- INIAP#tlllll Pro@f ile: Tri-State Regional Medical 'Program Grantee: Medical Care and Educatf-on Foundation, Inc. Two Center Plaza Room 400 Boston, Massachusetts 02108 617/742-7280) (Telephone: Prokram Coordinator: Leona Baumgartner, M.D. Oriainall.y Prepared_a: Spencer Colburn Operations Officer Or@inal Date: August 1969 Updla@@ed: i i I - I TABLE OF. CONTENTS I. Geography 11. Demography III. Politics IV4 Historical Review V. Core Staff VI. Organization VII. Procedure for Proposals to Review VIII. Funded Operational Projects Appendix 2 OGRAPHY The Tri-State.-Region encompasses the states of Rhode Island, Massachusetts, and New Hampshire. There were initial attempts to organize Ne@.Enaland into one regional medical program. However, Vermont hds.,i State Legislature mandate to go its own way, Maine wanted to be autonomous, and Connecticut emphasized its interface with New York' For the states involved, there is anatural flow of patients to Boston where a high'concentration of medical resources exist. NH. 3 II. DEMOGRAPHY 1. Population: 1965 statistics 6,940,000 Total --3 states @Massachusetts 5,350,000 Rhode Island 920,000 New Hampshire 670,000 a. Per cent Urban: Massachusetts 83.6 New Hampshire 58.3 Rhode Island 86.4 b. Roughly 98% white Median age: (U.S. average 29.5) Massachusetts 32.1 New Hampshire 31.0 @Rhode Island 31.9 2. Land Area (sq. miles): New Hampshire 9,304 sq. miles Massachusetts 8 257 sq. miles Rhode Island 1,214 sq. miles Total 18,775 sq. miles 3. Health Statistics: (Mortality Rates) per 100,000 U.S. Mass. N. H. R. I. Diseases of the Heart 395 167 433 460 Malignant Neoplasms 151 167 185 188 Vascular Lesions, CNS 104 100 123 90 .4. Facilities Statistics, Medical Schools: Enrollment Boston Univ. Sch. of Medicine, Boston, Mass. 91 510 Harvard Med. School, Boston Tufts Univ. Sch. of Medicine, Boston 431. Univ. of Mass. Sch. of @ted., Amherst-Authorized in 1962 Worcester, Mass. Dartmouth Med. School, Hanover, N.H. (2 yr.basic med.sci.) 97 Brown Univ.Di.v. of ,Fred. Sciences (develo inc,), p Providence, R. 1. (2 yr. basic med. sciences) 4 b. Schools of Nursing: Number of Schools of Prof. Nurs. 1964 Enrollment Massachusetts 60 7,189 N et4 Ham shire 10 p 1,022 7 Rhode Island :Total 77 8,944 Accredited Schools in Number of Schools @Medical Technology:_ (all hospital based) 1964-1965 Enrollment 144 27 Massachusetts New Hampshire @;2 20 Rhode Island 5 35 d. Schools of Cytote hnolo Rhode Island 2 -Rav Technology: Massachusetts 50 e. Schools ofX New Hampshire 8 (54 are college Rhode Island 6 or university affiliated) f. Schools of Physical Therapy: Mass. 4 (each college or Univ. based) g@ Schools of Medical Record Technicians: Mass. I h;' Hospitals: There are 251 non-federal hospitals and 15 federal. Of the non- federal hospitals 63 are long term with 26,937 beds and 188 are short term with 49,465 beds. The fifteen federal hospitals have 7,391 beds and 1,723 of these are in four V.A. general hospitals. 5. Personnel Statistics: a. In New Hampshire there are 772 active M.D.'s (115/100,000), achusetts 8 -i52/100,000) and Rhode Island 1,103 Mass $127 (120/100,000). b. In'New Hampshire there are 2,691 active nurses (401/100,000),, Massachusetts 21,025 (392/100,000) and Rhode Island 2,419 (263/100,000). 5 POLITICS ii ew Ha@pshire 'Governor: Walter R. Peterson, Jr. (R) 1969-1971 ..Senators: Norris Cotton (R) 1954-1975; Appropriation, Commerce, Republican Policy, Small Business Thomas Mchityre (D) 1962-1973; Armed Services, Banking and Currency Representatives: Louis Wyman (R) 1962-1970; House Administration, Public Works, Disposition of Exeuctive Papers, Organization of Congress Massachusetts ,.Governor: i:: Francis Sargent (R) 1967-1971 Senators: Edward M. Kennedy (D) 1962-1970; Judiciary Labor and Public Welfare, Aging Edward Brooke (R) 1966-1972; Aeronalitical and Space Sciences, Banking and Currency IRepreso-ntatives: i@ Silvir Conte (R) 1958-1970; Appropriation, Small Business Edward Boland (D) 1954-1970; Appropriation I Philip Philbin (D) 1942-1970; Armed Services Harold Donohue (D) 1946-1970; Judiciary F. Bradford Morse (R) 1960-1970; Foreign Affairs 6 0; Armed Services, Atomic Energy William Bates (R) 1950-197 -1970; Government Operations, torhert Macdonald (D) 1954 Interstate and Foreign Commerce Thomas O'Neil (D) 1952-1970; Rules John McCormack (D) 1926-1970; Speaker of the House 87th, 88th, 89th 90th, and the 91st Congress Margaret Heckler (Ri 1966-1970; Government Operations, Veterans Affairs James Burke (D) 1958-1970; Ways and Means Hastings Keith (R) 1958-1970; interstate and Foreign Commerce, Merchant Marine and Fisheries Rhode Island Governor: Frank Licht (D) 1969-1971 Senators: .John Pastore (D) 1950-i972; Appropriations, Commerce, Atomic Energy (Chairman) Claiborne Pell (D) 1960-1972; Foreign Relations, Labor and Public Welfare, Rules and Administration, Library Represtentatives: Fernand St. Germain (D) 1960-1970; Banking and Currency, Government Operations Vacancy 2nd District 7 IV. HISTO,'ZICAL RE-VIEW Tri-State RNP Pre-Incorporation History @1964-.19166 in Rhode Island following the release of the DeBakey Commission Report the cting on the Request of his governor, a Commissioner of Health, established an Advisory Committee on Heart, Stroke and Cancer, Membership consisted of medical experts in the three disease categories and included a representative of the Brown University Medical Program. They functioned as voluntary citizen advisors to the state Health Department. In 1965 the Committee applied for and secured funds from HEW for a staff coordinator, but the salary proved too low for the Committee to be able to fill the position. After PL 89-239 was passed the governor appointed additional members representing consumer groups and allied health professionals. The group continued intact until Tri-State was established, when it became officially the Rhode island RMP Advisory Committee. October 1965-September 1966 In Massachuse@ts the Associate Dean for Administration at the Harvard Medical School heard about PL 89-239 just after its passage, and convened the deans of the other three medical schools (Boston University, Tufts, and the University of Massachusetts) together with the Commissioner of Health and a representative of the Massachusetts Medical Society, to discuss the new program. After Tri-State RNP was officially established the governor appointed these partic ipants individually, plus other representatives of the health community. October 1965-September 1966 In New Hampshire the public health doctor in charge of-the state's heart program attended a conference on heart disease where she heard about the passage of PL 89-239 and upon her return informed the executive of the State Heart Association. They approached the Dartmouth Medical School, whose Acting Dean then took the matter to the State Governor, who became immediately 8 inte -State was rested. Later, after Tri established, the governor appointed an advisory :committee, which included consumer representatives and delegates named by medical and allied health organizations, --,and voluntary agencies. Janudry.,-MarcR 1966 All New England Activities. Governor Volpe of Massachusetts, in conjunction with his Lieutenant Governor, Elliot Richardson, -formerly Under-Secretary HEW, convened the bix,Nev England governors to consider -a -single RNP for the whole region. In Vermont the state legislature had already established a mandate to develop its own RMP; Maine it! elected to remain autonomous; and --Connecticut emphasized its interface with New York. However, New Hampshire and Rhode island both felt their natural flow of patients was to the medical resources of ---Massachusetts, so the governors of these three states agreed to a tri-state program, authorizing the creation of a single corporation. March-@eptember 1966 Pre-Incorporation Activities. Plans to incorporate were worked out jointly by the six medical schools in the Tri-State Region (Boston University, Brown, Dartmouth, Harvard, Tufts, and the University of Massachusetts) together with representatives of the three three state governors and three state medical societies. Interim meeting facilities, office space, and clerical assistance was provided by the Harvard Medical School, (then and until Tri-State became actually funded). Incorporation pap ers and By-Laws for the grantee organization, the Medical Care and Education Foundation, Inc. were filed with the New Hampshire Secretary of State on September 14, 1966. 9 Tri-State RNP History September 1966 First Corporation meetin and elected to the Board of Trustees six medical school representatives, three medical society representatives (one from each state), d three gubernatorial representatives an (one from each state). First Trustees meeting and Hencry C. Meadow, Associate Dean, Harvard Medical School was elected Acting President. RAG is established and committees are set up to draft a planning grant proposal and to secure an Executive Director. October 1966 RAG is convened, has 63 members (21 from each state) and G. H. Whipple of the Massachusetts Heart Association is elected Chairman. March 1967 The Medical Care and Education Foundation (MCEF) is incorporated in New Hampshire of purpose of sponsoring the Tri-State Regional Medical Program. M. V. Edds, Ph.D., Brown University, Division of Biology and Medical Science is elected President of Trustees. Trustees approve planning grant and aughorize three staff ositions: Executive Director; p Director for Continuing Education, which was filled by Norman Stearns, M.D., part-' time and funded by the Post-Graduate Institute (Pkff) of the Massachusetts Medical Society; and Director for Data Collection, which was filled by Osler Peterson, M.D., part-time and funded by Harvard Medical School. 10 appointed June 1967 Norman S. Stearns, M.-D. is Acting Director. Trustees are requested by RAG to expand their membership by ten and with members nominated by RAG. Trustees concur. August 1967 Revised planning grant is reviewed by Committee and Council. Major concerns: ambitious budgeting for stage of.development; lack of documentation of community support; and inadequate representation of those categorical institutions whose support is essential. Council approved $300,000 ($807,599 requested) contigent upon a site Visit.- September 1967 Site Visit Visitors were encouraged by: evidence of more enthusiasm in the Region regarding IDIP; the broadened representation on the Board of Trustees; and solution to past concerns are evolving. in a mail ballot to Council members,visitors recommended a high funding level ($400,000) based on findings.durina the site visit. Council approved. December 1967 01 Planning Award for $397,647 Program office staffin- is started: c; A. F. Popoli is appointed Assistant Director for Administration (1/2 time); and T. R. Dawber, M.D., is appointed Coordinator for Brown University Medical School. Post-Graduate Medical Institute is contracted is assist in data collection, to develop a information center on continuing education opportunities both medical and non-medical, and to develop a regional network of medical libraries. Spring.1968 Staffing_continues as follows:. February J. M. Tylor, N.D. became at Tufts University Medical Coordinator School. hi, M.D. became.Coor March.- R. U dinator for Rhode Island and Brown University Medical School. April Leona Baumgartner, M.D., is appointed Executive Director; Norman Stearns, M.D. resumes position as Director -for Continuing Education; D. Seibert, M.D. h Medical becomes Coordinator for Dartmout School. April 1968 Planning supplement for $87,824 is approved. This award is to accomplish studies of legal and service systems affecting the practice of edicine in the states of this region, fund additional core staff position, and to acquire office space. May, 1968 University of Massachusetts is contracted to conduct study of medical manpower in the Tri-State area. July 1968 A. Yarmolinsky, LLB, is appointed assistant -to Executive Director for legal affairs. R. Lium, M.D. is appointed Coordinator for Massachusetts. August 1968 Second planning supplement is approved ($47,557). This award to provide greater attention to the needs and resources of the Region in areas outside the jamor institutions. ,September 1968 Fir-st--operational application is received, requesting support for three projects as follows:- #1,- Proaram of Continuing Education for Qualified Physical Therapist #2 Expansion and Consolidation of Coronary Care Trainina #3 Establishment of a Comprehensive Inter- University Cardiovascular Program in Department of Health and Hospitals of the City of Boston. 12 C. Williams is appointed Associate Director for Communications. October 1968 B. J. Duffy, M.D., is appointed Assistant Director for Data Collection. C. Farrisey, is appointed Coordinator for Special Projects. November 1968 Site Visit: (Drs. James, Shep, Fox,. Mrs. Phillips, Mr. Russell, and Mr. Strachocki). Visitors were pleased with the progress of ..this region since Dr. Baumgartner has become the Executive Director. Also, the organization structure for decision- making appears Effective. The visitors believe that acquisition of operational status will give further impetus to the regionalization process. K. W. Toll is appointed Communications and Conference Secretary. Norman Stearns, M.D., resigns to become Executive Director of the Post-Graduate Medical Institute. December 1968 The following contracts are entered into: 1) With Executive Director, Rhode Island Health Planning Council as consultant for Cape Cod. 2) With Arthur D. Little, Inc., to conduct a study of Health Needs in the Northern Counties of New Hampshire and Vermont. 3) With New Hampshire Medical Society to study types and severity of illnesses in New Hampshire. February 1969 First Operational Award ($308,667) Project #2 - Expansion and Consolidation of Coronary Care Training and Project #3 Establishment of a Comprehensive Inter- Univeristy Cardiovascular Program. 13 June 1969 @.Project #4 Boston Universi@ty's Comprehensive Regional Medical Program in Cancer is funded. R. W. Keairnes, M.D. is appointed Coordinator for Evaluations. s Augu til@69 Council approves two projects Project #5 Teaching Program in Emphysema, and Project #6 Diet Counseling Service in Rhode Island. Due to the tight fiscal situation, additional funds were not awarded. R. W. Murphy is appointed Coordinator for Eastern Massachusetts. September 1969 Robert P. Lawton, is app inted Deputy 0 Director. November 1969 Massachusetts Hospital Association is contracted to study joint purchasing for western Massachusetts hospitals and to study Home Health Care on North Shore of Massachusetts. I 14 V. CORE STAFF COORDINATING HEADOUARTERS Tri-State Regional Medical Program Medical Care and Education Foundation, Inc. Two Center Plaza, Room 400 Boston, Massachusetts 02108 (Tel.: 617/742-7280) PROGRAM COORDINATOR Leona Baumgartner, M.D. Chief Executive Officer STAFF DEPUTY DIRECTOR Robert P. Lawton "ASSOCIATE DIRECTORS FOR ADMINISTRATION Alfred F. Popoli FOR DATA COLLECTION Osier Peterson, M.D. (50%) ASSIST@'T DIRECTORS FOR DATA COLLECTION Benedict J. Duffy, Jr., M.D. John Pearson, M.D. FOR CONMNICATIONS Greer Williams (50%) ASSISTANT TO EXECUTIVE DIRECTOR Adam Yarmolinsky (50%) STATE COORDINATORS MASSACHUSETTS Rolf Lium, M.D. NEW H@SHIRE Cornelia Walker, M.D. 15 Pleasant Street Concord, New Hdmpsliire 03301 RHODE ISLAND Henry S. M. Uhl, M.D. Brown University Program of Medical Science Providence, Rhode Island 2 12 I . - .15 AREA COORDINATORS EASTERN MASSACHUSETTS Robert W. Murphy WESTERN MASSACHUSETTS Open' UNIVERSITY COORDINATORS BROWN UNIVERSITY PROGRAM OF NEDI CPJ, SCIENCE Henry S.M. Uhl, M.D. BOSTON UNIVERSITY SCHOOL OF MEDICINE Thomas R. Dawber, M.D. DARTMOUTH MEDICAL SCHOOL -Dean Seibert, M.D. TUFTS UNIVERSITY SCHOOL OF MEDICINE John M. Tyler, M.D. HARVARD MEDICAL SCHOOL Open UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL Open COORDINATORS FOR EVATUATIONS Harold W. Keairnes, M.D. SPECIAL PROJECTS COORDINATOR (Miss) Claire Farrisey COMMUNICATIONS AND CONFERENCE SECRETARY (Miss) Catherine Toll FISCAL OFFICER Francis T. Lynch PROGRAYI COORDINATORS Open - 3 positions PRO-URAM AN-AJYST Open COORDINATOR PUBLIC-HEALTH Open RESEARCH ASSISTARF Elizabeth Ainslie Peter Simon Ruth Goodman Karen Ross (P.T.) ADMINISTRATIVE ASSISTANT Isabell McDermott FIELD WORKER Sean Kennedy Stephen Novak 'Elizabeth Steel Veronica Langelier open - 2 positions GRANTS MANAGENENT SPECIALIST Open EXECUTIVE SECRETARY. Hazel Grant Grace Myshrall Babette Kronstadt SECRETARY Linda Don Frances Evans Laura Hoey Trudy Leik Sharon Whitaker Margaret Smith open - 9 positions RECEPTIONIST Robin Grant CLERK-TYPIST Paula Ardizzoni BOOKKEEPER Open CARTOGP,APHER Open MIIEOGRAPH OPERATOR Open FILE CLERKS Open 2 positions 17 ir r c 7. e 6It! th,- s ;xi ,i slide oa': reorc,.in' %a tion rc" are beirt- of- tll-- ba ".7ct the 18 BIOGRAPHICAL INFORMATION Le@ona Baumgartner, M.D. (Mrs. N. W. Elias) a. .'Born Chicago Illinois, 1902 -B iUniversity of Kansas, 1923, Bacteriology b. A-k c. M.A'., University of Kansas, 1925, Immunology @d. Ph.D., Yale University, 1932, Immunolo y 9 ':M.D., Yale Univ e.- ersity, 1934 .@Positions held: '1923-28 Teaching in Colby'(Kansas) Community High School, Kansas City Junior College, University of Montana i:':1936-37 Acting Assistant Surgeon, U.S. Public Health Service @;11937-53 New York City Department of Health: 1937-38 Medical Instructor in Child and School Hygiene 1938-39 Director, Public Health Training 1939-40 District Health Officer 1941-48 Director, Bureau of Child Health 1949-53 Assistant Commissioner, Maternal and Child Health Services (on leave 1949-50) 1949-50 Associate Chief, U.S. Children's.Bureau (Consultant, 1950-56) @1953-54 Executive Director, New York Foundation @1954-62 Conmiissioner, New York City Department of Health 962-65 Assistant Administrator, Technical Cooperation and Research, Agency for International Development, Department of State 966- Visiting Professor of Social Medicine, Harvard Medical School Executive Director, The Medical Care and Education Foundation 2. Alfred F. Popoli a. ..@orn Massachusetts, 1932 b. A.B., Boston University, 1955 c M.S. Columbia University, 1961 Hospital Administrator d. Positions held: @.1958-59 Personnel Assistant, Meth. Hospital Brooklyn, New York "1960 Administrative Res Mountainside Hospital Montclair, New Jersey ;1961-63 Assistant in Administrative Medicine, School of Public Health & Administrative Medicine Columbia University .;1963-64 Research Associate, Bureau of Hospital Administration, Graduate School of Business Administration University of Michigan 1964-66 Assistant Director, Maine Medical Center, Portland, Maine 1966-68 Research Associate and Administrator, Department of Preventive Medicine, Harvard Medical Scliool 1968- Associate Director-Adininistrator -State Recional Medical Program Tri 19 -3. Osler Luthe't Peterson,-M.D. a. Born Minn&sotai 1912 b. A.B., Gustavus Adolphus College, 1934 .c. M. -B. University of Minnesota, 1938 M. D.' University of Minnesota, 1939 d. e. M@P.H., Johns Hopkins University, 1947 Positions held: 1938-1940 Internship, University of Minnesota Hospitals 1940-1943. Residency, Thorndike Memorial Laboratory, Boston City Hospital (Harvard) 1943-1944 Rockefeller Foundation Virus Laboratory, Rockefeller Institute 1944-1956 Staff Member, The Rockefeller Foundation 1956-1967 Assistant Director for Medical Education and Public Health, 'The Rockefeller Foundation, New York 1968- Associate Director, Data Collection and Evaluation, Medical Care and Education Foundation, Inc. 4. Benedict James Duffy, Jr., M.D. a. Born New York, 1920 b. A.B., Princeton University, 1941 @c. M.D., University of Rochester, 1944 d. Positions held: 1944-45 Interne, U.S. Naval Hospital, Brooklyn, N.Y. 1947-48 Medical Residency, Memorial Hospital, New York, N. Y. 1948-50 Clinical Investigation, Sloan-Kettering Institute, New York, N. Y. 1950-53 Assistant Professor of Radiation Biology and Medicine, University of Rochester 1954-59 Assistant Professor of Medicine, Georgetown University School of Medicine 1960-63 Professor and Chairman, Department of Preventive Medicine and Community Health, Seton Hall College of Medicine 1963-64 Director of Center for.Population Research, Georgetown University 1966 Professor of Preventive Medicine, Tufts University School of Medicine 5. Richard John Christopher Pearson a.. -torn'Cheshire, 1931 b. B.A., University of Cambridge, 1951 c.- B. Chir., University of Cambridge, 1954 d. M4B., M.A., University of Cambridge, 1955 e. M.P.H., Yale University, 1960 I- - - 20 M. D. 6. Rolf Lium, 'Born North Dakota, 1907 a. b.' B.A., Carlton College, 1928 c. M.D., Harvard, 1933 Positions held: 1040-1962 General Surgery 1962-1967 Medical Director of Admiral Bristol Hospital in Istanbul 1967-1968 Medical Director of Eastern Maine General Hospital, Bangor, Maine. 7. Cornelia Walker, M.D. a. Born 1907 b. A.B. Vassar College, 1927 M.D. Columbia University College of Physicians and Surgeons, 1934 C. (Hendrik Van Loon Fellowship from Vassar, 1931-32) d. General practice, 1938-1949 e. Part-time Director of Heart Disease Control Program, New Hampshire Health Department, 1952-1968 8. Henry S. M.'Uhl, M.D. a. Born Pennsylvania, 1921 b. A.B., Princeton University, 1943 C. M.D., Harvard, 1947 d. Positions held: 1952-1953 Instructor and Research Associate, Department of Medicine, Wayne State University College of Medicine 1952-1953 Assistant in Medicine, Visiting Staff, Detroit Receiving Hospital 1953-1958 Director of Medical Education, Worcester City Hospital, Worcester, Massachusetts 1958-1960 Director of Medical Education and Research, and Associate Visiting Physician, The Springfield Hcrspital, Springfield, Massachusetts 1955-1960 Medical Director (part-time) in charge of administration of courses, Postgraduate Medical Institute, Boston, Mass. 1960-1965 Assistant Professor of Postgraduate Medicine and Instructor in Medicine, Albany Medical College of Union University 1960-1966 Assistant Director, Albany Reaional Hospital Progra m C> 1965-1966 Associate Professor of Postgraduate Medicine, Albany Medical College of Union University 1966- Professor of Medical Science and Associate Director of Medicine, Division of Biological and Medical-Sciences, Brown University 1966- Associate Director of the Institute for Health.Sciences, Brown University 21 9. Thomas Royle Dawber, M. D. a. Born 1913 b. A.B., Haveriotd College, Haverford, Pennsylvania, 1933 M.D.-, Harvard Medical School, Boston, Massachusetts, 1937 c. d. M.P@H., Harvard School of Public Health, Boston, 1958 e. Positions held4 1937-1966 Commissioned Office@, U.S.P.H.S. 1944-1949 Chief of Medicine, U.S. Marine Hospital, Boston, Mass. 1950-1966 Chief, Heart Disease Epidemiology Study, NHI, NIH, U.S.P.H.S'., Framingham, Massachusetts 10. Dean John Seibert, M.D. a. Born Connecticut, 1932 b. A.B., Brown University, 1954 C. M.D., Albany Medical College, 1958 d. Positions held: 1958-1959 Internship (Rotating), Albany Hospital, Albany, N. Y. 1959-1961 Residency, Albany Medical Center, Albany VA Hospital 1961-1963 Fellow in Hematology, Dartmouth Medical School, Mary Hitchcock Memorial Hospital 1963-1965 Senior Assistant Surgeon (Lt. Commander), USPHS, National Cancer Institute, National Institutes of Healt 1965- Consultant in Hematology, Hitchcock Clinic, Mary Hitchcock Memorial Hospital 1965- Attending Physician, VA Hospital, White River Junction, Vermont 11. John Mason Tyler, M.D. a. Born Minnesota, 1921 b. B.A., University of Minnesota, 1943 C. M.D., Harvard, 1949 d. Positions held: 1949-1950 Internship, Boston City Hospital (Harvard Service) @1950-1951 Internship, Boston City Hospital (Harvard Service) 1951-1952 Assistant in Medicine, Boston City Hospital 1952-1953 Resident in Medicine, Boston City Hospital (Harvard.Service) 1952-1953 Teaching Fellow in Medicine, Harvard University 1953-1955 Research Fellow in Medicine, Harvard University 1953-1959 Assistant in Medicine, Peter Bent Brigham Hospital 1953-1955 Research Fellow in Medicine, Boston Lying-In Hospital 1953- Harvard Uiii-@/ar6i-@y School of Medicine Fellowship 1953-1955 Fellowship, Heart Institute of the National Institutes of Health, Public Health Service -1958 Assistant in Medicine, Harvard University School of 1955 Medicine 1955- Senior Physician and Director of the Cardiopulmonary Laboratory, present Lemuel Shattuck.Hospital 1955- Research Associate, Harvard School of Public Health present 22 1955- Diplomate, American Board of Internal Medicine 1960-1966 Assistant Professor of Medicine, Tufts University School of Medicine @.@966- "'Associate Professor of Medicine, Tufts University School ...of Medicine present i,1968- Chief of Professional Services, Lemuel Shattuck Hospital present @7 1 23 VI. ORGANIZATION Griantee: 'The Medical Care and Education Foundation, Inc. 'Room 400 TWO.Center Pl@aza Boston, Massachusetts 02108 Incorporators 1) There are six incorporators and they are appointed by the president of each university having a medical school in the region. 2) Term is until removal by university president, or until resignation, or until removal at any. meeting by two-thirds vote of the total number of members of corporation. 3) Meetings are annually and on call Trustees 1) The trusteeship has 22 members and by law the members are: the six incorporators; one representative of each State Governor; and ten TRAG members. 2) Term is until resignation or until removed by the president of the institution representing. 3) Meetings are quarterly 4) Functions: Appoint members of the Regional Advisory Group, Professional Consultant Panel, and Executive Director, @@king into consideration suggestions coming froi.n the Regional Advisory Group and State Committees; determine basic program and policy in cooperation with the Regional Advisory Group; approve all operational project proposals made to Washington. By law, none disapproved by the Regional Advisory Group can be forwarded; administer and evaluate pro'ects which are eventually funded; ate fiscally responsible agents. Tri-State Regional Advisory Group (TRAG) 1) There. are 63 members and they are appointed by the Trustees' who voted that TRAG shall consist of 21 members of each of the state advisory committee (Area Advisory Group). 2), Term is one-third of membership for 3 years, one-third for - two'years, and one-third for one year. 24 3.) Representation is as follows: Medical School 2; Medical Society'- 3; Hospitals - 5; Practicing Physicians 9; Nurses - 4; Allied Heal,th 2; Health Related - 1; Other Health Education Schools 3; other Health Prof. Association 3; .'Hospital Assoc. - 1; Health & Related Planning Agencies - 5; Voluntary Health Agencies - 10; Official Health Agencies 4; Consumer Representation 11 4) The Chairman is Louis Leone, M.D. (R.I.) Director, Department of Oncology, Rhode Island General Hospital, Providence, Rhode Island 5) Meetings are quarterly 6) Function: Advises Trustees and staff on overall objectives, basic development of the regional program, and its evaluation; sees all operational grant proposals and recommends approval or disapproval, using members of Professional Consultant Panel and staff as indicated; encourages cooperation among institutions, organizations, health personnel, and state and local health agencies; alerts itself to the needs of all areas in the region, seeing that each receives consideration; submits an annual statement to the national office of Regional Medical Programs evaluating the effectiveness of the regional cooperative arrangements (regionalization) established in the Tri-State area. Steerinz Committee 1) There are 12 members including TRAG Chairman and Vice Chairman (14 members in all) and they are appointed by a majority vote of those Regional Advisory Committee members present and voting at their annual meeting. 2) 'term is for two years and until their successors'-are elected. 3) There are four from each of the state Advisory Committees 4) i4leetings are at least bimonthly, and one meeting shall be held immediately following the annual ii-to-eting. . i 5) Functioii; Serve TRAG as its executive committee; shall review all project proposals and make recommendations on them to TRAG; shall perform such other duties as may be assigned; and shall report to TRAG. 25 State Advisory Committees New Ham2shire There-are 21.members and they are appointed as follows: one gubernatorial, one Medical Society, one public health, others as,representatives of health services or professional societies. 2) Term has not yet been specified. 3) Representation is as follows: Medical Society 1; Hospital 3; 2; Allied Hea t Practicing Physicians - 5; Nurses Health Related - 1; Health and Related Planning Agencies 2; Voluntary Health Agencies - 2; official Health Agencies 1; Consumer Re resentation 3 p 4) The Chairman is Donald C. Andresen, M.D., Assistant Clinical Prof. of Medicine, Dartmouth; also, President, New Hampshire Heart Association 5) Meetings are on call 6) Function: Define State health needs and stipulate planning in each',@tate and in local medical service areas; assist -in developing proposals for meeting these needs and express opinions on all proposals involving their own states before these proposals are submitted to Regional Advisory Group. The expression of these opinions is not an authoritative action but merely permits the State Committee to consider a, proposal before it is submitted to the Re-ional Advisory Group; express opinions on the appropriateness of all proposals through representation on the Regional Advisory Group. It is understood that members of the Regional Advisory Group vote:as individuals and not merely as representatives of their states; suggest individuals for appointment by Trustees as professional consultants; work with other state planning groups; advise staff, Regional Advisory Group, and Trustees on special problems affecting each state and on interstate cooperation. Massachusetts 1) There are 39 members and they are appointed in the same way as described under New Hampshire. 2) Term is consistent with TRAG (?) 26 3) Representation is as follows: Medical School 4; Medical Society,- 2; Hospital-2; Practicing Physicians - 5; Nurses - 2; Other Health Education Schools - 2; Hospital Associations - 2; Health and Related Planning Agencies 1; Voluntary Agencies -9; Official Health Agencies - 4; Other-Public.Agencies - 1; Consumer Representation - 5 4) The n, School of Medi Chairman is Lamar Soutter, M.D., Dea cine, University of Massachusetts Meetings are monthly Function: Same as described under New Hampshire. Rhode island 1) There are 21 members and'they are appo inted the same way described under New Hampshire. @2) Term is consistent with TRAG 3) Representation is as follows: Medical Society 1; Practicing Physicians - 2; Nurses - 1; Allied Health 1; Other Health Education Schools - 1; Other Health Professional Associat@Lons - 3; Health and Related Planning Agencies - 2- Voluntary Heaith Agencies - 5; Other Public Agencies - 1; Consumer Representation - 4 4) The Chairman is Melvin D. Hoffman, M.D., President, Rhode Island Heart Association. 5) Meetings are monthly 6) Function: same as described under New Hampshire.. Professional Consultant Panel 1) This panel has no formal arrangements for membership, term, or method of appointment. It is a resource pool of expertise p in the region to be utilized as desired. 2) Function: Advises staff, Trustee, Reaional Advisory Group, Q> and State Committees on specific problems, policies and priorities; evaluates or advises on choice of evaluators on specific planning.or.operational projects; suaaests those from outside the area who will be useful to the Tri. State Program; identifies nqw scientific advances for @IF implementation; defines criteria for best possible care of patients with heart disease, cancer, or stroke. The focus of the evaluation by the scientific advisors will be on the scientific and professional merit of the proposed operations or policies. The members of the Regional Advisory 27 ..Group and the.Trustees make value judgements. @Per'sons from the institutions applying for assistance WI obviously not advise on requests from that institution. Efforts wiil also be made to have persons from other states .-involved. Categorical and Other Committees This Region has established the following ad hoc committees; Continuing Education, Heart, Cancer, Multiphasic Screening, Screening for Cervical Cancer'; and Renal Disease. 28 I-. 'PROCEDURE. FOR PROPOSALS-T Proposals may originate from any group or institution within a local medical service area, state, or regional groups (e.g., govern- mental or voluntary.agencies, universities, RNP units, or similar ions They.@, will follow this route: 1. Detailed instructions are in preparation, but in any case applicant first should discuss proposal with'the appropriate state coordinator, who is a member of the RMP staff. All proposals whould be forma ly submitte to: 'Executive Director' Tri-State Regional Medical Program Two Center Plaza Boston, Massachusetts 02108 -2 After reviewing and further processing, the staff forwards the proposal to an appropriate consultant panel for evaluation of scientific and professional merit and contribution to patient care. .3. Staff sends all proposals which have been reviewed by the appropriate State Committees, together with the comments of the consultant panel, to Reaional Advisory Group. The Regional Advisory Group will a prove or disapprove of the p proposal and attach its comments for consideration and decision by the Trustees. 29 .1. FUNDED OPERATIONAL PROJECTS Project #2 EXPANSION AND CONSOLIDATION OF CORONARY CARE TRAINING FOR THE NORTHERN PORTION OF THE TRI-STATE REGION TO -PRO'VII)E STATE-WIDE SERVICE Objectiv6,s: To expand the Coronary Care Training Unit at the Mary Hitchcock Hospital, Hanover, New Hampshire, to help meet 'the unmet need for the training of personnel, to provide leadership and guidance to other local programs and,to explore new methods of training at, the community level. Project #3 ESTABLISHMENT OF A COMPREHENSIVE INTER-UNIVERSITY CARDIOVASCULAR PROGRAM IN THE DEPARTMENT OF HEALTH AND @'HOSPITALS IN THE CITY OF BOSTON Objectives: To establish a clinical-cardiovascular program to provide comprehensive in- and out-patient care for indigent patients with heart disease in the primary service area, to make this level of care available to patients referred by physicians throughout the Region, and to insure continuity of medical care and follow-up in Boston City Hospital. Project COMPREHENSIVE REGIONAL MEDICAL PROGW IN CANCER Objectives: Proposed by Boston University Medi.@al Center, project envisions two goals in its operational approach: (1) Resources of the Boston University Medical College and seven hospitals will be utilized to create a teaching,. training and patient care atmosphere; (2) Provision of a geographically distinct and identifiable cancer-unit at the University Hospital.