Cr@Et/Renzi OF 8 7 t') 2 PUj'@'LIC SER@VICE @l'IITZjJj liBALTII ADI.'INISTI@A21ON 3 IIEI@LTII SEIZVICES AlqD 1'1,, 4 I)X- GION7i.T-t 14F@DICAL PROGIU-il-IS 5 - - - 6 Review Conuiii-ttc-e 7 8 9 10 Conferenc-. Room Gl.'i Pztrklc,@.,,n Buil6ii-ig Roclc%rille, Thursday, May 4, 1972 12 The r,,eetii-,g conveil,&,d a'L-1 C@-.4'j o'cloc;l@- 131 141 I-layer presidiricj. Council Merbers Present: 15 Dr. Gladys Ancrum 16 Miss Dorothv Aiidersoii Sist,er Anii Jo,.opl,iine 17 Dr. Gerald El-sson Dr. G. V. B):indl,.ey 181 Dr. Effie 0. Ellis Dr. J o F, c @'c s s 19 Dr. Jolin 20 Dr. llill-i@ari 1.1a,,rcr .1 Mr. J'eznus Pa,--ks 21 Dr. Leoiiai:d Schcr5.,."..-, t Dr. !I. C.,clin-,,i-dt 22 Dr. @litchell Spell)ii@n Dr. Will4-@.m Thur,-rLin 23 Dr. Phili.r, Wliii-e 24 kce Reporters, Inc. 25 TRANSCRIPT REVIEW COMMITTEE MEETING May 4-5, 1972 Volume II Mr. Nash 2 CONTI!',IITS 2 LlendzL T'c--,r,,i P- ) e o 3 Corru'@nclits ):)y liar-old Margul:Les 3 4 Future l@eeting Dzites . . . . . . . . . . . . . . . . . . 37 5 Commc-rits by Dr. lierb Pahl . . . . . . . . . . . . . .. . 39 6 @enal Program - Dr. Hinmaii . . . 69 7 Consideration of Applications: 8 Oregon 94 9 Ohio 137 10 Northeast Ohio . . . . 16 7 I I lassau-Suffoll@ . . . . . . . . . . . . . . . 209 12 No;')ras I:a 2 4- 2 13' 14 15 16 17 18 19 20 21 22 23 24 Ace-Fedetal Repoiters, Inc. 25 3 P R 0 C B E D I N G S 2 DI.Z. MliYER: I thi),-ilc xjo rtii.glit begin. Pi-- some of you 3 are aware, there are four of'us who will not be with you at 4 the next meeting. 2ULd I note- that all four of us are- riTor-ousll. 5 in attei),dz)jice and on time. Paid as a co:isequ-oyice of that, I 6 thought we might commence and pick up the others as we go 7 along. 8 Hopefully, because of the changes that are here and 9 that we have laboriously @@,,orlied at and staff has laboriously 10 worl-.ed at, maybe we might be r)ble to get thro@igl-i without N..,o--kinc 11 'all night tonight and witlAout starting at 7 or so in the 12 mo-@iiiiig but at a reasolliAb'ie time. 13 A g)ceat deal has siiicc-, the I.azt mectii".g of 14 this committee. Harold kindly did send us an interii-,i repo.,:,L-. and 151 try to keep us up to date on it. I would have to say that my 16 grapevine suggests that evcn silence that interim reportf a 17 hecl,@- of a lot has happened. Arid I thought I understood what 18 a rapi-d rate of chanae ll:xrold, but X must adnit that I 19 aiA developing a new perfective on how t,-Iiat change. is- 20 and the degree of that slope. 21 Ilith. that,, let rc turn it over to Harold l@largulies 22 -Jr--or comments. 23 Harold. 24 DR. liAlIGULIESz Thank you ve)--y mu%-.h. Ace-Fedeial Repottefs, Inc. 25 The title of this presentation is "Prc@,@jent Shock." 4 1 Thr--re zirc a nurtiber of I woul-d l,ilzc to qO Over You, 2 but before I do and at 'the of saxying the obvious, I %@ould 3 like to co,-carLc@rLt. on the fact i-,he,.t 'cl-ic c-,nei of -Llio T?-"riod of 4 activity of the foi-i2: people %-@ho have b-,--n --c-y.-%!,ing on the 5 review is a point o'L real concern for all of us. 6 1 was just talking to Bill @@@lio confessed to something like 7 six years and six months with the R-agi.onal Yedical Program 8 which should represent some kind of a badge of honor, purple 9 hecirte or -,oinnzth4@ng oil- that I-Iiiid or purple heart for each 10 year, but it is going to make a big cli@-nge, Arid it is going 1 1-to be a rioi;abl-c- long when we Fee these very,, ve,-ry effect@.ve 12 r)eopIL- lc,.@ve 7@id it doas not-.Ytipv-r,,of coursc-, that w,,- Front .14 anticipate being cable to call on them regularly cis we have 15 with others who have served on both committee and Comci-I. 16 And we don't e@,pect to let tJ,-ien, leave the-, progr@zin that 17 effectively. 18 1 woLild like to bring you up to date on a series of 19 events which are not necessarily related, but all of which 201 have a heavy impact on our activities and on the r%.Ggionz%l 21 IIc--dic,-tl Programs. 22 'First, let's start with the current legislative 23 ii-ricerest @,.-Yiich sud,2@,nly into a point of great concern 24 and peop).e realized thz-it tli(! l@ccyiona.1 I@IL-dicz-@l Program Ace-Fedctal R(@portefs, Inc. 25 legislation along with just about every major legislative I pr orts P"o@:,,rains in 1'c@alth 1,71 i,ch 2 E-,ervice2;; end Fca it-ii I-ir.) foL- c.,,.teiLs,-on 3 during the coming f4&scal @vcar. I thc,,):e are at le,,77,. c, t 4 14 major health legislative acts Glitch have to be renei,;ed by 5 Ju-re 30 of 1973, nl,,iP i@- one of them. 6 I don't believe that the Adniinistra.ti.on has estab- 7 lishad a clear position on the whole range of therLi, but it has 8 made it clear in the first response to Senator Kennedy's 9 bill ti-iat it'hored to eddrc.@ss the legislation this t4-nie in a 10 much more fashion ri@ther than having a separate 11 'extension of Acts @qhich have come to lipv-o- -i relationship wi,,'--Il. them, b c-- cc c, 1 2one ano --it wc,, d ct i-)o-nt in tiiii-3 .13 withou-'k,-, that clearly -.pollod out. 14 I,?hzit d4-d hempen is thF.-c. wl-tcn Sonat:or IN'eni-iody iritro- 15 duced his bill on llcaltl-l he reiO-cd 16 to it fo@- purposes of opening the discussion tJ-ie extension of 17 several of tile legislative Acts. And Title IX for Regioi-ial 18 Medical Progrz?.-r,,Ls was one of tl-i'em, 19 I believe thE'@t hearings are already unden.@,ay anci 20 i,7ill continue. I don't lesson the forRiat in which they be 21 carried out. There have been discussions -i.n.,jidc-! I-IEW siia,,oly 22 leading up to what the legi@@slative form of the r@,.IP shoLild be. 23 The coordinators independently have sugge.@,ted cctrta.in legislat-i@ 24 bases for r@gional liedi,cal Prog@-aris !7;,o th,v@@t- tl,,ir-, Hill have a Ace-Fedc-ial Repoitefs, Inc. 25 very clear-cut influence on l@ihat ",,a do in the future. 6 N'@, icil yoli leave 1 The issues are all Ulos II 2 here in the Tlicy j:,eise t' c,.- que@@t4 on.@, of 3 how P@IP rctl@,@'-,ed@, to 1-i.ealth plc.,nz-.ing. T I-)@y 4 raise the question of the of the Na,--ional Iledical 5 Prograras to educational to the implementation of 6 planning, to the categorical devices which have been a p@-rt 7 of PdviP since its beginning, @nd to a iiu,,ilDer of - other organiza- 8 tiorial issues which pi-ob@@,,Ialy c@.rry the dc--@bate until well 9 after the election. I woi-ii-d b,-- su.%-p3-.,i&ed if there is tiny I 0 final zctioii on oil-.r -Lin,'Cil someti.mp- ,after tli@. next 11 -Congrers Bu-Il-,, of cou.@cse, it is concoivz,,ble it coul@d 12 b(-. do,,i,- in t-l-ic-. I?:cc,@ent- It ir, conceivable, vel-Y 13 dou-btft,.I. 14 1 also don't kiiow home much the Ilousc- cn-i-id Sci-ialt--e 15 coiiLTni-ttce-s are goirici to call o-.i o@er people to provide 16 testimony. And it is perfectli.v possible that if they liz,@ve 17 no L&I already, they iii,-,@y ac--,k tl-ii@l corimiittee to tcstLfy 18 regarding their recontmeiie,.ak-ion on Regional 1,I@diczil. Prog2:@jlis. 19 l@hile all that is going on, of coue,.-:;e, there are 20 appropriatici,. acts. IIL@ ha-,,o- had before both the 21 liouse and the Senate App@.,opri'.atioii Subco,,mi-i.ttees. They have 22 made c@veill effort this yea): to co7,tplete the appropriations 23 actions pri.or to Jiai-ie. I don't where Spnate r--.-tZ)..nds 24 at this point, but the I-louce li@-s completed its actions. Ace-Fedefal Rcpottefs, Inc. 25 I-,That now is necessary is for the chambers separately to I 7 Ire@).ch an o,-i whF..t thc!,y b@-lic,,ve the 2shoulclY,3 to get tl.-icD@c7! the I'Aotise and. t-l-io Senate, then 3to -re(,-orici2.e Einy 4 The request on the part of fhe Administrat-'@-on for 5RIIP viast cis I thin)-. we liav-o already, indicated at the last 6meeting, one which would tlic,@ Regional Programs 7to mainta4.n their p%-csent level of grant sLLPort %.ihiclx is 8in the general range of c-,boiit $108 million. They indicated 9durirg the te5tiniorty before bc)t-li cha.-ii-b@,rs t-.hat -&.ere v.,ould be 10 no special funds set aside in the coming fiscal yea@- for 11 Iicalth in--iritr-,nEti-;ce orgai-tiza-Lions out of the M4P budoct and 12 ma-"'o it qu;-te plat-r4 c@ 1-iscd this for 13 werc@ all that they had expected to use out of the RlfiP 14 appropriations. 15 They also indicated thct' i-lic construction funds whi&, 16 we i.@i).l tal.k abou,-- in a mortiei-it :Cor a cancer facility oiic,- 171 time funds in the r-,c-gioiiil 1,1@dical Progr@ims. P,,,-id there %,.Tould 1 18@ be no fui-,-Ihcr i-c-quef,,t for coi-i@truc,-tion fiLnds. They prefc-,r to i Igi )-,cop those under othe-- kinds of adriiiiic@trative EtuthoritiL--.s, I . Ily lii-II-Durton. 21.nd I would some und--,- 20 especia 21 cm-ic--er authority and possibly soiii-3 -Li),i(Icr the educational 22 institution support programs in i-Jie NIII. Therc,. @,ias an -i.nd,;_c@)lcioii al.so by the AdTIinistr@l;@on 23i 24 that they wz,.n,i@-@d to tho level of support for ezitercjcncy Ace -Fedeial Repoiters, Inc. 25 raedical ser%rices from tl-ic- $8 i-aillion to $15 million in the fiscal. yc-ztr and that tlii.,, bc @@ll 2 be rcqi)r-tsted for special whicl-i I will 3 refer to again in f,-i 4 There x,,las no rez,lll discusE-,,@.on of 5 Education Cen@--e-@r concept d,,ii"ing the de!4,b@,ration.@-, 6 but we will talk e).bout t-hctt in a also. So that I %,@ould 7 anticipate soi-oa final action on ou r appropriation le%@el in 8 the relatively near fiiturc;: %%,,hicl-i iTteciis on-- N@,ould guess by 9 midsurrcir@er which is far bett,@.- tl,.aii i-7c had been doix-ig el,;-i-ixig 10 the past several years. 11 N@i, there is a @@7ord of %qarniiig on that. Alt:hot,.gh 12 the appropriations action v.,z,.s completed la.@7,L ycz-,.r by AlLici,.,,,'t' 13 there was no fi.nv,), of ftitids until into the 14 well, it @@7asn't-i-@ntil after the beginning of tl-ic- nc,,@l,t fl-E;ca 15 year. So completing appropriations action in Congress is not 16 enough to assurc- us that we will Icno-,,i our zictuzil 'Level of 17 funding. And as you will b;,i hearing, this li,-is p,--oc',Lice-d some 18 specific for us (lu):i.iig thc@ present fiE-:ca.1 year. 19 l@oliq" I have got sc!vL-ril itaiT@.3, buL- if 20 are some questions z,@out tliz-@tt pc-.,rhal.-,s I shou:Ld stop. That is 21 really fairly riecha'nical up to this point. 22 D R. 1.14'. IYER: Harold, would you tr-ansli-t-k--e the 23 tions into dollars for WiP grants? 24 DR. 14ARGULIES: I,.riiat has happened this year is i-lialt-- (%ce- Federal Reportets, Inc. 25 with the finzLI resolution of carryover and so forth,, we c!ndc@d 9 1 .3 Millic,@-L fO:c 1'1'!P d 4 up at @out @98 2 iqhai-, anticil)iate for tire next 'Lipcal yc-@ar. 3 DR. 4 DR. SPELL.Tj7-a4: You sa-@-d the emergency roedical 5 services grant funds arc being i.nc,--cz7tsed to $10 rrdl,].irr@? 6 DR. I,I-kRGUAT-IES: The c-.,morcTency ipr-,dicFl fi-n-ids -re goil@g 7 to be increased froya the @3 million of this year to $15 r,4-llicn 8 next year, but that gets a little bit i,-,o.,cc- uncertain 9 during the disci,.ssions of budgetary process, since that money i-z 10 being not as an l@iP c..ctivity, but rather as a 11 I-IISI!IIA-wicle activity in ULe curi.-ci-it7 fiscv,)- ye,3r and probably wil@@, 12 be next fiscal year, it will very @'Lilely drop out of our I,)udget and bcccytle a sepa.,.cat-c, itcm. So it Niill riot be 13 , c@ 14 as a pa--t of the R:,iP budc-c. .j t, but this will not affect the 15ibasic level of grant support for l@iPs which i,!iil remain at leaskL,,' 16 constant. This is on the as,,:;uinption i-hr,.t the. Adt@iinistrt-'I-i,on 17 recorr@-,.eiida.,t--ioris P%-,- the samc@ a:z@ Coiigress'. In the past, t@ey 18 have net be,--n. Congress has regularly increased the level. 19 DR. RESSOIYI: To it7het extent does that apply to the 201 current $8 million, that sarae suggestion t-hcit you just 21 raised @out the $15 million being 1.1c,'I,'IiA funCis for emergency 22 radical services. 23 DR. DIARGULIES: I %.Iill got to i-lialt-- in a moli@lit. 24 But the question that is i,, the c,,:Lrr(@.,@it $8 ;-(ii,llion Ace-Fedefal fRepoitLrs, Inc. edical ser%ri.ces is being handled. And 'chat is 25 for emergency in 10 I being rlaxiagcd as a service 2 @,7it-h vont2:@,c.@tL; out o:r tire O'Lfice- of tl-i(;- Zid-miiiistrz@"tor. 3 It is not b-r@i.ng managed by the Rcg4.oiial Pi@-ogram. 4 Dr.,. BrSSO'j'@: I:s IL?-IPS tli@,n no-L, c-illoca-tii-xg i-aoney 5 separately for EMS ac-'tivity? 6 DR. MP@RGULIES: I hava that on my agenda to dil-i Clkl Ss 7 This is as good a time as any ii-' the--e a-@ no otl,.er questions 8 about that. 9 7-ill 5."ight, le-L's tall@ @boot the eirtergency medical 10 zysteiTs activities. 11 indicated in the state of the 12 union r.@-sodge and srLbce(:ue.,ntly lie to 13 level of i.i-ivc@c-;Icnciit in e,@,,c!-rci@-nc@y raedical -ysteni-,;, N,7as 14 at the saria time a dc-ci.,,.i-on to do ti'lis in basically -L@,-,To 15 way,.4 in IISIIIHA. 16 One o:F them @-,,as to develop some major crrargenc-y 17 medica.1 systci-,,,is dciiionc;t-,,--ation activates i,7i-L-h the 18, on it being a total syr@-'@--c--m and to do this in stch, a mani-i,@,r that the various eracrg@rt 19 ay acL-4vities which are fairly 20 wietef;-,pread 4-i-i !ISMH,,It coi-ild be well coordi.iiz-.ted once poS-rit. There ic., fo-- in Nliill suicide p.-,.,-Cventioxi and 21 221crises intervention c-yc@l-rgei,,6cy activities, natern@il and child 23 iheal.th services, general pediz@-Lric and poi-,-,on control cp-ntors. I 24 Tlier(-, is a Di-vision o@, Ern--rgency Medice.1 Services in lislill7-,, Ace-Fedetal Reportcrs, Inc. 25letc., a whole range of emergency activities. In order to b-@ing of th(@@,c' and to Produce sorae -@ed x,; a con r z,, 1 er ,,,D, 2 d 11 RC-( icnL@l 3 0,002:dilla-til'u, cJrOtIP %,IIL 4 paid I sit on the goll-@ ,ral (j3:oup on the small (--Xecuti\fe. 5 body v;liich decides the basic iranag,@rrent and coitr--act processes 6 for these activities,, 7 The determination, then., i;7cis that there should b-- 8 in this fi.scal year five major demonstration -icti.v,.ties -v7h,-ch 9 would be funded by contract--. r@aid these contracts were 10 in a request for a proposal which out som-cti.ric ago illz-,,4-ch 11 had an initial deadline of April 15, then extended to Ap):i-l 21.i 12 So that all o:E 'i--Iie rio-,.v in z;.nei ar(-- under 13 Tkiat is a discrete sepai-alc-(-, activity. 14 I would assume that next fiscal ye@@ir, if there is 15 axio'@bor $15 million added to the funds avail,--blg that it @%,ould 16 be carried out in essentially this fashion, but @e.,ould allow 17 us to also @"t the same time, establish a rc@nt,--alizcd da-t-a 18 gathering and evaluation --ctivity which the initial inv@strr,.-Zrl"t-- 19 is probably only going to g-tt started rather than fully 20 devel.op. X4 St@-( 21 @6 the same jl--ir:ier it was felt that all of the e 221 emergency activities in IUIP and in the other procrairs should 23 be continued, but in such E,@ v7,--iy that they consistcnl-- with 24 -@nd whenever convenient stipplarL,.cntary to the major contract Ace-FedeTal Repottc-is, Inc. demonstration progr,-zns so that- we did in RI@IP,, to mc-J-.e sure 25 12 I th at these deyr3iistrz'.tio".@, did not @,-imply b@ 2 w h no c- -4 Lect, which is too ofi:cii the care, initiitc- and 3 encourage the of eire,,-gency mad-,'%.cal activities 4 to thc-- M,,!Ps as a grarit Declivity c-2.ig.i.ble for 5 supploin--xi@-ary'g,,,z@nt award. Arid w-c h@ive do,@:i-@ that. And so @he 6 Regional ,@ledicetl P:cograms hi-ive r(-,coi.ved and are responding 7 to a description of a well-coo@dinzttccl to'czil cm--rgcilcy T,,,,--,Iical 8 service to be suppvrLed by granted; i-,,ilich is ccy-,tplem,-ntc-z.Llj' to 9 tl,.e contract-activi'z-.y. And in fact, we exchange day to day. 10 data bet%qeen viihat Ni@c are doing in g),@-iits and what we are doing 11 in contr@.cts iqitli the hope that @,ihc@i-x the whole thing ha-@ been 12 co-rrj3-etc-d, 'we ,7ii.1 have a" to,-al )Docly of and of .13 action i,,;hi-@ilt is ix-k order t-o ca@rry ou-@k-- -Ic-h@at ciiercj.-.-@ricy 14 medical activity. I-,.s I thin]; you we have set up a 15i separat(-' body %@,,hich i.-- going to look at 161respujiE;cs to our invitation to submit supple)-,.cnta).-y o,,.,ctuik6l 17 requests, 181 DR. 1,9-@YER: Tliiv, is i,@ithin @%IP? 19 DR. ivJ@RGULIES: This is wi-uiin Prlp. 20 DR. 1.1,'i,YER: And from the co,-,%tract? 21 DR. I'IARGULIES: 011).i-@e distinct and separate from the 22 contrz.,,ct. The contract activity is aK,.other i,-!7,uc- entirely. 23 In order to give enough to the IU@'@ps to 24 rcspond and to develop something N@yhi,ch.is mc.@ctyii-ncjful, we have Ace-Federal f@epoiters, Inc. 25 given them a fairly tight, but reasoriz@.bly broad pc--riod of time I in @..?hich to arc, 2 z-@t the prc@s@-.,r,,L t-.imc, i,411. in. Thc-@.,y reach a fai@1-y formidable 3 and IL-hc!y will ha@7@e to bc,. on May 15c, 4 we don(-,-r iii order -to sc-,t LTp an effective-. 5 review mechanism for a kind of special action, was to ask 6 Dr. Besson, Dr. TooriAey, Dr. Scherlis, i@?ho will act as 7 chairman from the zcvi-c-@,e- corcani-ttce, Dr. 11ciPliod'rz:@ii and Dr. r@oth 8 from the Cov.-nci.1 to i.,ci; tog "chr--,r for tl).ese two bodies and for 9 the Ytt,/;.PS in making a of the r,..r.-@rcjeiicy l@-@3dical 10 Systeris grants rc-.qtiests, occurs, we will give 11 Lliei-a in'Loi-i-nati-on the status of the cort@-a--,L- 12 nroposzils so is rio confirmation i-wo. Ar).O@ 13 will try to thr-,m discret(:, as 14 We would anticipate that the ET@-rgency Medical 15 Systarris activitic@s wouicl, con-cii-iia beyond this year. We have 16 not s(--t aside i)@ spLcifi,c sum for that pu@-pose, find I will get 17 into the funding aspects a little bit later. But you might 18 iyant to ask further questions about the Emergency I,,Ied@,-cal 19 20 DR. SPELLI-9@N: When you say that the grant awards 21 will complement -- 22 DR. 1,1.@tch, could you use the spectIr.er? 23 DR. My qnc@rtion is in iii,@ring one of the 24 qualifications f graiit a%qa"ds for 0 %cc-Fedeial Repoitefs, Inc. 25 projects ftmded by lIdiPS, dot!<, -IL-.his Tean tl-ion that the. grant aN,7zirds are. i.n -urP:Lem@l,-, t:s of or doc-,s -Llic 2 complemeiit-,,ry p:cocesl's occur iii a @ky@iy ill @..,hich. the 3 and gr,)-rit are,, two di.@-Ic-roxit d4 4 institutions or entities? 5 DR. MARGULIES: It is complcmentzxry in a conceptual 6 sense. V7hai: we are s@-ying is we don't went to develop 7 contract activity which would represent a totzs"- approach to 8 a system and have some grant awards \,@,I-iich have a piece of 9 equ5.pment here and training progyara there. I-Ze wE.,.@,it both of 101 -them to represent an c-.ffect.i%rr-- approach to orgar,-izing a to-tal 11 emer-goncy system. But with the PdvIP activit4-os, I think Nqe e la-Crality W114c-h ma.1, no-- b@ of tyke coi-itrc@ci.:.-, 121 110-vO sci-ft 13 because %.;e are dealirig with Li 1,1(@,.dicol Progra..m in 14 case, 15 Being very specific, if a contrac-l'-- is 16 contract -'%-.his is fa.- an 1,@'C-.clic-al System 17 to a unit of government in a community, it bc@ with the 18 Linde@:sAL-.anding that thi-s is a very ti.me-lirnit-.ed and emergency- 19 related activity. It has to do with the moment at which an. 20 emergency is identified until the Point of of 21 you do viith ihaL-1 emergency in the emergency room or whatev,@!r. 22 And beyond that, the contract activity, doesn't appl.y. 23 it doesn't, for go to in-lios,,Dita.L 24 emergencies, to referral activities. It has to be tliz:it Ace-Federal R(,poticts, Inc discrete. 25i in the lZcgion,,-,i Medicl-l 2 this moi.-C. tl-i@..n z,,n E,' S carryolz,L ef'ecti@ c---!Y, 3 bu@@ in a6,J3.tioxi to E@,oriietliirig which ha,,-Y, an 4 iii:[lL)c-ncc on the of @,jha.c. Rllr- does and on the re@st of 5 the systcm @,@hich is around it such as the other L-.i-,bulc,.to,%-y 6 care, the referral sex-vices. And, of course, with our spc-,c-Lal 7 interests in heart disease and in strokc-, we x,7ould be 8 particularly to how effectively they include cc,.rrip,--te,:,l 9 to deal iqith acute infections, acute strokes and so on. 10 DR. Two Harold. Oiic-, is you z-t--e 11 l,talking nc,@.@,.t year in torus of move. from $8 to .$15 million 12 of the c being theme to to d.,.air(>lop c:ent;:&.Ii 7-cd 1 3information. Is it the iii-cont to cxl)encl. on t-lioso- original 14 five contracts, to e7,:tend it to more or to expand on those 15 original five? What 5.s the in-Lent in terms of next 16 DR. MARGULTES: It is to e@:pand it to more new 17@ contracts, I aiii qu@.to su):(--, b;,-@cause I be'-ieve i@,hz-,t we will do 181 -- and -'c-liis ec--.T?c-nds in part on 'clic deinarid -- I jusi-- loo3,:c@cl at Ig some of the contract repoi:tt.,, subraissiaiis, yestc-,@da@ -- is 201contract in such a away that w3 obligate funds i,@',ii.ch will carry 211 them over -c-lie full. pEriod of th@-,,c--year coi-it;.-,ict so that 22 @they @;ill- be full fundc@d Contracts and the ones v7.',iich we 23@ would be )-oolcirig a,'L- in the xicx-t round, therefore, would be 241 new contracts. Ace-Fedetal Repoiters, Inc. 25 DR. 14AYER: Jerry. 16 I DII. P@ESSON.- Ma@, e I c 11 qlzcsticii in a 2 d-i.f v,ay. Ho@-7 yrtl,)CII znticip@.,,-e would be c, -v.7otild yo 3 allo@,?ed for thE-, five 4 DR. IIARGU,@'@7ES-. The fi%f-c co,.-it)cacts will for the most 5 part-. ccnsunie -Lhc, $8 m3..Ilion. 6 DR. L:'FSSON: Tlicii, the irioneys pertinent for R-T-,IPS-EiliS 7 are outside of any-thing in 8 DR. 1,11@RGULIES: Yost they are separate. 9 DR. BESSOI@,': Pmd the only reason they are not being 10, conside;:cd by this commit,--ea is ):)ecause of the lateness of 11 submi.,3sio.-i of the grant pT-@oposals. 12 DR. h@.ve tli e same problem with thoL,-e 13 and with the co-nniQnity education &(-,tivitics which I can a@t to 14 in a n,,.omen't-- also. 15 DR. BESSON: You previou sly have spol@.en of PI-@IPS 16 it-,oncy ar, F@-,aybe rot b-cing allocated, but sor@.ow'Lizit seqi-,@c'@:-,tcred 171 for kidney actiN,j.ties or olc-licr activities. is there any ,8 thoucht in Pj4PS about lio,,q match of the -- 19 DR. C@,li-i you hear him in the back? 20 Tl%,.ey can't hear you, Jerry. 21 DR. B'@7SSON: is there any thought in @IPS as to how 22 much money would be allo'L--6L-.ed from P@.TI.PS funds for other activities? 23 DR. I.V,,RGULIES: There is sorne thoi,.cjiit about it, and 24 Ace-Federal Reportefs, Inc. I will get back to that, Jerry, biit it is wrapped up in sevcral 251 17 things in our f4knal fundi-ic level. a-,-id the in ol:,." oo but 21 review cYcIc- @',hici'.l iE; not i-- it is interlaced. 3 7@,nd I rath,@,7-- .;o ove)-- it all -;tt OrLo tilil,.I n], t 4 would be clearer. 5 DR. DESSC)ZI: Well, perhaps I can indicate why I am 6 asking the question. In describing the five contracts N,,,Ii-i.ch 7 are going to be let for what you refcr to as broad systems 8 for rmergcnov I,!;edicLI Services contracts, the %.,,ay RMPS vTould 9 approach it, the implication is that we are interested in 10 finding out on a basis how to orc, a@rhic .,anize geogr 11 are@is for the provision of a total system. Bu'L-- l@iPS has 12 ,,o-rvc-d in rc-1,@,ting 131 to the in a coi-onuni-',-,\T. 7i,itd I am 141 wondering it might not be a more appropriate stance for 15 interest in r@l-ILS, rather than fui-iO, :demoiist.)--;.ti-on 16 programs to fund N,,hat I might call sccdl-ings and spread i@-s 171moneys as as rather than concentrating th('@m on 18.1 single largc, grandiose activities. 19@ This is peripheral. to the review comiTiiti--ee's 20@ ectivitie5, but E@irioe I 'I'lave bz;,,en ii@rersed in the 60 of 21, reading material I received the other day, I have beco-,e very 22 much a@,iare of P,-?4PS's emerging role in EIIS. Arid I wondered I whether it right not be appropriate that we gi\@ consideration 231 241 to being very lenicnt in funding some of -Lll-lese 35 proposals Ace-Fedeiai r'%cpotters, Inc' that are being received from the point of view of encouraging 25 I of i'-'-ici- devcl.OPTaent of 17@-IS 2 without nec,-c-sErily fal the strai'7,1-tt criteria 3 t-h,).-c i,@c- h,-tv@- --La5.d out in the for rcqLle."@tr., hewi-ng 4 very closely to a certain set of criteria and either being very 5 meritorioii,- and having, p.@:iori-L-y or being somewhat 6 lower merit and thcrefo@--e being passed ov,er. 7 I am just wondering as to how we can,most effectively 8 spend whatever dollar-s RI.IPS cc)ri@;iders tlicy are going to allo-t 9 to this aspect of their new activity. 10 DR. 14liYER: Harold, would you care to comment on thal@-'@,, 11 DR. Well, I don't think you need feel 12 bov,:,.id by the sizes t@)c i--Iae roou-'@r n ol, h 13 contract activities, jer,-cy. We would there world 14 be a fair range of potank-lialities in the grant requests. And 15 what we z,,re really telling aL)out is the Avoidance of funds 16 expended for iini.focir,.l iritc-r(@-sts tr@,ining 16 E@inbul.z,,i-ico 17 drivers i-7.hc-iii there isn't anyth-".ng for '--hem 'co drive or he,-i%7y 18 investiaents in radio cqiij.pm3i-it when tlierc-, isn't z,.iiybody at 19@ the other end. That is really, what I am tal)--.ing Ebotit. 20 1 thii-iY, -i.n looking at requests for grE,,nt awards in 21 the one merely r@cclkds to sure there is quality or 22 potential for quality. And it doesi-illc have -the some kind of 23 rigidity that the detaonstr@itioii d.oc-!s. )3ut at the same time, 24 we are hoping it represeii@u,,; a i-ii-@thod of polling the system kce-Federal Ref)orteis, Inc. togethc-r rather tl-ian dealing with only one -@ec-ent of it. And 25 pT that is realli, (-he cxiJy 2 DR. c@ oi-nir,-@ntf-7 an EMS? 3 (!lo 4 Vlhot would I)c, than, intent next ycar in tc-.i-itis of M.IP 5 acti\Fity in El-IS? 6 DR. I-t-ARGULIES: I th@inl-. this is going to depend 7 pretty much on total. irifluencc. of the current round. 8 And there a.-e really threl-, things involved. 9 one is our general appropriation level. 10 The second is the final decision on what will be 11 done with the addiL-lion,,).l c.,rr@.ergcnoN, mp-dical activities in the 12 $15 13 zncl. tl-.@- third ))c-,@ soi,.ie jiidgm,-@.Vii- about lio%@; ready 14 ,io are to do riore emergency activities. 15 1 tol(i you I thought the $15 million would go in 16 @that Bill, but it really hasn't been formalized yet. 17 tt is perfectly -sssibl(-, the role of rl,!P in the EMS --,ctikrity k, 18 will be a:,--defi-r,,cd either by legislation or by something else 19 during -cho co,%iii-ig yea--. But assiA@-,,ing everything I have said is true, I would anticipcite we would continue to show ct high 21 level of iii,@-crest in the support of Eme,-rgency Medical S,st@-,m 22 activities in the next fiscal year as wel).. 23 DR. 1,11,YER: Under IUIP? 24 DR.I.V,@RGULIES: Y(---- %ce-Fedetal Repottefs, Inc. DR. @IAYER: Under separate kind of review effort? 25 2 0 I DR. @qoiil-Ciyi' dr) it 2 becau-.r-- t'Al.'LS %'ILS c)- matter oir- duress. Pit that poi.nt, @ve could 3 enfold it into the @egular review 4 DR. IIZ,,YJ',I@. I think that is an important concept for 5 this coimnittee because it is the bits and pieces issue.. 6 Slowly but surely you dissect everything off. 7 DR. I.IARGUIIES: lqell, let me deal with that issue noiq, 8 DR. 14AYER: Before you do, let-. me malze a co,-,,.,mciit as 9 someone who is absolutely and irr(-.vocEbl.y Eiddicted to 10 nicotine that as all of you are aware, the Secreta.-cy of this 11 @Duperb ),,novm as IIEI@' has indicated a Ptpndat-o- w.rij. cli 12 1-i&.s c@Lie oy i do%.;-n though this. I thi.nl-. c%,cryoj-,e -.s on 13 owii in relationship to whet@,,(-j,.r@ they fe,@l the liglit.,).ing , @)o-l.t 14 coming do@.7n from dowrttovln or not in regard to that issue. 15 I say that in preface to I have already niade by 16 decision. I vian,- to leave tomorrow, nolt-. today. 17 DR. llARGULTES: That statements i.s part of the 18 confidentiality of the 19 I think it riiighl-@ be easier for us to deal with the 20 budgeta--Ir issues because they hocp coming up rp-thc@r than with 21 such things as the health education center concept. lihat 22 has happened in this fiscal year has been the appearance of a funding pa@@e-n which iii4g!it have c-,nil.3a.,cA-assed Lis badly, having 23 24 us reach the end of the fiscal year with more inoii(--y we hzi@- Ace-Federal Reporters, Inc' anticipated end no way to spend it or the ippearai-ice of that 25 21 to spcn.d it as X."Cll 1 &,mount of- l@.olir@y wit@h us 2 or no add4-!,-@-onal iriglit @,Et Occur. 3 l@ow, in rangc--- of is abci,,,"- 4 what happcx-.ed: I-le did not gc,'c. a clear r@tatc-,,i, Y@t Lsbout oull 5 total funds for this current fiscal Irear until after the end 6 of Januai:y. Even we hz.-.d receiv(-@,d that information, there 7 v.,lp-s uncertainty &,bou4L-. the fui,,dE, which would be sp--nt for 8 1,1@iintenarice organizations, so-roc-- $16.2 million, and the funds 9 which were set aside for l@rc.-a 11(naltl-L Ecli:tcatioii Ceiitei:s, 10 $7,5 million. 11 Furthe@iore, the $8 million @,;,I),ich had been 12 for lic-,d not y(,@,@t- bee@,ii F,@--t contract '13 aside as they are now as I described to you fo.7. 14 activities. And so we had this range of uncertainties. There was from the preceding fiscal year, you 15 16 recalJ., apprc)@,-imat(-,Iy $44.5 Ytillioii i@l-iicl-i wc-fs not in 17 that fiscal year which we had been promised @.-,-ould be released 18 in this fiscal. year. I@L. was released, but only in part. 19 So we aoL-. to about Jr.nr-j@.17iyig that there wore several I 1 20 possibilities which gave us a ronc,,e of difference in the ni@ on th 21 of JUiie %,.,hich is tur-,-&ing out to be true of about $22.5 million 22 uncertainty. 23 Well, Wi4-1 $22.5 i-Liillion unccrtEinty and the (7tesi.re to be able @-o iise it effectively, you have to dev(@loo 24 Ace-f'ederal Repoitefs, Inc. some footxqor)-.. And so we developed some footx,.,orl@o This 25 22 di. c E,, I included the 6@cision to -support Emcrgcnc,.@ I; v c;, t c--, m s 2 doci.dad on rath(-,r l@,to it I)eczi,-iie cl.(,-ay.- ho@.., other 3 EIIS activities @.7ould be-, that %,7()uld decade educatiol'IE-.l 4 activities which @qere but no,i-- the !;arro- as, E,,.n l@c!a 5 Health Educat@'A.on Center v,Tiiich had to be clc@c@ided l@,te for otl,,er 6 reasons which I will get bacl"- to, Hand we would at the same 7 time to co%rer our potentialities decide now to,c-harige the 8 review cycle from 4 to 3 a year. That became the pivotal 9 point in the whole bi-ldc,,et ar3r romance becEiu@,e -what we had to 10 do was to rtial-.c-, a decisio-,i to go from 4 to 3 a year, thereby 11 -change -.PiFcal yearst and @L-herc-by give. us the opportunity to i-i f-scaL 172 or 173 acco 12 use- ;.u,-iOs J. .1. r(li.ng to v.,hFt we 13 had emd in ',--he process of doing that anticipate tIl.e 14 level of coTm-4.tarent for 'Liscal 173 and 174 so we didn't ov,er- 15 ex-t-lend ourselves. 16 Added to that was the Uncertainty of tha FI@I&O 17 funds would actuall.y be to@Lally used. And as goes on, it 181 c,.Pi)ears to me p-@rsoi-iaily more and ictore likely tli.at they will 191 not be to-r-cilly used. So tl-i.@F, @..dds some funds 201 to the P:@--Ogr'a_ml 21 1-@hile all 'ch-.s @lo,.tng on, @.-- $7.5 million i,.,li4.ch 22 had been --ct aside for Area Health Education Ccitors v;cis 23 kept bac,',: and remains IDacl,:. So we still have the uncertainty 241 of whether we will, have av,-,ilz.,ble $7.5 million for educational Ar-e-Fedetal Repoftefs, Inc. 25 activities, whether some of the IIMO money v7ill be returned to u 2 I ar&d whether wc@ wil-." fu,-i@is availi,.blc n-t vzi3:yi.ng level,..;, 2 d@pendi@ng uprjxi the grant frorti the Regi-oiial Medi-cz,.l 3 Progra-ros in fiscal 172. 4 VThat we decided on is a "-@thl-@r simple rlarieuver to 5 give ourselves maxirourti flc,,.@.ib4.lity. And the way it is go4-ng to 6 work out, will be able to e@,p@@rLd all our funds no matter 7 v7hat the decisions I-le c>,.te-ncled the fiscal years of each 8 of the prog,.-arcts in this review cycle, but @,7e did not give 9 them gran-c. awards to coNter the whole pc@riod of time. So if 10 on ll!'P we.-it 12 months to 16 morths, the grant aucird Ni7,e,-s 11 -fol-@ 12 monL--h.-,. And what Nie told thc-.@m was, "Show us i,7h&,-. your 12 z@rc- for ,4L:he full 1-6 ii-ioa-itlia. find if y-ou requ3.re 13 X level, you can bo assured of gcttix-tg thac if that@ is aii- 14 appropriate level. But we can decide with you iihetlier you 15 need it this fiscal year or next f 4@scal year." That mean'i-- t'.iat, 16 in the majority of I--h(-- procr@-.m 17 DR. l@IAYERt In terms of release, Harold.' 18 DR. 1,17@RC-IILIES-. In terms of release, yes.- 19 It covers the saiae period of time, but this 20 that up to i ,tne 30, we h@.d a liebilui.t.y just in grant a%,,,ard 21 for basic R,,,!Ps of sometliii-ig 3.ii the r@.inge of $8 million i@,hicILI 22 could go in one fiscal year or the other and produce the same 23 result. This is the only ye@,r ever be able to do that, 24 but -it is also the yo@@lr in @,@hich the tincertitiil-ies app-c,.a-r to Ace-Federal Reporters, lric. 25 be maximal. I 24 That la@c;t do,.-i"c belicv,a that for ii 2 but the flexibility is 3 4 So we are really trying to play varying kinds 5 of games. 6 If you say in middle of that, "E.,cactly how much 7 is it @,@u are going to home for Ell@IS and how much for educational, 8 I can just add to the, fringe of interest by 9 telling you abou-L. what we are thinking about. lie hope that 10 can in the educational activities in ti)-c general ranae 11 -of abou-'L-l $3 million. And in thc@ we have had a greater 12 lc;v(!l of bc-car!,,,;e. It has be@-.q l@,vrd to 13 predict might zictu:tll-,, core in, But I i-7oiild not be A 14 surprised to see us workii-ig in the some general range for the 15 Emergency Iledical Systews. 16 Now, this depends o.). t@ zic-Lioi-i v.,hich may ba tal:4kng 17 place today, I am not sure. Part of it do-@s. Ai-id threat is than-. 18@ we have gone through, and T- will licivc- to comL)3.0.,te tl-LiE-,, B."Lll 19 I am sorry that this gets cc-nplex, but, de.-Tai it, all of it is 20 complex- It has been like that. V7e ha,\?,e gone through iii 21 interesting tayigo -- you can't -'Panama with four 22 we have gone through an interesting square dance on tlic- 7@ea 23 I'Lealt-h Education Center activity trying to decide who doas t4 <)- 24 what. And it has at lez-,st reached EL point of some d(,@f@'-n3, . ,I. Ace-Fcdeial Reportefs, Inc. And that is that in the opinion of - a office of nd 25 t-h a 2 5 I budget and of the Of'Li-co of th- S(@cret:aryr called 2 @tii A@,,7(@a lIez-,,Itli j,duczxt.",.o,-i Cr--Yitc,,r is rel@-ttcd to than 3 Coii),,,,tission iiioa,,@l which i!3 essentially an activity conduc,cocl 4 primarily under the au,---pLcos of z,, t)nivcrsit.v health scicn,@@e 5 center with thc.,, 7@rea@ IleE,-".th ECucat@.on Ceiiter a satellite 6 thereof. Paid this with some eral)allishmeiits is the concep,-, 7 The essential ingredient is the Extension of the 8 energies F@iid i-r,@,'L,-.crcsts of the i,,nixycrsicy health science 9 center. That is not exactly iihat the Carnegie CoirLmissio-r, 10 said. It has Lecome the general cot-icel@t in the JAIL@ ei-td 1-:1-ic 11 -article by Margare'L,-. Gordon and in the Office of the 12 C!@:,3 ai-,Id I Office of t'k,,@ Sccretary fc--,el tl,la-'%' t",Iat 13 is fit for Hill ilur(-@,au of rdi3c@.tioi P-,r,.d i,laiil)o-@ier Trailil-'..,.Ig to do, 14 not fol-- IISI,I.IIA r@@',P. 15 There was in the middle of this discussion of Area 16 health Edticatic)rt in among other places wli@,.t is 17 knoi@in as the blue sheet a statement which said -'chat 18 Counsel opinion d,%-lctcid )@,,IP f@rom c@ducEi-L-ion@,,l activities. That rt'her-c-, ha--,I bc@r--n at -L-.i.m3 no GP-yier-z,-,l Coti,-,i,;c-l 19 was in error. 20 opinion to en,.rl.-@lody. The-,--e had bc-cii some gi:arl,--s which .9 21 were incomplete @,ind which Nic- asl,,cd them to comolate et a later date. 22 23 The C-c-nc-ral Coiiiisel opinion on (-@dticat,-onal z@ctivitics 24 for P,!d,P is quite clear-ciat. It sa-s that u.rd,.ar 92.0(c), we @ce-Fedetal Repoficis, Inc. 25 can i,nc3.ec-d concitict educzxl-i.on@,l activities which need )iot. be 2 I conf-iic-d. to tl--c-.: conc,@l-@.,C-d with 2 Ui e"tiliz@i@tioll@ of b-Li 3 added the cormicnt- that -chcy J-elt cl,c,--,r- that-, Ylt.-IIP not IDL, 4 involved throucT)-i 910(c) in the supp-,)rt of tr@iining Z'4ctivities 5 which ec-.senti ).Iy cltang@cl the into Skilled. 6 And to be definite about it, they said such as 7 training a high school graduate to be an R14, )?@,yi.iig for tll@@IL-- 8 or paying for the stipends or facul-cy for r-@,,adical stizdc-xits and 9 so on, ayLd that were. concerned the community activity 10 which linked to service. And the-,, are quite co.-,.i- 11 for-'c-&-ble %,iith that diffc-)@cyik-liatilon, 8incc,,, tl,.al-@ i-7 tl-i,, pol4-cy w'-iich r-..!@IP 12 .13 h,),s been for so,YnL- time ziri(-l cetisc,,s us no concerti 1 4 DR. IIAYEI@: Since the ]:)c--g-'@nning, I-lax:old. CC and I 15 wrote tt.@or@e exa,.ct st-"m-, qui-d--,Iine,- f4-ve yea:cs ago. 16 DR. I-IFiRGTjLIES-. This is buttressed, then, by the 17 Generzil Counsel. opinion, so we have no problems over it. 18@ So wh,7-t @,,L- had done witl-,oi,,,t any of these decisions havixig been 19 made and without any G,---no-ral Counsel opinion is to run the r4-s)@l 20 of circulat4&ng to the Rcgio.,ial l@r--di.cal Programf-, the d(@@scription 21 O.L a prog,--zxil co-,)j-iunity based education activity to which %ic 22 invited their attention ar,.cl for wl-ii.ch -vie Zara going to provide 23 supplerentaj--y grant awards. This is parallel to the Ei-ti--rgency 24 14edical s,,sterq activity. Ace-Federal Reporters, Inc. 25 lie could not put this out with any term.that said 2 c, not OvOll Silre at 2 that pc)-'nt anyone would allo@q us to do it because 3 draft op-...-Lioii N-7e-s Erotird. But F,.,-iy@qay, i@.,e did it. 4 And this meant i,.,e had to wzz,.it uiiL@il t@c last minute, hoping to 5 golc, no clz.,rificr,,tion so we went: get some clarification. 6 ahead and circulated th@-,ouc,-I-tout thc- coLini--ry a description of wh 7 we meant by some kind of a coiflmtinity-based educational and 8 service consortium. This has led to a careful review by the 9 10 Ikle do ro%,i have in hc-tricl @a iiuab.,---r of submissions for 11 'gra-nt They \,7ill be. rcivic@@.Ired on Mcly 20 to 21 becEtz,-;e 12 @ some of tlie'ia a@ com-'@rg ii I:)c)tli r,,id 131 1-1c@E@lth Education And t@e ones involved in tlia-'L- 14 review process wlii.ch will bc, carried out at the same time as 15 the Allic-d I'Lealth Confarer-ice fro-,II the review committee %Still be 16 ililton, @.ndarc"on, Ec@r, and Hess, with Pari-y as chairm;--n, 17 and from '"-lie Cc.)tinc5.,l Torty tied Bob Ogdczn. And hz@@.,c 18, asked Al Popraa formerly oi,, the Coi-,n.ail, former I",IIAP coordinr;itor, 19 to join the group ro that %,:e bo t@aking @4 review acti-ovi 20 en bloc on the@;e educational activities at i-bat i@;ime. 21 The7.-e was jrstno by v:hich we could conduct 22 this order an orderly rovs.ew process. And as one more f(@atti,-e 23 to it, it i-- likely stop at this point Lc-,cau,-:-e 24 the additional feature gets complicated. The --(;-st of it has b--@@ Ace - Fedetal Repotters, life. 25 easy, 2 a Leonard. 2 DR. Hove you distribut-.c,@,.d to th@ of this coremittca the sait@a- you Pont-. out to the 4 various regions as far as their copi.@.l.-Ig 3-n foi: EL@IS or tli@s-@ 5 educational ceritc;.@,-,? 6 DR. 1,M- P.,GULIES: Yes. 7 DR. V-7,@s had th?@,L-? 8 DR. I.L7iYj-'.R; No. 9 DR. I,.IARGULIES: Didrift this go to review COITLmi.k@-tee? 10 I am SOKXYF it should have gone to review committee. 11 -I thought it went to revic,,i conunittce- end Co,@ircil. Tlipt i-ias 12 an error ci-i ou@.- pc.::t, than. 13 DR. SCIIERLIS: Per@izT3s we can hE-xve those. 14 DR. MI.RGULIES: We cari get them to you today. 15 DR. SCIIFIZT@IS: Fi,n@,. 16 DR. IVi.IIGUZ,'-rES: Lc@t me add one mox,,e, feature to it 17 which giv,!.s you an idea of som-@, of th@- special procedures we 181 have to ce,.r-ry ou6-- rcga):ding tl-lcse t-%,@,o categories of interest, 19 the Arc,@, Education Se;--vice one and the EIIS. If @.ia get funds 201 relc-ztE-,ed yet this fiscal and I think it 4-,- likc-ly, which 21 the Office of and Budgc-!Ic does not int(-,.nd to hAve 221in continuing appi@-or,,riz,.tion@,, we will have to nrovide evidence 23 that that ironey c@.--a be spent to support activiL-Ii.as in 24 without raising the level cf- to in(3ividuAl p,%--,)grairs. Ace - Fedei3l Reporteis, Inc. Now, that can be done. It can be dozie if we handle 25, 2 I for choice tile ):,!,RS actj-Nrity a@@, e, di,.',Cr@,tc-@ E@,ctivii--y in a 2 Prot If prog'4,1-cin in @)nd spys 1-i@4ve e, well -i.1cy, it will t@,,I@c- 3 kni;-_ qc-ncy Ij,-@dhcal Systcni activiL. 4 years to coR,,plete, it cost X e,,-irioi@,nt of money, " we c,-.- n 5 a@.7zx,d a grant based upoi-i 'clic-ir total needs for three yez,,rs 0 and reach an agreement for them to carry that as a separate 7 item in their budgc-,.-. At the end of those thx:ae years, that I 8 'Ctiv-'@ty N.:ill' havr-@ been complc@,ted end @,7ill a not be part o4 9 their basic commitment. 10 I think that the Offi@ce of ilai-ieget,.icnt Card Budgct @qill 11 accept -Beat procedure. 12 DR. Vlith t'Alle for 'I--hr@ 13 three years coming out of -- ).c-t iAs $3 riillioli 14 original $3 million. 15 DR. MARGULT@',S: That's ric,-Iit. It is ersential-lv 16 fon..,ard funding for the line item ii, tli,-.ir own budget. 17 DR. MAYFR: In o-',--hc-r word@;,, the, corrLmit,,iic@nt that iiotild' 18 be made, let us say. 19 DR. I-.-,c- would release all t-he fund@- 20 DR. 14AYER: There would be only a dol@.ars of 21 1 c..nnt-ializc--@d that would be inside at tlii,c- tire, if, that 22 @,ihat you are saying? 23 DR. @l"%RGIJLIES: Yes, we would relers(-- tile $3 million, 24 1 but at- th,-, el-id of th,--,t pox,i.od@ Nce-Fedoial Reportefs, Inc. 25 DR. l,'L%Y.ER; It v!ould be spread over tlirc@.e ye@rs. 30 th I DR. IIARGTJLIES: it 1,;oulcl be out If the y hii-pdle it -re syla,,7,f ?.I,(,ay would j)-@ 2 years. _@y ,go 4- 3 through some kind of a (,-ont.Cact 'CO )4.eeP At the 4 end of @ tliy:eo- ye,-.rs, t.1-Lei.r 1-c@\rel would be wh,-itcve@,@, 5 it liAd reached at that t- e>,clus.'@..-,re of t' F@t-. $3 million -li 6 then disappeared. 7 DR. SPELLI-IT@N: You wo,,).Id make the,, th2.-ec--year a@,:ard 8 at one title, one sum? 9 DR. 1,@IP,.RGULIES: To got the funds obligated-,,, 10 DR. OI@IB @,7i!l commill, thcm? 11 DR. MARGULIES: I,,Ie don't I,.now yet. That is our plan. 12 is 13 DR. I gi Pr@ U,-" 1 1, SIt is not so extraord4-narv. 14 DR. I-VIYER: They have becn do.@.ng that in construction 15 for years. 16 DP,. The roF,@-c-n theNr have- to do that is 17 because they are to L-'un("Ar,,,. It @s 181 their -- their being div@.1-ntown, @@ihoover is downtown, it i,--@ aliiayL-1t 19 they, all those peopl,c- downtown vlith r.-sponF;,@ility -- so the 20 fund was not released, and they have to &ev.i.se a method of 21 releasing it @id making ijt-. ez'focti.ve. I think -'c-h,-,y had position to r assumed we would not be in a (--@ci-)ond as effectively 22 & 23 as we can. P@d. we can do i-L. becaLl.,7je we @,;ill 1-izvc- reviewed 24 and approv-ed and identified actions on that ).and of .,-x base Ace-Feder,)l Repottefs, Inc. 25 because I guess it was staff %,,,isOom 8 months ago this is exactl@-I 31 2 DR. O.K., otlicr qvr,-@c,@ti-ons. 3 li@4,ve you got- the hard 4 That war,-, %@'he eaE,,y 1) L% rt 5 part, Har,old? 6 ju,,-t rv@,n over two or DR. IIARGULIES: Ie I,: y rthc:c 7 other things qiiic','Ily because they niigh-'#-- take somz u 8 time. we can come back to i-lic,.ia becv,,Llse this gets to be quite 9 a long unifocal d.4.alogue. 10 DR. ILA.YER: II-- are listening. 11 DR. li@.R%I-IULIES: The Cancer Center propose@l which was 12 reviewc-d by Cou@-ic.-'-.-,6 last til@@o for your li the investrct-@.n-- bFsed iip@n ct4oi-i of $5 million 14 for a ca-sicer construction cc,.nter in the I\Tortl,,cc@s-'c- par-," of the 15 United States. That was reviee@c-,d, ai-iCt there h@,s bec:n )avoralk,.Ip-, 16 action wi.th cert-"tiii recTu-46.y:,@ments attached to it by thc-,@ Co,17,iicil 17.1 for a cancer co@nter in Seattle called the. Fred Ilutcl-iins:o.,,i 18, Cz,,ncer Cent--or. 19 There were sr.,-,-!cific rc--qui-rori,.cnts by the Co@ancil and 20 some tlici@-- we iin-l-)osc--d whi-cl-i h@,d to (lo with such regulat4LOns 21 as are in the logi@l&.ti.on-t 5,ii F@t@l,tp- regiilai:ion, certSfilcate of 22 need and so on. They appear to bc- moving quite well to 23 complete their requircm,@i-its. 241 we said that we woii)..d relcase t-hc7-, oni-y Ace-Fedctal Repoitr-,fs, Itic. 25 all of these requirement met. So that the award was made, 32 I by but yLiLt,'-Ie P@.ward a 2 until al). of these Cou,,ici,l ha%tc-t 3 an oppo,,-:Lunity to loo),: ;,t E?.CJEI:Lrl e,.t least in'Lomally to sce 4 if it -atie;fies 5 ProbEibly the key i.c;sue fo.. som,@ mf!icti@c@.cs of the 6 Council -v,,es the pl@:i-i to pat4c,.iit beds in them researc-.h 7 center iG co,,-ineckl--,--d w@i-tl-i Swodi.F@h by a ti@-,inr@l, 8 but which i-s not. a part of the building itsel.f. And some 9 mairbers of the Cotircil fc,'@Ic \@c-,,,-y c;t)--oiigly tl,,Ett this 10 produce a good research onvivoxirpmit, )-)ui-- thEy x,:,orried abo,-i-@ thei, 11 adequacy Of rOgLIl@.r, arouiid.--'@te-clock irec3ical care in that 12 c'rcur,.standc, 13 DR. It 3.s. go@-ng to be physi.oz,,Ily 14@ to Swedish, is that it? 15 DR. IIARGULIES: Y@@s. And th.@y li,:%ve rec-p-ondcd r-how-'@nc-7 us ways in which they are go;-Ilg to give assurance of good 16 medical care. amid it is to be iip to thci Council t(@ j ii (i 17 Iwhether that ass"::ance is adequate. 18, 1 9 DR. Tlio@e, would be the only beds, I take it. 20i DR. I'IARGULIES: For research purposes, yes. 21 22 1 donl@L. kno-@%? how much to got into th3,.@, next 23 i.--sue bc-c use v,,e could spend a lot of time sl)c;-ci-ilatin,g oi-i -t. 24 I would be glad to speculate with you, and it is ,.n c-1cction Ace-Fedc(al Repoiteis, Inc. year, and that is the popular thing to do, but this has to do 25, I with the of tl-te of the 2 authority and of the in 'ch,-- form of 3 two major forms of You mc.,y reca.11 '%-,here was 4 new cancer authority pass-c-,,d to p@:odlL7,cc-, a special center for 5 cancer research c,,rid control. and tl@i@,re is a paral.lel bill for 6 managerient of heart disease. 7 This, of covr@,,e, @e question of 8 what relationship either of L-liese act"&vi4".i(-,s rciz.-4y have to the 9 Regional Medical- Programs Which are identified with the same 10 diseases. 11- It also raises the qtieL,-@ion 046 wliatlior there be 1 2 a of kii-,d -c-@f F,,-,d 13' clirc,@-sci 14 neurological disea2es or of tAic., I don't know 15 about that. 16 iTnat lias hap@-iic@d, howevc@-r, has b@-c-n a desire-, 171 in i--I-ie ce-.ncer bill to produce a pzLthi,iav fro.-ii -'clie 181 cancer laboratory researc(i rirc-.zi to tli,@- doli@very of good care 191 tothe public wi--'L-h prevention, diagnosis, treatrcn4-,, 20 tion. 21 This (,-ould be by or 22 the control programs whiol'i iier(-- carried unCi-@,r ijic- Div,-.,;ion of 23 Chronic Diseases in the p@ist-@. It could be dor,@c@ I,,,y othcr 24iriechanisriis. It could be done by the National Coi-jr--er li,@Ftitutc-@ Ace-Federal Reporters, Inc 25' managing the whole thing fr--jn the ro.,3cerch. end tL).tlie el@,live@r 3 4 I,. or j- could )D,@. Ctc,.ne 2 oLii, with prcgze,-m,,- 'tlie 3 Thc-.@3,,e has z:, deci@ici-i. maO,,-- ai-. present z-boi-i-L" 4 what our actual i@!o-.),.ing r-elLt-;.on-ship wi.11 be ei@-ior witl-., tliL-. 5 National Cancdr or t-.hc-, lqetiorial Iileart Brad Lung 6 Institute. Toyaorrow I am to cio over aid t@ilk with a grovil@ of 71 people in the Natioiieti IL-art and Lung institu"&-,e about hea,u-t 8 and strol,,e activit-@"cs Bunch we rii.glit bc-. abl.e to cnrry ou-Ic in 9 think the negotiations place 10 cr,,rrent'..y betv,@c@r-,n Offi(---o o--F the and with 11 Bob I,,.;-irston ai-- Nlli to dec.-Ldc-@ how wo car. this out. 12 I,.,rLat I hope for, i@-, a of tile ,special caac@r .13 intok@est@; @Tid special. heart vnd lung interests .,,-Ii-i.ch re-2,--ascnik- 14 1,@IIII's major interest and constituency wi.th tlioE;e in the Region,@-@- 151 Iip-dical And i,7h @- i'@,T.,ny of us liop-a for would if 16 the--e is a re-em,--rgcnc@. of the control p--rogrzm tIA,@t this be 17 desi-c@,.ned in such a Jay that it-, iicprov--s the de2.-Y.ve:L-y s,,,stcm 181 re-4zli-or then opc-irzti-ng in isole@ied seg,-cznts thereof. 19 But we. iq@.11 p@:o)@@-bl..y hav-c@ a clc-,,arc-r -@nsiqer to 20 that at some time in the future. 21 In the roc-. ci-ioucjh, jurt to 22 add to the- confusion of the picture, %,;lien @eiiatoL- Kennedy exk@.ended our I.c-tgislzLtiorL, lie dl-ol?pcd the cateaoT--ical desi.gnat-Lo" 23 241 out c-ntS-rc--.Iy iiid Iiiit his total orf,,I@ha@,is on Ace--Fedecal Repoitets, Inc. 25 and. the of delivery of ser%,,5.cEse So we are 35 1 in a cc;q.,itinuing period of time of s4,-xugglc 2 issues -v,@l-iich, if you lead t@iought 3 events is not 1-2-Icc--ly to o--cut in i-ir-xt yc-@irs. I do not 4 know -v.-liat final arritngemc:,.@Tits will be car;:icd o-ot. 5 in the meantiri..a, it has caused us to look auai-n 6 more sharply at hote much of our activities are. dealing i-iith 7 heart disease, cancer,, c2@d )zid,.io@y 7@iid they 81 still refrain a preponderant part of Regional Medical Progra4-ns. 9 I,?hat %..,e have clif'icult t." i,7:j-th, and it is dif; -c-,,E,!sing 10 that dot is 'k-Ilie idea tliatyou cc.,n ).)y irr,,,LDrovi.rig -- we3.2., 11 talked about it earlier -- total c.@@mc-,rgenc%r medical services a 12 a. coiitril.@ut-.@.C.,i to the control of hca)f,',,, 'Ph 13 never ci-i,.erges the ],,.,-nd of vre ptit torjc-)t--)-Ier. 14 If you are tal3,,ing about a categorical disease activity in the 15 way most of the people at it at Viae bu(lcjel-- end like 16 to look at it, it has to be exc!uE;ively for a specific d4-sease 17 Within the: if not, they cz-,.nlt recognize it. 18 If you iir,.,orove basic priy@,iary care services in a rural area, 19 the assui-@iption is, I gubs!;, that so:,ielio-,q you do that alid 20 exclude heart disease, cancer, strol,.e, and Ici-dncy dic-c.---se z!rid 21 related diseases ijlicn in fact- -cha'l-- is w-i @,-bsiirdii-,y. 22 If you try to tote up what you ae doing in soii-- kind 23 of- dollar: terfrs to impro%@c, of tl-l(;"-Ic di,,Car3cst it is 24 vory difficult to do. Slid we are in that kind of a dialogue. i Ace-Fedetal Report(,,fs, Inc. 25 I have no ansiiers for you. 36 D-fZ. IIAYER,.0 Harold? 2i DI@. l,li2@IZGULII:Sl. orie @,nd of these ol-hcrs 3 will come tip 4 W@, issuc,,l the nc,-,.j )-,idnoy very 5 and they are a'vailablc- to you. 7,,,ncl I think rather than cr o 6into de'--ail at the prosont timn, since we have been over quite 7abit of grou-rtO already t'AL4-s morx-iing, that @-,,e will bring up -LI-,-- 8details of that at a point where you are actually going to 9deal with the subject. Or we can do it now if you prefer, 10 Bill. it i@s VP to you. 11 I have a more significant issue to deal with, tlioucjli, 12 'or the is tlia of .13 hl Ican do is zc@cd yo,,,, tl-i@. 14 %,,Ih@.t happened. i,@as th--@t- the central payroll converted 15 to a new system. An old consultant timekeeper nu@ler was 16 used which resulted in ri@,ny consultant checl,,,s not I)cing 17, rcsc-,arch has been condnated to d,,),L,.bl.e cl-ic-ck on the consul@-&I'IW----- 18i no-c ppid and to clear up other-errors. Hopafully, all work 19@ will be completed and c.1).c@cks wri'c-i.-,z-;n for: May 23, 1972, p@y 20, day. 21 In ot:l-ier wordc,, we opc,,ra.@L.e our pc@y systc--iii when we 22 change frbm an old system to a new system just as others do 23 ineffectively. So that those who have not been paid have noL- 24 been paid beczit@se they 1-i@@.d wrong addresses, wro,-ig Ace-Fed(,tal Rel,)ortets, Inc. 2 5which the switcliover r@ianaaed to produce. And we will, if 37 lbo@y ge-s 1can gc@,L t@l@, to to make ove.)-@ A 21 paid lic,@ chou.I.d liavc--. 3 So.Te clear l@ac',: to 1F@ t 4octo)Der. 5 DR. SCIIERLXS: It has been speculated that is a 6source of fLiaid-'Lng for yoLi@.- eyp,--mdir,@g EMS 7 I'GUI,IES: 2@o a ma-Ltc!L- of fac-,-,' i..7a lixilzc,,d it up DR. 8to in ano-i;lic@:c subrcci.ber syritem. And if you 9don't get paid, you are go4lng to got a 10-year s%ibscrip@--ion to 10 the National Geo,@,ral;),I.ICI (Laught,.cr.) DR. Ot.hnr 13 (lio response.) 14 Than)-. you very r,,izch, Harold. 15 At the ri-zi'rz early 4-n the.., Yi,@cting of fixing dLzll-es, 16 I would lil,.e to tu%.-n to the calendars @-Thicli in 171 your no'L-,c-,,,books winder the fir@,;t tE@b @,7hi-ch is 18 "Calcnda"-" in air i-o aet the limk @,7ith Cow-icil c@,, close,-- 19 link to Cou.,icil a-L-- toy,@r-,orc-41!y i:E not philosopli-'&call.y, 20 1 we ric,--d to t@%lo dates o,-,t of the three 21 in the sul@sequant yecir. 22 If you pi-,t a c3.rcle around the Sept@Dcr 17-23 23@@ week, a circle t'ilo 15-19 and a -Y 241. around 'Cae I:,;-,y 1,6.-19 N-ic@ck, we to do is pic-@ir. AC..-o Ace-Federal Reporters, Inc. 251 days in that pe)-iod of tiiTa, each of those weeks, that you 3 8 1i,.,ould like to scheJule for -c, )?art of that 2going from four cycles to cy@l@, y(-.,ar. 3 Preferenca is in Sr@,n'@-ey@r)or'? l@lle arc-, noN@7 on a 4Thursday-Friday go. Is that good, bz,,Ci, 5 Iiow about the 21st and 22nd of Sept-leral.)cr as 6possibilities? 7 Going once, tiqica, right, cloiia. 8 In Januaryt is the 18-'L9 appropr3@.ample, in the Kansas, you see there they have 20 it -i%.7ardod for fi-ve year,,,-. so the fi-vst five colul-pns are the i 21 moneys that wej,,e a@-.,a-cded in cz,,.ch project and total at the botto-I 22 for each of those five years. To @ia right of the asterislz column are t-lio@,e 23 moneys th,@f- i:hc-y Zaire at the-.::-, @iyre for sub!-.-,-CTIICrlt 24 P,ce- Federal RLpottets, Inc. vc_lars, In the case of Kzinsas for years 06, 07, and 08. Ag@ii.n, 25i 45 I at- tl-ie requested. C\;.ar 2 o. r, o r n c.,, r ri c. u Y,:) LI 4 P 3 nuinbc@,r ta@b. The OIL 4 for each by typ,(,, of support being rcquestod, N.@hether it is 5 coi-itinL,,atiot.i N,7i.-Iiin ctr,,-,rov@d of ,@upport, \@,,j'-iich i,,- the 6 firi:t coluir@n, continues beyond the appro%@ctd of 7 wh-'-, cl-i is t-hc r,(.,cond irtC4' forch, tho,@,e- Yro,.-,c:ys tl-iat are 8 being requested for a particular year. 1 9 race page is a prog2:@-.rii period.. The fir.,;t page for 10 Yansas is their 06 of The secoi-,,d pz@ge will I-,C, 074 1 1 At tl%c ric-fli-it of th@, E@,,cfct,, yo,,i no-L orly have the 12 codes. b@c,.ing ti-,.c.; a,-id -i--Io-t-l@.1 13 (Ioll',@ars. 14 Now, the ntirt-.@)c;r /,. tab, i2,-ider Kansas, @.7e hav@, 15 ar, of Rivi!13S ftii-i'ds tht@-t be-L-@ig 16 as a of sou@,-c(-;@, of 17 1,@Tcw, in tl),-@ -Arinal,,cial data rocord that@ the P@@ ,7.1 18 svbr its to -os oil C-Etc,,L prc)jc@ct, tl-i@-,y id@,rztify i.'L t--h,-DY C,@ 01-@ g I 9to be getting othc!,-- of SUPI?Ort for that activity, 20 And we hav,,@ sl--,Iayed th4 s in toriqs of in the f i-st coli,@i%.tn after the tit@.e tlic- IU@,iP-0 ftiiids are, rc-,,quc-s-t(--d. 21 The secor-,d one is those fund,-- ';,-hat they have ind-',-cz@,ted %@2ill be 22 4'roiit others the to%@,@tl thc-,,-i in the th,---cl 23 24 cr)],uivn. A;-irl in -@ic E-ourth is tli@-.t of /kce-Fedei,il Rel)orters, Inc. that RI,IPS iqould L)a coi-,.tribiitii@),g. 251 1 A r% they have ol zAs Y'O',' cr 2 ci t supr-@c)xt for any of tl-,ci-.- 3 4 vie can go, th--n, b@,l@.ind the 9 tz,,b of !Kansas, 5 that tire descriptor surpm@ir)-e.-i 6 had beon submitted to us by the R\IIIP. We have this 7 b2:o):en do-.,.n in@@o three major groi).,-)angs. 8 @Phr-- firrt gro,,:tpinas are operational components. 9 in the case of Kv,-nasa, on the top left-hand co--ner, you cF-n 10 sea that they a@-a )7eqtie5ting 12 op@,r@@tional coi-,nonents v7hich o each of the 12 raajor gro@ir.)ings of 12 have 13' for you that i,.u:ril) r of @li,,At to tliu,-@ spa("if4c 14 thc- dollars tha@t are and Leon the. 15 of Ic-hose dollars that that money identifies of the amount i;-hat 16 they are regi@,--sting. 17@ Thel--e are four pages for that p):intoi-it. 181 And then ri.gl4bt behind tlze litL-Ilr-@ yellow tab, we a SiT,114.:L--r 19 type of displ@ay for the pl.@,i-inii-ig tl t tlicy ha%,-e 20 iCcrlcified in t@lic@ir a-,pr@llicatibn @.;hich rLinE-, se-ii,c pati-.c@rn, 21 the ntlp,.ber of programs that thcv are requesting axid @ie airotrt 221 of dollars. 23 And the third batcl-i are the 1)@-oc.5rz,-Tri fE@aSi-bi.l.i-ty 24, stuo.-ics and cr-@ntral services again in a siini).ar i-.rrangorieiLt-s Ace-Federal Ref)orters, Inc. 25 and array. 4-. '7 I The ne"t -,qu -PI 2of thcir page 7 O' 3 oppo,-tLni@-.y d.,t -La thcy to i:,S. Thf-,.co. A. are four mejo-- beirg core stafc-, again 5 broken doi,;n into technical and secre,:e@ri@il 6 and cler;-Calr tile same fo@.- projc-@c- 7 The tl-iird Y,,,,ajol,-- col.u.,@L-i j.t,,j, i-,I-ie regional @@.dvi,.-oi-y grou,p. 9 Anc3. -t--he c ,-Lc-. othc-,,,x, coni,,,niti::c@,c@s. 10 The ro@,is, I are self-explanatory. The -cop 11 is total which are Then you have the 12 TI,@cii yc)ii have-, -L-lie broakdu%qn i,,,ndar 13 I-.Iiat Fre 14 appropr4-ate to blacl,.s, inaians, Spanish, oriental and This i- a d-IL@cc-t-- f).-om 7 of their -zpplici@1--i-on. 15 1 6 The He Provided for c-ac,,h @IP 17 behind T,-.b ie@ li@-s bcc.,TL front the financial data rc-or,is h@v@-, id@-ri-Li.f4cd for t).icf7e. objcC,3 o' c@p@nditl2-- t"liat are on page 1G, 4..n ezir-lil th'--'-, have been 19 re, -c@), 20 L)O::tc-cl to ir. i,, partic,ilc,-- co,-rp 21 first be3.ng coca,, the r-:cc.@,Dlid oiic-t end the cor,.ir)o@'ien,L nui,:,bE:@.rs. The, to-cal in c,,@,,,ch object of e)znenditure 22 for each T,,IP world be the riglit-heiid row of the 23 Izist page. in Icl,,c czars-. of I-,aiisas, the last-- colui,,In oil pag,-@ 2. 24 Ace-F(,-dei,il rzepoftcrs, Inc. No%,i, there is one oth(-@r set of printouts that have 251 I p)@- vd@,d N,.,hcli, is for of yo'@ t to do 'at-. the tl, e re s 2 anc" "ly s i f3. that i-E! )Da,ck of the bool@, 1 31 a tab that ;-c identi:Cjc(l @,S )?I.7il@itout-,;, i f 1-7 cc-In 4 fli.p b,-@clc there i)-ndr-,r 14o. 10 toldr the)-,c are foLr d --L f f t L. @-t series Pnd these p!:jntouts ide-,ntif-- 5 printouts in -'@hi .1 6 are those-,., RJ-.APf:, that Et-ro in this @.-c@-view cycle brok,,@-n down z,-ccDrO.- 7 ing to the ni:,,riibor of ycars that thcy are So you 8 can see that there ave four t,,hat ae-.,e in their first year 9 of operational, one in t'zlc-, sec,-;iid Hand so fo--U-i. I 0 can thf,! is the sec@,-@qo- 11 from, the bottom we hzAvo l@c,,c@n follo-,q4-ng you 1 2c@.n sce 1 fc.,r five 13 Noii, a.@- to orl this printout is a compc),r4-@--oi-L of tl-Le m(-,;-icys that t-hc-y a@re rLquesti.-i-, 14 15 in colu.Tin 3, $1@.7 inillio,-x, @-ts a percentage of' thc.,.r ctirreiii--ly 16 bt).c7icjc-ted in 2, $1.3 million. 17 In tlli).-cl colui-iii requests is the percoi-it change f-c- 18 current. You can scc they 19.9 recent more moneys in total direc- cost than they are CUrrCn4l@, being 19 frknded for. 20 21 In the subsequent in t)-tat page-, we have alz;o given you a- ec),,c.@parison for you to see in terms of the history 22 of that W@P, tho pc,,rc,-,nta(je- clia-ii(,Yo 1-h@!.t occtirrci%.d i)-i that 23 0 24 years I and 2 -- in this ca5e 177.7 percent. Rnd their Ace-Fedf,@ial Repoftf-rs, Iiic'I@.c -,c-cor).d column would hc, yca;.E; 2 --u-id 3, a I:)ll@ 27 251 4 9 percent and so f or--th doi,;n -che 2 there are four to this sc@ries. 3first page that we have gart@- is to,@.z:l diy,cct cost. The 4second page has to do for corn comi:>oxic-,,n-i;s, thc-v third one for 5pro4act and the foi-irl@h for -I--'Iiosci th,-tt. develol?ivent@il 6 CoTaDonentS,, 7 Yost Siste):. 8 SISTER AlqN TOSEPlill@]-@ I am interested in this five 9 Y(--ars. 10 1.1,A.YER.- Sir@ter, could you title the rtil@.crophoric-? 11 SISTER PNN UTOSEPHII,@: in this five-year ope---@it.t.ona 12 a.,@ you loo't, at and yct,. lool@. F,,@t tl-",-c .13 bucg@t and zcquested, immediately the qii.,-@s-L-ion cr-@,,c@s up 14 is changing there? Becatiz!,c it is changing very rapidly. 15 IIR. ICHINOT;-7SKI: In the case of Kansas, they arc 16 requesting $1.7 million. Nnd they are currently being suiDpo2-'k-el@ 17 at the $1.3 million ic-vol. 18 SISTER PI,7,N JOSEI-,HlriF,;. I am tal1r.ing aboat Missouri. 19 I look tl-iose ti-.,o,- they z-,ro I.,ei.ng J'ui-).ded $1.9, and 20 til-ay are rclquesting $4.4. There are some signiL'i-c@-nt ch@-,ge@s 21 tal-,ing place here. 22 14R. ICHIII@OWSKI: In 1,@issouri? I believe yoLi I 1 23 discuss that at the time thc4 to IDa 24 p e@gented. Ace-Fedeial F@cpotters, Inc. 25 SISTER ANN JOSEPIIINE: This could highlight -L-hefe 1of sur23?,@se oii(-,, -v.7ou.I.d 1C)r,)" Z',t. 2 MR. That is tile j.yltert of Fly covr-@ri.-.,Lg 3this. 4 SISTER AIRI JOSEPli!N'E: I kc-op liolnirLg we the rigl-it 5questions because if -v@ don't, work on the x@irorct answe-s. 6 MR. ICIIINOI-ZSKI: Are tllcrc-, -my otller qucstio-,is? 7 MR. HILTON: Yes" 8 DR. MAYER: Yost Mr. on. 9 MR. HILTON: Is the current plan to have those 10 p"intoul;s replace rau--h of the reacli@ng v;c h@ive in the 11 'ot)-ter book? Is thi-s the -;.dca,? 12. Ye@. If,- there-, to -'L"hi.s p):i, i- 'L. 13 14 clearer? Somo of @ic@c-e z,.re 15 vc-r,. lie hav,-- juct in -'--his 16 -Iiade the doci.sioli to go f@.-om large printout to the rccl- d 17 printout. It is nn internal problem with tile use of a x@-ron 18. 7000 in tlic- building hore. And if c,-@n g,-t to use 19 the Bruning or one of tire other are for ri-ght now and get it tcd i:athc,,.r tl)an @ero-c-d,, 20 1. 21 wr-- can the quality f caiitly. And I belic,,re by 22 the nex-L urge these printouts are presented to you, you 23 note the difference in I-.hc,, quc,,.Ii-ty. 24 DR. I.IAYErl,: T;.-iat i!; extrc-,@i,cly dzi-il-a. I,.71i c@ n I Ace-Fcderat Reportefs, Inc. 25 f-cd to d4-@raecIL- out that-, "noi-i" Ohio prog--z-,-m, I i@ioul(I hav<,, 51 my eye teet-.h f Or thi,@c4 d@.ta. 7,,,r@d 1 ju,@t ci.Lkc.,d to t,,--y to 2 gc-,t sorie thz.,,t 3 yo way you CZ-,n vie,,,; tile tj-.-@lig 3.n z,, P4-c@tr,.,:o over 4 without so,-te fc(@,ling of this I-,i-nd oe data dj,_,,I@layc-d. rehc--re is 5 just no w@,-@,y if yo-ti hovr--i-ilt begin involved, :Le !:-t tlir-,t I ccin 6 capture, viithout this kir.,d of in:Eol-raotion. it is absolutely 7 esse,-iti-al. 8 MR. IIILTON. Pc@,rliaps this is a question for Dr. Pahl. 9 1 notice c-:o:,ic-'nei-@ colors in tire forra. Ir, there a color cc,,,-qil-lg 10 Do--s it mcan O-- we jus:t 11 surplus Pape-"? 12 DR. fall; to Lin, I 13 to ejo throigh it wi-tl-t hr@:c@-.I sure @--he 14 v-iiJ.1 checl: r,,iy accurz?.cy, 15 The Sta@--'f 7,,.iniversary Re\@iew, Panel acts on oi,.Iy 16 certain tvpas of you wi.11 re-call. 7And N..7@ien tlicl, 17 dot the repo&-t of'- that panel is givei-i c)n -,ort of this p4.nk 18 sheet. 19 DR. It @.s good you askE,,cl him. I art 20 color blind. 21 DR. PAliL: P. yalloii sheet ind4-catec, tl-ia-t is a 22 -L--aff docuiT,.ent for use by the- ccycirLi-ttoe @,,nd th(-- S@'L-,Pff 23 Anniversa,,--,v lzcview Panel has not acted. Thcrc@for(--, this ).@ii-id 24 of staff sr,,-,saary is corai,ng to yrju as @,.n Ac,e-Feder,il ficporteis, Inc. without pxior review by ai,. internal staff panel. 25i 52 i o n tli,e back-up info c3.c) have 2 ther color.-? 3 No, only o@lic little-, -f-@hing tl-,z-t 4 jarred us-, th,@it is thct-. p-rilltdi.- coritrz,,c-tc@d out@- ar@d, 5 tl-iorefo)-@c, we hu,@e Several shaci-es of the sarc,3 color. A p4-nk 6 is a pink, no iTiatter N..lhak-. 4-ts shade is. It dep--nds on what 7 contrz;ctor 8 IIILTC),N-. I-,'hat is a salinon',> 9 MRS. KYTTLr@-. Hiltcn, the salrion indicates I 0 review of tl,.-c Staff 7-u-in4Ver- generated by f f or the 11 -Cary 12 131 ar(-! z@1-1 14 DR. 1,1@'iYEP@: 15 DR. I do hzw,-- oii,@' or tx,7o points of 16 7uicl Ichcn I for you to st te about 3-s. o I c-, t r O. ,,o points rolativt',% 1 7 PrOPOsa o tal-o up the first ti 18 to Thc-,rc-. lio-.s bEa,-i ove.,., rLlo.,ntlis 19@ need by P-TI-T-s' fo-@ a cl-c@a).- fr-o,,,a rel.ativl- to 20 responsibilities Lnd of -the. grantee, the rkAG and 21 the coordi.ni:@IL-.or. llxd of s,L-,aff Niorl,. have no,@%7 gone. i 22 into a statement -Yihich h,@s bc!,2n Ic-,@31,-,cd E-,t by the. steering 23 _eC_ , of A- IC. 24 c 0 c@rq coordinators i@iid has. the @-pprovai Ace-Fedeial Repotters, liic. of the HSI,!IRLA grants policy office. And @,ie will be getting out 25@ ho Ily 1-i -,n th- t-,,;o c-t St 2 and of l@,7NG, g 3 4 rioe;, i.,,e are that I)y m@,lzi,,Ig this 5 and it -will be policy, thcr-c., i@ii!J. have to nic)dificzi---'Lons I 0 in some of the ri,'iP regions' by-1c,,,.i,7s @..nd F,-Ut in 7 general this is x.,,,hat the dixectoi@- zmcl I-IS.@Hl@ @nd the steciing 8 tl).e. coordinator believe is apnror.)riate. Ar, d 9 since it is )-P-ng-thy, I it into -'Che rc.@c-n@.,d. 10@ We do not ha%re it for you today. We have bce.vi 11 to m@@@o suc.',i a dc;@cllinr@, bu-L- h@.ve, bc.;t-,.n 12 unabl@e tc) galt-I the hSi-@14il@P. o,.- @r to do so. 13' Th-e %ta-lue of I v@,ill b-c. for olica 4ty 14- n f r both -he rc,@4ori.-s c@nd there N,7@-'Ll be air opport-Li 15 orgznizL,'L-.j.onal groups and cars to have a ccr,,-,non docun-..@tnt to 16 look al@- z,,@ v,@ pro!-)Icru @,7hi.ch do &Lric-@e in the 17 181 In the key statc-.rc,.,@nt i@,Thich ha@s bec@-ii i t,-: c-,. 1 f 19 so easy to read and has t@,)@:cn so long to get clca--anca on, 1 20 lilrr-- to into the 2.-c-cord bctcatise I think the @est o@L 21 it airiplif;-es this 22 The organization @,h@ill mari;-,.gc.,,. the gr@,i-it of 23 the Regi.onal Prog.-z@i,,i in a inanner i,.lhich N@7ill 0 24 the p%-ogran estcbl-@sl-icd by the, Adv-'@:7,o-@-y GrouT-@ in Ace-Fedetal Repotters, lfic. 2511 accordance witli Federal regulations and policies. c- Cj I rI A,, 1. d C' a I'l I:,ffDf i t - 2 O@c-,tail i;hc ro),c, slid Of the, 3 Regio.,-ial Advisoy.,,y G,-oL@p Ilcl %Iho in this docL@,--Cn@ 4 is also idei-itified vs k--hc- chief Of'Licer. And i C'. 5 represents, I thi.nk, a major step fori-7ard. And there will be 6 @rome specific, isolated but, roost of the proL-lems 7 which have arisen iy.-e of and 8 of agreement as to a common theme. 9 S o vie do hore that this in better understai-idi-n-";@ I 0i-nd rela4k-,ionshil)s. And o,.,c-r the couy-,se of the year, I a-m, sure, few rj-?-acific py.@oblc-.,ms wi.11 bo al)le to b-S out. Oil a 12 e 'b a, r, 14ISS @l,!D' ""SON: you going to the e - u p 14 of the R,:r@G end definitions of -Y.,hat co,@-as-i@mor is? 15 DR. PPHL: Not in this docu-T,.!@i-it. As vie 1-iave broti.-ht 16 before you at earli.e2: the;:e is ci by the 17 D@partment tha7.t mo@.-e of z,.ll I-IT@;q be put- -@n-co 18 )-,c-,,gulat-4.cns. This is a by tl,.,-- Secret@,nl,ls office!, 19 and we ar,e p.-,.-oceedi.ng as we d,-@velop to ti-ic@ri 20 couch there in broader, more gc-,iieral language in terms of regulations. We z@re trying to keep the formal regulat4-ons 21 22 as broad as possibt.c! to prov.;.eic @Lo botj.,l the 23 regions and oursel.vc--f--. Fnd to use these statem(?nt:z to TnE@l!.-e. licit what ic@.. ui-iCcrstoo6 Fi-Ld i.i-itai-idecl and 241 CxP Ace-Fedetil f@eportefs, Inc. i 25 But the points yoii mentioned are no-fk-- in. this I doctL,,@cr@t &.rid c@C-t of f -Lirthc;,r 2 Thec@e e, @,,'hil,(@ t-0 g@-t c-,VC"---:-Y).)Ody to C07,-,e3 to 3 agreement on. 4 DR. 1-11,:,YER-. When be released, H(z-,rb? 5 DR. 'PZ@,!iL: It has bcc-n clc,.a,-c-.d by HSi.,iiF@. I @,,You.Id 0 expect in the ne,-.L- Lwo wc--c-ks wc-, would be i).ble to begin 7 ir@echanic@lly getting thom px@inted and ol:4t. 8 The second point I %,-!ould mD7.-t,'cion is th@,t ii,-is 9 now established a policy effective 11 -- and thi,.@ i-s onl%@, 10 fo4- you-@ inforrRatici.-I -- which now makes it a require.T@ant, 11 places i-t as a or,. all programs to info-M operate diroct--r@:@: of a-n5r 12 tllc@ .. I .1@ - I .13 o@.- con,-ract to bc- in that@ 11-@'W 14 to that regional health director the opportunity to coTrcsnt 15 upon prior to the final decio4-ori eith,--).@: or contra(@li--. 16 H@ is required to subriit but he be provided 17@ i-12-0 OPI?Or-t.Lin-@i-.y i;o 181 It also is a that onQo the d4.spositi-oi-I 19 has been r,-tade, c-il-h,@,r approvlo.:L or a@;7ard 20 info,@i-,iat--',.on mu@-t be giv ).-L bacl@ t-.o tl)e region@l health director. obviously, tli4-s is -n tho iTitL-re@;t o@' lr,.-epiriq Iiiri 21 better info,--i-,,ad about all acti%pities, N@liL-thc-,,r they ctre 22 1 23 1 in his office or not, but \,.,h4lcli coi-.ic from IJ.Sl,!A'IA. 7ind %,.,e 24 already this to our grc,,iit z),c-rivii;y iii ,ce-Federal f?er)orters, Inc, i,ic are soliciting for c@arrent applications to go to the June 25 ii G Icouiici@l., 2applications, and also 'the oiLcs L@cfo.-L. If thL-.re 3not bcen -,o the rcg.-,.onal health 4director i.z-i I)roviC,.ing hira th@@l- oln I ,- I@o):tutii--y to them 5prior to this Jrne Cotzic-;@.l. 6 And then viill be- in an 7way for the c@,i-IL-ract wl-iich the. Ofx@ic.-('- of f@-ha 8Director of PAIRS dc,cs engage in. 9 I".OV, I woizld like to turn to the last iLein. Arid I 01 am sor.-y there e@rc@ so ni ny IL-hi-i,.gs- this i@; relativ,@lar 11 ir,.portant. And with your poryciissioii, I would to retd to 1 2yoll the b@--.,@ii to .13 YOu- @lid 4--'c i@, di-)'f,.-.,ul-t fo-,,' you.. Lo s-,)-c-ct out -ch-rse 14 iml?--r-tant Paracrrzir)h@-. 151 As Dr. 1,4iirgulies iyie@---catcd, %@l,c! have tl,.e 16 revised and loc-@,l for the ),.j.dncy of MTS. Dr. I-linirian 17 181 pick up %@@he.-e I o,"f.' @,ncl th-,,;ii ).c--,--,.d ii-ii--o i 19@ discussio,,i of t@ic,-e Bli'L.II i,.,ould to go ovor 20 the revie,,i proce5s ;.,ith you @,nd as a rviz-4.ttor of 21 YO" slid aico as PFrt of 01-ir ;-,(-Ico,.-d rc,@@t(I to yoi:. those 22 i@7hich a-rc--; per-('--inent to th.c- revi.ei4 r)roccss and Ic-@,ive to D,.--. Iliriman to then d4@sciiss the more general state-,iieiit about the 23 24 Icidney p--:-og.-am objec@@ives and sp,--,cifics to tlii,.s Ace-Fedeta@ f@c-poitcis, Inc. meeting and kidney applications. 25 57 I Th(--)-e ur c> f fort in it 2 trying e4nd -.',.ilto 3 lot m-o re.@-cl to you, the-, of -L-he review-., 4 process at the local Laid tl-i-a ii@tio-,ial is @,,.h..ch is Effective n@,7 and, to Lhe -zctivities of 5 6 the )Teeting of this 7 the -It-lechiiic,@-.1 process @,t 8 tbe local lcvcl and z44bout in-.-.tial discussions %,7hicl-i 9 may occur botA,@,@c-n the reg4-on and P-7@IPS st@ff as a co,,,-icop-t for 10 a ki.dney bu',-- Starting with @.e technical 11 review process at the local thc-, i,@,sucxice 12 to -'o2: a 13 thc- is c,,-"nact:cd tc) ol)tcxin a tec,i-iiiical 14 review of th,,@ proposal by a group N,.Fhich has not 15 the TI@e. i-c g@--oup r@,ust 16 be c!cl by 'chc- region, Pa-Nrivstit- of ca '@@S 17 tllc ga0graDII-c 181, of such be rtaC,.,P. by the Y--Cqu(@c@tiiig I'@,:P. T 19 1 hc,, :(-cgioa i-@y Obtain the of co,.i,-@ult.4ng 4 ri op t-@ c>@Loct)--ts by f oLr 20 21 a.- The of E,.i-,d Tc@C.',inical IDe\Felopm--nt raniiitai,n,-,@ z,. IiEt of roxial consultc,,nt,-@, and is 22 23 rc-@;PO!Isibl,c -J'-or assicjr@,-.@cnt. .131ioul-d -L-lic. 24 dc,@s-ire to chooe;c its ci,.,ri review i-iarv,.es aid Ace-Fedefat Repoftefs, Inc. Nri@.tiQ of prospective (--oNisultant.,@ riurt bc- cleire(:i with the 25 5 el ci @-L C) )Pl c n*- of ren 'IC-'C.'d )"Ot ready by mav be by iaail @,,,Iic,@n The R14P nego'c"ate &.ny 51 needz-,d -@@,o-old conflicting I-echnical advice be gi%ren,bv a ,h 6 7 Forwc-)@.'.-@i i-r@g onl.y those proposals x-:hi,ch cited 8! favo,--c-bly by local tachn-&cal revic-ii g2:012P 9 sh@-11 br-- c,@l-Agi-ble @o-- by r@TIPS. In addilcioi-1, 10 an oppor-c-uni;-_y b-@ pro,,rici@2d py.-io2: to of -IL-he T@G for rcvi.c@@,i a,l bN@ appr-c.-,pri.E,,te 11 prono a-I bv the P d by F>,@r;ti 9.04 (@b) 12 CI'P 0 13 A c 14 The RAk"3 sliall con.,@,3.,eor any CIILI@ and 15 on the 1. - ty oF the IL!,ill to rLiai@ c,. (7 @'i t' a, kid:-icy I?-o-'oci- 1-hout hind--ririq the d,@-,Fc--Iopraent of the ovciy-,v@ll r@l'.P p,,:og 16 tlic- reasonableness and adeqlie-cy of the propo,.-,ed. 17 The RAG is respo.-.s4.blc@ a!E;o @@o.- ii),d,.ca@-i-ng ira@or ;-Ssue,-l 181 19 raiscd by the locz@.1 to--!'Inical ql@-oup Still I-,e 20 Since kidney p-opo-lals arc revie@qed separately at tllel nation,-A3. I.eNiel, the- RhG iic,,,--d not give(! ranl,.ing to 21 22 )-idney p-"oposals in relation to other non-kj,.C-iiey RIIP o_ @on@.-@,, 23 activities. Kidney proposals. be consido@.-o-(-l by r@i@lP@ i n 24 relation to national priorities. Ace-Fedetat Repoitcis, Inc. 25 The col-,iplc@tc- constants of the me@ers of the technic,-.i .i c--r. d a n y1 .1 P i- i t r@ r@i ubc i,-i c:; 2 ii-i thef d,,:,(,-; 3 ILIVIPS the. sh@,ill 4 include: 5 a. The co;.-itribution of -t.-he project 6 program 0))j,-;.clcivest 7 b. The end i,,.@ttire of tl-ie of 8 the RAG. 9 c. Coir,,Tants of CliP agencies. 10 d,. The preferi-cd of fu,,idi.iig. 11 lu,,PS Review Cont:ni-@",tce - PL@IPS E,@taff- w,..Il 12 t-h@- pl-,op oses to suppoz.-t@ 14 objectives, F@id --ho substantive points, thro,,Ic,,h 10CE"l 15 review procesEes by the Tc@ch-n@'.,cal l@1-7@G, 16 thc- CIIP Lgen@y, For the @,.G-, 17 CHP @,gency; or. has 18iii(f,.ic a concr--rr, @tpE@):. oiii thc- technical Yr-o--i-ts of @@h,-- 19 project, the R.',!PS Pc@vic-@y., w.-!.l'L be to Fa 20 recoy,-,nL2nd&,tio,- to the lle.11--ioiial CoL@.,icil. 21 The 111,1@PS sy@,ici--Fically v7ill not 22 rc@vicvl on a t(--cAllnical basis thc@ r@,,--rit of I:Iie pro-,oosal, or 23 c s t -@ 1 is li formal. nu,,i;arical Yati.ngs for individi:,.al 24 rind., finall,y, secti.oi-L 6, Cotincil Ace-Fedctal Repotteis, Inc. pronosals shall be siab:Tti-t-'I--ed to the ilatior!,vl Acl\,,iso@y Cc)u--,Icil 25 6 0 \.jit-,-h tli,-@ c to .,c@@l 1 for fin,)-l I C4,., tj r4 2 ii;it,-,re of the ]@icbi@!y disease,, @@;,.'LLhin the Cok.-a@.cil 3 will reviev7 z).nd. reco,,,@iRieiid furidix).g Ic-v(,-@l,@, @o;c kid:-i-o-y prcip,-)sEils 4 Separately from tha funding le%rel of the R.%-IP. I'@idricy 5 program fvliding will be in addition to other Rl,!P program fu,-,,idi-n@., 6 Noei, those are pages 3 and 4 of this 4@ssuance. Zind 7 1 would like before i@.-a entert@i.4.n dic@cu..@-.rion, this is not i-n the co,,r@iDlete to havr--@ Dr. Hinmc,,@n 8 9 have distributed to you which 'ust &f;-Nsued and 10 corxcent on so2ne o'A- othe2: features of this i-lamely, the 11 'frar,,awork of kidney program, ob@E@c-k-.ives, 12 DR. 141 DT.I. PPXL: Of coursc-.,,. 15 DR. I.IAYER: -- to @ure v,,e. have got that iLid@-r- 16 Eitood? 17 DP,. PAI T f.. Of courrc-,, J3i.11. 181 i,,Iiat- I do -is indicates, to I,,ou the roLponsibilii--4-Es are o,.i p--ge 4, iteni 5, a,,@,d 19 r. up perhaps the two of us 20 if we can I-Lave D can try to rcspond tc@c@-c-!I--her Dr. to 'the 21 questions that may be raised@ 22 23 DR. @IAYEI@: I guess my problem relates to how u,3 24 dL-al with this., We are not dcaling wit 1--i the technical asr"@cts @4Lce-Fedetil l@epottefs, Inc' of it. We are dealing with its presumed relatio:islxip to the 251 6 1 re,,,t of the Is thz@.t cor),c@ct? 2 I air, to a fc;c,;l for, is @,-ole 3 the )z@.d.-ic;,y pro-;cc'c-.-s. I DR. P'illL: iic-1.1, this issuance cE.-,Y@,e about as a result 5 of the extended discussic@n at the I.;ist corr;,,r@ittee nic:;c@,tiiicj r@d 6 at the Cov,,ncil to that rctocting. 2'@nd in 7 ordc-,-- to it, Di:. cc-u-i reiterate, I tI.14-1-11c, 8 @-?hat et to the cor,,L?.iiiL@tee that afternoon of the 9 second day and which has been ii-t tlio principles C 4 10 enun Latcd hero. 11 So 1.@et ask Harold 12 I ncoi3. to F'. of frc,-Y!i t.@-!C-@h;-iical s 13 @.,,41;h c.@z?ivLy:? I ,t fincs z,.F, this what k@,ncl of 4s th"- 14 i.@Iiicli is -v.@hal-- it d,,- DR. l,il@RCLJYIES I thin',,- the most h2r@, 15 16 is tli-@. one tlia-t will-,. over quite zi pt--ri.od cf 17 Artd that is the bet@..een a propo2;ed kidney -'tccil.'Iy 18 iiliich may b teel-,r, 7factory ard a Pc;cjional l@.@-dical pi.obl-r,.-i-c. with it.. 19 ProgrE,@.r@i @,,,Iiich i,,,,Liy hove bcji 20 operating worth, at 1-oz,.st, 21 the i7nplic4l.t wl-iic-l-l i-7as in real t,-ou';])l-@ bably not a very good site for the cstz,@lishiTtE,,rit of all 22 was Pro 23 effective kiid,-, y prc)@,@.r m. Th;jt @1.)pca:ccd @i-L M@ai-iy 24 wayF, to be z,.s a. (,lejif@)Tal Ace-Fe(ler,,il Repoitefs, Inc. 25 coo wh---,-L- @@e would isk the review coraiittoo to do with tl-iL@t kirid 62 q" u":3 'c,oL j@,r; y t -,;,2 0 ri r 0C! %4 0 f Ii d 2 I)Y mc-z@iiing when vou see y 3 a k",-Cney lias gorc-, @.-t.-oi:;gh technical rc-vic-,.w and 4 is bu-i-- it is in a r, g4lo,-ial l@ic.-dicEil Prog:can,, L,,!>Olzt 5 You som-@, should O,,-, that 6 Occas'On raise those doubts and 7,.alce some kind of decision 7 abou-L. @.7liether i-L. is for that @RYIP and not itsel@4-- 8 to carry out a technical. rev4"cw, to --,-2cond tl-.e tocl-iiiical rc!v,ic-,-e,, 9 @.;hich 1-ias E,,Irc@.dy b,'en So it really is actioi@,. by 10 excep-c.-i-on i.ii i-ho-Ic DR. 1,1,1@YER:I my p2.-cbl,cm is I cci!i of CEr, LiFc@t a 12 r.,Ct C.-Illy 13 tc-chn b,@t- -c-d. 3 .9.,) 1 hv c 141 fit th@.c bnd I am goi-iig @Llo that th@,t @-s a and thoy go"- E@ p:coposE-ti- in it. 15@ 161 T---kd i-h@- r-i@IP ouclit to 'L,@p to b@, z-@ good a 17 as that I-,!-di-,c-y No,v7, N@p..at have I eLc,,i-ie?T ,,M I-,FLVil-Ig a l@.ojcjh 18 19 d c- a ig -L-Lh the o:T rr-.vici,,, th@it proccl,-5s and home do i-,,e zihold o',-: tlic@ to deal that 20 21 rolc-? D R. RG UT, I E S I think it is an d,-'Lficult 2 2 prob).@r,i. V?e gone ztt i-t tx,@o @,7cNys. In both instances, ,we 23 have felt -result. Th@-,@l-f@ ore IL-,ast 241 (Ace-Federil RCPOftE!rs, Inc. 1in our expericz-.&cc-t to t@,7o 251 2 Ori@. of @s a P"@@,is-ib,..Iity thzi-@ i--hc- 3 be th(i o,-ily tliii-l,ci iri the. is good. 4 7i 1 1 nc)i- involve the Regi It @-7i-ll bcz, :Large. It i 5 in Jr.,-i-id of- activ,@4-ty air-' 6 -LiAiC,.ar some bz@sc,%d tipoii your of those 7 ci):cumstcxic@s, i-iiight as c@,.cuse for th-C to g o o ii 8 doing a bad job they once do.4.ng sc,,-,.iething good i@lith tle 9 kidney in @qlzici-i ca.@e yc)u might d@@,cid@ no i-natter hotel 10 c,;ocd. the ac-'c-ivit,,, iv.,@.c- rc-,sult@- for the whol-e 11 ):e@iion wi.1.1 rv,@@de than better. 12 13 z@d E4,nd is 14 des3.gtAled to the. nccds of t,l-io. popu)-,,--ti-on in the best 15 poFc3-ble r.,i,@y p-o-v,@ z-i c- ograli f or _;ood %,ch3,rle in a p-@ 16 le@,rnirg h--,,@@! to do in @.xi 17 ayid Y,-.i-ght be an 18 Thcrc@ a-ronli: z.,--,iy on I--hz@t. are 19 tli-- Yir@.d of cvertc N?ou hp-vc@, -co ai E@n individual 20 b i c-, Alic', it is c@.@Fo2.ctly tlill@i.t ',,,ii-i@d of the 21 Co,-CM14t4-ee, I a,,%i is to have to (ic-al @,7ith. I doi-i 22 e@ny shar,,) for it. 23 24 SIST)@IR caii anticipate. anotl-itir .4ce - cal Repottels, lric. 25 the cox,.sultarit,z, do not have to oxc@iiine the project on i t vi.si-,'L-, but, c@i-i be con@@-ulted by phone or iTai 2 ma@--o. a@d of t'Le 3 -,@,id what actively C-@,xists 4 i.,i d-Lf'6--,-ent. Zi,,rid I c:z,..n sec-- that- the v@3L).idity of a 5 to-chri-F-cEF.1 -r-c-v-i-,-w co-@%16 ba in those Conditions. 6 And I cLri even visualize the conditions. 7 DR. l@.2@.r@GUY,.TES The5e visits @;,,ill lIEve t-.o 8i be on site visio-s. late are no4(-- goA".ng to accept the paper 9 review'. 10 DR. I.d, that is not @@liat it -,ays. DR. IIAPGUL-&ES: It el I-L I t? 12 o. 13 DR. Vl (-'II I I, irt tl-iat c,-Ic-,O, v7e to rlai:-Ilcil 14 full ag,--eer,.@-nt because I can't sce just a paper rov4-e@-i of it 15 either. There has got to be site visit invol%red in tl-.is. 16 DR. 7,.s the cz,,n tell, thcre ticks 171 been alnourt- of and is@ b r- tN-,Teen var4@oil-s coic.,.,nittc-,e Council mon,.be.CL@, r@.., @Aps , 19 @,td various people in the field. And it was not iintil- C4Sion IT,,@og 't . of S@ 20 Tuo--day there was a fi-nal de th c things, 21 the thought bz--Lng on i--h(-, F.,bili-Ly to leave a ria4-l volt-.-c. 7@nd e 2 2h4,4ve in liL,,rid somc, tc,,(-,hnical rc.,vieiqs in i.n c-!(--@ittle F-t th,@ 23 AS7,,IO meeting %%7hich @,ias con%rened, a rov2.o@ll cor,.l-m4&tt-e on a 24 p-oposal for five ri,.er@,bc-rs tliajt-l vere rre,@,en@@ tl,,ere, aaid they Ace-Fedei@it Reportors, Inc. 25 discussed it thoroughly, but they had not site visL@-ed the !3 wc)u,@ ty@ fi ca, c) r not-. reglon, 2 It i s ve L-Y 0, j' .milar all 3 This body siL'.s in lia,,7ing I-)'Iiy:7,ic&.!-.Iy clonc-. to 4 region to site visit. 5 DR. ' PT-J-IL: Sister Ann, I believe that both OIL the-., 6 que2L-lions that have already began raisc:d and those., that will 7 come up, you really 1-iz,,ve the. d i n e ri 8 by exception @.!hich is as broad as we coul,d conceive it to be 9 and yet be hal p-.1-cul. And that is, i,71icre the rxAG, where the 10 Cl-I.-D eg-onc@r,, where the DS.rectc,,-- and his stE@ff, or x@ei,.ere t-l-ie 11 h@-s a coi-iccrr. apart fror@. the acti@al toci-inical 12 Of p ,-c p to 13 thc- data ai-td to a 14@ IZoii, the concer4n c@,n be. on any poixit. fo-It th@,--e 15 %,.,cre oc:rvtr;-Lon,. %,;hen -Lt would nol@ be r..ctc-@csa.-cy to ii,.z4l.e a full 16 site visit beca,,ic.),e o,z- roc-z!r,,.t by -.zjtaf-f or 7t,-nd v-,,e v, re trying nci-- to bi t -4,nto a 17 eN,-eL-y arpl-ic C, 181 I't'e would that p@,iost wo,,xlcl involved site 19 visits, b-Lit ije wan-@,c-d to be f:L,@c on the,,',-- But if there 20ia concern by any pir@Ly to t@tis p---ocoss that it t-! i-,@-nlt 21 ark adequate-, valid revict@%,, tlii.,i coi-c.,-niti-,ce is g4-.vc@,ri -L-he fLill, 22 r.--sl-@nsibi-14-ty for raising that co,,-Lcorn, full 23 from the stiff, and m,:J-,iiig it so 241 dc!sirc-s to 1--lic' Ccllilc@l. Ace -Federal Reporters, Inc. It doesn't solve it point by point, bi-it. 25 tl) a,c @4-s the r 7it 'chr@ I ol @-ihole ul 2 ITz,,y L@x,-ise tl-.k:co-agh loce@li- O..c,tior,.s @'-',C'L 3 sec-,in(j 'cc)-Lal T).i,c,turc@ eE, the, 4 5 DR. SCIIIEP.T-,I.S: I aiTt cti@:ious as to why @he device is pok-Mii:t4 rig 6 used the ro-.g-',-on the kidney project to 7 selcct its techii.-,,cz!,.l rcercb@;r I worA--@d tl-t@.t 8 tf v,,e carry @--@t to th-@. wc, E-,IioulCi allow P,14Ps to 9 select o-,.7n siL-.e I think thls the 10 a if they dc.,;il-'t: like a. tachnica,2. 11 me7rbar to be in an position to say no. 12 c @;.rk , t@...C."u jUF4t 13 z-,, Ic gro,.ip coizicl 14 tcschanism i-n ways iqhich I think should not be part of the 15 national I.)ol@i-cy. I doi).It E@ea the,, rei?,son for-li,)vi-rLg thc--,-@t 16 ii-il,@tiate t@ic-t.r own technical review @-zhon it should be done, I f, ? 17. than),,, thro,@,i@h Rl,,,PS. Isn't. ',-hz,.t the responsibility o'L 18 DP,. IIAYER,: before you ansi@7or, let i-@-a 19 ait@p2.i'Ly tire @-(,,@.d it Find F-is I hea,@-d it. 20 is Jay th-@t them major 21 the burdc,-i of techi-i5.crtl.. revic,,,,7 b,-@longs to those 'local 22 who are brought i-n )Dy the rc-gioi-i fro,-i the outside. 23 Is tliatnot correct? 24 DR. 1,11-@RGUIIES: is right. Ace-Fedeial Rr-,porters, Inc' DR. M-KYER: TlieTi I @i.iilc Lc.@o,,ii,.rd's ciucE-@ti.oii ir, a ver,,,- 25i 67 pert4ilnent one, 2 DR, I,J'ARGIJLIF,,Oj: 3 The difficulty we- find in iri Your 4 suggestion is that we are still trying to maint@in soiie reasor.,z,,'.,' 5 balance even in the ca-egorical activities bet@,.,cexi a centrally 6 controlled activity and oi-tc- which is locally -Developed. 7 You might raise the question about technical 8 review for all activities in a Regi-onzil I,,Iedical Progrv@m. 9 The basic plan for non-kidney activities is the technical 10 reviov7 is carried out under the purvi-e-vi of i,],ie local Rec-ri-onal I II@-adical Progr,@ins electing its specialists and i-Us o@,?n 12 corf7ultari-ts , its own 13 The rc-,zison %,.re liavp- i-Rccl@ E,.n in t:i-ic klcl--ic-,y 14 activity is no more coy,-.pllicated than the fact it is almost 15 impossible to get tc-.,clin.!-cal revic-@,i by pc-.,cple within the @IP 16 without i-iivolv;-Ilg tlio,-(,. l@@'110 be in fact in the p--ojac4--. 17i Ari d z-, 2. 1we are really a.i-rling for is to n@l@@kc that 18 who are not actively p@-i:c.,,onally are -invc-,l,,i@d in the 19 And so long as they select ccmp3.@-c-iit Pao,-le, the rev.@C-NI? I - - t, 20 individual selection, it would sc@ci,.i to us, is reasona!Dl-y 21 left in the region as @-.t is with all oi-.h-cr -@(-,chiiical- 22 DR. SCIIERLIS: Then you are particulai-- ip ly c),,einpt CJ 23 any technical review.; by this co-Tt,,nittr-,e, arc- you nor--? 24 DR. li@qRGULIES: That's right. Ace-Fedetal Reportc-rs, Inc. 25 n- R. SCIIRRTIS: I gt,@ess I h@ive to wrestle with that 6 8 out- do@@,s,, Y,,gi,,yT@, iz: Lel- 2 a 3 @id havc,- )..)cen 4at it tiA70 holes in of hav(,- a ff:-(-.Iing @-ze L-re @jettinq a ii- L-Itle hea-,,,y 5 Aiid let ro.3 6c-,ugger;t i@?e take a 15-ini-nui--e break at this poin't in tivie and 7then c@-La back. 8 a rec,,c@.-,s wz-,@ taken.) 9 DR. 'e@c tP-li@ Our seats, please? 10 We 1-i,l@.e to cfo bacl,, to p,-ck 'Li,@o N-@le V,'c!re 11 ovi -Lhc- ki-@i,,-.,,c,,,y proposal and if there i,s fl2,.,:the@r 12 t:qat. 13 Yes r PI'AI I. 14 DR. lqlllTE: It 3.t; i@:ith clegrc@ of 15 1 can rtal@c- this co:,.-L,-,.cnt of the fu-t,.ire, but it 16 has bccii interacting to the grz-.dual 17 that door on ij-. tl-ie tli,-it @@ie %ic--e never allai.@zcd to ar.A.iik coffee in these @.-o-oms, shorlc- t4A-i-,n.0 ago, 18 jgi we were to)-d -co loo,!-. z-.,.t P2:oDc-,,;tst tod,@-y x,7@- P,,,'e 20 frO,-ft s,'cokS-nci,. I'xd &n v.-'KeT,7 of the nc,,e; guid,@-I,-xic-s, it 21 W-A.11 b-- -&c)," u.@,. to rqa)@e any deciF;3.o-.-iF, in the iiee,,r 22 f utll)fe - 23 1 hoy)e that the remaining iieinbers of the co,,Pai,4.ttoe 241 can be Ace-Ff,,doial Repottr--ts, Inc DR. It is C,-Yrai@-,i'Patic)ii,, thE,,Ic is what it 25 I -T ii nicd to -ccnal 2 are to dr@,@@7 f 3 the s, are @o 4 ends up in a sen-le of z:i k-@.Y.@d of rou,@id rol)bixi in xqliich 5 strip persoi-is are at them. And I 6 that becai-ir@o tlic@,n it would b@,-in(j re@tl:Lty to the qLi o n 7 if, -'Lndeed, the rogjot.-I cc-Lii i.t-- owi-i nnd 8 there are p2-e--ious few of th--i-n, wait li.be.-ty is this in the 9 final aiialys4ls? 10 Do@s someone have inforr@iation? Ed, do 11 'You h@%ic-. 0, 4 t, ? 12 Did rou @,12. tlic-., @le .1 13 DR. 1 4of v,,,- would kcir@p wo- 15 kr@-ci? available! h--r,- to acs4.s@f-- the 16 At t-j'_n-,o tht-,@.-- decision i,.7as made to i-n 17 this dirc-ctiol.,i., @,,C-! oi-it rer-uesl--s to 55 18 diflr(-,.rent e@:n-,irts in tlic- field w(@, felt could bc- of use in t)-i5 1 9activity. I don't e.,.ac'i:!-y how iiizr.nl, rcLpor,@dc-C-., y,@@t, l@u,'- 20 a of 50 21 v..,ho could b--- used by the th-c- p-@,-,ess I wotild li)re to address @his issue of tl-i@- 22 23 a Ir,0170 since il@, tY,-e ct),'k--,joct upon .,ih3.ch the coffee 24 br@,cL",@ w,-&r, taken.' Ijt-. is of tl-.c coffee b,-rO. @-k rkce-Fe(lefal Repottefs, Inc. 251 Has tal,,en during th,@@ Ir.,d.,,ic-y d-i.f;cuss).on. I assume that a 70 1 blr.,ddr-:r bcc-Elr, is to-O. 2 The issil-a of who does the tcr-hniCZ41 i3 Ol-,e 3 that has L@c,-@n of Fnajor concern. The point tl,@at Dr. 4 just raised about the nu,-,,bar of ccnsultOrts was the reason that 5 prompted us to insist upon there bc@ing pcoi-)le frc!,a outo-i-ei@- 6 the region. Bc^ause if you can 4,Tagine within any or@,a Flip 7 the total nur@@.)cr of consultants that coLild be zivciil,2blc--, and 8 would have the competency to do the kind of review w-e a@-e 9 loo)@ing for is such that they almost undoubtedly will be 10 involved in the projc-cts initially. 11 - DR. l@5P@YER: Or if they aren't, were c@-icor-,ied al@out 12 it. 13' DR. 'L'hat's Or if t-Yicy not, it 14 is bec@-use they a-.re from -nol@-ho),- i,,ed4-cal school and have 15 the scratch-c@.ch-ot,'.z-c-rls-]:)ack z,.pl?---oach. about was 16 So %.@h@:,.t we were concern g to 1 7assure there will not be a casual or cavalier ci-)rroacil to tl-i.-@ 181 technical rev3.c;.,v7. So the decision was made to upon 1 9t-Tiree people from outside the region. 20 Noi-i, it is impossible for us to keel? tip with who 21 might qualify on a Yr@on+.!-i'Ly be-,,,is or semiannual basis. And th4---, 22 was the reason why there was the freedom for the region to co-xa 23 to us and sciy, "I.!ay we constitute-! our review committee from 24 sorr,,@o@ne ot--",,or than those on l,otir @,st?" Ace-Federal Reporters, Inc. 25 To date, the regions that have called in and said, 71 fly havc. not-. i?rOPOs""71 2 rn g 0 t 'I -0 C),,,,' Tlle cr4 toria vje wov,,.Io is tllFt it 3 if 4 ba -,omeone Nqho has in the ar,@ -C 5 it x,.,Ould be a Pcdiatric nephr-ology -L-YT@le Of Ol-e 6 dealing wi,th children orL].Y, ): lqOu.Ld L-,e 'v'CrY distr,--sEC-d --f 7 technical review were done only by treating adults 8 only bc-caLiEe the px,-ob2.eyr.,.3 of children with k4,dney disease are 9 diffcArc--.-,-4t those of Courts with renal So do 101 have the righ4@- to say that this i5 not on adequate revi--,.4 12 1IC, also leave z,@ddcd i-,Iic 13' be to iia@L-ioria.L -Lc@@;,:!I, be fo.-- 14 perusal ei4--her by tia.4.s group o@- advisory cov"nc4@l or by staff. i limit aga4 I This will tend to @n peop';..e gi%ring a very 15 16 I @,ioiilcl thin@.. ilrid it is coi-iceivabl Eo.-ca pcio-olo 17 but z?,gain the nurc,..ber of co,.Eul-tants I-)cing, %s T 18 said, in the 50 to 70 rz,,ncj,@, the number of potontiEtL 19 being in a posr,-&bly if each reg4-on had 20 appli-ca--.ion:n, irL, again I .,joul(-' Y@c, su-):priccd if 21 is potential applicant f.7@-om A would gross ovc-,-,: a poor 22 ap ti.on of Region B bec,-,usc@ Yte in tu--r, is going to 1-@)O .pl--A-ca 23 submitting cai applic:at4-cn the line. So I thin'@- g activitv. 24 it @"ill be Of a POlicili Ace-Federal lcpoitets, Iric. 25 Of the rex;,icw.,; that come in so far since the 72 1 @-io,-d began to 1-c@ o,.,,t. r-)f @@;hc@ I W,.IS i..n 2 minutes last Poland of so- of -t v,@is goiii@-4 to 3 occur -- I ha%re been that li@,@,d 4 started lo,--ally and -"Iicy were People N@iithin the region, 5 there have bc.-en soT'Vle rLi.-,.irly gr@Avc! cue-stionE, rai.Eed about 6 ad@aquacy o@'- of @.c- that have come :Ln by reo,?I,e 7 i@7ithin the area sinc@- ),.no-,@7 is going to. be a written 8 revieiq. 9 The staf'L role in preparing that cor,,--- 10 to you o,- to tile counc.i-'- be to a,.@surs- th@t tl-ie-@c., ,has bcen not sz--y k,-@ftcther the Stay is ric-1. 12 O" 13 In the various o,-' tl-ie @bcuma.--it wc-@t 14, out, that particular E-:O;-Itenca lo,-r-t out under staff 151 Bu,,- in ti@o of Ic-li appl4c@tionE,, tl-.-at arc goirc,- e 16 to be discussed this Y;.-.orn",ng, @.c loca.1 rec,---.@Tit;.ended in t--h,,@ apl).-I.icFztion, the RI.,!P d4d not 17 .1 - 18 lic-@-d those and fo@,,,@iarded the applicaL-io.-i 19 It j,s our t-.ha-L tt-tc,,se be d4-s@.pp--oved. 20 Wd sc,-- our i:cle as bc-ir.-g a N,7,itch.Ciog to aFE:u,-e flat 21 the I.>rccc-ss h,@,,r, gonc, ori a:3 d(-@fii@cd. DR. I,,'AYEI@: Yo@z a--e go--;i-ig L-.o fc,3-31 free to o-,ilv 22 1 d 0-Ti 23 On P"'Ocesc-, net 24 DR. Contcnt i.f it is cli-spara-@ from the Ace-Fedeial Repoiters, Inc. national priority. Tlij.s iE; one oth,-)- arL-.@i, tharil@- you, that 1 25 h@.cl fc)rgo'-I.'Nn tc) bcgi,.i,ning of 2I have lost rci,,, copy her(@ on the page, @,e sentence 3iind(,,,..r' C-LirrC@rLt RI@',@PS ki(7,,Y,.ey it 4sort of casualllr refers to o@ p nel o'L regional authorities. 5We have t@,,,o plans, and we doxilt know %,.,Iii.ch is going to h@,v,@- 6to go into effect b--cause there are changing decisions. 71 Kidlicy is no dif'-crent frori the other IU.IP 81 A,-- one time,, x.ie were as),@,@ci to si.,JDmit scene recoiT@-a3ndations for 9c.@xpansi.on of Jcidnev aci--4i.@,ities . If -Lhis, was to occurs part of Id requ4-re the consL@.itu@@.'A.on of a formal adviso,,7y 10 this @,iou I Ii,group a-dv.i-@,oL-y to Dr. on kicLicy disec@@,.7,e N@.,hicli iqoii-l-d 12 tc> re p r i 0 t i, .13 that does occur, we w.14.11 a gro,@-p of 14 authorities to corra in and si:@cfcl!.ast priczities to look a'.- how 15 well the regionalization of is occi,,--cr4-rg 16 that ,;.s l@,.-iit -r. 7@-rid 17@ their finOin@-F, he to $the region so they 181 thcm, the P-,@IG cliai.%nnz,-ii and th,3 -consult@.-,it Lhis !;-St of i so th@,, go into e. region tl@,,Ly N-ii-11 hovc-, 19 so,@Tis-i@-hing to judge by. 20i 21 In tu@n, then it Icre, if staff .1co'@s end sees if i-.seeras to I)e the thi.F; @@7ould I)-- 22 L- @ I of the o--casions wc- i,.Toiii.d bring i,'- to -,rour attention and the 23 7idvisory Couiicil.'s It doc,,s not to fit into 24 /Ace-Fedc,@rEit Rc-poiters, Inc. the nc,,cds as dc!teriiii_rclcl by thin c)iztsi(I-e groul.) of e.,,tperts. So 251 74 we il!oul-.d in -chain coi'!,"(2xtr op 2 DTZ. rr,,O 01-10 MOI-cs, all@-I -T- @'@ill 3 AyLd thrt is the -.nd -Lhis i.,@ ai% i---sua I was 4 to gat out but do4-ng it br-,fc@rL, tlic-., bi:eok, let's see if 5 c,-,.n do it b-@ttc-- afte,@@:, eboLiL- -',---he ',-s@-ue- of rc--gionali-z;--@tion 6 7 one cf the tli; gs I co@,nrvenl@,'.ed on is -,-t cood recyioii 8 that is goi..,-Ig -chl-ough thrt process or a poor regi,o,.l tlia-L, 9 isn't and a k4.C-ir.--y prograia that is. And wy p:coblc--,m i-c, Alto is 10I tl,.Pt proceeds? Iii oi:l-.er word!,i, you 11 can heard coi,-,,@ztei-Lce in the iqorld across 12 one-,, ai:o- no'-- -"i-t a 13 14, NOV7r I guess I ncr-@d to hr-tve -t feel for i.,,ho .4.s looki-1.1c; 15 at threat. kid if 1 @,m not oi-7.t to samp'Le that and if 4:Ji---t 16 i s v@ p t of -,@-he of '#--h3.r, 171 has go-'-- -L--lo b-,! o-,it there t@ E@bo-al@- -chat issiLic. Or i-.s il@- 181 z,, of ;.-oviev;? Who has tha4L-. ros,;)onsi- 191 bili 20 T'I'ic, bc@.-,i(- rc!-.Ponsibility for 21 tion rc,-ts in li@-,,.ndq o@ -Tio,.ial Advisory ctroui:y -,i-i 22 each 1,@c Scale 01.11- staff :Cole, T,.AY staff sees its rol@e, 23 hr@rc@- It@-.o a-gain bQ.1-iiii(I T@,3 you the):c the 241 reg-ula-- rovic@@,7 7 process, w)i.ich Ace-Fedei@it Reportcrs, Inc 2 'C.0 loc)l,, issues of 5 90@-s on -y sti r B u -kf f ac 2 iy,, loc.,ki f,-v point in time cve--y 3 4 in vcc,,-Iss to a kiC@i,.,-,y floi-,, 5 to wat---hdog the 6 and again bririg it to 'che z@tL@ention of rev'ic@,7 7 corLro@itte and co,@ncil if it is not followed, 8 DR. 1,9@,YER: Sc) is ti@ia-Ic of t(--chnical revie@q or 9 is that pa.--t-.o f staff effort? In otlier ii6rds, I feel free 10 to cofLTPent abomt the reqionctl @,dvisory gronp locally in te:clrs I Iof how err-- they fvnctionj'-ng iii teLT@,.s of 12 13 I I -;@i i s i,@, that the @-@3 14 is a possi-bS.Iiiy t)),at tlie:L,t-- is go.:)d in !-.ichiev 15 bad regional.izetio,.i IC.,IP. I wait to is loo,ciiig at 16 17 DR. I am gcing to bring an cyp@ic.,plL- Of 18 to you vilicn i@,,e get into tlle E-,CCi:[,4C E),@ppliCp,-Lion@ beCaU,.S;e 19 have a region in k4h3..ch tl-,c,, kir,',-Pcy program j.-, b,@ccy,,iing 4 :,.rd to fi-.nl.,--h the p@-oc-,ess. !,lid 20 reglOila 21 it 4-s not tl)e I:U,.IP a A-rid .@ie ar@,- that to you foy-- adv@i@.ce @ii,ld coni.,Ten4t--s, t-l-iis 22 i - 231 DR. llolle O.K. 0 24 DR. P2%11@L: Bill, Ic-ilt-I Tiia try ci stateroeiit. T. Ace-Fedefal Repoiter,s, C. this will be a continuing staff co:i--crn becuuse it is one of 7 6 I bac,,.4c -3 0- l@'-S j,.5: tc,-) I)rorro-c-. 2 for 3 the local RMP, bu,c. -'t:-Iiis @,@ould. b,- a tli@t -@-La'A"f wol)-I,,l 4 !co],-ling ac, aid comc@:3 ui-Ldcr tlilc,% point of if the-,, F)i-)-ector, 5 has a apart from the I-ec-hnical of projac-.-, 6 it comes to this corc@iittee or if anyone (>n this 7 such a concern. So I don't thir@',@ if-, is @@-nl-loiiited i-o 8 ju,-lt staff. But certainly it @e@,ould be a --esponsibil-ity of 9 c;tv,,ff to at tj,.-'Ls and iiifori-i;,-%-ion to thic@ 10 DR. 1,L7V.ZER: Bill, yot,@ had a cc;,T@-a@nt? 11 DR. Le-c.'s tizlze a vr-,r-y spcci-4'.4.c- exarr,.?Ie, 12 o4nc-,. you on Ard -13 Va..I@l@y. Going back to Bill Tia,,,er's qv 1 4 estion, that 1 5tion 1,@as not by the RAG. There are good fac.i.lit4-ct-i 1 6across tlze st--eect froya each don'-, need 4;o bo 1 71,7ho does have the responsib.;.].".t-,17 fo-- lc4o)@ii-ig a.-c -'%-.Iic! 18, Vallc@.y? Is that E@upp@se-d to b,@ the RIIG? P"id if sot 19@ do--sn't N.,,ork. 20 That is Bill is really asking in a iqay. DR. IIARC-U.Ch!ES: T-h,-s is a very key quc-@stioi-i. It 21 22 iiivolvc-s the %.ihole cl),ancTc- in @3tructtirl-, 23 one of the thii,,cTei th@it @.ie lia%ro done in the process o@ changing 24 -1-h-a revic@,,? c@ cle f,--op, four to thr--a is free a Ace -Federal Reporters. Inc. 25 1 considerable amount of staff timo froi-a ilic pro@,,,@SCIY z:ind 7 n 2 The -L-o'yo,,ir is is V.I'l 3 respoi-isib4.1-iA,--y of to e). joeii,d 4 unon technical renologi-s-l@:s to do. I it, is quite clear 5 a man can loole. @.t oz no,'@L- r 6 can. be done effectiN7ely, 7ind he rii,,-,y try hi.s best to be 7 regional irt.-'Lr.6--d E.-nd i-,i@,y nr-,,c. bc-,, 8 The rc;.@rt of it no'$-- for tl-@e iio,-rLent 9 call ted-in,-ca.L but call reg.4.onali,zation revienq, is lo,@ I 0:r:ometi-4ing wci, ch siv..f f Tlic,,% x-ii-11 b-. in 11 @--E,@gion tl,.c-i apl.).I.2'.Cation ip, in, it is in. @rd 12 .13 d-oiie -.n L!17,L-- 14 DR. ir, the role the cor,-T-iittee p"-;@:,ys'? 15 1 we Zile b@,cl@ to question oi@e moa-e t4-rt,.e. 16 DI). reVie@,7. 17 DR. d rcvi-c-@,@i as you have 18 lust defii-i,-@d it. clo I succ- i,,Tiiat role them I I,,Iay tho"e 19 Plays i@L it C 20 DII. kIlilIG13L.'.r:.S: Yot),, 11-Iiicij, ;j ago 21 N-Ivs sO,@L-:3 mention made of Pnd I i-iou).d li-1,Ie to 22 rec@pond. cin- -chat b-,catise i-liot is onto of _-er-.sons we @.re 23 the of i.,Tom@-in oi-i i:ho. review co.@Tlitteo,. so N@,,e 24 -vion It ):>c- too (Ir@ Ace - Fedefal Pepotters, Inc. That real.ly isn't a very good N-joi.-d you iisecl bc-f,-)re, 25 78 DR. yol@ u C., d r, n . T, I z,. 2gocs either sax. 3 DR. I.IPRGtf--.II;S. 4little better. 5 (Laughtey.-.) 6 There iz no evadii@,g the f act flat wh(,,i-i you are 7 running aprogl-am as we cre which is dealing 95 percent of tl-lin- 8@ and. the Cray in %-7hiclji @ey 9fun action. that you cz,,nriot @@t tire c;@@ p tim,@- u@e th(@, s 10 on wl.'I@it is I Project l-,j..n@l of activity. 11 1,7-@ncl there is l@ittle doul:)'--- bti-'%-- th,@t the rovici@,,, committee, srole 12 0.0-,s ric),L-1 liz-zvc- P@.,ad the- it e @cl- a:L o-s v.,- 14 and c-)-ttcnAc.--on N.,@1),icli i,'L, cji-.v--s to 15 Medical Progrzns. Zind i,7c-, leave b(@,,:--n say@.,rg tl,.at iiow fo;r 16t 17 @%lhz,,t we a,.-e you to do is to look ztt the 18 of the Medi.cal Ig but not asll yours,,-Ives to be techn5.cal rcvici@ people and not: ask to I)c- fi,;cz,.l in 20 21 viha@-- t-l-ic actual bL%dg,-atz,, Ic-.,val be. 22 DR. 1.2.-.YI.7,R: l,c:,oni)-d, S Clt II I-a, T S -. 23 T) R. I cjuc@ss having --to,@-tc,.d the p@oblera 24 thi@, @'ar as trip, of- cin,@,.ul-@.@,nts, I V-0-Lil-d to Ace-Fedcral Pepoftets, Inc. 25 pursue that further. 7 to Y'Oup Dr. 2sce no rca@:cri 'o@ 3 rry, i yc-u h@znd him one? 4 DIZ. SCliEIU-,IS: to yo,.,,r to 5 @l-hy the regioii-O should Select-. -chci4-r oi@ii consulti@l-LL-.s, I ce@illlt-- 6 reality di,--cc-.:cn tj-ie you made. Tho. rt-are tha@,'@- tb,@, 7 IJI-sl@-s tILey eli@ii-Lge loci,-,Ily ar; wi?ll. ILatic,,nally. Slid 81 x,.,ould th--i.i).!-, if a @-,c@c,qnical review is ii-ideed to co;-,ie to t@r, 9@iith all of ill--s finality, as we have bxl-en told, that I would I 0-iivch prefer t@oal-- the technical review be done by consulterit-s 11 N,711 r"re selec@tc@,d I ly 12 1 s-a@ 11'10 ciri the, .13 on if 1 4 1 5Faly at all? I II o IC!,. e r w od r;, i t g. a C, s f r o m h ct. o t ho. 1 6A-fi.,,r,-Ic;o@y cclu-ici-lf is it that x,.-e h,,;,ve rLil-Adc-. sono 17 upon it or do Fire sort f i.g.-nol-e c-@ fact tlic-@re is a 18, 19 The po.4.n"-- I art-I goir,@9' to ic, if @,;c. leave zny 20i on thir,, I fi,rcl it iXpo,.3 4ble to )-.q al,@ e 2 1 uch acti-rn the,., Ekye ix,.(I@ed @PT.;oW,'-nted f -Cm 22 tire. national of ice and riot lo,-ally. I %,70uld 23 -chat poin,-- P,,i-,--sucd 41,n sorn detail, I have Father strong 24 feelings @.bout it, mine! I -v?oul.(I, life to c:!i-chv,,r hz,@,-ve. th(,@iii f@ce-Fed.Lial Rcporters, Inc. 25 by your co=.,Icn@-s or cc@r,@,y it -#-curt,her to in aclci-a-t by tlio- so s 21 i:,o is an tistc,,,ncy in 1,;h@'- 4 5 heard. @,@out for the loc@tl Pc@01?10 to E-elc'ct 6technical @.eview locally and ya.- have them approve SOT.-- ow 7@t natiol@l@l. Thc-,re constraints to he Placrd 8on Th--rc are fe@i people to be 9called "pDn, Th(@y to be e>cpert, would not c.,nly 10 in -',--h(-- of but aloo 11 -),-U:Ll@y a-'C. also P,-gionzil Iiedi.cal 12 sitc- vl,-si,-Lci@---@ 131 o -'co 0, SiTnplo- 14 technical @-sp,,Bcts of tIl.e rcnal 15 Lnd i--hc-- rol-.,.cy )-,,i mc,,2:c 16 to ric if-. rogiolis could fo-" to 'r-,z 17 p2.@@@cc-d oil i,. v-,anel and tILus the pc,.nel 1811 bv if yot,. like, 'Lrorp, regions of th@-"!7 19 i@.?oul.d to their the tcchniczy.1- 20 picked nationally ai,,cl. s,.jrit -Lo zt reg@.or,.. This @,,Tctild !De zi po),3.cy, a',-, P-nd -vro-ti)-d rci@jc--t them clesi:ccri z,@ s 21 2 2I have heard them 23 Pnd I belie@Fe @s lierc@, it i.,; incL-rici.rtor-t 0 24. rA-t sortl.,.@ poi-nt. . So 1for Ace-Fedr,-tal i@epoiters, itic 251 Agz,,in, 1 V70uld, li)fe romr-,body to to the I I I)Y 1f-,econd 2,since kidney posais are K@-viowed 3le-,rel," axid finally, "Kich-ic-@y s ":,.el l@)Y 4r,,I.Ips ill relation to natio,--ial 7ziid I N,70uld lil@e to 5kro@,., by whorit th,7-t is to b-@ d,,,,ia. 6 DR. l@A-NYE.R: Tt-io issiAes. @-tls the 7of the selection of the 8 I crucs,,- the conc@-.jn-i I rm I-,sar3.ng iE-, a corr--,-ra 9tl-.at is expressed on the of the 10 so to Sp--akt if the selection is iiade by individual group. 11 -1 ani no+- sure 1-io@q i-rLuch ciierclr is involved in settipg 15,P 12 of dic o@, 4 Cl., a . I't a@ and 14 seeirL to re that tl7iat is not too g::,@at a process, @,,-id it 15 teJ',cs away I am not say,@-iLg i,t will o,-- i-iill 16 it -- at least it Away i-@h@t is 17 going -,o be raised by pcopl.-c, I tli4-i-ilz, about 18 this area. 19 DR. th tlizxt if 4-s 2 C) Dr. -tia3-g-,ilic@@' decision. It v;oul.(7i not be @i rvt,-ijo-,-- to d-) 21 v.,hai-- Dr. Scl-tynidt sugoestud, 22 DR. I-'j.ARGULIES: I tl-iiiil-. this is zi very iriterc@L-@,tiylg and reasonF2)-33,.(-, idea. Ai,.d if i-t cypresses @.ihit the re-,iiew 23 0 d, PrO-:r-E!r, we certainly b):"Ln-g i-';iat 24 cOr,-Ynittee wOul Ace-Fc,defat Repofter@, Inc. 25 tion to the council and di-scu!7,s it with thepi. I don I t scc- it 82 ts YOIlr- F, to C) Iran d I @l 't 2 a@e 3 4 f 5 E,,o ha@rc,. @ri opinion rendered by 6 Coancil or,. thokl- quc-'@ for us to do the@t. 7 B@-caur3c-, T @7jo-old 1-11,1@,r@, -"--o qiic!,,;tion that sp@c-,.-- 8 point to tlia lac-@"I-- tlxa4-- po-lit is oi-ic manifc,-is;-_a- 9 -?c,.4-on of c4 iL,licYt q'oa w,-- should bo I 0N-7,4-th .P,.nd th&4-- is along the lire w-. h@.-.@ye got to 11 pt-, o--F- r-@Z@.G and local! revi,-,w zird 2 of- a 4-1 .rz n c ; cj u @r o -.,i 14 you @-b.-n4-t h,-@s P.FTG 1-ha-'%- Le-ids to reprove 15 -I.Lrg-c-r decision, aboli-L- 16 iii the but the .lord -ik 1--h@t 17 "cmascula-,-;On"ss ve-Y is being from aci-i-vitics. 7--nd I 18 19 @,7hr-,thor anyIDo,,-@,y is it 20 n@.Melcio-,, face).css 1.)c!oplo vl@ho c@,@-c cal.led vague.I 21 Mz@,ybe vie ought to dispose of thaws qucstioxi f.4.rsl--f 22 d then get to the largCr qUeSt4on tl-iat I tliint'. is (.I ILc-n ,an 23 vcll ry 14-.nipo@tant part of @.t. 24 DR. I,,IAYER: Viould sc@itteone cz:irc! to a riotio@l Ace -Fedrral r%epo,,ters, Inc. 25 relativ-e to -- I gather the key issucs are that the e>,@pl-rts 8 3 the 2lcvcl be salecteci y tire 3is that the es:@lence of it? 4 DR. SCHT@PI,!S: YCE;. 5 N..,ould tha'(- -@t(3m 2 or, pz,@,ge 3 be altered as 6follo@ls: 7 )?.i.-cl:),--bly it is 8to Cou,,ic."@l, th@it ax:-,,, 9 DP,. SCFEll,'r.!S.- Ye-q, to Cooy4cil bl-, alv-_ered @-ks 10 That the technic@.1 revic@w mi@c--L I-),@ cc)mpr.@-@,-,Cd of a-',- 11 thc- geo(@x-ei)hic are-c- 12 se-,-,vad b-,,r t'Lle. -'co 131 r@', P,13 . 14i 1-@ thc@@.t-c- -t zE-,corid, li-o -Lhzit? 15 DR. TIIUP,1'2i.114: DR. l@,YEr-,: 1 6 c v. s 17 181 All those in 'Lavor? 1 9 (Cho@uo of Lyos.) 2 0 0 2 1 (No 22 O.K. 23 DR. At tlic-,, of being child 24 coul-d T ask to say o,ic our Ace-Fedeial Repo@teis, Iric. 25 ):espon,.ibility is. Becac,.se I (lidn't catch it @,.,hen it by. 8 4 thil@ s i,,,i c i t a ):C-v .Itioll i'lli@L. 3 tcr-linica.-'L it Y01:1 the is 4 a ki@-i'@ly hFi!; --es @,,Thich daE-c-, 4b d or. 5 i-hcAt it Y'-F ii,- 6 in the wry tlia4l- Dr. H41-ni-@.lan laid thoyi okii: and wl-.ic2l go to t-o liE,,v,-- a national c, '14 c 7 8 ne-%;iork of kieney dialysis if all the tc-chrica-1 9 requiren, al"e icet Build the P,@gioxial. ic, a b,@-i).g Ico your t-he! f 101 gooc'@, sojnd rx7og, I thz,,t the aspects Fire, here rc@ally 12 iLn Badly I C)."l 1 3 o-- c n 14 tlic@-re is a ch@@2. oh is E),@oi:kglit up zt a-ny p- oint iii this 15 r@,-icje. of -'L-4LI*n YOU do co,-"t!2 ill-'%--o act--ion. DR. by this 16 17 18 DR. I 9 0 x c c- o r, . is i.rt t.,Iio 20 R. -,ci---7-ically states O- ii. &, c@ D I t L.@ p L-. g,@ I,;' it is 4 f c): @,!Illj.ch trip, I'@7@Gp CL-ILP 21 22 Or in(fil-c@,.tcid a 23 merit@-s of the t-he 24 P,"@PS \,fill be z,@@s3@ed to a. Ace-Fedetat RcV)ottf,[s, Inc. 251 So since -echni.cal if; rLoL'. clearly de f4ned, I would 1 very el,-,fi.nitions- of ,-hot: t--c-@,zm c 2as f @ir Eis -in 31 DR. I.,c, %@ioule). ttiir,-k probably 4 to d. b@-itrz-, one foi:i-i of 5 or. arcitlic-)f i-s biatt(@r, but yoli cortfi.nly want to get 0into ti-tc.@ of whc-t-l-iE!,r- wl-lat ic- be@-.ng prcposcd is going 7to the rec,ion@,11 81 DR. 112,YER: Jerry. DR,, BTSSON: PerliF,..ps, thc.,Yi, if we d.4',@r.,@osed of ieiat, 91 10 @..le cz@.n ce-L- to i-l-ic larc 7c@r quc,-stio,-,i of Z',Pd it is 11 PI-,.i,l, that at oii-- 1)):Calrf I used practically @,,e 12 ;Iunct.-c-.YN, of 3 C-L) T. Su-Is,,; 14 of this carimit"--c!c that oul- thoughts are not too Lear aparf@-, 15 I i,,-oulci like- to if this is 16 appr--Priz@to ti.ro,-cA. 1 7 DR. l@-17@YER: Could I sligge!%t, Jerry Alat thl--, 3 181 a major, broad issue wh.'.ch I thinl,. is going to load, 19 should lead, to half wi licur or nio@c, of discussion. 20 1 wo-a'Ld li,ke I-o dc) is tc,, fl.c)-g it, sac-- h@@,, i.-7e are c an 21 in of tii-re, in t,@,r of our go@i.1s, d i@l-i@,n c@@,:a 22 back to itt if I cciild. 23 DR. DESSOIVI: Srrc,, 24 DR. I-,,'P@YE R: To c,,,ct @i very re,-tl red @2,ag on the agenda Ace Fedcral, Repotteis, Inc. 25 to de I @,7j,th it. ]3ecaLi.,,,-a I tlillnl-l it is an irtport-.ant isf-,Ile. 8 G yoj 2 and I Jeff. 3 in that are 4 concernG, and 1 think th-@,y or@ght, to 5 on @:cnal 6 D Schriid-@ l').c4d raif7.c-Ck anothc-.-..- 7 that @.-;a@i d c@@ pecrc, I.,, -cl-,,e r-coc,-id 8 P@lid i@t v,,arj refcrriiig o t)ie@ fact thz@@- o--h,@ir of 9 the axe F@,c a who)i.e, send considered. 10 fn o@,-.hcr -tiry cne of tho,- on-0-5 o,.rc 1 1 1 -here a-@ a who]-c- , bu-k-- thc, is C, c- u 12 th,,)sc-; 13 to 14 Th@; ,sectc,@.id to tl-i@ 15 to prcvant hE,.-,.vii-ig z@n is technically 16 in bv a but docs lici-@ goal- ol t-he co@ntry 17, 1 19 c.-,-- c-, s 20 it I,.'OtllCl !7Cein Ic-lic regions tho.@il-- r3.o not 1 21 these., -Proud Ei prio)-i-ty th@n a 22 fo)-- in v. that al.rc@,@@dy lir@zs 23 ir, y bc-., v(--ry l@ut i,'- is one c@f Iclic, 1--hp-t are r 24 c,,p-@ (-, of Ace-Fedefal Repoftets, irc. 25 list. Until %,.,e the Nii.th fzic4-litic-, 87 t Ifor el p 2 3 -C T 5 o,-i page-, 3 @,t t-_i) eys 6 review conurittee and 7 the.,-% them Rn.G ijyid -'c-l-ion the,:@ C"IIP 1-Yould there be aiiy in th- lvjillo@y,@rtil of tl-,a 8 9 Apsociz@.t-'-oii in i-,.ake cG'ml',',CTlt on I 0t-I ci-r- rE,.i-tc@loq,!iEts i:,e@c,- ii-i .0-ical p 12 @14 inl)t 3 1 47@md this b-o by p7.@c-b@,,,blyc I don't kno7i, 15 DR. S 4 the propo2als 1 6t r 1.@ould fit 17 intc--i-.@,)- iii eleti.--nt :Ls 14 C C- 18 o-,-.h,-r gro@ips would 1 p 19 fc-cl th,,!y -'L-h@, r-i.g"zt to if it is 20 gi%re.-I to a Pz!rt- O-.Lc 1,13dic@.1 Sociok--y group. t j@ J(,ISDI@@T- @.7ould li)@c --Lo -@ha 21 22 all the ch--ld2:er,. %@'ould ),)ct tl-i,@- sz).nc-, just-, by 23 P@ut is truly riot 4 DR. TTIUR.17il@: Thz;,., 2 .41ty arc, rxo,,L-. Ace-Fedeial Reportc@fs, Inc. SISTI-7P, lil"41%1 they are not. 25 2 are DO comTr,@ -.3 3 about ifically. -0 4 DR@ 1,U@.YER: All righ,,--. 5 DR. have 6 applicat4l,ons containing ,-;ome clen,,, o@' involvc,,,o' in 7 them, ci.c-ht of @qhicli ii-i yo'O".-c and ciie i,,h,-ch i.s 81 outside. There are t@-@to i-@yp--s o,@-, tl-ie blue, 9 tab ard E,.L'ter- t,Lc bli-ic 10 Befo@--c thc!- tF-J:), trip% fi.:cst 11 is f 12 -io r c, ci 3 The is a 6ono@- y 141 to procure c d v-@@- vo fK,ci-a e,,t. 2 z 15 from @@-cvcn liospi-t&,3.s ,@i v,h-',r,,th isi @,t 16 to the p@og--a@m@ The appl4.c.@,ti-on 17 18 l@.I.L@w Yor)r. --irt z@In tc) 19 a tr-'L-)--t2gion C"1-0 f c-, nagotialc-i.o-l b,@itw 20 entire areat but e r. k c 21 and. the staff said inOividu,,).! -chc-,y -to gc-t 22 23 The total! reqi-lcrt,4Dd @,7aF, $27,060 for first, 24 year. Thi-, i%,oizld bc u@t-ad to I* . an O@, I Ace-Fedetal Reportet,,, Inc.I 25 tc-ams. I ",Icre WC DR@ I,IPXER-. LC,,t's pp 2 j- .,oing to go 3 at @,is poizil- in tii-r@-? I,-, 4 DR. 5 DP,,: right, I gu@.ss I need to be referred 6 to wh@-I.J-- I,,iiid of ral--criel and viherl-. is it in the iaz-@-cs thai-- I 7 m,--ty be mr-,J@irg to. 8 DR. soi-Li@ coiiuncnts in the 9 Nassau-Suffolk c,,n a N.;hii-,e ,@,hr@,ot, Ibelic@.vc-, not h@-,--i.lig a 10 foldc--. 11 I- - -I They a,le I sc.@e. It :Ls rio@l.it b-nh@.rd tl)e 121 13'1 Dr@. Ccz7,1.d I 14 vi-here wa are? Eass@-,u-St@,-r- -4'o 1 1, w h 4- t c- 31-, 15 Post-ilini SARP 16 DP,. O@- the n--'.nl,, ),.-ogions k-@"C@-,,icy 17 using the geno-i-L)- Dr. la-i-d d-c-,;,n, 18 eight, of @.re for yonr Oiia of them is for 19 your advice 20 is In o@.11in.,-- 21 words my to tl-,c 22 Unfcrt,,lnztely, as I al,-!c) indicated a I-Lttl.-- cerlicir, 23 SODIC OJ'-- th-.,se dii@@i.i@ig tlii-s %.,Oak so 24 t@La't-- the supporting is riot C-,).t Ace-FeOeral Repofteit,, Inc. 25 d(---,ircLblc@ either by my staff or by the reNr3.cw cc)t,,mitteL-. I\Te th, ti I. T would 2 she b@, ti-,bc.: ui-@d 3by th@- clf-! tha,- Ere ee,,@iio" tO to you lia,@Fe 5today. 6 This p@,,,)--t of the rc,,n,-,l proctircir@l-nt progro@,,i 7 d locv.1),y by IC,.,.G. Th-- s-L-aff had been reviewc 8revi@o@i consumed in the said iE,, 9of -@Lis part -,nf the 1 0 The second part of the home- 't@--ainii,@,-j p:co-@,r@ra, t:L-Lc,@ rt;,-,,t,-,d s t o C c., c,, p 5 0 v i d c, c, 1 2 :E-c, .13 at of riot-, L7"-: r,.i to be a@,@z:,ne of thct fact i-h@,.t 141 15 training y 16 suc:cced:Ll@t -,-i do-rig thic c@-u4-cc@, @qell, Thev v7erc rcq estilig u 17 $31,200 for th@i--@, c@,d he i 18 and lot funded @idv4.c,-e bz,.ck to th,- region 4 ,nt@ 19 Zurich, in 'lly, 1-1 gi@N,exl to t-ll(-@ nearly a ad 20 vcar bcfo,,-,e, that in hc>i@,o 21 indi..v4-ej,,,.. is w'L--,o holy., to do -i.t @.iLd aCivic.,@ to thc@in z@s to how 22 to go 3bo-Lit it, ai-id they to have ignored this. DP,. B'2c'SOII: C 1 i a ri r@ r- c@@ @-i e n g t o b c t I Iz n 2 3 2 4about '&,ese iiidividi-,al3.y o-,;- are wo t-,ce-Fedr-,tat Repottets, Inc. 25 flow? p C) C) nine kidney 2q u,-- n t i- a 1. ly i r., an E, v f z@ 3proposals that a-@e in cycl@ 4 DR. BE.13SON.- l,jill O,,c@y ))a of 5 revic-.w? 6 D R H'-F N M PJ@l f o r b n c, i,!p ahead tLrLg t@l'i fOr 7of t@ir@qo is so vjlien yati 0,4 d gc,,@ to 8 Yo" x,7o-Lld al2:ocdy be O:r wllz@.@ I 9on it. 10 DR. DESSOli: Thoy be a little b4@t YL-to.@-- e i n Dr. bu-- I fi.nd i-.yczc-,If iio-'c 12 2, i r,- i I I C, t 0 t y 0, 1) it i,.@ c,@ut o-i@ .13 i7it-.h i,,iat ouw- i-r i.@h,@,-cb i,-@ -1-@ loc3l,@ 14 areas in th-- cont@.e,-@t of c-@Fo.Ln -It,-4-nct that ic-. li@i@pen4-ng h,@" c- But 1 jiist Noiq, maybe th@t is iry cx,in 151 16 rrLcn-t'--4.o.-i that. If this -'-Is Uic proc-@-iCu.re -c-r).at is going to be 17 181 DR, 14,iiz,,,Lc,.@vp-i.- IFou all %,;zuii;. I hand no 19 vested intereit. 20 DR. DESSON: I v@,ould rather loo3,, v.41- 21 in so @,7e @,iotil,d what is 22 'DR. THAYER: Yes, Mac. 23 DR. SCHK.IIDT: I that-. c@,.rtraL@ed 24 does. I rup is as castva'k-cd poi--t Jei-ry and A,.e - FedL@tat Repor tefs, Inc. 25 be I.oo),.cd at as we look -@t the regions, 92 DI,. I-IAYEl@; O.Y,. Is them. c- of thc- 2 3 4the qcic-sl-iozi is iAc- thz,,t a.2:c-i doiiicj at thi-F, point in 5timo 6 DR. H I l@l I B-cfo--e I the cl-iai-- 7 8 -- riiy staff assures ma these items I distr4-b-Lited 9 during the bre@t", @qere 4,-o the 10 0--i,-- of 1-@hzri is a dc-atcd rc--):)iuary 25, 1972, and is the 11 -guiec@'d@-irs-s fo2: the-, E,'L,,IS that Dr. Scher,]-i@ ol-. Dr. 1 2 14 -Iat@.d ilarch 13, one dated March Ilz,, and one dated 7, that N,7c,3:e Sent-. out coiic--;,rniiig the 15i 1 6devel.opmec!nt just Tuc!sday 1 7Th;,,.t -7,-s @.iliy of yoLi p,@c@b.@ly did not ro.(.-.cjve it. 1,@a 19 DR. l@'IYER: I i-ioul.d bc! dcligh@@L-c-d -co tall-. to 20 your s-@aff is who has (jo-i-- 21 22 -DR. Beli,eve ipe, as confusing as tliii-igs 23 have been, I cm..,,.not be Certain. That is Njhy I gave t-.1-ieyri to you. 24 Ace-Federa[Reportr-is,lrlc. DR. P70-IL.- Wc)..I, i-7c,- on the if 25 1 the riCt or 2 A@iici all N.,- cEtn plead is it-1hi,-L i-l- has 3 Bv-t if you rccz@i,v@-d it, it: is really 4inc>-cusable. So @qe do 5 DR. Mi-@YER: 04k-her ite-iri--f I.Ic!rbe rc@ed t-o be 6 ,I--o the: attenl"-ioii? 7 DR. P@,!L: I thinlz the ci-ily one front Dr. 8i@ia-guj.4-es I-..Iantc.,d are to rcnt.i.oii %ihich is a -@-e@-y 9is &.n has rc@.ude @-he tiir,-n -,L-hat lo YOU lasL. meet-. Lrd this 7,@nd -icj -Lh@,t. Jr;dv S 11 -is t'ie Dapi@ty D,.:rcct.(Nr of tho s wo :-i D-4.vi@-Lon of C)r--arat-'o,. 12 tl-ie 01' of- bn-@n yoll,, 14 to m@,ntion thi-s pleasant duty. 15 So lir-Ae Sijsb,--,e c,@,hE-.rtgcd liats z!.ii(I i-s as D@-puty i-xi IL-IILE of tlio@Fe. pasha. 16 171 Ich,-in 18@ DR. Is @,hc to bc- or 19 DR. P2,@'iL: I aIrL,.oFt no-r- -',-o @.sk ha-@, 20 D),@. IV@Y-rR: I no,%--d to ha-\,c. bc-,fo,,.--@ 21 &n OPPOrti,,rii--"Y to on t-.t@@e order in wb.-i.ch ta@.p- 22 bec@-ase of people's prc2@,nca, rbsf-,nce., c@,lt--c. T,,qo iarc-, of relz,@4--e, in if,; @,m 2 3 E71@,.q c 0 24 Etlli c, and tl, at is zind O').,@,io, both SI-4ste,): Ace-Fc-defal Reportets, Inc. 25 and my--elf. I am not go4-ng to b,-- cbl.e to be pi-@cr@crit tcir,@ r@OT.- w@f @ 5 c7ri de 06 9 4 am w 2iii).vr-- thc"" of tai the 3 y 4 s?-ateicent. it ought to be, but isn' t -'.LY linl@ed '@o 5 io. But ?-Ila d4r@cus@ion ought to go on bacli@ to bi7Lc"r,. No-tiloast ol,- 6 -r-hi.r,.k, on those tl.?O. 7 Are th@c-,re, cithor speci,-r-4c p-robic@ms? 8 Johr, l@rale@-iski will be in 9 z@nd Dr. ought to be ii,4. to pick 10 Is crtiy@onc- els(@ N,?i.t-h 11 Phi I? 1 2 DP,, by DR. 14 conflict schr@eijlii-Lg th-@n I p@@-c,,pose 15 to N,7oiild bi to start. o-Lit the of 16 a, i-, s been vis4-t,@-r-1, Nth.@cli I,";hit,-- doos li,-tvc-,, for. 17 r c-, s,@ o n:-, 1 8 Phil., it is al). yours. DR. 1,@,IITE: One is suripOE-.ed neve-- to P",7e@@ace con@i@,.a 1 9 2 0 @,;-'@th an r,.I?ol.o@fy so I sliill not, bti-L I would lil,le, to 21 something to YOL', e"s my presentetioii ma@,, be lcss than sparlzl@@ng, 22 to an experionc,,-- @,.,-hich was sorr,,--@qhat di,,3t):cE.,.,:;j.ng 23 %.;hic.1 hz,.s Ic-@ft- ir@, I t is 24 coivi-ri,,,rit on o,,,@ L"l r hecl I came sysl-c-i,.i perhaps IV@R,PS ro.- y Ace-Fedefal Reportefs, Inc. 25 eventually in'Llu--,-ice. d in 2 Thir, iG @N i,n D,@t-e@04"-f 3@ih\r T WC. 10 4 Ho iqz@,s tc) a local h(.)s@)ital at 4: 30 in the 5 af tor _o c ci o:,. . A.,,- I f t' I clc>c,,- or @,hort'@',,y tk,OreZ, c' as 6 finally put in bed. lie, in the mean,tilna occupic(ft a cor@-""-(3or 7 along a Of othc,.@ c@lderly were also thc-r. 8 r.,Y,3paren-@ly Of oiie sort or ano ow of the ap ., p)-,, 9 im d I iFte in vi 1 0 r cj c- r, C. ysy@--cm 11 of h@ r., expo-rio,-,ices thc@@@-C, he wz,@- -.@)!-on 12 tc-,, t I s s e. I,. Z? 1 o t I 13, c-t; h@ip or e a-!- lie had an v@rge %Aii-ch ps relal-@es to tl- 'L prob.1 c s 14 e 15 have been tal}zing 16 To ny i-,,as r.,o 17 vic@.@'lit" .7 , r--iid no one to ht-@@7e t-.he vutl-,--r4-ty to 18@ i ri el @L c a .1@- Lt. Ol-).e C-OLl)-d bo r,,.,--ocu-rc@c3. So I .town to che 19 )-,-oom C-, )Dci.lig 20 tlic-y @,jo@ild usually he in a closet and prl-,cu,-cd one n-nd 21 to@- it U',f-). V:Z).S a littlc-@ agh@@-tc;t that 22 a white c-actt i@7,-ts cE,.rryii-Ig a u,@ii-iz,,l arc,,and. V?hil,e t@,,p in du-i.ng i,@h.;..ch s a,%,i ve 2 3 2 4 C-' w T),-Or)le, o.,ie-of tl,&-- c@l.c4c.-,.:Iy gcntler.,,- there had. a Ace-Fedeial Repofteis, Inc. 2 5 cz,.):diac arrest. And sudden'% , all Of the dOCt.01,75 vihich %..,e@-C 9 6 'CID 2 thc! got his hez,,rt-. g CT a.(Ye-int x@jl@icl-i Play !7,tooci aroiird ancl d-,.scis@-c-d 3 4 fc,;n 5 Thc- of @!hol,c is that i-t was 6my -@oersonal as Put I 7stood IL-Ili-c@re -Lor a).l tliosc- hours with my I d d 81 not iC,.@nti.fy n-@zyt@c@-If t-&-s a ttm lioi)@f',Il tll&,t@ it 9 if I 1-ia(l. 10 Finally, an sr,.rg;aon di..eL E:L-@-ive o@-,'i the 11 C-2,-Ic, !-I-- is a to exactly de C 4 j@@ 0 - 12 I-T@c, di-d I.I@ -L-(:) 13 4,Lii Flo to 14 1 @.e discuss@,r@ii, them proc,--sa, go,".ng to h-a 15 The r,,oint or I guess, i.3 I hac,.e to 16 sc@e If--Irg:a con'--rLclt---- be@i7,@4-tg cr core c-,ystc@-@,s 17 %@@h-&ch cr-@ha-@ize the cn ',.he 18 h u r@ i v,,i- r, i r-,Tltg @h,@+- bc- cc,,, in oi:,r 19 O,,-@r:7,. But h,@E; 20a tci 211wcy. I'.rd I 1-izi@rcA,ilt be@7,,i-L to cost it o,-' r,,tu d 22 proba-@).v write tO the hosp4-tal 23 and nov<,,r )-)e z,,ID).e to vt-ilr -@r, Datroit again. 24 P-n cl I zLtr, not pickiriclf or, D--t-roit, Jcle.. A Fldeial F@epoftefs, Inc. 25 9 7 P"2 id tile. 2 And D@- I -0 F@S 3 vs 1,,,u ar,.d Ai,d I 4 isback the@e today looJ,,4)-ng @,t t,@he3@-y: Icid-gi,,,,y 5 The@e has been a tu2,-novc-,:c ol'-- coox:-din;i"k-lor!f-- i@n tll4@-s 6 region (jv,--- the I thii-Ak thi-c,-! is, wh@,'---, the fourth 7 cool,,diya-Lor. Aiid. the o,-@ic- been on boacd 8 s'oiaothing @--out a year--. 9 in -cJ.-Lo pz,@",t, ti-ko. of tlio. Orc-gcn P,,Bg"'cna.1 10 fare la--,-gcly ori(@l-ited. Th@-I-,,' h@-,,d 12 1 T)i,@y had. co@coi city cE,,-i:e ',-(j @i,,-id @@CtiV4.1,ie, TI.) ey 11 Ve ---I. ul 13'1 14 of the near roission of the Pegion@,l 15 and have adopted objectives and ccein c,@nsol'i@.nt wi'L-,h 16 w ich have been sucFgested ,'rose Washing4@-on. 17 They hp,-ve@ 18 as tlioy cz@ll it, in th-i's pl@ini-iig -for tla.@ iiox-L yca@rs 1 9 And i-'c. to Lis tlip-t th,@y, and 20 Their staff is 21 %,7ho is the new coorciii-iz,,toi.- is a capable Y-.E.-n \@l,.o 1-ias 22 d ob- sp,lirred them on to changing gor.Is z@..n iecti-\;-P-s end 23 to participzt@-ng in the develoi3i-iic!nt of z,,n@d i 24 objectivoc,, I ',,c, deal Reporteis, [,,ic. 1 251 They are, as you can imagine, related to I 9 a 2 wllicli are 3 Yihich a e- y s N-"itli tl,71C 4 They fell%-, that ware 'r, 5 and goals and @,7c@.ro. rclcv,%n.'- to needs 6 in Oregon. 7 They had d4-fferen-'c- by these q-cic.:Ls 8 i.;ere to be achievcid, Th@-@y hid. st.@.3.,-,Cts O"- 9 and ;,,-,Iiich to tl-it@ on 10 We :Cc-,It in revic%.,,ing tl,.@-s th@ir 12 of goals 13 14 -Icliai-- heal.-Lh scme 15 proce2s in the c,,.roalr, arid 16 objec4L-iv(--.s, L@ljlzoly that Is 17 p r 0 b i - c- r @', G 're 1r. 0. I v cl f c,., n. t f i r, t h a r, o f t h s I-- o f 4--l p- i 18i country. it f-@'C)I:t I-,a -d 191 undartai@c-ii to st:c@,iiclchei@ tlIC4- d@,@@i b-se so i-@l-iey 20 O'- 10" rc@w zictiv-i,,--ies v@k-,Ijld have 21 a- n on the problems in oregon@ 22 In the as I men,,--ioncd, trey hav-e emphasized 23 edticatiortal t-%ey also vci-y 24 activ@ s a f f p,@ r- o'k e , a, n (I y @,7 c@ rc, oiit uLD @ce- d,,al Reporters, Inc. 25 d-vvloping relationships, Died a 1-i,.cji,,.I.y qualified and 99 hi- -c,-Iat,- to 2 be z,@ 3 -y 01@""P i@Lre rII02:e Coi"-Iplc so that the 4 C"z.-cs flood and accepted by tho co otkn b-cst havc @-n to lioi,7 th,@@,, 6usc the n TI-iiS iS i ie and 7 -s ill thcrind of D r:,-tiu,f ,,,itli thin in min@d. 8illa has plans to incr,@ctse the 9 so@ of the Irli@,t have und@,-;-t en in the 10 hav@-- bez:rt pliic@c-d They h@i-N7e attei@intc@d to devclcp o,'. the 11 funding for theac,, and in take acCCII" by- 12 ct.,ea;. -id (-)f 3' t In som-3 at of the p-ojCC4,s 14 1 5have beon tLkeii o,.re).- by o@-hcAr of -1-h-c;, 161 @-or by C) r 1 71 by soma of tl-ic institut-4-ons b@nefit4-nizi from tho 18 activities. Not @,11, of '@heir 19 ho,,,.-c!ver. 201 You n4Lght noi:c@ in the priiil-@-outs on tire 21 ass,-,,--,sirrent that there is some of 22 funeii@-ig I-)y sourcf@,-o. in to said 100 per(,,@,nt of the pro-;-c-l-s %@;ere by you Still 23 note that th(@re is a O.,@ogon. 24 deral Repoitct,, Inc. 25 We looked at the m4l-nor4yty inter(z:s@k--. it .4@s intaresti-r 100 there area to note ho-,,,,cvc@r 2 o): at IC, s @ho rc-@ iy-,. 3 rL u,- Il r vc@-"y f,o it h@-I 4 equal or pz-oDer on 5 in the Orcigon x.ias r c c o i i dd 6 than thciy unda,,--take 7 f o f.'Y--oia the 8 bl@acl-,s, z!n(3 them Fee i--F 9 e,,it4-c@:a oil b 10 Wo by Dr. an 11 -co his, :-,taff. liF c-- 12 0 Yi . o, c,,p i n c,@, i '13 i c@ "-D Ftz,.f -F. 14 of I,,Ie 4cl"iinlll also that he had 15 16 ano. thc@t Ic.Iiiay --IioulO, be 17 He had clone --elz,,,lt4-onsh4-p:7, the O-.-@ecjcn 18 &.,nd he to bc iiot 19 has o-,-,,n r,-talf and bL@-@- 1.)y o@licr -:arm 20 o):gl-@i-ii,-@.cll,--ionE@- i-n the Di@_, 21 need,-! help, hc,@e@,7c!r. of oi:,r 22 hc! seek a t-o C).SL@i Iii,ro. 23 The core st--aj@-f is up of 24 reviewed acted to fal Rcpotters, Inc. 251 tl-,c--Lr bacl:a,@-ound wind for us. It secmc; that th,@,y @@c-!re L UL Thev 1, @-v,@ d@, 2 of -"--ho 3 t- page of ):)udge-L 4 cuts br@dg,--t C,.4Tnr@ cl-bou-- but ratj,. ,IC --@t) r) or program 0 t o c ubacl-. on core Supper,,.-. 7 So v.,ovild rc-,cc@,,.Trc-nd to.o:cc--goii if tl-ie f@n-ting 8 is by this bojy aiid Coiinc4-l- that stews be undertaken 9 to strengthen core, ric>t E,- que,.Iil&@. si-,and,@oin,,-- so ra@ic- y 1 0as fro7i a 11 The ...Ca%ri5o@-y bol@,".y was roprcse,.itad in fo---ca. 1 2 a o@, h c u @iL 1 3' a,,. d t@,@,C) c@@,y@, cf @-he v@@ O.L .,-I j4 14 o L,,.it ak" by tlir-,ir in -,t 4ng c 15 1 sUT13 Po r "r- 1 6 Ile acc; told tlic- at thei." meetings is- 17 good. Tli,-y have indeed as yoti will note in the s4@to vis4-IL-. 18 rcPO2:t @-,,ho attciid@.nce vjas not good 19 and replacer thc;;m. h d %74-dc-@lic-@ tliE,.t of th,-- regloii,-zl 20, 21 Pdiisory Bo@i@:d on M-L role 22 1in the of p@-ojcc-'W--s. 23 1,Je did no-r-e tliall-- tl,-.ero- was a dccrtli of allied I.) -, 0 po n. thi.s corcni.ttcct and 24 tal Rep6rtc-is, lnc. 25 that. C>f Thez,e arO nO PrOhl C)f dic, C, f P is tlivt 3 and I 4 very bec,-inrii,.ig, acl--'-r-9 cni..y Ec--, t h c,. fC, Dr. Pahl,co,-@qpl@eic4-lY cc)nfoc-z-.lirlcy to t,"O c @,7hich ycii 5 6 read to us earlier about the relations,ii,ps beti@.-ean a rea-4,onal i 7 &dvisot@, group and g@ante,@, ox,ganiz 0 n We did n,-tc.@ pnoblem in that the scelc- Of 8 91 'clie University of Oregon Sc,-hool of I,,'cdic-ine D,-c . mid@ has h a d s c d recruiting certain 10 n s cla I,.iiids of pcop'ke to his ctaf,' he is not Thc-,v -ng @.b t o tli 12 c,z, dtlic-v ma%, clicrjzta to go to routa o-4' oil 13' 14 corporation. llov7aver, the so--v-4- c --s p@oviC-,,cd by i,-Iie have value, end do -v,,@,nt to thiL-, 15 16 enO, th--@. troy (5,,@ ee -aq givc.@ ll,E, @,c-rtoos 17. and lco'i,: a.,L: alt@-raativos to 18 Du&-ing th-3 site visit, @..e hz-id a of 19 by o4@@--r people frw,,i cth,@@,r a 20@ fropi. the CIIP B agenc4-ie@,, voluntcer healt@ 21 22 ilodc!l C3.t@-cs p,-,or)le, tlip- president of the State 23 and so on. It apy,,a.,:c-n-li-- tl-lp@.t 24 )jot-h by -'@-h,-- in I,, o E, Ace deial Reportcts, Inc. 251 activities and by tlieiti i.n activ4-tics. -LO3 are i,@rid 2 @@2orlci.ng c!oeely develop a pep-r 3 o-ther 4 pe:ct@..n,-@nt of To extent, throug'ki --@he 5 efforts of li-L,ld b@.an (fic@@,@olopad b-,.r the 6 0--eaon kieci-i.ca"- Pssoci-alc:--',.on a that marlibc@rs 7 certv,-j-ii li,.,urs of c odL, )-n o@--der to be 8 foy-- in tlia4L-1 body. ATz@d indeed i haNre 9 'che el-,act@- 11 10 of that society had b,--@czn dropperl 11 f,--iij.(,id to m@-et-. thc,,,@e ti 121 I'@- was c;@@-,c4,-i and 14 assistance, al-@iouc7h Pr,---r'i-taps tl-io2.-e N@,@as z!, n;,r@,ed fo.- @-ic-m -"--o 15 clearly uiderst d %,;hzt@@.-L-. OR'.LP ;,,-Il I,,Ild 16 the.4--- @@-acre should b-@ of OR!t,:@P's ):CIO i--o t-lic i 17 O',h--r- health Egc.,ncics i,n tli,-- 18 There are ho@eltli pl&i-anii-ig in Ig 0 r c,-, r-, n There is a No@- sell o'L the 20 B c.@cncic-s are 1,LU-ICI-io@--141, ,g iz; a clos-c- .L 4-.. I,- 1 21 relatio,,-i@,h-',-p between i.;h@@i-- do--s e>,js-c i,.n tl,.o. CHP and @n,,i 22 They abide by the i--c,-quire jo.-'4rit ard 23 co-.r,,monl-- @.,,here 6@.pplictb).e. 24 a A,, @dral f@eportcfs, Inc' 25 relative lac,',. of hard din,-La in tori-ris of hc,,.Ith nce-,,Is. they Th@.-,r 2noc:Cs asses5rio@it unit z;,P, )?z4L-t of 'Ll@-icir ne@-I 3 his in. wi,@"I the structure. 7-,.n d t 4 uni4l-- iri the CHP agencies th,@y exisl-- ir. 5th-- 'l)-@ undox.-tc,!,,-i,ng studies of what 6in 0--@egon to develop a g,@,caity care not jus-t 7only from the standpol-Ini-, of a lac'j,, o@ 8 bulc pr--s--ha@s more fr@, the standpoint oAr., the provider 9dc,'Lirtj,.,Akg nr-,-@ds to b,--. done, N,7h@-t procc-c@ sho-v,"Ld bc-, uricer- 10 tzJ-.cr,., ico rce-L-. the needs. This needs 11 'N.7ill of they tell IT.0, C;"-; CT 12 c@.,:otips the! S@-z-- 17 & rL, .13 ij Y 12 o:c 14. rf a 14 They will be d;-@,octc-@,d by It @7ill be 151 I,--'L-v to detc--ii4-n z.,nd dcfino i,.,Iiat is in a p@--r h 'L'"- i-@h-cit th 16@ arc-a of 1-7o fe. S 1,7 a S 17 CT,, cf d-@IL-@.cL---.ct.'I. Ile h@,.%;,e lil--'L-le or iio-q,,,@stioxi @,bout the r-.f 18, I 1 19Im a n2 m.-- n If-- o f th 4- r, r eC i-. T 1-i -c E,@ Ic a f f w a, s @T o o cl,I :I t i 0 20 -thc fisco.1 agei,xL-. was goc)(ft, ,-io the@-.te flat 21 =Iy r,,roblcri xi--th tl-i@. @@7@,y t-l-ic:y f-Lii-,.ds o2- }:cpt a 22 on 'tihat', x,,TE3.s cjoi.x,,q on ,L,n regioi-i, 23 to @,7EIs th-- c v a.1, u ao n o c,, 2 4T cri2,--%cs thez-o. hcl-%Fe bann sortie prol)lc-ms hc@-re in the r@r@rise Ace-Fedetal Repoiteis, Inc' 25 %@jit@t budgcll-- restrictions, Dr. Y@@gi was 1)u;-, on Ilan fU,l 2 3 they to I-C)OIZ at p.nd w@ 4 other kind of evaluation, Thj-y hE,,Vc;, at to they have 6 achieved IFOels or objc--,@t4 n @@ - 0 ves. @ld I guess as so'@ -,- 71 has said, tl-l.ev have ap- H & H @- pe of -a%riluai-iori procosc@',;r a @-Y 8 he@,d count and iridc-x sort o'L evaluation. 9 Dr. Yiqi, hot-,cver, s-earr-.Pd a @o@--t of rw ,,-son, 10 orgeri@---ed, d,-oci-pliiicd r,.i@i, and e.-a are hopo-i-cul that cor@-te f--ro-i his I.-time I)y t@--he 12 o @y T,.,. 1 3 to Y. n t o f.- 14 cf goal.s .-@-r2.d objectives. 15 -tlc, e.,ct4.oi-i pjlz7.n, I' need r,,ol-- go into a 1 6eaal roore b@Icause I hl-4,,lo c-o-@ci@-cd it to copie exte@,.t in 17 Y,@-y p-r,,vc,,os They area 18 19 go&-).r, ziid o-,ne 2 0o. LI c r, -, c-; @I z-: 'Rhe.-N? @irct T ti@ii,lkl, actio-,,,& 21 one add 22 that relc-_Ites to fL@r-diiig. You r,,ay notc, in their 23 -,,Iioy have a-l@cd fo:c .& 1. - He a 1, t- @- le b 4 -L- o f 24@ cli f -L (,@,a 1 lc-,,, gr w ii--Ii tli bL, c@,v-z: c wac-n le@ ar ii-i i,,iy Ace -Fedc-tat R(@portr,,is, Inc. 2 5raised at -Lh,.e on@,--t, cf dif j@l-c@rc.,nce b,@@L,.@icen grci@@q,-_h a)@id .1 0 b 1 2 1 thi.-@, buc c@.nd of th@-..;-3 fII2.ly 4 ard., o:E -L-ho. --pec-&fic 5budg,?ta):y nc,-@ds Vehicle N,,,oulCk )Dc.@ C) growth finds. 7 to -cct the rrvet 9 cariiot et 10 Tl,.ey gro@@th f,@,ids @,clat-C to ii in r-,irzil @--d c@ to cli 12 r i@11.0 f 1 a@ez),s, @in(a@ z. I 14 7 i t h tc@r&-ibly 15 s--i-isc 'L-h@m e, cl@.C-.@ck. P-u@@- a:F-.t-or Cl -' E7 CU_ S 4 1-1-f d@@,cl c,@e:rLt to th, -. 16 :h @ro 17 r,,:s 44--o that thc@,,-r no'-- -'(,hc- 1 8. thcni V;-ew 19 -@n uL- OA' clll il-,ft7-:1 L. 20 21 inaccessible a.)--cas to back z,,.nd to 22 to l@nowl.c-dc@--abl,-- 23 resourc3ful 24 It inay 'iD-, a N,7e lic,,.v Ace-Fc,ciefal f',eportets, Inc 2 5' @irc-as for: ge'(-t3.@-ig I)".r a 1 0,7 2 a t i e- ri t '--tie 3 The- 4,-lc,, bi@ 4 i,-i--bulou,-, I irL the sc-r,@r@a that ,"C-,@y WC-,ZE P;.-,--sumi-rlg 5 i t- h a p p,- a t c- f r; n c i a 1 i C. c-!.rr i t h c @, c o u 1 d e s 1 s h 6 f@,rrLily p.-L,,cti-ce el.in-ics irL s doaL-07.,@ li--,d not 7 previously chosen to that-. 8 r,,ocbuclir, h@,d. 9 They felt t@.hat r@-rhaps this mo,-re i-,.hEii Avoiding a ,bu4-ldin@-j J'o%- to i.n; tlivt th,"y CYOIIIC' uo 10 11 en cf@-or,t tco d-v@-lo-,,3 to in i;I.C!Cc 12 A, n ri i, f t:- i s 1-@, o;@@ s %@ o 12@ II c@ 'o @ ;I p c- I i.;-, c@ 1 3 Yo,,x .1 1 14 E d,,7@,-- @z o i i :Ce@@7 c?.goe d T cFnlt tlic., 15 oi-' @,;Ii%y raoopl-e 1-0 i@-t prac@-@'. 16 in rural areas. Px.,.d it -Lo -.cE,,ct !--,h-@t dc,-@tors feel when lc-b(-,,@ care by thz:.@-- 17 $ - - I r3o nc--d 'find @.,bout-. tha,,-i. 18 Piid 5-f O@--cgon c@'M ii-ids-ctcl 191 20 t-c-,ar.,.s in ).-niL-"Otc .4Lt be a So it i@-; to of acAL,.-;.v4.tic-s 21 22 that tlic-,, leave asked for funds, 23 f@o-el that the C).-.-,-c.@gon Mcd,!.c@.1 ProCjr4F.,,,@il is lqf:: fc-,@el t--hz,@t wi.1711 of i--Iicse Projec@l-ed 24 strol-ig- Ace-Fed(@t,il f@epoltels, Ific. thc-. davel-opntent-. of yit-@ed@, unii7, P-@,id the hce,.Ith 251 c C)'; C.-@, II-! @i t r C; A th C, i 2 3 4 ci.1, the teci),,! v7i@.s that ,O.S @la-4 .T.,.. at 5 this wais a good i-eg;-on card that 6 (4 n cj n 4 n cy r e c,, -, 0 -, it 3@ C, nt-sI g t 0rc@D.Cli ov,,t 7 in',L--o tho total'-ilt-- of -Ich@, ii of ti-ie thclt about y 8 70 pe@-c--nt of 'clie potv,,Iat 9 @,,,ould lil-,o Dr. Tliiiy@,inaii to so,4@ti@- Et th4-s 10 to do &@o @f.,e tEill-, the fui-xCi-ng. 11 DII. I,',]iYFR: 12 DR. 'O U F,@' .1 13 C,.V--IVA, 14 cc,,rce:cnr, v-7aG coca. i.s too SYCIrAll -L-0 do P,7,rticu).@A-I,,, 15 i-jith the new th@u--t jai) that they are trying to do. 161 W e w e,,. e ci I I i m p r c s c: cl h o r. p n,:@ w n, Et I t- h z,, I-- -'C, h c-: y 17@ had, F4dd--d P---nd I.loi-i much time hc- @-s on 18 ).-cad and br--,Ii-i(-ii-,.@, 19 poii-it h-, m@3.Cie and t-hat-is 20ii--hz@t is so st--ong if he a coco-n@:irv 211to-..orroiq, @iey might be in troublt@ real'I.y @--catise there is 22 no d--pt:h. So.tliat all of us brough-L. ov,cr to h,-m Ft@Tai.n the 23 buf;ii-icss of nec-,d.Liig a deputy to I'P of 24 4c!iese i-Jii-i-Lgs. @@ce-Fedei,-if Repoiters, liic. only otll(.N .r t@.:o po4ntS I ,@'Tot, 25 I think Id iLn.Or@rline cl, 9 t I y y d a U 3 h@;.d ef o,@l,,. t-hca f a@-- 'chat 4 once of IL--IH i-r core st,-,ff this 5 rc-a@ponsi).)i, I i t@y. I believe our vicit. ve-np 6 ii---oful -c-o them f@--cm @-liat st@@y,,.dpoiixt ax,td that tlic-@r 7 we tryii-ig, to stay, they @ay-t@ng it 8 reasonably nicc3.1y. 7,Y)d I thliy :Ln-cc@,@iid to mov,@ 9 on with relatioiisliip. 10 Irh a Pc)i,,cit orc-- hc@ niz,,de- a fair to o--F tl-,c-iir C-03L, p@7oc,? for 12 17 k.:z:.e @i at ineralv 13 do the 14 Dr. nor. 15 so -,uro h,@ k,.,io!is how -Lo c,-@rrc-c-c ein so sure, ii-izit-- 16 piiy,@o0y ho-.@,, to co-.--rc-cL- Evt it is 17 h-c do@nc @,7ith his in helping other p@Dopif,- g t 181 of-@ g-o-urid, But it 1-i r@ iio-'(-- the 19 for Pt@4LP .,-ri O:cogon it hz4vo 20 1 CIO,-to all that by sayi)-ig I @.j@..s very 21 this DP,. lil@ YE P, 22 do you h@,,ve, 23 MPN,. l,',r) 0 RI', - l@o. 24 Phi.1, your rc...cocTf@--ida-LL. !%cc - Fcd(,.iai Repo,,ters, Inc. 25 D P,. 1 T E : @,i7ell-, @@.s I m--ntic)ned, the 1,,,,ajor problem 110 I was this growth fund. You may note that they were asking 2 in the second year for $775,000 worth of growth funds. That 3 is a lot of growing. And it appears to me that this,is an 4 unrealistic estimate of their needs. And I think the site 5 visitors felt that. 6 There were things on th6horizion -- these television 7 systems, the family ractice clinics and so on, which will be p 8 coming to fruition in the near future. And some'funding will 9 be required, but it seemed improbable to us they would be 10 able to spend that amount of money that quickly, 11 We recommended, therefore, a reduction in this to 12 about $250,000 for each of the second and third years. They 13 did not ask for developmental funds the first year, so we have 14 recommended they get what they asked the first year; that each 15 of the second and third years they get reduced growth funds 16 plus their developmental components and instead of $1,588,000 17 the second year, we have recommended $1,063,000, the third 18 year in contrast to $1.6 million, we recommended $1.52 million. 19 DR. l@IAYER: That is in the form of a motion? 20 DR.WHITE: I would move the adoption of that. 21 DR. THURMAN: Second. 221 DR.MAYER: Questions or comments by the co=ittee? 23 DR. HIN14AN: Do you want me to comment on the kidney now? 24 I DR. HINI@L: Because that is included in that. 2 DR. IAAYER: The only reason I didn't mention it was 3 simply because I had heard somebody say that there was somebody 4 out there today. 5 DR.-HINMAN: Part of this application from Oregon 6 includes a cadaver organ procurement application. At the time 7 that the CHP A agenjoy es tablished its health-plan for the 8 State, kidney was a major activity and was a well-outlined 9 plan for entry points into dialysis and to transplantation 10 which design was accepted by the Governor. Parts of it, 11 particularly the dialysis aspects, have been implemented 12 to date. 13 Their application requests ftmding to enlarge organ 14 procurement activities throughout the State, particularly in 15 this valley right here where most of the population resides 16 and in which there is an interstate highway and a lot of 17 carthage on the road. So that the availability o@' organs 18 is right in this particular area. .They also-are r 19 equesting funds to @,pand their 20 transplant capabilities. The VA hospital in Portland has been 21 approved to increase its transplant capabilities. It is to procure.sufficient organs for the needs of all the residents 22 23 in the State, both the veterans and non-veterans. 24 This was reviewed locally by the RAG and by a kce- Federal Reportefs, Inc. staff group. There was some concern about some of the budgetar-4 25 112 I items and recommendation was made that a consultant visit the 2 area. And today was the only day in which we could arrange 3 to get more than one of the transplant surgeons who has had 4 extensive experience to go up. 5 There were a couple of areas in terms of equipment 6 in their planning and in some of the fee items that we felt 7 should have comment from someone outside the'region. So we 8 do not have an exact dollar recommendation. It is our 9 anticipation.,that Dr. Belcher will recommend that the program 10 be approved as it stands, but with some negotiation of the 11 budget items. 12 So that in your motion,.Dr. White, since it does 13 include the kidney dollars as requested, if it is acceptable 14 to allow some scaling down of that, depending upon negotiations 15 going on today. 16 DR. WHITE: It is acceptable to include that in the 17 motion as far as I am concerned. .18 DP,. MAYER: I gather-the site visit team from the 19 comments in the report had no concerns about the kidney proposa'"@ 20 DR. WHITE: We didn't look at it in any great detail,, 21 anticipating that someone else was going to do it for us. 22 DR. HINI@WI: Dr. Blomquist from our staff was a 23 member of the site visit team and talked with the investigators 24 before the site visit. Idetat Reporters, Inc. 25 DR. l@IAYER: Comments on the motion? 113 Jerry? 2 DR. BESSON: Philt do I understand then for this 3 fifth year, you are recommending no growth funds? 4 DR. WHITE: No, we are recommending growth funds, 5 but substantially reduced from their request, Jerry. 6 DR @IAYER: Not in the fifth year. 7 DR. 1,UIITE:, They have. not asked for them in the 8 fifth year. 9 DR. BESSON: I see, 10 In this summary sheet of what they plan to do with 11 their growth funds -- Oh, I see, they have just begun with the 12 sixth, used for the sixth year. 13 DR. I-MITE: Yes. 14 DR. BESSON: In reading at least your reiteration 15 of their goals and priorities, and you mentioned the holy 16 trinity of cost containment,the quality improvement, and what 17 was the third? 18 DR. MAYER: Accessibility. 19 DR. WHITE: Accessibility. 20 DR. BESSON: Increased . access to care that 21 they have some money set aside in their growth fund for the 22 additional funding of the establishment of a peer review 23 organization on a statewide basis. $50,000 was set aside for 24 the second year.. And since they are being funded currently kc fal Repotters, Inc. 251 by the National Center for the development of such an organizat@ 114 and if these goals are going to be more than just rhetoric 2 as far as Oregon is concerned, I wonder if in our letter to 3 them explaining the action of Council, whether it might not 4 be appropriate for us to encourage them in the use of their 5 growth funds for this kind of activity. 6 There is precious little that review committee can 7 do. Perhaps this might be one thing they.can' do. And there 8 is no need to make a motion, but I would just like to call 9 attention to-that use of growth funds and encourage it. 10 DR. MPYER: Phil, would you aLre to comment on that? 11 DR. @-MITE: I am sure that they would welcome this 12 recommendation. They are highly interested in this area, 13 and I think if we were to encourage them, thev would became 14 more active. 15 DR. Z@IAYER: Could I raise a comment about the 16 growth funds and the principles inherent therein? 17 As we move toward anniversary reviev7, triennial 18 review, whatever you want to call it, it said that each 19 program would hae the option of and has the responsibility 201 of coming in annually for an update of their requests. It was 21 my understanding when we did that that that provided a of the individ,i 22 mechanism for requests for new project proposals 23 regions once they have been fully formulated, fully approved by 24 the Regional Advisory Group, to find their way to Washington. 'Ace - edrat Reportefs, Inc. 25 And I guess I am caught on the horns of a dilemma 115 I of saying, "O.Y,., we are or are not going to use that mechanism 2 in terms of contingency funds." That is what the developmental 3 component was all about. 4 I guess it is that problem of should they come in 5 next year with additional project support identifying $250,000 6 worth of projects that they want to accomplish with the 7 assurance that they have gone through RAG in detail and have 8 been approved. I would have no problem with the annual 9 review within the triennium of dealing with that. 10 What is the problem with dealing with it in that way? 11 Because Ithought that is what we were proposing two years 12 back or ayear and a half back when we were moving in this 13 direction. 14 DR. WHITE: Well, this is precisely the same problem 15 that we examined on the site visit itself. Some of us,, at 16 least, were reluctant to accept this blank check in a sense 17 that we were giving this region. I do think I understand the 18 difference between how they are going to use these versus how 19 they would use developmental funds in the sense that they have 20 specific projects that are being generated which presumably 21 would be at an active level a year from now. 22 DR. 14AYER: But don't they have the option of coming 23 in a year from now and asking for additional funds to accorplis 24 that? %c al R@porteis, Inc. 25 DR. WHITE: Surely. I think they do. 1 DR. SPELLIAM: It seems to me this option would be 2 retained if they got frowth funds if you would like to 3 consider that. It seems to me if they are awarded growth 4 funds, they could still do this because this would not in 5 that sense be a supplement. 6 DR. BESSON: I see a subtle difference that if there 7 is something new in MIP that emanates from the regions that 8 this may represent. I see in the use o f the term "growth 9 funds" and as I read at least the summary that they mean to 10 use this in a slightly different way than developmental funds 11 in anticipating that what they are going to become involved in 12 is going to increase in scope rather than actually developing 13 new ideas, although they do list the number of projects that 14 they hope to fund with this. 15 And I think that I remember a couple of years ago 16 I made a suggestion which was unfortunately not accepted by 17@ this committee or C ouncil that when we see a region that 3'.s 18 moving in the direction that we are almost imp--lied to say, 19 "That's it, you are doing just what you ought to be doing," 2O.that-they be coir.@-rended in some way. And the only way in which 21 we can do that formally -- I had suggested some kind of 22 certificate -- is with bucks. 23 I wonder whether this use of growth funds and our 24 acceptance of their concept i-7ouldn't be a way of this review ce- d,,al Reporters, Inc. 25 committee at least indicating to them that, yes, this is a 117 I very appropriate way for Oregon to be moving in contrast to 2 some others that we will discuss over the next couple-of days 3 that are going in the totally opposite directi on, and we 4 would discourage by turning off funds. 5 This is a way of supplementing their request. I 6 like the idea. I have not encountered it before. But I think 7 it is a good one. 8 DR. I,IAYER:, O.K., further comments? 9 MR. HILTON; Just a question, really. I am going to 10 take advantage of my newness to this committee. 11 Is there still a distinction between this term 12 "growth funds" which is new to me and the developmental 1 3component? 1 4 DR. IAAYER: I have no problem with that because I 15 think that what they are saying is in te @ of the developmental, 16 component that that is priming, catalytic kind of dollars. 17 And they are saying that growth fund, if I understand it, Philil- -dollars for new projects 18 are 191 DR. I-IHITE: That's about right. 20@ DR. @SAYER: -- as yet not formulat ed in final form, 21 but have at least come along far enough so that they can see 22 that they are going to be in final form within a finite period 23 of time. 24 DR. WHITE: That is essentially correct. And'they kce- deal Repo(ters, Inc, 25 justified this in a sense that in the past they have gone 118 I through this process of developing an activity, a project, 2 but they have been unable to carry it out because of serious 3 restric#--.,,ons on the budget which you are all familiar with 4 a year or so ago. And they feel that without some kind of 5 a little carrot in hand, they may have trouble getting these 6 people who they need to cooperate with their transportation 7 system, peer review system, the family practice clinic system, 8 to go along with the whole idea. 9 I can see this point. On the airplane out, I felt .10 this was a nonsensical way of approaching the problem. I 11 felt just like you. once they developed something, they come 12 back next year and ask for support for it. But after talking 13 with.them, I understand their viewpoint ind feel perhaps there 14 is some legitimacy of awarding them these growth funds, 15 particularly since I think all of the site visitors were 16.partictlarly struck with the quality of the people involve 1 7 in this area. 18 DR. nzYER: I guess I.have to ask the question of 19 staff as to whether this is or is not within existing policy 20 of the RAG and whether this is a policy issue that ought to be 21 surfaced. I am not saying pro or con, Phil, in terms of the 22 approach because I think philosophically, I am in agreement 23 with the approach. But I am not sure that that is not a-p6licy 24 issue as opposed to a request issue. %C ral Repoiteis, Inc. 25 MRS. KYTTLE: Dr. Mayer. 119 I DR. IIAYER: Yes. Mrs. Kyttle. 2 MRS. KYTTLE: In back of the tab labeled "Council 3 Highlights" in your books is a resolution passed last Council 4 that says unless the review procedures have stipulated to the 5 contrary when regions enter a triennium, the approved levels 6 of the first year will hold for the remaining two approved 7 years of the triennium. 8 'K7e had to move to that because Oregon, like several 9 other regions proposing a triennium, particularly in your 10 fifth year, and it catches you betwixt and between with a 11 program that is ongoing and yet in the next year it will drop, 12 was attempting to establish a level for its triennial period .13 within which it could move in its triennium. That is the 14 concept of the approved triennium. 15 And yet, these regions when they map out their seco,-idli 16 and third year of the triennium are not in a position at that 17 time to specify the exact projects and the exact budget that 18 will preserve a level. So with last Councills action that 19 unless there is a certain reason for a decreasing level in 20 the triennium, the first year's level of the triennium, will be 21 the approved level, not necessarily the funding level, but the 22 approved level for the remaining years of the triennium. 23 DR. MAYER: Well, where does that then relate to the 24 annual review within the triennium? They are saying is that @ce -Federal R@porters, Inc. 25 option now no longer possible vis-a-vis the action of the 120 I council? 2 MRS. KYTTLE: O.K., within the action of the Council 3 establishing a level for the triennium, at the anniversary 4 a region may come in and propose uses of the dollars up to 5 the approved level by Council. And that is an action that 6 staff anniversary review panel considers and reports to you 7 about. 8 Should they request the use of dollars beyond that 9 level, then that would come to committee for action. 10 DR. I.IAYER: But that option is still available. 11 MRS. KYTTLE: Ohr yes, indeed. They may request a 12 second year triennium budget that is over the level of the 13 approved level for that year of the triennium if the staff 14 anniversary review panel recommends that that level be 15 increased. And I think last time 'Tri-State was one that came 1.6 to committee because staff was recommending the second year 17 of the triennium level be increased, but there vias no other 18 way for regions other than to forecast a program three years 19 ahead that might radically change than to either do as Oregon 20 did, provide'grov;th funds, you remember Ilestern Pennsylvania 2 1did it when they went to triennium. They were trying to 22 preserve a level, give you inklings of what they would go into. 23 But they are not yet ready to be specific about it. And it 24 led to the policy from the Council last time. -Federal Reporters, Inc. 25 DR. MAYER: I am not sure that answers the question I 121 1 tha@ I have raised, though. 2 DR. I,,IHITE: No,, I am not sure that is correct. At 3 least my understanding is that the second and third year budget 4 shall be not less than the 5 DR. MAYER: Let me try it again. 6 MRS. KYTTLE: I was waiting for your action because 7 this one increases. 8 DR. BESSON: That's why you are saying not less than. 9 DR. SPELL@IAN: Is that what you said? 10 DR. BESSON: You said it is at the same level. 11 MRS. KYTTLE: It would not be less than the level 12 established for the first year unless committee said, "Yes, 13 we want this decreasing because we don't like that." C- 14 DR. MAYER: But that doesn't answer the question whi 151 I raised which is what is existing-policy of the Council in 16 terms of this group taking action on providing contingency 17 funds for growth. You know, without clear-cut evidence of 18 what it is going to be used for. 19 DR. SCIII,IIDT: You are saying it is a new way to got 20 money. Is that what you are saying? 21 DR. IIAYER: No. I am saying is it consistent with 22 existing policy of the Council and in that sense legal? 23 DR. PAHL: Bill, we don't have a clearly formulated 24 Council policy on the point that you are raising. And at this al @eporters, Inc. 25 Point-in time, the concept of developmental components and gro,,i 122 funds which has been coming into it has not been fully assessed 2 by staff. This is one of our agenda items because we are 3 getting into various ways of providing flexibility to the 4 region. So it is appropriate at this committee meeting to 5 make whatever recommendation you want to the Council, and they 6 will be asked to establish a policy in connection with these 7 various ways of funding. 8 But you are not inhibited at this point in time 9 from recommending favorable action on growth funds if you so 10 desire and to recommend different levels of funding for the 11 different years requested. 12 Nothing in the Council policy that Lorraine mentioned 13 is restrictive. Both this committee and the CoLincil may set 14 whatever levels for the individual years are decided upon* 15 It is just thatunless special action is taken by the Council, 16 then a level is fixed. 17 DR. 14AYER: Let me try it once mo re with my problem. 18 @ly problem is I sit here knowing a year and a half of effort 19 and energy of a lot ofpeople went into establishing the 20 policy of the developmental component. And I think that was 21@ appropriate because out of that came son,.e'guidelines that were 22 known to everyone in the world about what developmental 23 component is. 24 We are now talking about growth funds. And all I am @c al Reporteis, Inc. 25 saying is to me that sounds like it is as every bit as big, if 123 I not-a larger, policy issu- than tlie. developmental component. 2 And rather than deal with that on an ad hoc basis, I would 3 just want to get it fla god as an issue that ought to be 4 looked at and guidelines established rather than doing it on 5 a hit and miss kind of ad hoc sort of basis. 6 DR. PAHL: There is complete concurrence. It is 7 just a question of priorities. We haven't had an opportunity 8 to do this. 9 I should say that although the concept of development 10 component vlas clear at one time which r,,eant that there would 11 be additional funds as a reiiard, it turns out that as one 12 moves into the triennial period and where there has been 13. responsibility delegated to the region for funding projects 14 within the Council-approved program without coming back and- 15 looking on a project-by-project basis and where no additional 16 funds are being provided because the developmental component is 17 awarded, the concept of developmental component lies been 18 changing. And right now, I don't think it is as clear as you 19 have indicated it was when it was first enunciated. 20 Many times we approve the developmental component 21 without additional funds which gives them a flexibility within 22 their program. But by now, going on to a three-year basis, 23 they have practically all the flexibility that they need 24 within their program.. And the whole concept of v,,Iiat develop- kc a[ Reporters, Inc. 25 Imental component is actually accomplishing under a level budget 124 1 is quite different than what it was under a rising budget. 2 And this is the question that staff and Council must discuss. 3 And it is further complicated by this new concept of 4 growth funding that has come in. 5 So we are not in a position to.say there is a 6 Council policy or that there has been a staff analysis and 7 clear statement policy. These things have ye t to be done. 8 So you are free to flag the issue, and we will be coming to 9 this as quickly as we can. But we don't have a policy for 10 you, and Council doesn't have a policy that I know of at this 11 particular point in tire. 12 DR. MAYER: Phil. 13' DR. WIIITE: I think it is worth bringing to Councillsl 14 attention, and I think it is worth pointing out that this regioi-i, 15 land I hope all, are full of integrity and honesty, but they 16 lcould haveIsaid these are projects we are going to undertake, 17 that we have them fully developed and planned, and we know 18 precisely what we are going to-do, and put down a budget and 19 say, "This is it." This waythey were honest with us at least 20 and said, "We are going to move in these directions, we don't 21 yet know what it is going to cost, and this is our estimate." 22 Their estimate varies from ours a bit, but I think 23 something ought to be done to deal with these sets of 24 circumstances. ;ce-Fedeial Reporters, Inc. 25 DR. MAYER: O.K., other comments? 125 1 MRS, KYTTLE: Just one, please, on triennium. 2 When we first defined the status of triennium, we 3 dy and that said that it declared a region as an accredited bo 4 it could move in this triennium. 5 Now, following that, the region needs some commitment 6 of financial stability through these three years. And that 7 is what is leading us to the concept of the funding level 8 established for the beginning of this triennium should not 9 decrease during that triennium unless there are specific reasons, 10 for it. DR. IIAYER: We have no problem with that, Lo--raine. 12 I think that is a second issue. 13 Yes, Mrs. Silsbee. 14 MRS. SILSBET: As I hear it, though, I think if you 151 decide you are not going to have any growth fun ds, the 16 level would automatically go down in this particular instance, 17 And while we don't have a Council policy, the discuss4-, 18 of Council at the time Western Pennsylvania proposed this very 19 same thing and the Council member who had it wanted to make 20 very clear that Council knew what they were doing here, and 21 they did agree to that as a concept. And they approved it. 22 DR. MAYER: O.K., comments? 23 Jerry? 24 DR. BESSON: We have cuTotion on the floor to accept kc al Repofters, Inc. 25 the recommendations of the site visit team. And I wonder if 126 inp'in-' I I could wnend that since this may be a focal point for p 0 2 this question, the amendment to include something to this 3 effect that where a region shows evidence of implementing 4 policies which are concurrent with it@ stated goals and 5 priorities and also consonant with national priorities, that in 6 order to encourage'its expansion in this direction, growth 7 funds may be awarded on application at the discretion of the 8 Council. 9 DR. MAYER: And upon recommendation of the review 10 committee? 11 DR. BESSON: Yes. 12 DR. SPELLI,@l: I would agree with that in principle. 13 @id I think taking what Judy has said and what Herb said, if 14 increasingly devel opmbntal funds are being used as growth 15 funds which is really what I understand you to have said, 16 the flexibility is even greater than was intended. Tien, you 17 might just as well drop any distinctions between developmental 18 and growth funds and call it by a single name and let the 19 full amount then bear some relationship to the difference 20 between the level of funding in the first, second, and third 21 year rather than that very modest increment in development. 22 funds. Because, again, you see, if he calls this developmental 23 funds by tradition or whatever, he is limited to a pretty 24 small amount. But by adding growth, he has an amount there al Reporters, Inc. 25 that is almost a fourth of the total level of funding. 127 I So X think you might consider now adopting a 2 single term, and that you look at it only in terms of the 3 increment above the first level of funding. it Nvouldn't make 4 any difference there, and that would @al-@e care of vihat,everybod@ 5 is talking about. 6 DR. @IAYER: Could the chair try to separate these 7 two out? They are linked, but I would like to-deal with 8 the individual proposal and then deal with the policy issue 9 if we could. 10 DR. BESSON: Then I will withdraw. 11 DR. I.IAYER: Because you may find yourself in a 12 position of having to vote against the recommendation that 13 you might agree with because you are disagreeing with the 14 principle. And I think that would be inappropriate. 15 DR. BESSON: O.K. 16 DR. I,,IAYER: Further comment on the recommendation .17 lof the site visitors relative to the funding and level of 18 funding for the Oregon PJ4P? 19 MR. 110ORE: I would like to add one point. 20 DR.' @IAYER: Yes, Mr. Moore. 21 MR. @IOORE: Of the seven growth fund activities they 22 are presently participating in five as a part of planning 23 feasibility and core activities. So these are not new 24 activities per se. And the use of the term "growth" that ce I Reporters, Inc. 25 should the feasibility planning studies grow to a point of 128 projects in the following years, then they would be 2 submitting such projects, 3 DR. 1,MYER: Further comments? 4 (No response.) 5 Everyone clear on the motion-and recommendation? 6 All those in favor say, "Aye." 7 (Chorus of ayes.) 8 Opposed? 9 (No response.) 10 Now, the question is how do we deal with the issue. 11 I think it needs to be flagged, obviously, as a policy issue, 12 And maybe,Jerry, the approach that you are taking is the 13 obvious one. I just have a feeling that the implications 14 of that are moderately significant in term of how people chanczd 15 in approach. And having been in on that discussion on a 16 developmental thing as many of us were, that got to be pretty 17 sticky. And I am not sure that it isn't just raising the 18 flag of the policy issue in suggesting that an appropriate 19 group be called upon to look at that issue and to insist or at 20 least to suggest that representation on that group come off 21 of this review committee as well as off of staff and Council. 22 I am just suggesting that as an approach. ilaybe it .23 is as simple as you say. 24 DR. BESSON: In the interests of being even-handed @Ce eal R@portefs, Inc. 25 with the bandying about of the notion of emasculation, I think 129 I putting some -- I will block that metaphor that just cam,-- to 2 mind -- but getting the review committee back in the saddle -- 3 (laughter) -- that I would like to keep this idea of a growth 4 fund separate. 5 Let me reintroduce my motion. But I would like to 6 keep it separate from the developmental component mentioned 7 because I think it really says something different. 8 if there is some merit to the'idea that the review 9 committee by its action can tend to move this ponderous 10 machine in one direction or another, then the use of growth funds can be what we used to do many years ago in awarding 12 funds for projects -- encouraging those that we said yea to 13 and discouraging those that we say no to. But now we can no longer do. All we can do is award a lump sum and approve 14 general principles and process. 15 16 But this might allow us to indicate to a region that.- 171 yes, they are doing what they should be doing and to other 18 regions that get zero growth funds, that can be a very obvious 19 sign to them that maybe this review committee and the general direction therefore for how R,114Ps should develop may be somewhat 20 more re-established. 21 22 DR. SPELUIAN: I would just answer that by saying that I think the differences between what the growth fund 23 and the developmental component are going to be used for in 24 -ce I Repofters, Inc. the future could be increasingly artificial. If you look at 25 130 that, it is only 13 percent different between the first and 2 second year. 3 What this means is this is just an assurance to 4 Oregon that they have a level of funding higher in the second 5 and third year with a wider latitude to determine what they 6 are going to do with that increment. That is all it is. And 7 I wonder, what Herb said, if people are already doing this 8 with the developmental component anyway, what is going to be 9 done with growth funds? It just doesn't seem to me any longer 10 to have any merit by creating two kinds of instruments which 11 in the final analysis are used for the same thing. That is 12 the only point I make. 13 DR. MAYER: Joe. 14 DR. HESS: As I have listened to this discussion- 15 here, I have wondered how much of this problem would have been 16 eliminated if they had just not put in those two words "growth 17 funds," and left those projects listed under the headings and 18 money attached to it and left the developmental component just 19 sitting there and get those two words out of there. How much 20 of this discussion we had had in the last few minutes would hav@ 21 gone on? 22 DR. MAYER: If you are saying if they had formulated 23 projects that were there that the site visitors felt were 24 consistent with their goals and it was clear that they had %ce eal Repofters, Inc. 25 gone through the internal review process, I would have no I 13 1 I problem with it. But those are two big if's. 2 DR. EIESS: But what they are saying here, it seems 3 to me, is these are areas in which we want to develop 4 projects. This is not completely flexible money that can be 5 used for anything that happens to come along, but these are 6 ideas that we have that are partially formulated that we 7 think are appropriate to be in-tlic regions that we are going 8 tofund. And they are projects in process which to me is a 9 different thing than developmental component which is sort of 10 flexible money that could be used for something that hasn't 11 even been thought about yet. 12 DR. SPELU.IAN: But the evidence I gather is that 13 the differences between these are rapidly fading and indis- 14 tinguishable from what he tells me. The question is really- 15 two years from now whether we viill be able to tell them in 16 Oregon what is the difference between the way they use the 17 $75,000 and the $250,000. They may lose their definition. Tha@, 18 is all. 19 But I can in agreement with the principle that thev 20 ought to have $75,000 plus the $250,000. I was just suggesting 21 that it be done in a way which in the future would make it a 22 lot less complicated than inventing nomenclature that is just 23 meaningless. It is the way of getting more money for the 24 second and third year. %C al Reporters, Inc. 25 DR. 14AYER: Maybe it goes something like this -- let 132 me try it and see if this is acceptable: That the committee 2 is in favor of the conceptualization of the growth fund issue; 3 that if definitive policies are to be established relative to 4 growth funds and how they might appropriately be done, that 5 the committee expresses its desire to participate in those 6 decision-making processes, 7 DR. BESSON: But they can't do it because once the 8 anniversary review, once you fall into that slot, then you 9 no longer have control. 10 DR. INLAYER: No, no. You are missing what I have 11 said, Jerry. I am sorry. What I am saying is if the Council 12 in its infinite wisdom listens to the fact that we think the 13 growth ft,-nds are good, they think it is appropriate, but.it 14 finally dawns on them that unless they start as in all things 15 to further define what the boundaries of growth funds are, 16 what percentages might be appropriate, da-da, da-da, da-da, 17 when they do that, all I am saying is we ought to participate 18 or representatives of this committee in the future ought to 19 participate in those discussions. 20 Yet, Leonard. 21 DR. SCHERLIS: Maybe I am hypoglycemic, and I don't 22 quite know why I feel as I do about it, but I really think we 23 are raising issues that we are looking to raise in this regard. 24 I would much prefer that the site visitors give us a 4ce eral Pbporteis, Inc. 25 recommendation that certain priorities have been set up which 13 3 obviously require certain funds of money. And it is 2 apparent that the money will be spent in that area. 3 1 don't like the term "growth" now. We are going to 4 have to define it as distinguished from developmental. 5 Maybe I am the only one who has the limitation of 6 trying.to distinguish between these two terms. I would much 7 prefer we keep the developmental as it is and just ask for 8 a little better definition of how they are spending the money. 9 You have defined it. You said seven areas they are 10 moving into. They have already moved into five, they need 11 the funds to move into the other two. After all, I would just 12 say they found some money, that is what they are .going to do, 1 3and they defined it pretty well, 14 I would hate to see us telling Council when they have 15 reached a decision they have got to come back to us, and we will@ 16 discuss it further. I don't think a decision is necessary in 17 this regard. 18 1 would move to strike out the last ten'minutes of 19 discussion. 20 DR.' MAYER: Joe. 21 DR. HESS: I think we may well be creating an 22 issue that doesn't need to be created here. If we understand 23 what they want to do, because they happen to use a couple of 24 words that were unfamiliar to us, let's not get hung up on kce I Reporters, Inc. 25 formulating a brand new policy. It seems to me this could be I I 134 I handled under existing policy of a region who has reached 2 the triennial status. 3 DR. MAYER: There is more than just the wordst Joe. 4 There is some substan tive difference between this approach 5 and other approaches of definitive projects. And I won't say 6 anything more about it. 7 DR. SPELLIIAN: If it is that simple, you can predict 8 that everybody will do that. 9 DR. BESSON: I think everybody else might have the .10 option of doing it. 11 At the risk of prolonging this discussion at an 12 inappropriate blood sugar level time, and many decisions we 13 may make are based on no more influence than that, I would 14 say that I see a difference. And I think that a 13 percent. 15 increment you referred to, implying that therefore it is not 16 very different from the developmental component I think I 17 read somewhat differently here, 14itch, because I see that that 18 13 p--rcent'increase is a result of a 24 percent decrease in 19 projects and an 18 percent decrease in core, but 100 percent 20 increase in growth funds. 21 Now, that gives you a figure which is not far from 22 the developmental component. But the point is I don't think 23 that 10 percent is adequate enough for what some regions want 24 to do in an expansion4-ng fashion. The growth fund concept, kc al Repofters, Inc. 25 1 think without putting a percentage figure on it, allows 135 I a region that is moving in the right direction to really 2 blossom. 3 Right now it is constrained from so doincj..by having 4 a limitation of 10 percent on it. 5 DR. MAYER: O.K., I guess the question I have to 6 ask is, we have taken.an action on one which does have this 7 principle that would suggest we are in favor of it, at least 8 as it relates to Oregon, and we have no'objections to the 9 principle at least as it applies to Oregon. I guess the 10 question I want to raise is do we want to make any comments 11 above and beyond that of a more generic nature to Council? 12 And if we dot what is it? And if we don't, then, fine, let's 13 end the discussion. 14 Mac, 15 DR. SCHNIIDT: I believe 'we should comment that it 16 seems apparent there is some change in the concept behind the 17 developmental component and the growth fund concept is worthy 18 of study in relation to the other. And the staff and Council 19 should take this under advisement and so on. 20 I think both of them have to be looked at in relation!; 21 to each other and something new developed, 22 I personally favor a single type of dollar. And I am 23 really closer, I think, with Leonard than anybody else. 24 DR. BESSON: I withdraw my motion in favor of that. ,C, "al Repotters, Inc. 25 DR. SC@IIDT: I would move the sense of whatever it Go 137 I AFTERNOON SESSION 2 (1:40 p.m.) 3 DR. MAYER: What I would to do sequentially as 4 a tentative agenda is go down the list mid pick up Ohio and 5 then pick up Northeast Ohio which is in a way linked, then 6 go back up to Nassau-Suffolk and to Nebraska sequentially. 7 And that gives John a chance to settle in before he has to 8 go to bat. 9 DR. KRALEWSKI-. Thank you. .10 DR. 14AYER: And I assume that you all followed the 11 explicit instructions given just before breaking for lunch to 12 use part of your lunch break to complete the rating sheets 13 on Oregon. If you did not do so, let's take a couple seconds 14 and do that now because I am afraid if we wait after we start in 15 another one that things may get a little fuzzy. 16 Vlhat we are turning to, then, is the new Ohio 17 Regional Medical Program. I'am the primary reviewer, Mr. 18 Hilton is back-up reviewer on it. 19 Let me comment in way of introduction about this one, 20 Phil said or someone said earlier you ought not to make 21 apologies, but I really feel that I have got to make some 22 disclaimers at the outset on this one because after six years 23 and six months of involvement in one way or another with IU,IP, 24 staff somehow seemed to have saved the toughest task that I %C a[ Reporters, Inc ' have had to the last day of my service. For what they have 25 138 I done is given me the opportunity, if you can call it that, 2 without benefit of site visit or personal involvement six 3 years after the funding of the first RMPs what is essentially 4 a new JU4P to review by guidelines which are long since moved 5 on to other kinds of things. 6 At this stage in the developmentr we are supposed 7 to be looking at total programs and not individual projects. 8 Yet, there is as yet no really total program existent here. 9 At the same time, there was a mandate from us and 10 Council that they try in the Ohio Region to put two or more 11 of those individual P-%IPs together because of their poor 12 quality to dater at least the three of them, and they have 13 done that, at least with two of the programs. our advice and 14 counsel are to go up to the National Advisory Council, two 15 of whom whose most sophisticated and long-standing members, 16 Bruce Everist and Clark 14illikan, have trod this sod which I 17 have not.trod in January, and they obviously, I suspect, have 18 some preconceived ideas about what ought to be done in the 19 area. 20, If there has ever been a setup to wipe out itself 21 on this one, and I can see the headlines now, "Mayer goes down 22 in flames on final mission." 23 To cap it all off, I am-not sure how much advanced 24 notice Mr. Hilton had. At least in the previous communications kc al R@porters, Inc. 25 that 1 had, it didn't appear there was a secondary reviewer on 139 I this. And so I really think it is going to be, "Mayer goes 2 down alone in flames on final mission." 3 So I commence this review knowing I picked up an 4 assignment befitting a chapter in "Mission Impossible," and 5 wishing that not only my instructions might have self-destructe( 6 but the whole region from Athens to Zanesville. 7 As a background, you,will know, as you recall in 8 previous meetings, we felt that although the State of Ohio 9 might be the mother of Presidents, we hardly felt it was the 10 father of RMPS. There were four @iPs involved in the State 11 the Ohio State @IP which was focused out of Columbus, the 12 Northwest Ohio @IP focused out of Toledo, Northeast Ohio RYIP 13- focused out of Cleveland, and then the Ohio Valley-Kentucky 14 PIIP focused in Kentucky and including Cincinnati and the 15 several-county area in southwest Ohio. 16 The first three, to put it mildly, had a great deal 17 to be desired. And it was suggested by staff and by ourselves 18 and Council that we might be able to put some bad apples 19 together and with appropriate aging come up with a vintage 20 wine rather than some sour cider. I am not sure how iate that decision was, but tha- was the decision we 21 appropr 22 Made. 231 Accordingly, in the April-may review cycle of last i 24 year when we had all of the bad apples together from Ohio in eal Reporters, Inc. 25 the review process, we extended their funding for an abbreviated 14 0 period from July of last year to January to provide them the 2 opportunity to get together. This they did with the following 3 results: 4 It looked like the Ohio State -- I think if you 5 will take your yellow sheets, page 7, there is a map which 6 outlines the region. It gives you some feel for the geography. 7 lihat appeared was that the Ohio State MIP which is central and 8 southeast Ohio and the Northwest Ohio @IP were making music 9 together, but the Northeast RMP really was keeping out and 10 saying they wanted no part of those other two. And really, 11 the Ohio Valley P.I@IP which incorporated the southwest component 12 of it was never really a ma)or part of the issue, feeling 13 they probably were a functional RMP and it may not be 14 appropriate to try to get them involved. 15 So we extended them for six more months from 1.6 January to July after having extended them six months from 17 July to January to try to work that out, then extended them 18 another six months and then sent the shock troops of @lilli):an, 19 Everist, and staff in on January 10 and 11 as a fact-finding 20 activity relative to the three regions. 21 The results of that visit are outlined in the 22 %,ery poignant comments of Millikan and Everist on pages 27 to 23 35 of the yellow sheets. I recommend those to you as reading 24 programs tonight because I think they are cia--sic examples @ce ,al Reportefs, Inc. 25 of what two pros can surface in just two days in a region. 141 I In brief, they,-.however, discovered the follo@,7ing: 2 That Ohio State and Northwest Ohio Pj4Ps were making progress 3 towards union and Northeast Ohio in its pristine purity was 4 having none of it. And although they had invited-the Ohio 5 Valley-Kentucky groups to participate, they felt that it was 6 probably not appropriate to incorporate them in it. 7 The end result was a series of recommendations that 8 came out of the February 172 issues of Council which are on 9 page 2 of your yellow sheets. And I will not go through those 10 in any detail, but essentially I think did recommend the 11 formation of a new P,14P which c @ined the Ohio State with 12 Northwestern regions and that the effective date of merger 13@l be September 1 and that this application of that merged, two. 14 merged PIAPS, are to be brought back to this particular review 15 cycle. 16 Well, that is the background of this particular 17 application. And what do we have in it? We have a proposal 18 then to merge previously existing Ohio State and Northwest 19 Ohio M.lPs into the Ohio Regional Medical Program. 201 We have a request for $2,082,000 in direct costs for 21 one year activity when as near as I can figure out from data 22 which are not totally complete, they are roughly at a $1.4 23 level of activity in that. 24 The request includes a request for $1.2 million of @ce "I I Reporters, Inc. 25 program staff, a core, compared to a current combined total 142 I of about $800,000 now in core. 2 We have a request of approximately $800,000 of 3 project funding which include the following: 4 Onet two projects, the first and second ones there 5 which have previous Council support for approva@ for support 6 for an additional year. 7 Two, a kidney project in the amount of $201,000 8 that is project three -- which will be reviewed on May 8. 9 And since this is May 4. I don't know what that review has 10 in common. 11 And thirdly, there are 12 other new projects, nine 12 of which are from the previously,existing Northwest Ohio .13 P@IP and three from the previously existing activity in the 14 Ohio State IU4P. And when I am saying nine in that Northwest 15 Ohio P,'L@IP, I have to comment parenthetically there has been 1,6 a considerable amount of concern that previous activities in 17 the Northwest Ohio P14P were moving towards the funding of the 18 newly developed medical school-at Toledo with emphasis on that 19 rather than to a greater degree on the RMP component. 20 And, finally, one out of the 12 that is a health 21 careers program of Ohio in the amount of $171,000 outside of 22 RMP guidelines. And that is contained on page 17 of the 23 yellow sheets as to why. 24 In my opinion, then, they have made progress in @ce I Reporters, Inc. 25 merger. They did attempt as requested by Council.to move the I 143 I Northeast Ohio and Ohio Valley However, this whole 2 application has the flavor of a new and developing region. 3 And it kind of has the deja vu of four to five years ago. 4 William Pace, the Dr. William Pace at@Ohio State 5 who is the acting coordinator, obviously has had a great 6 impact in trying'to bring this merger about and has obviously 7 been helpful in Pffecting it. However, he is' pulling out or 8 resigning on June 30 of this year, and they are looqing for 9 a now coordinator. The reasons why Dr. Pace is -leaving that '10 responsibility aren't clear, and perhaps staff may have some 11 comment on that that may be helpful to us. Secondly, in terms of the review process at the 13 regional level, this appliation is acknowledged by them to 14 essentially having been nonreviewed in the kind of review 15 process that they would hope to ultimately accomplish in a 16 combined region due to the newness of the effort. 171 Thirdly, the goals and priorities of the group are 18 general, not specific, but tJiey do have a mechanism and are 19 actively, I gather, working on them. 20, Fourthly, the advisory council is temporary and is 21 in the process of -- this is the combined advisory council 22 expansion in organization. 23 Fifthly, the staff is not yet fully formulated or 24 organized although there is a fairly good proposal for ce e",l Reporters, Inc. 25 organization that is contained in the application activity 14 4 materials. They now have, as I gather, 19 professionals in 2 the two pre-existing programs, 13 in Ohio State and 6 in 3 Northwest Ohio, and are requesting 32 professionals in the 4 core staff and the new development, an increase of 13. 5 Sixthly, they have agreed on a grantee and a fiscal 6 agent, the Ohio State University Research Foundation, which 7 is evidently a private corporation which is handling the 8 research funds of Ohio State in the amount this year of 9 around $20 million and obviously have competency at the 10 fiscal level to handle the activity. 11 And, finally, they evidently have settled in a 12 positive light on a relatively strong RAG chairman in the form 13 of Dr. Brain Bradford of Toledo. 14 So that's where we are. And I suspect you can 15 understand part of my problem that.I tried to outline at the 16 beginning of the presentation. When I got to this stage of 17 the report, debating about what to conclude about all of this 18 in light of the newness of the activity when most programs 19 have moved on in a far more sophisticated fashion, I recall 20 John Gardner@s beautiful essay on the anti-leadership vaccine 21 which some of you may have read. And it is in the part %,7h-.. 22 he was describing one of the great dilemmas of the day and 23 problems of today is the lack of any real confidence in the 24 leaders of today that is, confidence in their capacity to ce I Reporters, tnc. 25 perform and assume responsibility. When he was talking about it, lie described the 2 story of the little girl in the third grade art class who was 3 asked by the teacher,, "What are you drawing,, Mary?" To which 4 Mary replied, "I am drawing a picture of God." And the 5 teacher then said, "But, Mary, no one knows what God looks 6 like." Mary simply said, "They will when I get through." 7 So what I am about to tell you is I have no idea 8 in my own mind really what is the appropriate way of going 9 about evaluating this activity. We have an example of two 10 regions which have a poor track record in terms of what they 11 have accomplished in the past. We have told them to merge. 12 They have done that and have done that with, as I gather 13, reading between the lines, a fair amount of pain, but neverthe- 14 less have accomplished it and do look like they are beginning 15 to move in appropriate directions. So that is where it is. And I guess it is out of 16 17 that kind of anxiety and concern that I will blithely go 18 ahead and give some conclusions about recommendations about the 19 activity. 20 As I indicated before, the funding, as near as we 21 can get an estimate. of the program support of core staff of the two programs together, is about $811,000 on an annual 22 23 basis., I would recommend funding them at about $900,000 for 24 the first year which is roughly a 10 percent increase with %c ral Reportefs, Inc. 25 recommendation for second year funding about 1.0 percent above 146 I that or at the roughly $990,000 level. This does, then, 2 at least give them an opportunity to try to take the steps 3 of putting the two programs together and building a strong 4 and effective core staff. 5 They are currently funded at about $583,000 in terms 6 of individual projects and are asking approximately $800,000 7 for individual projects in this. And I would.recommend a 8 level not to exceed $500,00 0 in project activity with a 9 minimum of 5 percent increase in the second year. 10 Included in that funding of individual projects 11 obviously is the continuing commitment of the funding of 12 projects 1 and 2 which have already been approved if they so 13 desire And included in 2, is the funding of the renal 14 project if approved by the ad hoc panel. And if it is not approved by the ad hoc pane@, then'I would suggest a reduction 15 16 of that amount from the $500,000 that I recommended above, And then, fifthly, obviously excluded from approval 17 for them to spend any of their money on what would'be project 8. 18 19 which is outside the guidelines of the RMP. 20 Ande finally, I v7ould suggest that we indicate to 21 Clark Millikan and Bruce Everist at Council level that I this project for the review committee and suggest at least 22 23 that my tour of duty with P24P, at least at this point in time, at least equals or exceeds theirs, so when th ey get to alter 24 at Reporters, Inc ' these recommendations at the Council level they at least know 25 147 1 whose recommendations they altered. 2 Mr. Hilton, comment? 3 MR. HILTON: In view of the weak history of the 4 Northwest Ohio Regional Medical Program and the Ohio Regional 5 Medical Program prior to its consolidation, it might be 6 appropriate to ask whether encouraging consolidation would 7 really amount to lumping together weak programs in order to 8 create a larger weak,program. I think that is the dilemma we 9 are facing right now, and vie don't really know what with the 10 vacancy in the coordinator position and some of the other 11 things that are on the horizon. 12 However, I was positively affected by the documentatic 13 on this program. The statements of by-la@qs and very detailed 14 descriptions of administrative procedures which will be 15 implemented in this new, first operational year of the new 1 6 17 The R!,P- recognized that consolidation really has 18 been against the background of its history its major accomplish-! 19 ment for the last year. It also concedes that it has taken-a 20 good deal of time, staff time, and energy. 21 They face a problem, looking to this first year, I 22 think, a dilemma which was described in one of the documents 23 I read whether they should devote themselves aggressively to 24 piaqning and development activities in light of this new Ial Rbporteis, Inc. 25 consolidation effort or whether they should launch apparently 148 a real active involvement in new projects. I don't think it 2 was really an either/or position. They opted for the active 3 involvement in projects which I had the feeling would not be 4 appropriate. And so I totally agree with Dr. Mayers' suggestion 5 they not be funded to launch all those projects. 6 1 think there still remains to be enough uncertainty 7 about what would happen with the new coordinator. And I think 8 we are really inviting a situation where the body controls the 9 head to have this much predetermined before a new coordinator I 0could be hired, 11 I was impressed by the participatory RAG or what they 121call.their Regional Advisory Council, Regional Advisory Group. 13 Apparently that body participates fully and actively. And 14 there are some innovative ways in which RAG members will be 15 able to through task forces continually monitor the progress 16 of staff tc,@iard consummation of projects that have been 17 proposed for the area. 18 Some of the things that worried me -- I have alluded 19 to one already, and that is not knowing the coordinator and. 20 not knowing whether we are really talking now about a larger, 21 more efficient program, more efficient leadership, or just a 22 larger program. I was impressed by the efforts to keep the 23 door open for Northeastern Ohio and even for Cincinnagi, which 24 seems not to be inclined to join the group. 4,c defal Reporters, Inc. 25 On the matter of minority interests, the Statewide 149 I statistics suggest some 9 percent nonwhite population in Ohio. 2 Pnd for this region, this new consolidated region in particular 3 it would probably somewhere in the neighborhood of at least 4 6 percent minority overall. But on the staff, some 19 5 professionals', there are 2 black professional staff. There 6 are no other nonwhite minorities indicated in any of the 7 reports. And there are 2 blacks on the clerical staff. I am 8 uncertain as to the minority input into the RAG. And planning 9 committee, I-get numbers that range from 8 to 11 in terms of 10 participation and no clarity on the degree of participation. 11 Nor are there any statements indicating any move at 12 this point to act on that problem. .13 The new proDects, 9 new projects that were submitted 14 aside from the legal point on project No. 8 seem to have 151 been heavily designed by Northwestern Ohio which originally 16 covered only 12 counties. I was concerned whether the smaller 17 nui,-ber of counties to the extent'that these projects might be 18 based in those counties should'dominate the entire Ohio 19 Regional iledical Progran, which the other part of it is 49 20 counties and really the larger part of the area in question. 21 So I had some concerns about that. 22 Aside from that, I think we are put in the position 23 that we have to accept a good deal on faith at this point in 24 time due to incomplete information and the expectation of kce I @eporters, Inc. 25 new leadership in this region. And on that matter, I would iso I have to join Dr. mayer in the uncertainty, but I would agree 2 perfectly with the recommendations on funding. 3 DR. MAYER: O.K., additional comments or 4 questions. 5 1 DR. ELLIS: I would like to ask a question. Are 6 they working very closely with Comprehensive Planning A 7 agency? And how are they working with the section in north- 8 western Ohio? 9 DR. MAYER: Well, I gatlier from the information that 10 there is a very direct linkage with the B agencies. I missed 11 where that link was with the A agencies. in other words, 12 they are actually planning to subregionalize the area in accord 13 with the B agency geographic boundaries and linked to the B 14 agencies. That is part of their whole organizational chart. 15 You all got it. 16 DR. ELLIS: I just wondered what you thought about it.! 17 DR. ILKRGULIES: Could I comment on that? Because 18 Ohio is a rather unusual situation for CHP. The director of 19 Comprehensive Health Planning is Sewell Millik.-tn who is on 20 the National'Advisory Council. And he has played one of the 21 key roles in trying to carry this merger through and in fact 221 in trying to get what we initially were trying to achieve which! 23 was a merger of all three of the programs which was so far 24, ineffective. So that the relationship with the A agency is ,ce eal Reportefs, Inc. 25 unusually strong. 151 I And then added to that is the fact that the director 2of the State Department of Health is John Cashman who was 3 formerly the head of Community Health Services in HSMHA and 4 has had unusually strong interest in uniting these activities 5 in Ohio. 6 So that we are favored regardless of where they are 7 at the present time with some 'unusually strong elements to 8 em together better than they would under ordinary pull th 9 circumstances. 10 DR. MAYER: What they have programmed, they have 11 programmed a major build-up in the core staff of the total 12 region. They have developed two subregional groups with the 13 pre-existing ones, but with small staffs there, two people, I 14 think, in each one. 15 And they are proposing then they branch out from 1.6 that. For example, the Northwest Ohio Region covers two CHP 17 B agencies. And they are actually going to put their staffing 18 in those two B agencies. And the proposal is that there are 19 five 8 agencies relative to the Central Ohio one with a link 20 to those five agencies. Actually it is right on the 21 organizational chart. 22 Now, how far they have gone, I don't have a feel for. 23 But they are at least thinking about those issues. 24 MISS ANDERSON: Do they have a competent deputy kc at Reporters, Inc. 25 coordinator there? 152 I DR. IAAYER: Well, all I can comment is what I read. 2 And the opinion evidently of Millikan and Everist was that 3 the Northwest Ohio existing coordinator was not very effective 4 and that Pace had proven to be moderately effective. And the 5 problem is that they are now looking for a leader. 6 And this is one of the reasons why I personally 7 suggested that two-year funding for them as a mechanism of 8 at least providing an option for a guy to have two years of 9 assurance of a chance to build a program. 10 John. 11 DR. KRALEIISKI: Are they actively looking for a -- 12 DR. MAYER: Yes. 13, DR. KRALE;-ISKI: Everyone that is there knows that? 1 4 DR. MAYER: Yes. 15 Does staff have any further information? 16 MR. VAN WINKLE: They have a search committee, and 17 they actively now have 42 possible candidates for that position, 18 a sum of 42. Some of them are existing coordinators in other 19 @MPS who have shown an interest, one being an ex-Ohio State, 20 or graduate of Ohio State, I might say. And I believe he is 21 an Ohio boy. 22 They have hired, it is not really a deputy coordinator-' @3 They have a 'three-p--onged organizational chart there. And 24 they call them associate coordinators. And they have just al Rdportefs, Inc. 25 hired'tlr. Al Deitz who was the Deputy Commissioner of Health 153 I under the Rhodes administration. And I believe Dr. Ellis 2 is quite familiar with him. 3 DR. ELLIS: Yes, he is good. 4 I,IR. VAli WTNI@LE; He is quite an effective administra- 5 tor. And he is due to come aboard the first of June. 6 And Dr. Pace's reason for his stepping out is that 7 he said that he had 21 years commitment to Ohio State 8 University, and when it came to making a decision as to 9 whether we were insistent upon 100 percent coordinator, he had -10 to go and stay with Ohio State rather than stay with the @'-IP. I I It was his.election that he do that. 12 DR. MAYER; John, I think their problem is no one 13 in their right mind until the Council takes some sort of 14 action in this sequence, I think would dive into that. Because 15 the message that is there is that there have been two N@;eak 161 programs, and we have told them to do something about it in 171 terms of merging them. But they don't have any answer back 18 about vihether we think there ia a chance. 19 So I think what is done as action in this next step 20 is important. And this is why I put the emphasis on core 21 staff support as part of the planning and build-up of the 22 region as opposed to individual project.support. 23 DR. KRALEIISKI: That funding that you are suggesting, 24 e.,hat does that allow them to do? I am sorry, but I didn't ce I Repotteis, Inc. 25 follow that very well. I 15 4 DR. 14AYER: What it allows them to do, they 2 currently have about $800,000 in existing core staff at the 3 expenditure level. My guess is that they are going to lose 4 some of those people because of the cfianges that have occurred. 5 So that there will be some shrinkage and freedom that will 6 be as a result of that. 7 1 am suggesting another $100,000 internis of core 8 staff support for them. 2hd I am also suggesting $500,000 9 in project support if the renal disease program is approve,. 10 If the renal disease program is not approved, I am recommending 11 only $300,000 in project support. 12 Now, if the renal disease program is not approved, 13 that produces an operating budget for next year of.about 14 $1.2 million as opposed to an existing operating budget of 15 about $1.4 million. 1.6 Now, of that $1.4 million, a significant hunk of 17 that are projects which are due to be phased out. only two 18 of those that are there are previously existing projects. 19 You are caught on the horns of a dilemma. You provide 20 a significant increase for two regions who have not achieved 21 on the hopes for the future. And I guess what I am taking 22 is a middle road which says provide them approximately what the" 23 were getting as two separate regions to move forward into the 24 future to see if they can do something with it. al Repofters, Inc. 25 Sister Ann. I SISTER AN14 JOSEPHINE: I think it is significant 2 they are looking for a coordinator of the Regional Medical 3 Program. And I think there are several other programs that 4 are probably in that same position. And I think it is not 5 unrealistic to expect it is going to be difficult from here 6 on out to get good coordinators of programs. There is going 7 to be a lot of interprogram pirating. 8 And so I think that the national trend that we are 9 seeing in mergers and consolidations certainly should hold 10 on a.State level. You know, in California, we could be looking 11 for eight coordinators. 12 DR. MAYER: Other comments? 1 3 (No response.) 14 Any additional comments of staff who were on the 15 site visit in Jan uary? 16 DR. SPELLIIAN: Is it appropriate to include in the 17 level of funding a sum v7hich includes the renal project given 18 the quid--lines we have just had set? Can we do that? 19 DR. YAAYFR: Well,, it was included in their total 20 tab. 21 DR. SPELU-IAN: O.K. 22 DR. MAYER: Since that $200,000 was a part of the 23 $800,000 requested for projects, I dealt with it in that 24 context. 4,c d,,al Reporters, Inc 25 DR. HIN14AN: Do you want any comment on the kidney? 156 I DR. MAYER: Fine. I would love to have some comment. 2 I had assumed because it was being dealt with on 3 the 8th 4 DR, HINMAli: Just to set the background, all the 5 kidney documents did not arrive here until Tuesday which is 6 why it is being dealt with on the 8tho' 7 But Ohio in January of 1971 established a planning 8 group on renal disease that is statewide. It includes 9 representatives from Cleveland as well as the major cities in 10 the new merged area. 11 They have had adult type kidney doctors, and they are 12 appointing, either have or will be appointing,.pediatric 13' type doctors as well. And they are starting an organ sharing 14 program within the various centers that will be in the State of 15 Ohio. 16 There are three applications in for reveiw at the 17 present time. One is to support a pediatric neplirology 18 program. That lost its pediatric nephrologist, and it is 19 basically geared around acquisition of said pediatric 20 neplirologist and funding him. 21 The other two are organ procurement and transplant 22 expansion programs, one for Toledo and one for Columbus. 23 Those two organ procurement programs have had very critical 241 technical review. Interestingly enough, one of them, the ,ce deal Reporters, Inc. 25 investigators took into account at least-thd P,14P did 157 I and the applicantion as submitted has incorporated the critical 2 review, the things that needed to be straightened out. 3 The other does not. But it does begin to address 4 theissues of dialysis and organ procurement throughout the 5 State as a whole. 6 DR. 14AYER: It does, you say? 7 DR. HINMAN: It does begin to, yes, sir. 8 DR. YIAYER: Including the.troops in Cleveland? 9 DR. IiINI@@li: A little bit. They are still pretty 10 independent in Cleveland. 11 This overall pl anning group has the sanction of the 12 Governor's office. He in turn delegated to the Commissioner 13 of Health, Dr. Cashnan, to pull the committee together. And 14 it appears as if there would be some State legislation sought 15 by this group. And they are beginning to talk together. 16 DR. 14AYER: Other comments 17 (No response.) 18 Is everybody clear on the recommendations? Staff 19 clear? 20 All those in favor say, "Aye." 21 (Chorus of ayes.) 22 Opposed? 23 (No response.) 24 I would recommend to you that it might be worth takinc @c eal Reporters, Inc. 25 10 minutes tonight to read through those pages of 27 through 34 15 8 I in the yellow sheets of the millikan-Everist comments about 2 the situation that exists there. 3 DR. SCHERLIS: Pertinent to that, who is now head of 4 their RAG? Is it the physician Dr. Hudson who was mentioned 5 or who is his latest successor? 6 DR. MAYER: No. Brain Bradford who is evidently 7 a physician in Toledo who I gather from their comments and 8 other comments of staff is showing some fairly dynamic 9 leadership to it. In fact, the comment was made he knew 10 more about what was happening than the coordinator which was 11 an interesting comment. 12 DR. SCHERLIS: One other comment. Suppose elsewhere 13 in Ohio aregional program comes in for funding. Is there any 14 potential for a technical review group or that group charged. 15 with "regi.onalization" saying that there has to be an entire 16!Qhio renal program and not a particulated one? 17 DR. HIN@IP.N: You mean as far as the statewide corrlmitte@. 18 that is 19 DR. 14AYER: No, as far as RMP is concerned. 20 DR.HIIII,@N: The local ICIP or R:,IPI.3? 21 As far as the local PL@IP is concerned, they have been 22 an active supporter of this Ohio Renal Disease Planning 23 C:)mmittee as I believe is its formal name. 24 Technically speaking, they could address themselves ,ce de",l Reporters, Inc. 25 only to the areas that are in the map shown as being the Ohio 159 PIIP. I would assume in looking at the guidelines, the blue 2 sheets that were discussed for a while this morning and in 3 what I am hopeful wi 11 be further issuances coming from here, 4 they will understand that the whole area needs to be looked 5 at and not just their part of the State.- 6 DR. SCHERLIS: I hope this is the message -that - this 7 committee can help implement. And that is that even if 8 technical review is satisfactory, if all of these areas come 9 up with nice technical reviews, I would assume looking at.the 10 total national program, we would want to have evidence that this is an integrated program. And I think this should be 12 noted. 1 3 DR. HINT,@l: The Ohio Valley IU.IP out of Cincinnati 14 also has some kidney areas of concern. And we are attempting 15 to get into this total planning process as well. 16 DR. SCHEPLIS: 04L course, you are in a very fortunate 17 position in that you either do or do not recommend funding. 18 And you wouldn't have to be anything more than clear in your 19 direction as far as regionalization is concerned, particularly 20 4 f yz)u are talking about a n--tional network. Is that clear? 21 DR..HIN@IAN: I would hope to be able to be specific, 22 yes, sir. 23 DR. MAYER: Sister Ann. 24 SISTER ANN JOSEPHINE: Has Western Reserve been @c al Reporters, Inc. 25 brought into these plans? 160 DR. HINMALI: The Cleveland Clinic is involved, but 2 I just don't recall about Case Western Reserve, sister. 3 DR. MARGULIES: The Northeast Ohio Program is very 4 closely tied in with Western Reserve. That is the most 5 intimate part of their educational base. 6 When we were attempting to get a total Ohio program, 7 they were one of the principal actors in the'discussion. 8 But their area of concern involved in regionalization is 9 not East Ohio centered around Cleveland. 10 DR. HINI@I: The kidney area specifically, though, 11 there is already some organ sharing going on between Cleveland 121 and some of the other cities. Whether it is only from the 13 clinic or V@iestern Reserve, too, I just don't know the 14 specifics. But I think both- are involved. 15 DR. MARGULIES: I should tell you that the system 16 they are using for coordinating things in Cleveland is not the 17 same system they used for handling the poling booths. 18 (Laughter.) 19 DR. MAYER: Yes, @e. 20 MR. VAII WINKLE: The kidney committee, I would say 21 the head of the P14Ps in the State in terms of taking a look 22 at the total picture and true regionalization, they have 23 representatives from the Cincinnati area, the Toledo area, 24 the Cleveland area, the Columbus are. They are fully kc Ial R6porters, Inc. 25 represented throughout the State on this committee. And that 161 I also becomes their technical review body for any proposal 2 that comes in to any RMP within the State -- representatives, 3 you know, from that State committee. 4 DR. M7,.YER: on renal disease. 5 MR. V@l WINKLE: Renal disease only. 6 DR. 14AYER: O.K., I would like to move on now to 7 Northeast Ohio. 8 We will need to give some thoughts to the degree to 9 which we feel comfortable about rating or nonrating of this .10 proposal. I am in the comparison of apples and oranges kind 11 of issue myself which was part of my dilemma on it. And as I 12 go through it, I am at the one, two, three end of the spectrum 13 relative to this. 14 But I would have to say given the circumstances, 15 I don't know how they could be at other than the one, two, 16 three edge of the spectrum in terms of tkying to develop a 17 new @IP. So the question is do we want to rate it and what 18 are the potential implications of that. 19 Lorraine, any-comments on it? 20 MRS. KYTTLE: No, sir. 21 DP,. SPELL'L@'i: I don't think I could rate it if it 22 is going to be commensurate with the decision to fund it. 23 I don't see how to translate into this. So I just.couldn't 24 rate it, kc al Repotters, Inc. 25 MR. CHAMBLISS: May I comment there? DR. 14AYER; Yes. 2 MR. CHAMBLISS: You asked what are the implications 3 of rating, and you had suggested some numbers. Whereas I 4 would not suggest numbers, I would say whatever rating this 5 committee may.place on that region. would certainly give it 6 some indication as to where it stands. It would give it some 7 water line as to where it stands as a region-based on the 8 action of this committee. 9 MR. HILTON: Are we talking about rating the .10 internal structures now, the internal coordinator and internal 11 advisory committee, as opposed to region? .12 DR. MAYER: Well, I guess the question of the 13 committee is do you want to rate it or not. 14 DR. SPELT24AN: Let's have a motion. 15 DR. SCHERLIS: Again, I am in a dilemma in that I 1.6 don't see why we should rate it. We are rating all regions on 17 the basis of a lot of extenuating circumstances, some more 18 extenuating than others. 19 I would think that the numbers that we come up with, 20 and I assume you do as chairman misuse your prerogative in 21 telling us how you rated it. 22 DR. MAYER: I am sorry about that. Like Mr. Nixon, 23 I occasionally forget. 24 DR. SCliERLIS: I would think we should rate it just .@c al Reportefs, Inc. 25 to make matters clear. DR. MAYER: All right, fine. 2 Before we do thate I had promised Mr. Iciiinowski 3 we would coment briefly about the rating sheets before we 4 did Oregon, and then I flunked again. 5 Would you care to comment? 6 Lee, you have another conunent? 7 MR. VIU4 WINKLE: I think we are rating something that 8 doesn't exist, sir. This new organization that you are taking 9 a look at is not even legal until September 1. So are you now 10 rating the two old region@? 11 DR. SCIILERIS: Then we are funding a non-existent 12 organization. 13 MR. VAN WINKLE: That is an application for 14 September 1. 15 DR. MAYER: Subject to. 16 DR. SCIILERIS: I think we hve to view the combination 17 of the two and come up with some evaluating system. We 18 reach the evaluation by the level of funding that we gave it. 19 I assume there is something objective behind that.' 20 DR. 14AYER: Comments on the rating systp-m. 21 MR. ICHINOWSKI: I have a couple of notes I would 22 like to pass on to you which could help us as you do the 23 scoring and some problems that we had with the rating sheets 24 that we received from the review committee last time. ce -,,,I R6portefs, Inc. 25 The key to remember, of course, is the one to five 16 4 I rating. That second column with the numbers running down it 2 is the weights. And regardless of whether a criterion has 3 15 points, the scoring still goes from one to five. We did 4 get them running up to 10 and 15. 5 We would request that each criterion do receive a 6 score because if you leave one of the criterion blank, that 7 negates the weight. And this causes difficulty in calculation. 8 We also ask that you do not score, even if the 9 region is in-your opinion not worthy of but one, that criterion 10 as a zero. Because that also causes us some problems. 11 With some of the raters last time wishing for some 12 more expansion in terms of identifying a region other than 13 1, 2i 3, 4, or 5, we notice that some were scoring 2 plus or, 14 3 minus. The scoring system has now been expanded to include 15 1 decimal such that if you want to score a region 3.2 or 16 4.5, you can do this in each of the criterion. But try to 17 stay away from something like 2-1/4 because then that causes 18 another problem with two decimal places. 19 MR. PARKS: Would _you go over again the problem 20 a zero gives you? I really didn't get that. 21 MR.,ICHII;OWSKI: A zero, when we multiply by the 22 weight that criteria has just multiplies out to zero. I would 23 suggest if you feel a region should be given a very low 24 figure for that particular criterion, maybe give it a .1 ratherl k,e at Repoiters, Inc. 25 than a zero because then, let's say the criterion you select 165 happens to be number 2, accomplishments and implementation, 2 which is worth 15 points, by you scoring a 0 on that element, 3 your actual output of that is 0 times 15 or 0. 4 MR. PARKS: That is accurat7e. 5 DR, SCHMIDT: But we don't want it that way. 6 MR. ICHINOWSKI: That's accurate in terms of maybe 7 what you want to give, but in terms of then compiling it by 8 some automated calculation technique we are using, it.throws 9 it out as a reject. 10 DR. @IARGULIES: It is really conformity to the 11 machinery we are asking. 12 DR. IDAYER: No. 13 DR. I.,'-@RGULIES: Not quite, but actually it throws 14 off the total calculation if there is a non-entity in there, 15 DR. I.IAYER: Dr. liess, 16 DR. HESS: I have a question. If I understood you 17 correctly, you want some number of some sort other t:nan zero 18 in every one of those boxes, right? 19 MR. ICHINOWSKI: That's correct. 20 DR'* IIES-Q: One of the principles of rating is that 21 you try not to halo, and you try to be as specific as you can 22 on every point. If you don't have data upon which to base a 23 judgment, you are better off not making any judgment. 24 DR. 14AYER: I thought we arrived at we would circle kc at Reporters, Inc. 25 those.' MR. ICHINOWSKI: what we have done in the past is 2 we have circled those to indicate that the reviewer had 3 some concern or no data regarding his rating. 4 DR. HESS: For example, regarding Ohio, there are 5 many of these categories we essentially have no information on. 6 MR. ICIIINOIISKI: That is a tough region. 7 DR. HESS: It seems to me it is very unfair and 8 illegal to make judgments on the basis of no data. We have 9 data on certain of those categories, but others we have 10 nothing. 11 DR. @IAYER: Joe, I suggest you circle them and say 12 that thelprimary reviewer didn't provide you the information. 13, DR. WHITE: What if we should happen to --ay we cannot 14 rate this,> Does this make the machine angry at one of us 15 (Laughter.) 16 DR. ICHINOVISKI: If you do not rate the region, we 17 have provision for excluding all your dta elements in that 18 particular region. 19 DR. SCHERLIS:- If I follow you correctly, then, 20 if we exclude some, you are going to exclude it all? 21 MR. ICHINOIISKI: Or else try to come up with some 22 provision for filling in the blanks that seems reasonable. 23 DR. MAYER: The issue is, Leonard, your opinion is 24 probably better than his about it even though you feel ke ra I Reporters, Inc. 25 uncomfortable with it. iyvrj,nl*u:oi L/niv I* 0 0 A.U I 0 DR. SCHERLIS: But in reality, if you get down t 2 what we really do is we put down these numbers after we have 3 such a forceful, lucid presentation as we just had by our 4 chairman. Vle attempt to really extrapolate what he is thinking 5 in terms of numerical value. And in case we don't follow the 6 directions, he lets-us know what his numbers are. 7 (Laughter.) 8 DR. MAYER: In advance. 9 DR. SCHERLIS: It proves very helpful. 10 DR. 14AYER: other comments? 11 (No response.) 12 Has everyone who intends to rate the Ohio Region 13. rated the Ohio Region? 14 (Laughter.) 15 DR. SPELLI.IAN: Yes. 1 6 DR. @IAYER: Let's move on to the Northeast Ohio. 17 Sister Ann. 18 SISTER ANN JOSEPHINE: I have some of the same 19 difficulties in providing information on this particular region i 20 as Dr. Mayer did. The one contact I had with the data from 21 the region was as a member of this committee at which time it 22 was the decision of the group that rather than have three 23 very weak programs, there would be advantage in making a 24 reco@, ndation that there be consolidation in development C, ,al Reporters, Inc. 25 of one strong program. 16 8 However, as Dr. Mayer indicated and the 2 material that is in your book gives the details of this, 3 the Northeastern groups strongly based in Cleveland decided 4 not to go along with this recommendation and at the present 5 time are submitting a request for funding of an individual 6 Regional Medical Program, 7 In assessing this particular program, one has 8 to keep in mind that for 17 months, no coordinator was 9 present during which time there was not an entire lack of 10 leadership, however the leadership was shared by many people. 11 And as a result, the total effort was not coordinated. 12 More recently#, Dr. Gibbons has been brought i n as 13 the coordinator of the program. And in reading some of the 14 descriptive material concerning the new coordinator, apparently 15 he has been in the Cleveland area for many years. He is Very 16 well acquainted with the medical community and is able to 17 work very well with the diversified components there. However, one of the Concerns I personally would have 19 would be with the fact that-here we a coordinator who is 76 20 years old. @.nd this is not saying he can't be innovative and 21 all these things, but certainly the possibility of his availabi 22 over a period of time doesn't exist at the same degree as it 23 might if he were younger. And besides that, he has no assistant 24 coordinator to work with him in this program. @ce eal Reportets, Inc. 25 And one of the weaknesses of the program as it was 1 described by the site visit team chaired by Dr. White in-19,70- 2 was the fact that core staff at that time needed additional 3 development. I think the situation still exists. And I 4 think that in this particular area of'responsibility of a 5 coordinator in the absence of adequate core stafff we are 6 probably going to encounter a great many problems. 7 The operational projects, four in number, are 8 in no way related to the objectives that are stated for the 9 region. This was true in 1970 and apparently it hasn't been I 0 changed in the intervening time. In 1970, concern was expressed concerning the 12 composition of RAG. I believe some changes were made. Addition 13 "consumer representatives" were added to the group. Ho%.7ever 14 there is strong domination by the executive committee which 15 originates from the board of trustees. And in reading over 16 the material provided, I would get the impression that RAG 17 simply passes judgments on the kinds of recommendations that 18 the executive committee and the board choose to submit to RAG. 19 I.believe, Mr. Parks, would you want to give some I 20 of your other impressions? 21 DR. @IAYER: Mr. Parks is secondary reviewer on the 22 project. 23 MR. PARKS: Sister, I concur largely in what you 24 have said. As a matter of fact, totally. And, again, I think ,ce I R@portefs, Inc. 25 the predicament here highlights a situation which is incapable 170 I of evaluation. 2 The predicament does not lend itself certainly to 3 any of the factors w hich we have on our evaluation sheets. 4 We are faced with a situation where we have a new coordinator 5 who did not participate, I understand, in development of this 6 particular application that we have here and a rather sparkling 7 record 'of failure in this case. 8 I know of no other way to present it accurately. 9 My basic inclination is that assuming it would be 10 an appropriate remedy for this committee, I would recommend 11 that this program be shut down. 12 The situation is tempered somewhat by some information 13 that wa@ delivered to us today and by some previous action of 14 the National Advisory Council which would appear to pre-empt 15 the action by this particular committee. And that is contained, 16 I believe in the papers which you have. It is a letter 17 dated February 10, 1972, from Dr. 14argulies which transmits 18 to Dr. Glover the action of the National Advisory Committee 19 which is to the effect that the program be retained at its 20 present level of funding, 21 And so it would seem, then, that anything that we 22 might have to recommend to this committee with respect to eithe-@ 23 continued funding or level of funding would be superfluous at 24 this time. kce I Reporters, Inc. 25 It does, I think, relate to the larger question of th J.71 I role of this committee and especially in a situation where 2 the National Advisory Council has spoken on the matter previous' 3 There was, I think, in this case as in the other 4 Ohio situation a site visit conducted by some members of the 5 Council. 6 There are-some items about which we might particularly 7 with respect to the Regional Advisory Group, its make-up and 8 composition, the distribution and participation that is 9 effective participation of minority persons, the participation 10 of minorities on the staff, the non-application of priorities 11 which are established to program activities. 12 For example, they indicate that their top priority 13 is meet'ng some of the needs of the people in the urban zzreas, 14 And certainly running down those four priorities, I find none 15 of the op, erational effort directed to this. I find certainly 1.6 again with the exception of the Urban League director, I 17 don't find among the members of the Regional Advisory Group 18 or the trustees the kind of participation from among the 19 consumer element that you would expect to find in a situation 20 like this based in an urban setting such as Cleveland. 211 I think there is something to be said for having 22 engaged a coordinator who has the historical qualifications 23 that Dr. Glover presents. Among the papers which were 24 presented to us was a statement indicating that he has trained @ce I Reporters, Inc. 25 the majority of the practitioners within,this region's scope 172 I of activity. And it is largely through his standing within 2 the medical profession-and his personal.acquaintance with 3 the principal actors that he is able to bring together and 4 perhaps to effectuate some change. 5 The-papers that were handed over just momentarily 6 I think Sister has those -- may throw some light on it as to 7 prospective activity. But if what we are rating covers 8 the period in the past, I would say that this program is 9 questionable and based on its past performance, I would say 10 that'- it was of doubtful prognosis for the future. 11 Nonetheless, we are advised, I am advised? that the -12 new director, despite his yearst and possibly because of it, 13 has, I.guess accentuated change and is currently developing and 14 restructuring this particular program. 15 But for those qualifications, I would say, first of 16 all, there is a very real question as to whether this business 17 is appropriately before this committee. 18 The second thing is if it is an appropriate rertedy 19 for this committee to recommend, I would be for recommending 20 the money for this program be withdrawn. 21 DR. IIAYER: Could we deal with the question that 22 is being raised? Because I have a little trouble with 23 substantial inconsistency of the letter of February 10, Harold, 24 in which it implies that @ National Advisorv Council ce I Repotters, Inc. 25 recommended at this time, presumably in the February Council, 173 a continuation of supprt for one year at a basis not to 2 exceed the existing level funding. And then in the concluding 3 paragraph, it says, change in review cycle will start date 4 for Northeast Ohio program from June @o September @, 1972. 5 Therefore, the present grant period for Northeast Ohio will 6 extend through August 3le 1972. 7 And presumably, this application deals with that 8 period after August 31, 1912. And yet presumably there is 9 some kind of commitment for funding in the region through to 10 what -- February of 1973? I understand the issue you are raising because I can'4- 12 see it. 13 DR. DIARGULIES: What @-ppened earlier when we reached 14 the same conclusion you did about the program which is that.- 15 both Northwest Ohio and Northeast Ohio were of such doubtful I 1.6 quality that there was serious consideration about whether tney@ 171 should be continued at all, we did put considerable pressure 18 on them to make some basic alterations. We, in fact, limited 19 their funding during that period of time to six months and 20 then gave them an extension of six months to see how effectively 21 they could work out their plans. 22 And when they reached a tentative agreement which 23 required the Council to act on whether or not they should conti.-,-, 24 the decision was made they should have funding for one year. ce I Reporters, Inc. 25 What you are addressing would affect their activities I 174 1 thereafter. And so if you were to make a recommendation here 2 that this program should no longer be continued, it would be 3 a matter of phasing out their activities with existing funds 4 and then closing it down. 5 MR. PARKS: When would be the date that their 6 current funding would terminate? 7 DR. MARGULIES: Their current funding under this 8 one-year extension -- I will have to as k for some help on 9 that. 10 MRS. KYTTLE: August 31. 11 DR. I.IARGULIES: August 31 of this year as,far as 121 I know, 172. 13 DR. @IAYER: Except there is an implied commitment by 14 Council until Februaryt at least one year from February 10, 15 in your letter. 16 DR. MARGULIES: Well, I am sorry because the letter 17 was confusing. That referred to the six months and then 18 six-month extension so that so far as I know they are funded 19 only through August 31 of 172. 20 DR. SPELLMAN: Was one of the clear alternatives 21 merger or abandonment, so to speak? 22 DR. MARGULIES: No. We did not require them to merge. 23 What we did was lay out to all three programs their deficiencies 24 and recommend they give merger serious consideration. And @ce fal Reporters, Inc. 25 that's why we had members of the Council go out to see what 175 progress they had made. 2 The efforts to consolidate were partially effective. 3 So you see two programs instead of three. But we still have 4 the problem of Cleveland and the rest of Ohio. And the 5 viability of the program is one to be judged at the present 6 time. 7 SISTER ANN JOSEPHINE': This morning when I said we 8 have to be sure we ask the right questions, I was thinking 9 in terms of this report. And I personally don't feel that the 10 question is at what level shall we fund them,but I think the 11 question, is should we fund this program. Should we continue 12 to fund:this program? 1 3 DR. MAYER: Comment, Phil? 14 DR. WHITE: I don't understand this concern in 15 reading this. Some of the comments by Drs. Millikan and 16 Everist suggest that in spite of his age, Dr. Glover seems to 17 have some leadership qualities. What has happened since that 18 time? Has he made any move? 19 Is Dr. Hudson still a thorn in their side? 20 Has there been no progress at all since that visit by Dr. 21 Millikan and Dr. Everist, or has there been? 22 DR. MARGULIES: Do you want to comment on this? ?3 DR. MAYER: Mr. Ashby, comment? 24 MR. ASHBY: Actually, Dr. Glover is able to contain 4,e eal RLpottefs, Inc. 25 even Dr. Hudson. He does a good job of that. lib I And, yes, he has been very busy.. The program staff, 2 at this time, morale is much higher. They seem to be working 3 harder, although it is just.observation. Everyone that has 4 met him seems to be impressed. Even though he is 76, he is 5 a young 76. He realizes his age is a limiting factor as far 6 as being able to be around in that program for a long period 7 of time, 8 He impresses me as a mover, a iid I don't believe he 9 would have taken the position at all if he hadn't thought he 10 could do something with the program. He was one of the 11 biggesticritics the program had prior to his acceptance as 12 coordinator. 13, DR. WHITE: I gather Dr. Robbins 14 DR. MAYER: Phil, we couldn't hear you. 15 DR. IIHITE: I was asking if Dr. Robbins, the dean 16 of the s ool, was in favor of PI,IP. 17 DR. I.IAYER: That to me is one of the great unknowns. 18 Fred Robbins, in spite of his research background and his 19 Nobel-laureacy is really committed to community health action 20 efforts. And yet here sat that RMP all this time without 21 movement. And I can't put those two facts together in my 22 mind. If anybody can help me with that out of staff or 23 elsewhere 24 DR. ELLIS: I can. @ce I Reporters, Inc. 25 DR. MAYER: All right, Effie. 177 DR. ELLIS: His philosophy was a little bit out of 2 line with that of the rest of the people at the time. And I 3 think the Midwest is pretty-conservative. And this accounts 4 probably for the fact that it would take a little while to get 5 the show on the road. 6 DR. MARGULIES: Fred has been very deeply involved 7 in the efforts to rebuild this program. When we first tried 8 to have a merger of all three, he was one of the leading 9 voices for a true merger. 10 The problem, on the other hand, getting back to 11 Northeast and the question of why didn't it got Bill, so far 12 as I could tell, it was the inability of the people in ]3z Cleveland to resolve their own internal differences. It is the 14 II old issue of Western Reserve and the Academy of Medicine and 15 the local politics. And about the time he would make a 16 move an one direction, he would run into Charlie Hudson coming 17 from the.other direction. And he has not really been able to 18 overcome some of the resistance. 1 9 I think if he -had had a free hand and if there had 20 been a coordinator -- You may remember when this program was 21 first developed, the coordinator was a fellow named Barry 22 Decker who was a very vigorous, imaginative, hard-working guy 23 who got the program through the p2anning stage and promptly 24 was recruited away. And they then were unable to get a @ce "I I Repotters, Inc. 25 coordinator. And I think the main reason they couldn't get one, 17 8 and this is the real stalling point is because they couldn't 2 reach a resolution between the vying medical-political forces 3 within the Cleveland area. They would got somebody, and if 4 it was All right with Western Reserve, it wasn't all right 5 with the Academy. And sometimes they would say, "Maybe we 6 better go out of state to get somebody who is neutral." And 7 they were really bung up on their.own internal differences 8 while Fred was trying to get something reasonable accomplished. 9 fie is still actively interested. He still gives 10 strong support to the new cco--dinator. I don't know that they 11 have resolved those problems. 12 SISTER ANN JOSEPHINE: The question that arises 13- -in my ml d is would it be and it would seem to me that it might 14 well be to the interest of the total State to take a stand 15 that might give a little more encouragement to this merger. 16 DR. 14ARGULIES: I quite agree. What we have said 17 is that we acce ted the present arrangement as a tentative p 18 one, but we insisted they continue to work toward a final 19 resolution of a total State system. But that is sort of good 20 advice. I don't know how strongly it is accepted or how much 21 meaning-it has. They are meeting together. They will talk 22 with one another more and more, but it is not quite what you are 23 talking about. 24 DR. @MYER: Yes,, Leonard. @ce al Repotters, Inc. 25 DR. SCHERLIS: Do I read correctly the printout their budget essentially is divided between tl-le.four, the hospital 2 librarian, coronary care unit training strep culture, and 3 strong reh,@? Is this the total progr'@im? 4 SISTER ANN JOSEPHINE: It is really not. It is a 5 very difficult program. They call it program. 6 DR. SCHERLIS: That comes to something like 7 $800-some thousand. 8 SISTER ANN JOSEPHINE: Actually, I think we are 9 describing a planning component and calling it an operational -10 program. 11 DR. 14PRGULIES: We have had repeatedly from that 12 program whenever we have leaned on them hard, particularly 13 about the coordinator, the co--plaint that there is so much 14 national instability in the Regional,Medical Program that it 16 is impossible to get a coordinator. And we keep telling them 16 it is like arguing that you lost the ball game because it 17 rained. The other team is in the same rain. Other programs 18 have developed, have had strong coordinators, have replaced 19 them and got good people, and they haven't been able to. 20 But they have used this as a kind of a defense for not doing 211 anything. 22 Vlhen you look at how long that program has been 23 without a coordinator, it has been ever since they became 24 operational up to the present time when they have gotten Dr. kce I Rdpofters, Inc. 25 Glover in. And that has only been within a matter.6f a few I 180 I months. I think he came on board in January. 2 DR.I,.LAYER: Yes, Joe, 3 DR. HESS: It seems to me we have to look, if we 4 accept Mr, Parks' and Sister's 5 DR. MAYER: Could you use the mike? We really 6 can't hear you. 7 DR. HESS: If we accept Mr. Parks' and Sisterl's 8 feeling perhaps the thing to do might be to recommend the 9 phaseout of this program, then we have to look at what happens 10 if that actually is taken. 11 I think we would be in a better position or at least 12 I would feel more comfortable about being in favor of that if 13 the Ohio program were in a more stable state itself. But I am 14 just wondering if that wouldn't add an additional burden to 15 two regions that are already tryin@ to merge and a coordinator i 16 that is only there for another month or two. And how much can 17 it take? What are we going to do to MIP in that whole State 18 if we do this all at once? 19 Maybe one way out of this dilemma is perhaps delay 20 this for a year and give the Ohio RMP a chance to see what it 21 is going to be able to do and then take another look at it. 22 And maybe merger would be appropriate at that time. 23 But I must say I am worried about wiping this one 24 out and saying merge with Ohio right now in their current state ce I Repoftefs, Inc. 25 of flux. DR. MAYER: Sister Ann. 2 SISTER ANN JOSEPHINE: I wonder if in line with this 3 February 10 letter which could well give us a position that we 4 could continue the funding until February of 173 which would 5 be nine months and say by this time, you know, we would hope 6 you would be able to work out these differences, that would 7 provide that leeway in keeping with something that we made 8 some kind of a commitment to. 9 DR. MAYER: Well, what would we expect? I guess I 10 need to have some feel in term,- of the new cycle, what that 11 would mean. Presumably, that would mean that would have to be 12 reviewe4l in January which says that whatever new application 13@ would have to be inhouse when? 14 1 am trying to get a,feel for what kind of time is 1 5 that. 16 @DR. 14ARGULIES: November. MRS. KYTTLE: I think we ought to look at ohio's 17 18 schedule more than this region's schedule. If we want them 19 to think about effecting a merger within a certain period of time, should we not be looking at the place with whom thev 20 will merge rather than this place? 21 DR. MAYER: I am not sure I was hearing a clear-cut 22 23 call for merger. I think what I was hearing was a clear-cut 24 call for turning it around or else. That is v7hat I was hearing. ,ce I R6pofters, Inc. SISTER ANN JOSEPHINE: No. I think we are moving 25 182 I toward merger in this. 2 Really, it is very difficult to motivate any other 3 way in some cases. I mean,.it is a matter of really the funds 4 are the'strong point you have. And as I read all this, it is 5 not just an arbitrary decision. It is really in the best 6 interests of the total program for the people. 7 MR. PARKS: With respect to merger, if,you allow this 8 program to survive, I think the question of merger is an 9 appropriate local decision. I think it is an especially 10 important one. I think we should be careful not to get into 11 a posture where we begin to dictate what ultimately ought to be @decision because we also would be the ones who will 12 a local 13' come al@, ng and evaluate them. And we may have forced them into 14 an unnatural situation. And I would certainly hope that even though that may 15 16 be something of a tactical guess as the appropriate direction, 17 I certainly would dissent from any decision that would indicate' 18 to them that we expected or would expect as a factor of ig evaluation to have these programs merged into a single unit.. I think more important that we have an effective 20 21 unit that meets with your broad national priorities. And as long as it is operational and if you can ascertain that it is 22 23 moving effectively in that direction, if you can find a mechanis- 24 to close the book on a bad chapter and rate that chapter for .ce I Reporters, Inc. precisely what it is and then the next time you take a look at 25 it, measure it from this time forward, I am not so sure 1 2 would want to be in a position of this place and with the 3 information that we have indicating to them that they must 4 merge or else. 5 I really don't have the information to make that 6 decision. 7 SISTER ANN JOSEPIIINE: I agree. 8 DR. MAYER: Let me see. To me, it seems like we have 9 roughly three options given the kind of tenor of the discussion. 10 One option is that we say effective August 31, they 11 are out.of business. And they can come back in and reapply 12 for a ne, w RZIP if they want to do that in some form at some 13. future date. That's one step we can take. 14 The second step we can take is extend them to the 151 Februarylperiod and say that by November you must have a 16 program in here developed for review or you will be out of 17 business effective February 28. 18 Or, thirdly, we could say, all right, we are extending 19 them at some level from-,now, from August of this year, to 20 August or September 1 of next year with the same kinds of constraints on it. 21 Now, those to me seem to be the three options. 22 23 SISTER ANN JOSEPIIII,4E: And if we did No. 2, what would be our expectations at the end of that time? 24 ice I Reporters, Inc. DR. MAYER: That is up to us, the committee. And we 25 .L 0 -t 1 need to have those laid out more precisely. 2 Yes, Joe. 3 DR. HESS: In connection with your third option, 4 might we consider recommending what in essence would be 5 reversion to a kind of a planning phase? Phase out many of 6 these activities and ask them to take a good, hard look and 7 come in a year from now, fund them for sort-of a planning year, 8 come back in with a better plan which reflects some very 9 serious rethinking of where they are going to go and how they -10 are going to get there. And this would keep them in phase with 11 the Ohio, and that would provide an opportunity for them to 12 look at this question of merger as well as to look at the 13 strengths they have to pull the program together. 14 Is that possible? 15 DR. @IAYER: Sister Ann, comment? 16 SISTER ANN JOSEPHINE: Is Ohio in a planning stage now, planning phase? 17 DR.MARGULIES: No. 19 SISTER ANN JOSEPIIIINE: It is operational? 20 DR. IIAYER: Except that the recommendation we made vis-a-vis the new Ohio R.MP was most of the dollars in the core 21 22 staff to support that planning group and evaluation grouD that 23 they are proposing for the two combined regions with very 24 little money in terms of operation. The money that we %ce rat R6portefs, Inc. suggested was roughly two to one, three to one, in terms of 25 185 I staff as opposed to projects which is the reverse of the 2 usual situation. 3 So in that sense, we have moved them in that 4 direction. 5 SISTER ANN JOSEPHINE: Then, what Dr. Hess is 6 suggesting would enable us at the end of the year to 7 evaluate the region'-s capability of planning and ability to 8 become operational or not. Is that what you are saying? 9 DR. HESS: Right. Cut them back, phase out the 10 project funding or reduce it substantially. 11 SISTER ANN JOSEPHINE: And it might even be that 12 during this period of time, they could begin to look toward 13 maybe working more closely with the other Regional Medical 14 Program in the State. '4aybe that is the way they can take thei 15 first step. Maybe it isn't the most desirable way to go. 16 And then if their planning stage, if at the end of the' 17 planning period, the group felt that they were ready for 18 operational funds, then we could move in this direction. 19 Is it just one year for planning? 20 DR.' @IARGULIES: Technically, we would not put them 21 into the planning stage because that has too many legal 22 complications. Functionally, in a planning stage, which works 23 out the same way. 24 The only cor,-L-ient I would like to make regardless of ce I Reporters, Inc. 25 your decision is I think this extraordinary attention to the 186 1 prog ram is well deserved. If they get through the present 2 period of pressure and emerge as Northeast, Ohio feeling 3 that they can now feel as though they are on sound ground, they 4 will be making a very bad mistake, ana so will we. Because 5 what has come out of it is anything but satisfactory up to the 6 present time. 7 But we do feel the potentials are there. But potentia 8 aren't enough. 9 DR. SPELLI.IAN: Which means at the end of that year 10 they would if they had not merged or had not made progress, 11 you would have to phase them out. That would have to be Clear. 12 otherwise, you would just be repeating the same. 13 DR. MARGULIES: That's right. 14 SISTER ANN JOSEPHINE: And the success that has been 15 subscribed for this program rather'recently is all bound up 16 with one particular person, not a program. 17 DR. MAYER: Am I clear that their current level of 18 direct cost funding is in fact $690,000'.> I am looking on, I 19 guess it is pink. I am not sure whether it is pink or salmon, 20 but it has an asterisk and says "Does not include 24-month 21 extension for 01 year of $2,376,000." I don't understand it. 22 What level of funding are they currently at? 23 Let me make a suggestion-in terms of staff. At least what I need or what I needed when I reviewed programs is to 24 ce I Reporters, Inc. 25 have a fix on what the current annualized, most up-to-date 187 I operating costs are of the program as it is then functioning. 2 Now, maybe we' have got in here that data, but if 3 somebody said to me what are they currently functioning on 4 an annual rate basis in terms of core staff and in terms of 5 project -- that is the information we need to have in terms of 6 where they are. I don't know where they are. They are some@.;he 7 between $2.3 million and $690,000 on an annual basis. I don't 8 know where they are. 9 Ca4 staff help? 10 MRS. KYTTLE: We don't have their current expenditure 11 rate in here because we don-It have it. We get expenditure 12 rates 120 days after a program year is ended. And then they 13 are negotiated and audited. 7nd it is quite a while before 14 the review system gets that information. By the time we get- 15 it, the review system has traditionally felt it was so old 1.6 that it was not applicable to the year that we are considering. 17 DR. MAYER: Let me ask the question a different way. 18 We must have some idea of what-their anticipated expenditure 19 is from September 1, 1971, to August 31, 1972,, which is when 20 the thing runs out. or don't we even have that? 21 I-IRS. KYTTLE: Their anticipated expenditure? DR. MAYER: How many dollars have they got to deal 22 23 with? 24 MRS. KYTTLE:, You mean their award? ce I Repofters, Inc. 25 DR. 14AYER: Yes. 188 I @MRS. KYTTLE: This region had so many extensions 2 that it had a 24-raonth 01 year. And their 690 is a 12-month 3 proration of that 24-month money. 4 DR. SPELLMAN: That 831? 5 MRS. KYTTLE: lqhere is Vernon? Did I say that right, 6 Vernon? 7 MR. ASHBY: Not it is not. The $786,187, they are 8 funded now for an 8-month period. I was trying to figure it 9 out here. It is 5 something. And it was divided by 8 and 10 multiplied by 12 to give you the figure out here on the right- 11 hand column. 12 DR. MAYER: So the ball park is $786,000, then. That 13 is the level they are functioning at. 14 MR. ASHBY: Yes. 1 5 DR. @IAYER: O.K. 16 DR. SCHERLIS: May I have some other clarification 17 on funding? I-le have used the terms growth and development and 18 found that somewhat confusing. 19 Doctor, looking at the record, would you give me a 20 guess as to what you would think a reasonable amount of funds 21 that a region of this size with a core of $540,000 to allocate I 22 feasibility studies -- that is somewhat development and growth 23 DR. MAYER: I.don't under-stand the question, Leonard. 24 DR. SCHERLIS: I guess what I am driving at is @ce eal Reporters, Inc. 25 looking at their summaries of core, the $539,000 for core 189 I activities, they spent $246,000 for feasibility studies which 2 core activity in an area that has had so much difficulty with 3 lo oking for programs seems to me an excessive amount of money, 4 particularly since their entire project support is less than 5 that. 6 What I am making is obviously the one I don't know 7 how they manage it. :Is there any'reviev7 of RMPS of those 8 expenditures as they'go on? 9 SISTER ANN JOSEPIIINE: I don't have any data. 10 @IRS. SILSBEE: As a ramber of SARP, we looked at 11 the money they v7ere spending for those kinds of things under 12 core as being the only hope for this program. It was small 13' studies hat were going on under the core staff. 14 DR. SCHERLIS: It must have been a lot of small 15 studies. 16 DR. PIAYER: Dr. Ifinman. 17 DR. HIN14AN: One of these feasibility grants was to 18 the Youngstown Warren area which is one of their regionalized 19 areas and has developed into a community-based manpower 20 development Proposal which will be reviewed on the 21st. But 21 the planning group and the concerns of the group seem most 22 appropriate in Youngstown and Warren. So there has been some 23 payoff for these dollars. 24 SISTER ANN JOSEPIIINE: Were they specific about what kce "a[ Peportefs, Inc. 25 the payoff was? i:j u I DR. IiINMA14: Well, I visited with them in one of 2 their planning sessions, and they had brought together the 3 people from the three counties in Ohio and the two in 4 Pennsylvania that were contiguous that are in this medical 5 trade area -- consumer representatives, medical society 6 representatives, education representatives -- to sit down and 7 talk about whether or not they wish to try to do something 8 together along the model of either.the Carnegie Commission 9 mental health education center or the MIP defined community- 10 based manpower d evelopment. 11 The total dollar investment, I think, was in the 12 neighboxuiwv" w,- $12,000 or $14,000. And it was basically in 18 the salary of i,irs. Baird, the area coordinator, who was 14 spending, the time and effort in developing this program. 15 DR. SCHERLIS: It was $26,000. 16 'SISTER ANN JOSEPHINE: One of the strengths of this 17 program,, if I were to try to identify a strength, has been the 18 ability to get different groups together. You know, without 19 going into this as a feasibility study. At least this would be 20 my feeling. 21 DR. MAYER: Well, let me go back. I think we have 22 got the three possibilities. And then under those three, we 23 have to arrive at a level of funding with some principles 24 hooked to it that people can understand and rationalize. %c at Reporters, Inc. 25 Yes, 19 1 MR. GARDELL: I just say the funding, then, is 2 $781,000 we are working with. we had no Council level, approve,@ 3 level, of record because that was the end of its program period, 4 And so we were just working on an extension basis. That was 5 the level prior to the cut in 171. And it is the figure we 6 have been working with all along. 7 DR. 14AYER: The $781,000 which has roughly $500,000 8 or $600,000 of core and a couple hundred thousand of projects. 9 MR; GARDELL: I don't know what the breakout is. 10 All I know is the total figure. 11 I also should say to you we don't have any expenditu--O-' 12 reports from that year. We are still extending that'71 grant. And it is running 26 months. And you don't get an expenditure 14 report until 120 days afterward. 15 DR. 14AYER: Leonard. 16 DR. SCHEPLIS: I would suggest that they spend some 17 of their feasibility funds to learn how to write grants. 1 18 could make absolutely no sense'out of that document. 19 What you are telling me about the length of year one, 20 1 have always looked at year one rather conservatively as 21 being roughly 12 months, as I understand it. I don't accept 22 220 percent year one unless it is clearly stated in the 23 record. 24 And to pick up that blue book, I want to congratulate %C al R6porters, Inc. 25 the two of you who reviewed it for making any sense out of it. 192 I find it completely lacking as far as any history or what 2 went on. Was I short-sighted when I looked at it or were there 3 pages that were missing? Because there was absolutely no 4 history. And I tried to figure out h@w they did every thing 5 they did in one year. 6 How they can get this bad a record in one year is 7 something I could not figure out. It was a rather long year. 8 DR. 14AYER: Dr. Schmidt. 9 DR. SCHMIDT: I don't think it would be appropriate 10 to close them down. And I think what we ought to do is approve 11 them for a period of tire that would be approximately a year 12 or whatever it would be to get the end of their time matching 13 the end of the time of the Ohio proo-ram, whatever that 14 DR. MAYER: That is, I gather, August 30. 15 DR. SCHMIDT: And they should be instructed that the 16 options at that point would either be that they make the case 17 for an independent Northeast-Regional Medical Program or they 18 are merged or they will be shut down and that the level of 19 funding be someplace around $500,000 or $600,000, something 20 that will get them down so that they have to start shutting 21 down their projects and enter a planning phase and come back up again. And the funds should be limited to the extent that 22 23 this will force this, maybe $500,0_00 or $600,000 to do that 24 @with the instructions stating in effect what we are asking for re I Reporters, Inc. is a plan for this Regional Medical Program that we would look 25 19 3 I at and evaluate. 2 They have either got it or have to throw in with the 3 other one or they have got to quit. Having the end point 4 being the date 5 DR. MAYER: Which is August 31, 1973, which is what 6 it would be. 7 DR. SCHMIDT: If there is a sense to that, I would 8 so move. 9 DR. SCIIERLIS: Second. 10 DR. SP ELL14AN; This August or next August? 11 DR. MAYER: This August there is no way they can 12 comply with what he is asking. 13@ DR. MARGULIES: He is talking about '73. 14 DR. MAYER: So what Mac is talking about is reconLmenc 15 ing funding at a level which is kind of fuzzy, and we will 16 have to sharpen that up, from September 1, 1972,to August 31, 171 1973, which is one year and does include 12 months, Leonard, with explicit instructions that at the end of that period of 18 19 time, they ought to have inhouse a grant application which either 20 justifies their continuation as an @IP, as Northeast Ohio or merged or some other effective thing or their funding is going 21 22 to be discontinued. 23 DR. ELLIS: May I ask a question? DR. MAYER: Yes, Effie. 24 Ice I Reportefs, Inc. la DR. ELLIS: I want to ask one question. I want to 25 19 4 ask Dr. Margulies do you think if staff works with them more 2 closely as they are set up, they will improve and their 3 horizons can broaden? If you could get a younger person 4 with newer ideas to work under Dr. Glover if he is going to 5 be there for a few years or more or something like that, 6 this would be helpful. 7 It doesn't sound to me as if merger would be possible 8 that is, a real sound merger -- within the period of a year 9 or even two or three. Perhaps it would be bette r to say move 10 toward that if this seems likely. 11 But I don't know if they are going to be able to 12 do too much unless they do have someone kind of really helping 13 them and monitoring very.closely what they are doing and 14 suggesting a way. 15 DR. MARGULIES: Well, so far as staff capacity to 16 improve the program is concerned, I guess my best response 17 is God willing. They are there. In fact, I think probably 18 staff in that part of the RMP,.DOD, has spent more time on the 19 Ohio programs than any other. And the major benefit has been 20 in the other part of it where a merger has occurred. ?nd in 21 the process of merger, some real new thinking has gone on. 22 Staff at the present time, as I indicated, has some 23 hope for the Cleveland end of it doing well. But I think it 24 will not do well unless the kind of very specific action which @ce tal R6porters, Inc. 25 you are talking about does come out. So they don't think that 195 I this is just a mild gesture; but it carries with it not a 2 veiled, but an open threat, fish or cut bait. I don't see any 3 other way in which staff wil-1 have the backing to have an 4 impression on what goes on. 5 14ISS ANDERSON: Somebody mentioned their relation- 6 ship with Pennsylvania. is that a reality? Could they 7 possibly merge with that group? 8 DR. MARGULIES: No, this was just on the local basis. 9 MR. HILTON: I was just going to ask simply on the 10 discussion stage on this motion, I wondered if there is a 11 possibility or the danger that this action might be interpreted 12 by thoseIon the receiving end as indeed somewhat vindictive 13' on the nart of RI.IPS 14 DR. MYER: Somewhat what? 15 MR. HILTON: vindictive, punishment for them for 16 not Because it seemed there is no concept of merger. 17 The seed has been planted already even in that February 10 18 letter. It has been suggested, and they have heard that. 19 And they recognize that as a product. And would this action 20 coming when it does not come off as being a little bit of 21 we are punishing you already kind of thing? And possibly the 22 suggestion that Dr. Ellis raises of having somebody work in4q--er- 23 nally to bring about change might represent a more meaningful 24 alternative than bringing down the guns quite that firmly. AC at Reportefs, Inc. 25 1 just raise it as a suggestion in terms of the 19 6 I image of P14PS with regard to the local autonomy of these 2 programs. 3 DR. SCHERLIS: I would like that to be made very clear 4 DR. MAYER: Mac, would you care to sharpen your 5 thoughts either in consultation with Sister or how do you want 6 to arrive at a level of funding or do we suggest that you 7 might all do that tonight and plug in that blank tomorrow 8 morning? 9 DR. SCHMIDT: Either $500,000 or $600,000.33. 10 DR. HESS: To resolve that dilemma, I would like to 11 make a suggestion. 12 On page 4 of the pink sheets here, the summary sheet 13' DR. MAYER: Page 4 of what sheet is that, Joe? 14 DR. HESS: The summary sheet, table of contents, 15 14ortheast\ern Ohio anniversary application, page 4 that has the 16 figures on it, financial summary, if you add up out of the 17 column "Current Year's Award", one operation year, and I am 18 assuming that these are 12-month figures, if you add the 19 $481,000 for core, $55,000 for subcontracts and then add 20 approximately $70,000 for the phaseout of operational 21 activities, you end up with $600,000. And I think that falls 22 in the guidelines, shouldn't hurt them unduly in terms of staff 23 and planning activities, give them some money for phaseout, and 24 still the message should be there. Ice eal Repoiters, Inc. So I propose $600,000 as the figure. 25 19 7 I DR. @IAYER: O.K. 2 DR. SCHMIDT: The Mover will accept that. 3 MISS ANDERSON: I second it. 4 @IR. PARKS: I would think if we are planning to 5 extend this operation, that some consideration be given to the 6 recommendations from the staff which are on this, what did 7 you call the other color -- on these pink sheets -- which 8 do contain some very.valuable suggestions, both on the first 9 page under recommendations and on page 2 of the critique which 10 calls, really, for certain kinds of overall guidances and 11 certain:kinds of technical assistance and support. 12 I think, for example, if we are going to allow this program to continue and expect Dr. Glover to produce, it is 13@ 14 then enc mbent upon RMP to provide him with all of the kinds 15 of support that would give him at least a chance to succeed. 16 I think that ought to be considered in light of the money, for 17 example, with $600,000 that has been recommended and also with regard to the time period within which he is expected to 18 1 9 perform. That is, to disengage him entirely, whatever has 20 21 transpired in the past, and try to give him some freedom of 22 movement. 23 SISTER ANN JOSEPHINE: I think, too, it would be very, very important if staff can to find this assistant for him, 24 kce I Reportets, Inc. an adequate assistant, because to fill this role effectively 25 19 8 is going to require a lot of hard work. And it is going to be 2 a very tiring thing. And I think without an assistant and 3 without,the ability to delegate, you can almost predict it is. 4 notgoing to work. 5 DR. MAYER: Yes, Mr. Ashby. 6 MR. ASHBY: Dr. Glover, I don't think he intends to 7 stay more than two years. And'he is actively looking for an 8 assistant to train. And as I said before, he has one of the 9 biggest critics of thi s program. And at the same time, if 10 you consider the new coordinator, they have been without a 11 coordinator for 17 months. And then you limit their funding 12 to an -@ount where.you can't operate. 13 SISTER P-N-ii JOSEPHINE: But he can plan. 14 MR. ASHBY: Right. But it is like saying we are goinc, 15 to extend you for one year, Dr. Glover, although we are going 16 to place these restrictions, and here is what you are going to 17 come LP with. We know you are not going to do it because you 18 don't have the facilities and 19 SISTER A14N JOSEPHINE: I think it is just very, very 20 important you reflect the thinking of this group. And I don't 21 hear you reflecting@it now. 22 DR. MAYER: I am reminded of the comment that Bob 23 Marston once made when there was a leveling off at $1.2 billion 24 in the NIH budget. And everybody was having at him. And he kc al Repofters, Inc. 25 said, "Well, you can still do a lot of research with $1.2 billic And I would have to say that you.ought to be able 2 to do a fair amount of planning with $600,000. 3 Mac. 4 DR. SCHERLIS: I was going to say that is particularly 5 true when you have $250,000 floating around that can be used 6 for feasibility studies. Most feasibility studies I have 7 seen usually have been $3,000, $4,,000, $5,000 in the 8 developmental component stage. And these are in the range of 9 $26,000 and $30,000 which to me is a major project and not 10 just core function. 11 I think there is enough fat there to move. 12 DR. SCHMIDT: Concerning what Bill said, I think it 13@ is impo tant to state the action of this committee as intended 14 by me is.not to be vindictive, punitive, or anything else. 15 But it is meant to be a directive and be just a little bit 1.6 crisper than some of the actions and some of the things that have been going on, particularly in that area. 17 18 It is clear there has to be certain things happening. 19 And I think that there would be enough money with $600,000 to 20 reach the end point that is, I feel, necessary to set for 21 this region. 22 And the action of the committee is trying to be 23 helpful by setting an end point and giving some clear choices. One of them is to make the case for the region, 24 ral Reporters, Inc. 25 DR. MAYER: Yes, Phil. 200 I DR. WHITE: It seems to me you are going to have 2 difficulty doing what Sister thinks should be done if we are 3 going to send this clear message you have a year to go or else. 4 How in the world are you going to recruit that kind of guy to 5 come in and help Dr. Glover under those circumstances? 6 Aren't you going to kind of have to suggest that 7 Dr. Robbins or whoever is the head of the Cleveland Clinic 8 or somebody lend some expertise, give them somebody on leave 9 of absence from one of their institutions to get this thing 10 moving? At least, he is going to have a job to go back to in I I case it 'f lops. 12 DR PIARGULIES: We have some thoughts about oiq we 13@ might be'@ able to do that on a 3- to 6-months basis with someone 14 who can really be of direct assistance. But that is the 15 dilemma. 16 We have been carrying them on all this period of 17, time saying, "liell, you know, if we just give them the chance, 18 they will get the people and they will get things going." 19 And it hasn't worked. So it is a situation in which whatever 20 decision you make, you are going to feel a little uncomfortable 2 1 with. 22 DR. WHITE: I think the point earlier was if Dr. 23 Robbins -- I am not picking on him particularly -- but if the 24 people in that region want to see this thing go, there is %ce al R@portefs, Inc. 25 @probably enough talent already in that area that they ought to 2 0 1 I commit some of those hours of those people to make the thing 2 go. 3 DR. IIARGULIES: And if they can't find something 4 that needs to be done in Cleveland, they are having great 5 difficulties in their perceptions. 6 DR. MAYER: John, you had a conmient? 7 DR. KRALEWSKI: Back to this budget, I don't want 8 to beat it to death, but I am sorry I still don't understand 9 it. If we are recommending $600,000, what do we recommend as 10 a start this year? 11 DR. MAYER: September 1, 1972, to August 31, midnight 12 1973. 13 DR. KRALEWSKI: And that will be consistent w3th 14 the letter from Council? Are we asking them to revise? 15 DR. 14AYER: Yes. It can be made to be consistent 16 with the letter from Council. 17 DR. KRALEWSKI: And the group here feels, I qather, 18 there is enough information in this document right here that 19 we can make that $600,000 decision at the moment rather than 20 having maybe a small group with staff iron out a figure here 21 later'in the day? 22 I don't feel I can, but if the rest of the group 23 feels they are comfortable with it, I will go with it. DR. SCHERLIS: I would submit if yo u go through 24 ,ce I Repoitefs, Inc. 25 the entire application, you will come away with the same feelin 202 1 of restlessness. 2 DR. MAYER: Yes, Mac. 3 DR. SCHMIDT: Two comments. 4 One, if staff or anybody has a better figure to come 5 up with and want to justify it, I think it would be fine to 6 reintroduce that later this afternoon or tomorrow. And I 7 think it would be considered. 8 The second one is in my conversations with people 9 at Caser Cleveland Clinic, Medical Society, and so on, they 10 haven't got the foggiest idea of whether they want a Regional 11 medical Program or what one is. And I think at some point 12 everybody from delightful what's his name in the Cleveland Clinil, 13 on down have to get off this business of the Feds are going 14 to keep putting money in here and we get plenty coming in 15 anyway, and we don't need it. Tiey have got to quit ignoring. 16 And the big problem of getting a Regional Medical 17 Program going in that area from what I have been able to see is that people by and large have just ignored it. And if this 18 19 is a way to get them to pay some attention, whether it is 20 borrowing people from the university or whatever, then, fine. 21 But people have to look at it and say, "All right, here is a decision." They have never really done that. 22 23 DR. MAYER: Does everyone understand the motion? 24 MR. PARKS: One question. ce I Repottefs, Inc. 25 DR. 14AYER: Yes, Mr. Parks. 20 3 MR. PARKS: On the recommendations from the staff 2 anniversary review panel, there is a rating of 245. May I 3 ask what that means-and on what scale? 4 DR. MAYER: That is on the 6iie to five scale, I 5 assume. That puts it in group C which is the lowest grouping 6 which at-least says something, but it is at least barely in 7 there. 8 MR. CIUMLISS: If I may make a comment there -- 9 DR. 14AYER: No, I am-sorry, it must be .1111. 10 DR. BESSON: It runs from zero to five hundred. DR. MAYER: Yes, right. 12 Yes, Mr. Chambliss. MR. CHAIABLISS: I was simply going to let the comnitt 1 3 le' 14 know that the desk chief, Mr. Van Winkle, would be availab 15 to answer any questions on that if'you have further questions. 16 DR. MAYER: O.K. 17 Comments? Everyone understand the motion? DR. SCIFERLIS: Is there any feeling of staff that we 18 19 are misreading the signals? I am curious. 20 DR@ MAYER: All I have heard is a feeling that the therapy may not be appropriate. But I think the diagnosis 21 sounds pretty aood with everyone. At least, that is what I am 22 23 hearing. MR. CHAI@IBLISS; The comment from staff would be that 24 @ce I Reportefs, Inc. I feel the diagnosis is quite proper. Ile have some concerns, 25 204 great concerns, about this region. 2 DR. 14AYER: Sister Ann. 3 SISTER ANN JOSEPHINE: May I just make a comment 4 to you sitting at the end of the table after you were so nice 5 to brief us in. These are the kinds of pressures I get from 6 my board, And several years ago, I was saying this is too 7 harsh a'way of doing it. You know what? I am learning it is 8 a good management tool. You will be surprised how many good 9 things can come out of it. But I do know that it is terribly 10 important that you share our feeling about it. 11 This is really a measure to make it possible for them 12 to get moving. And so you will have to be very supportive of 13 it because they will read it very quiclzly. 14 MR. ASHBY: I want to apologize. I was talking out 15 of school@, 16 DR. MAYER: Further comments? 17 Yes, @e. 18 MR. VAN IIINKLE: I think one of the major reasons for 19 their problem out there is the fact their executive committee 20 and board of directors are one and the same. And that largely 21 reflects Dr. Charles Hudson's thinking. And I am hoping that 22 when we get this new piece of paper that tells us what the 23 RAG relationships and coordinator relationships and these 24 sorts of things are, we can put sufficient pressure on them to @ce eal Repoiters, Inc. 25 change their by-laws. 205 I But that is what is a real grievance out there. And 2 they are dictating, there is no question, the executive 3 committee and board of directors are the same, and they are 4 dictating to the coordinator or non-coordinator. 5 DR. 14AYER: Other comments? 6 (No response.) 7 All those in favor o f the motion say, "Aye." 8 (Chorus of ayes.) 9 Opposed? 10 (No response.) 11 We effectively have gone past coffee, but let's 12 take about a 10-minute break to mark the sheets and stretch. DR. SCHERLIS: Just one sentence that I think under- 14 lines w at you said. The organizational structure is apparently 15 not well@understood, and it is amplified as it goes on in the 16 next few pages. 17 (whereupon, a recess was taken.) 18 DR. IIAYER: Could we start, please? Are we ready, 19 John? 20 DR. KRALEIISKI: Right on. 21 DR. 14AYER: This is new. It isn't anniversary, but 22 was site visited. 23 I might comment before John begins that what we have 24 just done in terms of Northeast Ohio, there was a SARP rating @ce eal R'eporters, Inc. in which the question was appropriately raised about what that 25 206 I meant. And then we proceeded to go on to rate it. 2 I think what we might do in those that have already 3 been rated by SARP, we need to make a first decision which is 4 do we agree with the rating. And if we say, yea, then we 5 stop there and go no further in terms of subratings. If we 6 say that we do-no-L. agree, then I think we are saying that we 7 want to@,,also rate itt and we ail rate it. 8 John, we knew you were coming up because I assume 9 that is your material on the blackboard. 10 DR. KRALEIISKI: Right on, yes, indeed. 11 DR. SCIUIIDT: Were you asking a question or making a 12 comment?, 13' DR. MAYER: I am making a statement unless you want 14 to approach it otherwise. DR. SCI-LAIDT: I think we should rate tJie region. 15 116 Is that what you were stating? 17 DR. MAYER: Yes. 18 Well, maybe we need to take a minute. 1 9 DR. SCHMIDT: I think staff rated. I think that is 20 beautiful. I think we ought to rate it, too, as a committee. 21 My gut feeling is that staff's numerical score is a 22 little bit high, although I agree with the comments and 23 suggestions. 24 Am I out of order? Am I talking about something kc al Reporters, Inc. 25 lelse? 207 I DR. MAYER: No, it is a question of Well, let 2 me go back. When we originally talked, and I don't know 3 whether I am two meetings back, one meeting back, or three 4 meetings back, when we were talking r@ting scales, we said 5 that those which are anniversary reviews within the triennium 6 would be handled by the staff anniversary review panel, SARP, 7 that we would also comment on those and discuss those. And 8 then the question came in terms of how much time would we spend 9 on them and would we rank them, etc. 10 And I think where we were was to say, "All right, we 11 will look and see what the staff anniversary review panel 12 which was set up to do that job does, and if we agree with the 13 figure that they are at, fine. And if we don't, then we owe 14 it to ourselves to go ahead and rate them.' 1 5 DR. SCHIL4IDT: Are you talking about the 245 score 16 that was brought up before? 1 7 DR. MAYER: Yes, for Northeast Ohio. 18 DR. SCII14IDT: I would be uncomfortable with matching 19 my motion against that point score. 20 DR.' @IAYER: And we therefore rated it. So I have 21 no problems with that. All I am saying is we need to address 22 ourselves with each of the applications which on this sheet 23 have numbers. We have to address ourselves do we want to 24 accept that level or do we want to rate them ourselves? That al R@porters, Inc. 251 is all'I am suggesting. @ --a - - 4D 00 2 0 8 I 14aybe what you are saying is you want to rate them 2 all. 3 Yes, Leonard. 4 DR. SCHERLIS: I think having this sheet in front of 5 us makes us focus on individual items as they are presented. 6 And as s'uch, it is a very good way of focusing the attention 7 of the 'group, In so doing, a rating is arrived at. And I 8 would think we should do this with each presentation that is 9 made here. 10 I find it difficult to accept another rating without 11 going through the mechanics myself to see if I agree. But 12 once I hI@ve done the rating, then it is there and it is written 13 and some@hing might as well be done with it even if the 14 committee that goes over this chooses to disregard it. But at 15 least I would like to go through the mechanics of doing it. 1 6 DR. IIAYE R: O.K., does staff have any troubles with 17 that? 18 DR. SCIU.IIDT: If there are great discrepancies in 19 this rating and staff's rating, I think that is a nice danger 20 .signal that would signify we have got a-problem that ought to be 21 looked at. 22 DR. BESSON: I have viewed this as just your calling 23 the presence of this rating to our attention, no more. 24 DR. 14AYER: All right. kce -deal Repotters, Inc. 25 DR. SCIU4IDT: You got that? a % - - - - - - - -L 00 2 4 3 I And those eight recommendations are outlined on 2 the secondpage of the site visit report that you have. 3 The region at the time of our earlier visit had.just 4 come through the process of separating from the South Dakota 5 component, just reformed as a separate Nebraska region. And 6 there are some problems relating to that. 7 We found that there were some very fundamental 8 problems in terms of program management and direction. And 9 these eight points which you see outlined on the site visit 10 report addressed those issues. 11 I could say that in summary all of these issues, 12 that this advice letter had been taken very seriously, that 13 shortly after the receipt of the letter, the program coordinator 14 resigned, and very shortly thereafter a new coordinator was-. 15 appointed. He had been with the PJ@IP previously. And by 16 September of last year, the RAG had sort of reformed itself), 17 and they were down to brass tacks and working. 18 And most of this past year has been devoted to 19 reorganization, reforming the region and trying to address 20 those questions and suggestions which were raised in this advi--@-, 21 letter. The newly appointed coordinator is proving to be a 22 23 good.coordinator. He has@shown the ability to provide directions to RAG. Many of the actions of the RAG have been 24 kce eat Reporters, Inc. 25 upon his advice, and they have acted on it and not hesitated to 24 4 reaat to his leadership. 2 He has made a number of rather difficult decisions, 3 one of them being that some negotiation with the medical 4 school and the core funds now were under his direction instead 5 of under the medical school's control. And I think that kind 6 of action is indicative of the strength of leadership that he 7 is providing. 8 The RAG is playing a much more active role now than 9 they used to,, 10 DR. MAYER: Joe, can you use the microphone? 11 DR. IL-;SS: The RAG is playing a much more active 12 role than they formerly had in setting program policies, They .13 have reorganized themselves into five working committees, 14 an executive committee, nominating, the budget and finance 15 and the resource and development and operations review 16 committee. And each of these appear to be performing their 17 functions. 18 The program has developed documents which spell out 19 the proce dures whereby rojects are to be reviewed,. And the p 20 relationship between the gt@ntee and the RAG and all of these 21 kinds of things, all of those issues were appropriately 22 addressed., 23 They have had a management consultant from the 24 University working with them, and they developed a new .Ace deral Reporters, Inc. 25 organizational structure and developed job descriptions of each 245 I of the positions. And in terms of program management, there 2 has also been much strengthening. 3 I would also indicate that the morale of the staff 4 which is one indicator is much different than it was a year 5 ago. A year ago, we had indications in talking with members 6 of the staff informally there just was no communication, that 7 they were not working together, that the coordinator wasn't 8 listening to them and so on. But you get an entirely 9 different feel this time. They were working together. They 10 felt they were part of the team and that everyone seemed to be 11 unanimous in the feeling they had made a rather major change 12 in direction and function. 13 As far as identification of regional needs is 14 concerned, there was one survey which we learned about a year 15 ago which still is the major syste matic survey that they are 16 using. This is supplemented, however, by the information whic.-, 171 was picked uo by the R.14P staff in the visit throughout the 18 Nebraska region. And you can perhaps see from the little map 19 they have in the v'ellow pages, they have project activities 20 that pretty well blanket 14ebraska. So they do get out and do 21 spend a lot of time out in the community. And that supplements 22 and is one of their sources of gathering information. 23 But another important thing which at least has the 24 potential of having made their impacts in terms of needed @,e eal Reportefs, Inc. 25 identification is the study which has been carried out under I 246 I the cliP agency which will be in its completed form in June. 2 And in talking with the AAuc director who is a very intelligent 3 dynamic woman, already there are things coming to the surface 4 in that study that are going to have an impact on what R-7,IP 5 does. And they seem to be open, their communication is good, 6 their relationships appear to be quite good between those two. 7 So I feel quite confident that that study will result in some 8 change in their objectives and priorities in the months ahead. 9 The question of phasing out of the programs, this 10 has begun. And they are aware of it, and they intend to do 11 more. There has been some joint funding now through other 12 IU4Ps around. them. The university is beginning to pick up 13 certain projects which can be justified and so on. So that 14 they areraking movement in this direction. 15 The final issue in that letter has to do with the 16 mobile cancer project. The core staff has been actively 171 involved, and the R7iG al so, indirecting the course of the 18 cancer project. And it seemed-to us that they seem to have 19 these fairly well in hand. 201 Going on with the report, they have redefined their 21 goals and priorities. They look quite different than they did 22 a year ago. And they are consistent with national goals. 23 14ost of the projects which have come through the 24 review process now tend to be ones which conform more with the al Reportets, Inc. 25 older mission of @IP than the newer. And as near as we can 24 7 determine, one of the reasons for this is that much of the 2 core staff activities and so on, the RAGS, have been in this 3 reorientation process. They haven't had time to get out and 4 stimulate development of new projects. But they seem to be 5 aware of the need to do that. I think the chances are 6 reasonably good they will do so. 7 We mentioned continuing support. 8 Minority interests, these are not very well reflecte--',, 9 but they have told us they have tried to get more minority .10 representation and will continue to try. As we talked with 11 the lady who is the CIIP director, it seemed she had some 12 ideas and techniques for doing this that perhaps they 13 could learn from. And we suggested they might talk with her 14 and get some as.sistance from her in doing so. But at least I there was a willingness, @nd we indicated that we hope there 15 16 would be improved performance as well. 17 I mentioned already the coordinator in relation to 18 the RAG. The core staff seems.to be quite strong, In working with the management consultant, they have identified the need 19 for some additional staff positions -- one in the area of 20 bolstering their program evaluation segment and others in 21 area consultants. And after hearing the rationale and so on, 22 23 we concurred with that.assessment and agreed they should furthe,- 24 strengthen the core staff. 4ce eal fzeportefs, Inc. The Regional Advisory Group still tends to be 25 24 8 1 provider dominated, but there has been some change in the 2 balance since we were'tliere a year ago. They seem to be 3 aware and were receptive to our suggestion that they need to 4 give further attention to a broader representation on the RAG. 5 The grantee organization is the State Medical Society. 6 I think there has been -significant movement in the relationship 7 between grantee and RAG, the PJ4Ps, since we were there a 8 year ago. I think there is still some further delineation 9 refinement that needs to be carried on there, but certainly 10, they are moving in the right direction. 11 We pointed out some of the areas which we thought 12 they needed to give further attention to. And I would hope 13 that.these further additional. details will be attended to. 14 Their-participation, we mentioned, in terms of RAG 15 participation and so on. The State Medical Society, physicians, 16 seem to be the majority, but there is good participation in the 17 State Health Department, appears to be good working relation- 18' ships there. The CIIP seemed to be reaching out in the communities 19 20 to a considerable extent, and their record is reasonably good 21 in that area. 22 Hopeful planning, they are working with CIIP B agenci----z 23 that exist, but that program was just beginning to get geared 24 up. They have some of their own local mechanisms for doing it, Ac derat Reporters, Inc ' but I think again their performance is satisfactory. 25 249 We have talked, I think, enough about management. 2 The evaluation has improved substantially since we 3 were there a year ago. We agreed there is a need for more 4 staff in this area. And this function in this area has been 5 hampered somewhat by the ill health of their evaluation 6 person. But I was filled in this morning they have already 7 taken steps to bolster this area, and they recognize the need 8 for further improvement. 9 The action plan, again, is more in the.forroative 10 stages because of this reorganization they have gone through. 11 They have their goals and their priorities developed now, and 12 I would anticipate in the next few months, we would see an 13 action plan based on those goals and priorities begin to appear 14 in terms of projects more related to that. 15 They have been successful in the area of disseminatio;- 16 of knowledge. They have had coronary care training programs 17 and other educational type projects which have apparently been 18 well received and have served a real need and have been the 19 means of bringing inactive nurses and other people back into 20 the health care system. And there have been a lot of spinoff 21 benefits from the projects that were built as dissemination 22 of knowledge. 23 Manpower and facilities, there have been some, as I 241 mentioned, spinoff benefits from the coronary care and other @c al Repofters, Inc. 25 type education activities which have had an impact on this. I But we really were unable to get a very good handle on just 2 how much impact the W4P is having on use of those facilities. 3 They have stimulated cooperative arrangements among hospitals. 4 There is sharing going on as a result of these @IP projects. 5 So we got the feeling that they have had some impact. 6 The improvement of care, I think what I have already 7 said miore or less summarizes what I want to say in this area. 8 Short-term payoff, I think there has been some with 9 the coronary care learning resource center. They have plans 10 for more regionalization in the sense they are developing area 11 coordinators who are going to work in specific areas within 12 the region to stimulate more cooperative arrangements and more 13 joint activities in that area. 14 In summary, then, we felt that the region had 15 seriously addressed all of the issues v7hich have been raised 16 as a result of the site visit of last year and has made vo_rv 17 substantial progress in making the necessary changes in 18 reorganization and changing the direction of the @%IP.- 19 As a result of this, we came up with a funding 20 recommendation of $725,000. 21 Now, that.is based in part on the recommendation of 22 the Kidney Review Panel that neither of the kidney projects ought to be funded. And one of the important reasons is they 23 24 had not develope.d a well-thought-out regional plan for kidney AC al Reportets, Inc. disease. So that accounts for one of the major reductions 25 251 I below their request. 2 And we felt that there were some savings that they 3 could make in terms of the mobile cancer unit and one or two 4 of the other projects without hurting them and also that 5 some cutbacks should be made in the funding of current 6 projects to give them some seed money for feasibility studies 7 and so on to start off and do some planning at least in the 8 new directions which they want to go. 9 So.that this was the rather simplistic rationale 10 for arriving at the recommendation for $725,000. We recommend 11 that the find within that budget about $25,000 for initiating y 12 some small,planning feasibility studies, mentioned the two kidney disease activities, and we felt that they should be .13 14 given the option to submit a triennial application next year, 15 feeling that with another year to work and develop that they 16 may be in a position to merit that. DR. 14AYER: Dorothy, cor"-nents? 17 MISS ANDERSON: I was amazed, just reading the materi-@ 18 I v7asn't on the site visit at the progress they have made 19 20 in just six months with this new coordinator. And I think 21 this is a real good example where rather than getting the 22 person to change their thinking in coordinators and changing 23 their action that maybe vie do need to look seriously and 24 encourage some areas, .regions, to get new coordinators. kc ral Reportefs, Inc. 25 Now, I was impressed by the involvement.of the RAG 252 I group, They really got involved in committee meetings. They .2 were involved in site reviews and made recommendations for 3 changes of budget and relocation and reallocation of money, 4 as I understand. 5 They have also changed their by-la;,7s and realigned 6 budgets and did other things that really showed involvement 7 of the group. 8 I was interested that the staff kept relating to 9 a 1968 survey that was done. And I had a feeling that maybe if 10 the staff had been out in the community more, they wouldn't 11 have to wait for this new survey for some direction., 12 DR. HESS: I think maybe that is an unfair reflection 13! of the report because the staff is out in the community. Thev 14 get very high marks for being out and visiting around. T ey 15 really ride the circuit. 16 IIISS ANDERSOii: It seems like they have quite a few 17 things they are holding off until they get this new survey. 18 DR. HESS: That may be more a reflection of our 19 report than it is in reality. I am not sure that is really 20 fair. 21 I-IISS @IDERSON: Thank you. 22 Another area I thought was interesting was the 23 development of the new goals in regard to the new direction 24 that R:.IP is going in regard to health manpower, health care %ce I Reportefs, Inc. 25 delivery and management and administration. 253 I think everything else we have touched as far as 2 I can see. 3 DR. HESS: Just to elaborate on one point that you 4 picked up and I forgot to mention is that the RAG is involved 5 in the site visits-to projects. I think this is a very 6 tremendous thing. At least some member of the RAG has some 7 detaile d knowledge of nearly every project. And that is, I 8 think, rather unique. I don't know. There may be some other 9 regions, but offhand I can't recall others that have that 10 degree of involvement of the RAG. 11 14ISS ANDERS014: And I think another point I would 12 like toisupport you in is in-regard to representation on the 13 RAG. Th, ey do need more minority people. There are many 14 indians,as an example in this area. And blacks also. 15 And, also, they need more allied health people on 16 their RAG from what they hav.e had in the past to make it, 17 if you are thinking of comprehensive health care. 18 DR. MAYER: Dr. Hinman, comments? 19 DR. HIN,@@4AII: Yes. This region had two applications 20 in for support of kidney activities. They both had technical 21 review in the region by people from within the region who 22 made strong recommendations against the appropriateness of the 23 proposals. And on that basis, it is the staff recommendation 24 it not be approved even though the RAG sent them in. @ce al Oeporteis, Inc. 25 one of them was to produce six films of teaching 2 5 4 I tapes of undetermined type for an undetermined audience. And 2 the other was to train'some people for we didn't know exactly 3 what in the application. So it was our recommendation that 4 the region be given advice that there were existing guidelines 5 that could have assisted them, staff could have assisted them, 6 there were new guidelines coming out, and we recommended 7 disapproval. 8 It was $48,838 requested. 9 DR, MAYER: Further comments? 10 DR. KRALEWSI"I: I have a question about the core 11 staff. How many people do they have and how was this affected 12 when they split apart and all that? Are they saving any money -13 or what is happening to the core? 14 DR. IESS: Well, you mean when South Dakota-Nebrasl:a 15 DR. K@EI-O'SKI. Yes. 16 DR. HESS: They decided there was a division of funes, and so on that was negotiate d witli.PJIPS. 17 18 DR. SCH14IDT: I think the answer is in light of the 19 activity, the core type of activity, was really Nebraska and 20 South Dakotals problem is really to build up. The flow was 21 into -- at leastr I was representing South Dakota at that time - 22 the flow was kind of into Nebraska. We had a core staff. I 23 don It think they are cutting back any. The loss of South Dakota, 24 there wasn't much in South Dakota there. Ace deal Reporters, Inc. 25 DR. KRALEIQSKI: This budget expands that core now, 255 I does it? 2 DR. HESS: I-would have to go back and look at the 3 figures ayear ago versus now. 4 DR. 14AYER: Yes, by about $140,000. 5 DR..HINMAN: $232,000 to $376,000. 6 MR. POSTA: I might make the statement here I 7 think the core budget as outlined here for this upcoming year 8 really indicates the inclusion of four new members to the 9 staff. But in view of the fact that the drug information .10 center and resource learning center that was appointed a 11 project last year would be included under the core,.I think 12 would be increased for the next year total within core is about 13 $115,000 rounded off. And that would take care of assuming those two new programs or the two old programs and a couple of 14 15 now additions to the core staff. 16 DR. K@-LEIISKI: Now many vacancies do they have? 17 MR. POSTA: Frank. 18 MR. Z,-IZLAVSKY: They.are requesting four full-time 19 positions deputy coordinator, associate coordinator for 20 evaluation, and two additional area consultants. And this 21 totals about $70,000. $20,000 increases for fringe benefits. 22 Previously.under the previous coordinator, fringe benefits were. 23 non-existent. This is something they have been fighting for 24 three years. They have finally established it. Ac rat Reporters, Inc. That speaks to about $100,000. They have a couple of 25 256 I pha@acy students on part time answering the phones 24 hours 2 a day which speaks to abou@ $10,0'00. That accounts for about 3 $110,000. 4 We have got a little bit more money in travel, a 5 little additional money in equipment. 6 DR. HESS: I think you are asking how many existing 7 vacancies. 8 DR. KRALEWSKI: Right. 9 DR. HESS: And I don't believe there are any. They 10 are all ne@q ones that they are asking money for. 11 DR. I-IAYER: Four new professional positions, is 12 that what you are saying? 1 3 MR. ZIZIAVSKY: Right. 14 DR. IIAYER: Further comments? 15 DR. HESS: I would move-formally, then, they be 16 ao;oroved at $725,000, and we also felt we ought to make a 17 tentative recommendation for $700,000 for the second %,,ear so 18 they have something to plan on, but with the understanding -- 191 DR. i4AYER: They will probably be coming in with a triennium. 20 21 DR. HESS; That's right. DR. @IAYER: But in case they don't, we are recommends 22 23 $700,000. 24 DR. HESS: Yes, some sort of assurance for them. Ac ral @eporters, Inc. 25 DR. I.IAYER: O.K., is there a second to that? MISS ANDERSON: I second it. 2 DR. MAYER: Furtl-ier comments? 3 Yes, John. 4 DR. KRALEWSKI: A point of clarification. That 5 $25,000 is included? 6 DR. HESS-.. In the $725,,000. 7 DR. SCHMIDT: I am curious about this renal business, 8 Dr. Hinman. You said that the RAG approved it, but that people 9 within Nebraska recommended disapproval? 10 DR. HINMAN: There was a technical review by three 11 physicians from within the State who had adverse comments the 12 program was not adequately documented, adequately structured, 13 and they still sent it. 14 DR. SCHMIDT: From the university or Creighton or.-' 15 DR. HESS: One was Dr. Holmes from Colorado. They 16 were experts, kidney experts, that were called in. But they 17 were not all from without Nebraska. 18 DR. HINILKN: Two of them were, weren't they? You 19 are right about Dr. Holmes, but I thought the majority were 20 from with@Ln Nebraska. But either way. 21 DR. SCHi4IDT: It was on technical grounds that it was turned down, then? 22 DR. HINMAIN:' Yes. 23 DR. MAYER: Technical plus regionalization, I was 24 kce I Reporters, Inc. 25 hearing, Mac. DR. SCE14IDT: I know, but you see the RAG approved 2 it. 3 DR. IIINMAII: That is correct. 4 DR. MAYER: In spite of the negative comments. 5 DR. HINMAli: Yes, sir. 6 DR. MAYER: Ilhich makes the point we-were trying 7 to make earlier. 8 O.K., further comments. 9 (No response.-) 10 All those in favor of the motion? 11 (Chorus of ayes.) .12 opposed? 1 3 (No response.) 14 Before we break, I have got a couple of issues I 15 want to comment about. The first relates to this evening's 16 activities, to make sure we all understand where we are going 171 and how we are going to get there. 18 (Announcements ..iere made.) DR. IIAYER: one of the individuals who has been 19 20 participating in P-14P applications as long as anyone, including maybe myself, Lorraine Kyttle, who is on my right, who has been 21 221 serving us very effectively for the last three years, four 23 sessions of this committee, this is also her last review committee session. She is going to be assuming responsibility 24 @ce I Repoiters, Inc. for South Central Operations Areas which will include Memphis, 25 i@ Illj:nois and South Carolina as her activities, but will not 2 be serving in the capacity ,she has. So I just wanted to 3 indicate to you this evening while we are there that it is 4 also her last go viith the committee. 5 On the agenda for time, I will not be with you 6 tomorrow. My chancellor has called a budget session which I 7 have to be at if I hope to survive for tomorrow. And I will 8 have to go back tomorrow. But there were two items or three 9 items that were on the suggested items for the agenda that I 10 wanted to remind you all about so that you didn't forget them. 11 one was the, if I may call it that, emasculation 12 issue which Jerry had raised and others had raised that we 13- needed to talk about a little further. 14 The second was Mr. Parks raised the question 15 appropriately about several of the.questions that we sent. 16 up to the Council at the last meeting, and we need to discuss 17 a feedback of those. And I assume, Mr. Parks, you will raise 18 those tomorrow. 19 And then thirdly, there was sortie discussion of at least some of the people at lunchtime about new members of the 20 21 committee and new chairmen, vice chairmen, etc. And I think 22 that issue needs to be raised. 23 And with that, I would like to say it has been my very real pleasure having an opportunity of participating in 24 kce I Reporters, Inc. 25 this committee over the many years and chairing it the last .GVV two years almost in toto. I appreciate all the efforts that 2 have gone on in terms of helping us get through and the job 3 done. it has been done very well. 4 DR. SCHERLIS: I think somebody should recognize 5 the fact that you are not being here tomorrow, this is our 6 last opportunity to formally thank you for, I think, what has 7 been not just superb direction, but maintaining our good 8 humor and I think giving us a sense of at least thinking we 9 know where we are going. And I want to on behalf certainly ,lo of the committee extend to you our thanks for having been such an excellent chairman o ver the years. 12 DR. 14AYER: Thank you very much. 13 DR. KRALEV7SKI: l.'would like to formally move that 14 into the minutes. DR. BRII;DT ry: Second. 15 16 DR. BESSON: I move it up to the Council. (Laughter.) 17 18 DR. 14AYER: That is really a policy issue. Well, I hope to see most of you this evening at 19 20 6:30. I would also like to remind you do not forget those 2 1 22 of you because I didn't remind you in Nassau-Suffolk as well 23 as Nebraska in terms of your rating sheets. And I would 24 assume that if you held onto those, fold it up neat y at your kce I Repottefs, Inc. place so people aren't seeing them. I think you are probably 25 261 I in good shape. We can leave the materials here. 2 What time, 8:30 in the morning? I think we can 3 probably appropriately move it along. 4 (Ilhercupon, at 5:10 o'clock-p.m., the meeting 5 recessed, to reconvene at 8:30 p.m. on Friday, May 5, 1972.) 6 7 8 9 10 12 13 1 4 1 5 1 6 17 18 1 9 20 21 22 23 24 e - Reportefs, Inc. 25