DEPARTMENT  OF  liEA           L T H,  E D U C A T I 0 N

                                  AND  WELFARE

                        Health Services and Mental Health Administration

                            Division of Regional Medical Programs

                                National Advisory.Council on
                                 Regional Medical Programs

                                    l@tes of the Meeting
                                      May 26-27, 1969

                                                     C)f

                                                 3.L


                                                     U@DIJCfi-i!ON, AND @ARE
                                       Tr OF '@T TH,
                                          PUBLIC @TH  SERVICE
                        @tiolial Advisory Council on Regional Medical Programs
                                    Minutes of Sixteenth Meeting  1/  2/

                                           May 26-27, 1969

                                         Council on Regional Medical Programs convened
                   The National- Advisory
                   for its s@eenth meeting at 8:30 a.m., @esday, May 26,.1969, in
                   Conference Room 4. @ilding 31, National Institutes of Health, Bethesda,
                   Maryland.  Dr. Stanley W. Olson, Director, Division of Regional Medical
                   Programs presided for the Administrator, Health Services and @ntal
                   Health Administration, who was unable to be present for all of the
                   meeting.-

                   The Council members present were:
                    Dr. Michael J. Brennan                   Dr.        D.   Pel -legrino (5/26 only)
                    Dr. Bland W. Cannon                      Dr. Alfred M. Popma
                    Dr. Michael E. DeBakeY   (5/26 only)     Dr. Russell B. Roth
                    Dr. Bruce W. @erist                      Dr. Mack I.       oltz
                    Mrs. Florence S. Mahoney                 Mr. Curtis Treen
                    Dr. Clark H. Millikan                    Mrs. Florence R.  Wyckoff

                   The- liaison member attending was,
                    Dr. A. Earl Walker, NDMS (5/26 only)
                   A listing of DFd,4P staff mrrbers, and others, attending is appended.

              I.   CALL T'O ORDER AND OPF=G
                   Doctor Olson called the meeting to order at 8:30 a.m.

              1/   Proceedings of meetings ax-e-restricted unless cleared   by the Office of
                   the Administrauor, HM-L4.  'The restriction relates to   all material
                   submitted for discussion at the meetings, the supplemental mater---q
                   and all other official documnts-, including the agenda.
               21  For the record, it is noted that members absent themselves from the
                   meeting when the Council is discussing applications:  (a) from their
                   respective institutions  . or (b) in which a conflict of interest might
                   occur.  This procedure does not, of course, apply to en bloc actions-.
                   only when the application  is  under  individual  discussion.


                                               -2-

                ANNOUNCEd,2\7TS

                Dr  Bland Cannon, @s. Florence 14ahoney, and Dr. Russell Roth
                were introduced by Doctor Olson as the (along with Dr. Anthony
                Curreri who was unable to attend.  new Counci  memDers.

         III.   CONSIDERATIO14 OF         P=ING DATES
                    date of August 26"27, 1969, for the next meeting was confirmed.
                Dates for the following two meetings are scheduled for December 16-17,
                1969, and t@rch 31-April  1,  1970  (this  meeting  being  changed  from
                March 23-24).
           IV.  CONSIDERATION OF MD=S OF THE FEBRUARY 1969 MEETING
                'Ihe Council unanimusly recommended approval of the February      20-21,
                1969, meeting as written.

                REPORT BY MP,. IRVING LEWIS, DEPUTY ADMINISTRATOR, HFALIH
                SERVICF,,S AID =AL @TH ADIvIINI9=iION
                Mr. Lewis reported to the  Council  on  the  recent  round  of  meetings
                in preparation for a report of the  Health  Task  Force  to  advise  the
                Secretary of DHEW. - Planning was began by teams constituted to
                represent the  various  interests  ofthe  health-related  activities  of
                of the Department. These teams  in  turn  reported  to  the  Task  Force
                which includes Doctor  English,  Doctor  Marston,  Mr.  C.  C.  Johnson,
                and the Surgeon General. ',"he first reports  of  the  Task  Force  were
                discussed and presented to Mr. Veneman and Mr. Finch at a conference
                at-CaiT David, Ylaryland.  The planning team on the Organization
                and Delivery of Health Care, which included consideration of Regional
                Medical Programs is chaired by Mr. Karl Yordy and includes Mr. Peterson
                of RMPS. Mr. Lewis reported  briefly  on  the  meeting  at  Camp  David,
                particularly as it related  to  the  future  of  service  programs  such
                as RMP and their  part  in  the  Departmnt's  plans  for  affecting  the
                spiralling costs of delivery of medical care.
                At Doctor Olson's  request,  Mr.  Lewis  reviewed  the  @  ediate  goals
                for Health Services and t@,e,-ital Health Administration as seen by
                Doctor English and his sta-,.'f.  These include a concentration of e-..
                on lipr@     care" with the principal- aim  of  keeping  people  out  of
                hospitals and extended-care facilities.
                Mr. Lewis also gave a brief rundown of the status of legislation.
                relative to the programs  of  the  Health  Services  and  Mental  Health
                Administration.  At the   present t@ only the extension of the
                FT                                                     10
                                                            con@,id.!-rat n, He renor-ted

                year or  two w-i-i i be                         -Goa question  concerning


                       RMP extension legislation, Nr. Lewis said he-felt there could be
                       no fiTa arsvier until an Assistant Secretary for Health and Scientific
                       Affairs is finally appointed. He indicated, however,  that  in  his
                       view the Regional Medical Programs Service could comfortably  use..
                       another year of experience before reporting to the Congress and
                       that having this co@-. after a possible consolidation of CHP  activities
                                                                         he  Council  expressed
                       would not be at all harmful.  Several members of t
                       a different viewpoint and consider a delay in requesting extension
                       of Regional Medical Program legislation as representing  a  serious
                       threat to the Program.

                 V.    A REGIONAL @EDICAL PROGRAM SERVICE REPORT
                       A.  The Completion of Fy 1969
                       Doctor Olson presented the Division's plans for the utilization
                       of the balance of funds remaining forDY 1969.  He showed'that out
                       of the $72 million which was available for v-rants in FY 1969  that
                       the year will end with a balance of $21.5 million  in  Council  approved
                       but unfunded Regional Medical Program  applications.  This  balance
                       remains even though an additional $4.8 n-Lillion was made available
                       to fund operational supplements which would otherwise have added
                       to this total. It was also reported that the year  would  end  with
                       all but 15 of the 55 Regions in operational status.  Of  those  15,
                       four have initial operational applications recommended  to  the  Council
                       for approval at this mF--eting vfnich, if approved, will be funded
                       imedi@uely after the beginning of the new fiscal yeari

                       B.  Tne Present Outlook for 1970
                       Doctor Olson reported on the status of the Administration's budget
                       for 1970 which as presented to the House Subcommittee includes
                       $93.5 million for Regional iMedical  @gram  grants.  It  was  shown
                       that this amount of mney, in addition to meet@ the comit@nts
                       for future funding at the present level, will allow just under
                       $20 million for "reiAi" activities in 1970. According to  the  best
                       est@tes of the Division about $7.25 million of this balance will
                       be required to provide operational  @ts  to  the  1-9  ren@ing   Regions
                       (including the four to be acted upon  today).  Therefore  apT)roxjimtely
                       $12.7 rrdllion will remain for funding of new activities in on-going
                       Regional I,:edical Progrwis and for any possible funding of multi-program
                       grants under the new Section 910 authority.
                       Doctor Olson reported briefly on the progress of the reorganization
                       of Regional Yledical Programs Service @ntioning especially the
                       Nutrition Program and its Implications for  Regional  Medical  Programs.


                                                                  ion of  @ction  910
                  C.
                  The Division plans for the use of the nal-11-ti-PrO@ grant authority
                                                       et!.-ng in February 1969,  were
                  as approved by the Council at its rn-@                       ived
                  reviewed and a list of pl,@l-tnL=y abstract proposals rece
                  by the Division  was  presented.*  Relative  priorities  amng  kinds
                  of activities represented by these  proposals  and  between  these  grants
                  and further funding of the Regions were discussed briefly.  Doctor
                  Olson indicated that he AOuld appoint a co@ttee of the Council to
                  consider plans for multi-progrwn plants and to  look  n-ore  closely
                  at the kind of activities proposed.
                  Prominent among the prese@. T)roposals is one submitted through
                  the California Fiewjonal medical program which proposes a broad-scale
                  study of the drug clofibrate in the control of coronary heart disease.
                                                                    four western ReFJ-ons
                  It would involve cooperative arrangements aimng
                  (InterTwuntain, Oregon, California, and @Tashington/Alaska) and the
                  total request for the first year of the five proposed is $5,170,goo.
                  This preliminary proposal '@d been reviewed in depth by staff and
                  by Doctor Pellegrino.  He co@nted on the great need for a study
                  ofthis kind of cholesterol-lowering drugs in order to avoid the pitfalls
                  and lingerino- indecision that has surrounded the use of anticoagulants.
                              CD
                  He further coiwr--nted on the study protocol as being co@lete,
                  feasible, iiell-controlled, and statistically sound.  He then cited
                  a n@er of serious questions relevant to the actual undertaking of
                  such a study.  'fhp-se included the difficulty in controlling other
                  variables such as hypertension, diet, stress, and patient cooperation;
                  the ethical questions raised in such a double-blind study; and the
                  possible toxic side reactions to the drug.  He also mentioned the
                  questionable procedure of studyinr, a specific drug when the value
                  of the general effectiveness of lowered cholesterol in the control
                  of coronary disease is still unproven.  He further Mentioned the
                  coiTplete uncertainity of the cost-benefit ratio in launching such a
                  study as well as the very high  absolute  cost  of  this  particular
                  proposal.
                  Doctor Pellegrino raised further question concerning the relation
                  of this study to activities in other investigations, partidul, aTly
                  at the National- Heart Tristitute, of coronary disease and related
                  problems.  He concluded tl,-..at any such activity  as  this  would   requ@e
                  intensive investigation'@,d study by people experienced in fields
                  directly related to it, including cardiologists, epidemiologists,
                  and statisticians.  Doctor Pellegrino's impressions were generally
                  supported by +-he other nierbers of the Council and  it  was  agreed  that
                  it should be looked at in depth by a subcommittee of the co@ttee
                  for multi-piograms grants  (which  had  been  mntioned  by  Doctor  Olson)
                  before a formal proposal is to be considered.

             T-
                  Mr. Peterson reported briefly   on  the  Division's  efforts  toward
                  the evaluation of Regibnal@ 1,4edical Programs to date, on a national


                                                            -5-

                                                                                                       islatdve
                          basJ.,-,, in                        rc@nUF,";t for extension of le&,
                          authority. !I(-) a-'Lsc)           on trick     lic)cl advisory group on
                                                                               f   a.   subcomittee   of   that
                                      o,"      ar.@d    a                     o
                                                                          issues.   Doctor   F.,\rerist    vfno
                          is a mei-ibe,-, of the form, r a,,ic) F),)c'cor Caririon a inen3ber  of  the  latter,
                          reported              on                  In-house efforts.  At the request
                          of Doctor Olson, Doctc)-;-- l,'ai-in@)i-i.  has    a    special    @erstanding     of
                          the relatioi-i,-,hii)s beti,,--,--n Regional i@iedical PmgraTris and Co,,nprehensive
                                             esT)@-r,,ially in hi-, 1),oine area of l,'Aemphis, presented his
                          Health        -i-Z
                          concept of this    relati.@,ns,@.p and its @,;orl@k)i3.ity not only in Meiiiphis
                          but potentially    tl.,i,ol-i.@tc),,)t the I-',,Ltion.
                 VII.     DISCUSSTON OP Al,@rPNf@FT-V-,E                FOR APPLICATION

                          A.  Definitions of Pro,,@. am Cr,)mWnel'its
                          Recor,,ij.zir),@ the need for better identification of the         activities
                          of Rerrio,.@l Medical Pr,),7.am- v;hich are in general supported out
                          of  the  "core"   budgets.   in   Fe--.ruary   the   Council   requested   staff   to
                          work  to@@  the   development   of   a   scl-ienie   for   the   better   delineation
                          of all grarit,-sitpported activities.   In response to Councills request,
                          Mrs.   Phillips   proposed   definitions   of    four    categories    of    Regional
                          activities   under   iihich   all.   activities   in   exist@,   Regions   could   be
                          classJ.fied.  'Ilhe@se are:        --Ta;,.q direction and T)rofessior-al- services
                          which include the salaries and supporting (
                          staffs    established    for    Regional    Medical    Pro@ams;    central     mgiomd
                          resources which include evaluation units, data co le tfo-n and process@
                          units., regional continuing education resources, etc. , which are created
                          by  the  grant  and  will  require  grwat-.   support   as   long   as   they   serve
                          the   Program   of   which   they   are   =,t;   feasibility   studies   which    are
                          specifically definable planning activities req@iring a special
                          allocation of fends blL).t which are t@--lird-ted and do not represent
                          a continuing cost      .to   the   Regi.onal   Medical   Program;   and   orieratioral
                           r-oiects  which  when   completed   can   be   shown   to   have   ident   Jed   and
                                        in the Region so that it can be continued from "Local fundirg
                          resources, can be fo"Llowed-up by a new project a-,oproacki, or be terminated.
                          Mrs.  Phillips  reported   that   the-se   definitions   had   been   tried   on   an
                          experimental basis 1.1-   4  seven   operational   Regions   and   in   general   had
                          been found by the Coc@,-diriators and their staffs to be quite workable.
                          @ Council found              dcceptable   and   urged    the    Division    to    mve
                          ahead   in   Assisting   operational   Regions    to    organize    their    on-going
                          activitie-- accord4-rr,,,i.-I.

                          B.  Anniversa3-i Asses-.@,.@--r.,t - A thL-d. sta      in    Regional     Develop@int

                                                     1-ie
                          Also in response to k@".       interest   expressed   by   the   Council    at    its
                          February   meeting,   the   staff   has   further   pursued    its    proposal    for
                          a reor @zation of t.@-,e review of Regional Medical Pro@is and


                                             -6-

                 "arn-dversar-i review systei-,il' ifiiich was contained in a very prely
                 report to the Council in 17ebruai-y.*  Es@3ei-iti-ally, it provides for
                 an arrarie mert ',-)y @@;,-lich acan b,,:: thoroughly reviewed on a
                                            C-@
                 regi-il-ar basis both for coi-itj-r2@.,i,--it-i-on of' its on-,o,,oliig activities and
                 for the addition of supplemental proje(,-,-ts and studies; enjoy the
                 security of being classi.L@@Led as a    with a cori,-@atment for
                 continued fundino, at a certain annual level-; and utilize to a
                 greater extent its own review process and FAG approval for program
                 flexibility in the intervals between its regular anniversary review
                 at the national level.
                 Doctor Olson then presented to the Council an analysis of all
                 55 Regions which includes their present level of grant funding' the
                 total population they serve,* and an illustrative funding level for
                 each Region based upon a simple formula relating to that total
                 population and adjusted for population density and incidence of
                 poverty.  This he described as one basis for deciding on a reasonable
                 distribution of some $68,ooo,ooo among the 55 Regions to cover the
                 continuation of the Programs' runirral- needs for direction, planning,
                 professional services, and a small number of operational projects.
                 Such a distribution would assure the continued, although probably
                 uneven, development of the program nati.oral.1y.  All of the monies
                 available for grants in excess of the $68.,000,000 could then be
                 disbursed each year on the basis of regional progress, -individual
                 project excellence, and national priorities.
                 The Council Aras unanimous in expressing serious (,concern with any
                 fiscal plan which would appear to relate Regional Medical Program
                 funding to a nationally announced formula.  Principal among their
                 concerns were (a) that it -viould carry the iTTp@ssion that some
                 decision has been made as to the needs of the program and thereby
                 established a level at which an effective iDrogram could  be  carried
                 on; and (b) that it appear to substitute an arbitrary decision-making
                 for review by peer groups and recommendation by the Council based
                 on the quality of proposals.  It was stressed repeatedly that as
                 a growing program the Service should avoid, at all costs, creating the
                 @ression that a reasonable    cost" of Rea-ional TJ@edical Programs
                 has been, or indeed can be, established on the basis of present
                 knowledge; or the equally erroneous impression that an amount of mney
                 arbitrarily arrived at by formula and awarded as such, could adequately
                 serve to meet the needs of the Region as an addi.tive to  an  already
                 existing bloc support grant.
                 The consensus of the CoLL,@--il was that a formula basis for funding
                 Programs not be considered further by the Division  and  that  before
                 undertaking any fo @, 1 @teps tovrard the creation to a new grant format,
                 that the Division consi-Q'er the authority now available to it in
                 meting the reeds for arir-iversary review or some variation of it.
                                                      of the val.ue of regularly occurlrv,


                      regl,,onall.y-f F,,",sible projects.

                                              P
              VIII.  RF,,?O@E OF Tli  li-T@ HC)C G OUD T,) CONSTI),@@l RErTIO14AL
                      IV-F.Dic@f@        P@-7CkT CTS FO.,',       SFA@VIC@FS
                                                         the one day meeting of this group,*
                      IX-. Michael Brennan reported on u
                      vihich he'clD.irei., and v.@l.ch on tl-ie basis of their  deliberations
                      rec'uii@-nded Guidelines  for  review  of  applications  from  Regional
                      Medical Pro.@arns for projects of this kind.  The Co,@t-tee consisted
                      Of:
                         Michael J. Brennan, M.D., Chairman         James 11.  Nickson,  M.D.
                         President,                                 Health, Dept. of Radiotherapy
                         Michigan Cancer Folmdation                 Michael  Reese   Hospital
                         Detroit, Michigan                          Chicago, Illinois
                         Juan Del Regato, M.D.                      Robert J. Shalek, Ph.D.
                         Medical Director                           Professor of Biophysics
                         Penrose Cancer Hospital                    University of Texas
                         Colorado Springs, Colorado                 Houston, Texas
                         Robert Loevinger, Ph.D                     Kent T. @loc>dward, Ph.D.
                         Chief of Dosimetry Section                 Program Dir. for Radiation
                         National Bureau of )@ndards                 Extr     al   Activities
                         Department of Co@rce                       National Cancer Institute
                         Viashington, D. C.                         Bethesda, Maryland
                       The  Council  expressed  its  appreciation  to Doctor Brennan and the
                       other mTCoers of the group, and unanimously endorsed the recommend-
                       ations.  (Fhese are presented as a part of Section IX-B of these
                       Ibnutes).
                 IX.   REGIOIIAL @ICAL PFTOGRAM CT@ APK,ICATIONS
                       A.  Review and Recommendation          b  tILe Council i      raur
                       Mrs. Phillips reviewed with the Councilthe recommendations which
                       they had =de in February which are listed in the minutes of that
                       meeting and which now have been made available for the guidance
                       of all applicants.
                       B.  S-pecii@icall-,v Identified Issues ReT)resented in the Group
                                             t.(.) be Revie            il at

                            1.  Problc@,r--, and Role of Regional Med

                       The  Council reviewed ",-he presentation by staff* and expressed wit
                       the  description of the problem and the issues posed.  There was,
                                                                @s of
                                                                      the Rezlonal. Medical. Frop.,Tam


                  and the su@resti   that l@-i,,TS niiF@it iii@Te a somewhat, differ(@-nt role
                                  O'f                    ategy v@o-old be required to
                  and. that a different approach and str              iety of' health
                  achieve "reg2Lon-aj-iz.@Z,-@ion" aronc,@ tlil-- extensive var
                  care facilities @,i',,iich exist in CD hi,@,,j-i density population areas.  Several
                  members agreed that it Tpight be im@,ossi.bl-e for the Council to
                  undertake the delineation of sp(@cl.f'i-C polic@, -ecom-nendations in
                  relation to this problem as they @iD@ve with the are specific well-
                  defined issues presented to therq.  They did, however, suggest there
                  perhaps vras a need to supply Council with  a  set  of  general  suggestions
                  which the Council r@iight endorse and offer for the guidance of
                  Regional Medical @ograms.

                    2.

                  Reco@zing the complexity of treating chronic renal diseas6 and
                  the.enormous cost of mounting a service program even in a restricted
                  locale, the Council reco,@,e@ that Regj.onal Medical Pro@ams grant
                  funds awarded t(                 onic renal disease be limited to
                  support of those projects which provide for:
                     .  Trainirg of physicians, nurses, and technologists for
                        managemnt of chronic renal disease patients, and
                     .  Regional planning for a coordinated Regional approach
                        to prevention, diagnosis, and clinical          ement of
                        renal disease.

                    3.  Health                          TreC@ug, and
                        Continu

                  Basic Trainin& of Allied Health Personnel
                  @.e Council recommends  that  Regional  @dical  Pro,7,urs  grant  ninds  for
                  basic training :L/ ol' aiiied health personnel be l@ted as follows:
                          For projects which meet the criteria         funding
                          which are  set  for-h  in  the  GuidelinesfF/
                                             il                    - and
                          discussed furtherer the Council recorynendations
                          of February 1969 :I/; and

                  Defined for purposes of R@-@gional Medical Program grants as trai
                  required for a certificate, diploiTa, or degree   N or which otherwise
                  leads to the  fulfillment  cf  the  experience  and  education  requirements
                  for initial entry into a health career.

                  Guidelines,
            2/                  ip,)lement      Exmariled Statement on Fdiication & Train,'@,

           .3/    News, Infonnation, and ',-late, VolLufie 3, Number 175, May 13, 1969, National
                  Advisory Co.@ttee S-oeaks to Six Issues Re Coffponents of Program Acti-ifities,


                                              -',ated to newly developed technologies
                             Plor train@,  re,j
                             or new mdalities of   diaFiiosis aya,:i treatment for vihich
                             no standard ct-i-,t@riculLn is yet recognized and no  minim=
                             m4t                 for certification or 2.icens@- are
                             yet established; @-,,,Id     is not generally  Part  of  the
                                 lar offeri-t-@,,@j of' tied iealth-related educational and
                             regu
                             training system of hospitals
                                                            and/or technical schools@
                             junior arAd senior colleges.
                      This ,-(@s'@-riction on u@,e of Fegiol-,P-I. @'i,@-,dical ProgTams funds will be
                      limited to the actual costs of provision of the t            and for
                      payrr,e@-it of student sur@,port and assistance.
                      Regions are encou--aged to use both professional staff assistance
                          direct support of special planning studies to encourage
                      educational institutions (tecd,,nica-I institutes, public adult
                      education resources, extension pi,oEp?ams, junior and senior colleges,,
                      and hospitals') in conjunction with the resources for clinical
                      experience,  to  providt-@   new   educational   and   t@@opportunities
                      in the established a].-licd health disciplines and to ac  new discip@s;
                      but only after they a@ fully identified as essential to the
                      provision of a recognized service to patients.
                      At the l@tional 'I@evel, the Division  further  proposes  to  encourage
   io                 the incorporation of these disciplines into the various training
                      end education systems, such  as  those  which  set  standards,  approve
                      curricula, and aid in counselling and recruitment; as well as those
                      W-E.ch assist in the financing (F'ederal  and  non-Federal)  of  allied
                      health career programs.
                      In implemp-nting this recommendation, the Division will ask the Council
                      to consider the various disciplines separatelyand will base specific
                      lirAtations on their Judgment  whether  a  discipline  falls  into  the
                      category described.

                      Training of Cytotechrologi-sts
                      Upon recorrrrery-iatiori ol-.Ithe Council., the Division has identified
                      Cytotechnology as an established allied health discipline.  Its
                      training programs are approved by the American Medical Association
                      Council on Education -than properly  recommended  by  the  profession,,
                      and graduates are cer,.-,ified for practice by a nationally recognized
                      examination administered by the- profession.  Tne techniques of
                      exfoliative- cytology Tire now of universally recognized value in
                      screening and diagnosis of pathologic states.
                      'Iherefore, in line WL'-h general policy relative to s
                                              t,                              upport   of
                      established   programs and in  keening  with  above  policy  guidelines
                      on training                                      oral MedJ,cal  Pro
                                    the C(,,uri@il recom-r.,en(is that, Rewl

                      independent protect o,,, as part of a project demonstrating the application
                      of exfoliative cyto"Lo-,-,,,ic techniques to patient care.


                                                -lo-

                                    RecruitTpent
                  Healt
                  In recognition of the nationwide need for iTt)re and more coiq)etent
                  allied health @-rsorinp-1, t,,ie Council reaffirms its policy of
                  support for effective  Regi;@ll       cal  Programs   activities   directed
                  toward  meeti@,  those  needs. Ho@,,,eveT,, a direct  relationship  between
                       fic'recruitroent   efforts at  the  high  school  level  and  increases
                  speci
                  in qualified health personnel is difficL).I.t to deimnstrate; and the
                  real impact of a recruitment project on the care of patients is often
                  rewte  or  obscure.  The  Council,  therefore,  recommends  ti-,at  further
                  support of such projects with Regional Medical PrograTr@s funds be
                  granted only vihen a proi(-r-t is related to a clearly focused (specialized)
                  short-range approach to i.ii-- critical needs of a region, and
                         Has the documented condtted support not only of the
                         sponsoring agencies, but of the Region's hospitals
                         schools, and colleges whose cooperation is essential
                         for the success of the j=ediate project and its
                         continuation after Y@egional Medical Pro@ams support
                         can no longer be made available;
                         Includes a plan for evaluation of the @act of the
                         program on the rate of production of trained health
                         mnpo,vier;
                         Is directed  at special population groups, especially
                         those who d           lly seek, or have available,
                                     o not  usua
                         opportunities  for  trai     or education beyond secondary
                         school.

                   Dial Access A-u-diotape Prolects
                   The technique of directtelephone access to prerecorded tapes on
                   selected topics of interest to physicians and allied health personnel
                   is becoming increasingly popular in Re-ional Medical ProUams.  The
                   Council reconrriends that proposals for projects of this kind ineet
                   the following criteria before being referred for review as part o        f
                   a Revional Medical Pro@a-.n application:
                          The application s7nould contain an explanation of the
                          way in which the project fits into the total regional
                          education effort fcr physicians and other healtTi professionals.
                          Proposed evaluation of the service must involve its
                          receptivity and value to the professionals in their
                          practice. The mere measurement of numbers of the incoming
                          calls is insufficient.
                          When the request includes the establislnent of an
                          independent networl@ (in contrast to s           an already

                          for a  new  network  as well as a plan for   long-term use
                          of the network.


                           Th@-re Trust be a plan (bolh long and short-rwage) for
                           the develop,,np-nt of the tape library,  justifying  any
                           decision to n-ake rather than share or purchase tapes;
                           for the selection of subject iratter; and for the
                           identification of target groups (i.e., physicians,
                           nurses, etc.).

                     4.  Radiation and I)osi- t        ices

                     In accordance with the recombination of the Council in its
                     February meeting, wid. Ad lio(, Cc)rq@.ttee on Radiotherapy Dos@try
                     Services was convened @n Tp-rii. 8 to discuss  the  general  subject
                     of radiothera-,oy consultation and dos-imtry  services  in  Regional
                     14edical Programs and to provide guidance to  the  Council  for  the
                     review of proposals in this area.  -The following are the Co@ttee's
                     recomp-ndations --                         1.1 -- of what should  be
                     included in proposa                           iotherapy consultation
                     and dosimetry servi6es:
                             Indication of the applicant's intention to participate
                             with representatives of other specialties involved, in
                             a multi-disciplinary approach to the treatment- of
                             cancer patients.
                             Assurance that the radiologists  who  are  to  receive
                             the dosimetry service are adeouately trained in
                             radiotherapy or are willing to accept clinical
                             consultation and assistance from the Radiotherapy
                             Department providing the dositwtry service.
                             Indicationcf masures to be taken to-assure accurate
                             record keeping, careful  follow-up  of  each  patient,
                             continuity of care, and  feedback  of  information  on
                             length and quality of survival.
                             Assurance that there will  be  regular  monitoring  of
                             all radbtherapy equip@nt, including calibration of
                             the calibration instruments themselves.
                             Indication of T)lans to make the dosimetry and calibration
                             services self-supporting  within  a  relatively  short
                             period of


                                           -12-

                                          ons
             C. Consideration of.Applicati
                1. lloar initia@- operational avrards were recommended:

             BI-STATE RFGIOIIAL @l,DIC@t,L PRCCRAM
             In recormnding approval the Council concurred with the Review
             Comdttee except in regq-rd to project #4 - Stroke Unit- for which the
             first year was reduced to approximately $72 .5 8003deleting equipment,
             hospitalization, and certain related personnel positions. Future
             year funding remained the same. Projects #1, #3, and #6 are to be
             returned for revision.
             The following totals for the supplement to the core co@nent and three
             approved projects (#2, #4., and #5) resulted:
             01  $365,728; 02 - $287,667; 03 - $298,268.

             MISSISSIPPI REGIOQ@, MEDICAL PROG.W-4
             The Council concurred irith the recommendations of the site visitors,
             to whom the responsibility had been delegated.  They further recommended,
             however, that action@on Project #8 be deferred pending further study,
             by the Council, of projects of this kind.
             The following totals include funds for the core component (excluding
             the earmarked feasibility studies) are eight projects:
             01   $977,240; 02 - $631,134; 03 - $657,066.

             NOFUHWEST OILTO REGIONAL MEDICAL PROGRAM
             5/69.1 - The Council concurred with the Review Co@ttee in recorrmnding
                      the following total award which includes funds for six projects:
                      01 - $567,070; 02 7 $528,026; 03 - $605,455.
             5/69.2   Request for expansion of staff was also recommended. Six months
                      only.
                      ol   $65 200 (Six month amount)

             The designation 01, 02, etc., relate to the first, second, etc. budget
             periods of the subject Lap locations not necessarily the budget periods
                t will actuall  be s   I-er,,i@iited.


                7.ie Council concurred with the Review k-loiiiTiittee in recommending
                approvali- of --n initial opera.-io,-ia-i- a@,,,ard to -this region.  They
                further recommended, however, 'that final award of funds for project
                #)4 be deferred pending further study, by the Council, of projects
                of this kind.

                The following totals include funds for the core and five projects:

                01   $93)t3O4l; 02 - $944,376; 03 - $917,363.

                     2.  qhe following regions have been reco@nded for awards to
                         renew all or portions of their operational grants and, in
                         some cases., to add new project components.

                CAL=, O-'Ii@TIA P,@@UTOIJAL L@ICAL PRCril@@l

                5/69.1 - 'ihe Council failed to concur with the recommendations of the
                         site visitors and tire Review Coirmittee and recommended funding
                         of project #7 for one year only, at the current level - $336.$000.

                5/69.2 - The Council concLL-red with the Committee in reconnending
                         approval of project #35, as requested- and deferral of the
                         balance of the application.

                         01 - $178,84o; 02 - $1833792.

                5/69.3 - Rie Council concurred with the Review Committee and site visitors
                         and reco,@-nded an award to include funds for the 10 components
                         of core.

                         01 - $3,449 000; 02 - $3,796,780.

                2/69.1   The Council concw,red- with the Review Corrmittee in their
                         recommendation for approval 1'n a reduced amount; and agreed
                         that ["his project is within the relevant guidelines adopted
                         by them at this r,-,c@etj-,-ig.

                     ol   @')435,841; 02 - $D82,833; 03  $4o6
                                                              389.

                              REGIOIIAL @F-DICAL

                         a@i a,,,4ard Fo 2@riciu@--e trends l'or three projects.  'Ihe budget for


                                                  -i4-

                          one (#13) raoLlires do-vmward ric-,goluiation as prescribed.  The
                          a,@,,,qrd r,-uy not exceed:
                          Ol,- '4")284,035; 02  $16@1,680; 03 - $175,274.

                 2/69.1   in recom-.qerjdiiiy approval of this project, the  Council  found
                                         CD
                          it Lo be within  the  relevant  guidelines.  The  amount  is  to
                          be adjusted downward  by  el:@nation  of  the  costs  related  to
                          the computer netwo,-!-,.  The award may not exceed:
                          01 - $3211,988; 02 - $258,557; 03     $268,371.

                 KALTQSAS REGTO'L
                              @4.AL T;R=ICAL PROGRAIL

                 In concurrence  with  the Review Co.@ll-ttee, the Council reco@nded
                 approval of an  award  to include funds for  renewal  of  three  projects
                 (#l, #3, and #11) for three years and initiation of one additional project
                (#37) for three years.

                 ol - $417,3111; 02 - $413,667; 03 - $473,951.

                 MISSOTJRI RE@@@!Oi',IAL i".,'EDICAL PROGHK"@

                 The Council  concurred  with  the  Review  Condttee's  recommendation  for
                 renewal, for two additional years  of  project  #33,  for  disapproval  of
                 #4o and #42., and to return #41 for revision.

                           061; 02  -  $24 6,943.
                 01   $24031,

                 I-EW JERQJEY RD"TIOIi-A-L i'.IEDICAL PPOG.@@l

                 Approval for renewal of the core component of the pro@am was
                 reco,-nended, in concurrence with the Review Cormittee.

                 01 - $6385 000; 02 - $6'08,700; 03 - $699,100.

                 Tne Council was unwill-Ln@ to consider the request for the supplemental
                                           CD
                 request for staff for ',iodel Cities planning without the advice of the
                             -4
                 Review Co,-cirdu,-ee.

                 The Council concurred with -,he Review Comittee in  recornmendinp,,  the.
                 approval of the continuation of  two  of  the  four  feasibility  studies


                                               -15-

                                   4- ionq rojec'-s; -:Ind of one additional project
                (#6 and #9) as operaL,    p

                01  $428,71'(; 02   $11-111,794.

                O@@'GON PEGIO'@,IP@T @@,EDICAI, PROG.@M
                In concurrence with the RevieAl CorF,,n4ttee, the Council recommended
                                                   I-              I
                renewal of the support of the core -omponent of the program and approval
                of two new projects (#13 and #14).
                01 - $228,i-o6; 02 - $248,7b2; 03 -$269,050.

                TFX8,S REGIT,,!@J, IIEDICAL PROGR.AM
                5/69.1 - In concurrence ATith the site visitors and the Review Co@ttee
                         the Council reco,-Yaended aoproval of an award to include funds
                         for five projects.
                         01 - $286 424; 02 - $2893851; 03 - $163,96o.,
                5/69.2 - 'ihe Council concurred with the Review Committee in recbrffnending
                         an award to include funds for renewal of support of the central
                         coordinating office, the eight planning bases, and 11 of the 12
                         operational projects.  At the request of the region the
                         coaritment for the second and third years for the planning bases
                         was not included in the reconrnended award.
                         01 - $1.18623585; 02 - $961,18o; 03 - $782,564.
                5/69.3 - FLLrther, the Council. endorsed the Review Committee's recomendation
                         of funding,for seven of the nine projects included in this
                         application.
                         01 - $LI31,034; 02   $385)405; 03 - $3o4,751.

                V@IESTER,"4' VIEW YO@Rl@, @-TIOII-AL @@IMICAT@ PROGI@M
                Thp- Council concurred with the Review Connittee in recomending  approval
                6f an award to renew project #2 for three additional years; and   to approve
                project #10  for three       only.


                      3 -  'I'ht, Couiici-I dE:f'er,-ed action oil three applications foi,
                           rene,vi,@,l of p-wits in      of all. or portions of regional
                           prop, -is, for fl@,@L".rier@  by the- Cor-mrLittee and/or site
                           visitors.  @.hey delek-@Lcd to Lile ,3taff the authority to extend
                           supports of on.@-oi@-7 activities in these regions, as necessary
                           to n-al-r@'Lain pro  @iri integrity, until fo-yiiial action on the
                           renewal applications can be +,-,@l en.

                             Albany Reo,ional l@ledi-cal
                             Arizoi-ia        Medical    Program
                             lvlemohis Regional Medical  Program
                             North Dakota Regional Medical Program

                      4.  The Co,,mcil concurred with th- Review Coimdttee in reconnendin,7
                                                                                            C:>
                           action on a nurpber of applications from operational Regional
                           Medical ProUams for supplemental projects.

                             Arkansas Regional Medical Program
                             01 - $167,956; 02 - $78,6o6; 03 - $78,oBo.

                             Florida  Regional  Medical   ro@.am

                             No supplemental- funding and prohibition of use of
                             existing FL",IP funds for project #18.

                             Greater Dela,,ia-re Valley Regional Medical ProEam
                             01 - $197,401; 02 - $158,362; 03 - $159,387.

                             Indiana Regional I,,Iedica       am
                             ol - $4o,,428; 02 - $36,947; 03 - $38,720.

                             Maryland Re-7@-o!-,al i'vledi-ca'L ProoTLm

                             No funds and prohibition of use of existing Regional
                              edical Prograr..: funds in both #17 and #18.

                             Mountain Suates Regional Medical Program

                             ol - $96,593; 02 - $98,023; 03 - $101,933.

                             North Carol-ira Regional Medical Program
                             01   $219,162; 02    $218,153;   03  $1963152.

                             5/'o'9.1 and 1.7/6r-,.2

                                                                           Use of ar


                                   js in project i@i24 is prohibited.

                             5/69.3

                             No fund!,.,,-lg
                                            ka, r,,,.@p;Lc)nal Yie,(Iic
                             V,'aF-     Alaska,
                               L

                             5/69.1
                             01 - $681,544; 02 - $595.4847; 03   $151,163.  Use of
                             any RI@IT funds in projects #30 and #33 are prohibited

                             5/69.2

                             No funding

                       5.  In recommending action on applications f-roni the following
                           regions, Council differed slightly from the.Review coiriTdttee.

                  GEORGIA REGIONAL ME@DICAL PROGMI
                  Although they were in agreement with the Comnittee concerning the
                  desirability of a site visit to this region so@tjme during the sLmmer)
                  the Council recomended that those projects about which there v,,ere no
                  substantive (Tiestions be approved now (as specified by the cor@ttee)
                  rather than after the visit -  @ effect vnc s the recorirleridation of an
                  award for projects #18S, #19, #20., #22.1 #23, #24 and #28 in amunts not
                  to exceed:
                  01 - $350,000; 02   $350,000; 03 - $350.,000.

                  IOWA REGIOlqn ITDICAL PRCMM
                                                                   oving
                  Council agreed with the '-Review Comittee in appr      both the core
                     p  -        project #23, but specified that both be funded in the
                  SUP lenerit and
                  amounts requested:
                  ol - $196,558,- 02 - $190,@673; 03 - $5312110.

                  METROPOLITP@N, D.C. RR-GIOILAL MICAL PRCGFM4

                                                              In 'he'latter (#26) approval
                  education, and for  proje@ts #23     #26.     t


            i,,3 contingent upon the I-lospitalst willinoiess to pay the nursing salaries
            Project #25 was also aD roved, penrjin,- the favorable recclfrc@ndation  o
                                   @p
            expert site visit tea,-n and in an amount deemed appropriate by the team.
            Project #22 was also i:@eccifn@--nded for approval in a reduced amount
            ($1@50 000 per year) for two years only, with a major portion of the
                 .7
            redtiction,to be applied to personnel, particularly the academic positions.
            In concurring with the recommendation for revision of #24, the Council
                                            rovided either by staff or by outside
               ,ested that assistance be p
            consultants.  n@@,Dject #21 was disapproved and no PUMP funds are to be used
            for the project.
            Approved amunts   do not include any funding for project #25.
            ol - $467,387; 02 - $364 818; 03 - $171,585.

            MICIIIGAN REGIO"@LAL @IEDICAL PROG-RAM

            The Council concurred with the Review Corrmittee in its recommendations
            on this application and, in addition, delegated the allthority
            to staff to add funding in an amount sufficient to provide continuity of
            project #15 until a-site visit can deterra:i@np- whether it should be renewed
            or terminated.

            01 - $486,714; 02 - $492,530; 03 - $487,771.

            NEW IVEXICO RFLGIOI-,TAL i@ICAL PROGRAM

            In conc = in@ with the Review Co @ ttee's  reco  @  ndation  for  approval
            of this project, the Council specified that the award be contingent upon
            the Region's submission of an acceptable plan for evaluation of the     project.-

            01 - $59,237; 02 - $61,223.

            OIIIO IIP@,Y Rl,,r.'IOI,,IAL IIEDIC.AJ, P'IDGTW4

            The Council concurred with the Review Cormdttee's recomendation on
            projects #8, #10, and #11. In  regard  to  project  #9,  they  recommended
            that the application be returned to the region with encouragement to
            re-vise and re7@iibmit along the lines of the guidelines recomended by
            the special radiation therapy co@ttee which were endorsed by the
            Council at this meeting.  Project  #7  was  recomended  for  approval  for
            two years only  at a level of $200,000  per  year  pending  the  sub@ssion

                  $305,000; 02    $342,6511; 03  $342,654.


                                    MICAL P@-,OGR"@4

                 Council. v@,as not Filling to arr@Lve Li. final recommendation on this
                 application on the basis of the irifori-!,iatioii at hand and recommended
                 its reassessment by the Review Co,,,@,CLttee..

                               13OUTH REGIO-'VL MEDIC,8J, P,--@'CCrRAM
                 5/69.1   The Council conciu=ed with the recomeridations of the Review
                          Comdttee.
                          01 - $154 458; 02 - $136,755; 03 - $130  922.
                 2/69.1   The last recorded reco @ ndation of the Review Co    ttee  on
                          Project #40 was for deferTal. The Council- believes  that  in
                          the light of the project's fulf'ullment of relevant guidelines,
                          the recc,,mendation of approval is in order.
                          01 - $103,658; 02 - $37,024; 03 - $38,530.

                       6.  Two'special'actioris were taken by the Council in  approving
                           supp lements to the planning grants in two Regions:

                 PUERTO RICO REGIONAL r4EDICAL PROGML
                 Council approved a reqiest for an increase in core staffing which
                 requires a second year planning grant award of approximately  $18.,OOO
                 above the amunt co@tted.  One year only.

                 NORTHEAST OHIO REGIOI%TPT. IOED!CKL PROC!RKM
                 Council approved a reques@u for expanded core staff and for the initiation
                 of one study Wnich i-iill require a planning grant for the second grant
                 period of approximately $127,600 more than the amount committed.  One
                 year only.


           X.  ADJOURUr@21T
                                                              69.
               The meeting was adjourned at 3:00 on @y 27, 19

                                                         I hereby certify that, to the
                                                         best of nW knowledge the fore-
                                                         going minutes are accurate and
                                                         complete.

                                                         Stanley W. Olson, M.D.@
                                                         Director
                                                         Division of Regio@. Medical ProgrciTns

               *Text of the statements and
                additional mterials iihich
                were distributed at the meeting
                are available in the Office
                of the Council Secretary.


                                                  -21-

                         A'ITI@72\TDAI@TO@E AT THE NATIONAL ADVISORY COUNCIL MEETING

                                            May 26-27, 1969

               PUBLIC E7@7H SF,@,\TICE OFFICLALS AT=314G

                    Lionel Bernstein, Veterans Administration
               Dr. Joseph English, Administrator, H,7aR
               14r. Irving Lewis, Deputy Administrator, HSDSIA

               OTHEM ATM4DRIG

               Dr. J.1l.U. Brovffl  NIGMS
               Mr. David  Kp-fauver,  NEM
               Dr.  Helmut  Mueller,  DRG
               Miss  Pauly  Stephan,  NCI
               Mr. William J. Zukel, NHI

               D@@ STAFF A=-IDING

               Yir. Nicholas Cavc-=cchi, Financial Mariagemnt Officer
               Dr. Donald R. Chadwick, Deputy Director, DRT
               Mr. Cleveland Chambliss  Assistant to the Associate Director
                for Organizational Liaison
               14iss Cecilia Conrath, Chief, Continuing Fducation and Training Branch
               Dr. 'Alilfred David, Acting Director, Division of Chronic Disease
               Dr. Sam Fox, Chief, Heaxt Disease & Stroke Control Program, D(,D
               Mr. Edward Friedlander
                                       ., Assistant Director for Co      cations
                and  Public   Information
               Dr. David S. Hathaway, Acting Chief, Dialysis & Transplantation
                ProUam Section,, DCD
               Mr. Charles Hilsenroth  Assistant Director for Management
               Dr. Clarence Tmboden,, Assistant to the Associate Director for
                Organizational    Liaison
               Mr. Robert Lawton, Consultant to DRMP
               Mr. Gregory @,vrls, Chief, G.-,E4,nts Managemnt Branch
               Di?. Richard @egold, Assoc@te -Director for @ Cperations & Developmnt
               Mr. Roland Peterson, Assistant Director for Planning & Fvaluation
               Mrs. @ha Phillips., Assoc-:,ate Director for Grant and Contract Policy
               Mrs. Judy Silsbee, Assistant Director for Grants Review
               Mr. Robert Tnorr@er, Assistarii-I Director for Health Data
               Mr. Robert Jones, Chief, Pro@       Assistance Branch


                                                -22-

              OTHER DRMP STAFF A-=,@.UTG
              Miss   @da   Abrams                                Mrs. Patricia McDonald
                  Joseph Anioroso                                Mr. Praiik liasli
              Mr. Kenneth'Baiim                                  Mr. Rodney imerker
              Mr.  J&nes  @-attie                                Miss @tjorie Morrill
              Dr. Phyllis Carnes                                 Miss Elsa Nelson
              Mr. Roy Davis                                      Mr.  Jack  Pendleton
              Miss  Joy  Finnegan                                Miss Leah Resnick
              Mx. @ 0.  Gilr@ie,-                                Mr.  Dale  Robertson
              Mrs.  Sheila  Gould                                Mr. Richard Russell
              Mrs. Eva real                                      Mrs.  Jesse  Salazar
              Mr. Walt Hangen                                    Dr.  Jack  Schneider
              Mr.   George   @,le                                Mrs. Brenda Slasrmn
              Miss  Dona  Houseal                                Mr. Dan Spain
                                                                 Mr. Alphonse '3trachocki
              Miss Margaret Hulbert
              Mr. Joe Jewell                                     Mr. Lee Teets
                                                                 Mr. Fi@ Van Hee
              Dr. Bryant Jones
              Dr. Anthony Konwoff
              Mr. Ted Koontz
              Mrs. Lorraine Kyttle
              Dr. ltabert Mathewson


                                    ITJ'
                                     Ri@fO-, f@@                                             -23-

          B13EZM, Michael   J.3  M.D.   (72)                            MAHONEY, Mrs. Florence S. (69)
          President, Michigan Cancer 'P,I-indation                      3600 Prospect  Avenue,  N.W.
          4811 John R Street                                            Washington, D. C.  20007
          Detroit, Michiran  48201
                                                                        MTILTMI, Clark H., M.D. (72)
          Professor of.Medicine                                         Consultant in Nleurology
          l@layne State University                                      Ma@to Clinic
                                                                        Rochester, Minnesota  5590;)
          CANNON, Bland W., M.D.    (69)
          910 Madison Avenue                                            PEUEGRINO, Edmund D., M.D. (70)
          @lerrphis, Temessee  38103                                    Vice President for the Health
                                                                        Sciences and Director of the Ct
          Division of Neurosurgery                                      State University of New York
          University of Tennessee                                       Stony-Brook, New York  11790
          College of Medicine
                                                                        POPMA, Alfred M., M.D. (70)
          CROSBY, Edwin L., M.D.    (71)                                Regional Director
          -Director                                                     Regional Medical Program
          Amrican 1-bspital Association                                 525  West  Jefferson  Sbreet
          Chicago,  Illinois  60611                                     Boise, Idaho  83702
                    Anthony  R.,  M.D.  (69)                            ROM, Russell B., M.D. (69)@
          Professor and Head                                            240 'West 41st Street
          Depart@nt of Surgery                                          Erie,   Pennsylvania   16508
          University of Wisconsin
          Madison, Wisconsin     5370(,'                                Vice Speaker of the House of
                                                                        Delegates of the American Medic
          DEBAKEY,  Michael  E.,  M.D.  (72)                             Association
          President and Chief E-xecutive Officer
          Baylor Colleae of Medicine                                    SHANHOLTZ  Madk I.  M.D. (70)@
                       CD                                                        .1        2
          lbuston  Texas  77025                                         State   Health   Comdssioner
                                                                        State Department of Health
          Professor and Chairman                                        Richnioiid,  Virginia  23219
          Department of Surgery
          Colle@e of Medicine                                           TREEN, Mr. Curtis (71)
                                                                        United'Rubber,, Cork,'Linoleum,
          EVFFJST, Bruce W., M.D. (71)                                  and Plastic Workers of knerica
          Chief of Pediatrics                                           87 S. Hii4h Street
          Green Clinic                                                  Amn, o@io  44308
          709 South Vienna Street
          fpston, Louisiana .71270                                      Director
                                                                        Pension and  Lisurance Department
          MGNESS, John R., M.D. (70)
          Dean, School of Medicine                                      WYCY,.O'-PF, Mrs. Florence  (72)
          University of Washington                                      243 Corralitbs Road
          Seattle, Washington  98105                                    Watsonville, California  95076@

                                                 CHAIRMAN

                                           Dr. Joseph T.   English

                                            llea@-Ith Administration
                                           9000 Rockville Pike
                                           BetYtesda,   r4aryland   20014          May 1.969
                                                                                          & Cory,,rast Pdli,,