@@i i I 1 ; 'i i @iI @l@l I ,, ii IIII ii i i I ; 'II ii . I i @i . ; . i!t !It @114illil iiii liiii iiiii !@Iiiiii ii@iii I;ii iii@ i,ii: *EOO 1 2cpo* i i DEPA)7,TVi,El\'T OF fl'ZALTI!, t,14D 14ELF@ARE v P-L"@LIC ICE National Advisory Council on Medical Prograr,.s Minutes of the Tt,.7enty-sc,,, ntli l,teeting I/ 2/ June 5-6, 1972 Tli(@ National Advisory Council on Regioii,,il 1.@,,@dical- convened for its twenty-seven.th meeting at 8:.'>O a.m. on June 5, 1972 in Corif(@rence Roo@,@,. M of the ParV.Iai,;vL Builc-@inR, Rockvi'j,". Dr. Iltirold 11-3rgulies, Director, Regional '@iectical )?rogr!,nris I-ervi.ce pres,@dt@d over the meeting. The Council lisi,-Joers present were: Dr.. @-i.cha@Al J. P-.retin n Dr. Clark H. Millil,,an Dr. Bialid 11. C,-,.niiot). IA,.r .Seviall 0. ti.illik@,n llrs. Susan L. Curry Mrs. Mar.Lel S. Morgan Dr. Michael E. D,@.Bakey Dr. Alton Ochsner Mr. Ed;,,7in C. F,@"'@roto Dr. Russell B. Roth Dr. Anthony I,. Kor@-raff Dr. Geor@e,E. Schreiner llrs. Audrey l,L. I-Iifirs Dr. Benjamin W. Watkitis Dr. Alex,,.tnder'll. li@-Phedre-n Mrs. Florence R. Wyckoff Dr. John Dr. John D. Chase 3/ Dr. Gerhard A. Ileyer A listing of RMPS members ,@nd others attending is appended. Doctors Chase, DeL-akey, Milligan, 0--t-i@@ner and iloti-i w(@re present on June 5 only. Dr. Brennan was present beginning on the afternoon of June 5. I. CAIL TO O@@DER ti@D OPENING REF@,RKS The meeting was called to order at 8:30 a.m. on June 5,, 1972, by Dr* Harold @Lirgulies. Dr. Margulies called attention to the "Conflict of Interest" and "Confidentiality of Iteetings" statement in the Council Books. He then called upon Mr. Baum to make some routine announcements concerning the conduct of the meeting, dinner arrangements and Council materials. 1/ Proceedings of meetings are re stricted unless cleared by the Office of the Administrator, HSMHA. The restriction relates to all materials sub- -mitted for discussion at.the meetings, the supplemental material, and all other official documents including the agenda. 2/ For the record, it is noted that members absent themselves from the meeting when the Council is discussing applications: (a) from their respective institutions, or (b) in which a conflict of interest might occur. This procedure does not, of course, apply to en bloc actions-- c;nly when the. application is under individual discuss7o, Representing Dr. Marc J. 14usser @or the Veterans Administration. II. clol@ISYLI-),"""@).-Llolit or III 01' 8-9. lrA72 The Council considered and approved 1.1inutes of the February 8-9, 1972 L,,r!etiig (fr.,.i@i.script, Vol. 8) (Ir@ STS AID S., Dr. Margulies i,nll-rt)dliced a number of attending, the rlc--eting and tiTo new riLrrberc, of the @:!,S staff, F.)r. Larry Rose, Senior Health u@ontultr-,t,.t, @,7ho is in of Eir,.'-2r@!,ency @ledical Systems activities in the of and Tecl-iitical DLt,,,r(--Iopnic-nt, and He. f.@.obert Chief, Branch, Office of Program Plan-,iiriS and L,,,raltiatioti. IV. CONFYPY,-@A,@TION OF r@@-, THREE ii 'Ehe- Council confirmed the following ft,,,tiire ireeting States which had been set previously. ('.Ctanscript, Vol. 1, page 10) October 16-17, 1977 February 7-8, l@173 June 5-6, 1973 V. REPORT BY DR. A. Bue,,-Let Out-llooLc After considering all the variables, the maximum amount that may be available to Pa S for obligation in Fiscal Year 1972 will be about $112 million. RYXS is prepared to utilize that full amount with no difficulty because of the variety of activities which it has developed. It is too early to predict what the fi.nal.outcome will be with respect to the Fiscal 1973 appropriation. The Department's request was for $131 million, which contrasts sharply with the previous re- quest for $52.5 million obligationa'L authority for FY 1972, and apparently recognizes a rising interest in what Regional Medical Prograr,,s are doing. Various other proposals range up to a maximum of $229 million. B. Pulmonary Pediatric Centers The Congress has required through express language in the FY 72 Appropriation Act that pulmonary pediatric centers be funded at the level of the preceeding Fiscal Year. I*IPS will, therefore,be receiving a number of pulmonary pediatric activities in order to maintain a $1.7 million total for such centers. C. Automated @fulti.phasic Health Tc-rting I* .. The Council.'s attention was called to the'report of the conference on automated multipliasic health testing which t4as held in Rockville, ViarylaniLl on ilarch 8-9, 1.97?. Ti"i@r2 c(.,,7:,,@ei-ence was called in resp@nse to the Cou-iicil.'s request for information on the status of 12 automated t@iulti,,)hasic t@c@ tirig projects funded byIt@PL S . There N,,,ar, cc,,-,-isie-crable di:7@-,@ of project sur@,@n@:trized in the rc@1,Lort i.;Iii--h f.-liowed thz2@,t@ c@-,iJ.y 50% of tho e I.,ey.-sons as a re4;ult of .i physician. Dr. Mar@-ulies indic;?,,,t@cd @,hr-t questions rlisc,,ission t e need for stijdy of r-fl@c, o'L A,,,.H-IT before further in- vesti L@nts i,,ii kinds r,,,P @ctivil,.-i are made by RI/ir. The Council raised no to the R@port or its major con- cli.ision th@-t tlic@ or@ @t.@,-iding of i@kIT11T projects be continued. (Transcript, Vo@A. i, 50) D. L@c @(- ,,@i. @, of Cri,@tt The shift fro-ri 4, to 3-cycic- rcvi.ew s takina place siToothl.y. 0 Ai,niv,--rsar have bee,,,i iE, necessary, aiid @@IPS is negotiating rie,@,i levels for iffectcd regions on the basis of their new fiscal-yeara. in the process of shiftir,- i.-o ',:lie nc,@17 3-cycl e system, RMPS was able to two other Otic- is to schedule staff vi.sits to the -ref@ions three to four 3)cr yeir)on a regular basis, giving greater Attention to thocf,@, whi h have shown up poorly in the revie,,,, proc(,,s,,@@. The'otlier is tco cut down on staff paperv7ork,x,@hich accounts for the chazifFes in soire of the materials being provided to the Council. E. Regulations Dr. Pahl and @. Baum discussed proposed draft tl%egulations. The draft provided for consideration of the Council was developed in legal form and la-nf,,uage by 'tlif@, Of f i.ce of the General Counsel (OGC) t T '@- to reflect both the curren ,@-fill legislation and current program policies and procedures. Ri@iPS staff has drafted several additional sections to be added to the irater.ials drafted by 0G.C. These relate to Grantee-rtG-Codrdinator relationships, Section 910, and con- structioti projects. Dr. DeBakey and others expressed the opinion that certain language appeared to rigidly set ranl-,ed priorities for certain types of activities whLch Dr. Margulies and Dr. Pahl indicated was not the intent. Other objections were raised to the use of the term It cire,, without an adequate definition. The Council was advised that rYs.PS would revise the material along the lines suggested, and resubmit the revised draft at a later date for further Council consideration.. r the nct-7 of f c -(-h @11--@rl.c-@s ir5cn t t5, C! are -t';-! an o-F c. c!. sc! c- c-t.S. t cor c)f -.--vious 0 IL t -L of the s of L Z7-nC(@."t nz,@.tien@ folic;wup -r to bc- t,,-von. 1,o r-, -x- t@@ r o i a, 4 @ t) -Z ut:ilr - L ,i r c, t i.-., i-, t y f-@ f a r @,i i- I I f t,;3 n testir,,- ;nn,-! productivity @n@l feed Li s i-r y 0 flei e@ @,j@ i,7 @--i t i @)ra 1 i@,y t i-i a.@ i@.'L I c@s G. C attet).tioLi @,7zts called to read for a new dpi(@?,,F@tion of authority to.eii--'Llle Director, to fuod small projects (tti,,der *50,000) from ti-te.,T@-n@,inry "tt. Lo,,iis conference. The projects in qt.,estic.,i are based extensions of P@IF activities dc,-l with goals to I*IP. It @-.Yzls riove,(,i, seconded and carr-'@ed that the delegation be approved. Vol. 1, paI7,e 64) The resoluti-oti,as,passed,is reproduced as Appendix 4'jL of these @ll-inuLes. H. Re"tnrks by air. 1.1r. Cleveland Cillar-,bliss, Director, Division of Operations and Dev,ilopro,enl:, reported Ilict four rioribers of the P'TP.S RevieN; Cori- mittee: Drs. S@ll@,n, Resson, White and Mayer would be completing their ternz at the end of June. Dr. 1-@@iyer-, the present Chairman of the Co=-,ittee,will be -ucceedecl by Dr. Alexander M. Schr,@dt. Mrs. @taria Flood of El Paso, Te%a,-,,has accepted an appoint,.ient to fill one vacancy on the Com@ittee. Specific individuals have been invited to fill two other vacancies, but have not yet responded. 14r. Charibliss False discussed a General Cc)unsel's opinion relating to rights to and income from materials developed with grant funds (video-tapes being the case in point). The grantee can sell or otherwise dispose of the rights to such materials without prior ITElq approval. The Department retains the right to reproduce such materialirrcspective of copyrights by the grantee or others, and any income up to the cost of production is treated as grant related irco e. Such income iraiy be recovered by RYX.S or waived to the grantee for grant related purposes. I. Governing Principles for Discretioiiary Funding Cotiticil's attention was called for information purposes to a proposed policy statement entitled, "Governing Principles and dat@ed 26, 1972. The 11) oil these Mizaiites, tries to set funds by regions within thr@@l,r l@vel. of after eljl,.@o t.1-ic conditions under which prior ar;pro,,?F-.1 n,.ust 1-ic No-objecLioris to the pro- J. Gr e a C.) s@ and R 1. t . n A second I)o'Aicy I)ef,,)re the Council for ex- pl.an,.iti.,c.,,n -:kiid @zc:tion. Thir-, to '@r7@rantee aid Regional ",ry C- Dr. Pihl called the @itte@itton to points of tile proposed new .,",cng oL'@l@,r ttiinE Coi@@,.c,jl.lls att(--xit-,tc.7n was specifically called to the fol.1c,@@,ing key @;t tc-Iii,e@.it in the dx,iift: "The grantee organiz@@ti,c@.@,, n@.anage the grant of ttie Reg-Lonal Pro,,@,rcLm in a which will iTr@ple-@tent the proSy'ain established by the Rs@gioiial Advisory Gro@,i-v) z,,ncl in ccordinc@, with Federal Reculations one] This Ian-uage is intended to it clear that as a matter of policNr the Regional Advisory Gro,,ip and not the Grantee is responsible@ for establishing EtMLP's It t-las also poinLed out that the statement clearly indicates that the Coordinator is an employees of the grantee, and that he is nominated by tiie r,,&G,but by the grantee. Similarly, the RAG Chiirrr@an is selected by tli,-@ rA(, and confirrii@,d by the grantee. These procedures are design@d to-insure that both the Coordinator and the RAG Chairrian are acceptable to the RAG and Grantee alike. It was moved, seconded a@nd carried that the statement be approved. (Tran@,(-.ript,Vol. 1, page'112). The statement is reproduced as Appendix C of these Ilinutes. K. ne Cuidel.ines Dr. Iiiii.man reviewed the new kidney disease "Guidelines and Review Procedures State.-aent." The guidelines require that each kidney proposal be reviewed at the local level by at least three kidney experts who do not reside or i..Torl,, within the Region submitting the application. The written of these reviewers would be pre- sented to the Regional Advigory Group. The RAG would approve or disapprove the project and se):id it in to PM.S where it would be presented to the Review Connittee for priorities concerning funding, but not for further technical evaluation. There was extensive discussion of two points concerning the policy as a result of which it was decided that RMPS would issue a clarification of the term "full-time transplantation surgeons,' as -6- used in it@( 6B oil, 2 of A proposal advanced by ttie Revi.eiv,, Coll@t'lilit-t,k,-,@,,'! tecliiiictl be conducted only by selected frci@,,,k 7,, by trips ( i.e., a closc,Ci parr@1) was rL@,>t St@.I,,seqi-ient to the dis- @,7,:Is t@ovc:<@, S,,'2con(I-ed, carried th,-tt the E.@ui.dr@tlit-,es be apr)rovci@l presented @iith it to be distributed later clari- fy J'-ng tli,,-, earii.r-zy o' (Ti,rnscript, Vol. 1, p,i E@e 1.4@ li co-riy of ti@ ar, discussed, is aztached as A.ppendi,,,. D of t',,te@ze Mitiutes.,, VI. Mr. liichard Chi(-@f, @-c@rix Operations Pran,.ch, reported to the Cci:,iitil t-',,e for 20 in,l).,r@.tient beds in the Center. 'J."rif,s was I.,tl response to t@kc-- Council's previous reco veadation that f@rovi io-ii of tn accc)!r@-.,o,,adate 20 beds which isol.ate(li froti tlit@ Ili-@-dical Center be i,7ith furti-i,-r for review and @ipproval by the Council. Mr. Russell also reported that three o,@-lier conditions to the grant',, ,oyhich ,,,e re set by tl,,, id been met by the Cancer Center. These iqertl (1) that all State, Federal and local requir(,r,,ents for the co,,,istructioi-i of.' proposed type of facility be (2) t' at the lj,,,tl.v rsity ,)f and the Swedish Hospital 11 @ E-1 fo@ialize tlieiz- relationships witli t@,@D C..,,-lrcel- Center, nnd (3) that all conditions contained in t@,o'Cotincil's ',.Io%Tcmber 10, 1971 st@-teDlcnt on a Cancer Center to serve Region 10 be, satisfied. Subsequent to the reT,)ort, it was reeved, seconded and carried that the grant award be approved, including c,,pi"roval for inpatient beds in the I C,r,-titer, oi the basis that the other conditions established by the Council had been met-. vii. El@Ln) PROJECTS Dr. llarguli'es introduced Dr. Leonard Sclierliswho served as Chairman of a special coi@,,-,iittee which revic@@,ted proposals for grants for Emergency MP-dical Systers. Dr. Scherlis described the revi.ew of EMS Proposals. The Co@mmittee reviev7ed 35 proposals requesting a grand total of $33 million for three years. Of theses 5 were disapproved, and the remainder recom- nvnded for funding in the total of $11,663,05.9 for the three year period. Dr. Margulies raised the question of whether funds recommended for EMS, should be treated as raising the level of commitment for the @iPs involved. After a-l@rief discussion, he stated the.sense of the Council to the effect that the "emergency ir@(lical activity is of high priority and should be given full consideration in any 6xecutive funding." Subsequently, it was moved, seconded and carried that the recotzmddations of the special EliS Revi(.,w Com-itt:ee be approved. (Transcrip;@.. Vol. 1, pages 14@3 and 147. ) Specific ariountf, al)proved are shown iii Appendix E of these flinutes. 7 - Dr. 14ar.-ulies called on Dr. of the R@IPS Review who ,,t-r-ved as of P@ group established to review reqtic-r@t suppleri?n.tary rcqtl@3ts train for educational @le irclicited- -,-at are largely an enhance nt ine f it@ips h@-%,e, been 'Lor a lorp. to @4,i!,pro,%Ye the education of 1-ies@lth thr-- of th@at education to the delivery of serN7ices. Bec,-,ure of tibout the -project.5 in q-,i.@@stion have L-,,@en clc@a,,'Iy zer.,@lr--Lcd out fro-.1 arything that appeared to be an arc,,,-t health cei@e.-er as originally or ctirre.tLtly defin-.-@d. Dr. Perry indicted that reru(@rit-T i-irre receiv@f-I for and that-, of the@,7e, i total c),L: y@6,'C@',-114,096 rc@,coi@.--rided for approval. lie described the revi.cN,@ process -,Yid cited a of ti.,e s-Dccific proposals. tic in.dicitt-d that L-@@verz,@l f@,@cf,-ors lcd to disapproval of soiyi@- proposals. These f,@@@tors irclxide-d e-Ycessive ei-anhasis on contin- uin- ec;uca 4- ion, need for m3re adequate involvement, availability Of alternative funding, and lack of key of the @,@i,3ortium. Dr. @largulies then called upon Dr. Cliase with resnect to the VA point of view concerning educational activities of tl,,-- type under consider- ation. Dr. C'L,,I@ise stated that the VA is enthusiastic about the approach and is again cc,,,,Imiittin- another $3 million as its contribution for the 1974 Fi'ccal Year. IN'exti, it was ).-,rived, seconded and carried that the special J,evil-w Corr,mittee's recou-u-TP-vidations be adopted including a list of priorities for funding included in the group's report. (Transcript, Vol. 1, page 215) A list of individual actions and priorities included in the action is attached as Appendix F of these @linutes.. IX. SPECTAL ACTIO',I FOR INCRF-ASES IN NAC-APPPCVED LEVELS FOR CEPTAIN REGIo!4S The Council was requested to increase the approved level for six Regional Medical Prograr-as. These increases would permit the funding of pediatric pulmonary centers in accordance with Congressional action, and would provide P,@IPS with flexibility in dealing with-reqtiests from certain Regions where actual funding,eit@,er was at, or approaching ,the Council-approved level, and where progress indicated a possible need for additional funds during the extended period established to phase all regions into the new review cvcle. it was emphasized that funds would actually be awarded only after consideration of specific requests from the affected Regions.. It was moved, seconded and carried that the levels be adjusted as proposed. (Transcript, Vol. 1, page 222) A list of the individual Regions and the specific amounts included in the Councills action is attached as Appendix C. X. HF-klTil MI@ZTET4j@@T,@'CE ORGANIZATIONS The use of RMPS funds to support 11@IQ feasibility and planning studies was debated.vigorously and at length by the C3uncil. Extended dI@,@ct I. o II points in the D@-puty fit c, of tti;r-Tq -re during all, cl@ Dr. G@)rtlo 1 7@, r;'Lr@ctc@-r, 17 St. "Vice, JIS f t Ic !-I v i @.@ "f 29 for to do therc@ i..,, certain r@v""L@teni. in t @@l e c Q1@ .,k t 1-1 I t -i ('7@ c c 1 the Oi-'fic@ of ttie. ney for to I)r . I'@rth r,7@4-ser3 t@@,o 1. It i to former !.via tt-Ap of legi,,31atic@,i, clofinition of ,,in not exist. Pc-ndii@ li@',O bil,is and havo littjlo of pa,,sa ge in the current 2. are no lorr-ar groups -Yitiich serve 7.5 without Federal funds. r is to t'i@, i y aiid apr,.rol,.)riateness of 3. Ti,@ . e is t ciuc-s tj' or@. using RI!? fi;njs to support 1)."Ojects relate to (i@velop- @-nt of a syotic.n rat,!-,r@,r than the disseLniiiati.on of knowledge or dc-veloliiaent and uvi@ c@- @-L-a-apoi@er. 4. All of the funds reserved for stippc)rt of ll,,',tos should be released to @Lj@S. The proprc,-.ri i,s not limited to the support of Regional lAe-dical progra-@is and has great flexibility under Section 910. Dr. DeBatcey advanced the following opinions: @l. There are no Congressional eirtiarl-'s for HI@,Os. 2. The Council should be consulted on the use of appropriated funds. 3. There is a question of whether given the limited resources available to IUIll, should 1,@,tve sufficiently high priority for RMPS funding. There has been inadequate advance discussion iyitti the Council of the substance of IiYiO proposals, end there is insufficient evidence that the support of Adi'lat@icc-,.,@,; -the Pegional lledical Prograr&s, particularly t%,ithi.ii the. iiifzent of C(@rigress. -9- T I Dr. Can@:io,@i, D,.c. Koi,,,,.arof f D-. who p,.trti.cipitcd in t;he as of the Council, reported t]@lat, I. 2. of ,.,ic,.etioiis d'@(I not i,ticli.ide an W, @liCT iS 0.4 -it qtality c t r o 3 . T'@,e die, rr)t desirability of using RYIPS funds fcr tile -O,-Lcral ot.,!t in tl,-@ by var-'Lr@,us Council r@.@--n@,bers s siioLlld not bc, trapped than once for iLt@.,Os. 2. Theri e-toiil,d bt,, no ob e c t P. t c initiating or participating in 3. The COILincil h@@ks repe@itedl.y t--,,t@,erL the r@osition that e. quality control should be an part of every ER,;'O. Dr. .@xrc,,d -@z the p).-irci@l;al pc,'@iesni-an for the position in favor of' fulic!i@.),g the I.,,! indicated that the Departrient had every to believe t@].@t Ic!c,isl.ation liave I-,assed months ago. I-Ic! pointed okit that cvki.-y adiiiinistr@l.tor to find the resourc(@?s to anticipate, and, ilidec@d, Pi@ would have benef it-c@d -fror@,, Y)rc-.Iaratory prior to LI).C- riass@,@e of P id)lic law 89-239. In line with this, tire Secrel@:ary has indicated in testi.inc)ny to Congress that Rl,llp ap-@,)ropri-,iti.o-i-Ls would be iiGed only once for and would not be "ed for -shelf purpose.,, No @IPS grant or contract fu,@,d,,, have been used to drte for FMO,L@ except for intra-@i, F,',,O-related activities. I>Iecause of tiie slowdown in IIYTO funding, all of the RICIP furLds reserved for this purpose will not be utilized, leaving additional funds for the regular R@IP program. Dr. Margulies further stated th,3.t it-ic. not possil@le to have good .controls programs in a poor deli.vc@ry syf.-,tem. Allocation of RP@TS funds on a otie-tit,@ basis will. be a useful investment in improving delivery. In addition, the funding of 11'.,,'.Os invc-1v@-s considerations that extend beyond tire rd-,iP pro-rain alone. ,', narro,;,r definition of program pur- poses by Rl,!P and other programs would impede innovation and encourage fragni,ont*--ation of Federal efforts. By a narrow margin, the Council voted to approve the action recommended by with a stipulation that a qu@ility control el(-,r@.ient be included as an integral part of every project. FurL-lier,discussion snowed that the Council was uncomfortable with its-actiori, and it was move4 seconded and carried, with one.dissenting vote, that the previous action on HI!Os be set aside, and that a subsequent ballot I)e taken either by mail or @f ti@e CG-iincil of fi3rtlier information de,4:)nstrat-"Lnr:, p,,rant@ funes f(,r contribute to the purposes of Vol.. 1, Fired '"@00.) 'c@7, i-@h' '- C@)ttitcil. and the rc,.sc)].iition 1) &F;c@d by rajority: "It rc@ccn,(Ied tlt@Dt t,.dvisory Council ari)rc@,v@ @,@ut:ltority of @4.3 million to the 29 eelc.,@ct@d by vi @,7 process; for i,7it",, the that I)e, to oi.,@e yectr -tnd halt adequate attenl:i(@n be given to the bc, bers licinil- br@@cti by that tticli grir,,ts can be made within aiitl@,,ari.ty of 0,10(c) i,@j tir,,df..,.-,@-stood that Iii @,.tffirn,- ati.v(- vo-@e on thi.,,, by that X. co-Ili3i@3@"','@l,,t.@'@ll-@,(@Illl OF RI@-;'@' t o@ A. tio M@.red : Dr. Sclirein r Seconded: Approv@l at the level of $60@3,000 (Tra-;i3cript Vol. II, 229, I ind 2-) B. olliol Iliolied: Dr. Schreiner Seconded: ikirs. I,(,ars Approval of the Revie@,y Co:rinitteels recor-@,i endations for disapproval of the 3 kidney proposals and approval of the general funding level in the amount of $1,200,000 for the 01 year and @1,305,000 for the 02 yeir. (Transcript, Vol. 11, pg. 234, lines 3-8 and 23-25.) C. Nassau Siiffolk Moved: Dr. Ka,-aaroff Seconded: Dr. McPhedran Approve "the Review Co=nittee's recoirmendation on Nassau-Suffolk for ql,099,000, and appro@,,e the plan of joint funding of the RL,,LP and CHP provided that both -advisory groups vote in favor of that and defer a recom- niendation on the regional. project." The vote included funds for a kidney project for a regional owner-donor program in the amount of $27,060 for the first year. A second kidney request'for a home dialysis training pro- gram was disapproved. (Transcript Vol. 11, pg. 38 and 39; vote pg. 41, line 15.) 'mi. Millil,,en absented hi elf during the consideration of this application. D Moved: Di--. Caiirion Seconded: Dr. "To flilfil,l to( expe,,Iite -ervl.c e tion the o f @S i,@,,n,d ,alth ducal Vol. II, 41,* Vote pg. li6, line B. E. Mis- Appli,cati(@l-ii is f r of tric-niiit.,.m. I t v7,1 @'3 by@(@u !it I,(@fore t@.c (1) because increased funds i,7ere requcste.(I; (2" Corinittee a reduction .n the and (3) a technical site visit. for t'-Ic@ project resulted in an unfavorable repo@t:. lioved: Dr. Ilic-Phadr@in Seconded: Dr. ',%oi-.aroff Disapprove fiiticls j'o'r the automated F.I@IG, automated physi,cian's as,,@;4-stant-,itid bio medical i.nl'ormition service. Dise-,rr@)vo. Cci,,.,.ponent. Approve a level of @1,625,417 each for the 02 and 03 years of the and recommend that a site visit be condi.,cterl duriii- the sttirnier of 1.972 to e>,-- press the Cotilicil.'s concern with the Regiori's poor performance and It-o clarify areas of misunderstanding. Dr. l@'iaroulies to bring the Region's next anniversary apl:)iication before the Council even through still in triennial status. F. l@4ebrin'tca Moved: 14r. Milliken Seconded: Mrs. Wykoff Approve a fundin@, level of $725,000 for the 02 year and a tentative recoii,-a-,,ended level of $700,1000 for the 03 year. tiet,vi.c;c@- the Region to util.ize the $25,000 above the requested program staff budget for initiating planning and feasibility studies which result in ,ni",ort-term pay-offs. Disapprove the two kidney disease activities and advise the Region to develop a statewide kidney plcn. (Transcript, Vol. II, pg. 80, lines 1-20.) G. Oklahor.,ia Moved: Dr. Komaroff Seconded: i'-Irs'. 14tars Accept the recorii.@iend,,xtion of the Review Cormittee that.the Reiyion's current level of $739,000 be d t h I i iDi-i t o rg-@c rii i t a r, r 0 c,%,, t h n t h c-,, e@.v i s (,,, ry F, r ovtp c iic c@ & r i'; i@i @i t@ d r c@ I,,. t:i@ 0 r@ I i p 8 w i. t 1', t@o co@itititic..! the. initial c@r@., del,-V r@, shown @-i,@),r,)Iication. (Tran- script, Vol. 11, H. Or,.@ n I! cl Dr. IXI,@F".,.!,(@,-n.-,i t@rc,ir,-L tllo for an of @O fl,@,@- ',)5 yc-,@3.r r@o d(@vc,@ion@7,ental II t d z, cc,@1rponei-L of $75,000 foL- o@t th@ a@'id provide $250,000 of F@ro,.,7tli fit.rtd@ 'for years:-) to co,4c-,7.- the costs of the Yevio,w pnti@,tit orier@@.i tion study. (,rriiiscript Vol. 11, pg. 89, lines 2- 3. Puerto Accept the Revic@7 recot@mendation for $1.1 mi.114Lon autlic"izati.o,,i fc)@- the third y@ar for the Puerto Rico F,,f@giortal radical n,. (Tr@ins,^i@ipt,,Vol. II, pg. 92, lines 8-10.) Kidney proposal Moved: Dr. Merrill Seconded: Mrs. Curry Recor,--Pend for all three li@.,rts in the total amount of $183,634 direct costs for the first yea.-,-$161,915 for the second arid @,l2O,liO3'for the third. K. SAL@,P Reco-,i-,,.7.@n-,iations Continuing Applications fro-,-a the following Regions i,71-tich t,7ere revie%,;ed by StiRP and proposed actions by the Director were called to the Council's attention: Kansas South Carolina Mountain States Western Pennsylvania I,Torth Carolina There Tiere no Council cc) respect to these applications. (Transcript, Vol. II, pg. 94 and 95.) certify t@@z@t, to tl-tc best of the fore@,,oirip, ninLites Pnd are accurritr-- ati.,il complete. r r Regio@ibl Medical, Prograt-@is Service AT)'@ll ORY C)'Z r@ I'I'OGPTMS 1972 1-if@ to (5@, A - @,al Projects Appen(ii)c B - Discret:io.@Lary Appendl;-,,,. C (,roui) ApperL-liv L) and Revi..@,@,y Appendix -A,-tioii on E!-,,tS Propos-@ts Appendix F -Act@-.o@r@. on Pr@@)posal.s for Services fileIation Acti,7ities Appendix C -Action fo r Ircreises -i..n Advisory Cotiticil Approved for C@rtain lzc-ioris Appendix H -Acti,or@L on 1'.1io Appendix I -Atteridei-ice, l,i.r>t (,ATIO- O@E' AU'@IFO'@ FO@@ A-i@'PPOVPL DE@ILE F I 0 F C 11111]CA"10@'Al, ACTIVITIES -.1@'EZ'@SI.BILIT'i :Tiic, Council, recognizing the iic-ce, !:c)3- c@x,),-)clitious ict-,on and flexibility in f-Li,@i(i ii-ig feasibility that would permit L Id,liPs and loc2.1 areas to assess tiie and feasibility of devel,-)pin- ccn-:iii--tnity ba,-ed tcti-vitics, delegates to the Dirc@c, L-Dr of C.,',IIS authority to a-@,,ard supl)leiiiciit:a-il. grants to ii-i(li,v@clual- Pro(,r@,,n,.@, for such ptir@-)oses. it is understood that (1) no local area sliall receive finds for such feasibility study in c,cl)ansi.oi,@ n8titutior-61 settings of in y t or in a Z"" (@@IL of 4 .1 .) ,. L i -r c - -- c- c@ :T@ pre @)n a service It ol't i apT 1, t c-@ i y00 D,"i wlio die (,,-@ch year f(.).r cl,roni.c t-hzi'- a.-it to hr G t-tiea 20,GOD Of I,,itliiety disease i.s pro- babl.y S s i i@. f C. l@ @l, j, I:,,v e p r a g4i,@ w i I 1. b c- e 4 t a b I i s h e@, i A" I't 1, I-,' L @ ,, -t - .@ I I,,y of Li-e , f or the c, j ary Lo c@ I.,, 1 ai-id of the I -1 @,-, , @,nc.-,,, pati.ct@ts. i of c,7,,T-c@ 'c@c, s yiriyriirj.l,y with f V CC, t I Lion of 1-idnc-@y py.-o,-Y,ams p@ id cc, t (i sei.-vi(-,.es of dialysis and (.I() 'itive acce@,.s to such lifesaving care. The of inclu(ics- 1. 11).-ocedurc@@@ t:rj @.ssLtre early i.clc-iitif-,ication of p@iLicitts in, or approaching a tex.-ir@l.rial @.@,lca,,e of 0 2. Rapi,d referral of sucl). patients fro@:a the level. of prima@.ry care (private physician t.() tert-,.,@1-y care for dialysis and transplantation. 3. Ear"y patierit classification @@@ith regard to tis@;ue type, and other per- ti-nent factors. 4, Di.alysi.s @n.d trans-@la,.-,,tati-ori which a,-,su-.,-e treatn@e-tit alter- natives to both the patient aiid physician @l :i cl r)ot ZI r of C@l C, Tle c, 17 i, or not i- ! @ @ @,@ i.b f o CC-ZL@ V S 4,3 C@, C 1,1--4@,. o:f tied of systeTn y or part oj': ct r tiert.t: c if such th(@rcipy is j, a. coLit, b, oil f-,,i suri.,,eons @c"rvl c,ep@ requir(@@, C. fo'r tr c,@t T.Cic,-Ilt d. provi-clt-@ t-la(@-- refer:L-a@,. (ionor- amid organ sharing. 7, -,c@rvc- of 3-1+,rni,].lion persons.. 8. ut-'Lli-zat-ion. is r,-,ade of services @)7icl facilities for kidnc.@y a a, t i. c ri t,,,3 of tliird-part:@l iiic@clianism-@ is pursued 9. Continued de@Telop@ to support kij,-tic@y patient care services. 10. Intc@gration of renal. U'i,3ease patic@r.-t with other I)at@ient services and facilities is organized at all Ic@lvels. 1 . Iledi.atLic, dialysis,, and LrE,.iispl.an.t,@Ltion services are (,,oorc'tii).@,,Led adult T r lic, r e p c of i@TitercE.-t ii the Ci tl@).iri, the n e i@ n tl.-,c, of C); I-ons b r i f" abstract r.)-z' letler C) J- 1, i a Ltl of@ 1 C-! l@) r p a c t@ - i) y c,@ W v e s i: I e c, r! w Lc@ r -@.j 1 i i af f of the Divi- s o c,. f' c, i. n i' c i S ii@i 1.1 @iclvise th(@ e s' 1 of- c i@@ or 2 for a ret,@.Cil .......... t(@@ e. 1) a S @ri @i of f, . , p l@, @ C - 7c C. r - @ @ r -@: @ @' - I - t C! b f:l)@ R e i 11, I., J--' L'i c o f,7 t c) Ti t-ent sc,-)"vi.ces x@y' be mine by t by- Calling t t I s fc?@ The Di%,ision o' i@@ a list of ret-ipl. coristil- t p@ t z-, 7r e 5 4 1 j,@! for i t h e !I t - ,3 @ --i' n t @ Slic)tilcl the (I c,, t f) c, L 1. c, 5: i t s the iiamr--.s ctirricul,lLii-i). vit,-"-e o@' . cleared v@it'li the DPTD. cj'L iicit always be by consultant Si t(' biit truly be by when @il)prol)ri,@tte. Tt'ic l@@LP will. @ny conflicting technical alvice be 'ty the 3. tl,io.-c which are recolTLn,,c-@ided fa,,or- ably by Rcvi,-@@7 (per@igraph 2., above) shi.11 be eligible for co-,asicic-ratiori by l'i-k aciditiori, an opportunity ntast be I,)ro-vi(ied to cor,.sidcratic,,.@.-i of the Proposal by the RAL for review C'7yl and ccrr@.r.ient by the appropriate !7i ,goi).cy(ies) as req@tirc-d by Section 904(b) of the E 1 -I 't cl orl t@l:l(, y D f Ti to c (2 i- L I of t 0 1. f y t I be S n.at@i.c@-L-iaJ -I-evol, proP,01.,,] sh@t] I.. I Cc I I 0 l' C! F, c@, t !,I C! r El o a ,,City C" the forwarded p-rc,, o@,,,al. a. the the objectives. 1) . t 1-t e c C, iz-@) c@ rest t i-L o f th, t s o f t: (p o i 3 a b c@,,@ c of RI f f for Rl@L13P, 1.@c!vic,,w "D-, T'@@ t ci s to os,@'I y,,]-c@poses T to points developE-d '@y T(-!(,I,,Ilical Review the @,,@@)plic-@ciolis for wiLii(.,Il time, l@l-,@G; C",-,,' Rc-lviE-,@q Coir@Ll-' ttc-ie has j. n(I 21 c a t e d a c o i-i c aiD @,,r t f, he of tlic-t thc, Rll@JPS C"@-,i IL)o askeCt i.o a to the National Ad-,,,iso2:y TY,c., MLTIS Revie-,,i Con-@-,-,J-ttee @pec---'.ficall.,,r r@.ot-, review on a te(,.I-inical basis ttic, ri-,c-rit of the p-,Loposr@.'3@-, or forftial. numerical ratings for individual proposals. Council ilev-@@e,w - @q!). kid.-icy ri@ciposal6 sl%a,ll be submitted to the National Advisory Council fc;@c Iii lzo-cping with the categori- cal nature of the di,-4enL;e program @,,,j-thin the Council will review a,-id recoi@c,-@e-@d f,unditi- 'j;(,-vels for proposals separately from the funding level of tire ]@"'id-.,.iey progran@ funding will be in addition to other proj@,i-am fundinc@. c 1; i@, c),@ a 1 1 9 7 s rtiay 'cc! Ec@i- 'lleques t@ -n, 1-7 S C) s o L -Lo s :,':c, p p d @L s 11 o u AT-i- Plo r bf, rd to )et as and b,@ cl li)y each "L ti C', F(A( !,)7 p t 1, for n C t c- o f@ he pr e I j,!iii ry c 'I s c r c'., c zi I r2 (3. 2: n t -II y- b h 0, I p f ti I- (I 0. v e c@), p e r of -.i.ni,:t to ilic,- R@,TP'E@ b@--for(@ L,,i, apl)licL'- to 1)(@ I)rovicied o.,i For i.n deL@@L[.1 th(, ele i'l@,sc-,z6i,,)tic@)i@@ are coj-opri.,z,(7@cl otil.y of' genei.-,i- coy-,Lroj iTlec-ds the appl@ic on bc.s-is of solid d, @i i- -i@ig to of eLtd of-- c c@ L, ti i L, i,:L :i ror.@ Assi-st:ance ta-i 1- r -ci t:,-! c, t f-i cart ()I@ f..- the t:o he a(ldr@.11@,,,ed are 1, the magr.@.-;.Luje. of t]-i,@ re-i-ial 2. ind currr@-,-t".@@7 i,-i operation the needs they are 3. the n,@-.L@ci@ the. net.,, pi-opo5@,,ii tiie(@t and 1-io,,,, t@lic, I-,-,c)grairi will. w@Ath r,rc),,,,r,,-,iis to inrijrov(, patici)t carL, serv-i.cc@s wi,i:lio@it Duplication c,,I' servi.cc@s or facilities 4. ai-id poter@ti .1 sotircei of t.Iiird.-party payment for care and ho-,7 t@Lese resources v@i-Il.be d,--,veloi)cid. 5. the coiTiTr@.;.t@riic@nt of cc.)ol)erati-na iii.,tittitiaiis, groups and I:iealtli pric- titioriers Disclose col'Laljoration ic, to the success of the prof7rarq, 6. training, ,)I)en perti-i-,ent to the pta-,i, which is directly related to the projects com,?risi.-ag the pl.an, c)@t@ judicious expansion of existing progralfis ,31 i c) u I d i) y l-,@ Al' in li(,,, 1 i i@iT i@ t@ s c-, c f) 3 in ALC-'I tli-rou- li t@ t (3 c,,! 5-, tl-of,.@ll to -. - - --' , i @y El, j I C', )C a(@ t i.v i@@ I, iI I o f t it I,!(-) t i I' r ."i, C VI t I, lilLISL I-)o s p c@n r ii t: i. e t: t' t@ r, i,,@, y r(@bi-tc3-. @@7,L i' o -i u c i. i-e l@ i- o i: a,, r!i,,i ii f I- C) 1, t --(I 'b e @ . ..... levy i@il El S Y) u t tti.-I L' L i ncl d A-, of ty 'i@ Li @ll ftji-ids@ tc) t l@i cl@ i c,, - "7 t@ y t' L, be ollly 't f t@ E@@ 1 i I'- (i .,.Y C@ F,' c-- d t'i f,@,, o rtt--h on th(..@ t, c t relay I,,, exp,@iiidccl as L-y c).'- t:o '-lie I-,id,.-tey activity in :i.ii Llie l@oti-i cc- of C2,,afit ad (1@ t i@ t o t Io c T) (r c@ i c c, z,, r of ki.dricy di. ccise tc-,-El',is i.F', eiic@l-o@c,d for your i.tiforrr,@@tion. v L c,@, 3: z@; J, j - t@ lol) ti 1 ii,; Ai-, t- c, 110@@ @7t C@ t ic c t: o, -.I:' j c. i:: i-@ usc@d tn rejection i@ 11 0 f @1,C L@', Tc)t@,'Al sLs consist 1) (I I)y ty,@.C. C) c, -r. r! c, o t s c@, s E' 1) y '.I I 1-io Sp i t a i s v c@, in a C C"@ (1, -J:@. o tc, 48 4. traiiieLl I'oi-- sc@lf care. who, t@o I)Lrfori'Fl (ii.alysis wi.t..Iiout a,] -1 rl zi-(., c- prc,- dialysis I)i-ovi(lecl t 'L "".!,I t 0 1-i LI i@,-n t p @ir t @i. c, (i z@ tr,@n the nc,@,, I.y g,)-af t ('.d o I- i,,Zln to 5. bc@i-@,c2en Pi-i i T 'Li c-xpo ccil @.,.rtery and vcin pla-sc-;,c 6. I-o a pz,L-'ei-it seeks iiiedi.c-@il (i@j c,c@ ca2. riay bf,. tti@, @i l@ t:, s o f f i c e A c, h. o s c@'i c-, q v @n I c-, n t c @i,,) b I e- o f r e n d c@ r i -ri d c@ f i t i. v e d Also, @i. satellite dialysis facility. y In the case of kidnc@ it is a capable, of T,)c-,rforrni.rig trails- plaii,@Ektioli, supportive dialy,,@is and COIISLIltation to primary and sc@cotil@ary facilities. 7. I'@ii,idi.n@, - S,,7sLc-m of pf,,,@.sed reduction. of the Federil share Usually by ii-tcreasc-d asstli-aption of costs tliro-t.t,@t. e;7r,ned inco-.i,-, -,iid local third-pl.rty payments. 8. Tlle solution, used in an irtificial kidri(.!y to rid the body of kicet:tr,-.,ula,ted waste prod-,-tcts in blood. 9. S,,rstem - Tlijt,- 1),3)7t@ Of Lli(@ arti..F;.c@,il Iti.dncy w[iic], supplies the dial-ysate iid Fi.icli critical iL(.,,nis a-,; r@it(2 of' flow, tcrril)c@rature, ar).d coiiceiit-rat-ioi-i of c"ii.,ilysate. c, o ci @'.1 C) OlilL, of li c c, t@@ h c,,, r t ;I o d or d i (,i i)., n t@ h c-. a I t h )..3 I- @t. 1-@ d i@i 13r s i@ or y 0 14 t tl ei@LrecLly z.,- 2, to a access to c C, to stren,,ii i,@3 obtii.red th I e f 1.5 work control of ni@iii-itei-iance of propei.- -e t i@ori tj C :1@ c, 0 f 1 1 1) C, SY'S tc@ 4) t: 1, c, b 17 c t C) i, c, c i c', a 7," r,.-I tiric 16, (lircctly or indirectly itvo.v s @t COT I s .--, ti !,I the enLirc t t 1.7 I.,clw Aii.v kind of e@ wric-ire the ci),pc@iisive r ac i ri @i o c c o Z r.2. 1. I,, o Y) i i 1, c.@@ri Avoided. '@,uch facilities c,@rc, i-i,,@ed for ii<,,,e of I)I-iysic;ian time in staff i-eq-,i.ii@-ed 18. I.Iaint(-,na7.icc, of tli(-- ki.Lliic!y af tor it has I)cen removed frot-,i the ai-.cl tirit-.j.l it has into a recil)i(@nt. Or,,kin prc,sc@rvai':j.cii is iyir.--,gral I)art of ., kidney trarispl.anLittioii L-1 larogran!. 1.9* 0 Qtii nic-i@it - The identification of t propp(!(,-tive donor; the @-urgical rf@ii@oval iiid transportation of a donor kidney. 20. Peritoiic@@,l. An PI.Lernative to liemo(,Ij.alysis - the process by rich the c[i.,,L'Lysate is introduced into the abdominal cavity tisi.ng the pc-@-ri.toiic.,u-ii @is the, @@emi-periT,,c,,?,ble iremD-@@ine. rv -t e s f L 22, S J or 3.n @,i the, sj: of 0, f,,,inily 2 Ti-ie ol,.Iier tt-Laii @:1 c@ se(,l in (i,Lly-sis JA 24. to ol' 25. to t],@c.@ 7 II* FiLiiids (D-i-rect CosEs) a t -n Reouestcd Al ban-@, 0 $ i-@l 9@0- -Z.ZL- 0 0 1,548,4z,5 0 I'll E. ol 0 0 0 1,40,690 0 0 532, 9-@i-O 0 Al-ab@@ir!a (2 4 5,268,559 450,000 Arizo-'L-- 3 1 6, o@ 8 6 65,0'@)O Arkansas (6 1 l@,103,228 1 0 2 , Z[ 5,@@@ B:t - S 3 1, 31-6, 5/i9 200, C)O,') Cali-forni.a (2) 51 7 , 7 7 3 1 0 0 , 0 Ccri.tral- Yc-.rl@ 261,705 261,YO5 C(-)I-iriecticut- 3 328,095 19,000 934,313 @0,000 2 , -L3 ,2,:,327 j.:039,327 667,825 667,893 3 -----8 2 4,-,@1- 9 2 5 0, 0 Lc-)uiE,.ia-na (li) 4 3 6 3@CS 9 3 2 5 , c,'. 209,280 209,23@ :LI i 3 - 1-17 7qL 67,'C,38-- D.C. 2 79,li75 7 9 , 4 7 5 2 4,269,023 7 7 3 5 7 6 1 5 0 :(7) New Jersey (2) -.5 223,250 40,000 i 4 712-11.10 7 1 2, 1 !- C-, N.Y. -@llet-Iro 3 1 6@@@.- 50.00,@) No li . 4 72 060 72 OC@-) Northlarids 4 310,050 63,801@@ Ohio Valley 2 §2 9@7Q Rochester 3 7@2 946 1-86 Sotith Dal,-ota 2 470,zi68 50,000 Tri-State 4 2,542,357 2.542@35@7 Vir@ini.a 3 30,250 30,250 W.Vir@l-ni (3) 2 1975742 63,375 'Vlisconsin 5 1,959,256-- I.,959,256 Total 01 Yr. $1-4,071-,987 $ 5,78811,22 02 Yr. 10)875,664' 3)302$46-1@ 03 Yr. 8,302,746 2,572,473 Grand Total - $33,2505397 $1,1,663,050, Approvpc.1 @'Nati@oiiil A ci,,, i so,-v Co! C. i 1 c Ol a 1. i c Prc@@, r@,,ms June 5. 1972 A c c),i f@ f- I,"cluc a Liort Act iv i@l- ies 1 2 I'L(,) S 18 Laos 2 Yrs. 3 Yrs. Prc)jocL Alal)a7.a s 335,286 oi 2 Cal-;-fornia i -@ ri a , 1,159,418 !L (.Lr@-a lj7 870 t o oet a-1.) 5722 @ilO6 IV San joacquin Val-lc-y, $170,000 "-107 (-'@rea IV --Por 455,493 action) #108 (Ar c: o. V 45,370 10 V -'-.A. East Consorti.u@.i@@ 249,2412 'I 7@ 100,000 I.;o 2 Vil S,-in 150,000 :II Tit j, 2, 283..979+' Z@ C 42 060 50,000 "T 325,1@)OO 7. @L?7-4 @1-7 50,000 2 3 9 00 "3 0 2 @o 000 5 0 @i -r,@ c', s 7 4 100,000 n-5 @i)-,)rovil w:-thout funds. 0 598 81.1 I 9 Totals $882,060 $714,61 0,000 5,011,124 1 rr,,trr,41 f,,.n Grai-Ld Total - $6,874,996 PRIORITY '-DF-,OJECTS Na.-@.e of Region Project Nu,-iljer Anount Recoipnended @'4 5 335,286 (3 Yrs.) Ala'@ai-a 2. California !i 1 0 1,159,418 (3 Y-s.) 455,493 (3 Yrs.) 249,242 (3 Yrs.) I"29A-G, J'29J-N 325,000 (1 Yr.) 3. Lakes Area 4. @laine #27-#37 1,500,545 (3 Yrs.) 5. 1,@ew Jersey #30 200,000 (I Y-r.e) 6. Northeast Ohio #15 180,000 (2 Yrs.) 7. '2@'orthlands #68-#74 1.00,000 (2 Yrs.) 2 S. South Dakota 115,000 (I Yr.) 598,811 (3 Yrs.) 9. Tri-State #19 see r,ote, Page 1, Anp-,hdix F. DISAPPRO%@A-T,S of region Project Funds Requ6sted by '@lie PuviP -air, i@@ z@ 4 _75,354 lab, a t'@ 4-6 215,1000 27.598 i b T 3 _?4.,075 455,585 3. or i,,-',a -# 193,720 4. 7Titermountain 7@/41 ---- 947,200 @,;83S 1,14 243 659 7 ------- Oli:L,6 -L 6 .8 7 0 i 9 - - ------ 1,86,975 1'75,895 3 . @o es t er 3.-L 9. South Carolina ','rD3A-;, 63F i!61 3,691,581 0. Tennessee i@lid-S. not,2, A 7 e n APPEN!)IX G. I- 7AC R7QU7STS FOR AD@DITIO!@,AL F@l.@,DS CNCIZEASES IN N LE;ELS %NNUALIZED ADDITIONAL FUN'DS NEW \AC LEVEL RFGIO,I BITDCET PERIOD TI-@@":!".:-) I i'@ f-, 0 1iF-, D 1. Colorado/Wyoring 1/l/72-12/31/72 1,102,346 1,102,346 190,000 (40,000 Fed. Pul.) 1,292,346 2. Fi.or,'@da 3/l/72-4/30/7'@' 1,927,7C6 3@,927,706 321@,000 2,243,706 3. 1etro. D.C. 3/l/72-',/30/73 1,0,-,9,000 1,009,000 105,414 (Ped. Pul.) 1,114,414 4. l,ew '@xico 9/l/71-12/31/72 1,0116,719 1,036,719 22,000 (Ped. Pul.) 1,058,719 5. South Carolina 7/i/71-3/31/72 1,550,000 1,550,C)OO 98,186 (Ped. Pul.) 1,648,186 6. Ten,"s,@ce M'id--So. I/l/72-4/30@73 2,166,139 2,i66,139 216,613 2,332,752 @Dp owed: National Advisory Council or,. Pegional Medi-.al Progri-n3, iLile 5, 1972 2 1 4,3 5 3 7 3 0 8 '7 4 21 O,)f) 2 1 7 2 1 -i 7 5 1, 6 7 6 79 6 1 1 3,5 1 I 1 3 689 6 8 6 3 l@,@ 53 02@l 145 5 It@5 @175 2,-,9 752 -0- 64 00'@) 1 @qfll 11 8 7 1 1 1 (I c; 5 (i 50-@. I 10 331+,l 10 130 89'2 3 , 2 9 12 75 Olj@ f, 41 r 0 'I@ 2 5 7 3'-s 3 r5 2 5 0 0 "I 25 000 ld)4 764 12 1.764 1 t 1 1 i- tc- s 79,6 50 56 (,,')O 30 5r-,O 2 0 (,IOO 70 785 260,947 50 00',) 80,075 2 3f,) 085 90,00'i r o 25,000 95 (,)i)D 115 ooo f@-5 000 1?9 320 -0- Detroit @!edicnl Fouiidation 25,000 l@37,255 70,000 VI 114,601 188t255 188,255 -x@)r 63,820 122 3 122,34(,' vioxico Ilc@31th 2 5 O (,)O 224,600 224,600 Tti IiTii-, 81,707 86,095 -0- 3/ Representitig Dr. Marc J. Mtlsser tpr tire ver-erau5 iiuuti-LL-La v- L f f 5 (.1 1 81' 5 8 0 5 7 I 0 5 -o- e@ r c? V i 1, 1. 3 7 42'1' I 3 1-0 3c" 2c@5 1 90 36 7 500 7 9 0 p 1 1-1 C- r,-, i-t 0 3 80 5 2 90 8 55 2,@ i 19 2 , 70 218,206 128 0 0 4 208 , 1,0@4 ca 14 ll'ITTj'-,'l AT COIJ-QC IL Juiie 5--(,, 1972 r Mr. cl @.Cl-NIII n, n Dr. ll,r. T. 0. .,r. E. 0. OS-i --AA Fir . nrc)t@ii Po-rry, Corfziittee F,r . G c,@ ci)@, If I r, I D),- Co,.raittee Mr. L@@vi Dr. !:'r .(Ierick I,. Storte, Dr. i@ai,-,)I(2 Dr. Va,,4i Dr. ii Dr. Veriion E. Wilson, CA-I,S,%,-IA Mr. ;.'.o)Llitd L. Pcil@,cr on J. Mr. f@,.!.ctiar(i 14rs. T!,:ttricit Scli@,,,.ni Mr. Mrs. Saral-i Silzb@-e Dr. liir,,Lret 11. S).ol-ii Mr. Jerov,,e J. Stc,,lov 14r . Let-t Vin Wii@i,,,Ie Mr. Frerik Ziziavsky