*EOO12q6* D E P A R T M B N T 0 P H E A L T R, E D U C A T I 0 N A N D fl E L i A R E PUBLIC HEALTH SERVICE National Institutes of Health Division of Regional Medical Programs National Advisory Council on Regional Medical Programs Minutes of Meeting August 12-13, 1966 National Institutes of Health Conference Room "All Stone House DEPARTMENT OF tT,7.kLTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE NATIONAL ADVISORY COUNCIL ON REGIONAL MEDICAL PROGI@ Minutes of Fifth Meeting August 12-13, 1966 The National Advisory Council on Regional Medical Programs convened for its fifth meeting at 9:00 a.m., Friday, August 12, 1966, in Conference Room "A", Stone House, National Institutes of Health, Bethesda ' Maryland. Dr. Robert Q. Marston, Associate Director, NIH, and Chief, Division of Regional Medical Programs, presided. The Council members present were: Dr. Leonidas R. Berry Dr. J. Willis Hurst Dr: Xary 1. Bunting Dr. Clark H. Millikan Dr. Michael E. DeBakey Dr. George E. Moore Dr. Bruce W. Everist Dr. William J. Peeples Dr. James T. Howell Dr. Robert J. Slater Public Health Service members Attending some o.f the sessions included: Dr. William H. Stewart, Surgeon General, PHS Dr. James Shannon, Director, NIR Dr. Stuart Sessoms, Deputy Director, NIR '.Di. Bert Cole, OSG Liaison members: Dr. Sidney Farber, NCI Council Dr. A. B. Baker, NINDB Council (absent) Dr. Edward W. Dempsey, NIGMS Council'(absent) Dr.,John B. Hickam, NRI Council (absent) I/ Proceedings of meetings are restricted unless cleared by the'office of the Surgeon General, The restriction relates to all material . submitted for discussion at the meetings, the agenda for the meetings, the supplemental material, and all other official documents. For the record, it is noted that members absent themselves from the meeting when the Council is discussing applications: (a) from their respective institutions or (b) in which a conflict of interest might occur. This procedure does not, of course, apply to en bloc actions--only when the application is under individual discussion. Others present'were: Mr. Karl D.'Yordy, Assistant Chief, DRMP Mr. Stephen Ackerman, Chief, Planning & Evaluation Branch, DRMP Mr. James A. Beattie, Chief, Grants-Itaiiagement Branch, DITQ Dr. Carl Brewer, Chief, Grants Review Branch, D,@P Dr. Margaret Sloan, Chief, Program Development & Assistance Branch, DIDIP Mr. Edward Friedlander, Special Assistant for Communications and Public Information, DIUIP Mr. Maurice Odoroff, Assistant to Chief for Systems and Statistics, DIL14P Mr. Storm Whaley, Associate Chief for Organizational Liaison, DRY"TI Mr. Charles Hilsenroth, Execu@uive Officer, Dr,14P Dr. William Mayer, Special Assistant to Director, DRMP Dr. Kenneth Endicott, Director, NCI Dr. Robert Grant, Director, NHI Dr. Clarence A. Imboden, BSS Dr; W. D. David, BSS Dr. Benjamin Wells, VA Mr. Ralph Mueller, BOB Dr. R. L. Ringler, NHI Dr. Jerome H. Green, NRI Dr. G. Howard Gowan, NCI Miss Pauline Stephan, NCI Dr. J. H. V. Brown, NI@, IS Dr. 0. Malcolm Ray, NIITDB Mr Thomas McCarthy, DRG Mr: Frank Ehrlick, OD Mr. Bruce Carson, OD Miss Jane Fullerton, OD Mr. James Gregg, OD Miss Cecelia Conrath, DP,14P Mr. Robert Anderson, D@,'P Dr. James Mc k'Nulty, D,%,MP Miss Leah Resnick, DRMP Mr. Daniel Zwick, DUIP Mr. Larry Coffin, DRMP Mrs. Mary Ceisbert, DPliP Dr. Harry Roberts, DfU4P Mrs. Jessie Salazar, bRl4P Mr. Ira Alpert, DRMP Dr. John Hamilton, DRMP Dr. John Hazen, DE44P Dr. Robert O'Bryan, DRMP Miss Charlotte Turner, D,@ Mr. Harold O'Flaherty, DRMP Mr. Art Hiatt, DRMP Mr. Stuart Yaffe, DRMP -3- 1. CALL TO ORDER AND OPENING Y-S Dr. Marston called the meeting to order at 9:10 a.m. 11. REGIONAL MEDICAL P.POGRAMS PROGRESS AL,@TD PROSPECTS--Dr. Marston During this meeting we wish to direct attention to matters of po licy and to seek assistance in the areas of the broad implications of the program. An evidence of the progress of the Regional Medical Programs is that there have been established throughout the nation groups representing the major health resources. These regio@l advisory groups have been meeting and discussing the health needs of their regions. Thus, we have now for the first time a national communication framework for .regional medical programs. We will be utilizing this framework with less concern now than we did previously when we were concerned about the possibility of too much direction of the planning from the Federal level. In the future we will be able to obtain information in a way that was not possible prior to the local identification of the appropriate organization to approach in seeking such information. Mr. Edward Friedlander will soon be on our staff as Assistknt to Chief, DRMP (Communications & Public Information). He has already begun planning ways in which he can work in terms of communication with the existing or planned Regional Medical Programs. We are scheduled to give major speeches to several National organizations within the next few months. Our staff in the Development and Assistance Branch is making visits to all approved regions every 90 days. Some of the early grantees arq even now scheduled to have a second visit. Within the Government, we have expanded the distribution of our progress reports to the Surgeon General and are meeting with those agencies directly involved in interests related to research and development (R&D). A summary article has been submitted to "PHS Reports" for broad distribution. Another item that we discussed at the last Council meeting is, "Continuing Education". Dr. Mayer is currently expanding his program markedly, and he will discuss this further during the meeting.. Dr. Shannon presented his views regarding the Division of Reciona.1 Medical Programs. Ile stated that this is a very complex prograi-a, ia"' needs flexibility in the mechanism by which objectives are attained., because there are ro guidelines that we have conventionally used in the applicatioa of this program in its relation to others. This pto-rAm is t'> the direct outgrowth of the Prcsident's Commission on Heart, Cancer, and Stroke, the entire thrust of which is to provide a scientific base for the practice of medicine. This is complex also because one has to move the scientific base out of the university, university hospital, and actually into centers of activity that perhaps are best characterized as the, '!comijn4ty hospital.". This type of hospital might have a budget of around $200,000, and a flow of patients of sufficient ma-nitude that a whole variety of highly specialized services can be built in. We have to develop mechanisms for translation of both fundamental and applied knowledge from the point of origin to the point of use, and to recast the role of the scientist into two functions, the first of which is to develop new knowledge, and the second is to make it applicable, not as an individual, but as a scientific body. The scientist has to participate in some sort of core program upon which peripheral excellence can develop. This is the realistic program of continuing education. This program can only be in a community hospital, and will involve the base'of a good deal of the continuing education process. In order to have a good system of continuing education we have to modify the process of education at the medical school, since the present educational process prepares the person for specialty training in the university hospital, but not for the task of a continuously learning process throughout his entire career. To have excellent medicine in this 14ation, it is necessary to have a public education program which would begin in grammar school and carried through all levels of our educational process. This will not be the concern of the Regional Medical Programs, but one of the new Bureaus of the Public Health Service. The logistical problem of developing a framework for the transference of knowledge and making it easily accessible to the physicians at large constitutes the primary problem about which this Council is to be concerned. Thus, this cases the community hospital in a completely different role than ever before. In this program, we are aiming at excellence in a profession that,, if too far separated from the source of new knowledge, becomes mediocre and obsolete. It is in this light that one should approach the proolein. One of the difficult areas i-e, this program will be tilat of the big C-,LLY with all of its scientific excellence and the tendency of institutions to isolate themselves from t@e social problems in the geographic area within which they reside. III. DISCUSSION OF "StritGEON GENFRAL'S REPOR,,T TO CONGZESS"--Mr. Ackerran P. L. 89-239, Section 908, states that, "Da or before June 30, 1967, the Surgeon General, after consultation with the Council, shall submit to the Secretary for transmission to the President and then to the Co-agress, a report of the activities under this title together with (1) a statement of the relationship between Federal financing and financing from otner sources of the activities undertaken pursmnt to this tit'-e, (2) an appraisal of the activities assisted under this title -in the light of their effectiveness in carrying out the pwpose6 of this title, and (3) recommendations with respect to extension or modification of this title in the light thereof." The following are certain things that raised questions to which the Council must address itself: a) To what extent is the lack of construction authority an inhibition in achieving the fundamntal purpose? b) How should the funding policy unden the Division of Regional Medical Programs be delineated, what things should be funded under this procram in relationship to other program authorizations? These are difficult questions ,ihid-hrelate very directly to the policy in regard to the determination of Federal support. with relationship to other supporM, c) What is to be the Federal role? Regarding the timetable for this report, vwhave set a rough timetable that we would complete our work program w.@in a matter of weeks, that the ad hoc advisory group would meet in m@September; we would have a progress report at the November Council meeting; that we would expect to have a first draft at the end of November,. A National Conference wita the people involved in this program is cormmplated for January. Another progress report will be made at tImFebruary Council meetip.- and we expect to have a final draft in Mardi,. The intramural review resources will be used with regard to the @)molution of the report. It is contemplated that Council review of the final draft would be at the May Council meeting. We hope to have @@e report ready by May 30. Dr. Stewart said that normally, in legisl=i,'on which expires in the second session of the Conaress, we would@, @roduce the legislation in the first session. Since we have this reTa-rt Vnich is perhaps halfway through the first session, he -,lot dec,'@Ciad at what -oint ,would be introduced in the next Con-ress. It seems rather cumbersor"a to introduce it before the report is made. '.Itwould get no consideration -6- before the report is made. Because of this, we must have, by the end of November', estimates of certain sizes and shapes as to what this might be in order to include it in the President's legislative pac',cage even though it may go up later. So-this.first draft in November probable:" will be far enough along and show us where the gaps are to give us this kind of guideline. The policy and determination of Federal support and the clarification of relationships of the Regional Medical Programs to other Federal programs in the construction area and every other area will be the most sensitive issues. IV. ANNOUNCEMRNTS Dr. Marston made general announcements about the Service Desk and luncheon arrangements. Also, he read the statement on, "Confidenti- ality of Meetings." He followed up on the discussion at the last Council meeting concerning, "Conflict of Inter6st" about (a) how long after one has an active attachment with an institution is he considered a representative of that institution; and (b) what are the potential conflicts of interest where there is borderline of overlap of regional programs. Regarding item (a), there is -.io legislative restraint as far 'as consultants and council members are concerned. If either of these kinds of members are involved in the actual wri-ting or development of an application, then he should leave the room during the discussion of that application. With regard to item (b), members who happen to be in an adjacent State where there is not a direct and obvious involvement in the development of the application would not absent themselves from the discussions. These items have been discussed with the General Counsel ,7ho concurs with the above. V. CONSIDERATION OF FUFURE ZEETINC, D@,TES The Council approved the following dates for future meetings: November 27, 1966 (8:00 p.m.) November 28-29, 1966 (9:00 a.m.) February 19, 1967 (8:00 p.m.) February 20-21, 1967 (9:00 a.m.) May 2.1-23, 1967 VI. CONSIDERATION OF MINLITES OF JLTTN'E 1966 MR,,ETING The Council unanimously recoir=,ended approval of.the Minutes of the June 20-21, 1966, meetin- as written. -7- VII.' COK@,IFNTS FROM LIAISON MIBEP\S Dr. Farber had no comments to make for the National Advisory Cancer Council. Dr. Marston extended appreciation to Dr. Farber, who will be retiring from the Cancer Council on September 30. His replacement as a liaison representative to this Council will be: Dr. Murray M. Copeland Associate Director (Education) M. D. Anderson Hospital. and Tiimor Institute Texas Medical Center Houston, Texas VIII. R7nPORT ON ALL APPLICA-'RIONS WIIICII WERE CONSIDERED AT JUNE CObl,,,C.TL Appl@,iication No. 1-SO2-R?@1-0001.9-01, Cal.-'-fornia Coordinati.o,., A.@r@, _y for Training, Research, EdticaL@'.on in the FS.c.:Le, @f Heart Disease, C@i-,icer. S-tro-:e,---an@ Di5,@ases@ Dr. NeTnat 0. Borhani, Prograri Coordinator At the meeting on June 20-21, 1966, the Council rEcoT,-Yrended that .this application be deferred pending (1) a ,)roject site visit with members of the Council and the Division staff to explore in greater depth the relationship of the proposed plann-.rg activities to other planning activities already ongoing within the State on the regional level, and (2) clarification of the legality of support of this application under the provisions of Title IX of the PUb@ic Health Service Act, and exploration of possible alternative means of supporting this type of planning and coordinating activity if the importance and nature of this functi'on is established. As recommended by the Counci'L,. a project site visit was made to Berkeley, California. This application was revised, and upon consideration of the additional information, the Council unanimously recommends approval with the deferral of the subcontract portion of the application of @2,500,000. The applicant anticipates rectiesting supplemental support for the subcontract portion at a future date.- These supplements will be reviewed by the California Coord-',natin,, Committee and also receive the dual review by our Review Co:rziittee and Council. The amounts requested were: @2,723,400, @2,709,970, and $2,716,968. The Council recommends that the followin- direct costs be awarded: $223,400 first year; @209,970 second year; and $216,968 third year, plus appropriate,iiidirect costs. -8- Appli.cation Yio. I-SO2-@Q!4-k^)001,@ (1@ R(@,,,t!,irch. f of V;ie Ne,.@ vork Stall-e_Depart,-.,@c-,nt of Ilcalth; Dr. r@ @c a i, Program Coordinator In accordance with the Couiicil's recommendation at the June rieeting, a project site visit was nade by some Council and staff members to Alba-,iy, New York. Ilowever, t'le additional information which is no,ed,2d pr,.or to firther actior', by tl-ic Council has i-tot recei,,rc-d, and the Council.,, therefore., again recoaLuends deferral. @)nlication No. I-SO2-@lf-COO'l.2-01, Planning Committee on Oregon !-',c@g,io-Lial ',-'@t-dical Prograr-is, Portland, Or(---,on; Mr. Roscoe F,. ',,@.iller, Proara,,i Coordinator t@pplicatio.-i No.. I-SO,' Boston Univers@@, so-i, Massac'.itisetts; Dr. Thb-xas -4,, Dawber, Pro,-,-rair C;:;o-c@iinator ApD].ication No. I-SO2-P-l',,I-00021 i Yiin@esota Statc- Medical Foundation. St. Paul, ',Minnesota; Dr. J. Minott St@cicr,.6y, Program Coordl@nator Aprilication 1,To. 1-SOI@-PM-00022-01. Ohio State 'Uiiiversitv, Colle2p. of M, icine, ColLti-,btis, Ohio; Dr. Ricl,.ard L. Meilin-@, Prop,-r,,ni Coordinator The Council reaffirmed its recommendations for deferral of tlio four applications listed above, pending receipt of further information from the applicants. IX. CO@iSIDEL,@fIOI@xT OF-AP@@LICATI.ONS The Council made the following reco=,endations on each application, and sucgested that the staff of the Div,-sion of Regional @ledical Programs meet with each applicant whose application has been recommended for approval or deferral prior to making an award to clarify any questions raised by the Council,. Application No. I-SO2-PY,-00023-01, univ.-i-sit@7 of Cc.,nter, Oklahoma City, Oklzlhc,-.@a, Dr. Bc--,i 1. Hol.ler, Pro,.-rairt Coord-'@nator The Council recommends approval in the amounts and time requested of $143,250 and $137,168, plus appropriate indirect costs. ADplication No. 1-SO2-@@1-00024-.-Ol, The Florida Adv-,-sorL7 Coiincil on Heart Disease, Cancer, and Stroke, Inc.; Dr. Richard P. Schnititil Actin@ Program Coordinator Council reco@,,iiends t,iat the ap:)I--cati.on 'oe disapproved because o-@ the necessity @Q del ete the major systems analysis support, the Program Coordinator is serving in an acting capacity and other staff ii,--@nl)ers are yet to be named, and the planning arrangements and tasks are poorly defined. t I on No. !-.SO2-'."Ii@-00025-01., Unt-versi-ty of Rochester, Sclicol of red - chester, 1-i.Y.; Dr. Ral.ph C. Par !,c'r.e -tiid Dc@,-iti.stry, Ro ker, Jr., Prograr,i Coord-i-@i--tor Tl%e Council recommends approval in the amounts and time requested of $299,394, $329,364, and $343,867, pl,.us appropriate indirect costs. i@@t 01@110- 1-SO2-PM.-00026-0 niversi-tv City Science Center Pi-lilade'Lp',iia, Pennsyl@vania; Dr. Wil.'iau-, C. ST)r L The Council recoi-.,ncnds that this application be returned for revision because 'At contains too many operational coir@?onents, the 2 0 -,, eL-aliers of 1. y ill the the advisory group did not appear to have functioned extensive pla-ani-.ig.to date, there has been no appointment of hospital administrators for the program for plannin-, and the -@ubl4@c officials of UCSC have no%, entered &--he planning phase in any evident way in a protocol. lic,itio,n. No. I-SO2-R@1-00027-Ol.. tv of Iowa, Iowa Cit lcrk-la; L)r. ,-,,oDcrt C. '@qax-din P-fcl2r;- The Couricil recomends that this be deferred for staff consultation for clarification on the responsibilities and or-,inizatio,.i of t-@,ie liaison group.% the I,-C't-, of more represent tives of the consumer public of so.@e of the othe-,-- hos,@.-'Ltals in the State and practicing pL'L-ysiciars. Af",.er this information is obtaired, a mail ballot should be made of the Couicil for a final A;.) -L@icatq-on No. I-SO2-P,@1-0,0028-01 LTii--,',,,@rsit-v of Alaba-oia l@.ed4-cr:,! Center Al,-.ba-Pa; Dr. JoseDh F. Vol ri Coordirator The Council recommends that the application be returned for revisi-oi-,i. TLie concerns of the Council should be transmitted to the applicant regarding: strc@r,.Zt'iie-,i'Lng the advisory committee, elimination of certain of the operational components of the pro-ram, clarification of the specifics of C> pla,-Ln@i.ng and phasing-to justi'Ly tl-ie bud-et timing, and a more effective iti@, of community regioial planni-na to include a broader involvement of the population. Uai.versity of New York Do@.,@i rt Moore, Pro@rnr..i Coordina,@lo,r The Council recci=ends approval after assurance, throueii staff cOi@tactl that the a-,ward of the grant would not iiapedc the development of cooperative arrangements elsewhere in the New York .metropolitan area. Tiie amounts requested were: $137,980, $134,277, a-,id $133,557, plus appropriate i-@idirect CoLts. L og c al-f -rnia at Al,gale@g: Dr. Dor@aid Bravton, Pro?.r@@.ra Adminintrativdly withdravq. 14p-dic@@). Soclely_af the District of D. C. to b@ The Council a,,,proval after staff cets Keith the applicant to discuss the proD'I,e,-@a raised co-,ice,:nir,-: (a' ti-ie vagueness of the ,r@pplic,@tion-, (b) the reason for the lact-I o-' a representative of the co-,is@.,er pub'Lic on the Advisory Group; (c) t.,ie fac-" -Beat the coordinator was viot (d) clarification of the role of the racdical schools; (e) itivclvement of ,-he co=,z,.t,.4-ty hos,3i.t@, Is ; and (4') -c-o on the p'Lan-,-'@rg Lctivit'Les relevant to adjacent a-re,%s of l@@,,:irvia-.id ard Vir,y@ia. @Lhe ar.-,oi-,nts requested were: @'88 L 708, $169,658, and @169,658:o plus appropriate indirect costs. Dr. Peeples Obtained from voting. cat:iot-L i@llo. I-SO2-F&,-00cj@@2-01, I,Tcsterr, Iiit(,rf,,',atc., Coi-,mis,-,ioi! for 'tli--heL- Bot;!-dcr, Colorado; I)r. Kevi-ii P. Ltlii-@io7,L, Pr,-)g--ani Coor:"7..T-i@tto-c. The Council re'cozr.@enes approva' in the and t-@lme requested of 4 $774,033 a-,,id $761,983, plus appropriate 4-,-,direct costs. @',o. I-SO2--P,,4-00033-01 LoLisi,@na Stita of li'o@r)-!-air. Batc---i The Council rec@,,=-ends that this ap!)IicaL:io-ii be for It xias the opi'.nio-Li of the Council that @--liat applic--,,-ioii as subri-.-,ted was more in 'the ritture of a pre-pl.an-,iii@ rather ti-,.an a nia-,ir,.in2t proposal. It woul-d %ppear that the applicant has -uneyous opinions a'-,o,,,t T"ll--f-- migl-,t So i-.ito a planning grant application, but that they noiq need to assem'i)l@e these opinions and put them in soze foiTi-, which can be identified and clearly assessed by the reviewers. Dr. Everiat absented himself. @@'o. I-S(,;2-7?@,X-00034-0"@, o;: o@t-%ico, AIA.b-, irouer,,)t-e, Nc,w Fit2, Cocrdl.,-i.!itor The CoL;rci-1 recommends approval with sl-.afA' contact to assure compliance with conditions. The amounts requested w&re: $503,400, and $729,285, plus ppropr4-ate indirect costs. Dr. i@ooze o?po,@cd. I.-SO2-PI-Ok)035-c-i, Collct,@c-- of South Caro Ii-@i a; Dr. a '-2. S12 Coord iiia c c@r The Coiinc "LI reco=-,ic-nds that this application bit rc!turrc-,d for rel7;-Sion with the Eu2;,,esl.-ion that: (a) t,-iey start with tirc-c or folr la---4z regions a,-@d s-"Ddlv-'de thcai lai-or tl-,a-r @ 1 i V 4t:" - @t e i-'-c) -i-,ne @ A. de i',c @ at I,- - regioiiii; (b) they should be to se6ic the serv44f-es of a -lul'A. coordinator; (c) @'here is no irdica-14.on of ade-ua'@e ropresertation in the Negro population and; (d" there is no evide-,ice of itiliolviaz7.crt 0!7 t."c other educatio-,ial institutions in the State. Dr. 'L,,Loore aDst@)it,.ed A'rcr, A2pli-- C,-)o-LdinatinF@ OA, a n n, o a -o@ s o f T.'). 1 i n o i s , C ',., i c.@ z s,, o ii P, @r . L c, o i-@ Pro5.,rn.n C@,nrL4nator The Councl'l reco=e-.ids that this appl.-Icat-'Lon be e-isappro,,7cd the,:e ,was no rea@L rlosc---lptio-@i of the adviso::y rilciilD, the local problems to be faced, or L'cie po3-'Lti@, s to be f illad. 'i'!-,ere seemed to be total involvement of the i-aed4-cal schools rrri t,ie:Lr ter-cliir.- hosp4@tal;s, and T)raci--ically ro i7ivolve=ent of cc=-.,-.Jllity 4--P-d-'@cal facilities. Dr* Barry absented himself dur4",ir, this discue3io:i. T> -Ilca"iri Yio. ee -!3 -i@ T'r,e Council recommends approval witi co@--,@lact to assure 1,7ith cond4@ti6na. The amounts requcs('-ed were: $319,458 and plus appropriate 'Ardirect costs. 'A"'o. i-SO2-1,C4-00033-01@ of Cc)ordir-ator The Couacil reco ends approval in tie amounts and time requected o..c $213,998, @230,934, ind @241,795, plus appropriate '@r@direct cos---s. A,@ p I No. 1-SO2-@,,I--OOOIJ9-01, L@-c@w Yori@- 1,1(-,di.cal Coll.c@@; Dr. FLarol.d S, Cole, Coord.-Lnator AdLi'@riistratively withdrawn. Dr. Robert ',"i. O'Bryan, of the DevelopmenLI aTid c'L Regional @@.edical Programs, presented a report on this 6-c@jcct. Co-D-'-er, cc 1,1,,c report %@ere distri buted to the Council, and there was a general discussion. Ho,,iover, no firm Policy decisions were reached. EDUC(','4 (li@te-r-U,-ii,,rersity Cc(I-P.,,minic.,itions Con@-ill, Dr. Will-Lari D. Mayer, Associate Director (Cont4--Llu'Ltia Educz,,t,-o-,i) , Division of Re@ional 'eledical Programs, reported on activities in thi.s area. The ED[TCC)M held 'i-n July to discuss vai-io,,;s i-,i;ids of taat are going on in "he country in terms o-.r handling science EDUCIX! sLaLcf, wor7e@ing with other., fro@, the outside, expect to iuL)ir@i,,- a proposal. to a Government age-,icy, prestniably the Department of Yealtli, Education, a-,id Welfare, to set ap a prototype in in 'L'he question is yet to be evolved of how broad an area they will be involved in to begin a network of co,@.-zj-.iicatioTi@ bet,,,,een universities. Bec,@@i,-4e of this, so@aie of our staff has attended a meeting with A'JIIF4 staff to discuss this issue. it appeared that DIIL@ is interested in pursiAir." this co-,icev@. urtlior wit.i EDUC17@4, and that the Off4-ce of Education will becme i-,ivolved in the program. of Contracts to stud@7, Mr. 1.aur'Lce Odoro-@r$.:, Assistant to Chief, DL@@i'.n (Systems and Stat4.st-Lcs), reported that -@ie are exploring the Doss4Loilill-y of -etting c@,.4peo'-e@at help in the area o-.F "Systems Analysis." One of the things we x;ould be interested in is that such a person should have the ability to train a start to give technical @dv4-Ge concerning influences of technolo,-14-cal ao-v-znces on further capabilities -Ln terms of this program. Pro@lei,is of riaKirig grants to newly_,created, non-profit cc-rporatiors for t'iie purpose of Reaional M@,ical Progra,.:-.s &Mr. jar,.ez A. Beattie, Chief, Grants Yianagement Branch, discussed topic-. Section 903 of the Public La-,; T)crr,,i-@--s the Surgeon General to L th- --an,'@s @o nix-L-p.-ofjkt, private a-c@-.cies a-,id institutions Of tne applications which have been considered by this Council to date, 12 have been frc,.-i private, non-profit corporations. Since these cor,)orat4-@,.s arL- not largt-,, established organizations, there is a certain fira@-t--ial invo'k,,ted in making awards to theLi. One oossible way to this risk is to -equire that the iion-nrofit agency provide a surety bond iqzijLch guarantees c@.?liance with u-ritte-@i agreements. !,ia@v other pro'jlems arise with these types of situations, at which *size advice of the General Counsel is sought. It was sug,,ested that we should atL-cr@,pt to develop a reasonable set of 0 articles 6'L -r-,corporation, by-!---.ws, standards for fiscal accountability, etc. rer,ard to t-.-Lc- federal own insurance carrier... XIA- The meeting was adjourned at 12:40 p.m., August 13, 1966. I hereby certify that, to the best o,-F my t',-,(- forego.-IL-ri-I aad attaclirrLents are accurate and coraplete.. Ro@@ert Q. Associate D4rector, 'i\'IH, and Chief, Division of Regional %,edical Programs Eva I,,'. Handal, Recording Secretary Counc4@l Assistart, D,@i. REGIONAL %EDYICAL PROGirW!S COU,';CIL @',-@i!BERS 10/21/66 Dr. Leonidas P,..Berry Dr. John Vlillis ll,?irst Professor, Coo:c County Graduate Professor a-,id C,,ia;-r=n Sc@ool of I,.',cdicitie, and Department of Senior Attending Physician Emory University Sci-iool I TI Lviichae L\eese Hospital of Medicine 412 E. 47t'zi Street Atla-,ita, G@@rgia 30303 Chicago, Illinois 60653 D@- . C 11 Dr. @,a-,--,v 1. Bunting Consultaii 't in Neurology President, Mayo Clinic Radcliffe College Rochester, Minnesota 5@@902 Caz;br-'Ldge, Massachusetts 02138 Dr. George E. @,oore Mr. Gordon R. Cum,!.nc, Director Adx,inistrator, Roswell Park 14emori,,tl Institute S,icr,a,lr.i@n'lo County 'tlo.,,pital 666 @,lDi Street SLocicton Boulevard Buffalo 3, York '14203 Sacra;n,2ilLo, California 95817 Dr. J. e,-,) -L c o Dr. E. DeBakey CaimTissioner of Health Professor and Chairman State Departine-,it of @',ealtli Department of Surgery State Office Buil@di,-g Colle@ of Med'@C2'.ne 301 llest Prost-3r. St@-cez: C> Baylor University Baltimore, 'Maryland 2'@20'L F,o-astor., Texas 77025 Dr. Robert J.' SILLt:e-@- Dr. Bruce W. Everist Dean, Coll.ege of Green University of Ve@,--,ort 7'V'9 Sout,,i Vienna Street Burlington, Vermont 05401 Ruston, Louisiana 7'L270 Dr. Cornelius H. Trae-er Dr. Jo,-.Tes T. Howell 799 Park Avenue Executive Director New Yor'.@, Nle@i York 7LOO21 He.r,zy V-ord Hospital Detroit, Michigan 48202 E x- 0,1@ --F i c i- o @'e n-. T) e r Dr. William 15L. Stewart (Chairman) Sur-,eon General Public klealth Ser%,ice Bethesda, iviar),lL-id 2,j'014