1
60:00:04

~2
00:00:23

3
00:00:14

4
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5
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SOMEHOW, SOME WAY, SOME TIME: THE REGIONAL MEDICAL PROGRAMS
CUTTING SCRIPT, PART 1 (10/20/91)

VIDEO

BLACK. FADE UP ON
PHOTOGRAPHS OF LYNDON
JOHNSON SPEAKING TO
DEBAKEY COMMISSION

MORE STILLS

PAN OF COMMISSION
MEMBERS IN PHOTOGRAPH

DISSOLVE TO TITLE
SEQUENCE: SOMEHOW, SOME
WAY, SOME TIME--THE
REGIONAL MEDICAL
PROGRAMS, 1966-1976

 

AUDIO

(Audio recording: 41764.1bj)
PRESIDENT JOHNSON: I am firmly
convinced that the accumulated brains
and determination of this Commission
and of the scientific community of the
world will, before the end of this
decade, come forward with some answers
and cures that we need so very much.
NARRATOR: (Voiceover)

With these unvarnished words, Lyndon
Johnson told his Commission on Heart
Disease, Cancer and Stroke to get to
work. It was April 17, 1964.
JOHNSON (Voiceover) :

You have among you some of the great
doctors, some of the greatest public
servants of our time. Somehow, some
way, some time, you are going to find

the answers and I hope it will be soon.

MUSIC UP FULL.
.6 DISSOLVE TO MONTAGE OF
00:00:31 19605, GRADUALLY
BECOMING MORE FOCUSED
ON MEDICAL PRACTICE OF
THE 1960S

-7 DEBAKEY FOOTAGE FROM
00:00:20 BBC DOCUMENTARY

-8 DISSOLVE TO:
00:00:29 MEDIUM SHOT, DEBAKEY

 

NARRATOR (Voiceover):

It was the middle of the 1960s--a time
of dramatic change and new awareness.
The economy was booming, and medical
knowledge was burgeoning. But many
Americans were aware of a gap in the
benefits of medicine--a gap between
what was possible and what was widely
available.

No one was more keenly aware of that
fact that was Dr. Michael DeBakey, who
was even then world famous for his
pioneering work in cardiovascular
surgery. DeBakey knew that the
benefits of his research were not
spreading quickly.

DEBAKEY: The gap existed between where
the centers were doing this work and
out in the periphery, doctors in
practice not picking up patients who
had these diseases, and referring them
for operation. So there was a gap in
the knowledge available to treat
patients and the patients who were
being treated by doctors who did not

have that knowledge.
-9
00:00:17

-10
00:00:14

11
00:00:17

-12
00:00:14

213
00:00:31

JOHNSON PHOTOS / FOOTAGE

JOHNSON WITH DEBAKEY

DISSOLVE TO:
MEDIUM SHOT OF DEBAKEY

COMMISSION MEMBERS,
STILLS

REPORT

 

NARRATOR (Voiceover)

President Lyndon Johnson was concerned
about a major statistic--the fact that
71-percent of all Americans who died
were killed by heart disease, cancer,
or stroke.

Johnson asked DeBakey to chair the
commission which he hoped would come up
with a plan to restructure the American
practice of medicine in order to combat
those three major killers:

DEBAKEY: He asked me how long the
thing would take. I said, “About a
year." He said, "We've got to do
better than that. I want to be able to
include a message from this commission
in my address in January."

NARRATOR (Voiceover) :

DeBakey and other commission members
began their intense work almost
immediately, gathering and analyzing
material from all over the country.

The report was delivered in December of
1964, in time for January's State of

the Union message.

(CONTINUED)
-13 CONTINUED: 22

.14 DISSOLVE TO LBJ AND
00:00:17 COMMISSION

-15 DISSOLVE TO MEDIUM WIDE
00:00:44 SHOT OF LBJ DELIVERING
STATE OF UNION MESSAGE

 

A copy was sent to every practicing
physician in the United States.
PRESIDENT JOHNSON: (Audio: 12964.1bj)
Today it is a very high honor and great
privilege to receive the results of
your study. (E)

With these guideposts and with these
goals, we will begin this year in the
Congress and in the country to make a
concerted drive on these three enemies
to the health of two-thirds of all
Americans.

JOHNSON (SOT):

Our goal is to match the achievements
of our medicine to the afflictions of
our people.

We already carry on a large program in
this country in this country for
research and health.

In addition, regional medical programs
can provide the most advanced diagnosis
and treatment for heart disease and
cancer and stroke and other major
diseases.

(CONTINUED)
.15 CONTINUED: 23

.16 COVER, STATE OF THE
00:00:20 UNION MESSAGE

.17 DISSOLVE TO MEDIUM
00:01:01 SHOT, DEBAKEY

 

New support for medical and dental
education will provide the trained
people to apply our knowledge.
NARRATOR (Voiceover)

But the concerted drive on the three
enemies had to take a detour through
the political process. Proposal number
three, advocating the development of
regional medical complexes, turned out
to be extremely controversial.

DEBAKEY (SOT): It concerned this
so-called cooperative arrangement
between institutions, creating a
regional network across the whole
country.

(E) In each region, the idea was to
have a center of excellence which would
have all of the best technology, the
best facilities, the best personnel,
the best training, and then surround
that center of excellence with

(CONTINUED)
-17

18
00:00:04

-19
00:00:11

-20
00:00:29

CONTINUED: 24

MEDIUM SHOT, PAUL
SANAZARO

 

individual diagnostic stations and even
station hospitals, so to speak, which
would relate to the center of
excellence for the more highly
technical work. (E) M.D. Anderson is an
example of what we had in mind, you
see, and is, in that sense, a center of
excellence in carrying out the concept.

(Copy to be written.)

Unfortunately, as you look around the
country, you have very few. The
reason, of course, is that the
legislation never authorized then.
SANAZARO SOT:

Two bills were introduced with that in
mind, one in the Senate, one in the
House, and in the course of the summer,
various groups from organized medicine
made it be known that they could not
possibly approve the creation of
regional medical complexes if this
meant disturbing existing

relationships.
.21 MEDIUM SHOT WILLIAM

00:00:23

22
00:00:44

RUHE

M/S OLSON

 

WILLIAM RUHE: (SOT) Practicing
physicians tended to be apprehensive
about whether this was going to change
the practice of medicine. The American
Medical Association was worried about
this being a first step toward a

nationalized health system.

OLSON SOT :

I think it was the pressure from the
practicing profession that changed it
so that the focus really became more
heavily placed on education and
dissemination of information and
co-operation, and the bill that was
adopted had a very specific prohibition
about not interfering with the private
practice of medicine, and that
referrals, if any, in connection with
demonstration projects would have to be
made by referral by a practicing

physician.
-23
00:00:26

~24
00:00:53

MS RUHE

MEDIUM SHOT, PAUL
ROGERS

 

RUHE SOT:

The original report spoke, for example
of regional medical complexes,
complexes not defined, but I think in
almost everybody's mind, that evoked
the image of large construction
efforts, new buildings, new centers
assembled in either existing locations

or new locations.

ROGERS SOT:

So the Congress reacted and they cut
out any approval for the building of
facilities to calm down the concerns
that people were going to be sent away.
They made the program a cooperative
program, where it was not something
that someone can come in and direct.
You had to get cooperation from people
in all of the communities, the medical
center, whatever. The only patient
care that could be done was in
research, in demonstration, but you
really couldn't deliver care; it had to
be paid for in a traditional way.

(CONTINUED)
.24 CONTINUED: 27

.25 MEDIUM SHOT, MERLIN
00:00:20 DUVAL

.26 LEGISLATION, STILLS OF
00:01:07 LBJI SIGNING 28.a.
MEDIUM SHOT, RUHE 28.B
LBJ STILLS

 

You could not change that. so that
first legislation acceded, really, to
the concerns of AMA in those points.
MERLIN DUVAL:

As a consequence, we moved from
actually moving patients to moving
information so that you could
ultimately close the gap between
literally the laboratory bench and the
patient who needed information.
NARRATOR (Voiceover)

So the proposal for regional medical
complexes was modified into a program
for information exchange--and the
Regional Medical Programs were born.
RUHE SOT:

I think we have to acknowledge that RMP
was just another component of the Great
Society program in the health field.
The idea, of course, was to sell
something to the public which would be
new and striking and would save many,

many lives.

(CONTINUED)
-26 CONTINUED: 28

-27
00:00:17

20
00:00:34

CARTOONS FROM
MARSTON/YORDY ARTICLE
FIGURE 3: "THEY WANT TO
TELL US WHAT TO DO!"
"THEY'RE NOT GOING TO
TELL US WHAT TO DO?"
"YOU MEAN WE'VE GOT TO
DO EVERYTHING FOR
EVERYBODY?"

 

10.

NARRATOR VO:

President Johnson signed the
legislation in October, 1965.
PRESIDENT JOHNSON: (Audio: 10665.1b})
Its goal is simple: to speed the
miracles of medical research from the
laboratory to the bedside. Our method
of reaching that goal is simple, too.
through grants to establish Regional
Medical Programs among our medical
schools and clinical research
institutes, we will unite our Nation's

health resources.

NARRATOR (Voiceover)

That is not to say that the Nation's
health resources were eager to be
united. Throughout the winter and
spring of 1965 and 1966, health
professionals, educators, community
health planners, and hundreds of other
interested people grappled with the
process of planning, organization, and

grant applications.
-29
00:00:26

~30
00:00:07

FIGURE 5:"PLANNING
TOGETHER WASN'T SO BAD,
BUT. . DO WE REALLY
HAVE TO WORK TOGETHER?"

FADE TO BLACK OR
DISSOLVE TO SPECIAL
SLATE TO INDICATE END
OF PART 1.

 

11.

By June, 1966, activities based on the
first grants were up and running. In
June of 1967, a report on the progress
of Regional Medical Programs concluded
that it was too soon to comment on
their success or failure, and
recommended that they be funded for

another five years.
el
00:00:04

22
00:00:32

3
00:00:23

SOMEHOW, SOME WAY, SOME TIME: THE REGIONAL MEDICAL PROGRAMS
CUTTING SCRIPT: PART 2 (10/20/91)

VIDEO

GRAPHIC: MAP OF REGIONS
NAMES OF REGIONS
EMERGE:

GREATER DELAWARE VALLEY
RMP

BI-STATE RMP

LAKES AREA RMP
INTERMOUNTAIN RMP
SUSQUEHANNA VALLEY RMP
TRI-STATE RMP
TENNESSEE MID-SOUTH RMP

MEDIUM SHOT MERLIN
DUVAL

 

AUDIO

NARRATOR (Voiceover) :

One of the first characteristics to
become obvious about the Regional
Medical Programs was that each one was
different. That even showed in the
areas each region covered. About half
of the 56 RMPs corresponded to
political jurisdictions--and about half.
And each

did not. Some overlapped.

had its own concerns. But that was the
way it was supposed to work.

MERLIN DUVAL:

Regional Medical Programs was allowed
to look at the way patients and
information flowed in the real world.
If you looked, for instance, at Kansas
City, the question is, do you give it
to Kansas City, Missouri, or do you

give it to Kansas City, Kansas.
.4 M/S STARK
00:00:38

.5 M/S DUVAL
00:00:23

 

STARK SOT: And what we did there was
to organize a liaison committee between
both states with the University of
Kansas and the University of Missouri,
of course, participating, in order to
avoid any kind of duplication of effort
and to have more cooperation. I think
that's one of the principal roles that
I found coming out of the Regional
Medical Programs, and that is the
ability to get these diverse groups and
institutions together in a cooperative
way.

DUVAL SOT: So, Regional Medical
Programs was created and permitted
money to flow to entities that were not
geographic or political jurisdictions.
They were watershed jurisdiction. I
thought that was an incredible
breakthrough for the federal government

to take as a step.
.6 MONTAGE OF PHOTOS,
00:00:23 LETTERHEADS, ARTICLES

.7 FREEZE EGEBERG
00:00:08

.8 RELEASE FREEZE: MEDIUM
00:00:59 SHOT, ROGER EGEBERG

 

NARRATOR (Voiceover):

The Regional Medical Programs required
the cooperation of segments of the
community which were sometimes not
accustomed to communicating with each
other, much less cooperating. And
there was hesitation in many areas
about making the attempt.

Dr. Roger Egeberg was then Dean of the
School of Medicine at the University of
Southern California.

ROGER EGEBERG:

The university was conservative about
it, this faculty was, but the executive
committee, after I explained it to
them, came along. So we were the first
people in California to join. There
was still some hostility, but Congress
had done something terribly important:
they had included the medical
profession and the hospitals right in
the law. So some of the first money to
come didn't come to a medical school;
it went to the California Medical
Association. Wasn't that bright? And
next to the California Hospital.

(CONTINUED)
-8 CONTINUED: 64

.9 STILLS FROM MEETINGS OF
00:00:32 RMP ERA, OR WITH
RESEARCH OR OTHER
COOPERATION, OR LOGOS
OF SOCIETIES

.10 MEDIUM SHOT OF KARL
00:01:04 YORDY

 

And they became part of the program.
They saw that we didn't have horns or

tails, and we started to work together

pleasantly.

NARRATOR (Voiceover) :

In California, and in other regions,
the cooperation between the hospitals,
the medical schools, and the medical
societies was soon augmented by health
organizations such as the American
Heart Association and the American
Cancer Society, and by members of the
general public. For some
establishments the adjustment was
easy--for others it was not.

KARL YORDY:

Schools that had strong traditions of
reaching out to the community and
really viewed themselves as playing a
role with the broader community found
this new role rather comfortable and
found it, in fact, one that was able to
facilitate a lot of the things which
they'd been thinking about anyway.

(CONTINUED)
10

-1l1
00:00:20

~12
00:00:29

CONTINUED: 65

STILLS OF EARLY REMOTE
READING OF EKGs

MEDIUM SHOT, KARL YORDY

 

I'm thinking here of schools like the
University of Washington in Seattle,
the University of Missouri,
universities that often were state
universities and had a tradition of
reaching out. The more elite, private
medical schools, I think, had a harder
time sort of figuring out how this fit
into their own sense of their mission
and role.

NARRATOR (Voiceover) :

It is difficult to generalize about the
accomplishments of the RMPs, since they
all addressed different needs and had
different goals. But some remarkable
accomplishments stand out--some that
changed American medical care forever.
KARL YORDY:

There was an effort, for instance, out
of the Missouri RMP, one of the first
operation RMPs, that set up a

(CONTINUED)
-12 CONTINUED: 66

-13 MEDIUM SHOT, VERNON
00:00:28 WILSON

-14 MEDIUM SHOT, PAUL
00:00:41 SANAZARO DISSOLVE TO
CORONARY ICU

 

communication link between a group of
physicians, cardiologists, in
Springfield, Missouri, and the medical
center in Columbia, that would permit
the remote reading of EKGs, a capacity
that's now routine in medical care.
VERNON WILSON:

Utah dealt with getting that
information to a four-state area, and
very successfully they dealt with that.
They did what Missouri and Alabama did
so well, they formed a telephone bank
and people could call in for
information.

PAUL SANAZARO:

I thought, to me, I don't know if it's
exciting, but important, the most
important thing that RMP did was to put
in place, which is still in place, in
the United States intensive care units
for heart disease patients, the
coronary care units, and the training
of personnel for that, and specialized

equipment for that.
(CONTINUED)
-14

.15 STILLS OF EARLY REMOTE

00:00:43

-16 MEDIUM SHOT, CHARLES

00:00:47

CONTINUED: 67

READING OF EKGS

FLAGLE

 

That probably was its greatest
technical contribution to patient care,
and that's very exciting that that
happened. It came along at just the
right time.

NARRATOR (Voiceover): RMPs not only
spurred development of remote EKG
readings and coronary care units, but
also rapid strides in vascular surgery
and in the development of regional
trauma centers. But one of the
greatest contributions of Regional
Medical Programs was perhaps the
newfound cooperation between different
segments of society, and the
realization that regional planning
could yield worthwhile results.

FLAGLE (SOT): There was strong
cooperation between the University of
Maryland and Johns Hopkins, and there
was also a great involvement of such
things as the media, the heart

associations.

(CONTINUED)
-16 CONTINUED: 68

.17 MEDIUM SHOT, KISSICK ,

00:00:26

-18 MEDIUM SHOT, ARTHUR
00:00:29 RIKLI

 

I would call it an unprecedented--I was
about to say conglomeration, but it
really wasn't that. It was a
well-orchestrated program and it
resulted in the creation of the
Maryland High Blood Pressure
Commission, which is still in existence
and still operating for purposes of
implementing some of the results of
that five-year study of coordination.
SOT KISSICK: An unknown and
little-appreciated dimension of RMP in
Connecticut was CUPIDS, Connecticut
Utilization Patient Information Data
Systems. CUPIDS enabled them to
analyze the utilization of services at
all thirty-five Connecticut hospitals,
and brought forth diagnostic-related
groups.

ARTHUR RIKLI:

I think the Regional Medical Programs

(CONTINUED)
-18 CONTINUED: 69

-19 MEDIUM SHOT, MERLIN
00:00:29 DUVAL

.20 MONTAGE OF STILLS FROM
00:00:26 REGIONAL MEDICAL
PROGRAMS, HANDSHAKES,
EKG READINGS, MEETINGS,
PATIENT CARE,
LIBRARIES, TRAUMA
CENTERS, ETC.

 

really built an active bridge between
the medical school and the providers of
health care, not only in their
immediate area, but out in the rural
areas, as well. so the Regional
Medical Program still has that benefit
in most of the communities and regions
where they were set up originally.
MERLIN DUVAL:

I do think that this is, in its own
way, a watershed event. It's a
watershed event because it brought a
type of early partnership into the
providing elements of America's health
care system and the federal government.
Until that time, they did not have that

kind of relationship.

NARRATOR (Voiceover)

In spite of their accomplishments, the
Regional Medical Programs did not have
long to live. Some of the reasons they
went away were due to politics, to
changing times and shifting priorities.

(CONTINUED)
10.

.20 CONTINUED: 70
But the strength of the RMPs, their

adaptation to their regions, would also

prove to be a major weakness.

-21 FADE TO BLACK OR TO
00:00:05 SPECIAL SLATE: END OF
PART 2.
-l
00:00:04

22
00:00:41

3
00:00:14

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

VIDEO

1970S TELEGRAPH WORKING
SUPERS EMERGE:

"NO GRANT FUNDS ARE
INCLUDED IN THE
PRESIDENT'S REQUEST FOR
RMP IN FISCAL YEAR
1974"

"ALL OF FISCAL YEAR
1973 GRANT AWARDS WILL
TERMINATE ON JUNE 30,
1973"

", . .DO NOT ENTER INTO
ANY NEW CONTRACTS. . ."
", . .WE NEED TO
PROCEED WITH THE
DEVELOPMENT OF PHASEOUT
PREPARATIONS. . ."

NIXON INAUGURATION
(CLARK STOCK)

 

AUDIO

Natural Sound (:05)

The telegram sent out to all
coordinators of the Regional Medical
Programs on February 1, 1973, marked
the beginning of the end of the
Regional Medical Programs. Although
the Regional Medical Programs had
received their highest level of funding
ever in Fiscal Year 1973, they had been
completely cut out of the budget for
Fiscal Year 1974, and Dr. Harold
Margulies, who was then director of
RMPs, was ordering them to begin
shutting down. What happened?

Part of the answer to that question is
that the times had changed. Richard
Nixon was now president; the programs

of Lyndon Johnson's Great Society were

being dismantled.
4
00:00:20

5
00:00:14

6
00:00:11

7
00:00:11

8
00:00:38

MEDIUM SHOT, KARL YORDY

VIETNAM STOCK (BE
THERE, BE COUNTED
STOCK)

M/S MARSTON

STILLS OF CASPAR
WEINBERGER

 

KARL YORDY:

I think that the hope and the vision
for the program really were starting to
disappear shortly after Nixon became
president. It was sort of a holding
action, sort of a fighting the
frontiers at that point.

ROBERT MARSTON: (Voiceover)

The Vietnam War had raised the issue of
guns and butter, and funds suddenly
became very restricted at the federal
level.

Then, finally, I think, Regional
Medical Programs, as a part of the
Great Society programs, was caught up
in a rejection of such programs.
NARRATOR (Voiceover)

Caspar Weinberger, as head of the
Office of Management and Budget, had
been one of the RMPs harshest critics.
JOHN ZAPP:

OMB was certainly a harsh critic of RMP
at that time, but that was not
uncommon. They were basically a harsh
critic of most of the categorical

programs.

(CONTINUED)
-8 CONTINUED: 85

MEDIUM SHOT, JOHN ZAPP

.9 MORE OLD STILLS OF
00:00:35 WEINBERGER, TESTIFYING
AT CONGRESSIONAL
COMMITTEES, WORKING IN
OFFICE, ETC.

-10
00:00:44

 

Maybe that was one of the problems that
RMP was suffering at that time within
the administration. They just didn't
seem to be able to withstand the
constant requirements for justification
that OMB was throwing at the
secretary's office on the
re-authorization for each year.
NARRATOR (Voiceover) :

When Caspar Weinberger became Secretary
of Health, Education, and Welfare in
1972, his attitude toward the RMPs
could hardly be expected to change--and
it didn't. When Congress wanted to
extend the life of the RMPs for a
year--from June 30th, 1973, to June
30th, 1974, Weinberger took the unusual
step of lobbying against it. Congress
passed the extension overwhelmingly.
Nevertheless, the RMPs were doomed.
EGEBERG (SOT):

I think they were assassinated. Now
you can kill people by ripping them
open, you can kill them by a bop on the
head, or you can kill them by choking.

(CONTINUED)
-10

-il
00:00:08

~12
00:00:44

CONTINUED: 86

FREEZE, JOHN ZAPP

RELEASE FREEZE:

SHOT,

JOHN ZAPP

MEDIUM

 

This was from way up above. I think it
began with Caspar Weinberger, who had a
feeling that Regional Medical Programs
was just another program that was going
to drain money out of the Treasury, and
it would be better to cancel them all
and come out with a big program, which
I think medicine became worried about,
might be socialized medicine or health
insurance for all.

NARRATOR (Voiceover):

The RMPs had other political problems,
too.

JOHN ZAPP:

They had a base that probably provided
them with the weakest constituency in
the secretary's office and within the
administration. That was basically a
medical school base, where the
perception, if you will, was that an
awful lot of money just seemed to be
going to the faculties in the different
health science centers.

(CONTINUED)
-12 CONTINUED: 87

-13 WIDE SHOT, CAPITOL
00:00:14

-14 MEDIUM SHOT, PAUL
00:00:52 ROGERS

 

That was a perception that was very
difficult for the program
administrators to overcome because,
rightly or wrongly, there was a lot of
faculty support built into RMPs around
the country.

NARRATOR (Voiceover:

The legislative mandate for RMPs had
changed. Congress had made the choice
between keeping the focus for RMPs or
broadening their purpose.

PAUL ROGERS:

I think they were for broadening, as I
recall. They thought it should be
broadened, as long as we had the
facilities, and that network of people
working together, we thought it should
be applied to increase health care
generally, although, as we've talked
about, the first emphasis was
categorical on those three diseases.
But that began to change from those who
did not like the program, who said,
"Oh, you've lost the purpose." Well,
we really didn't because we were

improving health care for people.
.15 MEDIUM SHOT, EDMUND EDMUND PELLEGRINO:
00:01:01 PELLEGRINO
I want to go on the record of saying
that many of the regions did very good
things with this program. They carried
out many of the ideas, but there were
so many goals and objectives. It's
perfectly all right to have variety in
the regions, but the important thing
that mustn't be missed is that the
network that brings it about was
utterly confused at times, not knowing
where it was going. So that when we
looked at programs, we would have such
a variety, we didn't hve solid criteria
that we could use to judge them, and it
was a little bit unfair, as a matter of
fact, because, as you say, different
parts of the country had different

requirements.

-16 ZOOM IN DOOR OF HEARING NARRATOR (Voiceover) :

00:00:11 ROOM, 2218 RHOB
Money was tight. A program without a

specific focus had a hard time

 

competing for it.
.17 MEDIUM SHOT, JOHN ZAPP JOHN ZAPP:
00:00:35
I think one of the things that led to
the demise of the Regional Medical
Programs was the competition from other
more identifiable programs within the
Public Health Service and HEW that it
had to compete with. RMP had to
compete with Emergency Services,
Migrant Health, Rural Health, Indian
Health. It had to compete for dollars
with the entities and the Food and Drug
Administration.

.18 CONGRESS OR CAPITOL NARRATOR (Voiceover) :

00:00:25 SHOT
That did not mean that RMPs died
easily. Congress had voted
overwhelmingly to extend the life of

the RMPs, and they still had supporters

on Paul Rogers' subcommittee:

-19 MEDIUM SHOT, PAUL PAUL ROGERS:

00:00:35 ROGERS
I remember in the testimony, they sent

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

would not come, nor would the

 

Secretary.

(CONTINUED)
19

-20
00:00:26

~2l
00:00:11

22
00:00:38

CONTINUED: 90

MEDIUM SHOT, JOHN ZAPP

HEARINGS STILLS,
CAPITOL SHOT

MEDIUM SHOT, ROGER
EGEBERG

 

They let the messenger, who had to give
the bad news that they were cutting
this program, come before Congress, and
our committee gave him really a pretty
rough time, on both sides of the aisle.
JOHN ZAPP:

I get to deliver the messages, good and
bad, although sometimes others in the
department got to deliver more good
messages. A very combative time
between the administration and the
health committees, so most of them were
relatively contentious types of.
hearings.

NARRATOR (Voiceover) :

But in spite of Congressional support,
members of the administration were
still determined to see the RMPs die.
ROGER EGEBERG: Well, I think Caspar
Weinberger sort of worked up a
particular antipathy to this because it
was so hard to kill it.

(CONTINUED)
-22 CONTINUED: 91

-23 WEINBERGER, LAWSUIT
00:00:32 PAPERS

.24 MEDIUM SHOT, JOHN ZAPP
00:00:17

 

He tried to choke it by taking the
funds and impounding the funds in the
middle of the year, saying, "You can't
spend any more money. Save it till the
next year," and then using that for the
next year instead of giving them any
new money. That's choking them.

That's cutting down their funds.

NARRATOR (Voiceover): That was also
something the Regional Medical Programs
thought Secretary Weinberger had no
right to do, since Congress had clearly
appropriated the money to be spent by
the RMPs. So the National Association
of Regional Medical Programs sued to
have the money released--sued, and won.
On February 7, 1974, the courts ordered
the money released. Reluctantly, the
White House complied.

JOHN ZAPP: I don't think it was any
great surprise about the suit. I think
they were quite prepared for it. I
don't think they thought they were
going to lose, but they were prepared

to have the suit.
.25 ANIMATION: MAP WITH
00:00:17 RMPS. RMPS DISAPPEAR.

.26 MEDIUM SHOT, VERNON
00:00:20 WILSON

.27 M/S OLSON
00:00:43

 

10.

NARRATOR (Voiceover) :

The RMPs had won the suit, but it
didn't matter. The money released in
February of 1974 was for the budget
year ending in June, and there were no
further appropriations.

VERNON WILSON:

The suit at the end, you know, that's —
my only knowledge of a suit of that
kind in order to keep legislation in
existence. It had the end results you
should expect; it just prolonged the
agony, that's all.

OLSON (SOT):

Here was a huge bureaucracy that you
had to deal with, and you had all kids
of talented people in the programs.
The kind of understanding and support
that would have been necessary to make
the program effective just wasn't
there, so it was a sense of trying to
keep faith with the people who had
joined the program and yet you didn't
have the sense that at the top level
there was any conviction that they

wanted it to succeed.
.28 M/S RUHE

00:00:29

-29
00:00:08

30
00:00:05

MORE CLOSEDOWN SHOTS O
RMPS ,

FADE TO BLACK OR
DISSOLVE TO SLATE: END
OF PART 3

 

11.

RUHE (SOT): It's disappointing that
these things did not endure. I don't
know how long they did endure after RMP
quit. I had the impression that some
of this cooperation and collaboration
did continue for a few years, at least,
but as long as the people who were
engaged in initial arrangement were
still there, maybe still living, still
active.

NARRATOR (Voiceover) :

The RMPs wound down and dwindled; in

1976, independent RMP operations ended.
SOMEHOW, SOME WAY, SOME TIME: THE REGIONAL MEDICAL PROGRAMS
SHOOTING SCRIPT: PART 4 (10/20/91)

-1 VIDEO:
00:00:41 MONTAGE: MODERN MEDICAL
FACILITIES-~EXTERIORS,
PEOPLE RECEIVING
TREATMENT, PROCESSING
MEDICAL INSURANCE
CLAIMS

-2 MEDIUM SHOT, EDMUND
00:00:55 PELLEGRINO

 

AUDIO:

Music up and under

Times have changed. Since the
Regional Medical Programs ceased
operations, medical knowledge has
burgeoned--and so has the cost for
medical care. In the mid-1960s, the
cost of medical care was less than 5%
of the GNP--today it's 15%. Is it
relevant to consider programs along the
lines of the RMPs? Some people think
the time has come--if not to revive
RMPs, at least to consider something
similar.

EDMUND PELLEGRINO:

I think it was probably ahead of its
time. I think the time will come again
when we must reinvent it, because I
think regionalization is part of--by
the way, that's one of the other
defects I would like to add. It was
not part of a comprehensive program for
national health care, which we urgently

need.

(CONTINUED)
1.2

-3
00:00:29

4
00:00:23

CONTINUED: 95

MEDIUM SHOT, PAUL
SANAZARO

ROBERT MARSTON, MEDIUM
SHOT

 

1

I think if it could be placed within
that context, then the mechanism of
cooperative arrangements on a regional
basis would really have a tremendous
use in improving the health care of the
American people, which was the aim in
the first place.

PAUL SANAZARO:

It anticipated the present. In the
literature today, you are reading about
regionalizing, highly technical
services that require large volume,
highly skilled personnel, and special
support facilities. So we will see
regionalization, but unfortunately
maybe some 20 years after RMP was on
the scene.

ROBERT MARSTON:

I think this idea of cooperative
arrangements is difficult for a
government such as ours, and it's
uneven in terms of its receptivity. It
does allow people to look at the
elephant and see what it is that they

want to see.
-5 MEDIUM SHOT, ROGER
00:00:38 EGEBERG

.6 M/S KISSICK
00:00:26

-7 M/S PELLEGRINO
00:00:14

 

ROGER EGEBERG:

I think that if they were brought back,
appropriately nurtured, and not given
too much money--I don't think it should
be a very expensive program--that they
would help the basic problem we have
now, and that is of getting all these
people--hospitals, practitioners, the
societies and so forth and their
organizations--talking together. It
seems to me that if you can get people
talking together, you've made a big
step towards solving a problem.

KISSICK (SOT): I think we had the right
concept, but we didn't understand the
culture. (E)

I think that now that we have a
quarter-century under our belt since
Regional Medical Programs, that all
we've got to get is Congress to enact
them all over again, and this time
around we'll do a better job.
PELLEGRINO (SOT):

I think they're going to have to be
reinvented, because regionalization of
health care services in something I

think we really must have.
-8 MEDIUM SHOT, MICHAEL
00:00:20 DEBAKEY

.9 MEDIUM SHOT, WILSON
00:00:41

.10 MODERN MEDICAL PRACTICE
00:00:17

 

MICHAEL DEBAKEY:

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

I think that Mike DeBakey was
absolutely correct in his initial
instinct to establish complexes, but I
think they will have to come after the
national health insurance is invoked.
(E) I would say another ten to fifteen
years the House will have changed
enough and the Senate will change its
patterns, and it will probably come in
that order, and I think some Regional
Medical Program-type activity then will
become, perforce, a necessary part of
the system.

NARRATOR (Voiceover) :

The RMPs were not perfect. However,
they did accomplish one very important
thing they were set up to do--and that
is closing the gap between new medical

knowledge and the practice of medicine.
-11 MEDIUM SHOT, DEBAKEY

00:00:38

«12
00:00:17

~13
00:00:52

CONGRESSIONAL HEARING

DISSOLVE TO: MEDIUM
SHOT, JOHN ZAPP

 

MICHAEL DEBAKEY:

I think the gap has been reduced and
contracted considerably, because
information now is more readily
available and actually gets out to
doctors more quickly than it has in the
past, to some extent because of the
National Library of Medicine and what
it has done. No question about that.
You take MEDLARS and other means of
communication and information
availability for doctors, this has made
a tremendous difference.

NARRATOR (Voiceover):

There are other lessons to be learned
from the rise and fall of the RMPs.
JOHN ZAPP:

What's the trick in making it work? I
think the trick in making it work is

to have an effective constituency
behind any program. If you take a look
at the programs that have had real

(CONTINUED)
13

14
00:00:29

CONTINUED: 99

DISSOLVE OUT TO MEDIUM
SHOT, PAUL ROGERS

 

problems, it's been the ones that have
lacked, whether it's public assistance
programs that have had the terrible
problems through the years because of
the lack of organized constituency. I
think RMP suffered from that.

PAUL ROGERS:

I think there is building--and very
significantly--a demand for some cost
controls in the health care system
because it's just grown so
dramatically. Cost controls. I think
people generally are supportive of
doing something on access and I think
they generally demand, and will
continue to demand, quality. So lI
think that the whole effort to make
changes in our health care system is
being supported more and more. I think
it's growing very rapidly, and I think
you will see significant changes in the
delivery of health care service in this

country.
-15
00:00:29

16
00:00:19

-17
00:00:04

MORE MODERN
MEDICINE--TRAUMA UNIT,
ICU, COMPUTERIZED
INFORMATION SYSTEMS

DISSOLVE TO ANIMATION:
PHOTO OF LBJ RIGHT
FRAME, REVEAL TEXT:
"SOMEHOW,

SOME WAY,

SOME TIME,

YOU ARE GOING TO FIND
THE ANSWERS, AND I HOPE
IT WILL BE SOON."

REVEAL: JOHNSON
SIGNATURE

FADE TO BLACK.

 

NARRATOR (Voiceover):

The Regional Medical Programs
accomplished only part of what they set
out to do, and it may be that they were
simply ahead of their time. But many
of the ideas behind them have endured,
and it may be that somehow, some way,
some time, they will provide the
blueprint for the future of American

medicine.

MUSIC UP FULL.

Music up and out