i i'llil,il,,'@',,"I, if III File '111111, f d * ipt@ ot@@ Yroci 4 DEPARTMENT OF HEALTH, EDUCATION AND;@,WELFAR]k PMPS COUNCIL MEETING Rockville, Ma lahd ry 4 August 1071 ACE - FEDERAL REPORTERS, INC. Official ReporteTs 415 Second Street, N. E. Telephone: Washington, D. C. 20002- (Code 202) 547-6222 NATION-WIDE COVERAGE Cl,@-30 37 r, 01-1 q DEPAR"i"4ENT OF !IEALTI], EDUCATTOi.4, kN D i4ELFARL' 2 Public ilcalti'l Service 3 !I,--alth Services iiid P@ntal Health Adiainistration 4 5 I 0 N-,,@TIO'.Ti%L PDVISO,?-,Y COUii-CIL ON T-IL@GIO,-:ZAL ?,IE@DICAL PROCRAII.'@,@' 12 1 3 14 15 1 6 Parkla%.7n Buildina, 17 Conference Room GIH, Rockville, 1-larvland 18 Wednesday, Nugust 4, 1)71 .19 20 2 1 22 23 24 Ace - Federal Reporters, Inc. 25 2 C 0 N T E 11 T S 2 APPLICKTIOLI: PAGE: 3 Al'@,3any 53 4 Bi-State .37 51 California (S.V.) 3 0 Central Yor": (S.V.) 58 7 Georgia (S.V.) 39, '8 Ha-,qaii 17 9 T.-laine 106 10 -@lem-jhis 68 11 @letro D.C. 112 12 @,lichigan 103 13 Ne,v '-@lexico 129 14 Northern @4e@,7 England 21 15 L@lochester 62 16 Texas 27 17@ Tri-Stat6 139 - inia 18' Virg 31 Wisconsin 105 20 @'910" National Kidney Foundation 141 2i; 22 23 24 Ace-Federal Reporters, Inc. 25 3 P R 0 C E E D I N G S 2 DR. 14ARGULIES: I.,i the interest of sticking to various 3time schedules and getting our Council meeting over with 4promptly, we will begin now without any further hesitation. -We 5do know who has the earliest kinds of leaving schedules and so 6on, and I think we can adhere to that and not run into any 7difficulties. 8 I do.n't know when Dr. Brennan is coming. 'ge assumed he would be here and we haven't had word to the contrary, so 9 @io perhaps he'll come in a little later. So we will start the program review now. we will 12 take up those first which will make it convenient for those 13 who have to leave earliest and I will turn that part of the meeting over to Dr. Pahl. 14 15 DR. PAHL: Dr. Millikan, Dr. Everist and-Dr. DeBakey .have somewhat earlier departures, so with your permission, I 16 17 think we would like to rearrange the order of our reviews and 18 start with California. Dr. @lillikan. May I also ask the annronriate staff to sit at the 19 20 end of the table and add their comments as before, and the 21 regional office representatives, following their@meeting this morning, will be in to also participate on the individual 22 23 applications.as appropriate. DR. MILLIlWi4: On June 10th and llth, 1971, there was 24 Ac-e--F@ral Rdpotters, Inc. a project visit to the California Regional Medical Program and 25 4 1 and you have, I believe, under the California,tab, a green 2 abbreviated or synopsis version of the project site visit report 3 There's a longer one also available that has been distributed. 4 In any event, there are several interesting kinds of 5problems that are symbolized by the California Regional Medical 6Proaram, and I suppose one of them has to do with the potential 7differences in opinion between project'site visitors and bet;,reen-- 8the total concept of the Droject site visitors, and that of the review committee. It also exemolifies the potential diffi- 9 io culties in the triennial review process when we're,dealing with. 11 an altered budget structure from vear to year, and that has 12- inhere nt in it some difficulties in the judgment process with 13 the rest of us because of some differences in quality in the 14 subdivisions of the entire Regional Medical Program. Now, if you look at the first page of the blue sheet, 15 ,6@you'll see a series of recommendations and the first one 17 addresses itself to a portion of the original application after 18 the one kind of plan and the other to a second kind of p an; 19land ultimately you see there's a recommendation down here for $6.2 million ner annum for the California Regional Medical 20 21 Program. 22 Noiq, I disagree with this recommendation as a project site visitor and as a member of the Council, if that's@wl-iere 23 weire going to stop with our potential action, and in trying to 24 Ace-Federal Reporters, Inc. interpret the summary represented by the blue sheets, it seems 25 likely that a portion of this judgment to,make such a recommen- 2 Idation wasIarrived at because of the fact that a couiDle of these 3 subdivisions, which in actuality are regions, are very poor. 4 And if you look at the nine that make up California, one can 5 see unequivocably that what's called Area 1, Area 4 and Area 5 6 are among the very, very best in the United States, consisting 7 of San Francisco ,oortion, the U.C.L.A. portion and the U.S.C. 8 portion, the latter two having been the too that combined to 9 initiate the action that has been consuImmated by the formation 10 of the ninth area which is the one at Watts-Willowbrook or the 11 Drew School and King HosDital area. 12 These are offset, as one looks 'at the total program, 13 by a counle of areas that among the very poorest, and this is 14 San Diego and Oberlinden(?), 6 and 7; and numb er 8 has one good 15 program and that's the Irvine-Orange County area.' It has one 16 good -orogram, the community stroke program, and that is aioout 171it in terms of what's actually gone on in that entire area, 18 which, of course, is over several years. And, as one talks .19 rather candidly to the Personnel of that area medical program, 20 they don't have much in the way of nlans for anything more, if .21 you recall, at the time of our project site visit. 22 So, I think that while the California concept seems 2@@ to me continues to be working, that is having nine regions 24 reallv amalgamated under and working through a central office, I ikC6@Fe@ral Reporters, Inc. 25 think that phenomenon is working pretty satisfactorily. There 11 6 Iare certain disadvantages inherent in the situation where you 2@put very, very ooor quality area in combination with a very, 3 vat-,, good one and ask peop'le to assess a budgetary outl ay on the basis of their total reaction to this. So this is one of the problems inherent in the California Regional Medical Program grant application. 7 Now, the next item that I have already mentioned has 8to do with the problem which might be a delightful problem which 9might be created if in a year or 18 months or two years we had lo' a considerable change in the budget base from which we operate. In other words, suppose that our allocation and appropriations 'I@ in Congress is actually released and is considerably increased. i@@iby $30, $40, $50 million; and a program like this California 14 one is locked in to its triennial review process to $6.2. Well, l@'we would simply keep in mind that that would be the height of 16 inequity, at least that's my opinion about it, and we would need i7 to rereview the thing. ]8i. Now, there's one possibility that we could take an action at this point in time, because there are two nlans actually in front of us, plan A and plan B, which could make 20 some allowances for an altered budget structure if there was one 21 'lat the end of the line. 22 - Now, the review committee has a little bit of a dim 23 24 view of plan B. Well, I,tliink most of us on the project site Ace -Federal Reporters, Inc. visit seemed -- didn't see anything very materially wrong with 25 1 7 plan B at all. I don't know what the others' reaction is, but 2plan B sounded like an entirely equitable plan. 3 one of the poin@ about the whole triennial review 4process and about the kind of internal guidelines that we 5approved yesterday unanimously at this table was that we are f 0in essence giving what might be called a bloc grant. After 7careful and full review and inspection and deliberation, we are 8saying "For each of the three years we are going to give you 9tx' amount of money and you become the decision-maker as to the precise way in which various portions of this money is soent.1' And so what we're really talking about here in plan B is an increased total funding and it was the review team's 13 opinion that these people are highly competent to make decisions 14 a-bout how to wisely it was the project site visitors' opinion 15 that the California, the CCIU.IP and its subdivision.s are highly 161 competent to make decisions and good decisions about how to 17 spend that quantity of money. 18 So I think that probably there would be a-series of 191co,m.ents from staff and I don't want to belabor this issue any 20 further, but I am summarizing my'own reaction by saying that 21,within the context of what II've been commenting about that I 22'have some disagreement with these blue sheets. There's some 23 people here in the room who were on that project site visit and 24 studied this thing at great length. Ace @-Federal Reporters, Inc. 25 DR. PAHL: Does staff have any comments to make I 8 relative to the discussion? 2 MS. SALAZAR: I think that you can say that the '3 blue sheets reflects the consensus of the reviewers, as Dr.. 4@4illikan has nointed out, with the recommendations stated on the first page. It's a rather large team, as you can tell from @6.this report, and has received further information since '7 returning. DR. PAIIL: Dr. ochsner, have you any comments as the 9other reviewer? 10 DR. OCHSNER: No, I haven't. MS. KYTTLE: Dr. llillikan did I understand you 12 correctly when I thought I heard you say that it was your 131interpretation that Cie blue sheet was recommending $6.2? DR. MILLIKAN: Well, to go through this, they don't recommend $10.043. MS. KYTTLE: No. I was of the opinion that the intent of the blue sheet was to recommend '?B.3. DR. MILLII@N: ilinus 121. 1'9 MS. KYTTLE: Well, the kidney panel had met later 26,and restored the 121 which got it to $8.3. DR. MILLIKAN: Correct. And what I'm trying to 21 2@ emphasize here is that I think we either ought to make dual 'recommendation or say that we will bring this back to the review 2i Process if and when there is more total money in the P14P kitty 24'- Ace-Federal Reporters, Inc. 25,short of the three-year process. 9 DR. MARGULIES: Well, I think it's very important 2'right now to emphasize the fact that we really need to make decisions. We are asking the Council to make decisions based on what they think that program merits without regard to any 4 5assumed budgetary restrictions or we're in bad difficulties. So I think it should be based on what you see is meritorious and then we will have to make a decision based on the funds 7 8available. DR. MILLIKA14: Well, I could filibuster about this 9 io $10.2 million but I don't mean to get into that kind of a position. We heard a presentation yesterday concerning just one fragment of the California Regional Medical Program, and 12 that's what is now called Area 9. This is the ilatts-','Villo@,ibrook 13 This is one of the most exciting developments in the American @4 15 health scene as far as I'm concerned. That's just one portion of this thing. 16 Now, generally meritorious if you look at the San 17 -Jose-Valley project, the San Fernando Valley project, and a 18 1 ,- whole series of things in here where we have outstanding 19 examples of innovative and initiative kinds of ideas. We have 20 some of the best coordinators in the IJ.S.A., who are not even 21 Icalled RMP coordinators. They're local area coordinators. You 22 look at Areas 1, 4 and 5, I think they're really outstanding 23 people in the whole nation. 24 Ace -FedwaL Repoftets, Inc., Then when you look at the concept of $10 million and 25 10 you can't helm but quietly think about some of the other lU4Ps. This $10 million is relatively modest. 2 DR. PAHL: Is there further discussion by Council or 3 staff? 4 DR. MILLIKAN: llell, my inclination at this point in 5 ;Itime is -- Harold has made to me an extraordinarily important 0 "lbasic comment just now. He said that we should not consider 7 these simultaneously with thinking in our minds.eye about the budgetary constraints for our entire program. well, in a 9 "'sense, that's almost impossible to do, and I think you, having 10 been through the grants game for years, understand that. 11 The review committee can't do that either. They 12 really can't say, "All right, we're going to forget the 13i ,4'budgetar,y restraints in our entire review process." I don't .1. believe they'll work that way. We can't work thativay around 15 "this Co - uncil. 16 Now, if I were to forget those restraints, I'd say 171 unquestionably they should get the $10 million. Thisis what 18 we should mass. Now, knowing in one's mind's eye the money is 20 not available .1., DR. MC PHED@L: I agree with vou. 21 22 DR. 14ILLIKAN: Because on the basic item of wheIther they have put together an organization and have peopled their 231 organization dith individuals competent to go through the 241 Ace-Fedefal Repofters, Inc. decision-making process and work with one another an come up 25 I with a sound olan for instance, Area 5 has a whole new 2 initiative'planning process going-on and has some very exciting 8'things they're doing and it took us an hour and a half or two 4'hours to look at that particular -;)ortion of the thing. This 5 'is the U.S.C. part of it. They're moving, moving, moving 'continually. 7, So they have demonstrated unquestionably they have the 8 mechanisms and the Personnel to wisely use that kind of money. 9 DR. IIULITT: Total population of the area is what? 16 DR. MILLIKAN: 21 million. DR. KO.'4AROFF: That raises a point I wanted to make, 12 that@-.iith 10 nercent of the nation's people, California is 13.relatively underfunded. I don't mean underfunded in terms of I1.4merit, just in comparison with other Regional'Medical Programs. 15 I haven't read recent grants or been on-site visits recently, but I knew the program before and it seemed to me that 16 it is an outstanding region, that we ought to at least approve 17 a level consistent with our evaluation of its merit, takina per 18 capita Population considerations. @19 26 DR. PAHL: @irs. Silsbee has a comment I believe'. - MRS. SILSBEE: It's a question of Dr. Millikan. The 21 - last time California came u,,o and you were looking at the whole 24 - program, there was a recommendation for about $8.3 and that they 23 Ihad some hard decisions to make.and you wanted to get some notiOlt 24 Ace@Federal Repatters, Inq' of how they went about making those decisions. And in order to 25 12 have the record clear, I'd like to have some notion of the 2 difference in the decisions between the $10 program and the $6.3. Is there some indication that they made some tough ones? DR. -14ILLIKAN: I can't give you -- in their application are the details. There's some discussion of it in the project site visit. I can't give you the details of the difference i7 between the $8.3 million program and the $10 million program. Now, what has been accomplished out there -- for instance, there is an entirely new internal review committee 10 which has been formed and is now active. We had the opportunity to meet the judge who has accepted the chairmanship of that 12 co, -ooses ttee, who is -- one of the pur, of founding this -- of 131 having them actively internally reviewing the phenomenon going 14 on in each of the areas, is some extra internal monitoring. 1-5 RAG of the CCILP.IP is Now, the central office and the 16 fully aware of the problems of Areas 6','7 and 8, and they are 17,rather intensively trying by leadership examole and by personnel 18,from the central office going in to work with'these folks to do 19'lsomething about the lov7 level. 20i Incidentally, when you'have a central office like this 2iilit's highly effective. I couldn't helm but think about this in 22,the Ohio State instance. When you have a central office they 23@can take certain kinds of actions in a portion of the total 24'region that we really can't take at the district level, and this Ace-Federal Reporters, Inc. 25-is what Mr. Ward and his personnel are doing with Areas 6, 7 and 1 3 1 The decision-making process, Judy, about their own 2 priorities, as far as I'm concerned, has been adequately solved, 3 and they are now prepared to struggle with, argue about, and 4 ultimately make decisions concerning their internal priorities. 5 DR. 14ARGULIES: I met with that committee recently 61when T was out there and there's no question about the fact 7 that they're working hard to do exactly what you describe. 8 DR. MILLIKA.N: What did you think of the leadership 9 of that committee? DR. IIARGULIES: Iihink it's excellent. In fact, they 10 11 lare calling meetings on their own more frequently and with nore. determination than they had expected. 13 When I talked about considerations of funding level, 14 I should have also said that the regions themselves are in a 15 quandary over this kind of issue because they received at the 16 time of the cut in funding levels was promulgated a very strong suggestion that during the next fiscal year they would be held .17 to the same kind of funding level that they were in in the .18 19 Dreceding year, or that they were in after the funding cut was imposed, and this makes it difficult for them to decide What 20 - they should aim for because they don't know whether they s'nould 21 restrict themselves to what they think they're going to get 22 . because of the letter they received or whether they should try 23 . to go for something that they really believe that they can 24 Ace-@.Fedefat Reprottets, Inc. achieve; and they're struggling with this kind of an issue and 25 14 I it's a difficult thing for them; and if we then modify our 2 judgments in addition to the jud ments they've already imposed 9 .3 upon themselves, it's sortof a double hazard as far as they're 4concerned. 5 I know we can't ignore the total budget. At the same 6time, I don't know how we can anticipate our budget for this 7year because we don't know what it is, and in the absence of 8that kind of information, I think the most that you can do to 91look at the program on the basis of its merits is the closest 10 to a fair judgment we can ge 11 DR. MILLII@L: It's kind of interesting that one of 12 the simple signs of overall quality of California in the Regional.Medical Program is-the.very fact t'.,l 131 a.@.they have 14 already presented us with an alternate plan,. They're so effectively working and planning that they have two down here. 16 DR. PAHL-. Dr. Millikan, I'd like to ask you to 17 comment on point 2 on page 22 of the site visit report which 18 pints out that the $10 million plan of the region proposes 19 activation of some previously approved activities and so forth. 2b'Have conditions changed? 21 DR. MILLIK7uN: This is exactly the reason that I made 22 the comment tha t I did about the relative similarity of the 23 triennial concept and the bloc grant concept. You may not 24 recall that Yesterday I was the one that asked the question Ace - Federal Reporters, Inc. hether t going 'Tabour w his Council and the review committee are 25 to review brand new projects that are brought into a region 2 lby its personnel during the triennial? The answer is no, we're 3i not going to review them. 4 DR. PAHL: Not unless there's a request from one of, 5 the three parties. 6 DR. 14ILLIY@.4. All right. But what we approved '7 yesterday did not include reviewing new projects, only supple-. 'B mental and so forth. '9 DR. 'IkRGULIES: You do also have,the flexibility of, 10 making a decision at this meeting and altering it at t e next it one if there are changes in funding levels which you have to 12 respond to and .,7hich -,lou cannot identify at the present moment. 13 DR. MILLI@4: That's right. The only point I'm tryinc 14 to make is that whether we're talking about the $8.3 million 15 minus the 129, or whether we're talking about 9 of 10 or 16 whatever, we are really talking about a sum of money that is 17 going to be nut there, that is in California, with them as the 18 primary decision maker about the snending at year two and year 19 three unless some big questions are raised or whatever. That's 20 what I'm getting at. 2 DR. PAHL: That's correct. DR. MILLIKAN: And this.comment tJiat actually relates 22 ived one or 23 to some activities or projects which might be conce 24 two years ago is from a timing standpoint irrelevant. @ly Ace@ Federal- Reporters, Inc. 25 answer is it shows lack of practical recognition of the processe 16 that have been developed out there for decision making about 2 this money'. @3 DR. PAHL: Would_you care to place a motion before 4 the Council? DR. MILLIKAN: In light of the.comments and admonition,, '6 concerning our philosophy as we review these grant applications, '7 that being that we should look at them on the basis of their .8 merit and that the alterations in quantities of money be a portion of the staff's activities as it looks at our annual lolavailable budget, I move that we approve the amounts of money It listed under plan B with the provision that alterations in that 12 amount be the action of staff such alterations dependent upon 13 staff judgment of the availability of funds. DR. PAHL: Would your motion, Dr. t4illikan, be for thal. -15 level of funding for the 05 and 06 years also? 16 DR. I.IILLIKAN: Yes. 17 DR. PAHL: Well, if I may just rephrase it, the motion 18 then -dould be for level funding for three years at $10,043,175 with exact amounts to be determined on the basis of negotiation 26 by staff during that period, and for the sum to include the -Ikidney project. 21 2@ DR. MILLIKAL4: Right. 23 DR. KOMAROFF: Second. 24' DR. PAHL: The motion has been made and seconded. Is Ace-Fedetal Reporters, Inc. .there further discussion? 25 17 (No Response) 2 DR. PAHL: If there s no further discussion, I would 3'like to have all those in -favor of the motion please respond 4 by saying plAye. of ,5 ItAyesit) 6 DR. PAHL: Opposed? 7 (No Response) DR. PAHL: The motion is carried. 9 If we may now turn to the application from Hawaii, 10 with Dr. Millikan again and Dr. Ochsher as backuo reviewer. 11 DR. MILLIKAN: in December 1970, I believe there was 12 a project site visit and there have been,,as some of the Council 13 members are aware, a number of problems in the Hawaii Regional 14 Medical Program. One of them concerned with t'he quantity of 15 time the program coordinator was able to devote to' the program 16 and have I heard correctly that since the application was sub- 17 mitted and since the most recent project site visit there has 18 been appointed an assistant or an associate coordinator at a @19 full-time level? 20 MR. MORALES: It was Mr. Livermore Tuncks(?) dho was 21 on core staff as a program planner has now been put into the 22 position of executive administrator, and also, Dr. Hasegawa is 23 seriousl,,- considering the Possibility of coming on board at 24 100 percent kind of effort. Ptc@--Fedefal Reporters, Inc. 25 DR. MILLIGAN: In the application he's now listed as 100 percent in the application. 2 MR. MORALES: I understand he still hasn't. - DR. MILLIK@,,I: @lie reason I asked this question is 4'a series of project site visitors over many, many months, over '5 three years or so, have all recommended that the coordinator 6be full-time and/or have an associate or assistant or deputy @7 coordinator who can devote a significant amount of time to this @8'activity, and that had not taken place at the time of the last @9 oroject site visit and was mentioned as a matter of great 10 concern by the project site visitors. So that is now cleared 12 Another problem has to do .qith the allocation of money 131time and effort that are devoted to the Basin the Pacific 14 Basin, and the Hawaii R:4P is responsible for that activity. Now' 15 as I get the general scene, when discussion goes on in the 16 Hawaii Regional Medical Program RAG there is a friendly feeling 17 toward devoting activitv and money to the Basin, but when it 18 gets down to actuallv saying that "x" amount of money is going to be used for this purpose, why, the amount of money gets 20 smallers so it almost dwindles away. 21 Now, there's some problems, of course. The trans- 22 portation allocation must be pretty significant because it's 2@ costly to fly back and forth to the Pacific area, and I wonder 3 if any thought has been iven any Dldce along the line to maybe 24 9 Ace-Federal Reporters, Inc. in this instance helping, in a sense, the Hawaii RAG by putting 19 a little bit of earmarked, $30,000 or $40,000 or something like 2 that, for the Basin? Would that be possible? 3 DR. IIARGULIES: it could certainly come in the form 41of a strong recommendation which would produce about the same effect. 6 DR. MILLIKAN: I don't know how the others feel about 7 it, but from what I've kind of heard, it would seem in this narticular kind of situation this .qould assist the Hawaii RAG a little'bit and Hasegawa if there was some very strong 10 recommendation like that from this end of the line, just set 11, that aside, so to soeak, and use it that way and not get into 12 this interminable discussion and when you finally get down 13 to money matters about whether they're going to put any money 14 out there in the Basin. 15 1 don't know whether staff has any comme'nts about 16 this. 17i MR. MORALES: I think that this would be very helpful 18 to the region because Dr. Hasegawa has a concern and has had 191for years now that funds that he receives for Hawaii can be 20'easily depleted in the trust territory which is 3 million 21'square miles of area which he's responsible for, and the budget 22,tliat is reflect in the blue sheet is a recommendation by 23 committee course is keening really a tight rein on what fun s 24 Hasegawa will have for Hawaii itself, and if an additional Ace @cFefal Reportets, Inc 25 $30,000 was awarded for the trust territory then he will know 20 I what he will have to @vork with within Hawaii and, in addition, 2 can continue on with activities and possibly expand his '3@lactivities a little bit as,far as core staff and planning in the 4 trust territory with this $30,000. DR. MILLIKAN: The review committee has recommended, 5 and 06 0 as you see on the blue sheet, awards for the 04, 0 7 years $1.6, $1.4 and $1.3, and since this principal issue of the leadership appears at least to be temporarily solved, I favor or would move the recommendations of the review committee lolwith the conditions as stipulated bv the committee at the bottom of the first page of the blue sheet. DR. OCHSI'IER: I second that DR. PAHL: Dr. Millikan, in order to clarify the motion, would the funds which you wish to have'for the Basin be in addition to 16@ DR. MILLIKAN: I recommend $30,000 addition to be 17 with a strong recommendation or however one wishes to phrase thal that this monev be allocated for use only in activities in the 18 Pacific Basin. 2'04 DR. PAHL: The motion, then, is for approval of the 21 Hawaii application for one vear funding at $1,072,000 plus an hat that -22 additional $30,000 with the strong recommendation t money be,utilized for support of activities in the trust region 23 241and with the additional advice as specified on page 1 of the Ace -Federal Reporters, Inc,. '6,committee I s report? 2 21 DR. MILLII I 138 DR. KOIIAROFF: No, and they had an ideal opportunity 2 in which to do it. They're thinking about in Rio County a .3 rural health center ,,71iich .7ould use paramedical personnel and. 4 could very well have used these two-year men. 5 i4RS. SALAZAR: role have just a feedback letter stating 6 that the New -'4exico T-IP has not made any inquiry about the 'Health Services Act but the "B" agency has. 18 MRS. IIYCKOFF: They ought to get in line right away. 9 DR. PAHL: The motion is for the acceptance of the review committee's recommendations plus an additional $40,000 i@.-iith the recommendation that this be for the support of the 12 newly proposed kidney activities. Is-there any further dis- 131 cussion,> 14 14ILLIKEN: I wonder if that extra $40,000 should 15 be in the form of a site visit or a consultant to go and work 16 with them. 17 DR. ,,IARGULIES: I thin,-. you might want to consider 18 whether anv additional funds should be left unimpeded so that 19 the new coordinator and the new groun could have an opportunity 20 to move in the other directions or in the kidney direction, 21 whichever they ?refer, because they have a lot to do there and 22 obviously with the issues -- particularly which Bob Chambliss 28' raised they may really prefer to move in that direction. 24 DR. ClU,4NON: In other words, don't earmark the $40,000 kce@ Federal Reporters, Inc. 25 liust give them an extra $40,000. 1 39 DR. SCHREI"QER: It's meant to be a developmental 2 fund to make it @ossible. 3, DR. CANNON: Ilch go along with an amendment to the 4 11 for the question. motion if you'll accept it, and ca ..5 DR. SCHREIIQER: All right. .6 DR. PAHL: All in favor of the amended motion please say "Aye. 18 IlAyesti) 9 DR. PAHL: Onposed? 10 (1@o Resoonse) DR. PPIIL: The motion is carried. 12 We will now turn to the Tri-State.application.- with 13 Dr. @,oth as principal teviet..ier and Dr. Cannon as backup 14 revi-e%-ier. 15 DR. @TZOTII: Well, I believe that the Tri-State supple- 16 rentary grant application is relatively simple. This has been reviewed by the ad hoc committee. It has developed cooperative 18 arrangements with Vermont and Nort hern New England, with 19 Connecticut, and it's main unhappiness is it comes out ,,.,It 20 a name like NERCRO, which sounds like something indecent in 21 Iclandic. 22 The Council has already approved the -.,4'orthern New 23 England application, therefore, as you @,7ill notice that the 24 recommendation on page 4,the blue shoot, of the site visit, is Ace - Federal Reporters, Inc. 25 that, although there were some extravagances in some aspect of 1 40 I the )ronosed budget, that they considered that the revised 2 budget -)ro@osals should be approved; that if Vermont or Northern @3 N@--,..l England ,.ias approved, Ihat there be certain additional @4 deletions in the Tri-State oroposal. on the final page 5 they have presented figures @7hich reflect both,tliese considerations, with the deletion for the Vermont positions; and I would therefore recommend approval of funding at the rate proposed on page 5 of the revised application. DR. PAHL: Thank you. Dr. Cannon? io DR. CX,-INON: I second these recommendations. DR. PAHL: It has been moved and seconded to accept the recommendations from the review committee. Is there 13 further discussion by Council or staff? DR. ROTH: I can only say, in addition, that this l@ represents quite an accomT31ishment over a period of the past year and a half in doing the kind of thing that I think Bill 16 l@ihunt wants done in the '.Ietropolitan D.C. area. -8 When we site visited up there, there was a tendency .19 of Rhode Island, for example, to go its own way with Brown 20 University ins-bting on having a transplant-dialysis.program 2" totally independent of the very nearby Boston thing. So that I assume that this represents a meeting of the minds and some 22 compromise on these issues. Perhaps staff can fill thatlin t ':' for ni c 24 Ace-Federal Reporters, Ing. MR. MC KENNA: Well, I think you're right. There has 25 14 1 I realizaation of the need for this. 2 DR. P7'@L: Is there further discussion? 3 (No res?onse) 4 DR. PAHL: If not, all in favor of the motion please 5 say 117'.Yc. II 6 7 DR. PAHL: Opposed? 8 (No R,-s-oonse) 9 DR. PAHL: The motion is carried. 10 We turn -to the final action before us with Dr. Cannon as r)ritici-,oal re-,riewer, Dr. Hunt as backup reviewer, this. 1 2'I a,),,:)lication -from the National Kidney Foundation. 131 'DR. C.tUl-.40N: I'd like to ask before -@orge leaves 14 if he would briefly give the Council some information,s-.)ecifi- 15 callv how does the National Xidnev .Foundation differ from other foundations, the National Foundation for i,lultiole Sclerosis 16 and there are hundreds of them. Ts there'.30MI- difference that 17 we should oarceive? 18 DR. SCHREINER: One major difference is that it's 19 20 regionally organized rather than-by states, so it.differs from 21 Cancer and Heart in that respect. So it does get into some of the same dis tribution and personnel problems that the RMP 22 does. Some of the discussions we 23 iiave a@:)out the coordinators reminds me of the affiliates' relations committee because we 24 Ace-Federal Reporters, Inc. can T3ick out Ohio and Susquehanna Valley and the same trouble 251 - 142 there has troubled the Regional t-ledical Program. 2 DR. CA14NO,,4: It is a T)rofessionally controlled group 3 o@ lay controlled? 4 DR. SCIIREI@LIER: it's jointly. I would say it's 5 closer to the -- the organizati on is a little bit different 6 than the Heart Association. There is a Scientific Advisory 7 Board which is completely scientific and academic and non- 81 geographical. There is a 'I@,I,--dical Advisory Board which is 9 Ire-3resentative, with one elected by the @lledical Advisory Boards 10 in each region -- in each affiliate. There are about 41 11 affiliates. And the Board of Trustees is a mixture of doctors land lay ?eonle. The power the corporate responsibility is 13 in the Board 0f'Trustees. 14 DR. CIV4',-40ii: @le have a request for a million dollars 15 to spent over a three-year oeriod of time. The request comes 16 from the Iational Kidney Foundation. The objective is to !-lave. 17 a national .nrogram to increase the number of cadaver kidneys 18 for transplantation by seeking the active support of 50 million 19 iN-riericans and the medical community. 20' It has two projections.' one is a national project, 21' an expansion of the existing educational program within the 22 @I'Llational Kidney Foundation. The second is local projects at 23 the state or major metropolitan areas designed for more controllc 24 and intensive effort than is proposed at the national level. Ace@Fe@al Reporters, Inc. 25 In essence, they would like to have this million dollars to spen 14 3 1 in'a three-year period of time beefing up an educational 2 program to enhance the donor organ --'voluntary organ donor 3 3rograTq for kidneys and t@ educate the ?eople. 4 This would be under the executive director who would, 5 in turn, hire a full-time project director and other personnel 6 to carry out the message. There's also a request for some 7 equipment, like desks, chairs, filing cabinets, typewriters, 8 etc. 9 It's my feeling that while.this is a very worthwhile 10 and needed Projection, that the enhancement.of cadaver kidneys 11 must be forthcoming if you're going to get a program of trans- 12 plantation around the country to be effective, I do not see 13 how we can at the present put money into a foundation for this 14 ,)ur-,oose, because there are so many foundations and so many 15 ournoses that it would continue on infinitum. 16' So I would recommend the disap?toval of funding.Therel 1 two alternatives to frank disapproval. One is that, if you 18 really want to do this, there was earmarked $15 Trillion for 19 kidney in the last legislative act. Is that true? '@-I"Liat 20' lia-3nened to that? 21 DR. '%IARGULIES: i.4o. ',,?hat it finally ended up being 22 %.ias no more than $15 million will be spent for kidney. There 23 was no earmarking. DR. CANNON: There.wasn't any earmarked funds? Well, 24 Ace-Federal Reporters, Inc. if there are no earmarked funds, then I don't think we can get 25 14 4 I around the requests from other foundations. I thought that was- 2 a oossibility. 3 The other ?ossiUlity would be using Regional -',Icdic.al 4 Programs in an educational way, the existing @egional @,ledical, 51 Programs. 0 I have a lot of sympathy for the program but I just 7 don't see how we could onen the gate. 8 DR. ROTH: I'll second Dr. Cannon's motion to 9 disa-D-,)rove for a somewhat different reason. It seems to me that 10@ this Council should take a rather pragmatic attitude, that It before we start concerning ourselves with building demand for 12 transplantation and dialysis and compliance on the part of 13 those who would provide kidneys, we should have somewhat more 14 assurance that we've got that in-between step of the facilities 15 and the neonle that can make use of it and provide the service. 16' 1 think therefore, this is premature. 17 DR. PAHL: The motion has been made and seconded to 18 concur ,vith the recommendation for disapproval of this appli- 19' cation. Is there further discussion by Council? 20 (No Pesponse) 21' DR. PAHL: All in favor of the motion please say "Ayp-.' 2@ ('IAyes 11) 2 3' DR. PAHL: Onposed? 24 (No Response) Ace-Federal Reportefs, Inc. 25 DR. PAHL: The motion is carried. 14 5 1 Before we depart, I'd like to just take a moment and 2 thank Dr. Kloiger and Mrs. flicks who handled the logistics of '3 the meeting. I'd like to-corinend our own staff for their 4effective participation, and I'd like to thank the Council 5members, both those who ,7ere here earlier this morning And those remaining, for fitting this into a very busy summer '7 schedule. I don't knot whether there's any more business that the Council may have with us. I believe, Harold, we have no 10 further business to bring before the Council. 11 DR. '-IARGULIES: I can assure you it will be coller 12 in !4over@er and next August it will be just as hot. Thank 13 you again very muc 14 DR. PAHL: Thank you all. The meeting is adjourned. (Whereupon, at 1:20 p.m., the meeting was adjourned.) 15' 16 17 18 19 20 21 22 23 24 Ace -@F-ederal Repofters, Inc. 251