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               SOMEHOW, SOME WAY, SOME TIME: THE REGIONAL MEDICAL PROGRAMS
                          CUTTING SCRIPT, PART 1 (10/20/91)



           .1  VIDEO                        AUDIO
    00:00:04

           .2  BLACK.  FADE UP ON           (Audio recording: 41764.lbj)
    00:00:23   PHOTOGRAPHS OF LYNDON
               JOHNSON SPEAKING TO          PRESIDENT JOHNSON: I am firmly
               DEBAKEY COMMISSION
                                            convinced that the  accumulated brains

                                            and determination  of  this  Commission

                                            and of the scientific community of the

                                            world will, before the end of this

                                            decade, come forward with some answers

                                            and cures that we need  so  very  much.

           .3  MORE STILLS                  NARRATOR: (Voiceover)
    00:00:14
                                            With these  unvarnished  words,  Lyndon

                                            Johnson told his  Commission  on  Heart

                                            Disease, Cancer and Stroke  to  get  to

                                            work.  It was April 17, 1964.

           .4  PAN OF COMMISSION            JOHNSON (Voiceover):
    00:00:17  MEMBERS IN PHOTOGRAPH
                                            You have among you some  of  the  great

                                            doctors, some of  the  greatest  public

                                            servants of  our  time.  Somehow,  some

                                            way, some time, you are going to find

                                            the answers and I hope it will be soon.

           .5  DISSOLVE TO TITLE            MUSIC UP FULL.
    00:00:08   SEQUENCE: SOMEHOW, SOME
               WAY  SOME TIME--THE
               REGIONAL MEDICAL
               PROGRAMS, 1966-1976








                                                                               2



           .6  DISSOLVE TO MONTAGE OF      NARRATOR (Voiceover):
     00:00:31  1960S, GRADUALLY
               BECOMING MORE FOCUSED       It was the middle of the 1960s--a time
               ON MEDICAL PRACTICE OF
               THE 1960S                   of dramatic change and new awareness.

                                           The economy was  booming,  and  medical

                                           knowledge was burgeoning.  But many

                                           Americans were aware of a  gap  in  the

                                           benefits of medicine--a gap between

                                           what was possible and what was widely

                                           available.

           .7  DEBAKEY FOOTAGE FROM        No one was more keenly  aware  of  that
    00:00:20  BBC DOCUMENTARY
                                           fact that was Dr.  Michael DeBakey, who

                                           was even then world famous for his

                                           pioneering work in cardiovascular

                                           surgery.  DeBakey knew that the

                                           benefits of his research were not

                                           spreading quickly.

           .8  DISSOLVE TO:                DEBAKEY:  The gap existed between where
    00:00:29  MEDIUM SHOT,  DEBAKEY
                                           the centers were doing  this  work  and

                                           out in the periphery, doctors in

                                           practice not picking  up  patients  who

                                           had these diseases, and referring them

                                           for operation.  So there was a gap in

                                           the knowledge available to treat

                                           patients and the patients who were

                                           being treated by doctors  who  did  not

                                           have that knowledge.








                                                                                3



           .9  JOHNSON PHOTOS/FOOTAGE       NARRATOR (Voiceover)
     00:00:17
                                            President Lyndon Johnson was concerned

                                            about a major statistic--the fact that
                                            71-percent of all  Americans  who  died

                                            were killed by heart disease, cancer,

                                            or stroke.

          .10  JOHNSON WITH DEBAKEY         Johnson asked DeBakey to chair the
     00:00:14
                                            commission which he hoped  would  come  up
                                            with a plan to  restructure  the  American
                                            practice of medicine in  order  to  combat

                                            those three major killers:
          .11  DISSOLVE TO:                 DEBAKEY:    He asked me  how  long  the
     00:00:17  MEDIUM SHOT OF DEBAI<EY
                                            thing would take.  I said, "About a
                                            year."  He said, "We've got to do

                                            better than that. I want  to  be  able  to

                                            include a message from this commission

                                            in my address in January."

          .12  COMMISSION MEMBERS,          NARRATOR (Voiceover):
     00:00:14  STILLS
                                            DeBakey and  other  commission  members

                                            began their intense work almost
                                            immediately,  gathering  and  analyzing

                                            material from all over the country.
          .,13  REPORT                      The report was delivered  in  December  of
     00:00:31
                                            1964, in time for  January's  State  of

                                            the Union message.

                                                                     (CONTINUED)








                                                                            4




         .13  CONTINUED:  22
                                         A copy was sent to every  practicing

                                         physician in the United States.
                                         PRESIDENT JOHNSON: (Audio: 12964.lbj)

                                         Today it is a very high honor and great

                                         privilege to receive the results  of

                                         your study. (E)
         .14  DISSOLVE TO LBJ AND        With these guideposts and with these
    00:00:17  COMMISSION
                                         goals, we will begin this year in  the

                                         Congress and in the country to make  a

                                         concerted drive on these three enemies

                                         to the health of two-thirds of all

                                         Americans.

         .15  DISSOLVE TO MEDIUM WIDE    JOHNSON (SOT):
    00:00:44  SHOT OF LBJ DELIVERING
              STATE OF UNION MESSAGE     our goal is to match the  achievements

                                         of our medicine to the afflictions  of

                                         our people.
                                         We already carry on a large program in

                                         this country in this country for

                                         research and health.

                                         In addition, regional medical programs
                                         can provide the most advanced diagnosis

                                         and treatment for heart disease  and

                                         cancer and stroke and other major

                                         diseases.

                                                                 (CONTINUED)








                                                                                5




          .15  CONTINUED:  23
                                            New support for  medical  and  dental
                                            education will  provide  the  trained

                                            people to apply our knowledge.
          .16  COVER, STATE OF THE          NARRATOR (Voiceover)
     00:00:20  UNION MESSAGE
                                            But the concerted drive  on  the  three

                                            enemies had to take  a  detour  through

                                            the political process.  Proposal number
                                            three, advocating  the  development  of
                                            regional medical complexes, turned out
                                            to be extremely controversial.
          .17  DISSOLVE TO MEDIUM           DEBAKEY (SOT): It concerned this
     00:01:01  SHOT, DEBAKEY
                                            so-called cooperative arrangement

                                            between institutions, creating a

                                            regional network across the whole

                                            country.
                                            (E) In each region, the idea was to
                                            have a center of excellence which would

                                            have all of the  best  technology,  the

                                            best facilities,  the  best  personnel,

                                            the best training,  and  then  surround

                                            that center of excellence with

                                                                      (CONTINUED)








                                                                                6




          .17  CONTINUED:  24
                                            individual diagnostic  stations  and  even
                                            station hospitals, so to speak, which

                                            would relate to the center of

                                            excellence for the more highly

                                            technical work. (E) M.D.  Anderson  is  an
                                            example of what we had in mind, you
                                            see, and is, in that sense,  a  center  of

                                            excellence in carrying  out  the  concept.

          .18                               (Copy to be written.)
     00:00:04
          .19                               Unfortunately, as you look around the
     00:00:11
                                            country, you have very few.  The

                                            reason, of course, is that.the

                                            legislation never authorized them.

          .20  MEDIUM SHOT, PAUL            SANAZARO SOT:
    00:00:29  SANAZARO
                                            Two bills were introduced with that in

                                            mind, one in the Senate, one in the

                                            House, and in the course  of  the  summer,
                                            various groups from organized medicine

                                            made it be known that they could not

                                            possibly approve the creation of
                                            regional medical complexes if this

                                            meant disturbing existing

                                            relationships.








                                                                        7



         .21  MEDIUM SHOT WILLIAM       WILLIAM RUHE: (SOT)  Practicing
    00:00:23  RUHE
                                        physicians tended to be apprehensive

                                        about whether this was going to change

                                        the practice of medicine.  The American

                                        Medical Association was worried  about

                                        this being a first step toward  a

                                        nationalized health system.



         .22  M/S OLSON                 OLSON SOT
    00:00:44
                                        I think it was the pressure  from  the
                                        practicing profession that changed  it

                                        so that the focus really became more

                                        heavily placed on education and

                                        dissemination of information  and

                                        co-operation, and the bill that was
                                        adopted had a very specific prohibition
                                        about not interfering with the private

                                        practice of medicine, and that
                                        referrals, if any, in connection  with

                                        demonstration projects would have to be

                                        made by referral by a  practicing

                                        physician.








                                                                             8



         .23  MS RUHE                     RUHE SOT:
    00:00:26
                                          The original report spoke, for  example

                                          of regional medical complexes,
                                          complexes not defined, but I think in

                                          almost everybody's mind, that  evoked

                                          the image of large construction

                                          efforts, new buildings, new  centers

                                          assembled in either existing  locations

                                          or new locations.





         .24  MEDIUM SHOT, PAUL           ROGERS SOT:
    00:00:53  ROGERS
                                          So the Congress reacted and they  cut

                                          out any approval for the building  of

                                          facilities to calm down the  concerns

                                          that people were going to be sent away.
                                          They made the program a  cooperative
                                          program, where it was not  something

                                          that someone can come in and  direct.

                                          You had to get cooperation from  people

                                          in all of the communities, the  medical

                                          center, whatever. The  only  patient

                                          care that could be done was in

                                          research, in demonstration, but  you
                                          really couldn't deliver care; it had to
                                          be paid for in a traditional way.

                                                                 (CONTINUED)








                                                                            9




          .24  CONTINUED:  27

                                          You could not change that.  so that

                                          first legislation acceded, really, to

                                          the concerns of AMA in those  points.

         .25  MEDIUM SHOT, MERLIN         MERLIN DUVAL:
    00:00:20  DUVAL
                                          As a consequence, we moved from

                                          actually moving patients to moving

                                          information so that you could

                                          ultimately close the gap between

                                          literally the laboratory bench and the
                                          patient who needed information.

         .26  LEGISLATION, STILLS OF      NARRATOR (Voiceover)
    00:01:07  LBJ SIGNING 28.a.
              MEDIUM SHOT, RUHE 28.B      So the proposal for regional  medical
              LBJ STILLS
                                          complexes was modified into a program

                                          for information exchange--and the

                                          Regional Medical Programs were  born.

                                          RUHE SOT:

                                          I think we have to acknowledge that RMP

                                          was just another component of the Great
                                          Society program in the health  field.

                                          The idea, of course, was to sell

                                          something to the public which would be

                                          new and striking and would save many,

                                          many lives.

                                                                 (CONTINUED)








                                                                                10.




          .26  CONTINUED:  28

                                            NARRATOR VO:

                                            President Johnson signed the

                                            legislation in October, 1965.
                                            PRESIDENT JOHNSON: (Audio: 10665.lbj)

                                            Its goal is simple: to speed the

                                            miracles of medical research from the

                                            laboratory to  the  bedside.  Our  method

                                            of reaching that goal is simple, too.
           .27                              through grants to establish Regional
      00:00:17
                                            Medical Programs among our medical

                                            schools and clinical research

                                            institutes, we will  unite  our  Nation's

                                            health resources.



           .28 CARTOONS FROM                NARRATOR (Voiceover)
      00:00:34 MARSTON/YORDY  ARTICLE
               FIGURE 3: "THEY WANT TO      That is not to say that the Nation's
               TELL US WHAT TO DO!"
               "THEY'RE NOT GOING TO        health resources were eager to be
               TELL US WHAT  TO DO?"
               "YOU MEAN WE'VE GOT TO       united.  Throughout the winter and
               DO EVERYTHING FOR
               EVERYBODY?"                  spring of 1965 and 1966, health
                                            professionals, educators, community
                                            health planners, and  hundreds  of  other

                                            interested people grappled with the
                                            process of  planning,  organization,  and

                                            grant applications.









         .29  FIGURE 5:"PLANNING         By June, 1966, activities based on the
    00:00:26  TOGETHER WASN'T So BAD,
              BUT. . DO WE REALLY        first grants were up and running.  In
              HAVE TO WORK TOGETHER?"
                                         June of 1967, a report on the progress

                                         of Regional Medical Programs concluded

                                         that it was too soon to comment on

                                         their success or failure, and

                                         recommended that they be funded for

                                         another five years.




         .30  FADE TO BLACK OR
    00:00:07  DISSOLVE TO SPECIAL
              SLATE TO INDICATE END
              OF PART 1.









               SOMEHOW, SOME WAY, SOME TIME: THE REGIONAL MEDICAL PROGRAMS
                            CUTTING SCRIPT: PART 2 (10/20/911


            .1 VIDEO                        AUDIO
     00:00:04



            .2 GRAPHIC: MAP OF REGIONS      NARRATOR (Voiceover):
     00:00:32  NAMES OF REGIONS
               EMERGE:                      One of the first characteristics to
               GREATER DELAWARE VALLEY
               RMP                          become obvious about the Regional
               BI-STATE RMP
               LAKES AREA RMP               Medical Programs was that each one was
               INTERMOUNTAIN RMP
               SUSQTEHANNA VALLEY RMP       different.  That even showed in the
               TRI-STATE RMP
               TENNESSEE MID-SOUTH RMP      areas each region covered.  About half

                                            of the 56 RMPs corresponded to
                                            political jurisdictions--and about half

                                            did not.  Some overlapped.  And each

                                            had its own concerns.  But that was the

                                            way it was supposed to work.

           .3  MEDIUM SHOT MERLIN           MERLIN DUVAL:
    00:00:23  DUVAL
                                            Regional Medical Programs was allowed

                                            to look at the way patients and

                                            information flowed in the real world.

                                            If you looked, for instance, at Kansas
                                            City, the question is, do you give it

                                            to Kansas City, Missouri, or do you

                                            give it to Kansas City, Kansas.








                                                                            2


           .4  M/S STARK                  STARK SOT:  And what we did there was
    00:00:38
                                          to organize a liaison committee  between

                                          both states with the University  of

                                          Kansas and the University of  Missouri,

                                          of course, participating, in order to

                                          avoid any kind of duplication of  effort

                                          and to have more cooperation.  I  think

                                          that's one of the principal roles  that

                                          I found coming out of the  Regional

                                          Medical Programs, and that is the

                                          ability to get these diverse groups  and
                                          institutions together in a  cooperative

                                          way.
          .5  M/S DUVAL                   DUVAL SOT:   So, Regional Medical
    00:00:23
                                          Programs was created and  permitted
                                          money to flow to entities that were  not
                                          geographic or political  jurisdictions.
                                          They were watershed jurisdiction.  I

                                          thought that was an incredible

                                          breakthrough for the federal  government

                                          to take as a step.








                                                                                3



           .6  MONTAGE OF PHOTOS,           NARRATOR (Voiceover):
    00:00:23  LETTERHEADS, ARTICLES
                                            The Regional  Medical  Programs  required

                                            the cooperation of  segments  of  the

                                            community which  were  sometimes  not

                                            accustomed to  communicating  with  each

                                            other,  much  less  cooperating.  And

                                            there was hesitation  in  many  areas

                                            about making the attempt.
           .7  FREEZE EGEBERG               Dr. Roger Egeberg was then  Dean  of  the
    00:00:08
                                            School of Medicine at  the  University  of

                                            Southern California.

           .8  RELEASE FREEZE: MEDIUM       ROGER EGEBERG:
    00:00:59  SHOT, ROGER EGEBERG
                                            The university  was  conservative  about
                                            it, this faculty was,  but  the  executive

                                            committee, after I  explained  it  to
                                            them, came along. So  we  were  the  first
                                            people in California to join.  There

                                            was still some  hostility,  but  Congress

                                            had done  something  terribly  important:

                                            they had included the medical
                                            profession and the  hospitals  right  in

                                            the law. So some of  the  first  money  to

                                            come didn't come to  a  medical  school;

                                            it went to the California Medical

                                            Association.  Wasn't  that  bright?   And

                                            next to the California Hospital.

                                                                      (CONTINUED)








                            1                                                   4




           .8  CONTINUED:  64

                                            And they became part of the program.

                                            They saw that we didn't  have  horns  or
                                            tails, and we started to work together

                                            pleasantly.



           .9  STILLS FROM MEETINGS OF      NARRATOR (Voiceover):
     00:00:32  RMP ERA, OR WITH
               RESEARCH OR OTHER            In California, and in other regions,
               COOPERATION, OR LOGOS
               OF SOCIETIES                 the cooperation between the hospitals,
                                            the medical schools, and the medical

                                            societies was soon augmented by health

                                            organizations such  as  the  American

                                            Heart Association  and  the  American

                                            Cancer Society, and by  members  of  the

                                            general public.  For some

                                            establishments the adjustment was

                                            easy--for others it was not.

          .10  MEDIUM SHOT OF KARL          KARL YORDY:
     00:01:04  YORDY
                                            Schools that had  strong  traditions  of

                                            reaching out to the community and
                                            really viewed themselves  as  playing  a

                                            role with the  broader  community  found

                                            this new role rather comfortable and

                                            found it, in fact, one that was able to

                                            facilitate a lot of the things which

                                            they'd been  thinking  about  anyway.

                                                                      (CONTINUED)








                                                                            5




         .10  CONTINUED:  65
                                          I'm thinking here of schools like  the

                                          University of Washington in Seattle,

                                          the University of Missouri,

                                          universities that often were state

                                          universities and had a tradition of

                                          reaching out. The more  elite,  private

                                          medical schools, I think, had a  harder
                                          time sort of figuring out how this  fit

                                          into their own sense of their  mission

                                          and role.

         .11  STILLS OF EARLY REMOTE      NARRATOR (Voiceover):
    00:00:20  READING OF EKGs
                                          it is difficult to generalize about the
                                          accomplishments of the RMPS, since they

                                          all addressed different needs and  had

                                          different goals. But  some  remarkable

                                          accomplishments stand out--some that

                                          changed American medical care  forever.

         .12  MEDIUM SHOT, KARL YORDY     KARL YORDY:
    00:00:29
                                          There was an effort, for instance,  out

                                          of the Missouri RMP, one of the  first

                                          operation RMPS, that set up a

                                                                 (CONTINUED)








                                                                           6




         .12 CONTINUED: 66

                                         communication link between a group  of

                                         physicians, cardiologists, in
                                         Springfield, Missouri, and the  medical

                                         center in Columbia, that would  permit

                                         the remote reading of EKGS, a  capacity

                                         that's now routine in medical care.

         .13  MEDIUM SHOT, VERNON        VERNON WILSON:
    00:00:28  WILSON
                                         Utah dealt with getting that

                                         information to a four-state area,  and

                                         very successfully they dealt with that.
                                         They did what Missouri and Alabama  did

                                         so well, they formed a telephone  bank

                                         and people could call in for

                                         information.

         .14  MEDIUM SHOT, PAUL          PAUL SANAZARO:
    00:00:41  SANAZARO DISSOLVE TO
              CORONARY ICU               I thought, to me, I don't know if  it's

                                         exciting, but important, the most

                                         important thing that RMP did was to put
                                         in place, which is still in place,  in

                                         the United States intensive care  units

                                         for heart disease patients, the

                                         coronary care units, and the  training
                                         of personnel for that, and  specialized

                                         equipment for that.

                                                                 (CONTINUED)








                                                                                7




          .14  CONTINUED:  67

                                            That probably was its greatest

                                            technical contribution to patient care,

                                            and that's very  exciting  that  that

                                            happened.  It came along at just the

                                            right time.

          .15  STILLS OF EARLY REMOTE       NARRATOR (Voiceover):  RMPs not only
     00:00:43  READING OF EKGS
                                            spurred development of remote EKG
                                            readings and coronary care units, but

                                            also rapid strides in vascular surgery

                                            and in the  development  of  regional

                                            trauma centers.  But one of the

                                            greatest  contributions  of  Regional

                                            Medical Programs was perhaps the

                                            newfound cooperation between different

                                            segments  of society, and the

                                            realization  that  regional  planning

                                            could yield worthwhile results.

          .16  MEDIUM SHOT, CHARLES         FLAGLE (SOT):  There was strong
     00:00:47  FLAGLE
                                            cooperation between the University of

                                            Maryland and Johns Hopkins, and there

                                            was also a great involvement of such

                                            things as the media, the heart

                                            associations.

                                                                      (CONTINUED)








                                                                            8




         .16  CONTINUED:  68

                                         I would call it an unprecedented--I was

                                         about to say conglomeration, but  it

                                         really wasn't that.  It was a

                                         well-orchestrated program and it

                                         resulted in the creation of the

                                         Maryland High Blood Pressure
                                         Commission, which is still in existence

                                         and still operating for purposes  of

                                         implementing some of the results  of
                                         that five-year study of coordination.

         .17  MEDIUM SHOT, KISSICK       SOT KISSICK:  An unknown and
    00:00:26
                                         little-appreciated dimension of RMP in

                                         Connecticut was CUPIDS,  Connecticut

                                         Utilization Patient Information Data

                                         Systems.  CUPIDS enabled them to
                                         analyze the utilization of services at
                                         all thirty-five Connecticut hospitals,

                                         and brought forth diagnostic-related

                                         groups.

         .18  MEDIUM SHOT, ARTHUR        ARTHUR RIKLI:
    00:00:29  RIKLI
                                         I think the Regional Medical Programs

                                                                (CONTINUED)








                                                                             9




          .18  CONTINUED:  69

                                          really built an active bridge between

                                          the medical school and the  providers  of

                                          health care, not only in their

                                          immediate area, but out in the rural

                                          areas, as well.  so the Regional

                                          Medical Program still has  that  benefit

                                          in most of the communities  and  regions

                                          where they were set up originally.

          .19  MEDIUM SHOT, MERLIN        MERLIN DUVAL:
     00:00:29  DUVAL
                                          I do think that this is, in its own

                                          way, a watershed event.  It's a

                                          watershed event because it brought a

                                          type of early partnership into the

                                          providing elements of  Americals  health

                                          care system and the  federal  government.

                                          Until that time, they did not  have  that

                                          kind of relationship.



          .20 MONTAGE OF STILLS FROM      NARRATOR (Voiceover)
    00:00,.26 REGIONAL MEDICAL
              PROGRAMS, HANDSHAKES,       In spite of their  accomplishments,  the
              EKG READINGS, MEETINGS,
              PATIENT CARE,               Regional Medical Programs did  not  have
              LIBRARIES, TRAUMA
              CENTERS, ETC.               long to live. Some of  the  reasons  they

                                          went away were due to politics, to

                                          changing times and  shifting  priorities.

                                                                  (CONTINUED)








                                                                           10.




         .20  CONTINUED:  70

                                         But the strength of the RMPS, their

                                         adaptation to their regions, would also

                                         prove to be a major weakness.

         .21  FADE TO BLACK OR TO
    00:00:05  SPECIAL SLATE: END OF
              PART 2.









                SOMEHOW, SOME WAY, SOME TIME: THE REGIONAL MEDICAL PROGRAMS
                            SHOOTING SCRIPT: PART 3 (10/20/91)

             .1 VIDEO                          AUDIO
       00:00:04

             .2 1970S   TELEGRAPH   WORKING    Natural Sound (:05)
       00:00:41 SUPERS EMERGE:
                "NO GRANT FUNDS ARE            The telegram sent out to all
                INCLUDED IN THE
                PRESIDENTIS REQUEST     FOR    coordinators  of  the   Regional   Medical
                RMP IN FISCAL YEAR
                197411                         Programs  on  February  1,  1973,   marked
                "ALL OF FISCAL YEAR
                1973 GRANT AWARDS WILL         the beginning of the end of the
                TERMINATE ON JUNE 30,
                197311                         Regional   Medical   Programs.    Although
                to . . . DO NOT ENTER  INTO
                ANY NEW CONTRACTS. .  .  It    the Regional Medical Programs had
                11 . . . WE NEED TO
                PROCEED WITH THE               received their highest level of funding
                DEVELOPMENT   OF   PHASEOUT
                PREPARATIONS. . . 11           ever in Fiscal Year 1973, they had been

                                               completely  cut  out  of  the  budget  for

                                               Fiscal Year 1974, and Dr. Harold

                                               Margulies, who was then director of
                                               RMPS, was ordering them to begin

                                               shutting down.  What happened?

            .3  NIXON INAUGURATION             Part of the answer to that question is
     00:00:14  (CLARK STOCK)
                                               that  the  times  had   changed.   Richard

                                               Nixon was now president; the programs

                                               of Lyndon Johnson's Great Society were

                                               being dismantled.








                                                                                 2



           .4  MEDIUM SHOT, KARL YORDY      KARL YORDY:
     00:00:20                               I think that the  hope  and  the  vision

                                            for the program really were starting to
                                            disappear  shortly  after  Nixon  became
                                            president. It  was  sort  of  a  holding

                                            action, sort of a fighting the

                                            frontiers at that point.

           .5  VIETNAM STOCK (BE            ROBERT MARSTON: (Voiceover)
     00:00:14  THERE, BE COUNTED
               STOCK)                       The Vietnam War had raised the issue of
                                            guns and butter, and funds suddenly
                                            became very restricted at the federal

                                            level.
           .6  M/S MARSTON                  Then, finally, I think, Regional
     00:00:11
                                            Medical Programs, as a part of the

                                            Great Society programs, was caught up

                                            in a rejection of such programs.

           .7  STILLS OF CASPAR             NARRATOR (Voiceover)
     00:00:11  WEINBERGER
                                            Caspar Weinberger, as head of the

                                            Office of  Management  and  Budget,  had

                                            been one of the RMPs harshest critics.

           .8                               JOHN ZAPP:
     00:00:38
                                            OMB was certainly a harsh critic of RMP

                                            at that time, but that was not

                                            uncommon.  They were basically a harsh

                                            critic of most of the categorical


                                            programs.

                                                                      (CONTINUED)








                                                                                 3




           .8  CONTINUED:  85
               MEDIUM SHOT, JOHN ZAPP       Maybe that was one of  the  problems  that
                                            RMP was suffering at that time within

                                            the administration.  They just didn't

                                            seem to be able to withstand the

                                            constant  requirements  for  justification

                                            that OMB was throwing at the

                                            secretary's office on the

                                            re-authorization for each year.

            .9 MORE OLD STILLS OF           NARRATOR (Voiceover):
     00:00:35  WEINBERGER, TESTIFYING
               AT CONGRESSIONAL             When Caspar  Weinberger  became  Secretary
               COMMITTEES, WORKING IN
               OFFICE, ETC.                 of Health, Education, and Welfare in
                                            1972, his attitude toward the RMPs

                                            could hardly be  expected  to  change--and

                                            it didn't.  When  Congress  wanted  to

                                            extend the life of the RMPs for a

                                            year--from June 30th,  1973,  to  June
                                            30th, 1974, Weinberger  took  the  unusual
                                            step of lobbying against it.  Congress
                                            passed the extension overwhelmingly.

                                            Nevertheless, the  RMPs  were  doomed.

           .10                              EGEBERG (SOT):
     00:00:44
                                            I think they were assassinated.  Now

                                            you can kill people  by  ripping  them
                                            open, you can kill them by a  bop  on  the
                                            head, or you can kill them by choking.

                                                                    (CONTINUED)








                                                                            4




         .10  CONTINUED:  86
                                          This was from way up above. I  think  it

                                          began with Caspar Weinberger, who had  a
                                          feeling that Regional Medical  Programs
                                          was just another program that was  going
                                          to drain money out of the Treasury,  and

                                          it would be better to cancel them  all

                                          and come out with a big program,  which

                                          I think medicine became worried  about,

                                          might be socialized medicine or  health

                                          insurance for all.

         .11  FREEZE, JOHN ZAPP           NARRATOR (Voiceover):
    00:00:08
                                          The RMPs had other political  problems,

                                          too.

         .12  RELEASE FREEZE:  MEDIUM     JOHN ZAPP:
    00:00:44  SHOT, JOHN ZAPP
                                          They had a base that probably  provided
                                          them with the weakest constituency  in

                                          the secretary's office and within  the

                                          administration. That was  basically  a

                                          medical school base, where the

                                          perception, if you will, was that an
                                          awful lot of money just seemed to be
                                          going to the faculties in the  different

                                          health science centers.

                                                                 (CONTINUED)








                                                                             5




         .12  CONTINUED:  87

                                          That was a perception that was  very

                                          difficult for the program

                                          administrators to overcome  because,

                                          rightly or wrongly, there was a lot  of

                                          faculty support built into RMPs  around

                                          the country.

         .13  WIDE SHOT, CAPITOL          NARRATOR (Voiceover:
    00:00:14
                                          The legislative mandate for RMPs had
                                          changed. Congress had made  the  choice

                                          between keeping the focus for RMPs or

                                          broadening their purpose.

         .14  MEDIUM SHOT, PAUL           PAUL ROGERS:
    00:00:52  ROGERS
                                          I think they were for broadening, as  I

                                          recall.  They thought it should be

                                          broadened, as long as we had the

                                          facilities, and that network of  people

                                          working together, we thought it  should

                                          be applied to increase health care
                                          generally, although, as we've talked

                                          about, the first emphasis was
                                          categorical on those three diseases.

                                          But that began to change from those who

                                          did not like the program, who  said,

                                          "oh, you've lost the purpose."  Well,

                                          we really didn't because we were

                                          improving health care for people.








                                                                            6



          .15  MEDIUM SHOT, EDMUND        EDMUND PELLEGRINO:
     00:01:01  PELLEGRINO                 I want to go on the record of  saying

                                          that many of the regions did very  good
                                          things with this program.  They  carried

                                          out many of the ideas, but there were

                                          so many goals and objectives.  It's
                                          perfectly all right to have variety  in
                                          the regions, but the important  thing

                                          that mustn't be missed is that the

                                          network that brings it about was
                                          utterly confused at times, not  knowing

                                          where it was going. So that  when  we

                                          looked at programs, we would have  such
                                          a variety, we didn't hve solid  criteria

                                          that we could use to judge them, and  it

                                          was a little bit unfair, as a matter  of

                                          fact, because, as you say,  different
                                          parts of the country had different

                                          requirements.

          .16  ZOOM IN DOOR OF HEARING    NARRATOR (Voiceover):
     00:00:11  ROOM, 2219 RHOB
                                          Money was tight.  A program without a
                                          specific focus had a hard time

                                          competing for it.








                                                                            7



         .17  MEDIUM SHOT, JOHN ZAPP      JOHN ZAPP:
    00:00:35                              I think one of the things that led  to

                                          the demise of the Regional Medical

                                          Programs was the competition from other
                                          more identifiable programs within  the

                                          Public Health Service and HEW that  it

                                          had to compete with.  RMP had to
                                          compete with Emergency services,
                                          Migrant Health, Rural Health, Indian

                                          Health.  It had to compete for dollars

                                          with the entities and the Food and Drug

                                          Administration.

         .18  CONGRESS OR CAPITOL         NARRATOR (Voiceover):
    00:00:25  SHOT
                                          That did not mean that RMPs died

                                          easily.  Congress had voted
                                          overwhelmingly to extend the life of

                                          the RMPS, and they still had supporters

                                          on Paul Rogers' subcommittee:

         .19  MEDIUM SHOT, PAUL           PAUL ROGERS:
    00:00:35  ROGERS
                                          I remember in the testimony, they sent

                                          John Zapp, who was then, as I  recall,
                                          the legislative deputy assistant
                                          secretary.  The Secretary for Health

                                          would not come, nor would the

                                          Secretary.

                                                                 (CONTINUED)








                                                                                8




          .19  CONTINUED:  90
                                            They let the messenger, who  had  to  give
                                            the bad news that they were cutting
                                            this program, come  before  Congress,  and

                                            our committee gave him really a pretty
                                            rough time, on both sides  of  the  aisle.

          .20  MEDIUM SHOT, JOHN ZAPP       JOHN ZAPP:
    00:00:26
                                            I get to deliver the  messages,  good  and
                                            bad, although sometimes others in the
                                            department got to deliver more good
                                            messages.  A very combative time

                                            between the  administration  and  the

                                            health committees, so most  of  them  were

                                            relatively contentious types of

                                            hearings.

          .21  HEARINGS STILLS,             NARRATOR (Voiceover):
    00:00:11  CAPITOL SHOT
                                            But in spite of Congressional support,

                                            members of  the  administration  were

                                            still determined to see the RMPs die.

          .22  MEDIUM SHOT, ROGER           ROGER EGEBERG:  Well, I think Caspar
     00:00:38  EGEBERG
                                            Weinberger sort of worked up a
                                            particular antipathy to  this  because  it

                                            was so hard to kill it.

                                                                      (CONTINUED)








                                                                            9





          .22  CONTINUED:  91

                                          He tried to choke it by taking the

                                          funds and impounding the funds in  the

                                          middle of the year, saying, "You can't

                                          spend any more money. Save it  till  the

                                          next year," and then using that for  the

                                          next year instead of giving them  any

                                          new money.  That's choking them.

                                          That's cutting down their funds.



         .23  WEINBERGER, LAWSUIT         NARRATOR (Voiceover): That  was  also
    00:00:32  PAPERS
                                          something the Regional Medical  Programs

                                          thought Secretary Weinberger had no

                                          right to do, since Congress had  clearly

                                          appropriated the money to be spent  by

                                          the RMPS.  So the National Association

                                          of Regional Medical Programs sued  to

                                          have the money released--sued, and  won.

                                          On February 7, 1974, the courts  ordered

                                          the money released.  Reluctantly,  the

                                          White House complied.

         .24  MEDIUM SHOT, JOHN ZAPP      JOHN ZAPP: I don't think it  was  any
    00:00:17
                                          great surprise about the suit.  I  think

                                          they were quite prepared for it.  I

                                          don't think they thought they were

                                          going to lose, but they were  prepared

                                          to have the suit.








                                                                            10.



         .25  ANIMATION: MAP WITH        NARRATOR (Voiceover):
    00:00:17  RMPS.  RMPS DISAPPEAR.     The RMPs had won the suit, but it

                                         didn't matter. The money  released  in

                                         February of 1974 was for the budget

                                         year ending in June, and there were  no

                                         further appropriations.

         .26  MEDIUM SHOT, VERNON        VERNON WILSON:
    00:00:20  WILSON
                                         The suit at the end, you know,  that's

                                         my only knowledge of a suit of that
                                         kind in order to keep legislation  in

                                         existence. It had the end  results  you

                                         should expect; it just prolonged  the

                                         agony, that's all.

         .27  M/S OLSON                  OLSON (SOT):
    00:00:43
                                         Here was a huge bureaucracy that  you

                                         had to deal with, and you had all  kids

                                         of talented people in the programs.

                                         The kind of understanding and  support

                                         that would have been necessary to  make

                                         the program effective just wasn't
                                         there, so it was a sense of trying  to

                                         keep faith with the people who had
                                         joined the program and yet you  didn't

                                         have the sense that at the top  level

                                         there was any conviction that they

                                         wanted it to succeed.








         .28  M/S RUHE                  RUHE (SOT):  It's disappointing that
    00:00:29
                                        these things did not endure.  I don't

                                        know how long they did endure after RMP

                                        quit.  I had the impression that some
                                        of this cooperation and collaboration

                                        did continue for a few years, at least,

                                        but as long as the people who were

                                        engaged in initial arrangement were
                                        still there, maybe still living, still

                                        active.

         .29  MORE CLOSEDOWN SHOTS OF   NARRATOR (voiceover):
    00:00:08  RMPS
                                        The RMPs wound down and dwindled; in

                                        1976, independent RMP operations ended.

         .30  FADE TO BLACK OR
    00:00:05  DISSOLVE TO SLATE: END
              OF PART 3









               SOMEHOW, SOME WAY, SOME TIME: THE REGIONAL MEDICAL PROGRAMS
                        SHOOTING SCRIPT: PART 4 (10/20/91)


           .1  VIDEO:                      AUDIO:
    00:00:41   MONTAGE: MODERN MEDICAL
               FACILITIES--EXTERIORS,      Music up and under
               PEOPLE RECEIVING
               TREATMENT, PROCESSING       Times have changed.    Since the
               MEDICAL INSURANCE
               CLAIMS                      Regional Medical Programs ceased

                                           operations, medical knowledge has

                                           burgeoned--and so has the cost for

                                           medical care.  In  the  mid-1960s,  the

                                           cost of medical care was less than 5%

                                           of the GNP--today it's 15%.  Is it

                                           relevant to consider  programs  along  the

                                           lines of the RMPS?  Some people think

                                           the time has come--if not to revive

                                           RMPS, at least  to  consider  something

                                           similar.

           .2  MEDIUM SHOT, EDMUND         EDMUND PELLEGRINO:
    00:00:55  PELLEGRINO
                                           I think it was probably  ahead  of  its

                                           time. I think the  time  will  come  again

                                           when we must reinvent it, because I

                                           think regionalization  is  part  of--by

                                           the way, that's one of the other

                                           defects I would like  to  add.  It  was

                                           not part of a  comprehensive  program  for

                                           national health care,  which  we  urgently

                                           need.

                                                                    (CONTINUED)








                                                                             2




         1.2  CONTINUED:  95
                                         I think if it could be placed within

                                         that context, then the  mechanism  of
                                         cooperative arrangements on a regional

                                         basis would really have a tremendous

                                         use in improving the health care of the
                                         American people, which was the aim in

                                         the first place.

          .3  MEDIUM SHOT, PAUL          PAUL SANAZARO:
    00:00:29  SANAZARO
                                         it anticipated the  present.  In  the
                                         literature today, you are reading about

                                         regionalizing, highly technical

                                         services that require  large  volume,
                                         highly skilled personnel, and special
                                         support facilities. So  we  will  see
                                         regionalization, but unfortunately

                                         maybe some 20 years after RMP was on

                                         the scene.

          .4  ROBERT MARSTON, MEDIUM     ROBERT MARSTON:
    00:00:23  SHOT
                                         I think this idea of cooperative

                                         arrangements is difficult for a
                                         government such as ours, and it's

                                         uneven in terms of its receptivity.  It

                                         does allow people to look at the

                                         elephant and see what it is that they

                                         want to see.








                                                                            3



          .5  MEDIUM SHOT, ROGER         ROGER EGEBERG:
    00:00:38  EGEBERG                    I think that if they were brought back,
                                         appropriately nurtured, and not  given
                                         too much money--I don't think it should

                                         be a very expensive program--that they

                                         would help the basic problem we have

                                         now, and that is of getting all  these
                                         people--hospitals, practitioners,  the

                                         societies and so forth and their

                                         organizations--talking together.  It

                                         seems to me that if you can get people
                                         talking together, you've made a  big

                                         step towards solving a problem.
          .6  M/S KISSICK                KISSICK (SOT): I think we had the right
    00:00:26
                                         concept, but we didn't understand  the

                                         culture.  (E)

                                         I think that now that we have a

                                         quarter-century under our belt since
                                         Regional Medical Programs, that  all
                                         we've got to get is Congress to  enact
                                         them all over again, and this time

                                         around we'll do a better job.

          .7  M/S PELLEGRINO             PELLEGRINO (SOT):
    00:00:14
                                         I think they're going to have to  be

                                         reinvented, because regionalization of

                                         health care services in something  I

                                         think we really must have.








                                                                            4



          .8  MEDIUM SHOT, MICHAEL        MICHAEL DEBAKEY:
    00:00:20  DEBAKEY                     I think to meet the needs of the

                                          population for good medical care,  we're
                                          going to have to set up something  like
                                          this. (E) There is, I think a  need  to
                                          reconsider something along these  lines
                                          in the development of a health  policy.

          .9  MEDIUM SHOT, WILSON         WILSON (SOT):
    00:00:41
                                          I think that Mike DeBakey was

                                          absolutely correct in his initial

                                          instinct to establish complexes, but  I

                                          think they will have to come after  the

                                          national health insurance is  invoked.
                                          (E) I would say another ten  to  fifteen
                                          years the House will have changed
                                          enough and the Senate will change  its
                                          patterns, and it will probably come  in
                                          that order, and I think some  Regional
                                          Medical Program-type activity then  will
                                          become, perforce, a necessary part  of

                                          the system.

         .10  MODERN MEDICAL PRACTICE     NARRATOR (Voiceover):
    00:00:17
                                          The RMPs were not perfect.  However,
                                          they did accomplish one very  important
                                          thing they were set up to do--and  that
                                          is closing the gap between new  medical
                                          knowledge and the practice of  medicine.








                                                                                5



          .11  MEDIUM SHOT, DEBAKEY         MICHAEL DEBAKEY:
     00:00:38                               I think the gap has been reduced and

                                            contracted considerably, because

                                            information now is more readily

                                            available and actually  gets  out  to

                                            doctors more quickly than it has in the

                                            past, to some extent  because  of  the

                                            National Library of Medicine and what

                                            it has done.  No question about that.

                                            You take MEDLARS and  other  means  of

                                            communication and information

                                            availability for doctors, this has made

                                            a tremendous difference.

          .12  CONGRESSIONAL HEARING        NARRATOR (Voiceover):
     00:00:17
                                            There are other lessons to be learned

                                            from the rise and fall  of  the  RMPS.


                                            JOHN ZAPP:

                                            What's the trick in making it work?  I

                                            think the trick in making it work is

          .13  DISSOLVE TO: MEDIUM          to have an effective constituency
     00:00:52  SHOT, JOHN ZAPP
                                            behind any program.  If you take a look

                                            at the programs that  have  had  real

                                                                      (CONTINUED)









                                                                            6




         .13  CONTINUED:  99
                                         problems, it's been the ones that  have
                                         lacked, whether it's public  assistance
                                         programs that have had the  terrible
                                         problems through the years because of
                                         the lack of organized  constituency.  I

                                         think RMP suffered from that.


                                         PAUL ROGERS:

                                         I think there is building--and  very

                                         significantly--a demand for some cost

                                         controls in the health  care  system

                                         because it's just grown so
                                         dramatically. Cost  controls.  I  think
                                         people generally are  supportive  of
         .14  DISSOLVE OUT TO MEDIUM     doing something on access and I think
    00:00:29  SHOT, PAUL ROGERS
                                         they generally demand, and will

                                         continue to demand,  quality.  So  I

                                         think that the whole effort to  make

                                         changes in our health care system is
                                         being supported more and more.  I think
                                         it's growing very rapidly, and I  think
                                         you will see significant changes in the
                                         delivery of health care service in this

                                         country.








                                                                                7



          .15  MORE MODERN                 NARRATOR (Voiceover):
    00:00:29  MEDICINE--TRAUMA UNIT,
               ICU, COMPUTERIZED           The Regional Medical Programs
               INFORMATION SYSTEMS
                                           accomplished only part of what they set

                                           out to do, and it may be that they were

                                           simply ahead of their time.  But many

                                           of the ideas behind them have endured,

                                           and it may be that somehow, some way,

                                           some time, they will provide the
                                           blueprint for the future of American

                                           medicine.

          .16  DISSOLVE TO ANIMATION:      MUSIC UP FULL.
    00:00:19   PHOTO OF LBJ RIGHT
               FRAME, REVEAL TEXT:
               "SOMEHOW,
                SOME WAY,
                SOME TIME,
                YOU ARE GOING TO FIND
               THE ANSWERS, AND I HOPE
               IT WILL BE SOON."


               REVEAL: JOHNSON
               SIGNATURE

          .17  FADE TO BLACK.              Music up and out
    00:00:04