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                                                                                                                                                                          *EOO  1  31                           *








                 DEPARTMENT  OF  HEALTII,                  E D U C A T I 0 N

                                   A N D  W E L F A R E

                    flealth Services and M6--ntal Healtli AdnAnistration

                        Division of Regional Mc-dical Programs









                                  National Advisory Council on
                                   Regional Medical Programs
















                                    Minutes of the Meeting
                                      July 28-":Ig, 1970






                                      Parklaiqn Building
                                     Confeience Rooni G/ql





                                       OIP lb."AfjrII3        AND *-;It@ARE


                  National Advisory Council on f@ei-,Io@-il. Medical Programs

                              Minutes of the Twentieth Meeting  1/  2/

                                          July 28-29, 1970


              The National Advisory Counci'@ on Reri.oiial ".Iedical Programs convened
              for its twentieth meeting, at 8:30 a.m., @esday, July 2 , 1970 in
              Conference Room Czlf-f of the Parl@laein Buildi.ri@@, Rockville, Maryland.
              Dr. Harold @brgulies, Acting Director, !-',egional- Medical Programs
              Ser,vice presided over- the meeting.

              i7-ie Council members present  were:

                Dr.  Bland W. Cw-mori                    I),,. @.und D. Pellf7ino
                Dr.  Fdwin L. Crosby  (7/28  only)       Dr. Alfred M. Popma
                Dr.  Michael E. Eullakey (7/'19 only)    Dr. Russell B. Roth
                Dr.  Bruce W. Ever-ist                   Dr. i-lack I. Slianholtz
                Dr.  William f@. Iftitit                 Mrs. F'--orence R. Wyckoff
                Dr.  Alex,-tnder, M. McP]ieciran

              A listing Of HMP staff members, and others attending is appended.


          I.  CATI, TO  ORDER  AND  OPENING  FO,@S

              'I'he metinf,, was called to order at 8:30 a.m. on July 28 by
              Lh,. l@ld Mareulies.

         TI.  X4NOUNCF,',,T@,NT@9

              '1'he Council members were welcomed to tilie new Conference facilities in
              the Pai,klavRi Buildirv., and the LTeiiei,a.t arrwif-,emzits for the conduct of
              the meeting in these facilities wa,'3 explained.  Dr. Marpulies announced
              his plans for wi executive session with the Council at the close of the
              first dav of the meeting.



          1/  Proceedi@,s of meetings are i,@stt,!(@ted unless cleared by the Office of
              the Administrator, IISNUTA.  The r,ez3'Lli@ictioti relates to all material submitted
              for discussion at the meetings, the supplemental material, and all other
              official documents, including the aicnla.

              For the recor@d, it is noted that           absent themselves from the
              meetiW., when the Council is ctiscussirij-, applications:  (a) from their
              @@pective institutions, or (b) iii which a conflict of interest night
              occur.  'this procedure ioes riot,, of         ap@)-i-y to en bloc acti.ons
              oilly Nation   application is Llfl(jei,           discussion.







        III.   I@Zfliol)UCTION OF T L@, 4
                   Pbi,fnilies introduced two new         c)t' the Council who were in
               attetidai-ice for tl-iis iTioet I i-q,.  'They ai,e:  WI. I I..!.Lun II. I funt, M.D. ,
               a Coiiiiiissionei@ of the Cowity of Allf-@t-@it,iiy In Pennsylvania and medical
               practitioner in McKeesport, Pennsylvwiia; wid Alexander M. McPliedran, M.D.,
               Associate Professor of Internal Medicine (Neurology), Emory University
               School of Medicine . Atlanta.  'Die recent appointflient of i@. C. Robert
               Ogden was also m-iounced.  Mr. Ogden is President of the North Coast Life
               I,,isu,.,aiice Co@@.o@r in Spokine, Wisliir,,f.-ton and Chai. of the Washington/
               Alaska Regional Advisory Group.  fie will begin his regular attendance
               at the next meeting.
         IV.   RL,:GIONAL ICDICAL PROGRAMS AS A Pigr OF IfilL ]Ei!AL'Ill SERV'LCES
               AND %'U@                                 Vernon Wilson
               In his first @etinEr, with the.Council as Administrator of the Health
               Services and t4ental Hedltli A@nisti@atl.on., Dr. Wilson recalled his long
               interest and first-l-iand involvement in the cleveloprTent of Regional
               Medical Program .  fie assured the Council of his strong support of
               Regional Medical Programs as a part of' the broader efforts of HS@
               He expressed ',iis endorsement of the t)i@iiicil)les of decentralization of
               the adudnl.stration of IISPillA activities generally, and his belief that
               the concept of Regional @4edical Prof-@ams can relate well to these
               principles.  Altliouf-rh the mchanisiiis will be worked out slowly, he is
               confident that this can take place without dilution of effort,,
               either in the Regions or in the head@lti@-tei-s office.
               In recok,7iition of the very formidable @)roblt@ins facing Regional Medical
               Programs Service, Dr. Wilson expi@,,.ii(,d re@t that he was not able
               at the present tinie to resolve the         staffirifr problems.  He
               assi-tred the Council this has v@ry liii@i priority oi-i his working agenda
               and the fact that fie is as yet utizabl(? to report does not iridiqiate
               that he is not actively viorking toward a solution.
               Dr. Wilson asked the Council to meet with Iiiiii again in approximately
               six to eirjit weeks, in a special otio@,-iy session.  At that tin-e he
               Is assured he will be able to discuss his plans, as they are based on
               those of Secretary ]Ucliardsc)n, for the organization and administration
               of the Department's efforts to sti@erip,,tlieri and increase the nation's
               capacity to deliver health services.  fie indicated also that by that
               tire he would have iiiore definitive I)Ian.,@ for the staf.fing and
               organization of the Regional Medical Progr3nis Seiv'@Lce.
               AltlioLVji his plans will include a @,,eticral outline of the I'@ssion"
               of Regional Medical rt.oF@@amo as a part of the tl,'3MiA effort,, Dr.
               Wilson .said that It-le would rely heavily on the advice and guidance of
               the Council for developing the policies arid detailed program directions
               that would        to even raise Off,:I("Lerit (Effective cooperative ai@rar.-ements
    le         between the private sectors, wliic-ti they rept@e,,@erit-1, -ind the Federal effort.







                Dr. Wilson told the-Council of   the resignation of  iMr. Irving  Lewis
                as. Deputy Administrator of         and about ';Ir. Lewis'  appointment
                a@ Professor in-the Department of Community Medicine at Albert
                Einstein College of D4edicine in New York.  :4r.  Lewis  addressed  the
                Council briefly, stating again his faith in the  Regional,  ',4edical
                                                         -@t of'true  regia.-ialization
                Programs as, representing "the only conce
                of health services that can be expected to work" in the United States.
                @. Lewis expressed his thanks to the Council for the many pleasant
                working relationships he had  had  with  them.  f@s.  Florence  Wyckoff
                responded for the Council,  expressin-  their  appreciation  for  his
                assistance to them., especially in helping  them  to  understand  the
                principles of Federal financing of health care and in the area of health
                economics generally.

           V.   CONFIRMATION OF         P4,,L7TIkIG 'DATES
                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, 1971.
                In addition, September 30  1970 was set for the special meeting
                requested by Dr.  Wilson.  The.Cowicil  accepted  the  invitation  of
                Dr. Edwin Crosby to hold this meeting at the American hospital
                Association headquarters in'Chicago. 'Iliis will  enable  more  of  the
                members to travel to and return home from the meeting in a single
                day.
          VI.   CONS@' ERATIOIJ OF TI-E, MIIIU@ OF ri7lL @,ILRcli 31-APRIL 1, 1970 PIEETI14G
                The Council unanimously recommended approval  of  the  minutes  of  the
                meeting of the Council on ',%Iarcli 31-Api@il 1, 1970.
         'V-l I .A RE-POW FROM Tf-fl-" DIRECTOR - Dr. @-t,old Margulies

                A.  Progress of l@R 17570 and S3355
                Dr. 14argulies reviewed the contents of the twc Bills very briefly
                and referred the Council members to wi analysis prepared by staff which
                compares the Bills to one another uad to the present legislation.  This
                was included in the agenda materiafs.

                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 "new" funds to be available for major expansion of Regional Dledical
                @,ofTafiis in FY lg"ll.  Among these ii-e the $1.9 million earmarked for
                I'@iodel Cities activities; the 1% reserve of' funds to be used for evaluation








                                                             e possibility of
               activities at DHL,W, HSi@, and RMPS levels; th
               administrative "e     I,,ing" of some funds for @4P participation in
               comprehensive regional kidney disease programs; all in addition  to  a
               total amount slightly in excess of $77 million required to meet
               minimal continuation requirements of ongGing regional activities.

               C.  Funding Strategy
               Dr. Marpi-ilies made abrief introduction of a new mana ement information
                                                                    9
               system being implemented by @S.
               Ile also noted the effect of the 1969-70 strategy of permitting Regions
               almst unlimited rebudgetitig of unexpei-ided balances for program
               expansion.  Dr. Nlm,gulies stated Iiii intention to begin to apply
               more stringently guidelines to this kind of rebudgetinp, and to
               recapture some of these balances for reallocation among  the  Regional
               Medical Programs In response to evidence of successful regionalization
               apd program development.

               D.  The FAST Recommendations
               In a brief review of the recommendations of the Federal Assistance
               Streamlining Task Force and his plan for responding to them, Dr.
               Margulies emphasized the "liaison" role of the DHLIW Regional  Offices
               in the developmnt of IIS,"@ programs Generally, and in helping to
               relate Regional Medical Programs to both publicly and privately-funded
               programs in the area served; but with the retention of  the  principal
               mana,r,ement responsibility in the Re@ional Medical Programs Service
               at the national level.  Ile also mentioned especially the Service's
               concern, antedati@, the Task Force study, for better delineation of
               the multiplicity of activities now covered by the core budget in
               Regional Medical Program grants.
               Dr. ?4argulies explained the intent of TIMPS in placing, a Program
               Representative in each of the tei-i Dlil,@@l lief,-Iorial. Offices and described
               what he sees as the service role of these individuals.

       VIII.   PROGRESS DIO'I'ES FROM STAFF

               A.  Contracts under Section 907 - fx,. Margaret Sloan
               Dr. Sloui gave a brief review ani        r,eport on the three contracts
               made by the fuqrs under the terms of  ction 907 of Title IX of the-
               Public Health Service Act, which deals with the 11 ... list or lists of
               facilities in the United States equipped and staffed to provide the
               most advanced @tliods and techniques in the diagnosis and treatment of
               heart disease, cancer, and stroke....

                                                       LT
                     Llie contract 7qit@ti. the         t i@,,@ociat-ioll in support
                  of the Intersociety Commission for Heart Disease Resources, has







                 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 Dleurolop;ical  Association,
                 has chosen to withhold publication of-its  r@port  until  it
                 is entirely completed.

                 . The report of the Special  Advisory  Committee  on  Cancer
                 Care Facilities of' the Cancer Commission of the American
                 College of Surgeons, which was supported  under  a  contract
                 now completed, has been reviewed by the Regional Medical
                 Programs Service and was received by the National A@visory
                 Council at the April 1970 meeting.  Negotiations between the
                 American College of ')urfr
                                         ,eons and the RMPS,  preparatory  to
                 completion and RMP approval of this report, are now underway.
                 (This was discussed in more detail with Council during the
                 Y@ecutive Session).

            B.   Multi-Prograrn Services Project Grants - Mrs. Martha Phillips
            Authorized under Section 910 of Title IX of  the  Ilublic  Health  Service
            Act, this program of project grants will  be  implemented  for  the  first
            time early in FY 1971. @e  Council  was  reminded  of  its  original  role
            in the development of the basic  guidelines  and  operating  policies  for
            these grants.  They were assured that these are reflected in the final
            edition of the program documents which are now'in clearance.
            The 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 two major
            grant activities.
            C. Regional Medical @ograms In  Model  Cities  -  Mr.  Cleveland  Chw&.liss
            The Council was reminded of ttlE@ administrative e@    king of $1.9 million
            of l@4P PY 71 grant funds for use in projects  which  have  direct  impact
            on certain designated Model Cities neighborhoods.  Mr. Chainbliss outlined
            the procedure for determining the degree  of  such  impact  and  obtaining
            the certification of Model  Cities  officials  in  this  regard.  Although
            this procedure includes endorsement of DI@ Regional officials, Mr.
            Chwnbliss 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.
            Also in i,os@@onse to s@)ecific q),Iestio@-i@,, i@i@     ex@)lai@.,ied that
            Regional Medical PropTams which are planning arid subnLittirg  projects  to





                                                6


            serve urban populations 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 Traineeships - Mrs. Martha Phillips

            Mrs. Phillips recalled to the Council  :he circumstances  leading  to  the
            Departmental decision to place responsibility for the Senior Clinical
            Tt,aineeship program in Regional Medical, Programs Service.  She  also
            reported to the Council on,the selection of the first group of.@aineeships
            to be awarded'under liMPS sponsorship.  'Iliis selection process was carried
            out by panels of hon-P'edepal experts in the cancer field and  was  chaired
            by Dr. Michael @ennan, to whom  the-Council  delegated  authority  for
            the selection of individual trainees to the total extent  of  $300,000  of
            FY 1970 funds. Thirty trainees were selected  from  among  80  applicants,
            and represent t.ie disciplines of medicine, gynecology, pathology,
            pediatrics, radiology, and surgery. T"ne training  will  be  done  in  @or
            medical centers throughout the United States.

            E. G@uidelines for Instructional TeclinoloLV - Miss Cecilia  Conrath

            A second edition of these Guidelines was before the Council for tlie:-r
            consideration.  Dr. Pellegrino, who served as Chiirman of the Subcommittee
            to prepare these guidelines, expressed his belief that  they  are  now
            ready for publication arid -implementation, with certain  rewriting.  This
            is being done by @4PS staff, incorporatir@- Dr. Pc-Ilegrino's  suggestions.

               revaluation Activities - Mr. Roland Peterson

            In reporting to the Council, Mr. Peterson  mentioned  the  final  sunmtioh
            aiid distribution of the Regional ProF
                                                 ,less 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  earmark.

            rIThis 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  fISMLA,
            and DHFW.  It is anticipated that something slightly under- $1 million
            could be set aside under these circumstances and could be used by contract
            or by the Section 910 grant mechanism, at the discretion of .     )  w
            portions of the total withheld for HS@IA ind DIL7W  evaluative  activities.

            'n-ie 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.
            '@re was a good d eal of discussion of the contract with  Arthur  D. Little, Inc.
            and expression of considerable doubt as to the real value of any find--ngs
            being reported.  Several of'. the Council        have @d'i.iadiv,-dual experience







                                             ct activities and   feel  that  the@have   not
             with the conduct of the contra
             alw),y,s been handled in the best  interests  of  the  Program.  There  was
             unanimous agreemnt-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  affd-disclission.  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 originally let. They also  asked  to  see  the  final  report  from  the
             Artliur@ D. Little' 15 Inc. as soon as it is received by RMPS.
             In swruToi@izing the discussion,, Dr. Pellegrino suggested that all
             evaluation activities should, in the loii               e to test  h@e vi-abil@
                                              s they ai,@(,
                                                          ie.v are not.
       IX.   KTDNI,',Y DISEASE ACTIVITIES IN REGIONAL Iq@'i)ICAL PROGRAMS
             Dr. Marf,,ulles reviewed for the Cotiricil  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  Prc)Uams.  fie  asked  l'or  guidance  of  the
             Council In the development  of  a.  responsive  and  effective  policy  for
             Regional Medical Programs participation in comprehensive regional kidney
             disease programs throughout  the  Nation.  Ile  is  aware  that  the  final  .
             definition of such a policy, especially as it would apply to the @ediate
             future, will not be  possible  until  after  CorZi,essional  action,  on  both
             the continuation legislation and the appropriations, is complete.
             In order to provide some background foi, their deliberation, Dr. Margulies
             Oxplained that he had asked the staff to prepare some basic information
             and to draft some suFj-,ested  policy  guidelines.  These  were  part  of  the
             agenda materials presented to the Council-.  lie then introduced
             Dr. George Schreiner, Chief, Nephrolof-,y Section, Department of Medicine,
             Georgetown University and Di,. Richard 13. Freeman, Department of Medicine
             (Neplu-oloEW), University of Rochester ,,',cliool 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 @-ageinent of chronic kidney disease.  fie incl,-Ided resume of the
             techniques and methodologies of screeiiiii,(r. diagilLosis  and  therapy;  and
             the shortcomings as well as successes in prevention, treatment, and
             rehabilitation.
             Nepl   lot                         id a ri(@i,4 area of  specialization.  As
                 iro  V is, Dr. Schreiner sa
             such it has the disadvantage of a severe shortage of trained specialists;
             but has the advantage  of  having,  few  established  traditions,  and  is  in
             the enviable petition of           able to          from the niistat@es made
             in establishing resources for open nearly sui,@r(2i,y, high voltage radiotherapy, e'l-c.





                                                   8


              organization for the delivery of   servies to patients with kidney disease,
              Dr. Schreiner believes, lends  itself  so  ideally  to  regionalization  that
              the,development of such a program can and  will  serve  as  a  framework  for
              regionalization of' services  in  other  more  traditionally  established
              disciplines.
              Ap,ain, as in nearly all their past discussions of kidney disease, the
              Council expressed concern about the apparent lack of emphasis on
              prevention as part of an overall kidti(-,y  disease  program.  Dr.  Schreiner
              and Dr. @(-em-qn believe that the only li(.)[)e for real prevention  will
              come via prenatal care and "Frenetic       tieering" and although work
              in these areas is progressing, it will riot have any significant impact
              for fifty to sixty years.  'ITioy 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. Freemn 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  regard  have  been  misleading  and
              discouraging to institutions  and  coranunities.  Both  agreed  that  the
              $15 million mentioned in the pending I.e@,isl.ati.on could make a
              significant difference in the extension of services of' existing kidney
              disease centers or in the establishment of  some  smaller,  nurrber  of
              entirely new ones.  Dr. Marpulles reminded the Council that the
              $15 million to which the Bill makes reference, is recomeiided as a maximum
              assignment of Regional Medical Program grant funds to kidney disease
              efforts, and in no way e       ks or limits any dollars exclusively for
              this purpose; nor does it  provide,  or  even  recommend  the  provision,
              of funds over and above the grant funded, to be otherwise available for
              purposes of Regional Medical ProFTains.
              Dr. I-Iverist raised the question of  the  mechanics  of  incorporating
              kidney disease programs into the 55 Regional Medical Pro@ams if the
              principle of local autonomy and decisiori-makii-Vr is to be maintained.
              It is his belief that unless and until l'o-ions with appropriate
              existing facilities can be  "seduced"  into  affording  higJi  regional
              priority to kidney disease control, it will  be  necessary  to  use  t  e
              Section 910 authority, so that national  directives  rpay  be  used  to
              develop 'sensible prof;rains in sensible places."
              AcceptirT, the apparently inevitable laiT  time  before  the  results  of
              a planned program of prevention can be t'(@it, Dr. Pellegrino asked for
              the advice of Dr. Schreiner and Di,. @@c,,eman on vihat immediate impact
              Regional Medical Progpajns could reasc)i-iib.ly have,  considering the   -
              provisions of  the  proposed  legislation  and  within  the  amunt of funds
              that are likely to be available  within  the  next  two  or  three years.
              Responding first, Dr. Schreiner recon3ilt,t-id@--3 the stre @., herii@-r of
              existi@-,  facilities,  particularly  those  which  have   co@tted themselves
              to outreach beyonJ the confines of tli-@@          center   within which
                   exist; and           identifying those         t,@iis group that lend them-







                                                 9

              S?Ives to further interlinkage to provide a multiplying rather than
              cimply an additive effect.  Dr. Freernan recommends the support of the
                                                                              f
              completion  and extension to full services of a small number o
              centers which can be developed on the basis  of  existing,  although
              perhaps not entirely complete, resources;--the use of R,4P funds for
              support of planning, particularly in regard 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 Coundil. strongly endorsed Dr. McPliedi,an's point regarding the
              @ortance of thoughtful integration of a kidney disease program nto
              an existing Regional Medical Prograni; particularly in T,lanning,
              sub-regionalization, continuing  education,  and  inter-professional
              comnunlcation activities.
              In a subsequent discussion on the second day,  the  Council  members
              reflected on the recommendations of Di,. l,reen-an and Dr. Schreiner
              as well as on the goals, objectives, mid the basic operational concepts
              which guide Regional Medical Programs at  the  present  time.  Since
              these proscribe against the use of futi(Js f(i,the direct provision of
              patient services, and the total amount of funds likely to be available
              will proscribe against making @jor contributions toward the establishment
              of facilities, the Council agreed that the major focus of @.IP involvement
              will be (a) the encouragement of better and more effective cooperate   ve
              arrangements amng carefully selected institutions and resources which
              together might form @i "decentralized center" and (b) in the stre@, hening
              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
              plarniitT,.
              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 tc) have basic data concerning the resources
              in, and available to, each of the lj'3 Regional Medical Programs.  This
              should include (a) presently ,:-,elf-contained centers, (b) institutions
              which have the capability of becoming an integral part of such a center,
              at-id (c) institutions and resources which might participate in an inter-
              rec,iorial arrangement for the provision of kidney disease services.  An
                CD
              assessment of the "size and sl-iape" of' the kidney disease problem in each
              of the Regions would provide the other essential piece of basic information.
              IX,. Nlargulies agreed to provide these data based on the existing geographic
              pattern of the 55 Regional Aeclical Program.

         X.  RL,VIE@4 OE,' AFPLICATIONS

              A.  Issues Identified
     14@D     1.  In the matter of- FW suPL)ol-,t of' s@loi,t-totili t             the
              Council considered the history provided them by stat'@.', ana a nuniuei@ of







                                                          l'O


                    'fic projects included in the       apl,licat@,oiis under review at  this
               spec -L
               Meeting.  'Phey be'.ieve that tinder     iiiost cii@curpstances'i-t is not necessary
               or appropriate for Regional       @,ledical ProtTams grant funds to be used to
               cover the full costs  of  both  the  presentation  of  short-term  training
               projects and of stipends and expenses of the participants.

               'rhe majority of projects in  this  category  provide  opportunities  for  up-
               p,radinp, and development of new skil.Is in special techniques or procedures
               and are directed to individuals pr(@.,;eritlv employed in  health  care
               institutions.  Under  the  circumstances  these  institutions  should,   and
               -in rnc)st cases do, make regular provision for'tlils kind of training for
               their staffs.

               'life Council therefore recomended  the  following  changes  in  policy
               guidelines               Payments  to  participants  in  continuing,  education
               and tr@airiiii- projects (as defined j.r) the Guidelines Addendum, February
               1970, page 13) which are- supported by Regional i',Iedical  Prograin  grant
               funds.


                      Regional Medical Pi,oi
                                               _Tam grant, funds ma,.v not be @sed for the
                   payment of stipends, either  directly  oi-  on  the  Maintenance  of
                   income principle," to participants in short-term continuing
                   education and training projects. 'L'Iii,,s does  not  include  training
                   for new careers for new types of                T)eisonnel.

                   .  Otliei, allowable costs of parti.cip@itit's support may be
                   calculated accoiU-Lr4,- to  the  exist  !.like  fLlidel-'unos.  Regional  Medical
                   l@ogra.rn @wit  funds  nay  be  request.(@@.1  and  awarded  for  per  them  and
                   travel- to  the  extent  of  5OZ  of  the  tcftal  airiount  so  derived.  The
                   awarded funds nay then be paid to t,l)c, enrolled trainees as considered
                   appropriate  by   the   project   personnel,   depending   on   the   participants'
                   ability  to  provide  these  costs  for  t-li(,riiselves  and/or  the   willingness
                   of their employers to provide them.   @lo shift
                                                                       _,le individual may
                   receive per them or travel allowance ,it a rate higher than that
                   prescribed by the present Guidelit-ies.

                      TIP funds iiiay not  be  rebti(iget(@l,  t'rorn  within  or  without  the
                   project  budget,  to  Increase  the  total  airiowit  awarded  for   per   diein
                   and travel above the 50/'O level.

             2.    'ilie  Council  considered  the  present,  (iiii(ielines  regarding  ef-rional
             ',It
             .  @ilcal  Contain  f'@idir@,  of  projects  o'.'  torij@-tetin  post-doctoral  training,
             at the senior  resident  -tnd  L)ost-t,et3l(ierit,  levels,  z)ai,ticularly  in  the
             clinical sub-sDecialtie,,@ of iiiipoi@tanc(-, ir-i patient n@agement in the
             diseases tai,reted by I'vef-,ionil Mc@dica-1.               As  has  been   pointed   out
             by  both  the  Review  CoriuiLittee  and  the  (outicil  i'@quests  for  support   for@
             training  of  this  kind  are  appearing  There  and  ni(,)i,,e  frequently  in  Regional
             Medical             applications;              of' lul-ic,                critical
                                                                         but also 'Lt@cause  cf'  tiae
             drastic  reduction  in  NIH   funding   which   has   previously   been   available   for
             this purpose.








                                                                          f maintaining the training
               'Die Council unarlimusly agrees on the -importance o                     out the nation.
               prop,rams in these fields in the major teaching centers through
               They also agree that funding throuyli l@egional '.qedical Programs would serve
                                                                  these centers of' clinical
                                                                                           form the
                                      .rarr.ework of cg_o@@ttye @@in@erLtp which
                                                                -  E.  ft   is   recognized,   however,
                                      of  which  they  are  a   par
               that the  allocation of an amount of funds large enough to make a siFi-iificant
               impact, if provided from the present 1.     @4P appropriation, would create a
               serious  and  inappropriate.  imbalance  in  the  -.@  efforts  to   meet   more   their
               varied      comprehensive troals.  'L'@ie @'ouricil, therefore, requested the
               @.,IPS staff to forward  to  both  liSt                                       ndat    on
               that ai,r,            e made , o  pr@oi                         e to clinical departments
               in  IlWor, teaching  centers  to   off.,                        ducation
               distinct  from        osts,i  en   ifi(                           -,iei-it  serv:ces  of
               iie III-al-rit(--'riance of t@.ieii- clinica-                   Residency training
                                                                                              -iegional
                                         that fundinp.,,, ovei@ an(             current C-.

               AccordinE,,ly, the Council recommends, tt@--t until such funds are added to
               the annual appropriation, the Regional @4edical Program Guidelines for
               operational grants under Section 90)1 ol' 'Pitle IX of the PliS Act be
               changed to exclude the payment of stipends a-rid other participant  costs
               for long-term training at the post-doctoral level.
               3.  The Council is keenly aware of tli(-, potentially crippling effect on
               Refr,ional Medical Propxams of contiri(-)tis investment in p@o,jects which          were
               initiall               for deiiiotistr@atioti ot               in, new techniques
                                                                  an essential service to Patients.
                                                                  woul     e LMWise and indeecL
                                                                    il.y including or excluding
                                                                  e iVPS staff to work closely
                                                                o  be  certain   that   other   sources
               of support for maintenance of' the sei,vice involved be well in hand before
               such a project is initiated; and also to encourage i3egions to carefully
               investigate  every  possibility  of  capturing   the   fees   paid   for   the   service
               Involved,   for   reinvestment   in   the   project.


               B.

               NOHPfif@'A'O'FPI-@IN O]IIO RF,,GIONAL Nlf@",)ICAI,
               In response to a special appeal for reconsideration of previous action
               on Project #7 (A Comprehensive (@t-patient Stroke Rehabilitation-
               f)enioristration), the Council considered the additional information submitted
               and recommended that the project be approved as requested.
                      01-  $118,233                                                         -.)76
                                                      0)       -o,i              .03   $26,










                flAVIAII  RECTIONAL D/EDICAL PROGRAM

                RM  00001    7/70.1 -   Operational   Supplenieit Approval

                     Project   #21- -  Approval   I
                     Project    #22 -  Approval   I
                          01 - $202,7113                02    $99,168            03   $108 3252


                ILLINOIS @'GIONAL @'U-"I)ICAL PROGRAP4

                @,,i  ooo6l  7/70.2  -  Approval  with  specific  conditions.

                     Project  #   9-  Noti-approval  II  with  the  recoinmeridations  for  revision
                                     suEZested  by  the  lit@view   Cor@ttee.
                     Project    #10 -  Approval   I
                     Project    #11 --,-Approval  Iwith the conditions specified by the Review
                                     CoiiaiLittee.
                     Project    #12- Approval    I
                     Project    #13- Approval    Iwith       (,,(-)nditi,ons specified by the Review
                                     Comm-ittee;  with secoti(-l and third year funding contingent
                                     upon proFres  s in tire  first  year  to  be  assessed  by  the
                                     Council on the bis-i,,, of a progress report3     continuation
                                     application, and tli(@ report of the technical site visit
                                     to be held soa)et.iiii,-@ toward the end -of  the  first  year.
                         01 - $587,412                  o,? - @,661.%237        03 - $341,883


                INDIANA Pd@:(31ONAT, IVF.DICAL PROGUM

                RNI 000113  7/70.1  -Operational Supl)leiiriit - Non-appi@oval
                     Project  #19   -Tloii-appi-k)val T inappropriateness for f@vIP funding based
                                     on the Councills decision to defer@ approval of pro'ects
                                     proposing tilie cl.-iri.!,(.@al application of C,,eiietic counselling,
                                     pending  further,  sci(?titific  validation  of  the   clinical
                                     uses of this technique.
                     ,Project  #20  -Noti-cip[)T-ova.L ].I with the recorrrwndations for    revision
                                     suiyp,ested by the  Review  Coniniittee.


                I@KRMO@ITAIN REGIONAL, H-I'DICAI- I!FUCIWI

                RM 00015 7/70.1 -  C@er,ational  Suppl(@rliet-it  Return for Revision

                     Project #2'[ - 1,4oii-appi,ov,,:il il     t' I,,e t,,-@ccituTiericiatioris for revision
                                     she   sted by ttio i'@('?'vi(,w Coiiuriittee.








             NO     DS REGIO@IAL @'4,LDICAL PROGK-vl
             Thd National Advisory Council considered a request for the initiation
             of interim support to the Diabetes Detection and Education Center in
             !4inneapolis with the understanding that (a) these furds will be 7ade
             available from the Region's unexpencied bdlance:g and (b) that this
             approval does not in any sense indicate co@tment to approve the
             forthcoming application for RT participation in the long-range basic
           'support of this  Center.

             VIRGINIA REGIONAL P)EDICAL PROGM4
             In reoard to Project #14 (Stroke in a Simall Rural Cormunity  the Counci
             concurred in the staff Is recommendation for a waiver of the restrictions
             @osed as a condition of the original. approval of this project,
             subject to the satisfaction of HVIPS that the purposes of the project are
             being adequately achieved.

             WE,-,= NEW YORK RL,GIONAL DEDICAL I@R()(.',FiAM
             In regard to Project #10 (Vlestern New York 'ilumr Registry) the Council
             concurred with the Review Committee's reconrnc-ndation for continuation
             of the project as amended.


             C.  Recomwndatioi-is for Action
             'Ehe Council recorded their recommendations in t)ie forffiat which was
             adopted in the previous review cycle (Appendix I).


             ALBANY 13FGTO14AL ,')U@'DICAI, PROGFL*L
             PIA 000011 7/70.1 - Operational Suppleiiic-iital - Approval with specific
             conditions.
                  Project #7A(R) - Approval I with the conditions specified by
                                   tne Review CoiT3Tdttee.
                  Project #7B(R) - Approval I with the conditions specified by
                                   the Review Conunittee.
                  Project #18 - Non-approval II - Revision Required.
                     01 " $36,930              02 - $36,930         03 - $0


         1/  All amo@ts are direct costs only arid unless otherwise specified refer
             to a 12-month period.
             'I'he designation 01, O'C', etc. i@(-Iate5 to the first, second, etc. , budget
             periods of the subject aplication, not necessarily the budget periods
             that will actually be suppiemntect.





                                                   14


                                       T
               CAFTlt).V41,A L@IONAI, @D,"D-CAL PRXjfM

                   Project #56    Approval I
                   Project #60    Approval I in the reduced amunt
                                      approval I
                       01 - $107,307               02 - $117,248          03    $121,393


               CENTRAL NEW yoRK REGjotJAL MEDICAL PROGRAIL
               M 00050 '@/'(0. 1 - Operational Supplettiorit- Conditional approval.
                   Project #15 - Approval I at a reduced level with the conditions
                                  specified by the lieView Committee.
                       ol - $4o.,OOO               02 - $50,000           03 - $53,000

               COLO@/14YOMIN@-T FT-,GIONAL ML,'DICAL PliOGRNil
               RP4 000110 7/70.1 - Operational @uppleiiierit - Return for Revision.
                   Project #13,ri - Non-approval II.  Return for revision with the
                                   clarification requested by the Review Co@ttee.


               FLORIDA RdiPxIOI@IPL ML,DICAL PROGRAM

               RM 000211 7/70.1 - Return for revision.
                   Pro,iect #36 - Non-approval II with recomendations for revision
                                  as  suggested  by  the  Review  Comdttee.


               GFTORGTA ff,]GIONAL @U@:DICAL PR@,QAM

               R@,l 000)46 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 C.--eorFI,a FMP.
                   Project #33 - @lori-approval I.
                       01 - $100,000                02 - $100.1000         03 - $0

               GIT-ATE-R DELAVIARE, VALLL,'Y RFGIONAL @,a,,DICAL PROGRAM
               Rl,l 00026 7/70.1 - Dis    oval - inappropriate for        funding.

                   Project #19 - Non-approval I





                                                        16



               KAII.SAS REGIOIJAL D)EDICAL PROGRAM
               RM 00002 7/70.1 - Operational Supplerrent       -.Return for Revision
                    Project  #39  -  14on-approval  II  with   the   recommendations   for   revision
                                     suggested  by   the   Review   Committee.


               LOUISIINA REGIODIAL jNU;',DICAL PROGRX.,L

               @TI 000.-33  "(/70.1  -  Approval-  with  spcciCic  conditions.
                    Project  #  8 -  lqon-al)proval  II  with  the   recommendations   for   revision
                                     suf-i,,,osted by the li(-vlew  Coimdttee.
                    Project  #  9 -  Approval I in a             amount and with the conditions
                                     specified by  the  13(-@view  ConrLittee.
                    Project  #10  -  Approval I
                    Project  #11  -  Approval .1. I
                    ,Project #12  -  llori-appy-oval. II  with  the  recoTffnendations  for  revision
                                     sur,gested  by   the   vieview   Co@ttee.
                    Project  #13  -  Approval II
                        ol    $147,532                 O"-' - $'17,2112         03 - $79,342


               i@TiYLAND REGIONAL DR@'DICAL PROGRA2,1
               Pu'4 0001111 7/70.1 and 7/70.2. - C)peratioi-ial  Suppleiyp-nts  Approval with
               specific conditions.
                    Projects  #25  and  #26  -  Approva-1.  I  with  both  projects  to  be  combined
                                               at a reduced ainowit and with the conditions
                                               specified by the Review Coinnittee.

                   -Project //27 - Approval    I
                    Project 928  -  Noii-appi-ova-L  IT  with  the  reco,,niiendations  for  revision
                                     suggested  by  the  !',Oview   Conudttee.
                    PIoject #'C'9  - Noti-appi-ova--L I
                    Project  #-'O  - Noti-approval- I
                        oi - $914,975                   o') - $11111 1175        03 - $145,975


               NU,-t4PIiIS REGIONAL @@ICAL Pf:,'OG,,-aM
               RM 00051 7/70.1 --Operationil @ilDpleii?ot-it - Disapproval. Inappropriate for
               ITM    funding.
                    Project #2'7 - i%'()ti-appi,oval T.  ';Ilio        iAr@is in a,-.reernent vritli the
                                     Hc?view Co,,i@[Litt(.,e ill             ri...)ti-al)pi@c)val for the
                                     Peripheral Vascul.ai, Clinic Pi@oject.  'Itley wish, however,





                                                             17
              'Fg,lli[PIIT"' FiiBIONAL      ICA  PROGIW,,'l (COT-"i').
                                          to be certain that the project personnel and the
                                          Monphis FFIP under,.,t,@..-@ that the reconmndation in
                                          no way reflects a (11; a@@-eTwnt with the inherit
                                          service value of the Clinic nor suF@, sts lack of
                                          confidence in the st@iff and Institution.   The action
                                          does not preclude i@stibmission of a request for R,T
                                          funding for the continuing education aspects of this
                                          project at such tiii)3 as these are niore thoroughly
                                          planned and ready to be iiTplemented.
                     Project #28          Non-approval I

                .@7FROI@LI'FAN klASlIT14G'L'ON, D.C. RI@,CIONAL i@,D.--Il)ICAL PROGRAM
                P@4 00031  7/70.1  -                     1 Suppleiiierit - Approval- with specific conditions.
                      Project  #36   -    lqoii-,qpproval I
                       I  JOCT  #37  -    Approval I at the ie(-Iuced level and with the
                              It #3(
                                          conditions specified by the l@,evi(-,w Cormdttee.
                            ol - $38.%1177                        o'.1 - $Iio,618               03 - $44,928

                @MICHTGAN RFGTOt4AL NILDTCAL PR@)CtRA14
                 RM 00053 7/70.1 -  nperatioonnaali LSuuDplltefil@@t@i@t' - Approval with specific conditions.
                       Project    #16H      Approval I
                        r iect #2-(         Approval I with the conditions specified by the Review
                                            '-'o@ttee.  In concurring with all of the reconmndations
                                            of the Review CoiTnLitteel the Council urged the Ri'TS
                                            staff to work closely in the development of this project
                                            with the hope that it will come closer to a demonstration
                                            of comprehensive care., as proirdsed by its title, than
                                            it would presently appear to be.
                       Project  #28  -      Nori-approvcil II with the recormiendations for revision
                                            slif,                         ew Coifnittee.
                                               @, sted by the fievi
                             ol - $550,970                         02 - $ii5)1,574               03 - $1477,459

                  MTSSISSIPPI @,,'GIONAL iNIU!DlCAL PliOG13A@.'t
                  R-1 00057 7/70.1 --C@eration I Su@)ple[Tent - Approval with specific conditions.
                        Project #2r, - Approval in the reduced airount for 18-months with the
                                            conditions specified by the Review Coiirdttee and with
                                            .the understan(iiiii, ti-i@it this will represent the teriTLi-nation
                                            ol@ R@T               @)f        a,-, i v:@ t y






                                                     19


              N-n,,l NEXICO REGIONAL @@'EDICAL PROGRA:@I (C'OlVi')

                  -Project #111 - Approval I in the 1401-iLICed amount ar-ci with the
                                   conditions specified by the Review CoimLittee.
                   Project #15    -Approval I with the conditions specified by the
                                   Review Comittee.
                       01 - $923-100                  o@, - $99,900           03 - $101,765


                                                  H     Al   ;r) RPJ
               .,W YORK vU.,7ffiOF'OI,I'I.'AN TU,',GIONAL  I'l G  .I

              fIM 000'),'i '(/70.1 ind 7/'(0.2 - Operational Supplernents - Approval 'Arith
              specific conditions.
                   Project  #16   -Non-approval 11 with  the  r,ecotmi@-,t-idations  for  revision
                                   sup-,gc@sted by the li(@vi(@w Coiiinittee and with  the  advice
                                   that the Region (ief'(,t, further pl-anninf-, for R",IP
                                   participation in kidii(-y disease services in the New
                                   York Metropolitan area until they receive the National
                                   policy i7,uidelines wlilcli are in preparation.
                   Project #17     Approval I.  'flee Coui-icil based its recommendation on the
                                   findings  of  the  site  visit  team  wh--ch  had  visited  the
                                   project on the advice of the Review Coranittee.
                   Project #18 -.14oii-appr-oval I-
                   Project #19 - Approval I
                       01 - $117631)17-)              o-11 " $4911,@)65       03 - $3501000


              NOI'A'Ill ('AROLINA IU@',GTO@IAL [VUOI@ IIRC@Gl@14
              fi4 oooo6 7/70.1 - operational Sup[)lt-,rik?iit - Approval with specific conditions..

                   Project #31@ - Approval I
                   Project #26 - No Action 'Paken.  Site visit required.
                       Oi - $89,908                   o.,, - $62,550          03 - $@2,3o6


              NOIT[li DAFC(PA IU,:CIONKL @.IE-DICAL PROGI@M
              RNI 00060 7/70.1 - Operational-,')itl)pleiii@,tit- - Approval with specific conditions.

                   Project #5 -   Approval I
                                - Approval 1'. Altliotit,ii (,outi(-Il was in E,,ericral  agree@nt
                                  with the Review Cc)iiaTilt,tee (Concerning the shortcomings of
                                  this pik)ject, it w@i-:, ti)(,Ii, (-)piri:lon, based on first-hand
                                  laiowle@i@',C'. of' 'Lllit,       and pet@sofiriej- -@n@,o.Lved in
                                  tlic,. project and oti thin, experience in site visiting this






                                                        18



                MI,O)SISOOIPPI REGIONAL K-,DICAL PROCM@R!

                     Project #13 -.Approval t
                     Project  #14   - Noti--approval II tvit li tiie rccorm)etaclat.Lon thM the  Fiec-ion
                                      be requested to r@,cc)li.3i(lei, their prori,ani in the liffjit
                                      of the National                  t'ol, R.@, participation in
                                      coirpi-ehensive   kidney   disease   pr-oFrains.   Council   further
                                      r-ecoi@iided that  tiie  fief-,iori  be  afforded  direct  help  by
                                      the staff of RMPI) in iiulcing their decision in this
                                      .T@-gai,d and in            a revision if such is to be proposed.
                         01 - $213,llc-_'O               O;)   $125,gli6           03 - $39,455


                ,@iisll;omi IZLCIot@AL @/U,"DICAL PICGPAII
                f?4 00009 7/70-1. and 7/70.2 - 0-perat-,!-oi-i,@I1 SuT),pleirient - Approval with specific
                conditions.

                     Project  #60   - 14ori-approval II
                     Project  #bl   - Nori-approval  II.  Altliougji  the  Cow-icil   agreed   with   the
                                      f-,eview CormLLttee  limit  these-,,  two  projects,  as  presented,
                                      are   unacceptable   Coi,   Regional   Medical   Programs   support,
                                      they  recalled  the  i@-coimrendati.ons  of   the   recent   indepth
                                      site visit to Mol@IP ,ixici suW       ed  that  with   staff   help
                                                                        ,(-st
                                      from both RMPS a-rid i@lo,@Ill these ifoutreact-i" projects
                                      could be developed into i@ortant components of the Program.
                     Project    #62 - Approval  I  in  a  reduced  aitioutit  and  with  the   conditions
                                      specified by the lieview CoiiiTdttee.
                     Project    #63 - Noii-approval II - qhe Council recommends that this
                                      project be iritef-t,,it'e(i into the Qegion's overall continuing
                                      education effort in the preparation of the Region's
                                      Anniversary Revi.cw application.


                                                                    3
                          01    $33031'.1                 O:-' -@;36 984           03    $"D"-),165


                @40LJtZ,PAIN STX-Pf-,@) F@,GIONAL Pli,'DICAL I,]-',OGM'vl

                RM   00032   7/70.1 - Operational Supp-ietix2nt - Approval

                     Project    #12 - Approval I
                     Project    #13 - Approval I
                          ol    $i84,976                  O;)   $191.1117          03     $197-,8011


                Nl,,'W YU,'XTCO TU@IONAL, fT;-'DTCAL PF@(,]iANI
                101 000@)14 '(/70.1 - 01)(-)Patioiiai                Al-')PI'Oval- ,iiuli specific conditions

                     Project #13 - Noti-appi,oval. 'Fl







                                                     10


              iNDiMi DAKOTA REGIOIJAL @,IEDICAL PROGRAI@ (CONT)
                                   Region, that the approval of this project is
                                   essential for further development of the North
                                   Dakota Regional @,ledi--al Programs.  In recomending
                                   approval,  Council  strongly  urged  RMPS  staff   to   work
                                   with  the  Region  and  with  personnel  involved  in   this
                                   project to  correct  sorne  of  the  deficiencies  and  get  it
                                   off to a good start.
                  Project #7       Approval I for essentially the same reasons given above.
                                   The Council believes that the implementation of this
                                   project is essential to regional development and
                                   sue.-,@sted ti-iit it be approved  at  $35,000  (dco)  for  one
                                   year only with cotit@Li-itie(-t support  contingent  upon  revision
                                   of the pi,oje(,@t with staff assistance, and reapplication
                                   to the Council.

                  Project #8 -     Non-approval I
                  Project #9 -     Approval I
                       01 - $115,383                  O,' - 'p79,'@'(2         03    $79,549


                           Oill'O fld,:G-l'ol@IAL [/ga)I(AL

               it@l 0006-3 7/70.1 and 7/70.2 - Operational Supplenetits - Approval with
               specific conditions.

                   Project   #01-S  - Non-approval I
                   Froject   Pli   -Non-approval II witli the i,ecorrrneridations for revision
                                    suggested by the lieview Coiiinittee.
                   Project   #14   -Approval  with  the  conditions  specified  by   the   @@eview
                                    Cotriiiittee ,for one year only.
                   Project   #15   -Approval I.  Al-ttioLij,
                                                           @i  the  Council  recognized  this   as
                                    another of' the "COLItICil for@ Continuing l@ucation" projects
                                    which have been -,-@LibiriLtteci by the Ohio State tiegion
                                    and action upon wliicli       been deferred pending the
                                    outcome  of  the  initially   funded   one.   The   Council
                                    accepted  the  advice  of  the  site  visitors   that   the
                                    project is of  ci@itical  J-jiiportrance  to  the  Northwest  Ohio
                                    l@ef,-ioi-kil NIE-,@ll.cal. Pi,of,,i@ain -u-id probably has an excellent
                                    chance of success under t,lic,, leadership proposed.
                   Project   #16   -to be incoi-poi,at-lo@t with project #111.
                   E@jCct   #IT'   -Approval in the t,edLiced @)jiiottrit and with the conditions
                                    specified by the lieview Co@.-ttee.
                                    ql-ie Council           (,6risl(lered the  findings  of  the  site
                                    visit tea'TI r(@@                  )ti a@ a @,iliol(@; it,@
                                    organization,                      ajid iDlaris.  It is their
                                    recommendation tl)at the ii(,t:-,ion be urged to seek stronger
                                    leadership but tlit, (owic-1-1 a@-!  ed that  aiiv  specific   re-
                                                                      _,re
                                    conrw-ndation ref);ii@ilrie; personnel would be inappropriate.






                                                                21


                    NO.-@YtIVIF-,ST OHIO lif@,GTONAL MEDICAL PRO(iPiX@l. (COI\FP)

                                            'nie value of -in asst.@ssinent visit as recorrnT?ended by
                                            the visitors was qLi(-,,@,tioried since it would probably
                                            do no more than t@e-i,,ientify the pr)blern.   Council
                                            suggested    that    per,lia@)s    direct    and    L'requent     assistance
                                            from RMP staff' and consultants would be more helpful
                                            than further investigations of the situation.
                              oi        $lli5,830                  02 - $70,525                 03 - $21,250


                    OffIO           BE-GIONAL MF.DICAL PROGIWI
                    f@,l 00022 7/70.1 and 7/70.2 - Opei,ati@)t@:tl Renewal Tid Suppletneiit - Al@proval
                    with specific conditions.
                        Project    #lfZ    -Approval I at tli(, t,e(-Iuced level and with the conditions
                                            specified by he(, lieview CoiTn-d.ttee
                        I)ioject   q8fi    -Approval I in the t@(,dticed amount iid with the conditions
                                            spel-if'ied by tiit, l@ev'L(@w Coinrnittee.
                        Pro,j(@et   #22    -Approval I              I)i,(),ject was considered by the Council in
                                            the previous Y@vic-,w cycle and action was deferred at that,
                                            tiiic-@).
                        Prollect   #211    -Non-approval    ]-I    with     the     recommendations     for     revision
                                            suf,               bhe iieview Com-Littee.
                                               .,@sted by
                              01   -    $714>07@)                                                03 - $847,944


                    ,)IIIO VALd-J@:y FJ,)G-T.O[\IAL tU  ICAT,
                    .@Al  000218   7/70.1@   Operational- Suppleirerit - Approval with specific condit ons.
                        @@oject    #12     -Approval I in the reduced amount i,econytiended by the
                                            expert technical reviewer,.
                        Project     #13  -  Approval 1.   '-Pc) be ftiiided only if riot@d  by other
                                            Federal resources.
                        Project     #14  -  Approval IT
                        Project     #Icj -  Approval I
                        @,Oi    e6t #16  -  Non-approv,-tl    11    with    the    t@coraiiendations    for     revision
                                                    ,@est(@(A   b
                                            as suF              @y tti(, [-'review CornTiittee.
                        Pmj     ect #17  -  Noti-al)pl,ovil.   Tl-   with   the    i,ecormiendat@Lons    for    revision
                                            st47,c,ste(i I)y the lieVit-'W COITtnittee.                            -
                        Project     #18  -  t'-Jori-appr-ovil   I
                              01      -@$273 1)116                 02 - $--,96 215               03     $327,657








                                                   23


               TF-,XAS RL,GIONAL i'EDICAL PAOGRA[4
               FJ4'00007 7/70.1   Operational Supplerlietit   Approval with specific conditions.
                   Project #8R - Approval I contingent upon the satisfaction of a
                                 technical s te visit tean-rreg,,arding four specific
                                 points set forth by the Review Co@ttee.,
                   Project #1@R - Approval I with conditions specified by the Review Comdttee.
                   Project #15R - Approval. I
                   Project #118 - inoti-approval I
                   Project #IJ9 - Noti-approval I
                      ol - $li6o,6'io              OP - $;,96,595         03 - $2)40,386


               ':'RI-&PA'I'T,, P)FTTO,'4AL @U@ )ICPF, P130GHM4
               RM ;00062 7/70.1 - @)oratioi-kal Stip@)lotii(,,rit, Approval
                   Project #9 - Appi@oval I in a r-e(fLicett wTiow-it and with the conditions
                                specified by the Review CoitirLittee.
                      01 - $105,300                0-@) - $85,6oo         03 - $63,000


               VT-:IGINIA RL,(',IO14AL TU@TCAL Pa)GM@l
               fl%l 00049 7/70.1 - Operational Stipr)lcnieiit - Approval with specific conditions.
                   Project #10 -  Approval I with the conditions specified by the
                                  Revi.ew CoiiriLttee.  I'ti discussing this project the
                                  Council wished to stress the. importance of the condition
                                  for approvai- of' this project alid urges great care on the
                                  part of the start.' iii a,-Ijusti.rig the second and third
                                  year amounts of l@,11' support by utilizing patient revenues
                                  to offset costs of the project.
                       01 - $268,552               02 - $1180%li79*       03 - $533,504*

                 'fo be negotiated downward


               WI-'.STE;Ol NT-,IQ YORK RI,7C'@IONAL @lF@)TCAI, rli'O(j'l@l
               IDI 00013 7/70.1    Operational @')Ilf)[)I(@rilent - Approval witli specific conditions..
                   Project #15    Approval T in the r@c-,,(Iuced amount and with the conditions
                                  specified.
                   Pro-iect #16   Approval I  in tii(,         wiic)t.trits :uid witli t@-ie conditions
                                  sp&cified by tti(, liev@L(@,w Cornnittee.  Council expressed its
                                  willingness to callow the f@egioii to increase the funding









                                      24


           WES@ NEW YORK REGIOIIAL MEDICAL P@RP24 (COITI')
                          of this project to a maximum of $100,000, providing
                          such a level of funding would be required to maintain
                          this valuable regional resource.

              Project #17 -Non-approval I
                  01. $350,000         02 - $3@10 000    03 - $350,QOO

           WES"iY,@l PENNSYLVANIA REGIONAL H@'D.'rCfd, PPOGHAIL
           RM 000111 7/70.1 - Operational Sup !iierit Approval

              Project #9 - Approval I
                  ol - $43,911         02 - :I;Ilii 81@DO 03 - $li6,995

           WISCO14SIti PJ-,:GIO14AL n,,DICAL PROCj!W-.l

            "4 t)               "2--- Opei,atioiial
           P   003'( 7/70.1 and 7/70.                    Approval with
           specific conditions.

              Pro ct #13A (R) - Approval 11.
              Pro            rbval-I
              Pro          Non-approval I
              Pro          @Jon-approval I
              Pro          tlon-approval I
              Pro ect 1   Nori-approval I. Cowicil based this recoimendati-on on
                          the findings of a collateral. review of the project
                          by the staff of maternal and Child Health Service, IISL@,
                          which was requested at the suggestion of the Review Co@ttee.

              Pro.lect #20 Approval I
              Project #21 Nori-appi@oval I
                  le      Approval I
                  ct #2
                 0,
                  Iect 2  Approval I in tli(-, reduced amount and with the conditions
                          specified by the l@eview Coiiimittee.
                  01  $2923815          oo  $16,(,807     03  $172,395

















              XI.  ADJOUFNMU
                    The meeting was adjourned at 11:30 a.m. on july 29, 1970






                                                 I hereby certify that) to the best of
                                                                         ing minutes
                                                 nty igiowled,@, the fDrc-190
                                                 are accurate and complete.


                                                                           tki,)


                                                 Acting Direct
                                                 ReC
                                                    ,ional Medical Progr@ Service







                                                                           22



                      O@i',CION    M@X',IONAL,    @T-"D]'CAL    PROCzl3N4

                      i-e,l 0001,' '@/70.1 - op(,-ritiona.                                      Approval

                           Project  #12R - Approval I
                           Project  #lb-- Approval I
                                 01 - $59,375                              02      $28JI829                 03      $14-*843


                      PL)T,'I-M@ fii:CO RJDTONAT, @IT.-:DTCAL PfiCVjMl

                      iim ooo65 7/70.1             @ierationaJ@ SUPP.I.eliK.'tlt - Approval with specific conditions.
                           Project  # 9 - Approval I -Lnthe r@edticeci amount al-id with the conditions
                                                 specified    by    the    Review     Co     @     ttee.
                           Project  #11 -        Approval I with the conditions specified by the
                                                 Review Com@l,ttee.
                                 01 - $320,936                             Ol-I    $,)27,)136               03      $233,636


                      ,SOMI   CA'@3OLIi'iA   Pd-IiIOlqi@   t@   @'   ICAL

                      RDl 00035 7/70.1             C)perational Suppl-eiiic--iit, - 14on-approval..
                           Project        #35    lion-approval     T.[     wine      t,lie      recomei-idations      for      revision
                                                                                              i
                                                 stif7,,ested    by    the     %'eview     Coitirlittee.
                           Project        #36    14o action taken.   ,')ite visit is indicated.
                           Project        #37    Nlori-approva.1        I


                      S'@J.SQtJl-"ILA.@-,Iti-A VALLI,:Y TUrilONAL  P/D-.])TCAI,

                      ]DI 000c@9 '@,/'@0.1         Operational ",tippleinetit  - Approval with specific conditions.

                           Project      #'@10    @lon-appr-oval         I
                           Project      #21      Approval    I    in     the     reduced     @urit     to     reflect     the     newly
                                                 adopted policy on training project participants.
                           Pi@,i    ect          tlon-approva'L         T
                           Prt-)j   ect #2@3     i4oi-i-approval        T
                           Project      #211     llon-appioval      IT      with      the      i@cormienditions      for       revision
                                                 suf-Zested     by     the     Review      CoiTuiiittee.
                           Project      #25      Non-approval II.   'me Council was in general agreement
                                                 with the Review Coiiiiiittee regarding the specifics o
                                                 project but believe ttiat  further development of this
                                                 project   along   with    #,'211    Is    in    the    b(..st    Interest    of    the
                                                 the ReFioia md has i@e(Itiesteci that the iDT.S staff offer
                                                                   'c(-) tl)e             in this

                           Project  #26 -        Approval I
                                 oi - $gc--"1311                           02                                03 - $83,29LI





                                                                                    26





                                                                      CC)!Il"n.@,
                                            tc) t'lic-@


                                       -@Ly              ai-ij capably
                       l@e,,tslble utidei,
                       Uri@t,-,)pi-ov,-tble on tecl-ii-i--'tcal. p,-L          I iicl




                                         T        Acid-i@tll()ijl-il- fLl)l(]:-;
                       Ap-
                                         IT       l@-o

                                                      -                              foi,

                                                      -


                        I-lo @tct-,.,Lon tall,cii -
                                                          Noocl sitc,
                                                          Ncc,cl Couiac@.@i.'L




                        Ar)prc),,7, tl


                                      fOt-' F-,CV!@-,-!Otl
                                                                              foi,             f Lil ](If I II';



                                      .1 ot-i,,il A(lv-i,@oi,
                                                                                  t,c)




                           (A.,-,                         by tlic@                           Lt,t,@@o  ol,


                                                                               lo I, L)!





                                                              27
                                                     NA'I'TO,'I.@r, fil)@rT';O@@iY COIY,@( Ol'i



                 IIIIE'4NP,14, Michael    J.,     M.D.  (72)                MIILIY@Q,    Clark    If...    M.D.     (72)
                 President, L',IichiC,@in Cancer Foundation                 Consultant in Neurology
                 4811    John    R    Street                                @layo Clinic
                 Detroit,    ,@iic,lli,,,an    li8201                       Rochester, Minnesota   55902
                 Professor          of..@-dicine                            OGDE@',N, D@-. C. Robert   (70)
                 Wayne      State       University                          President and Geriei,,@il Counsel
                                                                            North Coast Lifc@ Iiisurince Coapany
                 CANNON, Bl,@cl lq. , I.I.D.   (73)                         Spokane., WashinfLton   99201
                 91.0     4adison     Avenue
                 Menpliis,       Tennessee       38103                      Plil-L'Gf-'JN.O, food D., M.D.  (70)
                                                                            Vice President for the Health
                 Division    of'     ',Ieur-osurfreiy                       Sciences and Director of the Center
                 University of 'iemessee College                            State University of New York
                 of 'Aedicine                                               Stony Brook, New York   11790

                                                                                           -ed 14.
                 CROSBY, I!'A,,iin L., M.D.   (71)                          POPP.IA, Al. fi          M.D.      (70)
                 l@ecutive Vice President and Director                      Regional          Director
                 A@ricai-i       hospital        Association                ,.loLtiitc@ri States  PT,.._r
                 Chicago,       Illinois        60611                       525    West     Jefferson     Street
                                                                            Boise   Idaho   83702
                 D-,BAKr,,Y  I-lichael E.,
                                               M.D.  (7")
                 President   ii-id    C,,iie f' !,'executive Officer        ROilll, Russell B. I M.D.          (73)
                 Baylor Collei-7,e of .lccilcine                            2110 West 41st Street
                 Houston,      Texis      7702-)                            Eric,       Pennsylvania       16508

                 Professor    and    Chai-ii,,iiri                          Vice   Soeal@er   of    the    House
                 D-opai@tm,@nt  of   Su-i-i7,erv                            of    De@eFcites,     @@IA
                 Colle,ge of D.'L-dicine
                                                                            S@l\nioLqlz, Crack I... M.D.          (70)
                                            r                               State    Stealth     Cc,,LiLissioner
                 F,VE!iTST, 9i@uce W., @.I. D.       (71)
                                                                                                     of 17
                 Chief of Pediatri.cs                                       State @,part!@,i@-,Yat       -iealth
                 Green Clinic                                               Rici@iici,       Vii@Cinia  2 3.,7 'L 9
                 Ruston.,       @uisio-na       71270
                                                                                      .Ir.      Curtis (71)
                 IRRIP3 Wil-l-i@iri R., I.I.D.  (71)                        Dii,c,@ctol@, Petisioi-i T-id Insurance Daznl 1-1
                 lbw,d   of   Cc),iz,,nssi,oriex,s                          United  I"@Ll@)bez,.,  Cor.1c,   Linole-ILM,
                 County of All,@rjier)y                                     and   Plastic   l@lori@ers   of   tj.@@,rica
                 101 coult;iou@,e                                           Akron,     Ohio      443o8
                 Pittsbur!ji, Peruisylv,-ulia  15219
                                                                            VNCY,Or,F,   IIrs.    Florence    R.   (72)
                 McP!E@',IA'4,  Al,e,,,aii,,Jei.-  M.,  M.D.  (73)          @)13 Cori,@,itos ',load
                 Rnory LJr)iv,,?r,@l-ty Clinic                              Watsonville,        California         95076
                 1365 Clifton Road, II.E.
                 Atlanta,      Gcorgia      30.)e-


                                                     Dr. Vernon l@:. Wilcl;ori


                                                     5C)OO
                                                                                   20C)52
                                                     Rockville,  i:u






                                  ATMOANCE AT     TTE  NATIONAL ADV@RY COUNCTT,

                                                Ju@-.y 28-29,   1970


                 ReS   STAFF,    ATMOING
                 Miss Rhoda Abrams                                 Dr.  Marion  E.   Leach
                 Mr. H. Earle Belue                                     Gregory Lewis
                 Dr. Edward T. Blomquist                                Ray Maddox
                 Mr. J.  Edgar   Caswell                           Miss Elsa Nelson
                 Dr. Donald   R.   Chadwick                        Mr.   Roland   Peterson
                 Y[r. Cleveland R. Chambliss                       Mrs. Martha L. Phillips
                 Mr. Clyde Couc@                                   niss Leah Resnick
                 Dr. Sam Fox., III                                 Mr.  Donald  @Riedesel
                 Mr. Edward      @@edlander                        INIrs.  Jessie  Salazar
                 Mr. Sam 0. @il-nier                               Mrs.   Sarah   Silsbee
                 P4r. Charles     Hilsenroth                       Dr.  Margaret    Sloan
                 ;Miss Dona Houseal                                Mr.  James Smith
                 I,lr. Frank Icliniowski                           Mr.  Dan Spain
                 Dr.  Anthony   Komaroff                           Mr.  Lee Teets
                 Mrs.  Lorraine   Kyttle                           14r.  l@ancis Van Hee, Jr.
                 Mr. John M. Korn  Jr.                             Mr.  Lee    Van'Wi@,le
                                                                   Mr.  Frank    Zizlavsky



                 OTHERS A      ING

                 Dr.  ;Maurice  @nder,   OS
                 Dr. J.H.U. Brovm., IIIGiV-,,14III
                 Dr. John Ca@an, CL-LS, @ISI.TIA
                 Mr. Jwws Dunlop, A.D. Little, Inc.
                 Miss Sylvia Kesi@rer, CIFS, HSYUFA
                 Dr. Richard @vinson, Vetei@ans AdrTLI.iiisty-ation
                 D4r. Wendall P@l-addrey, 1,JCHS-R&D, li'@NULA
                 14rs. Sylvia Payirer, NCI, 14IH
                 ,Nlr,. No   ilucker  Blirl,:Mr, NIfi
                 Dr. T. M. Ilal.ega, NTAMD, NIH
                 Dr. Williani zllukell l@I&LI, NII-F