i i "ii 'i i. i i, I I t t @ i @ i @I ' Hill I :it 4 IEI@"LO D E P A R T M E N T 0 F H E A L T Hs, E D U C A T I 0 N A N D W E L F A R E PUBLIC HEALTH SERVICE National Institutes of Health Division of Regional Medical Programs National Advisory Council on edical Programs Regional M Minutes of Meeting November 27-29, 1966 National Institutes of Health Conference Room "All Stone House DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SE,TVICE NATIONAL ADVISORY COUNCIL ON REGIONAL MEDICAL PROGRAMS Minutes of Sixth Meeting I/ November 27-29, 1966 The National Advisory Council on Regional Medical Programs convened for its sixth meeting at 8:0.0 P.M... Sunday, November'27, 1966, in Conference Room t'All, Stone House, National Institutes of Health, Bethesda, Marylan Dr. Robert Q. Marston, Associate Director, NIH, and Director,, Division of Regional Medical Programs, presided for Dr. William H. Stewart, Surgeon General, who was unable to be present for all of the meeting. The Council members present were: Pr. Leonidas H. Berry Dr. Clark H. Millikan Dr. Mary I. Bunting- Dr. George E. Moore Dr. Bruce W. Everist Dr. William J. Peeples 'Dr. James T. Howell Dr. Robert J. Slater Dr. J. Willis Hurst Dr. Cornelius H. Traeger The Council Members absent were: Mi. Gordon R. Cumming Dr. Michael E. DeBakey Public Health Service members attending some of the s6ssions included: Dr. Stuart M. Sessoms, Deputy Director, NIR Mr. James A. Cunningham, OSG Dr. William L. Kissick, OSG .Liaison members: Dr. Murray M. Copeland, NCI Council Dr. John B. Hickam, NIII Council Dr. A. Earl Walker, NINDB Council (absent) Dr. Edward W.. Dempsey, NIC@IS Council (absent) 1/ Proceedings of meetings are restricted unless cleared by the Of ice of the Surgeon General. The restriction relates to all material submitted for discussion at the meetings, the agenda for the meetings, the supplemental material, and all other official documents, 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-- only when the application is under individual discussion. -2- Others present were: Mr. Karl D. Yordy, Assistant Director, DRMP Mr. Charles Hilsenroth, Executive Officers DRMP Mr. Maurice E. Odoroff, Assistant to Director for Systems and Statistics, DRMP Dr. William D. Mayer, Special Assistant to the Director, DRMP Mr. James Beattie,, Chief, Grants Management Branch, DMV Mr. Edward Friedlander,, Special Assistant for Communications and Public Information, DRMP Mr. Stephen Ackerman, Chief, Planning and Evaluation Branch, DRMP Mr. Storm Whaley, Associate Director for,Organizational Liaison, DRMP Dr. Margaret H. Sloan, Chief, Program Development and Assistance Branch, DRMP Dr. Donald S. Frederickson, Director NHI Mr. Ralph R. Mueller, BOB -Dr. Robert Van Hoek, BSS Dr. Clarence A. Imboden, BSS Dr. R. L. Ringler, NHI Dr. Roy Hertz, NCI Dr. J. H. U Brown, NIGMS Miss Pauline Stephan, NCI Dr. Jerome G. Green, NRI Dr. Murray Goldstein--NINDB Dr. James E. Dyson, DPKIP Dr. Frank Husted, D Dr. Harry F. Roberts, DRMP Mrs. Mary V. Geisbert,,DRMP Mr. Roland Peterson, DRMP Miss Charlotte Turner, DRMP Mr. Alan Mason, DRMP Dr. Stanley W. Olson, HRFC Miss Leah Resnick, DRMP Dr, James A. McA'Nulty, DRMP Mr. Ira Alpert, DRMP Mrs. Judy Silsbee, DRMP Mr. Robert Anderson, DRMP Mrs. Rebecca Sadin, DRIMP Mr. William S. Brooks, DRI@IP Mr. Dan Zwick, D@IP Dr. John Hamilton, DRMP Miss Cecelia Conrath, DRMP Dr. Robert M. O'Bryan, DUIP Dr. John M. Hazen, DRIQP Miss Jane Shouse, DRMP Mr. Lawrence Coffins DRMP Mr. Nick Cavarocchi, DRMP Miss Rhoda Abrams, DRMP Mr. Lyman Van Nostrand, DRMP CALL TO ORDER AND OPENING REMARKS Dr. Marston called the meeting to order at 8:00 p.m. T-1. ANNOUNCEMEIITS Dr. Marston made general announcements about the Service Desk and luncheon arrangements. Also, he read the statements on, "Conflict of Interest, 'I and, "Confidentiality of Ileetings." Dr. Murray M. Copeland, Liaison member from the National Advisory Cancer Council, was introduced. Dr. Copeland is the replacement for Dr. Sidney Farber. 111. CONSIDERATION OF PLANNING GRANT APPLICATIONS The Council made the following recommendations on each applica- tion, and suggested that the staff of the Division of Regional Medical Programs meet with each applicant whose application has been recommended for approval, deferral, or revision to express concerns raised by the Council and to clarify any questions and negotiate on conditions expressed by the Council before proceeding with the grant award. Application No. 1 S02 R14 00040-01, Univer orado Medical Ce dinator The Council recommends4pproval with the condition that the following be met: (1) the membership of the Advisory Group needs to be extended to include a broader geographic represents-. tion of the region; (2) information should be furnished by the applicant as to the technique proposed to use in transmitting results of research generated by the medical center out to the practitioner; (3)the applicant should furnish a description of the technique which he proposes to use in evaluating the planning program. The amounts requested were: $323,418, first year; $326,114, second year; and $170,662, third year, plus appropriate indirect costs. Application No.1 S02 RM 00041-01, University HealLuthn %CeLnLtLte:jr of, ,Pittsburgh, Francis S. Cheever, M.D., Rram Coordinator TheCounc-firecommends that this be approved, subject to staff negotiation, in the amounts of: $271,736, first year; $260,484, second year; and $137,618, third year, plus appropriate indirect costs. Application No. 1 S02 RM 00042-01, New Jersey Joint Committee for Implementation of Public Law 89-239, Alvin A. Florin, M.D., rdinator The Council recommends that this application be returned for revision, because one medical t@hool is reorganizing and the other one is new and just developing, and there seems to be no central authority. Also, the budget is relatively large for the program to be undertaken. -4- University Foundation Application No. I S02 RM 00043-01, Indiana George T. Lukemeyer, M.D., Program Coordinator The Council recommends approval with staff contact to assure compliance with conditions. The amounts requested were: $301,500, first year; $373,710, second year; and $152,295@ third year, plus appropriate indirect costse Dr. Hickam absented himself. Application No. 1 S02 PM 00044-01,, Steerf@nf."CO. 1 Medical Program for Maryland on behalf of the Maryland State Department of Health, The Jo 31 and the University of 14aryla Peeples, M.D. (Chairman, Ste The Council recommends approval, following staff negotiation with the conditions that the applicant (a) clarify who will have fiscal responsibility for the grant; (b) demonstrate that he can legally accept responsibility for administering the program and (c) clarify the responsibilities of the eleven high-level professional people. The amounts requested were: $496,753, first year, and $431,821, second year, plus appropriate indirect costs. Dr. Peeples absented himself. Application No. I S02 RM 00045-01, We.C Universit Medical Center, Clark K. Sleeth M.D. ogram Coordinator The Council recommends approval, with communication to the applicant of the following concerns which need clarification: 1. More detailed description of the resources at the medical center in Morgantown, including a specific outline of how certain phases of the program can be carried through; 2. Further details concerning plans for achieving aims of the proposal in other outlying areas of the State; 3. Expansion of details of inter-relationships to peripheral areas, as well as other existing programs in the State, i.e., Appalachia Health Studies and Development at the University, etc.; 40' Indication of involvement of Advisory Group on procedures and methodologies. The amounts requested were: $136,281, first year; $175,250, second year; and $91,250, third year, plus appropriate indirect Costs. -5- Applic,-, ion No. 1 S02 RM 00046-01, i4edical Association of J. W. Chambers, M.D,,, Program Coordinator The Council unanimously recommends approval in the amounts and time requested of $208,781, first year; $203, 207, second year; and $104,749, third year. Dr. Hurst absented himself. Application No. I S02 RM 00047-01, Nebraska State Medical Association, Henry M. Lemon, M.D., Program Coordinator The Council recommends approval upon staff clarification of (1) the administrative mechanism which appears cumbersome; (2) the data. gathering process which, as described, may be inadequate if the region is to accomplish its planning goals; (3) r6lation- ships among the five relatively distinct proposals; and (4) the interfaces between major parties involved in the application particularly the role of the medical society. The amounts requested were: $289,350, first year; and $281,450, second year* plus appropriate indirect costs. Dr. Traeger abstained from voting, Application No. I S02 RM 00048-01, The University of Kentuckv Research Foundation on behalf of The Ohio Valle @Medical Program, William R. McBeath, M.D., Program Coordinator The Council recommends approval of this application. The amounts requested were: $215,500, first year; and $232,371, second year, plus appropriate indirect costs. Application No. I S02 RM 00049-01, Medical College of Virginia, Charles L. Crockett, Jr., M.D., Program Coordinator The Council recommends approval after the satisfactory resolution of the following concerns: (1) miiit-rity group and other health professions? representation on the Advisory Group; (@) involvement of the medical school faculties and the medical school administration; (3) the possibility of transfer of support of existing personnel to Pd4P grant funds from other sources; and (4) lack of sufficient emphasis on evaluation plans and procedures. The amounts requested were: $237,800, first year; and $254.,Ooo, second year, plus appropriate iadirect costs. Application No. 1 S02 RM 00050-01, The Research Foundation of State University of New York, RichArd H Lvons, M. Coordinator The Council recommends.approval after staff discussion with the applicant concerning the lack of evidence of cooperation among the categorical committees, and the budget, which appears to be quite large for the number of people in the region. The amounts requested were: $192,408, first year; and $211,206, second year, plus appropriate indirect costs. Application N. 1 S62 RM 00013-01, Research Foundation of the- State University of New York (formerly Health Organization of Western N. Y., Buffalo, N.Y.), Douglas M. Surgenor, Program Coordinator This application had been approved at the June 1966 Council meeting. However,@a legal problem was encountered concerning the fact that the applicant had set up a new corporation which had 100 members as the applicant. The same Lembers were on the Advisory Group. I-le, therefore, asked for a ruling from the- Generil.Counsel's office to clarify the legality of this, and we were notified that in terms of the specifics of the Law, this would not be acceptable. The applicant was notified of the above decision, and the application of the Health Organization of Western New York was withdrawn. A new application was received to change the applicant to the .Research Foundation of the State University of New York. The ramainder-of the application is identical to the first, and the 100 members are designated as the regional Advisory Group. The Council unanimously recommends approval of the new applicant. Application No. I S02 RM 00021-OIR,-Minnesota State Medical Association Foundation, J. Minnott Stickneyi M.D., Program Coordinator At its meeting on August 12-13, 1966, the Council recommended deferral of this application pending receipt of further information from the applicant. A revised application was submitted and it appears to be a great improvement from the first application. The plans for adjacent regions are now viewed more realistically, and there has been an effort to coordinate with at least the Iowa and Wisconsin regions.,,, The Council recommends approval in the amounts of $344,998, first year; $469,080, second year; and $469,400, third year, plus appropriate indirect costs. Dr. Millikan absented himself. Application No. 1 S02 RM 00022-OIR, Oh_io State University College of 14edicine, Richard L. Meiling, 14.D., Program Coordinator This application bad been considered at the August Council meeting, and was returned for revision. The major change in this application has to do with taking the parts of the original application that concern a TV system, the support of systems analysis$ and some contracts for systems analysis out of the application where it was, and moving it to the back and not requesting funds in the revised application. -7- Many of the same questions that existed in the first application are still in the present application. There needs to be evidence of involvement of other groups that would be working with the University,.after the Advisory Council had been involved, and the involvement of other groups that would be working with the University in the planning. The Council recommends that this application again be returned for revision with informal advice from staff prior to the submission of another application. ARPlication No. 1 SOZ RI-I 00024-OIR, The Florida Ad cil on Heart Disease. Cancer and Stroke. Inc. (fAg,_Tn@. Malcolm J. Ford. M.D. r( The Council, at its meeting on August 12-13) 1966, recommended that this application be disapproved with advice to resubmit. Since no significant changes are apparent in the revision, the Council againsrecommends that it be returned for revision. Ap@lication No. I S02 1*1 00028 tabama in BirminRham, The lledical Center h. D -Tr-09@M.- Coordinator At its meeting on August 12-13, 1966, the Council recommended that this application be returned for revision to obtain (1) a better conceptuali'zation of a total Regi6na@l Medical Program; (2) an indication of intention to collect resource data; (3) - strengthening of the Advisory Committee and continuing education activities; (4) the elimination of operation components; and (5) clear evidence of.involvemenl-- of minority groups. The Council believes that these concerns have been satisfied,- and recommends approval in the amounts of: $247,250, first year,, $286,750, second year; and $143,375, third year, plus appropriate indirect costs, Application No.- 1 S02 RM 00033-OIR_. Louisiana State D ment of Hospitals; E. Lee Agerton ordinator .'Program Co The Council, at its August meeting, recommended that this application be returned for revision. The Council believed that the first application which was submitted was more of a pre-planning rather than a planning proposal. Further, it was believed that the applicant assembled numerous opinions about what went into a planning grant application, but that they needed to-assemble these opinions and put them in some form which can be identified and clearly assessed by the reviewers. This revised application covers essentially all of the points which were considered to be inadequate in the original request. The Council-felt that some concern still remained about the effect of the proposed program outside of the metropolitan centers, the size of the budget, and the nature of administrative responsibilities. They recommend conditional approval with clarification of these items by means of a project site visit by some Council members. If resolution of these concerns are made at the time of the visit, this grant will be activated. The amounts requested are: $537,291, first year; and $514,251, second year, plus appropriate indirect costs. A@lication No. 1 S02 RM 00035-OIR, Medical Collepe of South Carolina; Charles P. Summerall, III, @I.D., Program Coordinator The Council recommended that the first application be returned for revision because of a number of problems, including the lack of A full-time Program Coordinator. After discussing the problems with the applicant, this revised application was submitted, and the Council recommends approval of $48,990, plus appropriate indirect costso The applicant will be informed that he may submit a supplemental request for more supportive personnel as they progress in the early stagesof the planning. Application No. 3 S02 RM 00006-OISI, Duke University; Harvey L. Smith, Ph.D., Program Coordinator This is a supplemental request to an award which was made on June 30, 1966 in the amount of $235,536, plus indirect costs. The Council recommends that Proects 1, 3, 4, and 5 be approved, but that'- Project 2, which deals with a hysician-based computer p network, be d4eapproved. The amounts requested, excluding Project 2, are: $109,351, plus appropriate indirect costs. Dr. Moore abstained from voting. Application No. 3 S02 RM 00007-OISI, The University of Texas, Charles A. Lei4aistre, M.D., Program Coordinator The proposal embodies two discrete projects (a stroke registry and the "cancer-in-man".project) @.yhich were deleted from the original planning grant during negotiations because they were included as part of operational proposals. The Council'recommends disapproval of the application because it felt that the activity for which the small supplemental request was made could be financed out of the sizeable planning grant which has already been awarded to the Texas region. Dr. Copeland absented himself. IV. OPERATIONAL GRANT APPLICATIONS Four operational grant applications, numbers 3 S03 RM 00009-01), 1 S03 Fd4 00002-01, 1 S03 @l 00004-01, 1 S03 RiA 00015-01, were discussed. Because these were the first of this new phase of the program to be brought before the Council, the discussion of -9- specific applications was preceded by a general discussion of operational policy issues and review and approval procedures for grants. This,discussion drew upon experience obtained through exploratory visits to the regions by member of the Council, the Review Committee, and the staff. After considerable discussion of-tbese'application§ the Council voted to recommend that the staff examine the possibility of taking favorable action before the next Council meeting on parts of the operational applications for the Intermountain and Missouri rdgions, if the staff encounters no administrative problems. V. CONSIDERATION OF FUTURE NEETING DATES The Council approved the following dates for future meetings: February 19, 1967 (8:00 p.m.) Februrry 20-21, 1967 (9:00 a.m.) May 21, 1967 (8:00 p.m.) May 22-23, 1967 (9:00 a.m.) August 27 (8:00 p.m.) August 28-29 (9:00 a.m.) 'November 19, 1967 (8:00 p.m.) November 20-21, 1967, (9:00 a.m.) VI.. CONSIDERATION OF MINUTES OF AUGUST 1966 MEETING The Council unanimously recommended approval of the Minutes of the August 12-13, 1966, meeting as written. The Minutes of the June 1966 meeting are hereby corrected to show that Dr. Millikan was absent during the discussion of application 1-SO2-RM-00021-01, Minnesota State Medical Foundation. VIT. PROGRESS REPORT ON "SURGEON GENERAL'S REPORT TO CONGRESS" The Council discussed the status of the development of the Surgeon General's report to the President and the Congress ,as required by Section 908 of Title IX. The activities of the augmented subcommittee of the Council'. established to advise the Division on the development of this report, were described by two members of the subcommittee. A National Conference with the people involved in this program will be held in Washington on January 15-17, 1967. Viii. COI-ZIENTS FROIL LIAISON MEMBERS Drs. Copeland and Hickam had no comments to make for the National Advisory Cancer and National Advisory Heart Councils. -10- IX. REPORT ON ALL APPLICATIONS WHIC COUNCIL l@IEETING ---------------- n on the status of application A brief progress report was give s which were considered at the August meeting. The Oregon application, number I S02 RM 00012-01R, was returned for revision. A new application is being prepared and will be in for review at the next meeting. The applicant expects to have more active participation on the part of the medical school in the development of the new application which wag one of the problems in the previous application. The California application, number 3 S02 RM 00019-01SI, has now been awarded as a result of the site visit. The part that has been awarded, in accordance with the Council action, was the corps planning staff. The $2-2-million item for subcontracts has been deleted and not awarded. It is anticipated that a supplemental application will be submitted which will contain some of the specific planning activities being proposed. The following grants have been awarded: Oklahoma - I S02 RM 00023-01 Rochester - I S02 RM 00025-01 D.C. 1 S02 RM 00031-01 WICHE 1 S02 RM 00032-01 New Mexico 1 S02 RM 00034-01 Wisco-,isin I S02 RM 00037-01 Washington"Alaska - 1 S02 RM 00038-01 Iowa - 1 S02 RM 00027-01 The Delaware Valley application no. 1 S02 RII 00026-01 is being revised. The application from Downstate and Brooklyn, Long Island, Queens, Staten Islandi number 1 S02 RM 00029-01., is bein-Imeld up as they participate in the development of a planning application for the metropolitan New York area which will be in for the next review cycle. Out of that process we will come to the determination of what happens on the Brooklyn po rtion. The Illinois application number I S02 RM 00036-01, which was disapproved, is being rewritten, and they expect to submit a new application. X. REPORTS BY STAFF Continuinp,, Education - Dr. Mayer Dr. Mayer reported that significant additions have been added to his staff since the last meeting. Drs. Frank L. Husted, James E. Dyson.. Mrs. Judy Silsbee, and Mrs. Rebecca Sadin,, are now on board, and more staff will join the group shortly. Comments on a meeting held on, "Continuing Education" had been mailed to the Council prior to this meeting. The meeting was held to seek the outside advice concerning the need to keep ultimate standards of continuing education and training. We are going to follow-up on these ma-tters on the communications that were initiated to develop some feeling of activity that is going on in related areas. A proposal from EDUCOM has been submitted to the Secretary, DHEW, for $9.7-Million to set up the initial trial of their network. It is too soon to know whether or not this proposal will be accepted. Some of our obvious relationships to the EDUCOM activity are, those of our continued involvement in their Task Force on Continuing Education which is being chaired by Dr. George Miller. Also, the potential relationship of our desire to have them develop some general information relative to how one gets into their network in terms of compatibility of systems so that this information is available to regions as they develop activities in this general area of communication. Further, we would like to have their advice and counsel on "hardware". We need to decide whether it would be appropriate to seek advice and counsel through EDUCOM and draw upon their competencies and potential resources or whether we attempt to seek this our- selves as a group, Dr. George Miller has a modest contract with DRMP to start training pro-rams in the area of continuing education. Dr. Miller's attention has been attracted, and he would like to pursue a major investment of effort in the area as it relates to continuing education in health. In.lboking at programs that are coming in, we have requested Dr. Miller's group to look at the areas of educational evaluation of the programs. Salary PoliSy - Mr,Yordy Mr. Yordy distributed a statement for consideration by Council on "Salary Policy." This statement will be used in terms of transmitting the Councills concern to the-applicants'. Svstems Analysis - Mr. Odoroff Mri Odoroff reported that as of November 1,, Dr. Herbert P. Galliher, Jr., who is Professor of Operations Research, Industrial Engineering Department at the University of Michigan, came to this Division as a consultant. Dr. Gailiher will explore the usefulness of the application cf cperaticus.research techniques to the planning and implementation of Regional Medical Programs. -12- Financial Report--Mr. Hilsenroth 'Mr. Hilsenroth reported that we have obligated a little over $7-million with Council actions to date. Assuming all of these approvals could be effectuated into awards, this Would total an additional $5-million for the obligation by December 31, 1966, or approximately $12-million of the $23-million available grant funds which we have. The $2-million for. direct operations lapsed on June 30, 1966. The authorization for the original appropriation for the grant part of the program carries through until December 31 of this year. We expect to lapse about half of that original appropriation because we were not given the full two-year period of avail- ability. Had we received the full two-year period of avail- ability in the appropriation language, we would have had no problem of lapsing funds until June 30, 1967. XI. DISCUSSIO',I OF P.L. 89-749 - S Dr. Stewart discussed the relationship of P.L. 89-749 to P.L. 89-239. Interest has been expressed concerning the relationship about these two programs, There have been meetings to discuss the course that these programs are following. At the present time, the specific. relationships between these two programs are not yet established. There are other programs which are related also, such as resource development, Medicare, Vocational Rehabilitation programs, the Ghildrens' Bureau, etc. P.L. 89-749 will attempt to create a State health planning agency which will relate all of the various health planning groups, with a specific focus on developing a certain kind of resource or certain kinds of service. In looking at these various health programs, the state health planning agency will be concerned with relationship between the increased demand for health services and the health resources available within the State. This is their major axis, as well As ways which they can use innovation and demonstration to.improve efficiency. We plan to administer this in a different way than we have other programs. The budget will be in the new budget item in the Surgeon Generalls office, since this cuts across all kinds of areas, and the grants operations will be managed in the nine regional offices of our Department. By-so doing, there will be one focal point to which to apply for a grant instead of the several offices which we now have. This would focus a lot of our operational details in the management of grants in the regional offices. Money will not become available for this program until July 1, 1968. XII.. DISCUSSION OF CONTRACT PROPOSALS Two proposals for contract support from this Division were discussed. These proposals include support for a task force the area -13- of choriocarcinoma. This activity would be carried out under the leadership of Dr. Roy Hertz, Professor of Obstetrics and Gynecology, The George Washington University School of Medicine, i Washington, D. C. The possibilities of joint funding have also been discussed with the National Cancer Institute and the Division of Chronic Diseases. A proposal from the American College of Surgeons to undertake a study of the mechanisms for developing a list of centers with outstanding diagnostic treatment and training capabilities in the field of cancer was also discussed. This study would provide assistance in carrying out the purposes of Section 907 which calls for the Surgeon General to develop such lists in the fields of heart disease, cancer, and stroke. A follow-tp report on these proposals will be given to the Council at a later date. XTII, ADJOURNMENT The meeting was adjourned at 2:30 p.m., November 29# 1966. I hereby certify that, to the best of my knowledge, the foregoing minutes and attachments are accurate and complete. Robert Q. 14arstont M.D. Associate Director, NIH, and Director, Division of Regional Medical Programs Eva M. Handal, Recording Secretary Committee Management Officer, DRMP NATIONAL ADVISORY COUNCIL ON REGIONAL MEDICAL PROGRAMS Dr. Leonidas H. Berry (67) Dr. Clark H. Millikan (68) Professor, Cook County Graduate -Consultant in Neurology School of Medicine, and Mayo Clinic Senior Attending Physician Rochester, Minnesota 55902 Michael Reese Hospital Chicago, Illir@ois 60653 Dr. George E. Moore (68) Director 1,1@ailing address: Roswell Park Memorial Institute 412 East 47th Street 666 Elm Street Chicago, Illinois 60653 Buffalo, New York 14203 Dr. Michael E. DeBakey (68) Dr. Edmund D. Pellegrino (70) Professor and Chairman Director of the Yed4-cal Center Departmerit of Surgery State University cf Now York College of Medicine Stony Brook, New York 11790 BAyl6r University Houston, Texas 77025 Dr. Alfred M. Popma (70) Reginnal Director Dr. Bruce W. Everist (67) Regional Medical Program Chief of Pediatrics 525 West Jefferson Street Green Clinic Boise, Idaho 83702 709 South Vienna Street- Ruston, Louisiana 71270 Dr. Mack I.-Shanhol@z.(70) State Health Commissioner Dr. John R. Hogness (70) State Department of Health Dean, School of Medicine Richmond, Virginia 23219 Uriversity of Washinaton Seattle, Washington 98105 Dr. Cornelius H. Traeger (67) 799 Park Avenue Dr. James T. Howell (68) New York, New York 10021 Executive Director Henry Ford Hospital Detroit, Michigan 48202 Ex Officio Member Dr. William H. Stewart (Chairman) Surgeon General Public Health Service 9000 Rockville Pike Bethesda, Maryland 20014