Sa ro oe wae i te arc e & 10 il 12 e : é i4 16 17 18 19 20 25 HOOVER REPORTING CO, INC. 320 Massachusetts Avenu, NE. Wachinetan Tt anon 82 DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE HEALTH RESOURCES ADMINISTRATION THIRTY-FIRST MEETING OF THE NATIONAL ADVISORY COUNCIL ON REGIONAL MEDICAL PROGRAMS — Executive Session —_ Conference Room M Parklawn Building 3600 Fishers Lane Rockville, Marylard Tuesday, November 27, 1973 The meeting reconvened at 9:21 o'clock, a.m., Dr. Herbert Pahl, Acting Director, Regional Medical Program Service, presiding. COUNCIL MEMBERS PRESENT: MRS, AUDREY M, MARS GEORGE E, SCHREINER, M.D. MR. EDWIN C, HIROTO DR, LAWRENCE FOYE MRS, MARIEL S,. MORGAN BENJAMIN W, WATKINS, D.P.M, MR, SEWALL 0, MILLIKEN MR, C. ROBERT OGDEN 10 il 12 e ° 14 16 17 18 19 20 24 25 HOOVER REPORTING CO. INC _ 320 Massachusetts Avenue, N.E. Washinoton. D.C. 20002 Michigan Motion Vote Alabama Motion Vote Florida Motion Vote Georgia Motion Vote Illinois Motion Vote Indiana Vote Memphis Motion Vote Mississippi- Motion Vote North Carolina Motion Vote Ohio Valley Motion Vote South Carolina Motion Vote Motion CONTENTS CONSIDERATION OF APPLICATIONS: South Central Operations Branch: 83 10 11 12 e » 14 16 VW 18 19 20 @ ~ 24 20 HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, N.E. Wachinatan NC. 20007 Tegnessee Mid-South Motion Vote Wisconsin Motion Vote Western Operations Branch: California Motion Vote Mountain States Motion Vote Oregon Motion Vote Washington-A laska Motion Vote Eastern Operations Branch: Albany Motion Vote Connecticut Motion Vote Central New York Motion Motion Vote Motion Vote Greater Delaware Valley Motion Vote Maryland Motion Vote 83a Page 126 134 135 136 136 137 138 144 144 144 146 147 147 148 150 150 152 15 154 155 156 157 161 » 161 162 © 166 ee LTO L171 172 172 176 178 178 181 182 83b 1 Page 2 New York Metro 182 Motion 186 3 Vote L87 @ 4 Puerto Rico 187 Motion © 195 5 Vote 196 6 Nassau/Suffolk 197 Lakes Area 197 7 Maine L97 Rochester 197 8 Susquehanna Valley 197 Pennsylvania 197 9 Motion 197 Vote 198 10 Metro Washington, D.C. 198 11 Nassau/Suffolk 198 New Jersey 198 12 Northern New England 198 Virginia 198 @ 13 West Virginia 198 Motion 198 14 Vote 198 15 Mid-Continent Operations Branch: 16 Arkansas 199 Oklahoma 199 7 Bi-State 199 Iowa at 199 18 Nebraska 199 New Mexico 0d 199 19 Missouri Ke / a 200 North Dakota 200 20 {1 Texas £00 Motion 203 91 Vote 204 gg |] 0. Intermountain 205 @ Motion 223 23 Amendment 227 Vote 231 94 . Motion 231 25 HOOVER REPORTING CO. INC. 320 Massachusetts Avenue, N.E. Washington, D.C. 20002 10 ll 12 e = i4 16 “417 18 19 20 bo — 25 HOOVER REPORTING CO, INC. 320 Massachusetts Avenus, NE. Washington, D.C. 20002 84 PROCEEDINGS DR. PAHL: May we now start our executive session. Judy, will you continue on, please, MRS, SILSBEE: We have five members of Council here, We hope to be able to move this along a Little faster this mornig, except for one branch operations. MRS. MARS: Mr. Hiroto will be back in a second. MRS, SILSBEE: In order not to give an impression that all regions that we are considering today are problem regions, we would like to shift back to kind of our initial plan yesterday. We promised to do this rapidly. But to go through by branch to get a quick overview of all of the region and then to suggest kind of special recommendations in the cas of one or two regions, and actions in terms of others. Mr. Van Winkle will go through quickly the regions that remain in South Central and at any point that Council wants to discuss the region further, please break in. Be- cause we don't want this to be a recitation on our part. On the other hand, we know that you were oniy look- ing at a piece of the region and staff does have more overall view, Limited as it may be in cases, Mr. Van Winkle. MB, VAN WINKLE: I think I would like to start with Michigan if I might. This was a region that had been sliding very rapidly Cy 6 ow] 10 11 12 13 id 16 17 18 19 20 21 25 HOOVER REPORTING CO, INC. 320 Massachusetts Avenu>, NE. Washington, D.C. 20002 85 downhill until they obtained a new coordinator, Dr. Tupper, and in a very short space of time he turned this region totally around and I thought they submitted an excellent application. I was quite impressed with the fact that their request does not include any indirect costs, either in pro- ject activities or the program staff component. The direct costs will not be awarded to the project activities so that th could maximize the benefit to the Michigan Health Care System, MRS. SILSBEE: You mean indirect? MR. VAN WINKLE: Yes. The project agreed to absorb these, Their review process is a model. I think other regions could well take a look at it. I think I should point out whereas Dr. Tupper is on only for @:percentage of his time, he did obtain a. deputy whom he has now named as program coordinator. His title has been changed, Tupper's title has been changed to Executive Director. And he is giving 25 percent of his time in that eapacity. Michigan does have a kidney component and they will be alerted to the provision in the interim rules and regula- tions, They have requested $627,536 for the support of the program staff component, 16 new operational activities all designed to implement the RMP's priorities and options. cy on a | 10 jl 12 13 14 16 17 18 id 20 25 HOOVER REPORTING CO., INC. 320 Massachusetts Avenu2, N.E. Washineton. D.C. 20002 86 We would recommend approval of this applications stated, - Pte scene nena sin een sn mans MRS, SILSBEE: Mrs. Morgan. MRS, MORGAN: I have Michigan and I have read it over. I think it is an excellent program. I do not believe their kidney program is new, though} Isn't it a continuation of an already approved program? MRS. SILSBEE: Well, approved by RMPS,:may not be approved by the Social Security. MRS. MORGAN: By Social Security. MRS, SILSBEE: We are going to flag-- MR. VAN WINKLE: That is the only reason we are doing this. MRS, MORGAN: Because they have had it prior to this whether it is an additional thing is something else maybe, An excellent program I feel with coverage, with the limitations that were placed upon them as far as Submitted and I move iia we grant the prehigan program as requested. Soonaen¢ekasyadencin mice Saat MRS, SILSBEE;: There Ls “just ¢ one-- MR, VAN WINKLE: I left out the staff did-- MRS, SILSBEE: Yes, one item. There is a request for stipends in one of the projects, which policy does not per- reenter GMT SN ACE nate an epi tn NEON PENNE Aca EMI Nay inant mit. So- if we could amend that motions MRS, MORGAN: Which one is that? MRS, SILSBEE: Project 74, ~} 10 11 12 13 14 16 1? 18 19 20 21 he N th WS = 25 HOOVER REPORTING CO, INC. 320 Massachusetts Avenu3, NE. Washington, 0.C. 20002 87 MR. VAN WINKLE: These $2,000 worth of training sti pends, We had recommended they be deleted. I passed right over it. MRS, MORGAN: Oh. Okay. I move as | amended. 7 MRS, SILSBEE: So this vould m mean that Michigan would be recommended for $627,536 with a "no' on the stipend, DR, WATKINS: Second, MRS, SILSBEE: Any discussion? All in favor? (Chorus of "ayes,") MRS. SILSBEE: Opposed? (No response, ) MRS, SILSBEE: That was the only one you really Singled out? MR. VAN WINKLE: That's right. MRS, SILSBEE: How do you want to handle the rest? MRS, MORGAN: That was due to just the stipends? MR, VAN WINKLE: Take them individually? MRS, SILSBEE: If you can do it quickly. How does Council feel? We feel that these regions have come in with these applications and there needs to be a little bit of discussion. We know your time is short. But, on the other hand, we will lose the picture of all the regional medical programs if we concentrate only on the problems, 88 1 MRS. MARS: I think they should be discussed, each one 9 taken individually. 3 MRS, MORGAN: This is the ofly one out of the @ 4 group that I had. @ 5 MR. VAN WINKLE: Want to discuss them all? 6 MRS, SILSBEE: Yes, 7 MR. VAN WINKLE: Start with Alabama, then, if I : ee 8 might. We will take them in order. 9 Alabama had lost some staff during the phaseout. They io|| have hired a new coordinator to replace Dr. Packard, Dr. Fl Clapper from the university school there, “42 Dr. Packard has remained available for consultation @ ” at any time that they need him, So has their evaluator and “14 planner, Mr. Hinkley, and so has their nurse consultant, who 15 is just over the hill at a small school there. 16 They also are covering their staffing situation on wi & consultant basis, 18 We have no difficulties at all with this region, We 19 think they are right on target, | 20 They have requested $410,312 to support a program staff component four discreet program activites and fifteen b operational activities. We recommend approval of the applica- seiguieriseen anita tion as submitted. 23 oA MR. MILLIKEN: So move. 7 MR. OGDEN: Second. HOOVER REPORTING CO., INC. 320 Massachusetts Avenu, N.E. Washington. D.C. 20002 on 10 11 12 e =: i4 16 17 18 19 20 25 HOOVER REPORTING CO, INC. | 320. Massachusetts Avenu>, N.E. Washington, D.C. 20002 89 MRS, MORGAN: I will second it. MRS, SILSBEE: Any discussion? Dr. Foye or Mr. Milliken? All in favor? (Chorus of "ayes.") MRS. SILSBEE: Opposed? (No response. ) MRS, SILSBEE: Carried. DR, FOYE: Margaret Clapper is like a cork. They stick her in whatever dike is leaking at the moment. MRS, SILSBEE: She has been on the periphery of this activity for a long time, various activities. MR, VAN WINKLE: Florida. Staff was impressed with the excellence of the total application submitted by the Florida RMP, This staff has re- mained in tact, They have continued their program. This is a region that has always moved ahead with new initiatives, oftentimes in advance of priorities being set here at the national level, We just think this is an excellent program, program staff component and 20 operational activities, all of which conform to the RMPS priorities and options. They do have a kidney component that we intend to alert the region again as to the interim rules and regulations 90 1 MRS, MORGAN: They have two, don't they? 2 MR, VAN WINKLE: Yes, they do. Yes. 3 We will see thatthat alert goes in and we do recom- @ 4 mend approval of this application as Submitted. ae @ 5 ee ‘MRS, SILSBER: Mrs, Mars, did you have any comment? 6 MRS, MARS: One thing in reading it through, there i doesn't seem to be much being done for the large Indian popu- 8 lation of Florida, This I wondered about, 9 Could you tell me just what they are doing in that 10 Line? 11 MR. VAN WINKLE: Nothing that I am aware of, 12 MRS, MARS: That is what I could not find.. @ 13 MR, VAN WINKLE: They are addressing the migrant health 14 issue. 15 MRS. MARS: Yes. 16 MR, VAN WINKLE: This has been a priority area with 17|, them, 18 I will tell you, as far as the Indian health 4s con- i9|} cerned, that is still being addressed through the-- what is it+- 29091} Indian Health Service downstairs. 21 Also in the Migrant Health Service they had a great 99, deal of difficulty getting into this; Migrant Health people not 93 || Wanting RMPS involved in what they had set out as their area of o4 || endeavor. So he has had to move slowly in some of these areas 95 not because of a lack of desire, but because of problems in-- HOOVER REPORTING CO, INC. |. 320 Massachusetts Avenu3, N.E. Washineton. D.C. 20002 10 11 12 13 i4 16 V7 18 19 20 25 HOOVER REPORTING CO. INC. 320 Massachusetts Avenus, NE. Washington, D.C. 20002 91 MRS, MARS: There just doesn't seem to be any contac at all, and I think this is something that should be recom- mended, MR, VAN WINKIE: All right. MRS, MARS: To that particular RMP, One of the things that I thought was very admirable i the fact that for every RMP dollar that has been invested, mor than $5 in local support has been generated, I thought that was a very outstanding statement. The transplant kidney system is certainly very fine. And I think the workshops they have conducted in qua ity care maintenance have been excellent, They certainly are continuing education in both hear stroke-cancer and dental health services. So really I think it is a very good program and L certainty n move that it be fund Popeecsiio sor ed as > apptied for. ‘DR. “FOWE: _Becond. MRS, SILSBEE: Motion ue _the Florida should be use approved as requested, $627,536, with | a word. ‘to them about the kidney project. MRS. MARS: Indians. MRS, PARKS: There is an error; it should be bee: pipers ERC Bee lone nn et el Pe ebiie ae ein ee ei tae pins hi Prater ce um MRS, SILSBEE: $683,048? eT oO 10 1] |: 12 e = 14 ]} 16 17 18 19 20 21 25 HOGVER REPORTING CO, INC. 320 Massachusetts Avenu>, NE. Washington, 0.0, 20002 92 MRS, PARKS: Right. Sorry. It is an error. MRS, MORGAN: $683,040 it says here on the yellow sheet. MR, OGDEN: $683,040. MRS, PARKS: Judy read another figure. I thought I would correct it for the record. DR. FOYE: Part of the program, I have been urging to give some thought to the Indian population, MR. VAN WINKLE: Yes, I have that, To digress just a moment, Michigan came up with petter than 90 percent of pickup on their activities. Georgia-- MRS, SILSBEE: Excuse me, we have to have a vote on it. MR, HIROTO: Question. MRS, SILSBEE: Ail in favor? (Chorus of "ayes.") MRS. SILSBEE: Opposed? (No response. ) MRS, SILSBEE: Motion | As carried, ya EN a AH Atee Georgia, Mit sypy sii MR. VAN WINKLE: I wiil begin to sound like a broker record on these regions; they are quite good, Speaking of Georgia, excellent coordinator, exce l- lent staff. Again a program that responds to new initiatives. 10 ll 12 e : 14 16 17 18 19 20 bho ont 25 HOOVER REPORTING CO, INC. 320 Massachusetts Avenu, NE. Washington, D.C. 20002 93 This is another region that is not giving indirect costs to their applicant agencies; they are usirgthe full amount of money to extend their operations as far as they ean for the state, They also have two kidney components. MRS. MORGAN: Correct, MR. VAN WINKLE: We intend to flag that also in terms of alerting the region, They have requested $779,592 to support a progran staff component in five operational activities involving insti tutions. I might point out that five operational activities i all you see here. Georgia's program has many more than that that were instituted under the October 1 moneys and any ete PANT THRE minuto HE ECR een can tote earryovers they may have had, and we go recomme nd approva L of this application as it is submitted, a MRS, MORGAN: I think the nice thing about these, als in the material I received, Emory University and so many of the other universities are able to pick these programs up a continue them should RMPS drop out of business. They are pre- pared to pick up many of these programs. I move | wage the Georgia region be awarded the full MRS, SILSBEE: Is there a second? DR, WATKINS : Second. AO te EE MR a png, gppmitins et TO Pe uemeeey ot 10 jl 12 e i4 16 17 18 19 20 ho —_ 25 HOOVER REPORTING CO, INC. | 320 Massachusetts Avenu, N.E. Washington, D.C. 20002 94 MRS, SILSBEE: The motion has been made Georgia Reglon- al Medical Program application be approved as submitted, $779,592, with the kidney proviso. MRS, MORGAN: With the kidney flagged. MRS, SILSBEE: Any discussion? All in favor? (Chorus of "“ayes,") MRS. SILSBEE: Opposed? (No response, ) MRS, SILSBEE: Illinois. — MR, VAN WINKLE: Illinois is another excellent region. They are covering an area with very large population and many problems. In the phaseout they had Lost quite a number of staff. They are in the process of regaining some of those, We feel that they have the key staff necessary to carry this program forward, The coordinator had planned to leave, but as we got notice of new life, he decided to stay with the program, and we feel that they are moving forward as they should. They did, the RAG delegated authority to the execu- tive committee of the RAG to act for them last summer, and they did present an accounting of discharge of those responsibilities and received full endorsement from the RAG on the actions they had taken. 6 ~? 10 11 da i4 16 17 18 19 20 nh por 25 HOOVER REPORTING CO, INC. 320 Massachusetts Avenu2, N.E. Washington, D.€. 20002 SON Cal OOS 95 They have requested $806,142, aay There is a kidney component in there, frozen blood program, We still feel this is an expansion and would have to bealerted as to the interim regulations, Their new proposals are predominantly in the area of VMS, hypertension, quality assurance, They are going in to engage in a staff contract type of activity in areas of problem oriented medical record assis- tance and planning methodology assistance to health planning councils, CHP B agencies, and we do recommend their request be approved. MRS, SILSBEE: Mr, Ogden, MR, OGDEN: Yes. Dr. Credit has always been one of our most innovative and reliable directors, In my opinion this funding application represents an excellent continuation of his efforts, Frankly, the extension of the program in southem Illinois is welcome and I think it removes some of the previou concern this Council has had about the turf problem of I1linoi and neighbors, The proposal includes development of a statewide frozen blood program which would be available to a select group of users, particularly kidney patients. Also includes continuation of computerized hypertension programs, I assume both of those will need approval under Social Securit kidney regulations. J 10 ‘li 12 13 i4 16 17 18 19 20 ai 25 HOOVER REPORTING CO, INC. 320 Massachusetts Avenu2, N.E. Washington. D.C, 20002 96 The balance of the proposalas I read it continues in novative activities we have approved before, this Council, in earlier applications, I would recommend that this program continue and be oct jn NEL AE a seu OOM macnn’ nasa: PRE eccyesn twat, oe 1s funded. jeeigingere fie aon I would, however, suggest that the staff does need strengthening and that our staff here should visit with them about the necessity of adding personnel to be able to accom- plish what they indicated they wanted to do. MRS, SILSBEE: Is there a second? DR, FOYE: Could I ask, what is the Mid~Southside Hypertension Registry Project? It has $100,000 in this budget. MRS, SILSBEE: Mrs. Kyttle. MRS, KYTTLE: It is an activity that has been on- going in this region I believe under Dr, Williams far some- time, and it is nearing completion. This is their last effort It covers an area that is coterminus with the CHPB set aside area;that is a:rough,°-tough area of Chicago, they used as a testing ground for certain knowns and unknowns and screening for hypertension and.developed a registry from it. Hopefully they have made tentative agreements with some of the hospitals in the area to build a base from that so that paramedical personnel can treat the people on this @ © 10 il 12 e * id 16 li 18 19 20 N — 24 25 HOOVER REPORTING CO, INC. 320 Massachusetts Avenu>, NE. Washington, D.C. 20002 97 registry and put into this registry the treatment rendered under it. DR, FOYE: I see, MR. OGDEN: I believe also encompassed with that was the intention of continuation of this program under the auspices of the hospital, they would pick it up. DR, FOYE: Yes. MR. OGDEN: This is what it was for, DR, FOYE: Another reason I was asking, general history of most registry attempts has been total nonproduc- tiveness. It is always a very exciting thing to set up a new registry. And there are cancer registries all over the world that do nothing. MRS, SILSBEE: Sounds a Little more-- DR, FOYE: This is tied in withtherapy, guidance, help. MRS, SILSBEE: The motion has been made, I haven't heard a second. MRS, SILSBEE:; Okay, that the Illinois Regional Medi cal Program should be approved, application should be approved at $806,142 with the kidney condition, and the recommendation that staff follow up with the RMP regarding strengthening of their staff there. | MR. MILLIKEN: Question, ~ 10 ll 12 e » i4 16 17 18 19 20 bo nt 25 HOOVER REPORTING CO, INC. — 320 Massachusetts Avenu>, NE. Washington, 0.C. 20002 98 MRS, SILSBEE: All in favor? (Chorus of "ayes.") MRS, SILSBEE: Opposed? (No response, ) MRS, SILSBEE: Motion is carried, Next, MR. VAN WINKLE: Indiana. ee We feel this region has come a long way during the past year, As you know, Council had some problems that they had expressed, or some difficulties with this region, We feel that they have addressed those. They have certainly straightened up their entire review process to where we feel we can certify them. We do intend to site visit this region, to follow the process through to see how it is working. They have redone their bylaws to bring them in accord with the RMPS policy statement on that, The region has worked on an EMS bill for introduction by the Governor in the upcoming session of the Legislature, And the Indiana RMP, which served as a coordinating agency, brought some 20 groups together to develop this legislation end we feel they are to be lauded for this endeavor, They also developed the State Renal Committee, Btatewide plan for renal control, and through the efforts of the staff, State Legislature appropriated haif a million dollars annually for the support of transplant and chronic dialysis, 10 il 12 13 i4 16 17 18 19 20 25 HOOVER REPORTING CO, INC. 320 Massachusetts Avenu, NLE. Washington, D.C. 20002 99 They have strengthened the relationship between the health planning and the health program implementation func- tions in the region, We think that they have strengthened the relationship through the RAG with the health care organization in the state. In all, this program has turned around and is addressing what we feel are some of the real problems in the State of Indiana and they are getting out of Marion County. They are moving out into the state and addressing some of the problems other than just in Indianapolis. Dr. Beering, the coordinator, is 33 percent time on the program, Heis, however, actively involved in the management and development of the total program. He has hired a fulbtime program director, executive director they call him, who is a full-time employee. The present one is leaving the program on December 1 and is being replaced by another member of the staff, Dr. Geor Leamnson, who is now serving as director of the Indiana RMP Co munity Relations Division. We have talked with Dr, Beering and he has indicated to us that he intends to replace Mr, Leamnson, or to hire a man to replace him, but that that position will.not remain vacant. The state has, or the RMP has requested $304,113 for program staff and three activities. They do have a kidney ir pe ne ~ 10 11 12 16 17 18 19 20 21 25 HOOVER REPORTING CO, INC. 320 Massachusetts Avenu3, NLE. Washington. D.C. 20002 100 component in here that we feel should be flagged in terms of alerting them to the interim regulations, And we do recom- aire ee otter yanneneneniniennnti st mend approval of this application as it is submitted. DR, WATKINS: Iso move, penne ne MRS, SILSBEE: Mrs. Mars. MRS, MARS: Yes. MRS, SILSBEE: Or Dr. Watkins, MRS. MARS: I have a few comments to make about it. I am not questioning the priorities d@the program, but it just seems to me the question is really whether or not adequate funds have been requested, or can be allocated to do an ade- quate implementation of these programs. There just isn't enough time to do site visits that might be required and to do really an efficient administration jou of some of these proposed programs, especially the emergency medical service one, because if a state does help with that, take over, that will certainly help that program But it isn't -- besides the money factor, it is the time- frame work, It just seems'to me in re€ding through the pro- gram, there just isn't time enough for completionof any of these programs, and whether or not they are programs which will be picked up and carried on if RMP does go down the drain is very questionable. So this is my only concern and my comment about it. They are spending a lot of money on a hypertension on 10 11 12 e » i4 18 19 20 e- * 25 HOOVER REPORTING CO.{NC. 320 Massachusetts Avent, NE. Washington, D.C. 20002 LOL program which I don't think really is a significant health need in that area, I would rather see it put into some of the state- wide projects and it is just-- this is my criticism, Can you answer that for me? Just how do you feel about it? MR, VAN WINKLE: I don't think that we addressed that, Mrs. Mars, in terms of project review per se, We looked at these in terms of whether or not they were within the guidelines, the options. MRS. MARS: I say I didn't question the priorities. MR, VAN WINKLE: We are pleased that the region is moving out of Indianapolis in some fashion, which they had never done in the past. Mostof their activities were totally concentrated there, Could I get Mr. Torbert to come to the microphone? MRS, SILSBEE: Dr. Watkins may have some other comments. DR. WATKINS: I endorse the recommendation SCOB, At the same time, I think that they have a more visible and more people project than many of the others, not like the peripheral program, which I call peripheral, Like the PSRO's and CHP's, So I really gave this a strong endorsement for that fact. MR, VAN WINKLE: I would Like to add one thing if I HOOVER REPORTING CO, INC. |. an 6 = 10 jl 12 13 14 1G 17 18 19 20 25 320 Massachusetts Avenu3, NLE. Washingten, D.C. 20002 102 might. Dr. Ron Brand, who at one time was Assistant Secretary of DHEW, heads up -- what is it ~- experimental heaith care delivery system in Marion County, Indiana. Dr, Brand has become intimately involved with the Indiana RMP and is chairman of their committee, who reviews ail of their work and prioritizes it and brings it before their RAG for consideration. We think this is a real step forward in the Indiana RMP. Prior to this year, there was absolutely no contact between these two agencies. MRS, SILSBEE: Any further discussion? There was a motion. MRS. MARS: I think you were going to ask Mr, Torbert a question. MR, VAN WINKLE: I wanted to ask if Mr. Torbert had anything to add on the hypertension, Do you know? MR, TORBERT: I don't know. MR. VAN WINKLE: I am afraid I can't speak to it further. MRS, SILSBEE: That was in the October award, not of this particular application that is already in operation. MRS, MARS: No, but the other, apart from that, is I said the rest of the orogramming, I just don't see the time or adequate funding really to make these strong programs, to =) 10 11 12 e = 18 19 20 25 HOOVER REPORTING CO, INC. |. 320 Massachusetts Avenu2, N.E. Washington, 0.0. 20002 103 bring them to a completion. MRS, MORGAN: Aren't they getting money, though, from the state government? They could continue on? MRS, SILSBEE: That is true, in the EMS area, MRS. MARS: That is what I am asking. MR, VAN WINKLE: And certainly kidney. MRS, MORGAN: Yes, Half a million dollars from the state government in kidney, and theyalready have an EMS bill before the legislature which may continue most of these programs in other funding. I second the recommendation they be granted. nants senna nena NNN MRS, SILSBEE: The motion has been made and seconded that the Indiana Regional Medical Program be approved at $304,113, with the kidney proviso. MR, MILLIKEN: I think Council should recommend that the staff give very close attention to this program in ‘terms of the factors Mrs. Mars brought up. So we are indeed on record as being concerned. And if there is early indication of this program developing this, we should take this u again at the next meeting or whatever meeting. MRS, SILSBEE: Then the motion has shone amended to approve the application at $304,113, With the k kidney “proviso, - and with the advice to staff that they follow this region and monitor the region with regard to concerns about adequate pickup from the region and adequate followup of the proposals 6 ot 10 il 12 e « id 16 17 18 19 20 bo set 20 HOOVER REPORTING CO, INC. |. 320 Massachusetts Avenu 3, NE. Washington, D.C. 20002 104 contained and to report to the Council at its next meeting. MR. MILLIKEN: Right. MRS, MARS: I second the motion. MRS, SILSBEE: Is there any further discussion? MRS. MARS: I second the amendment I should have ssi: te aust goin EP ates sca, se serge sya kanes eM EEE Sie ATMS ANTS epecersiaita said. DR. WATKINS: I accept the amendment. MRS, MARS: I accept the amendment. MR, MILLIKEN: Question. MRS. SILSBEE: A1L1L1 in favor? (Chorus of "ayes.") MRS, SILSBEE: Opposed? (No response. ) MRS, SILSBEE: Indiana application has been approved, FIER tng cerstin Memphis: MR, VAN WINKLE: Did I skip that one? Memphis. This region we think is a very strong, viable region, They have retained very strong staff complement. They still ha 19 full-time employees. This is a region that even during phas out, remained totally optimistic in moving ahead at all times. I don't think that they were ever of the belief that they were going to phase out. And their activities so indicated. They roughly are in this application, they are de- voting about 33 percent of their moneys to local planning, about 10 percent quality assurance, 19 percent EMS, about rougt ve e— LLy 6 10 il 12 14 16 1? 18 19 20 BR ~ 20 HOOVER REPORTING CO, INC. 320 Massachusetts Avenu3, N.E. Wachinatan NC INN? 105 10 percent in kidney, 6 percent in hypertension, 32 percent in other. They have been highly successful in generating monitoring and evaluating their activities and they have devel- oped an excellent profile locally as a broker for health inter est in that entire area, The experimental delivery system contract awarded to Health Systems Management, Incorporated, had very heavy RMP staff input into the application itself and into the future implementation of the program. We had indicated earlier to Council that there was somewhat of a turf problem here, We think that Emphis has addressed this. | They have developed a very close working re lattonshig with the State of Mississippi, the Mississippi RMP, and have invited both Mississippi and Arkansas to attend all of their RAG meetings and have full input into the proceedings. | ‘They have requested $494,788, We recommend that th phere ARENT ee NC aR een ue ect application be approved OER PETITES a: a RI Smet, There is a small contract in this, in the kidney di- sease area, and here again we intend to alert the region as to the interim regulations. MRS, SILSBEE: Mr. Hiroto, do you have any comment? MR, HIROTO: Yes, I only have a question. Was there not at one time a guideline relative to screening as being something this Council might discontinue? 7 MRS, SILSBEE: Sorry, guideline? ° MR, HIROTO: Multiphasic screening. ® 4 MRS, SILSBEE; Multiphasic screening? © 7 The Council did have a policy at one point of not initiating any new ones, but as I recall, this one was in place, 8 MR, VAN WINKLE: Not only that, but the moneys to bé utilized here, Mr.Hiroto, are for evaluation. i MR. HIROTO: Evaluation, iW MR, VAN WINKLE: They hate to Lose all efforts that 12) have gone into this. This is for the evaulation, windup © 13 evaluation, i4 DR. SCHREINER: What are they going to do with this? 15 MR, VANWINKLE: What they are doing in northern 16 Mississippi is lending assistance to the creation of a kidney Wi foundation, if you will, that will pull together all of the 18 administrative aspects of that program that is being developed 1s there. 20 It will have input, Dr. Schreiner, both from the 21 Mississippi program and from the Memphis program, 22 Dr. John Bower is in the process of developing a satel 23 lite unit in that area and this will be the administrative unit 24 that administers that total program there. 25 It is a small amount of money. I know that Dr, Bower HOOVER REPORTING CO, INC. 320: Massachusetts Avenu3, N.E. Wacshinstan DC. 79007 10 11 12 13° 18 is 20 25 HOOVER REPORTING CO, INC. 320 Massachusetts Avenu>, NLE. Wachinstan AC IANA? 107 had requested that Memphis furnish him with a trailer and they didn't buy that, instead put it into the development of this organization that would administer the program. So I gather the trailer would probably be bought with local donations, DR, SCHREINER: It strikes me as being kind of token less to spend this, kidney area, 33 percent of the planning. Technically they are in the last year of their thing; they ought to be pushing some stuff in the program, MRS, SILSBEE: Mrs. Kyttle. MRS, KYTTLE: It is time to stop planning and start doing. That ought to be the message. MR, VAN WINKLE: I think that program in Mississippi ‘ought to get:off the ground even if Memphis didn't put any ‘dollars into it. I think as much as anything, this is their effort in the collaboration with the Mississippi program, MRS, SILSBEE: The Mississippi portion of the pro- gram has been funded well in the past few years, renal . for the last ten years, I don't believe that Memphis has even in the past put much effort into the renal area, I am not aware of any dollars in the. past. Loraine, could you speak to that? MRS, KYTTLE: Shortly before I had this regional =) T 10 11 12 13 id 16 17 18 19 20 20 HOOVER REPORTING CO, INC. 320 Massachusetts Avenu3, NE. Washinotan..0.C. 20002 108 assignment, I noticed in reading back into it Memphis sub- mitted a rather ambitious renat. program to RMP, It got shot down, They have never recovered, MR, VAN WINKLE: Yes, MRS, KYTTLE: This, Dr, Schreiner, is a response to a request from the budding northern Mississippi Kidney Foundation, to help them with the tubulo operation, and they asked for assisance with the director's salary, and that is what that represents, the director's salary in tubulo to fortify Bowers' satellite there. DR. SCHREINER: Yes. What I am saying is I think that is @ very, very much needed --~ it is a real poverty area with very little going on. It seems to me it is kind of a small pebble in a big pond. They ought to be doing more of it. MRS. MORGAN: Maybe Mississippi is taking it up. MR. HIROTO: I move to approves MR. 2. MILLIKEN: Second. — MRS. SILSBEE : Motion has been made Shat aca Heaphis application should be approved at the requested level of oT $494,788; with the even small kidney portion being flagged with regard to the Social Security regulation. MRS. MORGAN: Could we add to that if more moneys become available, that they may look towards helping more in this area? “1 10 11 12 e » i4 16 17 18 19 20 nN neat 2A 25 HOOVER REPORTING CO, INC. 320 Massachusetts Avenu>, N.E. Washington. D.C. 20002 staff to give a better Picture has ne setaney. programm ng 109 MRS, SILSBEE: With advice to the region that they consider greater programming in the kidney area, MRS, MORGAN: Right. I think so. MRS. SILSBEE: Mrs. Kyttle. MRS, KYTTLE: The local Regional Advisory Group gets its kidney money elsewhere and does not come to us, “MRS, MORGAN: Doesn't need it. This is fine. MRS. SILSBEE; Maybe we could amend that, MRS. KYTTIE: That would be a difficult amendment for them to work with, MRS. MORGAN: Well, it wasn't seconded. MRS, SILSBEE: Do you want to withdraw it? MRS, MORGAN: I will withdraw my amendment . MRS, SILSBEE: We will ae it with advice to Papen mein ete EEE Hd te ao ty Pare that is Ocourr tne in bhe region for Gounett next Eime. 7 ernie tieasrtesl Te ee ee DR, “SCHREINER: They get the direct program, they are the biggest state with vocational rehabilitation, but private kidney foundation matches it. They get $4 for every dollar they raise, which is a very effective program, However, it seems to me that, you know, that is patient care money, and this is what I am trying to develop is that where such possibilities exist, that is where the RMP ought to be very, very aggressive to get up the facllities, They have been doing that for four years; for 6 ~~} 10 11 12 13 i4 16 17 18 19 20 24 25 HOOVER REPORTING CO. INC. 320: Massachusetts Avenu2, N.E. Washington. B.C. 20002 110 example, and question could be asked as to why wasn't, you know -- if all it took to utilize vocational rehabilitati« money was to get a truck or store front or part of a manager's salary, that is precisely where our RMP ought to be aggressive where the other part is already being taken care of, In other words, how to put the small tap into the big well, that should be the secret of RMP, The fact that they are getting money elsewhere for patient care is not an argument to me that RMP shouldn't be in there; it is the argument why RMP should be in there full fledged. MR, MILLIKEN: I think your suggestion would be adequate for now, staff come back to this Council with more information, MRS, SILSBEE: Okay. MRS. MORGAN: I think it was moved and seconded. I withdrew my amendment, MRS, SILSBEE: A1l in favor? (Chorus of "ayes.") MRS. SILSBEE: Opposed? (No response, ) MRS, SILSBEE;: Next application is from Michigan -- I am sorry, from Mississippi. Ralaluiteleio ti MR, VAN WINKLE : Mississippi. This region has re- Satine Homo apes gE STE tained its key staff. They have nine professionals left that ie) . 10 ll 12 13 i4 16 V7 18 19 20 25 HOOVER REPORTING CO, INC. 320 Massachusetts Avenu2, NE. Washington, D.C. 20002 JAAR En Bee Lil represent medicine, education, plarnaing and evaluation, demography, sociology, psychology, fiscal management, and program development. They have an excellent coordinator, Their RAG has remained very active and so have their task forces, They presently have 13 contractual activities and 5 operational activities that were proposed to be ongoing through June. The 13 contracts are all new. I would Like to point out the State of Mississippi, with the few resources, economic resources that they have, they still have been able to find funding for 80 percent of their terminating activities whim I thir is commendable. | We feel that they certainly have been a change agent in the region's health care delivery system. The coordinator at the present time is involved with the Governor's office in the total health care planning for the State of Mississippi. So we feel he is getting some recognition there. And the RMP some visibility. They do have renal projects in this application. We will alert them to the provisions as we have stated before of the interim regulations. They have an excellent renal pro- gram that really is covering the entire state in a very commendable fashion, md I think this is one state say they have done as much in cost containment in renal disease as any state I am aware of, an ~] 10 11 12 13 i4 16 17 18 19 20 a1 25 HOOVER REPORTING CO., INC. 320 Massachusetts Avenu>, NE. Washington, 0.0. 20002 ile They have requested $325, 836. to Support 18 activities oe we recommend Spprova t oF “= application, VRS. “SILSBEE: Mrs. Mars, MRS. MARS: TI move Le be approved, as stated, cama aN ING ROALaN e : B Dg merit alan Wee ita, coy de alpae eet Steet eigasiiins wae HSER tte negates at oat NY but ft would | _Like to make a | few (Comments . wn rt seveeniate emai CB Pia hehe nat aes In reading through the application, they suddenly have come up with some 39, is it, newactivities, not all of which have been accepted. But it looks and sounds Like a sort of feverish and unnecessary attempt to add a show of strength to the program, I felt that many of these are of really Little permanent value as a contribution to the benefit of the health needs of Mississippi. And suddenly organizing a lot of one- day seminars and hurriedly organized workshops, and I can't find that a constructive way to create any permanent effec- tiveness, So I do think that this programming should be watched carefully and the staff should be alerted to that fact, So that they carefully examine the new activities and try to get Mississippi to eliminate some of them MR. VAN WINKLE: You are particularly referring to those that-- what is the Lady's name in Mississippi who is responsible for most of their continuing education? MRS, MARS: It iooked like just a way to spend money} So to speak and use up the fund in a panic, 6 ~l 10 ll 12 13 i4 16 17 18 19 20 21 20 HOOVER REPORTING CO,, INC. 320. Massachusetts Avenu2, N.E. Washington, DC. 20002 113 MR, VAN WINKLE: All right. Some of these activities, though, that have come in have been a result of an -- I would say a two-year buildup on the part of the Mississippi program, in getting around the state and becoming recognized. And I think some of that mo- mentum is still rolling right on forward. MRS, MARS: Yes, that may be true. There is also in the pias recommendation here a poi aces ett that maus be brought in, the region should be alerted to the meckssash cbt Sit atta provision vontained an ‘the interim rules ‘and ‘regulations | unde x science, Ronan chattS aR Bae we i ea et anaes Tole. 20, chapter 3 of ‘SSA-DHEW Regulation. 5, Part N05 5 Federal Hea Lth Insurance ‘for The Aged, This regulation per- tains to payment for services in connection with kidney transplants and renal dialysis to entitled beneficiaries. sn aah a I OE So this | is a recommenda tion being ino Luded in the ae moeton which t have moved 08 ‘acceptance, _ MRS, “BITSBER; | D. Do I hear a second? MRS, MORGAN: I second it. MRS, SILSBEE: Any discussion? All in favor of the motion? (Chorus of "ayes.") MRS, SILSBEE: Opposed? (No response. ) MRS, SILSBEE: The application is approved as re- quested and with the conditions noted. nt 10 11 12 e »: 14 16 17 18 19 20 21 22 23 24 25 HOOVER REPORTING CO, INC. 320 Massachusetts Avenu, N.E. Washington, D.C. 20002 114 MR, VAN WINKIE: North Var oLee > enreeeoar ee tenseae ree Spee Rt MRS, SILSBEE: North carolina. MR. VAN WINKLE: This region accepted the phaseout instructions very Literally, I might say, and had submitted a plan to terminate their entire program as of June 30th last, This plan was accepted and then when they got the word of the turnaround, they picked back up, they retained their key staff, and you will find that this application does request support for 11 activities, Those are continuing activities. And funding of 165 new ones. They, too, have a backlog of approved RAG projects that are sitting in the wing, so to speak, They are requesti Bac. “ARR yetom eet cree tas $586,504 to support a total of eT BebiyEbics rong hit AD ities They do have an application in ‘here for care of patients with chronic uremla, and again we have put in with our recommendation the alert as to the provision under the interim rules and regulations, This is not a new program that they have, but it is an expansion. MRS, MORGAN: Is this with dialysis or they don't really -- MR. VAN WINKLE: Yes, ma'am, it is. MRS, MORGAN: They really don't say, MR. VAN WINKLE: It is expansion of an existing program. 115 1 DR, SCHREINER: Community hospital satellite system 2 Dr, Robertson runs. -- 3 MR, VAN WINKLE: Yes, @ 4 MR. MILLIKEN: I don't see any item here for progran e 5 staff, 6 MRS, SILSBEE: This is one of the anomalies of this 7 method. December 1, the region will be submitting plan 8 for their funds that were not expended from the October award 9 and it is not program staff in that? 10 MR. VAN WINKLE: Yes, it is. 11 MR. MILLIKEN: How much will it be? 12 MR, VAN WINKLE: On their program staff? They will @ 13 pe requesting approximately $260,000 for support of program i4 staff and staff activities. 15 MRS, MORGAN: This is from unexpended funds? 1G fp MR. VAN WINKLE: Yes, matam, it is. And they took 7 total amount of this and put into operational activities, 18 MRS, SILSBEE: Mr. Ogden, did you have any comment? 19 MR,__OGDEN: Yes. My comment in reviewing the materijais 20 that have been sent to me was program really appeared to have suffered from complete phaseout plan followed by scramble to bh net 99 keep the ship afloat, with a result these projects, at Least. 93 appeared to me to lack 4 programmic adhesion. They are the spat RPDF SHE ose AEH HA, endiangeneection tes o4 || more traditional support programs we have seén before and they 95 are aimed, a great many of them, at health manpower and there HOOVER REPORTING CO, INC. | 320. Massachusetts Avenu, NE. Washington, D.C. 20002 on 10 ll 12 e : 14 16 17 18 19 20 to nm 25 HOOVER REPORTING CO, INC. |. 320: Massachusetts Avenu>, NE. Washington, D.C. 20002 are a lot @ Little ones. Nevertheless, I think there is some recognition of the EMS and PSRO needs. i hese encourage Sanne to naa them | move Bheads but I would urge this RAG renew their efforts to channel - into more meaningful substantive proposals. MRS, SILSBEE: I think that will be very helpful advice to come from Council. MR, VAN WINKLE: Yes. MRS, SILSBEE: Do we have a motion? MR, OGDEN I will | move that it be approved. passes Peace en nme MR. ae Second. Setule dL ASSL act hor tha Rte ore tee MRS SILSBEE: Motion has been made | and seconded bis gach ge ace gee ree Rs Hite nego the North Carolina application for $586, 50l be 5 approved with 't kidney condition, and advice to the region with regard to Council's concerns about the apparent lack of program co- hesion and responsibility of the RAG in regionalizing the important aspects of the program. Does that state your views? Is there any further discussion? Allin favor? (Chorus of "ayes.") MRS, SILSBEE: Opposed? (No response. ) MRS, SILSBEE: North Carolina's application is he 10 ji 12 18 18 i9 20 25 HOOVER REPORTING CO, INC. 320-Massachusetts Avenu>, N.E. Washington. B.C. 20002 117 approved, MR, VAN WINKLE: We covered Northlands yesterday. MRS. MORGAN: Yes, MRS, SILSBEE: How about Ohio Valley? MR, VAN WINKLE: Ohio Valley. This has always been one of our stand out programs under the leadership of Dr. William McBeath, As you are aware, probably, Dr, McBetth left this program to become Executive Director of the American Public Health Assocation. One of his staff, Mrs. Hebbeler, who is a former program development specialist and a member of the staff since 1969, has been appointed as Dr, McBeath 's successa This program and staff have maintained their working relationships with all the key health agencies in the region and the present staff is changed somewhat; they certainly have been reduced in number, but I know that Mrs. Hebbeler has -been recruiting and she has hired some new staff, The RAG in Ohio Valley is as active as any Tinow. They do provide the leadership for the Ohio Valley RMP, Extremely strong, extremely active. Well indoctrinated RAG people. And I think that the process that the staff has set up for indoctrination of new RAG members is one that any region could well follow. The staff feel that we need to provide them with some staff assistance in the very near future on @ continuatio Lr. an wl 10 11 12 13 i4 16 li 18 19 20 ho nw bo gD 25 HOOVER REPORTING CO.,INC. 320 Massachusetts Avenu>, NE. Washington, D.C, 20002 118 basis, particularly in the areas of fiscal management, and in the administrative management of the program. Mrs, Hebbeler is new. We feel she needs some assis- tance, and we certainly intend to provide that, They have requested SHOT, 201 for the Support of a FP esha lta oR EORE DAS ig NA Die ly santos program staff component, ‘16 operational activities. There - is a request in here for support of a kidney activity. This request, as near as we can determine, through telephone conversations, it is to be:basically utilized for region-wide followup and data system that relates to their transplant effort in the area, So here, again, we intend to alert the region as to the interim regulations, so that they are aware of this, and so can alert the applicant agency. We do Foc mmenc 1 @pprova lL of. his application as aie Submited. Bi eg “DR, SCHREINER: When they talk about regional organi sharing networks, is this to plug into an ongoing retwork or are they trying to create-- MR. VAN WINKIE: It is plugging into a total system. They are not trying to create anything new. Dr. Schreiner, you may recall that they had come in for kidney activities in the past, which had been approved by Council, and those are ongoing. I think one that was turned down that you might Cc wl 10 ll 12 13 44 16 V7 18 19 20 20 HOOVER REPORTING CO. ENC. 320 Massachusetts Avenu, NLE. Washington,.D.C. 20002 119 recall was trying to put a Belther unit in a mobile unit and haul it all around the state, and they did take advice of Council, they did get their unit but stationed it at the place where the transplant was to be effected, So far as I can re- eall, they do have a very active program in Louisville and in Cincinnati, and also there at Lexington. But it is a tri- partite effort. They are working quite effectively together. So if they don't have the duplication of effort-- DR. SCHREINER: I was wondering what they were plug- ging in in southeastern-- MR, VAN WINKLE: Erwin. And with Arkansas and otherg yes. MRS, SILSBEE: Mr, Hiroto, did you have any comment? MR, HIROTO: Only it seemed to me the program cost as compared to the total was running something like 40 percent, I was wondering if there was a reason for that or if that is considered too high? MR. VAN WINKLE: With program staff, there is still a lot of staff activities that are being carried out, operatio} al activities if you will. Are you speaking only of personnel? MR. HIROTO: It was just the numbers really, MRS, MORGAN: 185 staff, MR. VAN WINKLE: If we had a total breakout for you 1 10 11 12 e : i4 16 17 18 19 20 tw _ 20 HOOVER REPORTING CO, INC. 320 Massachusetts Avenu3, N.E. Washington. D.C. 20002 120 in terms of staff versus activities that they are supporting out of staff, you could see the difference. It is a difficulty we also have in trying to iden- tify what is listed in here as core, MR, MILLIKEN: This is also very complicated in a state program where they have to keep constant relationships with medical schools and state governments and voluntary and professional organizations in three states. MR, VAN WINKLE: And four at sometimes when they get over on the West Virginia border, MR. MILLIKENS: It absorbs a great deal of staff. MR. VAN WINKLE: They have been tremendously effec- tive, you know, in utilizing their resources of the-- what is the group, Appalachia program? DR. VAN HOEK: Regional program. MR, VAN WINKLE: Yes, quite effective in using that. They have been the starting agent, people who got the seed money in there. And Appalachia has picked up almost all of those programs without their help. MR, OGDEN: I appreciate the comments of Mr, Milliken, who,Il would remind you,is Chief of the Office of Comprehensive Health Planning, State of Ohio. I think he is more familiar with this program than the rest of us. MR, HIROTO: And I move for approyal..... ate . —— * ena uae el RRS PASEO aT 10 il 12 3 ‘14 16 17 18 19 20 21 20 HOOVER REPORTING CO. INC. 320 Massachusetts Avenu3, NE. Washington. D.C. 20002 that the Ohio Valley Regional Medical Program application be approved at the requested level of $497,201, with the kidney condition, and the advice that the management program t followed rather carefully. Wisconsin, and then have coffee, It was a bit lengthy, but if you can wade through it, I think they covered all contingencies. lel MRS. MORGAN: Second. (Laughter) MRS, SLILSBEE: Motion has. been, made. and Seconded | a Is there further discussion? MRS, MARS: Question, MRS, SILSBEE: Ail in favor? (Chorus of "ayes,") MRS, SILSBEE: Opposed? (No response. ) MRS, SILSBEE: Motion is carried. Let's do South Carolina, Tennesse¢, Mid-South and MR, VAN WINKLE: South Carolina. one he gg eet This region has presented an excellent application, MRS. MARS: I certainly do. MR, VAN WINKLE: Any questions we might raise. (Laughter ) Quite thoroughly I might add. They still have a 13-member staff with 7 professions Pe 1s an ~ 10 11 12 13 i4 16 wi 18 19 20 24 25 HOOVER REPORTING CO., INC. 320- Massachusetts Avenu+, N.E. Washington. D.C. 20002 122 out of that. It has been a very active program, They have’ an extremely active RAG, I might say that they represent a very conservative constituency. We feel that their staff down there does an out- standing job of keeping the RAG informed, and that the members of this RAG come to meetings with a level of knowledge con- cerning agenda items far above most of the counterpart regions we deal with, We do feel, however, that this traditional conserva- tism still tends to produce certain programmic confinements and I think you can see that reflected in the work that they are carrying out, | I.would point out to anyone the RAG chairman's repor in this particular application as one of-- I just think it is excellent and Iwish we could get other RAG chairmen'to. report as this one has, It is an excellent report and provided us with a great deal of information in terms of what is happening in South Carolina region. This application does have a kidney component in it. Again, we intend to alert the region as to the interim guide- Lines, or rules and regulations. I wanted to point out that 15 new activities approve 10 ll 12 13 18 19 20 21 25 HOOVER REPORTING CO, INC. 320 Massachusetts Avenu, NE. Washington, 0.C. 20002 123 by the RAG at its November meeting assigned priorities per- mitted proposed funds for only 10; 4 of these in quality of care, 2 in renal dialysis, 2 in hypertension, 1 strengthening local planning and 1 concerning EMS, In addition, this application proposes continued support ror 8 activities that were begun under the October 1 allotment. We think the geographic distribution of the activi- ties are very good, and that their sponsorship represents tlhe satisfactory spread when one considers it, MUSC is the single medical school in the state, They have very close ties with the CHPB agencies and they are requesting their full allocation of $516,510, and we would recommend approval of this application MRS, MORGAN: I have a question on this; 608 pro- gram, screening hypertension in children, and 78, uropathies and hypertension screening in children, is there an overlappin or are these in the same areas, or were they in different parts of the state? MR. VAN WINKLE: Mrs. Kyttle? MRS, KYTTLE: 608 has been traditionally called, and I don't know why it is coming up in this sheet as "screen- ing hypertension," it has traditionally been their pediatric pulmonary activity. (Laughter ) Wa 124 1 I haven't tracked that down yet. 2 MRS, MORGAN: It sounds like they have overlapping 3 programs from just looking at the green sheet. @ 4 MRS, KYTTLE: Yes, because they are both out of MUSC, But I think the misnomer is on 60 rather than 70, an 6{| I think 60 is their pediatric pulmonary and the other is 7 a different department. But they are both out of MUSC, 8 MRS, SILSBEE: Dr. Chreiner or Mrs. Mars, did you have 9 any comment? 10 DR. SCHREINER: Yes, I was very happy to see-- they 11 have some areas°~ outside of Charleston with extraordinarily 12 high instances of hypertension, I think it is good to see they @ | 138 turned some of their priorities in this direction, because the i4 patients are there, studies could-- I think their mix of pri- oritles looks pretty good to me. 16 MRS, SILSBEE: Mrs. Mars, 7 MRS, MARS: One interesting program I thought that I 18 picked up was the fact, weil it is not Rmp's but they are con- 19 tinuing with it. The governor of the state has created a og || Health Policy and Planning Council which is viewed ultimately as being the clearing house for health dollars in the state, Dr, Mosley, the coordinator, doesserve on the steer- rh od ing committee of the task forces of this, and this is certainly oA a very useful health process, 25 I really have nothing to say except that would not HOOVER REPORTING CO, INC. 320 Massachusetts Avenu3, N.E. Washington, D.C. 20002 =~] 10 1 12 13 i4 16 17 18 19 20 tt ho bo SS 25 HOOVER REPORTING CO, INC. 320: Massachusetts Avenu, NE. Washinotan. D 20007 move for its approva 125 be complimentary to it, because it is a good program. I thin they are very optimistic but~-- MR. VAN WINKLE: Yes, MRS,-MARS: But apart from that, nse I | certainiy pone ay way = Ret pee “full. fundinge.. I think the RAG possibly is a Little overzealous in its knowledge, because at times it does hinder -- seems to hinder some of the programs, MR. VAN WINKLE: Yes, we were there for one o: the RAG meetings and at five o'clock in the morning we began to think they were a little overzealous too, and it did go that Long. (Laughter ) MRS. MARS: I still don't think it is too much of a fault. MR. MILLIKEN: Second... “MRS. SILSBEE: “The mouton nas peSh made ane second- ed that the South Carolina application be approved at the requested enount of $516,510 with the kidney condition. Is there any further discussion? All in favor? (Chorus of "ayes.") MRS, SILSBEE: Opposed? (No response, ) MRS, SILSBEE: How about Tennessee? memeemianayny y 1 st 8 ng en . EP AH a9 om 10 11 12 oe = i4 16 17 18 19 20 25 HOOVER-REPORTING CO, INC. 320 Massachusetts Avenu>, N.E. Washinoton. D.C: 20002 126 Tennessee Mid-South has experienced a tremendous reduction in staff. This was a region that we have been work- ing with quite intensively over the past several years in try- ing to break them away a bit from the grantee institution, Vanderbilt. In this process, during the last year, the coordina- toy our Dr. Teschan, was-- let's say he resigned as coordina- tor and accepted another position in the grantee institution. Dr. Richard Cannon was appointed as coordinator, and at that time he came in and spent a full day with staff, weturned to Nashville and within the next 48 hours had met with his RAG and totally accomplished everything that we had been requesting in terms of revising their bylaws and having certain things affected. We were quite impressed with his performance and there is a new dean at the school, a Dr. Chapman, and he and Dr, Cannon seem to have a very effective working re lationship. We are still concerned, though, about -- perhaps a lack of financial expertise within his particular staff, Dr, Cannon is aware of this. Staff is working with him im terms of suggesting staff from other RMP's who can come in and assist them with their fiscal management. So we feel that this program does have a restruc- tured RAG as a result of the bylaw changes. They certainly will have turnover of that RAG in proper manner, They have a no } 10 11 12 e « 14 16 17 18 19 20 ND — 25 HOOVER REPORTING CO, INC. 320. Massachusetts Avenu, NE. Washington, 0.0. 20002 127 new coordinator. They have a very small staff. Arm they have a lot of funds coming. So we do have some concerns about rebuilding the central capability. But we are basing our recommendation I think on Dr, Cannon's success in the past, in meeting some very thorny issues and getting them resolved in a very short period of time. The application requests the full remaining alloca- tion of $658,912. These activities are Spread among 18 components, 13 new activities, 2 proposals, fortifying and continuing activities generated on October 1, and there is a kidney component in this application. Here, again, we will see that the region is alerted 4 to the interim regulations, We would recommend that the application be approved ore allie ES orbrerntmicer tT as petere PNRM Belo ERNST, as requested, MRS, SILSBEE: Mr. Ogden. MR. OGDEN: ves. My reaction at the moment is not PS tees Ae NR pms ANNs apeysts RSS Soot memati ates! to be overly critical of programs which “have b been “torn ‘apart wi they appear to be less cohesive in approach than previously, but I am constrained here to suggest this regional medical program would appear to need good RAG review and staff coor- dination to pull a program together, particularly in view of th fact that the coordinator is new, The emphasis on this program, as I.read the material s en 128 1 Sent to me, is on quality assurance or individual projects. 2 I am pleased to see many of them have considerable 3 impact in rural areas, Partly because of the way in which @ 4 Dr, Teschan was removedr- and I am going to use the word precilse- © 5 ly in that way-~-and the Vanderbilt influence, and also 6 because it is new, I would urge this coordinator seek the 7 advice and assistance of his experienced peers around the 8 country and I think this should be a direct suggestion to him 9 from Council. 10 Now, there are two things in this application that iW I would like to ask the Council consideration on and staff 12 consideration, because I am somewhat confused as to what we © 13 are permitted to do, i4 There is included in this proposal the purchase of 15 equipment for renal dialysis for the University of Tennessee 16 Hospital, and a proposal to establish a Georgia-Tennessee Regiion- 17 a1 Medical Communicatiors System by purchasing and installation "48 of standardized equipment in 11 hospitals, and a microwave 19 relay station. I am concerned about the propriety of buying 20 hardware and installing it in particular Locations? 21 I need advice as to whether this is still -- well, the propriety of doing this, nN Nm MRS, MARS: I thought we weren't permitted to buy hardware, 35 MR, VAN WINKLE: Certainly you can't very well HOOVER REPORTING CO, INC. 320.Massachusetts Avenu>, NE. Washington, B.C. 20002 10 11 12 13 id 16 17 18 15 20 21 23 24 25 HOOVER REPORTING CO, INC. 320 Massachusetts Avenu>, NE. Washington, D.C. 20002 129 create a new dialysis unit without providing some equipment to get it under way. This is located at the eastern part of the state. MR. OGDEN: I recognize that. MR, VAN WINKLE : Where there are no services, MR. OGDEN: Yes. Well, in a way it is similar to what we did with high voltage radiation for Anchorage, Alaska; people either died or went to Seattle if they had the money to do it. But I just raise the question about these things because I think it is something that shouldn't go by without at least being mentioned, being brought up to talk about directly. MR. VAN WINKLE: Could I ask Mr, Gardell if there is any restric tion on the purchase of such equipment? MR. GARDELL: I think we have been discouraged from doing nothing. but supplying equipment for any activity. But I am assuming here we have more: of an interest than in just putting equipment into a location or an activity. MR. OGDEN: I think this may be true with renal dialysis. Iam not really questioning that one. I am, however, concerned about this system, emergency medical communication system which seems to encompass equipment in eleven hospitals and microwave relay station. DR. SCHREINER: Television? 10 11 12 13 L4 16 17 18 19 20 21 20 HOOVER REPORTING CO, INC. 320 Massachusetts Avenu3, NE. Washington. D.C. 20002 130 MR. OGDEN: Radio. Emergency ambulance call and so forth. Perhaps staff personnel who can follow this rexion, give us some advice as to what this is all about and some guidance as to what we can do. MRS, SILSBEE;: Was Tennessee Mid-South one of the regions visited on EMS projects this summer? MR, POSTA: Not EMS, MRS. SILSBEE: Mrs, Kyttle? MRS, KYTTLE: The State of Tennessee in which we have two regional medical programs has passed state legisla- tion regarding emergency medical systems. And because its requirement called for training of X number of EMT's by X date the Memphis program concentrated on that aspect statewide. It is not Western, Tennessee, Some of these efforts were done collaboratively with Nashville, | Nashville out of staff efforts, and I don't know a great deal about its past efforts, Mr. Ogden, because I am comparatively new in this regional assignment, have been work- ing with EM councils which the state legislation also requires And in working with these councils, particularly in the easter part of the states which has a rugged terrain and more rugged than the west, the need for the communication Link was viewed in the Regional Advisory Group at that time as a staff effort 10 ll 12 e 18 19 20 ~ int 25 HOOVER REPORTING CO. INC. 320: Massachusetts Avenu2, N.E. Washington, D.C. 20002 wees Aone 131 to build on. And it wasn't ready for the October application but the RAG meeting that I attended at which these were discus oF sed brought these efforts forward that with the DOT, Departmen of Transportation support, the state support under its legis- lation, and with RMP, RAG was told the circle would be com- plete. MR, OGDEN: Let me just read Council the opera- tional activity summary that appears on this, for what it is worth: "Pirst to develop an emergency disaster system... by June 30, 1974, including purchase and installation of standardized equipment in 1l hospitals by April 30, L974; training of personnel in the 11 hospitals in the proper use of communication equipment by May 31, 1974; purchase and installation of microwave relay equipment on Lookout Mountain by April 30, 1974, to overcome the effect of possible terrain on communication capabilities; and to assure the proper functioning and usage of equip- ment by June 30, 1974." MR, VAN WINKLE: Could we suggest perhaps a restric tion on these funds until we have an opportunity to-- MR. OGDEN: I think we ought to restrict this until epee we have some idea whether the State of Tennessee could pay for this, or maybe somebody else. It troubles me we are getting into the installation 10 11 12 e » i4 16 17 18 19 20 bo No iw) a x 25 HOOVER REPORTING CO. INC. 320 Massachusetts Avenu:, NE. Washineton. B.C. 20062 132 of something that is not demonstration, This is something that is going to be there permanently. MRS, MARS: Right. MR, OGDEN: We are setting it up. MR, MILLIKEN: This timetable is not realistic, We just set one of these up in southeastern Ohio; it took 2-1/2 years. MR. OGDEN: Thank you, That is something to know. Let me go on just half a second, Judy, because I would like to have Dr. Schreiner's thoughts on this. Renal dialysis unit, it says "to approve the purchase of equipment not presently in the unit, weighing pad, cardiac monitor, and reverse osmosis water treatment machine, " "This unit is designed for...short-term dialysis until kidneys recover...;function as a team," That is what they are urging us to spend these funds for. This would go into the University of Tennessee, MR. VAN WINKLE: At Knoxville, is it? MR, OGDEN: I assume it is at Knoxville. MRS, KYTTLE: Yes, DR. SCHREINER: They probably have a bad water problem from the sound of things, and that is one way of solving it -- not necessarily the only way. Not necessarily 10 ll 12 13 14 16 17 18 19 20 20 HOOVER REPORTING CO, INC. 320 Massachusetts Avenu>, NE. Washington, 0.¢. 20002 133 the best way. But there are about five different ways of approaching bad water and that is one of them, That is accep- table at least, MR. OGDEN: Would you rather have someone look into that a Little more carefully before you funded it up? Do you think maybe it isn't the best way? DR. SCHREINER: It probably would be cheaper to use constitutional dialysis, something like that, where you are not so troubled by the water, MR, OGDEN: tT would think = _wouk take to ask re- striction of both of these things anti they + can ‘be reviewed further. MRS, SILSBEE: It seems to me, Mr. Ogden, this also relates to your initial concern, which was the RAG and the way in which it is-~- as we know, this is in a tender stage right now, but this might help to put a little teeth in it. MR. OGDEN: I hate to suggest it, but it sounds to me Like somebody who wants hardware is sneaking it into a new director before he has things nailed down, I don't want to suggest that is the case, because I don't know. But these are brand new and these are somewhat unusual programs, I really would suggest we hesitate on these and Look into them a little more carefully to see whethe the State of Tennessee can fund the hardware on the emergency system, and have someone =-- --Dr, Schreiner or someone who an ~ 10 il 12 13 id 16 17 18 19 20 20 HOOVER REPORTING CO., INC. 320 Massachusetts Avenu3, NE. Washington, 0.C. 20002 (ONO BAL BRAK 134 knows this situation in kidney look at it pretty thoroughly, DR, SCHREINER: Good role for a technical consul- tant, because lots of people approach these kinds of problems, you know, with a fixed idea in mind and there may be a less costly solution to the situation, MRS, SILSBEE: Also with the condition that will be put on an expenditure of those funds until exception approval, we have two ways of getting at it, MR, OGDEN: Okay. MRS. SILSBEE: pr, Foye, did you have any further comme nts ? DR, FOYE: Not on this. MRS, SILSBEE: Could I have a motion? MR, OGDEN: Iwill move it with the amending nts that saaxensenes EEE Her ca esse pepe Ute ppt edn tgmene nce spiapted RAS RUE gmat page arto I have made, restrictions. MRS, SILSBEE;: Thanks. MRS. MARS : . 2 econd. ae Ree praca Betas 8 MRS, SILSBEE: The motion | has _been made anes bas DORR tt eet lin preg sty et aerial Tennessee Mid-South application be approved ab the requested eee tein a aia amount of f 8058, 912 with the ‘following ‘ond tions : 2h St _ A iReteap gitar iene One, that the general kidney condition 1 be put on with regard to Social Security Administration. Two, that the amounts proposed for the purchase of t EMS communications equipment and the kidney dialysis equipment be restricted pending technical review. he ie a 10 ll 12 e i4 16 17 18 19 20 ho Nm 2 HOOVER REPORTING CO, INC. 320 Massachusetts Avenu2, NE. Washington, D.C. 20002 135 MR, VAN WINKLE: For the record, the renal project is number 76, in the amount of $13,200. The EMS is project 81, in the amount of $50,000, I do believe that you had further advice to the region, MRS. SILSBEE: And number three, that the staff carefully monitor and the Regional Advisory Group review process, And four, that the coordinator be urged to-- yas te MR. OGDEN: Urged to seek the advice and assistance from his experienced peers around the country in getting his RAG and his Regional Medical Program well organized, so that he is not directly Listening to them at the university. MRS. SILSBEE: Motion has been made and seconded. Is there any further discussion? MRS, MARS: Question, MRS, SILSBEE: All in favor? (Chorus of "ayes.,") MRS, SILSBEE: Opposed? (No response, ) MRS, SILSBEE: Tennessee Mid-South application has — PS tanec psn ND nade been approved, DR. SCHREINER: I might just comment, I think the education of the people to run the communications network would be an enormously important function of R&D, A lot of 136 1 these things are bought and don't have-- 2 MR. OGDEN: Educating the people so they can continue. 3 We might suggest, take a look at what has been done @ 4 in Ohio Hills on this type of thing before they get involved @ 5 in this themselves, 6 . MRS, SILSBEE: The last one in South Central is 7 Wisconsin, — 8 —— Mr. Van Winkle says he can do it in short order. 9 MR. VAN WINKLE: I understand we have a coffee break, 10 so I will hurry. ll MRS, MORGAN: ALL right, 12 MR. VAN WINKLE: Wisconsin is an excellent program. @ 13 They have retained most of their key staff. During the phase- i4 out, they closed their Milwaukee office and moved their 15 entire operation to Madison, 16 Dr. Hirschboeck has resigned, been replaced by Dr, 17|| Tracy, who has been a member of the staff for sometime, 18 We have no difficulties with this program. The Ponce meant selregamit tp 19 have requested $540,646, which represents their full remaining 29 |; @Lllotment for FY-74, 21 I could sing some praises about this region, but I Will not due to the lack of time and we will recommend that nh NS 93 the application be approved as submitted, oA MRS, SILSBEE: Mr, Milliken, 25 . MR. MILLIKEN: So move. Agree, name pepoimemsteaccae stam sssongpenge sen AIS pro ta HE HOOVER REPORTING CO, INC. | 320. Massachusetts Avenv3, N.E. Washington, 0.C. 20002 on 10 ll 12 oe i4 16 1 18 19 20 tw ie 25 HOOVER REPORTING CO. INC. 320 Massachusetts Avenu, N.E. Washington, D.C. 20002 137 MRS, MORGAN: Aren't we here, though, doing the same thing, purchasing equipment for microwave EMS in this area? MRS, SILSBEE: This particular region has an EMS planning effort of which this is a big-- there has been a Lot of attention made in the planning and this may very well be a natural corollary of it. MR, VAN WINKLE: They were awarded a two-year EMS activity that was carefully reviewed by a special EMS committe and this is a portion of that two-year program, MRS, SILSBEE: I heard a motion, but I didn't hear a second, DR, FOYE: Second. ' MRS, SILSBEE: mObLon has | been made and Seconded the sitatreaianr Wisconsin application be approved | as | requested, at $540, 646. —— hey aves All in favor? (Chorus of “ayes") MRS, SILSBEE: Opposed? (No response. ) MRS, SILSBEE: Okay, Wisconsin application is approved, Could we be back, please, at eleven o'clock. (Whereupon, a short recess was taken.) MRS SILSBEE: Could we get started, please, We are going to take up the Western Operations HOOVER REPORTING CO, INC. |. 10 11 12 18 i4 16 VW 18 19 20 2] bt nh tS Qo x 25 320 Massachusetts Avenu, NE. Washington, D.C. 20002 138 Branch regions, the remainder, There are four of them, and that is in the gray book, The first one is California, MR. RUSSELL: The California RMP, as noted on the yellow sheets, went through an HEM audit, which raised a num- ber of issues, MRS, SILSBEE: Excuse me. Mr, Hiroto, you have to go, MR, HIROTO: Bye-bye. MRS, SILSBEE: Yes, (At this point Mr, Hiroto withdrew from the room. ) MR, RUSSELL: The issues raised by the audit, many of them were resolved by the phase-out of RMPS, the notice. California has closed down all of its area offices, There were nine, The staff has been centralized out of the Oakland area, with staff in the northern and southern parts of California, field staff. To quickly bring you up to date where the program is now, and the problems as we see it, is that, one, the staff is very, very short as of right now. This was a concern, Mrs, Sadin called the director of the program just this past week and he assured us that they have more applicants available thay there are vacancies on the CCRC staff, So we don't believe thd is going to be a problem, r Lt ® & 10 il 12 13 i4 16 17 18 19 20 25 HOOVER REPORTING CO. INC. 320: Massachusetts Avenu>, NE. Washington, 0.C..20002 139 California continues to be innovative. Its health services educational activities are noteworthy. Its EMS activities have been very successful. And as indicated by their budget, they have programmed in all of the option areasj One thing that we are concerned about is that the Deputy Director, in all probability, will be Leaving the CCRMP, We see this as leaving a very big gap in the manage- ment aspects in the Central Office, There are a number of kidney activities. Most of these are ongoing. But we would want to recommend to the CCRMP that they check everything they have got going in the kidney area to make sure it does comply with the appropriate policies. The CCRMP RAG is in tact, It has been expanded since the last review, from ail indications. We believe the program is still viable with those concerns, that we have already noted those do need to be addressed, With that, I would like to ask the Council if they have any questions raised on the information they have avail- able? MRS, SILSBEE: Mr, Ogden, MR, OGDEN: The California RMP application material was sent to me. I thought it was quite good. It appears they are approaching their continued function in the state almost on a better programmic basis than 6 =] 10 ll 12 13 i4 16 17 18 19 20 to rt bo wd = 25 HOOVER REPORTING CO., INC. 320 Massachusetts Avenu>, NE. Washinotan. 0.0. 20002 L4O before; with the elimination of these area offices, except for the Northern-Southern California field offices. They had a proliferation of projects in the past, with these area offices, almost made some nine independent RMP's in that state, Now, it seems to me that what is resulting here is going to be a great increased administrative burden on the central core staff and I would suspect that the central core staff ought to be augmented to handle some of the work done by some of these area offices, That would necessitate a good deputy being on board. Manpower assessment, development patient care quality control structures... I am impressed with the EMS program as well as continuation of emphasis on the coordinated kidney disease program. I suspect that this is the largest bloc of money we will be dealing with, $2,645,305. ECE tk mpcpas coy California has always been a vigorous innovative program, I think what they are doing here continues that tradition and I recommend that this be fully funded. on MRS, SILSBEE: Mrs. Morgan. MRS, MORGAN: I thirkhere again there is some-- whe- ther they have complete technical review processes going, IL think they need to be reminded of that. And, of course, the kidney components. And is there still not the quality assurance that EMS has been approved by-- ~~) 10 li 12 o » 14 16 17 18 19 20 25 HOOVER REPORTING CO, iNC. 320 Massachusetts Avenu3, N.E. Washington. B.C. 20002 14L MR. RUSSELL: The situation here, Mrs. Morgan, is that the Regional Advisory Group has allocated specific amount of money to go in each of the various program elements, The technical reviews will be conducted, reviews will be conducted the first part of December. We have assurance, we have a list of the consultants they are using from out of state. They are all recognized con sultants in their respective fields. We built this recommendation in to make sure that they did follow, which we think they will. We would Like to just clarify the recommendation say ing that the CCRMP not fund those activities until they have gone through @ complete review process, ‘We did not mean to imply RMPS should withhold any money for those, MRS, MORGAN: Right, MR. RUSSELL: Yes, sir. DR, SCHREINER: I listened to a presentation from a young lady from there who was spending this year I think she said something like $180,000 on quality investigation for the kidney program, She said it was funded partially by RMP. And she said the statement in public, that they had received assurances that as of July, this would pe taken over by the state health office. I notice this is in here for continuation. I. think 10 ae 2 - 13. ae a : 16 4. at 18 49 20 aL |) take. at over as of when this. program: would be. ended, this brings up. an inte resting question as to whether some oo these programs we may not actually be deterring the takeover if they have already made these contract arrangements , and do a perjarative way ~~ but L wonder if we are deterring sone basis of that kind of expenditure, They, according to her, of RMP money? presentation at the National Kidney Foundation meeting @ and she ~ At over, ~ Go after the. phaseing out of business. — She said, “Ne: way.” | She gaia, Ne are. going to continue on," pean we want to do that? I don't know. I don't know that out in . of the takeovers? MRS, MORGAN: This coming saty they vere going to DR. ‘SCHREINER: Yes. Because, after all, the California Medica 1 spent $85 million on ‘itaney disease and they obviously have a steke in quality assurance on the were qui te prepared to take over their efforts. The question] - is do we want. to de tay that by ‘etving them another six ‘months MR. RUSSELL: Is this project Listed as 1459 '. DR, ,SCHREINER:~ I don't know. “I listened to! her made the statement they had received RMP money » was. very | successful, and the State Health Department was: going to. take a I asked the specific question, what are you going te Q e ri was wondering if it is: the ‘same project? 10 ll 12 13 14 15 16 7 18 19 20 21 22 24 143 DR, PAHL: Dr. Sehreiner, I think we have certainly seen that in the phaseout, we have asked regions to give us commitments from other organizations, state or nongovernmental for continuation ofthe projects. And many of the regions- gave us very fine statements which represented true commitment and then when the program started up, I am sure we could find a number of regions where we are continuing the project, I don't believe there is anything basically wrong with that, because there is still the overriding policy that we provide funds up to a certain point in its development and then turn on over, and I think the regions are doing that. That was the emergency measure. So I don't think we should hold them to what was an emergency situation as long as we have the standard policy. | MRS. SADIN: In three years they would be over, say. they were approved running for three years. | DR, SCHREINER: This is just the past year, quality assurance program, going in actually putting on computer the coded records of patients and doing cost control, running through the whole thing. It is a very detailed program. MRS, MORGAN: I think as long as you give RMP credit for having funded them, it is in our favor, | MRS, SILSBEE: Also staff can follow up to see what happened to that and investigate whether~-~ DR, FOYE: Who is the residing deputy director? id 10 li 12 13 14 15 16 17 18 19 20 Zi 22 24 144 MR, RUSSELL: Dr, Jack Mitchell. MRS, BADIN: We will know next week, this week or next week how the negot lations are coming. DR, FOYE: I see, | MRS, MORGAN; Did you move? MR, OGDEN: I wlll move the approval, Pragretens MRS. MARS: Nannies IN MRS. STLSBRE: The notion a Been made that the cabin. ae MP application be 4 funded as - requested at ge, 645, 305, with the followlng proviso, that. the kidney appli- cations be reviewed and funded in accordance with the Social security regulations; that the CCRMP withhold funding of those activities pending a full’ technical review; and that advice pe given to the region that the central staff needs augmenta = tion, and that good management is a must, is there any further discussion? MRS, MARS: Question, MRS, SILSBEE: Ail in favor? (Chorus of "ayes.") MRS, SILSBEE: Opposed? (No response. } MRS, SILSBRE: The California application is approved. Would someone call Mr. Hiroto in? (At this point Mr, Hiroto returned to the room, ) MRS. SILSBER: Mountain States is the next one, Som eee te, "nee hee 10 11 12 i3 14 15 16 17 18 19 20 al 22 24 an EMS visit to the Mountain States down at the local level, sults of that activity of the program staff in these various gram staff and in project activities. L145 MR, RUSSELL: The Mountain States R i Medical Prograin is one that most of you will remember covers carts of Idaho, Nevada, Montana, and Wyoming. This program is one of theprograms that while re- sponding to the phaseout instructions, continued very optimis tically and retained most of its staff, There are positions in each state for directors; two of these directors have resigned since phaseout, one in Nevada, one in Idaho, It is anticipated that the Nevada director might be replaced by a nonphysician, depending upon the results of this application, md the length that RMP's may stay alive, this will influence the ability bo recruit a physician for the Sta of Idaho. This program really doesn't come alive on paper very well and even staff had some concerns untii we did male and we were impressed with the amounts of activity and re- states, The one concern that we have now has also been reflected by the regional health director, I believe this is one in Denver, over the lack of minorities involved on pro- This was a concern of Council's during the last tT wa be 10 il 12 13 14 15 16 17 18 19 20 21 22 23 24 LH6 review, and this should be noted, This is one of the RMP's that we will be going back to to take a ¢loser look at the review process. We never reaily got that clarified, | One of the problems here, as noted in the review of some of the programs yesterday, is the turf territory problem, We have indications that Mountain States has attemp to make effective the document with the long title where everybody gets together~~ MR, POSTA: Interregional? MR. RUSSELL: Interregional, but have not been effective in getting one of the other programs. to respond. MRS, SILSBEE: Mrs. Morgan. MRS, MORGAN: [I belteve, I move _that we fund Shem Pa hat Bees as requested, $470,652, h the fact t there visit to review their revie ey, os cia sant een ean EE Et ce. ce aaa sphere di ege Mountain States. tried to coordinate with Inter-Hountesn and also really, these Ir ‘think seh neces fe BIN Rg ons tee Ser Geet -_ Sees and ‘the neee of ‘them and commend them. ‘to continue to pitt an interrelationship between them. Because I believe this has been the region that has attempted to keep it ongoing and they have had trouble from some of the other regions, MRS, SILSBEE: Did you also want to put that in: abou the minorities? LLL be RMP site, Led t 10 li. 12 13 14 15 16 WV 18 19 20 21 22 24 147 MRS, MORGAN: Yes, I lived in Idaho for many years| You have got the Indians, You don't have any other minorities in but you do have the Indian group there, | MR, RUSSELL: That is part of staff's recommenda- tion. MRS, MORGAN: Right,. MRS, SILSBEE: Is there & second? MRS, MARS: Second, DR. WATKINS: Second, MRS, SILSBEE: Any discussion? All in favor? | (Chorus of rayes.") MRS, SILSBEE: Opposed? (No response, ) MRS. SILSBEE: The Mountain States application RMD Mae is approved as requested, tN Su EEE i np MR. RUSSELL: The Oregon Regional Medicat Program is in our opinion probably one of the strongest we have had the pleasure to work with, | The coordinator continues to provide outstanding leadership. The Regional Advisory Board has remained intact, extreme Ly active, Although the program took phase-out extremely seriously, it was down to really about three staff members at one time, When the good news came, they res ponded, 10 il 12 13 14 15 16 17 18 19 20 21 22 have been yery, very active and it is amazing they are clear . appears to be purely planning. 148 have hired back, restored their staff with experienced staff members, and it continues to function extremely effectively. MRS, MORGAN: It is a very short presentation as far as the green, but if you read through the program, they back up to the strength they were in-- as a matter of fact, over what they were professionally a year ago, 12/72. And i move yenet we Fully 3 fund the | Oregon ‘program with no restrictions at fall. DR, WATKINS: Second, MRS, SILSBEE: Kidney? Is there kidney in it? MRS. MORGAN: They do have a renal disease progran,. We probably should flag that, MR. RUSSELL: We did not point this out, it We thought since all regional. medical programs will be given the interim regulations, that this would cover that, But we will call it to their attention, DR, WATKINS: If we are going to strengthen the CHP's, perhaps we should ask them to submit their information, to submit from CHP and not telephone call, I think from all I have looked over, we found a rub+ ber stamp thinking in the CHP, | If we want to spoof it up, we might ask for this all the time, 10 ll 12 13 14 15 16 17 18 19 20 21 22 24. necessary, I take the full blame for this, But the fact | they. dovhave a standing committee, CHP... as part of the Regional Advisory Board, this is just the continuing evidence | Program application be | approved at the “requested moans a 149 MR, RUSSELL: Dr, Reinclapper, coordinator, offered to submit this last week, I said I didn't think it was of thie involvement of CHP, Some of the activities you will notice are with CHP's, | DR, WATKINS: Before the vote, the group purchias ing program of $10, 000 seems to have the same priorityas the cancer program of $10,000, How did you see the group purchasing program? MR, RUSSELL: Well, in trying to relate this to the cancer program, the $10,000 for the cancer activity is to Support the other activities which have been approved by the National Cancer Institute, So I don't reall, you know, see any problems, DR, WATKINS : Okay, Thanks, | MRS, SILSBEE: The motion has been made and second- ed. DR, WATKINS: It was seconded. mrs. Silsbee; That the Oregon Regional Medical tne cin nents tennant > tamu Is there any further discussion? 10 il 12 13 14 16 16 17 18 19. 20 21 22 150 ALL in favor? (Chorus of ‘ayes,") MRS, SILSBEE: Opposed? (No response. ) | MRS. SILSBEE: Motion is carried, Washington-A laska ¢ and Mr. Ogden wilt leave. pon . a al et teen ncn Antenne nt pegs ee {At this point, Mr. Ogden withdrew from the room. } MR. ‘RUSSELL: Here, again, the Washington-Alaska program is another progran which has continued to be extremely strong during the phase-out period, : Please ignore the yellow sheet figures on personnel. We had them up to 75 support staff, That was wrong; it should have been 25, As indicated on the green sheet, the Washington- Alaska program staff was reduced, It is now back up to 88 percent, where it was before phaseout. | During phaseout the Washington-Alaska program continued. to work with the community groups, monitor their programs, and this is one of the regions where the Regional Advisory Board insisted that it be deeply invoived in the managementand monitoring of the program through the phaseout period. | The program has continued to res pond to advice given from the last Council review and staff has no problems with this application, But Council may have some, 10 il 12 13 14 15 16 VW 18 19 20 21 22 24 And I got’ to know Dr. Sparkman very well during those few 151 MRS, SILSBEE: Mrs, Moers, MRS, MARS: I didn't actually -- they have site visits on there, I didn't site visit the RMP, What Tf site visited was the Hutchinson Cancer Center, But at the time I had a great deal of contact, of course, With the program, because they were very heavily involved in the establishment of this Canoer Hospital Center, days since we were together practiceally 24 hours a day, and we were Snowed in also, so that was-- (Laughter } so I think it is the only time in years that it Snoed in Seattle, but it certainly did snow, He, as you all know, Is an exceptiona ily fine and intelligent, ad I suppose one of the most progressive coor- dinators that we have in the country, It has taken a great deal of imagination and ability to steer this program, par- ticularly when he is being involved with Alaska and has had s much territory to cover geographically. So with all differen types of people, ethnic eroubs ranging from the Indians to the Eskimos, and I think that he has just done a remarkable job. He certainly, from what I read in all my reviews, proceeded with the most orderly phaseout that I have seen in any of these programs that I have to do with, and he has developed a concept of functional program activities, I beli¢ Ve 10 li 12 13 14 15 16 i7 18 19 20 21 22 recommend the soceptance | of “the: “funding 4 for it at tts, full ‘disease? It’ doesn't say on the green sheet, but they have L5e it is here on this green sheet, to give the staff a vehicle to catalyze activities that could be productively completed by December 31st, 1973. The ‘program Ls Just & great one and a certainly reques ted _Bmount «,, _MRS,. MORGAN : Are they doing anything with kidney several operational projects that could be included in this, | “MRS, MARS: ‘They have in Seattle, they have-- I don't’ know just how much the RMP is connected with it, They have @ remarkable dialysis, home dialysis program of teaching for home dialysis, and it is quite a setup. In fact, I think people come from all over to learn home dialysis there if I remember correctly. _ I am not too sure what else they carry on in their kidney program. MR, RUSSELL: I don't know but they have been deeply! involved in the kidney program, MRS, MARS : In this home dialysis teaching program I know that is true, | MRS, SILSBEE: This is one of the regions that Couneil cook @ look at about twice before they approved their overall kidney plan and it was funded for awhile. “MRS, MARS: Yes, 10 “it 12 13 14 15 16 17 18 19 20 21 22 23 153 MRS, SILSBEE: Dr, Watkins, did you have a comment you would like to make? DR, WATKINS: No, I endorse this, It is a beauti- ful program. MRS, SILSBEE: Would someone make a motion? DR, SCHREINER: Mrs, Mars made a motion, DR, WATKINS; I will second ite ee ee rete MRS , SILSBEE The motion has been made and seconde that Washington-Alaska RMP application should be approved at the requested level of $545,473. _ Any discussion? ALL in favor? (Chorus of “ayes,") MRS, SILSBEE: Opposed? (No response, ) MRS, SILSBEE: The motion is carried, Would someone please ask Mr, Ogden to come in. (At this point, Mr, Ogden returned to the room. ) MRS, SILSBEE: Now, that finishes the Western Sperattong »_ Now we can move to the East, MR, NASH: With the Orange book, MRS, SILSBEE; With the orange book, and Mr. Frank Nash is the Eastern Operations Division Chief, MR, NASH: We have 18 left in the Eastern Branch to ea ® 10 11 12 13 14 15 16 7 i8 19 20 al 22 154 discuss, I think we will just take them in alphabetical orde} as they appear in the book, the first being Atbany. ‘iii This. As & | request for $325, 836. a TAs ee ci HY “aso aly Dr. Girard Craft replaced Dr. Woolsey in this region as coordinator, The region was site visited in August 1972. Mr. Ogden participated in that site visit. Went to Council in October 1972, _The program was approved for three years, ine Luding the, developmental components, and reviewers were pleased with the maturity and "pain" by the region at thet particular . time. Staffing has decreased in this region from 40 to il positions. However, all 11 are very competent people and we feel they are certainly capable of carrying on this program, The RAG has 40 members, It has remained very active and interested in the program, at times in the past year, The committee has also remained very active in participating in the program. As far as this proposal is concerned, ali the acti- vities fall within the option areas, There is a kidney project Ln here which probably will have to have approval, This particular region sent their application to the regional director in the HEW Regiona e 10 ‘LL 12 ag M4 4B 16 17 18 19 26 21 22 24 155 Office, and we received a phone call from the region saying that they approved and endorsed this program, The review process originally was given conditional approval, The region responded to the conditions; RMP did not follow up, did not phase out, Staff has no concerns about this and recommended approval. MRS, SILSBEE: Mr, Ogden, _R. _ OGDEN: ti artielpated in the last site visit that was done in Aveus st 1972, I was very impressed at that time with Dr. Craft, who was then the deputy, and is now the coordinator of this program, He is a very ample administra tor, has a. good touch with this region, Sd _ This RMP serves an enormous geographical area, ini Upper New York State, has good regional balance on the RAG, and g00d, attendance, People come substantial distances, over Substantial terrain to get down to these meetings, The program when we saw it was well balanced, It still is, even though it has been reduced, greatly, in form | I think it appears to me to still have good touch with the local needs in the various ares in which they are working. I would say the program Looks to have the capability for perhaps rehabilitation and continued progress, and I certa ly second Bland's recommen dation this be funded fully. . MRS, MORGAN: Second, << in- 10 11 ae? 13 15 16 YW 18 19 20 21 22 MRS, SILSBEE;: Dr. Watkins. DR, WATKINS: Question again, I question CHP relationship. Did anyone discuss this CHP relationship? MR, NASH: They sent this application for the estal lishment of assistance in establishment of the agency, did. go to the CHP agency in the state and also went to the CHPB people in HEW Regional Office. One or both of those agencies placed some conditions on this and these conditions are now being addressed by all the parties concerned. DR. WATKINS: You will follow up? Is this how it ig done? MR, NASH: Yes. Right, DR, WATKINS: I second the motion, MRS, SILSBEE: The motion has been made and seconded that 1 the Albany application. be approved. at the ‘requested tevel of $325,835, with the kidney condition, Is there further discussion? MR. MILLIKEN: Question. MRS, SILSBEE: If not, all in favor say "aye," (Chorus of "ayes,") MRS. SILSBEE: Qpposed? (No response, ) MRS, SILSBEE: ‘The moeron | aS carried. Ft AB yu Frank, Dr, Schreiner stepped out for & moment. I Dn 10 tl 12 iB 14 15 16 7 18. 19 20 21 22 wonder if we could skip Central New York? And go to. Greater Delaware Valley. | MR, NASH: No, I believe the next is Connecticut, MRS, SILSBEE: Excuse me. } | MR, NASH: Connecticut's request is $482,720, Mr. Ed Morrisey went in as coordinator May 1973, and replaced of course, Dr, Clark, This region has had triennial status, was never approved for components. Had site visit just prior to February 1973 Aavisory Council. Due to the phaseout, however the findings and recommendations of Council at that time were never transmitted to the region. Council will recail many of the letters did not-- advice letters were not sent to the region after February Council. The Regional Advisory Group in this region remains intact, and very active, They reviewed and approved the en- tire application. This region I think you will recall has an extensiv review and evaluation program and they are still quite active The application was sent to the CHPA and B agencies one B agency responded and their comments were discussed and considered by the board, The other comments were not received in time for RAG consideration. This program continues to be primarily a supporting 10 il 12 13 14 a5 16 Ww 18 19 20" 21 22 23 24 25 158 community study, staff at Yale and University of Connecticut, and university-based regional faculty at Yale and UCon, There are some EMS, kidney, and state-wide health manpower development activities and this particular applica- tion, they nad some activity in hypertension, | This region has always had a very small staff, Eight professionals I think is the most they have ever had at one time, They are down to five now; however,they're:con- sidered by staff to be adequate to carry out the activites proposed, | We have no real concerns about this, region_and — MRS, SILSBEE: “Frank, it does have a kidney compo-- nent, doesn't-it? MR. NASH: Yes, MRS. SILSBEE: Mr. Hiroto. MR, HIROTO: Yes. As a member of the site visit. team, there were certain soncerns that seemed very real to the visitors and, as you indicated, these coneerne other than verbally were never given to the Connecticut Regional Medical Program, However ~- and still continues that a large per centage of the funding of RMPS money goes directly through Yale and University of Connecticut, Now, in @s much as we are at the stage we are at, I guess I recommend approval, hi ong 10 il 12 13 14 16 17 18 19 | 20 21 22 24 MRS, MARS: Its grantee is who? MR. NASH: Yale, MRS, SILSBEE: Yale, MRS, MARS: Yate, MRS, SILSBEE: The other aspect of that, you re- member, the third faculty with the full-time chiefs of staff, that part has been @liminated from the budget, MRS, MARS: What percentage are they taking? MRS, SILSBEE: The hospital support, MR. HIROTO: I was glad to see that. MRS, MARS: What percentage of their fee isa MR. NASH: Indirect cost rate? It is high. I don't have the figure in front of me. Spencer, do you know what the indirect cost rate 15 |. 18? M. ‘COLBURN: I am Looking on the form 16 now, MRS, MARS: $75,000? $70,000? 66 percent? DR, SCHREINER: That is close, | M, COLBURN: Based on salary and wages, study personnel --yes, MRS, MARS: That just kills me, Absolutely, MR. NASH: Of course, one of the things staff hopes will happen in this particular region, since we for years have been Supporting these full-time chiefs, which certainly 10 11 12 13 14 15 16 17: 18 19 20 21 22 24 health care system and oretty evenly distribute the system. tion development. - 150 should improve the quality of care in the hospital, but one facet of their program was that these full-time chiefs were also Supposed to get out into the community and do some activ] ties there. I would hope they will continue with that part of their original proposal, but we can't be sure of that. MRS. MARS: So far they haven't done it. MR. NASH: Well, not very noticeably, no, MRS, SILSBEE: Mr. Ogden, MR. OGDEN: Well, I would just comment, the. CRMP has really, during its existencence, aimed to establish this for purpose of improving-- MRS, SILSBEE: Could you speak up? MR. OGDEN: heir application continues to stress this structure at the university, make program development assistance in Local planning. I think . an area like Connecticut will develop the The way they have gone at this in the past seems to have had the desired effect of producing advances in assurance of quality of care and especially manpower coordina+ You may recall in the pas t I have criticized Con- necticut's program institutionally based personnel, but under the current circumstances, this does appear to have produced responsive, statewide structure and program in this | bir 10 il 12 13 14 15 16 17 18 19 20 ra 22 LOL application, [ think it is resulting in a fair balance, and it onent ae bbe continued and fully funded, MRS, MORGAN: Is that. a motion? MR, OGDEN: 7 wate 80 Rouben MRS. SILSBEE: Is there a ‘second? MRS, MORGAN 1 i Will second it, MRS. SILSBEE: The motion has been mage a second - ed that the apeliceticnntyee eens Regional Medical Program be _Bpproved at the’ requested amount of e482, 720, with the “Laney condition. 7 Frank, is there any further condition? MR. NASH: No, I think we, of course, want to visit this region certainly will take another look at their process, Although they have an extensive review and eva Lua- tion procedure there, when we made our initial review process verification visit, we found there were some problems so far as being in compliance with the RMPS standards for review and verification and we, of course, will be following through on chat.. MRS . SILSBEE: Is there further discussion? ALL in favor? : _ (Chorus ef “ayes,") MRS, SILSBEE: Opposed? (No response. ) 10 11 12 13 14 15 16 17 18 19. 20 Zi 22 23 24 ostaff with additional competencies and &@ need to strengthen 162 MRS, SILSBEE: The application is approved as re- quested, We will go back to Central New York NOW, MR. NASH: ALL right. If you will back up one appl cation to Central New York, this is a request for $200,686, Mr, John Murphy continues as coordinator, with Dr, Clark Case as the RAG chairman. He has been the RAG chairman there for at least three years that I know of, and certainly has been active and extremely interested and sup- portive of this program, although the program does appear to have a few problems, This region was last reviewed by Council in October 1972, That review was preceded by a site visit in August, Dr. Schreiner from Council participated in that, There were some problems and Council recommended a reduced funding level, $889,000 versus the request of one full midlion thet had been submitted by the region, The problems noted at that time were a need for large planning and fiscal management, We still find the same problems with this region. today in staff's opinion. | AG the maximum, this region had a total staff of 22 ogople, They are now down to 9 people, 2 of whom were part time, And we feel that there isa Llittie concern about L~ PY 10 ll 12 13 14 15 16 17 18 19 21 82. 23 24 | about that. - 163 staff because some of these 9 are recent graduates of the Maxwell School in that area, two or three of them did participate as interns with the Central New York Regional Medical Program, However, this probably doesn't necessarily give them the depth and background that a competent RMP staff would be expected to have, This particular proposal, I think we should describe how it came about. They sent out 4,500 letters of solici- tation to all the hospitals, physicians, nursing homes, and other groups involved in the heaith care delivery system in the region. From that mailing they received 40 project pro- posals, These weregiven a technical review, review by the Regional Advisory Group; 12 were approved and 6 were selected to be included in this application. Those 6 do appear to fall within the RMP options, MRS, SILSBEE: Excuse me, staff-- MR. NASH: Staff did note one of their proposais; pediatric hypertension activity which appears to be part of a ten-year research effort, the Regional Medical Program is asking to support this for the first one-half year, The rest of the activity. then will be picked up for 9-1/2 years by Etor Laboratories.. So the question,staff raised a little question -. MRS, SILSBEE: What number is that, Frank? MR, NASH: Jerry, what is the number? a s 10 11 12 13 14 15 16 17 18 19 20 21 : 22 The program staff, as I pointed out earlier, appears to lack depth and experiénee. And we have some recommendations , but 164 MR. OGDEN: 47, MR. GARDELL: 47, MR. NASH: [I think the red application is one other thing. This region did submit as a part of their review com- ments of all of their technical review committees and the RAG and the executive board, So someone pointed out to me that there is a Little confusion about one of the comments on one of the projects, CPR training activity, It appears that we were recommending from here that this not be approved due to some technical or technicalities, but that was not our recommendation, This was a recommenda tion of one of their own technical review committee people, Apparently that particular person was overruled and the RAG did approve the activity and it is part of this application, The review process for this region was given con- ditional approval, The region responded to the conditions that we had placed and we did not follow up due to phase out, Staff concerns here, then, are the program manage- ment and direction certainly appears to need strengthening. I will save those until you people discuss it, MRS, SIISBEE: Dr, Schreiner. _DR. SCHREINER: Yes, I was at the site visit there. 10 ii 12 13 14 15 16 17 18 19 20 21 22 23 24 it did result in some very, very innovative kinds of ideas bei 105 It is an interesting region, goes from Canada down to Pennsylvania, and although in a rich eastern metropolitan state by image, the density is actually Lower than most of our western states that we talk about being sparce ly inhabi- ted, They do have a tremendous number of problems, in- cludes one Indian reservation which is total ly mishandled because it apparently didn't sign a treaty with the United States Bureau of Indian Affairs and is a state responsibility, and it is really falling through the cracks, They had dental equipment there that had never been unwrapped and all kinds of wasted sorts of things that weren't very well coordinated, | One whole county, as I recall, without any doctors, So they do have lots of problems, even though, as Iosay, your image of the center part of Connecticut doesnt carry those kinds of things in your thinking, but this fellow Murphy is a very, very energetic, vivacious man and I was, I will admit, a little prejudiced against this kind of wide network of projects, what he calls mini projects; however, brought into the widely cast net,-one of which was a combined: well baby and venereal disease clinic, which I don't think any doctor would have thought of. (Laughter) We recommended that he get some professional ng 10 il 12 18 14 15 16 17 18 19 20 21 22 25 166 assistance, although I felt he was sort of a spark and this fellow who is chairman of the RAG is an excellent, remarkable person, really, for the amount of time he devoted, The morning I got there, he operated in the morning and rose at five o'clock in the morning to get there. He really knocks himself out. He is an exceptionally well-trained man, trained at Mass General as a matter of fact. So I think that they are trying. I have a few minor quibbles, I think their video tape projects on home dialysis, they don't really have that good a home training program that is worth video taping. They probably could buy it commercially cheaper than to develop their own video tape capability. But they were working and their outline thing, the things up in the north country I found particularly exciting. -I thought they were trying to get into a very difficult area, So I would overall move for approval. MR. NASH: Dr. Schreiner, I think you recall Dr, Cari Hart, who was with the university part time and with, RMP part time, andhis primary assignment over the past year has been in what they call their thrust north, trying to improve the medical care delivery system in the northern part of the region. : I notice, I believe in the cover letter, that came 10 il 12 13 14 15 16 v7 18 19 20 21 22 24 regions, covers 15 counties, 167 with this application that he is being pulled out of that area and assigned to the southern area, Thatalso has a lack of health personnel, The reason being he has attracted or recruited 35 out of a desired 45 physicians to practice in. the north country, I think this is remarkable. DR, SCHREINER: Yes, he was a real shirt-s lee ved fellow, rolled them up and went out in nis old car and really moved around the field. He was a very impressive man. | MRS, SILSBEE: Dr. Foye, did you have anything to add? | DR. FOYE: No, I would agree with staff's recom- mendation. | MRS. MARS: Why'can't this region, if it is such a weak one, be divided up and put into, part of it into the Lakes area, and so on, even into Maine? Wouldn! t it be more constructive to do that? Instead of leaving this as-- MRS, SILSBEE: Your geography is a Little bit off. (Laughter ) MRS, MARS: That is what I am wondering -- well, Dr, Schreiner said -- I would like to see. a@ map. Dr. Sechreing said it comes from Maine on down to-- DR. SCHREINER: From Canada. MRS, MARS: Must touch the Lake regions, MR, NASH: It is up between Rochester and Albany Pr 10 11 12 13 14 15 16 17 18 19 20 Zi 22 24 25 One is a Beproval. of the request and two, certainty. the ‘transmittal of the concerns that a been expressed bo the 168 DR, SCHREINER: Goes up the Saint Lawrence River, up in the Indian reservation. M ny of the houses are on the border and when the women get pregnant, they move in the back of the house so they can gO in the Canadian Health Service; : (Laughter) MRS, MARS: Wonderful idea, MR. NASH: I think the regional boundaries were around the Medical Center in Syracuse, medical training area involved,. I don't belteve the people of Syracuse would really prefer to be put in either Albany or Rochester, MRS, SILSBEE: As an old New York Stater, the boundaries of this region reflect regional plan that was . deve Loped by the state, oh, must have been 25-30 years ago, } DR, .SCHREINER: The only thing that might be split off would be the ‘Bradford -Susquehanna area in Pennsylvania, But all the people we talked to from there relate to Syracuse < MRS, SILSBEE: That is the Syra Clinic, I think the} call it, DR. SCHREINER: Yes, MRS, MARS: Yes, I see, MRS, SILSBEE: Frank, MR. NASH: Yes, staff has some recommendations, oS MARE A esate to 10 11 12 13 14 15 16 7 18 19 20 21 22 169 region. A little more, better concerted monitoring of this program by RMPS staff, and the provision of technical assis- tance when and where indicated, We also recommend this be given a rather high priori for management assessment visit, MRS. SILSBEE: In the discussion of the RMPS staff, the concern about the management of theprogram and, you know, the 4,500 letters of intent, and so forth, and the fact that this has been sort of a perennial problem, we were hoping in addition to these recommendations here that perhaps Council might consider asking for a report on how they are overcoming some of these management deficiencies and that that might put a little more muzzle into what staff has to do, DR, FOYE: So recommend. MRS. Loney meen MRS, SILSBEE: The motion has _been rl yi EE nena etna tnat the Southern New York < application be approved at the level requested, $200,686, and that the concerns of ‘the staff and Council be transmitted to the region; and that there be more concerted monitoring of tne program by RMPS staff, technical assistance, and the regionke given priority to PS" assessment visit, and there be a report to Council on the oroaresees made in solving some of these perrenial management problems, nd. seconded) | 10 11 12 13 14 15 16 17 18 19 20 2i 22. 24 25 we feel could be handled rather quickly, ‘Branch that staff expressed some concerns about, ad perhaps 170 Is there any discussion? All in favor? (Chorus of “ayes,") MRS. SILSBEE: Opposed? (No response, ) MRS, SILSBEE: Motion is carried, MR, MILLIKEN: I am wondering if it is possible to éritertain a motion to keep going? Some of us have to leave for the airports at two, two-thirty or three, I am wondering if our rate of speed is golng to -- MRS, SILSBEE: I am glad you brought that up, Mr, Milliken, MRS. MORGAN: There are a lot of them that have to MRS, SILSBEE: What are the plans? How do you want ¢ proceed here? We can concentrate on those that we think need some special action and we still have Quite a few in, unfortunately, the Eastern Operations, and we have one in the Mid-Continent that we feel does need discussion, The rest of them in a way MR, NASH: Actuaily I have three left in the Eastern Council : ‘would want to have some dis cussion on, The. ‘vest of theln start feels pretty well satisfied with the application, view 10 ll 12 13 14 15 16 17 18 19 20 21 22 i771 those: in the books;we did recommend approval of them. | Mrs, Morgan.: MRS, MORGAN: I move we go through the three that Mr. Nash has a problem with as a group of three, and the rest of them that he has no questions with, that we take them en bloc. MRS. MARS: You can't do problem areas with a group of three, : MRS, MORGAN: I mean this group of three that he has a problem, that we go through, and then the rest of | them we go through as an entire -- if this is possible, | MRS. SILSBEE: How do the rest of you feel about that? MRS, MARS: Yes, MR. HIROTO: Second. MR, MILLIKEN: You have a seconder, MRS, SILSBEE: Okay, motion has been made and seconded, as far as the Eastern Operations Branch is concerned that there will be three -- do you want to identify those? | | MR. NASH: The ones I have here are Greater Delaward Valley, Maryland, and Puerto Rico, MRS, SILSBEE: Not New York Metro? MR. NASH: Excuse me, yes, New York Metro, MRS, SILSBEE: ‘Could we amend: your motion to four? MRS. MORGAN: Yes, ls - 10 il 12 13 14 ag 16 17 18 19 20 21 22 23 24 25 172 MRS, SILSBEE: And these be discussed and acted upon by Council, and that the additional regions be Looked at in terms of bloc action. Further discussion? All in favor? (Chorus of “ayes.") MRS, SILSBEE: Opposed? (No response. ) MRS,.SILSBEE: Mr. Nash. “MR. NASH: Greater Delaware Valley. Hurricane Agnes did a tremendous amount of damage up there floodwise, but there is another reason that that is known as flood territory also, This is a request for $591,332, which is the re- mainder of this region's FY-74 allotment. | Dr. Dean Roberts, from Hanahan, is currently servin as executive director. He replaced Dr. Ingraham, who replaced Dr, Wolhman, who left in June. The region was last site visited in December 1971. Dr, Watkins, from Council, oarticipated in that site visit, It was reviewed by Council in February 1972. At that time Council recommended denial of triennial status, no deve Lopmental components, and reduced funding. Council recommended two-year funding and site visit at the end of the old full year, us i 10 1 12 13 14 15 16 7 18 19 20 a 22 finement of the regional planning operational objectives and 173 Throw this in just to give you the idea that the region hasn't always been what we would like to see it be, The principal issues at that time were needed re- priorities, and two, that the policy and decision-making proc was cumbersome and in eonfiiet with the Spirit of RMP intent. There was limited Involvement of allied health pro-| fessions, and consumers, And further, that the policies on continued support not be developed by the region, | The staffing in this particular region dropped from a total of 49 to a current 35, Historically this region has maintained a rather complex structure consisting of the central core staff, five subregional offices, and an RMP staff unit at each of the five medical schools, In the past this region has been slow to respond to new initiatives, This appeared to be primarily the result of the prograns early involvement with continuing education activities in the medical schools, . NOW, in the past year the RAG has undergone rather extensive reorganization which we. certainly were glad to see. This was needed in order to bring the program into compliance with the RMPS policy statement on RAG grantee relationships. This particular application was sent to CHP for re- view, but comments were not received in time for consideratior w a 19° eee s 10 il 12° 13. 14 15 16 17 18 20 21 22 24 | ment of the program, so that we can see whether we are getting anything out of the dollars that are going into those schools. 174 by the RAG, . This particular proposal, the staff that reviewed it, thought that it was @ good application, one of the better ones to come out of this particular region. However, the comp Lex organizational structure with the large staff compo- nent leaves no funds for project type activities. So, there- fore, this region at the direction of the Regional Advisory Group, revised the current program along task force lines, and these are all within the RMPS options. The application does contain a kidney proposal, which I am sure needs to be flagged. One positive feature of this application is that the staff supporting the medical gehools are now assigned specifid responsibilities which we hope will be monitored by the manage MRS. SILSBEE: Dr, Watkins. DR, WATKINS: I noted you have a revised application that the money was revised downward, MR, NASH: Yes, the initial application that came in apparently during this change of coordinators up there that we on through the summer, they misread some signais from here and included in their initial request the remainder-- not remaindd but the impounded -- it wasn't even Impounded -- restricted portion of the $6.9 '73 dollars, so the application was over ‘~ nt rs 10 IL. 12 13 14 15 16 17 18 19 20 21 22 24 on $100,000 of that. Ikcause at that time they nad task force executive, the fact that there was some -- I have to use the and above their remaining allotment for FY-74,. I think I should point out also that when they came in for their first quarterly allotment, RMPS put a restriction working to determine the organizational structure and the direction of the program. ‘So since they had no good plan for a program, RPMS qid restrict $100,000, and they were asked, when they decided what their program was going to be, what their staffing and organizational structure was going to be, they could apply to us for release of those funds. So the release of those funds I believe is con- tained in this request for the release is in this application, MRS, SILSBEE: Put in the same blocks. DR, WATKINS : I have a quick overview. That is,., the program at five medical schools certainly has some poten- tial, but we discovered further that there was a situation of the tail wagging the dog, and I think we have to monitor itl for several reasons: The fact that Dr. Dean Roberts is a new word "suspicion" we might be assisting with the staffing, meaning the salaries of the medical schools, I was up there at the time of the secession of Delaware, as you recall, and what I am saying is we may have t¢ cuddle it, monitor it, closely, ine Luding their bookkeeping, to be sure they are distributing the money in the right way. 10 il 12 13 14 15 16 17 18 19 20 al 22 the degree of goal attainment. 176 And also if we are going to continue or increase funding, if a new grant is given, then it should be revisited or visited by either staff or perhaps a member of the Council. MR, NASH: Staff recommendation on this for this particular region was to require periodic progress reports for the medical school and subparagraph staff for measurement d DR, WATKINS: I move it be accepted, iat MRS, SILSBEE; is there a second? that the Greater Delaware Valley application be approved at’ the requested level of $591,332, with the kidney condition and the condition that written progress reports be submitted to RMPS, indicating the progress that has been made by the atsk forces and the utilization of the staff in the medical schools and that in the event that additional money is forthcoming, th a Council site visit be held. : DR, WATKINS; Thank you. MRS, SILSBEE: Is there any further discussion? MRS. MARS: How long has this program been in opera- tion? MRS, SILSBEE: Practically -- MRS, MARS: From the beginning? MRS, SILSBEE: Yes, It has hed problems. ft . et, 10 11 12 13 14 15. 16 17 18 19 20 2i 22 23 24 ‘cal schools at least has an objective to it and some way to Templeton? L77 MRS, MARS: One was divided up in that area, I can !t-- MRS, SILSBEE: Delaware broke off. MRS. MARS: Delaware broke off. DR, WATKINS: First state to secede, MRS, SILSBEE: It is a complex region, It has the City of Philadelphia and covers quite 4 wide area of Pennsyl- vania. And it fas rural problems over into New Jersey-- and then the five medical schools have been.a real problem, They have tried to develop this, they have responded in variou WayS. JAG one point they put a superstructure on top of all of this thinking that would help and all that did was have almost twice the staff that was needed, Now, they have gotten rid of the superstructure and in the view of the staff, looking at this particular applica tion, for the first time the money that is going in the medi- monitor it, The question is whether one of the medical school heads can manage the others, and that is the question. DR, WATKINS: Dean is head of Hanahan; «Can he manage MRS. SILSBEE: Yes, that's right. MRS. MARS: Is Delaware doing all right on its own? MRS, SILSBEE: Delaware is out of the picture entire] WE LV eo 10 u 12 13 14- 15 16 17 18 19 20 a 22 24 whether he can serve as executive director impartially with “past. © 178 They were phased out because we thought perhaps ther might be an application for this Council, but-~ MRS.MARS: They were phased out entirely. MR, NASH: Spencer, Dr. Roberts, didn't he go off the Hanahan. payroll and now is 100 percent time on the RMP payroll? So it is a matter whether the other medical schools will consider him as still favoring Hanehan or not, or all five medical schools, | MRS, SILSBEE: Did we have @ motion? DR. WATKINS : Yes. “MRS, SILSBEE: The motion has been made and seconded Is there further discussion? ALL in favor? (Chorus of "ayes,") MRS, SILSBEE: The apy ation has been approved. Maryland. MR, NASH: Maryland is the next one we will considey This is a request for $226,873. . Dr, Davins continues as coordinator of this program, and,surprisingly enough, this is one of the regions in the Eastern Branch that did have their review process certified, although the region is known to have had some problems in the * 10 il 12 13 a} 15 16 17 18 19 20 21 22 23 24 absence of leadership by the Regional Advisory. Group and the fact that this program was almost totally Baltimore based, characterized as one which continually tried to anticipate L79 This program was last reviewed by Councll in Feb- ruary 1973, which was preceded by a site visit. At that time Council recommended a reduced level of support, $1 milliq versus their request of $1.29 million, and that this program be considered on probation. The key issues were the continued support of the epidemiologic and statistical staff, which had a staff of 14 people, and these were carried for several years as part of the program staff-in Maryland. And also the absence-- apparen I think in the past that this region has been federal heip initiatives and to move in that direction, rather than assessed Maryland's health needs and trying to develop a& program to meet those needs, This I think was evidenced by the program's prema- ture and heavy involvement in HMO activity. The staff has bee reduced from a total of 26 down to 4-1/2 people. This is primarily brought about by the removal of the-- and no further support of the 14 people om the EMS staff which certainly was a move in the right direction, and one that has been recommended by this Council for two or three years. We feel that the present staff is probably adequate n 10 ll. ‘a9 13 14 15 16 17 18 19 20 21 22 24 _ 180 to manage the program herein. proposed. However, if additiona RMPS dollars are made avallable, then certain more staff wouk be needed, Now , the Regional Advisory Group, if you recall my prior statement, there was concern by Council and by site visitors that the RAG was not giving leadership to this pro- gram, | Mr. George Hinkel, of our staff, recently visited up there within the past two weeks and he documented the fact that the RAG, technical review committees, are very active in deve lopment of this particular application, As a matter of fact, the Regional Advisory Group for the first time used 8 priority evaluation form in its review process. “Rnd another consideration was the fact that all of the proposals which were presented to RAG were not approved, They actually disapproved some projects, So that is a good indication anyway. Maryland, . a8 far as their relationships with CHPA and B agencies seem to be excellent. All the projects in this particular application were reviewed by the agencies involved and the total applica- tions reviewed by the agency and we have copies of their letters on file, This particular proposal contains requests for sup- port of three projects and one staff activity, Three of the l 16 il 12_ “43 14 “18 _ 16 1 18 19 20 21 22 181 four activities are strengthening of Local planning -- under strengthening of local planning option; other in kidney, kidney thing will probably have to be flagged, One project that they have which is a pediatric- nurse-~practitioner project, is a continuation of activity they were carrying on last year, The kidney activity, which is an organ procurement and preservation project, was approved by this Council in its meeting February 1973, and met the complete RMPS review re- quirements prior to Council approval, We are pleased to see, as I mentioned before, they have taken their funds: out of Support of the EMS activites and are ho’ Longer in the HMO business, The staff's primary concern with this region is the lack of adequate staff to plan, develop and monitor larger program as funds become available, . | MRS, SILSBEE: Mr, Miliiken, MR.MILLIKEN: I have nothing to add, a as tey think the staff recommendations are adequate. I move it be accepted. MR. HIROTO: renga 0 RMA pA PTR SIRE B10 I DR. WATKINS: Second, MRS, SILSBEE: The motion has been made and seconded that the Maryland application be approved at the requested level of $226,878, with the kidney condition, 10 ll 12 13 4 15 16 i “18 19 20 21 22 24 Any discussion? MR, MILLIKEN: Question, MRS, SILSBEE: ALL in favor? (Chorus of "ayes,") MRS, SILSBEE: Opposed? (No response. ) MRS, SILSBEE: The application has been approved, MR, NASH: New York Metro, Crete MRS, SILSBEE: Dr, Watkins. {At this ‘poing Dre Matkins withdrew from the > Foon. ) MRS, SILSBER: ‘he record will ‘refledt he is out of the room, | MR, NASH: This 1s request for $458,584, Dr. Aronson, who is a former deputy coordinator, replaced Dr, I, J, Brightman, who resigned last December, ns We have a little concern about the management of this particular program due to health condition of Dr, Aronson, He recently had 4 second heart attack and has been out for sometime, However, we learned lest Friday that he is now back on board at least on a half-time basis, This particular region was last reviewed by Council February 1973. That was preceded by site visit in December, Council recommended at that time one-year funding at about $2 million level, The key iss ue then was primarily administrative problems and their relationships between the 10 11 12 13 14 16° 17 18 19 20 21 - 22 February 1973 meeting due to phaseout, they were unable to initiate any of these activities and are proposing to do so in this application. 183 grantee and Regional Advisory Group, program director, pro- gram staff, I think Council will recall that the former gran- tee was the Association of Medical Schools of Greater New York, and the key problem was the grantee was not willing to turn over decision-making authority to the Regional Advisory Group, This has been changed, The New York Academy of Medicine is the new grantee. The RAG remains active and there has never been any question about the technical consulting panels for this region, They are certainly considered excellent. From the total staff of 24, as of last December, the region's now down to 5 people, This certainly gives us some concern. This application requests support far four projects and one staff activity, which all appear to be within the option areas and all were previously approved by this Council in its The proposals fail on three within the local plan~ ning: One in quality assurance, one in hypertension. | The Regional AdvisoryGroup in considering these pro- posals disapproved two projects and two staff activities. So the four that we have plus the staff activity were all approved by the RAG, i 10 il 12 13 14. 15 16 WY 18 ‘19 20 2 22 23 184 There is no request for kidney in this particular application, However, some further Support was provided to the New York Regional Transplant Program out of the region- al's first quarter allotment, so that probably should be flagged, fam not real sure whether they put that money in the New York Blood Bank or not. Council may recall, Council will recall there was a 9-10 application involving Nassau/Suffolk, New York, New Jersey RMP, That ran into quite a few problems here, fallen by the wayside, I do know New Jersey has pulled out and is requesting to support their own activities apart from Metro New York, This application was sent to the proper CHP agencie but comments were not received in time for Regional Advisory Group consideration. Review process of this region has not been certified, | - Key staff concerns then are lack of adequate staff to monitor-evaluate the program, particularly if more RMP - dollars are made available, We have some concern about program direction in the event of further setback of Dr, Aronson’ health, MRS, SILSBEE: Mrs, Morgan. MRS. MORGAN: In going through this, this seems to be the biggest problem, although Dr, Aaronson replaced a gentleman which the Council at the time was very willing to by of 10 11 12 13 14 15 16 17 18 19 20 21 22 24 185 have replaced, or felt 1t wise he be replaced, It is unfortunate that his health has failed him Ln taking care of this program, whether he will be able to maintain will be something we will have to see, but I recom- mend we do fund the program but that we do highly recommend that Dr. Aronson get very competent help to assist him in performing this program, so that he does have good, strong technical people onboard in case he should have to be relieved MRS. SILSBEE: Does anyone else have any comments? This region is one that gives me problems because of the staffing, I think they have gone overboard on getting rid of people, | MR. NASH: Dr. Brightman was an excellent recruiter but his retention rate wasn't too good, (Laughter ) MR, OGDEN: How long have you had the grantee? _ MR. NASH: Sinee I believe it was, wasn't it, Jerry? ; | MR, GARDELL: Yes, MR. OGDEN: I thirncthis has been a good deal. My re action to it is certainly to fund the thing, I agree with Mariel, with the new grantee some of these things may improve, There was @ very tense situation there before, this RMP, and I am sure Dr. Aronson has been one of the great ! 16 li 12 13 14 15 16 17 18 19 - 20 21 22 | get additional staff who are competent in the areas of program pased? 186 difficulties, disappointments of this Council. MRS, SILSBEE: Actually I think the fact they went ahead during the phaseout and proceeded to change the grantee is an indication of strength in the RAG, MR. OGDEN: Probably the most welcome sign we have H for sometime, (Laughter) MRS, SILSBEE: Did you have-- MRS, _MORGAN: | in the form of a motion, we do Fund et Chem with the recommendation that they ‘Look for strong staff addition. _ MRS, SILSBEE: Is there a second to that? MR. OGDEN: L will Second Abe MRS, SILSBEE: The recommendation has been made that the region be approved at the requested 1 LeveL. ‘of $458, 564, that there be kidney condition not on this application but on the activities that are ongoing, and that the coordinator be advised that Council make strong recommendations that he concerned, MRS, MORGAN: [I think particularly, due to his healtt that this’ is our main concern. . |.BR. SCHREINER: Where is the transplant registry MRS, SILSBEE: The transplant registry? ad hy 10 li 12 13 14 15 16 7 18 19 20 21 2 25 transplant registry? 87 MR, NASH: Jerry, do you know anything about this MRS, MORGN: It was in their first quarter. MR, GARDELL: I thought it was at the New York plac Te I thought they were the original recipient, that is Cornell-- next door to Cornell; it is not Cornell, it is Independent. DR. SCHREINER: It is going to be very interesting a problem for Social Security. There are 17 transplant programs.in the New York area and four different typing tech- niques. 7 MR. HIROTO: Seventeen, (Laughter) MRS, SILSBEE: Any further discussion about New York Metro? MR, OGDEN: Qvestion. MRS, SILSBEE: ALi in favor of the motion to approve the application with theconditions listed say "aye." (Chorus of "ayes,") MRS, SILSBEE: Opposed? (No response, ) MRS. SLLSBEE: eon iS carried. Could someone brine Dr. W Watkins vin,’ please, (At this point Dr. Watkins reentered the room.) -MRS, SILSBEE: And sak Rico. MR. NASH: Puerto Rico, yes, This is a request 10 11 12 13 14 15 16 17 18 19 20 21 22 23 eh 25 188 for $304,113, which is the remainder of their FY-74 allotment. -fThare has been a fairly recent change in coordinators of this program. Dr, Rivera-Castano, who was former deputy, is now th coordinator. Dr, Fernandez, who was the former coordinator, is now part-time deputy coordinator, So they had a Little switch around there, Dr, Fernandez apparently was barred by Dr. Negaglion to participate in some health services deve lopment projects jin the western part of the tgtand. This particular program was last reviewed by Council in June of 1972, that review was not preceded by a site visit but was nade on the recommendation of staff anniversary review panel's comments and comments from the review committee oo . The recommendation at that time was for increased sy port for this region, "The review process of this region was not fully certified. They were given conditional approval, | The region res ponded to the issues which were raiseq with the. team, but we did not follow up due to phaseout, | The staffing in this region, this is about the third: tim around really for Pyerto Rico, It seems every time there is a black cloud on the federal funding picture, the whole staff down there resigns. (Laughter ) And we have had two or three of these, ‘The latest Loom p= 10» i 12 13 14 15 16. 17 18 19 20 21 22 189 one . ‘being phase out, they were down to about two or three people, Since that time they have boosted the staff back up to a total of el, or at least it will be 21 if this applica- tion is approved and if they are able to recruit the people they request, In this region's request for the first quarterly aliotment of the FY-74 dollars -- this region, by the way, Just about went out of business in June and were sort of resurrected at the last minute, Anyway, . their first quarterly allotment was used primarily for staff to support three projects, in the~ health manpower development, They budgeted part of their fourth quarter allotment, in project evaluation, The region stated they wanted to do Some in-depth evaluations with previous ly funded activities, The other one was in the health Planning assis+=_ tance, This particular application requests funds to add more staff and to refund two previous projects, and add one new one, Staff sort of questions why they would have to go back and resurrect two categorical projects for funding. ‘There has been a recent change in the chairman of the Regional Advisory Group, There was no transmittal letter with this application, no report from the Regional Advisory 10 li 12 13 14 15 16 17 18 19 20 21 22 23 190 Group. Staff here suffers froma lack of current informati on this particular region, So we are not real sure what is going on down there or what the status of the Regional Advisory Group is at this time, And their participation in the direction of the program, Staff has some coneerns, one is the potential for fulfilling budget vacancies with qualified personnel, We wonder about the intactness and degree of the Regional Advisory Group involvement. | We question the need for reinstatement of two previously supported categorical projects, There needs to be some evaluation of Pyerto Rico RMP staff activities since July 1973. DR, SCHREINER: What is. the progress? In the gree sheet there is nothing in the BD&& columns, | MR, NASH: They are ali under multi or other, or under A, DR, SCHREINER: I don't see any point in bullding up staff if you have no program. MRS, MARS: Theyhavent. That is the whole trouble, MRS, SILSBEE: Mrs, Mars, MRS, MARS: This is one of the weakest applications ul have. ever read, I really don't see any future for the program the way it is set up at the moment, bn n 10 | 11 12 i 4 15 16 17 18 19 20 21 22 24 tinuation of the program, LOL I nave little to add to what Mr. Nash said, I think he said it all for me, which is what I had in my own notes. There is only one program on here really which seems to me that if it could be implemented, it might be of help and that is the number 18 project, which is "the integration of heath between the public and private health sectors has been a continually expressed concern at ali federal Levels of review." | If that could be implemented, that certainly would be worth while. | Most of their programs are being partially supported, being state supported Ln any: event and could certainly be car+ ried on by the State Health Department to say the last. I really cannot recommend funding as far as for cont I think it should literally have adequate funds to phase it out gracefully and then that is it, I just can't see any future to it, without com plete reorganization and es tab lishment of 1t. I think Mr. Nash and I more or less would agree ‘on that, except perhaps he won't go as far as I have. MR, NASH: In discussing this with other staff that reviewed the application, I thir there is consensus that there isa lot about this region ne don't know, and I think before recommending complete phaseout of the program, 10 il 12 13 4 15 16. 17 18 19 20 21 22 23 192 perhaps there should be & visit down there to really assess what is going on and what potential is. MRS, MARS: We have had quite a few visits, haven't we, down there? MR, NASH: I don't think we have had one down there in the last two years really. There have been a couple of fast visits. MRS, MARS: Then we are the ones that are being negligent. MR, NASH: This is part of the problem, yes. MRS, SILSBEE; That is true, As I recall, Puerto Rico -- you know, before the phaseout, it was working. on. its triennial application. MRS, MARS: That's right. MRS, SILSBEE: = think it was due and then there ws going to be a site visit. MR. NASH: Then we got the phaseout, MRS, SILSBEE: It phased out. The recommendation was that it be phased out and then, as Frank mentioned, there was @ resurrection, And I had occasion to talk to Dr, Merril who was the other reviewer, and he expressed the same Teeling of frustration that you do, Mrs, Mears; he said there wasn't anything to the application, | MRS, MARS: No, there just isn't. So why is it so worth saving? Why not start all over again? 10 ll 12 13 14 15 16 7 18 18 20 al 22 193 I can't see the logic, MRS, SILSBEE: Well, I think Mr. Nash is right, tha we do not have adequate information one way or the other, MRS, MARS: But in the meantime, we are going to glve them a considerable amount of money to put down the drain. MRS, SILSBEE: I haven't heard a motion to that ef- MR, NASH: One consideration might be, perhaps, restricting some of these funds until a look-see could be take of the region. That is a possibility. MRS. MARS: I would restrict all of them until sum 2 time. (Laughter ) MRS, SILSBEE: I think this is a very difficult thing MRS, MARS : Give them enough for continued operatior al expenses and I think @ very, very imminent visit is indi- i eT tna ti Mt ei MRS, SILSBEE: Does anyone else on the Council have some suggestions? DR, FOYE: I am inclined to agree wits the sugges- tion. DR. SCHREINER: I don't think they understand what it is .all,about. | I was down with the VA a year and a-haif ago, and ty od 10 il 12 18 14 15 16 17 18 19 20 Zi 22 24 194 We got. to talking with one of the people, and they really didn't understand the regional project. MRS, MARS: Certainly from the application, they don't. “DR, PAHL: f think that is an excellent suggestion, nae ; HN eigen Pd if you wish to make a motion along those lines, restriction and full Council visit. We are as a staff I think partly responsible for not having kept in closer touch, and that in turn has resulted in phaseout and not the site visit with triennial application, We have had a difficult time with them, It was our intention to phase them out ar, wisely or unwisely, they con- vinced us that we were in error, MRS. MARS: But no one bothered to go down to see, DR, PAHL: Well, we didn't have the luxury. Like a 24-hour decision, it was the close of fiscal '73 and we had pressures from the Department and pressures from other places, and rather than make what could be @ gross error, whid Lt seemed to be on the surface, we proceeded to maintain the viability which, by the way, was the instruction from the Assistant Secretary of Health, ‘So we were at least in compliacne with the Department, MRS, SILSBEE: But with no dollars for awhile. DR, PAHL: With no dollars. Over the summer, it was very complicated. 10 11 12 13 14 15 16 17 18 19 20 21 22 24 195 To sum it up, I think it would be a mistake to take a terminal action without a visit, but I am not at all sure - we wort arrive at the same decision after. And perhaps the pest and kindest thing would be to start all over, But it should be done on the basis of first-hand information’ And restriction of funds pending the outcome of that visit I think would be a most appropriate action. MRS. MARS: Very well, I will so move MRS, SILSBEE: Are you moving restriction of the total amount? MRS, MARS: Yes, Except for enough for continued operational expense, MRS, MORGAN: Would this depend on when a site visit could be made? Says a site visit couldn't be made until February. They really need something to operate through-- MRS. MARS3. I said for operation, exclude funds © absolutely necessary for continued operational costs until that time, MR,MILLIKEN: Second, MRS, SILSBEE: If I could paraphrase your motion then, the motion has been made and seconded that the funding for Puerto Rico Regional Medical Program as requested in the sipplication be restricted at an amount to be determined by staff. MRS, MARS: Right, a 10 eel 12 13 14 15 16 17 18 19 20 21 22 23 24 196 MRS, SILSBEE: That would enable the region, the staff to keep inoperation, but not expand the program, MRS, MARS: Until such a time until-- MRS, SILSBEE: Until such time as a Council site asc visit is made, “MRS, MARS: And staff definitely. MRS, SILSBEE: Will you delegate to the site visit, if they say everything is fine, to release more funds, or if everything-- MRS, MARS: I think it should come before the counet 1. wats INE! ges alee RNP be garrnecimeseeanllomgesO MR, OGDEN: Come back before the Council. | MRS, MARS: = it must come. before the Council, MRS, MORGAN: It is Soneauied protey B- soon. ‘anyway. MRS, SILSBEE: Report back to Council, for. further action, MRS, MORGAN: I second it. I second your evavemeny Binet 89a gears eng tee eam EU amr POS ieee aoe ae ° TP ean gncanconganmeitgaeyemey tet ‘ vt as "Hutton ene eae mimes eS sree tpn vin "emus NEES OS gyro ete of her motion, {Laughter ) _ MRS, SILSBEE: All in favor? (Chorus of "ayes, ") MRS, SILSBEE: Opposed? (No response. ) MRS, SILSBEE: _Motion is carried. cu MR, NASH: May ‘I have just one other thing, It is 10 il 12 13 14 15 16 17 18 19 20 21 22 24 ‘with the CHPB agency in Nassau/Suffolk area, would be able to straighten that out, Jerry, the Eastern Operations Branch, I have Looked through the staff area ; » Maine, Rochester, Susquehanna Valley, Pennsylvania, be 197 not a. region, I won't go through the whole discussion on it, but in addition to one death in the Eastern Operations Branchi, we had one divorce in the last year, that being Nassau/Suffolk. You may recall this is a region that requested and was approved. to sort of merge and be funded, now, jointly Recently they requested to be divorced, separated, They moved into different quarters, that appears to be operating satisfactorily. mo I think there is one little problem as far as fiscal financial management: people from the two groups now appear not to want to talk to one another, but I think you MR. GARDELL: Yes, MR. NASH: Thank you, MRS, SILSBEE: For the remainder of the regions in recommendations, ani the staff has _recomme ded. 2 lakes see uegeasanc tise vat She requested level, DR. FOYE: So MOVE eure MR, OGDEN: Could I ask if there are any comments from those who reviewed those applications? MRS, SILSBEE: Any comments from any of the reviewens MRS, MARS: The only thing that amused me in the 0 10 u 12 13 14 15 16 17 18 19 20 21 22 23° 196 Lakes region, Dr. Ingalls apparently was optimistic that this program was going to endure and he hired more staff instead of decreasing ite MRS, SILSBEE: It is the only one that went up over the interim. MRS, MARS: I think that was quite a point. MRS, MORGAN: I so MOVE » we accept it. hin MR, OGDEN: Move they os approved. MRS, SILSBEE: ALL in favor? (Chorus of "ayes,") MRS. SILSBEE: Opposed? (No response, ) MRS, SILSBEE: Then of the — Pest ons 5 eae ROR 7 Metropolitan Washington, Nassau/Suffolk, “New Jers ey, “Northem New England, Virginia, West Virginia, the all have kidney condition. (Laughter ) MRS, MARS: In more ways than one, MRS, SILSBEE: Otherwise staff recommends they be approved as requested, MRS. Monae: -I move that these be approved as " vee "at AS anit, requested, with the ‘flag § on _ the kLdney condition, wR. ‘MILLEN: Second, atsbig MRS, SILSBEE: AL in favor? (Chorus of "ayes,") 10 il 12 13. 14 15 16 17 18 19 20 | 21 22 23 199 MRS, SILSBEE: Opposed? (No response. ) MRS, SILSBEE: That is carrled, poo eae iso eased ans ra aiedicnesablestets Now, We move to Mid-Continent, Mr, Posta, Do you want to have a five-minute break? MR, POSTA: Maybe they do need a kidney break. MRS, SILSBEE: We only have one region that has been identified by staff, but it may require considerable discus - sion, so Let's take a five-mintue break, | (Whereupon, a short recess was taken, ) _ MRS. SILSBEE: Could we get started. This is Mr. Posta, from the Mid-Continent Operations Branch, and he has for your consideration Inter-Mountain, saieithteg ese Reiss Of the regions that are left for the Mid-Continent Branch, staff had recommended that Arkansas and Oklahoma be approved at the requested @mounts. In addition, ¢ ~Br-State, Towa, Nebraska apelica- pos GLons , | staff is recommend ing approval at the requested amount an. spins iaice the kidney proviso, and ‘the, pending full RAG review “eon- dition, because in these instances it is evident that they ji were doing the technical review and RAG was going to look at it in December. Then the New Mexico one had an HEW, after complying pa resi aagianarnanionan SS with some regulations with regard to a public education. thing, it had kidney. 10. e il 1 12 13 14 15 16 17 18 19° 20 21 22 23 24 200 Missouri and North Dakota and Texas all had Kidney projects that had to be flegged. Otherwise the staff recom- mends they be approved.as requested, If any of the Council members who reviewed these pave some Questions about them or would like to have them considered, please let us know, | DR. SCHREINER: I have a couple. . Arkansas has a terrific state-wide kidney program, “which was set up by Pat Flanagan, and they really moved out i _.to the boondocks and set up some installations, I notice they have not had anything going in hypertension. ours, MARS: That's right. .DR, SCHREINER: But they came up with one after the phaseout, And I think the staff ought to take a look at 7 | For one thing, it seems to me that the geographical planning that went into kidney coulda be used for the hyper- tnnsion unites, I hope they are not going to use this money to start &@ whole different kind of network, It seems to me it could be closely coordinated. MR, POSTA: I would like to respond to that, I think 34 percent of this particular application fi 10 11 12 13 ya tt 15 16 17 18 19 20 Zi 22 201 from Arkansas is in the area of hypertension and they have coordinated the planning that the HCHPB agencies that work in harmony with the EMS proposal that is being funded through Dr. van Hoek's shop, and they do have extremely good coopera- tion with the A, B. and Experimental Health Delivery System down there, | It is definitely a state-wide coordinated effort, MRS. MARS: Is Flanagan still there? MR, POSTA: Yes, _In. the kidney, they did get legislation passed during the funding of their particular program from RMPSs, They do not request any additional moneys for that particular project éontnie up. itis just about finished, They did get about $300,000: a year for the last three years from the state legislature, to carry on the kidney activity. We felt that was a real good program, good appli- eation, good management, MRS. MARS: They have a renal satellite program, don't they? | MR. POSTA;: Yes, DR. SCHREINER: Yes, I was thinking it would be a natural to hang their hypertension screening Bn those | units, because they are all around, MR. POSTA: Good suggestion. 10 li ' 42 13 “14 el 16 17 18 | 19 20 21 22 24 202 MRS, SILSBER;: Staff will follow through on that. The suggestion they monitor-~ it may indeed be in their plans, but we certainly will check on that, and advise you at the next Council meeting. MR, OGDEN: I have a comment really concerning Kan- sas. “It seemed to me that this application suffered from 4 tack of cohesive quality, they scattered shot among all of these identified areas they have had out there for along tine it seems to me, and while they have done something with Kidney, and hypertension screening, I really think that somebody from the staff ought to get out there and encourage na ett tment pn a more cohesive program. semen (i eat ney I wonder if they are just not doling some funds out Ren bo the. ‘various regions that they have without being very careful about what they are using them for, MRS, SILSBEE: Would you like to put that in the forme form of a motion? “MR. OGDEN; Whatever aon a made here on approve 1 | ‘earthed I would Like to have that ine Luded in connection with Ka Bas » MRS. SILSBEE: All wight, that it would be funded Ln the amount requested, but with the condition. ‘that ‘staff ae MR. OGDEN: staff, ‘MRS, SILSBEE: -- work on deve loping more cohesive program, 10 11 2 S138 14. at 16 17 18 19 20 21 22 to make | a motion these be Approved. program and in Kansas follow through to help on developing a whether with that small amount, how much they can do in that 203 Any further discussion? MR HIROTO: Including those comments, I would Like ES ee MRS. MARS : cons MRS. SILSBEE: Okay, the notion has been made and seconded that the applications from Arkansas , Oklahoma , Bi- State, Iowa, Nebraska, New Mexico, Missouri, North Dakota, and Texas be approved peek the Feccnmehdet tons and conditions that have been noted before; and in addition, that an 'n Arkansas, _ staff will follow through on the coordination to see how the hypertension screening program be coordinated with the kidney tore cohesive program, Any further discussion? "MRS ¢ MARS: Is there anything noteworthy happening in seandi, . “VRS. MORGAN: They have changed, lost Dr. McCall there, their director. But Dave Ferguson, who has been his deputy director for sometime, took over and I think even thoug he is not an M,D., is a very capable, viable person that ean keep the cohesiveness that is necessary in the State of Texas. They don't have a large amount and I am concerned huge state, But I think what program they have is very good, MR, POSTA: I might respond, Mrs, Mars, having 10 il 12 13 1 15 46 i 8 19 20 21 22 204 followed Texas closely for the last several years, that this particular application gets services or RMP activities involved in both urban and the rural areas, concentrating on Mexicans, Indians and blacks. They propose to do more than they have in the past years, They do have a relatively small staff, However, most of the activities proposed in the project area is going. to be administered through the contract mechanism, MRS, MORGAN: And they did do away with their region al areas? | MR, POSTA: Subregional offices were closed when they got their phaseout instructions, That hurt them as far as outside assistance is ‘concerned additional moneys coming in from other sources end so forth, we MRS. MARS : Thank you. ARS, SILSBEE: Is there further discussion? Further’ discussion of any of these applications? fil ‘Tight, eae in favor of che motion to approve - these with the conditions noted in the staff recommendations and the additional comments made by Council, (Chorus of "ayes,") MRS, SILSBEE: Opposed? (No response, ) MRS, SILSBEE: Now, that leaves one region and that ¥ 10 li 12 i ° 15 16. 18 20 ‘a 22 24 that money specifically because it is ore of the highest rate on salaries andwges was 61.4, who has been onboard since January of this pastsoyear, re- is Intermountain, eR. POSTA: In your red books, in introducing a litt background about this region, I would like to say that there ha been quite a few comments by all of our RMPS staff concerning this particular region, We have also got or have received 10, 12, 15 points from the HEW Regional Office in Denver. : As a result, we have invited Mr. Webster to attend this ‘particular session and to feel free to bring up any questions once the Council members have made thelr proper comments, We would like to say that the Intermountain program is requesting $760, 374— in this particular request I mention in funded regions in ‘the group of Mid-Continent regions. of that ‘figure, about $165,000 is earmarked for indirect costs. ‘The present application calls for about 39.7 percent of their award going for indirect costs, That sounds Like an awful lot of money, but believe it or not, a year ago that ‘I have heard from Dr. Ward Studt, the coordinator, placing Mr. Hanklins, that he will be coming in this week to talk with Mr, Gardell and others concerning the possibility of going to a private organization which, if that does take tA 10 il 12 13 14 15 16 old “18: 19 20 21 22 24 206 place, WLIl greatly reduce the indirect cost, MRS. SILSBEE; You mean changing the grantee to a nonprofit organization? MR. POSTA: Yes. Yes, to a private, nonprofit organization. | If that does take place, of course, that rate would gO down to about 23 percent. For your information, statt nas prepared in your booklet the legal size sheets in white that totally break down the total staff complement and all of the people working on the various proposed activities, whether they are core activities, program staff activities, or whether they are projects, One of the big questions that we have had in the past concerning this region is the total number of people on board.. =I think when the site visit took place last year, Mrs, Mars was onbard, and I am sure that she will have some ‘comments about that, But they were concerned about the total number of people onboard. “With the submission of this particular application, we asked them.to send us information so that we could tell exactly how many of these folks vere calling program staff and how many were actually working on projects, If you look at that particular breakdown, you will see breakout of time for about 69 people, which includes 10 Ab. 12 13 14 15 16 a7 18 19 ‘21 eo aa Th 23 “itself, also involved in three or four other project activities. onboard about 87 percent of the time. 20 junction with the indirect costs with reference to the total sity. And we had hoped that this particular region would 207 everybody on all of the projects proposed, and program staff You will note that the coordinator, Dr. Studt, is working 35 percent of his time on the program staff and he is When Pete gave you the breakdown yesterday, you may nave noticed that he, Dr. Studt, was part time, However, when you add up his time for the four other projects, he was If we add them all up and divide them by 100 per- cent, we have about seven full-time professionais on this particular staff. MRS, SILSBEE: 70? MR, POSTA: 70. MRS, MARS: 70. MR, POSTA: If you add all of the percentages together. That is professional. . of course, they have a. like number of clerical staff too. . Needless to say, with another big concern in con- staff, most of the money happens to be funded to the univer- get more activities funded outside of the region to the extent that the dollars would be going to the other institutions 3 10 1 12 13 14 15 16 18 AWS 20 21 22 23 24 17 208 outside of Salt lake, However, as you Look at the applica- tion and indirect costs involved, most-of the money is going into the university, and the services emanate from there in the surrounding three or four states, We can't say that services aren't belng rendered to those four other states, because I think of all of the turf problems that we have and certainly Mid-Continent seems to have their share of them; this particular region has been getting or has had more complaints, let's out it that way. We are concerned that Mid-States in particular, Colorado, Wyoming, programs be more intimately involved with the particular activities suggested in this particular appli- cation and also those requests that might come through for the unexpended funds December Ist, We are concerned about the total amount of dollars earmarked for option A planning. We wonder if all the CHPA agencies have been notified in the area, and whether or not the mandate fromthe HEW Regional Office not to fund any further B Sgeng! es. has been considered, ..We ave not talked with the region regard ing this. However, I do think that it would be vorthwhi te to pursue this in. your ‘conversation this morning. They do have two kidney proposals, relatively small. in ‘amount, and they will be receiving or alerted. to the interim regulations where the kidney disease is concerned, 10 11 12 13 14 15 16 17 18 19 - 20 94 22 “yelationship established, 209 With that as an introduction, I turn it open for Giscussion, Mrs. Mars, would you like to continue? MRS, MARS: Well, when I was there on a site visit, I be Lieve it was about @ year ago, isn't that right? MR, POSTA:; Just about, | MRS, MARS: They had so many problems we sort of almost didn't know where to begin as to what to advise to do,: Of course, the coordinator, Mr, Hagland, who was in charge at that point, was only in. the capacity of acting. And there was great discord between the university which. is the grantee, and the RMP which seemed to be partoy Lodged in Mr. Hagland. | | | Mr, Hagland didn't seem to dislike the university, buat the university seemed to dislike Mr. Hagland very much. a iI think possibly Mr, Hagland was trying to weaken the university's control, shall we say, over the program, and perhaps this was the basis of the dislike that was expressed for him. - Since that time there seems. to have been a better The Dean of Medicine is on RAG and the university is beginning to accept the decentralization concept of the RAG responsibilities, I believe a new president has come in since in the 10 11 12 13 14 15 16 17 18 19 20 21 7) 24 210. university. MRS, MORGAN: Gordon. MRS, MAR: Yes, And this was part, the president and his assistant were both extreme ly antagonistic to the fact that RMP wished to express itself, and they did not wiish RAG to really have any part in the program, From what I could discern in reading this applica- tion, Dr. Studt is making an effort to follow the recommenda - tions. of the site visit team, 7 The RAG is certainly being more involved in greater program participation and planning. The supposed staff reduction is certainly one of my worries likewise, | | | I counted them up yesterday witn Mr. Posta, We. arrived at 69 people on here, When we were out there at that time, frankly they didn't know how many people they had, They Literally didn't, , _ They had So many part-time and bits and pieces, the program director was a woman who -- well, I don't know how quite to express it; she was efficient, but she - on vacitilated. : Is that your assessment, more or Less? MR, POSTA: Right. -. MRS, MARS: And so I believe she has been eliminate MR. POSTA: I think so, yes. 10 ll 12 13. 14 15 | 16 17 18 19 20 21 22 ° 23 24 MRS, MARS: Is that true? Mary? MRS, MURPHY: University, MRS, MARS: Can't hear you. MRS, MURPHY: She is in the university. MR. OGDEN: She is vacillating to the university. (Laughter) MR. POSTA: She doesn't happen to be on this group of 69 anyway. MRS,. MARS: No. (Laughter ) I note that Mr..Hagland is still 100 percent time as director of operational projects here, So I am not sure whether that is good or bad, I think it is a bit on the bad side, shall we say. The turf problem, of course, is a very difficult thing. Certainly there is a need for the Interagency Council to be reestablished and I think that we should have an ass ur- ance from the program that this is-- a very definite effort, very serious effort is going to be made to reestablish the rapport between the states, and that this Interagency Council be activated, - Of course, it didn't matter while the competition for money wasn't there during the ohaseout perlod, but with the money that is being Funded, there must be development of 10 il 12 13 14 15 16 wv 18 19 20 21 22 24 ele program, and we must have an a&ssurance that there certainly will be no duplication of programming. | I think this is very, very importent, This region is a peculiar region. It certainly could be & region that could be designated as improving. grounds for really an organized effort to improve the quality of life in rural America, it is a paradox that the urban centers really have | some of the finest equipment in the western United States,- They have the manpower and they have the technology there. And I think that RMP there has done a great deal to try and identify these, I think that one of RMP's efforts should be made in trying to mix these, | Certainty they have too few health care profes- sionais with possibly too little modern equipment in the rural areas, It all seems to be concentrated in the urban areas, This is sad, really unfortunate. We also were concerned at the time over the min- ority representation on RAG, I believe thet this is being corrected, And from the application, I gather that it is be- ing carefully monitored and that efforts are being made to ensure proper representation, The program was making an effort to take care of 10 il 12 13 14 15 16 17 18 19 20 21 22 23 in the project, 213 the health needs of the migrant worker; certainly there was some thrust in that direction, The migrant workers are a very large percentage of the population at certain times of the year, and there are many many problems connected with them, and the thrust was being made towards that, So there are some funded agencies in the area ands anfunded. And that I think more or less cone ludes what I have to say about it. | Tt certainiy needs careful supervision. I would like to see another site visit made there. I would like t see more or less of a site visit mad and as far as funds, I would fund it, yes, but under great supervision, shall we say, with restrictions. Thank you. MRS, SILSBEE: Dr, Schreiner, DR, SCHREINER: Yes. I find the programs, in view | of their resources, singularly unimaginative, “They have got one of the ten top transplant sur- geons in the country, and virtually nothing in their programs to reflect any interdigitation to this. They have one of the three biggest artificial heart| programs, with Dr, Coles there, and nothing appears anywhere They have got the first artificial eye program, whic] ome 10 ll 12 13 14 15 16 17 18 19 20 21 22 24 244 is s pend ing about $2 million a year, and they are running all over Washington looking for money for that, and ib doesn't seem to have entered into the RMP at all, I think $10,000, you know, for a Little informa- tion gathering service is a pltiful unimaginative kidney, progran for a place with that. kind of resources, I think to}: spend 33 percent, 37 percent on overhead and 33 percent. on planning out of a chunk of money of this sort -- it is an aw4 cul: Lot of paper work and very, very little reality of what is actually going on in the place, I would like to see the planning money chopped in half or something like that as a gesture, Notice to them, MRS, MARS: Another thing that worried me which I forgot to mention is the fact they don't show any salaries dinywhere. You can't find out what they are paying anybody, MR, POSTA: Well, to just respond, you are per- fectly right, the master sheet did include salaries, but none of the reviewers at the B level or regional office; that has |. been an administrative complaint too, | In all sincerity ~- I am not putting a finger on them because the salary rates don't seem to be out of line, Tt is that the way they submitted their applications, they felt that was privileged communication between RMPS and the region -- period, But you are exactly right. MRS. SILSBEE: Mary, did you have anything to @ HOOVER REPORTING CO a 10 end hewk font IND nw he is 6 25 iar a TPE, 320 Massachusetts Avenue, 1k.E. Washinatan OC. 2000? | i ir H ro an wn say about this application or about the efforts of the intermountain program in the kidney area in the past? | MRS, MURPHY: Well, they came on with several big proposals for kidney and I think we shot them down a few times, So there may be more solutions to it. As far as the salaries are concerned, apparently they consider this confidential and just put it in the initial application because I have requested many times that they duplicate it, but they just refuse, MR. POSTA: I do know, Dr, Schreiner, that RMPS, ® couple of years ago, has put quite a few dollars in contract money to that program, MRS, SILSBEE: Dr, Schreiner, I went on two site visits, not this Last one but two previous ones, and the problem with the kidney program is the same as it is in some other areas in Intermountain -- there were training projects, there was another aspect of the kidney project, and two parts of the university, would be two different departments, were not coordinating. A lot of this Intermountain Program seems to send out &@ lot of activity to the local areas, but they are all in each centrally from whatever division or department of the university that is in charge of it, S. MARS: Of course, I do think they are just trying to serve too large an area, TI really do, ® HOOVER REPORTING C 320 Massacnusetts Ai Washington, 0.0. 26602 0. INC. Rog lé if 20 21 MRS, SILSBEE: It isn't coordinated, MRS, MARS: No, it just isn't a coordinated effort, Anc Tam not too sure thatit can be, MRS, SILSBEE:; Mr, Webster, from the Denver Regional Office. MR, WEBSTER: I would Like to start out with one commendation for the Intermountain RMP, and that is the fact that they have dropped or done away with their huge print Lng plant, (Laughter) On past site visits, I think we Looked rather askant at this operation, doing work for the whole university as well as its own operation, Lo would very quickly Like to thank Dr. Pahi for the opportunity to be here, I don't get back to Washington very often and it is good to see all of you people and the staff as weil, and it has been really an enjoyable experience, But in being here today, I have to took at IRMP potn from the viewpoint of having been an RMPS steff member, and I still am representing RMPS in the Regional Office, even though unfortunately our communications with the RMP 's are not as strong as they were, because we do not have the travel and support money. I mention this because I would hope Dr, Pahl, when things get better -~ which they will -~ I think we needed this type of RMPS Regional Office—RMP i i ee reletionship and this is the other reason I am here represent-~ ing the Regional Health Administrator, because of the question g | of how do RMP activities interface with those activities © 4 | which emanate from the Regional Office? 5 Som of the problems already have been mentioned 6 here quite clearly, we feel that possibly -- and we have put ; this io the form of & question +- that there probably should g be more Support to outside agencies and organizations to help 4 them do their thing, rather than doing things for them, 10 This hes come up in this particular application in i regard to EMS, it has come in regard to the creation of addi- joi} Ulonal locatized planning groups, without having first @ gj) evidently consulted sufficiently with the peopte in those 4, states who have the direct charge for EMS, such as in the 5 state nealth Department or the CHP agencies, which certainly ig] Want -- need to be strengthened and we want to see strengthening ic bo Uhnett.s 18 But by setting up additional units where there is no hope so we are told,of there being any additional B 19 on | @gencles created and funded, that future CHP moneys will go 21 to the strengthening of existing agencies only. At Least as & oy |) OF the present moment, That perhaps we would hope that these . || efforts and resources might be redirected in that direction, | And let go ~- help the A agenci nelp give better coverage to the states concerned, HOOVER REPORTING CO, 1 320 Massachusetts Ave Washington, D.C. 20002 & 16 jd oe @ " " HOOVER REPORTING C0, (NG. 320 Massachusetts Avenue, NE. |! gf Washington, 0.0. 20002 Quilte naturally, the nas certain things he looks at that may be different from what the RMP or RMPS does, For example, equal employment oppor- tunity. We Pind 1t somewhat disappointing, and I seem to come up with different figures even, but I guess there are about 40 professional and technical personnel employed, more a LESS 4 I didn't have the table, so I didn't know just what percentage. But of the 40, there is not evidently, from their own application, a sins minority member employed in 4 professional or technical capacity. [am sure that with proper searching, there must be people of those backgrounds that have capabliities, and I would hope that maybe a recommendation might be made that as the pro gram expands, that they consider hiring of these people. it also is true that there are no female employed as professioml or technical people on the program staff, But anyway let me just summ@rize by saying we would Like to see maybe a more broad cross-section representation on the staff as well as on the RAG, I agree, I think the RAG representa- tlon as approved, we would Like to see more Support being given to agencies and organizations in the health field, The IRMP has a tremendous staff; sometimes we think they may be @ Little too courageous in what they do, The amoet seems to be constantly changing in shape and size,and even in ad ¢ pe oo wl @ 10 “17 18 “19 e ° 24 25 HOOVER REPORTING CO.,.iNC. 320 Massachusetts Avenue, N.E. Wachinotan NC INN? great deal of concentration as you will note of money under the A and B agencies. So the question is, of course, is this have been recommending what Dan alluded to, to get out of Sait Lake and to get out of the Salt Lake direction, 21g this application it has raised the question we couldn't ge&t answered, where they evidently proposed putting in a poison control satellite in Boise, Idaho. We are not even sure the Mountain States RMP, which is headquartered in Boise, knows about it. I think we have raised some questions which we would like to turn over to staff possibly, some may be answered well but I think it would be well. MR, POSTA: Thank you. MRS. SILSBEE: Is there any further discussion of Council? MRS, MARS: The other thing, they will turn to their green sheet here, the allocation of funds here, There is a Avhere, And, of course, much of this is in conjunction with lost money? How much of it is Lost? MRS, SILSBEE: For years Council and site visitors In other words, to let the communities decide what it is they wanted to do, MRS, MARS: Right, MRS, SILSBEE: And then seek the help from Inter- mountain. A on 6 ~ 10 1 12 ® 16 18 20 21 . ° 24 25 HOOVER REPORTING CO. INC. * 320 Massachiisetts Avenue, N.E. Washington, D.C: 20002 V7 19: 220 This application is the first time that I have seen that they were even thinking of developing advisory groups out there, It is sort of late, (Laughter ) But I think the fact that they are thinking in terms of community planning is helpful as long as they dort have to do it themselves, I mean, start from scratch, If you recall, Dan, they used to have an excellent staff member who had been a former League of Women Voters, MR. WEBSTER: Yes. MRS, SILSBEE: Staff. And she had the best sense of this kind of community organization, But she did not stay long with the program, MR, WEBSTER: No. No, MR. OGDEN: Could I ask, what is project number 64? Regional coordinator for planning. I am trying to get at Dr, Schreiner's comment, is number 37 Boise, Idaho, poison control program? MR, WEBSTER: I would like to take a little answer on that, There is one thing I thought from an RMPS viewpoint was rather peculiar in this application, and that is in most instances where they have an activity proposal, they have a separate project proposal to administer the other project or cluster of projects, And I think this gets back to the first an ~l 10 ll 12 e » 14 16 17 18 19 24 25 ‘HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, N.E. Washineton..0.0. 20002 221 question you have asked, So, forexample, the regional coordination for planni which I dont have the figure on, but I think it is a pretty hands ome figure, is a separate project to administer five suc- cessive projects, We wondered about this when we looked at it, why that wasn't just built into those projects. The same thing is true in the area of quality assurance, They have a separate project for regional coordina tion of three separately funding projects and they have done that even with kidney, They have in their activity project of expansion of kidney network, they have a paralllel project funded in about or to be funded in about thesame amount of money to monitor or to operate it. And it seems to me they should have been combined. MRS, SILSBEE: Is number 37 the Boise project? MR, WEBSTER: Number 37, yes, I think that is the one. MR. POSTA; B-3, MR, WEBSTER: Yes. In the application they did not specify locations, but in a meeting with one of the staff members, just before coming here, we determined that one of the two places ~= this is under item 2, develop dialogue at minimum of two communities in the region. We Learned "dia- logue" meant subsatellite centers, NS s peed me 10 ll i2 e : 14 16 i? 18 19 20 ee * 24 20 HOOVER. REPORTING CO, INC. 320 Massachusetts Avénue, NE. Wachinotan DC 90002 eee While I don't know one of them where they are proposing to put one of these satellite centers -- we even possibly questioned whether there needed to be an additional satellite -- was in Boise, That is why we raised the question about Mountain States was aware of this, and had their con- ourrence. DR. SCHREINER: Is there any legai problem about running conferences for state legislature? MR, WEBSTER: Our own feeling on this was while the IRMP might certainly give support to this type of activity, IT can't see any objection in that. We felt it was more the Logical function of the state comprehensive health planning agency, because the con- ferences would be on the basis of statewide and subregional heaith needs, MRS, SILSBEE: I think there is a problem, Dr, Schreiner, particularly when Mountain States, which is respon- sible, doesn't know that this kind of thing is going on MR, WEBSTER: I don't know. MR, OGDEN: I don't think the Boise thing ought to eset EAS Sg ans ae i ki ne Nm a "Hin tne iT IR i be approved, | | I question this business of information assistance to state legislature. I wonder about the business of the regional coordinator for planning,gets all the money involved for planning. on s} 10 11 12 eo : 14 16 17 18 19 20 e - 25 HOOVER REPORTING CO. INC. 320 Massachusetts Avenue, NE. ‘Washington, D.C.20002 ee3 It looke to me like the program is unbalanced and a Little incomprehensible. And I think we, as a Council, have every right to simply decline it. I don't know if you want to go that far, Certainly pull parts of it out. DR. SCHRE INER : I would be Willing | MO: bry a motLon {et il ta gE DEP NESE MOS EE Sie to approve with deletion of the Boise project, legislative project, and withhold 50 percent of the planning money, with an encouragement that it be released by the staff if some of these peripheral activities money can be put into programs, MRS » MARS: . I will second that motion. Es: SrLsEY; ‘Any discussion? MR, HIROTO: May I raise a question or point? I think it has some bearing on this? Iam reflecting on the five areas, categories, of concern that would be acceptable for these applications, and then upon the words of Dr, Margulies and Dr. Endicott yesterday, then conversation that occurred at this table among Gouncil members relative to thrust of the program, of course thrust of the project. And though the Council doesn't want to get into the area of approving or disapproving specific projects unless they are beyond the scope of the extent, I wonder if the-Council, if we were to make a general statement that should any of the RMP's desire to redesign those accepted dollar amounts into different projects, that fit the scope of 10 ll 12 eo» 14 16 17 18 19 20 eo ° 25 HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, WE. Washington, D.C. 20002 224 RMPS, this might not resolve some of these things. I wonder if these were thrown im here quickly to make certain that the dollar amount met the maximum due to thd region? And that there wasn't too much thought given to the program itself or the project itself. MR, POSTA: I think your point is well taken, sir. That is one of the main reasons I think that we brought up thi particular region for discussion specifically as a branch, and too I think everybody is in accord, The recommendation that was suggested, not moved, if you knock off two of the programs, it is about $50,000, I mean, the one on legislature and the one on Boise, on pois control, I wasn't exactly clear whether 50 percent reduction of planning, total budget itself -- DR. SCHREINER: 150, whatever it is. MR, POSTA: That would knock off $145,000, So we are talking about $194,625 off the request of $760,374, _ MR. OGDEN: $194,625, back. MR, HIROTO: Out of all the projects, someone men- tioned there was a particular project they would much rather have funded here, but inasmuch as they have these constraints upon which direction their projects could direct, they had “chosen one instead of another, or something of that nature, DR. PAHL: We will be correcting that, hopefully, in f Seteneruigenet veer 10 11 12 e » 14 16 17 18 | 19 20 * ° 25 HOOVER REPORTING CO., IHC. 320 Massachusetts Avenue, N.E. Wachinotnn 9G. 20002 ‘in my office, over the last few months, with Intermountain | face-to-face conversations with Dr, Studt and we have had some rather lengthy convoluted discussions concerning the space requirements of the program, and it always turns out we don't have abl the facts and figures at their fingertips and this is the only reason we seem to have these difficult problems in 225 @ manner in which I indicated this morning, and that B to get ~ out a written statement following its approval by Dr. Endicott office, to all regional medical programs, So that we will be able to give that information uniformly to ail regions, I would Like to make the observation I think at this point in the discussion that our own staff and now here at Council table we hear a rather lengthy catalogue of problems of this region, and I would just call to your attention the fact that in an application earlier today in Puerto Rico, we had a similar cataloguing of problems, and an action was taken which perhaps might be a precedent, to look at in terms of this region. I don't kmow whether that is further than you want to B00 But I dare say we have had some experience,at least quite understand what is going on. Ss We have a number of staff here who never seem to quite those regards, I would dare say even though we rearrange a few doilars or few projects in that particular application, that is 10 11 12 e = 14 16 17 18 19 20 a1 ® 22 oF 23 24 25 HOOVER REPORTING CO., INC. 320 Massachusetts Avenue, N.E. lAfnabiandan FP OANA St gi - 226 not going to go very far toward resolving the issue. I do not know what it will take to resolve it, but I do look to that Puerto Rico type of activity as being one that may be appropriate, We do have Council meetings scheduled, we do have a staff that is rather knowledgeable on many of the issues; ia ‘perhaps: again a Council staff wisit elec a Full report 7 siya giant gre Bese ui is SES, goon cena sas ss the Council & rs action ae thet Gime permitting them suffteient saebn Mic PTT EA AE Ria at Aho PE esac asmumanr roan Seer funds to maintain their ernie. throughout ‘this “intervening period might provide everyone a little bit better way to approach, I just suggest it because it does seem that there are a number of issues which the specific actions that are now being discussed,at least from my point of view in recent discussions with the region, would not seem to materially change. MRS, MARS: I do think the university is handicappin the region, I feel that it really should separate from it as its grantee and form its own organization. I think that will pe one help, and possibly ‘one solution. And certainly from there on, why the RMP could go on by itself and strengthen itself, | It certainly needs to move off of the university as - far as the staff headquarters go, Of course, it was all separated, I believe -- Mrs. ~1 9 10 ll 12 oe ° 14 16 17 18 19 20 24 25 HOOVER REPORTING CO, INC. 320. Massachusetts Avenue, N.E. Waehinatan 10 F007 2e7 Murphy, wasn't it, in four different spots when we were out there at that point? MRS, MURPHY: It is located in a temporary building. MRS. MARS: But it is still with the university, so to speak. And this is very necessary, that it is moved off of the university grounds. MR. aELE EEN: r would tke to 2 alien the motion Ain RN Se ea sai tn Leveson nessessnsgnsaset REN SS DRA eae dE btn accordance with Dr, Pahl's suggestion. MRS, SILSBEE: Would you restate your amendment? MRS, MORGAN: Who made the motion? DR, SCHREINER: I will accept the amendment, MR. OGDEN: I ‘think what you ‘are saying is we with- hold granting of these funds until there has been a thorough review, bring back to Council sometime next meeting? MRS, MARS: And be granted nécessary operational funds. MRS, SILSBEE: So the motion is to restrict the ‘i oe stants 4S aut idSpee RRS So abe on PNMAS EDR NR cm Sy aA PE neh ny Baa ala A eR : funds -- MR, OGDEN: Right Lol | e MRS, SILSBEE: -- to Intermountain, with the exceptic & operating | funds to be determined by staff? MRS, MORGAN: Yes, MR, OGDEN: Yes, I have a comment here. I wonder about, and I may be wrong, but it is my recollection that neither Idaho nor Montana nor Nevada nor Wyoming -- I may be n 10 il 12 e : 14 "16 “17 “18 “49 E HOOVER REPORTING CO,, INC. 320 Massachusetts Avenue, NE: Wachindtan HC NNN? 228 wrong about Wyoming -- has a medical school. MRS, MORGAN: No. MR. OGDEN: The influence of the University of Utah Medical School is an issue here, It isn't a turf problem, Put it this way, there is a turf problem perhaps in our sense between Colorado-Wyoming-Intermountain and-— MR, POSTA: Colorado-Wyoming. MRS, SILSBEE: Mountain ebatess MR, OGDEN: Mountain states, But there is another turf problem that involves the influence of the University of Utah Medical School and the WIND program, which is the Washington-Montana-Idaho program, I think we are drifting into an area here, we are getting an overtone of it in this kind of thing with the University of Utah sponsoring a poison control center in Boise, Idaho, People are sending their medical school students to University of Washington, putting them back in their local eommunities, having some medical training, I think there are things here that don't quite meet _.the eye in this kind of application, and | Tr think all these ‘hi ngs need bo, be assessed and considered and Drought beck to eet i iil Rai i scndjgetdige cola stdaet sta me saree cE NT Et Nerang tetas are BE utr ABR Saga tha tad HUA NR LT the Council, So we will have a _Hibtle better “understand ing alenener tes! ss aR er en nt cet, of all of the things involved in this. It is a complicated picture, MRS, MORGAN: Having Lived in Utah for many years 10 ll 12 e : 14 16 17 18 19 20 ee ~* 24 25 . HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, NE. Washingtan..D.C. 20002 229 myself, you realize how come you don't have any women on it. (Laughter ) Because they dont believe in women working, that is all there is to it. MR. OGDEN: You might also say there are religious overtones. MRS. MORGAN: Very. Very. MRS, MARS: Very much so, religious overtones, MR, OGDEN: And this has to do with the fact there are no minority employees perhaps. MRS. MORGAN: Yes, MR. OGDEN: These may be things on which it is dif- ficult for us to comment, but I don't think they are things we should ignore, nor do I think they are things we will ignore and I want that statement put in the record: They are not thir we will ignore when this application comes’ back. MRS. SILSBEE: Along that line, some of those con- cerns you are mentioning and the ties are what made the original group of the Council committee members team to go out and see why they couldn't get together better, At least kee ping one another informed in communicating with one another would help. They can't, wouldn't say: Intermountain, you can't operate over here because there were other things, but at least you ought to keep the respective political programs zs 10 11 12 e - 14 16 17 18 19 20 21 o ° 23 25 HOOVER REPORTING CO., INC. 390 Massachusetts Avenue, N.E. Washinotnn DC. 720002 24} 230 informed. MR, OGDEN: One reason we are withholding this thing, we might say, is to make sure they cleared it all of the policy and procedures, or interfacing these varlous med i- cal programs, regional medical programs, I don't think that has been done, pretty obviously. MR. MILLIKEN: Question. MRS, MORGAN: I was going to volunteer to go out there since I know about half the people on that staff. MRS, SILSBEE: Mrs. Murphy. MRS, MURPHY: I would Like to add, they were working to o, putting minority and women on the staff, When the phaseou came, a2 lot of those women left and I think it is just a matter of getting bodies for the staff, DR, SCHREINER: Question. MRS, SILSBEE; _The motion nee been made and seconded a . "Fie insu gi kt DR Abel rie plage heb HE esvenrsv HAS Rasy a SRM ace spenesty Medical Program -- I hate to use the term, ‘but. ‘to. ‘be “approved ween the large proportion of the funds being restricted, the, aren ae aaa tten pa TR exact amount to be determined by staff and on the ‘basis. of keeping the program operating at a certain level with no new. activities. And that a Council site visit WALL be made. And to Look into at. of the. ee that have been identified in this discussion and to report back to Council pefore that restriction is Lifted, st a 10 ll 12 14 16 17 18 19 20 21 e ° 20 HOOVER REPORTING CO, INC. 320 Massachusetts Avenue, N.E. Washington, D.C. 20002 231 Is that the sense? MRS, MARS: That is it. MRS, SILSBEE: Any further discussion? MRS, MARS: Question, MRS, SILSBEE: All in favor? (Chorus of "ayes.") MRS, SILSHEE: Opposed? (No response, ) MR. MILLIKEN: Different subject. I move Council commends the staff for an outstanding job on these materials, They @re made under trying conditions, MR. HIROTO: Second, MRS, MARS: Three cheers, MRS, SILSBEE:; I certainly, as Chairman of this session, want to thank Council members for doing their homewor and reading under very, very trying circumstances. We appre -— ciate it, DR, PAHL: We know that Dr. Schreiner is just itch- ing to dash out the door, and please feel free to do so. (Laughter ) But if I may take one more minute, Mr Milliken and Mrs, Silsbee just took two of my points, that is thanking the Council for full and productive meeting and our own staff, who, as you have already recognized, have worked really very hard under trying conditions in preparation for and during K 10 11 12 e - 14 16 17 18 49 90 24 20 HOOVER REPORTING CO., INC. 320 Massachusetts Avenue, NE. Wachinatan AC 2AAN? 232 this meeting. And although Dr. Foye is absent, I would like to recognize his participation and very helpful contribution, and again I would like to note that this is the last meeting of both Dr, Watkins and Mr. Milliken, although we do hope we will be able to call upon their services again and recog- nize their very valuable assistance during the entire period of their tenure. And lastly, but really not again least, there have been a few people who have helped with the preparation of this meeting and I would like to identify again Mrs. Handai and my . Miller, and Mr, Ken Baum,who had the right materials at the right places, and the only comment I would like, Ken, is next time we need more Kosher corned beef and “fot so much turkey right after Thanksgiving. (Laughter ) Meeting stands adjourned. (Whereupon, at 1:45 o'clock, p.m, the meeting was concluded, )