f. !@n, 3 D E P A R T @-i E N T 0 F H E A L T 11, E D U C A T I 0 N AND IIELFARE Health Services and liental Health Administration Division of Regional Medical Programs National Advisory Council on Regional Medical Programs Minutes of Meeting August 26-27, 1968 National Institutes of Health Conference Room 4 Building 31 DEPAR';I,IF,NT OF IIT,@.LTH, EDUCATION, AND WELFARE PUBT IC REAITfl SERVICE II -U@ L@'.LIl SERVICES Al@t-) ADMINISTRATION NATIO'@I&L ADVISORY COUNCIL ON RE'V"10'iqAL MEDICAL PROGRAMS Minutes of Thirteenth Meeting 2/ August 2'Q-27, 1968 @@@-"The National Advisory Council on Regional Medical Progrims convened for its thirteenth meeting at 8:30 a.m. on Monday, August 26, 1968, in Conference Room 4, Building 31, National Institutes of Health, Bethesda, Maryland, Dr. Stanley W. Olson, Director, Division of Regional Medical Programs, presided for Dr. Robert Q. Marston, Administrator, Health Services and Mental Health Administration, who was unable to be present,for all of the meeting. The Council'triembers present were: Dr. Edwin L. Crosby Dr. George E. Moore (8/26 only) Dr. Michael E. DeBakey Dr. Edmund D. Pellegrino Dr. Bruce W. Everist Dr. Alfred 14. Popmi Dr. John R. Hog-iess Dr. Mack I. Shanholtz Dr. Clark H. Ilillikan The Council members absent were: Dr. Helen G. Edmonds Dr. James T. Howell -3r. Curtis Treen Public Health Service members attending some of the sessions included: Dr. Samuel M. Fox, National Center for Chronic Disease Control Dr. George E. Goodman, National Center for Chronic Disease Control Dr. Daniel Ilorn, National Center for Chronic Disease Control Dr. O.W. Maddrey, National Center for Chronic Disease Control Dr. Robert Q. Marston, Administrator, Health Services and Meittal Health Administration Dr. Frank W. Mount, National Center for Chronic Disease Control Mr. John L. Pendleton, National Center for Chronic Disease Control air. Donald Riedesel, Natio7ial-Center for Chronic Disease Control Dr. W.H. Ross, National Ce--iter for Chronic Disease Control I./ Proceedings of meetings are restricted unless cleared by the Office of the Administrator, HSINA. T'.'Ie restriction relates to all material submitted for discussion at the meetin.,s, the agenda for the meetings, the supple- mental material, and all other official documents. institutions, or (b) in v7h4.ci a conflict of interest might occur. This procedure does not, of cours@, apply t:o en bloc actions--only when the application is under discussion. 2 Liaison members attending; Dr. Sidney Farber, NCI Colincil Dr. A. Earl Vall,,er, NIIt-i) Council (8/26 r,,"Iy) others Attending: Dr. J.R.U. Broem, NIG@,3 Dr. William D. Mayer, UriiversLty of Missouri Dr. Mathilde Solmqey, N'Li,;D Miss Pauline Stephan, NCI DRMP Staff: Mr. Stephen Ackerman, Associate Director for Planning and Evaluation ,Mr. Nicolas Cavarrochi, E'i.nancial Management Officer Dr. Donald R, Chadwick, Deputy Director, DRMP Mr.' Cleveland R. Chambliss, Assistant Associate Director for Operations Mr. Edward M. Friedlander, Associate Director for Communications and Public Information Mrs. Eva 14. Handal, Committee Manage-nent Officer Mr. Charles Hilsenroth, Executive Officer, DRMP Dr. Charles A. Iinboden, Assistant Associate ))irector for Organizational Liaison Mr. Gregory Lewis, Chief, Grants Management Branch Dr. Richard lianegold, Associate Director for Program Development and Research Mr. Maurice E. Odoroff, Assistant to the Director for Health Data Mr. Roland Peterson, Assistant Associate Director for Planning and Evaluation Mrs. Martha L. Phillips, Chief, Grants Review Branch Dr. Alexander Schmidt, Chief, Continuing Education and Training Branch Dr. Margaret Sloan, Associate Director for Organizational Liaison Dr-. Richard Stephenson, Associate Director for Operations Miss Cecilia Conrath, Continuing Education and Training Branch Mr. Arthur Curry, Grants Management Branch Miss Joyce Finnegan, Grants Management Branch Mrs. Mary V. Geisbert, Office of Planning and Evaluation Dr. Louis Gerber, Operations Officer Mr. Sam 0. Gilmer, Jr., Operations Officer Mrs. Sheila B. Gould, Comnittee Management Office-' Mr, George Hinkle Grants Management Branch Mr. Bryant Jones, Operations Oj'ficer Mr. Robert Jones, Grantf: Review Branch Dr. Anthony Komaroff, Operations Officer Mr. Glenn Lamson, Operations Officer Mr, Robert Lawton, Consultant to DP,14P Mrs Emily Macafee, Continuing Education and Training Branch Mrs:-Patricia McDonald, Grants Review Branch Miss Leah Resnick, Planning and Evaluation Branch Mr. Richard Russell, Grants Review Branch 3 Mrs. Rebecca Sad'Ln, Continuing Educatio,@i and Training Branch Mrs. Jessie Salazar; Grants Revie-yi Branch Mrs. Ella R. Scates, Planning and Evaluatior, Branch Mr. Alphonse Strachocki, Operations Officer Mr. Lee Teets, Grants Management Branch Mrs. Mary A. Tell,er, Planning and Evaltiation Branch Mr. Francis L. Van Hee, Continuing Education and Training Branch 1. CALL TO ORDER AND OPENING RD-LKRY.S Doctor Olson called the meeting to order at 8:30 a.m. 11. ANNOUiqCEI-ILIIITS Doctor Olson made general announcements about the Service Desk, and called attention to the statements on, "Conflict of Interest," and "Confidentiality of Meetings." IIAT. COI\ISIDEPA,"L'10.1 OF FUTLRE IEFTING DATES The Council reaffirmed the following date: November 25-26, 1968 (Monday-Tuesday) These dates for 1969 were tentatively approved: February 20-21, 1969 (Thursday-Friday) May 26-27, 1969 (Monday-Tuesday August 18-19, 1969 (14onday-Tuesday November 20-21., 1969 (Thursday-Friday) IV. CONSIDERATION OF MINUTES OF MAY 1968 MEETING The Council unanimously recommended approval of the Minutes of the May 27-28, 1968, meeting as written. V. LEGISIATIV-L DEVELOPMENTS 1. Budgetary Status Doctor Olson presented the current status of the budget situation for Fiscal Year 1969. There a-l-e cari-y-over funds from Fiscal Year 1968 in the amount of approximately $35 million. The total amount which will be available for Fiscal Year 1969 will depend on whether the Senate or the House version of th.-@ authorization Bill is finally approved. The Senate Bill would result in approximately $63 million for a total (with carry-over) of $018 million, @,71icroas the House Bill would permit $50 million for a total of $85 million. With continuation reouireri@-nts for Fiscal Year 1969 of approximately Year. The Senate Apptopriatir-,!ls fo-aniittc-e has earmarked at least $5 million 4, 2. RMP Le5yisl.ation Different versions of the authorization Bilt for rMP have been passed by the Se-@iate and the House. It reriains for these differences to be resolved in conference. T-tie significant differences are: (1) a three-year extension in tl-ic- Senate Bill and a tnqo-year extension in the ',qouse "ill; and (2) $65 million for Fiscal Year 1.969 and $140 'Ilion for Fiscal Year 1970 in the Senate Bill, and $50.million in m3. Fiscal Year 1969 and $100 million in Fiscal Year 1970 In the House version. VI. REOj'-@.GANIZATION OF HEATTH SERVICES A[,") 14El@ITAL HEAL'Ell AD@,IINI'STRATION Doctor Olson introduced Dr. Donald R. Chadwick, Deputy Director of the Division of Regional Medical Pro-i.-ains, who, prior to this 0 appointment, was Director of the National Center for Chronic. Disease Control. Doctor Olson discussed the organization of the new Health Services and l@ientali- Health Ad@ninistration (IISIIHA). He also discussed the relationship of the Division of Regional Medical Programs to the Division of Chronic Disease; Co,,mprehensive Health Planning; and the National Center for Health Services Research and Development. VII. G-PANTS REVIEI,7 AND WOR17,LO-,kD The Council reviewed only supplemental requests at this meeting in the amount of approximately $1.0.8 million. Staff presented the expected workload in the grants review process for the next review cycle. All regions are expected to have operational activities by the end of the Fiscal Year. It would be desirable, not only in order to reduce the workload of the Council but also to carry out a more effective review, for each Regi,in to have a single anniversary date and,, therefore, submit one application per year, VIII. STATUS OF T iF6 54 REGIOIQAL MEDICAL PROGRA.14S Doctor Manegold presented a brief report of the current developmental status of the individual regional medical progr=s. He briefly described the individual strengths and weaknesses of each region, characterizing strengths @.,s: 1. The existence of a str-onr, coor inator and adequate central program staff able to provide positive leadership to the program and the region; 2. A regional advisory truly representative of the region and which knows its role @-nd accomplishes it in an effective manner; ? t-h- 4. The forraulatinn by tl-e region of a valid planning and concept consistent re-ionr-.1 medical program philosophy- 5. Involvement of ti@ic critical of the region, most often the medical rcliool(s), private pr@.cLiLiotters and the medical society, hospitals of all types, and health interests; 6. Sound and wor@-bl- cooperative arrarigeiiients established among the above; 7. Granti proposals well presented -,nd reflecting activities within the strategic concepts of the rcgioi-i, adequate evaluation of the activities, and a good balance of activities among the categorical areas; 8. Sound relationships with comprehensive health planning; 9. Balarce between health service and continuing education,activities, and attention being paid to particular regional problems, such as the urban ghetto, migrant field laborers, etc. Characteristics that seem to impede regional. development are: (a) an inability to express thoughts and ideas via grant requests or during a site visit, (b) difficulty in recruiting adequate staff and establishing a regional advisory group,, (c) the region being awk'-v7aid,ly constituted, (d) the region enmeshed in a difficult polit;.cd situation, and (e) the program has become deeply involved withczailarticular institution or interest. The issues raised by this summary ,,tig-est possible means of Regional Medical Programs achieving better the programs' goals. IX. SLTI--TARY OF ACTIVITIES OF THE DIVIf,;IOli OF CHRONIC DISFASE Doctor Chadwick discussed the organization and function of the Division of chronic Disease (DCD). The functions of DCD are to carry out applied research, to promote the development of improved health services, and to support the training of health personnel in chronic disease prevention and control. Staff from the Division of Chronic Disease was introduced, and presentations were then made by Dr. Samuel I.I. Fox, III, Chief, Heart Disease and Stroke Control Program; Dr. George E. Goodman, Chief, Kidney Disease Control Pro-rani; @nd Dr. William L. Ross, Chief, Cancer Control Program. X. COORDInkTORS CONFERENCE-,U.,' SEP'EEIfBir,R 30-OCTOBER 1 1968 The second meeting of the Progra-@.,i Coordinators Will be held at the Marriott Twin Bridges Motel, Arlington, Virginia, on September 30- October 1, 1968. XI, @,CUTIVE SESSION The Council met in Execu@lve Session. the afternoon of Aup ,tjst 26 with 6 @@ll, SITE VTSIT RLPOR'"S A Council received summries of all of the site visits which we re made as a result of council ictior@ at the 1968 meeting. Xiii. CONSIDERATIO@L 01@ GRANT @.PIILICi%TIOiNS ,&,PPRO@IED IN TIIT-, Al\'D RE@RSZED 3 G02 @M 00019-02S],. Celiforii@ia @IP The Council recoi7ruended approval in the tire and amount requested with the provision that the re-ion clarify and document the proaram's relevance to the categorical diseases. The Coun--il vie%@Ted the proposal more favorably than the Review Committe while essentially agreeing with its concerns. The consensus was that i s sh ortcomings were insignificant and reinf-@diable by clarification and documentation of the relevance to heart, cancer, and.stroke. The amount requested for a three year pt@ri.od beginning July 1, 1968, through June 30, 1972, is $zil8,243, plus appropriate indirect costs. 3 G02 RI-I 0002L-02S3 Alabama R@iT The Council concurred in general with the recommendations of the Review Committee and rec@-nended approval in the time And amount requested. It was noted that the previous successes of this Region tend to substantiate its ability to accomplish a reasonable portion of the proposed activities. The amount requested for a ten-nionth period beginning September 1, 1968, through June 30, 1969, is $273,509, plus appropriate indirect costse 3 G02 R7ri 00062-02RS2. Tri-State PIIP The Council recommended approval in the time and amount requested. The .Council requested that staff advise the Region that in preparing future applications, special attention should be given to clearly describing the relationship of the proposal to the objectives of the Regional MedicAl Program. Also, unusual budget requests such as limousine service and automobile rental should be thoroughly justified. The amountr--quested for C-@ fifteen-month period beginning September 1, 1968, through November 30, 1969,is $198,439. No indirect costs were requested. 3 G02 RM 0005 02SI YP-m-,his PIIP The Council recommended E@pproval in the time and amount requested. A minor concern was expressed regarding the relationship of the Regional i.fal. Cfnte-r. Council noted the The amount requested for a one year period beginning July 1, 1968, through June 30, 1969@ i@,; $248,184, plus appropriate indirect costs. 7 APPI,-@OVFD VIT.Tll COI-I!)I'CI(@@TS I G03 M4 00001@@0. The Council concurred with the Review Committeels recommendation for conditional ap,?roval of the core planning and administration component in the mount of @334, 123 plis appropriate indirect costs for one year, with a site visit and reconsideration of requested future years of support at the next Council meeti,.ig,, The amount requested for a five year period beginning September 1. 1968, through August 31, 1971, is $2,503,417, plus appropriate indirect costs. 3 G03 rii 00032-OISJ, 1.11 ITT@ (IM4ounttaa RMP The Council recommended approval of the Core Administration-, Advanced Planning and Evaluation portion subject to the findings of, and at a levelto be rec n6ed by, the site visit team for a period not to exceed one year; site visitors to consider reduced staffing and funding commensurate with the viability and appropriateness of the region. The amount requested for a five year period beginning November 1, 1968, through October 31, 1973, is $8,123,165, plus appropriate indirect costs. 3 G03 I\'I-i 00037-.02Sl, Wisconsin PDIP The Council recommended conditional approval of the core program component for one year in the amount requested, $438,974, plus appropriate indirect costs, with a site visit and reconsideration of future years of support at the next Council meeting. The amount requested for a five year period beginning August I 1 1968, through July 31, 1973, is $4,488,182, plus appropriate indirect costs. 2 G03 RI,,j 00026-02, Greater Delaware Vall RMP The Council recame-Jed conditional approval in principle at the present level of moi@-,.hly obligations with a site visit to assist the. Region in a reaeonab'.@Le rcvision of the present application and with delegation of authority to the visitors to set the appropriate level of funding. The amount requested for a three year period beginning September 1, 1968i through August 31, 1971, is $7,846,690, plus appropriate indirect costs6 DEFERRED 3 G02 RM 00024-02Sl, Florida RMP The Council recommended deferral of this application with a site 7 The amount requested for a three year period beginning Noveimb6r 1, 1968, through October 31, 1971-@ , is $658,200, plus appropriate indirect,costs, 8 3 r,02 Et.,@ 001@O@9ZS_2-..@01 The.council reconnended deferral for a site visit for additional iTif orrnat ion aff to and clarification. ,@urth@,r, the clale,,gated authority for st by amend the current pi-anni.tig grant Lricreasing the funds awarded for personnel in an amount not to exceed $14,500 provided there is a sound basis and justification for additional funds. The amount requested for a one year period beginning July 1, 1968, through June 30, 1969, is $281,527, plus appropriate indirect costs* 1 C03 P,@i 0000"-Ol, Connectictit P-@IP The Council recmranended deferral pending satisfactory confirmation of cooperative artangraents required I)y law, and of support for the proposed operational program by the groups upon which implementation would depend, specifically the practicing physicians. llessage conveyed to Region should emphasize that Council is impressed with the progress to date of the Regional Medical Program developing in Connecticut) that the deferral action was taken to facilitate the rapprocliment between the CPIIP and the Connecticut State Medical Society, and.that a site visit of Council and staff will be made to help if the parties at issue request it. The amount requested for a five year period beginning July 1, 1968, through jvne 30, 1973, is $21,237,593, plus appropriate indirect costs. Mr. Roberi Lawton absented himself. DISAPPROVED 3 G02 @l 0006 -02SI, North Dakota The Council recommended disapproval of this application. Among other things, the North Dakota RIIP not only has to determine the incidence of the categorical diseases, but aleo determine the available facilities and care. PECIAL ACTIONS The Council approved the Special Actions on the following: 5 G02 @l 00013-02. Weste--7n New Yor RMP The Council-recor.-.innded ,ipproval in principle of the proposed planning study on stroke but without a commitment of additional funds beyond the current grant award peri,3d. 5 G03 RM 000 up to $94,006 in direct costs provided it can be demonstrated that the computer costs involved cannot otherwise be met. 9 5 G02 id,@l 00058-O' @N'e@,7 Yorl', 14etr(12,2 c, n st to provide interim The Council recomended@ approval of the reqtie support in order to continue the 14,emori.al, I-lospital Fci.si.bility Study in cancer for the six months period begi-tii,iitig January 1, 1969. 3 G 2- RM OOO(I-02SI 11@lil'Ois IZI@,D The Council recomended approval of the request for $32,000 for direct costs" Mr. Friedlander commented on the Conference which was held-recently by the American Hospital Association. The proceedings have been edited by Mr. Friedlander, and these should be ready in about two monthso XIV. DELEG-KTION OF ADIllORITY PY NATIOI- A., L,@RY OUNCIL ON REGIO@'QAL liFDIC&L PROGRAY@S TO THE DIVISION OF REGIO',,itkL @ll rRA iS STAFF FOR AD-MINISTRATIVE MKNGES 114 s OF ON-GO'f@IIG G&OITS On August 28, 1967* the Council approved the delegation of authority to the Division staff to approve increases in amounts for acti 0 grants for four general purposes. The second of these was: 11(2) Extension of grant period with additional funds, at a rate not to exceed the current rate of support, for a period not to exceed six months-- in order to prevent hardship to personnel or loss ofinvestment already made under the grant, to provide additional time for preparation, review, and approval of a renewal application, or to provide for orderly termin- ation of the grant. Such extension would be reported to the Council." On August 27, 1968, Council approved the further use of this authority in the following circumstances: "In the case of grants which included commitments for a final budget period of 12 full months but which were arbitrarily shortened (and amounts concomitantly reduced) by the Division's decision to extend commitments iLo longer than 12 months beyond the life of P.L. 89-239 (June 30, 1969)." 1.0 XV. ADJOIJP,','T@,'iFNT The meeting was adjourned at 1-:00 p.i,,i., A,tigust 27, 1968. I hereby certify that, to the best of my knowledge, the foregoing minutes are accurate and complete. Stan ey Olson, @I.D. Director Division of Regional Medica Programs Eva M. Handal Committee Management Officer Council Secretary r@J-,f I 0 DTfk L A D V 'L,@"Oli@.Y CO!,@-@TCITI 01@N Edwin L. Crosby, Yi.D. (71-) Clark H. Ifillikan, M.D. (68) Director Consultant in Neurology American Hospital Association Mayo Clinic Chicago, Illinois 60611 Rochester, Minnesota 55902 Michael E. DeBakey, M.D. (68) George E. Moore, M.D., Ph.D. (68) Vice President for Medical Director, Public Health Research Affairs of Baylor University Net.., York State Department of Health Professor and Chairman Ros;7ell Park Memorial Institute Department of Stirgery 666 Elm Street College of Medicine Buffalo, New York 14.203 Houston, Texas 77025 Edmund D. Pellegrino, M.D. (70) Helen G. Edmonds, Ph.D. (71) Vice President for the Health Dean, Graduate School Sciences North Carolina College Director of the Center Durham, North Cirolina 27707 State University of New York MAILING ADDRESS Stony Brook, New York 11790 Alfred M. Popma, M.D. (70) P.O. Box 432 Regional Director ,idurham, North Carolina 27707 Regional Medical Pro-ram 525 West Jefferson Street Bruce @l. Everist, M.D. (71) Boise, Idaho 83702 Chief of Pediatrics Green Clinic Mack I. Shaiiholtz, M.D. (70) 709 South Vienna Street State Health Commissioner Ruston, Louisiana 71270 State Department of Health Richmond,, Virginia 23219 John R. Hogness, M.D. (70) Dean, School of Medicine Mr. Curtis Treen (71) University of Washington Pirector Seattle, Washington 98105 Pension and Insurance Department Ur.,.ited Rtibbor, Cork, Linoleum James T. Ho@;ell, M.D. (68) and Plastic Workers of America Executive Director 87 S. High Street Henry Ford Hospital Akron, Ohio 44308 Detroit, Michigan 48202 Robert Q. Marston, M.D. (Cbdirman) Director Health Services and Mental Health Administration 9000 Rockville Pike Bethesda, Maryland 20014 DRMP/CMO ,July 196n