76 EXHIBIT VI Regional Medical Program Review Committee Mark Berke Director Mount Zion Hospital and Medical Center San Francisco, California Kevin P. Bunnell, Ph. D. Associate Director Western Interstate Commission for Higher Education Boulder, Colorado Sidney B. Cohen * Management Consultant Silver Spring, Maryland Edwin L. Crosby, M.D. Director American Hospital Association Chicago, Illinois George James, M.D. (Chairman) Dean Mount Sinai School of Medicine New York, New York Howard W. Kenney, M.D. Medical Director John A, Andrew Memorial Hospital Tuskegee Institute Tuskegee, Alabama Edward J. Kowalewski, M.D. Chairman Committee of Environmental Medicine Academy of General Practice Akron, Pennsylvania 1 Deceased, April 1967. George E. Miller, M.D. Director Center for Medical Education College of Medicine University of Illinois Chicago, Illinois Anne Pascasio, Ph. D. Associate Research Professor Nursing School University of Pittsburgh Pittsburgh, Pennsylvania Samuel H. Proger, M.D. Professor and Chairman Department of Medicine Tufts University School of Medicine President Bingham Associates Fund Boston, Massachusetts David E. Rogers, M.D. Professor and Chairman Department of Medicine School of Medicine Vanderbilt University Nashville, Tennessee Carl Henry William Ruhe, M.D. Assistant Secretary Council on Medical Education American Medical Association Chicago, Illinois Robert J. Slater, M.D. Executive Director The Association for the Aid of Crippled Children New York, New York John D. Thompson Director, Program in Hospital Administration Professor of Public Health School of Public Health Yale University New Haven, Connecticut Kerr L. White, M.D. Director Division of Medical Care and Hospitals School of Hygiene and Public Health Johns Hopkins University Baltimore, Maryland EXHIBIT VII Consultants to the Division of Regional Medical Programs Stephen Abrahamson, M.D. Director Office of Research in Medical Education University of Southern California Los Angeles, California Roy Acheson, M.D. Epidemiologist School of Medicine Yale University New Haven, Connecticut Alexander Anderson, M.D. Director Training Programs for Center of Medical Education College of Medicine University of Illinois Chicago, Illinois William Anlyan, M.D. Dean Medical Center Duke University Durham, North Carolina Norman T. J. Bailey, Ph. D. Professor Biomathematics Department Cornell University Medical School and Sloan-Kettering Institute for Cancer Research New York, New York A. B. Baker, M.D. Professor and Director Division of Neurology University of Minnesota Minneapolis, Minnesota 268-649 O—67 6 Norman Beckman, Ph. D. Director Office of Intergovernmental Relations and Urban Program Coordination Department of Housing and Urban De- velopment Washington, D.C. A. E. Bennett, M.D. Department of Clinical Epidemiology and Social Medicine St. Thomas’ Hospital Medical School London, S.E. 1, England Robert Berg, M.D. Professor and Chairman Department of Preventive Medicine and Community Health University of Rochester Rochester, New York Donald Bergstrom Assistant to State Health Commissioner Vermont Department of Health Burlington, Vermont Mark Berke Director Mount Zion Hospital and Medical Center San Francisco, California Leonidas H. Berry, M.D. Professor Cook County Graduate School of Medi- cine Senior Attending Physician Michael Reese Hospital Chicago, Illinois Mark S. Blumberg, Ph. D. Special Assistant to the Vice President for Business and Finance University of California Berkeley, California Nemat O. Borhani, M.D. Head, Heart Disease Control Program Bureau of Chronic Diseases California Department of Public Health Berkeley, California Paul Brading Director of Research in Medical Education Albany Medical College Albany, New York Kevin P. Bunnell, Ph. D. Associate Director Western Interstate Commission for Higher Education Boulder, Colorado Mary I. Bunting, Ph. D. President Radcliffe College Cambridge, Massachusetts Ray E. Brown, L. H. D. Director Graduate Program in Hospital Administration Duke University Medical Center Durham, North Carolina Hugh Butt, M.D. Professor of Medicine Mayo Clinic Rochester, Minnesota Donald J. Caseley, M.D. Associate Dean and Medical Director College of Medicine Universities of Illinois Chicago, Illinois Hilmon Castle, M.D. Associate Dean College of Medicine University of Utah Salt Lake City, Utah Leonard Chiazze, Jr. M.D. Assistant Professor of Community and International Medicine Georgetown University Washington, D.C. Sidney B. Cohen Management Consultant Silver Spring, Maryland John D. Colby Chief Research Training Branch Division of Research and Training Dissemination Office of Education Washington, D.C. Warren H. Cole, M.D. Emeritus Professor and Head Department of Surgery University of Chicago Chicago, Illinois Murray M. Copeland, M.D. Associate Director M. D. Anderson Medical Hospital and Tumor Institute Texas Medical Center Houston, Texas Edwin L. Crosby, M.D. Director American Hospital Association Chicago, Illinois Gordon R. Cumming Administrator Sacramento County Hospital Sacramento, California Anthony Curreri, M.D. Professor of Surgery Director Division of Clinical Oncology Cancer Research Hospital University of Wisconsin Madison, Wisconsin 78 Frederick Cyphert, Ph, D. Assistant Dean School of Education Ohio State University Columbus, Ohio Michael E. DeBakey, M.D. Professor and Chairman Department of Surgery Baylor University Houston, Texas Edward W. Dempsey, Ph. D. Chairman _ Department of Anatomy College of Physicians and Surgeons Columbia University New York, New York McCormack Detmer Assistant Director Division of Longterm Care American Hospital Association Chicago, Illinois E. Grey Dimond, M.D. Director Scripps Clinic and Research Foundation La Jolla, California Robert Dyar, M.D. Chief of Research California Department of Public Health Berkeley, California Paul M. Ellwood, Jr., M.D. Executive Director American Rehabilitation Foundation Minneapolis, Minnesota Bruce W. Everist, Jr., M.D. Chief of Pediatrics Green Clinic Ruston, Louisiana Sidney Farber, M.D. Director of Research Children’s Cancer Research Center Boston, Massachusetts Charles D. Fiagle, M.D. Professor Public Health Administration School of Hygiene and Public Health Johns Hopkins University Baltimore, Maryland John G. Freymann, M.D. Medical Director Boston Lying-in Hospital Boston, Massachusetts Herbert P. Galliher, Jr., Ph. D. Professor Department of Industrial Engineering University of Michigan Ann Arbor, Michigan Kermit Gordon Vice President The Brookings Institution Washington, D.C. Jack Haldeman, M.D. Executive Director Hospital Planning and Review Council for Southern New York New York, New York John Hammock, Ph. D. Professor Department of Educational Psychology University of Georgia Athens, Georgia A. McGehee Harvey, M.D. Chairman Department of Medicine School of Medicine Johns Hopkins University Baltimore, Maryland James E. Heald, Ph. D. Director School for Advanced Studies in Educa- tion Michigan State University East Lansing, Michigan John B. Hickam, M.D. Professor and Chairman Department of Medicine Indiana University Medical Center Indianapolis, Indiana Charles J. Hitch, Ph.D. Vice President for Administration University of California Berkeley, California Howard F. Hjelm Acting Director Elementary and Secondary Research Bureau of Research Office of Education Washington, D.C. John R. Hogness, M.D. Dean School of Medicine University of Washington Seattle, Washington James T. Howell, M.D. Executive Director Henry Ford Hospital Detroit, Michigan J. Willis Hurst, M.D. Professor and Chairman Department of Medicine School of Medicine Emory University Atlanta, Georgia Ralph Ingersoll, M.D. Director of Research in Medical Educa- tion School of Medicine Ohio State University Columbus, Ohio George James, M.D. Dean Mount Sinai School of Medicine New York, New York Hilliard Jason, M.D. Chairman Department of Medical Education, Research, and Development College of Human Medicine Michigan State University East Lansing, Michigan Boisfeuillet Jones Director Emily and Ernest Woodruff Foundatio: Atlanta, Georgia Richard D. Judge, M.D. Assistant Professor Department of Internal Medicine University of Michigan Ann Arbor, Michigan Howard W. Kenney, M.D. Medical Director John A. Andrew Memorial Hospital Tuskegee Institute Tuskegee, Alabama Charles V. Kidd, Ph. D. Executive Secretary Federal Council for Science and Technology Office of Science and Technology Washington, D.C. Charles E, Kossman, M.D. Professor Department of Medicine New York University Medical Center New York, New York Edward J. Kowalewski, M.D. Chairman Board of Directors Academy of General Practice Akron, Pennsylvania Peter Lee, M.D. Assistant Professor Department of Pharmacology School of Medicine University of Southern California Los Angeles, California Jack Lein, M.D. Assistant Dean and Director for Continuing Education School of Medicine University of Washington Seattle, Washington E. James Lieberman, M.D. Director Audiovisual Facility Communicable Disease Center Public Health Service Atlanta, Georgia Abraham Lilienfeld, M.D. Professor and Chairman Department of Chronic Diseases School of Hygiene and Public Health Johns Hopkins University Baltimore, Maryland Robert Lindee Assistant Dean for Administration Medical School Stanford University Palo Alto, California Samuel Martin, M.D. Provost College of Medicine University of Florida Ganesville, Florida Manson Meads, M.D. Dean Bowman Gray School of Medicine Wake Forest College Winston Salem, North Carolina Richard L. Meiling, M.D. Dean College of Medicine Ohio State University Columbus, Ohio GC. Arden Miiler, M.D. Vice Chancellor for Health Sciences University of North Carolina Chapel Hill, North Carolina George E, Miller, M.D. Director Center for Medical Education College of Medicine University of Illinois Chicago, Illinois Clark H. Millikan, M.D. Consultant in Neurology Mayo Clinic Rochester, Minnesota George E. Moore, M.D. Director Roswell Park Memorial Institute Buffalo, New York William D. Nelligan Executive Director American Institute of Cardiology Bethesda, Maryland Charles E. Odegaard, Ph. D. President University of Washington Seattle, Washington Stanley W. Olson, M.D. Program Coordinator Tennessee Mid-South Regional Medical Program Nashville, T ennessee John Parks, M.D. Dean School of Medicine George Washington University Washington, D.C. Anne Pascasio, Ph, D. Associate Research Professor Nursing School University of Pittsburgh Pittsburgh, Pennsylvania Joye Patterson, Ph. D. Publications Director Medical Center University of Missouri Columbia, Missouri William J. Peeples, M.D. Commissioner State Department of Health Baltimore, Maryland Edmund D. Pellegrino, M.D. Director Medical Center State University of New York Stony Brook, New York Alfred M. Popma, M.D. Chief of Radiology St. Luke’s Hospital and School of Nursing Boise, Idaho Samuel Proger, M.D. President Bingham Associates Fund Boston, Massachusetts Fred M. Remley Chief Engineer Television Center University of Michigan Ann Arbor, Michigan David E. Rogers, M.D. Professor and Chairman Department of Medicine School of Medicine Vanderbilt University Nashville, Tennessee 79 John Rosenbach, Ph. D. Director State University of New York at Albany Albany, New York Carl Henry William Ruhe, M.D. Assistant Secretary Council on Medical Education American Medical Association Chicago, Illinois Paul Sanazaro, M.D. Director Division of Education Association of American Medical Colleges Evanston, Illinois, Raymond Seltser, M.D. Professor of Medicine School of Hygiene and Public Health Johns Hopkins University Baltimore, Maryland Mack I. Shanholtz, M.D. State Health Commissioner State Department of Health Richmond, Virginia Cecil G. Sheps, M.D. General Director Beth Israel Medical Center New York, New York Arthur A. Siebens, M.D. Director Rehabilitation Center University of Wisconsin Hospital Madison, Wisconsin Robert W. Sigmond Executive Director Hospital Planning Council of Allegheny County Pittsburgh, Pennsylvania 80 Robert J. Slater, M.D. Executive Director The Association for the Aid of Crippled Children New York, New York Vergil N. Slee, M.D. Director Committee on Professional Hospital Ac- tivities First National Building Ann Arbor, Michigan Clark D, Sleeth, M.D. Dean School of Medicine West Virginia University Morgantown, West Virginia John M. Stacy Director Medical Center University of Virginia Charlottsville, Virginia Robert E. Stake, Ph. D. Assistant Director Center for Instruction, Research, and Curriculum Evaluation College of Education University of Illinois Urbana, Illinois Jacinto Steinhardt, Ph. D. Scientific Advisory to the President and Professor of Chemistry Georgetown University Washington, D.C. Patrick B. Storey, M.D. Professor of Community Medicine Hahnemann Medical College Philadelphia, Pennsylvania Emmanuel Suter, M.D. Dean College of Medicine University of Florida Gainesville, Florida Adrian Terlouw Educational Consultant Sales Service Division Eastman Kodak Company Rochester, New York John D. Thompson Professor of Public Health Director Program in Hospital Administration School of Public Health Yale University New Haven, Connecticut Cornelius H. Traeger, M.D. New York, New York Ray E. Trussell, M.D. Director School of Public Health and Administra- tive Medicine Columbia University New York, New York A. Earl Walker, M.D. Professor of Neurological Surgery Johns Hopkins University Baltimore, Maryland James V. Warren, M.D. Chairman Department of Medicine College of Medicine Ohio State University Columbus, Ohio Max H. Weil, M.D. Associate Professor of Medicine School of Medicine University of Southern California Los Angeles, California Burton Weisbrod, Ph. D. Associate Professor Department of Economics University of Wisconsin Madison, Wisconsin Benjamin B. Wells, M.D. Assistant Chief Medical Director for Re- search and Education in Medicine Department of Medicine and Surgery Veterans Administration Washington, D.C. Kelly West, M.D. Chairman Department of Continuing Education University of Oklahoma Medical Center Oklahoma City, Oklahoma Robert E. Westlake, M.D. Syracuse, New York Storm Whaley Vice President Health Sciences University of Arkansas Medical Center Little Rock, Arkansas Kerr L. White, M.D. Director Division of Medical Care and Hospitals School of Hygiene and Public Health Johns Hopkins University Baltimore, Maryland Kimball Wiles, Ph. D. Dean School of Education University of Florida Gainesville, Florida Loren Williams, M.D. Director Research in Medical Education Medical College of Georgia Augusta, Georgia George A. Wolf, M.D. Provost and Dean School of Medicine University of Kansas Kansas City, Kansas Richard M. Wolf, Ph. D. Assistant Professor of Education School of Education University of Southern California Los Angeles, California Alonzo S. ¥erby, M.D. Head Department of Health Services Administration School of Public Health Harvard University Cambridge, Massachusetts Paul N. Ylvisaker, Ph. D. Director Public Affairs Program Ford Foundation New York, New York Lawrence E. Young, M.D. Chairman Department of Medicine School of Medicine University of Rochester Rochester, New York 81 EXHIBIT VILk Program Coordinators for Regional Medical Programs, June 30, 1967 Kegional Designation Preliminary Planning Program Coordinator Regional Designation Preliminary Planning Program Coordinator Region Region ALABAMA. Alabama. Benjamin B. Wells, M.D. CALIFORNIA, California, Paul D. Ward University of Alabama Medical Executive Director Center California Committee on Re- 1919 Seventh Avenue, South gional Medical Programs Birmingham, Alabama 32533 Room 302 655 Sutter Street San F. : wes ALBANY, N.Y. Northeastern New York, | Frank M. Woolsey, Jr., M.D. an: Franciaco, Caliivenia 25102 and portions of Associate Dean Southern Vermont Albany Medical College of . and Western Union University CENTRAL NEW Syracuse, New York, Richard H. Lyons, M.D. Massachusetts. 47 New Scotland Avenue YORK. and 1 5 surrounding Professor and Chairman Albany, New York 12208 counties. Department of Medicine State University of New York Upstate Medical Center ARIZONA. Arizona, Merlin K. DuVal, M.D. 766 Irving Avenue Acting Dean Syracuse, New York 13210 University of Arizona College of Medicine . Tucson, Arizona 85721 COLORADO. Colorado and Wyoming, | C. Wesley Eisele, M.D. WYOMING. Associate Dean for Postgraduate Medical Education ARKANSAS. Arkansas. Winston K. Shorey, M.D. University of Colorado Dean, University of Arkansas Medical Center SO ere street 4200 East Ninth Avenue est Markham Stree De , Col 80220 Little Rock, Arkansas 72201 nes, Szoletexto 6022 BI-STATE. Eastern Missouri William H. Danforth, M.D. CONNECTICUT, Connecticut, Henry T. Clark, Jr., M.D. and Southern Illinois centered around St. Louis. Vice Chancellor for Medical Affairs Washington University 660 South Euclid Avenue St. Louis, Missouri 63110 Program Coordinator Connecticut Regional Medical Program 272 George Street New Haven Connecticut 06510 82 Regional Designation Preliminary Planning Region Program Coordinator Regional Designation Preliminary Planning Region Program Coordinator FLORIDA. Florida. Samuel P. Martin, M.D. Provost J. Hillis Miller Medical Center University of Florida Gainesville, Florida 32601 GEORGIA. Georgia. J- W. Ghambers, M.D. Medical Association of Georgia 938 Peachtree Street N.E. Atlanta, Georgia 30309 GREATER DELAWARE VALLEY. Eastern Pennsylvania and portions of Delaware and New Jersey. William C. Spring, Jr., M.D. Greater Delaware Valley Regional Medical Program 301 City Line Avenue Bala-Cynwyd, Pennsylvania 19004 HAWAII, Hawaii, Windsor C. Cutting, M.D. School of Medicine University of Hawaii 2538 The Mall Honolulu, Hawaii 96822 ILLINOIS. Tilinois. Leon O. Jacobson, M.D. Dean, University of Chicago School of Medicine Chairman, Coordinating Com- mittee of Medical Schools and Teaching Hospitals of Illinois 950 East 59th Street Chicago, Illinois 60637 INDIANA. Indiana. George T. Lukemeyer, M.D. Associate Dean Indiana University School of Medicine Indiana University Medical Center 1100 West Michigan Street Indianapolis, Indiana 46207 INTERMOUNTAIN. Utah and portions of Colorado, Idaho, Montana, Nevada, and Wyoming. C. Hilmon Castle, M.D. Associate Dean and Chairman Department of Postgraduate Education University of Utah Salt Lake City, Utah 84112 IOWA. Towa. Willard Krehl, M.D., Ph. D. Director, Clinical Research Center Department of Internal Medicine University Hospital University of Iowa Towa City, Iowa 52240 KANSAS. Kansas. Charles E. Lewis, M.D. Chairman, Department of Preventive Medicine University of Kansas Medical Center Kansas City, Kansas 66103 83 Regional Designation Preliminary Planning Program Coordinator Regional Designation Preliminary Planning Program Coordinator Region Region LOUISIANA. Louisiana. Joseph A. Sabatier, M.D. MICHIGAN. Michigan. D. Eugene Sibery Louisiana Regional Medical Executive Director Program Greater Detroit Area Hospital Clairborne Towers Roof Council 119 South Clairborne Avenue 966 Penobscot Building New Orleans, Louisiana 70112 Detroit, Michigan 48226 MAINE. Maine. Manu Chatterjee, M.D. MISSISSIPPI. Mississippi. Guy D. Campbell, M.D. Merrymeeting Medical Group University of Mississippi Medical Brunswick, Maine Center 2500 North State Street Jackson, Mississippi 39216 MARYLAND. Maryland. Thomas B. Turner, M.D. Dean, The John Hopkins University MISSOURI. Missouri. Vernon E. Wilson, M.D. School of Medicine Dean, School of Medicine 725 Wolfe Street University of Missouri Baltimore, Maryland 21205 Columbia, Missouri 65201 MEMPHIS. Western Tennessee, James W. Culbertson, M.D. MOUNTAIN STATES. | Idaho, Montana, Nevada, | Kevin P. Bunnell, Ed. D. Northern Mississippi, Professor and Cardiologist and Wyoming. Associate Director and portions of Department of Internal Medicine Western Interstate Commission Arkansas, Kentucky, University of Tennessee for Higher Education and Missouri. College of Medicine University East Campus Memphis, Tennessee 38103 30th Street Boulder, Colorado 80302 METROPOLITAN District of Columbia and | Thomas W. Mattingly, M.D. WASHINGTON, D.C. 2 contiguous counties in Maryland, 2 in Virginia and 2 independent cities in Virginia. Program Coordinator District of Columbia Medical Society 2007 Eye Street N.W. Washington, D.C. 20006 NEBRASKA-SOUTH DAKOTA. Nebraska and South Dakota. Harold Morgan, M.D. Nebraska State Medical Associa- tion 1408 Sharp Building Lincoln, Nebraska 68508 84 Regional Designation Preliminary Planning Program Coordinator Regional Designation Preliminary Planning Program Coordinator Region Region NEW JERSEY. New Jersey. Alvin A. Florin, M.D., M.P.H. NORTHERN Vermont and three John E. Wennberg, M.D. New Jersey State Department of NEW ENGLAND. counties in University of Vermont Health ; . Northeastern College of Medicine Health-Agriculture Building New York. Burlington, Vermont 05401 P.O. Box 1540, John-Fitch Plaza Trenton, New Jersey 08625 NORTHLANDS. Minnesota. J. Minott Stickney, M.D. Minnesota State Medical Associ- NEW MEXICO. New Mexico. Reginald H. Fitz, M.D. ation Dean, University of New Mexico 200 First Street, Southwest School of Medicine Rochester, Minnesota 55901 Albuquerque, New Mexico 87106 OHIO STATE. Central and Southern Richard L. Meiling, M.D. NEW YORK METRO- POLITAN AREA. New York City, and Nassau, Suffolk, and Westchester Counties. Vincent de Paul Larkin, M.D. New York Academy of Medicine 2 East 103d Street New York, New York 10029 NORTH CAROLINA, North Carolina. Marc J. Musser, M.D. Executive Director North Carolina Regional Medi- cal Program Teer House 4019 North Roxboro Road Durham, North Carolina 27704 NORTH DAKOTA. North Dakota. Theodore H. Harwood, M.D. Dean, School of Medicine University of North Dakota Grand Forks, North Dakota 58202 - two-thirds of Ohio (61 counties, excluding Metropolitan Cincin- nati area). Dean, Ohio State University College of Medicine 410 West 10th Avenue Columbus, Ohio 43210- OHIO VALLEY. Greater part of Kentucky and contiguous parts of Ohio, Indiana, and William H. McBeath, M.D. Director, Ohio Valley Regional Medical Program West Virginia. 1718 Alexandria Drive Lexington, Kentucky 40504 OKLAHOMA, Oklahoma. Kelly M. West, M.D. University of Oklahoma Medical Center 800 N.E. 13th Street Oklahoma City, Oklahoma 73104 85 Regional Designation Preliminary Planning Program Coordinator Regional Designation Preliminary Planning Program Coordinator Region Region SUSQUEHANNA Block of 24 counties Richard B. McKenzie OREGON. Oregon. M. Roberts Grover, M.D. VALLEY. centered around Harris- | Executive Assistant Director, Continuing Medical Education University of Oregon School of Medicine 3181 S.W. Sam Jackson Park Road Portland, Oregon 97201 ROCHESTER, NEW YORK. Rochester, New York and 11 surrounding counties. Ralph C. Parker, Jr., M.D. Clinical Associate Professor of Medicine University of Rochester School of Medicine and Dentistry Rochester, New York 14620 SOUTH CAROLINA. SouthCarolina. Charles P. Summerall, HI, M.D. Associate in Medicine (Cardiol- ogy) Department of Medicine Medical College Hospital 55 Doughty Street Charleston, South Carolina 29403 burg and Hershey. Council on Scientific Advance- ment Pennsylvania Medical Society Taylor Bypass and Erford Road Lemoyne, Pennsylvania 17043 TENNESSEE MID- SOUTH. Eastern and Central Tennessee and contigu- ous parts of Southern Kentucky and North- ern Alabama. Stanley W. Olson, M.D. Professor of Medicine Vanderbilt University Baker Building 110 21st Avenue, South Nashville, Tennessee 37203 TEXAS. Texas. Charles A. LeMaistre, M.D. Vice-Chancellor for Health Affairs University of Texas Main Building Austin, Texas 78712 TRI-STATE. Massachusetts, New Hampshire and Rhode Island. Norman Stearns, M.D. Medical Care and Educational Foundation 22 The Fenway Boston, Massachusetts 02115 86 Regional Designation Primary Planning Program Coordinator Regional Designation Primary Planning Program Coordinator Region Region VIRGINIA. Virginia. Kinloch Nelson, M.D. WESTERN NEW Buffalo, New York and 7 | Douglas M. Surgenor, M.D. Dean, Medical College of YORK. surrounding counties. Dean, School of Medicine Virginia State University of New York at 200 East Broad Street Buffalo Richmond, Virginia 23219 101 Capen Hall Buffalo, New York 14214 WASHINGTON- Alaska and Washington. | Donal R. Sparkman, M.D. WESTERN PENNSYL- | Pittsburgh, Pennsylvania | Francis S. Cheever, M.D. ALASKA. Associate Professor of Medicine VANIA. and 28 surrounding Dean, School of Medicine University of Washington School of Medicine Seattle, Washington 98105 counties. University of Pittsburgh Flannery Building 3530 Forbers Avenue Pittsburgh, Pennsylvania 15213 WEST VIRGINIA. West Virginia. Charles L. Wilbar, M.D. West Virginia University Medical Center Morgantown, West Virginia 26506 WISCONSIN. Wisconsin. John S. Hirschboeck, M.D. Wisconsin Regional Medical Program, Inc. Room 1103 110 East Wisconsin Avenue Milwaukee, Wisconsin 53202 EXHIBIT IX Review and Approval of Operational Grants This exhibit outlines review and ap- proval procedures for use in review- ing grants for the establishment and operation of Regional Medical Pro- grams authorized by Section 904(a) of Title IX of the Public Health Service Act. Background These procedures were developed after extensive consideration of: (1) the philosophy and purposes of Title IX; (2) the initial experience in re- viewing the planning grant applica- tions awarded under Section 903; (3) consideration of. the first opera- tional grant proposals, including site visits to the regions involving mem- bers of the National Advisory Council on Regional Medical Programs and the Regional Medical Programs Re- view Committee; (4) preliminary discussion of the issues involved in the review of operational applica- tions by the National Advisory Coun- cil on Regional Medical Programs at its November 1966 meeting; and (5) extensive discussion with both the Review Committee and the National Advisory Council concerning the ef- fectiveness of these procedures dur- ing the actual review of the first op- erational applications. As a result of these considerations, the resulting re- view and approval process is to the greatest possible extent keyed to the anticipated nature of operational grant requests and to the policy issues inherent in the Regional Medical Programs concept. Characteristics of Operational Grants In designing this review process, at- tention has been given to the follow- ing characteristics of applications for Regional Medical Program grants: (1) complexity of the proposals with many discrete but interrelated activi- ties involving different medical fields; (2) the diversity of grant proposals resulting from encouragement of initiative and determination at the regional level within the broad parameters provided in the Law, Regulations, and Guidelines: (3) the many different attributes of the over- all operational proposals which need to be evaluated during the review process, including not only the merit of highly technical medical activities in the fields of heart disease, cancer, stroke, and related diseases but also the effect of the proposal on improved organization and delivery of health services and the degree of effective cooperation and commitment of the major medical resources: (4) the re- lationships of the proposals to the responsibilities of many other com- ponents of the Public Health Service and other Federal programs; (5) the characteristics of these initial pro- posals as the first steps in the more complete development of the Re- gional Medical Program, guided by a continuing planning process. Objectives of Review Process The objectives sought in the develop- ment of this review process are based on a careful assessment of the goals of the Regional Medical Programs and how the achievement of those goals can be most effectively furthered by the process used in making deci- sions on the award of grant funds. Consideration of these basic policy issues led to delineation of the follow- ing objectives of the review process: [] The operational grant applica- tion must be viewed as a totality rather than as a collection of discrete and separate projects. (] The decision-making process for the review and approval of opera- tional grants must be developed in a way that stimulates and preserves the essential goal setting, priority 87 determination, decision making and evaluation at the regional level. [] During the review process the staff of the Division of Regional Medical Programs and the review groups must be concerned with the probability of effective implementa- tion of the proposed atcivities in ad- dition to the inherent technical merit of the specific proposals. (] The review process must provide the opportunity for the reviewers to assure a basic level of quality and feasibility of the individual activities that will make an investment of grant funds worthwhile. [-] The review process must have sufficient flexibility to cope with the variety of operational proposals sub- mitted, allowing for the tailoring of the review to the needs of the par- ticular proposal. [] The review process should en- able the staff and reviewers to view a Regional Medical Program as a con- tinuing activity, rather than a dis- crete project with time limits. There- fore, the review process should have continuity during the grant activity and should provide the opportunity to judge the development of Regional Medical Programs on the basis of results and evaluation of progress, in addition to the evaluation of the prob- able effectiveness of initial proposals. 88 Criteria The basic criteria for the review of Regional Medical Program grant re- quests are set forth in the Regulations as follows: “Upon recommendation of the Na- tional Advisory Council on Regional Medical Programs, and within the limits of available funds, the Surgeon General shall award a grant to those applicants whose approved programs will in his judgment best promote the purposes of Title IX. In awarding grants, the Surgeon General shall take into consideration, among other re- levant factors the following: “(a) Generally, the extent to which the proposed program will carry out, through regional cooperation, the purposes of Title IX, within a geo- graphic area. “(b) The capacity of the institutions or agencies within the program, in- dividually and collectively, for re- search, training, and demonstration activities with respect to Title IX. “(c) The extent to which the appli- cant or the participants in the pro- gram plan to coordinate or have co- ordinated the Regional Medical Pro- gram with other activities supported pursuant to the authority contained in the Public Health Service Act and other Acts of Congress including those relating to planning and use of facilities, personnel, equipment, and training of manpower. “(d) The population to be served by the Regional Medical Program and relationships to adjacent or other Re- gional Medical Programs. “(e) The extent to which all the health resources of the region have been taken into consideration in the planing and/or establishment of the Program. “(f) The extent to which the par- ticipating institutions will utilize existing resources and will continue to seek additional nonfederal re- sources for carrying out the objectives of the Regional Medical Program. “(g) The geographic distribution of grants throughout the Nation.” In utilizing these criteria in the review process, it was determined that the sequence of consideration of the various attributes of the proposal would be important if the objectives of the review process listed above were to be achieved. The review proc- ess, therefore, must focus on three general characteristics of the total proposal which separately and yet collectively determine its nature as a comprehensive and potentially ef- fective Regional Medical Program: (] The first focus must be on those elements of the proposal which iden- tify it as truly representing the con- cept of a regional medical program. The review groups have determined that it is not fruitful to consider spe- cific aspects of the proposal unless this first essential determination con- cerning the core of the program is positive. In making this determina- tion, considerations include such questions as: “Ts there a unifying con- ceptual strategy which will be the basis for initial priorities of action, evaluation, and future decision mak- ing?” “Is there an administrative and coordinating mechanism involv- ing the health resources of the regions which can make effective decisions, relate those decisions to regional needs, and stimulate the essential co- operative effort among the major health interests?” “Will the key lead- ership of the overall Regional Medi- cal Program provide the necessary guidance and coordination for the de- velopment of the program?” “What is the relationship of the planning al- ready undertaken and the ongoing planning process to the initial opera- tional proposal!” C) After having made a positive de- termination about this core activity, the next step widens the focus to in- clude both the nature and the ef. fectiveness of the proposed coopera- tive arrangements. In evaluating the effectiveness of these arrangements, attention is given to the degree of in- volvement and commitment of the major health resources, the role of the Regional Advisory Group, and, the effectiveness of the proposed ac- tivities in strengthening cooperation. Only after the determination has been made that the proposal reflects a regional medical program concept and that it will stimulate and strengthen cooperative efforts will a more detailed evaluation of the spe- cific operational activities be made. (1 If both of the two previous eval- uations are favorable, the operation- al activities can then be reviewed, individually and collectively. Each activity is judged for its own intrin- sic merit, for its contribution to the cooperative arrangements, and for the degree to which it includes the core concept of the Regional Medical Programs. It should also fit as an in- tegral part of the total operational activities, and contribute to the over- all objectives of the Regional Medi- cal Programs. Review Procedures Below is a chart which describes the various steps in the review process which will be applied to initial oper- ational grant proposals from each region. The first four operational grant proposals were subject to the various steps of this process. Those steps were not carried out in precisely the order and sequence provided in this chart since the first four ap- plications were used as a test situa- tion for the development of this op- erational procedure. It is also likely that further experience will lead to appropriate modification of these procedures. The following comments may help to explain this review proc- ess, which has been agreed to by the Regional Medical Programs Review Committee and the National Advis- ory Council on Regional Medical Programs. The complexity of these igrant requests and the steps in the ‘review process which seems appro- priate for their review will require as much as 6 months for the completion of the total review process in most cases. C] Initial Consideration by Review Committee—The first steps of the re- view process involve preparation for the site visit which will be conducted for each operational grant applica- tion. The first consideration of the application by the Review Commit- tee will be for the purposes of pro- viding information and comments for the guidance of the site visit team, utilizing staff analyses of the plan- ning grant experience, considerations of gross technical validity, policy is- sues raised by the particular applica- tion, and initial input on relation- ships to other Federal programs. [] Site Visit—Initial experience has indicated that a site visit by mem- bers of the Review Committee and the National Advisory Council is es- sential for the assessment of the over- all concept and strategy used by the Regional Medical Program in de- veloping the operational proposal and for assigning priorities to specific proj- ects included in the proposal. It also provides the opportunity to assess the probable effectiveness of cooperative arrangements and degree of commit- ment of the many elements which will be essential to the success of a Regional Medical Program. As the discussion above points out, favor- able conclusions on these aspects of the Regional Medical Program must be reached before it is justifiable to begin the major investment of the time of the Division staff, technical reviewers in other parts of the Pub- lic Health Service, technical consul- tants, and the Division of Regional Medical Program review groups, which is required for the assessment of the various components of the ap- plication. The site visit is not a sub- stitute for the investment of this effort but provides the opportunity to evalu- ate the cooperative framework of the Regional Medical Program and the overall probability of the success of the proposed program. (] Intensive Analysis and Technical Reviews——If the site visit report jus- tifies the investment of additional ef- fort in the review of the application, the Division staff proceeds with an intensive analysis of the specifics of the application. This analysis pro- vides the framework for obtaining specific comments from other com- ponents of the Public Health Service and other Federal health agencies with related programs, detailed com- ments from the various components of the Division of Regional Medical Programs staff, technical site visits on specific projects within the overall application when considered neces- sary, and for the assimilation of ad- ditional information from the appli- cant as a result of the site visit. The technical review of specific projects should not only evaluate the intrinsic merit of the project but should help to identify specific problems on any project which might prevent that 89 project from making a meaningful contribution to the objectives of the Regional Medical Program. Techni- cal reviews also consider the justifica- tion for the particular project budget as presented. This aspect of the re- view process presents the opportunity to consider possible overlaps and duplications with other Public Health Service programs which can be a factor in determining how much sup- port should be provided for the par- ticular activity from the Regional Medical Program grant. The oppor- tunity to raise these questions is not limited to Division of Regional Medi- cal Programs staff initiative since copies of all applications are distrib- uted to the interested National In- stitutes of Health, to all Bureaus of the Public Health Service, and to the National Library of Medicine at the time of receipt. Representatives from all these organizations are invited to meetings of the Review Committee. [1] Second Review by Review Com- mittee and Recommendation for Ac- tion—The Review Committee con- siders all of the information available concerning the application. In addi- tion to the application itself and the site visit report, a summary of all available information is presented to the Committee in a staff presenta- Flow Chart Operational Grant Review and Approval Process a Guidance for Site Visit Team Initial Staff Information re: > a. Planning grant experience b. Gross technical validity c. Policy issues d. Relationship to other Federal programs Review Committee Guidance —_—_> ———-» +9 Judgments re: 1 . Concept of Regional Medical Programs 2. Cooperative Arrangements 3. Relationship of projects, one to another and to the total 4. Approximate magnitude of support warranted 5. Quality of projects where appropriate (Prepared 2d day by site team) “ REVIEW COMMITTEE MEETING: In addition to application and —_-___> es j : Actions: site visit report: fs, FOR. CONSIDERATION. AND ACTION, 4 1. Recommendations 1. Additional information from Besa dels aE ie bid canines i il a a a. Approval applicant b. Approval with conditions from outside Division of Regional c. Deferral Medical Programs, where indicated, d. Return for revision including comments from other com- e. Disapproval ponents of the Public Health Service; may 2. Instructions to Staff have necessitated technical site visit on 3. Recommendation of an overall specific project(s) grant amount based on discussion 3. Further Staff information of specifics of the application 4. Discussion by site visitor(s) of additional information obtained subsequent to site visit In addition to above: —— > Actions: 1. Review Committee recom- 1. Recommendations mendations a. Approval 2. Further Staff information b. Approval with conditions per Committee instructions c. Deferral d. Return for revision e. Disapproval Provided to Applicant: 2. Instructions to Staff 1, Recommendation and comments of 3. Recommendation of an overall Council; if overall approval grant amount proceed to 2 ——___» 2. Recommend overall budget ceiling for grant 3. Summation of all comments derived from the review process about particular activities contained in application Applicant action: Submission of revised proposal within recommended overall budget ceiling utilizing the comments and criticism resulting from the review process Staff review of revised proposal Action: a. Award of Grant or b. Further negotiation with applicant 92 tion. The Review Committee then makes its recommendation concern- ing the application. Because of the complex nature of the applications, the Review Committee can divide its recommendation into several parts re- lating to different parts of the appli- cation. If there is an overall favor- able recommendation on the readi- ness of the Regional Medical Program to begin the operational program, the Review Committee recommends an overall grant amount based on a dis- cussion of the specifics of the applica- tion. This amount takes into consid- eration problems raised by technical reviewers, overlap with other pro- grams, feasibility of the proposals, and other relevant considerations raised during the review process. While the overall amount recom- mended is based on discussion of the specific components of the total ap- plication, the recommendation does not in most cases include specific ap- proval or disapproval of individual projects except when a project is judged to be infeasible, to be outside the scope of Regional Medical Pro- grams, to be an undesirable duplica- tion of ongoing efforts, or to lack es- sential technical soundness. (1 Review by National Advisory Council on Regional Medical Pro- grams—The National Advisory Council considers the Review Com- mittee recommendations. It has avail- able to it the full array of material presented to the Review Committee and a staff summary of that material. Further information obtained by the staff on the instructions of the Re- view Committee may also be pre- sented. The National Advisory Coun- cil makes the required legal recom- mendation concerning approval of the application, including recommen- dations on the amount of the grant. The Council may delegate to the staff the authority to negotiate the final grant amount within set limits. A recommendation of approval applies to all projects except when indicated by the Council, even though the grant amount recommended may be less than the amount requested because of the judgments applied during the review of the application or because of overall limitations of funds. ( Meeting with Representatives of the Applicant—Following the Na- tional Advisory Council meeting, the staff of the Division meets with rep- resentatives of the applicant and presents to them the recommendation and comments of the Council. If the recommendation is favorable and the Division intends to award a grant, the staff also presents the recommended overall budget ceiling for the grant along with a summation of all the comments derived from the review process concerning particular activi- ties contained within the application, including criticisms of specific proj- ects and comments about the budget levels proposed for specific projects. The staff also indicates if any proj- ects included in the application are not to be included in a grant award because of Council recommendation or Division decision based on nega- tive factors as discussed above. {] Submission of Revised Propos- al—On the basis of this meeting, the applicant submits a revised pro- posal within the recommended over- all budget ceiling, utilizing in the re- vision the comments and criticisms and technical advice resulting from the review process. This step of the process requires the applicant to reconsider their priorities within the recommended budget level and to assume the basic responsibility for making the final decisions as to which activities will be included in the operational program. Unless a project has been specifically excluded from the approval action, the appli- cant may choose to undertake an activity even if doubts about the activity were raised during the re- view process. The applicant includes such an activity with the under- standing that the progress of the activity will be followed with special interest by the review groups and will be judged in the future on the basis of results. ( Final Award Decision—Follow- ing staff review of the revised pro- posal, the final decision on the award is made by the Division Director. Additional negotiations with the ap- plicant may also take place. June 1967 EXHIBIT X Principal Staff of the Division of Regional Medical Programs, June 30, 1967 The Office of the Director provides pro- gram leadership and direction. Robert Q. Marston, M.D. Director Karl D. Yordy Assistant Director for Program Policy William D, Mayer, M.D. Associate Director for Continuing Education Charles Hilsenroth Executive Officer Maurice E. Odoroff Assistant to Director for Systems and Statistics Edward M. Friedlander Assistant to Director for Communications and Public Information The Continuing Education and Training Branch provides assistance for the quality development of such activities in Regional Medical Programs. William Mayer, M.D. Chief Cecilia Conrath Assistant to Chief Frank L. Husted, Ph. D. Wead, Evaluation Research Group 268-649 O—67-—-—7 The Development and Assistance Branch serves as the focus for two-way communi- cation between the Division and the in- dividual Regional Medical Programs. Margaret H. Sloan, M.D. Chief Ian Mitchell, M.D. Associate for Regional Development The Grants Management Branch inter- prets grants management policies and re- views budget requests and expenditure reports. James Beattie Chief The Grants Review Branch handles the professional and scientific review of appli- cations and progress reports. Martha Phillips Acting Chief The Planning and Evaluation Branch ap- praises and reports on overall program goals, progress and trends and provided staff work for the Surgeon General’s Re- port to the President and the Congress. Stephen J. Ackerman Chief Daniel I. Zwick Assistant Chief Roland L. Peterson Head, Planning Section Rhoda Abrams Acting Head, Evaluation Section 93 94 EXHIBIT XI Complementary Relationships Between the Comprehensive Health Planning and Public Health Service Amendments of 1966 and the Heart Disease, Cancer, and Stroke Amendments of 1965 A Fact Sheet from the Office of the Surgeon General, Public Health Service, March, 1967 Public Law 89-749, the Comprehen- sive Health Planning and Public Health Services Amendments of 1966, establishes mechanisms for compre- hensive areawide and State-wide health planning, training of planners, and evaluation and development ef- forts to improve the planning: art. Public Law 89-239, the Heart Dis- ease, Cancer, and Stroke Amend- ments of 1965, authorized grants to assist in the planning, establishment, and operation of regional medical programs to facilitate the wider avail- ability of the latest advances in care of patients afflicted with heart disease, cancer, stroke, and related diseases. Public Law 89-239 has been in op- eration for about a year. Public Law 89-749 is yet to be implemented. The purposes of P.L. 89-749, de- scribed in Section 2(b) are: to estab- lish “comprehensive planning for health services, health manpower, and health facilities” essential ‘“‘at every level of government’; to strengthen “the leadership and ca- pacities of State health agencies” ; and to broaden and make more flexible Federal “support of health services provided people in their communi- ties.” P.L. 89-749 asserts that these objec- tives will be attained through “an effective partnership, involving close intergovernmental collaboration, of- ficial and voluntary efforts, and par- ticipation of individuals and organi- zations. . . .” The Act establishes a new mechanism to relate varied planning and health programs to each other and to other efforts in achievement of a total health pur- pose. The law has five major sections: (J Formula grants to the States for comprehensive health planning at the State level through a designated State agency; [] Grants for comprehensive health planning at the areawide level; LJ Grants for training health plan- ners; (J Formula grants to States for pub- lic health services; CI Project grants for health services development The purpose of P.L. 89-239, as set forth in Section 900(b) of the Pub- lic Health Service Act, is “To afford to the medical profession and the medical institutions of the Nation, through . . . cooperative arrange- ments, the opportunity of making available to their patients the latest advances in the diagnosis and treat- ment of (heart disease, cancer, stroke, and related) diseases... .” The process for achieving this pur- pose is to establish regional coopera- tive arrangements among science, education, and service resources for health care . . .” for research and training (including continuing educa- tion) and for related demonstrations of patient care in the fields of heart disease, cancer, stroke, and related diseases... .” (Section (a) ) This law focuses on the cooperative involvement of university medical centers, hospitals, practicing physi- cians, other health professions, and voluntary and official health agencies in seeking ways to build effective link- ages between the development of new knowledge and its application to the problems of patients. The law pro- vides flexible mechanisms which em- phasize the exercise of initiative and responsibility at the regional level in identifying problems and opportuni- tics in seeking these objectives and in developing specific action steps to overcome the problems and exploit the opportunities. The Public Health Service sees P.L. 89-239 and P.L. 89-749 as serving the common goal of improved health care for the American people along with other Public Health Service and non-Public Health Service grant pro- grams such as community mental health centers, migrant health pro- grams, air pollution control, programs for the training of health manpower, the neighborhood health centers un- der the Office of Economic Oppor- tunity, the medical programs of the Children’s Bureau, and State and local health programs. In the States and communities, P.L. 89-749 will provide a vehicle for effective inter- action among these programs, recog- nizing as it does that the diversity of the various States and areas of the Nation is considerable, and that the specific relationships between and among programs will have to be worked out at these levels rather than through a specific Federal mandate. The planning resources created at the State and local level under Public Law 89-749 are expected to afford valuable assistance in the achieve- ment of the objectives of Public Law 89-239, other programs of the Public Health Service, and other health en- deavors in each of the States. Public Law 89-749 provides, however no authority for these planning resources to impose their conclusions or recom- mendations on any other programs, Federal or non-Federal, except for activities carried out under Section (d) and parts of Section (e) of the Law which must be in accordance with the comprehensive State health plan developed by the State compre- hensive health planning agency. The Public Health Service intends to stimulate effective interaction among these programs, recognizing that the diversity of the various States and areas of the Nation is considerable. Both P.L. 89-239 and P.L. 89-749 provide flexible instruments for es- tablishing productive relationships between these and other programs. The maintenance of this flexibility in the administration of the grant pro- grams will permit each State and re- gion to design and develop a relation- ship that is appropriate for its par- ticular circumstances. Both programs call for a close private-public part- nership. Both programs must place dependence on imaginative, reason- able local approaches to cooperation and coordination. recognize that they can only achieve Both programs their full potential by the close and complete involvement of other com- ponents of the health endeavor. A vital partnership must be developed between the Federal government, the universities, local and State govern- ment, the voluntary health interests and individuals and organizations de- signed to develop creative action for health. The Congress recognized the rela- tionship of comprehensive health planning to other planning activities. The Report of the Senate Committee on Labor and Public Welfare (No. 1655, September 29, 1966) stated: “The comprehensive planning of the State health planning agency with the advice of the council would comple- ment and build on such specialized planning as that of the regional medi- cal program and the Hill-Burton program, but would not replace them... .” “The State health planning agency provides the mechanism through which individual specialized plan- ning efforts can be coordinated and related to each other. The agency will also serve as the focal point within the State for relating comprehensive health plans to planning in areas out- side the field of health, such as urban redevelopment, public housing, and so forth.” Characteristics of These Two Important Acts The complementary relationship of the programs established by P.L. 89- 239 and P.L. 89-749 to foster de- velopment of a “Partnership for Health” is illustrated by the follow- ing outline of some of their major elements. Scope P.L. 89-239: The Regional Medical Program. To identify regional needs and resources relating to heart dis- ease, cancer, stroke, and related diseases and to develop a regional medical program which utilizes re- gional cooperative arrangements to apply and strengthen resources to meet the needs in making more widely available the latest advances in diagnosis and treatment of these diseases. P.L. 89-749: The Comprehensive Health Planning Program. To estab- lish a planning process to achieve comprehensive health planning on a Statewide basis which identifies health problems within the State, sets health objectives directed toward im- proving the availability of health services, identifies existing resources 95 and resource needs, relates the activi- ties of other planning and health programs to the meeting of these health objectives, and provides as- sistance to State and local officials, private voluntary health organiza- tions and institutions, and other pro- grams supported by PHS grant funds in achieving the more effective al- location of resources in accomplishing the objectives. Participants P.L. 89-239: centers, hospitals, practicing physi- University medical cians, other health professions, vol- untary and public health agencies, and members of the public. A re- gional advisory group representing these interests and playing an active role in the development of the re- gional program must approve any application for operational activities of the regional medical program. P.L. 89-749: State agency designated by the Governor does the planning. State advisory council advises on the planning process. Membership must include more than half consumer representation. Membership will also include voluntary groups, practition- ers, public agencies, general planning agencies, and universities. 96 The Process P.L. 89-239: LJ Establish cooperative arrange- ments among science, education, and service resources. (-] Assess needs and resources. C1 Develop pilot and demonstration projects, emphasizing flow of know!- edge in uplifting the cooperative capabilities for diagnosis and care of patients. (1 Relate research, training, and service activities. [] Develop effective continuing edu- cation programs in relation to other operational activities. (1 Develop mechanisms for evalu- ating effectiveness of efforts in the provision of improved services to patients with heart disease, cancer, stroke and related diseases. P.L. 89-749: (J Establish State and areawide health goals. (1) Define total health needs of all people and communities within area served for meeting health goals. [1] Inventory and identify relation- ships among varied local, State, na- tional, governmental and voluntary programs; regional medical pro- grams, mental health, health facili- ties, manpower, medicare — so that these programs can be assisted in mak- ing more effective impact with their resources. (0 Provide information, analyses, and recommendations which can serve as the basis for the Governor, other health programs and communi- ties to make more effective allocations of resources in meeting health goals. — Provide a focus for interrelating health planning with planning for education, welfare and community development. (7 Strengthen planning, evaluation, and service capacities of all partici- pants in the health endeavor. (1) Provide support for the initiation, integration, and development of pilot projects for better delivery of health services; develop plans for targeting flexible formula and project grants at problems and gaps identified by the planning process. Specific Planning Relationships (J There are a variety of ongoing health planning and community health organization activities. Many are supported in part by the Public Health Service, such as Regional Medical Programs (P.L. 89-239), community mental health centers, areawide health facility planning, and the Hill-Burton programs. These activities are stimulating the creation of new relationships between health resources and functions as well as as- sisting in the creation of additional resources in the stimulation of more effective performance of functions for the purpose of achieving more ef- fective attainment of identified health goals. Each of these programs re- quires participation not only by a broad range of health professionals but also by representatives of the con- sumers of health services. Each of these programs is dependent upon the interaction of the full range of relevant health interests, including those in the public sector and the private voluntary sector in achieving the particular progam goals. Comprehensive health planning (P.L. 89-749) is designed to provide assistance in the development of more effective relationships among such health programs and to provide a better basis for relating these pro- grams to the accomplishment of over- all health objectives at the State and local level. Based on similar prin- ciples of broad participation, it calls for the stimulation of all parties to contribute to the goal of insuring the availability of comprehensive health services to all who need them. © Both regional medical programs and comprehensive health planning are intended to strengthen creative Federalism—more productive mech- anisms for partnership and cooper- ation between the national, State and local levels of government, the public and voluntary private health activities, and the academic and health services environments. P.L. 89-749 will create planning resources at the State and local level. The in- formation, analyses, and plans de- veloped by these planning resources can provide invaluable assistance to State and local authorities, to volun- tary health organizations and insti- tutions, and to the other health pro- grams involved in planning and de- veloping the organization of health activities which are supported through other Public Health Service grant funds. This planning resource created under Section 314(a) will thus contribute to the more effective accomplishment of health objectives and the setting of priorities in achiev- ing those objectives through the ac- tivities supported under the other sec- tions of this Law. In addition, the resource will contribute to the deter- mination of priorities for action not only by those with public responsi- bility and accountability for health services but also by the many other health organizations, institutions, and personnel which bear the direct re- sponsibility for the delivery of health services for most of the population. P.L. 89-749 recognizes that the ac- complishment of improvements in the quality and coverage in health serv- ices, both personal and environ- mental, depends upon the voluntary participation and energies of both the private and public sectors of the health endeavor. (J The planning, operational pro- grams, and organizational frame- works being created under the Regional Medical Programs, commu- nity mental health centers, and area- wide health facility planning groups, including the advisory groups estab- lished for other programs such as the Regional Medical Programs, should serve as sources of strength and valuable assistance for the areawide and State-wide health planning coun- cils created under P.L. 89-749 and for the planning resources created under this Law. {_] The broad range of health inter- ests represented in Regional Medical Program planning efforts, along with other appropriate health interests, will be essential participants and con- — tributors to the State health planning council and to the activities of the health planning agency. When the activities of that agency address themselves to the problems of extend- ing high-quality personal health services which fully benefit from the developments in new medical knowl- edge, the cooperative involvement of these health interests in both the Re- gional Medical Program planning and development and in the planning and evaluation activities under P.L. 89-749 will make an essential con- tribution to productive relationship between these activities. [] The comprehensive health plan- ning activities will use data available from many sources including that generated or analyzed by the Region- al Medical Programs, particularly on health status of populations ef- fected, health resources, and health problems and needs. The compre- hensive health planning activities can also benefit from the experience obtained under the Regional Medi- cal Programs which have represented an exploratory effort of considerable importance in developing an en- vironment for concerted planning by many elements of the health en- deavor and in the implementation, development and evaluation of new systems for the facilitation of the de- livery of the benefits of medical ad- vance in specific disease areas through more effective means of communica- tion, education, training, organiza- tion, and delivery of health services. Many of the planning and imple- mentation activities under the Re- gional Medical Programs will have implications and applications to a broader range of health problems than heart disease, cancer, stroke, and related diseases. The mechanisms created by the Regional Medical Pro- gram can be useful in achieving the broad goals of comprehensive health stated under P.L. 89-749. Training Health Planners Section 314(c) of P.L. 89-749 au- thorizes grants to public or nonprofit organizations for “training, studies, and demonstrations,” in order to ad- vance the state of health planning art and increase the supply of competent health planners. For the first years, emphasis will be placed on increasing health planning manpower. (Until Public Health Service effort has been lim- ited to ad hoc short courses or in- now, service training.) This new activity will help meet a critical shortage faced by regional medical programs, medical centers, operating health agencies, as well as comprehensive health planning agencies about to be launched. 97 Operating Grants Section 314(d) of P.L. 89-749 au- thorizes formula grants to State health and mental health authorities for comprehensive public health service. The Act brings together a group of previously compartmented or categorical Public Health Service grants. Grant awards will depend on a plan submitted by the health agency which reflects the way in which the State intends to use the funds as part of an effort to provide adequate Public Health Services. This plan, in turn, must be in accord with the State’s comprehensive health planning. Section 314(e), authorizing project grants for “health services develop- ment,” broadens and consolidates a series of Public Health Service proj- ect grants, making possible Federal support for new and innovative proj- ects, locally determined, to meet health needs of limited geographic scope or specialized regional or na- tional significance; stimulating and initially supporting new programs of health services, and undertaking studies, demonstrations, or training designed to develop new or improved methods of providing health services. The first two of these categories of health service development grant 98 must conform to objectives, priorities, and plans of comprehensive State health planning. With the exception of the statutory requirement that the programs sup- ported by these grants must conform to comprehensive State health plan- ning, P.L. 89-749 formula and proj- ect grants bear the same relation to the comprehensive health planning process as do, for example, the opera- tional grants under regional medical programs, air pollution control, or community mental health center staffing. The operational grants under P.L. 89-239 will support an interrelated program of activities which utilize regional cooperative arrangements to accomplish the objectives of that law in the fields of heart disease, can- cer, stroke, and related diseases. The cooperative arrangements and the specific program elements are viewed by many regions as providing useful models for application to a wide spectrum of health problems which can be implemented through other means and which will have close relevance to the achievement of many of the activities supported under P.L. 89-749 and other health pro- grams. Conversely, the regional med- ical programs can benefit from the planning and operational activities of other health programs including those supported under P.L. 89-749. Other programs supported by Public Health Service funds such as mental health, migrant health, and air pollu- tion can have the same type of pro- ductive interrelationship with the comprehensive health planning pro- grams. The Public Health Service has a re- sponsibility to prevent waste of scarce resources through useless duplication. To assure the most effective inter- relationship among these and other Public Health Service grant pro- grams, the Public Health Service is currently developing informational, and review systems to promote effec- tive coordination between all of its varied grant programs. EXHIBIT XII Public Law 89-239 89th Congress, S. 596 October 6, 1965 An Act Heart Disease, Cancer, and Stroke Amend- ments of 1965. To amend the Public Health Service Act to assist in combating heart disease, cancer, stroke, and related diseases. Be it enacted by the Senate and House of Representatives, of the United States of America in Congress assembled, That this Act may be cited as the ‘Heart Disease, Caneer, and Stroke Amendments of 1965”. Sec. 2. The Public Health Service Act (42 U.S.C, ch. 6A) is amended by adding at the end thereof the following new title: “PITLE IX--EDUCATION, RESEARCH, TRAINING, AND DEMONSTRATIONS IN THE PIELDS OF HEART DISEASE, CANCER, STROKE, AND RELATED DISEASES “Purposes “Sec, 900. The purposes of this title are— “(a) Through grants, to encourage and assist in the establishment of regional co- operative arrangements among medical schools, research institutions, and hospitals for research and training (including con- tinuing education) and for related demon- strations of patient care in the fields of heart disease, cancer, stroke, and related diseases ; “(b) To afford to the medical profession and the medical institutions of the Nation, through such cooperative arrangements, the opportunity of making available to their pa- tients the latest advances in the diagnosis and treatment of these diseases ; and “(e) By these means, to improve gen- erally the health manpower and facilities available to the Nation, and to accomplish these ends without interfering with the pat- terns, or the methods of financing, of pa- tient care or professional practice, or with the administration of hospitals, and in co- operation with practicing physicians, medi- eal center officials, hospital administrators, and representatives from appropriate volun- tary health agencies. “Authorization of Appropriations “Sec, 901. (a) There are authorized to be appropriated $50,000,000 for the fiscal year ending June 30, 1966, $90,000,000 for the fiscal year ending June 30, 1967, and $200,000,000, for the fiscal year ending June 30, 1968, for grants to assist public or non- profit private universities, medical schools, research institutions, and other public or nonprofit private institutions and agencies in planning, in conducting feasibility studies, and in operating pilot projects for the estab- lishment of regional medical programs of research, training, and demonstration activ- ities for carrying out the purposes of this title. Sums appropriated under this section for any fiscal year shall remain available for making such grants until the end of the fiscal year following the fiscal year for which the appropriation is made. “<(b) A grant under this title shall be for part or all of the cost of the planning or other activities with respect to which the application is made, except that any such grant with respect to construction of, or provision of built-in (as determined in ac- cordance with regulations) equipment for. any facility may not exceed 90 per centum of the cost of such construction or equipment. “*(e) Funds appropriated pursuant to this title shall not be available to pay the cost of hospital, medical, or other care of patients exeept to the extent it is, as determined in aceordance with regulations, incident to those research, training, or demonstration activities which are encompassed by the purposes of this title. No patient shall be furnished hospital, medical, or other care at any facility incident to research, training, or demonstration activities carried out with funds appropriated pursuant to this title, unless he has been referred to such facility by a practicing physician. “Definitions “Sec, 902. For the purposes of this title— “(a) The term ‘regional medical program’ means a cooperative arrangement among a group of public or nonprofit private institu- tions or agencies engaged in research, train- ing, diagnosis, and treatment relating to heart disease, cancer, or stroke, and, at the option of the applicant, related disease or diseases; but only if such group— (1) ig situated within a geographic area, composed of any part or parts of any one or more States, which the Surgeon General determines, in accordance with regulations, to be appropriate for carry- ing out the purposes of this title; “(2) consists of one or more medical centers, one or more clinical research cen- ters, and one or more hospitals; and “(3) has in effect cooperative arrange- ments among its component units which the Surgeon General finds will be adequate for effectively carrying out the purposes of this title. “(b) The term ‘medical center’ means a medical school or other medical institution involved in postgraduate medical training and one or more hospitals affiliated there- with for teaching, research, and demon- stration purposes. “(c) The term ‘clinical research center’ means an institution (or part of an institu- tion) the primary function of which is re- search, training of specialists, and demon- strations and which, in connection therewith, provides specialized, high-quality diagnostic and treatment services for inpatients and outpatients. “(d) The term ‘hospital’ means a hospi- tal as defined in section 625(c) or other health facility in which local capability for diagnosis and treatment is supported and augmented by the program established un- der this title. “(e) The term ‘nonprofit’ as applied to any institution or agency means an institu- tion or agency which is owned and operated by one or more nonprofit corporations or as- sociations no part of the net earnings of which inures, or may lawfully inure, to the benefit of any private shareholder or individual. “(f) The term ‘construction’ includes alteration, major repair (to the extent per- mitted by regulations), remodeling and renovation of existing buildings (including initial equipment thereof), and replacement of obsolete, built-in (as determined in ac- cordance with regulations) equipment of existing buildings. “Grants for Planning “Sec. 903. (a) The Surgeon General, upon the recommendation of the National Ad- visory Council on Regional Medical Pro- grams established by section 905 (hereafter in this title referred to as the ‘Council’), is authorized to make grants to public or non- profit private universities, medical schools, research institutions, and other public or nonprofit private agencies and institutions to assist them in planning the development of regional medical programs. “(b) Grants under this section may be made only upon appHecation therefor ap- proved by the Surgeon General. Any such application may be approved only if it con- tains or is supported by— “(1) reasonable assurances that Fed- eral funds paid pursuant to any such grant will be used only for the purposes for which paid and in accordance with the applicable provisions of this title and the regulations thereunder ; “(2) reasonable assurances that the applicant will provide for such fiscal con- trol and fund accounting procedures as are required by the Surgeon General to assure proper disbursement of and accounting for such Federal funds ; (3) reasonable assurances that the ap- plicant will make such reports, in such form and containing such information as the Surgeon General may from time to time reasonably require, and will keep such records and afford such access there- to as the Surgeon General may find neces- sary to assure the correctness and verifica- tion of such mepore and “(4) a satisfattory showing that the applicant has designated an advisory group, to advise the applicant (and the institutions and agencies participating in the resulting regional medical program) in formulating and carrying out the plan for the establishment and operation of such regional medical program, which advisory group includes practicing physi- cians, medical center officials, hospital ad- ministrators, representatives from appro- priate medical societies, voluntary health agencies, and representatives of other organizations, institutions, and agencies eoncerned with activities of the kind to be carried on under the program and mem- bers of the public familiar with the need for the services provided under the program. “Grants for Establishment and Operation of Regional Medical Programs “Sec, 904. (a) The Surgeon General, upon the recommendation of the Council, is au- thorized to make grants to public or non- profit private universities, medical schools, research institutions, and other public or nonprofit private agencies and institutions to assist in establishment and operation of regional medical programs, including con- struction and equipment of facilities in con- nection therewith. “(b) Grants under this section may be made only upon application therefor ap- proved by the Surgeon General. Any such application may be approved only if it is rec- ommended by the advisory group described in section 903(b) (4) and contains or is sup- ported by reasonable assurances that-—— “(1) Federal funds paid pursuant to any such grant (A) will be used only for the purposes for which paid and in ac- cordance with the applicable provisions of this title and the regulations thereunder, and (B) will not supplant funds that are otherwise available for establishment or operation of the regional medical program with respect to which the grant is made; “(2) the applicant will provide for such fiseal control and fund accounting proce- dures as are required by the Surgeon General to assure proper disbursement of and accounting for such Federal funds ; Records. “(3) the applicant will make such re- ports, in such form and containing such information as the Surgeon General may from: time to time reasonably require, and 99 will keep such records and afford such access thereto as the Surgeon General may find necessary to assure the cor- rectness and verification of such reports; and “(4) any laborer or mechanic employed by any contractor or subcontractor in the performance of work on any construction aided by payments pursuant to any grant under this section will be paid wages at rates not less than those prevailing on similar construction in the locality as determined by the Secretary of Labor in accordance with the Davis-Bacon Act, as amended (40 U.S.C. 276a—276a-5) ; and the Secretary of Labor shall have, with respect to the labor standards specified in this paragraph, the authority and func- tions set forth in Reorganization Plan Numbered 14 of 1950 (15 F.R. 3176; 5 U.S.C. 1332-15) and section 2 of the Act of June 13, 1934, as amended (40 U.S.C. 276c). “Nattonal Advisory Council on Regional Medical Programs Appointment of members, “Sec. 905. (a) The Surgeon General, with the approval of the Secretary, may uppoint, without regard to the civil service laws, a National Advisory Council on Regional Medi- cal Programs, The Council shall consist of the Surgeon General, who shall be the chair- man, and twelve members, not otherwise in the regular full-time employ of the United States, who are leaders in the flelds of the fundamental sciences, the medical sciences, or public affairs. At least two of the ap- pointed members shall be practicing physi- cians, one shall be outstanding in the study, diagnosis, or treatment of heart disease, one shall be outstanding in the study, diagnosis, or treatment of cancer, and one shall be out- standing in the study, diagnosis, or treat- ment of stroke. Term of office. “‘(b) Each appointed member of the Coun- cil shall hold office for a term of four years, except that any member appointed to fill a yaeancy prior to the expiration of the term 100 for which his predecessor was appointed shall be appointed for the remainder of such term, and except that the terms of office of the members first taking office shall expire, as designated by the Surgeon General at the time of appointment, four at the end of the first year, four at the end of the second year, and four at the end of the third year after the date of appointment. An appointed mem- ber shall not be eligible to serve continuously for more than two terms. Compensation. “(¢) Appointed members of the Council, while attending meetings or conferences thereof or otherwise serving on business of the Council, shall be entitled to receive com- pensation at rates fixed by the Secretary, but not exceeding $100 per day, including traveltime, and while so serving away from their homes or regular places of business they may be allowed travel expenses, including per diem in lieu of subsistence, as authorized by section 5 of the Administrative Expenses Act of 1946 (5 U.S.C. 73b-2) for per- sons in the Government service employed intermittently. Applications for grants, recom- mendations. “(d) The Council shall advise and assist the Surgeon General in the preparation of regulations for, and as to policy matters arising with respect to, the administration of this title. The Council shall consider all applications for grants under this title and shall make recommendations to the Surgeon General with respect to approval of applica- tions for and the amounts of grants under this title. “Regulations “Sec. 906. The Surgeon General, after consultation with the Council, shall pre- scribe general regulations coverng the terms and conditions for approving applications for grants under this title and the coordination of programs assisted under this title with programs for training, research, and demon- strations relating to the same diseases assisted or authorized under other titles of this Act or other Acts of Congress. “Information on Special Treatment and Training Centers “Sec. 907. The Surgeon General shall es- tablish, and maintain on a current basis, a list or lists of facilities in the United States equipped and staffed to provide the most ad- vanced methods and techniques in the diag- nosis and treatment of heart disease, cancer, or stroke, together with such related infor- mation, including the availability of ad- vanced specialty training in such facilities, as he deems useful, and shall make such list or lists and related information readily available to Hcensed practitioners and other persons requiring such information. To the end of making such list or lists and other information most useful, the Surgeon Gen- eral shall from time to time consult with in- terested national professional organizations. Report to President and Congress “Suc. 908. On ‘or before June 30, 1967, the Surgeon General after consultation with the Council, shall submit to the Secretary for transmission to the President and then to the Congress, a report of the activities under this title together with (1) a state- ment of the relationship between Federal financing and financing from other sources of the activities undertaken pursuant to this title, (2) an appraisal of the activities as- sisted under this title in the light of their effectiveness in carrying out the purposes of this title, and (3) recommendations with respect to extension or modification of this title in the light thereof. “Records and Audit “gec, 909. (a) Each recipient of a grant under this title shall keep such records as the Surgeon General may prescribe, including records which fully disclose the amount and disposition by such recipient of the proceeds of such grant, the total cost of the project or undertaking in connection with which such grant is made or used, and the amount of that portion of the cost of the project or undertaking supplied by other sources, and such records as will facilitate an effective audit. “(b) The Secretary of Health, Education, and Welfare and the Comptroller General of the United States, or any of their duly au- thorized representatives, shall have access for the purpose of audit and examination to any books, documents, papers, and records of the recipient of any grant under this title which are pertinent to any such grant.” Sec. 3. (a) Section 1 of the Public Health Service Act is amended to read as follows : “SgcTION 1. Titles I to LX, inclusive, of this Act may be cited as the ‘Public Health Service Act’.” (b) The Act of July 1, 1944 (58 Stat. 682), a9 amended, is further amended by re- numbering title IX (as in effect prior to the enactment of this Act) as title X, and by renumbering sections 901 through 914 (as in effect prior to the enactment of this Act), and references thereto, as sections 1001 through 1014, respectively. APPROVED OCTOBER 6, 1965, 10:15 A.M. Legislative History: House Report No. 963 accompanying H.R. 3140 (Comm. on Interstate and Forefgn Commerce). Senate Report No. 368 (Comm. on Labor and Public Welfare). Congressional Record, Vol. 111 (1965) : June 25: Considered in Senate. June 28: Considered and passed Senate. Sept. 23: H.R. 3140 considered in IYouse. Sept. 24: Considered and passed House, amended, in Neu of H.R. 3140. Sept. 29: Senate concurred in House amendments. EXHIBIT XIII Regulations Regional Medical Programs March 18, 1967 SUBPART E—GRANTS FOR REGIONAL MEDICAL PROGRAMS (Added 1/18/67, 82 FR 571.) AurHority: The provisions of this Sub- part BE issued under sec. 215, 58 Stat. 690, sec. 906, 79 Stat. 980; 42 U.S.C. 216, 299f, Interpret or apply secs. 900, 901, 902, 903, 904, 905, 909, 79 Stat. 926, 927, 928, 929, 930, 42 U.S.C. 299, 299a, 299b, 299c, 299d, 299e, 299i. OD 54.401 APPLICABILITY. The provisions of this subpart apply to grants for planning, establishment, and operation of regional medical programs a8 authorized by Title IX of the Public Health Service Act, as amended by Public Law 89-239. O 54.402 DEFINITIONS. (a) All terms not defined herein shall have the meaning given them in the Act. (b) “Act”? means the Public Health Serv- ice Act, as amended. (c) “Title LX” means Title IX of the Public Health Service Act as amended. (d) “Related diseases’ means those dis- eases which can reasonably be considered to bear a direct relationship to heart disease, cancer, or stroke. (e) “Title IX diseases” means heart dis- ease, cancer, stroke, and related diseases. (f) “Program’’ means the regional medi- cal program as defined in section 902(a) of the Act. (g) “Practicing physician” means any physician licensed to practice medicine in accordance with applicable State laws and currently engaged in the diagnosis or treat- ment of patients. (h) “Major repair’ includes restoration of an existing building to a sound state. (i) “Built-in equipment” is equipment affixed to the facility and customarily in- cluded in the construction contract. (j) “Advisory group’’ means the group designated pursuant to section 903(b) (4) of the Act. (k) “Geographic area” means any area that the Surgeon General determines forms an economic and socially related region, taking into consideration such factors as present and future population trends and patterns of growth; location and extent of transportation and communication facilities and systems; presence and distribution of educational, medical and health facilities and programs, and other activities which in the opinion of the Surgeon General are ap- propriate for carrying out the purposes of Title IX. O 54.403 ELIGIBILITY, In order to be eligible for a grant, the applicant shall: (a) Meet the requirements of section 903 or 904 of the Act; (b) Be located in a State ; (ec) Be situated within a geographic area appropriate under the provisions of this sub- part for carrying out the purposes of the Act. D 54.404 APPLICATION, (a) Forms. An application for a grant shall be submitted on such forms and in such manner as the Surgeon General may prescribe, (b) Evecution. The application shall be executed by an individual authorized to act for the applicant and to assume on behalf of the applicant all of the obligations speci- fied in the terms and conditions of the grant including those contained in these regula- tions. (c) Description of program. In addition to any other pertinent information that the Surgeon General may require, the applicant shall submit a description of the program in sufficient detail to clearly identify the nature, need, purpose, plan, and methods of the program, the nature and functions of the participating institutions, the geographic area to be served, the cooperative arrange- ments in effect, or intended to be made ef- fective, within the group, the justification supported by a budget or other data, for the amount of the funds requested, and financial or other data demonstrating that grant funds will not supplant funds otherwise available for establishment or operation of the regional medical program. (d) Advisory group; establishment; crt- dence. An application for a grant under see- tion 903 of the Act shall contain or be sup- ported by documentary evidence of the es- tablishment of an advisory group to provide advice in formulating and carrying out the establishment and operation of a program. (e) Advisory group; membership ; descrip- tion. The application or supporting material shall describe the selection and membership of the designated advisory group, showing the extent of inclusion in such group of practicing physicians, members of other health professions, medical center officials, hospital administrators, representatives from appropriate medical societies, voluntary agencies, representatives of other organiza- tions, institutions and agencies concerned with activities of the kind to be carried on under the program, and members of the pub- Hie familiar with the need for the services provided under the program, (f) Construction; purposes, plans, and specifications; narrative description. With respect to an application for funds to be used in whole or part for construction as de- fined in Title IX, the applicant shall furnish in sufficient detail plans and specifications as well as a narrative description, to indicate the need, nature, and purpose of the pro- posed construction. (g) Advisory group; recommendation. An application for a grant under section 904 of the Act shall contain or be supported by a copy of the written recommendation of the advisory group. OF 54.405 TERMS, CONDITIONS, AND ASSURANCES. In addition to any other terms, conditions, and assurances required by law or imposed by the Surgeon General, cach grant shall be subject to the following terms, conditions, and assurances to be furnished by the grantec. The Surgeon General may at any time approve exceptions where he finds that such exceptions are not inconsistent with the Act and the purposes of the program. (a) Use of funds. The grantee will use grant funds solely for the purposes for which the grant was made, as set forth in the ap- proved application and award statement. In the event any part of the amount paid a grantee is found by the Surgeon General to have been expended for purposes or by any methods contrary to the Act, the regulations of this subpart, or contrary to any condition to the award, then such grantee, upon being notified of such finding, and in addition to any other requirement, shall pay an equal amount to the United States. Changes in grant purposes may be made only in accord- ance with procedures established by the Surgeon General. (b) Obligation of funds. No funds may be charged against the grant for services per- formed or material or equipment delivered, pursuant to a contract or agreement entered into by the applicant prior to the effective date of the grant. (c) Inventions or discoveries. Any grant award hereunder in whole or in part for re- search is subject to the regulations of the Department of Health, Education, and Wel- fare as set forth in Parts 6 and 8 of Title 45, as amended. Such regulations shall apply to any program activity for which grant funds are in fact used whether within the scope of the program as approved or otherwise, Appropriate measures shall be taken by the grantee and by the Surgeon General te assure that no contracts, assignments, or other ar- rangements inconsistent with the grant obli- gation are continued or entered into and that all personnel involved in the supported activity are aware of and comply with such obligation. Laboratory notes, related tech- nical data, and information pertaining to in- ventions or discoveries made through activi- ties supported by grant funds shall be maintained for such periods, and filed with or otherwise made available to the Surgeon General or those he may designate at such times and in such manner as he may deter- mine necessary to carry out such Department regulations. (da) Keports, The grantee shall maintain and file with the Surgeon General such prog- ress, fiscal, and other reports, including reports of meetings of the advisory group convened before and after award of a grant 101 under section 904 of the Act, as the Surgeon General may prescribe. (e) Records retention. All construction, financial, and other records relating to the use of grant funds shall be retained until the grantee has received written notice that the records have been audited unless a differ- ent period is permitted or required in writing by the Surgeon General. (£) Responsible official. The official designated in the application as responsible for the coordination of the program shall continue to be responsible for the duration of the period for which grant funds are made available. The grantee shall notify the Sur- geon General immediately if such official be- comes unavailable to discharge this respon- sibility. The Surgeon General may terminate the grant whenever such official shall become thus unavailable unless the grantee replaces such official with another official found by the Surgeon General to be qualified. O 54.406 AWARD. Upon recommendation of the National Ad- visory Council on Regional Medical Pro- grams, and within the limits of available funds, the Surgeon General shall award a grant to those applicants whose approved programs will in his judgment best promote the purposes of Tile IX. In awarding grants, the Surgeon General shall take into con- sideration, among other relevant factors the following : (a) Generally, the extent to which the proposed program will carry out, through regional cooperation, the purposes of Title IX, within a geographic area. (b) The capacity of the institutions or agencies within the program, individually and collectively, for research, training, and demonstration activities with respect to Title IX. (c) The extent to which the applicant or the participants in the program plan to coordinate or have coordinated the regional medical program with other activities sup- ported pursuant to the authority contained in the Public Health Service Act and other Acts of Congress including those relating to planning and use of facilities, personnel, and equipment, and training of manpower. (d) The population to be served by the regional medical program and relationships 102 to adjacent or other regional medical programs. (e) The extent to which all the health resources of the region have been taken into consideration in the planning and/or estab- Hshment of the program. (f) The extent to which the participating institutions will utilize existing resources and will continue to seek additional non- federal resources for carrying out the objec- tives of the regional medical program. (g) The geographic distribution of grants throughout the Nation. O 54.407 TERMINATION. (a) Termination by the Surgeon General. Any grant award may be revoked or termi- nated by the Surgeon General in whole or in part at any time whenever he finds that in his Judgment the grantee has failed in a material respect to comply with requirements of Title IX and the regulations of this sub- part. The grantee shall be promptly notified of such finding in writing and given the reasons therefor. (b) Termination by the grantee. A grantee may at any time terminate or cancel its conduct of an approved project by notify- ing the Surgeon General in writing setting forth the reasons for such termination. (ce) Accounting. Upon any termination, the grantee shall account for all expenditures and obligations charged to grant funds: Provided, That to the extent the termination is due in the judgment of the Surgeon Gen- eral to no fault of the grantee, credit shall be allowed for the amount required to settle at costs demonstrated by evidence satisfac- tory to the Surgeon General to be minimum settlement costs, any noncancellable obliga- tions incurred prior to receipt of notice of termination. O 54.408 NONDISCRIMINATION, Section 601 of Title VI of the Civil Rights Act of 1964, 42 U.S.C. 2000d, provides that no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Fed- eral financial assistance. Regulations imple- menting the statute have been issued ag Part 80 of the Title 45, Code of Federal Regula- tions. The regional medical programs pro- vide Federal financial assistance subject to the Civil Rights Act and the regulations. Each grant is subject to the condition that the grantee shall comply with the require- ments of Executive Order 11246, 30 F.R. 12319, and the applicable rules, regulations, and procedures prescribed pursuant thereto. (1 54.409 EXPENDITURES BY GRANTEE. (a) Allocation of costs. The grantee shall allocate expenditures as between di- rect and indirect costs in accordance with generally accepted and established account- ing practices or as otherwise prescribed by the Surgeon General. (b) Direct costs in general. Funds granted for direct costs may be expended by the grantee for personal services, rental of space, materials, and supplies, and other items of necessary cost as are required to carry out the purposes of the grant. The Surgeon General may issue rules, instruc- tions, interpretations, or Hmitations sup- plementing the regulations of this subpart and prescribing the extent to which parti- cular types of expenditures may be charged to grant funds. (c) Direct costs; personal services. The costs of personal services are payable from grant funds substantially in proportion to the time or effort the individual devotes to carrying out the purpose of the grant. In such proportion, such costs may include all direct costs incident to such services, such as salary during vacations and retirement and workmen’s compensation charges, in ac- cordance with the policies and accounting practices consistently applied by the grantee to all its activities. (d) Direct costs; care of patients. The cost of hospital, medical or other care of patients ts payable from grant funds only to the extent that such care is incident to the research, training, or demonstration activi- ties supported by a grant hereunder. Such care shall be incident to such activities only if reasonably associated with and required for the effective conduct of such activities, and no such care shall be charged to such funds unless the referral of the patient is documented with respect to the name of the practicing physician making the referral, the name of the patient, the date of referral, and any other relevant information which may be prescribed by the Surgeon General. Grant funds shall not be charged with the cost of— (1) Care for intercurrent conditions (ex- cept of an emergency nature where the inter- current condition results from the care for which the patient was admitted for treat- ment) that unduly interrupt, postpone, or terminate the conduct of such activities. (2) Inpatient care if other care which would equally effectively further the pur- poses of the grant, could be provided at a smaller cost. '(3) Bed and board for inpatients in excess of the cost of semiprivate accommodations unless required for the effective conduct of such activities. For the purpose of this paragraph, ‘‘semiprivate accommodations” means two-bed, three-bed, and four-bed accommodations. 0) 54.410 PAYMENTS. The Surgeon General shall, from time to time, make payments to a grantee of all or a portion of any grant award, either in ad- vance or by way of reimbursement for ex- penses to be incurred or incurred to the extent he determines such payments neces- sary to carry out the purposes of the grant. O 54.411 DIFFERENT USE OR TRANSFER: GOOD CAUSE FOR OTHER USE. (a) Compliance by grantees. If, at any time, the Surgeon General determines that the eligibility requirements for a program are no longer met, or that any facility or equipment the construction or procurement of which was charged to grant funds fs, dur- ing its useful life, no longer being used for the purposes for which it was constructed or procured either by the grantee or any transferee, the Government shal! have the Nght to recover its proportionate share of the value of the facility or equipment from either the grantee or the transferee or any institution that is using the facility or equipment. The Government's proportionate share shall be the amount bearing the same ratio to the then value of the facility or equipment, as determined by the Surgeon General, as the amount the Federal partici- pation bore to the cost of construction or procurement. (b) Different use or transfer; notification. The grantee shall promptly notify the Sur- geon General in writing if at any time during its useful life the facility or equipment for construction or procurement of which grant funds were charged is no longer to be used for the purposes for which it was constructed or procured or ts sold or otherwise transferred. (c) Forgiveness. The Surgeon General may for good cause release the grantee or other owner from the requirement of con- -tinued eligibility or from the obligation of continued use of the facility or equipment for the grant purposes. In determining whether good cause exists, the Surgeon Gen- eral shall take into consideration, among other factors, the extent to which— (1) The facility or equipment will be de- voted to research, training, demonstrations, or other activities related to Title IX diseases. (2) The circumstances calling for a change in the use of the facility were not known, or with reasonable diligence could not have been known to the applicant, at the time of the application, and are circum- stances reasonably beyond the control of the appHcant or other owner. (3) There are reasonable assurances that other facilities not previously utilized for Title IX purposes will be so utilized and are substantially the equivalent in nature and extent for such purposes. OF 54.412 PUBLICATIONS. Grantees may publish materials relating to their regional medical program without prior review provided that such publications carry a footnote acknowledging assistance from the Public Health Service, and indi- cating that findings and conclusions do not represent the views of the Service. OF 54.413 COPYRIGHTS. Where the grant-supported activity results in copyrightable material, the author {ts fre to copyright, but the Public Health Servi: reserves a royalty-free, nonexclusive, irrev: cable license for use of such material, 0 54.414 INTEREST. Interest or other income earned on pay- ments under this subpart shall be paid to the United States ns such interest is received by the grantee. EXHIBIT XIV Selected Bibliography I. Selected Historical Documents and National Reports Citizens Commission on Graduate Medi- cal Education, The Graduate Education of Physicians. Chicago, Illinois. Council on Medical Education, American Medical Association, 1966. Coggeshall, Lowell T., Planning for Medi- cal Progress Through Education. Evan- ston, Illinois. Association of American Medical Colleges, 1965. Commission on Hospital Care, Hospital Care in the United States. New York. Commonwealth Fund, 1947. Committee on the Costs of Medical Care, Medical Care For the American People: The Final Report (28). University of Chicago Press, 1932. Consultative Council on Medical and Allied Services, Interim Report on Future Provisions on Medical and Allied Serv- ices. The Right Honorable Lord Dawson of Thames, Chairman. London, England, His Majesty’s Stationery Office, 1920. Council on Medical Education and Hos- pitals, Money and Medical Schools. “hicago, Illinois. American Medical As- “ciation, Undated. ‘“ryer, Bernard V., Study Director, Life- ime Learning for Physicians: Principles, Practices, Proposals. Joint Study in Con- tinuing Medical Education, Journal of Medical Education, Vol. 37, No. 6, Part 2. June, 1962. Flexner, Abraham, Medical Education in the United States and Canada. A Report to the Carnegie Foundation for the Ad- vancement of Teaching. New York, 1910. Kidd, C. V., American Universities and Federal Research. Cambridge, Massa- chusetts. Belknap Press of Harvard Uni- versity Press, 1959. Mountin, Joseph W., Pennell, Elliot H., and Hoge, Vane M., Health Service Areas—Requirements for General Hospi- tal and Health Centers. Public Health Service Bulletin, No. 292. U.S. Govern- ment Printing Office, Washington, D.C., 1945. Mountin, Joseph W. and Greve, Clifford H., Public Health Areas and Hospital Facilities. Public Health Service Bulletin No. 42, U.S. Government Printing Office, Washington, D.C., 1950. National Commission on Community Health Services, Health Is a Community Affair. Cambridge, Massachusetts, Har- vard University Press, 1966. President’s Commission on the Health of the Nation, Building America’s Health: A Report. U.S. Government Printing Of- fice, Washington, D.C., 1952. President’s Commission on Heart Disease, Cancer and Stroke, Report to the Presi- dent: A National Program to Conquer Heart Disease, Cancer and Stroke. Vol. 1. U.S. Government Printing Officc, Wash- ington, D.C., December, 1964. President’s Commission on Heart Disease, Cancer and Stroke, Report to the Presi- dent: A National Program to Conquer Heart Disease, Cancer and Stroke. Vol. 2. U.S. Government Printing Office, Wash- ington, D.C., February, 1965. Price, D. K., Government and Science: Their Dynamic Relation in American Democracy. New York, New York Uni- versity Press, 1954. Price, D. K., The Scientific Estate. Cam- bridge, Massachusetts. Belknap Press of Harvard University Press, 1965. Sheps, C. G., Wolf, G. A., Jr., and Jacob- son, C., editors, Medical Education and Medical Care—Interactions and Pros- pects. Report to the Eighth Teaching In- stitute, Association of American Medical Colleges, Evanston, Illinois, 1961. Somers, Herman M., and Somers, Anne R., Doctors, Patients and Health Insur- ance. Washington, D.C., The Brookings Institution, 1961. U.S. Congress, Senate Committee on Appropriations, Federal Support of Medi- cal Research. Report of the Committee of Consultants on Medical Research to the Subcommittee on the Departments of Labor and Health, Education, and Wel- fare; 86th Congress, 2nd Session. U.S. Government Printing Office, Washington, D.C., 1960. U.S. Department of Health, Education and Welfare, The Advancement of Medi- cal Research and Education. (Bayne- Jones Report). U.S. Government Printing Office, Washington, D.C., 1958. U.S. Department of Health, Education, and Welfare, Surgeon General’s Consul- tant Group on Medical Education, Phy- sicians for a Growing America (Bane Report). Public Health Service Publica- tion No. 109. U.S. Government Printing Office, Washington, D.C., 1959. 103 Il. Publications on Regional Medical Programs Battey, Louis, L., “Georgia Regional Medical Program,” Journal of the Medi- cal Association of Georgia, Vol. 56, No. 4, p. 141-142. April, 1967. Burgess, Alex M., Jr., Colton, Theodore, Peterson, Osler L., “Categorical Programs for Heart Disease, Cancer, and Stroke,” The New England Journal of Medicine, Vol. 273, No. 10. September 2, 1965. Callahan, Barbara, “Those Regional Medical Programs: Where the Action Will Be,” Hospital Progress, Vol. 47, p. 57-64. December, 1966, Callahan, Barbara, “Regional Medical Programs taking Giant Steps,” Hospital Progress, Vol. 48, No. 3, p. 78-83. March, 1967. Castle, C. Hilmon, “Regional Medical Programs,” Rocky Mountain Medical Journal. January, 1967. Clark, Henry T., Jr., “Shaping the Hos- pital for its Future Role,” Hospitals, Vol. 40, p. 49-53, February 1, 1966. Clark, Henry T., Jr., “The Challenge of the Regional Medical Programs Legisla- tion,’ The Journal of Medical Education, Vol. 41. April, 1966. Clark, Henry T., Jr., “Regional Medical Programs,” Hospital Practice. March, 1967. “Conference on Regional Medical Pro- grams Examines Plans for Heart Disease, Cancer and Stroke,’ The Modern Hos- pital, Vol. 108, No. 2, p. 79-80. February, 1967. 104 “Continuing Medical Education—Does it Matter?” (Editorial), Journal of the American Medical Association, Vol. 197, No. 6, p. 505-506. August 8, 1966. Dempsey, Edward W., “The Case for Regional Medical Complexes,” Medical Opinion and Review. October, 1965. Dodge, Harold T., ‘‘Regional Medical Program for Heart, Cancer and Stroke,” The Journal of the Medical Association of the State of Alabama, Vol. 36, No. 7. January, 1967. Ebbert, Arthur, Jr., “A Look at Public Law 89-239: The Heart Disease, Cancer, and Stroke Program,” Connecticut Med- icine, Vol. 30, No. 9, p. 8-16. June 21, 1965. “Evolution or Revolution in American Medicine,” Modern Medicine, p. 8-16. June 21, 1965. “Get Together If You Want a Regional Grant,” The Modern Hospital, Vol. 107, No. 2. August, 1966. Guidelines for Regional Medical Pro- grams, Division of Regional Medical Pro- grams, National Institutes of Health, U.S. Department of Health, Education and Welfare. July 1, 1966. Hill, Lister, ‘A Program to Combat Heart Disease, Cancer and Stroke,” The En- quirer, Boonville, Indiana. November, 1965. Hogness, John R., “The Northwest Hos- pital,” Bulletin of the New York Aca- demy of Medicine, Vol. 43, No. 6, p. 495- 503. June, 1967. Hudson, Charles L., ‘‘(P.L. 89-239) Re- marks on Regional Medical Programs,” Journal of the Medical Association of Georgia, Vol. 56, No. 4, p. 154-155. April, 1967. Huston, Phillips, “Do We Need Those Regional Complexes?” Medical Econom- ics. June 28, 1965. “Innovative Plans for the Georgia Re- gional Medical Programs,” Journal of the Medical Association of Georgia, Vol. 56, No. 4, p. 149-151. April, 1967. James, George, “Implications of the Heart Disease, Cancer and Stroke Programs, an Interpretation,” Medical Opinion and Review. October, 1966. 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