DEPARTMENT OF liEA L T H, E D U C A T I 0 N AND WELFARE Health Services and Mental Health Administration Division of Regional Medical Programs National Advisory.Council on Regional Medical Programs l@tes of the Meeting May 26-27, 1969 C)f 3.L U@DIJCfi-i!ON, AND @ARE Tr OF '@T TH, PUBLIC @TH SERVICE @tiolial Advisory Council on Regional Medical Programs Minutes of Sixteenth Meeting 1/ 2/ May 26-27, 1969 Council on Regional Medical Programs convened The National- Advisory for its s@eenth meeting at 8:30 a.m., @esday, May 26,.1969, in Conference Room 4. @ilding 31, National Institutes of Health, Bethesda, Maryland. Dr. Stanley W. Olson, Director, Division of Regional Medical Programs presided for the Administrator, Health Services and @ntal Health Administration, who was unable to be present for all of the meeting.- The Council members present were: Dr. Michael J. Brennan Dr. D. Pel -legrino (5/26 only) Dr. Bland W. Cannon Dr. Alfred M. Popma Dr. Michael E. DeBakeY (5/26 only) Dr. Russell B. Roth Dr. Bruce W. @erist Dr. Mack I. oltz Mrs. Florence S. Mahoney Mr. Curtis Treen Dr. Clark H. Millikan Mrs. Florence R. Wyckoff The- liaison member attending was, Dr. A. Earl Walker, NDMS (5/26 only) A listing of DFd,4P staff mrrbers, and others, attending is appended. I. CALL T'O ORDER AND OPF=G Doctor Olson called the meeting to order at 8:30 a.m. 1/ Proceedings of meetings ax-e-restricted unless cleared by the Office of the Administrauor, HM-L4. 'The restriction relates to all material submitted for discussion at the meetings, the supplemental mater---q and all other official documnts-, including the agenda. 21 For the record, it is noted that members absent themselves from the meeting when the Council is discussing applications: (a) from their respective institutions . or (b) in which a conflict of interest might occur. This procedure does not, of course, apply to en bloc actions-. only when the application is under individual discussion. -2- ANNOUNCEd,2\7TS Dr Bland Cannon, @s. Florence 14ahoney, and Dr. Russell Roth were introduced by Doctor Olson as the (along with Dr. Anthony Curreri who was unable to attend. new Counci memDers. III. CONSIDERATIO14 OF P=ING DATES date of August 26"27, 1969, for the next meeting was confirmed. Dates for the following two meetings are scheduled for December 16-17, 1969, and t@rch 31-April 1, 1970 (this meeting being changed from March 23-24). IV. CONSIDERATION OF MD=S OF THE FEBRUARY 1969 MEETING 'Ihe Council unanimusly recommended approval of the February 20-21, 1969, meeting as written. REPORT BY MP,. IRVING LEWIS, DEPUTY ADMINISTRATOR, HFALIH SERVICF,,S AID =AL @TH ADIvIINI9=iION Mr. Lewis reported to the Council on the recent round of meetings in preparation for a report of the Health Task Force to advise the Secretary of DHEW. - Planning was began by teams constituted to represent the various interests ofthe health-related activities of of the Department. These teams in turn reported to the Task Force which includes Doctor English, Doctor Marston, Mr. C. C. Johnson, and the Surgeon General. ',"he first reports of the Task Force were discussed and presented to Mr. Veneman and Mr. Finch at a conference at-CaiT David, Ylaryland. The planning team on the Organization and Delivery of Health Care, which included consideration of Regional Medical Programs is chaired by Mr. Karl Yordy and includes Mr. Peterson of RMPS. Mr. Lewis reported briefly on the meeting at Camp David, particularly as it related to the future of service programs such as RMP and their part in the Departmnt's plans for affecting the spiralling costs of delivery of medical care. At Doctor Olson's request, Mr. Lewis reviewed the @ ediate goals for Health Services and t@,e,-ital Health Administration as seen by Doctor English and his sta-,.'f. These include a concentration of e-.. on lipr@ care" with the principal- aim of keeping people out of hospitals and extended-care facilities. Mr. Lewis also gave a brief rundown of the status of legislation. relative to the programs of the Health Services and Mental Health Administration. At the present t@ only the extension of the FT 10 con@,id.!-rat n, He renor-ted year or two w-i-i i be -Goa question concerning RMP extension legislation, Nr. Lewis said he-felt there could be no fiTa arsvier until an Assistant Secretary for Health and Scientific Affairs is finally appointed. He indicated, however, that in his view the Regional Medical Programs Service could comfortably use.. another year of experience before reporting to the Congress and that having this co@-. after a possible consolidation of CHP activities he Council expressed would not be at all harmful. Several members of t a different viewpoint and consider a delay in requesting extension of Regional Medical Program legislation as representing a serious threat to the Program. V. A REGIONAL @EDICAL PROGRAM SERVICE REPORT A. The Completion of Fy 1969 Doctor Olson presented the Division's plans for the utilization of the balance of funds remaining forDY 1969. He showed'that out of the $72 million which was available for v-rants in FY 1969 that the year will end with a balance of $21.5 million in Council approved but unfunded Regional Medical Program applications. This balance remains even though an additional $4.8 n-Lillion was made available to fund operational supplements which would otherwise have added to this total. It was also reported that the year would end with all but 15 of the 55 Regions in operational status. Of those 15, four have initial operational applications recommended to the Council for approval at this mF--eting vfnich, if approved, will be funded imedi@uely after the beginning of the new fiscal yeari B. Tne Present Outlook for 1970 Doctor Olson reported on the status of the Administration's budget for 1970 which as presented to the House Subcommittee includes $93.5 million for Regional iMedical @gram grants. It was shown that this amount of mney, in addition to meet@ the comit@nts for future funding at the present level, will allow just under $20 million for "reiAi" activities in 1970. According to the best est@tes of the Division about $7.25 million of this balance will be required to provide operational @ts to the 1-9 ren@ing Regions (including the four to be acted upon today). Therefore apT)roxjimtely $12.7 rrdllion will remain for funding of new activities in on-going Regional I,:edical Progrwis and for any possible funding of multi-program grants under the new Section 910 authority. Doctor Olson reported briefly on the progress of the reorganization of Regional Yledical Programs Service @ntioning especially the Nutrition Program and its Implications for Regional Medical Programs. ion of @ction 910 C. The Division plans for the use of the nal-11-ti-PrO@ grant authority et!.-ng in February 1969, were as approved by the Council at its rn-@ ived reviewed and a list of pl,@l-tnL=y abstract proposals rece by the Division was presented.* Relative priorities amng kinds of activities represented by these proposals and between these grants and further funding of the Regions were discussed briefly. Doctor Olson indicated that he AOuld appoint a co@ttee of the Council to consider plans for multi-progrwn plants and to look n-ore closely at the kind of activities proposed. Prominent among the prese@. T)roposals is one submitted through the California Fiewjonal medical program which proposes a broad-scale study of the drug clofibrate in the control of coronary heart disease. four western ReFJ-ons It would involve cooperative arrangements aimng (InterTwuntain, Oregon, California, and @Tashington/Alaska) and the total request for the first year of the five proposed is $5,170,goo. This preliminary proposal '@d been reviewed in depth by staff and by Doctor Pellegrino. He co@nted on the great need for a study ofthis kind of cholesterol-lowering drugs in order to avoid the pitfalls and lingerino- indecision that has surrounded the use of anticoagulants. CD He further coiwr--nted on the study protocol as being co@lete, feasible, iiell-controlled, and statistically sound. He then cited a n@er of serious questions relevant to the actual undertaking of such a study. 'fhp-se included the difficulty in controlling other variables such as hypertension, diet, stress, and patient cooperation; the ethical questions raised in such a double-blind study; and the possible toxic side reactions to the drug. He also mentioned the questionable procedure of studyinr, a specific drug when the value of the general effectiveness of lowered cholesterol in the control of coronary disease is still unproven. He further Mentioned the coiTplete uncertainity of the cost-benefit ratio in launching such a study as well as the very high absolute cost of this particular proposal. Doctor Pellegrino raised further question concerning the relation of this study to activities in other investigations, partidul, aTly at the National- Heart Tristitute, of coronary disease and related problems. He concluded tl,-..at any such activity as this would requ@e intensive investigation'@,d study by people experienced in fields directly related to it, including cardiologists, epidemiologists, and statisticians. Doctor Pellegrino's impressions were generally supported by +-he other nierbers of the Council and it was agreed that it should be looked at in depth by a subcommittee of the co@ttee for multi-piograms grants (which had been mntioned by Doctor Olson) before a formal proposal is to be considered. T- Mr. Peterson reported briefly on the Division's efforts toward the evaluation of Regibnal@ 1,4edical Programs to date, on a national -5- islatdve basJ.,-,, in rc@nUF,";t for extension of le&, authority. !I(-) a-'Lsc) on trick lic)cl advisory group on f a. subcomittee of that o," ar.@d a o issues. Doctor F.,\rerist vfno is a mei-ibe,-, of the form, r a,,ic) F),)c'cor Caririon a inen3ber of the latter, reported on In-house efforts. At the request of Doctor Olson, Doctc)-;-- l,'ai-in@)i-i. has a special @erstanding of the relatioi-i,-,hii)s beti,,--,--n Regional i@iedical PmgraTris and Co,,nprehensive esT)@-r,,ially in hi-, 1),oine area of l,'Aemphis, presented his Health -i-Z concept of this relati.@,ns,@.p and its @,;orl@k)i3.ity not only in Meiiiphis but potentially tl.,i,ol-i.@tc),,)t the I-',,Ltion. VII. DISCUSSTON OP Al,@rPNf@FT-V-,E FOR APPLICATION A. Definitions of Pro,,@. am Cr,)mWnel'its Recor,,ij.zir),@ the need for better identification of the activities of Rerrio,.@l Medical Pr,),7.am- v;hich are in general supported out of the "core" budgets. in Fe--.ruary the Council requested staff to work to@@ the development of a scl-ienie for the better delineation of all grarit,-sitpported activities. In response to Councills request, Mrs. Phillips proposed definitions of four categories of Regional activities under iihich all. activities in exist@, Regions could be classJ.fied. 'Ilhe@se are: --Ta;,.q direction and T)rofessior-al- services which include the salaries and supporting ( staffs established for Regional Medical Pro@ams; central mgiomd resources which include evaluation units, data co le tfo-n and process@ units., regional continuing education resources, etc. , which are created by the grant and will require grwat-. support as long as they serve the Program of which they are =,t; feasibility studies which are specifically definable planning activities req@iring a special allocation of fends blL).t which are t@--lird-ted and do not represent a continuing cost .to the Regi.onal Medical Program; and orieratioral r-oiects which when completed can be shown to have ident Jed and in the Region so that it can be continued from "Local fundirg resources, can be fo"Llowed-up by a new project a-,oproacki, or be terminated. Mrs. Phillips reported that the-se definitions had been tried on an experimental basis 1.1- 4 seven operational Regions and in general had been found by the Coc@,-diriators and their staffs to be quite workable. @ Council found dcceptable and urged the Division to mve ahead in Assisting operational Regions to organize their on-going activitie-- accord4-rr,,,i.-I. B. Anniversa3-i Asses-.@,.@--r.,t - A thL-d. sta in Regional Develop@int 1-ie Also in response to k@". interest expressed by the Council at its February meeting, the staff has further pursued its proposal for a reor @zation of t.@-,e review of Regional Medical Pro@is and -6- "arn-dversar-i review systei-,il' ifiiich was contained in a very prely report to the Council in 17ebruai-y.* Es@3ei-iti-ally, it provides for an arrarie mert ',-)y @@;,-lich acan b,,:: thoroughly reviewed on a C-@ regi-il-ar basis both for coi-itj-r2@.,i,--it-i-on of' its on-,o,,oliig activities and for the addition of supplemental proje(,-,-ts and studies; enjoy the security of being classi.L@@Led as a with a cori,-@atment for continued fundino, at a certain annual level-; and utilize to a greater extent its own review process and FAG approval for program flexibility in the intervals between its regular anniversary review at the national level. Doctor Olson then presented to the Council an analysis of all 55 Regions which includes their present level of grant funding' the total population they serve,* and an illustrative funding level for each Region based upon a simple formula relating to that total population and adjusted for population density and incidence of poverty. This he described as one basis for deciding on a reasonable distribution of some $68,ooo,ooo among the 55 Regions to cover the continuation of the Programs' runirral- needs for direction, planning, professional services, and a small number of operational projects. Such a distribution would assure the continued, although probably uneven, development of the program nati.oral.1y. All of the monies available for grants in excess of the $68.,000,000 could then be disbursed each year on the basis of regional progress, -individual project excellence, and national priorities. The Council Aras unanimous in expressing serious (,concern with any fiscal plan which would appear to relate Regional Medical Program funding to a nationally announced formula. Principal among their concerns were (a) that it -viould carry the iTTp@ssion that some decision has been made as to the needs of the program and thereby established a level at which an effective iDrogram could be carried on; and (b) that it appear to substitute an arbitrary decision-making for review by peer groups and recommendation by the Council based on the quality of proposals. It was stressed repeatedly that as a growing program the Service should avoid, at all costs, creating the @ression that a reasonable cost" of Rea-ional TJ@edical Programs has been, or indeed can be, established on the basis of present knowledge; or the equally erroneous impression that an amount of mney arbitrarily arrived at by formula and awarded as such, could adequately serve to meet the needs of the Region as an addi.tive to an already existing bloc support grant. The consensus of the CoLL,@--il was that a formula basis for funding Programs not be considered further by the Division and that before undertaking any fo @, 1 @teps tovrard the creation to a new grant format, that the Division consi-Q'er the authority now available to it in meting the reeds for arir-iversary review or some variation of it. of the val.ue of regularly occurlrv, regl,,onall.y-f F,,",sible projects. P VIII. RF,,?O@E OF Tli li-T@ HC)C G OUD T,) CONSTI),@@l RErTIO14AL IV-F.Dic@f@ P@-7CkT CTS FO.,', SFA@VIC@FS the one day meeting of this group,* IX-. Michael Brennan reported on u vihich he'clD.irei., and v.@l.ch on tl-ie basis of their deliberations rec'uii@-nded Guidelines for review of applications from Regional Medical Pro.@arns for projects of this kind. The Co,@t-tee consisted Of: Michael J. Brennan, M.D., Chairman James 11. Nickson, M.D. President, Health, Dept. of Radiotherapy Michigan Cancer Folmdation Michael Reese Hospital Detroit, Michigan Chicago, Illinois Juan Del Regato, M.D. Robert J. Shalek, Ph.D. Medical Director Professor of Biophysics Penrose Cancer Hospital University of Texas Colorado Springs, Colorado Houston, Texas Robert Loevinger, Ph.D Kent T. @loc>dward, Ph.D. Chief of Dosimetry Section Program Dir. for Radiation National Bureau of )@ndards Extr al Activities Department of Co@rce National Cancer Institute Viashington, D. C. Bethesda, Maryland The Council expressed its appreciation to Doctor Brennan and the other mTCoers of the group, and unanimously endorsed the recommend- ations. (Fhese are presented as a part of Section IX-B of these Ibnutes). IX. REGIOIIAL @ICAL PFTOGRAM CT@ APK,ICATIONS A. Review and Recommendation b tILe Council i raur Mrs. Phillips reviewed with the Councilthe recommendations which they had =de in February which are listed in the minutes of that meeting and which now have been made available for the guidance of all applicants. B. S-pecii@icall-,v Identified Issues ReT)resented in the Group t.(.) be Revie il at 1. Problc@,r--, and Role of Regional Med The Council reviewed ",-he presentation by staff* and expressed wit the description of the problem and the issues posed. There was, @s of the Rezlonal. Medical. Frop.,Tam and the su@resti that l@-i,,TS niiF@it iii@Te a somewhat, differ(@-nt role O'f ategy v@o-old be required to and. that a different approach and str iety of' health achieve "reg2Lon-aj-iz.@Z,-@ion" aronc,@ tlil-- extensive var care facilities @,i',,iich exist in CD hi,@,,j-i density population areas. Several members agreed that it Tpight be im@,ossi.bl-e for the Council to undertake the delineation of sp(@cl.f'i-C polic@, -ecom-nendations in relation to this problem as they @iD@ve with the are specific well- defined issues presented to therq. They did, however, suggest there perhaps vras a need to supply Council with a set of general suggestions which the Council r@iight endorse and offer for the guidance of Regional Medical @ograms. 2. Reco@zing the complexity of treating chronic renal diseas6 and the.enormous cost of mounting a service program even in a restricted locale, the Council reco,@,e@ that Regj.onal Medical Pro@ams grant funds awarded t( onic renal disease be limited to support of those projects which provide for: . Trainirg of physicians, nurses, and technologists for managemnt of chronic renal disease patients, and . Regional planning for a coordinated Regional approach to prevention, diagnosis, and clinical ement of renal disease. 3. Health TreC@ug, and Continu Basic Trainin& of Allied Health Personnel @.e Council recommends that Regional @dical Pro,7,urs grant ninds for basic training :L/ ol' aiiied health personnel be l@ted as follows: For projects which meet the criteria funding which are set for-h in the GuidelinesfF/ il - and discussed furtherer the Council recorynendations of February 1969 :I/; and Defined for purposes of R@-@gional Medical Program grants as trai required for a certificate, diploiTa, or degree N or which otherwise leads to the fulfillment cf the experience and education requirements for initial entry into a health career. Guidelines, 2/ ip,)lement Exmariled Statement on Fdiication & Train,'@, .3/ News, Infonnation, and ',-late, VolLufie 3, Number 175, May 13, 1969, National Advisory Co.@ttee S-oeaks to Six Issues Re Coffponents of Program Acti-ifities, -',ated to newly developed technologies Plor train@, re,j or new mdalities of diaFiiosis aya,:i treatment for vihich no standard ct-i-,t@riculLn is yet recognized and no minim= m4t for certification or 2.icens@- are yet established; @-,,,Id is not generally Part of the lar offeri-t-@,,@j of' tied iealth-related educational and regu training system of hospitals and/or technical schools@ junior arAd senior colleges. This ,-(@s'@-riction on u@,e of Fegiol-,P-I. @'i,@-,dical ProgTams funds will be limited to the actual costs of provision of the t and for payrr,e@-it of student sur@,port and assistance. Regions are encou--aged to use both professional staff assistance direct support of special planning studies to encourage educational institutions (tecd,,nica-I institutes, public adult education resources, extension pi,oEp?ams, junior and senior colleges,, and hospitals') in conjunction with the resources for clinical experience, to providt-@ new educational and t@@opportunities in the established a].-licd health disciplines and to ac new discip@s; but only after they a@ fully identified as essential to the provision of a recognized service to patients. At the l@tional 'I@evel, the Division further proposes to encourage io the incorporation of these disciplines into the various training end education systems, such as those which set standards, approve curricula, and aid in counselling and recruitment; as well as those W-E.ch assist in the financing (F'ederal and non-Federal) of allied health career programs. In implemp-nting this recommendation, the Division will ask the Council to consider the various disciplines separatelyand will base specific lirAtations on their Judgment whether a discipline falls into the category described. Training of Cytotechrologi-sts Upon recorrrrery-iatiori ol-.Ithe Council., the Division has identified Cytotechnology as an established allied health discipline. Its training programs are approved by the American Medical Association Council on Education -than properly recommended by the profession,, and graduates are cer,.-,ified for practice by a nationally recognized examination administered by the- profession. Tne techniques of exfoliative- cytology Tire now of universally recognized value in screening and diagnosis of pathologic states. 'Iherefore, in line WL'-h general policy relative to s t, upport of established programs and in keening with above policy guidelines on training oral MedJ,cal Pro the C(,,uri@il recom-r.,en(is that, Rewl independent protect o,,, as part of a project demonstrating the application of exfoliative cyto"Lo-,-,,,ic techniques to patient care. -lo- RecruitTpent Healt In recognition of the nationwide need for iTt)re and more coiq)etent allied health @-rsorinp-1, t,,ie Council reaffirms its policy of support for effective Regi;@ll cal Programs activities directed toward meeti@, those needs. Ho@,,,eveT,, a direct relationship between fic'recruitroent efforts at the high school level and increases speci in qualified health personnel is difficL).I.t to deimnstrate; and the real impact of a recruitment project on the care of patients is often rewte or obscure. The Council, therefore, recommends ti-,at further support of such projects with Regional Medical PrograTr@s funds be granted only vihen a proi(-r-t is related to a clearly focused (specialized) short-range approach to i.ii-- critical needs of a region, and Has the documented condtted support not only of the sponsoring agencies, but of the Region's hospitals schools, and colleges whose cooperation is essential for the success of the j=ediate project and its continuation after Y@egional Medical Pro@ams support can no longer be made available; Includes a plan for evaluation of the @act of the program on the rate of production of trained health mnpo,vier; Is directed at special population groups, especially those who d lly seek, or have available, o not usua opportunities for trai or education beyond secondary school. Dial Access A-u-diotape Prolects The technique of directtelephone access to prerecorded tapes on selected topics of interest to physicians and allied health personnel is becoming increasingly popular in Re-ional Medical ProUams. The Council reconrriends that proposals for projects of this kind ineet the following criteria before being referred for review as part o f a Revional Medical Pro@a-.n application: The application s7nould contain an explanation of the way in which the project fits into the total regional education effort fcr physicians and other healtTi professionals. Proposed evaluation of the service must involve its receptivity and value to the professionals in their practice. The mere measurement of numbers of the incoming calls is insufficient. When the request includes the establislnent of an independent networl@ (in contrast to s an already for a new network as well as a plan for long-term use of the network. Th@-re Trust be a plan (bolh long and short-rwage) for the develop,,np-nt of the tape library, justifying any decision to n-ake rather than share or purchase tapes; for the selection of subject iratter; and for the identification of target groups (i.e., physicians, nurses, etc.). 4. Radiation and I)osi- t ices In accordance with the recombination of the Council in its February meeting, wid. Ad lio(, Cc)rq@.ttee on Radiotherapy Dos@try Services was convened @n Tp-rii. 8 to discuss the general subject of radiothera-,oy consultation and dos-imtry services in Regional 14edical Programs and to provide guidance to the Council for the review of proposals in this area. -The following are the Co@ttee's recomp-ndations -- 1.1 -- of what should be included in proposa iotherapy consultation and dosimetry servi6es: Indication of the applicant's intention to participate with representatives of other specialties involved, in a multi-disciplinary approach to the treatment- of cancer patients. Assurance that the radiologists who are to receive the dosimetry service are adeouately trained in radiotherapy or are willing to accept clinical consultation and assistance from the Radiotherapy Department providing the dositwtry service. Indicationcf masures to be taken to-assure accurate record keeping, careful follow-up of each patient, continuity of care, and feedback of information on length and quality of survival. Assurance that there will be regular monitoring of all radbtherapy equip@nt, including calibration of the calibration instruments themselves. Indication of T)lans to make the dosimetry and calibration services self-supporting within a relatively short period of -12- ons C. Consideration of.Applicati 1. lloar initia@- operational avrards were recommended: BI-STATE RFGIOIIAL @l,DIC@t,L PRCCRAM In recormnding approval the Council concurred with the Review Comdttee except in regq-rd to project #4 - Stroke Unit- for which the first year was reduced to approximately $72 .5 8003deleting equipment, hospitalization, and certain related personnel positions. Future year funding remained the same. Projects #1, #3, and #6 are to be returned for revision. The following totals for the supplement to the core co@nent and three approved projects (#2, #4., and #5) resulted: 01 $365,728; 02 - $287,667; 03 - $298,268. MISSISSIPPI REGIOQ@, MEDICAL PROG.W-4 The Council concurred irith the recommendations of the site visitors, to whom the responsibility had been delegated. They further recommended, however, that action@on Project #8 be deferred pending further study, by the Council, of projects of this kind. The following totals include funds for the core component (excluding the earmarked feasibility studies) are eight projects: 01 $977,240; 02 - $631,134; 03 - $657,066. NOFUHWEST OILTO REGIONAL MEDICAL PROGRAM 5/69.1 - The Council concurred with the Review Co@ttee in recorrmnding the following total award which includes funds for six projects: 01 - $567,070; 02 7 $528,026; 03 - $605,455. 5/69.2 Request for expansion of staff was also recommended. Six months only. ol $65 200 (Six month amount) The designation 01, 02, etc., relate to the first, second, etc. budget periods of the subject Lap locations not necessarily the budget periods t will actuall be s I-er,,i@iited. 7.ie Council concurred with the Review k-loiiiTiittee in recommending approvali- of --n initial opera.-io,-ia-i- a@,,,ard to -this region. They further recommended, however, 'that final award of funds for project #)4 be deferred pending further study, by the Council, of projects of this kind. The following totals include funds for the core and five projects: 01 $93)t3O4l; 02 - $944,376; 03 - $917,363. 2. qhe following regions have been reco@nded for awards to renew all or portions of their operational grants and, in some cases., to add new project components. CAL=, O-'Ii@TIA P,@@UTOIJAL L@ICAL PRCril@@l 5/69.1 - 'ihe Council failed to concur with the recommendations of the site visitors and tire Review Coirmittee and recommended funding of project #7 for one year only, at the current level - $336.$000. 5/69.2 - The Council concLL-red with the Committee in reconnending approval of project #35, as requested- and deferral of the balance of the application. 01 - $178,84o; 02 - $1833792. 5/69.3 - Rie Council concurred with the Review Committee and site visitors and reco,@-nded an award to include funds for the 10 components of core. 01 - $3,449 000; 02 - $3,796,780. 2/69.1 The Council concw,red- with the Review Corrmittee in their recommendation for approval 1'n a reduced amount; and agreed that ["his project is within the relevant guidelines adopted by them at this r,-,c@etj-,-ig. ol @')435,841; 02 - $D82,833; 03 $4o6 389. REGIOIIAL @F-DICAL a@i a,,,4ard Fo 2@riciu@--e trends l'or three projects. 'Ihe budget for -i4- one (#13) raoLlires do-vmward ric-,goluiation as prescribed. The a,@,,,qrd r,-uy not exceed: Ol,- '4")284,035; 02 $16@1,680; 03 - $175,274. 2/69.1 in recom-.qerjdiiiy approval of this project, the Council found CD it Lo be within the relevant guidelines. The amount is to be adjusted downward by el:@nation of the costs related to the computer netwo,-!-,. The award may not exceed: 01 - $3211,988; 02 - $258,557; 03 $268,371. KALTQSAS REGTO'L @4.AL T;R=ICAL PROGRAIL In concurrence with the Review Co.@ll-ttee, the Council reco@nded approval of an award to include funds for renewal of three projects (#l, #3, and #11) for three years and initiation of one additional project (#37) for three years. ol - $417,3111; 02 - $413,667; 03 - $473,951. MISSOTJRI RE@@@!Oi',IAL i".,'EDICAL PROGHK"@ The Council concurred with the Review Condttee's recommendation for renewal, for two additional years of project #33, for disapproval of #4o and #42., and to return #41 for revision. 061; 02 - $24 6,943. 01 $24031, I-EW JERQJEY RD"TIOIi-A-L i'.IEDICAL PPOG.@@l Approval for renewal of the core component of the pro@am was reco,-nended, in concurrence with the Review Cormittee. 01 - $6385 000; 02 - $6'08,700; 03 - $699,100. Tne Council was unwill-Ln@ to consider the request for the supplemental CD request for staff for ',iodel Cities planning without the advice of the -4 Review Co,-cirdu,-ee. The Council concurred with -,he Review Comittee in recornmendinp,, the. approval of the continuation of two of the four feasibility studies -15- 4- ionq rojec'-s; -:Ind of one additional project (#6 and #9) as operaL, p 01 $428,71'(; 02 $11-111,794. O@@'GON PEGIO'@,IP@T @@,EDICAI, PROG.@M In concurrence with the RevieAl CorF,,n4ttee, the Council recommended I- I renewal of the support of the core -omponent of the program and approval of two new projects (#13 and #14). 01 - $228,i-o6; 02 - $248,7b2; 03 -$269,050. TFX8,S REGIT,,!@J, IIEDICAL PROGR.AM 5/69.1 - In concurrence ATith the site visitors and the Review Co@ttee the Council reco,-Yaended aoproval of an award to include funds for five projects. 01 - $286 424; 02 - $2893851; 03 - $163,96o., 5/69.2 - 'ihe Council concurred with the Review Committee in recbrffnending an award to include funds for renewal of support of the central coordinating office, the eight planning bases, and 11 of the 12 operational projects. At the request of the region the coaritment for the second and third years for the planning bases was not included in the reconrnended award. 01 - $1.18623585; 02 - $961,18o; 03 - $782,564. 5/69.3 - FLLrther, the Council. endorsed the Review Committee's recomendation of funding,for seven of the nine projects included in this application. 01 - $LI31,034; 02 $385)405; 03 - $3o4,751. V@IESTER,"4' VIEW YO@Rl@, @-TIOII-AL @@IMICAT@ PROGI@M Thp- Council concurred with the Review Connittee in recomending approval 6f an award to renew project #2 for three additional years; and to approve project #10 for three only. 3 - 'I'ht, Couiici-I dE:f'er,-ed action oil three applications foi, rene,vi,@,l of p-wits in of all. or portions of regional prop, -is, for fl@,@L".rier@ by the- Cor-mrLittee and/or site visitors. @.hey delek-@Lcd to Lile ,3taff the authority to extend supports of on.@-oi@-7 activities in these regions, as necessary to n-al-r@'Lain pro @iri integrity, until fo-yiiial action on the renewal applications can be +,-,@l en. Albany Reo,ional l@ledi-cal Arizoi-ia Medical Program lvlemohis Regional Medical Program North Dakota Regional Medical Program 4. The Co,,mcil concurred with th- Review Coimdttee in reconnendin,7 C:> action on a nurpber of applications from operational Regional Medical ProUams for supplemental projects. Arkansas Regional Medical Program 01 - $167,956; 02 - $78,6o6; 03 - $78,oBo. Florida Regional Medical ro@.am No supplemental- funding and prohibition of use of existing FL",IP funds for project #18. Greater Dela,,ia-re Valley Regional Medical ProEam 01 - $197,401; 02 - $158,362; 03 - $159,387. Indiana Regional I,,Iedica am ol - $4o,,428; 02 - $36,947; 03 - $38,720. Maryland Re-7@-o!-,al i'vledi-ca'L ProoTLm No funds and prohibition of use of existing Regional edical Prograr..: funds in both #17 and #18. Mountain Suates Regional Medical Program ol - $96,593; 02 - $98,023; 03 - $101,933. North Carol-ira Regional Medical Program 01 $219,162; 02 $218,153; 03 $1963152. 5/'o'9.1 and 1.7/6r-,.2 Use of ar js in project i@i24 is prohibited. 5/69.3 No fund!,.,,-lg ka, r,,,.@p;Lc)nal Yie,(Iic V,'aF- Alaska, L 5/69.1 01 - $681,544; 02 - $595.4847; 03 $151,163. Use of any RI@IT funds in projects #30 and #33 are prohibited 5/69.2 No funding 5. In recommending action on applications f-roni the following regions, Council differed slightly from the.Review coiriTdttee. GEORGIA REGIONAL ME@DICAL PROGMI Although they were in agreement with the Comnittee concerning the desirability of a site visit to this region so@tjme during the sLmmer) the Council recomended that those projects about which there v,,ere no substantive (Tiestions be approved now (as specified by the cor@ttee) rather than after the visit - @ effect vnc s the recorirleridation of an award for projects #18S, #19, #20., #22.1 #23, #24 and #28 in amunts not to exceed: 01 - $350,000; 02 $350,000; 03 - $350.,000. IOWA REGIOlqn ITDICAL PRCMM oving Council agreed with the '-Review Comittee in appr both the core p - project #23, but specified that both be funded in the SUP lenerit and amounts requested: ol - $196,558,- 02 - $190,@673; 03 - $5312110. METROPOLITP@N, D.C. RR-GIOILAL MICAL PRCGFM4 In 'he'latter (#26) approval education, and for proje@ts #23 #26. t i,,3 contingent upon the I-lospitalst willinoiess to pay the nursing salaries Project #25 was also aD roved, penrjin,- the favorable recclfrc@ndation o @p expert site visit tea,-n and in an amount deemed appropriate by the team. Project #22 was also i:@eccifn@--nded for approval in a reduced amount ($1@50 000 per year) for two years only, with a major portion of the .7 redtiction,to be applied to personnel, particularly the academic positions. In concurring with the recommendation for revision of #24, the Council rovided either by staff or by outside ,ested that assistance be p consultants. n@@,Dject #21 was disapproved and no PUMP funds are to be used for the project. Approved amunts do not include any funding for project #25. ol - $467,387; 02 - $364 818; 03 - $171,585. MICIIIGAN REGIO"@LAL @IEDICAL PROG-RAM The Council concurred with the Review Corrmittee in its recommendations on this application and, in addition, delegated the allthority to staff to add funding in an amount sufficient to provide continuity of project #15 until a-site visit can deterra:i@np- whether it should be renewed or terminated. 01 - $486,714; 02 - $492,530; 03 - $487,771. NEW IVEXICO RFLGIOI-,TAL i@ICAL PROGRAM In conc = in@ with the Review Co @ ttee's reco @ ndation for approval of this project, the Council specified that the award be contingent upon the Region's submission of an acceptable plan for evaluation of the project.- 01 - $59,237; 02 - $61,223. OIIIO IIP@,Y Rl,,r.'IOI,,IAL IIEDIC.AJ, P'IDGTW4 The Council concurred with the Review Cormdttee's recomendation on projects #8, #10, and #11. In regard to project #9, they recommended that the application be returned to the region with encouragement to re-vise and re7@iibmit along the lines of the guidelines recomended by the special radiation therapy co@ttee which were endorsed by the Council at this meeting. Project #7 was recomended for approval for two years only at a level of $200,000 per year pending the sub@ssion $305,000; 02 $342,6511; 03 $342,654. MICAL P@-,OGR"@4 Council. v@,as not Filling to arr@Lve Li. final recommendation on this application on the basis of the irifori-!,iatioii at hand and recommended its reassessment by the Review Co,,,@,CLttee.. 13OUTH REGIO-'VL MEDIC,8J, P,--@'CCrRAM 5/69.1 The Council conciu=ed with the recomeridations of the Review Comdttee. 01 - $154 458; 02 - $136,755; 03 - $130 922. 2/69.1 The last recorded reco @ ndation of the Review Co ttee on Project #40 was for deferTal. The Council- believes that in the light of the project's fulf'ullment of relevant guidelines, the recc,,mendation of approval is in order. 01 - $103,658; 02 - $37,024; 03 - $38,530. 6. Two'special'actioris were taken by the Council in approving supp lements to the planning grants in two Regions: PUERTO RICO REGIONAL r4EDICAL PROGML Council approved a reqiest for an increase in core staffing which requires a second year planning grant award of approximately $18.,OOO above the amunt co@tted. One year only. NORTHEAST OHIO REGIOI%TPT. IOED!CKL PROC!RKM Council approved a reques@u for expanded core staff and for the initiation of one study Wnich i-iill require a planning grant for the second grant period of approximately $127,600 more than the amount committed. One year only. X. ADJOURUr@21T 69. The meeting was adjourned at 3:00 on @y 27, 19 I hereby certify that, to the best of nW knowledge the fore- going minutes are accurate and complete. Stanley W. Olson, M.D.@ Director Division of Regio@. Medical ProgrciTns *Text of the statements and additional mterials iihich were distributed at the meeting are available in the Office of the Council Secretary. -21- A'ITI@72\TDAI@TO@E AT THE NATIONAL ADVISORY COUNCIL MEETING May 26-27, 1969 PUBLIC E7@7H SF,@,\TICE OFFICLALS AT=314G Lionel Bernstein, Veterans Administration Dr. Joseph English, Administrator, H,7aR 14r. Irving Lewis, Deputy Administrator, HSDSIA OTHEM ATM4DRIG Dr. J.1l.U. Brovffl NIGMS Mr. David Kp-fauver, NEM Dr. Helmut Mueller, DRG Miss Pauly Stephan, NCI Mr. William J. Zukel, NHI D@@ STAFF A=-IDING Yir. Nicholas Cavc-=cchi, Financial Mariagemnt Officer Dr. Donald R. Chadwick, Deputy Director, DRT Mr. Cleveland Chambliss Assistant to the Associate Director for Organizational Liaison 14iss Cecilia Conrath, Chief, Continuing Fducation and Training Branch Dr. 'Alilfred David, Acting Director, Division of Chronic Disease Dr. Sam Fox, Chief, Heaxt Disease & Stroke Control Program, D(,D Mr. Edward Friedlander ., Assistant Director for Co cations and Public Information Dr. David S. Hathaway, Acting Chief, Dialysis & Transplantation ProUam Section,, DCD Mr. Charles Hilsenroth Assistant Director for Management Dr. Clarence Tmboden,, Assistant to the Associate Director for Organizational Liaison Mr. Robert Lawton, Consultant to DRMP Mr. Gregory @,vrls, Chief, G.-,E4,nts Managemnt Branch Di?. Richard @egold, Assoc@te -Director for @ Cperations & Developmnt Mr. Roland Peterson, Assistant Director for Planning & Fvaluation Mrs. @ha Phillips., Assoc-:,ate Director for Grant and Contract Policy Mrs. Judy Silsbee, Assistant Director for Grants Review Mr. Robert Tnorr@er, Assistarii-I Director for Health Data Mr. Robert Jones, Chief, Pro@ Assistance Branch -22- OTHER DRMP STAFF A-=,@.UTG Miss @da Abrams Mrs. Patricia McDonald Joseph Anioroso Mr. Praiik liasli Mr. Kenneth'Baiim Mr. Rodney imerker Mr. J&nes @-attie Miss @tjorie Morrill Dr. Phyllis Carnes Miss Elsa Nelson Mr. Roy Davis Mr. Jack Pendleton Miss Joy Finnegan Miss Leah Resnick Mx. @ 0. Gilr@ie,- Mr. Dale Robertson Mrs. Sheila Gould Mr. Richard Russell Mrs. Eva real Mrs. Jesse Salazar Mr. Walt Hangen Dr. Jack Schneider Mr. George @,le Mrs. Brenda Slasrmn Miss Dona Houseal Mr. Dan Spain Mr. Alphonse '3trachocki Miss Margaret Hulbert Mr. Joe Jewell Mr. Lee Teets Mr. Fi@ Van Hee Dr. Bryant Jones Dr. Anthony Konwoff Mr. Ted Koontz Mrs. Lorraine Kyttle Dr. ltabert Mathewson ITJ' Ri@fO-, f@@ -23- B13EZM, Michael J.3 M.D. (72) MAHONEY, Mrs. Florence S. (69) President, Michigan Cancer 'P,I-indation 3600 Prospect Avenue, N.W. 4811 John R Street Washington, D. C. 20007 Detroit, Michiran 48201 MTILTMI, Clark H., M.D. (72) Professor of.Medicine Consultant in Nleurology l@layne State University Ma@to Clinic Rochester, Minnesota 5590;) CANNON, Bland W., M.D. (69) 910 Madison Avenue PEUEGRINO, Edmund D., M.D. (70) @lerrphis, Temessee 38103 Vice President for the Health Sciences and Director of the Ct Division of Neurosurgery State University of New York University of Tennessee Stony-Brook, New York 11790 College of Medicine POPMA, Alfred M., M.D. (70) CROSBY, Edwin L., M.D. (71) Regional Director -Director Regional Medical Program Amrican 1-bspital Association 525 West Jefferson Sbreet Chicago, Illinois 60611 Boise, Idaho 83702 Anthony R., M.D. (69) ROM, Russell B., M.D. (69)@ Professor and Head 240 'West 41st Street Depart@nt of Surgery Erie, Pennsylvania 16508 University of Wisconsin Madison, Wisconsin 5370(,' Vice Speaker of the House of Delegates of the American Medic DEBAKEY, Michael E., M.D. (72) Association President and Chief E-xecutive Officer Baylor Colleae of Medicine SHANHOLTZ Madk I. M.D. (70)@ CD .1 2 lbuston Texas 77025 State Health Comdssioner State Department of Health Professor and Chairman Richnioiid, Virginia 23219 Department of Surgery Colle@e of Medicine TREEN, Mr. Curtis (71) United'Rubber,, Cork,'Linoleum, EVFFJST, Bruce W., M.D. (71) and Plastic Workers of knerica Chief of Pediatrics 87 S. Hii4h Street Green Clinic Amn, o@io 44308 709 South Vienna Street fpston, Louisiana .71270 Director Pension and Lisurance Department MGNESS, John R., M.D. (70) Dean, School of Medicine WYCY,.O'-PF, Mrs. Florence (72) University of Washington 243 Corralitbs Road Seattle, Washington 98105 Watsonville, California 95076@ CHAIRMAN Dr. Joseph T. English llea@-Ith Administration 9000 Rockville Pike BetYtesda, r4aryland 20014 May 1.969 & Cory,,rast Pdli,,