I 4 B&B INFoRmAkreom & IMAGE MAkm^gnMmp.NT 300 "Inom G=Stncon SOUL"Jmo Ulefoem M,&KLAC:lRC2, Mftw Iwo Z0772 a us^ 0 (201) Z4@i 10 D E@ P A I' T @l E N 'I' 0 F 11 E A L T llp EDUCATION A N 1) IV 1, L F A R E I-lealt@i S--rxi.ccs aaicl Molital llealcl-i Administration @egional lledi.cal Programs SonTice ]\Tational Adi?-isor>T CoUnCil 01-1 4 Rec,ional @led-Lcal Prociranis @liliutes of the @-lecting August 3-4, 1971 Pa-rklm@,n Buildina Conference Room G/11 01, I\Tltiojial ]@civisor), Coll], CT on ')'Iedical Prograltis @li@tes of ljl,, TI., 'tilig AugLIS t 3-4 1972 'fl, e I\Tati-onal Ajl,iso-r\;, COU]ICil c for its oil Regional dical I)roryrb@ 'I'uesda)r . I L,3 -ercy) -e Rooiii C)-Il of to, Parl-I.,Il@ll 1-@ , @L'gust 3, 1971 ill C031f at 8:.30 Colikoiiod Dr. Harold Director ildiaig, I-Z@ch,-il-le presided o-t;-(.r the Meeting. -al P"OUQnls Service I Plegioaial j\ledic The Colmcil @lenibei-s resent ivere:@ p Dr. Pla-Tad 1-@. caimm, Dr. @licliaei I-,. DeBakey ken @Ir. Sei%,all o. Dr. Bruce TV. Bierist Dr. Alton ool-,sn-er Dr. R. IlLmt Dr - Rtissell B. ll\otll Dr. Antlloli), L. Koi-,ia-ro,,:[@. . Dr. George E.S,:]-Irei,,, Dr. A-lexaiider @l. @'IcPliedra-Ti Cars. Florence R. IV),Cl-off Dr. 'JO]Ila P. @ferri.:Ll Dr. Beiijaillin l@,T. IV(Itl,,ins Dr. Cl--- ark II. @lillilcan l,riedlaiader for A listing of Rff) Dr. @@'usser staf-I members, and others attending is appended. CALL TO ORDE-R A,\M OI)ENTING Pl@, IIRKS The moetin, i,,,as called to Order at 8:30 a.m. On August 3 by Dr. Harol,@ Ilirgulies. '@-,ODUCTIO,@ OF ND S TA r, l@- Cg@l'CIL @T.-kiBBRS CO,@i@fISSIO,\TE@D OFIICBPIS, AM Dr. @,largulies introduc ed the fol-lavi,,g -vlho i@ere atte-ndi,iiL7 their,, -- , ,e,,, raepbers of tle Council Dr. join p. -,-'-rst )neetin2: Dr. Anthony L. Komaroff- @ll 0. 1-@'atkins. Dr. I.,I@ir2ll- ilikeii @Irs, Audre)7 1,1. @la@s lies not-ed that ti and Dr. Beiii,-znir, TV.' 4"-, C - R the Council andA @O 1101@T mel'il- ers of , ' present. obc-rt OCT(len i%Tere .1 ulia-b I e to be -are,-rest . ricted unless Cleared by the Office or, H@'@,'- @,rhe res ssi, tr'ctiOn relates to all ipaterial ial. I --.meetings, th@ supplemental Material Iclucling tiie agenda. respective institutions a coil-L-lict 0- Occur. This procedure.,@-.@ 'I' 47 Of course apply to ]flight only even tjle al?l)licati" eii bloc actions-- -.-?nder indivj " dual discuss- - 1011. 2 Tlio follo,,%,illccl co",Tj,,lj.ssioiaed Of:E-'Lccrs mid iiei@ l@RIS staff moi,,Ibers there then introduced: r O.L'Vicors Elvin E. A(I,..i-,2is , i\,!. D. @lirtiai A. G-ce--n-f-iclcl, @T.D. -nes I. @I.D. Jai Komictli E. Joslyn, @.I.D. Paul E. Colia-rt, i%I.D. Michael A. Nc-iNflian, @I.D. Jeff-To), B. Duiie-I @,Tei@zer Alan KaT)lma, @I.D. ']\Ic,i@r 'Sta:E:f --@s Charles Barnes Cars. Glinter Johnson ]ZicliaTd Clanton Cars . I\Tancy @IcC,ui-re I,,b-s. Shirley Fai@y Roger I%,Illlor John l@'arrell, @I.D. Spero @foutsatsos IZobc,rt I-land),, PI-,.D. Jeffrey A. Passer Calvin Jacl@son Rolai-icl Illilli&@-is Dr. @'@a-rpulies made general announcements, and called attention to the statement on conflicts of interest" in the information folder. IV. COiN'F@IP@cl-kTION OF FU=- I%-TET!i\'G D-,klT,S The Council reaffirmed the following dates for future meetings: No-i2-enibcr 9-10 1971 Feb-rua3.-y 8-9, 1972 Council then set the following subsequent meeting dates: May 9-10, 1972 August 15-16, 1972 V. CO,'\ISIDI@,ltkTIO-,\T OF OF 'fTiF, @LAY 1.1-12, 1971, @F@E-TIf\'G The Council considered @uid-approired the minutes of the @lay 11-12, 1971 moetinc, into the follu,%,iii- chances: 1. South Carolina Pro4ect 1'r'43 "A Regional Program for the Iniorovcd 'n-ierapeiitic of I-lypertei-isi-on for South Carolina.'' 0 The record should sl,.oij that the -renal disease panel recoimended disapproval and that the Council concurred. 2. The addition to the minutes of a resolution concerning funds placed in reserves i,riiich iNas ad,,)-nted i-i TY-CC.7-iti.ve. Session at the 3 Council of- I-el)-i-uar),, 3, IP,71 i@i-tli a recpiest t), Z 14- L, it be transmitted to the Sccret@l-,>,. The :Cull text Of- the resolution and the copies of -@)ie @DI-)-ropri.ate transmittal n,@enioa-midLijn are appended as Attacl-nii@-iit A. ITI RT, IJ BY DI',,, @l-NlZr.'U!,TES A. Meeti.na the Secretary Ih-. @larg-Lili-os, scica7al Council riiembers, Coordinators, -,nd others ii-ite-restcci in Rc(-ioi@a.1 ',\.'Cd3".cal. Prograitis, met the Secretary on thy 24,th. Viie meeting has, the. effect c)-f ro-r-rectilll(-Tl some -ting scriTed to identify prior misconceptions about P'.,-P. The iiiec all the st@enyths -,,.,Iaicli characterized Regional ',kledical Procrans. Du-riii,- the iiiegtiTig, st-ron(T support i@as elicited froni the Secreta,@,-Is professional staff-, and the Secretary himself indicated..that in the future R@Hl iqill be @i key element in devel- opin(, mechanisms such as @L%10's tlirouul-i i.,,-Iiich the Department full carry out near initiatives. B. Heai.-i3iR .i3-id rol)rj-ations Both the Senate and the I-Jouse liai7-e reported out marked increases in funds for Fiscal Year 1972. The House I.ToUld add $'@O million, and the Senate $70 million to the aniou@,-it requested. In addition to this, $10 million supplementary appropriation for FY 1-971 increases the @,iiount held in reserve for FY 1972. Tlae marked increases plus the la-rcTer reserv.,,e indicate that greater amounts may possibly be available for grants in 1-Y 1972. Dui:iaia recent Senate appropri.atioa-i hearings, the Chairman ssed his determination that budget procedures i@ould not expi7e block expenditure of all rioi -s appropriated. In response to questions conceni-inc, the possible use of Section 910, it iva,,; pointed out that Section 910 has not been iiiTole),,iented in the past because of restricted avail,-ibilitv of f-un@-. Use of this authority i-@qi-glit ]fire been misunderstood as a signal that additional funds i,:ere available. If additional funds become available, lioivei,-ei-, 1)@iTS i@ill consider usina the Section 910 authority. First consideration i@ould 'be aiven to allocation -of additional funds to strono RNUlls that 1-iive been hurt by cuts in the past. C. Area Health Education Centers The Conares-s is considering -hqo proposals relating to Area Health Bducatioia Centers. The Administ-ration's Bill ivliicli has passed 4 i@oulcl place Area floaltli Education Centers in the lIoLiso The other i,,,oulcl I-)Ii,,:c, ,'J-]E@C's in ]@,IHIS. Senate and flo,,ise Bills ai-o-.sti.11 in co,i:Ec-relice and it is still not cortaii-i i,ilietliey IkToa I-loal-Lli I:,di-icitioii Cei-,toTs fill (,-o to NII-I or P@,,U)S. 'nie I-lo-Lisc, Bill i,@-Iiicli i-iiikos responsible, rcciLiires that any Area Iloal-Lli E-diir--@ition Center I)c, doiclopecl in cooperation i\Tj.tli '%Ic 1: Z, a.Regioiial. i -di.,al 11-i-o@@Lm, so ill -:DI), e-1,031t, R'I'I) i,:ill Ila-,re extensive in of this @-iL has de@,elo,.-)-d a irer, close -,,elatio3-iship, i,,,itl-i the. 'Iliii-el-.u of @lanpo,,,:ei.-. I'he ti.,,o oa7(-c-@-nizatioii,-; lia-x.Tb been i-l-orl@incT l@-oll toaether, have a cood uiidorstandino- of needs to be done and i@ill be able to coq@eTate effoctiarcl)r. Votera@'s Adiiiinistr,-.tio.,,-i his also exhibited a high level of interest in Area 1-1--altli Education Centers. The IA in' cooper- ation i,,,itli l@%P and has mounted a series of site visits to examine the potentialities for establishing Arei lical-Oi Education Centers ijliicli i,,,Ould include an imrestn,,-iat @i.,Icl on the part of the VA. Ti-iese visits have been conducted in -Lreas 1-iaviiia inadequate medical services, there good ivorl-,ing 3-clatioi-i- ships :-.-rc =already established i@ii.t)i Recional 'j\ledical Procr@i--,. The l@1% has made it quite clear that R%IP relationships ijould be very desirable, if not essential in all cases. Dr. llargulies asked Friedlander to comment on the l@@'s interest in AI-fE-Cls. 'i%lr. r@-ricdlm-ider indicated that only those communities ivould be funded th-rouoli @@,k i@liere activities have, a direct relationship to improved quality of care. ITA f-undiiau ivould provide initial support id-,icli aii Area Health Education -pccted to pick up once legislation has passed Center i@ould be ex and funds have been appropriated. D. Equal 01@,)ortLuiity ProRress Report The Regional i',Iedical Progrmis Service has developed a vc-'ry strong Equal E-iiil)lo),mient @1), oi7tiz-iit), program. The Service has an EEO Council made up of r@, iPS employees ivliicli meets i@eekly. R@IPS has established definite coalF, and targets for er@iplovnient of minorities. ai-id reopen bNy, January 1972. R@U"S expects similar EEO efforts to be uhdeT+-aken by granteesand affiliates. B. Report on Orientation Sessions - AuF-m st 2, 1.971 An orientation session for neiv Council members was held on August 2, 1971. staff discussed the general purposes, organizational structure and history of I'xccyj.onal @ledical P-rogranz. Ilie kinds of matters that come before the Council Here also 'Die se.-,sio-i i-;as I-)y l@rcl,-off, F. ll\!')Is Pro@-rcss RCI-)Oyt Rec7ioTial Medical Proar= throughout the col,)iiti-)r have developed t, LI an intense interest, in Health 1,1,@iiiitcnuice Or@,Yii-iizatioi)-s. l@%-IP has been ti-l-o specific responsibilities in Tola'L--ioii to 'I'lic-!se a@e to Set Up 7 'Llidelill S for ri', Ilitorill(T tIlEl 0 LI quality of care cnd (2) to describe for noaiitoi7i.ii,) or for guide- line purposes is meant by "Health iii-lintoii,,ij-ico,." 'Flies.0 a-re an out(,ro,,,:th of increased of the need for a -more sati-sfac'o-n, method of d--te-i-iiiinii,.- or not quality of care boi-n,) provided mid paid for i@itli Federal or iioi-i-Fede-ral is indeed .ideqLia-l@-c. ]%Iai,iy units of the Federal Government have been dealing with 4- these and o-Lliw--issues -rel.aL, to quality of care. Ik,\fPS is t.> COI'Ise-quea-itly i,.,orl\iiia ijith other units, NIJ.-I and Social C, Security to gain the benefit of their c,@p---rioi-ice'. In addition, R\!P is settiiic, -up some TncetincTs with coordinators and other ii-idi:%7j-duals who are concerned with measuring and monitoring the quality of care. I%le will also be callil-ig on members of the CoiLicil to contribute their thinking and special skill.s in relation to quality of care issues. G. Present Status of Section 907 Section 907 of the Act -requires that the Secretary annually publish a list of hospitals which possess the most advanced scientific techniques for dealing with heart diseases cancer, stroke, )@idne), -ii-id 3-elated diseases. Recei-it Coiicressioi-ial interest in Section 907 makes it laiol-ily undesirable not to -reparation of the required list proceed iijuiiediately with the p and )@Nn' intend-, to do so. The list will not attempt to be all- 3.nclusive or to include all institutions ivhe-re limited services are provided, but rather to list those institutions Israeli demonstrate really St erior and advanced performance. Tiie list will be IP carefully selective and will be desiaiied around criteril which 0 have been dorive-d 'Crom contracts to set up ouidelines for cancer. heart disease and stroke, and some other information which has 4 already been asseinl)"-.ed in the Kid,,aoy Disease Proo@ran to identify t' institutions which i..,@ould appropriately be included. 4 I'he list will be coi-,,piled on the basis of a voluntary response to a survey of hospitals throughout the country. The list would identify those hos-r.-'!-tals having 'characteristics associated with special qualit@l-. '11-iere would be no sense of accreditation or -regulation, 310T would a sense of approval or disapproval be involved. 'nie list will constitute a. selection derived from 6 Sec-reta-nr Is decision, prc-.,siu-r,,ibl.)- be to physicians and to tire public i.ii -uid i@oulcl. profile i nfo'nii,-Lt ion about i.,-Iicre certain leiels of iTie-clical care are ivi i iib 1 e There has --,came qtcstion in the past is to i..-lietlic-r 'cl@i-- -reatioT h@-@ been i of suc-@ lists is a feasible endeavor, one of the. reasons for failing to proceed raLicll), this acti-vit)@. General discussion follo,@.ied, but no action i,:as taken. VII. 'P)Y @h@. BE.\@,,TY AJ.)-.If!NTSTP\,@k-@'Oiz, SEP,@7ICES @ii,. liall, -representing Dr. I%Tilson ivlio ivas unable to attend greeted the Council and -read a I)-reT)a-re-d statement coiiccrni.na the creation of a better 'Health care system tli-roucli the application of tocliiiolo- gical develcr-r,,,o.@.it to the health field. The discussion i@hicil foll.o-,..Tcd indicated that the Council and the health field (Toneral-ly have, long been i,.vaTe of the )ote-iil:i,-:Llities of cor;,outer tec.1-iiiolo(,,@, and fallout from the Aerospace p.-oc, mn in the provision of health care. A number of Cou-1--il -nien-ibei-s, hoiie-kroy, strongly indicated that sub- ste2-iti@l additional funds i,@?oulcl be needed to turn the interest into practical results. @ll@. Hall also discussed. iargending changes in the organization of the I-IS!I.H!% Administ-rator's Office and indicated the likelihood that in the near f-uc-i-re a number of pToc,-raiiis fouler be grouped under four Deputy Acl--,anistrators -rather than -reportiiia directly to Dr. I%Iilson. "TS VIII. SIIE-CIAL RFI)OT\ A. P,-\IPS Reorganization Dr. Palil briefly outlined the current status of reorganization ivithin the ]Ze-ional 1,1@eclical Programs Service. C, The reorganization is currently unde-nvay and it will probably C, be early Septe,,Tiber-before all branches are able to get together and interact appropriately. .t The reorganization -t@ill restructure the in iqhicl-i PV\LPS inter- acts iqith tjie individual Rec7ioiial '\Iedical Pro(Traiiis. Four operational branches have been established on a geographical basis. 'niese, to,-ether with th@ Grants @.-Imagement mid Grants Re-kTieiv Branches coii.t3titute the i-iciv Division of Operations headed by @ir. Robert Chan)bliss. Four Operations Branches have, been set up on a geographic basis. Team of professional and supporting 7 other di@@i.sioi-is -u-id offices, such as Plm-inil-ia F@@,alua-L-io-,i ,ind Pro:L'ossioaial -uid Tocluiical been identified to sei-ie as joint appointees with 'clic Operations Branches. B. Rf:-vici@ Criteri.a Dr. Palil and I.,'r. Peterson discussed the net,,, l@i-PS critcria and rating system . 'D i e, revi-eij criteria and -rat-Li-ia syste,@i-i were developed by staff, and 0 ciTipl.o),cd for the first tL-Te by the ReATi.ei,: Co,@ij-iiittce as its July 1971 Eieetii@g. 'fi-ic criteria were derived fToiii t]-ie R.%U-)S 'LI -id a 1 "@,"ssioi-i Statc3-nei-it." Each criterion i,,as i%Tei-liteti, ai 5 scorii-i-- system ivas cimDlo)red for each. re-\,-i@ivers were asked to-ci3-cle the score for r criterion about i@Iiicli they were uncertain. In - addition, the ratina sheets includ-d a place for each revi.e7tver to indicate the basis for his c@,aluatioi-i. 'nie reA,ic@,Nrers appeared to feel cw,@lfort,-,ble with the o,,reral-1 process in which they had engaged. of the Reliel@ Co-Tli- mittee. felt 'chat the 17 criteria were comprehensive and that the s-Lib-crite-ria. raised in the fonii of questions were, in fact, useful in lielpinT them to channel their thoughts. Su,-ne.niodi- --o-rove-ire ere suggested, hoi@.eirer. fixations and i3ii, ]its I., As a result of this initial experience, plans - a-re unde-n%Tay to rea,rran.c,c@-ai,.d clarify a i-iLLmber of the criteria -nicl to provide more adequate iaif-o=.iation about certain items with a vieiv to increasing the revieiic-rs confidence in their ratings. In general the initial trial indicates that the criteria and rating system are both i@orlcable and satisfactory. C. Comcil,'Rffviei%r Comittee and Staff Responsibilities for Grants Dr. @-la@,ulies-read to the CoLu-icil the material under VIII, C. in the Acyei-ida Book Dn-L-@tled "Re\,iei@ Responsibilities Under the 7 Trieru-iial S-%stem.1' It was moied by Dr. @lillikan and seconded by Dr. I'@o'cli tli-at this stateni--nt be formally adopted. 'I'lie motion i,,.as api-.)ro,,recl unanimously. Ilie full text of the state- ment is appended as Attacl-uiient B. D. Watts -lVillut@I)i-ool@ Dr. @,lar,,@ies introduced Dr. Alf--red @t. liavnes, Cliain-nai-i, Department of ComLuiity I,,Iedicile and Assistant Dean for Conmnity Health Affairs, Charles R. Drew Postgraduate Medical Scl-iool, Los Angeles, 8 Di,. I-IgAiaes Oil t)lc-, I)rool@ i?3.-o-ioct i,,,',iicli 'cllic coa-,,--orted effort s of t'IIC@ Kil-1(7) Jr. I'..,).,;I)ital an-,I the Clii3-les R. Drei@ Post@T@Ldii-,it-- j\.Icdical SC-l-iool as fell C9.s other con,l- Ilie-sc, lia-ve cori@!)j-iied ii-i a coliccrteli el-f-o-rt to est<-Lolisla a health se,2-vice center in -the IVatts area to prc)v.,icle qiial.iL)T cqre to the residents. a'he project i---, oro-iiilzecl in such a that serv-Lco 'co tlie cai,;iiiTLmity is Teo-a-rdocl -is ea,-Liall),, --i,,d perhaps i-,.iore iri,,,oytaait, than educatioi-ial aiid research activities. E. St@-I'L.Lis 01, R"@S ]Ze 'atio@ @Ir. Kenneth La-L-E-a sirnarizecl the status of efforts to @vise RIP policies and f-,Ir--,g,,llatioi@ d \_ ID el The Gen--3-al- Co@i-,e.1's Office has -,icl-k7-ise M,.S to co ct -.v rei@,rite tl-i- ProyraTn's Rc,,(,,Lilatioa@ to -reflect the most -r cent clia-i-iaos in the Statute v--, i@ell as nc-,7,%r operational procedures. The General Cc7,uisells Office is developi.ii,7 in initial draft of such Pcoula.-Lions in cooperation i@rith PI.IPS. Considerable py--.,-"ess has also been i-.qade in developing a loose -itees, affiliates and use of ayai leaf polic), m, -a-i or tli @TS staff. Departi,,--ntal, I-I&12-Lk and R'\IP policies lia--k@e been assembled for ijiclii--,ioii, lig@@e-kTer, considerable editorial. i%Tork still -reniaii@ to be done. -Liter Assisted EKG -Analvsis F. Co@vr, Dr. John Farrell and Dr. i@,biineth Giiiible discussed a draft report Ol'i the subject of coi7ateT assisted EKG analysis that wqs prepared at tl-ie.request of the Council. Technolocj.cally fully operational EKG analysis -requiring no further -reading a pia),sa.ciai-i has not been achieved. Development of a full), a-Lic,-.--. --d syste,-ia of that level of sop7,iisticati.on is problematical. ' CoIT,)uters haire been accurately -Md reliably used for screening i-ioffal and abiioni-,il L-KG's i@itli less than 1 percent error. 'fhe cost of Automated E-J,Gls is estimated at $2 to $4 per cardio- grai-a exclusive of .1-te cost of rereading by a cardiologist and assun)inc, a r-unjiyri-r@i annual volume of input. Basic coiiclusions.2-f!@,zhccl from the study -were: (1) that coTn-,outer assisted EKG ana-LYsls an effective and -reliable screening teclinioii---, (2) that clc-finit-L-kre Tp.,,iqt@ bE, dope 'hN, a c;:- LL 1!,@ c)l it cannot -replace him. 9 IX. li@T-"Ctyl'i@-li@ the SI-ssioii there ivas a discussion of the stit-lis of efforts to consolidate three Olii-o In vi.ei@, of p-ro(,-rcss that has been ii@icle it i-jas proposed to p--rjnit these l@ccyioiis to ,-TPI)7. in It i,,-a-,, also p-:opo-c;o@l tli@,lt Coiu-@cil -and other -tpl:)3.- i-iate stiff i,,,it)i the Interim C-n2-,-nittee and the Fiscal A-ci-it. It was moved I-,)- Dr. and seconded by Dr. ]@u..7@aroff that the Coiil--ic-d.l. (,o on record as SUPPC)Ttillu this initial plan @-,]I')S I)c(@iii to Jerry ClireCtl_)7 I- including the l@.co@,'so that R ,i-th Ohio -i a stafl b is. The motion was adopted unanimously. s oi as Otl-ior items discussed during the Executi-kTe Sessi.pi-i included (I.) the status of the Alb,-:ny@@, Rochester and Central Xoii York P,,\P, Is; (2) the stitus.of the S@isqueli,-mna Valley P\i\E3; and (3) tlio-,. possible separation of De@,jare froi-n the G3.-eater Delat%Tare Valley Pi,-Ul. lio action was tal@eii on these matters. X. P\E.\TIBV OF PPPLIC.@TIO@,,S A. Hai-iai.i Re,-,i oa-.ial @.1-3di-cal P-roa-ram @ldtio.,i made by Dr. @,lilli-l@ma Seconded by Dr. OcJ-isi-ier "Approval of the Hai,;aii application for o L ne year failing at $1,072,OOD plus an additional $30,000 with the strong recom- inendation that none,, be utili--ccl for support of activities in tJie Trust -r-cyion and with the additional -:idi7ice as specified on page 1 of the Coiiunittee's report.'' (Transcript, page 20, line 20) The notion was unanimously approved. B. Northern ]\Ioiv Eii@olai-id Regional @'@edical -r Motion iiiad- by Dr. l@Lillil@an - Seconded by Dr. Scli enter -rove -r AI)ID the r'eco..-c@iidations of the IZeviei-i Coimiittee, including recordi-n- the six items of their critique, iiitli these items to 0 be kel-)t stroii@.v in mind then the triennial application is ultimately and with advice that through street" admin- istratiara leadership some of the real concepts of should be included in the ))-rogra-rn. (Transcript, paue 26, line 3) The motion was un,-iii; sl), approved after further discussion @mou which sua@lestocl tli.-i-l- t@-ic Region Ought profitably examine goals and objectives do-\,c.!@oped by other TC.%@IP's and develop a plan for use of collectecl data. C. Tc,,K,-is @loti.on b), D'.. T'@,@;,erist Seconded by ljr. Fric-cllm-idc-r "Appro@T,il- for t@o )?,ea--i-s at a f--Lindi.ii.(- of $1,590,000 iliclujilig tire Cl---A'Cl@oli,,licl-ital (TTaiiEc-ril.)t, paoc 29, line 25) 'Jlie motion i.,,as aT -r v .,)p o , c,-I. D. 1'Prb(T-ruii @lot-ion made b), Dr. D--Bal@ey - Seconded by Dr. Everist Con@,yreiico ililt-li the Cor@-Eiiittee's recol-@Tji,,oiidation i.,,itla the proviso tliit if 11-lic!' site visit slioul-d indicate a. need. for additional -@.cls, the request be brought back before the Council., .(Tyii-iscTi-pt, p.),<,Te 36, line 5) The riiotion i@-as ui-@,miroasl), ipproved. In subsequent discussion, it ivas a,@eed tJiat there i@oald be appropriate -representc-itioii from staff and tlic., T@idrc.,y Disease Pinel on the site visit. E. Bi-state Pcgiona. @di.cal Pro,@r@,m @lotioii i,@i,-de b), Dr. Oclis,.-ic-r - Seconded by Dr. D.3Bal,,ey Concur i,,,ith i%,Iiat the R@-@Tic-,iv Comiiittc-e -reco,=u ended, that there be an additional ),oar instead of the three years requested, and that this be in the aroix-it of @924,113 and further coii- currence i@ith the Co,--Tiittee's disal)p-rov,-d of the developmental component and the other -@,idiiig relative to the project. .(Transcript, pace 37, Iii-ie 16) 'Die motion i%,as ui-iai-iimously approved. F. Geo-rgi-" P,,6(,ioi-ial :-cal Prouam @ioti-on made by Dr. Canno-.q - Sect)iided b), Di-. Nli.llil@an Approval in the .-niol.-nt of $2.9 mi.'Ll.ion for each of the first -h%lo years and $'L.9 r@,illio2-i pl-Lis the requested amoui-it for project 30 for tJic third year, the oxict amount to be deteiiv,Liiicd by staff oi-i -LI-ic I . - -' @ of the intent of Council. In addition, the Council conc-L--.- --Ln the -recomici-ida-Lioiis of the site visitors with respect to spocificall)@ identified projects with the exception of kidney and the Stc-rhens County r 1 4 'llie motion iNm.s u-D-,-iii-,iously approved. ivas' not proseiit durii-L.@ consideration of this ai),r)li cati oi7i. G. AJ.ball)@ @lotion iiia(Ic- by j',,Irs. l@ycloi':f Seconded by Tli-. "Al,.proval. of- -Cno Rci-ici,,, Ccj-r@,iiitce-ols R-@coa-,,@-q@-lic-latio3-1 tll,-It --Oii-s pi-oj - oii- yeiT more for $900,000." ect be for oiil)7 I (Ta-m-isc-rii)t, pace 57, line 14.) -i i@as ui-i -mai-inous 1), afl)a7oved. The motioi li. Central Yo-rl.- @ieLii.cal 'P-rocram Motion made bv @-IT. Friedlai-ider - Seconded by Dr. Cajuion Approval for 6ne year funding, contingent oii a staff- folloii- up visi-t six IPO,'.'CIIS f-olloi,!iai(T the ai@,i.rd o-ic this application to cil@ eve..lu,@tte the pi.-ocloss -L-liat's been iiia'- in i-@ceti.no the conditions. 0 0 (Tr@,iscTipt, paoe 61, line l@D) Ilie motion unaii-uiousl-y approved. I. Rochester Pv@(,@io-iial @.,,-odical P o.-,am -Lion iuad- by Dr. Mc Pliedr,@-i - Seconded by Mr. @lill-iken no Approval of -Ciie Rc-kTi.ei,7 Coiru7Ottec's recor,-.-.iondation of $800,000 and deferral of any action;uiitil the next Council,ii,,cetii-ig on the kidney project. (Transcript paoe 63, line 24 and pace 68, line 15) -aously approved. Ilie n@ption iNTas unani-i J. @ien,.Pllis I'@o,,cTional Medical Progr,-ti-a* Motion made by @Irs. l@,yckoff - Seconded by @ir. Milliken Ap,-,oToial of the P@ey',eiq Co,-mitte-- recommendation for a funding level $1,627,0'VO for each of three years, or a total of $4,950,000 plus approval of su,,,,ge@ii-oiis in the, blue sheet with deletion of tl-ie to "!--clical l@soci,-:ition @es for project 39. (Trai@cript, ppce 71'), line 7, and page 87, line 20) The motion Has un@,,,-. imou-sly approved. K. @li ij.(,an RegioncLI Program ci Motion made by Ih-. 'Ic Ilhecl-ran Seconded by Dr. Komiroff li:Ul@, I llg -L U'.'L' Li@@, Lji, ..L Lli al!CL SlXLii years I-or eacii year, @-Dr. Czinnon not consideration of this qpplicLition. 13 @lotion made by Dr. Roth - Seconded by Dr. Cajuioji "Ap])rov.,).l o-r' f-iinAiii(T at the -rate proposed on pl"c, 5 of the -revised i]-) lica,tioai.1' (TrLlisca7ipt, pace 140, lilic 6) 'Die motion i.,,as -i-,r.?-pi7oved subsequent to so.-Pc fLi-rclior discussion i,,iii.cli iiijicatcd that I)rocyress on this Project Provide some cxarlples that could be used in @letiopolitpn D.C. 'I'dOija6y'F6i:ii@dacibii.' '%,iotion r..ia@ie byDr. Camioia - Seconded 1)), Dr. Roth Disa-PPTOVal. (Tr@-,tript, page 144, line 17) 'nie motion i@as unanimously approved. R. California Recional. @1--dical Proarpja** Motion made by Dr. ]%Iillikpa-i - Seconded by D.-. Ko-.,naroff "Leiel f-Lindi.-io for three years at $1-0,043,175 iiith exact amounts to be determined c-ii the basis of negotiation by staff duriii- Z> that pericfd, and for the sm to include the kidney project." (Ty,-uisca74-I)t, pacye 16, line 17) The motion i@as unanimously app-ro-ved. X. ADJgLJIZ%',%E,\'T 'Ihe meeti-na i@as adj oun-iecl by Dr. Pal-il at -1: 20 pill. on Au,@t 1971. 4 I hereby certify that, to the best of my kiio,,.,,ledc,,-, the foregoing minutes 0 t-I and attachments are accurate and complete. '/7 ','I -ulles, @l Director Regional @l,edical Programs Service coi-isictur *-Mrs. W atioii oJ-' this application. Yckof-f- was not present du-ri-ni consideration of'this application. ATTAC"','LT'?@T A Page April 26, 1971 c 0 p y resolution from the National Advisory Council on regional Medical Prograris Service Roger 0. E-eberg, M.D. Assistant Secretary for Health ind Scientific Affairs Attached is a me,-no @7oui the National Advisory Council for Regional Medical Pro-3:a-,iis which c-.xpi-osses -their deep concern. it was issued without their having had a detailed chance to look at the report by the group of consultants. I would hope that we would have a chance to discuss this in the very near future. /s/ Vernon E.. I%Tilson, M.D. Adminis tre tor cc: Herbert B. Pahl; Ph.D. Harold Margulies M.D. 2 SU13JECT: UN@'@Vj\l],A6@3-1l'Y Ol,' 'J'IIOSF, 1'1'0"'l' '@l 1-@'i,ICII l@ I Aj,, I r) J.'))' Till," )'071-', l-')'SC'Al, YJAl\'. 1971- l@i\l) 'O\ ]]AVE 1'1,,ACI-"D I'EQU@'@,STS I-I]iEl-@],@AS Tiie Pi.-ocriii,,s Sc,.'ivi.cc, c-rc-,@3Lc@d iii(i -poscs of (1) iTi-,prc)-,,i.iic foi- all. citi@cns iccc,.ss tc). for Llic I)tii. find iLitil.i,7@it:i.c)ii of Llicir local I)c@@tltli s)Tstei,,is, and (2) iiiipro,,,!.nct Llie quality aii(3 cffccti@,(-@-,-icss C)f"L-lic lic@altli services pi.-ovicloci x.?illiiii rf@c,i.ons, pirtictilarl3, %.@iL]i recard to cai-icer, strol-,e and. disc ases of' LI-ic lic-,.irt incl ]@icliiey, iii(I 'I-'lie Scrvi.c,-.o during tl)c five years of i.ts c!>,j.,,itc@nce liis est@-blislic@et N,i,3b].c, local t7i)e i-iiajor lic@,iltli care providers, and ii-,prc)@,ed tl)c-- -iiicl qti@-il,iL)@ c)'L tlir-, no@.,7 c-,xi@;t-bctx..,ecii tllE!";c providers anci Llie cotisttii,.c-rs i..,Iio coi-,ipris(-. Llic- several i-egioiis ; and I,)I,EP,EAS For these clisc.@ise c@ite-o):ics tl-ic Ilc@c J,,'c@dical Pro-ra-iis Sc,.rv5.cc %.?Eis to be @-@ prii,,-,ary, fui-icti.on@il. irl.'l of t] IC! 1)cp@3rt II', C' LI t of II c@ a I tli , rLC],Licatioi, and 1-7(,.Ifire i..?Iic-i.-eby tlie- potential benefits i.@Iiicli result frori tlic@ n@--ti.oii's support of the I)ioiiiediccil rc.,sc@ircli enterprise at the @latioi-t@il Iii&tS.Lutcs of lic.,il-tli can be realized froii practical @-I)plicat'ions I.,,itlliii coir@-nutiiLics; therefore bc- it IZESOLNIED: Tliit the Netionbl Advisory.Councl.1 for 'recional, I-lecli.cil Proc,rinis C-1 iqislies Lo C-P).-c!ss to the Adi-iiiiistr@tor,, Ilealtli Services and -it S I-Tc-ntal. IlealLli I-.(ii:iiiiistratio-, and to I:Iic, Assist@ii ec3:etary for llcal.tli @ind Scic@iitific Affairs its deep concern that tlic! .-,Linavaj.l,-I)il-ity of tiiose I..,I)i.cli i.@orc@ appropriated by Llie Coiii,,i-ess for fiscal year 1971 and Liiicli E,,tib@,eqtici-itly hz.-,,,c been placed in rc-sc-3-vc- i,7ill result in --c@riotis ciii:tailii,,c!nt the rioinc.-nttim of tlic,. ovEt,-i).l pi:o-riin ii-I iiiceti.iic, its objectives and, tlic-re.'Loi.-e, rcct-,lests i:cco,,-iFI.cleratic)ii of this iii,)Ltcr in tcyiiis of Llic Adi-,ii.iiistritor's e@:prc@,sed n@itionil priorities for iriii)rc)vl.iic, tl-ic lic@@ilti) services and delivery systc-iii of Llic country; and be it fui.-t:lic@r ]'\.I:@SC)LVI:"D: I'li @i t as near syst(--riis for tlic- delivery of licaltli services to corr,;iiuni.t5.(-,.s are (Icvisc-d iiicl instituted, the C.oulicil respectfully submits LI),IT the I-Ic!clicil Progrii.'I.-, Service i the vio.3t -i.iici.i)al I)rogrei-,i T,.,Iiicli @ill of Llic to I)(- Llic 1) I provider!; of I)cialtli care witlij.ii CC)nl,-.ii,,ii-ii.Li.c-s; i II (I be it fLirLilcr 3 OL@IED slil)[)O).-t Of CC)LIlici@l 3.,;Sllrc."C; '02- SccreL@ll@Y Lhit Cf. fol ?(,ell Llic! ]IC,.C, oil COnLi@iijil,'71 b oil 1) C' 0 c I fo -ii- f f C) r t .3 11, icl '!oil [:a " Ellcl c 0 1) o ra t c, t r C'. I-ileill .3s @i I I Cl 1115,tiLIlLes tl)('- NatiO-Ill, IiisLit@tiLcs of in orclea.- Ll)aL no L)c ol.,crlool@czd for briiic@ ciii, to tile the crcgte,,3t POSsil)ICI SI)eclcl Lfiose niccli-ciJ.'rescarcii adx,aiicc@s i.@!ii,cli can fori,@i tile I)asis for ii-,iprovii)@ 3cccsc; to all(I the oN,cr@J.'l of tile liE!,Iltll cpl:c- a x,,iil.pble to tile people of tl)(..Se I-cg@o,-Is.. li-i @,O ClOilIC-1 Llic' CoLilic5-l aiii-io,,iices Its 5.iltclit to estali).isli 1-1111)IC!Cljatcl@, for tile T),Ciioilpl 1-ic-cl SC, a set of sliarpeiicd p),-c,, prioriti -e@i @s. dcLeri,iiiicd. in coi-,sLltition 1.7itil li'cp]L-I) @Ser%,icc@s @,iicl Centel -lic!@ilLfi.Aclriii-ti-stration, Ltic InstiLL'tcs or llc-@@II.Ll) '.Iilcl otlier Iciz@,clers in tile fibid of I-'! C, A(Ivis council once cicli tilrec, i C,. j r E!t, @;clrv C.,; to rccoi@ni,,,,o :L on .7,s iii to F;CL a gellel.nl CO"Ilci-.I.'s ii c-,@, tj al)pi,o\,,Il ,or 1-til ]','fP Lis @-.:n for c In tc)' of, actions oil to tl"(.! A -cai,it or Prior to revici-T l@y tlic-. Co-Lilicil r(@V4 (I l@y 1. F, i i c- d IS s t i f f -a r-, t-. evisit tc,,i,.t ztiid the )@il'S Conriit'cco. Excop@l- as specified bel.o;.!, t-le cont:@,.iiu- ctivi":!.(-,F., for sLip,,,ort 't)r nc!-,! z c@coii(I and tliird (02 ind O.'i) yeqr st,@,)I@ort %.:i,,Iio,it fi.irt-I'lie-.-- C,,;,-,,icil act--!on insofar as the prol)o--ed activitief@- P,17C with policies. :ill Lc,- pi-ovi-dcie@ @i of sucl) nzlyirds. SI)ecifl- The Cot.tic@il i- call.y, ti-le Cc)tiic--"-l's ac'tvi-ce X.2,ien: 1. Su7)plericfit;,,rv ftii-,(is are rciqiiest:e(l in to the E.,,c,.nc-,ral- for t'l-tc, yc,.ir ir, quc-,stioi-I. sup])or,: r 2. A iie-@,7 or increased J.'jeveloi)illc,@tzil Cop-,poneiit is requested. 3. The Council, the ))ii.-c-.ct--or, IZP-@PS, or tlic-. R(-,gion r(@ciiiests Council revici-7. The @il)plic,:nt-liis failed -'.Tl Tr,,ItCrial r- ).ct to -Iec-t the eatjireiic-,i)ts of t'ic, Proi,,r@@m or .,,T)plic@-@DI.c I S, reCrUl,-,t@ioi-is r . I t, or fo@.,allv pro-,,ulp,,-itcci 1),-@licic-s of the De))@irti.,ent, IIS":'I"A or ]@il'S. The to I)c, to the Co,,ipci-1 ,Til.l inc).Ilcl!2 the inforf:),-,tio.-i coricc@i-,@iiii@ c--Etcli revj.(@@,ed b-,, for contiiuntion support: 1. Tl)'C .inc)tint recc-in,!)e)irled by the Council for r-undin[,, and the za7.,o-,jnt 2. A list of activities stipr)(irtc-@d during tire! iio@t recent f,,rint year, ideiitifv-fii- those ],,iv(--- been collected I-.icl tl!ose %,.,inch leave ],(,c--ii @-@upl)ortc-d tlirou,,Ii a devc-lop,,-,,,@iatLl cor,-.poi-icnt. .1 I TT,% C i A Pag-e 2 3. A 'o Of tllc! 4. A stir..lmqrN, of @),iy cf ,;i7,,y .7il@l. I)c -,:C-. oil f r request 1)3, Llia Couric-il. Iii),)roved Ncitioi,-il n'dvisory Coul@@cil. @l.-I Au-ust 3, 1971 AP PEN I) IX 1,IST 14ational Adv4@or -y CoL-,Ticil o-i I-,C"i.o"lal 3-4, I-)71 cou@.Ir-'Ill Dr. Bl--nd Cnrill,@Oll 0. Dr. y Dr. P, 1 t o. i Dr. B-@ucc-, W. Evz--rist Dr. B. @c)th Dr. @@i IIiaiii li-L;nt Dr. Ceor-!e. E. Scli--2 i rier L)r . t'@l'itht-.)iiy I,. \Irs. F'J.ol-eiice l@'. L."Ycl" off Dr. A'Le)--aricicr '.i. @IcPhc.-drai Dr. Bzri 1.4. 1,@l.,'@kins Dr. Jaiii P. '@Icrrill Mr.. Edi..,a--.-d Fried'Lander Dr. Clark H. i@,'illikan Dr. li:,rol,-l P.1,VIPS ST'lli@r Dr. E).vin Mr. Rocier ',Geller Kenneth Miss v -,Clcvc@l@qnd @@'out-.atsos iMr. Richard CJ.anton Miss ',jary @iiirphy Dr. J@.i-nes Clee-nan Mr. Nz,.@li Dr. Paul CoharL Miss 'N'els,)n ir. Src-@Ticer ColbLirn r . N--Mzcr Dr. Jeff @--andal Dr. Mich,@--@l \Icx@!Tiati Mrs. Shirl-2y 1--airlev Dr. Torbert Pa(il Dr. John Farr,211 Mr. Potersai-i l,ir. Gerald Cardell Piitei-, Mr. Terrence U-enz r. Mi'chael Posto Sa-,iuel U-iliner Mr. Lawrence Pullcil Dr. Keni-teth Miss Leah @z-_snick Greenfield @ir - ',,!ortc)n @ltobins Mrs. Eve. I, tidal Mr. I'%Icliard Russell Dr. Robert Mrs. Jessie Salazar Mrs. Gloria 'Ticf@s Mr. Luther Says Dr. Ed@@:,@rd Iiiiipa!l Miss Tlieresa Schcc-@i Mr. Calv.@Lii Mrs Patricia Schoe,-li Mr. Josepli Jc-x,,Lll irs. Glinter J,),inso,.i Judy Silsbec Mr. @liltoii Jo,---I--n Mr. @-lat-thcw S-,-)ear Dr. '.Kenneth Sid:-lev Stc!iri I Dr. Alriii J,-,rci-,ic Stolov Dr. Pliili;) I'llic,,er Mr. 14ill-,i-ii' Torbert Mrs. Lorraii-ic- '\'yttle Mr. I,ec2 Va-i 14i-il@le Nliss Carol Larsori Lyman Van N'ostrand Dr. ilarian Le.@i,--Ii Mrs i\lar,,,Irct Welst, Dr. Harold slar@,,ulies Dr. Gordon ;@-lacLeod Mr. Richard l@hite Mr. Roland Williams Pagc 2 "IC F S R% I-IS "f 1, l,ir 'tq i 1 1 i @l c 't@ e n, t i ico ii IL V l,ir ll%obert Sha,,.i, Re@,)iori II l'c5?,ion VI r C).ydL@ "-ouchf-.iaii, itc,,ion III Mr. D@-iii@-I t,,ebster, @IIII :Ile-lo-i IV Cu)-ric-@, IX OT 11 ',Ilr. Dzivicl Lovenvirtli, Cot-irultaiit .I,jr. tIc-@er Fo%, O%Iil@ 1-fiss Bctl,3'(-@ \101.)].CY, lis%i,IA ,kli,. lliltc,,i, N!IFC @-ir. Carl Ta),Io--, O,'4B Cars. FrEaicr--s !',card 2 National Advisory Co,,iricil oil Regi.oiiil iicdicil 1.1rograms SCILIP,EINEI',, Georgc, E., @I.D. (74) Director, Division of Nc@.pliroloay 0 Georgetown 11-iiiversity School of I,,Iashin@toii, D. C. . 20007 I,'ATKIl@S, l'Ic-nj,@,;nj.n W., D.P.M. (73) li'/O Leiio@. A-,7cnue New York, New York 10037 I,."YCKOFF, llrs. Florence r,. (72) 243 Corralitos Road Watsonville, California 95076 EX OFFTCIO 1-@,,!,,BER I,IUSSER, Marc J. , @f.D. Chief Medical Officer Veterans Administratioi.-i Washincton, D. C. 20@@20 Vernon E. Wilson, M.D. Adminis tra tor Health Services and Mental Health Adm@inistration 5600 Fishers Lane Rockville, Maryland 20852