0 C 0 "I T E N T S opening by Dr. Pahl 2 Remarks bv !lr. C. Robert Ogden Ogden Resolution 10 4 5 '!embers of the@ Public: Comments of Dr. Donald Sparkman 1,3' 6ii Response of Dr. Richard Janeway to Remarks of 7 Dr.,Sparkman- 20 8 '3 6 9 Arthritis Report of N4r. !@latthew Spear 10 Comments by I-lembers'of'the Public: 11 Mr. John Serqeant (Maryland) 48 5-7 Dr. La%vrence Scherr (ilassau-Suffolk) 12 13 review of Applications for Regional Medical Programs: Alabama (Plrs. Gordon) 72 14 15 Albany- (Dr..-Watkins) 74 16 Arkansas (Dr. @Kornarof f,) -79 17 Bi-State (Dr. Watkins)- 8,3 18 California (Dr., Janeway) 90 Central New:York (Mrs. I-lartinez) 102 19 Central Wyoming (Mrs. Martinez) 106 20 21 !3!ock Action .115 Arizona (Dr. Gramlich) 120 22 Connecticut (@ir. Hiroto)@ 122 23 Inter-Mountain (Dr. Komaroff) 128 24 25 Louisiana (Dr. Janeway) 132 1 Contents (Continued) 2 Maryland (Dr. 1,7ammock) 139 3 @lassau-Suffolk (Mr. Milliken) 14 2 4 South Carolina (Mr. Haber) 152 5 Texas (Mrs. Morgan) 1:') 3 6 Virginia (Mr. Hiroto) 163 7 northern Pennsylvania (Mrs. Martinez) i66 8 9 10 12 13 14 15 16 17 18 19 20 21 22 23 24 25 ID 0 I', T 1,T I- T i- T 7' I A D T, A T- 1 r 117',Tl( '.'7kT, @@',7Tc(@py T Con@erei,t--e POOM (,-17 Lane ""aj'vl,-ind 20P,@)2 "hurscfa@:, Puqust 8, 1974. The r7eeting convened at 9:1,@ arm., Dr. I!crhert P. Acl;-_incr D3.rcctor, Di-%7ision o-@- a I i. a 1 P r,@ cl r a T-,. s , c t i i, cT T) c-,,- r c-% c f7@PAF J. SII,SBEF, Acti-ra Cl-ir-f OT-eraticins and DP@IP, I'FN@,,ETTT r;%U!-', Fi@e-cuti.@,e Szecre+--ary. EDITIT l@l. YLFII@L, Pr)ise, Ica"io. DR. ITOI@ WA@@MOCY, La C-rance, Georaia. E. @LOOD, !'I Paso, Texas. SFI,,7ALL 0. Ol,.j.o. Jo!:T".T P. C,.(,-,.,c.,nnc- P. S,('T'RIT71"T P., ncrton, P. lic@@r Yorl-. C 11 I:'T, @lII @,,,@ic@hi.ncTton. T3oFton, !,@asFacliusetts. T 0 Li Carolina. ('@'1,7A R. CNRDOII, Creat Beiid, Fansas. T@r Cal-if orrii-r-i. T@, C. IiIr.,OrPO, -)F, Angeleq , I.IARTEL S. T@IORGA,@l, All)uc-tuercfilci, !,Im@,7 @le@,j-c!r,). A.nd Others. I T-@e@--tinc lease c,,oT-.e to orL',cr? T, no,.;7 -i in, @tl,,c head table, and I think ..e are proceed with this r,,-i@eti.ng of tl-le !National Advisory w,2 can Council. ijost of ;,ou were here yesterday for the meeting of 6 the ad hoc PIIP review Committee, but I do wish to @q-21come to 7 the table ',irs. Gordon, and Dr. Ilabor, and @'Ir. i are very pleased that you can re-arrange your summer schedules 9 and be here with us. 10 As you know, this will be, or is expected to be, the i@ final meeting of the.National Advisory Committee, called to disperse the remaining fiscal 73 funds, which have been release@, 13 as a result of the court or(fer. All of the 1974 fiscal fund@-': 14 i' were obligated prior to the close of the fiscal year, June 3,0@l,L. 15 16 And as of this state, we have approximately 28 to 30 4 -on dollars for mal,-lng our aviards following this August 17 Council meeting. ',:low,, we will be discussing more of that in a few minutes, because we had a rather lengthy open session 20 yesterday. And -,any of'the topics were discussed with both the Council members sitting as observers, and the review com- !IP-Fitate to go over all of the ma4.- --rial again, @-id perhaps it Tight be better as we oo into the closed session to 24 taken up some specific noints. If there are qu-3stions that bear 25 on the po2.nts we discussed yestc--day, but I s'lould makT-. (,)n.@, of ici@,,ll@, for nc-fit o.@L the thrc-c- who coulc-l is iinIDortant for, not S !)CC E IU@; the day'.,i l'irst rllb 1 e O..i(l, ,,nake a and go over the current @;tE,,tus of tli@ legislation, 6 and we did provide,, I believe, a hand-out, did we not, Gerry,l 7 yesterday? 8 BAUM: Yc-.s 9 DR. @-,7AMMOCK: Ilo. 10 Dil@. P2\IIL: @,lell, it was intenO@d to give a '@iand-out 11 out. Can we make sure that we set those now, toCaly. 12 @-IR. 3AUPI: All right. 13 DR. PAIIL: X@7hich summarizes the basic elements of the Iiouse bill that has been @-CT)orted out by the full com 14 mittce 15 I won't go into all of that now. Because, really, I believe I 16 that we still have mny steps to go before we have legislation 17 and by giving you our summary statement, I believe, you will 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 we full' 20 anticipate that the local regional medical nrocra..@- together 1 .iitli these Cli'P agencies and experimental. !,-rplth s 2 SYSL@ems, and 1,Iill-Burton organizations will be given the proper 23 li opportunity to becomc incorporated into the proposed orcianiza 4 tioris. 25 -ainl,,,, in an\ war c -@d no@ c tho@,e of 7ou to i@,@rpc-tiia4L--c@ 2 ---ion closc-1, @i..Il certainl@, bee- le c7,- anp-eciate, tl"-. 4 .ye have cc)-,Dies t,,c floor bill we will try 6 to -,et them out to you, i do believe that it will be faily close tc) what may be Passed. And of course, the time 7 table for enactment of legislation is unknown for good and SU'Lficicnt reasons. 11 But it be Passed later this fall. 10 l'IR. 1311,P,@tDWS: You ha%,,e just c,,iven me a note sayincT the suTrj.@,a.ry of ",,Dii'L is attac;ied to t-@e Council agenda. 12 c- i -n, sta@:)led. -3 It s 13 DR. PPIIL: Oh, I thou,--t it @@l,as a seperate hand-out., 14 5 I see it. It's @-.ie next to t' e last item. There is a @@Tatio.-ia-@ Council for Pol.icv c do not know at this time what relationshi,.') such council will have 17 i with this council, or to the ol--@er legislatively mandated councils, of the constituent procrra,7,s. OCDE'@ 1-ilould it h)2 a--D--onriate for me to s,@ak to 3. - a-.ion at thi s 21 P,,.",,L: Yes, I bcli-e%,o it ould be a goc,,C, im-@@. 22 0 r) F",L I r c- v 3- C.,@ ., l' n c@ Pubel's summary yesterdE,.,,., and in think-@@lc,- bout tie matter overnight, while I have not 241 t lia.c7, an opportunity to read -t"-'ie sur,-,rary fully it is here. that Ili? '1620@,,, @!e !-aware a d has played in tile to i@,no.-cc- a s c r seems ronment in recent y@@ d lil'-Ic-. to crivi session, thei rc ad s council and to those r)@ -it at t@ open s@i.,,sion a letter from c-natot @l.agnusen who is chairman 5 i I of tile -F@@.)coTrmitt---ce on Labor, llc-al,.th, education and @,7-alfare, 6 addressed to 7 Senator 1,-c-nned@,7. And I am quoting. Dear Senator Kenned@y. It has i been reported to me that th,@ proposed legislative revision of t,,ie Pul)lic health Service Act in ef@'ect eliminates the Reuion,-:,.-i 10 Programs. And w tha oulc?@ ,Iivert the aopropriation t has been used -,'or purposes, to local I,,lanning agencies, as 12 ii 11 the present pro7 osz,,I. Planning agencies would then be expected to develop 14 services in --he same rtanner that I-Id@iP has been doing in recent 15 y,,2ars. I am somewhat conc3rned whotner planning agencies are -he al,3 to be eng 4@ .-Propriate bodies age(i in the &cvelooment of 17 services. 18 I From my ncc- with -@,7ashincTton-Alaska Regiora 'ledical rrograT. it seems to Tqo that tile dc-vc-lo-,.)i-,an,@- of services ii-in this domplicated undertaking tl-i@-@ si-lills of -,,)e@rsons 4 c. 1 Y, -,p @-; r i c, n c c d@n o."' c@@r:a, and contract -)iannincT )ends almost entirely on the determination of health care needs 24 By an agenc,", @;taf,,- can at-@cm@. t to i,,iatcli a] Ocinand for @,erv It scarrs that few if z4,, i,, 1 1i-i n i.-i g :i c@ n c,sL,7@Ve 3 a br(- @,@7,cctriiiii cj--@ -ence i 4 for thc,, actual cr,-lati,@. services. r does 5 il it see r, m Practical for the F)IaiinincT agencies to do so, s4 ce 6 it would create an unnecessarily lar c- and cum!.)c-.rs rganiza- 7 tion. I would think that a plann-iig board should be caoable 11 of expressing the communities will an(, the board of a develop@; 10 able of mal-,itig sound tac, !I rient agency should be cap t C. g- inical -u ments about the best way to develop scrv)-ces at level to meet the needs outlined by the -r)lannir,.c, raqc-ncy. 13 These are two distinct a c t v i L-. is @,,,h i c-, r@- v. r e t@f, e involvement of boards and staff with tl-ioir efforts and different skills. This is the v,,ay the successful r@@ip sued as the ',i', 16 RT,IP are now @@,orking. I am concerned that if we atteml-)L- to thrt)rv 17 both activities into the @tructur@o, one of the activities!' 18 d it may @4ill suffer, an vc-,r@l well be the quality of the service., 19 developed in the function. he me cl I s cli oo 1 facult@!, the medical specialists 21@ the medical admin' ators :irc inter- 22 ested in -the way care is delivered at the patient level 23 I withdraw or not be if both functions are assiq-rc-, 24 to a'planning agency. 25 for a carc- p r! 7@, ai, n, @3 c-) n a 1hr@ i.,-, 'Li r a ii c,-@ the talents o@ 4 has t cl, C- s of those MO :D 5 St a!-', oi: all 6 Z;if2:,Ir record for c-,ai-ii",Ig the coo@r@ra.t@-"-on iT-,,rcvina the ci,,Iality a.nd access4L 4- 7 of the delivery syt(- and ',iea 8 of care is unequaled amoncT the ru!D!,Lc lth service Act pro It does not -,eem reascna 17 9 drams. ble to assume tlat the ca,-)a!Di',L- 10 1 il ities R@IP organizations are developing are trans--Ferrable to 1 1 other organizations, especially -,,,:here the -ieiq organizations 12 have few of the ta'L--nt --ssors org@krii 13 Certainly I recoan.-"Lza ali-1 zai@-ions 14 lil-,c- olann4..ng aaenci es and ol--@ vc-. not ',-@-,en 15 uniformly successful tliroucThout nation. But anv lack o@ f 16 e attribut@olc to laci of consistent leaders--iTD success is mor 17 direction at the fc:O'c-.,:ral t,ian it is fault of the 18 1 anDroach. 19 And undoubtedly arc doing to need to make SOMP- 20 effort sometime in ,-.he develo,@-,-.en@- of healtl-i care resources. y a s c, d t o a c,, c- n c i. e s c) c- y iD c r n(a -2 @-@@a@ht r@d to on-,, strt@,'I(7tlien-@d ir, sr-)Iille 0 24 But in ii-@ r o nt the bes- means of increasing (juali-ty and accc,@,@7,i-L)-i@lity o@L ccire for! 2 the average ci.@-3'.zcnl. t'ic- 3 In egisla-tion 4 will be able to rct, both the ccnsur@ier ond proviOer i@ak the health sy!7,teri .,-or,-, -r- o;Dcrly. relationships needeu. e 6 There should be some wav the new legislation can i7i @ir-e the 7 cont-,i-nuation of healt'i sc-rvice,3, development agencies si7@,il-ar 8 to ,ir i@- in structure and experience-, thereby not dissipate the 9 national resources that we have Cic@veloped. It might well be advantageous if the new i-ec7islatl-4-o-i' were to establish a formal mechanism to assure that t@-)e -efL@o:-ts it,, of the planning agencic---, -Lnd ti-i@ r-..'.!P arc.,coordinatc-(I, i.@ 11 that P,,"--P's are in fact Oevel6ping delivery s-,r Zstems to 7-@e-t 14 the healtli needs identified by t@le- -)lann,-nq and suc-' 15 mechanisms could certainly bebe established without sr--ro,-,@,ing 16 the present programs. 7 Creating entirely new bureaucratic structures in 13 future, and in the process, using what would re-main nave achieved for existing I@.IP systems, such as the I-lashiiigton- e@iias,,-.a program have been highly successful. Thank you for your c,,c)nsiderat-i on. C. -(7,iiusen. I V70ii)-d to @.,i.iggest thvt. it is the :-@@-nse 23 of this Council thE,,t llr,, l@204 as Ili-,-iLv!z l@icard it 24 dequa-te as it is now drafted. In that it fails to rc@!cog-! 2,5 is i n,,-i niz@ sufficiently ti-L@-,- 0 1 d 1. 0T-i n t c@ c) 2: liiiii@-(.@d to 7 f f 0 I.- 3 ,,,n d --iiii a s+,at@A to bc! h i c of th@, 'Local lic,@Iltli s@.rviCc area 5 ir, the c,,-., c c wi--thi,-i a state @,vhic-, @jc)v@,-rno.L- 6 7 75,000 a yraar t,,,, 8 @,d -ils p is gros y -a:r- r a T) r o -, @, c @ -, mit fc) sly in,nC@-cuate in our c-x@er- a v ot tc -a c," or ay)i-)Jicaticns. ',herorLt) 3-- c- ',Ioul(:' li'll-,e to a 12 these ].4Lresi 4 i a -L- in acio,@:)tixig .3 4 inanci. a-,- sirtilar legislat4 eF-,c'i c @tatut,@,, ai 4 15 al support to -1@ainta4@nahealth on a s'-,ats-%qi6e or i-ndc,,-,De.-i,@lent (:c;i-,,missj-c)n 17 11 i.n a p-Labli---Iy P@rd devoted to 18 work, and be it furl.-l.,,i,-a-- that t.,-Ie corrnent.:@-@ T-)rece-od.i-ng 19 this resolution, cind @-esc)lu@-@ion itself I)e trE,,-ismitted to @o 1 the of the IntcrctE",.- a,-,d Fo.-eign Con@merce Tpit4-Ce, and the Sc!nr,,t@-, atid Pi:@l;)lic cc)mm- 21 ittee @o- @"thcir consj.(ic--.,@-ati-on. DP. PP@TIL: ,,,-@U "@r. Ocrden. 'k r,.,ioti-on has 23 0 U-"4 on. is t'@ m@,d@,.@, to he,@i,,a 4 a sc-@i-bnO, to 25 c- o r,d i e s- c- u sc n DR 0(7,(I(-,n, would you rr@ael thal- r-c:- please. 5 O(':D-N: Bc- it resolved that t'-,.c Conciress in 6 ii ador)'-ing IIR 16204 or similar legislation qi a-"e the L ve each s@- 7 statutory and financial support to maintain a separate h@-alt'- 3 systems development agency on a state-,,,iide basis or 9 confession appointed in a publicly n-ccoun-L-ablE@; i,7ay a.,id e 10 exclusively to such %qorl,,. And be it further resolved that -L"I,,e comments pre- cc-ed-',-,-.g this resolution, and thc-, resolution itself be tr@-ns- mitt-c-d to the members of IJOUSC- Tntersta%@.e and Forc-liarA CC-.- mierce Committee, and the Senate Labor and Pi-,blic li7e]-fa,--e 'I Committee for their consi(-,,cration. DR. PAIIL: Discussion? Dr. Schreiner? D S C 11 PE I'-"@ l@ IZ: Y r@, s .I just wanted to ask a quc-s@-i-c-. 18 You would favor the dissolution of the regional process? l@4R. OGDEN: Yps, I are. T,@ecause I think this piece of legislation is directed to@,7ard the state-@@ide activitv. 1 Droarans flo-- "cognize that many of our regici-.,al and r.@-ted4- state boundaries L@ut @r-- to have @in incapsulatc@e, )rogram which is state !)oui,-ir3ary oriented, it seems to me that we can accomodate to that through our ekisting RJIIP'S. DR. WAL@ILIOCK: Your point was a specific statement b-z 25 a t -i r i- i.,@ o f 1 z@,a 01"DE": Yes, L j-n ca,--4 c,,ala:r Of legislation D R Y' 0 C.,,' 4 'Because the Pi',P as vie have b@-en !co':-,ing a4- them doesn't over- 5 6 flo-,,7 into other stated-, Dan(! -@c) OGDEDT.: That's cc-r--cct. 7 T n I DR. aS rstand it I was told them could be no larger than this room, or they coulC, be. 9 II the whole United States. T,-. E, ts h at Called a re,;,i.cnal area. 10 co are seeing sor,,l@-' of L-hes Pines, this is sor,-,.@-. of the t--tj-nc, to ;..i:-,d a].' Cay @,,c-sterday, an@ things that I @,;as PuJ 12 13 I did.,-i't get i-ip c.- a sit,@st of pancr. MR. OGDEI-,': Cf' course, 'It,,e Iiave so,--,e sta-L-es, for 16 example, California, where we iave one- -TZ@'ID for the -,...?hole s t a For the state of New Yo--].r, at lc-z,-@,st four. 18 DR. Four, ritht. I-!R. OGDEN: -P)Lncl under this ne@,@,, r)i,@ce of legislation, 19 J-1 T,;ILP I '-.iese four F- 20 s would b;ncome one. "i,"i'21.a','MOCI'@: Yc-s. 21 -all-,, Dmetninq I have n nL- 2 suggested to this Cou.,)c--'Ll 23 11 DR. T7AIl@ LIOCK n on :a e c, it longer than I 24 1-i ave . 25 u r -t DR. ra vote on it until l@ a 0 c, C- to Dead ti-,e 4 !-,u-mz,-rv of tlii ,@2, I i c'- ',.a, t ',a-! a chance 5 to do yo@-. T oa'): e a c t i o n c n c E,. l@ @a basic an,,Dreliension@ 7 that a r.)lz,.nn4 -nci auency is not +---,,Pica!-, a ConsL-ituteca to represent th-- orbvi-(fc-r-,, or to service activi+,-i@ti.! I thin'," it is a -\7e--ry real con,@n-rn, but i s',,iar=- 10 P@TTL: I am sure others ave no+.- has. e -:D s "I opr3ortiini v also to read this, anr. !cunc4l's Sensei 12 17o w 1 d -t 4 1 r -r, ha r c r or. th -L S -orn "had n r-) -n t-, o L. @.L n,7 L,- inc; c-f -re-- 14 !'break. I believe I ,.:ould like to @,usuail- step of 17 asking x-7hatl-.er an@,r of the r.@ necatise I know that Ilse-veral people are here from P-'-'.Pls and al@so -@r. Sparkman, \.,,ho ..is the Chairman of the Steering ',national 19 ,Coordinators, r-,igl-it .,7ish to add a cor-@,lc-nt at this Doint in Ilthe proccedinus, and if -ict, ano@Lher o,:)nor'L-.unity 21 li@during the formal public session @or cc.-@.@@-ts, on this 22 I; ii.point. Dr. -@,-,ark.-nati, wcjul@ car:2 to -.a",.e s,):ne cor,,@Tr.@-rits ati 24 ithis YDoint? On the topic u,-iifer cons,-,@---ration? 2,I) for tlii,, D'@ on the D P,. tl,t.Lnkin(., of cor, i-i c c C) f s c o a ns, if IOU C- @-,D,Dj.Cf U PT@. ,-'P 71, T -c the you. @rc-cia4t- 6 chance of before you again. And r,@ nting th- prose 7 Coordinators, cii-ici i sup,-,o.-c'L--., motion as read by llr. Ogden. 8 I thin)-, the two important factors in the bill as I understand i 9 it -- I, too, h@i@ie not the entire bill, although I have seen the summary that has been distributed to you. And T have lool@-led with care on 13995 which is -i@3 not be -v@Thich I -L.Ilink hL en m(,-.)Cified -,Tcry 12 it',-, -,rodecesso,, I but iini-, there are t,/jo -i-T,@I)ortcii),t factors. 14 ii one is t,-ic of existing stat6-v7ic'@,-3 O.L 15 regional PIIP'E-, into smaller area-%iid-a regional Pledical ProgranLs, 16 I than!, the subdivision into multiple smaller areas is a,,Dproprj..- ate for rlanning as has been do-7ionstrated by the act4-.-on of ithose C.TIPB or area-wide agencies which can identify health 19 problems in their areas and deal with them. 20 But +--his I think, a totally inappropriate way 2i from rc-gio.-io.1 @-'@odical Prograris to fLinc,;: ,@n since on a state@ wide ]:)asis we can acquire staff z4,-'Id .1 and a brcad-,.-.1, 23 of (iif'o-ront kinds of di5cipl.ines and deal w )roblc%-rp@s which 24 v@e clc) on a I)cisis with the @-;Socia-Lion, the 25 volunta@,, health association, health dcpartr,.-@rts, and otherwise rs II deil with health as si i think it oulci virtually J-@-rmd.nat,@ an liar ,,iith. P,,nd as a matter in t",,.c@ arcf-a:--, %.Inch of fact, 4-i-i blue -@L@ C.)n(.; o.L@ @@-h@, --@@i:)nrts on @-7ashi..,-igton ..-!"-h mat-t"cr@,, @,.,hi.cli I se-i@; of @,,,ou are familiar with, last rcl?ortsd tliit @ill as written 6 would be the last rites P-,I'@P 7 f or' 8 at any health I think this in effect is -rLic, ,-;-l 9 11 resource development activity '@-i.nd of things r,,,'iP doing, 10 look to me to be added as an afterthought and in a totally 11 !I inadequate manner. I would like to mention just a couple 0 12 other things, Ilerb, if i eight. DP,. PAHL: Please. 13 DR. SPARK@,,@-,'.'.,: Relative to the or.,L,-,ntat@-c)n have 15 Ilto regional medical program I know that -oine of you have served on regional advisory groups, or ati.ior co:T,,irtittees or in ther'ways -!lave been involved with the rec@ic.)nz@.'L i@.@.@--@clical 18 lpro@lrams. I reccanize that some of the others of you have 19 some are new. 20 Sor@,ie of your Predecessors have had the o,,).,t),@--tunlty having to site visits to regional medical proc,,rams, aiif,, those -i v(@,,:@ helpful 2 I have talked to liiv! indicated that this L experience in understanding what P,'.IID's do. I r co,7niza that 23 ii tiyou all carefully' read the written material we Sil'-Mit to You, 2,1@ '@-,,:Iie applications for pro-rams or projects. t i r,@ v -L '@'o You for !:h,@ (@Ui 4-. that -thn- a 1, o tli,-2 st(-,ry tha- I iavr@ an o.l,)i@,ort-upity to und,-3r- t, or had -,nd f you were actually had had on-sitc@,, vi-s- 5 littlk@ Moore co@,-ta--t %,7 you have an orientation session for Dr. Pahl kno and his staff the details of which I Or)n't kno-,,,,,. But since 7 1 I have thoughl-- about than I I:)L@latedl,! rc.@cocTnizc--cl that as, a n grou,), the coorc-ii-ators of il,,Pls hEvc done i I)oc)- lob i i 9 E-, f un expressing to what th the -,,on. 7@,,nd I h@,vc. %,@ri.tten to Dr. Pahl as]-,ing %,,,,h,-th--r there i -iE@t id -,lines f u us from commurilc,,, .2 are stren-ths ti with you, and I h E@ not had an opportunity to have a res,,-)onse@ to him (.;n this, lir,i to follo'.1y, u,-) on unl@,,-@'s vlnu want to speak to it at thc-@ moment. 15 4 16 DR. Pi'k!,L: I ve not, i--.,glit at this time, I-)ut we 17 will be discussing this with some C)4-' -r individually and with th--- Steering Committee. DP,. As an example, I don't )@now whether 19 mbers of the National. Advisory Council i:-cceivecithis which all me is a report of a ac,@couT-.,t@,@oil-';_ty rCT-)ort that was submit-'--,- 21 that was released about E7, i,.,,onL@-ii EcTo. 'L,V'Iij.ch is -this a familiar iidocumen@- to you? 23 14R. BAUI-1: Tt's b,,-.,en mailed. 25 DP,. SPAI@,Y,@'-IAN: I'lo!i@7 many of @ou had a chance to see it? It DP,. PA. 4- 2 @-7c-11 at t@ic- time of our I,,)hon,-., call it E,-"-Iould hav,-@ I-,f,-@n re@--@l"v@---d bv you. 5 OGDE,',I'4. I did i). o4L-- receive 6 DR. SPAPKllAN: l@ot verv many. 7 DR. PAIIL: shall make other copies available to 8 you. SPAP.J.'@i",@.11: 'v-@ell, this is of no value in r-@easurinc 9 10 individual 21-@iP's. But it is a r.,teasure of the aggregate Impact of Pd@.!P's -n helping to train health professionals and actuall,,-, 12 servina neoole. ZrLd in implementing community activities, of it i4- and while I iqouldn't ex,@Dect you to read c-,-v,@-ry @,i o r cl. 13 is reasonable -well done. 14 15 And it is the kind of thing that I would hope you had had a chance to look at. In order to better understand 17 what we are trying to do. I would like to, @-heri, after I have 18 had a chance to talk to Dr. Pahl, follow-up with Plays in 19i which we may communicate with you. 4 T,7ithout burdc- Lng you. 201 I know that you all have 1 more than enough to read. -A.he @;econd item I would like to 21 retention briefly is the goal of -the @Tati,onal Advisory Council nd I am pleased that in the motion that llr Ogden that was 2s a !I seconded tiiat you all looking at the policies of PIIP that %,,ou 24 all, I think, then beginning to take steps to provide the I leadership that the I atic).nal Advisory Cou-,icil has ,)rovider, For 2 Pl@,P in tile past. 3 I recognize that in your left two meetincTg in tli-- 4 s year th4-ngs have bec@ii T:)r-t-I @@ll. upset, first as previ.ou 5 a result of the (,IlLit directed by the administration, and 6 then the rather abruT3t release of impounded funds so you were kind o.L overwhelmed with applications. 7 8 But I would like to remind yoii that you are a very 9 respected group, on health care !scene. You represent 10 a group of distinguished and dedicated people and that your 11 word relative to regional medical programs partlin health care, is important an h a tyo take tire to d 3 v@r 1 12 d I tliiiil@ t should to consider health )olicy from the stand oint of t .13 p he National 14 Advisory Council. Arid I hOD6 that you will have time to do this. At 15 16 your last rieetinq, as an example, two resolutions came to ou from the National Pc-view Committee, and one f them recent 17 y 0 18 mended that CTIP's turn to i@!,IP's when appropriate for technical 19 and professional assistance regarding health care changes. 20 And the second one encouraged ',Dd@IP's and Clip's at 21 the state and local levels to work together closely to eXp ore ways in which better @)rograms would be carried on rega d ess 22 23 of the exact lanauage that is in the legislation. These, I thought--, were both good ideas. 24 Mr. Rubel spoke against both, and after what I though 25 tion in @l discussion by you, both of I was verv brief connide.-a 2 til-cm were rejected. On June 2 0 , i.m,,@;;clj.ately after the meeting 4 3 I wrote to ll,lr. Ptibc-1 and said i @,jas d'i,qap nted in s dis [)Ol 4 approval of them, and it seems to me 3 is i.nconsistent with. his previous statement relative to on..,-@@Din positive relations, 5 6 between PJIP and CIIP. V.Ihich I wholeheartedly support. And I said that 1 7 I hope that there will be some tangible evidence from him 8 on action relative to this positive relationship. Ile hasn't 9 10 responded to me, nor have I seen any evidence of this action 1 11 on his part. 12 To -,ul)Dort what he said at the meeting last regarding this, Pt the I,,Iasliington- 3 Let me add an anecdote Alaska area we have two particular grants where have t 14 15 forces looking at these kinds of alternative arrangements I 16 between RMP and CIIP with the best people we can find in both 17 RivIP and CHP and other health care activities in 1.)otli states. 18 kleeting and trying to shed their vested interests 19 as much As possible to se-- what kind of program should @mergei 20 and lastly, that in Alaska, our coordinator, who is how a v-3rVi ab week that sh- 10 young lady announced -.to me last i was about@ 21 to get married to the director of the Anchora c- CIIP agenc y- 22 23 I said I was all for this kind of exploration, but it seemed to thi@ @,las carrying it A little to far. 24 25 Thank you, very much. AIIL: Thank you much, Dr. Sparlcmari. 1,7c- 1) R. P viill have a formal open session a little J'-@,-tcr, and others 3 Presf--nt should :Lc--l Lrc@- '4-,o comment u on matters tl-i-at 4 were discussed anci Dr. Sparkman, should you wish to make 5 additional comments. 6 But .qe shall table the motion until. the Council hasil 7 had the or,)portunitv to review thc.,z summary. 8 DR. JIY@IEIIAY: At some time in the agenda-, I would 9 like to resoond to Dr. S$-)cirl,@manis comments about the 10 ations of the Council relative to the resolutions. 11 DR. PAi'IL: Perhaps this might be an appropriate time@I 12 1 tlien, Dr. Janeway. Our agBndE;-, is fl-(@--xible thick; corn ncT, and perhaps this would be a good time. 14 DR. J7,NEIIAY: I would like Dr.. Sparl@man, I would 15 not like the impression to go unanswered, that the Council 16 did not deliberate appropriately upon the substance of the 17 resolution brought bv the Technical review Committee. In 18 particularly that the wording of it is such th,-t,t it implies 19 a necessary conflict between CHP and P.DIP. 20 The concern of the Council, or at least the sense i 21 of it as 1 recall it, was that there was some concern over 0&2 the Planning in control function being amalgamated into the @23 same agency. The iii-Lo'Licati6ft is there, we felt, and I think, 24 quite correctly that the advisory council for rJ,P -- it would 25 be inadvisable for this Council to be making dictatorial statement from an adversary Positior@L to t O'Ll r, control. 2 of Ein agercy over havc-.@ no that thcre was -@@nd I ould liop- to r,,"ia@,sure you 3 w 4 adequate discussion, at least in the mincls of the pe6,nlO who nd this table. 5 are arou 6 DR. PAIIL: Than]-, you. Is there further discussion 7 on this point? 8 If not, I would like to return to my brief report q to you. There are several points and items of business we 10 should consider this morning. First, I would like to, with 11 the indulgence of the Council iii--P@iber-.3 who were here yesterday 12 to repeat very briefly for the benefit of those who were not here y6sterddv, our current status with respect to two ap .-a- 13 14 tiofts that the Council ,lead considered last time. Let me take this opportunity to do this, because we@, 16 have representatives from both of those regions here this i 17 morning, and they will be speaking with us, very shortly. 19 And in order to provide the proper background and undetztandir.,7, 19 1 believe it is necessary for me to repeat these remarks of 2o@ yesterdAv. 21, As you w;"Il recall, at out last council meeting, o of the tdcor-r@iencaations rTiade @@@ith regard to sliec- aonli.c4:i 22 ?.3 tions the Applications from and nassdu--S,:,'@'foll-, f the fbllo,.vi that is, trial funds should no4-- 24 %%Ye re o ng nature-. be awarded for those particular apl@).ications and also that the I i @ : I I I .i @ tvyc) programs i.i-i ,;houl.d !)c. terminated in an ord,,L-rly 2 O@ by the r,.lctor Tho --ccornraenclati,oris @,,Ic@,re accc,, and we were on our to @'@e in good faith 4 when it was called to our attention thal@@ ar.Tain, as a result 6 I am afraid, of a dismal ignorance of the law, that @,,e were not able, as a matter of fact, to implement what had been th--@t 7 Council recommendation. 9 71,nd the second part of that, the orderly termination of the two programs, that is, we had only the opporttinitv to 10 implement the first part@of the recommendations and threat is 11 not to Provide funds for those sl-@r-%dific apl)l.icEi4-ion-, that were 12 re'vie,v?ed at that time. 13 In fact that ,vas the case. No awards were r-ade at 14 "the June Council to either the Nassau-Su@-folk or the 15 !I programs. we were in error in believing th-@@, @,our G recommendation could be implemented and when we were advised 17 of t:,ai@- error by our off:Lce of general counsel, ir,,i-Tradiatelyi 13 got in touch with the reaions, and pointed out that there had' 19 been an error, on our part, and that what we @.7ishe@, 4t--,-) do was 20 inform them i they (.].i.d havc- a riaht, and @@c- ho,,-)-- -L-,Il=v 21 -zercise -t to rn-submit- applications for 22 11 by the revie@-i Comm itt c- @7@st rda.,,, and by this Cc)uicil. 23 The reason that that action was risen was that the. 24 @%le reviewed appl4 cations in question, the cations t@ial- 25 i I I I in both the June -and @ipf)' ic,!atioi-is under Council @7 are sup.. 2 a,r- Council techriiczil.' T31ement,.-, to @-xirtinri @)@rcint.-,. 3 The I)u(Iget p,@,r.4Lod for all. re(-.,ional medical i .?rograms@ 4 extends from February 1, 1974, tliroiich June 30, 1975, and 5 those ai:)Dlications revic@vc-;cl at the last Council meeting, as ii you todav technically are sul)i)lc-rk@@ents], 6 well as the ones before to exis4L-.ind aiiard@,. 7 t 8 Therefore it is not appropriate for the Council to 9 make a recommendation beyond funding for the specific applica- I tions in question* Having g r that psy holoc' 1 0 otten ove c Iica hurdle and shocked everyone we as a headquarters staff, toget,ie 12 i@ with the staffs of the tN.7o regi@s in question try to work I effectively within the time constraints that @,7c-re on all of 3 14, us. 15 And we extended the deadline from,. July 1 to July 9 16 to those two specific regions to amend, to,revise and to 17 '!i' amplify those applicationc>. And our staff met with the staff 18 of the two regions and you may imagine that there were both 19@@ several trips involved, and many telephone calls, and as a result of this we believe that the regions in question under-i 20 stand fullv the concerns that the review committee and the Council had ana had spoken to those concerns in the ai)plicatioi-i 22 Also we have Made two, made know to these re ions 9 the fact that during the open session both the review committee 2,4 and'the Council there was the opportunity to speak on behalf FL, matte--s. ot the 2 (,Tc@,-.,t to @T'On session, this r,,,criing, 'I -eqions.@ r,,,en-t@; from r c.@,, i, c-@ s :-, iof bot' 3 have i t o. t i Now, apart Ercm that r-,i@,tter I ii-ioicate to tile co-@-@,ncil 4 you will recall at the June meeting you aT-,proved 88 rii-Ilion 5 dollars recommended for approval. ions of dollars. @-le actually made ao:atds of 7 a4 millions of dollars, and the reason we did not implement 8 fully your recommendations was because it was felt to '@-e better 9 management to reserve the different, four ,nillion dollars, 10 to that we would have a total of 28 millions of dollars for 11 support of the recommendations at, this because we had 12 -).)roxi-,7,at!l-,ly 43 r@,il'Lion 13 anticipated at that to !,. ave a@ I dollars in recrtiests. 14 And we felt we needed the 28 million in order to 15 rrovide appropriate implementation of the recommendations front 16 thit Council. As a result of the@@ actions just taken thatI 17 18 recited with @laryland, and liassau-Suffolk, those two an-olica-I tions have increased the requested figure so that the review 19 committee yesterddv had in the 53 applications before itf 20 a total request of 46 million dollars. 21 Our -L-c,@i-al dollars that are available for supi@dr*. of 22 Re ional radical Pro@rains included not oiil,,! tile 28 riillion 9 23 Idollars,,but some unexnended balances of approximAtely one andit 24 a half to no more than two million dollars, from prior L-udq--t 25 p--riods. 2 co +,-iat the total -moni(-@,s that !,ia,),c, cin- ,qe wil' a 3 know exa(--tlv as we the rc-,)ort and expenditures forms tl this 4 total amount that will 5 Council ig -for sul@),-@ort of P..ogional l,ledic@;; rograms will 6 be approximately 29.5 million dollars, to 30 million dollars. 7 The committee acted yesterday in out closed session. 8 So we will be going over the specific recommendations. @,7e 9 have a point, however, ,,jhich does require your conside-ra4@- ion . 10 And as I discuss what the point is, I would like to pass this 11 statement out to you. 12 And indicate to you @7hEit our problem is; under the 1,3 court order which %,was signed ario, - I.ius the litigation is enc',Le-md, 14 five millions o-' dollars @,,7@re given to the defendants, if You will, for purposes other than the direct support Of regional 15 1 C> medical programs. 17 This @,;as the negotiation that oc,,curred durii.g the 1 settlement, and those purposes were described very completely by lilr. Ptibel. Now, the condition in the court orcc-r is that 20 if .@Ir. Rubel and ,3taff are unable to Obligate the five million dollars withit-) 90 days, 90 days from the si(7,ninv of the final cou@@t order, -e.,raininc funds of that five million then @22 reverts to th,'@, @.@uoi.)ort of the regional medical ptoqtar.1s. 23 24 Ttius, i@.a may be faced in late Octol-,bt with the nossi@.-. ity of distributing a very small or medium size; or although unlikely a large size sum to the regional medical programs. Up ),)e ars rc-r@-,@ainj-n(j, bccau,,s-,-. t 2 3 c7roa-'-- interest o,-i '-he ,,art of the administration to ui-i 7a t h oE--- c--@7fc@cl-ivcly for the y@urposes they u@ 4 1 the negot.@. i-ons. 5 6 But we do not wish to call this Council back should 7 it be required for us to distribute the small sum. Thus, 8 we have drafted a statement which perhaps I can explain to rather than co over the formalities, which would, I th,'-n'r, 9 10 accorodate the situation very well. 11 And not require vour further attention on ma@-ters 12 which I believe are not o'i' sufficient importance to have anot.!-,n] 13 meet;-ng. TIhat we will propose to do with the close -t--o 30 million dollars that have avai.l@41..)le, is this 14 ce t of your redony for eac,@l 15 firs pay up to 100 per n iandations of the PPLV-a@h. 17 Should there still be funds available to us after 18 v7e have awarded 100 percent levels of your recommendations 19 todav, we would then return to your recom nded levels at the Jun-- council meeting. Because I just indicated to .rou 20 21 that although you reco,,-.Yrtencled that we sur)TDort proqra:-,s --t a total level o--F gq T-,illiol-l, we reduced that --o 84 Milli-or@, so .2 we would then take any remaining funds and pay appropriate 23 24 amounts, up to the June council recommended levels. in the event, and these are a lot of if's, but I.-n4LS 25 @rc, S t 4@ 1 14 S the @i@ty this pro-ram iT,,ust things. Should -t',,c 2 .@S 1 aY)l from jac-it iic,7 have. avail,," 1. moni- ava-- 3 to us or .,@liat may become available to us in Oc-tol@-)c-r, zi.s -a 4 !result of the s ituaticn I have just indicated to ycil (--h 5 five million dollars, we would then proposed to mak@,11.@ distti-i i 6 bution by formula, and the formula is given at the bottom 7 of this page, and it @.,ould merely state that we v7ould take 8 the actual award that @,ic made, from this Auaust council reetih@g, 9 and the actual award made following the June council meeting, 10 and find out what percent of those tt,,7o at7ards are of t 11 awards made at the June and Augu 12 And apply that parCentact@ to whatever remaining fund'", 1 we have. lmd 6 3 istr4-bute those fiLnds to each region. T@"a 'feel thr-it,this is e u- 14 q itable and in Icc-a-,oiricT with your recommendations na '15 of the June and August council meel--ings/h@ve been unusual, in 1 l@6 ithat All programs, basically hi:lv@ been reviewed, simultaneously 17 rather than at q-aarterl ario68 6@4 the vear. y p 18 Secondly, the competition, the applications have come ig in under a competitive system, whereas during the earlier lz>art,l @@20 of 1 74 we were ion.on a formula bAsis, ch 1, p -endings of rc-, 21@ lper @atua.ted rank st, 1 is at the last t,,.,o council meetings this one and the 2 lfce 23 IcOuncil meeting, are our best indication of the latest c6ns@ider- ation of Merit of each region. 24 2 Th6tefore the formula that we have d--Vired we believed 1 to be fair. I hivc- made it clear, t @3 c C) @@'T" 3 uld 3 to - 'have. c@i the ra. @li.scu.(3sion or --iidorsenien -ind I v7o 4 or, if ou %should, like to consider it later, discussion or endorsement of -either this Proposal or a modification because 5 6 ds we still may be faced with a lonce this council meeting en 7 distribution of funds. 8 And I do not have that authority unless we reconvene;,. 9 At some future date, so I would like to open it now for c7enera@ discussion or clarification if I have not made it clear. DR. @-771,11',IOCI,': That's only a minor sum of money, youi -2 say about four million dollars. Or a million and a half is that correct? First you will take the sunt we allocated for!@ 13 eighty eighty million dollars, DR. PAIIL: Well, let me tr first I will use the @Lun6.s 15 y 1 that were available to us to pay up to lor) percent of %.,,hat 17 we recommend today. 18 DR. PAIIL: The funds remaining I will then return 19 your June council recommendations and pay up to 100 percent I f those r c o e omr@.endations. If funds still remain, either what .@;e have currently available, to us this su.-ri,3niar, or any that 22 may become available to us in October, I would then employ the formula that. I have given %,7)iicii would represent a nerdeftta 24 determined for each region based oh the June and August Counc 25 'c-tual lo ti-iz.,,t rec,,.i.on, Iiich N@iill be at t! 3 100 Junc, and t,,ugi.,ilst Cotincil recommended 3.--vels and apply 4 th@- L- vil-iatevcr I)ala,@ca reir,@i,-is. 5 T @,7ou.Icl lilze to move that that be ell- 6 dorsed or approved that r I-IR. OGDE,4-. Can I ask a question.> 7 8 DR. PAHL: Yes. 9 1,1@R. OGDEN: I am unclear as to,wi-tat this five million 10 iwould be used for andthe manner in which that will be done. DR. PAIIL-. I can speak- more full to the second part y ltl-ic-n to the first point. 12 11R. OGDEI@: I think it is the first p 13 oint that 1 am 14 lmore. interested in. 15 DR. PAHL: I can get @rc)u material for the first point 6 17L--t me speak to the second point, however, @Ir. Ogden4 The 17 negotiations on the settlement or- this litigation have been 18 conducted primarily on behalf of the defendants by#, of course,l I our office of caneral counsel and the person of lir. r,,ubel. enqes tha 20@ And to the purposes,, needs, and chall t ,,illi represented by hl-%rj.l-l(-T dollars Available 21 b-- five -millions of r to the administration thus have been our most and unde his 22 @diredt personal consideration. 23 24 I-lo handed to us, yesterday, a rather lengthy statement 'c' fran v7li vi kly I had not seen until yesterday, because it is a sc-,i-;arate activity '@,7i.t,in tl-%i!-@ bill.. c; o th a t t s c,,,i n d i@, rcfe-r to @ai-.,@ that I have, h 2 e we 4- oget lir. r\ul-,cl to speak -L(-) it i,iore directly, c@ 3 do not have inz"O.-rtation be@rond he distributed 4 i! @,sterday. 5 'iliow, the manner in which @@a money e,,'ill ".)a snent 6 I understand is fully through contract process. @-nd the purpo-@@-,l 7 generally designed to look to,,,7ard the new legislation an to have organized, defined, cleared, and publish t.-,ose kinds of studies which are concerned with health plannin m6thod- 10 9 oligies, evaluation studies, and to development of manuals 11 s And procedures which will be of assistance to the orc6nizatiol@ 12 which we expect to be developin and supporting as a result 9 13 of t,.@proposed legislation. 14 I am not sure that that says much nbre or even as 15 16 well as 4hat he said yesterday, but I cannot ami)li'Lv @-hat. DR. SCI.Ir@,I,:7ER: It's kind of anticipatory as I 17 18 DR. PAIIL: It's kind of anticipatory let'r@ go off 19 the record for a moment please. 20 f the record 21 DR. PAI!I,- 1-7e can baclc on the rec 7o orc4. auain. I wo be if @lir. q,@re here today, to try and get him to 23 CoTr@,@ @-@id sT)eall to this p@)4-iit . It is kind of ir,7L,,Dorant but it 24 @25 has n quit6 peripheral to m@! activities. Unless t'@'lere is c- o n i r e iT 2 sibi.litv of thi.s Council to think it 4-s the st...itu,.torv rE,.@,pori 3 ap enditure this is five-, million 4 prove the exp f or IZI,IP money and dollars oLc PIli@ moncv. And I i---rik unless we ii-ql.,)rove the manner 5 6 and purpose of Mr. rubel's expenditures the money may not be appropriately spent. 7 DR. PAIIL: Yes, well that does bear on home tlie rnonevi 8 is spent. It is the responsibility of this Council to approval 10 all grant funds. @%IR. OGDE',N: Unless we say to @Ir. Pubel's resolution ate 12 that you have the authority to expehd that money and we delcg to you th-- ti(,,ht to -pend it in the manner it which you sl@-@nd.il it, ho@,7 you choose to pond i.t, and then I question o7l.-iothc-r her 14 is spending it under authority. 15 MR. IIIRITO-. Isr, It this the result of the court order, 17 Bob, rather than 18 PIR. PAHL: It's the result of the court order but I am in a very poor position to take issue with flr. Ocrden. 19 IIR. IIIROTO: Okay. 20 DR. PATTL: l@,?hcit I would say, is that it is mv under- 21 nding that an expenditurb of grant funds must tom,-- be-fore, c> 22 ecotpmended for approval by,this council, but contract 23 an e I 0 I and I d n.1t kno%q %that iihc-tlier it is cLif,-L@orn or a,. 24 Ifra@n),@ly but certainly to tlio- best of mv knowledge no contracts t@-,at funds are requ2-r,--,(@l to CO-1"1"3 I)y tlii come before oi, be ditures are rcqu4-rc-(l to council. havc@,. not so that as loria as 4 c @A 5 five million doll,@: is a%-,7a.ded in contract I believe techt 6 it must not come before, but I believe it wou'Ld Le %Raise for 7 You to have a better understanding. PJIR. OGDT'@l: ;,7as it dc;sic,,na@t,@din the court orO,--r 9 as contract funds? 10 DR. PAIL: I turn to my quasi-lawvcrs. 11 IIR. GARDELL: I'm both have a little information. I think one of the things the cou-t order did to release 12 L. im then allocated to us 13 ded funds and --ho8e f uii (a:L-, L)oun 14 the amendment to the court otd;-nr takes million Color '15 of the released i.m,@ounded funds to up,, @,,-idm,-tkes it av-@ilzibILe 16 to -n contracts that ITRP, and tiiat'@s really it is 17 c,,o, then, @@;d have five million l@-cs to allocate to our 18 @IR. OGDEN: if that is the case and it goes in thdt! 19 route, then my question is out of order. 20 I,.IR. GARDELL: Yes 21 PAIIL. Is it act ually spelled b as contract? DR. U k: 22 R. C'@All, hat'F, right. They don't have to e D"LL: T I made as contracts. They are not mad,@3 availa.bl@-- to us to ELl Ol".,- 23 to our P..j'4'Ps ,,4 25 IIR. OGDEN: Okay. DP,, Pi@T@li,: C- Y T 17 1) ')-I't th D 1-@, 3 T)ract eas ib IL,", ay of ng cax,e 0 4 @--;ally would be m-.@,aniiigle@, Have ci c,:),., n c,- for that! purpose. I don't really any reason for s--endinc,, an%7 timei 6 on 7 I move the motion-. 8 DR. PAIIL: All in favor of the ropos9nd resolution? 9 Relative to the formula for distributing 10 We didn't get a second-. 11 I,IRS. IIORGAN: Yes we did. I s@:Bcondcd it. @d And secbneed.1 12 DR. PAIIL: I'm sorry, it'i").as --)een 13 All in favor, please say aye. VOICES: Aye. 14 15 DR. PAIIL: Opposed. 16 (1:@lo r---snonte) 17 DR. PAI',L: Themotion is carried. I-!R. OGDnll: As a matter of editorial cor,.r,..ent, should 18 19 the bottom line read -- Juii--@ 20 11R. GARDELL: The words will be dated in @@iucTust. r.Pheyl will be 6-ffcctive September 1. You're !)eina terribly t---dhnicall@. 21 DP,,. PPITIL: All right. 'I'@ow @@ha@@@ ,a%"e gotten that, 2,2 I next wanted to move over to the arthritis, @ut I see that D Gramlich and Mr. @-r)ear just, ft @ll so, fir t 2,, both, r. I e,: a roor.4 s ju t like to ha -le s n 1 wo'uld s ve tl minute of last reeti coi-i-I 25 -)el-i-@-ve tlic,,7 are att,,@cht2,,i if you have nct had an oppor,tuni-tv.to read -)s could dc@fr-@r action on -2 M 4 These 1-iialien't beer, mailed out. I 6 no reason not to suggest a motion that they be approved.. 7 Second the 8 DR. PAJIL: The motion has been Face to accept the 9 minutes as submitted. Any discussion? 10 (-,,'4,o response.) 11 Dr. PATIL: All in favor Of the motion? 12 VOICES: Aye. 13 DR. PUIL: Opposed? ('@lo resi)ons-z 14 15 DR. PAIIL: The motion is carrie,-d. MRS. 14ORGP.N': 0-F 16 As a matter -act, it would be illegal and still is part of the minutes. 17 18 DR. PAIIL: lle walk a tight ro:.?e here. 1-7e will be, brinc'j 19 in ]ust a t6t6-nt, having a report from '.Ir. Ilatt Spear to 20 you up to date on the status o,-P t l@-I --arthritis program. As 21 You will --ecAll, at the last council -,-,e--ting, I belie e -we@@e just about getti tDyou .It t-.is -)oint nq 22 Z3 SPJV,P@rl: rine. DP,. PzjiL-. T@-' that is s,,-cfj.c@ent. As you recall at 24 the.last Council r-,-@etiiig you did 1-is-.an to a presentation '@-y 25 I 11 both Dr. llr. relative to thc- T)ilot @art 2 prograTri. 3 t...- acti,,,Ii-ti.c.@;, coiisidcrEi-ticil,@l:.,:; and formal 4 rc-cor-,rt,@,ndat@ of the ad hoc Committee; 5 subsequent -'.qat time, have made a@,iarOs and I @@o-L,10, of 6 like to call on- ','Ir. S-Dear to describe the current status 7 the I?rogram, and our activities since the last Council 8 rqeeting. 9 12 13 16 17 19 20 21 22 25 It %@7i jiIL73t a!7, convenient s on the same startin7 Poin@@. 2 just recapitulate @,o c-%lc@r@7onE., 1 l@474- prizite for ?,.',,IP an all()cc-.t4@- c) n c- a r - 3 rf c@li-vc-(l in an al)i-)ro marl@c,-.@l: and a half million dollars for the d--velopnieftt of a 4 ")ilot -hritis c@nter. 5 6 @'Then the request for al?pli.cations went out we receiv"@c . 1ap ns from 43 .plicatio regions, totalling almost 16 million 7 8 dollars. So it was a highly competitive situation in the te- view. Policies were established which took out of the turiningfl 10 thos,-- kinds of activities which did hot seem to be directly did not so--m to dir6ctly.bear on patient services and the 4 ngS 12 d--vc-loDr.--nt of th-L for )atientc, and the extension of care 13 to pat-.c-lits. 14 In tl-i outcor.,ie, then, as recommended by tl,ls ad hoc 15 arthritis review committee and the Counc'xl at it".-. last session 1;3 l@ 31 of the P-,'4P annlications for pilot arthritis funds were 7 d ur, 17 alDprovc The approval exceeded the earmarked f Cs by some small amount. 19 I shouldn't say small amount, that's editorial. By 1 20 an amount of almost a half a million dollars. l@7ith, the appro, @2, fval c-ic t,,ie Council funded, 0 r El l@) proved, t nded to approve i !the allocation o'L fund to all of the pro(rams ti'lit co,.,i fall 2 the earmarked amounts Available to three, program. 23 P.nct is 27 of those approved prbgramst and the 24 re-rla5-@,iinq four @..jho were approved, but for which there were not! 2.5 i I ,I 0 II @ I I i ii @i I" i 4 i :a,il-I c)r4 clif7c-cti.c,,iarl, -funds up to 2 or uti'l@, 4 letters to this effect that a re-,,,t'-on 5 is or is not an,,Dro%,ed for c7%ar,-qarked funds or is or is not 6 approved for the Ltilization of discretionary funds I..as issuel@, e 29. The letter also requested that each of the reg4o-.-, 7 on Jun 8 receiving approvals for pilot arthritis activity resno.-.@id in 9 writing as to its acceptance of the award, where an award is 10 involved and or in all cases the conditions of the a.,,,,ardl 11 which was the s@L.,atem,--2nt embodied-in the approvals as to the 12 kinds of activities that should be undertaken. 13 P@nd -he +-8 of the funds that could e ex-.oended 14 for those activit-'-c-,s. "L'o@ay have acceptances /'-l of thos-=, 15 P@IP's and we are waiting for an additional ten. To round t 16 uT). Eight of those have been contacted as.of @esterday, arid 17 they ar- -,,7orkinc; as ra-,)idly as thev can to get their ciccept- 18 anc@s in. @19 As vou can imagine,, going from a request of sixteen 20 million to'somethinu in the order of less than five r,@illions 21 i!i some drastic cut,-, .,;erc rade, and some restructuring of il.,I.7ithin the ar)TDro%ral@-, 1,Deen necessary, and those ch--naes are 22 LI@ ing negotiated. 23 -wo of t appears I at tl-ii s ent, that onlii one or 24 5 ithe 31 approved reaions may turn down the funds. One aiDparentI.@; 2 I I I ii difFicilltY in deciding what the, h is having some n 2 be LiseCl or Pot. 3 *,low, t',c,, coll;@,@littee and the Coiari--il both 4 -two @@@her actions, both at the same time, they recommend 5 the @-)e some centralized fol.lo%q-up from the Division 6 Regional l.Ladical Proarams. The major part.i of that I think, 7 the most important as@oect-is a desire that there be A method dinating like kinds of proarar".s that 8 and an approach to coor 9 nevertheless are dispersed the 31 T.U@T's. 10 T.,,Ie are also in the advice letter of June 29 asr@ed 11 tile Pd@IP's to give it some thought, and to give us the @,:i§do:,r of their c-.Y.P,@rience and thoughts Ilowever, they did no'r- have 12 the full information nc@-c"ted b-,i then to g,.@vc, a proper 13 14 in Our estimation 15 T--nd we are Dresently preparin a letter to follows,. 9 16 that up and give them more concrete information such as @..ho 17 are the ball ii avers, who got awards and for %@!hA4.- ks 18 of i?urposes and what are the nature of the programs that -19 have been approved for 4Lunding- 20 And just in conclusion, to these remarks, let me read you draft D@lrt of the letter that purports to The ein@)@asis of th e lot the a-,)T,,roved progral-s. e approv d pi 2 4: 23 programs is the c,@-.tcnsioft oi, present kno%qledge in arthritis 24 diagnosis, treatment and care to coordinated services which 25 demonstrated improved patient aces8 to care,, and extension ol hrou(ii uti,ii.za+@-io,,i @rc)fc-s!7@ional -@ervic 3 t i-@isourc s. 2 :af?lslcnal personnel, ancl, clinics @@,ill be established in rcO@ical I 3 Aity hospitals, and other community health 4 iter,,;, COTPIT'IU h -s. Educational programs in hospitals and tliroug the arthritic 6 visiting multi-disciplinary teams will increase private physicians 7 handling capabilitie,.3 of I-lospital-s and 8 and will equip larger nu7ibers of medical and health Personnel,, 9 as sup-port services in hospital clinics and -- increased patient care wil.1 be increased through the development of 10 11 patient training activities. Semina s and workshops will be conducted at manv i 2 r sites -.'"-or improved utilization of coi,%muhity resources -for 13 a -S, In tthritis servic c uding home care, quidai-ic6- s"r 15 lence. Ekistinq health department personnel and facilities,, 16 and health groups, such a E, the visiting liu,-rse-s Assodi.ation i7 local councils on atfing, and operating community health trai 18 programs are cooperating and demonstrations of appr 'V@ 19 arthritis health care deliveries. Several mode st studies 20 to develop criteria for qualitiative care through provided ed; and industr-,.7 performance standards are b,ing conduct 21 surve,,.r is planned in c)nc,, region. @md an educational program will 23 be developed in-coi-,c@-rt with better organized occu c-iti.o al 24 n health services. Another region will. investigate the utilize,"- 25 I ationt restorati dUC4-' of solar work.-,.'-io,)s to ,;u,,),:)ort T.) on to nro 21 2 activities. 3 iiur@,ber@o-@ T)r,--gram.,3 are focusing on t-.e -,rcblems 4 of low income qroupst rural groups, and others are focusing 5 on the development of care deliveries in economic di8advanta.cn--z 6 inner-city residents. Pt-@diatric arthritis services be 7 developed in a variety of-settirigs, and one prograq is demon-@@ 8 strating improved services to the geriatric po ulati6h. p 9 Localities which presently have little or no rh6u-,Ia- lo@ tological resources are being supported by the initiation or the expansion of medical, new medical institution -66-each4-ng 12 cat3abilitxes. 13 Across the country, chapters of the art-ri@-is 14 foundation ate providing program coordination to - @@Ublicat4-c,, 15 and increased numbers of volunteer @ workers in supportive 16 services. And increased agent referrals to local setvi6es 17 and resources. 18 That completes my report, Dr. Pahl, U.-,,less there 19 are questions. 20 DR. PAIIL: Thank you very much, I,,Iatt. Dr. !Tabr@r? 21 DR.IIM3ER: 1,That is, where is that program iqith the geriatric services,> 22 --'IR. SPEAR: In .@lichigan. Uhivekritv of ,ichi an. 9 23 DR.PAHL: Thank you, I.,att. Dr. crarlili(-,.ile 24 DR. GT.WILICIT ndicat6d to you, As I i I 25 to you for not havi,,ia been able to get with you a bit this mornina due to the road construction which (lelaved gr@tti-ng here. 21 wondered, lio,.,7evcr, if you 'lave a statement to 3 make generally or I ti-i-,'.rik to aOd and the information 4 I did pass to you I thought I %,?ould 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 the P@'-n 9 process, in the administrative organization that is able to 10 acce 1 pt the task, early on, accomplish it rap'dly,- and a,-)paren-l-,- bring it to reasponabl@r successful solution. 12 13 Matt's renort is superb and I have nothing to add 14 DR. PAIIL: Thank you. Let me just take one or two 15 16 minutes, and indicate to you. I,,7e are attemptinai should there be further funding coming to us this year than anything 7 we have spoken about to date, or will there be special Arthritil 18 funds made available to this program we would attempt to enqata 19 20 in those Activities which the committee recommended to you, and you endorsee that is to pro@,7i-'-- centralized audio-Vi-c-ualI 21 re-sources, the development of cnrtain training films, va.@.c-o- 22 tabas and so forth. 23 But this requ4res a reasonable investment, inO, %,7e 24 do n6t have the dollars at the moment. I,-7e do intend a. 25 to pull 4-oq,2t'lior nc, d I Spear indicated to try the exist- 2 activities into a cohesive program through the qood offices of ir. Spear. 3 4 And beyond minimal funds needed for some confl4-ctiv-- 5 meetings, and so forth, I believe we can accomplish that. 6 So we do hope to be able to report bacl,, to you at some futurel time that the program is not an assemblage of disjointed 7 8 pro]ects but does represent a total national program. TIow, facing us yesterday and today there are a 9 10 limited number of arthritis applications in the itly 1 Pl,!P applications. I believe five regions saw fit to include 11 arthritis requests in the current applications. @,-7:,iich is to 12 say that most regions clearly understood that the pilot 13 arthritis program was related to the fiscal 74 -@Pundin 14 cj an,. '15 the activities of the specially established ad hoc arthril-@7-s 16 review committee wnich met for one time and was disbanded. 17 Thus, we have a situation in Kenichi administratively 18 and indicate to those regions that basically their applications 19 h although I think in 20 some cases there have been honest misunderstandings, so that perhaps this news would not be taken lightly4 21 I feel that, however, it is important to reo en 22 with you very briefly the fact that we believe the oilot 23 arthritis cen4-er program was established and is no longer 24 open. That is, regions should not b6-'permitted to spend 25, iv a-,,a.ilal)le funds or whatever Funds core to currant 2 in th@ the clistri!Duti-,:)ns been d,-!7,cussi.n@,, 3 this rorninq to Su,),-)Oft additional activities. 4 ',.e are trying to build a national cohesive proarar.-, 5 and as a result of that I have prepared a statement whic@ 6 I would like to read to you, and if you feel you need to study 7 it we can distribute it. The timing is perfect, Xen, 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- regional medical programs and to try to build coh(--siVe 'r)ro-i! 12 gram .'Lrom those activities that,-@iere reviewed and approved 'MOWN alim-ii by the Technical Boar of ';-Ikpbr S. 13 T e stat--r@n ould therefore, for vca 14 to read to you and ask for vour endorsement is tIlc 15 16 l@the underlying authority for the 1974 initiative in arthri4--,',si. 17 was ii 4- p ot- in scoQe and intent. rmd heterogeneous activ.-'@-L."-@- 18 beyond this level would not be appropriate employment of 19 current grant funds. 20 The full d@,veloi?z,,ient -gnd delivery of servides for arthritis is an enormous undertaking, -Lind requires a cor,-,@-i-@-,u4-nc 21 well o--qanized attack such as could be initiated un6-or, 22 pending legislation. 23 1 Thus, -,,7hile Co,-,,-ici2. is fully aware of the 24 needs in the arthritis ficl6,, it dN-las not cdn!-,id@-r 25 for arthritis, other than for approvals and recor@-ffnend,-tt,-'.C)r,,.', made at the June council -@@eeting to be ai')I?ro,@ri@,,@-e in 2 present environ,-,,i,@nt,. 3 end the allocation or expenditure by indi@.",,-Iual 4 regional medical programs of funds for arthritis in -clition 5 to approvals provided at the June 13-14, 1974 Council meeting' 6 t are not approved. The Council will entertain approval of 7 8 additional thrusts in arthritis in the event of appropriate authority and new grant or other funds become available to 9 the M4P's. 10 Dr. Gramlich? 11 DR. G@'U-ILICII: I heard thc--refore-in the p6riodizatio,41 12 cess at the June meeting there were four applications pro 1' that were approved by not funded. Those were outside the 14 II Iscope of this 15 DR.PAIIL: Those four are outside and'they have been I 16 given specific permission following that Council disc s.@.ioh 17 ito utilite their funds to support. Because those aT)nli&ati6nq' 18 went to and through the review process by the arthritis review 19 20 committee. this pertains only to those activities that were 21 .not reviewed by that special arthritis review group. 22 DR. CP@-ILICH:Oka@l. DR. PAIIL: Because regions are permitted to rebudget.,@ 24 and anybody can rebudget into arthritis intli6- coming year. 25 an I don't know how we can @,stal-)Ii.,,h a national WC% 2 basically leave it open ended. 3 The applications in arthritis that have coTre be f ore rthritis panel, and 4 you today have not been reviewed by the a 5 cannot be because we have no possibility, have no possibility 6 of calling them together again. 1-i'hat we are saying, therefore, is that your June 7 actions, including the form which we did not have funds to pay, but were given permission by that closes th arthritis program effort unless s ecial arthritis funds were made avail-i 10 p it able to us, or unless additional PJIP fundsi and then it would, 12 come back to this Council in full measure. That is the statement, the intent of the statements 13 DR. GPJJ4LICII-. It seems reasonable and perfectly 14 15 clean to-me. I move that it is adopted. Unless Council 16 wishes 17 DR. ;.it'UII.IOCK: Second it. 18 DR. PAIIL-. It's been moved and so6onded6 is there a discussion 19 DR. J@NEWAY: Isn't the intent of that also to exclii(-'@'-- 20 those grants which on technical grounds were disapproved? i 21 DP,. PZJIL: Yes. 22 DR. JXIEI-IAY: Ithink this will clear in the sc-ns-@@, 23 of it 24 DR. PAIII,-. This then will be incorporated. This 25 cti-vities in the J I11 says tha tivity a t only cipproved ac 2 S Of r,.c-etin(7,s can utilize I-'-'iP funds, d,@sa,,-)pravr-,-;d c t ii e,- 3 activities cannot be sta @.c-('@,with cannot utilize theTL-,,, an_ 4 currently or ex ected to be available of the p 5 a c 4L--lons we taken to date, this morning. 6 DR. 1"01"lAP.OFF: Do you )-,novi off hand those five regions 7 that we can consider that in making funding? 8 DRt PAHL: The specific four regions? 1.1r. SpeAr? 9 LIR. SPEAR: Florida, @,@emphis, L%Iississip i, and Tri- p 10 State. 11 DR. FLOOD: Tri-State brought up 12 DP,. PPHT: There is a motion on the floor and sedond,--d 13 All in favor of tJie motion, please say aye. 14 VOICES: Aye. 15 DR. PAHL: All opposed? 16 (No response.) 17 DR. PAHL: !,lotion carried. That concludes the forr,,.ai@ 18 business, except for, I think the very important public 19 session, and I would like to ask Council whether you would 20 like a brief break and then bring some coffee back to the 2, ntati es table and have your open meeting with the repte@s "12 or -...lheth--r you would to continue oh; and then have a @23 break. 24 DR. l@ltLLIKEN: Coffee now. 25 DR. PAHL: All right. I think that is fair to our I visitors too. 2 '@@ny Oon' k@- trk, to reconvene in, oli, ten c.- 3 minutes, as soon as-@17e can bring some coffee or douqlinuts 4 back to the table. And then we will be refreshed for hearing 5 from our guests. 6 (I,.ihereupon, a short recess was taken.) 7 D @T),. PAIIL: I.,lay we -come to ceder 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. 10 I would like to welcome both Mr. Bacon and Mr. Sargeant from 11 the I-,Iaryland PP4P. 12 !iirs. L,'AcCarthy, Dr. Scherl, Mr. Prasadl from "4assai-l- i 13 Suffolk @,-IP, and of course, Dr. Sparkman has alread snok6h y [with us this morning. 14 15 If there are other guests, I do not have their namesi, 16 here. @qe would certainly invite you to participate in the open sion. I have been asked because of r commitments to 17 ses othe 18 if we could call on Mr. Sargeant, from the, Maryland PLIP first,' 19 and I would do so now. 20 And I would ask to have you identify yourself; if 21 you will, for the record. And give us vour statement, or su,,,)-@ init a stater.-ant and then following an discussion will you y 22 23 please -- we'll hear also from Mr. Bacon. If you care to sp6a""I 24 and then if that is satisfactory, we will come to Dr. Scher!, and others from the liassau-Suffolk R@IP. 25 IIP,. SARGEMIT: Thank you I do have a 12:00 aopoin@-- ent in Baltir,,,or@, an,@,@. '--hat is what you get vou try 0 2 3 ,5chedule things so tight. 4 I am a member of the Executive CorLmittee of @.ie Regiona 5 @idvisory GrouD and the I'@aryland 1-@legional -@lledical Program. Like I am a volunteer and give my time for -- towards ,-.0pefull'., 6 operating an: efficient and.effective regional medical programme 7 8 I do have a statement which has been aistri'--Uted to 9 @ou but in the interest of your time, I am going to sLLnmariz- 10 it if I can. IIhen wb,,.received the hews referred to earlier 11 this morning in -!Ilaryland we did discuss it at 8orc length, 12 jancl felt it -important that perhaps people coming fro--i all over lithe country are not ascdgnizant of the ctv of Ball-.4--ore and i 13 r 14 ;the state of Maryland, as they might be, and we felt it would 15 be irinortatt that you understand our case, And bur philosophies 16 and therefore that is Part of the reason that I h re today. am e The Gentleman from VA is ptobablv close to "@-aryland 17 18 iso understands the geographic situation perhaps better than imbst of you and I am sure Dr. Schreiner does, from Washington. i 19 aryland has a fairly large population but our Regional l@-le icali 20 2@i 1POptlation only serves about three million of that p6..rulatiorl is mad-- un of 2.7 million, in 14,,iryland. 22 23@ And 300,000 in York, Pennsylvania. I-. thirl-, it was 'r f@erre-d to earlier this mornina, that. reqional medical nrograT:i@ 24 o cross state boundaries and ours indeed does. As all of 25 I the Regional Programs we have been involved in changing prio@-- 2 ities, and a change in the effectiveness of funding, ai-ici :7,o 3 fort!-i. 4 So have been somewhat perplexed at times, and 5 somewhat harried at times in order to get in our applications 6 for money. And 1 am sure that you have experienced .@ie same- 7 Situition that we have. 8 Now, of the throe million people that we serve in 9 the Maryland Regional @-ledical Program approximately two 10 million of that total is included in the metropolitan Baltimors 11 he five standing counties as well as area, That comprises t 12 Baltimore city itself which is a separate and distinct politir-- 13 subdivision,, not part of a county. And in western 4'-Iar land there are approxir@atel',7 14 y 15 300,000. These figures are on the stateme nt which was 16 given to you, I am rounding it off; on the Eastern Sliore of 17 1-1@aryl.and, which 1 quebs is referred to as Chesapeake country.,, @.18 there are approximately 250,000, And in the southern part 19 of Maryland is 115,000. 20 Then we have an additional 300,000 in York, Pennsy 21 vania. Interestingly enoughi.,of the population, and that is two Million in the Baltimore area, 75.6 percent of that pop- 22 are ulation/in the low income area, in fact, 25.6 percent of the 23 24 people in metropolitan Baltirctre city alone are Medicaid 25 recipients. In fact, 54 aercent of all the people in the state@i 2 of Maryland, the entire population of .','aryland who are inedi-! 3 caid recipients reside in Baltimore city. lIence., I think i 4 what I an. tr ing to point out to you is that many of our y 5 obligations have been centered on Baltimore city, o7hich has 1, 6 been om the driticisms that we have had. 7 And we have tried to expand our services in areas I 8 outside Baltimore but primarily-the greater part of our eff r 9 and concentration has been toward improving methods of the i 10 people in Baltimore city to receive medical dare. And so, 11 while it may seem out of proportion to the members,of the 12 group, And the members of the technical advisory grouol indeed n't when you look upon the geographic and the econ 13 it has oini c 14 distribution that exists in the state of Maryland. 15 Now, we have adopted many approaches in our effort@,, 16 to submit grant applications. 1-7e have -- amongst those 3@ncludc-1, of planning, for Health I.',Iaintenance Organizations 17 support i8 we have been a great deal of atieht education in hyper-tensib7- 14 for the low-income black families, PArticularly in Baltimore city. 20 21 We have pioneered in the areas of home health care 22 services- to neighborhood corporations and we have also Assistc in the training of pediatric nurse practitioners who to8av I 23 in Maryland Are serving not 6nlv Baltimore dity; but they 24 are,servinq in the rural poverty areas as well. 25 -tant 1 I would 14ke to 7'0 in tout some of the very -Le c 2 e-ffe t@- of the P@,',') h as li,-.d on activities i,n title, lieal. id 3 in the state of 11"4,irylaiid. In Baltimore -- I c-:im sure 4 those of you associated with medical schools in the @7ity. 5 There is always great rivalry between the medical schools, 6 who is going to be the first with what. 7 In Baltimore when we developed our mechanism for 8 let me get the correct title here. lidney Transplantation 9 Program. Ile were funding part of this several years ago. we were able to bring together the state's two medical sdh@Oll,, 10 the state Ilealth Department, la l@idn--y foundation, and two 11 12 or three of the communit@7 hospitals which had their own pro- grams,, to bring them together. 13 So now we have one unit working in a cooperative 14 manner to accomplish the objectives that four or five units 15 were working towards before. Ile think that this is a very 16 1 positive accor d 17 ,Iplishment that has been ma e in the city of 18 Baltimore, particularly when as I said earlier, there have al- 19 ways been rivalry. 20 And I see some smiles on some Doctors faces her 21 Ile also bacY, in 19G9 asked for and received a grant of 8115;000 il't6unJed off for a three vear closed chest cardio-ptlitonarv 22 11 resuccitatioh training proaram. And this has been ta'p-.en over I 23 since that tire by the ileart Association of @-iaryland who has i; 24 trained some 13,000 individuals in the life saving technique. iria them in connection with m a r -Lals into Dutch. And is us 2 its patient education )rogrL-,-ns in Europe. So, a(Ilain', we think that this is a very important 4 for us @.-,Iow, these three things that I have just mentioned 5 to you. ile feel they demonstrate the vital role that the 6 ',,Iaryland Pegional %'iedical Program has played in the devblopr,-@.,it 7 of new and effective methods of providing critically needed 8 es where f@ reviously existed. servic -w if any p 9 You have before you today, or you will have before! 10 i:l you today two projects which applied for in our Jull, al3plicat'ici two of them applied directly to the 1--estern part of Nlaryland. 12 lkrriere three hundred thousand of our population reside. They are part of the second application oroaram. 13 They involve health education in one case, h6alt, 14 15 1 education for teachers and Professionals in school system, 16 a ]olnt effort to educate the teachers so that we can cormunidra, 17 i this information to the students, and the school svstem in 18 liestern Maryland, which is part of the Appalachia Poverty @191 Region. area. 20 i Over on the Bastdrn shore we have, which is 25o#,Ooo population, we are funding a clinical cancer program a 21 hospital di charge planningo:ogram and c6htinti du at'onal s n c I al, in Tiv t County. 7i!l th 6e f the program in gener ar r 0 se areI 23 24 now being continued under private enterprise and private fun in York, Pennsylvania which we serve, with a population 25 i i I i 1 with a population of 300,000, approximately (-T'vO@n 2 continuous attention to this c-,'roa. @e have an acute intermediate nd long term scol a 3 ogram begun in 1969 .iitli a grant of $561,000. '."his 4 care pr pe ial hospital unit for the total care and 5 established a s c ince the termination of the rehab of stroke T)atients. And s t 6 funding for that program 7 in 1972, the entire program has bee@ continued and today is serving an areas with a population 8 of 300,000. 9 10 lie are very proud of these accomplishments T ich we t'@'link are positive things which perhaps in the rush of all!, 11 the other applications and information coining to you may be 12 13 overlooked I would just like to make one li?.St comment, o 14 15 point out that each of the eight projects that we have pro- 16 posed for funding which will be before you today, at least, i we anticipate is aimed at achieving a specific ob4-ctive spelle 17 out in the latest, I said latest interpretation because as I 18 have indicated 6arlier, there have been continuous changes 19 of Federal guidelines, and that is developed cooperative 1 20 21 relationships in the improvement of care in unoer-@erved at--asi Developing innovative approaches to meclica'L care. 22 All of these projects received full review by the T.Br-,hnical 23 Review Committee or our Regional Iiedical -3rocl!ram ID, 24 t-h regional advisorv group and by the ,,aryland CoTnpr--hdnsive 25 5 5 Health- Plan agency. 2 I thanlt vcu very i-,uch for @7our time. I have been 3 as brief a!7, I cotilcl--. do have --orr,,Dlet-c details on the 4 material that has already been distributed. I am glad to ansi-7er 5 your questions. 6 DR. PAHL: Thank You very much, Mr. Sargeant. Dr. 7 Gramlich? 8 DR. GRAI-ILICII: Mr. Sargeant, I am sure we all very 9 much appreciate your lucid comprehensive remarks. May I ask 10 your occupation? 0, 11 MR. SARGEAITT: I happen to be the Executive Direct t 12 of the State lledical Society, 13 DR. GRAI-ILICI@I: For the state of IIaryland? MR. SARGEA,4T: Yc-s. 14 15 DR. PAHL: Dr. I-lammock? 16 DR. XIAIU40CK: I,,That did you say about the medical 17 schools competing together. 14hat? 18 !LIIR. SARGEANT: We did get them into & kidney transpla 19 program. It has been very effective and we have very &6 ive 20 recruitment for kidnel transplantation that are 21 DR. But that is the only program they met 'together on. 22 MR. SARG'-rAITT: They have gottc-n to ether in many 23 9 others. The university medical service program is@working 24 25 very-closely with them, as is the I%Iedical Society. ille@have a close relationship that we try to bring them together. Try think -om- 1 to get them to see each other's vie%i points. 141,@ 2 petition is good. li@ov7ever, we 6on't think that is entirely1 3 bad. 4 DR. P.,MIL: Is there any other discussion or contents. Thank you very mueh, L',Ir. Sargea @iou ma 5 nt. 1-7e ho, e you- 6 appointment in Baltimore without bre'aking the speed limits. 7 Mr. Bacon, do you have anything to add? 8 MR. BACOi4: '@io, in view.of the time pressures, Dr. 9 Pahl, it has been a pleasure to be invited. And if there 10 are questions I would stay around. But I also want to get 11 !-It. Sargeant back to his meeting. So I won't interfere w@ithil 12 that. 13 DR. PAIIL: Yest Dr. Janeway. DP,. JA'.IIEI,,IAY: Could I ask one question of Mr. SarqecAn 14 15 When you say you got them together, does that mean n t e 16 kidney transplantation and dialysis@ are being done in oniyl 17 one of the universities? 18 MR. SARGEIU4T: we have in !,Iaryland, perhaps, a unique 19 situation. Two years ago the state legislature passed a 20 statute which set up a I-laryland Kidney Commission. That 14arylAnd KidneV Commission has jurisdiction working with the 21 2A CIIBA to designate only cc@irtain areas for kidney transplants and dialysis. 23 In answer directly to your question, no. That do@sli 24 not mean that there is only one university in Baltimore oin(i 25 would have to be some interchange I that. Obviously %@'herc 2 back and forth. b c- 1 3 -here ar& manv dialysis centers. But I think I 4 to my understanding there are onlv two units, two transplanta- 5 tion units in the City. 6 DR. PAIIL: Thank you very much. @7e certainly under-@ ash off to Another appointment perhaps we may 7 stand as you d 8 now turn out attention to I believe Dr. Larry Sthett, 9 from NassAt-Suffolk has a statement, And Dr. 8cherr, if you 10 will identify yourself for the record we will be pleased to 11 hear f rorq you. 12 DR. SCHEPP: Dr. Pahl, members of the Council, t.Im 13 Dr. Lawrence Scherrt Chdrman of the Nassau-Suffoll-I regional 14 advisory group. @d I am a member of the area's r,6oi641 15 community. I appreciate the fact that I can appear 0 ore I 16 you. 17 The purpose of my visit here is, to express the 18 strong support of the regional advisory group for our program -19 and to answer any questions that)pu may have. I,,e recognize 20 very well the critiques of this Council and the organizational 21 of.. our PAG group. 22 And actually to that end I visited the di 18ion of the regional medical program with another member of @.G 23 24 to speak -with the staff#, to work but means to put into effecl@- 25 what was necessarily to present this grant before 6 man I Yesterday I unfortunately could not be here, but y of 2 you did hear our coordinator, lir. Prasad qo over the contents@ 3 of our program. 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 -- tliev are 7 explained in that statement. 8 I just would like to clarify one or two poitts, 9 that are not in that statement itself. To begin with, our 10 region, Long Island, the two counties as in Maryland has a 11 competable population of 2.6 million people. The distribution 12 of the population is in a rather h6tero geneous fashion. Half being in an established suburban community 13 r 14 the other in; a rural cor,,.muhit@7 fast becoming a suburban 15 community. Secondly there is a rather unique geoqraphi c 16 position of our region. It is penni iisular in origin, and 17 finds itself admirably to regionalizatibn. 18 And it is that end that we have developed our Pro,- 19 gram. it is a community based regional medical program 1,7hic.'I@ 20 has been in actual operation for the past four '. years and cyi 21 ..as been recognized by the community as an appropriate agen. -ntation of certain health programs. 22 for the 4-mplem@ ITO",L earlier this year,, till-- Regional Advi rv Grou@' 23 so 24 through it's committee had established the goals and 25 of ambulatory care. The actual development of delivery -.3er@ reventive care vi.ces and diagnostic servicaf7, of and this fortunately conformed to our areas, th@- goals anO 3 of TTassau-Suffol)-, Coiil)rc-liens4-vE,, ilcalth Pla,,iiing Council and 4 'Was actually the start of-good effective coon---ration beti.,,een 5 the two agencies. 6 @oiq, the grant before you is reall%7 a revitalized i.4 L 7 approach for our liassau-Suffolk regional medical program. 8 I-le are oroud of the stated objective and the methods of achi---v- 9 ing these objectives. 10 To go into details it does have fourteen dir6-ctiA4 11 ambulatorycare projects.. It has two emergency services project which are in essence ambulatory qare 12 I.Drojects. @.nd it has 13 two renal programs which have arhbulatoty care components to 14 them. '15 Thereby meeting our goals and nriotities. l@o@,q, some 16 of the programs, despite the current limitation on RI.",Ps futur6 17 course do requite two years for realistic completion. Our@ 18 grant contains provision for this as well as t.rie means for 19 continuing staff support. 20 That is, not only for the monitoring those particular 21 programs that are carried forward, but for monitoring what 22 has cone@on before, what is going oft this year in the brbqramg that have been started in previous years. ;',-id W6 believe 23 that is-a rathet vital and imp ortant role. 2-1 Just three other very brief items. on-- is the 2z -lP sta 1 P ff. The advisory group believes that our newly 2 staff under the direction of tir." ilrasad has the strcncjth and sdom and tl-ie@Ic-adershi.p to heir) us carry this I)rogr,-im. 3 the @,@ii 4 Through to it's successful complc-tion. 5 The grant before you will,, I think, not only reflects 6 their dedication, but I think it reflects their expertise in i, 7 their field,, and I point out again, that their technical 8 competence and their cooperation with regard to our area-wide 9 comprehensive health planning council. 10 Cocondly the PAG itself has corrected some of its -7 11 most of its prior organizational difficulties. That is, 12 the separation of t@-functi6ns of the grantee organization- 13 from the regional advisory group itself. The by-l.aiqs have 14 been revised And completely conform, now, to PI-IP directives. 15 And I think they have sustained a continuing int---reOt 16 by the way, in it's,objectives by this representative communi@N, 17 group. And we believe that it is a major and a viable organiza. 18 tion to serve the health needs, on Long island. 19 Secondly, a word abouf.@the grantee organizations. 20 OUr grantee organiztion is independently incorporated specie c ly to deal with P.J.IP functions. I would just likd to point 21 out that in a recent fiscal audit, covering three to five 22 months on a rather intensive basis really on a ddil y basis, ii 23 the grantee organization was commended for its' expert handlii Ii( 24 of the fiscal matters. 25 1 This, I understand, is unusual to have a comr,,,--nci.,.--., 2 on --,-I exit conference. Finall,,Y, in c"oTin(T, I viould just 3 like to reaffirm my.-supoort of our program in the support C, gional advisory group. 4 the re 5 Ile believe that the program is well designed and it is well coordinated to meet the needs of the people of i 6 Long Island. Ile have asked for an amount which exceeds slic7l,-,,t.11 7 8 two million dollars for this next period. we do ask And o request and do request that you favorably consider this, and 9 10 thank@ y-ou very much. DR.PA,IIL: Thank vou very much, Doctor. I am sure %,ou 11 12 would be very responsive to any questions that may come up. Is there a discussion question? illr. l@ililliken? 13 MP,. PIILLIKEil: T-?ith regard to past budgets i in recar e@ 14 15 to p the projects that you are oro osing, or recommending, .;ithin 16 this, what has been built in to see that those projects are 17 inter-related with other sources of funding. And what is 18 the potential for their continuation in case the PIIP money is 1 "119 not available after this grant period. 20 DR. SCITERR: That of course has ali-.@Ays been a r..a3or 1 consideration of the Regional Advisory Proup. Despite the 2 'SUPPOsed@la8t year of funding, and that is to seek a N-7a*@ to 2 2 stimulate the project to ]:)-Z@,in @.,it)i. encourage the T)ro@ec,-r- ffi 6 or other provider organizations to ick up the Dtdora,-i @24 0 c P provxd6-d it is demonstrated its worthiness. 25 Now, I think that theroin is the strength of our I that have started have been picked u!-, program. Those l@rograms tions emergency services ).)Al m@- csT.)r-ct by other organza 2 in so 1 1 bv some institution,:-, 3 county health O@par,,ti,,ents, renal programs hopefully the institution 4 and by community medicine, and by by which that is developed, and so on. 5 om the ver beginning to it is our intention fr y 6 ogram as a stimulus to start developing use the regional pr 7 e permanent 8 each programs, ultimately to be picked up on a nor 9 basis by other means. DR. PAHL: Thank you4 Is there further discussion 10 f questions of Dr. Scherr? 0 12 (-,io response.) DR.PAIIL:Mr. Prasad, @-7ould you have anything to 13 4 add? 15 MR. PPASAD: No. I spoke yesterday. 16 DR. PAHL-. Would you use the micro-,)hone, please, if 17 you care to make a comments MR. PPASAD: 1.10. I Spoke yesterday before the Revie@"7 18 19 C6mmitteeo and most of the Council members who were present, and I have no comments to make. U.-iless you have some questions 20 to ask. 21 DP..P,,NIIL-. you. Miss McCarthy? 22 Miss IICCARTIIY: I-lo. Thank you. 23 DR. PAHL: Well, theft, if there is no further dis- 24 cUssion on Nassau-Suffolk, I want to thank You for returning 25 submitting your stal ment through Mr4 Prasad here today, and y,-,sterd--,y. Are ther-a any ri@-.mbers of the public who wish to make A statement to comment upon the proceedings so far? Does the Council have anything further to discuss in the open session. Dr. S-,arkman? DR. SPARKMAN: Can 1 make one mote pblhti HOrb? DR. PAHL; Yes. DR. SPARKI@IAN: I think you are all familiar with the National Association P14Pf which instituted the i,ai,:suit which released the impounded funds. @vhen this was set up it was our view that this would serve not only this lawsuit urpose, but alto some organization like the American Public p Health Association and others to provide staff education and i training. li And in fact we do have such a meeting Planned in -1 7 Denver for September 3rd, and 4th, I At which I think a very good program has been developed. Iqhich sb far., has been oversubscribed by the various RMPS. 20 onto parts of MIP And which will.@ieal with the vari 21 t develoT3m@ n programs.-projec -nt. llanageme t, and I am sure ,.vill be of considerable Part, and we see that as the logical i" extens on of the National Association. 24 Actually, all of ou are invited to attend, and y .le will see that information is given to you about it. I I . ii nl DR. PAI-TL: Than!,, vc)u. Dr. (,ramli.ch? 2 DR. GRAMLICE: Would it be appropriate to ask Dr. 3 Sparkman to give us a one-minute explanation of what the 4 NPJ,!A is? 5 DR. SPARTUIAN: Yes. I had hoped that Dr. Jack 6 I Enale from the Lakbs Area PI,!P was going to }--e hero, since 7 he is the president of the board. This is an organization Dr. Giamlichi set up 9 aside from. the steering committee in the regular coordinating 10 with the coordinators committee, funded bv personal and6 .11 private sources quite aside from anv grant funds and initiated 12 i@! originally around September of last year when it became apparent that without the release of impounded funds the 13 -)ad,. 14 P14P future looked pretty I 151 But it has continued with meetings of the board, 16 lil the board being made up of some representatives of the 17 coordinators, some have come from the steering committee. 18 W6 think there is a real need.for the kind of staff traitind I that such an organization can provide. 19 00 11 We hope that this is going to be th e ultimate 21 future. obviously we should be out of the legislative i@ I rleani the leaal problem. As Dr. Pahl has said and as vou 2 ii know, this, I believe, has been handled andi &8 I h6p6; done 23 with shortly. @24 There has been question as to whether PIIP crAnt 25 r, 5 L2 funds could be used for this purpose. So far they have not been used. And I have spoken vigorouslv,to this point. I am told that legally it may be appro ri.atb to use grant 4 funds. 5 r-ut I think until @,7e are beyond the legal problem, 6 until we have clearly established that this is an educational 7 activities, that these should not be used. So far they have 8 hot been used. 9 The membership is made up of a xyide Varietv of 10 people -- Pi-!P staff, advisory group people, other individuals 11 with whom we have worked. There are some institutional 12 memberships, peo le like medical assocations, hos itals, p 13 volunteer orqahitations @,iho wish to 4oin in that fashion. 14 DR. PAHL: Dr. Hab6rP 15 Thank you, Dr. Sparkman. 16 DR. HABER: Dr. Sparkman, I hope you v7ill indulge 17 me to the extent that I will probably ask you about matters 18 that have concerned me deeply for a long -period of time. 19 But it strikes me that with the imminent emergence of a 20 national health insurance' strategy certainly the brgahiza" I 21 tional and substantive efforts demonstrated by RMP have a 2 role to play, particularly in the transitional vear8. 23 July question goes to thig@point6 if indeed as this booklet indicates there are some 21 million people 24 wine can begin to be beneficiaries of a .-national medical 25 n3 programf what has been done to bring home to the people 2 the clients, if you will the benefits accruing to the 3 program? 4 It strikes me that I am unfamiliar much of the 5 effort has gone into the providers in terms of popularizing 6 or informing. I-!hat 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. SPARKTAN: I think not enough has been done, -10 Dr. Pabet If I understand the intent of vour question 11 one of the goblems that-I see as a coordinator of an PMP 12 is that it order to futction most effectively you do some 13 very low-key way to bring people together and make as relatively little evidence of your existence. 14 15 And I find that this is the way you can get d3.f- 16 fer6nt groups together. And sometimes they hatdlv recognize is accompli. hi this. 17 that the regional medical program s ng 18 But it order to demonstrate to Congress, the public And 19 1 others that you are accomplishing something, this it not a 20 very effective order of operation. 21 And so we find ourselves caught between these two. I think that in general regional medical programs have done 22 a T--)oor 3ob of deirotstrating to beneficiaries that thev havei 23 in fact- served a useful purpose, I find continually as I 24 move around our txio-State region, @,7ashingtbn.ahd Alaska, 25 (,7 n4 that there are unexpected and surprising numbers of people i..Tno nav ched in some way bv our r gi@onal medic 1 e been tou a @l program who volunteer the fact that their appreciation and 3 4 their hope that something like this will be continued because', 5 they have been unable to find any kind of assistance to 6 bring together activities to accomplish needs, to respond to needs that they have. 7 DR. HABER: I would hazard a guess that probably 8 9 90 to 95 per cent of the beneficiaries, while they may be aware of the local clinic or school operation or outreach 10 operation, are not aware of the fact that this is served by the regional medical T)rogramin tqrms of coordinating, plan- 12 ning and executing of it. 13 And that is a critical step, it seems -- to bring 14 15 that realization home. 16 DR. SPARKP.IPIT: I would agree. And I would welcome 17 an@7"thoughts here any of the members of the National Advisorv, 18 Council have about this. I think we have done a poor job 19 in this respect. 20 DR. PAHL: I think in view of the time I will closel 21 this open portion of the meeting and again thank our visitors -and guests for appealing and speaking with the Council And 22 being available for discussion, and ask at this time that alli 23 individuals in the room other than those .-.,ho are part of 24 25 our.council or Federal empl6vbes please leave at this time. and th n5 I Let's take a ti,7o-minute stretch en @,7e v7ill 2 enter our review of anplications. 3 (A short-.recess was taken.) 4 T)R. PA17L: ?,,@lay v7e come to order again, please? 5 Will Council come to order, T)lease. I would like to r6con- 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 confidentiality etings which you will find imm6diatelv of me 10 behind your agenda. 11 And I would like now to turn the meeting over to 12 Mrs. Silsbee who will guide us through,the at)nlications. 13 Most of you were here vesterdav and hoard the discussion 14 We hope that that wasa mutually rewarding and satisfying 15 experience. 16 Ihave heard some favorable t6mments(from the 17 Review Committee members. And I certainly hooe that you fo nd 18 it 'of interest. Let me state @,.for the record that this was '19 an unusual proceeding and that it was through a comedy, a 20 set of highly unusual circumstances, but that the members of 2'L the Couh6il were sitting as 6fficiA! visitors and not in any way, as participants. 22 And so your discussion, review And recommendations 24 today are now as Council members and may be in sur-port of or quite divergent from whatever discussion, recommendations 25 n6 were made yesterday. And with those few comments, Judy, would you 2 please lead us through? 3 4 MRS. SILSBEE: There are a courle of background 5 items that I think are important here. The committee did 6 expre s 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 9 not have been Apparent to all, but at the gbt-toqeth6r in 10 11 July the individual reviewers did talk with one another and, i in most cases, where they were not able to, the tried to 12 y communicate by phone. So there was a good deal more back- 13 ground in terms of their deliberations than appeared in i5 public in the record. 16 The other thing is that we put on your desks this 9 17 mornin I mean, in front of you this is supposed to 18 be pink. And this is the Staff's -- yesterday as the CoTnmit-'@ 19 tee was deliberating we were trying to vrite these up so 20 that you would have something in front of vou. This is the gist of the recommlet6ati6nt of the 21 c ommitt66, and they are alphabetically arranged. Also, r just now we have -- I feel like, yes, Virqifiia; there is a way of 23 doing this - we did get the transcript for Yesterday 24 mbrning's session back in time. 25 7 0 This is the first we have been asking for this n7 2 for some time, but it finally came abou That is only t those regions that--were reviewed in the morning. The after- 3 noon session is still being typed. So we have asked the 4 Staff to take apart the transcripts and give you the 5 verbatim transcript of those regions that we now have the 6 .i I transcript available on., 7 l@lith that background, I think this morning we will try to go alphabetically. Dr. Schreiner? 10 DR. SCHRPINER: Before you do that, I would find i 11 1 it helpful in perspective to know if vou added up all thebel 12 what did it come to? 13 MRS. SILSBEE: A very good point. 14 DR. PAHL: l@lell, I have the figure. 15 16 MRS. MORGAN: It was on the board. MRS. SILSBEE: I erased it from the board this 17 18 morning because it didn't seem to be a thing to be public knowledge. 19 DR. PAHL: The figure is $26,5570154, which ist 20 from a management point of view, a verv nice level. But you 21 1. should not be bound to it in either an upward or downward 22 direction, particularly in view of the action you took this 23 morning which gives us that kind of flexibility to manage 2 our affairs. DR. SCIJREINER: That,gives us a feel for where we 2 are. 3 MRS. SILS.BFE: i am asking Mrs. Leventhal to dis 4 tribute the kind of running summary we keen that puts toge- 5 -ther as much information as you have at this point. This is 6 the summary data on the recommendations yesterday. 7 DR. JANETIAY: Mrs. Silsbee, can I make a ratuitbus; 9 8 comment? 9 MRS. SILSBET: Yes, sir. 10 DR. JANEIIAY: 1 think it is an extraordinary 11 accomplishment to be able to get b the transcripts on the ta 16 12 this morning, You must have had-people chained to the 1.7alls 13 all night. I don't know how that was done. 14 MRS. SILSBEE.- Well, this gentleman to my right -15 and his peers are the ones that are responsible for that. 16 But also, a push I think, from the Dit6ctor's @,off p ice@hel edJ 17 DR. PAHL: We found that once the rumor that I 18 relayed yesterday didn't materialize,there was a free eveninlai 19 for everyone. 20 21 22 23 ALABAI.!A n9 !-IRS. SILSBEE: O.K. Could we start with Alabama? 2 3 I think the best wdv to proceed today is to ask the primary reviewer to make whatever comments and make recommendations and then if the secondary reviewer has anything different I ill ask for that. But it may not be necessar at this w y 7 point. Alabama. Mrs. Gordon? 8 MRS. GORDON: 1 was pleasantly surprised this 9 10 ii morning when I read the various and sundry things we have 11 received, since I wasn't here Vestetdav. I agree pritrarilv with the comments made ye8terdavi The onlv addition that 12 I would have is that Alabama does have a couple of their 13 pro3ects that noarlv all of the monev is for equipment. 14 And that I do question. 15 That is 126 and 125. 16 MRS. SILSBEE: Mr. Ogden, you were present yetter- 17 18 day. Do you have an thing to add? y @19 MR. OGDEN: No. I would agree with the comments i that woke made yesterday, particularly those which appear 20 in the transcript from Dr. @Taun. Project number 134 does 21 2 indeed appear to be the same project that appeared here in 2 the previous application and was rejected. 23 And it is unlikely -- I felt in reading the material 24 that was sent to me that it could he completed in a 25 7 3 d some of their oth r projects nlO I reasonable neriod of time. An e 2 feasible within the periodof one perhaps are not terribly 3 year. 4 The matter of the equipment doesn't bother me that 5 much. And I would agree with the allocation made by the 6 Review Committee yesterday. 7 Mrs. Gordon, do'you have any other feeling on @8 that? 9 MRS. GORDON: No. I would agree with the alloca- 10 tion 11 MRS. SILSBEE: Could I have a motion, pl6ase? 12 MR. OGDEN: If Mrs. Gordon will move it, I will 13 second 'It. 14 MRS. GORDON: All riaht. 15 MRS. SILSBEE: The motion has been made And 16 seconded that the Review Committee rtcommendAtion6f a 17 funding level for the Alabama application for $680,000 b e 18 approved. DisdussiOh? 20 response.) 2 1 MRS. SILSBEE: Nll in favor? 22 @70ICES: Aye. 23 MRS. SILSBEE: Opposed? No response.) 24 MRS. SILSBEE: The motion is carried 25 7 4 ALPANY nll MRS. SILSrrE: The next region is Albany. Dr. 2 Watkins is the primary reviewer. 31 4 DR. WATKINS: Albany has a history as a superior 5 region. In the May funding which Council recommended in Tune it almost got 100 per cent of the request. In other 6 words, it was 1 million 66.hundred thousand and they got 7 1 million 12 thousand. 8 They Are asking this time for 541,437. Mr. Barrows!, 9 recommended 4870000. Based on Albany's superiority and 10 community involvement, I make a motion that they get 487,000 which was recommended Review Committee. .yesterday by the 12 MRS. SILSBEE: Dr. Haber? 13 DR. HABER: I have nothing to add, except that 14 would ask Dr. Watkins if we could amend his motion to make 15 16 it $500,000i $13,000 more than he has suggested. MR. MILLIKEN: For what reason? 17i 18 DR. HABER: I think that these projedts are well 19 conceived. I think that the one I am particularly intere ted 20 in is the one commented on in terms of evaluation of the medidaid screening ere seemed to program. I think that th 21 be some disparity between some of the reviewers about what 22 the level of funding should be. 23 Since.b6th of them are a little bit below what 24 they asked, I think we can be slightly more generous and give@i 25 12 1 then some more. 2 MRS. SILSBEE: Does thatconstitute a second, Dr. 3 lTaber? 4 DR. HABER: Yes, it does, if Dr. TTatkins will 5 i accept it. 6 DR. IIATKTI\'S I accent it. 7 1 MRS. SILSBEE: The motion has been made and secon e 8 that the Albany ap lication be approved at a $5OOtOOO level. p 9 Additional comments? 10 Dr. Milliken t mean, air. !,Iilliken? 11 MR. MILLIKEN: I am concerted about the precedent 12 for the future applications. 13 MRS. SILSBEE: Could vou use a Microphone, pipAse, 14 sir? 15 MR. MILLIKEN: I am a little concerned about the 16 edent of this amendment for consideration for the forth prec 171 coming applications. I think if v7e could use specifics the 18 Dr.'gAve in terms of a specifid projedt that the increase 491 be allocated specifically to that for the reasons that he 2o gave rather than -leaving it to the judgment of heaven, they 21 might spetd it on projects that this Council and the Committee feel were not viorth 22 y. And I notice a departure from out usual routine. 23 I am not against it. But I believe there ought to be more 24 specific instructions. 25 7 F Mrs. Morgan? nl3 1 MRS. SILSPRF: 2 MRS. MORGAN: Can we give srecifi-C instructions 3 to the regions as to how they are to snend the money? d that the 4 MRS. SILSBEE: T,,Te can stronalv recormmen 5 basis of the funding decision was based on that asnect* 6 DR. PAHL: We cat qive advice, but we do not really! earmark it for one specific vroject. And in that sense, 7 in adding additional funds we would just have to rely n 8 . UPO 9 whether they chose to follow our advice or not. So your to reasons should be very -well spelled out. 11 But we can't guarantee the results. lie do our best! 12 to transmit that advice. 13 DR. GRAMLICH: Dr. Pahl, Mr. Milliken't remarks 14 'have crvstalizod a growing concern that has wbrm.06 its way 15 into my mind. This sounds a little bit like -- I want to 16 ap6logiz6 and make it very brief. 17 The mechanism that is used is illustrated by this 18 particular request, especially where yesterday you Will 19 recall that one reviewer said, let's make it this figure, 20 the second" reviewer said, let's make that, and they said, 21 well,, 16t,s just split it. And I like the approach that Dr. Habet has suggested: 22 that they be mote srecific. And this poitts uD to rnd the 2.3@ @Urqoncy of the problem which is only existing in this;parti- 24 cular session, -because if this is the last session it will 25 77 nl4 1 never be up again. ion in 2 But here is a situat which the whole structure 3 is a reverse pyramid. The primary reviewer, who is the onlv 4 one who has really had the time and the ability to go over 5 the grant request in detail is the one who starts at the 6 bottom of the apex of the pyramid on which the total funding 7 process is accomplished. 8 The secondary reviewer savs, well, yOtl I think 9 it is probably all ri ht, or mavbe we ought to do this or 9 10 that. But then the Review Committee accepts that, and if 11 we accept ito in turn, the Review Committe6ls recommendation 121.ex pro facto without any really serious consideration we are just compounding that pyramid, on which some vdty 13 important decisions at the regional level might well take 14 15 place. 16 Sd my plea is simply that I think y6st6rday's 17 review session, which wasinterbsting, very interesting, was 18 ni u it was Pres§urdd timewise- and may probably u a e in that 19 have reached the tight decision ntobibly in most instances 20 it d:bd. 21 But I would agree. I think the Council should subject that to air.,ole scrutiny before acc6Dtiho it. @22 23 MRS. SILSBEE: The notion has been made and A seconded that the Albany application be approved 24-@ at $500,000 with advice to the region about the one project involving 25 7 8 nl.S 1 the State. 2 Is there further discussion? 3 (ITO.'response.) 4 MRS. SILSBEE: All in favor? 5 VOICES: Aye. 6 MRS. SILSBEE: Opposed? 7 (ilo response.) 8 MRS. SILSBEE: The motion is carried. 9 The next region to be reviewed is Arizona, and Mr. 10 Firoto is the primary reviewer. 11 MR. HIROT6: May t ask if the afternoon transcripts 12 from yOsterdAy's session will be available later? 13 MRS4 SILSBEE: Yesi Mr. Hiroto, would you like to 14 hold off? 15 MR. HIROTO-. Yes. 16 17 18 .19 20 21 22 ii 23 24 25 79 i nl6 1 ARKANSAS 2 MRS. SILSBFF,: We will go to Arkansas. 3 I'm sorry, I can't remember which ones came tp, 4 so if you all will point this out it would he most helpful. 5 Dr. Komaroff is the primary revieuet of the 6 Arkansas application. 7 DR. KOMAROFF-. The June Council rated this region 8 as average4 Its funding level on.the basis of the June 9 Council recommendation is currently 1.425 million. They seek 10 a supplement of S816,000, The main 6oncetn of the June Council denteted 12@ around the stability of the core'staff and the uncertainty About a new coordinator to teplac6 Dr. Silverblddt. 13 According to Mt. PostA and the Staff of DR!'@IP, that Di6biem is 14 15 being resolved. 16 virtually all the vacant staff positions have been filledi And the current acting coordinator verv likely will is become the p6rmaneht coordinator. The proj6dt roo6sals in p 19 this supplement are somewhat disapo6intinq to me. And I 20 think Dr. Carpehter's review yesterday sumnaiii6s my imt)res- sions. 21 The application consists of a great variety of 22 23 unrelated pt6iedts. Many seem designed 0 uith6r the goals of a single institution within the region rather than to 24 accomplish'regionalizatioh. I agree with that. Th6te are 80 nl7 1 I two projects that I think the Council should be parti6ularlv 2 concerned about. 3 one is a.'very large project, the Arkansas digestive 4 disease center, which requests $176,000. It is actually a 5 low priority project from the RAG. The thing that concerns 6 me about this project is that they state their primary objec- 7 tive is to., quote, facilitate the further development and 8 upgrading of the gastroenterology training program at the 9 medical center. 10 And they wish to purchase $880,000 worth of ecruit)- 11 ment. Additionally, they will hold a weekly conference to 12 which practitioners from the community would be invited, as 13 I imagin6 they currently would be, and hold a few educational sessions around the region. 14 15 But it is clear, and I think they state frankly, 16 that the purpose of this grant is reallv to supplement the 17 training proaram in gastroenterology at the medical center. 18 Ahd-I think the Council ought to express some tangible 6on- about that, -19 cern 20 The second project that perplexed me is a project 21 to establish rape crisis center control program. this is i. sponsored by,the National Orcranizati6n for relomon NOW,,And 22 the State of Arkansas, and x..,ould enhance the abilitv of A 23 woman who had been raped to seek ik@.ediate guidance as to 24 what she should do medically and legally. 25 nlB 1 I think there are similar prototype for-this kind 2 of a rape crisis center around the country,that apparently 3 are quite effective. But the concern I have is whether @!P 4 funds under section 900 -of the law really allow for this 5 kind of a categorical activity to be supported. 6 It is not noncategorical; it is categorical. And 7 it does not fall, in my estimation, viithin-the language of 8 the law. 9 DR. PAHL: It is also discriminatory. 10 MR. KOMAROFF: I suppose rape can be. would, to 11 make these recommendations tangible, agree with the level 0-4 12 $4OOiOOO the Review Committee recommended yesterdayi@but 13 with two restrictions: one, that there be no dollars exbended 14 for the rape project andi second, thatho more than S30 000 15 be expended for the digestive disease proposal. 16 DR. TTTAMIOCK: Which would be for 6ducation? 17 DP.* KOMAROFF: Yes. 18 DR4 PAHL4. Dr. Komaroff, I think we would feel 19 comfortable with that recommendation at a program, 20 MRS. SILSBEE4. Dr. Janeway? 21 DR. JANETIAY: Dr. Komaroff and have discussed 2 this prior to the meeting. I concur with the technical 2 23 review and with Or. KomArbff's comments, and second the proposal. 24 MRS. SILSBTE: A motion has been made and seconded 8 2 nl9 I that the Arkansas application be approved at a S400,000 2 level, with the fol lot-!ing conditions: that no dollars be I expended for the rape review project and that no more than 3 4 $30,000 be expended for the digestive diseases activity. 5 DR. JANEWAY: That is component 104. 6 MRS. SILSBEE: Component 104. 7 Is there further-discussion? 8 (No response.) 9 MRS. SILSBEE: All in fAv6r? 10 VOICES: Aye. 11 MRS* SILSBEE: Opposed? 12 (No response.) 13 MRS. SILSBEE: That motion is carried. 14 15 16 17 18 19 20 21 22 23 24 25 8 3 BI-STATE n2O I 2 MRS. SILSBEE: The next application to be r6viewed, Milliken. ii 3 is Bi-State. The principal reviewer there is @ir, 4 Mr. Milliken, 'Dr. Watkins was here yesterday And' i 5 you weren't. I don't know whether that 6 MR. MILLIKEN: Iwill defer to him. 7 MRS. SILSBEE: Dr. Watkins? 8 DR. WATKINS: Yes. The Bi-State request was for ended funding level wag for 8275,000., 9 $472f458, and the recomm 10 And I agree with the Review Committee. I think that this Bi-State critique, the projects compared to:May-Jtne were 11 sort of around the same level - in other words, the same 12 level of priorititation and so forth except that since time is running out it is possible that they might have oAdd6li 14 15 a little to get the $472. what we are asking is that this be reduced to A 16 So 17 more feasible figure for them at $275POOO. There wag a 18 recommendation by two reviewers of 270 to 300 thousand. And 19 I think one reviewer even suggested 335 thousand. But we 20 are suq4estihq that it be 275 thousand, 21 MRS. SILSBEE: Mri Milliken? MR. MILLIKEN: I would like to in general agree 22 with that. Powever, in looking at the many pr6l66ts that 23 were recommended be dropped, there was one, number 59, 24 evaluation And placement of long-term care OAti6ht$. I don't 25 84 n2l know.the qualitv of this program. 2 However, generally there are two great needs in 3 the country which @ould show a need for developing and 4 continuing such projects. One relates to cost containment 51 for health care, and the other to get resources in lace for p 6 the impending national health insurance. And based on this, and if this is I would have 7 8 to rely on Staff -- if this is a program that can be a 9 quality ptograri and make contributions to those two needso I wou;-d recommend that we add $30,000 specifically 10 Earmarked 12 11 for funding of number 59. 12 MRS. MORGAN: 1 don't see where 59 was deleted, 13 an ay. YW 14 MR. HIROTO: It wasn't. 15 MRS. PORCAII: We've got 57, 58, then we go to 60. 161,@ MR. MILLIKEN: Oh, really? The list I have 17 indicates;@,-- 18 DR. WATKINS: Let me see if I can the regional -19 office made comments on 60, 57, 59 And 64, which were 20 favorable. And it would be an additional $60,000. The 21 I; question is: Ate we in agreement with this? If you are in agr eme e nt I will acdthe $30,000. 22 MR MILLIKEN: Right* 23 MRS. SILSBEE: O.K. Mrs. Flood? 24 MRS. FLOOD: The Review Committed's comments that t 25 8 5 n22 I are listed on the pink sheet says that brief mention is made 2 as the new coordinator. Fowevetil of Dr. Velix's arrival le i plans or the 3 little discussion was giv(n to his new ro n 4 role he might play in the development of this application. 5 Being A little bit familiar with the past history 6 k,that the power that of the Bi State program,,I thin a man 7 of Dr. Velix's personality and capability might have in 8 making the program develop into something stronger even in I 9 this last phase is something we shouldn't overlook. 10 Now, I would agree that at first.glance some of these projedts do hot appear to be of the most outstanding 12 quality. But I viould think that Dr. Pelix has the 6apabilit-vi@ 13 of holding neutral ground in a particular area where there 14 is quite A bit of thiversity medical school dis ussi6h; and I c 15 there is impingement on ti-Stato by the Illinois RMP and 16 There has been inactivity at times by the Mitsouri RM-P. I would like to Iask if the 17 gentlemen might consider,, 18 in light of the cut that was given at the itno Coundil; an. 19 Additi6hal $100,000 to fund the Bi State program at $375,000 20 rather than $275,000, with your specific recommendation of 21 that pr6je6t being included, that 59 but with no comment 221.,@e about the rest of this money that it, $60,000 or 23 $70,,000. 24, That might be of value to Dr. F6!ix to accomplish 25 something; coordination in another area. P 6 n23 1 MR. MILLIFFN: You feel that he needs additional 2 staff, do you? 3 MRS. FLOOD: FO,I don't think he needs necessarily 4 additional staff. I think he needs a little discretionary 5 capability there, to be responsive to these things in the so 6 r6qion/that he doesn't have the stigma of being r@elat6d to 7 the universities in that area. 8 I think he needs a little more discretion so he 9 can be more able than the previous coordinator to relate to 10 needs,in that region 11 DR. WATKINS: Well, if we were to review and we 12 were to add, I would suggest that it be based on what we 13 just mentioned, the regional office comments. -And t ose an additional 60, not 100. So I would w nt 14 comments were a 15 to have a reason for adding to the 275,, end the reason would 16 1 be .strongly in favor of the regional comments which were 17 the projects just mentioned, 59, 64, 60 and 57. 18 That was the group eliminated by the reviewers. 19 That is a group that is worth 60,000. So it would give me 20 a better feeling if I said 60 rather than 100. 21 MRS. FLOOD: Well, I would accept the 60. MR. MILLIKEN: What bothers me "- I am hot aoainst 22 adding Another 40-000. We have the money. But I think we 23 24 need a more tangible, specific advice for so doing, in line with my earlier comment. 25 87 n24 1 think it puts us in a vprv bad light to add additional amounts without avery snecific cause 2 3 DR. WATKINS: Can we have Staff comment on this? 4 MRS. SILSBEE: Mr. Posta? 5 MR. POSTA: I think the purpose Of what Mrs. Flood-'ti 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 DRM-P. 10 He did respond with a three-pa4e letter stating I 11 some of his goAls, what he would like to do dtrihg the next 12 year in the St. Louis area. As we know, he does have a 13 terrific reputation. And to date -- he has been on board 14 since Jul !St -- has gotten together with 6xpotimental y health delivery service system there in St. Louis as Well 16 as with ARCH program and the CITP agency. 17 And one of his primary goals is to utilize the 18 institutions already set up and yet At the same imeto 19 pursue some of his goals in primary dare 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 h as layed p in establishih And prepa @22 9 ring this particular Application. 23 And v7hen we asked him that, the answer was com- 24 pl6tely h6gative: He did hot have a role in pre_pArih4 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 heard the discussion,, is 8 thatcertain of your activities we think are first rate, 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 11 your priorities all over again and put your faith in Dr. 12 Felix. Now, this could be translated in some way or 13 another, but it does create a problem. 14 15 MR. HIROTO: Is there a motion? 16 MRS. SILSBEE: No, there isn't. 17 DR. WATKINS: V-7e move $335,000. 18 MR. MILLIKEN: I second it. 19 MRS. SILSBEE: The motion has been made And seconded that the Bi-State application be approved at the level of 20 $335,0004 21 Is there further discussion? 22 (No response.) 23 MRS. SILSBEE: in favor? 24@ 25 VOICES: Aye. 89 . I n26 1 MRS. SILSBFE: Opposed? 2 DR. JANEV7AY: No. 3. MRS. SILSBEE: Let the record show there was one 4 in opposition. 5 The motion is carri ed. 6 MR. PIROTO: Am I to leave? 7 DR. JANETIAY: Yes. 8 9 10 12 13 14 15 16 17 19 20 21 22 23 24 25 90 n27 CALIRORNIA 2 MRS. SILSBEE: The next application to be reviewed 3 11 is from California. And 'Mr. Firoto is out of the room. 4 ti! Dr. Janeway is primary reviewer. 5 DR. JANEWA-Y: As noted in the Ma-v-june review, 6 the program was above average and continues, in my opinion, 7 to be above average to superior. The May-June request was 8 on the order of $8,170,000, with a DRMP funding decision of 9 almost 7 million dollars even somewhat below the 10 Committee recommendations The current request is for $5,592,000. It is mv 12 opinion in reviewing this -- And I concur with the technical 13 review committee that the request is overl ambitious y 14 for the time frame of accomplishment. And the amount can 15 be effectively reduced to an amount of 3 million dollars. 16 11 would express only one administrative concern: 17 Although there seems to be a reasonably good relationship 18 between the @MP 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 somewhat more dispersion of activity 21 in this State tending to get back to the way it was before ,;!,reorganization, that the coordinator should he cautioned 22 if i in this regard. Z3 The recommendation for funding is at the level of 24 3 million dollars. And I so move. 25 9 1 n28 MRS. SILSBEE: Mr. Ogden? AIR. OGDET%T: I disagIree with Dr. Janeway on the 2 3 level of funding. -.And I would like to spend a few moments on this particular application, inasmuch as 1 think it is 4 the largest before us today. 5 Those of vou who were here yesterday and listened 6 7 to the discussion will recognize that Dr. Heuttig, who was the primary reviewer yesterday, recommended this be funded 8 in full, $5,592iOOO. Dr. flirschboeck, who was the secondary 9 10 reviewer, suggested it be reduced to 2 million dollars. After considerable discussion among the eople 11 p around the Review Committee table about the projects and a 12 group of other things, the final decision dame down to a bit 13 1 of dickering. Now, at the risk of going over things that 14 15 YOU li_,iten6d to yesterday,, there was a show of hands on how 16 many would prefer 3 million. 17 Dr. fleustis said, how about 4 or 5? 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, well, then I will move it at '-3 million. And they finally got an acceptance at 3 million 221 1 without any discussion of whether these were valwble rr6jects, 23i 24 whether the RMP was being cut too far or patticularditdussion 25 with respect to the quality of the this program. 92 n29 1 Now, you don't have available to you, I don't thinki, 21 the yellow printout sheets on this. Do you have this in yo 3 your books? If u would look for a moment with me at the 4 yellow printout sheets on the California Regional Medical 5 Program, there are some things here that I think are of 6 considerable interest to us. 7 MR. MILLIKEN: These are numbered. which one do 8 you want to look at? 9 MR. OGDEN: Let's begin with the cover sheet for 10 just a moment. There are 83 projects here; 61 of them are 11 new, and 22 are requests for@continued support -- 1.3 million! 12 of continued support. 13 And if you look at the next page, you will see that program staff, which includes existing projects as well as 14 15 continued projects, is 1.6 million. Now, if vou add un the i 16 continued support and program staff, you are at 2.9 million, 17 which is the 3 million dollars that we ate talking about. 18 Admittedly program staff may be possibly reduced II 19 in the event they do nothing on new projects. But the 3 20 million, I -suggest, may only continue the projects that they! have and cover Drograms. That does not cover now projects.- 21 In 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 I 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 11 DR. JAIIEWAY: 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,, 1. 10 you will begin to tee 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 14I of which were funded at very small amounts in the Tulv '74 I 15 to June of 175 request and for which they are now requesting 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 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 are talking about funding for the period of September 174 to 22 23 June of 175. Now, I find some of these to be of considerable 24 interest and also of value. There are projects here concerning 25 94 n3l the health care network in the Imperial Valley which involves 2 migrant workers. There is an American Indian clinic aware- 3 oject here. ness pr 4 There are upgrading of free clinics, ambulatory 5 care facilities -- a whole series of things that I feel were simply ignored in the discussions yesterday. And I 7 came awav 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 reaction 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_gram, 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 wou sug- 18 gest,that if we added back upwards of a half million dollars,' 19 maybe-@-even a million, we would be finding money well spent 20 in a superior program that has always had exceptional mAnage-I 21 ment and has done a great deal of good in what is now the 22 largest State in this nation. 23 MR. IIAIIMOCK: 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. 9 5 n32 I DR. JANEWAY: Let me respond to that. PerhapsI 2 am speaking not as a member of the National Advisory Council 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- sion screening program in 10 months, you had better be 5 pretty well prepared as a physician population to have some 6 reasonable idea as to what you are going to do with the 7 8 people who you identify. And that is where my comments saying that they arei 9 being overly ambitious: If there are indeed 23 unidentified 10 hypertensives in the United States, and probably more than 11 that, you can set up programs wh@ch build up people's expec- 12 13 @@tatli6ns 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 I think it is an admirable program. And I am hot 16 17 making a comment there. I am just saying that as to the 18 cjuality of it I think it is overambitious. And that was my ig iinterpretation of the technical review that was also given. I would agree that on the surface there would appear to have 20 21 been some bargaining as to the level of funding, at the 22 -outset of which one would get the impression that it v7as not being done on 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 96 n33 I factor. And I would say that I agree with your comments to 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. GRAMLICH: 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 recommended 11 a million dollars for a hypertension screening program and 12 treatment program in the State of Mississippi. 13 DR. JANEWAY: They cut is by $840,000 specifically.! 14 DR. GRAR-ILICH: Yes, but from a 2 million dollar 15 level, leavin them with a million dollars. 16 DR. JANET-IAY: The incidence of hypertension in 17 the State of Mississippi or prevalence, whatever you want I 18 to use, based upon the racial distribution and the characters 19 isties 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 22 technical reviewer on this, but when you have a very high 23 percentage black population,and in the entire Southeastern 24 United States, if you look at the prevalence of hypertension,i. coronary, arterial disease you are dealing with a different 25 97 n34 1 type of population and a different health care need. 2 MR. OGDEN: Let me make one brief comment here. 3 I think since the time we started the Regional Medical 4 Programs in 1966, we have witnessed in Pinerica-@@probably the greatest migration of People in historv. And I speak about 5 6 the migration of the black peoples of this country from 7 the South to the North and-the West. 8 We may'not all be aware of this, but as recently 9 as probably 1946, right after the war, some 77 per cent of 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 country live in the North 13 and the West and are really thought of as An urban problem. The black population in this nation has settled 14 15 in California, New York State, Michiqan, 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 19 in Mississippi it also exists in California. There is a 20 tremendous black population in California. And it has been, 21 a very rapidlv growing population. 22 Dick, may 1 just comment, too, then I will close this off: Many of these projects,I asked you to look at on 23 pages 8 9 and 10 of this computer printout are not hyper- 24 ol I 25 tension projects; these are projects spread among a great 9 8 n35 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: Dr. Schreiner? 7 DR. SCHREINER: -I.just @nt to ooint out that both 8 the reviewers have made some excellent specific points. I 9 do think, however, we should put in perspective that.7 inillio 10 do-Ilars plus 3 or something over that is roughly 10 per cent 11 of the entire nation's RMP funds. 12 .1 don'tthink we should view California as being I 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 unds that were requested in this cvcle. 3 million;,,- the f out of a request of 5 is about 60 per cent. 20 So an average region ought to get around 3 million.i, 21 But I would think that if this region is, in fact, regarded 22 to be superior or above averaqe that -- jtst that is another 23 context within which one might look at the 3 million. I 24 MRS. SILSBEE: Dr. Janeway has made a motion that 25 the application be approved at the 3 million dollar level. 9 9 n36 1 I didn't hear a second. 2 MR. IIMIMOCK: I will second that motion. 3 MRS. SILSBEE: All right. The motion has been 4 made and seconded that the California application be approved.;. 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 rut your hands up, please?i 11 That is one, two, three, four, five, six, seven say aye. 12 Nay> Seven. 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 projects over 17 here. I have just been looking at that hypertension. And if you look at on page 9,1 thought I had it, California, it' 19 -seems to have gotten away. But it looks to me that there arel 20 lots of hypertension projects over here -- 159C, 159Di 159B 'I 21 159F 159G, community h pertension awareness project, 159H, Y. 22 'high blood pressure control in Berrett County, 159 -- there's! 23 about 10 or 15 down there that go right on to the hyperten- 24 sion. 25 So.I think there is a tremendous amount of money 100 n37 I11 being put in that program there. 2 MRS. SILSBEE: Well, I think that was brought out 3ii a little earlier. 4 DR. TIA@IMOCK: it was brought out a little earlier. 5 But this is in the nev7 projects in which they are reauestina 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. ORAMLICH: Second. 11 MRS. SILSBEE: The motion has been made and seconded 12 that California application be approved at the level of 4 13 million dollars. 14 Is there further discussion? 15 MR. MILLIKEN: I think 3 and A half. Try 3 and a 16 half. 17 DR. JANEWAY: How about 3 million 640? 18 MRS. SILSBEE: I miaht add that the Council doesn't @19 seem to be any more deliberate in its setting the fund levels 20 than the Committee seemed to be yesterday. 21 All in favor of the motion to approve the applica- 22 tion at 4 million raise their hands? Four. 23 Opposed? Eight, nine. 24 The motion is defeated. 25 MR. ODGEN: Dick, you want to move it? 1 01 n38 1 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: I would like to ask for a short 8 explanation of the magic mathematical formula used to arrive 9 at that? 10 DR. JANEWAY: It is 65 per cent of 5.6 million. 11 MRS. SILSBEE: Does that answer vour question? 12 Is there further discussion? 13 (No response.) 14 MRS. SILSBEE: All in favor of the motion sav aye? @15 VOICES: Aye. 16 MRS. SILSBEE: Opposed? 17 (No response.) 18 MRS. SILSBEE: The motion is carried. I-lould someone ask Mr. Firoto to come back? 19 20 2 1 22 23 24 25 10 2 n39 CENTRAL rIEll YORK 2 %,IRS. SILSBEE: The next application is Central 3 11 New York, and Miss--Martinez is the primary reviewer. 4 MISS IIARTINE7: The Committee recommended a fundinc 5 level of $450,000. I was not auite 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 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- 1. 12 tion 'of 38.1,372. 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 161 developments from the previous time. I agree with miss 17 Martinez on those two particular projects. 18 I would also like to point outi however, that in -19 the region's own priority list they are in the low nriority 20 groups so that they have insight into the problem which she 21 mentioned. Ile helped them actually set up a very democratic 22 method for determining the priorities in the various places. 1 23 24 And I think it has worked extremely well there. There are i a high number of inputs, and they have a verv go 25 od type of 10 3 1 rating system for establishing priorities. 2 Now, in previous sessions the kidney programs were i 3 toned down because-'they did have some problems in getting 4 areawide agreement on anumber of the projects. I do think 5 that they made a lot of progress in that particular area 6 our last funding. since 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 11 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 i 15 number of very uniaue minority circumstances up there, 16 including an Indian reservation which never sighed 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,,OOO worth of 21 projects relating to the north country area. So I am afrai'd 22 that my recommendation would be a little bit higher. if I 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 fiaurei ^4 n4l 1 of $562,000. 2 So then I am a little far away from Miss Martinez. 3 ii 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 figure. 6 MRS. SILSBEE: We've got three figures before us 7 now. 8 MR. OGDEN: What are those, please? 9 MRS. SILSBEE: But we don't have amotion. 10I DR. SCHREINER: I would like to move 562. 11 MISS MARTINEZ: 5 6 2 12 DR. SCHREINER: Yes. 13 MRS. SILSBEE: lt562,000. 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 MT-SS MARTINEZ: 82. 20 MRS. SILSBEE: 382,000. Is there a secon ? 21 (No response.) 22 MRS. SILSBEE: Is there another motion? 23 DR. KOMAROFF: I move the Committee's recomm6nda- 24 tion of S450,000. 25 DR. JANEWAY: Seconded. 10 5 n42 1 MRS. SILSBEE: The motion has been made and seconded 2 that the Central New Yor@ 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.) lo MPS. SILSBEE: The motion is carried. 12 13 14 15 16 17 18 20 2 1 22 23 24 25 n43 I COLORADO/WYOMING 2 MRS. SILSBEE: The next region to be reviewed is 3 i Colorado/Tiyoming. And let the record show that Dr. Gramlicl-. 4 is out of the room. 5 Miss f@lartinez? 6 MISS I-IARTINEZ: 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. 1 have a comment to make on one of the projects 10 in particular -- well, two, all right. 11 one, number 59, seems to me to be Primarily An a 12 education project. And I was wondering %,,hether/Staff person 13 could tell me if this was developed in cooperation with the 14 educational commission of Colorado? 15 MRS. SILSBEE: Miss Murphy, did you hear the aues 16 tion? 17 MRS. MURPHY: Yes. I have to check.it. 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: 1,7ell, if it is the information that 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 1 hazy in my mind. So I have severe questions about that 2 one. But the one that I really object to is number 64, 3 4 which is entitled, health promotion service, primarily a 5 project to teach senior, Spanish-speaking senior citizens, 6 sort of an education Droject. And at one point the comment 7 is made that the money is 'going to be given to the public 8 health department to2hire 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 13 is an example of a lot of poor planning that goes into pro- jects which are supposed to reach minority people and don't. 14 15 In other words, it is an exmple of the use of a 16 minority population for funding. And I would suggest that 17 either that project proposal be developed so that it is under 18 community control and hires community persons to do the out- reach or that they be requested to not fund it. 19 20 MRS. SILSBEE: Dr. Haber? 21 DR. HPJBER: I have a serious question about project number 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 EMS for consideration. We will not fund it until it qets 25 10 8 n45 I approval. 2 DR. HABER: Very well. 3 MRS. SILSBEE: It has not been referred to EMS. 4 That was one we wanted to get the Corinittee'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 canit 11 tell here -- I would say that the scope appears to be hope- 12 'I lessly inadequate. 13 The demands of these burn centers are such that 14 you should deploy these with the greatest precision and in. 15 areas where they are likely to be well utilized, and concen- 16 trate the rest on developing transportation svstems to aet 17 people to where the burn centers are. 18 I don't know what this, but $17,000 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 Col orado has a burn 22 -center or such at the present 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 n46 I who has been working in, quote, unquote, what they call 2 their burn center where they treat their burn patients which is a $12, 3 000., 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. EABER: Well,.if it is preparatory or edtca- 8 tional 9 MRS. MORGAN: I think it is really a study to get 10 information to develop one. 11 DR. HABER: T@7ell, O.K. Under those circumstances 12 T will be mollified.. 13 MRS. SILSBEE: I haven't had a motion on Colorado/ 14 Wyoming. 15 MISS MARTINEZ: Yes. I would to make a motion that! 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 20 that the Colorado/v7yoming application be approved at the 21 level of $146,959. 22 DR. KOM@ROFF: Including that caveat that she 23 mentioned about theSpanish-speAking 24 MRS. SILSBEE: That is project 54. 25 MISS MARTINEZ: Yes, either it be developed with the safeguards I mentioned or that it not be done. n47 I 2 @IRS. SILSBFE: All right. Is there d4-scus- 3 sion? 4 DR. JANEWAY: Does that mean, Miss !ilart4--ez., that 5 if it is developed in a manner satisfactory to Staff and @-'P 6 that the allocation is increased by @65,000? DR. KOMAROFF: or $41,000. 7 8 DR. JANEWAY: $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. 12 MRS. SILSBEE: That requires a motion, @.en(iment. 13 MISS 14ARTI17EZ: I would like to make a r-@.o.--4Lon to J.4 that effect. '15 MRS. SILSBEE: Vle.still have one on the -floor nov7. 16 MISS PIARTIITEZ: I see. 17 MRS. SILSBEE: The motion was not t at. 18 MISS MARTINE?,: Can I withdraw the original motion? 19 MRS. SILSBEE: Yes. 20 Does the second o7ant to withdraw? 21 DR. KO@IAROFF: Yes. 22 MRS. SILSBEE- All riaht. Start again. 2.3 MISS MARTINEZ: All right. I move that Colorado/ 24 Wyoming be funded at the level 146,959 and -- how should I 25 put.it -- which would include the elimination of nroj6ct number 64, unless that project can be developed to include 2 a community control policv board and outreach workers who 3 are from and sensitive to the needs of the particular nonu- 4 lation being served and that if such conditions are met that the funding level be increased 51 6 MRS. SILSBEE: No, you have to go the other wav 7 to get a motion like that.- 8 MISS MARTINEZ: $41,000. 9 DR. YOMAROFF: 187, 188, but restrict the $41,000 10 unless they do it right. 11 MISS MARTINEZ: O.K4 Does it come out exactly 12 187? 13 MR. HIROTO: 188. MISS MARTIITEZ: All right. Let's try this once 14 15 aga3.n. I move that Coldrad6/Wvoming be funded at 188,182 16 with the condition that project 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 146,959. 211 MRS. SILSBEE: You have heard the motion. Is there !'a second? 22 23j DR. @IAIIMOCK: Second. 24 MRS. SILSBEE:: Any further discussion? 25 (No response.) 112 a49 MRS. SILSBEE: All in favor? 2 l@ VOICES: Ave. 0 3 MRS. SILSBEE: Opposed? 4 DR. J@'\TEWAY: I'llo. 5 MRS. MORGAN: 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 hands. 9 The ayes have it. The motion is carried. 10 Dr. janeway? 11 DR. JANEWAY: It seems to me that there must bea 12 reasonable balance between fulfilling all the responsibilities 13 and carrying out the policies and statutes of the RP-!P versus 14 II the selective identification of Particular Projects. The 15 technical review has been done. 16 And there are only two Council Tier-hers who have 17 had the opportunity even to read the forms 15. I would just 18 hope that we don't gitt-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 and he killed them. 21 'I And he just kept running into more alligators and 22 'killing alligators and forgot after he was down there with 23 ii all those alligators around that somebody sent him down to 24 clean out the swamp. 25 DR. WMTIIOCK4 Common, Sam Ervin. 1 1 3 n5O MR. PIILLIKEN: You mean he is up to his elbows in 2 alligators? 3 MRS. MORCAtl: fle's not quite that far. 4 DR. JANEWAY: 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 Re ional Advisory Group itself does not 9 10 @i take into consideration the problems of dealing with minority! 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. 14 And we do face the responsibility of questioning 15 the development of individual projects when they are serving; 16 a population that many times is not articulate in expressing 17 it s own needs. 18 DR. JANEWAY: I don't disagree with that one bit.. 19 MRS. SILSBEE: Thank you. 20 The transcript for Arizona has arrived, and have 21 you had a chance to look at it, Mr. Hiroto, or would you 22 rather go ahead? 'Vie can come back later? 23 MR. HIROTO: All right. I will take Conn6cticut. 24 MRS. SILSBEE: Yot'll take Connectidut. Do you 25 have that one.! A 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 here. 5 (Whereuvon, at 12:30, a luncheon recess was taken 6 until 1:00 p.m.) 7 8 9 10 12 13 14 15 16 17 18 19 20 21 22 23 24 is 25 11 5 AFTERN00141 SESSIO@4 2 MS. SILSBEE: The meetina @.:ill come to order. 3 In the break that-we have had, I've had about three or four I' 4 requests of individuals in regions who have to leave early and I'm prepared to accomodate them as much as Possible, but@ we're going to have to move alone. 1,'Ir. Hiroto. 6 7 MR. HIROTO: Ms@ Chairman, would you entertain a 8 motion that should the primary reviewer and the secondary 9 reviewer have no Problems or difficulties with the result of the Review Committee, that we vote in block on those and 0 11 go along the table and list those states that we feel securer with and only review those or discuss those that some Deop ei 12 13 may have questions about. MS. SILSBEE: I will entertain the motion. 14 MR. MILLIKEN: Second. 15 16 DR. HABER: One mechanism for accomplishing that 17 might be if you were to read down the entire list of remain-; 18 ing proposals and ask if objection is raised on the Part of primary or secondary reviewer with the committee's retommen-i 19 20 dation. A negative answer would seem to indicate that it 21 would then be part of a block to vote on. MS. SILSBEE: Riaht. 22 23 DR. TAIMIMOCK: You said you would read down the 24 list? 25 DR. HABER: Yes. ',"here are several ways to 11 6 1 I accomplish this, but the most cxdeditious would be for Mrs. Silsbee to read down the list and if anyone feels 2 ft that he doesn q@ along with the committee's report, he 1 3 so states and it is then removed for@ individual considera- 4 tion from the Block Vote. i 5 6 MS. SILSBEE: I think the record should show that the entire council has before them the composite recommends-' 7 tions of the review committee showing the requested level 8 9 and the committee approved recommendation. I also think 10 that the record should show that this is in view of the .11 fact that you participated as observers in discussions of the committee's deliberations yesterday. 12 I-IS. GORDOII: con- 13 Was there any problem with the flict of interest? 14 .15 MS. SILSBEE: Not on block action. All right, 16 the motion has been made and seconded that we qo throuqh 17 this. I'll go down the list and if anyone has any ob]ec- 18 tion to the committee recommendation, we will tbLke that 19 particular application out for discussion, otherwise there 20 will be a mo tion about the block action. All in favor. MS. SILSBEE: opposed. 21 Motion carried. 22 23 I will not only read the list, but I will read into i 24 the record what the recommendation was as far as the funding level. 25 1 1 7 1 MS. SILSBEE: Arizona - $150,000. 2 MR. IIIPOTO: Object. 3 MS. SILSBEE: Connecticut - $750,000. 4 DR. GRIVALICII: Object. 5 MS. SILSBEE: $600,000 Florida. Greater Delaware Valley $684,512. 6 Hawaii - $486,750. 7 8 Illinois $750,000. 9 Indiana $240,000. 10 Intermountain 11 DR. KOMAROFF: Object. 12 MS. SILSBEE: Iowa - $173,929 13 Kansas - $363,545 14 Lakes Area - $150FOOO Louisiana 15 16 DR. JANEWAY: Object. 17 MS. SILSBEE: Maryland - $650,000. DR. 1,7AMMOCK.- I think we had better go over that. 18 MS. SILSBEE-. Memphis - $9501000 19 Metro-D.C. - $250,000 20 21 Michigan $500,000 Mississippi - $2,000 000 22 23 Missouri - $540,000 24 Mountain States - $300,000 Nassau/Suffolk 25 1 DR. KOIIAROFF: I think we had better discuss that.1 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 - $25OiOOO 9 Oregon - $148,693 10 Puerto Rico - 131,335 11 Rochester - $1,000,000 12 South Carolina 13 MRS. GORDON: 'Objection. 14 MS. SILSBEE: South Dakota - $88r850 15 Susquehanna Valley - $500,000 16 Tennessee/Mid-South - $570,000 17 Tri-State - $610,000 18 MS. SILSBEE: We'll come back to Texas. Tri-State 19 $61 0,000. Virginia - $960,860. 20 MS. MARTINEZ:. Object. I-IRS. FLOOD: They have an arthritis program. Tt-'s, 21 22 not essential, it's automatically taken care of. 23 MS. SILSBEE: From the previous recommendation. 24 Washington/Alaska - $530,000 25 West Virginia - si,ooo,ooo MS. SILSBEE: Western Pennsylvania $450,000. DR. HABER: Objection. 2 MS. SILSBEE: Wisconsin $200,000. 3 We'll review Arizona, Connectucut, Intermountain, Louislana,l, 4 5 Maryland, Nassau-Suffolk, South Carolina, Virginia, Western Pennsvlvania with Texas. 6 MRS. MORGAN: I move that we accept the Review 7 Committee's recommendations for funding of the regions 8 not specified to be taken care of separately. 9 10 DR. KOMAROFF: Second4 11 MS. SILSBEE: Is there further discussion? 12 .(No response) 13 MS. SILSBEE: All in favor. 14 Opposed. 15 MS. SILSBEE: Motion is carried. 16 I-le'll now go to Arizona. 17 MRS. KLEIN: This is just a minor thing, but we 18 has taken some this morning and the way the motion was worded, all those other than the ones that were recentlv '19 20 enumerated so I think the motion should show, except for I those already discussed and approved4 21 I think that was the consensus MS. SILSBEE 22 of the discussion beforehand-. 23 24 25 1 2 0 1 ARIZONA 2 MS. SILS BEE: Arizona - Dr. Gramlich. 3 DR. GU.I@ILICH: As a matter of principle, Arizona 4 has had difficulty with the organization, the leadership and 5 had had some other difficulties that were technical with thei, 6 DRMP and counsel said to clear it up, so Arizona cleared them up and the Technical-Review Committee rewarded this 7 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 project it had ordered. 13 That was a minor element, but the concern on the part of 14 the technical review committee was, if you haven't been goodl 15 up to now, that you've changed everything we said you should 16 do, so we're goina to reward you by cutting your grant. i 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 pro3ects that have the highest oriority. 21 DR. GRP2-ILICH: If that's a motion, I second it. 22 23 MS. SILSBEE: The motion has been made and 24 seconded that the Arizona application be approved atthe level of $240,7i8. Is there further discussion? 25 121 1 (No resnonse) 2 14S. SILSBEE: All in favor. 3 opposed. 4 MS. SILSBEE: The motion is carried. 5 .6 7 8 9 10 11 12 13 14 15 16 17 18 '19 20 21 22 23 24 25 12 2, CONNECTICUT 2 1114S. SILSBEE: We will now go to Sonnecticut. 3 Mr. Iliroto. 4 MR. IIIROTO: I can appreciate the problem that 5 probably we all face with Connecticut and that Connecticut's'! 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. 12 DR. GRAMLICH: Yes. Aaain, these are general 13 comments and more philosophical then technical. Here, 14 apparently and I don't know the region well at all. I 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 justification for dropping the funding because of the fa t 22 c 23 of the different kind of program, one from the other. MR. HIROTO: Dr. Gramlich, I don't think that is 24 a Primary consideration. The problem seems to be that all 25 1 2 3 of the P14P funding or most of it has gone into the institutional area, rather than into other areas and 2 3 despite staff efforts to spread the Drogram a little rore 4 fully throughout the state and throughout other institutions, 5 this was not accomplished. At the last council meetincrf council agreed to reduce funding dramatically because this 6 was the only way that Connecticut would get the message, 7 so to speak. They have gotten the message to a degree and so the $750,000 level seemed reasonable to rhe review 9 10 committee. DR. GRA14LICH: Rebuttal time. MS. SISLBEE: Dr. Gramlich4 12 DR. GRAMLICH: To begin with the May request for 13 14 funding was not large. It was something in the order of $636,000 dollars. The major request is-what we have in 15 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 accezt their major funding request. 19 MS. SILSBEE: Dr.Janeway. 20 21 DR. JANEWAY: It is my recollection; Dr. Gr&-,nli-ch that one of the things that was taken into consideration @as 22 23 considerable amount of their funding was going through into 24 1976. 25 DR. GRAMLICII: Correct. 1 2 4 1 DR. JANEIIAY: And the way I recall the technical 2 discussions, there was a general sense of that qroup that 3 und Projects through '76. felt they should not f 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 30th, but in addition, there were the two university 9 resources that were funded at a fairly s3zable amount, 10 Other portions of the program that would have been of con- 11 cern was the third faculty. There were no funds requested 12 for that. The Connecticut application in @lay, Dr. Gramlich 13 was requesting support for staff plus two months of continual 14 tion projects. This amplification asks for 10 to 22 months 15 for some activities and 10 months for others, so it is 16 complicated by that factor. 17 DR. GRIU4LICH: Right, but neverthelsss, if you 18 take all the two year pro3ects and this iscrude arithmetic I '19 but nevertheless if you take the two year pro]ects 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 dame in for 23 a small grant request last May, if we cut them way down thisi 24 25 time, we're in effect, killing their total program. 1 2 5 1 MR. IIIROTO: There was something like $240,000 2 more or less requested just for the monitoring bv Yale 3 University of the-.second year program, so we might sub- 4 tract further your total by that much. I may be wrong. DR. GRI@,LICH: The principal involved is o we 5 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 th6 9 screaming and hollering, 1 will therefore move that 10 Connecticut.be awarded a grant in the amount of $1,435,800. 11 MS. SILSBEE: Is There a second? 12 DR. HABER: I will second it. 13 MS. SILSBEE: Dr. Gramlidh, what was the total? DR. GRAMLICH: $1,435,500. This is arrived at 14 15 by very crude arithmetic, by taking each two year nro3ect 16 and dividing it in half and totalling it with the ones of 17 the one year projects. It's the only way I could really 18 fi,4ure it. 19 Ms. SILSBEE: The motion has been made and seconded 20 that the Connecticut application be approved at the level 21 of $1,435,500. MRS. GORDON: I'm just wondering, there's really 22 23 no way probably that we have'of knowing whether dividing the two year project in half leaves you a viable project. 24 25 MS. SILSBEE7: I think in this particular instance,! 12 6 we have--- MRS. GORDON: --- it's not a matter of a new activi@L-y 2 3 so much. MS. SILSBEE: I think we may need some help here 1 4 new 5 from Mr. Nash. The two year Projects, are they a 6 or are they continuations? 7 MR. NASH: I think some of them-are new. The onces, I think, that concern the review committee the 8 four projects going to Yale and Yukon are for over $800,000 9 for the two year period. 10 11 MS. SILSBEE: Mrs. Gordon, because you were not 12 here yesterday, there was considerable discussion with the 13 committee and Dr. Pahl about the two year request. T e 14 region recieved its money and has the ontion of putting 15 some money away for some activities, if they feel they 16 shoudl go longer than two years, if they can work out some 17 kind of a contractural arrangement, so this is just a way off 18 arriving at a level and I don't think that should be a major 19 worry for you. The Regional Advisory GrouD will make that 20 decision. Mr. Milliken. MR. MILLIKEN: My understand 21 inq is that you have--i my understanding is that Yale was just awarded one of the 22 few large cancer centers --- cancer development research. 23 Are they going to be able to spend all of this with the 24 limited staff they have there? 25 1 DR. GRA,14LICH: 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 4 university budget. They won't --- I don't think they will 5 have much of a problem spending money. MS. SILSBEE: Thev have had experience in this. 6 The motion has been made-and seconded that the Connecticut 7 8 application be approved at $1,430,500. All in favor. Could'i 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. 'MR. HIROTO:, I move the review committee's 12 13 recommendation of $750,000 be.approved. MS. SILSBEE: Is there a second? 14 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 2 8 INTEP,P,IOUNTAIN MS. SILSBEE: The next application to be reviewed 2 3 is Intermountain and the record shows that Mrs. Klein and 4 Dr. Gramlich are out of the room. Dr. Komaroff was the reviewer. 5 6 DR. KO@,IAROFF: Intermountain was rated by the June Council as an above-average region. They were awar 7 ded 8 2.23 million dollars, as a result of last councils session.i 9 They now request a supplement of $481,000 for 19 new project@!, I 10 activities. The last council expressed several concerns 11 which appear --- most of which appear to have been resolved 12 and let me surunarize them briefly. There has always been 13 a turf problem with the Intermountain regions, the mountain states and Colorado and Wyoming regions. This appears to 14 15 have been resolved by some interlocking membership of the 16 advisory groups and frequent regular meetings of the membersi 17 of the advisory group --- of the members of each of the threei, 18 advi'sory groups as well as by some joint funding of projects 19 which have a geographical overlap with these three RMP'S. 20 A second concern has been the relationship of thisi 21 RIIP its CHPH agency and apparently, according to the staff review and the CTIP letters in the application, there is now 22 a serious review by CHP under consideration by the RAG of 23 24 CHP. 25 The third concern that the council expressed last 2 9 oping and moni-Icr- 1 time involved the role of the RAG in devel 2 ing projects. The region has developed what they call a 3 drag advocate nrogram whereby individual members of the 4'1 RAG are responsbile for shepherding a project proposal through it's passage and subsequently monitoring that 5 project 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 corporation. Dr. Pahl mentioned yesterday that through 9 10 action by the State Attorney Gen6ral and through meetinas 11 with the RMP staff members, this conflict of interest ates- 12 tion has been resolved. There was concern that council I 13 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 are 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. 22 They have some very uninspiring continuing education oro- 23 jedts and they propose to develo-pe their own audio visual materials. Many of them give the impression of duplicating 24 25 kinds of activities which have gone on in other regions with- out giving evidence that they plan to build on the ex-@erienc;e of others and I have the uneasy feeling that they may be, 2 repeating the failures and not the successes of other such 3 attempts at @IP, but it's hard to.tell from these abstradts.l 4 .5 One proposal is to establish a workshop on drug and alcohol abuse, and I just wonder why they haven't 6 applied through the institute for drug and alcohol abuse 7 8 or such an activity. It seems to me on the fringe of 9 P14P's funding mandate. Several strong projects are 10 listed. one of the most interesting involves a computerized, 11 agency referal for extended services in which they would 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, 16- 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 i 21 22 $350,000, out of a total request of $480. I would also convey to them again, as council did At its last meeting 23 that the project --- the corp staff, not the project staff 24 should include more minority representation particularly 25 LOUISIANA MS. SILSBEE: The next region to be reviewed is 1 2 31 Louisiana. Dr. Janeway. DR. JAIIEWAY: I.Im the secondary reviewer --- I'm thei 4 5 primary reviewer. The reason why I wanted to take it out ofthe block was partly to get some technical advice from 61 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. JANEVIAY: I'll hold my comment until Mrs. Klein gets back. She's a lawyer and she may be able to 12 help 13 (Dr. Gramlich and Mrs. Klein re-enter6d the 14 15 hearing room.) 16 MS. SILSBEE: Is staff ready to listen to the 17 question Dr. Janeway has. Can theycome up tDthe table, 18 please. 19 DR. JANEWAY: My questions are technical and 20 relates to Project C-10-in the Louisiana application which is entitled "Study of N. 0. Tax Supported Clinics Servincr i 21 Title 19 Recipients." It's the major request in the 22 Louisiana Application and I would like to know whether it 23 is appropriate'that RMP funds be used to evaluate the 24 25 activities.of the clinics supported by other tax funds. 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. 8IBLOWSI: Not really. It's a hard one to 8 swallow. 9 DR. JAIIEWAY: I brought it up BECAUSE Nobody in 10 Technical Review even mentioned it6 11 MRS. GORDON: As secondary reviewek, we only figur@d 12 what they were trying to do was get an impartial judgement 13 on it and the other federal agencies weren'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 medic-aid 17 level is extremely low. 18 MR. SIBLOWSKI: -I canot really respond4 I really 19 had some concernwhen I was talking to Dr. Savlier as to why 20 they decided to participate. He was basically saying that the RAP is in the only neutral position in the state to 21 attack it. Everybody else seems to be involved and it's i 22 i a non biased review assessment and if you look on Page 16, 23 the people all-involved in this- -are involved with the 24 consulting firm of Shindell and Associates. The Louisiana 25 1 3 4 Division of Administration and'Planning; the Division of ce; the ivision of Health Maintenan i Family Services; the D 2 1 division and it seems reading Charity hospital systems 3 bers in many in between the lines that many Board mem 4 I non biased type of thing where the 5 organizations, it isa 6 RMP is entered in and is trying to fulfill a certain role. DR. JANEWAY: Let me ask*you --- try to explain to 7 8 me the comments-coming out of the HPC in Lafayette, Louisiana 9 to which is attached, at least in my copy a memorandum, the last paragraph which says,, "This study is intende to in- 10 11 fluence the manner in which HEW funds out patient medical 12 services in the state and may result in increased availability 13 of these funds. I'm only asking this question because I 14 don't want the people in this 14ational Advisory Council to 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. This is not related directly to your question, which I 19 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 BEgional Medical 22 Program, more involved with bringing the private institt- 23 24 tions in and the private sectors into the indigent clinic 25 or the hospital system. I'm not saying this was developed 1 3 5 I totally as a result of that recommendation, but to me it 2 sort of fits into that cline of the Regional Proqram--- 3 Regional Medical Proaram through some of its new leaders 4 who are making a conscientious effort to upgrade the care 5 of all thepeople. 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 goin 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 vou badk.. 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 22 C-10 which IMP funds are going to be used to evaluate the 23 medic-aid services for children-@- 24 MRS.-GORDON: Tax supported clinic. 25 DR. JANEWAY: Tax supported clinics for Title 19 13 6 ut,, at least recipients and they are going.to contract this o 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 want 6 some technical input. 7 MS. SILSBEE: That's a better way to put it. The 8 legality of counsel taking action. 9 DR. PAHL: As usual, I am not prepared, certainly 10 on the spur of the moment. I think what we would like to 11 have is your recommendation within,what the legalities are 12 13 and we can determine then post counsel and act accordingly. 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. behlnd it. What I would prefer to do is find out whether 1 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 which! 20 encompasses those dollars, but they could use those dollars 1 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. Janeway. I 24 thou ht this was a particularly apt use of funds,, Regional 25 9 7 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 w@uld be susceptible to a final verdict, 4 I think that one of the Purposes of the Recrional Medical 5 Program is the development of innovated projects and 6 certainly the evaluation of ongoing government mechanisms. 7 I agree with Dr. Schreiner assessment that- Louisiana is hard put in terms of development of medic-aid programs 8 9 and I think it would be very useful to get independent 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. 13 MS. SILSBEE: Is there a motion? 14 DR. JANEWAY: In light of the discussion, I move 15 therefore that we accept the recommendation from the 16 Technical Committee that louisiana be funded it the amount 17 of $168,680 dollars, pending review bv the staff on the 18 legality and appropriateness of C-10. 19 MR. HIROTO: Second. 20 MS. SILSBEE: Dr. Janeway, does that motion en- compass, as a rule, if they could not spend money on that, 21 that the region should have the money or have it taken a,,.,,av. 22 23 DR. JANEWAY: No. 24 MS. SILSBEE : Is there any discussion? 25 (No response) I MS. SILSBEE:' The motion has been made and 2 seconded that the Louisiana application be approved 3 at the level of $i68,680 with the condition that the 4 funding for the amount of money for Project C-10 be contin- 5 gent 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 19 20 21 22 23 24 25 MARYLAND 2 MS. SILSBEE: The next application to review is Maryland. Dr. Wammock, would you get the micronhonebe@@or-- 3 4 you start? DR. WAMTIOCK: I think so. I was the primarv ju--4ae 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?: 12 MS. SILSBEE: Let me look at the sheet? 13 MRS. FLYNN: That was May-Jtne. 14 MS. SILSBEE: Mr. Nash, could you come up to the 15 table please? 16 MS. SILSBEE.- Did you hear Dr. Wammock's question?. 17 MR. NASH: I did not. 18 I-IS. 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 Mav and 22 June, the request was then $762 and the new one is for Prcc--r=--. 23 Staff of $233,000 and $724,000 for July. The Program StAf.@ of $233-000 with the approval yesterday of $350,000 --- no, 24 25 $650,000---that's one-third for staff. 1 MS. SILSBEE: Dr. Wammock, ifyou will look at the 2 printout labeled 7-74i you will see that the total request 3 was $724,000, of which the staff is$302,961. 4 DR. T@7AI-IMOCK: That's right, the indirect column s@@ 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? MR. NASH: I thin, one of the recommendationswas 12 13 that $250,000 for staff and $400,000 for projects. 14 DR. WAMMOCK: 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. is is staff activities, so that you canot judge the total 19 request for a particular project as being the total cost 20 because some of that.act.ivity is being carried out by staff 21 people themselves. DR. V7@LMOCK4 I recognize that. 22 MR. OGDEN: So, I don't,believe the action yester- 23 24 day of say $250'.-OOO for staff and $4,00,000 for programs is 25 any sense out of line. I A DR. IlAt-IPIOCK: 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. VIM-L'40CK: 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 thin.., 7 and looked at the various projects which I described and I 8 don't know whether they're goingtb be implemented or not. 9 Perhaps it may do some good and perhaps it may tot do any 10 good. I'll let the motion stand as it is as of yesterday, 11 but I wanted to bring this up for clarififation in my own 12 mind. I make a motion. 13 MR. OGDEN: I'll second it4 14 MS. SILSBEE: The motion has been made and -15 seconded that the committee recommendation of $650,000 16 stand. Dr. Watkihs, did you have anything to add to that 17 as secondary reviewer.7 18 DR. WATKINS: No comment. 19 MS. SILSBEE: The motion has been made and seconded 20 that the Maryland application be approved atthe level of 21 $650,000 dollars. Is there any further discussion? 22 (No response) 23 Ms. SILSBER-" All in favor? 24 Opposed. 25 The motion it carried. I NASSAU?SUFFOLK 2 MS. SILSBEE: The next region to review is 3 Nassau/Suffolk and-the pririar@, reviewer is Mr. Milliken. 4 MR. MILLIKEN: Was this discussed yesterday? 5 MS. SILSBEE: Yes, sir. Do -vou have a transcript 6 on that? MR. MILLIKEN: Yes, I do. With the information 7 we had this morning, it would appear that we do have to 8 9 change our previous decision of no funding. I have no 10 evidence to find fault with or change the review committee 11 recommendation of $900,000, although I personally question if that much is necessary due to'the situation therein. 12 Maybe the second reviewer has something to add. I'll make 13 14 a motion later on. 15 DR. GRAMLICH: I find this interesting. It 16 appears we're reversing our position of June and July. 17 They have made a strong appeal and I guess if council has 18 no ma.or objection to reinstating them, I would have to 3 19 support that decision. So move. 20 MS. SILSBEE: Second. MS. MO'.RGZL'q: Second. 21 22 MR. OGDEN: Could I ask the membe@s of council--- 23 MS. SILSBEE: Mr. Ogden, could you use the 24 microphone. 25 MR. OGDEN: Look At the page concerning Nassau/ Suffolk. The program staffing here of $343,000 for what 2 they have proposed to be slightly over a $2 million dollar program, now if wel@e limiting this to $900,000 dollars, 3 4 obviously we cannot let the entire $343,000 for the -program:.-. 5 stay, so I think there needs to be something said if we 6 accept the $900,000. I didn't hear the review committee 7 yesterday. MS. SILSBEE: They made the point, Mr. Ogden, it 8 was not in the motion, but it was in the advice to the 9 10 region. 11 MR. OGDEN: That may be in the minutes. Idon't have' 12 that in my notes. I 13 MS. SILSBEE : The pink slip says: "Based on the 14 funding recommendations for the attending period, it was further recommended that the Nassau/Suf-folk RMP be adjusk--ed, 15 16 Staffing request to be proportionate to the forthcoming 17 award. 18 DR. GRAMLICH: In relationship to the presentation 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 21 they should be in a phase out period 22 MS. SILSBEE: Mrs. Floodi 23 MRS. FLOOD: May I ask if staff has verified that 24 Projects 021 and 022 of the E@IS projects are appropriate to 25 the allowable concepts of our funding. 1 MS. SILSBEE: We have had a return from 11.1r. Reardon 2 who is EMS Systems Chief and he doesn't see any problem with 3 regard to their Dor@ion of the legislation and we got a 4 telephone call this morning from the part of HRA that is administering the training part of EMS and they also do not 5 6 see any problem or conflict. That is not to sav 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 recommending-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 emeraenc 13 y medical services and emergency medical training. 14 15 MR. STOLOV: We have received the priority level on 16 the projects and the equipment is below the $900,000 dollars, 17 however, the EMS training is above it,but again, 1 feel it i 18 is expensive, but it was their determination where to put 19 the money once they get this $900,000. They may not put it 2o all into that EMS training. The Nassau County which is the 21 more populated and richer county is way down at the bottom ofl 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 $900,000? 1 !4R. STOLOV: I believe Dr. Pahl mentioned yesterda,.7 2 that we still have not developed policy regarding what hannens 3 in terms of independent P.,,NIP beyond June of '75, so we don 4 know liE',l wide if this is allowable under grants and admiriistra- 5 tion practices, but I believe it would have been a contract 6 in their own Nassau/Suffolk E--'P Inc to carry this out in this, 7 scope and amount. When the-committee looked at this, it did 8 not 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 I 11 in terms of continuing the program or putting money aside. 12 DR. SCHREINER: I was primary reviewer on the i 13 last go round. MS. SILSBEE: Acdordina to the old assignment list, 141 15 Mr. Milliken, you had it last year also. 16 DR. SCHREINER: I was hoping it would be somebod,,i 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 ig 'with his $900,000 speed. 20 DR. P2UIL: Mr. Milliken, right, I'm afraid you're it. 21 MS. IIORGAN: Mr. Milliken, you were it last time. 22 @MR. MILLIKEN: I don't recall all the details. MS. SILSBEE: In terms of making the assignments, 23 24 I try to keep them as consistent as possible. 25 MR. MILLIKEN: On the yellow sheet, the second yellow 1 4 6 I sheet, the second item CO-5,COG-5, Grantee Central Service. I 2 Could somebody explain what that is? 3 MS. SILSBE'E: That is what we were just discussing. 4 MR. STOLOV: it's an independent RMP, therefore 5 according to instructions, they should close by June of '7n 6 and they have to issue contracts to extend beyond that period 1; 7 and they felt it would be good use of Government money if theyl 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 Dri Schreiner's question. We have a policy 12 lwhich comes out of the DHEW decisi!on not to permit staff or 13 an MIP to perpetuate itself beyond June '30 of '75. To merely state that all grantees, regardless of what they wish to 14 15 do in terms of contract activities may hot engage in that kindi 16 of situation which would perpetuate the RMP or the staff bevon(i 17 June 30 of 175. They may contract with groups to carry out 18 activities past June 30 of 175, bu not in such a way to 19 perpetuate themselves, so if Nassau/Suffolk, and I don't know 20 Ithe details of this, if Nassau/Suffolk or some other RMP has 21 funds in.it which, in effect, would continue to support staff 1. 22 @eyond that point in time, then I believe we would take 23 riate administrative action with our office of manage- 24 nent because we re applying a uniform rule in accord with 25 Departmental policy. I hope I have made that distinguishing 1,17 1 line rather clear. 2 r@'iR. MILLIKE'11,7: I still go with the action of June 3 and the reTDort of the committee unless there is new informat4@cn 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 @ second to that? 13 MR. K014AROPF: 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 $9OOiOoo dollars is for the 18 purpose of helping conclude their efforts and not continue 19 the program as they proposed. DR. PAHL: I'm not sure I'm going to clarify this 20 21 situation at all. I think we do understand that in all of 22 these recommendations, particularly where there has been some 23 drastic cuts from requested levels and I ,i 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 1 really in error for us to characterize this more than some 2 others that.f.@,,e have been concerned with here as phase out 3 or terminated. I think we really should onlv 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: VJould you restate your motion. 8 MR. MILLIKEN: I move that council accept the 9 committee recommendation to fund this agency at.$900,1000 i 10 dollars. 11 MS. SILSBEE: Is there a second? 12 MRS. MORGAN: Second. 13 MS. SILSBEE: The motion has been made and seconded that the Nassau/8uffolk application be aDnroved at the level 14 15 of $900,000. Is there further discussion? 16 DR. TIILMMOCK: 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. ;,,,ill somebody explain'@, 19 that to me? 20 MR. STOLOV: Your addition is correct on that. 21 MS. SILSBEE: Ilhat do you want explained, Dr. 2 Wammock?' 23 DR. I-7MU4OCK: Are they going to train practical 24 nurses or what? 25 MS. SILBEE: Ile don't know if thev'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 nractioner 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 Drojects. 9 MS. SILSBEE: The question is, where do they fall 10 on the priority list? 11 MR. STOLOV: I'll check that out on my paner 12 work. 13 DR. G@,ILICH: May I ask a question? It does not relate to the subject at hand, but it does relate to the "Ilassau 14 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 MS. SILSBEE: That has a long history. -I think they actually didn't have a combined board There was a 19 20 combined grantee and we made them have a different reaional 1 21 advisory group and a different council. Thre was some overia@ butthe combined grantee situation did not work out andt-hat was 22 23 was about a year aco September or so. We had joint sta'L4-:i,"a 24 too, Dr. Gramlich. 25 MR. STOLOV: I have on both proDects my paperwork. i5o 1 on both projects family nurse oractioner v.,hich was $142,0001! 2 project, it ranks number 11, which the critical care nursina 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 sioendinq 13 dollars the same? Ms. 14 SILSBEE :Yes. There is a motion on the floor. 15 MR. STOLOV: Mr. Ogden raised @h6 question, what wa 16 the title of the project. 17 MS. FLYNN: It's a computer analysis of whether 18 health educational materials have been written by authors in i 19 a leval that is readable by the health care consumer. $36,000 20 dollars to have a computer analyze all health education 21 materials so it will be at the 4th grade readina level. 22 MS. SILSBEE: There's amotion on the -floor to the i 23 effect that the Nassau/Suffolk applications be aporoved at the;! 2-t level of $900,000 dollars. Is there further discussion? 25 (No response) 151 I-IS. 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 5 2 14cLane 1 %IRS. SILSBI:'E: l'Irs. Flood, we will convev your 2 concern for this corolete documentation at what level health 3 education Traterial,-q,need to be prepared for consumabilit,@ 4 capability. 5 As this discussion went on before you finallv 6 acted, there was reluctance, but in terms of the final action@ 7 '@iassau/Suffolk now has $90r),Or)O. @@le viill be glad to work 8 with them further on this. 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 rm2 1. SOUTI] CAROLINA 2 SILSBE@@, The next application to be 3II reviewed is South Carolina, and Dr. liaber, you are the pririari 4 reviewer. 5 DR. IIABR@R: I must confess 6 MRS. SILSBEE: Could you talk into the microphone, i 7 sir? DR. HABER: I must confess to a larger degree of 8 9 confusion about this protocol than I felt on first reading it. It seems to me that it is difficult to reconcile the 10 11 reviews that we had in June with those that are submitted now.! 12 T wonder if staff could accomr@iodate me to the extent of d'IS- 13 cussing one of the major issues of the concerns that -.-7e had 14 at our last meeting about the involvement of the Govertor's office in the -P-14P. Could that be brieflv clarified now? 15 16 !.IRS. SILSBEE: Mr. Van l,linkle? 17 MRS. MORGAN: The Governor is going to resign tonight, 18 MR. VAIL !II@@ll'ILE: Dr.. ;'4oslev has recently. sent 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 21 been resolved. Negotiations are going on. I am not sure there is any resolution in terms of getting them to agree n&2 to agree. 23 I,IRS. SILSBEE: Tlould you spe@, into the i7.icrophone. 24 25 MR. VAIJ The region originally responded 1 5 4 rmi I very vehemently because they felt that the representatives 2 of the Covernor's commission had been a part of the -- both 3 the technical revie-@q and the regional advisory groun in 4 1,7hich the decision had been made, and there were none of 5 these difficulties raised, and they felt that the project had had proper review, but we have been explained bv phone, 6 7 the council's condition took the consideration, but still felt there'had to be a resolution locally. That has not yet occurred. 9 10 DR. IIABER: llell, that is unfortunate, of course. 11 Nonetheless I feel, and mv contention is that the funding 12 review that sorne of the reviewers have recommended for this 13 is unduly harsh. I -feel that this has been a good oroqrami In the face of adversity they have tried to keep it together. 14 15 They have replaced their losses with admirable fortitude. 16 T think that manv of the projects are well constructed and 17 conceived. It seems to me we are criticizing them, or at 18 least some of the reviewers are criticizing them, for a wide 9 variety, apparently, of disorganized projects, and yet in the 1 20 earlier criticism was that it tended to be too global and 21 not specific enough, so we are getting them both ways, and .1 think this unfortunate. 22 23 Again, I feel that manlv,of the projects are well constructed. I feel that there is no point in our 24 perpetuating our own indecision or worse, contrary viei..,-@,, 25 1 5 5 rn4 towards them. I think thev have had the endorsement on 2 al review confere pages 1,,34 and following the CliP @',IP annu 3 it seems to I)e indicated the ult;,rate. think that they have; 4 phase-out of this be modest extensions of some of these 5 activities, and I would suggest that instead of the t)ronosed 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. KOI-4AROFF: I think a series of projects, 66 11 projects which are described here, can both be vague in 12 their individual description and disconnected, without an%, 13 kind of sense of cohesiveness, and I -- well, that in fact is. 14 my feeling about reading this ai),olicatidn. '@ve have aregion 15 that is a relatively small state in terms of its T)opulation 16 which is alreadv funded at a level of two million dollars, 17 and I have kind of a gut feeling that their supplement ought 18 to be closer to $400,000 recommended bv committee-than an '19 additional million dollars, bringing our level up to three 20 million. 21 DR. 'r"olIAR(.)FF: I will summarize. As an exar,@nle 22 of m-v edginess, I will tell you @.7h-N,, I am edav. Yesterdav 23 there was a question as to whether the '-RAG had set anv 24 priorities among these 66 T)rojects. 1,7ow, in fact, there is 25 a listing of priorities,, but you will notice that the rankings 156' rm of the projects within each groun is in exact ordinal D 2 sequence to the numbers of the project. !,.@at I mean is 3 these Drojects .7hich are rated one through 12 are projects 4 number 91, 2, 3, 4, 5, 6, 7, etc. You have the feeling that unless thev numbered the orojects after thev set priorities, 6 that this priority rating is simoly a kind of a joke. They,, 7 just took blocks of projects in sequence as they appeared 8 in their numbering and gave them, quotes, "prioritv rating." 9 That mav be unfair to the region, and the staff knows whetherl 10 this region numbers its projects after thev give them a 11 priority rating which would be quite unusual in mv experience 12 then I would be mollified. 13 I-IR. VA14 WI'LIKL E* I don't know when they number them.1 f ly guess would be that that is one of the last orders o 15 business before they mail to us. I haven't been down to 16 r regions South Carolina in recent months. Some of the othe i 17 when thev r)reoare those, they prepare them bv title only. 18 I-IRS. SILSBEE: Thev have their own local nurlbering 19 system, and then thev relate it to ours. 20 DR. KOI-IAROFF: It may be nothing, but I had a feeling 21 reading through this that it was kind of poorly connected,. 22 over ambitious, in a region that was alreadv quite well Z3 funded for its size, and I would be reluctant to bring their 24 level uo to three million. Z5 .4RS. SILSBEE: '7e don't have a motion on the floor. 15 7 rm6 DR. l@OrIAROFF: CouldI move five hundred thousand? 2 DR. T@IA!.,U-IOCN: I second that motion. 3 'i4RS. SILSBEE: The motion has been made and 4 seconded that South Carolina application be approved at the 5 level of $500,000. 6 Is there further discussion? 7 ('.,,To response.) 8 MRS. SILSBEE: All in favor? 9 VOICES: Aye. 10 MRS. SILSBEE: Opposed? 11 (No response.) 12 MRS. SILSBEE: The motion is carried. 13 14 15 16 11 18 19 20 2.1 22 23 24 25 rm7 I TEXAS 2 If we go alphabetically, we come !IRS. SILSBEE: 3 to Lexas. 4 MRS. FLOOD: 1,7e are going to Texas? 5 MRS. SILSBR.E: llrs. Flood is going out of the room. 6 Has the Texas pink sheets, or white, been distri- 7 buted? 8 MRS. MORCAN: No. 9 MRS. SILSBEE: Let's distribute then,. 10 Off the record. 11 (Discussion off the record.) 12 MRS. SILSBEE: On the record. 13 You will recall that the Ilay application from the 14 Texas regional medical program included requests for funds 15 for a series of contacts of which the ideas were spelled out 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 doing 20 through the national reviev7 -process. 21 Council considered this application and decided 22 that in general the goals and objectives of the region and 23 the general management of the region seemed to be sufficient 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 rm8 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 They recommended that the Texas application be funded at 6 the requested level of two million three hundred and thirty- 7 three, five hundred and fiftv-one, pending the satisfactory 8 review of the specific contract proposals bv the July review 9 committee. This was to enable Texas to go ahead because it 10 was a non-profit corporation that had wanted to do their 11 thing in the 12 months, and til6v didn't want to slovi them 12 down in that process. 13 The July committee was not able to meet, and they 14 gust, which was yesterday, and the discussed had net in Au y 15 the Application. 16 .Now, Mrs. Illiorgan, I am going to let you pick u-o 17 from there. 18 MRS. MORGA-,i: Our pink 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. The review committee 22 recommended the use of one million dollars. The reviewers 23 were still apprehensive regarding the monitoring capabilities 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, 1 6 0 rm9 review committee which will consist of on this, T)lus members I from the RA(',. The concern of the re%,i-e%.i committee was health professionals reviewing these -,)rojects. If you are familiar 3 4 with the Texas RAG, it is practically all health professionals. 5 About 95 percent of them are nhvslcians on the RAG, and these 6 physicians are going to be the ones, and this is from the material we have received,.who will be on the review committee. 7 There is no question in my mind but that there will be healt-hl@ 8 9 professionals reviewing these area contracts. Thev have 10 Sent in their form, which is a six page form. It has to he 11 filled out monthly on the various contracts and sent in; will 12 be reviewed by their committee. Ihavein my mind no doubt that these will be reviewed bv health T)rofe8sionals), and 13 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. SILSDr-_E: Dr.Schreiner? 18 DR. SCHREI.IIER: I am a little bit confused about 19 the back and forth thing and the old grant. If vou could 20 clarify that a little bit? in other words, are you didn't hear the discussion yesterday on this Darticularone. 21 "Are they-prooosing anv additional now money? 22 IIRS. SILSDT-7E: -Io. T@,,Tell, they are. I was going 23 to ask Mrs. Morgan if she would mind rewording her motion4 24 We gave them an award for two million three hundred whatever 25 0 6 1 rmlo it was, and we restricted 1.4 million dollars pene@@ng the 2 satisfactory review, so in a sense they can't snend that 3 1.4 million. 4 DR. SCIIPEIIIER: It is called internment. 5 MRS. SILSBEE: Internment for a reason. The actioni 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. ',IIORGIUI: May I change my motion to state 10 that we released to Texas RMP one million four hundred 11 thousand dollars of impounded funds to them? 12 DR. PAHL: We remove all restrictions. 13 MRS. MORGA,:i: In other words, restrictions are 14 remved from Texas. 15 DR. '@lP@4-xIOCK: The restricted funds 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, any money at 20 all. 21 DR. SCPR'-PI'zlv-R: So this comes out of the 84, not 22 l,'o ut of the 20. Thatis what I wanted. 23 MRS. 11110'-RG@l: It comes out of that money. 24 tiRS. SILSBEE: The money that has alreadv been 25 awarded. 1 6 2 rml 1 DR. SCIT.@, I@4ER: I @.7ill second that motion. 2 MRS. SILSBEE: The motion has been made and seconded 3 that the restrictions on the contract funds in the j@exas i 4 a@-iard be lifted. Is there further discussion? 5 MR. HIPOTO: Quettion. 6 J"IPS. SILSBEE: All in favor, aye. 7 VOICES: Ave. 8 '@IRS. SILSBEE: Opposed? 9 (.No response.) 10 @IRS. SILSBEE: The motion is carried. 11 12 13 14 15 16 17 18 -19 20 21 22 23 24 25 0 1 -'j 3 VIRGI@4IA rml2 'last we go to Virginia, and Dr. 2 .IRS. SILSB]7@l-: 3 l,latkins. DR. T,IATKILIS: I @have no problem with Virginia. 4 5 This is Virginia, and T)r. Perez has changed the face of t'---- whole program. Pliss Martinez had a question4 6 MRS. SILSBEE: Miss .@lartinez? 7 IIISS MARTI',NTEZ: In thinking over the project descriptions, I notice that a great manv of the iDro3ects 9 are really supportive or extending grants to CHP's for 10 11 planning, for the normal planning of CHP programs, which I am not sure is terribly wise, even if it is legal. In anT.7 12 case, I think the committee recommended nine sixty-three? 13 14 MRS. MORGA:I: It is nine sixtv-t-hree eight six---.,. MISS P4ARTIIIE"7j: And I would liPe to reduce that 15 16 sum somewhat to seven-oh-seven seven fi'Lty-nine. just 17 went through the projects, and eliminating things like nu:.-.her 18 48 which is a grant to a CIIP agency for a 19 MRS. SILSBEE: Miss Martinez, in terms of what @rou 1 20 are recomnendihq there, have you, are you aware, that a message was sent back to the re ional medical programs 21 9 concerning the need to do "- or to get geared up for healt', 22 23 resources planning and that this should be done in collabora+--ic with the CHP agencies? 24 MISS '@'4ARTINEZ No. 25 rml3 1 i@IIZS. SILS13FF,: And this was a definite suggestion 2 that was given to the regional medical orogram back in I 3 or April, sometime like that. 4 !IISS @,IARTI@ll',Z: All right. It doesn't seem to !-.e 5 that anv of their projects are terriblv innovative or 6 looking, but if that is with the @'.IP 7 '-IRS. SILSBEE-. No. If you don't thinkthe acti%,it' 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 vou satisfied? 11 DR. WATKINS: Yes. T.,Then we were on site, we were 12 very hard on them, and I feel that Perez has done a good 13 in changing that program. He has changed the PAO, he has 14 increased the minority representation, minoritv input in L@.-e 15 urban areas., and I think I would like to see it remain as 4s 16 MISS MARTINEZ: Okay. I will reaffirm the 17 recommendation. 18 MRS. SILSBEE: Is there a second? 19 MRS. r-IORCAkl: I am seconding. 20 I-IRS. SILSBEE: The motion has been made and secon@-e@- t 4 21 that the committee recommendation on the Virginia anplica @cn 22 to approve the application at the level of $963,860 be annro,.,e@-,, 23 recommended. 24 Is there further discussion? 25 ('.,lo response.) 6 5 rml 4 I-IRS. SILSBEE: All in favor? %7,OICES: Aye. 2 3 MRS. SILS'BEE: Ooposed? 4 (@To response.) 5 MRS. SILSBEE: The motion is carried. 6 7 8 9 10 12 13 14 15 16 17 18 19 20 21 22 23 24 25 1 6 6 rml 5 1 @,' E S T E R',i PE41@SYLVANIA 2 ilps. SILSBEE: Now we will go to Ilestern Pennsy 3 vania. 4 MISS !,IARTILNEZ: In that Case I would like to do 5 the very same thing on @,lestern Pennsylvania because the 6 number that I cameout with was about a hundred thousand 7 dollars 16ss, I had subtracted number 49 from that, so it comes 8 outimore or less the same. MRS. SILSBEE: Would you move? Would ou Put the 9 y 10 dollar in? 11 MISS ?.IARTINEZ: Four hundred fifty thousand. 12 MRS. SILSBEE: Is t here a second? 13 MR. IIIPOTO: Second. 14 MRS. SILSBEE: The motion has been made and 15 seconded that the Western Pennsylvania ao be approved ,placation 16 at the level of $450,000. Is there further discussion? 17 MRS. MORGALL: 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 23 ends the review of the applications. 24 25 1 6 7 DR. GR7U4LICTI: Mav I Open ulo mall sub rml6 one more s ject 2 DR. PAHL T 41@e have that as well as Mr. Ogden's 3 .resolution. 4 DR. GP-NILICII: I mean relative to this project, 5 specifically Mississippi. 6 MRS. SILSBEE: Yes, sir? 7 DR. GR7V-,ILICII: There is a verv 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 t@io million dollar request for hypertension screening and 11 treatment program including one million dollars for salaries,i, 12 and included in that salary scale was 82 public health hursesi 13 who presumably are alreadv on deck, so that the @T funds 14 as far as I can determine from the grant requests, be used 15 SirIT)ly to'supply what is now being spent by the state health 16 department. Included also is $500,000 plus or minus for 17 drugs for treatment of some possible 110000 hypertensives. I 18 llow, the review committee's attitude is, it is a poor state i 19 and they have got lots of blacks and they need all of this, i 20 but there was no particular attention paid to the construction 21 of the budget which included apparent substitution of PIIP 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 rm!7 is to be administered to the count,7 health officer in each county. ,low, this Doses a problem of nractice of medicine, 3 if you will, bN7 r,-4P funds. If the council feels this is 4 I'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 T)Oint? 8 DR. KO!iA-ROFF: Can staff enlighten us as to whetheri 9 this will supplement the resources of the state health 10 department, or merely supplant them? 1 1 4 @'@.IRS. SILSBEE: Mr. Van Winkle, there are two 12 issues here, in case you couldn'@ hear. 1 13 MR. VAN WINKLE: I heard. I was trying to hide. 14 My answer is, no, I don't know. I read the aoolic@-k--ion. -15 Ile did ask that thev include the full, T,@,hen they sent in, not the center form 15. That is all vou @.7ould have had. 17 1 I presume that Dr. Vaun looked at it, b.eina -Eie tDri--mar-v 18 reviewer. He did 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 22 'year funding. The government has put already a line out of 23 its budget to supnort 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., 1 6 9 rml 8 !.IRS. SILSBI@: Dr. Komaroff? 2 DR. XO"!A',P.OFF: 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 probably 5 .-7.hat was going on was that IU@T money was offsetting certain 6 expenditures that were Dart of the state department of ublic'! p 7 health this year, but that the quid pro cTuo was that the 8 government was going to take over the support of the program 9 in future years,, and that that seemed to me a reasonable 10 bargain; consider the importance of this problem in that state medically. 12 DR. OPLILICH: I am satisfied. Thank you. 13 DR. PAIIL: I have two items of business before 14 we adjourn. 15 16 17 18 19 20 21 22 23 24 25 1 7 0 ction i,"-ici is that tl-le a i) c-, e n rnhe @irs4l- t'- ta,@en, @er-,i.@ions made 1) y ,is Council result in a total 2 1 ded dollar level of @-27,154,37," @597,22@, rpco=en c s 3 a@ove the total recor..i,@iende,-l to you Play the "';Icvicw Committee 4 40 of @l-e re-,ions you concurred %Keith the Con7,iL- -te-@ s 5 recommendations; five rec-,ions had some amount added to the 6 corL,@iittee's recommendations, and in t%,o cases, your redor,-,nendati 7 @,cre to reduce the Co:,7,mittee"s recommendations. -.he sccond item of 1-usiness I @,.7ould li.e to come 9 baci: to, unless there is discussion on that -- 1.)r. l@omaro;-:f? 10 p that mean @,@e approve less @O@P: @Does 11 money than is available to spend? Ilow does that affect the iDolic,,, ,.?e aT)oroved earlier today about prorating a kind of 12 an extra supplement after the fact. 13 D'@l . Plk T TL: @,',Ie are in 3ust fine shape at these 14 levels. ','e ended the -Cray verv 7.1.,e action you 15 1-001- this morning and the recommended dollar level is nq to nerm 16 goi i@ us to distribute all of our r,.onles in,-' 17 on @..hat 1-iapr,-ens over tlie. course of the L@all, @-iill be able to - with the formal order that you endorsed, be able to accommodate any chanae there. 19 So, r-aftaqerially everything is o'@lay. 20 i,r. jane,,.7aty? 21 jl'7T7T,l %,,a,@, -,us .,in- t chec' 22 n. I TT you --F so sure t-i-@s I am not 23 are in su--!@, good s ape. 24 @,7as checking mv o,,@-n mat'@-@e-matics 25 I-ecause I thought we had added '@--ut it is such 171 a small amount of differ onl@T en,-P-i 2 1 -forence, @.7ill DTZ. P,' TT L: if ticre is a dirL 3 either take it out ?'5f 7--c,ith's salary, or give it to her. 4 I-le have one of t@iese fantastic data -matic 5 aides on sale, or something, and there is volt--aae fluctuation and during one of my afternoon telephone calls, I found 6 Tdith sitting poking these keys. At the same time, doing 7 everything in lona hand because with voltage fluctuation 8 you don't end with the same digits you should. So, I think 9 we better qo back to lead pencil and nar)er. 10 I gather the correct fiaure is @,,17,349,054. 11 Another one of the rumors. 12 I have received information, also, again, I don't lknoi-,7 whether it is a rumor or not,"-Iut presumably it has 13 1 !'f.-,een announced out of the '-,7hite Fouc@e that, as .;,ou I:no7,,,, 14 15 will he announcement either at 01:00 and now some people say 8:30 - and Congressman Ford is to undergo his i,-iaugerationj 16 at 6:00 p.m. tomorrow. I quess we will all learn as to 17 go to airports whether this is rumor or -Lhis was 18 given to me as a statement. 19 'L"he other item of business @n more firm ground ab out is to reconsider the resolution --hat PI.-. Oqden introduced, and which we tabled until hopefully you had an opportunity to look over. -mbe summary material pertinent to the resolution. 'Ir. Ogden, I think i,,,c have distributed this to each person. 24 Po-r!,,aps, vou i,,7ould like to make some comments. 25 1,@,'R. OODEIT: I hopeIthat many of you have had an 3 1 7 2 1 opportunity to lool@ at the material 'i,earle(i "Su.=.arv of t-e .national Policy Plannina and '?resources De%,elopment 2 P@ct of 1074." r. J.-maro--Ff, @qho is sitt4ncT next to me here, 4 ihas probably (Tone throu,7,li it a little more carefully than 5 many of you and underlined the areas and I will call on 6 him just in a few moments for his comments. But, in doing 7 through this piece of legislation I found no-place where I 8 could find anything that fitted tile function of any existilicl regional medical program, save per-al)s some of the progra,-is 9 which are in fractions of states, such as some of those 10 perhaps in the State of @.'ew York. If the Governor of the state were to decide the 12 health service area, -for example, .:as '-Iassau/su-'folk - per.-a-s! 13 I'l.'assau/Suffbil- R:@,P could become the health service syste-s 14 agency in that particular area. --u@@, this particular pi-c--e 15 of legislation while it seems to encompass Hill'Burton-al ost I 16 completely and you Still find that comes un on Pac,,e 5 on @-'.-e I 17 description of the health resources -.Ikevelopment the onl,,7 place that I find -J@IP perhaps even suggested is on Page 6 18 under Area Health Services Develonment Fund. 19 20 @@Tow, remember here @@,,e arc talking about a health system agency. '7ow, health syste profit m auency is a non- 21 private operation on a local or area-,7ide basis. But, t-4--- 22 is a health service area no7@ulat4-cn of less than half a 23 million. It is not permitted. It can be up to about t@,.,b 24 million, as I recall ilr. Rubel's corc-,ent yesterday. But, it woulcl encompass-the health service area would encompass an-,7 25 1 7 3 4 standard m,-n@@--opolitan-statistical area, %.7hiel-i is entirely 2 ,-.,itli a 1,Doundry - it can cTo over state lines, but there arc 3 I'-Iiterall-y, 1 understand, 100's of S141SA s in the United -at ,-.,e are lool:in 4 lit'ta+-es. So, that w' q at here is an area 5 li.ioalth services development fund which is going to be a 6 hing, and indeed we find that the arant that ocalized t can be made for the development within one of those on page 7 2 - no single crant or contract may excee(I $75,000 be made 8 for more than two years. 9 It simply tal'r-ed about the area health services 10 development fund. -.,is is whv I have proposed this resolution 11 lThat this piece of legislation it be suggested that this 12 Ibe amended to give each state the statttorv and financial 13 to maintain a senarate health s-,-,7@-teis development support aaency on a state-@.,- ,ic:c, '.@lasis. Do, that at least @,,,e iav--- I 14 15 to,-ething si.-qiliar to the PT,'P's v7e have today can perform a state-iiide mission or function. And, indeed, @.@.c could 16 !even say, goinCT beyond state lines. "ut, I suspect the 17 J'-incl of legislation T@ic are -,eeing coming up here is.going to 18 be limited to state !-.)oundries and national health insurance-. 19 -@nav indeed have in it have some sort of state-wide function 20 mechanism. 21 So, this resolution and in it, the I propose -second part of it I have said, "@-he comments that proceeded 22 rf--soltuion and the resolution itself be transmitted to tliei 23 members of ti-c !'louse Interstate and-Foreign Cor@imerce Co,-Lriittee 24 -- and 1.)v that meant to encompass the comments that I made ON 25 in the letter from Senator i!aqnuson to Senator c"@ennedy, which 1 7 4 5 i read to you earlier and which should a7ir@ear in the transcrip 2 o-- the inutes of this -,ice4-inc .7e vou that let,-er L l@ c,:-i n 3 cl:. i -f you .ould 14-,!-e to ,'erox it. I 1 2@':, to Iliave it ba 4 But, I will I)c hcirpy to hand it to you. 5 1 do recommend that we do t-is. I am quite 6 concerned that the kind of legislation '-a4L. ..,e see coming out simply does not recognize the place tat regional medica 7 proarams have come to serve on the Ar,,er4-ca.- scene. And, 8 certainl many of us who worked with this -Droaram since its y 9 nception eight years ago this Sprina feel that it has acccmpl.,-, 10 fat more than it has been given credit 'o-- and that it has 11 the potential to accomplish a great deal 4L-I-a-@- is qoi-ncTto 12 ]De necessary in order to mal:e nat-?onil legislation --c v-r-,.r complicated 13 function when it begins to deal with undertaking of the Aeliverv of services an4- the deliverv of 14 care. 15 And, it seems to me that unless the nroviders of 16 this ration are given an opportunity to their in put 17 through something like irl@P, that the success oi national 18 health insurance is jeopardized and I lo-ce that we are going 19 to be able to have the continuation of so-:e'Lhinglike the 20 regional medical r@rbqrams. Pi-.iTL: Thank you, very illucl- .,.r. Oa-l,cn. 21 -here @@7as a motion introduced and seconded, I think 22 possibly.. 23 D R . I 1,T, I 0 C KSedond. 24 DR. PLIAl'i'L: Thank @,,ou, Dr. !@@'a=cck. 25 I think there should be room j@cr discussion by 1 7 5 r Council on this im@ortant topic. 2 Dr. i'lomarof.@'? 3 Ps I loolr, through this, the Bill, 41 the thing that concerns me is that all of the various aaencies which would he created bv the Bill seem to relate 5 to planni-na and to the Tnonitorincr of facility expansion 6 %-here is no sense or very within the region. That 4- little 7 language that would relate to what you might:thihk of as 8 a perational arm of such an agenc.yor 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 motionibob -- I am junclear about your first -- the first component of it. Do 14 you-mean that this operational agency would be independent 15 o.@o s E-, d i n 16 I Yes, I do. 17 D,R .0, '@,N R 0 F'@r ally the null-. of the 1 8 question. l,'ho reports to who? I believe that there ought 19 to be a separate and clearly defined and funded operational arm tha-t__Inc)ks lik2 P-T,!P. i am bothered, though, at the 20 prospect of havincT that agency wholly separate from the 21 leadership, or @@@hatever, supervision of the rlanning agenc,-es.i 22 DR. I ,,:ill Vield to you. 23 DR. J7k@,-,E',AY: 30 seconds? 24 DP . 30 seconds of my time. 25 DR. PAIIIL: Dr. Janev@Tay. 7 would sunport, quite frank-l@-,, 2 Peparation of iDlanninq function, -particularly t,-e 3 strategic PI-annina function, to use a managerial ter 4 is implied by the sur-,rLiarv of the legislation - propose 5 legislation. I thin;,- that to have planning and control 6 I say operational control the implementation mode c-@ 7 any kind of management function in the same agencv is co,,:r--,n=@ 8 disaster and, Although, I would aaree with you, Tony, t.-at 9 there ]-as to he a responsive inter-rel-ationsl-4ip, that 10 is so much to be -Tained by having the planning function separate from the implementation function. That, I %.:ould 12 certainly be prenared to support a resolution of this T np,. YOIIz@.PCFF: do you feel it ...,ould be 13 disaster. Are %7ou thinl-.i-ncr ';-)ac,@ to experience bctl,7eei- 14 @l', P-and CLIP? 15 DP,. J@A"7E7@ 7AY: ',70. I am thinking in terms of +--'@-e 16 -is -@.anageTlent function and there is room for disagreement 17 but if you read @Inthonv'E Plannincr Control S,,,ste-s, 18 the Possibility of the planner-becoming so involveo.'in 19 plans that the implementation L,,ecomes impossible, or i-.at e 20 there is no outsie, regulation of it. It puts too 21 power in one place. @TOT..7 there are aJmittccllv some ranaaers -,@-ho 22 v7i-th that and sal,, the E,,lanning.control oualit to he in e 23 same agency, If you set plahnina or isolate it you develop 24 think tanks that @l,on'@"-clrain any@,.here. 25 But, i4 vou put planning and control in the same 1 77 vou go to the opnosite extreme @,.,herp- you think h a 2 li@y creating an infinite nui-i,'@.)or of haystacks will give you 3 1 an infinite sun j I :)l,i of needles. 4 7. @n,,',ATZOT'F: It cuts @@,,avs, '@-ut the for lp 5 ltl.-e reason vou just cited, it seems to me that the providers li@,-ould more likely be attracted to these I