; % i @ 3 1 i 1 i i 1 1 1 i i i 'I 1 i !II i i . - !@!i ! I!i : i i il@i i ! I i : ii @ @illil il!!! 11,111"'l i ,II lii iiiiii @, i@ .@ll @ *Eo,.)i25 34 89th Congress, ist Session Ho@e Report No. 963 HEART DISEASE, CANCER, AND STROKE AMENDMENTS OF 1965 REPORT OF TIM COMMITTEE ON INTERSTATE AND. FOREIGN COMMERCE ON H.R. 3140 SvPTEmBF.R 8, 1965.-Comniitted to the Committee of the Virhole House ,on the State of the Union and ordered to be printed U.S. GOVERNMENT PRINTING OFFICE @ill 0 WASHINGTON : 1965 CONTENTS Page 5 Purnose of the bill ------------------------------------------------- 5 Nature of the proposed program 7 Ba ---------------- 8 Co ----------------------------------- ------------------------------- 9 9 and related diseases ---------------- 10 Thre ----------------------------------------- 10 Pilot f( bility studies ------------------------------ 10 10 Trai --- ----------- ----- 10 Finan, -t-i-e-n-t -c-a-r-e-; -r-cier,,al of patients ---------------- Comp 9faadvisory committees ----------------------------- 11 Approval by committees ------------------------------- 11 National Ad noil -------------------------------------- 11 Clinical research centers ---------------------------------------- 11 Diagnostic and treatment stations ------------------------------- 11 Inf6-rmation relatin to facilities --------------------------------- 12 Relationship to existingg@ederal health programs ---------------------- 12 ------ 12 P -icipation of co munity physicians-;@d-ii;lth organizations --- Emphasis upon planning -------------- ------ 13 programs ---------------------------- 14 dt3 --------------------------------- 15 -------------------- 16 18 18 22 -------- 29 hip of I Disease, and Strgk ---------------------------------------------- 43 ni 89TH CONGRESS HOUSF, OF REPRESENTATIVFS RFFORT ist Se88ion I No. 963 HEART DISEASE, CANCER, AND STROKE AMENDMENTS OF 1965 SUMIFBFB 8, 1965.@ommitted to the committee of the Whole I:Iouse on the "I-tate of the union and ordered to be printed Mr. HARRIS, from the Committee on Interstate and Foreign Commerce, submitted the following REPORT (To accompany H. R. 31401 The Committee on Interstate and Foreian Commerce, to whom was referred the bill (H.R. 3140) to amend 17he Public Health Service Act to assist in combating heart disease, cancer, stroke, and other major diseases, ha 'ng considered the same, report favorably thereon YI with amendments an recommend that the bill as amended do pass. The amendments are as follows: Strike out all after the enacting clause and insert the following: That this Act rnav be cited as the "Heart Disease, Cancer, and Stroke Amend- ments 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: "TITLE IX-EDUCATION, RESEARCH, TRAINING, AND DENION- STRATIONS I-N THE FIELDS OF HEART DISEASE, CANCER, STROKE, A.,ND RELATED DISEASES ((PURPOSES SEC. 900. The purposes of this title are "(a) Through grants, to encoura.-e ,ird assist in the establishment of regional cooperative arrangements tmong -medical schools, resetreh institutions, and hospitals for research and training (including continuing education) and for related demonstrations of patient care in the fields of heart disease, cancer, stroke, and related dise,@@-; "(b) To afford to the medical profession ,tnd the medical institutions of the Nation, through such cooperative arrangements, the opportunity of making ,Lvailable to their patients the latest advances in the diagnosis and treatment of these, diseases; and "(c) ]3v these means, to improve generally the health manpower and facilities available to the '\ation, and to accomplish these ends without interfering with tli(@ P@tterns or the methods of financing, o@ patient care or professional practice, or with the adniini@t ration of hospitals, and in cooperation wit li practicing physicians, I 2 HEART DISEASE, CANCER, AND STROKF, AME-NDMENTS OF 19 6 5 medical center officials, hospital administrators, and representatives from appro- priate voluntary health agencies. "AUTTIORIZATION OF APPROPRIATIONS "SEc. 901. (a) There are authorized to be appro 000 for the fiscal year ending June 30, 19 ng June 30, 1967, -and $200.060,000 for the nts to assist public or nonprofit prii-ate uni titions, and other public, a in conduct- ing feisibiut n ent, of regional med at es for dei section for in grants iinti end of the ar for which t @priation is niarle. be for pa of the cost of the planning which the app made, exec t that anX ilt-in (aspdetermined eqi may not exceed 90 per ce in "(c) Fun( be available to pay the cost of b patients e t to the extent it is, as determined incident t t'@ ch. training, or demonst ation activit which are enco of'this title. No patient any facility incident to t wth funds appropliat4 d to such facility by a practicing It DEFINITIONS "SEc. 902. For the purposes of this title- I term 'regional medical program' means a coonerative arrangement '(a) The among a of public or nonprofit private institutions or agencies engaged in research, gtrroiunping, diagnosis, add treatment relating to heart disease, cancer, or stroke, and, at the option of the applicant, related disease or diseases; but only if such group- ,Y(') is situated within a. composed of iny part or parts en-eral determines. in accord- of any one or more States, ance with regulations, to t I iiig out the purposes of this title; "(2) consists of one or more medical centers, one or more clinical research tnd centers and one or more hospitals; , 'g(3) has in effect cooperative arrangements arpong its component units which the Surgeon General finds will be adequate tor effectively carrying out the purposes of this title. (b) The term 'medical center' means a medical school and one or more hos it aaffiliated there-with for teaching, research, and demonstration purposes. '?(C)OIIThe term 'clinical research centei,means an institution (or part of an institution) the primary function of whict is research, trai and demonstrations and which, in connection therewith, proN @igh- quality di., tment services for inpatients ar I' (d) Tb means a hospital ts defined in r other health faci al capability for diagnosis -ind trettinen is Supported and tugin4 established under this title. (C) -Tli tpt)lied to anv institution or agency means institution owned arid operated by one or more nonpront, corporate part of the net earnings f which intires, or may 01 lawfully ilklire, to the any vrivite shareholder or individual. (f) Tli(@ term 'coi includes alteration, major repair (to the extent permitted by regtilat remodeling and renovation -of existing buildings (iii- chiding initial eqiiip thereof), and replacement of obsolete, bitilt-in (,is determined in accordance Nvith regulations) equipment of existing buildings. 11 GRANTS FOR PLANNING "SEc' 903. (a) The Stiriz,eon General, upon the recommendation of the National Advisorv Council On 13egional '.\Iedicaf Programs established by section 905 erre(i to .ts the 'Council'), is authorized to make grants (hereafter in this title r(f HF 1) F3TRO" AMENDMENTS OF 1965 3 ,ART DISEAF3E, CANCER; AN 0 or nonprofi universities, medi@ johools, research institutions, t private an(, istitutions to assist them in ap ication therefor Ve approved only ,Dsid Pursuant to any such "(I) reason assurances ths - din accordance with ' - in be,, aid an der; 'nt w' is fiscal gr the -cab such Ipph 0, thi (2) re Surgeon procedures as ar, control andI sement of and g Federal General to aF funds; (3) reasonable assurances that the @pD]icant will make such reports, in it such .as the Surgeon General may from inforrastion ,Inch form and containing oh sonably requir . and will keep such records and afford s@' time to time r .General MSY find necessary to assure the access thereto such reports, correctness ani 91(4) a satis that the aPPI d the instil isory group administra; health a ith acti to be e and agen( of the ith the Carr on UU progriL need for the se icei provided under the program. . ILISHMENT AND OPERATION OF I&EGIONAL MEDICAL PROGRABDS "013ANTS FOlt ESTAB "Szc. 904. (a) The Surgeon General, upon the r commendation of the Council e' o- ities, medical is authorized to e grants to publi r nonprol es and schools, research .and other public or in itutions to assis estab in and eq a] der this se only eon Ge' if by the dvif and C( orted by reason e assursue that- purst used only fo the purl paid vi ns of tb reiul a t unting to assure dis- unds; such form and containing me to time reasonably require, an i access thereto as the Suigeon Gei find necessary to assure the correctness and verifica- tion of such "(4) any I 0 n chanic employe or or subcontractor const payments pursuant be pi not less than@hose n in the e- ith the et 0 Secretai I et n at c- p l@ of the of June 13, U.S.C. 276c). 4 HEART DISEASE, CANCER, AND STRO@ AMENDMENTS OF 19 6 5 49 NATIONAL ADVISORY COUNCIL ON REGIONAL MEDICAL PROGRAMS "Szc. 905. (a) The Surgeon General, with the a proval of the Secretary, may ivil service laws, a 9ational Advisory Council on Council @U consist of the Surgeon General, d twelve members, not otherwise i-n the regular States, who are leaders in the fields of the funda- ciences, or public affairs. At least two of the tieing @hysi6ians, one shall be outstanding in the of heart disease, one shall be outstanding in the of cancer, and one shall be outstanding in the A diagnosis, or treatment of stroke. Each appointed member of the Council shall hold office for a term of four except that any member appointed to fill a vacancy prior to the expiration 40 term for which his predecessor was appointed shalf be appointed-for the remainder of such term, and except that the terms of office of th-e 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, andfourattheendofthethirdyearafterthedateofappointment. Anappointed member shall not be eligible to serve continuously for more than two terms. it (e) Appointed members of the Council, while attending meetings or confer- ences th6re-of or otherwise Serving on business of the Council, shall be entitled to receive compensation at rates fixed by the Secretary, but not exceeding $100 per d'ncludng traveltime, and while so Serving away from their homes or regular ay'' p-es of bugine he may be allowed travel expenses, including per them in lieu K oried by section 5 of the Administrative Expenses Act of la ss t of 'Subsitence,as aut 1946 (,5 U. S.C. 73b_2) for persons in the Government service employed inter- mittently. 11(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 adininistra- tion of this title. The Council shall consider all applications for grants under this title and shall make recommendations to the Sugon General with respect to approval of applications for and the amounts of grants under this title. REGULATIONS "SEC. 906. The Surgeon General, after consultation with the Council, shall vering the terms and conditions for approving title and the coordination of programs assisted research, and demonstrations relating i under other titles of this Act or other Acts of Congress. (I INFORMATION ON SPECIAL TREATMENT AND TRAINING CENTERS "SEC. 907. The Surgeon General shall establish, and maintain ,)n a current basis, a list or lists of facilities in the United States equipped and staffed to pro- vide the most advanced methods and techniques in the diagnosis and treatment of heart disease, cancer, or stroke, together with such related information, in- eluding the availability of advanced specialty training in such facilities as lie deems useful, and shall make such list or lists and related information readily available to licensed practitioners and other persons requiring such infori-nation. To the end of making such list or lists and other information most useful, the Surgeon General shall from time to time consult with interested i)atioiial profes- sional organizations. REPORT "SEC. 908. On or before June 30, 1967, the Surgeon General, ifter consultation with the Council, shall submit to the Secretarv for transmission to the President and then to the Congress, a report of the activities under this title together with (1) a statement of the relationship between Federal fintncitig and fitiincitig from other sources of the activities undertaken pursuant to this title, (2) an appraisal of the activities assisted under this title in ihe light of their effecti%,Clicss in etirry- ing out the purposes of this. title, and (3) recommendations with respect to extension or modification of this title in the light thereof." SEC. 3. (a) Section 1 of the Public Health Service Act is amended to read as follows: "SECTION 1. Titles I to IX, inclusive, of this Act may be cited as the 'Public- Health Service Act'." HEART DISEASE, CA-NCER, AND STROKE AMENDMENTS OF 1965 5 (b) The Act of Julv 1, 1944 (58 Stat. 682), as amended, is further amended renumbering title IX (as in effect i)rior to the enactment of this Act) as title and by renumbering sections 901 through 914 (as in effect prior to the enact- ment of this Act), and references thereto, as sections 1001 through 1014, respectively. Amend the title so as to read: A bill to amend the Public Heafth Service Act to assist in combating heart disease, cancer, stroke, and rehited diseases. PURPOSE OF THE BILL The principal purpose of the bill is to provide for the establish- ment of programs of cooperation between medical schools, clinical research institutions and hospitals by means of which the latest advances in the care of patients suffering from heart disease, stroke, cancer, and related diseases may be afforded through locally adminis- tere( programs of research, training, and contini@ing'editeation and related demonstrations of patient care-. The reported bill authorizes appropriations of $50 million for the current fiscal year, $90 million for fiscal year 1967, and $200 million for fiscal year 1968. NATURE OF THE PROPOSED PROGRAM The program authorized tinder this legislation would provide support for cooperative arran enients which would link medical-schools ad& affiliated teE s, with their ed capa- bilities in diagno iid treatment, research centers, local co: itals and pra( These cooperative arran ents would be tablished locallv with the participa of existing it medical practitioners. These cooperative arrangements would mit the interchange of personnel and patients and would provide f, the more effective flow of information concerning the latest advances in diag- nosis and treatment. There are several proarains currently beina conducted in the United States similar in nature to the programs proposed under the bill. For exftm-i)le, the Bin hiini Associates program, which was begun in 1931, links' Tufts Cofiege Nledical Sch6-ol and the New Eng- lajtd Medical Center in Boston with a substantial number of commu- iiit@-vhospitalsin',\,IaineandotheriNewEnglandStates. Thisprograin provides continuing education for Dhvsicians, traininiz for medical specialists, and supporting services tor' doctors in the lew England area in paramedical fields. Through programs of patient referral, patients whose illnesses or disabilities ar@ bevoiid the capabilities of local hospitals obtain care tinder this progr;m at facilities where ip.ore advanced equipment and techniques are availabk, A similar prograi-n is carried Out by the Department of Post Grtid- iiate Medicine at Albany Medical C6',Iege of 'Onion Uiiiver,;;ity. This pi-oL,.ram links the medical school to ix community hospitals- loct-tted tis far as 90 miles from Albany and involves weekly visits of medical school faculty to the participat uct of teaching rounds and conferences in hos Oil particular problems of medical education, nce and advice to hospital administrators tind medical educa- 0- 1115 6 HEART DISEASE, CANCER, AND STROKE AMENDMENTS OF 19 6 5 tion, and provision for guest speakers. In addition, the Albany Medical College conducts a widespread network of continuing medical education utTizing two-way radio hookups currently involving 72 ho tes. dean of the University of Wisconsin m vice president of Marquette ul Wis.- in testifying in favor of the programs conducted by their two m tinumg education, referraf of patients from throughout the St e to the tiachi-ng'ho 'itals of the m.edical SP school, and intensive training of personnel. The representatives of these two schools testified that this- legislation would greatly aid them in carrying out and expanding the programs which they are currently conducting. The statement of Dr. Robert C. Hardin, dean of the College of Medicine, Universitv of Iowa.(p. 478 of the hearings), points out: "The plan embodied in the bill reflects the steps in the Revolution of a fleidbli pattern of medical research, education, and service which was begun 'm- Iowa back in 1915. In 1915 the Iowa Legislature created a @entral institution for the care of crippled childre@, which was so successful that in 1919 the program was extended to include all diseases and all age group?. A @edical school was built around this nucleus, serving as a regional medical center, which has become a center of 1,400 beds with an annual impatient admission rate of a full-time staff of 300 physicians, a body of 500 medical 1)ostdoctoral training programs all medical specialties, and a educational program prodUCMg Dioscientists. The Iowa program involves thoroukh and complete communication and co- operation with the physicians in the region served by the medical center. Dr. Hardin's statement points out further that in addition to training associated with the care of referred patients, seminars and @cal demonstrations are conducted at the center. The staff carries out teaching demonstrations throughout the State. Closed circuit television programs are conducted daily for hospitals in Des Moines and Cedar Rapids. Postgraduate programs are conducted in these hospitals. Through cooperation with -the Iowa Medical Society, a preceptorship program ope@ates where medical students between the ]Umor and senior ears work with practitioners throughout the State. 7rhe success of t Iowa demonstrates the potentials inherent in the I( ted herewith. The approach of the bill, as amended is consistent with the summary contained in Dr. B ased upon the 50 years' experience with this program in Iowa. That summary is as follows: Our experience shows in summary that: (1) The develop- ment of categorical, highly specialized areas in a medical center enhances the practice of medicine in the region served and will affect the quality of medical care as @eR as the uch development need not interfere with the uantity. S of medicine in the area but should attract physicians semirural area-like Iowa nL, ar.mem- a7rea. This is extra d for such HEART DISEASE, CANCER, AND STROKE AMENDMENTS OF 19 6 5 7 is the key to success of the plan. d in the bill will allow for the th a diversity necessary to the (4) Trained manpower is the complexes and must be t building of research and treatment cen PIE inns preserve in the medical schools a suitable envir4 for oth fundamental educa- tion and the later specialized training. Both are absolutely necessary for the modern medical center. (5) There will be need for continued planning after actual implementation of the program. BACKGROUND In March 1964 the President appointed a Commission on Heart Disease, Cancer, and Stroke to "recommend steps to reduce the in- cidence of these diseases through new knowledge and more complete utilization of the medical knowledge we already have. A complete list of the members of this Commission is set out in appendix A to this report. Under the chairmanship of Dr. Michael DeBake@, the Commission received testimony from 166 expert witnesses and con- sulted 60 health organizations and associations. There were 45 Commission hearings, over 7,500 pages of testimony prepared, and great amounts of data collected iin& analyzed. After 9 months of study, the Commission submitted its final report in December 1964 and made a number of specific as well as general recommendations. The report of the Commission points out that over 70 percent of all deaths occurring in the United -States each year result from these three dread diseases. It was pointed out that these three diseases' effects upon our economy cause close to $30 billion each year in losses due to premature disability and death. In order to carry out certain of the Commission's recommendations which require legislation, the administration prepared legislation, H.R. 3140, which was introduced January 14, 1964.- Hearings were held on this bill on July 20, 21, 22, 23, 27, 28, 29, and 30, 1965. Testimony favorable to the legislation was submitted on behalf of the American Heart Association, the American Cancer Society, the American Hospital Association, the American Public Health Associa- tion, the Association of American Medical Colleges, several deans and.officers of medical schools, and others. Testimony in opposition to the legislation was submitted by the American Acade@iof General Practice, the American Medical Asso- ciation, several St-ate medical societies, and others. The bill as reported bv the committee differs substantially from the bill as originally introduced, althouah it will still carry out the basic objectives of the introduced legislation. Numerous changes have been made in the bill, and on September 2, 1965, the American Medical Association issued the following press release: [News release, American Medical Association, Sept. 2, 19651 ClilCAGo.-Dr. James Z. Appel, president of the American Medical Association, disclosed toda@that an AMA advisor@ committee met this week with resident Johnson and Secretary of Health, Education, and Welfare Gardner to 8 HEART DISEASE, CANCER, AND FTROKE AMENDMENTS OF 19 6 5 discuss the medical profession's concern about a bill that would have established regional medical complexes for the treatment of heart disease, cancer, and stroke. The AMA president said he was gratified that as a result of these meetings some 20 amendments to the bill recom- mended by th@ AMA committee were accepted by the administration. "Many of the changes are substantial and will allay many of the f-ears the medical profession had about the original bill, he said. Dr. Appel said he had appea4ed to President Johnson to defer action on H.R. 314-0- because the likelihood of its assage was jeopardizing AMA's attempts to work with the secretary of HEW to the extent of providing consultation in the preparation of regulations and in other actions relating to the medicare law. "President Johnson told us he could not support defer- ment of the bill, that he favored it and wanted it passed in this session of Congress," Dr. Appel said. "President Johnson did, however, direct Secret Gardner to work with the AMA committee to make the biless objectionable." ',We feel we were successful in getting a number of major cb,,n!; in the bill which will help to preserve the high quality Of in cal care and the freedom of h;spitals and physicians." Dr. Appel said he told administration officials iha-t passage of the 6iiginal bill would have been followed by a severe adverse reaction from ,he medical profession. "Most medical leaders felt that the establishment of the series of medical complexes initially conceived would have had a more serious long-term effect on medical practice than the recently enacted medicare law," Dr. Appel said. "The alreadv existing misgivin e members of the medical profession -about the relationships with the D'epartment of HEW would have b4 en markedly aggravated by the enactment of another lam so stronolv opposed by physicians," Dr. Appel told the ecretary of "While we still cannot support H.R. 3140, as amended, because we believe it still introduces un undesirable concept, the amendments agreed to bX the administration-and now adopted by the House Committee on Interstate and Foreign Commerce-certainly make the bill much less objectionable." The committee feels that the bill herewith reported has been modi- fied in such a fashion to meet the principal objections to the introduced bill, and the reservations about it expressed during the hearings. COMMITTEE AMENDMENTS The amendment as reported by the committee is a complete sub- stititte for the text of the bill. 14timerous changes were made in the introduced bill by the committee designed generally to better define the scope of the program and to clarify the intent so as to guarantee that the legislation will accomplish its purposes without interfering HEAliT DISEASE, CANCER, AND STROKE P-MENDMI.ENTS OF 19 6 5 9 with the atte rns, or the methods of financing, of patient care or p professional ractice or with the administration of hospitals. Re.@ mo dic@ progi-a?ns.-Several of the changes made by the committee are primarily semantic changes, designed to allay. mis- understandinlys which have occurred with respect to the provisions of the introduced bill. The introduced bill referred to t(regional medical complexes-." Although Secretary Celebrezze explaine,& that it is not intended by this program to construct a number @f buildings, but that the intent rather is to utilize existing facilities and provide through the legislation for arrangements among existing facilities, many persons have expressed to the committee the fear that this a innvolve ultimately construction of large Federal facilities pro r u vhoout the United States, staffed-vn'th Federal em- mi y downgrading local hospitals and g scatter t 0 Flo @w th e local medical y acihtles. The committee has therefore substituted for the phrase "regional medical complexes" the phrase "regional medical programs," so as to emphasize the local nature of this program, its limit e, and ci the fact that the primarv thrust of the Orogrim will b@tose-foap litate nLr institutions. Complementary to this definition of "construction." Under the s term in section 902(f), the onlv construe- under the reported bill will be alteration, nd renovation of existing buildings, and . ment of exrsting bifildings. o new construction will per under this defiZition. It is intended by the committ that where new construction wiU be required in connection with any local program established under the bill, Federal participation in the costs of such new construction must come from sources other than this legislation. Witnesses on behalf of the administration specifically requested that authorization for nenv construction be retained in the bill. The justification for this position was that new construction will be required in some areas in order to meet the requirements of the legislation for establishment of a program. The lack of this authority for now construction should create no serious problems during the 3 years authorized in this legislation, and when a request is made for extension of this legislation in the future, the committee will review this question again, along with other questions. Heart disease, cancer, stroke, and related dis@a8es.-The introduced bill would have established a program for heart disease, cancer, stroke, and other major diseases. The committee has deleted the phrase "other major diseases" and substituted "related diseases." if at sometime in the future it is in the public interest to establish a pro am for major diseases not related to heart disease, cancer, or s ke, the Congress will give consideration to the establishment of such a program at that time; however, at present the committee feels that this progra@ should be limited to the three named diseases and other diseases wnich are related to them. For example, it is known that there is an apparent relationship between diabetes and heart disease. A program of research, training, and demon- strations relatiilg to heart disease which did not include work on diabetes would, of necessity, be incomplete; therefore, the com- mittee feels that research sh'ould be conducted into diabetes under 10 I-IEARTDISE@SF,,CANCER,ANDSTROKEAMENDMENTSOF1965 the program dealing with heart disease insofar as diabetes is related to heart disease. 'similarly, certain kidney diseases are associated with high blood pressure which, in turn, is associated with stroke and heart disease. The committee feels that insofar as they relate to stroke or heart disease, these kidney diseases would be a propriate for coverage under the programs established under the biif Cooperative actirdies.-In several places, the introduced bill provided for "coordination" of programs, arrangements, or activities. Fears were expressed to the Committee that these words implied some pos- sibility -of Federal control of medical practice. The committee feels that there is no basis for these fears; 'however, in those places where "coordination" is referred to, the committee has substituted "cooperationy' instead. In the opinion of the comniittee this does not constitute a substantive change in the legislation. Three-year program.-The committee has amended the bill to reduce the scope of the program from 5 years to 3 years; has retained the proposed $50 million authorization for current fiscal year and has changed the open end authorization for the remainder of the program to an authorization of $90 million for fiscal 1967 and $200 million for fiscal 1968. Pilot projects znd feasibility 8tudies.-Under the introduced bill, these funds were authorized for grants for "planning, Establishing, and operating regional medical complexes for research, trainin@, and demonstration activities." The committee has changed this language so as to further delineate the scope of the program. As reported, the bill authorize for grants for "plan- nmg, for conducting feasibilit fc operatingpilotprojects for the establishment of r programs of research, training and demonstration is intended that, there will be careful planning before the program is approved in any area. The committee has been informed that there are eight programs in the United States already in the planning stage which are well enough worked out so that it -.vill be feasible to start, these programs withiw-n the fairly near future. The committee anticipates that if these programs are authorized they Nvill proceed, step-by-step, and provide in this fashion experience on the basis of which similar pro- ams may be established in other areas of the country if on the ffasis of the pilot projects authorized under the bill the establishment of further prooTams appears feasible and desirable. Training.-A further amendment adopted by the committee pro- vides increased oniphasisfoii training, by including this concept in the heading in the proposed new title IX. Financinq of patient care: referral of patients.-As introduced, the bill prohibited the use 'of @pproprfat6d funds to pay foi- the care of patients except to the extent that such care was incident to research, training, or demonstration activities. A clarifying amendment has been adopted which requires that the research, training, and demonstration activities referred to be those encom- passed by the reported bill. The committee has itdopted a further amendment to this provision, which provides that no patient sliall be furnished care incident to research, traininL,. or demonstrations at any facility unless he has been referred to t@t facility by a i)racticin(@ physician. This is a customary arrangement at, reseiiriti institutions. For example, at the Clinical Center at the Ntitioiial Institutes of OF 1965 HEART D16EASE, CA-NCER, AND STROKE AMENDMENTS Health, in Bethesda, '-\Id., all patients who are treated are referred to the Clinical Center by practicing physicians. Except in the case of those patients who, after referral to a facility by a @ra@ticing physician, receive care incident to research, training, or etnonstrations, the legislation will have no effect one way or tfie other upon the patterns, o@methods of financing, of patient care. Composition of advisory c;mmittee8.-The conunittee has been ver 'y carefuf to establish machinery in the bill which will insure. local control of the programs conducted under the bill. The conunittee wishes to empihsfze that this legislation is intended to be admin- istered in such a way as to make no cbanae whatsoever in the tradi- tional methods of furnishing medical car@ to patients in the United States,ortomethodsoffinan-cingsuchcare. Asoneriaeansofinsuring this result, the committee has changed the provisions of the bill of advisory groups on the local level to cation may be received and acted on tinder have designated an advisory grou which cians, medical center officials, Eospital ppropriate medical societies, ves of other organizations con- i th the program, Su health officials, and members of the public. APiiroval by advisory committees.-The committee has amended the bill i6 provide that before any application submitted for establishment in any area may be approved by the advisory group must have considered the ed its approval. er. similar, change has been I the'National Advi;-ory Council. er e 1 as in ory Council was req'uired to be established t( advise t] geon General, to consist of 19 members of whom I was required tc I outstanding in the study, diagriosi§, and treatment of heart disease; I in cancer, and 1 in stroke. The com- mittee has added to this requirement a requirement that at least 2 of the members, in iddition to the 3 previ6lisly referred to, shall be practicing physicians. In addition,-the Surgeon General may not ma e a grant for any proo,,ram tinder the bill, except upon the recom- mendati@on of this Council. Clinical research centei-s.-The introduced bill provided that one of the component agencies required to be included in any area pro@ram was req@ired to be a "categorical research center." The committee has changed this concept to provide that the research center mil.st be a "clinical resetirch centers This change in terms is intended to change the emphasis of the research programs conducted under the legislation to tfie end that such programs will involve patient care. Diagnostic and ti-catinent stations.-The introduced bill also provided that one of the components of local programs was to be one or more "diagnostic and tretitment stations," defi-ned as a "unit of a hospital or other health facility providing specialized, high-quality, diagnostic and treatment services." The committee has deleted this concept from the bill. and his provided that as a substitute for the diagnostic and treatment station-, the local program must include participation by hospitals. 12 HEARTDISEASE,CANCER,ANDSTROKEAMENDMENTSOF1965 Information relating to facilities. One further amendment was add4;d by the committee, -providing that the Surgeon General shall establish, and maintain, on a curre@t basis, a list Or- lists of facilities in the United States providing the most advanced methods and tech- niques in the diagnosis and treatment of heart disease, cancer, or str'oke. The pur@ose of establishing these lists, and maintaining them on a current basis, is to Drovide in one place information for doctors in the United States concerning the 61aces where patients pres nting unusual problems can best be cared'for. The lists would also indicate the availability of advanced specialty training. In order to make sure that these lists are most useful to doctors, the Surgeon General is required to consult from time to time with national professional organizations such as the American Medical Association and others. RELATIONSHIP TO EXISTING FEDERAL HEALTH PROGRAMS This program is not intended to supersede or absorb existinc, Federal health programs but rather to build on the capabilities created and strengthened through those programs., The many developments in the health field stimulated bv previous ie -blished Lyislation have esta the opportunities for the furtKei advances which would be possible under- -this legislation. Other lirams have helped expand the supply of @ealth manpower and Yarcoi ties and have helped to support the extensive medical research activities in our great @edical schools, universities, and research institutions. The recional medical pro- grams pygposed in this bill will draw upon the iicc,)mplisbments of these existing programs. EMPHASIS UPON PLANNING The committee has h@@rd persuasive testimony that hastily planned programs, which would inevitably lead to poor performa@i, n-dght resillt if this program were implemented quickly upon too large a scale. Moreover, it is apparent that sound prog.ra@s viiii require extensive discussion amoni the local participating institutions and in medical and other professional organizations. he committee intends that, for these reasons, planning assisted by grants under section 903 . s attention of the National Advisor will receive the most senou y Council on Re ' al Medical Programs piid of the Surgeon General. gion Since in some areas of the country extensive Planning and organization have already been carried out, -this attention to iiitensive planning should not pre nt the fundingdurin@ first year of ilot or deiiion- , @he p stration projec e Council is satisfied that a high standard of planning he The project tinder this progrtiiii will be quit( vaned, depeYI4 reg ion of the country and the nature o p the existing t robleins to be overcome in a sparsely settled regio@.in which mos of tile hospitals are relatively small an( are separated b, considerabl distances are clearly different from those to be met in co areas. Because of the L-reat variation and also becaus ces exist in disease incidence in diff eren locations, th@ ( the opinion that several pilot project should be iinde r ation available to the committee stig HEART DISEASE, CANCER, AND STROKE AMENDMENTS OF1965 13 gests that perhaps 8 communities have plans sufficiently advanced to begin their programs initially and that @1) niiolit be activated during the 3-year period authorized. Planniniwill not, of course, be a one-shot operation in this pro am. Where a regional medical program has been funded under this legisla- tion and therefore moves from the stage of plaiininz to establishment and operation, it is obvious that planning must continue. As the program continues in the area which it serves, experience will indicate changes that might be desirable, requiring furtl;er planning. Illustrative of the foregoing is the experience of the Bingham Associates program, which started in a very limited fashion, and, step by step, changed as experience indicated desirable modifications. This program began in 1931 with the support of the operating costs of a 20-bed diagnostic unit within the Boston Dispensary to be related to the 50-bed Oxford County (Maine) Community Hos'ital, 200 miles p away. The plan was to bring Boston to the Rumford Hospital through a series of 10 one-moiitli clinics conducted by the staff of the Dispensary. Paramedical supporting services were established. As the program grew, an intermediate level was created in the relationship between Rumford and the Dispensary, which was the -bed Central Maine General Hos 190 pital in Lewiston. This hospital became the immediate referral center for problems beyond the scope of the Rumford Hospital and seven other area hospit@ls. Especially difficult cases were then referred to Boston. Later ihe Easterri Maine General Hospital in Bangor was designated as the referral center for eastern Maine. By 194@, 28 Maine hospitals were linked around the 2 regional centers. Tufts 'L%Iedical School became affiliated with this program, which now extends to community hospitals in other northeastern 3tates. PARTICIPATION OF COMMUNITY PHYSFCTANS AND HEALTH ORGANIZATIONS The committee notes tile tigreeiiient itmong all concerned that full participation of practicifig physicians is required for the successful operation of this program. 'I'lie Pre.,;ideiit's (!oiiiiiiission on Heart Disease, Cancer, and Stroke stressed tlitit its recommendations were designed to strengthen tlie.L\'atioti's health resources, to make the best use of the resources we now liaN-e, and to assist tile doctor in practice in the care of his patient. LNoteAvortliy ad%,@itice,-;, made voluntarily and individually by ryietnbers of the medical profession, have greatly improved tile citre of patieD S suffering from heart disease, cancer, and stroke, ,is well its many )ther diseases. Efforts to improve and to modernize the itiforniatiol of physicians and the facilities thev req@ire lia%,e been @)tit,,taii(incIr. Yet., there tire limits to what, unaided, local communities call do and what iiidin@idital physicians can accomplish. The committee believes that inaiiiy improvements will be possible tinder this program. Among these are iiiiproveitients in diagnostic laboratories;, assistance in acquiring and operating iienv, complicated, and expensive equipment, and participation in the developing communication linkages reporting adverse drug reactions and transmitting bioinedictil information rapidly from the research laboratory, through the library to the doctor. 14 HEARTDISEASF,,CANCER,ANDSTROKEAMENDMENTSOF1965 Despite these advantages, the committee has noted several ways in which-additional assurances against undue interference should be pro- vide.d. To assure that local physicians and institutions are a-de- quately represented, the committee has stipulated that "practicing Physicians, medical center officials, hospital administrators, representa- tives from apprODriate medical societies, voluntary health agencies, representatii@ o-t other organizations * * *" should be included as members of the local advisory group and that at least two members of the National Advisory Council should be practicing physicians. The committee has also @pecified that patients provided care under this program shall have been referred by a practicing physician. And to assure that the locally initiated programs, whether supported by Fed- eral grants or not, are adequatelv- known to the medicil-professi@n, the committee has required that the Surgeon General pu'blish a list of facilities eqUiDDed-fiRd staffed to provide the most advanced methods and techniques in heart disease, cancer, and stroke so that such lists may be available to licensed practitioners requiring such information. CONTINUING EDUCATION-EXISTING PROGRA'MS The committee was impressed with the great advances that have been made in recent years- in the continuing education of physicians. For example, in the last 5 years the number of formal courses reported for annual @ting in the American Medical Association publication, "Continuing Education Courses for Physicians" has increased almost 50-percent from 1,105 for 1961-62 to 1,641, for 1965-66. In addition, the number of Physicians attending these courses has also increased markedly. For-t@e year 1954-55 the number of registrants in courses offered by medical schools was approximately 19,060. It is conserva- tively estimated that over 100,000 physicians will take some formal course offered during the coming academic year. In addition to for-Mal courses, all medical-orgaiiizatioiis hold scien- tific meetings; medical education programs are conducted on radio or television networks; medical iouinals, books, abstracts, summaries, and monographs are available; in addition to hos 'tal staff meetings, journal clubs, therapeutic conferences, and scienti@c lectilreships. In May 1961, the board of trustees of tbe American Sledical Association appointed a joint study committee to "spell out the dimensions of a program of continuing medical education." The SI)ODSors of the study included in addition to the AMA, the Association of American '.%,Iedic-al Colleges, the American Hospital Association, the American College of Phvsicians, the American Academy Of Pediatric--,, the American Psyebiatric Associvitioii, the American Col- lege of Obstetricians and Gynecologists, and the American Academy ot'General Practice. When this committee submitted itb report, ti prograii-i was initiated to create a nationwide "ujiiversity without %@-alls" responsible for developing educational programs of the Iiigli@,it cali.her for all practicing physicians. Work On the recommendations of this coin- mittee is progres--,iilg. BEAI?T DISEASE, CANCER, AND STROKE A@MFNDMENTS OF 1065 15 CONTINUING EDUCATION-FUTURE NEEDS Notwithstandiitg the progress that has been made in the fields of continuing education, it seems to be generttlly recognized that the flood Of new information developed through ii-iedical research presents extremely difficult problems for physicians seekifi_u to remain abreast of the latest advances. III addition, it is frequently difficult for a busy physician who is working 60 to 80 hours tt week to ttike the time to travel sometimes great distances to attend continuing education courses. Frequently the physical n is faced with the choice between providing for the in@mediale day- o-day needs of his patients and the necessity of taking time away fro n his practice and the patients who need his services to pursue cont nuing education pr ogram' It is intended by the committee that the programs Iabli@iled pur- suantto 'this legislation will include provisions to assist busy physicians in pursuing programs of continuing education. The rapid advances of medical knowledge in recent years and the prospect of further advances through our extensive research p@grains place a premium oil the effective and convenient transmission Of that knowledge to the medical practitioner and the development of the advance& skills necessary for utilization of the new knowledge. This is especially true in complicated disease fields such as heart disease, cancer and stroke where the difficulties of diagnosis and treatment present tremendous challenges to the skills and Capabilities of our Wgl;lv trained physicians. It is well-recognized Sy all physicians that medical education is a lifetime process. Our American pbysicitliis have done an outstanding job of bringigg to the benefit of tfieii patients the many breakthroughs in medical science during the last several decades. But the magnitude of this need for et)iiti@ed learning is highlighted by a widely held estimate that the best medical education and training can becoi-ne obsolete ii, 5 vears unless the physician makes a very determined effort to coiitit@ue his education. - physician needs every help nd assistance in The hard-workin, a meeting his need foil it C'Oiitiniiiii,, education. 'rare reported bill will help to provide foil significant improvements in the effectiveness of LI continuiiiL, education i-ogi-itins and will provide assistance for.the p expansion of these PI-Otrranis and the development of iipw, creittive z, ai;proacties to the problems of postgraduate medical education for pvvsicians. - The operation of programs tinder the bill will provide, the continuity which is essential for any effecti%-e education program. A well- planned program! @itli continuity between the separate elements will enable the practicing physician to i-nake the most effective use of his valuable time I)v it. -liiillL, that etieli time lie participates in the pro- gram lie will his earlier educational experiences. The bill will help to provide -,taff, facilities. communication systems, and ctirrictiltliii Claiming whicit are iieces@ry for the development of a c ntiniiing education pro(,riiiii -%Nitli tile essential element of coii- tiiiitity. Increased iceessibilitly is another desirable attrii)tite of more effec- t.i%,e coiitiiiiiiii(@ education program,,. In tcliievinL, (lie objective of providing assistance to tile busy practicing physician, the bill will help to J)rox-i(le i(l(litioilal opl)orttiilitie,-, foil Ptil-ticipatioll ill well- 16 HEARTDISFASE,CANCER,ANDSTROKEAMENDMENTSOF1965 planned and substantial programs which do not require the practicing' @hysician to leave his piactfce and go off to a distant medical center for an extended period7of time. Biestablishing continuing relation- ships between tfie medical center and the community hospital, the proposed program under the bill can provide contin'w'ng Education ,Ograms that are integrated with the activities of the community gos@ital and readil -v accessible to the practicing physician. Witmn the-community hoipital settinL,. the education programs can be de- signed to have real-and immediate relevance to- the problems faced by the practicin p@yocian i 9 p his daily activities. All ol these continuing education activities will be enriched by the constant interaction between the medical center, with its advanced capabilities for research and specialized service, and the community hospital setting, with the dai-to-dav involvement of the practicing physicians in the problems of delivering good medical service to the patient. This interaction will help to mammize the contribution of each element of the medical service team in bringing the latest ad- vances to the benefit of the patient. EFFECT ON SUPPLY OF PHYSICIANS One of the objections to the legislation expressed to the committee was that it would have an adverse effect upon the supply of scarce medical manpower, and would discourage physicians -from locating in suburban or rural areas. These objections appear to have been based in part upon the theory that the programs established by the bill would involve massive construction 6f ii'-ew facilities which w- ould be required to be staffed with doctors and other medical personnel admittedly in scarce supply. Since, as has been pointed out, the bill does not provide for such a program, it will not, have the effect feared in this area. In fact, the program established under the bill should serve 'to a degree'to alleviate somewhat manpower shortages existing in the m&iical field and should encourage more physicians to settle and practice in suburban and rural areas than is now the case. The bill as reported will provide a more effective means for contiii- uin, education of present medical manpower and for the training c' of 11 it hly skilled medical specialists. The pro@ams provided in the bi s ould lead to the development of new and creative methods to carry the benefits of scientific progress to the local practicing physician. By making the latest advances more widely available, existing medical manpower can be more effectively utilized; better spe ialty c training can be made more widely available so that the medical manpower already engaged in the treatment of the difficult problems presented by heart disease, cancer, and stroke can be afford-ed better opportunities to be trained in the latest techniques. The programs established under the bill make medical practice in rural or semirural areas more attractive through providitiL' a varietv of links on a continuing basis between medical ceiiter@'and con@- munity hospitals. The planning already done in States with large rural or. semirural populations such as Virginia, North Carolina Vermont, Wisconsin, Maryland, and Alabama shows that the pro- gram can have great benefits for such areas. Rather than central- izing medical capabilities in the great medical centers, the prograi-n HEARTDISEASE,CA.NCER,ANDSTROKEAMENDMENTSOF19r35 17 will provide the incentive and the means to break down the gap which too often exists between the medical centers and the practicing phy- sicians in the communities who remain the first line of defense in th@ fi lit against diseases. -rhg e erience in the State of Iowa reinforces the above statements expi to the effect that the establishment of regional medical prog@m-, under the bill will lead to (1) improved utilization of scarce mecticai man- and (2) to encouraging phv ans to locate in rural and semi- Powle-rareas. The statement 0 ean Hardiman rura f of the College of Medicine, University of Iowa, concerning the experience in Iowa is as follows: III atdditiott, in our experience, more formalized techniq'ues for continuing education should be developed and intensively utilized. For example, the urologists of tile State come to mv department monthly for seminar and clinical demonstra- tio"ns. Likewise, the anesthesiologists frequently attend weekly ineetinLTS and seminar-, in the department of anes- thesi6log.@: . Si!nilar programs are cttrried out 'in all the various ciinicai areas. Our staff moreover is ready at all times to carry out reaching demonstrations in appropriate aFe&,; throughout the State. We have developed closed circuit television for a series of hospitals in Des Moines and r the continuing education of interns and prao e have extende&the dean's committee concept of the Vet ans' Administratioi@ to corn- munify hospitals in Des Moines and Cedar Rapids to he in developing postgraduatte rogritins in ttie!;e hospitals PI Of Clie stliffs of We have appointed members these liollpitttls to our ftClltv. who participate in these educational programs We have set up it Drecei)tor,,hip program in which the mediettl students between their junior and senior year work' closelv ith geiieritl practitioners throughout t" and intimiltely -,i, State. This hit,, been done through tile close cooperation and help of the Iowa Medical Societv and hit,,; been of tremendous ng the niedicitl - aid in eductiti ,ttideiits with regard to coiii- munitv inedict),l problems and has ttlso been it @i-einetidousI.v stimutatii)g think for the genera T)I.ttctitioiiers of the State. As we review tile development ;f highly specialized areas in the college of medicine, such its tile Crippled Ciiildren's Center in 1915 and, subsequently, the %-alrioll,, "I)eciktlized ,ervices of ophtlittlmology, otola@ligol@gy, urology, iieii- rologv, itnestl@esiology, sur;,rery, and i-ne(ileitie, we note thitt tile stronger ttiev have become, the sti-oii 'Yer and better been the pretence of i-ne(li(!itie in the State. Both specialists iLnd general pritctitiotiei@- ltit%,e been attracted to tile itreit it,, !t result. F'or exattiiple, in tirologv alone there This been itti increase froiTi 5 urologists,; priLcti@iiig in tile Statte in 1936 to ttltnost 50 itt the present time. All of these iti-e ititiiiiittely ii,,;-.,ocittted with our deptirtiiieiit. Tile same is true in otliei- specialties. It is important to note that there lilts been no significant increase in populattioii during this 30-Nlettr period. 'riie '\franc its it result of the Biii,,Iiatni A,,,,oci@tte.-; experience in lilt., been Similar to that in Iowa. 18 HEARTDISEASE,CANCER,ANDSTROKEAMENDMENTSOF1965 EFFECT ON NONPARTICIPATING SCHOOLS AND HOSPITALS Fears were expressed during the hearings that the enactment of this legislation would adversely affect med@ical schools and hospitals which do not participate in the programs set forth in the legislation. It is true that those medical schools which participate in the pro- grams conducted under this legislation will aerive -added strength for their programs of research, training, and continuing education, and to that eitent will be in a somewhat more favorable position then medical schools which do not participate in the progra@. The fact that one medical school may benefit from a; program whereas "another school -,vhich does not participate is not benefited is not, in the com- nuttee's opinion, a valid reason for saying that neither institution should be Permitted to participate. The committee recognizes that there are medical schools in the United States which are in much stronger positions insofar as con- cerns their facilities, endowments, and sources of income than are others. The committee has recently reported, and the House has 3141, a bill designed 6 deal @th'this precise problem, provement grants for all medical schools vement grants directed in large measure i financialfy the weakest. ultimate goal for all medical schools'to e sort contemplated by the reported bill, but some may to participate, and otheis may become in- volved in the prog a later stage. With respect to t t of the pro-,ram on hospitals, the committee oints hat the intent of this program is not to centralize medical pa ab in a single, or a few, medical centers within a region, but e- p rathe extend the capabilities now present in the medical centers more widely throughout the region. Participation in the program will,. of course, be on a voluntary basis. In the initial phase of a pro- L,ram. not all institutions may i6sh to rticipate. In fact, siiiceit is pa Contemplated that the program will proceed on a step-by-step basis, it is unlikely that P.U institutions in an area will participate- in the program initially, although they may join in as the program develops more fully in an area. It is expected by the committee that the plan submitted for programs in any .ven aiea will be established in such a manner as to add to the medicagil capabilities of the area, and will not adv ely affect existing hospitals and other medical resources. The @rs bill i@ not intended to support p@ogranis in competition with existing activities and one of the strengths of the bill is that it provides the flexibilit necessary to accommodate the many different patterns of y i medical inst tutioris population characteristics, and organizations of medical services found in this Natioii. SECTrON-BY-SF,CTio,@N, DESCRIPTION OF 'CHE COMMITTFF, SUBSTITUTE AMFNDAIENT This legislation has been reported by the committee with an anieiid- ment in the nature of a substitute. ' The following is a section-by- m section description of the committee substitute amendment. Section 1 provides that this legislation ma be cited as the "Heart y Disease, Cancer, and Stroke Am@ndments of lgc)511. HEARTDISEASE,CANCER,ANDSTROKEAMENDMENTSOF1965 19 Section 2 amends the Public Healtli Service Act by adding a new title IX at the end thereof. The followin"7 is it section-by-sectioii description of this proposed new title: TITLE IX-EDUCATION, ItESEAItCH, TRAINING, AND DE-vtONS-TitATIONS IN THE FIBI.DS OF BEAI?T DISEASE, CANCER, STIIO[IE, AND I(FI,ATED DISEASPS .-qection 900. Purposes This section sets forth the purposes of this proposed new title. They are (a) to encourage and'assist in the establishment of regional c operative arrangements among medical schools, research institit- tio@s, and hospitals for research and training (incltidine contitiuicnl education) and for related demonstrations of patient cai-@in the fiells of heart disease, cance@, stroke, and related diseases; (b) thus to afford to the medical profession and the medical institutions of the Nation tile opportunity of making available to their patients the. latest advances- in the diagnosis and treatment of such diseases; and (c) b-v these means, to improve generally the health manpower and facilities available to the Nation, and to accomplish these ei@ds.withotit interfering with the patterns, or the methods of financing, of patient care or professional practice, or with the administration of hospitals, and in cooperation with practicing physicians, medical center officials, hospital administrators, and representatives from appropriate voltin- tary health agencies. Section 901. Azithorization of appropriations Subsection (a) authorizes- the appropriation of $50 million for fiscal year 1966, $90 million for fiscal year 1967, and $200 million for fiscal year 1968. Amounts appropriated would be used for grants to assist in planning, in conducting feasibility studies, Staid in operating pilot projects for the est@tiblistinietit of ief,,ioiittl iiiedicil pi-o(yrii-ns of research, training, and demonstration tctivities for carrying out tile purposes described above. riie i-ecipieiit of tiny grant iiiidei- this proposed new title would have to be it public or nonprofit igeiicy or institution. Sunis appropritite(i would be a%-ttilztl)le for making grants until the end of tile fiscal yetit- followill(.f the fiscal yeiii- foi- which they tire appropriated. Under stibse(-tion (b), tiiy su(@ii grant could be used fol' part 01- all of the cost of the plttniiiiig or otliei- tctivities with to which the apl)li(!atioli is itittde, except tliatt tiny such gi-ttiit with i-espe(@t to construction of, or provision of bitilt-in (.is determined in ti(-coi-(Iaiice with regulations) equipment, foi-, ilty facility could not exceed 90 perce it of the cost of such construction oi- equipment. Undei- subsection (c), fluids itppropi-itited pursuant to this proposed new title would not be itvttiltible to pay tiny cost of patient cati-e except to the extent sticl) citre, as determined in accordance with regulations, is incident to those research, training, or demonstration activities which tire encompassed by the purposes of the title (de- scribed above); iioi- could tiny patient be furnished tiiy 'care tit tiny facility incident to research, training, or demonstration-, e@it-i-ied out with such fluids, unless lie were i-efei-i-ed to stl(,Il fertility I,)Y at pi-iteticifig I)IIysicittil. 20 HEARTDI@SE,CANCER,ANDSTROKEAMENDMENTSOF1965 Section 902. Definitions This section defines a number of terms which are used in the terms are used, as defined in section 902, ection description. a cooperative am" is defined to mean of public or nonprofit private institutions training, diagnosis, and treatment or stroke an&, at the option of the c ease-,-, but only if such iroiip (1) is ai SI' aphic area, composed of any part or parts of any one the Surgeon General determines, in accordance with regi be appropriate for carrying out the purposes of the title; of one or more medical centers, one or more clinical research centers, and one or more hospitals; and (3) has in effect cooperative arrangements among its component units which the Surgeon General fi7nds will be adequate for effectively Durposes of the title. "'Vel'coaultienfer" is defined to mean a medical school and one or more hospitals a@ted with it for teaching, research , and demonstra- tion purposes. "O,Iini'cal esearch center" is defined to mean an institution (or part of an institi n of which is research, training of specialist: which, in connection therewith, proiiaes sp ality diagnostic and treatment services for inpatien ents. ,,H70spit general, tuberculosis, and other types of d other hea facilities, in which local capability for supported and augmented title-. However, the torn @s e any hospital furnishing 1- ciliarv care. '@gonprofit" as applied to any institution or agency, would mean an institution or agenda which is owned and operated by one or more non rofit corporations or associations no pait of the net earnings of p which inures, or may lawfully inure, to the benefit of any private shareholder or individual. "Construction" is defined to include alteration, i-naior repair (to the extent ermitted by_ regulations), remodeling and 'renovation of existing buildings (including initial equipment thereof), and replace- ment of obsolete, built-in (as deterniiTiea in accordance with regtila- tions) equipment of existing buildings Section 903. Grants for planning Subsection (a) authorizes the SurL-eoii General to make grants to assist in planning the development of regional medical programs. Any such orant would have to be recommended bv th@ Nitional Advisory Council on Regional '.\Iedical Programs (see description ol sec. 905 below). Under subsection (b), each recipient of a grant, would have to make an application therefor to the Surgeon General which would, in turn, have-iobeapprovedbyitbeSiirgeonGeii,,@ral. Hecoijldapproveany such application only if t contained or was supported by (1) reasonable assurances with i-e,;pect@ to the use of, fiseftl control of, and accounting for, funds received by the recipient uiidei- sect,ion 90:3, and with respect HEARTDISEASE,CANCER,ANDSTROKEAMENDMENTSOF1965 21 to certain reporting and recordkeeping, and (2) a satisfactory showing that the applicant has designated an advisory group, to advise the applicant (and the institutions and atenciues participating in the r@iulting regional medical program) in orm rating and carrying out the plan for the establishment and operation of such regional medical program, which advisory group would have to incl@de practicing physicians, medical center offi@ials,, hsspit@l administrators, repre- sentatives from appropriate medical societies, voluntary health agencies, and representatives of otherlorganizations, institutions, and agencies concerned with activities of the kind to be'carried on under the program and members of the public familiar with the need for the services provided under the program. Section 904. Grants for establishment and operation of regional medical programs Subsection (a) would authorize the Surgeon General to make arants to assist in the establishment and operation of r nal medical programme including construction and equipment of i'oageiiolities in con- nection therewith. As in the case of planning g@n@s, any grant for the establishment and operation of a ggional me(ticat prog would at jam have to be recommended by the ional Advisory ouncil on ReL,ional Medical Programs. fJ'nder subsection (b), a zi-ant under section 904 could only be made on the basis of an application which was approved by the Surgeon General and recommended by the advisory group described in con- nection with section 903(b). Each such application would have to contain or be supported @y'reasonable assurances with respect to use of funds, prevention of supplanting of funds foi, the establishment or operation of rep-ional medical programs, fiscal contr.01 and fund ae,- counting for fu@ds received under section 904, (@ei-tain reporting and recordkeeping, and protection of laborers and mechanics e-ulployed in connection with construction assisted with a grant under section 904 (Davis-Bacon provisions). Section 905. National Adi@ory (oitncit on Regional Medical Programs This section provides for a National Advisory Council on Regional '.\Iedical Programs. The Council would consist of the Sur con 9 General, who would be chairman, and 12 members, not otherwise in the regular full-time ei-nploy of the United States, who are leaders in the fields of the fundamental sciences, the medical sciences, or public affairs. The 12 members (other tlittn the Surgeon General) would be ap ointed by the Surgeon General, with the approval of the Secretary of @ettltll, Education, and Welfare, without regard to the civil service laws. At least two of the appointed members would be practicing physicians, one would be oiit!;t-andiiig in the study, diagnosis, or treat- meiit of heart disease, one would be otitstandiiio, in the study, dia- L nosis, or treatment of cancer, and one would be outstanding in tge stilA.&F diagnosis, or treatment of stroke. The term of appointed '7 meni@ers of the Council would be 4 years except for some initial e 'lio would be appointed for a shorter period to achieve appoint es w staggering of terms. No appointed member could serve continuously for more tlittn two terms. Provision is made for coi-npeiisating members of the Council while engaeed in its business (including travel time) and fol- illiowilil, travel expenses, including per dieiii in near of subsistence, Aviiile s@engaged. ii7,-- -,4 i)3- Ill 0 TSOF 1965 22 HEARTDISFASE,CANCFR,ANDSTROKEAMENDMEN The Council would advise and assist the Surgeon Gener I in the with preparation of regulations for, and as to policy matters arising respect to, the administration of this new title. The Council would consider all applications for grants and make recommendations to the Surgeon Geniial with respect to approval of applications for and the amounts of such grants. Section 906. Regulations Under this section, the Surgeon General, after consultation with the Council, would prescribe geiieral regulations covering the terms and conditions for approving applications fo ants and the coordination of. ams assisted under title IX @'trh programs for training, reseparrofh, and demonstrations relating to the same diseases assisted or authorized under other provisions of Federal law. Section 907. Information on special treatment and training centers This ection requires the Surgeon General to establish, and maintain on a a list or fists of facilities in the United States equi to provide the most advanced methods and p te@hm, sis- and treatment of heart disease, cancer, or stroke such related information, including the avail- ability specialty training in such facilities, as he deems useful. He would her be requir@d to make such list or lists and related information available to licensed practitioners and other persons requir I IQ information. For the purpose of making such list or lists a@ other information most useful, the Surgeon General is directed to consult from time to time with interested national professional organizations. Section 908. Report Under this section, on or before June 30, 1967, the Surgeon General, after consultation w ,ith the National Advisory Council on Regional Medical Programs, would be required to s.ub.mit to the Secretary of Health, Education, and Welfare for transmission to the President and then to the Congress, a report of the activities under title IX of the Public Health Servic@ Act-together with (1) it, statement of the relti- tionshit) between Federal financings, and fiiitincing from other sources of the Activities undertaken pursuant to such titi-e (2) tin appraisal of a the activities assisted under such title in the light of their effectiveness in carrying out i@@'purposes, and (3) recommendations with respect to extension or iiio(liticat'-ion of such title in the light thereof. Section 3 of the bill makes certain technical amendments required by the inclusion of i-i ileNv title in the Public Health Service Act. AGENCY REPORTS DEPAItT@,11,@NT OF HEALTH, EDUCATION, ANI) WELFARE, Jtil?l IOP lD65. Hon. OREN HAIlItt',, Chairman, Committee on Inte),,,4tate and Foi-eiflii (om7net-ce, House oj Representatives, 14'ashington, D.C. DEAR MR. CHAIRIIAN: This letter is in response to your request of Febniarv 15, 1965, for a report On H.R. :3140, a bill to iiineiid the Public Ilealtli Service Act to assist in combating, heart disease, cancer, stroke, find (other ititijor (liscitsez. HEARTDI-SEASE,CANCER,ANDSTROKEAMENDMENTSOF1965 23 W , e t!rge enactment of this bill. In his health message of January 7, 1965, the President recom- mended "legislation to authorize a 5-year program of project gants to develop multipurpose relgyional m@dical complexes for an all-out attack on heart disease, cancer, stroke, and other major diseases." H.R. 3140 embodies the administration's legislative proposal to carry out the President's recommendation. Since we are scheduled to testify on Tuesday, July 2 on this legis- detadedq' lation, we shall not burden this r@port with a justification of its provisions. We are, however, enclosing for your convenience a section-by-section analysis of the bill. Sincerely, WILBUR J. COHEN, Undcr Secretary. SECTION-BY-SF,CTION ANALYSIS OF THE BILL To encourage greater activity in the medical sciences and to insure that the most recent advances in the medical sciences are made avail- able to the public, this bill authorizes the Surgeon General to make grants to public or nonprofit private institutions and agencies to assist them in planning and development, and in establishment and =atiuotn regional medical complexes. Each such complex would ' of tit e, for the area for which it is established, an administrative framework for coordinating existing and (where necessary) newly constructed medical facilities devoted to research, trail and treatment relating to heart disease, cancer, or str major diseases. The component units of each such ( pr(;vide-without interfering with existinz patterns ( f Natient care, professional practice, or li6spital administrat on- emonstrations to thecomniunityof the most advanced specialized equipment and services available for patient care. SECTION 1 This section provides that the bill may be cited as the "Heart Disease, Cancer, and Stroke Amendments of 1965." SECTION 2 This section adds a new title IX, "Regional -%Iedical Complexes for Research and Treatment in Heart Disease, Cancer, Stroke, and Other Major Diseases," consisting of sections 900 to 907, to the Public Health Service Act. Section 900. Purpo8e This section provides that the purposes of title IX are (1) to assist in the establishment of regionally coordinated arrangements for re- search, training, and demonstration of patient care related to heart disease, cancer, stroke, and other major diseases, (2) to enable the medical profession and medical institutions to make available to their in diagnosis and treatment of such dis- these ends without interfering with ient care, professional practice, or hospital 24 IJEARTDI.SFABF-YCANCFR,AND8TROKE@MFNDMFNTSOF1965 1. Autho@ion Of appropriations or fiscal sectim 90 I)riation Of This section authorizes the ,ppro. 8, 1969, as may be neCe-r 6f.plan- 1966 and sucb Sums - assist in Meetil es f or and 19', operating of out the ning, . e dimoust@atlo 0 a or pro- researe Grants to go perce@l I the cost p@os not be used to pay @ion may . I there rch, training@ or demon- the coE Of c strs,tio ac mplex 902. Definitions edical co . I section erms regional m -. and ould define. t it lidiagno tic T section @.. I I )) Thesrepional categoric' n. aLen e' (in (gm( ci s "nonprofi titutions. o@ - tree cen- ould consL' categoricai researc me( or more n in research, e,IUI ters,. relatir trainy ail d or s ai ox tive framem ters ve aE co wow and Si SI but WOU nel I Oh an treatment I stations wou also atment serv ant to ttIs woul@ as tl training function by or conn e ol the commun@ ues for 69nv, latest inforniat pyactitiona a group ?f treatm4Tt-, ornplexii is defined to mean for, ies enga@@d in reslarcl'2 I ions or agenc@ e-,,pe-,r,, pul nt relating to heart qisease, be ol tra found by t@ (1) is or appll( m0 Sil rn treat"'( of its con ,Iediciii school a@d tion of center" for teftellilig, research, The affiliate 0e or more is defined @o metill an insti-, rainiiig., anJ research, zed high-quality difLgno8tic t service@. station" is 4@fined to "'Oaf' 1 treatmen@ jo I of wilich @s to supper t)rii,nary t@ll"@ I L)y prod to ditianosi@@111(itretitilielt r seilvi(.es. llo-,t HEART DISEASE, CANCER, AND STROKE AMENDMENTS OFi965 25 Section 903. Grants for planning and development onsultation with This section authorizes the Surgeon General, after c the National Advisory Council on Medical Complexes, to make grants to public or nonprofit private, universities, medical schools, research institutions, an(f other publie, or nonDrofit private agencies and institutions to assist them in planning'regionil medicar complexes. The Surgeon General may approve an i 1)@lication fo such a grant only upon reasonable assurances that will be used onl-y for the purposes for which paid, will provide adequate procedures for fiscal control a of funds, (3) the applicant will make such reports, @nd will keep an afford access to such recor s, as the Surgeon General requires, and (4) the applicant will provide ation of an advisory group to advise the applicant an( al medical complex in formulating and carrying out the stablishment and operation of the complex. Section 904. Grants for establishment and operation of region(d medical comple2,e8 This section authorizes the Surgeon General, after consultation with the National Advisory Council oii Medical Complexes, to make grants to public or nonDfOfit private universities, medical schools, research institutions, and'other public or nonprofit agencies and institutions to assist them in establishment and operation of r@- onal medical complexes. The Surgeon General may appro@ an Application for such a Lyrant only upo@ reasonable assurances ttiat (1) zrant funds will be used only for the purposes for which paid and will not be used to supplant funds ot@erwi-se available to the complex, (2) the applicant will provide adequiate procedures for fiscal control and ac- c;@nting of funds, (3) the app licant will make such rey),)rts, and will such records. as the Suraeori General re- s designated or Nvill designate an advisory ol out the plan for the complex, and (5) a dards will be applied to construction s section. ,5ectio,a 905. Nat ory Council onilledical Coinplefes This section provides for appointment of a National Advisory Coun- cil on Medical-Coi-nplexes t-o-advise and assist the Surgeon General in the prepar itioii of i-e@ iilations for, and as to policy matters arisiiig with respect @o, the administration of this title. The Council is also to consider a I applications for grants and to make recoi-nineiidat,ions to the Stirge(n General with respect to approval thereof. Section 906. I?egiilatio@s This section requires the Surgeon General, after consultation with the National Advisorv Council on Medical Complexes, to prescribe regulations for the approval of applications for (yraiits anci tor the coordination of programs assisted under this title with similar pro- grams authorized tinder other a@. Section 907. Report This section requires the Surgeon General, on or before June 30, i969, to submit to the Secretary for transmission to the President -to Congress, a re-port of the activities tinder this title tocether and 26 HEART DISEASE, CANCER, AND 8 TROKE AMENDMENTS OF 19 6 5 with (1) a statement of the relationship -between Federal financing and financing from other sources of the activities assisted under this title, (2) an appraisal of the activities assisted under this title, and (3) recommendations with respect to the extension of modification of this title. SECTION 3 This section makes technical or conforming changes in the Public Health Services Act and the act of July 1, 1944 (58 Stat. 682), to take account of the amendments made by the bill. U.S. DEPARTMENT OF LABOR, OFFICE OF THE SECRETARY, Wwhington, A7tgiist 2.1i, 1965. Hon. OREN HARRIS Chairman, Com;W on Interstate and For@n Commerce, House of Representatives, Washington, D.C. DEAR MR. CHAIRMAN: This is in response to vour request for the views of the Department of Labor on II.R. 3140, a bill t@ amend the Public Health Service Act to assist in combating heart disease, cancer, and stroke, and for other purposes. It is our understanding that your committee is also considering S. 596, a similar bill passed by the Senate. This legislation is designed to implement recommendations of President'Johnson in his January 7, 1965, health message to the Con- gress. We note with approval that section 904 (b) (5@ of _ both bills contains labor standards protection for workers on federally assisted construction. Although the language in se@tion 902(f) which defines construction differs somewhat from the definition of construction in the Davis-Bacon Act, it is our understanding that the proposed lep-islation is intended to provide labor staiidftrds idi,otection for truction, alteration, or re@air, including e type covered by the Davis-Bacoii Act. es of these bills we defer to the Depart- and Welfare, which has primary adminis- the proposed legislation. t advises that there is no objection to the submission of this r from the standpoint of the ttdministritt,ion's program. Sincerely, W. WILLARI) WIRTZ, Secretary qf Labor. U.S. CIVIL SERVICE COMMISSION, H;'ashingion, D.C., July 19, 1965. Hon. OREN HARRIS, Chairman, committee on Interstate and Poreign Commerce, House of flepresentatives. DEAR MR. CHAIRMAN: This is in further reply.to your request of February 15, 1965, for the views of the Civil Service Commission on H.R. 31740, a bill to amend the Public Health Service Act to assi.st in combating heart disease, cancer, stroke, and other major diseases. F 1965 27 HEART DISEASE, CANCER, AND STROKE AMENDMENTS 0 This legislation provides for the establishment of reaional complexes for research, training, and demonstrations of patient care in the fields of heart disease, Cancer, stroke, and other major diseases. The urlrose is to coordinate efforts to combat these diseases. The Civil service Commission strongly endorses this objective. There is onl one section in H.R. 3140 having a direct bearinE, on ,@e Commission. Under sec the work of t tion 905, a National Ad- visor-v Council on Medical Complexes would be established to assist in pl@nning and developing regional arrangements. It would be Corn- poied of the Surgeon General and 12 members chosen from among leaders in the fundamental. sciences, medicine, or public affairs. Members would be appointed to 4-vear terms withotiC regard to the civil service and classification laws-. Rates of i.)a-v would be fixed administratively bv the Secretary of the Department of Health, Education, andw@lfare, but would not be in excess of $100 per da Travel expenses would be allowed to the same extent as authorized tinder 5 V.S.C. 73b-2 for persons employed intermittently. The Civil Service Commission has no objection to any of the provisions of this section. The Bureau of the Budget advises that from the standpoint of the administration's program there is no objection to the submission of this report. By aireetion of the Commission: Sincerely yours, JOHN W. 'i%IACY, Jr., (chairman. COMPTROLLER GENERAL OF THE UNITED STATES, Washington, D.C., March 80, 1965. Hon. OREN HARRIS, C'hairman, Committee on Interstate anti Foreign Commerce, House of Representatives. DEAR MR. CHAIRMAN: By letter dated February 15, 1965, you re- quested our comments on H.R. 3140. The stated purpose.of this measure is to amend the Public Health Service Act to assist in com- bating heart disease, cancer, stroke, and other major diseases. Th-e following comments are offered to the comniittee for use in its consideration of this measure. This measure is, in many respects, similar to, the Health Research Facilities Act of 1956 which is codified at 42 U.S.C. 292. While that act at 42 U.S.C. 292e(a), provides for maximum Federal grants of up to 50 percent and the proposed measure would, in subsection 901(e), provide grants for part oi all of planning costs and up to 90 percent of the cost of construction or bi-lilt-in equipment, the mechanics of operation of the two grant programs have similarities. Subsection 8(c) of the cited act, 42 U.S.C. 292(c), provides that in determining the amount of the grant, there should be excluded from the cost of construction other Federal grants with respect to con- struction of the same facility and non-Federal matching funds required to be expended as a condition of the other Federal grants. While the percentage of iion-Federal f finds anticipated for use in construction tinder H.R. 3140 is small, the committee may want to include similar provision in the measure considered. By so doing funds granted 28 HEARTDISEASE,CANCER,ANDSTROKEAMENDMENTSOF1965 under other Federal programs may not be used to meet the non- Federal portion of construction costs. The language c@dified at 42 U.S.C. 292(O provides for the recapture of a certain portion of the Federal payments, if within 10 years, (1) the applicant of the facility ceases to be a public or nonprofit 8 -hall cease to be u-ed for the research in tallation, or (2) the facility.s s purposes for which it was constructed. We believe that a similar provision should be included in H.R. 3140. Subsection 903(b)(3) of H.@. 3140 affords the Surgeon General access to records of recipients of ants for planning and development and subsection 904 (b) (@) similar] oFeon General access to records of recipients of grant@ t and operation of re onal medical complexes. However, no or( ions are -included 91 for access to such records by the Secretary of Education, and Welfare and the Comptroller General. We s language @e included in the bill wfiich would authorize aci e nent records bv these officials for purposes of audit and examinat on. The proposed bill is @ilent regarding the extent to which Federal funds @ be available to aid projects which are under construction at the time the pro sed bill may become law. We suggest that this matter be specifie2yocovered in I-I.R. 3140. This measure, in certain respects, would authorize programs that are similar to existing programs currently being conducted by the Public Health Service. For example: (a) The Surgeon General through the National Cancer Institute, 42 U.S.C. 282a, conducts, assists, and fosters research, investigations, experanents, and studies relating to the cause, prevention, and methods of diagnosis and treatment of cancer. (b) The National Institutes of Health has programs for the estab- lishment of general and categorical clinical research centers. Grants for these centers are awarded to individual institutions by National Institutes of Health, whereas H.R. 3140 would provide for grants to a 9TO11D of institutions on a coordinated basis. (c) tJnder title VII of the Public Health Service Act (Health Reseaxeh Facilities) provision is made for the construction of facilities for the conduct of 're-search in the sciences related to health. (dl, Construction of hospitals and related facilities is provided for in tit e VI of the Public Health Service Act. (e) Under title III of the Public Health Service Act formula grants are made to the States for heart disease and cancer control programs. Generally, the existing programs require a greater financial iiartici- pation by the recipient than would be requi@red by the subject bill. Because of the overlapping of these programs, and the greater Federal participation under H.R. 3140, we woufd like to point out that enact- ment of this bill with more favorable grant ,allotments could serve as a precedent for increasing the Federal portion of other grant progri6s. This is particularly true where the proposed program will overlap existing programs with less ftivorable-Federal grant allotments. We have no further comments to make concerning this measure. Sincerely yours, , JOSEPH CAMPBELL, Comptroller General of th,, United States. 30 HEARTDISEASE,CANCER,ANDSTROKEAMENDMENTSOF1965 until the end of the fig@ year-fo@ng the fiscal year for which the for part or all of the cost of the to Which the application is made, i to construction qf, Or PrOVi8iOn Of 0 uith regulations) per centumof ta cost of Sib omkte ,d pursuant to this title shall not be available tA except to the iniident to e are encom- h shal be fu P'p t to research, training, Inh ria d pur8uant or I at funds approp te to this title, unless he has been rej to such facility by a Practicing physician. DEFINITIONS SEc. 902. For the Purposes Of this title- program" means a cooperative arrange- (a) The term' ,ment among a gri n7onlirofit private institutions or agencies engaged in re8ea and treatment relating to heart disease, cancer, o o@ n of the applicant, related disease or diseases; but c uv- ea. composed of any part (1) is Si General deter- te for carrying medical centers, one or more clinical and among its c ne t ,unit whii h t, I adequate for 7epcto ive'l'y carrying out the pi (b) The term "med-ic eans a m4 dical school and one or more hospitals affiliated thereuia for teaching, 'research, and demonstration purposes. The term "clinical research center)y means an institution (or part w .- of institution) the primaryfunct@n of which is research, tratn?,ng 0 Specialists, and demonstrations and @hich, in connection therewith@ laity diagnostic and treatment se@s for cans a hospital as d@fined in section 625(c) local capability f@i- diagnosis and treat- nted by the program established under this title. (e) The term "nonprofit" as applied to any institution or agency me'ans an institution or ageneu w@iih is owned and operated by one or more nonprofit corporations or associations no part of the net earnings 0 which inures, 6r may lawfully inure, to th@ benefit of any private !hareholder or i@ivUual. Cf ) The term construction" includes alteration, major repair (to the extent permitted by re ations), remodeling and renovation oj en'sting it buildings (including giunl ial, equipment thereof), and replacement oj I-IEART DLSEASE, CANCER, AND STROKE AMENDMENTS OF 19 6 5 31 obsolete, built-in (as determined in accordance uith regulations) equipment Of Awaiting buildings. GRANTS FOR PLANNING SEC. 903. (a) The Su@qeon General, upon the recommendation of the grams established National Advisory Couniil on Regional Medical Pro. by section 905 (hereafter in this title referred to as the "Council"), is authorized to make grants to public or nonpro.fit private unit;ersities, medical schools, research institutions, and other public or nonprofit private agencies and institutions to as@t them in planning the develop- ment of reqwnal medical programs. (b) Gra'nt8 under this section may be made only upon application therefor approved oy the Surgeon General . Any such application may be approved only if it contains or is supported by- (1) reasonable assurances that Pederal.funds Paid pursuant to "n@ such gz-ant will be wed only for the @rposis for-which paid an in accordance with the applicable promtons of this title and the regulations thereun&r; (2) reasonable assurances that the applicant @l provide for such fi8cal control and fund accounting procedures as are . d by the Surgeon Gi-neral to assure proper disbursemen reS,, t of a 4Z ounting for such Federal funds; (3) reasonable assurances that the' applicant will make such reports, in such form and containing 'siwh information as the S@rgeon General ma' Om time to time reasonable require, and will ,, Vdr keep such record a I afford such access thereto as the Surgeon General nayfind necessary to assure the correctness and verification Of @iwh reporte,- and (4) a satisfactory Showing that the applicant has designated an advisory group, to advise the applicant (and the in,,titution,,;- and agenciee participating in the ret?dtinq regional medical program) and carrying out the plan -for the establishment and edical prog ich advisory Group medicgcme'ntwe'r otWcial8, @"P appropriate -medical societies vo alth afen an of other organizations, in and agen, con I @ies of the kind to be carried on under the program and meml of the - ublic p _familiar u;ith the needfor the servwes provided uA t@e program. GRANTS FOR ESTABLISHMENT AND OPERATION OF REGIONAL MEDICAL PROGRAMS SEC. 904. (a) Y'he S,?t= General, upon the recor/imendation of the Council, is authorized to gra@ts to public or nonprofit private . uni- r ver@ies, medical schools, resea ch sastitution8, and other public or non- profit private agencies and institutions to a-q8i8t in establishment and ope@ation of regional medical programs .ncliiding construction and there@ 2 equ, ment 6f facilities in connection th. Gra@ under this section may be made only upon application or approved by @he Su@qeon Gen ved only if it ts recommended 903( t r Ppp 0 section b) and contains or is that- 32 HEARTDISEASE,CANCER,ANDSTROKEAME.ITDI@1E.LNTSOP1965 (1) Federal funds Paid pursuant to any such (A) will be used on@yjor tk@ purposes for which paid and in a=nce with the a t e regulations thereunder, and (Vlicable proz,%Sto@ Of th7U title and h - )will not supplant dg that are otherwise available fqr establish- ment ol regional medical program u7ith respect to Which ti (2) t provide for such fiscal control and.fund account required by the Sur eon Geneial to assure accounting@or st such reports, in su as the Surae7o?i Oenerat .10 tainint g time re and uQl keep such recor6 uch access i eon General @ayfind necessary to assure the correctness and v@fu ontractor or sub- .(4) any laborer or contractor in the perf, payments Pursuant i n uu!Te-8 at rates not le& in the lowWy as deter or in accordance with the Da@-Bacon Act, c (40 276a-276a-5); and the Secretary of Labor t to the labor standards specified in this paragraph, i and functions set forth t'n Reo@qanization'-Plan ivuinbered 1, 1950 -(15 F.R. Slf6; 5 U.S.C. l@Sz-15) and section 2 of the A t June 18, 1984, t7,8 amended (40 U.S.C. 276c). NATIONAL ADVISORY COUNCIL ON REGIONAL MEDICAL PROGRAMS Szc. 905. (a) The Surgeon General, with the@ap@ he Secretary, Z.ay, OW without regard to the Civil Service wg nal Advisory uNon lieq@ Medical Programs. The Cou consist of the Surgeon Gene7ral, who .shall be the chairman. and twelve members, not otherwise in the regular-fuu-time emp v of the United States, who are leaders in tAefiel6 of the en&losyclfncies, the medical scienceq, or At least t@ fundam ointed me mber8 shall be practicing study, diagnosis, or treatment study, @iaeosis, or shall be ou b in the study, d?,agnosts, ber of the Council shall hold offlu for a te of four except ani/ member appointed to fdl a vacancy tion of the termfi@ which his iredecessor was appo,&nted the remainder of such term, and except that the bers first tak-ing o@ shall expire, as designated at thi time of appmntment, four at the @ of the at the end Of the 8eC@jear, and four at the end of the the t. An appointed memb -hall date er s not b ve eon than two terms. (C) mber while attendin confi or oth4 business of the be ei ve compensation at rates fixed b@ the not exceeding $100 per t&y, including traveltime, and wt, away from their homes or regular places of business they n travel expenses, including per them in liiu of subsistence, as a o HEARTDISEASE,CANCER,ANDSTROKEAMENDMENTSOF1965 33 bv section 5 of the Administrative Expenses Act of 1946 (5 U.S.C. 7@b-2) for persons in the Government service employed intermittently (d) The Council shall advise and assist the Surgeon General in t Preparation Of regulations for, and m to policy matters arwing with administration @f this title. -The Council shall consider r this title and shall make recommendations approval of applications for and REGULATIONS SEC. 906. The Surqeon General, afte@ consultation uith the Council, shall p@es@e general regulations covering the terms and approving applications for grants under th@ title and the c rams as@- u@ tct8 title uith programs for traii Pa;l demonstrations relating to the same diseases assisted under other tides of this Act or other Acts of Congress. INFORMATION ON SPECIAL TREATMENT AND TRAINING CENTERS SEC. 907. The Surqeon General shall establish, and maintain on a current basis, a list or 7iSt8 of kcilities in the United and sta e the most owvanced methods and tec diag.- .ffed to provid nosts and treatment of heart disease, cancer,-or strok such related information, -including t) training in such facilities, as he c shall ma e s or lists and related information ret to licensed practitioners and other persons re VI To the end of making such list or lists andrthrer Surgeon General shall"from time to time co inter ste nc professional or- ganizations. REPORT SEC. 908. On or before June 30, 1967, the Surgeon General, after con- sultation with the Council, shall submit to the Secretary for transmission to the President and then to the Congress, a report qf the a-cii@ies under this title together with (1) a statement of the Relationship between Federal financing and financing from other sources of the activities undertaken pursuant to th@ title, (2) an appraisal of the activities assisted under this title in the light of thei@effect@ieness in carrying out the purposes of this title, and (8) recommendations with respect to @ension or modification of this title in the light thereof. TITLE [IX] X '-TEMPORARY AND EMERGENCY PRO- VISIONS AND AMENDMENTS AND REPEALS EXISTING POSITIONS, PROCEDURES, AND SO FORTIA SEC. [9013 1001. (a) The provisions of this Act shall not affect the term or tenure of office or employment of the Surzeon General, or of any officer or employee of th6 Service, or of anv i@mber of the National Advisory He@lth Council or the National Xdvisory Cancer Council, in office or employed at the time -of its enactment. (b) Notwithstanding the provisions of this Act, existing positions, divisions, committees, and procedures in the Service shall continue 34 HEARTDISEASE,CANCER,ANDSTROKEAMENDMENTSOF1965 unless and until abolished, changed, or transferred pursuant to authority granted in this Act. EXISTING REGULATIONS, AND SO FORTH SEC. [902] 1002. Notwithstanding the provisions of this Act, existing rules, regulations of or applicable to the Service, and Execu- tive orders, shall remain in effect until repealed, or until modified or superseded by regulations made in accordance with the provisions of this Act. FUNDS, APPROPRIATIONS, AND PROPERTY SEC. [903] 1003. All appropriations, allocations, and other funds, and all 5ropirties available:ror rise by the Public Health Service or any division- or-unit thereof shall continue to be available to the Service. APPROPRIATIONS FOR EMERGENCY HEALTH AND SANITATION ACTIVITIES SEC. [90-4] 1004. For each fiscgl year during the continuance of the present war and during any period of demobilization after the war, there is hereby authorized to be appropriated such sum as may be necessary to enable the Surgeon General,, @ither directly or through State health authorities, to conduct health and sanitation activities in areas adjoining military or naval reservations within or without the United states, in areas where there are concentrations of mflita or naval forces, in Government and private industrial plants engag7d in defense work, and in areas adjoining such industrial plants. EMPLOYERS' COMPENSATION SEC. E9053 1005. (a) Section 7 of the Act of September 7, 1916 entitled-"An Act to provide compensation for employees of the United States suffering injuries while id the performance of their duties, and for other purposes", as amended (U.S.C., 1940 edition, title 5, sec. 757), is @ended by chan at the end thereof to a colon and adding the foRowin@ at whenever an -v person is entitled to receive any be et b reason of h7is injury, or by reason of the aeath of an empl( i as @efined in section 40, and is also entitled to receive from thi ited States any payments or benefits (other than the proceeds of any insuranc olicy), by reason of such injury or death under any other ActeoP Congress, 'because of service-bv him (or in the case 6f death, bv the deceased) as an employee, as so- defined, such person shall elect @hich benefits he shall receive. Such election shall be made within one year after the iniurv or death, or such further time as the Commission may for good caus@ allow, and when made shall be irrevocable imless otherwise provided by law." (b) The definition of the term "employee" in section 40 of such Act of September 7, 1916, as amended (U.S.C., 1940 edition, title 5, see. 790), is amended to read as follows: "The term (employee' includes all civil employees of the United States and of the -Pa-nam'h Railroad Company, commissioned officers of the Regular Corps of the Public Hea-Ith-Service, officers in the Reserve of the Public Health Service on active duty, and all persons, HEARTDISEASEICANCER,ANDSTRO@AMENDMENTSOF1965 35 other than independent contractors and their employees, emplo"d on the Menom'mee Indian Reservation in the Sfate- of WisconsM, subsequent to September 7, 1916, in operations conducted pursuant e- Act entitled 'An n- m- b to th Act to autho 'ze the cutting of ti er, the manufacture and sale of lumber, and the preservation of the forests on the Menominee Indian Reservation 'm the State of Wisconsin,' a-nnroved March 28, 1908, as amended, or any other Act relating to total timber and IoLpLying operations on the'-%Ienominee Reservatio-n.yo (d) In the case @:rd@tfi of a comniissioned officer of the Service which occurred after December 7, 1941, and prior to November 11, 1943, the rights provided to surviving, beneficiaries bv section 10 of the Public Health Service Act of 19437shaU continue notwithstanding the repeal of that Act. Such beneficiaries, in addition to the riizht to receive six months' p . shall have the same right of election and of SY, revismw elections as is provided by subsection (e) of this section, except that in case of a revised election no deduction shall be made on account of such six months' pay. PATIENTS OF SAINT BLIZABETHS HOSPITAL IN PUBLIC HEALTH SERVICE HOSPITALS SEC. r9O83 1008. Insane patients entitled to treatment in Saint Elizabeths ITospital who -may heretofore or hereafter, during the continuance of the present war, or during the period of @ months thereafter, have been admitted to hospitals of the Service, may con- tfnue to be cared for and treated in such hospitals notwithstanding the termination of such period. TEMPORARY PROVISIONS RESPECTING MEDICAL AND HOSPITAL BENEFITS SEC. rglol 1010. (b) Subje4Tt to regulations of the President, lightkeepers, assistant ligh@keepers, and officers and crews of vessels of the former Lighthouse Service, mcluding any such persons who subsequent to June 30, 1939, have involuntarily been assigned to other civifian duty in the Coast Guard, who were entitled to medical relief at hospitals and other stations of the Public Health Service prior to enactm- ent of this Act, and who are now or hereafter on active- duty or who have been or may hereafter be retired under the provisions of -section 6 of the Act of June 20. 1918, as amended (U.S.C.-1940 edition, title 33. see. 763), shall be entitled to medical, s4gical, and dental treatment- @nd hospitalization at hospitals and other stations of the Public Health Service-: Pro@d, That such persons while on active duty shall also be entitled to care and treatment in accordance with the provisions of section 322(e) of this APPOINTMENTS TO HIGHER GRADES FOR MENTAL HEALTH AND HOSPITAL CONSTRUCTION ACTIVITIES SEC. r9ii7i 1011. Twenty officers may be appointed to grades in he R@ -Corps of the Service t ar above ihat of -senior assistant, but not to a grade above that of director, to assist in carrying out the purposes @f this Act with- respect to mental health and tweniy officers may @e appointed to such grades in the Regular Corps to assist in e,@g j@t title VI of this Act: Officers - ointed pursuant to this app 36 MMT DIS@E, CANCERT AND STROKE AMENDMENTS OF 19 6 5 section in any fiscal year shall not be counted as part of the 10 per centum of @ ntments authorized to- be made in such year under sec ut they shall for all other purposes be treated as thoi pursuant to such section 207(b). The twent officers this section to be appointed to carry out tle purpose of this Act th respect to mentd health and the twenty officers so authorized to be a@pointed to carry out"title VI shall be reduced by the number of officers appointed under clause (A) and the number appointed under clause (B), respectively, of Section 208 (b) (2) of this Act, in effect prior to the enactment of t@s section. CERTAIN RETIREMENTS FOR DISABILITY SEC. rgl2l 1012. An officer of the Reserve Corps of the Public Health service who was separated from the Service or returned to inactive status by reason of-a disability incurred in line of duty after December 6, 1941, and prior to July 1, 1944, and who woula have been eligible for retirement by reason of such disability if section 211 of the Public Health Servie-e Act had been in effect on and after December 7, 1941, shall be considered as though he had been retired at the time of such separation or return to inacCive service. Any such officer, and any oth@ officer of the Reserve Corps retired for-a dis- ability which was incurred in line of duty after December 6, 1941, and prior to July 1, 1944, shall be entitled, for periods both before and after the date of the enactment of this section, to the same retired pay to which he would have been entitled if such section 21 1, as amended simultaneously with the enactment of this section, had been m effect on and after December 7, 1941. REPEAL OF EXISTING LAW SEC. [913] 1018. The following statutes or parts of statutes are hereby repealed: The two paragraphs under the subheading "Marine-hospital establishment (custo-ms:)" under the heading @'Under the Treasury Department" in section 3689 in title XLI of the Revised Statutes 6f the United States; Sections 4801, 4802, 4803, 4804, 4805, and 4806 in title LIX of the Revised Statutes of the United States; The last paragraph under the heading "Miscellaneous" in chapter 130, 18 Statutes at Large 371, which paragraph is the seventh begin- nin on page 377; apter 156, 18 Statutes at Large 485; Chapter 66, 20 Statutes at Large 37; Chapter 202, 20 Statutes at Large 484; Chapter 61, 21 Statutes at Large 46; Sect-ion 1, and the final clause of section 2 (which reads as follows: ('and the said Quarantine stations when so established shall be con- ducted by the arine Hospital Service under regulations framed in accordance with the Act of Xpril twenty-ninth, eikliteen hundred and seventy-eight"), of chapter 727, 25 Statutes at Large 355; Chapter 19,, 25 Statutes at Large 639; Chapter 51, 26 Statutes at Large 31; Thelast sentence of the paragraph headed "Office of the Supervisin- Su.-o,con General. Hospital Service" in chapter 541, 26-Statute's' HEARTDISEASE,CANCER,ANDSTROKEAMENDMENTSOF196.5 37 at Large 908, which appears at page 923 and reads as follows: "And hereafter, the Supervising Surgeon General is hereby authorized to cause the detail of two surgeons and two passed assistant surgeons o- all each receive the pay and allowances for duty in the Bureau, wh sh of their respective grades in the general service."; Chapter 114, 27 Statutes at Large 449; The last sentence of the paragraph headed "Office of Supervising Surgeon General, Marine Hospital Service", in chapter 174, 28 Statutes at Large 162, which appears at page 179 and Which reads as follows: "And heredter the S eon General of the Marine Hospital Service is herel cause the detail of an additional medical officer and 4 eward for duty in the Bureau, who shall each receive t] wances of his respective grade in the general service."; Chapter 213, 28 Statutes at Large 229; Chapter 300, 28 Statutes at Large 372 - The last sentence of the paragraph headed "Office of Supervising Surgeon General, Marine Hospital Service", in chapter 177, 28 Stat- utes at Large 764, which appears a@ page 780 and which reads as follows: "And hereafter the Supervisini Surgeon General of the Marine Hospital Service is hereby authorized to cause the detail of two hos om the port of New York for duty in the pitar attendants fr laboratory of the Bureau, and who-shafl each receive the pay equiva- lent to the compensation of a fint-class hospital attendant."; The proviso at the end of the paragraph headed "Office of Super- visino- 8urgeon-General Marine-ilospital Service" in chapter 265, 0 - t Large 538, which appears at page 554 and wfiich reads 29 Statutes a as follows: "Provided, That the Secretary of the Treasury is hereby authorized, in his discretion, to.grant to the medical officers of the Marizie-Hospital Service commissioned by the President, without deduction of pay leaves of absence for the same period of time and in the same manner as is now authorized to be granted to officers of the Army by the Secretary of AVar"; Chapter j49, 30 Statutes at Large 976; Section 10,chapter 191. 31 Statutes at Large 77, at page 80; The first paragraph of section 97 of chapter 339, 31 Statutes at Large 14 1; Chapter 836, 31 Statutes at Large 1086; That port-ion of the third paragraph of sect-ion 84 of chapter 1369, 32 Statutes at Large 691, which ap s at page 711 and wliich reads ofpear as follows: "and the provisions law relating to the public health and Quarantiiie shill apDIV in the case of all vessels entering a port of th-e United States o@ @ts aforesaid possessions from said islands, where the customs officers at the port of departure shall perform the duties required by such law of consular officers in foreign ports"; Chapter 1370, 32 Statutes at Large 712; Chapter 1378, 32 Statutes at Large 728; Chapter 1443, 33 Statutes at Large 1009; The last sentence of the last paragraph under the heading "Public Health and Marine Hospital Service" in chapter 1484, 33 Statutes at Large 1214, which appear 217 and-which reads as follows: "And the Secretary of the I for the fiscal year nineteen hundred and seven, and an ter, submit to Congress; in the reglular Book of Estijiia stinitites of the expenses of maintaining the Public Health'and Marine Hospital Service,"; 38 HEART DisrASE, CANCER, A'ND STROKE DNENTS OF 1965 Public Resolution Numbered 21, 33 Statutes at Large 1283; Chapter 3433, 34 Statutes at Large 2'U'U,, SociCion 17 of'chai)ter 1134, 34 Statutes Large 898, at page 903; That portion of the third aragraph under the-heading "I ck Pay and Bounty'' in chapter 20( 373, as amended bv chapter 213, 52 Statute is at page 352 of 5§ Stafutes at Large and v ttand-ofdeceased commissioned officers of the Service"; The proviso in the tenth under the beading "Public Health -and Marine Hospital chapter 285, 36 Statutes at Large la63, which appears in the eight paragraph on page 1394 and hiih reads as follows: "Provided, Thi there may be admitted into for study, persons' with infectious or other diseases iiblic health, and not to exceed ten cases in any one tan,L,ially siinil ns appear- Health and Mari 4;@cep I Service" in th, atutes: Chapter 355 at Large 417, at poLg 3, 38 Statutes at 1 24: chapter 209, 39 61 Statutes at Large 459, i page 468; 4 34, at page 644; chapti 24, 41 Statutes at 171; "geStatu a 37 tes Large 309; the end of the last paragraph under the heading py I chapter 149, 377 Statutes at Large 912, Service in r@ which appears at page 915 ancf which reads as follows: ded, That hereafter the @ector of the Hygenic Laboratory shall receive they and ances of a senior sureeon"; allow at iDortion of the second paragraph under the heading "Public Health service" in chapter 3138 Statutes ak appears at page 23 and which reads as follows: "at.1, assistant ed for hereunder shall be requii diagnosis sanity anq'mc the exam g aliens with spei on of n at the end er the head' Service" in chapter appears at p&Lm( 24 and ich r- ds after comm@ osi the Service shall hospital reli ured i duty The last apter 124, 38 Statutes at Large @871. W@ ich reads as toy "ar, the said Secretary is hereby autliorizea to detail for duty on revenue cutters such surL7eons and other persons of the Public H-ealth Service as he may deem necessary"; Section 5 of chapter 41 39 Statutes at Large 536, at page 538; Chapter 26, 39 Statutes at Large 87 That portion of section 16 of ch at Large 874, which a pears at page 885 and = s: "who shall have ha@ at least two years' experience e of their pro- fession since receiving.. the degree of doc The sixth paragraph undei-the headi Cel, ir chapter 3, 40 Statutes at Large 2, at page 6; IREARTDI-SEASE,CANCER,ANDSTROKF,AMENDMENTSOF1965 39 The seventh paragraph under the heading "Bureau of Mines" in chapter 27, 40 Statutes at Large 105, which is- the third full paragraph page 146; at Large 242 paragraph under the heading "Public 113, 40, Statutes at Large 634, which ch reads as follows: "ProR&d, That the quarantine and immigration sta ons, w ose p less than the rate of $1,200 per annuin, may be iner a rate' not to exceed $1,200 per annum"; The proviso in the eleventh paragraph under the heading "Public Health Service" in chapter 113, 470 'statutes at Large 634, which appears at which reads as follows: "Prot3ded, That the lVblic Hea in and after July first, nineteen hundred and eighteen, sl nt Elizabeths Ilo ttil the actual per capita S Pfi ' tte(f by cost of ma the said hospital 0 patients commi that Service"; The sixtieth paragraph under the heading "Bureau of Fisheries" in chapter 113,-40 Statutes at Large C)34, which is the fourth full paragraph appearing on page 694 - Sections I-, -3, 4, 6, an& 7 -of chapter XV of chapter 143, 40 Statutes at Large 845, at_page 886; The thirteenth para apli under the heading "General Expenses, Bureau of Chemistry"'. tatutes at Large 973, which is the second full parap page 992; Section 2 of chapter Large 1008; Chapter 196, 40 Stal 1017; Chapter 98, 40 Statut s at 1302; The last paragraph ui er ading ''Public Health Service" in chapter 6. 41 Statutes at La which is the sixth full paragraph a n page 45; PrhaerinDrgoovris6 at the end of the first paragraph under the heading Health Service" in chapter 94, 41 Statutes at Large 503, "Public which appears 07, an&which reads as follows: "Provided, That the Secret is authorized to make regulations governing the d roduced by patients in the course of their curativ by allowing the patient to retain same or by sell depositing the iiioney received to the credit of t-b ri from which the materials for malting the articles were pur The second paragra] the heading "Public Health Service" in chapter 94, 41 Stal Large 503, which is the seventh full paragraph appearin@ on page 507 -$ The last paragraph under the heading "Public Health Service" in chapter 94, 41 Statutes at Large 503. which is the seventh full :para- graph appearing on page 508, and th@ substantially similar provisions in chapter 161, 41 Statutes at Large 1367, at page 1378; The fourth paragraph under the heading "Quarantine Stations" in chapter 235, 41 Statutes at Large 874, which is the eighth full paragraph appearing on page 875; The third paragraph under the heading "Public Health Service" in chapter 235, 41 Statutes at Large 874, which is the iiiiith full'para- graph appearing on page 883; 40 HEARTDISEASE,CANCER,ANDSTROKEAMENDMENTSOF1965 Chapter 80, 41 Statutes at Large 1149; The second paragraph under the heading "Public Health Service" in chapter 23, 42 Statutes at Large 29, which is the thirteenth full paragraph appearin on Rag@ 38; Tfie proviso at too end of section 4 of chapter 57, 42 Statutes at Large 147, which appears at page 148, and which reads as follows: "Piovided, That all-c-ommissio-ned personnel detailed or hereafter de- tailed from the United States Pub@c Health Service to the Veterans' Bureau, shaU hold the same rank and grade, shall receive th6 same be subject to the same rules for relative or hereafter may be provided by law for the same rank or grade or performing the e United States Public Health Service"; The ninth paragraph under the headin'g "Bureau of Mines", in chapter 199, 42 Statutes at Large 552, which is the fourth full para- graph on page 588, and the substantially similar provisions in chapter 42, 42 Statutes at Large 1174, at page 1210; chapter 264, 43 Statutes at Large 390, at page 422; chapter 462, 43 Statutes at Large 1141, at page 1175; The last sentence of the paragraph under the heading "Public Health Service" in chapter 258, 42 Statutes at Large 767, which ap- pears at page 776 andwhich reads as follows: "Tlae Immigration Serv- ice shall reimburse the Public Health Service on the basis of per capita rates fixed by the Secretary of the Treasury and the sums received by the Public Health Service from this source shall be covered into the Treasury as miscellaneous receipts"; The first proviso at the end of th-e ninth paraoTaph under the head- "Public Health Service" in chapter 84, 43 Statutes at Large 64, i'lg pears at page 75 and which reads as follow - ' d, which ap s: "Promde That the Immigration Service shall permit the Public Health Service to use the hos@itals at Ellis Island Immigration Station for the care of the Public Health Service 'patients, free of expense for physical upkeep, but with-a charge of actual cost for fuel,-Iiglit, water, tele- phnione, and similar supplies and services, to be covered into the proper Immigration Service appropriations, and moneys collected by the Immigration Service on account of hospital expenses of persons de- tained under the immigration laws and regulations at Ellis Island Immigration Station shall be covered into-the Treasury as miscel- laneous receipts:", and substantially similar provisions under the heading "Public Health Service" in chapter 87, 43 Statutes at Large 763, at page 775; chapter 43, 44 Statutes at Large 136, at page 147; chapter 126, 45 Statutes at Large 162, at page 174; chapter 39, 45 Stat,iftes at Large 1028, tit page 1039; chapter 289, 46 St-atute-s at Large 335, at page 347; chapter 110, 49 Statutes at Large 218, at page 229; chapter 725, 49 Statutes at Large 1827, at page 1839; chapter 180, 50 Statutes at I.,arge 137, at, page 149; chapter 55, 52 Statute,,: at Large 120, at page 133; chapter 428, 54 Statutes at Large 574, at page 585; chapter 269, 55 Statutes at liarge 466, at pace 481 ; and chapter 475, 56 Statutes at Large 562, at page 581 Chapter 146, 43 Statutes at Large 809; The M'or(is "iiii(i public health" in the last sentence of section 7(b) of chapter :344, 44 -St-iitiit.@ tkt Liir(re 5C)8, at piL-e 572; L- -- @m HEART DISEASE, CANCER, AND STROKE AMNDMYNTS OF 19 65 4 The words "or public-health" in section 1 1 (b) (2) of chapter 344, 44 Statutes at Large 568, at page 574, as amended; Section 3 of chapter 371, 44 Statutes at Large 622, at page 626; Chapter 625, 45 Statutes at Large 603; The-proviso at the end of the fifth paragraph under the heading Public- Health Service" in chapter 39, 45 Statutes at Large 1028, which appears at page 1039, and which reads as follows: "Pro@d, That funds expendable for transportation and traveling expenses may also be used for preparation for-shipment and transportation to their former homes of remains of officers who die in li@e of duty", and 7 substantially similar provisions appearing under the heading "Public Health Service" in chapter 289, 46 Statutes at Large 335, at page 346; chapter 110, 49 Statutes at Large 218, at page 228; chapter 725, 49 Statutes at Large 1827, at page 1839; chapter 186, 50 Statutes at Large 137, at page 148; chapter 55, 52 Statutes at Large 120, at page 132; chapter 428, 54 Statutes at Large 574, at page 584; chapter 269, 55 Statutes at Large 466, at page 480; Chapter 82, 45 Statutes at Large 1085; ent in the The second paragraph under the heading "Governm Territories" in chapter 707, 45 Statutes at Cargo 1623, which is the seventh full paragraph on page 1644; So much of chapter 70, 46 Statutes at Large 81, as reads: ", and at his discretion to permit the erection of other- buildings which may in the future be donated to promote the welfare of patients and per- sonnel"; Chapter. 125, 46 Statutes at Large 150; Chapter 320, 46 Qtatutes at Large 379; Section 4 of chapter 488, 46 Statutes at Large 585; Chapter 597, 46 Statutes at Large 807; Chapter 409, 46 Statutes at Large 1491; The-words "or public health" in the last sentence of section 2 of chapter 656, 48 Statutes at Large 1116; The ninth paragraph under the heading "Public Health Service" in chapter 110, 49 Statutes at Large 218, Which is the second full para- graph a pearing on page 229; Title VI of chapter 531, 49 Statutes at Large 620, at page 634; Chapter 161, 49 Statutes at Large 1185; That portion of chapter 550, 49 Statutes at Large 1514, which reads as follo - : "or of the United States Public Health Service"; Ws The proviso at the end of the thirteenth paragraph under the heading "Public Health Service" in chapter 725, 49 Statutes at Large 1827, which appears at page 1840 and which reads as follows: "Provided, That on and after July 1, 1936, the Narcotic Farm at Lexington, Kentucky, shall be known as United States Public Health Service Hospital, Lexington, Kentucky, but such change in designation shall not effect the status of any person in connection therewith or the status of such institution under any Act applicable thereto"; The fourth paragraph under the heading "Public Health Service" in chapter 180, 50 Statutes at Large 137,. N@bich is the sixth full para- graph on page 148; Section-2 -of chapter 545, 50 Statutes at Large 547, at page 548; Chapter 565, 50 Statutes at Large 559; The first proviso in the para ra h having the subhead "Division of y- ione" under the g Pld]iii-, "Public Health Service" in Mental H " hea 0 42 HEARTDISEASF,,cANCER,ANDSTRO'KEAMENDMENTSOF1965 chapter 55, 52 Statutes at Large 120, which a 134 and w@h reads as follows: "Pro@d, That on an, 1938, the United States Narcotic Farm, Fort Worth, T known as United States Public Health Service Hospital Texas, but such change in designation shall not affect the stat, of any person in connection therewith or the status of such institui n under anv Act applicable thereto:"; V,hapter 267152 Statutes at Large 439; Cha-pter 92, 53 Statutes at Large 620; ChfCt)ter 606, 53 Statutes at LarLe 1266; Cha:pter 636, 53 Statutes at L@ie 1338; Section 509 of chapter 666, 53 Statutes at Large 1360, at page 1381; Section 205(b) of Iteorganization Plan Numbered I, 53 Statutes at Large 1423, at page 1425 Ch tatut apter 566, 54 s es at Large 747 -fourth paraLral)h under the hea@g ,public Health Service The in public Law 11, seventy-eig4th Coiagress; and Public Law 184 ,Seventy eighth Congress. PRESER'VATION OF RIGHTS AND LIABILITIES SF,c. [914] 1014. The repeal of the several statutes or parts of n 713 shaU not affect any act done, statutes accomplished by sectio . Ly had or or any rig@@ accruing Or accrued, or an suit or proceedin- d commenced m any civil cause, before su rights an parts tl sfiaR con- liabilities under the statutes or repeal had tinue, and may be enforced in the same I not been made. 44 HEARTDI@SE,CANCER,ANDSTROKE@NDMENTSOPI965 Mr. James F. Oates, chairman of the board, Equitable Life Assurance Society, New York, N.Y. Dr. E. M. p or and chairman, Department of Anesthesi- ology, Co] ans and Surgeons,-Columbia University, New- York Dr. Howard or and chairman, Department of Physical Medicine i New York University Medical Center, New York, N.Y. Dr. Paul W. Sanger, surgeon, Charlotte, N.C. Gen. David Sambff, chairman of the board, Radio Corp. of America, New York, N.Y. Dr. Helen B. Taussig, emeritus professor of pediatrics, Johns Hopkins University, Baltimore, Md. Mrs. Harry S. Truman, Independence, Mo. Dr. Irvink-S. of clinical medicine, Cornell University, Medical C N.Y. Dr. Jane C. associate -professor of research surgery, New York of Me&cine, New York, N.Y. APPENDIX. A MEMISF,RSHIP OF PRESIDENT'S COMMISSION ON HEART DISEASE, CANCER, AND STROKE The following persons served on the President's Commission on Heart Disease, Cancer, and Stroke: Dr. Samuel Bellet, professor of clinical cardiolo , Graduate School of Medicine, Uiiiiersity of Pennsylvania, Phifay@elphia, Pa. Mr. Barry Bingham, editor and pubfisher, Louisville Courier-Journal, Louisville, Xv. Mr. John M. C-aTter, editor McCaU's magazine, New York, N.Y. Dr. R. Lee Clark, director and surgeon in chief, the University of Texas Af. D. Anderson Hospital and Tumor Institute, Houiton, Tex. Dr. Edward W. Dempsey, former dean, School of Medicine, Wash- ington University, St. Louis, Mo.: Resigned on September 28, 1964, to become special assistant to the Secretary (Health and Medical Affairs), U.S. Department of Health, Education, and Welfare, Washington, D.C. Dr. Sidney Farber, director of research, Children's Cancer Research Foundation, and professor, Harvard Medical School, Boston, Mass. Dr. Marion S. Fav, former president and dean, the Woman's Medical College of Pen7n@v@vania; Philadelphia, Pa. Mr. Marion B. Folsom, director, Eastman Kodak Co., Rochester, N.Y., and former Secretary of the U.S. Department of Health, Educ'ation, and @Welfare, ivashington, D.C. Mr. Emerson Foote, former chairman of the board, McCann-Erickson, Inc., New York, N.Y. Gen. Alfred M. Gruenther, immediate past resident, American National Red Cross, Washington, D.C. - p Dr. Philip Handler, professor and chairman, Department of Bio- chemistry, Duke University Medical Center, Durham, N.C. Mr. Arthur 0. Hanisch, president, Stuart Co, Pasadena, Calif. Dr. Frank Horsfall, Jr., president and director, Sloan-Kettering Institute for Cancer Research, New York, N.Y. Dr. J. Willis Hurst, professor and chairman, Department of Internal Medicine, Emory University School of Medic'-Me, Atlanta, Ga. Dr. Ilugh H. Hussey, director, Division of Scientific Activities, American Medical'Association, Chicago, ID. Resigned as of September 5, 1964, to become special consultant to the Commission. .,Mrs. Florence Alahone-v, cochairman, National Committee Against Mental Illness, Wash!6gton, D.C. Dr. Charles W. Mayo, emeritus staff surgeon, Mayo Clinic, Rochester, Minn. Dr. John S. Meyer, professor and chairman, Department of Neurology, Wayne State University College of Medicine-, Detroit, Mich. 43