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                                   P-1@,-PAT@TI, -7,7 'T 01' @'k'EAT@TT-T
                                                                j-,DUr'-ATIO'  i@,TD 1,7FLPAP
                                                OF AD T
                                                        @IOC  CO'ISIJLTY@ITS Pj',VIM17IIT(,
                                      P,7,CIOIIPJ,) !4r,,DICPL PRO(';PMi APPLICATIO@IS
                                                                      Conferenc.-e RooTn I-T
                                                                      'Pe.rkl.a.@-in PiiilOincT
                                                                      5600 Fisbers Lane
                                                                      Rockvill.(-., @-laryla:n(-l  20P,52
                                                                      Thursda,,, May 23, 1974
                              Panel B conveneO at 9:40 o'clock, a.ir,.             l@ir. 'Pet@- rson
                        Chai.rma.n, r)re--,iclincr.
                                      (A-, liereto-'7ore notnC-.)

                                                                                                     1'0'4-A
                                                     C 0 117 T r. @T- T 9-
                                                                             (Continiaprl)
                                                                                                                ar5e
                                                                                                                    7
                                         !Medical Plan  for I'Tec;tern 'Oenn-,yl.vania                          33C)
                                            @loti.on       for       recommendation                             350
                           Virginia R@@rional lieclic-al Pro(-rz,,m                                             35  5
                                            motion       for       recorr,,en0ation                             367
                                                                T.,],,@n  for tie
                                                                            ti@ T@c7ket; @rei
                                            motion  f(j--    recormene8tion                                     .3 M')
                                            Motion  for      -r, c c c T-,T,@ c n (I. ac) n                     40(,
                            I- TE'v7 Rec7it-,nal "eoical-    TIrorrrE,,.rp  for t-ie
                                    State of  ,@lar,,/Ic-inO,                                                   14
                                            illc)tion    for    rp-ccmr@,on-@z-tion                             Al.6
                            H.7W Rcc7io-ial @',e@ica"L T)I.an  for tho
                                    Di-,tri-ct of Coli-ir-i@ia                                                  4 2
                                            'lotion     for      recor,.-,men0ation                             431)
                            1T-'T@,7 Reciional ',Ileeical Plan  for
                                    Lonc-T Isl.an(4,  ',Ie@,7 York  anO.
                                    Suffoll-,        Counties                                                   443
                                            Motion    for     reco!rr,,(--ne,-.tion                             @55
                            TIF"t7 Rei7,ional                !Ilan  for
                                    Susciiehanna                                                                461
                                            notion     for      rccop.,Lr,,en0ation                             4 7 2

                                                               P R 0 C E E D  I N G S
                                                                  -- - - - - - - - - -
   iy  23                                    [Thc-,  B P-ATiel @,ias  called to order                 at  8  90  a.m.  by
   Session                    a.     L,      Peterson,      the      Chairman.]
                                             CIIP,III-I)L@@ PETErSO-@i-            We    are     still     missing     a     coulnle
                              of peonle,
                                             I  took some  stuff home  last night  and  this  is  just to
                              ive    vou    an     idea     of     -vThat     .,7e     did     yesterday.     [Indicatinq     the
                              9
                              blacl-,boarO..,]  on iihich was  inscribed
                                                                                             P@,ec Pund-
                                                               Overall   Item                ing  in Ks   %Rea                  % Tard,ot
                              Alban,.7  (1)                    SU-?           3.0                 1.066            100          70
                              i.@aine                          Sun            2.9+                1,600           80             120    1
                                                               P-A S C,-)     2.5                7 0  0           67            52
                              C,j-) Valleii                    Al@            2.5            2 , 3 0  0           82            83
                              C'-,l York                       Aug            1.8                615              77            61
                              ila,raiit                        Aucr           1.8                 irioo           70            7n,
                              Ariz  (1)                        Blk            1.7                360              64            50
                              Conn                             BA Poon        1.6                510              30            22
                                                                                                 $3,751       c   80            70
                                              Ti,'.L  CIIAIP-',,L@T     It  seemed to         me  clie  rcaions  fell           out
                              into about  four nice  rTroups.
                                               The  first column  indicates  that  sort of overall  ratind-
                              that reviewers  aave  "Su-)erior",  "-@ove AveracTe",  "Bel.o@,i
                              Averaae",         or  "T)oor. "
                                               Now     the     second     colurin     is     sort     of     an      itemization.
                              You will recall  that you vrere  asked to chec,,-,  'IC-,ood",    "Average

                                                                                    LUU        I
                                                                                              -!I
    2                "Belo@.7 ,@@veracTell -- and I sort of 1.7ej-cThted that as "3"p "2" rind li,,,
                     and didn't count in where peonle     said there @.ias insufficient
                     basis for judgment.  And again,     it seems to me those scores,
                     that itemized kind of scoring is     roucthlv consistent with  the        i
                     verbal score.
                                And then I indicated @.71-iat your recommended funding         i
                     levels i@7cre, in thousands.
                                And the list t@,.7o c             the percentage   of that
                                                     olumns are
                     recor,,i-,(-,nO..ation vis-a-vis the recTuest in the first column;
                              -vis the                -Tct ficTure or level for L.,.a
                                         overall tar,                                at
                     and vis-a
                     rerTion.
                                    .ie do have -m                        "IT
                                So               arl-led disTDari.,L--ics @.aine , ..or e:@annl--
                     if -,rou -.,i-ll recall, t,icirs is onl-,7 coming in now (1)
                                Connecticu@@ is at the very bottom of the lisL-..   @-S
                                    I
                     it ha-.oponed, heir initial reuuest was really quite it,,odcst
                     compared to what @-ic were exnectina.
                                But this is nothing authoritative or final, but I
                     thought vou might be interested in just  sort of secina one T,!a@7
                     of  cuttincT, ho%@7 thincfs came out yesterday.       It did see-r.. to r-,e
                     thev sort of fell out into four equal arouses,        rather ti-ian t-.,"O
                     small ones and   then the middle       we don't have a  bell  s'-,Iapeo.
                                 ,.i,iich I guess is something
                     ::urve  vet,                                that educators are ex-
                     tre-melv interested in.
                                DR. TESCIIA@,L -  That's  because  tl'iev  are  saving  money
                                                                       .1
                     For the nrogram.

                                                                                                  187
    t 3                              Tlyr, CIIAIr,',,'@.JI:   Well --yes.   Those are rou(Th      nercentacf@s
                         at the bottom.        You reco-v,,ended about 80 nercent of the
                         requests in the acarcoate,  and about 70 percent of the target
                         figures -- on the eight regions we looked at yesterday.
                                     Tell, I'm not sure that we reallv @,7ant to wait on
                         Bill   and   Joe.   '.,7e @,,7ere aoinrt to take up Puerto Tlico first, and.
                         both   of   those are Puerto Rico.pcople.
                                     DP.,. McCALI,:      lio@,7 al)out taking 1-7cst virainia first?
                                     TIIE                  '%'7ell.  r)r otherwise
                                     You   haven't had your coffee vet,  Sister Ann, @,7ould
                         you mind if we go to @7est Vircfiriia?             OtherT,7i-se, I was gci,-I(-,    to'@
                         o to Orecion.   She ,,,as the onlv 7oerson @@7e didn't aet to%--sterc@,ay
                         9
                         -- and,           t@-iat @,iarn't entirely accidental, there @@,ar, a
                                                   @i            ir,.Ilan.   It r,.7as r)art of the
                         little collusion wit,        ti-ie c'@ia'
                                    1 noverient.       (Lau 'iter.)
                         eclaraenica                         q
                                           cbn't we      start Haiti  T,-@'est VircTinia,  then, and let
                         Sister   IZinn   drink   her   coffee -- and riaN7!De then bv that tir@ie
                         Bill Thurman and Joe %,7ill be          here.      If thev aren't, the,.,'ll
                         have   two   black   T,-arks   apiece     thevlve alread@7 cTot one.
                                      And on l,"'cst Virginia, @7e have   Paul Tcscllan and              Chari@-s
                         'IcCall      and you neonle have colluded                 or do vou ,@,Tant    to fli-
                         a coin?
                                      DR.  TE-SCI,'@'q:   !lo.   r)r. I!cCall,  I vield the floor i,,litli
                         pleasure to Tiy senior colleague;  from Texas.

                                                                                188
  t 4                        -HE             No@-7 if N-7e -:ire going to get into these
                   Senate type protocol-, x,,7e're not going to ctc-lt fourteen regions
                   don,---todav.   [Laughter.]
                             DR. !'JlcCALL:  I'm not sure whether I accept the floor
                   under those circumstances.
                             I'm sorrv Bill is not here-.  I wanted to point out
                   to him that I find another "Superior" region, but that I'r@,
                                                                           olification,
                   not one that cari.(,- in with t,,,70 volums of elaborate am,.
                   T                     1-le onnoslLe.     quarter inch, non-
                   .)er se  -- but just t'
                   bound, non-color, blaclir, and,@,7hi-te application that is one of
                   t7,ie s jr,.o                                                IV
                           lest, clearest--, rio-@t concise aonlications that I  e
                   r.@ad   and it's siiaple for a lot of reasons:
                              One, is the state, itself, and thev the-k7 Have
                   devel-o-)e--' the procrran, b 't also because this application is
                                             u
                   a request  for suoport for          and onlv t,,7o continuation
                   projects     7.7ith the plan to come in for all of ti@ir new
                   nrograms  in July.
                              And that is clearl,7 as stated here, it is a region
                   that car-,e in rather late in terTis of the overall -- 56 allies
                   tha'L- ultimately  @,7as our pealz -- so that they came in,
                   developed their orogram based on the neeris of the recion,
                   developed their   Priorities, stuck with them, haven't had to
                   shift them      they have a strong.staff and region advisory
                   grouT) leadership and an integrated program that has been
                   consistent,  right   along.

                                                                             189
  t 4                       A-rid I have already mentioned that it's reall-,7 a staff
  Lge 4A
                                ,iarily -- just t@.7o continuation projects    -;ust
                  ?roposal, prir
                  Some- tliin(Ts continued in other funds.
                            I think the feasibility of their accomiDlishj-ncT, in the'
                        of r,,ihat they say her(,. @.7hat they have done in the past,
                  is    excellent  and @,.ihile there is not a lot of information on
                  :7@..P relationships  there is nothing that indicates there is
                              no,.@i there, at all.
                            r.@hc,7 are reauestil-irf, no-,,,, 663,132. The onlv thing 1
                  qould noi-nt out there is that  there is a significant indirect
                  ::ost in this that has come up  before, about  130 some odd -- or
                  136,663 wlaic-i rias indirect cost   but that  is an establ-is'@iec@
                  L'-hi-,ig that @.7c couldn't do anything about at this ooink-- in tiT-e.
                                 it to 170u.- attention.
                  1 merely call        -1
                              In I think i'll ston there.
                            -Lhe regional -@,dvisorv rroun is a little hea,,r7 on tl-ic_
                  Drof,2ssional me.,=Crshj.n, but it's there    I don't think it's
                  3erious     Droblem.
                            TIIE Cil@,I     71,iul?
                            DR. m.11SCil.Yi: "l'ile have no reason to disagree ..7ith an,%7-
                  :hing that ha- been said.  It's a pleasure to read a proaram
                  --hat has not onlv been able to carry      not onl-,7 been able to
                  accumulate funds currentl,7,  and  arranqe  ongoing fundinc, -- ':)ut
                  @,hd is able to accumulate  funds  concurrently  in multiples
                  @.e., %,!here the,,,ill put in half a Billion  and they @,yill  c

                                                                                         igo
                       running about a t7.,,o to tiirce million dollar program
    5                  that ,.7ho-n T?j4P vias going to -,)hasc  out,  the  (.',ovo-rnor  and   the
                       State Government were readv        to take the staff on.            it
                       looks  as  if  they   are   as   far   along   becoming   tic   follow         I
                       operation of PLIP as anv re(Tion that i-7e have come across.
                                   @'.Ie have  kno@,7n  Charlie,  in  operation  of  @,lest
                       !7irginia, because it's a  mer@oership in the Southeastern Groun,
                       and     have been a%.,,are of this development in the general
                       direction, un to.no@-7.
                                   rL"hev seem to accorqnlish more       interaction, and
                       starting   of   more   services   and   develo-oincT   of    manpower,
                       fe-iier dollars than almost any group T.,i(@ are a@@.,are of.
                       So my recommendation -- if I can nreerqot the dignil@-v            of    my
                       Predecessor        I @,7ould reco,@,,cnd  fundin(7 as       requested.
                                                    I'll second that.
                                   TT,!E C.tIAIP21A-;.,T: O.-T,\.   Before .7p@ or)en  that  u-) as
                       Charlie did indicate, this is a verv, in            one sense,     a verv
                       modest adolication          a  continuation  of  -,)rocTrarq   staff with
                       funding       a slight expansion in viei-7 there and a couple of
                       projects       so that it totals "1663,000.00 in round nu,-L',-L@rs.
                                   They do anticipate cor-.ina in with a major su,,oplemental-,
                       application ini
                                         ,ulv for   $1.2 million.
                                   DR. @l.cCALL:    But that, added to this, would out then'
                       above the   target.  i,le're recognizing that.
                                   But I ti.iinl-, we are in a Dosition       to let them make

                                                                              igi
                    the judgment of what they do come in with, in their      new
                    coiii-nittee.
                              THE CIIAIP-1",@14:  All we-, kne@i -- this is one of the
                    reasons -- this is one of  maybe  eight  or  ten,  where  the  initial
                    application is, indeed, restricted to continuation  and to
                    program staff -- and all of their new activities will be
                    reflected in the July submission.
                               O.N., !\Torm, are there any comments regarding C-AP
                    or  this  matter
                               I recall T,!est @.,Iirginia has at least considered,  overl
                                                                                         I
                    the years, some Dossibility of disassociation from the
                    University     but I'm not sure @..?he,--Iier that ever got much
                    d sort of
                                   NOR!,L-X@l A-'IDETI S O'L@, AnNi AgOnc,7 Director isa
                    I'ller,@,er. of ti-ie LecTal 2%dvisor-,,r rroup  a
                                                             nd thev did recor,)@Tend
                    annroval of this Darticular anolication.  And as I said, it          I
                    has been previously approved by the aqenc-,i, since the @vorl,,: is
                    continuing on schedule.
                               The major  thrust of the  uroaram  we  can  anticipate  ini
                    the ne--,t application, @7ill be on the State-wide basis,' as
                    opposed to the individual project,     or community basis.
                    l,lo,,7 I thin],, it urobably will be  the size that thev will get.
                               DR. @mESCIlPa,7:  They have helped build P.NC aaencies
                    in an area.
                                                rrOM
                               THE CIIAII?J.LAJ.,l   do you have anv particular insic,-..-

                                                                                                           192
   r@t 7                  linto this as regards West Virginia?
                                        MR.  SIMONDS:   Well I think Norm summed it up very
                          well.   That's a pretty good state.
                                        THE CHAIRMAN:   Most of West Virginia is still that way,
                          I know.
                                        We do have a recommendation                  but are there additional
                          comments,  questions,  observations.
                                        MR.  BARROWS:   I      would like   to ask a question,  just as
                          ia matter   of my own information:               What qualities,  as you fellows
                          I
                          see it,  accounts for this marvelous support on the part of
                          their constituency?
                                        DR. McCALL:         The usual fact of strong,  capable
                          Ileadership involving
                                        MR.  BARROWS:       On the part of the coordinator, or do
                          they   have a good RAG too?
                                        DR. McCALL:   I       think it goes on further than that.
                                        MR. NASH:        The coordinator,  the university,  and the
                          force of the medical society
                                        They started off with           -- had the RAGs to start with
                          and they haven't had to shift.                They have been right on target
                          throughout.
                                        MR.  BARROWS:           The university and the medical
                          society &re united -- i.e.  -- they both agree.   Now,  I didn't
                          ilsay the relationship was good between the medical society and
                          !the university, but both units support the PM
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                                                                       193
  t 8                       DR. TESCHAN:  There's a very important phrase       about
                 ihalf of one line in the application that says that, in working
                  with the medical societies in the  health  delivery  area,  they
                  have restricted their activities to their legislative franchise.
                  And then the thing goes on.
                            Well, anybody  who reads English in the context that
                  we have all experienced it, will know  exactly  what  they  mean.
                  That says that Charley's been very careful as a non-MD,
                  he's been very careful and he's working with full understanding
                  with the people who might otherwise take umbrage.
                            MR. NASH:  That's right.
                            THE CHAIRMAN:    I think  I've observed something
                  this isn't 'ust West Virginia -- it does seem to me that in
                             3
                  those states which have, perhaps less in the way of health
                  resources, institutionally and otherwise (and Maine falls    into
                  that category certainly) and during  the  phaseout  period,  they
                  seem a little more, for whatever  reasonsi  anxious  to  preserve
                    at little they've got, including the  RMP,  than  some  states
                   here there is almost an embarrassment of riches, in    one sense.
                            I don't know that that's an  axiom,   but I  have  that
                  impression. tha-E in places like Maine and West Virginia,   they
                   eem to be, or to have been willing -- and I   think they   ha,7e
                   ad good programs there, to  try and preserve  the RMP with
                   tate and other fuhds,  moreso than had it -jDeen Michigan or
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                                                                         194
                 Illinois, necessarily.
  t 9
                            DR. McCALL:   But I think also, in addition to that
                 the good leadership, good program     a lot of needs relative  to
                 the resources.
                            THE CHAIRMAN:  Yes.
                            DR. McCALL: But also, a rather  homogenous  noncomplex
                 region, too.
                            You know there has been a lot of competing institutions
                 and people, so that they were able from the beginning to focus
                 it, and then have not only the need to recognize  their  function
                 but they were productive in it -- and therefore, you can rally
                 when the legislation gets shot out from under you.    People
                 come in and say:  This is a worth while thing, and
                            MR. NASH:  There's a motion.
                            THE CHAIR14AN:  Yes, there is a motion, but are there
                 any other questions or comments?
                            If not, we have a motion to recommend approval of  the
                 amount requested, $663, 000.00  which has been seconded.
                 I call for the question.
                            [Approval of the amount requested was put to vote
                 and carried unanimously.]
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                                                                              195
                                                                 still  short  Bill
   wt 10                     THE CHAIRMAN: 'O.K.,  again  we  are
                   Thurman. He's got three  black  marks  now  -- but he can afford
                   it,'he's a dean of a medical school and he's got enough major
                   insecurities without worrying about black marks from the
                   Chairman.  [Laughter.]
                             I wonder, Sister Ann, since Bill isn't here, if     we
                   could again improvise, and ask you to review Oregon?
                             This is a region where we only do have a single
                   reviewer, Sister Ann,  since Dr. James is  not here.
                             SISTER ANN:   There is a staff person here.
                             THE CHAIP2.,IAN:  Yes, there is a staff person here,
                   Dick Russell, and he's just  coming  up  here.
                                                 OREGON
                             SISTER  ANN:  Oregon  is presently at the $767,000i
                   level and they are asking  for  $1.2  million.  They are
                   bringing in three new activities, and a total of eight
                   projects, and they plan to come in, in the July review    for  a
                   project at the cost  of  $200,000.
                             The program,  from  what I can read, and I -questioned
                   a few people who were there  on  a site  visit,  and  apparently
                   it has been a good program over  the years.
                             From the  material  that is presented in the book I
                   was able to identify a strong program leadership, with staff,
                   with the regional group, that has a good review process and
                   apparently it functions adequately.
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                                                                         19b
                             The Regional Advisory Board select   projects and
   wt 11         '!I assign priorities, and they do this through  three   standing
                   committees, by which this is accomplished.
                             It was interesting to me that the coordinator of the
                   program is  really in control of three projects with a total
                   of $360,000.   You might want to comment on this, this is
                   rather interesting     it kind of indicates the style of leader-
                 1 ship in this'program.
                             MR. RUSSELL:  Yes.
                             SISTER ANN:    There are eight professional staff   and
                   there are three vacancies that they hope will be filled.
                             Credentials could indicate that  the  staff  is  well
                   qualified. Their job descriptions  are  well  written,  and  if
                   they operate within that framework, they should be able to do
                   a good job.
                             In the past, they have had adequate technical review,
                   problem analysis, and documentation of need and technical
                   soundness.   They have also addressed themselves to
                   efficiency and containment of costs      and this would appear
                   to be on an ongoing basis.
                             The project, submitted in two ongoing projects
                  (approved but unfunded projects due to phaseout directions)
                   and the new activi@s not reviewed by the Board -- the
                   methodology for achieving the goals listed on page 42 of the
                   project -- and I won't read it -" if the methodology is
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                                                                            198
  wt 12           followed, it's very adequate.
                             The three priorities are ones  that  were  established
                 lby the Federal Government -- the availability and accessibility
                  and improvement of following, and  containment  of  reduction  of
                  costs -- it would appear that they would be  able  to  carry  out
                  the projects in the allotted period of time.
                             And the CHP relationships  appear to be good
                  although as I looked at the letters and concurrence on the
                  last project, I noticed that there  was no return on about
                  50 percent of them, which kind  of  conflicted  v&h  some  of
                  the other impressions that I got.
                             And these are the main things that  I  picked  up.
                             THE CHAIRMAN:  I think Sister Ann was the only
                  reviewer, but I think perhaps you will want to elaborate on
                  this
                             MR. RUSSELL:  Well, let me respond to Sister Ann's
                  quest--ions, because 1 think they are very  pertinent  questions:
                             The one that you didn't quite  understand  the  50
                  percent return -- was this of letters?
                             SISTER ANN:  Yes, that's right.
                             MR. RUSSELL:  0. K.    This is a matter  of  procedure
                  as part of the Oregon structure.     They have a CHP subcommittee
                  and all the project applications come through   that subcommittee
                     so they do have input there.
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                                                                         igg
  wt 13                     And in the applications for Oregon, I think it was
                  only nine of those did not respond formally.  But the CHP
                  relationships are
                            SISTER ANN:  Yes, that is very good.
                            MR. RUSSELL: Now in terms  of  the  staff,  they  do
                  show two professional  vacancies.  Now  those  vacancies  have been
                  filled.  They, you know, knowing that it is sometimes difficult
                 Ito recruit just on short time, they are using interns from the
                                               Ten
                  WICHIE program -- The Western  States  Commission  for  Higher
                  Education.   And these young men are on board.
                            SISTER ANN:  I think ther  w
                                                       e  ere five they were going
                  to bring in -- is that right?
                            MR.  RUSSELL:   Well there were  only  two  vacancies
                 Ion page  53
                            SISTER ANN: Yes, but five  interns  were  going  to  be
                  hired into those vacancies.
                            MR. RUSSELL:  No,  I think there were only two as I
                  understood it, and  those  two are filled.
                            Now the three projects which  Sister  Ann  referred  to
                  which show the coordinator as project  director  --  which,  I
                  believe would be a CHP priority as 1, if I remember correctly.
                            The other is an emergency  medical  service  consul'ca-
                 ition.
                            Yet he is not project director, per se      it's   that
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                   and all of that money will  be  subject  to  Regional  Advisory
  wt 14            Board review, and approval.
                              You are right, the Regional Advisory Board   is
                   aware of them     I sat with  them for their four-hour  meeting
                   to look at the  applications,  and they have been very  much
                   involved, and it has been  a  very strong program.
                              DR. TESCHNI:  How  many of the new  activities  are
                   going to be  processed  through,  or managed by  the  University
                 I of Oregon?  Just  in  round  numbers -- one out of ten,  or  ten
                   out of ten or -- there are a  number  of  these  projects  who
                   will be managed through the University.
                              MR. RUSSELL:  Very few, if I  remember.
                              DR. TESCHA.N:  Wiall, when I se6. the list here   look@
                      it looks as if they were managed somewhere else.
                             "A hundred thousand dollars  to CHP priority"  was the,
                   title, and I was interested in what   it was.
                              SISTER ANN: But that, then, is  when  it  was  under
                   [Dr. Rhineschmidt] and that --.is under staff     $900,000
                   and then ther6ls another $150,000 somewhere       itis total
                   $360,000 under his direction, so he keeps it in the program,hi@se
                              DR. TESCHAN:   What do they plan to  do  with  that?
                   Can you tell from that?
                              SISTER ANN:  No, I can't  tell from the application,
                   but apparently the staff is going to  address  itself  to  the
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                  management of it, but I would think that CHP is going  to be
  wt 15
                  involved in the planning, and I think the various agencies
                  in the area- are going to be involved in providing the
                  services.
                            MR. RUSSELL:  What   this is -- this is, you know, in
                  keeping  with the emphasis being placed on the particular
                  relationship
                            DR. TESCHAN:  That signal, I got.  I wanted to   know
                  the content -- I can read this myself.
                            MR. RUSSELL: And they have a  number  of.activities
                  that now are in the developmental stage. These will  come  in
                  as projects -- go through the advisory group interview, and
                  then will be approved and awarded to individual  CHP  agencies.
                            DR. TESCHAN:  I gather the decision is exactly
                  what the content would be -- it's open ended.  They  wanted  to
                  get some staff resource to move in that direction and  to  have
                  it earmarked for committee for that purpose, to get the
                  signal to you all and to the rest of us on  that.  (Reads  from
                  the document.] what they are saying, you see, the law  is  that
                'they have to do this and most CAPs or many,  would  say:  This
                  in our experience has not been  ready because they didn't have
                  the basis to make the judgment.
                            SISTER ANN: I got the impression  that  the  majority
                lof the funds for these programs, that it's really kind of a
                 ithrust into the future as well beginning in the present,  and
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                                                                  f link '-hese programs
                  iit really would be very difficult to kind 0
  wt 16            together in the  kind  of  a  model  that  their  Federal  Government
                   talks about at the present time.
                              Is that right?      Does that reflect
                              MR. RUSSELL:-  Yes.
                              THE CHAIRMAN: Paul, with respect to the      University
                   of Oregon and  the Medical School, I recently, on     a  flight,  was
                   sitting  next to somebody from the University  of  '.Oregon',  and
                   I had the --  apparently, you know      Oregon  is  a  "different"
                   state you see in many respects.
                              They are trying to keep  people  out,  and  they  led  the
                   way in gas rationing -- but  also,  its  University  is  one  that
                   they are at the end of the line in  feeding at the Government
                   trough     They get less money in terms of Federal grants
                   percentage-wise, than  any  other  medical  school  in  the  country.
                   And the Dental  School  won't  even  accept  percapitation  grants
                   and that, you know, is almost unheard of.
                              So it isn't  surprising in  one  sense  that  despite  the
                   fact that the University is a grantee here, that very many
                   W4P a'6tivi-Ei'es  now, or in my recollection in the past, has
                   been  university-sponsored.
                              DR. TESCIIAN:  You  really must have a first rate
                   coordinator out there too.
                              MR. RUSSELL:  Not too long ago there was a     management.
                   ,Ias@sessment    this was by a management program -- and the best
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  wt 17             I can remenlber, the only recommendation  was  that  the  grantee
                    ought to buy some curtains for the RMP Office.
                              MR. SIMONDS:  Well, that's a little    exaggeration.
                    [Laughter.]
                              DR.   HEUSTIS: Well, while  you folks  feel  sorry  for
                    the university,  I   know that they are getting $163,000.00 in
                    indirect costs.--
                              MR. RUSSELL: I didn't  say  I  was  feeling  sorry  for
                    it,  Al.
                              THE CHAIRMAN:  I seldom have bled for a university.
                              SISTER ANN:  But you know, for a university grantee,
                    they get the lowest amount.
                              DR. TESCHAN:  What's   their rate?
                             .SISTER ANN:  Oh, I think it goes    up to 60 percent in
                    some  cases
                              DR. TESCHAN:  And how low
                              MR. RUSSELL:  40  percent   for salaries  and   wages.
                              THE CHAIRMAN:  Well,  this   is an  application   for,
                    again, in round numbers $1.2 million.    They  have   estimated
                    that they will be in with  a  very  small supplemental,    roughly
                    $200,000.00 in the July request       but this  is  their  major
                    request.
                              The total   of those would bet again,  almost   their
                    target level- figure  of 102 percent by our calculation.
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  wt 18                        Any other questions, or any other comments?       Sister
  wt 18            Ann?
                               SISTER ANN:    I recommend that they get the amount
                   ,that they  are asking br     $1.2 million.    Their target is just
                   102 percent.     I believe in rewarding good programs.
                               DR. HESS:  Was that a motion?
                               SISTER ANN:  Yes.
                               DR. HESS:  I'll  second it.
                               THE CHAIRMAN:  We have a motion and a second, to
                   approve,  or recommending the funding at the level requested,
                   $1.2 million.
                               Is -there any further discussion, comments, questions?
                               In that case, the question.
                               DR. HESS:  Let's Vote.
                               [The motion was properly put to vote and carried
                   unanimously.)
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                              THE CHAIRMAN:  Again, unanimous      we re just
  wt 19            continuing the complacency of yesterday afternoon.
                              DR. HEUSTIS:  I think the Chairman should find a
                   better word than "complacency."
                            THE CHAIRMAN:     Everything, in the eyes of the
                   beholder, Al.
                              Well, we are still missing  Bill Thurman, so we're
                   going to continue to extemporize.
                              DR. HEUSTIS:  If they ever subpoena these tapes, I
                   would just hate to have anybody think we were complacent.
                              THE CHAIRMAN:  Well I don't think they will find
                   very many  explicatives, or, on my part, many "inaudible"
                   portions.
                              As long as we are on the West Coast, and if John and
                   Al feel up to it, we might want to   take one  tenth of our MP,
                   namely,  California, which in terms   of population, past
                   funding, has roughly come out that way.
                              Al, do you want to lead off?     Or John?   Again, I
                   don't   know
                              DR. HIRSCHBOECK:  No, Al does.  [Laughter.]
                              DR. HEUSTIS:  You see, I have a voice problem, this
                   morning.
                                             CALIFORNIA
                              DR. HEUSTIS:  Well,  california is submitting  two
                  Ilapplications for this year, and the one that you have before you
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                   is for approximately $8.3 million, of which    about  $1.6   million
  wt 20            is for the program staff.
                              And they would  estimate that  with the July application
                   they would come to $14 million and you    can note, if you care to
                   look on your white sheet that the RMP    are prorated figures
                   at $12.5 -- so there are approximately $1.5 million ahead     of
                   what they were advised to do.
                              They.served the area  of  California  with  two  regional
                   offices, both of them (note) located near major airports,
                   one in the northern part of the state and one in the southern
                   part of the state.
                              The Regional Advisory Group has established si4,goals
                   and six program elements, and the  will implement these.
                                                      y
                   The goals are to be  implemented  through  six  programs,  and  they
                   have assigned a percentage  of  funds,  and  have  determined  their
                   priorities in this way to each of the majbr goals.
                              The percentages are      the largest, they  held manpower
                   at some 25 percent and the least is 4 percent        with others
                   ranging in between.
                              The RAG is strong, stable, and very interested
                   and this is judged by the attendance which has a very well-
                   known committee structure.
                              In addition to the Executive Board, there are three
                   standing committees on program development, one on program
                  .1review and one on evaluation -- and then they have what I like,
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  wt 21            the program element committees in each of the areas      and
                   their charge is to develop programs and to monitor programs.
                             Here, again, it seems to me that real guidance is
                   provided to people that would request money, in what the
                   money should be requested for.    It came  through  strong and
                   clear to me that the RMP Central Staff  plays  an  extremely
                   important role in actually coming up with the projects   and
                   trying to define what our RMP role ought to be in each   of the
                   general areas -- and trying to define what kind of applications
                   they ought to address themselves to, and they actually have
                   pretty well defined criterias for  the  program  development
                   and provide actual guidance and request preparation
                   I don't know whether they actually write  the requests  or not,
                   that wasn't stated.
                             It was stated that the nine  RMP  Area  Committees
                   that formerly existed, had been phased out  and  that  the
                   program elements committees had replaced these, and that the
                   they were well satisfied with the fact  that  the  volunteers
                   were now doing -- at least I got  the  impression  from  the
                   ,Work, that they were now doing a better job than  the  good
                   job they previously thought that the staff  had  been  doing.
                             The final budget, as requested, has been approved
                   by the RAG, and first of all, apparently  in  the  process
                   the reports of the Program Area Committees goes to an Executive;
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                   Board, and the Executive Board reconunends a  division  of  the
  wt 22          Ili funds among the Program Ar@-as   and then the  RAG  makes
                   the decision as far as the --  within  that  context,  with
                   regard to  the  applications.
                              I think they  have a really well  defined  review
                   and approval  process,  which is adequately  described  and
                   interestingly --  and  before I reviewed this, I didn't know
                   that this was exclusive.    They  used  technical  experts,
                   apparently from outside the region  --  but  the  technical.
                   experts work under the supervision  of  the  Review  Committee.
                              The one matter that I felt was  defective,  and  yet
                 I I am extremely understanding, because California is a pretty
                   complex state -- and other large  states  have  been  having
                   similar problems -- and that  is:
                              First of all, who speaks for CHP?
                              And how do they effectively  communicate  what  they
                   think, to RMP?
                              I gathered that RMP has, what I  would  consider  an
                    arms length" relationship with CHP and that RMP was extremely
                   strong, relatively, and CHP was relatively extremely weak
                   and there was no described CHP  development  or  input  into the
                   preparation of requests prior to  the  RAG  action,  except for
                 I the legal review and comment -- and that seemed as though
                   at minimal, CHP ought to in some   way formally be consulted
                   about what they thought their  needs  and  priorities  were.
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                                                                      hey don't h
  @t 23                    Of course, the whole problem may be that t            ave
                  any need for priorities that have as yet been developed
                  but that is rather reading between the lines rather than
                  reading what's there.
                I          DR. TESCHAN:  Well, they have had seven years time
                  to acquire
                            DR. HEUSTIS:  The staff is well seasoned and exper-
                                                                                  t
                  ienced, although substantially cut.   They used to have
                  approximately 50 percent of the total awards that went to staff@
                  and it's now down to 12 percent.
                            The past results that I found, seemed to be impressive
                  both with regard to the numbers trained and, I guess I have
                  to interpret some of these figures, I'm not quite  certain  how
                  meaningful some of this is, as far as the meaningfulness.
                            We talked about new medical power  resources  created
                     or  new medical people power resources created"  and the
                  number wasn't really very impressive.  I think it was a little
                  better than 2,000.
                            But the access to care -- it seemed as though the
                  two major provider systems that had been started and  now  were
                  expanding with other funds -- they have given attention to
                                 and they have done  some work with the
                 Iurban Indians,
                  California Council of Free Clinics -- all helping the under-
                  iprivileged.
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                                                             ojects without
                                cord of continuations, the pr
                         The re
                                                     d that  out of  76  ongoing
   24          RMP funds, was impressive.    They sai
                                                   s that had  terminated  since
               projects, or a total of 81 project
                                   rcent had continued with other funding
                July, 1960 -- 70 pe
                sources.
                          In the first year, it said that following the RMP
                discontinuance, the projects that  had  previously  been  funded
                over three years fot a total of IUAP funds,  in the amount of
                $7 million - in the first year of going along with other
                 funds -- the people came up with $4.5 million to continue what
                 was going on.   I thought that that was  rather  an  impressive
                 figure.
                           The continuations supported by  all kinds  of  money,
                 including voluntary funds, university  funds,  hospital  funds,
                 State Governmental funds
                            In the proposed program, they are trying to set u@
                  a network of what they call "Health Services, Educational
                  Activities" to cover the entire state -- and yet  some  14  of
                  these formed ten of them are incorporated and four are
                  developing -- and these are supposed to  improve  the  quality
                  of health care for coordinated state-wide system for health,
                  manpower, training utilization and health education.
                             And again, it mentioned that over a hundred colleges
                   and 120 hospitals(seemed low) and clinics
                        involved in this with some 200 people on the boards of

                                                                          211
                   of directors of these organizations.
  wt 25
                             In high bloodpressure control  programs,  they  have
                   a state-wide plan, and I thought it was  interesting  that  of
                   the 36 applications that had been received, the project said
                   that sixteen were selected for funding.
                             Then I think the others were,  of course, pretty much
                   there.
                             Again, as I indicated before, the thing that probably
                   bothers me the most, and yet probably shouldn't bother me
                   too 'much, knowing what the facts of life are -- are the
                   relationships between CHP and the  Regional  Medical  Program.
                             THE CHAIIUMN:  Oh, I think Staff may have something
                   to contribute to that -- we  spent  four  days  in  California
                             DR. HEUSTIS-.  It is very difficult for a person
                   with just the information we have, to evaluate the real meaning-
                   fulness of the CHP comments -- whether they are just bemoaning
                   the fact that they haven't been recognized and watt to say  some
                   things, or whether they really have a beef and maybe the staff
                   could be helpful there.
                             But before we get to that, as far as my assessment
                   was concerned, I have rated on the Review Sheet,  all  of  the
                   items from -- on the first page, program leadership, program
                   staff, the RAG and the performance and objectives      in  the
                   "good" to "excellent" category.
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   wt 26                      on the second page, I had to break down the three
                   items in the proposal, thinking that  they  were  congruent  and
                   that they were addressed to areas of  emphasis,  and  because  I
                   didn't know about the CHP input of plans, and because there
                   were criticisms, I rated that down to "Above Average."
                              And then on CHP relationships, I  thought  these  were
                      very     I couldn't make the determination,  and if I had
                   to vote I would have to vote that these were certainly "Poor."
                   But the column that I checked was the "Insufficient Data'
                   and then the overall assessment of the program was "Above
                   AVerage."
                              And the recommendation was made that as far   as  the
                   funding level, that we  ought to know more  about CHP.   And  tnen,
                   I should say after that that we need  to  have  staff  comments.
                              THE CHAI.@'4AN:  Well, thank you.
                              You have raised the matter of  CHP.  Perhaps  I  would
                   comment on that before we ask John, and then Rebecca can
                   complement some other things, as relates to California region.
                              Relationships with CHP there, are  uneven,  but  even  i
                   CHP relationships one to another,  are  uneven.  Let  me  explain
                   that:
                              There are twelve B agencies in California  and  I  think
                   the relationship of the California PDAP, with most of the
                   medium-moderate sized ones (Fresno  and  the  northern  counties,
                   Empire Valley, which is Sacramento)  we  met  with,  during  the
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                 Icourse of our four-day visit, Rebecca and Sandy  and  I,  met
  at 27          !with  six  B  Agency Directors and the A Agency Director.
                 !The relationships -- I would describe those agencies as
                  "Fair to Excellent."
                             Much of this has been as a result  of  the  Health
                  Service Educational activities where the State is blanketed
                  by those which have been sponsored by the California RMP
                 tagain, the development has been somewhat uneven, but in many
                  instances, one finds that these  health  service  educational
                 11 activities, most of which are now incorporated as private non-
                 lprofit groups, are in a very real sense, the health planning
                  arm, or at least an important adjunct of the local CHP agency.
                             Relationship, on the other hand, with the three maDor
                  CHPs in terms of Population areas -" Bay Area,  Los Angeles,
                  and Sany)iogo -- are arms length to "awful."
                             MRS. SADIN:  Well, LA  was all right
                             THE CHAIRMAN:  Well, yes, LA -- at least the word we
                  got was that LA wasn't doing anything, so that they weren't
                  getting into anybody's way.
                             But some of that is a matter of  personalities,  I
                  think.   We found, for example, that in the Bay Area, the
                  Director of the CHP (and that's sort of a federated CHP,   as
                  there are nine counties, and each of them with one exception
                  I believe)--
                             DR. HEUSTIS:  Yes, but it seemed to me that in
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  wt 28            addition to the  B  Areas, that   every county had its   own
                   CHP, and to kind of sort out the comments it became     very
                   complicated.
                              THE CHAIRMAN: Well, the  Bay  area  is  an  interesting
                   CHP -- certainly the most vocal, outspoken, bidder, director
                   we ran into,  that was Don Ardell  in the Bay area.       He
                   was having problems with his  eight  County  Directors,  and they
                   sort of meet apart from him.
                              Correspondingly, those  B  A@encies, and perhaps the
                   B  Agencies in general, but certainly the larger ones -- I'm
                   not sure it's constructive, I think there was some destructive
                   tension going on presently between the  A  Agency      and the
                   area wide agencies out there.
                              I think the @IP has, on the  while,  pretty  good
                   relationships with the  A  Agency.  Now  part  of  that  may be
                   the fact that the A  Agency is, comparatively speaking, poor
                   So that it has been getting some  money  from  the  State  EMS
                   Office, or from the RMP, to do some  of  the  things  that  it
                   really hasn't been able to get  State  funds  or  State  positions
                   for.
                              But the picture is a mixed  one,  but  certainly  based
                   on our site visit, Rebecca has thrust  in  front  of  me  here
                   both our report to Dr. Paul and our feedback letter to Paul
                   Ward -- while we did have some recommendations about their
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                                                                                   5
                   relationships, I think there are more that have to do with
   wt 29           details, that they really ought  to  do  a  better  job  in  insuring
                  ithat the letter, as well as  the  spirit  of  the  law  is  followed.
                   If for no other reasons, the defensive purposes.
                              They were kind of sloppy in logging in    things,   and
                   showing that they      you know     somebody wants to get you
                   over a barrel
                              But we  felt that on balance, that   the   requirements
                   for CHP reviewing comment were largely being     met in substance
                   as well as technically.
                              We did,  also, have a chance to  witness  at  the  RAG
                   meeting we attended, that there.are several CHP representatives
                   on there -- one from the State CHP and the area-wide agencies
                   have a California Conference of CHPs -- it's kind of their
                   "trade  union" and they have a  representative  on  the  RAG  and
                   at the  RAG meeting we  attended  an  alternate  member  was  sitting
                      the  fellow from San Diego -- and  they  certainly,,  not  only
                   spoke out, and they had  some  objections,  but  the  RAG  took  them
                   under advisement to the  extent  that  they  deferred  --  they  were
                   going to look into the matter and either accept them in whole
                   or ignore them      and I think, you  know,  that  even  that  slight
                   demonstration suggested to us  that  in  the  RAG  councils  they
                   have the ability to make themselves    heard.
                              So it's kind of an uneven   picture, Al, I don't
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                   at least from what we've
  wt 30                      DR. HEUSTIS:  From what you have said previously
                   what comes up with what I get out of the thing -- I had written
                   down a summary of the comments that had  been  made,  and  that
                   was marked in red -- and I admitted that the ones that I thought
                   were important, and I had  imported negative comments from
                   six of the twelve areas -- at least what I thought were impor-
                   tant negative comments of the six
                             MR. BARROWS:  I don't think we can charge them with
                   the responsibility for  resolving  these  intramural  conflicts
                   within the CHP.
                             THE CHAIRMAN:  Oh. no.
                             MR. BARROWS:  But we can grade them on their effort
                   to relate to CHP -- and would you regard that effort (and this
                   should be a positive one)  as "Good" "Average"  "Weak?"
                             THE CHAIRMAN: I would have  to  ask  for  Rebecca  to
                   comment too.
                             My judgement, I guess, would be "Atrerage" to "Good."
                   I think there are some situations where my impression is that
                   California RMP  feels that it has walked the last mile.
                             For example, when the  Area  Offices  are  abolished,
                   that was a kind of a structured cross-over situation.,    When
                   they abolished all their area offices and with   them the area
                   advisory committees, and came up with the Program Element
                   Committees as a substitute -- there became a number of vacancies
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                   on various  B Agencies     you know our  slots  targeted for  the
  wt 31
                   RMP, we found in the Bay Area  that an issue of longstanding
                      the B  Agency Director wants an RMP person, but he  wants
                   a consumer.
                             But it just so happens that in that part of California
                   Paul has only got some providers on his RAG, and you know, I
                   think there is a real personality kind of conflict.
                             But I think on  the whole -- and one of the suggestions
                   we have in our feedback  letter, was that they should  consider
                   the possibility of having a fairly senior staff person as kind
                   of a liaison with the Conference of the Aqencies  --  they  have
                   met with them, and again, this is not  a  monochromatic  picture
                   at all
                             DR. HEUSTIS: Have we any  kind  of  a  written
                   agreement that has been either tried,  or  achieved,  as to  what
                   each of them have thought they were supposed  to  be  doing  and
                   what their responsibilities were
                             DR. TESCHAN:  The answer to that is:  Yes, as I
                   recall.
                             Now whether it is current or not is more to the
                   point, but I recall that there was circulated to the coordinators
                   some two to three years ago -- and this was  the  first  example
                   of a written memorandum of agreement as to what RMP and
                   CHP roles were going to be and how each would interact wlth
                   them.   I'm quite sure Paul Ward was
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                              DR. TESCHAN:  I thought it was a marvel.  As a
   wt 32           matter of fact, when we got around to signing a statement in
                   Tennessee, we used that as one of the bases of ours.
                              MRS. SADIN:  But I think it's uneven -- the
                   relationships are uneven.
                              The only suggestion I could think of and we discussed
                   this -- I  think we need a Rabbinical Council -- you know, you
                                    mediate.
                   just need  it, to
                              i'm awfully sorry, Sister Ann.   (Laughter.]
                 I            You know, in the old days, they  didn't need lawyers
                      both parties just went to the local Rabbi, and I kind of
                   thought that's what they needed..     [Laughter.]
                              They are doing, you know, the legal part of it and
                   getting the review in comments and submitting the things,
                   etc, etc,, etc, but it's a relationship thing that's the proble,7,
                   in some areas.
                              They are now logging in, as  you can see in their
                   applications,   all of the comments that are sent out and all
                   76 projects
                              DR. HEUSTIS:  76?
                              MRS. SADIN:   well 75     not that's a lot of projects@
                   for review and  comment -- and they just sent me another whole
                   batch  from the LA  -- and this is all just LA CHP  (Displaying
                   a dossier.]
                              DR. HEUSTIS:  That came in late.
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                             MRS. SADIN:    Yes, that came in  late.  [Laughter.]
   wt 33                     So it is -- you know, one of the   things we suggested
                   and this is the letter sent back to Paul Ward -- and one of the
                   things that we suggested is that they have a senior staff
                   person as liaison, to spend more time and pay more attention
                   to that problem.
                             DR. HEUSTIS:  Well I am satisfied from what I have
                   heard, that I would change my recommendation from "Insufficient
                   Data" to at least a "Satisfactory" relationship.
                             THE CHAI@IAN:  Correct..me, Rebecca -- but most of
                   the program elements committee do have a CHP representative
                   on them.  This is really their program development thrust.
                   Now
                             DR. HEUSTIS:  Yes, it is pretty good.
                             THE CHAIRMAN:  Well, I wonder if we want to hold
                   withhold  other staff comments, and let John as a second
                   reviewer, take a look at California -- we have  spent  an  awful
                   lot of time with CHP but given the fact that they are probably
                   10 percent of the CHP in California, also.  At least, in terms
                   of family, I wouldn't think that was far off.
                             DR. HIRSCHBOECK: Well, I  won't  repeat  the  comments
                   which Al made because I think they hit the  target  right  along
                   the line in most instances.
                             I am troubled in one way that in  reading  this  over,
                   I didn't see what really happened when the areas were dissolved
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    wt 34           and they were put into two.
                              Is CHP, again, is  it moving into the area-wise
                    approach here that existed with@ the regional setup?
                              I think that because of this, maybe this is one
                    of the reasons for some of the problems that they are encounL@-e---
                    ing there in relating to the CHPS.
                              The other point that bothered me is this enormous
                 ll'project that Dr.  White is in charge of -- it's how many
                    millions?   Altogether, I guess he's asking for
                    a state-wide consortium of colleges and universities and
                    hospitals and this enormous arrangement seems to me really
                    going too far.
                              At the practical level, I don't know how they are
                    going to work this out, but if this is the way to go in
                    California, maybe it should he allowed, but I have my
                    druth6rs about that enormous approach to dealing with area-
                    wide health education aspects.
                              MR. BARROWS:   Resolving that at Berkeley
                              DR. HIRSCHBOECK:  I guess so.      [Laughs.]
                              I have made several visits, site visits, to other
                    agencies in the California region, and there is  one for the
                    California RMP and one in their Review Team consulting visits,
                    and the thing that impresses me out there is that things are
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  wt 35          @i so different in different parts of the State       that to try to
                    resolve a problem on a state-wide basis becomes extremely
                    difficult and this is  recognized  initially  by  their  setting
                    up a CAP region.
                               And now that this has gone, I am   uncomfortable.
                    It's like setting up a Regional Idedical  Program  for  a  whole
                    nation, and doing it in one'-- as a sub-set of another nation.
                    I don't think
                               DR. McCALL:  That is difficult to do.  We tried it.
                    [Laughter.]
                               DR. HIRSCIIBOECK:  So that my overall evaluation is:
                               Sure, the leadership is good.
                               The problems are difficult.
                               The program and staff is good.
                               The Regional Advisory Group
                               I might differ a little with Al on all these
                    he has perhaps read it in a little different way.  I had     the
                    feeling at least that the  Regional  Advisory  Group-  was@  not
                    really involved in the actual process of evaluation
                    as much as other Rk4Ps are.
                               In other words,  they take the word  of  others  very
                    readily,  without  being,  themselves,  directly  involved.  Now
                    I may be all wrong on that but I sort of sensed that
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   wt 36                     Past performance and accomplishments ...
                   objectives and priorities  -- I think these are well defined.
                             Feasibility -- here, again, the whole idea of
                   true regionalization on a state-wide basis, I think, is    very
                   difficult.
                             In general, I would say "Average"  or "Good."
                   "A,v3rage" would be my overall evaluation.
                             MR. BARROWS:  Let  me ask a question:
                             One of the things  -- California,  as  you both pointed
                   out, is not only vast, but extremely complex.
                             One of the very unique complexities   is the strength
                   of the foundation movement.  Now nobody has commented on how
                   this program relates to the practices of the community
                   which happens to be an unfortunate bias of mine -- have they
                   been relating to these foundations at all?     This is including
                   the interplay between
                             DR. HIRSCHBOECK:  Well some of their projects are
                   involved in the quality  insurance.
                             DR. HEUSTIS:   They mentioned particularly some of
                   the foundations have picked up the check for some of the
                   projects which  had gone on
                             THE  CHAIP24AN::  Great.
                             DR.  HEUSTIS:  Now how  extensive this is, I don't know@
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                11 or how wide.
                             MR. BARROWS:  Good    well- boy, that's the acid
    wt 37
                   test to this hard-earned
                             DR. HEUSTIS:  Whether this was two foundations or
                   twenty foundations I couldn't -- I believe my notes are not
                   clear.
                             FROM THE FLOOR:  Could you tell roughly how mahy
                   grantees there are, other than their sponsoring grantees
                   programs?
                             DR. HEUSTIS:  You would have to help me there.
                             DR. HIRSCHBOECK: Let's see the agencies other than
                   central staff that are handling the money -- as grantees.
                             MRS. SADIN:   They have subcontractors -- or
                   contracted, that is, most -- for instance, all of the health
                   service activities are contracted to the independent facilities.
                   They are calling their shorts
                             And almost all of what they have, when they
                   develop a program element, they have sent out RMPS, you know,
                   throughout the state, and in which they really outline what they
                   want   and then they contract it out.
                             They have in their access, which is going to be
                   coming in in July, they have had something like -- from their
                   RMP they have something like 250   isn't it?   I think it's
                   250 letters of intent, which is the, way they go about this
                 libusiness.
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   wt 38                       In answer to some of.your questions on the definitions
                    of area offices -- one of the    things the  CHP  --  or  some  of
                    them, told us     was that well   now that  they  don't  have  the
                    area offices in California, that we could kind of take their
                    place in terms of local input.
                               And when-we mentioned  that  to  Dr.  Mitchell,  he  said
                    ';Yes, do you think  this is the first  time  I  have  heard  it>"
                    They have never communicated this to us.   (Laughter.]
                               Some said that they missed the area offices     and
                    some of the agencies said they were glad they were gone.
                    You know, it was kind of a 50/50 kind of thing, almost through-
                    out the state.
                               The result of  the  definition  of  area  offices  really
                       you know they had something like a three-months visit when H7--,','
                    audited them and this was the latter part of 172 "- that was a
                    fact that one of the strongest recommendations was that they
                    not have all of the area-- offices.
                               And I think Paul Ward took the opportunity to follow
                    the advice of the  HEW auditors,    and they  now  have  a  northern
                    field -- it isn't just a central    office,  they  have  a  northern
                    field office and a    southern field office.
                               THE CHAIRDIAN:  Yes, but  these  are  quite   different
                    from the old areas.  These are essentially administrative
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  wt 39             or for program development, and monitoring purposes.
                             MRS. SADIN:  Right.
                             DR.  HIRSCHBOECK:  One@  wonders  whether  they  shouldn't
                    really make  two RMPs instead.
                             MR. BARROWS:  Right.  From  a  management  point  of  view
                    this is too damn big for one
                              MRS. SADIN:  Right but
                              MR. BARROWS:  But we can't do anything about it.
                              THE CHAIRMAN:   I think that represents, though,   a
                    very conscious, deliberate, decision made at the time Pj4P   came
                    along and involving what, at that time, were a lot of the
                    influential people in California.
                              At that time you will remember,   Breslow was the
                    State Health Officer, and Brown was the Governor, and they
                    made a conscious decision and they wanted a "state-wide"    PIIP
                    even though it might be juggled.     They came out exactly  the
                    o posite from N'ew York, which now has six or seven P14Ps.
                     p
                              So they didn't blunder into it, and I'm sure,    like
                    any decision, it had both then and in retrospect both its
                    plus and minus qualities.
                              MR. BARROWS: Well, there's  not  much  we  can  do  about
                    history now.    What's the recommendations
                               SISTER ANN:  I was interested in your comment where
                    you said the technical experts work  under  the  direction  of  the
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                 IReview Committee of     would  this be inhibitory to the technical
                  experts?
  wt 40
                             DR. HEUSTIS:  Are you talking to me?
                             SISTER ANN:  Yes, you indicated in the  report,  that
                  the technical experts work under  the direction of the review
                  committee. What's  the  purpose  of bringing in  these  technical
                  experts?
                             DR. HEUSTIS: Well, I think the  purpose  of  bringing
                  in the technical  experts, as I understood it from a person that
                  made a site visit too,  with me one time when we got  into  this
                  discussion -- is that  this is to get rid of the local bias
                  and the local conflicts of interest and  the  local  antagonisms
                  between the centers from which the experts come.
                             SISTER ANN: Then you said that they  work  under  the
                  direction of
                             DR. HEUSTIS: Well, the "direction" --  perhaps  if  I
                  said  the overall direction or overall supervision
                             DR. HESS:  Or "they report to"
                             MRS. SADIN:   I started in on that  -- to review
                  particularly the manpower, and they do bring   in top experts
                  and they have to counteract the ones in California -- and I
                  think what was meant was  that  the recommendations go into a
                  review -- but it isn't
                             DR. HIRSCHBOLCK:  But this is  exactly the point I was@
                  tryingto   make a little while ago.    I think that the distance
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  wt 41             between the RAG and  that technical review process, is at least
                    at the time that I was out there      it seemed to be a larger
                    gap than really should be.     That the RAG should be much more
                    closely involved in the  actual  review  of  the  project  itself
                    and not just take the report with the badge of an expert pinned
                    onto it.
                              MRS. SADIN:     I don't know if they changed it   since
                  Twelve   been there, but they now have a member of that RAG
                  Represent  at every one of these -- which helps tremendously, and
                  @i he  reports back.
                              THE  CHAIRMAN:  They  have  two  standing   committees.
                              A review -committee, and;
                              An evaluating committee.
                              Under  the  Review  Committee,  the  technical  experts
                    operate in a panel fashion, sort of.      They look  at  the  new
                    projects.
                              The Evaluation Committee, on the other hand,
                    doesn't have that close  line  of  the  smaller  committees,  and
                    they are the ones who look at and then forward to RAG.
                              And then, both of these standing committees      are
                    RAG people, on continuation, so that they have that kind       of
                    relationship      And what goes through RAG, if it's a continu-
                    ation of the Evaluation Committee -- if it's new, it goes to
                    the technical panel.     So it's the overall "umbrella" supervision
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                   of the Review Committee.
  wt 42
                             SISTER ANN:   And then @re, too,  on page 3 of  the
                   Staff Comments, they have  70    requiring surveys, four  kinds
                   of positions -- they are adding the 19     but  one of the
                   concerns is the proposals are not being monitored and
                   evaluated on a systematic basis.
                             And here, I just wondered if adding more and more
                   people would complicate the issue.
                             MRS. SADIN:  There is some urgency to this.  In
                   fact, they have added evaluations to their  staff,  and  they
                   are asking -- part of the 70 is for more.
                             But we had, after  their  supplemental  application
                   we sent an advice letter back to Mr. Ward.     We had suggested
                   that such a vast program would merit  that  they  spend  more
                   time on surveillance and monitoring.
                             And when we were there in April -- if anything, they
                   had gone the other way.  They are  sending the people in the
                   Southern Field Office to the Northern Field Office and require
                   a monthly progress report. So if  anything,  they  have  gone
                   overboard.
                             So they are monitored     all their people in their
                   Field Offices are monitored -- every single contract -- and'
                   this is the contracts mostly, so that they have a condition
                   written into the contract.
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  wt 43                      DR. HESS:     I see.
                             DR. TESCIIAN:  I would like to say that the evaluation
                   effort of what public accountability of funds really means
                   in terms-of output benefit -- that  whole  concept  was  jelled
                   for all  of the RMPs in the country by  the  initiative  of  Paul
                   Ward and that staff in California.     And a good deal  of  some
                   of the numbers you are,seeing, John, and  all  the  rest  of  us
                   are aware of how that ultimately   became generalized  in  order
                   to get the data  together, to show to  various  critics  what
                   the numerical impact of these activities was.
                             I am interested that you consider  that  some  of  it
                   became a little bit more compulsive than others -- but I
                   understand the atmosphere in which  such  compulsion  can  be
                   generated     so that I even have some tolerance for that   as
                   we 1 l..
                             MRS. SADIN:  In terms of the H.E.       Doctor, you
                   asked a question about  the manpower.
                             When we said  "supplemental  funding" in  July of  172
                   California of  course  as usual, got the most money  in the
                   supplemental  funding  for manpower control -- they  started out
                   with something  like  10, plus the Central Coordinating one.
                   They now  have  something like 15 and they  just  about  cover
                   the state.  Some  are  in the planning stage but most  are  now
                   independents   consortium with  independent boards.
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                             It's interesting though,   that at  conferences  like
   wt 44           the schools of  Allied Health Protection -- and they have had
                   some -- there's a national conference   in Boston this year
                   they had Dr. White speaking in some of   the consortia of
                   the directors.
                             The people at the conference were   so excited about
                   it that they then sponsored their regional California conferencEs
                      they have done some  exciting things.
                             But it is a  lot of money, though.
                             DR. HIRSCHBOECK: Well, I  would  like  to  see  it
                   sometime, to see how it  functioned.    It sounds good  on paper
                   but I would like to
                             DR. TESCHAN:  Well, John, the thing that bothered us
                   is that each one of their nine regions was about as big as
                   one-point-some million      as most of the other  RMPs  we  are
                   talking about -- and to  see Paul Ward, in one application,
                   with a dissolution of area offices, jus-. boggles my mind.
                             And Ken's point of "management,  how  do  you  get ahold
                   of it?"  I am surprised at the HEW  Audit.
                             We know a little bit about the  origin  of  that,  or
                   have suspected some of the origin of it, and I'm wondering whethe:
                   acceeding to it -- the fact that it has some budgetary    require-
                 ,Iments    isn't  a "giving in" to what  would in Ken   s view be
                   sound management     since we would have  insufficient data to mark
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  wt 45          11 or to be able to make that judgment from here.
                             MRS. SADIN:  Well, some of the things  Dr. [Hirschfeld]
                  has-said  -- nobody knows this is  going to happen -- they
                  had more  than a norm -- they recognized that -- perhaps   not
                             DR. HESS:  You are dealing with a state of some
                  twenty million people, and $2 million for health, education
                  though it seems a lot in one lump sum, is not a disproportionate
                  amount for the population.
                             THE CHAIRMAN:  Al, you've been trying to
                             DR. HEUSTIS:  Yes, I've been trying to push      and I
                  would like to make a motion.
                             THED CHAIRMAN:  Fine.
                             We have a request here for a little over $8 million
                  and we have an indication that California will be in  -- and
                  this is a request just for continuation and program staff.
                  Roughly, they are at the   $6 million level for all new activities
                  in July.
                             That would total, if my figures are correct, almost
                  $14 million.
                             DR. HEOSTIS:    If you would then look at another column
                  you would note that if they did that, they would then come to
                  111 percent of the amount that you   requested for them.
                             And because both John and I have rated   this as
                  "Above Average" it seems as though, in conformity    with our
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   wt 46            policy of rewarding the people  that do well, and taking away
                    from the people that don't
  INDEX                       I would therefore, move that it be funded at the
  MOTION
                    requested level, some $8,170,374.00
                                                  (Th6 motion was properly seconded.]
                              THE CHAIRMAN:  All right, we have had a motion to
                    approve at the requested level of $8.170,000
                              DR. HEUSTIS:  374.  -- it's a separate    item.
                              THE CHAIP24AN:   $8,170,374.
                              Are there any further comments, or any additional
                    questions?
                              SISTER ANN:  Excuse me.
                              Are there any things that you feel we should look
                    at, or that you think should be looked at, serious enough t at--
                    by reducing this funding (since they are coming in in July)
                    might be an impetus for them to look at the funding?
                    Are there any points or things that bother you about    the region
                    that maybe could be looked at?
                              DR. HESS:  But the point is, there is no time for
                    them to look at anything.
                              DR. HEUSTIS:  I guess the answer, as far as I'm
                    concerned, Sister, is that I thought it was a good program
                    with good management and that the CHP situation bothered me
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                    but that has been resolved satisfactorily for the moment
  wt 47             they still ought to work on that,  but  at  this  time  I  think  I
                    would say  no" to your question.
                              SISTER ANN:  As I read    those notes  here  and  the
                    Staff Summary, I'm not all that    impressed with the good
                    management, and I think part of    it is because it is such a
                    difficult   region   and as I have heard it reviewed from time
                    to  time  and  the management  hasn't  been  its  strong  point.
                              But   as Dr. Hess says,  there  is  nothing  that  can  be
                    done about it now except in terms of a recommendation.
                              MR. BARROWS:  I feel as you do.       We  can't   reverse
                    history. I would  certainly  not  recommend  this  as  a  model
                    program  for the new House Resources Agency -- it's too
                    monstrous.
                              SISTER  ANN:  Well  now  I  would  think  thatwould  have
                    to dome through -- it  would  make  me  much  more  comfortable  if
                    that came through as a :--recommendation.
                              MR. BARROWS:  But  I  don't  know  what  --  it's  bigger
                    than both  of  us.
                              MRS.  SADIN:  The  target  that's  figured  though,   you
                    knowi which is, I guess,   less than what they       less than the
                    $14 million     they have  communicated  over  the  telephone   and
                    they have allocated percentages to each program analysis --       and'
                    of course if that came down  to  --  say  $12  million  instead  of
                  11$14 million -- the man had written 25 percent of 12, etc
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                             THE CHAIRMAN:  They have pretty well -- you know,    I
   wt 48           assume there is some ability to make adjustments at the tail
    &49
                   end.of the process.  But they have gone through a process
                  lby which the RAG has said in effect:  One way of expressing
                   priorities is that we'll put essentially 25  percent  of  our  money
                   into the access program -- now whether that  is  X-plus  $2  million
                   or X-minus $2 million -- so I do  think we have a notion
                   both here and looking at a new application, of what the       or
                   where the cuts would come.
                             DR. THURMAN:  Yes.    Question.
                             THE CHAIRMAN:  All those agreeing with the recommend-
                   ation to fund at the level requested indicate.                    i
                             [The motion was properly put to vote   and passed
                  "by a vote of 6 in favor and 3 opposed.]
                             THE CHAIP-IIAN:  In that case, I guess that's by
                   default.  I can't think of any better solution.  There should
                  The one, but I can't think of it.
                             O.K. for California.
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                                                                                235
                               THE CHAIRMAN:  O.K., Bill, since you guaranteed      us,
  wt 50             last night, that you could dispose of Puerto Rico in ten
                    minutes, we'll take  you  up  on  that.  And  then  after  Puerto
                    Rico, we'll see if the  group  wants  to  take  some  coffee.
                    You and Joe -- I'll call on  you  first,  since  you  are  on the
                    site   visit -- well
                               Maybe you were too, Joe, were you?
                               COMMENT:    No.
                                           PUERTO RICO
                               DR. THURMAN: Just  a  reminder  of  the  fact  that  a
                    site visit was asked for by Council, as to whether or not
                    Puerto Rico would get any  money  at  all  --  whether  they  should
                    be discontinued.
                               Mr. Nash was on the site  visit  with  us  and  the  most
                    important thing about the site  visit  was  that  we  had  a  multi"
                    lingual team, and I think that resolved all our questions
                    because in our meeting with the Puerto Rican groulD
                    the  Coordinator  now,  he  was  the  Associate  Coordinator before
                    he has the respect  for  the  program  and  control  of  the people.
                    They  continue  to  have  real  translation  problems,  even during
                    the site visit and even though we were multilingual.
                               Some of the concerns that came out were onl  handled
                                                                               y
                    by a girl  who was even more fluent    than the  Site  Team  was.
                               The RAG is very strong.     It's very representative
                    despite the differences involved with Puerto Rico, and poor
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                                                                          236
  wt 51           transportation     and despite the phaseout  as concerned that
                11 part of the program in toto, the RAG has continued to work
                  quite  well.
                             The real strength of the program as far as the
                  future is concerned, is that 70 percent of all health services
                  in the island are public, and the grantee being the University
                                                          I
                  of Puerto Rico which is also a public agency has forced the
                  staff to flow from agency to agency, but nevertheless, has
                  worked quite well.
                             I think the most eloquent thing  that we heard
                  was several testimonials that came from cnnsumer groups about
                  what Puerto Rico and the medical program had meant -- the
                  delivering of health services to the underprivileged groups
                  in the continuing organizations.
                             Therrojects were just superb, when you really under-
                  stood them (which is not true on paper, and this has been out
                  problem the whole time.)
                             They have an operational  VSRO which is phenomenal
                  in every sense of the  word.
                             They have a very good plan for their EMS  and
                  they are working hard  at the geographical spread.
                             I think that this program, having gone  down there
                  thinking it wasn't worth supporting for another   day -- the
                  Site Team came away totally satisfied that   it was an excellent
                  program, and I would recommend approval of   their request.
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                                                                               237
  wt 52                        DR. TESCHAN:  Second.
                               THE CHAIRMAN:  Joe.
                               MR. de La PUENTE:     Well I have many  good things to
                    say about them.  I  have  discussed  with  friends  of  mine  who
                    lived there and who have been living with the government
                    structure, which is quite monstrous        and they speak of   Puerto@
                   iRico P14P as   La creme de la cr6me" as    far  as  entered  into
                   l'our conversations -- with living over there.
                               And  under the circumstances I have written          I
                  @,lwrote a lot that has  already been said, but    in summary,
                    this application represents tenacity in the     face of
                    austerity in that a viable program is being     presented.
                    It is possible to enhance the staffing pattern with the
                    introduction of a physician who possesses some training        in
                    the field of epidemiology, and this is tremendous.
                               It is apparent that the Regional Advisory Group
                   ihas continued their efforts towards program development and
                    review.  Their track record in terms of the number of
                    programs that are eventually adopted by the community      appears
                    to be better than average.      Most of the present priorities
                    appear to coincide with the needs of the Island.
                               Special attention should be    paid  to  assuring  the
                    dissemination and application of findings     for additional sites
                   lin Puerto Rico.
   HOOVER REPORTING CO. INC.

                                                                            238
  wt 53                      But I certainly, strongly concur with the present
                  recommendation.
                             THE CHAIRMAN:  Thank you.
                             Yes, Al.
                             DR. HEUSTIS:    I am impressed by what was said.
                  In fact I was so impressed by what was said that I looked     over
                  into the next to the last   column on this tabular sheet, and
                  I noticed that Puerto Rico is one having the honor or
                  distinction (or otherwise) for requesting the lowest     amount
                  of the allocated funds, for any group.
                             THE CHAIRMAN:  Yes, the lowest percentage of that so-
                 icalled target figure.
                             DR. HEUSTIS:  Yes, the lowest percentage.
                             THE CHAIRMAN:  Yes.
                             DR. HEUSTIS:  Now,  with the obvious need, and I say
                  "obvious" need, it's from what you have said after a one-
                  week visit -- and whan I was there under different circumstances
                  and not for RMP and quite sometime ago
                             Is this because they were tired, or because they were:,
                  discouraged, or because there was a lack of understanding on
                  the part of what  RMP was looking for?      Why this low figure?
                             DR. HESS:  I don't think that's a good measure,
                 lat all.
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                                                                             239
  wt 54                      DR. THURMAN: I think I  had  better  respond  to  that.
                             I agree with you, I don't really think it is.
                             It's not a matter of being tired, it's not a     matter
                   of being fed up, or anything else.     This program has  been
                   going and again, we didn't understand how well    it worked  with
                   all the other health affairs and activities.
                             Now th ey have wanted to avoid  an  outward  appearance
                   of affluence, and that's why they  were  so  well  accepted,  as
                   Joe points out.
                             Again, I would just emphasize that -- not in talking
                   to people who are getting anything out of  it,  but  in  talking
                   to the little people -- and these people were able to speak
                   in Spanish to the people involved -- it really is the cream
                   of the program and they felt that they can use this money
                   wisely and not jeopardize the future of  anything  else  --  and
                   they would only ask for the money they think they can use
                   well.
                             DR. HEUSTIS: Now in view of  this,  do  you  not  wish
                   to retract the statement that you made yesterday about the
                   people "always asking for more than they need?"
                             DR. THURMAN: No, these  people  have  asked  for  more
                   than they need.    I would never retract a statement, like
                   that.   [Laughter.]
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                                                                         24c)
  tit 55                    DR. HEUSTIS: For the moment I thought I  had  you,
                  but I couldn't go further
                            DR. THURMAN:  No, I am going to defend the sheet, a
                  little later on, with the fact that.I think it's useless, so
                  I only bring that up
                            No, the only place that -- the place that I  would
                  criticize their budget, if you still look at the core of the
                  staff program -- as to what was indicated earlier -- they just
                  pick up all the staff, and they didn't really, physically
                  pick them up, they just moved them to other  budgets  within
                  the medical science campus, and  try to find a place for them
                     and then they kind of flow them back.
                            And that "flow" is very worth while for the very
                  reason  you bring up -- that these people will be able to  do
                  an awful lot with a very little bit of money.
                            So that we are approving more money than they  can
                  truly use right now, because they are funded through other
                  mechanisms.
                            So that I'm not defending my very dogmatic statement
                  too much.  [Laughter.]
                            DR. HESS:  The point is:  How many people are there
                ilin Puerto Rico?
                            DR. THURMAN:  Higher than New York City    per squarer
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                                                                            24i.
                   foot     it's the most densely  populated region in the United
  wt 56            States.
                             MR. NASH; About 2.5 million I guess.
                             DR. THURMAN:  But a higher density than New York
                   City, per square foot of ground.
                             And yet the most of the island, you couldn't set
                   foot on if you wanted to, because of the trees and the water.
                             MR. NASH:  Dr. Heustis, that figure may change  --
                   69 percent -- depending on what comes out of their application
                   that they will submit.
                             DR. HEUSTIS:  I didn't care to explore that any more
                      but it just seems as though where there was need -- was
                   there a language problem.
                             But I think my question has been satisfactorily
                   answered.
                             MR. NASH:  All right.
                             THE CHAIRMAN:  We do have a motion, and a  second,
                   on this one -- to approve in the amount requested, which is
                   $696,862.00.     Is there any additional discussion'?
                             All those in favor
                                                  [The motion was regularly put to
                                                 vote and carried unanimously.]
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                                                                         242
                                 (IT
  wt 57                      THE           O.K., it's ten o'cl.oci-,.  T;,,Ih a t i stLi c
                   Pleasure of the qrouT)?  Do @ie @,7ant to take on another one
                   or do %@7o- want to break for fifteen minutes and have a cu-o of
                   Cofi@ce?
                             Do @.7c have anot@i@r ten minute one? How about the
                   Tloul-it@-ain States of Idaho, I'llontana, 1,7yortinq, and Nevada?
                             '-"O'i,IEI,TT: Is that c-ilT.-;ca,,7s that same four rtates?
                                            It's al%.7ak7s been a little unclear in
                   m,,, mind'. @-7"lat i'vp- read nor,.., suc-rgcsts it's sort of a northern
                           ir-7,7
                   half of   omin,@ -@ it doesn't really make much difference
                   as "7,701"i.na has been "I-IlPs "P-oland" there arc three .7Z.'!Ps @L. 0
                   -olot over; in the mountains:  Colora6o, !,7yominq, and -- the
                   mountain  states
                                     THE 1.10@-iTAIN STATES
                             DR. 1@!cCALL:  They have cot a tableLof staff
                   and a pri-oritv aroun, and a Priority setting on a ori-oritv
                   basis, they have handled that in a hiah, mcditip., and lo-@.,7 c@,roun,-nq
                   in this application -- @,7hic,-i is a good application -- clear
                   and I think it n@-esents a picture of the recion Pretty ,@7ell.
                             Tliev have had rcction review certification visit
                   and management assessment visits ii7hich came out as, I think
                   prett-,), much all "nlu@,cs" from that rcaion.
                             Assessment of their Past performance and accomplish-,
                   ment has also been T)rcttv (-,,nod.

                                                                                                                  243
                                                                                                         d     with
     -vit 58                               The current pronozal8 seem to be                  in      accor
                            their    stated    objectives    and     priorities,     and     I     thin]-,     thev
                            are         feasible.
                                              The C@'!P    there    are    four    A    Agencies     and     sevenB
                            @lgeiicies       that have to be dealt i,7it'L-1 by        this -,2,cgional "-Icdical
                            Program,     and    thev have received   in this application,  comments
                                                    '%gencies,     and fo                                gcncies
                            from all         fourA                          ur   of   the   seven   B    A
                            are         included.
                                              The ICia@o A Aaencv disapproved one of the T)rojects
                            the physical        assessment field -- nurses                   and the D       .7\-ccncv
                            hE,.d nec@ative     cc-iiqcnts   on   about   four   -)ro]ccts   --    but    @.7cre    no
                            an in (fto--,oth stt,,-Iv or criti.ql-,e of t.iosc              it @.,,a!3 just  on(,-.
                            sentence co-L-,ionts.
                                           I   state   that   to   sav   tiat   I   C@on't   have   ant7   T17,1@7 to
                            evaluate   the   auali-.tv    of    the    CliP    reviexi    and    relations'@i4--)s th2ra
                            but these were --- t@-ie extent of the necativo tv-De co@--,@nL---.
                            L,,Iat would neee deali.nc,                 by the               and from the
                            applications, I ,votild -feel Seasonal comfortable, all@-houch
                            I @-iould ,-7arn the Sta-Ff to comment on these if 4--liev @70uld
                            wis.-i to deal -,,i4-th them.
                                           This application contains 27 orojects.  11 of these
                            are for continuation, and 16 are new,-- makina uD in dollars
                            an eleven continuation of about $1.5 riillion; and the sinteen
                            new ones,  at $640,000 -- the staff buduct being some c7uarter
                            of a million dollars -- the total recuest $2.4 million.

                                                                                       244
                                  -liey intend to aniolv'for aaipplement of some
      59               $220,000.00 in iulv.
                                  I rated   this  "Above   Avo-racre."
                                       CI"AIPJ-@--',l Thank you,  Charlie, and Joe.
                                  DR. IIESS:      I generally    concur with that.      It is
                       evidence to ri@ that the people @.7ho     t)ut this iTDplication toac-@thc!@-
                       thin]-,  clearl@7,  concisely,  and  are  v7ell  organized,  and   are
                       using apiDronria-IL-.c Procedures.    They have   atterinted to reach
                       out   and nrovi(,c c-ood service to   all four   states, and      they havc,,@
                       offices  in each of the four states, and        seem to have      aood
                       @7otkinc relationships  %,7ith  the   state   Governments,   and   the
                       CHP   and so on.
                                   Just  to comment on that one oroject that @Te  ave
                       ne",atiVe  comments  on  --  aivon   a   little TDri.ority in the list;-nc,
                       so I think that -ia,-l be a   result   of   the Cl-!P 7(-,vie@,,,.
                                                 CT@p
                                   I t'i-link'the-    comments on    that Particular one Zero
                       relevant but t.,Iat ,vas ta'i',en account of.
                                   The onl@r real- (-Iue-sti-on I  had about t'li,2 bu@cet @.;as,
                       the rather larce amount      of  mone,l   goina into Elt4s  from ?--,IP.
                       I leave no doul:)t t.iat in  that area of vast distances -ind so        on
                       that an @-!IS system is an important element to aet orc-anj-zed
                       and goina.
                                   But there has been a substantial increas in
                       money goincT into that and I su-,)nose that it @,iould be ap
                                                                                          proor4 a--@
                       to sort of flaa that as an issue and ask them to take a close

                                                                                  245
  wt                 lool@ at that when thev ce'k-- their arcint a@-,,ard.
                                                     it ,.;oul-d be anprooriate to have
                                DR. @cCALL:
                     a staff comment on that.
                                D'P,. IIESS:  Yes, I was goincT to sav, that i@.7as sometninr
                     I meant to point out -- and because of the distance, of course,
                     it miaht v7ell be justified, but vou can't tell.
                                r',.IHT:,' Cl-LAII@'L@l:  Yes.
                                Some of- the -- N@,,Iiile a good nart of this is continue,
                     ation, some of that continuation is really oxnansion, and it's'.
                     larcfelv in the Y,@.i-S area.
                                Dic@, T don't   1-nO7.'7 @,71-iother vou 1.@@ould i-7an- to co:7,j,,ien+-
                                                                              k-
                     on this, or                  arc, any police,, issues.
                                                @t tills 7DOi.nt til@ere are no notice,,
                           do.@s not annear to 17)c .in-,,, T-ol.ic,,7
                     flagged this to raake douL)I.v sure,.
                                I.,i terms of the 7"',-S nrocTrFt,-@a  in t'@@ic @lountai.n States
                     area, all of those nroara-.is starl--@C, cut 1-iit.i assistance f-ro.@.
                     ,,Iauntain States in terms of vor@;, small. contract-,.
                                Like, 7!@-vada, for instance, started out    @@7it",l
                     and as a result --,jou can see.
                                @lontana, is the same   @@7aV.
                                Idalio.
                                So this is one of their big, major Program          we
                     do have some concerns about that larger
                                DR. 1IT7SS:  This is one of the things that impressed

                                                                            246
                   me about their management techniques; and that is that thev
  Tt 61
                   used the contract mechanism as a device for getting thin(7F-,
                   done that they have  identified and perceived as a means and
                   thc,,7 ',.iavc, i7"jnc-,Oiiately tal,--cn the initiative -- as opposed to
                   ,..7aitino for it to come in.
                            And I -tlaink tlliis reflects very sound, sor,,'-ii-,ticatc-(2
                   inanac,o@i,,,.l.ent on the part of 71?1'P.
                                 @@c(7ALI,: Just one other tA-ii.nq, one Point ti-la-i@-
                   I thinir,    L--i-ie Stz.,.ff might 1,7(.int to on, too.
                               L
                   It is no@ecq- that thev clearly clio@.7 the allocation o-T- -7,oll-rs
                                       ObV40
                   anr,@ rrograrLs -- and L U     there is a strong stiL--F, and
                   t'liev have generated and involved in a lot of    znr-!. sc-cr.-,
                   to be involved  with An-,. T!I.entionc(l in tl.,iesc,, oro3ecL,-s
                   the grantee  auencv.
                             In -.anv of the activities, I   -)rctt,'/,   t"lat
                   ,-,o-.L-.bodv kne-,.7 the rcaion I)ctter than I did, m,7sel-@ -- and
                   that      was accentible @.7ithin the re-Tion  it @,7asn't too
                   much generation.
                                           Is "-his IT'.'!S exr)onditur-c, -For i-)r@-.nara",@,-,
                   for a system. for the purchase of hard@,.7aro>
                             @iR. RUSSI@LL:  It's preparation of -- rat,@ier than
                   the T.)urcl-lasc.
                             THE C I I,@ IL%,-. ISandy  Flythe,  and D4C]Z RUSSCIJ
                   were both out in the !Iountain States, I quess this -.7aF,
                   -larch, or carlisli, on a review verification of th(,, management.
                   l@

                                                                                     247
         6 2          I goes it @@7a.9 combinccl:     neview Verification of @"ana.cTer,,cnt
                      7%ssessr,-Lent --- p                                 @-iould  a\r(-, some
                                        o T3erliap@3 Sandy an(!/or Dicl:
                      comments as it relates snocifically to CHP           and also the
                      abilit,7 to manaae projects under the accis          of -oroQrar-@ staff
                         which I  train}:. I  heard Charlie raise a ctucstion a,'@out.
                                   Sandv.
                                   is. ILYTHE:    Basicall@,, the CITLP rclationshin within
                      the region are qood.
                                   T'l-lore is one nroblem, 7-)crliaT)s, but they are i@.7orli-inci i
                                                     at  worked  out  --  but  general-1,7,   the
                      on t,iat, trying to get th
                           t 4
                      rela -Lors'-:iins are cTood.
                                   C'IP is     in fact,    'IP "las generated. some  iDrojc-,ct@,
                      ,.7itil.j-n t-,ic- rcc-3-on rel,-tion---I-iip@-, are basically @ood.
                                   T.,@q i C Iis                                   I
                                               just really, the graitcc-@         tl' cv ',-ve  no
                      responsibility     T
                                         jhatsoever as 7ar a.s the projccts arc          co@icern
                                   Staff and T3roqrapi staffs,      1.)asicall,7
                                                                                   arp- r--Snc,@n
                      sible for monitoring      that sort of t,,iincr      which is just
                      grantee.
                                   11". PUf'DSELL:   I would       you know, we spent reall-,;,
                     la whole week anu covered, I think at least t@,,,o counties evorNr
                      day, and this is @,,,i-iat it takes.
                                   Before i-7e went out, we had some concern, really
                      because @-,,e didn't understand that program  that well -- as to
                      how one -,anacted the program in four state!--, from that P.,ecTional
                      Officc-,, -- and            v(--i-%7 Y@-iuch ir,,,@rcsseci @,7ith the cormuni-cat,.cll:l@

                       among the staff and the whole setulo.           We kept loolzing, and
  wt 63                lool-,incr, and looking for somethin(7,    \%7rona  and  we  really   couldii'j,
                       find it.
                                    And I talked with Pod @ll-,erck-er, @,,7ho had  the  @@lanicTcmcnc.
                       Assessment -- and his impressions we-re nretty much the same
                       as ours.
                                    DP,. FIF.SS:       I ended un, based on what I read in            i
                       here, givina them "(-,ood" and "@.'.xcel.lent" ratincts-in near]--,,
                       everv cateaory        and I think  it  @@7as  one  of  the  best  orcranizc-,C.@
                       and managed IT.lPs.
                                    M@,. BAR7'0@,,',S l,"4'hat's the nur-l-)cr?
                                    'TiE              @,'Icll, the numl)cr is our       in t'
                       case of the Ilountain S,"-ates         t'Licv are asi@i-icr for @2.2  i@-Lillion
                           no, I m sorry -- 6'2.4 million.                                            i
                                    Thev did indicate, as         thin!  one of the r
                                                                                        evic@iers
                       said, that they will be in for a         vc@rv (')v comparison modest--
                       sunT)le-mcntal additional amount of @200,000.
                                    DP.'  !!cCALL:   I recommend $2.1 million.
                                    D',2,. IIESS I had written do@qn $2.2        rLauc-ihter-I
                       So @,7e are prettv close.
                                    T)R. TESCI@-N:     $2.lr--.   (Lauchtcr.]
                                    TIIE CIIAITZPIAN:  @le have a  motion of    recommended func-ti.@,--
                       level of     $2.15 million.      Is there   a second?
                                              [Th(-, motion @l,ar, pro-)erly seconded.]

                                                                            249
                             DR. TTIIU-T,@@l: ilav we discuss this?
     6 4                     THE CH.NIRTtTd4: Certainlv.
                             !)R. TILIURI@@T: I have no disagrecricnt with everyti-li-.n@,7
                    that both of them ilave said about the manacr(--ment.
                             But on some of these projects and  the    funds for
                    them are absolutely unreal.
                             "To@                                        -icet here   I
                                4 if vou i@yill turn back to the Staff SI
                    in our little grey bool@-.  and we have already heard the
                    concern expressed about         and I share that concern
                    $181,000.00 for @,Tevada  @,,7hic-h is for @iorkina on the E@IS
                    Program on which thev have been ,,ior3,,ing for ten years.
                    Now E?-.IS in P'llontana and Idaho both, make un to $350,000.00
                    not to mention Nevada's share.
                              But look at some of  these other projects.     Area-
                    wide, thev would simply scare  you  to the tune of $270,000
                    and as I listened to this motion, @,,,c are talking abojl,-- a
                       L-.Ie o
                    lit4    ver  8,000  nersons at the r,,osl-
                              ITo@,i vou figure that 8,000 births -- and vou are
                    going to have rouahlv 120 children that may need intens3-v@-
                    care a year -- and you divide that by the two hundred some
                    thousand dollars and it's an astronomical figure4
                              Well, Nie move on doi-7n to the breast cancer    @:hich
                    regionally continues to be funded at $30,676.00 and thatlt
                    an old nroject, again.

                                                                              250
     65                       And the TleQional medical audit system develor--ient
                   project,   $177,000.00.
                              Let's see, there is one other herc-  that rocked my
                   ,)oat, but I've forgotten @.7'@-iich one it @,7as
                              But 1 just, I really have no disagreciient i,,ith the
                   management anc@ I knov7 the difficulties of communications and
                   orqai-ilze.tion -- but the fun(,'tiiici of these TDro3-cct.-j, I thin)?,-
                   I am qoiicT to move to a mountain state nb,,@7 and  [Lauqhter-I
                              T,T'IE         Thev need a medical school.
                              DP..          Thev really need one.
                                              Sounds like the staff and the ib%G    i
                   are a,,,7full,,7
                              T,T:ll"        Joe, I thinl,, @7ou intent to !7,,:a,,r something.
                              T
                                P. FESS:  ITell, I @,7as
                                                      _7oin,.i to sa,,. that one
                   judg7,p-nt here a"@)out nun@-)ers of T)eoole has to be modified bv
                   the  distances and the distribution of  i-)oTDulation in thoce irc-,--c-z
                   and it's m@7 judament or estimate, that  @-7ith the T-)o-oulati_uii
                   spread  out  the wav they are, it's going to be more costly
                   per person,  to act some of this more sophisticated  services
                   organized and available than it @,7ould he in a denselv ovulate
                   region.
                              So I would make some allowance in my mind for the
                   geographical distribution of the   population, vou know.
                   so that doesn't unsct     -L--oo much.

                                                                               251
                               SISr,,,E         have a comment to made on the Use        i
   t 6 6                          L 11 ALI-i.l:I                                         I
                    of medical services -- because the regions intending to
                    being in Salt La]-,e rial@it near the University of Utah, @,7here    i
                    the,
                         I-lave funds for the Recional @,@,cdical Program for lust
                    the same kind of service and are cryiiaq for, you I-,noii, people
                    to use the service.
                               P,ncl for an ,-ir- tran@i-)ort bein(T available in terms
                    of this service,-and   -.,,ith the birth rate aoi-ncy down
                    think that is a ver@7  -- if @.7c, jest     ho-@,7 this program
                    ovf,-rla-.)-)ecl 1-7i-th the other nrorra!ns.
                               But this one nroaraia, I 'r,,nO@-7 IS CToin(T to @l-)e com,,-)cti-
                    tive and neither of the--i are c.,ciha  to be a!Dle to use their funds
                    effectively.
                               DR. TIIUR'I-7%.!.I: coul(a alrios-t buv each i-Dao,,- a plane
                    for this r@one'7, and let's fl,7 them in.   [Lauchter
                               ,.,P.          @-hat's a 1--ouj. thincT   @ut you're
                    oneninq a @,71iole ne@,7 thing there @.ihen you 3tart tall@incT about
                    numbers of neople and t'@ic- other T)r(,,-,leris.
                               But in connection @,iith  t,iese costs, is it  true, or
                    is it not true, that these peonle     have further to cio in these
                    things     and-thek7 don't have the   TDresent resources  thai-
                    many other rcaions   do?
                               DR.  IIFSS  1,7ell,         no "(,,dical school in the irt@n
                    nor in the re   ion     and they are trvincT to relate -- Vou kno@.,I--

                                                                                       2 @@2
  wt 67               they are trying to relate you               they are trying to build
                      up their secondary terciary resources in the region.
                                   But for raedical schools, thev tried to relate to
                      Utah, to Oregon, Seattle and to T)enve-r.          Those are the four,
                      I guess.
                                   DR. THUP2,L@-,I:  They none have a medical school for
                      associates
                                   ,)P. IIT.ISS:  TI@ierets one developing there, -,)Ic--s
                      and that's the first one in the region, and it's            just gerund
                      qoincT.
                                                                                   m-mchts
                                                     @-7ell, @,7o'vo- heard sorAe co
                      rec-,ardina  'oudcet  4un&s,   and   narticulariv   as it   relates   to  n,@-o-i
                      natal nrojects.       Dici@?
                                   -4R. -PUSS"LL:   I ,,ould.  like  to  resoonO.  to  Sister
                      concerns about the Salt       'Liake    inter-mountain nroqramt.
                                   !7e have, we  in  ')Ir!P,  have  sort  of n u the  sc@-,@77S to i
                      t'ne  inter-rec-,ional  e,,ecutive  council   --   the three coc,--IlinaL-cr-,
                      you kno,17, that Council was formed to avoid ti-le tvr)c of
                      you are tall-,inq a!Dout, during the nhasebut, for some
                      reasons, it just 6iOn't aet off the            ground.
                                   It's bacl-, in action, no@v.           have   a   comnlete
                      listina that came in just a counle of days ago, of every
                                                                                          T  7c,
                      community listed, and which RMP         is programmed    there.
                     i are very concerned about the effectiveness of           that ccmr,,,3ttce   I

                                                                                                      253
                         and i-7e think v7e are cToj-ncr to see some improvement in t-(--re,
       6 8               in their action.
                                       DTIDI.             Yes, ind vou I-Ino@,7
                                       T'IR. RUSSELI,:    In terms of transportation there, @@7e
                         have found on t,io trips,  that to clet to T7.elena, "Tontan,-i,
                         one must ao to Portland, Oregon and spend the night.   '@"hat's
                         @.'Doul- the onl-,7 @@7a@7 -%,,ou can get   @L.here.
                                            IT 7,
                                               S-     Ac @- ii a 1 1 @7 , ,.7hit k@-liev are trvinci to do is
                         -.Ti'-'@ this @ll',000.00 is C.@@-v-elo-cD   local     resources and train
                       I  Peor)le  on trip. local level to I)<-@ able to T)rovide the hiqqer                   I
                         lov,--3. 04
                                       DR.                @ut   t','Iat's a criticism     of  manactei!l@-nt.
                         ljl-- should,   -@116 tlic-,rc ancq. @207 on our sheet -- and        117
                         else that difference is                     that piece of iDancr and
                                       riT
                                                                           Irincr it t.,.,ie @-e3-lo,.7
                                                            You  are   I.oo,
                                               L'CTT71-'l
                                       DR. TE,.,            Could this     be a   typocranhi-cal error?
                                       DT@Z. T"-IU@'LM:                it  %@7ould be less tiian a hun,@',r@',
                         babies        at the rost       it @@7oul-d !)c 1','O Keith 8,000 e-l-nected
                         births    in    this     bonulati-on    and that .@.,ould, of course, not             i
                         be every ba',D,,,.
                                        II,', CITI%Ill'.@"L7'@T:  .navbe @!ie have -- I don't kno@@7
                         Diclc and I @,7ere huddling here              mi@7be, @@ic have an ariti@.,:naticzil-
                         error -- 'out the                sheet ..7!iich   you have in Nrour boo,',: ancl.
                         ,,7hich I alather T)r. @hurrLian @l!as lookincf it, is a          staff ou--out.

                                                                           254
   t 6 9                     DR. THTJ'P,@l-@q:  And Imlooking at this too it does
                   sho@.@i 116.
                             THE CHAIPZ@@N:  Yes.
                             DR. TIIU@4PII:  But even at 116, this project is
                   glittering in gold because       have intensive care over all
                   the country    and
                             DR. "'cCALL:  Pind they can cret intensive care every
                   place else, too.
                             DP,. T7111TR'-lT,@l:  But il you lool,: at a lot of this is
                     -if -,.lou looli@ at the staff s'.ice@, and cTet hung u-P on that, voti
                   are tal'ling about $1.5 million for continuation of  eleven
                   projects and some of those -- the last time this came un  for
                   revie@@7 @,7ere
                             DR. lIcCALL:  @,600,000 for the eleven
                             THE CHYIIR:l@l: You're tali'-,ing, about the continual.-io,-
                             DP,. TIIUTI@?,' L@Tl in the continuation they are askincT fo-
                   'el.5 million for that.
                             THE CHAIR-PLZV4: If there are no more comments  or
                   questions,   the notion on the floor is to aonrove $@/-.15 millions
                   for  Mountain States.
                             All those in favor.
                                                  .7as regularly, put to vote and
                                        0 r@'Lotioni
                                     (Th
                                     carrie(l, %,;itl.-i 6 in favor and  3  opposed.]

                                                                                      2 5
      70                        TIIT-' CIT-AI IT'," i@',l i thii-ii: it v7oul.d be good,  if
                      the  concensus  of  tiie  groun,  thoiiah,  in  reporting  your
                      recommendation to Council         and  assuming  tliev agree  in the
                      feedback to the !,Iountain States    @-,IP -- that to  indicate that
                      there @@7as some concern @%7ith the    dollars invested in some of
                       ilo-se ,Dro@ectq and singling out neonatal, among others, as a
                      aooci example of ti.'Iat.
                                  DR. TI-1,SCTI71,j'.,I: I @L-hinl@ we ought to have a decision
                      n o@@.@i a s to @7!iat the actual ni-inber is.
                                  Tf  there  are  three  or   four -- v7e have several differ2--
                      read4j-iics and there oucht to  b(--  a  @7ay to tell the
                                  DR.  TTEOI[-,, I tiiin), @@o;. have to acc--T)t theira@,nlicati,,-.-i
                      as the
                                  DR. TESCII,@,-T: Tii,cre ire t,,,7o T)laces in the a-o-ilicatioi.
                      One is the 16 that vou are lool,,,ii-icT at and I ,.,7ant to j@no@,,7
                                  TIIE CIIP.IiVIA,.I:  1,7cll no@,7 I can see --
                                  16 shoN,7s $234,000.00 and that includes indirect
                      costs.
                                  DR. THUILNW.,I:  They mtiltiT)lv one vear bv ti,7(-).
                                  ,'L "R. RUSSELL: T,@7here are you  getting  the  116 from?
                      l,rnat pacTe is that on?
                                  DR. IIESS:   Paqe 105
                                  DR. THU@.IPil:  Tmd  page   199.
                                  ,:TOT,7 I don't mean to get hung up on the intensive carol

                                                                          256
                                                                         104- of
     71             There are an artful lot of high nriced and an awful
                    continuing projects, and I thought I would just go along @%,ith
                    the advice  --
                              DR. FESS: I%Tell again, th@-s is an area-wiclo  thing
                    that covers four states -- and that's roughly, $ 25,000.00
                    Der state for developing this care -- and  I  don't  think  tha
                                                                                  t
                    is excessive at all.
                                                    there is  some  incongruity,  I
                    thing, bet@,7cen the ar)nlication they have prepared and the
                    fi-aures on the Form 15 and 16 -- @,7hici-i obviously don't agree.
                              'L'he figure that @,,,c have translated to the nrint-
                    out here is the !Porri 16 fi.cTure.
                              DR. TT
                                   ,.IUP@
                                      ,LW,I: Yes
                                         L:  I'll see if I can find it on the
                                  RUSSEL
                    other sheet .7hen  . . . (Lauqhter.]
                              THE             Ilell are thev askincT for t@@@o @,-ears?
                              DR. THUPJW.,T:  !,To
                              -7lPx. RUSSELL: If I could call your attention to
                    page 21, Consolidated Budget Request -- 21 of the At)plication.@
                    Because I think this shows how I-lountain States Programs
                    it's right in the middle of the page.
                              The 116 - 231 is budgeted as a discreet nroject
                    activi-tv -- and add to that $91,738.00 which is  the  rest  of
                    tl-e Peaional Program -- the cost of that.

                                                                                                   257
  @it 72                              That brings the cost u,,) -to 207.
                                      DR. TICCALL:   That is what I Questioned.
                                      That  was the additional budget allocation, on the
                          staff -- looked like about 45 percent of program activities
                                      THE                     Well.,   I   think   that   one   of   the   things
                          we have seen, or at least I have seen,  and I susnect this is
                          ti          n Ilountain "tal-es:   Some of the more sophisticated
                          .ie case i  J.
                          rerTions  (if that's the adjective to use)  in California
                          certainl-,7 in tlii@, cl-aF@-@ at this juncture,  from the manauer.@ent
                          stan,-',,-)oint -- California i.@, ;,)udqcting a aood deal of
                          nroc,rr.i,i       a!-, sort of c). -)rojec-L, i-tc!rq and each of the
                                                     at          froii m@,, -First hand observation
                             r e ,                          a rcasonEt'!-)le form of nroc@-ran.  buclc-f-cti.-ir'
                                   k--iaat seeriECt to b-
                          so that a  Chuck                @@@-ho              F,-)enOs,  if  not  4ull.  tir.,-?,
                          a r-alor -)ortion of ",is ti-c on health services educational
                                                                   4-
                          activities and            and one or @.70 oti@ler neon3.e -.7ilo ar(?
                          tire T-7a'7      arc 3ct u@),  the people T-7iio 1-I'loni-.,@-or a   nar-,ic,,ilar
                          nro@ra,-n element the-,7 are sort of the cost of that                -.,oroaran@
                          element -- as a separate nroject -- and there --a@7                  be 90rie of
                          that here, also.
                                                           There ma,,7 be some of that.  I don't
                          think it is thOU(T;I.
                                        -h
                                          is i@, ti-ie case:  say, for examnle, that t!iev are
                          going out into a Programmed area and they will call a T)roject
                          like "a:cea i,,idE-- neonatal voii I:no%,7 -- that is a r)rbcfran.  thrust

                                                                                              258
                        that's a project -- thev roay have two or three funded activities
    t 7 3                    a contract, or an agreement etc --  affiliations
                                    So to save title, they have budget set aside like
                        you know,             if thev need to support a Governor            s Confercn@c-@
                        on neonatal or @,.7hatever,     then that monev is considered a
                        "reaional" budqet rather        than tacking it onto an individual
                        project.
                                     DR. THU-Pl.Uli:   But I think I hear @.,hat vou art,- sr-i,,,7 "L n (7f 1
                        but that sa,,7s that they have act $54,000.00 -" if vou                go all
                        the .,,a@, 'reach-., to ao to consultants to nut on the regional
                        oroaram.      nut    vou cet hung uo on one      nrourar,,, or one
                        and    that    shoulon't "De.
                                     it's    the                        am S,,Dcakinq acainst,
                        to do overfuno@.ina of loro4ec-@s -@or i,7hich there is         n o vi I
                        and the over-fanding of continuation t)ro-icc s.
                                     @l..5 -Pj-llion of the l,,2.1 or the @2.4 that tieN;, i-iav,--
                        requesteo for continuation nrolects -- some o-F @@ihich are                six
                        and seven -,7ears aao -- anO that         is not cTobd management.
                                     T
                                      )id vou  move that the      staff and        that   th,--v should
                        pa\7 Particular attention to this?
                                     llr.. RUSSELL:      Yes,  @-le N,,iill clcirif-,, this bo.--Fore it
                        aoes to Council.
                                     !)P. IT',@,TSTIS:  I @-.7ill sunnort th-L S .
                                                               cl,.iri-f@7 this.    O.K.?
                                     TI@IE                0. 1,.  7@nd this is a    prize    item for

                                                       it did vote a
                   Council, that the
  @-7t 74          of 2.15 -- it had Some cicTnif3-cant concern in this regard and
                                                        -ie Council ,,7ith some
                   lior,eful.1,7 reacheO. out and -)rovicles ti
                   ad-itiona'!. clarification so tli@,it they might talz(-- a critical
                     ci
                   looj,-, at    recTion, nerh,--).r)s (lifferentlv than they for
                   most, 1-@--caiise -L-heN7 are accc-,pt3-i-ic,- ,,our rc,@corn-,,ncnOation.
                             DR.             The  amount   of   money   for   each   of   thesel
                   activities     it @,,,oulci be hel--j--r-tal to tiic-, determination as to
                                     accurci@o or not.
                     ether
                                  @USS--ILL: Yes, T-jell I  think  I  @-lould  have  to  r)oil-i-
                   out  '@.lere  thatn    I-oo@ed at     of tlicse activities,  it
                   lia@> CIS e- continuation and t,iis i-,r--,ans tTiat thev are    I
                   contin.tiina in that nro7rari area.
                             T                   ut  "I             t@7     la+-
                                  ',,cC.@LL: ycc@, 1,    sai-c actinii         3
                              T)
                                  P.USS!'ILL: '-.Tc), no, does not !-,ean the sa7,e
                   activ@-t@7.
                                            7@-re ,Te on ti-iat 'oreF.,'I: vet?
                               TliT"         Yes.    [Lauqliter.]
                              I,et's nlease he bacl- i)-,7 a (-uarter of eleveni
                                       c to                        o more re,7@-ons
                   @,ould certainl-          Dolis@i off at 1 c a s t t,.@i-
                   before   lunch.
                                             [The assei@Dl@, recessed for cbr-fee
                                            at-10:31  a.r@i.]

                                                   [Proceedings Caere  resumed at   10:501
  wt 75                          TIJE; CIIAIPIITIIT: I tt-ic)ii@4lit @.7c N,,,ould jumn to tire "@.ri-
                      State, at  this juncture -- that will talze care of the last
                      of the regions @.,here Dr. @IcCall is a reviewer, and that ,,7ill
                      let hi-,i, without anv problems, cTet a%.ia@7 bi midafternoon for
                      per his earlier understanding.
                                 So @-7e have 1-7ister Tnn and Charlie on this one.
                                 I don't 1,@,noT@7       @rou t@,:o have -- I s             lj,
                                                                                a@,,, @,,ou hud@.
                      at coffee --- I don't I-,no%,7 @,7'@-iether vou had aarced as to i,7ho @..,,as
                      cToinc@ to lead off, or
                                                 T @@l
                                 TTITI             Chirlic     Massachusetts,
                      Island, and       Hamos'L@i-i-r,@.
                                 DT'. '!c",T:,LL: 71,icht. T:iis is three states 4r(-;-,L
                      7-1/2 @,illi-on iDconlc -- and 'D.C) of  that  7.5  million  "Joint
                                                                   ,irc! ana 11151),
                      in '!assac'@iusc--,tt,7,-, 7,1,',,')Of) in
                        o d  T
                              s !an(]-.
                                 i,xnd at the outset, I tl-,inll--l I @,,,ould also noint out
                      in this T)articular a-,),n]-ication, as far as additional no@@.r
                                         -T
                      activities,       "lamT)shire is not in this aT)r)licati-on,  buL'-
                      t,
                       iiey @7ere a little qlo%,,cr in getting tiieir revi(--@.7 and t7,iincTs
                      in -- and olan to come in the -u-,)nlernent --  .7'liich  ,7ill  Le
                                                                       tate" is reallv,
                      in the Julv I annlicati-on.       F)o the "tri s
                      as far as this is    concerned, a "bistate"' of ,,Iapsachusetts and
                      ,7.hoae Island for  this particular aT)nlication.

                                                                                                                              261-
          7 6
                                                                                 o               a      1-1 t 1 c I-) i t 11 1  -f u
                                  initially  to  loolr  a  'Little  !--it                 at  tho,              Iiistor,,7  of        t,i s
                                  rccrion,  because  in  ri-,                               in  ad(liti.oi-i  to  a        col-i-r)lc   o:i@
                                  oolic,/  @.,ucstions,  it's  not  (-)tr                      tied  r,,,Ftjor  cTu(--,,;t-i-on   is       not
                                                                                                                s  much  as         t',@C
                                  ,ioi-nci  to   le   (Ti),alit@,-   of   staff    ii-icl    r)r(,)oraT,,i,    ci
                                  func@inq  level               anCt  it'--  i-n               rc,@3.on @@7hi.ch @.7e'vc-,            had a
                                  ra-,@_licr  c-,,T-)onentiall-,7       risinrT                of    fi:,n(.-).i.ng    from     one     1.2
                                  .@ill-ion  to  1.,?,  to          2                              train  irtr@,7DincT  to              mi3.1i.C)-',
                                  in  lc"73,  )ri-or  tot le                                T,-,,ith  a  current         six      r@@.ont@is
                                                                             I  aiicsi;  tha@'s  a  si--
                                  current  level  of  1.@                                                          months             level c,
                                                    I;o    that    at    th,-2            -",(-,n             t  t 7-i
                                                                                 O@
                                  o n    u        z i n    t 1 i -2  c@ o n',- r,7@, c@i i  n         ra2-@-'[).er                t    t' zn@
                                  at           curr@n4-  @L
                                  b @'L-- t e rncrs-)cc-.1 @7e.
                                                    l@L.  ric-ans  t'.iat             have  hid  c-c)ocl,,  e:@nerienc@d
                                                      at  ti@  s-L-a                   c    s  a  f ,  E,, @-,  I  me n t i on
                                                                                   L                                                 .7ac-   a
                                  --a@-h----@r  ':)4L(-T  r--,taf---  in  173 !)u@.  -',-t  'ias   ',,)ccoTi-c   a   ra@@l-@cr   s;,-,-all
                                  staff    at    this    point    in    ti--c-,     @:ith     si,-:     full     time     r)rof--f,-si-on,@-,-
                                  aiic'  five  T-.ar'L  -@ i:,n
                                                    -And   t',aere   lies   also   a    -)oi.i-it    t"    at    ,77c    mav    Giant    to
                                  focus     on     a     little     bit     in            of               -it  aas  come  u-o
                                           u i-,., --1,7    ..-,Iiat                     n,-irc:  tii:ie-    r o f  L@  i  n     s      and

                           1                                                                                              @62
                                                 of  sa-ric@
     t 77
                                               The  nec
                                                    o..                            r,-@ c c, iir
                                                                           vj,,,          _so !:,,v  I-'-,-ie  @Dtaff.
                                     l-,an,-,cei--@nt  as,@c-,9F3 T
                                               Tlaci-r TDroc@rarq anO..       aoalr3     of  o@Djectives  are  l@i.nd of
                                 interesting.         Ihc@i  are  verv        cancer,  in 1-)oj.ntin(7  ou'L-,  as  'C  sa"7
                                                resr.)ond                    to nation  1 70rioy-i.tieF,                   @-ocv,.,@
                                 ,-in,,      to match       tliesc  to     collic
                                 t',                        iria-k7 @DO E',. little       @,lorc
                                             c-trateT,,              is  not                c@i       lnal.,7si-:,  o--F  Ca,@a
                                 fro,-.i the  rcuio-,,      ncr  se.
                                                But  it     scc-,T-"s  to I,,--                 cct,,.r@t@r't:)alancc  c)-r
                                 is  th@,t  as  @,ou              a-@L.                               @,ro-  ver@,r   c,
                                                         is  the                        t                    ti C,.7   C,       Li
                                 sa,7    tl)at                                                                 I
                                 as          r(.--sT-)on(7.  to national                               t'-c  dollar
                                 do d,,3al            it     n  a  r   a s,,D n,,i",,'Le,  r.@
                                 -.he,@ use  this
                                                                                              .-ien Area-,.  lo-':  -Ij-
                                                 There  are  a
                                                           C-0t,  4  n  t,ic           icatio,   F-,,   t,'-.ere    are- a@  le@i@)-
                                 one  or  t-:,'O TDOli---'7    i S     S      0        r z,,
                                                 "holi  are  rec-ucst-Lnc           in     tli@           ")udaet,  so,-ae
                                                                                 -T
                                                                                                                                     0
                                 $2 10 , 0 0 0   to bont_T-act        @o,,-  t'@,@                 n@,anac,,eTro-nt  anc7, -r@.-@onit
                                 in      1976.               no,.,7,  t,i@,@t
                                                        CTT7" I                                        @,taff  a,,ic. --cc  (-,7i
                                 that.

                                                                                                       2'0- 3
                                                                                            ncc,@df7, to
       7L')                                  an@i. ti-iit had-> to     (fp-al,t. with.    Nc),,..T ,,7h,-,t is
                                      C,,-   -:ICti Vj 4-V    '7(      and 1).avi.ncr the (Trzintc-,,c.-c
                                         or
                                                         in
                        1 dissolve     a contract @,7ith                      to r,,,onitor  the   contii-iliiri@l
                          activi-        @,o as
                                       .,,@-n(i the T),cvic@@': (-'nnTrittee needs to I-lee-o in r-.iiid -that
                          re,7,iie.qt is for $210,000.00 -- and it could cTo one. i@7a-,7 or
                          anotiior dc,@,@ndin(- on 1.7",'Iat t'@-@e T)olic@, decision is.
                                       T-ind the  other is, not onl@,        @,zit@-ii-n    monitoring
                                     'L-,",-Iat ro-queE@t of a little over @200,000        -- it' s
                                       for  a   fourth   @,ear   of   fundin,,T of an  f-@VIEX]
                          a --.hode  Island !T--cilt@i SCi(2T-,(-_C !',JU(7-citiorial Council,  ma,ibe
                          state wide in Phode Islan,@,..            And @.,Ir. La@,7on,  -.Former Denutv
                          Coo.-di.nali--or, has returned to Rhode Is]-and as the Direc't--or of
                        1; -,:nar-
                                  C@r4- 4.  C, Iar nroc-r@.-.@ 7@tE-@te-,,                      a n
                                                                                in scc)no.
                              o --"c-         Coord4-nal-l-or  L@cr tn@ @-riS@-a@u-e at a l@, )@@rcrz2n""
                           art           as onc of the na                           there.      So      -h-Lni-,
                          that nc--@s to he focused         unon.       it sceis to ir,,e  that this
                          thin(-, -,7a7, founded            is t,-ic-, second Vear of its funeL-Inc-@
                          it   Tias   funded   ini-tiall-7    at    S600,000.00 'i)ut oot off to a sloT@7
                          start,  and 1 -@hin)- this is        a s i rT,,'i if 4-cant a-,T
                                                                                     -iount of mone-,7
                          %,,'@lich is left in that, t'i,-lt thc@7      are. ii,,iincr at the monciit.
                                             the comments in -,io-tir ,;ta-Ff          you micT'at
                                                V4 F-
                          indicate in one        -L.              t,        ,7a!-,     c.ijc-stion o@ @t@,
                                                                                                                 i
                                                                                                                 i
                          of-fec-ti.v!.2ness of tiie %,,7a@7 tiis @@7a.9 c  I          nd -,7et sitic,2  that
                                                          -               joi..ncT --  a
                                                                                           -                     i
                                                                                                                 I
                        I                                                                                        i
                        i                                                                                        i
                        i                                                                                        i
                        I                                                                                        i

                                                                                                                                                                     2o@ 4
             7)                            4-ho                              c:t@         this                           one                      rial@c  a.  con!-,"
                                           ,ooint  t'!i,@re.
                                                                  F.) o  tho7,c,         t@,7o                  of-         til@          r-ontractiiic          for
                                                                       Ltnd
                                                                  That       fourth  @7ear  of  that  f7,tZ@,tC                        -1'7i(lo TDroject oil
                                           that lev@,l of  '11000,000                                      thin',               %.7c)ul(-'L              t o  a
                                           ti
                                                                  It  sc-e-,-rl.7,  clear  t,.-iat                            T   1-@,,nd              'i-la@d    sc,,
                                                                                                                                                                            Vit
                                           i-n                                                                                                   i-id  :the        F%,    4
                                                    --,I                                                                       -o@cther          so          @,ye.11
                                             i   h  4          a 4.-     4L-. a      Ion'4-.                      '.role      4L@                                           a
                                           TD r     r                    i                 t h    t
                                                                  u@
                                                                r F. 4-
                                                                         far                             one
                                           has                                  a    r@ro---,c-L
                                                                                     T
                                           @Tivcn    -,-e    a     co@-!     o     1-@ a                    'L  c   i   IL- i,    --ccr@'4na,-or,
                                           T.7j-t"l
                                                                       anei         it secr,,r-,C,                   @n@  ';-!ad  to  do  I.,7it'ji  @.'.ac@
                                           recti-onali--ati-on                      of ne,@.7  born  car-2                                          [LaucThtc-r.
                                                                                                                         -,2d       to       car       to        Dr.
                                           attention.                     (Lauc:,T-.it,@l-.
                                                                  DR.     -T!,TJ"T          7:    Cc)o@@L        tlij-ng        I'T-.        not         -)arino@(@.
                                                                  i)@TI.   I lcC,@ LL:            And                  1.3       -@@(-7@ncy        that        voted ('is-
                                                                                                                                 ra-'u-cc'  as  one
                                           ar),nro.7ial of the t-,'.ii-nc,                                                                                     0
                                                                                                                       e                    ai)T)rovcil            o@L

                                            71                                                                                        roject         1,i 3
       t      r)
                                                                        tlii- 13                               ad  i
                                                           1-  4-  I,ia-d  !Dcen  involvcc'               bV          a           particular cot,,rit.-,7
                                                                        ,)eon                                    -Fact                     the      c--, o'n,
                                       )@,,j t  t' a t     ha@
                                              t'.                                  it.            not  to        be  include,   to                  b r@
                                                                                                                                                            in  @,7 j- t.
                                        @u--  in       an-7  event,   it  ha7,                           r(@,-qov(-d       no@,,        Lind
                                                                f---ror.-i  ti.e  bur"@c,,c@t,  @-;-i-i,ch  i.iivc)lvec@  ti-i,-it  i)art-icu',Laa-
                                        cc)@-ant-,  7
                                                                  c',     the     ot'lier     area      o@,c      iie(-ati
                                                                                                                                 resnonse                voi!
                                                       aca  to  do                          a  c,?,rdionulr-,oi,,a-,_-@7
                                                                                                        ),nd                of-:              c-c)r-linetic,- @7-i
                                                          for  rc3u:-,,-,ita  4c.
                                                        and  t,.-)@-s  @,,-@s  n             --.,.,n                                              t   j.       7,
                                                                            in  tili.F.
                                                               ,'n@..  I   L--hin@:  T  f,@el                      /c  nccCi  more  E,:t:a-f-!'  co  ..,.:.-nts
                                                                 @-T  I                  'n,
                                                                   -@,   ---   -n,@-7-   -@                              @-    -L.@@7
                                                                                                                                           t'irf-@e
                                                                                               -nc-     t'ie  ceo(.7ra                    of the  n,,r:,;-
                                          and  no@  -eall,,7             un
                                          0 -F
                                                                            o-    tho  C,,@-c7rce  of            o@    0- - r_ I  0
                                                L.                                                                                           a,-.  n 0
                                                                                     I r   e                v c  c c      i c--, n t       I    Flrl    SC14-iS'  ;@d
                                          the@,              !:)einc-i     cl
                                                                            ealt                 a n@                  havt:,       no       reaF@on       to
                                                                                                                            -1-irec  states             @,70
                                                                                  c, n 7,'i i.,D                       the                                  uld  1--,e
                                          un@3a'L-isj',icL--or@7                but  if         I         not  correct,   T  v,.7oi,]-d   lik4--   for
                                                             to
                                          the  !7)tclff  cor--@-,c+-
                                                                                 t'-iat  ir,,-,Drc,@,@3ion.
                                                                                             T,-icro-          arc C,,q  of  tj
                                                                                                                                   ,c-se  in

                                                                                266       i
                     negative comments b-,7 sho@@,-i-@ia that they had, in this annli-catio".t
  wt 81              erroneously sent in  a letter -- and I belie-,re it @%Tas a   neqat-.,,.%"@
                     one ijhen in actuality, it @,ias part of a project iil-iich @,Tas
                     removed.
                               They are also      I-lurphv has, as a result Of the
                     Revievi @roccss, nut on a CIIP renresentative on the Executive
                     Board.  Ile has funded a $93,.OO@0.0@  A 2NcTenc,7 project in
                        T T
                              -ilre
                               2%nd so b,i and large, i think the A and T3 a cf  n c,,,7
                     renrenenta@@iVef-, arc going alon7 nrn@@,--t,7 ,7ell.
                                            I   T"cr(,- vou th-ouah, Cliarlie?
                               DR. "'!cC2-1-1,L:  Yc7,, @L am,
                               TIIE                         )crians     can c,!e@
                                                                                          i
                                                                                          i
                     @-in's re-,-riew of this roc-           .,..on,               -T
                                              .,ion.   @,n @.1 t,, corl,--z,.inl,,;, col,l-Lnrl
                     ba--"-. to the r)ol-ic,7 issucs aron(.T o--her     I thin',: t'-Ia-.
                                 haic "-o7ne auiaancc, an@ so@,,- idea of -,!head .,e are
                     up to on that one.
                                SISI-1-1", P.,NN: I really don't have anvthinq to add
                     to that at this point.
                                TIIE CI-IAILl.,@,l:  You @,,,cre on the last site visit
                                STST-:]I'@ 71-NIT: ilio, I @,7asn
                                But,I        just likc-,, to kinel, of see ho,,., soi,,e of
                     nroble-..@, I have heard over, in(I over ar            2.een
                                                                jain, have
                     resolved.
                                                 T@-jell, i'll- leave the nrobl@-,r@, resolu'-L 'I

                                                                                                                       (7           r 4-c)l,ov.
                                                                            cc)-                                 on
            32
                                                                            i-n  (-@@'-ct,
                                                                                                                       to  all  of  trip
                                                                            c.    D n        c),@i
                                                                                                                                        to          sea
                                                             1 Or'-
                                                                                                                                c         e
                                        c c),       c                         c n t    r C-1
                                                                                                   @to               fvndr,                o'DlicTattcl   -for
                                                           l@75.
                                                                                                               r
                                                                                                                 (-,jcct  hcrc--,   nii.@,c],17
                                                                              c-,  i!7)  on,@      @,tl(7,i
                                                                                                               r,  t 1, e                             f   our
                                        @-'-i o                                                                                                     o
                                        @)Ol i@C@7,
                                                                                                                   tc)          0
                                          r (D-@             C)    1: i o, I                 c7     c --r  t   c::! r; c-- -io       7c  are        !7-.
                                              t                                                                                     to                    form
                                                  "O@
                                                    or                                 'L-',
                                                                 -@.Do  rccc,---
                                                                                                        11-iii7,  @roun  to,,-,'a,,,                4,-.' a
                                                             @u'@  a                              c,,   a      c) -1- cl  o n  t'-,
                                        untj-'@                           ccin
                                                             T'-
                                                                                                                 to
                                        t'--iore             role                                            FirjoncT  @,c)r@o  r,'L-- E.,, f f     n d  n t,,,
                                                                                            r-oiTi(-T  tc)  sce  ac@L-.ivitc.-,,   at  I.--a@@,t
                                        a 4-.                           at  -l-,@a@,t                                                        r)c)inz

                                                                                     268
      8 3            ,,7e are not ai.lo,,@iin-, any rro(!,r<im staff fundinc7 I)eyond that
                     date -- and, you l-,no@,i, ,,7ho %.ias goiiicT to monitor the T)rojects.
                                Teie had all i-lincls of - c                    S, @qhicli
                                                       ,Tlib ansi,7ers, grantee
                     is at least conceT)tuall,i valid  --  @qhere  there  is  a  grantee
                     that is not a free stanO-i-na corporation
                                In those instances, iie. felt that this hcidn't been
                     the first tii-ie that a i@e@L(---ral Droqram had been nhaseO, out ano,
                     t'ne iic)ni@-orinr-T of activities !:)E-,-N7oiici its authorization z,.n,@
                     fuii-'@iii,-:, did seer, to Feet taken care of -- not necessarily   2
                     but I can rer-.-@i.,LbLr the c"-,ironic CtiscaFc- TDro-7,ram that bc-ca:"7@,-- a
                     seat ol       three or four          a-io -- and there
                                                                             @%7a s s o,@,
                     7eCe--al monitoring of -it.
                                So       in effect, have   in a sense         sur)rose
                     sal,-l "that i7,ru(--- @.7ill ji,
                                                  t
                                                     icive to t,-Ake cFr@ o-c
                     @"C re not goin(, to
                                 L    LcCZ@,LL: One cT,, Ftion tiat occurred to T-@,-
                     that  night   have some             there or crrounJs is the
                     region -- at the    tir.,@ this reuion iiad the hi.-h level of
                     funding of almost $7 million      anJ multiple activities named
                     in the contract -- thny have      indicated  currently   --   there
                     is sore, ra,      @3 mil.i@.r-  in these cont acts still under
                                                                  r
                     @lav.    !7ill these be continuinc'into '76>
                                 Even not considering net activities, %,7ere  t,.-ier,--
                     thincrs contracted for that lona, that there's cToin@, to have

                                                                                                                            2
   yt 84                      to 1.)e      lyic),,)3'-torj-nc., o@, rc(7,arcllc,,f-,s 0-c                 clone   1-tere?
                                                T-1 E C T  T T                                          or (,c.,rrv  can
                                           '-iat qu@-sj-ic)                don't-. IrnoT,7.
                                                               n
                                                                                of  nonc,     I)Nr      excerit T"ITi,')EC
                              t',ie  onl@,r one li@-3.n(Tina  on
                                                      ST,'-)' OV:                        the           -nCiituro;,s  are nc,@
                                                    i,nii  of  TDro-iected mon-L@'ily  (@@:@i-)en
                              reac'i,,lng  a po                                                         @liture         ral-c
                              an,,@  t'                         once     to   c.-irr,7    thcri    over    to    the    ne@;,
                                                    so TI(l       n
                                                                       ",!.i r - '-t   i d             d      th c        r,@v
                                                                         t'@,inir  tl-i,@  ans,..Tcr             is        -@4
                                                                             lol-  o@ r@c)nc2-%7
                                          T) r c)                                                           (.,ever   f   red
                                     t       7  '7   r
                                                                                       @@-0"7 rl@Cil i,,,a7,  tha@l-?
                                              0 O,>
                                                                                  @,z-cnt  @;201)  --  i  little
                              200         so  it            at  59-@,        a        '--le  lc,,,-,s  than  40,I),OOO
                                                     tc)l--'  r    --ic-v %,?antc-,Ct  t'ie            O'@)O . 00  for  a  -F- -,ca-,
                              o,4!':4-c,@r,     a                     a  socrct,@r,7  and  an  evaluator                      the,,
                              nee(aed     soT-@e     sun-,Dlic5,     some      travel,      fri.n(,-c      !)cnefits      for tho---
                              grou,,--)s        a.nc@,  t'iere  is                       a i-)u(9gct  cchedulc-.
                                                       coordinator -,,'.,o,.nted,  -i,ilien  (7,irciiL-,sincf this  ,i@@-h
                              @o,  Has  very  @-)ractic@ll                     @qc  said),        !,lion  they  qct  t@icii.-
                                                                                                                    -                       i
                              I                                                                                                             i
                              i
                              I
                              I

                                                                       270
                   a@.7ard notice, half of the Council meets in August."
     85            T@.L(,,rc-, is "x" number of months for these T)rojects to
                   be VLable.  If the grantee, which is a  free  stand,  has  to
                   clcse, he reallv has to terminate his projects around
                   February, for him to close shop in June.
                             So it hurts the project, and at the same  time  it
                   @-iould not be Practical unless they could find out  1,71.iether
                   the free standing grantee
                             SIs,,-7Ep\   is this goina to be I-,ina of an
                   e-z..cE-r)t--ion in this cas(--? or is this the beginning of a net.7
                                "ASI'-,:  T701.1 cis I sav -- all the free statdina
                   cornoraL@ions TDrobabl%, @ace the same thi.,nrr.
                             -LIIJ-', CHAI !P-ll:  mLhe-,,r are the only ones that have
                   -oroooser-I to deal xyith it this @,.7ay, and as I ;aid., Olis-tcr 71,.nn
                      4
                      Ln staff, after some agon3-zyn7 discussion to date,
                           't7oU ',.-.n OT@7,that t' it nrobler, 1-7OUld have to be
                                           .1
                   handled  in some ,,7av. 1,3ut that v7e ,.,,ould permit, on the one
                   hand, proaram activities to continue bevond that point in
                   time.
                             I t'iiinl@l, you ',,:no-,@7, this is an issue quite anart fro,@,.l
                   tile LUISOttlCd POli.CV -- @-7ill- it be oermitted is somethina
                   that the arou,-) can address itself to.
                             T 7    not have -- as a result of the deci@-j-on, t,7e
                              C M
                                ,aV
                   may not iiave any o@tion, it ria-,, be -)rccludc(-@,. On tile otior

                                                                        271
                   lianO,, the aroup may have    vie-,is unon the Oesire,'L)ilitv
                   of it in any case, I Con't I:no@@,,.
                                            i don't think there's much eisDute    i
                   in some cases. T don't knoT,,7 @,7he@tlier those are the anoror)riat(@,
                   ones or not, but there ;7ill @)c a legitimate need for conti-nued-i
                   monitoring b(@@'ond the life of the nroqram, and there should.
                   lie a reasonable mechanisms for dealing @,7ith that.
                             Does anybody feel differently al@,out that'
                             @-To@@7 @ii'icti-ior these T.)rc@,c@nt a legitimate need for
                   continued monitoring or %,j'lieth(--r this is the best r,,@,@clianism,
                   I ju@,L-- Con't kn()@.,7.
                                                 '.ilat's ei'liat has been the
                   @@!ith '-he  O@iio proc,-ram that Islas, out -- then     of
                   their .ic@@ivitics ll)eina monitored
                                                               r
                             T,1"17, Cl.L AI I (zon't 'J",no-,7 if aii@,t"linc7 -- I c,@.n't
                   sr),-ak: to it, 7ohn -- one of t,ic-,- nhio zictivitcs, for
                   ti
                   ,iere ;7as an              activj-t,
                                      J.               u-,n in the ClevelF@.ncl-
                   ,.,7hich .ias continued a@fter the -,.;r)rtl-ieast Ohio @,,7as nh,@seei o,,i-t-
                   it @7as continued under allr9lO arant, ,.Tith fu-i&s coincr directed,
                            I T A
                           .1 , @C"
                   to t',ie
                             I assurie, ')ut don't realIN7 kno@,i, that the r.,-onitorincr
                   that has tal@en place in that instance has been essentially,,,
                   sta4@ rionitorin(T. you l@no,..7, from. here. There is not a
                   .,IorIL--i-ieast O.,-li-o !Z'@14,P, I don't think [Case -,,"'eastern 'Z(--!3crvc]
                   .7!iic'i -v7a,.; the grantee in t.-i(-, ol,-l Ohio        cast

                                                                                              272
                     an@, r loncr sllado@,.7s over t,L-iat.
  t 87                                14ASII: No, they are d.oin(T the evaluations frc,,,,n.
                     that activity.
                                 B,,, the @,yciv, @@7e i,7ill se-- that activity in a later
                     a,@,TDlicati.on in I-Testern P.A. j--r @-io- get to it todav.
                                 "'HE                       i,7(- have heard from
                                      iiAF)IT: 1"),@cuse ric.    In vie@@.7 of the "IIT,.'Sr,,C
                     thizir-T @,,'-,,iich concerns r-,@ ri little i-'--roi,l Staff -- the fact
                     t@ia4L. @7e have it.)out 401),r),00. le-@t over fror,@i tiie first tT.io years
                     anO,      @.,-ie-v are aslz4-nj for @").00,000. T-,",orc -- I don't j-,no@7
                              t'--at concerns anv of @),oii necolc, or not, but
                                T)'?. ,!cCALT@               it does
                                T'r!E CIT
                                                                         I-,ring to tic
                     attention -- nerha-)s ,7ou    ?ant to elaborate.        There ,.Tar, a
                     staff visit      and this is pre-7-a@,7ton               involved,
                     I believe -,),ou ;aiO, T)r.  [@lar(-Ilulu@;] anci.  @7,@s the
                     of the proura,-.i, is that r4.r,,ht?
                                     !T.I\SII: Yer,.  J..Le c,,,-iest-Loned as to @,71,ic-ther that
                     T)ro(7ram N.%ias on tarcTet or not.   He fell, they 7ere rToinr,, bacj'z
                     into the traditional sort of Health manT)o,.7er       activities
                     rather than follo@.,7in(-T the      concept.
                                -So nerl,.,ins .-7ith La,.,7ton there, the,.7 can get the th4-ncT
                     back on traci:     but I jur@t ,.",oy-idor if thev rcallv need '--,iat
                     muc'l iionev.
                                SISTR@T'         I @,7aE, just looliin(7, at this   6.n here

                                                                              2 7
                    on the line-here and the  1.4  next ,ica,r    and you Should ju@-L-
   t 8 8            @-.i-nCt of I,,no@,-7 that t'tie,7 @7or(,- ovcrfunding.
                                             S-)eal@.incT of L'u-IeLincT, I have a
                    concern:  Pi-ori t"ic@,e caption descriptions, the real ,7erit,,;
                    ar--@t  clear -- at least in the Countrk7 nuicle -- but here
                                            lo
                    7 t@ ve got   n-rolcc 3 ,- r      t,iev are aF7,lrj.n(-.T almost a
                                                                                   4- t
                    lic-il@' million '@)ucl-@, -- aof ii(--altli nolic,,,- in "aFscic@-ILISO-@ 'I
                    .1-or @?230U,000. -L'call.th services in tiT!,.e of 6-,-onomic trans!-ti-o-I
                    2 5   0 0
                              '7 o,-7 1 rion't !,,no,.@? @,7]iit t'iev Are like, but sicTht unseen
                    I l@7oul.d li',r:o to take those on, on an entrepreneurial basis.
                              DR. 7@cCAT,L:  Anc7 tiie     onc-,, that naval 'jase
                    in -PI-Lode I7,la.-id
                              D '@n, .  TT@ U, -7@' @L@ -i Bo careful no@,, t,io're qoinq to call
                    @,7ou a "T',-cri-@an" if @,oi-i're not c,,ireF-,.il. [Lau(7'i-itcr.
                                      T,
                                             I c7.on"L- -,,,ant to annc-ar c@,,nicc@l or
                    arce'-@L
                               1 1 Fi,' C'.T    o ar   the snonsors?
                               I"n  STn-Lr)@l: rOhe rovernor of @ode lo]-and snonsors
                        Phoac Island  one;
                    th                     and ".orri,,[,)onnaliucl, t'lie -Forrc-@r
                    Pr--si-C-,ent o-@- tie           '-7tate L(@uislatur,-- and no7..7 @%7ith
                    the T'niv,-@r@,i-t-,r              ,@as ciske(-! to looli,: at the
                                              -i transition to the legislation.
                    state policies  issue a,.F,
                                   c,-uc,3tion staff rai.E,,e(I in reference to ioO,-@
                    Island -- ind     called tl(-, T'!:','7 "C-Igional r)ficicc toa

                                                                                              274
                         better handle on it -- @.ias the need           for this in @hod-c island
       8 9.              for t@,o counties in -,'@iode Island --         but  the   Staff   told   us
                         that one out of every ten T)o-oT)le in          P,,iiode Island Caere ui-ierqT)lo,7
                         as i result of the D--f(--n!7,e -niillout,      and in the ti-7o counties
                         one out of every five jo@)S T.-7o-re hit        as a result of this.
                         And half of tiie jo')s %,,,ere  "I("Ivv  and  tl-ic  other  half  @;ar,  for
                               4
                               .,an sunnort of- the @civy installations.
                                      And the C-c)vernor is bri-nainq ne,@7- industry         into the
                         area,  and there is a vacuLim i-7itiiin t,iat area of the            hcaltl
                         serv4ccs                  it 'De later -)erforT@Lcd b-,,;, I',"O or  -)repaid
                         h@-alt'i -)racticrz-, or sorietlj.liii(-T I.il-le that.
                                      TIU- they   felt   that this Has an area :[or focusi
                         on at this tiTic.
                                                                                  to  this   nolic-,r s ttid@
                         in   assacfiuf7,etts,  mv,ctuestion  @.7ould  @,c:  I,,That  in  tile  hel-1  r@
                         Cl:.'LP @nd '-',"-T) l@)een doinc7 'or t'-,e T:)ast six or seven  -,,e,@rs  i  -F
                         it's croinc- to talzr-, @2@@8,'-)OO ';-,uci-s to come u@n @,,ith tl-lat.
                         I  ould thin.'-, that ..7ould have been       the crul--s of @il,-iat thev
                         had been doing.
                                      THI@                rcrr,,7,  do @7ou have any
                                      'ili,T?. STOLOV:   VjTell, I can only say that if you
                         read the CIIP reports, both the A and B, they do sunport
                         the nroject, the,7 feel it's a necessary niece of unfinished
                         business that t,',iov need in the health          T)lannina transition.
                                      Tliov did question @-ii-let'lier the  U  of  ',!ass  @,ias  the

                                                                       275
                           (-:.ncv or a governj--icntal- acency, sin,.(-- the rrovornr,,,cntal
                  Drol or acT
    9 0                                      the @li.cy is beina made.    But
                  agency  is clos-@- to @,iliere
                  they did support.
                            This came from the    anO B -- and PIIIST.'C --
                                             T,7ell I hoar Questions, @@eing raised
                  at least !)v    Barroi@,,f-,, about t,.,io of these- larcTe studv
                  nro@octs.
                            I car-, onlv speculate, -'out liavina sat in
                  I         t@iat     closing of tire '-@aval. !:)aso. at '@7,c@@7r-ort, there
                       literally f-iill -)aco ads  in botli of the Tlar,'@'lin@tc-,n oi-,Dors
                  over a ncrj.bd of    I su,,-)nose -i month not ever-,,- 0,Ei,,7
                  "ou @l:no@,?, sort of )ubli.c ad@, nleadin(- -,io- @resido-nt not
                  to clo e the        '@ase at                  cK,,t--ntuF,11,4I
                  done,, of course.   @xicl no coast it had a vcr,,,           c coffee,c
                  i r.,-) a c
                            .,-knd also, Ialso acinncnc(', to   that  t"ic
                  of @iocle Island is tie Cliai-rrian oil ti (',nvcrnors' "c-i@r-rence
                  you know the Conference of r@overnor@, held a cor.,jnittr-,e .-- he
                  testified in t"lat capacitor I)--for,2  "(@,nate on the 1ealth
                  ,Tl@sotirces Plan2aina lecTir@leti-on.
                             r.i',iosc are just facts
                                             L.       @,)ut Niou knoT,l the nressure
                  I ar., sure for qettinq as manv Federal dollars to fill that
                  !'4avy vacuum in 7'iode island, you know the 7oolitical anO. otlier
                  ,)ressures, 1 suspect, have I)een verv fierce.
                                               l@'ilel-1, I sort of read the ou@stion

                                                                           276
                    as: lio@,l     vou spend ,i quarter of a million dollars in
                    a k7ear, and get something out that is north a quarter of a
                    million?
                              And studies in cTeneral, tend to be T)ublished and
                    never read..
                                                  this  is the type of tliina
                    don't kro-,7, "C can't resolve it -- I)Ut T don't kno,.7
                    Conarcss can intelliaentl@7 evaluate E,,n,,,tl-iinc @,7hen t,,ie-v c-ot
                    ti'iir@ @,ic3-le,,r !IOU-,e stuff.
                                       are, deali-na Keith t-,'-iis (qisister oro---,IL-7i
                    @,;ith a re@ional medical i-)rc)@raii mechanism -- usina t'--Iis. to
                    treat that
                                              o, this is T-iorclv T)t,ittincT -i T-),ai--@-Aid
                                  TIT'S C'
                    on it.
                              DR. -!IcCALL:  Exactlv.
                                                  a quarter of a million !Ducl,-,s is
                    just oone.
                              @l@ - S"'OLOII: I  dir,  d. ti-ii.s with ['Ir. '.-7alkor]
                                                  c "Is @ c
                    T,7ho is the neNi I-oordinator o4 -hodo island, or @.-ill he t"-.e
                    nc@i Coordinator, and I mentioned "iirnh@,- s stud-\7 o--F  the
                    .$1.40 ner canita goina into PJicde Island, as onposed to
                    45@ in @iass, and 75@ in      Ilampshire -- and although this
                    is an economic disaster area, uThen you look at the @,7!iole
                    state of -Rhode Island, it is a large project      and i,a@,7ton

                                                                                     277
  N,7t 9 2             said:   X@7e @.7ill be  lookina at  it,  not only  froin the  t@,%7o
                       counties,  but T)ossiblv utilizing  it  for  the  State
                       But  this  is  sort of off  the  record,  but the  question has
                       been  raised,  at  least  to Tic.
                                   '-"I P, .BAP,@O"IS: To me  it  loc)]-,s  lil@e  t@7o professional
                       staff goodies.
                                   rPT-Tr CT17@l@7,1'A@
                                                     But  to get ba.cl@  --  sorrv
                                   1)7@? '17T         -).n  I  refresh m@r m(--mory,  c
                                       1,  SITS:
                                                     C@                              an  I  have
                       r..l.y r-or,,or-,,r  refreshed?
                                   TIIP,             ro  ahead,
                                                    Is  the  --  is  t,i.is  the  same  -nroject
                       as  has  t'@ic healt'i  nl,@n  e@i-icat.4-on  T)ro@nct  that  alrcic7,.@,7  ;,.ac;
                       @,400,000.00?
                                   MT   Cl@
                                                        7, , that's  their
                       activity, There there is annarently a carr,7over annroac-@iii-).rT
                       8400,000.00  from -Dric)r  a@..7a-@df-@ so      are  til"3'-na aiDout
                       rouchl,7                for t-.,,,o       for that  activitv.
                                                    r-"h i. sis  lec-al  --  just jes, or no
                                   ,k4T3  OT,Oll   Ye@, . The i-,one@7  is
                                                                          o!Dlicateel.
                                   DR. 111',SS:  Could we   -(--t a description a   little bit
                       Tiiore?   I think it's very, v,@rv difficult        to mak6  an,i kiftc! of
                       C!7,-,ential juda,-,iont on a one line stateT,-,.cnt of a title   of a
                       project amid I 'L-.'iiin,-, it ,,.Tould bc-, hf,-lT)-Irul, to r-.c at lE@a@,t, to
                       kno-,-7 @.7her(--  to  fit  in  this  tikiing if @,TC  could hear a  little

                                                                                           2'78
                        more description as to @-7h,-.t these t@,7o r)ro4r@,ctr, are
   wt 93
                        the science and   (Scic-ncc,- Council)  an(. the       health      services
                        in time of economic transition.
                                    DR. 1,@cCALL:   The  I'@.ea.ltli Science -@(.I.ucation,,,l Council@.
                        takes  in  --  the   r-,erbershin   includes   all   educational   liealt)i
                        services institutions tlirou(Tli the State -- pu,'Dlic and
                        T)rivate consortium -!iolde(i into a data @,a!-,e which couolcci
                              the sophisticated de-termination of their needs and
                        result o--F iaan-c@17or su-)-)I@r and distribution c.@ianqes
                        ':)one f it.
                                    S-necificall.y, t':iis Dronosal is ask!-na fc,-@ i four-l"-i-l
                                    DP       ESS:        is the roncv used 'or?
                                    DR. ',"cCALL:    I ,Ion't I-.no!7.
                                           !IESS:    I kno@@7 these   one-nacte summaries are ri      t
                        very e-.,-r)licit al@Dout these.
                                              for e;,.amTDle, is this to       some of it T  E,.Ill
                        sure, is for administrative niir,,Doses, or  -- is it to na
                                                                                                y
                        for facult,7  or for conferences, or T)artl-,,, su@-)oortive
                                    ,T)R. "ICCALL:   OIL the @200,000 re(-udst,       123,000    is
                        salaries  and   i,7acTes,
                                    In that request is 5,000 consultants,
                                    813,000 rent
                                    @5,000  communications

                                                                                279
  ,.?t  9 4                     $7,500  corqDuter clita  r)roc@Fsii-icT.
                                And of  course  I ',save nothina  at  all  concerning the
                     $400,000.00  carryover.
                                P,nd navl)e  --  I have  not I)eian  to the  region  at  all
                     so  I  reall@r can'-L. --
                                    @l]-, SS: T' , o@.1
                                -DR.             Tnanv  schools  are  involved  in  this
                                DR.  :!cCALI,: The nUT-"-)--rf7,  arei-i't  in  the  sui-,mar@,  list
                     at  all..
                                              @,11  the  institutions  in        Iceland
                                MTT-
                                                           r..an@7  are
                                                                     there?         .1;
                     @@rn
                                               @..n@,     ar@  cor,,-,.munit-,7  colLec,-,c,.s  Ei@,
                     Tell, in Tiho(7,-@ Island, and  La,,@7@-on' f--, letter T-,iay 'oe
                     snecific -" it c'@oes snell out--
                                P,s to the $400,000 fiourc@ treat @,7as as of a fe-@@
                     r,,lontA,is ago -- so t@iic sr)on@,,incT rate at the end of this fiscal
                     vear nro;Dablv @,!ould be reduced
                                They do -Dlan  to do  a  lot of  subcontracting  locallv
                     and if -,iou T-7anted to comment on that, Dr. 'IcCall, as   to
                     ivhether
                                DR. lIcCALL:  -.his letter is dated @'llay 10th, from
                     'lob Lar,7ton to Jorrv --  say
                                                    s that
                                   . . . interests of -@.ode Tsland in terms of

                                                                                               280
                                 recTionalizin(                          o@,7(--r  and   the   continuing
   wt 95                                           its .'Icalth i-,ianp.
                                 education of health nrofessi-onalc,,  lies in a fourth
                                 year of sunr)ort for ITESIC"            (Or whatever it is)
                                  In its developmental i--)criod.   TI-iis is the nrocl.uct
                                    -oart of a. slo7- st                 -i is nerhans not so
                                 in                         art,   ,7hic.L
                                 unusual considering tire difficult              of establishing  a
                                 via'-@le and coordinated consortium           of many forces.
                                        ","irr,-t I @.7ould        and m,,7 r)resnnce here is       t,. I C-
                                 7,Droof of tili,,, t,-icit the conco-)t              -r'I',.S"C c@,nd t'@,e
                                               of   the   T)u'@llic   and   nrivate   nartners   to   its
                                                                                                 :@ITIS"C
                                 success is still excellent.             The elc?(-ance of
                                 C@csi-CT]l Still !)e                            pro(fucti-ve
                                 of its nro(-ram.
                                                                                            joCt4
                                        "So7.c of t-ic                 a n (-I -,T) c, c ic or@   -L @7@-
                                    -1,,7 crystallized,  ar,-- -'ic, 'ollo@@,,in(-,:
                                 neT..
                                        "The development of criteria for             neec', in t@c r-a-;or
                                 health nrofcssions.         Tii!-, is essential to deter.".inincT
                                 the   gaps   after   the   completion    of    a    current    inventory
                                 of active professionals, nor in process.                        consider
                                 a difficult     and r)ioneeri.na, but necessar@7 effort.
                                        "2.,  A  riajor exploration and develonraent of             a positi,-@-
                                                                                                             4-
                                 on TDlivsician e::ten@,ors of all ].-.inds :ind t,io-ir ccrtifica@-,--.
                                                                                      -,,-cntorV of tl-ic
                                 or licensure.               %7ill   include   an    in
                                 authorized and informal          extenders, T)lus a detbrininati,on

                       of the nee(-Is for tlac,,-q, ",)y type-.
                             3.  The annlicat4-on of a successful deciaii of
                       core curriculum incl career ladder, alread@,, develoncd
                       ex-)erii-nentall,7 for inhalation therapists, to other
                       nrofes8ions.
                            "4 17@ coordinateCt nroaram for continuing education
                       of -rhy7:,icians siriilz,,r to the 'com-,-)actl siiccersA4ul1v
                       develoned in 71orida.
                            115  .7\    effort for the continuing education  of
                                   idliarmacists, and nurses on tli(,      of
                       c@rur., interaction.
                                       !To-,, c,@n 7c)tj tell- --FroT,-, thissi c-@ t
                  or           hO-7 MUC@N  the collcis-)or@it-i-nct institutions are
                  contril;)uk--i-ncf to this overall Y)ro4--ct?
                            DP,.         @.,@lo, tl,is in not sho@t7n
                                        T
                            DP,. IT.ESS:  '.,,o mone@, is sho@,,,n
                            DT2. @.IcCZ-@LL:  ilo money is -,ho,!,in as comincT fro.,:i  o-L"I-ier'
                  sources, on the record that I have.
                            Dit. !IESS:   In some of this there is a legitimate
                  concern of the educational institutions, and I can see  %,?here
                  RIIP can form a linl-.in@, a coordinating function.
                  But -,;,ou no7li , Nrou knoT Ithe hard @,ioric of doing this is basicall-,7!
                  an institutional resT)Onsi,@ilitv.
                            DI',. Ti']SCiT,.@,l: You don't have to provide them @,,,ith.
                  a linl-,
                            DR. lij"@,SS:  Yc:-@

                                                                                              282
   ,,@7t 9 7                          L@ 'I- E c i'll d@. I1-@, In   response   to    vour    other    question
                         tire @@250,000.00   study health services in a time of economic
                         transition   --   skipping   throu@l@i   here,   this   is   in    the    Office
                         of  t'iqc  Coverhor  of  7Z'@iode  Island  --  but  some  of   tj'-ie   specific
                         activities -- and I am readin(-,I:
                                      "7@nti-cinatp- that durii-ic-T the fiindina -,@@(,-riod, include
                                an assessment of the j-rinict of 'oa@e closinar, on the
                                deliver-,, and financing of- health care in the affected
                                coii=,,uni-tv.
                                        A  fo--cccircil-na of sun,,:)l@,,-dc-,-,nand relationships
                                for health services resulting from information o.)ta                4, e)ed
                                in the assessment,  formation of nolicy options and
                                t'ie coordination of variou7, planning efforts
                                State nlaiis a,-id resources .  .  .
                             and L-.'Ien -@he-@,7 cTo on to tal.lz a',,)out economic anC. ot',Ier i,!.a@14--
                                siio-nose         susf-ect @-hat th(--rc-,'.-, an a@.7full lot of
                          economic    as @7ell as health in that -- but again, I can't
                          that'f3 a  bac@lzdron.
                                       DTZ.               Do ,,ou have to (Tet doT,7n to 'DraF@s tac'@:cll)
                          ',7e  don't  have  enough  in-Eornit-i-on  here   to   get   aliold   of   this
                          one in the 'I-,in(i of d--tail that "7otilc3 justij7ll nutting a half
                          million into so,-.1.,@thincT @,,,e don't kn@,7 @,7,-iat.    It  looks   lil":Ol
                          a -oic-5 in a nol-,c situation.
                                       'I, site visit @-@ould he in order, a d seems to
                                                                                    n

                                                                               283
                    since @,?e are- no@,.7 site visiting 56 nrograr.,.s, or 53, T'ii@Tht
  1,7t 9 a          as      site  visit this one.
                              SISTEP@,      At this time, at this T.)oint in time,
                    i,,re have a demonstration project that can't be completed in
                    the demonstration time -- so their @,,,Iiole T)rojcct system
                    needs to be looked at in the i-jay thcy@ve desiaiied these.
                              11                                                        i
                              ,,.,nd then t'ilere's one here "for regionalization
                    and maternity for ne@..,born care in PiiFsachusetts"  And th'
                    hasn't @-)(-,en broii,@',lt uo @,7itlil neoDle are (7oing to be til-C
                    Dtoviders and the consumers       and there       ';--)e some
                    emotional issues, Tle could  stir  uo a horiict's nest if t,iev
                    are not ready to use this.
                               S 0 I @-.7ould concur t'-lat this this seems to r@
                    a oroarai-a that needs to be loo",@c-d at, it this point in
                    if ,7c are- qoincT to givr2 funds.
                                               TT 10
                                                   is
                                TIIE                   tl-ie cu,,@   the actic,-i i.1
                    this aroun?
                             D P,, TESC.Ti.T@,-: Thurman. (Laur-T',ito-r.
                                TIIE           Socr"ts to rne that r,,or@- than almost
                    an,,7 r(-,cT-i-on -.7c have lool,,cd at, i have heard a lot of concern
                    e:,@nresse@- about individual TDrojects @@,,hich I-)-,7 an larae, in
                    terms of  dollars,  are  significant.   @io studies, each a
                    quarter of a million, the   continuation of 'Rhode Islane,
                         -i, if you @-iill lool,, at the carrvover funds, is at least
                      iic'@
                    a half a million.

                                                                                                   284
                                       So   those   are   certainl,7   --   and   beti-yeen   the   three
     wt 99                or among the three is getting                and   I   don't   mean   to   be
                          because I think the neonatal one             is     around      $80,000.00
                          about   $600,000   out   of   an   application   at    this    point    of  $1.9
                          or roughly one third of the           project -- the group has           some
                          serious    concern   with   and    I think   we   need   to   flag   that   for
                          the Council.
    i@IDEX                             DR. Hj@,T@TSTIS:    I  move   we   approve   it   at   a   million
                          dollars.
                                       DR. THUPIIA@L:   Second
                                                       Second.     I don't    mean to com-,)ete @,7ith @7,@'Ll@
                          but
                                                            ',,7e have a motion and a secoT-i(l,  to
                          an-,)rove at a rillio
                                                    n.
                                       Chu c')'@- , Ithink I sa@-7 a little strain
                                       DTZ. T'cC.ALL:      Excuse me, I think @,7e haven't 'ic,@rd
                          from Sitter .@-nn on this
                                       SI.@lm.ER  @IN:  '@,lo, I'm
                                       DP,. HF@,TTSTIS:    I  J4 M'7 motion is nreriature          I'Tn.
                                       DR. @lc('--',%LL: I assume that @.7ith       the tire restraints
                          it   may   not   be   Practical,   at   least   in   numbers,   to   have   a
                          site visit. 1'rLi not  sure.
                                       If it            I would stit)nort that           But if  T
                                                                                                   .7c are
                          not going to be able         in these unii!-,,Liil circiiri7,tances,     to have
                          one and @.,!clvo c,roL-- to come uT) @jith :i figure           and it's certain;

                       that ,7hatever  T.-@e  recomrena  --  zeroing  in  on  all  these  concerns'
  1.7t 100             -- specifically -- so that if @,7o- took the @,1600,000  back
                       that i,7ould  leave almost $1.3 million and surely it         s not  t]-iat@
                       .,imr.)le in rise mind
                                   I @7as thinkina about $1.4 million as a recommendation.
                                       BA@-RO@,7S  I think that is reflecting the ,.7 lole
                       .)attern of their anproach.
                                   If ',70U Caere to describe this as you do meat, this
                       has more fat in it than anv cut @7e have seen to date, and
                       T)robai-)1%7 ever
                                   DR.               Can @-To @,T)eal@ to the issues raised'
                                   "o@z7 June ank' TUJI,7 are not bad months to  et t-,ie
                       citations raised if there are availal-)Ic T)ersonnel.
                                   Can @@,,e advise Council that this -oroc!ram,     !)ccause
                       of all t,ie things  that have been discussed ',-iere this morninc,
                       badly need-, crui-ck site visit
                                   T H E C',- I,". I  @'T 1, @lini-sitc visit
                                   There mav even be the Possibility, althoucjli 1 can't
                       VOUC.'L  for  this,  that  one  could  mount  a  mini-site  visit  bet,,ieen
                                              I  1,T
                       net  and the Counci        cetin(j, @-.7hich one of  the  Council  @Ic,-@crs
                       might      a one-dav sort of thina
                                   DR. @@cCALL:    I think that's highly desirable.
                                   DR.              Because I certainly couldn't su@cort
                       this figure -- Ilrti havinc-T difficulty supporting a million.
                                   DR. !IJ',T]STIS: I  agree.

                                                                      286
                            @@.R. BARROT
                                     @qS    agree, yes, I'm ,%Titll vOu.
  N-,It 10 1
                            DR. IIEUSTIS:  I'd like to get this in as soon as
                   possible, I guess
                            DR. HESS:  I think you have to recognize that
                   currently funded at an annual rate of about $2.7 million
                                           Joe, -,7ou @,iell l-,no@%, that we have never
                   discussed this nrogram -- but everybody has said that it has
                   been overfun(-IeO,.'
                                           T
                                            1,;Iell, is the suaqestion one of
                   reallv trvin7 to count  aP,,ini-site visit, either l@)cfore the
                   C(')iii-icil convenes or certainly immcOiatel,i after before a
                   fundinQ decision is -)aclr@, to really,, sha-,)(@ the recoi-Ticndaticn
                   as to the funding  level?
                             Or do you ..,7ant to put a base fundincT rc-cc)nn@@@-nO@ati@,n
                   in an--'
                             DR. '-!-cCALL: I @@7ou,,t lil-le to -,ee us cro tIFiat --b@,te
                   of the mini-site visit before, prefetra,,-)lv before tic
                   Council
                             DP,.          Could I ma,,:e an alternate, substitute
                   rqotion suggestion   or Whatever -vie really @,7ant?
                             If
                                Vou read Stan's first pAcrc here, they are
                   as]-lincT for 1896 two continuation projects, and elevei ne,.@7
                   T)rojects -- that dives them a  .)rogram before the $671,1@oo.
                   and if you add :'?324,00 to  continue the t%vo projects for a

                                                                                            287
                          neriod of time, vou do cor.'.e up ,,7itla a base of a million,
   ,.it 102
                                      And so I thin]-,, i,71,iy not let's -- this 671 ficure
                          they don't currently have those people now -- T,,.7hy not let's
                          arrive at  ei-c-ht, or a million, ,,:ith an understanding that
                          the :7,@.te visit %.iould either add to or subtract from--
                          I')                     pos-Dibl(L, rllii-thout --
                          ut no l'ianO,4n(-
                                                    !Vnd no continuation fund.i-na-            I just
                               to ,,@a@,.e sure i understand @7ou no,.17 -- no continuation
                                          7
                          lund4-,n@j ne-,t Oscar    the @200,000.  for the                  until
                          ti.lat.
                                                                      @AOO
                                       R. T'@7,-  UT@7,L       have          000 no@7, so it -,.,c,,nt
                          hurt        at    all.
                                        T' C;.Il,@I@l@.   TTOUld 70U
                                      -1 -I               i.           :,CC(-,.Ot @-!,,iat as a
                                      "T                                                      o ,I' s t i
                          motion?
                                            T                                                         once,
                                                         I didn't tin@c-,rstand tiat liou vc c@@,
                          it an'7  -except to add        the site visit
                                                  @T7
                                                 L,_ :   Tl-
                                      t) R. T  U          --Il not rc!all,.r.
                                                                                                  o@
                                                                                               4
                                      I   saiO,, aoinc,  !)acl;- to the f act  that @,7e            @7c
                          there an,,,,,L--hincf, in L@-1-iat sense of the word,  for iealti.@ sc:Lence
                          council- because the@7 are carr,iin(- this money for-.,arc!.
                          1 ,.,ac-! shootina for @,'U'00,000, which really wouldn't hi.i.rt them
                          by the time @.ie   ran the site v4-si.t here.
                                      DR. IIEUSTIS:   l,',Ioiild you c@lange a million to
                                      DR. THU,7-!@',-7\2.,@:   Yes.

                                                                                                            288
                                             DR.  IIE@TS'@IS:              I @,7oiild su-p.port that.
                                                     SCTT,@-"T:
     t 1 0 3                                 DTZ.  T@r                  I  second that also.
                                                                   0. l@.    @ihat I have heard.
                             have then,  if I understand it,  is  a minimal,  interi-a
                             or not  "minimal"  necessarily 1.)ut interim fun(-ling  level r,@com-
                             riendation of  $OJOO,000.00                   a      strong       recommendation       that
    I IOML I ()@T
                             some            of a mini-site vi-F-,j--t !)o made to -ri-statc,  lool,,in(-l
                             a-i@  sbr.,,e  of  these   n--,,..,   activities,   and   also   the.   [.Hitachi-]
                             to Cotcrinine ..i'.iother that  r-igurc  should li:)e uo-p,--d,  and if so
                                   r       --  or  i.nO-e(--c@,  that  it  rii,71  t  even   b@   lo@,7crc-,cl,.
                                    @uch
                                             if-@ that rou,(7"ilv           sense of the rLotion,  7@ill?
                                             DT.  @TT@@-IIISTIS:  :)(.)es   ti-lat   include   tiic,   '@200,0@00    for
                             monitoring activates?
                                              p .                 -lo that              t'@.iat out.
                                             DT@'@. ITEUSTIS:     You. arc,, cli.i-.,,i-riatinc-T that.       n.
                                             DP,.  T E cj C'lI           ,-,,e @@7otild love  to   .'@zno-v7 -licit  the
                                   har, been thin]-linct.
                                             -'4.11.  Ni%SI71:        the PAG dic,n't really anDrov-c
                             I don't believe.
                                             TIIE CT@Ajrjj!,@l:     Tle
                                                                       ri-)  is   here,   let's   tr@,   tii,;   i-C,--a
                             on hill,  to see if this  is reasonable  the TZogional
                                                   NASII':    Ile'll be sorr,@ he Totaled in on                this at
                             this        tire.
                                             TIIE CHAIR'@L@l:         1-lerb, @,ic    ave s-,)cnt a good deal of
                             tine @.7ith Tri.stat@-,  ro-centl@.,,.           @,.Ie are concluding no@,,,,  and

                                                                               289
                      perhans more than anv other reoion, serious (7,ucLtions have
      104             been raised about a    sr,,iall number of projects -- several
                      nev@7 ones that total  half a million -- continuation of that
                      -@@-f-iode island  @"i7l-C@'\  for @,7hich an additional $200,000.00
                      is being asl,,Od, but for ,,7hich there is so,-,IO $400,000.00,
                      or r@ia@7be $300,000.00, in carryover fundr,.
                                 And the crou-)'s  recommendation,  @@ihicli  hasn't  7:)ecn
                      voted on, but .,7hicli is on the ta@-lc  no@-i,  is  to  recommend  an
                      interi,-.-, --f-'tinaincr level of silnnl,7 $nOO,000.00 in tire place of
                                       -Trillion request -- ..7ith a strona re
                      a rcu@,.@il,,7                                             cor@-i-,nclation I
                      that       fine, of mini- on-c-da,,7 site visit be made to
                      IL--r@@L8L-ate to loo'@-. at several of these large, no@7 stud,,,,-lilpr-,
                      activities @,.cit are boina oroposed,  as  x,!ell  as  the  -oroqrcsp,
                      and needs -- future neectL-,      for the nhode Island-F.,-", - T- !@.C
                                                                     is a s'aori-. ti-T-.e c@@Ta?-
                             IC
                         c-,it.  r '--)cfore (,oun,--il       @@7hich
                      or a',Ilout -L..-rec    or less than t',arcc   .,,oeks; or he'Lor@.a tile
                      final fundinc-, decision is -,,,ade.
                                      this is the first-- tiT-.o @-ic have come to ai-i,., ki,.-ic'
                      of a recommendation.
                                  I think tlicre are enouaii   serious concerns about
                      sT)ecific activities, and Questions
                                      Pl\.,Ill,: lj7cll @-le, of course, have not been  site
                      visitinq other regions, ')Ut T tl-ii.ni: it's an unusual set of
                      circumstances, in something lil-,e this, there is no reason
                      that     couldn't accor.,noclate that recommendation.

                                                                            2 0,0
                                 But    would much Dref-@r to have     the  site visit
   @,yt 105          prior to Council ',IcetincT 'than -ifter Council
                                 TIIE CHAIPI-1.@,l: @d                includi.na  rome@.)odv
                     from Council
                                 '4
                                      P@,IL:  Somebodv from Council and liaison.
                                 I think  the  Tristate   one,   particularly,   has   given
                     us soT-.e questions, internally? also, and this certainly
                     reflects,   nerhans a little bit more emol-liaticallv the        issues
                     that have   come  to rv attention.
                                 lie can acco,--L@-,ioclat(,- that recommendation, and
                                      I.Tr,
                     act on              can't accommodate  rianv  site  visits  '-')ecau@.e
                     of the tir,.c ini7olv,@O.,     cert.ainl-,,7 in unusual circumstances
                         call.
                                 I' 7'
                                                   17clI t'iis ncee,. is dramatic, @-oo.
                                                   T
                                                   ,7c-- do leave a motion to t@-iat
                     '-then    let's call for the cuest@.ioii if there's no      fur4L-.-er
                     discussion.
                                 7'ill those in favor
                                                    rohe Tiotion ,-ias T)roperl,,7 out to vote
                                                   and carried unanimous!-v.]

                                T 1 C T T,7%
                                                        Paul.
                                                 O.T
                                Drl,. TESI-'T-T-@,.,@: I,,,Tell, the '-IeT@i Jors(.-.-,7 application is a
                    little longer than 1-7ert Virainia, but  'iias  about  the-  same
                    Qeneral qualities in ')eina able to describe simply and
                    in relationship to the  rcgion's needed c
                                                                  ,joals and their
                    shorter term, objectives @,Thic,li have been arrived at by explic@-t@
                    process, so that -,7ou can follo@,i  it.
                                rlrlherc -are cor@orate Grantees -- -t.ie Program serves
                    7.2 milli-on neonle.     Thev have established sixteen profession
                    al.s and some ciaht clerical noonle anproximatelv, and        they
                    are asl@ing a nrogram staff sunDort to the tune of @825,000.01@.
                                They have ciaht projects, as far as I see it, an@
                    this spans, reall,,,, the   entire set of @als relating to
                    access, sun-oort of categorical. -- sunnort of cTual-i.tv    assurances
                    activities and sor,.--- efforts in the area- nov..7 of cost contain-
                    ment, and a beginning exploration as to ho@,,, the CITP and the
                                                                develbd,@ient in  the
                    T"!P -,nav be setting ready for the ne..@
                    legislative activities.
                                The,7 also function on the contractual svstc-m.
                    fLn.-,Llev have a large contractual Yjudaet -- that's essentially
                    ho@@7 they are functioning.
                                '7hev have             tincr staff organization so that
                                           an interes
                    in addition to   the usual essential    min@i@crs,  that  is  the
                    fiscal., development and evaluation     tipc-- thing,  they  also have

                                                                                    292
                      a I)roa-ra@-,,,, aeveloT.)T,.ient @,7]io has aon-line, full time
   107                r..-Lanac-ter that ias to do -,.7itl-i the ri-i@)ject matter -- so that
                      there i-7, somcbo(qv free -- and -,o -,7ou q(-,t the sense that
                      there is a ver-,,- discrete pror-iram  ,is-,i(-,ncd responsibility for
                      the conduct of   these affairs throughout the -region
                      and sort of a ticht, ei,,nlicit @-7av.      if you read a c','I,-xrt
                                   -rsta                        are Droceedina.
                      ,You can unci      nd c-,:actl-,7 ho,,,T the,@7
                                 Our i,-)ast O-.,,ncrience is coherent @,7ith the i(-I.o-a that
                      t'ie     annears,to I:)c  e-tr(--T-c2li, (.-xnlicit and  active, and hot,
                      so,-,e of the :-,ost ef4-c-,,-,tj-v@ T-.eor)le i.ncludina one of the
                      T'@oi-j)erF, of this (7.ouncil in t.-ie other opiiel  this co7n]-ttee
                         on tric ptin(:-]- -- v7ho hi!--,   not only c-,;,'.tr(--mely
                      able, ;Ijulk-- verv articulz,-Lc a'@)oiat the nrocra,,.i in nresen4--,;.il(-.T
                                                                                      _Tp
                      ho7,-,, t' e @@I  should be .7or,@in(-T in cif--voloiDing not only Cil
                      cai-)z,b,-litics, ',,)ut the nrojr--cts in virt-uall@,7 all tiic- areas.
                                  I am interested that there are t-,.7,,-nt@7 cTr,:int,@ef', a@-nrT-c
                      ti-le 41-hirt,7 so-.e nroj(--Ct@,. r-7-1-iey had 3(i operational -rolects
                      't-lut not all of then are current, I miuh-u add -- and 7
                      developmental ones.
                                  So that ariona t.,iat entire aroup there  are quite a
                      number  of Grantees Prince air)arentl-,7 ire the recipients of
                      the contractual funds -- Dririarily boeratinq out of Prog--ar.,.
                      Staff.     So t;lat it's not   either centrally managed or
                      qrante6 r-anacfed, or an,7thin@ of the sort          you oet the
                      feelinc7 there   that there's   a  good clisscmi,-iition of rcsidonsi-
                                                            irorTram.
                      bilitv in the    oncration of    the

                                                                                         2 -Q3
                                   One of the fascinating thina@, about               Tc-r.,@ey
                        has I-,ccn the @,7ay thev have been on too of so rqan-,7 of the
                        ne@,,7 issues in terms of better access          emergency medical
                        services -- cTualitv care insurance including assistance in
                        nS?,-O develon,,nent    but also, more explicitly than ali',Ios
                        anv other )roqrai@n I   I:no,,,,, al@')out, touch the Staff -may kno@-,7
                        better than 1, of course, for good reasons.              But the Post
                                          ---nco- I 'liav(-, had in settinc-,T t;c-andcird--; for
                        e.-.nelicit  cyner4,
                        cualit@7  for certificate o-F- nee(!. tvne activities -- i.e.
                        the technical rev-'LeT,.7 arou-Ds, or ti-Le  coTTii.ttccs, hatle T)ut
                        to(-,
                                   standards of excellence, or        standards of aua,-it--V
                        care, in a @.71,-iole varic-,t,! or -;i-)eci,:,,!.Ize(l@ anC.      @(--rvicc--s
                        4--nd one cfathers from till- narrative, that t;-Iese have,       in fact,
                        been u5c@, in certificate of need and that          the @l,"P Cc,,Tl@.,-'Ii-ttce@,
                        have been  used 'I-)y        certificate of need type activities
                        for advice on the basis of standards -- i-)ut not onlv the
                                                             Y CT-,TL
                        standards have been amended                 but the staff has
                        Dartici.@ated in the reviews,, of certificate of need          and
                        given the otofessior@al and technical advice to '-'I'LP Oelil)or-
                        ation-@.
                                    !,low that's rcall,7, one of the. first e,",-Dlicit
                                                                          CTTD
                        exa.m,-)les in my experience ti-iat in fact,  1-..     has used 7.TP
                                           te  @@:av.   I t'iinl-.' it's i real credit to t" c
                        in  an   ay)t)ronria
                        l@iisto--,i of  that d(@-velor)-,i(,-nt.

                                                                                            294
                                     i,loT,l tire -final thinc.       I @,7an@@ed to ao into
   1.7t 109              t'@ic,,rr--Is a  fair  amount  of  detail
                                     But t'!,Ic-  other thincT I %,7anteci to mention -,,,7as
                         a good deal of i-)acle: and forth      Ci@,cuf7,@,-I-on, epnociallv -in    one
                         set of correspondence %.,,hich Frank has (-Tot a nice cov@ri-no-
                         letter on -- from a7,@paro-ntl-,r the "':."Iorti,@rn T.-To@,7 7p-rse-v
                         Con-Ference   of   Clinical   Coi-inci.l"   I  can't  tell  @@7i-ictlicr  it's
                         an A or B
                                      MITI'
                                           C  'ITI'T'.7
                                                                       are,
                                                         It's    r,
                                           T@ C' r'TT@,l:
                                                        An,,-l tl- ec@i.!-,cu@si-on of @'c    letter    of
                         t,qe  -m@,cotj-vc-, ")ircc-tc)r of  the   7, lll.(7cnc-,7, is sort of a c,-,ntan.k.@r,7
                         buckshot       tvne of vi-tunerati.on, ,@.,to ,.7hich,  t@-iere is one of the
                         rrot ID--au@uiful res-nontcs ti@lat T have ever had the
                         of rea(3ina.
                                      P,l  [T'lori.nl  '-,iciE-@ Krone, in -five pa(Tcs, to
                         the histor-7 of hoT7 Cll'-O existence in                       is
                         a  result  of  @-!-'-D  effort,   through         <,-cncrations of
                         e,c2cutivc di-rectors         and he takes each of the issues
                         relative to each of the projects,  and @),--autifullv
                         t'@Ie@A in some verv sir,-.nle,  clear lanouaoe,  in a hi@'i y
                         ,Drofcssional        and  ',-ii(-hl,,
                                                        unvitiincrative and une.,-iotiona  i,7ay
                         civin(-T  It--he   facts of     the case.
                                      You   kno@7,    this    little    correspondence    file,    to    met
                         is one of tll,.e most beautiful pi--cc@-c.; of exchange that i've
                         had the pleasure of reading.,   I'm just delighted that i-7c

                                                                              2 9r,
                                                %7 j-, at(--ria-I it's the )DaFi.:3 of
                     @.iad this for suDpl@,.entar   'I
  1,7 t 1 1          really a more acneral reco,-,-xicndat4-on that I        lil7.e
                     to leave ,,7ith you all, and that is that -- not in my o,@.,n
                     feelina --- is that recognizing the legislative mandate of
                            recoani--in@,- the relations the regulations of nl-'IP
                     -For interaction -- I feel that @-ye should recommend to
                     Council, for Council  iDolic-,7, that scivs that-
                                   urge that (-'oLin(Ilil l-,rin(@ to 'Ir. [Pavell?]
                     anc@ ot-i.--r anoro-)riate noonl.e's attention, that interaction
                     is a reciprocal nroc--ss and t.,iat @.,,e should have mandated
                        regulation      suite isiOc from lec-fi.r:,lation   reciprocal
                     intera,ct@o
                                n and                     mutual respons@!Dili-t%,,
                                 directed fro.-" the !-amid of -L.'Io- Cilp Agency,
                     here, to call 7,           @art-i.cular!N,,, @7hat thev do i t,-L
                     the @-is is a different         of course, and it's uT)   to them.
                                Secondl,,,  tiat so far as our raclibcrations in
                     this Col@"IM4-ttee and in Council, that i-7e should ic@nor,-- c
                     nec,,a4L-.ive C"-!P co,-j-,cnts, c:,Icept as
                                 (a) number one,    the -P, :,%aenc@,-7 informs the local
                          of their criteria and reviei  in corm@on orocess
                     nrecisel,7 as our T-1-@"D incomes, the B @genc@7 of the
                     reviev7 of coiri@,ion T)roj--cts -- total reciprocity.
                                 (b) nur,-bcr tNqo, that the 13 Agency shall furnish
                     to t,-ie TI-@@T? z).cTcncv, e:,.,nlicit-- staterionts of the ol3jectives
                     and Priorities and as need statements, against @,ihic,li

                                                                                                                       296
                                t,,rclc@ts              (lc-,velo@r.,Ient.
    ,7t                                          So mNi  feeling  is,  yes,  we  reco,7,nize  and  feel
                                entirely appropriate the                         should  respond  to CIIP  --
                                ju7.t  c-xactl@,,  as  sai@l  -- no  argument.                    i.@@ut    that    it    needs    to
                                 0 r                                      ssional,  level  to which                       is
                                     ,I -1
                                      Ore  @t  the  same  T'Drofc
       c 0  l@r, @ll i-4 T-)    bein<-,         called.    ,"hat needs  to be  established  as  a simple
                                issue     of basic  intecrity bot@,7cen  the  tl.,70 T)rocTrams
                                .-nar@,i-cularl,i  if  t'@'lcv     are  (Toinc,  to be  1(--gi.slated  into                 o m
                                ki-'I@l of  rclations'il-In.
                                                        that's  a  -irorr-,al  recorlinencl,-:ition  I N,,7ould  lillt--  to
                                'iavc,  t,-iir,  (7roun discuss  and                           at  !-,olne  T)oint.
                                it'3  @t  Cic-@rcss-ion  froi,), t.-ic  current  thinking  ind
                                                 .@nd   no,,7   T,,,,7   final-,   to   sum   it   un,   I   t.iin',@   this   is   a
                                beautiful -oroaram,,  a  ton  level  operation.                             Our      feelina       is
                                that r,7e i.,ouleL nroba,)l,,,  r(--cor.-mc-,nct               fuiic@incT
                                15  to  20  te------nt  above  t',ac  current  (--ar(-@t                    hut r@,inzis  cl..@O'il@
                                                         is  clue  about  7ul-,7  lst               and  tLnat  co-,.os  out  to
                                be  al)out               million.
                                                                    he                                              -)e  conctrat-
                                                 .@nd   that  ti       -.ecion   -,Fcntiall@@  si oiil(ft
                                ,,ilat,-a(i   for  ti-ie i,7a-,,          !lave    -oroc--c-,cOecl.
                                                 T-) -@'. IlEiiSl@IIC,: @That     @.7as     ,7our     fi@,ure     icrain,     nlease?
                                                 DT
                                                  ,Z    @17SCTY,@-
                                                      . L , .1 ,  :
                                                 D-TZ.  TIEUSTIS:        And  t'- cn    @,ou're    qoina    to    1    nocl-     them
                                do,.in by  a     million?
                                                        i@,\Sll    Tiiis  an,,Dlir-ation  is  3.9.

                                                                         297
  @.7t 11@2                      BARTZO,-@'IS:  Ye-,, @,,,e ire knocl@,ing them do@qn hv
                   million bucks.
                             D R. TESCTIIIN: I thought that the recommended j'unO..,j-n@
                   r(--].ates to the target, about 15 to 20 T)erce-nt above the target,
                      minus about  @601),O,00.00 in Jul-,7.
                             The.v are over target b%T some    I forget izhat
                             D@-,'@. 11-@SS: Tliov are currentl,7 fundel"
                              R  T,-, S C H And I thought  that from 1.6 to 2.9
                   it's a substantial rise and it allo@,7c a little iioiie,,7 for
                   Julv 1 Council situation, and it bi-inap, it a little closer
                   in line       ,.7hat the ficurec, a@nT-,car to be, ,.7hich ar2 availa-.".@l -2
                   for the nroclran.
                                   ITioulOt -It.@vc no election sor-,e.@od,7     L- 0
                               fully or in some larger amount, @,,ou kno@,,.
                                                   @,,Ie OUCfht to, since "r. Barrc,,,---
                             Ti"P Cil,
                   @,7as the other rev-Le,@.,,er on this, hear from him before .le carr@!
                   the matter of funding level, or other comments or
                   observations further.
                             MR. BARROWS: P;.v revie,,7 is T)rettv much a reflection
                   of just what Paul has said. In short, the program leadership
                   ranks, participation, I thought, @.ias sunerb. In fact, overall.
                   I came out @7ith the impression that this T,7as particularly
                   in death, the type of nro(Tram I @,7ould recommend. Period.
                              r@"he relevance of their nast activities and the

                                                                                               298
                          oronosed activities in the !-)road,                 mission, @.7as just
   @.7t 113               ton notch, and more than tl-iat, t@lev are rel.(@vant to the
                          needs of tl.,ieir area -- T.Darticularlk7 tlic uneLc,@rserved,
                          seemed to he jtist riaht on tar-et.                I .7as cleenl@7 i.r.)nressecl..
                                              harl another attril)zi-l@-c, T,,,i'licli .ias outstanding
                          and this to me,  and really this is maybe a -nl,.Iilosor-,'iical
                          matter @,7j-th @.7]ii-ch vou r-a-,7 not all cicirc,@e;     !-,le need t',-ie ideas,
                          the c,@:-,ortise oil ac;nd,@r-,iii and '1;7e need the sunnort of the
                          r,over,rip.-,r@,-it if @,?r3 are real-117 croincT to (-,t@t anvt' incT reall@7 done
                          in t?ic n@.ainstreaT. of ironrovina.           It's set to come frc:7, the
                                           )rofessional I                    .I                  @ - 0.
                          T)ra.c@                                           tl-cv have doni--
                          t':,@.,@n anNi nro-ra--.i 1 have         to c,,,-2t the TDracticin@r @rof@@,si-C,'ni
                                              @@-'Iat, I cz,.@o out          ji-irt t'.-l.is      tc)@-) ral@-i-nr-
                          ane, I di,sr@issed the ('!,IT-3 t-iina a@i a ventilation of
                          pique    il4-c',l ha@ no r-.crj-t.
                                                            T.!a,,71)e T C)U(@-11@ to ask 77ranl:.
                                        I think .7c           an issue tlaat is resolved here,
                          Fran'," on tie M-
                                               @.STT:  You rcei,-i on the CEP?
                                              iT
                                                   71,
                                        "@"ilil C"r.@ I 7i T .@Ll Yes,  rj-cT,.t.
                                                                        of course T-)r.     hu  Man
                          i7, (-(--rtainlll,, accurate in his de@,crintion of the letter
                          Dr.  [Ford? I 's af f air -- it 1-7a,; ll)ei.uti,f ul.
                                        z@,nCi T i-iavc @,inc  '.ic,-ard from the recTion,  that the

   ,,,7t 114            B Y7-1.gency Board an-oroveO, I i,@ican, recoTriin"-,i-id(--d aTDproval of t'@iis
                        application -- so I thin],, ti-iit this )Dit of "@,r)leE--n vcnt4-nc,,"
                        ]Dv t@ie CIT@P Director @..7i-io '@-ias onl-,, ;Dcen on the board about
                        five r,,ont'.,3 in -that z:)articular a(fc--,ncy an@7a@,r , is
                                      TIE                T
                                     Ti                  Lavc@  -,You  cTot  anv  more  insights  on
                        ti.Ic- -,@@7arf are in   Jcrsev,                    7ersev, Tom?
                                             ITE
                                           T     FLOO-P,:   That's not Pay I)ailiwick.
                                                        oh, oh, t-iat's ri ht.                Jersev
                                   co.@-,olit. (T,aiiaht(-,r.
                                                       T'm @iast cal.lin,-T -for fairii(-,E-.-, an@
                        (--Cru,alit-r
                                      C 1 T,@.! TI",@
                                                           that  i:-, a     t"-i@ letter @,7a   a
                        Director's l@tter, !-)ut tr)(,- 1,oard -- under              duress or
                        r,ro--nt-od h@;, %,lh,-it rea@,on, cli.d ta"e iction          O-),@OS4@-te  to
                        that,    annrovinCT    the     @7,--rsev aT,.nlica-"ion.
                                     I realize -,7ou're just as!@incT for       fairness    anO,.
                        cc,-ualit,,r
                                     '!R. '@-7.AS IT "o repeat, @-re i@-.av hive a oolicv (-,ueE-,t@on
                        in this       Particular region.      one of their Dronosals is         to
                        estaljlio'i   3   PS,rOs and I don't l@no,.@7 @,7hetiier !,7c can ur;e  our
                        mone-7 for the act,,ial                      of  iSPos or not
                                     @47. BAIIT@IOTi-'S Is that to he established,        or just to
                        nrovi-de the T)rcnaration ictivit;@es?
                                           eAi     I'm not sure,      it'@, I)ackun  sup-nort.

                                                                                                    300
                                                                  t actual Eupport here,
     t 1 1 Z')                                                 It         I)e an issue that @,,,e want to
                           flaq,   though,   and   get    into    sor,@,e consultation,    if    @@,,c     haven't,
                           with   the     anoropriato-E-IST3,0      staff here,   and    deTDenOinc    uT)on    the
                           outcome   of-   that,   we   mav,    or    mpv not, want to hiqhlicf',.I-,
                           soiti-tl@iinci    for    Council.
                                          I lia-,,,e the same question in iav mind.                It    co-rtainl,7
                           is,  ill one sense I                  ver,7   consistent   v,7iL--Ii   the kind of
                               14.
                           c-,ua       assurance   activities    ancl    st--anO-ar(q.-,    @,ettinrT -- or
                           standards d@velo,,D@-@,nt,  t'-,iat ha-, characterized one riajor thrurti
                           of-.
                                          On the ot'@,icr ',7anc@,   '@)tircaucrat:7, heave a           of
                           to  h,--lnincT   the   Y.,,@dical               cTet rcicl,,, for this T)rcc-,rE.,m
                           and
                                          ITT7'
                                                                          -7ant to C",-ieck uT)
                                                                    r, a
                           staff,    I  ti-iinl-,  in  an,., case       just so that !-.eor)le Oon't '@,iave
                           their   noses   out   o-r    joint    arounr-l here.
                                          D'@Z.  @7;SCIT@'T:  -'-ie   '-a@,ic   fundin7,   of   the   PS@O    comes   i
                           from,  ti@,,-c  nrocessinc-i  of  the  !;:)uziness  --  so  ,?ou  l-,no@.7,  it  isi-i't
                           goin(- to taize -- tile actual fi-rianci.nry of the PSTIO is not
                           a Droblem.
                                          'IP
                                               PAIIL:     '@"ICV %-7ant to r)rovi(-Ie the same t@,,rDc,- of
                           cun@ort         @)tat it'-, a          a@oncv.
                                                                '@OTl cir(-, there aii,,7 ot -ip-r matters or

                                                                                                                                                              201
                                        or      comments      or      @,uic@,tions      o-f-      the      t@@7o      rovi-(-7,7c-r@,,      or      of      t]-ie
     %..7t                              staff,   for  tl'lit                               that  rc,.I.ate  to                      @7o-rsey
                                                              j)P.       I.F,,T,,S"-TS:    1)(i  @7c)ii  tqinl,,  ilarro@?:7,  @,7ill  acirce-  ivit.ri
                                        the  monev  figure?
                                                              !IP,.  R)ARP                    cll  I  i-7as  a  little  rore  generous.
                                                                              ,OTIS           W
                                        11-m      not      as      good      at      r)icl,:ina      @igures      out      of      the      air      as       vou
                                                         are  --  but  I  @,,,ould                Fa,@.7  that                         ,,Yind  u.n,       this
                                        should                in  the                         cate-(-,or,,7  ---  ver@7  cle,-irlv  in                    t.1 I "2
                                                         cate@,or-,7.
                                                              -.1o@,7,  Share  thi-   fi<-riirc,  iT,,   :1.  don't
                                                              ITT-                            T-7n                                       CT
                                                                                                           the,,  are  a@@l,--in                as      aul  ii,
                                                                           arc  r
                                                                t'                                         in               a@-)@.nlicition           al-oct
                                        "4
                                                                        'i-iavo                            air  that  Coes  not  in,cll.u.-@--  a,@,7
                                                                         3-n  one  senior,                                                    soTa-@-  nc,,,7
                                        ,D,--oc,--ra-@       :7,ta-Ff       activi-t,7,       1                   and  conic--
                                        and  -ic@7  T@7ill  '--@e  in,                          a  i-ru',7  cir),Dlication  that
                                                                                                         J--
                                        at  ly'C@)00,000.
                                                                             rT'17'1: T'lell lil-.e I                            I     avc-  no  o,)j(-'ction
                                                                       L
                                        to  unnin7,           that  ante,  but  I  jii-,k--  (liCn't  know                                      to  do  it.
                                                              D L@    i-:!E SS        Let  r,:tc  as!:  you  a  cou--le  of  questions:
                                                                             one:         @,.'iiat'p,  the  -population  of  the  recTi-on?
                                                              DrZ.                          Seven  and  a  li@-1f.
                                                                                      7.2,       rcill-,7.
                                                                        T T:l
                                                              D P,.                   ,%,n@  i.@,  tqis  ju:7,t  the,  state  of                           -i  .-,T-rso-,?

                                                                                                302
                                       r" ITIE              Pig'at, it foll@,is the state line.
   %,it- 117                           There    i-s some overl,-iD ,.7iti-i Treater r)ela@,7cirp- @lalle.V
                          in    the    Southern and  less   T)ooulated   --   PI-iilad(--lphia   and   Camd,,@n
                          area, and the Cran]Dc-,rr-,,,'Lloqc, and the resorts
                          But T thin), certainl,7 ileT.i @-Ter@ey            has defined      itself as the
                          entire state and,  indeed, have conducted activities throualliout'i
                          the     state.
                                        _7. 11.7@Sll:   'hear sent a staff nerson do@in to Southern
                               7o-rse@7,   anc, TDairl the  salary and all       expenses for a ,,ear
                          in est,-@'.  lisliinu the           Jorsev CAII actencN7.        ll.'hev    consider
                          ther@selves a state-iqide nrograin.
                                       liod Tlur,@nhy?
                                              CTTI
                                                            O'll, Y---s, T.Od laterally;, is             -Oee-.v
                          from a Management                       visit to          .Ter:-,ev earlier    t',,'l 1
                          7 e
                                       @,4R. @IE-lt',CKER:  I -,,Dent 1.1unscla,,7 and
                          the Proara.-@n Staff of the             k-)Ier-:,ev Reaional. ',Iedical  ProcTrar.-i
                          and tiic'-r i,.anacemont is e:-cellcnt@-.          The  nrocrai-.   .-.@anaCTcrip-nt
                          in :)@-irti-.ular -- they arc, in the -oroc5@f,-s of ta']-,iii(T (@)-i --FU,Ll
                          corporate resnonsibilitv -frori -the -2nivor--,it,.,              t!IC,. Tjl-ii vcrsi- IL--
                          ,,.',(-,dical Sc,-iool  and thcl --iavo developed the additional nolic
                          basis for this, but thev still have               some administrative
                          Tianaaement nolicies to dovelon.
                                       But their nroarai-a manaaeTqent was ru,)erL-1.                      have
                          a T@ia-,,r of- operatinc- hv health snecialt-,7 ar(-,a!7,,              their f7@taf-,

                                                                                       303
                       meyqbers interact extensive-l@7 ind effectively @@,ith the
  @,7t 118
                       -projects.    It       verv, vor,7 Lmnrcs,,4-ve.
                                    T
                                  T.L  r-H7kIR)IL7@T I don't think @@7c hive -- unless the
                       Chair,-qan rqissed it -- a formal recor,-onendation on It]-le floor to
                       -- of course a ficure ,ias mentioned, but I didn't ask for
                       it, nor did I hear a second.
                                   !1,7,. B.7'@p,.RO-@"7s I'll second that.
                                                      Ti beclinn-na to (-,ar a conccnsiis
                       @.)ecau53c- if   have a 7.2 -- and it's on a ner capita basis
                              -@e tal'j:i.n(-T about 3.6.
                                                                           @?our motion?
                                                     Tire    -i rcvisi-nq
                                                      f
                                                    I  @ raising the    Question.
                                                    I  ,.,(-),uld !)e rore comfortable @,7it'-i
                       so          -life 3, or 4, or   5.
                                                      2.9,   3.4,    3.6,   3.5      @,7'-iat do I
                       ,Near ne-@t?   (Lauc,
                                        Oc La               1,7ell, in vic,.,7 01@ @@7,qat 1 have
                       iiearO,, and in vic@,7 of the @-)uelact that I havc- seen, and -Ln
                       views., of @.7iiatever I I-,no-,Ij of the '."@C@-7 Jerse-,,7 iDrocTram, and in
                       vie-,.,7 of t.-ie other sucfr--@@F@tions that have been r,-,ade durin(,-
                       this session, 1 think      that  $1 million do@-in from tire fiaure
                       they ',Llave requested is too much.        So I @,7ould cTo along @,7itl-i
                       'Tr. Barrm-7s.
                                   Til'IE C"IAIMla'j4: Sister,  you liavk-- better connections
                       than      do -- ..i'at do -,-7ou sa@7?

                                                                                 3o4
  ,7t                            S I S Tr, P,        Barro%,7s, there is one thing I
     119
                      haven't N-7orked out, and  that is the process of di.scorn-@,ient.
                      (Laucjhter.]
                                 DR. TIIUPJIIIP@lli:  @fter T,7',,IaLt Joe just said, I acTree
                      @vith this, and I an certain that all of us x,7ho have seen
                          Jc-,rse@l, are very, vo-r,,, pleased Tiith the !,7a@l, it runs.
                                 But     are ta,!]!.-.inci about i recTion right no@@i t.,iat
                      is gettingl@1.4 Tqillion -- and then %@ic are talking about
                      sudd.enl@,7 lea-,)incf to $3.4 million.
                                             @io, @, 3. 6. On
                                 CO'll!7-@--TT:              the other f-,heet.
                                                  T',.,--n I bac'@ to my criticism c)-c
                                 DIZ.                     7o
                           s,-icet.
                                 ,3ut on the other hand, i think theit's an unreal
                      lean into
                                                  @-,,Toll, @.7ould ,cu buy @3.2?
                                 DR.             i @.,ould cTo bacli@-, to 2.
                                 S I S R ,Y, 1',-q And I cfo back to $'-).9 too    that's
                                        SCTIAIT:  I,,rjiv not riovf-- for $2.9?
                                 DR. TE
                                 Ilo@.7 that's Keith the point that this is the su@erlat-j_-;-:-@
                      story, and if the Council felt di.snosed to increase still
                      further, that the T'loview Committee @)7ould take no unL'Drac,-e
                      of that.
                                 DR. IIESS:  I @@iould like to just make a Doint hbre:

                                                                                                     305
        120                               I hate to see us undulv influenced bv a region                    that    ii
                                                                                                                    I
                           comes in with a huge recuest and               grant a lot o4       funds,  just
                           because they ask for a lot of money.
                                          In  other  @7ords,  @,7e  loo'j,,  at  Puerto  TZico  --  a   toT,)
                           notch   program,   that   comes   in   @.;ith   a   modest    request    --    and
                           ,,,ou  ]!,no@.,7,  i)rett-%i  close  to  ,7het  w(:-  think  theV  can  use-   and
                           v7e c-i-ve them that.
                                          '@1,4oi7  this  is  a  first  rate   -nrociram,   but   they   come 1 'LI
                                 @-7ay over -- vou ]:none? -- @7hat thcv have preViouF,]..@7 '.-.)een
                           cTetti-na in -the last vear of funding.                 And Foricho@i,  that
                           just doesn't sit ri(-ht.
                                                  t
                                          DR. TITT           Could I add sor,@ethina again?
                                               CIIAI7-"IP--,T:   Cert,@i-nlv, Bill.
                                          T          "L@l:  Tio voil see     an        d for an extra
                                          )@TZ.  TTIU@@                            n e c
                           r@li.ig of none@,,  for   them to carr,7 out their          corporate tn3nc,?
                                                   I?CT
                                                               A modest su,,i of monev.            Thev havc@
                           requested an      added accountant to the staff.
                                                TTT          0
                                                                       I second the       motion for  .2.9.
                                          r"jlr CT             0.1'.   @-ie have a motion to reco@.-cn
                           funding ',"el-7 k-,--rsey on this      annlication of @,2.9, with the
                           sense,  I believe, of the groun that certainly it reflects a
                           favorable   task to,.;ard the region and otesumablv  (but aaaiii,
                           one'nas to see the proposal,  their supplemental                     oronosal
                           should be loo'@:ed at in Iulv                this   c-irou-))  in a quite :ravora'@,,,-@,

                                                                                     306
                     light.     That should be around'@600,000.00
  y@t 121                         Is that essentially the sense of       the motion?
   7
                                  DP,. FESS:    e s .
                                      BAPRO@7S:   Yes.
                                  TIIF,             Is there any more comment on t.,iis?
                                  If not      all those in favor
                                                    [r.Plie motion was regularly put to vote
                                                    and passed favoral)lv by       and
                                                    un f avo r.@l-) l@ 1 vote. I

                               TIJE                 it's  (a!7, they siy in l'oll@!i,,,Ood)
      12 2          llili.(TIl !,7oon" and I  thin'j-,  11-7ith  the  concurrence  of  t.@le  @roti.-D,
                    this  is  about   the   busiest   time   in   the   Cafeteria   and   I   ti-iinl,l
                    ,,ie  do  have   time   for
                               DR. TESC-TI@-1.11:   T@,7o more.
                               r.",-TLE C.L-IP-I Two more?
                               T@7oll then, @lou will have to !-lelT) me identify the
                    eas7i     ones.
                               -Pochester has been -suggested    is that one on @..,hi-c-
                    you are not t'i(? revlp,.7er,  Joe?
                               D'2,. TTT,](,;S -Ilell,  I   couldn't   -mal:e   the   ju@cTment   il@
                    I @.!erenit      Lau-T-@lr
                               '-IIE-          Oh,  i clon'-'L--
                               DT   JITI
                                   T          The hur@,,or is q--ttin(T strona.
                               ITII@ C@lp"j T,
                                                 t'li.nl@ Ile are goina to !,ia-,@c to c,--"--
                    in about half an hour, thinas are c.,ettina out of hanl-".
                                     @@7liv don't  just  lead off ,,7ith @oclier-,tc-r
                    and ask Joe to lead off.
                               DR.  Vii-,SS: !less volunteers.
                                                 TiOCill',ST-T"P,
                               DR. T,-Ij@ISS @-7ell, this is the third anolication
                    we have discussed this morning in i-71-iicli there is an  inverse
                    relationship bet,qeen the size of the  --  the  amount  of  nancr
                       and the quality of i,?Iiat's on it, at least in ry estiriaL.'@ on.

                                                                                                          3o8
                                            In   terms   of   the   overall    orci--i.,.-iization    of    the
    12 3                     tliev   seer,-,   to   be   well    organized    in    terms    of    their    overall
                             goals and o'Djectives,  and they are consistent with the
                             national goals  and objectives.
                                            Their revie@,7 process is clear and well defined.
                                            ,,-@s near as  I  can tell from the ar)olication,  the
                             leadcrr,l   i-P   on   the   .Dart   o'   the   T3roc7rar-,   staff,   seems   to   be
                             hiq"-, c.Tualit@7.      They    have     identified     .,7ithin     their     recTion
                             the areas of need --   the@,, lia@7e ci-,)narcntlv done sor,.c (7ood
                             ':)ac!,,-crrou-i-id .,or',,. in       of '@-h(,-  identification,  and
                             c-,ot a '-Ic-,r.74-onal Plan             out              dis'. la-,;,@-  it clearl@7
                             an-'-           on a man                               in    teris    of     their
                                                                    or
                             undcrsurvevs   and    t-i(--    nec,-9.     -)i-in@ar@7 care,  and that tvne of
                                            one oil -he thinc-,:; @@!hich -I enforcer a,-,out third
                                   -'cat-ion
                             annlL                  the-:7 have    tli-2i r coals,     and   t,-ien   at    the   ac"
                             thev     have     their     @jec@@ives     of the     nrolects     rela@@e@     to
                             goals -- and the  'undincr is disnla@,,eift               ri(@l.it alon(T     i t'-i i t
                             [T)is,Dla@?-s a Oocur,.cnt.]
                                            ;',fear overall 7oal ii-erc,  and listed in nriori@li,7
                             order the i-7aN7 tl-,c,7 nr,-ori7 e  t'                     F,     the  T-ione-,,,  ti
                                                                          ic nroDcct                              .,iat
                             goes           it.       Tnc@ then    the    cll,-iulative    total     that     .,ill
                             spent on that particular              aoal.
                                            @.0"7   this   T)arti    cular  i,')I)licai---'Lon  is  onlv   )'or   a
                             continuation of a core                 staff,         a     small     increment     -- i-)lu'73

                                                                                                                           309
     ,1.7t  12 4                  @,,7o small increment -- t,,..7o small 7,)roj(--cts -- and the rest
                                 of i,7hat we see listed here under "goals" @,.Yill be coming
                                 in in the form of projects in July.
                                                   So that basically, all we are                       asked to do here, is
                                 to proof the cumulation of a relatively                               small  corns  staff
                                 an& t@io small T)rojectc., and this is communicated in such
                                 a @,.7ell orc5anizee. 'Las.@-iion that it just 53@eT@is to me tliev got
                                 their                tocTother in that r(--,g
                                                                                         ion    prett,7    well    ---     and     T
                                        favora,Dllz  im-)rc-,sred  and  I  see  no  reason i,7i-iv ,.7e  shouldn't
                                 give  the,@i              t'.Icy T.7ant.
                                                   D@.                     Is  L@h@---o- i-.ore  co,-,inc7  in  7u!,tr@
                                                                              tTi@-,j are coi-.iii-ici in                          a
                                 bia  increment  corin(-  in  in                              'L--.',ic  ,,)roD@oct,3.  '7ou   c z-,, n
                                     -aad%7 sce clca                  .1
                                 al.                         rl,7 T,' at t,-io@,e      T)rojcct-,  -ire  going  to be
                                 and  ho,;:,   t'@,i
                                                   e,i T-iill  relate  to  -Eric  cToal.
                                                   '@o  I  have  rated  ti.acii on          either  "Satisfcicto--@,"
                                 or "E.--.cellcnt" in evn-r,@, catcaorN/,.                      --'Ji(@re  @.7cre  justt.,o      that
                                 I  nut  "Satisfac-or@7"  on  I'lo7,7cver,  @,!it'
                                                                                                 ,i i,,ore  in.:.-orration
                                 D -c r.@l aT3s at staff level,
                                                                           ti-ic,/ mial,.t ,.7ell  be       categories            of
                                 excellence       --       and       overall,        based on ,,7hat  I     see    here,  I      have
                                 rated     it     as      a      "Su@n--rior"      region.
                                                          P@Tll,:     1-7hat's  t:-Ie    CITP ?
                                                   D       H U             Ed Lane            he  sent  in  a nice  letter
                                 sav,incT ',-ic,-  su@nT3orted  the @,7hole  thinri.

                                                                                   310
                                  Til- CIT.Nj@llpl-1: You have a region    hr@re, an T,
      125              @@7hich geoqranhically  is clefined in cxactl-,,r the same
                       configuration as the sin@tle arc,,a-@,,7ide B ,%cTency (,@-nesc-@e
                       they  have,  I  think,  good  relationships,  and  I  think  7.@vle  nav
                       even have an incestuous re]-ati.onslii-c) d(,-velo-r)incr in the sense
                       that I believe    Peter ',Iarkl.,@ brother  nay become the B T,gcncy
                       Director,         T, 'alter s retirement this sun,-Tne r.      '@,,Ic)T,@7 this
                       r,.iay not help -- havina   kno-,,7n other brothers, but
                                   DR.  TIIU-,@'-@@l:  '-,lo sisters?
                                                     ',3ill, -,Iou @7cre the other rcv@-.c@@7@r on
                                        CIT
                             annlication       it is a ver@,7 modest one in -- bok--"-@ in
                       amount and in          it is         are -,)ronos3-nc, noi.@7. --ut @..ic"
                       Ir-@ -n oT@7 T3re'Ltv %.Tell ,,,hak'- t"l--ir -',]-.4 million annliceti-on is cToi-niz
                       to lobK like in terms of speci4ic activities.
                                   DP,.             Joe said cv@2r'%,7thincT thaL--.! @-oialo,. ha,,7'o
                       said aoout those -Dri-orities -- @.7ell orcrani-z@-c'.,
                       rTrant-3e situation is a separate from the s@andnol-rt of
                                                                                     CT'
                       never liavinc.T had a real evaluation group; an(!, the
                       voted unanimously  to recommend  approval of the annlication
                       and sent a vcrv cood letter.
                                    So that i @,7oul(-l su-or3ort ev(,-rv,t,-iina he  said  and
                       recommend    the absolute figure of  @Y361,437.00.
                                     -to also bring uT) t,ic ou@@stion i                       4-
                                    T'f -ki                                 n tieir i-),)l@cL L'@O
                       thou-TI'll that t@,icy have r)ut  out  an  @,PP  of  Sentember  1,   '74
                       June   30th,  '76, in the    'T"P that t'-,  cy  ilave  distributed  all

                                                                             311
                     the @,7ay do@@?.n -- this is the health care Oeli.ver@7 oroarain
                     and al-..,7ays has )een   "1,300,000
      126
                                                 ilhat @7ou are sayina, I  think, is
                                                                                   LTuly
                     that @.7e may see a nura:,Dcr of activities Y_DroDosed in   the
                     a,-),,)lication,            run I)eyond the end of nel<t fiscal
                                   ,.7'ich @,,,ould
                     @7(--ar -- i-7hIi-ch @,7e have said is at least perrqissil:)lc to be
                     lool@eO at.
                                P..gain, I don't kno@,.7 @-7.',.-ictlier @-7e i.,Yill see ..ii'lat @,7c
                     are tr@7in<- to look at in I-lot.ro '7e,@7 Yori@: later tiai.s afternoon
                     T.7.,icrc almost everything      be -)ronoso-d -For t,,-7o@c-ars.
                                      @ill, ,,cu                 @,ori(--t" in(-?
                                                   .int,@d to F,
                                                  @@'oulo@. second.
                                                 You -@..:ould second  o.k.
                                D". 11-SS:   I so movc-A.    L aucT!i e r.
                                                      r..Io-I.-ion recrularlNr -out to vot@-
                                                  and carried unanir-o,.islv in f-aior.
                                                  0.     I think -.,,e have it.   I
                     think treat is a record       %@7c  even  beat  Puerto  7ico   on ti-iatt
                     Joe.

                                                                                                                  312
                                                                 T' 17, S l@', I',@ 7C-'@TOl  F@ A-
                                                                      I  tliin)@       could,  z,.qain,  pro@ai,)l@,,
         1 2 7
                              take  u-) one more region.
                                              Dic]: aave me  a       nod from his end                 he has been  in
                              co.-,it,)-ct @@7ith @,7as-riington  a  lot  this itiornincr,  because 'ile did
                              iiav(,,  sort-!   cTue@3tions %,7(-- thoucjlit micli-it ]lave      soirp- partial
                                                                                      e.      I  don't     kno@,i @7'iiether
                              ans@7ors  o as  it reJ.ate@,  to CP@ li'ler
                              ,..7e       to nrocer@d @@7itili 7i-eshinc-fton  and Alaska,  or another
                                                    t,.7o  rp-vie@..!ers  on    TI@ra.,,3'!,iin(-,ton and -7,%Iaska are
                               r      a r r o,' ,,.3 @n --I  d e  L ci P u P- n t cDo @,ou -@,7ant to take  it un?
                                                                    Y@-f-,,  I  think ..,c  can.
                                                     3
                                              --!-iis,  in m,.-  i-,il--'-imi@nt turneO, out to be another
                              fine pro,-,--am.
                                              1  rate  them nr@tt-,,  hi@-il-@l.,.@  in almost ever@-7  ctitecor,,;,.
                              T'--le coordinator  Donald  fC!arl--.,--nl    I understand,                            a
                              verv fine  reputation.
                                              !!AG Chairman,  is  a Dean of the  University @-ledical
                              Scliool.
                                              T,'our mei-jDers  of the Universit,,y of @lasl-lincTton are
                              on the Executive CorLimittee,  @.7hich concerned us  a little bit                                    i
                                   and that's out of seven.
                                              They did suffer quite a depletion of staff during
                              the phaseout   i-)robl(:-m.            They dropped  from 52  do@,7n to  35.
                              Thev planned to rebuild,  and the rc-beefi.ng ur) mav   constitute

                                                                                    313
                      something of a nroblem  for them.
  -vit 12 8                       I-!R. de La  PTJEi'ITE:  Ycs.
                                  @14R. BAPRU@IS:  T'Lleir staff organization looked
                      to      logical and simple.
                                  They've got a   rcaional advisor-,7 grou3? of  42
                      and six or seven of    there. are from the UniversitV -- the rest
                      from the si--anclr)oi-nt of interest the representation is nretty
                      iqell balanced.
                                  P,A,G seems to @e forcefil     and active, and  is still
                      T,)rf--stir,@ous enough to attract a C.IOCO,, OUCIlit@7 of neonlp- to
                      replace those @.-ilaose terms have            durincf all of
                      surveillance   of    that.
                                                                       -ecn 'coi@-.it'---s a
                                  I"heV've   aot soriethina like -rour4l-                    d
                      su'ocor@j7,iittees   t',-Icv arc Dr,@tt,,r             but @L'Lie@7 seer.-.-
                      to be functionally ----Fl'ccti-vo.
                                  Past Performance --     continuation c-i-fter r-@IP
                          in the to-)  dra,,7er.
                                  m
                                  -Lheir direction has been            on target,    7h--reas
                      bot-'-a tilde -aission and t-ir--ir s-.occi.al area needs -- 1.@d I
                      night @oint ou- in that connection that L-hc@,, are (fcal-'Ln,7,      4
                                                                                             th
                      three  categories of pro",Dler,.S:
                                  Thcv are a tcrti@ir,i  center for a large oco(-ranlaic
                      area.     rr',aerc are metropolitan areas ...7,iich -irc-. fairlv classic.
                      And then thev    have trcmen(-.LOUr, remote area Problems        7,lasl,,a
                      and TTas@iin@ton both       and  their sc-@c-iii  to dcil ",ith all o'

                                                                    314
  129
                                         responsive to ot",
                            They have been                c@r federal
                  initiatives.  Their Peqional @ledicil I,,cyencies and netATorlc
                  all the Cray uTD the line, is aood.
                                          CT.lp
                            Thev assist the      the ad hoc studies
                  close collii)oration.
                            J'heir ol.3jectives arc, aaain  on target.  They are
                  specific anO relative to the needs.
                               ,:)ronosals see,-, to bo-, to ri,2, consistent
                      the e,,!.nrp-ss(-,d o'i-@jc-,cti-vcs anO nri-orities and they have
                      @l t  r i r r'-- i ti a e,. o l@ c--, -,Ihson it.
                            r
                            -.,here has ]Deen ahun@-an@L. exposure to (-'@lj--.P fooe,'@)aclll
                  on c-,rerytliina - and the,; have aotten some feeo@iDac,r,-. and that
                  is not beina studies.
                            Feasibility, based on a trFcll-. record -- tiic nature
                  of the T)rogram and special conditions,     iDrett,,7 coccl.
                  to me
                                 CTI
                            Their IP relationships   I might mention a little
                  bit a,iotit that:  rri hev have t@.70 CTIPS and seven full tir,,,c staf-@
                  functioning Bs, nlus sonic others in various staaes of
                  dcvelon-.ent. "7.@cNi maintain a recular communications contact
                  i@iith t'-in -@@s and thev -)rovi0c them, @,,ith technical sunnort
                  and sore
                          ...o&est funds on their (,nteriori.ses.
                                  directors arc on the
                            'Poti'l                       and there i s o t'r i,-- r

                                                                                                                                            15
     130
                                                       P@d  one       of       their       projects,       Project        @luml-)cr        88
                                    for  ',175,000.00,  is  to  develop  a  test  idea  for  combining  of
                                    CIIP,  P@AP,  and  to  nrenare  for                     the             upcoming              legislation
                                    and  I  tliinl,,  that  ti-ie@.,-  @.7ill  do  a  good  jol).
                                                       I  had,  to  start                        one  reservation,                            sort
                                    of    vanif-,Ii(--d,    as    I    @-7ont    ti-irouqh    it    --     this     @,:a-,     a     orocrram
                                    %-Ii@ticl-i        SuLcficientl.y  hi-(-lilN7  dominated  b,7  the                        Un i vri  r  F@  t-,7
                                    of @7  @,7,hj-ncTton            1-ut   it    diC-n't    s(-,e..-.1    to    com@,--    out    in    tj-,c
                                    nroduc@.  t'-,-iat  cam2  out.                  1     could     find     no      evidence      of      t'.,@at
                                    do-7.inance.            '@c,7.7  ...,'@icthcr  i  am                 or  not,  i  don't             I  -r. 7
                                    IjUt     7     couldn't     sun,)ort      t:ie      conclusion      tl-la.--      t7-icre      -iias      that
                                    dbT-,ina,nce.
                                                       In  siir,,narv,  I  rated                       as  a  "Sunerior"
                                                                                                                 'D
                                    sur,stantiallv  better  than  the  avo-@aae                                            loci-ed     to     r.c!     a
                                    relevance  to  @-iission,  needs,  involvcrient                                     ')oth
                                    and     pu"-,,lic     cor-,i@unities      an(5.      t'icir      efforts      rate      --      @,icrc      is
                                    aggressive        preparation        for        the        u-,oco.-i.i-nc-lf        transition         in
                                    plannina  and  they    -,ee.-.eial  to  ]De  ver,,.7  @,7ell  organized.
     I'-:i'DE X                                        And  so  I  --7oulcl  recom.-fic--i-id  them,  acTain  being                       one  of
                                    our  hetter  nrocraTr,,s,  if  t'--acre  is  a  nrcr.-ium  treatment                                  avail@,-)lc
                                    that  thc,7  ,..,oul(-l  (7ualif,i  for  it.
                                                       T -,, @TI@  CIT 1 4@@. I     r.v',-iink  vou.
                                                                                                                                            TIl, -7
                                                       Joe,  k7oi,i  .7ere    -the  other              revic!@7er  on  this                          CL

                              you have on this  to acid,  su'Dtract,  or
                                                 A
                                                                           1,7e 1 1                                  ha-t
   131                                            (7,e Ta PIT,                      I @.,lant -to emrliasj-,,,c t
                              tli,--y   are   areas   of    prograr@i               on target
                              frop.i ;,,Iiat I See.                               cTood r(--lationsh,4.n ,,lith
                                                          T',,ic,v Iiiavo v e r,,,-
                                                                    at  state     C,"f'D     Director      oro-)osed
                              ti-le           an@ that in         tl,,
                              17a?,',ii.ncT-Lon and Al%lasl,-Ia Y.,ic'rlll)ers of the @eaional T%,dvisor-,,          o a r d
                              anJ that -the staff narti-ci-pates               ancl. is  as@,icTned sTDecificallv
                              to Gore ,,,,ith tire Oevelon,,aent of            the CIIP Acjcnc-i.
                                             I think this  iF,  iri-)ort,,iiit.
                                             Thev hav,3 created            many thii-ic,,.-,           -ire outside Of
                              the uni-v@rrit,,7 enclave.              -ho-.@, -,,-,or,@ed        tli@- Go@i-icra3- '.',ison
                              -@esearc.'.@.i Center,  the Scattl-e-   -lc(-Ti-oiaa      1 T7eal.ti "oar@,L,
                                               15  "C'-Ool T',i3t3-
                                                                      iC4-
                              ,--!IC                                                     Tli-iivcrf-,itv,  Oj-     -@,':a
                              L
                              t'le rate !To@,-)ital  Association,  tied 'TaFI-inr-@on
                              @'@socia,-ibn,  tile                        Still-c "cclical -7,sFociet-@",
                              the -Irl--,t'k--er @Craini@,'L--ral-@l'on o@ '-,os@)itals  in
                              last bu   not least,  t7;.io-                         Chiopno             7orce,     @roTa
                                                 peonle   I have hcarO. vcr@.7 favora"l@ cor,.77,--nL'7@
                                                                    T
                              in terms of   @,@7ashi-ncT to n -J,;i L@ in 7,jicrican neor)lc.
                                                                            T
                                              So T  are .7itli 7ou.             .I-i ir,lior@-@secl with l@ashinr,-ton,
                              what they '@iav@- L-cen   doincT.
                                              -.hat's a'.)Out all        I      have.
                                              DP,.  TESCTIV'-'
                                                                    Sorqebod-,7 7.:as  saving that t"ic,7 ,7c--e TTa--@
                              a@-lead in tile c@uality of assurance                      ind t'Liis @.,,a!7,  @,icll      orc-
                              the      quality      of      assurance

                                                                                     @17
                                  At the conference thev had motion pictures 11-@li'lo@17inc-,
  1,7t 132             the currents of stanl,'.z,,rO s--,ttina and studies of patient
                       manac-j(---,-i@-nt -- and in coin-narison @t7j--th T'll,hat hannened to natients:
                       and ,.7hat standards of rtiff           put together -- and
                       r,ho-;ic-d the          b@7 @,7hich ciianqcs in  management @,erc
                       effcctc(@' ',)v tire ouL@-nut of that e.@!.c-,rcisc,,.
                                   "lo,,,.., that's a corinlc:,,to renal. circl.e done on 16  nm
                       color r@@--)-'L--ion pictures     the rest of us ,.7ere still
                        c a r n i n cT o@,7 to    "ought,! a.@,surance."       @-id I just
                       felt        this @-houlet !)c
                                   T,7,TI
                                                     T felt t' c same thin(.,-  come  t'irou(7'i
                                          -ion o-r  foresi-clit                 -)lanni-
                       their de--.onstra4.                       ario. ordc--lv         n(-  .,or
                       anticipated events.
                                   .L                 I thin,'-,           alit  to  hea   roiiL
                                    IT'r                         c   t7,h t             r
                       Dic'.@, because          relEitionslij-@s @.7itli f-'TTP i-i@,,vc L)c,,.cn
                       a s a o o  T  t'.Ilinl-, i.4-- .@,-as also clca-- frc,@ni this       n
                       ha.,@T,)cn,a('@. to !)c one that -L lool-,eCi at, r,,,7self, ',Dy acc4-c@cnL--
                       when they first @,7c,-rc co.-iin(-, in.  I @,af,@ just tr,,,ing to act a
                       sam7.)lc of T,,hat the an,-)li-cations loo,:cd
                                   T-nd certainly tqcir applications drc,"71 some  !-irp-
                       from some of the C-l-@-- acToncies, a-, ,rou not,- -- indicat-Lil@
                       their -,,,Iccutive               @,7a@:, meeting ,,--sterOav and -)icl:
                       had T@)een in contact bv nion(-- @-7it"I Tlasi-iin@.ton and           this
                       morning, to a-it           f(-c-,cl,l)acl@, on that situation.  7,nci that's
                       one of the reasons ii(,- li(-,l(l over on this one.

                                                                                                       318
                                         Dick, %,7ha.t (Io you 'iave for ii@'?
      3 l@-,t                                                       I
                                                              T           the concern that I  had  @,,ith
                          th@ ar)-olicrition ,7a-@ that t'le@7 did not snell out holds thc-,Nl
                          x@7cre goj-nc to resnonJ to Cll'.P comments,.               Tt'lat       one   concer
                          1 had.
                                           I      ariu@,ce. .7hen I r@-cir3. the one from Sr)ol,,ane,
                           the  C-IIP  P,  "7,lr-T(,-PcN7,  to  !-,Ce  this  t.@7,ne  of  coi,ii-nent  coming  from
                           an ac,-@-nc-,,, @.,,hicii       in T),.a @;eout devoted 50 percent of
                                    f4@]  I                        -),@-ti-cular ac.T@n
                           @ici
                                          _C i@,antial to this                           CV.      I tAOU7,@'it
                                  -,@@as intcrogtinf7.
                                          T 7@-
                                                   an,7" oll,  t'                  Conr"iLtc-@c i-, cr(--)in(7 to
                           r.@,s,,)onc@, in -..7r-.Lti.n@, to         o,l tI.,,e              comi-,--nt@-,   and
                                       .iav@-- cc)-)j-cr, o                I fl--lt it 7ac,  iiT,,-)ortant  -Fo
                                                             thosp                                                r
                           tl-ie-;-,i to Leave a for;-ial res,nonse -- for their                   record.
                                           "T,7 CH@ !"'I'         Coi-incil @,7ill     ave  L-1-ic @ono-F-it     of
                            this letter,
                                                                  didn't ffloss over that, but  tqe,,,
                            met m-,T criterion                 are in @ood communication to
                            thev uct fee,-";-)ack and       the@7 have a legitimate and fait nrocess
                                                                                                  .,e can asl7- for.
                            for dealing %.Yith          at.    @lo@.7 I thin!: that's all
                            l@e  can't  as!-.  for   over,7Dor
                                                                11,7 to lool- Ur)
                                           '.IR.  RUSSI@1,L:    lo, i acTrcc.         But I just felt that
                            for their      Drotection, tLi(,\7                 r(--.-Y)on.d.
                                                 T   I" " iT    I  .,-on(ier, to   s,7ee if k,oi-i can

                                                                                       319
                      if your current re-adincT a,7,rec-s that Donald i.,'.nari-Iman  carie out
                                       on(- of the first carefi,.Il-,,, drafted revisions
  @,7t 134            ,7it-I  proba3Dl,.7
                      of bN,,la@.?r, to accommodate the Auc    t 1972  EP.'-,:j'PF iDolicy fo
                                                            fu.!3                           r
                      tile clianae around -- and has, therefore, a free            standing
                      self--,oernetuatinq  @C.
                                   I @.7ould infer from  @,7!iat  vou  said,  then,  that
                      .members  are  not  appointed.   There   is   no   snecial   right of
                      a,@--)oin-@,c@nt, as I gathered there -- and if  there         are iianpcninct-
                      before  7  7,EC  E@cec pconle -- that tiat lian7Dcner2       in  the
                      fair nlaV of standard no-ninat,'-ii.cT Process.
                                   is that correct?
                                                   I don't recall se--inc, their no,7,inaf--i-nc-
                      ,nroccss, but        en(-9. result of .@,,hatever their -L-)roccsr,, loo-l@s
                      like cood balance e,".cont for this one t;Aina I mentionel
                      j@@d I could  find  no  evi(f@encp_  of  the  @Tniversity,  or  TDro-
                      universitv bias in @7hat the-,,, T,.,rere doin(7,.
                                   T-IR. RUSSELL:    -Lhe voice in -@lasl-la, @qa.-,
                      the first nrogram that came up and dre@,7 u-o a verv clear
                      letter of understanding '.)et-,,.,cen the ITni.v(--rsitv and tile  T?
                      I 'i@no,,.z there has not been that dominance.
                                   '--'-Io%.7 there @.7as one occasion @@7here tile ui-iiversitv
                      hasi as grantee, come into tile prograratic concern, I)ut
                      as   grantee   --   thev   couldn't   exercise   the   nrouramatic
                      aspect  --  so  that  it  hasn't  been  a  vro!Dler@,  let's   sav.
                                   Ij I I,' CT
                                                     I don't l@no@-7 @,7hy peonle should 'De

                                                                                                             320
        135                 sur-.)riscd   by   the   nh(,-nom,@non   o@    ",".)itin-,    the    hand    that
                            ITOU.        It FP-E,-rn-; to r@-@- that r-,tic"l   of the no,,;t-1:7orld l,"7ar IT
                                                      ce x,.7ould su(7,cTcr-,t that as       a natural ind,
                            economic          assi.stan
                            per.i-ianf-3, not       even unhealthy pr.-icilo@-,enon.
                                            r
                                            ,-)nce vou I-lel-r) a c,-u,7 cc-,t on his               he @,7j-ll take
                            a ,,hac'j@, at iou a-, (-uicl@  aq he                 the next c.-u@7.
                                                                          t,-i-re is  a certain E,,mo rt of
                                                                                                            u
                            fc,c!l.i-n(- @,,our oat,@  in t'iit ]mind of thincT
                                                                 TTo@,7 r-,,an-k7 rc-,oi le ir
                                            !)n.  T,@SC-@                                    c    i-nvolvec;, in     this
                                                                  1  aEi not sure                              -,.,o an(.
                                                                                             it's       aDout
                                       or three -iillion
                                                                                                         T-"",,.-@n '-r ,a:7,
                                                                       )uar
                                                                          tor of a millions
                            t'@.ierc it @,7as  less t-@-ian                 ro,,.int,7,  ten venrs  acTo.
                            But    thev    are    scattered     out     all ovcr.
                                                            Sc--It"--lc  is  le5s    tian    a     L@j-llicn.
                                            S,@oi:ane
                                            'I,?.  T.371,Tan-,,7,',- F@i-)oi@anc,  their 2nace nro,Dle-.qs and
                            culti.,ran nrohlei-.s are:. Iliorrciidoiis.
                                               Jr
                                                  C71A
                                                        @"iAt-I -  I  tliinl@   it's   nrol:)a')l-,,,   a   little   over
                            a million,  Joe.
                                            "IR.  RUSS",LL:   But I don't have that -- I've aot the
                            figures    in     m,i briefcase,  !)ut not here.
                                            I.lu i'- for t,-ic-, record,  tl.,i,-3 arDnlicz-itionc, you rovic-l-lod
                            did not have the salaries of  t',-ic T)roqram staff.                            c y @,,T (? r c

                      --U)-)Mittcd in the reqicnal, ani)li@ca.t'on, and  i,,7e do have those
   @,7t 136              but tlle'%7 are not out of line.
                                  DP,. TIIUPl@IE-1: I juct @-7ant to as',, voti one cuestion:
                      You are satisfied that th,-,-,j, are a,',-,le to Utilize the  c-i(3(9.itional.@
                      half million dollars that @7ou're (Toing to r(,com(--n(l?
                                  T'R. B. @ P F)    i @7ould have only on(:- reservation
                      as i,.7as said on these  oeonle             have suffered  a fairly
                      substantial staf -F acT)I--@tion.
                                           thin!-., ti@ioucTA, based on  the comr)etenc(,- of
                      t'-.e Coordinator, ).nd their r(,-latioi-i@'iii,) i-7it'i '@oti-i acaO.@r,,i-c
                      and  nro,7iCcr centers,       t'.iov could r,.c-)u:-it a good tei@i.
                           as cooci                 I'm not too @,,orrieCt         t-,@t.
                                  P,nd I ti-i.i-nl@ '-,hat tho,,,,- are hein(- fairly
                            arc, jur,,L@-Ln(- from, no@.,7, a ftai-id-i-n(- -Level- of a-',Doiat 1.5
                      to 2 n4-llion      and T tiiini-, the,  can
                                  Suliject to this staffi-ncf              i tlii-nl,: t',, cc7n
                      ar-Iju,3i-- to it.
                                  DR.           All riaht, if you have this vie,,,,
                      current l'undinr, level of 1.8         so that if
                                                   I have 1.4 or 1.47.
                                  r     -fSS: "'Icll, there has been a diF,,creTD,--nc,7
                                  ,)R.
                      bet@7ec,n that sheet and    this  one.
                                  !'II. TIUSSELL:  The  latest fiauto @7e have, is 1.4
                                  DR. TIESS:   1.@h.(-,ro do the f-i(-Iures cone to on this
                      sheet?  T'.-lo first si.-I rqont'@,l@-'?

                                                                       322
                                 TT@US@IS
                                 ii.-      -,re these figures not six months old?
                             DR           p
     137           The only date I can find on ti-ii@, (@occiirc-nt is January, 1974,
                                    believe  iii-s 7,7af7, T)rci-)areO as of January
                   and I Islas leO. to
                   1974.
                                 PU"DSELli: i.,T 0
                             T)p T717S  IliS '[,,7OUlCl !-)C-, the fundincT level -For t'@le.
                   six riont",-Is one. t,irougli six.
                                           I       this on tl-ie other one,
                   is 1.5 to 2 m,-11.4-on -- call thc-,v handl(-, -tl-ie c-,@tra !-ial-F million
                             -1@. "ITIIOT7S:                    -all-inr, a'@o7Lit
                                              total n
                   jul.,,, of another '@-ial-Lr i@Iiii-lion T Co-i't thev  '@.)C
                               ,tl-l    4
                          ever,    nc,-
                                 r@:17 'T'
                                            u ta, rNYou          1-ic-- con
                             u!7,e -L-.'Liir,?
                                   SS-
                                 '!!J -@TT,: y,_@ s7@ut let m.--
                             T
                             ,.7h c n t.-i i scz,,,,c oi-i.-, t:ii:-, c!,iv@- tici-i an on-,
                   unit,,,, to r--vaT:i,-) the4--, 7,o it %.,a-,n'@@ all los!7@.
                                                    -ina(-, i-I  -z onc-y.
                             Yes, I thin]: thev can r,, 2 t' e
                                   T
                             DP,. T-11       @-yould r:,ovo aT)T)rove tlAe rc,7ucs4- a@
  IOTIO-,,A
                             [The -,motion @qas nro-perlv !-,(--coneted.
                             THE CIIAI@'@1701: That's 2.77 -- as requested.
                             Is  there any further (Tuestion, additional coi-nents
                   or  corrections

                                                                                             323
                                                       -5avor
       1 3                            All those in
                                                          [,-,-he motiop. ,,7a@, TDut to votc,- and
                                                          carrier3., un,-ini.,@l-,,iou@,1%,.]

                                                                                                                              3211
                                                                                                                                  CT
                                                          CTI I @- 17@@- 1  it is 1,2:20 arici, this r(i,@v bp- a oc)c')-
    @7t 13",                             to                  ,-"e  have  cor:i-,-)Icte,-l  nine  r(--C.Tions   and   N-le   '@@ia",7(.;
                                ciali@,  left  to do.
                                                  C 0        T     '-)o  you  -think N.ie  can @,7ra-o  this  u-p?
                                                   Tlll  CTTA                                                                         t
                                                  TJ. J,              T:      I    think    that    i-@,    still     --- an (7,  ti      s
                                       I    need     to     consult     @.7itii      colleagues      --      @ut       if @.7(-   Io
                                ;I,Ive it -,.7i':.!,iin oLir T,7.T-i,-3re,,7ithall -to cor@inlotc@, t,ior.,i  all  toda-,,7,
                                           ,--4,on't tl.'                     ot3-io-r               t,iat  T  have  t"!Ie
                                :)fit                             on
                                ani  @lia  other  r7L'aff   to                              of   t-hr?oe    thj-ncTs    u,--)    and
                                              tic@T, @i  for you.
                                                  I  thin!-. ,ic @-oul--'  hov(-,  to                7ou    to    -,it     aro,,inc7
                                an  hour  after  t@l-lat.
                                                    o I  t   I@ainl-,,    r(-@ali@-LnCT    that    sor@e    of    7ou    arc,    -o-inc,
                                to have  to  leave  toOc,,,,  an,7,1,aN;,                 c-)a.rli.c,        @7ou arc,-   (-o;lnc-    tn
                                                                                                            L
                                have     to      leave      todav      4ai.rl,7                             'licit   1.7e ,Dr
                                still  are  :Cace@  @.7j-th  a
                                ,-':.on'-L.  -@no@.7 @7hEt        colJ..eacTuc--s,  are       cloinrT.
                                                  i  think @@7c  cin                          act        t@irouc,I@"I
                                a?'@)lications  toOa,,7.
                                                                          Could @@!e  -shoot  for  that,  anc@  then
                                @.7hatev,er    time    @.7e    have    to7,-,,orro@.,,    1,70    could     just     look bacl.      @n(I
                                see 7hat @7c!  have  don(-,?
                                                  TIIE                      Yos.
                                                  T e
                                                       can't  Co       this  instantly              [Tndicatina 'r)lacl@t-,oard]
                                not  that  this  has  anything  to  rc,-coi7ric:,nd                    for it, -@ut  1  @L.,-i  i  n';,-,

                                                                                                                                                 325
          140                       @.7e can shake some things out and aive                                you some idea of
                                    ',,iat your actions @,7ere,                  %.7T@iat thev look like, collectivel@7f
                                    and the others may want                      to Jook at it a little, too, and
                                    see r,.iaybe adjust soTethina un, or dozen, something here
                                    or there -@7here sor(ietliincT seems to ;De inconsistent.
                                                       But I don't think @.ie can cTive you that immediatcl,,,.
                                                       D@7. T@ISCT-T,@T,,7:      ".Lnhat is ci ver@7 helpful chart.
                                                             rT' T
                                                       DR.                       T,,re @7e re(-,uired to l@cep t"lc.-S(-,?
                                                                   I'@'     7
                                                       T@- T T'  C'                'lo
                                                                                   Do   @7e ha-,ic any otli,-r eas-,,7 .-cc,,ioiis
                                    !."C-, could knock o-@@L)
                                                        1 i   c -1 i @, IT, -,T                !ola   r)c:-c-)lc   are    L--',-ie    rcvj---,,,7@rs.
                                                       I T-7ould thin!-.  @rav         I)C  T,7
                                                                                            @-estcrn  Penns,il-vani.a  i@  an
                                    easy  regi.on
                                                       DR.    TTIIJTI@T          I r-, tr,7ino  to  see  if  the  qroun
                                                                                   ',7o,  '7cstern  Ponn--@vania
                                                                             --Io,      'v7est  Virainia  is  prirarjl,.7  a
                                                            of -.7estern               ,7ou act
                                    continuation                                                   i  act  a  lot  of  c-Tucstionc-
                                    on  that.   .   .
                                                       T'r!E                       John, you and 'Jr. T-larro,,-7s  @,,,ere  t',-ie
                                    reviewers   -- Oo ,7ou recall --inv difficulties                                           is   that    one
                                    t.qat  @.7e  i-.ialit  nolisli  off  in  a  brief  ncriod?
                                                       T                                 1,7cll I thin]-, @,7c@        !,.ad better  ,,,,ait
                                                       .)P,.       T'I'Pf7)C"!Br)TCT
                                    Until       after       lunch       an,@-7a-,,,.

                                                                                                326
       141                            TIT!71               0.
                                       I tliinl@ @ie'r@-  c@oinqf  to  cor,,.c  to  having  luncl@i  nor,I
                         So it is 12:0@5.         Coul.d ,%le- tr,7 to be bacl,l i-),.7 1 :1.0 or I!:  15
                         at tire latest?
                                                   @ie havc four hours and eicht reqi-ons,  and
                                      You see
                             1,7:p- can Co tl,.at
                                                              [The proc--ccOinqs %%7cre recessed for
                                                             luncheon at 12:25.1

    HEW                                                              327
  Ns-1                                   AFTERNOON SESSION
  fls arc
  hws-1                                                     1:15 P.M.
                             MR. PETERSON:  I guess we are ready to commence.
              4              Joe is not back, but before we do, I did huddle
              5   briefly with Bob next door.  They broke a little later than i
              6   we did.  We are just about neck and neck how.  They have six
              7   left to finish. We have eight, but I think our view was, andi
              8   I wanted to check it with the group, that we are going to
              9   be able to finish the applications today, but there seems to
                  be some need for a meeting, however, of a very brief duration!
              10                                                              01
                  an hour or so, perhaps two hours tomorrow morning to sort of
              11
                  take a step back and look at each of what the panels has done!
              12.
                  and ratify it as a whole group, that is the actions of the
              13
                  respective panels, so that just Bob and I made that decision.
              14
                             I see all kinds of problems that we try at the
                  end of a long hard day for both groups to try and come to-
                  gether briefly.  It is going to be late.
              17
                             How do you people feel about it?
                             DR. HIRSCHBOECK:  I agree with you.
                             MR. PETERSON:  I know you are going to have to go,ii
              20
                  Charlie.
              21
                             You know, if there is someone else who feels as
               2
                  Bill or others may, that in one sense the plowing of the
                  field has been done, and I think you know one would be able
              24
                  to take off at the end of the day.
              25
  HOOVER REPORTING CO, INC.
  320 tlassachusetts Avenue, ti.l.
  Washinc,,to-,i, D,C. 20002

   hws-2         1             DR. HESS:  If we can, as a group, look at the onesi
                 2 we have reviewed, and satisfy ourselves within that review that
                 3ii we have been fairly equitable based on the factors tha
                                                                            t  we
                 4 identify, and then the basic work is done, and it is a    matter@l
                 5 of seeing if the two groups can function.
                 6             DR. HEUSTIS:  To do that don't  we have to have
                 7 something up on the board?
                 8             MR. PETERSON:  I don't think the  board  is  large
                 9 enough.  I started doing somethings with respect to the morning
                 10 applications. This is something that  I  think  the  two  groups
                 11 are debating a little bit.
                 12.           This percent of target figure column I don't think.
                 13 that important.
                 14            What I was doing was to show a figure if there
                   was any for a July application so that I was keeping the
                 15
                   first three columns, or that is, the first four columns,     but
                   then indicatin the  estimated  July  application,  again  trying
                 17               9
                   to group them  so that, you know, looking  at  this  mornings,
                 18
                   I find New Jersey and Rochester and  several  programs  sort  of
                   up in that first group, and Joe did ask, and I will try    to gets
                 20
                   this data so we can incorporate it for all of them, a rough
                 21
                   population figure like  3.2 million, or 2.1 million.
                 22
                               I think if you can settle for  A legible Xerox COPY
                 23
                   of a legible longhand sheet-we can have  that  for  you  first
                 24
                   thing in the morning, and we would, on Panel B, take a look
                 25
   HOOVER REPORTlt4G CO, ItiC.
   320 Massachusetts Avenue. N.[.
   Washington, D.C. 20002
   11)(le)% rAc. clra

  hws-3         1 for 30 minutes at what we have. done before we reassemble,
                21and if that means we get together at  8:30  instead  of  nine,
                .9i! that I again leave up to you, but again I  sense  it,  and  it
                4 seems to make sense to me if you look at some of these things;,
                5 -- well, we won't have that job done, obviously, at five
                6 0 'clock.
                7            DR. HESS: Can we find out, or do we  know  which
                8 of these two figures are the most correct on this previous,   1
                9 or let us say, the six-month current funding level?
                10           DR. THURMAN: I think Al is correct when  you  look
                11 back on the applications.  I think this really goes back to
                12. January, and I think this sheet, although I don't particularly
                  like it, is the sheet.
                13
                             DR. HESS:  This one?
                14
                             MR. PETERSON:  I am embarrassed by numbers  that
                15
                  I don't agree with, thus I tried to either only have one  set
                  of figures in front of people, or if one  is  going  to  put  two
                17
                  sets of figures to see if they don't agree before you place
                18
                  them,
                             The first column in this figure I believe is correct
                20
                  in this sense. It is the current six-month award  times  two.
                21
                             MR. NASH:  No.  It is the annualized level, on the
                22
                  third level.
                23
                             MR. PETERSON:  Yes, that is the way  it was explained
                24
                  to me.
                25
  HOOVER REPORTING CO, INC.
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                                                                          3,30
   hws-4                       New Jersey currently, for the current six month
                2
                   period has a grant of X number of dollars.  The figure that
                   is shown now in this column is X times two.  That is one of
                   the always surprising things.
                               DR. HESS: I wonder if  there  is  some  staff  person
                6
                   we can call on, whoever put that together.
                7
                               MR. ARNOLD:  I don't know where   that came from.
                8
                               MR. PETERSON: Let's  not  introduce  another  set  of @i
                9  figures.
                10             DR. HESS:  I think somebody on the staff level
                11 ought to be checking these out.
                12.            MR. BARROWS:  Let us  have someone look into it.
                13             DR. THURMAN:  I think your point earlier that Dick
                14 White's sheet is a sheet that was put together months ago, and'
                15 I think this sheet is fairly close to up to date.
                               MR. SIMONS:  This one is correct, but   it will  take
                17 Larry to explain it.
                               MR. PETERSON: It is always a  puzzle  as  to  why  we
                I!) pass out three of them.
                20             MR. SIMONS:   This first column does  not  have  such
                21 things in it.
                               MR. NASH:  It may not have the Region's portion
                22
                   of the 6.9 that was held and later released.
                23
                               It may not reflect 1972 dollars for EMS and HSEA's.1,
                24
                25             There are 'a lot of basic  possibilities,  and  maybe
  HOOVER REPORTING  CO,  INC.
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                                                                                                                                  331
    hws-5                    1      Grant  can  explain  it.
                             2                          DR.  THURMAN:    It  does  not  reflect  carryovers?
                             3;i                        MR.  NASH:    It  is  taken  off  the  last  award notice.
                             4      It  doesn't         tell  you  the  real  fund B  picture  in  the  Region,
                             5                          MR.  PETERSON:    Can we  sort  of  make  this  our prime
                             6      reference?
                             7                          We will  entertain  an  explanation  from  staff  as  to
                             8      what  the  disparities  are.
                             9                          DR.  HEUSTIS:    After we  get  through with  all  of
                             10     the material?
                             11                         MR.  PETERSON:    I  am always  reluctant.    I  know  I
                                    should be  saying yes,  but  I  don't  differ  myself,  and  I  am
                             12.
                             13     looking  around  and  saying who  is  going  to  deliver.
                             14                         DR.  HEUSTIS:    No  earlier  than  before  we                             get
                             15     through with  all  of  this.
                                                        MR.  PETERSON:    Mr.  Pullett,  Review  Panel  B  and
                                    its  Chairman,  humble  Chairman,  sort  of wanted  a brief  explan-1
                             17
                                    ation  as  to  spare  sets  of  figures,  column  one  of  a printout.
                                                        I  just  tended  to  ignore  it.    I  was  lucky.    I
                                    thought  one was  more  credible  than  the  other.
                             20
                                                        What was  the  recent point  in  that                           case     that  gave
                             21
                                    us  a  problem?
                             22
                                                        In   New Jersey we  show  a  current  and  annual  annualized
                             23
                                    at  roughly         $1,458,000.    That  I  understood,  and  correct  me  1                                       1
                             24
                                       am wrong,  was  literally New Jerse  is  current  six-month
                                                                                                     y
     HOOVER REPORTING CO     INC.
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                                                                                                                   332
    hws-6                      ar,.iard times two.
                       21                              PULLETT:   What you do  is,  you double                      what you
                                                  MR.
                               had in  the        1974  funds  that  they  received,  plus  the                   carry-
                               over.
                       5                          MR.  PETERSON:   That  includes  the carryover?
                       6                          MR.  PULLETT:   Yes.
                       7                          MR.  PETERSON:   Their share of the  six?
                       8                          DR.  THU@L@:   That truly  represents  a total  figurer
                       9       of  the dollars  they had to spend in the  six-month period
                       10      multiplied         by  too.
                       11                         MR.  PULLETT:    if  it  is  carried out.
                       12.1                       MR.  NASH:   If  they  contracted it out.
                       13                         DR.  THU@IA,-N:   That  is obligated  funds.
                       1-4                        MR.  NASH:    It would not even show here,  you see.
                                                  DR.  THUI@v@N:   As we  look  at  it,  we  are not con-
                       15
                                cerned about obligated  funds.
                                                  We  are  talking about  an operating  figure,  and
                       17
                                this  is  the  total  actual operatin   figure on  this  printout
                                                                                      9
                                                  MR.  PULLETT:   No,  it is what they  received out
                                of  1974  funds,  plus  their authorized carryover.
                       20
                                                  DR.  THURMAN:   That  is what  I  thought                    I  said.
                       21
                                                  MR.  PULLETT:   You said their operating level                            times!,
                       2
                                twoi  and it  is  not.
                       2t'3
                                                  DR4  THURMAN:   I  see.    I  stand corrected.
                       24
                                                  DR.  HESS:   The total.            amount of money that they
                       25
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                                                                                                                           333
    hws-7                       have  to work with during those.six months.
                          2
                                                  MR.     PULLETT:     We     made      a      distribution      of      1974      tuncis@
                                which was  approximately  $24 million,  and that went into the
                          4     awards  beginning in Award  1.
                          5
                                                  To     get     their     annualized     level      we      doubled      that,      andi'
                                added their authorized carryover,  so when you say an  annual-                                           i@
                          7     ized level  in  a  12-month period                    it  is  not doubled what they
                          8     have been operating on  in  the  six month period.
                          9                       DR.  HESS:   Are you  familiar with  this  sheet?
                          10                      MR.  PULLETT:   Yes.
                          11                      DR.  HESS:   These  figures  are  generally higher if
                          12.    you double       the  six month present  funding?
                          13                      MR.  PULLETT:   They would be higher than  the
                          14    annualized        level  in  a  lot of cases.
                          15                      When we made the  initial                  awards  they were  for a
                          1(;   six month        period,  so we  gave  their                distribution of  the  $24
                          17    million  for six month period,  and                       authorized any carryover
                          18    from the previous period,  but  to get  the  annualized  level we
                                doubled the  1974  funds  and then  added in  the  authorized carry-;
                                over,  because that was  only  for a six month period.
                          20
                                                  DR.  HESS:    So  this would be plus  the  carryover
                          21
                                figure.
                          22
                                                  MR.  PULLETT:   The  six month period would at  least
                          2!@)
                                equal the  annualized level,  and in most  cases  exceed it.
                          24
                                                  MR.  BARROWS:   The working  capital  that they had  to
    HOOVERREPOR      0 IN--
               TING C     C.
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                                                                0           334
  hws-8         I   work with last year.  It was this figure, was it?     I mean
                21  up until now.
                               MR. PULLETT:  That is another projected 12 month
                    figure.
                51             MR. BARROWS:  So in terms of real money this is
                6   what the program was operating with.
                7              MR. PULLETT:  That would be projected over a 12
                8   month period.
                9              MR. BARROWS:  That is the base that we wanted,
                10             DR. HEUSTIS:  On this document the only date that
                11  I see is funding award January 1, 1974.
                               Am I to assume that this was  as of Januaryo that
                12.
                    everything on this hseet is January 1,  1974?
                13
                               MR. PULLETT:  If you  look on the  face page of
                14
                    that, there was a face page.
                15
                               DR. HEUSTIS:  Never mind.  Tell me what is on the
                    face page.  I don't think I ever saw one.
                17
                18             MR. PETERSON:  I certainly never saw a face page.
                               DR. THURMAN:  Is this the face page?
                               MR. PULLETT:  That is the summary page.
                20
                               DR. TESCHAN:  Region 17.
                21,
                               MR. PULLETT:  The six-month level was actually what
                22
                    they are operating on, on a six-month period.  They are the
                23
                    funds we have authorized.  That includes the carryover plus
                24
                    fiscal 1974 money.
                25
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                                                                             335
  hws-9        I               Now, to project the 12-month budget period we
                 I                                                                   1
               211  doubled what we gave them out of our 1974 money, which was
               13   approx
                          imately $24 million, and that added on to that any
               4    authorized carryover which was based on two things, their
               5    distribution of the 6.9 plus any unexpended balance they had
               6    under the previous budget period.
               7               DR. THURMAN: He has  answered  my  question.  I  know',
               8    what it  is.
               9               MR. PETERSON:  Okay, we want to get back to our       i
              101   business here on the review of applications.
                               I think we have already highlighted both Western      I
                    Pennsylvania and Virginia as regions we did not feel too
              13    prepared to deal with before.
                               Having had lunch we might start off with    Western
              14
                    Pennsylvania.
              17
              18
              20
              21
              9-?
              2I3
              24
              25
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                                                                         336
  hws-10                       REGIONAL MEDICAL PLAN FOR WESTERN PENNSYLVANIA
               2
                                         REVIEW BY DR. HIRSCHBOECK
               3i.1                                                      entially
                               DR. HIRSCHBOECK:  The application is ess
               4    for continuation of funding, except for the addition of one
               5    project, which is the Health, Education Network.
               6               As stated here, this constitutes $170,825 of our      i
               7    total request, which I understand will  not  be  counted  againsti
               8    the total amount appropriated with PRFP.
               9               MR. PETERSON:  I will explain   that.
               10              Because of the court order  which  reads  these  fundsi
               11   are to be made available to the plaintiff,   that is to  mean  the
                    RFP'S, and we had funded this particular project under 910,
               12,
               13   and thus in order to give it a legitimate umbrella we asked
               14   that it be submitted as part of the Western Pennsylvania R,14P
               15   application, but what you people really need to do is vote
                    a recommendation for Western Pennsylvania, and then take an
                    auxiliary, or adjusting the one in effect.
               17
                               It is a matter of administrative convenience in
               18
                    the event the court  order would not be modified, which it
               20   probably will not,
                               MR. NASH:  Really two applications.
               21
                               MR. PETERSON:  It is really two applications, but
               22
                    in order to be able to continue to fund   that AHEC it had to
               23
                    come under the aegis of an RMP at this   time.
               24
                               DR. HIRSCHBOECK:  Another factor   that  is   confusing
               25
  HOOVER REPORTING CO, INC.
  320 Mawchusetts Ayenue, N.C.

                                                                                                                                               337
                                 1 is  that  funding  for many  projects  terminated  on  April  1.
        hws-11
                                 2                       There  is  a  gap  of  two  months,  or  three  months
                                 -iii really,  between  the  end  of  the  project  and what  appears                                             to
                                 oi be  a  start  up  again  of  some  of  these  same  projects,  with  a
                                 5  gap  of  no  funding.
                                 6                        Now,  I  am  getting  this  information  principally
                                 7   from the  Forms  15,  and  I  think  we  ought  to  have  that  explaine,
                                 8   by  staff  a  little  later on.
                                                                                                                                       d,  at  the
                                                          As  far  as  the  Re  ion  itself  is  concerne
                                 9                                                        9
                                 10  time  of  phaseout               they  were  grappling with  the  possibility
                                     of  becoming  an  independent,  freestanding  corporation,  and
                                     they  ate  now  the  grantee,  that  is  the  grante6  is  the  Universiiv
                                 12.
                                      of  Pittsburgh,  and  apparently  the  cost  figure  was  very  high,
                                 131
                                      almost  $500,000,  and  the  question was  raised,  I  suppose,  by
                                 14
                                      central  staff  here  that  maybe  they  should  look  into                                           a  re-
                                 15
                                      arrangement.
                                                            At  least  it  sounds  that  way  in  the  way  the  text
                                 17
                                       reads.    They  set  up  a  task  force,  and  the  task  force  decided
                                 18
                                       to  stay  as  they  are,                 and  that  is  an  independent,  free-standing
                                 19
                                       corporation.
                                 20
                                                             The  University  of  Pittsburgh  Health  Center  is  the
                                 21
                                       grantee.    The  bylaws,  of  course,  do  not  even  mention  it,  but
                                 22
                                       that  is  okay.
                                 23
                                                             The  bylaws  are  arranged  such  that  they  function
                                 24
                                        very  independently.
                                 25
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                                                                                                                                            338
       hws-12                                            However,  the  Regional  Advisory  Group,  the  Coordin-
                            2
                                     ator,  Dr.         Kiefer,  who  is  the  Coordinator  of  the  program                                      is
                            3i,      also  a  member of  the  Regional  Advisory  Group,  and  is  in
                                     various  positions  along  the  line,  and  still  the  coordinator,
                            5        and  yet,  what  I  am  trying  to  say  is  that  he  has  fingers    n
                            6
                                     many  pies.
                            7                             The  relationship  with  CHP  is  difficult  to  assess
                            81       because  there  is  only  one  communication which  says  that  they
                            9        will  apply  in  the  near  future  regarding  the  comments.
                            10                            I  would  like  to  find  out  a  little  more  about  the
                            11       CHP  relationship  here.
                            12.                           Well,  they  distributed  quite  a bit  of  project
                            13       support  for  the  insurance  development  as  a  one  shot  venture.
                            14                            The  statement  is  made  by  the  Joint  Commission  on
                            15       Creditation  on  Hospitals,  which  is  found  in  quite  a  few
                                     hospitals,  and  this  area  has  not  had  the  working                                        expertise  to!,
                            17       deal  with  the  medical  audit  situation  and  other                                        similarly
                                     newly  acquired  activities  by  the  Join
                            18                                                                                t  Commission.
                                                           The  Western  Pennsylvania  RMP  provided  funds  for
                                     some  six  or  seven  hospitals  or  related  agencies  in  the  Regioni
                            20
                            21       to  get  quality  assurance  and  medical  audit,,  and  so  on.
                                                           As  I  interpret  this,  this  was  a  single  one                                   shot
                            22
                                     deal  that was  given  to  these  institutions.
                            2 t3
                                                           In  general,  I  would  say  that  this  is  an  average
                            24
                                     program  all  the  way  down  the  line.
                            25
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                                                                       339
  hws-13                     I do not see anything outstanding about it, nor
                2 is there anything that  would  seriously  criticize,other  than
                  possibly a relationship with CHP, which is not well expressed!
                4 here.
                5            Also, I should say a word about the staff.  The
                6 staff seems to be quite complete.  There are hardly any
                7 vacancies, so there should be the capability of carrying  on
                8 with the additional funds which they intend to ask for in
                9 July.
                10           MR. PETERSON:  Thank you, John.
                11           Ken?
                             MR. BARROWS: My observations were  very  parallel
                12.
                  to the doctor I s.
                13
                14           To show you my skills as a planner, I  approached
                  my five projects alphabetically, and I have considerably run
                15
                  out of gas on Western Pennsylvania, as it is the end of  the
                it;
                  line.
                17
                             Generally, I came up with the same conclusion that
                  this was a pretty good average type of program.
                             The management and administration of the thing
                20
                  looked a little bit cumbersome to me.  They have a number of
                21
                  regional advisory groups, area advisory groups.
                22
                             This did not look like a very skillful thing from
                23
                  the management point of view, but now I will have to eat  my
                2,4
                  words and come back with this. They have done  an  excellent
                25
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                                                                           340
  hws-14           job of community interest and participation in this thing.
                2
                               I might say they are really one of the better in
                   that respect, and there is commendable honesty in this report
                4
                   They talk about a lot of programs that are terminated, and,
                5  in fact, come out and said the program laid an egg because
                6  the people found out it was too much work.
                7              I think it is an application you can take at face
                8  value, but  I came out with a good average type program.
                9              MR. PETERSON:  Norm, I don't know if you want
                10 to come up  to the table.  It seems to me that there were at
                11 least three areas that questions were raised about.
                12.            One is what appeared to be a gap in funding.  The
                13 other is CHP relationships, and the third may be the tbiqui-
                14 tousness of Dr. Cleary, but that is something we have lived
                15 with.
                it;            MR. ANDERSON:  I imagine the survey was made  a
                17                  and we have determined that Dr. Kiefer was
                   year or so  ago
                18 not  in  line with the grant relationship.
                               The recommendation was made at that tirie  to  rectify
                   this, but during the same week, at the time of the survey#,
                20
                   Also a notice came out from RMP that we were to be  phased  out.!,
                21
                22             We sort of let it slide at that time,  and  Or.  Kiefe r,
                   .as I understand, is to retire sometime this summer, and as
                23                                                                  1
                24@  you have very adequately observed, Dr. Kiefer is a member
                25 of the Executive Committee, and also plays a very active   role
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                                                                            341
  hws-15            in determining program policy.
                               I won't try to minimize this, as that is a fact.
                               On the other hand, I think Dr. Reed has pretty
                    much determined what their program priorities are, and has
               5    tried to allow to promote these through Dr. Kiefer.
               6               The second point was there has been some animosity.@
               7    I am not sure what precipitated this, but nevertheless it has   i
                    existed, and I think over the past two years my experience
               8
               9    with the Region is that they have made  every  effort  on both
                    parts to try to rectify the problem, and  here  again,  I would
               10
               11   be the last to try to identify what  the  problem  really is.
               12.             Now, in terms of the third area  --  what  was that?
                               MR. PETERSON:  The gap.
               13
                               DR. HIRSCHBOECK:  Some of these projects ended in
               14
               15   April, and they were asking for funding beginning July 1.
                               MR. ANDERSON:  Part is due to the phaseout and
                    terms of priorities to try to complete certain activities
               17
                    within a timeframe, and they do have a very good selective
               18
               19   procedure to determine their own priorities.
                               I think in all due fairness to them, they felt this
               20
                    was some of the things they ought to complete within a certain
               21
                    time period.
               22
                                There has been a certain amount of lag time, but
               23
                    that doesn't mean the activity has completely stopped.
               24
                                DR. HIRSCHBOECK:  It is, as you read these Form 15rl,
               25
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                                                                       342
  hws-16          I got the impression that there is going to be a gap in fund-i
               2ii' ing between, or beginning July 1, 1974  and  what  apparently
                  was a termination on April 30, 1974.
               4
                           .@It has either been improperly placed there, or I
               5  don't understand what it is all about.
                                                                              t
                             MR. ANDERSON: I am not quite sure I understand
               7  your question.
               8             MR. PETERSON: I think if  I  understand  John,  he
               9  sees some projects which presumably are going to stop at the
               10 end of April and renewed funding beginning July 1, which is
               11 being requested.
               12.           That does seem a little unreal, and it may be.
                             MR. BARROWS:  I got the impression these were some;
               13
               1,4 programs they would like to have carried on, but they ran out;
                  of money, and they have some pro rams they want to revise,
               15                                9
                             MR. ANDERSON:  Local support may come to their
                  aid for a temporary time period.
               17
                             DR. HIRSCHBOECK:  Here is one discreet activity
                  summary    Laurel Mountain Quality Assurance Program, Mercy
                  Hospital, Johnstown, and the progress period, in the progress
               20
                  section which is from July or from January lst, 197  to
               21
                  A ril, 1974, and then the period of the project is July, 1974
                   p
               22
                  through June, 1975.
               23
                             In other words,,there is a period of April, May
               24
                  and June.
               25
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                                                                                                                                       343
     hws-17                                              MR. NASH: What is he doing there? This is                                              some-
                               2      thing they initiated in January, and he is giving you progress
                                      on the four months up until the time they formulated their
                               4      application?
                               5                          MR.  PETERSON:    I  was  just  comparing  notes  with
                               6      Tom,  and he  said  he  really  didn't  have  anything  of  substance
                               7      or  concreteness.
                               8                          I  think  both  he  and  I  can  specula                         te  about  some  of
                                      the  reasons  for  the  less  than  cordial  relationships  between
                               9
                               10     the  major  fee  agency,  and  I  am not  sure  it  is  called  Alleg  eny
                               11     County,  but  anyone,  the  one  that  encompasses  Pittsburgh  and
                                      the  surrounding  area,  and  I  know  something  1  observed,  I
                               12,
                                      think  I  observed  out  there  two,years  in  the  review  process,
                               13
                                      and  it  was  out  on  the  table  and  Bob  Carpenter was  in  the  ne.,%-t@
                               14
                                      room  and  it  caused him  a  great  deal  of  travail  as  long  as  he
                                      was  in  that  post.
                                                          MR.  BARROWS:    You  think  they  feel  competitive?
                                                          You  see,  this  has  an  apparatus  of  local  advisory
                               18
                                      groups  that  RMP  might  treat  as  a  threat  or  something.
                                                           MR.  PETERSON:    Some  of  it  may  have  been,  and  con-
                               20
                                      tinues  to  be  personalities.
                               21                                                                                                                             i,
                                                           I  don't  know  if             the  same  gentleman  who was  there
                               22
                                      when  I  was  out  there  two  years  ago,  and would  come  down  from
                               23
                                      Buffaloi  where  Jack  Angle  had  encountered him,  but  is  he
                               24
                                      still  the  same  person  out  there                                Mitch  Roth?
                               25
     HOOVER REPORTING  CO,  INC.
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                                                                         34@.
                                                                      do  share
  hws-18                      MR. ANDERSON:  On the positive side they
                21 the same types of review committees at the local level  which
                il! the CHP's participate with RMP.
                4             DR. TESCHAN:  I don't think we can resolve the
                5  question here, and if it is an important  question  in  an  out-
                6  going way we have to cite it to them.
                7             MR. NASH: The question came  up  about  Dr.  Kiefer.
                8  I don't think he is in the budget for next year.
                9             MR. PETERSON: He is retiring this summer,  and  it
                10 was always a kind of strange relationship.  He was the name
                11 coordinator, but in recent years he never drew any salary
                12. from the RMP budget.
                13            MR. ANDERSON:  He was never on salarye
                              MR. PETERSON:  I knew in recent years he never
                14
                15 had.
                              When Bob Carpenter was the Director, the full time
                   sort of direct management program has always been in  someone
                17
                                                                               It
                18 elses hands,, but Kiefer was not to say adamant, but he didn
                   want to step out of that symbolic spot.
                20            Maybe our problem is being solved by retirement,
                21            DR. THUP14AN:  Looking at the staff document for
                   a minute on the projects, the first five really are all  pro-
                2 --?
                   gram staff, it that correct, as I read this, $731 000?
                23,
                              MR. ANDERSON:  The first four, yes.
                24
                              DR. THURMAN:  So we are talking about a corps
                25
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  hws-19           figure of $731,000, and the request is for $1.9 million when
              2i   we really get right down to it.
                              MR. ANDERSON:  I accept your figures.
                              DR. THURMAN:  Obviously they are correct.
                              Then I have just two other questions.
              6               Are we conflicting with ourselves in the Regional
                   program because it is carrying over for two years, and the   i
              7
                   statements in it show no reference to reality about what is
              8
              9    going to happen over the next two years, and they have not
                   fulfilled the primary criteria initially that was to limit
              10
                   transplantation to one area, and instead we are supporting
                   two hospitals that are doing it in the same county.  They did@,
              121
                   it themselves.
              13
                              MR. ANDERSON:  I didn't read that.
              14
                              DR. THURMAN:  Regional renal project, to ration-  i
              15
                   alize transportation resources within the Health Center and
                   program due to inadequate numbers, and they said they still
              17
                   have not solidified the four Allegheny hospitals to bring
              18
                   together for one transplant thing4
                              I am not so much concerned about that, or are we  i
              20
                   really, for over a two year period here, looking at the
              21
                   Regional renal transplant in the way that it should be done.
              22
                   That is a staff question.  I don't know.
              23
                              MR. ANDERSON:  The limitation of my knowledge
              24
                   here is that the University of Pittsburgh is doing transplants.
              25
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  hws-20            only within its particular Region,  and  they  have  attempted
               2                                      es  in  community  hospitals
                 I  to set up some satellite faciliti
                    that can participate with the so-called network.
               4                DR. THURMAN:  Everybody does that for  bringing in
               5    cadaver kidneys, but the way this reads, they are doing the
               6    transplants in other hospitals.
               7                DR. HESS:  Read that again.
               8                DR. THURMAN:  "Rational,ize  transplant  resources
               9          within the Health Center  and  the  limitations  imposed
               10         on transplants from cadavers."
               11               This is a major question of the Kidney Panel about
               12.  whether or  not they were doing it, and for hospitals.
               13               DR. HESS: You didn't read  the  sentence  you  did
               14   before, but it sounds to me as though they were coordinating
               15   four hospitals, not transplanting in hospitals.
                                DR. THURMAN: You have to  read  the  whole  thing,
                    and I m
               17          ay have misled you.
                                MR. PETERSON:  This is  an issue we need to get
               18
                    some specific concrete information of how many hospitals in
               1!)
               20   the Pittsburgh area are actually doing transplants.
               21,              I think the Council ought to be aware of   it, be-
                    cause we had the same sort of situation in Philadelphia.
               9.?
                                MR. ANDERSON:  If you are right, we will have to
               23
               24   put a stop  to it.
                                DR. THU        One last question.
               25
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  tYb-21                     On Project 225 we are talking about $239,000.
              2,@            MR. ANDERSON:  Project 225?   You are getting
                  ahead of me.
              4              DR. THURMAN:  $293,000, and we are going to educate'
              5   less than 40 nurses.
              6              DR. HEUSTIS-.  That is $490,000.
                             DR. THURMAN:  It is going to cost us $10,000 a
              8   nurse, and it is a two year project, but if you are  going  to
              9   put it on a one year basis it is still $10,000 a  nurse,  so
              10  that is an awfully high figure.
              11             MR. ANDERSON:  We have flagged this, as you have
              12! to.
              13             This is a policy decision that has to  be  deter-
              14  mined.
              15             DR. THURMAN:  I don't argue with the need for
                  these people, but I have never seen a budget quite  that  high
              1(;
                  for this kind of a program, and I just wonder about it.
              17
                             DR. HEUSTIS: How much of the $1.9  million  is  for
              18
                  projects that will be carried out in the second year?
              20             MR. ANDERSON:  There are only two projects  identi-
              21  fied, 25 and 26, and the one Dr. Thurman has  identified,  and
                  the renal project goes into 1976.
              22
                             MR. PETERSON: Those two projects all  add  up  to
              23
                  roughly $725,000 out of.$l..9 million budget if you  assume,
              ?,4
                  which I don't think we can necessarily can have in one year and
              25
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  hws-22
                1   a half, and in another year it is saying about $350,000 plus
                2   would dangle over into FY 1976.
                              Those are the two other than program staff, the
                    two larger projects, renal and adult nurse practitioner
                4
                    education program are the two in that carryover.
                5
                6             DR. HEUSTIS:  They would probably get  around  the
                    one year grant by making a contract for some people to provide'
                7
                    services and the GAO will allow this kind of thing  for  ser-
                8
                    vices to be provided in the future.
                9
                              MR. PETERSON:  I cannot  answer  that.  We  have
                10
                    said as a matter of policy that we would permit it, and  I
                11
                    think it also includes grants management, which was in on
                12.
                13  the discussion, and if the obligation was a valid one entered.
                    into prior to June 30, 1975 that the basis for  taking  an
                14
                    audit exception by GAO-HEW would not be  there.  It  would be
                15
                    a valid expenditure of the funds.
                               DR. HEUSTIS:  Is this any different than entering
                17
                    into a contract for someone to maintain  your  typewriters
                18
                    for two years?
                               In that case I think there would be a  valid  GAO
                20
                    objection.
                21
                               This is something that was brought up earlier, and@
                22
                    I didn't follow it at that stage, and  this is something that
                23
                    I think ought to be referred to staff  for clarification  of
                24
                    policy.
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   hws-23                      MR. NASII: Is your question whether  to  contract
               2
                   this for two years or one year?
                               DR. HEUSTIS:  My question is is it  possible  for
               4   someone to  use fiscal 1975 funds to provide services that
               5   obviously will be provided in 1976, that is fiscal 1976,   and
               6   the only reason for entering into a contract  is  to  subvert
               It  well, that is pretty strong.
               8               In my opinion the reason for entering into the
               9   contract is to get around the one year limitation.
               10              We can't answer it, but it should be resolved.
               11              MR. PETERSON: It does seem to me it  may  not  be
               12  good procedure, and indeed might be illegal.
                               I don't know about the latter, but this is not all
               13
                   that unusual in terms of either Federal granting operations,
               14
                   forward funding, and indeed in many situations, and I can       i
               15
                   remember AHEC activities, many of the RMP's I believe in
                   effect are contracted for a period well beyond one year    in
               17
                   the early fiscal year.
               18
                               That doesn't make it right, but there is a great
                   deal of practice and precedent there.
               20
                               DR. HEUSTIS:  It seems to  me the funds for  1976    i
               21
                   ought to come out of the next year's   budget rather than here.
               22
                               MR. de la PUENTE:  A person in good faith makes an
               23
                   application in a certain year.   This application is supposed
               24
                   to do a certain amount  of work,  and supposed to take one year,;.
               25
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                                                                            3 @r, 0
  hws-24           two years, three years, and when this period or this applica-
                2  tion, if it is awarded that year, he is entitled to do his
                3il
                   work regardless of how long it takes.
                4              DR.-THURMM:  What is your   recommendation?
                5
                                     MOTION FOR RECOMMENDATION
                6              DR. HIRSCHBOECK:  I was waiting  for the Chairman,
                7  but I move  that we approve this application for the continu-
                8  ation phase, and this amounts to   $1,814,588, and we will have!
                9  to take up the others separately.
                10             MR. PETERSON:  Your recommendation, John, if I
                11 heard you correctly, is for the continuation of Western
                12. Pennsylvania, and the amount requested Norm tells me ought to
                13 deal with the total figure.
                14             We will put them together.
                15             MR. ANDERSON:  Okay.
                16             MR. PETERSON:  We havea motion for Western
                17 Pennsylvania, and that is the amount requested for the RMP
                18 separate from this one AHEC which is an appendage to their
                19 application.
                20             Do I hear a second on that?
                21             DR. THURMAN:  Before we offer another motion, can    i;
                22 we go off  the record?
                               MR. PETERSON:  Off the record,
                23
                24             (Discussion off the record.)
                               MR. PETERSON:  Back on the record.
                25
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                                                               with no second.
      hws-25    1            Parliamentarily we have a motion
                             MR. BARROWS:
                                            Does it die?
                              Informally then I didn't share the doctor's
                   enthusiasm.   They are now a-;'_- a.level of $1.2 million and
                5  they are talking in terms of this and their upcoming applicant
                6  tion is going to amount to about $2.6 million.
                7             That is well over a 100 percent increase in activ-@,
                8  ity, and I don't think based on what they have done to date
                9  they have the horses to take up that additional work.
                10            I would be much happier, let us say, they  should
                   talk in terms of $1.4 million, or something like that.
                11
                12@           MR. PETERSON:  We have in what effect is a  sub-
                   stitute motion of $1.4 million in terms of the $1.8 million.
                13
                              Is there a second to that motion?
                14
                              DR. TESCIIAN-  I will second it.
                15
                              MR. PETERSON:  Any more discussion or corrections?
                              DR. HEUSTIS:  May I say the current level of
                17
                18 funding according to this summary sheet I have is $1,193,000,,
                   is that  right?
                               MR. BARROWS:  I said $1.2 million.
                20
                                DR. HEUSTIS:  Okay, and you are saying $300,000
                21
                   more?  You  are saying $1.4 million is what you said.
                22
                                MR. BARROWS:  Yes.
                2t3
                                DR. HEUSTIS:  I think it deserves more than $1.2
                24
                   million.
                25
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    ly b-26                   MR. BARROWS: I refuse to answer it on the grounds
              2    it might incriminate me.
                              I was trying to come to a figure that would be
              4
                   appropriate for an average program.
              5               DR. HEUSTIS:  This is an average program.
              6               MR. BARROWS:  But apparently some more new vital
              7    direction.
              8               DR. HEUSTIS: If you were increasing it  you  would
              9    be treating it the way we were treating some of the better
              10   than average programs.
              11              MR. PETERSON: I don't think we really  have  those
              12,  programs at hand.
              13              DR. HEUSTIS: In my opinion you would  be  treating
              14   that way.
              15              I call for the question.
                              MR. PETERSON: Well, $1.4 million had  been  recom-
              17   mended for Western Pennsylvania.
                              All those in favor signify by raising your  hands.
              18
                              (Showing of hands.)
              19
                              MR. PETERSON:  Those opposed?
              20
              21              (Showing of hands.)
                              MR. PETERSON:  The motion fails for lack of a
              22
              2 t3 majority.
              24              MR. BARROIIS.:  We are ready or a new one.
                              DR. THURMAN:  I make a new motion to present
              25
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  hws-27        1  operating levels, and let's make them $1.2   million with  a
                21 provision that staff try to clarify, number one, the legit-
                   imacy of the renal regional program as we now know it, and
                   much better clarification of the nurse practitioner program,,
                5  025.
                6              MR. PETERSON:  It is still a motion of $1.2 million,
                7  and those two clarifications I think are inherent.
                8              DR. HEUSTIS:  Can I ask a question?
                9              MR. PETERSON:  O@urely.
                10             DR. HEUSTIS:  In that $1.2 million which is the
                   current operating level, is there not included $170,000 in
                11                                                                  i
                12. this extra separate project?
                               MR. PETERSON:  No.
                13
                               MR. NASH:  That is  funded by a 910 grant currently.i
                14
                               DR. HEUSTIS:  So that does not include the $170,0001@.
                15
                               MR. PETERSON:  No.
                               DR. HEUSTIS:  It would limit their current level
                17
                   exclusive of this added net worth.
                18
                               MR. PETERSON:  This is just coming into the same
                19
                   package.  It really is not reflected in their base.
                20
                               DR. HEUSTIS:  I think we are giving them   $200,000
                21
                   too much.
                22
                               MR. BARROWS:  I will second  that.
                23
                               MR. PETERSON:  Any further comment?
                24
                               The motion is for $1.2 million.
                25
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                                                           ends.
   hws-28                      Those in favor show your h,
                2
                               (Showing of hands.)
                               MR. PETERSON:  Unanimity and this does include
                   the clarification by staff both on the renal project and
                5  apparently cost per capita of educating our training nurse
                6  practitioners.
                7              MR. ANDERSON:  Can we ask Dr. Thurman to state his
                8  concerns about that projects-?
                9              DR. THURMAN:  Before we do I move that we approve
                10 Project 0044 in the amount shown.
                11             DR. TESCHAN:  I second.
                32             MR. PETERSON:  Any discussion?
                113            Those in favor show  your hands.
                14             (Showing of hands.)
                15             DR. THURMAN:  With the Chairman's permission we
                   can  do  that without holding up the nrogress here.
                               MR. PETERSON:  Certainly.
                17
                18             MR. ANDERSON:  May I be excused?
                               MR. PETERSON:  We have disposed of Western
                   Pennsylvania.
                20
                21
                22
                2,3
                241
                25
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                                                                       355
   hws-29                      VIRGINIA REGIONAL IIEDICAL PROGRAM
               2                RE-VIEWED BY SISTER ANN JOSEPHINE
                            MR. PETERSON: I think again one  of  the  Regions
                   we sort of hesitated in getting involved with before  lunch
               5   was Virginia, and if it is okay with you, John, I am going to
                   put you on two in a row, but I am going to ask Sister Ann to
                   initiate the review on this one.
                             SISTER JOSEPHINE:  Virginia is a program that for
               8
                   a long period of time kept a categorical orientation, and
               9
               10  once they changed from their categorical orientation to prbjeq+
               11  and subsequently a program, total program orientation, I
                   think that Dr. Perez has to take care of needs in the whole  I
               121
                   State of Virginia by meeting with all of the different agencies
               13
               14  in the State and parceling out the funds to meet these needs
                   in rather small increments in the total State.
               15
                             The first time I went there on a site visit, which!
                   was around 1970, the first place he took me was to the State
               17
                   Capital, and the first thing that happened to me, I was the
               18
                   only one who was searched, to be sure I had no bomb, so the
               I!)
               20  next day we went along with the sightseeing.
                             The soldier said to me when I said it is inter-
               21
                   esting that I am the only one you searched, well, he  said
               22
                   the Berrigan brothers made you suspect.
               2 tl
                              The whole climate in Virginia -- and I assume
               24
                   there will be someone going to help with the staff  review
               25
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      hws-30                 1      there is something very different about the climate in
                             2      Virginia.
                                                        There is something different about this Regional
                             I      Medical  Program.
                             5                          Once  they  get  the  direction  of what  it  is  the
                             6      Federal  Government wants,  it  appears  almost verbatim  in  their'
                             7      objectives,  in  their thrust  and everything,  and  this  type,  but
                             8      it  is  a  little  difficult  to  evaluate  if  it  represents  a  con-
                             9      viction,  represents  a way  to  go,  or  represents  a way  of  con-
                             10     forming  so  they  can  move  on  with  their business.
                             11                         I  think  possibly  this  is  not  too  far  from wrong.
                                    At  the  present  time  I  have  conflicting  figures  on  the  number
                             12,
                                    of  staff.
                             13
                             14                         On  hand  there  are  14  members,  and  as  I                          see  it  there
                             15     are  20  budgeted  positions  that  are  vacant,  I  believe  this  is
                                    right,  and  this  has  been,  as  I  remember  it,  an  ongoing  probleffi
                                                        They  have  always  overbudg6ted  the  number  of  people                                      @i
                             17
                                    that  they would  like  on  board  from one  time  to  the  next.    They!
                             18
                                    never  come  on  board,               but  the  figure  keeps  staying  high.                                      I
                                                        MR.  NASH:    This  is  a  convenient way  of  perhaps
                             20
                                    having  some  additional  funds  to  take  advantage  of  an  opportunity
                             21
                                    that might  arise.
                             22
                                                        DR.  TESCHAN:    We  have  also  seen  some  diagrams  and
                             23
                                    charts  relative  to  capital  expenditures,  so  that  on  any
                             24
                                    correlation  plot,  Virginia  seems  to  be                             out  of  line  on  the  low
                             25
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  hws-31                      SISTER JOSEPHINE:  Presently  the  program  staff,
                2
                11 plus the program of $368,000 they are budgeting for $559,000,@@
                t
                31' but that includes over $200,000 for these 20 vacancies that    1
                4  I doubt they will be able to get.
                5
                              On July 1 they are planning on coming in with
                6  another proposal that will cost $1.3 million,  making  a  total
                7  of $2.8 million for this program.
                8             As of this time I reviewed the projects that are
                9  listed, of the 19 projects listed on the  yellow  sheet,  you   i,
                10 will notice that seven of these relate to hypertension.
                11            My question would be  could  these  robably  somehow
                                                                 p
                12. or other be coordinated a little differentl     I don't  know.
                                                                y
                13 You may want to comment on this, or this may   be a way of just
                14 involving different agencies in this whole  project  of  hyper-
                15 tension, or maybe they are doing some research  that  is  going
                   to generate statistics or some paper, I just don't know.
                17            MR. NASH:  This is an ongoing project, and I   cannot@
                18 really answer your question.
                             SISTER  JOSEPHINE:  There  are  seven  hypertension
                20 projects.
                21            MR. NASH: Gene, do  you  have  anything  on  this?
                22            MR. NELSON:  No.
                              SISTER JOSEPHINE: This  program  has  generated  a
                2,,l
                24 lot of community activity. I  would  say  the  leadership  is
                   satisfactory, and probably the leadership, Dr. Perez, is    a
                25
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    hws-32         very sensitive to the different groups he  has  to  work  with
                2
                   in Virginia, and probably one has to work with many for some
                   period of time to appreciate this fact.
                4              The Regional Advisory Group,  I think, it seems to
                   me is doing a good job.
                6              I notice that Dr. Neuno is Chairman of the Group
                7  at the present time, and Dr. Neuno is a young Spaniard from
                8  Malesia, and I have seen him stand  up  on  several  occasions
                9  to Dr. Perez, which is interesting, in making the decision.
                10             They have indicated when this  program  is  phased
                11 into the new program that is going to  be  developed  by  the
                12 Federal Government there will be  no  difficulty  in  phasing
                13 these projects out.
                !4             They have also phased out a certain number of
                15 projects.  I can't remember now how many, but they have phased,
                1(; out without any difficulty  in  getting  additional  funding.
                17             Their objectives and priorities follow the national
                18 guidelines specifically, and they have listed their projects
                   under the objectives  of  improved  availability,  continuity,
                   improved quality, efficiency and economy, and improved health
                20
                   data  base.
                21
                               The health data base is one of the projects that      1
                22
                   is 3ust beginning to be developed in the State.
                2 t3
                               The CHP relationships are good.  In fact, I got thei
                24
                   impression on two site visits that the Regional Medical Program
                25
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  hws-33        1  funds a number of projects through and in  conjunction   with
                2  the CHP.
                I
                3ii           Dr. Hirschboeck, any comment?
                4             DR. HIRSCHBOECK:  I have nothing to add, partic-
                5  ularly.  I am not very familiar with this Region.  I had never
                6  visited  nor had much to do with it.
                7             On the other hand, it  may be a judgment  just  on
                8  the application, and data presented.
                9             I would rate this as an overall average type pro-
                10 gram, nothing unusual about it, struggling to meet the changing
                11 times, and that sort of thing.
                              MR. PETERSON:  Okay, we may or may not have a
                12,
                   CHP problem here, and perhaps Tom Smith, who is from the
                13
                   Philadelphia Regional office, and Virginia  is  serviced  out
                14
                15 that Regional Office, has something to say  in  this  regard.
                              Tom?
                              MR. SMITH:  We have had a special concern, one in
                17
                18 particular.
                              MR. PETERSON:  Which one is that?
                20            MR. SMITH:  Is that necessary?
                              MR. NASH:  Probably Tidewater, isn't it?
                21
                              MR. SMITH:  Tidewater, correct.  Everybody knows
                22
                   that.
                23
                              This may be another sort of Western Pennsylvania
                24
                   situation, I don't know, but the specifics had to do with
                25
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   hws-34       1   project review by the P-MP, particularly regarding the BMS
                2,  project which apparently was not considered for review, and
                3'@ CHP thought it should be.
                                Apparently the agency was not advised of this fact@@
                5   and interestingly, on paper it seems the relations are excel-!
                6   lent, because the agency director is a member of RMP, and I
                7   am quite surprised the project was being considered.
                8               I guess I can't say much more than that.  At
                9   least one agency is very unhappy, whether that has to do with
                10  personalities or not, I don't know.
                11              MR. PETERSON:  Is Tidewater Norfolk?
                12              MR. NASH:  That is right.
                                Pete, the gentleman which you are speaking about
                13
                14  is a member of the Regional Advisory Group, and the   Regional
                15  Advisory Group in Virginia is likely to include no new
                i(i activities in this particular application.
                17              This is a request for continuation of staff and
                18  ongoing projects.
                                They have sent out, or solicited hew project pro-
                    posals for the July 1 application, and our last communicationi
                20
                    with Region 5 of the 18 agencies have submitted a total of
                21
                    12 proposals.which in Virginia RMP's review process at this
                92
                    time.
                23
                                I think what we have here is a personality conflic
                24
                251             DR. TESCHAN:  When you get this kind of news what
   HOOVER REPORTiliG CO, INC.
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    hws-35                           happens?
                               21                         MR.  SMITH:    Can  he  stop  punching  that  thing  over                                          i
                                     there?
                               4                          MR.  PETERSON:    Let's                 go  off  the  record.
                               5                          (Discussion  off  the  record.)
                               6                          MR.  PETERSON:    Back  on  the  record.
                               7                          SISTER JOSEPHINE:    All  RMP  planning  has  been  closel
                               8     coordinated with  the  Governor's  Committee.
                               9                          This  is  a  program  that  has  stayed  very  close  y  to
                               10    the  Governor's  Advisory  Committee,  and  originally  then  I  think
                               11    the  Chairman was  the  head of  Public  Health,  and  then  finally
                               12,   we  got  someone  else  as  Chairman  of  the  RAG.
                               13                         Then  this  close  association  with  the  Governor's
                               14    Advisory  Committee  may  well  be  the  thing  that will  make  it
                                     possible  for  this  program to  phase  into  a  State  program,  and
                               15
                                     there  are  a  lot  of  different  projects.
                                                          MR.  NASH:    This  particular  project  you  are  speaking
                               17
                               18    of,  if  I  am not  mist               aken,  has  been  sub             .mitted by  Tidewater  CHP
                                     to  the  Regional  Office  in  Philadelphia  for  consideration  of
                                     funding  by  John  Reardon's  shop  also.    It  is  also  considered
                               20
                               21    for  the  July  application.
                               22                         Now,  whether  the  RAG will  approve  it  or not,  no  onei
                                     knows  as  of  this  time.
                               23
                                                          MR.  PETERSON.:    I  wonder  if  any  of  the  other  reviewers
                               24
                                     have  any  observations  or  comments  they  care  to  offer,  or
                               25
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                                                                           362
  hws-36           perhaps have some comments?
                2i             MR. BARROWS:  Just from the caption and titles of
                   these proposed activities it would appear that they have pret@-,,
                   good program direction.
                5              That is they are working on the right theme.  is   i
                6  that a reasonable observation?
                7              SISTER JOSEPHINE:  Yes, I think that my impression@@
                8  that the Virginia Regional Medical Program is that Dr. Perez
                9  keeps very close tab on what everyone is doing, and then also'
                10 keeps tab on the agencies with whom they are working.
                11             I don't think he is the greatest developer of
                   personnel,  you know.
                12,
                13             MR. BARROWS:  I wasn't talking in terms of manage-,
                14 ment, but talking in terms of purposes and objectives.
                               SISTER JOSEPHINE:  These are the needs identified
                   by the  eopl6, apparehtl
                          p                 y-
                               These are really in response to needs, and they
                17
                   don't look spectacular, or anything of this type, but I thin)-,;'
                18
                   they are in response  to the needs that can be identified.
                20             DR. TESCHAN:  It is undertarqeted.
                               MR. PETERSON:  Dr. Thurman, as a displaced
                21
                22 Virginian, do you want to speak?
                               DR. THURMAN:  I think it would be inappropriate,
                2 t3
                   having really left the State.
                24
                               Nothing hurts me more than to be constrained to
                25
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  hws-37            science.
                2             MR. PETERSON:  Do any of the other reviewers have
                             tions?
                    any ques
                4               DR. HEUSTIS:  I understood, Sister, you said the
                                             hat came out of the Regional @ledicali
                5   beginning  they parroted w
                6   Program.
                7              SISTER JOSEPHINE:  I think the objectives and the
                8   guidelines they line up for themselves are just as close as
                9   they can make them to what it is that the Federal Government
                10  dictates, and then I think they try to fit into this program.
                11             MR. NASH:  They suffer from being too close to
                12  Washington.
                               DR. HEUSTIS:  I would have problems under similar
                13
                14  circumstances.
                                DR. TESCHAN:  We have agonized with Gene for years!
                15
                16  in the Southeastern Group with these things, and I get the
                17  sense from what I am hearing, you know, coming in with that
                18  background, I am hearing a much more positive type of sitq-
                    ation there now, and the thing I don't think is that we couldl
                20  accuse Gene of, as it were, conformity as a subterfuge.
                               I think that Gene is conforming on two grounds.
                21
                    One is that he is lost, you know, he realizes that you really
                22
                    do have to play ball with the front office, and the other
                2.3
                    feature about it is that the front office is asking is not
                9-4
                    so different from what the situation is in Virginia as in
                25
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  hws-38           most other States, if not at all.
                2
                             The main national priorities of health  we  are  slap-,
                3!1 posed to be recognizing are really what the problems are.
                4            I don't find that an artificial  situation  at  all.i
                5            MR. ANDERSON:  May I say something?
                6            I am not responsible for the program in  Virginia,  i
                7  but I did have the distinct honor of being on the site  with
                8  the Sister and two or three others two or three years ago.
                9            At that time I was very impressed with the fact     i
                10 that they laid the program out in a very honest and straight
                11 forward manner, not trying to please Washington, or the rest
                   of us, but they laid the problems out in terms of this is
                12.
                   our problem, and this is the way we are trying to deal  with
                13
                14 it.
                              In my limited experience with the State of  Virginia
                15
                   and the RMP's throughout this has been their approach to
                I(;                                                              i
                17 trying to resolve the problems.
                              SISTER JOSEPHINE: You know I have  no  reason  to
                18
                   question the way they have gone.
                              In fact, after the first visit, when I went on
                20
                   the first visit, I came with some preconceived notions,  but
                21
                   after the first visit I realized that there their response
                99
                   was a very sincere response.
                23 i
                              I realized also that they were making an  attempt
                2,4
                   to identify the problem and they were making an  attempt  to
                25
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  hws-39           listen, and then to design projects that were  in  respoiise  to
                21 the problems and, you know, whether they were reading it
                3' correctly or not, that is another ball game, but they did
                4  seem to be responding. But then  it  has  been  several  years  i
                5  since I have been there.
                6              MR. NASH: I think  the  hypertension  activity  is
                7  an   example.
                8              If you will recall, on our site  visit  they  were
                9  just proposing that at that  time.  They  had  some  representa-
                10 tives from two or three communities that  were  present  at  the
                11 site   visit, and explained the need for this  sort  of  thing.
                12,            Sister, I certainly agree with what you say.
                13             MR. PETERSON: We have a  request  here  for  roughly
                14 $1.3 million with an indication that Virginia, and it is
                   essentially a continuation, that Virginia will begin all of
                15
                   its new activities in July with an  estimate  that  this  will
                   be a little larger than the $3 million plus.
                17
                               I don't know whether you, Sister,  and/or Dr.
                18
                   Hirschb6eck have a figure in mind with respect to the current
                   application.
                20
                               SISTER JOSEPHINE:  I would like to ask a   question. 1
                21
                               Do you feel those 20 vacancies, that it   is realistic
                22
                   to assume these 20 vacancies are going to be filled?
                23
                               MR. NASH:  You put me on a spot there.  My personal
                2,4
                   opinion is they probably  will not, if we  consider  the  length
                25
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  hws-40           of time remaining for R14r-.
                2              You see, this is an award that will  not  be  made
                   until   July.
                               MR. PETERSON:  Late June, for a period of July 10    I
                5              MR. NASH:  This gives them one year, and their
                6  ability to  recruit that number of people for one year's
                7  employment  I think would be questionable.
                8              Dr. Teschan doesn't agree with  that.
                9              DR. TESCIIAN:  Yes, but coming down to the question
                10 of employment  of the people under those circumstances, I
                11 would go right along with the conclusions you would draw    that
                32, in terms of hiring and firing, there is no question about it,
                13 because the people hired and fired would not have the exper-
                14 ience, the background in the context in which to make those      i
                   Judgments.
                15
     (3)                       We cannot expect them to go out on a limb.
                               DR. HEUSTIS:  I note in a program that has    been
                17
                   described as average, if I understood correctly, they     have
                   proposed overall to  increase their total  request  about  100
                20 or some 100 to 150 percent.
                21             Is the program much more than  maintaining  it  at
                   the current level the way we have done at the other average       I
                22
                   things?
                2t!
                               SISTER JOSEPHINE: Yes, it  is  my  question  also.
                24
                               it is one of  the reasons I asked about the
                25
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     hws-41                                       lities of bringing in people who they will have to
                               I      possibi
                               2      have to maintain or develop the kind of program to carry on
                                      the kind of program they have indicated, and I would think
                               4      they could not.
                               5                           I would think that in the July review all the
                               6      projects are going to be there, and I think one is going                                                       to
                               7      have to take a hard look at this.
                               8                           This present May 1 request I would recommend that
                               9      they are at the same level that they presently are, with the
                                      indication that there is concern about the number of projects
                               10
                               11     that will be coming in in July with the 20 vacancies on the
                                      program, and it may be that can give some indication where
                               12
                                      they plan to get these people, whether they plan to bring
                               13
                                      them in from CHP staff, I don't know. They may know where
                               14
                               15     they are available.
                                                           MR.  PETERSON:    When  you  say  at  the  present  level,
                               17     you were  thinking  then,  Sister,  in  terms  of  that  $971,000?
                                                           SISTER JOSEPHINE:    $1  million.
                               18
                                                           DR.  HIRSCHBOECK:    I  second  it.
                                                           MR.  PETERSON:    Any  additional  questions  or  comment4?
                               20
                                                           MR.  de  la  PUENTE:    I  call  the  question.
                               21
                                                           MR.  PETERSON:    Those  in  favor of  $1  million  with
                               22
                                      concerns  being  expressed,  and hopefully  some  of  this  can  get
                               23
                                      in  with  the  larger  projects  coming  in  the  first  of  July,  and
                               24
                                      their  real  ability  to  filling  some  of  the  vacancies.
                               25
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  hws-42                      All those in favor raise your hands.        368
                              (Showing of hands.)
                2
                ji
                              MR. PETERSOIN:  it is unanimous.
                4             1 think we are now at 225, and  I  would  like  to
                5  have  one  of the staff people we asked  to  come  down  specificalliy
                6  for our next project, the  Metropolitan  New  York  and  Lakes
                7  Area, which is Bert Kline, who previously handled those
                   Regions when he was with P14P.
                8
                9             Bert is now in Planning and Legislation, and if
                10 there is no objection I would like to move on to that Region,
                   because this is a very unusual application in one sense.
                11
                              I don't know whether, Bert, you or Frank, or  I
                12,
                   should set the stage, by the nature of this next  request.     I
                13
                14            Suppose you core to the table, Bert, ani  et us
                   have a brief comment or two so that everyone will have the
                   backdrop for the reviewer comment in the nature of this next
                   application.
                17
                18
                ji)
                20
                21
                22
                23
                24
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                                                                        369
   b.ws-43                                          AL PLAN FOR THE
                               HEW RE@ COI,'il4ENDED MEDIC
              2i               METROPOLITAN NEW YORK AND THE LAKES AREA
                                     DISCUSSION BY BERT KLINE
              4              MR. KLINE:  Well, Mr. Chairman, what kind of back-!
              5    ground would you like, a little on the program, and how  it
              6    got where it is right here now?
              7              MR. PETERSON: I was thinking  of  everything  for
              8    two years.
              9              MR. NASH: If you gave a little  rundown  on  what
              10   has happened to the organization down there, because we used
              11   to have real problems in that region.
                              MR. KLINE: I will take a couple of  minutes  for
              13   those not familiar with some of the history of New York
              14   Metropolitan Area, which in approximately 1971, I think New
              15   York Metro had some severe communication problems between the
                   then Coordinator and the grantee.
                              At that time I was associated with the Metro Board
              17
              is   of New York and the staff, and also the Regional  Advisors,
                   and it just seemed it was sort of a shell game.
                              The grantee could not very well keep track of whatl
              20
                   was going on at the program level.
              21
                              The staff was kept fairly well shielded from what
              22
                   was going on, and likewise the RAG.
              2 t3
                              As a result of all this the situation with everyone
              24
                   was sort of reaching in to see what they could pull out of
              25
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                                                                                    i
   hws-44       I   the program in terms of support for their  particular   efforts,it
                                                                                    1
                2   a little lobbying going on within the RAG, lobbying going on
                ,4  within the grantee, a little bit of lobbying going on with
                    the Coordinator.
                5              Staff morale was some kind of shot.
                6              Well, any way, some dynamics began,   and we started@i,
                7   off with the management assessment visit, and   started into
                8   getting into some of these problems, documenting some of the
                9   problems.
                10             This went oft with some recommendations.  Some funds
                11  were cut back, some were reprogrammed.
                               All during this time the staff turnover was
                12
                13  tremendous, and through the course of eight or nine months
                    with some pressures perhaps from here in the ways of money
                14
                    being held back, and so on, things began to happen by November
                15
                    of 1972, that the Coordinator had resigned, and by December
                    of 1972, if my memory serves me correctly,, Dr. Thurman, the
                17
                    grantee, resigned, and we had more or less during the-course
                18
                    of the year of 1972  sort of cleared the deck, which was kind
                19
                    of interesting, because at   that point there had been a
                20
                    residual staff which was waiting and somewhat eager to    get
                21
                    on with the job they could see very clearly, but could    not
                22
                    get to.
                23
                                Dr. Harrington, who had  been the Deputy Director
                24
                    at the time, was named   as the Acting Director.
                25
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                                                                                 ime
  hws-45                       Jack Eller, who had been the Evaluator at the     t
                2
                    was named as the Acting Deputy Director of the Program,   and
                    they began to make some changes which  had  long  been  recom-
                4                                                         about  tha@
                    mended, and to do it rather effectively, and it was
                5   time that RMP's became the phaseout Victim of the budget.
                6              This, then, throw everything into sort of chaotic
                7   situation, but I think in terms of looking  at  this  particular,
                8   application, in terms of talking to some of the people up
                9   there, I tend to suspect now that their staff is  getting  justly
                10  a little better.
                11             In any event their  application  has  been  certainly!
                12  stronger than it had been in the past.  Their organizational    i
                13  structure is a little better.
                14             What they did do  in  this  particular  application
                15  was to, I think, they read  the  directions  rather  carefully
                    as a matter of fact, and what I can gather they assured
                17  within this application the grantee would assume responsibility
                18  for all activities which extended beyond the period of June
                    30, 1975,, so they asked for monies for two years, by and
                20  large.
                               I have broken it out in  the  little  yellow  sheet
                21
                    there about $,3.0 some million for the second year of activ-
                22
                    ities, and a total of about $4 million for the first year's
                2t3
                    activities, which include staff  and  other  activities,  with
                24
                    the grantee saying, and  being recorded herein, that if
                25
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    hi-is-46                   1      is phased out at June 30, 1975, they, themselves, will take
                               2      responsibility for monitoring and surveiling that money.
                               3
                                                          I think in the instructions                           that went out,  I                think'
                               4      this   was deemed as somewhat illegal, so they took the legal                                                         @i
                               5      approach and requested almost $7.5 million, and that is kind
                               6      of where it's at.
                               7                          I don't know if there are any further questions
                               8      on this.
                                                          MR. PETERSON:   There may be after the reviwers.
                               9
                               10                         We have Dr. Bill Thurman                         on this one.
                               11                         Dr. Thurman, you want to                         lead off there?
                               12,                        DR.  THURMAN:    I  think  Bert  has  filled  us  all  in
                                      quite  completely,                and  excuse  the  term,  Sister  and other  ladies
                               13
                                      present,  but  I  have  never been  more  bastard  on  a  site  reunioni
                               14
                               15     than  we  have  been  there.
                                                          We  had  to  meet  with  all  the  medical  school  deans
                                      who  wanted  to  quit  because  we were  there,
                               17
                                                          We  had  real  concerns,  as  Bert  indicated,  right
                               18
                                      then  about  Arronson't  ability  to  take  over  a bad  situation.
                                      He had  nothing but  fighting  going  on  in  his  staff,  and  there
                               20
                                      was  absolutely  no  question  that  the  staff was  totally  blockedi
                               21
                                      off  from  participation  in  this  program.
                               22
                                                           It  is  just  unreal,  and yet,  there  was  a  talented
                               23
                                      staff      there.
                               24
                                                           I  think  the           present application reflects the fact
                               25
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   hws-47          that Arroiison has taken over very well.  He has  pulled  to-
                   gether a staff that is adequate.
               211
                              They have also put together an application that if@@
                   it was inconceivable they could have put together before.
               4
                              our real concern is that he looked  at  that  moment
               5
                   like a terribly weak sister -- and that is not  a  pun,  Sister
               6
                   Ann -- we didn't think he had it.
               7
                              I think our other major concern that is still
               8
                   reflected in this application, and that is one that I have,
               9
                   is that this, in essence, was then, and is now, a one-man RAG'I
               10
                   in the presence of Mr. Popper, in a way, and I think if there   i
               11
                   is anybody who did read every fine line and  figure  out  how
               12,
                   they would do it, and swear he could monitor it for the coming
               13
                   two years is the RAG Chairman, who is a  very  unusual  indi-
               14
                   vidual.
                              This RAG Chairman is  very  much  dollar-oriented,
                   and he orients the dollars to the RAG, and that does show
               17  through in here occasionally.
               181
                              There is no question in my mind that  the  staff  is
                   far superior to what it was, and there is  no  question  also
               20
                   that in the preparation they have much better morale than theyi
               21
                   had  before.
               22
                              I think that the weakness of the RAG is not becausej
               2.'.3
                   of lack of interest in that some of them really  took  us  over
               24
                   the coals, but they also were not informed, and  I  think  that
               25
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   hws-48          again I would question whether or not they   are truly informed;
               2   now about what is going on.
               3                             informed then about the difficulties
                               They were no,
                 1
               4   with the schools, which  I think was unfortunate, and made it   ;i
               5   very unfortunate for us.
               6               I think the school situation now is well handled,
                   I mean because they got out of it.
               8               You will notice from the list of projects in here
               9   that there is still an attempt to carry forward to each
               10  school some RMP money, or we have used the term the day of
               11  political payoff to keep things running smoothly.
               12              On the other hand, some of those projects are
               13  quite good and strong.
               14              In reference to the projects there are some very
               15  strong ideas, but most are carbon copies of other programs
                   within the Region itself.
               17              My question was whether or not all the projects,     i
               18  that the same thing could be strengthened by corps staff
                   leadership with multiple outreach indications.
               20              The examples are kidney, manpower and hypertension   1
               21  problems, and so on.
                               I feel the money here is  going to be wasted, but I
               22
                   have been wrong before.
               23
                               We have spoken of the problem of the continuation
               24
                   of the money past June 1.
               25
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            hws-49     1                                 The CHP has never worked'out of New York.  Their
                                 2    relationship is good only because CHP does not have the strength
                                 31   to react yet, so it has given it a cursory review.
                                 4                       The  CHP  is  becoming  much  stronger,  and                                 if  this
                                 5    program  goes  on,  the  CHP  will  get  into  it.
                                 6                       All  in  all,  I  feel  this  program has  significantly
                                 7    changed  since  the  days  of  our  last  visit  there,  and  it  is  well
                                 8    reflected  in  this  document;  the  changes  that  have  occurred
                                 9    and  have  taken  place.
                                 10                       For  that  reason  I  support  the  program,  and would     i
                                 11   call  it  now  a  slightly  above  average  program.
                                                          I  think  it  is  clearly  better  than  some  of  the  other,
                                 12
                                      programs  we  have  classed  as  average  in  the  past  two  days  in
                                 13
                                 14   leadership  and  direction  and  everything  else.
                                 15                        I  will  come  back  to  the  figure  after Al  has  had
                                      his  say.
                                                           DR.  HEUSTIS:    Al  worked  under  the  constraints  of
                                 17
                                      what  he  had  available  to  him,  which  was  the  written  document,
                                 18
                                      and  I  take  respectful  exception  to  the  staff  saying  that  they
                                 20   followed  the  direction  that  at  least  in  my  copy  they  did  not
                                      number  the  pages,  and  I  never  had  so  much  trouble  to  find
                                 21
                                      anything  in  trying  to  relate  back  and  forth,  to  try  to  get
                                 22
                                      things  going.
                                 23
                                                            I  did  not  have  the  appreciation,  not  having  done
                                 24
                                      this  before,  when  I  took  a  crack  at  the  first  because  it was
                                 25
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  liws-50          ths thinnest, which was Cony).ecticut's, and the' one I took a
                   craclr. at second was Metro Now York.
                              MR. PETERSON:  Is that when you called and said
              4    you weren't going to be able to make it?
              5               DR. HEUSTIS:  Just from the document I am not par
                   to this other information, but just from the document I was
              6
                   not too impressed, and as you have said, I certainly wasn't
              7
              8    impressed with what thev have done in the past, and it seemed
              9    as though they had great difficulty in sorting things out,
              10   for example, and it was very confusing.
              11              ror example, there is an item that has a different
              12,  project number that is in twice for $947,632.
              13              MR. KLI14E: Project Numbers 50 and 62.
                              MR. PETERSON:  This is the EMS?
              14
              15              MR. KLINE:  Number 50 was their pilot of last year
                   which was not supposed to have the money attached to it this
                   year.
              17
                              DR. HEUSTIS:  My proiDlem was this was widely
              18
                   separated in the organization and getting discouraged, I
              1!)
                   wondered if somebody said let's just duplicate this without
              20
                   too much thought.
              21
                              I guess you folks have so much more valid inform-
              22
                   ation than I have that my very discouraging report, and  my
              23
                   rating as far as this goes was below average, and as far as
              24
                   the other kinds of things, it looks as though the program
              25
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    hws-51          leadership was satisfactory; the  program  staff didn't  impress
                 2
                    me too  much.
                                The RAG which was satisfac-tonj in the past in
                    performance got a low rating.
                 51                                                             -
                                The objective,, and priorities  again  were  satis
                 6
                    factory.
                 7
                                The proposal is satisfactory, and one feasibility
                 8
                    I just didn't really think it was very hot, and CHP relation-
                 9  ships again, you tell me there is no CliPi and  I  rated  the
                 10 thing as pretty good.
                 11             MR. PETERSON:  There i.si-i't any, in one sr.-ns-@.
                 12, There is a funded areawide CHP, and in so many major metro-
                 13 politan areas, Washington, D. C.,  still  doesn't  have  one.
                 14 It was very slow in getting  organi2ed,  in  getting  funded,
                 15 and even now I suspect that Bill suggested it is not really
                    functioning, and it is difficult not to have at  lease  adoauziteL,
                 17 relationships with someone who is not functioning.
                 18             MR. NASII:  Pete, I was up there in February and
                    March to take a look at their review process, and we had a        I
                 20 representative from the CHP Agency also visiting with us, and     I
                    I don't know how far along they had gotten with their mission
                 21,
                    of developing a plan, but certainly from what he told us the
   0             22
                 23 relationships between the two organizations couldn't be
                    better.
                 24
                                MR. KLINE:  This was interesting too, because all
                 25
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   liws-52         the -very back to, I guess about 1.971. or early 1.972, 1 am losinc.,,
              2            time now, they did have good relationships with
                   track of
                   wnatclver existed in the way of CIIP.
                              THE CHP was coining into existence at the time, but
              5    there was a good working relationship right from the outset
              6    with the CHP.
              7               DR. THURMAN:  I didn't mean to imply it was bad.
              8    It just didn't exist.
              9               The problem is there was nobody there to argue
              10   with.
              11              MR. KLINE:  I think the CHP, although I am not sure,l
              12.  if it advanced along the same kind of slope and graduated
              13   advancement that was going some time back, it should be
              14   functioning reasonably i@@ell now.
              15              DR. TESCHAN: There is a $1 million project  on
              I(;  this, Health Care Services.  That is a pretty big ficTure, and
              17   it is a one year -- well, I guess two vears.
              18              MR. PETERSON:  All of those projects which have a
              1!)  C are essentially two year activities so the annual cost again
              20   is roughly, I guess, about half of that.
              21              That is still a $550,000 activity.
                              DR. THURMAN: That in zictualil-v, the design of
              22
              2@3  this program is superior probably to most other programs we
                   run across of this nature.
              24
              25              DT. TESCHlUi:  To what?
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                                                                          7
   hws-53       1               DR. TIIUP.IlMi:  They are trying to make all of the
                2   hospital rooms and clinics operated by the   City of New York,,
                    and also by private hospitals much more in   touch with each other
                4   and much more of a regional type of referral, so that the
                    lady in Queens who decides she needs a ceasarian operation       i
                5
                6   can go to a hospital there rather than come to a hospital in     i
                7   downtown New York.
                8               That is what the impact and the plan was,   and
                    their ability to get the great majority of the hospitals in
                9
                10  the area to at  least consider this.
                                It was easy to get the City of New York, the city    1
                    hospitals,  but they brought in a lot of the private hospitals
                12
                    There is a  lot of fighting going on in Westchester County,
                13
                    and   certain parts of Queens, which have never gotten iny
                    money at all, and metro New York City.
                15
                1(;             It is overly priced here just like the E@11,3 prograr,.!3'
                                                                                     i
                    are overly  priced, but it is a great idea as far as  trying  to',
                17
                    deliver health services to an  amorphos  population  that  cannoti
                18
                    be reached well at this moment.  It is overpriced.
                                DR. IIIRSCHBOECK:  Are we going to judge these
                20
                    projects on the basis of one year funds, or two year funding,
                21
                    or what?
                22
                                How do we handle the desire on their part to
                23
                24  vent   these?
                                MR. BARROWS:  Let me get some preliminaries here.
                25
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                                                                          380
  hws-54                       Is the nature of these projects such that they cou d
               2   have been presented as one year, or will it take two years to,
                   get the job done?
               4               DR. THURMAN:  Of all the C project in here, prob-
               5   ably about  40 to 50 percent of them, that is a  rough  guess
               6   now, need two years to really come to fruition.
               7               Take the program we are referring to, the $1
               8   million program, on the other hand is going  to  be  financed
               9   either by the City of New York hospitals, or the consortium
               10  of New York hospitals if it goes into a second year.
               11              MR. PETERSON: I guess John's  question,  I  wouldn't
               12@ want to provide an official P14P response, this is  almost  a
               13  case of one, the extent to which Metro New York  has  asked  for
               14  two years support, and my own personal  view,  and  underscoring
               15  the word personal, is that I think we heed to  look  at  this
               I(; in terms that say to Metro New York, or any  other  Region  that
               17  really has done this, here is an amount of money if you want
               18  do some activities over two years you are  going  to  perhaps
               I!) feel the pinch in other areas, because most Regions, you know,
               20  if we were to consider most reqlons, I suspect  there  are  some
               21  Activities  which they could have looked forward to mUl 3ple
               22  funding on  a grander scale.
                               I think it disposes of a  difficult  question.  I
               23
               24  don't have  a real answer to it.
               25              Maybe Bill Thurman's recommendation will  help  come
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  hws-55         I   up with an answer.
                 2             MR. KLINE:  I would like to comment on that one
                 311 point really, the $2 million project in particular.
                 4             That project has a series of discreet activities.
                 5   Were they to receive reduced funding on that particular thing  11
                 6   they would fund particular activities on a priority basis
                 7   within that $1.2 million.
                 8             DR. TESCHAN:  Was there evidence of some priority
                 9   setting?
                 10            DR. THURMAN:  It is not in order, on that list.
                 11            Bert's point is a good one.  It was asked for unde@
                     RMP from the standpoint they could involve everybody with
                 12.
                 13  RMP dollars, whereas otherwise the City of New York is going
                 14  to fund it for all the City of New York hospitals.  They
                 15  believe they will combine with some of the others, and t e
                     County Medical Society is going to fund it with Queens.
                 17             Its availability as a plan will become somewhat
                     more difficult.
                 18
                                DR. HEUSTIS:  That makes very good sense, I think,
                 19
                     that is that approach.
                 20
                                MR. BARROWS:  Looking at the thing in a very.  broad
                 21
                     sense, and taking into account the population we server   which  1
                 22
                     is what, seven million or eight million?
                 2.3
                                DR. THURMAN:  They say 14 million.
                 ')4
                                MR. PETERSON:  That is probably a little too high.
                 25
    HOOVER REPORTING  CO,  INC.
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    W@@hin,,tnn D C. 20002

  hws-56                       MR. BARROWS:  We are talking about, let us say,
                2
                    ten million people. We all  go  by  the  extraordinary  expenses
                                                                                    I
                    in New York, the extraordinary amount of time it takes, the
                4
                    extraordinary difficulty in getting things together, as witness
                5   trying to get a CHP.  They have been  working on that for
                6   eight years now.
                7              When you look at all those  together,  and  you  con-
                8   sider there what they are asking, it is really kind of modest
                9   it seems to me.
                10             MR. PETERSON:  Bill, you said something which
                11  suggested to me at least that you might have a motion in your
                12. hip pocket, or recommended funding level.
                13                MOTION FOR RECO@DENDATION
                14             DR. THURMAN:  I move we approve it as a slightlv
                15  above average program, and we throw  out  for  discussion  here,
                    discussion of $2.2 million.
                17             1 think if we do that, my own opinion is, and that
                18  is all it is, is an opinion, they will look hard at some of
                    these projects.
                               I am afraid some of the buroughs  of  New  York  will
                20
                21. go out.  But there are some very significant steps they can
                22  make in developing health services in Metro New York with that
                23  kind of money.
                24             MR. BARROWS:  It is about 30 percent lower than
                25  last year.
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     hws-57      1              DR. THURMAN: No,  they  are  operating  on  $1,142,000
                 2  now,
                 3!
                                My figure is in the range of $2.2 million to $2.5
                 4  million.
                 5              I have read Bert's  recommendation,  and  I  can't
                 6 -argue with  it too much, but I have ended up with $2.2
                 7  million.
                 8              MR. PETERSON:  Did you say $2.5 million?
                 9              I was thinking $2.2 million.
                 10             They have indicated to us  Metro  New  York,  that
                 11 they will be in with an application in July of around $2
    (4)          12, million in addition.
                 13             MR. NASH:  That brings it to a level of $441,000,
                 14 five percent above the target figure, assuming both applica-
                 15 tions are approved in the amount requested.
                 I(;            DR. THURMAN:  They requested $7.7 million.
                 17             DR. HEUSTIS: My problem, I  go  along  with  the  $2.5
                    million, and my problem is really this.  I wasn't anywhere
                 18
                    nearly impressed with the written  document,  but  I  sure  am
                 20 impressed with some of the things that they were trying to
                 21 do together involving Metro  New  York  hospitals,  and  certainly
                 22 am impressed with the problems of  doing  things  such  as  an
                 23 area of New York City, and this  two  year  business,  I  just
                    am not particularly impressed with that.
                 114
                                What I was really trying to do  is  wrestle  with  the
                 25
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  hws-58            fact that really on the past record they didn't deserve   very
                 2  much, but it looks as though maybe they have a new    lease  on
                 3i! life, and that they could do something, and if you   could comel
                 4  up with some kind of a figure that would give them   a  little
                 5  help, but certainly not everything that they wanted.
                 6             DR. THURMAN:  That is why I gave them $1.3 millions
                 7  That is not an insignificant amount of money, except when you
                 8  look at 8.5 million, nine million, or ten million people.
                 9             DR. HEUSTIS:  I look up there at the greater
                 10 Delav;are Valley.  Is that Philadelphia?
                 11            That is really the only problem I have in this.
                 12.           DR. THURMAN:  Well, if somebody wants to go higher
                 13 and
                 14            DR. HESS: I wonder about going  up  to  $3  million
                 15 or something.
                               New York is a health care jungle, and my guess is
                    that New York probably has had it.
                 17
                 18            This is a small staff, seven full time professionals,
                    no planned incremental, so that was one of  my  concerns,  can
                    a staff that small handle it.
                 20
                 21            Do they have the  administrative  mechanisms  to
                 22 handle th is much money?
                               Mr. Kline?
                 23
                               MR. KLINE:  I had the same kind of concern, and I     i
                 24
                    cannot answer it, because I have almost an all new staff.
                 25
   HOOVER REPORTING  CO,  1-iC.
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                                                                        are the
   hws-59        I              The only new people being carried over
                 2  Deputy Director and Director.
                 3                                              it?
                                MR. PETERSON:  How long ago was
                 4
                                MR. SIMONS:  Bert was up there in 1972.
                 5              MR. PETERSON:  Really, that information  on the
                 6  staff is completely new.
                 7              It always has been a small staff, as you know.
                 8              MR. NASH:  Pete and I were up there, at least on
                 9  a part time basis, some 60 percent, four physicians, and thes'
                 10 are people with excellent reputations in New York City, and
                 11 it was their proposal then to hire a full time nonmedical
                 12 staff to assist these four people in various program areas
                 13 in which they are working, so this would add tremendously.
                 14             DR. TESCHAN:  How about the financing?
                 15             MR. PETERSON:  Maybe Tom, who has been part of
                 I(; the management assessment effort has some insight.
                 17             MR. SIMONS:  The grantee does all of the accounting
                 18 for them.
                                I don't think there is any of that going oh, on
                 20 the staff   level itself.
                 21             DR. HE8S:  So we don't have to worry about that.   1
                 22             M. SIMONS:  One other thing, as far as staff.
                 23             Jack Eller was with me on a management assessment
                 2,4 to    another place,  They have hired on a part time basis a
                 25 physician to work with them.  These are physicians who have
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                                                                       386
  hws-6(j          reached a stage that they don't want a full time activit,,?
              2'1  but they still want to get involved.
                              MR. KLINE:  I talked to Jack Eller on' the pho,..,,@@
              4    the other day, and he has extremely high praise for  the  part
              5    time people.
              6               Iqueried him about the size of the staff once
              7    again, because that has been a chronic problem with him,  and
              8    I said I noticed vou have some part time people, and he  said
              9    they are very helpful.
              10              MR. PETERSON: I think that is a case  where  the
              11   proposed additional positions would come in, would it  not?   i
              12              MR. NASH:  Yes.
              13              MR. PETERSON:  We have not been consistent.
              14              DR. HESS: Does that mean seven  additional  pro-
              15   posed full time professional clinical people?
                              YiR. KLINE:  Yes.
                              DR. THURMAN: To get back to the  staff  sheet  one
              17
              18   more time, the $88,000 is in overhead and is what pays  for
                   all the accounting and financing mechanisms, and at  the  New
              20   York Academy of Medicine in the program staff figure  there
              21   is a $88,000 overhead, but that pays for their accounting  to 1
              99   the New York Academy.
                              DR. HEUSTIS: I would like to  support  the  motion
              23
                   as made with the proviso that when this comes to the Council,
              24
                   and should there be extra money, that the Council  look  upon
              25
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                                                                               387
  hws-61            the -eeO-- of Nei-! York i.-. a favorable zashicn and that  -,iy
                21
                    thogh,  Abou@  increasing, is what I think a-bout the needs of
                3'il New York City more than anything else.
                4               MR. PETERSON:  You have any   problem with that?
                5
                                DR. THURMAN:  No.
                6               MR. PETERSON:  We  have  a  motion  for  $2.5  million
                7   for this  May  1application for Metro New York.
                8               Any additional discussion?
                9               DR. HESS: I may  just  ask  what  will  that  do  now?
                                Let's say that they come in  with  a  batch  of  new
                10
                11  applications in July, and  a  certain  number  of  those  are  again
                12. passed. They  still  have  the  freedom  to  reallocate  within  the
                13  two decision making periods, so  if  they  want  to  boost,  for
                                                                                     t
                14  example, this Medical  and  Health  Care  Services,  they  can  ou
                15  of that total package that we are not bypassing a lower figure.
                1(; now, we are  not  necessarily  restricting  their  ability  to
                    increase funding in that particular project.
                17
                                MR. NASH: No.  As  a  matter  of  fact,  about  a  month
                18
                    ago Dr. Arranson and the RAG  Chairman  came  in  and  met  with
                20  Dr. Paul, and they  explained  at  that  time  that  their  applica-I
                    tion is going to be  roughly  $7  million.  That  is  the  first
                21
                    application, and the fact that they would be asking for support
                22
                23  for many  of their activities over  a  period  of  two  years.
                                Obviously, Dr. Paul  told  them  that  seems  like  a
                )4
                    little high figure, but go ahead and send it.in.
                25
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                                                                                 a u
  hws-62                       There is very little else you can tell them, bec
               211  they can request anything they want.
                               They did say that they would  take  whatever  was
               4    recommended in this award, and would have their RAG meeting,
               5    and they would look at their total program.  They would
               6    prioritize the activity and select those that they wished to
               7    fund.
               8               MR. PETERSON: I think in response  to  what  I  heard
               9    is your policy kind of question, that New York Metro, or any
               10   other Region, would have the kind of discretion  and  J.attitude
               11   within the two awards which becomes a single  pot  of  money
               12,  again within the Council's  policy  regarding  discretionary
               13   funding to move things around.
               14              The problem that they would have in  the  short  run,
               15   of course, is that they are not sure of how much they will get
               16   out of a July application.
               17              There may be some things that they  have  got  in
               18   this application that they would want to defer starting  until@
               19   they see that, or some things that they might  start  at,  start
               20   at a minimal level, and depending upon the outcome of July,
                    extend it.
               21
                               But the general answer to your question is yes,,
               22
                    they would have that kind of discretion.
               23
                               DR. HESS:  Then these projects will not be in the
               24
                    next package.
               25
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    hws-63      I             MR. PETERSON:  No.
                2             DR. HEUSTIS:  But  there is nothing to  prevent  them,
                3  for funding these projects after they get their July money.
                4             MR. PETERSON:  No.  There are a few caveats, but
                5  I didn't see any projects that involve construction of some
                6  kind.
                7             'DR. HEUSTIS: I look at this arrangement as  perhaps,,
                8  simulating the use of non-RMP money that I feel confident is    i
                9  there, and whereby perhaps instead of paying for the whole      I
                lo thing as far as this working relationship, the city emergency
                   rooms, that they might pay for part of it, and the city might   i
                12 pay for part of it.
                13            MR. PETERSON:  We do have a motion on the table
                14 for $2.5 million providing for the Council looking at your
                15 recommendation given the needs of New York City, that there
                   is some leeway, and that we look upon it favorably.
                              Any additional comment or questions?
                17
                18             If not, all those in favor signify by showing your
                   hands.
                19
                               (Showing of hands.)
                20
                               MR. PETERSON:  Okay.  We had one member absent.
                21
                               We,did what I was trying to avoid doing,  if that
                22
                   clock is-correct, and the cafeteria is now closed, but I was
                23
                   wondering, we have five applications left, and I think we
                24
                   can get them under our belts if we probably work until 5:30
                25
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                   or so
                2
                              Would you people like,  despite the fact tl,,at .,,e
                3!1 cafeteria is closed, to take a stretch at this poin,'%---
                4             (Short recess.)
                5             MR. PETERSON:  Well, let us proceed now with the
                6  Lakes  area.
                7             Mr. Barrows:
                8             MR. BARROWS:  I will try to be brief.
                9             The Lakes area is a nine county area in Western
                10 New York and Northwestern Pennsylvania.  I  think  they  are
                11 asking $2,072,000.
                12            I do not have the last year figures here.  Last
                13 year they were running about $1.4 million.
                14            Their Executive Director is Dr.  John  R.  Angle.
                15 He has been in the program since its inception.  He spends
                   80 to 90 percent of his time with it.
                              The RAG Chairman is Father Garrard, an educator.
                18 The Executive Committee is composed of four officers.
                              The professional staff has  19  full  complement.
                19
                   They have 13 on board of the complement, and need six.
                20
                              I might add that by my guess they are well   supplied
                21 with chiefs, but they are short of  the  important  Indians.
                22
                            . In  the Regional Advisory Group they have 43 people,,@
                2il
                24 two from each  of the nine counties.  The rest are fair y
                   diversified by interest and background.
                25
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                                                                                io
  hws-65        I              There is a substantial non-provider representat  n
                2   In fact, it is aill"),-@ k-. ..ike a CHP Advisory Group, usually
                3@  routine about       Processes.
                4              They have a very  elaborate  structure.  They  have
                5   25 committees, and it looks to me as if there  are  a  certain
                6   amount of overlap, and what have you.
                7              It appeared to me that their processes were demo-
                8   cratic,, but awfully complex.
                9              Their major thrust normally has  been  along  three
                10  lines.  The main one seems to be education.
                               I, too, think we are giving more lip service to
                11
                12  the current RMP mission than they were actually.
                13             For example, these are things that I am  not  t  at
                14  particularly acquainted with. They  are  asking  for  $154,000
                15  for the telephonic electronic program, $200,000  for  a  tumor
                    registry, which I understood was pretty well half full.
                               Area prospects for success undertaken seemed to
                17
                18  be fair, reasonable.
                               Their objectives and priorities are adequately
                20  stated     transmission of new knowledge, regiohalization,
                    and improvement of delivery, but they seem  to  treat  contin-
                21
                    uing education as the way to achieve all of the goals.
                22
                               The proposal looked to me like something of a
                23
                    residual rural mission.
                2,4
                               The feasibility is good and bad.  They have a fair
                25
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   hws-66         1   showing of Sta'--e and local cost sharing on some of their pro-
                  2   grams which wou'Ld suagest some commitment back of them.
                                  Tho-,-@    two CHP B's that they have in Western
                  4   New York and Northwestern Pennsylvania.  Each has a repre-
                  5   sentative on the RAG.  Five of their county committees are
                  6   joint.  They share in their development review with CHP.
                  7               When New York expressed its concern whether the
                  8   large majority of these proposals relate to the major goals
                  9   of LARIIP, of 21 proposals they disapproved eight, because
                  10  .they were not related to the goals, where they had weak pi.@a,,.ng,
                  11  and they approved two with major conditions.
                  12              Now, I would say that ordinarily I can understand
                  13  the sibling rivalry between CHP and RMP, and there is a lot
                  14  of ego trips and petty bickering, but this letter from the
                  15  Western New York B Agency struck me as being a pretty darn
                      rational critique under a proposal that had been submitted to!
                  17  them.
                                  That was my impression, in any event.
                  18
                                  Generally, I would say that this is a weak average
                  19
                  20  program, slow in responding to the 1971 mission.
                                  They have a staff shortage of what I think are
                  21.
                  22  fairly key people in any implementation activity, and         that
                      will limit their capacity.
                  23
                                   I have some question whether the staff and RAG
                  24
                      structure are functioning effectively.
                  25
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    hws-67                     As I say, I wind up "th a no  better  than  average
                                                   wi
               21'                  f weak average.
                   rating, a kind o
                               I would be glad to hear somebody elsels  view  that
               4   might be more cheerful.
               5               MR. PETERSON: I am not sure I can  satisfy  you  on
               6   that   score.
               7             1 Dr. Heustis is the next reviewer, and I  can  say
               8   that.he is charitable, but I cannot say he is going to be
               9   charitable about the Lakes Area, and perhaps the  best  way  is
               10  to  ask  him.
               11              DR. HEUSTIS:  In general you almost read my notes.1
                               This was one of the ones that I t hink that I  made
               12.
               13  the remark that the first time I went through this  I  got  a
               14  pretty decent impression when I went through it fast.
               15              Then when I went back and read it more carefully
                   and tried to put things together, I had great difficulty
                   trying to pinpoint the reported specifics, for example, short
               17
               18  term goals and priorities may well in fact  exist,  but  they
                   were not emphatically stated, and not  with  sufficient  speci-
               20  ficity at least to satisfy me.
               21              I found it interesting in the  classification  of
               22  the projects that some, if you classified them by the so-called
                   major thrust,, there were three of them on the use of knowledge,
               23
                   one on Regional linkages, and nine had to  do  with  personal
               24
                   health in one way, and they also classified them another way,
               25
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                   three for health screening or assessment, tl-re- having to do
  hws-68
                2  with patient care, one coordination, and six o,., Ttaripower
                3  development and education.
                4             That, you can see, is where the emphasis 'Ls.  I
                5  couldn't find any information that was very helpful on how
                6  the staff planned to implement the major thrust, and I could
                7  not find any information on how the relative priority of the
                8  various components was assessed, although they do  say  the
                9  priority was assessed.
                10            My comments as far as the CHP, I have  the  same
                11 reaction to the letter from Western New York, in which they
                12 very specifically commented on the new projects.
                13            Of the five new projects, two were not approved,
                14 and three were approved.
                15            Of the two that were not approved, they had to do
                   with regional hpertension and the preparation of nurse
                   faculty.
                17
                18            The three that were approved had to do with ambu-
                   latory health planning, somebody in the household.
                19
                              I think with the extent and capabilities and the
                20
                   program staff, I just can't help but wonder why they couldnit
                21
                   provide sufficient information in health planning to put some
                22
                   of these things together to stimulate those asking for grantsi
                23
                   to get something done.
                24
                               Apparently they didn't, because as  I  analyzed
                25
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    hws-69      1                                                                 es
                    the money figure here, somc-l.ihere that out of the total requ
                2   of $2.072,000, almost $800,.OOO or slightly less than one-thir@
                3   was listed foi: the           a f f
                4              In addition, a.,.atost $1.1 million was listed  for
                5   activities for program  staff  activities,  leaving  sponsored
                6   projects only some $215,000 as far as others were concerned.
                7              It would seem to me that in one  way  it  could  be
                8   a little onesided.
                9              DR. TESCH@L: You  are  saying  the  staffing  isn't
                10  adequate enough to handle that amount of business?
                11             MR. HEUSTIS:  No, the staff ought to be concerned,
                12,  to be responsible, and to get others to try to handle the
                13  projects, rather than running it themselves.
                14             It looks to me if you have a difficult Region and
                15  a capable staff, the easiest way, at least to my thinking, is
                    to distend it and carry it out with your own group, probably
                    a very limited usefulness in the long  run,  because  it  goes   i
                17
                18  when you go.
                19             The harder way in the long run is to get somebody
                    else interested in carrying out the good idea so that it has
                20
                    a greater chance of  staying.
                21
                22             I guess my general belief is that those projects
                2   that are carried out by others probably have got, on the whole!',
                    a greater probability of being f-anded into projects.
                24
                                DR. TESCHAN:  Continuation funding?
                25
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   hws-70       1              DR. HEUSTIS:  Yes, yet dealing with strong medical
                2   schools, and with a strong situation we        -the difficulty a
                3   least in getting started.
                4              In the overall specific assessment I thought the
                5   program leadership was good to excellent.
                6              I thought the same about the program staff, the
                7   Regional Advisory Group, a little lower, satisfactoilr; per-
                8   formance and accomplishments, satisfactory.
                9              I have trouble with the objectives and priorities,
                10  and I had to break those down as poor, the proposal I wante
                11  originally was higher, but again it is on the poor side.
                12             The feasibility again is on the poor side, and
                13  CHP working relationships, in spite of the disagreements, it
                14  looked as though there was the opportunity to communicate,
                15  and on that my judgment is good, even though there was differ-
                i(i ences of opinion expressed.
                17             I weighted the whole program the same as my
                18  colleague did, on the low, average side.
                               MR. PETERSON:  Well, I think there have been a
                20  couple of concerns expressed that have been shared by staff,
                21  and I will call on Frank, and also ask Bert two or.three
                    things that we had some questions about.
                22
                               MR. NASH:  I will make a comment about the CHP.
                23
                24             What Dr. Angles did, was as soon as he got a pro-
                    ject in and before it had gone through his own review process,
                25
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   hws-71          he sent it to CHP agency for review.
               21@             As it ended up he sent in  21 projects.  The com-
               311
                 ,! ments were received by CHP.
               4*              The Regional Advisory  Group  approved  themselves
               5   only five of the 21 projects.  They did approve one that the
               6   CHP recommended disapproval for.  This was the one submitted
               7   by Niagra University for  training  nurse  practitioners,  and
               8   the Region explains to me that the CHP agency there does not
               9   have a nurse on their staff.
               10              The Regional Advisory Group thought from a tech-
               11  nical standpoint the CIIP's comments in this particular case
               12, were not really accurate.
               13              MR. PETERSON:  There were a couple of projects
               14  or activity concerns that you at least noticed or mentioned
               15  to me.
               i(i             MR. NASH: You will notice  Project  1,  the  Tele-
               ii  Phone N6tworki that activity they have been supporting now for
               18  about seven years, and they propose to continue this in the
                   coming year, and even a year after that.
               20              DR. HEUSTIS: There were  some  two  year  requests
               21  I failed to mention.
                               MR. NASH:  That is right.
               22
                               This for me is a staf f person.
               23
                               I think in the past if they didn't have a policy
               24
               25  we practiced it at least that PM would usually fund an
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                                                                         s ,perhaps
   hws-72       1   activity for three years, and then on rare occasion
                2   for another 12 to 18 months, at the most.
                3!i            Staff would wonder if this concerns the Committee
                4   any that they would continue to fund this thing into the
                5   1970's.
                6              MR. PETERSON:  Let me mention one thing in that
                7   regard.
                               My office, a couple of years ago, we contracted
                9   for a study of these types of networks.  I don't recall that
                10  the New York one was one of the subjects of it.
                11             The contract was an abysmal delivery product by
                12  Systems Development Corporation, but one of the things that
                13  we pretty well knew beforehand, and they did manage to d6cu-
                14  ment the ability to find continuation funding for these kinds
                    of telephone radio networks was fairly low.
                15
                I(;            Now, I think in Wisconsin there was about as much
                17  success as anybody had, and that was in percentage terms of
                18  what, 50, 30, 20?
                               DR. HIRSCHBOECK:  The University extension coh-
                    tinues to support it.
                20
                               MR. PETERSON:  I know in Wisconsin it really was
                21
                    the University Extension Service, and you were looking at
                22
                    nurses, as well.
                23
                               DR. HIRSCHBOECK:  We were just augmenting their
                24
                    program.
                25
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                              MR. PETERSON:  But the-e ha@ -ot been a very good
  hws-73
               2i  track record on the whole.
                              Wisconsin is the exception.
               4              Anybody seeming to get much  money to cost share
               5   or to continue funding these activities, once they are empty,
               6   to pull its dollars out.
               7              I think that may be a reflection of what is
               8   happening in Western New York.
               9              I don't know, but this is  the  staff's  concern.
               10             This seems to have been part of the Western New
               11  York - Lakes area package of projects since  the  year  one.
               12             MR. BARROWS:  It has never been my impression
               13  that RMP was designed to provide continued operation of
               14  service.
               15             Here, you are asking for about one-third of a
                   million dollars for this network that is  seven  years  old,
                   and their tumor registry, that alone they are asking $200,000.1
                              I would think once you establish  whether  it  is
               18
               19  going to fly or not fly on its own, that is the time for RMP     1.
                   to get  out.
               20
               21.            MR. NASH:  I asked them for the tumor registry,
               22  and they said,they had funded it for three  years,  but  you
               23  need at least five year support to gather enough data to make
               24  these things useful in feeding back information to physicians.
                              MR. KLINE:  Can I comment on that?
               25
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   hws-74                       MR. PETERSON:  Surely.
               2                                                a site visit
                                MR. KLINE:  In 1971, December,
               3
                    strongly suggested that the program get out of that tumor
                 11                                                                  1
               41
                    service registry because it was not  felt  at  that  time  that
               5    it represented a very strong project.
               6                At the time the indication  was  that  it'had  been
                    contracted  or planned for a five year effort.
               8                This plan as it now shows carries it into the
               9    fifth year  and on into the sixth year.
               10               I tend to have a little bit of concern about
               11   that.  The  other concern that I have  about  this  program  is
               12.  that it doesn't look very, very  much  different  than  it  looked
               13   three years ago, which is kind of amazing.
               14               This is sort of like a static program.    T e rura
               15   program has been going on for  three  or  four  years.  The  tele-
               I(;  phone collection network, from the day the program      opened.
               ii   The tumor service registry almost from the day the      program
               18   opened.
                                The two activities  essentially  are  there,  emer-
               20   gency medical service and  their  area  health  education  center,
               21   and the other activities they have are relatively.small and
               22   new.
                                I guess my primary concern is I looked at this
               23
                    with a tremendously huge staff, and they  do  have  a  very  large
               24
               25   staff, and they do have some  very  excellent  people  on  that
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  hws-75        1   staff.
                2             The problem is they essentially haven't come up
                311 with a program.
                4             MR. BARROWS:  They don't have the leadership.
                5             I have concluded that  the  program  that  wasn't
                6   doing much probably wouldn't change, and  the  upper  limits of
                7   my responsibility would certainly not warrant coming forward
                8   with a proposal that does much more than continue their
                    present funding level, which would be about  $1.4  million.
                9
                10             MR. PETERSON:  Let me add one thing regarding a
                11  specific activity which Bert singled out as being  one  of  the  1
                                                                                     1
                    few newer things, and that was the  Lakes  Area  Health  Education
                12
                    Center.
                13
                14             Now, my information is roughly 18 months old, but
                15  we did staff visit a large number of  the  health  services
                    educational activities back in May, June and  July  of  197
                               The old one that I went on happened  to  be  the
                17
                    Lakes Area one, so I don't have any personal comparisons to
                18
                    be able to make, but I do know in talking to people who were     i
                19                                                                   I
                    on that site visit, and more importantly,  the  others  who
                20
                    would have been on a far broader range of site visits, that      i
                21
                    was one at that point, one of the weakest ones.  They had
                22
                    real problems with getting any kind of commitment.
                231
                               This wasn't a  matter  of  domination.  They  had  what
                2,4
                    was admittedly an extremely difficult, nasty situation in
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  hws-76        1   Erie, Pennsylvania where you have two hospitals jockeying
                2   for some sort of number one position, the medical staffs, thel
                3i  physicians in the community being staffed sort of, you know,
                4   their appointments with one or the other, and at that point
                5   was one of the weaker looking ones, and I don't know whether     1
                6   we have any later information, and it wasn't in the prog-
                7   nosis for good progress, and was not all that good in the
   (5)          8   health educational center.
                9              MR. NASH:  They still have the same Project Direc-
                10  tor for this.
                11             MR. KLINE:  Pete is commenting on the Erie,
                12  Pennsylvania Health Education Center.
                13             I visited five emergency health service projects
                14  last year.
                15             Of the five we visited, I tended to suspect that
                    it probably ranked at the top so probably offsetting the
                    possible deficiency in the health activity, their  medical
                18  service activities were performing very highly.
                               DR. HEUSTIS:  I wanted to ask Mr. Barrows if he
                    would accept a slight amendment to his thought of financing
                20
                    at the current level -- that is financing it at the current
              .21   level less or a deletion of all of the money for project
                22
                    that have already been financed for three years, less a
                23
                    deletion of one-half of all the money that is requested for
                ?,4
                    the two year projects.
                ,)5
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  hws-77       1             Staff is going to have to help figure  that  arith-
               2  metic out.
                             MR. BARROWS:  That would be suitable to me, pro-
                  viding the net answer isn't more than they got last year.
               5             DR. HEUSTIS: It would be substantially  less  than
               6  they got last year.
               7             We should probably indicate on that, that our
               8  Committee is dissatisfied, or expressed some  dissatisfaction
               9  with the way the program has developed.
             10              DR. HESS: I do not think you can be  that  strong.
             11              You can give strong advice, but you cannot  delete
             12,  line items, can you?
             13              MR. NASH:  The only thing we can do is give them
             14   X number of dollars and advise that they then rechoose  these
             15   things in the seventh year.
             16              DR. HEUSTIS:  I am not deleting the project.  I
             17   am deleting the money for the project.
             18              MR. PETERSON:  We are not arriving at a figure.
             l@)             DR. TESCHAN:  That is your intent, but the net
             20   effect is a bundle of money.
             21              DR. HESS: Rearrange it any  way  yo.u want.
             22              MR. PETERSON:  I think what we have heard reflects,
             23   in part, the concern that the staff has whatever the  figure,
                  assuming Council goes along.with this, because this is  their
             24
                  policy, pointing out and taking notes of it, and the fact that!
             25
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                                                                           4o4
    hws-78        several of their activities are well beyond that point   and
              2 1 that they ought to be governed, hopefully, accordingly   without,,
              3, i
                  in effect, saying you can't do it, but they are.
              4               Whatever figure, if we are talking at  the  present
              5   level, or something less than that, this request   as I loo
              6   at it totals roughly $2.3 million.
              7               If they get a significantly less amount  than  what
              8   they have requested then it seems to me they are going to
              9   have to make some hard decisions.
              10              MR. BARROWS:  Let me see if I understand this.
              11              If my arithmetic is right, we would come out not
              12,  too far apart on this.
              13              There is $200,000 for registry, $154  for  electra-
              14  network.  Those would be out, and half of this remaining
              15  $150,000, another $75,000, knocking those out would reduce
                  this thing by $225,000.
              I(;
              17              They are asking for $2 million.
                              DR. HEUSTIS:  My statement was their present level
              18
              19  of   funding.
              20              MR. BARROWS:  Excuse me.
              21              DR. HEUSTIS:  I propose to  knock the $225,000  out
                  from the $1.4 million.
              29
                              MR. BARROWS: That might be  a  little  severe.
              23
                              DR. HEUSTIS: Do.you  understand  the  process?
              24
                              DR. HESS: That takes it down  to  $1  million.
              25
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  hws-79                       DR. HEUSTIS:  The process is we do not provide
                2   money for projects we have already financed for at least
                3
                    three years, second, the report shows that they have been
                4   advised on at least one of these that they had some advice
                5   back in 1972.
                6              The other is that we provide only half the money
                7   necessary for any -- that is half of the money requested for
                8   anything that they have requested for two years, which reallyi
                9   doesn't do a very great disservice to the remainder of the
                10  program.
                11             DR. TESCHAN:  I don't like that.  It creates a
                12.  problem.
                13             You are handling it in a way that riles everybody.
                14             DR. HEUSTIS:  I make a motion to bring this to a
                15  head, that we say that staff has to do some arithmetic,
                I(; because I can't come up with the figure, but $1.4 million
                17  less the other two items.
                               MR. BARROWS:  Let's round it off to $1 million.
                               MR. NASH:  What figure are you using as their
                20  current funding level?
                21             Apparently we have two different figures here.
                22             MR. BARROWS:  I was using the one on this sheet,
                23  the current and the annualized.
                24             DR. HEUSTIS:  We rounded it off to $1.4 million,
                    and we started to subtract from $1.4 million.
                25
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  hws-80                       MR. NASH: The sheet I  have  shows  $1.81  million
               2   current, and the annualized level.
                               MR. PETERSON:  We are really in great shape.  We
               41  have two sheets that have separate figures.
               5               MR. NASH:  Mine is dated May 20.
               6               MR. PETERSON: What is  the  correct  figure,  $1.4
               7   million?
               8               MRS. WILSON:  Yes.
               9               MR. PETERSON:  It seems to me with having done
               10  some hurried arithmetic, if we were singling telephone,
               11  tumor registry as having gone beyond the three years, having
               12i those three other small projects that were asked for two
               13  year supports that rough analysis is  about  $400,000,  and  I
               14  think that is what you are talking about.
               15              DR. THURMAN:  It is $1.370 million minus $354,000
               16  minus $65,000, which is $419,000, so  $1  million  takes  care
               17  of your recommendation.
               18              MR. PETERSON:  You  Iwould make that as a recommenda-
               19  tion?
               20              DR. HEUSTIS:  I accept your arithmetic.
                               MR. PETERSON:  I take comfort from the fact that
               2
               22  Bill Thurman agrees with me.
                               DR. HEUSTIS:  He was agreeing with me.
               23
                               MR. PETERSON:  l.was not at odds with someone
               24
                   elsels  number.
               25
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   hws-81      I              Is there a second?
               2              DR. TESCHAN:  I second.
               3              MR. PETERSON:  Any additional discussion?
               4              I would just point out that we do have an   estimate
               5   that roughly a $500,000 plus application would be coming in,
               6   in the July cycle.
               7              If there is no further  discussion  or  question,
               8   those in favor raise your hands.
               9              (Showing of hands.)
              10              MR. PETERSON: Those  opposed  raise  your  hands.
              11              (Showing of one hand.)
              12,             MR. PETERSON:  We have a seven to one vote.
              13              Before we dip into the next application, could I
              14   ask a question of the group, because I have  been  handed  a
              15   note asking me what time will be good for  us  to  reconvene
                   with Panel A tomorrow as a single group, and I am assuming
              17   that if we are going to allow ourselves a little time to review
              18   our own actions, that whatever time I tell them we will need
              I!)  to allow ourselves a half hour in advance.
              20             Is the group willing to get together at 8:30
                   tomorrow?
              21
                             If that is satisfactory I will do that.
              22
              23             Now, we have four Regionsi  I am going to try to
                   get away so some of you who.have been reviewing more than othe@s
              24                                                                   1
                   here at this particular point in time I wonder,  Sister  Ann
              25
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                                                                            4o8
    hws-82       1                HEW REGIONAL MEDICAL PROGRAM FOR
                 211                    THE STATE OF MARYLAND
                 .Jill         MR. PETERSON: Now, here  again  I  think  the  staff
                 4  person involved, Frank and Gene Nelson,  need  to  be  prepared
                 5  to supplement this.
                 6             We have the free State of Maryland.  It was separ-I
                    ately set up from the beginning.
                 7
                 8             MR. SIMONS:  Hopkins is a grantee.
                 9             SISTER JOSEPHINE:  Johns Hopkins is the grantee
                 10 agency in Maryland, and one of the  criticisms  of  the  ongoing
                 11 criticisms of the Maryland program has been its very close
                 12. affiliation with Johns Hopkins University.
                 13            The program leadership  is  relatively  poor.  I  get
                 14 the impression, and these are just impressions at this point,
                 15 but I do get the impression that the strength of the Maryland
                    medical program has been to kind of  maintain  a  broker  image
                    in the area,, and to use regional medical program funds to
                 17
                    just give to other agencies so they could carry out their
                 18
                    work, and I think they describe this  type  of  available  money
                 19
                    as mini-dontracts.
                 20
                               When we were there about three or  four  years  ago.,
                 21
                    I remember there was a question raised by the site visit
                 22
                    committee, whether or not this was a good way for them to
                 23
                    proceed, and after it was discussed with  the  group,  the  con-
                 24
                    sensus was that this practice should,  if  not  be  eliminated,
                 25
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  hht-83       1  be modified. But I notice it is still being  carried  out.
               211           The program staff is  satisfactory.  Ho.wever,  they
               3.1 draw very heavily on staff from affiliated programs,  partic-
               4  ularly of the other universities, and that is not always bad.
               5             The Regional Advisory Group looked, on paper, to
               6  be adequate, but I would have to ask the staff person working
               7  with the program whether they are really aware of what  is
               8  going on in the program, or whether they simply go along
               9  with programs that are outlined.
               10            Past performance and accomplishments have  been
               11 satisfactory to poor.
               12            It was difficult for me as I looked through this
               13 program to identify, to really identify a program that was the
               14 program of Maryland rather than the program that is going  on
               15 in other institutions without close coordination from their
                  Regional Medical Program.
                             The objectives and priorities are  satisfactory
               18 as they are stated.
                             The proposal is inadequate in many ways.
               19
               20            Feasibility is checked inadequate, and the  CHP
               21, relationships in the written document appear to be good.
               22            The overall assessment I gave the program is below
             .2.3 average, but I am simply going on the material that was  here
               24 in the.book.
                             MR. BARROWS:  Let me ask a question, as I don't
               25
  IOOVER REPORTING CO, INC.
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    hws-84         know the area that well.
              2
                              In Maryland can you get very far without &'Jeing
              3
                   pretty closely identified with Johns Hopkins?
                i                                                                i
              4 .1            MR. NASH: Either that or the University  of  Mary-
              5    land.
              6@              SISTER JOSEPHINE:  It may be there is no other way
              7    to go about it.
              8           -   DR. TESCHAN:  Where is -@he element of limitation
              9    you are implying?
              10              SISTER JOSEPHINE:  I think I am probably reading
              11   that into the proposal from the impression I had on the  site
              12   visit, where it was very difficult to sit down with the staff
              13   and to have them, you know, really identify a program and  talk
              14   about a program.
              15              The ones who could really do it effectively were
              I(;  those who were carrying on the program. It was  usually  from
              17   one of the universities, and it was always someone from Johns
              18   Hopkins.
              19              I would be interested, and I may be over reacting,
              20   but I would like to have the person who works oft the program
              21,  reflect on that.
              22              MR. NASH: Unfortunately, the person who  has  worked
              2.3  on this program for the last three years now has other  employ-
                   ment.
              24
              25              That person is not here, and I think one of the
  HOOVER REPORTING CO, INC,
  320 Massachusetts Avenue, N.[.
  Washington, D.C. 20002

                                                                           4ii
   hws-85     1    things that has been pretty typical of  this  program  in  the
              2    past, the observation of site visitors  and  people  who  study
              3 1  the Region is that this particular  program  has  never  really
              4    taken a good look at the needs, and then  made  an  effort  to
              5    develop a program within the State  that  would  help  overcome
              6    those needs; that the projects and activities they have
              7    engaged in appear to be opportunistic.
              8               Somebody comes up with an idea, and they say  let
              9    us fund it.  That has been one of the major complaints about
              10   this region in the past, and to a certain extent it may still
              11   be true.
              12.             MR. NELSON:  I might say my identification was
              13   about two weeks, and I am no authority.
              14              Basically, I made some notes saying in  reviewing
              15   that they were criticized in the past for three major things
              1(;  -- failure to acquire sufficient staff to do the job, depend- I
              17   ency'to concentrate in Baltimore, and I mean Baltimore City,
                   and a tendency to keep the program to themselves.
              18
                              It seems to me we are looking at a different prc
              20   gram this year, and, in fact, whereas they had 22  projects
              21.  last year, a great number of w ILch were in Baltimore and
                   environs, we are now talking in terms of, let me see --  let
              22
                   us talk about these three concerns, and first failure to
              23
                   provide. sufficient staff.
              24
                              They have, in fact, as a result of advice letters,
              25
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                                                                            412
     hws-86    III  -roved from 4.5 people to nine people in this application.
               2111            Thi@.; is some-thing that they have been constantly
               3"   prodded to do.
               4               The second concern is  concentration  in  Baltimor
   0
               5    They have five projects.  One provides planning and services
               6    in Ocean City.  This is planning for health services in the
               7    Ocean City area.
               8               One is a CHP Planning Seminar for Consumer Orien-
               9    tation  throughout the State of Maryland.
               10              They are requesting $25,000 to,  in  fact,  under-
               11   write orientation of consumers to the CHP Plan.
                               DR. TESCHAN:  Is that the Health Plan for Maryland
               12 @                                                                i
               13              MR. PETERSON:  Except for the title.
               14              MR. NELSON:  I think it is quire indicative of
               15   the good relationships between @IP and CHP.
               i(i             I might add that I talked to Eugene Gunthries,
               17   who was former Director of Chronic  Diseases,  Public  Health
               18   Services.  He just left under questionably circumstances two
               I!)  or three weeks ago.
               20              Up until that time the limited information I had
                    is that his successor is continuing with  his  concept,  very
               21
                    close cooperation between the two hospitals.
                               A third project, even though it is centered in
               231
                    Hopkins, involves care services for the  poor  in  outpatient
               24
                  ! departments, correlating with Hopkins in the outpatient
               25
   HOOVER REPORTING  CO,  INC.I
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                                                                                413
   hwlg-87          department.
               2                DR. rLrHUR-VAN That is Number AU56.
                                                        or Pla.-n4-g  and  Data  Systemi
                                MR. NELSON:  The Manp^w
               4    more effective use of manpower    md related services @.i-i hospit 1
               5    outpatient service depar-Lr,,ent.
               6                We have a fourth program involving SAEA    concepts,
               7    30 health education agencies.
               8                DR. TESCHAN:  1-7hich one is that.@
               9                DR. THUR@IAN:  That is 058.
               10               MR. PETERSON:  Those are the most undescriptive        I
               11   project types.
               12,              DR. TESCIIAN:  Let us come back to that.
               13               MR. NELSON:  The third concern, the makeup of the      i
               14   RAG now shows involvement of  an  amount,  a  large  number  of
               15   consumer groups, and  groups  representing  the  poor,  and  so
                    forth, so I think the program has turned itself around.
                                The percentage of increase in staff would be     39
               1 7
               18   percent.
               19               As to projects they have $760,000, a little less
               20   than half of which is for projects, a little more than half
               21   of which is for programs.
                                DR. TESCHAN:  Another $442,000 due in July.
               22
                                MR. PETERSON:  Well, we have requests here,      as
               23
                    Sister-Ann  indicated, for $.762,000 or $763,000, if you    round
               21   it off upwards, which is slightly above what their operating
               2 5
   HOOVER REPORTING CO, INC.
   320 Massachusetts Avenue,
   'tlpf@hingtoti. D.C. 20002

                                                                          4i4
  h b-88           level is now.
                2
                              They have indicated they will be corung  in  in  July
                   for about $400,000.
                4             DR. THURMAN:  Could I ask a question?
                5             MR. PETERSON:  Surely.
                6             DR. THURMAN: On the total program  staff  they  have
                7  a figure of $144,000 under "other."
                8             Do we have any idea what that is?
                9             Is that beyond salaries and wages?  They have a
                10 total of the other category.
                11            MR. NELSO'll: $125,000 requested for contracts  and
                12. studies.
                13            DR. THURMAN: Then Maryland has not  changed  in  the
                14 $125,000 plus the $57,000 listed under 058 which  goes  to
                15 Johns Hopkins Computer Center, which has always  been  the
                I(; biggest argument we have always had about Maryland, so  it  has
                17 not changed.
                18            MR. BARROWS: It sounds like a program  with  a  lot
                I!) of paper shuffling to me.
                20            DR. HESS: An indirect measure  of  RMP  impact.
                21            Last month I was at Hopkin's on a site visit for
                22 another program which is supposed to have an  outreach  comoon-
                23 ent, and it was evident from the level of think3ng on that
                24, proposal that for this, this had a lot to do with  the  school
                   of public health among other things, but RMP's had  little  or
                25
   HOOVER REPORTING Co, INC.
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                                                                           415
  hws-99         1 no impact on the thinking of those people, and they did not
                 2 know really how to go about, you know, needs assessment and
                 3@i this whole ball game, and effective RMP would be educating
                 4, somebody about it.
                 5             I rather mused to myself that this seemed to be
                 6 further evidence of a rather weak RMP.
                 7             DR. TESCHAli:  It didn't occur to the Project
                 8 Director to ask to get the project data.
                 9             DR. HESS: Neither were  RMP's  mentioned  once,  and
                 10 the people didn't seem to know how to do it.
                 11            This was really a very self-serving application,
                 12. as I viewed it, self-serving to Hopkins,,  but  not  necessarily
                 13 to the community and the State at large, which it was supposed
                   to be.
                 14
                               SISTER JOSEPHINE:  I got the impression the com-
                 15
                   munity at large doesn't really know what the  RMP  is,  and  the 1
                   Program Director really has funds that he  gives  out  to  other
                 17
                   agencies, and the people in the agencies are the receivers
                 18
                   of the service, a.-id really aren't aware where the money comes
                 19
                   from.
                 20
                               DR. TESCHAN:  It seems to me we have an inactive
                 21
                   RAG in terms of directing it, an inactive coordinator as
                 22
                   defined here, and we  have  a  self-serving  unconcerne  grantee
                 23
                   in terms of the principles of the program.
                 2,4
                               If I remember the basic notion of the essential
                 25
  HOOVER REPORTING CO, INC.
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                                                                             416
  hws-90            ingredients of an PIT. as delined in the August 1972 policy,
               211  those are the threia essential ingredic@nts so that if we don't
               3"                                              don't have an RMP.
                    have '%-.he essential, ingredients it says we
               4                            otion in order to  discontinue Mary-
                 I             Why isn't a m
               5    land?
               6               DR.  HEUSTIS: Make a motion, and I will support
               7    it.
               8               DR. TESCIIAII: I so make it.
               9               MR.  BARROWS:  I don't share your abrupt change at
               10   this time.
               11              In support of what you said, there  is  a  fourth
               12,  striking deficit in this, and that is the end product is
                    useless.
               13
               14              I don't care if they give it to this guy or that
               15   guy if they are coming out with something that is beneficial.
               1(.             There are a lot of play things for the computer
                    people, so I would say in addition to these other weaknesses
               17
               18   their end product is not impressive.
               I!)             DR. TESCHAN: There  are  four  important  reasons
               20   not to spend the  money.
               21              MR. BARROWS: But you get  the  other  point,  the
               9-2  reason, and that is for the Council.
               231             I don't think it would be appropriate for us to
                    make recommendations, but yesterday we pretty well agreed you
               24
                    are not going to get a leopard to change its spots this late
               25
   HOOVER REPORTING CO,
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                                                                          417
      hws-91     1  in the day, that we are not going to create any grea4- changes
                 2  in any of these programs in their Remaining life scope.
                 3             I think probably in order to avoid capriciousness
                 41 we better continue the policy basically of the past without
                 5  any wild swings up or down.  That would be my conclusion.
                 6             DR. HEUSTIS: We have here,  for  the  first  timer
                 7  that has been spelled out the three things, and the one you
                 8  added, and it would seem as though quite a part of our func-
                 9  tion was to make a recomri@-ndation to the RAG according to  thei
                 10 motion that has been duly made, and supported,  and  I  would   I
                 11 like to see those four items put in the motion  so  we  don't
                 12 lose them somewhere, and let the Council see  what  we  think
                 13 about this overall situation.
                 14            MR. BARROWS:  I will buy that.
                 15            DR. HEUSTIS: The motion you  say  that  you  would
                    now buy is to give them no money, and that was  my  intent,  and!
                                                                                    I
                 17 see what happens, because probably there isn't  anything  that  i
                 18 could have a better influence upon the  whole  IRD  structure
                 1!) for someone to stand up and take the bat and swing it.
                 20            MR. BARROWS:  Let me ask you a question.
                 21            We have been told by legal, who has wiser and
                    finer minds  tIhan ours, that part of our job now  is  to  prepare,
                 22
                    for this transition to a new type  of  combined  agency,  and
                 23
                 1  what the impact of ending one right at this time instead of
                 24
                    retaining a leap year fund upon which to build
                 25
   HOOVER REPORTING CO, ItiC.
   320 MasF-,chusetts A@ieii(i-- t@.E.

     hw,-, -z    III             DR. HEUSTIS:  If liou will pardon me, the    cc
                                                                                    that
                 2   is rocking  in the bo,lc doc.;sri't do much good to keep it in  the
                     refrigerator.
                 4               DR. TESCHAN:  I  feel  that  the  new  planning  corpor-I
                 5   ation is going  to  need  a  widely  based  representative  operation
                                                                                         I
                 6   with clout, that the worst place to start from would be one
                 7   of these, -ind that we do  the  entire  process  of  representatives.
                 8   of health planning a greater service by getting r4-d of
                 9   grantee.
               10                MR. BARROWS:  Right now you have reason in there
               11    that I can  buy that this future entity will be a lot better
                     off by starting from scratch than it will be     trying  to   build
               12
               13    on some pretty weak foundation.
               14                DR. TESCHAIN:  Especially when you have all the
               15    years of badgering.
                                 Now, Hopkins and company  have  to  learn,  in  my  own
                     view, it is long since time that somebody got somebody's
               17
                     attention.
               18
                                 I know some of the  people  who  are  involved  in  this,
               19
                     and they have been disastrous in other places they have
               20
                     attempted to manage.
               21
                                 MR. PETERSON: Let me see if  I  have  a  sense  of  whati
               22
                     I hear the Review Panel saying  in  effect  is  it  would  like  to
               2 t3
                     propose to the  Council  in  effect'that  the  Council  give  serious
               24
                     consideration to terminating  or  phasing  out,  I  think  we  might,
               25
  HOOVER REPORTING CO, INC.
  320 Massachusetts Avenue, P4.1.
  ','Iashingtofi, D.C. 20,',02

                                                                        l@ig
  tiws-923      I  you know, whether it would come to an end June 30,   the  Coui-icii,',
                               I                                                    1
                21 doesn't meet until June 14 and 15, so I think really the
                   termination or phaseout would entail some money based upon
                4  a conclusion by this group that what we have here is a largel
                5  inactive, ineffective RAG.
                6              I had written down, and I don't think  you  had  used,
                7  the word, and I am searching for a word  --  a  coordinator  who
                8  is ineffective, a grantee that has been self-serving in the
                9  sense that it has raanaged to use the program for  some  of  its
                10 own interests for a long period of time, and  this  is  a  situ-
                11 ation of longstanding, where there is really li-'--tle, if  any-
                12@ thing, to show in the way of accomplishments, any output.
                               MR. BARROWS:  The end product is the thing that
                13
                14 impresses me.
                15             You don't have anything coming out with these
                   bucks.
  (6)                          MR. PETERSON:  Is that the sense?
                17
                               DR. IIEUSTIS: If you would not object  to  the  word
                18
                   termination, and we have a full idea that the Council being
                   a reasonable body will probably give them  some  time  to  phase
                20
                   out if they accept the sense of the motion.
                21
                               MR. PETERSON:  I was trying to summarize what I
                22
                   heard said, not necessarily putting my views on the table, andi
                23
                   I certainly would like to hear some response from Sister
                24
                   Josephine, who did review the a  placation,  and  you  conducted
                                                    p
                25
  llt)f)VER PEPORTiriG CO, INC.
          Avpnue, N.C.
        D

                                                                    420
  hws-94          the site visit.
                             SISTER JOSEPHINE:  I would agree with this.
                             The question I would raise at this point is to
  0            1  phase this progrc-m out.
                             How much of this $684,000 do they have?
              6              MR. PETERSON:  Current?
              7              Gentlemen, do we have any idea of what Maryland
              8   may have in an unobligated balance coae June 30?
              9              They have been operating at a fairly modest level.
              10  I suspect their balance is not likely to be large, Sister.
              11             SISTER JOSEPHINE:  You see,, that would maintain
              12. staff during the phasing out period.
              13             DR. HEUSTIS:  There is nothing to preclude the
              14  Council from putting in whatever money is necessary to do
              15  whatever they want.
                             SISTER JOSEPHINE:  Yes, and between now and July
              17  we might have some communications.
              18             DR. HEUSTIS:  I hope this is the whole purpose of
                  the arrangement.
              19
              20             DR. THURMAN:  I move the question.
              21             DR. HESS:  Just speaking for myself, I am not
              9-2 prepared to vote on that at this point.
                             I would like some time to study this application.
              23
                             This is, I think, the most drastic recommendation
              24
                11 that we have considered today.
              25
  HOOVER REPORTING CO, INC.
  320 flassachusetts Avenue. N.[ -
  Viashiiizto.i. D.C. 20002

   hws-95                        DR.  THUR.MAN:  We  made  this   recommendation twice
                2i!
                 ii  before, though.
                                 DR. HESS:  Termination?
                                 DR. THUP14AN:  Yes.
                5
                                 DR. HESS:  I don't   remember  that  we   have.
                6                SISTER JOSEPHINE:    This was considered.
                7                I think  when  this  was  reviewed  thesp  same question
                8    came up. But  I  think  this  was  reviewed  the  same  way  the
                9    same questions, that is this morning.
                lo               DR. THURMAN:  The Sister is very charitable.  The
                11   person who reversed us the last time was the Council.
                12.              DR. HEUSTIS:  It is Councills responsib
                                                                             ility to
                13   do what they think.
                14               MR. BARROWS:  I think we ought to do the honest
                15   thing and pass the buck.
                                 MR. PETERSON:  We do have a motion.
                17               Rod  Merker  recently,  I  understood  from  Frank,
                18   that he recently -- well,  I  don't  know  if  that  is  within the
                1.9  past six months or  past  two  weeks,  had  made  a  management
                20   assessment visit to the Maryland @IP.
                21               MR. MERKER:  It wasn't recent.  It was two years
                     ago,, and I think you have a good acceptance of what 1 found
                23   two  years  ago.
                                 I found no overt domination by the medical school,
                24
                     but a lack of leadership on the part of the Advisory Group,
                ')5
   HOOVER REPORTIN(, CO, It,
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   "lashin,,tot
        D.C. 20002

                                                                              422
  hws-96           which enabled the medical school to get what it needed from
               2   the grant, and I think you all know there was    a large
               3!i epidemiological body or school supported  in  the  school  for    i
               4   four   years.
               5               DR. HEUSTIS: Mr.  Chairman,  the  question  was  calle,
               6   for, as I recall it.
               7               You remind me of an Episcopal Bishop.  Pardon the
               8   pun, Sister.
               9               MR. PETERSON:  The question has been called.
              10               I will make a specific point because  we  will  be
              11   getting together tomorrow, and you will have a chance to look
              12.  at an application.
              13               Some of these people will have slept upon what I
                   understand  to be the motion.  There is no reason that we
              14
              15   could not,  if you and others see fit,  make  the  motion  tomorroo
                   that would, in effect, modify or remove this item, but given
              i(i
              17   the motion to recommend to Council  the  termination  of  this
                   program within a reasonable period of  time  with  such  un  s
              18
                   as may be considered, and  we  don't  know  the  carryover  situa-,
              19
                   tion for the reasons indicated which  I  tried  to  summarize.
              20
                               DR. HEUSTIS:  Did you say this has been done twice
              21
                   before?
              22
                               DR. THURMAN:  Once before we asked for a site
              2 r3
                   visit, because the point he just made that we were supporting
              24
                   an epidemiological study.
              25
  HOOVER  REPORTING  CO,  INC.
   32OMassachusettsAvenue,N,E.
  Washington, D.C. 20002

                                                                         4-@3
     hws-97    I              DR. IIEUSTIS:  Have we ever recommended to Council?
               2              DR. THURMAN:  It was recommended to Council that
                   consideration be given to terminate the Regional Program.
               4              DR. HEUSTIS:  Would you object to an edit,)rial
               5   change to the motion that we repeat the motion that was made
               6   by whatever it was, the previous Review Committee, that this
               7   be terminated?
               8              I think this gives further emphasis to it.
               9              DR. THURMAN:  The only thing I would have to say
                   to it is that it was recommended to Council that it be con-
              10
              11   sidered for termination, and Council voted to keep them going.
              12.             DR. TESCHAN:  Put something in there like a comma
              13   and then quote in view of the past recommendations * * *
              14              MR. PETERSON:  I am not sure I have that.
              15              Well, the question has been called for about ten
                   minutes ago.
                              Those in favor raise your hands.
              17
              18              (Showing of hands.)
              if)             MR. PETERSON:  Those opposed raise your hands.
                              (Showing of one hand.)
              20
                              MR. PETERSON:  There is just one opposed, and the
              21
                   motion is carried.
              22
                                   AR. WS*.  Pete, may I ask one thing?
              23
                              MR. PETERSON:  Surely.
              24
                              MR. BARROWS:  In this message that we transmit to   i
              )5
  HOOVER REPORTING CO, iNG.
  320 hiassachusetts Avenue, N 1.
  Washington, 04C.20002

                                                                           421',
  hws-98         III ttie cou,,-icil, do you contemplate including the fact that we
                 21@ faced up to the impact on the upcoming legislation, and came
                 ,3 squarely to the conclusion that we would be better off start-!
   0             4  ing from scratch?
                 5             MR. PETERSON:  What exists is there is not a te-
                 6  source for HRP, or anything else that might come down the
                 7  pike.
                 8             This is just my praseology of what I heard.
                 9             MR. BARROWS:  I thought we said it would be more
                 10 harmful to have them around than to start from scratch.
                               MR. NASH:  If it is to be a State Health Plan
                    organization, it is highly unlikely to be the agency.
                 12.
                 13            DR. TESCHAN:  I think it is arrogant.  I keep
                 14 hoping that our encouragement to a ttansistion stance will
                 15 allow them to tidy up their relationships so at least they
                 1(; are in the running.
                 17            The alternative is to lose what is there, and the
                 18 health field hardly can afford to lose any more than it has
                 I!) already lost.
                 20            MR. BARROWS:  I am not quarreling with you.
                               MR. PETERSON:  Okay, we have three Regions left,
                 21
                    Metropolitan District of Columbia, Nassau-Suffolk,, and
                 22
                    Susquehanna Valley.
                 23
                 24
                 25
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                                                                          i[25
  hws-99        II                HEW REGIOII@AL MEDICAL PLAN FOR THE
                2                        DISTRICT OF  COLUZABIA
                31,            MR. PETERSON: I  wonder  now  if we could turn to
                41 a sister jurisdiction  of  Maryland,  namely the District of
                5  Columbia, or the  metropolitan  District  of Columbia RMP, and
                6  Joe, if you would lead off on that.
                7              DR. HESS:  The Metropolitan Washington RMP is
                8  one that I  know from pas,-- reviews that has been of some con-
                9  cern,
                1.0            It is, however, in a triennium status.
                11             The grantee is the Medical Society of the District
                12,  of Columbia.
                               The Coordinator is new since I remember the last
                13
                14 review of this Region.
                15             Their broad goals are to provide assistance to
                                                                                     I
                   CHP's in developing plans, and incidentally, within the last      i
                17 few months the CHP has been organized in Washington.
                18             A second goal is to increase availability and
                   access to  primary care services, and to improve along with that
                   possibly  the hospital care, and a third one is to regional-
                20
                21. ization of experience and secondary and tertiary health care
                   resources,
                9-2
                               The letter of submission which is signed by the       I
                23
                   Chairman of the Regional Advisory Committee is quite enthusi-
                24
                   astic,  and I would like to read some sections from that.
                25
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   hws-100       1             This is written by Dr. John A. Kenney, Jr., 14edica'-
                 2 Doctor, Chairman, Yietropolitc-m Washington  Regional  Advisory
                 311 Council.  He says, and I quote:
                 4             "First I would like to address  the  past  perform-
                 5       ance of MWRMP. I have had the  privilege  of  serving  on
                 6       the RAC since the inception of  MWRMP.  From  this  vantage
                 7       point, and from my faculty position at Howard University,
                 8       I have been greatly impressed by  the  significant  contri-
                 9       bution MWRMP has made by improving  the  accessibility  and
                 10      quality of care of the underserved  areas  and  populations
                 11      in the metropolitan region.
                 12,             "Certainly the activities with which  I  am  most
                 13      familiar are those at Howard and  Freedmen's.  Hixaaver,  I
                 14      will cite several of the most noteworthy projects:
                 15            "Hbward's Cancer Radiotherapy project provides
                         the seed funds that have assisted in developing one of the
                 17      highest quality cancer treatment centers on the East
                 18      Coast.
                               "Freedmen's Stroke Project  has  demonstrated  that  i
                 15)
                 20      the mortality rate and the cost of quality  care  can  be
                 21      greatly reduced.
                 22            'The Kidney Project (Howard, Georgetown, George
                         Washington, D. C. General and Arlington) has demonstrated
                 23
                 24      that the three medical schools can  cooperate  and  further
                         involve D. C. General and a suburban hospital in the
                 25
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                                                                         42?
  hws-1                 implementation of a coordinated regionwide attack on
                        kidney disease. This  project  is  moving.  Already  one   ii
                        facility has indicated that they need no additional
               4        funds.  It appears that all facilities now participating
               5        will be self-supporting by July 1,  1975,  thereby  per-
               6        mitting any new funds to be used for  expansion  or  new
               7        locations.
               8               "Recently initiated activities include the EMS
               9        regionwide planning contract, a nurse midwifery project n
               10       the inner city, and expansion of hypertension control.
               11              "Several other significant projects include:
               12.             "Coronary care nursing training - Howard.
               13              "Cancer Registry - Departm6nt of Human Resources.
               14              "Inhalation Therapy   Washington Technical Insti-
                        tute.
               15
                               "Pediatric Pulmonary   Georgetown and Children's
               17       Hospitals.
               18              "Second, I would like to comment on  the  Current
                        viability of the Program.  The RAC is enthusiastic and
               20       active.  Even with the on and off directions of the
                        past 15 months the RAC and its Committees have been
               21
               22       active in promoting the principles of RMP'S.
               23              "In the past three years the RAC has developed
                        into an "action" group.  In the first few years of MWRMP
               241
                        the RAC reacted to proposals that  were  submitted.:  In
               25
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  iws-2                   developing  the  last  applications  the   RAc   has   appraised
                 2
                          the needs and acted to allocate 'blocks' of funds to
                 3
                          help meet these needs through requests for proposals
                 4        and  subsequent   contracts.   The   current   application   has
                 5        again been developed within this concept."
                 6                From that, you can get a flavor of the view of
                 7   the Chairman of the Advisory Committee.
                 8                Just as  one  issue  in  the  composition  of  the  RAC,
                 9   which is comprised of 73 members, 15 of these are minority
                 10  members.  They have a current professional staff of eight,
                 ii  and they want to increase this.
                 12,              Now, I may have, myself, misinterpreted these
                 13  white  sheets.  Apparently  they  propose  to  add  nine,   if   that
                 14  is    correct.
                 15               I thought this was an increase from eight to nine.
                 i(i              MR. PETERSON:  I am not sure.  I would have to as
                 17  staff.
                 18               In most  instances  I  think  the  proposed  was  a  new
                     total, but   in some  instances  --  well,  I  think  this  again  is
                 19
                 20  a total.  They are simply proposing to increase the staff
                 21  from ten to 13.
                 22               DR.  HESS:  Well,  in  terms  of   the   accomplishments   I
                     they have establishe   d several primary care clinics, and have
                 2 tl
                     been working on improving specialized services in the area of
                 24
                 25  heart disease, coronary care, hypertension, patient education,,
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                                                                            1429
  hws-3        1   and obstetrical care.
               21              In the area of quality of care they have initiated
               3!  projects on review, utilization review, a Regional Cancer
               4   Registry, a Stroke Station, Cardiovascular  follow  up  and  a
               5   bacteriological screening project at Georgetown.
               6               Projects which they cite as increasing efficiency
               7   and utilization include their cancer, heart disease structure,
               8   high blood pressure, and kidney project.
               9               They have a fairly good record of  join--  funding
               10  and phasing into other funding.
                               Ten of the 19 projects are  jointly  funding,  and
               11
               121 seven have been phased out, seven of 19  phased  out  and  con-
               13  tinued under RMP funding.
               14              In terms of their CHP relationships  there  was  no
               15  active B agency in Washington until recently.
               i(i             Their coordination seems to  be  satisfactory  with
               17  the B agency in Maryland and Virginia.
               18              There is some funding of B  agency  activities  in
                   this proposal, and there is an  agreement,  a  written  agree-
               19
               20  ment in the application between  Metropolitan  Washington  lu4P
                   and the Washington B agency as to how they will work together.
               21
                               It seems to be a fairly clear and well defined
               22
                   document.
               23
                               In terms of looking at the  program  priorities,  I
               24
                   think this is an indirect measure of where the influence,
               25
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     hws-4      1   that is, much of the major influence in  the  Metro  Washington
                2   RMP is at the moment.
                3              The number one priority is kidney activities.
                4   However, the amount of fundirg is  not  excessively  large.  It
                5   is about one-tenth of the total.
                6              They are proposing $100,000  for  kidney  activities
                7   out of the total program budget of $1.1 million.
                8              The second is nurse midwifery, $71,000.
                9              Next is primary care activities, $332,000.
                10             The next is health care for senior citizens,
                11  $150,000.
                12,            Next, hypertension for $150,000.
                13             Next, emergency medical care for $100,000.
                14             Next, chronic constrictive pumonary diseases,
                    $165,000.
                15
                i(i            Assistance to CHP's is for $132,000.
                17             Now, the largest single proposal is the one
                18  relating to primary care of patients, $332,000.
                               I thought it might be  worthwhile  just  to  discuss
                19
                20  this proposal in a little detail so that you know what is
                21  involved in this rather major project.
                22             Their objective is to develop facilities at
                23  hospitals to provide more high quality  primary  care  to  non-
                241 urgent.patients who appear.at hospital emergency rooms.
                               The approach is to go to hospitals which have
                25
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                                                                          431
    hws-5        I  emergency departments and to work with these hospitals to
                 2  determine the quality of urgent and non-urgent patients who
                 311
                    appear there, and develop a body of information which will
                 4
                    then allow these hospitals collectively to plan for better
                 5  primary care services to help take the  load  off  the  hospital
                 6  emergency rooms.
                 7             There are also in this budget  some  funds  for  some
                 8  facility reconstruction, as well  as  some  equipment  purchase,
                 9  so that it is more than just planning, but also some reorgan-
                 10 izational facilities, in order to be  better  prepared  to  take
                 11 care of the patients who appear at the emergency rooms for
                 12, primary care.
                 13            SISTER JOSEPHINE:  How many hospitals do they
                 14 have?
                 15            DR. HESS:  Three to five.  They want the best
                    alternative system.
                 17            MR. PETERSON:  They are D. C. General, Freedmen's,
                 18 maybe George Washington, Georgetown, and -- well, is that it?
                 19            DR. HESS:  The hospitals are not listed here.
                 20            MR. PETERSON:  They said three to five, so there
                 21 may be a couple of others, too.
                               DR. HESS:  They don't list them in this synopsis
                 22
                 23 of their plan.
                 24            It was unclear, just to further comment on the
                    project, it was unclear whether- the primary care project will
                 25
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  llwb-6        1  need funding after the first year, or whether  it  is  something
                2  that could be accomplished,,
                311           It looked as though it was a steady  reorganizativ.Li
                4  and some revision of facilities, but I am  just  assuming  that
                5  although it is not stated, that the hospitals, or  some  of  the
                6  sources will pick up the cost after this first year.
                7             Looking at the overall project, program  proposals,
                8  the medical schools are still quite heavily involved.
                9             There is a project in here for something like
                10 $55,000 for health care for senior  citizens,  which  indicates,
                11 in a short synopsis, no provision for continued support.
                12,           It did appear to me like this was, to a large
                13 extent, direct services to senior citizens, showing an area
                14 of need, but not reflected in this description.
                15            What their thinking was, was  about  future  funding
                I(; beyond the funding of RMP.
                17            This particular one was sponsored by TV&A in
                18 Washington.
                              Overall it seemed to me things were a little bit
                19
                   better than the last time I heard this           eview, but
                20                                        program r
                21 still overall I could rate it no better than  average  program.
                22            The thing that I found that offered some  hope  was
                   the fact that they are trying to address, and  apparently  have
                   addressed in the past primary care in trying to  expand  these
                24
                   services to the underserved population of Washington, and I
                25
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                                                                              433
  hws-7             am sure they are considerable.
               2                I checked them.  I might say there was a farily
               "i@'i well developed and outlined. review  process,  the  Committee
               4    structure, and the staff structure, which appear  to  -me  to be
               5    satisfactory.
               6                MR. PETERSON:  Well, thank you, Dr. Hess.
               7                Joe, do you want to give your report?
               8                MR. de la PUENTE:  I found the program, in my
               9    opinion, and considering past experience, as better than
               10   average at this stage of the game.
               11               I mentioned its priorities, you know, not neces-
                    sarily one, two, three, four, five, and mentioned the reasons
               12.
               13   for these projects.
               14               Let me say that the  projects  are  timely.  They
               15   are addressed to not only the present but the future heeds
                   in an area where there is a great deal of  need,  in  an  area
                    where if health insurance comes through we are going to have
               18   a lot of expenditures.
               1!)              In the particular areas that they  happen  to  be
                    attending to, ergo, the elderly, and ergo, the needy, I was
               20
               21   impressed like you were in terms of the primary activity
                    that because what they are going to do  as  far  as  the  descrip-i
               22                                                                     I
                    tion that I read is going to be an operational research and
               23
                    analysis in which they will  consider  all  the  present  resources
               24
                    of personnel, equipment, floor space that is being utilized       i
               2,5
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                                                                           1134
  hws-8            right now to serve the groups that have to be served.
                2              Then they will follow this study in proceeding to
                31 alternative programs to these hospitals, and help serve thesei
                4  populations.
                5              I agree with you.  I think it is a one-shot invest-
                6  ment, but it @,s going to be a worthwhile investment and a
                7  system in which you get these different hospitals, Georgetown,
                8  George Washington, D. C. General, et cetera to decide', you
                9  know, what type of priorities they can attend to, or what
                10 type of priorities they cannot attend to, and where the
                ii patients will go.
                12,            In addition to that, they are going to be helping
                13 and providing monies for workin  g  with  the  planning  agencies
                14 which relate to this particular project.
                15             The other project I  was  impressed  with,  and  this
                i(i is Priority Number 4, is the one for senior citizens, because
                17 at this point, since the  senior  citizens  are  poor,  and  they
                18 happen to have Medicare, they go to either the nursing homes
                   if they are able, or to private facilities, or they are in andi
                20 out, one admission after the next, and from what I     Iread   the
                21 visiting nurses would be providing care in the home, and also
                   they will have preventive programs in    areas where they are
                22
                23 allowing the senior citizens in terms of making sure that
                24 emergency episodes do not occur, and if the emergency epi-
                   sodes do occur, that somebody will take care of them.
                25
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      hws-9                                                   I  think  this  program,  in  my  opinion,  will  save  an
                              2       awful  lot  of  money  for  the  District  of  Columbia  in  the  near
                              3
                                      future,
                              41
                                 1                           DR.  HESS:    The  thing  I  was  looking  for,  and  may  be
                                      just  an  oversight  on  their  part,  but  I  hope  the@  are  thinking
                              6
                                      about  it,  is  that  they  can  demonstrate  that  for  the  population
                              7       that  they  reduce  the  hospital  costs,  that  what  seems  the
                              8       logical  outcome  of  that  is  to  go  to  sources  of  payment  and
                              9       say,  look,  put  some  of  your  money  in  the  home  care,   and  not
                              10      so  much  in  the  hospital.     But  that  was  not  written  in.
                              11                             MR.  BARROWS:    That  is  always  under  consideration,
                              12.     and  I  am  not  too  optimistic  about  that.
                              13                             From what  you  fellows  have  said,  and  for  what  it  is
                              14      worth,  it  sounds  to  me  as  if  these  people  are  tackling  some
                              15      monumental,  very  teal  problems,  and  the  amount  of  money  they
                                      are  talking  about  is  relatively  small  for  what  they  are  trying
                              17      to  undertake.
                              18                            I  think  we  ought  to  resolve  any  doubt  in  their
                              19      favor.
                              20                            MR.  PETERSON:    How  about  some  of  the  other  reviewers
                              21,     here?
                              2-@                           DR.     HEUSTIS:     I  have  nothing  to  add.
                                                            DR.  THURMAN:    Just  two  procedural  inquiries.
                              2@3
                              24                            The  $132,000  is  for  assisting  CHP.     Is  that  proper?
                                                           MR.  PETERSON:     It  is  something  vahich  we  in  our
                              25
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    Viashingtnn- D.C- 20002

                                                                                                                                          4
       hws-10                       instruction guidelines for applications, it was one of  sever,-AJ!i
                              2     areas that we were asking to assist  with  CHP  planned  devel.op-i
                                                                                                                                                            i
                                    ment.
                              4
                                                          I cannot be sure from looking at the computer print-
                              5
                                    out that that is what it is.
                                                          We do have a case                 here, though.  I was unaware,,
                              7
                                    Joe, and you corrected 7tc@ properly, that there just has been
                              8
                                    an  arepwide  B  agency  organized  for  the  District.    They  have
                              9     lon    been  without  one,  and  the  one  in  Northern  Virginiai  they
                                         9
                              lo    never  could  resolve  the  Virginia-Districk@--Maryland  problem.
                              11                          There  is  probably  a  lot  of  catching  up  to  do  in
                              12.    one  sense,  and  I  think  it  wouldn't  be  considered  inappropriate!
                              13    in  a  policy  sense.
                              14                          Whether        the  money  could  be  effectively  used  is
                              15    another question,  which  I  cannot  speak  to.
                                                          If  an  thing,  we  sort  of  pushed  them  in  that  direc-                                        j
                                                                   y
                              17    tion,  at  least  as               far  as  Mr.  Bell  is  concerned.    He  is  prob-
                              18    ably  looking  over                our  shoulder.
                                                          DR.  THU@IAN:    I  support  the  need.
                                                          My  question  was  purely  policy,  and  the  other  is
                              20
                              21    policy  also.
                                                                                                                                                        f
                                                          There  are  $80,000  here  in  kidney  projects,  all  o
                              2-)
                                    which  on  July  1  are  going  to  be  funded  from other  sources.
                              23
                              24                          Other  than  that  I  support  it.
                                                          That  is  a  policy  question.
                              25
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                                                                           437
                              MR. de la PUENTE: As far as  the  kidney  project,
                2
                   if I could speak to that, as long as Georgetown is involved,
                   and I feel confident that they are upgrading in  the  total
                4  eastern complex, they have tissue typing, and they have some
                5  transplanting, and they are operating in the eastern comp ex,
                6  which is from Atlanta to Boston, and which  they  interchange
                7  patients with the computer, and with tissue typing information
                8  on the computer, which "Ln my opinion helps.
                9             DR. THURMAN:  Don't misunderstand me.  All four
                10 of those can be paid for as of July 1 out of  other  funds.
                11            I am not sure that it is proper, because  mine  is
                12, a procedure, and I am all for supporting them, but  all  four
                13 of the things that are listed can be supported  from  other
                14 funds as of July 1, this July 1.
                15            DR. TESCHAN:  Which other funds?
                              DR. THURMAN:  Medicare and the Kidney Dialysis.
                              MR. de la PUENTE:  They might well go into that
                17
                18 type of funding, but if we don't have this complex in which,
                   for instance, they started deciding  how much do we  charge
                   for procurement for an organ, cadaver, how much is it going to
                20
                21 cost to tissue type every patient on  hemodialysis  waiting
                2'.1 for a transplant; start making all those cost  values,  and
                23 they won't have as good a chance of certifying  those  costs,
                   and some of the people will have to pay for it.
                24
                              DR. THURMAN:  I was asking a policy qqestion.  That@!
                25
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                                                                           3'
   hws-12           is all.
                 2              MR. PETERSON:  That sort of thing you might N,;-ant
                    to note.
                 j:
                                MR. BARROWS:  Might I ask a question?
                 5              MR. PETERSON:  Surely.
                 6              MR. BARROWS:  I know that Medicare and Medicaid
                 7  will be paying for reimbursement for services delievered.
                 8              Do they a so have funds for development costs>
                                DR. TIIURMAN:  All of us are building in develop-
                 9
                 10 ment   costs.
                 11             We are being reimbursed for Medicare for organ
                 12, procurement, tissue typing and dialsysis right now, and we
                 13 have the lousiest system in the country out there.
                                I was under the impression that none of these
                 14                               1
                 15 types of programs were going to be funded, other than that
                    by July 1.
                 I(;
                 17             DR. TESCHAN:  One of the projects is to reimburse
                    the institution for the procurement of unused kidneys.
                 18                                                     1
                                You know, that is not, so far as I know, in the
                 19
                    Medicate reimbursement.  You get reimbursed for the ones you
                 20
                    use and transplant.
                 21
                                One of the projects talks about reimbursing for
                 22
                    the cost of the harvest of the unused.
                 23
                                DR. HEUSTIS:  But isn't it built into the cost of
                 24
                    the ones you used?
                 25
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  hv@,!3-13                   You divide the total cost by the total  number of
                   patient days served, and that is it.
                3
                              DR. THUP-@    I didn't mean to get us off here.
                4             Let me say again I am in support of the two re-
                5  viei-,7ers.
                6             DR. HEUSTIS: Can we hear again where  you  rate
                7  this program in terms of average, above average, or  below
                8  averztcre, from the two reviewers?
                @-            DR. HESS: The first time I read it I  checked  it
                l@o in the above average.
                11            The next time I read it I went through and  looked
                12. a little more carefully, and I put it on a line between  the
                   two, so in looking and thinking of its past  history  instead
                13
                14 of being on a plateau, I think this program is on an  upward
                   curve, and because of that I am willing to extrapolate  a
                15
                   little bit and give them the benefit of the doubt based on
                17 recent past performance.
                18            With that in mind I would like to propose a  level
                I!) of $1.1 million.  They are currently at $1,756,000.  They
                20 asked for $1.27 million.
                21            As I look at their priority ranking and  their
                   programs there is one, the pulmonary diseases for $65,000,
                22
                   and assistance to CHP's of $132,000, it seems to me that  the
                   CHP's should be able to stand on their own two feet now,  and
                24
                   I don't see why RMP should need to support that, to  that
                25
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                                                                        41-10
   hws-14
                   tune.
                2                           for $200,000 right there.  They seem
                              That accounts
                   to be z,,oving in the right direction.
                4             There is an area of substantial need, and so forth;
                5  Mr. Chairman.
                6             I would make that as a motion.
                7             DR. HEUSTIS:  This is the full yearly HEW pro-
                s  rated amount, your $1.1 trillion?  It is 100 percent of the
                9  targeted available funds now in Column C?
                10            You see, what I was getting at in my other ques-
                11 tion was they are going to ask between this application and
                12, the next application for a 50 percent increase over their
                13 money that they have right now.
                14            DR. HESS:  They are going to ask for another
                15 $500,000.
                              DR. HEUSTIS:  Or a total of $1.7 million, and their
                17 targeted allocation is $1.1 million.
                18            If we give them more, then we have to take it away
                   from somebody else.
                I!)
                20            DR. HESS:  I don't think we need to worry about
                21 that for the moment, because that is not a target type figure,
                22 and I think this -- I don't know the population, but my guess
                   is it is probably in the neighborhood of two million people.
                23
                241           MR. PETERSON:  I am glad you asked that question.
                              DR. HESS:  It is an urban area.
                25
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                                                                         441
                              MR. PETERSO!I: It is a little over two million
              211! peonle,  2.1 million.
                              The District of Columbia, I think, has  just  under
              4    one  million people, but you have two big bedroom areas in the!
              5    suburbs.
              6               DR. HESS: There it seems to me  the  management  is
              -                             there is an area of need.
                   picking up now, and that
                              DR. THURMAN:  I second the motion.
                              MR. PETERSON: There is a motion  of  $1.1  million,
              9 1
              I 0  and we have a second.
                              Any further discussion?
              12              MR. de la PUENTE: I just wanted to add  I  hate  to
              13   limit them on the CIIP that much.
              14              MR. PETERSON:  I don't think I hoard Joe say he
     (7)           was going to cut it out.
              15
              I(;             DR. HESS:  We ate going to issue the money.
                              MR. de la PUENTE: Is there any way we  can  put  in
              17
                   a recommendation there, phasing out as many of the kidney
              18
              19   activities as soon as the self-support is available?
                              DR. HESS:  Some of these they have listed.     They
              20
                   state no additional funds requested on there.
              21
                              They have already phased out some:
              22
                              MR. PETERSON:  These are the residue of a number
              23
                   of kidney activities, but even these are continuations, and  I
              24
                   am assuming, and I have not looked at the application that
              25
  HOOVER REPORTING CO, INC.
  320 Massachusetl,sAvenue, N.E.
  l,',,'ashin ton. D.'U. 20002

                                                                           4 @t2
   hws-16        I- close, that most of 'k--hese will really have come to ai-i end
                 2  someti-nie during the next year.
                 311            DR. HESS:  They have a prior4-ty 1 ranking, so we
   0             4  can't go in on a line item and scratch out something they have
                 5  on Priority 1.
                 6              I just don't think we can do much with that, Mr.
                 7  Chairman.
                 8              MR. de la PUENTE:  Then I have no objection.
                 9              MR. PETERSON:  We have a $1.1 million recommenda-
                 10 tion.
                 11             Any further discussion or question?
                 12.            All right, those in favor raise your hands.
                                (Showing of lia,@lds.)
                 13
                                MR. PETERSON:  It is unanimous.
                 14
                 15
                 17
                 18
                 20
                 21
                 2
                 2il
                 24
                 25
   HOOVER REPORTING Co, INC.
   320 tAa@chusetts Avenue, N.[. It

                                                                                                                                              L-L Li K
        hws-17                                               HEW  REGIOIIiiL  l@EDICi@  PLAN  FOR LONG
                                                             ISLAND,  NEW  YORK  AND  NASSAU-SUFFOLK
                               2
                                                                                       COUNTIES
                               3!1
                                                          MR.  PETERSON:               Well,  we         are  down  to  two  Rngions,
                               411
                               5    and  it  is  a  quarter  to  five.
                                                          I  think  we  are  going  to  switch  gears  and  touch
                               6
                               7    upon  Long  Island of  New  York  and  Nassau  and  Suffolk.
                               8                          Do  you want  @lo  lead  of f  on  this?
                                                          DR.  IIIRSCHBOECK:    This  was  to  be  the  model  combin-
                               9
                               10   ation,  twin  agencies,  and  it  was  split  off  from  the  Metro-
                               11   politan  New  York,  and  put  under  the  aegis  of  Stoneybrook  for
                                    a while,  at  least.
                               12.
                               13                         With  the  phase  out  of  RI@IFJ  the  Nassau  Regional
                                    Medical  Program  lost  its  Coordinator  and  I  believe  mush  of
                               14
                                    its  staff,  at  least  there  are  a  lot  of  vacancies  here,  and
                               15
                                    there  was  a  shift  from  this  program priorities.
                                                          Incidentally,  the  Nassau-Suffolk  Medical  Program
                               17
                                    and  the  Comprehensive  Planning  Council  jointly  produced  the
                               18
                                    priorities  for  the  Region.
                               1!)
                                                          With  the  split,  with  the  phaseout  of  the  PIMP
                               20
                                    resulting  in  the  split,  all  of  the  planning  projects  were
                               21
                                    deleted  from  the  RllP  priorities,  and  the  remaining  ones  have
                               22
                                    to  do  with  increasing  health  manpower  availability,  increasing
                               2,,3
                                    coordination,  cooperation,  resource  sharing,  instituting new
                               24
                                    preventive  health  measures,  innovative  improvements    in
                               25
     HOOVER REPORTING  CO,  INC.
     320 Yassachusetts Avenue,,4.1.

  hws-18           professional continuing education aid priority number 5
                   deve3.cping within the purview of 801-239 R@IP legislation,
                 2
                   ambulatory care services.
                               This seems to be the project that they have put
                 41
                   the most emphasis on in  terms of their priorities and planning
                 5
                 6 for the future.
                 7             Also the PSM project is underway, and a kidney
                 8  ,;:Oject.
                 9             One gets the impression that this application, when
                 10 he reads it, is really dealing with the broad plan worked
                 11 out prior to the departure of  the  Coordinator,  Dr.  Hastings,
                   and there is hot much room projected here,  other  than  a  data
                 12
                   base development for ambulatory care in Suffolk CoiLnty.
                 13
                               Everything else apparently is a  holdover  from  the
                 14
                   grand design of the previous activity and programing.
                 15
                               As far as the leadership is concerned, the staff
                   Dr. Hastings has, it is extremely weak.
                 17
                               Everybody on the project is at a Master's degree
                 18
                   level, including the Coordinator.
                               Those proposed for employment are mainly from
                 20
                   social work, and then there is a serious  question  in  my  mind
                 2 1
                   as to whether this staff is going to be able to follow through
                 22
                   with the project in terms of leadership and evaluation as
                 23
                   described in the document.
                 24
                               The relationship with the CHP agency, one gets the
                 25
   HOOVER REPORTING CO, ii'@C,1
   320 tla-@&ichusetts Aver..,je, N.E.

                                                                            45
  hws-19           fec-lii-ig that CIIP is so@L. of taking over.
               2
                               The Regional r-idvisory Group is still a discreet
                   entity.
               4
                               The CHP agency has endorsed everything in one
               5   letter.
               6               The projects that are being  proposed  are  contin-
               7   uation projects, except for one, that is  the  data  base  con-
               8   tract for  ambulatory care.
               9               They do expect, however, to bring  in  six  projects
               10  in July, new ones, and there are  some  continuations,  so  that
               11  I th,,nk we ought to hear from staff about the  real  state  of
               12, affairs that exists between the CIIP and the MIP  there  as  to
               13  whether there is any prospect of this staff being improved
               14  back to what it originally was.
               15              Doctor Hastings is the Coordinator.
               1(;             MR. PETERSON: Do we want to  ask  Paul  to  present
               17  his review  first, or would you want us -- well,  I  don't  know
               18  to what extent the staff has any comment.
                               We really are down in one sense, and  not  only  did
               20  Glen Hastings leave, but Harrison Owens, who had been in many
               21  ways,, I don't recall it was hit name, but he certainly was
               9-2 functioning as Glen's deputy. He was  acting  for  a  period  of
               23  what, six months?
               24              Harrison has left, and went  to  NIH.  The  present
                   Coordinator who has been there a couple of years, he was
               25
  HOOVER REPORTING CO, INC.
   't?R Mi@",hi!,Ptt@ Avpniif-  N  1,@i

                                                                                                                                                         41.,6
       hws-20
                                   i     their  evaluation  person.     lie.  is  an  East  Indian.
                                211
                                                                 I  site  visited  Nassau-Su.4folk.     I  was  on  the  last
                                         visit.     I  had  some  contact  with  Persade.     My  impression  of
                                4
                                         him  would  be  that  maybe  he  holds  a  few  things  together,  but
                                         I  don't  see,   for  a  variety  of  reasons,  his  background,   and
                                6        what  have  you,  by  that  I  don't  mean  the  fact  that  he  is  an
                                1,       Indian,  but  he  is  a  numbers  man  by  and  large.
                                8                               I  think  he  is  fairly  new  to  the  health  field,  and
                                9        I  certainly  wouldn't  see  a  great  deal  of  positive,  imagina-
                             10          tive  leadership  coming  out  at  least  through  his  person,  and
                             11          I  think  the  other  staff  there  have  some  problems  as  relates
                             121         to  the  grantee.
                             13                                 MR.  NASH:    Why  don't  we  hear  from  the  second
                             14          reviewers
                             15                                 DR.  TESCH@N:     In  reading  the  document  it  is  put
                             16          together  with               a  good  deal  of  mental  confusion  on  the  part  of
                             17          the  author,  or  the  Committee  didn't  talk  to  each  other,  or
                             18          was  put  together  at  different  times  with  interruptions.
                             1!)                               It  is  hard  to  follow  with  groups  of  projects  they
                             20          are  talking  about  and  what  the  status  of  the  projects  that
                             21          are  being  described  are.   so  there  are  some  projects-that  are
                             22          not  described  in  the  narrative,  or  their  rationale  developed
                                         in  the  overview,  and  there  are  som ethat                                         are  described
                             231
                                   1
                             241         several  times,  or  more  than..once,,                                 in  different  ways,,  so  you
                             25          can't  tell  whether  they  are  talking  about  a  rejuvenation  of
    110OVER REPOR.Til@l-,G CO, ltic. , I
           Stan D (.1 2 I)r@f@9

                                                                             1-i47
  hws-21            of an old project, or a new -Droject, or the relationship
                2
                    between them.
                                There is a minor confusion point here to tidy
                4   minds in the sense that in the one form, the 158, there      are
                    the progress reports that relate to 1971-73, and the proposal
                6   relates to 1974--75.
                7               There is a one year's gap in the situation, which
                8   doesn't.overly distress in-a, but it sounds as if there is a
                9   problem in terms of accounting for what happened to the
                10  projects in the meantime, and how do we now ask for new    funds@l
                11  if, in fact, in the meantime either the project died com-
                12  pletely, or survived with other funds since then.
                13              Should we not be over  on  new  funding  altogether?
                                                                                      i
                14              Why do we recur after a year's absence?
                15              Now, that may be just a technical question on how
                    the numbers appear. It  may  be  an  administrative  type  staff
                17  thing, but I don't understand it, and it doesn't make any
                    sense.
                                The priority statements, these  things  are  two  or
                    three years old.
                20
                                I was on a site visit when  Glen  was  still  there,  1
                21
                    and I remember distinctly the long discussion how they got
                22
                    the priority,  and this is really Castings' work, and it hasn't',
                23
                    been revised  since, and you get the sense, the end of review
                1-14
                    process is sort of a Xeroxing of something.
                25
   HOOVER  REPORTING  CO,   triC.
   320 Ma@-@,hLsetts Avenue  N.[.

                                                                             41!r8
  hws-22                       DR. HEUS'J'IS:  This is what I wanted to convey.
               2!!             DR. TESCfl7@: I get the feeling  that  if  this  docu-
                   ment is reflecting sort of the state of affairs then it says
               4   that 66 members of the RAG have been asleep.
               5               It says the grantee has been asleep, and it says,
                        I don't see a focus a
               6   tha4                        round which you can  organize  a  next
               7   step.
               8               1 don't know where to turn to fish for that focus  i
               9   of the new entrepreneur relationship that is needed in the
               10  thing, because one thing on the CHP business, the two agencies
               11  say they are going to reexplore what the lesson is from the
               12. experience they have had.
               13              If the document is any indication, I can't tell if i
               14  there has been any.
                               Well, in view of this, I think  that  we  are  tending
               15
               ](; to go somewhere between a below  average  and  a  poor  situation,
               17  and one where I don't see where there is viability.
               18              I frankly don't know what to do about a funding
               19  recommendation on it.
                               I think maybe we ought to hear from staff, and maybe
               20
                   we will be a little more illuminated than I am at     the  moment. 1
               21
               22              MR. PETERSON:  Jerry, you have any comment that
               2t3 speaks specifically to the point?
                               To put the question crudely, how bad is the situ-   1,
               124
                   ation?
               25
   IIOOVER REPORTITIG CO, iNC.

   hws-23                      MR. STOLOV:  We have members from Grant's    manage-
                   ment here.
                               We are about in the fourth recite  of  their  bylaws
                41, and PAG grantee relationships.
                5              When we tried to review their process, their RAC,
                6  was rally dominated by the corps in terms  of  numbers,  and  we
                7  asked that there be a change in numbers,  and  they  did  adjust
                8  that  change.
                9              The auditors were out there for ten weeks, and their
                10 came up with a whole pot ppuri of  items  which  represented  to
                11 Dr. Paul, Mr. Silbus and operations people.
                12.            They felt, though, the RAG was do minating the
                   corps, but  this is only a sideline to what they did find.
                13
                14             They did look into some of the projects you have
                15 mentioned,  as to the gaps in time, the Nassau-Suffolk believes
                   they can reinstate from all indications.
                17             DR. TESCHAN:  I did have one more comment on the
                18 project, that there are two kidney projects, the relationship
                1() between which is unclear, and we don't, or they don't seem to
                20 have a lot of content and don't have a specified relationship.
                21,            I am a little less critical of  the  same  situation
                   in the EMS  story, because the counties appear  to be big enough,
                   and the divergency between them  sufficient,  and  the  location
                   of the population centers sufficient  to  justify  two  separate
                   operations in that case.
                21
  HOOVER,IEPORTING CO, INC.
   320 @hssachusetts Avenue, N.'L.

                                                                               0
   hws-24                       Thc- 1-idney gaiT,.e is differc@yit, because both o f' tllp 11-1
                 21!11 talk about relationships to Metropolitan New York and the biq!
                    eastern consortium, so there is reason for more coordination
                 4;1 than I f in d.
                 5              MR. STOLOV:  Could I just ask that we get to the
                 6  issues that staff looked at?
                 7              MR. PETERSON:  That is what we want to get to.
                 8              MR. STOLOV:  EMS Communication Project.  We touche@
                 9  base with Region 2 Office, and the same people applying for
                 10 the equipment dollars were the same people applying under Mr.
                    Rearden's program and HSA under the new law.
                 12@            This was almost the identical proposal, even more
                 13 dollars to  them.
                 14             Well, it was briefly presented.  We asked the- El-I
                 15 Communication Specialists to look at it, and we consequently
                    heard from Region 2 that they turned it down.
                 17             One could draw a grey line between whether they
                    did mention communications in their original proposal.  How-
                    ever, we were asked to highlight it because of the magnitude
                 20 of the dollars.
                                That is where we stand in EMS.
                 21
                 22             In Kidneyi we asked the Region, before they sub-
                 23 initted their project, to have it reviewed by outside consult-
                    ants.
                 24
                                They got one consultant, got one one night in the
                 25
   HOOVER REPORTit@G CO, ItiC.
   320 Massachijsptts Avenue,  N.C.
         D.C. 20002

   hwfj-25         Kidney Meeting in Chicago, and,he dictated something over thei
                2
                   phone, and we called him 'today to get h,-s impression, and he
                   agrees with Dr. Tesclian, that the two projects should be
                4
                   brought together into one, P,3.id this shows supporting two
                5  institutions rather than getting a new thrust.
                6             DR. TESCHAII:  He shows no CIIS function, and it
                7  shows no RMP coordination, so it is a total bust, no matter
                8  which way you look at it.
                9             MR. STOLOV:  In terms of the proposed staffing
                10 pattern and the present staffing pattern I think we asked then
                11 Region, and they only sent in    they were allowed to budget
                12, the $6.9 million, and they elected to put into staff, so,
                13 prior to this application what they actually sent in was whati
                14 they were budgeting into.
                15            We haven't seen the new coordinator function.  Thel
                i(i 111,AG had a committee, and they have 70 applications to con-
                17 sider, soma from the nearby regions, et cetera, and other
                18 people.
                              Well  they chose their own man for the job.  We
                19                1                                              1
                20 have not seen him function.  We did ask him to expand on the
                21 organization chart, and he had four health analysts reporting
                   to a girl who was in the program since it started, for  four
                22
                   and a half years.  8he was the grant's management gal, and
                23
                   did a good job at it, and we were concerned the poor  people
                24
                   reporting to her, she has a BA, and she has four and a  half
                25
  [IGOVER REPORTING CO, INC.
  320fil,a5 chusettsAvenue,t4.1.

                                                                            2
  likes 2 6     1        of experience, &nd her experience was another factor
                   years
                2  he looked at in the decision, bu-i-- the organizational cha--ti
                t
                   has  changed.
                4             He has sent in a new one, having two report to
                5  his evaluator, and two reporting to tier.
                6             Again, we ques tioned the decision, but haven't
                7  seen it in operation.
                8             The seven vacancies are social workers, as you sai.r-,,
                                                                                  1
                9  Dr. Ilirschboecl@.
                10            MR. PETERSON:  Tom, did we have a management
                11 assessment visit at the same time as the review verification
                12, visit this year?
                13            MR. SIMONS:  I have almost lived  with that Region.
                14 I have a very hardnosed View.
                              I think Frank better talk before I do.
                1,5
                              MR. NASH:  I think it was over two years ago it     i
                17 was recognized that the structure and relationships between
                18 the grantee institution and the Board of Directors of the RAG
                I!) of this program there was something very much wrong there.
                20            I think they had a 25 member Board, each of whom
                21 was also a member of the RAG.
                22            The normal procedure for the Board is to meet., dis-,
                2.3 cuss the business.  They would adjourn, and 30 minutes later
                241 they would convene a RAG meeting, and most of the time some
                   of the RAG members didn't show up.  All the Board meii,,bers
                25
   HOO'IER REPORTING CO, IN,-.
   320'@l,as.@chusettsAv,,'flLie, t4.E.

  hws-27           were there, so the clear dominance of the RAG in the   whole
               2
                11 decision making process was by the Board grantee institution.   I
                               This gave us a lot of concern.  They were ad-,rised
   0               they   should be concerned about this.  They would send us backi
               5   letters assuring us that they would do this.
               6               Then they would get involved in phaseout, and so
               7   from our part we didn't follow up on it until we got the one
               8   year's extension.
               9               We have been after them again to straighten out
               10  this situation, and that is why we are now looking at their
               11  revised bylaws, and I think Tom's later review of those indi-
               12. cates there is still the possibility of dominance of the RAG
               13  by the Board.
               14              I don't know how we will straighten this situation
               15  out.
                               Does that cover part of it?
               17              MR. SIMONS:  Yes.  1 don't think it has come out
               18  that Rt,!P and CHP has separated.
                               MR. PETERSON:  Yes it has.
               20              MR. SIYIONS:  There was mention of the HEW audit
               21  that has been up there ten months.
               22              They came in and met, and had a very long report
               23  on the Region.  They selected five projects that ran when
                   they first went in, based strictly on the time the project
               124
               25  occurred, and the dollar volume, and they traced it from therd   i
  HOOVER PEPORTING CO,  INC.
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        n r

                                                                            454
    11 b-28     1  from the time it started up until it was  complete.
                21             Now, all five of them they considered a dismal
                31'                                 qement by the program staff.
                11 failure because of the poor mana
                4              They now ask them to select two more teams, to giv
                5  it  to  them.
                6              MR. NASH:  The audit report doesn't bother me
                7  quite so much, because this is a reflection of  what  went  on
                8  in the  past.
                9              The question that concerns me is what is the future
                10 for thisprogram.
                11             MR. SIYIONS: I,have two more points I  would  like
                12. to make,
                13             I think the philosophy of that region,  the  three
                14 or four times I have been up there, seems to be we are going
                15 to do what we want to do.
                               We will try to write it to make P,1,4P's and the
                17 Councils believe we are going to do what they say,, but we are
                18 still going to do the things we want to do here.
                               As far as the domination of the program by the
                l@)                                                                 1
                20 corps, as Frank said, I don't know how we are  ever  going  to
                21 get them to stop that.
                22             The climate is still ripe for the corps to domin-
                23 ate, the bylaws still provide for domination by the corps.
                24             The only way that they are ever going to change is
                   a very  hard approach from here.
                25
  HOOVER REPORTING CO, INC.
  320 Massichusetts Avenue, N.[.
  Washingto,-i, D.C. 20002

    hws-29      1              I think the recommendation you made for Maryland
                  would be a   little kind to them.
                21
                i
                               DR. TESCHAN:  You made the funding contingent on
                311
                   their compliance, either get with it or ship out.
                4
                5              MR. STOLOV:  The letter from Dr. Paul  said exactly
                6  that.  Unless those bylaws are changed to meet our conforma..--,
                7  and the Region --
                8              MR. SIMONS:  No ifs, ands, or buts.
                9              DR. THUP14AN:  I move that we approve this program 1,
                   for a level of approximately $150,000 for staff phaseout.
                10
                               DR. TESCHAN:  I second.
                11
                               MR. PETERSON:  The motion, if I understood it
                12,
                   correctly, was $250,000 for staff phaseout.
                13
                               DR. HEUSTIS:  Aren't you rather generous,>
                14
                               DR. HESS:  I don't see how that is consistent
                15
                   with the decision you fellows made on Maryland.
                                              Then I am missing something.
                               DR. TESCHAN:
                17
                               DR. HESS:  I  wasn't ready to vote with you  for or
                18
                   against   it.
                               But it seems to me, from all that we have heard,      i
                20
                    that this program in New York in nearly every dimension is
                21
                    worse off than Maryland, and the vote, as I remember, it was
                9-2
                    to recommend termination for Maryland.
                23
                               Now, if Maryland deserves that kind of vote, I
                24
                    don't see how you, in any consistency, can vote any money
                25
  HOOVER REPORTING CO, INC.
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   Washin2ton.. D.C. 20002

                                                                    456
    hi,is-30    1 here.
                2            DR. TIIURMAN:  That is not what my word was.  I
                  don't think we ought to fire these people tomorrow by term-
                4 inating all funding, and $240,000 will carry them until  their
                5 staff can find other jobs.
                6            DR. HESS:  You didn't make that proviso with
                7 Maryland.
                8            DR. THURMAN:  Yes we did.  We said terminate it
                9 with adequate time.
                10           DR. HESS:  Okay, the same general language.
                             DR. THURMAN: Except to make it worse  in  Maryland.
                12, How is that?
                13           DR. HEUSTIS:  I thought the motion we voted on
                14 before was we recommended termination, and left it up to the
                15 good judgment of the Council to bring about an orderly term-
                  ination, without out getting involved.
                17           DR. THURMAN: I will rephrase my motion,  and  let's
                18 make it the same as Maryland, but a little worse.
                             In that way we will have the same terminology,
                19
                  because I think the program ought to be terminated.
                20
                             DR. HESS:  I call for the question.
                21@
                             MR. PETERSON:  Let me be sure that I have the
                22
                  motion correct.
                23
                             The motion is termination at the earliest  possible
                24
                  moment.
                25
  HOOVER REPORTING CO, 14C.
   320 filassachusetts Avent@, N.I.

                                                                        457
      hws-31    1              DR. HEUSTIS:  No, just the termination.
                2              MR. PETERSON:  Termination with only such funding
                3.i  as may be necessary to provide for'the orderly termination.
                4              DR. HEUSTIS:  But you didn't do that for Maryland.1
                6              MR. PETERSON:  I think what we are hearing now is
                6   we are really acting on a kind of generic motion that we will
                7   rephrase the Maryland one accordingly.
                8              MR. BARROWS:  Funds sufficient for an orderly
                9   termination.
                10             MR. PETERSON:  It may require slightly more funds
                11  than one or the other for the orderly termination, but that
                12, is a minimal amount of funds, really.
                13             DR. HEUSTIS:  Why cannot we, as a review committee,
                14  recommend to the staff, as I understand it, we recommend
                15  termination, and the staff, under whatever it deems best,,
                    make whatever it thinks is a proper recommendation to the
                17  Advisory Council?
                18             MR. PETERSON:  As to funds?
                19             DR. HEUSTIS:  It puts us firmly on the record as
                20  far as termination, and what you do with it is the orderliness.
                21             MR. PETERSON:  Termination with such funds as staff
                22  finds necessary to make that an orderly process.
                               That is poorly phrased.  We don't know.
                23
                24             MR. NASH:  The Department would insist on this,
                25  any way.
   HOOVER REPORTING  CO,  INC.

                                                                             458
   hws-32       1              DR. HEUSTIS:  With such funds  as are necessary.
                2              MR. PETERSON:  I want to make  sure whether it is
                3   in the motion or not that we have the sense of that.
                4              Termination is i guillotine.
                5              DR. HEUSTIS:  There has been  so  much   pussyfooting
                6   around on this thing, I would like to  use  language  so  nobody
                7   misunderstands what we say.
                8              What they do with the  language  after  that,  after.
                9   I understand it, is fine.
                10             MR. PETERSON: I  think  I  understand  the  lanquaae.
                               DR. HEUSTIS: I am glad you do,  but  do  you  have  a
                12.  vote on the Council?
                13             MR. PETERSON:  No, I don't.
                14             DR. I-IEUSTIS: I would like to be  sure  the  Council
                15  understands what we say.
                               MR. PETERSON:  I will reduce the motion to one word
                    which will be "termination," and we will supply appropriate
                17
                    parentheticals.
                               Again, I am just trying to get a sense here.
                20             MR. BARROWS:  It is very important to avoid an
                21  appearance of capriciousness and arbitrariness on our part
                    that this termination be provided with whatever is necessary
                22
                    for an orderly termination.
                23
                               MR. PETERSON:  Early, orderly termination.
                24
                    Termination with  only  such  funds  as  is  necessary.
                25
  HOOVER REPORTING  CO,  INC.
   320 Massachusetts Avet-@ue. N.[.

                                                                           459
   hws-33       1              MR. NASH:  Any program that I have ever seen in
                211 IIEW that has been terminated, the Department insists on an
                .3 orderly termination.
                4              MR. BARROWS:  We should mention that.
                5              MR. RUSSELL:  RMP would go to any RMP  and say sendi,
                6  us your plans for going out of business.
                7              DR. TESCHAN:  They will either roll over and die,
                8  or scream and come in here with all kinds of important reso-
                9  lutions.
                10             I wouldn't mind July 1 in that sort of situation
                11 to review if they have more life than we hava seen in two
                12. years.
                13             MR. PETERSON:  On both Maryland and Nassau-Suffolk
                14 I have a sheet of paper in front of me, I am filling in the
                15 last few figures on, in both cases I am showing the figure
                   of equal to or greater than zero.
                17             There is a motion now.
                18             All those in favor of the motion raise your hands.
                1!)            (Showing of hands.)
                               MR. PETERSON:  It is unanimous.
                20
                21             MR. BARROWS:  This will include the proposition we
                   faced on the impact on the new program.
                22
                               DR. HEUSTIS:  This has the same reasons Maryland
                2,,3
                   had.
                24
                               MR.-PETERSON:  The set of problems are not all that
                25
  HOOVER REPORTING CO, 114C.
   320 Mn,,sachusetts AvenL,-. N.E.

                                                                                @!.6o
  hws-34           d i fe rr@- n
               211             Grantee Number 1 is of a different order.  It is
                   not  a  Johns Elopki.ns with a grantc.,c! domination vis-c,-vis the
                   RAG, questionable leadership, and certain results of no
               5
                   signif icance.
               6               Well, we are down to the wire now with just the
               7   Susquehanna Valley, which is the central part of Pennsylvania.
               8               Let us move ahead.
               9               Joe, you were one of the reviewers here.  I wonder
               10  if you wanted to lead off.
               11
               12,
               13
               14
               15
               17
               18
               I!)
               20
               21
               22
               2,3
               24
               25
   HOOVER REPORTII@G CO, INC.
   320 Ma@,sag-h-is-tts Avenue, N.L@

                                                                            46.L
     hws-35                       HEW REC@LONAL ZIEDICPJ, PI,7-@ FOI@ THE
                                       SUSQTJEI',At4NA VAI.,LEY
               2
                                MR. de la PUENTE:  This is an application for
                    $721,606.
               4
                                On July 1 they are going to come in for $1,05,000.
               5
                    They have 14 positions, including three physicians devoting     i
               6
                    25 percent of their time to staff functions following the
               7
               8    recommendation of management.
               9                They have been successful in filling three addi-
                    tional kev  positions with former IUIP staff who are rejoining
               10
               11   the  program.
                                The present request is for a fully viable prdaram.
               12.
                    Their activities are addressing thcrnselves to the  Rec@,ional
               13
                    what the Board concedes as need in  the  primary  health  care
               14
                    availability of services for room area and accessibility to
               15
                    the urban service.
                                They are with the  Pennsylvania  Medical  Society,
               17
                    which is providing excellent physical management sources.
               18
                                The staffing pattern coincides with their program.
               I!)
                                Many parts of their program are grants.  The grants,
               20
                    present an opportunity for realigning their staff pattern in
               21
                    a manner which coincides with their new plan.
               9-2
                                The present application is for  support  of  their
               23
                    positions from July, 1974 to June 30, 1975,  as  well  as  two
               24
                    months of support.
               25
  HOOVER PEFORTING Co, INC.
           Aventie N.E.

                                                                          462
    hws-36                     Their July 1 application  will  emphasize  project
               2   support.
                               At that time they will  present  approximately  18   1
               4 1                                                                  1
                   projects presently under review  by  their  Regional  Advisory
               5   Board.
               6               While they represent present activities, their
               7   application does not include comprehensive updating of their
               8   plans.
               9               I have not seen anything as to how  they  are  up-
               10  dating their plans.
                               They intend to continue the AHEC activity in South
               12. Central Pennsylvania, as well as  the  Area  Health  Education
               13  System in North Central Pennsylvania, and the ambulatory
               14  patient dialasis is also going to be continued.
               15              What they are going to do as far as new activity
               Iii is concerned, is to facilitate  the  development  of  Regional
               17  Health Authorities, and adequately address the need of inte-
               18  grated functions of health plans, implementation, and regula-
               19  tions.
               20              As they develop their plans they will have active
               21  participation of the B agencies in the Susquehanna Valley
               22  Region.
                               One of the major concerns regarding this Region is
               23
                   the evaluation of their activities.
               2,4
                               This is the problem I have with this Region, how      i
               25
  HOOVER REPORTING CO, INC
  120 Mi-@rhij,,,tt@ Avenue. N.[.

                                                                         463
   hws-37          do they evaluate what they   are going to do, and how do  they
               21
                   decide what they are going   to do next, and what are their
                   priorities.
               4
                               SISTER JOSEPHINE: I have some  of  the  same  problems
               5
                   that Joe has.
                               As I looked over the proposal I got the impression
               7
                   that they got  on the bandwagon very quickly to phase out the
               8
                   program, and they ended up with three people from 22.
               9               Then they hired, and they are at a level of  14  now,!
               10  and they propose to build it up to the original level, and
               11  they realize when they get the whole group in they are going     1
               12,
                   to need to develop them to have some program to work on.
               1.3             All they are going to do now is to tie up for   a
               14  poor staff and a development program which is the only thing,
               15  a development to develop that corps staff so they will be
               it; able to identify some projects, but there are no plans for
               17  how they are going to implement the projects, or how they are
               18  going to develop the project.
                               This creates a real problem for me.
               20              MR. de la PUENTE:  Maybe sta    can  e p us.
               21              What was the story?
               22              SISTER JOSEPHINE:  Another thing here, too, their
               23  past performance, there are three things that they identify,
               24  and one- is that they have been able to elicit grassroots
               25  involvement, but you don't know.
  HOOVER REPORTING CO, INC.
  320 Massachusetts Avenue, N.E.

   hws-38                      They talk about the coronary units which %@7ere one
                    of the- first types of tliiric s, which b,,@g,-iti wlic-,n the program
                    first evolved.  There were  five,  Now there are 30.
   0                           They had a management consultant firm come in and
                5   help them learn how to develop a program.
                               I feel they are very much in the same place as
                7   when they first started the program.
                8              MR. BARROWS:  Sister, you better be careful.  You
                9   are going to acquire a reputation of a hanging judge.
                10             DR. TESCHAN:  She is helping us to be one.
                11             SISTER JOSEPHINE:  This is the way I have to read
                12@  it.  They are going to ge$-- the kiss of death any how.
                13             MR. STOLOV:  I thought maybe Tom would comment
                14  since he was on the management assessiiian
                               My visit was the last visit, where the RAG met on
                15
                    this application.  I could supplement maybe what the reviewerl
                17  had to  say.
                18             MR. SIIIIONS:  We were up there in January.  There
                I!) were two people at that time, plus the secretary.
                20             There was the Acting Coordinator, the Fiscal man,
                    who has been there since the day one, I suppose, and the
                21
                2   secretary.
                               They had sDent the entire year of the phaseout
                    doing absolutely nothing, just s  itting there reading the newsJ,
                24
                    papers.
                25
   HOOVER REPORTING CO, lt4C.
        DC, 2r,@iP,2

                                                                         465
     hws-39                    MR. PETERSON:  In I-Iarrisburg?
               211             MR. SI14,@ONL-):  They were reluctant to hire people
               3
                    because the Coordinator had almost a paternalistic attitude,
               41   although some of the staff wanted to come back.  He didn't
               5    think they were fair to themselves to want to come back.  But
               6    now with more money, they will come back, he thinks.
               7               This was just a very inactive operation.
               8               MR. PETERSON:  You were at the PNG meeting when
               9    this application was considered.
               10              What kind of life did you see?
               11              MR. STOLOV:  I attended not only the RAG meeting,
               12,  but the Executive Committee meeting.
               13              The first thing that impressed me was that it was     I
               14   at the Pennsylvania Medical Society Headquarters, which is in
               15   Camp Hill, and the grantee is an ex officio member of the
                    Executive Committee, so most of the people in attendance    at
                   ,the Executive Committee meeting were physicians, and if you
               17
                    are in the medical Society building, which  is  quite  impressivei
               18
                    but there was adequate participation in the Executive Com-       I
               20   mittee.
               21              This was around April 17, so one of the physicians
               22   just paid his taxes, so he was carrying the torch    at that
                    meeting, and he was trying to question the Coordinator as to
               23
                    dollar expenditures.
               24
                               Most of them,, I still believe, are similar to one
               25
   HOOVER REPoRTitiG CO, ItiC.
           Ave tiue,  N,

  hws-40            of the cor@,,,-nts we made in another r@c@gion, that this is a fun@-
                    ing strategy rather than a prouram Strategy that at this
                 2
                    due to the conservatism -- well, they just appointed a
                    D4              t meeting.  He was Actin
                     @ro-ctor at tha                          g Director, so    there
                 5  was a sort of sitting on the fence sort of attitude there,
                 6  as well as due to low salaries  that  the  grantee  has  in  this
                 7  structure.
                                This was a  negative-  force.  However,  the  Executive
                 8
                 9  Committee is behind the Coordinator, and the RAG was well
                    attended at this meeting.  It was a well attended R-kG meeting.
                 10
                 11             They had  minority  representation  there,  and  people
                    made their  voices known, and after the RAG meeting, and they
                 12.
                    reviewed the arthritis applications,  as  well,  and  we  did  note
                 13
                    some positive progress.
                 14
                                The Chairman was also well liked, and is a good
                 15
                    Chairman.
                                Staff  went  just  like  Nassau-Suffolk  staff.  They
                 17
                    were at the position where  you  are  today,  because  this  Region
                 18
                    wanted to put its rebudgeting into staff at that time, and
                    they sent us their staffing pattern, and we asked them to link
                 20
                    it  to  their goals, objectives and  priorities,  but  I  think,  as
                 21
                    Tom mentioned, they are very  slow  to  move,  and  have  to  ave
                    the dollars in hand before they  will  move,  and  I  think  this
                    was a negative point to them.
                                As to evaluation, this  last  Saturday  they  had  an
                 25
   HOOVER @IEPORTING  CO,  INC.

                                                                                 467
   hws-41
                 I I evaluation.
                                 One of the reasons was one was just appoin4-
                                                                                 -ed a
                     inenLber on the staff.  They evaluated the two AREC's     there
                 4   with outside consultants, and they were      at a point i,.,Iaere thevi
                 5   were Handicapped because of the dominance of this medical
                 6   clinic, and one of the physicians in charge is on the Executix,
                 7   Committee as well, and up to this point they were really
                 8   handicapped by not performing an evaluation.
                 9               However, they did conduct evaluations on Saturday,
                     and the eval
               10                 uation report will go to RAG.
               11                They did, however, use their outs,4.de consultants
                     and   staff, and this is the first time they have probably
               12.
        (8)    13    evaluated  something on a scale like they did.
                                 MR. BARROS:  It seems to me, from what you have
               14
               15    -,aid,  what we are dealing with here is essentially a rebuild-
                     ing  of  the budget.
               17                Do you think that is going to bear fruit?
                                 MR. STOLOV:  I think that we iden    tify about $142,000
               18
                     in vacancies in this budget, and the question is when you readi
               1!)
               20    their narrative, and realize what they went through in the
                     steps they have to take, this is one thin , but they were
               21                                                 9
                     quite honest to say that they mav not fill all of      these
               22
                     positions, yet their R7iG and Executive Committee gave them
               2 t3
                 1   authority  to go ahead with the strategy.
                                 DR. HESS:  Can you tell us more about Chad Holmes?
               25
  iOOVER REPORTING  Co,  INC.
  320 Massachusetts Avenue, f,,L.

                                                                          4'c)  8
   hws-42        1  Apparently lic- has beer, appointed in May of 1974.  That is
                 2  this month.
                               MR. NASH:  That is as Coordinator.
                 411           MR. PETERSON:  Maybe I could offer  a little
                 5  historical impression of this Region.
                 6             One of the first times I visited I spoke  to  the
                 7  RAG in the early days of the program, and while I  have  not
                 8  been a frequent visitor, I have sort of kept an eye  on  it.
                 9  It seems to me this is a program which is in a  sense  almost
                 10 like three distinct faces to it.
                 11            In the early days when the Pennsylvania  Medical.
                    Society was still the grantee, but in the early days the first
                 12.
                    Coordinator was McKenci.e, and I don't recall the first name,
                 13
                    who had been an employee, I think he had been  the  Executive
                 14
                    Director, and at that time there was indeed, a great deal of
                 15
                    pulling and tugging between the grantee and the RAG, that
                    was trying to make itself felt, but did not have  a  great deal
                 17
                 18 of, it seems to me, moxie behind it in  there  individually,
                    and certainly collectively.
                               Well, that issue began to get  clouded.  There  is
                 20
                    the new medical school over at  Hershey,  Pennsylvania.  I
                 2 1
                    don't recall if the Dean is still there, but despi te  the
                 22
                    fact that the medical school at Hershey was put in the business
                 2 t3
                    of training primarily physicians, some of the  impressions  I   i
                 24
                    got, &rid I can remember a Dutch uncle talked about  that,
                 25
   HOOVER REPORTING CO, INC.
   ,20 'i',a@sachusetts Aveno,@, N.C.

   hws 4 3
                1   that Harold rolled with so7rie of the pE-,opl.e from Susquel-ip,,-Ina
                21' Valley.  The medical scl-iool',-! interest was to get some m-oney
                    to do some things that were @.)retty, at least some peoi:)Ie @-iP@o
                    knew better than I, was certainly exotc, and totall-,   in-
                5   congruous with any total prirctary care.
                               It sort of shifted from the  iledical  Society  and
                6
                    got clouted by the medical school, and   as a result  of  that
                    Dutch uncle talk they did bring in a Docto--  Ector,  who  was
                8
                9   from Philadelphia, axid I think he started working in trying
                10  to build some sort of program objectives which had never
                    really existed before, but really got caught up -- well.,    I
                11
                    don't think he had been in the post more than ten or 12 months,@
                12,
                    before the phaseout order came  and I don't know what his
                13
                    motivation was.   He didn't stay around ver  long.
                14                                               y
                               Since that time, Chad Holmes has   been first Acting,';
                15
                    and now he has been recentl.y confirmed as a  Coordinator, but
                    they not only have looked forward to  a  fairly  rapid  phase-
                17
                    out, but I think it does sort of reflect a Region which prob-
                18
                    ably never did have much momentum or sense of direction.
                               There was not too much to reach back to, and    Holmes:,
                20
                    he was job hunting actively for a while,  but  with  his  con-
                2 1
                    firmation as Coordinator, I guess he stopped doing that.
                22
                               DR. HESS:  Was he the fellow sitting around
                2!3
                    twiddling his thumbs?
                24
                               MR. PETERSON:  I assume so.
                25
  HOOVER REPORT[T@G CO, INC.
  320 Massachusetts Avenue@ if.[.

                                                                                      ordin-I
   hws- 44                         well, any way, they got dcAvn to the Actii)t:j   Co
                   2@i
                      ator or Finance Officer to close the books, and the secretary!,
                      to do the typing, and they all read the newspaper, according
                      to Tom.
                   5               Holmes was there the whole time.
                   6               DR. IIELJSTIS:  Is there anything there worth
                   7  salvaging?
                   8               DR. HESS:  No point in trying to gear up a program
                   9  for a phaseout.
                   10              MR. PETERSON:  Do we have any idea?
                   11              Susquehanna Valley has indicated they are asking
                   12.  for a little over $700,000 now, which is about their current
                   13 level, and they have indicated they are going to care in. with
                   14 another $700,000 package.
                   15              Any idea of what it specifically looks like?
                   I(;             MR. de la PUENTE:  They talk about improving the
                   17 quality, the high quality care in the Valley Region.
                   18              The Second Reqion is to improve the high quality
                      health care, and then they speak of each mission, and how the
                   1!)
                   20 are going to do it, so I think in here an awful lot depen s
                   21 on what they come up with in the other application.
                   22              How they do that I just don't know.
                                   MR. STOLOV:  There are some plusses, when they star@le(
                   23
                      getting.rejuvanated that they have supported the B agency
                   24
                      directors at one of the B's Previously not supported, and
                                                                                          his
                   21
    HOOVER REPORTING CO, 1,NC.
    3@'@     Avenue, t@.E.

                                                                                                                                             -T I
              4 5
     h-vis-                       1     name is in, referred to by the budget staff.
                                  2                           The second point is 'ch,-- Region is in the State
                                        Capital area, actually, @iiid therc is a need in that arca                                                             to
                                                                                                                                                                          I
                                        coordinate with the th,--ee unidei-i-I.-ified B agencies, and the                                                                 i
                                        RMP.
                                  6                           I   believe this Coordinator can do it.  He has thc!
                                  7     personality.     He  has  a  Master's  in  Theology.    He  calls  it
                                  8     theracit  medicine.
                                  9                           Any  way,  he  is  well  liked,  and  the  other  point  I
                                  10    want  to  mention  is  the  RAG  Chairman  is  a  specialist  in  cardi-
                                  11    ology,  quite  devoted  and  a  good  leader,   and  he  has  the  RAG
                                  12.   support  at  this  go  around.
                                  13                          MR.  BARROWS:    Would  it  be  fair  to  say  at  the  mini-
                                  14    mum  this  will  be  a  built-in  block  for  the  transition  if  we
                                        keep  this  program  going?
                                  15
                                  it;                          MR..  STOLOV:     I  would  ask  the  Committee  to  encourage,
                                  17    that.
                                                               When  Doctor  Ecort  left,  prior  to  his  leaving  they
                                  18
                                        were  going  to  come  in  for  a  triannual.     They  actually  had
                                  20    100  applications  in-house.    This  is  an  indication  of  some
                                  21    identity  in  the  community.
                                                               What  they  plan  to  do  is  to  try  to  bite                                    on  some  of
                                  22
                                        those  back  applications.
                                  23
                                                               MR.  BARRO;QS:     Let--s  give  them  a  reasonable  budget                                                i
                                  24
                                        and  see  what  they  come  up  with  in  their  ne),.t  one.
                                  25
     HOOVER REPO
                  RTING  CO,   INC.
        320hiass"husettsAvenue,N.C.

        4 6
   hws                         DR. TESCIII',,i4: That soux,ids  except  what  I
                 2  think I have heard up u,,iti). no-v7, until you just said what
                    you just said up to now we are going to need a couple of
                 4  Dutch uncles.
                 5             One did not carry very far here, so it seems to ii,,P-
                 6  that the Chairman and the Coordinator, or whatever else needs
                 7  to be invited down here has to come, and you have  to  line
                 8  up and lay it on in terms of what needs to be done up there.
                 9             MR. BARROWS: Could you give  them  a  transcript
                 10 of this discussion?
                 11            MR. PETERSON:  I prefer not to do that.
                 12.           DR. THURMAN: As you look at  their  budget,  what
                 33 they have proposed is $498,000 in staff, $95,000 in definitive,
                 14 projects, and $127,000 in grantee administrative costs.
                 15            Going along with what Mr. Barrows said,  why  not
                 i(i think about $95,000 for the definitive projects, because
                 17 most of them are transitional projects for a  few  agencies,
                 18 and added to that, $250,000 for program staff.
                 l@)           I am making a motion that we not  terminate,  but
                 20 we ought not to commit this kind of money until we see what
                    is going on.
                 21
                 22            MR. BARROWS:  Your recommendation makes a lot of
                    sense.
                 2,3
                               We have a good Coordinator.  We have a good    RAG
                 24
                 ii guy UP there.  I think the two give you a ray of hope.
                 25
   HOOVER REPOPTiliG CO, tNC.
   320 tla@chus,,it. Ave,,,.tie, i@I.E.

     hws- 47                     MR. STOLOV:  iffid the grantee follows the f i.na-licicil
                     practices as to their philosophy  and  their  whole  sala@r,,,  is
                     something else.
  0             4                DR. TESCHATI:  You will need a bellows in Condition      i
                5    to the dollars  to get them started.
                6                DR. HESS:  In- circumstances like this I wonder if
                7    mp,,be I am just thinking  here,  if  he  could  somehow  learn  a   i
                8    little something from the fellow in Rochester       Peter   IIott,
                     as judged by the grant application, and I never met the man,
                9
                10   except I like the way he thinks, as represented in the appli-
                11   cation, that organization that is there, and the way he got
                12,  that thing lined  out,  I  wonder  if  a  little  apprenticeship
                     with a first  rate  Coordinator,  and  looking  at  what  a  first
                13
                14   rate Coordinator  does  with  an  application,  if  it  would  not
                     be helpful saying, you  know,  much  more  than  you  have  to  do
                15
                     better.    He needs some direction  as  to  how  to  do  better.
                                 I gather from what you say  he  has  the  interest'.
                17
                     and motivation.
                18
                                 MR. STOLOV:  Ile did expand from three to 14, and
                19   a lot of his staff are following him.
                20
                                 He does have some leadership that did come to
                21
                     work for him.
                9-2
                                 MR.  PETERSON:  Let  me  make  sure  what  figure  you
                23
                     were coming up with, Bill,  and  what  the  basis  for  it  was.
                24
                                 You said leave the $95,000 in projects?
                25
  HOOVER REPOPTit,G CO, ltiC.
  320 Masvchtisetts Avenue,

                                                                     4'@
       48                                                   rains staff activit-,.,:;@
  hws                        DR. TliUl@,IALN: $250,000 in prog'
                2 which would also bring then $60,000 in grantee administrativei
                31:, costs which is $310,000 and $95,000 they have asked for in the-."!
                4 projects they have, which is $405,000, so why not $00,000?
                5            That will not make him lay off any of the 14.
                6 It will give him some room for expansion in that 14.  This
                7 will carry his projects, and pay his overhead.
                8            MR. PETERSON:  And try and see what  their July
                9 application looks like in terms of any hint of  A program
                10 there.
                11           MR. BARROWS:  Is there any way of getting the
                12. reasoning to them?
                13           Could you do that, Jerry?
                14           MR. STOLOV:  We have to send a policy feedback to
                15 the Coordinators, but we expect whatever domes out of this
                             DR. IIEUSTIS: There are only about three  or  four
                  instances in all of these discussions we have  thought  there
                17
                18 might be some real value to get some information back reason-
                  Ably soon.
                1!)
                             Would it be possible for the staff to discuss this 1
                20
                  with the higher ups, to see whether or not, in a  very  small
                21
                  number of cases an exception to the general rule could be
                22
                  made, and that maybe some of these people could go?
                23i          DR. TESCHAN:  I have a question.
                24
                             Our recommendation is to Council who  has  charged
                25
   IIOOVER REPORTING Co, I!I;C.
   320 Massa,:husptt@, Avenue, N.[.

         4 9                                                                      4'(5
     hws-            us, and it seems to me if Coiu-icil. says we don't want any part
                2
                     of that'-, we will do this.
                                 DR. HESS:  I recommend staff do that.
                41               MR. PETERSON:  Your recommendation is     for a feed-
                5    back?
                6                DR. HESS:  No, officially.
                7                DR. THURMAN:  That letter you signed made us report
                8    to the Council.
                9                MR. PETERSON:  You have an official legal status
                10   now.  You are legal.
                11               DR. HEUSTIS:  Shouldn't they give us a copy of
                12.  that letter to make it legal?
                13               DR. TESCH@L:  It is a little techinical point, and
                14   we might be overridden by Council.
                15               DR. THURM.U    Staff has the option to ask if Council
                     approves, ask somebody to go with them to explain all of this.
                17   The staff can ask about that.
                18               MR. NASH:  If Council approves this, and of course,
                     this information goes to the Advisory Letters, you know.
                20               MR. PETERSON:  I thought I heard Al say something
                21   different.
                                 Here and in a few other instances we won't have
                     Council action until the 14th or 15th.  I don't know-if it
                23
                     makes any difference, but I,thoiaght I heard Al suggesting if
                24i
                     it is agreed at a higher level.
                25
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                                                                            -6
                                                                            1
   hws- 50                     DR. HEUSR.OIS I gather from the discussion  there
                 2  was no great enthusiasm for the suggestion I made, so  forget  i
                 3
                               DR. HESS:  There was, indeed.
                 5             DR. HEUSTIS:  My suggestion is, as soon as I)ossibli
                 6  after this meeting, that in a very small number.of iii.-,Lances
                 7  where you believe it important, that the staff seek the
                 8  approval of a higher level in this organization to at least'
                 9  informally discuss with the local people what we have talked
                 10 about in those instances where it will be thought to be bene-
                 11 ficial to the program.
                 12.           DR. THUR@IAN:  I second.
                 13            MR. BARROVIS:  I move it.
                 14            MR. PETERSON:  In this instance if it is concurred
                 15 in by Dr. Paul that we would get back to, I hope, if tl,.a RAG
                 i(i Chairman is an impossible i-,iover, indicate to them in frank
                 17 terms the Review Committee's recommendation will still have
                    to be looked at by the Council, That we have serious reser-
                    vations about the Susquehanna Valley program, but would be
                 20 looking at their July application largely in terms of whether
                 21 there is any indication of some kind of program being performe
                 22 there, and they need to keep that in mind.
                               I don't think they are going to generate any new
                 2t3
                    projects, but it may make a difference in terms of their
                 24
                 25 priorities, and how they present what they have in the pipeline
   HOOVER REPORTItiG CO, INC.
   1,20 taassahusett@ Avenue.  N.[.

                                                                           L@77
  hws-51           now.
               21              DR. HEUSTIS:  When is the deadline?
                               MR. PETERSON:  July 1, but for most Regions this
               4   means their RAG's are going to be looking  at  things.  @lost  of
               5   them are scheduling meetings in mid-June, or early June.
               6               MR. RUSSELL:  We have a precedent and can handle
               7   this and accommodate the concerns of this group.
               8               What I hear this group saying is that   there  should
               9   be a staff  visit.
               10              MR. PETERSON:  Maybe we ought to ask Ho mes.
               11              MR. BARROWS:  Let's clarify this thing.
               12@             We are not preempting the role of the Councilo or
               13  reporting  decisive actioni but we do feel under some obliga-
               14  tiot to help the programs.
               15              We think it would be in their best interest to
               1(; know some of the concerns and some of  the  reasoning  that  went
               17  into this discussion.
               18              What they do with it is their own  business,  and  we
               19  are not reporting any definitive action.
                               DR. TESCHAN:  The site visit isn't the term.
               20
                               MR. RUSSELL:  It is a staff visit.
               21
               22              MR. PETERSON:  I think in  some ways it is particularly
                   more effective since we are not that   far away.  Harrisburg
               23
                   is a little over a two hour drive, and let's see if we can't
               24
                   get the Chairman and Dr. Holmes to come down for a half day
               25
   HOOVER  REPORTifiG  CO,  INC.
   320     A,@etiue, i@.E.

                                                                          4'1/ 0
  hws-52           visit.
                 2             Sometimes the direction in which   you move is  most
                 3 helful.
                 4             DR. THURMAN:  Excellent.
                 5             I call the question.
                 6             MR. PETERSON:  The question is on a $400,000 recom
                 7 mendation  for Susquehanna Valley with the communication to
                 8 Holmes, the Chairman, that he meet here  as  soon  as  possible.
                 9             Does that meet with your concurrence?
                 10            DR. HEUSTIS:  The appropriate division of that
                 11 within program staffs and projects.
                               MR. PETERSON:  All in favor raise your hands.
                 i2.
                 13            (Showing of hands.)
                               MR. PETERSON:  The vote is unanimous.
                 14
                 15            MR. NASH:  Remind them of the confidentiality of
                   deliberations particularly in the case of Maryland.
                               MR. PETERSON:  Yes, particularly Maryland and
                 17
                   Nassau-Suffolk Counties.
                 18
                               Are we agreed then that we will try to get together
                   at 8:30 tomorrow?
                 20
                               I will have something in some kind  of  rough  shape
                 2 1
                   to pats around then.
                 22
                               We are planning, according to  the  last  communica-
                   tion I got from the other side of the wall, to reconvene as
                 24
                 ii a single group, or as a whole, between nine and 9:30 tomorrow.
                 25
  HOOVER REPORTiliG CO, INC.
    320f,la@chusettsAvenue,N.E.

                                                                                                                                                         79
      hws-53                                                 One  final  thing,  if-  there  are  any  of.these,  partic..!!
                                2      ularly  as  they  relate  to  Nassau-Su.ffolk  and  Maryland  tlia@
                                      have  not  been  turned  in,  please  let  me  have  them back.
                                4                            We  will  meet  again  at  8:30  tomorrow  morning.
                                5                             (Whereupon,  at  5:50  p.m.,  the  meeting  adjourned,
                                6               to  reconvene  at  8:30  a.m.,  the  following  day.)
                                7                                                         -  -  -
                                8
                                9
                                10
                                11
                                12!
                                13
                                14
                                15
                                it;
                                17
                                18
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                                2@3
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    OOVER  REFORTlt%G  CO,   INC.
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                                L
             D.C. 2OfjO2