B&B ImFoRmikriom & ImAimE MAkm^mEmmmT 300 "Incic G=Itncoa BOULXVARD Ulopoca MARLOCitc, Mapt No 20772 41 USA 0 tac 1) 249-01 1 0 D E P A R T M E N T 0 F H E A L T 113, E D U C A T I 0 N AND WELFARE Health Services and M6--ntal- Health Administration Division of Regioiial Medical Programs National Advisory Council on Regional Medical Programs Minutes of the Meeting July 28-29, 1970 Parklawn Building Conference Room G/H DF!,F'Af?IML,:tfll 01? ifl@F f,',I)IJ(',IVII[ON AND *@ARE Nationai Advisory Council on fiegiorial Medical Programs Minutes of the Twentieth P4eeting 1/ 2/ July 28-29, 1970 The National Advisory Counci'L on Ref,,ional @ledical Programs convened for its twentieth meeting at 8:30 a.m., Tuesday, July 28, 1970 in Conference Room G/H of the Parklawn Building, Rockville, Maryland. Dr. Harold @@gulies, Acting Director, Regional Medical Program Service presided over the rweting. '.Die Council mrrbers-present were: Dr. Bland W. Cannorl Dr. @und D. Pellgrino Dr. Fdwin L. Crosby (7/28 only) Dr. Alfred M. PoprTa Dr. Michael E. @Bakey (7/29 only) IX,. Ilussell B. Roth Dr. Bruce W. Everist Dr. Mack I. Slianholtz Dr. William R. Ilwit Mrs. Florence R. Wyckoff Dr. Alexander M. McPlie(iran A listing of RMP staff members,, and others attending is appended. CALL TO ORDER AND OPENIND REMARKS The meeti@, was called to order at 8:30 a.m. on July 28 by Dr. Harold Margulies. II. ANNOUNCEMEWS 'Ihe Council members were welcorwd to tile new Conference facilities in the Pai@klawn Building, and the genei-a-L arrangements for the conduct of the meeting in these facilities was explained. Dr. Margulies announced his plans for an executive session with the Council at the close of the first day of the meeting. 1/ Proceedings of meetings axe i,cistri-eted unless cleared by the Office of the Administrator, 11SHiA. 'Ihe restriction relates to all material- submitted for discussion at the meetings, the supplemental material, and all other official documents, including the agenda. For the record, it is noted that members absent themselves from the meeting when the Council is discussirr, applications: (a) from their respective institutions, or (b) in which a conflict of interest nAght occur. This procedure does riot, of course, apply to en bloc actions only when the application is under individual discusslo-n7- III. INDIODUCTION OF t L@ i@, 31,M Di,. Pbr6nilies introduced two new ot' the Council who were in attendance for this trieet@- 'lliey also: W.I..l I.LLun fl. liunt, M.D., a CoTmiissioner of the County of Allegheny lii Pennsylvania and @dical practitioner in 'McKeesport, Pennsylvania; and Alexander M. McPhedran, M.D., Associate Professor of Intenial Medicine (t4eurology), Emory University School of Medicine., Atlanta. The recent appointment of @. C. Robert Ogden was also announced. Mr. Ogden is President of the North Coast Li-fe, Insurance Corrpany in Spokane, Washington and Chain= of the Washington/ Alaska Regional Advisory Group. He will begin his regular attendance at the next meeting,. TV. RL,GIONAL MEDICAL PROGRAMS AS A P@.U OF THE Iff!ALrEi SERVICES AND MENTAL l@TH ADMINISTRATION - Dr. Vernon Wilson In his first meeting with the Council as Administrator of the Health Services and Mental- Ilealth Administration, Dr. Wilson recalled his long interest and first-l-land involvewrit in the development of Regional Medical Programs. He assured the Council of his strong support of Regional Medical Programs as a part of the broader efforts of HSMHA,; He expressed his endorsement of the principles of decentralization of the a@@.stration of IISMHA activities generally, and his belief that the concept of Regional Medical Programs can relate well to these principles. Although the mechanisms will be worked out slowly, he is confident that 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 Medical Programs Service, Dr. Wilson expressed regret that he was not able at the present time to resolve the Tiialor staffing problems. He assured the Council this has v@ry laifrji priority on his working agenda and the fact that he is as yet unable to report does not indicate that he is not actively working toward a solution. Dr. Wilson asked the Council to meet with liini again in approximately six to eight weeks in a special one--(iay session. At that time he is assured he will be able to discuss his plans, as they are based on those of Secretary Richardson, for the organization and administration of the Department's efforts to strengthen and increase the nation's capacity to deliver health services. fie indicated also that by that t@ he would have more definitive plans for the staffing and organization of the Regional Medical Program Service. Altliour ,,h his plans will include a general outline of the "Mission" of Regional Medical Prograrm as a paz@t of the llmia effort, 'Dr. Wilson said that he would rely heavily on the advice and guidance of the Council for developing the policies and detailed program directions that would lead to even rare efficient and effective cooperative arrangemnts between the private sector, which they represent, and the Federal effort. 3 L)i.,. Wilson told the,Council of the resignation of Mr. Irving Lewis as.Deputy Administrator of list, and about @,lr. Lewis' appointment as Professor in the Department of Community Medicine at Albert Einstein College of Medicine in New York. i4r. Lewis addressed the Council briefly, stating again his faith in the Regional,,"4edical Programs as representing "the only concept of true regio.,.-lalization of health services that can'be expected to work" in the United States. Mr. Lewis expressed his thanks to the Council for the many pleasant working relationships he had had with them. @s. Florence Wyckoff responded for the Council, expressing their appreciation for his assistance to them, especially in helping them to understand the principles of Federal financing of health care and in the area of health economics generally. V. CONFIRMATION OF FUTURE, MEETING )ATES Council was apprised of the necessity for reverting to a system of four meetings per year in order to accommodate the changeover to Anniversary Review. Two new Council dates were set: November 9 and 10, 1970 and February 2 and 3, 1971. In addition, September 30, 1970 was set for the special meeting requested by Dr. Wilson. The Council accepted the invitation of Dr. Edwin Crosby to hold this meeting at the American Hospital Association headquarters in'Chicago. 'Ehis will enable more of the members to travel to and return home from the meting in a single day. VI. CONSIDERATION OF THE MINUTES OF THE i@CH 31-APRT-L 1., 1970 P=ING The Council unanimously recommended approval of the minutes of the meeting of the Council on @Marcia 31-April 1, 1970. ITI. ARE-PO@ FROM TEE DIRECTOR - Dr. Harold Margulies A. Progress of IIR 17570 and S3355 Dr. D@guliesreviewed the contents of the twc Bills very briefly and referred the Council members to an analysis prepared by staff which compares the Bills to one another and to the present legislation. This was included in the agenda materials. B. Appropriations for Fiscal Year 1971 Status of the Appropriation Bill was reviewed and the Council was remdnded of the various circumstances which impinge on the total amount of "new" funds to be available for mjor expansion of Regional Dledical Programs in FY 1971. Among these are the $1.9 million earmarked for '@lodel Cities activities; the 1% reserve of funds to be used for evaluation 4 activities at DHEW, HSMHA, and R4PS levels; the possibility of administrative "earmarking" of some funds for PMP participation in con4)rehensive regional kidney disease programs; all in addition to a total amount slightly in excess of $77 million required to meet minimal continuation requirements of ongoing regional activities. C. Funding Strategy Dr. Margulies made a brief introduction of a new management ii-iformation system being implemented by RMPS. I-le also noted the effect of the 1969-'70 strategy of pen-u'tting Regions almst unlimited rebudgetirig of unexpended balances for program expansion. Dr. @.@gulies stated his intention to begin to apply more stringently guidelines to this kind of rebudgeting and to recapture so@ of these balances for reallocation ariiong the Regional Medical Programs in response to evidence of successful regionalization and program development. D. The FAST Recommendations In a brief review of the recommendations of the Federal Assistance Streamlining Task Force and his plan for responding to them, Dr. @gulies emphasized the "liaison" role of the D@ Regional Offices in the development of HSP@ programs generally, and in helping to relate Regional Medical Programs to both publicly and privately-funded programs in the area served; but with the retention of the principal manage@nt responsibility in 'the Regional Medical Programs Service , at the national level. He also mentioned especially the Service's concern, antedating the Task Force study, for better delineation of the multiplicity of activities now covered by the core budget in Regional Medical Program grants. Dr. Margulies explained the intent of FWS in placing a Program Representative in each of the ten DIIL,',W Regional Offices and described what he sees as the service role of these individuals. VIII. PROGRESS NOTES FROM STAFF A. Contracts wider Section 907 Di-. @garet Sloan Di,. Sloan gave a brief review and status report on the three contracts made by the RMPS under the terms of Section 907 of Title IX of the Public Health Service Act, which deals with the 11... list or lists of facilities in the United States equipped and staffed to provide the most advanced methods and techniques in the diagnosis and treatment of heart disease, cancer, and stroke...." The contract with the American Heart Association in support of the Intersbciety Commission 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, has chosen to withhold publication of its report until it is entirely completed. @e report of the Speciq] Advisory Co@ttee on Cancer' Care Facilities of the Cancer Co @ ssion of the American College of Surgeons, which was supported under a contract now completed, has been reviewed by the Regional Medical Programs Service and was received by the National A@.visory Council at the April 1970 meeting. Negotiations between the American College of Surgeons and the RMPS, preparatory to completion and RMP approval of this report, are now underway. (This was discussed in more detail with Council during the Executive Session). B. Multi-Pro&rain Services Project Grants - Mrs. Martha Phillips Authorized under Section 910 of Title IX of the lUblic Health Service Act., this program of project grants will be Jmplemented for the first time early in FY 1971. The Council was reminded of its original role in the development of the basic guidelines and operating policies for 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 R'egions). 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. Rpfrional Medical Programs in Model Cities - Mr. Cleveland Chambliss The Council was reminded of the administrative earmarking of $1.9 million of IPM FY 71 grant funds for use in projects which have direct impact on certain designated Model Cities Neighborhoods. Mr. Chambliss outlined the procedure for determining the degree of such impact and obtaining the certification of Model Cities officials in this regard. Although this procedure includes endorsement of DHEW Regional officials, Mr. Chambliss assured the Council that the procedure would entail no authority for further review 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 6 serve urban populations need not plan them exclusively for Model Cities areas and need not seek any endorsement or concurrence beyond their own review and approval mechanism. D. Senior Clinical Traineeships - Mrs. Martha Phillips t, Mrs. Phillips recalled to the Council -,he circumstances leading to the Departmental decision to place responsibility for the Senior Clinical Traineeship program in Rep;ional-Medical Programs.Service. She also reported to the Council on the selection of the first group of @aineeships to'be awarded'under RMPS sponsorship. This selection process was carried, out by panels of non-Fedelal experts in the cancer field and was chaired by Dr. Michael Erennan, to whom the Council delegated authority for the selection of individual trainees to the total extent of $3001000 of FY 1970 funds. 'Ihirty trainees were selected from among 80 applicants, and represent t,@e disciplines of medicine, gynecology, pathology, pediatrics, radiology, and surgery. The training will be done in mjor medical centers throughout the United States. E. Guidelines for Instructional Technology - Miss Cecilia Conrath A second edition of these -,uidelines was before the Council for their consideration. Dr. Pellegrino, who served as Chairman of the 8ubco @ ttee 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 Dr. Pellegrino's suggestions. F. L@aluation Activities - Mr. Roland Peterson In reporting to the Council,, Mr. Peterson mentioned the final summation and distribution of the Regional Progress Summaries which resulted from the questionnaire developed and tabulated by his staff; on the Regional Medical Program 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 will be chargeable to the "evaluation earmark." This earmark was explained to the Council by both Mr. Peterson and Dr. Margulies as a 1% administrative reserve to be used for evaluation activities not only at the program level, but also at the level of H&M 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 mecl@ism, at the discretion of RMPS., with portions of the total withheld for and DIJEW evaluative activities. The entire matter of evaluation sparked considerable discussion in the Council. It was the consensus that in order for 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 meTrbers have had individual experience 7 with the conduct of the contract activities and feel that the@have not always been handled in the best interests of the Program. There was unanimous agree@nt with the suggestion, 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 made available to thecouncil for review and discussion. The Council requested a more definitive report from the staff on the results of the contract, particularly as it relates to the purposes for which the contract iginally let. They also asked to see the final report from the was or Arthur D. Little'. Inc. as soon as it is received by RMPS. In summarizing the discussion, Dr. Pellegrino suggested that all evaluation activities should, in the long run, serve to test the viability of Regional Medical Programs as they are developing; and if they are found not to be viable to determine why they are not.. IX. KIDNI,,Y DISEASE ACTIVITIES IN REGIONAL ME)ICAL PROGRAMS Dr. Mar,-,ulies reviewed for the Colincil the circumstances leading to the addition, in both the House aiid Senate versions of the continuation legislation, of kidney disease as one of the specific disease categorical targets of Regional Medical Programs. He asked for guidance of the Council in the development of a. responsive and effective policy for Regional Medical Programs participation in comprehensive regional kidney disease programs throughout the Nation. He is aware that the inal definition of such a policy, especially as it would appl@ to the immediate future, will not be possible until after Congressional action, on both the continuation legislation and the appropriations, is complete. In order to provide so@ background for their deliberation., Dr. Margulies explained that he had asked the staff to prepare some basic information and to draft some suggested policy guidelines. These were part of the agenda materials presented to the Council. He then introduced Dr. George Schreiner, Chief, Nephrology Section, Department of Medicine, Georgetown University and Dr. Richard B. Freeman, Departmnt of Medicine (NephroloEW), University of Rochester School of Medicine, whom he had invited to the meeting to provide expert reference to the Council in their deliberations. Dr. Schreiner made a detailed presentation of the "state of the art" of the management of chronic kidney ilisease. He included resume of the techniques and methodologies of screening, diagnosis and therapy; and the shortcomings as well as successes in prevention, treatment, and rehabilitation. NephroloEW 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 having few established traditions, and is in the enviable position of being able to profit from the mistakes made in establishing resources for open heart surgery, high voltage radiotherapy, etc. 8 Organization for the delivery of servies to patients with kidney disease, Dr. Schreiner believes, lends itself so ideally to regionalization that the development of such a program can and will serve as a framework for regionalization of' services in other more traditionally established disciplines. Again, as in nearly all their past discussions of kidney disease, the Council expressed concern about the apparent lack of effphasis on prevention as part of an overall kidney disease program. Dr.' Schreiner and Dr. Freeman believe that thE! only hope for real prevention will come via prenatal care and "genetic engineering" and although work in these areas is progressing, it will not have any significant in-pact for fifty to sixty years. They also believe that the more traditional approaches to prevention generally will not be seen to be effective for at least 20 years. Both Dr. Schreiner and Dr. Freemn spoke to the issue of the cost of developing regionalized kidney disease services; and the way in which the enormous numbers often used in this regard have been misleadirg and discouraging to institutions and communities. Both agreed that the $15 million mentioned in the pending legislation could make a significant difference in the extension of services of' existing kidney disease centers or in the establishment of some smaller number of entirely new ones. Dr. Margulies reminded the Council that the $15 million to which the Bill makes reference, is recommended as a maximum assignment of Regional Medical Program grant funds to kidney disease efforts, and in no way e ks or limits any dollars exclusively for this purpose; nor does it provide, or even recomend the provision, of funds over and above the grant funds to be otherwise available for purposes of Regional Medical Programs. Dr. Everist raised the question of the mechanics of incorporating kidney disease programs into the 55 Regional Medical Prograrns if the principle of local autononW and decision-making is to be maintained. It is his belief that unless and until Regions with appropriate existing facilities can be "seduced" into affording high regional priority to kidney disease control, it will be necessary to use the Section 910 authority, so that national directives may be used to develop "sensible programs in sensible places." Accepting the apparently inevitable lag time before the results of a planned program of prevention can be felt, Dr. Pellegrino asked for the advice of Dr. Schreiner and Dr. Freeman on what @diate impact Regional Medical Programs could reasonably have, considering the provisions of the proposed legislation and within the amount of funds that are likely to be available within the next two or three years. Responding first, Dr. Schreiner recomends the strengthening of existing facilities, particularly those which have co@tted themselves to outreach beyond the confines of the medical center within which they exist; and further identifying those among this group that lend the@ selves to further interlinkage to provide a multiplying rather than -irTply an additive effect. Dr. Freeman recommends the support 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 complete, resources; the use of RMP funds for support of planning, particularly in regard to increased effective utilization of expensive resources; and the training of personnel, principally physicians, who can serve to train others (other physicians and paramedical personnel). The Council strongly endorsed Dr. McPhedran's point regarding the importance of thoughtful integration of a kidney disease program -Lnto an existing Regional Medical Program; particularly in T,laming, sub-regionalization, continuing education, and inter-professional comunication activities. In a subsequent discussion on the second day, the Council members reflected on the recommendations of Dr. Blreeman and Dr. Schr6iner as well as on the goals, objectives, and the basic operational concepts which guide Regional Medical 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 against making major contributions toward the establishment of facilities, the Council agreed that the major focus of @,IP involvement will be (a) the encouragement of better and more effective cooperative arrangements amng carefully selected institutions and resources which together might form a "decentralized center" and (b) in the strengthening of existing institutional resources co@etent and willing to develop outreach, both in the demonstration of service and the training of personnel. Both of the above require national as well as regional planning. In summary, the Council endorsed the general plan presented by the staff; they also agreed, however, that to develop a workable overall policy it will be necessary to have basic data concerning the resources in, and available to, each of the 55 Regional Medical Programs. This should include (a)-presently self-contained 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 for the provision of kidney disease services. An assessment of the "size and sliapell-of the kidney disease problem in each of the Regions would provide the other essential piece of basic information. Dr. Margulies agreed to provide these data based on the existing geographic pattern of the 55 Regional Medical Program. X. REVIEW OF APPLICATIONS A. Issues Identified 1., In the matter of RMP support of short-term training projects, the Council considered the history provided them by staff, and a nunter of io - specific projects included in the applications under review at this meeting. They be--ieve that under most circumstances'it is not necessary or appropriate for Regional @ledical ProLwams grant funds to be used to cover the full costs of both the presentation of short-term training projects and of stipends and expenses of the participants. 'Die majority of projects in this category provide opportunities for up- @ading 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. 'llie Council therefore recomended the following changes in policy guidelines regarding @a@ents to participants in continuing education and training projects (as defined in the Guidelines Addendum, February 1970, page 13) which are supported by ReFional i4edical Program grant funds. Regional Medical Program grant funds may not be used for the payment of stipends.- either directly or on the "maintet-iance of income principle," to participants in short-term continu@ education and train@ projects. 'I'his does not include training for new careers for new types of health onnel. Other allowable costs of participant's support may be calculated according to the existing Guidelines. Regional Medical Program grant funds may be requested ind awarded for per them and travel to the extent of 50% of the tcftal amount so derived. The awarded funds may then be paid to.tlie 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 travel allowance at a rate higher than that prescribed by the present Guidelines. @,111 funds inay not be reblidgeted, from within or without the project budget, to increase the total amount awarded for per them and travel above the 50% level. 2. role Council considered the present Guidelines regarding Regional Medical Program funding, of projects E)f long-teiin post-doctoral training, at the senior resident @ post-resident levels, particularly in the clinical sub-specialties of importance in patient n@age@nt in the diseases targeted by Regional Mc@dical l@oF4,anis. As has been pointed out by both the Review Comdttee -and the Council., requests for support for training of this kind are appearing nioi,e and more frequently in Regional Medical rrogram applications; because of the increasingly critical shortage of' individuals trained in these fields., but also because of the drastic reduction in NIH funding.which has previously been available for this purpose. '.Die Council unw'dmusly agrees on the importance of maintaining the training programs in these fields in the major teaching centers throughout the nation. They also agree that funding through Regional lledical Program would serve to stren@h8n the essential involvement of these centers of clinical excellence into the framework of cooperative arrangements which form the basis of the Reo-ion of which they are a part. It is recognized, however, that the allocation of an amount of funds large enough to make a significant impact, if provided from the present I-U,4P appropriation, would create a serious and itiappropriate.irrbalance in the RMP efforts to meet more their var:!.ed and comprehensive froal-s. The Council, therefore., requested the RDVIPS staff to forward to t)oth li,')D/EIA and DIIEW its w=ij-nous recommendation that arral-igei-nents be made,to provide Federal assistance to clinical departments in major teaching centers to offset the identifiable education costs (as distinct from the costs-identified with provision of patient services) of the maintenance of their clinical residency and post-residency training proF,r-ams;that this mechanism be provided through the framework of Regional @-ledical Programs; and that funding, over and above the current'grant funds appropriated to Regional Nledical Progr-qms, be sought for tl-iis purpose. Accordingly, the Council recommends that until such funds are added to the annual appropriation, the Regional. P4edical Program Guidelines for operational grants under Section 90)-i of' Title IX of the PHS Act be changed to exclude the payment of stipends and other participant costs for long-term training at the post-doctoral level. 3. The Council is keenly aware of the potentially crippling effect on Regional Medical Prog-ams of continous investment in projects which were initially approved for demonstration of, or training in, new techniques of patient care, but provide what becomes an essential service to patients. They continue to believe, however, that it would be unwise and indeed impossible to develop a firm policy arbitrarily including or excluding projects of this kind, and instead urge the RMPS staff to work closely with Regions, as-they develop projects,.to be certain that other sources of support for maintenance of the service involved be well in hand before such a project is initiated; and also to encourage Regions to carefully investigate every possibility of capturing the fees paid for the service involved- for reinvestment in the project. 3 B. Special Actions NORTHEAS'fFl@ OliIO REGIONAL DEDICAL PliOGRAM In response to a special appeal for reconsideration of previous action on Project #7 (A Comprehensive Out-patient Stroke Rehabilitation Demonstration), the Council considered the additional information submitted and recommended that the project be approved as requested. ol - $481233 02 - $50.9145 03 - $26.1076 12 NORTHLANDS REGIONAL 'VEDICAL PROGRAM The National Advisory Council considered a request for the initiation of interim support to the Diabetes Detection and Education Center in TvJirmeapolis with the understanding that (a) these funds will be made available from the Region's unexpended balances and (b) that this approval does not in any sense indicate co@tment to approve the forthcoming application for RNT participation in the long-range basic .support of this Center. VIRGINIA REGIONAL MEDICAL PROGRP24 In regard to Project.#4 (Stroke in a Small Rursl Connunity) the Council concurred in the staff's recomendation for a waiver of the restrictions imposed 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. WESTERN NEW YORK REGIONAL MEDICAL PROGRAM In regard to Project #10 (Western New York Tamr Registry) the Council concurred with the Review Committee's recommendation for continuation of the project as amended. 1/ C. Reco @ ndations for Action - The Council recorded their recommendations in the fo@t which was adopted in the previous review cycle (Appendix I). ALBANY REGIONAL MEDICAL PROGRAM Rm oooo4 7/70.1 - Operational Supplemental Approval with specific conditions. Project #7A(R) - Approval I with the conditions specified by the iaeview Coimittee. Project #7B(R) - Approval I with the conditions specified by the Review Co @ ttee. Project #18 Non-approval II Revision Required. 01 - $36,930 02 - $36,930 03 - $0 1/ All amounts are direct costs only and unless otherwise specified refer to a 12-month period. 'Ihe designation 01, 02, etc. relates to the first, second, etc., budget periods of the subject application not necessarily the budget periods .1 that will actually be supplemnted. 14 CAfTf ).INIA 13L,G'LONAI., @T.-@'D-CAL PROGRAM Project #56 - Approval I Project #@O - Approval I in the reduced armunt Project #61 - Non-approval I 01 - $107,307 02 - $117,248 03 $121,393 C NEW YORK REGIONAL YEDICAL PROG@L RM 00050 7/70.1 - Operational Supplement - Conditional approval. Project #15 - Approval.I at a reduced level with the conditions specified by the Review Committee. ol - $4o.,OOO 02 - $50.1000 03 - $53,000 COLORADO/WYOMING REGIONAL MLJDICAL PROGRP2,1 RM 000110 7/70.1 - Operational 9upplemerit - Return for Revision. Project #13R - Non-approval II. Return for revision with the clarification requested by the Review Co@ttee. FLORIDA REGIONAL MEDICAL PROGRAM RM 00024 7/70.1 - Return for revision. Project #36 - -Non-approval II with recommendations for revision as suggested by the Review Co @ ttee. GEORGIA REGIONAL YA)ICAL PROGRAM fu4 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 Project #33 - Non-approval I. 01 - $100.1000 b2 - $100_%ooo 03 - $0 GRF,,ATER DELA14ARE VALLEY REGIONAL @IEDICAL PROGRAM RM 00026 7/70.1 - Disapproval - inappropriate for RMP funding. Project #19 - Non-approval I HAWAII REGIONAL MEDICAL PROGRAM RM 00001 7/70.1 - Operational Supple@it - Approval Project #21 - Approval I Project #22 - Approval I 01 - $202,743 02 - $99,168 03 $108 25@ ILLINOIS REGIONAL @E@DICAL PROGRP24 !I-Ni 00061 7/70.1-Approval with specific conditions. Project # 9- Noti-approval II with the recommendations for revision suggested by the Review Co@ttee. Project #10- Approval I Project #11- Approval Iwith the conditions specified by the Review Coiianittee. Project #12- Approval I Project #13- Approval Iwith the conditions specified by the Review Co@ttee; with second and third year funding contingent upon progress in the first year to be assessed by the Council on the basis of a progress report, continuation application, and the report of the technical site visit to be held somtiine toward the end of the first year. 01 $587,412 02 $661@237 03 $3413 883 INDIANA FD@,GIONAL MEDICAL PROGRAM @l 00043 7/70.1 Operational 9u2pleiTent Non-approval Project #19 Non-approval -I inappropriateness for RMP funding based on the Councills decision to defer approval of projects Proposing the clinical application of genetic counselling, pending further scientific validation of the clinical uses of this technique. @ject #20 Non-approval II-witli the recommendations for revision suggested by the Review Committee. INT,UMOUNTAIN FEGIONAL ML,DICAL PROGRAM RM 00015 7/70.1 - Operational Supplement Return for Revision Project #27 - Non-approval II with the recommendations for revision suggested by the Review Committee. 16 KAPI,'3AS REGIONAL MEDICAL PROGRAM RM 00002 7/70.1 - Operational Supple@nt - Return for Revision Project #39 - Non-approval II with the reconmndations for revision suggested by the Review Comittee. LOUISIANA REGIONAL MEDICAL PROGRA-r4 RT'i 00033 '7/70.1 -Approval with specific conditions. Project 8-- Non-approval II with the recommendations for revision su.Feested by the lieview Co@ttee. Project 9 -Approval I in a reduced amount and with the conditions specified by the Review Comdttee. Project #10 -Approval I Project #11 -Approval II Project #12 -Nori-approval. II with the recommendations for revision suggested by the Review Co@ttee. Project #13 -Approval II 01 $147,532 O'C-l - $77,242 03 - $79,342 MARYLAND REGIONAL DFDICAL PROGRAM Rm ooo44 7/70.1 and,7/70.2.- C)per-ational Supplements Approval with specific conditions. Projects #25 and #26 - Approval'I with both projects to be combined at a reduced amount and with the conditions specified by the Review Co@ttee. Project #27 -Ap-provalI Project #28 -Non-approva'L II with the recommendations for revision suggested by the )ieview Committee. Project #29 -Noti-approval I Project #30 -Non-approval- I ol - $94,975 02 - $144.11175 03 - $145,975 MEUHIS FEGIONAL i@ICAL PROGRA.M RM 00051 7/70.1 - Operational Stip2len)ent.- Disapprovql. Inappropriate for RMP funding. Project #27 - Non-approval I. 'llie Council was in agreement with the Review Committee in recommending non-approval for the Peripheral Vascular Clinic Project. 'I'hey wish, however, 17 - M@IPEIIS RL,:GIONAL @E-DI'CAL PR,DGRAM (CO@,"I'). to be certain that the project personnel and the Menphis RMP understc@.a that t.rie reconmndation in no way reflects a di:a.@e@nt with the inherit service value of the Clinic nor suggests lack of confidence in the st@,iff and Institution. The action does not preclude iksubmission of a request for FLNT funding for the continuing education aspects of this project at such ti@ as these are niore thoroughly planned and 'ready to be implemented. Project #28 Non-approval I ,@ROPOLII.PAN WASIiING'l'ON., D.C. REGIONAL @EDICAL PROGRAM R%l 00031 7/70.1 - Operational Supplement Approval with specific conditions. Project #36 - Non-approval I Project #37 - Approval I at the reduced level and with the conditions specified by the Peview Cormiittee. 01 - $38@477 02 - $llOi6l8 03 - $44,928 MICHIGAN REGIONAL MEDICAL PROGRAM RM 00053 7/70.1 - Operational 9upplement Approval with specific conditions. Project #16R - Approval I Project #27 - Approval 1 with the conditions specified by the Review Co@ttee. In concurring with all of the reconmndations of the Review Condttee, the Council urged the H4PS 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-approvcil II with the recommendations for revision su@, sted by the Review Committee. 01 $550,970 02 - $)454,574 03 - $477,459 MISSISSIPPI REGIONAL NMICAL PliOGRAM JIM 00057 7/70.1 - Operational Supplenent - Approval with specific conditions. Project #2R - Approval in the reduced amunt for 18-months with the conditions specified by the Review Co@ttee and with the understanding that'this will represent the termination of W funding of this activity. 18 - IVEESSISSIPPI REGIONAL ML,DICAL PROGRAIA@ (C@@)rTP) Project #13 -Approval t Project #14 -Noii-approval II with the r@cometidatiota thattlie I',e-lon C., be requested to reconsider their program in the ligjit of the National- @ , deliries for RMl@ participation in comprehensive kidney disease program . Council further reco@ilded that the Region be afforded direct help, by the staff of @S in making their decision in this regard and in planning a revision if such is to be proposed. 01 $213,1120 Oc@:. $1,05,946 03 - $39.1455 @.-IISSOURI ITGIONAL WI,DICAL PFIOGPMI FiM 00009 7/70.1 and 7/70.2 - Operation,-:;i Supple@nt, Approval with specific conditions. Project #60 -Non-approval II Project #61 -Non-Approval II. Although the Council agreed with the Review Committee that these two projects, as presented, are unacceptable for Regional Medical Programs support, they recalled the recommendations of the recent indepth site visit to MOIW and su@, sted that with staff help from both RMPS wad Mol@IP these "outreach" projects could be developed into important components of the Program. Project #62 -Approval I in a reduced amount wad with the conditions specified by the lieview Committee. Project #63 -Non-approval II The Council recommends that this project be integrated into the Region's overall continuing education effort in the preparation of the Region's Anniversary Review application. 01 $3303,243 02 - $36,984 03 $39,165 @40LJNTAIN @13TATES RJ!,GIONAL YE@DICAL Pl'iOGP-LAM RM 00032 7/70.1 - Operational Supplemnt - Approval Project #12 - Approval I Project #13 - Approval I 01 - $184,976 o,, - $l9llll7 03 - $197,8o4 NEW MFXICO REGIONAL YEDICAL PROGRAM RM 00034 7/70.1 - Operational Supple@nt Ap .prova.1 i\Titti specific conditions'. Project #13 Nori-approval II 19 NEW DEXICO REGIONAL MEDICAL PROG@L (CL@NT) Project #14 - Approval I in the reduced amount and with the conditions specified by the Review Co@ttee. Project #15 -Approval I with the conditions specified by the ReView Committee. 01 - $92 100 o@ - $993900 03 - $@01,765 NEW YORK IVU-IROPOLIVAN REGIONAL MEDICAL PROGRAD-1 RM 00058 '(/70.1 and,7/70.2 - Operational Supplements Approval with specific conditions. Project #16 -Non-4pproval II with the r-eco@,ridations for revision su,F,,gc-@sted by the lic@view Coinnittee and with the advice that the Region defer further planning for @T participation in kidney disease services in the New York Metropolitan area until they receive the National policy guidelines which are in preparation. Project #17 Approval I. 'Ilie Council based its recommendation on the findings of the site visit team wh--ch had visited the project on the advice of the Review Committee. Project #18 -lion-approval I Project #19 -Approval I 01 $1176147@) o,) $494,965 03 $3503 000 NOR'I'H CAROLINA @IONAL MEDICAL PROGrW4 RM 00006 7/70.1 - Operational Supple@iat Approval with specific conditions. Project #3R - Approval I Project #26 - No Action Taken. Site visit required. ol - $89,go8 0, $62,550 03 - $42,3o6 NOITHI DAKOTA REGIONAL MEDICAL PROGIIAM RM 00060 7/70.1 - Operational Stipplenietit - Approval with specific conditions. Project #5 - Approval I Project #6 - Approval 1. AlthouL2,,Ii Council was in general agree@nt with the Review Coi@ttee concerning , the shortcomings of this project, it was their opinion, based on first-hand knowledge of the Institution and personnel involved in the project and on their experience in site visiting this 0 NO,RTH DAKOTA REGIONAL MEDICAL PROGRAIM (CONT) Region, that the approval of this project is essential for further development of the North Dakota Regional 1,4edical Progr@ . In recommending approval, Council strongly urged @S staff to work with the Region and with personnel involved in this project to correct so@ 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 implementation of this project is essential to regional development and suggested that it be approved at $35,000 (dco) for one year only with continued support contingent upon revision of the project with staff assistance, and reapplication to the Council. Project 8 Non-approval I Project #9 Approval I 01 - $115,383 O"' - $79,7'T2 03 - $79,549 NORTHWL@ST OHIO RFGIOIIAL D)EDI("AL PliOGIWI @i ooo63 7/70.1 and 7/70.2 - Operational Supplemnts - Approval with specific conditions. Project #01-S - Non-approval I Froject on-approval II with the recommendations for revision suggested by the lieview Coinmittee. Project #14 Approval with the conditions specified by the t@eview Coranittee, for one year only. Project #15 Approval 1. Although the Council recognized this as another of the "Council for, Continuing Education" projects which have been submitted by the, Ohio State Region and action upon which has been deferred pending the outcome of the initially funded one. The douncil' accepted the advice of the site visitors that the project is of critical importance to the Northwest Ohio Regional Medical- -rrog@arn and probably has an excellent chance of success wider the leadership proposed. Project #16 -to be incorporated with project #14. @ject #IT -Approval in the reduced airK)urit and with the conditions specified by the fieview Co@ttee. The Council further considered the, findings of the site visit team regarding the Region as a whole; its organization, a@rCinistration, and plans. It is their recommendation that tlie'liegion be urged to seek stronger leadership but the Council agreed that any specific re- co@ndation reading personnel would be inappropriate. 21 - NO.RTTIWEST OHIO REGIONAL ME, DICAL PR(@GF,*l (CONRP) TI-ie value of an assessment visit as recomended by the visitors was questioned since it would probably do no more than t,e-identify the pn)blem. Council suggested that perhaps direct and Lrequent assistance from RMP staff a-rid consultants would be more helpful than further investig, ations of the situation. 01 $145,830 02 - $70,525 03 - $213,250 OIIIO STAriL@ RE@GIONAL DEDICAL PROGRAM PuN-1 00022 7/70.1 and 7/70.2 - Opei@ational Renewal and Supplement - @proval with specific conditions. Project #lR -Approval I at the reduced level an-d with the conditions specified by the 'tieview Committee Project #8R -App roval I in the t.@educed amunt aid with the conditions specified by trick Review Committee. Project #22 -Approval I ('Phis I)r,oject was considered by the Council in the previous review cycle and action was deferred at that tine). Project #24 -Non-approval II with the recommendations for revision suggested by bhc- fieview Committee. 01 - $714.1075 02 - $778,731 03 $847,944 'OHIO VALLEY REGIOIAL l@MICAT, Pi'iOCjR&\l @l 00048 7/70.1 - Operation,,tl Suppleirerit Approval with specific conditions. Project #12 -Approval I in the reduced amount recommended by the expert technical reviewer. Project #13- Approval I@ To be fwided only if not @d by other Federal resources. Project #14- Approval II Project #15- Approval I Project #lb- Non-approval II with the recommendations for revision as suggested by-the f@eview Co@ttee. Project #17- Non-approvil II with the recommendations for revision sue,p-ested by the l@eview Committee. Project #18- Non-approval I 01 - $273,5)16 02 - $296.$215 03 - $327,657 22 - 0170i',GON RL@,GIONAL ME@DI'CAL PROGRAM PAM 0001:' 7/70.1 - Operational Suppieiii(@rit, - Approval Project #12R - Approval I Project #16 - Approval I 01 - $59,375 02 - $28,829 03 - $143,843 PMFI,,@ RICO REGIONAL MFDICAL PROGRAM l@ 00065 7/70.1 OperationaJ- Suppleiii(--iit.- Approval with specific conditions. Project # 9 Approval I inthe reduced amount and with the conditions specified by the Review Committee. Project #11 Approval I with the conditions specified by the Review Cormiittee. .01 - $320,936 O't-l - $,)27,436 03 - $233,636 SOUTH CILROLINA REGIONAL @IMICAL PliL)GMl RM 00035 7/70.1 Operational Suppleinent - Non-approval. Project #35 Non-approval II witli the recomendations for revision suggested by the Peview Committee. Project #36 No action taken. Site visit is indicated. Project #37 Non-approval I 'y REGIONAL MO)ICAL rROGRAM susQm @A VALdr,, RM 00059 '7/70.1 - Operational 9up2leinerit Approval with specific conditions. Project #20 - Non-approval I Project #21 - Approval I in the reduced amunt to reflect the newly adopted policy on training project participants. Project #22 - Non-approval I Project #23 - Non-approval I Project #24 - Non-approval II with the reco,@mrendations for revision suggested by the Review Committee. Project #25 - Non-approvai II. The Council was in general agreement with the Review Conndttee regarding, the specifics of the project but believe that further developmnt of this project along with #2)1 Is in the bF-.st interest of the the Region and has requested that the RMPS staff offer assistance to the Region in this regard. Project #26 - ApDroval I 01 - $925,134 02 '@)78,915 03 - $83,294 23 TF,-US RE,GIONAL iMEDICAL PROGfW4 EM 00007 7/70.1 Operational Supplement - Approval with specific conditions. Project #8R Approval I contingent upon the satisfaction of a technical site visit team regarding four specific points set forth by the Review Co@ttee. Project #14R Approval I with conditions specified by the Review,Co@ttee. Project #15R Approval I Project #TIT-- Nori-approval I Project #T9- - Non-approval I 01 - $46o,6'to 02 - $296,595 03 - $24o,386 rT-,I-gTATF, RE@GIONAL P@ICAL PROGRAM @l 00062 7/70.1 - @)eratiot-ial Suppleiiic@nt - Approval Project #9 - Approval I in a reduced amount and with the conditions specified by the iieview Co@ttee. 01 - $105,300 02 - $85,6oo 03 - $63,000 VI-.,iGINIA REGIONAL @qDICAL PROGRAM @l 00049 7/70.1 - Operational @upf)lement - Approval with specific conditions. Project #10 Approval I with the conditions specified by the Review Comittee. In discussing this project the Council wished to stress the Lnportance of the condition for approval of this project aiid urges great care on the part of the staff in adjusting the second and third year amounts of fU4P support by utilizing patient revenues - to offset costs of the project. 01 $268,552 02 - $48o 3479* 03 - $533,504* 'fo be negotiated downward - WES= NFW YORK REGIONAL DO)ICAL PP-,DGRAM RM 00013 7/70.1 Operational Supplement - Approval with specific conditions. Project #15 Approval I in the reduced aiTiount aiid with the conditions specified. Project #16 Approval I in the reduced amounts and with the conditions specified by the lieview Committee. Council expressed its willingness to allow the Region to increase the funding 24 WEST'E'RN NEW YORK REGIONAL MEDICAL PROGM4 (CONT) of this project to a maxinn of $100,000, providing such a level of funding would be required to.maintain this valuable regional resource. Project #17 - Non-approval I 000 02 - $3@10 000 03 $350 obo 01 - $350@ WESTERN PENNSYLVANIA REGIONAL @ICAL PROG@L RM 00041 7/70.1 - Operational Supplenient - Approval Project #9 - Approval I ol - $43,911 02 - ,@114.1820 03 $46,995 WISCONSI14 REGIONAL ML-DICAL PROG@M TU4 t)0037 7/70.1 and 7/70.2 - Opei@ational Supplenent Approval with specific conditions. Project #13A (R) - Approval II Project #1 A - Approval I Project #lbB - Non-approval I Project 1 I - Non-approval I Project #1@K - Non-approval I Project #19 Nori-approval I. Council based this recommendation on the findings of a collateral review of the project -ernal and Child Health Ser by the staff of Mat vice, iisi@ which was requested at the suggestion of the Review Committ(--e. Project #20 -Approval I Project #21 -Non-appi,oval I Project T2-2 -Approval I Project #23 -Approval I in the reduced amount and with the conditions specified by the-rieview Committee. 01 $2923815 S)2 - $167,807 03 - $172,395 XI. ADJO The @eting was adjourned at 11:30 a.m. on July 29, 1970 T hereby certify that, to the best of my knowledge, the f,@regoing rnJ-nutes are accurate and complete. arold Margulies, M Acting Director Regional Medical Program Service 26 I"Lllc,.ls tc) t,lic-, Cc)iitn.@it.t@(,(@ 01-Lly, ) Tc-,,cluiical.'Iy -,c)ui-id a),id capably di-i,ocl,cd Feasible widei, -,pecl.f'jcd coiadi-tior).--, Un@ippi-,ov,-ibl,e on teclii-i.-'tcal. gL@)iiiid,3 tell(? IN'Ov.lcii Con.,ri.itt-,(@c tc) tli(-, N,.Lt,.ioiii,l. Aclvj-soi.@y CC)Llll(,.l I' -1 -;r-c@j T, 6 -CT, F - - - A@,I)i-c)vil. T. ACiC]itll()Ill'll. Ap@)i,o\),tl. II No ad(ii.t-loiacil. ftirid,,,, Noii-,,;il-)I-)i,Noval - Noi,i-@il)l)i,oval IT - No act;jon tal-Icia - Ncc,cl Noccl s.tto visit, Noc@d Coutic-.,'i'L (On l@,iitirc@ ApT)I.-i.c@ition,,.) A@)pro,,7, t] Apl)t,ov,,tl w-.ith spccl.f',Ic- ccii-icl-Ll,'ioi-is re.L for-, Rovi@;:Iotl D.I.sappi-,oval foi, DI?Mll f'Lll l(i 1 1 it', N,I.it..Ioi-i,,il Acivi-soi,,v Cc)utiol.'L i,c) -il. w.'ttli -,pccifl(@, condit,@iotis by ilic,, Coiiuiit.t,tt,c, oi, POT, fl@2v.l@gioll 27 - NAq'10,',IAI, ADVISORY COU%TCIT, ON BIU-4NAN., Michael J., M.D. (72) DITILIKPdq, Clarl@ H. 31 M.D. (72) President, Michigan Cancer Foundation Consultant in Neurology 4811 John R Street Mayo Clinic Detroit, Michigan 48201 Rochester 3 Minnesota 55902 Professor of-PIedicine OGDEN, i@@. C. Robert (70) Wayne State University President and General Counsel North Coast Life Insurance Company CANNON, Bland W., I.I.D. (73) Spokane, I-lashington 99201 910 Madison Avenue -Merrpliis, Tennessee 38103 PET,TFGRINO, Edrqwid D., M.D. (70) Vice President for the Health ' Division of l@eurosurgei@ Sciences and Director of the Center University of Tennessee College State University of New York of 14ed,icine Stony Brook, New York 11790 CROSBY,, lEdviin L., M.D. (71) POPMA, Alfred M., M.D. (70) Executive -Vice President and Director Regional Director Awricai-i Hospital Association Mountain States @IP Chicago, Illinois 60611 525 Viest Jefferson Street - Boise., Idalio 83702 @-BAIEY, Michael E., M.D. (7('-') President and Chief ]Executive Officer ROBI, Russell B., M.D. (73) Baylor College of .Icdicine 240 West 41st Street Houston, Texas 77025 Erie., Pennsylvania 16508 Professor and 'Chainnan Vice Speaker of the House Department of Surgery of Delegates, k".IA College of Medicine SM\Tlio@LZ, ,Attack I., M.D. (70) FVERIST, Bruce W., M.D. (71) State Health Co@ssioner Chief of Pediatrics State Department of Health Green Clinic Riclunond ,Virginia 23219 Ruston Louisiana 71270 TPEJ,--Nl '4r. Curtis (71) IUT-U, Will.iain R., M.D. (71) Director, Pension and Insurance DeT)t. Board of Co@ssioners United Rubber., Corlcl Linolem', County of Allegheny and Plastic Workers of @rica 101 Courthouse @,on, Ohio 443o8 Pittsburg!-i, Pennsylvania 15219 WYCKOFF,, Mrs. Florence R. (72) Mcr@' RAN, Alexaiader M-3 M.D. (73-) 2113 Corr,-ilitos Road Ehory University Clinic Watsonville., California 95076 13c@)5 Clifton Road, lq.E. Atlanta, Georgia 30-'22 CIIAIT@,%IAN Dr. Vernon E. Wilson Adminii-,tr@,.itoi@, Ilealtli Services and @4entLil- liealt-,Ii Acini:Lnistration 5600 Fisl-i(-,r@:3 @ic -id @uylw 20852 Rockville, L August 1970 G&C'@' AT=ANCE AT THE NATIOIQAL ADV-ISORY COUNCIL Ju'-.y 28-29, 1970 RMPS STAFF A@ING Miss Rhoda Abrams Dr. Marion E. Leach Mr. H. Earle Belue lvlr. Gregory Lewis Dr. Edward T. Blomquist Mr. Rav Maddox Mr. J. Edgar Caswell Miss Elsa Nelson Dr. Donald R. Chadwick Mr. Roland Peterson Mr. Cleveland R. Chambliss Mrs. Martha L. Phillips Mr. Clyde Couc@ Miss Leah Resnick Dr. Sam Fox, III Mr. Dona]dRiedesel Mr. Edward Friedlander iMrs. Jessie Salazar Mr. Sam 0. @ui@r Mrs. Sarah Silsbee Mr. Charles Hilsenroth Dr. Margaret Sloan Miss Dona Houseal Mr. J@s Smith l,ir. Frank Ichniowski Mr. Dan Spain Dr. Anthony Komaroff Mr. Lee Teets Mrs. Lorraine Kyttle Mr. Francis Van Hee, Jr. Mr. John M. Korn Jr. Mr. Lee Van Winkle Mr. Frank Zizlavsky OTHERS A ING Dr. i'4aurice Bender, OS Dr. J.H.U. Brown, NIGMS,NIH Dr. John Cashmn, CHS, HS.@ Mr. J @ s Dunlop, A.D. Little Inc. Miss Sylvia Kesinger, CL-IS, HSMHA Dr. Richard '@vinson, Veterans Administration Mr. Wendall Maddrey, NCHSR&D, liSDM Mrs. Sylvia Payirer, NCI, NIH @Ir. No Tucker, BHPME, NIII Dr. T. M. l@ega, NIAMD, NIH Di,. William Zukel, NH&LI, NIII