113LI,'ARE DEPARTMENT OF li'E/,LTII, EIIUCATION AND l@ ICE v PUF;LIC I-lEt',LTI' SL on Regional Medical Programs National Advisory Council Minutes of the Ti@enty-f if tli Meeting 2/ 'November 9-10, 1971 The National Advisory Council on Regional Medical Procyrams convened for its D.@,enty-fifth meeting at 8:30 a.m. on Tuesday, November 9) 1971, in &6hference F.,oo-m GIII of the Parklawr. Buileiing, i@cl@ville, Maryland. Dr. 'lies, Director, Regional Medical Programs Service presided Harold V.--r u over the iieetin-. The Council limbers present were: Dr'. Bland 11. Cannon Mr. Sewall 0. Milliken Dr. Michael E. DeBakey Dr. John P. Merrill Dr. Bruce li. Everist Dr. Alton-Ochsiier' - Mr. Harold R. Hines Dr. Russell B. Roth Dr. Anthony L. 1',omaroff Dr. George E. Schreiner Dr. Alexander M. McPhedran Dr. Benjamin l@'. I%Iatkins Mrs. Audrey M. Mars Mrs. Florence R. 14yckoff Dr. Clark. R. Millikan Dr. Marc J. Musser Dro Roth and Dr. Musser were present on.November 9, o-,ily. Dr. DeBakey was p7:esent on November 10, only. Dr. Br.ennan was present beginning on the afternoon of November 9. A listing of 114P staff members and others attending is appended. 1. CALL TO ORDER AND OPENING REMARKS The meeting was cplled 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. .6.udrey M. Mars and Mr. C. Robert Ogden, who .,ere attending their first Council meeting. Dr. Margulies then introduced Dr. Vernoa E. Wilson,-Ad@-ainistrator, Ilealth Se).-vices and IIrental Health 'Administration., 1/proceedings of meetings are restricted unless cleared by the Office of the Administrator, RSrdA. The restriction relates to all material su 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 thd Council is discussing applications: (a) f ro,,i their I c.,.Inflict of Interest mi,@ht only when the applicat-i:.cr, .@.s order individual discussion. 2 Rtl.LkRKS BY DR. VEIUIoi@ E. WILSON The new organizational structure for BS@IIIA has been approved by the Department. Under this arrangement, the 15 IIS'eftiA programs will be grouped under four Deputy Adm-Lriistrators. 'RMPS %.,,ill be under the 'Deputy Administrator for Development, Mr. Gerald R. Riso.. Mr. Riso's immediate Dep,4ty will be Dr. Jack Brown. sible for.. The Deputy Administrator for Development will be respon change agent" type programs. In addition to RNPS, other programs grouped under the Dcputy Administrator for Development-include: (1) Comprehensive Health Planning; (2) the National Center for Health Services Research and Development; (3) the Hill-Bdrton Hospital Construction Program; and (4) the Health Maintenance Organization Service. -Dr@. Wilson next turned to the subject of improving the use-of advisory groups. About two thousand people.provided advice to IIS@IHA through Councils, Co-i@--iittees or consulting'appointments. In'order to-improve the utilization of this resevoir of talent, BSriHA is@trying to develop a l(skills inventory." Staff is now developing a short questionaire designed to catalogue the skills, interests and availability of ad- visory group members and consultants. If IIS@' is able to establish e skills inventory, it-%,7ill be able to utilize more the prospectiv effectively the resevoir of-consultative advice available to it, parti- C-ularly as new "crash Vrogrants" materialize. Next, Dr. Wilson discussed his participation in a "ite,llouse study on the applications of technology. The study is under the direction of the Federal Council on Science and Technology, and it involves six different panels. These groups are charged with determining those fields in which technolo y can now make the greatest economic contri- 9 butions. Each panel dedls with a service area or industry which uses little automation. much labor and Dr. Wilson, chairs a twelve-man panel on Health Services. The panel consists of outstanding individuals of National stature includ ng, among others, representatives of the American Medical Association, the Veterans Administration@,' the Departments of Transportation and -Defense, etc. It is expected that each of the personal services ori- ented fields will make its &an case for the advantages of technological investments in its particular area. The final report will ptobably identify those fields in which technological improvc7lents will have the greatest econo-"iic imDact. It will most likely identify those fields which can make the best use of investments in technology rather -than how technology can be applied in each field health, housing con- struction, etc. 3 ted act4vitics tend to become self-defeating un- Personal service orien less provided x7itli a certain amount 'of technological assistance. At present 20 per .cent of the- I.,,,at'ion is underserved in relation to health services and praised ixaprovoinent ca-,inot be made without appropriate technological assistance. . There are a great ri-ii-iy places, Dr. l@lil@-on stated, where i-,,ithotit at all interfering with the position of the pro-. iessional-paticiit interface, we can still do things a lot more effec- tively. Dr. 14ilson indicated that lie had some "considerable feeling" that in the future there i-iill be a substantial investment in the field of technological ini,,@rove.-ieiit. He asked the Council to keep this in mind when considerin- opportunities for sponsoring new activities through MT. III. REIVRKS BY GERALD R. RISO tir. Ris6 indicated' thdt he had only been with HS@RIA for a f o-w 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 HSr2iA's ability to identify health care needs; (2) de- velopina better relationships among research activities within HSIIHA- (3) identifyi.n,, health delivery practices of significant value; (4) pro- motip-g the introduction a-.id practical application of such practices; and (5) promoting relationships between liSliHA programs. Very great interest- in in@,Os has developed as a result of the Department's efforts in this area. A very practical and pragmatic approach will be taken i-7itli respect to providing assistance and stimulating ILviO develop- ment. Among other things, an attempt is being made to correct several widely held misconceptions about. M@,'Os. First, there is and will be no element of. compulsion in I*iOs. Sp-cond, I-Dllos are not intended to be a substitute for health insurance, and third, the responsibilities of IDlos Will not actually be as broad as 'the term "health maintenance" .rould seem to imply. X4hile the Gove'rrLment does not@have e ability to respon th d to every ex- presbion of interest in developing an MO, HSIFHA is in a position to provide modest financial assistance to some lu@10 developers. It is pre- pared to provide advice to developers concerning (1) iqliethdr they should proceed further (2) reevaluate what they already have done, or (3) desist from their efforts to organize an HYO. The Department does not contemplate insuring continued operation of all iolos. soud are expected to fail and we will learn from their experience@'s. 4 sypiion of f those groups which It is the Departitient'@c intentions to should not be encouraged, to encourage those which -,how truly good propects,, and to iriprove those which appear to have good prospects, but marginal performance. At the present stages of IDIO develop- ment,, it is expected that a number of 11@10's currently in the plan- ning and development stage will reach a decision within the next six months on whether or not to proceed further. The initial grants and Contracts for planning and developing IR-10s 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 granl- for IU@iOs 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 trialler-grants will probably go to rural areas. At the close of his presentation, lir. 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 RNT Program. 2 HSMHA has not developed an "ABC of eligibility" which might e a good idea, but, if there are churches or other small groups which would like to be involved in MO and have questions -con- cernin g their eligibility, they should contact the IDIO program Director within the appropriate HEII Regional Office. 3. Funding levels for the November W-10 review cycle will be modest and the magnitude of activity in the Februar' and June review y will be determined b,,- legislation, and the geographic and spon- sorship pattern that evolves from earlier awards. IV. ANNOUNCEII.ENTS "p intment ot Dr. A. nt of Dr. Hinman Dr. IJargulies introduced Dr. Edward J. Hinmah, the new Director of the Division of Professional and Technical Development, @%IPS. 5 Dr. iiiiin, an has had a very distinguished career, most strikingly as Director of the Public Health Servi.ce'Rospital in Baltimore. B. Loss of Dr. Klieger -Dr,. Margulies next announced the sudden passing of Dr. Phillip Klieger, '@-ilio for many years has been part of the Regional Medical Progri,-as Service. Dr. Klieger most recently served as Chief'of the Office of C@.@cittee and Council Affairs. The condolence of-@ RMPS has been expressed to Dr. Klieger's widow and his family. Responsibility for Co-@nmittee and Council Affairs will now be picked up by ',fr. Kenneth Baum. V. CO FIRMATIO-NI OF FUTURE IJEETING DATES The Council reaffirm ed 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 thp Council, Dr. Margulies indicated that con- deration was being given to the idea of reducin- the number of Council Si meetings to 3 a year, rather than 4. VI. CONSIDEPAT OF MINUTES OF THE GUST 3-4 1971, MEETING The Council considered and approved the minutes of the August 3-4i 1972 meeting. IARGULIES Vii. PORT BY DR. I A R14P National MeetinR in Januarv. 1972 There will be a National Meeting of Coordinators in St. Louis on January 17-20, 1972. lie-nbers of the Council will be invited to ttend. The Conference will cover a number of topics about which a there is a @igh level of interest such as: Area Health Education Centers, Health Maintenance Organizations and improved utilization of health manpower. 6 B %@tPS Reor@,aiii@-.@@ The-RMPS reorganization previouFI.y announced to the Council has been put iiito'effect and the geographic operations desks have in fact, been put into action. C. Status of Revised @IPS Regulations W-IPS has for some time been developing an updating of the Regula- tions for the program. Some nei-7 material has been prepared in draft by the Office of the General Counsel. The Council will have the opportunity t,-t@ and make recommendations on any proposed new Regulations. Among other things, the Regulations being developed will deal with some issues which have been troublesome, particularly -the proper relationships between the grantee agency, Regional Advisor Group, y Coordinator and Core staff. These have now been defined with some clarity, but as with all regulations.tllere will remain room for in- terpretation uhicli is going to be the responsibility over time of the Council. D. Participation of Minorities and I,,Io-nen on Advisory U The Departmer@-.'L-.'as 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 RlfPS'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 Coi,,mittee. This group is now at full strength and new members include: Miss Dorothy E. Anderson, Assistant Coordinator, Area V, California Dr. Gladys l@ crum, Executive Director, Community Health Board, Seattle Mr. Williaia J. Hilton,-Director, Illinois State Scholarship Commission, Chicago, Dr. Willia,-n G. Thurman, Professor and Chairma n, Department of Pediatrics, Uhiversity.pf Virginia, Charlottsville, Virginia Mr. Robert E. Toomey, Director, Greenville Hospital System, Greenville, South Carolina 7 E. Current Status (,T- Area Health Editcation-Center There appear to'be three possibl.e developments with respect to area health education centers: (1) that there will be no legis- lation; (2) that the primary responsibility for AliECs will be placed in the National Institutes of Health; or (3) that the primary responsibility for AIIECs %.;ill be placed in RMPS. The Regional. Medical Pro,-,ran. legislation contains all of the necessary authority for A!IEC development. Regardless of the legislative outcome, it is quite clear that IUIP will be in- volved with in any event, will be working closely with the Manpower Education at NIH, and the Veterans Administration. There appear to be two concepts of Area Ilealtb Education Centers: 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 dominating role. The.secotid-model in which the certifi- cate, diploma or degree is subordinate to the service performed has the best chance of becoming a viable and effective institu- tion. Dr. Endicott, ,--',:,-@ector of the Bureau Health Manpower Education at IIIH, does believe that APECs should be a mere extension of the university health science center or a satellite thereof. IU-IPS and NIR will be working on AHEC 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 E.IPS to develop a list of hospitals that can provide the most recent advanc es in the treatment of heart disease, cancer, stroke, and kidney disease. The Guidelines for heart disease, cancer and stroke have bpen produced under contract previously. These either proviso serve as a basis for developing the appropriate institutiona'.-.-..,.iteria. In idditioii, a small group is now working on criteria for kidrey disease. The most important recent develop- ment with respect to section 907 is the com leti.on of a contract p with the Joint Ccrrm4j-ssion on Accreditation to produce a,series of reports thae will enable physicians or the public to have a wide ra 'ive help. nge of choice on where they r6ce -G. Review of Kidrr@-,; Proposals In the past kidnc- rojects have' been,liandl n y,p ed in a ma ner different from the'rest of Regional Medical Programsi In the future, they I 8 parately but, in the somewhat will continue to be handled se modified manner described below: 1. Kidney projects will be brought before the Review Commit- tee and Council having had a technical review. 2. Kidney projects will also be reviewed with respect to how they -relate to the total program of the sponsoring @ill. 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 P@IIP. The Coune4l was next asked 'to take into consideration four questions forwarded by the Review Co.@,nittee. l.- Whether Courrcil recommends that money apportioned' for renal disease be considered 'in a proportional ratio to the total amount of money- of the P,,IIP s budget? 2. Whether the 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 reaions 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 lino, 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 o will-be put i f section 910 for kidney projects is perfectly reasonable. At this point Dr. Margulies called upon Dr. Hinman to outline the manner in which kididy project will be handled in the future. Dr. Ilirman outlined the following procedures: 1. Immediately upon receiving 'a kidney proposal, the R@gional Medical,Progra,-a will be asked to contact PLNIPS to determine whether the proposal is within the scope of IOIP National priorities. At this point P.IIIPS will advise the Regional Medical Program. on'whether it is desirable to proceed fur- ther. The Regional Medical Program is free to either accept or reject this idvice. ..-I . 7- 9 2* Each Regional. "ical P r o g r,,-, viill be eypected to establ.is This could a technical group for kidney projects. either be an Ad itoc or t standing group. it',fP Swould have a list of appropr4-.-ii--e review consultants throughout the country who could be called upon by Regional @iedical Programs to serve on such revie-%l panels, 3.. Once nn appropriate review group has been established at the local level, P@',PS will be in a position to certify through the Council that an appropriate technical review has taken place. It is at this point that the larger question of the relationship - -'-4een the kidney project, the total f unction- iiig of the and the relationship the kidney budget to the total 101P budget would be taken into consideration. Dr. Hinnan also discussed other -proposed kidney activities of the Division of Professional and Technical Development. He cited plans to develop a coordinated federal strategy on certain issues, parti- cularly that of anti-lymphocyte globulin. H. Distribution of Advice Letters o Regi li@al Ordinarily after the Council reviews t Regional Medical Programs grant proposal, an advice letter is prepared which goes only to the Coordinator.--._.i-id the Regional Advisory Group Chairman. This letter ordinarily contains ratlier-detailed advice. Both the Steering Committee and the Review Committee 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. Ilyckof f and seconded by Mrs. Mars tliat'fur- ther distribution'of the advice letters as suggested be authorized. The motion was approved unanimously. Dr. Margulies stated that ILITS would also make all advice letters available to Council members including those who have not been reviewers or si'-2 visitors. VI. STAFF REPORTS A. Reortianizatic;n and Functional Directions of the Division of Pro- fessioiial and Technical Development._ 1.0 Dr. Hinman reported @%,-,thc reorg .,anization and functional direc-' tions of the Divis @i- of Prof essic)rial and' Technical Dc-@velopment. The Divisicii's objective is to fii:Ld and implement solutions to identified problems. In doing 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 H,@los 2. area health education centers 3. rtiral health care 4. manpower on 5. experimental h-@ @ Lli service delivery systems In view of Dr HiiLuan's re@-rarks 'there followed an extensive dis- cussion of the importance of medical records in maintaining quality of care. Several types of records syste,-as currently being tried in Indian Hospitals Lnd VA Hoepitals, 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 Revi@x,3@ng,@,nnLv ications Dr. Pahl reportee@.-,--,-,t further progress in reorienting RI@IPS review mechanisms. Dr. fahl announced that a "Staff Anniversary Pan.elis has been formed and met for the first time in August. The panel reviews applications fro--i Regions which have not yet received triennial support, and anniversary applications from t ose 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 IM Review Process - St tus Pep@rt Mr. Baum reported to the Council with respect to the current status of activities for insuring that the review mechanisms of the fifty- six RIlPs comply the ILIIPS "Revieu, Process Requirement and Standards." The6e standards constitute requirements to which the local review process must coiif orm as a quid pro quo for decentral- izing project review? to -the individual P,LiPs. REPS is now in the process of conducting site., visits to verify that each of the lUlPs meets the review process requirements. The first two site visits have already been conducted and the results will be forwarded to the tt)propriate coordinators shortly.. These pilot visits have helped to develop a standard site visit procedure and .J-ize some troublesome issues. In order to have helped to cryst,z er of site visits to a given region at a keao the nLmb RMPS will attc-!n-r,@t @-.,herever practical to m-nbine revicA,7 process verification,wit'i iranag@-nt assessmit visits and other site visits. D. RevicAi,,Criteriaard -Patinq System - Sta ii,@3 R- r-L- Mr. Peterson rel?ort-ed on a need of ii@or chan s in the R.MP gp RevieF,v Criteria and Rating SystEn. As a result of the initial trials by the Revioq C - 'ttee and Coix.-icil last suT-i@-r a number of the criteria have been mre explicitly delineated. During the current cycle, applications @.7ere rated either by the Staff Annivers@ Panel or the Review Ccn@ttee. The average nm)erical scores given by these groups were almst identical. The scores for the current cycle, hodever, were sa@@,,hat higher than those of the previous cycle, and som scoring adjustments have been made accordingly to insure c -@a-rabilit-y. Nm,, -that the rat:L-i system has been tested PLM PS -v7oul d like to 9 I stabilize the criteria and ratings in their present form and continue to use th.ETn substantially unchanged for an extended period. VII. EXE;CUTIVE SESSION The status of the airalgamation of the Ohio RMP'S, progress velcping a separate R-T for Del@.,,are, and tl-le-appli.cation for con- struction of a cancer center to serve 10,,q Region X Here Discussed durii-ig the Executive Session, VIII. 7 OF APPLICATIG'-\'S* A. Arizona Regioi-ial Medical Program Motion mde by Dr. Cannon and Seconded by Dr. Ochsner.. Approval of the R--viai @, -Littee re dations of $1,211,000, for the 03, 04, and 05 years; the developmental component is,*71,000 plus. Tnis motion does not include the renal proposal, '(Transcript, page 120, line 18). The mtion was unanimuslv approved. action- inc uc. consideration of the kidney projects where appropriate, unless otherwise specified. 12 B. Arkansas P--qional @'cal Pr2Eam Mtiol-i trade by @:rs. Y3xs Seconded by Dr. Oclisiie-r "Approval of the reco-amjidati-ons of the Revie%,i Coi-@mttec.1' @-ansas is asking for a vcn, substantial increase -L-i funding to s@rport ten addit ioni ---@le, mad they are very much needed. They ask for $595,673 to support core which should be approved. "Tne renal program has r,,ade renoA-able headway. A year ago there was not a single hen-odi.al-ysis unit in the State, and n(x,7 there are -h..enty. (Transcript, page 127, line 24). The mtion was tLianimusly approved.. C. Colora f,btioii rude by '@,!rs. I,,Iycl-,off ".Seconded by Dr. llatkins. "M-iis is a triennial application for a-total of @@,384,030 for the fourth, fifth, and sixth year of operation, -including a re- quest for a develW.Tent nent of $288,000 total for all three years. "Approval of the rec dation of the Revie@,7 ComTd-ttee an the Ad Hoc Panel on Renal Disease was reco, ded. Further, the mtion was mde and seco@nded for acceptance of the site visit teF, -M.'s reco-m@-endatio@-i on Project 29," and that they should be enco-LiracT---,-l either 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-b--d iL-iit instead of a, t-7o-bed unit, -because tl-ie personnel cost x,7ould be very little mre. The R%-IPS Staff is -to negotiate with t-l-ie,-n. " (Transcript, page 132, line 6, Nov@-r 9; transcript page 73, line 3, Nov@r 10) . The mtion was unanimusly approved. Connecticut P--cyional- Medical Program D. @lotion mde by Dr, I-Lillikan - Seconded by Dr. Cannon. The mtion was mde! and seconded to accent the site visitors' rec - ded level of support, with the kidney consideration to be the s@ject of a second motion. (Transcript, page 153, line 3, Noveir!Dex 9). The budget is for $2r250,000 and $2.5 million. Yjr. Hines mved that the Council not render a policy guideline on the matter of support of faculty physicians, because he doubts that there are very mnv Reqi.onal Yedic'al Progr@ aruand the country tl-iat do not have so,,-e faculty physicians ipvolved-in them somplace. 13 Secondly, as far as the Connecticut RT pro@rid-big a precise statcrr-nt on relationships of organized mdicinc-@, this just does not seei-n possible, l@. Ilines P,,ov,--,d that the Council vote no on it@,- t@,,,o and three. Cars. I%Iyclcoff seconded, 111-ie motion was unanimusly approved. E. Connecticut Re@,j.onal Medical Pr@ani (Continued) Dr. Brennan further mved tl)at the ConnecticuL-- RNT be notified that it is the desire of the Council that ways of reducing the RNT share of these projected @-idit-:ures be found. Dr. Schreiner seconded the mtion. Tnis iTo-tion was -unanimously approved. Dr. Schreiner mved for the approval of the -b.7o-year period of project 39; Dr. Brennan seconded. Tnis n-otio.-ivias i-inai-iimusly approved. P. Ohio Valley Regional Yedical Pr am Yiotion rmde by Dr. Roth - Seconded by Dr. Merrill, The motion is for acceptance of the Revie@,i Co,-niiittee's reco dations, exclusive of those sms which relate to the kidney project. rule motion was unanimusly approved. kb:, YiilliJ-,en absented hiTpself during this dis- cussion. G. Tri-State Amivers tion Motion ipade by Dr. Roth Seconded ]7y Dr. ochsner f approved the reco@ dation for $2.5 @llim for each of the 04 and 05 years, and that there be an increase in the developmental 'Level which v.,uald be included in the $2.5 n-Lillim. (Transcript, page 194, line 2)@. This does not b-iclude the kidney nei-it, which will be discussed separately. The mtion was unanin-ou.-,ly a,,o- d. LDrove Drs. Komroff aAd li@ill @sented themselves during this discussion. H, North Dakota Pp-qional radical Pr ani Motion Trade by Mr. Ogdoi-i - Seconded by Dr. Brennan Ap rove the recorn-p-nda .p tions of the staff anniversary revia%, pamel, specifically including the salary of a deputy program director and an assistant director for mnagemnt planning and evaluation in the re- ded level of support for the one year. (,Transcript, page 208, The ilotioii was un@'O-,%3ly app@ov@. 14 I. Indiana P,@qio-nal ProcTrain notion mde by Dr. Bre-fl-ian - Seconded by @irs. @ckoff A, Iatio 3prove the recoi,,ire--n, -is of the ReN7iov Comnittee and the Site Visitors on -this triennial application, Tnis includes the. }ddi-iey proposal. (Trinscript, page 3, line 17, No,,e, @-r 10) . The mtion was un@-Lnimusly.appro\7-ed. T. V gi-nil Regional @,@dica@ ProgrE4-n Motion mde by 15r. @eris@'- Seco@nded by Mr.. iiines Approve the Reviexq Comittees recoi-,@- dation to award this region $1,010,000 for the third operational year from January 1, 1972, through Dec@r 31, i972. (Transcript, page 6, line 17, No-%7elTber 10). The mtion was unanimisly approved. Mrs. Mars absented herself during this discussion. K. Iowa onal tiedical Proara notion mde -by Dr. @IcPhcdran Mr. Milliken koprove the recommendations of Co@ttee. Tnis is to include a r hdatioii fo A--Lu-iding. (Transcript page.14, line 6,.' No%7-@oer 10.) The mtibn was unanimus.Ly app@o@rea. L. N. Y. 14etro.,@li.tan P.,--qional M@-Ctical Pam Mo-tim mde by Dr.- l@',,cPhedran - Seconded by Dr. Millikan Pp.-L3rove the request for- $2--235'rlu'_llim for the third y@; for $100,000 in addition -Lo that for the @eens' pro@ect. (Transcript, page 16, line 15, Nov-@-r 10). The mtion-was manimusly approved. Dr. Harkins absented hiTpself during.this discussion. 15 K. IcF,.ja Regio@-al lledir am ilo-Ic-io,-i nude by Dr. McVncdran - Seconded b@7 YLr. millil-en Approve the re dati-on of the Review Co-m-nittc-e. In-iis is to in--lude a re,-oi-,Tmdation for dex7elop@, tal funding. (Transcript, page 14, line 6, Novc,,,Tber 10.) -Lhe mtion was unammusly approved. L. 1\7-@ York Yetropoli-ta.D. Regional Y-edical PrOcJram Motion imde by Dr. YcPhedran - Seconded by Dr. Millikan Approve the reV--st for $2.235 @llion for the third year; for $100,000 in addition to that for the Queens'. project. (Transcript. page 16, line 15, Novenber 10.) The mtion was unanim,,isly approved. Dr. Watkins absented @elf during this discussion. M. Tennessee mid-Soa-d-i Regioi-ial @@cal Program Motion made by @irs. l@cl-,off - Seconded by Yir. 14ilLiken Approve the re P-datio.ns of the staff anniversary reviovi panel together with the reco.@ations of the technical Iddney site visit team to @icl-i is added $10,000 for section 58-C of the kidn-@ proposal -(for 1-@-har3--y) .(Transcript, page 29, line 22, Nove,@er 10.) Tne mtion was unanimously approved. N. Was-hin@4/Al6ska R,@,qional @ical Program kbtion made by Dr. Komaroff - Seconded by Mrs. Approve the re @-dation-s of the staff anniversary reviai panel. It was suga ted that mre Es)-dms or Indians be placed .,m on tl-,e RAG as representatives of those minority groups (Transcript, pages 34-38, ibv 10'.) The motion was unanimusly approved.. Mr. Ogden absented himself during this di scussion. 16 0. Ilest Virginia P,,egio@iEll "I-@cal P-L-@,r klotion mde by Dr. L;verist - Sccondcd by Dr. WatK-ins Approve the reco. da@ions of the staff anniversary review panel. Tne mtion was unanir@ly approved. P. Missouri giona-I i-cal Program YDtion i@de by Dr. Ko-,@-off - Seconded by Dr. McPnc-dran Disapprove the propoqa.1 from Dr. Jac],, Bass on "Autoii-ated PI-iysician's Assis@L-" for zidditio,-,a3. 'Lurds, but not deny the Region -E-ie option of rc-budgetirg within its overall $2 ldlli.on grant to kee,o this activity alive. (Transcript, page 59, line 25, Novmber 10.) The mtion was approved by all except too Council @ers. Motion made by, Mr. Ogden - Seconded by Dr. @zaey "Tnat there be an analysis more by staff of tl-ie current state of activities of our overall,efforts in the area of Co@uter projects. Tnis -,hould include the total. mney which R\IP has If spent in these areas. (Transcript, page 64. KID.N= PROPOSM-S Arizona Motion made by'Dr. Schreiner Seconded by Dr. Merrill. Approval of the rcca dations of the site visitors for the kidney proposal i-n ti-ie Arizona application. (Transcript, page 71, line 9, Mvenber 10.) The rmtion was u-ianLT=asly ap ,proved. Ohio Motion by Dr. Schreiner -.Seconded by Dr. @lerrill Disapproval of the 0aio Kidney proposal. (Transcript, page.76, lovember 10.) line 18, I\ 17 Motion made by Dr. I.Ierrill - Seconded Dr. Schreiner Tne action @@cn on the Io.@7a kT)-,Dlication the first day does rDt include the su-n requested for the Jl:idne@,, aspect of that proposal.. "Approve the $19,575 relative to Project 23." (@l-iscript, pages 78-80, I\Iove4-iber 10.) Tne mtion was un@usly.approved. Cali.Lornia Su,2pl@@L-al Kidney koplication Motion mde by Dr. @@ill - Seconded by Dr. Schreiner Approval in the amu:it of $214,500 instead of tl ae requested amunt of $625,287. (Transcript, pages 83-86, lbverdDer 10.) The mtion was una-@usly a.@rovo-d. Mrs. V- yckof fabsentzl herself during this discussion. Georc.ria Yiotio.Ti made by Dr. Schreiner - Seconded by Dr. @ill "There was $211,000 recfuested and the Ad Hoc Panel recommended $46,000. If the $46,000 includes funds for surgeons, it should be deleted. 'Ihe Ad Ho-- Panel reco ded completely deleting all the @center personnel, but -bio half-salaries should be put bad,-,, and @e- them contingent upon actually opening uo an -88, lioveiTber 10.) area center. (Transcript, pages 87 Dr. McPhedran absented Mmelf during this discussion. Rocliester Motion mde by Dr. Schreiner - Seconded by Dr. l@ill Approve Project 21, but with negotiation by'staff on the basis of,Council discussions. (Transcript page 91 line 17, Novcnber 10.) The mtion was unanimusly approved. 18 SEATrL--r, The CoLuicil adopted a resolution concerning tl-ie proposed "Seattle Cancer Center." A oo,@ of the resolution, as edited for di.S7 tributiori, is attached. ADTO@@n?r she meti-ng was -,-,.djolained by Dr. P,@l at 11:55 a.m. on rovenber 10, D71. I hereby o--rti@ that, to the best of Try.,..kncF..,,ledg--, the foregoing minutes ard attac@ts are accurate and complete-. Harold ilargulr s@, -M,.D. Director @ional Yiedical Program Service 13Y l,"ATION@-L AD'@'l@)O)'Y (,'Ot',':CJL ON' rR,)GP,..\-(S 'j'O Sl',!,,\7L lie'-l X 1971) The Natioiia'L Acll%,j.forv Coi,.iici.l. on recoiri7ici,cl,,; the lir.Liiciples to ooverii tlic, i)roe,roin of a Caiicc@i- Center to be located i.,,i a T.,iajoi- i-.-2dical center, in the ire.,l scr\yed I)v,lljl,l" P,cgion X., for construction of wl.iicli $5 iiil.lioii ]la-, already been iated. appropr 1. The center, to insure its perpetuity and ichicve its ultimate. objectives, sliox-,ld l@,,ive ori,,,-liiz--Lioial rel.atioii@;hil.)@ N.,,-Ltli a Ui-tiv@-rsi.tv l,ez-,lth Science Cc,,-t@r aiid other medical educational, trainin.@ and research facilities in IIEI%L 'Pc-ti!!.oii X. 2-. The Con'tcr should have adcouate acre(,ment-s with the granted concernin- accouri---".'i)ili,L-y for rro,,rar!i, fac-Llit-I.&s and ec..uipr,@--it and, in Addition, should arrp-i-,-e. for liaison ind coc)rdi.ii-,ntic.-i with the Pegional 'Lfeeicp-l P-o,rra-,!-,g in its entire are@ and vith the CIIP (a) -,-.id (b) agc@ncies in tiie vAriotis States in Pegion X. 3. The Center should provide o-@)t,-' cii:e to 1).-ti-c-nts neo-.)laqtic diseases v?lio are icceDtc@d into tiie C(-!i-iter ztjid slici-ild @sure that diEE;,.os-.'-s -,:e-c;earch, and ',ire det(,ri7.i.ncd th7-,-,uc,@@ a coordinated T:'UltiJiscipii-,iary a.@@roach @nd that record--kc-eping and patient l'olloT.7-lin are exe,,,-,plary. 4. The should oe ripcogiia-. @d a rel,ional- cooperative cancer center rather tlinii the., siiig'2 ir.!DQrt@int institution in its fie@ld5 and ever,, effort s',lould be to insure adequz,.te regional representation at the Center. 5. The Center should provi.e@e care to Patients in the iiio.,;t hun,@;,Pe panner possible i-7ith consideration of I)syclio,'.c-@cal ind' sociological probl ..is, incli-id-ii- irrancci!-.en,;s i",)r housi.,,i- the parents or relatives of patients %.,Iio come froi-,i ):c-,r@otc, areas. 6. The Center sli ,6uld assLre co,,n:rulliczitj.or" interaction, ivd coop,--r@.tic,--, existing cric,@r re--eai-cli rr.,.dical services, and nospit,al-s in the r(,(-ion inet i!--t-.Ii the voluntary societies interested in cancer. It sliou.I.d be L-.ble to foctiq on the i)robler,.s of cancer -roE-earcli aiicl cancer tretiti,@,eiit al3. the relevant i:CSCL,,rce-s of the idvanced teclinolo-i' rc?,ion of the -cal co-,-@r.,,iiiitv of the nortli,,,,est United States. 7. The Center should nrov--,(Ie ol-,portu-,)ity for education in the opti7.i.11 ctre of cii-icer i),iti(,ni-s fee ir,3(lical students,, residents practiciiic, Health f7-o,.,i t. I 1r C', t! 71 2 8. I'he Centel- slioti!,J 11L""e,: (,i) a Bo.ard of I)ii:ectors N,71iicli includes rc,,coc",nizcd J.(--ztic!rs in the fi.cl.d oj' c,@,,icE!r !,xi the irei; (b) I Pefioi)al- C@.iir-or C(.,LIIIC4]. Co-- -epresent-li-%,(-@s from the ,,!)I:iSC(I Of i- virious in@;ti.ttjll-ioi-.s interests iiivo3.vc,.(l froiii tl-li:rili.@,liotit i,71iic,i i.@ill i:e@, cool)c@rztivc@ irrzincc,,,T,@ents; (c) 3 Sci-c!i-itifi.c iTl@i-Lcti %.iill coordinate c,-iiicer research, -? ser\,icc-@; (d) iii Aclvi-qoi--v Co,,Il,.7.:it@tc-C der.).c)n--@ t r.3 t 1@oii , of j4@--tioiiilly iiid i-nterii@tL-Loliilly rocc),,,,,i)izc!d atil@hbrit-,'.cs ---'ii t'fiis Periodic a-.id (,ct,@sultitioii x,7itli r field to provid- esiect to the efforts sl)onsorcei I)y the Cc-,itf-,r. 9. The Center 8hotild provide rc,.asrnEI)le @-Fstir@incc- that there is an to i-.aint@iin and operate effective irc,-clioiiisi@, to T)ro%7j.dc:t the funds I the Center at tilic,. high o.4L: ad,-iiiii.@@trati-%7C Pnd lyror-e,,;sioiial competence al)proi)riate to its desipn@it:'L(,ii as a riajo@ regional facility for canc.@r research -iid clinical naiiager,,ent. : 0 li 11 - I . II . . I I. 1. 'I.:. r ATTEI@DANTCli, i@T Til@E 'P'AT'10@@."%L ADVISOi',Ni COtr,\TCIl, @,T-,r,,TING t 1\10vai.,iber 9-10, 1971 R@IPS REIIRI,'OEliT.,\TI%IES IN IOIPS ST,@1,F OFFICES Mr. Charles D. Barnes Mr. William A.. McKenna Region I Mr. Keniieth.Baum Mr. Robert Shaw Region II Dr. Edward T. Blomqtiist Mr. Clyde L. Couclimati Region III Mr. Cleveland R. Cliambliss Mr. T. H. Griffith Region IV Miss Cecilia C. Conrath Mr. Maurice C. Ryan Region V M. r. Thomas C. Croft, Jr. Mr. 0. D. Robertson Region VI ir. Roy Davis Mr. C. R. Maddox Region VII Dr. John Farrell Mr. Daniel P. Webster Region VIII Mr. Gerald T. Cardell Mr. Ronald S. Currie Region IX Mr. Samuel 0. Gilmer, Jr. Mr. D. R. Hutchinson, Region X Mrs. Eva Handal Office of Comprehensive Mrs. Gloria Ilicks Health Planning Mr. Charles Hilsenroth Dr. Edward J. Hinman OTHERS T TE@,D NG I-fr. Frank Ichniowski Mrs. Lorraine Kyttle Dr. Margaret H. Edwards, NCI-TTIH Miss Carol M. Larsen Mrs. Frances Howard, NLI@L-NIH Dr. Harold Margulies Mr. Ce rald R. Riso, Special Mr. Roger Miller Assistant to Administrator, HSMHA Mt. Ted C. Moore Dr. 'Vernon E. Wilson, Administrator, HSIIlLk Miss I-larjorie 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. Jessie Salazar Mrs. Patricia Q. Schoeni Mrs. Sarah J. Silsbee Dr. Margaret H. Sloan. Mr. James Smith Mr. Jerome J. Stolov Mr. Lee E. Van Winkle Mr. Frank Zizlavsky I\IATIONAL ADVISOI-,Y COUN03'.1, -ON REGIO@'.\,AL 1-11-DICAL PROf@'P\A@IS October 20, 1971 BRENNAN, Michael J., II.D. (72) IIA'R.3, Mrs. Auclrcy @l. (71) President, Michigan Cancer Foundation The Plains, Virginia 22171 4811 John R Street Detroit, Michigan 48201 @IcPIIEDI@N, Alexander 11., M.D. (73) Emory University Clinic CANNON, Bland W., M.D. (73) 1365 Clifton Road, N.E. 910 Madison Avenue Atlanta, Geor-,,i.@i, 30322 Memphis, Tennessee 38103 MERRILL, John P. , II.D. (74) CROSBY, Edwin L., @I.D. (71) Professor of Medicine Executive President Harvard Medical School' American Hospital Association Cambridge Massachusetts 02115 Chicago, Illinois 60611 @fILLIKAN Clarl@ H. , II.D. (72) DEBA,KEY, Michael E., M.D. (72) Consultant in Neurology President and Chief Executive Mayo Clinic Officer Rochester, Minnesota 55902 -Baylor College of Medicine Houston, Texas 77025 MILLYI@EN, fit. sci,7all 0. (73) Chief, Office of Comprehensive EVERIST, Bruce W., @I.D. (71) Health Planning Chief of Pediatrics Ohio Department of Health Green Clin'ic 450 East Town Street Ruston, Louisiana 71270 Columbus, Ohio 43216 (73) HINES., Mr. Harold H., Jr. (74) OCHSNER ' Alton, II.D Senior Vice President Ochsner Clinic 'ffarsh & McLennan, Inc. 1514 Jefferson Highway 231'South LaSalle New Orleans Louisiana 70121 Chicago, Illinois 60604 OGDEN,.Mri C. Robert (74) HUI\IT2 William R., M.D. (71) President and General Counsel Commissioner North Coast Life Insurance Company County of Allegheny 1120 Paulsen Building 101 Courthouse Spokane, Washington 99201 Pittsburgh, Pennsylvania 15219- ROTH, Russell B., II.D. (73) KOMAROFF Anthony L., M.D. (72) 240 West 41st-Street Bdth Israel Hospital Erie, Pennsylvania 16508 Boston, Massachusetts 02215 2 National Advisu.y Council on edical Procrams Regionil 'el SCIIREINER, George E., II.D. (74) 'Director, Division of Nc-phrology. Georgetown.Uiiiversity School of Medicine Washington, D. C. 20007 X,t'ATKINS,, Benjamin W., D.P.M. (73) 470 Lenox Avenue New York, New York 10037 .-JfYCI.r,OFFI llrs. Florence R. (72) 243 Corralitos Road Watsonville, California 95076 EX OFFICIO IIE@FBER IIUSSTR, Marc J., II.D. Chief Medical Officer Veterans Administration Washington, D. C. 20420 CHAI@IAN Vernon E. Wilson, @I.D. Administrator Health Services and lien-Lal Health Administration 5600 Fishers Lane Rockville, Maryland 20852 RMPS-CIIO