ini *111pil I i Pl',OFILE: WESTERN NEW YOFK REGIOilAL I-ILDICAL PPOG'@U@14 Grantee: Research Foundation of t]-@ State University o' New Yorlc Chief Execu+,-i.vc: John R. F. In,.,all, M.D. profile originally prepared by: Spencer Colburn Ori-i.iial date: October 1969 Up-dated:. TABLE OF CO,@ITENTS 1. GEOGR-4PIiY . . . . . . . . . . . . . . .. . . 11. DEriCC@RAPIlY . . . . . . . . . . . . . . . . . 111. POLITICS. ... . . . . . . .0 0 0 3 IV. HJ.',3TOPICAL REVIEL@ . . . o . . o . . . 4 V. CO-,,tE STi'@FF. 0 . . . . . .0 . 0 8 VI. OIZGANIZATION . . . . . . . . . .o. . . . 10 Vil. PPIO-@OOSAT, - RE@IIEI.-,' PPOCT,.SS . o. . . .o . . 13 VIllo F@i DED OP,@PAf!ON',AL P.@OJECTOQ . . . . . .o . 15 Gi;o 4@l" West Cb GEO(' ,@AP-t-Y Presently, eight counties represent the geographic confines of the Western I\Tew York Regional Medical Program. Seven of the counties are New-York's western- fact.'Lhe Eighth most.count,@es-and is, in C--- -i--crt LA District liledi'cal Soc-Ldty of the State. Al@ Erie County, Pennsylvania is the other a EL,3 C, C., (C.1 c county completing this Re-ion. Oolfield CZ ctf.:(; kc roy. This is a natural forming Region.as it is 0 G'il @. 0 Clotoac,. 0 C.Pemu boarded by the Great Lakes to the West and 0 Buf North and by the-Allegany National Fgrest to the South. -Medically, the trend P071. To-ir.4 of those'counties Eastward of this C, Regi6ri--@@o@elate lo.Rochaster,.N.Y. Oz. Ivtor orsaw Orci.c.rd Pk. l@ A C) 0 V.'Zst fill$ 0 ].VA or a 0 r.Col@l a E.CoAcwd, ocz::i..: C!Iti( 0 0 A West Valley* ALLZGA?i,,, Ea,.t 01100 D Ctn-..:hs i-d@ 0 OS.DWOA OC410 4D Cheffy Crttk,) *Lto4 uxia;tvi:lg I Moyl C@0000 L;r!o Valley isc@, ii4a ll;iait4no r-;,M.Ont 0 Grtzt Va.141 Fork 03uu Cuci )"SC41# 0 Scia Ile 0 f@of I ike Chat CFalcancf OW ci-k.-ile V@c!;";::Oo 0 0 w a L;ff4: KAI.1; C.-CCI PCf;vi: to Lill;: it 0 Callyo, vr.:O,% Cii/6 iij,. DEIIOGRAPHY 1) Population: The 1968 estimated population is 1,940,000. There are two metropolitan areas - Buffalo, 600,000 and Erie, 150,000. a) Roughly 77% urban. b) Roughly 94"/. white. c) Median age: 30.3 years (U.S. average 29.5) 2) Land area: 7,200 square miles 3) Health statistics: a) Mortality rate for heart disease--461/100,000 (high) b) Rate for cancer--180/100,000 (high) c) Rate for CNS vascular lesions--107/100,000 (average) 4) Facilities statistics: a) School of Medicine, State University of New York, Buffalo 381 students. b) Roswell Park Memorial Institute - 300 bed Cancer Institute c) Fifteen Schools of Nursing - 4 degree granting d) Six Schools of Medical Tech-Pology e) One School of Cytotechnology f) Eight Schools of Xray Technology g) One School of Pharmacy h) There are 54 short term hospitals with 8,500 beds, four Veterans Administration Hospitals with a total of 3,]'00 beds, and two State Hospitals with.nearly 6,000 long.term beds. 5) Personnel. statistics: a) There are 2,623 (138/100,000) @U)s in the Region. b) There are 8,350 (439/100,000) active nurses in the Region. in all there are 13,000 nurses. POLITICS 1) Governor Nelson Rockefeller (R) 2) Senators a) Jacob K. Javits (R) 1956-1975, Member Foreign Relations, Government Operations, Labor and Public Welfare, Joint' Economic Committee, Select Committee on Nutrition and Human Needs, and Select Committee on Small Busineds. b) Charles Goodell (R) 1968-1975, Member Bankin- and Currency, Commerce, and District of Columbia. 3) Con-ressmen a) Thaddeus J. Dulski (D) 1958-1970, Member Veterans Aff.airs, and Post Office and Civil Service (Chairman) b) Richard D. McCarthy (D), 1964-1970, Mer,-,ber Public Works Committee IV. HISTORICAL REVIEW November, 1965 The Interim Coordination Committee is formed. This committee is a group of seven professional health and health planning people concerned with the development and implementation of a Regional Medical Program in Western New York. Dr. Douglas M. Surgenor, Dean, School of Medicine, New York State University at Buffalo sends "Letter of Intent" to NIH. December, 1965 Dr. George Moore, Director, Roswell, Park Memorial Institute, Buffalo, and member of the Interim Coordination Committee is named to the NAC. January, 1966 Organizational meetings continue, progress is excellent and involvement is expanding. April, 1966 - Dr. Douglas M. Surgeon, Program Coordina- tor submits application for planning grant. December 1966 - 01 Planning Award $117,026 DC April, 1967 - John R. F. Ingall, M.D. became Program Coordinator. September, 1967 - Planning supplement is submitted and request funds for the addition of three new activities to its planning grant. The three activities are: 1. A two-way telephone communication network. 2. A coronary care program. 3. A model comprehensive pulmonary care facility. The November 1967 Council felt that all the proposals presented in this application are worthy of support. Ilowever, after full and thorough discussion of this application, the qlicstions-raised and the appropriate use of plinnin,.y and operational fiii-ici@;, it -,;@is determined that a site visit be necessary so as to identify those facets which could be funded. (See February 1968 and March 1968) December, 1967 - 02 Planning Continuation - $117,026 DC February, 1968 - Site Visit: Drs. Slater, Hirs,-,hboeck, Prior, and Hall. The site visit team felt that: 1. Official representation on the RAG and special committees is well balanced. 2. Administrative arrangements for planning and program are beginning to be well developed. 3. Administrative - advisors relationships h.ad-be@ more formalized since sub- mission of application. The three project activities were reviewed in detail and it is suggested that the Communications Network and the Coronary Care Program be funded as operational pro- jects 1 and 2 respectively. (SEE March 1968' It was recommended that the proposal for a Regional Model Comprehensive Pulmonary Care Facility be a planning activity. (See March 1968) March 1968 - 01 Operational Award - $289,063 DC funds the Two-Way Communication Network and the Coronary Care Project. - 02 Planning Supplement Award - $153,559 DC To accomplish the project Planning,for Pulmonary Care and to HOWNY to hire and support additional core staff. May, 1968 The first operational supplemental grant application is submitted and presents six new operational activities and core activi- ties as follows: #3 -Chronic Respiratory Disease #4 - Immunofluorescence Service and Training #5 - An Integrated, Computer'-Based Regional Poison,ConL-rol Program #6 - Pilot Study Program in Nuclear Medicine #7 - A test of Two Continuing Medical Education Techniques #8 - Dialysis and Kidney Program #9 - Core Program Council recommended: a) Approval of Projects #3 and #4 at a decreased level of $607,159 in direct cost for the first year with recommended future support for each in the second and third years as req Ft(!J; uc b) provision of up to $50,000 each for projects #7 and #8 for one year of planning, the actual amounts to be negotiated by the Division; and. c) disapproval of projects #5 and #6 December, 1968 $405,689 DC award This award provides support for core proFr@iiii activities only. March, 1969 Operational Continuation Award for $777,763 DC, and a supplemental award of $79,738 is granted. These awards align core activity and operational projects with the intent to-eiihance fiscal management for the program. July, 1969 Supplemental. award of $563,006 for remainin- nine months of budget period. This award is to accomplish renewal of project #2 - Coronary Care Program and the implementation of project #10 Tumor Registry. Reviewers considered pro ect #2 to a standard CrU training program but expressed concern that there was no indication of long ran,,e goals or when a saturation point would be reached. Project 1,@10 ideas a well written proposal clearly establishing a need. August, 1969 In the August review cycle two projects were under consideration #11 - Medical Genetics Cl-inic; P12 - Provide Mass Media lleal.t:b. lnforeiation to Iriproverislied Resiclen't:s of the Pegion. Project IPII was d,-.'ei-red for further study by Council. The major -oyi(-ern is "relevancy." Project #12 was di.s,,-ipr)rol,7ecl @iiid revi-c,@@,,crs e>:pressed reservation recrardi.itc, priority f o i@- fundin- this type of proposal. V. CORE STAFF Coordiiiati@ll a@d Western New York Regional Medical Program 2929 Main Street Buffalo, New York 14214 (Tel.: 716/835-0728) Prop,ram Director *John R. F. iiigall, M.D. Staff Associate Director Jerome I. Tokars, M.D. (30'/.) Administra@ive Associate for Grants mana Tpent Leonard Kaye Administrative Associate for Business and Personnel (Mrs. ) 14arion Su-iuner Administrative Associate for Assessmeni-. and Evaluation Elsa Kellberg Administrative As S4 stant for Area Liaison Donald Meyers Director, Nursing Affairs (Miss) Patricia Shine, R.N. Director of Communications Anthony Zerbo, Jr. ilroject Directors Coron@r Ca e@PaF.Lam (Mrs.) Betty Lawson, R.N. Telephone Lecture Network Joseph Reynolds Yectitive Officer BIOGRAPHICAL INFOP,@fNfION 1) John R. F. Ingall, M.D. a) Born En-land, 1929 C> b) Medical Schools: - Kings College, London University - 1947-49 Westminster Medical School - 1949-52 C) Bachelor of Medicine, London - 1953 d) Bachelor of Surgery, London - 1953 e) Royal Aruiy Medical Corps - 1954-56 f) Senior Residency - Westminster Hospital - 1956-57 g) Junior Attending.Surgeon - 1958-62 h) Senior Cancer Research Surgeon, Roswell Park Memorial Institute - 1966-67 2) Jerome 1. Tokars, M.D. a) B.S., University of Buffalo - 1944 b) M.D., University of Buffalo - 1947 c) Private Practive, Internal Medicine 1951-52; 1954 -'present d) Chest Clinic Physician, Erie County Health Department 1955-64 VI. ORGANIZATION Board of Directors 1) There are 28 members who are chosen as follows: two members from the counties of Allegany, Erie, CattarauauS, Chautauqua, Genesse, Niagara, Wyoming, and the county of Erie, Commonwealth of Pennsylvania, one of whom shall be a physician selected by the County Medical Society and one to be a non-physi-cian to be selected by the county committee for each of said counties; two members representing the School of Medicine at The State University of New York at Buffalo, one of whom shall be the Dean of the Medical School or a person selected by him and one to be chosen by the Faculty of Hea t Sciences at large; two members representing the Roswell Park Memorial Institute; one member representing the Western New York Hospital Association; one member representing the Comprehensive C5 Health Planning Council of Western New York, Inc.; one member representing the Regional Health Director, Department of.Health, State of New York; one member representing the Commissioner of Health, Erie County, New York. The-foregoing persons shall then choose three members at large from the Voluntary Health Agencies not above represented; and three members at large from members of the public. 2) The members are appointed by P= (HO14NY). 3) Each of the directors shall serve for one year or until his successor is chosen. 4) Chairman 5) Meetings are held as needed. 6) Function: To conduct the business and affairs of the corporation, approves all proposals, defining program objectives, determines priorities for implementing these objectives, and review and evaluation of program activities. @p- iolial Advi o@ry@ll@i_IE_ ri\TYI 1) The Health orgaiiziti-on of New York (HOT-INY) is the Regtoiial Advi.sorv Group to,the Western New York Regional Medical Program. The Oraanizati-on is made up of the regional advisory oroup in each of the PIIP's eight counties. These.county groups vary in membership from 10 to more than 120 and'IlOliiqY membership is now approximately 250. The by-laws are constructed in such a manner that membership can be flexible to allow for greater representation as interest increases.' Membership must however, include practicing physicians, medical center officials, hospital administrators, representatives from medical societies,, other health and health related professions, voluntary and public health aaencie,@;, and representatives of other organizations,.institutions and agencies and members of the public familiar with the need for the services provided tinder the program. 2) HOVINY is also the Comprehensive Health Planning Advisory Council. f3) Members serve until replaced by the organization or interest they represent. 4) The Chairman is William Chalecke, M.D., a practicing physician. 5) Each county group meets monthl and they meet as a body annually. y 6) Functi.ons: Elect a Board of Directors for HOrv@i'Y and to review all proposals for funding by RMP. Proposal critiques by RAG are sent to the Board of Directors and the proposals committee to insure that re ional views are considered in the review process. Proposals Committee 1) The proposal committee has 14 members and they are appointd@ by The Board of Directors from the RAG inei@c)ership. 2) This committee has four responsibilities: 1) To receive recommendations on proposals from the county committees, 2) to enlist experts as consultants on proposals requiring a technical review, 3) to review all proposals and inform the Board of Directors their recommendations, and 4) to review evaluation reports on operational projects and recommend continuation support in light of the review findings. @at@e,orical a-,id Other Committees 1) The following committees have been formed: Coronary Care, Cancer, Heart, Stroke Pnd Strolce Education, Dialysis, Constitution and By-Laws and Long Raii-e Planii-Lng. 2) The responsibilities of these committees arc to set prior;-.ties, establish objectives, maize recommendations and co-nti.nue to be an .... " - I -I I integral part of the RMP's activities. 3) With the exception of the Long Ran-e Plaiini.ncr Cormnittee all have conducted at least one planning study and have reviewed a project. VII PROPOSAL REVIFW PROC-@ISS This process is schematically diagramed on the following page. Proposals are usually firsl-.received at the RNP coordinative head- quarters and from here they are sent to each of the county advisory committees. The county committees have 30 days to review each proposal before they send their critiques on to the Proposals Committee. The Proposals Committee reviews the project application incorporating recommendations of RAG (HOIMTY) and technical reviewers, if such is performed. The Proposals Committee may elect to obtain a technical review from experts in the field of Wai'ch the application is written. The Board of Directors now reviews the application with the aid of all past reviewers recommendations, and arrives at a final decision regarding subject material. The remaining steps in the review process concern themselves only with budgeted line items such as salary scales, etc. A UTHO'@ R K7"i P OFFICE COUNTY GO,@q@vfilTTEE PI% L REVI'-' BOA,ntD OF DIRECI'ORS D E A-I.J scl,--ilooi- Olz flf,,ED,'Cli",JE PR OVOST HEI.IL_'-rl--i' SCIENCES V I C E - P S. F O;- @ Pt E A R F GP@AN-I-EE FISC,@Al- A(-jENI' @H F"@;U R SE -A D VIII, FUNDED OPERATIONAL PROJECTS TELEPftONE LECTURE NETWORK Objectives: A txqo-way tle@p@oll@c @,n n@c tioli il -@t 7c)@r would link hospitals of Western New York.and Erie County, Pennsylvania to the Continuing Education Departments of the State University of New York at Buffalo and the Roswell Park Memorial Institute. Equipment would be leased from the New York Telephone Company The network could serve several purposes, such as continuing education for physicians, nurses, and the health-related professions, public education, administrative communication, consultation with experts, and contacts aiiioiacr blood banks. #2 CORONARY CAPE, PROGRAM Objectives: The proposed coronary care program would test a training technique for providing qualified nurses who will be required to staff developing coronary care units in the Region. Abproximately 80 nurses (4 groups of 20) have been selected from all parts of the Region for a combined academic and clinical course. Additional nurses will be trained. In addition, physicians would receive a condensed course to include that given to the nurse plus an opportunity to study physical, legal and administrative requirements of coronary care units. #3 CHRONIC RESPIRATORY DISEASE PROGRA!4 Objectives: Funds are requested to develop a model regional comprehensive pulmonary care proaram. A nine point program is presented, including correlated educational activities for physicians, nurses, and allied health personnel. Other selected program aspects are: early case finding, outpatient and in-patient care, rehabilitation services, intensive care for acutely 'Lll patients, and extended care services. Maximum use would be made of existing service, teaching and research resources. Four major hospitals will participate in this cooperative program. A site-team which can be any combinations of chest physicians, respiratory nurse specialist, and/or a blood gas technician will be available to all hospitals in the reaion upon request. This will act as suVpo):t consultation for problems of diagnosis, management, in-service education, staff conferences, or whichever will serve-tlie local purposes. #4 Il*f[JNOFLUORESCENCE SERVICE TRAINING objectives: This proposal would ipake available immunofluorescent antibody tests for diagnostic purposes on a regional basis. Physicians in the region would be given information on the applicability of these tests. A teaching program for pathologists and laboratory personnel from regional hospitals would be offered so as to decentralize routine tests away from the host facility. #6 PILOT STUDY PROGP@L IN NUCLEAR MEDICINE Objectives: This is a pilot or feasibility study of cost- effectiveness and patient service aspects of a nuclear medicine unit'in a small community hospital. Funds are requested to equip such a program. Program objectives include provision of diagnostic services, educational programs for practitioners as to the potential of this procedure, and the development of.a training program for isotope technicians. #7 A TEST OF TWO CONTINUING MEDICAL EDUCATION TECHNIQUES Objectives: The purpose of this proposal is "to define a research strategy which will measure the effectiveness of the central tape library and the medical juke box as teaching and consultation tools for physicians and subsequently for paramedical personnel... This study will evaluate the educational advantages and cost-effectiveness of: (a) central. tape medical library, (b) juke box medical recording, and (c) central tape versus juke box." #10 TUMOR REGISTRY Objectives: To contribute to epidemiological research, obtain clinical/pathological mortal4..ty correlations, aid in a diagnostic/treatinent method evaluation, and to establish a guide for future educational programs.