D E P A R T M E N T 0 F H E A L a' I i, E D U C A T I 0 N A N D W E L, F A R E Health Services and Mpntal f-lealt-h-Administration Division of Regional Medical Progr@ Nationa-i Advisor--y Council on Regional Medical Pr-ograms Minutes of the Meeting July 28-29, 1970 Parklawn Building Conference Rooril G/H AND WT-,;Lt"@@' National Advisory Council on lief-Y ,,Ioritil. Medical Programs Minutes of the Twentieth D@eeting 1/ 21 July 28-29, 1970 The National Advisory Counci'l- on ReFiotial Medical Programs convened for its twentieth meeting at 8:30 a.m., 'Riesday, July 28, 1970 in Conference Room Gl@l of the Parklawn BuildititT,, Roci@ille, r@yland. Dr. Harold '4u,gulies, Acting Director, l@ee-,ioi-ial Medical- Program Service presided over the meeting. 'ITie Council @rrbei@s present were: Bland @l. Cw-mon IX,. I,-khund D. Pellgrino Dr. Fdwin L. Crosby (7/28 only) Dr. Alfred M. Pop@a Dr. Michael E. D--Ilakey (7/29 Only) IX,. l@ussell B. Roth Dr. Bruce W. Ever,ist Dr. i@ck I. Sliar-iholtz Dr. William l@. Iltitit Mrs. Fi-orence R. Wyckoff Dr. Alexander M. Mcl'iie(iran A listing of fiMP staff Ambers, and others attending is appended. CALL TO ORDER AND OPENING RFI@S The mt--eti@, was called to order at 8:30 a.m. on July 28 by IX@. Harold Mareulies. qhe Counc:Ll irK-,rnt)erc--, were welcomed t,c) tiie new Conference facilities in the Pai-kl-aiiri Buil.diri@, and the i,@,riei@aL @r-aiii-,eim@iits for the condLct of the rn(,etinr, in these facilities wci.@ (@xplained. Dr. Mar,pulies announced I-LL-s plans for an executive session with the Council at the close of the first (lay of the meeting. Proceedlngrs of meetiziE,,s are i@Osti,j-(@ted unless cleared by the Office of the Administrator, 11")@,IJIA. The r@et,,tt,ictioii relates to all material submitted for discussion at the meetings, the supplemental material, and all other official documents, including the af-,(,,tOa. F,'or the lecol,d3 it is noted that absent themselves from the ancient,, when the CC)UIICil is applications: (a) from their respective institutions, or (b) iii which a conflict of interest ,might occur. Iiiis procedure does not, ol' coui,L;c,,, to en bloc actions otil ]Fort. ,v w@ien the application Is widei,, (Jiscuss' IT. Iffi-liC)DUCq'ION OF @r@C@14 @, 31-',13S Di-. Plm,,@-illes introduced two new c)[' t,lic? Council who were in attendai-ice for this trioetlni- M.D. ,. 'lliey at,(,: W.I. I L.L@un li. Ilunt., a Coiinitissioner, of tYi(@ County or Alle@-jit,tiy lti Pennsylvania and medical practitioner in, McKeesport, rennsylvaiiia,- and'Aiexandei@ M. McPliedran, M.D., Associate Professor of Internal i@edicine (neurology), F@ry University School of @Medicine, Atlanta. 'I'he recent appointment of ivt,. C. Robert Ogden was also announced. Mr. Ogden is President of the North Coast Life Insurance Co,-.Vany in Spokane, Vlashi-rirton and Chairman of the Washington/ Alaska Regional Advisory Gr@up. lie will begin his regular attei-idance at the next meeting,. IV. lUi:GIONAL NEDICAL PR(VTRAMS AS A PArTr OF '-PIIE JU@'ALT7i SERVICES AND Nlfll['AL I '@irti ADf;IINIS'I'f Vernon @ll son In his first meeting with the Council as Administrator of the Heal-th Services and 14ental @ledltli Administration, Dr. Wilson recalled his long interest and first-liand involvemiit in the developii-ent of Regional Medical Pr-ogram . He assured the Council of @iis stro@-, support of Regional @ledical Programs as a part of t@ie broader effor@ts of IISMHA; He expressed his endorsement of' the principles of decentralization of the adNdni.stration of fIS@@T-LA activities E,,enerally, and his belief that the concept of Regioi-ial @edical Programs car relate well to these principles. Altliouf-,h the mchaiiisiiis will. be worked out slowly, he is confident that-this can take place without dilution of effort, either, in the Regioi-is or in the headilliai@tei@s office.- In recok7iition of the very formidab I)i,obl@@ins facing Regional D4edical Programs Service, Dr. Wilson expressed re@t that lie was not able at the present time to resolve the ii@t,joi, staffinf7, problems . He assured the Council. this has v@ry Iiii-Iii priority oi-i his working agenda and the fact that lie Is as yet unable to report does not indicate that he is not actively working towar@(-i a solution. Dr,. Wilson asked the Council to meet with liiiii again in approximately six to eiFht weeks, in a special on@ay session. At that him he is assured he will- be able to discuss his plans, as they are based on those of Secretary ldcliardSC)n, for tiie orr,,@ii!Lation and administration of the Department's efforts to sti@etip,,tlieri and increase the nation's capacity to deliver health services. fie indicated also that by that time he would have more definitive plans for the staffing and oi@ganization of the Regional Medical ProE,,ranis Service. AltlioLt,,@li 1-iis plans will include a ,,,,c,iieral outline of the "Mission of Regional i@ledical ProfTanis as a part; of the IISNUIA effort, Dr. Wilson said that 1-ie would rt?ly heavily on the advice wad oiidance of the Council for developino- the policies and detailed program directions C, - that would lead to even rc)i,e o-f"C(@,otive cooperative arrangements between the private,see'Llot--, wiii-cli tli,@,y represent', -i,,-id the Federal effort. 3 Dr. Wilson told the Council of the resignation of Mr. Irving Lewis as. Deputy Administrator of and about ,',,Jr. Lewis' appointment a@ Professor in the Department of Comianity Medicine at Albert Einstein College of '4edicine in New York. @Ir. Lewis addressed the Council briefly, stating again his faith in the Rt--gional, l,4edical Program as representing "the only concept of true regio.,Ialization of health services that can be expected to work" in the United States. P4r. Lewis expressed his thanks to the Council for the many pleasant working relationships he had had with them. 14rs. Florence ',gyckoff responded for the Council, expressin,- their appreciation for his Assistance to them, especially in helping,tbem to understand the principles of Federal financing of health care and in the area of health economics generally. V. CONFI@TION OF I )ATES Council was apprised of the necessity for reverting to a system of four meetings per year in order to accommodate the changeover to Anniversary Review. Two new Council dates were set: November 9 and 10, 1970 and February 2 and 3, 19'@l. In addition, September 30, 1970 was set for the special meeting requested by Dr. Vlilson.,,. The Council accepted the invitation of Dr. Edain Crosby to hold this meeting at the American Hospital Association headquarters in'Chicago. 'Pliis will enable more of the members to travel to and return home from the meeting in a single day. VI. CONSIDERATION OF TfiE@ @lIliUrES OF L71L @,vl,'icll 31-APRIL 1, 1970 PELTI14G The Council unanimously recomende(i approval of the minutes of the meeting of the Council on %@cli 31-Api@il 1, 1970. ifTI. A RE-POriT FROM TIE, DIPECMR - Dr. fim,old Margulies A. Profrress of I-IR 17570 and S3355 Dr. Margulies reviewed the contents or the twc Bills very briefly and referred the Council rwTd)ers to @i analysis prepared by staff which compares the Bills to one another -Lli(i to the present legislation. This was included in the agenda materiafo7. B. Appropriations for Fiscal Year 1971 Status of the Appropriation Bill was reviewed and the Council was reminded of the various circumstances which impinge on the tota-l- amount of "i-iew" funds to be available for- major expansion of Regional lledical Programs in FY 1.971. Among these @u,e the $1.9 million earmarked for ',Iodel Cities activities - the ].% i,esc,,,%,e of funds to be used for evaluation activities at DHE,W, HSDIIA, and R@S levels; the possibility of wlministrative "earmarl-,ing" of some funds for W participation in con4)rehensive regional kidney disease programs; all in addition to a total amount slightly in excess of $77 million required to meet ndnimal continuation requirements of ongoing regional activities. C. Funding Strategy Dr. Marmil.ies made a brief introduction of a new management ii-iformation system being inipleinciited by l@TS. Ile also noted the effect of the 1969-'To strategy of permitting Regions almst unlimited rebudgeting of wiex@)erided balances r program expansion. Dr. @lai,i7,ulies stated his intention to begin to apply more stringently guidelines to this kind of rebudgeting and to recapture so@ of these balances for reallocation among the Regional Medical Programs In response to evidence of successful regionalization and pro,@arn development. D. The FAST Recormiendations In a brief review of' the recommendations of the Federal Assistance -and Streamlining Task Force his plan for responding to them, Dr. .@gulles emphasized the "liaison" role of the DHL@ Regional Offices in the development of IIS,,4HA progr-@- F,(-@nei@ally, and in helping to relate Regional Medical Programs to both publicly and privately-ftmded proi7ams in the area served; but with the Retention of the principal manaF,er.ip-nt responsibility in the Re-ional ',Iedical Program Service at the national level. Ile also mentioned especially the Service's concern, antedatinr the Task Force study, for better delineation of the multiplicity of activities now covered by the core budget in Regional @ledical l@opain grants. Dr. Margulies explained the intent of 13MPS in placing, a Program -t Representative in each of the ten Dlil,:W Re@@-Lorial. Offices and described what he sees as the service role of these individuals. VIII. PROGRFSS @@OTES T,'ROM c)'I'A-P7F A. Contracts wider Section 907 - fx,. Sloan @-. Sloan gave a brief review and sttLus report on the three contracts made by the i,@irs wider the terms of ;cction 1)07 of Title IX of the- Public Itealth Service Act, which deal,; with the 11... list or lists of facilities in the Unital States equipped and staffed to provide the most advanced metl-i(xis and techniques in the diagnosis and treatment of heart disease, cancer, and stroke ...... 'iiil- contracts ',-,lie As@,ociat-,ion -.n support of the Intersociety Coimission fot, heart Disease Resources, has 5 begun serial publication of its report and will continue .to do so throughout the period of the contract. The Joint Committee for Stroke Facilities, supported by a contract with the American Neurological Association, has chosen to withhold publication of its report until it is entirely completed. . The report of the Special Advisory Committee on Cancer Care Facilities oil the Cancer Coitaiii.,.3sion of the American Colleir ,e of Surgeons, which was sul)poi,ted,under a contract now completed, has been reviewed by the Regional Medical Programs Service and was received by the National ACvisory Council at the April 1.970 meetit@(-. Negotiations between the American College of Surgeons and the RMPS, preparatory to completion and @1P approval of this report, are now underway. (This was discussed in more detail with Council during the FLxecutive Session). I B. P4ulti-@,o@a-7-fi Services lIro@ect Grants - Mrs. Martha Phillips Authorized under Section 910 of Title IX of the lUblic Health Service Act, this program of project..grants will be implemented for the first time early in FY 1971. The Council was reminded of its original role in the development of the basic guidelines and operating policies for these grants. I'hey were assured that these are reflected in the final edition of the program documents which are i-low'in clearance. 'llie Council expressed its persistent concern about the potential effect of the funding of these grants on the total funds available for Section 904 grants (operational support to Regions). Dr. Margulies said that he expected to be able to present to the Council at its next meeting, a plan for allocation of grant funds that would take into consideration an appropriate distribution of the available dollars between these twD major grant activities. C. Regional Medical @-o@cims in Model Cities - r@,. Cleveland Chambliss. The Council was reminded of the administrative earmarking of 1.9 million of llP4P Fy 71 grant funds for use in I)i@o,jects which have direct impact on certain designated Model Cities neighborhoods, Mr. Chambliss outlined the procedure for determining the def,7,ee of such impact and obtaining the certification of Model Cities officials in this regard. Although this procedure includes endorsement of Dlil,,W Regional officials, Mr. Chambliss assured the Council that the procedure would entail no authority for further review and approval of these projects beyond the local Regional Advisory Group and the National Advisory Council. Al.so in response to silecif-ic '@-Lt,,.-Lilies e,,@plai.,ied that Regional Medical Progranis which are planning and submitting projects to 6 serve urban popul@;ions need not plan them exclusively for Model Cities areas and need not seek any endorsement or concurrence beyond their own review and approval mechanism. D. Senior Clinical @aineeships - Mrs. Martha Phillips Mrs. Phillips recalled to the Council -,he circumstances leading to the Departmental decision to place responsibility for the Senior Clinical @aineeship program in Regional Medical Programs Service. She also reported to the Council on 'the selection of the first group of @ainee8hips to be awarded under IM-IS sponsorship. 'niis selection process was carried out by panels of noi-i-Fede@al experts in the caficer field aiid was chaired by Dr. Michael FTennan, to whom the Council delegated authority for the selection of individual trainees to the total extent of $3003000 of FY 1970 funds. q'hirty trainees were selected from among 80 applicants, and represent tie disciplines of medicine, gynecology, pathology, pediatrics, radiology, and surgery. The training will be done in mjor @dical. centers throughout the United States. 1 E. Guidelines for Instructional TeclinoloLV - Miss Cecilia Conrath A second edition of these guidelines was before the Council for their consideration. Dr. Pellegrino, who served as Chairman of the Subcommittee to prepare these guidelines expressed his belief that they are now ready for publication and implementation, with certain rewriting. This is being done by TU4PS staff, incorporati.i-i., I)r. Pellegrino's suggestions. F. I,,valuation Activities - Mr. Roland-11(@lu,ei,son i , In reporting to the Council, Mr,. Peterson Mentioned the final summation and distribution of the Regional Progress Summaries which resulted from the questionnaire developed and tabulated by his staff; on the Regional Medical Program Evaluation Conference to be held at the University of Chicago Conference Center in September; and on his plans for evaluation activities in Fy 71 which will be chargeable to the "evaluation earma-rk.11 This earmark was explained to the Council by both Mr. Peterson and Dr. Margulies as a 1% administrative reserve to be used for evaluation activities not only at the program level., but also at the level of li@ DIIF,vl. It is anticipated thit something slightly under $1 million could be set aside under these circumstances and could be used by contract or by the Section 91.0 grant mechanism, at the discretion of RMPS, with portions of the total withheld for @EIA and DIIEW evaluative activities. The entire matter of evaluation sparked considerable discussion in the Council. It was the consensus that in order for these funds to be effectively utilized, a much broader concept of evaluation must be developed. There was a good deal of discussion of the contract with Arthur D. Little, Inc. and expression of considerable doubt as to the real value of any find--@s bero- reported. Seve.11.@li of the ("owicil have had individual experience L 0 wit@l the conduct of the contract activities and feel that the@have not alway.s been handled in the best interests of the Program. There was unanimous agreement with the suggestion, made by Dr. Roth and Dr. Cannon, that interim reports on the progress of such undertakings, either this current one or any future such contracts, be required and that they be made available to the Council for review and discussion. The Council requested a more definitive report from the staff on the results of the contract, particularly as it relates to the purposes for which the contract was ori ginally let. They also asked to see the final report from the Arthur D. Little, Lac. as soon as it is i,c@eived by RKFS. I I In s izing the discussion, Dr. Pellegrino suggested that all evaluation activities should, in the loi e to test Th-e viability t. IX. KID@ll,,Y DISEASE ACTIVITIES IN RF-GTOW-IL nll)TCAL PROGRAMS Dr. Marirulles reviewed for the Coiiicil the circumstances leading to the addition, In both the House and Senate versions of the continuation legislation, of kidney disease as one of' the specific disease categorical targets of Regional Medical Programs. face aske(I f'or guidance of the Council in the development of..a.responsive and effective policy for Regional Medical Prbgral-,is participation in comprehensive regional kidney disease programs throughout the Natioii. Ile is aware- that the final definition of such a policy, especially as it would apply to the immediate future, will not be possible until after Congressional action, on both the continuation legislation'and the appropriations, is complete. In order to provide some background for tliei,i.- deliberation, Dr. Margulies explained that he had asked the staff to prepare some basic information p--,r lines. These were part of the and to draft some su ested policy guide agenda materials presented to the Council-. fle then introduced Dr. Georp,,e Schreiner, Chief, Nephrolof,,y I)ection, Department of Medicine, Georr,etown University and Di,. Richard B. l,reei@i, Department of Medicine (NephroloF.y), University of Rochester '@,claool of Medicine, whom he had invited to the meeting to provide expei-t reference to the Council in their deliberations. Dr. Schreiner made a detailed presentation of the "state of the art" of the management of chronic kidney disease. Ile included resume of the techniques and methodologies of screening, diagnosis and therapy; and the shortcomings as well as successes in pi@evention, treatment, and rehabilitation. Nephrolo@ is, Dr. Schreiner said a new area of specialization. As such It has the disadvantage of a severe shortage of trained specialists; but has the advanta@e of having few established traditions, and is in lulio enviable posi.tioi,@ @i' ',,and al)'-e t@ Proi@,l tY,,e mistakes made in establishing resources f'or open iiearu III-gli voltage radiotherapy, e'.- c . 0 8 Organization for the delivery of servies to patients with kidney disease, Dr. Schreiner believes . lends itself so ideally to regionalization that the'develop@nt of such a program can @ will serve as a framework for regionalization of' services in other more traditionally established disciplines. Again, as in nearly all their past discussions of kidney disease, the Council expressed concern about ',-lie tpl)arent lack of emphasis on prevention as part of an overall kiciti(,,y disease program. Dr. Schreiner and Dr. @et--iTnn believe that thc, onlv hope for real prevention will come via prenatal care and " @netic eric-riiieering" and although work in these areas is progressing, it will not ha@e any significant iirpact for fifty to sixty years. They also believe that the more traditional approaches to prevention generally will not be seen to be effective for at least 20 years. Both Dr. Schreiner and Dr. Freerran spoke to the issue of the cost of developing regionalized kidney disease services; and the way in which the,enormous numbers often used in this i,e.@ , d have been misleading and discouraging to institutions and con-iniuilti-es. Both agreed that the $15 million mentioned in the pending lc,),,!.sl.ation could make a significant difference in the extension of services of' existing kidney disease centers or in the establishment of some smller number of entirely new ones. Dr. l@p-ulies reminded the Council that the $15 million to which the Bill makes reference, is recomended as a maximum ass!F,n-nent of Regional Medical @oFr@am f;rarit funds to kidney disease efforts, and in no Aay earmarks or lijn-Lts any dollars exclusively for this purpose; nor does it provide, or even i@ec(3r=ei-i(i the provision,, of funds over and above the grant nz,,(is to be otherwise available for purposes of Regional Medical Propyains. Dr. Everist raised the question of the mechanics of incorporating kidney disease prog@ams i.nto the 55 @e@@l.onal Medical PropX@ if the principle of local autonomy and decisiori-makir r maintained. -4, is to be -1 It is his belief that unless and until Ilerions with appropriate existing facilities can be "seduced" into affording, high regional priority to kidney disease control, it will be necessary to use the Section 910 authority, so that national directives may be used to develop "sensible prof-g@ains in sensib.Lc, places.'' Accepting the apparently inevitable I-ai,, time before the results of a planned prop-ram of prevention can be felt, Dr. Pellegrino asked for the advice of Dr. Schreiner, and Dr. @@eeman on @ihat immediate impact Regional Medical Prop.Tan-ts could reasotyib.ly have, considering the - provisions of the proposed legislation and within the amount of funds that are likely to be available within the next two or three years. Responding first, Di,. Schreiner recoriiiierids the stre@, heninf, of existing facilities, particularly those which have committed theriise ves to outreach beyond thin confines of the center within which they exist; an@,d fu.,,'L-"I-,er identifying this group @@,liat lend the,@ 9 salves to further interlinkage to provide a multiplying rather than simply an additive effect. Dr. Freeman recommends the support of the completion and extension to full services of a small number of centers which can be developed on the basis of existing, although perhaps not entirely complete, resources; the use of RMP funds for support of planning, particularly in i,e,@ to increased effective utilization of expensive resources; and the training of personnel, principally physicians, who can serve to train others (other physicians and paramedical personnel). The Council strongly endorsed Di,. Mcl,liedran's'point regarding the importance of thoughtful integration of a kidney disease program into an existing Regional Medical Program; particularly in @,lanning, sub-regionalization, continuing education, and inter-professional communication activities. In a subsequent discussion on the second day, the Council members reflected on the recommendations of Dr@. f,reenan and Dr. Schr@iner as well as on the goals, objectives, @id the basic operational concepts which guide Regional Medical IlrograiiiL-, at the present time. Since these proscribe against the use of funds fathe direct provision of patient services, and the total amount of funds likely to be available will proscribe against making majoi, contributions toward the establishment of facilities,, the Council agreed that the major focus of fU.IP involvement will be (a) the encouragement of better and more effective cooperative arrangements among carefully selected institutions and resources vihich together might form @i "decentralized center" and (b) in the strengthening of existing institutional resources competent-, and willing to develop outreach., both in the demonstration of service and the training of personnel. Both of the above requii@e national as well as regional planning. In summary, the Council. endorsed the general plan presented by the staff; they also agreed, however, that to develop a workable overall policy it will- be necessary to have basic data concerning the resources. in, and available to, each of the 51-) Hegional Medical Programs. This should include (a) presently ,@elf-coritained centers, (b) institutions which have the capability of becoming an integral part of such a center, arid (c) institutions and resources which nd@it participate in an inter- regional arrangement for the provision of kidney disease services. An assessment of the "size and si-iape" of' the kidney disease problem in each of the Regions would provide the other essential piece of basic information. Dr. Nlargulies agreed to provide these data based on the existing geographic pattern of the 55 Regional :4e(iical l@oF@ram. X. RL,VIL;ll OF APPL,ICATIONS A. Issues Identified 1. In the matter of PUMP support Of.' 31-toi,t-tt@iiii train@, projects, the Council considered the hista,-y pi@c)vicial them by staff, and a number, of specific projects included in the appli.cat';oiis under review at this L meeting. @ey be'-!-eve tl.iat ifinder most cii@cumstances'it is not necessary or appropriate for Regional Medical l@ot7-ams grant funds to be used to cover the full costs of both the presentation of short-term training proje cts and of stipends and expenses of' the participants. The majority of projects in this category provide opportunities for Up- -@ading and development of new skills in special techniques or procedures and are directed to individuals preserit-Lv employed in health care institutions. LIndel, the circumstances these institutions should, and I .1.n most cases do, make regular provision for this kit-id of training for their, staffs. 'ibe Council therefore recommended the f'(@l-iowi@, changes in policy guidelines reg,,L@nL),, Payments to participants in continuing, education and tral-rii-ii- projects (as defined in the Guidelines Addendum, February z::, 1970, page 13) which are supported by lierioiml i4edical Program grant f)-mds. Regional Medical Pi-oLTam p-.r@atit, i -,v not be -,tsed for the na- payment of stipends, either dir@ectly oi- on the "inaintei-iance of income principle," to participants i.ii continui@., education and tralai@- projects. does not include training for new careers f'or new t ,ypes of peT,soruiel.. Other allowable costs of parti-cLpitit' ',,; support may be calculated accor@-Lr4r to the existing Regional Medical gxa-tit funds may be r@equesl,t@i -itid awarded for per them a-rird travel. to the extent of' 50% of' ti@l(@ t(,TLal- amount so derived. 'ihe awarded funds may then be paid to the enrolled trainees as considered appropriate by the project personnel., depending on the participants ability to provide these costs foi@ t-.It(,riiselves aiad/or the willingness of their e=lc)yei,s to provide them. @io si.ritTle individual may receive per diem or travel allowance -it a rate higher than that prescribed by the present Guidelines. I'@.IP funds may not be rc@btidgete(i, t'roiri within or without the pr,oject budiTet, to increase the total. wtic)unt awarded for per diem and travel above the 50 level. 2. 'I'@lie Council considered the presents @@,Ll-i(ieliries regarding, iie-ional Medical @'0,1@l:@@TI of I)roj(!ct's of' post-doctoral- training, at tire senior resident it-il iDost-i,e,,31(i@,ri'L, .].evels, Particularly in the clinical sub-svecialties of' iriipoi,t@)nc(, patient management in the diseases tar@,eted by Regional @ol(-,dica.l. As has been pointed out by both the i-@evieiq CormLittc,,e and the ('OL[I-IC@,i I, Requests for support for tr,ai.ii.l.nfr, of' this kind are appt?ar@it4@ ritL)i,c@ and iilc)r,e frequently in Regional Medical. a@)pli,@,it@Lons; b(,c,.iii,-,(- of' the critical but aiso bec,,aus-@, (:f' the dx-astic reduction in NIH fund@,, which has previously been available for this purpose. 'Die council @iimously agrees on the importance of maintaining the training p-rop,rams In these fields in the major teachim centers throughOUL" the nation. fundi@ through i-,egiortal i.,Iedical ProFrarns would serve They also agree that to strenp-t@ ential...involverri-nt of th( ol' clinical @6e-llence into the @@aj,,,ework of cooperative arrq_@ments which form the basis of the Rev-ion of which they are a part. It is recognized, however, that the allocation of an amount of funds large enough to make a significant impact, if provided from the present i@IP appropriation, would create a serious and inappropriate imbalance iii the iiMP efforts to meet more their varied @ii-id conipi:,e@ic@tisive trc)als,. '-Die therefore, i@eaLiested the R@,IPS staff to forw,@.-.u,d to both @iti@i i@illi,,W, s w n that ai-,r,-wireiTiet-its be made, to eral as@-I.sl tments in iiii,lot@ teaciiirV, centers to offset-, the !.(.ienti.fiab- ovis on f v WI 0 1 above the curre s be sour@it for tl-iis purpose Accordingly, the Council recommends tly-t until such funds are added to the annual appropriation, the Regional F4edical Pr,ot,@ain Guidelines for operational iWants under Section 9011 ol' 'title IX of the PliS Act be changed to exclude the payment of stipends a-rid other participant costs for lonf,,-term training at the post-cloctoi@al level. 3. The Council is keenly aware of' ttie I)otentially crippling effect on Repional Medical Prop7,ams of contin(@ti@, investment in projects which were initially approved f'oi@ demonstration c)t' ; in, new tecnniques. of patieit care, but orovide what s ,:ui essential service to patients. 'P.@ey con ver, tell it would be L!nWise impossible to develol) a firm policy ax,bitr@arily. including or excluriing projects of this kind, and instead ur,,,e the i@4PS staff to work closely with Reo-loris, as they develop projects, to be certain that other sources of support for maintenance of the seivi.ce involved be well in hand before such a project is initiated; and al,@o to encow,age Regions to carefully investigate every possibility of' capturing the fees paid for the service involved, for reinvestment in the project. B. Special Actions ICA[, 11'@ OIIIO 1-U,,CIONAL In response to a special appeal for reconsideration of previous action on Project #7 (A Coripreliensive oa-@)atient "Itroke Rehabilitation Demonstration, the Council considered t@ie additional information submitted and recommended that the project be approved as requested. 01 03 - $26,076 NO@ NDS @IONAL @',EDICAL PROGRA!4 Th6 National Advisory Council considered a request for the initiation of interim support to the Diabetes Detection and Education Center in -Minnea,oolis with the understanding that (@a) these funds will be Tade available from the Region's unexpended balances and (b) that this approval does not in any sense indicate commitment to approve the forthcoming application for H4P participation in the long-range basic .support of this Center. VIRC.'INTA RF,,GIO14AL D)U7DICAL PROGRAPL In regard to Project #11 (Stroke in a @)niall Rural Community) the Council concurred in the staff Is recommendation for a waiver of the restrict ons inposed as a condition of the original approval of this project, subject to the satisfaction of ftl@IPS that the purposes of the project are being adequately achieved. WFSTERIQ Nf,,Vl YO.@ t@,GIOI\IAL MFIJ)ICAL ["130(,'IiM In regard to Project #10 (Western 1,4ew York 'i@r Registry) the Council concurred with the Review Com,-attee's recommendation for continuation of the project as w-nended. C. Recoinendations for Action The Council recorded their 'recommendations in the format which was adopted in the previous review cycle (Appendix I). ALBAt4Y 'rU,GIONAL PJTDICAL PROGr-,Xl R',l 000011 7/70.1 - 4)eratiorial Suppleiiietital - Approval with specific conditions. Project #7A(R) - Approval I with the conditions specified by the i@eview CoiTDnittee. Project #7B(R) - Approval I with the conditions specified by the Review CoiiaiLittee. Project #18 - Non-appro%,al II - Revision Required. 01 - $36,930 02 - $36,930 03 - $0 1/ All amounts are direct costs only arid unless otherwise specified refer to a 12-mntli period. 'I'he desir@lation 01, 0,1, etc. i-o'la",-es to the t'irst, second, etc. . budget periods of the subject. ipplLcati,on, not necessarily the budget periods that will actlial-ly- e@suppTe@nted. 14 @ect P56 Approval I Approval I in the reduced amunt Project #bl Non-approval I 01 - $107,307 02 - $117,248 03 $121,393 CL.,NTRAL l@v, YORK Rl,',GIO14AL MFDICAL PROGE@,L @M 00050 7/70.1 - Operatior@ t - Conditional approval. Project #15 - Approval I at a reduced level with the conditions specified by the fieview Co@ttee. ol - $4o,ooo 02 - $50.%OOO 03 - $53,000 COLORADO/WYOMIN"@, REGIO14AL KOICAL PliOGRAI,l Rr4 000110 7/70.1 --Ooerational ')uppl(@iiic,@rit - Return for Revision. Project #13,"@ - Non-approval II. Return for revision with the clarification requested by the Review Co@ttee. riLORIDA RF,,GIODIAL @@lC@' PROGRA-M 1114 00024 7/70.1 - Return for revision. Project #36 - Non-appr-oval II with recomendations for revision as suggested by the l@eview Co@ttee. GFORGIA REGIONAL @1LOICAL PROG,9AM @,l 000)16 7/70.1 - Conditional approval. Projects #31 and #32 - Approval in the reduced amount of $100,000 to be used for the initiation of both projects as seen fit by the Georgd.a Project #33 - @lon-approval I. 01 - $100.1000 02 - $100 3000 03 - $0 GRF,,ATE,R DELAA4,L',IE IIALLI@,Y RF@IO@ 'U,'@)TCAL PROG@N .RT,l 00026 7/70.1 -.Disapproval - inappropriate for i@ funding. Project #19 - PNon-approval I liAVIAII RECTIONAL l@,lh'DICAL PROGRPJ4 RM 00001 7/70.1 - Operational Supplenieit Approval I-Iro,jec #21- - Approval I Project #22 - Approval I 01 - $202,7113 02 - $99,168 03 $lo8,252 ILLINOIS RL@'GlOtJAL @'ff-IDICAL PROGRAP4 00061 7/70.1 - Approval with specific conditions. ri-oject # 9- Noti-appix)val II with the recotTyneridations for revision suE-,,4,,ested by the Review Coimdttee. Pro,lect #10- Approval I Pmject #11- Approval Iwitq the conditions specified by the Review COII#Tdttee. Project #12- Approval I - Appr@oval Iwith tli(., (,oriditions specified Project #13 by the Review ConrCLttee; with second and third year funding contingent upon progress in the f'ir@st year to be assessed by the Council on the basis of' a progress report, continuation application, and tli(, report of the technical site visit to be held soii)etiiiie toward the end of the first year. 01 - $5871412 o2 -$661.1237 03 - $341,883 INDIANA RI--.'c3TONIAL YEDICAL PR@)GM.1 R@l 000113 7/70.1 -Operational ")upl)leitri-it - Non-appi,oval Proje-.t #19 -l@loti-appi-oval I inappropriateness for@ fld4p f'wading based on the Couricills decision to defer approval of projects proposing the clinical application of t- ,enetic counselling, pending fai,@l-tiei, scientific validation of the clinical uses of this technique. ect #20 Noti-@ip@)t-ova-L I']- with the recomwndations for revision sufr,r ,ested by the Review Conni:Lttee. INTI-@OLDHAIN @IONAL NR,"DICAL RM 00015 7/70.1 Operational Suppler,,ient - Return for Revision Project #27 ',oi,,-appi,oval 11 @'i t'lie .,@L@cciir;ietidatioiis fOr@ I'E'V-1-sion sued, sted by the ii(?vlew CoiiurLittee. 16 KAtl.SAS REGIO14AL I)EDICAL PROGRAM RM 00002 7/70.1 - Operational Supple@nt Return for Revision Project #39 - lion-approval II with the recommendations for revision suggested by the iieview Committee. LOUISIANA RL,GIONAL @T!,DICAL PRC)GRX.,l @ql\l 00033 'Tl-(O.l -Approval with spc@c-it'ic conditions. Project # 8 - Non-approval II w.Ltii the recommendations for revision su@l@,ested by the lio:.vi(@w Coiirdttee. Project # 9 - Approval I in a Tric)unt and with the conditions specified by the lic-@v.Lew CotiuTLittee. Project #10 - Approval I Project #11 - Approval II ,Project #12 - Nori-approval. IT with the recommendations for revision surf,ested by the Review CoimAttee. Project #13 - Approval II 01 - $147,532 O':-) - $'(7,2112 03 $79,342 i@IATiYLPJ4D RE-GIONAL @DICAL PliOGMl R'4 OOOLIII 7/70.1 and 7/70.2 - C)perail.Lciial Supplepients - Approval with specific conditions. Projects #25 and #26 - Appi,ovi-I. I with both projects to be combined at a r,o@luced airiowit and with the conditions specified by the Review Coniiilttee. .Project #27 - Approval I reject #28 - Nori-appiova-L IT with the recommendations for revision suggested by the !',Oview Conndttee. I-. roject #C'-19 - Noii-.qpprova-L I Project #')O - Noti-approval- I ol - $94,975 o2 - $lllllqll75 03 - $145,975 M4PIiIS RI,7,GIONI\J, M)IC,'kL PliOG,,3AM - P,M 00051 7/70.1 - Operational Stipl)leiient, - Disapproval. Inappropriate for !W fending. Project #@"( - @1c)ti-,qL)pt,ovai -r. w@i,-@ in ci,,c@ref?ment v@Ltli the Review CoitiiiiLtc,(- i.ti for the Peripheral Vasculat, Cliiiic Eli@oject. 'ITiey wish, however, 17 MI@qPIIT',' F@[13IO14AL I-TI-L)I@CA @Li PROGIiM@l (CO@4'i to be certain that tlie project personnel and the Mo-,nphis IDIP under-It,@.,i that trie recommendation in no way reflects a (J'i; -if@eirent with the inherit service value of the Clinic nor sued, sts lack of confidence in the staff and Institution. The action does not preclude i@stibrnission of a request for R@IP funding for the continuing education aspects of this project at such tirw as these are more thoroughly planned and ready to be irrple@nted. Project #28 Non-approval I .@@ROI"OLI'rAN @IASIIII4(lill.'ON, D.C. RL,'GIONAIJ %Ifl,"DICAL Pr-,O(Ij@ F,,Il 00031 7/70.1 - oe-ratio0nnaall SluuoPplleviii-e@@n@t' - Approval with specific conditions. Project #3(') - l@oii-ap oval I .pr Pr,o.ject #_i( - llpproval I at the te(-Iuced level and with the conditions specified by the Review Coinniittee. 01 - $38,1177 03 - $44,928 ,MICHIGAN RF,@GIONAL ,LOGICAL PR@)GRAIL RM 00053 7/'70.1 - Onerational Supplerrent - Approval with specific conditions. Project #16R - Approval I Project #@( -Approval I with the conditions specified by the Review O.ondttee. In cotictir@rinE, with all of the recommendations of the Re-view COITUldttee, the Council urged the H@TS staff to work closely in the development of this project with the hope that it will come closer to a dei@nstration of coTrprehetisi.ve care, as promised by its title, than it would presently a@)pea-i- to be. Pro'ect #28 -Non-approv@il II with the recommendations for revision sti@, sted by the review Coirnittee. 01 $550,970 o2 - $)I@11,5711 03 - $1177,459 MISSISSIPPI @@CIC)NAI, iNTiDICA!, Pfi()CTW@l P,M 00057 7/70.1 - oratiOnalL '-'3,uul))pl'Le'I'TTCI-lt - Approval with specific conditions. Project #2R - Approval in the reduced ajWLirlt for 18-months with the conditions specified by the Review Condttee and with the understanciirif, treat this will represent the termination of' @IP fLirlditi@@ or til-@Ls @)-C'L,iv--Lty. 18 nl,Q,SIS,O)IPPI REGIONAL Nff,,DTCAL PROGW,,@t- Project #13 Approval t ct #14 'Joti-appr-oval II tiie recommendation ttial-,ttie I-,e(,ion @@,i e C-1 be i@equested to their piori,aiTi in the litjit of the 14ational C@ii(ik,].ities for l@-vil) participation in comprehensive kidtit-,y disease prc)Fjains. Council further 'r,ecojmietided that the ]Lee irect help by ,ion be afforded d the staff of 94P,'.', Li-i tialcing their decision in this regard and in plaii@ii.iii,; a rev!-si-on if such is to be proposed. 01 $213,1120 o@ $125,9lt6 03 - $39,455 ]@'f!IONAL-@ID.@:DTCAL I'I-VGPAAI I:C4 00009 7/70-1. and 7/70.;? erat-,!.oti,@] SuT)@)leriient Approval with specific conditions. Project #60 -14ori-approval II Project #61 -Non-approval- II. Altliou@ji the Council ap7eed with the Review Committee that tlies(:, two projects, as presented., are w-lacce table t(-)i@ iieriot'i@il D4edical ProEX@@ support, . 1. P they recalled the i@ecormtpiidations of the recent indepth site visit to Mol"Il' ,-iiid stir 4-,(--sted that with staff help from both liTilPS wi(i these "outreach" projects could be developed into irtpoi@tarit components of the Program. Project #62 -Approval 'I in a i,(.@dticeci wiiouflt arid with the conditions specified by the l@,C!view ('oiinTiittee. Project #63 -tloti-approval II - 'llie Council i,eco@rids that this project be iritef-,inile(i Into the Region's overall continuing education effort !it tl@e preparation of the Region's Aiuilvei-sary tievic,w application. ol - $330,"113 o@ 36,9814 03 $"'9,165 @4C)LJN.PAIN S'.FA!.rf--c') f@,',GIONAL P@,'DTCiVL lllx'OGIAM r@M 00032 7/70.1 - Operational Supp-I.eilK@tit - Approval Project #11 - Approval I Project #13 - Approval- I ol - $184,97(- o@) $191 $197,8011 )117 03 NI,M DE@:XICO @' ION.AL PIEDTCAI, PfiOCj'l@4,1@l @,l 000-4 '@/-O.l - opera'Llioiial f@)provaJ- specific conditions. Pi,oj e c t//13 - f@ori-appi@oval. -11 19 NM, I NEXICO REGIOINAT, IT,',DICAL PROGRA:,' (COilTL r@roj ect #14 - Approval I in the l@-dLIced amount ar-d with the conditions specified by the Review Committee. Project #15 - Approval I with the conditions specified by the Review Committee. 01 $92 100 O', - $99,900 03 - $101,765 tJf@,Vl YORK @,-'GIONAL I'IUGPAII@,q R4 000')c@ '(/70.1 and 7/'(0.2 - @)ei-atJ.oriil Supplements - Approval with specific conditions. @-oject #16 Non-approval 11 with the T@ecorruiit@tiQiations for revision suf--g(!sted by the li(-,vi(@w Coitunittee end with the advice that the Region (reform further pl-cgniinr, for ff,,IP participation in disease services in the New York Metropolitwi Lu,ea until they receive the national policy f- ,uidelinc,s @qlilcli are in preparation. @ject #17 Approval I. 'llie Council based its recommendation on the findings ",of the site visit team whlch had visited the project on the a(tv-1-ce of the Review Committee. Project #18 -floii-approval I Project #19 -Approval I 01 - $1176.1][7t) o'l, - $49'i,965 03 $3501000 NOI','171 (Aff)LINA FU!,GTONAL [VUDICAL PROClAr4 f@4 oooo6 7/70.1 - Operational Ful)l)len@iit - Approval with specific conditions. Project #3j'i - Approval. I Prolect #26 - 1-4o Action 'Paken. ')Ite visit required. o@ 01 - $89,908 -j,62,550 03 - $42,306 NOR[ii DA@,UPA IU@RIONAL li',IEDICAL I-)Fio(iiihm RN1 00060 7/70.1 - Operational Stippl.eiiierit - Approval with specific conditions. Project #5 - Approval I pproval 1. Aitlic)Lit,-Ii ('our-i(,-Il was in general agreewnt I with the I-x'eview Cc)iiaTilt,tee concerning, the shortcomings of this project, it @,@pinion, ba,,@ed on first-hand I t@rio@, led@ L .,I ,c, of' tlit, @id personnel involved in the pr oject alid on ttit-,ir, experience in site visiting this )o NORRH DAKCFTA REGIOliAL DIFDICAL PROGRAIpi (CONT) RQgion, that the approval of this project is essential for further development of the North Dakota Regional lledical Programs. In recommending approval, Council strongl-y-ur@ @IPS staff to work with the Region and with personnel involved in this project to correct so@ of the deficiencies and get it off to a good start. Project #7 Approval I for essentially the same reasons given above. 'me Council believes that the inplei-nentation of this project is essential to regional development and suggested that it be t@)proved at $35,000 (dco) for one year only with continued support contin@nt- upon revision of the project with staff assistance, and reapplication to the Council. Project #8 - lion-approval I Project #9 - Approval I 01 - $115,38-)' O,') - $79,'('['@-' 03 - $79,549 NO.@,',ST 01110 I:URTOIIAL [.'U,:I)I(AL Pli'OGIU@ 9,1 00063 7/70.1 and 7/70.2 - Opei@at.Lc)tiil Supple@nts Approval with specific condit ons. Project #01--S - ilon--approval I @jec - on-approval II witli the recoriirnendatioris for revision suggested by the lievic--,w CottiTiittee. Project /,'III- Approval with the conditions specified by the Review Cornid-ttee ,for one year only. Project #15 - Approval I. Aittioti@,@i the Council recognized this as another of the "Cot,tricil for Continuing @ucation" projects which have been -LibirCLtteci by the Ohio State region and action upon wliicii has been deferred pending the outcome of the initially funded one. The Council' accepted the a(IvLeE, of the site visitors that the project is of critical importance to the Northwest Ohio 1'r,ot-.i,ain -u,id probably has an excellent cliai-ice of success uii(ter the leadership proposed. Project #16 - to be iricot-poi,al-le(-i with pi,(-),jc@ct #111. E'M,i(-,@ct - Approval in the r@e@iLicc-d wiiourit and with the conditions specified by the lieview Corru@ttee. ql-ie Council niptli(@i, considered the findings of the site visil t e T I rei-,itkiii, i.-I@i@, a.wliolc-; its aiid ol,-uis. It is their animation, recommendation tli@it tile ii(-@t,-,ion be urged to seek stronger leadership but tli(, (owic@ll arreed that any specific re- conniendation roF@ii@ilrie-, personnel would be inappropriate. 21 NO.@ITR-IF,ST OHIO ff,.GIONAL MF,,DICAL PRC)C,P@',l (U-OfTf) 'nic value of an asst,ssiTient visit as TecorrrK-,tided by the visitors was qLit@stioried since it would probably do no more than i,e-@Ldentify the pr)blem. Council suggested that p(.,riiaps-d-irect and L'requent assistance from FFIP staff and consultants would be more helpful than further investigations of the situation. 01 - $1115,830 02 - $70,525 03 - $21,250 OF[IO STA'j'-T@l' @-',IONAL NIFDICAL PROGIINL @,l 00022 7/70.1 and 7/70.2 - Oper@atioiial Renewal iiid Supplement - Af)provql with specific conditions. Project #111 - Approval I at the i,ecluced level an-i with the conditions specified by the t@eview Corm-Littee Ilioject #8H - Approval I in ttit- i,edticed amount a-id with the conditions specified by t[it@ lx'(-@vL(@w CoiTmittee. Project #2P - Approval I I)i,c),Iect was considered by the Council in the previous revif,,@-i (,@ycle -ind action was deferred at that hire). Prc),Iect #211 - Non-approval II with the recoirm--ndations for revision 'ttee. suf,,@sted by bhe l@eview Coinm 01 - $714,075 O,' - $77,9,'[3,1 03 - $847,9144 0iiIO VAI@,Y IU,:CTOI-@Al-i f@@ICAJ, PtIO(JPX.l "T-1 000,48 7/7C).l Oper-ation:-il @')uppleir-erit - Approval wit h specific conditions. Prolect #12 - Approval I in the i,educed amount i,ecormiencied by the expert technical i@eviewei@@. Project #13 - Approval 1. To be funded only if riot@d by other Federal resources. Pro,ject #111 - Approval IT Project #15 - Approval 1 @,oj ect #It) - '4on-approvql II with the r@corrrnendatioiis for revision as suggested by t-Itit@ lieview Coraii-ittee. Project #17 - Noti-appi,ovzil II with the recormiendatLons for revision st,4@ sted by tfie lieview Coiiiiiittee. Project #18 - 14on-approvil I 01 .$273,')i6 02 1,@96.1215 03 $327,657 22 O@@r,ON MIX'ITONAL @@'E-',DI'C,AL PRO(,RAM i@l 0001:' '(/70.1 opoi,@itiorial. Approval Project #12R Approval I Project #16 - Approval I 01 - $59,375 02 $283829 03 $14 3843 PUT,'I,L@) li-ICO IUTTOIQAL @lf.@'.DTCAL PliXlt*l iim ooo65 7/70.1 @)eratiorial. )upplefti(.,tit - Approval with specific conditions. Project # 9 - Apl)mval I -Lritlie t,(.@duccd wrr)unt and with the conditions specified by the Ileview Coii-trattee. Project #11 - Approval I with t' fie conditions specified by the Review Coai@ittoe. 01 - $320,936 01". $;12'(,LI36 03 - $233,636 SOUnl CA'@iOLI@@A Rll'zIOlq,,VL PILDICAL fr,,l 00035 7/70.1 - Operational Suppl-(?tti(--rit - t4on-approval. Project #35 !4on-appioval II wit' li t,lie reconrneiida@ions for revision suf,,@sted by the ieview Coitinittee. Project #36 No action taken. ',-.)ite visit is indicated. E'roject #37 Nori-approval I S@)SQtJl-"IIAI,114A V.4LIJ-@Y TUIGIONAL i'/[L'@)TCA], Z4 000f-)9 '[/ "(0.1 Operational ",uppletri(,rit, - Approval with specific conditions. Project #20 - Non-approval I Project #21 - Approval I in the i@t@(luced amount to reflect the newly adopted policy on training project participants. Project #2@' - 14on-appr-ova.-L I Project #23 - t4ori-approval I Project 11211 - I,,Ion-appi-oval 11 wLtli the recommendations for revision sufr@,ested by the !@eview Coiruliittee. Project #25 - Non-approval II. 'llie Council was in general agreement with the Review (,oriirdttee regarding the specifics of the project but believe ttiat further development of this project along with //@ll is in the b(-.st interest of the the Region Lind has i@e(Itiested that the LUTO) staff offer this @ject #,'16 - Approval I 01 - $92',1311 02 - :1@;78,91@ 03 - $8332911 23 TF--XAS REGIO14AL IMEDICAL PROGRAr4 IU4'00007 7/70.1 - Operational Supplenieiit Approval with specific conditions. Project #8R Approval I contingent upon the satisfaction of a ,technical site visit team regarding, four specific points set forth by the Review Committee. Project #14R - Appi,oval I with conditions specified by the Review Co@tt.ee. Project P15R - Appm-)val. I Project #118 Noti-,,ipproval I Project #LI 9 Noti-@,ipproval I ol - $li6o.,6'io Of@ - $"-"96,595 03 - $24o,386 -MT-STA'I'T-, RE(',IO'LIAI, @,U)ICAI, PliD(,RPJl @i ooo62 7/70.1 - @)oratioiial SLip@)leiTierit - Approval Project #9 - Approval I in a re(-ittce(i w-aount and with the conditions specified by the 'ievl(,w Coii-gnittee. 01 - $105,300 04') - $85,6oo 03 - $633,000 VT',IGINIA RL'(-'TT014AL @IDTCAL PEUGfW@l iini 00049 7/70.1 - Dperational Sti@)@)I.oriietit - Approval with specific conditions. Project #10 -Appi,oval I with the conditions specified by the Review ConTnittee. I'n discussing, this project the Council wished to stress the importance of the condition for approval- of' this project and Lirges t7eat care on the part of the start.' iii adjusti.rifr the second and third year amounts of support by utilizing patient revenues to offset costs of the project. 01) 01 $268,5 52 I- - $IfBos)179* 03 - $533,504* .Po be negotiated downward WI-:STF-,'IN @ YORK RF,,GIONAL @U@')TCAI, PiiCVMNI RM 00013 7/70.1 - OlDei-atior-i-al StiT)[)Ieiiient - Approval with specific conditions. Project #15 - Approval I in the r,c,,(Iuced cTriount aiid with the conditions 'sDocif'ied. rroject #lu@ -Approval 1. in the E,,iotints -.@ii-id with the conditions specified by the lieview Committee. Council expressed its will)nmess to illQ)w the Fiegion to increase the funding 24 WEI-@',RN NEW YORK REGIONAL MEDICAL PRCCjFVV4 (COITII) of this project to a maxirmm of $100,000, providing such a level of fundi@, would be required to maintain this valuable regional resource. Project #17 - Non-appr-oval I 01 - $350,000 02 - $3'@--'03000 03 - $3505000 WESTEPJL PF14NSYLVANIA REGIO14AL fU-,D'ICAI@ fly-110GRAI,4 RM 000111 7/70.1 - C@erational Supplettiorit - Approval Project #9 - Approval I ol - $43,911 02 :@li,13820 03 $116,995 WISCONSIII JU-@,GIONAL M'!I)ICAL PROCL P&4 @)0037 7/70.1 and 7/70.2 _Opetatioti;il Supplerrent Approval with specific conditions. Project #13A (R) - Approval II Pro,rect #i Approval I Proiect #!U'B - Non-approval I Proj Non-approval I Pi@.fect #18K -t@on-approvil I Pro.ject #i9 - Nori-approval 1. CoLuici.1 based this recommendation on the f indinfr ,s of a collateral review of the project by the staff of Matei-i-ial and Child Health Ser@ice, liS,@, which was requested at the suggestion of the Review CoimAttee. Pro.ject #20 - Approval I Nori-app-t,oval I @,c Approval I n,c Approval I in the i-e@luce(i amount and with the conditions specified by the i'-@ev!eW COTirnittee. 01 $2923815 02 $16'(,807 03 - $17"@',395 2@) XI. ADJOTHIE= The meeting was adjourned at 11:30 a.m. on July 29, 1970 I liemby certify that, to the best of niy Iciowle(Ige, the f, :)regoing rn:l-nutes are accurate and complete. tkt,) Regional Medi@ al Pi anis Service 26 r"tllcls to tlll(., ilc,,vi-cw CotitrCi t.t.c(l I)ccluii(-,il-l.y E,,cjuiid a) id capably di.i,oct-,(,(i 10easible utidc@i, spocif'ic!(l coilLi-.1-tiorl,; UnEipprov,-tbi.e on teclit-i-.ical@ gLollilti.1, 1, v _Icll C,/jT,@,n:ittec to tll(-- N@Ltioii-il. A(Ivj.,@oi@v Counc,.I.14 A@i T. I Al)l)i.,ovzil. 11 No cicl(ii.t@ic)ii@il fLirid", Noii-,,il)l).Poval I.T. no ttct-'Lon taiceii Nc-ocl ,icidit@i..oiin.l. iiif'oi-,jiifttio!l Nced site vast Need Couii(-,.L'L (On Appl-ic@ition,,@) -il w. -),,,c. .Al)l)t,iz)v, ith sl cc)l-lclit..Lorif,, IlctLir,i-i' @fc)t- Rcvi@,-iori Di.suppr-oval fol, Dlik@lli' Aclv-i-,,oi t- I Cc)uti@@i.1 t,c) Ai'l@iii ri-i At)l-lioval. w-itli Epool.f.L(@ by ttio 13c,vic,v; oi, c)tl)c!l-ci) 110.tLIt'll fOl, I 0 I 27 - NA9'TO,'.IAI, tO.)\rT@)0,1@iY (,Y)'Jl@'( ODI BIM-4NAN Michael J. M.D. (72) MIILIYVI Clark li. M.D. (72) President., r-lichi-,@ Cancer Foundation Consultant in Neurology 4811 John R Street Mayo Clinic Detroit ',4ichigaft 48201 Rochester, Minnesota 559Q2 Professor of-@-ledicine -.CCDFN i@@. C. Robert (70) Wayne State University President and General Counsel North Coast Life Insurance Company -la hingtoh 99201 CANNON, Bland W., M.D. (73) Spokane I s 910 Madison Avenue !4errpliis, Tennessee 38103 PF@C;HINO, d D., M.D. (70) Vice President for the Health Division of Neurosurf,-ei-j Sciences and Director of the Center University of Tennessee College State University of New York of 4edicine Stony Brook, New York 11790 CROSBY, Edwin L., M.D. (71) POPDIA, Alfred M., M.D. (70) Executive '\lice President and Director ReCiotial Director ATeritan Hoscital Association 'I'-',OLItltain States PJVIP Chicago, Illinois 6o6ii 525 West Jefferson Street Boise Idaho 83702 3 DEBAIT,Y 'I D. (72) Michael E. I r . President and Chief !--'executive Officer ROrfli., Russell B., M.D. (73) Baylor College of .Iodlcine 2110 West It St ,,,treet Houston, Texas 77025 Erie, Pennsylvania 165o8 Professor and Chaiiii iui Vice Speal@er-of the House Depai,tmnt of Surgery of Delef--,ates., X,.IA Collef,,e of Medicine SIIAI\fl 10@i z,i4lack I., M.D. (70) F,VEIIIS'P,, Bruce W., @I.D. (71) State Health Comdssioner Chief of Pediatrics State Depa,.,t,-n@rat of I-lealth Green Clinic Rici Brand . VirCinia 23219 ton, Louisiana 71270 TH,"I!'Ilil '4r. Cw,tis (71) Director, Pension and Insurance Dep IRRlr, Wil.1-iclin R. , i-I.D. (71) Board of Comqlssionex,s United RLibb6r, Corlc, Linolelxni County of Allerhery and Plastic Workers of @-ric@: 101 Courthouse Akron, Ohio 443o8 Pittsburgi-i, Peruisylvuiia 15219 WYCKOFF, Mrs. Florence R.. (72) McPH-M@@N, Alex-ajidei- M., M.D. (73) 2113 Cori,,-O.Itos ,@,oad @ry University Clinic Watsonville California 95076 13'u5 Clifton Road, li.E. Atlanta GeoPgia 30-)'22 CIIAT@@IAN Dr. Vernon f,'.. 'Wilson art(I .) . .7 - ... . health 5600 Fisli(@i.3 PrieL-Arl I 1 tN r,@71 PC)P@@p ATRENDANCE AT THE NK.VIOIQAL ADV@RY COUNCIL J@.y 28-29, 1970 F&TS STAFF, A ING Miss Rhoda Abrams Dr. Marion E. Loeach Mr. H. Earle Belue IVUI. Gregory Lewis Dr. Edward T. Blomquist Mr. Ray Maddox Mr. J. Edgar Caswell Miss Elsa Nelson Dr. Donald R. Chadwick Mr. Roland Peterson Mr. Cleveland R. Chambliss Mrs. Mar tha L. Phillips Mr. Clyde Couchman Miss Leah Resnick Dr. Sam Fox, III Mr. Donald Riedesel Mr. Edward Friedlander Mrs. Jessie Salazar Mr. Sam 0. I'@lilmer Mrs. Sarah Silsbee Mr. Charles Hilsenroth Dr. i@garet Sloan Miss Dona Houseal Mr. James Smith @@4 Frank Iohniowski Mr. Dan Spain Dr. Anthony Komaroff Mr.@Lee Teets Mj7s. Lorraine Kyttle Mr. Francis Van Hee, Jr. Mr. John M. Korn Jr. Mr. Lee Van Winkle Mr. Frank Zizlavsky OTHERS A ING Dr. Maurice Bender, OS Dr. J.ff.U. Brown, NIGitS,NIH Dr. John Cashman, CHS, ILI@IA r4r. James Dunlop, A.D. Little, Inc. Miss Sylvia Kesinger CL-IS, HSNUIA Dr. RI chard @vinson, Veterans AdnLinistr-ation Mr. Wenda-11 @laddrey, NCHSR&D, liSYUIA Mrs. Sylvia Payirer, NCI, NIH i%'h,. No i@cker., BHPPMR, NIII Dr. T. M. Ildlega, NIAMD, NIH Dr. William Zukel, NH&LI, NIII