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DEPARTMENT OF HEALTH, EDUCATION
AND WELFARE
Health Services and Mental Health Bem stra.

‘Division of Regional Medical Programs

National Advisory Council on
Regional Medical Programs

Minutes of Meeting
March 31-April 1, 1970

National Institutes of Health
Conference Room 4
Building 31

 
 

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IT.

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
Public Health Service

National Advisory Council on Regional Medical Programs
Minutes of the Nineteenth Meeting 1/ 2/

March 31-April 1, 1970
The National Advisory Council on Regional Medical Programs
convened for its nineteenth meeting at 8:30 a.m., Tuesday
March 31, 1970 in Conference Room 4, Building 31, National
Institutes of Health, Bethesda, Maryland. Dr. Joseph T,
English, Administrator, Health Services and Mental Health
Adm¥fii stration presided over the meeting.

The Council members present were:

Dr. Michael J. Brennan Dr. Alfred M. Popma
Dr. Bland W. Cannon (3/31 only) Dr. Russell B. Roth
Dr. Bruce W. Everist Dr. Mack I. Shanholtz (3/31 only)

Dr. Clark H. Millikan (3/31 only) Mrs. Florence R. Wyckoff (3/31 only)
Dr. Edmund D. Pellegrino

A listing of RMP staff members, and others attending is appended.

CALL TO ORDER AND OPENING REMARKS

The meeting was called to order by Dr. Harold Margulies who
introduced himself as Acting Director of Regional Medical
Programs Service. Dr. Margulies replaces Dr. Stanley W. Olson
whose resignation was accepted by Dr. English on March 16, 1970.

ANNOUNCEMENTS

Dr. English acknowledged Dr. Olson's very important contributions
to the development of Regional Medical Programs, both as a

former Coordinator of Tennessee/Mid-South RMP and as Director of
the Service and stated that he has asked Dr. Olson to remain as a
consultant until he assumes his new position in San Antonio.

 

Proceedings of meetings are restricted unless cleared by the Office
of the Administrator, HSMHA. The restriction relates to all material
submitted for discussion at the meetings, the supplemental material 7
and all other official documents, including the agenda.

For the record, it is noted that members absent themselves from the
meeting when the Council is discussing applications: (a) from their
respective institutions, or (b) in which a conflict of interest might
 

‘ITI.

services.

Page 2

 

In addition to his principle position as Administrator of
the Health Services and Mental Health Administration, and
also as Chairman of the National Advisory Council on Regional
Medical Programs, Dr. English explained that he has now
increased his direct involvement in Regional Medical Programs
by assuming into his office the direct operational responsibility
for the Regional Medical Programs Service. He has asked

Dr. Margulies to accept, on an acting basis, the direct
responsibility of administering RMPS. Dr. English asked the
Council for their help in finding a permanent Director and
Suggested that they write directly to him with the names of
candidates whom he might consider and also any special
characteristics that they feel he might wish to identify in
making his final selection.

Dr. English reported briefly to the Council on his recent
appearance, along with Dr. Egeberg, before the House Ways and
Means Committee, as a part of their closed hearings in regard
to the MEDICAID Task Force report. He said that both he and
Dr. Egeberg considered this a Significant first opportunity for
representatives of the nation's health professions to be
included in discussions of Federal financing of health care

2o

CONSIDERATION OF FUTURE MEETING DATES

The dates of July 28-29 and December 8-9, 1970 were reconfirmed.
No dates were made for meetings to be held in 1971.

CONSIDERATION OF MINUTES OF THE DECEMBER 1969 AND
MARCH 2, 1970 MEETINGS

The Council unanimously recommended approval of the December 16-17,
1969 and the special March 2, 1970 meetings.

UPDATE IN THE LEGISLATIVE PROCESS
A. Extension Legislation

In discussing the Health Services Improvement Act of 1971

the Council reactions were essentially the same as those elicited
at the time of their earlier discussion of the proposal with

Mr. Irving Lewis, at the special meeting on March 2, 1970.

Dr. English assured the Council that many of their concerns
were based on what he believes is a misunderstanding of the
intent of the Administration inthis legislative proposal. He
made it very clear that there are no intentions to place one

9
 

 

Page 3

of the programs "under" any other of the programs involved, and
that the very essential role to be played by Regional Medical
Programs in the Federal effort to improve health care services

rather than any attempt to change, subordinate, or destroy one
Program while endorsing or developing another. The Council is
not, however, sufficiently confident that the Program can
withstand what will be the apparent, if indeed not the real,
effects of the implementation of the provisions of this proposal.
The members also expressed frustration in their ability to make
& genuinely supportive interpretation of the proposal to their
colleagues who have served and cooperated so enthusiastically

at the national and local levels and in their institutions.

Dr. Pellegrino effectively summarized the Council's belief
that none of them can honestly and conscientiously serve as

a "salesman" for the proposed Health Services Act of 1971 and
therefore, their only effective role at the present time can
be that of "negotiator." This they can do by attempting to
identify the aspects of Regional Medical Programs that have
made it sufficiently useful to the Administration, and then to
make every effort to see that these aspects of the Program
are preserved,

In discussing the future role of the Council, several of the
members , particularly those who had been unable to attend the March
meeting, were surprised and disturbed to learn that Section 901

of S 3443 is in error, and that in fact the role of the expanded
 

Vil.

Page 4

comprehensive advisory council would be limited to advice and
assistance to the Secretary on policy matters and an annual
retrospective review of the grant supported activities. Such

a role, they believe, would severely limit the effectiveness of

the Council in influencing either the direction or the quality .

of the program. Questions were raised concerning the administrative
arrangements to be established under this legislative proposal

and the general concept of peer review of grant application.

The Council voted unanimously to go on record as recommending

that the present mode and authorities of the National Advisory
Council on Regional Medical Programs be preserved; by administrative
regulations if not by law; either as an independent Council or

as a subgroup of the larger comprehensive Council proposed in

the Health Services Improvement Act of 1971.

The Council likewise voted unanimously to record their
recommendation that the disease-categorical emphasis of the
program be preserved, not as a limiting factor on the development
of the Program, but as a focus for program emphasis and to
define the "principle concerns" of Regional Medical Programs.

B. Appropriations - FY 1971

Dr. Margulies informed the Council that hearings before the
House Subcommittee on Appropriations were tentatively scheduled
for the week following the Council meeting. He said that he
expected them to be uncomplicated and probably brief, in

this Congressional election year.

APPORTIONMENT OF THE FY 1970 BUDGET AND BUDGET PLANS FOR FY 1971

Dr. Margulies reviewed the circumstances which led to the DHEW
and Bureau of the Budget decision to release the $20 million

in grant funds which had been held by the Department as part

of the expenditure limitation. Based on a specific plan presented
by Regional Medical Programs Service at the request of the
Department and the Bureau, $5 million is available

for obligation between now and June 30, 1970 and the remaining

$15 million is to be added to the amount requested in the 1971
budget; bringing the total amount proposed for grants in FY 71

to $94.5 million.

IMPLEMENTATION OF MULTIPROGRAM SERVICE GRANTS (SECTION 910)

This grant authority was added to the RMP legislation in June 1968.

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Page 5

However, due to the expenditure limitation imposed at the same
time, and subsequent constraints on available grant funds, it
has not been implemented. The Council was reminded of the
general guidelines recommended by a special subcommittee chaired
by Dr. John Hogness, the report of which was adopted by the
Council at its meeting in August 1969. Staff advised the
Council that they intend to develop a set of specific Terms
and Conditions, based on the general guidelines contained in
the Council recommendations. These will be made available
nationally and applications will be invited to compete for
grant awards early in fiscal year 1971.

In this connection, Mrs. Phillips described the Senior Clinical
Traineeship program, which provides direct support for

individual physicians to undertake post-residency training in

the clinical management of neoplastic diseases. This program
was begun as a Clinical Fellowship program of the National Cancer
Institute very early in that organization's history. In 1963

it was transferred to the Cancer Control Branch of the Division
of Chronic Disease. Initially it was funded by them as a direct
award program, and later as a program of institutional awards
under the 314(e) authority.

Scheduled for phase-out along with the other activities of the

Division of Chronic Diseases, this program was singled out both

by the Office of the Assistant Secretary for Health and

Scientific Affairs, and by oncologists in the medical/academic

community, as being of sufficient importance to the Nation's

potential for caring for cancer patients as to warrant its

continuation as part of the ongoing activities of the Regional

Medical Programs Service. It was agreed by the Health Services

and Mental Health Administration that this Program would continue

to be funded at an annual level of approximately $1 million,
and be administered under the Section 910 authority of the

Regional Medical Program legislation. Although at this late

date in the medical/academic year probably only a small number

of qualified candidates remain unplaced and only a very few

first rate training opportunities remain unfilled, it was agreed

that it is important to maintain the continuity of this program.

Therefore, an amount of $300,000 (of the newly released $5

million -- see above) will be set aside for awards to be made
during the remainder of this fiscal year.

Because the Council will not meet again in this fiscal year, the
Council unanimously agreed to delegate to Dr. Brennan the V
authority to select appropriate candidates for these awards. He

will be assisted. in this effort by an ad hoc panel of experts in

clinical management of cancer, representing the six basic disciplines
 

VIII.

Page 6

of internal medicine, pediatrics, surgery, radiology,
pathology, and gynecology.

GUIDELINES -— IMPROVING CONTINUING EDUCATION ACTIVITIES
USING INSTRUCTIONAL TECHNOLOGY

Dr: Pellegrino reported on the work of the subcommittee which
developed the draft guidelines which were before the Council.

He explained the workings of the task force which undertook

the study and the nature of their report to him and to Dr.

Mack Schmidt and Dr. George Miller who represented the Review
Committee. He said that after a great deal of discussion it

had been agreed to present this very preliminary draft to

the Council only as an indication of the directions being

taken by the subcommittee. The Council agreed to approve Part

I of the report, in principle, with the recommendation that it
undergo substantial substantive and editorial revision and
resubmission to the Council. Part II of the report was considered
separately and found to be entirely satisfactory in its present
format. The Council unanimously recommended its approval without
further substantive revision.

GUIDELINES FOR CANCER CARE

Dr. Sloan recalled to the Council that these Guidelines were
prepared by a Special Advisory Committee on Cancer Care
Facilities of the Cancer Commission of the American College
of Surgeons, under contract with the Division of Regional
Medical Programs, in response to Section 907 of the Regional
Medical Programs legislation which provides that "The Surgeon
General shall establish, and maintain on a current basis, a
list or lists of facilities in the United States, equipped
and staffed to provide the most advanced methods and techniques
in the diagnosis and treatment of heart disease, cancer, or
stroke. . ."

She introduced Dr. Warren Cole, who served as chairman of the
Special Advisory Committee. Dr. Cole outlined the procedures ,

the representation, and the data gathering activities of the
Committee and formally presented the report to the Council.

He also reported that the Guidelines had been reviewed extensively
by the National Advisory Cancer Council who recommended that a
concise sunmary be prepared.

In response to questions regarding the apparent stringency of the
guidelines, Dr. Sloan reminded the group that the document is
indeed intended only as a guide, and only for hospitals which wish

 
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Page 7

to be designated as providers of definitive cancer care.

In accepting the report, the Council offered their congratulations
and sincere thanks to Dr. Cole and the Committee. In further
discussion, however, they stated very clearly that in accepting
the report they have not approved it for publication. Instead,
they agreed unanimously to recommend further work on the report
and further assistance from the National Advisory Cancer Council,
with reference of the final draft to a subcommittee of the
National Advisory Council on Regional Medical Programs before
presentation to the Council as a whole.

REPORT FROM THE AD HOC COMMITTEE: ON KIDNEY DISEASE

 

Dr. Margulies reported briefly on a one coy ad_hoc meeting held
February 13, 1970,of a group of experts in the Kianey field.
Although the principle purpose of the meeting was to offer
professional guidance in the development of an effective kidney
disease program as an integral part of Regional Medical Programs
under pending legislative proposals, the discussion concentrated

 

- on recent trends in the treatment of end-stage kidney disease, ~

focusing particularly on regional requirements. Although it

was not presented as a definitive document, the general
recommendations of the ad hoc committee met with general agreement
on the part of the Council. Dr. Everist suggested that when

such a document is finally prepared it should include more emphasis

on prevention of kidney disease, particularly in children.

REVIEW OF APPLICATIONS

 

A. Relevant Issues

1. RMP grant contribution to the establishment of
and continued demonstrations in intensive care units

 

At the request of the Review Committee, the Council was asked

to consider the role of Regional Medical Programs in continuing

to establish and equip facilities-resources in institutions which,
although initiated for purposes of training and demonstrations,
will continue to provide patient services for which fees are
routinely collectable from virtually all third party payers.
Recognizing the very great difficulty faced by the Review
Committee in making judgements on such projects, particularly
when they are of recognized value in the establisnment of a
Regional Medical Program in a community; the Council continues to
believe it unwise to attempt to develop a firm policy, arbitrarily
including or excluding such projects from Regional Medical Program
grant support. oe . uO

acy EE iaoas ta IS nd Sits ct A Nigra A

 

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Page 8 9

Relating this general issue to a specific request contained in
the application from the Greater Delaware Valley Regional Medical
Program, Dr. Millikan suggested, and the Couneil unanimously
agreed, that funds from Regional Medical Programs should not be
used for support of the establishment or maintenance of stroke
centers designed to evaluate specific modalities of stroke
treatment. Sixteen such centers are eurrently funded by the
National Institute of Neurological Diseases and Stroke for
carefully designed and thoroughly controlled studies of these
therapeutic modalities, and will provide sufficient information
and data to make the definitive judgements in this regard.

2, Need for a study of Regional Medical Program
Participation in Projects Involving Automated

Technology

In response to a repeated request from the Review Committee for

guidance concerning projects which are clearly identifiable as

fipesearch and development" and require large expenditures for

expensive equipment, the Council has agreed to undertake a study

in this regard. They also agreed with Dr. Margulies on the

necessity for some background information on the current status
of Federal. funding of such activities, particularly funding by 3
the various component programs of HSMHA. This study Dr. Margulies
promised to have available at the next meeting as a basis for

further investigation of specific roles of Regional Medical

Programs in this arena.

3. Review of Council Policy on Health Manpower _and Recruitment

At the suggestion of the staff the Council voted unanimously to
amend the Guidelines on health careers recruitment (Guidelines
Addendum, February 1970, page 15) to include the following
additional statement:

"This does not include the use of RMP funds for
remedial education, enrichment programs, or
student loans or scholarships."

4, Kidney Disease Policy - Retain for Remainder of
FY 70 or Revise? .

In the light of the present uncertainities regarding both

legislation and appropriations for Regional Medical Programs in

1971, the Council agreed that it would, at this time, be premature

for them to undertake the development of a more specific policy
regarding Regional Medical Program support of kidney disease activities.
 

 

 

Page 9

At the same time they recognize the difficulties inherent in
continued deferral of action on Specific kidney disease projects
which reach them for final recommendations.

In addition to several which are before them in this round of
review the Council agreed to reconsider the three which were
recommended for deferral at the previous meeting:

WISCONSIN REGIONAL MEDICAL PROGRAM
Project #15 -— A Comprehensive Program in Renal Disease

Approval in the time and amount requested with the suggestions and
recommendations cited by the Review Committee in July 1969
(see also Section XI C).

NEW YORK METROPOLITAN REGIONAL MEDICAL, PROGRAM

Project #13 — A Regional Program for Training of Physicians
and Other Allied Health Professionals for the Management of
Chronic Renal Disease Patients

Approval at the reduced level and with the Specific conditions
recommended by the Review Conmittee (see also Section XI C).

METROPOLITAN WASHINGTON , D. C, REGIONAL MEDICAL PROGRAM
Project #31 - Hemodialysis Training Program

Although conditional approval was originally reconmended by the
Review Committee, the major reservation expressed was the absence

of a transplantation center to witich this project can directly relate,
either immediately or in the forseeable future. In the absence

of any satisfactory resolution of this particular aspect of the
recommendation, the Council again deferred final action.

 

 

 

 
Page 10

B. Special Actions ‘

NEBRASKA/SOUTH DAKOTA -— The Council was apprised of recent
correspondence between the Region and the Division regarding

its possible separation into two state Regional Medical Programs,
and the proposal of the South Dakota Governor to combine RMP

and CHP in his state.

 

The Council expressed interest in this as an experiment but
declinéd to make any formal recommendation. It was agreed
that their involvement would be appropriate only at such
time as an application for a planning grant from South Dakota
is submitted.

WESTERN PENNSYLVANIA - Project 8 - Laurel Mountain Home Health
Aide Training and Demonstration

This revised application was submitted to Council at the
specific request of the Region in order to provide additional
information intended to clarify the relationship of the project
to the Region's total effort.

Council reaffirmed its original assessment of the inherent
quality of the project, particularly the educational aspects.
On the basis of the additional information and the revised
budget, they agrealon its appropriateness as a part of the
Western Pennsylvania RMP and believe that the cost is realistic.
Approval is recommended for the time and in the revised amount
requested with the understanding that the income produced

by the project will be used for the purposes of the project,

as stated by the applicant.

01 - $76,600 02 - $77,850 03 - $81,500
 

Page 11

1/
C. Recommendations for Action ~

The Council recorded their recommendations in the format
which was adopted in the previous review cycle (Appendix I).

ALABAMA REGIONAL MEDICAL PROGRAM

Approval with specific conditions recommended by the Review
Committee.

01 - $257,357 02 - $231,956 03 - $0

ALBANY REGIONAL MEDICAL PROGRAM

Return for revision with the suggestions of the Review Committee.

ARIZONA REGIONAL MEDICAL PROGRAM

Return for revision with the suggestions of the Review Committee.

BI-STATE REGIONAL MEDICAL PROGRAM

Non-approval

Project 10 - Non-approval I = Inappropriate for RMP funding ~ Council
finds this project outside the policy guidelines relative to basic
training of allied health personnel.

Project _11 - Non-approval II = To be revised according to suggestions
of the Review Committee.

Dr. Pellegrino abstained from voting.

 

All amounts are direct costs only and unless otherwise specified
refer to 12-month periods.

The designation 01, 02, etc. relates to the first, second, etc.,
budget periods of the subject a lication, not necessarily the
budget periods that will actually be supplemented.
Page 12 e

CALIFORNIA REGIONAL MEDICAL PROGRAM

Approval with specific conditions, as detailed below, in
amounts not to exceed: .

01 - $806,942 02 - $828,158 03 - $885,254
#7R - Approval I for one year only. uo a .
#54 ~ Approval II with conditions set by the Review Committee.
#55 - Approval I
#56 ~ Deferral with the new information to be reviewed by

experts in the field.

#57 ~ Non-approval II with the Suggestions of the Review Committee.
#58 ~ Approval I.
#59 ~ Non~approval II with the Suggestions of the Review Conmittee.

CENTRAL ' NEW YORK REGIONAT, MEDICAL PROGRAM
Approval, without additional funds and with the advice of the

Review Committee.

COLORADO/WYOMING REGIONAL MEDICAL, PROGRAM y

Approval with specific conditions as recommended by the Review
Committee.

01 - $48,037 02 ~ $67,003 03 - $73,472

FLORIDA REGIONAL MEDICAL PROGRAM

Approval with ‘specific conditions as recommended by the Review
Committee.

01 - $146,380 02 - $162,918 03 - $179,857

GREATER DELAWARE VALLEY REGIONAL MEDICAL, PROGRAM

RM_00026 3/70.1 - Approval with specific conditions as recommended
by the Review Committee.

Q1 - $190,628 02 - $195,655 03 - $150,493
RM 00026 3/70.2 - Return for Revision.

The Council agrees that this project is proposed by highly 8
competent individuals, to be conducted in an institution well
 

Page 13

situated for, and capable of becoming, a regional center

for training and demonstrations in the diagnosis and management
of stroke patients. They therefore recommend that it be revised
to focus on those objectives and offer the following suggestions:

1. RMP funds should not be used to establish or
otherwise support centers for the evaluation
of methods of treatment of stroke patients, since
sixteen such centers are funded under careful
Study by the National Institute of Neurological
Disease and Stroke. ~

2. The proposed number of beds is unnecessarily

large and unmanageable for teaching and
demonstration purposes. .

3. Although the proposed course material apoears
to be well planned and inclusive there is no
evidence that the potential trainees from throughout
the Region have been included in the planning
nor has any study of their training needs or
home-resources been undertaken.

4, There is only very brief mention of cooperative
planning with other metropolitan centers toward
the establishment of Philadelphia General as
the stroke training and demonstration center for

the Greater Delaware Valley RMP or for any area
of it.

HAWATI REGIONAL MEDICAL PROGRAM

Approval with specific conditions as recommended by the
Review Committee. .

FM 00001 ~ 3/70.1

Ol - $165,200 02 - $127,328 - 03 = $120,521
RM 00001 ~ 3/70.2

Ol ~ $116,382 02 - $110,000 03 - $110,000

ILLINOIS REGIONAL MEDICAL PROGRAM

Deferral including a site visit and with the suggestions of the
Review Committee. Note: The Council agreed generally with the
Review Committee concerning project 12 but recalled the difficulties
Page 14 q)

recommended that the entire application be included in the
site visit.

INDIANA REGIONAL MEDICAL PROGRAM

Approval with specific conditions as recommended by the Review
Committee.

01 - $211,516 02 - $30,050 03 - $32,390

INTERMOUNTAIN REGIONAL MEDICAL PROGRAM

Approval in the revised amount and under the specific conditions
set forth by the Review Committee and technical site visitors;
with further clarification of the issue of future support of
this: project as part of the RMP. .

01 - $382,478 — 02 - $223,483 03 - $193,409

IOWA REGIONAL MEDICAL PROGRAM »)

Approval with specific conditions recommended by the Review
Committee. So

01 - $82,437 02 = $94,089 03 — $12,689

KANSAS REGIONAL MEDICAL PROGRAM
Approval
01 - $58,051 02 - $6,415

MAINE REGIONAL MEDICAL PROGRAM

Approval with specific conditions recommended by the Review
Committee.

01 - $50,000 02 - $70,000
Note: The Council expressed special interest in project 15

and urged staff assistance to the Region in further development
of the activity.
Page 15

MARYLAND REGIONAL MEDICAL PROGRAM
Deferral for a site visit.

#24 - Non-approval ITI.

#25 - Deferral

#26 — Deferral

#27 ~ Deferral. The Council asked that the site visitors further
assess the merit of this project without the film component. They
question the value of teaching films for these patients or for
physicians and allied health personnel who work with them,
principally because of the great variation in the physical and
emotional characteristics of the individual patients and the

great variety of surgical procedures resulting in the stoma.

METROPOLITAN WASHINGTON, D. C. REGIONAL METC8', PROGRAM

RM_ 00031 5/69.1 ~ Approval with specific recommendations of the
Review Conmittee on projects 1R, 3R, and 35; but with 34
recommended for non-approval I.

01 ~ $264,058 02 = $213,337 03 - $29,850

NOTE: Project 34 is considered inappropriate for RMP funding

on several counts. First, the Council is generally very doubtful
of the value of films for use with patients or health professionals
in the management of stomas because of the great variation among,
patients (both physically and emotionally) and the location and
function of the stoma. Secondly, the Council was not impressed
with the value of this particular project as a regional effort.
Thirdly, the relationships among the proposing group, the
national organization of the American Cancer Society, and the
Regional Medical Program, in the joint sponsorship of such a
film is uncertain. .

FM 00031 5/69.1 and _8/69.1 - Project 25 - Cancer Radiation Therapy
Unit for Howard University.

The Council agreed to lift its previously imposed restriction
on the funds approved for this project; thus .allowing the
grantee-affiliate (Howard University) to expend funds prior to
the actual employment of a project director. They restated

their condition, however, that the director appointed must be a

qualified radiotherapist. The revised budget seemed to fulfill
the other conditions of the award relative to expenditure
ceilings for equipment. The revised direct costs are:

01 - $273,000 02 - $143,850 03 - $149,572
 

Page 16 ®

MICHIGAN REGIONAL MEDICAL PROGRAM

 

Approval.
Ol - $85,730 02 = $95,926 03 - $107,900

MISSOURI REGIONAL MEDICAL PROGRAM

 

3/70.1 - Approval with specific conditions and contingencies , for
three years, beginning July 1, 1970. \

“OL = $2,129,133 02 - $1,129,333 03 - $1,129,133

The approved level for the 01 year includes $1,129,133 for Core
support and $1,000,000 for those projects (mainly the advanced
technology activities) for which the Region has requested only one
year support -- projects #2R, 13R, 14R, and 49. In the 02 and 03
years, Core support is continued at the O01 year level.

The Council stated that the $1,000,000 support for the one year renewal
projects be contingent upon assurances from the Region that the
recommendations of the site visit report on each advanced technology

project would be generally followed. »)

3/70.2 - Approval with specific conditions.

The National Advisory Council concurred with the recommendations of
the Review Committee, except that project #54, ODARS, was returned

for revision because it was not considered to be technically ready

for expansion. ;

The Council recommended that the approved projects receive Approval IL
(approval without additional new funds) in the O01 year, and

Approval I (new funds) with specific conditions as described by
Review Committee in the 02 and 03 years.

Project #50 - Approval with specific conditions
Project #51 - Approval with specific conditions
Project #52 - Approval with specific conditions
Project #53 - Non-approval I

Project #54 - Non-approval II (return for revision)
Project #55 - Approval with specific conditions
Project #56 - Non-approval I

Project #57 - Non-approval II (return for revision)
Project #58 - Approval with specific conditions
Project #59 - Non-approval I

O1 - $532,154* 02 ~ $562,240 03 - $404,848 @
j
*To be funded from unexpended balances in the grant period ending 6/30/70, ~
 

 

Page 17
MISSOURI REGIONAL MEDICAL PROGRAM (Cont)

Overall Program Recommendations

1. The National Advisory Council considered the recommendations of
the site visitors on not only the operational renewal and —
operational supplements described above, but also the overall
levels of support for Missouri RMP -- including projects previously
approved byCouncil which carry a continuation commitment. They
were in general agreement with these recommendations:

.. In the grant year beginning July 1, 1970, the site
visitors recommended that approximately $3,060,000
in new funds be made available to the Missouri RMP
in the grant period beginning July 1, 1970. This total
recommended level includes four components: (1) Core,
$1,129,733; (2) Renewal projects, $1,000,000; (3) Projects
#46, "Hi~Blood," approximately $160,000; and (4) Continuation
projects #25, 26, 27, 29, and 33, approximately $800,000.

. The site visitors suggested that the Region use up to
approximately $940,000 in carryover funds for the support
of additional subregionalization activities approved by
Council — projects #36, 37, 38, 39, 43, 50, 51, 52, 55,
and 58.

- In the grant years beginning in July 1971 and 1972, the
visitors recommended that approximately $2.2 million and
$1.8 million, respectively, in new funding be available
for the approved Core, new supplemental, and contimation
projects. Council stated that these reconmended levels
in no way represented ceilings, and that the Region could
compete for additional funding with subsequent applications.

- None of the advanced technology activities are recommended
for support beyond the 01 year. Council pointed out,
however, that if any of these activities develop sufficiently
to the point that Couricil feels they could contribute
significantly to improving the health care delivery system,
and to developing regional cooperative arrangements, they
could compete for future funding.

2. Council concurred with the site visitors and the Review Committee
that the region be strongly urged to expand the Missouri
Regional Advisory Group.

5 G03 RM 00009-02A1

In a special action, the Council reconsidered a request made in
April 1968 for $246,483 for use in project #17 - Bioengineering ,

Crt atnaliia nananwmnndAnAd Pawn annnaren) FLA Mand Leneenk Lene wee elt lee

 
 

Page 18
MISSOURI REGIONAL MEDICAL PROGRAM (Cont)

pending the outcome of a study of the Missouri RMP such as the
one just completed.

The Council now recommends release of the funds, to be rebudgeted,
with DRMP approval, into any previously approved activities except
Core, #2R, 13R, 14R, and 49.

NEW MEXICO REGIONAL MEDICAL PROGRAM

Return for revision, reflecting the recommendations of the

Review Committee.

NEW YORK METROPOLITAN REGIONAL MEDICAL PROGRAM

 

RM 00058 3/70.1 - Return for revision, reflecting the recommendations
of the Review Committee.

RM 00058 3/70.2 — Approval with specific conditions recommended
by the axeview Conmittee.

01 - $181,300 02 ~ $181,300 03 ~ $181,300 D

NORTH CAROLINA REGIONAL MEDICAL PROGRAM

 

Approval with specific conditions as recommended by the
Review Committee.

O01 - $54,813 02 = $23,763 03 - $0

NORTHEASTERN OHIO REGIONAL MEDICAL PROGRAM

 

Approval with specific conditions.

The Council concurred with the Review Committee and the site
visitors in their recommendation that this Region: be awarded
operational status. In reviewing the differences between the

site visit and Review Committee recommendations on the individual
projects, the Council has accepted those of the Review Committee.
In regard to Project 9 (Summer Workshop in Career Development) the
Council considers it outside the policy guidelines and thus
inappropriate for RMP funds (see Section XI of these Minutes).

01 ~ $786,187 02 - $803,696 03 - $805,221 @
Z
 

Page 19°

NORTHLANDS REGIONAL MEDICAL PROGRAM

Approval with specific conditions recommended by the Review
Committee.

01 - $121,904 02 - $140,898 03 - $45,942

NORTHWEST OHIO REGIONAL MEDICAL PROGRAM

Approval with specific conditions recommended by the Review
Committee.

01 - $335,200 02 - $0 03 = $0

OHIO STATE REGIONAL MEDICAL PROGRAM
Approval with specific conditions. |
01 - $78,559 02 - $75,000 - 03 - $76,000

OHIO VALLEY REGIONAL MEDICAL PROGRAM i

Return for revision reflecting the suggestions of the Review
Committee.

OREGON REGIONAL MEDICAL PROGRAM
Approval.
O01 - $28,920 - 02 = $28,180 03 - $29,622

PUERTO RICO REGIONAL MEDICAL PROGRAM

Deferral for a site visit. The Council concurs in the recommendation
of the site visit with one exception. Based on information gained ©
on a previous site visit, the Council agrees to delegate to the

site visit team the authority to investigate further and, if
appropriate, recommend approval and determine the award level for
project 10 — Community Family Prevention Program on Stroke (not

to exceed the amount requested).

01 - $194,403 02 = $193,356 03 = $202,503
Page 20 ®

ROCHESTER REGIONAL MEDICAL PROGRAM

Approval pending endorsement of the site visitors whose visit
to the Region as a whole is to take place on April 20-21, 1970.

The Council is in general agreement with the Review Conmittee's
recommendations but would not insist on any of specified budget
cuts except that of the office space costs. They believe that
special nursing services and regular professional handling and
transportation of these critical patients is essential and
that back-up sets of the highly delicate equipment are required.

SOUTH CAROLINA REGIONAL MEDICAL PROGRAM
Return for revision reflecting the reconmendations of the

Review Committee.

SUSQUEHANNA VALLEY REGIONAL MEDICAL PROGRAM

Approval with specific conditions as recommended by the Review ae
Committee. )
01 - $595,503 02 - $603,199 03 - $571,160

(Figures include project 16, a budget for which has been submitted
and reviewed by staff since the Review Committee meeting).

VIRGINIA REGIONAL MEDICAL PROGRAM

 

Approval with specific conditions recommended by the Review
Committee and with special emphasis on the questions regarding
the computer aspects of project 8.

OL = $225,444 02 - $211,225 | 03 - $226,025

WESTERN NEW YORK REGIONAL MEDICAL PROGRAM

RM 00013 3/70.1 ~ Deferral for technical site visit to each
of the three projects

RM _ 00013 3/70 - Special Action - Deferral, to be studied as part

of the site visit recommended for the other projects. Staff is

authorized to arrange for funding to maintain the program until _
final action is taken. OD

 
 

 

@

 

Page 21

WISOONSIN REGIONAL MEDICAL PROGRAM

 

RM_00037 (formerly 8/69.1 and 12/69.1) - Approval in the time and
amount requested, with the suggestions and recommendations cited

by the Review Committee in July 1969. (See also section XI, A, 4 of
these mimutes).

Ol ~ $542,155 02 - $465,305 03 — $442,805

XII. ournment

The meeting was adjourned at 10:45 a.m. on April 1, 1970.

I hereby certify that, to the best of
my knowledge, the foregoing minutes
are accurate and complete.

Lense Tosno-actoe
Harold Margulies, M/D.

Acting Director
Regional Medical Programs Service

® Text of the statements
and additional materials which
were distributed at the meeting
are available in the Office of
the Council Secretary.
 

 

Page 22

RECORDING OF RECOMMENDATIONS

From the Panels to the Review Committee
(On Projects Only)

Technically sound and capably directed
Feasible under specified conditions
Unapprovable on technical grounds

From the Review Committee to the National Advisory Council
(On Projects)

Approval I - Additional funds recommended.
Approval II - No additional funds recommended

Non-approval I - Inappropriate for DRMP funding
Non-approval IT - Revision required

No action taken ~ Need additional information
Need site visit
Need Council decision

(On Entire Applications)

 

Approval .

Approval with specifie conditions

Deferral

Return for Revision

Disapproval - Inappropriate for DRMP funding

From the National Advisory Council to the Administrator
(On Entire Applications)  . an

Approval
- Approval with specific conditions
(As recommended by the Review Committee or others)

‘Deferral .
Return for Revision
Disapproval - Inappropriate for DAMP funding

 
 

 

 

BRENNAN, Michael J., M.D. (72)
President, Michigan Cancer Foundation
4811 John R Street

Detroit, Michigan 48201

Professor of Medicine
Wayne State University

CANNON, Bland W., M.D. (73)
910 Madison Avenue
Memphis, Tennessee 38103

Division of Neurosurgery
University of Tennessee College
of Medicine

CROSBY, Edwin L., M.D. (71)
Executive Vice President and Director
American Hospital Association
Chicago, Illinois 60611

DEBAKEY, Michael E., M.D. (72)
President and Chief Executive Officer
Baylor College of Medicine

Houston, Texas 77625

Professor and Cnairman
Department of Surgery
College of Medicine

EVERIST, Bruce W., M.D. (71)
Chief of Pediatrics ‘
Green Clinic

Ruston, Louisiana 71270

MILLIKAN, Clark H., M.D. (72)
Consultant in Neurology

Mayo Clinic .

Rochester, Minnesota 55902

CHATRMAN

NATICNAL ADVISORY COUNCIL ON
REGIONAL MEDICAL PROGRAMS

 

Page 24 | @ |

PELLEGRINO, Edmund D., M.D. (70)
Vice President for the Health
Sciences and Director of the Ctr.
State University of New York
Stony Brook, New York 11790

 

POPMA, Alfred M., M.D. (70)
Regional Director

Mountain States RMP

525 West Jefferson Street
Boise, Idaho 83702

ROTH, Russell B., M.D. (73)
240 West 41st Street
Erie, Pennsylvania 16508

Vice Speaker of the House of
Delegates, AMA ,

SHANHOLTZ, Mack I., M.D. (70)

’ State Health Commissioner Q

State Department of Health
Richmond, Virginia 23219

TREEN, Mr. Curtis (71)

Director

Pension and Insurance Dept.

United Rubber, Cork, Linoleum,
and Plastic Workers of America
87 South High Street .

Akron, Ohio . 44308

WYCKOFF, Mrs. Florence R. (72)
243 Corralitos Road
Watsonville, California 95076

Dr. Joseph T. English

Administrator

Health Services and Mental 2
Health Administration