am . I B&B INFORm^-riom & IMAME moo @opocc D=nmwm noUL"mm Up,p,r.n M,%nLnoltc2, MA 040 Z077Z 0 Us^ 0 tacil 24wol 10 DEPARTZIENT OF IF@/@LTII, EDU'@'IAITION IJ@DL PLT,11LIC i!EALJ-IT 'I'@'ICE Li l@ational A'v4sory Council on Medical Programs Minutes of the Twenty-fiftli @ieetin& I/ 2/ 'Nover@iber 9-10, 1971 The National Advisory council on Regional Medical Pro-rams convened for c; its ti;enty-fiftil meeting at 8:30 a.in. oil Tuesday, November 9, 1971, in COnfcrcncc roo.'u GIII of the Park@ai..,n Building, POclzville, Maryland. Dr. Harold p Director, r%.Ogional Medical Programs Service presided over the meeting. The Council Members present were: Dr. Bland I?. Cannon Mr. Sewall 0. Milliken Dr. Michael E. DeBakey Dr. John P. Merrill Dr. Bruce l@. Everist Dr. Alton-Oclisner Mr. Ifarold H. Hines Dr. Russell B. Roth Dr. Anthony L. l'oriaroff Dr. George E. Schreiner Dr. Alexander M. @IcPhedran Dr. Benjamin W. Watkins Mrs. Audrey M. liars Mrs. Florence R. Wyckoff Dr. Clark if. Millikan Dr. Marc J. Musser Dr. Roth and Dr. Musser were present on't,,ovc-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 PJ@IP staff members, and othe.rs attending is appended. I. CALL TO ORDER AND OPENII,'G REMARKS The meetin- 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 @f. liars and Mr. C. Robert Ogden$, who were attending their first Council meeting. Dr. Margulies then introduced Dr. Vernon E. Wilson,-Administr ator, Health Services and bit!ntal Health Administration. restricted unless cleared by the Office of RSMIA. The restriction relates to all material sub- ion at the meetings, the supplemental material, and documents) including the agenda. 2/For the record, it is noted 'tllat-members absent themselves from meeting when the Council is discussing applications: (a) from their the (b) in c@7"cl"-- Of irternpt mioht only when the applicati On is under individual discussion. 2 rEII&Pd.',S BY DT". VEPl@0,@ E. IYILSC)N The new organizational structure for IISIUIA has been approved by the Department. Under this irrarcament, the 15 II.SifilA programs will be grouped under four Deputy Ad-.iinistrators. r@S will be under the Deputy Administrator for Dcvclo@@ent, Mr. Gerald R. Riso.. Mr. Riso's immediate Deputy will be Dr. Jack Bro;q-n. The Deputy Administrator for Development will be responsible for... change agent" type programs. In addition to ruMPS, other programs grouped under the Deputy Administrator for Development include: (1) C=prehens-Lve Health Planning; (2) the National Center for Health Services Research and Development; (3) the Iiill-Btirton Hospital Construction Program; and (4) the Health Maintenance Organization Service. 'Dr. Wilson next turned to the subjedt of improving the use@of advisory gr oups. About two thousand people .provided advice to HSMIIA through Councils, Co-mittees or consul.tin@'appointments. In order to improve the utilization of this resevoir of talent, ES@FRA is trying to develop a ilskills inventory." Staff is now developing a short questionaire designed to catalogue the skills, interests and availability of ad- visory group members and consultants. If HSMHA is able to establish @he prospective skills inventory, it will be able to utilize more effectively the resevoir of consultative advice available to it, parti- cularly as new "crash programs" materialize. Next, Dr. Wilson discussed his participation in a White House 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 technology can now make the greatest economic contri- butions. Each panel deals with a service area or industry which uses much labor and little automation. Dr. Wilson, chairs a twelve-man panel on Health Services. The panel consists of outstanding individuals of National stature including, among others, representatives of the American Medical Association, the Veterans Admini@-'7,-,.:ation','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 probably identify those fields in which technological improvements will have the greatest economic impact. 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. t i I % 1. .I I -@ I . . 3 Personal senicc rriciitc-d actvities tc@i-@d to becom(-. @@elf-defeatiiig un- less provided with a certain a,,.iouiit'ot technological assistance. At prescnt,.20 percent of the @,'.-,ition is uneierserved in relation to health services and pro-,ised improvc,-,aent cannot b(! r@,ide Without appropriate technological assistance.. There are a great niany places, Dr. Wilson stated, where i,,ithout at all interferin- with the position of the pro- fessional-patient.interface, we can still do thi.n-s a lot more effec- tixrely. Dr. Wilson indicated that he had some "considerable feeling" that in the future there x,,ill be a substantial investment in the field of technological ivtprovemciit. He asl:cd the Council to I,,eep this in mind when considering opportunities for-sponsoring new,activities through P-T.T. REI.IAPKS BY -IT,. GERALD R. RISO Itc. Ris6 indicated'thit he had only been with HS@IHA for a few weeks. He 'outlined a numbe6of matters, however, which are expected to command his'special attention during the next several months. These include (1) improving 's ability to identify health care needs; (2) de- velopinc, better relationships among research activities within RSIAIA; (3) identifyin- health delivery practices of significant value; (4) pro- moting the introduction a,-id practical application of such practices; and .(5) promoting relationships between liSYdiA programs. Very great interest in 1010s has developed as a result of the Department's efforts in this area. A very practical and pragmatic approach will be talen %.,,ith respect to providing assistance and stimulating ILVO develop- ment. Among other things, an attempt is being made to correct several widely held misconceptions about.lWiOs. First, there is and will be no element of.couipulsion in IRI.0s. Second, IDIOs are not intended to be a substitute for health insurance, and third, the responsibilities of MAOs will not actually be as broad as'the term "health maintenance" would seem to -imply. While the Gove'rnment does not-have the ability to respond to every ex- pression of interest in developin- an.BMO, IISIqiA is in a position 'to provide Tiiodest financial assistance to some I-DIO developers. It is pre- pared to provide advice to developers concerning (1) whether they should proceed further (2) reevaluate Vnat they already have done, or (3) desist from their efforts to organize an HKO. The Department does not contemplate insuring continued operation of. all HMOs. Some are expected to fail and we will learn from their experiences. . I I 4 4 It is the Depe.rt,.-,ient's .Nations to syplion off tlio,-;e groups %.,hich should not be encourag(.. to encourage those which slioA, truly good propects, and to irip,-ove those which appear to have good prospects, but marginal performance. At the present stages of iLqo develop- ment, it is expected that a number of IL\10's currently in the plan- ning and development stage fill 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,',Os' were made between May and July 1971. A second round of 'applications was submitted in July. Av7ards on the basis of these applications are expected to be nae-. -@-)re the end of the calendar year. Two more application cycle planned prior to the close of the fiscal year in June 1973. The original set of-grants and contracts made between May 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 s@,ie more modest grants in the neighborhood of $25,000 to $50,000 will be made to prospective IV,10 developers to explore whether they should p7-rRed further. Some of these smaller-grants will probably go to areas. At the close of his--presentation, Mr. 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 HMOs is the responsibility of the @NT Program. 12. HSYHA has not developed an "ABC of eligibility" which might be a good idea, but, if there are churches or other small groups which would like to be involved in EMO and have questions con- cerning their eligibility, they should contact the IDIO program Director within @be appropriate RE-1-1 Regional Office. 3. Funding levels the November IDIO 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 fro-,a earlier awards. IV. ANNOUNCE'@,ENTS A. Appointment of r i@J-nman Dr. Margulies intmdfaced Dr. Edward J. Hinman, the new Director of the Division of Profession'al and Technical Development, MIPS. 5 Dr. lliii.,@n has had a very distiii-uislic@d.career, most strikingly b as Director of the Public Health Service Hospital in Baltimore. B. Loss of Dr. Klieger Dr. Margulies next announced the sudden passing of Dr. Phillip Klieger, iiiio for many years has been part of the Rev ,ional Medical Procr@-,,;is Service. Dr. Klieger most recently served as Chief of the Office of Co:,--,rittee and Council Affairs. The condolence of.- PXPS has been expressed to Dr. Klieger'ls widow and his family. Responsibility for Committee and Council Affairs will now be picl@ed up by Mr. Kenneth Baum. V. CONFIPd-LkTION OF FUTURE IiEETIliG DATFs The Council reaff imed 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 3-4, 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, 1972 There will be a National Meeting of Coordinators in St. Louis on January 17-20, 1972. Me-zibers of the Council will be invited to attend. The Conferc@-..ice will cover a number of topics about which there is a @igh level of interest such as: Area Health Education Centers, Health Maintenance Organizations and improved utilization of health manpower. 6 B PIJPS Reor,---iiization Tlie-RMPS reorganization previously announced to the Council has been put into'effect and the geographic operations desks have in fact, been put into action. C. Status of Revised MIPS Re@,ulatioiis P34PS has for some time been developing an updating of the Regula- tions for the program. Some 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 proposdd new, Regulations. Among other things, the Regulations being developed will deal with some issues Irish have been troublesome, particularly the proper relationships between the grantee agency, Regional Advisory Group, Coordinator and core staff. These have now been defined with some clarity, but as with all regulations-there will remain room for in- terpretation which is going to be the responsibility over time of the Council. D. Participation of Minorities and lqomen on Advisory Groups 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 RITS'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 Ancrum, Executive Director, Community @ealth Board,, Seattle Mr. Williaiq J. Hilton,-Director, Illinois State Scholarship Commission, Chicago Dr. William G. Thurman, Professor and Chairma 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 A-re@i Health Edtication Center There appear to be three possible 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 Itealth; or (3) that the primary responsibility for AHECs will be placed in RMPS. The Regional Medical Pro-.ram legislation contains all of the necessary authority for A,.IEC development. Re@ardless of the legislative outcoiae, it is quite clear that P\:!I-l will be in- volved with AlIECs aid in an event@ will be working closely y with the Bureau of Ilealth Manpower Education at NIII, and the Veterans Administration. There appear t on Centers: Q be two concepts of Area Ilealth Educati (1) an expansion of the activity revolving around a university health science center, and (2) a co-.-ir@,unity based-activity pro- viding service with educational activities playing an essential but not dominating role. The second-r..odel 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, Director of the Bureau Health Manpower Education at IIIH, does not believe that AHECs should be a mere extension of the university health science center or a satellite thereof. IOIPS 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 RMPS to develop a list of hospitals that can provide the most recent advances in the treatment of heart disease, cancer, stroke, and 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 Cwmission on Accreditation to produce &-series of reports thae will enable physicians or the public to have a wide range of choice on where they receive help. G. Review of Kidney Proposals In the past kidney projects have been handled in a manner different from the rest of Regional Medical Programs. In the future, they 8 will continue to be handled separately but, in the somewhat modified r..ianiier 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 witli respect to how they relate to the total program of the sponsoring KT. 3. Kidney projects will be reviewed with respect to the size of the budget for the kidney project in relation to the total budget of the P@IP. The Council was next asked to take into consideration four questions forwarded by the Review Co-,,-aittee.@ l.- Whether Coup.-cil recommends that money apportioned for renal disease.b: considered 'in a proportional ratio to the total amount of money of the P@iP'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 being 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. Everisi and seconded by Dr. Roth that the 11 answers 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 will-be put into kidney disease, the utilization of section 910 for kidney projects is perfectly reasonable. At this point Dr. Margulies called upon Dr. Hinman to outline the manner in which kidney project will be handled in the future. Dr. Ilinman outlined the following procedures: 1. Immediately upon receiving a kidney proposal, the Regional Medical@Program will be asked to contact RI-IPS to d6termine whether the proposal. is within the scope of @T National priorities. At this point @IPS 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 advice. 9 2. Each Re@-ional iled-.:Lcal Progr.@,m will be expected to establish a technical review group for kidney projects. This could either be an Ad illoc or a staiidini,- group. r@IPS would have a list of appropriate review consultants throughout the country who could be called upon by Regional Medical Programs to serve on'such review panels. 3. once an appropriate review group has been established at the local level, Pl,,,PS,x,.ill 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 between the kidney project, the total fui-iction'- ing of the r@@IP and the relationship the kidney budget to the total RMP budget would be taken into consideration. Dr. Hinman als@iscussed 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 tdvice Letters to Re@ional Medical Programs Ordinarily after the Council reviews 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 Co-,ar,-iittee and the Re-view 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. liyckoff and seconded by lirs. Mars that fur- ther distribution of the advice letters as suggested be authorized. The motion was approved unanimously. Dr. Margulies stated that P,@IPS would also make all advice letters available to Council members including those who have not been reviewers or site Nigitors. VI. STAFR, REPORTS A. Reorganizatio"n and Ft,nctional DirectioTis of the Division'of Pro- fessional and Technical Development. 10 direc-' Dr. Hinipan reported on the reorganization and functional tions of the Division of Professional and Technical Devclopment. The Division's objective is to find 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. So,-.ie of the current issues being dealt with by'the Di@ision include: 1. quality of care standards for 11',IlOs 2. arc-,a health education centers 3. rural health care 4. manpower utilization 5. experimental health service delivery syste-ais In view of Dr. Hihman's remarks'tbere followed an extensive dis- cussion of the@mportance of medical records in maintaining quality of care. Several types of records systems currently being tried in Indian Ilospitals -@nd VA Hoi;pitals, for exa-Diple, 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 Reviei-Ting tinnivers, tions Dr. Pahl reported on further progress in reorienting R@IPS review mechanisms. Dr. Pahl announced that a "Staff Anniversary Panel" has been formed and net for the first time in August. The panel reviLews 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@,e o@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 r@s comply with the @TS "Review Process Requirement and Standards." These standards constitute requirements to which the local review process must conform as a quid pro quo for decentral- izing project review to-the individual RNTS. RIIPS is now in the process of conducting site visits to verify that each of the RbiPs 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 ]@cup t-l-ic nml.)c-r of site %7isits to a gi%7,cn region at a minirr,,=, M-IS N,,7ill attc,-,-,,nt @@.,'-racrevo-r iDractical to combine reviaq process vo--rif ication x.,@itl-i n-u-iag t a,-ses -it visits and oti-ler site visits. D.' Revi-@,j,Criteria and-Rating @ystem - Status Report Mr. Peterson r@o@L-ed on a nu@ of i@or chai-iges in the P,'L,:P Revia..@ Criteria Ea-id @-tirg System. As a result of the initial trials by the Co- k='ttc-@e and CoLuicil last sL,4r,.-ier a nunbe-r of the criteria have been are eiTlicitly delineated. During the c=ent cycle, applications i.,,ere rated either by the Staff 7=iversary Panel or the Reviiaa Co:@ttee. The average nm)--rical sr-ores gi%7en by these groups N.,-Cre aLnost identical. The scores for the carre,-it cycle, hc,,,7ever, were s@%,hat higher than those of4he p--evious cycle, and s @ scoring adjus@t,- have been rmde accordingly to insure ccn-parability. Nm, that the rating system has been tested, MIPSv7ould @-e to stabilize the criteria and ratings in their presei-it form and continue to use them, substantially unchanged for an extended period. VII. EXECU= SESSICN '1,2's, progress on de- 'B-ie status of the amlga.-Lmtion of the Ohio R veloping a separate 7@T for D@..,are, and ti-ie application for con- struction of a cancer center to serve M-@ Regim X were discussed during tl-ie Executive Session. N7iii, m=.7 or 7TPLicATio-,qs* A. Arizo@na Regional Medical am Yotion made @7 Dr. Cannon and Se=dcd by Dr. Ochsner.. Approval of the Peview ttee reccnnl-ndatiom of $1,211,000, for the 03, 04, and 05 years; the developmental nent is $71,000 plus. This mtion does not @lude the renal proposal. '(Transcr t, page 120, lino 18). ip 'Ihe notim was unan=usly aporovp-d. *All acHons included consideration of the kidney projects where appra .priate, mless otherwise specified. 12 B. Arkansas regional i@@dica -rcgraTn Motion made by ,,:-rs. Yiars Seconded by Dr. C--Iisiaer "!approval of the rec adatians of the Pevie7,%,- Ccm-nitteo-. " @-ansas is asking for a ,7en7 substantial increase :L-i fundh-ig to s@ioport ten addition;,@----pic--,, and tl-icy are very r-,uch nc@ed. They ask for $595,673 to support core which should be al:)-,Droved. "Tiae reseal program has rade remarkable heacl@,7ay. A year ago there was not a siiigle he-Li@alysis unit in the St-ate, and n(IT there are tx,;er,@,,." (Transcript, page 127, line 24). The mtion was Lu-ia,@usly approved. C. Colorado g Regional radical Program /Iqqyo Motion rude b]r.'L,,Irs, 1-@dKoff @. Seconded by Dr. INTa@,ins. "Tnis is a tri-mnial-applicatio.-Li for a total of $3,384,030 for the fourth, fifth, and sixth year of operation, incl-Ld@g a re- quest for a devel t co,,ipo,-ient of $288,000 total for all three years, Approval of the rec dation of the Revieij C @tt-ce and the Ad Hoc Panel on Renal Disease ivbs re ded. Further, the mtion v7as Trade and seconded for acceptance of the site visit tean's re ndatia-i on Project 29," and that they should be encouraged either to share their dialysis training program facility by having it contiguous with an adult unit ne@,oy, or else ask them to go to a four-bed unit instead of a b-7o-bed im-iit, because the personnel cost i,,,ould be v@7 little are. The R%IPS Staff is to negotiate with them." (Transcript, page 132, line G, Novei@-r 9; transcript page 73, line 3, NoveTrber 10) 'Ihe mtion was unanamusly approved. D. Connecticut Pc-gional Y--dical Program Motion mde by Dr. l@'i llikan - Secondc- d by Dr. Cann(i-i. 'Ihe mtion was iTade and seconded to accept the sit-- visitors' rec @-id--d level of support, with the kidney consideration to be the s@ject of a second motion. (Transcript, page 153, line 3, NoNre,7ber 9). 'Ihe budget is for $2,250,000 and $2.5 million. Mr. Hines mved that the Council not render a policy guideline on the mtter of start of faculty physicians, because he doubts that there are very any Regional Yedic'al Program a-round the country that do not have s@.e faculty physicians involved in them somplace. 13 Secondly as far as the Connecticut R@T providing a precise stato@.-it m relationships of organized in--dicine, this just does not seo,-n possible. @Ir. Hires n@7ed that the Council vote no on itmu- @.@ and three. @@s. ilycl-,off seconded. rB-ie mtion -ous was unal@ ly a.-@ roved E. Co@nnecticut ioTial Medical Program (Continued) Dr. Brennan further mvcd that the Connecticut P,,',fP be notified that@it is ti-ie desire of the Council that @%7ays of reducing the @T share of these projected @.@ditures be found. Dr. Schreiner seconded the mti@. Tnis notion was mai@usly approved. Dr. Schreiner iTioved for the approval of the -tio-year period of project 39; Dr. Brennan seconded. Tais mtim @,7as unai@@ly approved. F. Ohio\7alley PecTio-nal @@cal P-rogram, Motio@,i-mde by Dr. PDth - Seconded by Dr. M-=ill. The @tio-n is for acceptance of -tl-ie Revi@,i Co =tteel@ rec @- @-tiors, exclusive of those sum @,I-iich relate to the kidney project. ,The mtio-,i was unan=usly appro%;,ed. @ir, @lil@-en absented himself during this dis- cussion. G. Tri-State Annivers2a@lication Motion Tmde by Dr. Potl-i - Seconded by Dr. Ochsner 7ppro-%7,ed the re @ dation for $2.5 millim for each of the 04 and 05 years, and -0-iat there be an increase in the develo@-ntal level which @.,,ould be included in the $2.5 @llion. (Transcript, paae 194, line 2). TI-iis does not include the kidney ccnponent, which will be discussed separately. The mtion was un,- ugly approved. Drs. Kainaroff aAd evil @sented themselves during this discussion. H, North Dal@ota Rcgio-@ radical P--@ani Motion mde by Mr. Ogdei-i - Seconded by Dr. Br- Approve the re . dations of the staff anniversary revia-7 pannel, specifically including the salary of a deputy prograTn director and an assistant director for nmag t planning and evaluation in the re- d--d level of support for the one year. (Transcript, page 208, I.i-n..@ 3) Tiie @tion was 14 J. Indiana P,-,gior@al @@-@'ical. Program Nbtion made by Dr. Drei-inan - Seconded by Yirs. I%Iyckof f @.,LDrove th6 rec=.@ndat-ions of -Uie Revio,,.,, Ce@ttee and the Site Visitors on this triemial application. Tnis :L-icludes the ]@iclnc-y proposal. (TrEu-iscript, page 3, line 17, IZov 10) The motion was unaniiTK)usly apn ro@,,ed i . VirginicA Recrional Medical Progrr-@-n Motion mde iDY-15r. Everist - Seconded by Mr. Hines Approve the Rev:Le7@-7 Co,=ttecs ro=@mndation to'm@?ard this region $1,010,000 for the third operational year from January 1, 1972, tl-irough D-@ceTb--r 31, 1972. (Trai-iscript, page 6, line 17, Nox;,enber 10) . The mtion was unanimusly apnroved. this discussion. Mrs. Mars absented herself during K. IcF,@,a Pegional iledical Procrram i,lotion mde by Dr. @IcPhedran Se 'd by Mr. Milliken c e t Approve the recommendations of heRe-vlew Co@ttee. TI-iis is to include a rec dation' fo lopmnt funding. (Transcript r lovenber 1 page-14, line 6 h 0. The mtion was unan=, us-Ly apprcn7,ea. L. N. Y. 14etrooolitan- Pe ional cal Program 9 Motion mde @y Dr. - 1.@cPl-i@an Seconded by Dr. Yiil I -7 Approve the request for $2,235 nill-'to.,n for the third y@; for $100,000 in adc'-it3-on to that for the Queens' project. (Trw-iscript, page 1"), line 15, NovoTber 10) . The motion was unan3musly approved. Dr. 1,7atkins absented himself during this discussion. 15 K. Io.,7a Regicr-al radical P@am Motion m- de by Dr. McP!-i@an - Seco.-id--d by l@ir. 1-ii lliken Approve the rc,- dation of the @-vi@@ Co- ='tt--e Ti-iis is to ir-clud-- a rc,- dation for dev-elop.@- tal fundii-ig. (Transcript, page 14, line 6, @v@i:)er 10.) Tne mtion was unanimusly approved. L. new Yorlc. Metropolitan Re#anal Y,@'cal P@rani @iotion mde b@Dr. @.,cPl-iodran - Seconded by Dr. Millikan Approve the r@st for $2.235 @llion for the third year; for .L $100,000 in addition to that for the @-em I project. (Transcript, page 16, line 15, liovenber 10.) The imtionv7as unanimusly approved. Dr. liatkilis absented l@elf during this discussion. M. Tennessee YLid-South @onal Medical Prc>gr notion made by l@s. l@ckoff - Seconded by Mr. I-lilliken Approve the re dations of the staff anniversary revia,7 panel toge@er with the re ndations of the technical Itidney site visit team to iqhicl-i is added $10,000 for section 58-C of the kidney p@sal (for I-lehari:y). (Transcript, page 29, line 22, Novaiber 10.) Tne nation was unanimously approved. N. washingto@a'ska P.-gional @iedical Program Motion @-de lz)y Dr. l@cnaroff - Seconded by Mrs. Mars Approve the'rec=a@datio.,-,-s of the staff anniversary reviEw 1. It was suga pan,-- este-d that n-or'e Es]-@s or Indians b-c placed on the RAG as repr@-entatives of those minority groups (Transcript, pages 34-38, LTov -- 10.) The motion was iLn usly approved. Mr. Ogden absented himself during this discussion. 16 0. 1,@7est %7irairia P,--gioiaal M:-@'cal Prc)gra,.rn klotion by Dr. L@@7e-rist - Seconded by Dr. lqa-Udns -4-p-rove the reca --dations of the staff anni%,@a-ry review panel. 'lhe mtion was unan:L-,icp@-ly approved. P. Missouri I?eqional k!edical Progra-Tn @tion @de by Dr. Ko-maroff @ Seconded by Dr. McPhedran Disapprove the@@@,sal from Dr. Jad-, Bass on "Autormted Physician's Assis@L." for additional funds, but not deny the Region the option of rcbudget-ing within it,- overall $2 million grant to keep t-his activity alive. (Transcript, page 59, line 25, Nove-@er 10.) The mtion was approved by all except two Council @ers. Motion rmde by. Mr. Ogden - Seconded by Dr. DeBaJ-,ey Tnat there be an analysis made by staff of the current state of activities of our overall efforts in the area of @,juter projects. 7nis should include the total mney which RNIP has spent in these areas." (Transcript, page 64.) PROPOSAIS Arizona Motion made by Dr. Schreiner Seconded by Dr. Merrill. Approval of the re daticins of the site visitors for the kidne7y proposal in the Arizona application. (Transcript, page 71, -line 9, No%;,enber 10.) The mtion was ur usly approved. Ohio Moti-on by Dr. Schreiner - Seconded by Dr. @l=ill (Transcript, page 76, Disapproval of the O.-iio Kidney proposal. line 18, I%Ioverrber 10.) 17 Ia,7a -ireiner @tion mde by 1,lr. 11 Seconded by Dr. Scl The action taken on the Icy.@.7a application the first day does-nol' include the sizn @ted for the kidney asp--ct of that proposal. "Approve the $19,575 relative to Project 23." (Transcript, pages 78-80, I\Iove-Tyber 10.) The wticn was un ly approved. Calif oa.@a. Sup-ple,-n@L-al Yidney @licaticn Motion mde by Dr Y,=ill Seconded by Dr. Schreiner Approval in the amunt of $214,500 instead of the requested amunt of $625,287. (Transcript, pages 83-86, hbvenber 10.) The mtion was unani @musly approved. Mrs. @l.%7c)-,off absented herself during this discussion. rgia Seconded by Dr. Yle=ill Motion imde by Dr. Schreiner "Ilhere was $211,000 requested and the Ad Hoc Panel re -d $46,000. If the $46,000 includes funds for surgeons, it should be deleted. The Ad Hoc Panel reco - ded @letely deleting all the @center personnel, but two half-salaries should be put back, and ir@-e them contingent upon actually opening up an area center." .(Transcript, pages 87-88, I\Ioverrber 10.) Dr. McPliedran absented himself during this discussion. -e Rc,dnester Motion ilmd-- by Dr. Schreiner - Seconded by Dr. Merrill Approve Project 21, but with negotiation by staff on the basis of Council discussion. (Transcript page 91., line 17, Novc-nber 10.) The mtion was unani,@usly approved. 18 SF-,@= @-NCER CR= Inie Council adopted a -resolution co,-icerning the prop@-cd "Seattle Cancer Cc-nter." A c--py of tl-ie resolution ,-s edited for dis- tribut-ion, is attacl-,--d. ADJOrLn,,D= lihe reetiryg was adjourned by Dr. Pahl at 11:5@ a.m. on l@ovenber 10, 1-971. .1 hereby certi.L@ that'. to the best of the foregoing minutes and attacl @ts are accurate and ccnplete. Harold ilargu-lies,'-@l@iD. Director Regio@-ial 1,@cal Program Service 2. Tlic. Center sliotild li@ve: (a,) a Board of 1.)irectors x.!]-iich includes in t.,ic fj -old ol c-,,icc2r in the @ire@i; (b) a ,C t 'joi,Zil CIlIC6.r CC-,Il-,IC4]. CC)::, 2:i Ee(I of rcpresenta'ivas froi-,i the in tore,-,ts involved frc)iii tl-lrc)u@liolit variouf, in@31, coo-,)C@r,'ItiNe qrranc-cm.@nts; (c) a Scieiiti.fic, @..?h-Lc'ti coc)rdinitE,- cii-iccr researcfil, service; (d) an AdviE;or%, Co-,P.,r.:!.ttc-e of in@@e -.os- -@il tili@ field to p-rovid2 Dcriod@ic aid CC,T'@Sul.tatioii N..7ith resT)ect to the efforts sponsored b@, the Cc-ntc-@r. The Center should provide reasrnE;I)le asstir@i,