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1974

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DEPARTMENT OF HEALTH, EDUCATION AND WELFARE
DIVISION OF REGIONAL MEDICAL PROGRAMS

AD HOC REVIEW COMMITTEE

Conference Room G-H
~ Parklawn Building
5600 Fishers Lane
Rockville, Maryland 20852
Friday, May eu, 1974
The meeting convened at 9:45 o'clock, a.m,
Dr. Herbert B. Pahi, Acting Director, Division of Regional
Medical Programs, presiding.
PRESENT : -
Mr, Peterson, Chief, P&E
Dr. Winston Miller, Minneapolis, Minnesota
Mrs. Jesse Salazar, Albuquerque, New Mexico
Dr. Leonard Scherlis, Baltimore, Mary Land
Mr, Joseph de LaPuente
Dr. Paul Teschan, Nashville, Tennessee
Sister Ann Josephine, Notre Dame, Indiana
Mr. Kenneth Barrows, West Des Moines, Iowa

Dr. Joseph Hess, Detroit, Michigan

Dr. Albert Heustis, Three Rivers, Michigan

 
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Dr. John Hirschboeck, Milwaukee, Wisconsin
Mr. Robert Toomey, Greenville, South Carolina

Dr, William Vaun, Long Branch, New Jersey

Mrs. Florence Wyckoff, Watsonville, California

Mrs, Silsbee, Acting Chief, O&D

Mr. Chambliss, Acting Deputy Director

Dr. Herbert Pahl, Acting Director, DRMP _
Mr. Francis Nash, Eastern Operations

Mr. Richard Russe1l, Western Operations
Mr. Michael Posta, Midcontinent

Mr. Lee Van Winkle, South Central

And others

*

 
 

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CONTENTS

Reports by:

Mr. Lee Van Winkle
(South Central)

Mr. Michael Posta
(Midcontinent )

Mr. Richard Russell
(Western Operations)

i

Mr. Francis Nash
(Eastern Operations)

Discussion re equity of treatment by two
subcommittees ‘|

Criteria
Ok lahoma
Bi-Sgate
Louisiana

Discussion re policy matters

‘Recommendations to Council

Motion ‘
. Recommendation amended
Vote

Adjourned

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43
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56

60
61

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. getting a cup of coffee, but I understand some people had to

 

 

DR. PAHL: I would Like to call this session of the
meeting to order.

a There may be one or two of the committee still

depart. I believe we still have a reasonable amount of acti-
vity before we can conclude the overall meeting. But before we

go on further, I am sure all of you have probably noticed that

Mrs. Silsbee has been able to join us this morning, and I hope

that we don't have any more relapses which we had the other
day.

Glad to have you back, Judy.

I guess probably one of the biggest disappointment
in her Life was to miss the other day. We will be busy

briefing her as to what is going on.

The purpose of this meeting really is to have one of

the panels inform the other what the actions were, very

briefly. And any really important points that may be pertinet

to that action, each panel has had certainly a few very exciti

moments and some very difficult moments and I believe that
this information should be shared with the group as a whole,
because We are taking the full committee's recommendation

to the Council and also we hope to have all of you back for tI
July review and you should all hear at this time what the |

actions were.

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‘to, first, take Mr. Chambliss' group of applications and have

 

for getting out this morning. So really don't wander down the

“be an in and out.

 

It is difficult ‘to do this, as you know from past
experience, because having not shared in the full Length
discussion and read the applications, you may feel that some o
the actions are overly harsh from what your present informa-
tion is. But that information may be outdated by 18 months
or two years or 50. So what I would like to urge us all to .
do is not try to reopen all of the sessions which we have
just gone through, but use this as an information session. Ané

I propose to do this in the following fashion, and thet is

the two desk chiefs run down alphabetically the ones that

they were responsible for, and give you the highlight and any

point whith they feel you should know.

Now, because we are still on the confidentiality of
information and conflict of interest, I should say that when
your own conflict of interest region comes up, we would Like
to have you out of the room.

These WLIL be very short presentations; that is, a

few minutes on each. Because we have 53 and We are heading
hall and start that long distance telephone call, It will aimo
On the other hand, I believe that perhaps one or two

points may require more than that few minutes, because there a

some serious considerations that have come to my attention, an

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I believe you will perhaps want more than just a sentence or
two. So that. you will be better prepared to understand the
applications as they come before you in July.

The other matter is, & least Dr, Teschan, maybe som
others, have some points you would like to raise for group
consideration, possibly formal recommendation for policy issue
for the Council and other matters. So as soon as we finish
this, we will be willing to entertain any kind of further
discussion on points to the staff or points to the Council

that you wish to make,

Now, if that is a satisfactory agenda, I am sure we

can proceed rather quickly, and I would Like, first of all, to.

ask whether that fits in with the way you feel we might best
convey a large volume of information over two days.

Ail right, first I would Like to ask, Bob, let's
take yours first.

Do you have any general comment you want to make
for the group about the total set of applications, and then we

will go right into them?

MR. CHAMBLISS: Yes. I might say as a matter of

general information that panel A handled the applications from] |

the South Central and Midcontinent areas. We handled a total
of 28 applications and the total request from those applica-
tions amounted to $65.5 million.

The overall actions recommended from this panel,

5S

 
 

 

total $50 million, $50,273,913.

We are going to ask, then, for the respective branch
chiefs of the South Central and Midcontinent Branches to give
just a brief summary of the individual actions taken by this
panel. |

Lee; will you proceed.

MR. VAN WINKLE: I don't propose to get into the |
specific rationale behing this and how they arrived at these
decisions, but basically Iam just going to give you what the
decision of the panel was.

On Alabama, they considered--

DR. PAHL: Give time for people to go in and out of
the room. :

MR VAN WINKLE: There is no one from Alabama,

DR. PAHL: Just in general. Okay. |

MR. VAN WINKLE: In Alabama, they considered this
to be an above average region and they recommended funding at
the level of $2,028,389.

There were no specific recommendations other than
that.

Florida, no one here from there either, is there?

This was considered to be a superior region and was
recommended at a funding level of $2.7 million,

Georgia, another region that was considered to be

superior, was recommended at a funding level of $3,629,757.

 
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‘recommended for funding at $1,121,159.

 

 

On Georgia, they don't propose to. come in in July

at all. This is their total request.

IlfLinois was considered to be an above-average region,

was recommended for funding at $2,816,935.

Indiana was considered to be an average region, was

Memphis was considered to be an above average region
was recommended for funding at $2,600,000,
“Michigan ~- I believe we have some people from
Michigan?
MR, CHAMBLISS Yes, we do.
“DR. HESS: Bat I have no conflict of interest.
DR. HEUSTIS: I come from Michigan, I have no con-
flict of Lnterest. ‘Do you want me out?
DR. PAHL: Please, if you will.
(At this point, Drs. Hess and Heustis withdrew
from the roon, )
MR. VAN WINKLE: Michigan was considered to be an
average region, was recommended for funding at the level
of $2.5 million.
DR. PAHL: Let the record show Dr. Heustis and Dr,
Hess have both left the room, Thank you,
(At this point, Drs. Hess and Heustis returned to
the roon. )

MR. VAN WINKLE: Mississippi was considered to be a

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- $2.2 million.

 

 

superior region, was recommended for funding at the level of

~ North Carolina, considered to be a superior
region, recommended for funding at the Level of $2,375,522.
Northiands -- | |
(At this point, Dr. Milier witharew from the room. )
MR. VAN WINKLE: Dr. Mi lier has left the room.
North lands was considered to be a be Low average
region, This largely had to do with staffing difficulties.
Was recommended for funding at the Level of $1.7 million,
(At this point, Dr. Miller returned to the room. )
MR. VAN WINKLE: Ohio Valley was considered to be
an average region, recommended for funding to the level of
$2,305,636.
“South Carolina was considered to be an average region,
was recommended for funding at the Level of $2.2 million.
Tennessee Midsouth. |
DR. PAHL: Or. Teschan.
(At this point, Dr. Teschan withdrew from the room. }
MR. VAN WINKLE: Was considered to be an average
region, was recommended for funding at the level of
$2,133,972.
(At this point, Dr, Teschan returned to the room. )
MR. VAN WINKLE: Dr. John Hirschboeck is Leaving.
(At this point, Dr. Hirschboeck withdrew, from

the room. )

 
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MR, VAN WINKLE: Wisconsin was considered to be an
average region, was recommended for funding at the level of
$2 million. | 7

Now, there was one common thread I think that went
through all of these funding recommendations, in terms of some
reductions, is the fact that irrespective of the superiority
or excellence of the region, in many instances there was a
question whether the amount of work cut out could be accom-
plished in the amount left. I think that was probably one
common theme that went through that.

DR, SCHERLIS: Sum total, ;

MR, VAN WINKLE: $32,311,370.

That is all of these,

DR. PAHL: Thank you very much, Lee.

Are there any comments or discussions of these
apptications? |

Yes. .*

DR. SCHERLIS: This will come up, I am sure, as we
discuss other sections, but looking at the target figure of
some 35-plus against the recommendation of $32,3 million,
does that mean we will have at the most $3 million for the July
request? |

I know it will add up in the different groups, but
is this the sort of calculation we will have to make in terms

of what will be available in July?

 
 

 

 

DR, PHAL: Yes, I will go into that at the end of
the full recitation here.
- DR, SCHERLIS + Fine. Thank you.
MR. VAN WINKLE: I vould mention that the total May
‘request that was being considered here came to $41,159,472.
MRS, WYCKOFF: For this group?
MR. VAN WINKLE: For this particular group.
DR. PAHL: ALL right, thank you, Lee.
Mike, would you Please take your group of regions.
MR, POSTA: Just as a beginning, the 14 regions
from the Midcontinent Operations areas, requested in their May
L application $24,436,527. Of this $24 million in request,
$17,962,843 was recommended for approval.
First region in this group is Arkansas.
DR. TESCHAN: Would you get a Little closer to the
mike, :
MR. POSTA: Okay.
Arkansas, reviewers felt this region was an average
one. They were concerned with the Los s of Dr. Silverblatt,
a top-notch coordinator; because of this they did not feel tha
the full amount of $1,830,000 request should be approved.
As a result, their recommended figure was $1.5 mil-
lion.

Bi-state, St. Louis, reviewers considered Bi-state t¢

be average to below average. The request of $1,128,000,

 

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étabus. Their track record was considered below average.
. : ‘ I .

 

 

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roughly, was cut to $800,000,

This is approximately $71,000 below the projected
l2-month funding level.

Poor leadership, particular Ly with reference to the

RAG involvement, was noted. Theyhave never received triennial

Colorado-Wyoming? Colorado-Wyoming was considered
| oe
above average to- superior. The target figure of $1.5 million
was recommended, which was about $280,000 less than was re-
| ;

quested.

Intermountain? No problems.

This region was considered above average. One
reviewer in individual grade sheets considered it superior,
They commented on the good staff. However, the application wa
most ambiguous. The region was considered to be overly funded

by some of the reviewers, including staff.

The panel recommended that $2 million of the $3.85 mi

Lion request should be approved and this compares to $3.6 mil-
lion target for this region.
| Iowa,
(At this point,Mr. Barrows withdrew from the room.)
MR, POSTA: Iowa is considered above average to
Superior. The request was approved in the total amount reques
ed of $1,061,349, which is about 80 percent of the target

figure.

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target figure. =

 

. Leadership is still in question. The coordinators on a half...

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(At this point, Me Barrows returned to the room. )
MR. POSTA: Kansas « Kansas was considered average
to above average, approved $1,633,380, which is $100,000
less than requested. |
This region ‘had requested about 78 percent of the.

|

Louisiana? This region was considered below average
| . .
This never has achieved triennial status, It has always .

come in for an annual type of an applications

time basis. However, the request of $985, 212 was approved aS
requested, which is 77 percent of the targeted figure.
Missouri, This region was considered average region
The reviewers felt that the region has improved significantly
over the last several years, As many of you are aware, this..
particular region put an awful Lot of emphasis on computer
and hardware in the past. They have completely gotten away
from this particular thrust and are getting into outreach
programming. The MS needs and requests in this particular
application should be reexamined by the health service agency
staff. The reviewers felt that the program staff was too high
and that the application was considered to be too ambitious.
The reviewers approved the targeted figure which was

,

Approximately $715,000 was trimmed from the budget

 
 

 

 

request.

Nebraska? This region has never achieved triennial
status and as many of you will recall, their funding was cut
back after the divorce from South Dakota several years ALO.

The reviewers felt that the Nebraska's application w
the best they have seen to date. They note considerable im-
provement. And recommended a ne funding level in the amount
$912,000, which, in essence, was $50,000 below the requested
amount, but over the target figure. |

DR. PAHL: Before we Lleave,Mike, was that considered
an above average or superior? General rating?

‘MR. POSTA: I can't be sure. |

DR. PAHL: Okay.

MR, POSTA: This region was reviewed by Mr. Thompson
and he commented on theapplication, but I don't recall seeing
his notes or his grade sheet. |

New Mexico.

(At this point, Mrs. Salazar withdrew from the

room, )

MR, POSTA: Considered an average region by the
reviewers, there was some concern about Dr. Gay, their excel-
lent coordinator, leaving. However, the panel felt that the
region was still in good hands with Dr. Walsh's takeover.

This region will not be coming in for July 1 funds.

The target figure of $1,644,754 was approved, which

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unbiased report, submit it back to the coordinator for possible

 

 

 

was approximately $1,L million under what was requested.

Tyo particular projects were noted. The health edu-
cation for the public was considered overly ambitious as far as
its funding request ves concerned, and it was suggested that

an out-of-state group visit this partic ular project, give an

rebudgeting to other areas,
|

!

|

of double the amount of the current application.

Also the EMS project is considered to be well in excg

Mos t of the cuts were in those two areas.

(At this point, Mrs. Salazar returned to the room. )

MR. POSTA: North Dakota, this region is considered
below average. However, the reviewers noted that this has beer
the Lowest funded region of the 53. ooo |

The target figure of $582,517 was approved or recom-
mended for funding, which is about. $180,000 Less than was re-
quested. - | |

Oklahoma. Oklahoma was consideréd average to below
average region. It never has achieved triennial status, The
target figure of $1,062,237 was approved; $320,000 vas
trimmed from the request.

The reviewers felt that a new thrust in dealing with
hospitals through regional development area districts was a

significant improvement over the old thrust, which dealt with

continuing education programming.

i

 
 

 

South Dakota. South Dakota was giveran outstanding
review. The reviewers felt this region+-as you recall earlien,
I had mentioned the divorce with Nebraska? Both regions,
Nebraska and South Dakota, have definitely improved. Maybe
the divorce was great, Anyway it was given an outstanding
review. — | | |

The application was approved in the amount requested)
of $729,417, which is over the targeted figure.

The target figure in this particular region was _
$571,095,

Texas. This region took the Longest of any in our
panel, well over an hour. I was sort of a unique request,
They did request 98 percent of the targeted figure and had
stated in the application that they would not be coming in
with a July application assuming this oartheular application
was approved.

The application was for $2,333,531.

The ‘real ‘problem as the reviewr saw it was that
approximate Ly $1.5 million of the request was in the form of
an open ended contract calling for five programmatic areag fro!
which requests for proposals would be submitted to the vartous
consumer and provider organizations within the state. We
were apprised at the last minute that about 62 applications
had been received, responding to those requests for proposals,

in the amount of $6.2 million. And the RAG had requested the

 
 

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review committee to allow them approximate Ly $1.4 million,
$1.6 miliion considering about $200,000 of the request was in
the form of a deve Lopmental component, to give them approval
to check on June 28th at the RAG meeting, and to submit to the
regional medical program form 15's which are your summary .
sheets, form 16 your budget sheets. So that they could begin
those contracts promptly and get a full 12 month project
period behind them,

Considerable debate took place and it was decided
that the review committee could not in all due conscience
approve an open ended application of this sort. They wound up
by approving $1.1 million at this time which would take care
of the continuation activities and the program staff, and had
recommended that this be brought “to the attention of the Council
that meets in June with the croviso that after the RAG reviews
their 62 or more contract proposals and submits the 15's and
16's intoDRMP by July LOth, that this body, the Review Committe
would be able to review them so that funding could begin immedi
ately after this next review body would meet. So that they
would not have to go again to the August review.

DR, PAHL: Thank you very much, Mike,

Sister Ann. | |

SISTER JOSEPHINE: I am sorry I am so used to respond

ing to Intermountain, I did not move to Indiana.

(Laughter) -

 

7)
DR, PAHL: We are glad to have you with us, Sister.
(Laughter ) |
Is there any general discussion on the applications
C) — that Mike has gone over?

DR. HESS: I would just comment that listening to wh
little qualitative comments we had, that I would guess that, i

general, your group used the rating system a Little bit

 

more Liberally than ours did.

It is hard to tell, but I would just raise that
comment. Maybe as you hear the other half, you might keep
that in mind.

I think one of the important things we ought to do

any

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now is to Look at the matter of consistency of rating and con-
sistency of funding decisions between the two subcommittees.
DR. PAHL: Dr. Scherlis.
DR, SCHERLIS: I think in all fairness to our group,
we want to be considered extraliberal or noneredible, we have
never been accused of that.
Our group never reached decision as to average or
superior.
I was wondering how you all arrived at those. I

think you got a flavor from what we said, then decided we reall

 

meant they were superior. We did not as a group really say
these things.

MR, VAN WINKLE: I took these off the rating.

 

 
DR. SCHERLIS: Got it off the review rating?

MR, VAN WINKLE: That's right, not as the group.
° DR. SCHERLIS: Final block. |
C ni DR, PAHL: ‘This represents staff, analysis of the
rating group results. _ | |

| DR. TESCHAN : ' The question concerning the Texas
discussion which I thought was extremely interesting, I note

from the sheet here they: are triennial status.

 

I was wondering whether that set. of provisos for
review here of the 15's and 16's was in accord with triennial
management policy? I would gather that that has been decided
in the first group, so it is just for information as to whe-

ther or not that essentially takes from a triennial approved

 

region decision up to this group?

it is a policy question.

DR. PAHL: Yes. I think it had to do with the mag-
nitude of the funding. I wasn't in on the entire discussion.
Perhaps somebody can elaborate. But I think the problem here
wasnot-- the question was not to remove flexibility from a
region, but it was such a -- I don't remember the exact amount

but it was such a large amount that I gather the panel didn't ~

really feel that it could handle the decision making with the

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information that was at hand.
Judy, do you have something to contribute?

MRS, SILSBEE: I have a question. I was wondering

 

 
 

 

if the same consideration had been given to the Georgia appli-
cation which was somewhat similar?
DR, PAHL: Perhaps that can be answered here.

.

Lee, has thé same consideration been given ‘to ‘the ;

oes
ee

Georgia application? ~

UF?

MR, VAN WINKLE: We aian't have the same difficulties
with Georgia. The Texas application did not have sites. tt
did not have project directors. It did not have budgets.

The Georgia application was full blown,

MRS, SILSBEE: Except it is still under review which
is the only difference.

The principle is the same, Lee, in both those appli-
cations.

MR. VAN WINKLE: It did not come out, Judy, in the
discussion. .

“

DR. TESCHAN: I would respond to that by saying

a

your answer, Lee, is entirely satisfactory to me. _
DR. PAHL: Yes, Dr. Miller. ,
DR, MILLER: It might be brought out again that we had
rather extensive discussions about this issue, and in several
RMP's -- not Georgia's as I recall either. Maybe we didn't
pick it up —the principle of whether a region under the
present system would be allowed to have the equivalent of a

developmental fund, slush fund, fund of money awarded to them

without us knowing what they were going to use it for exactly.

 
 

 

 

be he

I think although we didn't ever pass a motion to that
effect, there was general agreement in our group that we could
not authorize a bloc of grant components.in this review - |
process, |

We have troub Le defining some of. these as to whether
they were block grant components or not. Some of them come
awfully close in other ways. But anyway this was the issue

;

that we grappled with and Texas. was the outstanding and the

!

most extreme example.

DR, PAHL: Perhaps Dr. Heustis.

DR, HEUSTIS: I would ask Dr. Miller if you would
be willing to correct the record for his words and delete
that Little -- few adjectives he used after the word
"deve Lopmental grant"? It bothers me.

“I wouldn't want to even say the word.

(laughter) | | | .

DR. _MILLER: Yes, I am happy to do that.

DR. PAHL: .ALL right, that constitutes the findings

of panel A, I would Like to ask Mr, Peterson if he would

we

care to introduce, mke any general comments concerning panel B}
And then proceed along the same lines with the individual
applications.

MR, PETERSON: Panel B was transcontinental in scope,
naving looked at 25 regions handled by the Eastern and Western

Desks. As its chairman I was very pleasantly surprised,

 
Prank, but the panel judgments and actions were more near Ly

 

 

perhaps not the word but by the serious self-discipLlined
way in which this group operated in the face of the same con-
straints that I am sure panel B was under except for Lack of

information, time, and what have you.

I think it will be clear as you hear from Dick and

critieal than otherwise.

We did re-review our actions this morning on some
sort of overall comparative basis, but only in three cases
were some minor -- 10 percent changes made in the recommenda -
tions that previous Ly had been taken by the panel in the two
prior days,

Since we are probably going to be breaking and
everybody is going to be running off, I would also like to
take this opportunity now, rather than trying ti, seize Lt
later on, to say one other thing. I think at a time when the
federal government and Public Service is held in generally
lower esteem than it has for along, long time. The credibilit
of this government and the public's faith in it would be far
greater if they could see the kinds of actions that are
taken by groups Like this to see..the submerged part of the
iceburg, not that tip that attracts the headlines. For that
reason I would Like to say thanks to panel B and all of the

groups, both personally and professionally.

DR, PAHL: Thank you, Pete.

 
 

 

wy
Dick, why don't we take your applications first?
MR. RUSSELL: AIL right.

DR. PAHL: And proceed along as we had before.
MR. RUSSELL: I will go alphabetically.

Arizona was considered a below average program;

funding recommendation is $860,000, which is approximately

64 percent of its request. ee os
|

The reasons for this action, one is that the program

is not in conformance with the RMP grantee Regional Advisory
|

Group policy. :

Two, the program is under an extreme influence,
perhaps control of a key representative of the grantee.

The third area is the questionable effectiveness
of the coordinator. — a

Whi le there are some indications, changes are being

brought about in the program, this is attributed primarily

to the deputy of the program who has brought about some changes

however, with the history of this program, the group came up
with this recommendation.
- California.
(At this point, Mrs, Wyckoff withdrew from the room.
MR, RUSSELL: Let the record show Mrs. Wyckoff
excused herself, .
In the initial review which was yesterday, Califonir:

was rated as an above-average region, and it was recommended

ad

 
 

 

 

that it be funded in the amount requested, $8,170,374.

MR, PETERSON: Are you going to indicate--

MR. RUSSELL: I am getting into the record, Pete,
the grouo did reconsider the action in California this morning,
and inview of the rating and the needs of California, the
group decided to reduce the amount recommended for California
to $7,353,000, which was a 10 percent reduction in the amount |
requested.

| The third orogram is Hawaii --
(At this point, Mrs. Wyckoff returned to the room. )

MR, RUSSELL: -- and Hawaii was considered an average

wy

rating. This is primarily due to the recent change of coordin
tors who has done a tremendous job in a reasonably short perio#
of time.

It was recommended, however, that Hawaii be funded
at $1.1 million.

Mountain States Regional Medical Program, which covers
Idaho, Montana, Wyoming and Nebraska, was considered to be an
above average to superior region. There was some concern
perhaps that the budget was inflated. And the panel recom-
mended a reduced level of $2,150,000. And there was indications
staff should get additional information on the budget which
we feel very comfortable in doing. I know we can get this
before Councli. ,

The Oregon Regional.Medical Program was rated as a

 
AED,

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superior region. Recommendation was in the amount requested
$1,201,357.
| The Washington-A Laska program was rated as a superior
region with recommendation as requested, $2,077,311.
| And I believe that 1s all six of them.

DR. SCHERLIS: Do you have a total on that?

MR. RUSSELL: No, I am sorry, I do not. |

DR. PAHL: Frank, would you please then take the
regions that you have and describe them briefly to us.

MR. NASH: ALL right.

Albany -- can you hear me, Pete? Albany was viewed
as a superior region in all respects; recommended funding level
was $1,066,000,

Central New York was an average region; recommenda~
tion for funding was $615,000,

Connecticut, below average to poor, funding Level
recommended $510,000,

Greater Delaware Valley, rated as above average
region, and recommended funding level was $2.3 million.

Lakes area was rated as below average to average
program; recommended funding level was $1 million.

That figure was arrived at by taking the current
level and deducting the cost in the application of all pro-
jects that had been funded for at least three years, plus one-

half the cost of projects requesting two years support, which

 
excused himself,

 

 

they had several.

os Maine, this was the superior region in all respects;
recommended funding level here was $1.7 million, $1,760,000.

DR. SCHERLIS: Hold it.

. MR, NASH:.. Yes, Let the record show Dr. Scherlis

(At this point, Dr. Scherlis withdrew from the

room.) | |

DR. PAHL: Frank, that changed.

MR. NASH: Yes, This, the recommendation by the
panel yesterday for Maine was $1.6 million. This was reconsid
ered in our meeting this morning and final recommendation was
for $1,760,000, which is about 90 percent of their targeted
figure, and this is the only application we expect to get from

Maine.

Maryland, recommendation for Maryland was for termine-

tion of the program, This was based primarily on the four
items; one was lack of direction by the Regional Advisory Group
Two Was inspective coordinator. Three, disinterested or
se 1f-serving grantee. And four, end product of supported
activities ih the past period would be useless.

I am sure you WiLL want some discussion on that.

DR. PAHL: I think this is one of the points why we
did want to have the total group Lnvo Lved because this obvious

is a very serious recommendation. “And I certainly would —

 

1;
 

 

 

 

entertain any discussion by the committee even though a number
of you have not been involved in the details, but to raise any
questions of those who were involved in this or for further
clarification before this recommendation is passed on as a
committee recommendation to the National Advisory Council.

ALL right, if not, Frank, will you proceed with the
other applications. |

MR. NASH: Metro, D.C, this was considered to be
average to above average region.

(At this point Dr. Scherlis returned to the room. )

MR. NASH: I think the panel noted improvement in th
region over the past years. ,

Funding level recommended, $1.1 million.

Nassau-Suffo Lk -- anyone here from Nassau-Suffotk?

This, the recommendation for this prozram was for

1

termination, and due to some problems with the Regional Adviso

4

Group, their lack of direction and leadership, the fact they

have had three coordinators within the past year or two, there

wes great concern over the leadership. Capacity of the presen
coordinator, problems between RAG and grantee organization,
again this was a recommendation for termination. They may wan
to discuss this.

DR. HESS: An important factor, there is another
very important factor too that was not mentioned; that is, the

lack of a capable staff on board which to my mind is a very

aa

cr

 
mre

Le

 

 

central concern.

MR. NASH: Thank you.

- DR. HESS: The unlikelihood they can recruit capable

staff and do anything in the time available.
| DR. PAHL: Thank you.

Mrs. Wyckoff.

MRS. WYCKOFF : I would like to ask about both of the
that are recommended to be phased out. I would like to ask
about both of these that are recommended to be phased out.

Would you say that the principal reason Lay with the
traumatic effect of the cutback on their program,or was it
due to something internal that couldn't be corrected regard les
of what happened?

DR. PAHL: There are a number of people in the
room who I believe might contribute to that. But Dr. Heustis

had his hand up first.

Does that pertain to responding to Mrs. Wyckoff?

DR. HEUSTIS: I think I can do this. The procedure
in these areas was of long standing and failure to respond
over a considerable period of years with diligent staff effort
and previous recommendations of the Aavisory Council, this

was taken careful considerate, deliberate way with full under-
standing that staff and Council were reasonable people and if

they accepted the recommendation, they would make such arrange

ments for an orderly termination of the program as in their

 
 

‘gram, whatever 16 is, would be better off to start from scratch

 

judgment was best.
, DR. PAHL: Pardon me, before we proceed further, I
think the chair has erred in not asking Dr. Scherlis to remain
out of the room probably during this discussion, md I have a
feeling it may go on for just a few minutes.
Don't wander away too far, please, Dr. ScherLis.
_. Sorry, that was our error. |
(At this point Dr. Scherlis withdrew from the room, )
MR. BARROWS: Our arrival at this decision ‘occurred
with great deal of anguish and discussion. We were influenced

by another very important consideration, the upcoming course

of planning. It was pretty well conceLuded that the new pro-

than to have this ineffective building block to work on.

DR. PAHL: We certainly appreciate having that com-
ment.

I believe there are some others who may wish to
comment on this. For example, Mrs. Silsbee or Mr. Nash and
others who have been involved.

| Judy, would you care to make any comments?

Does staff have any comments to add to this discussion
at this point?

Mrs. Salazar.

MRS, SALAZAR: I have a question, Dr. Pahl. What is

the timeframe in which these two regions are tote terminated?

 
 

 

 

What type of on-going funds and what amount would
“they have for appropriate termination?

DR. PAHL: [I can't answer that question, because
I haven't been in on these discussions unfortunately.

Dr. Heustis. |

DR. HEUSTIS: The committee Left the timeframe--
really, we thought it ought to be done as soon as it could be
done in orderly fashion and left the specific timeframe up

to staff and Council,

DR. PAHL: Dr. Teschan.

DR. TESCHAN: Yes, and we also said probably the
present budget would have sufficient funds to assure an
orderly phaseout and if not, the recommendation includes
languages as I recall it, to ask Counei t to afford the region
sufficient funds for an orderly phaseout.

MR. PETERSON: Yes, the words early and orderly
are part of the recommendation without being specific in
terms of 30 days or 90 days,

DR. HEUSTIS: We felt so strongly about this, we wan
to be careful and not water Lt downwith the full understanding
that we were dealing with reasonable people as far as the
staff and. the Council were concerned, and they would take the
orderly process,

DR, PAHL: Thankyou.

Is there further discussion on this application?

ce

 
 

 

De

If not, Frank will return to the rest of the applica
“tions. a
” MR. NASH: Okay. |
- (At this point, Dr. Scheriis returned to the room. )

MR. NASH: New Jersey, this program was considered
to be superior in all aspects. The funding level originally
recommended yesterday was for $2.9 million. Now, that brief‘.
meeting this morning, the recommendation was changed, the
final recommendation being $3,190,000.

New York Metro, this was considered to be an average
program with funding recommendation of $2.5 million. Also
going with that Is recommendation to Council that if dollars
are wailable, New York Metro be given a high priority to recei
additional funds.

This was an application for over $7 million and abou
half of the activities were proposed for two-year support.

Northern New Eng land, this was considered to be an
average program; recommended they have a funding level of
$700,000. And that the region be given advice to terminate
support of their data collecting activities there.

Puerto Rico was considered to be an above average
program, recommendation for their funding level was $695,862.

Rochester, Rochester was judged to be a superior
program with funding recommended of $3,061,471.

DR, HESS: Explain that. That is mainly for staff.

ive

cr

 
 

 

They have $1 miliion for projects coming in, that accounts
for low figure.

MR, NASH: This was really all they asked for, this
particular application, because they only asked for staff
support and continuation of ongoing activities. Their July
application will be considerably in excess of that.

~ Susquehana Valley seems to be a below-average region,

As a matter of fact, I believe the panel had some serious

reservations even as to the viability of this program,

Recommendation here was for $400,000.

This primarily to support staff and very small amount
for projects. -

Tri-state, this was considered to be a below average
to average retion. “The panel had many questions I believe
which we were unable to resolve.

The panel highly recommended a site visit be made to
this region prior to Council meeting. |

The recommendation for funding was $800,000, Anda I ¢
assuming it was the intent of the panel that should the site
visit get some of these other questions resolved, then that
figure could be raised prior to recommendation of Council.

Is that correct?

Virginia was considered to be an average region,

Funding level recommended was $1 million. And with advice to

us that we express concern to the region, particularly over

 

m
‘their program staff budget.

 

 

 

their ability to fill the many vacancies that they listed in

- West Virginia was considered to be a superior
program. The recommended funding level was exactly what they
requested in this first application, $663,132. This is basics
ly @ program staff support plus two smal projects.

The region will be coming in in July with a much
larger application.

Western Pennsylvania, this was considered to be an
average program. The recommended furiing level for Western
Pennsylvania was for $1.2 million, plus $170,285 to support

the Mahoning Shenango HEC project in Ohio,

DR. PAHL: Is there any further question or clarifi-+

cation on these? _
Dr. Teschan.

DR, TESCHAN: I would like to refer again to the

Arizona application and to ask if the reporter clarify -- as |

recall, in our panel, Arizona was thealy program which at the
time of the processing had not completed its review process
certification, and I believe our recommendation started out
to be that there be no further allocation unless that process
were completed.

During the discussion, however, we found that indeed
that project was well under way, that some of the influences

that would be inappropriate under the August 1972 policy were,

 

L-
 

A
Yaw
tye

le

 

 

as a matter of fact, being rectified, And the question I have
is whether your notes and recollection is that the recommenda-—
tion of panel B was somehow contingent on the completion
after process that was already underway.

The question I am simply sort of raising is the issue
of approving funding for a region that has not been certified.

Do Por recall that, Dick? Where are we in that?

MR, RUSSELL: I don't recall it that specifically.

I will ask Mrs. Sadin if she will comment on this
discussion yesterday.

MRS. SADIN: No, I think what we said was their
RAG was going to meet and at the next RAG meeting, they were
going to consider the revision, already Looked at the revision
of bylaws, They needed 30 days before they consider this
would take place. It has not taken place, but they said it

will.

4

DR. TESCHAN: I think it is almost a truism I
don't think there is any issue here carticular ly, bub I
gather it is understood or we should understand and make clear
ly a matter of record that review process certification will
be essential for Arizona before dollars will flow. In other
words, it seems to me that is a basic assumption under which the
regions need to operate.
DR. PAHL: That would be a recommendation to the

Council, then the Councll condition on the grant award.

 

Ve
Ay

iid

 

 

Under the court order, staff may not impose restric-

tions, but we may obviously. carry out any Council conditions on

grant awards and this recommendation would be taken to the
Council, . That is my understanding.

DR. TESCHAN : | But the application, instruction for
the current cyc le says clearly all applicable policies will
continue to apply except those specific interdictions which
had been specifically rescinded.

DR. PAHL: That is correct.

DR, TESCHAN: I have no evidence August 1972 policy
does not apply.

DR, PAHL: Yes, Dr. Heustis.

| DR. HEUSTIS: I think it might be in order to clarify
what we did this morning and to cmake: perhaps panel A under
stand the three rather modest changes that were made.

Staff over the evening took the material which we had

4

prepared yesterday and organized it with all of the superior
projects together and above average, the figured out some
percentages. And so we tried to take a Look at the numbers we
had come up with on an individual basis yesterday and to see
whether in fact we nad treated them in context with what we
thought the process and merit indicated.

That was the reason for the relatively minor changes

that were made this morning. I think it was a good device —

and helped some of us to see things all in perspective.

 
 

 

 

DR. PAHL: Thank you very much. |

Are there other comments from anyone concerning the
activities or conclusions reached by either of the panels?

Dr. Hess, |

DR. HESS: Yes, I would like to have us spend a few
moments on what I would consider one of the major items of
business for us to attend to this morning ang that is the equi
of treatment by these two subcommittees. a

; : :

I am particularly concerned about those with whom we
have deait harshly end on the other end of the scale. I would
like to just raise one Question about one region that may have
been treated by panel A more generously than would have happen
had they beenzeviewed by panel B.

Because I think this is something we have to be
very much concerned about when we break down into. putlic sub-
committees this way, that the decisions that come out are not
too much a function of which group reviewed a oarticular regio

Now, perhaps let's take them one at a time and let's
take the easiest first. That is, I would Like to raise a ques
tion about intermountain and its level of funding which, as
I understand, is $2 million. It was rated as an above average
to superior region, according to my notes. They apparent Ly
are funding, their annualized rate, close to $2 million, and

they were granted $2 million.

Well,it is $1.8 I guess.

 
 

Sy
No

 

a I
Ari they are going to be comeing in with -- let's see
MR, POSTA: Between $400,000 and $500,000,
- DR. HESS: $500,000 -- for another half million in

July, that will have to be dealt with.

‘

This region does overlap to somedegree with Mountain
states and does it overlap with Colorado-Wyoming at all?

SISTER JOSEPHINE: Yes.

MR. POSTA: Yes, sir.

DR. HESS: Okay.

Is there some way of knowing on a sort of FTE concep
how many people this region serves?

MR. POSTA: I believe Lee has got the copulation
charts back here. |

MISS RESNICK: It is complicated as Dr. Hess sug-

gests.

MR, POSTA: That is six states involved,right?
MISS RESNICK: We know it covers all of Utah and
a@ portion -- small portion of Colorado,.a portion of Montana

which is part of the Mountain States--

MRS, WYCKOFF: And Washington-Alaska has also some
turf problems.

DR. HESS: With Intermountain?

MR, CHAMBLISS: Yes, they are also a part of it.

MISS RESNICK: But since I am not the reviewer and als

wasn't called on to support the population distribution, I am

 
 

 

 

w

a Little hesitant to quote a number of figures. I don't know
what went into their orogreins as they developed their estimate
of need. And how they got together.
- I think there is a three-region committee that looks
at it from that point of view, isn't it, Mike?
MR. POSTA: Yes, For your information, in panel A,
what did come up was the turf problem that we have had for a
number of years with the three regions concerned, and on May
9th, the coordinators of all three regions got together along
with their RAG chairman and went over everything that they
have in the hopper at the present time, what they are funding,
together with the May 1 request, together with the request for
the use of the $6.9 million that was restricted, and went
through allof the applications to be assured that one region
knew what the other one was doing, and got their endorsement.
| They approved everything in the application with the
exception of ten activities, and those ten activities could
not be funded until this group got together againand they
have two definitely scheduled meetings a month from now,
the first one, before actually funding consideration would be
given to any of the approvals that would come forth from Coun-
cil.
I dont exactly understand--
DR. HESS: Maybe it is not an answerable question.

MISS RESNICK: I have some better figures on the

 
population. We estimated last spring that the Intermountain
program roughly was responsible for $1.9 million. That took
into aceount Uteh, a portion of Wyoming, a small portion of
(| . || Névadea; a piece of Idaho, and a plece of Montana.

It is very rough. We have a map that kind of
over Jays and So On. | |

DR. HESS: ALL right. That sounds fairly reasonable,
And I don't have any real question about that, about that re-
gion. I am satisfied.

DR. SCHERLIS: May I interrupt for a moment?

Iam trying to discern the relevancy of that issue.

 

Are you suggesting we should Sive dollars per population that

would make our task very easy?

ay .
Me - DR.HESS: No, that should not be the only basis, but
E:think-we do have to Look at the amount of money going into a
region in relationship to not only the population, but the

quality of the program, needs to people, the other resources
they have towork with. And ali these factors ought to énter
into our judgments about what is appropriate. And that we

should not take a narrow vision and Look at the quality of

 

the program,alone, as the sole criterion upon which to base

judgment,

 

So I am satisfied-- And I know that we have been Look-
ing at quality andwe have got your rating and all that king of

thing, but I do think that we have to not be unaware of the

 

 
3
ced

 

actions er recommendations that our group made in relationship

 

number of people to be served and the kind of problems that
exist in the region.

MRS, SALAZAR: Dr, Hess, would you speak to the point
then of, in my view, certain element of inconsistency in the
elimination of two regions this morning?

These regions have people in them and they are still
in existence, . ce cafe

DR, SCHERLIS: Shaiil I leave the room again?

Will you stop that for a moment? |

DR. PAHL: Off the record.

(Discussion off the record, )

DR. HESS: Okay, I think my concerns at the high

level are satisfied. Now I am concerned about some of the

to some of the-- well, I think we need to share this a Little

more in depth,

‘

Also I think I would raise a question as to Whether

_

some of the regions that Broup A reviewed, if in fact we as a
Group as a whole are going to follow that and support the
recommendations of panel A, whether or not similar recommenda-
tions ought not be made for One or two regions reviewed by panel
A,
I got the A and B mixea up, but maybe you can follow
the sense of what I am saying. a

Too, based on your discussion, the two that I thought

 
fils

aide

 

 

ought to be Looked at again in Light of this factor are
Louisiana and Bi-state. And questicnmark Oklahoma.

Now, I think the most efficient way to do this is
to Look at the eriteria which group B used for making the
recommendations and ask group A how those criteria apply to
those regions in question.

The reason I single those out, number one, the region

| .

are still on annual status which means there is a rather long
|

history of not performing very well or they would be on
triennial satus. |
And number two, they were--well, again, as I Listened

I wondered if maybe we as a group were & little bit more
strict in our application of the rating criteria than group A.
And so therefore the rating of average or below average may not
mean the same for the two groups.

| So could we just review now the basis for our recom-
mendations on the two regions were, one, the unsatisfactory
nature of the current. leadership, program staff leadership;
number two, the leadership of the RAG and feeling of weakness
at that level; thirdly, the status of the grantee; and fourth,
the role of the grantee -- fourthly the nature of the program
specific projects which were put forward as representing the
implementation of a program concept.

DR, PAHL: Before we proceed, Dr. Teschan has a

comment and question,

UT

 
7 Eh

a DR, TESCHAN: I want simply to amplify or illustrate
those four points didn't come out of the air. The first three
will be recognized by I hope everybody here as almost a direct
quote from page one of the August 1972 policy as to what are th
essential ingredients of an RMP.

You have got to have a coordinator who is capable,

You have got to have a RAG that functions. You have to have

to that, then, the committee appropriately, in my view, added

the outputs in terms of dollars in and what then happens is

 

in the region in terms of project as staff activity result.

So this wasn't an arbitrary set-- it is simply
elting the ground rules on which all regions need to be judged.
a | “MR. BARROWS: Plus the consideration the new program
boul be better off without having this to-- |

| DR. PAHL: Dr. Scher Lis, I believe, has a comment ,
before we respond to what those points were in these cases.

DR. SCHERLIS: I admire the fact you have set up what
appear to be rather rigid criteria. I think it is the interp-
retation of these criteria of the individual proejects that
obviously you have to fall down and have to fail.

Because as we are speaking for the coordinators who
are resigning, seeking other positions, who have found other
positions, I think a great deal of our response to these appli-

cations admittedly is based on rather soft sand, as far as.

 

a grantee that will stay in its fiscal administrative box, And

Ww

 
EnF Psy

Mea ie

 

are rather ephemoral in terms of utilizing them.

three since I was a reviewer.

 

43
trying to be as rigid as we might be a year or two ago. We
don't have the potential ability of saying, well, we Will Let
them get started and site visit them.

We don't have the potential threats in terms of the
careful supervision. |
| We lack the central staff, on and on and on.
And a great deal of the de terminations here, regard-
less of what we can hose or assume we use these criteria,

really become more qualitative and less quantitative, I think

that goes without saying, just as some of the criteria used
Let me speak to Oklahoma. I think this is one of the

“DR. PAHL: Why don't you proceed with Oklahoma, since
you were the reviewer?

DR, SCHERLIS: Yes. I site visited Oklahoma, and
this is a program that has changed very significantly since the
time that I site visited it. | |

The rating of average minus is probably taken from
my formal review: that I handed in and this was based in great
measure upon my recollection of the area as it was when I
was last there and what I could deduce from the document.

Remember that none of us at this time have the bene-

fit of. the very carefully documented pink sheets we used to

have which I found to be extraordinarily good. And we don't

 
 

 

have the evaluation of all the preceding letters, site visit,
documentation and SO One

_ ‘There is Little question in my mind that Oklahoma
has moved from what was essentially a post-graduate training
program, educational parade, through the state, into what I
think now is a very exciting potential network for better
medical care through the area. 7 oo.

‘They have a new coordinator. The program that he ha
designed here I would view as being something that could fit
into whatever survives, whether it is regional medical program
or regional planning council, or comprehensive bulk programs,
what have you; theseare networks which I think will lead to
better care in Oklahoma.

I don't reach this decision lightly. It was pretty
well forced on me after a very vehement, active discussion,
and I, for one, support the recommendation that has been
made.

The grading of average minus was from my original
sheet. In terms of the discussion that took place here, I was
impressed with the fact that this group has changed directions
significantly, what I will think will be very helpful whatever
form planning takes and whatever form actual application takes
in this region as far as whatever survival will be of RMP.

I could detail the document. I would say this, I

was most impressed with the change. I had viewed if Oklahoma

 
ary
nL?

 

 

had come in this way two years ago, 4t would be by now one

of the better states.
It is very heavily provider oriented, but I

think one year to go, this would be a more fruitful way of

os

moving than in another direction.

DR. PAHL: Thank you very much, Dr. Scher 1is.

Is there further discussion concerning the Okiahoma

. |
application from staff or other committee members?
i
Dr. Hess, I think that is responsive.
DR. HESS: I am asking is there reason for optimism.

I think that is putting it in a nutshell.

DR. SCHERLIS: It has changed markedly.

DR. HESS: The only question I would ask, you doi't ha’

to elaborate--

‘DR, PAHL: These are very valid points. This is the

purpose for this session, It is in order.

—

DR. SCHERLIS: I was asked at the meeting how I react
ed the conclusion and I wished that I had had your points
score to use. I said it was a guts reaction in a great degree,
and I think all of us eventually have to come to that honest

admission.

rt

DR. PAHL: If there is nothing further in Oklahoma,
believe one of the other regions that could bear some discus-~

sion was Bi-state.

I am not sure whether the reviewers of Bi-state are

 
$71,000 below the projected 12-month funding level for this

 

 

here or nob.

MR, POSTA: No.

DR. PAHL: Then, Mike, could you be responsive
to Dr.Hess! points and perhaps just clarify a Little bit

further some of the thinking that went on with Bi-state.

MR. POSTA: Well, I think in my earlier summations,
it was as succinctly put, they did come in with an application!
of $1.1 million, and they were cut back to $800,000, which

is not only well below the targetted figure, but about

region. And that was, in my opinion, a punitive action.

_ Now, whether that action was as punitive as panel B
would have taken would be up.for debate. |

"DR, HESS: The question I would raise is, you know,
to try to bring some consistency into how we deal with regions
Is there a staff and a RAG that can effectively use that
$700, 000-$800, 000 next year? And, you know, have something
worthwhile to come out of it that justifies that amount of
money and justifies continuing that RMP?

MR. POSTA: Well, Doctor, I think the main concern

again is the cast track record of this regia, which has not

been too good.

Now, we do have reason to believe that Dry Felix
will be coming onboard to serve as coordinator. And I am sure

that many of us in the room know Dr, Felix. He does have a

 
FT,

fy

base optimism. That is all I am Looking for really.

 

or perhaps Mike, we can turn back to you.

 

 

terrific track record himself. And will be and has been in-
volved to a degree in the application which was drawn up. And
some of the activities that he has got certainly the-- I should -
relate staff feels that $800,000 is not an excessive figure. |
| . DR. HESS: Your basis for optimism is Dr. Felix?
MR. POSTA: At this time, yes, sir,

DR, HESS: Something will depend upon which to

DR. PAHL: Is there any further discussion or comment

by anyone on Bi-state?
| If not, let's turn our attention to Louisiana. And ‘|
again, I am not certain who the reviewer on the committee was.

Is there any comment fromthe committee on Louisiana,

Go ahead, Mike.

, MR.POSTA: Louisiana did come in with an application
of $800--$985, 000, which was 77 percent of its targeted
figure. |

This is a private corporation that is the grantee.
They do have a terrific track record as far as expenditure of
funds, They have had very little unexpended balances.

The indirect cost rates have been extremely nill in
this particular region. It has been well managed. They do have
a couple of outside consultants who have stayed with the progral

Since it was terminated.

 
 

the termination orders or the phaseout orders very strictly.

more people. They brought back their deputy director. How-

 

. fully say in visiting the region two months ago with Mrs.

_ehalansky, that the chairman of the Regional Advisory Group

 

46

‘Staff and the reviewers felt that this region accepted

And when they said close down, that is exactly what they
decided ‘to do, is to close down. |

However, in the State of Louisiana, they have to
notify the Secretary of State within six months of termination
to carry out that termination or Liquidation.

In the meantime, we got a continuation order to

continue as a result staff did carry on. They did hire a few

ever, at this time the staff is Limited in scope. ‘They have
hired four additional peoplé, Dr. Sabatier, the coordinator,

is back on board, about 50 percent of the time. I can truth-

and the ‘chairman of the evaluation committee of ‘this particu-
lar progra mare exceptional people. And their Regional Advi-
sory Group does function quite actively and does not fund pro-
grams unless they are: exceptionally well monitored from the
start. That is, they do not fund just to be spending federal
money.

DR. HESS: I guess my question, the main thing I
would ask is are they doing appropriate things for people in
the region and is there good leadership there?

In other words, are things looking-- is there a

 
so

 

 

 

 

basis for optimism for next year?

MR, POSTA: That is spéculative, Doctor.
. Based on 50 percent of the coordinator's time, based
on the fact this is a corporation that would be phased out
on time with no expectation that this corporation will
continue as a grantee, the same as many of our say universi-
ties will continue to function and will be able to monitor
toward the end, I think all of this was considered when the
overall comments or grading to this region was below average.

DR, PAHL: Thank you, Mike. 8 |

Sister Ann.

SISTER JOSEPHINE: Your last comment kind of preempt
what I am going to ask.

‘ Over the years I have heard us from time to time

concerned and particularly indirect costs and direct costs

also, when a university is the grantee agency. And in terms
of atilization of dollars’ to’ provide: services and development
of programs, it has been the experience of this program that
where the grantee agency was other than the university, we
got more dollars down in services and in programs.

Your last comment was a little disturbing to me. I
wonder are we going to reflect on that experience and do you
think reflecting on it, itis going to probably appear in the
new guidelines for whatever this new model ls that is going to

be developed?

TH

 
f 3

ar,
sg

 

50

DR, PAHL: I think I can answer for Mr. Posta and say
MR. POSTA: I had hoped you would.
(Laughter)
“DR. PAHL: -- a number of us are hopeful that the
experiences will be trans lated into action as we go into this
new phase.

Mr, Rubel, who isn't here this morning, I think would

say that in his various task forces that he has set up internal
ly to try to plan something concerning the organizational
framework and direction and policies, he has ine Luded @& num~
ber of people -- for instance, Mr. Peterson is in charge of one
of the subcommittees working with Mr. Rubel in designation of
possible health service areas, And we have RMP people on all
of these little subcommittees,

Unfortunately beyond the agency level I an not cer-~
tain how much of what we talk about will survive, but there is
& very real intent to try to take the best from both the
CHP and RMP and learn from it.

I think thew is some reason for optimism in this, but
when one comes to a specific point, such as the one you are
referring to, I don't have any first-hand information. Maybe
Someone in the room knows, but we are concerned with maximum
impact, with available dollars, and utilization of skills and
techniques that have been developed,

I think in many cases the Congress is going to be

 

 
 

 

 

51
more alert to this than possibly some of the elements in the
administration.
SISTER JOSEPHINE: I think I ama Little sensitive
on :this point, maybe oversensitive.
But I-remember a number of years ago we were just
doing a little study on one of the OEO orograms and it took

$60,000 to get $1,000 down to the people. It is disturbing.

te

DR. PAHL: Yes. Yes. We are having a meeting at th
other end of themll oh arthritis center program and yesterday
afternoon that same discussion came up as we Look at the
available dollars and what can be done to have an impact, and
then see the cost-benefit. So that there are many groups

that are recognizing we have to reconsider this and I do hope
we benefit from it. |

Bob.

MR. CHAMBLISS: Yes. I think Sister, and there is
some indication that there WiLL bebenefits from past experienced
in that in the new legislative proposals, the operating agencid
are shown to be nonprofit corporations, that deais I think spe-
cifically with the question that you were raising about the in-
direct cost.

There will be a new set of grantee types under the
new legislation, that is as it is now proposed.

DR, PAHL: To return to the business at hand, I would

like to ask if there is any further discussion on any of the

 

s
so

 

 

52
findings, recommendations, on the applications, because it
not, then the chair will understand that the findings and reco
mendations which have been made and discussed here are those
which are adopted by the committee and will be passed on to th
National Advisory Council. | |

Mrs, Silsbee

MRS, SILSBEE: Dr. Pahl, I would like to suggest
that the gist of .this discussion that has taken place in terms
of the bounce between the two, be sort of a preambie to the
Council, which WLLL have an opportunity to Look at all of the
actions again, that this might very well be kind of a caveat
that the committee gives to the Council in Looking at the indi
vidual actions.

DR. PAHL: Yes. I think as is customary, staff does
try to reflect as well@w we understand what we hear for the
Council, so that they can act in an intelligent fashion on the
various recommendations. And we are sensitive to the problems
that you labor under in two separate groups,

We had no choice but we will try to reflect the

various interpretations and shades and interplay of feelings

-not only by the sheets but by all the record that is here in-

the staff in the room. So I think you should be assured of th
Dr. Miller.
DR. MILLER: Could you give us an overall summary

picture of what we have done now?

a

 
cy

 

 

53
How much did we approve and--=-
DR. PAHL: I am delighted to do that.

DR, MILLER: How does it look in terms of the July

process?

DR. PHL: Yes, I am delighted to do that. Because by

coincidence, it makes calculation which I had made back in
March appear very brilliant, when really it was just sheer
coincidence. |

The total figure that apparently the A4WOo panels
have approved with the various modifications this morning
comes out to be a recommendation of $85,047,297 for June Coun-
cil awards, If Council goes along with all committee recom-
mendations.

This is from an anticipated amount available for bot
June and August awards of $114 million -~ let's just leave it
at $114 million, because you will recall from the discussion
I had the other day, because of the unsettled state of the
Litigation, we sre still talking about between $109 million
and $114 million.

If, however, we-do have the $114 million available

for support of RMP regular type programs, the recommendation o

$85 million asa result of this committee meeting would represe
using 74-1/2 percent of the total available funds.
This is very encouraging. Because back in March we

had to establish an allocation mode between the June and

 
C

'as of a certain date, but obviously won't reach full staff or

 

 

54
August Counci is and we had arbitrarily at that time set aside
75 percent, precisely, for June and 25 percent for August.
And at that time we didn't know-- we hadn't even issued the
instructions for regions to prepare applications. And we also
didn't know within $30 miLLion how much would be available to
us.

So as I say, it is sheer accident and not due to som
Texas ins trument that was hidden away somewhere.

So basically you have approved 75 percent of probabl
what would be the dollars available to us.

If the litigation does award $5 million to the Depar
ment for some of its other purposes, which are certainly
direct ly connected with the forthcoming phase, this would stil
bring us within about 79 percent; your recommendations would
be about 79 percent of the total funds available. |

so that come your July meeting and the August Counci
we are right on target with about the proper ration if you go
back to my 75/25 percent. |

Dr. Scherlis,

DR, SCHERLIS: Many of these projects will start

full operation for a significant period of time after that.
What happens to those funds which are left either at
a local level or at a national level as of July 1975, give or

take whatever period of time the extensions are?

WwW

eT

 
 

 

 

22

DR, PAHL: The only strict requirement which the
Administration has placed on this is that RMP's may not in-
cur obligations beyond June 30, 1975. Thus contracts can't be
written beyond that length of timeand there comes a moni-
toring and surveillance issue at hand, which is the same one
chat any program faces which we faced last year as program is

We are lactive ty involved, as I think I mentioned yes
terday, in trying to get the Administration to put forth what
a federal responsibility is.

I don't believe we have the exact answer, but in

general, over the coming months, allL‘of us who are involved in

headquarters operations truly believe that there will be
mechanisms developed and guidelines developed that moneys woul
be able to be spent for the purposes intended and there will b

continuation of monitoring and surveillance.

We certainly don't wish to see contracts entered into

and then June 30, 1975; everything terminated again. And we |
are trying to plan since we have a whole year ahead, the answe
isn't here, bub that is the clear intent and interest.

Now, with the business of applications aside, I
believe, I know Dr. Teschan has one or two points which he
would like to bring to the committee's attention and perhaps
there are other matters of business before we adjourn.

Mr, Barrows,

D

scheduled to terminate and how do you handle on-going activitip:

t

r

 
we,
BT

 

 

| 56

MR, BARROWS: I just wanted to take one moment to
say on behalf of my fellow reviewers how much we admire the
strength and dedication that staff has exhibited during this
extremely trying time.

You have got a great bunch of people here, compe-
tent. They are straight arrows and whom you can believe.
We hope you can keep your team together,

(Applause )

DR, PAHL: Well, on behalf of the staff, it is a pled
sure to hear it. I already know it, but I do thank you very
much,

There is nothing we can do without the staff that we
have. They have been extremely Loyal under circumstances which
you recognize as difficult and which indeed has been the case.
SO thank you very much.

That is one of the rewards for being one of the

faceless,nameless bureaucrats, able to accept that on behalf of

the staff.

Dr. Teschan, would you Like to bring up the points wh

you mentioned to me before the meeting for committee discussion?

DR. TESCHAN: Sure.

Ken Barrows has just preempted point one.

I look at Ken for having said it the way it needed tq
be said.

The matters that I think we might consider as a groug

 

Le

9
om,
Po
‘ ?

 

 

af

are some recommendations to Council, generally three. One,

y

we have already dealt with I think, and might go without saying

te

but I hope that Dick and others who were preparing these thing
might also focus again on the point that we do need to reiter-

ate that we would recommend strongly to Council the whole facts

U?

in the matter of those’ policies that your RMP'S has used throu
the years and I refer specifically to the August 30th issuance]
of Council for 1972, that they be very sure that as a matter

of fact each region is in compliance with that policy before

funds are allocated. That is to say, that that can accommodat

wD

a firm contingency.

I think that is not only correct from everything
I have said, but it is also a fairness and human -- its”
essential intrinsic integrity in the program be maintained
so that all of the regions are dealt with thesame way.

I am very sensitive to Dr, Hess' concerns on that
and I think we did a good job. I was satisfied and learned a
lot in Listening to how we dealt with that particular issue.

This is raised much in that same viewpoint.

Now, the other two things I happened to have written
out I am going to leave copies with Herb here in just a minute
and they are issues that also came up in our discussions in both
panels undoubtedly, but I want to put the following little

comment; that is, while I am sensitive and meet at every hand

UI

in all of the discussions I have the kind of thing Dr. Scherli

 
aan

eee

‘so our job here is to give it a decent burial and to utilize

 

 

20
pointed out we just seem to have this year left, Lord knows
the coordinators have been faced with that in their regions
and in discussions with one with the other. But the critical
issue is I think we have to Look at the context of the era
in which we Live and not simply be caught in what appears to

be the near-term programmic potential or efforts.

We are told on every side that RMP is going to finish

funds as well as we can, and allow slippages because Lorg
knows there are slippages.

I would take the other view that we are not dealing
with the next year. We are dealing in history up to this
time, and we are dea Ling with many years to come in which this
oarticular year is one of several turning points.

I don't think thisis a one turning point; I think it
is one of several turning points. Therefore, I feel if we
are going to conduct our business responsively, we need to
conduct it with a clear recognition that what we do now and the
integrity with which we do it must necessarily influence to an
unknown, but to some degree what happens hereafter.

‘So that when we have considered some of the regions
and when we sounded a Little bit pedantic, perhaps, in citing
the August 1972 policy, that you have got to have these ele-
ments and there has to be regional support within the region

and a good image in a region for a region to warrant continuat

Ve

 
‘Council can contribute in some small measure to tidying up the

 

 

59
et cetera. We have done that with the notion that if the
oo.

RMP in a region is going to be useful for something hereafter ,
then it needs to have that quality of image or quality of
function in a region that is going to be worth something to
build around as the follow-on version, following RMP, et ,
cetera, . ,

It is terribly important that the issues and profes-~
slionalism and quality which are so clear in the superior regio
application particularly, be the hallmark in contrast to all t
other alternatives of which there are plenty.

So it is really on that basis that I feel the
Council now has a particularly vital turn in the road, a fork
in the road to confront. Either the Council can take what to

me seems to be a defeatist attitude in saying, well, we are

only here to occupy space and to while away the hours, or the

situation, And in strengthening the regions for the transitio
period.

Therefore, it is with that in mind that there are
two statements in pernaos somewhat-- well, there are two state
ments that in my view this group might consider for recom-~
mendation to the Council for a formal policy statement to the
region. In other words, it is not just a recommendation to th
Council, but recommendation Council take these and issue them

as guidance policy to the regions in the country for their

ne

 
oN

 

 

60
implementation and guidance, it ls a two-step operation.

First of these has to do with getting ready for the
next phase. And a statement which says that might read some-
thing like this:

"Tn view of legislative developments now underway foy
further evolution of RMP, in association with the CHP and
HiLL-Burton orograms, in the interests of national health
planning, Gounci? sneoureges RMP 's to develop organiza-—

|

tional readiness, ‘structural changes, and any remaining
regional relationships which are appropriate to lead,
participate in and accommodate the anticipated new opera-
ting structures and requirements. The purpose of this
orientation is to preserve for the new formats within

the states and regions the capabilities and voluntary
cooperative relationships which the RMP experience has
created." an

That sounds a little platitude an albraistic, but
I think if we have organizational structural arrangements in
a region, that defeats the region's capabilities in getting
ready; being an appropriate participant in the new development,
that those organizational changes should be made.

The second recommendation for Council policy and the
request to HRA, as I understand, might read Like this -- and
it has really to do with CHP's -- it might read like this:

"While recognizing legislative mandate and DRMP

 
OL
regulations regarding RMP-~CHP relationships, Council
‘requests that the national CHP leadership transmit to
areawide CHP (b) agencies nationally the mandate for
. fully reciprocal relationships with RMP's, especially
in calling apon RMP assistance for professional and
| technical input into ongoing CHP plane deve Lopment ;
and in the interests of fairness and full reciprocity
Council furthermore agrees and instructs ad hoc RMP |
review committee and staff to set aside any influence of
negative CHP comments upon an RMP application unless the
commenting CHP(b) agency has provided the RMP with, one,
the criteria and a description of the (b) agency review-
and-comment process, and two, a list of the (b ) agency
objectives and priorities upon which at least a part of
the RMP response should be focused." |

DR. PAHL: ALL right, thank you.

DR. TESCHAN: I would Like to move the acceptance of

these, or for any purpose.

 

DR. PAHL: Thank you.

Perhaps the committee would Like to discuss the

first of these in order, or have the first one reread.

What is the committee's -- I am sorry in a sense

that so many of our members had to depart, because I think

these issues are important ones, and I am also sorry Mr. Rubel

is not here for the closing session, because I believe that he

 

 
 

 

62
would have been quite impressed to see the kind of activities
and discussions that have ensued over this period. And also,
of course, with this theme which is something which we are
all concerned with, the reciprocity of action.
But beyond that, what is your desire in this matter?
Wou you care to discuss these?

Dr. Scherlis, you look Like you are about to make a

f
|
|
1

.
DR. SCHERLIS: Sort of digesting what you said.

comment.

I agree completely with every word you said and would
be pleased to second.

My big concern is really what effect this would ha ve

As all the people at this table have, I have been on
site visits where you have contact with various (b) agencies
and: (a) agencies, and I must confess that in terms of profes-
sionalism and in terms of objectives and goals, I have to say
one can point to rare instances, at least in the space that
I have been able to visit, where (b) agencies or (a) agencies
have been relatively effective.

My big concern is really what will happen to all of
the work which RMP has accomplished?

I remember when RMP's first started, trying to
describe vhat- regional proper ‘venture. was.. These words were
meaningless to mee I ‘think in terms of their effectiveness,

the various projects that wecarried out only speak to a small

>

 
 

 

63
part of the accomplishment.

I strongly support both statements. I just question
what WiLL happen to them.

Perhaps you can alert us to what you view as the
probability as to what will emerge from CHP and RMP and
Hill-Burton at this time.

I am more impressed with both the planning and pro-
fesslonalism and the discernment of need by RMP as compared
to the (b) agencies and (a) agencies, even those communities ©
where they are supposedly relatively affected.

I think there is an obvious need for these groups
working. together.

This is a problem not only of logistics, but day to
day political strategy and this is where I have a real concern}

[am more impressed with the relatively objectivity
of RMP's as compared to the relative Lack of objectivity of
(a) ana (b) agencies.

The sorts of letters that you read and request after
request from the regions in terms of the review process of (b)
agencies and (a) agencies, we like that. But we don't Like
this one. We Like that one; that one is just great. And you
come avay with you just don't know what the basis for the |
evaluations are and this is where I would strongly support both
of your statements. | | |

I would just hope that they would do more than just

 
,

 

 

 

64

go to the Council. I would hope that whoever sets policy,

whoever that might be, whatever dark room, that somewhere this
would ‘glimmer in and possibly shed some Light on what could be
a very complicated process,

DR. PAHL: Well, without responding completely
to your question, because again I don't think that I can speak
from a nonbiased point. of view, I do believe that from our ob~
servation of what it is we do in RMP, relative to what I see
happening in CHP's, T must say that as the orogram director
here, I subscribe to everything you have Just said.

We are trying to work more closely in headquarters
relationship. We have been interested in trying to, as you
know, strengthen the CHP individual agencies, planning pro-
cesses. I honestly don't know Out of my personal experience o

one program that has actually tried to do more to cooperate

with and support another program than RMP has through the years,

the comprehensive health planning effort.

And it is only recently that the headquarters staff
have been interacting and that is as a result of this func-
tional reorganization that is going on,

I think the statement is a very good statement. I
would be pleased to give it maximum impact within the agency
because I know there are many individuals who feel the same
as you have expressed that there is an imbalance here in the

way this is being discussed, looked at. And to the extent tha

FS

 
 

 

 

OD
the Council would like to adopt this as a recommendation,
whether they would or not this is what we are trying to do
as staff, But I think it could have some greater force if
it were a Council recommendation. |

Perhaps I shouldn't say anything about the first one
since we haven't discussed that point. |

So from staft point of view, we would not be adverse
by any means to taking such a recommendation to Council, and
I believe a recommendation by them to the Administrator and hea
quarters staff, and permmaps higher through the Department
could, again, bring to the attention of people the feeling and
sense not only of this group, but of the entire organization

‘that is connected witn the RMP program,

This has been said over and over again. This is ano
ther way of saying it. But it is a good time to say this
because it is important. And I believe that it could have some
impact and it should be said, because I think what is being
stated is true. So many times the RMP's have tried to assist
and get the advice of the Local agencies and in fact have

found that there is very little relative to the kind of strengpft

T

~~ and there are many good reasons for this. It is not demean
ing the CHP (b) agencies by any means; there are a good many
reasons. But all of this should go toward providing a better
future for all of us.

I thinkwe are looking to the future, not trying to

 
 

 

66
investigate what happened in the past.

DR. SCHERLIS: Point of information. As you made
the motion, where did you wish this to be transmitted to
Council cr to Council and to appropriate agencies?

DR. PAHL: It can be both.

DR. SCHERLIS: It can be both?

DR, TESCHAN: I felt the first step, formal Council
recommendation, that then becomes instruction to staff to get
the message at the staff level here. But I am more concerned--
well, equally concerned at this point that the regions have
strong Council backing and I recall clearly. when Council made
a statement, I don't think Council ever understood how
impressive that was to coordinators, regional advisory groups,
et cetera.

This Council pronouncement of encouragement, et ceter
more or less I expect from region to region, but generally had
a lot to do with how we shaped our sort of concept of how we
should be conducting business.

So while intangible, I feel it has a terrifically
important potential impact and particularly now.

So a strong move to Council, and if Council then
says it, it becomes encumbent.on staff as executors to some
extent, on Council advice, that that would carry forward in

the further deliberations.

DR. PAHL: I presume this recommendation would be a

 
 

 

67
recommendation by Council to the Assistant Secretary of
Health, because obviously our Council has no responsibility
over comprehensive health planning but through the Assistant
Secretary of Health. And there could be coordination of effort
within the bureaucracy.

Sister Ann.

SISTER JOSEPHINE: Yes, I too would Like to support

|

this type of activity. And, you know, in reflecting back on
the program and in reflecting on something that came to me
in a note from one of the members here, you know, the
Regional Medical Program has had some thing of a Year of Came lot;
you know, we return to Camelot. And the knights returned
and the armies of the Middle East shing up -- (laughter) --
but, you know, it is so gratifying to me to see we still dream
dreams and that the innovative program, yoo know, still has
that spark. |

I believe that we cantsay a thing too often, because
one day someone might just listen and hear it is what we are
saying.

| I would think it is very important that gets wide-

circulation.

DR. PAHL: Mrs. Wyckoff.

MRS, WYCKOFF: I agree wholeheartedly with that
statement.

I hope something can be done so this conversation and

 
—
oy

ar

 

 

68
this resolution we have will be passed along in such a
way that it will not be lost through the decentralization
process that seems to be contemplated,

I was very sad to hear you all act as though you
were going to be gone very soor.

| DR. PAHL: Not everyone, just

MRS, WYCKOFF: It just means HEW regionalization,
which is very different from our RMP regionalization.

I hope that ‘something can be put in the mill so that
this will not be Lost in the dreadful shock of pulling the
center magic apart.

DR. PAHL: I hope so.

I don't think this is the point, ‘to get into that.
But it is quite possible that under new legislation, be that
enactment of extension legislation for the individual programs
or health resources planning legislation, unless there is quit
a different environment I suspect the Department will probably
make the determination that this program should be decentral-
ized in the regional offices and our staff-fully understand
this, Ana this would mean basically very few individw ls
would actually go to regional offices, because they would find
satisfying work locally which most of them would prefer to do,
so that would mean positions would go to regional offices.

Our staff would be reduced in members by that amount and

functions would be shifted to regional office and the

0

 
character of the program I would have to say I think would

 

 

69

probably suffer in the initial stages at least, because there
would be many new faces handling RMP responsibilities in the
regional offices. |

MRS, WYCKOFF: Will decisions be made at the region
al level for many of these things we are now making?

DR, PAHL: Yes, that is what-is contemplated.

MRS, WYCKOFF : That is the thing. |

DR, PAHL: ie Will have National Advisory Council,
that will come back, |

MRS, WYCKOFF: If that is kept in the legislation,

DR. PAHL: There are so many ifs. But the armour
is not completely rusty. -

Dr. Hess.

DR, HESS: I fully support these two recommendations
in principle and would just like to suggest a possibility
of an amendment to each of them, The first one, as I thought
about that, I wondered if I were an RMP coordinator, how
would I respond to such a general directive when you don't

know what it is you should. be shaping up for or moving toward.

Ww
m1

And so the amendment would be that if Council approve

this, that it be part of Council and/or staff responsibility to

keep the regions informed so that they will know, you know,
be in receipt of advice as to how best to prepare for this kind

of transition,

 
 

 

70

Now; I know that is very hard to do and the time
and the nature of the advice would be very important to not
keep things in a turmoil on the basis of changing signals.
But. nevertheless, just. to say that without any further
guidanceas to what that means may not be as helpful as we woul
like to have it be. | |

so that if you can get the sense of that really
further specification of that--~ |

DR. PAHL: I appreciate that.

Actually I have a problem with perhaps two words in
here, which I think bear directly on your point.

If I may read the statement again, Paul, and then
show what my concern is, because this is a concem that is
shared by many of us in headquarters in order to try to be
most helpful to the groups We are serving.

The statement reads:

"In view of Legislative developments now underway

for further evolution of RMP, in association with the
CHP and Hill-Burton programs, in the interests of nationa
hea Lith planning, Council encourages RMP's to develop
organizational readiness"--

And here is where I would like to delete "structural
changes. "

-~- "and any remaining regional relationships which are
appropriate to lead, participate in and accommodate the

5
anticipated new operating structures and requirements.

 
ff Tha,

 

 

(iL
The purpose of this orientation is to preserve for the
new formats within the states and regions the capabilitie
and voluntary cooperative relationships which the RMP
_ experience has created."

The reason that I personally, although we will take
your recommendation to what it is you wish .to say to Council,
but the reason I have problems with having the Council encouras
the regions to develop structural changes at this point is be-
cause that is one of the primary uncertainties and is still th
subject of debate.

Organizational readiness capability, closer cementing
of relationships in the regions is ali to the good. But both
CHP leadership and we and Dr. Margolis and Dr. Endicott in our
various capacities know, both privately in the office and -pub-
licly, have urged groups not to jump the gun into what they
presume to be the proper organizational structure. |

So I have 7 feeling in reading these words about
organizational structural changes, this would encourage some
people to move perhaps faster than would be for their own
good.

In terms of keeping regions informed I think we all
again, in our separate capacities, and with what knowledge we
have, are trying to do this. Some groups are moving ahead.

For example, there has been a change of grantee in

Northern New England just recently, but it is not as a result

GT

Le

 
wish to transmit.

 

 

f2

of the Last few months’ thinking. They have been doing this
now for a couple of years and thinking about it.

It has had a Lot of thought.

Others are trying to anticipate the exact outcome
of the legislation and are trying to be there when it happens,
and both Mr. Rubel and I and, as I say, our administrative |
superiors indeed are cautious people against undue haste.
That was my only concern, Paul, with your statement. But I

don't want to impose my concern on what may be the committee's

‘So I would like to have that point of view further
explored, if you will.

DR. TESCHAN: I would like certainly to respond to
that.

Sometimes I think this kind of discussion, or at
least issue we are now talking about, is a Liattle bit, oh, a
little -- it is distinctly unsubstantial. It is ethereal.

First of all, practicalities are nobody is really
going to go to a Lot of trouble in any RMP to make large
changes into something they know not what.

There are, after all, some pretty practical figures
and they have a Limited amount of staff time for such busy work

Moreover, I also think it is important for us to remg
ber that instructions or encouragement or guidance coming down

from Council and staff.is also paralleled by a good deal of

pin

 
 

 

73
information transfer between regions through the coordinator
organizations in HS-L. Moreover, all the coordinators are
oerfectly capable of reading the legislation and reading
the reports on the committee hearings, et cetera, and so are
members of the RAG and some of them do.

So there are several routes, I don't think either
having it the way it is or not having it the way it is is real
Ly going to have any enormous impact.

I sympathize with this and if you feel more com-_
fortable and if the Council would then be able to be saved,
all kinds of minutes of backing and filling on such an unsub-
stantial point, I would be perfectly happy with the notion for
making preparations for or sort of getting oriented toward ,
rather than to actually put on paper and get signed in some
crucial way @ specific thing we know not what at the present
time. ;

Critical issue, it is almost code, it is hard for me
to say what needed to be said,

DR. PAHL: Excellent statement, really is.

DR, TESCHAN: But what is meant by structural change
specifically is the notion there are structures in some of the
regions, either the way staff is put together or the way RAG
is bullt, or the way the relationships actually work between
them, or who the grantee is or how that whole business works,

under the August 1972 policy, which effectively for many of

 

T

Lv]
Ams,
SOT

 

 

 

74
the prime movers of health affairs in states and regions vitia
the ‘significance and possible impacts of RMP,

If RMP and RAG finds that is the case, that particu-
lar corner of that statement was to open the possibility that
if there are serious _. if any part of that is a serious ball
md chain to the image and function of an RMP in: a@.region, thi
would be a good time to get that out and to get it settled and
to move on its own merits, quite aside from what the future
might be.

DR. PAHL: Sure.

_ DR. TESCHAN: It is to encourage those changes,
tidy up the ship, plug the leaks, get the thing ready for sea.
Because ve ere going to be in highey heavier water for awhile
than we are right now. |

So I think we really ought to get underway with it.

DR, PAHL: _To be specific--

DR. SCHERLIS: He would Like to have his statement
launched, I gather.

(Laughter )

DR, PAHL: To be specific, we have had a spate of

inquiries in going into not-for-profit grantee structures.

That is all we have been trying to pull the bit of brake on for

their good as well as for what we belleve to be sensible
reasons, but certainly not internal rearrangements, and the

kind of structural changes you are talking about.

bk

YW

 
 

“Looking at the practical application of that, and if your

 

15
DR, SCHERLIS: You would not be adverse to removing
those administrative covers -~ what are you talking about?
What kind of structural --
DR. PAHL: We are heavi Ly involved with it, more
people are involved,
It is their insistent demand we are here to serve,
DR, TESCHAN: My feeling on that, if in the region
thereis serious problem with a structural situation --
DR. PAHL: Specific.
DR. TESCHAN: -- let us say, for example, a nonprofi
corporation mode would be better for very good independent
region reasons, then Let's go now for a nonprofit-- for

its intrinsic merits in the region, not for something down the

road.

DR, PAHL: That we are doing. I think we have a sense

and I think it is a very excellent statement.

OR. TESCHAN: We can take those words out if that

part of it is understood.

DR. PAHL: Is there further discussion?

Dr. Hess.

DR. HESS: Yes. On the second statement, again I wa:

intent was that that would be applied in this next upcoming
two reviews, that being the case, I don't know that there

would be information to be able to apply that criterion to

CT

WE

 
 

- dowed as to how to seek -- I think this puts it on a simple

 

 

76
Know whether or not each (o>) aseney had submitted its criteria
and priorities, and so on, to the RMP's. I don't see how that
is implementable during the next-- these immediate two
reviews in the next month or so.

DR, TESCHAN: I don't think that should bother our
deliberations. I think it is the resolve of our group and if
Council backs it, which is really the question, then I think
we can deal with CHP comments on somewhat more official ground
within the RMP review process than we felt really comfortable
doing up to now.

I have been concerned, but reassured by the last two
days. I was concerned when I came here that we would be worry
ing. We would be unduly influenced by insubstantial grounds f
negative comments from CHP. We have not been SO.

What this will do as I see it, the purpose is really
not to influence us SO much if we already exreed to it, but
I would hope it would strengthen Herb's hands and that of
his staff in conducting their business with their counter-
parts in these new ad hoc subcommittees, And will also influ-
ence the regions in how they deal in the future, regions at th

point, seeing the ascendency of CHP, may be increasingly en-

professional basis,

DR. HESS: My only concern is for these immediate

applications.

WH

Ls

 
 

 

 

(7
DR. TESCHAN: Wouldn't worry about it.
DR, HESS: <-- it seems’ to me a little bit too tight

to apply.

- MR. BARROWS: Without respect to the recommendations)

the fact of the matter is our panel, panel B, concluded that
all we can do would be to examine the RMP 's share in this rela,
tionship. .

‘DR, PAHL: Surely.

MR. BARROWS: They had done what they were supposed
to do. We had no way of measuring the other-- I think that
is a factor in the recommendation to the Council involved.

DR. PAHL: Yes. This picture certainly will be
presented to them, so that they can view this in its proper
perspective.

DR, HEUSTIS: I would Like to call for question on
the motion, as editorially amended, without having you read it
again.

DR. PAHL: Without reading, all those in favor of the
two motions, the first one as amended, please signify by
saying "aye."

DR. PAHL: Opposed?

(No response. ) |

DR, PAHL: Motion is carried andrecommendations will
be transmitted to Council.

DR, SCHERLIS: May I state it be carried unanimously

wa

 
 

 

 

78
just for matter of record.
DR, PAHL: Carried unanimously.
You might be interested in hearing the arthritis gro
status report. |

I am happy to report they probab Ly feel if they were

panel C, they have the’ tougher problem. They are working

very hard. Dr. Roger Mason from Nebraska is serving as chair-

man of that group. We have a very fine ad hoc group with 43
applications requesting I believe it is$16 million with $4.2 m

lion earmarked for the support of these pilot arthritis center

The group yesterday spent the better part of the day}

discussing -- this is a brand new concept, not only program,
for us, but brand new concept as to what are the elements whicl
should be in a center and how to give various weighting to
these elements. |

(Discussion off the record.)

DR. PAHL: “the arthritis panel is sbruge ling with
$16 million in requests, with $4 million available and they
spent the better part of yesterday trying to deve Lop the
element and important features of centers. And they scanned
through the applications in a descriptive fashion, one by one,
and about Last night the time that you broke up I believe they
did also and came back to work at eight o'clock this morning a
are working today, possibly tonight, and possibly into tomorro

morning. Because they feel it is also important not just to

Ut

rie

MW

 
aes

Ty,

“it, and therefore I have a request to make of our own staff to

 

 

79
spend $4.2 million as you feel it is not just to distribute
funds, impounded funds, but to get something more out of
this, to get more than the sum of the parts.

I am very pleased to say they are very much aware of

stay around this afternoon and do their post-committee work
in the offices, because some of the people that you have seen
departing in the. last naif hour or so here a being requested
to go into that room and tell that ad hoc Arthritis Committee
the capabilities of the region for managing what is a special
arthritis program.

So we are not trying to divorce this activity out of

the RMP activity.

I told Dr. Mason we couldn't be holding the Arthritis

Committee at a better time for having a full survey of 53
regions with as much information as we can accommodate right

now.

So I thought you would Like that status report and

somehow those difficult decisions will be made,

Before closing, I would Like to reiterate Mr. Barrows

comments from my own point of view, and I know from Bob's point

of view on our own staff efforts,

We have been carrying two activities of arthritis and

RMP applications simultaneously. You do recognize, because

you have been with us for a much longer period of time, the

i

 
“
f
f.

committee, —

 

 

60
kind of work and quality of work that has come out and you
have duly acknowledged that for which I aim very appreciative.
The Arthritis Committee prior to the end of yes-
terday also expressed itsappreciation for the Quality of the
staff work, done by a group who I had never seen, who had
never seen arthritis application, had to read textbooks,

listen to experts, do homework, and do staff work for that

. I think my very real persmal impression &s I come
away from these two and three days of meetings is that I have
never been associated with a program that has risen really
to the need that they have, and done so in such a high quality
fashion. |

Many of them have been holding two jobs over the montt
of May in order to get these materials for you, and so I’
personally thank them, I know both Bob and Mr. Peterson,
chairing the other cpanel, do, and it is very nice to record that
and I am sure the Council will appreciate all of the work.

But in addition to that, I would also like to thank
you. It has been a very difficult job on your part to have
been away from the many changes that have taken place and then
to come back and with the kind of short time and the extremely
heavy workload, to do the kind of decision making that you have.

I think this morning's session has been particularly

gratifying to me to be able to discuss some of these points,

 
 

 

 

81
and issues, because we do feel a real responsibility not
for winding down a program, but for moving into the new phase
and maintaining the strength and improving it where we can,

So again we thank you very much and we Will Look
forward to seeing, hopefully, all of you in July, and wish you
well on your return trips.

Meeting is adjourned.

Thank you<

(Whereupon, at 12:00 o'clock, noon, the meeting

was adjourned. )

_