DEPi%RT,'IFNT OF li-EAI,T-I., EL@UCI@TION AND WEI,F!-,RE C P ,EALTI-T, ST 11,VICE PUBLI National Adv4-sory Council on Regional Medical Programs Minutes of the Twenty-fiftli Meeting 2/ November 9-10, 1971 The National Advisory Council on Regional Medical Programs conveiied for its @,enty-f if th T,,-,@etiiig at 8:30 a.Li. on Tuesday, 'Liovc-.,.nber 9, 19 7 1, in Conference room G/11 of the Parklai-,n Building, Rocl-,ville, Maryland. Dr. Harold Director, Regional Medical Programs Service presided over the meeting. The Council Members present were: Dr. Blaiid W. Cannon Mr. Sov-all 0. Milliken Dr. Michael E. DeBakey Dr. John P. Merrill Dr. Bruce W. Everist Dr. Alton Ochsner Mr. Harold H. Hines Dr. Russell B. Roth Dr. Anthony L. Koinaroff Dr. George E. Schreiner Dr. Alexander M. l@IcPhedran Dr. Benjamin W. Watkins Mrs. Audrey 11. Mars Mrs. Florence R. I-Jyckoff Dr. Clark H. Millikan Dr. Marc J. Musser Dr. Roth and Dr. Musser were present on-Novc-.mber 9, only. Dr. DeBakey wa'spresent on November 10, only. Dr. Brennan was present beginning on the afternoon of November 9. A listing of R,@ staff members, and others attending is appended. 1. CALL TO ORDER AND OPENING RE@MARKS The meeting was called to order at 8:30 a.m. on November 9 by Dr.. Harold Margulies. Dr. Margulies called attention to the "Conflict of Interest" statement in the Council books. He then introduced two new Council members, Mrs. Audrey M. Mars and Mr. C. Robert Ogden, who were attending their first Council meeting. Dr. Margulies then introduced Dr. Vernon E. Wilson,.Adviin istrator, Health Services and Mental Health Administration. 1/rroceediiigs of meetings are restricted unless cleared by the Office of the Administrator, ESVJIA. The restriction relates to all material sub- mitted for discussion at the meetings, the supplemental material, and all other official documents, including the agenda. 2/For the record, it is noted that members absent themselves from the meeting when the Council is discussing applications: (a) from their 4,i T,)!@ht only when ttie applicat@-icii -@-s under inciiviu'uai d@A.Scussi-oa. 2 REI@ By- DR. V F,- P-hl ON E. WILSON The @new organizational structure for HSIRIA has bee ai).Dle the@ r Under this arrangements, the 15 r R: ograms@wil Depa tment. i1 be under th Pdministrators. grouped under four Deputy diopment Mr. Oetild Riso,. De uty Administrator for Dcv p @ediate Dep4ty will be Dr. Jack Brown. The Deputy Administrator for Development will be responsible for, to RM cha ams. In addition 'PS, other pro ams nge agent type progr _,. .1, I grouped under the Deputy Adm' istrator for Deve!6 meht indlud 1: in Comprehensive Health Planning-, (12) the National Center for Ilea Servitet Researdh and Development; (3) the Hili-Bdtt6n Hospital Construction Program; and (4) the Health liaint an c Otganizat on Service. turned to the subje6t of improv g the use,of @Dr. Wilson next .groups. About two thousand people.provided advice to IISIIHA th Councils, Committees or consulting"appointments. in @rder@to the utilization of this re6evoir of talent, HSI is@trying to a "skills inventory." Staff is now developing a short qu6sti designed to catalogue the skills interests an availability OL Viso bers and consultants. If IIS @is able@to est ry group mem the prospective skills inventory, it will be able to utilizem effectively the resevoir of-consultative advice available to@ crash programs" materialize. cularly as new Next; Dr. Wilson discussed his participation in a White Houses the applications of technology. The study is under the 4iiecti-on or, the Federal Council on Science and Technology,@ and it involves S different panel6. These groups are 'cliarged@wi h etermining. th fields in which technology can now make the greatest economic c butions. Each panel deals with a servic6 area or indu.tl@ i h@ Uses much labor and little automation. Dr. Wilson, chairs a twdlve-man panel on Health Servides. Th consists of outstanding individuals of National stature in6lud among others, representatives of the American ea*cai Asso6iat6 the V6terans Administratiorf, the Departments of Transportation Defense, etc. It is expected that each of the Personal serv entea fields will make its @ case for the a antap,,es of.iec Investments in its@par ticular area. The final report will@ ob identify@those fields in which technological Movements will the greatest economic impact. It will most likely identify tI no fields which can make the best use of investments in tech 169 t4r @than how technology can be applied in each fi i4 health, ho s struction, etc. 3 Personal service oriented activities tend to become self-defeating un- less provided with rtain i@-@-@oulit 'of - technological assistance. At present, 20 pc@rceiiL--:,jL the location is underserved in relation to health services and promised improvcTaent cannot be made without appropriate technological as--istance.. There are a great many places, Dr. Wilson stated, x@,here without at all interferin.- with the position of the pro- fessioiia).-I>atient interface, we can still do things a lot more effee- tinely. Dr. Wilson indicated that he had some "considerable feeling it that in the future there will be a subst@i-iitial investment in the field of technological improvement. He asked the Council to keep this in mind when considering opportunities for sponsoring new activities through IU-!P. III. REIIAPi.,,S BY -IIR. GEPALD R. RISO Mr. Ris6 indicated'th-@t he had.oi-tly been with HSHHA for a few weeks. He.outlined a number of matters, however, which are expected to command his special attention during the next several months. These include (1) improving HSI,-U-ILA's ability to identify health care needs; (2) de- veldpillc,, better relationships among research activities within HS@; (3) identifying health delivery practices of significant value; (4) pro- moting the introduction and practical application of such practices; and (5) promoting relationships between HS@IIIA programs. Very great interer,: -ri HMOs has developed as A result of the Depattment's efforts in this A very practical and pragmatic approach will be taken with respect to providing assistance and stimulating MO develop- ment. Among other things,, an attempt is being made to correct several widely held misconceptions about.1-ki0s. First, there is and will be no element of.compulsion in tWi.0s. Second, I-.@10s are not intended to be a substitute for health insurance, and third, the responsibilities of Inios will not actually be as broad as'the term "health maintenance" would seem to imply. While the Government does not-have the ability to respond to every ex- pression of interest in developing an H!.io, I-ISIDIA is in a position to provide modest financial assistance to so,-,ic INO developers. It is prd- pared to provide.-.1@@'..Oce to developers concerning (1) whether they should proceed further .,-' Reevaluate what they already have done, or (3) desist from their efforts to organize an HMO. The Department does not contemplate insuring,continued operation of all W40s. Some are expected to fail and we will learn from their experiences. t, 4 YI)Ilon off those groups which it is the Departiiient's intentions to s should not be encouraged) to encourage those which show truly good , and to improve tilose which appear to have good prospects, propects At the present stages of ILio develop- but marginal performance. f IDols currently in the plan- ment, it is expected that a number o ning and development stage will reacli a decision within the next six months on whether or not to proceed further. The initial grants and contracts for planning and developing M,',Os were made between I-lay and July 1971. A second round of applications was submitted in July. Awards on the basis of these applications are expected to be made before the end of the calendar year. Two more application cycles are planned prior to the close of the fiscal year in June 1973. The original set of grants and contracts made between Ilay and July -of this year are currently being examined in relation to geographic spread and types of sponsorship, and this will have some effect on the future pattern of awards. The average planning grant for ID10s has been $100,000 to $150,000. In the future some more modest grants in the neighborhood of $25,000 to $50,000 will be made to prospective @,10 developers to explore whether they should proceed further. Some of these stialler-grants will probably go to rural areas. At the close of his presentation, 11r. Riso made the following points in response to questions raised by various members of the Council: 1. The definition of the quality of care within the confines of the 1010s is the responsibility of the I:U%IP Program. '2. HSMHA has not developed an "ABC of eligibility" which might be a good idea, but, if there are churches or other small groups which would lilce to be involved in IL-MO and have questions-don- cerning their eligibility, they should contact the IDIO program Director within the appropriate HE@1-1 Regional Office. 3. Funding levels for the November IV-10 review cycle will be modest and the magnitude of activity in the February and June review will be determined by legislation, and the geographic and spon- sorship pattern that evolves from parlier awards. IV. ANNOUNCE'r',ENTS A. @p Ililur-an Dr. Margulies introduced Dr. Edward J. Hinman, the new Director of the Division of Professional and Technical Development, P,,TS. 5 Dr. Hinman has had a very distinguished career, most strikingly as Director of the Public Ilealth Service Hospital in Balt:hpore.. B. Loss of Dr. Klieger Dr. Margulies next announced the sudden passing of Dr. Phillip Klieger,'Niho for many years has been part of the Regional Medical Programs Service. Dr. Klieger most recently served as Chief.-of the Office of Committee and Council Affairs. The condolence of- RKIPS has been expressed to Dr. Kliegeris widow and his family. Responsibility for Committee and Council Affairs will now be picked up by Mr. Kenneth Baum. V. CONFIRMATION OF FUTURE 1,P-'ETING DATES The Council reaffirmed the following dates for future meetings February 8-9, 1972 May 9-10, 1972 Council then set the following subsequent meeting date,. August 15-16, 1972 For the information of the Council, Dr. Margulies indicated that con sideration was being given to the idea of reducing the number of Council meetings to 3 a year, rather than 4. VI. CONSIDERATION OF MINUTES OF THE AUGUST 3-47, 1971, MEETING The Council considered and approved the minutes of the August 3-4, 1972 meeting. VII. REPORT BY DR. MARGULIES A. RMP National Meeting in January, 9@72 There will be a National Meeting of Coordinators in St. Louis on January 17-20, 1972. Members of the Council will be invited to attend. The Conference will cover a number of topics about which there is a Iligh level of interest such as: Area Health Education Centers, Health Maintenance Organizations and improved utilization of health manpower. 6 B. @IPS Reor--@iiLzatioil The-'Rl.,PS reorganization previously announced to the Council has been put j-nto'effect and the geographic operations desks have in fact, been put into action. C. Status of Revised @-TS Re;,ulations RMPS has for some time been developing an updating of the Regula- tions for the program. So!,ic new material has been prepared in draft by the Office of the General Counsel. The Council will have the opportunity to study and make recommendations on any proposed new Regulations. Among other things, the Regulations being developed will deal with some 3.ssues which have been troublesome, particularly the proper relationships between the grantee agency, Regional A v sory roup, Coordinator and core staff. These have now been defined-with some clarity, but as with all regulations.tliere will remain room for in- terpretation which is going to be the responsibility over time of the Council. D. Participation of Minorities and-l-lomeri on Advis rou s The Department has expressed a desire to increase the participa- tion of women on advisory groups and it is anticipated that the two ladies presently on the Council will be joined by others as the present vacancies are filled. Some reflection of the RMPS's hope to create a better balance in terms of minority membership and the balance between the sexes can be seen in the present make-up of the Review Committee. This group is now at full strength and new members include: Miss Dorothy E. Anderson, Assistant Coordinator, Area V, California Dr. Gladys Ancrun,, Executive Directo Community Health toard r, Seattle Mr. William J. Hil-@on,-Director, Illinois State Scholarship Co.-amissioit, Chicago Dr. William G. Thui-man, Professor and Cbairma n, Department of Pediatrics, University of Virginia, Cliarlottsville, Virginia Mr. Robert E. Toomey, Director, Greenville Hospital System, Greenville, South Carolina 7 E. Current Status of Arccaa Health Edtir-ation'Center There appear to be three possible developments with respect to are-a health education centers: (I.) that there will be n legi 0 s- lation; (2) that the primary responsibility for AHECs will be placed in the National Institutes of Illealth: or (3) that the primary responsibility for AHECs will be placed in RMPS.. The Regional Medical Program legJ.sl.ation contains all of the necessary authority for AIIEC development. Regardless of the legislative outcome, it is quite clear that [oil) will be in- volved with AIIECs and in any event, will be working closely with the Bureau of Health Manpower Education at NIH, and the Veterans Administration* There appear to be two concepts of Area Health Education Centers: (1) an expansion of the activity revolving around a university health science center, and (2) a community based activity pro- viding service with educational activities playing an essential but not decimating role. The second-model in which the certifi- catei diploma or degree is subordinate to the service performed has the best chance of becoming a viable and effective i.nstitu-, tion. Dr. Endicott, Director of the Bureau Health Manpower Education at NIII, does not believe that AHECs should be a nere extens on of the university health science center or a satellite thereof. R14PS and NIH will be working on AL-IEC in any event, and there is no significant difference in their respective goals. F. Status of Section 907 Section 907 is that part of public law 91-515 which requires RMPS to develop a list of hospitals that can provide the most recent advances in the treatment of heart disease, cancer, stroke, an kidney disease. The Guidelines for heart disease, cancer and stroke have been produced under contract previously. These either provide or serve as a basis for developing the appropriate institutional criteria. In addition, a small group is now working on criteria for kidney disease. The most important recent develop- ment with respect to section 907 is the completion of a contract with the Joint C @41)4-ssion on Accreditation to Produce &@series.of reports that! will enable physicians or the public to have a wide 'ive help. range of choice on where they rece G. Review oL Kidn ProEosals In the past kidney projects have been handled in a manner different from the rest of Re@ional Medical Programs. In the future, they 8 somewhat will continue to be handled separately but, in the modified manner described bel.otq: 1. -Kidney projects will be brought before the Review Commit- tee and Council having had a technical review 2. Kidney projects will also be rev'Lc@@,ed with respect to how they-relate to the total program of the sponsoring RMP. 3. Kidne projects will be reviewed with respect to the size y of the budget for the kidney project in relation to the total budget of the l@ill. The Council was n(.,xt asked to take into consideration four questions forwarded by the Review Cor,,nittee. l.- Whether Council recommends that money apportioned for renal diseaselbe con^oido-redin a proportional ratio to the total amount of money of the Mill"s budget? 2. Whether th e total amount of money spent in a given region for renal disease should be in proportion to the total amount of dollars bein- spent in that region? 3. Whether renal programs funded by the regions will come out of their total budget or out of a separate budget? 4. Whether renal programs should be considered outside of the total regional activities or not? It was moved by Dr. Everist and seconded by Dr. Roth that the answe.rs to these questions ;in order, are "no, no, yes, and no," with the additional comment-in relation to question number 4 that on the assumption that funds will be greater and that more money 'nio kidney disease, the utilization of section will.be put i 910 for kidney projects is perfectly reasonable. At this point Dr. Margulies called upon Dr. Ilinman to outline the manner in which kidney project will be handled in the future. Dr. IlimLian outlined the following procedures: 1. Immediately upon receiving a kidney proposal, the Regional Medical@Program will be asked to contact W.IPS to d6termine whether the proposal is within the scope of @IP National priorities. At -@his point P@IPS %,till advise the Regional 14edical Program on.whether it is desirable to proceed fur- ther. The Regional Medical Program is free to either accept or reject this ;advice. 9 2. Each Regional Medic@n.l. Program be expected to establish a technical. review group for ici(I-iiey pbjcc-ts. This could r either be an Ad iloc or a staiidi-@-i@,, @,,roup. R"113S would have a list of appropriate coi-if-;i-il.tants throughout the country who could be called upon by Regional liedical Programs to serve on such review panels. 3. once an appropriate review group has been established at the local le-,7el, K,,IPS will be in a position to certify throug h the Council that an appropriate technical review has taken place. It is at this point that the larger question of the relationship between the kidney project, the total function- ing of the P@IP and the relationship the kidney budget to the total Id-iP budget would be taken into consideration. Dr. Ilinman also discussed other-prol)osed kidney activities of the Division of Professional and Technical Development. lie cited plans to develop a coordinated federal strategy on certain issues, parti- cularly that of anti-lyripltocyte globulin. H. Distribution of Advice Letters @o @,@,:Ln@a@Mel@c-a rams Ordinarily after the Council revie@is a Regional Medical Programs grant proposal, an advice letter is prepared which goes only to the Coordinator and the Regional Advisory Group Chairman. This letter ordinarily contains rather detailed advice. Both the Steering Committee and the Review Cc@n@ittee have proposed that Committee members and Consultants who have served as site visitors get a copy of the advice letters as well as the regions to whom they are addressed. It was moved by Mrs. llyckoff and seconded by Mrs. Mars that fur- ther distribution of the advice letters as suggested be authorized. The motion was approved unanimously. Dr. Margulies stated that IL'fl'S would also make all advice letters available to Council members including those who have not been reviewers or site visitors. VI.. STAFF REPORTS A. ti@ and FiLincti.onal Directioiis of the Division of Pro- 10 Dr. Ilininan reported on.the reorganization and functional direc-' tions of the Division of Prof essi.onal and, Technical Developraent, The -DivisiotA's objective is to find and implement solutions to identified problems. In dol.n- so, the Division will use a task force approach.rather than the traditional Branch and Section form of organization. Some of the current issues being dealt with by the Division include: 1. quality of care standards for li@10s 2. ar(--a health education centers 3. .rural health care 4. manpower utilization 5. experimental health servi.ce delivery systems In view of Dr. Hihmaiiis remarks'there followed an extensive dis- cussion of the importance of medical records in -maintaining quality of care. Several types of records systems currently being tried in Indian I'Losf)itals and VA Ho@lpitals, for example, were discussed. Other items included: (1) the need to develop a satisfactory re- trieval system; (2) riedical passports, and (3) the patient's right to know what is in his medical records. B. Procedures for Revic@@iing Anniv ications Dr. PzCnl reported on further progress in reorienting RI-IPS review mechanisms. Dr. Pahl announced that a "Staff Ann versary Panel" has been formed and net for the first time in August. The panel reviews applications from Regions which have not yet received triennial support, and anniversary applications from those regions which already have been approved for three years. The new review system is designed to better utilize the time of staff, Review Committee, Council members and outside consultants. C. Local RMP Review Process - Status Report Mr. Baum reported to the Council with respect to the current status of activities for insuring that the review mechanisms of the fifty-@ six RMPs comply with the P-I-IPS "Review Process Requirement and Standards." Thege standards constitute requirements to which the local review process must conform as a@quid pro quo for decentral- izing project reviewer to-the individual l@'4Ps. Pd,fPS is now in the process of conducting site visits to verify that each of the IU-Ts meets the review process requirements. The first two site visits have already been conducted and the results will be forwarded to the appropriate coordinators shortly. These pilot visits have helped to develop a standard site visit procedure and have helped to crystalize some troublesome issues. In order to keep t--bc nullll:)er of site visit,- to a cTiven region at a minimuq, PIVS attup,,ot @.@e-co@7er practical to combine review process verific@oi-i,with m-lag@,-nt c-iss@-sm--nt visits and other site visits. D. Revic-e,,,Cri-@ia and -Pating Svstm, - Status @rt I,lr. Peterson re -in the .ported on a i-iuTboer of minor cliuiges P,evic-%,7 Cri.teria and Rating Systo-ki. As a result of the initial trials by the Rovi@,.@ Co,=ttee c-L-id Council last a -nuTrber of the cr iteria have been mre e-%pl.icitly delineated. During the current cycle, applications were rated either by the Staff 7@-iiversary Panel or the Revi@j Caii-nittee. Ihe average numrical scores given I:)v these groups were almst identical. The scores :For the current cycle, horqever, were so,@,,,hat higher than those of the previous cycle, and sum scoring adjus@ts have been imde according insure Comparability. ly to Now that the rating system has bean tested, RMPS would like to stabilize the criteria and ratings in their present form and continue to use the-a substantially unchanged for an extended period. VII. EXEC-L3T@ SFSSICN TI-ie status of the anial@Tration of the Ohio MTls, progress on de- veloping a separate MIJP for Del@@iare, and the application for con- structim of a cancer center to serve I-IEW Region X were discussed during the 1-7xecutive Session. VIII. I Or APPLICATIOINS* A. Arizona Reqioi-ial YL--dic 1 Progr@-n Motion @de by Dr. Cannon and Seconded by Dr. Ochsnc--,r.. Approval of the Re-,,,iai @ttee roc dations of $1,211,000, for ti-ie 03, 04, and 05 yea'rs; the developmental neiit is t7l OnO plus. Tnis mtion does not include the renal proposal. '(Tzanscript, page 120, line 18). The mtion was uncinlmusly ap.Lorov--d. ation of the kidney projects where appropriate, unless ot,ien7ise specified. 12 Bv Arkpnsas Pocli-onal i%',adiczil Pr r im Motion ira(3.e by ,,I-rs. Mars Seconded by Dr. 0--lisiier "Approval of the reccmi@-idal:ions of the Rc-,vi.c-@@,,j Comu'ttee. " Ar}-,ansas is asking for ave-ry siL'Dstz,,i-i-ti-al increase L-i funding to support ten ad-ditio,-i @ '- le, and -L-)cy a-re very much neeCed. They -@- p ask for $595,673 to support core @,,,hich should be approved. "Tne renal program has Y,-,ade re-,T.-arkal:)I-e heacN,7ay. A year ago' tl-icre was not a single henn,-Ij.alysis -Linit in the State, and i-iav there are (Transcript, page 127, line 24 'fTie mtion was unanimusly approved. C. Colorado/A,@,ommg izecriona], 1,@eCiical Pr am @bti.ci-i role by ,%Irs, I,,@7CKoff Seconded by Dr. liatkins. -iis is a triennial "TI application for a total of $3,384,030 for the f-oLLrth, fifth, and sixth year of operation, including a re- quest for a develuT,;ent co.,cponent of $288,000 total for all three years. "Approval of the reco, dat-ion of the Revie@q Comm-ttee and the Ad lIoc Panel on Renal Disease was real ded. Further, the mtion was trade and seconded for acceptance of the site visit teem's reco=.@,aclatio-n on Project 29," and that they should be encouraged eit)-ic-r to share their dialysis training program facility by having it contiguous with an adult unit nearby, or else ask them to go to a four-bed Lu-iit instead of a t,7o-bed unit, because the personnel '%IPS Staff is to costv,7ould be very little are. Tne R negotiate with tl-ie-m." (Transcript, page 132, line 6, Nov-@r 9; transcript page 73, line 3, Nova@er 10). The mtim was unanimusly approved. D. Connecticut P,-Igional Medical rocjram @tion i-,iade by Dr, 1,@llil-,an - Seconded by Dr. Ca-Mon. The mtion was m-de and seconded to accept the site visitors' rec - dc--d level of suoi-)ort, with the kidney consideration stbject of a second motion. (liTanscripL-, page 153, to be the line 3, Noveii-,,:)er 9). The budget is for $2,250,000 and $2.5 millio,-i. Mr. Hines mved that the Council not render a policy guideline on the matter of s@,,port of faculty physicians, @caLise he doubts that there are very rony Pcgional I.,,-dic'al Programs around the count-n, that do not have sa-e faculty physicians involved in them somplace. 13 Secondly, as far as t2,e Connecti-@it Tl,-,'%Ttl prow-'-dirq a I?recise sta @t on relationships of org,-,,.-ij.zeCi im-dicine, this just does not seem possible, Mr. IlLnes r,,nvod tl-iat the Council vote no on it-.@- t@.,o -ind three, Cars. liycl-,off seconded. ,The notion was unanimusly approve . E. Connecticut regional Medical Pr @,m (Continued) Dr. Bra-man further mvc-,d that the Connecticut R@ be notified that it is the desire of the Council Uiat ways of reducing the RvT share of these projected e@,,@--iditure@, be found. Dr. Schreiner seconded the mtion. This nation was unanimously approved, Dr. Schreiner Troved for the approval of the t-"7o-year period of project 39; Dr. Brennan seconded. Tnis notion ATas -unwli-rcous]-y approved. F. Ohio Villey Peqional Medical ProcTr--,.m Yjotion @de by Dr. Roth - Seconded by Dr. Merrill. ,file nation is for acceptance of the -Pe-@,i@,i CaT.,ii-tt els recoi@ndatioi@, exclusive of those s@ which relate to t-he project. ,The iTo-tio,-i was ii-ianir,-ously approN7ed. Mr, @iillil;,eii alD@cnted h.@t-elf during this di.s- cussion. G. Tri-State Annivers plication Motion mde Ixy Dr. Roth Seconded by Dr. Ochsner A,,oprove-d the rem dation for $2.5 ndllion :for each of the 04 and 05 years, and that there be an increase in the developmental level which would ID-- :b-icluded in the $2.5 n-CL11ion. (-Transcript, page 194, line 2). This does not -b-iclucle the kidney co.@nent, which will be discussed separately. The mtion was unanimu--ly ar-),LDroved. Drs., l@o@off aard 14errill absented -th@elves during this discussion. H, North Dal-,ota Peqional ','!:-Idiccil Prograni Motion m-)-de by Mr. Ogdo-i - Seconded by Dr. Brennan Approve the reco.-mndati-ons of the staff anniversary roviai @nel, specifically including the salm-7 of a deputy program director End an assistant director for imnag t planning and evaluation in the re- c dc-d level of s@,x)rt for the one year. (Transcril?t, page 208, J;-" 'I'he l@@tioii was un@, 3ii-c)@)-Ly LLI)p:Lc)vc2ci. 14 I. Indiana @ckof f Motion made by Dr. llro-u-ian - Seconded by Mrs Approve the reconnp-rdations of the Revic-,q Corm-Littee and the Site Visitors ori this @,o-i-ini.al -Application. This C incli-id--s the kidney proposal. (Transcript, page 3, line 17, I,,,Iovemb--r 10) The wtio-,-i was uncin@usly arrl?ro@7od. J. Virginia RecTional @'-Odical. Pr@,i-n Motion i@@de fDy 15r. Everist'- Seconded by Mr. Hines Approve the PP-vic-@,q Caymttees re@rtpa-idation to award this region $1,010,000 for the third operational year from January 1, 1972, through recei@-r 31, 1972. (Transcript, page 6, line 17, N-o@7aTber 10). The mtion was unanimusly a-,o- _.,Droved. Mrs. llars absented herself during this Discussion. K. IcFva Regional Medical Proar,-im I-lotion mde by Dr. YicPliedran - Se by Mr. Milliken Approve the recc)mn--ndations of th Comitt-ee. This is to include a reco,=tr-,ndatiol'i fo lopmnt funding. (Transcript page .14, line .6,, I\Ioverrb'Der 10.) The mtio'n was unana-Tmus-Ly appi--O%7ea. L. N. Y. l@o-tro.@litm-i I?,egi-onal MoCtical Program motion mde Dt.-I-icPl-iedran - Seconded by Dr. Millikan ,A.,Wrove the request for'$2,235 reunion for the third year; for $100,000 in to that for the Queens' project. (TranscriTDt, page 16, line 15, Nov@-r 10). The mtion was unariimusly approved. Dr. lla -@is absented himself during this discussion. 15 K. I(Yqa Pegional- l@, di-c Pr@@ Motion made by Dr. McP!acdran - Seconded by Mr. 14illiken ApID,rove the ):c,,@-,mmdati.on of the- Rcvi@, C,on@mttee. This is to includ@ a re,-oim)aiad&jcj-on for developmental funding. (Transcript, page 14, line 6, I,)oveffbc-,-r 10.) Tne motion was unanimously approved. L. Na@i Yoy--'k, e@tr , 1-it--.n - onal Medical Projram Motion made by Dr. McPl-i-@an - Seconded by Dr. Mill-ikan Approve the roauest for $2.235 @llion for the third yea-r; for $100,000 in addition to that for the Queens' projecti (Transcript, page, 16, line 15, l@-ox7eiTber 10.) The mIL--ioi-i was unani-m-usly approved. Dr. 1,@at-kins absented hini,-elf during this discussion. M. To-rirjp@see I-Iid-South onal Yiedical P=am Motion made by iirs. l@ckoff - Seconded by Mr. Mil@en Approve the re P-dations of the staff anniversary re-via-i panel together with tl-,e rc-,co-.nTendations of the technical Izidney site visit team to vjhich is addcd $10,000 for section 58.-C of the kidney proposal (for PI--har3-y). (Transcript, page 29, line 22, Nove,,d:)er 10.) The mtion was iLi@-Lmo@-ly approved. N. Washingt n/Al6Lsl @P@ gionz)l I,,@-d--Lcal Proqr@ Motion mde by Dr. 1,@omaroff - Seconded by Mrs. Ma-rs Approve the"rec---f-. -.datio,.-Ls of the staff anniversary review panel. It was sug@ted that Trore Es@,os or Indians be placed on the @L as rciDre entativc@s of those minority grou.Los (Transcript, pages 34-38, l@ve.-,TLbc-,x 10.) Tne irotion was iL-iar,,-41musly approved. Mr. Ogden absented himself during this discmsion. 16 0. West Viruir,-i a P@@ionEil l,"@@ical @lotion mde by Dr. Lveri--t - Seconded by Dr. WatJcins Ar)-,3rove the rc--co-mendatj-ons of -0-io- staff an-aversary reviaN7 panel. The @tion was unaiaLma@-ly approved. P. Missouri l@eg-ional Y dical Prc)gr@ra MDtion Tmde by Dr. Ko-rnaro'Lf - Seconded by Dr. McPhedran Disa,oprove the proposal frorti Dr. Jaci@ Bass on "Autoi-nated Physician's A,-sis@L," for additional 'Lunds, but not d@i@7 the Region -Uie option of rcbudgetir@g within its overall $2 Billion gran@ to keeiD this activity alive. (Tr@cript, page 59, line 25, Nova-be-r 10.) The motion was approved by all @:cc-r)t two Council @ers. Motion made by Mr. Ogden - Seconded by Dr. D-cr>akey "Tnat t here be an analysis m---'-Ie by staff of the current state of activities of our overall efforts in the area of Cor,-p'Liter projects. Tnis should include the total money which R@IP has spent in these areas (Trwiscript, page 64.) KID,@, PROPOSAIL Arizona motion made by Dr. Schreiner Seconded by Dr. Merrill. Approval of the rec--i datio.@ of the site visitors for the kidney pro,@sal in -ie Arizona application. (Tx,Euiscript, page 71, line 9, I,,bveirber 10.) The mtion was una-ni--musly approved. Ohio Motion by Dr. Schreiner - Seconded by Dr. Merrill Disapproval of @e O'--iio Kicb-i,--y proposal. (Transcript, page 76, line 18, l@ov@,4ber 10.) 17 Motion @de by Dr. Seconded by Dr. Schreiner The action @,-en on the I(a.-ja apol.ication the first day does not include the saw, r@e-sted for the kidney aspect of that proposal.. "Approve the $19,575 relati@7o to Project 23." (Tral-iscript, pages 78-80, I\Iovepbe-r 10.) Ihe mtio-.q was un@ously approved. California S-L@pla@-ntal Yddne, Ap ication y pl Motion mde by Dr. @i--=ill - Seconded by Dr. Schreiner Approval in the an-ou--it of $214,500 instead of tl-ie retested amiLnL@- of $62@@,287, (Transcript, pages 83-86, I\b-,7enber 10.) The mtion was unanimu-,ly approved. birs.,%,P",Ck,off absented herself duri-i-ig tl-iis discussion. y Georgia Motion mde by Dr. Schreiner - Seconded by Dr. @IL-rrill "There was $211,000 r@-sted and the Ad Hoc Panel recon-m:-!nded $46,000. If the $46,000 includes funds for surgeons, it should be deleted. The Ad Hoc Panel reco@-nded completely deleting all t-l-ie @center personnel, but two hal.f-sal,-@ies should be put baifK, and Tr@-e them contingent upon actually opening up an area center." (Tram--cript, pages 87-88, 1\7ovenb--r 10.) Dr. YicPhedran absentf--d h@elf during this discussion. Roc7rie-ster FLotion made by Dr. Schreiner - Seconded by Dr. 14errill Approve Prolect 21, but with negotiation by staff on the basis of Council discuss-lo-,-Ls. (@am-cript page 91., lin,-- 17, Nov@er 10.) The mtion was unanL.,ously ap,,Droved. SF,j%TFL'-r C2!,NCER C12\71TR The Council ad(-)pted a resolution concerning tJ-ie proposed "Seattle Cancer Center." A cD-,cy of the resolution, as edited for dis- tribution, is attacl-,-d. ADJO The meting was adjourned by Dr. Pahl at 11:55 a.m. on Novenber 10, 1971. I hereby certify that, to the,best- of ny.-. ),-ncj,,?ledge, the foregoing minutes @ attac!L@-it-s are accurate and complete. arold I.,Iargulies, -1,1,.'D. Director Pegional @l-@r-al Program Service STAT.!:"i,il,,@\T )jY 'i,7AT10@@'I--T-, C(@'L;',CIL O'@ ON 'i.'O lie"i' X Council c);i the to the of a Cancer Center to be located !--,i zi i.,,,,ijcr in tlic@ arc@,i served I)V 1-1,-TI foi- the construction c)l' @.-,hicii $5 iiil.lioii liLls, Ilready been appropriated. 1. The center, to insurer its and ziciii-O-Vc,- its ultimate 0I)jc--Ctj.vc,s, S'LIOUICI I',,IVC' i,,itli a ITC,C@] L_ _tll SCie oc-Iticitioiiil, Uiiivcrsi.Lv iict,- Cc-,iii:,r &aid other i7,,@ trainin,@ and rose-,rcli J,c@@,ioi-i X. C> 2. The Ccn'ter should have adcouatc a[,Ycterient.-s i.?itli the grii-ite@ coi-icerniii(I rccour. for localities aid ecuipre-,-it "d for 14z7ij.Fon a,l(l -i I coorc-I i and, in addition, -Iioi i --,iticn with the Pegiop-@-11 'fedi-ca-1. in its erit-Lr,2 and i.@ith the CIIP (a.) Ll,,d (L)) agencies in tiie various States in )legion v. The Center slioulO ,Provide c@ire- to p,@ti-c-,.qts i-7it-.Ii neoplastic diseases v7iio are ac,.cc@lDtii,-d iiit@o t'l@ @iiid @.ssure that d i a o:@i -I- s r@@earch, end ,i)7e a coordinated approach -@nd @-'tiat re--corcl-'k',C--Ieplllg and patient follcT.'-lln are 4. The CQn@-c@,: should t)c- @-11 iis a rei,,j.onal. cooperative cancer c: center rather tlicn sii-i@-'-2 institution ii i t s fiuld, and every effort should L-c! i,'Iacl,-, to adeoLl,,te regional representation at ti-tc- 5. The Center sliould proNi.de cni-.a to i)ati-ciitE@ in the rioF;t hu',Ial-.e @.anner possible of i)syclic)].c-7,ic,-ll @-,nll' sociological proble-is, housi-iio the parents or rc-iliti-,,es of patients @,'iio co,-..ie froi-,i j:ci-@ot:e areas. The Cc!,itc@).- should iiitei-,i(,tion, ind coOT)eretio!-, .7ith existing c,-@i vices, and nospital-s in Llic@ rc,,"-ion tIlC ','OlLint:@.-ir), -ocieties interested in caiicer. Ilu- s@oLi-1,J be z@.D.-Le to foc,,tis on the -Droblc,@iF, of cancer c@inc@@-.- tre@-ttinppt il.3- LI).C@ rel.civi,@-it resources of the -tdx,anc(-d toCl-@llolo,:4 C@'ll Co,,-,, ',t,@, o' the nortl,-,l est reiion of the United Stat@es, 7. The Center should OPI')O)-tillity for education in the- o-ptii-i@il care of cancer for students, practici@115! Tlte Ccntei- sliotil.,J liavc,' ,i of I)irectorg x.iliich includes e d in f-lie o@' in ttic,, F,'i) C,-Ill C: 0 r C (',II 11 C C)f- 'c -i. @, o- r, fror!i the r r C', @', c, II t: "@ v.irl-oL,-, involved from tl-irc)LiFIiout coc)-,)c-rat-ive irrance,.i),ents (c) a Scici-,iti l'-@; c, ct) %.,Ti-l.l coc)i-dinz-@tc, c,nncer rc,.sEarch3, @iii Aciv:i-Loi-v Coir,:,:f.ttc-e of- ro-co,,,,,iiizecl @itit',@oi-it4c,,.s -,ii this fj-(!I(l to -,c,ri.oej.c cci,@sul.tatioii N,,lith resDcct to titc-. ej'foi.-ts ,;I)onsorc!ei 1)@, the Tlic, Center shL)tild i)roviOc tliit there is an effective to prc)\,.ie..,i the J@ui-ids to r!,,o-int@iin a-@ld oT)C-r@ite the Cciitc-r @,t: tricks Iti@,ii ol@ Fiicl I;rcr,-essioiial co,Tipetcrice -,I)prc)i,@3-iate to :its -is a riijorI regional facil-ity for ca;-icr2i- research end cl.ii-iical. Management i@'@ Till@, COUiNCIi, PIT@ETING 'ic)vc -.,il)er 9-10, 1971 P,@1))S Rl,"T) I@%i,'Sll'iiTATIVES IN P@IPS STAF@F 11 ici7-s Mr. Charles D. Bari-ies Mr. II j, I- I i- ziii) A. McKerna Region I Mr. Keni'@eth 1,,itim Shaw Region II Dr. Edward T. Bloiii(Iiii.sL Cl@.-(lc! L. Coucl-iman Reaion III Mr. Cleveland R. ChnT..bli-ss Mr. T. H. Griffith Region IV Miss Cecilia C. Conratli Mr. Maurice C. Ryan Region V Mr. Thomas C. Croft, Jr.- Mr. 0. 1). Pobertson Region VI 'Tir. Roy Davis Mr. C. R. Maddox Region VII Dr. John Farrell 3,lr. Daniel- P. Webster Region VIII Mr. Gerald T. Gardell @lir. Ronald S. Currie Region IX Mr. Samuel 0. Gilmer, Jr. D. ]Z. Hutchinson, Region X Mrs. Eva Handal Office of Con-it)rehensive Mrs. Gloria Ilicks Health Planning Mr. Charles liilscnroth Dr' ' Edward I)'. Iliru-tian OTIIT,"IZS ATTI'@l,,,TDII\'G Yir . Frank Ictiiiioi,@ski Mrs. Lorraine Kyttle Dr. Margaret H. Edwards, NCI-NIH Miss Carol 1,1. Larsen Mrs. Frances Howard, NLII-I\Tlll Dr. Harold Margulies Mr. Gerald R. Riso, Special Mr. Roger Miller Assistant to Administrator, HSMHA Mr. Ted C. Moore Dr. Vernon E. Wilson, Administrator, HS@-IHA Miss 1-farjoric Morrill Miss Elsa J. Nelson Mr. Joseph Ott Dr. Herbert B. Pahl Mr. Roland L. Peterson Mr. Eugene Piatek Mr. Michael Posta Mr. Lawrence Pullen Miss Leah Resnick Mr. Richard Russell Mrs. Jessi.e Salazar Mrs. Patricia Q. Schoeni Mrs. Sarah j. Silsbee Dr. Margaret 11. Sloan Mr. James Smith Mr. Jerome J. Stolov 1,T Mr. Lee E. Van @inkle Mr. Frank Zi.zlavsky NATIONAI, AL)VISOI-',Y ON REGIO',@,"Al, October 20, 1971 BRLt'INAY,, Michael J., M.D. (72) IIARS, Mrs. Audrey M. (71) p esident, llichigqii Cincer 3,1@irland. Foundation The Plains, Virginia 22171 4811 John R Street Detroit, Michigan 48201 3,IcP'@i]@IDIIAN, Alexander M., M.D.-(73> U,,i-rory ITniversity Clinic CAI@NON, BI-and W., II.D. (73) 1365 Clifton Road, N.E. 910 Madison Avenue Atlanta, Georgia- 30322 Memphis, Tennessee 38103 MERRILL, John P., M.D. (74) CROSBY, Ed@,7i.n L., M.D. (71) Professor of Medicine Executive President Harvard Medical School American Hospital Association Cambridge, Massachusetts 02115 Chicago, Illinois 60611 @ll LL']']