i i [I I I s * 00127 * DEPARTMENT 0 F HEALTH, EDUCATION AND WELFARE Health Services and Yental Health Administration Division of Regioial Medical Prograr,,s Natio-.,ial Advisory Council on Rego,@ if@cal Pro Minutes of the Meeting July 28-29, 1970 Parklai,vr Building Conferc-nce Room G/H A 7' D,-@i@@ OF I-ZALTH, EDUCATION AND W=ARE PUBLIC @TH SERVICE National Advisory Council on Regional Medical Programs Minutes of the Twentieth Meeting 1/ 21 July 28-29, 1970 The National Advisory Council on'.Regional 'i'4edical Programs convened for its 4u-wentieth Teetirg at 8:3C a.m., i@esday, July 28, 1970 in Conference Room 'jl'H of the Parklawn Building, Rockville, Maryland. Dr. Harold @@galies, Acting Director, Regional Medical Program Service presided over the meting. The Council mergers present were: Dr. Bland W. Cannon Dr. Edmund D. Pellgrino Dr. Edwin L. Crosby (7/28 only) Dr. Alfred M. Popma 1'r. 4ichael E. DeBakey (7/29 only) Dr. Russell B. Roth Dr. Bruce W. Everist Dr. i4ack I. Slianholtz Dr. Idillia,-n R. I'@it Mrs. Florence Ri Wyckoff Dr. Alex@,ider M. ','4cPhedran A listing of RYIP staff m@ers, and others attending is appended. @@RKS .'I. C@T LM ORDER Aa%D OPE,.T LhG The meeting ,was called to order at 8:30 a.m.,on Jul 28 by y Dr. Harold i@galies. II. AViOLT.%C=, L@ T,-ie Council members were welco@d to the new Conference facilities in the Parklav.,n Bu4.lding and the general arrar.Zenents for the conduct of the meeting in these facilities was explained. Dr. Margulies announced his plans for an execut4-ve session aith the Council at the close of the first day of the meeting. 1/ Proceedings of meetings are restricted unless cleared by the Office.of the Administrator, TISNM. The restriction relates to all material submitted for discussion at the meetings, the-supplerrental material, and all other official documents, including the agenda. 21 For t.,ie 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 mi@t occur. This procedure ,aoes not, of course, apply to en bloc actions only when @he application is under individual discussion. 2 @DUCTION OF 1,EW INID@ Dr. 1.@gulies @uroduced two neAr members 'of the. Council who were in attendance ilor this meeting. They are: William R. Hunt, M.D. a Commissioner of the County of Allegheny in Pennsylvania and medical practitioner in McKeesport, Pemsylvania; and Alexander M. McPhedran, M.D., Associate Professor of Internal !Aedicine "Neurolo@), Emory University f viedicine, Atlanta. Tne recent appointment-of Mr. C. Robert School o Ogden was also announced. I\lr. Ogden is President of the North Coast Life Insurance Conpe-ny in Spo@e, Washington and Chairman of the Washinp:ton/ Alaska Regional Advisory Group. He will begin his regular attendance at the xt me@eting. ne IV. REGIO,@,,AL l,EDICZI.T@ PROGRAMS AS A PART OF THE @TTH SR,:RVICES AND i@iAL In his first meeting with the 'Ad-ninistra@or 0 Council as f the Health Sen ices and Ili'ental Health Administration, Dr. Wilson recalled his -'Long interest and f@rsL-,-hand 4rivolvemnt @n the development of Regional L Viedical -Prc-gm-,-S. He assured the Council of his strong support of Regional -Y,,ed-@cal Progr@-.as a part of the broader efforts of HSi@. He ex-pressed his endo.-serr,-rt of the Principles of decentralization of the administration of HSi'@,A activities gene--ally, and his-belief that the concept of Re@ional Y@edical Progr@, can relate well to these principles. All.-'nough the rrech&nisms will be worked out slowly, he is confid7e,nt '-V',-at this can take place without dilution of effort, either in the Regions or in the headquarters office. In recognition of the very formidable problems facing Regional @4ed-Lcal Programs Service, -Dr. Wilson expressed re@t that he was not able at the present 41-ime to -esolve the.rrajor sL"affinu problerm. He assured ti-,e Council this has very liigh.priority on his working agenda and @ul-,e fact that he is as yet LLnable to repo--t does not indicate that he is not actively wo,-ki@ toward a solution. Dr. Wilson asked the Council to meet with him again in approximately six to e-LFht itieeks, in a special one-day session. At that time he is assu--ed he.will be able to-discuss his plans, as they are based on I those of Secretary Richardson, for the organization and administration of the Depa.-t,-nent's efforts to strengthen and increase the nation's capacity to deliver- health services. Ile indicated also that by that tire he would have more definitive Dlans for the staffing and orf,tanization of the Regional r,4,edical Program Service. Although his plars will include a general outline of the "mission" of Regional iledical Pmgr@, as a nart of the hSMHA effort, Dr. Wilson said that he would rely heavily on the advice and guidance of the Council for develo-oina, +the policies and detailed program directions that would lead to even--nore efficient and effective cooperative arr@ngemnts between the private sector, which they represent., and the Federal effort. Dr. .I- Ld @ie rrji.Lno.1 of the resi-@tion of 4r. Lewis az @-piit"j oL' and abou+,-, 1.1r. Le,.,tis anpoini,,.@nt as Pro,"essc,-r, ir; 'the Depart;-,ient of Co..,,, ty ',Ip@,-cine at Albert Einstein College of 4edicine iA New York. :,x. @iis addressed the Council briefly, stating again his faith in the Regional D@edical Programs as representing "'Vhe only concept of true regio@alization of health services that can be expected to work" in the United States. Mr. Lewis expressed his thanks to the Council for the zany pleasant working relationships he had had wit-lh them. irxs. Florence Wyckoff responded for the Council, expressing their appreciation for his assistance to them, especially in helping then, to understand the principles of Federal financing of health care and in the area of health econo,-ncs generally. V. COlEmlI-T4ATICN OF @v=J.RE =LNG DATES Council was apprised of the necessity for reverting to a system of foir meetings per year in order to accommodate the changeover to C) I Amiversary Review. Tlao new Council dates were set: November 9 and 10 1970 and February 2 and 3, 1971. In addition, Sep'ue@er 30, 1970 was set for the special meeting requested by Dr. I-lilson. i@.e Council accepted the invitation of Dr.'Ediain Crosby to hold thi3 meeting at the American Hospital Association headquarters in (,bicago.. This will enable more of the members to travel to and return home from the meeting in a single day. VI. CO@NSE)ERATION OF THE 'L,M@LP-S OF 7rE i@CH 31-A'-PRIL 11, 1970 ',/U=IG Tne Council ura-riLmusly recommended approval of.the minutes of the ireeting of the Council on 4arch 31-April 1, 1970. vrII. A '.,RE-PO@@- FROM TIE DIREC-IOF - Dr. Harold @gulies A. Pro,@ss of HR 17570 and S-@,355 Dr. r4argalies reviewed the contents of the two Bills very briefly and referred the Council .@mbers to an analysis prepared by staff which corTares tne Bills to one another and to the present legislation. This was included 4@-I the agenda materials. B. Appropriations for Fiscal Y@ar 1971 Status of the AnoroDriation Bill was reviewed and the Council was reminded of the various circumstances which iapinge on the total amount of "new" funds to be available for @or expansion of Regional 14edical Progr,am in FY 1971. Amng these are the $1.9 million earmarked for '@lode'l Cities activities the 1% reserve of funds to be used for evaluation 4 activities at D@, HS,-TrLA, and R4PS levels; the possibility of administrative earmarking of some funds for HT participation in comprehensive reg-Lonal kidney disease programs; all in addition to a ce@s of $77 million required to meet total amount slightly in ex minimal continuation requirements of ongoing regional activities. C. Funding Strategy Dr. ivbrgul'Les made a brief introduction of a new management information system being :L-plei,-,e@ued by R) He also noted the effect of the 1969-70 strategy of permitting Regions alwst unlimited rebudgeting of unexpended balances for program e)Vmsion. Dr. D4argulies stated his intention to begin-to apply more stringently guidelines to.@uhis kind of -ebudgeting and to recapture some of these balances for reallocation among the Regional 14edical Programs in response to evidence of successful regionalization ani nomogram develoo,,,nent. D. The FAST Recomerdations In a brief review of the recommendations of the Federal Assistance Streamlining Task Force and his plan for responding to them' Dr. !4arg-ilies e@hasized the "liaison" -role of the DHEW Regionai Offices in the developr.-ent-of programs generally, and in helping to relate Regional lledical Programs to both -oubl-'Lcly and privately-@nded pro in the area served; but with the retention of the principal management responsibility in the Regional '4edi-cal Prog?am Service at the national level. Fe also mentioned especially the Se.-vice's concern, ante@-t-'@o' the Task Force study, for better delineation of the mltiplicity of activities now covered by the core budget in Regional ,@ical Program grants. Dr. @',Targalies explained the intent of RYPS in placing a Program Representative in each of the @uen DIED Regional Offices and described what he sees as the service role of these individuals. VIII. PROG-?ESS @,l@l--S FRO@4 STAFF A. Contracts under Section 907 Dr. Margaret Sloan Dr. Sloan gave a brief review and status report on the three contracts made by the',TTS under the terms of Section 907 of Title IX of the Public Health Service Act, which deals with the "...list or lists of facilities in 'the United States equipped and staffed to provide the most advanced methods and techniques in the d@osis and treatment of heart disease., cancer, and stroke.... The contract with the American fieart Association in support of the Intersociety Co@ssion for Heart Disease Resources., has begun serial' publication of its report and will continue to do so throughout the Period of the contract. The Joint Committee for Stroke Facilities, supported by.a contract with the American Neurological Association,' ha@ chosen to withhold publication of its report until it is entirely coiTpleted. The report of the Special Advisory Condttee on Cancer Care Facilities of the Cancer Commission of the American College of Surgeons, which was supported under a contract now completed, has been reviewed by the Regional Medical Pro@ Service and was received by the National Advisory Council at the-April 1970 meeti@o'. Negotiations between the Arwrican College of Suroeons a,-,d the R14PS, preparatory to completion and R.MP approval.of this report, are now underway. (This was discussed in mre detail with Council during the Fxecutive Session). B. Multi-Progam Services Project Grants Mrs. Martha Phillips Authorized under Section 910 of Title IX of.the Public Health Service Act, this program of project grants will be tTlemented for the first time early in FY 1971. The Council was reminded of its original role in the development of the basic guidelines and operatinn- policies for CD these grants. They were assured that these are reflected in the final- edition of the program documents which are now in clearance. The Council expressed its persistent concern about the potential effect of the funding of these grants on the total funds available for Section 904 grants (operational support to Regions). Dr. Margulies said that he expected to be able to present to the Council at its next meeting, a plan for allocation of grant funds that would take into consideration an appropriate distribution of the available dollars between these two major grant activities. C. Regional Medical Programs in Model Cities - Mr. Cleveland@Charbliss The. Council was reminded of the administrative earmarking of $1.9 million of FC4P ',;y 71 grant funds for use in projects which have direct impact on.certain designated Model Cities neighborhoods. Mr. C@liss outlined the pro@dure Llor deterrrliniro, the degree of such @ct and obtaining the certification of Model Cities officials in'this regard. Although this procedure includes endorsement of DHEW Regional officials, Mr.. Chambl-'L,--s assured the Council that the procedure would entail no authority for further revive and approval of 'these projects beyond the local Regional Advisory Group and the National Advisory Council. Also in response to specific questions, Dr. Margulies explained that Regional Medical Programs which are planning and submitting projects to I . 0 6 serve urban populations need 'not plan them exclusively for rAodel Cities areas and-need not seek any endorsement or concurrence beyond their ow-'l review and approval mechanism. D. Senior Clinical Traineeships D4r sMartha Phillips. Mrs.: Phillips recalled to the Council the circumstances leading to the De @ tmental decision to Dlace responsibility for the Senior Clinical Tiaineeship program in Regional 14edical Programs Service. She also reported to the Council on the selection of the first group of Traineeships to be a!@ed @er R@12S sponsorship. This selection-process was carried out by panels of non-Federal experts in the cancer field and was chaired by Dr. i4ichael Brennan, to whom the Council delegated authority for the selection of individual trainees to the total extent of $3003000 of FY 1970 funds. Thirty trainees were selected from among 80 applicants.' and represent the disciplines of medicine, gynecology, pathology, pediatrics, radiology, and surgery. TTie training will be done in major radical centers throughout the United States. E.' Guidelines for Instructional Technology - Miss Cecilia Conrath A second'edition of these guidelines was before the Council for their consideration. Dr. Pellegrino, who served as Chairman of the Subcommitte-E! to prepare these guidelines, expressed his belief that they are now ready for publication and implementation, with certain rewriting. This is being done by RMPS staff, incorporating I)r. Pellegrino's suggestions. F. Evaluation Activities - Yir. Roland Peterson In reporting to the Council, Mr. Peter son mentioned the fina-'- summation and distribution of the Regional Progress S ie8 which resulted from the questionnaire developed and tabulated by his staff; on the Regional ,Medical Proo?a-rn Evaluation Conference to be held at the University of Chicago Conference Center in September; and on his plans for evaluation activities in FY 71 which vtill be chargeable to the -"evaluation e K. rrnis earmrk was explained to the Council by both Mr. Peterson and Dr. '4argulies as a 1% administrative reserve to be used for evaluation activities not only at the program level, but also at the level of and DHEW. It is anticipated that something slightly under $1 million could be set aside under these circumstances and could be used by contract or by the Section 910 grant mechanism, at the discretion of RMPS, with portions of the total withheld for and D@ evaluative activities. The entire ffatter of evaluation SDarked cons iderable discussion in the Council. It was the consensus that in order fo.-- these funds to be effectively utilized, a much broader concept of evaluation must be developed. There was a good deal of discussion of the contract with Arthur D. Little, Inc. and expression of considerable doubt as to the real value of any findings being reported. Several of the Council members have had individual experience with the conduct of the contract activities and feel that t heed have not always been handled in the best interests of the Program. There was unanimous agree,@nt with the sugAestioii, made by Dr. Roth and Dr. Cannon, that interim reports on the progress of such undertakings, either this current one or any future such contracts., be required and that they be nade available to the Council for review and discussion. The Council requested a more definitive report from "-,he staff on the results of the contract, particularly as it relates to the purposes for which the contract was originally le-.. They also asked to see the f inal report fro,-n the Arthur D. -Tittle, Inc. as soon as it is received by RMPS. In s -i@-- the discussion, Dr. Pellegrlro suggested that all evaluation activities should. in the lon@ -LLn. serve to test the viability of Regional .@.O-=ar,.s as their are aeveioDing; and if they are found mlv- -Uo be viable to de--Ue-@ne Tt;i@ not. KIDNEY Di-SEASn- ACT-=IES --L@N @P IONAL VEDICAL PROGRAMS Dr. Margulies reviewed for +,,-he Council the circumstances leading to. the addition, -in both the Tiouse and Senate versions of the continuation legislation, of kidney disease as one of the specific disease -categorical targets of Re@7ional 'Aedical -Programs. He asked for guidance of the Council in the development of a responsive and effective -ooli-cy for 0 Regional- Medical gra.T@-,s participation in coriore'nensive regional kidney disease proc-ams throughout the Nation. He is aware that t,.L@ f inal definition of suc.,i a policy., especiplly as it would apply to the innediate future, will not be possible unti'L after Congressional action, on both the continuation legislation and 'the appropriations, is tomplete. In order to provide so,-Lne back&,otLnd for their deliberation., Dr. Margulies in -aff to -,orepare exp@ ed that he had asked the s4 some basic infonration and -uo draft sor,-e suoo-ested policy guidelines. Tnese were part of the agenda -@rater@ials ,oreserted IL-lo the Council. He then introduced Dr. George Schreiner, Chief, ;Nleplirology Section, Department of Medicine, Georgetown University and Dr. Richard B. i",reeman, Departr,,ent of Medicine (Ne @ology), University of Rochester School of Mediciiie, whom he had invited to tne -,.,eeting to orovide expert reference to the Council in their deliberations. presentation of the "state of the art" Dr. Schreiner mde a detailed of the gerent of chronic kidney disease. He included resume of the techniques and Methodologies of screening, diagnosis and therapy; and th6 shortco, @.gs as.well as successes in prevention, treatment, and. rehabilitation. ifiephrology is,-Dr Schreiner said, a new area of specialization. As such it has the disadvantage of a severe shortage of trained specialists; but has the advantage of ilav .ng few established traditions, and is in the enviable.posit-2Lon of being able to profit from the mistakes made in establishing resources for.open heart surgery, high voltage radiotherapy etc, Organization for'@-@',@,7,delivery'of servies to patients with kidney disease, Dr. Schreiner.be',--'@-,-@s, lends itself so ideally to regionalization that the developmnt o' h a program can and will serve as a framework for regionalization o- '@@,.@--vices in other more traditionally established disciplines. Again, as in nearly their past discussions of kidney disease, the Council expressed ",,-(@ern about the apparent lack of emphasis on prevention as par',, ',;,- an overall kidney disease program. Dr. Schreiner and Dr. Freeman br-.,,.--- +-ha@ the only hope for real prevention will @e come via prenatal and genetic engineering" and although work in these areas is '-,!-'@---,essing, it will not have any significant impact for fifty to sixty They also believe that the more traditional ctive for approaches to pre,i,-,@,..on generally will not be seen to be effe at least 20 years, Both Dr. Schreiner, Dr. Freeman spoke to the issue of the cost of developing regior@,..:@@ kidney disease services; and the way in which the enormous n@e"" often used in this regard have been misleading and discouraging to J'-@,'-,',i-tutions and comunities. Both agreed that the $15 im'-llion mentir@f,e-,i in the pending legislation could make a Significa 'nt diffe-.-,,,,,..,.,,e in the extension of services of existing kidney disease centers ci, ',ti the establishment of some srpaller n@er of entirely new ones. Mar@lies reminded the Council that the $15 @llion to the Bill makes reference., is recommended as a rraximm assiguient of Reg-'-,,,,,,;jl Medical Program grant funds to kidney disease efforts, and in n,-@ earmarks or limits any dollars exclusively for this purpose; nor it provide, or even record end the provision, , of funds over @ the grant funds to be otherwise available for purposes of Regic)r;i@ @/iedical Program-s. Dr. Everist raisc-@@ question of the mechanics of incorporating kidney disease into the 55 Regional Medical Programs if the principle of local @,,@,onomy and decision-r,-aking is to be maintained. It is his belief ,@nless and until Regions with appropriate existing facili'ui(-@., @Li be Itseduced" into-afi'Ording high regional priority to kidne.,/-,-)'-."-,P-ase control, it will be necessary to use the Section 910 author,",,-/, so that national directives may be used to develop "sensible f,@,,,,i7ams in- sensible places." AcceT)ting the app,,ii,,-@..-,Iy inevitable lag time before the results of a pl@ed program (,$ -,--r-evention can be felt, Dr. Pellegrino asked for the advice of Dr. '@,---c@-iner and Dr. Freeman on what immediate impact Regional Medical could reasonably have,. considering the provisions of thc- i,@-,-,:,-sed legislation and within the amount of funds that are likely t(, available within the next two or three years. Responding first, @---hreiner recommends the strengthening of existing facilitl.t-:-@. -,,--rticularly those which have co@tted themselves to outreach bey!DLi(i ;@-z- confines of the medical center within which they exist; and identifying those among this group that lend them- selves to furth6r interli@,Ye to provide a multiplying rather than -'fect. Dr. Freeman recommend simply an additive e,- s the su,,oport of the completion and extension to full services of a small number of centers which can be developed,on the basis of existing, although perhaps not entirely co=lete, resources; the use of RMP funds for support of pl 17, particularly in regard to increased effective utilization of e ve resources; and the training of personnel, principally physicians, ,qho can serve to train others (other physicians and paramedical persomel). The Council strongly endorsed Dr. i@ephedran's point regarding the @rtance of thoughtful integration of a kidney disease program into an existing -Regional Medical Program; particularly in planning, sub-regionalization, continuing education, and inter-professional co cation activities. In a subsequent discussion on the second day, the Council members reflected on the recommendations of Dr. Free@n and Dr. Schreiner ectives, and the basic operational concepts as well as on the goals, obj which guide Rea-ional Med,-cal Programs at the present time. Since these proscribe against the use of funds fcrthe direct provision of patient services, and the total amount of funds 'Likely to be available will proscribe acainst @g rWor contributions toward the establishment of facilities, the U-ouncil agreed that the major focus of RDIM involvement will be (a) the encouragement of better and more.effective cooperative arrangements armna, carefully selected institutions and resources which CD together Ta@,'u form a "decentralized center" and (b) in the strengthening of existing institutional resources competent and willing to develop oix;reach, both in the demonstration of service and the training of personnel. Both of the above require national as well as regional planning. In surw@, t,qe Council endorsed the general plan presented by the staff; they also agreed, however, that to develLOD a workable overall policy it will be necessary to have basic data conc erning the resources in, and available to, each of the 5-D Regional '4edical Prov?ams. This should include (a) presently self-contaired centers, (b) institutions which have the capability of becoming an integral part of such a center, and (c) institutions and resources which might participate in an inter- regional arrangement Lor the provision of kidney disease services. An assessment of the "size and shape" of the kidney disease' problem in each of the Regions would provide the other essential piece of basic information. Dr. Margulies alleed to provide these data based on the existing geographic pattern of the 55 Regional ,4edical Program. X. 4@IIE7vi O'@P APPLICt'l@LIONS A. Issues identified 1. In the'rmtter of R7,IP support of sho@,,-terTn trai l@ projects, the 4S@ Council considered the h-L Llory provided them by staff, and a number of . 8 I 10 he applications under review at this specific projects included in t meting. They believe that under most circumstances it is not necessary @t funds to be used to or appropriate for Regional Yiedical Programs cover the full costs of both the presentation of short-tem training jects and of stipends and expenses of the participants. pro ------The majority of projects in this category provide opportunities for UP grading and development of new skills in special techniques or procedures and are directed to individuals presently employed in health care institutions. Under the circumstances these institutions should, and in most cases do, make regular provision for this kind of training for their staffs. The Council therefore recommended the following changes in policy elines regarding payments to participants in continuing education training projects (as defined in the Guidelines Addendum, February 1970, page 13) which are supported by Regional i'Aedical Program grant funds. Re ional iMedical Program grant funds,irav not be used for the . 9 payment of stipends either directly or on the "maintenance of income principle," to participants in short-tem, continuing education and training projects. Thi,,: ining for neA new types of heal n personnel. Other allowable costs of participant's support may be 'ing to t,,ie existing Guidelines. calculated acco.-a Regional Medical Program grant funds may be requested and awarded for per them and travel to the extent Of 50% of the tbtal'amount so derived. The awarded funds my then be paid to the enrolled trainees as considered appropriate by the project personnel, depending on the participants' ability to provide these costs for themselves and/or the willingness of their employers to provide them. no single individual may receive per them or +.-ravel allowance at a rate higher than that prescribed by the present Guidelines. R4P funds may not be rebudo.-eted, from within or without the project budget, to increase the total amount awarded for per them and travel above the 50% level. 2. The Council considered the present Guidelines regarding Regional .'4erlical Program funding of T)roiects of long-tem. T)ost-doctoi at management in the diseases t ed by Fegional 'eledical Programs. As has been pointed out arget by both the Review Committee and the Council, requests for suoport for training of this kind are appearing more and more frequently in Regional f4edical '.,DrcVam applications because of the increasingly critical shortage of.i,-idividual-s trained in these fields, but also because of the drastic reduction in NIH funding which has previously been available for this purpose.. the training The Council w, @wusly agrees on the iiTportance of maintaining programs in these fields in the major teac@ centers throughout the nation. They also @ee that :Dindi@, t@u@ri Re-.-ional iledical Programs would serve to strenpthen the essen@,,ial invoive,-,Ierr, of these cente@-s of clinical 'ts which fonn the excel.lencte! ilini-uo the Casework of c -erat@ve emen 00@ a. p t basis of the Region of ivnich they are It is recognized, however, that the allocation of an amount of -@ds large enough to make a significant impact, if provided from the present RD4P appropriation, would create a serious and -@napl,)ropriate imbalance in the @lT efforts to meet more their varied and comprehensive goals. Tne Council, therefore, requested the. RP4PS staff to forward to both HSrir,@- and D.H--Lld its unanimous recommendation that arrangements be raae to D.-Oviae i,,eaeral assistance to clinical departments in major teaci,.,!-@ centers to offset he identifiable education costs (as distinct L'r o ni t. enti,-Pied Tijith orovis.4on of natlent services) Of the mi-i@uera--ice oL' nci ar-( dency training_ pro@,.s;tnai; this the frane,,qork of Reg-tonai Prog7faTs; an iat o' ve the current grant lunas .Ep-plooriat,ea to Regional @@edical @ams, .oe Sought for ti@s purpose. Accordingly, the Council recommends that until such funds are added to the annual approo@-i@,-Lc)n, the Reg4-oral P@edi-cal Program Guidelines for .operational grants arde.- Section 904 of mLi-tle IX of the PHS Act be changed to exclude the pa@nt of stipends and other participant costs for lo@o--ter,-,l training at the post-doctoral level. 3. Tne Council is keenly aware of the potentially crippling effect on -Regional ?4edical Pro@ams of conrinot,.s investment in nro.jects Vnich @iere initia',- L@or de,-icnstra..tio.@-o-,P. or trainitifr in, new techniques of patient care, but orov4Lde w-ha-u becomes an essential service to Da@uients. Tney cont-inue to bell-eve, ho7,tiever, that it would be unwise anct inaeea i=o*s 'Lble to develop a firm policy @oitrarily including or excluding projects of this kind, and instead ar@e the @TS staff to ,vork closely with Regions, as they develop projects, to be certain that other sources f of support 'or i-ai.@enance o the service -involved be wel-l- in hand before such a proiec@, is ti@ved; and also to encourage Regions to carefully u investigate every possibility of capturing the ,'ees paid for the service involved for reir-ves-L,,,iient in the project. B. -,peciai Actions NORrrrE-AS.i@,@.%4 Ol',IO REG!OiqAL 'vEDICAL PROGRAIM In response to a special appeal for reconsideration of previous action on Project #7 (A C-ormrehensive Ou'u-patient Stroke Reha:oilitation Demonstration), the Council considered the additional information submitted and recommended that the project be approved as requested. ol - $48 233 02 - $50 145 03 - $26,076 12 NOff S @jIOL'@IAL '/EDICAL PPOGRA:4 The National Advisory Council considered a request for the initiation of interim support to the Diab4tes Detection ahd Education Center in Minneapolis with the understanding that (a) these funds will be made available from the Region's unexpended balances and (b) that this 1 does not in any sense indicate co=.'tment to approve the approva forthcomin- a-o lication for RMP participation in the long-range basic tD @ p support of this Center. VIRGIIIIA REGIONAL r4ED:ECAL PROGRA:A In regard to Project #4 (Stroke in a Smal 1 Rural Co ty) the Council concurred in the staff's recommendation for a waiver of the restrictions @osed as a condition of the original approval of this project, subject to the satisfaction of RMPS that the purposes of the project are being adequately achieved. N N09 YORK REGIONAL MDICAL PROGFW4 In regard to Project #10 (Wectern lqew York T=r Registry) the Council concurred with the Review'Condttee's recommendation for continuation of the project as amended. C. Reconmndations for Ac@uion The Council recorded their recommendations in the format which was adopted in the previous review cycle '(,ki)pendix I). ALBAiiY REGICiqAL @'@IC@ '@DROGML R4 00004 7/70.1 - Operational Supplemental Approval with specific conditions. Project #7A(R) - Approval I with the conditions specified by the Review Co@ttee. Project #7B(R) - Approval I with the conditions specified by the Review Co @ ttee. Project #18 - inon-approval II - Revision ,iequired. 01 - $86.%930 02 - $36,930 03 - $0 1/ All amounts are direct costs only and unless otherwise specified refer to a 12-mnth period. The designation 01, 02, etc. relates to the first, second, etc., budget periods of the subject an not necessarily the budget periods .placation, IP that will ac"u-ua'l I y be s,,ippienfenrect. 13 ARIZONA REGIOIIAL '/=ICAL PROGPL,4 FC4 00055 7/70.1 Approval with specific conditions. Project #11 Approval I with the conditions specified by the Review Committee. Project #12 Approval I with the conditions specified by the Review Committee. 01 $151,395 02 $1461053 03 $15OJ628 ARKPil4SAS REGIO@IAL DIEDICAL PROGRAM ,%M 00052 7/70.1 -Ooerational Supple@nt Conditional approval. Project #35 -Approval I with the conditions specified by the Review Coffdttee. 01 $88jl4g 02 $82j769 03 $0 BI-STATE @"IONAL /E)ICAL PROGFAM FC4 00056 7/70.1 -Operational Suloplement Approval with specific conditions. Froject #12 -Approval I. The Council concurred in all t.,@ conditions recommended by the Review Committee except for the budget reductions inthe equipmnt category. This item may be increased by a figure not to exceed $15,000, after negotiations with the Region concerning the University's ability to provide part of the equipmnt cost. Project #13 @lo action taken. The Council requests the Review Comdttee to reconsider the project in the light of several. issues identified by them. .01 $68 000 02 $58 425 03 $61,023 CALIFORNIA REGIOt4AL IVEDICAJ, PROGRX4 M-4 00019 7/70.1 and 7/70.2,- Approval with specific conditions. Project #41 -inon-approval II. Revision rer -luired. The Council consiciered the findings of tne Review Committee and of the technical site visitors whose report was available to them. They s7oecifically recomended that the Region be given benefit of the advice of the site-visitors and urge@ to revise the project along those lines. (,ALlbyi?@'IIA Pd-rzIOi-iAL :.IEDICPL P @M4 Project #56 - Approval Pr-o,iect #60 - Approva'L I in the reduced amount Project 1 - Pon-approval I 01 $107,307 02 $117,248 03 $121.,393 I\EW YORK REGIONAL MEDICAL 'D G@4 RO RM 00050 7/70.1 - Operational Supple@nt - Conditional approval. Project #15 Approval I at a reduced level with the conditions specified by the Review Committee. ol.- $401000 02 $503000 03 $53,000 coLoRADo/wyc),,YaNTG REGibiqAL i4iEDicAL PROGRAf4 R4 00040 7/70.1 - Operational Supplement - Return for Revision. Pro ect #13R - inon-approval II. Return for revision with the clarification requested by the Review Co @ ttee. FLORIDA REG!Oi'TAL @,/,EDICAL PROGFAM PJ4 00024 7/70.1 Return for revision. Project #36 Ilon-approval II with recorinendations for revision as suggested by the Review Comdttee. GEO.RGIA REGIOIGA:L @,MICPJ, PROGRAM re4 ooo46 7/70.1 - Conditional approval. Projects #31 and #32 - Approval in the reduced amount of $100,000 to be used for the initiation of both projects as seen fit by the Georgia R4P. Project #33 - i-lon-approval I. 01 - $100.1000 02 - $100.io0o 03 $0 GIEAimM DEL,*IA-RE, "'ALLEY @,-IONAL ,,IEDICAL PROGRAM R,!A 00026 7/70.1 - Disapproval inappropriate for !W funding. Project.#19 - Non-approval I 15 HAIIIAII -7,-, Ii IA LI/,EDIr,'AL PROGR94 RM 00001 7/70.1 Operatior@a-I SLipple@nt Approval Ao rova-I I Loject #21 -P Project #22 Approval I 01 - $202,743 02 $99 168 03 $108325.2 ILLINOIS RT-zG!ONA-L P.L@-DICAL PROGRAM R4 00061 7/70.1 - Approval with specific conditions. Project # 9 - Non-approval II with the recommendations for revision suggested by the Review Committee. Project #10- Ar) roval I -P Project #11- Approval Iwith the conditions specified by the Review Comdttee. Project #12- koproval I Project #'L3- Approval Iwith the conditions specified by the Review Co@ttee; with second and third year funding contingent upon progress in the first yea-- to be assessed by the Council on the basis of a progress report, continuation applicati on, and the report of the technical site visit to be held somtim,@ toward the end of the first year. 01 $587,412 02 $6.61,237 03 $341 883 BOTRIA R-FGTO@@v'_AL IC-D-CAL 11 PAM L Rfi 00043 7/70.1 - Ooeratioral SuDDlerr:ent Non-approval @e--t #19. - 7-.Ion-approval I inappropriateness for RAT funding based on the Councills decision to defer approval of projects proposing the clinical application of genetic counselling, ndiniz further scientific validation of the clinical pe uses of this technique. 'on Project #20 N -approval II with the recommendations for revision suggested Uy the Review Co ttee. B@iOlPtYPAI[4 P ,EGT 0 I,,IAL DJF DICAL P.ROGFW4 RM 00015 7/70.1 Operational Supplement R6turn for Revision Projejct'#27-- iqon-aT,)proval II with the reco,@ndations for revision suggested by the Review Co,=,ttee. 16 KANSAS REGIO@"TA-L ')EDIC-AL PROU@@M RM 00002 7/70.1 Ooer@uional Supplemnt Return for Revision Project #39 Non-approval II with the recomTendat.Lons for revision suggested by the Review Committee. LOUISLANA PEGION@l ivEDIC.4L PROGRA,:4 RM 00033 7/70.1 - Approval with specific conditions. Project # 8- NTon-approval'II with the reco=iendations for revision sug _gested by the Review ComrLittee. Project # 9- Approval I in a reduced amunt and with the conditions specified by the Review Committee. Project #10- Approval -L Project #11-- Approval !I Project #12 -Nori-approval II with the recor@mendations for revision suggested by the Review Co@i t@Lee. Project #13 Approval II ol - $147,532 02 - $77,242 03 - $79,342 i@@24'D REGIO-NIAL @IC@T P,-iOGRAD4 94 00044 7/70.1 and 7/70.2 Operational Sun-o"emerts Approval with specific conditions. Projects #25 and #26 7 @Dproval I with'both projects to be combined at a reduced ar,,iount and with the conditions specified by the Review Co @ ttee. ,Project #27 -Approval I Project #28 -i\lon-appr-oval II with the recomendations for revision su@sted by the Review Co@ttee. Project #29 -Non-a,,oproval I Project 930 -Non-approval'I ol - $94,975 02 - $144)475 03 - $145,975 tin-JIPIiIf') @-,IONAL. '@ICPJ, PPOGRA.D4' R4 00051 7/70.1 Onerational Supplewnt Disapproval. Inappropriate for RD,T flznding. Project #27 r4on-approvpl I. The Council was in agreement with the Review Co@ttee in recoTrmending non-a7c roval for the .P Peripheral Vascular Clinic Project. Tney wish, however, YE4plfI-@ L@IONAL IVE@DICAL PROGRP24 (CO@,fr) to be certain that the project,personnel and the Menphis RT understand that the recoffmndation in no way reflects a disagreemnt with the inherit service value of the Clinic nor suggests lack of confidence in the staff and Institution. The action does not preclude resubmission of a-request for R4P funding for the continuira education aspects of this project at such ti@ as these -are mre thoroughly planned and ready to be irrplemnted. Project #28 Non-approval I MMOPOLITAN WASHD4GTON, D.C. REGIONAL MEDICAL PROGRAM RM 00031 7/70.1 - @erat4.onal SUT)-olement - Approval with specific conditions. Project #36 - Non-approval I Project #37 - Approval I at the reduced level and with the conditions specified by the Review Comdttee. 01 $38@477 02 $4o,618 03 - $44,928 MICHIGAN REGIONAL lvEDICAT, PROGR.AL@ RM 00053 7/70.1 ODer@u@Lo-ial Sup-olerrent Approval with specific conditions. Project #16R - Approval I Project #27 --,kuproval I with the conditions specified by the Review Cor=ttee. In concurring with all of the recomendations of the Review Cormttee, the Council urged the R'eS staff to work closely in the development of this project with the hope that it will come closer to a demonstration of comprehensive care, as promised by its title than it would presently appear to be. Project #28 Non-approval II with the reconnendations for revision suggested by the Review Co @ ttee. 01 $550,970 402 $454,574 03 -,$477,459 MISSISSIPP-7 REGIONAL YEDICAL PROG-.@P-1 RM 00057 7/70.1 - ODe.-ational Sui)plemnt Approval with specific conditions. @ject #2R - Approva.1 in the reduced amount for 18-months with the conditions specified by the Review Comdttee and with the understanding that this will represent the termination of R14P funding.of this activity. 18 Ml,'3SISSIPPI REGIOI@AL 'VEDICAL PROG.PA4 (CON,-) Project #13 -Approval I Project #14 -lion-ao roval'!I with the recommendation thetthe Region -P I be requested to reconsider their program in'the light of the National guidelines for RMP participation in comprehensive k-idney disease programs. Council further recommended that the Region be afforded direct help by the staff of !?r2S in @ing their decision in this regard and in planning a revision if such is to be proposed. 01 $213,420 .02 $125,946. 03 $39,455 IUSSOURI REGIONAL PC- DICAL PF.OGRAIM RM 00009 7/70.1 and 7/70.2 Operational @plement Approval with specific conditions. Project #60j- Tqon-a-opro%ral II Project #61 -klon-approva-I II. Although the Council agreed with the Review Corrnlttee that these two projects, as presented, are unacceptable for Regional D4edical Progrann support, they recalled the recomrri--ndat2Lons of the recent indepth site visit to Yio@'-T and suggested that with staff help from both RNIPS and i@.o@T these "outreach" projects could be developed into important corTonents of the Program. Project V62 - Approval I in a reduced amount and with the conditions specified by the Review Conmttee Proi6ct #63 - Non-approval II - The, Council reconmnds that this project be integrated into the Region's overall continuing education effort in the preparation of the Region's Anniversary Review application. 01 $3303243 02 $36,984 03 $39,165 !40UNTAIN ',3TAri"n.S RE'IIONAL -rIEDICAL PROGRAM R-M 00032 7/70.1 - Operational S-applerent Approval @oject #12 - Approval I Project #13 - Approval I 03 $197,8o4 ol - $184,976 02 - $191,117 MI DTXICO REGIOINAL @ICP.1 PROGRKM RM 00034 7/70.1 Operational Su-ople,@nt Approval wi@h-specific conditions. -#13 'ion Pmj ect -, -approvd]. II 19 NEW @CO REGIONIAL MEDICAL PRIOGFW4 (CONT) Project #14 - Approval Iin the reduced arrbunt and with the conditions specified by the Review Condttee. Project #15 Approval Iwith the conditions specified by the Review Co@ttee. 01 $921100 02 $99,900 03 $101,765 NEW YORK v-, L=POLITAN FEGICNIAL MEDICAL PROGRX/L' RM 00058 7/70-l.and 7/70.2 Operational Supple,-ne@nts Approval with specific conditions. Project #16 tion@approval II with the reco,@ndations for revision suggested by the Review Co @ ttee and with the advice that the Region defer further planning for RTIM participation in Sidney disease se-@ces in the New York Metropolitan area until they receive the National policy.guidelines which are in preparation. Project #17- Approval I. The Council based its recommendation on the findings of the site visit team which had visited the project on the advice of the Review Commit.:;ee. @ject #lC)- @lorl-approval 1 Project #19- Approval I 01 $476,475 02 $494,965 03 $350,000 NORI-.I CAROLI@i'-A REGION.AL =T CAL PROG@PX4 R,4 00006 7/70--l Ooerational Supplerrenu Approval with specifi .c conditions. Project #3R - Approval I@ Project #26 - @4o Action Taken. Site visit required. Ol,- $89,908 02 $62,550 03 $42,@o6 NOT LM DAY,(YRA REGIONAL @?DICAL PROGRAIM 94 00060 7/70.1 - Ooerational SuT)olement Approval- with specific conditions. Project #5 - Approval I Project - Approval I. Althou&h Council was in general agreerwnt witn the Review Committee concerning the shortcomings of this project, it was their opinion, based on first-hand knowledge of the Insti'uution and personnel involved in the project and on their experience in site visiting this 20 NO.@ DAKOTA RM'LONAL NLDICL PROG@-W, (CONT) Region, that -,he approval of IL-,his project is essential for Awther development of the North ndino- Dakota Regional l@edical Programs. In reco@. CD approval, Council strongly urged RMPS staff to work with the Region and with personnel involved in this project to correct som of the deficiencies and get it off to a good start. Project #7 Approval I for essentially the same reasons given above. The Council believes that the :L-rplementation of this oject is essential to regional development and Pr gested that i@ be approved a'- $35,000 (deo) for one sug u v - year only vrith continued support contingent upon revision of the pro@ect with staff assistance, and reapplication -to the Council. Project #8- l,qon-approva"L I Project #9- Approval I 01 $115,383 02 $79,772 03 $79,549 NORTI-',TATEST OHIO IMI01i.Al@ ',)E-DICAL PROGRAIM R-m ooo63 7/70.1 ard 1/70.2 - Operational Supplerrents Approval withI specific conditions. Project ff'Ol-S - !,Ton-approval I emiect Wi@- :4on-app--Oval II with the recormndations for revision suggested by the Review CorTn,'Lttee. Project #14 - Appro-ial@ with the conditions specified by the'Review Condttee, for one year only. Project #15 - kuproval I. Although the Council recognized this as another of the "Council for Continuing Education" pmjects 'tted by the Ohio State Region which have been sub-a and 9 action upon which has been deferred pendin the outcom of the initially funded one. The Council accepted the advice of the site visitors that the roject is of critical importance to the Northwest Ohio p Regional iMedical Program and probably has an excellent chance of success und er the 'Leadership proposed. Project #16 - to be incorporated with project #14. rmject #i7-- koproval in the reduced amount and with the conditions specified by the Review Committee. The Council further considered the findings of the site visit team regarding the rieo,-'-on as a whole; its organization, adrrlinistration, and plans. It is their recommendation that the -ie--Ion be uro-ed to seek stronger leadership but the Council agreed that any specific re- co@ndation regarding personnel would be inappropriate. 21 NO, T OHIO REGIO,'QAL i4EDICAL PROGRAD4 (CONT) The value of an assessment visit as reconmnded by the visitors was questioned since it would probably do no mor e than re-identify the problem. Council suggested that perhaps direct and frequent assistance from R14P staff and consultants would be more helpful than further investigations of the situation. ol -.$145,830 02 - $70,525 03.- $211250 OHIO STATE REGIOIJAL MEDICAL PROGRA24 EM 00022 7/70.1 and 7/70.2 Operational Renewal and Supplement-- Approval with specific conditions. Project #lR - Approval I at the reduced level and with the conditions specified by the Review Co @ ttee Project #8R - Approval I in the reduced amunt and with the conditions specified by the Review Co@ttee. Project #22 - Approval I (Tl,,is project was considered by the Council in the previous review cycle and action was deferred at that tire). Project #24 -'Non-approval II with the recommendations for revision suggested by the Review Committee. 01 $714.VO75 02 $778,731 03 $847,944 OHIO VA=@Y REGIO,'QAL i@ICAL P,@C)GRAM RM 00048 7/70.1 - Operational Supolen-ent App roval with specific conditions. Project #12 Approval I in the reduced amount recomended by the expert technical reviewer. Proj ect #13 Approval I. To be funded only if not fun:bd by other Federal resources. Pm-ect #14 Approval II @ect #15 A-,oproval I Project #lb Non-approval II with the reconTnendations for revision as suggested by the Review Co @ ttee. Project -#17 Non-approval II with the recommendations for revision suggested by the Review Co@ttee. Project #18 i%Ton-approval I 01 $273,546 02 $296,215 03 $327,657 OREGON REGIONAL i,PEDICAL PROGRAP4 F14 00012 7/70.1 Operational.Supplement Approval Project #12R - Approval I Pmject #16 - Approval I 01 $59,375 02 $28 829 03 - $14 843 PU= RICO REGIOIQAL MED7CAL PRC)GRAM RM 00065 7/70.1 - Opera:t4@ona-1 SL.,pplemnt Approval with specific conditions. Proj ect # 9 - Approval I inthe reduced amunt and with the conditions specified by the Review Committee. Project #11 - Approval I with the conditions specified by.the Review Co@ttee. .01,- $320,936 92 i227,436 b3 $233s636 SOUFti CAROLI@NTA REGIO14t'J, '@IEDICAL PROGML R4 00035 7/70.1 - Operauio.@l Suoule,@nt Non-approval. Project #35 lion-approval II Adt-lh the recommendations for revision suggested by the :Deview'Co@ttee. ec'u #3.5 -!4o action taken. I)ite visit is indicated. Proi Project #37 -@Tor.-approval I S-LJS@@kMIA VA T=-Y REC-IONPL i@ICAL PFDG@M FC4 00059 7/7b.1 - O,-erational Supplement - Approval with specific conditions. Project #20 - I-Ion-approval I Project #21 - Approval I in the reduced amunt to reflect the newly adopted policy on training project participants. Project #22 - ;,Ton-approvil I Project #23 - ilon-auidr-oval I Project #24 - ilon-approval II with the,reco@ndations for revision suggested by the Review Co@ttee, L Project #25 - -@lon-a-oproval II. TT-;e Council was in general agr-ee@ment with the Review Co=,attee regarding the specifics of the project but believe that further development of this project along with #24 is in the best interest of the the Region and has requested that the RMPS staff offer assistance to the Region in this regard. @ject #26.- Approval I 01 - $92 - 02 - $78,915 . .03 - $83,294 .1134 4 23 - TEXAS REGIO@l.@ MEDICAL P.ROGRA14 RM 00007 7/70.1 - Operational fipp"ement Approval with specific conditions. Project #8R - Approval I contingent upon the satisfaction of a technical srte-visit team regarding four specific points set forth by the Review Condttee. Project #14R - Ppproval I with conditions specified by the Review Committee. Pro,,ect #15R - Approval I Pr,oj c@t #48 @@on-approval I Project #49 Non-approval I $460 $296,595 $240,386 ol .64o 02 TRI-STATE @r'IOiNAL 14EDICAL PROGRAM Fj4 ooo69- 7/70-11- Operational Supplement Approval Pr,o@ect #9 App.-ovaL I in a reduced arw@u and with the conditions specified by the Review Col@l'ttee. 02 $85.6oo 03 - $63,000 01 - $105,300 VLRriIN'IA RE,.'!ONAL nDICAL PROGRAiv, RM 00049 7/70.1 - Ooeratio-.,ial Supplement Approval with specific conditions. Project #10 - Approval I with the conditions specified by the .Review Co,7mttee. In discussing this project the Council wished to stress the importance of the condition for approval of this pro@-ec-u and urges great care on the part of the staff in adjusting the second and third year amounts of P14P support by utilizing patient revenues to offset costs of the project. Ol,- $268,552 02 $480 479* 03 $533,504* To be negotiated downward WESML'I l@,[ YORK @IO@'4AL MEDICAL PROGRPJ4 PJ4 00013 7/70.1 - ooerational @o le,-,nent Approval with specific conditions. Project #15.- Approval I'in the reduced amount and with the conditions specified. Project #lLo' @Approval I in the reduced amounts and with the conditions 'ttee. Council expressed its specified by the Review Comi willingness to allow the Regioft to increase the funding 24 WESTW@ IIDI Y@ORK REGIOTAL YEDICAL PROGRATri (CODIT) of this project to a maxir=.of $100,000, providing such a level'of funding would be required t-D maintain this valuable regional resource. Project #17 Non-approval I 01 $350,000 02 $350JO00 03 - $350.1000 WESTFa'q P@-,4SYi-,VANIA REGIO,'QAL iMMICAL PROGR94 RM 00041 7/70.1 - @eratio,@L Supplement Approval Project #9 Approval I ol $43,911 02 $44 820 03 $46,995 WISOD,L@SIN REGIO','@ i@ICAI, PROGRAM RK 00037 7/70.1 and 7/70.2 - Operational Supplemnt Approval with specific conditions. Project #13A (R) - Approval II Project #!bA - Approval I Project #!bB - Ilon-approval I Project #16I - Non-approval I Pmj ect #lbK - I,,Ton-approval I Project #19 - l@Ton-approval I. Council based this recommendation on the findings of a collateral review of the project by the staff oL' Maternal and Child Health Service, HS,@, which was requested at the suggestion of the Review Committee. Project #20 -Ai) oval I . Pr Project #21 -Non-approval I Project #22 -Approval I Project #23 -Approval I in the reduced amount and with the conditions specified by the Review Co @ ttee. 02 $167,807 03 $172,395' 01 $2922815 25 - Xi. ADJOURNMM n July 29 1970 The rrL-eting was adjourned at 11:30 a.m.0 I hereby certify that, to the best of -MY knowledge, the forego@ @utes are accurate and complete. Regiorial Yiedical Prograrm Service 26 fli 1;@;rjl a7i i.i .1 -n the Pan.@-].s to !"I @.@Lew Co;,,;-@dttee -(On-?rojc@ct-s Ci-O.y) Ilechnically sound and cap-ably directed Feasible wider specified conditions Unaoprovable on tecl-ii-iical. gl@uiids Pron the Revic@,i Co7.TitL-.ee to the National Advisory Council. -EcTi ec41- s) Approval,. I Additional. fui-Lds mcoinir.,nded Approval II No additional fu.-(ids r,-,cornTiended Non-ar@r)r<)val I - Iri@Lppropria'uc.@ for D,7@U-1 funding Non-approval II - llc@visioi-i required en 1-b Ecti-on tak l@c-@cd additional infor7rir-ition Need site visit Need. Council dc-cision (On E-ntire @rplications) Approval Approval with specific conditions Deferral- Re 4- .un,i for Revision Disapproval -.Inappropriate for TL)RviP funding Fyorii the I,'aL',j.on,-L. Advisory Council to th,-, Ad!-nini:str,,-ttor (On En'u-irc! Apl@l -c@L;-j.or s Approval Approva-I wilu-Ii z,,r)ecif-'Lc conditions (As reconnected by the ',Devie-vi Corrii-Lttc-c or others) @,ferral Returii for !-I(@vi.sion u Disar),T)r-ovz).l I,,iapl)n-)f)rj.a.te for fLLridinL), 27 -NATIO:!.@r @.D@r!S',).@Y CO,71'@'LrL, r-)!' EL-'GI BRE4iNAN, Michael J. , M.D. (72) MIILIKA14, Clark H., M.D. (72) President, 1.1ichig@an Cancer Foundation Consultant in ','Neurology 4811 John R S-reet L' e Mayo-Clinic Detroit '-Iichigan 48201 Rochester, P@@sota 55902 Professor of-1.1p-dicine OGDEN, Mr. C. Robert (70) Wayne State University President and General Counsel North Coast Life Insurance Company CANNON, Bland W. M.D. (73) Spokane, I-lashinpton 99201 910 Madison Avenue - (70) r4errphis, Tennessee 38103 PELLEG.@10, d D., M.D. Vice Pre 'dent for the Health si 'Division of 14'euro--urgery Sciences and Director of the Center Universi'uy.of 'Lenressee College State University of New York of Medicine Stony Brook New York 11790 3 CRO.@BY, Ed,/iin L., M.D. (71) POPD4A Alfred 14. M.D. (70) Executivp- -Vice President and Director Regional Director Amrican I-,oso4L'v-al Association @lo@uadn States Pl,,T Chicago' Illinois 6o6ii 525 Vlest Jefferson Street Boise Idaho 83702 @,BAKEY, Michael E. I M.D. (72) President @d Chief Executive Officer RO-IH ssell B. M.D. Ru (73) Baylo.- College of ,Iedicine 240 VIest 41st Street a 165o8 Houston, Teyas 77025 Erie, Pennsylvani Professor and @.a@=.,an Vice S-,oeaker of thc- Hous6 Depart@-nt oL' Surgery of Delegates, A College of medicine SHMqHO@j-Z, @,lack I. M.D. (70) E=ST, Bruce W., M.D. (71) State Health ComTissioner Chief of Pediatr-Lcs Sta,.-e Department of Health Green Clinic Richmond, Virginia 23219 Foiston Lou@Lsiana 71270 TPdM, Mr. Curtis (71) IU4T, William R., M.D. (71) Director, Pension and Insurance Dept. Board of Corwissioners United Rubber, Corltc, Linolein., County of Allegheny and Plastic Workers of -@,-ica 101 Courthouse Akron Ohio 44308 P-I.ttsbur,-@i, Pennsylvania 15219 WYCKO,,-,F, Mrs. Florence R. (72) Mcplrml@ll, Alexarde,,r M.., M.D. (73) 2143 Corr,-ditos Road @I ry University Clinic Watsonville California 95076 l@65 Clifton Road, !'4'. E. Atlanta Georgia 30@22 CHAI94k'q Dr. Vernon E. Wilson Administrator 3 i'ealth Services and Iffental Health A(i-,iinis+.,ration u 5600 Fishers Lane Rockville, 1'.@yland 20852 26 AMMANCE AT THE NATIONAL ADVISORY COUNCIL July 28-29, 1970 RMPS STAFVI A ING Miss Rhoda Abrams Dr. Marion E. Leach H. Earle Belue Mr. Gregory'Lewis Dr. Edward T. Blo@mquist Mr. Ray Maddox Mr. J. Edgar Caswell Miss Elsa Nelson Dr. Donald R. Chadwick Mr. Roland Peterson Mr.- Cleveland R. Ch@liss Mrs. Martha L. Phillips Mr. Clyde Couchnm Miss Leah Resnick Dr. Sam Fox, III Mr. Dona]dRiedesel Mr. Edward Friedlander i'@s. Jessie Salazar Mr. Sam 0. Gi@r Mrs. Sarah Silsbee Mr-. Charles Hilsenroth Dr. Margaret Sloan Miss Dona Houseal Mr. Jarws Smith Mr. Dan Spain ik-. Frank Ic@-owski Dr. Anthony Kormrof f Mr. Lee Teets Mrs. Lorraine Kyttle Mr. Francis Van Hee Jr. '4r. John M. Kom, Jr. Mr. Lee Van Winkle Mr. Frank Zizlavsky OTHERS ATi-E4DING Dr. iMaurice Bender., OS Dr. J.H.U. Brown, NIGIMS,N-IH Dr. John Cashman, CHS, HS!4M Mr. Jams Dunlop, A.D. Little, Inc Miss Sylvia KesirZer, CHS, HSNM Dr. Richard Levinson Veterans Administration f4r. Wendall lliaddrey., IICHSR&D., HSI@ fArs. Sylvia PaTwr, NCI, NIH Mx. liorman @cker, BHPDT . NIF, Dr. T. M. l@ega, NIKMD, NIH Dr. William Zukel NH&LI, NIH