z3 withdraw or not be well utilized if both functions are ass 24 to a planning agency. 25 It is these @-,ct@-sons, who with I.ea@tershj,,), can 2 expands %--he present health Cate system in pr,.@@oaration for a 3@l natioi-i caltli insurance. The regional medical I-Iro@ to ram 4 date h, nvolved the talents of most of those most cap,-ible--@, 5 m sorry -- of those most able to develop services. 6 Their:record for gaining the cooperation of all parts 7 of the delivery system and-improving the quality and.accessibi'i- 8 of care is unequaled among the public health service Act pro-@ 9 grams. It does not seem reasonable to assume that the capabil'i- 10 ities P-NIP organizations are developing are tran8ferrable to I 11 other orgahitations, especially,@@@here the new organizations 12 have few of the talent orientations of the pred--C,.,Ssors. Certainly I recognize that all rYip organizations 13 like planning agencies and other health programs have not been 15 uniformly successful throughout the nation. But- any lack Of 16 success is more attributable to lack of consistent leadership 17 .1 direction at the federal level than it is t'r,, fault of the P?i 18 approach. 19 And undoubtedly are we going to need to make some effort sometime in the development of health care reso urces. 21 Hop6fully this task can be assigned to agencies whose dypbrt-isd -and experience can iiial@e the optirriim contribution. iu@.I.P organiz@-- 22 -ianaed and,strengthenod tions might need to be cl in some -arts 1 23 24 of the nation. 25 8ut in my opinion they probably represent the best sibility I means of i,,-, sing the quality and acces of care for@ 2 tire average .it4-zan'. 3 In 8urrary, I am ho,)eful that the new legislation 4 Will be able to reco,7i-iize both thr-, consumer and @rovLder 511 relationships needed to make the health system @,orj', -0 p- perl,, 6 There should be some way the new legislation can insure the 7 continuation of healti services, development agencies si4-.,ii-ar 8 to in str cturb d experience, thereby not dissipat thei u an e 9 national resources that we have developed. 10 It might well be advantageous if the n---,,.7 le@islat-',_c:i 11 Were to establish a forr-lal mechanism to assure that t.-ie Of 12 the planning agencies and tli@@. P-1@IP -ir,,@co6rdinated, i.6-.f 13 tli at m@l-ip Is are in fact developing deliverv systems th-.health needs identified bv the planning auenci6s, and such@ 14i 15 mechanisms could certainly behe established without scrapping 16 present ptoc[rams. 17 Creating entirely new bureaucratic structures in 18 future, and in the process, using what would remain .,:e have 19 achieved for existing I?J.!P systems, such as the I.,Iashinqtbr.- 20 Alaska program have been highly successful.. Thark -v6,l for r consideration. 21 You SI @i,@car--ly, '@,larren G. nusen . 22i 23 I would like to suggest that it is the sense 24 of this Council that TIP 1,,-)204 as we have heard it cic-s6ri 25 lis inadequate as it is now drafted. In that it faiis'to teccg- all- le of adequate he -4i serve c---,@ nize sufficiently the ii-@por@@ @,L ro prient ef.C 3 @d e,4forts which simply cannot be li-ited to t,.-- 4 localited geographic areas @%71thin a stcite would seer. to !De 5 encompassed in @@'re concept of the local healtl- service area 6 within a stAte which the governor would designate under t"iis 7 bill. 8 And further, that this proposed 75,000 a year t,,."o 9 year limit for a project is grossly inadequate in our ex,Der- 10 ience since it simply will not attract meaningful or useful 11 applications. Therefore I would like to propose a r-solul.-,Ion. 12 along these-lines. t6- it resolved that the Congress in aa-optirc 13 or similar 1--aislation give each stat(-@ the statutor@,, a.-Li@ n, an C 15 a! support to maintain a senarate ealth sv8tems 6evelobi-,c-n'r_ 1 61agency on a statd-wide basis or inde endent oinriss on 1 7 in a publicly accountable way and devoted exclusively to Such 18 work, and be it further resolved that the dorrent8,nrece Ing 19 this resolution, and the resolution itself be transmit ed to 20 the members of the House Intekstate a d For ic i-.merce ,Tn o 21 mittee, and the Senate Labor and Public Welfare Com,:rittee pc)- 'th 'r co sideration. 22 ei n DR. PAIIL.- Thank you .@ir. Ogden. I,, r@,o' Ion n-a-@ been 23 made, to have t-he dbuncil ddop t 24 MRS. PIORGA14: I second it. 2 DR. P7,JIL: Seconded. Is there discussi.orA? 3 DR. @Ir. Ogden, would you read that resblut.' 4 again, please. 51 ?,I ROC-@DEIT: Be it resolved tlicit the Congress in 6 adopting IIR 16204 or similar legislation give each state the 7 statutory and financial sui,)port to maintain a separate hbalthi, 8 systems development agency on a state-wide basis or independent 9 commission appointed in a ublicly accountable way and devoted p 10 exclusively to such work. 11 And be it further resolved that the omme 12 ceedina this resolution, and the resolution itself be traii,(3 13 mitted to the members of the Ilouse Interstate and Foreic-Tn com@, i4 mic$rce Committe6, and the Senate Labor and Public:l,-7elfare 15 Committee for their consideration. 16 DR. PAHL.- Discussion? Dr. Sdhreiher? 17 DP,. SCHREINER: Yes. I just wanted to ask 6 questionI 18 You would favor the dissolution of the redional prodess? f 19 MR. OGDTN: Yesi I am* Because I think this Pi6de o 20 i6aislation is directed toward the state-@vide activity, I 21 rP-cbcrnize that many of our regional and medical nrogra flow 22 over state boundaries but if we are to have an in6apsulated program which is state boundary oriented, it seems to me that! 23 that we can accoinodate to that through our existing MIP'S. 24 DR. WAIIMOCK: Your point was a specific statement of 25 I operated plan? OGDE'I: Yes (it this particular piece of 16qi8 2 3 tion. 4 DR. WAIUIOCX,. This particular piece of legislation e because the RIIP as we have been looking at them do6sn't 6v r flow into other states and so forth. 6 MR. OGDEN: Tliat',i correct. 7 DR. I-IP@l-@21OCK: Pegio-is, a.-, I understand it I was 8 told them could be' no larger than this room, or they couldibe, 9 the whole United States. That's what called a regionAl area.i 10 So we are seeing some of these things, this is some of the thin s that I was putting to my mind all day yesterday, and 12 9 13 III earlier this morning. I didn't get tp and write it on a s'Al@,et of p@i:?er. 14 ii MR. OGDEN: Of co rse, we have some states, for u 15 16 ekdmple,, California, where we have one TUIP for the whole s tate;. i For the state of j%low York, we have at least four. '17 DR. WP2,11-IOCK: Four @-hat's tight. 18 19 MR. OGDEN: And Under this hew piece of !6gis atibni these four Pi@IP's would become one. 20 DR. WPM40CI"": Yes. 21 ',IR. 2 23 suggested to this Council previously. DR. WAt4MOCK: Well, yoi:Llve been on it longer than I 24 have. 25 DR. PAII@@: Is tliere fiirtli.,-,r Discussion. Dr. ro OR. KO."IROFF: Yes. I find 2 i n synpat--Ily 'I Ogd---n's ?rc,-,)osal. I ,qondc..r tliiouqli, if could d,!-nfer a 3 4 vote on it until some of us have had a chance to read the su i-,ary of the Bill, which I, at least, ha,,7--nlt had a chanc= 5 to do yet. 6 7 To take action on.it, because the basic apprehension that a T)lanning agency is not typically a body constituted 8 to represent the providers or to implement service activities.,@ 9 I think it is a very real concern, but I share 10 DP. PAIIL: I am sure others perhaps have not had the 11 'Opportunity also to read this, and thus, with Council's sense 12 ae wi'Ll- defer voting on this motion until later when we have 13 ihad an c portunity perba-)s follo@,7incT at least the m p orning cor ee 14 break. I believe I v7ould like to take the unusual Step of 16 aski--.g whether any members of the public, because I know that 17 several people are here from PMP s and also Dr. Sparkmah, who 18 7 is the Chairman of the Steering Committee of the National C06r6inatotgi might wish'to add a comment at this oiht in 20 21 Ithe proceedings, and if not, there will be another opportunity 7 iduring or ub ic session the f mal p l' for any comments. on this 22 23 Dr. Sparkman,, @,7ould you care to make some comments at .4 this point? On the topic under consideration> 25 speal@ing for tll m tion, or DR. SPArl'!,tU@'-I: You iii,2an 0 2 j .-n general. 3 s thinking of commenting 0 the r@lotioni DZ. P't'I IL: "I wa n 4 if vou will. 'Lhe to,3ic of substance of l@Ir. Ogden's comments. 5 DR. SPAI@N!Ali: Well, than],-. you. I appreciate the 6 chance of appearing before you again. And representing the 7 re Ogden. Coordinators, and I support the motion as ad by Dlr. 8 I think the two important factors in the bill as I understand 9 it -- I, too, have not seen the entire bill, although I have 40 seen the stmmarV that has been distributed to you. 7L-id I have looked with some care on 13995 which is 12 it's predecessor, which I think hAs not been mo6ifidd very much 13 but I thin]< there are two important fattots, 14 or,,-- is the subdivision of existing state"wl6e or 15 regional PL@,IPIS into smaller atea-wide Regional t@ledical Program$. 16 I think the subdivision into multiple smaller areas is appropri- lL7 ate for planning, as has been demonstrated by the action of 18 those CIIPB or area- which can iddhtifv h wide agencies ealth 19 problems in their areas and deal with them. 20 But this is, think, a totally inappropriate way 21 fro Pecrional !,.,Iedical Programs function since On A stat6- 22 wide basis we can acquire s-',.-@. and have caliber an a bread@. of different kinds of- disciplin@@-@@ and deal with p w 23 hichi 24, we do on'a state-wide basis with the medical associdt on,. the 2,5 Voluntary health association,, health departments, and 0 enqise, deal with health as stat@--@,@,ide t 2 I think it oulel, virtually tcrm,'na-e an PJIP in t@@le areas which i familiar with. And as a mat'-.n-r 4 of in the blue slit--et ,.iYiich is one of the re-ports on 5 1-7as'li@E-, .,,jton I-lealth matters, @..,Iiich I am sure some of you are 6 familiar with last week reported that the bill as written 7 would be the last rites for PJ@IP. 8 I think this in effect i-S true, that any health resource development activit kind of things is doing, 9 y 10 look to me to be added as an afterthought and,ii a totally 11 inadequate manner. I would like to mention just a couple c-@ 12 other things, fie@o, if I might. DR. PAIIL: Please. 13 DR. SP2-1,i@K!-IP'-,@T: Relative to the orientation 14 15 to regional medical program I I-,now that some of you have 16 served on regional advisory groups, or other committees or 17 in otheiways have been involved with '--he regional r@.e,A.ica@L 18 programs redcgnize that some of the other f s 0 you hd enot, 19 some are new. Some of your Dredecessors have had the 6T)08rtunit%, of 20 2 aving o site v' dical id theme 'I have talked to have indicated that this was a ve y he 22 experience in thddkstandin what P--'.,Il"ls do. I recognize t 1 23 2 you all carefully read the written m,@t@.rial we submit to %'ou 4 the Appiicat ons or programs or pro]ec s. 25 Ile are grateful to you for the time takes to oesn't (@l,uit-- tell 2 all of these, @,ut I that t"@@- -a-,-.)er & 3 the story that I tl-hin',@ iou ,%,ould have an o,,Dportunitv to ander-'! 4 stand %70U were actually had had an on-site visit, or had a li't", more contact @.,,ith a coordinator. 5 I know you have an orientation session for Dr. Pahl 6 and his staff the details of @7!ii-ch I don't know. But since 7 T hav- thought about this I belatedly recoaftized that as, a I 8 9 grou,@:), the coordinators of @.!Pls lia@,-,-- done a poor job in 10 expressing to what they feel the @,a@, @@,P's function. 11 Itnd I have written to Dr. Pahl asking v,h,--t -mr ti-iere are strengths that would prevent us frori co-,Imun-icat ncT frcell/' 12 with you, and I have not had an op,,Dortuvii+,-v to have a response 13 to him on this , but 1 i-nt.6-n,," to 7c! lo%i un on it, unless you 14 want to speak to it at the momc..I,)t. 15 1 DR. PA.TIL: I believe not, right at this time, but we 16 ers individually I 17i will be discussing th s ,@7ith sc)iil= other matt 18 and with th-- Steering Committee. DR. SPARKI-.UU-i: As an example, I don't know whether 19 all membe_rs of the National Advisor-,,r Council rd6eivedthis w'nich 20 is, a resort of a program accounta',--i'Lii--.v re-pbrt that was submit@c- 21 that was released about a month aco. is this a familiar; 22 document to you? 23 I-IR. BAUM: It's been riailed. 24 DR. SPAYWW.,T: Tlo%@; many of @u had a chance to see it? i 25 I DR. PAIIL: It @,icis rrailed 2 3.r'ull: It was mailed out as soon as vTe CTO. 3 L,R. PATII,: @@lell at the time of our phone- call it 4 should ha.-, -@en received by you. OGI)T@'.@'@l-. I did not receive i 5 t. 6 DR. SPARKIIAN: Iiot verv many. 7 DR. PAI-IL: We shall mal-le other copies available to 8 you. 9 DR. SPAPi"\I@ll@ll: this is of no value in r.6-asu nc 10iindividual Tu-lPls. But it is a measure,., of the aclqt6qat6 -ir,,Dact 11 Of PJ-!P'§ in helping to train health n@@ @@ssionals and a6t,-,all@@ servin eo-ole. I,,-nd in iT-,,,@.) 1me n tc i n @f i tv a c t i VI ti e 12 9 p 3 0 and while I w uldn't expect you o read every word of 4" is reasonably well done. And it is the kind of thing that I wou ope VOU 15 16 had had achance to look at. in order to better understand 1,17 what we are trying to do. I would like to, then, after I have 8 had a Chance to talk to Dr4 Pahl, @4ollow-up ,,it,n ways in 19 which we may communicate with you. T 20 I'lithout burdening you. I know that you all qa ore than bn6uOh to read. The second it6 1 w6u! m k- to mention briefly is the goai of @tli-c @,lational dvisorv coanc4 I and I am T)lbat6d that in the -notion that llr. Ogden th a t ',,,,a s 23 24 seconded that you all looking at the policies of Pi@ip at you all,'I think, then beginning to take steps to provide the 25 t I leadership tha .1tional Advisory Council has ",,-ovidecl forl 2 RYP in the past. 3 I recognize that in your last two in the 4 previous year things have been pretty well i@ ,first at 5 a result of the phase out directed by the adi.z,,Iistratibii), and 6 then the rather abrupt release of impounded funds so you were 7 kind of overwhelmed with applications. 8 But I would like to remind you that you ate A very 9 respected group,, on the health care !scene. You represent i 10 a group of distinguished and dedicated people and that Your word relative to egional medical programs part in health dde! 11 r 12 im ortant an -liat you should tak time t d iv r is p d I think 4L. 0 C-1 c 13 to consider health colic from the stand point of the NationAli J.D y i Advisory Council. 14 15 And I hope that you i@ii-11 have time to do this. At 1 16 your last meeting as an example two resolutions c me to 17 you from@the I-lational ReviCN4 ConLmittbe, and one of them r,-mcom-l 18 mended that CHP' turn to IU@IP's when appropriator or technical! 19 and professional assistance regarding health care changes 20 And the second one encouraged PJIP's and CIIP,8 at I 21 the state and local levels t. Aork together c ways in which better programs would be carried on kdqardless 22 of the exact language that is in the.legislation.@ thes6, 1 23 thought'. iqete both good ideas "4 Mr. Rubel spoke against both, and af e wh t I thou h t 9 discussion by y 1, was very brief consideration and ou, both of 2 them v;cre rejected. On Ji:tne -00, immediately after the i-,eetl-C@ 3 to l,ir. "iibc-1 d said I was disappointed in his dis- .11 I wrote an 4 al?pr@--\7al of t'@ and it seems to rrp@ '-.his is inconsistent @qit-@ his previous sr em--nt relative to on-going positi've relations 5 6 between PDIP and CIIP. IIhich I wholeheartedly support. -I\.iid I -.;aid that i 7 I hope that there will be some tangible evidence from him 8 9 on action relative to this positive relationship. !Tle hasn'*- 10 responded to met nor have I seen any evidence Of this action 11 on his part. To suni-)ort what he said at the Meeting last time. 12 T@et me add an anecdote regarding this. At the 'i,',a.-,hington- 13 Alas]-la area we have t.,70 particular grant.-, @,7h-r- la vo t C, s'- 14 forces looking at these kinds of alternative arrancTei,-iants 16 @between PJIP and C'.IIP with the best people we can f i cl in 1D bth 17 r@IP:and CHP a d other health care activities in '@)oth .gtates. l.@26tinq and trvinq to shed thei sted iht-r- ts r ve -S 19 as much as possible, to tee what kind of pro ram sh6u cl emergei 9 20 and lastly, that in Alaska, out coordinator, @vho is no@,,,, a very;, 21iable vouhq lady announced -.to me last wee],, tha -,h4n I @,,,a-@ about to get Carried to the dirtctc-)r of the Anchorage Clip acral@IC%7. .2 said I was all for this kind of O-XT3 oration but 23 lit seemed to me this ,,7as carrying it a little to r. 24 Thank you,, very much. 25 I DR. PAIIL: Tilanl@ you very much, Dr. ST) ai-, a n . 2 v7ill have a formal open session a little later, and others 3 rrs8ent should feel free to comment upon the matters that 4 were discussed and Dr. Sparkman, should you wish to make 5 additional comments. 6 But we shall table the motion until the Council has:@ 7 had the opportunity to review the summary. 8 DR. JANEIIAY: At some time in the agenda, I would 9 like to respond to Dr. Spat},,man's comments about the dalil)er-: 10 ations of the Council relative to the resolutions. DRi PPJIL: Perhaps this might be an appropriate ti,,. 12 then, Dr. Janeway. Our agenda is flexible this rnorn--ncT 13 and perhaps this would be a good time. 14 DR. JAI;EWAY. I would like Dr. Spari-Iman, 15 not -like the impression to go unanswered, that the Council 16@ did not deliberate appropriately upon the substance of the 17 resolution brought by the Technical Review Committee. In particularly that the wording of it is such that it implies 19 a necessary conflict between CIIP and RPIP. 20 The concern of the Council, or at least the sense a ssome con ern 71 of it as I recall it, was that there the planning in control function being amal atdted into the 22 9 same agency. The implication is there, we felt; and I think 23 quite correctly that a o 'Id. '.)4 the dvi.sor,,r council for P@ i t @17 U.L 25 Ibla inadvisable for this Council to be making d' t t 1 ic a oria ry 1.)o!-,ition 'rc.,-lativ-3 to the 1 statement from an adversa '-@cns -iavi-@@@ no (-,@ontrol. 2 of an @i@,enc,! 1 h@l'-che ui-a you that there 3 @nd I %,@ould to 4 adequate discussion, at least i@ minds of the peb-@-;le e 5 ar around this table. 6 DR. Pz'@IL: Thank you. is there further discus@i-c-. 7 on this point? 8 If not, 1 would like to.return to my brief rdport 9 to you. There Are several points and items of business 7.1"e 10 should consider this morning. First, I would like to, 11 the indulgence of the Council members who were here 12 to repeat very briefly for the be@iefit of those who were --o-- 131 here yesterday, our current status with respect to t@@,@o c:@-- 14 tions that the Council had considered last 15 Let me take this opportunity t6 do this, bec@.,-,s--- .,.e 16 have representatives from both of those regions here this 'll be speaking ith us, ver s o t@, 17 ribrning, and they wi VI h t 18 And in order to provide the Prover background and utdetstar,,din 19 1 believe it is necessary for me to repeat these remar s 04: yesterday. 20 As you will recall, at our last Council meet ng, 'two of the recommendations made with regard to sp6cif 0 tions -- the applications from I-laryl@ind and I,-'@assau-Suf--Oi,-: 23 were of the following ftatLird: that is, that funds should tc,@: 24 be a,.-.,iardtd for those particular applications and also that the 2 2 t,@io programs in (ju,@:-,t4-on should be terminated in an ord@rly 11 fashion. 2 The rccoi r,,C.,id,-itions were accepted by the director and i@ re on our T,@,,iy to in aood faith 4 these when @@,7as called to our attention that again., @ii. a result, I am afraid, of a dismal ignorance of the law, that we were 6 t abler as a matter of fadt, to implement what had been the@ 7 not tnoil recommendation. co And the second Part of that, the ord6r!v terminator, 9 of the two oroqrams, that isi we had only the opp rtunitv to 10 0 implement the first Dart of the recommendations and that is 11 not to provide funds for those s ecific anplicitions that were p 12 reviewed at that tire. 13 In fact that was the case. 14o awards were made at 14 the June Council to either the Na8sau-Suffolk or t e @-laryla@di 16 programs. However, we were in error in believing th t your 17 recommendation could be implemented and when w e of this error by out office of cefteral counsel Tiiinediat6l"i 19 9 p n e ou a bn 20 --n An error, on our parti and that v7hat we to do was inf orT'@l c- r-I ey I ave a rio an e 21 tiliat right, t rc--FtibTnit a-o c 0 r h r L 22 by the review CO.@rlittoe -v@estetda@r, and bv th @q 23 m'he reason that that action ii at the 2,4 as taken @,7 s lauplications in ques ion, e app ic la 25 li-atic)ns under considerate the June Council and aE)E,) @.c)n This Cc)uncil are slinT.).Icr.,,ents to 3 Tac bud@,,@,t pe,@ri-od for all ro-@io,-ial medical proqra@,@,-- bruary 1, 1974 tIl.-C)uq"I Junr@, 30, 1975 arid 4 extends from Fe 5 !I those a-o,,Dlications reviewed at t,ie last Council meeting, as 6 well as the ones before you today technically are supplements 7 to existing awards. Therefore it is not aDor@riate for the Council to 9 make a recommendation beyond funding for the specific applid-,- 10 tions in question. Ilaving gotten over that psychological hurdle and shocked everyone we as a headquarters staff, i,76th the staffs of the two regions in question try to worl@, 12 13 effectively within the time constraints that were on all o.L us. 14 15 And we extended the deadline from July 1 to JUIN,7 9 16 0 0 1'7 amplify those applications. And our staff met with the staffs 18 the two regions and 6u may i ne that there were both several trips involved, and many telephone calls, an as a 19 20 result of this we believe that the regions in question under- 21 stand fully the concerns that the review committe nd the Council had and hai.@sl,:)ol-.eii to those concerns in the oplicati-I'@. 22 Also, we have made two, made know to th @-e r&qioiis 23 @24 the fact that during the open session both the revieq coiilrllltt@s and the council the-re was the opportunity to s,,?e on behalf 2 of these matters. And get to t.'iL, oocn session, this morni@n 2 ,3 we will have staterr@ents from rer,@reserititivc@,s of both regions. 4 ii apart from that i,:.,,atter I ,,7ill indicate to the Coundil !'I you will recall at the June meeting @-oi,i approved 88 million 5 dollars recommended for approval. 6 88 millions of dollars. we actually made awards of 7 i 8 84 millions of dollars, and the reason we did not implement fully your recommendations was because it was felt to be better 9 management to reserve the different, four million dollars, 10 so that we would have a total of 28 millions of dollars for 11 su,,Dobrt of the recommendations at this meeting, because iqe had 12 anticipated at that time to ha@@le aDpro@limciteiy 43 million 13 dollars in reques 14 der 0 15 An d @,76 felt we needed the 28 million in or t provide appropriate iT-.T)lementatibn of the reconind dati f 16 n on ro I is Counci s a resu 0 e ac ions 3us a e a 17 recited with P-lar land, and Ndssau-Suffolk, those'two ap lica- y p ti6ns have increased the requested fiqure so that the eviet@; @19 committee vdsterdav had'in the 53 applications e re it ,20 a total request of 46 million dollars. Our total dollars tl,r-@t are available for sup ort O.'L 22 i Rcaional Medical Programs included not only th6 28 mii 16n 23 1 dollars, but some unexdendbd b lances of anpt6,xin@at iv one and 6 half to no more than two dollars, from prior budget 25 periods. So that the total monies that we have, and we will knovi exactly cis @@ic re-ceivc--, the re,.-L)ort and expenditures forms this the total amount that we will have following this 5 Couftcil meeting for support of regional ?@ledical Programs @,7illt 6 be approximately 29.5 million dollars, to 30 million dollars. 7 The committee acted yesterday in our closed ses8ion.,@@ 8 So we will be going over the specific recommendations. We 9 have a point, however, which does require your consideration. 10 And as I discuss what the point is, I would lil,,e to pass this 11 statement but to you. 'tL2 And indicate to you what our problem, i S, under the I dburt Order whidh was signed and thus the litigation is bndedl 13 Lbns of dollars wai7e given to the defendants, if you Ve Tq .iJJ4 15 Will, for purposes other than the direct support of rdqi6nal 16 medical programs. i Th's wa the negoti is -.-@ttlem--nti and those purposes were described very completely by 1-@ir. Rubel. Now, the condition in the- court order it that 20 if l@Ir. Rubel and staff are unable to obligate th f rli, ibn dollars v7itl-lin 90 days, 90 da s from the signin Of the final 21 y !-court order the remain g reverts to the support of the regional medical prog Ms. Thus, May be faced in late October with the 06ssi@ll ity of distributing a very small or medium s'ze, or ait-h6uo 25 unlij-.ely a large size sum to the regional medical programs. 2 C, u:) to five riillio,,,l doliz-,.rs. h,@li-eve 'L--hat there will few dollars obviou@;l, theta is a 2 be very great interest on @@-hc; ;)art of the administration to utilize 3 those funds, effectively for the pu rposes they were used diirina 4 5 the negotiations. But we do not wish to call this Council back @-hould' 6 it be required for us to distribute the small quTn. Thus, 7 i@i-- have drafted a statement which perhaps I can explain to you 9 rather than 6 over the formalities, which would, I think, 9 10 accomodate the situation very viell. mind hot require your further attention on matters 12 which I believe are riot OIL sufficient importance to ]-,air r--)I,Aot e: meeting . T,,Ihat we will propose to do with the close to 30 13 1 i i n o ars 15 first pay up to 100 potcdnt of your recommendatl6 s; f6 each of the Ppill's. 16 Should there still be funds available us fter i 17 18 vi6 have awarded 100 percent levels of your recommendations t day, we would then return to your recommended leve s f 11 w ti se I j 0 at the June council mee ng. Becau ust indicated@to vou or ro ra I that although you recommended that we sul)P t Ms t a p 21 2 'total level Of 88 million, we reduced that to 84 million, so .2 we would then take anv t6maiftiftg funds and pay appropriate 23 amounts to the UP June council recommended leve S. In the event, and t" a lot of if's bu this1 is ,,7ay this program trust things. Sh,,)uld t',, st' 1 -I' avai" :)I e 2 ctober, 3to us or ,,ihat ma.,l bcco'@iLc, available to us in 0zt s a 4ilrestlt Of the situation I have just indicated to vou with tle-m ke a di.->tr4-- 5ifive million dollarst we would then proposed to ma 6 la, and the formula is iven at the bottom bution by formu 9 7of this page, and it would Tqe,rely state that @,,,e would take made from this August council meetings 8the actual award that we r 9 a,-id the actual award made following the June council i-.eeting, of those two awards ate of tile total 10 land find out what percent I hd and A u oil 7,eeting* lawards made at the Ju ugust co n age to whatever remaining funds I And apply that percent 12 clion. !I'..,e have. And distributc- those funds to eOc"I re at Uitable Dnd in keeping with your recom-end Ions 14i-IL-.hat this is C-Cl anci 15 of the June and August council meetings/have been unusual, in i6 basically have been revi=-,,.ied, simultanecusl,, Ithat all pro5tAmst 17 ';rather than at quarterly petiods of the year. 18 Secondlyt the competition, t e alp Ita @yis @19 lin un er a competitive syst6m, whereas during the earlier part: 20 of 1974 we were mal,,in'g. disttibutib on a ormu a as 21 perpetuated tank standings of regibns for 10,72. So v,,bdt we 22 Ilfeel is at th last two council meetings, this one ande icouncil- meeting, are bur b-tt indication of the latest 6onsido@-- 23 24 latioi of merit of each region. fore the formula that we ave@ @-vise e b c 1 j. There 1 to be fair. 2 That is 0 . I I -lade it clear, 3 and I would Tilde to !,IEivc- either a (tiscc,@S-@io.-4 or endorsement 4 or, if you would, to consider it later, Discussion or endorsement of either this ,)rcrosal or a Modification because i 5 n this council meeting ends we still r-.a-%T be f aced w a 6 o ce 7 distribution of funds. And I do not have that authority unless @@e reconvene!. 9 At some future date, so I would like to o@-en it no,,., for cancra,l 10 discussion or clarification if I have not nade it clear. 11 DR. Tv@7A!,',-PIOCI": That's only a minor sum of onbyi you i 12 say about four million dollars. @jr a and a half dbllar5-, I is that correct? First you will take the sum alloca ed @4or@! 14 eighty eighty million dollars, 15 rst I will S6 th -icun- DP,. PAIIL- ilell, let me try, :L e as 16 that were available to us to pay 1-,p to -o r e o a 17 we reco n 0 19 DR. PAHL: The funds remaining then return t of those recommendations. If funds still either %.,,hat i@ 21 we have currently avail@i'lle, to us tiis 8u er, or an, L@-lat 23 may become available to us in October, I ,,-Culd t On emT)Iby 4- he f ormula that I have give-,,i %@Iiii.ch @,@iould fenrese t ercente"g 24 t&rmi d r each region based oft the viLn6 and 6ust t6unciil 25 ictual a,,,,,ar s to that rc@gion, @@,lill ;Dc at I'@e 311 100 -P-rcc-nt Jun.@ and @LUgkist Council recori@-@-c-nded levels and a:D@'--Z@ 4l@ that to ,.;ha@---ver bala,-icc-- rciTtains. ,7) DR. I N-,,ould life to move that that be t-=n- 6Idorsed, or approved that 7 161R. OCDE"il,,T: Can I ask a (Itiestion? DR. PAHL: Yes I.j'.R. OGDEN: Iam unclear as to what this five million 10 !!would be used for andthe manner in which that will be 11 DR. PAHL: I can speak mote fully to the second ',then to ,-he' first point. ,IR. OGDEN: I think it is the first i:.)oiit that 1 an i,@-or interested in. 15 DR. PAHL: I can get you material for the first 16 !LeL'. me speak to the second point, however, @,ir. Og 61n. t@16 17 negotiations on the se enen o is 18 @'conducted primarily on behalf- of the defendants by Of 66uisef 19 ,our office of caneral counsel and the person of 121"a"e And to t e purposes, nee s, liat 2@ibe r6nresented by having 142'.V6 millions of doll sa 22@ :,to -the administration thus have been our most -n(I under his ir6ct Per onal consider tio 23 yr--sterd e II,-- handed to us, ay, a rath t len4th state en,- ,,hich frankly I had not seen until yesterday because t is a 25 te ac-Ei.v'ty @,7-i ,'-in bill @.,t a r a :L do is vou F-, a Tnc,.! 1@'i t I I"L a vtI i'l. -c0 2 'to get I'@r. st)-@,a@- t-,o @-@orc L,@-cause we 3 d 4 5 L I the riannz.!r in ich th@,- money will be sne-nt 6 7 I understand is fully through contract process. And the purpose generally designed to lool@. to,,,.,ard the new legislation a-nd to 8 have organized, defined, cleared, and publish those kinds of studies which are concerned with health planning method- 10 oligies, evaluation studies, and to development of manuals and procedures which will be of assistance to the organizations 12 which we expect to be developing and supporting as a result 13 of t@. proposed legisl-c,.ticn. am not sure that that says much more or even as 15 well as what he said yesterday, but I cannot anii@lif@), 16 DR. It's kind of anticipatory, -as I 17 t it . 18 DR. PAIIL: It's kind of anticipatory let's go off 19 the record for a moment please. 20 (Discussion off the record.) 21 DP. P@-T@l-'L- I-'- c-c-iri go b,ck on -the record again. 2- I-)@c haT.DLD Y i f 1, 'Jr. Bell today, to try an.,,I. get 1-i3m t@c) 23 l@ coTpe and speak to thi-s point. I'L@ i@c. of imporant, but it 24 hz,,s been quite rcri-p.@.1--ral to my -ictivi-.-t,ic@s. Unless tl-ierc is 25 I i I I i i @-I oil t tiink i.t ti-@c, 1 -i o f t'@i E., co c for I'@li',IP Hand tlii.:71 is file t'd 1 Ti,(,,i-i@,y. 2'incft I tjllini@ wc-, iri,71-).E-ove the Manne and of I-Itib(-,ls the. P,,onc-,y mav ,iot 6 be apl)ronriatelv snent. 7 ear on how tho money1 DR. PAIIL: Yes, well. that b )ent. It is the re-sn6nsibil.ity of this Coun il tc) approve 9 is s, c all grant funds. 10 '-@4R. OGDEN: Unless say to I,.tr. Pubel's resolution that you leave the authority to ex,-.)encl that mc)n,-y and 12 to rol-i tie right to spend it in the in vou s,,7@nd.@ 13 ns- it, ho,,, ,r)u clioo!7,c to siDena it, and 0 14 is spending it under authority. 15 Isn It this the result of the count cr-@er, i.17@. HII@IT06 17 Bob, rE,,t-11@l--r than 18 PAIIL: It's the result of the court order but 19 I am in a verv poor position to take issue with lir. Oc,,e@n. @IP,. TIII"OTO: Okay. 20 DE. PAT)IL: T'@7hat I @%Tould say, is that it -ir. m,,, c- r - 21 I .- , -,n -t- -,t col-..I-@- @ Ford, . 5,tanding,that --n c@,nr, of gran- funds mtir@. C.L 22 and be rc-coi-dr.-encir@-d for @ipprovrLI. by t@-iis council., but cort--ac,"" 2.3 it is cu,,:,,tom or @,C- C@ i4-- f ra @-i 1 ybut cer@-i-ij-nlv. to of Try T no C,:l - f ti -to d t u@!7, a r c- i 3 c o -i-ii 4 five t e ch n c @,i r 6.,D din con-trE,.c I je V,@ c o r 6 it must co - o re u-t I 7 you to have a undc-rstaiiding. 8 PIP,. i,7as it dosignat,c.@lin the court or,,m-r 9 as coi-i-@-ract fune,@-? 10 DR. T turn to r@,,,y quasi-la@,,,,7c-rs. 11 ],)oth a little infori7@a4@ion. 12 think one,of the ti,-LngF, the court did to 13 impotindr-,O 'L u-ri Lis an c) kii @ti-i i-i 2 r o c; a us. 4 C) t@,,cs a@,,,7a,,, 14 the a@ t -d funds to us, it a@,7F 4Z-ib I(. 15 of tied released andina) es iG to nine, ten con@-.rac,tF@ 4@-l-,at ill,,P that's @,.,Iiat it is. @l 17 11 So, then, have five i7L-'Ill.ioii l@E@,s, to alloca,tc- to our T 18 LNIR. OGDI@l@'i: If tlj,.at is case and it goes ii-i ti-iat@ 19 route then my question is out of order. YOS 20 21 DR. Is it ac,tuallN,7 spelled out as contract. MR. GARD!-7LL: T@iqt's right. I.P'icy Cio,.'Ilt !lave to I,-)e 22 nade as contracts. Tl-,@y arc- not ria6e availal)2.e to us to a 0 24 to our 'LIR. OluDEI@l: Oka,,,,7. D'- LI,, 4 -TI CLI1,C@ oi. ti, r c c, a a s- 0 -to h,.iv,-@ a coun --For t at@ li 2- c- zz ,,:k)uld br@ T don't reall@T for sl,? -endin@i a-i"7 ti r,,-c 6 on I move the motion. DR. PAIIL: All in favor of the proposed resolutioil,? for distributing 9 Relative to the formula 10 l@LEI@l: didn't get c). second. 11 @,,OPGA-@ : Yes we did. I secc)nCi@a 12 DR. PAIIL: Ill'i sorry, -L, ha,,3 be-en riov,@ci and seconded. 13 All in favor, plei--c- say lye. VOICES: i%ye. 15 DR. P7--i.TIL: Ori-oosed. 16 (No resT)cnse) DR. P,,%Il@LT d. 17 .@@@otion is carric 13 i MR. OGDEIT: As a matter of editorial consent, shoul 19 the bottom line read J'une? GA:ID7-71.L: The words will be datc%-d in 20 will effective Scrtc-.r,!)clr 1. You're being terribly @n@zhn DR. T@T.TL: ,'@ll r3.g)it. @'o@.7 we have @.,ottc..@:n that, ver to the arthritis, btit 1 sc-@-I '-t I next wanted -,ov-c o both Dr. Gramlich and @ir. left tl,@, rooni. So, first 2,5 ;I @@c)UlCi -J'U.-.t like to have the minutes of the la t meeting con- I I II ii II if T t'i@@v arc att,-ict-iA z@i.ij. f u i a n,@ ai-i 4 @).cti.or, on OCD'@c"'T: Tlilcse I-,aven't mLLil.,-,d out.T -ic 6 no reason not to suggest a iic)tion t,@i@it tl -y a@.) provec@. 7 Second the notion. P IIlk P',!L: The motion has bec@-,n to -accept the 9 minutes as submitted. Anv discussions 10 (Iqo response.) DR. PI@LIL: All in favor of tlis. @@otio,-i? VOICES: Aye. PAIIL: OD;Doscd? lit DP. PAIII,: The motion is c@ii-i-icd. As a ,niattcr of fa,--t, it @,!ould b@, ii and still is part of the minutes. DR. P'IIL: We walk a tight @--ope here.. in just a -Iioment, having a report from '-Ir. '.,Ilatt @,,Dear to ]Drinq @?OU, ULD to date on the status of the. arthritis procra-,n. Pis c- ia v 21 ,,ou will at the last council meeting, ..'att, just -ibout g-attircTt,)vc)u at this r.)oint. Q'Dl p@@P: DP. Pz'-IiIIL: if that --,.s su@I'L@.ci@-_Iiit. you recall at 2,1 25 1 the last Cot,-ncil m,2ei--ing, you did to a I?i-ss--ntation by I* i, 6 ii 11 - ii ii r C, Z?, 0, 1c 2 d d c-@@ r a t a C,' c v c-, j. t t C- 4 r@co-117.endat,4.c)n,,; of th a(3 hoc c 0 ITLM@ o u 5 czli'-'@@7F-Tu@nt to that %@7@::' liav,,@ r:@ad and s n i7 j.-t t o 4 cl.@@ci-i, - the ct,,@rent status O@ 6 li'@le to call on ',-,Ir. r ti Critics Piece the last Council 7 the program, and our ac 8 meeting. 9 10 1 2 1 7 2!Qj 2,i 25 j. t on t r r-, c f ear,- 7 4 r 0 f p 0 4 Tried 4 and a h,-i 1 f f C.) r)i-lol- @2Lrthr4-tit-, ccnt@.-e 5 i-Ilh.@n the for 6 ar)pl..icatioxis from 43 r,@gi.ons to-t@.illing almost 16 -i',-lion 7 8 dollars. So it @ias a highly col@,@retitive situation In the re- 9 Vic-@7 . Polic,2'.c-s establ.isi-ir@@d @@,,]-iich took out of t-I.E-. @unnizi(-, those kinds o-r activi.t-i.@as @-,-hicii did not C,@li-@l-n t(-" "Dc@ C.@ ructI.-,i CLi.d riot seem to directly Is:)--ar on patient t e 12 d -)f th,@:-,cTs j"or nC. c-,,,.,,tensic c- c a r to pztieiits. y c- o u't-- c 0 t I 1 -I r e c o i i @d j,4 15 art.-irl tis rl-vie-@v-7 a-.,id Council at it s c- S c,@, 16 32. of t-lic@ Y@-74i:l aTDr)lic,-,-Lions for ilot 17 a p -,2. r d ',n c, '@ed f ig ismall amount. 19 I shouldn't say small ainotint, tIA-1@it's editorial. Bv 20 an amount of almost a )ialf a million t:le apr)ro- 21 ii val of the Council --un(',cd, or approved, ten@,e@,, to @,-Dprovc@ U 1-1111.,,'i--h,&, allocation o@- -lack ne, to all of the r:@rc,,,,-ra 7, i--ha-L- 7,,l f @.1 @l.. ,%,.,itlain tl-ie -carrar'@@ed amounts avail.al:)l-@- to thc- --,)rograr:@,. that is 27 of ind the 24 renaming 'Lour @.,,ho were but for thc-,re @."--re n(-)i-- e 1-i@ ci i-n,-) i,,. n t a@,c2 in 3 y o c. r c-@ff,@ct t):,.@at a rc7,,r,,;.cin 5 iF, or is not approved for funds o:c- Ls or not C, for the utiliz,.-A-t@.ion of fundc. 1!7as issue-' Fi. 0 v e 7 on June 29 The lettcr also that each of 4,-,he regions lot ar-t"iriti@3 activi-tv respo,-C, in receiving approvals for I writing as to its a--ceptari(,-e of the award, @,@hc-'re an al,,7ard is 10 !I involved, and or in all cases the conditions of tlic- a@.7ard, which was the sl;-_@;%Ltement embodied in the ap,,@,rovals as to t 0 kinds of -@ctivi-@ies that ,..@,liould bc@ undertaken. And the limits of the fi),nds that be exp-enc4@ecl- .for those a c t i v s . To@,iay acce-pt@@iiicc-s 21. t'losc- IV4P's and we are waiting for an additional ten. To round it I la up. Ei<4-ht of those have bc-@r@ii@l contacted as of @@c.,ster,-Iay, irLd i7 theory! ar.@@ cis rap-,-di. get their accept- y as tlic@\,, n to 13 ,nce@s in. 19 As vou can imagine, going from a request of sixteen 2,,) million to something in order of less tlai-i five millions -tic cuts were iiiEicle, and some restructuring of 1 S Or[10 CA Z @,.i c -the 'I-as n-cc@,n-,s,3ary, an('t i@iithi..i,, ap,,:)rov,@ls L, once cli, ,nac-@s arc; )Deing negotiated. It anrc-:ars at this that cnI.v on,@@ or t,@.,o of Z5 the 31. approved regions may tarn down the funds. On(-; Ovcrh-@-,i@i C@ V.1 - C'I t aTid C rc,,copir,,enCi c@ r act'; c,,ris both at t,.ic,. (D ion c; ,,i - u from tile 5 -the re I-De some centralized fO@@ part , of tha' I ti :1 !I-dicc at there be a met 7 -he r,iost important aspect -is a dc--,si-r-c@ tli hod and an approach to coordinating liko:. kin6is of programs that nevertheless are c'@.-Lspersed the 31 Rl,f(P's. 10 W6 are also in the advice letter of June 29 z@,,,s)-led 11 i,!! tile l@.1p, sto give it some thought, and to give us the of their r@x,-@er4.-.nc-a and thoughts. IT(D@,@eve-r, tl-i,@y did not have'; the full nac;,3c@i by then to @.vc- z., proper 9 i-n our estimation. 15 7@-nd we a@-e presently preparing a letter to I that un and give them more concrete @,uch .i@3 %,?iio 1 17 arc,. trip, I-)all got -@,nC, fc4,1- @That !-.j-nds 18 of purposes and what are the nature of the @@)rc)g@'tams that 19 have boon approved. for fun@ti.ng. t m c-@ ii 20 And just in conclusion, to these remarks read vou draft part of the letter that pi)rpO'--tS to ij ij -the api-)r-nv(--d prograicis. Tl,,@@, eml?has.Ls of tile approved pilot ains is the extension of 1)resci-it I-,nowleclae in arthritis pL-,@gr treatment and care to coordinated services (3,c,inons-'"-rated imv)roved patient acess to care, and extension ci:; V 4 scr C( s r c'@ @i. n,i. c s cc@i!i I'@u y @3 a! 4 -r i ni.t -i n hc!7,,@,).i,tals anCi th---c,--,@ f ucoL.-Lc.,-,.c7l T)rof-ira 1 j- t s I'd 4 lt4 C, v @,,i'l increase tl,io 4 1-iancilin(.j capabilities of 4.- a s and ,)rival@-.e rhys@@.cla-.s 7 a and @,yill e(7,ui@n larger i,. u ml),c r s o.@.7 i-,,@Ci-Lcal and health perscnne3, 9 as support services ill ,Hospital. c 'I- in -Lcs @.i-id increase--' a c. cars @.,7i!l be incrp-asc-(3 t,@irouc,,:-i the o- I'l t t ra i i@@ I @n g a c@@ vi -L.'l C-,::o 12i conductc--,('A F,4@- -.an-.- f or 4 rt-,- ro-,,ed u.@-i.li.,,iation c @"D -,I r (@, s 0 u r c7 @@- s--c-- 13 @is s@r' -I ci @juiclanc@-; 15 Ic@,nc@. Exi@ti.n,-, h:zalth and C :L - r-i n cl@ c- a 1 th c,, r o,,i s s -Li !I E., r., F-. s p@ s s c, 'i.7 and 13 prograi-.s ar@ coo,---rating and (f,@,,-,,.onstrations of a:,?prov@n-@- 19 ark@-',-iritis health car@ Celiveries. Sevn-ral modest studies o c.@ri@tr2ria fc,.-@ aualitiative care through l) r,7,,,, i- c'e @rmance@ -on@,uct,,@(1, and 2@ @,,,n c-". .)lovcr educational. be C,,cvclop@6 in rt -@ith occuDaL.- n o', icr rc-gD..o.i r @i r t n t of 5aiar 2 a c t i. 4L t of @for-uf@inci on the p- 4 of o-,7 income c,.rol,r-,,S, -urz 1 others are i:," c 11 .13 -i ngi 5 on t'@-ic develotiiilci-it of care Czaliverics in economic dirocivantag,!",., 6 inne r 'tatric arthritis s -city rc-sid.,2n s. P cervices will be I 7 developed in a variety of settings, and one program is derron-I strati,.-jg ir. 2:@oveei services to the geriatric population. p 9 Localities which Pres@ntly have little or no rhp-tma@- resources are being supported by the initiation or i the expansion of medical, now medical institution teaching Across the coz,.ntry, chap,-c-rs of t'@i-z art,,-,ritis 4 on t o -i,c,-n are ',,? f ou,."- rovidi.nq program coordinate 15 and increased numbers of volunteer workers in supportive services. And increased agent to local ser%yj_ccl@.3 17 and resources. 13 i That coimT)letes my report, Dr. Pahl, unless t-eicre 19 are qu--stiofts. DR. P2ilIL: Thank you very much, !Iatt. Dr. Ilaber? i 20 21 DR.Ilt',jl@EP@: @-,3hat is!,, where is that procrtim get I at ric services? 22 IIR. SPE-AP-,: In lichigan. @'7j@,,ivcrsity of Thank you, Dr. Grcirilich? 24 D.'Z. C-,7,,A@ILICII': l@L'@7 I i-j,-clicated to you, I 2@5 t 1. C 'D t@o Y,-)U for not havina becii a.blc to clet @%7i-'L-.l YOII a l@"@ this mornina due to -Li-ie road construction eelavp-d T,,.,! 'I I wona-(-@red, if voia have a statement to 4 make 9!-=nerally or @'i @ ri k to add cii-,@ci the information 4 I did pass to ,iou 1 thought I would like to make an 5 and statement to council, rather than a formal resolution. 6 But perhaps you would like to make some comments, as a result. 7 I would have,a great deal, Dr. Pahl, except to say 8 that this is a great example of the flexibility of 9 10 process, in the administrative organization that ic; to and 11 accept the task, early on, accomplish i4L-. rapidly, bring it to reasonably successful solution. 12 l@latt's report is superb and I have nothing I.-O add 13 to it. 14 DR. PAIIL: "L'hanl,, you. L-- t me just take one or two 15 16 minutes, and indicate to you. are attempting, should 17 there be further funding co,-ling to us this year than anything we have spoken about to date, or will there be special arthritis! 18 funds made available to this program we would atterot to engage 19 in those activities which the committee recommended to you, 20 i and you endorse that is to Provide centralized audiovisual 2! .-ssource-@, the O@, v,2 c-) @):n on L-- of certain training films, vic4ao- tapes and so forth. 23 But this requires a reasonable i.nvestrr,,,ant, -nd %,:e 24 do not have the dollars at the moment. 1,7e do intend as -r. 25 the e>,.4 St- -icate@r,@ to to !:)ul.l t Sp@ar ina activities in4- LIO a cohesive 13ro--r@-im through the qood 2 3 of ",r. SF,.-;ear. 7,-nd heyond -,i:iiinal funds for some etings, and so J'or@' , I believe c@an accomplish 5 m c@ 6 So .,7c do hcp-@ -L-o h-2 able to report back to you at so--@2 Luture time that the program is not an assemblage of disjointed 7 8 ,orojects but does represent a total national program. 9 Tio@,i, facing us yesterday and today there are a 10 i limited nuirl@or of arthritis applications in the Juli-,., I- @',"p 11 1 applications. I believe five regions saw fit to include l@ 12 arthritis requests in the current applications. to sa,; t,@-la-k"- most reg-@-c-L-is clearly understood that the 13 )@r --ad to ar@hri L.1 s inr, -am was @-,ala the fiscal 74 act 14 the activities of the specially established ad hoc a--'-.r4t4:,: 15 16 review committee which met for one time and was r--is'--ancl.--d. 7 Thus, -,.N7e havc a situation in i,7hichI ac7jr,:L-i4@stra@@ivel-: and indicate to those regions that basically their '19 have been submitted inappropriately, although I thi-n-@ in 20 SOY-@-3 cases there have been honest misunderstandings, so that 21 perhaps this news would not be taken lightly. 11 I 'Leel that, '4@,,o%.!ever, L. is important to rn-cpc-n ,c)u very briefly tl-i-_ fact that we believe the -@-Ilot 4, arthritis center TDrc(7z,,3r,, -@...,,as established and is no icnc,-er Olson . That is, regions should not be ncrmitted to siDend curr,-!r@itiv avi-.il.lal)lc-. funds or @@,,iiatever furi(is col-o tc) @hc (Ii.f-,tr.-L!Dutionc, 'iF tijn '-.)L,,en d4 2 in Y,,@a,-, 3 this -nornina to su,-j@-)ort additional activities. are trying to !)uil-@lz a national coliesi,,.c 4 5 and as a result of that I have prepared a statement I would like to read to you, and if you feel ,,-ou need to stua,. 6 7i it we can distribute it. The timing is perfect, !',en, thank 8 you. 9 But I believe it would provide you with the sense 10 of what I believe is necessary in order to be fair to all 11 regional medical programs and to try to build a cohesive Pro-i gram . from, those activities that were reviewed and aDT.)roved 12 by the Technical Board of Exneri--.s. 13 The statement that I would lik-c@ therefore, you 14 15 to read to you and ask for Nrour endorsement is the follo-@@.,ing,, 16 the underlying authority for the 1974 initiative in arthr---tis- %@ias pilot in tcbi)e and intent. found heterogeneous activities 17 18 beyond this level would not be appropriate employ,-ant of 19 current grant funds. 20 The full development and delivery of services for arthritis is an enormous undertaking, and requires a continuing 21 i@ell organized a+--tack such as could be initi..,a -d un--"--r pr 2 tc pending legislation. 2z') 24 while Council is fully aware of the uraent needs in the arthritis field, it does not consider @,x-,)3rditurc-,! 25 ritirr ot@-hc-r than fox' a r,-h I m-etinri to be in ti-i@, 2 mac.,@@ at the jtanl,, cou!-ic:L. present environment-,.. 3 and the allocation or expenditure by individual 4 regional medical programs of funds for arthritis in additi 5 to approvals provided at the June 13-14 1974 Council meeting'; 6 are not approved. The Council will entertain approval of 7 additio hritis in the event of ap 8 nal thrusts in art propriate authority and new urant or other funds become available to 9 10 the RIIP S. Dr. Gramlich? 11 DR. GRM4LICII: I heard i.-.,-,erefore in-th-- p@-riodizatioii 12 13 process at @-he June meeting there were four applications that wore approved by not funded. Those were outside the 14 scoi-3a- of this 15 DR.PAIIL: Those four are outside and they have been 16 given specific permission follo,..,,inct, that Council discussion 17 18 to utilize their funds to supi,)ort, Becatse those aDnlidations, 19 went to and through the review process by the art]-Lrj,.'tis review committee. 20 21 This pertains only to those activities that were ,.not re viewed by that special arthritis review cfroui.). 22 23 DR. GRAT-ILICT-1t:okay. permitted t rebudget,@, 24 DT-Z. PAIIL: Because regions are 0 and Finybody can rebucl(,f into ,III-tliritis in.tlie doming year. 25 a (2,oi-i It l@nov7 hovi @,le cc-',,' 2 b,-isicallv leave it c),,-)cn c-, n, d c-, d 3 The applications in arthritis that have come be@4ore rthritis panel, and 4 you today have not been reviewed by the a r)ossibilit@, 5 cannot be because @@e have no possibility, have no 6 o4 calling them together again. Flat i-7e are saving, therefore, is that your June 7 actions, including the form whic';-l @.ie did not have funds to pay, but were given permission by that closes the arthritis 1 9 10 program effort unless special arthritis funds were made avail- 11 allc- to us, or unless additional funds, and then it @qculdi come back to this Council in ful@ measure. 12 That is the statement, the intent of th,@ stateT,-en+..@ 13 DR. GP..M@ILICII: It seems reasonable And Perfectly 14 clean to me. I move that it is adopted.. Unless Council 15 16 wishes 17 DP. 1-@Al@.L@.IOCT',: Second i@.. 18 DR. PAHL: It's been moved and seconded. Is there 19 a discussion? 20 DR. JAI-TEI-7AY-. Isn't Lee intent of that also to exclu@@-- those grants which on technical grounds were di,@ap,,?rovc-d? 21 1)@. PLT.-IL: Yes. 22 I think this @,7ill be clear in the sc-tns-@. 2,3 24 of it. DR. PAHL: This then %.7ill be incorporated. This i 2 4-n t-@e Junc, .)@)r(,voct a says corn I-"P f un@'@; Ok i E@, aF ca. v s of ic-, c@ n cr ot II!' can-,,)Il- utilize th,--ni, any activities (,Eliln 04- or e,--c@)ected to 1.)e availo.t@l? 4 currently ava4-la@l,:)la 5 actions we have taken to date, this mornina. 6 DP,. L@OTIAPOFF: Do you know off hand those ve regi ors 7 that we can consider that 'in making funding-? 8 DR. PAIIL: The specific four regions? ".r. Spear? 9 IIR. SPEAP,: Florida, T,,Iississippi, and Tri- 10 State. 11 DR. FLOOD: Tri-lcdtate brought up seconded 12 DR. PPIIL: -here is a ri64-ion on the "Ic.,cr anr- J. 13 All in favor of the motion, please say aye. 14 VOICES: Aye. 15 DR. PALIL-. All opposed? 16 (!40 response.) 17 DR. PAIIL: notion carried. That congeries th@ formal 18 business, except for, I think the ver important pi-,bl c y 19 Session, and I would like to ask Council whether you %,.,ould 20 ck like a br,-ef break and then bring some coffee ba t-0 the 211 table and have your open meeting with the reT)reF,@-riL@-a4@-ives, 22 t iild lilrc, to continiic- on, and have a or the .,c-r you wo 23 break? 24 DR. t-IILLIKMI: Coffee now. 25 DR. PATIL: All right. I think that is fair to our visitors too. oh, tc-n or y It reconv@-n(-@ in 'inuts minutes, as soon can i,i." soi-,,, coffee or Ooug' back to -the table. And then fill be refreshed for hearin 4 9 5 from our guests. 6 (',-.@reupon, a short recess was taken.) 7 DR. PAIIL: I-lay we -come to(xder please? Now that we 8 have had a chance to get some refreshment, I would think we 9 are in better position to consider the remarks of our guests. lo I would like to welcome both Mr. Bacon and Mr. Sargeant from 1 11 the I,,Iaryland I'li-!P. 12 Mrs. i.icCarthy, Dr. (.3cherl, Prasad, from 14assau- 13 Suffolk PDIP, and of course, Dr. Sparkman has already spoken iidith us this morning. 14 15 If there are other guests, I do not have their names! 16 here. We would certainly invite you to participate in the open 17 session. I have been asked because of other commitments to 18 if we could call on Mr. Sargeant, from the 14aryland @,IP first,! 19 and would do so now. 20 And I would ask.to have you identify yourself, if !you will., for the record. And give us vour statement, or sub-@@ 21 it a statement, and then following anv discussion will you 2 ,ipl---ase -- we'll h,,-,-ar also from Mr. Bacon. if you care to spea.l,. 23 i! 2@S and then if that-is satisfactory, we will come to Dr. Sdherl, and others from the Nassau-Suffolk RI,IP. 2.1) ap@;oint SAPGF,@ITIT: Than;, you. :r do 12 '@,@ent in Balti@@or3, a,-iO, that is @,7h,-,t ,;,ou .7c,t wi-,,,n voLi trlr 2 'chedul things so -"4qht. 3 OM ittCa of t'le TI@egjol@,7 4 -IL-he Exectitiv@o C m I am a member o Advisory Group and the Maryland !:,cgibnc-il ,,"Iedical Program. i,il,,e 5 you I am a volunteer and give My time for -- to%,,,ards hopefully 6 110 7 perating an@ efficient and.,@@ffective regional medical proc,,ram.1 I do have a statement which has been distributed to 9 liyou, but in the interest of your time, I am going to summarize iit if I can. 1,Pac-n we@received the news referr@-d to earlier 10 !this morning in IL,-Iaryland we did discuss it at sc)Tn.,@ length 12 i,and felt it important that perhaps people comma from all ov-@,a r1 'the country are not aE;cogn4zant of the City of E;Lnd 13 '@the state of iiar-,71and, as tlic-v might 1)@, and wo- felt it would The important that you understand our case, and our philosophies!, 15 16 land therefore that is part of the reason that I am here tor-I.ay. 17 The gentleman from VA is proba'Dly close to @lar@;, an 18 so understands the geographic situation perha-.ps I)ct-L-sr than 19 most of vou and I am sure Dr. Schreiner does, from T@7ashington. aryland has a fairly large population but our Regional ,Medicaid 20 0 T,)ulation ovulation only serves about three million of t@i,3@4L 4 @@,.Iaat is -@,ade up of 2.7 million, in 1%117,rvland. L7'-%nd 300,000 in Yorl,-, Pennsylvania.I thi.nl@ it @,.,a@, t! f -c-rrc-d to s iio.-ni.n(!, i.@ re (.7 i-,ic-dical -)rogr,@.,@ 24 1 I all ofi @rl.o cross state boundaries and ours indeed does. As 0 25 1 I i I I I have been IL-.he Regional Programs we 1%@(,d in changing prior", 2 itic-s, and @a change in tile effectiver@ess O--r and so i 3 forth. 4 clo we have been somewhat per-,-'Ilc-xed at and i somewhat harried at tim get in our a,-olica@ions! 5 es in orC-,er to 6 for money. i@ad I ar,. sure that you have e>:-.)erienced the same 7 situation @-hat we ha ve. 8 'I@0%,7, of the three million people that we serve in 9 the !."Laryland Pegio.-ial ZLeOical Program approxir"atel,-,7 two million of that total is included in the Metropolitan Baltimo3 -e Al." arm-a. That comprises the five standing counties =.s well as Bal,-,imore city itself which is a separate and distinct politic 13 subdivision, not part of a county. 7,nl in western II,-iryland tl,,.3re are 15 300,000. These fi on th- statement which was gtires are 16 given to you, I am rounding it o'Lf; on tne Eastern shore of i7 1.1@aryland, which I guess is referred to as Chesapea'@.-- coun ryti 18 there are approximately 250,000, and in t';ae southern part 19 of Maryland is 115,000. Then we have an additional 300,000 in Ybr1r," Penns@l 20 21 vania. Interestingly enough, of the population, and that is 0 Million in the Baltimore a--ea, '75.() percent of tlat po-,.)- 22 are ulation/in the low income area, in fact, 2-D.6 percent of the 2", peo le in metropolitan Baltircre citN.7 alone are 'k,@edicaie, 24 recipients. 25 In fact, 114 u@-i-cent of all the people in ,--he of LI-,La.ryland, the c-@nt,-rc -,:)ot,)ulation of i-laryland ,,7'.Io z.,r,,a r7.,edL- caid recipients reside in altirtiorc citv. li'@nce, T t'ii-n'- i3 I 4 il what I am trying to point out to voti is that many of our 5 II obligations have been centered on Baltimore city, has 6 been onathe cr4tiCiSMS that we have had. And we have tried to expand our services in areas 7 ii outside Baltimore, but primarily the greater -Dart of our effor 9 and concentration has been toward improving methods of the people in Baltimore city to receive medical care. AnO-.so, 10 11 while it mav seem out of proportion to the men-)ers of the group and the members of the technical advi.sor-,, arcuLi indeed 12 it hasn't when you look uDon the geographic and the --coromici 13 distribution that exists in the state of 14 Now, we have adopted many approaches in our efforts 16 to submit grant applications. i,le have amongst thoseinclude@ support of planning, for llaalth Maintenance Orqanizations 17 18 we have been a great deal of patient education in hvner-t--nsic- 19 for the low-income black families, particularly in Baltimore i 20 city. T@,le have pioneered in the areas of ho7a hn-all.-"" care 21 services to neiqliborhood corporations and have also IFL@sisi--iF 22 in the training of pediatric nurse practitioners @,.,ho --odav 23 ii land are serving not only Baltimore city, bul- they in marv 24 2', are serving in the rural rov(-,r-,%--v areas as well. to out cor,-tc- of the ver,:, 4- of -L-he i.,-, th hc. d r) n (,-4 T-1 S 4 ur t i-i-i the late of i a I--i,-iore can c c-t 3 -issoc.ici those of vo,l L @@,ith medical schools in the city. 4 There is always great ri-valrv i)-@t@.,-een th@ medical schools, 5 6 who is going to be the first with what. 7 In Baltimore when we developed our mechanism for a let me cret the correct title here. I@',idnc-y Transplantation 9 Program. We were funding part of this several years ago. We were able -@o bring together the state'.@ t,@@.,o medical schoolE, 10 11 the state health Department, a kidney foundation, and two or of the communi-@@,- hospitals which '-=-d their own pro- 12 13 gramso- to bring them together. 14 So no%, we have one unit working in a coope ative manner to accomplish the objectives that"Lour or five units 15 16 were working to@-7ards before. 1-@le think that this is a very positive acconnlishmcnt that has been made -n the city of 17 -L 18 Baltimore, particularly when as I said earlier, there have al-I ways been rivalrv. 19 20 7-\nd Isee some smiles on some Doctors faces here. 21 also back -n 19'@)9 a@ske:d for and received a grant of 5115,OOE -ou,.i(7ed off fora c.@-,FjeO, chest c-a_rdic-pulmonark,, eL% 2 rssucci;--ation @-raining program. @@nd this has been taken over 23 since that time '-)v the ITeart Association of 'aryland who has 24 trained some 13,000 individuals in the life savincT technique. 25 is then in coiiri@cticii @,,7it"i i i-ratarials into Dutch. fair 2 it.,; patient education ,')roc-framT, ii,, rL,.roT@--. very important 0 3 lo, again, tli.L tliFtt this is a A il i@or us. t'@iese thinc,,s that I ha-ve just mentioned 5 to you. we feel thev demonstrate the vital role that the 6 @laryland Regional .1@ledi-cal Program has played in the develoDr,.enL-- of new and effective methods of Providing critically needed 7 services where few if any previo sted. 8 usly exi 9 You have before you today, or you will have before! 10 you today two projects which applied for in our Jul@, applicati@c.-,: 11 two of them applied directly to the Western part of llarylan@.. 12 Where three hundred thousand of our population reside. They i3 are iDart of the second application T)rogtam. 14 They involve health education in one case, health 15 education for teachers and professionals in school system 16 a joint effort to educate the teachers so that we can corinunic a 17 this information to the students, and the school s@,stem in 18 Western Maryland, which is part of the App@l,tlachia Poverty 19 Region. area. 20 Over on the Eastern shore we have, which is 250,OC)o i population, -,,ic- are funding a clinical cancer program a 21 4. 4 ho,--@.)itcil discharge planning p7oc ram and continuing e(.-@,ucci@-Lonal program in generali in Tiv!-nrt Coui-ity. All three of these ar-- 23 ii now being continued under private enterprises and private fundi@'i 24 York, Pennsvlvania which we serve, with a population 25 ro-,cimately we ,,ia%l@" c,-von ,@,ith a population of 300,0,,@0, ap,@) 2 continuous attention to this area. '.le have an acute intermediate and I.or.,7- term scope 4 care program negun in 1969 with a grant of $561,000. -@h4Ls i established a sp- 5 z=cie.1 hospital tLnit for the total care and 6 rehab of stroke T),:itients. 7@nd since the termination of i--"ie 7 funding for that program, in 1972, the entire program has beer- continued, and today is serving an areas with a population 8 9 of 300,000. 10 We are very proud of these accomplishments. T.@@ich @.ie tlink are uositive things which perhaps in the -ush of all7 the other applications and information coming to irou rray be 12 13 overlooked. I would just like to make one last to 14 point out that each of the eight projects that @,:e have pro- 15 16 posed for funding which will be before you today, at least, 17 we anticipate is aimed at achieving a specific objective speller 18 out'in the latest, I said latest interpretation because as I @-ed earlier, 19 have indica4 there have been continuous c@-anges and that is cl r a-" i of Federal guidelines, evelop6d doop @lve 20 relationships in the improvement of care in unde@-sn-rved areas. Develo-.)l,-ig Innovative approaches to medical cart. 2 ,Hill of these projects received full review by t,,-- Tn-chn@---al 2-3 t e e of our Rectic)nal Dic@dical program iew Com 24 reQional advisory group and by the "'@aryland Cor,-Prehensive 25 IT-al@h Plan agency. 7 much for -%,,our time. I h c-i v c,n c,,u (-Io ha.ve c details on @.2 3 ii as brief as I could-. T, T@ omplete has already been distributed. I am glad to answe-- 4 material that 5 III your questions. 6 DR. PAliL: Thank you very much, Mr. Satgeant. Dr. 7 Gramlich? 8 DR. GP@-,',LICTI: !@ir. Sargeant, I am sure @%7e all ve---v 9 much appreciate your lucid comprehensive remarks. Play I ask 10 your occupation? 11 I happen to be the Executive Director 12 of the State l@l-C-dical Societv. 13 DR. GRP-.1-ILICII: ror the state of I,Itar,,land? 14 i S.71,@.G@.,@-'@-iT: Yc-s. 15 DR. PAJIL: Dr. Wararoclc? 16 DR. 1-7AI@IOCK: ,-7hat did you say about the medical 17 schools competing together. I,,Ihat? 18 'lR. SAP.GFA' rn : T,,l e did get them into a kidney transDla-@@- 19 lprogram. It has been vorv effective and xie have very active 20 recruitment for lcid,-iev transplantation that are 21 DR. P@ut that is the only program thev get !!'together on. Si@P,(,7A@JT: They have gotten together in -anv others. The university medical service program is wor@-,@-ng 24 i Iv,--ry closely -@,7ith them, as is the Medical Society. have 25 a close relationship that able try to bring them together. @rv T@l"a tl-ii-nk cor.- to 11 see each other's vie,,%, Points - t, em to il: that is e7.@@rel" io,7aver, we caon't t 2 )etition is good. @@'i a. I 3 'Dad. T: y other discussion or co!-,-r,,.ents. 4 P,'@H-1 -Ls there ai-i 5 -L,hank you very much, @@'Ir. Sar@ieent. 1-7e hope you make @,-our 6 appointment in Baltimore without breaking the speed limits. 7 @Ir. Bacon, do you have anything to add? 8 PIP,. BAC014: @10, in view of the time pressures, Dr. Pahl, it has been a pleasure to be invited. And if there 9 are questions I would stay around. But I also want to get 11 .'-Ir. Sargeant back to his meeting. So I won't interfere witi-i@, 12 that. 13 DR. PAIIL: Yes, Dr. Janeway. J7-,IIET.-,IAY: Could T ask one (-,uestion c)-F- DR. ;-'r. S-@rcie-a,li 14 15 even you say you got them together, does that mean in the 16 kidney transplantation and dialysis. are being done in on J',7 17 one of the universities? 18 !@-ITZ. SARGE7,,'L,;T: @,le have in Maryland,, perhaps, a unique 19 situation. Two years ago the state legislature -Dassed a 20 statute which set uD a Maryland Kidney Commission. That Maryland Kidnev CorL-mission has jurisdiction worki-na @,,ith the 21 I! CI'BA to designate onlv certain areas for ki-dnev transplants 22 and dialysis. 23 24 In answer directlv to your question, no. r.hat does not me it 25 an that there is only one univers y in Balt4-or-a doing some interchano,@- t 0 ly there wouid liav I that. OlDv4 011-@ 2 back a@@ld for@,:,i. I think But y dialysis, centers man 3 lanta ndiiig there are onlv,t@@io 4 to my ui-id@-rsta units, two transp t-;on u 'ts in the City. 5 ni 6 DR. PAIIL: TIAIani-I you verv much. He certainly under-@ rhaps we may stand as vou dash off to another appointment, pe 7 now turn our attention to I believe Dr. Larry Scherr, i 8 s, from d Dr. Scherr if you ilassau-Suffolk has astatement, an 10 will identify yourself --For the record we will be pleased to 11 hear from you. 12 DR. SCIIEPP,: Dr. Pal-il, members of the Council, I.'m 13 Dr. Lawrence Scherr, Charrian of the llassau-Suf-folk regional 11 advisory group. I'@-nd I am a member of the area's medical 14 :i @15 community. I appreciate the fact that I can appear iefore 16 you. 17 The Purpose of my visit here is to express the 18 stron t of the regional advisory group for our program g suppor 19 and to ansvier any questions that pu may have. V4'e recognize 20 very well the critiqucc of this Council and the organization 21 Cf. our RAG group. 2%nd actually to that end I visited the division 22 r3 ti of -.he regional -i=-clical ,-)rocT,.-am with another member of Pj',,C, ,taff, c .,.rorl,, out means to put into effect 24 to speak with @-ie c 25 what v7as necessarily to present this grant before you. 1 Yesterday I unfortu,nat(-@Iv could not be here, but rFiny oF 2 you did hear our coordinator, .1lr. PrasaO,. go over the contents 3 of our P--oqram. 4 You also have a prepared statement from me and I 5 will not go over that again. The content of the program and 6 any questions referrable to that I will explain -- they are 7 explained in that statement. 8 I just would like to clarify one or two points, 9 that are not in that statement itself. To begin with, our 10 region, Long Island, the two counties as in Maryland has a 1: 11 comparable Population of 2.1@. 7,.iilllon people. The distribution 12 of the population is in a geneous fashion. 13 lialf being in an established suburban community, 14 the other in. a rural conmunit@, fast becoming a suburban 15 community. Secotdlv, there is a rather -anique geographic 16 position of our region. It is pcnninsular in origin, and 17 finds itself admirably to rc-gionalization. 18 And it is that end that we have developed our pro- i 19 ram. It is a community based regional medical program @,7hic'-"i 9 20 has been in actual operation for the past four '. years and 21 has been recognized by the community as an appropriate acjc-ncv! 22 o the implementation of certain health Programs. Dole, earlier this year, the i@egional Advisorv @'rouT@ 23 th@-ough@it's committee had established the goals and priorities 24 25 of ar@-Lbulatl-ory care. The actual development of delivery ser@ and this ostic Services Of preventive care and diaun 2 @-as, the goals and conforr, d to our ar 3 aiin@-ng Council and o-@ ",,issau-Sui@.L@olk Coriprc-ii,@nsive liiaalth Pi good effective cooperation bet@,.,een 4 was ac4--ual!Ni the start of 5 tic- two agencies. t 6 he grant before you is really a revitalized regional medical Program. 7 ani3roach for our Nassau-Suffolk 8 '-.T@- are proud of the stated objective and the m6thcCts of ach' 9 ing these objectives. 10 does have fourteen directing To go into d@-tails it 11 arlbulatozycare projects. It has two emergency services pro4j---, 12 which are in c-ss-.3nce ambulatory care projects. And it has 13 al programs which have aft@'Dulatory care components to t@..,o ren 14 the -,i 15 Thereby Meeting our goals and -priorities. Now,, some 16 1 of the nrogra-ms, despite the current limitation on @--@"@Ps future 17 course do require two years for realistic como etldni Our 18 1 grant contains provision for this as well as the means for 19 1 continuing staff support. 20 That ly for the monitoring those particular -s, not on 2 1 programs that are carried forwards but for monitoring, what ',',as gone on !Defor--, '-i@it is going on this vear in the T)rocTr a.-, 22 that have been starting', in previous years. 7@iid v.16 believe 23 that is a rather vital and important role. 24 25 Just three other very brief items. One is the p b-al-cver, that our newel rnc-7,,ni,. P-@,@IP staff. The advisory grou and 2 s k--a f funder the dir@cction of @?@Ir. !)rasad has the the wisdom and the leaC@@crshi.p to holn us carry this )rogr,, 3 it IS F ,UCCC@,f;fUl Cor 4 Through o on. 5 The grant before you I think, not only refl-cl-:z, 6 their dedication, but I think it reflects their expertise in i 7 their field, and I -oint out again, that their technical 8 competence and their cooperation @,ith regard to our area-,.,7idei 9 comprehensive health Dlanning council. 10 Secondly the PAG itself has corrected so.7,--, of its 11 most of its prior oraanizational difficulties. That is, 12 the separation of tl,-je,functions of' the grantee organizations i 13 from the regional advisory group itself. The ':)y-lai.,7s havn 14 been revised and ccmple@Lelv contor,-,n, now, to RI!@T.1 directives. 15 Pnd I think they have sustained a continuing interest 16 by the way, in it's-objectives by this representative communitllr 17 grouo. Pmd we believe that it is a major and a viabie organize 18 tion to serve the health needs, on Long Island. 19 Secondly, a word abou-6:the grantee organizations. i f 20 oUr grantee organlztion is independently incorporated sDeci ic 21 ly to deal with PIIP -functions. I ,,7ould just likes' to ,')oint out that in a recent fiscal, covering t.-iree to five 22 months on a rather intensive basis,, really on a daily basis, the grantee orcanization was commended for its' expert handli--Ic 2,1 of the fiscal matters. This, I understand is uiius-,uzAl to have- a commendit.@.ci-,, (-';n an c,--n'Ler--ncc Final l-,, i n @3 i n (7, .@U@ 2 3 li',,,c to reaf firm sLipoort of our program in the sunDort or 4 the regional a--'.visor,,/ group. 5 r@,7e believe that the nrogram is well designed and 6 it is well coordinated @-o meet the needs of the, people of Long Island. @,@le have asked for an amount which exceeds slign@--7 7 two million dollars for this next period. @,,7e do ask and do 8 request and do request that vou favorable consider this, and 9 o thank you verv much. Di@.PAIIL: Thank you very much, Doctor. I arm sure vou 12 would be very responsive to any questions that ma,%i Come up. Is there a discussion question? l,'Ir. @lilliken? L3 n re aci 14 lith regard to past bu@,gets, 15 to the projects that you are Proposing, or recommending, within 16 this, what has been built in to see that these projects are -relaL@-ed with other sources ,:ha4- s 17 inter of funding. And 18 tlie'potential for their continuation in case the P.;'iP money is -19 not available after this grant period. 20 DR. SCIIERR: That of course has al%@,,ays been a ma or L spite the 21 consideration o' the .2,egional advisory Group. Da %,7 !-Sunl)osed last @,car of funding, and that is to see. a av 0 @'2 stimulate the Droject to j3z@iin- t%nd encourage the- office or o4,--ller provider organizations to iDicl-. U,,:) the -.orc-ram 24 provided it is demonstrated its worthiness. 25 I tii.-ik that therein is the strencTL-h of our have been picked ur-,, Those programs that have started program tion,,; ci,-iarc-Tcric, in some asi3ect by other orcianiza services bi 2 11 county health departments, renal programs, by some institu-,io-,;-,, 3 4 and by community m,-@dicine, and by hopefully the institution by which that is developed, and so on. It is our intention from the very beginning to 6 use the regional program as a stimulus to start developing 7 8 0 each programs, ultimately t be picked up on a more permanent 9 basis by other means. DR. PAHL: Thank you. Is there further discussion 10 of questions of Dr. Scherr? 11 (-.,To response.) 12 13 DR.PAIIL:-',Ir. Prasad, would you have anything to add? 14 l,4R. PPASAD: No. I spoke yesterday. 15 17OU Use 16 DR. PAI-T@L: liould the microphone, please, if 17 you care to make a coriment? 18 I-IR. PPP!,SAD: 'Alto. I spoke yesterday before the Revie%@ 19 Committee, and most of the Council members who were present, 20 and T have no comments to make. Unless you have some questions to ask. 21 DP.PAIIL: Thank you. @,iss I.,,TcCartliy? 22 @@IISS @ICCAPTIIY- @lo. Than],, you. 23 DR. PAHL: 1,7ell, then, if there is no further dis- i 24 25 cussion on ilassau-Suffolk, I want to thank you for returnin@, to av, and L,-ubriittii-icy y@),,ir through Mr. Prasad d -a,,7 Ar.--@ there any of the pi:,.)Dlic who wish to a statement to cor,",nant upon the proceedings so zLar? -iscuss T@',@,es the Council have anything further to a in the open session. Dr. S,.@,arkman? JL '7 DR. SPAPJ'@@N: Can I make one more point, Herb? DR. PTJIL; Yes. DR. SPAPK@%IN-4: I th-,'-nk you are all familiar iqith the National Association PIIP, which instituted the !-a,-@-,,suit which released the impounded funds. 1,7hen this was se t up it was our view that this would t,4erve not Only this lawsuit purpose, but also some organization like the rmerican Public i a' staff educak@.,-l-on and ith Association and others to provice training. And in fact we do have such a meeting planned in -:7 I,,--zriver for September 3rd, and 441--h, I i,7hi@h I think a very good program has been developed. so far has been oversubscribed by the various P,@.lPs. end which will deal with the variol-spatts of !UIP p2--oc4r:a-Pis: pro3c-ct e,@svelopment. Management, and -L @,7rt sure iqill. be of considerable part, zrkid we see that as tli-3 logical iation. e.-.tension of the Nati(-;nal 'ssoc T,,cl@ually, all of you are invited to a+--tend, and @i 'I we Hill see that information i.s given to you about it. ij @l @i i 11 @l 6 4 DR. PAI-TL: Than]-, vou. Dr. Cramli,ch? 2 DR. GRPIILT%@'ll: Would it @-c, appropriate to ask Dr. ,3 -Sparkman to cTive us a one-minute explanation of what the 4 NPJ,!A is? 5 DR. SP).\-RKDIP.N: v-es. I had hoped that Dr. Jack 6 Enale from the Lakes Area PMP was going to be here, since 7 he is the president of the board. 8 This is an organization, Dr. Gramlich, set up 9 aside from the steering committee in the regular coordinating 10 with the coordinators committee, funded bv personal and 11 private sources quite aside from anv grant funds and initiated 12 originally around O-eptember of last year when it became apparent that without the release of impounded funds the .13 @P@14P future looked prettv bad. 15 But it has continued with meetings of the board, i 16 the hoard being made up of some representatives of the 17 coordinators, some have come from the steering committee. 18 age think there is a real need for the kind of staff training 19 that such an organization can provide. We hope that this is going to he the ultimate 21i future. obviously we should he out of the legislative I mean, the leqal problem. As Dr. Pahl- has said and as vou 2 i know, this, I believe, has been handled and, as 1 hope done 23 with shortly. 24 There has been question as to whether PIIP grant 25 @2 func-,',; 7ould he used for this T)urr)os(,-. So far they have not 2 been used. @.nd I have spoken vigorously to this point. I 3 that lectallv it may be. appropriate to use grant am told 4 funds. 5 rut I think until i,7e are l@evond the legal problem, 6 until we have clearly established that this is an educational 7 activities, that these should not he used. qo far they have 8 not been used. up of a @.?ide varietv of 9 The- membership is made people P:--!P staff, advisor@r group people, other individuals, with i,7horr, we have worke6. There are some institutional memberships, people like medical assocations, hospitals, 13 volunteer organizations @,7ho @,,,ish to join in that fashion. DR. PAIIL: Dr. Haber? Thank vou Dr. Sparkman. 16 DR. IIABER: Dr. Srarkman, I hope vou 1,yill indulge 17 me to the extent that I will probably ask you about matters that have concerned me deeply for a long -period of time. -19 But it strikes me that with the imminent emergence of a a 20 national health insurance strategy, dert iniv the organiza- 21 tional and substantive efforts demonstrate by RDIP have a role to play, particularly in the transitional vears. 22 ?,!,v Question goes to this point4 If indeed, as 2@.1 this booklet indicates, there are some 21 million people 25 Who'can begin to be beneficiaries of a -national medical i-i3 program, that has been done to brinq home to the reonle the clients, if 70U 1 1 the benefits accruing to the 3 program? 4 It strikes me that I am unfamiliar much of the terms of p a effort has gone into the providers in opul rizing 6 or informing. 1-7hat has been done or what could be done to 7 bring this home to the people that are the potential natural 8 beneficiaries? 9 DR. SPARKI@ll: I think not enough has been el-one, aber. If I understand the intent of your question, @O Dr. P 11 one of the iroblems that I see as a coordinator of an P@IP 12 is that in order to function most effectively you do some 13 very 16i.7-key way to bring people toaether and rake as relatively little evidence of your existence. 14 J!t And I find that this is the way you can get dif- 16 ferent groups toaether. And sometimes they hardly recognize that the regional redical program is accomplishin this. 17 9 But'in order to demonstrate to Congress, the public and 18 -19 others that you are accomplishing something, this is not a very effective order of operation. 20 21 And so we find ourselves caught between these two I think that in general reaional medical proarams have one 22 a poor job of Demonstrating to beneficiaries that they have, 23 in fact, served a useful purpose. I find continually as I 24 25 move around our ti-7o-State region, T@7ashingtob and Alaska, C 7 n4 I that there are unexpected and surprising numl-ers of people who have been touched in some way I)v our regional medical hat their appreciation and 3 m who volunteer the fact t procrra 4 their hope that something like this will be continued because kind of assistance to 5 they have been unable to find any 6 bring together activities to accomplish needs, to respond to needs that they have. 7 8 DR. FABF@R: I would hazard a guess that probably 90 to 95 P-er cent of the beneficiaries, while they mav be 9 aware of the local clinic or school operation or outreach 10 11 operation, are not aware of the fact that this is served @,v the regional medical -oroaramin terms of coordinating, idlan- 12 ning and executing of it. 13 And that is a critical step, it seems -- to bring 15 that realization home. 16 DR. SPAPKMA@,l: I would agree. And I would welcome 17 any,-thoughts here any of the members of the @Tational Advisor,,, 18 Council have about this. I think we have done a poor job 19 in this respect. 20 DR. PAHI,: I think in view of the time I will close 21 this open portion of the meeting and again thank our Visitors and ouests for appearing and speaking with the Council and being available for discussion, and ask at this tire that all 24 individuals in the room other than those v,,ho are part of our Council or Federal employees please leave at this tine. 25 6 8 h, and then vie will n5 I Let's tal@-e a tN,7o-minut(,- stretc 2 enter our review of at-.)r)licatioii,;. (A short-.rccess was tal,,en.) 4 T)R. PAIL: l@lay vye come to order again, please? 5 Will council. come to order, please. I would like to recon- 6 vene the Council for now the closed session and the review 7 of individual applications and, just as is our custom, call 8 to your attention the statement on conflict of interest and 9 1 confidentiality of meetings which you will find immediately o behind your aaenda. And I would like now to turn the meeting over to uide us th 12 Mrs. Silsbee who will c .T rouah the apnlications. 13 Most of ),ou were here yesterday and heard the discussion. We hone that that was a mutually rewarding and satisfying 14 15 experience. 6 I have heard some favorable comments from the .7 Review Committee members. And I certainly hope that you found 18 it of interest. Let me state @-.for the record that this was@ 19 an unusual proceeding and that it was through a domedv, a sot of highly unusual circumstances, but that the members of 20 21 the Council were sitting as official visitors and not in any @'-way as particinants. And so your discussion, review and recommendations today are now as Council. members and riav be in support of '4 ii or quite divergent from whatever discussion, recommendations 6 9 n6 I were made vesterdav. Pnd with those few comments, Jud@i, @.,,ould.. @),ou please lead us throuah? 4 @RS. SILSERE: there are a couple of background 5 items that I think are important here. The committee did 6 express after the meeting yesterday some concern about the speed with which they had-to move, but they never had a 7 choice. 8 They had the Council meeting today. And it may 9il 1. 10 hot have been apparent'to all, but at the get-toaether in ii July the individual reviewers did talk with one another and, !I in most cases, where thev were n6t able to, thev tried to 12 13 communicate by phone. So there was a good deal more back- 14 ground in terms of their deliberations than appeared in 0 public in the record. 15 16 The other thing is that we put on your desks this 17 11 morning -- I mean, in front of you this is supposed to 18 be pink. And this is the Staff's -- yesterday as the Commit-! 19 tee was deliberating we were trying to write these up so 20 that you would have something in front of vou. 2"L This is the gist of the recommendations of the Committee, and they are alphabetically arranged. Also, just j; now we have -- I feel like, yes, Virginia, there is a way of doing this -- we did. get the transcript for yesterday morning s session hack in time. 25 7 0 n'7 This is the first we have been askinq for this 2 for some time, but it finally came about. That is only those regions that-'i,;ere reviewed in the morning. The after- 3 noon session is still beincT typed. So we have asked the Staff to take apart the transcripts and give you the 511 verbatim transcript of those regions that we now have the 6 transcript available on.- 7 With that background, I think this morning we will try to go alphabetically. 9 Dr. Schreiner? 10 DR. SC11REINER: Before you do that, I would f nd it helpful in perspective to kno%f if vou added up all these,i what did it come to? 13 JA IIRS. SILSTFE: A very good point. DR. PAHL: Well, I have the fiqure. MRS. MORGAN: It was on the board. 17 IIRS. SILSBEE: I erased it from the board this morning because it didn't seem to be a thing to be public 18 knowledge. 1 DR. PAHL: The figure is $26,557,154, which is, 20 from a management point of view, a verv nice level. But you 2 1 should not he bound to it in either an upward or downward direction, particularly in view of the action you took this 23 morning@which gives us that kind of flexibility to manage Z04 our.affairs 2,5 ng DR. SCITREII@IER: That gives us a feel for where @.7e are. 3 @IRS. am as)-,inct @,lrs. Leventhal to dis- 4@i.1 tribute the kind of running summary i@:e keen that puts toge- 5 ther as much information as you have at this point. This is 6ii the sui=.ary data on the recommendations yesterday. 7 DR. JANETIAY: Mrs. Silsbee, can I make a gratuitous, 811 comment? 9 MRS. SILSBEE: Yes,, sir. 10 DR. JANEIIAY: 1 think it is an extraordinary 11 it accomplishment to be able to get the transcripts on the tabl6' 12 must this morning. You have had people chained to the @.?all.s 13 all night. I don t know how that was done. 4 MRS. SILSBEE: lqell, this Gentleman to mv right 15 and his peers are the ones that are responsible for that. 16 But also, a push, I think, from the Director's office helped. 17 DR. PAHL: We found that once the rumor that I 18 relayed yesterday didn't materialize there was a free evenina@ for everyone. 0 2 1 23 24 25 ALABAI,!A n9 I-.IRS. SILSBEE: O.K. Could v7e start with Alabama? 3 I think the best wAv to proceed today is to ask the primary reviei-7e 0 4 r to make whatever comments and make rec Emendations and then if the secondary reviewer has anything different I 5 ot be necessary at this 6 will ask for that. But it may n 7 point. Alabama. Mrs. Gordon? MRS. GORDON: I was pleasantly sur rised this 9 p 10 morning when I read the various and sundry things we have I received, since I wasn't here vesterdav. I agree primarily 12 with the comments made yesterday. The onlv addition that 13 I would have is that A2,abaTra does have couple of their projects that nearly all of the monev is for equipment. 14 15 And that I do question. 16 That is 126 and 125. 17 MRS. SILSBEE: Mr. Ogden, you were present yester- day. Do you have anything to add? MR. OGDEN: No. I would agree with the comments 19 that were made yesterday, particularly those which ap 'pear in the transcript from Dr. Vaun. Project number 134 does 21 indeed Appear to he the sane Project that appeared here in 22 ii the previous application and was rejected. .3 And it is unlikely -- Ifelt in reading the materia'L that was sent to we that it could be completed in a 25 7 3 nlO reasonable period of time. And some of their other projects 2 e withi.n.the periodof one perhaps are not terribly feasihl 3 year. 4 The matter of the eaui.pmerit doesn't bother me that 5 much. And I would agree with the allocation made by the 6 Review Committee yesterday. 7 her feeling on Mrs. Gordon, do'you have anv ot 8 that? I 1 9 MRS. GORDON: No. I would agree with the alloca- 10 tion. MRS. SII.SBEE: Could I have a motion, n ease 12 MR. OGDEN: if Mrs. Gordon will move it, I will 13 second it. 14 MRS. GORDON: All, right. 15 MRS. SILSBEE: The motion has been made and 16 seconded that the Review Committee recommendationof a 17 funding level for the Alabama application for $680,000 be 18 approved. 19 Discussion? 20 (No response 21, MRS. SILSBEE: All in favor? VOICES: INye. 2 23 MRS. SILSBEE: Opposed? 24 (No response.) 25 MRS. SILSBEE: The motion is carried. 7 4 ,ALBANY nll tIRS. SILSBEE: The next region is Albanv. Dr. Watkins is the primarv reviewer. 4 DR. @'Y'ATKIIIS: Albany has a history as a superior region. In the May funding which Council recommended in 5 June it almost got 100 ner cent of the request. in other 6 words, it was 1 million 66.hundre-d thousand and thev got 7 1 million 12 thousand. They are asking this time for 541,437. Mr. Barrowsi 9 1 recommended 487,000. Based on Albany's superiority and 10 11 community involvement, T,make a motion that they get 487,000,1 li which was recommended -yesterday,by the Review Committee. 12 I-IRS. SILSBEE: Dr. Haber? 13 DR. HABER: I have nothing to add, except that I 14 would ask Dr. Watkins if we could ameftd his motion to make 15 16 ;III it $500,OOOJI $13,000 More than he has suggested. 171 MP.. MILLII 4 MRS. SILSBEF: Mr. Posta? IIR. POSTA: I think the purpose of what Mrs. Flood 6 Picked up in the green sheet was primarily instigated by 7 Staff. It was something that was not said rather than what 8 was said. Dr. Felix did come in and talk to Dr. Pahl and 9 the proper staff here at DPJ4P. 10 He did respond with a three-page letter stating 11 some of his goals, what he would like to do during the text 12 year in the St. t6uis area. As we know, he does have a 13 terrific reputation. A 0 s been on o nd t date -- he ha b ard 14 since July lst -- has gotten together with experimental 15 health delivery service system there in St. Louis as well 16 as with ARCH program and the CIIP agency. 17 And Ono of his primary goals is to utilize the 18 institutions already set up and yet at the same timct6 -19 pursue some of his goals in primary care and in manpower. 20 Now, the other point that was mentioned in the pink sheet 21 you have before you was the role that Dr. Felix has played in establishing and preparing this particular application. 22 23 And when we asked him that, the answer was com- 24 pletely negative: He did hot have a role in preparing this 25 particular application. So it is our strategy at least to 88 n25 1 present this to you with expectations that perhaps Dr. 2 Felix would have more latitude in getting into those areas 3 that he particular"has a special talent for. 4 MRS. SILSBEE: But for Councills consideration,, 5 they have the application in front of them. This is sort 6 of the horns of a dilemma. And in terms of the advice that 7 we would give to the region, as I hoard the discussion, is 8 thatdertain of your activities we think are first rat6t 9 some of the others we don't think are good. But we really 10 think that you ought to scrap the whole thing and look at your priorities all over again and put your faith in Dr. 11 12 Felix. Now, this could be translated in some way or 13 another, but it does create a problem. 14 MR. HIROTO: Is there a motion? 15 16 MRS. SILSBEE: No, there isn't. 17 DR. WATKINS We move $335,000. 18 MR. MILLIKEN: I second it. 19 MRS. SILSBEE: The motion has been made and seconded. 20 that the Bi-State application be approved at the level of $335,000. 21 Is there further discussion? 22 23 (No response.) 24 MRS. SILSBEE: In favor? VOICES: Aye. 25 89 n26 1 MRS. SILSBEE: opposed? Ilo. 2 DR. JANEWAY: 3. MRS. SILSBEE: Let the record show there was one 4 in opposition. 5 The motion is carried 6 MR. EIROTO: Am I to leave? 7 DR. JANFIIAY: Yes. 8 9 12 13 14 15 16 17 19 20 211 22 23 24 25 90 n27 I CALIRORNIA 2 MPS. SILSBEE: The next application to be reviewed 3 is from California-., And Mr. Firoto is out of the room. 4 Dr. Janeway is primary reviewer. 5 DR. JATIEWAY: As noted in the May-June review, 6 the program was above average and continues, in my opinion, 7 to be above average to superior. The May-June reatest was 8 on the order of $8,170,000, with-a DR.MP funding decision of 9 almost 7 million dollars -- even somewhat below the 10 Committee recommendation. 11 The current request is for $5,592,000. It is MY 12 opinion in reviewing this -- and'i concur with the technical io 13 review committee -- that the request is overly ambitious 14 for the time frame of accomplishment. And the amount can 15 be effectively reduced to an amount of 3'million dollars. 16 I would express onlv one administrative concern: 17 Although there seems to be a reasonably good relationship 18 between the RMP activity and the various CFP-agencies, there 19 are some areas of clearly unresolved conflict. And I think 20 that with what I see as sonev?hat more dispersion of activity 21 in this State tending to get back to the illav it was before 22 reorganization, that the coordinator should he cautioned 23 in this regard. The recommendation for funding is at the level of 24 3 million dollars. And I so move. 25 91 n28 1 MRS. SILSBEIC: Mr. Ogden? 2 MR. OGDEN: I disagree with Dr. JanewAy on the 3 level of funding. .And I would like to spend a few moments on this particular application inasmuch as I think it is 4 the largest before us today4 5 6 Those of vou who were here yesterday and listened 7 to the discussion will recognize that Dr. Heu8tis, who was ded this be funded the primary reviewer yesterday, recommen 8 in full, $5,592,000. Dr. liirschboeck who was the secondary 9 reviewer, suggested it be reduced to 2 million dollars. 10 After considerable discussion among the people 11 around the Review Committee table about the projects anda 12 group of other things, the final decision came down to abit 13 of dickering. Now, at the risk of going over things that 14 you "listened to yesterday, there was a show of hands on how 15 many would prefer 3 million. 16 17 Dr. Heustis said, how about 4or 5? 18 Then Mrs. Silsbee said, well the motion has been 19 made at 2 million, how many in favor. That was voted down. 20 That motion was defeated.. 21 And Mr. Barrows said, welli then I will move it at .3 million. And they finally got an acceptance at 3 million 22 without any discussion of whether@these were valuble Projetts, 23 24 whether the PI-,P.was being cut too far or particulardiscussion. with respect to the quality of the this program. 25 92 n29 Ilow, you don't have available to you, I don't think@';/ 2 1 the yellow printout sheets on this. Do you have this in 3 your books? If you would look for a moment with me at the 4 'yellow printout sheets on the California Reaional Medical 5 Program, there are some things here that I think are of 6 considerable interest to us. 7 MR. M.ILLIKEN: These are numbered. 1-7hich one do 8 1 you want to look at? 9 MR4 OGDTN: Let's begin with the cover sheet for 10 just a moment. There are 83 projects here; 61 of them are new, and 22 are requests for continued support -- 1.3 millioni 12 11 of continued support. And if you look at the next page, you will see thA I 13 ti I I @l program staff which includes existing projects as well as- 14 15 continued projects, is 1.6 million. Now, if vou add un the co n, 16 ntinued support and program staff, you are at 2 9 millio 17 which is the 3 million dollars that we are talkina about. 18 Admittedly program staff may be possibly-reduced in the event they do nothing on new projects. But the 3 19 20 million, I @-suggest, may only continue the projects that the I y have and cover programs. That does not cover new projects. 21 i'ln looking across, I see that there may be some cutback on 22 program staff if there are no new projects. 23 DR. JANEWAY: May I make a point of clarification? 24 It was my impression, as I was primary reviewer, that none 25 9 3 n3O 1 of this was for program staff. That was all funded in the 2 May-June application. 3 MRS. SILSBEE: Is that not correct, Mr. Russell? 4 MR. RUSSELL: That is correct. 5 DR. JAtln7AY: That 1.6 million has already been 6 funded, 7 MR. OGDEN: All right. If you come down to the 8 request for September of '74,to June of 175 which is in the 9 third column, that is under the heading of five in here, 10 you will begin to see the programs that thev are proposing 11 are those to which they propose to add some additional 12 funds. 13 These include a series of kidney programs, some 14 of which were funded at very small amounts in the July 174 15 to June of 175 request and for which they are now requesting i 16 additional funds. 17 And when you come over, come several pages along, 18 don't you have a printout,, now beginning on page 7 you begin I 19 to pick up new projects which they are talking about beginning 20 with about 147T. And you will find some that are added to. 21 But beginning on page 8 they are all new Projects that they iare talking about funding for the Period of September 174 to 22 23 June of 175. Now, I find some of these to be of considers e 24 intexest and also of value. There are projects here concerning 25 94 n3l 1 the health care network in the Imnerial Valley which involves 2 migrant workers. There is an American Indian clinic aware- 3 roject here. ness p 4 There are upgrading of free clinics, ambulatory 5 care facilities -- a whole series of things that I feel 6 were simply ignored in the discussions yesterday. And I 7 came away from yesterday's discussion somewhat dismayed with 8 the manner in which the California application was handled. 9 I recognize that this is a big program and it is 10 an expensive program. It is a lot of money. But my r6action; 11 to it is that the cut from 5.5 million, nearly 5.6 million 12 to 3 million was done almost on a bargaining basis, without 13 much consideration of the actuality of the needs of this 14 pro ram. 9 15 And I think or feel that we should add back money 16 into this application. I haven't totaled up the requests 17 that appear on pages 8, 9 and 10 at all. But I would sug- .18 gest,that if we added back uowards of a half million dollars,,, 19 mavbe-even a million, we viould be finding money well spent 20 in a superior program that has always had exceptional manage- 21 ment And has done a great deal of good in what is now the. 22 largest State in this nation. 23 MR. WAIIMOCK: You would take it back to 5 million? 24 is that what you are saying? 25 MR. OGDEN: I would take it back at least to 4. 95 n32 DR. JANEIIAY: Let me respond to that. Perhaps am speaking not as a member of the National Advisory Council 2 3 and a little bit too much from a technical standpoint. But 4 if you are going to put 1.5 million dollars into a hyperten- 5 sion screening program in 10 months, you had better be pretty well prepared as a physician population to have some 6 reasonable idea as to what you are going to do with the 7 people who you identify. And that is where my comments saying that they are 9 being overly ambitious: If there are indeed 23 unidentified 10 11 hypertensives in the United States, and probably more than that, you can set up programs which build up peoplo's expec- 12 1-Itations to a level which you cannot possibly meet within the limits of the delivery system or within the cost barriers 14 that would be imposed by defining that population. 15 16 I think it is an admirable program. And I am not making a comment there, I am just saying that as to the 17 18 quality of it I think it is overambitious. And that was MY, ig interpretation of the technical review that was also given. I would agree that on the,surface there would ap ear to have 20 p been somo bargaining as to the level of funding, at the 21 outset of which one would got the impression that it was not 22 being done oh the merits of the proposal. 23 But I thnk ultimately that it was and that the 24 technical expectation was the one that cast the deciding 25 9 6 0 n33 factor. And I would say that I agree with your comments t 2 a point, but I certainly agree with the recommendations of 3 the Review Committee. 4 That is just too much money. it would not be as 5 well spent in that as it would if it were distributed dif- 6 ferently throughout the regions. 7 MRS. SILSBEE: Dr.. Gramlich? 8 DR. GRA14LICH: Dr. Janeway raises a criticism of 9 a million dollars for a hypertension screening program. And 10 I would observe that the same Review Committee recornehd6d 11 a million dollars for a hypertension screening program an 12 treatment program in the State of Mississippi. 13 DR. JANET4AY: They cut is by $840,000 svecifically-I 14 DR. G@-ILICH: Yes, but from a 2 million dollar 15 levelf leavin- them with a million dollars. 16 DR. JANET,7AY: The incidence of hypertension in 17 the State of Mississippi or prevalence, whatever you want 18 to use, based upon the racial distribution and the character-! 19 istics of people living in that area, I think you will find .20 a striking difference from California. 21 As I said, I don't want to get into being a technical reviewer on this, but when you have a verv high 22 23 percentage black population,atd in the entire Southeastern 24 United States, if you look at the prevalence of hypert tsion,@, 25 coronary, arterial disease -- you are dealing with a different 9 7 n34 I type of population and a different health care need. 2 MR. OGDFN: Let me make one brief comment here. 0 i 3 I think since the time we started the Regional Medical 4 Programs in 1966, we have witnessed in America-@-probablv the 5 greatest migration of People in historv. And 1 speak about 6 the migration of the black peoples of this country from 7 the South to the North and-the Tlest. 8 We may not all be aware of this, but as recently As probably 1946 right after the war, tome 77 per cent of 9 10 the black population in this country lived in the South and 11 was thought of as the rural Southern problem. Today 65 per 12 cent of the black people in this count live in the North ry 13 and the @7est and are really thought of as an urban problem. The black population in this nation has settled 14 15 in California, New York State, Michioan, New Jersey. And 16 I think we sometimes are not aware of these things that have 17 been affecting our regional medical programs. 18 And I would suggest that if hypertension exists in Mississippi it also exists in California. There is a 20 tremendous black population in California. And it has been 21 a very rapidly growing population. Dick, nay I just comment too, then I will close 221 PI I this off: Many of these projects I asked you to look at on 23 24 pages 8, 9 and 10 of this computer printout are not hyper- tension projects; these are projects spread among a great 25 n35 1 many other things. 2 I plead no particular case for California. I am 3 not from California'. But I simply feel that this is a pro- 4 gram that deserves better consideration than it received 5 yesterday. 6 MRS. SILSBEE: Dri Schreiner? 7 DR. SCH@REINER: -1 justuant to point out that both 8 the reviewers have made some excellent specific oints. I p 9 do think, however, we should put in perspective that 7 million 10 dollars plus 3 or something over that is roughly 10 ver cent 11 of the entire nation's P-MP funds. 12 I don'tthink we should'view California as being 13 a deprived State. 14 MRS. SILSBEE: Dr. Komaroff? 15 DR. KOMAROFF: Another was to'look at the perspec- 16 tive is that California has 10 per cent of the population of 17 the country. And we had available about 64 per cent of 18 the funds that were requested in this cycle. 3 million@,,-- out 19 of a request of 5 is about 60 rer cent. 20 So an average region ought to get around 3 million.': 21 But I would think that if this region is, in fact, regarded 22 to be superior or above average that -- just that is another 23 context within which one might look At the 3 million, 24 I-IRS. SILSBEE: Dr. Janeway has made a motion that the,application be approved at the 3 million dollar level. 25 9 9 6 n3 1 I didn't hear a second. 2 MR. l@IMIMOCK: I will second that motion. 3 MRS. SILSBFE: All right. The motion has been 4 made and seconded that the California application be apt)roved. 5 'at the level of 3 million dollars. 6 Is there further discussion? 7 (No response.) 8 MRS. SILSBEE: All in favor say aye? 9 VOICES: Aye. 10 MRS. SILSBEE: Could you nut your hands up, please?i 11 That is one, two, three, four,, five, six, seven say aye. 12 Nay? Seven. 13 MRS. MORGAN: Maybe we should set it aside and go 14 to 15 MRS. SILSBEE: Dr. Wammock? 16 DR. 1,7AMMOCK: You talk about the new Drojects over 17 here. I have just been looking at that hypertension. And .18 if y'ou look at on page 9,1 thou ght I had it, California, it 19 seems to have gotten away. But it looks to me that there are, 20 lots of hypertension projects over here -- 159C, 159D, 159F,, 21 159F, 159G, community hypertension awareness nrolect, 15,OH, 22 'high blood pressure control in Berrett Countv, 159 -- there's! 23 about 10 or 15 down there that go right on to the hyperteh- 24 sion. 25@ 'So I think there is a tremendous amount of money 100 n37 I being put in that program there. 2 Ithink that was brought out ,MRS. SILSBEE: Well, 3 a little earlier. 4 DR. T-7AM-MOCK: It was brought out alittle earlier. 5 But this is in.the new projects in which they are requesting 6 this. 7 MR. OGDEN: Can-I make a new motion that we put 8 California at 4 million dollars?. 9 MRS. SILSBEE-. Is there a second to that? 10 DR. GRA14L!Cg: Second. 11 MRS. SILSBEE: The motion has beet made and seconded 12 that California application be approved at the level of 4 13 million dollars. 14 Is there further discussion? 15 MR4 MILLIXEN: I think 3 and a: half. Try 3 and a 16 half. 17 DR JANEWAY: Pow about 3 million 640? 18 MRS. SILSBEE: I might add that the Council dbe n't 19 seem to be any more deliberate it its setting the fund levelsl 20 than the Committee seemed to be yesterday. 21 All it favor of the motion to approve the aptlic&- 22 tion at 4 million raise their hands? Four. 23 Opposed? Eight, nine. 24 The motion is defeated. MR. ODGEN: Dick, you want to move it? 1 0 1 n38 DR. JANEWAY: I move approval of the California 2 application at $3,640,000. 3 MRS. FL06D: I will second that motion. 4 MRS. SILSBEE: $3,640,000. The notion has been 5 made and seconded that the California application be Approved 6 at the level of S3 640,000 7 MRS. GORDON: Iwould like to ask.for a short 8 explanation of the magic mathematic&l"formula used to arrive 9 at thAt? 10 DR. JAIIEWAY: It is 65 per cent of 5.6 million. it MRS. SILSBtE4 Does that answer vour ouestioh.7 12 Is there further discussion? 13 (No response.) 14 MRS. SILSBEE: All in favor of the motion sav ayo? 15 VOICES: Aye. 16 MRS. SILSBEE: OnT)osed? 17 (No response.) 18 MRS. SILSBEE: The motion is carried. v7ould someone ask Mr. Firoto to come back? 19 20 21 22 23 24 25 10 2 n39 CENTRAL @IET-7 YORK 2 MRS. SILSBEE: The next application is Central 3 New York, and miss--Martinez is the primary reviewer. 4 MISS I.IARTINEZ: The Committee recommended a funding. 5 level of $450,000. I was not quite so generous. I found 6 that at least two sets of projects duplicated or extended 7 each other in that they were two that were, number 77 and i 8 78 were really building of facilities, which I don't think 9 is feasible for one year projects. 10 Two more were really sort of education projects. 11 The end result is that I ended up with a funding recommenda- 12 tion'of 381,372. 13 MRS. SILSBEE: Dr. Schreiner? 14 -DR. SCHREINER: Yes. I had perhaps the advantage 15 of site visiting this area. And there are a number of 16 developments from the previous time. I agree with Miss 17 Martinez on those two particular projects. 18 I would Also like to point out, however, that in 19 the region's own priority list they are in the low priority 20 groups, so that they have insight into the problem which she 21 mentioned. 22 We helped them actually set up a very democratic method for determining the priorities in the various placeb. 23 And I think it has worked extremely well there. There are i 24 25 a high number of inputs, and they have a verv of good type 1 0 3 i4O I rating system for establishing priorities. 2 Now, in previous sessions the kidney programs were 3 to,-,,@d down because-'they did have some problems in getting 4 areawide agreement on a number of the projects. I do think 5 'that thev made a lot of progress in that particular area 6 since our last funding. 7 And the kidney projects have been asked for at a 8 level of 111,000. The second area that I would give very 9 high priority to, and I can find in their priority list 10 reasonably highly rated as well, are those relating to the north country, which is an extremely desolate area. 12 Even though it is in New York State, within easy 13 driving distance of New York City, it has one of the lowest 14 population densities in the United States. And there are a 15 number of very uniaue minority circumstances up there, 16 including an Indian reservation which never signed a treaty 17 with the United States and therefore doesn't come under the 18 Bureau of Indian Affairs and it is entirely dependent upon -19 this kind of activity. 20 I can identify about another $135,000 worth of 21 projects relating to the north country area. So I am- afraid 'that my recommendation would be a little bit hiaher. If I 22 23 assumed the program staff figure is correct -- and I would 24 agree it is possible it could be cut a little bit and put two 25 the emphasis in these/areas I could come up with A fiaurel 104 n4l I of $562,000. 2 So then I am a little far away from Miss Martinez. 3 MRS. SILSBEE: Well, I don't have a motion. 4 DR. SCHREINER: I would like, obviously, to move 5 the higher figure and she would like to move the lower fiqtre!!. 6 MRS. SILSBEE: W6've got three figures before us 7 now. 8 MR. OGDEN: What are tho e, please? 9 MRS. SILSBEE: But we don't have a motion. 10 DR. SCHREINER: 1 would like to move 562. 11 MISS MARTINEZ: 562 ? 12 DR. SCHREINER: Yes. 13 MRS. SILSBEE: $562,000. is there a second? 14 (No response.) 15 MRS. SILSBEE: Is there another motion? 16 MISS MARTINEZ: Yes. I would like to make a motion 17 for 382,000. 18 MRS. SILSBEE: 383,000? 19 MISS MARTINEZ: 82. 20 MRS. SILSBEE: 382,000. Is there a second? 21 (No response.) 22 MRS. SILSBEE: Is there another motion? 23 DR. KOMAROFF: I move the Committee's recornpienda- 24 tion of 9450,000. DR. JANET-7AY: Seconded. 25 n42 1 MRS. SILSBEE: The motion has been made and secondee 2 that the Central New York, application be approved at the 3 level of $450,000.-. 4 Is there further discussion? 5 (No response.) 6 MRS. SILSBEE: All in favor? 7 VOICES: Aye. 8 MRS. SILSBEE: Opposed? 9 (No response.) 10 arribd. -MRS. SILSBEE: The motion is c 1 1 12 13 14 15 16 17 18 19 20 21 22 23 24 25 10 6 n43 1 4.t COLORADO/T,7YOMING 2 MRS. SILSBEE: The next region to be reviewed is 0 3 Colorado/T@7yoming. And le t the record show that Or. Gramlich 4 is out of the room. 5 Miss Ilartinez? 6 14iss IIARTINEZ: I am waiting. 7 All right. I believe the Committee's recommendation 8 was for $200,000. Again I am a little low in that I recom- 9 mend 146,959. I have a comment to make on one of the projects I 10 in particular -- well, twoi all right. 11 one, number 59, seems to me to be Primarily an a 12 education project. And I was wondering whether/Staff person 13 could tell me if this was developed in cooperation with the 14 educational commission of Colorado? 15 MRS. SILSBEE: Miss Murphv, did you hear the quet-I 16 l@ tion? 17 MRS. MURPHY: Yes. I have to checkit. 18 MRS. SILSBEE: Could you get over to.the microphone! 19 please? 20 MRS. MURPHY: I really know no more about the 21 project than what is on page 15. 22 MISS @IARTINEZ: Well, if it is the information thati 23 I read last night, then I just make the observation that the 24 educational commission or agencies in the State were not 25 consulted and that the project description was extremely n44 I hazy in my mind. So I have severe questions about that 2 one. 64, 3 But the one that I really object to 's number 4 which is entitled, health promotion service, primarily a 5 project to reach senior, Spanish-speaking senior citizens, 6 sort of an education project. And at one point the comment 7 is made that the money is 'going to be given-to the public 8 health department to@hire nurses who will go out and try to 9 overcome social barriers. 10 That doesn't explain how it is going to be done, 11 it doesn't explain who, you know, what criteria is going to 12 be used inthe selection of staff'to do this. To me, this is an example of a lot of poor planning that goes into pro- 13 14 jects which are supposed to teach minority people and don't. In other words, it is an exmple of the use of a 15 16 minority population for funding. And I would suggest that 17 either that project proposal be developed so that it is underi 18 community control and hires community persons to do the out- 19 reach or that they be requested to not fund it. 20 MRS. SILSBEE: Dr. Haber? 21 DR. HABER: I have a serious question about project n)mber 61. Could Staff enlighten us about what is intended 22 with the $17,000? You can't buy bahd-aids for $17,000. 23 MRS. MURPHY: That proposal has been called into 24 25 EMS for consideration We will not fund it until it gets r) n45 approval. 2 DR. PAPER: Very well. 3 MRS. SILSBEE: It has not been referred to E@IS. 4 That was one we wanted to get the Committee's views on, 5 because it doesn't conflict with the legislation. 6 DR. HABER: I would like to point out that a burn 7 center is an extremely expensive operation, requiring heavy 8 staffing by very skilled people. And I think that we sadly 9 or badly need the development of such burn centers. But 10 unless this is some kind of exploratory project -- I can't 11 tell here -- I would say that the scope appears to be hope- 121 lessly inadequate. 13 The demands of these burn centers ate such t at 14 you should deploy these with the greatest precision and in -15 areas where they are likely to be well utilized, and c oncen- 16 trate the rest on developing transportation svstems to set 17 people to where the burn centers are. 18 I don't know what this, but S17,000 seems to be 19 so inadequate that it is ludicrous, I would think. 20 MRS. SILSBEE: Mrs. Morgan? 21 MRS. MORGAN: I don't believe Colorado has a burn 22 -center or such at the lDresent time. They have applied to 23 the legislature and were turned down last spring for money 24 to build-a burn center. 25 this $17,000, I believe, mainly is to take a nurse 10 9 n46 1 who has been working in,@ auote, unquote, what they call 2 their burn center where they treat their burn patients, 3 which is a @12,000.., add to it travel about the State, and 4 I think really to urge passAge of A legislature bill where 5 it will be taken care of by the State at-the Colorado 6 General. 7 DR. HABER: @lelit if it is preparatory or educa" 8 tional 9 MRS. MORGAN: Ithink it is really a study to get 10 information to develop one. 11 DR. HABER: 1,7ell, O.K. Under those circumstances i 12 I will be mollified. 13 MRS. SILSBEE: I haven't had a motion oh Colorado/ 14 Wyoming. -15 MISS MARTINEZ: Yes. I would-to make a motion thati 16 we fund at the level of 146,959. 17 MRS. SILSBEE: Is there a second? 18 DR. KOMAROFF: Second. 19 MRS. SILSBEE: A motion has been made and seconded 1 20 that the Colorado/@lyoming application be approved at t e 21 level of $146,959. 22 DR. YOM@ROFF-. Including that caveat that she 23 mentioned about the,Spanish-speaking 24 MRS. SIMBEE: That is project 54. 25 MISS MARTINEZ: Yes, either it be developed with i; I n47 1 the safeguards I mentioned or that it not be done. 2 @@IRS. SILSBEE: All right. Is there further discus- sion? -7AY: 4 DR. JANET Does that mean, Miss E4artinez, that if it is devel tisfactorv to Staff and UU4P oned in a manner sa 6 that the allocation is increased by $65,000? 7 DR. KOMAROFF: Or $41,000. 8 DR. JAIZEIIAY: $41,000, whatever it-is, so it would 9 come out 187,000. 10 MISS MARTINEZ: Yes, I would be willing to go along; 11 with that idea. MRS. SILSBEE: That requires a motion, Sentiment. 12 MISS MARTIITEZ4 I would like to make a motion to i 13 that effect. 14 15 MRS. SILSBEE: V7e.still have one on the floor now. 16 MISS PIARTINEZ.: I see. 17 MRS. SILSBEE: The motion was not that. 18 MISS MARTINEZ: Can I withdraw the original rmotion?!, -19 MRS. SILSBEE: Yes. 20 Does the second want to v7ithdraw? DR. YOMAROFF: Yes. 2 1 MRS. SILSBEE: All richt. Start again. 22 MISS MARTINEZ: All-right. I move that C61orAdo/ 23 I-lyoming be funded at the level 146,959 and -- how should I 24 put it which would include the elimination of 'project 25 n48 I number 64, unless that projpct can be developed to include 2 a community control policy board and outreach workers who 3 are from and sensitive to the needs of the particular popu- i 4 lation being served and that if such conditions are met that tl.ie funding level be increased 5 6 MRS. SILSBEE: No, you have to go the other way 7 to get a motion like that.- 8 MISS MARTINEZ: $41,000. 9 DR. KOMAROFF: 187, 188, but restrict the $41,000 10 unless they do it right. 11 MISS MARTINEZ: O.K. Does it come out exactly 12 187? 13 MR. HIROTO: 188. 14 MISS MARTINEZ: All right. Let's try this once 15 again. I move that Colorado/W.voming be funded At 188,182 16 with the condition that r3roject 64 is to be developed to 17 include a community policy board and community outreach 18 workers sensitive to the population in question, and that 19 if such conditions are not met that the funding level be 20 reduced to 146i959. 21 MRS. SILSBEE: You have heard the motion. Is therei a second? 22 23 DR. @7,A-MM.OCK: Second. 24 MRS. SILSBEE:: Any further discussion? 25 (No response.) 11 2 i49 1 MRS. SILSBEE: All in favor? 2 VOICES: Ave. 3 MRS. SILSBEE: Opposed? 4 DR. JANEWAY: No. 5 MRS. @IORGAN: No. 6 MRS. SILSBEE: Let's see. Let's have the ayes 7 raise their hands. 8 O.K. Let's have the nays raise their han s. 9 The ayes have it. The motion is carried. 10 Dr. Janeway? 11 DR. JAI@IEWAY: It seems to me that there must be a 12 reasonable balance between fulfilling all the resrbnsibilities@ 13 and carrying out the policies and statutes of the R!!P versus 14 the selective identification of particular projects. r-rhe .15 technical review has been done. 16 And there are only two Council members who have 17 had the opportunity even to read the forms 15. 1 would just 18 hope that we don't-gibt'-like the fellow who went down into 19 the swamp and he saw an alligator down there, and he beat 20 that alligator over the head a nd he killed them. 21 And he just kept running into more alligators and 22 killing alligators and forgot after he was down there with 23 all those alligators around that somebbdv sent him down to 24 clean out the swamp. 25 DR. TIM@IOCK: Common, Sam Ervin. 1 1 3 lb6ws in n5O MR. @III,LIKEN: You mean he is up to his e 2 alligators 3 MRS. MORCIAN: Ile's not quite that far. 4 DR. JATIFIIAY: I have to abridge the storv a little 5 bit. 6 MRS. FLOOD: As a matter of comment and again, 7 as Dr. Janeway occasionally says, gratuitously I do think 8 though that we have some responsibility. If the technical 9 reviewers or the Regional Advisory Group itself does hot 10 take into consideration the problems of dealing with minority 11 groups and using terminology such as overcome cultural 12 barriers rather than to address cultural barriers in a 13 manner that can be adapted to the health delivery system. And we do face the responsibility of questioning 14 15 the development of individual projects when th6v are setvingi 16 @l a population that many times is not articulate in expressing 17 its own needs. 18 DR. JANTWAY: I don't disagree with that one bit. 19 MRS. SILSBEI?: Thank you. 20 The transcript for,Arizona has arrived, and have i 21 you had achance to look at it, Mr. fliroto, or would you 22 rather go ahead? l@7e can come back later? 23 MR. HIROTO: All right. I will take Connecticut. MRS. SILSBEE: You'll take Connecticut. Do you 24 25 have that'one? 11 4 n5l MR. HIROTO: No. 2 MRS. SILSBEE: we have to hold for just a few 3 minutes while there is a switch -- the changing of the guard 4 1 here. (Whereupon, at 12:30, a luncheon recess was taken 6 until 1:00 p.m.) 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 11 5 1 AFTERNOON SESSION 2 MS. SILSBEE: The meeting i@@ill corie to order. 3 In the break that-we have had, I've had about three or four 4 requests of individuals in regions who have to leave early 5 and I'm prepared to accomodate them as much as nossible, butl 6 we re going to have to move along. Mr. Firoto. 7 MR. HIROTO: Ms@ Chairman, would.you entertain a 8 motion that should the orimary revier.-@er and the secondary 9 reviewer have no problems or difficulties with the result 10 of the Review Committee, that we vote in block on those and 11 go along the table and list those states that we feel secure with and only review those or discuss those that some oeople 12 13 may have questions about. 14 MS. SILSBEE: I will entertain the motion. 15 MR. MILLIKEN: Second. DR. HABER: One mechanism for accomplishing that i 16 17 might be if you were to read dov7n the entire list of remain-! 18 ing proposals and ask if objection is raised oh the part of 19 primary or secondary reviewer with the colnliittee's recommen- 20 dation. A negative answer would seem to indicate that it would then be part of a bloc k to vote on. 21 MS. SILSBEE: Right. 22 23 DR. 11@IOCK: You said you would read down the i 24 list? 25 DR. HABER: Yes. There ate several wavs to 11 6 accomplish this, but the most expeditious would be for Mrs. Silsbee to read down the list and if anyone feels 2 3 that he doesn't q@. along with the committee's report, he 4 so states And it is then removed for, individual considera- tion from the Block Vote. 5 6 MS. SILSBEE: I think.the record should show that the entire council has before them the composite recommends 7 8 tions of the review committee showing the requested level and the committee approved recommendation. I also think 9 10 that the record should show that this is in view of the fact that you participated as observers in discussions of 12 the committ6e's deliberations yesterday. @13 I-IS. GORDON: T@,7as there any problem with the con- flict of interest? 14 15 MS. SILSBEE: Not on block action. All right, 16 the motion has been made and seconded that we go through 17 this. I'll go down the list and if anyone has any objec- 18 tion to the committee recommendation, we will take that 19 particular application out for discussion, otherwise there 20 will be a motion about the block action. All in favor. MS. SILSBEE: Opposed. 21 22 Motion carried. 23 I will not only read the list, but I will read into the record what the recommendation was as fat as the funding 24 25 level. 11 7 00 0. MS. SILSBEE: Arizona $150, MR. IIIP.OTO: Object. 2 MS. SILSBEE: Connecticut $750,000. 3 DR. GRI-J4LICH: Object. 4 MS. SILSBEE: $600,000 Florida. 5 ware Valley $684,512. 6 Greater Dela Hawaii - $486,7.50. 7 8 Illinois $750,000. 9 Indiana $240,000. 10 Intermountain 11 DR. KOMAROFF: Object. MS. SILSBEE: Iowa - $173,929 12 Kansas - $363,:')45 13 Lakes Area $150,000 14 15 Louisiana 16 DR. JANEWAY: Object. 17 MS. SILSBEE: '4aryland - $650,0004 18 DR. WAMMOCK: I think we had better go over that. 19 MS. SILSBEE: Memphis - $950,000 Metro-D.C. - $250,000 20 21 Michigan - $500,000 mississIT)pl - $2,000,000 22 23 Missouri $540,000 Mountain States - $300,000 24 25 Nassau/Suffolk 1 DR. KO'-IAROFF: I think we had better discuss that.@ 2 MS. SILSBEE: Nebraska - $95,000 3 New Jersey - $1,100,000 4 New York Metro - $950,000 5 North Carolina - $120,000 6 Northern New England - $600,000 7 Northlands - $300,000 8 Oklahoma - $2501,000 9 Oregon - $148,6 10 Puerto Rico - $131,335 11 Rochester - $1,000,000 12 South Carolina 13 MRS. GORDON: Objection. MS. SILSBEE: South Dakota - $88,850 14 Susquehanna Valley - $'500,000 15 16 Tennessee/Mid-South - $570,000 17 Tri-State - $610,000 18 MS. SILSBEE: We'll come back to Texas.- Tri-State',- 19 $610,000. Virginia - $960,860. 20 MS. MARTINEZ: object. I-.RS. FLOOD: They have an arthritis program. it's 211 not essential, it's automatically taken care of. 22 23 MS. SILSBEE: From the previous recommendation. 24 Washington/Alaska - $530,000 West Virginia $1,000 000 25 MS. SILSBEE: Western Pennsylvania - $450,0004 DR. HABER: Objection. 2 MS. SILSBEE: Wisconsin - $200,000. 3 We'll review Arizona, Connectucut, Intermountain, Louisiana,l 4 Maryland, Nassau-Suffolk, South Carolina Virginia, Western 5 Pennsylvania with Texas. 6 7 MRS. MORGAN: I move that we accept the Review 8 Committee's recommendations for.funding of the regions 9 nor. specified to be taken care of separately. 10 DR. KOMAROFF: Second. 11 MS. SILSBEE: Is there further discussion? 12 (No response) 13 MS. SILSBEE: All in favor. opposed. 14 15 MS. SILSBEE: Motion is carried. 16 We'll now go to Arizona. 17 MRS. YLEIN: This is just a minor thing, but we 18 had taken some this morning and the way the motion was 19 worded, all those other than the ones that were recently enumerated so I think the motion should show, exce t for 20 p those already discussed and approved. 21 I think that was the consensus MS. SILSBEE: 22 of the discussion beforehand. 23 24 1 2 0 ARIZONA 2 %IS. SILSBEE: Arizona - Dr. Gramlich. 3 DR. GRNILICH: As a matter of principle, Arizona 4 has had difficulty with the organization, the leadership andi 5 had had some other difficulties that were technical with thei 6 DRMP and counsel said to clear it up, so Arizona cleared 7 them up and the Technical-Review Committee.rewarded this I 8 function by cutting their allocation --- their recommenda- 9 tion. The question is one of principal. Do you reward 10 virtue in a negative fashion or a positive fashion? 11 There's not much question about the technical capabilities 12 of the region to accomplish the @roject it had ordered. 13 That was a minor element, but the concern on the art of p 14 the technical review committee was, if you haven't been goodi 15 up to now, that you've changed everything we said you shou d 16 do, so we're goina to reward you by cutting your grant. 17 MR. HIROTO: I echo that. I was going to request 18 the council to consider changing the amount of the award 19 to $240,000 --- $240,718 because at least it meets the three 20 component projects in the upper three pro]ects that have the highest oriority. 21 22 DR. GRP2,ILICn: If that's a motion, I second it. MS. SILSBEE: The motion has been made and 23 seconded that the Arizona application be approved atthe 24 level of $240,718. Is there further discussion? 25 1 21 1 (No resnonse) 2 14S. SILSBEE: All in favor. Opposed. 3 i4S. SILSBEE: The motion is carried. 4 5 6 7 8 9 10 12 13 14 15 16 17 18 19 20 21 22 23 24 25 12 2. I CONITECTICUT 2 '1'4S. SILSBEE: We will now go to Sonnecticut. 3 Mr. Iliroto. 4 MR. HIROTO: I can appreciate the problem that 5 probably we all face with Connecticut and that Connecticut's'i 6 program has continued as it was'designed until just the last 7 10 months. The technical reviewers, one recommended a 8 a level of $250,000; the other recommended a level of 9 $1,400,000, which reflects, I think, the difficulties we 10 all have in reviewing Connecticut. Dr. Gramlich, if you 11 have any comment that you would like to make. 121 DR. GRAMLICH: Yes. Again, these are general 13 comments and more philosophical then technical. Here, 14 apparently and I don't know the region well at a 15 may be in error, but it appears this is an RMP set up with 16 a different kind of program from the pattern throughout the 17 rest of the States, throughout the rest of the nation and 18 therefore, our last Technical Review Committee said, well,, 19 since it doesn't conform, we shouldn't give them any money. 20 Now, maybe this is an entirely wrong interpretation. I 21 would appreciate staff input on the assessment of the ication for droppin g the funding because of the fa t justif c 22 of the different kind of program#, one from the other. 23 MR. HIRBTO: Dr. Gramlich, I don't think that is 24 a primary consideration. The problem seems to be that all 25 12 3 of the IU4P funding or most of-it has gone into the institutional area, rather than into other areas and 2 despite staff eff@rts to spread the program a little more 3 4 fully throughout the state and throughout other institutions'!, this was not accomplished. At the last council meeting, 5 6 1 council agreed to reduce funding dramatically because this 7 was the only way that Connecticut would get the message, so to speak. They have gotten the message to a deqree and 8 so the $750,000 level seemed reasonable to rhe review 9 10 committee. 11 DR. GRAMLICH: Rebuttal time. MS. SISLBEE: Dr. Gramlich. 12 13 DR. GRAMLICH: To begin with the may request for funding was not large. It was something in the order of 14 15 $636,000 dollars. The major request is what we have in 16 front of us now. Therefore, since the timing again with 17 Connecticut, was differnt, we are penalizing them even 18 further by not killing their program by refusing to accept their major funding request. 19 20 MS. SILSBEE: Dr.Janeway. 21 DR. JANEWAY: It is my recollection, Dr. Gramlich that one of the things that was taken into consideration was'l 22 considerable amount of their funding was going through into 23 24 1976. 25 DR. GRAMLICH: Correct. 12 4 1 DR. JANEIIAY: And the way I recall the technical 2 discussions, there was a general sense of that group that 3 felt they should not fund projects through '76. 4 MS. SILSBEE: There were several considerations, 5 Dr. Janeway in terms of the level. One of them was the 6 two year funding request. The other was a contract that 7 would have enabled the monitoring capacity.to go beyond 8 June -'Oth, but in addition, there were the two University 9 resources that were funded at a fairly sizable amount. 10 Other portions of the program that would have been of don- 11 cern was the third faculty. There were no funds requested 12 for that. The Connecticut application in May, Dr. Gramlich 13 was requesting support for staff plus two months o continua 14 tion projects. This amplification asks for 10 to 22 months 15 for some activities and 10 months for o thers, so it is 16 complicated by that factor. 17 DR. GRAMLICli: Right, but neverthelsssl if you 18 take all the two year projects and this iscrud6 arithmetic 19 but nevertheless if you take the two year projects and cut 20 each of them in half and award them one half of the two year 21 total, you're in effect awarding them for one year. They still wind up with a figure $1,430,000. The way I visualized 22 this, it was incorrect, that since Connecticut came in for 23 a small'grant request last May, if we cut them way down thisi 24 25 time, weire in effect, killing their total program. 1 2 5 1 MR. IAIROTO: There was something like $240,000 2 more or less requested just for the monitoring by Yale 3 University of the-.second year program, so we might sub- tract further your total by that much. I may be wrong. 4 5 DR. GRMILICH: The principal involved is do we 6 want to kill Connecticut or not. 7 MS. SILSBEE: There is no motion on tie floor. 8 DR. GRAMLICH: Since I have done most of the 9 screaming and hollering, I will therefore move that 10 Connecticut,be awarded a grant in the amount of $1,435,500. 11 MS. SILSBEE: Is There a second? 12 DR. HABER: I will second it. 13 MS. SILSBEE: Dr. Gramlicht what was the total? DR. GRAMLICH: $1,435,500. This is arrived at 14 15 by very crude arithmetic, by taking each two year project 16 and dividing it in half and totalling it with the ones o 17 the one year projects. It's the only way I could really 18 figure it. 19 MS. SILSBEE-. The motion has been made And seconded 20 that the Connecticut application be approved at the level 21 of $1,435i5OO. MRS. GORDON: I'm just wondering, there's really 22 23 no way probably that we have of knowing whether dividing 24 the two year project in half leaves you a viable project. MS. SILSBEE7: I think in this particular instances 25 12 6 1 we have--- 2 MRS. GORDON: --- it's not a matter of a new activi'@L@@il 3 so much. 4 MS. SILSBEE: I think we may need some help here 5 from Mr. Nash. The two year projects, are they all new 6 or are they continuations? MR. NASH: I think some of them are new. The 7 8 onces, I think, that concern the review committee, the 9 four projects going to Yale and Yukon are for over $800,000 10 for the two year period. 11 MS. SILSBEE: Mrs. Gordon, because you were hot here yesterday, there was considerable discussion with the 12 13 committee and Dr. Pahl about the two year requett. The region recieved its money and has the option of putting 14 15 some money away for some activities, if they feel they 16 shou6l go longer than two years, if they can work out some 17 kind of A contractural arrangement, so this is just a way of 18 arriving at a level and I don't think that should be a major 19 worry for you. The Regional Advisory Group will make that 20 decision. Mr. Milliken. 21 MR. MILLIKEN: My understanding is that you have 22 my understanding is that Yale was just awarded one of the few large cancer centers --- cancer'development research. 23 Are they going to be able to spend all of this with the 24 25 limited staff they have there? DR. GRA24LICH: The money that goes into the 2 Regional Medical Program aspect of this program would 3 not --- this is their community outreach part of the university budget. They won't --- I don't think they will 4 5 have much of a problem spending money. 6 MS. SILSBEE: They have had experience in this. The motion has been made.and seconded that the Connecticut 7 8 application be approved at $1,43.0,500. All in favor. ould 9 I see a show of hands? Five. Opposed - the opposed have 10 it. The motion is not carried. I will entertain another 11 motion. 12 MR. HIROTO: I move the review committee's 13 recommendation of $750,000 be-approved. 14 MS. SILSBEE: Is there a second? 15 MR. OGDEN: Second. 16 MS. SILSBEE: The motion has been made and 17 seconded that the Connecticut application be approved 18 at the level of $750,000. Is there further discussion? 19 (No response) 20 MS. SILSBEE: All in favor? 21 opposed. The ayes have it. 22 23 24 25 1 12P INTEP,14OUNTAIN 2 MS. SILSBEE: The next application to be reviewed i 3 is Intermountain and the record shows that Mrs. Klein and 4 Dr. Gramlich are out of the room. Dr. Komaroff was the 5 reviewer. 6- DR. KO@IAROFF: Intermountain was rated by the 7 June Council as an above-averacre region. They were awarded 8 2.23 million dollars, as a result of last councils session.! 9 They now request a supplement of $48liOOO for 19 new project!, 10 Activities. The last council expressed several concerns 11 which appear --- most of which apnear to have been resolved 12 and let me summarize them briefly. There has always been 13 a turf problem with the Intermountain regions, the mountain 14 states and Colorado and 1,7yoming regions. This appears to- 15 ha ve been resolved by some interlocking membership of the 16 advisory groups and frequent reaular meetings of the members'! 17 of the advisory group --- of the members of each of the threei@ 18 advisory groups as well as by some joint funding of pr6jectsi 19 which have a geographical overla-P with these three RMP'S. 20 A second concern has been the relationship of this'i 21 RMP its CHPH agency and aodarentlvt according to the staff @i review and the CHP letters in the application, there is now 22 a serious review by CIIP under consideration by the RAG of 23 24 CHP. 25 The third concern that the council expressed last 12 9 time involved the role of the RAG in developing and monitor-I 2 ing projects. The region has developed what they call a 3 drag advocate program whereby individual members of the RAG are responsbile for shepherding a project roposal 4 p through it's passage and subsequently monitoring that 5 pro3ect after it has'been funded. It seems like a worth- 6 7 while idea. There was a.question of conflict of interest 8 in the establishment of a health development services 9 corporation. Dr. Pahl mentioned yesterday that through action by the State Attorney General and through meetings 10 11 with the RMP staff members, this conflict of interest ques- 12 tion has been resolved. There was concern that council epxressed regardingthe university domination of past 14 projects. In this cycle, 18 of the 19 projects were 15 sponsored by outside agencies which may have created a 16 Problem, but has solved at least the @concern of council 17 from the last time. The directorship of the program and 18 the capabilities of the four staff ate deemed to be good 19 by those people who know the region best. I have not 20 visited there. The project proposal, however, seemed to 21 me to be exceedingly non specific and hard to evaluate. They have some very uninspiring continuing education pro- 22 jects and they propose to develope their own audio visual i 23 24 materials. Many of them give the impression of duplicating kinds of activities which have gone on in other tegions with@- 25 out giving evidence that they plan to build on the experience of others and I have the uneasy feeling that they may be, 2 3 repeating the failures and not the successes of other such attempts at PJ.!P, but it's hard to tell from these abstracts.,@i 4 15 One proposal is to establish a workshop on drug 6 and alcohol abuse, and I just wonder why they haven't applied through the institute for drug and alcohol abuse 7 or such an activity. It seems to me on the fringe of 8 9 P14P's funding mandate. S6veral strong proje@dts are 10 listed. One of the most interesting involves a computerized agency referal for extended services in which they would 11 12 try to do,a better job of referring patients to apparently 13 social service agencies. I would --- I'm not concerned that 14 the projects are over inflated as has been described by the 15 past council and the review committee yesterday. In fact, 1& if anything, they appear to underestimate the cost And time 17 needed to accomplish local objectives,,but I have a feeling 18 there is a lack of cohesion about the whole package and I .19 take issue with the committee's decision to fund them at 20 virtually 100 percent of their request and would reduce the request from --- reduce the award from $450,000 to 21 $350,000, out of a total request of $480. I would also 22 convey to them again, as council did at its last meeting 23 24 that the project --- the corp staff, not the project staff 25 should include more minority representation. particularly 1 31. repr esentation of women in professional Positions. 1 2 MS. SILSBEE: Mrs. Flynn. 3 MRS. FLY'Z4N: I would have to concur with Dr. 4 Komaroff, that even though they have answered many of the concerns of council and site visitors, nonetheless, the 5 6 weakness of the application and particular project 7 proposals for which they seek funding demonstrates in this application that they are not addressing the total 8 program in view of their area and I would concur with his 9 110 recommendation to reduce the award to $356,000 dollars, so I would second his motion for thatanount. 12 MS. SILSBEE: The motion has been made and seconded that the Intermountain application be approved 13 14 at the level of $350,000 with advice tr the region reo-ard- ing the employment of more minority representatives and 15 16 more women. 17 DR. KOI.IAROFF: On the corp staff. 18 MS. SILSBEE: On the corp staff. Is there further discussion? 19 20 (No response.) 21 MS. SILSBEE: All in favor. Opposed. 22 23 The motion is carried. 24 25 LOUISIANA 2 MS. SILSBEE: The next region to be reviewed is 3 Louisiana. Dr. Janeway. 4 DR. JAIIEWAY: I'm the secondary reviewer --- I'm the, 5 primary reviewer. The reason why I wanted to take it out 6 ofthe block was partly to get some technical advice from 7 the staffon this. I am concerned about the application 8 for $75,000. 9 MS. SILSBEE: Bring Dr. Gramlich and Mrs. Klein 10 back in. 11 DR. JANEWAY: I'll hold my comment until Mrs. 12 Klein gets back. She's a lawyer and she may be able to help. 13 (Dr. Gramlich and Mrs. Xlein re-entered the 14 15 hearing room.) 16 MS. SILSBEE: Is staff ready to listen to the 17 question Dr. Janeway has. Can thcvcome up tothe table, 18 please. 19 DR. JANETIAY: My questions are technical and 20 relates to Project C-10 in the Louisiana application which 21 is entitled "Stud of 0. Tax Supported Clinics Serving y Title 19 Recipients.' It's the major reotest in th6 22 Louisiana Application and I would like to know whether it 23 is appropriate that RMP funds be used to evaluate the 24 activities of the clinics supported by other tax funds. 25 1 3 3 1 One wonders if that shouldn't be the function of either 2 the state, per se or the agency that provides medical 3 funding. It's just a question that I, myself am unable 4 to answer it. I don't have the knowledge. 5 MS. SILSBEE: Mr. Sibloski'-, do you have any 6 comments? 7 MR. SIBLOWSI: Not really. It's a hard one o 8 swallow. 9 DR. JANEV7AY: I brought it up BECAUSE Nobody in 10 Technical Review even mentioned it. 11 MRS. GORDON: As secondary reviewer, we only figur6d 12 what thev.were trying to do was get an impartial judgement 13 on it and the other federal agencies weret't impartial. 14 DR. JANEWAY: It might Pay to have Blue Cross come 15 in and do it for them. 16 DR. GRA.MLICH: My impression of the m6dic-aid 17 level is extremely low. 18 MR. SIBLOWSKI: 'I can't reall respond.. I really y '19 had some concernwhen I was talking to Dr. Savlier as o why 20 they decided to participate. He was basically saying that 21 the I:,14P is in the only neutral Position-in the state to attack it. Everybody else seems to be involved and it's 22 23 a non biased review assessment and if you look on Page 16, the people all involved in this---are involved with the 24 consulting firm of Shindell and Associates. The ILouisiana 25 1 3 4 tion and Planning; the Division of Division of Admi-nistra ivision of Health Maintenance; the 2 Family Services; the D Charity hospital @ystems division and it seems reading 3 in between the lines that many Board members in many 4 non biased type of thing where the organizations, it is a 5 u a certain role. RMP is entered in and is trying to f lfill 6 DR. JANEWAY: Let me ask you --- try to explain to 7 me the comments coming out of the HPC in Lafayette, Louisiana 8 to which is attached, at least in my copy a memorandum# th 9 10 last paragraph which says, "This study is intended to in- 11 fluence the manner in which HEII funds out patient medical 12 services.in the state and may result in increased availabil:UtN 13 of these funds. I'm only asking this question because don't want the people in this National@Advisory Council to 14 be put in the position of approving something which is 15 16 against statutes. I'm not trying to hurt the Louisiana 17 RMP. 18 MR. POSTA: If I could make a brief comment. 19 This is not related directly to your question, wh c -I 20 think is quite valid. The last council, if you will remember, one of the reviewers specifically requested 21 to get them more involved with the REqibnal Medical 22 Program, more involved with-bringing the-private institu 23 24 tiohs in and the private sectors into the indigent clinic or the hospital sys@-t-r-1. I'm not saying this was developed 1 25 i-i b 1 totally as a result of that recommendation, but to me it 2 sort of fits into that cline of the Reaional Proaram,--- 3 Regional Medical @.rouram through some of its new leaders 4 who are making a conscientious effort to upgrade the care 5 of all thepeoT31e. 6 DR. SCHREINER: My comment to that comment is 7 the last time --- it's a very unique system. This represents 8 an extremely high percentage of the state budget going into 9 the support of these hospitals which are really state 10 hospitals and I think it's very superficial to say the 11 private practioneers should get involved at the expense 12 Of the state hospitals. If you have essentially a Govern- 13 ment hospital and the physicians there are on salary, there 14 is really no practical way those kind of physicians are going 15 to get involved and this is what they have. They have a 16 network hospital, and a very high percentage of the state 17 budget goes to it, a very high percentage. 18 MS. SILSBEE: Dr. Pahl, I'm glad to see,you back. -19 DR. PAHL: I'm gearing up for Texas. 20 MS.SILSBEE: Dr. Janeway has raised the question 21 with regard to the Louisiana application. The project C-10 which 7MP funds are going to be used to evaluate the 22 medic-aid services for children--- 23 MRS. GORDON: Tax supported clinic. 24 25 DR. jANETIAY4. Tax supported clinics for Title 19 13 6 ou at least I recipients and they are going to contract this t, i it says in the memo here they will contract it out to 2 Shindell Associatds. 3 MS. SILSBEE: He is questioning the legality. 4 DR. JANEWAY: Far be it from me to question the 5 legality. I'm questioning whether it is legal. I watt 6 some technical inout. -7 MS. SILSBEE: That's a better way to put it. The 8 9 legality of counsel taking action. DR. PAHL: As usual, I am not prepared, certainly 10 on the spur of the moment. I think what we would like to i 11 have is your recommendation within.what the legalities Are 12 and we can determine then post counsel and act accordingly. 13 In other words, on a technical matter like this, I'm not 14 really prepared to give you an answer that has any force 15- behind it. What I would prefer to do is find out whether 16 it is the consensus of this committee that, if legal, do 17 18 you recommend that we make the award which would-include -19 that or if not legal, do you recommend a funding level whichl 20 encompasses those dollars,, but they could use those dollars 21 for other purposes, so we need vour assent and we will determine the legality. 22 23 DR. HABER: I too was concerned about this project,: but in a direction somewhat different from Dr. Janewayi I 24 25 thought this was a particularly apt use of funds, Regional 1 1 37 Medical Program and at a stage'when winding down is in process and when one would hope that funds appropriated 2 3 for the project would be susceptible to a final verdictt I think that one of the Purposes of the Regional Medical 4 5 Program is the development of innovated projects and 6 certainly the evaluation of ongoing government mechanisms. I agree with Dr. Schreiner assessment that Louisiana is 7 8 hard put in terms of development of medio-aid programs and I think it would be very useful to get independent 9 10 surveys. I think it is appropriate. I'm not qualified 11 to judgethe legality-In terms of appropriateness, I think 12 we ought to approve it though. MS. SILSBEE: Is there a motion? 13 DR. JANEWAY: In light of the discussion, I move 14 therefore that we accept the recommendation from the 15 16 Technical Committee that louisiana be funded in the amount 17 of $168,680 dollars, pending review by the staff on the 18 legality and appropriateness of C-10. 19 MR. HIROTO: Second. 20 MS. SILSBEE: Dr. Janewayi does that motion en- compass, as a rule, if they could not spend money on that,- 211 that the region should have the money or have it taken away. 22 23 DR. JANEWAY: Noi 24 MS. SILSBEE: Is there any discussion.> 25 (No response) MS. SILSBFE:' The motion has been made and seconded that the Louisiana application be approved 2 3 at the level of $168,680 with the condition that the funding for the amount of money for Project C-10 be contin- 4 5 geht on our staff review of the legality and appropriateness 6 All in favor. 7 Opposed. 8 The motion is carried. 9 10 11 12 13 14 15 16 17 18 @ig 20 21 22 23 24 25 1 3 9 1 MARYLAND 2 MS. SILSBEE: The next application to review is 3 Maryland. Dr. Wammock, would you get the microphonebefore @i@ 4 you start? DR. TIAP*IOCK: Ithink so. I was the primary judgei 5 6 in this case and at the May-June Council meeting, there 7 was a request of $762,000-dollars and this was denied And 8 then they put in a new request for $724,000 dollars and 9 786 cents and at the meeting yesterday it was approved for 10 $756,000 dollars. I need a little bit of information here. 11 The total program staff - C-0000 - is that $336,604 correct?l, 12 MS. SILSBEE: Let me look At t e s eet? 13 MRS. FLYNN: That was May-Jtne. MS. SILSBEE: Mr. Nash, could you come up to the 14 15 table please? 16 MS. SILSBEE: Did you hear Dr. Wammock's question?i 17 MR. NASH: I did not. 18 MS. SILSBEE: Dr. Wammock wants to know what about[ 19 was it 338 --- ? 20 DR. WAMMOCK: $336,467 was the original program 21 staff- -total program staff. The original grant in May and i June, the request was then $762 and the new one is for Progra':n 22 23 Staff of $233,000 and $724,000 for July. The Program Staff 24 of $233,000 with the approval yesterday of $350,000 --- no, 25 $650,000 --- that's one-third for staff. I MS. SILSBEE: Dr. Wammock, ifyou will look at thel I 2 printout labeled 7-74, you will see that the total request 3 was @724,000, of which the staff is$302,961. 4 DR. T@IP24.MOCK: That's right, the indirect column is! right,. 5 6 MS. SILSBEE: There was no money provided for 7 staff because there was no,money provided from the May 8 application, so this is it. The $650,000 as I understood 9 the committee recommendation yesterday would Allow for the 10 staff, about half for staff and about half for the activities 11 that were proposed. Is that right, Mr. Nash? 12 MR. NASH: I thin, one of the recommendatiomwas 13 that $250,000 for staff and $400,000 for projects. 14 DR. IIAW40CK: 400 for projects and 250 for staff? 15 MR. NASH: Yes,sir.. 16 MR OGDEN: I think we ought to be aware that a 17 great deal of the activities that may go into this project 18 is'staff activities, so that you can't judge the total 19 request for a particular project as being the total cost 20 because some of that-activity is being carried out bv staff 21 people themselves. DR. W@NIOCK: I recognize that. 22 23 MR. OGDEN: So, I don't believe the action yester- day of say $250,000 for staff and $400,000 for programs is 24 25 any sense out of line. 1 4 1 DR. I-IlvklMOCK: You don't think that's out of line? 2 MR. OGDEN: No, I don't. I recommend that it be 3 accepted the way-'-it was yesterday. 4 DR. WZLT40CK: 'I just reopened it for the question 5 of clarification in my own mind as to which way this was 6 going because I wasn't quite sure. I went through this thing 7 and looked at the various projects which I described and I 8 don't know whether they're goingto be implemented or hot. 9 Perhaps it may do some good and perhaps it may not do any 10 good. I'll let the motion stand as it is as of yesterday, 11 but I wanted to bring this u for cla rififation in my own p 12 mind. I make a motion. 13 MR. OGDEN: I'll second it. 14 MS. SILSBEE: The motion has been made And 15 seconded that the committee recommendation of $650,000 16 stand. Dr. Watkins, did you have anything to add to that 17 as secondary reviewer? 18 DR. WATKINS: No comment. 19 MS. SILSBEE: The motion has been made and seconde@ 20 that the Maryland application be approved atthe level of 21 $650,000 dollars. Is there any further discussion? 22 (No response) 23 MS. SILSBETM All in favor? 24 Opposed. 25 The motion it carried. NASSAU?SUFFOLK 2 MS. SILSBEE:- The next region to review is Nassau/Suffolk.and-the prirz,,r-,, reviewer is Mr. Milliken. 3 4 MR. MILLIKEN: I-las this discussed yesterday? MS. SILSBEE: Yes, sir. Do you have a transcript 5 on that? 6 7 MR. MILLIKEN: Yes, I do. With the information 8 we had this morning, it would appear that we do have to change our previous decision of no funding. I have no 9 10 evidence to find fault with or change the review committee recommendation of $900,000, although I personally question 12 if that much is necessary due to the situation therein. 13 Maybe the second reviewer has something to add. I'll make a motion later on. 14 15 DR. GRAMLIC116. I find this interesting. it 16 appears we re reversing our position of June and July. 17 They have made a strong appeal and 1 guess if council has 18 no major objection to reinstating them, I would have to 19 support that decision. So move. 20 MS. SILSBEE.4 Second. 21 MS. MORGAN: Second. 22 MR. OGDEN: Could I ask the members'of council--- 23 MS. SILSBEE: Mr. Ogden, could you use the 24 microphone. 25 MR. OGDEN: Look at the page concerning Nassau/ 1 4 3 Suffolk. The program staffing here of $343,000 for what they have proposed to be slightly over a $2 million dollar 2 program, now if we're limiting this to $900,000 dollars, 3 obviously we cannot let the entire $343,000 for the program 4 o I think there needs to be something said if we 5 stay' s accept the $900,000. I didn't hear the review committee 6 7 yesterday. 8 MS. SILSBEE: They made the point, Mr. Ogden, it was not in the motion, but it was in the advice to the 9 region. 10 MR. OGDEN: That may be in the minutes. Idon't havel 12 that in my notes. MS. SILSBEE : The pink slip says: "Based on the 13 141 funding recommendations for the attending period, it was 15 further recommended that the Nassau/Suffdlk AMP be adjq8tedi 16 Staffing request to be proportionate to the forthcoming 17 award. 18 DR. GRAMLICH: In relationship to the presentation I 19 this morning, I was a little at a loss and wondered if the 20 applicant was fully aware.of the fact that this council felt i they should be in a phase out period 21 22 MS. SILSBEE: Mrs. Flood. 23 MRS. FLOOD: May I ask if staff has verified that o 24 Projects 021 and '022 of the E,4S projects are appropriate t 25 the allowable concepts of our funding. 1 MS. SILSBEE: We have had a return fi@r.)ri Mr. Reardon 2 who is EMS Systems Chief and he doesn't see anv problem witn i 3 regard to their Dor@ion of the legislation and we got a telephone call this morning from the part of HRA that is 4 Administering the training part of EMS and they also do not i 5 6 see any problem or conflict. That is not to say they are looking at it from any other standpoint but that. 7 8 MS. FLYNN: Those two line items approximate 9 $400,000 dollars and even though we're redommending-from 10 committee that their staff be brought into line by readjust- 11 ment according to the award, if they're just given an award 12.@ without further recommendation, other than staff limitations, it would appear that their only endeavor would be emergency 13 14 medical services and emergency medical training. '15 MR. STOLOV: We have received the priority level on 16 the projects and the equipment is below the $500,060 dollars, 17 however, the EMS training is above it,but Again, I feel it 18 is expensive, but it was their determination where to put 19 the money once they get this $900,0004 They may not put it 2o all into that EMS training. The Nassau County which is t e 21 more populated and richer county is way down at the bottom of@i 22 -their priority list. 23 MR. OGDEN: would you explain to me what this 24 $355,000 is, how much of this would be funded out of the 25 $900.,Ooo? -rIR. STOLOV: I believe-Dr. Pahl mentioned yesterday 2that we still have not developed policy regarding what happensi in terms of independent @@1P beyond June of '75, so we don't 31 4know IIET,,L wide if this is allowable under grants and administrai 5tion practices, but I believe it would have been a contract 6in their own Nassau/Suffolk RD-IP Inc to carry this out in this@i, 7scope and amount. When the-committee looked at this, it did 8not consider this in their funding level. They left it out. 9 MS. SILSBEE: The Chairman suggested the $2,000,000 10 request be cut down to $900,000 and that maybe a moot issue 11 in terms of continuing the program or putting money aside. 12 DR. SCHREINER: I was primary reviewer on the 13 last go round. MS. SILSBEE: According to the old assignment list, 14 Mr. Milliken, you had it last year also. 16 DR. SCHREINER: I was hoping it would be somebody 17 here. I'm very impressed as Dr. Scherer happens to be an 18 old friend of mine and I was wondering if this was in line 19 'with his $900,000 speed. 20 DR. PAHL: Mr. Milliken, right, I'm afraid you're it., 21 MS. MORGAN: Mr. Milliken, you were it last time. I don't recall 22 MR. MILLIKEN: all the details. MS. SILSBEE: In terms of making the assignments, 23 I try to keep them as consistent as possible. 24 MR. MILLIKEN: On the yellow sheet, the second yelloi@, 25 14 6 1 1 sheet, the second item CO-5,COG-5, Grantee Central Service. 2 Could somebody explain what that is? 3 MS. SILSBEE: That is what we were 3ust discussing. 4 14R. STOLOV: It's an independent R-NIP, therefore 5 according to instructions, they should close by June of '75 6 and they have to issue contracts to extend beyond that period 7 and they felt it would be good use of Government money if they 8 continued to fund'the grantee should over ride contracts be 9 issued. 10 DR. PAHL: I was about to make a statement on that 11 when we got to Dr. Schreiner's question. we have a policy 12 which comes out of the DHEW decision hot to permit staff or 13 an RMP to Perpetuate itself beyond June '30 of 175. To merely state that all grantees regardless of what they wish to 14 do in terms of contract activities may not engage in that kindl 15 16 of situation which would Derpetuate the RMP or the staff beyon 17 June 30 of 175. They may contract with groups to carry out 18 activities past June 30 of '75, bu not in such a way to 19 perpetuate themselves, so if Nassau/Suffolk, and I don't know 20 the details of this, if Nassau/Suffolk or some other RIP has 21 funds in.,.it which, in effect, would continue to support staff 22 eyond that iooint in time, then I believe we would take 23 appropriate administrative action with our office of manage- tent because welrd applying a uniform rule in accord with 24 25 epartmental policy. I hope I have made that distinguishing 14 7 line rather clear. .MR. MILLIKEN: ne 2 I still go with the action of Ju 3 and the report of the committee unless there is new information 4 or evidence that shows reconsideration should be made. 5 Ms. SILSBEE: Would you state that motion again 6 and into the microphone so we can all hear it. 7 MR. MILLIKEN: I'move the committee recommendation 8 of a phase,--out award of $900,000 be awarded to this state. 9 MS. SILSBEE : A "phase out" award, do you want 10 that stated in the motion? 11 MR. MILLIKEN: Yes, I do. 12 MS. SILSBEE: Is there a second to that? 13 MR. KOMAROFF-. Point of clarification. Would you 14 resolve your ambivalence? 15 MR. MILLIKEN: I will remove from the motion the 16 phase out words, but Iwould like staff to be instructed 17 to have them understand that this $900,000 dollars is for the 18 purpose of helping conclude their efforts and tot continue 19 the program as they proposed. 20 DR. PAHL: I'm tot sure I'm going to clarify this 21 situation at all. I think we do understand that in all of 22 these recommendations, particularly where there has been some 1. 23 drastic cuts from requested levels and I'm sure more so in 24 the case of this region, that it will have a very serious 25 impact on their program development. I think it would be 14 8 really in error for us to characterize this more than some 2 others that we have been concerned with here as phase out 3 or terminated. I think we really should only accept the 4 motion for a funding level recognizing that probably what 5 you say will cause serious dislocation from what they had 6 anticipated. 7 MS. SILSBEE: Would you restate your motion. 8 MR. MIL LIKEII: 1 move that council accept the 9 committee recommendation to fund this agency at $900,000 10 dollars. 11 MS. SILSBEE: Is there a second? 12 MRS. MORGAN: Second. 13 MS. SILSBEE: The motion has been made and seconded 14 that the Nassau/Suffolk application be approved at the level 15 of $900,000. Is there further discussion? 16 DR. IIAMMOCK: I would like to ask a question about 17 32 family nurse practical and critical care nursing patient 18 family nurse, that comes to $150,000. Will somebody explain 19 that to me? 20 MR. STOLOV: Your addition is correct on that. 21 MS. SILSBEE: What do you want explained, Dr. 22 Wamm@ock? 23 DR. I-.7APU4OCK: Are they going to train practical 24 nurses or what?' 25 MS. SILBEE: We don't know if they're going to do 1 anything because they have had a request of $2 million. 2 Jerry, do you know the purpose? 3 MR. STOL-OV: They are separate projects. One is 4 the university base and the other is a community base. 5 one is nurse trained - nurse practioner and the other 6 is more of a socio emotional thing to train nurses in 7 giving support to families who have critical illnesses. 8 They are different projects. 9 MS. SILSBEE: The question is, where do they fall 10 on the priority list? 11 MR. STOLOV: I'll check that out on mv paoer 12 work. 13 DR. GRA14LICH: May I ask a question? it does not 14 relate to the subject at hand, but it does relate to the Nassat 15 question. In one of the other regions, we find that the 16 regional advisory group apparently worked very well and in 17 Nassau/Suffolk, they apparently did not. 18 S. SILSBEE: That has a long history. I think 19 they actually didn't have a combined board. There Hasa 20 combined grantee and we made them have a different regional I 21 advisory group and a different council. Thre was some overlao l'butthe combined grantee situation did not work out andthat was 20& 23 was about a year ago September or so. We had joint staffing @l 24 too, Dr. Gramlich. MR. STOLOV: I have on both projects my paperwork. 25 15 0 On both projects - family nurse practioner which was $142,000 2 project, it ranks number 11, which the critical care nursing 3 project, Number 16.-'. The dollars fall out,if they stick to 4 the original dollars submitted, $860,000 off of projects 5 1 through 10 and it stops at venereal disease. These 6 are well below the level again. 7 MS. SILSBEE: So'they would fall out. 8 MS. FLYNN: If I may just ask, does Project Number 9 29, fall out. 10 MR. STOLOV: Project 29 does not fall out. 11 MS. SILSBEE: That project--- 12 MS. FLYNN: They left their priority and spending 13 dollars the same? 14 MS. SILSBEE :Yes. There is a motion on.thd floor. 15 MR. STOLOV: Mt. Ogden raised the qu6stion, what waq 16 the title of the project. 17 It's a computer analysis of whether MS. FLYNN: 18 health educational materials.have been written by authors in 19 a leval that is readable by the health care consumer. $36,000i 20 dollars to have a computer anAlyze all health education 21 materials so it will be at the 4th grade reading level. 2 MS. SILSBEE: @@here's amotion on the floor to the 23 effect that the Nassau/Suffolk applications be approved at the!, 2,t level of $900,000 dollars. Is there further discussion? 25 (No response) 151 1 MS. SILSBEE: All in favor say "aye". 2 Opposed. 3 The motion is carried. 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 1 5 2 I,IcLane I ',IPS. SIL@-Bl@IE: l@Irs. Flood, wc,will convev your 2 concern for this complete documentation at what level health 3 education material,,;,need'to be prepared for consumability 4 capability,. 5 As this discussion went on before you finally 6 acted, there was reluctance, but in terms of the final actionl 7 ',,Iassau/Suffolk now has $900,000. lle will be glad to work 8 with them further on this. 9 10 11 12 13 14 15 16 i7 18 19 20 21 22 23 24 25 1 53 rm2 i SOUTII CAROLINA 2 T,IRS. qlLSBET: rilhe next application to be e the pr 3 reviewed is South Carolina, and Dr. liaber, you ar imarvi 4 reviewer. 5 DR. IIABITIR: I must confess 6 @-IRS. SILSBEE: Could vou talk into the microphone, 7 sir? 8 DR. HABER: I must confess to a larger degree of 9 confusion about this protocol than I felt on first reading 10 it. It seems to me that it is difficult to reconcile the 11 reviews that we had in June with those that are submitted now. 12 I wonder if staff could accommodate me to the extent of dis- 13 cussinq one of the major issues of the concerns that we had at our last meeting about the involvement of the Gbvernor's 14 15 office in the -TAP. Could that be briefl-I clarified now? 16 !,IRS. SILSBEE: Ilr. Van I-linkle? 17 l@. .1,IORGA@l: The Governor is going to resign tonight 18 MR. VAIL WINKLE: Dr. !.Ioslev has recent y sen us, 19 not a series, a whole bundle of correspondence, memos. He 20 has been in touch with these people. I don't think it has been resolved. Negotiations are going on. I am not sure 21 there is@any resolution in terms of getting them to agree 22 to agree. 23 14RS. SILSBEE: ilould you speak- into the microphone. 24 MR. VAN WI,.,II"LE: The region originally responded i 25 0 1 5 4 rm.j 1 very vehemently because they felt that the representatives I 2 of the c@overnor's commission had been a T)art of the -- both the technical review and the regional advisorv cTroun in 3 4 iihich the decision had been made, and there were none of 5 these difficulties raised, and they felt that the broject had had Drooer review, but we have been explained b,,, nhone, 6 the council's condition to k the consideration, but still 7 Q 8 felt there had,to be a resolution locally. That has not 9 yet occurred. 10 DR. IIABER: Wello, that is unfortunate, of course. Nonetheless I feel, and mv contention is that the funding 12 review that some of the reviewers have recommended for this I 13 is undulv harsh. I feel that this has been a good orogram. in the face of adversity they ha 0 14 ve tried t keeD i@ together. 15 They have replaced their losses with admirable fortitude. 16 I think that many of the projects are well constructed and 17 conceived. It seems to me we are criticizing them, or a 18 least some of the reviewers are criticizing them, for awide -19 varietyi apparently, of disorganized projects, and yet in thel 20 earlier criticism was that it tended to be too global And I not specific enough, so we are getting them both wavs, and 21 .I think this unfortunate. 22 23 Again, I feel that rqanv of the projects are well constructed. I feel that there is no point in our 24 perpetuating our own indecision or worse, contrary views, 25 rm4 1 towards them. I think thev have had the endorsement on 2 pages 104 and following the CIIP J"'IP annual review conference. 3 T thin): that they have; it seems to be indicated the ultimate! 4 phase-out of this bi modest extensions of some of these 5 activities, and I would suggest that instead of the t)rooosed 6 level, that they should be funded at a level of a million 7 dollars for the supplemental request that they have come in, 8 which is some $473,000 less than they have requested. 9 @IRS. SILSBEE: Dr. Komaroff? 10 DR. KO!,4AROFF: I think a series of T)rojects, 66 11 projects which are described here, can both be vaaue in 12 their individual description and'disconnected, without anv 13 kind of sIense of cohesiveness, and I well, that in fact is! 14 my feeling about reading this aTD-olication. "',e have aregion 15 that is a relatively small state in term of its population 16 which is alreadv funded at a level of two million dollars, 17 and I have kind of a qut feeling that their supplement ought 18 to be closer to $400,000 recommended bv committee than an 19 additional million dollars, bringing our level ub to three 20 m-llion 21 DR. 1',O?,IAROFF: I will summarize. As an example 22 of my edginess, I will tell you @.7h,,;, I am odav, Yesterdav 23 there was a question as to whether the PAG had set anv 24 riorities among these 66 projects. Ilow, in fact, there is p 25 a listing of priorities, but you will notice that the rankingi 1561 rm.5 I of the projects within each groun is in exdct ordinal 2 sequence to the numbers of the project. 1--@at I mean is 3 these projects .,7hich are rated one through 12 are projects 4 number 91, 2, 3, 4, 5, 0, 7,, etc. You have the feeling that I 5 unless the@7 numbered the -Drojects after thev set priorities, i 6 that this priority rating is simply a kind of -- a joke. They 7 just took blocks of projects in sequence as-thev appeared 8 in their numbering and gave them,'quotes, "prioritv rating." 9 That mav be unfair to the region, and the staff knows whether 10 this region numbers its projects after thev give them a 11 priority rating which would be auite unusual in mv experienced 12 then I would be mollified. 13 T .@II17KLF,: I doft't know when they number then@.1 14 @ly guess would be that that is one of the last orders of 15 business before they mail to us. I haven't been own to 16 South Carolina in recent months. Some of the other regions 17 when thev prepare those, they prepare them bv title only. 18 MRS. SILSBEE: They have their own local numbering 19 system, and then thev relate it to ours. 20 DR. KOI-4@T-ZOFF It may be nothing, but I had a feeling 21 ootlv connected, reading through this that it was kind of Q 22 over ambitious, in a region that was alread-,, quite well 23 funded for its size, and I would he reluctant to bring their 24 level up to three million. 25 MRS. SILSBEE: We don't have a motion on the floor. 1-@7 rm6 DR. l'OT4AROFF: Could I move five hundred thousand? 2 DR. ".'A!,UIOCK: I second that motion. 3 The motion has been made and 24RS. SILSBEE: 4 seconded that South Carolina application be approved at the 5 level of $500,000. 6 Is there further discussion? 7 (@io resoonse.) MRS. SILSBEE: All in favor? 9 VOICES: Aye. 10 MRS. SILSBEE: Opposed? (No resoonse.) 11 12 MRS. SILSBEE: The motion is carried. 13 14 15 16 17 18 19 20 21 22 23 24 25 TEV.AS rm7 2 !IRS. SILSBEE: If we go alphabetically, we come 0 3 to Texas. 4 MRS. FLOOD-. 1,7e are going to Texas? 5 MRS. SILSBEE: Mrs. Flood is going out of the room. 6 lias the Texas pink sheets, or white, been distri- 7 buted? 8 MRS. MORGA-N: No. 9 MRS. SILSBEE: Let's distribute them. 10 Off the record. 11 (Disdussion off the record.) 12 MRS. SILSBEE: On the record. 13 You will recall that the May application from the 14 Texas regional medical program included requests for funds i 15 for a series of contacts of which the idea,,; were spelled but 16 in the May application, but the specifics regarding who was 17 going to carry it out and what institution and the amount 18 for each contract was missing because that was going through 19 their local review process at the time that it was cToing 20 through the national review -process. 21 Council considered this application and decide 22 that in general the goals and objectives of the region and 23 the general management of the region seemed to be sufficient 1 24 to enable council to delegate to the review committee which 25 at that time had felt that it was going to meet in June or 1 5 9 rmB July, to delegate to the committee the authority to look at 2 the individual project proposals and recommend whether that 3 money should be released or not, so in effect council made 4 a recommendation of -- well, let's see if I can find it now. 5 "hey recommended that the Texas application be funded at the requested level of two million three 6 hundred and thirty 7 three, five hundred and fiftv-one, pending the satisfactory i, 8 review of the specific contract nronosals by the July review 9 committee. This was to enable Texas to go a-head because it 10 was a non-profit corporation that had ,-;anted to do their 11 thing in the 12 months, and thev didn't want to slow them I 12 down in that process. 13 The July committee was not able to meeti and they 14i had met in Atgust, which was yesterday, and they discussed. 15 the application. 16 pick up Now, Mrs. I-lorgan, I a,- going to let you 17 from there. 18 I-IRS. MORGA-,I: Our nink sheet that has now turned '19 white, the application for funding for the various contracts 20 of one million four hundred thousand dollars was what was 21 left over from our meeting in June. m@he review committee 22 recommended the use of one million dollars. The reviewers 23i were still apprehensive regarding the monitoring capabilities i - 24 we,have had, and I don't believe the review committee had this 25 information, and this is that they are going to activate their 16 0 rm9 1 review committee which will consist of on this Plus members 2 from the RAG. The concern of the revi-e%.i.committee was health professionals reviewing these projects. if you are familiar i 3 is practically all health professionals. 4 with the Texas RAG, it 5 About 95 percent of them are ohysici.ans on the RAG, and theseil 6 physicians are going to be the ones, and this is from the 7 material we have received,.T@iho will be on the review committee. 8 There is no question in my mind but that there will be health' I professionals reviewing these area contracts. They have 9 10 sent in their form, which is a six page form. It has to be 'filled out monthly on the various contracts and s nt in- will e 12 be reviewed by their committee. I havein my mind no doubt @13 that these will be reviewed bv health professionals, and I would like to move that the level from June meeting of 14 15 one million four hundred thousand be returned to the Texas 16 RMP. 17 MRS. SILSBEE: Dr.Schreiner? t 18 DR. SCHREINER: I am a little bit confused abou 19 the back and forth thing and the old grant. If you could 20 clarify that a little bit? In other words, are you -- I didn't hear the discussion yesterday on this Darti6ularone.- 1 21 'Ate they proposing any additional new money? 22 MRS. SILSBEE: ilo. Well,.they are. I was going 23 to ask Mrs. Morgan if she would mind rewording her motion. 1 24 We gave them an award for two million three hundred whatever 25 rml 0 it was, and we restricted 1.4 million dollars pending the 2 satisfactory review, so in a sense they can't spend that 3 1.4 million. 4 DR. SCIIPEIIIER: It is called internment. 5 MRS. SILSBEE: Internment for a reason. The action@ 6 of the committee yesterday would release one million dollars 7 of that. Another four hundred thousand, presumably, would 8 come back here, and they would not be allowed to spend it. 9 MRS. @IORGIU-1: I-lay I change my motion to state 10 that we released to Texas R-NIP one million four hundred 11 thousand dollars of impounded funds to them? 12 DR. PAHL: @,7e remove al!l restrictions. 13 MRS. IIORGA:14: In other words, restrictions are 14 rermved from Texas. '15 DR. Wpil-MOCK: The restricted finds is what you 16 meant, and not impounded. 17 MRS. MORGAII: Had this one million four hundred 18 thousand dollars been released in June to Texas, they were 19 not planning on coming in on this cycle four, anv money at 20 all. 21 DR. SCHREII@@vR: So this comes out of the 84, not 22 o ut of the 20. Thatis what I %,;anted. 23 I-ILPS. '.IlORG@il: It comes out of that money. 24 MRS. SILSBEE: The mbnev that has already been 25 a%-7a2!ded. 1 6 2 rml 1 1 DR. SCIIREI@CTER: I @.7ill second that motion. 2 MRS. SILSBEE: The notion has been made and secon,@'e@- 3 that the restrictions on the contract funds in the Texas 4 a-v7ard be lifted. Is there further discussion? 5 MR. HIPXOTO: Ouestion. 6 TIPS. SILSBEE All in favor, aYe. 7 VOICES: Ave. 8 MRS. SILSBEE: Opposed?. 9 (No response.) 10 MRS. SILSBEE: The motion is carried. 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 1 6 3 rml2 VIRGI@IIA 2 MRS. SILSBrr,,: we go to Virginia, and Dr. l@latkins. 3 DR. T/7ATKIIIS: I have no problem with Virginia. 4 This is Virginia, and Dr. Perez has changed the face of the 5 whole program. !.,@liss Martinez had a question. 6 7 MRS. SILSBEE: Miss Martinez MISS MARTINEZ: In thinking over the project 8 9 descriptions, I notice that a great manv of the projects are reallv supportive or extending grants to CHP's for 10 planning for the normal planning of CHP programs, which I 11 12 am not sure is terribly wise, even if it is legal. In any 13 case, I think the committee recommended nine sixty-three? MRS. MORGA@I: It is nine sixtv-three eight sixtv. 14 MISS P4ARTINE.7i: And I would like to reduce that 15 16 sum somewhat to seven-oh-seven seven fifty-nine. I just 17 went through the projects, and eliminating things like number 18 48 which is a grant to a ClfP agency for a MRS. SILSBEE: Miss Martinez, in terms of iyhat, o 19 y u 20 are recommending there, have you, are you aware, that a message was sent back to the regional medical Programs 21 concerning the need to do -- or to get geared up for health 22 resources planning and that this should be done in collaborated 23 24 with the CHP agencies? 25 MISS IIIARTINEZ: No. 1 6 4 rml3 I MRS. SILSBrl',: And this was a definite suggestion 2 that was given to the regional medical ;Dr'ogram back in I-larch 3 or April, sometime .'l'lke that. it 4 !IISS PIARTI'@IEZ: All right. It doesn seem to me 5 that anNi of their projects are terriblv innovative or foniardi 6 looking, but if that is with the IU4P 7 MRS. SILSBEE: No. If you don't thinkthe activities 8 themselves, that is fine, but as far as being legal, this is 9 something they have been sort of urged to do. 10 MISS MARTINEZ: All right. Are you satisfied? 11 DR. WATKINS: Yes. When we were on site, we were 12 very hard on them, and I feel that Perez has done a good ob 13 lin changing that program. Ile has changed the PAG, he has 14 increased the minority representation, minority input,.in the 15 urban areas, and I think I would like to see it remain as is.@ 16 MISS MARTINEZ: Okay. I will reaffirm the comLmitte64is 17 recommendation. 18 MRS. SILSBEE: lb there a second? 19 MRS. f-IORC-YAN: I am seconding. 20 MRS. SILSBEE: The motion has been made and seconded 21 that the committee recommendation on the Virginia application 22 to approve the application at the level of $963,860 be approved, 23 recommended. 24 Is there further discussion? 25 (No response.) rml 4 I-IRS. SILSBEE All in favor? 2 VOICES: Ave. 3 MRS. SILSBEE: ODposed? 4 (@io response.) 5 MRS. SILSBEE: The motion is carried. 6 7 8 9 10 11 13 14 15 16 17 18 19 20 21 22 23 24 25 IL 6 6 rrll5 1-7ESTEP-q PE@Z'@@SYLVAl,4IA TIRS. SILSBEE: Now we will go to Western Pennsyl- 2 vania. 3 MISS @.IARTI'.NEZ: In that case I would like to do 4 5 the very same thing on @,.Iestern Pennsylvania because the 6 number that I cameout with was about a hundred thousand 7 dollars less. I had subtracted number 49 from that, so it 8 comes out'nore or less the same. 9 MRS. SILSBEE: ',,,,Iould you move? Would vou put the 10 dollar in? 11 MISS IlAlrj.IIIEZ: Four hundred fifty thousand. 12 MRS. SILSBEE: Is there a second? MR. IIIPOTO: Second. 13 14 MRS. SILSBEE: The motion has been made and 15 seconded that the Western Pennsylvania application be approved 16 at the level of $450,000. Is there further discussion> 17 MRS. I-IORGAil: Question. 18 MRS. SILSBEE: All in favor? '19 VOICES: Aye. 20 MRS. SILSBEE: All opposed? 21 (No response MRS. SILSBEE: The motion is carried, and that 22 ends the review of the applications. 23 24 25 16 7 1 DR. GRA14LICII: May I open up one more small subject rml6 2 DR. PAHL: We have that as well-as Mr. Ogden's 3 resolution. 4 DR. GPM@ILICII: I mean relative to this project, 5 specifically ilississid Pi. 6 MRS. SILSBEE: Yes, sir? 7 DR. GRMILICII: There is a very strange request 8 and it is kind of the review committee didn't pay an 9 awful lot of attention to it, a two million dollar, roughly 10 tvio million dollar request for hypertension screening and 11 treatment program including one million dollars for salaries,! 12 and included in that salary scale was 82 public health nursesi 13 who presumably are already on deck, so that the RMP funds 14 d as far as I can determine from the grant.request e use 15 simply to supply what is now being spent bv the state health I 16 department. Included also is $500,000 plus or mints for 17 drugs for treatment of some possible 11,000 hypertensives. 18 lloxi, the review dommittee's attitude is, it is a poor state 19 and they have got lots of blacks and they need all of this, 20 but there was no Darticular attention paid to the construction 21 of the budget which included apparent substitution of MIP 22 salaries for what Are now state health department salaries. 23 That is one item. 24 The other item is, if the treatment to be applied 25 to the suspect hypertensive or to discover hypertensive which 1 6 8 rml7. is to be administered to the county health officer in each 2 counter,. Now, this poses a problem of practice of medicine, 3 Ls IS if you will, by r@ funds. If the council feels th' 4 appropriate, this is fine. All I want to do is bring it 5 to the council's attention to make sure it is considered 6 appropriate. This has to do with Mississippi only. 7 MRS. SILSBEE- I's there discussion on this uoint? 1 8 DR. KOIIAROFF: Can staff enlighten us as to whether 9 this will supplement the resources of the state health 10 department, or merely supplant them? MRS. SILSBEE: Mr. Van Winkle, there are two 12 issu es here, in case you couldn't hear. 13 MR. VAN WINKLE: I heard. I was trying to hide. 14 My answer is, no, I don't know. I read the application. 15 We did ask that thev include the full, when they sent in, 16 hot the center form 15. That is all vou 1"70uld have had. 17 I presume that Dr. Vaun looked at it, beinq the vtimary 18 reviewer. He aid not discuss that; however, as far as 19 practice of medicine, we have been in the habit of doing it 20 for years on demonstration projects. I do know that they 21 proposed to take these over and continue it after this first 1: 22 'year funding. The government has put already a line Out of 23 its budget to support it, but I do'not know if these nurses 24 are on bid, or if they intend to hire new ones. I just don't 25 know. 16 9 rml8 Dr. Komaroff? ,'4RS. SILSBI',I'@: 2 DR. KOI,IAROFF: I looked at that application 3 last night after our discussion, and I had the impression 4 that it was an unusually well documented request, but probable,, 5 what was going on was that P@IP money @,7as offsetting certain 6 expenditures that were Dart of the state department of public! 7 health this year, but that the quid pro quo was that the 8 government was going to take over the support of th e program, 9 in future years, and that that seemed to me a reasonable 10 bargain; consider the importance of this problem in that 11 state medically. 12 DR. GR2UILICH: T am satisfied. Thank you. 13 DR. PAHL: I have two items of business before 14 we adjourn. 15 16 17 18 19 20 21 22 23 24 25 1 70 rl"he first is that the action which ha,@' ',:)een ta'--on, made 1) y this C'oui-c-i.1 result a total- 2 --PCO.Mlrlpncled dollar I'c-vel of @,27,1-5@1,37,@' ,,7hich is @597,n@O-@ 3 c 4 above the total re om,,nendei to you D t 41) o4 t@ currc(: %,:it@l the Co.-@-@@-L'--tee s j,.e regions you con 5 recommendations five regions had some amount a@,deCi to t-e 6 committ6e's recommendations, and in t@.7o cases, \,,our recc-.-endati 7 were to reduce t.,'Le Committee's reconj-,enc-.at;-ons. 8 @Lhe second item of 1-usin-ess I T..-ould l@"-c to --o:-.e 9 back to, unless there is discussion on that !'Or,.arc 10 i,,,n!iT@poFr Does that mean @,.,e apprc@.,e less money than is available to spend? Ilo%,; does that affect 11 polic%, @,ye approved earlier today @bout prorating a kin,4" of 12 13 an extra supplement after the fact. D-TZ. PAT' in jus- fire! SI_a,te al- -nese I,,7e are 14 levels. ended the day verv harpil.v. action ,,c,-, 15 took this morning and the recommended @iollar le%7c! is 16 going to permit us to distribute all of non.,@es ana 17 depending on %-.-hat ll,apTDcns over the course of t,e :.alIL "e 18 T@,7ill be able to - with the formal order that you 19 be able to accommodate any chanae there. So, managerially everything is okay. 20 Dr. Janc,,-.?av? 21 7, J @,r I @,ias just checl:inc7 22 I' T, T- I am not so .'@,,cn you --r, s Lz- e s 23 are in such good shape. 24 @N7as checking my o,, t@ .-rn ma ..cmat@--S because I thought ..ze had added $-ilvl,.qOO, but it is suc- 2,5 171 a small amount of difference, onl,,, r3On,nOn. 2 D'Z. PZ-@'@TL: l@- is a difference, will 3 tal;-,- it Out Of F,-Iith's salary, or give it to '-,er. T,7e have one o' these fantastic data erratic 4 L i@ 5 aides on sale, or something, and there is voll@-aae fluctuation and durina one of i.@y afternoon telephone calls, I found 6 7 L"dith sitting poking these l@evs. At the same time, doing evervthino in lon-7 hand '--ecause with voltage fluctuation 8 you don't end with the same digits vou should. So, I think 9 we better go back to lead nencil and naper. 10 T gather the correct fiaure is @27,349,054. 11 Another one of the rumors. 12 T have received information, also, again, I don't know whether it is a rumor or not,but presumably it has 13 been announced out of the 'I-7'lite Fous,-- that, as ,,ou I,-no@-,,, there 14 announcement either at 9:',)O -- and no@,, some pec-le 15 say 8:30 - and Congressman @"ord is to undergo his inaugeration 16 at 6:00 p.ri.. toi-,orro@-7. I guess we ,,iill all learn as to 17 go to airports v@heti'ler this is rumor or direct. This was 18 given to me as a statement. .19 The other item of business which I think we are 20 on more firm ground ab out is to reconsider the resolution that @Ir. Ogden introduced, and which we tableO until hopefully 1 21 you had an opportunity to look over. 22 The su.---,iarv material pertinent to the resolution.1 23 I think @-,e have distributed this to each perso .-Ir. Ogden, n. 24 Perhaps, vou would lil-e to T-.ake some comments. 25 @-,TR. OCDNT: I hope that many of you have had an 1.7 2 opportunity to lool,. at the material headed "Summarv of the 'Tational Yealth Policv 1'31 annin(T and P,,esources Pcvelopment 2 Act of 1074." 3 Dr. l'omaroff, who is sittinc next to me here, 4 Ihas probably gone through it a little more carefully than 5 .many of you ana underlined the areas and I will call on 6 him just in a few moments for his comments. But., in ooincr 7 through this piece of legislation I found no place where I 8 could find an thin g that fitted the function of any existing y regional medical program, save perhaps some of the programs 9 10 which are in fractions of states, such as some of those perhaps in the State of 1'4'ew York. If the C@ovetnor of the state were to decide the 12 health service area, for example, @.,,as 1,Tassau/suffoik - perhaps 13 TIassau/Suffoll@ P@IP could become the health service systems 14 agency in that particular area. But, this particular piece 15 of legislation while it seems to encompass Hill@Button-almost 16 completely and you will find that comes un on PacTe 5 on the 17 description of the health resources development the only 18 place that I find M.IP perhaps even suggested is on Pag6 6 under Area Health Services Development Fund. 19 ,,,Tow, remember here we are talking about a health 20 system agency. T_,qoij, health system agency is a nonprofit 21 private operation on a local or area-@,,7ide basis. Buti this 22 is a health service area population of less than half a 23 million. It is not permitted. It ban be up to about two 24 million, as I recall air. ?,ubells comment yesterday. But,, it 25 would encompass-the health service area would encompass an'V 1 7 3 4 Istandard metropolitan statistical area,.-@l-l-,,ich is entirely 2 a boundry it --,-in cfo over state 14-nes, but there are 3 I understand, l@O's of S7'S.-@ s in the United 4 IFtates. So, that that %@7e are loo-incT a iier,@- is an area 5 1',I--altl-i services develOT)Ment fund is cToing to be a localized thing, and indeed -v,,e 'Lind k--'.-a-L. the crant that 6 can be made for the development ..iithin one of those on page i 7 2 - no single grant or contract inax,, e:.,ceed $75,000 be made 8 for more than ti,7o years. 9 It Simply talked a.-out t.-c area health services 10 lqbvelor@ment fund. This is %,,-hv.I have n-oposed this resolution 11 That this piece of legislation - it be suggested that this 12 be amended to give each state the stal@-,ator%, and financial 13 support to maintain a separate health -,?ste-is development laaencv on a state-v7ide basis. @o, -..a@- at least @@,e leave 14 something similiar to the 7.,',!'D's have toda-,,, wil-lo can Perez, 15 a state-iiide mission or function. 1,.nd, indeed, ijc could 16 even sav, goina beyond state 'in s. -ut@-, I susT3@ect the 17 kind of legislation ,ee are seeincT cci7i-g up here is going to 18 be limited to state boundries and -,at-'Lol-.al health insurance- '19 mav indeed have in it have some sort of state-wido function i 20 mechanism. OlUt4on and in it, the 21 So, I propose this res ilsecond ,-)art of it I have said, T.- - -@ -c-.--.,ents that proceeded 22 li-@ --resoltuion and the lution 4-=cl-' be transmitted to thei reso 23 members of the liouse Interstate an,@ l@oreign Commerce ComLmitteei 24 -- and by that I meant to encor,,cass the comments that Imade 25 in the letter from Senator I'l@agnuson to Senator Nennedy, @-,-hich1 17 4 5 I read to you earlier-and which s'A iotild an lDear in the transcrin,@ 2 o'L the minutes of this mecti.ncT. I can give you that letter 3 if you @..,ould 1;-r-.c to r.ero-x it. I Gould lil-e to have it back. 4 Dut, I t,,ill be happ -.y to hand it to you. 5 I do recommend that we do this. I am quite concerned that the kind of legislation that we see coming 6 out simplv does not recognize the place that regional medical 7 proarams have come to serve on the @erican scene. And, 8 certainly many of us who worked with this program since its 9 enception eight years ago this Spring feel that it has accompl.4s 10 far more than it has been given credit for and that it has 11 the potential to accomplish a qreat deal that is q6i-ngto 12 bb necessary in order to make national health legislation 13 function ,7hen it begins to deal with the verv complicated undertaking O@4 the delivery of services and the deliverv o I f 14 care. 15 And it seems to me that unless the providers of 16 !this Nation are given an opportunity to make their in put 17 1 through something like P,-,IP, that the success of national 18 health insurance is Jeopardized and I hope that we are going 19 to be able to have the continuation of somethinglike the 20 regional medical programs 21 DR. PA!zL-. Thank you, vcrv much I P-1r. Ogden. 22 There @.7as a motion introduced and seconded, I think nossibly.. 23 DR. Second. 24 DR. PAITL: Thank youi Dr. 't,@lammoc 25 I think there should be room for discussion by 17 5 Council on this important topic. 2 Dr. l,,o-,Aaro'lcf? 3 AFF As I look through this, the Bi O'@AR 11, 4 the thing that concerns me is that all of the various aaencies which would he created bv the Bill seem to relate 5 to planning and to the monitoring of facility expansion 6 within Ithe region. That there is no sense or very little 7 language that would relate to what you might think of -as 8 anoperational arm of such an aacncy or group of agencies 9 to actually do demonstration projects in health services. 10 And, the funds that are alluded to 314a and b funds, I 11 believe, are by title 9, Planning Funds. Not operational 12 funds. 13 So, as I understand your motion'Bob -- I am unclear about your first -- the first component of it. Do 14 you-mean that this operational agency would be independent 15 of the agencies proposed in this Bill. 16 "-IR. O('@DETT: Yes, I do. 17 DR. @vO@iP@ROFF: That is reall.y the nub of the 18 question. 1-7ho reports to who? I believe that there ought 19 to be a separate and clearly defined and funded operational 20 Arm that looks like rl,!P. I am bothered, though, at the 21 prospect of having that agency wholly separate from the leadership, or whatever, supervision of the planning agencies.j 22 I ',Vill vi6ld to you. 23 DR. JA@,'T',I,@7AY: 30 seconds? 24 DR. 1,7jv@,IOCK: 30 seconds of my time. 25 O@R. PAIIL: Dr. Janev?ay. 7 DR. JA,1,71'1-7AY: I would sunport, quite frankly, the I§eparation of the planning function, particularly the 3 strategic nlanning function, to use a managerial term, which 4 is im7Dlicd by the summary of the legislation proposed 5 ile islation. 9 I thin!, that to have planning and control - when 6 I say operational control the implementation mode of 7 any kind of management function in the same agency is courting 8 disaster and, although, I -v7OUld agree with you, Tony, that 9 there has to be a responsive inter-relationship, that there 10 is so much to be oained by having the planning function separate from the implementation function. That, I would 12 certainly be Prepared to support a resolution of this nature. 13 DP,. YO'.!'-..rZOFF: ',,7hv do you feel it would be courting disaster. Are ,7ou thinking back to e-,,T)erience between 14 and Ci"@P? 15 DP,. JA" ET-.7,t@Y: rO. I am thinking in terms of the 16 management function and there is room for disagreement in thisi 17 but if vou read L@,nthony's book oh Planninq Control Systems, 18 the possibility of the planner becoming so involved in the 19 plans that the implementation becomes impossible, or that 20 there is no outside regulation of it. It uts too much. p 21 power in one place. there are admit4@-cdly some managers who disaar6el 22 with that and sav the planning control ought to be in the 23 same agency, If you set planning or isolate it you develop 24 thin]-, tanks that don't,clrain anywhere. 25 But, if you put planning and control in the same 1 7 7 aacncy, you go to the opposite ex,-remE,- @@,here vou thin], that 2 @D@, creating an infinite niiL-ibc-r of i.,ivstacks @,:ill give- you 3 an infinite supply 'o'f ncej!cs. 4 s @,,o-l @.,avs, but the for TIT>. KOP'Ai@OFF: It cut 5 the reason iou just cited, it se@-'s to me that the providers would more likely be attracted to these kinds of o'Lanning 6 agencies, and therefore, -the doing of- reasonable planning. 7 If there were some - or more tangible operational components 8 that they could be involved with. 9 1 think one of the problems i-7ith CHP has been that 10 the T3roviders have found it unattractive because it was 11 so abstract and so unrelated to subsequent tangible accomt)iisnt 12 ments and if there could be some iLnitinci of this OT3erational 13 arm,and the planning arm, so that ..i,',at the operational arm was doing didn't in fact thv,latt the rational plans of the 14 region, then it would seem to me to r,.akemore sense. 15 DR. JA-@7,ETo7AY: T,,-,hat I @-7as trying tC indicate is 16 that I would hope that the planning -Function would not thi-7art 17 the normal-operational arm. 18 MR. OC-,DEi@i: I think that this, perhaps, could be 19 corrected by having the development component also report 20 to the state health planning and development acencv, which is 21 assumed to exist under this piece of legislation. It has to come into being. --@ut the legislation just simply doesn't 22 spell out sufficiently how that development is going to tA'@,e 23 place, except for these very local agencies. And, I would 24 like to see drafted into this piece of legislation the 25 provision that there be a separate health systems development 17 8 agency .,7ithin the state health nlannina development aaency 2 structure. 3 llu+- it would rep L)P,. l,'O'4A,@OFF: ort to the state 4 health planning aqenc,,7. I @,,ould support that. 5 .,,R. PGD@-17: Idon't see how it could do otherwise. 6 I don't think it would report to a central body in !,,7ashinaton, D. C. It would have to be on a state level. 7 8 DR. I have been somewhat disturbed since I have had the privilege and the opportunity to serve on 9 this council, and in particularly in fact seeing the ministries 10 fractured or other number of states or group, region - what 11 ever you want - try to plan a health. program. It see@-s @o 12 ,me to be a rather difficult situation to put two or @-',-ree 13 states on the 1,7estern side or the Eastern side together to 14 wed -them, in the @,'ilorth and @-outh - to wed them, in o-.e 15 program. 16 I don't see how this is possible to develop any 17 worthwhile health svstem care delivery, or whatever you want to call it, unless you have it on a state-wide basis and 18 you have all the components of all the agencies that are invol e 19 a system.@iorking .. toqether4 Because if YOU in this kind of 20 are going to put it in one community or another community, 21 or 15 different projects, unless it comes under one tells, 22 they are going to ',-,e in difficulty. I I)as-c this on ..!-at 23 little hit that I know about the operation of the regional 24 medical program, and from the standpoint of a state-@-,-ide operation that something has come out of this. But, if 25 1 7 9 1 0 it gets dissolved -- and I haven't read this -- and if T 2 read it i am qui4k--e sure I -.!ouldq't l@-,no@@., what Ircaalna. 3 ray '!iave to read it '*-aciz the third or the .fourth time 4 or the fiftli time, and -,nay not kno@,,7 what I @,!as rcaa-ina. 5 oi,,,,i T)ersoTial feelin(7 is that I am -Iro'-,abl-,, too close to the trees to see the forest, or the forest to see 6 the trees. Or i..,@hatever you call it. rorest-trees, trees- 7 Lorest. !,ITZ. OGDE',':.7: Woods. 9 DR. I,.7:LVUIOCIT,": I think that, as @ir. Ogden has 10 pointed out and someone else, that people don't knovi about 11 the good that the i@l"P has done and I think it is TDretty 12 hard to get across to people @,lhat'@7,"P is and I am sure 13 that there are a lot of -nil-,7si.cians that do not unc:ers'@-@-@-id the operation and the mechanism o--F S---e o-- 14 them feel that it has not been Worthwhile but I Personally 15 feel that it has been worth@,71)ile and I think this resolution 16 ,here drawn up !--)y 'Ir. Ogden. I ,,,ant to conqratu'Late him 17 for the foresight and the merit and the courage and the 18 good common sense and judgment to draw this up and I tlin': 19 we need to support this resolution and somehow or another 20 get it across. effective it 1.7ill as far as Concress is 21 -concerne(,', I r@'on't 22 23 I:., there further discus-lion or 4 1 @iA ,F: --e to add scm anguaae T< (7 @@ DR. @,OT' I v7ould lill 24 that makes it clear that this health systems development 25 agency will Support demonstration health services T)rojec@@s. 180 n I don't tilin-- @hit health services is written i 2 Iam not sure 1,- is quit 4 c clear how this agency would be 3 Idifferent from the planning agencies that are in the current 4 tate that this '-)ill, and se--ondly, I tliinlz we ought to s 5 separate agency would report to the state health plannina 6 and development agency that is described in the Bill. 7 DR.,-J-,@l@IM-7AY: Would you read it to us? 8 DR. KOI-IAROFF: Read the proposed language? I haven't written it yet, but I will. 9 How would this be: "'.resolved: That the Congress in adopting HR 16204 or similar legislation give to each 10I 11 he statutory and financial support to maintain a state t .12 separate health systems development agency which supports 13 demonstration projects and health services, This agency 14 would report to the state health planning and development agency, or siImilar independent I am sorry agency 15 and be devoted exclusively to such work. And be it further 16 resolved. 17 DRo WAZLt-,IOCK: Dr. Komaroff, I am sorry,, but you 18 tting too wordy there. l@7e are going to get lost are ge 19 because I think the first sentence-what you say - the health 20 systems development agency on a state-wide basis -- and I 21 think health systems development aqency is very comprehensive., TO me it is. 22 DR. IIADER: Ilight I suggest Health system development 23 and, demonst ration agency. 24 I'lP,. OGDEN: On astate-wide basis for similar 25 2 independent commissions in a publicly accountable i,7ay 2 in reporting to the state health and development agencv 3 iand devoted exclusively to such work. DR. 7@'O@,!Ar-,OFP All right. 4 DR. T@ili-ii;IOCK: I yield. 5 DR. P,@-ITI,: I-lay we have the final @vording before 6 we have the question? 7 @'IR. OGDEi@,,: The ;.7av that I have this drafted at the moment reads "Resolved: That the Congress"in adopting 1 9 IIR 16204 or dmilarlecjislati-on g-ve to each state the statutori@; 10 and financial support to maintain a separate health systems 11 development and demonstration agency on a state-@,7ide 12 basis, or similar independent c onmission appointed in a 13 publicly accountable way, reporting to the state health accounting and development agency and devoted exclusivel,,, 14 to such work, and be it further, Resolved: @@hat the 15 comments preceding this resolution and the resolution 16 itself be transmitted to the members of the House Inters@-Fte 17 and Foreign Com@merce Comtmittee and the Senate Labor 18 and Public Welfare Committee for their consideration. 19 DR. PAHL: rLhan'jr, you. 20 DR. IIP@@-T.!nCK: Tir. Ogden, for clarification. Accountable i-.,av anct reporting? 21 7 P. .OGD.@@@- Y. APT.Dointed in a publicly am sorr 22 accountable @,7ay. That has to do @.7ith 23 T 4?"rOCK. DR. -i:,VL i But you put another word in there. 24 i'tR. OGDE,@,! We inserted the words "reporting to 25 the state health and planning agency." I- 3 @..,as Tony's -Point, that separate health 2 systems development has to report to somebody. @,Te are going to have ;it rt,31)ort to the state health planning A: 4 ;)R. T,-@'Ouldn't that be under state, or not? 5 0(7,D;-,N: @@Tell, I c,;on't think that' this damages the sense of what I am tryin- to accomplish. 6 @Lr. Chairman. 7 D-;-\.. PAIII, -Yo-s, ;'Irs. l@lein. 8 YLEIi"j': This reporting bothers-- me as to whether 9 i.L- should be to the a4encl7 or,as in Idaho, the planning 10 groups report to the Governor, who is responsible for admiiis- 11 tration of all programs. And, that would keep it on the 12 state -- As I understand it, the rpurpose of that insertion is to keep it on a state-wide basisi rather than reporting 13 to any federal agency, 'or example. So, I %.,.,-ould lil@.e to see 14 it made more general, rather than a specific title, because 15 some states don't have that type of agency, or one that is 16 IIL-itled that way. 17 1',OR(.'@A@7: -,hey will ",'lave this Bill. 18 rAR. OGDEN: Under this Bill, they will have to. 19 at do you moan DP. (7P-ld.',-LICH: in the resolve, @,7h 20 by, "in the comments ,oreceding.this resolution?" as the letter from Sen or 21 n(7 E@7 rrh i s gnuson. a 22 r,'R. PATTL: Ts --hcre furtlier discussion by Counsel? 23 S Question. 24 T 0(7,T,)E'-:': .@Tait just a moment. On the matter 25 of information. Tony and I have decided that this should be 1 8 3 health coorclinatinc, counc reporting to t-e state----, 2 cc,?, e tha4- hav,@ tl-ic JC) mom,!)-r3rs. 'Have -liosc are the r, 3 he @,iron(7 rroi-in to report to. e health 4 T,-e are (-,oincT to report to the state7v7id 5 coordinating council. it? @6 is cvcry.-Iodv terribly confused? Can we vote on Di?. PAFL: @-7itla that change, namelyo, the state-wide 7 health coordinating council. T@iith no f rther di u scussion, 8 would ask the question - all in favor ofthe resolution as 9 I it ,last amended, please say aye. 10 VrjICES: Ave. 11 DR. PAHL: onposed? 12 (,T!o res,2onse.) 13 D,2,. PAITT, - '"Lhe motion is carried. In closing, I @7ould life to tliani- I.Irs. Silsby 14 15 and the staff verv much for again going through an unusually 16 difficult Period and specifically say that I am hot quite certain under flat circumstances this council -- @-Te may or 17 may not meet aaain. 1-@le have not set a future meeting date. 18 I would, hoiTever, like to thank you individually and collective'. 19 as a council for vour guidance and support throughout a 20 rather di .fficult Period, and not this particular review 21 cycle. Since i.!e are uncertain what does face us, I want i-you to understand that terms of appointment continue until 22 such time as we inform you otherwise because of the passage 23 of legislation or other unforeseen circumstances. 24 But, I do loo'r', forward, as I know the Staff does 25 to working with vou again in some way as we enter into 1 8 4 lour ne%.7 error. 2 Unless there are furti-icr comments, I then 3 adjourn this T-,eet,-nd. 4 Than!,: you. T-7hereupon, at 3:15 the meeting was adjourned.)i 5 6 7 8 9 10 12 13 14 15 16 17 18 19 20 21 22 23 24 25