HEALT H, EDUCATION DEPARTMENT OF AND WELFARE National Institutes of Health Division of Regional Medical Programs ry/ 2’ Le Mealy het yl e/ 5 ~ of . ~ tfyop fob Vak. Led te Ceece weg J i: Jat /' LO fen National Advisory Council on Regional Medical Programs Minutes of Meeting May 27-28, 1968 National Institutes of Health Conference Room 4 Building 31 DEPARTMENT OF HEALTH, EDUCATION AND WELFARE PUBLIC HEALTH SERVICE NATIONAL ADVISORY COUNCII ON REGIONAL MEDICAL PROGRAMS * Minutes of Twelfth Meeting 1/ 2/ . May 27-28, 1968 The National Advisory Council on Regional Medical Programs convened for its twelfth mecidag at 6:30 a.m. on Monday May 27, 1968, in Conference Room 4, Building 31, National Institutes.ofHealth, Bethesda, ~.Maryland. Dr. Robert Q. Marston, Acting Director ,eBivision of Regional Medical Programs, and Administrator, Health Services and Mental Health Administration, presided. The Council members present were; Dr, Edwin L, Crosby . Dr. George E. Moore (5/27 Only) Dr. Michael E. DeBakey Dr. Edmund D. Pellegrino Dr. Bruce W. Everist Dr. Alfred M. Popma ; Dr. John R. Hogness Dr. Mack I. Shanholtz (5/27 Only) Dr. James IT. Howell Mr. Curtis Treen Dr. Clark H. Millikan The Council member absent was: Dr. Helen G. Edmonds Public Health Service members attending some of the sessions included: Dr. K, Kasuga, Bureau of Health Services Mr. J.L. Pendleton, Bureau of Disease Prevention & Environmental Control National Center for Chronic Diseases Dr. E. G. Phoebus, Bureau of Health Manpower Dr. E. P. Offutt, Extramural Programs, OSG Liaison members attending: Dr. Edward W. Dempsey, NIGHS Coundil Dr. A. Earl Walker, (5/27 Only), NINDB Council Proceedings of meetings are restricted unless cleared by the Office of the Director, NIH. The restriction relates to all material submitted for discussion at the meetings, the agenda for the meetings, the supplemental material, aad all other official documents. For the record, it is noted that members absent themselves from the meeting when the Council is discussing applications: (a) from their respective institutions, or (b) in which a conflict of interest might occur. This procedure does not, of course, apply to en bloc actions-- ely chen the aretication fo umdes t-dtwidual discussion. ‘ - © Others. attending: Dr. Lionel Bernstein, Veterans Administration . Dr. N.G, Lawton, Yale Regional Medical Program Dr. Ian Mitchell, National Cancer Institute . Dr. Staniey Olson, Vanderbilt University Dr. R.L.Ringler, National Heart Institute Dr, Mathilda Soloway, National Institutes of Neurological Diseases and Blindness Prof. Dean Wilson, University of Michigan DRMP Staff: Mr. Stephan Ackerman, Associate Director for Planning and Evaluation Mr. Edward Friedlander, Associate Director for Communication and Public Information , Dr. Louis Gerber, Operations Office Mrs. Eva Handal, Committee Management Officer Mr. Charles Hilsenroth, Executive Officer Mr. Greg Lewis, Chief, Grants Management Branch Dr. Richard Manegold, Associate Director for Program Development and Research Mr. Maurice Odoroff, Assistant to the Director for Health Data Mrs. Martha Phillips, Chief, Grants Review Branch Dr. Alexander Schmidt, Chief, Continuing Education and Training Branch Dr. Margaret Sloan, Associate Director for Organizational Liaison Dr. Richard Stephenson, Associate Director for Operations Mr. Karl Yordy, Deputy Director, DRMP Miss Rhoda Abrams ,OfFice ‘of.the Asseeinto Director for Planning & Evaluation Mr. Ira Alpert, Office of the Associate Director for Operations Mr. Robert Anderson, Office of the Associate Director for Operations Miss Sheila Beach, Committee Management Office Mr. James Beattie, Grants Management Branch Dr. Thomas Bodenheimer, Office of the Associate Director for Operations Mrs. Marilyn Buell, Grants Review Branch Mr. Cleveland Chambliss, Assistant Associate Director for Operations Mr. Peter Clepper, Grants Review Branch Dr. Veronica Conley, Continuing Education and Training Branch Miss Cecelia Conrath, Continuing Education and Training Branch Mr. Arthur Curry, Grants Management Branch : Miss Judith Fleisher, Office of the Associate Director for Communications and Public Information 7 Mrs. Elizabeth Fuller, Office of the Director Mr. S. Gilmer, Office’ of. the.Associate Director for Operations Dr. David Golde, Continuing Education and Training Branch Dr. John Hamilton, Office of the Associate Director for Operations Mr. Arthur Hiatt, Office of the Associate Director for Planning& Evaluation Mr. George Hinkle, Grants Management Branch Dr. C.A. Imboden, Office of the Associate Director for Organizational Liaison . , Mr. Robert Jones, Grants Review Branch Re Phittig Vitacss MESte AF the Aeanntote Director for Onerations and Evaluation ~3- Mrs, Lorraine Kyttle, Grants Review Branch pr. J. Mark, Continuing Edycation and Training Branch Dr. H.O, Mathewson, Continuing Education and Training Branch Miss Majorie Morrill, Continuing Education and Training Branch Miss Elsa Nelson, Continuing Education and Training Branch Mr. Harold O'Mlaherty, Office of the Associate Director for Planning and Evaluation Miss Leah Resnick, Office of the Associate Director for Planning and Evaluation Mrs. Rebecca Sadin, Continuing Education and Training Branch Mrs, Jesse Salazar, Grants Review Branch Dr. Jack Schneider, Continuing Education and Training Branch Mrs. Judy Silsbee, Continuing Education and Training Branch Miss Jane Shouse, Office of the Associate Director for Planning and Evafuation Mr. Alphonse Strachocki, Office of the Associate Director for Operations Mr. Lee Teets, Grants Management Branch Mrs. Mary A. Teller, Office of the Associate Director for Planning and Evaluation Miss Charlotte Turner, Continuing Education and Training Branch Mrs. Virginia Waller, Office of the Associate Director for Operations Mr. Stephan Walsh, Office of the Associate Director for Planning and Evaluation Mrs. Anna Windsor, Financial Management Office ; I.s, CALL TO ORDER AND OPENING REMARKS It. III. Doctor Marston called the meeting to order at 8:30 AsMs ANNOUNCEMENTS Doctor Marston made general announcements about the Service Desk, and calicd attention ¢o the statements on, "Conflict of Interest," and "Confidentiality of Meetings." Mr, Curtis Treen, Director, Pension and Insurance Department, United Rubber, Cork, Linoleum, and Plastic Workers of America was welcomed as a new Council member. Doctor Pellegrino was congratulated on his new title as Vice President for the Health Sciences, Director of the Center, State University of New York, effective April 15; and Doctor DeBakey for his new titles” as Vice President for Medical Affairs, Chief Executive Officer of Baylor University, and Professor and Chairman, Department of Surgery College of Medicine, Baylor University, effective May 20. CONSIDERATION OF FUTURE MEETING DATES The Council reaffirmed the “Bga lowing dates for future meetings: Be Gy OU These meetings will be held in Conference Room 4, Building 31, beginning at 8:30 a.m. @.. VI. VII. when CONSIDERATION OF MINUTES OF FEBRUARY 1966 COUNCIL MERT ING The Council unanimously recommended approval of the Minutes of the February 26-27, 1968, meeting as written. ' LEGISIATION . we ee ee ee ee ee ee ee ee ee ole Yordy Since our last Council meeting, the House on Interstate Foreign Commerce Committee considered the Bill extending the authorization of the Regional Medical Programs. The Sub-Committee held Hearings in late March, and was chaired by Mr. Rogers of Florida, The Hearings went smoothly and well. With no significant exception, the testimony was supportive of the Regional Medical Programs’ progress to date and stronglyin favor of the extension of the legislative authority. There was some confusion because the Bill not only includes the extension of the Regional Medical Programs, but also the extension of services for Alcoholics and Narcotic Addicts, as well as a program for Migratory Workers. Regarding Regional Medical Programs, Mr. Rogers expressed concern about (1) the paucity of hospital involvement in Regional Medical Programs; (2) the relationship between Regional Medical Programs and Comprehensive Health Planning, P.L. 89-749, He indicated that he hoped these two programs might be more effectively davetailed in their administration at the Federal level. Mr. Springer, the senior Republican on the full Committee, made a brief appearance during which he recounted the budget history of Regional Medical Programs from the first administration authorization request in 1965 to the current request being made of the Congress on the extension, His point was that the funds requested by the Administration for Regional Medical Programs had been greatly in excess of the real need. His implication, that the funds currently being requested were excessive, was clear. The Sub-Committee will make recommendations to the full Committee which will then report out HR-15758. COMMENTS FROM LIAISON MEMBERS None of the liaison members had comments to make. CONSIDERATION OF GRANT APPLICATIONS NEW PLANNING GRANT APPLICATIONS Puerto Rico Regional Medical Programs Council concurred with the recommendation of Committee for approval of this application in the time and amount requested, This will round out national planning coverage. There was agreement that the Program Coordinator has outstanding ability, and that there exists a tradition mE et ° wtit pteecethen the lLoadershin. be urged to recruit an Associate Director who will devote full-time to RMP activities, Council members were aware of the unique backdrop that Puerto Rice furnishes for both P.L, 69-239 and P.L. 89-249, and regional planners are aware of this. Indeed, they believe that the two programs must work together in order to mobilize for health services. The amounts reguested are: $194,839, first year, and $194,097, second year, plus appropriate indirect costs. PLANNING SUPPLEMENTS Massachusetts, New Hampshire, and Rhode {sland Regional Medical Program (Tri-State) In discussing this application, the Council felt that it was lacking precise information as to what was desired and what could be accomplished ” from this support. Therefore, during the meeting a Council member called the Region for more information, It was learned that all previously awarded funds have been committed, and that unobligated funds for additional planning activities are not available. Among other things, the request involves a new position of Regional Coordinator for Rhode Island and the acquisition of rental space suitable for the Regional Medical Program staff, The Council, therefore, agreed that these activities were appropriate and deserved support. This supplemental planning grant application was recommended for approval in the time and amount requested of $87,824 (six months), and $123,717 for an additional year. Indirect costs were not requested. Oregon Regional Medical Program The Council noted that this is a modest supplemental planning grant request which will enable the Region to analyze data obtained from on~going studies and provide for additional secretarial support. The Council recommends approval for the time and amount requested for $34,408, first year, $16,448, second year, and $17,447, third year. Indirect costs are to be negotiated. Mississippi Regional Medical Program The Council concurred with the recommendation of the Subcommittee on Earmarked Funds that the application for a rural community hypertension control program be deferred for a site visit to clarify a number of issues, This application is to be returned to the Review Committee and National Advisory Council for final action, sure US ELSE REUL pablus Wl Bua Tea AR te SE VhG hi yg WAL beet be returned to the Review Committee and National Advisory Council for final action. o The training program in diagnosis and treatment of chronic pulmonary diseases is a well-thought-out proposal in a region badly in need of higher quality medical care. The only questions raised about this proposal were whether support should be committed for three to five years, and if the budget requested should be reduced. Since the Mississippi Region has already received earmarked funds for one activity and has one other being reviewed concurrent with this request, Council thought that the three might consgitute an operational program, Therefore, Council recommended that a site visit be made to ascertain the Region's readiness for an operational award and to resolve the issues mentioned above. ColoradoMyoming Regional Medical Program * The Earmarked Subcommittee agreed that this project for establishing a Pediatric Pulmonary Extension has merit and deserves approval. The Council endorsed this recommendation in the amount and time requested of $74,206. Maine Regicnal Medical Program © ‘ The Council agreed with the recommendation of the Review Committee that this is a reasonable supplemental planning grant request for funds to support additional staff and feasibility studies. It was suggested that Division staff investigate the possible overlap of personnel between this application and the operational application also under review at this time. The Council recommends approval for the time and in the amount requested of $163,010 for one year only. Indirect costs were not requested. Illinois Regional Medical Program * The Council concurred with the Earmarked Subcommittee's recommendation of approval in the time and amount requested to establish a hyper- tension screening program. First year funding requested $149,000, plus appropriate indirect costs. Doctor Crosby absented himself. Alabama Regional Medical Program It was pointed out that participation of the Mobile area ina Federaily sponsored program was a breakthrough and tha the emergency nature of this request, based on the need to respond quickly to ' strong local show of interest, was well justified. The Council © recommends approval in the time and amount requested of $14,509, ay Florida Regional Medical Program The Council concurred with the Earmarked Subcommittee’s recommendation of approval to establish a hypertension screening project, The amount requested is $68,000, plus appropriate indirect costs. Indiana Regional Medical Program , This application is for funds to supplement the Flanner House Multi- phasic screening program, a pilot demonstration of which is being conducted as part of the Indiana Regional Medical Programs’! planning program, The proposed activities will provide for a special summer health program for the disadvantaged urban population of Indianapolis. The Council discussed the importance of developing proposals that will aid the urban poor, and this application was viewed as an excellent example of such an endeavor. ‘ The Council recommends approval for the time and amount requested of $94,269 (one year only), plus appropriate indirect costs. New York Metropolitan Regional Medical Program The Council concurred with the Earmarked Subcomnittee’s recommendation of approval in the amount of $90,419. This project will establish a mobile coronary care unit operating out of St. Vincent's Hospital. The Council cemcurred with the Earmarked Subcommittee's recommendation of approval of the Pediatric Pulmonary Disease grant application in the time and amount requested of $206,870, plus appropriate indirect costs. Northland Regional Medical Program The Council felt that this supplemental planning grant application does not show evidence of progress nor any apparent relationship of ‘these projects to one another or to a developing regional concept. Since three of the proposed activities--all except the St. Paul Heart, Cancer, and Stroke project~-are of an operational nature, the Council agreed that the three should not be funded at this time. The Cottncil recommends approval in the amount of $55,698 for one year only with the condition that funds be granted only for the St. Paul Heart, Cancer, and Stroke proposal and after staff determines that this activity interrelates with the planning activities of the Northland Regional Medical Program.. Doctor Millikan absented himself. Ohio State Regional Medical Program Rab Wee iba Gg AI asd babe ote de a about 50 percent of the funds requested for core planning for the first year, and commitment of the requested amount for the second year; (b) a site visit by a technical team of computer specialists ~B- to clarify questions concerning the Computer-Assisted Instruction Study, with authority to determine the level of funding for the study; (c) funding of the two other feasibility studies for time * and amount requested (approximately $791,860 direct costs in the first year). Council inferred from this competing renewal planning grant application that the basis for planning the regional medical program was established this past year in the Ohio State area. A permanent Coordinator was hired, and a planning process was organized. Plans were made for the identification of information and material to guide the development of operational projects. The amounts requested are: $1,122,528, first year, and $643,930 for the . three additional years, plus appropriate indirect costs. Mr. Treen absented himself. Arizona Regional Medical Program Council recognized that this program is just beginning and that it needs to acquire a larger full-time staff, The amount approved, however, should be commensurate with realistic projections of what can be profitably obligated, It was suggested that the final approved amount car be determined by staff negotiations and does not ! require further peer group review at this time. The primary intent is to carry on a broad informational program which, hopefully, will bring about a higher degree of public support. It is difficult to be specific in reviewing the objectives and resources of the Arizona Regional Medical Program in detail, There is no leading center of excellence at the present time; there are very few identifiable qualified persons available who could lend vitally needed assistance and guidance. The Medical School is a new one and is still in the process of attracting a faculty. Planning activities for the Region are necessarily proceeding slowly and the Region is still in the preplanning phase. Council recommends approval of this supplemental planning grant application subject to downward budgetary revisions to be negotiated between the Region and DRMP staff, The amount requested is $106,813, plus appropriate indirect costs. The Council concurs with the recommendation of the Subcommittee on Earmarked Funds that the application to establish an adult pulmonary disease center should be deferred until a site visit can be arranged. Central New York State (Syracuse) Regional Medical Program The Council concurred with the recommendation of the Review Committee to approve this racuest as presented, The Council was cognizant that Sain ZOE Cit CGS ploy Qo ge ees ee GRE y LE WaS ESao Cela wale eeu _PeL Ju the additional professional staff requested in this application was well justified and supported by the findings of a recent site visit to this Region. The Council fully discussed the possible substitution of time/effort of other departmental physicians in lieu of the time/effort of the three part-time Senior Teaching Associates budgeted, It was agreed that this would be appropriate provided all applicable grantee and Division policies were adequately met. The amount requested is $138,268, pilus appropriate, indirect costs for seven months. , NEW OPERATIONAL Central New York State (Syracuse) Regional Medical Program In considering this revised application, the Council reviewed the findings of the site visit made in March. The Council noted that this application had been processed through the complete review cycle with presentations to the Review Committee on two separate occasions. On the basis of the information presented by the Committee and the site visit report, the Council moved approval as presented in the time and amount requested with the first year costs of $391,952 plus appropriate indirect costs, and restriction of expenditure of $29,255 for a mobile unit in project #2 until authorized by the Division, The amounts requested are: $285,569, first year, $391,393, second year, and $389,622, third year, plus appropriate indirect costs. California Regional Medical Program The Council addressed itself. to the basic problem of the Region-- its size and means by which it could be forged into a funct Loning and cohesvie Regional Medical Program. It appears to be separated into at least six “regions", which raises questions concerning ‘the validity of the central coordinating office. This problem is common to other regions, but clearly needs study and a statement of policy by Council. There is overlap in the projects, with no apparent coordination or screening before submission. There was feeling that the program could be improved with the strengthening of the central administrative committee, The amounts requested are: $11,052,294 (01) for five years; and $2,147,645 (0181) for five years, plus appropriate indirect costs. The Council concurred with the recommendation of the Earmarked Subcommittee of approval for a Pediatric Pulmonary Disease Center in the Irvine area, in the amount and time requested of $292,936. 4 4. wag d west ifens hypertension proposai in the San Francisco area. Lowa Regional Medical Program The Council shared the site visitors' disappointment with the progtess made in this Regien, but thought that the site visit report represented a thoughtful analysis which merits Council's acceptance, Following discussion of individual projects, the Council recommends conditional approval of $402,779 for the time and amount requested for core adminiatration and planning staff, CPR training, CCU training and Out+of-Hospital Services; reduction of award for the Stroke Center, Comprehensive Stroke Management, and Mobile CCU; no funds to be calculated in the award for tumor registry or telemetered ECG. The amounts requested are: $947,718, first year, and $5,169,059, for nine projects with one to five years support. New Mexico Regional Medical Program " In weighing the findings of the site visit, the recommendations of staff and Review Committee, Council thought the seven projects range from fairly good to fairly poor. Cowncil was in unanimous agreement that the approval of a modest operational grant would be in the best means of encouraging the region in the development of a meaningful program. Thus, for the first year of the combined operational~planning request, Council recommended $593,549 for support of the seven projects plugs an amount for core support at approximately $400,000 (based on findings of technical site visit by management staff). Concern over the Long-range operational program remains, particularly theexzg ordinary relationship and interdigitation of the NMRMP with the Schsgl of Medicine. It is further recommended that pregress reports at more than the usual intervals be requested and that a second informal, informationeseeking and hopefully stimulatory site visit be scheduled in the fall, The amgunt requested is; $768,185 first year, Future support request will be furnished by the region and will imelude a separate cgompgnent fer core activitics. The Ceupcil concurs with the recommendation of the Subcemmigsee on Earmarked Funds that the proposal to establish a demonstratien elinic fer pediatric pulmonary disease at the Lovelace Clinic has merit and shguld also be approved in the amount and time requested of $71,860. Texas Re ear rional Medical Program Couneil shared the concerns brought outby Conaittee review; the similarity of proposals with no apparent coordination; the relative roles of the Regional Advisory Group and staff in program development ; the relationships of the Coordinator in Austin and the Associate Coordinator in Galvesten and of both to the various planning offices; -LL- it is determined that @erational proposals fit into a plan. Also, Council was concerned about whether the two-year planning effort. had indicated that Texas should remain a single region or whether alternative courses were still under consideration, While the application inadequately covered these matters, Council felt that many answers would be readily available to the site visit team. Council also felt that a number of the proposed operational activities would clearly improve cooperative arrangements and result in better patient care, and should be funded as soon as possible, providing, of course, the gite visit team found the overeall regional medical program viable. Other operational propesals should undergo further review of the site visit findings by both committee and Council before funds were’ made available. The Council recommends conditional approval for the time and in an amount to be determined by a site visit team, after exploring the vias: bility and feasibility of a single regional medical program for the ° state of Texas, and to gather further information about how the proposed operational activities relate to the over-all plan and priorities for action. The amounts requested are: $2,513,785 (includes funds requested for Project #5 which was considered by the Council Subcommittee on Earmarked Funds, but not for Project 714 which has already received an earmarked award), first year and $2,328,876 second year, plus appropriate indirect costs. The Council concurs with the recommendation of the Subcommittee on Rarmarked Funds that the program for area-wide total respiratory care is a reasonable project and recommends conditional approval for the time and amount requested, The amount: recommended is $193,066, plus appropriate indirect costs. Doctor DeBakey absented himself. Maine Regional Medical Program The Council agreed that the application provides an adequate resume of planning activities but is not indicative of strong regional development. It was felt that the readiness of the Region for an operational program could be assessed during the site visit. The Council regommends conditional approval for the time requested subject to favorable findings dering a site visit, but with the stipulation that no Regional Medical Programs’ fund be granted or used fer the Physician Seminar. ($334,989 direct costs for the first year). The amount requested for a five year period is $1,440,630, plus Ape ye a So am oe ny “ ia ~ . ae er) wo] 2~ South Carolina Regional Medical Program The consensus of the Council was that this operational grant application holds merit, and that a number of the proposed activities are worthy of support. It was felt that the viability of the South Carolina Regional Medical Program as well as its capability and resources to inaugurate an operational program of significant proportion could best be assessed through the site visit mechanism, Council recommends conditional approval at a reduced level of funding subject to a Council site visit. The amount requested for a-five year period is: $5,764,380 plus appropriate indirect costs. - Georgia Regional, Medical Program It was pointed out that the application shows the efforts of . enthusiastic leadership with well-coordinated proposals and good understanding of the purposes of Regional Medical Programs. Regional viability seems well assured, Several projects need further clarification by the site visit team. The Council recommends conditional approval upon completion of a site visit with limited project funding recommendations to be © : determined by the site visitors; and with the provision that Project No. 12, Stroke Instruction Clinic, not be supported at this time. . The amount requested for a five year period is $8,638,040, plus appropriate indirect costs. * The Subcommittee on Earmarked Funds agreed that the project for establishing a pulmonary pediatric diagnostic center has merit, but it shows a lack of information concerning the methodology involved. The Council concurs with the recommendation of the Subcommittee that approval should be based upon satisfactory findings ‘of a site visit team. * The Council Subcommittee on Earmarked Funds recommended approval of this project for a Stroke Instruction Clinic pending a forth= coming site visit. The Council, however, after a lengthy discussion recommended disapproval of this project because it reflects obsolescent treatment methods and lacks any signs of significant progress or capacity for productive expansion. Memphis Regional Medical Program Council members felt that the application reflects local discussions ef local needs but that it does not show much imagination or substance. © The projects are not related together into a total program, It was aeeend hae pet Po ee em te Be en ht Ban pote, undertaken soon and that the activation of some operational projects may be an appropriate means cf stimulating more intensive regional planning and cooperation, The Region is a poor one outside the ~13- city of Memphis and is lacking in medical resources. There is evidence of growing interest in regional programs on the part of medical societies and other groups in enaller communities in the Region. The Council recommends conditignal approval, based on site visit team recommendations as to appropriate project funding levels, with report of final action to be submitted to the Review Committee. The amount requested for a five year period is $4,615,901, plus appropriate imlirect costs. The Council Subcommittee on Earmarked Funds recommended approval in the amount of $95,482 of a project fer establishment of a Stroke Intensive Care Unit, The Council concurred with the recommendation that it should be reviewed by site visitors in connection with the review of the current Memphis operational grant application. Michigan Regional Medical Program It appeared to Council that this large, disjointed application involves a heavy coumitment to administrative and planning staffs, On the other hand, regional development has made progress since the submission of the application and regional readiness for moving into more advanced planning and operational status may be greater than what the application indicates, Comments on specific projects need clarification by the site visit team. The Council recommends epproval of plenning activities in the time and amount requested, and eenditional approval of operational projects subject to satisfactory completion of a site visit with recommended funding or other action at the discretion of the site visitors. The amount requested fqr a three year period is $5,644,511, plus -appropriate indirect costs. Doctor Howell absented himself, Connecticut Regiqnal Medical Program Cquncil felt that the application was 4 remarkably lucid document that may well become a model for & comprehensive program plan, However, it cexeurred with the Review Committee that a site visit for further information was casential before adequate cangideration of the major policy queations could take place, In general, Council was favorably disposed toward Cqnnecticut's bread approach to planning, but concerned that funds were requested from P,L. 89¢239 authority for all the operational activities which the planning had yielded, Council was impressed at the apparent involvement ef the mafar health céro inetttueions and agencies and en. etree tm Aina end tet, mT oy en ing efnrertonal faroces Sete im The emounts requested aret $3,252,208, first year and $17,985,385 for four additiecnal years, plus appropriate indirect costs. OPERATLOPAL SUPPLEMENTS Tennessee Mid-South Regional Medical Programs It was pointed out that although there has been a great range of planning activities in the Reg*on, there has been a lack of Medical Society participation and that efforts to overcome this gap are implicit in the additional staffing requested in this application. The need for a large, well-qualified staff is also obvious from the size of the Region, the scope of activities now underway, and the task of further development to meet stated objectives. The Council recommends approval for the seven months requested in the amount of $382,279, plus appropriate indirect costs. Doctor Olson absented himself, Washington-Alaska Regional Medical Program The Council recommends approval as requested to expand current planning activities through the establishment of (a) a subregional office in Spokane during the current grant period and to continue through the next +03 year without additional funds; and (b) a pilot continuing education program in guest residents during the current grant period without additional funds, and to continue through the next -03 year with additional funding in the amount of $8,500. The Council concurred with the Earmarked Subcommittee's recommendation of approval for one year requested in the amount of $64,470, plus appropriate indirect costs of the project for Pediatric Pulmonary Disease. “Doctor Hogness absented himself. Oregon Regional Medical Program The Council agreed with the Review Committee's favorable analysis of the content of this operational supplemental application, and, likewise, felt that some problems should be resolved before the application is funded. Specifically mentioned were the uncertainties in the resesrch designs for project #2, Early Diagnosis and Therapy of Cerebrovascular Discase, and project #5, Project Evaluation and Education of Statewide Program. There was also concern about the administrative details in the coronary care unit training projects, #6 and #7. Since Council felt that these problems could easily be corrected, it recommended that Division staff negotiate budget items with the Region and with assistance of the NINDB in advising the Region on the design of project #2. bee 3 tay Tem te yey eames questions about research designs and administrative details in specific projects. ie be ae Ceihce A Lip wee BLE bane @156 The. amounts requested are: $443,060, first year, $387,988, second year, and $397,287, third year, Indirect costs are to be negotiated. North Carolina Regional Medical Program Council agreed with the Review Co:nmittee 's. recommendation that Project No. 12, "The Regional Coronary Care Unit," in this supplemental operational application should be returned for revision with a better, more detailed justification of the educational and training programs this unit will serve. It was also agreed that Project No, 15, the, "Comprehensive Stroke Program,'' is an ambitious project but is still essentially in the planning stages. Involvement of a wide variety of regional institutions and individuals seems to be more developed here than in most other regions. The Council recommends approval in the time and amount requested of $222,831, plus appropriate indirect costs for Project Nos. 13, 14, 15, and return for revision of Project No. 12 (Regional Coronary Care Unit for Physician and Nurse Education). The Council concurs with the Earmarked Subcommittee 's recommendation of approval in the amount of $49,411 to establish a Community Hypertension Screening Program in North Carolina. Rochester Regional Medical Program The Council recommended that the program periods for all four of the components of this application be made for three years each rather than the five years requested, It was felt that the multiphasic screening activity (project #7) could provide a vehicle for gathering data.on health manpower utikization. The Council concurs with the Review Commitcee's recommendation of approval in the amount requested for a three year program period, with the first year direct costs in the amount of $411, 284, plus appropriate indirect costs , Kansas Regional Medical Program It was the consensus of the Council that the funds requested for the renewal of the core planning activites and program administration were reasonable and well justified. The opinion was expressed that the amounts budgeted over the next five years would permit the continued orderly growth and development of the Kansas Region within the functional framework already established. The Council recommends conditional approval of this supplemental operational grant application as submitted to reflect the following actions: . fa™ ° a rb Bot yee de Bee more rey Po BR ome a ween ine try which is $855,856 plus appropriate indirect costs); . ~16=. (b) Deferral of the multiple hospital stroke program (project #13) for a site visit and return for review, and; (c) Approval of the four new continuing education activities (#14~17) in the total amount of $27,446 with indirect costs where applicable. The amounts requested are: $1,311,638, first year, and $5,959,451 for an additional five years, plus appropriate indirect costs. The Council concurs with the Earmarked Subcommittee's recommendation for approval for the two years requested with a first year budget in the amount of $203,956, plus appropriate indirect costs for a hypertension program in Kansas. The Council concurred with the recommendation of the Subcommittee on Earmarked Funds for deferral of the stroke application pending a site visit. . Missouri Regional Medical Program Council recommends approval in the time and amount requested on this supplemental operational application in concert with three other supplemental requests from the Missouri RMP (-0251, ~0252, and =0283). Council coneurrred in the site visit team and Review Committee's recommendations for approval of both projects #28, Cooperative Tumor Registry and Computation Service and #29, Northeast Missouri Cooperative Stroke Pilot Project in the time and amounts requested. The amounts requested are: $155,072, first year, $82,651, second year, and $82,651, third year, plus appropriate indirect costs. PART A-