A B&B lmpmrm^,riom lm^j3E MAkm^iB@EmT 300 @IP40C M=lt=C*= SOULXVAMO Ulaseest P4^RLBORD, M-ftor No ZC'77Z 0 USA 0 C2011 24@l 10 DEPARTMENT 0 F H E A L T 11, E D U C A T I 0 N ND WE LFARE flea-Ith .9errces @,and MPntal- Healtli Adniinistration Divis n of !Regioiial Medical Illogram 110 N@tional Advisoi@y Council on Regional Medical Programs Minutes of the Meeting July 28-29, 1970 I.Parklaivn Building Conference RooiTi G/H Df,',F'Affi'Mi-'Hl' I( lti@,AIint, I,,,I)lj(,.A'I'ION ANI) WI!U,'ARE National Adv!8@ory Council on fiegiorizil Medical Programs Minutes gf the Twentieth Meeting 1/ 21 7 I July 28-29, 1970 z The national Advisory C6unci"- on Ref-,ional Medical Program convened for its twentieth @eti@ at 8:30 a.m., q'uesday, July 28, 1970 in rig Conference Room (3/@l of the Park-lawn BuildirfU, Rocl,,-ville, Maryland. Dr. Harold @brp-, Acting Directoi,, Regioi-ia" Medical Programs ulil6s.5 Service presided oVer tl@ '@etiiig. 'il@ie Council mmbet@@ present were: Dr. Bland W. Cw-inori Dr. @.und D. PellfTino Di,. li-,dwin L. Crosby @128 only) Dr. Alfred M. Poprm Dr. Michael E. (7/1'1'9 only) Russell B. Roth Dr. Bruce W . E,,ve'rist IX . r4ack I. Slianholtz Dr. Williain [Z. 11@irit Mrs. F'--orence R. Wyclcoff @ 4 Dr. Alexandei, M. mcriieciran A,listit-ig of RP4P staff n@)embers, mici others attending is appended. CALL TIO ORDER AND OPENI@IG RET,@@ Tlae meet@, was called tp order at 8:30 a.m. orl July 28 by Di,. 1-@ld Mareuli6s. 'nie Council Berbers werefwelco@d to tlic@ new Conference facilities in the Pai-klawti Build'@tv., and the genei,@ arra-iif-,emi-its for the conduct of the niLotinr, in tlie@,e facilities was explained. Dr. MarErulies announced li.Is- plans for an executive session w.Ltli the Council at the close of the first day of the rloetirig'. Pioceedi@,s of meetings are restricted unless cleared by the Office of the ActiLLnistratoi,, Ilr-,HIA' The restriction relates to all material submitted I for discussion at the meetir@s, the supplemental material, and all other official documents incli@din- the cifrotida. For the record., it is noted that ineiiib(@i-s absent themselves from the meetit@ when the Council is cliscussirii.-, applications: (a) from their respective institutions, or (b) iii wlilcii a conflict of interest @ght Occur'. qlils proced@ does riot, of course, qppl.y to en bloc actions Lire oiily w@ien the application is under lri@ilvi.dual discussion.- III. TIT-EiC)DUCrl'ION OFI q .,RS Di,. Mm@Ciilies int@rOiLIC&(t two new t-)t' the Council who were in attendance for this iriee@t.Ltig. 'They are: W,I.IL."L,:ijil 11. Itunt, M.D., a Coiiiiiissioner of the qotuity of' Alle@-lit@iiy lti E'ennsylvania and medical practitioner in M,cKees@port, remsylvaiiia; and Aiexandei- M. McPhedran, M.D., Associate Professoi? of@Intenial Medicine (!4eur@ology), Story University School of Nlediciiie, Atianta. 'Ihe recent appointment of ;vlr. C. Robert Oeden was also announced. Mr. Oglen is President of the North Coast Life Insurance Cr-,:Tpar@ in Spokane l@p-slair-,Cton and Chaim..an of the Washington/ Alaska l@egional @@viso@ Group. lie will begin his regular attendance IY at the next meeting. IV. lUiGIONAL MEDICAL PROGRAMS AS A PA-@P OF 'IliE IE!7.ALDi SERVICES AND ',\Ui'N.VAL f@rih ADMINI,13TRA'I'ION - i)i-. Vernon Wilson I - In his first @etinF with the Council as A@nistrator of the Health Services and P4ent6l @lealtli A@nisti,ati'on, Dr. Wilson recalled his long interest and firslt-liand involvemrit in the developiyL-nt of Regional Medical Programs.@ Ile assured the Council of his strong support of Regional Medical @rogra[ms as a part ol' the broader efforts of liMiA; Ile expressed liis 'endorsement of the I)i@iiiciple-s of decentralization of the administration! of @is@ activities generally, and his belief that the concept of I @416dical ProCranis can relate well to these principles. Al the Mechanisms will be worked out slowly, he is confident that arI@ take place without dilution of effort., either in the Regloi or In the headqLia-i@tei,s office. In recok ion fltlie very fo@dable- problems facing Regional lledical @it 0 1 -r Pi-ogram ScrvicelDr. Wilson exp-essed re@t that he was not able at the present time to iresolve tIlO Tll@101' staffini-, problems. He assured the Cotinc,@l this has v@ry liif-ji priority on his working agenda and the fact that he is as yet uriabl@, to report does not indicate that lie is not ac ively working toward a solution. Di-. Wilson asked the Council to meet with their again in approximately six to eif-,ht weeks in a special orie@ay session. At that time he is assured he will $be able to discuss his plans, as they are based on those of Secretary Ri-cliardsc)n, for the organization and administration of the Department@'s efforts to strengthen and increase the nation's capacity to deliver health services. ffe indicated also that by that tire he would hav,iTiore definitive I)lans for the staffing and organization of the Re@ional Nledicai Progranis Seiv'Lce. AltlioL4@li his plan[swill include a freiic@ral outline of the 'Irrdssion" of PtE-gional i@ledic@l Elr6o7ams as a part of the fISNUfA effort, Dr. Wilson said that he iio4ld rely heavily on the advice and 2;uidance of the Council foi, d6velo@ing the policies wi(i detailed program directions that would lead 't eve@ more cff'icic-rit and k@@@(-,ctiv'e cooperative arranc.-e@nts between the priva,@e sectors, wlilcii t;liey represent, ;@d the Federal effort. 3 Wilson told the Council of the resignation of iMr. Irving Lewis as.Deputy Administrator of and about LIr. Lewis' appointment a@-Professor in the Department of Comunity Medicine at Albert Einstein College of P4edicine in New York. i@. Lewis addressed the Council briefly, stating again his faith in the Regional,,','4edical Programs aE,, representing "the only concept of true regio..-lalization of health services that can be expected to work" in the United States. r,lr..Lewis expressed his thanks to the Council for the many pleasant working relationships he had had with them. 1,@s. Florence llyckoff 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. CONF@ IR'QATION OF FUTURL,' DF=I@JG )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 r;equested-by Dr. Wilson. L@ie Council accepted the invitation of. Dr. Edwin Crosby to hold this meeting at the American hospital -ers in'Chicac,,o. 'Iliis will enable more of the Association headquart members to travel to and return home from the meeting in a single day. VI. CONSIDERATION OF TTIE @IlIqUTES OF T',IIL,' MRCII 31-APRIL 1., 1970 @l-.IEETI14G The Council unanimously recommended approval of the minutes of the meeting of the Council on @@cli 31-April 1, 1970. 'VII. A RE-PORT FROM THE, DIRECTOR Dr. fanfold i@gulles A. Progress of I-IR 17570 and S3355 Dr. Margulies-revieived the contents of the twc Bills very briefly and referred the Council m@)ers to.an analysis prepared by staff which compares the Bills to one another, and to the present legislation. This was included in the agenda materiai7!3. B. Appropriations for-Fiscal Year 1971 Status of the Appropriation Bill was reviewed and the Council was reminded of the various circumstances which ilTpinge on the total amount of "i-iew" funds to be available for @or expansion of Regional lledical Programs in FY 1971. Among these c@e'the $1.9 million earmarked for l'-Iodel Cities activ,-ti--s; the 1% 2,eserve of fuiids to be used for evaluation 4 activities at DFEW, HS,@, and RMPS levels; the possibility of administrative "eanTiarl-,ing" of some funds for Pi4P participation in comprehensive 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 StrateFy Dr. j@pulies m.(ie a brief introduction of a new management information system being implemented by FLMPS. I-le also noted the effect of the 196-0-70 strategy of permitting Regions almst unlimited rebudgetirig of unexpended balances Por program expansion. Dr. @t-u,pulies stated his intention to be.-in to apply -more stringently guidelines to this kind of rebudgetinr, and to recapture some of these balances for reallocation ar;iong the Regional '4edical Programs in response to evidence of successful regionalization and procTam development. D. TI-ie 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 liS,-4HA 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 manai,,,,eniei-it responsibility in the Regional Medical Program Service at the national level. Ile 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. l@. Ma-T:-trulies explained the intent of TU4PS in placing a Program Representative in each of the ten DIII-14 Ref,-iorial Offices and described what he sees as the service role of these individuals. viii. PROGRF,,SS PIOTES FROM STAFF A. Contracts under Section 907 - Di@. @g@et Sloan Dr. Sloan gave a brief review an@l status report on the three contracts made by the @4PS under the terms of Scetion 907 of Title IX of the- Public Health Service Act, which deals with the "...list or lists of facilities in the Unitecl States equipped and staffed to provide the most advanced methods and techniques in the diagnosis and treatment of heart disease, cancer, and stroke...."' 'nie contract, with the Aiiiericari 'report ,Issociat-,ion in support of the Intersociety Co@ssion for lieart Disease Resources_, has begun serial publication of its report and will continue .to do so throughout the period of the contract. The Joint Comdttee for Stroke Facilities, supported by a contract with the American Neurological Association.1 has chosen to withhold publication of its report until it is entirely co@leted. The report of the Special Advisory Cormiittee on Cancer Care Facilities of' the Cancer Co@ssion of the Pitierican Collecr _,e of Surgeons, which was supported under a contract now completed, has been reviewed by the Regional Medical ProVams Service and was received by the National Mvisory Council at the April 1970 meeting. Negotiations between the kwrican ColleL-e of @geons and the RMPS, preparatory to completion and RMP approval of this report, are now underway. (This was discussed in mre detail with Council during the Executive Session). B. Multi-Pro.-@am Q-e@ces Project Grants - Mrs. Km,tha Phillips Autl-iorized under Section 910 of Title IX of the Ilublic Health Service Act, this program of project grants will be implemented 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 "Or these grants. They were assured that these are reflected in the final edition of the program documents.which are now'@n clearance. I The Council expressed its persistent concern about the potential effect of the funding of these grants on the total funds available for Section 904 grants (operational support to Regions). Dr. i@gulies 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 twD @or nt activities. C. R@rio@ql Medical @,ograms In DI@el Cities - l@. Cleveland Chambliss 'I'he Council was T@einind(-,d of ttiE, administrative e, king of $1.9 million of f@Ul 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 deiTee 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, Di,. flu,Falies exp2ained tiat Regional Medical Progr@ which are plannin- arid submitting projects to 6 --serve urban populations noed not lan them exclusively for Model Cities I p areas and need not s@Qek @y endorsement or concurrence beyond their own review and approval @ec@sm. D. Senior Clinical @ain@eshi2s - Mrs. @tha Phillips Mrs. Phillips recalled t0 @t.he Council ;he circumstances leading to the Departmental decisio@n to place responsibility for the Oenior Clinical Traineeship prcg7am in Regional Medical Programs Service. She also reported to the Council o the-selection of the-first group of @aineeships., to be awarded' @er IWS sponsorship. 'Iliis selection process was carried out by panels of noii4Feder tool experts in the cancer field and was chaired, 0 by Dr. Michael Bre@, , whcim the Council delegated authority for the selection of individual trainees to the total extent of $300,000 of FY 1970 funds. 'Ibirty trainees were selected from amng 80 applicants, and.represent the disciplines of medicine, gynecology, pathology, pediatrics, radiology, @q surgery. The training will be done in major iTedical centers throughout the-United States. E. Guidelines for I6,struc@tional Technology -.Miss Cecilia 'Conrath A second edition of these '-uidelines was before the Council for their f' gr-ino consideration. Dr. @elle who served as Clitirmn of the Subcommittee to prepare these guidelines, expressed his belief that they are now I @ ready for publication and implementation, with certain rewriting. This is being done by RMP@ staff, incorporating Dr. Pellegrino's suggestions. Fi'. I,,'valuation.Activities Mr. Roland Peter-son In reporting to the Council, Mr. Peterson mentioned the final sunmtion and distribution of the Regional Progress S ies which resulted from the questionnaire developed and tabulated by his staff; on the Regional Medical Program E,val@tion@Conference to be held at the University of Chica-0 Conference Center in September; and on his plans for evaluation activities in FY 71 which will be chargeable to the "evaluation earmrk.11 This eaiqnark was expi ined@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@progi-m level, but also at the lev6l of 11,31M and DIEW. It is anticipated that sonietliir)g slightly under $1 million could be set aside under these circwnstances and could be used by contract or by the Section 91 I I 0,Er,rant mechanism, at the discretion of RMPS, with portions of the totaliwiti@eld for H-MIA and D[IL;W evaluative activities. 'I'lie entire iTatter of evai@tion sparked considerable discussion in the Council. It was the consensus that in order for these funds to be effectively utilized,@a mti(ill broader concept of evaluation must be developed. '-Phere was a good deailof discussion of the contract with Arthur D. Little, Inc. and expression of considerable doubt as to the real value of any find4-ngs be@., reported. Several of thu Council r-@lernbei,s leave turd individual experience 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 agreement with the suggestion, made by Dr. Roth and Dr. Cannon, that interim reports@on th@ progress of such undertakings, either this ny future .1 current one or a such contracts, be required and that they be made available to the' Coun@il 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 was originally let. @They 'also asked to see the final report from the, A.r'Ll,,ui, D. 1-@itt-'Le. Iii,--. as soon as it is ,-cceived by MPS. In sLuiir-m@izing the discussion Lyr Pellegrino suggested that all evaluation activitieSI'shouid,'in the long run, serve totest the viability of Regional Medical I,).,c)pTams as they are developing; and if' they are foui-i@l not to be viable to determine wliy they are riot. IX. KIDNI,'Y DISEASE ACT@T=S @IN @IONAL H@I)ICAL PROGRAMS Di,. Marf-,ul.les reviewed for'@the Cotiricil the circumstances leading to the addition, in bot6 the House and Senate versions of the continuation legislation, of kidney disease as one of the specific disease categorical targets of Regional Medical Programs. Ile asked f'or, guidance of the Council In the devel6pment'of a. responsive and effective policy for Regional Medical -Programs participation in comprehensive regional kidney disease programs thr6u,,@liout the Natl-on. Ile is aware that the final definition of such a@polic@y, especially as it would apply tIo 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 @o@ b'ackground 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@ Chie@, Nephrology Section, Department of Medicine, Georgetown Universitv' and Dr. Richard l@. Freeman, Department of Medicine (Nepl@oloF.W), University of Rochester School of Medicine, whom he had invited to the meeting to 'Provide expert reference to the Council in their deliberations.i Dr. Schreiner trade aideta@led presentation of the "state of the art" of the @,iFr rlic kidney disease. Ile incl,-ided resume of the .,eiiient of @ CIU-0 techniques and i-aethodologles of screening, diagnosis and therapy; and the shortcomings as well successes in prevention, treatment, and rehabilitation. Nephrolo@ 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 'L--ho enviable positions of L),@- I r C. L-i b 1 eto I)rofit from tl-.e mistakes nide in establishing resources @for open heart high voltage radiotherapy, etc. 8 Organization for the delivery of servies to patients with kidney disease, Dr.'Sclireiner believes iends itself -so ideally to regionalization that the,development of Isucli a program can and will serve as a framework for regionalization of' ervi6es in other more traditionally established disciplines. Ar .,ain, as in nearly,,all their past discussions of kidney disease, the Council expressed concer[n about the apparent lack of e!rpliasis on prevention as part of ati@overall kidney disease proEram. Dr. Schreiner an(i Dr. Ilreeman believe that thc-- only hope for real prevention will come via prenatal care @d IfErenetic (-,i-iririe'ering" and although work in these areas is p@oLg@e@sing, it will not have any significant impact for fifty to sixty years". They also believe that the 'More traditional approaches to prevehtion@generally will not be seen to be effective for at least 20 years-. Both Dr. Schreiner and Dr. Freeman spoke to the issue of the cost of developing regionalized kidney disease services; and the way in wl,-ich the,enormous numb sed in this i@egard ]have been misleading and discouraging to i s and communities. Both aoTeed that the $15 million inenti pendii-ig I-ei-islati-on could make a sip-iificant diffe ie' extension of services of' existing kidney disease centers stablislmient of some smaller number of entirely new ones. Dr. Marpulies reminded the Council that the $15 @llion to ivhic the,Bill makes reference., is recommended as a maximum assignment of Repio@l M@dical Program grant funds to kidney disease efforts, and in no way e ks or limits any dollars exclusively for this purpose; nor does i@ provide, or even recounei-id the provision, of funds over and above the grant nzitis-to be otl-ierwise available for purposes of Regional Med:ical Programs. Di,. Everist raised the question of the mechanics of incorporating l@idney-disease pro rams into the 55 Pief-,iorial Medical Programs if the principle of local Autonomy and decisiori-makir@r is to be maintained. It is his belief t@Iat unless and witil l@egions with appropriate existing facilities can be "seduced" into affording him 4i regional priority to kidney disea@e control, it will be necessary to use the Section 910 authority., so that nati-ot-ial, directives may be used to develop "sensib in sensibic T)laces." Acceptin,-, the a inevitabl(- lag time before the results of a planned pi,ot7 i@ition cai-i be felt, Dr. Pellegrino asked for the advice of D r and Di,. Freeman on iihat imediate impact Regiot-ial Medical L-7-anis could reasonably have, considering the - provisions of the Oi-opos@d legislation and within thE@ amount of funds that are likely to be available within the next two or three years. responding first Sc@einer recometids the stre@,-hen@r of existing facilit particularly tliosf-, wyilcli liive committed themselves to outreach beyo lie confines of the iiiedi@-tl center within oiliich '-Iiey exist; and her identifying those cuiui-iC, t@iis group that lend the@ selves to further interlinkage to provide a multiplying rather than -zimply an additive@effecit.' Dr. Freeiran recommends the support of the completion and extension to full services of a smll number of centers which can be developed on the basis of existing, although perhaps not entirely complete, resources; the use of R,4P 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 stronger endorsed Dr. McPli@an's point regarding the importance of tho@itful@integration of a kidney disease program -nto an existing Regional Medical Program; particularly in 'Planning, sub-regionalizatioh, continuing education, and inter-professional coninunication activities. I In a subsequent d on on the second day, the Council members reflected on the naations of Dr-. lilreeman and Dr. Schreiner as well as on th @,5biective-S, and the basic operational concepts which guide Regi ical l@ograms at the present time. Since these proscribe e use of funds fcpthe direct provision of patient service total amount of funds likely to be avail-able 'will proscribe ing major contributions toward the establishment of facilities, 1 agreed that the major focus of RP-T involvement will be (a) the encburagZient of better and more effective cooperative arrangements amonp- bare 11 selected institutions and resources which I Y together might form a "decentralized center" anj (b) in the strengthening of existing institutional resources competent and willing to develop outreach,, both in the demonstration of' service and the training of personnel. Both of'itlie above requii@e national as well as regional plannii@,. In surm@y, the Council endorsed the general plan presented by the staff; they also af:Teed,@however, that to develop a workable overall policy it will be.nbcessdry tc, have basic data concerning the resources in, anci available t each of the 5'5 Regional Medical Programs. This SI-IOLIld include .(a) presently ,-,elf-coritained centers, (b) institutions which have the capability of becoming an integral part of sLfch a center, and (c) institution @ resources which might participate in an inter- .r,eg,riorial arrii-Cemen @t for@the provision of kidney disease services. An assessment of the "Size and s@iape" of' the kidney disease problem in each of the Regioiis would provide the other essential piece of basic information. Dr. Nlarg -ulies apxeed to Provide these data based on the existing geographic pattern of the @5 R'@ ional ,4e(lical Program. @g X. RL@'VIF,@4 OF APPLICATIONS A. Issues Identifi6,1 1. In the matter olf @Ir @s@ippoi-t of' stioit-tetITI train-Lng projects, the CoLu-icil. considered the histo-.- provided them by staff., and a number, of y 10 spec-'Lfic projects' i6cludL@ in the apl:lj.cat@joiis under review at this meeting. They be-3-i'eve tilat under most circumstances it is not necessary or appropriate for Regional Medical ProL7ams Uant funds to be used to cover the full costs' of both the presentation of short-term training I projects and of stipends and expenses of the participants. The majority of proectslin this cateEo@v provide opportunities for up- gradi@p- and develop@ient of new skills in special techniques or procedures and are directed to n(liVJ.duals presently employed in health care institutions. Undoi, ttie@circumstwice@ these institutions should, and in most cases do, r*ke r6,gular provision for this kind of training for their staffs. 'llie Council therefore recIo'mmended the following changes in policy guidelines regardine'- Parents to pw-t.icip',-mts in continuing educat, on and trairiii-i,,7 projects (67s@, defined iii the Guidelines Addendum, . February 1970, page 13) which are supported by Rej7,ional Medical Program grant funds. Regional Medical @-,oL7aiii g-r@aiii, futids may not be used for the payment of stipends, either directly or on the "pi-Anteii-ance of income pr@inciple@" to participants iii short-term continuing 3 education and trili-ilriF, projects. 'I@iis does not include training for new careers for new types of health personnel. Otliei, allowable cos,@s of participmit's support may be calculated accoiU.Lr4@ to the existiri@ Regional Medical ProgrL-im grant 'I '3 @-ly be requestc-@l and awarded for per diem a-rid travel to the @tetit or 50% of tllc! tribal amount so derived. 'i-he awarded funds nia@ tliet-i@ be paid to the enrolled trainees as considered appropriate by the project personnel, depending on the participants' ability to provide these costs foi@ themselves and/or the willingness of their employers to 'provicle tla(@in. tlo single individual may receive per diem@or travel allowance at a rate higher than that prescribed@by the pres Orit Guidelines @.IP -fwids iiiay @not be reblidgetal, from within or without the project budget, to Increase the total wnount awarded for,15pr them and travel aboveltlie 5b' level. 2. rP@ie Council cons i(iered the I)reseiit, Guidelines regarding Ref,,ional Medical n,oC@,Lim fwidi@ of@ proi(!cts ot' loncr-teiiii post-doctoral- traini@-, at t.],e senior resident tnd post-i,esi(iorit levelz-,, particularly in the clinical sub-specialties Of' illi@)ol'tanc(., i.i-i patient iiianak-,ement in the diseases targeted by!Ref,,iohal Medica.L I-It,oi-,t,anis. As li@D been pointed out by both the Review CO'TmLitt6o anti the (council, requests for support for tr,aiiiiry.., of this kind are ippem,it@, There and nic)re frequently in Regior-al Medical. Pro,c r@ii appl@c@itior s; bE,catire of the ltici,(-,asiR(-ly critical c)t' individuals i.ii tiit?sL, but aisb Lecause cf' the drastic reduction in',NIII funding which has previously been available for this purpose. 1-nie Council @iimously @ees on the importance of maintaining the training proEr,r@ in these fields 4n the major teaching centers tlirou@out the nation. They also agree that funding throupti l@egional 'Iedical- Program would serve of these centers of clinical ive arr ments which form the part. It is recognized., however, s large enouc-@ to @@e a si-pii-ficant appropriation, would create a serious cir iii,-ippro riate@. imbalance in the i@ efforts to meet more their Val,.led Ill(J coll-T)I,eiietI@sive 1'roals. '.Dic, Couticil, therefore, .@eqLiested the iiid i)IfLI%T its Lu-i-ai-iiiiious reconn - staf C to forward to Iioth li, en@ation that ai,raii tits be ni-ade,,to -prove[(, i@ederal assistance to clinical departments gelTie in teaclair4r t the identifiable education costs (as ,centers to offse distinct from the cbs-ts-identific@ witti provision ot' patiei-it, s( tll(-% ni,-i.Ltitenance of' @clinical i,es@Ldoiacy and post-i@esidency training I-)i.,of-,raiiis;tlaat '-his ipect-i@sm be provi(i(--(i througl-i the framework of Regional f-ledical Ilroc,;rams; E#ici that fur,@ding, ovei, and above the current =t funds appropriated to Regional@Medicai Pi,oE@,yns, be sought for tl-iis purpose. AccorditT,ly, the Coluncil@recoiirnends test until such funds are added to I I the annual appropriation, the Regional. P4edical Program Guidelines for operational Uaiits 'qtider@8,bction 90)i of' '-'L'itle L@ of the PHS Act be i ne -Kls and othe e n, -@x changed to exclude @h yi nt of stip( r participant costs 'for long-term training ral level. the post-ciocto 3. The Council is ke@e aware of the potentially crippling effect on ly 'Regional Medical Pr, tnient in projects will 0 of continotis i.nves ch were initially a@j2roved Or new techniques @ -demonstration of', or trdiniric,-, in., of patient care, but provide what becoiTies an essential service to patients. '!'hey continue to believe., hoviever, that it would be unwise and indeed impossible to d volb e p a Piiiii policy arbitrarily including or excluding projects of this kind, and instead ur-e the i@S staff to work closely with ReF they develop projects, to be certain that other,,sources ,Ions, as of support for mairiltenanc@@,,e of the seivice involved be well in hand before such a -ro,ject is @itiated; and also to encow,a,-,e Regions to carefully p investl,@te every possibility of capturing ttie fees paid for the service involved, for reinvestment in the project. B. Special Actions NOHq'IIF'@AS'Pl@2@ OI[IO 1)'I,,'rIONAL @,U-Li)ICAII In response to a spocial@appeal for reconsideration of previous action on Project #7 (A Cont)ieli@nsive (Xtt-patient Stroke Rehabilitation' L@emonstration), the Council considered the additional information submitted and recommended that tlie@project be approved as' requested. jllr- oi - $118)233 02 - $E-)03 03 - $263076 12 NO@ S REGIO@IPL, ,EDICAL PROGRA:,L Th6 National Advisory Co@cil considered a request for the initiation of interim supportlto the Diabetes Detection and Education Center in Minneapolis with the understanding that (a) these funds will be ,nade available from the@Regio@n's unexpended balances.and (b) that this approval does not in any@sense indicate co@t-ment to approve the forthcoming application 'for HvT participation in the long-range basic .support of this Center. VIRGINIA RF,,CI.UNAL rkLuiCAL PROGRAI;L In regard to Project #11 @Stroke in a Sniall Rural Co ity) the Council concurred in the stLaff's',recoiTmendatior) for a waiver of the restrictions Imposed a,,-, a condition of the original approval of this project, subject to the satisfar-t@on of @IPS that the purposes of the project are being adequately achieved. WE,j @',W Yuru@ i@uiuNAL MR!DICAL rf,'OGRAM in regard to Project /110' (IATestern I-Jew York '1'umr Registry) the Council concurred with the@ireviei;i Com-nittee's recommendation for continuation I of'the project as amended. C. Recommendations for Action The Council recorded their L-@uu,tanci-idations in the format which was adopted in the previous review cycle (Appendix I). ALBANY TU,,GION.AJ, 1,9,'DICAL PROGF'Lql RM 000011 7/70.1 - Opc-r,.it@orial Suppleiii(-,ntal Approval with specific conditions. Project #7A(R) - Approval I with the conditions specified by the i'leview CoinTdttee. Pi-o@ect #7B(R) - Approval I with the conditions specified by th,@ Review Coninittee. Project #18 Non-approval II - Revision Required. 01 $36,930 -02 $36,930 03 $0 1/ All amounts are direct costs only c@ unless otherwise specified refer to a 12-mnth period. The desir@-ation 01 0.) etc. relates to the first, @,,ecorid., etc... budi.Tet periods of the subject application, not necessarily the budget periods that will actually @upplerr)entect. i4 CALTI-@).iNI.A l@.r[014Af,. i,'D-"DTC@ F'ROGRAM Prolect #56 -Approval I Project #60 -Approval I in the reduced amdnt Project #61 -Non-ap@roval I p 01 - $107, 07 02 - $117,248 03 $121 CENT.RAL NEW YORK EL, I QIOIIAL MEDICAL PROGI@ @M 00050 7/70.1 @ei-at'i onal Suppleiiion'u@ - Conditional approval. Project #15 Approval I at a reduced level with the conditions specified by the Review Co@ttee. ol - $4o o6o 02 - $50 000 03 - $53,000 COLORADO/k@IYO@IINI(7@ REGTO14AL 1,11-DICAL PfiOGMl R,4 000110 7/70.1 - Oberational @pplenierit Return for Revision. Project #13R -INon-approval II. Return for revision with the blaripicati-on requested by the Review Committee. FLORIDA 'Rl,',GIODiAu Iv@j.UAL, P-POG@M RM 00024 7/70.1 -R,@turn'for revision. Project #36 -Non-apbroval II with recommendations for revision as suggested by the Review Comdttee. GF,,ORGTA RL,'GIONI@ iv@iUAL PRODRAM it-,i oooli6 7/70.1 -Conditional approval. Projects #31 and #3Zi@ Approval in the reduced amount of $100,000 i to be used for the initiation of both projects as seen fit by the C--eorgl.a Project #33 -@@orl-a@provai I. - 01 - sioo.%boo 02 - $1003000 03 - $0 GRF,,ATER DELAIPIAFE@ VALIZY @@,GIONAL P.'F!DTCAL PROGRAM RM 00026 7/70.1 -Disapproval inapp@priate for iW funding. Project #19 -Non-approval I IIAWAII @I014AL @,EDICAL@ PROGRAD4 RM 00001 7/70.1 -10perational Supplemeit Approval Ill,oject 1121- roval I l@@oject #22- roval I 01 - $202.1@7113 02 $99,168 03 7 $108,252 'G ILLINOIS Rf,. T014AL @@U-@'I)ICAL PROGRAP4 RNI 00061 7/70.1 -@Approval with specific conditions. Pi,o,ject # 9- N,,@i-@prc)val II with the recorTr-neridations for revision - isug4-,e@ted by the Revic-w CorrurLittee. Pi,oj ect #10 - Approval I Project #11 - Appiol i Val I with ttie.conditioias specified by the Review @CoiiDnittee. I Project #12 - @pproval I l@j ect Y 1 3- @pp-ro@al 1 viitli tli(, Conditions specified by the Review Co@@tee; with second and third year funding contingent @rogress in first yc@ar to be assessed by the 11. on the basis of a progress report, continuation cation an,-l the report of the technical site visit Shield soriK-t.iriie toward the end of the first year. 01 $5873 12 02 - $661.%237 03 $341.1883 INI)IANA fLTi,GIO@14AL W,,DICAIL PR03TWI @l 00011') 7/70.1 Qpet,ational Supl)lo.,iriit Non-appi-oval Project #19 @@oti-,-i@proval I i.iiappiopriateriess' for H'VIP funding ba.sed on the Couricills -decision to defei, approval of projects I 'itig tl- clinical application of t propos iie _,enetic counselling, en(-Iiiig further, scicr-itific validation of the clinical p ses of this technique. Project #20 Noti-Eil)l)i,oval IT with the iecornrp-ndations for@ revision ui,,gested by the Review Conni:Lttee. INIIT,MMOUNTAIN FU---,GI6Nf@ @,"DICAf, llf;DGPANI RM 00015 7/70.1 -b ,pei,,q@ional Supplenient - Return for Revision Project #27 -l@ori-app,,oval IT the i,cccirmet-iciations for revision suggested by the llc-,vicw Coii-arLittee. 16 KAIISAS REGIONAL MEDICAL@PROGRAM RM ()0002 7/70.1 -.Qpera@ional Supplerrent Return for Revision Project #39- Non-apip'roval II with the recommendations for revision 'ted by the !review Gomd-ttee. sugges LOUISIANA REGIO@IALI @-F,,DI@AL PROGRA!,L RAI 00033 '7/70.1 pi,o4al with speciCie conditions. - Prolect # 8- @Non-a@proval II 'Witii the recommendations for revision e@ted by the 'i@eview Co@ttee. Pro,ject # 9- A@ ppi-oval I in a re(lu(!ed airiount and with the conditions specified by the 13t-@view Coii@ttee. ll.t-oj ect #10 - Approval I Project 11_ @@@roval II ,Project #12 - Noti-approval. II with the recommendations for revision Sur Oted by the Review Co@ttee. .ge Project #13 - @PP]70val II ol $147,@32 On $77,2112 03 $79,342 ,NIA.RYLPd4D REGIONAL DI@DICAL PROGRAfl fQ4 00044 7/70.1 7/76.2 - Operational Supplewnts Approval with specific conditions. Projects #25 and #26 Approva-t I with both projects to be combined at a reduced amount and with the conditions specified by the Review Co@ttee. .Project #2'7- i)tov@ alI " p Project #,)8- Noti-ap!pT,ova-L II with the reco,,niiendations for revision su@,7Ve4ted bit the l@eview Conrnittee. Project #L)q- Noii-approva'L I Project 7/3-0- @0il-a@ t@oval. I p 01 - $9419,,@5 02 $11111 31175 03 $145,975 DU4PIiIS REGIufqAb "LW.LUPt Pl@OG-,@Ni RM 00051 7/70.1 ,2era@ioi-lal -@ippleiient-- Disapproval. Inappropriate for RMP funding. Project #'@'7 Nt,)l I-Zt@i T. . ']lie C,otuicil wi,,@ in a@reement vritli the Review CoriiiLittee iii ri,..)ri-appi,oval for the PePip@ral Vasculai, Clinic Pi@oject. 'Itiey wish, however, 17 NU.-],TPIITS f@IGIONAL '@'U,-DICAtL (Cot.i,i,). L to be certain that tiiE,, project personnel and the Mc@,'riphis@ MT under-,tir.:i that the recommendation in no way reflects a (II: a@emnt with the inherit s(i.rvice@ value of the Clinic nor sue-,@sts lack of confidence in the st@iff and Institution. The action does not preclude i@,sub@ssion-of a request for H@T fqnding@for the continuing education aspects of this pro ect@at such ti@ as these are niore thoroughly j p@anr,ed@and ready to be irrplemnted. Project #28 No@n-app@oval I PLTl@OPOLIrAN 14ASI [Tf4(' "[ON @ t). C. RL,C@IONAL i%F,,DICAL PROCPAM ff@l 00031 7/70.1 - Operational Supplenient - Approval with specific conditions.- Project #30 - Noll-approval I Pi,oJect #37 - Ap ilov@'-I at the reduced level and with the lp conditions specified by the Peview Cormiittee. 01 - $381117, 02 $1103()-18 03 $44,928 MICHIGAN REGIONAL NU,,t)ICAL@@ PR(@RAfl RM 00053 7/70.1 O@brati@nal Supple@nt Approval with specific conditions. Project #16P-, Alp I p Project #27 A I with the conditions specified by the Review 0 III concurring with all of the recommendations of the ileview Coiiuidttee . the Council urged the helps staff to work closely in the development of this project with the hope that it will come closer to a demnstration of comprehensive care as promised by its title, than it would presently appear to be. Project #28 - N proval,II with the recommendations for revision s t'p-a by the Review-Committee. 01 - $550,90 OL@ - $)1514,5711 03 $477,459 MISSISSIPPI U@IONAL IU-DICAL PliOGFiANT RM 00057 7/70.1 - C)berational Sul)plemnt Approval with specific conditions. Project #21'i - A@pprova@l in the reduced aTwunt for 18-months with the conditions specified by the Review Committee and with the understanciirif-, that this will represent the termination o@ RNT- of this activity. I i - i 18 DUSSIS,")IPPI REGIONAL KF-,'OTCAL PROC7,@,f, (('OfFP) Project HiJ -l@PI)I@ValI oti-app Project //14 -NI, roval II with ttie recomenciat.loti thettlie Fie ion be requested to r-ocotisider their program in the li@it of the 14ational i@il(lelities for R,@) participation in @oTrpre @iensive kidney disease p roEr@-@,-. Council further recoimierided that the Region be afforded direct help by the staff of R@-IPS in nursing their decision in this, regard and in planning a revision if such is to be proposed. 01 $213,le_o 0-@' - $1-95,946 03 - $39,455 'Cil @,ITSF,OtJ-TII l@,, OTIAL f@P',:DTCIL PfiOGFWI frlvl 00009 7/70.1 and 71/7Q.2 - Operatiot-i,@l Supplei@nt Approval with specific conditions. Project #60 -@4oii-ap roval II Prt-)j ect #61 -Non-ap@-roval II. Altlic)ugji the Cow-icil agreed with the Review CormLittee that these two projects, as presented, are wqacceptable for !regional D4edical Programs support, they recalled the i-ecommi-idations of the recent indepth s lisit to Plol@',T @-id sugE,@,sted that witli staff help ite v @m 8oth MTS and t4o"@III) these "out@actill projects could@be developed into important components of the Program. Project #62 @ppro@al I in a 1,(3duced ainout-it and with the conditions 'eview CoiirrLittee. ppecif ed by the li Project #63 oii-aT)Iproval II - The Council i,eco@rids that this project be irite@,ileci into the r-,egion's overall continuing 'education effort iii the preparation of the Re-ion's @iti.Lver@sary Reviow application. ol $330 2)13 02 - $36,984 03 $-9,165 @l()LJNf-PAIN N.'@"dIONAL MI-,DICtU, I'IiOGP-,AM R"I 00032 7/7LJ.-L -@er-a-,lonai @upp.l.eiwnt Approval Pro,ject #12 -pro@al I Project #13 -Appproval I $197',8011 01 $184 7( O,-) $1913117 03 M',,'W @,FIXICO @-' IONAL ML,DICAL PliOCil@M ]:Ull ',)00314 '(/70.1 -Opei@a@ioiiai ",I)prova.i ,ii-cli specific conditions. Project #13 -Nori-approval. TI 19 N-n,,l MEXICO REGIOINAL@PE-DIOAL PROGFW i (COiT,') -Project #14 - Appilova-I I in the l@'dLICed unount ar-d with tlie conditions specified by the Review Coiiriiittee. Project #15 - Approval I with the conditions specified by the Review 'Qommittee. 01 - $92.1106 o@ - $99,900 03 $101,765 )'L(,'Al, I'ROGPvU-.l NI@,W Y013i@ %Ifl"llliomLlll IONAL, @U"L 11,4 00058 '(/70 -.1 -tnd 7/70 C)r)el@atl.otial Supplernents Approval with specific conditions.' @-oject #16 Non-app,@val II with the recormiieii@lations for revision su.. .@ste @ d by the lieview Coii3nittee and with the advice Icth@ Region (if@tei, f)-,rtliei, planning for 9--.,IP @T e th, participation in lddriey disease services in the New York @'vIe opolitan a-i,ea until. they receive the 1--lational !licy ideliries which are in preparation. PO .Pro,ject #17 Abbrova-1 I. rBie Council based its recommendation on the I f the site visit team which -had visited the the a(ivice of the Review Co@ttee. Pr@lect #18 - I val I Project #19 - o,,, $49'i 65 03 $3503 000 01 $1176 '(i 3.) NOI'i'lll (ARC)LTNA fL',',GIONAL ML-DICAL l'ROGli.M4 RM 00006 7/70. 1 - Operational Supi).Lerik--tit.- Approval with specific" conditions. Project #31i - Approval I Pro,lect #26 - NO Action Tak-en. @o)ite visit required. 01 - $89,90@ ol,)- - $62 3550 03 @42 3306 NOR.EI DA-KCYPA PJ,"ClllONAL D.'a,-,DICAL PROC,'IIAM Rl%l 00060 7/70.1 - Aerations]. Approval with specific conditions. Project #5 Ap rov-al@ I i,ova Altli(-)tit,l -encral agreemnt Pi,oj ect #6 App l@ . I i Couilic-il was in C,- with the, r,,evi(-,w CoitunLt-,tee concerning the @,@hortcomin-.s of this pi-k)ject, It ttielt-, opinion, based on first-liand 1,21(3ille(it76 Of' .1.11',tL'L,Lltioia and pet,sorLie involved in the project aiid on tfae)ir- experience in site visiting this L DAKOTA REGIOT@ @@ICAL PROGRAI@I (CO14T) Region bijal of this project is hat the appr essntial for further development of the Dlorth ,e I Dakota Regional @,ledical Programs. In reco@ndi@- app@val@ Council strongly urged @TS staff to work 3 wit@ the Region and with personnel involved in this project @o correct soft of @he deficiencies and get it i off,to a good start. Project #7 Ap@roval@l for essentially the same reasons given above. 'ITie@ Coun@cil believes that the' j-npleinentatioti of this project is essentd,@ to regional development and s @. -@ _,sted that it be approved at $35,000 (dco) for one year Only with continued support contingent upon revision of@tlie-pi@oject with staff assistance and reapplication 16ie Council. to Project #8 Non approval I Project #9 Ap rovai'll 01 $115,3@@l 02 $79,772 03 $79,549 NORrS.IM@"ST OIIIO Pi@MTbiqAL t,,uEDT(@'AL Pf,'OGiWI R@l 00063 71'TO-1 and 7/7Q.2 Opei@atiotial SuppleTwnts Approval with specific conditions. Project #01-S al I .Froject 9 - I? II with the recommendations for revision Su ttic--, l@eview Corii-aittee. Project #14 - Ap i the conditions specified by the -Review ugmra tee for one year only. 'Project #15 - Abpi,oval I. Altliotidi the Council recognized this as abothe@ of the "Council-for, Continuing l@ucation" projects which have been ,-,Ltbtnitteci by the Ohio State Region and action upon wl,,iicii has been deferred pending the outcome of the initially funded one. The Council accepted the advice of the site visitors that the oc@ is of ci,itical importance to the Northiiest Ohio @l @locil.cal. Pi,ogi-ain Euid probably has an excellent I'@O@ioi-ia chance@of success wider tlic- leadership proposed. be incorporated with pi@6,ject #111. Project #16 - to k@ject VIT- - Approval iii the reduced wrk)wit and with the conditions s; ecified by the lieview Co@t-ttee. p @e Council furtliei-- considered tliE, findings of the site visit tealTi this !ie@ion as a whole; iL. s 0 @'lizatiori, a@iiiiiistr,at,!.on, atii -olaris. It is their recorm)endation that the iiegion be urged to seek stronger leadership but the (.owici.1 ai.7,reed that any specific re- cOmpndation personnel would be inappropriate. 21, 4AL' rvE, DICAL PRO NO-7il R@nE--,T OIIIO PF!, IO! CPVV,,,l (CONRP) rD ,value of ,in assessment visit &,3 iecormended by I the visitors was qLlt@Stio'ned since it would probably ,,lo noImore than t,e-id(@ntify the pr)blem. Council suggested that @)c.,r@ii-al)s direct and .,L'@quent assistance from ffT staff mad consultants would be more helpful than further investigations of the situation. oi silic 02 - $70,525@ 03 $21 250 @30 OIIIO STAIII," @,'GlOt4AL LOGICAL PROGRAP@L R%l 00022 7/70.1 and 7/7'0.2 - Opei@atlotial Rei-iewal T-id Su2plemei-it Ai@proval with specific conditions. Project #lR A ve approval I at tli( i,e(.Iuced le 1 and with the conditions specified by ttit@ 1-@eview Comiiittee reject #8R -A@,pproval I in the t,edLiced al-nourit aid with the conditions Spec '(--,vic@w Committee. ified by 1,L Project 1122 -)p-iov@l I I)i@oject vias considered by the Council in deferred at that previous review cycle and action was t@ine). Pr-oJect #211 -Non-api@roval II with the reconmndations for revision @sted by @he iieview Co@ttee. 01 $714 3675 O" $778,73,1 03 $847,9144 fiIO VAILJIY RL,:GIOIIAL P'@-Lulu, -1 OOOIIQ 7/7 -10pera@ion,,il Suppleirerit Approval with specific conditions. 0.1 Project #12 - approval I in the reduced amount i@ecornnien(ied by the @'Apert@ technical reviewers. Project #13 -@pproval I. 'Po be funded only if riot @d by other Fieder@al resources. Pro,lect //III -Approval IT Project //15 -Approvdl I Project #16 -@on-approvql II with the recommendations for revision as su,-@,6sted by the t@cview Cormiittee. Pro,ject #17 -@ori-a@)px,ovil TI w'-,tli the recommendations for -revision ,@-s@ed I)y ttie lieViOW COITnlittee. Project #18 -14on-approvil I 01 -.$273,')116 02 $@@96 215 03 $3@7,657 22 OFIJ-"GON P@@:(I.'[O@4AL, P"H" DI'CAL PRCXIM @l 0001,"' 7/70.1 Operzitional A@)pt,ovai Project #1,"J@ Approval Pro,ject #16 - API)Ilov,al I 01 - $59,375 02 $283 03 $14 829 843 PLJT.@'@A-) RICO IU!rIO@'AL MFDICAL PliXMvi WI i3m ooo65 7/70.1 -@OL)er@tionai- ")upp.Lettit@rit Approval "th specific conditions. t # 9 -4@)I)Ilc)val T 4Lnthe reduced amunt aricl'with the conditions specff ied b@y the Peview Co@L-tee. Project #11 -A7 L ,pproval I with the conditions specified by the Review@ComrLttee. .01 $320,936 O-) $;)273436 03 $233,636 SOUill CjkaOLINA Pd., ,('IONAL. i@ED ICAL 'operational Suppl.eitiei-it @4on-approval. @l 00035 7/70.1 Pm,lect #35 -Npn-approval 11 with the recommendations for revision SP91gested' by the -,review Coi@5 ttee. Project #36 -14,o action t@ceii. Ojite visit is indicated. ect #37 al I Proi - Npri-ap6l rov S,, J,-, Q I R N N.4 IONAL ',,U:,@)TCAI@ rT,,oGiiu%i 13M 00059 'fi"70.1 6per,a@ioi@ ",u ",at, Approval with specific conditions. Project 1120- 1,4()ri-approval I Project #21- Approval I in the reduced amurit to reflect the newly adopted policy on training project participants. Pr,oject #2.'-)- tion-approva--L T - Pqo, ii-app.@val I - 149p-appi-oval II with the recomiL-ndations for revision st@ .-6d by the lieview CoimLittee. , ,est, Project - Non-app@vai II. TTie Council was in general agreeme@. with the 13evi(@w Conziiittee regarding the specifics of the pr"oject@but believ(@.ttiat further developmnt of this p abject along with //-@ll is in the bt-..st interest of the the Re-gioti and has i@e(Itiested that the j@T-S staff offer assistance 'co tli@2 in this road. Pr(-),Ject #26 - App@va,i I 01 $9,@, 31311@ 02 @,7t9.,915 03 $83,294 23 TF,-XAS REGIONAL IMED@CAL PIkOGRAr4 R4'ODOO7 7/70.1 - operational Supplenient Approval with specific conditions. proval I contingent upon the satisfaction of a Project #8R A@' t@chnical site visit team re@i@, four specific p ints! set forth by the Review'Corrnnittee. Project #14R pi,oval I with conditions specified by the Review Corrrnitt6e. Project #115R A io@al I ,, PP Project #Ilb @4pri-@ippr-oval I Project #Llg Npr-i-,.ip'roval I p 01 - $lt6o.6i, O" - $296,595 03 - $2)10, ,to -386 -.@i I-STA'I'T,, fiEGIO'@IAL; M[I)ICPJ, P130GRAP1 @i ooo62 7/70.1 - bl)ora@ioi-nl SLtpl)letiiL,,rit Appi-oval Project #9 - Ap'pi,ovai I in a r-e@ILIceci amount and with the conditions specified by the tieview Conanittee. 01 $105,@00 01 $85,6oo 03 - $63,000 Vl'-@GINIA RLiGT.OlqAL rlUGMl @operat'iona -it -i specific conditions. fi%i ooo49 7/70.1 1 Siipl)leinet - Approval witl Prb,lect #10 Appi@oval I with th(--, conditions specified by the Review Coiiynittee. In discussing this project the dotjiicii wishe(i to stress the iWortance of the condition for approval of' this project ECI(I urges great care on the ult or the staff' iii a(-Ijusti.rig, the second and third ts of' support by utilizin,-.patient revenues y,(--ar amoun to offset costs of the project. 01 $268,5 52 of'-, $1180 479* 03 $533,504* 'fo be negotiated downward NT,,14 YORI@ RF,,GIONAL @U!I)I'CAI, Ph()Gll*l 'Di 00013 7/70.1 - 10pera@lori-ii Stjpi)ictiient - Approval with specific conditions. Project #15 - Approval Iin the t,o(luced .uTio-wit aild with the conditions spt--Clfied. 1-@oj 0 c t#16 -4@I)r@ov@l Tin the i,(@duc(-,ci ani(3Ltrnts iuid with the conditions ecified by the I-',oview Con@ttee. Council expressed its ip willi@iess to allow the P,(--gioti to increase the funding 24 WES@ NEW YORK RFGIONAL MEDICAL PROGRPJ4 (COI@) of this project to a maximum of $100,000, providing such a level of funding would be required to maintain this valuable regional -resota,ce. Project #17 Noia-approva:l I 01 - $350,000 02 - $3,@03 000 03 $3503 000 WESTEFJL PENNSYLVANIA RI,7,GIONAL @'ff,,DTCAI, Pf'tOGRAfl RM 000111 7/70.1 - Operational Suppleiiient - Approval Project #9 - Approval I 01 $43,911 02 -,$li4 820 $46.,995 03 WISCO14SItl RE:GIONAL NUMICAL PFMIINL R4 00037 7/70.1 and 7/70.2 - Operational Supplenient Approval with specific conditions. Project #13A (R) - Approval II Project #lbA - Approval I Project #lbB -,Non-approval I Project #lbI -,Non-approval I Project #16K - 14on-approval I Project #19 Nori-approval I. Council based this recommendation on the findings of a collateral review of the project. -by the staff of Matei@nal and Child Health Service, last which was requested at the suggestion of the Review Corm'ttee. Project #20 Approval I @ject #21 Non-appi-oval I Project #2'-3 Approval I @,oj ect 72 3-- Approval I in tlif-, reduced amount and with'the conditions- specified by the Pieview Conrnittee. 01 $292 3815 op - $167,807 03 - $172,395 26 ,I t,l )C, I'@ Li IC, Itc) t,l ](7, r@v'i-cw cc)!! r ri I t ,lb.cYltiical-ly E,,cjui-id a,-)d Capably di.),oc'L@cd T@easiblc-., uiidci- ec:,if'iecl@coiid-l.tiori@-I Un,,i,-)I,)i,ov,-il)lc? on tectiri-ical'. c;Lc i i i trick IN,(2vici-I to tll(-, I - A(-l cl -1 t. a ()i j,, i 1. 11 - No TT. I-lo actic)ii taiccii l@t-,c,ct Ncc@d 06ut-ic-..@i'L (Oi-i Ap@)-l.ic@itioi-i,@') Apprc),,,, tl w-@ith spccj.f'.i(! RetLIl'i-I fOl' A(Ivl.-,o@l \, Cc)utic,!.l i,c) Aii!tii ti-i Al)l)i,ov,-O. w.itli spcc-ific'. by til(@ ol, R@t,lit,ii @-)I, f'LU Ill.! I 1'r 27 NA9.TO,'!Ar, 1,F)@rT@013Y IMIJ,,!( 01 i EL J.0"4.U7j -Ti -7) t UPL Bl-'J,34NAN, Michael ii., M.D. (72) DIII'Lli@4, Clark li., M.D. (72) @sident, r-lichiCa'n Cancer Foundation Consultant in @,.eurology 4811 Jolui I', Street' Plivo Clinic Detroit, Michi.,an 14820@ Rochester, Minnesota 55902 Professor OGDF24, P/Lr,. C. Robert (70) Wayne State University President and General Counsel North Coast Life Insurmce Co,,@. any CANNOPI, Bland lq., Ill. D. 1(73) Spokane, llashiiif,,ton 99201 910 -4,qdison Avenue@ Mcmpliis, Tennessee @il 38103 PEILLEGRINI-0, id D., M.D. (70) Vicc- I)resident for the ficaltl-i Division of' I uros igel-y! Sciences and Dirc-ctor of the Center University of T(-@nnessee Pollege State University of IJew York of @'.Icdicine- Stony Brool@, l@i',@w York 11790 CROSBY, 1-@',di-iin L., M.D. @71) Porj%lk, Alfred T4., M.D. (70) Executive 'Vice @-es'ident'and Director 'Reeioiial Director ATirrican liost)ital ilfsz)ci@tion States P,,@.IP Chicago., 'Illinois 160611@ 525 I-lest Jefferson Street Boise, Idmlio 83702 D--BAITY, I-Lichael E.,, L@l. D. ( 74) Resident and Ciiiefl '-',x 'tive Officer Ravil, i@ssell B., P.I.D. (73) ecu Bavlor ColleCe of .It@cilcin 240 I-.7est 41st 'treet Houston TE-,xas 770@5 Erie, Pennsylvania 16508 Professoi, and Chaiii,,Il@l Vice Spealter of the Ifouse Depc,u,tm,ant of Surf,-ellY of De@egates, k",!A College of P-L-dicinei SILDII\Tlllljr@TZ 7%lack I., M.D. (70) FVEIITST, Bi,uce W., @l. D. (71) State liealtli Coi@'ssioner Chief of Pcdiatricsl State D,--part.,-,i@rit of i-iealth Green Clinic I Ricii,-,.oiidl Vir:-inia 232'Lg @ton_, Louisiana - -@1270 -rf@alill.1, Mr. Curtis (71) fulf, Wil.l.i,,:)iri R., M.D. (7@) Director, Perisioi-i and Irisu-ra--ice Board of ConiTLissiorie.TIS United FiLibber 3 IC, -1-ii-noleLn. Cor. County of Allee.,Jierv and Plastic I-lorl-:ers of Ark,-.-ica 101 Courtilou,-,e Akron, Ohio 443o8 Pittsburg!-i, Penrisylv"-L'Iia @115219 - I-ricKOFIF, Mrs. Florence R. (72) McrIlm,@N., Al.exaiidei,', M., @li. D. (73) 2113 C,,)ri,Eil.itos 't@,oad nnory University Cli@@n c Watsonville, California 95076 13U'5 Cliftc)ii P%oad, lq.E. - Atlanta, Georgia -'O@22 @r. Vc.@rnoii E. 'WI.Isori and 5600 Rocl@ville 3 2OF,52 CE AT aff NATIOliAL ADV-I@RY COIR4CTT, iu_.y 28-29, 1970 @S STAFri' ATIENDING Miss Rhoda Abr Dr. Marion E. Leach Mr. H. Farle BelLie 1,4,r. Gregory Lewis Dr. Edward T. Bi ' uis@ Mr. Ray Maddox 0 Mr. J. Edgar CaswTll Miss Elsa Nielson Dr. Donald R. Ch@wick@ Mr. Roland Peterson @Ir. Cleveland R.@Chambliss @s. Martha L. Phillips Mr. Clyde Couc@ Miss Leap Resnick Dr. Sam Fox, III Dir. Donald Riedesel Mr. Edward Friedlander, i%lrs. Jessie Salazar Mr. Sam 0. "Ti@, r' Mrs. Sarah Silsbee @,lr. Charles Hilsen-PoCh' Dr. i@@t Sloan @liss Dona Houseal ilqr. James S@th r,lr. Frank Ichniowlski Dar, Spain Dr. Anthon Koma@ff Mr. Lee Teets y N@s. Lorraine @,tle @ancis 'Van Hee, Jr. Mr. John M. Korn,' Jr. Mr. Lee Van Winkle Mr. Frank Zizlavsky OTHERS ATTEIIL)i.Nu Dr. -Maurice Bend6i7, OS@- Dr. J. ff. U. Brown @ Dr. John Cashman CIIS,, ILONff IA 14r. J@s Dunlop, A.D.@Little., Inc. Miss Sylvia KesirW-r, CIIS., ESMIA Dr. Richard @vinson., Vetei,aris A@t-iisti-ation @Vendall @lad@y N@HSR&D I-L9@ULA 14rs. Sylvia Payi@r, NCI,, NIH iNh-. ,lo L@cke@,, BIUI@.:'mr NIII i 11 3 a,. T. M. "lalega NIAMD, NIH IX-. Williani Zukel, NII&TI3 NIII