I
                                               @l,l























                               EXCERPT OF TESTIMONY AND MATERIALS


                                         Presented On

                                    MARCH 26 AND 27, 1968

                            Re: Sections Of H.R. 15758* Relative To

                                   REGIONAL MEDICAL PROGRAMS


                                           Before The

                                  SUBCONMTREE ON PUBLIC HEALTH
                                          AND WELFARE


                                             Of The


                                          COMMITTEE ON
                                INTERSTATE AND FOREIGN C04ERCE
                                    HOUSE OF REPRESENTATIVE
                                       NINETIETH CONGRESS
                                         SECOND SESSION










            *A Bill to ainond the Public I-Icaltli Service Act so as to extend and
             improve the provisions relating to Regional Medical Programs...









                                                                               CONTENTS


                                                li(!](l Oil                                                                                                    Plig
                                                     2(;,        -------
                                         @l    i-(@ii  27,       ----------------------------------------                                   --------
                                                                                                ---------------------------
                                                                                                                                                                    2



                                                                                                                                                                    7





                                                                                                                                                    'hr
                                                                                                                                                 T't,



                                         lir,,ttrti(le, Di-. Aiiios, @Vtsliiiigtoii (Sttte)                                   Associttioii ,tii(i
                                               Association of General Practitioners                     ----------------------------                           197
                                         Breslo@N-,      Dr.      l,ester,      I)resi(leiit-clect,      American       Piiblic       Ilealtli       Asso-
                                               ciitioii -----------------------------------------------------                                                  168
                                         lirill,     Dr.     Ilenry,     rncml)er,     Committee      on      Alcoliolisiii      iii(I      Dr@ig      De-
                                                             American 'i%l(!dical As.-,ociatioii                               ----------------------    147,     150
                                                       ae                                b e, I ; 4;                      I   A

                                                        Dr.  131@tiicl  NV.,  inciiii)cr,  Cotiiicil  oil   Mc(lical
                                               At@i(@ric,,tii  @Nle(lictil Association                            -----------------------------------    147,  148


                                                                     J.   W.,                                                I                          of
                                               (:(.ol.gi:t                                                                                                     208
                                                                                l@., As.-io(,-iittioii  of  Aiiii-i-i(@;Liw                   (!olli@g(!s-     12:i




                                                                                                                          of     Siii-g(@i-y,     ll:tylor
                                               Iiiiiv(@r.,iit,y (,oll(,g(! of                    Ifoiistoii,
                                                                                                   1.  A
                                         J4"



                                                        Dr. Si(iii(@y, (lir(@et,or o  reseal   1, Ciiii(ireii"S CLiic(!i-
                                               I"ot   (ILtiol), liostoll, Mass         -----------                                                             I:ii)



                                                                                                                                                               147










                                                                                                                    f
                                               v





                                                                                        -    - ... @ @ 1,  @', @ L'-  'tl '- 7 @-L  @   I., @,  -        -                  ",L"@@ @ -@  f
                                                                                                                                                               77"






                                                                                               IV






                                                                            AssistiLiit  @ecr(,t:i,ry  for                     @iii(i    S(!i(@iitific
                                               AIT@tirs,                       of  ii(!:ilt,ll,  ]"(IIIC@ttioii,  :111(l
                                           l,iliolT,  I)t-.  Willi@iiii,                     1):is@                  Aiii(@ri(,;Lll    College     of
                                               (':tr(liology   - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - -        - - - - - - - - -    I C) I
                                                                   IMP

                                                          1)1-.  It@ill) I (@.,  I)ir(@(:t.or,  I)ivisioll   of   I',(@gioli@Ll   Nli!(Iie@il   [Iro-
                                               gl.:Lllls,                11
                                                                           1, of lle:ilt,li, l@diictit,ioii, :iii(i                      ------------         i)
                                            Nlillik:tii,  I)i-.  Cl;trk, cli:tiriii:Li), Coiiticil oil                                      J)isetse,
                                                                                                  --------------       ------                             16:i
                                               A                                                                                 -          ---------


                                           N(@llig@iii,    Willi@irit    1).,    execkitive    director,    AiiiericLii    Coll(@g(!    of    Ctr(li-
                                               ologly                                      ----------------------------------------------------------     161




                                                     I)r.  NVilli.Liri, director, Divisioii of Me(licti                                  Alliericiiii
                                                            Associtt@ioii                            ------------------------------------------------     147





                                                                                                                   1)(@ti-oit Al'( L      0   )it   I
                                                                                                                                                          218














                                     Addit,i                                                   li(@ record I)v






                                                                    it,@il   Associ:tt.ioii,              fi-oiii                      Willitiii.Soll,                         Ir
                                                                                                                                                          2t)!)






                                                                              4)1@  l@(!giollil                  l'i-ogi-i@ills,                   of
                                                ])I-.           III.(.Nlolv                     ------                                                    171







                                                                                                              Ir

                                                     AdditioiiLl iiiforiiiat,ioji siil)ttiitt(@(I fol' II)(',              I)y-Cont@in iod
                                                               Joill-11:11  of  i,li(!                               A@;so(!iit-ioii,
                                                                            "lio-;I)it:ils :11)(I  lt(@gioii@ll                l'i-ogi,@tilig:  A   III(,;i,   for
                                                                                                                                                                     222
                                                            11;Ii@II)toll,                                                                                           :304
                                                                                                                                     -oil)     Will(isol.       C.
                                                                                        of, @.llt)ol of                           fl
                                                               ('tit t itl)4',                                                                                       :10:;

                                                                                fol. 1,11(@
                                                                                      l@f                                                                              84
                                                                                          ol)lit!:Liioll                                                1 5 7.r') 8
                                                                       roi. fis(.:ii        I!)(i@) -.77 (t:i I)Ii@)
                                                                                of                                                         oil--                     12    1
                                                                    liosi)it;kl                                            ill  ]'(@giotl:Ll  lll(!(Iic:il   I)I-o-
                                                                                       III('II t O                               -   --------------------              (@2
                                                                                      of t,li(@                               liosl)it.11  ill  tll(,,   Mi.,isoiiri
                                                                       ).Cgioliil lll(!(Iicil I)rogi-:tiii,.,it:i,t     i oil                   ------------------     85
                                                                       igi-,ti I (, liciltli I)rogr@tiii st!ztt,t is, ',\I @t r(@li I @)(iS, stttteiiiciit oil        ------- 87
                                                                    ;Nligr:tiit li(!:@lt,ii I)i. ojects @issist,(,([ 1)3'       IICLltll    Service     gr,,tiits,
                                                                                                                                                     -------------
                                                                        (lireclory of    --------------------------------                                              88
                                                                    \,Iigrajit liospitiliz,,itioii, stiteiiiezit oil                      ------------------------   115
                                                                    Ol)ci-.itioii,,Ll projects tffcctiiig ritr@tl itroas, stat(@iriciit oil             ----------     76
                                                                    Pttictit    care    costs    supported    Nvitli    regional     medical     program     grant
                                                                       funds    --------------------------------------------------                                     65
                                                                    Professional     involvement      in      regional      medical      programs,      stttcincnt
                                                                       on                                   ------------------------------------------------------     64
                                                                    Piiblic    Ifealtli    Serviec    report     oil     12     operating     regional     medical
                                                                       programs                                   ------------------------------------------------     46
                                                                          Television,     ra(lio,     and     t(,Iel)lioiie      networks      for      continuing
                                                                                (,(itic,ttioli ------------------                          -----------------------     61
                                                                                                                           report,  for lictrt
                                                                    lt(,tgiotilLI  ille(lic,,Il 1)rogrzttiis,  1)i,o,
                                                                    I"(,gioll@ll  illf-(Ii(@ill  I)rogl-:Ltll  (,Irol't",                        t'll(@
                                                                       1)1-01)1(-Ills of              ci (,N , 'it,:Lt       oil ----------------------                7:@
                                                                                of rt@gioititl           i)j-i)gt-llllls,                                              66-72
                                                                                ------                 in  i-(@gioii,,@l                I)rogrtiiis    I)y    iii-
                                                                                                                                        ------------------
                                                                                                 J))(!(iic;ll              tot.@ti  ol)ligtit,ioll  of   ritil(is,
                                                                       fiscal




                                                                                                                                                                           L







                                    d
                                                              -NI is@                                                                @til(i                            lt)5

                                                                                                                                    IITI:LL









                                                                                                                      -Y
                                                                                s                                                                                      :10 1
                                                                                                                                        tiF Ni6@iot  liw-povi  is,










                                                                          i(@i I III(]       111(@l It. of it It -i @lio  4@i- ii@i r(-ot it! ,t(] (II(-(i(i
                                                                        II                   ol,       gl.;Iiit iiil(14@l, Iiiis
                                                                                                                1114, (-o'l  lo 1)1'
                                                                         tll(@ (1111.@itioll (If       I)ol'(ioll (It' ill(' Kl.;tljt@
                                                                            ill@itil)ll.,Z, ])(I              11.4 tilf@ligii 11)(@ gl-,Iiitl
                                                                        (,g

                                                                                                              of
                                                                                                                                     @y  ])Dart,  1), ill  tll(@  e,,i   @e
                                                                los     I- tll(, iir@N,.(@litioIl  41:1(1               of,
                                                                                                       -Olt (:08'1'  01@'

                                                                     @(,(.tioll  I    0:@f         ii,til@il


                                                                                                                           ioll
                                                                                                                          (,I, illl.V :11lotill(@lit oi- 'IllotrIi(@
                                                       sii(-Ji Si@tt(, iiii(i@@r 1)@ii-t. 't of, I:il[4, If      1)1.              -to 1):Iy
                                                     It I @l 11(@i- SI I @ I I.(@ ;Is t 11(@ @(; IIt@ 11141.N' F(Il I(? I' III L. (-X 1)(@ II( Ifo III I (I
                                                                            foi-     111(@                                                (1111-ifig stl(.Il Y(,:Il,  (11,
                                                                                                                             1.      iticpi-(@ t ]III it 2         [till
                                                   @of  ill('  Total]  (II,  tili@  itlli)ljltl,lls  of,  sll(.Il  S:Ilq.   foil   III- :,s5O,OO(@,
                                                                                       l'ol-        Itiii-lito@(' f4)1. Sit(-II       I'llylil(.Ilts of :ill)
                                                   ilil(.          I)iis                 Italy 1)(@ ill@141(@ iii            ol- li@@-iiy of i-eiltilliirs(,
                                                     11 (I I 11 SI I('] Li I Is I ('IItS, :is t 1)(@
                                                      "(2)  @iiy :irll(Plll;r,                                    (1)  to Italy Sti@itc@,fi)r iiiy

                                                   fol-         ye:ir,,fi)r I(ilililli',tr.,iti4)ii of Ili(@ St@it(@ I)I:iii iil)l)rov(,(l iiii(ler sii(,Ii it
                                                     ot         tliad the total Illioulit exl)eii(le(i  for sii(@li  I)url)oses frolli Sliell  S(
                                                 @LLtilig tIlrI.          yeir cii(Iiii, Jiiii(- 30,

                                                                                       I)L;PA)tT-\Il-,NT Ol-' Ill,',AT,Tll, 1,DUCATION, AND Wi-@,I,FAItF,
                                                                                                                    IVa87tiizgto)i, D.C., Alai-c7t 18, 1968.
                                                   1-1011. l@IA]iLl,,Y 0.  STAG(;I@R,',,
                                                                  Coilli)littcc        OIL                              coi)l)ilcl.cc,
                                                   11(i?INC    of    li'C))@-escilt(ifil7cm,    itiglo)t, D.C.
                                                                     CIIAI[t.-,[A',N : Tljis letter is !it r('.@-poii.@e to your request of                          6.
                                                           for i  report oil               157i!8, t ])ill  ... I'll            the     Ptil)lic     II(@,iltli     @Service
                                                   ,ket   @o   ,i,,   to   e%t(,,ii(I   iii(I   iiiil)rove   tl)e   1)roN-i,,ioii.,;   i-(,I:itiiig   to    r(,gioliil    iiie(licii]
                                                   I)rogr@iiii,,;,  to  (,xt(,ii(I  ill(! atitliorizttioii  (If            foi-            Of     iiiigratoi-y      iigri-
                                                   (@iilttir,,il worlwr.,;, to I)rovi(le for                                    for    iilcolioli(-,,-    liti(I    narcotic
                                                               fiii(i for t)tli(@r
                                                                                                      ill-ol)oslll (-olltllill(@(I iii :I  (ira.ft, I)ill
                                                        this                    to  tll(@               oil             @t,        lo                  tlit@
                                                                    oil  exl(,Il.,4ioll  ;Ill(]                    or  I.(.gi(illill  ille(li(-Itl          I s      I-
                                                                                                                        (ill            'I'lie lilil also
                                                                        J)I'oj)os:ll                III  lli:i(  ili-;irt  I)ill  i-(,Iittiiig  to  t(,.jiil)oi-;try  (@xt(,Ii-
                                                   Sit)ti  4pr  fli(@  ill-ogi."ijil  or  gi-iiills  fol'                      l'oi-  iiiigr;tfoi-.N@

                                                         ili,;Ii'l  I)ill               11.@,  lili,,                   to  Ill('               oil

                                                                                                                                                            7,   .11)1;8
                                                                OIL  iil','Ili.illg  I'll(-                  @ilill  1114'('Iilig  till@ 4.111111(,Ilgl. of         I



                                                      Tli(@             of tli(@ Itti(lg(-(@            tli:it                 4)f    this    I)Vol)oS(@(I     legisiiitioil
                                                   @voiild Ile it) it(-cord witli the progriiiii (@f the
                                                            Siiiecrely,
                                                                                                                                    WXLBUlt J. C011rN,
                                                                                                                                         Actiiig  Scci-etai-y.













                                                                                                                                                                         17"










                                               REGIONAL MEDICAI, PROGITAAIS; ,kL(',OIIOLI()'S  AND
                                                  NARCOTICS AI)Dl(',TS FA('111,ITIES; HEALTH  SERV-
                                                  ICES FOR  D031ESTIC  AGITICIJLTIJRAL  311GRATORY@
                                                  WOIIKI'@,RS


                                                                          TUESDAY, MARCI-I 26,  1968


                                                           Sujic4)mi%ti,rn,L ON Pullf,IC                    AND NVFLl@',kllE.
                                                             COM-,NflriLE ON IN'IEltST,%'171-, AND Foiwiow C031miitcL,
                                                                                                                    1,Va,37tington, D.C.
                                                  The   subcommittee   )net   at    10.1.iii.,    pursuant    to    notice,    in    room    2"122,
                                               Raybuni    lIouse    Office    Building,    Iloii.    Paul    G.    Rogers     presiding     (floii.
                                               John Jarman, chairman).
                                                  iAfr.  ICYR
                                                                                    The    subcommittee    will     please     be     in     order.
                                                  The    heai                        on     I-I.R.     15758,      introduced      by      Chairman
                                               StaLyzers  ,It                    t-he,,tdministratioii.
                                                  'ties  bill                     ,tnd     expand     the     existiiitr     authorizations     for
                                               yegional    medical    pro    rams,    would    extend    the    pro(-rrtm    of    health     serv-
                                               ices     for     domestic      aoTicultural      migratory      worke@,'aiid      would      provide
                                               i-natcliing   (-rrants   f@r   construction   and    stiffing    of    facilities    for    preveii-
                                               tion   of   @l@holism    addiction    and    for    treati-n@iit    of    alcoholics    and    iiar-
                                               cotic addicts.
                                                                          REGIONAL '.NIEDICAL PROGRAMS
                                                  In   1965,   the    Congress    considered    legisl;ttioii    prol@osiiiL,,    the    establish-
                                               @liie,iit, of            medical    1)ro,,rriiiiS'ilesialle(I    to    ii-nl)@@ve     the     Health
                                               (!are of the Aiiioriclii I)eol)]@ in the fields                    disease,                  strolie
                                               itii(I   related   dise:ises.   Tli@    (,oiigi-(@s        substantial    revisions     ill     this
                                               proposed I)rogriiiii  l@t-ovi(Iiii(r-ill                    -foi-  it  iiiitxiiiiiiiii   of   de(-ei
                                               utilization of the (le(!Isiollllltl(ili,r 1)1.o(@(",.,s and eii(,oiti.@itgriiig             liiitxi-
                                               failure feiisil)I(N cooperation I)e,(,W(@ell  I)III)Iic,  and  I)riN,itte  @rroiil)s  iiit(,@recited
                                               in tii(@  li(iilt'li  of  the  Aii)ericiii  people.
                                                  It is iiiit)ossil)lo to riv(@ t                (Ies(..I.il)tioll  of  it  i-elrioiiiil   medical]
                                               I)ro,-,,r,,tiii Since eve                         )Iislle(l,is  (lilrerelit,   i@itli   eteli   pro-
                                               (rr:i  i ttilor(-(l spe(lirl,                     e(@(Is of tile, re(,rioii served.
                                                  Over 90 per(-,eiit, or                         I of tll(@  IT]Iit-cil  Rotates  is  ol.  will  be
                                               covered ],)y re@rioiiil,                          :tills   established   Oil   tile   locl]    level
                                               either oil all OI)Cl-,Itl                            oi-  tiii-oti;,rli.   I)rogriiiii,,   currently
                                               ill the                iti,-e. Eveiitutill        I   0   I)ei-(,etit   of   our   population   will
                                                                   9
                                               be covered by these programs.
                                                  Ak@   iiy   f@.   i-s   tii(I   -reservations   were   expressed   itt   the   time   the   Coll-
                                                  ress    was    considering    the    initial    legislation.    It    is    my     understanding,
                                               9
                                                                                       ,rroiii)s    which    had    rese@-    ioiis    about     th
                                               however, that many of the                                                 vat                      c
                                               initial   proposals   have    since    -modified    tlieii-    positions,    in    large    Yneasure






                                                                                        2

                                     1-w(,,aiiso of the iiio(iiii(,@tt@ioiis i.iik,t                       ill the                  by    tl)o
                                     (14)11(,ro,-s :111(t illoilillilit@i, ill wlil(!Il                      ]ills
                                     to (1:1 I
                                          s   I' iiiidei-st:iii(I tlio bill                  to ils, 110 illtioi-                          pro-
                                     I)Os(,.(I. 'I'lio I)riiicil)  1.1  ])Ill-])O@o  of  the,  le-islatioli  is  to  extend  tl)e  Pro-
                                     griiii beyond its sclic@litled expiration ditt-,                 of  .1-une  30   this   y(@ar,   with
                                     minor iiiiprol-elllellts tll,-tt experience lits slionvii to be iiece-Ns,.try  or  de-
                                     sira,ble.
                                        In regard to the section on (loin@ticigricLiltiir,,tl ii-ii@r,,itory
                                                                                                                                     worriers,
                                     the    ])ill        proposes   to   extend   for   two   additional    y@-ii-S    tli-o    existing
                                                  of                ,-riiits  for  liciltli  services  to   (.Ioine,,tic   tgriciiltiirLl
                                     illiLru,ttol-V worriers.
                                        'the  existing  pi,ogi-@itil  is  11,,o  wliediile(l  tlo  exl-)irt@,  J'tiiie  30  this  yeir,
                                     so extension is                      it this t-iiii(,, if tli(@s(@ worried-,  ivlio  ire  ',Iilloilg
                                     the               today,   ti-e   to   continue,   to   receive   the   services   they   need.

                                                               AL(jOIIOT,T(@ ANI) NATtCOTI(',S kl)I)ICTS
                                        Title II of this bill woti](I            establish  t   1)ro@rr@iiii   (lesi-lied   tl()   provide
                                                    ill i'llo treat iiielitiii(I rehabilitation  of,  ,Ileoll()Iic  :ill(l  )),ll-cotic
                                                 Tli(@  1)ro(rrtiii   pi-oposekl   is   ,tti   extension   of   tl)o   principles   11-
                                     ],(lady embodied tili the  coiiiii-iiiiiit,.y  iiici-ital  lic,@titli  centers  -iiid  iiieiit,,t]
                                                      facilities  acts  tl-)I)i,oved  by  this  (-oiiiii-iit@tee  in  196,3.  The  bill
                                     I)I.Ovi(les                  griiits  foi-   c(>iistrtictioii   'Lli(I   operation   of   facilities
                                     which   :ire   part   of   ,t   complex   providing   essential    -eleiiiejits    of    coinl)re-
                                     lielisive   month   health   services   in   order   to   provide   services   for    the    pi-e-
                                     veiitioii and treltii-iciit,of -tlcoliolisni.
                                        Grtiits   tro   tlso   tiitliorized   for   coiigtriietion   iiid   op",Itioii    of    special
                                     residential   ii)d   other    facilities    for    treal,iiient    of    harmless    ,tlcoliolics;
                                     frraiits   for   construction    iiid    operation    of    fwilitic-9    for    prevention    and
                                     treatment   of   iitreotic   addi(,,tioii;   tiid   graiits   for    training    and    eiT,,tlua-
                                     tioii               to  I-,lie  1)rei,eiitioii  and  tre.,ttii-iciit  of  narcotic   addiction.
                                                  ;11.o it                  parallel. of witnesses Avllo ]I,-tV(',                       the
                                     ol)])ol-tlllllit,v t4) ]le           4)11   t-Iii-,   le,rislttioii,   which   is   indicative   of    the
                                                                       to 1,110 needs NV]ii(-Il %Vill 1)(@ served by the
                                            of, t,iiis bill.
                                        I've 1101)(', to 1)(', able to exl)(@(litle these,             igs,iii  order  that  I-,lie   Icais-
                                     lilt ioll early 1-t@:leli t li(@ I                                               ])OKiil)l(t           ill
                                     illeNv ol@ t'll(@ I.(,]:ItiN!(@ly brief         I-eiiiliiiiii,, 1)(@rol-t@ two of t@)I(@ I)t@)(rrilms
                                     (.olll ii,ille(t ill lllo [),ill ztt.os("]Ie(lllle(i t@o expire.
                                                bill  iiiid(@r  consideration,  all(I  -Igelicy  reports  Oil   the   bill,   will   be

                                                                                                    i,(@I)oii,,i   thereon,    follow:)

                                                                    L II.R. 157r)S, f)Otli Coiig., second scsg. I
                                     A lllf,T, To aiiien(I tli(- I'@il)llc Itealtli S(,rvice Act so as to CXtPll(l and iinprove the  provisions
                                        r4,]iitlzig to regional iii4,ijical i)rogrniii4, to extend the iiiitiiorlzfktion of graiitm for  Health
                                        of migratory iigrictiltiirni Avorkei-s, to  provide  for  specialized  facilities  for  alcoholics  and
                                        narcotic addicts, and for otlier I)iirpo-,,es
                                        13'e it c@nacte(l,  bli the              an(l, IloitN(,@ of                        of the  Uttite(I
                                     States of A))tcrica iii Congress asset)? blc(l,

                                                         TITLI@, I-REGIONAli AIEDICAL l'ItOGRAAIS


                                                              EXTENSION OF REGIONAL MEDICAL PROGRAI.18

                                        SEC. 101. Section      901(a) of the Public  I[Icaltli  Service  Act  (42  U.S.C.  299a)
                                     is amended by striking  out  "and"  before  11$200,000,000"  and  by  Inserting  after





                                                                                                                      3

                                                        ".Tiiiie    @0,    11)68,"    -    the    following:    "$6,-i,000,000    for    the    lisi@al     year     ei)(Iiiig     Jtin(-
                                                        30,            @,iii4l @-iieli          its iiiiiv I)(-                     foi- t,ii(, ii(,xi@ four fiscal

                                                                                                        ()I' lti,'.GlONA], ',I [-,'I)ICAT, I'ItO(!ItA?.iH

                                                                  102.  St,etioji ()Ol(jt)  of tli(, Ilitl@li(- Ili@.iltli                               is ftirtli(,i-
                                                        I)y ills(@l,liilg lit fit(, ('11(l tlli,r4,of ti)(@ follon%,iiig                                "14'or  iiiiy  ils(,iil   y(-.ii,
                                                                                     :10,                    1)oi-ii4iii of tlif, ;il)i)i-oi)riiitioiis                      to      this
                                                                                                                        I)iit                                  (-(@iittiiii t, i('i,(@o
                                                        -Ii:lll  tire  li,viiil:il)l("  lo  tll(@                   for  (@v;tltiiii@ioji                    or    by    gr4iiit.,i    or
                                                        coiitrtct,4) of the 1)rogi-@iiii iiiitlii)riz(@(i I)y tlii,4

                                                                                                   INCI,I-TtiloN Ol-' 'I't,;Iil@TTOI?TES

                                                                   10:1.  S(,(,t:ioii  ()02(it) (I.)  of  Ili(,                                                 ket      (42      ii.s.c.
                                                        2@)91))  is  tiiieii(le(I  I)y  iiis(,rtiiig iifl(,i-                       tli(-    following:    "(Nvlii(-Ii     for     I)iir-
                                                        )lo.-;(,.,i  4)1'  t,lii,,@  fill('  ill(-Itlql(@s  tlk(@           of                     til(@   (,'ollllllo]INV(@;ilt@ll    of
                                                        I'lierto  Itico,  tlk(@  N@il-giii  lsliill(l,,,                   kiii(@ri(-iiii   Sjijiio;t,   iiii(i    the    Trust    'I'er-
                                                        1-itory of the I'liciti(' Isi@lit(IS) ".

                                                                             CONIIII.NATIONS Ol,' Itf-@OIONAf, MI@;[)ICAI, IlitO(iltAill AGI@NCIEs

                                                                                         i)03(iL)   ;iii(I   s(,(-tioii   ',)Ot(:t)    of    @tli(@    lliil)lie    Ileiltli    Sei,vic(.
                                                        Act   (4'-)   U.S.C.   21)9e,   21)9d)   are   (@ii(:Ii   itiii(@it(le(i    liy    iiis(,rliiig    after    "otlit@r    I)tililie
                                                        or      nonprofit      private      agencies      and      institutions"      the      following:      ",      and      coml)ina-
                                                        tions thereof,".
                                                                                                  AI)VISORY COUNCIT, AIENIBERS

                                                            @i,@,c.    105.    (a)    Section    00,-P(a)     of     the     l'iil)lic     Health     Service     Act     (42     I;.S.C.
                                                        '-199c)     is     aii)eii(letl     by     striking     out     "twcli-(@"     and      inserting      iii      lieu      thereof
                                                        "sixteen".
                                                            (1))   Section  ',)05(l))   of  such  Act  is                                  by    @,tril@ilig     out     "-,Ilid     four
                                                        it    the    end    of    the    third    year"    iiii(I    iiisertiiig    iii    lieu    thereof    "four    at     the     end
                                                        of the third year, and four at the cii(I of the fourth year".

                                                                                                     '.k[ULTIPIIOG]tAll SI,:RVLCES

                                                            Si,-c.    10C).    'I'itle    IX    of    the     lltil)]!(!     Ile@iltli     Service     Act     is     further     amended
                                                        1).)' ,)(](Iitig it the (@iiil tit(@reof tile following ii(@w section

                                                                                                   (i]tAN'I'H ],'Olt                          SE[TVICIIH

                                                                      )IO.  Fiiii(is                            iiii@lt-v  this  fill(,  sliiill  also  1)(@                          for
                                                        gi-iiiils   i(o   @iiiy   I)iil)li(-   oi,   tioiil)r4ifill   iii-iN,itlt@   iigi,ii(-y    oi-    institution    fo)r    services
                                                                    by (it- -%Vjii(-Ii Nvill I)(- (Of siil)stiiiil iiil          to, itiiy two or iiior(@ i,(@giotiiil

                                                                                        (if,Altll,'YINO Olt 'I'l@OIINI(IAL AA(ENDTIFNI'S

                                                                   107.   (it)   Sef,t.ioii   1)01((-)   of   t.li(@   lliil)li(@   Ilealtli   Service    Act    14    iiiiieiideil    by
                                                        iiis(@i'tiiig before  tli(@  IK!i-iotl  lit, the (@ii(I thereof "or,                            iil)l@rol)riitte,   it   I)rit(--
                                                        ti("Illg (rental".
                                                            (1))               1)01 of sti(-Il            is    further    @iiiieii(le(I    by    adding    lit    tile    end    thereof
                                                        tile following new                             :                                                                                                   I
                                                            "(d)     Grants     under     this     title     to     tijy     a,-eii(-y     or     institution     for     a      regional
                                                        inedical    pro,-miii    may    be    used    by    it    to    assist     iii     m@tiiig     the     cost     of     participa-
                                                        tion in such prograni by any li'ederal hospital."









                                                                                   nil l@-@






                                            l@.)-Ros. I understand our            witness  this  morning   will   ]X.,   Dr.
                                          Pliilil) IZ. I", Assistttiit SC(@,ret@itryfor lle,,tit,li :111(l Scielitifi(-, AfTttii-s
                                                            of lleiiltli,              :111(l Welfare. Dr.
                                          STATEMENT OF DR. PHILIP R. LEE, ASSISTANT SECRETARY                            FOR
                                          HEALTH      AND      SCIENTIFIC      AFFAIRS,      DEPARTMENT      OF      HEALTH,
                                          EDUCATION,    AND    WE,    LFARE;    ACCOMPANIED    BY    RALPH     x.     HUITT,
                                          ASSISTANT    SECRETARY     FOR     LEGISLATION;     DR.     RAI;PH     Q.     MAR-
                                          STON, DIRECTOIL, DIVISION OF RL- GIONAL MEDICAL PROGRAMS
                                          DR.     STANLEY     F.     YOLLES,     DIRECTOR,     NATIONAL     INSTITUTE     OF
                                          MENTAL      HEALTH;      AND      HELEN       JOHNSTON,       CHIEF,       MIGRANT
                                          HEALTH BRANCH, BUREAU OF HEALTH SERVICES
                                          Dr.      Tliaii]@ you, Mr. Cliiii-iiiiiii.
                                          Mr. Rociits (presidiii-). I iyii,,-Iit say tll:lt, tllC' COIIIDlitteC  is  pleased
                                          to have -you with iis,,tiid I)articitlarlv siiic-P, your  new  duties  litve  been
                                          stated b- the Secret-,try  to'be  coordii@,  tor  fo@  health,  and  "Mr.  Health"
                                              y
                                          for the Goveriiinent.
                                          We  are  delighted  to  have  you  with   us   in   this   capacity   today,   and
                                          we  are  pleased  to  have  your  associates.  We  will  be  glad  to  hear   your
                                          statement.
                                          Dr. lrE.  Tli-,iiik you, sir.
                                          Accoinl)anying  iiie  are  Miss   Johnston,   Dr.   Marston,   and   Dr.   Yolles.
                                          Nfr. Ralph Huitt is with us this morning -,ilso.
                                          Mr. Ro(.i.,its. IVe are glad to see Mr. I-Iiiitt, here.
                                          Dr.       Mr. Cliaii-miii -,iiid iiiciiil)ers of the      SUI)COlilillittee    oil
                                          I-lealtli,,tiid Welfare it (,Tives  i-ne  greit  pleasure  to  appear  before  you
                                          today in siii)i)ort, of the I-Ieitltli Services  Act  of  1968,  which  colitiiiis
                                          .ill exteligi(;ii tiid iiiil)roveiileiit,,,  to  the  ITeii.,t,  Ciiieer,  and  Strolce
                                          Aiiieii(iiii(@iits of 1965,;tii extension of tli(@ Migi-itiit",Ilealtli Act of 1962,
                                          :Is itill(@11(te(I ill 1965 the ti-;iiigfel- of ;authorities now in sect@ioii 402 of
                                          the Ntrcotic Addict   Reliibilitatioii   Act   'of   19C)O   to   the    Community
                                                Ife@ilt-li (eiiters Act, and the e,.,itiblislii-neiit of ;i,  I)rograiii  to
                                          :assist,  communities  to  iml)rove  treiti-neiit  services  to  tlcollolics,  the
                                          I.,tt t er t wo I)rogriii-ns to be known @,is the Alcoholic  and  Narcotic  Addict
                                          P,,(@li;il)ilit,itioii Aii-ieiidineiits of 1968.
                                          These  I)roirr,,ti-ns  arc,,tll  designed  to  cti-i-y  foi-wtrd  our  commitment,
                                          to  make  tli@best  health  services  iv,-tiltble  to  ill   Americans.   In   his
                                          sl)e(-iit]  message  to  Congress  oil  health   in   1965,   President   Tohiison
                                          stated:
                                          Our firFt concern must be to assure that the advance of medical  knowledge
                                          leaves none behind. We can-and must-strive now to assure the  availability
                                          and accessibility of the best health care for all Americans, regardless of age or
                                          geography or economic status.
                                          @kltliougli  much  has   been   accomplished   in   the   last   3   years,   much
                                          remains  to  be  done.  We  must   rei-nove   the   barriers   of   discrimination
                                          that  ]live  so  long  barred  the  alcoholic  and  the   narcotic   addict   from
                                          receiving trtil
                                                       -Y   comprehensive   care-a    discrimination    based    on    diag-
                                          iiosis, which i@ just ii,3 intolerable as discrimination based on race.
                                          rlle   migrant   worker   suffers   from   not   only   t-he   disadvantazes    of
                                          Iftiiguage,  poverty,  and  geography,  but  of  teii  the  even   mom   Ciffieult



                                                                                                                                   @7






                                                                                                    10

                                                            of i(rnoriii(,,e, iiii(i
                                                                                                                                     of ii.io(lerii  iiiedi-
                                               Tlio, i-oiiioN-:il  of ;t                       :kill(]  of                          time, lig
                                            dis(-oN-ei-y iiicl                                         of    iie%v    kno%vle,(I,-(,@is    a     goal     f     the
                                                                                                                                                        0
                                            re(,@ioii:ll    iiit@(lie:ll    I)I.Ogrll-ll,.    ill    iliS    lietltli    ItleSS,,I(re    this    yetr,    Pr@ideiit
                                            Toliiisoii     stated
                                               Its  I)tirpose  iq  to   t@rnii@l@ite   resc-,,,ircit   into   action,   ,;o   fliat   all   of   tli(',   1)(,ol)le
                                            (ye car nation (.:Ill 1)4.lleflt Is rilpi(Ily as Ix)ssil)le froin the               tclii(--veii)ent    of     ino(lern
                                               Title. I of lf.IZ.              r)8     extends     tlie,      i-e,,Ioiial      iiie(lictl      program      through
                                            fis(,:Il  ye@ii-              Ill(l    (@,Iirities    ,Ill([    iiiil)roves    cci-t.,,,tiii    Lipe(-ts     of     the
                                                   )II WI                  fl'ol)l yolit- (!ollsi(lel.:ttioll of tl)is le,@isltt.ioll ill til
                                            Stiililiiei- of  I')05              it,          introduced              t             of     ili(@     findings     of
                                                                       ('oiiiiiiissioji  oil                                                    t,iid     Sfr-olce.
                                                                                                                                   (@reftte(l    the,    I)ot@4oli-
                                            t@i:i,l to             tilo lie,@tvy I-olis of                   (lise@ises    but,     that,     this     pof(@,iitiil
                                                  ]lot 1)(kill" I.(@:Lljz("(l l'ol. )Italy of our
                                                                                             I  '('oiiiiiicroo ("oiiiiiiit             I)ILyiod     :t     )iitj'or
                                                    in    (,Clarifying    I)ot,it    t,li(@    ii,,tt.iirt@    of    tli(@    I)ro,-riiii    all([    the    direc-
                                               ,riie. b:isi(.,                   of   tIlis I)rogrtill        is   to   t,,-,ur(,   that,    t-lic    people,    of
                                            tllis 'i\'.Itioll,                            iiiity   1-@,   evil]   1)(@iietit   fi,oiii   the,    .t(lv.,tnees    of
                                            iiie(lie"tl  science                     tile  threats  of          lieti-t.       disei@       ctiicer        strol.:e
                                                   relatp,(l  diseases.
                                               .iks,,tit    id(litioii-,tl    dividend,    this    I)ro,,,,riiiii    %vill    li(Lveiii    iiii     act     extend-
                                                                                                                                                p
                                            Ing    far    beyond     the     control     of     sl)eciiic     diseases.     'I'lic     physicians     and     other
                                            health      -,vori@e-i-s      involved      in      the      regional       medical       programs       ivill       be
                                            tpplyilig     their      iic-%v,      l@iio-,vledge      iiid      new      techniques      to      patients      being
                                            treated      harder       the       inedic,,ti(l,       iiiedicire,       and       otlier       Health       progrtms.
                                            Tile, lessoiis                   ill     the     regional     ii-iedical     progrtiris     ciiiiiot      help      but
                                            el
                                               illAlleo     tile     quality     and     efficiency     of     these     Other      -Le-tivities.
                                               Tile                     t]rG@adv
                                                                                     ina(le    ]its    just,it    ed     our     (@xl-)ect.atioii     that     this
                                                            NVOIII(L  Si(,'Ilifvlc.@llitly                     I-,Iio
                                            of                (.,Il.o  fol.  illost@,   Nvll()           ft-olli.    tile     ]major            diseases.
                                                                                           I)I-iligiiig                     (livel.,;(t    4'rolll)s    ill     the
                                                                                                                                      iii:i.iiiiei-  t,iiitt,   re-
                                                          :I.                         of  (11(@  lififili(,(l                            or iii(@
                                                                                                                                                tire      I)reseiit
                                                           of iti:iiil)olv(@l-, Ill(',
                                            tlii.oll"llolil, tile                                  I)ei,soiis                  lo    airline,     firiii     career
                                                                   to                             goals of (II('

                                                                                      lolillit:it-y,  llt,'Illo  ilitt,iollill  @ti)(I  I-(@4,'ioll:Ll   l(@,V(@ls.
                                                                                                                                   v
                                                             11(@l 1)(!(t ox                                               I       N  Ili   @@li   have   (@xiste(I

                                                                       liiis          :1  J)osit@i@'(@   I'(@SI)o]IS(@,   to   tllis                       1111111-
                                            (I:Lto ill 11)(@ ol.i",illll                       That, tllls 1)1,0(rl,,Ilil Woll](I 1)(@
                                                                                                                                                (!Olllllillllit@y
                                                          li@it tile                           -for  i)],Iiiiiijio-  tii(I  oiLr-,tiiiziii,r  tile   opera-
                                            t,ioii    of    tile,    I)ro(,riiii    would    clear    to    tli(@    region,    iiot     to     tile     Ft@de-riii
                                               As      evidence      of      this      response      tlii-iost      1,000      inedical      institutions       are
                                            participating      ill       the       regional       medical       pro'grtiiis,       including       every       med-






                                                icil ,cliool ',tlid hundreds of ]Hospitals. This involvement-, of  ilic(lic@t]
                                                S(.]Iool.,; @ll)(I ot'lle,,I.             ikii(I                institutions         helps         (lovelol)
                                                clo"o    @ill(I    continuous    eollt,.tct,    twtweeii    itic@(licil    advances    tnd    their     tl)-
                                                pli(,at   ioii   iii    the    community.
                                                   Almost    900    health     or(-,,aiiizttiotis     tre     1).til,icit),Iting,     iiiellidilig@y     r@,
                                                St;tt-,o iiic@(lie'll society,              licil-t,li    (Iel)iti-titiciit,    Sttte    lictrt     associt-
                                                tioii,,,tiid State, cancer sooie)i,y.
                                                   Over      7,000      iioii-Fedei-,t]-coiiiieotp(l      individuals      ,tr(@      iio8v       .tet@ively
                                                engaged    iii    t@lie    progi-:iiiis,    including     1,800     eiyil)loye(I     either     full-     or
                                                part-time     b@     the     regional     pyo-rams,     over      1,90@)      illei-nber.-,      of      the
                                                re-ioii.il    advisor    -roilps    required    by    the    law     who     must     advise     oil     the
                                                                       y
                                                de'velopiiiei-it     of     the     progrtnis     and     Ll)l)rove     tll      o@ritioiitl      tctivities
                                                before     'they     call     be     funded,     and     memi)ers      of      various      subcoi-nmittees,
                                                task.    forcei,    .iiicl    local    -,irtioii    -roups,    who    ,tre    contributing    their    time.
                                                   This   represents   all    involvement,    not    only    of    the    experts    ill    the    re,,,,ion
                                                but   tlso   tlic   lieailtli   personnel   tt   the    grassroots    ]ever,    ,tnd    this    is    illus-
                                                tr.ited iii I-,,tble I (I-). 33) -,which is submitted with the testimony.
                                                   These     people,     institutions,     ',tlld     organizations     -are     the      forces      which,
                                                Nvitli    yoiii-    ,iil)poi,t,     evil]     carry     to     fulfillment     the     high     expectations
                                                for till-,
                                                   The             of the I)i-o,rriiii is                     the i-e(,rioiifti (-rroiips to
                                                                                    t,                     9
                                                thoroughly    t@lto    lick@(IS     Ill(l                      within their
                                                         ivilt 'the             tliltt,       1)(@
                                                I.,]lo    (Illinois    k)l(i                 ol, i,ll(. lli:tjol.
                                                   eso 111-01)1(@iiis oil  IL ].V(riotilli              (]lo -rrolli),4 iti-o 111)
                                                the most,                  list) (  f                   i-esoiil-t-@ fol.
                                                from    t Ii(@ I@t I-, ri@ I I I
                                                                   ?I   (Is   , ( I i (! I I       0 t,li(@ also] IV( e(I         I
                                                          i-egioll@ llllN,o foill)(1. that many                         t'vi)(@.-,, ol II    ivities     Call
                                                (,@oiit.riliiiite lo ol)ie(-t,iye,-, sii(.-,It as (I(@lyloii,,(i-,tt@ioiis @)i advanced (11,,I,(r
                                                ti(-,                          technique-,,   t,i-:tiiiiiig,,tii(I    coiitiiiiiiii,,-    edu(-,ttioii    of
                                                                                         telit     of     communication     -.tiid      I);tticiit      date
                                                lict,wol@l@s,   ,il)pli(@ttioii    or    coiiil)tit(@r    tii(I    other    modern     t(@e-liliology     Io
                                                health    care,    -.laid    research    into     better     means     for     orgaiiiziiigtild     deliver-
                                                iiig improvements iii Health care.
                                                   The   first,   plateauing    grLiit    was    -,-Lwtrded    less    than    2    years    ,-tgo.    Today
                                                there    ,ire    53    troaioiis    which    litve     received     planning     graiits     and     include
                                                                                                              co,    ,tild    ,tn     -application.     from
                                                the entire pol)i-il,,ttioii, exceil-)t Puerto Iti
                                                tli,,tt,Coiiiiiioll-N..ettItll is now being reviewed.
                                                   Eleven    region-,     ]live     received     griiits     to     siLi-I)y)ort     initial     operational
                                                                       1,;   other   j-(@,gioiLs   litve    stibniitti;(l    iT)plic.,ttioiis    to    begin
                                                t@llo                    1)11,tse   of   I.)]I(,4ir   I)ro(-rrtins.   To   finance    tliinw,    itctiviiies
                                                t,liel.(l li;tsl)(Til  :1@                       III  the  4jl)li-,Y-Ittioii  of  funds,  tti(I   'this   is
                                                   Tli(@  iiivo]N,(,iiieiit@  iii   t@lio                            1)1'oL'I-.Illls I)V lo(',-,II ill,",ti-
                                                                   iii(livi(itillis ll;is                                @Villilili   t)i(t    next.    year
                                                it]]  (@f'  (lio                             lo                                               (@f      their
                                                I)I.ogl..I,lll. 'J.'Il(@y iti-t@        to (-,olit,ilitlo t'lie wol-Ic t.11(@y ]leave 1)(trtll
                                                                       to  extending  t,ii(@  -I)ll,si(..  authorities  of-t,lie   i-egi(   l@l   tll;lle(l-
                                                                       i.ii(i ))ill I)(.,fol,.o You (countries IL]IICII(11)1(!Ivts to                  itil-
                                                                                                                                                     ilioi-C
                                                eirwtively. It                      it    provision    t)liat    Nvoiti(i     assure     proper     ovaliia-
                                                treat    of    the    accomplishments    of     the     piv(,rritm     by     provicfiiig-that     up     to


                                                        lo@53 0-08-2






                                                                               12

                                   1 percent-, of tlie, apl)ropriitioii for a)iy              year    beginning    with    1970
                                   I'll,  1)(@       b                  try for t.lio
                                        Ilyll(@ bill iyi,,tlies cleir that regioii,-tl iiiedic,-ti (rrtiit,,i etn be ulvtr(led
                                   to t  coiiibiliat-.ioii  of  regioiiti  @'edic,,tl  I)ro,,Yralli  agencies  for  carrying
                                   on ,t
                                        Also, It IIONI                  added wliioli would        Ivi-iiiit the aavardi
                                                                                                                             "Ig
                                   of  gFIllts  to  I                            iionprofit,.-Lgefiey   or   institution   for
                                   sorn,ices  -%iliicl                             value  and  use   to   any   tNvo   or   more
                                   regional    medical programs. Such             services     mi,-Iit     include     producing
                                   education    materials,    developing     evalu,-ttioii     techniques,     creating     uni-
                                   form   d,,tt,,t-gatlieriiig   systems,   ,tnd   ot-lier   types    of    activities    @vhich
                                   CLllllot  Ilw-,iys  be  developed  most   efficiently   4;ii   the   basis   of   the   needs
                                   of I siii(,Yl@rc@on.
                                        The  @ict  is  -Liso   amended   to   %iitliorize   the   use   of   reaioiial   medical
                                   @l)orso@l@'I'll, @riiit   fluids   to   I)Crjllit   the   full   1)articiptti-Oli   of    Federal
                                          I t   in I g       il medi               tiiis    ,is    the    important    community
                                                      Lioii,          C, I progr,
                                   r@tire@ -Nvllicii they in fact,.Lrc@.
                                                   tnieiidiliciit  clarifies  that  t  1)r,.tcticiiiix  dentist  as  -%voll   as
                                          YSICIIIII ilillt'V refer -L I)atieiit to t flt                      out      research,
                                                                                                                 by        oiial
                                               or (lei@ioiistratioil @ivities wlii,                                  all
                                              program funds. Dentists e-tii I)Iq                                   0  in-   such
                                   trelis is the early identifip,.,ttioii of or,,tl                          ic     ainendm(@,nt
                                                                                                               ioli   does   not
                                   corrects tii unforeseen Iii-nit,.tti.oii in tli(@      or g iia  i;ct
                                   I)crii-iit such referrals.
                                        Ali            in t.lio  A(Iviioi-
                                                                            y Couli(,il   iiieiiiI.)ei-sliij), from    12     mein-
                                          to '16, is provided ill the bill, Lli expulsion iylitde ii                   tr     by
                                                                                                                         y
                                   the  ii-Lei-ea-siiia   -%vorltlo,,td   of   the   Council   in   reviewingtpplicati   s   and
                                                     l@y   of   having   members   Nvlio   reflect   t   broad   diversity    of
                                                                                                                     on
                                   t@ii.o    desir@il'
                                   interests.
                                        The   bill   -,tlso   extends   the   provisions    of    the    programs    to    Gutm,
                                   American  Sai-not,   tnd   t   io   Trust   Territory   of   the   P-.icific   Islands.   The
                                   H,.twaii  reLioii,,tl  @edict  prograi-n  has  iii(lictted  t,litt   it   would   be   inter-
                                   estp,(l in in'@luding these areas in it-, I)roaraiii.
                                        These provisions wil  strengthen rcaioii,,t]             itiedictl   i)rogr,%i-ns    and
                                   will  provide  the  flexibility  their,  will  t@(i  in  ilia.Icilig  the-   mast   efficient
                                   Use of Ill the health elements of the community ill the prolrrain.
                                        The   committee   has   received   copies   of   the   S@rgeoii    C;eiieWal's    report
                                   Oil  1  egiontl  medical  1)rozr,),iiis,   which   (lescril)cw   in   detail   the   ii@itial
                                                               c                 -or   the   record    material    which    adds
                                                I would Iiii' t6siibinit f
                                   pro
                                   to                 and  which  will  I)riiiL,  voii   up   to   date   on   the   accomplish-
                                   intents of the regional inedict
                                                                          I pro@@a
                                        may I sul)mi@ that for tli(,3                      Chairman?
                                                                           rcc()rcll
                                        Mr. Ro(ii.,,its. Without objection, it            be received.
                                        (The document referred to follows:)












                                                                                        @!7@!7





                                                                          13


                                            PRN"GRESS REPORT




















                                                                  U.S. I)EIIARTMENT OF
                                                          IJEALTH, EI)UCA'riON, AN[) WELFARE
                                                                   Public Health Service

                       %





                                                                               14




























                                                                                                      30












                                               53    >Regional Medical Programs have been awarded
                                                       planning grants*...
                      4                                      to develop operational proposals through . . .
                                                                   survey,; of needs and resources
                                                                   feasibility studies
                                                                   organization and staffing



                                                       Regional Medical Program is currently under
                                                       development









                                                                                                                       77





                                                                                        15


































                                                 47

                                                                                                                  Q42





                                                                           Re i4)iiil Nit@(lictil  Pro,,rani@9  have  received  opera-
                                                                             ti,nalgratits*
                                                                               0  to improve patient  care  through  research,  ct)ll-
                                                                                      iii,,, education, training,   a@d    demonstration
                                                                                  projects
                                                                               *  to (ICVCIOI) better metlio(I.-i for the exchange  of
                                                                                  information   kmo   "   medical   schools,   medical
                                                                                                    n,
                           41
                                                                                  centers, community    hospitals,   practicing   phy-
                                                                                  sicians,  and  other  health  institutions,  organi-
                                                                                  z,itions, and personnel
                                                                               o   to   continue   to   develop   new   and   expanded
                                                                                  plans  for  further  improvement  of  patient   care

                                                                                  *As of February 29, 1968






                                                                                                    16


                                                       REGIONS AND PROGICAM COOIIDINATORS
                                                                                     Olt  Dlltl,,CTORS


                                            I   AI,AIIAR*IA                     10          FI,OLIIDA               19                    LOUISIANA
                                                   Wells, AT.D.                 S.   P.    Mitriin,    M.D.         J.   A.    Sailo2itier,    M.D.
                                                                                Provost,  J.  flillis               Claiborne      Towers      Roof
                                            U. of Ala. Med. Ctr.
                                            1919 7tit Ave. S.                   Miller   Med.    Ctr.               119    S.    Clail)ornc    Ave.
                                                                                                                    New    Orleans,    La.    70112
                                            Birmingham, Ala. 35233              U.  of  Florida
                                                                                Gainesville,   Fla.   32601
                                            2   ALBANY, N.Y.                                                        20   MAINE
                                                                                11            GEORGIA
                                            F. M. Woolsey, Jr., M.D.                                                M.      Cliatterjec,       M.D.
                                            Assoc. Dean                         J.   G.    Ilarrow,    M.D.         295 Water St.
                                            Albany ille(l. Coll.                M(!d.   Assoc.    of    Ga.         Augusta,       Me.        04332
                                            47 New Scotland Ave.                938 1'e@iciltree  St.  N.E.
                                                                                Atlanta,     Ga.      30309         21                    MARYI,AND
                                            Albany, N.Y. 12208
                                                                                                                    W.   S.   Spicer,   Jr.,   M.D.
                                                                                12          GIIEATEII               550        N.         Bro4idway
                                            3   AIIIZONA                                      I)],'I,AWAIIE         13@,illimore,     Md.     21205
                                            4M. K. I)uViii, id.D.                             VAI.LEY
                                            Dean, Coll. of Med.                 W.  C.   Spring,   Jr.,   M.D.      22                    MEMI'llIS
                                            [J. of Arizona                      Wynnewood             house                                 MEDICAL
                                            Tucson, Ariz. 85721                 300   E.   Lancaster   Ave.
                                                                                Wynnewood,    Pa.     19096         J.   W.    Culi)ertqon,    M.D.
                                            4   ARKANSAS                                                            Coll. of Mcd.
                                            W. K. Stiorcy, M.D.                 13             HAWAII               IJ. of Tennessee
                                            Dean, Sch. of Med.                  W.    C    Cutting,    M.D.         858         Madison         Ave
                                            U. of Arkansas                      Dean,    Sch.    of    Med.         Mcmpliis,      Tenn.      iBI03
                                            4301 W. Markham St.                 U.  of   Hawaii
                                            Little Rock, Ark. 72201             2538     The     Mall               23                 METROPOLITAN
                                                                                Honolulu.     Ha.     96822               WASHINGTON, D.C.
                                            5   BI-STA,RE                                                           T.    W.    Mattingly,     M.D.
                                            W. II. Danforth, M.D..              14           ILLINOIS               D.C.      Medical       Society
                                            V. Chan. for Mcd. Affairs           Wright     AtiamFi,      M. D.      2007     Eye      St.      N.W.
                                            Washington U.                       112   S.   Michigan    Ave.         Washington,     D.C.      20006
                                            660 S. Euclid Ave.                  Chicago,     111.     60603
                                            St. Louis, Mo. 63110                                                    24                     MICHIGAN
                                                                                15            INDIANA
                                                                                                                    A.    r!,.    Ileustis,    M.D.
                                            6   CALIFORNIA                      G.    T.    lukemcycr,    M.D.      1111       Michigan        Ave.
                                            Patti D. Word                       Assoc.     Dean                     East   Lansing,   Mich.   48823
                                            655 Siittcr St. #302                Indiana U. Sch. of Med.
                                            San Francisco, Calif. 94102         1 100  W.  Micilig4in,  St.         25                 MISSISSII'PT
                                                                                Indianapolis, lii4i.4,6207
                                                                                                                                                  M.D
                                            7   ('I,'N'I'IIAI,                                                                                    ct'.
                                                NIIIW YOI(K                     16   IN'I'I-'ItMOIJNTAIN
                                                                                   II.    (',agile,    M.D.         251)0     N.     State      Ct.
                                            It. II. Lynn%, M.D.                                                     Jackson,      Miss.       39216
                                            state U. of N.Y.                    Assoc.     Dean
                                                                                U. of Utah
                                            750 E. Adams St.                                                        26                     MISSOURI
                                                                                Salt    Lake    City, Ut.  84112
                                            Syracuse, N.Y. 13210                                                    V.     E.     Wi]Aoii,     M.D.
                                            8   COT,OLIADO-                     17         IOWA                     Executive             I)irtTtor
                                                WYOMING                         W. A. Krelil, M.D., Ph.D.              for     ll(!alth     Affairs
                                                                                308   Melrose    Ave.               U. of Alissouri
                                            P. R. Hildebrand, M.D.
                                                                                U. of Iowa                          Columbia,       Mo.       65201
                                            U. of Col. M(@ti. Ctr.              Iowa   City,   la.    52240
                                            4200 E. 9tlt Ave.                                                       27  MOUNTAIN STATES
                                            Denver, Col. 80220                  18             KANSAS               K.    P.     Bunnell,     Ed.D.
                                                                                C.    E.    Lewis,     M.D.         Assoc. Director
                                            9   CONNECTICUT                     Chairman                            Western              Interstate
                                            11. T. Clark, Jr., M.D.             I)epL   of   Preventive   Med.         Comm.   for    Higher    Ed.
                                            272 George St.                      U.  of   Kansas                     Univ.         E.         Campus
                                            New Haven, Conn. 06510              Kansas   City,   Kan.    66103      Boulder,       Col.       80302





                                                                                                                        17


                                                                                                           37                NOItTlIWESTrRN        46               TENNESSEE
                                                                     28                Nl.'IlIIASKA-           01110                                              MID-SOUI'll
                                                                       S6UTII                 DAKOTA
                                                                                                           C. It. Tittle, Jr.  M.D.                S.    W.    Olson,    M.D.
                                                                     11.        Morgan,         M.D.
                                                                     1408 Sh   lildg.                      Medical College f Ohio                  110 llakcr Bldg.
                                                                                                                                                   110 21,t Ave. S.
                                                                           Neb.                68508       at Toledo
                                                                          3r
                                                                     Lincoln,                                                                      Nashville,   Tenn.   37203
                                                                     29        NI",W        JEltSI,Y       38   OHIO STATE
                                                                                                           It. I- Mcilitig, M.D.                   47   TEXAS
                                                                     A.   A.    Fl(.riii,    llq.l).                                                                                                                                  ;
                                                                     N. J. State I)t!Pt.  of  filth.       Dean, Coil. of Med.                     S.   C.   'I'lloiitpson,    M.D.
                                                                                                           Ollif) St@ll(: U.                       Suite 724
                                                                           St.
                                                                     E.    Orange,    N.J.     07018       410 W. joth Ave                         Sealy-Smitit   Prof.    Bldg.
                                                                                                           Colombo." Ollio 4@i2lO                  Galvcston,fex.       77550
                                                                     30          NEW          MEXICO
                                                                                                           39   01110 VAIIL,,Y                     48              Till-STATE
                                                                     Rcgiiisll,i     Fitz,      M.D.
                                                                     Dean,    Scii.     of     Nied.       W. 11. Melletkill,,M.D.                 N.      Stearns,      M.D'
                                                                     U.      of      New      Mexico       1718 Alexandria I)r.                    22 The Yepiway
                                                                     Albuquerque,     N.M.     87106       Lexington, Ky. 40504                    Boston,    Mass.     02115
                                                                                                                                                   49               VIIIGINIA
                                                                     31           NIW           YORK       40   OKI,AIIOMA
                                                                        AIETII.                AIIEA       K. M. Wcmt, M.D.                        E.    R.    Perez.    M.D.
                                                                     V.    del'.    [,Arkin,    M.D.       IJ. of Ok. Med. Ctr.                    Iliclimond   Acad.    of    Med.
                                                                     N.Y.    Academy     of     Med.       800 N.E. 13tli St                       1200 E. Clay St.
                                                                     2 E. 103d St.                         Oklahoma   City,    bk.    73104        Richmond,    Va.     23219
                                                                     New    York,     N.Y.     10029
                                                                                                           41   OIIEGON
                                                                                                                                                   50                WASHINGTON-
                                                                     32   NORTH CAROLINA                   M. R. Grovcr, M.D.                           ALASKA
                                                                     M.     J.     Musser,      M.D.       Director, Cont. Med. Ed.                D.     R.     Sparkman,     M.D.
                                                                     Teer Ilouse                           Sch. of Med.                            Sch. of Med.
                                                                     4019     N.     Roxboro     Rd.       U. of Oregon                            U.      of      Washington
                                                                     Durham,     N.     C.     27704       3181 S.W. Sam Jackson                   Seattle,    Wash.    98105
                                                                                                           Portland, Ore. 97201
                                                                     33         NORTH         DAKOTA
                                                                     T.     H.     Harwood,     M.D.       42   PUEIITO ]tico                      @l         WEST         VIRGINIA
                                                                     Dean,     Sch.     of      Mcd.       A. Nigaglioii, M.D.                     u.   L   Wilbar,    Jr.,    M.D.
                                                                     U.     of     Nortli     Dakota       Chancellor, S II- Of Med.               W.  Va.   Univ.   Med.   Ctr.
                                                                     Grand   Forks,    N.D.    58202                       c                       Morgantown, W. Va. 26506
                                                                                                           U. of Puerto Rico
                                                                                                           San Juan, P.R. 00905
                                                                     34                 NORTHEASTERN                                               52                 WESTERN
                                                                         01110                             43   IIOCIII-"S'F]-'.11, N.Y.                 NEW            YOIIK
                                                                     F.    C.    llobl)ins,     M.D.                                               @.  it.   F.   Ingall,   M.D.
                                                                                                           It.  C.   ilarker,   Jr.,   M.D.
                                                                     Dean,     Scii.     of     Med.       Sch. of M,-(J. and Dcnt.                Z)Cil, of MC(l.
                                                                     Western       Reserve        U.       U. of Rocll(!Stcr                       State U. of N.Y. at Buffalo
                                                                     2107        Adelbert        Rd.
                                                                     Cleveland,      Ohio      44106       Rochester,     N. Y. 14620              Buffalo,    N.Y.     14214
                                                                                                           44   SOIJTII CAROLINA                   53                 WESTERN
                                                                     35                   NOIITIIERN                                                                   I%NNSYIVANIA
                                                                                                           C. 11. Stiiiinterall, III, MD
                                                                           NEW              I-NGLAND       I)ept. of                               F.    S.    Cliecver,    M.D.
                                                                     J.    E.     Wennherg,     M.D.       fqcd. C4,11. hospital                   Dean,   Sch.    of    Mcd.
                                                                     U.  of  Vt.   Coll.   of   Med.       55 Douglity St.                         U.      of      Pittsburgh
                                                                                                                                                   3530      Forbes      Ave.
                                                                     25       Colchester        Ave.       Charleston, S.C    . 29403
                                                                     Burlington,      Vt.      05401                                               Pittsburgh,    I'a.     15213
                                                                                                           45                SUSQUI--,HANNA
                                                                                                                                                   54               WISCONSIN
                                                                                                                  VALLEY
                                                                     36                  NOWrIlLANDS
                                                                     -,M.       Stickney,       M.D.       R. B. McKenzie                          J. S. Ilirsclil)occk, M.D.
                                                                     Minn.   State    Med.    Assoc.       3608 Market St.                         Wisconsin      RMP,      Inc.
                                                                     200      Ist      St.      S.W.       P.O.   Box    451                       110   E.    Wisconsin    Ave.
                                                                     Rochester,     Minn.      55901       ckmp Hill, Pa.'17011                    Milwaukee,      Wise.      53202

                                                                                                                                                   *Associate Coordinator







                                                     other factors which occurred in 1964 and 1965.
                                                     One of these factors was the creation of a          national        biomedical
                                                                                                                lied       anywhere
                                                     research effort unprecedented in history ;ltl(l une(iiia
                                                                                              tivity was  and   continues   to   be
                                                     else in the world. The effect of this ac
                                                     intensified  by  the  swiftness  of  its  creation  an(]  expansion:  at   the
                                                     ])Cl,iTiiiiiig of World War 11 the national cxi)(-ii(litijrc for  medical  re.
                                                         It totaleti $45 inillioFi; by 19,1.7 it was  Si@7  million;  and  in  1967
                                                     scai,(@
                                                     tile  total  was  $2.257  I)illion-a  5,000  percent  increase  in  27  years.
                                                     The most significant characteristic  of  this  research  effort  is  the  tre-
                                                     meti(loki.,; rate at which it  is  producing  new  knowledge  in  the  medical
                                                              tti oijtl)oiiriii,,, wlii(@,li only recently began  and  which  shows
                                                     no signs of ](@(,Iine.  As a result,           in  health  care  have   I)ct-n
                                                     dramatic. l'i)(lay, tia(tre  are  (!tires  wli(-,re  none  existed  before,  a
                                                     number of discast@s  li:tvc  all  but  disappeared  with  the  application  of
                                                     new  vaccines,  and  patient  care  generally  is  far  more  effective   than
                                                     even  a  decade  ago.  It  has  become  apparent  in  the  last   few   years,
                                                     however,   (despite   substantial   achievements),   that   new   and   better
                                                     means  must  also  be  found  to  convey   the   ever-increasing   volume   of
                                                     research  results  to  the  practicing   physician   and   to   meet   growing
                                                     complexities  in  medical  and  hospital   care,   including   specialization,
                                                     increasingly  intricate  and  expensive  types   of   diagnosis   and   treat-
                                                     ment, and the distribution of scarce manpower, facilit
                                                                                                                 ics,   and   other
                                                     resources.  The  degree  of  urgency  attached  to  the  need  to  cope   with
                                                     these  issues  is  heightened  by  an  increasing  public  demand   that   the
                                                     latest  and  best  health  care  be   made   available   to   everyone.   This
                                                     public  demand,  in  turn,  is   largely   an   expression   of   expectations
                                                     aroused  by   awareness   of   the   results   and   promise   of   biomedical
                                                     research.
                                                                                        mitment   to    biomedical    investigation
                                                       In a sense, the national corn                                      0                                           I  I  :
                                                     is  one  manifestation  of  the  third  factor  which   contributed   to   the
                                                     creation   of   ilegional   Medical   Programs:   the   changing   needs    of
                                                     society-in  this  case,  health  needs.  The  decisions  by  various   private
                                                         public  institutions  to  support  biomedical  research   were   responses
                                                     and
                                                     to this societal need perceived  and  iiiterl)rete(I  by  these  institutions.
                                                     In addition  to  the  support  of  research,  the  same  interpretive  process
                                                     led  the  Federal  Government  to  develop  a  broad  range  of   other   pro.
                                                     grams  to  improve  the  quality  and  availability  of  health  care  in  the
                                                     Nation.  The  Iiiii-Burtoii  Program  which  began   with   the   passage   of
                                                     the  previously  mentioned]  Hospital   Survey   and   Construction   Act   of
                                                     1940,  together  with  the  National  Mciital  Health  Act  of  IW,  was   the
                                                     first  in  a  series  of  post-World  War  II   legislative   actions   havin-
                                                     major  impact  on  health  affairs.   When   the   89th   Congress   adjourned
                                                     in  1966,  25  health-related  bills  had  been  enacted   into   law.   Among
                                                     these  were  Medicare  and  Medicaid  to  pay  for  hospital   and   physician
                                                     services  for  the  Nation's  aged  and   poor;   the   Comprehensive   Health
                                                     Planning Act to  provide  funds  to  each  state  for  non-categorical  health
                                                     planning  and  to  support  services  rendered   through   state   and   other
                                                     health  activities;  and  Public  Law  89-239   authorizing   Regional   Medi-
                                                     cal Programs.





                                                                                     20


                                                  Ile   report   of   the   Presi(letit's   Commission   on   I-leart    Disease,
                                                  Cancer,  and  Stroke,  issued  in  December   19(A.,   focused   attention   on
                                                  societal needs  and  led  directly  to  introduction  of  the  legislation  au.
                                                  thorizitig   Regional   Medical   Pro,,rams.   Many   of    the    Commission's
                                                  recommendations  were  significantly   entered   by   the   Congress   in   the
                                                  legislative  process  but  The  Act  was   clearly   passed   to   meet   needs
                                                  and  problems  identified  and  ,,iven  national  recognition  in   the   Corn-
                                                  mission's  report  and   in   the   Congressional   hearings   preceding   pas-
                                                  sage  in  The  Act.  Some  of  these  needs   and   problems   were   expressed
                                                  as follows:


                                                  0  A program is needed to      focus  the  Nation'.-3  health   resources   for
                                                     research, teaching and     patient   care   on   heart   disease,    cancer,
                                                     stroke  and  related  diseases,  because  together  they   cause   70   per-
                                                     cent of the deaths in the  United States.
                                                  0  A  significant  number  of  Americans  with  these  diseases  die   or   are
                                                     disabled  because  the  benefits  of  present  knowledge  in   the   medical
                                                     sciences are not uniformly available throughout the country.
                                                  0  'Mere  is  not  enough  trained  manpower  to  meet  the  health  needs   of
                                                     the  American  people  within  the  present  system  for  the  delivery   of
                                                     health services.
                                                  0  Pressures   threatening   the   Nation's   health   resources'are   building
                                                     because  demands   for   health   services   are   rapidly   increasing   at
                                                     a  time  when  increasing  costs  are  posing   obstacles   for   many   who
                                                     require  these  preventive,  diagnostic,  therapeutic   and   rehabilitative
                                                     services.
                                                  0  A  creative  partnership  must  be  for-e(l  among   the   Niition's   medi-
                                                                                            n                                                               @,;,@.
                                                     cal ,i(@ientists, practicing physicians,  and  all  of  the  Nation's  other
                                                     heitltlk  resources  so  that  new  kiiowl(!dgc  can  I)(-  translated  more
                                                     rgkl)i(ily into better patient care.  'I'Iiis  partnership  should  make  it
                                                     liossil)l(- for every (,4)inmtitiity'ii            I)Ikysiciiiiis  to  share
                                                     in  the  diagnostic,  therapeutic  and  consultative  resources   of   major
                                                     medical  institutions.  They  should  similarly   be   provided   the   ol)-
                                                     I)<)rtunity  to  participate  in  the  academic  environment  of   research,
                                                     teaching  and  patient  care   which   stimulates   and   supports   medical
                                                     practice of the highest quality.
                                                     Institutions  with  high  quality  research  programs  in   heart   disease,
                                                     cancer,  stroke,  and  related  diseases  are  too  few,  given  the  magni-
                                                     tude  of  the  problems,  and  are  not   uniformly   distributed   through-
                                                     out the country.
                                                  0  There is a need     to  educate  the  public   regarding   health   affairs.
                                                     Education  in  many  cases  will  permit  people   to   extend   their   own
                                                     lives  by  changing  personal  habits  to  prevent  heart  disease   cancer,
                                                     stroke  and   related   diseases.   Such   education   will   enable   indi-
                                                     viduals  to  recognize  the  need  for  diagnostic,   therapeutic   or   re-
                                                     habilitative services, and to know where to find these             services,
                                                     and it will motivate them to seek such services when needed.





                                                                                    21

                                                     During the Con,,ressionil hearings on  this  bill,  representatives  of
                                                     major groups and institutions with an interest in the  American  health
                                                     system were heard, particularly sl)okesm(@n for  practicing  physicians
                                                     and  comniunity  hospitals  of  the  Nation.  The  Act  which   emerged
                                                     turned away from the idea of a detailed Federal blueprint  for  action.
                                                     Specifically, the network of  "regional  centers"  recommended  earlier
                                                     by the Presi(lent's Commission was replace(] by a concept of  "regional
                                                     cooperative  arrangements"  among  existing   health   resources.   The
                                                     Act establishes a system of grants to cnttl)lc representatives of health
                                                     resources to exercise initiative  to  identify  and  meet  local  needs
                                                     within the area of the categorical (liscases'tlirough a broadly defined
                                                     process. Recognition of geographical and societal (liversitict;  within
                                                     the United States was the main reason for this  approach,  and  spokes-
                                                     men  for  the  Nation's  health  resources  who  testified  during  the
                                                     hearings strengthened the case for local initiative.  Thus  the  degree
                                                     to which the various Regional  Medical  Programs  meet  the  objectives
                                                     of The Act will provide a measure of how well  local  health  resources
                                                     can take the initiative and work together to improve patient  care  for
                                                     heart disease, cancer, stroke and related diseases at the local level.
                                                     The Act  is  intended  to  provide  the  means  for  conveying  to  the
                                                     medical institutions and professions of the Nation the latest  advances
                                                     in medical  science  for  dia-nosis,  treatment,  and  rehabilitation   of
                                                     patients afflicted *with heart disease, cancer, stroke, or related  di-
                                                     seases-and to prevent these diseases.  The  grants  authorized  by  The
                                                     Act are to encourage  and  assist  in  the  establishment  of  regional
                                                     cooperative  arrangements  among  medical  schools,  research  institu-
                                                     tioiis, hospitals, and  other  medical  institutions  and  agencies  to
                                                     achieve these  ends  by  research,  education,  and  demonstrations  of
                                                     patient care. Through -these means,  the  programs  authorized  by  The
                                                     Act are also intended to improve  generally  the  health  manpower  and
                                                     facilities of the Nation.
                                                     In  the  two  years  since  the  President  signed  The  Act,   broadly
                                                     representative groups have organized  themselves  to  conduct  Regional
                                                     Medical Programs in  more  than  50  ltegioiis  which  they  themselves
                                                     have  defined.  These  Re,,ions  encompass  the  Nation's   population.
                                                     They have been formed by the  organizing  groups  using  functional  as
                                                     well as geographic criteria.  These  Regions  include  combinations  of
                                                     entire states (e.g. the Washington-Alaska  Region),  portions  of  sev-
                                                     eral states (e.g. the Intermountain  llcgion  includes  Utah  and  sec.
                                                     tiong  of  Colorado,  Idaho,  Montana,  Nevada  and  Wyoming),   single
                                                     states (e.g. Georgia.), and portions of states  around  a  metropolitan
                                                     center (e.g. the Rochester  Region  which  includes  the  city  and  11
                                                     surrounding  counties).  Within  these  Regional   Programs,   a   wide
                                                     variety of  organization  structures  have  been  developed,  including
                                                     executive and planning committees,  categorical  disease  task  forces,
                                                     and community and  other  types  of  subregions]  advisory  committees.
                                                     Re-ions  first  may  receive  planning  grants  from  the  Division  of
                                                     Regional  Medical  Programs,  and  then  may  be  awarded   operational
                                                     grants to fund activities planned with initial and subsequent  planning





                                                                                 22


                                             gr,iiits.  'niese  operational  programs  are  the  direct  Yneans  for  Re-
                                             gional Ale(iical  1'rogriins  to  accoinl)liih  their  objectives.  Planning
                                             moves  a  ]ic,,ioii  toward  ol)cratioiiil  activity  and  is  a  continuing
                                             means  for  assuring  the  relevancy  an(]  appropriateness  of  operational
                                             activity. It is the effects of the operational  activities,  however,  which
                                             will  produce  results  by  which  ltegional  Medical   Programs   will   be
                                             judged.
                                                On  November  9,  1967,  the  President  sent  the  Congress  the  Report
                                             on  Regiottal  Medical  Progrants  prepared  by  the  Surgeon   General   of
                                             the Public Health Service, and gul)ziiitte(i to the  President  through  the
                                                                                                                 th   The
                                             Secretary of Health, Education, an(] Welfare, in compliance wi
                                             Act.  The  Report  details  the  progress  of  ltegional  Medical   Programs
                                             ,ind  recommends  continuation  of  the  Programs  beyond   the   June   30,
                                             1968, limit set forth in  The  Act.  The  I)rcsidcnt's  letter  transmitting
                                             the  Report  to  the  Congress  was  at  once  encouraging  and  exhortative
                                             when it said, in  part:  "Because  the  law  and  the  idea  behind  it  are
                                             new, and the  problem  is  so  vast,  the  program  is  just  emerging  from
                                             the  planning  state.  But  this  report  gives  encouraging   evidence   of
                                             progress-and   it   promises   great   advances   in    speeding    research
                                             knowledge  to  the  patient's  bedside."  Thus  in  the  final  seven  words
                                             of  the  President's  message,  the  objective  of  Regional  Medical   Pro-
                                             grams  is   clearly   emphasized.



                                               THE NATUITE AND POTENTIAL OF REGIONAL
                                                                  MEDICAL PitOGItAMS

                                             GOAI-IMI'ltOVEI) I'Al'IEN,r CAltE
                                                The Goal  is  describer]     in   the   Surgeon   Gencral's   Report   as
                                                   cleir   and    unequivocal. The focus is on the  patient.  The  object
                                             is  to  influence   the   present arrangements  for  health  services   in   a
                                             manner  that  will   permit   the best  in  modern  medical  care  for   heart
                                             disease,   cancer   stroke,   and related diseases to be  available  to  all."

                                             MEANS-TfiE PROCESS OF REGIONALIZATION
                                             Note: Rcgionalization can connote more than a regional cooperative  arrange-
                                             ment, but for the purpose of this publication, the two terms  will  be  used
                                             interclian cal)ly. The  Act  uses  "regional  cooperative  arrangement,"  but
                                                      9
                                             "regionali7,ation" has become a more convenient synonym.
                                                A  regional   cooperative   arrangement   among   the   full   array   of
                                             available health resources is a necessary  step  in  bringing  the  benefits
                                             of  scientific  advances  in  medicine  to  people  wherever  they  live  in
                                             a Region they themselves  have  defined.  It  enables  patients  to  benefit
                                             from  the  inevitable  specialization  and  division  of  labor  which   ac-
                                             company  the  expansion  of  medical  knowledge  because   it   provides   a
                                             system  of  working   relationships   among   health   personnel   and   the
                                             institutions  and  organizations  in  which   they   work.   This   requires










                                                                                    i  17





                                                                                    2@3


                                                   a comniitmciit of individual  a,,,l  institutional  spirit  and  resources
                                                   which  must  he  worked  out  by  each  llcgional  Medical   Program.   It
                                                   is facilitated by  voluntary  agreements  to  serve,  systematically,  the
                                                   needs of the public as regards the  categorical  diseases  on  a  regional
                                                   rather than ;orne more narrow basis.
                                                   Itegi4)iiiiliziition, or a  regional  cool)(!riitive  arrangement,  within
                                                   the context of lte,,ioiial Medical  Programs  has  several  other  iml)or.
                                                   tajit facets:
                                                   0    It is both functioiiil and  -cographic  in  character.  Functionally,
                                                        regioiialization is the mechanism for Iiiikiii,,  patient  care  with
                                                        health research irid (-(Iucatioii within tl)c entire region to provide
                                                        a mutually beneficial interaction. 'I'Iiis interaction  should  occur
                                                        within the operational activities as well as in  the  total  program.
                                                        The geographic boundaries of a rc,,ioti serve to define the  pol)ula-
                                                        tion for which each  Ile-iotial  1'rogritin  will  be  concerned  and
                                                        responsible. rhis concern and  responsibility   should   be   matched
                                                        by responsiveness, which is  effected  by  providing  the  population
                                                        with a significant voice in   the   Regional   Program's    decision-
                                                        making process.
                                                   0    It provides a means for  sharing   limited   health   manpower    and
                                                        facilities to maximize the quality and quantity of  care  and  service
                                                        available to  the  Region's  population,  and  to  do  this  as  eco-
                                                        nomicaily as possible. In some instances, this may   require   inter-
                                                        regional  cooperation  between  two   or   among   several   Regional
                                                        Programs.
                                                   0    Finally,  it  also  constitutes  a  mechanism  for  coordinating  its
                                                        catc,,orical  program  with  other  health  programs  in  the  Region
                                                        so that their combined effect may  be  increased  and  so  that  they
                                                        contribute  to  the  creation  and  maintenance  of   a   system   of
                                                        comprehensive health care within the entire Itegion.
                                                        Because the advance ol knowledge claingcs the nature    ol    medical
                                                        regio7tali.-ation  can  best  be  viewed  as  a  continuous   process
                                                   care,
                                                   rather than a plan ivhich  it  totally  developed  and  then  implemented.
                                                   This process  of  re,,ionalization,  or  cooperative  arrati-ements,  con-
                                                   sists of at least the following elements:  involvement,  identification  of
                                                   needs and  opportunities,  assessment  of  resources,  definition  of  ob-
                                                   jectives setting of  priorities,  implementation,  and  evaluation.  While
                                                   these seven elements in  the  process  will  he  described  and  discussed
                                                   separately, in  practice  they  are  interrelated,  continuous  and  often
                                                   occur simultaneously.
                                                        Involvement-The  involvement   and   commitment    of    individuals,
                                                   organizations and institutions  which  will  engage  in  the  activity  of
                                                   a Regional Medical Program, as  well  as  those  which  will  be  affected
                                                   by this activity,  underlie  a  Regional  Program.  By  involving  in  the
                                                   steps of study and decision all  those  in  a  region  who  are  essential
                                                   to  implementation  and  ultimate  success,  better   solutions   may   be
                                                   found, the opportunity for wider  acceptance  of  decisions  is  improved,
                                                   and  implementation  of  decisions  is  achieved   more   rapidly.   Other








                                                                                                                  77





                                                                                      24


                                                attempts  to  or,,anize  health  resources  on   a   regional   basis   have   ex-
                                                pcricii(,,ed  dilriciiity  or  have  been   (livcrte(i   from   their   objectives
                                                because   there   was   not   (his   voluntary   involvein(!iit   and   commitment
                                                by  the  neceisiry  individuals,  institutions   an(]   organizations.   The   Act
                                                is quite            to          this   necessary    involvement    in    liegional
                                                Medical I)i-o,,@,ritins; it (if!fiiies, for (!xiiiil)l(i, the minimum  cotni)()gi-
                                                tioii of ltt!lioiiiil Advisory Groups.
                                                        Act states theme  ltt!gioiiiil    A(Iviiory             rziu8t     include
                                                practicing I)Iiy.,iiciiiiis, in(!(Iicjil center offi(!iiil-.i, lio)sl)ittil a(imiiiistra-
                                                It)rs, representatives front nl)lir(il)ri,,iii, iii(!ili(@al societies,  voluntary
                                                health             and                     (if  )ilicr  organizations,  iiiititii.
                                                tions ikii(i agencies concerned with activities  of  tli(,-  kind  to  be  carried
                                                on  unoler  the  program  and  members  of  the  1)tjlili(!  familiar   with   the
                                                need  for  the  services   provide(]   under   the   1)ro,,ram."   To   ensure   a
                                                maximum   opportunity   for   success,   the   composition   Of   the    Rc,,ional
                                                Advisory  Group  also  should   be   reflective   of   the   total   spectrum   of
                                                health  interests  and  resources  of  the  entire   llc,,ion.   And   it   should
                                                be  broadly  representative  of   the   geo-ral)hic   areas   and   all   of   the
                                                socioeconomic  groups  which  will   be   served   by   the   liegional   Pro-ram.
                                                   The   Regional   Advisory   Group   does   not   have   direct   administrative
                                                responsibility  for  the  Regional  Program,  but  the   clear   intent   of   the
                                                Congress  was  that  the  Advisory  Group   would   ensure   that   the   Regional
                                                Medical   Program   is    planned    and    developed    with    the    continuin-
                                                advice  and  assistance  of  a  group   which   is   broadly   representative   of
                                                the  health  interests  of  the  Re-ion.   The   Advisory   Group   must   approve
                                                                                 C,
                                                all  proposals  for  operational   activities   within   the   Regional   Program,
                                                and  it  prepares   an   annual   statement   giving   its   evaluation   of   the
                                                effectiveness   of   the    regional    cooperative    arrangements    established
                                                under the liegioiial Medical Program.
                                                   Identification   of   Needs    and    Opportaizitie.,;-A    Regional    Medical
                                                Program  identifies  the  needs  as  re,@,irds  heart  disease,   cancer,   stroke
                                                and   related   (liscakes   within   the   entire   lie-ion.   These   needs   are
                                                stated in terms which offer opportunities for solution.
                                                   This  process  of  identification  of  needs  and   opportunities   for   solu-
                                                tion  requires  a  continuiii-  analysis  of  the  problems  in   delivering   the
                                                best medical care for the       target  diseases  on   a   regional   basis,   and
                                                it  goes  beyond  a  generalized   statement   to   definitions   which   can   be
                                                translated  into   operational   activity.   Particular   opportunities   may   be
                                                defined  by:   ideas   and   approaches   generated   within   the   Region,   ex-
                                                tension  of   activities   already   present   within   the   )legion,   and   ap-
                                                proaches   and   activities   developed   elsewhere   which   might   be   applied
                                                within the Region.
                                                   Among various      identified  needs  there  also   are   often   relationships
                                                which,  when  perceived,  offer  even   greater   opportunities   for   solutions.
                                                   In  examining   the   problem   of   coronary   care   units   throughout   its
                                                Region,   for   example,   a   Regional   Program   may   recognize    that    the
                                                more  effective  approach  would   be   to   consider   the   total   problem   of
                                                the   treatment   of   myocardial   infarction   patients   within   the   Region.
                                                This   broadened   approach   on   a   regional   basis   enables   the   Regional








                                                                             7
                                                                                                                                      77





                                                                                                       25


                                                                 Program  to  consider  the  total   array   of   resources   within   its   Region   in
                                                                 relationshil)   to   a   comprehensive   program   for   the   care   of    the    myo-
                                                                 car(lial   infarction   patient.   Thus,   what   was   a   concern    of    individual
                                                                 hoql)itals  about  how   to   introduce   coronary   care   units   has   been   trans-
                                                                 foi@ine(i  into  a  1)i-oj(@(@t  or  group  of  related  projects  with  much   greater
                                                                 I)ot('iititil  for  effective  itii(i  (!fli(@ierit  utilization  of  the  legions  re.
                                                                 sotir4-cs to itni@rov(, patient care.
                                                                 "Issi!ssrlictit of It't-sources-As  part  of  tll(,.  process  of  rep,,iotializatiort,
                                                                 a ltegioil Colitilkuously Update";    its    ii)veiitory    of    existing    resources
                                                                                   ill terms of function, size,  ritiml)cr  ail(]  quility.
                                                                 l,',vei-y effort is iiiiifl(! to i(ii-iitif), and tiie existinl,, inveiit )ries, filling
                                                                 in the gal)s as           riitli(!r entire st-itijil, out oil  a  loiil;,  cxl)eiisiv(!
                                                                 process of           all    entirely    new    itiv(@jitory.    Information     sources
                                                                 include state  flill-iturton  jigt!it(@ies,  liosi)it@il  ail(]  medical  associations,
                                                                 and  voluntary  a,,cncies.   'I'lic   inventory   provides   a   basis   for   informed
                                                                 judgments   and   priority   setting   oil   tictivitie,4   proposed    for    develop-
                                                                 ment under the   Regional   1'rograni.   It   can   also   be    used    to    identify
                                                                 missing     resources-voids     requiring     new     investment-and     to     develop
                                                                 new coiifi-urations of resources to meet needs.
                                                                 Definition     of     Objectives-A      Regional      Program      is      continuously
                                                                 involved   in   the   process   of   setting    operational    objectives    to    meet
                                                                 identified    needs    and    opportunities.    Objectives    are     interim     steps
                                                                 toward  the  Goal  defined  at  the   be@inning   of   this   section,   and   achieve-
                                                                 ment of these objectives should         have   an   effect   in   the    Region    felt
                                                                 far  beyond  the  focal  points   of   the   individual   activities.   This   can   he
                                                                 one    of    the    greatest    contributions    of    Regional    Medical    Pro-rams.
                                                                 The  completion  of  a   new   project   to   train   nurses   to   care   for   cancer
                                                                 patients   undergoin-   new   combinations   of    dru@    and    radiation    therapy,
                                                                 for    example,    should    benefit    cancer    patients    and    should     provide
                                                                 additional   trained   manpower   for   many   hospitals    in    the    Region.    But
                                                                 the   project   also   should   have    challenged    the    Region's    nursing    and
                                                                 hospital   communities    to    improve    generally    the    continuing    and    in-
                                                                 service education opportunities for nurses within the Rc-ion.
                                                                 Setting  of Priorities-Because  of  limited  manpower,                      facilities,
                                                                 financing  and  other  resources,  a  Region  assigns  some               order      of
                                                                 priority  to  its  objectives  and   it)   the   steps   to   achieve   them.   Besides
                                                                 the   limitations   on    resources,    factors    include:    1)    balance    between
                                                                 what  should   be   done   first   to   meet   the   licgion's   needs,   in   absolute
                                                                 terms,   and   what   can   be   done   using    existing    resources    and    compe.
                                                                 tence;   2)   the   potentials   for   rapid   and/or   substantial   progress   toward
                                                                 the   Goal    of    Regional    Medical    Programs    and    progress    toward    re-
                                                                 gionalization    of    health    resources    and    services;    and    3)     Pro-ram
                                                                 balance  in   terms   of   disease   categories   and   in   terms   of   emphasis   on
                                                                 patient care, education and research.
                                                                 Implementation-l'he   purpose    of    the    preceding    steps    is    to    provide
                                                                 a  base  and  imperative  for   action.   In   the   creation   of   an   initial   op-
                                                                 erational   program,   no   Region   can   attempt   to   determine    all    of    ihe
                                                                 program   objectives   possible,   design   appropriate   projects    to    meet    all
                                                                 the   objectives   and   then   assign   priorities   before   seeking   a   grant   to




                                                                                                                                   26


                                                                                                                     ii I)ri              Nylli(,)i  encompasses  all   or   (tvcti
                                                                           implement iii ol)critioti,
                                                                           most of the                              liiii)l(!iiiciitatioii can occur with an initial
                                                                           ol)t!ratioii@il program (!iicoinl)@issiti,                               ;t  sitiitll  [Surlier  of  well-
                                                                           desigii4-(l projects i%,Iiicii will iiiov(! iii(, lt(!,ioii toward  the  attainment
                                                                           of valid 1)ro,,,riiTn objectives. 13ccitis(,- r(,,gionzilization  is  a  continuous
                                                                           process,      a      ltegion      is      expected      to      continue      to      submit       supplemental       and
                                                                           additional operational proposals as they are developed.
                                                                               Evaluation-Eacii  planning  and  operational  activity                                      of       a        Region,
                                                                           as  well       as       the       overall        Regional        1rorani,        receives        continuous,        quan-
                                                                           titativt-  and  qualitative evaluation  wlierever  possible.                                   Evaluation              is
                                                                           in  terms     of     attiiiittit,,iit     of     interim     ol)j(!(!tives,      the      process      of      regionali-
                                                                           zatioll,     and      [lie      Goal      of      llegiorial      Medical      Pro;,,ranis.
                                                                                        -live      ev;iliiition      is      simply      a      reasonable      basis      upon       which       to
                                                                               0I)j(@(,
                                                                           determine      wlt(!tlicr      an      i(!tivity      should       be       continued       or       altere(l,       and,
                                                                           tiltitnat(@ly,      whether      it      achieve(]      its      purposes.      Also,       the       evaluation       of
                                                                           one       activity        may        stig,,est        modifications        of        another        activity        which
                                                                           would increase its effectiveness.
                                                                               Any      attempt      at      evaluation      implies      doiji-       whatever       is       feasible       within
                                                                           the     state     of     the     art      and      appropriate      for      the      activity      being      evaluated.
                                                                           Thus,      evaluation      can      ritige      ill      COIIII)I(!Xity       from       simply       countin-       num-
                                                                           I)crs      of      people      at      meetings       to       the       most       involved       determination       of
                                                                           behavioral changes in patient management.
                                                                               As      a      first      step,      however,      evaluation      entails      a      realistic      attempt      to
                                                                           desi-n      activities      so      that,      as      they      are       implemented       and       finally       con-
                                                                           eluded,     some     data     will      result      which      will      be      useful      in      determining      the
                                                                           de-ree of success attained by the activity.




                                                                                                                 REVIEW  COMMI=E

                                                                           K. P. BUNNELL, Ed.D.                         G.  E.   MILI,ER,         D.                 D.  E.  ROGERS,   M.D.
                                                                                                                                              M
                                                                           Assoc. Director                              Director, Off. of Research                   Prof.       and        Cliaiman
                                                                           Western lnicr,4tate Comm.                      in    Me(l.     Educ.                      Dept. of Mc(l.
                                                                               for    Higher     Ed.                    Coll. of M.!(I., U. of Ill.                  S(@liool of Mcd.
                                                                           Boiiltlcr, Colo.                             Cliicago, 111.                               V4kiiderbilt IJ.
                                                                                                                                                                     Niiblivill4@, Tenn.
                                                                           C.   J   AM   FS,    M.D.                    P. M. MORSI-" I'li.D.
                                                                           (Cli:tiriii:iii)                             Director, OI)t!rlttiolis                     C. II. W. 111111E, M.D.
                                                                                   Niotilit Sinai                         Itcg(,;ircii    (:tr.                      Assi-,itint        St,(@r(!tary
                                                                               SI-11001  Of   M4@(1,                    Nl;tsfi. ln.4t. of'recia.                               oil   Nf(!(I.    Ed.
                                                                           New      York,       N.Y.                    Cainl)ridge, Mzi,.4.9.                       Aiiii.-ric@iii M(!d. Atisoc,
                                                                                                                                                                     ('Iiictlgo, Ill.
                                                                           ]I. W. Kl-"NNI@',Y, M.D.                     A. I)ASCASIO, I)li.D.
                                                                                         I)iri!(@tor                    Assoc.                  Prof.                It.    J.    SI,ATEII,     M.D.
                                                                           Ji)liti A. Aiiilrew Memorial                 Nursing S(!Iifiol, U. of                                         I)ir(@iitor
                                                                                                                                                                           Assoc. for tli(! Aid of
                                                                                         Iiit;tititte                   l'itttil)urgii,     Pa.                         Cril)l)lt-d      (:Iiii(Ircn
                                                                           Tusko!gt@o!, A]Li.                                                                        New York, N.Y.
                                                                                                                        S. II. lll(o("Il"li, M.1).
                                                                           F. J. KOWALFWSKI, M.D.                       1'r(if. and (:114iil'llLan                   J.   1).   IrliOMI'SON
                                                                                                                        1)1!1)1. of mt!(I. and                               Of  lltililic,   Ifith.
                                                                                           (@f I,',tiviron. Mcd.        I'laysl(-iiiii-iii.Cliicf                    Seliool of llublic Hlth.
                                                                           A(@a(l. of Gen. Practice                     Tufts N.I,'.. Mcd. Ctr.                      Yale U.
                                                                           Akron, Pa.                                   Pres., Bingiiiim Assoc. Fund                 Now        Haven,         Conn.
                                                                                                                        Boston, Mass,













                                                                                                                                                                                                                     7
                                                                                                                                                                                                                        77





                                                                                                         27










                                                                                                     F. V FN Ts                       ACNON


                                                               1964           DECEMBER  It,-port  the
                                                                                        CoinniiKmioii on il.!i@ Disease,
                                                                                        Cancer. and Stroke


                                                               1965           FEBRUARY
                                                                                TO      Congressional hearings
                                                                           JULY
                                                                         OCTOBER        Enactment  of  P.L.   89-239
                                                                         DECEMBER       National  Advisory  Council  meeting Initial policies and pre.
                                                                                                                             liminary Guidelines
                                                                                                                             reviewed


                                                               1%6            FEBRUARY  Establishment  of   Division
                                                                                        Publication  of  preliminary
                                                                                        Guidelines
                                                                                        National  Advisory  Council  meeting Policy for review proc-
                                                                                                                             ess and Division
                                                                                                                             activities set
                                                                           APRIL        Review   Committee   meeting
                                                                                        National  Advisory  Council  meeting 7 planning grants
                                                                                                                             awarded
                                                                           JUNE         Review  Conunittee   meeting
                                                                                        National  Advisory  Council  meeting 3 planning grants
                                                                                                                             awarded
                                                                           JULY         Publication  of   Guidelines
                                                                                        Review   Committee   meeting
                                                                         AUGUST         National  Advisory  Council  meeting 8 planning grants
                                                                                                                             awarded
                                                                                        First of 5 meetings of Ad Hoc        Report material
                                                                         SEPTEMBER
                                                                                        Committee for Report to the          discussed
                                                                                        President and Congress
                                                                         OCTOBER        Review   Committee   meeting
                                                                         NOVEMIIER      National  Advisory  Council  meeting 16 planning grants
                                                                                                                             awarded


                                                               1967      JANUARY        Review   Committee   meeting
                                                                                        National Conference                  National views on
                                                                                                                             Programs & information
                                                                                                                             for Report provided
                                                                         FEIIRUARY      National  Advisory  Council  meeting 10 planning and 4 opera.
                                                                                                                             tional grants awarded
                        k                                                  APITIL       Review   Committee   meeting
                                                                           MAY          National  Advisory  Council  meeting 5 planning and I opera.
                                                                                                                             iiona, grant awarded
                                                                           JUNE         Report to the President  &  Congress
                                                                           JULY         Review   Committee   meeting
                                                                         AUGUST         National  Advisory  Council  nweting 2 planning grants
                                                                                                                             awarded
                                                                         OCTOBER        Review   Committee   meeting
                                                                         NOVEMBER       National  Advisory  Council  meeting 2 planning and 3 opera.
                                                                                                                             tion., grants awarded
                                                                1968           JANUARY  Confemnee-Workshoi)                  Regional activities and
                                                                                                                           lideam presented




                                                     t)8-453 0-68-.'l





                                                                              28

                                                    PUBLIC LAW 89-239


                                         'Mrough grants, to afford to the medical profession and  the  medical  inatitu-
                                         tions of the Nation the  opportunity  of  planning  and  implementing  programs
                                         to make available to the American people the latest advances in  the  diagnosis
                                         and treatment of heart disease, cancer, stroke, and related diseases by  estab.
                                         lisbing voluntary regional cooperative arrangements among . . .
                                         0 Physicians                                   0  Voluntary   Health   Agencies
                                         * Hospitals                                    0 Federal, State, and Local
                                         0 Medical Schools                                 Health Agencies
                                         * Research Institutions                        0 Civic Organizations


                                                  R'JvUGIO'ivNAL ADVISORY
                                                                   COULN.CILS
                                         The activities of Regional  Medical  Programs  are  directed  by  fulltime  Co-
                                         ordinators  working  together  with  Regional   Advisory   Groups   which   are
                                         broadly representative of the medical and  health  resources  of  the  Regions.
                                         Membership on these groups nationally is:



                                             Hospital Administrators
                                                                                                       Practicing
                                         Public He&                                                    Physicians
                                         Officials


                                         Other
                                         Health
                                         Workers




                                          Voluntary
                                                                                                                       nter-
                                       Health    Ag
                                                                                                                       ials




                                                                              Members
                                                                              of the Public













                           7





                                                                                                       33


                                                                                                                                                                0


                                                                                       c@I)i(]Vliliolotri<-,  iiii,it, to  study                                d
                                                                           of  tlltt  coiniiiiiiiity's           addiction  p
                                                                                 the,  1)i-ol)osc@d  @iiii                             the             Community
                                                                                        ,@ct, are ilitell(                               the   roots    of    an
                                                  intensely  traaic \-tiiatioii.  In  most                                            mmunities,           alco-
                                                  lioliesiiid iii@(,oticN(li(!ts-aiid their                                          UiTer      with      them-
                                                  1)@t %-e I'(@w 1)1,ices to ttirSJoi- I)i-ofessiolill'                                     f    these     people
                                                  could    I)c ].(@stol,e(l to                                                               within        reach.
                                                    (,,oi)iiiiiiiiity inciit:tl liN                                          eritiiia ill cities with  ,t
                                                          illei(ICIl,ce of .11(@oll(                                         dictio'@i.     Ifowever,      the
                                                  ("olillillillitv ',,Nf(@,iltal Ifeil                          t,   now   offers   no    special    induce-
                                                  lliciit to              wisliiill(r t                          critical   ,tiid   difficult   pr(@l)lcins.
                                                                                     tn
                                                  Tlip-  1)i-ol)o                                                                        e     the     necessary
                                                                ,Lll                             do flie, jol),
                                                                                                 ts I)efol-C t                           today    will     serve

                                                  -is
                                                       I  1110(le,                         s in devclol)i                                                       wn
                                                  voiiilliill)it,y                            alcoholism,
                                                    This                                                   the     ii-nl)ort,,tncc
                                                                    r the       c)   it,   i     iiid treatment, of Ilcolic,
                                                                    ito t;lic community Rental health center ci
                                                                    ribiitioii toward ,Iellievill,r I)reveiitioii and contr(
                                                                         to  Ilisei-filit-liol.(@.ol.(Itwotll)le              slioNviliLy               participation
                                                  in the regionti medical   rogr-.tiii, :In(                    total 0   gation 6f'funds.
                                                     ('I'Iie documents referred to follow:)
                                                     TA)ILF-, I.-Participatia?b i,)@ rcgio?tal t@tcdical programs  by ittd@duals                           an(i
                                                                                                 organi.-aliotis
                                                  lndivi(iiialg     -------------------------------------------------------                                7,200
                                                        '4taffi of 5-1  progranit4                               ------------------------------------------ I.,    800
                                                                     of regional advisory groiiji.-4                        ----------------------------   .1,900
                                                        8111)(@ollil)iitt(,p )iic-iiiberi4                       ----------------------------------------- 2,500
                                                        JAH-al      ictioii      groiip       lumbers ------------------------------------                 1,000
                                                  Iiist,itiltiolis  -------------------------------------------------------                                     f)lli
                                                                                                   -----------------------------------------------------        Soo
                                                                              -----------------------------------                                               103
                                                        I)elitjil wlioolg                 -------------------------------------------------                     18
                                                        S(']I(>01.4 of           lieiiltli                          ----------------------------------------    1'.3
                                                  Orgiitil7.ittloiis                                    -----------------------------------------------------   779
                                                        State  ine(lical  ,40(.I(.ties                         -----------------------------------------        152
                                                        ('olllity itle(ll(.Ill                                     ----------------------------------------     90
                                                                                            -------------------------------                                     152
                                                                  licilth del):irtiiiezit,4                                                     --------
                                                        St@ite  cancer  societies                             ------------------------------------------        1  51
                                                        State lie,,irt association                             -----------------------------------------        152
                                                        St.ite.      hospital       association --------------------------------------                          40
                                                        AreiLNvi(le  Health  facility  planning  agencies                           --------------------        30
                                                        State octal  association                                   -----------------------------------------    29
                                                                                                                               -tee,   L-tc ---------           383
                                                        Otlier professional qoeieties, local voluntary agene
                                                      100 percent participation.








                                                                                                                                                                    7





                                                                                   34

                                               TAliLE II,-PcgiotiaZ itwdical progrants, total obligation of fund8

                                            y(,iir:
                                                                                                         ----------      $2,500,000
                                                                                                                  ---    28,  %O,   O(X)
                                           1 !)C)7              ---------------------------------------------------
                                                                                                                            153,800,000
                                           1 (W)8 ------------------------------------------------------
                                                                                                                         of),  800,   ow


                                                                                                tllis   ol)l)orttiliit,y   to   explain
                                                              yoll, Mr. Clllirlll;lll, fol
                                       to  tliis.,illl)collllliittt!e  our  views  oil  11.11.  157.")8.  Mr.  lfiiitt,  Dr.   Marstoii,
                                                                                                                    tiiy       questions
                                           )@'olles,  iiid  Miss  Toliiistoii  will   be   liil)py   to   Ill,,Nver
                                       oil  rally  litvc.
                                       y
                                               IZocins.    T]i@iiik    you    very    mucli,    Dr.    Lee,    for    your     statement
                                       covering   the   proposed   legislation.   I   think    Nve    will    start our        questions
                                       by  -.,Mr.   Kyros.
                                           Mr. KYRO,-,. Tli,,tiik you, Mr. Chiirmaii.
                                           I  want  to  coiiiiiieiid   you,   Dr.   I,",   oil   ,i   very   excellent   statement   and
                                       to  welcome  you  here.   I   would   like   to   sttrt   w@tli   the   last   thing   you   stid
                                       oil page 18 of- your st,,,Lteiiieiit..
                                           I-lo-sv   will   (,oiniiiuiiity   iiieiital   lictltii   center    'coi-npletioiis,    wliere
                                       'Von                                                                         -ircoticid(lic-
                                           will li;tN@e facilities for treit iiieiit.  of  tlcoliol  isiii  iiid  ill
                                       -iioil,   iii;ilw:t   vital   contribution   toward   preservation    of    such    1)rol)lenis?,
                                           1)'V.     ]'would like  to  -,t-,3]c  Dr.  Yolles  to  coiiiiyieiit  oil  that,  itil(I  then
                                       T will (!oiiiiy)eiit,,Ilso.
                                           Dr. )'oy.r,is. 'I' le 1)),Ovelltlloll r(@fei-i-ed to ill teriii@ of  tli(@,se  I)i-ogriLiiis,
                                                             -il@ i)oiiit(@d to treatment,
                                       wlii(!Ii ti                                             of    iticoliolics:tiid,,id(licts,    re-
                                                                          ioii. '.riie s(!coji(l:ti-v  i)rcveiit)ioii
                                       -r(,,rs to @-oiidlir  7                                                         )proteli      is,
                                                         y                                    ir(Iii,@r' pttliology      om       occur-
                                       ill (,@jr("Ct, etri   ii tcllv(@ll   11 to prevent fi
                                           I g
                                           We would hope tli:tt t@lic preventive                                            coiislilt-,i-
                                       t,ioii  Nvitli  other  lig(,@iicics,   AV()tild   Ile   li@iiidled   under   other   legislation,
                                       Public   Law   89-749   the   Ptrtiiersliij)    foi-    Tlctltlt    Act,    which    also    will
                                       detl with these problems.
                                           Mr. Kyito,,.  Will  tli(,,kse  centers  be  sii-nilar  to  some  of  the  iiieiit,,tl  health
                                       centers in Mttssacliusetts? Will they tr@, t people is outpatients?
                                           Dr.  YOLLr!,s.  Depending  oil   tile   type   of   c,-Lse,.Y@u   mty   have   -it   v,,tria-
                                       tion   in   types   of   treatment.   If   someone   came   in   in   an   acute    state,    lie
                                       would   be   hospitalized,    L,,enerallv    in    a    general    hospital,    and    then    go
                                       Oil  to  Pe],liil)s   transitional   dty   care   or   nigl-it   care   ,i'nd   then   outpatient
                                       care,,Ilid followtip thereafter.
                                           Mr.   KyRos.   Let   me   -risk   a   question   generally   about   the    regional    medi-
                                       c,:tl I rogr.
                                           As  1-iiii(lerstiiid  it,  it  liar,  been  in  operation   iieti-ly   2   years,   is   that

                                           ,)r.              is correct.
                                           Mr.  lCyito,,.  li@ive  you   been   able   to   lit@tl<c   qtiiilit@ative   tll@tlysis   oil
                                       whether this I)rogr;@iii has int(le knowledge of                  iii(@dici-tl sciciiee  ilvilil-
                                           Dr.        Y(%;  I  t.,Iiiiik  we  coal  (@,ite  examples.  I  would  I  ilce  to   emphasize
                                       t@litt  the  (efforts  until  now,  of  course,,   have   been   prii-nitrily   I)riii@iiig   the
                                       vti,ioii-,  groups  together,  biiildiiiir  t@li(@  f  otiiidftt@io-n  oil   which   the   opera-
                                       tiontil     1)rogra.ms will be moving f@rw,,trd rapidly.




                                                                                                                                       7"-





                                                                                         35


                                               Dr.';\I,,Lrstoii?,
                                               Dr. 'k\jl,@r@STO.N. This is not all easy       question to  answer  at  this  early
                                            stage in the program. We do  ]live  ol)(@ritional  grants  awarded  which
                                            include, iiiore tli'aii 100 projects tl),tt are uiide;rw@y in the re)aioiis.
                                               Perl       t@lic, best way I could answer this nii@ht be to t,,@Ice the ex-
                                                   "I'Tosi-ic   re,rioii   and
                                            Illlple 0           tn           ]low  it  ]its   moved   in   tlie,,trea   of   heart   disease,
                                            ciiicer,,ind stroke.
                                               I  would  lilie  to  Ilse,  from  time  to   time,   some,   of   the   words   of   the   ap-
                                            I)Iic@iiit, because this is a prpgr.@iii tli.@t-, I,-, oectirriii- in the region.
                                               'rlie   North   Caroliiit   refrion,,ti   medical    I)rogrim    decided    i'n    the    late
                                                                             3re-,,trifter   it   received   its   pltnning    grant,    that
                                            sui-nmer   of   1967,   about    t
                                                                                                                                       teLrv
                                            it, liked :itt,,tiiied readiness for ol)erat,ioiitl stttus. Conceptual stra,
                                            to achieve the goals of the re,@ioiiil inedictl I)rogrim had been
                                            vclol)ed. A ratified, representative le-,tdersliii)           of   the    region,    the    prin-
                                                                         in the region, II,                            -for the s
                                                                                              ,id been org,
                                            cipal health interests '                                           -,tiiized                timii
                                            Ittioii   of   productive,   cooperative    effort    for    f-ruid,,tiice    and    coordination
                                            of   I?@ograiii   devclol)iiienc,   tiid   ,tii    organization    structured    for    effective
                                            decisioiini,ti.ziiig   based   on   needs   in   the   region    had    been    developed    ,tnd
                                            idequately tested.
                                               During   1966   and   1967,    North    Carolina    had    had    ,t    small    project    in
                                            the   area   of   heart   disease.   This    development    was    described    'in    ihe    re-
                                            gioii's    prozress    rei-)ort    as    follows:    Sinie    cooperative    arrangements     in-
                                            volvi-ng   such   it   wide   assortment   of   people   aifd   institutions   in    one    proj-
                                            ect,   was   a   novel   departure   for   us,    the    experience    has    been    invaluable.
                                                                                         I'll    project    contained    seriously    iiiade-
                                            We (Illic1cly  letriie(I  tlitt  t@lic  ori,,iI
                                            qii:itv,  I)ro@isioiis  for   manpower-.   ',']Ills,   ill   oiii,   operational   grant   appli-
                                                   I-stibiiiitte(I   in   Oc.-tLbor   19(;7,   :in   eki)-iiisioii   of   the   project   was
                                            I)i-ol)@-ed,,tiid its time              f iiiiliei- iiio(ii fl(@,ftt.,ioii is ttiiti@l)ttfcd. Coii-
                                            fe,r@,iice,s with it,.tirs of  Silltil  eDiiiiiiiiiiit@y  lio,,sl)it-,tls.,tiid  observations  of
                                            1),Iti(@lits witliiciltAl-flyoc,@irdi:tl                                tliej-ciii      convinced
                                            us   initial   effort    had    to                  ei-iii i   the feasibilit-
                                                                             be made to (lot           ]le                   v  of  all   ap-
                                            prol)ri,dely (Iesjffiie(I coroii,,ti-y            unit- for these small ll;spit,.tls.
                                               The,  relioii's  report,  goes  oil  liter  to   (,Iescril)e   the   ttvailability   of   cor-
                                            oii,,try care  units,  -.iiid  1), irticiilti-ly  tlieil)ility  in  these   units   to   do   some-
                                            thin-   is   far   as   the   rhythm   or   the   electrical   disturbances    in    the    heart
                                            is    concerned,    which    is    not    possible    without    the    specialized     equipment
                                            ,iildtr,tiiied             copleintliescunits.
                                                            p
                                               The  growiii_z-iiiterest   ftiid   ,tv@til,,tbility   of   coronary   care   units   in   this
                                            ret-rioii  tlso  has   generated   the   need   to   provide   t   c,,tidiopulmoii,-tl-.y   ,tiid
                                            resuscitation   train'   Ig   pfogrtm    to    cxpqiid    on    an    earlier,    limited    pro-
                                            grain of the, North @,,trolint I-leart, Association.
                                               Additional   projects   in    the    heart    area,    which    are    in vtiiious      stages
                                            of     implementation     or     planning,      include      the      diagn@ and        treatment
                                            of    Iiypertension    the    use    of    -,p;ociilly     equipped     ambulances,     pediatric
                                            cardiological screeiiing,,,ilid       so     rtli.
                                               Ill   the   ctjicer,.trea,   the   North   C,:trolilll%    program    worked    with    exist-
                                            iilg.gi-oiips   who   liaN-e   worked   in   the   cancer   field   before,   ,tnd   they   state
                                            ,in   increasing   iiuiiiljer   of   community   liosl)ituls   and   their   Staffs   ire    .it-
                                            tempting   to    meet    the    standard    of    tli(@,    American    College    of    Surgeons
                                            foi- the 11)1)rov"tl of tlleii-                programs.    III    this    region    there    are
                                                    -eveii'lios  ititl I)rogi,:@iiis t]),tt
                                            only ,              l@                                       -Y   [tile   app@iT@,    and    they
                                            would    hope    t(>    increase    ttiis    through    the    regional     medical     programs.





                                                                                 36

                                        Tlic) Nortli Ciroliii,,t                          I)i,ogi-@tiii no
                                                                                                          w   0    11@ysi    accord-
                                        lll(-r to .1 I'L'I)orl, ( f 1)1.o(ri.ess, all ililli','Il:lily L(@t@ive Coo])Cl-l,tiv(@ itri-,tii@re-
                                                             t le itiijor (ri-oill)s                              -tiiiiiiig    find
                                        !Ilellt wit-II tll0   1                                  led Nvitli   )I,
                                        ilill)leiiieiii iiig c,,tiicerteti%,ities.L
                                        'rlie   cancer   .subcommittee   of   tile   I.(.gioiitl   Idvisory    LYI'OIIP    I-ovi(les
                                        :1 iiie(-,Iiini-,iii whereby alTort,-, c,:iii be I)et,toi- (@,oordiiiit@ed-,tnd tft"@cs  ii,iore
                                        il:ll)i(lly Ill(l Cil'O(@tively                  'I'liey        @ti@)Ollt  to   illiti:tte   I
                                        central caii(!er re,-Yistrv  ,tiid  t  central  c-,iii(@er  iiiforinttion  service.  Tileii-
                                        (Toal   is   to   establish   t   @vell-coordititte(l,   comprehensive   ciiiicei-   program
                                        with   full   participation   of    Stite    tgeiicies,    academic    at-reiicies.    coin-
                                        illuiiitv   lio@T)itals;and   professional   tiid   voluiit,,ti7   organi@,-,tiolis'.   This
                                        9                rating   g@oups   also    includes    it    special    cancer    commission
                                                         the Governor soi-ne yeirs ago,          before    tlie,,tdvent    of    the
                                        r                           in.
                                        The Noi,t      I   ri       program   reports   that   rnucl-i    less    has    been    ac-
                                        coml)lislied iii the        of   stroke   their   iii   the   other   disease    categories,
                                        but there is aii emphasis      in   this   statement   thtt   there   is   aai   intent   to
                                                         tiii   into    balance.
                                        bring  the  progr,
                                        Knowledge sufficient,       to  ],,ttiiicli  and  i-n.,tiiit,,tiii   a   meaningful   stroke
                                        I)roaram  in  both   iirl)aii   ,tiid   rural   Nortli   Carolina   communities   is,,ivail-
                                        able  tiid they litve ,tii       tpplic,
                                                                               ttioii   before   us    for    development    of    a
                                        coniiiiiiiii(y stroke program.
                                        I   Wealth[   Iii(e   to   just   mention oil(,, otli(@,]. t,liilllgl  ]lot  ill  L  categorical
                                                                 dire@r  for  hospitals.   In   tli(@,   western   ]@itit   of   the
                                        St:tt(@          SeNlell 110',I)i;ttls ill :I,-, many                        tre      facing
                                                                                             (.011 I Ill 11 11 tries t'll"tt
                                                   1)rol)lellls-tliitt fire, fl(.Ii])Lr t@lic            of             lip.
                                        I)'r.  Aiiios  Toliiisoll,  Who  is   it                   of    the    Aineri@@ii    Aet(l-
                                        einy   of   General   Prtctice,   told   the   l@C)8   Wtsliiii@rtoii   (-onfpreiice   work-
                                        sliol)  oil  i-(@gioiitl  i-tiedictl  I)ro(rriiiis  tlitt  these  ,(3veii  hospitals   Nvill
                                        be brought together in t coordinated pi-o(ri,iiiii            by   the   people   ill    the
                                        I.e(-Yioll. 'I'liese llo.'il)itils itre, I)reptre(I to go so fitris to apply as  it  Lrroul)
                                        for   :L   smile   icereditatioii   under   the,   Toiiit    Commission    oil    Ac@@dita--
                                        tioli of I'fosl)it@tis.
                                        Thus,  Noi-tli   Carolina   is   in   the   raiders   of   testing   tlie   concept   of   a
                                        iiiii(Ille  1-(@;zlollal  liosl)it,.tl  organization  where,  no   one   liospital'is   able
                                        to  rovide' the full r,-tn,-e of n        try capabilities.
                                             Kyitos. Think you
                                        Dr.  LFr  There  has  bee;i  in  the,  last   ii   yetr.,,-aiid   we   want   to   make   it
                                        (-]ear we  do  not  t?,il@e  credit  for  this  with  rc@  ect  to  the  region,.tl  medical
                                                                                              p
                                        ))rogl.:Ilns-,,I,   significant   decline   in   deaths   from   Itiali   blood    pressure.
                                        Tt, is about, it 20-I)erceiit. decline. ovei- (I)(. past, 3  yeiii-,,i.  I  think  there  is
                                        no qii(@@tioii tli'ltt its tile )-O(rioll:tl ll(,Ilit@ll I)IloLI.@Illis (Iev("Iol) activity find
                                        tile,            of ei 1.1-V (let (',(-t ioii of liyl)ei-i      find  early   ti-eittiyieiit
                                        1)(@(.,ollles lllol.(. :ivililill)f(@, we will See fill          of t-Iiis  very  s'lgiiifi-
                                           (le(.                     -,oiii-se, will        part          -1
                                                      Nvliiell, of                                icitl@ii  y  tli(i  stroke  I)rob-
                                        ]cut .11)(1, tot       (@X(Clit, tile, (I(@:ttlis f I-oil) (!or0iiitry (liscitse.
                                        Mr. Kyitos.          l,ce, pursuing tile, qttest  ioll  of  tile  effectivell(@,ss  of  tile
                                             iln, let's tliilili for it lylolylellt:II)olit cost-S.
                                        I)rogr,
                                        A s I iiiidei@stiiid it f voiii your t;il)le  I  f,  "lZe(,rioiiiii  Medical  Pro,(,,raiiis,
                                            II obligation of fuii(I-S foi- the fiscal                                            you
                                        t tot,                                              -v(mii-, 1(,)OO tliroiigrli 1968,
                                             approximately   $85    million,    citli(@,r-    iii    planning    or    operittionit]
                                        slioV





                                                                                         37
                                                           asiired against that       $85   million,   ]live   ou    inside    any    kind
                                              'i\'ow as me,                                                   y
                                           of III @ill',Ilysis  01-  eviillitt,ioli  Wlli(!]I.Sllows  that.,  foi-  that  kind  of  money,
                                           we   litve,,Ieliieve(i   soltie   significant,   advance   through   the    regional    medical
                                           program?
                                              I)i,.  TrF.  The  I)rogriiii  to  date  priinii-ily  li@is  been  one   of   i)lanninL,,,tnd
                                              'e,lol)iiig tli(@ in
                                                                (@(,.Illklllsiiis wlii(li then c@iii be evtltiitted. i4or  ex,,t'-M'  ple,

                                           W(,
                                              were   developing   the   dita   b@ise    Nvliicli    in    many    areas    is    seriously
                                              After  we   develop   such   t   (iitt   base   in    the    regions,    we    will    carry
                                           forwird   the   evtlii,.ttioiis   for   which    we    -,ire    asking    spezific    earmarked
                                           funds.
                                              I  think  it  is  really  too  early  to  be   able   to   state   ,vith   any   degree   of
                                           ceitLiiity t cost-to-beiiefit effect.
                                              I thick that we should              reco(_niize  what  I  think   is   goina   to   be   one
                                                                                                                             the      spin
                                           of the ii-iost significtiit contributions of the program. That is
                                           olT   of   benefits,   well   beyond   the   program   itself,   not    only    iii    torms'of
                                           people whose care is         paid for      through     medicate      or      medicaid.      For
                                           (,Xlliiil)le,   is   improvement   takes   place   in   coinniiiiiitv   hospitals   the    w.@y
                                           I)i-.  'iN,[,,trstoii   (Described   it,   is   physicians   ire   abl;   to   Participate   in
                                           these  ])I'Ogrlli-is  ill   community   hospitals,   the   I)rogritiii   is   bound   to   have
                                           ii,sigiiific,,iii l,iiiiptet,oii iiiiproviiig(iiiitlity.
                                                               ',St@ II)IIY ill itic@(ii(.Itl A.;Il,(@ I,, ,'oo(I  care,  liigli-(Iiiitlit,y,  tiid
                                                 to 11)(@, is L'oil)L' to 1)(" oil(.  or  I,114@, latest., important                 (!oil
                                           tril)'Iit-,ioiis of the program. And I Lima]( trial i,,-Oii(@ of tli(@  i-ei,soiis  ill  I  fit
                                           NN,e s(@(@    l(iiiii of (@litlilisiiisti(-, Sill)l)ort@, itillolig                  physicians
                                           in iii@iiiy 1):ii-ts of     cotiii(i-y N%,Iio w(@i,(@, itt@, transit really  very  suspicion,.;
                                           of t@lle I)rogri III.
                                              As tli(@y liii,v(@                      :Is tli(@y li:Lv(@,                  they     llltve
                                                                      (!]it             INr(" will 1)(@, (Ievu,]()I)iliLr for tii,i-s st)ili-
                                           oil,  ,,olllo  tk@A@iiiii(Iiies   for   measurement,   so   tiitt   we   call   determine   the
                                           ,L(I(Iitioll,t] (@)iiiiiiioiis of t lit-, 1)rogi-:Liii.
                                                   .1@yizos. I)r. l,ce, ill cars  bill  list  it  is  I)rol)o,@d,  I  iiiiderstitiid  that
                                           $6,@) i-riillioii is -x)iiglit, for the fiscal year calling Julie 30,1969.
                                              I)r.       That, is correct,.
                                              @Nlr. ICYROS. IVII"tt ctrryover of funds will we ql"tve
                                                                                                                 for     this     program?
                                              I)r. l,i,-,E. The carryover is,%30 million.
                                              @Nfr.   1,CyRos.   So   of   the   tpproxii-nttely    $95    million    we    are    talking
                                           -il)oiit,, vou li(tve $30 million iinobligated as yet.
                                              I)r.  !,,iF.  Yes.  That   is   held   in   r@rve,,,actutlly,   by   the   Bureau   of   the
                                           Iiiidcret
                                              -Nir. l@YIZOS. My )Iext
                                                                          question    is    t    zeiieraloiie    about    your    program.
                                           Ills   t-li(3   Ainericitii   Medicil    Associttloii    now    eiidorsp-,&    this    -progrim
                                           ,Ls it@ is       ctrried out?,
                                              1)1'.               I think    the 1)("St Iliswer to tjiftt, is .t  ).,tl)er  t-li,,tt  I)r.
                                           I)%N-iLrlit IVill)ur (rLve ittt                   ivc)rl@,iliop-wllicq   Ills   I)CCII   Pill)-
                                                     iii  the  current,  issue  of,  .[AillA.  It   is   very   sitl   I)ortive   of   the
                                              ;Nll.. ]@yitos. What does tli-i,,                  (to   for   it   general    practitioner,
                                           Say  @ ill, IL illivi-tl aret like, in i-ny owii     of Maine?,
                                              1)1-.       I  might  IUI(L  oili  inner.  f@f  the,   AINIA.   litts   eiidoi@   it,   tli@
                                                                                                                    so
                                           :ti-P, ;tctioiis tli4tt would have to be, tltl@eii by the           liou     of      delegates.
                                           'Ili(-,y would Iiitve to vo
                                                                           te   oil   I   resolution   saying   they   endorse   iC,   and
                                           I am not stire that action has bwii t.-,-tkeii.





                                                                                    38

                                             l@ylzo"@. ]lilt, t Ile I I

                                               @-I)II tell iis                  I)ONN- :1
                                            gets                                     S:ly t.        is 11 I-(@,giolliti I)I.ogi.-Itill ill
                                                                                 I)ilt 11(@ is ill t          t@o@%,Ii limit (lovsil't

                                                                                                        to                             it
                                                                                                :tire   iii)   wlic@re   I   left@   off-
                                         )i-ol)lciii-ii-gaiii in Nort]) (,':troliii:t, to t
                                         I
                                         of ;I, (.ollllllllllit. y t,liit AV',IS -,Il)otit to Ile, N%-Itliollt t I)IIysi(@,itll, tll(l  tile  1)(@o-
                                         I)lo ill tile (@oll)iiiiiiiity ttii-iii@(I to tile re,rioiiil               pro(rrttiii   for
                                         ,assist,  -,e.
                                         Tlio re(-,ioiit] 1)ro@rrtni was tl)le to exiiiiiii(@, wliitt. the I)rol)lenis  were
                                         in Li,trtetiiig                to   tliit    community    tii(i    growing    Out    of    that,
                                         tii(@,i-e, li.Li (lvvelol)ed -it rttlier m,,tjor study !or tJi;tt region in tilp, prol)-
                                         leiiis of the rural tmt.
                                         riie ),-iiciptl example, I think, is tii eisy One,:  The  trqdition  of  the
                                         Bii-ii-iiiigliaiii  Associites  which  its   you   will   rec,.tll   from   testiji-iony   16ad-
                                          to  I),ISSIge  of  this  le(risittioii,  was  held   iii)   as,,t   model   of   ]low   various
                                             -institutions   and    resources    cvii    li:iN@e    t
                                         li(.41.lt,li                                                relationship       through       tii
                                         or(r@tiijzttioii   such   as   the   -,tssocittes.   The   activities   of   the   13irmii@lliam
                                         kssocittes   ire   beiii   expanded    ',til(I    CV'Tied    further    I)y    tl-ie    regional
                                                                   9
                                         medical proor,,tiiis.
                                         'I'll(@i-otre ft  jr.,triety  of  other  things  I)ciiig  done  to  -,is-,i-,t,  the  I)hysician
                                         ill      arets        where no    liosl-)itil    exists.    There    ti-e    opportunities    for
                                         liysici,,tii,,   from   one   pvrt,   of   Wtsliinatoii   St,ittc@   to   come    into    -,iiid
                                            tlly spend tii-n(3 in              liosl)it,,,tls:'Tliis includes ftii ex I  i g,
                                         ,total,                                                                         c )'it I  ('    ,o
                                         t,liit  Someone  ltrr,.-Liiges  to  ttl<e  ovei,  t@lieir  I)rtetice  for  a  period  of   time.
                                                   tll(@  iistitl  (.continuing  ediieitt@ioii  1)rogr:tilis,  ])Ilt.]@  think  with   it
                                                                         the eiiij)]litsis Oil (]OiilLy  tll@S(@,  things  tllftt  1-neet
                                         the needs of the physician rather thin ofTeriiig it course                    that   is    I)rc-
                                         -kle@,d for him.
                                         The difference has been tliit the                            is    involved     in     decisions
                                         Iiiid  in  planning  in  terms  of  his  needs   @atlier   than   coining   in   at   it   later
                                         stage.
                                         There  are  tlso  other  ftcilities  or  scri,ices   in   :i,   iiiiii-iber   of   the   regions
                                         that   are   planned   and   will   be   implei-neiited   for   the    physician.
                                         Dr.  Lri,,..  I  would   just   add   -,another   coii-imeiit,   on   initiated   this   relites
                                         to  a  I)ersoii,,Ll  cxl)eri@iice  I  had  visiting  Viiiel  I-Ttven  I-,I,,tnd,   where   there
                                         is oiie physician in               practice.    I-le  has  been  tble,   to   ,tttrict   occ,,t-
                                         sioii.-tlly third- tild   fourtli-year    medical    students    to    come     ,,Liid     spend
                                         ])art of the staining witli Iiiiii, -.tild  this  li.,ts  I)eeii  t  trei-neiidoii-,  -stimulate
                                         to Iiiji,i. It has I)rovided Iiii-n tells b(@st-, I)OSsil)le o )I)ol-tllllity  to  ](eel)  111).
                                         Til      ,tlso         t. unique e(iii(!,ttioii,                   for   tlicittideiit,,,    be-
                                                                                                                   I ,  -til(I
                                         (!;Lils(@ 1)(@ol)lo   ]avoid tliei-(@ foi- iiiiiiy, many
                                         sllil)', Nvitli, for                                     late               NVIIO        I)e,(@ll
                                                    ill (Iiltl)(@tes ill this               I)OI@iil;kt,ioll g  111).
                                         lilt I.(@
                                         Ile ]it's been            to ]Cecil 111) fill- more
                                         I              '11)(I ol)O of        things talent-, is I)eillg CXI)Ior
                                                                                                                    (id  in         I)ro-
                                                                                                   fourth
                                         gi-:i,lll is the i).I,rticil);ttioii of treat'                 -yeitr     medical     students-,
                                         ill t-,Iicso coly)lnllllity 110SI)itill t@citcllilig I)I.ogriiiis.
                                         The   development-.   of    reaching    i)rolyritiiis    in    community    lio@I)itltls,    the
                                         extension    of    ikacliing    prograi-ns,'Wiil'attract    young    physicians    to     areais





                                                                                                                    77@@,





                                                               otherwise                                                                 ft o  C(,
                                                     tli:il NN-oiild                                                                       v      b       n
                                                     I                                       ns in         ,,,,!varsity      (@,nteN,      ftn(I       they
                                                     lls(,(l to     t(@:I(..]Iillg I)rogi@:ti
                                                     ll.,tN,(Itcll(le(lilot.,tow,illttogot,oo l@,tr
                                                                                   rtiinity    to    Ixel)    up    I)rofessioll"tlly,    to     inter,,tct
                                                     Iiiit T. t@,liiiik  the  ol)l)o
                                                     with  other  1)eople   ,tnd   wi'tli   stiideiits   oil   t   continuin(r   bl%S'I'S,   will   be   an
                                                     td(led benefit.
                                                     @A tiiie is :t very ,,,ood extiiij l(@ of tli(,,             of   the    coiintt-.v    to    ,tttr,-wt
                                                     pIlysi(,i:tlis to areis ot,lier I,li;tii                  itreits where ITiost  O@f  tIlCM
                                                     I   t-Iiink   tliit   the   regional    medict,l    pro@rtms    ,tre    m,,tking    tnd    cin    eon-
                                                                                                              this.
                                                     tiiiuc to n-i,@tlizo a sit iifictiit contribution
                                                     ,\fr. Icynos. I lilvc One              (illestioli,     Mr.     Cb,,tirmtii.     That     is     this:
                                                     Yoit li,,Lvo wcii the I)rogr@iiii in ol)crtt,ioll for :t coul)](@, of ye:irs now.
                                                     Wli:tt' (!:III Yolt @,uy tl)ollt 411(@, f:LK@,i, I ]let, i@Iiis is              illoll("Y, tl)@it
                                                           t   possibility,   ,Ilwtys,   when   iising    Fe(l(@i-:tl    ftiii(Is,    tlitt    the    Fe(l-
                                                     (,Ioveriilrielit gret,,;  -,Oine  Iciiid  of  (,oiit@i-ol  over  the,  i-riediciiie  -,tii(I  iri(@di-
                                                     c 11        Yoti  Iiiiow,  we  li(,,tr  this   -.vll   the   tiiiie,,tii(i   we   iii-e   (!oiieeriied
                                                     al)olit, it,, iiid I wouldn't, want, to see Fedej-,tl control over iTic(liciiie,.
                                                     Ilow   c:iii   you   sty,   sir   ,ts,,tdmiiiisti-atoi.,   of   this   program,    tli,,it,    Federtl
                                                     (control   is   not   all   ciicroaeiiinciit   oil    iyie,(Iic-,il    I)r,,tct.ice    through    this
                                                     I)r.                I    think    this    coii-iinit,t)ee    took    tv    very    iml)ortilit    step
                                                                             -illy veto power
                                                             @tv(,, es,,eiiti,                        to the regional          dvisory             gr?tips.
                                                     This iii(-,,iiis that we ciii1lot,              oil the iiitioll.,tl    level ,Iily 1.0(,rloll;ll
                                                     ol)crat@,ioiiil -,iotivity t,liit    not,   lit(l    I)i-ior    approval    (yf    ,the    appropriate
                                                     R(,,,),ioii-.tl Advisory Grou  . And this is ])erlial)s the.               strongest,           point.
                                                     r                   t, s        p
                                                     rlio other 1)oiji        tli-.It,,igiiii,   the   Sili-,-,(,,oii   General   is   limited    by    the
                                                     fact  that  every  application  iiiiist   be   I.e,(.Olilllle,                                     the
                                                                                                                  iided for ipl)rov-,tl by
                                                                    Natioiitl     Advisory     (oiiiicil     oil      regioiiaf      i-nedicz-LI      1)ro-
                                                     'tills.   I   think   I);tsicilly   these,   are   the   two   sharpest.   assurance-,   tlititl   the
                                                     gr.
                                                     coi               -iiiiit the regional level.
                                                     itrol w i 1 1 reiii.,
                                                     .8,   third   assiii-,.tiice   is   that   the   I)ro"rl.,Ims   111-0   working   with   the   control
                                                     I'Clllllllllllll- tt, the, regional  level. @l'liis   is   I-eco(rilizeA   I   tliiiilcl    "it    the
                                                                                   tlirouf_rlioilt tli(@ (Country.
                                                             -1.1tos.  Yoli   II,(IV
                                                                                   o   lii,(!   no   f(Tdl)iu(,Ic   of   tiiy   I)rol-)Ieiiis    concerning
                                                                   of              control  lil@c  we   li:tve   liid   ill   I)rogr-,tllls,   stiell   its
                                                     Of@,O .
                                                     'I)i-.      I  tliiiil<  tli(@r(@  wis:i,  gl.(@:tt,  (](@ll  of   speculation   that,   this   woiild
                                                     I)o -tll(@   'I'lle I':t(t t-litt. it li:is ]lot I)CCII t'll(@         the    ft(@     tliit     there
                                                                                                      ])V                    I)IIysicitlls     ill      the
                                                               (Yf t@ i(@ I)I-o    :iiii-,   ,tild   :is   the   operational]   I)roLri-iiiiis    develol),
                                                     thin          of                                  tli             :tr
                                                                                          t,ii(@ f@       It                 800       hospitals       with

                                                     I' A%.olll(l I('                    Iiii(y 14)         I)r. Winston sit.i(l. I think  the
                                                             )f this                    and   the   )(Tio(li(.,   ()Vel.si(-rllt   (yf   the    I)rogr;tiii
                                                     i)Y tll(-l  (',Ollgl.(@,qs  is  tllot-lit,@r  t.,isiiritil(@  to  1)liysici,@iis,  with  the  law  its
                                                          -itt,c@ii   tlivt    there            (I
                                                     it is WI                      will not I)    Federal control.
                                                     ('v,rt-,tiiily,   the   way   in    which    the    pr(yariiii    has    been    ,tdmiiiistered    has
                                                     I)mii   jiist   in   the   opposite   direct-io    to    @imulttte    to    the    maximtini    extent
                                                                                                 n9
                                                     possible,    local    initiative.    Those     who     participate     have     to     solve     their
                                                     local    differences,    which    have    been    considerable    in    some    of    the     regions.




                                                                                                                                                          @7





                                                                                  40

                                       Soilio pml)le have felt that the                      w@is   iiioNiii,(Ir    too    slowly,    but
                                       it. t:llw,, t-iiiio to work out difrei-eiiecs wlii(-Ii late lojig existed.
                                          liiit. is we view i,t) the wtv we           I)I.orek,(Iil)g giN7(!S tll(-          I)OS,,iil)le
                                                                                        it,  is  stiiiitilittiiig  local  ii'itiiitive
                                       follil(l:ltioll  fol. tll(', pi-otrrai 1  beetiis(l,
                                          @Nl I,. I(Ylz()S. I :1111           to  ]I(.;Ir  oil  ,;fly  illikt,  Dr.  Lee.   I   Iciiow
                                                                                         y
                                             III%,               I'l-oill 1:11]iilig %Vill) (I()(@ !tolls ill I 11(@  of         Mitill(@l
                                       that        iiiiiik tli(@ I)i-o,ri-:iiii is ii.ii olit.,4(1111(lillg  ol)(@,  that.  it,  (lo(@sli't-
                                                  oil t       iiii(I I I liiiil( t his is it        lo your ll(,Illlilli,"t I-iti i(YI1.
                                          Tell :11-e, (]it, 1)(-ol)l(-, Nvlio )live, to (to :t Iiiii-d  iol),  iiii(t  I  w:tiit,  to  (-ojii-
                                                                               -liig IL 1)1-0(,O.
                                             N'oll lli'Yllly 4)il ;I(lll)illistel,                        this,   which   is   (-,oin-
                                                                                      of the   iiiil)ortiiit     r(@littionsliij)      be-
                                       t.w(,(Ill (lo(.,tol-S fill([ 1):ttieiit@s.
                                          'i,oll ]iiivo (toll(@,lii oiitsl iiii(Iiiigjol), and ltin I)roud of you.
                                          lAll.. lzo(,.],Its. Mr. Cqi-ter9,
                                                          I  notice  tllftt  t]IP-  IIOW  bill  will  include  ,tn  ftiitlioriz,,ttion
                                       for fluids for                  of   alcoholics,   IIid   it   will    also    include    funds
                                       for tre,,Itlylellt, of ,tddicts, too.
                                          Dr. I.,r7,-. Yes sir.
                                          Mr.   CAnTiiz.   How   much   will   that   be   this    year',,tnd    next    year,    your
                                       additional authorization?,
                                          Dr.   1,FF,.   The   amount   trill   we   have   requested   is,   for   the    alcoholics,
                                       $7   million,   and   for   the   narcotic   addict    rehabilitation,    $8    million,    and
                                       ill fi,,cil   1970,   $15   million   for   the   ,tlcoliolics   and   $10   million   for   the
                                       addicts.
                                          Most,   of   that   illoiie_y   will   be   for   the   development   of   services   rather
                                       trivial  (-contraction.   Tt-is   ,tl)oiit   ilO   percent   for   construction   or   reiiova-
                                       tioil of
                                          Mr.             Will   these   treatment,   (!eiiters   fol-:ilcoliolic,-,   find   narcotic
                                                     Ill             I),trt,  of  the  iiieiittl  ]rental  centers,   or   will   they
                                          I)r. T,i,,i,,. I would lil@e to a-,Ic Dr.  Yolies  to  fiirt,li(@,r  eltl)orat@e  oil  that.
                                          Dr. YOI,T,],',S.                        facilities,   Dr.   Carter,    would    be,    built
                                       i)lto fit(" (.out) iiiiiity health (-eiiteriiid Nvoiild be  fill  iiit(@,zrtl  T).Ii,t  of  it.
                                                                       t lp
                                                                                                    oi. lioillel(@'g":I,](.Ollolics to
                                       this (.cadmium of S(.I.%,i(@es. 'I'llis is  tlit@,  li(@y  I)oilit  ill  fit('  legislation  to
                                       i-el,,it-o iii(@,s(@ s(,rN,ices for ti-ettiiteiit of  il(,olioliesiiid  ii:tr(,otict(idicts  to
                                       tile, totil I):Iliol)ly of @rviciNs iii the community health center.
                                          'I'llev    July    I;e'pliysicaily    sepiriteal,    but    there    would    be    adequite
                                       triiisf-@r of -I)atie-nts   i),iid  records   between   the   services,   just   as   iii   the
                                       basic program.
                                          Mr. CAR'I-fPli.  I  think  that  it  is  good  that  it  is  so.  It  will  be   less   dif-
                                       ficii It, as I see it.
                                          I  lioti(@e,  threat   ill   your   regional   licqltli   development,   11   regions   have
                                       been f iiii(led. Istli,,it rifrlit?,
                                          Dr.   Lil,,.   Yes,   11   operational   grant,,   have   been   funded,   and   53    plan-
                                       iiiiig Lrr"tllts.
                                                          This is iii its iiiftiicytt the I)reseiit time?
                                          Dr.                is correct, sir.
                                          Mr.               Of course, there has                it  decrease  iii  t-lic   number   of
                                       stl-ol(es iii the,, I)iist                 you   really   wouldn't    itttributo    all    that
                                                                                 tlic.,-oll regions?
                                          Dr.         No, not itt all, Dr. Carter.




                                                                                                                                                 7'
                                                                                                     '@7





                                                                                        41

                                                                          t wtnt to inil@)ly           either     these     -programs      or
                                                 I tliiii]@ we .vould no
                                                 soiiie of tli(k otlici-                      1)0(,ii  iiiitliatc(.1  in  the  last  3  years
                                                                                              would   in   ,tii   way   litve    tlone    so.
                                                 that' li,-tve I)eeii iii,,tl<iiig good I)i-otrj,(@ss         y
                                                 T@liey July have contributed, but                  as   fir   as   the    national    figure
                                                 iscoiicerne,d, it woiildbe ztsli(,Ilt (.,Ollt,l.il)lii ioii to dite.
                                                 .Nll'.  ("Alt'rillit.  Actii@illy,  tliei-(@  are  iin,l-)i-oved   methods   of   treatment,
                                                 re,,tllv,  dilTereiit  iiiediciiies  used  in  treatment  of  strokes  tli,,ttli,,tve   been
                                                     responsible forthis.
                                                 ])I-.      Yes,   sir.   I   until(   the,   ilill)lloved   @Iriifrs   tn(I   the    earlier
                                                 diagnosis  of   the   liyi)(,,rtensive:ts@,ittio;i   LI),,ttltliey   get   under   treatment
                                                 at,iii Carl ier sttge @f the  disease  have  coiit@ributed  t(;iliis.
                                                 'Nlr. CAITTFR. I would like to know
                                                                                              how    the     specific     organization     of
                                                        ,is. Could you give us ,t plan
                                                 a region                                        who   is   head   of   i@t,   and   how   it
                                                 branches do-%vn?
                                                 Dr.   MA'RSTON.   I   think   what   one   needs,   Dr.   Carter,   is   the    organization
                                                 of inore than one region to -,tcliieve what you want.
                                                 The  one  tliina  that  has  to  be   est,,tblisfied   in   each   region   is   a   broadly
                                                 representative   @gion,,tl   advisory   group.   It   is   a   requi@ment   of   the   lal*v
                                                 that this be established.
                                                 In  every  region,  so  far   .ts   I   call   rei-neinber,   there   %re   task   form   in
                                                 the   areas   of   heart   disease,   ciiicer,   and   st,rol<c,   which   include    people
                                                 Nvitli -;Peci ,II knowledge in these ,ireas.
                                                 III each i-(@,ion          is also :t core    :i(iiiiiiii,,ti-ative unit,  it  ,t,,tff  that
                                                 v,ti-ics in size. But-, oil t-,Iie, itvt@i,il(-ro ill tli(@, lesions -funded foi- 1)lrtnniiig
                                                 oli]Yi i@t-, is :tl)oiit, 20 to 2(; I)eol)i('@, and in the ol)eritti(iiiit]   regions,   I-lie
                                                                              oil 'tll
                                                 Ol)cr@tt,ioll of the,              is S(@t, fit) (lifr("],ellily ill
                                                                  tli(,,r(@ ii-  10                 fii Kttiisii.,  there  tire,  l@)  sifl)-
                                                 I-egioiis. In  Georgia,  there  is  real]  it  S114)1.egioii  for  e,@iell  (.01int,y,  with
                                                                                          y
                                                 -el)reseiit,,tt ives f ron-i every I)OSI)ittl in  the   St,,tte,   and   -Nvitli   representt-
                                                 tives   from   every   county   @iedic,,i]   -,ociet,y.   T]i@   local-level   groups   -@@e
                                                 active  in  determining  @li(@,ir   local   need   -   In   some   instances   these   units
                                                 tre cilled local ,idvisory groups.
                                                 Now,  to  come  to,,t  specific  re(,rioii,   in   Kansas   these   local   action   gro@p-,
                                                 may   either   respond   to   information   t,liat   has   come   from    studies    carried
                                                 out by the regional stair or                                 ups   in    the    State.    Or
                                                                                     'indeed, other gro
                                                 the   local    action    groups    may    propose    projects    tflat    they    themselves
                                                 identify is being p,                       ed in tliftt aret             -i,,rning     @hes@
                                                                       trficularly need                           In des
                                                 projects,  the  local  tction  groups  can   work   with   the   staff   of   the   regional
                                                 medical program, calling on experts from outside of                    the    region,     if
                                                 necessary.
                                                         on the bisis of sciciltiriciii(I 1)1.-
                                                 reviews                                           of-essiollql   ]net
                                                 Fill-,Illy, -,Vitli t@lie          of  this   review   ,tvitil,,tble,
                                                 Wlli(-,Il )early )live been stilillil;lt(@(I eitliei, it, the local I                      ve
                                                 1)(T,ll sti II
                                                        in  ltted -,is the           of  ditt  til@it,  his  been   ga                      re,
                                                 comes before t@lic regional advisory group, which i-niist approve                          ,tll
                                                 operational projc(-t,     rol)ostllls.
                                                 A. recent    exai-nple lo)f- Islas            in   Ktiisits   resulted   in   il)out    half
                                                 of   the   proposals   that   etime-   to    the    regional    advisory    groiii)    being
                                                 returned   to   the   originators   for   one   reason   or    another    for    a&ditidiial
                                                 work   before   finttl   approval   tit   the   regional   level.   After    regional    ad-




                                                                                                                                            7i





                                                                                               42
                                                                :11)1)1.ovlll is g:lill(@(1, :I               I)I@i)[)o@tl    fol'    filli(Iiii"    J)I-o-
                                                                   (,ollles to tile I)i%,isioll of
                                             lkt' tiii,,, I)oilit, ll'(@        tilt@ ol)l)ol-tililitN  to                                 %,i,,its    Is
                                                            fli(@ (@.Ise, of tii(@, W:isiiiii@'tol      I-.kiiisli;l
                                                                                                                              ioll,     I
                                                               Ilk this (.:I"o we li(.t-,iiillv                  tile lo(,@it,
                                             ("(@ts NVOI-O, I)I-ol)o@(!(], iii(I            i i-(@,I)oi-t, to oiii@ review                         itil(l,
                                                                                      I%,isol.
                                             iiizilly, to otii- Nitioii:tl  A(                    ('olill(@il.
                                              T)o(@s   tltis ])ell)?,
                                                                   'Yes, sit,; tilit, is licll)flll.
                                              Wli@it@ 1)i,o(-(,,(Iiii-es do yoii              for (,oiitiiiiiili,,r                   t.,o  get  to   tllt@
                                              lici-,,tl                     :tiicl coiiiiiiiiiiities yotii- ;i(IN,ill ces ill I-esc;tl.(!119
                                                                      Az,,-ciii, this            varied. 'riier(,.                j)ceii sokii)e     iii-
                                             strike,,; ill wliicli ,t     @,oml'i-iiiliity too]( fil(@              Greit liciid, loans.,              for
                                             example, li-,is esttl)lislied all edticat,ioii:il  stil)ceiiter, if yoii waiit,                            for
                                             li(@ trc@t ii-nDledi,,itely ,;iirroliii(Iiiig Great Ileii(l.
                                             t
                                                 riie  )iiri)ose liere is to try          to  foe-tis  edticatioii  aiid  to   fociis   ctre   is
                                             clos(3 t(; tli(, I-):iticiit's boiiie ts I)ossil)le. Aiid  ill  the  iiistiiiee  of  K-.tiisas,
                                             Y61 11 fiii(I  this  foatis  ]its  I)ecii  iiiov(@(I  oiit  twty  from   the   iiiiivei-sity   to
                                                                        I)reA@xistiiig I)i-ogi-;iiiis iiii(i f:l("ilities ]iitve 1)(@eii  iiti-
                                                  ---All);iiiy,  N.Y.,  foi-  example,  ])its   ;I.   tNN,o-w;ly   radio   system   Wlli(-Ii
                                             ])I-oN'i(i(@s                  e(ill(.@ilioll ilil-oil".Ilolll             of tli(-, New
                                                                                                   I)y   tli(@  AII)itiiy  )-e,,riollill
                                                 1. %Volll(t stay (@()Ili..illiiiilg                              t@o  file  I)IIysi(!i:Lli   and   t@,11(@
                                                                    :is ol)])oS(@(I    to (@,olitillililig                   little,   ,,oin(@,I)ow   Iiits
                                                         Lw:ty from t.11(@ (@,11-o of                       is  it  very  illijor  fo(.Ils  of  tile
                                             program.
                                                                    1)()  voii  litvo  regional  seiiiiii,,ti-s   oil   iieiv"   concepts   in
                                             ille(li(,illo               I)Y                        from tile
                                                                      "I'll(@1-0 Wlt, :1 IYII,jOr Oil(', in Oregon tliitt            it ii@ieii-iber of
                                                                                         :ILYO.
                                             illy  , i If  ttteiide(I     not loii(r
                                                 Air. CA]TTFIZ. Tii(3 1)iirl)ose of            this I)ill is to dii-niiiish           deitlis    fi-oiTi
                                             lieirt, disease, cancer, .iiid strol(c.
                                                       oii  hive  aviil,,tl)le  to  the  I)r,,tetitioiiers  in  tlie   sul)r   gioiis   close
                                                 Do                                                                                    e
                                             liaisoil  witli  specialists  in   the   regional   treas   so   that   they   can   get   iii-
                                             foi-iii,,it,ion qi-ifckly, or advice, or lie]]) in trettmeiit?
                                                 Dr.  MATZI;TON.   There   is,,til   example,   ill   Wisconsin   of   t   24-lioiir-a-d,,ty
                                             telel)lioiie,  service  to  i)liysici,.Iiis  in  the  tre:t.  Tiiere  is   a   specialty   team
                                             in Tow,,-L that li,,is I)eeii ,tctiv:lte(I to            Ictiitlly  Lro  olit  to  the  -,ceii(@   and
                                             I)ro%,i(l(@ (,oiisiilt@,i.tioll to tIlo lociti I)Ilysi(@i:tii ltii(i Iii,, -,trol,:e patients.
                                                                              is 1).Il.t. of Yolli- i-egioliitl  systcyll  lit  tile  I)I-CSCllt

                                                 ])I-.  M'Altl;'I'ON.   Y(@S.
                                                                    'f %VIllt, t@4) ('()Iigl.:Ii allied Yoll oil t ]fill-. I' t-,Iiiiilc t-,Illtt. is  very
                                             good. I                          t,lit.L I-lieso i(ieis oil              (Itiest,iolis wliicll  I  ]leave
                                                      Yoll Slioll](I 1)(%                 illil)lelli(@lite(ig if I)OSsil)lc.
                                                 'I'll:tillc Yoll, Af i-.

                                                                                              oil lliis                     till(I I am  frotyl  tll('
                                                 I)o(!iol. I finite t           lll(.l
                                             gl.(titt@ St.,Lt@(@ of Xtiists t.Ilitt-, Yoll                      1)].Itisiiig so Iiijrlily.
                                                 Doctor, I am iiiteresteal in a iittiyil)cr of filings.




                                                                                                                                                   7




                                                                        to ,ay                           tll("          t'lifit,  you   tr(I  I     iitereste,(l
                                                                                                                 ey to            this      show      oil       the
                                                                     liol)(@ W(@
                                                                     ioii(@,y    ivas    tiitliol,ize(l,    I)o(@toi-,     for     these     regional     i-nedical
                                                     110AV iiiiieli )I
                                                     progi-aiiis iii I()C)C)?
                                                                                                     Nvils $50 i-ail@lioli.
                                                     'N,fr.  Si@I)I@ii
                                                                     Z. I-Tow            wts:tl)l)i,ol)i-itted?
                                                                     -N. $2,@-)  inilli
                                                     I)r.   'INIAIISTO                  Oil   inclit(iiii,r $24        niillion          for           grtiit.@,$25

                                                                     Z. Ill 19c)
                                                     IN I,.  Slitil@il            7, how      iiiii(@li wit,, iiitliol,-izc(l?
                                                     1)1'.    'INfAl@"]'()N.    rlic    tiitllol,izzillioii     Nvi,,     $00     million.     The     tr)propriit-
                                                     tioli   Nv;ls   $il:l   illillioll   for   (rl.;Illt,;   -,tiid   $2   nilili.oii   for   direct   operations.
                                                     Mr. Si.:uiii,i,z. You ]I-avet tott] of ]low
                                                     T)r.    'iNT,@its,roN.    $4r)    i-nillioii    was    il)l)i-oi)riited     for     1967,     $2r)     million
                                                     11)1)rol)i-iated for 1966, so that would be t tot,,,il of $70 million.
                                                     -,iNfr. @Sl,:TJI@ITZ. In 1968, how much wis @tutliorized?,
                                                     T,)I'.               $200 million. We li,%ve received $53.9 million                             in         ap-
                                                     prol)riitioils  for  (yrants  and $4,900,000  for  direct  operations,                           for        It
                                                     tot,,,tl of $58.8 iyiil]1011.
                                                     Mr.    SL@UTBITZ.    Ollt    Of    this    total    iiiioiiiit     of     tl)proprittioiis,     how     i-nuch
                                                     do you litve,,tvtiltl)le to you now?
                                                     Dr.    1\1,\IZSTO-4.    $5i3.8    Illillion-iiiclii(IiiiLr    $4.9    i-riillioii    for     direct     opera-
                                                     tioiis.   I'Iiis   totil   is   coi-nl)rised   of    $27.()    million    of    our    19C)8    -,tl)proprilt-
                                                                                                                                                                  y-
                                                     tioii-$30.9 million wis put in reserve-pltis $2.).,9                           .,nillio-n       in       citrr
                                                     over   funds.
                                                     Mr.   Sii-ciiiij,z.   T@lic   tliinz   tli,,tt   botli(@rs   iiie,   I)oct   or,   is   tliat:,    you    come
                                                     lici-C with  ,tii                I)r, griiii. It, It)olis fiii(@ oil pti-)er. ]3iit, iiiil
                                                                                         0
                                                     t-,Iiiscoll(rressgivesyotilflolle"vwe"tc.(-,Ollll)lisllllotl)ill                                 Sofitraslllim
                                                                                                                                    9.
                                                     COII(IerD(@,d,  I  -%vaiit  to  be  ,is  licf'pfiil  its  T  c,,Lii  to  as-,ist,   you   in   this   ii-npor-
                                                     taiii-, work.
                                                     ri, a,, ic voii, Ai,.. (' litiriii,,tii.
                                                     I)r.            I'woiil(l   like   to   nl"tl(e   tii   it(l(litiollill   co1iiiiient    oil    thwart,    Mr.
                                                     As   t@lie    pro(-rr,,tiii    has    developed,    of    course"    wibli    4,'Ile    evolution    of    the
                                                                 tlio",,ttitlioriz,,ttioiis    were     well     iill)ove,     those     required,     tiid     ,is
                                                     we  I'flovc into     the     operational     I)li,-tse     we     feel     tlitt,      of      course,      si
                                                                                                                                                                  9
                                                     ilific:iiitly lylore funds -,vill be, required              with      t,lie      opertitiiig       pro(,Yrams.
                                                     Planning is one thing, Iiiit operating I)i-oLri-ain-, is quite %ii(ytlier.
                                                     "\II'.   (@AWr
                                                                        Mr.      Cliiirnllili,      would      the                        eld?
                                                     Tiist; liow ]its this inoiiey been Spent I)octor                      ,,()St Of it?.,
                                                                           illoll(',.V,   PI-iiii.,Irily,   gross   of   (w)ilr.@,   foi-   the   aiiiiiini(,    of
                                                     st:til' :all(] foi.                    of tllo stiff, ill Sol)IC ease-, for the I)II                      lase
                                                     of                                               of  (-.oroiiitry     citre unit,,      or      for      long-
                                                                                      of                          wlii"cli  is being         testADd   oil    11,11
                                                              l@ill(I of telling, St..,ttr itii(I                          .vliieli      would      lw      related
                                                                          I)o You '11)LV(@ 11,                   1)lji@@o in                       to     wlii(,,li
                                                                                                                                                              1)ro.
                                                                     Not,  ii,  e:i(,Jli  i-t@gioii.  I  t!liiiili  tilftt the experimental
                                                     gi-  is (rollig oil, in Mi@tiri.


                                                          93-453 0-6






                                                                                                                 71





                                                                                   44

                                         T)i,.               Tli.,it  is  .1  lli:ijoi-  oiie,  wliieli  ]its  been  siir)ported   by
                                      tli(, N;itioii:il            foi- ('Iii-olli(. I)ise:ls(! (,olltl.ol ovLI. tll(,@ ]list r) years.
                                      It is         fi(,](l        ill illissoill-i ;it the

                                         I)i-.                  Yes.
                                         Arl..             I)o voll VIIN,isioIl  ill  tile  fiitiil.e  t'lle  Ilse  of  sticli  ceii-


                                                                t@li:it yoll (.:Ill                               Ill(]  that  it  is
                                                                                                               w
                                                  l'i@oll)  :1 (.0st, stlill(il)oilit, that. ot.11(@,l- 1-(@(,.iolls ill t,])('Il. lvtlit,
                                      to             Silililill' I)I.otrl.llll)s. lt Italy be tll),tt t                       set-i-c
                                                  ]nor(, t-11.111 one                                            (IOPCII(Iiiig    Oil
                                      t,li(,, kiii(Is of I)i-o(ri-:iiiis ti).ti, ;11.(@          'il.]( 11 t-, lititol-ntt(,@d iiiiilti-
                                                             Fol.  ex;tiikl)le,  to  (I(@,tect  Solii(,,  of  tile  disetses   cirly,
                                                                                                         tli(@   develol)i)ieiit   of
                                                                                                        otlier  ,t(lvtiices   t-,tl<c
                                      I)IIIICC, say, ill tile  :II-e:i  of  I.,I(Iiologyl  it  iiiay  be  that  those  woti](I  false
                                                    oil i regional basis.
                                         I t@Iiiii]@ it is  wise  to  test  them  otit  first.  in  a.  single  area,  as  is  iio)v,
                                      ])P,iil(,r (loans in 'iN,fi,,souri,  to  find  out  how  fe@isil)le  it  is  it  the  level  of
                                      the    community    lios)itil,    and    in    the    communities    where     the     patients
                                      are tii(I tli(@, I)Iiysici@iiis ii-e ill ])I"Ictice, to see if it is pr@ictical.
                                         iNfr. CA]t'I'l,'l
                                                        Z. i@faiiy of otii- (,oiiiniiiiiity liosl)it,,tls have lines to        tlieie
                                                                                   ))is ill t, let, w,,iy.
                                         Dr.  iNI,@izs,roN.  Dr.   Ctrter,   this   goes   "   bit   1)@yoiid   tliit.   The   reason
                                      fli(@y w,,iiit(@d to try this idvaiiec(l "iyst(iii is                in  ttiditioii  to  t-,Iie
                                      lisii:tl              Iiiies fol, tile t,i-:Iiislilissioll of           t'llis   new   systeill
                                      (lo(@sji@t, tilc(, the       of ititei-I)r(@iitioi) 1)@  t@lle  l@@,ysieiilll,  but  does  gave
                                             ill SIIPI)]Yillt"r t-1)(@, attendant I)I)Ysi(,-],I.ll ivit-ii all It iiilysis   of    the
                                                               done by it centrally sittl:lt(!(l
                                         IV]i:tt@ t@@iiis          is fa(.Iii,,,r is the, ftet     Nve tre not, going to  Iiiii,-c
                                                                          over time  to  (lo  1,KG  :tilalys(@s,  itil(I  ive  litive
                                      to              soiiie system to aiigi-neiit the, IiiLIilv si<ill@(I                   manpower
                                      r(,@(Iiiire(i in tlliis      So this system is more tliti@i-t t(,Iel-)hoiie line.
                                         Nfr. Siiiiiii,i,z. I,ft-. (Iliitiriiitii, nity I ask oiie, more q'uestion?,
                                         Nlr.              Yes.
                                         @Nfr. SI-Z-L@,IIITZ. Did you gay $200 million wts authorized                in 1968?

                                                                                              I)I)ropri,@
                                              Si@1,11ITZ. I-loiv much did Coii(rresst
                                         Dr.                  $53,000,000    for    grtnts,     and     $1,914,000     for     direct
                                      op erttions.
                                         ;\fr. SKUBITZ. Thank you.
                                         iAfr.    ROGEIZS.    What    do    you    think    of    combiiiina    the     comprehensive
                                      health    planning    progriin    -tnd    the    regioiitl    program?    Whitt    would    you
                                      think of combil-lin(r these two programs?,
                                                      The two i-)ro(rrtms
                                         Dr. LiF                   -   t, ,        eve   t   diltereiit   purpose.   As    we    move
                                      down  the  pitli   @i,iid   as   these   I-)ro,@rims   develol),   they   will   be   obviously
                                      ,-Ios(,,Iy                 .Iii(i iiite,(-,-rited. 13tit I  doi-i't  believe  inlay  should  be
                                                   iiii-,ot single pi-ogr,.tin.
                                         iMr.              Yoii don't, feel    tlitt  it  Colill)I-Vliellsiv(3  health  plan  for  it
                                      Si-itto slioiii(i iii(-,Iii(Iti wliitt we  are   doing    in    tells    regiotiitl    program?






                                                                                                                                               7,7





                                                                                      45
                                             ])I,.      Y("-,) T tliiiii@ is we (](,velol) Our                         at    the     State
                                                fol-                    .t                                       ))I:tllllilig,   it    will
                                         ell(IO1111)@iss ('011(-.Orlls Nvit'll                          Iiill(,I" of
                                                                           inciii    c    consideration-,    of    re,(rioriitl    medictl
                                         (,.Vollt)s, Lll(l it Nvill tlso          (I
                                         pro,-rri-Liiis.
                                             'I,.fr.                   coiiil)reliciisiv(@,   plan,   don't,    we    give    money    for
                                                        In tile, 1),ti,t,tiersliij) foi- lie;tltlll, it fol-iiitilt
                                             I)i,.                                                              grtllt tVO(@,,;  to  the
                                         Stite,  tii(I   project   graiits   for   the   (I(,@v(,,Iopinctit   of   (comprehensive   health
                                         Se,l.N,iccs   tiid   these,,   iii,.ty   include   services   for   people   who    have    heart
                                         disease or other diseases.
                                             The   focus   of   the   regional   iyicdical    programs,    and    I    think    this    is
                                         fundamental   to   -,in   iiii&rst@indiii(y   of   the    program,    is    that    tlle@    have
                                                        -t    foundation    for    c    @eritive     ,trraiiirei-nents     that     simply
                                         (levelope(@    @                          oop
                                         didn't   exist   before.   We   did    not    have    this-iii    some    areas,    there    were
                                         progrtti-is   of   continuation   of   ediic,.ttion,   such   as   in   K,,tnsas,   or   we   had
                                         the  Biii-iiiiii  Associites   in   New   Eiigl,-Liid,   but   we   had   not   seen   the   kind
                                         of (rrassroots I)ai-ticil)atioii focusing Oil improving patient ctre.
                                             The coinl)r6heiisiv-e health plan his             to      eiicomp,@       manpower,       en-
                                         viroiimeiital      liciltli      problems-tlie      full      spectrum-aiid      the      project
                                         (yr,,tiits c..tii rel:tte tot variety of these tliin(,s.
                                             '.\Ir.         I  reilize  we,   tre   gettiii(Y   tills   I)roaram   -started   now,   ,iiid
                                         it is in -,t I)c(,iiiiiiiig stage, but I won d think
                                                                                                           r    planner.-,    should    be
                                                                                                      YO"
                                                          lit  to  (-,oiiil)iiiiiig   these   programs   ivilere   there   will   not   be
                                         :Lii                     I    -.voiild    tliiiiktliittlici-c    would    I)esoiiietreis    where
                                                -%voiild  be  r,,ttlier  coiisideril)](@,  overlttp  within  it  State  plftii,  p.-irtic-
                                         iil-,irly for          cancer, ind st-rolce.
                                             I)r.       We                        not  only  about  tli(@,   r(@latioll-,llil)   of   tile
                                         i,(@gioii,,tl  programs  with  t-,Ii(i  I)art@iiei-,Iiip  for                but,    @lso    tile
                                                        illol.(,,           its(., of :LI]  or  the  I)I.ogi-itill",  stl(.,Il  its  01@,O
                                                        iti)(I \v(@ IiiLvo seen in the Watt,,; iir(@.% ,iii                        example
                                         of        (.ool)el.;It,ioll            it, I-(@giollill          ])I.ogi-itill, tl)(I (I(@,V(@,lol)-
                                                of,  t  (1-ollillitillit,y  lioSI)iti  1,  :tii(I  tli(@,  neighborhood  I)etltli   center
                                                     funded by 01@,O.                                 -,vit-11  stii-niilating  ,it,   the
                                             We are concerned it, tile national  love
                                         St:tte:tiid  local  level   the   close   iiite(,ritioii   of   these   programs   so   thit   we
                                         (,,in  niilie  arrest  efficient  use,   of   manpower,   which   is   our   scarcest   resource,
                                         I)iit,ilso  the   fluids
                                             '@NTr.  Ro(.i,,its.  Yes.  I  I)ol)e  to  see  soi-rie  of  these   OT4',O   progrims   under
                                         your                    T  fee,]  ,troiiiTlv  oil  this.  I  re:tli7c  this  was   itii   innova-
                                         ti v(,      o:lcll, but T thin]                                  -e el osel Y.
                                             ,  :11)1)1                   c it sl@oiil(l be tied ill  I)IO1
                                             ],(@t, me fish :I, -f(@%v            that   You   may   Witilt,   to   give   stilswers   for
                                                        t'll@it. y@)II may itot@      with You.
                                             [oN@' lately I.(,glolis      II(-(Illilly              its4)f Jii,iiiiiti-y 19C)8?
                                             ])I'. NI,N]N"I'ON.         lll'(@ now I'-) Wit-II            OIK)1'11,t.i4)llltl
                                                I-. IZ4 ltii,,its. I lillt)%%, ril ll(iq. I II ill 1,111 Iii iig 311)olii ol)erittilig.
                                                                Y(@, Sil', (11(@y                       'I'liis Will Vill-Y ri-oill  oll(@
                                         'I  siirll(,(t                                             " (,Ioill".         to olle,',
                                                                     wlii(@ll is obviously lli)t"           PI
                                                                iig it yell]-.
                                             i%l'r.         Woiil('l you -,east gi %,e its -for tile  record  it  rillidoNN'll  of  efteli
                                         of@   these   12,   the   personnel,   how   they   are    involved,    ]low    i-niieli    money
                                         they   are   getting,   and   I   would   like   tL   know   where   that    money    is    being





                                                                                                                   46
                                                                ]low niiieli oil television tie-ilisi ;tiid liow iiiaily liosl)itils                                            1-ic(l
                                                                                                       ll:l(le i 1) lioSI)il :ils.
                                                          III ot@lici., ivoi,ds, wlieii we                             tells ])ill, tlio idea of the tlii-ilst@  of
                                                                               his to iii:ilie stll.(@ t,lic 11(@%v iliet,lio(ii  of                                           iv(,-r(,-
                                                     (eoi II Lr to @-ret tot] IC ])Col)le.
                                                                      re@ilize it is %-ei.-y e.Lrl.N, :iii(I too sooll 4,ol. it,, to lattice, it
                                                                         I-)i,ol),,tl)ly,    but    I    get    the     feeliii,,-     that     this     iyilty     be     ',tol)l)ill"
                                                     ill  t tie deziii's oflice at the iiie(lict] colie("es.
                                                                   I just, wtiit to fiiid this out.

                                                          I)r. LEII,.IT liid better iiot be.
                                                          (Tlie folloivii)g itifornifttioii -,vas receiN,ed by the coinm
                                                                                                                                                            ittee

                                                     Dj,,,PARTNf.FNT 01@ IIEALTIR, l@,DUCATION, AN]) lVlqFART,, (PllinT,10 IIFALTIT                                       $'EnVICE)
                                                                        Iti@PO]tT ON 12 OPI@RATING Itte)GIONAI, ',Nll,;I)ICAT, 13ROGIIA@%f.(4

                                                                                        ALIIANY BEGIOITAI, @flrf)ICAL IlitOCItA?,[
                                                          Tti(, All)@@iiy R(,,,ion,,i.l                   Ilrogriiii   %vii,,,-   (Pii(@   of   the   first   regloii,,   to    receive
                                                     nil  ()I)erittloiiiil  ,iwir(i  (oil  April  1,  ll.'W@7.  Giirrei),tly  ftiii(14@(I  in,itli                                  the
                                                     r(,gioii has ;il)l)ro,.iiii:it(-Iy 4'i                            ,(;ifr,                 iiielii(iiiig        ftl)l)roxiiiiiitely
                                                          I)Iiy.,;i(-i;tiis, 17               5 (Grolier itilie(i                1K@rsoiiii(,I,   iiiid   (o   geii(ti,;tl   4iil)l)ort
                                                                      ()v(-r  t%vo-tliir(is  of   tti(@   si@an'   ii't-   fi,otii   Ll)(@   (,(kiiiiiiilllit@y   IIOKI@itils,   iiii(I
                                                     they iir(- w(ii-i@iiig (-Io.,4i@ly iN-I(ii than                                          ItIL(i  ItMIl   ttiiff   to   lticr(-.tse
                                                                               fo)i- (iiiiilit@y (-.tr(@ :t;t@ tii(@ lioi-,Il  ]lo.',-Ilitlils.
                                                          Al)l)roxiiiia,t(, y (@O                     froin   ttit,   Ail)ziiiy   ltegi(@ii   iir(,.   1)artiell);tl:itig   Ill   i@lic
                                                     I)rograii-t.   kl)l)roxiiiiitt,(@ly   30    of    these    hospital].%    itr(!    (iii-4@et@ly    1).qrticil)iitiiig    in    the
                                                     of)(@rit'loii@il I)roj4@ct,,i oiii@Iiii(@(I  I)elow. 'l.ivo                          itr(@   rel)resezite(I    oil    -tile    Ad-
                                                     visory     Cojiiiiiittee,     and     the     remaining     are     involved      in      oii-going      planning      activities.

                                                                                                    Operational Projeett4
                                                     1.  Tic@way radio coinntiiiamtion slystcni, direct cost-$lJI4,100
                                                          This     pri>jcct     will     expand     an     existing     two-way     radio      iietavork      to      incltide      @)7
                                                             -tals and '14 high wliool,4, It will provide eotitiniiiiig e(lue.,,ttioii for
                                                     liosl)i                                                                                                               1)11Nsicians
                                                     iiii(I    allied    iiiedi(-al    personnel.     It     will     ilso     1)rovi(le     information     and     education     Pro-
                                                     griiii,4    for     i(IiiiiiiiN-trator.%     meiiil)(-rs     of     I)oir(Is     of     treaty,     voluntary     health     agen-
                                                     eie.,4,   adtilt   (@(Iticatioii   (-Ia@    -.,4,    nn(I    sel@q@ed    civi(!    groups.
                                                                             ioifor;it(jtion coo?,dipiato@-m,                               coRt-$73,800
                                                                                                                           will  Ile  lis(@(I  to                  local      Pll)%'4i-
                                                                          1114@iii III)f)lit, It(.giollill                 lll,ogiitill,,4  liti4i   t@o (Evaluate     tlitlr      ittti.


                                                                 ill-i)Kl-lllli                to ]lliv(@ (-XIK.I.Illl(.Iltlli little                  groups or                     to

                                                                                                                            l@(-              to                  the     t@n,(,(!tlve.
                                                                       I list
                                                          (,foiiit)tiiiiilll hospit(it                                                 t!(ovt---.$75,800
                                                                             %%,Ill I'-41:11@li-411 l(@iirlillig                                       liot4l)ittll@s    Using    "Self
                                                                         units" iiii(i      ii.iiilio@-i-isiijil                   I,(ki.  I-III)itl  (Ii,"(,Illlllll.lloil  (@f  ll(-W
                                                                                                                  (til'(4'tOll.'4 (@r this 101-0j(-('l 1101)(@ @tO (-,Vlklllltte
                                                     joliysi(-iiiii I)rogr"-.,i.  Iiiiiisilly, 8 li(K4l)iilils %Vill 1)(@ illvolv(@(l.
                                                     5. Alb(itill                               corollary    (,,a;r(,,    trai)i,ioig    (iii(I
                                                            (ti)-cet (@oxt-$125,200
                                                          A eol.olk;l.ry
                                                                             -are Hart       will  IK'  ('.itliti4isil(@(I   II;(,   jkll)tjiiy             C4)11(@;!(@    to     Kcrve
                                                     it-4 it iijotiol iiii(I training iiijit for training loliysi(-iiiii,; iiii(i                               Nl-ll()  %Vill   tilelk
                                                     Ile i"o to                       siiiiiliir   tinit.4   at   eoiiiiiiiiiiity   liosl)italls.   'I'his   I)r(@jtet    will    alig-
                                                     lateral the exis
                                                                           titig     Coronary      Intensive      Care      Unit      at      the      Albany      Medical      Center.




                                                                                                                         47
                                                                G,.t  aii(I 61?. Coiiiiiiiiiiitil Hospital roi,oila;'Il         cai-c       traiiii)ig       and       dc)non8tration        Pro-
                                                                            (Iii@c(-t cost- $5,5,400
                                                                'I'Iiis N%-ill                    1)roj(@(-t  -45 Jay                          coi,fjiiitry    ciir(@    units     of     t@lirce
                                                                            iit tiirt,i- (,oiiiiiiiiiiit@- li4).@I)itiiis    l'ittsli(,I(l                St.              and        Vassar
                                                                                      x%-ill            its                          iiii(I (-(Iii(@iitiotiail  projects  for  other
                                                                            iii     the     region.     A     continuing      educational      program      will      sc@rve      the      perma-
                                                                iieiit. ITilit St@iff tii(I ,tiff.,;from siiiiillerlio@I)itals.
                                                                7.     Ti-aiiiiiig     a)t(l     (Iciizoitsti-atian     1)2-ojcct,     ititot.@ii@c     cardiac     care     unit      Ilcrkitner
                                                                                   Ilospital, direct cost-43,500
                                                                'I'li(- initial            of   tlii.,4   l@rojt@(-t   is   to   tr@iiii   (;   or   8    fears"    from    small    coinmtinit.V
                                                                            it              :tii;ttoiiiv and pliy.,4iolog3,, coroii@iry                          the       principal,;        and
                                                                o@'llit;kls I
                                                                starting  (If t cir(li;i(,                  cire     unit,     iiii(I     In     liaii(llliig     the     complex      equipment.
                                                                                                 lie sent to All
                                                                      iiiir,4@s ivill also                            )tiny                 ("enter      for      active      training       with
                                                                sl)(,(-iilize(I equipment.

                                                                                               'ItTfOUNTAIN  RI-'(;IO-NA
                                                                                        INTI,,                                  T,  Mi@f)l(@Al,  PItOGItANf
                                                                '['II(,    Iiit(@i-iiioiiiitiiin    lt(!gioiiiil    11(@(licii]    Ilro,,r,,ttii    j-(@(-eive(I    its     firit     opcrationil
                                                                gr.iiii.         oti April      1, ],!)67 ;III(] its                 ol)(-r.,itiollil      iwir(I      totitls       $I,,832,800.
                                                                                     80 ,(;iff members iir(@                           III    tli(,     (@1)(@ritioiial     project,,,     ibotit
                                                                                                       III   (,oiiiiiiiii)itv    I)t@.,I)it;ils    Nvorliiiig    together    with    tii(@    Re-
                                                                otit,-tliit-(l of kA-lioiii       fro
                                                                gioll:ll             Ilrogi-4iiii staff from tli(@                                   they    sire    I)riiigiiig     to     local
                                                                                              @iii(I    hospital,,    tlii,(@iigliotit    ill(,     r(@gioll     iilo(Icni     techniques     for
                                                                Al)lkroxiiii:it(-].v  thirty  hospital,,  iir(@                                participating       in       tli(@        Program.
                                                                                                                          lt(@gioll:ll                       k(lvi"orvGroiij),aii(Iiiiiiiostcvcry
                                                                ll;t.ior   lios1iil.,il   in   than   r(@gioii   III,,   ('st:ll)lisli(,(]   it   lo(-;tl   ultimate   group   to   study   local
                                                                       field to              a-, li;list)ll with tll(,                    IltNII)        staff.        Seventeen        hospitals
                                                                   iiii-ti(-il@.iiiiig   in   tli(,   ol)er4iti(oii;il    1)roj(@(.t"    olltlill(.(l    I)el(-)w,    and    as    the    program
                                                                (.oiitiiiii(@s  to  grow,   it   is   aziticil).itt@(I   tliitt@   :ttltlit   ioii:kl   hospital,;   will   I)ecojiie   involved.
                                                                                                             Operational                Projects
                                                                1.  Regional facitlty and corc-staff sciiziiiarl direct C08t-412,600
                                                                                          of  I't.@ili   -.Nle(lic.11   S(.Ilool   will   liol(I it     .eries      of      quarterly      seminars
                                                                oii                        ]it-.iltli      (,,ire,      continuing      edii(-.,itioti,      contemporary      learning      the-
                                                                                                                     al)(I     iticilsAir(@iii(@iit     technology.     The     faculty,      ex-
                                                                      from    ii(-r(>s-.,    the    country,    will    a(l(lr(@.,;s    all    audience    of    health     professionals     in-
                                                                VoIN-4@(I ilk II
                                                                2.    Netivor7o    for    coittiiiiii)ig    editcatio)i,    iii.    licart    disease,    cancer,     8troke,     and     related
                                                                    diseases, direct coit-$2113,000
                                                                         ol).i(@(-tiv(,s (if this l@ro;,,riiiii      iir(@ t4)                 a   (!Oll)ltllllii(-,Iltioiii    ll(-tworic    be-
                                                                                             hall                 itist-it-iitif@iis   to   (,ii(,oilr:   gc,    Iiiii.,;oii    between    health
                                                                                      in tlio- :ir(,ii.           t-iii-i-i@iitly 4@xistiiig 2-wity radio                               including
                                                                                   in 7 (-annihilates in tii-                    @iilt  l,iili4@           will 1)(@                   tlo    re-
                                                                illot(@ hospitals to sel.v(@ II.,; (@i)o Iiiilc.                                 'rV     and     use     of     KVFD      (IJiii-
                                                                               I'llili (.(Illt.lltioll ['N') is ill@o                    ']'his may                     1)1(-    (-Ollllllllllity
                                                                )lips-I)it3il its til(@ lo(-IISI)f(-(@litilillillg('(Ili('Iktiolk.
                                                                3. liifi)i-i)i(itio)t all(/,                                                         (it)-cet cost-4110,000
                                                                                   is it rt@gioii-wi(l(-                    Iii)xis(@     for     information      about      lltillr.      Staff
                                                                will  i)(@ ))lit, ill loe,,il  (.olllillllllltl(@', to it(-t ii,4               i-t-Ijitioii,;    r(,I)res(@iitiitiveq     ITTI(I
                                                                ills(@ (o (list I.il)llt(@ illf(@i-iiiii                                                                                 maturity
                                                                                                      i loii t@o             I    ))(,rsoiiii(,) and t@lic I)til)lic. ']'lie (@oi
                                                                ,;tlklT  will  also  g;itli(-r  ii,roi-iii;ti@i(oi,  II,,  4-oiiliiililiit@y  needs  and  reqoiirces                and       re-
                                                                            and serve ii,4 it stitl@ioii for                                                                                data.
                                                                JI.  (,'at,(Iioi)iiltitonat-y i-ciiiscitatiopt ti-ai7lill!l                                    coqt-$f),3,1100
                                                                  'I'll(,   liiiversity   of   (Ji@,ili   will    give    it    :I-(lity    (-otir,;e    in    resiiwitativ(@    techniques    to
                                                                S(qeci.(@(@l)liysician,4 from siiiiill                                         physician     will     then     be      respoiisi-
                                                                bl(!     for     te:iching     the     techniques     to      health      I-K@rsonnel      In      his      community.      rnils
                                                                "r(,siis(-itittloii     coti.,4iiltiiit"     will     also     collect     data     about      the      number      of      times
                                                                ref3uscitation is employed and the results.





                                                                                                                            48


                                                          5.  ,I                                  in i)ltcltsiil(,                             (Iii,(-(!t co-it-$118,600
                                                                         f@t(.Iilty of experts in using                              (!art- I"iiits itti(I diagnosing and  treat-
                                                          ifig Iit,;Ii-t                will              ,Iiort                  in  tli(,ii-   siii).I(,(!ti.   Tli(@   ,tti(](,iits   will   I)t,
                                                                                                all(]  iiiirs(@s  from  (-t)itiiii@iiiity  hospitals  building                              coronary
                                                          cire units.
                                                          t;. 7'i-(iiiii@irl fo)-                in                care     (i)i(t,     (-(it-(liol)iilittonary      rc.,iii8ritation,      (lirc(!t
                                                                 (-o.,it,@34,000
                                                                 I'Iii@ is ,III integral                of both  tli(@                    car(-       find       ('ILr(liopulmonitry        r(@su.4-
                                                          (.it:itioi)     l@i,ogr:iiiis     for     pliysi(-i:iiis     (#4.     #5).     Niir,,(,s     trained     in     Salt     l,iik(!      City
                                                          Nvill                to    their    (,oiiiiiiiiiiiti(@s    to    s(@i,vt,    its    it    (@or(@    ftt(!iilty    for    reaching    tli(-
                                                                                                                                   %Vill     work     (-Ios(-Iy      with      the      sliyiilttrly
                                                          tr@iiiie(I physicians.
                                                          7. Cti),iic(il tt-(ii@ico program, tit cat-(Iiolotly, direct cost-$65,700
                                                                 This program ]its two
                                                                                                                                         iiit(,riiist'4      find       cair(liologist.,4       with
                                                                 training I)rogriiiii,4 tit  li4@iirt                                             tiiiilor     made     to      their      llidivid-

                                                                     (2)  To                       the       number        of        formally        trained        clinical        citr(liologlst-4
                                                                 through       it    tritiiiizig    l@(-rio(I    (.'@    iiiojitli4    to    one    year)    tit     the     existing     cardiology
                                                                 s(-Iiool tit the University of lJtaii.
                                                          S.                co)tsiiltants      an(/      teacher      lirogratit      for      8ntall      comniiinity      IL08Pital8,       direct
                                                                 rost-4111,800
                                                                 Sxy@;ill     cf)iiiiiiiinities     will     be     given      the      option      of      requesting      one      or      two-day
                                                          elitii(@s.     A     iiiiiiit)itiiii     iiiiiiil)(@r     of     four     car(lite     patients     will      be      required.      These
                                                          (!Iillies    will    ill@gi-@l(le    the    level    of    (-.ire    to    N,ictiiiis    of    heart    (Ii."ase    living    in    remote
                                                          :ireii.,;.    l'isitizig    1)liy,;Ieitins    will    ,issist    tli(@    local    physician    in    it    I)rec,!,4c    diagnosis     In
                                                          :i precise (Iiigiiosis of his liatients.
                                                          9.      A      7-cgioiial      conipittcr-ba8cd      sy.,itct)t,       for       ?;ioi@itoi-ing       physiologic       data       on-line
                                                                 fro?)@      i-c))iote      hoipitals      in      the      regional      t)ic(lical       program,       direct       cost-$637,100
                                                                 This    I)roject's    purpose     is     to     test     the     feasibility     of     using     a     central     computer     to
                                                          I)ro(,ess     i     variety      of      physiological      signals      g(@iieriite(I      by      patients      In      remote      hos-
                                                          I)itils,      feediiig      the      results      of      calculation,;      from      these      sigiiils      back      to      stations
                                                          within the hospitals, and iisiDg the information for diagnosis.
                                                          10. Cancer teaching project, direct cost-$911,300
                                                                 Tlii.,;    project    attempts    to    upgrade     the     le%-el     of     (-are     available     to     local     coiiiniul)i-
                                                          ties.      The      coordinator      will      direct      a      1)rogriiii      of       physician       education       to       create
                                                          trained     cancer     specialists     who     in     turn,     will      1)(,coiii(@      c(@iit(@rs      of      cancer      information
                                                          lit   their   rocket]    (-oiiiiiitiiiities.    The    I)Iiysi(-Iaiis    "-ill    receive    it    siiiill.,;tipcild    for    t(@acliiiig
                                                          and    cil)t@:iiiiiiig    information.    A    regioii-NN,i(](@    tiiiiioi-    i-(@gi.,itry    will    be    started,    as    will     a
                                                          training I)rogriiiik lit new t(@cliziiqii" for I)iit@liologists.
                                                          11. Stroke (laid related )tcitrological                                   direct co,,It-$.98,700
                                                                 'I'Iiis I)roje(!t will (,sllil)li,41i cliziic,4 to bring                        (-ojisiiltiitioii      ;ervice     in      ,;trolce
                                                          ;iii(I              ii(,iirologi(-jil  (lis(!iis(,s to lot,:il                                   will       provide        (!oiitiiiiiiiig
                                                          adulator)    to    local    I)II.Vsi4.iiiii,,    iji(i    Niii-st-s;    Nvill    (-oll(@(-t    data    about    sti-olc(@    I)ilti(-ilt,4
                                                                         tli(@                   ti)(@y                if) trial                         A 2.1-lioitr                         (-oli-
                                                                         s(-rvi(,(@ an(] liil'oi-iiii1tioll library                           will    to(-    ]uninitiated    lit    the     Iltitli
                                                                                                      (-olli-lkillllity I)II.N.:4i(-Iillks IN'itli                                    III   ll(](Ii-
                                                                                                         %Vill  1)(@  triiiiii@il  itt@  tli(@  iii(@411(-iil                lit   (II(-    liti(@st
                                                          flijigiio.,itit! and  lr(@ailiiit@iit                                                 Will   last   froiki   4    wt,(.Icm    to    1)11("
                                                          .V(,Iii
                                                                                                                             tlict-(ipy    foi-    I)hltRi(-I(itis    atttl    ntit-s(,s,     direct

                                                                 To train  physician-,  iti(I  iitirses  to  iitiliz(@  the                                  t(@cliiiiqiiem       and       (mtiij)-
                                                          iiieiit  in     respiratory     tlieril@y.      Five      day      s(@iiiiiiir8      and      follow-up      2      dtiy      refre.,41ier
                                                          courses will train             participants to administer                    therapy and to             teach others.
                                                          13.  Regional o)i(locri7ic t)ictabolic laboratory, direct cost-$,2.77,900
                                                                 To      provide      service       facilities       where       practicing       physicians       can       obtain       laboratory
                                                          data      essential      to      the      diagnosis      and      treatment;      to      create      awareness      among      I)Ily.@;i-
                                                          clans       of       the       possible       presence       of       metabolic       and        endocrine        abnormalities;        to





                                                                                                                    49

                                                                               Iiii co rii IIItio II. 'I'l I   1,11)orlltq)ri eswi II 1)(@ (!St,:Il)l I ml) (@(i : it IIIinnIII I) o-
                                                                 I;ilioritti)ry, it                    laboratory       to)                                              till(I    IL
                                                                              I:il)orittorv to i-eiiiii@ ti!(-Iiiii(iiii,s. @(!itiiii@irs will 1)(!  held  I)Otll  iiisi(l(@
                                                                                                                                                  i-(@I)orte(i  to  the  refct--
                                                              iiiitl otit,,i(](, of tli(@ I,,iboriit@orii-s. AI)iiorii)ai liti(iiiig.,i will 1)(@
                                                              riiig  l)li3,sicittii  by  telephone  by  it  I)Iiysici@ill  Wil(@  is  Competent  to  offer   consultation.

                                                                                          KANSAS REOION'AL, lfLDICAL PROGRAM
                                                              The    ol)er,,ttioii,.il    ii(!tivities    of    the    I<,iii,,4as    lt(!gioiiil     Ale(lical     Program     began
                                                              oti  June  1,   I()(@7,   and   tire   currently   fund(,(]   at   tli(@   level   of   $691),852.   Al@I)roxiin;it(!Iy
                                                              So iii(livi(IiitLs with viiri(-(l                     coitil)ri,,e   tl)e   (current    staff,    of    which    ,ibout
                                                                              physicians,      oiic@-Jiftli       are             Ili(i    an     additional     oii(--ilfth     ftre
                                                              otlici, tYI)e.,i of;tllie(l health personnel.             rei@iiiiiiiiig    ,itiiff    lii(!Iitdcs    related    health
                                                              personnel, ,;ticli as communications                             and     so(-iiil     scientists,     :in(I     general
                                                              support;    personnel.    kl)oiit    half    the    st,-itT    ii).(@    from    the    medical    center    and    the
                                                              otli(-r    half    are    from    community    hospitals.    'rog(@tlier    they    tire    working     on     programs
                                                              to iitil)rove community (capabilities foi- tr(@,,itiiig the (!categorical (Ilselt"4c,4,
                                                              ,kl)i)roxiiii@itely 20 (!ojiiiiiiiiiity hospitals iii-(@ etirr(!Iltly involved in the                            Kansas
                                                              Ilrogriiiii, tried it  is ;iiiticil@
                                                                                                 iite(I     tiiit     additional     liosl)ititi.,i     will     become      Involved
                                                              its e,,I)arlsioii                (Iiirizi-   the   iie-,t   few   y(@,ir4.   TeiL   of    tlies(@    llospitalt;    iir
                                                                                                                                                                                    e
                                                              directly involved in operational            projects,     two     tire      represented      on      the      Advifiory
                                                              Conunittee, and eight tire involved la on-goiiig planning activities.
                                                                                                     Operational  Projects
                                                              '(Ziicational progra)tz,?-(Ircat Bc@i(l, Kaii
                                                              1. l@                                                       S.-$261,000 (direct cost)
                                                              'I'o  (lev(@lop  a   iiioilel                   I)ro,,r,,tiii   in   t@Iii.,;   ;iii-all    community    a    full-time
                                                              f,l(@lilt,Y,  iviii(!Ii  ivill  1)(@  iillili;tt(,,(i  ivitli  tlit-  K2iii,,ii,4  Aledictil   Center,   will   be   In
                                                                        Iii(-Iiitle(I   in   tlii,;   cojiil)r4@ii(@iisiv(,   program   lire   plai)!s    for    continuing    I)Iiy-
                                                              si(!iiiii  and  jitir.@  4-,(Iiieiitioii  and  clinical                    for        hcath-reliite(I        personnel.
                                                                                    ,tde of community                        resource,;, etc.
                                                                     %vill be in.
                                                              2.     1IC(lltlt     Scic?zces      Coz)i;ti,ii?tfcatio?b      and      Infori)iation      Ceitter-$77,000      (direct
                                                              cog t
                                                              This    project    I,;    ei)gige(I    in    conducting     studies     to     determine     the     feasibility     of
                                                              establishing      communication      linkiges      vital      to      education,      service,       and       research
                                                              -I)rogriiiis.    S@ific    -4t.udies    to    be     undertaken     are     it     physician     communication     sys-
                                                              teiii, '.PV reaching, ele(-tr(@iiie Iiiikitg(@s, and NliNlljtrs search capacity.
                                                              S.   Stit(IY   of   the    qitality    (in(l,    ai)ailability    of    ittrdical    carc-$11,9,000    (direct    cost)
                                                              I'(j  (I(,t(@riiiiiie  iiiiiiit@t  it(-(,(Is  of   I)ikti(@iits,   lo(-iit@loiis,   l@rof(@.,.iional   education,   and
                                                              -working   tirriitkg(,iii(@jits   of   I)Iiysi(!iiiiis   and   those   !it   I'lit@   health   rel;ittd   dincipliiies.
                                                              110,41)ifal                                      (I(lt(t f(l(,ilitic,@--$67,500 (direct co.,it)
                                                                 (.oll(lll(.t,            within   tlit!    I.(.gioll                  various       aspects       of       community
                                                                                          (@l)!(I(@iiiiologi(- 4]iit@it and 1)iirti(!!I)iitioti of ]return  care  per-
                                                              .Solili(@l   ill   (.maintaining   e(ill(.Iitloiiitl   I)i,ogriiiii8.   iL   computer   syqtctn   will    1)(!    used,

                                                              5,
                                                              ']'o           all                  tt-jkiiiijig iii-ogi-iiiii to prepare                  wli(o                Iranian
                                                              silly  (of  (-i@i-otiiiry                Ill  i-olikililillil,'m  114)Sl)illi]S.  with   I)IISI(!   ])IIYSI(>Iogi(-.Itl
                                                                                             in  li(piii(,          itit(i   filiikiltitril,y   with   t4o(!Iiil   4igc)ncle.4   that

                                                              6.                                                            11(oNl)itat --- $.@5,000  (direct  cost)
                                                                                                                              (of  t.lit@  (,'itiieer   l')ett.,Ctioik   Center   now
                                                              i)l@(-i-4ititig Its  III)      t-(-ft!ri-iil           iik                     lio@l)lt@il  la  NarLins           City,
                                                                      'I'lit@             of 1)ttt.i(@iits will I)(- si@ii(114-(l to Nlio%v etT(,etiveii(-.,;s and             yieltl
                                                              of t(@s('r(@siilt 's,  tylx-  of  lo(-rsoiiii(-l  who   lijiv(-   xis(@(I   illic   (-Iitiie   unit   their   ,4oiirce   of
                                                              reforr@ll, and eff(@ctiv(@ii(kss of
                                                              7. Cat-flioi,(tscularicorkevalitatio)t-4.11,100 ((Iircctco8t)
                                                              'I'lils    project    will    (leiiion,4trate    the    C@ir(liqe    Work    Evaluation    Unit    and     show     its
                                                              usefulness    for    the    evaluation    and    rehaiiiiitation    of    the     patient.     It     is     developing
                                                              all effective technique for %howing physicians and the                            community      at      large      the
                                                              ai)ility    of    patients    to    return    to    work    after     receiving     the     appropriate     rehabilita.
                                                              tion.




                                                                                                                                                 71:@





                                                                                                                   50


                                                                  ,NfE'rROPOLITA'@\' DISTILICT OF COLI@NtillA ItrOlO.-NAT, ',ItEI)ICAT, PROGRAM
                                                                r(-gioii              its                                                     1,    1968,    with    all    award     of
                                                                         ,tiiff   of   47,    iii(!Iii(iiiig    iil)otit    11    I)Iiysiciitis,    two    iiiirs(@s,    s(weii    other
                                                                11(@,iltli  1)(@i-sollilel,  and  27   otli4@i-   tyl)(-s   of                          I)ersoiiiii@l               its
                                                     (-fiiiijoiit(,i,                         (-oiliiig  (,I(-i-lis  :iiiil                      will     worlc     tog(@tli(-r      t(i
                                                                                                                                     Ali(iiit Iiitlf of t)i(@              1.4 fr(pill
                                                                                                                                     (.ojllllltltlity  lio.,il)lt;ils  1111(i   otli(-I-
                                                              ll(,:Iltli                 'I'lliS ('01111@illiltif)li 4sr
                                                                        it
                                                                                                                                     ;tii(i  titis  iiiiiiii)(,r  will
                                                     :is  ')I('  l@l-ogi-itili  (@l)giiitis  over  fli(@   iii-xt@   i'l,w   y(@iti-s   to   r(@ii(-Ii   otit   t@o   t@ii(,   (,iitir(-
                                                     I-i,gil)ll.           of            I)oS])it4ll,'4 ill'(! (111'(@('tly                      ilk   tile   l@rOj(@('18   Otillill('(l
                                                     I)t@lo%v,  two  :it](litioii.,tl   li(@,,I)itiiis   fire   oil   Ili(@   lt(@gioiiiil   A(li,isory   (@;roiip,   ftit(i   two   are
                                                     .@(-rvitig oil  1)1@iiiiiijig                                               s(@v(,r:il   ,i(l(liti(oii@iti    lio,41)itllls    will
                                                                 front   tli(@s(@   1)i-ogriiiiis   its    they    "'Vll(l    tii('il-               to    lie    trained    fit     the
                                                     I)rogr@im,,; outlined I)elow.
                                                                                                    Operational  Ilrojects
                                                                                                                                 c      Di(igizosis,      Trcatmcnt,      aizd      lit-
                                                         I,'?-ccd))iaii,'s  Ilospital  St)-o7cc  Statio)t fo?-  th
                                                           t,(,Sfiga-tion of Cci-cbi-(il Vaqculai- Di.,?case, dii-ect co,3t-$181,889
                                                        This    project     is     a                         al)pro:tcli     to     strol@e,     from     diagnosis      and      treat-
                                                     talent    to    home     (-are     and     rehabilitation     in     qn     iirl)@,iii     Negro     area.     Based     in     the
                                                     Free(Iiiiiii's  llosl)ital,  a  community  hospital  in  the  region,  the                                 stroke           station
                                                     will     serve     as     t     teaching     componeDt     for      I)Iiysiciaiis      and      medical      students.      Related
                                                     epidemiological and socioeconomic studies will be undertaken.
                                                     2.  The TVasititigton,  D.C. Regional Cerebrovasculat- Di8ea8c                                     Followitp       atid       Stir-
                                                            veilla?ice SVitent, direct cost-$9]i,200
                                                        17ii4it@r the  spoiisorslill) of Georgetown                      IJiiiv(!rsity,     this     I)roject     1,4     titteiiil)ting
                                                     to   P.,4tiil)lisli   a   iiiiifoi-iii    system    for    iiieisiiriiig    an(]    eN,;tliiit,iiig    in(@(licitl    care    given
                                                     to               I)jiti(-zits   in   t@lie    jir(@ii,    ilk    oi-(I(@i,    to    fii(-ilit4it(@    nursing    and    follow-iiii
                                                                   It          I)rovi(It-    information    Iii-II)fiil    !it    41(-t(@riiiiiiiiig    (-ojiiiiiuiiitv     iii4-(Ilc;il
                                                                     1,(,flklireiii(,iits,  and  in  (!iirryiiig  out,                                       or        il(-iiiogritplile
                                                                                   (,titt,riiig    tli(@    syst(@iii    through    tli(@    viirloti.,4    community    li(osl)ltjtl.,4
                                                     III   I   lie    region    will    r(@(!eiv(@    ft)llow-iij)    tittt@iitioii    all(]    therefore    greater    continuity    of

                                                     3.  ,[  ti-aiiiii?g progi-aiib for cardioiia-8citlar                                    direct coit-$71i,707
                                                                                        -ire  1)(@iiig  triiiii(,([  at  tli(,  Wiisliijig(oli  I
                                                        Qiiiililie(l  slii(lejxt.,4                                                                      lo.41)ital      Center       in
                                                                                   III             :tr(@jis  of   iiit-(Ii(-itl   ol),,,(@rvittioii   and   1)roec(Iiire.4   to   cojii-
                                                     1)1(!ii)eiit    jitirs(-s'    tetiviii(-s.    III    addition    to    listening     I)ersoiiiiel     for     work     in     lios-
                                                     1)it;ils   throughout   tli(@   rt-gi(iii,   this   I)roje(-t   liolK@.,i    to    I)ro(itic(@    it    material    for    training
                                                     tlies(! t(@eliiii(,i:iiis in the other r(@gloiijil lio,,41)il,jils.



                                                                                                        in                 oil AI)ril  1, 19()7,        and      current       (il)(-ra.
                                                     tioiiiii  fiiji(l,,4  iiiii(otitit  it)  $2,('oll),OOO.  Title  ('Stifillit('41  I(',O                        '4tilfr     I)eol@le,
                                                     wit' ]I  (livi,rm@   1);i(-Icgroiiii(L,4,   art,   s(,r%-iiig   i@ii   Ili(!   llr4)griiiii,   lii4-Iii@lliig   iilyi)roxiiiijilely
                                                          I)Iiysi(-iiiis,   four    iitir,,(-s,    l(o    iiiii(,(i                               tlir(@(@    social     s4@leiitist.,,,
                                                                                                                                       -ir     siij@l@(@rting     I)ersoiiiiel.      The
                                                     ikii(I @il)l)r(oxiiii@it(,Iy (;O ci)jiil)titer sl)(@(-iiiiists and tli(
                                                     reiii4iiiiiiig  staff  I)i-ovi(l(@  overall                                     Is  resefir(!Ii  and                ii.,isistitiits
                                                                                 IMP
                                                                (](@velol)iixeiital      al)l)rot(,Ii      1)(@iiig                  I)y    this    region    ;iii(i    outlined     it)
                                                     liroje(-t                          b(@low  siigg(@sts  that  hospital  involvement                                         increase
                                                     ral)!(Ily    over    tli(@    next    two,yeirs.    Ctirr(@iitly,     iiin(,@     lio,31)itals     fkre     involved     in     the
                                                     I)rogr@iiii,     including     two     lio,;I)itil-s     wlii(-Ii     are      represented      oil      the      Regional      Ad-
                                                     visory               Committee.
                                                                                                     OI)erittioiiil  Ilrojects
                                                     1.  St)tithville  coiotiiiiinitil  hcaltlt  metric(!  I)royrat)i--flii-cct  cost  $200,9.57
                                                        Tli(@                of   this   I)ri)ject   is   to   establish   11   1114)(It@l   (14)lilllltlllitv   lit@ititli   s(@rvl(-(@
                                                     ))together     iii(!Iti(litig     (@()iiliiiiiiilg     education     Trial      training      I)rogriiiiis      and      li(.Itllll
                                                     (,(III(.Iltioll    for    tll(@               (-Iii(-rg(-ii(-y
                                                                       I)rogriiiii.4; I)tiioli(-                  I)rt@veiit:iv(@                  and Fx@ii(x)l ll(,411til; (m
                                                     or(Iiiiiitt,(l with voluntary health iigeiit,iet4.  llrogriiiik                                      around           SiiiitliviII4





                                                                                                            51
                                                        ,and to ijl('Ikl(l(l ;,I)Ollt 50,000 persons      ill (@oillity  (Clay).  Activities  are  centered
                                                                                                  llosl)it@,11     itii(i     the     groul)     practice     clinic     as     a
                                                        1-1. llilltil)ll(tqic, t(-.'itii?g of all ao)tbillfllit                         (!oRf, $/,,"./,/17]
                                                                                                                                                    !es   of   (linglio4tic
                                                                                         to (@siliii)lilili            for  iii.,.r(@riiiiiig   ,,(,r
                                                                  t4@st",  to  iii(@litlfv  till(@  likokt,                                       for  i-ceniiig          Ifirgc,
                                                                                                                               ,Plains            for Ill and          11(@jtltl)Y
                                                        1-111-1kl  I)o])Illlliioll  grolilps;             ti
                                                                                                 viol, (If
                                                                   :is lilt aid ill
                                                                                                      will   II(,                   ,it    111(@    ljiilv(,r4lt@y    M(@(11(!Iil
                                                        (.1iiii(,Itl silig4,s, NIO(14,1 tt-st (It,                             Ilosilitill    it,     Missouri.     A     tl)ir(I
                                                        is 1113111114'41 fol- the. @tilitlivill(.
                                                        (,oiili)tttct. fact                   cost $27-1),3(;5
                                                        ']'his 1)1,oje(!t I.,;             to (levelol) Jill(]    ill)l)ly                   for      (](@liv(!riiig       latest
                                                        iiif(iriii;itioti  oil   diagnosis   iiii4l   (-itr(@   of   illilli(@lits   with   strolc(@   and   itlli(@il   diseases
                                                        to tll(@ local                                tl;itit     ijiforiiiii[ioii     storiig(!     and     retrieval     system
                                                        will    1)(@    developed    at     the     University     Metli(-til     Center     (Coltiixibiii,     Missouri)     and
                                                        later extend to include Smitliville and other communities in the region.
                                                             sci,eciii?ig-i-(i(liology-(Iircct cost $511,8111
                                                        '.1111ii.,; I)roje(!t will liell) iiiil)rovo the                   of    1-ii(l.iol(@gic    dingno,,i,4    of     li(-art
                                                              (!iiii(!cr   iiit]   stroke   through   elect   roiii(,   (,t)iiiiiiiiiii(.:It@iolis   iiie(litt.   Three   ,4niall
                                                        rural    liosl@ittls    will    be    hooked    into    the    Uiiiv(@rsit,.,y    of     ilissotiri     computer     itnd
                                                        Depiirtiti(@nt     of     Ridiology     to     evaluate     diagnostic     eflici(@jicy     and     determine     applic-
                                                        ability of ultrasound and thermograpliy in diagnosis and therapy.
                                                        5.     Coi)iprchcitsive     cardiovascular     care     iinits-Springficld,      Afo.,      direct      cost      $69,347
                                                        A     comprehensive     care     unit     for     grouping     patients     with     heart     disease      or      other
                                                        circulatory     system     illness     or     who     have     been     admitted     for     other      purposes      but
                                                        re(juire    close    cardiac    observation    is    being    develol.)ccl.    The    project    Is    to    be    under-
                                                        taken    at    hospitals    without    a    house    staff,    where    it     1,;     hoped     that     grouping     of
                                                                                                                    -sc.,4     oil     general     medical      and      surgical
                                                        patients will relieve the workload for niii
                                                        w@ir(lq. @St. Jolin's Ilo.,tpital medical st@iff iiid                       County       Medical        Society        ar
                                                                                                                                                                                e
                                                        coordinating activities with :1 local lio.4pit@ttlq !it  S'I)riiigfield.
                                                        6.  Co)tlt)lltnic(itio)t research iiiiit-dircet co,;t  $61,711,'i
                                                        Supporting     research     unit     for     program     to     identify     piil)li(!     attitudes     and      kiiowl-
                                                                                                     and    stroi((-;    to    understand     iiiotiviitioii,,4     for     seek-
                                                          about heart (11,
                                                        itig   health   (!tire   and   to   determine   and    (lov(,It)l)    (@ffective    itiettio(],4    for    couiiiiunicat.
                                                        iiig with        and lead them to seek iii(!dicit-I (!iir(@.
                                                        7.   I)ata    evaluation,    coniptitct-    sintitlatio)t    all(/    silstcliis    (Icsiglt-(Ii).Cct    cost    $329,712
                                                                                                                                                                              ans
                                                        This I)rogr:iiii will liell) to determine data                          fr4)iii file public and I)IIY,4tel
                                                        for (fairly (I(@tk@ctioil of lk(@art diseiis(@, ciiii(-t@r and ;tlr(klc(@ tlir(@ugli                        oil       the
                                                        foriii     of     data,     mechanisms     for     cla"ifyliig,     titoriiig     and      retrieving      data      most
                                                        effectively.
                                                        8. llioc?lgiilccl-iizg projcct-$229,129
                                                        'I'ii(@ aiiii of t@lik
                                                                                ik(!t@ivitly    is    wi(ler    distribution    !it    rural    areas    of     Sensor     traiis
                                                              for early                    of 11(@.irt disease,               and    stroke    and    to     1,,eiierate     more
                                                        iziforiti@itioii oil physiological 1):ttteriis of t'lies(@
                                                        i). lli-ograi)@ cvttlitatio)t ccntcr-dircct cost $103,899
                                                        Through t multidisciplinary research approach                             accumulate      data      in      two      SCPI
                                                        itritt(!   (-oi)ijiiuiiities   about   lietitli   care,   needs   and   attitudes   as    iL    base    for    developing
                                                        iii.,itriiiki(,-iit,4 for measuring (juality of i@ttre and levels of health in terms of an
                                                        iii(livi(Iti"tl,sfuiietion in ]ii,4 community.
                                                        10.  Alito@o)i(itc(l, 1)ati(,,tit hiRfory-(Iircct       cost $77,56/
                                                               1)roj(@(!Il is t@estizig the                                                         -teiii     for      obtaining
                                                                                                  feltl,l))ility   of   oil   alltOl'nllte(I    t4y.,
                                                                            and     iiiiiilyz(@     (-()iiijklitijits     prior     to     examination     by      I)Iiysi(!Ians,
                                                                                                                                                                                as

                                                        itiL aid in early
                                                        11,                                                                                         (cost  $@t6.'),OOO
                                                        'I'(o I)I.tjvi(ii, I)oSl)ltllis fill([ I)Iiysi(-iiiii.4 fit  rural               %vil@ii  ittitoitilit(@(i   fitellill(@s
                                                        rtir  triiikstiiitlilig                               itil(I gill illitolilltl(-ti  '4y.'41,(@lli  tOV  allitlYS(@S     0 f
                                                                 t4)  (leitiolist-eiti(i  t@ll(,  f4@lisil)ility  of  Sll(-Ii  SYSI.4'1)IS  wlier(@   Iti)IH   service          is
                                                                                           and t,t) (IOV(@101), t('st ltil(I 11111)1(-Iilt'llt 'the IIH(@ Of  I)I(K@1191-
                                                        ii(@riiig signals as aid In diagnosis.





                                                                                                                                     52


                                                                    01)(,r(itioits                                                                               (,o.4/  $39,055

                                                                                                           ()I)ernt@ioiiiil iiit@tlio(Is of early (](@t(,(-t@loii tests for a Ilirgi-



                                                                 lisiiig Ntttloii;il 11@titli Survey (iiie,,,t,ioiiiijiir(!                                     factors contributing to  as(,
                                                             of lit@:tltii ;(,rvic(,s iii qiiiill t:owiit, With                                         oil tli(- lliflilell(@-0 of livailitiollit.Nl
                                                             of (,are.
                                                             13.  .@littokittilcel  lioii)itat  )-cco)-ti,                                           (-oil          $@;'-"IOO
                                                                 'I'Iiis   activity is testii)g the aiitom@it                     'iozi      of      liosl)itiil       record data      through       iis(-       of
                                                             eoinl)iiter      systej)is      to      organize      a      ready      reference      service       and       easy       access       to       lios-
                                                             I)ital      dita      as      i      base      for      iiieasuridg      effectivene.,is       of       changes.
                                                             15.  Coi)il)zttet-  As8c)izblcd  O)i-Goi)tg  3faiitiul  of                                               a)td  Ilara)ttcdic(it
                                                                       ices-dii-cct  cost  $26,8112
                                                             16.         Central         core         adlllilli8tration,         planning         and         coor(lination-direct          co8t          $238,805
                                                                 (University          of          '@%lissouri          M@cal          Center,          Columbia,          Missouri)          MiEwourf          Re-
                                                             gi()nal medical Program.

                                                                                            ,kfOUNTAIN-STATES  REGION'AL  lkfEDICAT,  PROORAM

                                                                 'I'Iii,4       foiir-stata,       region       (I(Itilio,       Nfoiitait,,i,       INryoiiiiiig       nii(I       Nevada)       began        its
                                                             OIK-,r@itioii,il  ,i(-tivities on              'in[areli     1,     ]()GS     i%,itli      tii      ol)erjttionil      award      of      $2(@(@,1)13
                                                             to                  oil(,     activity     in      coronary      (-far(,.      Ali      ol)erati(@ii;tl      ,4tiiff      of      itl)l)roxiiii@ttely
                                                             eleven    will    serve     in     the     I)roject,     and     iiicliid(-s     live     I)liirsici@iiis     an([     six     niirs(-.,4.     'I'lie
                                                             IIO.Sl)it.11'4     involved     will     include     'the     coiiiiiiiiiiit@y     lioil)itiil      in      wlii(-Ii      the      it(!tivity      is
                                                             telling                  it's    well    21'3    those    liosl)itftls    wli(@    %vill    ,ieii(i    t@lieir    staff    to    the     unit     for
                                                             training.        The        Itegioi),il        Advisory        Group        iii.4o        liielti(l(@s         tw(@liospital         representatives.

                                                                                                                   Operational  Projects
                                                                 litietz8ive      coronary      care      i?t       qt@iall       hospiffil.,;       i;i.       the       rcgion-rlirect       coit       $206,913
                                                                 Ilosl)itiil,,     at     true     Region     will     send     Itegistere(I     Niir.,;(@     iiitf)     St.      Ilittricl@',4      liosl)lttil,
                                                                              !%Ioiitiiiia    for    (-oroiiary    care    tt4iiiiiiig.    Fiat,,    t    w(@(,.]@     (!oiirs(@     will     1)(@     ()ff(!r(-(l
                                                             tlir(-(- tiiii(,s it v(@itr       for   21    iiiirs(@s,    find    tliel.("    will    1)(@    follow-lil),i    lit    tll('    liolil(-    I)oSl)i-
                                                             f@tis four times it y(@iir.  lit                                 it       I-(Ijiy        training        program                            (designed                                     ::  @
                                                             for siiiitll town  l@liysici:tti.4 will be held lit t)i(, Iiiiii,(@i-.Alty of iN[(?iit,4iiiii four
                                                             it year,
                                                                                             NORI'll  CAltOl,INA  lll@(ilONAI,  ',Il',[)ICAI,  I'R(XIltAht
                                                                 Ott                  1,  Ilk@S,  the  North (',jii,oliiiii                                                 111-ogi-iiiii       received        it
                                                             Colill)ill('(l                     find  4)1)(,i,iitioiiiil  award  totaling                                                         01)(@ritiloji;il
                                                                                     of        jiNN-iir(I  tot.,ill(@(i  $7.@j:1,7r'DO in                     (-osiK      oiily.      'rli(,       (@lienitioiltil
                                                             stiff ill(.Ill(les 4il)l)roxiiiiately forty iiitlivi(Iiiiil.,;, lii(-Iijdiiig
                                                             one    ntir.,;(,,    ;ix    other    ii.Ili(-(l     lieilt@li     I)ersoiiii(@l,     and     five     geii(@ritl             I)er.,if)niiel.
                                                                 .Nortli     (,;troliti;t     li;i.4     already     iiivolv(41     t%v(@iity-.seveii     of     it,,;     lio,.41)itals     in      the      Pro-
                                                             grain.       Tli(@       ,Advisory       Groiij)       includes       four       hospital       rel@r(-s(@jitii,tives        and        l@Iiiiiiiiiig
                                                             siil)e,ollllll,i@,es                       all  ndditioii@il  it-ii                               Alil@roxiiiiiitely                    tnveitty-oiie
                                                                              iir(@ lxirtiell)@itiiig Ili  iii(@ ol)(-rittloiuil  I)roj(,vts oiiltliiic4l below:                                                                         4

                                                                                                                  01)(@riltioiiiii  Ilroj(@(@ts


                                                                                             II          C4) I,  1 1-ii I I k II kg        III I.41 I(.III  it II (I  it1114.(]  iiii4li(.Ill  ,4t II([(.] I t.,4
                                                                                                        4-4111(.Ii i.i4kikil 1 4-N                                    11  Trial l@(- I'll fill ly            I(-('
                                                                                                   lifiv(@  it                                                    Iii-ogi,@iiii    Ill.    Ill(-    illi@411(.Ill
                                                                 14)(01   I t) SI                   I,i('t4                 I lll@ Ill('(] i('Ik I                          retail            I(-i   lig    I)IIY.
                                                                                                                                                                            (.ollillllllilly        jollilillilig
                                                             rt),. improving iiii@ 4iiiiiiii,.v t,ii(I availability of                                         (-are.                    l@,v    tlilt4    I)rt)j-
                                                                   itrt@  tli(@  ft)lli@%viiig  git)iilk4:  ii)(@  l@iiivt,],slty                                           tlli@                      (,'(@ililty
                                                             Itiii-4ii    ifi@iilt@lt    Services     ilrojt@(!t;     ilit(@     It(-gioziiii     II(,Iiltli     (Ioilll(!il     of     l@,iit;l-eriL     Al)l)ii.
                                                                                                      of 14'riiiikliii Ili-iii(li
                                                                                      i@lt),4(-s      Coii(@      M(,,iiioritil      lf()t4l)ital,      Greeii8t)(Yro;      and      the       Dorothea       I)lx
                                                             N(,,uroiiiedical Servi(-e.





                                                                                                                   53

                                                               2. Coroiiarll carc traiiii;ig and dcvclol)iiic)lt, (ii?-crt en-it-$56,938
                                                               l'o      tli(@  1)rojei-t  ,is  a  ille(iiiiiii  for                         (-ool)(,riitiv(@            arriitig(@iiietits
                                                                                                                                (-(@ilillilillity.    lilit@ilil    and    (-ont,itlllillg
                                                               (!(II,(.:It,ioli will IK' lirovi(]('(l to iiiirs(,s laid                  ill   (!ollll)lllllity   11(@stoititl'4,    Coll-
                                                               sultiitioii   will   be    available    to    lio,;I)itAlls    ill    establishing    CCtl's,    and    ;t    coxiil)iiter-
                                                               1);ise(I ,iysteiii of iiieclical record keeping will be                            Tlii,,,4   project    liaf,    led    to
                                                               iiew Nvorliiiig trrajigeiiieiits                          tli(- University                   centers;       (2)       I)(!-
                                                               t%N-Lcii        and iiiirse ediicitors;                                doctors ;tri.d                 in             commu.
                                                               iiity    liosf)itiils;    (4)     b(!twc@,n     I]Diversity     iiie(li(-al     centers     and     community     liovital&
                                                               3. T)iabctic co)i8iiltatioib and cditcational                          direct co8t-$132,081
                                                               To establish three iiie(li(!al tcai)i.,j to deliver s(,rvi(,e,4 throughout -the                          -,tate    ;     to
                                                               :t.,isist   in   (Expansion   of   (liabetic   c(--PiistiltAii.ioris    ,iii(i    te.,tcliijig    clinics;    to    provide
                                                               s(-iiiiii@ir.,i   for   physicians    and    t,(,itcliiiig    s(,s.,iiojis    for    iitirbes    and    lifitiezit.,4    to
                                                                                                                                             sin(I    I(>(-iii    chapters;    to     test
                                                               ;issist ill oi,g4iiiiz.,ttioii of  iL  State               A.,
                                                                         or (I"tf;i                    Many joe(olol(@ of                                       ill      partly      Coal-
                                                               iiitit)itie-4 are involved la tlii,,4 iii-()Jcet.
                                                               /1. I)cvcloplilcibt of (t ccttti'al Cancer regi,31i-y, dircct cf)Rt-$66,615
                                                                            ,t iiiiiforiii regioil-wi(le                   reloort,in      syrteii),      lntegrat(..(l      with      the
                                                               To devise .                                                              g
                                                                        c(@iiij@iit@r-stor(!(l    (iita    froizi    wlii(-Ii    (!all    I)(-    retrieved    to    serve    ii.    broad
                                                               range   of   (@(Iii(-atioii,,il,   research,                   all(]  other                      The           folloin-ii)g
                                                                        ,ir(@   participating   in   the   first   y(@:ir   of   ill(-   project    :    I)til@    ljniver,,4ty    ',Nled-
                                                               ic.il C(@iiter, North C@,irolintL M(@iiiorial lIosl)i.tikl, North Carolina 13111)tist
                                                               (',Ii,,irlotte Ateiiiorial Ilosl)ital, Veterans A(Iiiiiiiistratioii                            WatL,;          110@I)it;il,
                                                               Hanover     'i%,I(@iiioriiil      llosl)i,t;4i],      Southeastern      (@eneral      Ilo.,;pitAil,      Craven      County
                                                                                   -c
                                                                        In    @.stib,,,queiit.    years    the    registry    will    be    ex:l)anded     to     include     all     hos-
                                                               I)it@i@i and physicians in the region.
                                                               5.  ifcdical lib)-ary   cxtcitiio?u service, direct  cost-$25,839
                                                               To bring medical librtry facilities of the three iiie(lical                           school,,     into      the      daily
                                                               work     of     those     engaged     in     inedical     practice.     l,ocal     hospital     personnel      will      be
                                                               trained    to    assist    inedical    ,taff;    libraries    will    be    organized    into     a     functional     unit
                                                               for     responding     to     requests     for     s@ices.     liii)liogril)hic      request      service      will      be
                                                               established.
                                                               6.  Cancer l@ifori)tatio)t  Center,  direct cost-4111,716
                                                               To     provide     pricticiiig     physicians     with     iiiiiiie(liitte     consultation      by      telephone      and
                                                               follow-111) literature.              of    tli(!    tlir(@(@    medical     schools     will     be     responsible     for
                                                                                                                I(x
                                                               providing service in its gt,<)grttl)lii(,                   The    iiiII14    of    this    project     iir(@     two-fold;
                                                               (1)  to assist I)IIysiciiiiis in lDrovi(Iiiig        ol)t@iiiiiiiii   (-ilr(@   of   l@titi(@lits   with   cililcor;   an(]
                                                               (2)  to continue tli(@ (@(Iii(-ittioii of tli(-      physicians       by       giving       new       Information        In
                                                               I)itti(!iit-eviit(@re(I
                                                               Co?ttiniting c(lite(itiott, in         internal                      (tirt@ct cost-$33,313
                                                               To bring 1)r;teli(-iiig iiit(@riiist.,; front         all   over   tli(@   Kiiit(@   to   the   Al(-(Iictkl   Center    for
                                                               II month of til)-to-(].it(@ training lit tli(@ir                                                 sliire       re,;I)oiii4i-
                                                                                                      i(-igllim and               N@,tr(i roiiii(I-9 with                           staff,
                                                               I)iliti(@s  %vitli  ittt(@11(jilig I)IIYS
                                                                                                                                                     tioti    in    the     lliiiversi-ty,
                                                               and             This                       should                  the     itl)l)reciii
                                                               1)4)tll  lit  f4l(tillt,y  and  Stll(l(!Iltl  lt-v(@ls,   for   the   (Expanding   role of     the     in(@dical      center
                                                               for tli(@ qu@ility of care lit the coiiiiiiuiiity.
                                                               8.    Coittittit-ing    c(litc(itioi@     itt     dentistry,     direct     (!oi"67,500
                                                               To    I)rovi(](@    PIlysi(.!;il)s    ilik(l              Nvitli      til(@      knowledge      of      mutual      concern
                                                               wlii(.It will           tij(@iii to I)t- iiior(-                iii(@iiii)(@rs  or  the  health  t(-iiiii.   Cotir.,4(,.,.4
                                                               will  1)(@ given lit tli(@ lTiiiv(@r.,41ty of Ni)i-fli                      itil(I   Ill    (,olllllllllllti(@m.    studies
                                                               %I-Ill 1)(@ ill:[(](! of                       to ])Vo%'I(I(-  (I(@iitikl  (!itr(,  lit  lio.,q)ltiilt.  Tli(@  I)tirl)os(!
                                                               of this             Is  to  ltisiii'(-  Iltitt,  ii,,4  iii:%"Y  ])Itti(')It,4  118   l@Ossitol(@   N%@lio   siiffer   from
                                                                                                          or it  r(@littq,il  (Iis(,:Is(@  1,(,(.eiv(@  iii)l)roliriiite  (I(,iitiil  care
                                                               rest joitrtof
                                                                                                        for                                 direct coqt-$27,838
                                                               To (Iev(qol) and establish regional (-outlining (!(Iucatioll programs for                                          physical
                                                               tli(!r;il)i.,;ts   in   order    to    strengthen    I)Iiysi(-al    tli(@riipy    tiervices    for    preheats    la    all
                                                               parts    of    the    Plate.    Subregioii4    will    be     delineated     where     needs     and     interests     will
                                                               be Identified and committees will be organized to arrange local activities.





                                                                                                          77@
                                                                                                                                                                                          7-





                                                                                                                54

                                                10.  7'h(@ Cvt(tbli.@Iii)i('iit of (t                        of  rot-o@ift;-Il  c(li'(,,  itilitq   in   -Riiiall   cot)toiiiinitil
                                                       liovl)it(its i;),                        A'oi-th (!fit-oli)t(t
                                                                                                                         lillit.4 ill            llosl)itills Ill tills
                                                                               Itlil' N%-ill                Ill(-                                       (1114' lio',I)illil
                                                                                              ll(l(-ijililli-Iv ti,4jiii(-41 I)livsi(-Iiiiis iiii(I jitirs(@s iii-(@
                                                                                                                                   N%-ill  1)(@
                                                gi-.iiiiii(,  regioii,  tti(l  (,fiiitiiiiiiiig  (@(iii(,iitioit  1)i,ogi,iiiiis  Nvill  1)('



                                                                                                         111-ogi-itill           its                      it(-Iivil@i(-S   Witil   11
                                                                                                         ol' $2.-)rt,,187.
                                                                                                         N%,ill
                                                                                                            ;Ill(l C%Vo ;Illi(@(i lit@:illli                      A      iiiii.lority
                                                of    tll(.        :irt@ from (.(@illillilility I)oSl)illl]S, lit](I Ill.(, %@'ol-iiiilg i-lo.'4('IY                     llie(li(-Ill

                                                                                                         froiii  tli(,  i-(@gioii  @ir(-   ii(jNN,   1),irti(-Il)itfiiig   la   the
                                                I)rogr.iiii, ,Iil(l tlii.,i will exl),.iii(I its fli(! I)i-ogi-,jtli iiii)v(@s                         over   tli(@    ii(,xt    few
                                                          Foiirlio.Kpital,4itre      initially      li:irti(,il),itijig      iii      tlieol)(@r;itioiiiil       I)ro.Jeets.Tliree
                                                of tli(-,,e four i.re r(,I)res(,nt(-(] oil tli(@ lt(@gioji;il @k(lvisory                                         S(@veii     a(l(li-
                                                tioii.,il    lio,,I)itils    ire    ,;ervjjig    oil    the    A(Ivi,,,-ory    (,otiiiiiitt(,e    -laid    planning    sul)coiii-

                                                                                                Operitioiiil Projects
                                                1.  Piot-ovritiott  and  cqitil)ping  of faciliticR  fo*-  a                                      'center      fol-       p@-ojected
                                                       trai?tiiig     programs     related     to     heart     di8ca8C,     cancer,      and      stroke,      direct      co8t-
                                                       $26,1100
                                                    The iwarcle(I                     ire for the I@url)o.,* of altering iii)(I rt@nov:itiiig                                     iii
                                                Helen         Ivoo(I          ivliicli  11011.-4(@  tli(@  Dep,,irtiii(@iits   of   Ntir.,;ii)g   ,it   the   ITijiver.,-,ity   of
                                                Rocliester.   It   is   pLiiiiied   to   e(jilvert   five   rooiiis,   itito   two   r4)otii.,4   for   s(@lf-iii,,@triietioziitl
                                                le.,iriiitig.  Tlies(, fficiliti@  initially  Nvill  1)(,                       for four                     (Corollary         care
                                                training (-oiir,,e.,; for                    iii(I                    ill  l@lie  i-(,gioii.  N(@w  I:e(-Iiiii(ju(@'4  tll:lt  tire
                                                                      I)Y 11)(1-1,11is of tile,,(- (-oiirs(,.,; will tlt(,ii 1)(@                    to tli(@ viirioiit4
                                                jikiiijity liosi@i@titl.,; iiii(I rural ill-(-Il'4  ill  tile  I-(@giq)li  I)Y  Ill(-  ir4killilig(.otlrf4(@  I)III.tiell)llllts.
                                                2.                         I)-flillitig                  foo-  flit,  I)hll.Ni(I-i(i,)iv   let   th(@   Ito(,,heqtci-   10-coil)tty
                                                                             (@ost-$8.11,900
                                                                           of (lit,;  1)roj4.(.l,  III'('                $il-oilll(l 111(@                                    of  it
                                                I)osigi.lt(liilt.l. I)I'ogl,iillk Ill i-lil.(Iiology.  f,iiil-liiiig                                 will 1)('  iiiii(it@  tl'v;iil-
                                                                                                                                              (,@irill4iloglsi,,4
                                                                                                                                                                 I('Ilgl.ll  fl'olll
                                                oil(--Ii:ilr (Illy 14) two                    11  is                              it                 (If Ili(- I)III'li(-Ilyli,llllg
                                                                                                                                         Ill.4-liS.


                                                       flio#i(ll
                                                    ()]I(-          !V(@ of' iiii,,4 .(@gisi ..v  I,, ito                    it iii,ir(ot-it,  (i@itit             loll    SYHI('Iil
                                                l'i-tolli  N%,Ilif.il  I)otli               llifol-lii:ltlflll  its           Its  loligilli(lilliti  itillily.,i(-H   rally   1)(@
                                                                                     liifoi-iiiiii4ill its to lit'(@Klifosisill)(I
                                                          'to iiiii-ti(.il):Iliiig 114).@liil:ils all(] (-IO(OIK@i,iilillg                        ill  111(@   I.(,gioli.   Sli-ioiig
                                                                                                     N(,Av                                                  Ili  tills  I)roj(@(-ti,                      4
                                                .@ii(I  it,  is                                                                          114)Sl)itiLls,     ('81)eciltlly      those
                                                          -it it r(@;i
                                                iii   rare             will sooii :i,iso Ill- I);irti(-iloitiiig.
                                                    Ili-ol)osal   foi-   citablimli?ii(7it   an(/   xitl)l)ot-t   of   (i   i-(,flioot(it   f(iboi-(tfo)-y   fo)-   the    (@duca-
                                                       cat,io2t  all(l,  t?.aill@ing  in  the                  of    I)afiejtt.,;    it@ith     th@-opiibotic     and     hctiiot--
                                                       rhagic di.,ior(lei-m, (li@rect cost-$69,)iOO
                                                    'tt  tile  I)r(,  eiit   tiiiie   iio   siiigle,   (neutral   fi(,ility   (-oii(-(-rii(@(I   witli   tli(-   diagnosis   aii(I
                                                                   s
                                                tll(-I-llpy  of  iktti(!Ilts  ivitli  tlil-oiiil)oti(- or lieiiit)rrliiigi(-                           exists   Ili   tli(-    Ito-
                                                (-Iiester r4-gioii. T,,il)oriitory t(,cliiiiciiiiii froiii the regional                                      will   lie   iiivit(-(l
                                                to  ,;I)eiid  tlire(@  (@r  four  (ltys  Ili  tile  iie%v  fit(-Iiity.   Ili   Ai(l(litioii,   file   I)Iiysi(!Iaiiis   dire(-it-
                                                I 11, t II I s I)roj oet; wi I I v I s I t I lie 1). I rt I (,I 1)a t I I ig (-oi I I all I i I I t I (@s ,4o t II it t I t (-oil t It I i I I i ig e(I a-
                                                (-it t I (Ili it I 1) i-ogrii it I for I @rs I (-t I (- i iig I @liys I (@i ti)i s I it t lit, (-it ri, o t I n I t I (,I i'l s wi I It tlir4)iii I)otle
                                                (Iiseits(.s will 1)(@ iiiiiiiltiiiil(.(].


                                                                                           Atli)-HOXJ'I'll  ]tFAIJONA),  lfleI)IOAI, Ill?O(ii(ANI

                                                    ()it  I,'(-Ioril4kry  1,  l)68,  Ill(-                         iNti(I-84iiit)L      lt(@gii)iijil                   J.'rogritiii
                                                I)t@gaiii  Its ol)(@rittloiiiil il(!I@lvities witli  it           (Iivt-rse   sirriiy    of    lirogriiiiim    (losigii(-(l    t@i)







                                                     proi,i(](@    lo(,iii    health    practilioitel's    :I]'(]    liosl)iflll,,    willi    :I(Ivlliice(I    teeliniqiie,4     and
                                                                                    for (iiiiilif@y                                lifl.N,            are   (!iirr(,.iitly   serv-
                                                     i,ig  on  iii(@  -;t:ifr  (or  fli(@  4)1)(,rittioiiitl  1)rogr@iiii,  ill(-Iii(lilig  approximately   fliirty-ilve
                                                                       JIN-E  iixirs(@,  liv(@  otli(@r;illi(,(l  li(@itltli  personnel,  and   iiiiiegener.,Il   stipport
                                                                       AI)oiit   oiii@-fotirtli   of    tli(@    stiifr    are    front    (-oiiiiniiijity    hospitals    and    the
                                                     r(@iiiiiiiiiiig    are    medical    center    st,,tlT    Nvlio    iir(@    %vorlciiig     on     the     community     oriented
                                                     1)1-4)jt,cts                  ])Clow.
                                                          S(!veiit       hospital,,      are      currently      I)iirticil)@iting      in      the       operational       projects,
                                                     representing     broad     geographic     spread     t@liroijgli4)tit     the     region.      Teri      of      these      bos-
                                                     I)itils ;ire ilso represented oii t@lie Itegional Advisory Group.

                                                                                                   Operational Ilrojects
                                                     1.  Coiitiiiiii)ig i)ic(liral c(l.,ttcatioit--Ifch(irry, (Iii-cct                coqt-$44,800
                                                                                     (,'ollt@ge    Is    izifoi-iiiiiig    Negro    ])IiYSICIIIli8    11)    tli(t    region    about
                                                                                              for tr(-iii.ijig )i(@iiri@                              and                  'I'eitilis
                                                                            %Vill          two-%v(,(,k (-oiirs(,s in tli(- llir(,(@ area,, iti@ the                              @ll.
                                                     I(,r, using v4tri(iiis iiii(lio-vi.,iiiiil :ii(is an(], wli(,i-(!                       I)rogr@ilriiiie(I     ]rise 'reaction.
                                                     (,)a(! of         I)Itii's   ]zitA@r(,sting   I)rovi.Qoiis   is   s(-,jidiiig   itseii.lor    r(@.,ii(leiit    from    MeliiLrry
                                                     to (,are for tl)e 1)liyqiciiin's practice wliil(,, li(@ is itt.t(!ii(ling the Course.
                                                     2.  Coitti)iiti?ig  c(litcatioit-Van(icrbilt,  direct  cost-$Ilil,600
                                                          Vanderbilt      proposes      to       establish       continuing       e(Iticqtioii       (Tnters       at       community
                                                     hospitals   Iiiilied   to    a    proposed    I)ol).,irtiiieiit    of    Coiit@iiiiiii)g    lt,(Iii<-at@joii    tit Vaii(ler-
                                                     I)il(@. libraries and iiiforiii:it@ioii centers jit@ the local liosl)ital.4                      will         bring Vander-
                                                     I)ilt's    information    resources    to    tlic@     local     physician.     'I'lie     1)ro,,,raiii,     though planned
                                                     and                        by    Viiii(leriiilt,     will     fiiiiet@ion     through     the     local     centers and        em-
                                                     I)Iiiisi7(!    bringing    information    to    the     physician     at     the     times     he     needs     it.
                                                          a@t(I      li,      Ilop7zin8ville      Editca-tiott      Cont(,r      and       Chattanooga       Edticatiot@       Center,
                                                           ([,it-(,Ct cost-@73,700
                                                          'I'liese ire tli(@ first of       the    local    continuing    c(lu(-.,itioii     (!eiiter.9     sl)ecilled     in     the
                                                     I'ariderbilt    plan.    At    each    hospital,    a     fiill-tiiiit@     I)irector     ,i,itli     all     appointment     at
                                                     Vanderbilt     and     an     -,assistant     director     will      ,ul)ervis(@      resident      and      physician      edu-
                                                     catioii    in    their     ,irea.     Their     services     %Vill     be     available     to     physicians     at     smaller
                                                     community    hospital.,;    in     Pacli     irea,     as     will     the     enlarged     hospital     library     facilities.
                                                     The     Chattanooga     iiid     I-loplciiisvillc     locations      proi,i(le      the      basis      for      looking      at
                                                     problems in continuing education in urban tii(I rural settings.
                                                     5.      HI)ccial      t)-ai)tittg      foi,      practici'@ig      radioloqist,,f-17a-tidcrl)ilt,      dircct      co8t-$50,1100
                                                          This     plan     focii,,es     oii     developing     1)riieti(-iiig     i-ii(liologl-4ts'     skills     in      vascular
                                                     radiology, but might Iiit(@r 1)(@ I)roii(l(-ii(@(i to                             all     nspectm     of     diagnosis     all(]
                                                     tlit,riij)(@iit'ic  radiology.  ',Vivo                                (,(Iti(-ii.t.ioiial   iiietl"Lg    will    lx@    iL-3e(l.
                                                     Oji(@ to) llire(@ itioi@tli (-oiii-,,i-.4 for                             %Vill    1)(i    offered.    III    addition,    eini-
                                                     tit!iit,    rit(ii4)logis(.s    %%,ill    1)r(-sl(le    at    t.%vo-lioiir    monthly     s(@iiiliiiirH     to     which     all
                                                     riiiliol(@gisti in             r(-gloji  will  be invited.
                                                     6.        C(ir(liae        franc        ti-(tiiii,)tg        progra)i@3[i(l,-Htatc        Ilaptist         lloipitat-yaqltville,
                                                                       co.,it-$J,9,600
                                                                l@(,y  fii(!I(,)r In  re(iii(-iiig mortality fi,oiii                         itrr(@.,4t@  is  the   ]iiiiii(@(ilitt(i
                                                     itvltil.-Iloilil,Y   of   it                           1)(,rsiiii    to    iiiitiitt@(@    r(,stis(@ilitt,ioii.     Mi(I-Sotitli
                                                     ltiijiti.,4t, l@rol)ost@s t.4@ iii.4trii(!t@ (-jtr(Iiiie iktirs(,,; !it                                                       by
                                                     )i4)1(liiig           foiir-wt,(-Ic   (-otiri(@. Tlies(@                  will  tli(,@ii  1)(@  itvjiiltkl)le   to   liosl)ltalm
                                                     tiiroiigliotil. trial i-(@gloii.
                                                     7.  School of X-?-ay atttl,            tcehiiology-Alchai-i-y,  (lircot  coi"19,500
                                                                       lkllllls  to   (@.stit'lolisli   it   two-year   1)rogi-ikiii   for   tr4t'iiiliig   at   least   tell   X-ray
                                                                          it(@r y(-iii-. Tlit- facility will 1)(@ !%It?lijtrrv'm I?Ai(llology staff.
                                                                 for      establishing      nuclear      medicine       and       rit(liollicral@y       programs       will       be


                                                          ]@,(i(liolotly  tcchitologist         training          1)t-ograiii-Va@i(tei-I)itt,          direct          colt@1-430,300
                                                          l'iiii(l(,rlfilt   I)rol@os(,,.4    to    increase    the    iiiiiiilx@r    of    X-niy    technologists,    improve    the
                                                     initially    of    tli(-ir    training,    and     iiier(@tttc     their     opportunities     for     (.Annealing     c(Iiieii-
                                                     tioti.     Three     miii,.ill     hospital     training     programs     in     the     area     will      be      discontinued
                                                     its     sel)4irittc@     (@iitities     and     subsumed     by     a     new     school     of     X-ray     technology      at
                                                     Vaii(ler'uilt.     Practical      clinical      experience      will      be      both      at      Vanderbilt      and      the
                                                     tiiii,aller       hospitals.







                                                                                                                                             77





                                                                                                                            56


                                                                                                                                                                   Nt--$25,300
                                                                                                        litilgli(, I)y I)jir;iiii(@(liciii itii(I iiiN]I(@-itl                        Nvill 1)(',
                                                                                     to                                                      to                tli('il- sliill ill
                                                                                            IVII(@ll                  fit(-   I)II.1'sielill   all(I    Ili,;    t('(!Ill)Ologist    will    @,11(l
                                                                    triiiiiiig t.illl(' I:oget,])Pr to w(@rli oiit'                ]@r(x@(,(Iiir(@s   siiite(i   to   their    sittintlioll.
                                                           Ti-,,tiiiee,4 will 1)(@                   front   siiiitller    (-oillillliiiity                    I)Itiniting,  t(o  (@.4tal)lisli
                                                                                                             services.
                                                           10.                     of      School       of       Ilc(lir(il       7'celtiiologll-B(ii-otiess       ],,'rlaiigct-       Itovpital---
                                                                  Oliatta)ioo!l(t, (lircct co,3t-435,400
                                                                  To @iiigiii(!iit  iii(,die,,il  t(-,Miiiology                           lit  tli(@  iir(@it,  this   1)14tii   iii;ili(@s   t%v(j
                                                           I)ropo.,;iils:  (1)                   tli(@    lt;iroii(-ss    1,;rl:iiiger    1)rogriiiii    for    inc(][(!iii     t(x.-Iiiiologist,4;
                                                           .111(l       est@ill)lisll    'k     School     for             ]:it)   ii."ist;iii(s   NN-lio    (-oii](I    free    t(@(-IiiioIogist.4
                                                           front     iiiore      routine      worli      for      inore      (-oiiipl(,x
                                                           11.       Va)t(lc@-bilt        Coronary        Care  Utiit,  (lircct  coit-$51,600
                                                                  This  I)roject's  I)tirpose  'is  to  estil)lisli  it  network  of                           corontry         cire          units
                                                           with                     equipment,      staffL,(l      I)y      well      trained      personnel.      Vaii(lert)ilt      will      I)e
                                                           t)i(@  training     tir)tl     information     center     for      the      region      ;      a      demonstration      unit      there
                                                           will     provide     @t     foeil     I)oiiit     for     continuing     c(lu(!.itioii.     In     ,id(litioii,     comixiiini(-@,itioii
                                                           ,;yst  ll)S will I)(! set  111) l'O fl(-ilitilte ili(@ flow of Iiiforiiiittloii front                                                 to
                                                           the    (-oinniiiii.ity    110.141)it@lls.    Stildie,4     ire     I)elng     made     to     ,m     if     the     rniall     hospitals
                                                           coiiii(@(-te(I     NN,itli     Viiii(lorl@ilt     (!an               in     turn,     (!(,iiter,.4     for     local     networks     of
                                                           Coronary     care     facilities     lit     still      siiitiller      liosl)ittils.
                                                           12.       Ft-a,)tllin,        Co;-onarl/        Care        Unit-lVilliaiitiott        Coitntll        I108Pital-Franklin,        direct
                                                                  cost-$31,JIOO
                                                                  If,iiis  is  (@ti(i  of  ill(,,  -,itl)sl(liary   units   attention(-(]   lit   tti(@   Viiii(lerl)il,t,.I)rfyl)o.,4til.   Tlilfi
                                                           I,,,  I)ri)iiixrily  it  iiili)tl  I)r(yj(-<,tl  t-o  .4fil(ly  tii(@  f(@jltiil@ilit,.V  lit)(I  iii4eflillies,4  of  ent'lll)limllillg
                                                           it           ill it William (.01111111111111Y Ivo"l)itlill.
                                                           J3,      ltol)k;)?,,ii@ille      Ot)r(@oiat-11      C(ir(,,      tltiit-l(?2t)iic      Stit-at,t       Alctitot,lat       Hoqpital-Itop-
                                                                                                     cost--$J,9,500
                                                                  li,lkl,4 ])talk is f4illlll,lll. to                                             (11111, It                    (@.stltl)li.4]iilig
                                                           ]liters to                                   hospitals    liy    )i(@ilviiig    8@@t,                                    lit    lh(@iii,
                                                           I liiis I)i-io%,i(iiiig for lit(- grt)til)iiig (of rural (-Ollllllllllitly                                      jiioi-(- (@lliel(!nt                       4
                                                           list- (@f (.Xisf liig
                                                           14.      Clap-ksi)illc      C(,Pro)zai-il      Care      Unit-CI(irkRville      3[(,-))zo)-ial      I[oRl)ital,       direct       coal-
                                                                  $,19,000
                                                                  As   Uli(@   Fr@iii]@iiii   1)rogrniii,   this   I)rt)j(,(,t.   Is   it   stil)sl(li@irv    of    the    Viiii(lei-I)ilt    I)ro-
                                                           I)o.'4111. Sill(!C trials II-iosliltilil          1)(-(-n  4kl)(@r;itiiig  it  iiiii,t,  tli(@  I)Iiiii  calls  for   it.4   exl)all-
                                                           sioii, coiitiiiiiii)g                                I)Iioile     lrool(-tip     to     VAI)(lerbilt.
                                                           15.      Xa87tville       Gcizct-al       Cot-(,4tat-y       Care       llttit-Na8hi;illc       Aletropolitan       Geitcral       Ilo8-
                                                                  pital          direct           co8t-$42,100
                                                                  Agaii),   this   is   like   tlie   Fra7ikiiii   I>Iaii.   Niir.,;e.,4    here    will    be    iiiclii(letl    lit    the    in-
                                                           s(@rvi(!o traiiiij)g l@rogriiii.4 initiated ;throughout -the ly:irticipating hospitals.
                                                           16.  Ifcha?-t,ll 3[eflical College Coronai-11  Care  Uiiit,  direct ci)8t-$85,800
                                                                                                                                                                                         facilities
                                                           wlii(!Ii  %N,ill  serve  its  it <-Oiitiiiuitig                             ceitt(@r    for    miiiiiller    lio,;pittilfi    lit    its
                                                                                                                                                                                                                         4

                                                           17.                                                                                          (Kll,)        (.,Ioitoity         Hospital,
                                                                  (lit-cf,l
                                                                                            (Country      11(isl)lliil,      ilit-      training            for   '.Nliiri-iiy    8titt(@    (fill-

                                                                                                                         will   ])A-   (@Silli)118114-(l    with    ViiiiII4.1-1)llt,    Willi-II
                                                                                             ri.oiii its st-lio@4@l                                             'I'llis                  liiisili(@
                                                                                  .4yr I-(-Illtijig Ill(- Nliii-i-iiy                  Niii-siiig    1)rogi-iiiii    (i)    all    (-stiil)lislie(I
                                                                                          I)ri)vi(iiiig       r(-glotiiil       training                t(o   it
                                                                                                        0(ii-e      Uitit-Itat-oticqs      I,,'t-laiigcr      Hospital,       (li)-(!rt       cost-
                                                                  $,14,Ji 00
                                                                  t II                                  l@o (@mt,iii)lisli it                   (-are unit iik a I)rogriiiii of
                                                           (olm@rii!t@ii)jL   Willi   Viiii(l(,rl)iit,    ll()tll                                              111111                      ilintil-                                    I @
                                                                                                        ivitli Vililglerl)llt will 1)(@ instant. 'niiH unit will  t4ei-ve
                                                           tire it (-(@ijt(@r for the Kiiijiller lioil)ItAil" lit







                                                                                                                '77@




                                                                                         57

                                          19. Baptist Iro8pital Cot,o?iary Care          U)tit-,Ifid-State     Baptiqt     Ho8pital,      Vash-
                                                     direct cost-$51,000
                                            'Vlii,4 I)Iiiii ii sitiiiljir to tli(,       iiielti(l(-d fit the V,Ll](leri)ilt plan.
                                          Ilo.@I)IC@il will (,xltiiii(i its I)rese]Yt f:l(.iiiti('.S and ai(i est.'Il)l!Slllll(@lit of stiinllcr eclil-
                                          ttrs at  'I'lilliiiioziii  and  Crossville.  Tennessee.  I)Ircet,teleplione  lines  will  be  estab-
                                          lislie(I for                  The  unit  director   will   have   a   clinical   faculty   i,ppoint-
                                          iiieiit  it  Vanderbilt.  lIc  will  devote  approximately  2Wo   of   his   time   to   the   unit.
                                          @@0.   C?-os,3vilto   Coroitai-y   Care   U-nit-Upland8   Ctimbcrland   Medical    Center,    Cro88-
                                               i-ille, direct cost-,V28,300
                                            This  1)roject  has  two  pi3rpo.,;es:   (1)   to   establish   a   two-bed   coronary   care   unit
                                          In  tli(@  hospital  ;  and  (2)  to  determine  the   feasibility   of   operating   acute   coronary
                                          (-.ir(,  unit,,   In   rural   areas.   The   hospital   will   cooperate   with   Mid-State   Baptist
                                          Ilosl)it4il and Vanderbilt.
                                                             Cop-otiat-l/    Care    UtLit-ilai-ton    Afentorial     Hospital,     Tultahottia,
                                               7'cn?t., di)-cet cost-$28,800
                                            Sc,(@ liil)tist Ilospitnl Ilrograin.
                                               Jfchap-t-y Riii)ct-i.-ollagc Iii,crapy I)rograi)t, direct cos@58,300
                                            'I'kiis I)rojt-(-t is       s]@ecifl(,jilly  at  improving  cancer  tli(-rapy  for  it   large   in-
                                          ilig(@lit ih)])Illittoii. ',Nleliiirry will use Its ftiii(I.,4 t.() obtain it (-Ol).-tlt, Cio Iligii liiiergy
                                                  for  l@ii(,rgil)y  and  i  computer,  liook--iij)  with  Vanderbilt.  These  facilities   will
                                          iklso   li(@   used   to   Improve   undergraduate   and   graduate   radiology   training    programs
                                          at Nleli.@irry.
                                          23, Ilrojrct to             I)aticitt care iit  a  rc)itote  t)intintain  coinntunitli  bit  rccrilit-
                                               itig aii(l ti-aiiii)ig lic(iltli, aides for  a  netv  extc@iide(i  care  facilitli-Scolt  Coitnty
                                               lftox))ita[-Oiici(la, 7'c)tn., direct coRt@10,300
                                            l[iiiil)oNN-ei- ;Iiortiig(@ In this isolate(] iiioiijitiiii hospital  Is  critical.  Personnel  to
                                               an               care  facility  now  under   construction   will   be   ol)taiiie(I   by   two
                                                      (1)   Iii-,gervlcc   training   for   hospital   1)(@rsolinel;   (2)   an    (-dileational
                                          tlir(-(-tor  (an  IZN)  to  serve  as  a  liaisoit  to  tli(@  high  schools  to  (!tieollrage   young
                                          people  to  enter  the  medical  field  all(]  come,  back   home   to   practice.   In   addition   a
                                          training  program  leading  to   the   LPN   would   be   initiated.   Clinical   training   will   be
                                          supervised   by   the   Educational   Director   while    local    high    schools    provide    basic
                                          training.
                                          24.   ll'caZt7b   cvaluatioi@   stttdic8   on   a   defined   population   grou@mtiltipha8iC   80reen-
                                               iitg-)Icharry Afcflical College, direct C08t-$436,000
                                            Ifeliarry   will   determine   the   effectiveiie&,;   of    a    comprehensive    health    progrim
                                          and  iiiultil)liasic  screening  examinations  in  early   (liagno.4is   of   heart   disease,   call-
                                          c(@r, stroke and their                  To   run   this   exl-wriiiierit,   a   neighborhood   medical
                                                  supported  by  OEO   will   ,4erve   @t   selected   I)ol)iilition   of   18,000.   The   test
                                                       and a  control  1)o])tiliitioii  will  be  (,valitiit(@(I  with  ref(@rexice  to  morbid-
                                          Ity, (-Iiiiiiges !it ]i(@altli attitudes and  iitiliziit@loii  I)jitterii,,4,  effectiveness  of  the
                                          ,4cre(@niiig procedure and tit(', cost per patient diagnosed or treated.
                                          25. I,,'xl)ct,ii)ic@it to te8t ati(I  intplctit(,,itt  a  t)zodcl  of  patient  care-Vandcrbilt  Uiti.
                                               activity Ilospital, direct roNt
                                            stairs Is @iii ii(@teinl)t to (leflii(N a ii(@w @triiet@itr(@ for patient (,-are. New  I)er,;oiiiiel
                                                  ste%vir(](@ss(,s will be trained to titk(,@ Liver tlit@              iioii-cliiiien]   duties.
                                          Niii'se,4 @voii](I then I)t, free to  spend  more  little.  with  the  patient  itiid  'to  keep  iij)
                                          tli(-Ir                      After tli4@@ izio)(lel 19 refined  tit  Vanderbilt,  it  will  be  tested
                                          ill (paramilitary liosl)ititls-si)(@,iJlcally lliiptist and St. Thomas.
                                          26. A.          stirgical  ntirse  specialist  graduate  progratit   to   ititprot)c   ntirsing   care
                                               of   patic)Lti   letter.   h(!art   (lisca,,tc,   canccr,   and,   stroke-Vandcrbilt   Vnivcr8ity
                                               S(@hool of Afe(licin(!, direct (.-o,,tt-$23,f)'OO
                                            Vikii(l(-rliilt is (leveli)l)liig it program  to  train  medical  surgical  niirst,  slwciali.,.;tti
                                          to iiiil)rov(@ nursing care of heart, (,iiii(!er, iii)(I stroke patieiitm.  It  will  be  a  inaster's
                                          degree program shared by I)Iiy.,;iciniis and clinical                    (.1   calendar   year)   plus
                                          one  year  of   clinical   cxlK-rieii(-e   half   tit   Vanderbilt   and   half   at   the   community
                                          Ito,ypital. Stipends will be provided during the first year only.

                                                             WAGIIINGTON-ALASKA REGIONAL NFZDXCAL PRGGBAIL
                                            With all operational grant award of $1,032,003 oil February 1,                   1968,   this   two-
                                          state  region  began  its   efforts   to   bring   quality   care   to   the   dispersed   populations







                                                        of (his          AI)oiit, forty ol)(,rit@ioiial
                                                                                                                        , iii(.,mbers     nre     currently     serving      on      th(,
                                                                     iii(@iti4iiiig  il)oiii,                     liliysi(,Iiiti,;,                           six     other      aill(@(i
                                                                                    iiiiii  foiii-l(-4,ii               lii-jiltli  iiii(I   g(,ii(@ritl   siil)l)ort.   I)o,i-soiiiii@l.
                                                                                    ti,4@ sitin, is           I ]it,                         iiii4illif-i,  ililr(l  Is  rr(iiii   cOlyk.
                                                        ilitillit.1' llosl@it:ils  :kill[  lill@  litst@  lliii-il  Is  l'i-oiii  ot'li(@r  li(-jilili  an(]  iii(@411(-jtl  orgiijilzil-
                                                        tioiis. 'Vli(@              sf.@iff   Is   %vori<iiig   In   (-oii(,(!rt   to    I)riiig    iij)-to-(Ijtte    iiie(lical    tech-
                                                        111(lites to coliiililiilit.i(",4 flil,oiiglloll(: t@lle region.
                                                        Stroiig                     jzivolveiii(@iit@    in    tli(@    W,,t,,;Iiijigtoit-Alitsicn    I)rogriiiii    is    evitlent    in
                                                        Ili(,    project    (i@cril)(ioit-4    I)Plow.    Al)l)roxiiiiat(!Iy     3(;     hospitals     ,tr(@     currently     I)ttrtici-
                                                        1)@itiiig   in   fli(-   1)rogi-iiiii,    almost    20    (if    Nvliicii    ir(@    (lir(,(!Lly    involved    In    operational
                                                        iietivitit-s.  Six  of  III(.Se                                                    on        the        R(!gjontl        Advisory
                                                        Groiil)s,    and    :in    additional    four    of    tli(@s(@    ire     on     planning     stil)committec.,4.     T%e     re-
                                                        inaiiiiii;,,     participating      hospitals      ,tre      involved      in      current      planning      activities.      It
                                                        is    likely    that    tlies(@,    and    the    inaiiy    other    hospitals    in    the    region,    will     become     in-
                                                        creasingly involved in operational ictivities.

                                                                                                    Operational                 Projects
                                                        1.        Central         TVashington-Comniiinication         system         for         continuing         education         for
                                                           pltysiciait8-$18,181  (direct cost)
                                                        This     project     is     designed     to     bring     the     i-ne(lical     resources     of     the      University      of
                                                        Washington    to    physicians    and    coniiiiiiiiity    lio.,41)ltlil.9     in     Yal@iiiia,     who     in     turn     will
                                                        ict     as     coii.,;tiltiiiiti     to     siirroiiiidiiig     ,;iiiallor     coiiiniiinities     through      seminars      and
                                                        (@ozif(@r(-ne",       educational       TV,       other       audiovisual       instruction;        and        exchange        of
                                                        teachers     ,iiid     practitioners     It      will      also      connect      iiiternit;ts      in      Central      Washing-
                                                        lioii to Y.,ikiiiia cardiologists via EKG telephones hotel e, t
                                                                                                                                                 0      1)erlnit      quick      analysis
                                                        (.starting     with     5     c4)iiiiiiiiiiity     hospitals).     Three     general      hospitals      in      Yjtkima      In-
                                                        volveil     tire:     St.     Elizql)ttlil.,4,     ytil(iiiiit     Valley     Mciiiorial,     and     Now      Valley      Ostco-
                                                        1)@ttliie.    Niii(,,    other    coiiiiiiuiiii@y    hospitals    to    I)e    reached     iiiitiitily     are     located     in
                                                                                    J,ake, Otli(,.Ilo, Tol@peiiisli, Ilro.,;ser and Cyiiziy.,41(le.
                                                        2. goiithcaitcrib Alaqka-Postgra(lizat(! cdttcatio;z-$27,OC)2  ((Ili,cct cost)
                                                        .I'Iils program will help lnil)rov(, eoiiiiiiiiiii(@atioii                         we(@ii Seattle                           Coal.
                                                        Initially  and  13iiiN,erqity   to   itll(@viitit@   I)i-olil(,jiis   ol'   than              j@llysl(!Illlls    fit     moiltl)-
                                                        (,:is(, Aiiisliti t@ll I(,.s all(]                                   Sit   icil,                  (3    Ifirgest).     As     fit
                                                        (,iilr4il Wiif4iiiiigt,oii                 iii(q,lio(is   Will   1)(@   118(@(I    NIIC]K    air    t(,Ielectiire,4,    cozisiii-
                                                           s(-rvi(- s, s(,iiiiiiiirm itii(I                      hot   iiii(@   lo    liosl)itill.4    III    flijieali,    Sltka,    and
                                                        IIIIS Ntitiv(, Hospital tit Mt.                              4iii(I Keteiiikaii community lio.4pltal.
                                                        3.        lloqtgraditate        1)rcccpior8hip         foi,         phy8iciaiz,,t-Co?-Oltary         carc-417,610         (direct
                                                           cost)
                                                        A  pilot     project       to       provide       opportunity       for       practitioners       from       isolated       coal-
                                                        annuities   to          it    week    or     more     UD(ler     a     precelitor     at     major     medical     centers     to
                                                        study     ,idvances     in     care     of     coronary     heart     disease.     The     4      major      medical      centers
                                                        tit          ire       Ilrovi(lezice       Hospital,       Swedish        Hospital,        Virginia        Mason        Hospitals
                                                        and    If    e(lical     Center,     and     University     Hospital     and     I%ledical     Center;     two     in     Spokane
                                                        are      Deaconess      Hospital      and      Sacred      Heart       Hospital.
                                                        ii. Caroitary care unit coordiiiation-$70,255 (direct cost)
                                                        This      activity      will      serve      as      coordinating      unit      for       CCU       related       projects-tbeir
                                                        development,       Improvement        of        operations,        and        training        activities.        A        mock-up
                                                        (coronary   care   unit   will   I)c   ii,-,e(l    in    the,    educational    1)rograni.,4    for    iiiirsek;    and    pliysi
                                                             audiovisual s(qf-iiisirtictiolt materials will ]Io produced and evaluated.
                                                                     plillitotia?,Ii technician liwiptiiifl--$Iil,.I)54  (direct cost)
                                                                              Nvill 11(l])                  it     fi)i-iiinl     program     for      training      (,ttr(lio-I)itliiio-
                                                                              IAO                lioll-(-I-ll I(-@il rtil)(.t io]114 ],I) (-f)l-ollllrv         Harris   Jill(]    fi-(@e
                                                                     for   01114@l'             l,'4)tjr liirgt,i- gt,li(@i-ill Ikosl)ltlll,,A III                   will
                                                             Willi  1,41)(kiiiiii(- (!ollilillliiily                            4    lioql)itiilm     iki,e,     I)ejicoties.,4,     Holy
                                                               Sacred Heart Aiii(I                1',iiii(!'.4 Iloql)itjtl.
                                                                                    cditc(itio?t
                                                              l)r4)gl.tilkl  %Vill  114-11) III-ov
                                                                                                      1(1(, lll(411('Ill (lolililitifilt@l(-s Nvitli  the  skilled  assist-
                                                           %vilit'll   Will   II(-]I)   1(1(@iii@ify   lli(@ir   (@(Iii(,tttloiiiLl   needs    and    t4(@rve    its    it    titil)lx)rt
                                                        fault;  III  (lov(@loll )Itig  programs I    ';I     iii(!et     them;     to     es(@al)llgli     it     ceiktral     production
                                                        unit,    t4)    coor(lillit((@    ikil(lio-vislijil     projects     and     the     dik;tril)utioii     of     materials,     to
                                                        ikiietrate life eiitir(,,- region.









                                                                                                         a)id
                                                               @@ix  I)Ilot, I)I,ogi-itili,4 (Oil                        iiii4i                        il()  I)o   lli-itiimliiilll(@(I   via
                                                                                                                               to                     and I)oKI)II@ill  Nlikirs  oil
                                                                                         ll:kii(@l of                    stjii-iliig Ivan      20 iio,41,)iliils  fit  WtiqlifzigLoji
                                                                                 11, @viii                liol,t-lit.iiii  ft)i,   (-(Pii(iiiiiiiig   ii4@Lwo)i,lc   H(-rl(!.4   with   local

                                                                               t'illif-litioll    (I)i(t,    on-the-job     li-(ii)iiiifl     of     l(ibot-(ttoi,y     1)crRo@)ine"5;3,1/116
                                                                  flil.(!Ct cost)
                                                               Ili-ijiijir,%,             of  line,;  activity  is  lo                                     I)er.'4oiiiiel   la   ll(!wCr
                                                                                                                                                     availability       of       fl(]Vlili(!O
                                                                                                          l@'ii,sli l@Iiiis(@ is to II(!                 itt, r) loefil
                                                                                                                            of                 Til(@oiriii,         Spokane,          Yakiina
                                                          iii(I                      @iii(i      Aileliorig(@,      Alt@kt.      L;Iliversit,y      of      Washington      will       select
                                                          froin    ,t    list    of     ivail,,il)le     lab     procedure.,;,     iirr@inge     training     courses     for     technicians
                                                          in      specific      ones      at      designated      facilities      and      establish      quality      control      criteria;
                                                          they      will      follow      through      with      education      of      physicians      in      newer      and      practical
                                                          tests for better diagnosis and treatment.
                                                          9.  Ala.,?ka medical librarV facilitie8-$21,751, (direct co3t)
                                                               This     activity     will     help     develop     a     coniiiiiiiiity     m(,@dical     library     located     at      the
                                                          PIIS       Alaska       Native       Medical        Center,        Anchorage,        for        Alaska        physicians        and
                                                          health     related     staffs     and     agencies.     It     will     have     close      ties      with      community      col-
                                                                   Arctic      Ilealth      Research,      University      at      Fairl)Rnks      and       to       supl)leinent       con-
                                                          tiiiiiiiig     e(Iii(@ittioji     projects     for     Soiit'lleii.,3t      A14isIcit      and      the      Anchortige      cancer
                                                          project.
                                                          10. Aoiclio)-(ige c(iticcr pi-ogi-aj)t-$51,)150 (direct cost)
                                                               'Pi) is l@roj(@t    ivill    slid     !it     providing     it     stil)(,rvol(Ifil.,,c     therapy     unit     for     cancer
                                                                        to  1)(@               !II   :Ili   ii(14]it.i4)ji   to   I)rovi(l(@ii(@e    11(@sl)ll-jti    Ili    Anchorage.    It
                                                          iiivolit(,s tr@iiiiiiig or  i-ii(liol(ogis(, and  t(@iiiiic:il                         coiiitiltant        clinical        coiifcr-
                                                                                                   and      analysis      of      (Iijtiiogstic      (Itittt.      llresl)ytcrinii      Corn-
                                                          iiiiiiiity Ilosl@ititl In Atielioriig(@ will 1)(@
                                                          11.  C(ir(@ (if (,hiiiii-e)t ivith caiterr                                      (direct coqt)
                                                               Tlii.,4 Is all t@l)!(It@iiiiologi(!iil study to                          l@li(3   izyil)it(-t   of   different   illCtlioti.14
                                                          of (@,,ire for                   with                 fo(-iisliig     oil     (lifft!reiie(@s      among      children      treated
                                                          Ili  lo(.Itl  (.olkllllllliiii(@q  and  Ili;  Junior                        to    I)(,    conducted     by     the     stair     of
                                                                           Orthopedic lio.,41)ittil and
                                                          12.     ],!a(li(itio,)t     pli,lisici.,4t     co)t.,iltltalioib     1)7-otiratit     for     radiologists     in     IVa8lti?igton
                                                                 (i)id A.I(t.,ika-$56,393  (direct cost)
                                                               This     ]@i,oj(!(!t     %vill     lirovi(le     consultation     services     of     a     ra(liologil4t-pllyglcit4t      for
                                                          sl)litll(!I.    114)sl)it.11'4,    ill    (lo,";ijlietry    and    other    I)robleins    of     radiotherit]jy.     To     enhance
                                                          liostgr,,idi.itit(,,      (Education      for      radiology      residents      and      I)araiiiedical      trainees      outside
                                                          of the University system.
                                                          13.     Caiiipitter-aided     instruction      in      7teart      di"a8o,      cancer,      and      8tro7ce      and      related
                                                                 diNcuses-$53,390 (direct co8t)
                                                               To      develop      and      evaltiitte      the      effectiveness      of       coinputer-aided       instruction       for
                                                          reaching     medical     techniques.     Participants      will      be      instructed      in      the      use      of      com-
                                                          1)titc,r terminals.

                                                                                    WPHTE(TN  NEW YOlLiC Iti-.'GIONAL Ntl@,DTOAL IlltOGRAM
                                                               With    :Ili    nwiir(I    of    $:tt')7,761,     t@lie     West(@i-ii     New     York     Itegiotial     Ate(lical     Pr(>-
                                                          gr,-iiii    begin    Its    ol)(-i-ittioiial    program    oil    M,@ir(!Ii    1,    11)(;8.     The     (!iirrozit     operational
                                                          staff of                I)IIYHI(-IjlllH, oil(!                and     two     s(.,cretji.ri(!s     will     be     expanded      to
                                                          over 20                   tli(@   ii(-xt    s(@v(@riti    iiioiit@iis.    Over    forty    Iii)sl)ltitls    are    currently    In-
                                                                      Ili falls  I)rt)gi,iiiii, silitiosl@ jilt of wlil(-Ii jtrt@                    Lo   1)4@   part    of    the    @ievel-
                                                          obtain    I.(.glolilll    Two-way    'I'V    11(@t.wori@    for    (!obtaining     (!(Itlcjltloll.     Iglev(@ll     110.'41)ltftls
                                                          are                        oil    the     It(-gloiiiii     A(Ivls<)i-y     Groul),     mail     all     additional     two     hos-
                                                          I)ittils @tre,4ervlixg Oil planning f4ubcolilltiitt(!(!.4.

                                                                                                           OI)eraitiotittl Ilroj(@(!(s
                                                          1.  7'tvo-,it,-(tV  (!oittkitittticatiotis       nctii@orh-.,  dir(wt  cost-$170,519
                                                               A  two-way  communication  network  will  link  hospital                                       of         Western         Now
                                                          York       and       lilric       County,       Pennsylvania       to       the       Continuing       IDducation       Departments

                                                                    93-453-68-5






                                                                                                                   60


                                                      of iii4,          iTiiiN,(,i-.sity of New Y(orl@ @it lttift'itlo :111(l tll(@ ltosw(,]] I'lli-Ic  Meinoriil
                                                                                          will Serve                                       much   R.4    continuing    c@(luca-
                                                      nor)  for IVIlysi(-Itlll,4 iiii(I  (,)it,                               ilrofe",Sioll'4,  public  (!(Iliclltioli,  a(]-
                                                      iiiiiii,,Ir,.ttive     (,oiiiiiiiiiii(,.ti,ioii,     ct)tistilt:itioii     witlk     experts,     all(]     coi)ta(!t,14     among
                                                             I)IIIIIis.   It   Nvill   lk"isist   both   the   I)Iiysi(-itiri   iiii(I    (@orniiiiiiiity    liosl)iiiil    in    either
                                                      Ili(@ i,kii,;tl or          (@iiviroiitk)(,iit   in    I)aviitg    at    ili4@ir                 the litte,4t i(lv,,iii(- .4
                                                                                                                                                                                       e
                                                      iii  tli,(@ (iiiigiiosi.,; tiii(I trejititi(.Iit of ii(,:trt                   str(ilc4,, and                        llitrticiiiqr
                                                                   will      1)(@            lll)oii iiiv(kln,iiig  rtir@il                      in      this      progr4iin      there-
                                                      1),N- iiiilirovitig both ttivir(11(14tc!tic tii(I                          fklilctioil.
                                                      ('(ot-oi?(zt-y   cat-(@    iii-for)ii.(tti(iii,    coot-(Iiii(itot-s,    (iii-cct    covi--$I,',17,rA4.@
                                                      'I'liis              will    test    a     training     le(-Iiiiiqiie     for     I)rovi(Iiii,,     qualified     nlIrSe.4     who
                                                      will   be    r(@tliiire(I    to    staff    (levelol)iiig    (,t)roiiLi,y    fire    units    in    the    lt(,gion.    Al)loroxi-
                                                      iii;ttel.v 80 iitir,,(,s will li(@                   froiii    ill    1),irts    of    the    Region     for     a     (-Oiiibined
                                                      @ica(leiiiie    and    clinical    course,    It    is    I)Itii)ied    that    the     iitirs(%     receiving     this     train-
                                                      iiig     will     return     to     both     rural     and     urban     hospitals     for     the     purpose     of     I)rovid-
                                                      ing     a     diagnostic     and     didactic     fui)ctioii.     NN'Ixile     the     program     will     he      housed      at
                                                      the    iiic,(Iical    center,    the    coiiiii-iuiiity     hospitals     of     this     region     will     be     the     bene-
                                                      -ictoi,s    of    the    project.    Siii(-e    there    ire    few     iiurses     tr4iiii(@d     to     work     in     coronarY
                                                      ire            particularly     in      tli(!      rural      ciiviroiiiii(,rit,             ,.itteiition     will     be     paid
                                                      C,
                                                      to  itttr;t(,titig iiiirses who will  return to tll(" collillillilit@y hospital.

                                                                                    WISCONSIN REGIONAL All,'I)ICAL PILO(;ITAM
                                                              IVI,,4t-oiisiii     ilrogriiiii     began      its      ol)(@riitiorial      activities      oil      Sel)teiliber      1,
                                                      .I!)('o7 %vli(@ii it               tli(!    first    lt(!,ioti;il    M(@(licitl     I:Irogi,attii,     to     be     awarded     a
                                                                                             OI)CI-fitiollill  grant.                            futiil(@(i      with       $(@:)10,147,
                                                             i)ii(@   third    of            Is   for   ol@i@riLt.loiiiii   ik(@tivitli(@s,   the    oj)(!riii'loiittl   14tlkfr    iiiim-
                                                      )(-tN  20.  AI)4)iit                   of    ill(!    Hi@iil'C    tire    I)IiyHl(!itiiis,    atiolli(!r    third    are    failed
                                                      health   I)ersoiiiiel,   trial    tile    lilht    one    t@lilrd    tire    Htilil)orLive    itikd    other    type    of    per-
                                                      Ajil)roxiiiiitt@ly     20     hospitals     tire     involved     fit     the     current     plias(@      of      the      11'ro-
                                                      9).:Ilil. 1111(@v(,Il of  I'lk(@e   hospitals   lire   (live(.(,Iy   involve(]    ill    tile    ol)(@t-iti,iolitil    I)].oj(!Ct,4,
                                                      14'iv(@   art,   relwi,t,selit.(,(l   ill   the    Iti@,ioiijil    Atlvlsot-y    Gi-oiii)    and    use,    r(@iniiiiiiiig    tire
                                                                        ill  I)III[ilillig                              As      the      j)rogr:kiii       (](@v(.@lop4       additional
                                                      activities    (itirli)g    the    ii(@xt    fimv    years,    it    Is    iiiit,leiiiittt,d     tlijtt     iiiiiiiy     additional
                                                      11041)itzil,,3 will be illvolvt-@(l.
                                                                                                                    -al)l/           cvftlll(ltion,       (7,ir(!ct       coNt-$11.0,100
                                                      @lit(ly 1)),ograat foi- itt(,,rino c(,tncer th(@?
                                                        iii,,4 pilot ])roject, is 41oqigii(@(i to review ;iii(i ev:iliiai,(@                                 radiotherapy            for
                                                                  Nvit-li                                it,,.,   first   I)Ii@tse    it    will    involve    Iiiforiiiilti()Il    (-X-
                                                      cliaiig(@     tii(I     (losiiiietry     Standardization.     ilosl)ItAtls      at      Alitrqii(,Lte      and      the      Uiii-
                                                      ver.sity    of    Wis(!oiisin    will    be     coiiiiect(@ti     to     it     central,     coiiil)itiei-iz(-(]     data     bink
                                                      Ili    Milwaukee    which    will    coiiil)ittt@    radiation    classes.    Wll(!li    tile     )t(-(!(@s.,iry     Collitilit@er
                                                                     tr(@    develol)(,(I,    IL    is    I)ro.i(,ct(@(i    that    the    central    facility    will    be     linlied
                                                      to      other      liospitil4      outside      the      Alilwa,ul(ce       and       Madison       areas       with       similar
                                                      treatment    programs,    and     the     long-term     result     will     be     to     iiiij     rove     local     medic     I
                                                      il)abilities    for     the     treatiiient     Of     all     utiE@rili(,,     ciiieer     pati(@ii,Ls     in     the     Region.
                                                      C.
                                                      2.      A      pilot      (1cnion8tration      program      for      ptzl?itonary      throtitboembolist)t,      dircct      cost-
                                                        $811,600
                                                      Ili tlii.-; l@roje(@t a center Is l@(@iiig                               -at ATiirslifle](I Ilosl)it:il in                                           4
                                                             Wis(!oi@,,iii,  foi-
                                                      tli(!viil)y for ])iiiiiioji.,ti-y                   iiiiolisiii.           I)ro,i(@(-t;  liit,.4  :i  (-oiii,iikiiiiig
                                                         ('olkil)oll(-'Iit   wlii(@ll    Nvill           illkysi(-Illlis fr(@iii reality                       !It    fit('    Itegioli.
                                                           will  lni@4)lv(,  ,t  2.1-liotii,                                           tli(@    I)r(-I)iiriitioik    (@f    a    iiiovlc
                                                                                                                       fi)r grolil@,4 of j@liy4l(-Itiiiq.
                                                                            Nvill                     a                              I)rogi-ttiti     wlii(-Ii     Will     ciicoinpas.4
                                                                                                              1111(i I't'lllll)illl@llt!Oll                       for
                                                                                         it   riii@iii   ti-iiii,,41)orl,:vt,loii   syst,eiii   for    1)itil(@ii(s    front    Northern
                                                                of    Lll(,    Still("    :111(l    (!ool,)4,rittioii     between     the     ciiiiic     and     other     liosliltal.4

                                                                        (ii(st            t(riw                    til)t,(ei-y  ratio  tli(@  fit,t!(ts  of  hc(rt,t   dis(,,a$C,   Can-
                                                        e(:I', 4t?'Ol,'@C, Utt(l. rCI(ft(!(t                                COM 1, -,V 1 8,.') r)
                                                                                 stii(ly   N@,111   j)(@   (-iirrit@(I   t@iit   by    tli(,.    ITitIV(@r.,;ity    of    ll'i,,,consili
                                                      ivlii(-Ii  will             final     store     ,4]iort,     ]-(I     affiliate,           oil  Vill-ioti.S                     of
                                                      fulfilling  l@iitit,jits  with  tli(@                                   Any      1)hvslcirtn      niiywii('rt,       Ill       the






                                                                                                                 61
                                                       Itegioli   Call   (Iiii   the   lil,,rary   it   any   time   tin(I   re(ju(,,,t    n    ttpe    relevant    to    a    problem
                                                       iiL wlii(-Ii lie;,s
                                                       II.  Nllii-siiig  telephotic  (ii(tl                late ?'CCO?-(Iit?tl  libl'(Ii'll it&  t7tc                          lica)-t
                                                                                     stroic(,,, (zgt(i 1-claic(i                              cost-.-$18,800
                                                                                  stii4ly, sii)iil.,ir to t@li(! oti(@                N%'Ill (@still)ii"li it                   little
                                                                 N@,itli  iiiforiii:iti4tri   r(,col..(Ii@41   oil                                                    new       ])I-o-
                                                                  ,Iiid   ('(Illll)lki4@lit,   ;Ill(l                                in  )Aiir.@iiig.  Niii-s@,       front        any
                                                                   !it fli(@ r(@gioit will I)e 411)14, to (.:Ill :tl  Italy tilil(,' to Iiii.ve a tAll@c@             I)IIIY('(i    to
                                                       til(@iii.
                                                                               tof  iii(,-(Iical (tiad  lic(ilili,               siiitll(@   coitcept    fllt)t    pi'(            /it
                                                                                                                                                                      )!It a ?it
                                                                               lio.,fl)itals,  direct  cost-$";;;,@)50
                                                                 ("(Itleatioii  f(!iisil)ilitv  1)roj(!(-t  iiivolv4,,.,,       t(,i'i  coiiiiiiiiiiitly                  !it      its
                                                                                     fillll.';    Oil
                                                                 iiii(I   strol@e,   N%,Ill   be   (](,velol)(-(I.                 4111(l  (,I](,   ailing   will   I)e
                                                                                                                                                     4(iiyicl at  their  ciiii-
                                                       ill tile 110!41)itfils for use by            hysterias )ii(i (it@li(@r li(@:ilt,h per. )
                                                                    a,, ,t continuing education (I(@vice. After four -to ,4ix months the  ina-
                                                       t(@ri.,tls will I)(,, reloc,@ite(I in te)i.,i(l(litioilill liosr)it@ils.

                                                                VISION, ITAI)IO ANi) Ti,.i,rpjioxi@,                                FOI@ (@ONTINUIQG li',DUCATI0,N
                                                         TFLF

                                                                                                    OI'EJtA'1'10,XAI, l'ICO.IIIC'I'S

                                                                                       1. Albiiiy Regional -iN[edical Program
                                                       7'ico-i(I-ay )radio co))i@nitin,icatio)b systcii&-Dii-cct  cost, $lJ,//,IOO
                                                         This project will expand  an  existing -two
                                                                                                                            -way     rti(lio      network      to      Include      57
                                                       hospitals     and     24     highwl'Ools.     It     will     r@rovi(le     constraining     education      for      physicians
                                                       .iii(I    Filled    ii-ie(lic@,il    personnel.    It    will     also     proi,i(le,     iz)foriiiittlon     and     education
                                                       l@rogr,iiiis    for    a(Iiiiiiii,,t@r.,ttors,                of               of      II-listees,       voluntary       health
                                                       [agencies, 'I(Illlt education                        :tn(i Reelected civic groups.
                                                                                11. litt(!rzjiotiti@taill Regional M(@(lic,,il Ilrogrttm
                                                                                               edite(ttiott  ill  h(,,(it-t                   ca?tcct,,    811-oke,  a)t(l
                                                            latc(l disco,@s-Dii,cet cost,  $243,000
                                                                 01)   -.Liv(@,4  of  this  1)roriiiii  iir(@ t@o                       it  (@olillillilliclt(:Iorlq  ll(,.tw
                                                                                                                                                                                  oric
                                                                                                                 ii",titilli(oiii     to     4)ii(!oiir@ig(@     Ilitisoll     between
                                                                                                                                   (Existing      l@wo-wi).y      radio      t4yqit-m,
                                                                                                                                                             C
                                                                           1108))Itiils     in      7(!oiiiiiliiiiitl(.,,4  in or  ii(@.ir  4jtlt               It@y    ])its    I)een
                                                                      to   10 additional                                                                         'I'lik    '4.1,81eill
                                                       will  I)t@  (@xl>llli4l(,(l  l@(o  additional  liosi)ltlils  Ill                         to
                                                                               v nine Its(. ill, ]@Vlill)                           or  17.1@11.11  c(Iii(!tiil@loti   TV)   Is   also
                                                                                                                                 q           H  11    focus       of        continuing
                                                       I)Iixiiii4@41. This iiiity (establish tile colillilillill@y 110. I)IIIII 11  t
                                                                                                          lt(@gloilitl  Ale(li(-itl Program

                                                       Ifealti@ icicnccs                                all,(l
                                                                                                                                 t                         coit, $77,900
                                                         Tlii,4 project Is engaged In con(Iii(!till,@ st I
                                                                                                                            (li(@ l@o d(q(,riiiiii(-
                                                                                                                                                          the     f(!iigibility     of
                                                                          communication      litil(figes      Vital      to      c(lil(-Iltloil,      service       and       research
                                                                                     -til(li(@s to ))(@                                                                                                            I
                                                       I)i,(ogr4iiii.q. Specific                                            are     a     physician      (,,oinniuiilcatioTi      sys-
                                                       t(@iii,  Illv   t,(!acltillg,   clectrt)iii(!   linl@.ig(@,                               (@al),t(!Ity.    T,Inkage,,4     will
                                                                                                                               -bar- and l@angas city.
                                                       be cqtal)li,@;hcd at hospitals in Gr(@fit Ileiid, l'itt,,
                                                                             IV. Wit@,4]iington-Alill.;]<tl  It(-gioiiltl 'iNf(!(Ilcitl Program
                                                                   tVashiitgtoll-Coininitnicatiott      syNtctit      fol-      co)iti?illiii.g      education      fot-       plty8i-
                                                             cian.,?-])i?-ect cost,  $18,181
                                                                  I)I'oj(!(,f; Is designed(]  t@o I)I@iiig tll(@                    II(Ill'(Oiill(,("4 of  title  Ijiliv(@i,.,iity  or
                                                       N@ItS)Iillgt@Oll to I)IIY.414-11111.14 final floilillillflit,.Nl III)sl@illl).,l Ill                IvIlo  [it   till-II   will
                                                       late; its                     10 siil,),olllltllllg Filill)14'1-                                        q(,Illlll;il.m    and
                                                                                                      01114'1-                                                   (@x(.Illkllgo     o
                                                                    find I)rilt-f II loiit!rh, li@ will also                                         (14,111i'til     NvllilliligItill
                                                       to    Yfil@iiiiii    ('11rillologisl.s    Vill                          114)11-lllli',  to  ll('I-Ilklt,   (Jill(-IC   analysis
                                                       (,iiiir(iiig   wit)l    5    (.I)liillltliiily
                                                                                                                                                              Ill
                                                       volv(@(i are:              loilizill)(@1,1118,                                          and      N(@w       Valley       Ostoo.





                                                                                                                  (i2

                                                                 Nine olli(@r eojiliiiiiiiity                          to 1)(@                   initially are located  in
                                                                                   T,Ilke, Ollitt@llo, Tol)l)eiiish, Ilros,,(@r iiii(I Siiiiiiy,,;i(le.
                                                                                                               c(.I?icatioit-Dii-i@ct co.@t, $27,062
                                                      This progr@ini N%,Ill help improve coiiiiiiiiiiieati(-)n                                     Seattle                   Corn-
                                                                 aii(I IJiiiversity to alleviate I)rol)14@iiis of tll(@ isol,,It(@(i I)Iiy@,deiins in south-
                                                    cast                cities      and      communities:      Juzi(@,iu,      Siti@,t,      X(@telilkaD      (3      largest).      As
                                                    in     Ceiitr@il     IVashiiigtoii     several     methods     will     ))e     used     siiell     Is      telelectures,      con-
                                                    sult@iiit     services,     seminars     and     the     EKG     hot     line     to     hospitals     in     Jiineati,     @.itka,
                                                          1111S     Native     I-Iospital      at      '@Nlt.      Edgeciiiiibe      ind      K(,tchil@an      community      hospital.
                                                    Tzvo-ioall radio conference and slide presetitation-I)ii-cet co,@t, $8,11115
                                                      Six     pilot     programs     on     heart,     cancer     and     strolic     topics     to     I)c      traiisinitted      via
                                                    tN@'o-NN,ay     ri(lio-telel)hoii(!     slide     conferences,     to     1)liysi(,i,,iiis     and     hospital     st4iffs      on
                                                    topics   selected   I)y   a    panel    of    I)Iiysiciail,41    starting    ivitli    20    lio.'41)it.'Il@4    !II    wa,4]lillg-
                                                    toii     )re     iiii(lorw.,ty,     It     will     exl)lore     potential     for     continuing     network     series      witli
                                                    local :iyi(I remote regions.
                                                                           V.  AV(@@tern  Now Yorlc  lt(,@loii@il  Aledical  Progrilill
                                                              -fill                           ncti4;oi-k-Dii,(7ct         cost,          $17,0,519
                                                      A     t.wf)-w.ziy     telephone     coniiiiiiiii(-ittiozi     it(@tworlc     will     lijilc     over     40     hospitals     of
                                                    W@-tc,rti    New    York    and     Erie     Coillit@y,     P(-Illl'.,YIV,,iiiia     tD     the     Coiitiniiing     10@dii(-atio7i
                                                                                          -te    IJiiiversity    of     New     York     at     lliiffitlo     and     the     Itoswell
                                                    Dc])artin(@iits of the Stit
                                                    l@arl<       Nlciiiorial                 Irlie    network    will    m@rve    @everal     purposes,     Sll(-Il     'ft,4     coli-
                                                                                                                                        'I     @(I
                                                                                  for I)hy,;iciitiis and the lic@tltli-rel. t(
                                                    location,      @'I(Illlillist,ritive       communication,       consultation       with       cxl)(-rts,       and       <.contacts
                                                    among blood
                                                                 lzo(,rlts. T. notice you said iii the Nortli C,,troliri,% pro@rrtiii tliel-o
                                                    iv(,I,o  soille  coronary  eltre  units.  Ilow   many   coronary   @ir'o   units?   I
                                                    want, to Iciiow ivll',Lt isli-,Ipp(@,iling to tiloliosl)it,,Ils.
                                                       LN'ONV, liow iiitiiv liosi)ittl adiniriistrttoi-s  or  1)pol)lo  inv<)Ived  in  the
                                                                 -tdininistri@tion 6f  IIOSI)it-,Ils  wliere  services  tre  delivered?  Ilow
                                                    mail  Itroonyouriittionftlcoiilicil?
                                                           y
                                                       Dr. AfAltSToiv. One,  Dr.  J.  T.  I-lowell,  of  tlio  I.Tenry  Ford  Ilospit,,tl.
                                                                                                                    -noric,Ln Ilo,@pittil A
                                                    The executive director of the A@i                                                                   - @@oci,,tt oi            Dr.
                                                    l@,dwiii                      is tl,,o t nleml)er, so this  is  2  out  of  12  directly  repre-
                                                                                                                   du
                                                    selit@illzt   IV              l@)Oilltofllosl)ittila  -iiiiistr.,ttion.
                                                        (I'  i'  followil-  iliforinatiOll  was   received   by   t-lic   committw:)
                                                    I)EPAWflil-.NT     OD'     IIIPAT,'rll,     lfIIU(]A'I'ION,     AND      IVIPI,IPAILIO      '4'PAII'IPMICNT      ON      Ilosi,xrAL
                                                              AI)AfXNXSI'ItATOItS       I"AlCfICIPATINO        IN        ltli.'OIONAI,        MIPI)ICAI',        IlitooltAkiii

                                                                                                                                       Nujiiberottiospital  0  Porcontollotal
                                                                                                                                          administrators           membership

                                                                    .........     .............   .    ...............          ....             338                         10
                                                    Rep,ional advisory groups ...............................        .............               222                         12
                                                    Subcoiiiniittees .....................................................                       83                          7
                                                    Boards of directors I............................................                            33                          19

                                                      I Boards of directors of the 14 now organizations formed as tire coordinating agencies for tlioir programs,

                                                                 IIOSI-I'J'Ar,       ADMI@NlgriLATORS       ON       Iti@(;IONAL       MEI)ICAT,       PICOORAM       STNIIIPS
                                                       AI)I@roxiiii,,ttely    40(lo    of     the     regions     have     established     a     Division     of     I-Iospital     and
                                                    Facilities     I'laiiniiig.     These     tire,     as     a     rule     under     the      direction      of      a      hospital
                                                    administrator.

                                                                   EXAMPLT-',S OF  IIOSPITAL ADMINISTRATOR PARTICIPATION IN RUP

                                                    Geortlia
                                                        In    Georgia,     each     hospital     in     the     region     wis     encouraged     by     the     Georgia     RMP     to
                                                    tippoint    a    local    advisory    group    to    work     with     the     Program     to     advise     on     local     needs




                                                                                                                                       '7





                                                                                              63

                                                                                                                                  orgia        Central
                                            iii4l I)rol)l(,iiis LTI(l to serve as the liniion group between tile
                                            IZogloiiiil            l'i-ogr,.ini olliet@ find t@lic local coiiiiiiunitly. To (late,  121.  h(,)sl)itals
                                            have  :iplioiiite(I  local  iclvlsory  groups  out  of  the  total  1.78   hospitals   in   tile   region.
                                                      represent   90rlo   of   the   general   and   limited   services   hospital   beds    In    the
                                            region.   The.-()   groups   consist   of   a   physician.   a   hospital    administrator,    a    nurse,
                                            all(] at least one interested ineiiiber of the piil)lic.
                                            ("o,)Illccticlit
                                               In Coiiii(,eti(,iit, four Advisory Coiifi,r(,.zi(-.cs    liive   been   estal)lisl)e(l   to   aid   the
                                            Advisory  loai-(l  in  its  work.  These  four   coiif(@reiiees   consist   of:   (11)   tile   Presidents
                                            of tli(,@ ]-'o:ir(is of  Trust(,"  of  tli(,@  hospitals  of  Connecticut;  (1))  [,he  Clilefs  of  Staff
                                            of   these   hospitals;   (e)   the   A(Iiiiiiiistritors   of    these    hospitals;    and    (d)    rep-
                                            i-(@,,(,iit:itives   of   over   50   "health"   ngencies   of   Connecticut.   I)irectors   of    Medical
                                                          froiii   Connecticut   hospitals   have   also   been   invited   to   meetings   of    -the
                                            A(Ivi.,ory Conferences.
                                            Albatill
                                               Part   of   the   Alliaiiy   operational   prograin   1,3   concerned   with   the   eqllipl)iltg    of
                                            lio,.,I)ittl,,; with t-,vo-w@iy radio equipment.            Regional  Ale(lic.,tl  Ilrogriiii   lx,i-soll-
                                            net have visited the iioii-i@:irticil@@itizi,-                 in(I  (lis(@iisse(I  with  the  adiiiiiiis-
                                            tritl()i,s :iii(i iii(-iiiiiers of tli(@     tli(@ 9(lviiiit;tg(,.s of joining tli(@
                                            q'li(,  Diiiiil)er  of  hospitals  involved  in  that  network  lii(!rcase(I  by  500/,  in  t]iL,   first
                                            year, ]raising to 3C) the number of participating lio,,;pitail.,4.
                                            ilf(li-Yl(l?lll
                                               In  Alitryliii(l,  the  ItA[ll  staff  liti-,  devoted  coiisi(](@ral@le  effort  to  developing  coil-
                                            t@i(-ts with tli(@ (@oiiiiiiiiiiity lio,,4p!ttil,4. At least 21 of tile  38  lioipitills  in  the  regioll
                                            liaN,e I)ek@ii visited by t]iL, lt(,giotial M(,,di(-,,il Ilrogriiiii staff.
                                               Iii  Noveiiil)er  If)67  ft  three-day  I)Iqjiyiiiig  wori@liol)  was   held   by   the   'iN[iirylan(I
                                            RAIII. Trivit@ltit)ll@q wcl.(, extended to tilt ('lie  liosl)ltitIF4  in  the  region  all(]  over  litklf
                                            of the sliol-i@-tel'ill,  lioll-fe(lel-lil  lioql)ititis  sent  one  or  more  rel)res(@ii[;itivc,@  Those
                                            who attended expressed a geiiiiiiie (I"Ire to cool)(!rate In the planning process.

                                                                                   OTIlLrR I)]OVl@,T,OP,%(ENTB
                                               (-'t)iiiiiiiirkity I)Iiii)itiig eotiiiklitt(@(,q IIILVC 1)(Ttl orgitniz(@(I In  several  other  regions
                                            lii(-Iii(Iiiig   South   Carolina,    Intermountain,    and    (,tr(@it(!r    Delaware    Valley.    These
                                            loctil    planning    committees    all    include    hospital    administrators    In    their     lilem-
                                            bership.

                                            11081'1']',&L ADMI.NISTRATOILS ON TI[r, NATIONAT, ADVISOITY COUNCTI, AND ON TIIE  ]TEVIEW
                                                                                         COAIMITTEE

                                               Council:
                                                      (1) Edwin     L.     Crosby,     M.D.,     Director,     American     Hospital      Association,
                                                 Chicago, 111.
                                                      (2)    James    T.    Howell,    M.D.,    Executive    Director,    Henry     Ford     Hospital,
                                                 Detroit, Mich.
                                               Coiiiiiiittec,: (1)  Mr.   John    D.    Thompson,    Director,    Program    in    Hospital    Adniin-
                                            istratioii, School of Public Health, Yale University, New Haven, Conn.
                                               Formers Aleinbers:
                                                      (1)    Alirk    Berle,    Director,    Mount    Zion    Hospital    and     Medical     CeLiter,

                                                      (2)   Itowar(I   W.    Kenney,    M.D.,    M@lical    Director,    John    A.    Andrew    Memo-
                                                  rifil Iloql)itiil, Iruskegee, Ala.
                                                                  It  S(.Cnis  to  iTio  t,11(3  tlil-ust  of  this  I)ro(vritiii  lias  got  to   get
                                            down to tlii(.
                                               I low :I i)olltl III V()Illl II(Ilt'lotiiil ilic(li(!Itl coiiiicilsl tlie lo(":II ol)(@s
                                                                                        Of I.Ilo',(@ repres(@lit-, liosl)it@ILIS.
                                                                  Sliolit(I t@liere be iriore?
                                                                                 ]@iiow tlio itii,4wer to                Afr. Cliitirilitill.
                                               Mr.                 Give its youl- [,Iiijilciii         oil  tliitt.   I'iilii   colicol-lif-@d   tliit
                                                                                                    9
                                            Wi)   .11-0   ]lot   g(kttilig.   ellolilrll   of   ilic   I)COple    iliVOIVC(I    wlio    are    meeting
                                            tlio ptiticiitiiid getting care to Iiiin.






                                                                                                                 64

                                                                                                                                               1          ]living     a     coil-
                                                                                                                               AS@"O(."@l't 0 1
                                                                 ill  olti.                                  Lo loolis oil itist             file   prol)l(@,iii   you    aro
                                                                              I  NN,otild  I)o   iiitei,,(@,sted   in   following   ttic   results   of   that
                                                         Coll          @ll)(I Yolit- itet iol)S Oil it,.
                                                         NoNv, wiltit. ot liel- 1)1.-o region,., :11-o ilivol ve(i  ill                     'lle'so
                                                         I)ro,(-ri,:it)is, ;tii(I ill l@llo             (,'otil(l Yoll ,(,rlvi@ 111(@ it  iltill(TOWII  oil  tliitt?
                                                         If.@'olt 1kril I  l(@t,  ils  ])Itv(3  t-,Ilis  it  wolil(i  I)e  II(,]  p  [Ill.
                                                         Al-(@, you I'(@:11]y tyilig tliein                                       (leliti@tsi    ttil(I    io    Tottli-as
                                                            is ediieitol.-s?
                                                         (Tlie  followiji(,           information                                        I)y th(@, committee:)
                                                                                                                                                         ON   PROFESSIONAL
                                                         DFPAIZ'f2,ILNT OF I,-Il@ATTll, EDUCATION, AND WELFA]tr STATEMENT
                                                                              INVOLVEI.[ENT IN RFGIONAL MEDICAL PltGGBAMt3
                                                         The scope of       professional   iiivolveiuent   in   Regional    Medical    Programs    is    both
                                                         broad  tii(I  balance(],  @tnd  is  evident  in  ill  facets  of  the  pro,,,r,,tms  across  the
                                                         country. Broad proft,,.,siolial involvement is  seen  in  tli(,,  e@)liii)ositioll  of  Regional
                                                                                                                                                                  tl    activities.
                                                         Advisory  Groups,  planning  committees,  program  staff  s   ,iiid   operation,
                                                         Siir.li      involvement      reflects      the      essential      cool)eritive      nature      of      Regional      Medical
                                                         Pro,r.iiiis     -i.s      they      Nvoric      toward      harnessing      the      multiple      health      and      medical
                                                         re.,oiir(-(,,,   in   local   ity(@its   in   o@ier   to   help   provide    high    quality    cire    in    heart,    cancer,
                                                         strol@ii,,iiid          (lisetis(@s.
                                                                                   of tli(@ lt("gi()Illll k(lvisol.y at.()         iil)s,     wlii(!It     currently     totals     Al).
                                                         )Ilo\iiii:lt(.Iy 1!)OO individuals, ill(.Ill(14,s                                                        1.").Oell"
                                                                                                                                              I'l.7ey,)      voluntary       ll('Itlt.ll
                                                         1)4,r of. tli(@ I)til)lif@ iiiil 7'lo ot.ii(@rs. lllitiiiiitig                       Nvlii(,Ik      currently       iii(,Iti(le
                                                         III)otit@ fl,@)OO  itl(li%'i(ilifilm,  also
                                                                   18C                                          .11'/
                                                                        /(,                                           a                                           1:10/0     lii)sl)ital
                                                         ii(Iiiiiiii@t.rjitorH;  (;Ixo  voluntary  II('Illtll                                   I)Iil)li(! 11(@filtli officials,
                                                         10,llo allied health w(irl@(!r.,4; 51/t)                       of     III(,           and Gillo Others.
                                                         Ill t(Tlllc4 (@f                         organization,,,  it.  I,;        (,st,iiiiiit@(41    talent    over    1700     orgit-
                                                         illylitiolis iii,t@ ]low Involved In lt(@giofiiil AIO(li(!Iil             IlrogrILills,    Tli(@i4e     Inclu@le     all     of
                                                         the                                                         I(!S,                    and      cancer       societies,       and
                                                         F;Lfltlc lie.,ilt@ll (14'1          Almost; (,)Ol/o of                     liur,,41llg     ftil(I     (rental      associations
                                                         are  involved                 80,Yo   of,   i.11(@   S(!Iio(IIS    401'           health     DII(I     -StAtte      110,41)ital
                                                         associitt@ioiis  itre  il)Voll'c(i  ;  itti(i  report  :1,7)Xo  of  I   li(@   S(.Iioo]H   of   (lellistry.   In   it(l(lltlon,
                                                         many schools -of nursing iii)tl otlici- @aille(i                         i)rof(,q,4'loiis     are     Involved     as      well
                                                         as    a    broad    array    of    other     professional     org4iiiiz:ttioii,4     and     institutions.
                                                                                   COITF PLAN'\ING AND AD@tINISTRATivr, STAFLP
                                                         Reports      from      the      Regions      indicate      that       apl)roximattly       470/o       of       theprofessional
                                                         iiid     technical      planning      staff      are      physicians.      Allied      health      professionals      including
                                                         nurses,      hospitals      tdministra@tors,       dentists,       and       others       account       for       approximately
                                                         32,Yo     of     the     core     staff.     Related     health      professionals,      including      health      economists,
                                                         medical     ,;ociolo@,,Ists,     statistici.-iiis,      and      otli(@rs      :tceount      for      approximately      :Lgo/o
                                                         general     sul)port)ive     staff     accounts     for     about     1601o     ;     and      "other"      groups      account
                                                         for 6171o.
                                                                                                      0111@,itAq'IONAT, STAIPIO
                                                                                                                                         with    i'll(@    ]tnl)lelll(@lit@litloil    Of
                                                                   ol@i'l-ill,iolili'l  I)r(oj(@ct@s,         iiiiiiil)ow4@r   liivi)lv(@(I   In   (,ii(@u@   I)t-oj(@(!t,.i    (,oin(!s
                                                         -oill it I)I.oll(l  riiii;,4,  of.                                                       (2r)"Io)        iiiir,,i(-44   (81,lo)
                                                                                       IOXO)                 ioll   final   (.oiIiiiiiiiit(-iiti(ojis  (5'yi))    counting         aii(i
                                                                                                   find t,ii(@it, Stil)lO(ll-(,iilg                                other
                                                         Ciltli$4  (Ilt"Xo)  Ill'lllillllstrat,ive find                    ('@l()('Io)  ;  final  o4@ii(-.r   21/o.
                                                                                          'il)Ol(o  t,o 80                     ill       Wiscoii,,iiii       In.,3t iii(rl   t,   via   o6
                                                         tel(@i)lloll(,                   slelyi-
                                                              r. ("A]tTl,,It. Wly, yoii yiel d on tli at
                                                         Mr. RoGirits. Yes.





                                                                                                       65
                                                     i\lr. CAIZTI@',IZ. I notice this bill provides t,it, t d nti.ts may                                     refer
                                                  ,iticiit"s  to  some   of   tll(3   ]-e6ollll        Centers,  @171(,l   1   want   to   say   that   I
                                                  1)
                                                  tiiiilc  tliftt  is  very  (yood.  I  @n-i  li,,tl)l)y  tliit  dc@iitists  and  oral  surgeons
                                                  are included.
                                                     Mr. l,.oci,,its. I'litiilc you.
                                                     I)o You I)Vovi(l(@        J': 0 I.- 1);
                                                                                                   costs                           to           will(.,II    ttl.(3
                                                                                                                     oi. ([(@,illf)llst,rtLt,ioll itot,iviti(@,s
                                                                 to
                                                  Suiide(lby t@110,1't@giOllill
                                                     We coiisulf,c@(,l  various  liosl)it,,Ll  grot@l)S  to                          of   llo,-,v   W("   would
                                                                                                         1,s t,ii@it    c (3]iotild be  v(@i.-y  et  itioiis
                                                  administer this -iiid their tdvice iv,                            , Ni-                              I
                                                  ,Lboitt @tlic actual 1),tyniciit of                       cost-,,  so  we   I-itve   not   spent   much.
                                                                               ]-lie lltv(3                         oil Nvlltt you liaN,e done
                                                  wlie re it II ,ts -011(,.
                                                     ('I'Iie fol  Iowing information was received by the committee:)
                                                     Tiic D(,I),ti,-tiiieiit of            E(illetitiol),    @iii(i    Welftre    has    determined    that    ttie
                                                  follonviiig j),,itieiit (,:ir(@ cost.@, llosl)itztlizlltioii eo,,t,;, litye becii supported  with
                                                  re.-ioziilitie(lie,,ilpr(igr;iiiigi-aiitfuii(is:
                                                          (1)    Missoiiri    Itegionil     'jnle(lieiil
                                                     Mr. T'             Do  you  use  consul  t-,.tiits,  and  lvliere   are   these   used   mainly
                                                     fir is tilL, re,(-rioll:tl iiie,(Iic"l,L                  is    (Concerned    ?
                                                     Dr.                    IVC  litvc  used  (,Oii,,iilt@tiits  :It   the          national           promr@m
                                                  from just tl)out every tre,.t of lie,.tltli-liospit,.tl                       1)1,'Lillililg  Lrroul)s  in-
                                                                     receive t -rtiit re(Iii(@t tiicl we use                    coilstiltancs    wiih     ex-
                                                  I)CI-tiseiiit.lie,,tl.(@:tcover(,@dbytliereqtiest,oiitliesitevisit.
                                                     iA[i-.               Who determines                       the,  re-ioii   shill   be?   Do   you   de-

                                                                         Al-(,,  i-,Ii(@v  too  liti-sp  iioNN,?
                                                     ])I.-.                 SoIIIO                             I)II4, I tIlil)lc it-, will
                                                                         Ai-(@,  (,Iiei-0:111Y  I)t@ilis   l'ol.
                                                     ])I-.                   Tli(ii-o   is   discussion   (Iiii-ii'i'g   i'llo    I)Ittllliill,r    I)erio(I    ill
                                                  ,eV(-,I  y  I-(@gl()Il  I'(@g:tt-('l  ilig  tile  (@xt@eiit@  to  which  t-.Ilo   regional   al)l)roxii   iatioil
                                                                      @111(t tlii,,i is                     oil  ill  t,11(3  (YI.Itilt  ,t  J;If@,titioli's   that
                                                                                                                            tn          p
                                                  -Coill(l, in to II,,,.
                                                     I I-,Iiiiilc tilde will be                        ov(@,i-  there,,  I)Iit-,  I  tliilil,,  intiiy  areas   are
                                                  fil)(1,111(v  t-11(@,y   Nvltllt   tile   tdv@ii(@itg(-,s   of      1,Li-g(,,r    regions    ttiid    yet     the
                                                  -0 )1)01'tliiiit@@ of                    down into                            groups,     ,ttid     we     li,%vo
                                                                                      ]):Is                    in                  I'     don't     think      they
                                                                  11 oir tile ground                   li:tvt, tli(%Y'@,
                                                                             -rllev li:tvo                           iiit  that   was   made   this   year.
                                                                          Soyoiiwoiild,,tiiticil):ti@,tyc,-Li-.
                                                                   SI,ON.
                                                     D            t             es.  I  t,,,Il(c  tiiit,                         We    liivo     had     tii     tl
                                                                 from Floridt sili(@,e tiitt 1)1-,tiiiiiiiLr                     ,tskiiig     for     funds     for
                                                                      ,,tlidy,     which     the     National      A(FN,!,,,ory      Council      allows      under
                                                  ',I 1)1'(tililill(,r grtiit. This -,ii)l)licatioii ,irrived oii  iiy desk
                                                                      -.S.  I w           I  0 tile Status. if vou c )Iil d cr'v Yi@ to                  of     all
                                                                                otil(I l@k                                           "I  0          us
                                                  the                 the                        0             tl-(' i  II,  WI  ell  we  call  (,Xl)cct  to  se,(3
                                                                            r)i@, wll.%t St,-It, i tll(,,V
                                                                    tr(@,t down to the lo(,,,,tl li@)sl)itals all(, into the                 M(3ilical        pro-





                                                                                                 66

                                               (Tlie followiii,r itiforiiiittioii wts i-(@(,oive(I I)y t'li(!, (,oiiiiijittee,:)

                                                              oi,' I           I"I)tl(!A'I'ION, AN])                        I-;NT ON  Till@,  S'l-ATUFi  OF
                                                                              ICEGIONAI,                 I'li(hil(AMS

                                                                    111(@        I)t'IOIV, :ill It(,gioll',          1111(@l-to Iti(-o )I,'tV(@
                                                                                                                                 have l@(!(!D  (.I)gllg(@(I
                                                                           for it Y(,,tr (ir loiiA(-r.                           q.ctiviti(@s  li@iv(!   in-


                                                                                          of' :t                      of            il)stittillioll"  all(]
                                                                                                                                  lll(!dical   So(.ieti(-S,
                                            ofilei@it and voliiiltiry              a,(@ii(,ies, ,iii(I  stil(@  lio.@I)it@il  associations.  These  iii(li-
                                            vi(lual,, :ire            on  I)Iiiiiniiig  t@isic  for(-es  ,iii(i  local  a(li,isoi-y  committees  as  i@,ell
                                            as Ilegioziil. Advisory Groiip,4. In                      ft 11111111)(1@r  Of  ,;LICII  individuals  are  also
                                            serviii,- on tliecentril core staffs of iiitriy Itegioiiil Programs.
                                              L@xl)erience    to    date    clearly    demonstrates    tliit    the     involvement     of     couiiiiunity
                                            hospitals ,tjid ot@li(@r local health                     private   1)rft(!tit@loriers,   and   other    health
                                            )i-ofession:ils    becomes    more    extensive    and    iiiteiisive    is    Regional    Progrftiiis    enter
                                            I
                                            the operational                At   that    stage,,    for    (,xiii)il)le,    community    hospitals    become
                                            the    sites    for    coronary    care    unit    demoiistrgtiot)    @ind     training     programs;     local
                                            ribysiciatis     and     hospitals     undertake     the     training     of     cardiopulmonary      tKIiniciins
                                            needed in the (,oiiiiiiiiiiity; private practitioners and their                            In   rur4il    areiii
                                            ll(.n(@tit from Itltolli@ltt,(l 147iKC. rei(Iiiigs iitilizin,,,                   lines;    ind     pro,,,rains
                                            to   i-(!(@riiit   iii(I   train   siib-I)rofessionii]   health   aides   required   to   staff   extended   care

                                              Iiiitiit   ol)c@rilioiiil   -riiiis   have   been   nw:ir(l(@(I   to   12   Ilegioilal   Programs   to    date.
                                            Aiit)tliei- 12 Itegloiis   ]Steve  siil)lllit@te(i  initial  OIX@rtilliori:il  grant   re(Iiiet4ts   which   are
                                            no\%, under review. litis(,d upon the                 iiifoi-j)i,,it@loti            itvalljible,  it  Is   itn-
                                                        that tli(@ ot@li(,r .10 lt(,@gtoyis will         the  ol)(@riii@ioiial   phase   bcf(ire   the   end
                                            of lise@il y(-,.ir                 involvement;     and     I)artieil)ittloik     by     community      hospitals
                                            ,iii4l    1)rivtte    practitioners    in    Itegloiial    M(@di(.-al    Ilrogritms    should     become     more
                                            widespread   and   in(!retisli)gly    evident    over    the    next    12-15    months







































                                                                                                                                              7- 7






















                                                                                                                                                              S7ATUS OF REG[Ot4AL hIEDICAL PROGRA',IS (AS OF fTAR. 30, I9&8

                                                                                                                                                             Beginning date                                                          Funding
                                                                                                                                                                                                                                                                                            Operational status
                                                                                                 Region3l medical progran                              Planning         Operational                 Currently available                    Cumulative awards
                                                                                                                                                                                                    Planning   Operational                 Planning    Pe,-tio.-I
                                                                                                                                                                                 ---------          $393,788 --------------                $661,756 -----         -------- initial  operational  grant   request   anticipated   in   fiscal
                                                                                Alabama-State       of        Alabama ------------------------      Jan.     1,   1967 - -----                                                                            -                year    1969.
                                                                                                                                                                     6  Apr.    1     1967          384,244              $921,510          707,   033             $921,510
                                                                                Albany-Northeastern                 York,   potions   of   southern    July  1,196
                                                                                  Vermont and western Massachusetts.
                                                                                Arizona-State       of        Arizona --------------------------    Apr.     1,1967     ---------     ----          119,045  --------------                119,045  --------------            Do.
                                                                                Arkansas-State      of       Arkansas ----------------------------        do ----------------     :   ----          360,174  --------------                360    174 --------------          Do.
                                                                                Bi-State-@tern    r,.issouri,    centered    around    St.    Louis    ..---do ---------------------                6,33,965 --------------                6D3:965  --------------            Do.
                                                                                  and       southern        Illinois.                               Nov.     1     966  ......     -------          3,2 6, 225 ---       ----------        4,0 9. 593 --------------     Initial  operational   grant   request   under   review.
                                                                                California-State    of     California ---------------                                                               2            -                         7
                                                                          -Central   @4e-,v    Yor@.-Syracuse,    NeN    York    and    'f@-s-u-r--    Jan.  I:  11967  --------------              268,  r>34 --------------              434,156  --------------            Do.
                                                                                  rounding counties.
                                                                                Woreo-Viyoming-States       of       Colorado       and       Wyoming ------- do ---------------------              339,605  --------------                488,359  ..............       Initial  operational  grant   request   anticipated   in   fiscal
                                                                                                                                                                                                                                                                           year    1969.
                                                                                                                                  ----------                                                                                               41     932                    Initial operations
                                                                                Connect!cLt-State of Connecticut            -------                 July     1,   1966  --------------              338,   513 --------------                                 ------------                   I  grant   request   unde@   review.
                                                                                Flofida-State       of        Florida ---------------                                                               240,   CCO --------                    '@     ODO ----------         I n      -                    r
                                                                                                                                  ------------      Nov.     1,   1967  --------------                                     ------          24                              itial  operational   grant   equest   anticipated   in   fiscal
                                                                                                                                                                                                                                                                           Year    1969.
                                                                                Georgia-State       of        Georgia ----------------------        Jan.     1    1967  --------------              341,824  --------------                694    427 ----         --------- I  ni'tial  Operational  grant  re4uest   under   re@@m.
                                                                                Greater DelwareValley-Philadelphia-Camden                           Apr.     I"                -----------          1,534,494 --------------               1, 534:494 --------------     Initial  o    bonal   grant   request   anticipated   in   fiscal
                                                                                                                                                                                                                                                                                  ;era.
                                                                                                                                                                  1967  ---                                                                                                           69
                                                                                  metropolitan    area    and    adjacent    areas     of     eastern                                                                                                                      year
                                                                                  Pennsyl,@ania,   southern    fie@v    Jersey,    and    State    of
                                                                                  Delaware.
                                                                                Hawai@State         of         Hawaii ----------------------------  July     1,   1966  --------------              194    771 --------------              212,781  ---         ----------    Do.
                                                                                Illinois-State      of       Illinois -------------------------------     do----          ----------------          336:366
                                                                                Indiana-Stale       of       Indiana.                                                                               496    013 ----                        33:     366 ------------         - Do.
                                                                                                                    -------------------------       June     1,1967 --..   -                                                               706    889 --------------          Do.
                                                                                Intermountain-Utah    and    portions     of     Colorado,     Idaho, July   1, 1966  Apr-.'                        363:524       2,   038,   123          608,615       2,    038,    123
                                                                                  Montana, Nevada, and Wyoming.
                                                                                low2-State of Iowa      ----------               -------------------- Dec.   1    1966  --------------              290,   591 --------------              552,939            ------------ Initial  operational   grant   request   uider   reiiew.
                                                                                Kansas-State        of         Kansas ---------------------------   July     1:   1966  June    1,    1967          281,   627       699,     852          371-,240                699,852
                                                                                Louisiana-State     of      Louisiana -----------------------       Jan.     1,   1967  --------------              454,445  --------------                710,290  ...............      Initial  operational   grant   request   anticipated   in   fiswi
                                                                                                                                                                                                                                                                           Year    1969.
                                                                                Maine-State         of         flaine ----------------------        May      1    1967  -------------               193,909  --------------                193,909  --------------       Inftial  operational   &rant   request   under   review.
                                                                                           -State   of   rlary   land -------------      --       ----- Jan. 1    1967  -------------
                                                                                Maryland                                                                                                            770,230  --------------                967,459  --------------       nitial   operational   grant   request   anticipated   in    fi=i
                                                                                                                                                                                                                                                                           year    1969.

                                                                                   See footnotes at end of table.































                                                                                                                                                              STATUS OF REGIONAL MEDICAL PROGRAMS (AS OF MAR. 30, 1968)-4onUiued


                                                                                                                                                              Begj,,i,,iir.g date                                                Funding
                                                                                                 Regional medical program                                                                          Currently available                    Cumulative awards                                    Operational status
                                                                                                                                                              Planning          Operational
                                                                                                                                                                                                       Planning        Operational     Planning                Operational

                                                                               Meml)his-Western        Tennessee,         northern         @issizs',pi AV,.         1,19-7 --------------          $173,119   --------------              $173,119   --------------       Initial operational grant request under
                                                                                  and    portions    of    Arkansas,    Keitucky,    aid    t,',issuri
                                                                                                                                                                                1,1968             527,089                $418,318        651,171                 $418,318                                                                        co
                                                                               Metropolitan Washington, D.C.-District of                             Jai.     1, 1957  Apr.
                                                                                  and     surroupdiigsuburbancounues     in      @',.3ryl3,,d      and
                                                                                  Virginia.
                                                                               Michigan-St3te      Of      Michigan -------------------------        June        1,1@067 --------------        1,294        449 ---------              1,   294,   449 --------------           Do.
                                                                               Missi;sippi--S,ale     of     Mississippi -------------               J;--    I! 1,  !z',57      -------            322:845    --------------              322.     945 --------------           Do.
                                                                               V,issour;     state   of   flissouri   excluding    me'ro@,L    ,    an        do
                                                                                                                                         :-ii  ------         -------     pr.    1,    1967        324,     254          2,887,903        635,967         2,   987,    SG3
                                                                                  St.   Louis.
                                                                               f?ountain States-States of Idaho, Ni-,ntara,                                   v. 1, 1956   '@,ar. 1,     1968  1,   082,    107            206,913     1,      747,370             206,913
                                                                                  and Wyoming.
                                                                               Nebraska-S,)uth       03kOta-States       of       rlebras@.a       and Jai.   1,     l@7 --------------            349,367    --------------              597,609    --------------             Do.
                                                                                  South Dakota.
                                                                               New Jersey-State of tiew Jersey                     ------------------- J.@ly  1.  I  @,7 --------------            2'7y.    466 --------------            297,466    --------------             Do.
                                                                               New NlexicD-Sta,e of               ,,lexica           ------------------ co       CI,      i@ - -----------         55       270 --------------            W3,      866       ------------- Initial operational grant request under revis@y.
                                                                                                        'a-       -           rk    City,     tias-2u, J-j-e  1,    .1%7
                                                                               New   York   metropolis   @i   area   Crew    Y.                                                   ---------        967,010    --------------              967      010            -------- Initial opertional grant fE@Ue$t 3.itiCip3tOd in @.sal
                                                                                  Suffolk,    aid     Westchester     Counties.                                                                                                                                                 year 1969.
                                                                               North Carolina-State of r@ort.i Carolina                 -------------- Jj      ty 1,   1966   hl3r.   1,   1968    773,     674     1,     652,164     -1,  OnO,   374     1,652       164
                                                                               North   Dakota-S'   ale    of    tiorth    Dako@ ---------            J,@iy    1.  '  937 --------------            188      010 --------------            188@     010 ----------        ---    Do.
                                                                               Northeastern       Ohio-Cle,@eland       and        surrourdi-n-g--i@-- I      an. 1,   l@@59 --------------        285:     783 --------------            385,783    --------------             Do.
                                                                                  counties@
                                                                               Norther          w                                                                                                  723,920    --------------              $93,695    --------------             Do.
                                                                                             @e     EnR!and-St-@te     of     Verrroit      and      3Ju!y    1,   135.5 --------------
                                                                                         je  in   north@aster.,i   r@ew   York.
                                                                                  coun
                                                                               Northlands-State       of       Minnesota ---------------------       Jz.,L    1,  1   %7 --------------            629,     887 ..............         1,      000,791 --------------           Do.




















                                                                       tiorth@,,e@'eri   O@io-20   counties   in    n@hviestern    Ohio, Jan.     1,  1968 --------------           309,180    --------------             309,180   --------------           Do@
                                                                          urta.,Ed a.-cund Toledo.
                                                                       0.@;,j   St-,Ie-Certf2i   and   s:uthern   3i   of    Ohio    (61 Apr.     1,  1967 --------------           136,    771 --------------            136,   771 --------------          Do.
                                                                          t,,UIties)    c-2.ite,,ed    around    Columbus,     excluding
                                                                                      r,-Et.@opolitan  area.
                                                                              Va@lay-Gre3@er    Dayto,,i-Cinci,.irati,    Ohio,    areas Jan.     1,  1967 --------------           346,    797 --------------            472,096   --------------           Do.
                                                                          and               couit;ei and part of Kentucky.
                                                                       O@,la@om@Sta',e      of      Okleorra ----------------------      Sept     1,  1966 --------------           282,100    ----      ---------        330.318   -----------              Do.
                                                                                                                                                                                                                          53'760    --------------       Award of initial operational grant pend,
                                                                       Crego.--State of Oregon               --------------------------- Apr.     11  1967 -------- -               231,    125 --------------            3  ,                                                                      l' Z.
                                                                       Pi:ert-) R;@ommon@o;ealt@'i of Puer,o Rico             ----------                   ----------------------------------------------------------------------                        Initial onrational grant request anticipated in fiscal
                                                                                                                                                                                                                                                          year IF9.
                                                                       RDc@ster-Roc@es,er,  ti.Y.,  and   11                 surrounding Oct      1,  l9S6  ?,Iar.   1,   1968      318,    286        255,    487        500,425               255,487
                                                                          counties.
                                                                       So-,t@', Carc,!ina-State of South Carolina         -------------- Jan.     I 1  967 --------------           379,    246 --------------            502,773   -------------        Initial operational grant request under review.
                                                                                        Va!@y-2.     counties,      centered      around lure     1,  1967 --------------           263,    530 -----------------------------------------                nft;al o,-eaftoral grant request anticipated in fi@i
                                                                          Harri@lurg-He,-@,ey ir,. ce@tral Pennsylvania.                                                                                                                                  y@ar 1969.
                                                                       Tet,.@ee-,.!'d-So,-th-East-2rn     and     certral      Tennessee
                                                                          ard                counties   of   southern   Keituc.Ky    and
                                                                          scrther;l At @ari3             ------------------------------- July     1,  1966 Feb.    I,     1968      523,738         1,63D      304        673    421          1,630,304
                                                                       Tex3s-S'@ta'acf Texas                  ---------------------------------- do ---------------------         1,  260,  181 --        ---------       67:    194 ----------------    Initial operational grant request uider revie
                                                                       Tfi-St@-to-States    of    Massachusetts,    there     Hanpshire,
                                                                          and Rhc,,e Island             -------------------------------- Dec.     1,  1967 --------------           439,037    --------------             439,037   --------------       Initial operational grant request anticipated in
                                                                                                                                                                                                                                                           fiscal year 1969.
                                                                       Vfrgi,,ii3-S!ste of VirZiri3           -------------------------- Jan.     1,  1967 --------------           254,000    --------------             545.454   --------------           Do.                                                           co
                                                                       Washii,.gt,,-,-A!aska-Stales   of   Viashirgton    and    Alaska- Sept     1,   1966   Feb.   1.   1968      655,148              1,032,003        937@   948          1,032,003
                                                                       West Virgii@a-Stat,3 of 'Nest Vir i-ni'a         ---------------- Jan.     1,  1967 ----------               208,910    --------------             282@   663 --------------          Do.
                                                                                                             9
                                                                  -West-2r,-i   ?lev   York-Bu.@la    arid    7    surrounding    r4e-ei Dec.     1,1966     Plar.     l,iii'      2&3"    717            357,761        313"   033            357,761
                                                                          York  c3-,@ities  and  Erie,   Pa.
                                                                       West-2ri    @n.,sy;@nia-Pittsburgh,    Pa.,    and    28     sur- Jan.     1,  1967 --------------           34D,    556 --------------            340,   556 --------------          Do.
                                                                          toindl,.g c3:jr.-ties.
                                                                       Wixonsin-State      of      Wiscorsin ----------------------      Sept.    1,  1966 SepL    1,     1967 --------------        2     630,149        344,418           630,    149

                                                                          I  Initial  planning  grant  application  has  been  received  and  is  under review.                                    2 Combi;ied planning and operational grant; includes some $340,OVj for               planning,





                                                                                                                          70


                                                                                      ILLUSTRATIVE  EXAAIPI,F:S  OF  (,'LT)tltFNT  8'r,@'I'tfS
                                                                                     to 'tells  list@ill@  of  gi-iiiit                                  1)r(j.i(@(!t(,d    iiiiti,@i.tion    of
                                                       olit@l,ii1ioli.,tl licti%@iii(@s I)Y tli(,' :,)[                                                              (II,  II(.tivitil.,4  (!Ilrl
                                                                to        illti@ti-:Ito      ,4t;iills of                       ill  tll(t ]t(@gioilill                   1:11.f)gl.tlltl    ')Il(i
                                                                                                        to  ll(.Iki(!I'ijig  801114@  of  tll(!  l])IIJ(or                            of   t'll(,.

                                                                                                                                iiiitlt,i-  it. Ill.(. i(o 1)(,                                 of,
                                                       :Iiiil                         to tii(@ evollifloll of 11 sysli-iii                      ('stillolisli(@,4    iiii(I     '41ri'ligl@114'114,
                                                       Olk  ;I                            I'lltl(!I.iollill                          ilitiolig  1,11(@
                                                                              ]:INV                   tillit;  oilly
                                                                                                                                        I Lll(@ ll(.1.01111)liq
                                                       i,itt@ 114,@iltli                                                                                          illii(,IltS of
                                                       ()I.  give  I)I-Olllisf)  or  I)t.ilig  (.rf(!fl.ljv(@  ill  iiifill(@1)(@-ijig  I.Iie  (iiiiililv  of  li(-iiltli  (-are  iiii(ler
                                                       l@114@      follo%@-iiig                                                 Ari-iijig(-iiit!iits;  2)             lt(!Iatioiislill)        of
                                                                                                                  and     'I'r;tiiiiiig;     4)     1)('Ill()]I.'itrittioris     of     llliti(,Ilt
                                                                 @4ii(I                                 Llrojects.


                                                                                          Ilrogriii)s      itr(!      I)itse(l      iil)oii      v(pliiiii:ii-y      (,ool)erat@ive      arr;tiige-
                                                                                      til(i  it(t@ilill                         in                                    (,-ool)er,,tlivc        ar-
                                                       r.,i? I                                   the tl'l)C of 1-4!gioll4tli/,Iltioll %%-itli                         this     I)rograiii      is
                                                                         The    NA7ord    "r(@gloiiilizttioji"     ill     Llie     content     of     lt(@gioiitil     Aledi(-al     Ilro-
                                                                                                                                                                                       I)o
                                                       gr,iiiis does      not. refer to the dei,clof)iiient of i rigid plan Nvliicli has I)f-eii iin                                         -sell
                                                       froi)i  :i))oA,e.                   it     stresses     the     I)t-o(@cs8     whereby     locil     resources      are      joiiie(I
                                                       together to identify needs ikii(I ol)portiiilitit!s, t@o                                      resources,     to      defiiie      ol)jec-
                                                       tives,    to    ,zet    priorities,    and    tli(@ii    finally    to    iiiir)leinciit    t    program    and    to    est@ablish
                                                       methods     of      @c@lf-evlluitioii.      Here      ti-e      soine                exiiiiples     of     how     stich      tirr;iiige-
                                                       iii(,Iits ciii  be c-,pecte(I to iffect 1):tti(@nt service.,; directly.
                                                         Foiir      hospitals      in      I,,,ifayette,      Louisiana,      are      pooliiig       resources       in       cooperation
                                                       with    the    Stite    I-leitrt    Associ@itioii    and    one    of    the    in(@(lictil     schools,     to     improve     the
                                                       care     Of     PLtielItS     With     niyocartlial     iiifiretioii     in     flat     area     of     the     Region     through
                                                       the   @-t-ibli,,Iitiieiit:   of   it    corollary    care    deiiioilstz-.,tt,ion    find    tritiliillg    iiiiit.    The    local
                                                       d(.ei.,4!on      NN,;Is           to                         oil                      a    iii;,,Ii    (Iiiiilit:y    corozitiry    care
                                                       Unit ill a single liosi)it:tl. 'I'Ikeso Vftrle(I                                      joined   with    I-lie    I)iil)lic    to    raise
                                                                     fililil'4,              and II-iiiii                 find   1'411111)   (.fit)   trial..    Aitlioiigli    I'lie    liiv(@sf;-
                                                                    lti-gii@ilill i@!I(@(li(@,11111-(@gi-iiiii
                                                       10.@,  1114-,  111-4@gi,@illi ]lot; 4)fily                                     bill;  11184)  IlitS  14(!rV(@41   14.4   it   illo(l(@l   or
                                                                  (-oiiiiiiiiiiif@y (tf Aii4-liot-iig(@,  AI)i.-41(ii,  III                         lo  t.li(!              1(1(@iiiiil(,41      by
                                                       title                                    lt(@gio)llltl                   Ill,ogi,iiiii   l'ol-   it    lilgli    4.11(@i-gy    radiation
                                                                              thank                   NV:I,,ilililgl.oll,  Is  llo%V  (,ipii(iii(-Iliig  it   fiiii(i   riii,,ii)g   (,iitik.
                                                       I)jiigii.  S4)li(,It(@fl  I)rivile ftiii(I.,q  will 1)(@                     to                    lii)tisitig for like
                                                       iiii@iit,              will be 1)iir(-Iiitsi,41 by I:li(,, It(-gii)iiiil                         Ili@ogriiiii.   TJk(@    tlr(@tltjii(!iit
                                                                  NN-ill  1)(i                   .1'4 it  I.(.gil)]):Il                    l@y 1,11(@                       lfo"41)11111,   it.,]
                                                                     itil(i  111)1)1,ovecl  by                 iiii4l  I-t,gii)lilll  naively  gi-olll)4.                     (14@ei.,4ioll    to
                                                                     tells  it(-I.ivil..v  Iiiv(ylv(!.4                           iiil-i-iiiig(@iii4,iii:8  itt@  ittiol.li(-r
                                                       f(ii-   tli4,,    N:it,ioii:il             Itistlitlitt(!                     (II(!               visit    wheat    gitv(i    it,,,-silr-
                                                       Illit-e  (of  t'll(@  @)IIII(I                 iii)(I                                 i)l' (his  I)i-oj(,,t-t.               Aii(!Iioriige
                                                       l@iiii(iii@g     @iii(I                                                                             soiiie    14     ijikloiis     li@ive
                                                       titl@(,ii   oil   tl)e    coiistrii(@tioti    of    ill(!    I)iiii(iiiig    as    it    project,    thus    contributing    iiiore
                                                       t@li:iii  oi)i   half the tot,:tl cost froin  i:lii.,4 early ,,oiirce.
                                                          Out,, of     the     mo.,4t     lll(!alliligfiil     issoei@itiolis     Sponsored     by      no,-ioiitl      Ale(lical      Pro-
                                                       gr,,tiiis is    between            Vanderbilt            TJiiiversity                   School        and        Moliarrv         Medical
                                                       (college   oil    the    4)iie              iii(i     the     Neiglil)orliootl     Health     C(@iit(@r     supported      by      the
                                                       Ofrice   of   E(,onoiiiic   01@IK)rl:iiiiity,   10@LI(@(I   lielli-    @%leli@irry    oil    -t@110    otli(@r.    Coil,,4ultllrlts
                                                                              -bill,                                            -ulty    (of    Aleh,,irry    and    the    stiff    of     the
                                                       froiii       V.911(1(@i        are     working     with     the     fa(
                                                                    Center     to     provide     coiiij@reliensive     health     (@.ir(@      for      iiiil)overiglic(i      (!oitiiiiu-
                                                                 fotit)erly     without     ,i(leqtiiite     care.     III     iklaiiy     other     Rc,7!ojts      similar      collitbo-
                                                       rittiolis    1)(@tw(,ell     iristitiit@ions     of     varying     iiiitttirity     and     streiigth     have     resulted     in
                                                       ft(-Iiiei,c@iii(@iits lt(@r(,@tofore (litricult, if not impossible.
                                                       2.    Tire    ]@cl(itioit8liip    of     Sci(4nee     to     Sc?'vice
                                                          Tli(,     complex      I)rol)leiu      of      retailing      -the    nior(@       sophisticated       and        advanced        ac-
                                                       tivilies    available    ill    only    a    few     institutions     within     it     Region     to     the     broader     n'cc&
                                                       of    1)1'01)le    of,    the    Region    Is    it    gigiiificaiit    mandate    for    tlio    programs.    Tlils    task     is
                                                       being carried out In it variety of ways.








                                                                                                                                         79






                                                                                                            71
                                                                colill)llte                                                                    Nliqsoiiri     tiia     tile
                                                                                                  facilities   of tile 171)iversity of
                                                                  Nvorl< of Ili(! llitblii,, Ile.,illli                Niiii(iii,,ii   Center   for    (',Iiroiiie    J)is-
                                                            (,olltl.ol,       being            by lo(-III                   11) i(@,,t file (,fft!ci; of tll(',

                                                         gt,@iiiis oil I lii.@ (@:tr(- of
                                                                                      ](4-gioll  has  itii  oiit.,4(iiiiiiiiig
                                                         gi-oill) iliv(",Iig@itill,             al)l)li4@;ili(iii  10 ('Iiliif'lll                                   I)IIY-
                                                                    (.'Ity t@o four O)tll(!r liosl)il:tls in I lead lt(@gioii, l,iii-oiigii                of     r(@i)iote
                                                                                                        4@                                of
                                                         C('Jlill)lltl.l.        :Illo%villg it
                                                                    ill  this c@IS(-, as ill  ability                 tile  (ii,v(@loi@iii(,iitnl   w(@rlc w@i..;    siij).
                                                         I)oi,[(,(] l@y fill,  National  lf(!Ilrt  nictitate.,   wlii(.ll   ]low   1.4   jointly   fill)(lilig   %%,Itli   Itc-
                                                                                                        -4ii,ioji                       "I(!
                                                         gi(iii:tl         Ilrogriiiiis Llit! itloi)lj(l
                                                                                                                           111140   Ill   lll.4tit,iltiotlli   other   thin
                                                                                                                                           -ilt,4    -oill
                                                                      Hall r(,se.   -II                  Wis(-oii.,4iii li:iH II  (](Bull  I   - f]

                                                         Avis(@olisill Itegioliiil              1'rogriiiii  is   stii)lii)rtiiig   fi   unit,   :kt   the
                                                         'Iiiiic for the cl(!iiionsirition of tile best                      for    diagnosis    find    iioii-.@iii-giefLi
                                                         iiiati.igenit@iit of patients with I)tiliiionary         ciiil)olisiii.  Tlit,   I%l@ir(,Iiiiel(l
                                                         esliii)iisli(@(I   referral   routes   froiii   five   I)osl)itals   in   the   Region   for    emergency    car(!
                                                                          -pected of having pulmonary enil)oliszii. 'Pile effect of tills unit
                                                         of  patients   sus
                                                         already   been   nia(l'e   apparent    by    the    increased    demand    froin    I)Iiysiciiii.,;      throiizli-
                                                         out    the    Region    for    educational    services    there.     The     unit     already     has     trea@e(i
                                                                                                                                                         -a        distinct
                                                         iiiore   than   30   patients,   with   results    I)et@ter    than    the    national    average
                                                         improvement in patient care.
                                                         Iteseirch institutions are           anxious    that    nip(licil    fnacti(!e    I)eneflt     froiii     research
                                                         efforts.   l@or    several    years,    tITe    I%Iet)ioriiLl    Sloan-Kettering    Cancer    Center    has    ex-
                                                         toned    Its    consultation    and    reaching    progriiiii.4    out    I:o     the     practicing     community
                                                         in    six    hospital,;.    Now,    through    the    New    Yoric    M(-tror)olitaii    Regioli,,Il     %re(lical
                                                         Pro,-rani   it   is   able   to   expand   it,4   coverage   to    surrounding    areas,    find    Is    planning
                                                         to         28  n(l(lition@il  lio.,4pitiils  ;o  that  tile  linoNN,le(ige   and   lateral   of   the   '.Nfeiiio-
                                                         riil   Sloiii-Kcteriiig   Cancer   Center   call    Ile    made    available    to    practitioners    tliroiig)i-
                                                         out the area.
                                                         In funny siniiiar projects, Regional                                           serves    as    n    vehicle    for
                                                         i.rili,411lis,,41011 of tll(,                              i4) II k(@
                                                         I.  II(Iii(i(itioit, o)tfl  Pi-ai)tittg
                                                                          a.ii(I Triiiiiiiig have been Irii(litit)ij,,il                   of   liiil)i-ovliig   (Itl:illtv
                                                                          'I'lie t,.iiil)liasi.,4 Ili Regional               Ili-ogi-iiiii,; lin,4         t-o
                                                         (Iiieiii@ioii ,iiid training, not as ,;(,Tytrate, i,,,oliii(@(I                                     ill tei-iii..4
                                                         of r(,(,ogiiiyi,(l        for the. lii)proveiiieiit of 1)ittl(@nt care service.
                                                                                                                                                   8  find  as   all   !II-
                                                               i)ftrt of otli'er,,ictiviti(-s.
                                                         Al) (@Nitlill)le of  tile  (IOVClol)lll(@ll.t.  of  tili.'4  IVl)('  of  training  limit].  (.(lllenfloll@ll  pro-
                                                         gi,:iiii RI-0'4(@ ill ill('              Itegioti, wli(@i,(, 21) lio,,41@itiils w(,i-t,
                                                         I)ri@l)lf@iii of (,.stnl)li.@iing corollary care iiiiitt. 'I'Iii-oiigli  i-.Ii(-Ir Regional
                                                         Ilrogrtim,  fli(@y  li,,iv(@  been  able  to  focii,4  iii,4te,,i(I  oil  tlt(-  l@i,ol)]4iiis  of   giving   tile
                                                                            ,iii(I tretttt)iez)t to fill lpiii@i(,,Iifs with                     illfill'(ttioll ill  tllt-
                                                         Jt4@gioii.   A   re(-(-iitly   awarded   operatif)ijal   grant;   will   siii)lyort.    Training    aiiil    coii-
                                                                                                                           aiitl  nitr@(@s  to  .4taff  flags
                                                         failures                   I)rogrfitns  for  pliysi(,!,,iii.4
                                                                              of evaliintion technique,, and                  establishment     of     a      congilintiorl
                                                         resource in a community hospital.
                                                         Tll(,.  C.,iliforiiit  Ttegiozi   plans   to   aiitieii),,itt,   tli(@   needs   for   education   find   training
                                                         in i ii(,iv e(@iiiniiiiiit..v li,(.@ital tA) @1)(, conil)l(,I@t@(I wit.Iiiii th(@ next lJi@rL,(, year.,; in  t-lie
                                                         W,,itt.,4 area of l,os Angeles. A Po,;t-Grq(lii,,tte                       Nvill   be   reeriiit-NI    now    nn(i
                                                         ,;Iw)ii.,zored jointly by the Charles Drew                         Society,    the     University     of     Call-
                                                         fo)-iiiq in T,().Q Angel(-,, ind the ljniverqity of Sotifli(@rii                            On(,(@   built,    the
                                                         lio.'41@itl]      will    support    the    facility,    but    Regional     Medical     Program     funds     are
                                                         being            for int(-rini assistance.
                                                         Niiiii(@rous   progi-ni)is   ii-e    ,;eeking    to    provi(l(,    expert    con,'4iiltal@ion    oil    reoiieqt.
                                                         Tlit,.-c    Include    mnking    con@-iiltntlon    avallqi)l(,    by    telephone    or    two-way    radio     on
                                                         it  24-tioiir  I)asli;,  a   dial   access   teleplit)n(,-nil(lio   tape   F4y8t(@in   In   WL,4consiii,   ind   a
                                                         ni(-(]I(-al   juk(,Iyox   la   Albany   'watch   will   show   a   variety   of   ,41iigle   concept   films   oil
                                                         domfind.







                                                                                                                                                                                     7F7l





                                                                                                     72

                                               4. Dettio)?,vt;-atio)is of llaticitt Care
                                               1)(,iiioii,,Iritioii4 of l@ittif,iit,          are ]Proving to I)+@                   in serving the  goals
                                               of the I)rogrtiii, and have                  it iii.,tjor i@xlpr(@,41oil of cooperative itrrang(@ments
                                               for the I)ett(-Iriiieiii. of it 1)@i@rtictilitr situation.
                                               R(,@-oikre@        in                 for  t@lie  iii.,iii:ig(@iiieitt   of   sti-oli:c   patients   ire   limited.
                                               I;otir   intensive   cire   t)e(is   for   the                       of    latest     advttlic",     and     modern
                                               potential    of    qtroko    care    have    been    e,,;t@tblished     tinder     Regional     M@cal     Programs.
                                               The   tisii@il   hospital   cost,,;   are   being    siil)l)or@l    from    other    sources    but    with    this
                                               newly    ftinded    demonstration    uiiit,    J)hysiciins.    nurs(-,s,    and    all    allied    health     pro-
                                               f@sioiials   have   access   to   excellent   tra@iiiing.    The    resitlt    of    such    training    and    "on
                                               line" experience is already leading to improved care for 4troke patients.
                                               fit    lowi,    a    different    demonstration     pattern     is     being     used.     Through     the     Iowa
                                               Regioiiit    Al@icil    Ilrogra,ni,    a    .,troke    tf-,qtin    with    pliy%iciaiis    iLnd    allied    health
                                                             I,-.  Ivziil.,il)14LI  for  ozi@site   coii,@ititatioii.   This   unit,   taken   to   the   patient,
                                               I)roviol(-,4                                                         c-diietktion     for     those     responsible
                                               fol- (.4)lltillllill"
                                               In   1,4iiiiijiville,                an ciitiie (4(@iiiiiiiiiii(,y liii,4                            1)(.")qne    a
                                               "d(@iiioiist:j@iii,ioii I)i-oj(4!t" IVit-ii trials funding of t             i)i@(-ili@d  T('1111I)iiII41tioli  unit
                                               III  Halt   town   of          NN'lill-li          it                  of   r)O,O(X),   t;lif@    imagination    of
                                               11)(@ (.ojlllllllllit@y W.1.4                              liy fine                     Itegiojiitl       AI(4lical
                                                            t-lic t@i)wii  leaders ,;oiiglit Intel                   it    "(I(,inon@trittloii     siil)-rf-gioii"
                                               for 111(@                            'PILir4,   ovt@r   a   dozen   r(@gi<)iiiil   proje(.,ts   are   now   I)eiiig
                                                          Sliiit:liviil(,.
                                                              iiiaiiy (,x:irn-l)li,&  of  iiyiit,.4  (i(@iiit)iistral.ilig  care  of  -I)a@ti(,nts  with  -a(-Iite
                                               niyo(.,.itr(iiitl iiifaretioii. 'I'lie iinitt4 tire vitri(,(I.  @ottic  are  in  -4iti@ill  and  some  III  ljtrg(@
                                               hospitals.    @(ollic              ji(iiiit   cIT4)rl,,;   I)i@twe(!ii   "Mtdicsil   Ceiit(@r',9"   and    outlying
                                               11(i@I)it:ils. Soill(@                       by joliy.,4iciiiii,4 while              are    adminl,4tc-r(,41    lay
                                                       Tli(,@i@   iiio(l(!I@s   r(@ogiiizi--   the   r(@.ilitios   of   manpower    shortages,    and    of    the
                                               sigiiijicitzit difTer(@tic(@ in  tlic, locales where patients are treated.
                                               5. li,'j@pct-iinental Projects
                                               R(!;,ioll:ll              111-ogi-aiiis  are  oIT(@riiig  an   (-Excellent   (opportunity   i@(pi-   tli(,   tl,-,e
                                               of illfOl-111,Lt,iO]l         out   of   re,%ettreli   into    better    in(,@thods    for    making    -.available
                                               the   adviiie(-s   of    in(@dical    science.
                                               iNorth   Caroliiit    is    piyii)g    considerable    attention    to    the    special    problein.,4    of    an
                                                   in the                 part    of    the    statle    known    as    the    "State    of     Franklin."     For
                                               e         seven    hospitals    in    as    many     different     communities     are     testing     the     fea-
                                               x
                                               sjl)ility   of   a   common    Board    of    Trustees    and    a    coordinated    program    to    the    extent
                                               thit   they    will    request    aceretlitation    as    one    hospital    by    the    Joint    Oommission    on
                                               Accreditation     of     Hospitals.     Separately      these      hospitals,      pligiied      with      manpower
                                               and    facility    shortages,    face    not    only     an     uncertain     future,     but     the     knowledge
                                               that   they   will   have   increasing   difficulty   in    iii:iiiit@iiiiiiig    quality    patient    care.    As
                                               a    result    of    tli(,    Regional    Medical    Program,    these    hospitals    are    now    testing    the
                                               concept    of    a    iiiii(lue    regional     hospititl     organization     which     will     make     possible
                                               the iiiil)l(@iiieiitRtioxi of improved care in beirt disease, cancer, and stroke.
                                               'I'lie    University    of    Miclilgaii    School    of    It,iigiziecriiig    Is     cooperating     with     the
                                               Iikt(!rziioiiiitaiii    Regional    Medical    Program    in    a    mysteins    and    operations     study     of
                                               coronary   care.   Ilere   we   see   recognition   of   the   area,(]   for   the   health   syt4teiii   to    In-
                                                     t@ixe (@rrectiveii(@sg ,,,a                    of  car(,,   iito(ltliti(@s.   In   this   crit   when   iiii-
                                               noun    attention    is    dir(,-te(I    to    rising    medical     care     costs,     many     resources     and
                                               tyl)c@4   of   exl)(@rtise   will    be    needed    to    minimize    needless    expense.    Vermont    is    in-
                                               volve(I in It iii4Oiile(l cost               iiiitilyqi,4   of    several    health    :Ictivities    being    lni-
                                               ti4it(,il.   'I'lic   data   collected   should   provide   not   only   Clio    Vermont    Itegioniil    Mc(liciti
                                               Ilrogriiiii,    but    the    health    Industry    In    general    with    informittion    upon    which    deel-
                                               sioiis can be made on substantive rather than intuitive bases.
                                               Mr. P-.OGEIZS. Is thero,,tny particular emphasis given in the  regional
                                               rograms to the core city T-)rol)lcin?
                                               p
                                               l@r. MARS'LON. Yes, sir. '.rfi                                                               more    slowly
                                               in the very large, complex Ur                                                                for  the  same
                                               reason soi-ne other  programs                                                                    But    there
                                               are some Itcy ex
                                               In the Califoi                                   Watts  group  is  working  on  a  DrogTam
                                               with UCLA, tb                                     of the-Nat7lonal Medial Association,
                                               and USC.




                                                                                                                           7:1
                                                                                                                                          slivill(@ is  Stll),)ortiiig  a  I)ro-
                                                                                                                                               ive  voli  a              of those.
                                                                                                                                 voiild g
                                                                                                     Nvitll 0
                                                                                                     )I-,Iv(l it list"    (:)f t,lies(", :tll(l @llftt lioipitttls in these
                                                                         :11,(, lllv()Iv(.Cl itil(I (]IC J)el'.Iollllcl illvolv("d.
                                                                                                                 i'ii w,,ts received by                  the committee:)
                                                                    (Tlio folloiviii(v iilforiyiat o
                                                                    I)FPILR'I'Nil,,NT OF                 I;,[)UCA'I'[O.N, ANI) Wrl,]-'Altil TATIIMI?NT OI-I ItEGIOPfAL
                                                                                                             Dilti                     s,r Tllb  IlrALTIL                           OF    TIIN
                                                                    NILIDICAL l'ItOGItA,%f 14;FFOICTS               ',(7rl;j) AGAIN
                                                                    I-JNEit CITY
                                                                    III Auguit I()67, the Nitionil Advisory (,ouji(@il oil It                            ')nal                             Programs
                                                                                                                                                     egl(
                                                                    is,@tic(i    a    st,,iteinent    which    gave    consid(@rnt,ioii    to    i,h(@    h(!tilth     I)robleins     of     metro-
                                                                                -Ls    and    their    ilin(@r    cities.     While     r(-cogikizizig     the     cotiil)l(,,xities     of     the
                                                                    I)olit.in ar(,@
                                                                    lirl).iii eiivironiiiejit, the Coiiiicil stressed the i-(!SI)Ollsil)ility of Itegionil
                                                                    llr(o,L,nkiiis C4)               t@o    the    sf)ltitioii    of    ll(,4tlllli    prol)lejns    there.     In     fiti(lition,
                                                                    it                   ttiit   all    il)l)rol)riittlc    gi-otil)    or    i)ittioziitl              ))c      iiiiine(i      and
                                                                    ciill(@ft   t@og(@tli(!r   to   (!t)tx.,;ider   how   the    iitt4.,Ilt,ioll    of    Itegioiial    M(,@(li(-Iil    Ilrogritins
                                                                    coill(I I)CST, 1)(! focils(@d oil 1,114! i.,Stlf,.
                                                                    Ill              to tli(@  stilt(!Illellt al)(I  to tli(,.        Siii-g(,oii                    meinorin(Iiini              of
                                                                    Of,.,tol)er i) 11)07   "lizil)roviiig   tii(@   lle:iltli   St:tt.iis   of   iii(@    I,Irl)iiii    Iloor,"    it    iiii,t!l@izig
                                                                         I(l   it  Novt-iiii)er 16,  1.)(;7 to                         the lorol)l(@iii
                                                                                                                                                              Aiiiozig                   I)er,,ojis
                                                                    il)vit(@(I to :it.teii(I Nv(,re  lio.,41oitiil                            ltl%IP      coordinators       froiii       xirl),tii
                                                                    aij-(t:ts,  li(,:iltli
                                                                                @vitli  re,,pon4il)ilitly for t@lie lir  vi,.,i(iii t)l'          care    to    the     ilrl)ttii     poor.     The
                                                                                                                               front  Ol,,(),      ine(lic,,il    9(!Iiool     oiliciiiis     iii(I
                                                                                                       iie(@(i for                       :i(!tioii  lo   re(Iti(!e   tli(@   )i(@alt,li   stiitii.4
                                                                    ditT4@i-(,Yiti@il  Nviii(-Ii  ]low           ill(,              for                            ill   tile   iiietlio4l..4    of
                                                                    (I(-Iiv(@riiig   li(@:tltli   (-fire,   fill(]   the   ii(@'(1   for   (.ool.(Iiiiiitiiig   tit(,   tctiviti(@    of    diverse
                                                                    groill)s  N%.Iii(,Ii  I)r4)vi(Ic  lie:tll@ii   care   s(!i-vi(,e4   in   t,ii(@   iiiiier   city   as   Well   its   HI)e(!illc
                                                                                       I)roj(@ets wlii(!Ii iiiiglit lie
                                                                    Al,  t,iii!  local  lev(!I,  Ilegioiiiil  M(@4]icitl  Ilrogriiiiis            wlii(!It      include      in,.ijor      iiietro-
                                                                    I)olit;ili      li@iv(@ (I(-v(@lol)(,(l viri(,d                         to     solving     these      lirol)l(@iiis.      These
                                                                    (!fforts   iii(@Iii(it@    cool)(,ritiv(@    arri.iigeiiieiit-s    I)otwe(.,n    liosl)itils,    health    (Iel)itrtiiieiit.,3,
                                                                           seliool,4,    voluntary    agel)ci(@.,;     .11)(I     I)ract@icing     physicians     to     iiie(@t     the     health
                                                                    needs    of    the    poor.    Exiinples    of    these     itl)proit(@lies     flow     under     develol)inciit     or     in
                                                                    ol)er@illion can he suiniii,,trized as follows:
                                                                    California      Re,,ioiiil      Medical      Ilrogr-.1iii      his      @-til)lislied      a      siii@)re.@loii       covering
                                                                    the     W-,Itts-Willowl)rool@     irea     of     l,os      Angeles      which      will      facilitate      the      develop-
                                                                    iytejit of activities :iiined it IUCOtiDg tile                        11(le(114   Of   ill(-.    people    tli(@rc@.    Through
                                                                    i.ii(,  Itegioiial              Ilrogritin,      the      Uiiiv(-i-,,ity      of       Southern       California       @@cliool
                                                                    of 'NIC(licill(, .111(l tile IJ(,T,A  S(-Iiool  of                         fire     cooperating     )vit.ii      the      local
                                                                    CliLrl(,s   It,    I)r(@w    Me(li(!iil    '4o(!iet..v    (fill    annually    of    the    National    Ate(liciii    A.4socia-
                                                                    l,ioii)  tit  (@.,4ttl)lisliitig a  postgraduates                       S(@llool    fit    tile    @otitliellit     C,(@iieriil
                                                                    lf(psl)it:il  now  uil4l(ir                         ill    Witi,(.s.    rlli,4    S(!IIOOI     will     provide     bii(!Ic-iip
                                                                    services  to tlk(@  Of@,O  ii(@iglil)oi-lioo(I  li(-iiltli                   tit    the    tir(@it,     (lev(,Iol)     training
                                                                    I)rogr4iiiis for allied lit,:tlt@ii                     i)i-ovl(l(@  st@ii)iiiIii4   for   ii(](Iit@ioiitil   I)Iiy.,;I(!iiiii4
                                                                                                                                                                                    programs
                                                                    to eii((@r t,II(, 1)r@t(.                tli(@ coiiiiiiiiitit..y find will (](@velol) i,i
                                                                    for ljliysi(-i.,tiis already tli(!re. (,:ilif(iriii;t It(-gii)liltl Alt!dl(!Iil Ilrogriiiii Iiix,4
                                                                    fund,;   for   partial   support   of    the    s(,Iiool    la    tli(@    early    .4tilge4    of    (Ivv(!Iol)lllellt.    Ill
                                                                    41(14]il.lon,   work   is   now    underway    tit    the    IJiiiv(,@rsit,y    of    1.4otit@ii(,rii    California    S(-Iiool
                                                                    of    'iNI(@(liciiie    oil    the    application    of     (-ittic(.-r     ease     finding     methodology     to     poverty
                                                                    groill).'4.
                                                                    New     Jersey     Itegioji@il     Alediciil     Program      has      organized      fill      tirl)iiii      health      unit
                                                                    within tlkeir of]!(!(! find hit,-,                         it 'I'lisk              oil TJr)).tn                      Service.,i
                                                                    iiii(i(@r tli(@  (chairmanship  Of  Mrs.  Anne  Sojii4@i-s,  it                                 of     tli(@ir      Itegloiiitl
                                                                                               -Inl)erslilp                                                             (@ritative.,4   of    t@lic
                                                                    Advisory Groiii). 'i%l(                      on tli(@             ii'oi-(-(@              rel)r(@
                                                                    NeNv  Jersey                    A,.4so(,iiitioii,    t,li(@    N(@Nv    Jersey    Stiiti(@    Del)@it-t@iii(,jit    of    Corn-
                                                                    affinity  Affiirs,  county                                        lo(!iil       OleO.CAP       programs       find        other
                                                                    grotil)4. 'L'Iie function of the grotil) will 1)(@ t@o                                 find    r(,@vieNv    1)roj(@(-ts     for
                                                                    improving the availability of health t4(,rvie(,s to 1)(!r.,4oiis living ]it iii-bfiii                                         of
                                                                    tit(!    ,tite,    particularly    low    Income    gi-otil)s.     q'lie     groiij)     currently     is     woi-i@itig     on
                                                                    the    development    of    hospital    I)ased    group    I)ract@i(!(@4    at    Middlesex    Gei)ertil     I     lo.'Il)it.11
                                                                    in    NeNv    liruiiskN,Iclc     and     at     West     Jersey     I-losl)it:il     !it     Ctinden,     as     demonstrations
                                                                    of improved systems for patient care for heart disease, cancer and stroke.
                                                                    The      NeNv      Jersey       Regional       Medical       Program       will       assign       a       coordinator/plaiiner
                                                                                                                                                              oken.      The      function       of
                                                                    to    the     Model     Cities     offices     in     Trenton,     Newark,     and     Ilob






                                                                                                                                                         77





                                                                                                                    74


                                                                            %%-ill 11(@ to  911(i)(@l.  (I:lf:l  Ill)                             f.,Iciliti(@      available       for
                                                                             g  J'I-IP]lk                                                          to I)I-ovi(](! 11,11.@oll  I)(,-
                                                                                                      -I I I I I s 11 I I (I I I I.1 I f 14 1 4 -1 i I i4 -S 1) i,og I'll I I is ; I I I I (I t o it Ss I -St
                                                                                                 Ilrogi
                                                                                                                      I)I,ogi
                                                                                                                                                           0I)jectiv(!14    Of     tile

                                                                                                iegiollil               I,I,Ogr,,Illl  has  developed  a  iiiiiiib(,,r  o
                                                     pi.ojc.(.ts              :iffe(.t tile                c@tre  of  tli(@  l@oor  fix                        Corollary           care
                                                                                                                                           l(@liel-iii Ilo.,31)itii and             ub-
                                                     iiijil,4 %Vill 1)(@
                                                                                                  1),itiel)(8    Ilirg(@ly    (11,.,%vil    front    all     Indigent     ljol)ulttion.
                                                                                 (,'-Oll('ge    Nvill    (,oti(Iii(@t    coitl@iiiiiiiig     e(lucittion     programs     for     Negro
                                                                       anti     will     establish      a                      radiation       unit       to       improve       cancer
                                                     tjl(@l'.11)Y    ill    tile     colkiiiiiiiiity     anti     liiilirove     grit(iiinti--     and     undergraduate     rt(liology
                                                                            I (I i I i (Pi], t II (@ I-(@ I   8Iro.i t (, t, Io t(,,S I. file                  Of    IIIUltil)il,'I',iC
                                                                    (@itillill@itioll'; ill flip (Fairly tli:i;,,iiosi.,4 of                             ciiil(!er fill(]
                                                     \I(@li@iri-y  will  C,,4i@iii)lisil  't  s(@r(@eiiitig (-ejit(,r  Nvlii(!Ii  %vill                     ]it   fiii))I)ort   of    a
                                                                             11(@iglil)l)l.lioo(i health                              by   (')I",O   find   evil   serve   it    I)ol)-
                                                     til@itioli   ol'.18,000   li(,ol)lc.   Tli(!   (i@,   1;   population   fill(]   it   (-oii(Irol   group   will    be    evaluated
                                                                            %%,itli                   to (!Ii:iiig(,s !it jilol-I)i(lit.y,                   of    utiliv;ltioii     of
                                                     heiltli    ,;crviceq,    lic@ilt@liiftitud(@    and    cost    Tier    patient    di:igilo'.,-c,(].
                                                        'I'ri-@Stitte lt(@gioii,'Il                   Ilrogr;titi    received    it    I)Iiiiiiiiiig@    grant    la     late     19()7
                                                     find     I.,.,     only     iio%i,     becoming     completely     orgiiiiz(@(.1.     Since     tli@it     time     Dr.     Norman
                                                     Steiriies,    I'vogr@iiii    Coor(Iiii.,ttor,    his    been    iiii,olv(!(l    in    a    number     of     meetings     N\-Iiere
                                                     II(,    ]),is    made     kllo\vll     national     Medicit     Ilrogr@.iiii's     interest     !it     working     to     improve
                                                     the   tvailil)ility    of    liciltli    services    to    the    urban    poor.    Ile    also    Is    serving    on    an    ad
                                                     hoc    coniiiiitte(,    formed    in    Boston    by    Blue     Shield     to     discuss     the     plai)ilillg     of     home
                                                     services     tii(I     will     sit     oil     the     Health     Services     Advisory     Committee     to     the      Bostoil
                                                     City   Del),,trtiii(@iit    of    Ileiiltli    tii(i    I-To.,41)itils.    At    this    tim(@,    there    are    two    projects
                                                     for    etritiarl@(!d     fluids     under     development     in     the     Boston     area,     -I     stroke     project     at
                                                     the    Neiv     lejiglaii(I     Me(liesil     Center     which     will     have     a     tie-in     with     the     C-oluiiibit
                                                     Point,      N(@igiil)orlioo(I      Ilealtli      Center      and      it      hypertension      project      being       developed
                                                     1)3,    Dr.              Ktss     of      the      Cli@iiiiiiiig      laboratory,      Iloston      Department      of      Health
                                                     and I-lospitals.
                                                        Illinois                     )[(,(Iicll    Ilrograiii     his     e.,;tAil)li.,;Iied     a     number     of     formal     and
                                                     informal      contacts      with      persons      in      the      Clil(@,igo      area      responsible      for       providing
                                                     health                   to     the     inner     city      including      Dr.      David      Greeley,      Associate      Direc-
                                                     tor,    Chicago     Iloii-d     of     I-leilth     ind     Dr.     iNIirk     f,el)per,     Vice     President,     Presbyterian-
                                                     St.     T,iilce's     Ilosl)itil     which     operates     all     OEt     0     Induced      neighborhood      healtil      cen-
                                                     ter.    Now    !xi    tli(,-    planning     stage     at     Pre,:byteriiii-.@t.     f,iike's     Ho,4p!tal     is     a     com-
                                                     iiiiiiiity                       (]election    program    wiii(!Ii    Avill    Ile    focused     oil     the     Mil(@     Square
                                                          t of Chicago, Included would be evaluation of c@ise finding methodology                                                   ef-
                                                                       of                                                 Avilli p:iti(,@iits find all analysis of                  the
                                                                       of file I)I-o"l.;Illl to t@11(@ (!olllllltlllity.
                                                        iNli(@ilig:tli It(.giollill 1%14,41ielil I.Irt)graiii : At         Ili recent l@I)riiary                          the       Re-
                                                     gioiiikl    Ailvis(@i-y    (.rotil)    of    l,iiiq    program    formally    ii(lol)l.(@(I    it    statement    for     i.irlor-
                                                     lt,i(@8 for l@("ioll;il IIIV(li(.:Il  Ilrogriiiii                        %viki(,Ii       iik Iiiii-(,        Iii,st@       insularity
                                                     for   ft(-gloji@il   ill(,ilit,:il   Ili,()griiiii             Nvill    1)(!    given    l@o    those    projects    which    fire
                                                                      iN,i(,Ii  [lie  iiiil)roveiii(@iit@  of  t@lit@               sysi@(,iii    of    Health    care    tiieltitllilg
                                                     Stl(-Il              its  (it)  iiiil)rov(!iii(@lit of tli(@                     systi(,jii  of   li(@filtli   (-Iir(-   if)   low
                                                     ii)(-olli(@  groups:  2iii(l.  (1))   innovations  ;iii(I                                       Ili    tile     utilization     of
                                                                                                 is it planning                                        Jointly     by      Tt(@giOI)III
                                                                  I'l,ogi,illik", :11141  tells  Sl,;i(.e  ]it,:iltli                       (ilro.j(!ct:                 ft)i,g@itlier-
                                                     ilig  (121111  (Oil   1114'   health   liceils   Ili                           (-)C Wayne County, Ali(!Iilgitil.
                                                        Wtiyii(- ('Iotiiii@y                   Ilosl)itiii  has siil)iiiit,t(@(i it                    to    faulty    the    use    of
                                                     Kill@lwofe,ssit)llllt \vo)rlc(,rs t@o lis,,ist l@i)(@                          ill  1):Ifit@iii;        field \Vill
                                                     ,izk(i    (@                                                                                                                                         A
                                                               stiil)lisli  tlt-:iiiiiiig  for  such  persons                            from       file        local        community.
                                                     AV@iyji(@ ('binary                    Ilosl)it,:il   .,(@rv(@,;    the    iiiill;,(!iit    trepanation    of    Wayne    (,Totally
                                                     find   is   loe@ii@t.(l   @i(Ijiieciit   to    a    large    refulgent    groul)    Ili    western    and    qoiitliern    Wtiyiie
                                                     Collilt,N,.
                                                        Ill   Itl(lit@ioll,   Itegioll:tl   31C(Iicql   Progrxiii   -4:iff   ,it   W,,iyii(-,    '    Atatt-    ljziiv(!rsity    School
                                                     of  Afe(liciii(@  is  worl@iiig  to                            liaisoii      with      urban       health       programs       Ili
                                                     Detr(iit    in(.-ludizig    OEO     and     'iNiodel     Cities.     The     14',xecutive     Director     of     tile     Detroit
                                                     Urt)@iii League has been named to the Wayne State Advisory Group.
                                                        Indiana      Regional      Ifedical      Program      is      working      with      Flanner       House,,       a       volun-
                                                     tary     community      agency      in      Indianapolis      to      develop      a      multiphasic      health      ,icreciiing
                                                     program      for      low      income      population      groups.      With      State      and      local      support       the





                                                                                                                     75


                                                        Regional  illedicai  rro,-raiii  is  conducting  pli?iziizig  and  f(@,i.,;Iioility                                            to
                                                        determine the tvl)(@ of scrt-eiiiiig procedures which will most                                                          rea(,Ii
                                                        tirget I)oliuiitioii -rotips iiid which can in part be a(Iiiiii)ist,er(@(I  by
                                                        uiitr.,iiii(@(I     lier.,ioiis     from     tl)e     comniiinity     who     liive     received     oii-tiie-jol)      training.
                                                             New York Aletrol)olitan Regional Ale(licitl Ilrogi-am has made
                                                        iii(,Ilt,4 to                 of    tlk(-ir    core    s(@.,iff     for     maintaining     ]iitisoii     with     community
                                                                    health I)I.ogl.:Illis, ()]@.0 III)(] Model (cities.                                        ]ills              ]tied(!
                                                        to   (I(-V(,Ii)ly II wi)rl(iiig r(,Iitl-it)iislli]l %vitli tll(! .11roviii(@lit,                   @o(-i(@l,y,  tliq@  llio%'-
                                                                                                                         Ilroolilvii iiiit] a,, ,i  r(@.,ttlt  Iii4-  iii-4-si(li@lit
                                                        of   tiara  org.,illizfl(il)ll  11414                              il)l)oiiitt,(l     to     ilif@     It(,gioiini     A(Ivi@oi-y
                                                                                                       t@lit@   It(,glotiil   M(@(lie@il   Progi-@iiii    is    I)rii(-ti(!Illg    Nvitli
                                                        r(,I)r(@s(,iitiitiv(@s of the Nikt,loii@il                       Asso(-i@itioti,    (,i)lititii)iii    Uiiiv(@rsity    Col-
                                                        li,,,e of I'llysi(.!@ilis .111(l @ill,g("Olls, 'inloillit Siilai S(.Ilool of                            all(] St.
                                                        IloSI)it@ll  ill l@lit@                        of f!olil@illiiiilg c(ltl4:ltioli Programs f(ii-
                                                                         Iril(' lt(,giolllll AIP(II(@ill Ilrogi-itill Is also titl@ijig                               iii f-o-,41-Kiii-
                                                        soriiig    It                    Oil            (-iire(@rq for tli(@                                to    I)j-liig    tog(-tli(@r
                                                        all                   forces in the                 to  (](,v(@lol)  a  coor(Iiiiil(-(l  lirogi,@iiii.   Al.'44)   ill   the?
                                                                                Htllgo,  are  several  projects  for                                     fluids    iikeiii(Iiiig     -t
                                                        1)(,(iiiitri4-  I)illriioititry                center at llal)le.,4 Ilospitiii, it                              study        for
                                                             (](-Vt@iol)lii(@iit   of.,;(!reciiijig   and   treittirk(@ilt   of   stroke   ))aticiit,,,   it   lliirleiii   lIosloit,,i],
                                                               :,I  iiiol@il(@  (-4)ro?tftry           unit   to   operate    out    of    St.    Viiie(@iit's    Ilosl)it.,il    Ili
                                                        Gr(@eiiwicli Village.
                                                             iN[cti,opolitaii       Washington,       D.C.,       Regional       AIM!cll       Program       will       establish       a
                                                        strol@e     station     at     Pree(iiiiiii's     I-lo,-,pitil,     the     reaching     hospital     of     I-lo%vitr(I     Uni-
                                                        ver,ilty    Af(,(Iical    School.    The     project     will     idiprove     the     care     of     l@.Itielits     from     a
                                                        predominantly     N(-.gro      population      group      by      setting      up      an      inteilqive      care      stroli(s
                                                        unit     in     the     hospital     and      by      developing      extensive      follow-up      services      for      stroke
                                                        patients.     'I'lie     unit     will     be     used     for     training     inedletl     students,     irea      physiciin,4,
                                                        niii-ses     and     paramedical      personnel      In      the      latest      techniques      of      stroke      management.
                                                        There      will      be      reseirch      -;tiidies       undertaken       on       diagnostic       methods,       epidemiology
                                                        nii(i      the      etill@iiral,      behavioral      and      socioeconomic      consequences      of      sl@rolc(@.       Also
                                                        submitted     for     review     are     gtroke     projects      to      be      ol)eritte(I      at      George      Washington
                                                        IJDiversity                        ]).C.                  Ilosl)ltitl     -iii(I     Glenn     T)ttl(@      Ilosl)ltil      which
                                                        woll](I (,Oiikl)ltit@  iiiiiN,4@i-.sity  niid              I)PI)itrt@iiieiit  of  Ilulille  health  (@frort@,t.
                                                             Alissotirl  ]regional                       Program  will                          :it  Nitii,;ii.,4  City
                                                        Ifo.,;Ilit@ll ;L              (li:lgl]oSlic iiiiil                      unit   for   I)jtl@it,iits    with    (-.(@r(@I)i-ovikF;-
                                                        (-Illlxr                                         ;-POO                 it   real'   will    1)(@    ref(-i-r(-(l    from    t,lic
                                                                                                                        (-Iiiii(-itl
                                                                                                                                          (,iLy                IfoHI)IIAil   serves
                                                        111(@ llill.!(ki-ity of indigent                        ill   i@1)(@   Kansas   (,'ity,   Alissolti.1   lir(.Il    Jill(]    will
                                                                     tilt@               Ito all 01@,O iieigIII)oril(@o(i ))truth                        lionv earlier
                                                        lll(,Iit  ill  ('11(@ 4-olillikililil.y.  I%Iissoiirl                   Aft@(lic:tl  Ili,ogi-aiii  and
                                                        gioll4il                ].,Vogl-iiiii larval lki,,i) estiil@lis)ie(I a gr(@.tl.(@r                   (',Ity   Iiiiisoii   (@otii-
                                                                    to   review   and    co(ir(Iiiiiiie,    the    ii(,tivlties    of    both    I)rogritnis    Ili    the    m(@tropoli-

                                                             G,@(@r,,iii    Ito,-iojial    Me(licil    Program    lia-4     siil)iikltt(.'(l     for     review     a     project     for
                                                        the                        or    a.     col)lj)lllliity     hyl)(@rtezisive     control     program,     to     determine     the
                                                        most    efr,(@Tt,ive    Ill(.tllo(ls    to    id(@iitifv    gyitiptoiji.Atic    hypertension    in    titi     urban     racially
                                                        iiiixe(i     community     Ili     Atlanta.      The      project      which      woill(i      be      conducted      by      the
                                                        (.e(@rgit       St@ite        Health                     would      assess      the      most      citective      methods      to
                                                        achieve     good     blood     pressure     control     in     tljes(@     liypertensive,4,     train     lny     blood     pres-
                                                        sure             iii(I     (it@tei-iiiiiie     whetlipr     a     community     I)rogrtiii      in      hypertension      control
                                                        Is (Tonoinically feast e 11 ilig pit  c  ea t  met o s.
                                                                    Itoei@its. Wli,%t,,tbout the rural areas?,
                                                             Dr. ill,klt.STON. I tliiiik tbings h-ttve tended to move more rapidly iii
                                                        the rtiril -areas.
                                                             Af i-.                Let us have a, breakdown
                                                                                                                                                        "S
                                                                                                                                "ler'
                                                             (The f ollowing inf ormation was reserved '@ytot'h"el)co('@ (m'.ittee:)




                                                                    1);i 4           53--O,@-6





                                                                                              7(3


                                                            OF IIFAI,Tll. l@,'[)U('A'I'ION,  ANI)               @,"J'ATIrM.FNT  ON  OPEITATIONAL
                                                                                                     IttijtAi, A]TFAS

                                                                         AT,IIANY lti-',(IIONAI,             ilit(Xl[tA@i
                                              )Iikity of Ili(, All)@iiiy  ol)(-ratiojiitl  act@iviti(,.4  will  serve  to ellhiiilc(,'  the  cal)tlblll-
                                           ties   of   health   I)rof@sioiittls   in   the   rural   iir(Nts.   lly   bringing    professionals    from
                                           siiiill  coiiiiiiuiiiti4@s  into   t@lie   medical   center   for   continuing education   and   by    iiii-
                                           Ironing   (-otjiiiiiiiiientions   between   the    medical    center    and   the      communities      they
                                           liol)(@  to  raise  the  level  of  patient  care  in   th(.@   comtiiuniti(-I.   The   following   proj.
                                           eeL-i involve ruril areas:
                                                                                  Operational Projects
                                           1.   Ti(-o-,tvay   Iladio   Comnizin@ication   Systeiii:   Direct    Co8t,    $1411,100
                                              11' 'his project will expand an existing tw@way                 radio iietworli      to    include    57
                                                        tii(I  24   high   schools.   It   will   provide   continuing   education   for   physicians
                                           -iii(I  ,tllie(l  medical  personnel.   It   will   ilso   provide   information   and   education   pro-
                                           grains   for   administrator.-,,   members   of   boards   of   trustees,    voluntary    health    agen-
                                           cies, adult education classes, and selected civic groups.
                                           2. Coiiz?ttunity Information Coordinatoy,s: Direct Co,@t, $73,800
                                              Former   pharmaceutical   representatives   will    be    used    to    contact    local    physicians
                                           to   tell   them   about   Regioxiil   Medical   ProAriiiiis   and   to    evaluate    their    attitudes
                                           tow,ird,i ITIIP.
                                           S. Cot)itititnity   Hospital Learning Ce?itc)'s: Direct Ooit, $75,800
                                              This  I)ro.iect will esuiblisli  leiriiii)g centers  at coix)ziiunity              hospitals       using
                                                   Iiistrii(,-tioii  I)jilts"  and  ati(lio-vi.,itial  (,,(Iiiil)iiieiit  for  rapid   dissemination
                                           of  ll(,%v  medical  kiiowl(,-d,,,(!.  ll,v(,iituallv,  the  (lircet@ors  of  this  project   liop(@   to
                                           e@iltuLL(@  physician  progress.  likitially,  8   liosl)lttlls   will   be   involved.
                                           4.                  Ilo.,il)ilal Cut-ott(try  Care  2',i-aitiiitg  and  D(,iito@ot8ti,ation  Pi-ogi-atit:
                                                 ])it-cet Coit, $55,400
                                                     I)roj(,(!t NN'llI establish coronary car(! iiiiit.,i of tlii-(@o              cii(!Ii  at   three
                                           c(oiiiiiiiiiiit,y             Ilitt,411cl(I Gititeritl, St.          itti(I  Vii4.,ittr  Ilrol@liers.  Tti@
                                           will serve its (ii-iiiozi,4triilioyi and                     I)r(oj(!cl.H for  ot:li(!r  hospitals  In  the
                                           region.  A  (!oiiiiiiiiiiig  e(Iii(-Ittioii-al  lorogriiiii  will  servo   the   permanent   Unit   Staff

                                                                                      I,?.oj(!Ct,  flit(@itsii7c  Ca?-(Iiao   Care   Unit   Ilcrkimer
                                                              iloxpit(it:            oot4t, $3,r)00
                                                    nation           of tiara I)roje(-(-, is to train 6 or 8  Tiiir,4(@q  from  ginall  (!oiiiintiriity
                                                                               v and 1)liysiolt)@y, (-)rotiiii-y              tlxL, priticil)itlm  and
                                           sitting of it e@ir(Iiiie iiiteiisive care  unit,  iiii(i  in  Iiii?i(llliig  the  complex  e(Iiiil)inent.
                                           Tlie.s(@  i)iirse,4  wili  ;tlso  be  seat  to  Albany  i)lc(liejtl  Center  for  active  training   with
                                           specialized equipment.

                                                                   INTERMOUNTAIN REGIONAL MR[)ICAL rItOGRAM
                                              The    Intermountain    Regional    Medical    Program    has    essentially    three     types     of
                                           projects   for    remote    communities.    Several    projects    are    educational    involving    the
                                           training   of   health   professionals   who   are   brought   into    the    medical    center.    Other
                                           projects  send  sl)ccialists  from   the   me(lici.1   center   to   the   small   communities   to   aid
                                           local  I)Iiysi(-iaiis  with  ,4pecifte  areas  of  patient  care.  A  third   type   involves   the   use
                                           of    (q(@l,rojiie    monitoring    equipment    which    -transmits    liliy.,41ological    signals    from
                                           j)liii,i(,ii@t@s in r(@inote 4iri@its to the iii(!(Ileiil  c(@iiter  for  Interpretation.  A  listing  of
                                           fli4@(t I)roj(@et,.4 follows.
                                                                                   01)(@riLtioiial Projects
                                                           for Co)iti)tiii)ig f@l(lii(!itfiott in          ])Ii(@aRe,   0(inecr,   Stroke   and    Ro-
                                                                              cost,
                                                                   (@f t@Iiis 1)r4)griiiii iii,(@ to 4]t,v(@iol) it (!oiiiiiiiiiil(!ittii)zis ii(@twork be-
                                           tWe(!Ii 1):Itrii'll(@-(,ftt-(@ itiitl r(,-s(,3treli         to (!Il(!Ollrllg(@ lllki'4oll
                                           (-iirt@             in tli(@ 4ire@l.      (-iirrt-iii.ly (@xi8t@iiig 2-wal, radio systems,  iii(!Iiitliiig
                                           11 hospitals in 7  coiiiiiiiiiiiti(@,4  in  (@r  iit@iir  Suit:  ralco  City,  will  be  (@xtetid(t(I  to
                                                ot(@  litwl)ititis  to  servo  as  one  lliilc.  Closed  circuit  TV  and  use   of   KVIPI)   (Uni-
                                           reiki
                                           ver,,;it   of   Utah   education   TV)   Is   also   planned.   This   may   establish   the    community
                                           hospital as the IOCU,'4 of continuing education.






                                                                                                                                                                  7@





                                                                                                                    77

                                                           [@ifot'lli(itioll, (ilift                                                              Direct Cost, $110,'OO
                                                           ']'lie          is ;I regioji-wi(le  (-Ieiring  house  for  liiforiiiiiiiion  tboiit  I]tM].'.  St,4tft
                                                       will I)i, put in local (-Oziiiiiiiiiitics to ict a,,; public relait@ion.,4 r(@lor(@.sf@ijttitiveF4 and
                                                       -I I so to distribute Itiforiiiiiti(i II toiiii@(I!Cl                          II[) (I tileI)III)Ij C. ']'lie coin  III  un  I  ty
                                                       st@iff will til.,4o               information oii coiiiiiiiiiiity                        and     re.,;oiircej     and      serve
                                                       @t.4 :I station for collectitig eeotioziiie, socitil, nikd medical data.
                                                       S.  Ca?-dioi)tilt)io-nai-li  Rc.,tuficitatioi&  9'raini?ig Ilrogi-a,@n: Dit-cct  Cost,  $1;3,1100
                                                           'Vlit, lliiiversit@y of lit@:ili will giv(, :I 3-tlaty (!oiLrse in                                                          to
                                                                   I)Iiysi(,itik@ froiii Sunni (-oiiiiiiiiiiities.                    l@iiysiciiiii will  lii(@it  1)(!  r(,  1  Pt  I-
                                                                                                                                                                            s Ft  is
                                                       I)IC., for t(@:I(.]Iillg tile te(.Illli4lll4@ to lk(,4iltli 1)(,r.@oititel  in lii4 coiiiiiiiiiilt.y. 'I'Iiis                  re-
                                                       .411scitiitt,iori   cori-;iiltitlit    will    also    collect    data    about    tli(@    number    of    tljnes    r(@stiscita-
                                                       tioii I-, L@ii)l)loy(@41 and the results.
                                                       J;. A Trai,@iitig Pi-ograiit in Int(!?t.@ivc Cardiac Care: ])irect Cost, $118,600
                                                           A (,or4- f@t(!iilty of                 in           Cardiac Care                    and    (Iiiign(witig     and     ti-(@itt-
                                                       itig 11(@:lrt               will te:leli              courses   in   tik(@ir   sul)j(@et.,;.    The    stii(l(@iitt3    will    be
                            4                                           physicians       and       iiurs(-s       from       cotiimtinity       hospitals        building        coronary
                                                       car(, units,
                                                       5.       Ti-ai@ii@igfot-.Viirses       iit        Cardi(ic        Care        and        Cardiopiili)toptai-VReitescitation:Dircct
                                                             (,ost, $34,000
                                                           This    is    an    ijite.-ral    part    of    both    the     car(liic     care     and     cardiopulnioiiiry     resuscita-
                                                       tion    I)rograins    for    physicians    (#3,    #4).     Nurses     trained     in     Salt     Lak(@     City     will     re-
                                                       turn    to    their    communities    to     serve     as     a     core     faculty     for     teq.ehing     tile     techniques
                                                       at     the     local     level.     The     nurses      will      work      closely      with      the      similarly      trained
                                                       physicians.
                                                       6.       Visiting       Co;tsiiltants       and       Teacher       Program       for       Small       Community       Uospitals:
                                                             Direct Cost, $14,800
                                                           Sitiill    coiiiiiiiiiiities    will    be    given    the    option    of    requesting    one    or    two-(Itly    Clinics.
                                                       A                   number     of     four     car(liac     pwtieiits     will     be     required.     These     clinics     will
                                                                                                                                                       ar,
                                                       upgrade ill(,- level of                 of vi(!tiiiis of heart disease living in                     (,Mote     fircit.     Visit-
                                                       iiig                   will   t"ist   t   lie    local    phyticlaii    III    a    prceise    diagnosis    of    his    patients.
                                                       7, A  l@(,Ilio)iat                                 Sll.,?tcm      for      Afonitoring       Pitysiologio       Data       on-line
                                                             front     ]@@ciotole      lioqpital,,t      in      the      I?,cgioital      Atcdical      llrogram:      Direct      Cost,
                                                             $637,100
                                                           ll'iii-,4 l@roj(@(-t@',.4 I)tirlios(- is to @t,(@st@ (,II(, fk,it.-4il)ility of  iikijig  it  c(,iitritl  computer  to
                                                                   11  V:ii.i(.ty  4)c  ipilyhjologi(,iii  :qigiiiiis  g(-ii(,riii@(,(l   by   patients   in   reiiiot4-   lio.,i-
                                                                              III(! I-t-siilt.,4 of (.Iil(!Illi)tliolis fallen            migtiltls  i)li(!Ic  to  14tiltloilH   with-
                                                       ilk tile lio',I)lt@itis, 4111(i noting L11(@ iilftirililit,ioll for diagnosis,
                                                       S.
                                                           ll'lki8 joi,ojo@(.t, iiii-4@llilol.s lo               tlit@ level of             ltvitilili)l(@ to             (!olliilltll)i-
                                                                                            will               it  1)rt)gi,siiii  of                    (@(Iiit-itlioii  to
                                                       tr4ilii(@(i              sl)i@(-iiilisls wlito, III Ciii,ii, will
                                                       I.ioil ilk their lo(.II]                            'I'lie 1)liysi(!Iatiis will                   it iiiijill t4t,il)t,aifl  for
                                                       ti@jt(!Iiiiig  still  obtaining  ixiforiiiiit,i(@ii.  A  regl4)ii-wl(l(,,  I  tiitior   rt@gi.4try   will   be   stitrta@d
                                                       its will it training I)i-ogriiiii Ill new t(!(,Iiiiiqiie.4 for lottiliologists.
                                                       .9.  St-i-oko and Ilelated Nourological Disca.@.s: Direct Cost, $98,700
                                                           This    I)roje(,t    will    establish    clinics    to     bring     expert     conf3ultittloii     service     in     stroke
                                                       and      related      neurological      diseases      to       local       containment,;       will       provide       continuing
                                                       education     to     local     physiciiins,aixd     iiurt3es;     will     collect     data      about      .@roke      lwi,tients
                                                       seen      and      the      problems      they      present      to      the      practitioner.      A      24-bour      telephone
                                                       consultation      service      and      Information      library      service      will      be      maintained       at       the
                                                       Utah       Medical       Center       to       provide       comniunity       physicians       with        immediate        advice
                                                       In     addition,     practicing     physicians     will     be     trained     at     the     medical      center      in      the
                                                       latest     diagnostic     -and     treatment     techniques.     The      courses      will      last      front      4      weeks
                                                       to one year.
                                                                                          li:ANSAB  ICFGIONAL  MEDICAL PItOUItAM
                                                           The Kansas Itegion              is emlyha.,4izln,,, cardlovat4cuIttr care in Its rural                               programs.
                                                       III addition It is setting up it comprehensive model training progratki                                          ill  a   '4111all
                                                       community. The proj@ descriptions follow:









                                                                                                                            7"






                                                                                                              78


                                                                                                Olli@l-,Iti@)11;11 Ilroj(,Cts
                                                                                                              A'(tiis(im:  I)ii'cf!t  Cost, $,?6,1,000

                                                  facility,  NN-Ilii-)l  NA-111  1)(@  :illlli;lte(l  xN,illi  file  l@ikii,@its                 Center,    will    1)(@    in
                                                                                                                                      are      plans      for       continuing
                                                                                                   :Iii(I (-Iiiiif-:il                     for liellill)-r( I tt     I    per-
                                                  soilil(!]. stil(lit'.,4 %%-ill 1)(t           (Pr   colillillillit,y           r(.Stollr(,Cs, etc.


                                                                                                                           to                liul,si!,14, Nvilo ill.(!  tll(@
                                                  iii:iiiist::iN, of co)r@)ij@try          iiiiiis in                                    ivit'll  I)I-LSIC  I)ll@'siologi(-Ill
                                                  kiio%vl(ilge of                               Utility  to   ii.,;e                     and e@(iiiil)jti(-iit la  (.-oro-
                                                  ii@try care units,                          in   lioiiie   c:trt,,   itii(I   f@iiiiiljiiritly    with    sociii    agencies
                                                  that call ii(i in the r(-Ii:kl)ilitiitioll of
                                                                                 lv(f),k
                                                     lilhi.,; project will deiiioiisLritt,o Lli(@                               ]@%,iiiii;ttjozj IJ)iit and  gl)i)@v  its
                                                                   for   the   evaluation   ikii(I   reli@il)ilit:iti4)il   of   ill(!   patient.   It    1,4    (lev(@ol)lllg
                                                  ;in     effective     technique     for     showing     physicians     and     ['lie     community     at     large      the
                                                  ability  of   patients   to   return   t@o   worlz   -after   receiving   tli(@   appropriate   rehabilitation.

                                                                                  MISSOURI RLGIONAL  @NfEI)ICAT,  PRO(IltAlf
                                                     The      Missouri      Re,,ional      Medical      Prograi)i      operational      activities      involve       projects
                                                  directed      toward      iuiproved      screening      techiii(Ities,       early       disease       detection       all(]
                                                  rapid     diagnosis,     and     more     effective     delivery      of      services.      These      are      coordinated
                                                  with     automated     ,,Ystems     for     transmission     of     information     and     health     data      to      aid
                                                  physicians      and      community      hospitals      in      the      treatment      of      patients      with      heart
                                                  disease,     cincer,     stroke     and     related     diseases.     Six     projects     focus     on      the      health
                                                  needs,    the     care     of     patients,     and     training     of     staff     for     rural     communities.

                                                                                               Operational Ilrojects
                                                  1.  Stititltl)ill("  00))Illlli)iity lf(,'ttltlb Sci,,i)ico                       Di?,(@ct      Oo,@t,      $200,957
                                                     ll'o eit@,li)lisll it lito(l(.l colillillilili.y ll(!Iiltll                lorogiitill   tilellillilig    (!olltillllll)g
                                                                                     I)rogt'.,Ijlifq ,Iil(l li(4111.11                for  the   I)III)Iic;   (@ill(.I.g(@licy
                                                                                                                              care    ]orogi-2iiii,,4;    I)iilollc    Health,
                                                                                  find sell(k@l                                   witli     Voillilt'ill-.V     health
                                                                                       ,tr(oiiii(I 4iiiillivill(!                      typ  t,500)  @ill)(I   to   ill('Itl(le
                                                  111)(@ilt 50,000                 ill (,'Iiiy (,oijii(.y. A(-Ilvilit-.q ill,(-                  around          Hittitltvillo
                                                                     llo$l)it.(Il (75 be(I.,i), Suit[ than gi,(itil)                    (!Iiiiie iii4 a
                                                  2. Atoilli'phti-ilo Pe.,iti-)tg of (tit Al)'.bltt(ilit                                                     $4,@1,471
                                                     To                               for I)t@i-fol.lililig               iq   (Illigiloqcie    lst))4)vllt@ory    tests    to
                                                                       latest;  IIS('flll                         for                     litrg(@    rural    I)t)i)iiliktiott
                                                  grOLII)14;                                         Hatteras   for   ill   @iii(i    healthy    I)ol)utqtloiis    ii.,4    an
                                                  aid ill (let(@ctioll of heart                       ciiii(!er, and               in     I)reclliiical     stag@-.      model
                                                  tf-.st             will be                       at  t)ie  lJiiiv(@)-,,;Ity  iN,[(,tlical  C(@iit:ei-I   Ctoltiiiibit,   the
                                                  State NI(.Iltlll IIOSI)itill and IL third Is                              for t@lio Stititltville cotiil)l(@x,
                                                  3. 111(iqs Set-cei@,i)tg-l@(tdiology: Dit-c(@t Cost, $5,@,,@14
                                                     To iiiij@rov(@ the jte(-tii,,icy (if ri(liologio                            of heart                   @.ine(T       find
                                                  strol@t@ t.lLroiigli (!Ii@etroiiie coiiiiiiiini(!,,ttioiis itie(lia. Three ,jiitill rural                               will
                                                  be    I)ool(ed    into    the    Uxiivti-,@ty    of    Alis@)tiri    computer    and     Deliirtiiieiit     of     It.ti(ii-
                                                  ology;     to     ev,,iluite     di;i;,,iiostic     eflicieiley     tn(I     determine     applicability     of      tiltrt-
                                                  sound and tlierinography in diagnosis and tlierttl)y.
                                                  11.       Cot?tpre7i(,,nsii)e       Cardiovascitlat-       Cai-c       Ultit8-SPI-ingf(eld,        Alis8ofiri:        Diicct
                                                         cost,
                                                     To   (](!v(@lol)   :t   coijil)r(,@lienslve   car(!   unit    for    groiijiltig    l@tieiit.,i    with    heart    (]is-
                                                  cii.@    or    other    eir(!iil:itory    syst@eiii    lliziesi    or    ivlio    have    been    admitted     for     other
                                                  I)iii-I)ose4    but    rt,(Iiiiro    close    t!itr(lia(!    observation.    The    project    is    to    be     undertaken
                                                  -it   Itoq7)it(ili   illiberal   a   hoiisc   8taff,   wlit!re   it   is   liol)e(l   tlirtt    grouping    of    I)aticiktg
                                                  will    relieve    the    workload    for    iitirs(-4     on     general     iii(4]lcitl     and     surgical     wtir(114.
                                                  Springfield     (a      community      of      over      100,000)      has      4      general      community      hospitals








                                                                                                                                                                                     @7
                                                                                                                                                                           77





                                                                                                                         79

                                                                        !II Si7,@ frCIll @,.l to 511  (,q total (of            til)(Piii     1,200           St.     Jolin',4
                                                                                                   (',@iiiity                So(@ii@ty   tire    coot-(Iiiintiiig    aetivil@i(-,@4    @vitli

                                                                                                                        ti                                           $,'?()!),OOO
                                                           fi,i- tr;iiisi.,iiiiiiig  i!lil(@lti-4)(.;Ii.til"gf-jll)l"  ,ifk(l  all                     SY$t('Ill    for    aiiitly.@(@s     of
                                                                                                   Ili(.  fel.@ii)ililv  of  ;ti(.Ii                      wli(,i-o  tlii,'4   14(,rvi(!(@   is
                                                                                                  and to) ili,vt!lol), t@@-t and iiijl)l(-iiieii,t  the  use  of  bioeligl-

                                                           6.  Cli),                                                              Di)-(!ct   (,Io.,?t,   $.,I.9,05r@
                                                                                                  colic(@rn(!@l  Ni,illi                     "(@@irly         detection"          liypotliesis.
                                                                                                         of early                 ioll tests- for  a  Itii,ge      rtirgil    population,

                                                                                     @IOUNTAI,N'      STATFS      ltll,(,'IONAT,       ',\frI)T.CAL       PR.OGICANE
                                                                              II ,Ictivity in t                                   -itt,s  Itei,
                                                                                                       lie  'INIolilit"l,ill   St,,              Iort      is      -.I)eciflcally      designed
                                                           to    1)(-iielit    siDqll    liospi@-ils    Ili    rural     areas     and     to     train     licaltli     professionals     from
                                                           rural        ,treas.
                                                                                                            Operational            Ilroi(@(!ts
                                                                                O())-ottat-y  Care          iii,  Si)iall  Ilospitali  in  the            Itegion:         Direct         C08t,
                                                              II(@sl)ilils    Ili     the     region     will s(,ii(I regist(!re(l iitirw..g iiiito       St.       P4itriclc's       Hospital,
                                                                           'infoiitaiia,    for    corollary    (!tire    Ili,;iiiiing.    This     -tlirce-we(@Ic     cotir,-R     will     be
                                                                                times   t   yeir   for   21.   iiiirses,    aiitl    there    will    Ile    follow-ups    at    tl)e    horiie
                                                           hospitals     four     entries     a     year.     Ili     ttdditioii,     a     4-(Itiy     Planning      program      eil)eeittlly
                                                                         for  siilitll  town  lkliysiciaiis  will  Ile  li(@l(I  at   the   Univert4ity   of   Montana
                                                           four tiiii(@s a year.

                                                                                       NORTJF      CAlt0l.TNA      ltil,(IIONAT,      Ille,[)IOAF,       IlitOOltAht
                                                              Ili North Cirol[iia l@liere are 10                              opei-gtti(piiiil           I)roj(@(!ts all   of    wlii(!It    have
                                                                                  upon         liosiill,jtls,                                                        Ili rural iir(!iis.
                                                                                                 I                                ijilikA,,   of   physicians      and  nili(@(I   health
                                                           Some   iai-t@   coi)eei,iie(i   wil    I    e4litcttlloit    and    trit
                                                           personnel, and oiliers with patient care. All of                                        are (.1e.41giie(I to Turing,, t@lic
                                                           latest    4(-i(iiitiflc    advances    (Iowa    to    the     (!oiiiiiiiiiiity     level.     The     l@rojects     are     listed
                                                           as          follows:

                                                                                                            01)(@riitioiiiil        1'roji'Tts
                                                           1.  E(Iti(-(ttio,)t a)?(I, rcscai-c7@ ill, colizi)blioiitll t)ic(lical (,-itt-c-(Iircct C08t, $.'09,P,100
                                                              To     develop     resources     for     training      iiior(@      medical      @iii(I      allied      medical      students;
                                                           to     1)roi-!(Ie     new     types     of     educational     exl)erience.,i     which     will     inike     family     practice
                                                           more      ,tttr.,icLive;      to      have      a      postgraduate       education       program       at       the       medical
                                                           school:      to      strengthen      ties      between      the      medical       school       faculty       and       practicing
                                                                                                                                  become       involved       In        community        plan-
                                                           physicians;     and      to      have      the      medical      school
                                                           nin@-    for    approving     the     quality     and     availability     of     ni(@dical     care.     Affected     by     this
                                                           I)roj(@ct,-@re      the      following      groups:      the      University       Community;       the       Caswell       County
                                                                                                                                  al     Health     Council      of      Eastern      Api).,t-
                                                           Riii-fLI      Health      Services      Ilroject;      the       Region
                                                           laebi.,i,     Inc.;     the     State     of     Franklin     I-Icaltli     Council,     Inc.;     the     Chfirlotte     Memorial
                                                                -pit.,Il;    the    I%IOS(!.,;    Coiie    I%Ieiiiori:xl    Ilo.,Al)ltjil,    Greensboro;     and     the     Dorothea     Dix
                                                                                  Service.
                                                           2.    ('e@ro)i(ii-li        training        drift                                     co8t, $55,938
                                                              To  11,4@   til(@            1114 11               for   (Iev(,Ii)l)iiig    (,o4)li(!i-iitiv(@    ftri-iiiig4@iii(@iits    among
                                                                                                                   car(,                                           (-Oiil.iiiiiiiig  e(iii(-n-
                                                           Taipei  N%,Ill  Ili-               l@o             llti(I                   Ill     (!(Immunity     I)oSiiitllls,     (-ollstllllt-
                                                           tii)ti          II(,                I,()                 Ill    ("41111)11,'41iillg            lil)41  11                                                II   11:                i
                                                           ,tyhl@@itt o@f iiit,41i(,itl r(,(,oril                 %Vlll 1)('                                                 li'(]    to    new
                                                           N%,(ji,ki)ig                                                   llkt@    iiiil%-4,i,sity    iiii,tli(,jtl               (2)    1)(@-
                                                           t                                                            (:")                 (10)(-I@ors      4til(i         Ill
                                                           lilty hospitals; (4) I)etw(,(@ii titiiv(@r,;ity iii(@tli(-til                            and        colillillillllv
                                                           S. DI(ib(,,Iie constitution aiitl educational                                                  cost, $13'-),08.1
                                                              To es(@at@lish three medical t,eikiiis to deliver services throughout the state;  to
                                                           assist     Ili     expansion      of      (Iitil)ctic      consultations      and      teaching      clinics;      to      provide







                                                                                                                    so

                                                          seiiiiiifir.,; for                 find f(@,iciiiiig                  for                and  I)atl(@nts   ;   to   assist
                                                          in  organization  of  a  Siftte  I)ijil)eteq  Association  jt)i(I   local   chtipters;   to   test   tech-
                                                          iiii-lii4,,,i  of  (I,,iti  collection.  Many  people  of  different  (lisciplincti   in   many   communi.
                                                          ties are involved in this project.
                                                          4. D4,,)@(,Iop?)ic)it of a cctit),at caitecr rcflistrlt-(Ii?,cct cost, $66,615
                                                                         i iiiiiforin regloii-wi(le  (-,iiiic(,.r  r4@poi-t@iijg  Hystetyi,  itit(@grtite(I  Willi  the
                                                                                                          froiii %vlil(,Ii (,-all 1)(,. i-(@t'ri(!v(@(i to      s(@rv(@    a    bron(i
                                                                            ,,itioii,il,
                                                                                                                             find otli(r I)Iirl)os(@,           life         following
                                                                                                                                                   I)III(cullivel'sity      M(@(@li-
                                                                        N(@i-ili    C,,Lroliiit    Meitiori:il    Ilosl)ii@al,     Noi-tit     (,jirolliia     Tifipt@ist     lfosl)itlil,
                                                          ('Iiiirlot@t(-               lio.,41)itfti,     V(@ter.,ins'     A(Iiiiiiii,,tration      Ilospitfil,      W@li@t@s      Ilospi-
                                                          t@,il,    Ifitiov(@r    'iN;I(@iiiori:tl    I-lo,,I)ital,    Sotitheasterii    Geiiei-gil    Ilosl)ital,     Craven     Coiitity
                                                                      In                      years    tli(@    registry     will     be     expanded     to     include     all     lios.
                                                          I)it@.ils ii)(I I)li."-ici;iiis in the region.
                                                          5.     lf(,,(Iical     llbi-aril     extcnvion      service-direct      cost,      $25,839
                                                          'I'o    bring    in(@(lical    library    facilities    of    tli(,    three    iTic(lical    schools     into     the     daily
                                                          woi,lc  of  tlios(!  (-engaged  in                     practice.      Lo(@.,il      hospital      perSOTIliel      will       be
                                                                           -ist medical stiff'; lil)rari(@- will
                                                          triiii)(,(l to ii@                                                   be    org:kiiized    into    a    fiiii(,ti(piiil     iinit
                                                          foi-    r(@lioii(liikg    to     re(IiiestH     for     services.     Itil)liogritplii(!     request     service     will     be

                                                             anec)- i@ifor)iiatio@i ccntcr-(],ii-ect coqt, $Iil,716
                                                          6.  c
                                                          To  provide                          I)IiysiciiiII4        Willi        immediate        consultation        by        telephone
                                                          .11)(I folliw-lll)                    I",ii(-h   of   ill(.   tlii,e(,   iilt@(ii(.Ill    H(!Ilools    will    be    responsible
                                                          for providing                  in   its    g(!ogriil)iiie    locale    'I'lic    films    of    J;Iiis    project    are    two-
                                                          fol(l:                  (1)                  l@o,'IS@i.,41,1)liysiciiiiisiiil)rovidingol)tiiiiiiiiicareofpittientswitliefiiicer;
                                                          all(]                  (2)                   to(@oyititilictli(@(@(ilielitiolloftli(,@l)I'Ysicittilsl)ygiviingiiewiiiforitiation
                                                          7.                                   in iittcrnal ittc(liciitc-ili)-cet  cost,  $83,313
                                                          To bring                         ljit@(@riiist@4  from    all    ov(@l,    the    ,4tate    to    the     M(!(Ii(-iii     Center
                                                          for @i 111(@iitik of up-to-date l@riiiiiiig in t,li(@ir                                  Tb(@y    will     f4liiire     resl)on-
                                                          Sil)iliti(,.14 I.Vitil attending Physicians tkll(l lilltiCe             wrr(i      rounds      with       students,       staff,
                                                          and tog(@ilier. ']'his                       t4liotil(I               the      appreciation      In      the       IJiliverRity,
                                                          both    at    faculty    in(I    stu(l(@iit    levels,    for    the    expanding     role     of     the     medical     center
                                                          for tli(@ quality of ciro in tli(@ community.
                                                          S.    CO?Itillfling     c(l,?traliott     in     dc)ttkvtril-dii-cct     cost,     $67,508
                                                                                                                                knowledge      of      mutual       coii(@orti       which
                                                          To provide pliysici@iiis and dentists Willi the
                                                          will    enable    them    to    be    iiior(@    effective    members     of     the     health     teiiii.     Course%     will
                                                                                                                                                                                      will
                                                          be given at the TJniversity of North Carolina and in communities.  Studies
                                                          be    made    of    facilities    needed    to     provide     deiital     care     la     hospitals.     The     purpose     of
                                                          this    project    is    to    ensure    that    is    many    patients    as     possible     who     suffer     from     heart
                                                          disease, cancer, stroke, or a related disease receive appropriate deiital care                                          as     a
                                                          part of their comprehensive treatment.
                                                          D.  Cov,tiniting education for pltysical thei-apists-(Iirect cost, $27,888
                                                          To develop iiid establish regional (-oiitiiiiiiii,- education progrim.9                                    for          physical
                                                                        in <)r(ler to  strengthen  physical  tli(@riil)y  services  for                                        ill    till
                                                          part.,;  of  ill(@  stiii@c.  Subregioii,.4  Nvlll  I)c-   (lellite@ite(I   where   iiec(l.,4   and   iiitq,re.4t,,4   will   be
                                                          ideiitlill(@(I iiiitl (!oniiliit,te(,s will I)(.
                                                                                                                orgtiijiz(@d  to  tirriii)ge local activities.
                                                          10.    The    ct;tablisitviciit    of    a    network    of    cot-o,)iarli    c(tre    itnits    in     small     conintitnitil
                                                                hoipitals in AI)pal(iclt@i.(t., Noi-tlt. Cat-oliiia-(Iircet cost, $93,019
                                                          lilillm   is   it   proposal   to   (I(w(@iol)   (@oroii;iry   (@itre   mania    in    Novell    110,141)11:11114    Ill    this
                                                          rural, mountainous                    It,'i%lll   %Vill   siil)l)ly   t)i(@    monitoring    (@qilif)lllollt    (the    ho,41)i-
                                                             I)rovl(le,4                  SI)ll(-C)  Wil(@ll 1141(@(Ilillt,(@ly i i-ii iiit-(l I)Iiy,4i(,Ittii,4 and
                                                                                              training                                                                         Ill     the
                                                                        Ali                                             f(ii- I)IIY@it-iiiiis will  be C(Oll(lii(
                                                                                                                                                          be      coll(lilt!te(l      when
                                                          gei)gi-iil)liie r(!;,ioii, aiiil continuing e(Iiii-iii'loil  Iit-ogriiiii-4 iviii


                                                          '1)11(@ to    tilt,  g(4)gl,ltlllll(.Ill (Iiv(!I-.'41ly of iii4@, r(,gif)ii, ilit@ 11
                                                          IL(@gi@)IIIII AI(@iII4,111  Intestinal  1111.4                               iviiii  piston  the lle;il(li
                                                          ol,  til(@          poor as wt,ll its the neither                                 tor r(,tiiot(, rural itrt-as. The
                                                                         program Ikiim sought soltitioiim to                              and      other       regional       I)rogriiiii4









                                                                till'oligli a               of. Iiiih.,iges                   the   iiiq-(Iiciil   ceiit-.(!rs   and   tli(@   rural   ireii,4.    In
                                                                :141(litioll to I)rovi(iiii,@, l@t,ogrtiii.9 to ii1ioNv itie(licftl personnel ni)ti                                          I)Iiysi-
                                                                eit7is   from   rural   ei)iiiiiiuiiii,y   Iii).sl)itill,,4   to   come   to    tli(!    iii(@(liciil    (!Piit(@r    for    training
                                                                                                       program   hit.,;   cii(leikvoi-(!(],   through    the    ii,,,c    of    iiio(](,@rri    Coal.
                                                                Inundation                             to (-reiite                 education    resour(,-    "     la     the     rur4ii     aretit4.
                                                                The 11(@l)liiii.,;ville                        dealer,      ,ti)d      the      deployment      of      Coronary      care      units
                                                                ire two (                                                                                                                                               i
                                                                              xit iiij@l(,@,i of         I)I.oj4@(-t',.



                                                                           2.       lfoi)kiiisvitto       L'etticatioit       Cctit(!t-       aitd       Chattaitooga        Bducation        Center-
                                                                                (!Ost, $711,'@oo
                                                                   Tii(,s(@, jirc@ tli(@ lii-,@t   of tli(@  lo(-;tl  (-oiitiiiiiiii;c e(Itieaii@ioii (!(,liters                          In      the
                                                                Viittti(,i-l@ilt   Julian.   At    vii(-Ii               it   ftill-iiiii(@   I)ii-(@(-Ior   with    all    jiloin)jiii,iticiit    at
                                                                                             jissist@iiiit (lir(,(-t@or will                       resi(l(@jit and
                                                                tioii     la                   'I'li(-ir              will l@(@                    to    l@liysi(-iiii.4    it     smaller     coiii.
                                                                )]reality hospitals III                          its                              hospital library                               Tile
                                                                (',Ii@it,ililoi)glt  'III(]   llol)iiiiisi,iii(t   lo(-:it.lipii.,4   provide   I:Iit!   I)itsi,,i   for   looking   at   probit-iiis
                                                                ]it (-oii(,iiiiiiiig e(lti(-iit,ioii In iirl)iiik and i-itritl set,tiiigs.
                                                                J.         le'i-a?ikliib         Coroiifz,)-il         Caro         linit-lvilliaiiison         County         Ilospital-rfranlcliit-
                                                                       dii-cct      cost,       $31,)IOO
                                                                   This    is     one     of     the     subsidiary     units     mentioned     III     the     Vttii(terbilt     I)rolxmil.     This
                                                                is    primarily    a     pilot     project     to     ,,:tudy     the     feasibility     itnd     usefulness     of     establishing
                                                                a center In a sniill community hospital.
                                                                4.        Clarksville         Coronary         Care         U?tit-Clark8ville         Me-niorial         Hospita@direct         Cost,
                                                                       $19,000
                                                                   As     the     Franklin     program,     this     project     is      a      subsidiary      of      the      Vanderbilt      pro-
                                                                           Since    this    lio,.;I)Ititl    has    been    operating    a    unit,    the    plan    calls    for     its     expan-
                                                                sion, continuing education and a phone book-up to Vanderbilt.
                                                                5. Alvrray           Coronary           Care            Unit-Murray-Calloway            (Ky.)            CotintV            Hospital:
                                                                       Direct       Cost,        $38,800
                                                                   '.Nliirrtiy-Callowiiy      County      hospital,      the      training      center      for      'I\Iurray      State       Ulli-
                                                                v(,rsity s(-Iiool of                     will   ,;(,.rv(!   :is   it   (I(,iiioiistr4itiOlk   c(@iit(-r   for   the   stil@-regi4)11.
                                                                I)Irect    phone    (-()ijiiiiiiiiie4itioti    will    be    estAit)li,,Iie(I    with    V.11)(]('rliiit,    whi(.-Ii    will    send
                                                                coiisiilt@iijitq     from     its     F;cli(iol     of     continuing     education.     This     project     has     the      dii.11
                                                                ot).i(,(,tive   of   r(@Ijititig   t.li(@   'i%tiirriiy   StAit(@   Nursing   I)rogi-iiiiL   to   all   (@.Htjil)lislied    iii(,-di-
                                                                cal c(@itter and providing r(@gioji,,tl training r(-soiire(!s to It remote area.
                                                                6.      Cro.-t,,;villc      Cot-oitary       Caro       T7ttit-Upla@id8       Cuniberlatid       2fedical       Center       Cro,,48-
                                                                       villc: Direct Goit, $28,300
                                                                   This    iii-oject    has    two    purposes:    (1)    to    establish    a    two4)(,d    (-oroillkry    en    r(@    unit    ill
                                                                tli(@             ;   and   (2)   l@i)   (I(@t(@riniiie   ill(,    feasibility    of    ol)erfl.ting    acute    cor(oiiiiry    care-
                                                                failing Ili riir;kl             The     liospititt      will      cooperate,      with      @litl-Stiitc      Baptist      Ilosl)ltal
                                                                       V4iii(leri)ilt.
                                                                7.    Tiill(i7i()t;)rt    Coi-o@i,(ti-li    Care    17ttit--Itai,ton     @f(,t)torial     Ito.-epital,     7'itltahot)ta,     Tenn..,
                                                                       ])it-cct      coqt,       $1@,800
                                                                   See Bil)t.ist Ilosl)it,,tl Progriiii.
                                                                8.   Ili-ojcct   to   Ii)ipi-oiie   11(iti(-iit   Care   Ili    a    I?c)i?otc    3loitiit(,,iit    Conii)iitnity    ?)y    I?ccruit-
                                                                            (itid,                               Ai(lc8 for a, New                               Care               lf'acilitll-Scolt
                                                                       Cotinty                                              Direct Cost, $10,.IOO
                                                                   Nf:tiil)ower     sl)4)i-tnge      !it        isolated mountain hospital                   is critical.                          to
                                                                111,1111 till               cir(@    f:t(!ility    tio%v    iiii(](@r     construction     will     1)(@     (obtained     by     two
                                                                                      Iii-s(@rvi(!e traiiiiii,- for lio,,;I)itnl                               (2)  4in                          ill-
                                                                ri,(-14@r  (till ItN)  to sqii-v(@ as a linisoii to tli(@ high Feliools to                                        young         1)co-
                                                                1)1(@  to  (@iit(@r  tli(t   iii(,411cii)   li(-](l   all(]   coiii(@   loit(!Ic   home   to   I)riieti(-e.   Ili   ii4l(ll@lioii   a
                                                                training   l@r4igi,iiiii   le@t(Iii)g    to    the    LIIN    would    II(,    !nitrate(].    (,Iiiij(!Ill    training    will    l@e
                                                                                 by  the  ]@,(Iiientiotiiii  I)ir(@(!tor while  lo(,jil lilgli  scliools,  provide
                                                                ti-illillill".
                                                                   liolil,.iti,'47lill(!                   (,are                            Sletat-t
                                                                                     Kll.:               Cost, $Iil),500
                                                                           plan   Is   similar   to   the   li'r;tnliliti    plan,    (@cel)t    i-litLt    It    iil(-i)tlollm    O.,4till)limllillg
                                                                Iiiiii.4   to    sii).,tllt@r    community    liospit4ils    by    helping    set    III)    smaller    care    units    Ili    them,





                                                                                                          82

                                                        ))rovi(Iiii;,,   for   the   groiii)ing    of    rural    community    Hospitals    for    more    efficient
                                                 iie of existing resources.

                                                                        NVASIII',GTO.N-AT,ASKA                        AIFI)ICAL PitOC-RANI
                                                    Tli(- IV,,i,-Jiin@toii-Al,,i,;]@a                               llr(@,riiii op(li-,itiozit]                  coii-
                                                                         I.,iri.,,(@ly witli eoiii@iiiuiijg                 ati(I training      iictivit@i(!s to  t@ii-
                                                            Ilic iiie(II(Nil  all(]                     C:il):Ii)ilit,Y. '1'11('Y  focus Oil    COI)IIIltilil(!IltiOlIS
                                                                 iiii(i iii,,I:riiet@loii               fiji(I iii(,tlio(it)logi(@s wlii(-Ii tire ii(ljil)tiil)le 110
                                                 tlic@ far filing iiii(I r(,iiiotc communities in t)t(, east St.,tt(, of Alit.,;Iitt fill(]                    many
                                                               rural (Communities, in Wiisititigtoii                      S(!v(!i,,,il I)roj(!ets                Coll-
                                                            to iiiil)ron,e Llic             iii@iiil)ow(,@r               ill (!4)llilllllllitl(!s witli  limited  or
                                                 no                          ,4(!rvice.4,           art, (Iist4iiit-, from  it  major  iii(@(licjil  c(@iit(!r.


                                                                                                                          fot-   Owiti-iiititig   ],,ditcatio?@   for
                                                                        I)ii-ect Co-vt, $18,181
                                                    To  bring  tit(@  medical  ri@soiirces  of   Lli(@   lJitiv(@i-,,ity   of   Witslilligt,(jii   to   I)Ikysi(!Iiiiis
                                                                                       ill Y.,tliiiii@t, %vlio ill turn will act ,t,4                        to  ,;tir-
                                                                     y
                                                 I'l)tlli(lillg   @:lii,@illor   communities   tliroiigli                                       educational        TN',
                                                 4)lii(@r                    instruction; aii(i (,xeli,,iiige of                       and   I)rtt(@titioiier,4.    To
                                                 ef,)iliiect   intervals   in   Central   Wasliijigtoii   to   Yiiiiiii,,t   c@ir(liologist.,3    via    14,KG    tele-
                                                 j)))one   li(@t-line,   to   permit    quick    analysis    (.,4.irtin,,    ivitli    5    community    lio,,I)itils).
                                                 Y:il@iiii@i   i-,   ,t   community   of   ,ibout   45,000.   The   total   I)opiil.,ttiou   in   6   Central   W,,ish-
                                                            c(@iiiiti(@s   exect,,ds   "AO,000.    In    addition    to    tliree    general    bospitnls    in    Yik-
                                                 iiii:i-St.     Elizil)etli,     Yakima     Valley     ',Nteiiioriil,     ind     New     Valley     Osteol)atlile-nine
                                                 otlier   community   bogpittls   to   be    reaclic(l    initially    are    located    in    small    rural    colli-
                                                       'tie,,; of 11'
                                                 iiiiiii             Ileiisl)urg, '.Nfoses              Otliello,     Toj)i)enisb,     Prosser      and      Sunnyside,
                                                    ol)iil.itioii ranges front @I)OO in ',Nfoses City -to "iii(- 8,()               in 14rlleii.,,,I)urg.)
                                                                                                                                00
                                                 2. Soiitheast Alavka-Pogtgt-a(litate I,,'(Iitcation,: Di?-cct CO.RT, $27,062
                                                   To iiiil)r(@v(, coiniiiiiiii(.-tition                  S(-iittl(, Nfe(li(,itl Community          find    ttio  uill-
                                                 N,(,r.,;ity to  jill(@viittc  I)i-ol)leins  of  fit(!  isolated([  ltliysi(!iatis  In  soutli(@it4t  Al@isk.,t  cities
                                                                            Jiiil(@illi. 1,4itiiii, l@et(-Iiiliitjk (,t  Iiii-g(,.,;t).  As  Ili  Central  Wlisliiiikl-
                                                 toll             iiii@tilo(is %-.,ill be
                                                                                                          Its                    consultant
                                                                                 Iii)(@ t(i lio,41)itjil,4  Ili  artificial  @iticii  and  l(@lilliaii.  Tli(@  1)01)u-
                                                          Ili                   l@(itiils iil)oiit, 1.7,000.
                                                 S.     Poktfl)-(t(?,itate     Ili-cc(!I)torRhil)     for     Pli,ysici(i,,)is-Coronai,V     Care:     Direct     C08t,
                                                      $17,6.10
                                                   A   I)ilot.  1)i,o.i(,ct,  to  ))rovi(le  ol)lx)rttiiiit-.y  for  I)rii(,tjtioii(@rs  from  reiiiote  and  i.,4o-
                                                 ])tell colikilillititi(',.4 to           it weeic or iikore iiii(l(@r it I)r(,cel)t@or tit major
                                                 centers  to  stti(ly  a(lvitiic(,,.,  Ili  care  of  corollary  li(@iirt   flis(@itse   filed   carry   out   these
                                                              in flicii- (,oii)iiiiiiiit,i(@s. q'li(@ 4 iiiiij(oi- iiie(ii(@til (!(,iiter,4 Ili Seattle  tire  Ili-ovl-
                                                                                                    Virgiiiit   'iNIiisoii   Iloql)itjtl   and   Medical    C(,zit(.,r,
                                                 -tied (Jiiiv(@rsity Ilo.,4))it@il kiid                 Center    and    two    Ili    Spoliiiiie     are     Deaconess
                                                              itzi(I  Siier(,(l  lf(!iirt,   Ilosi)ititl.
                                                                                                                                  $111,554
                                                                 t fi)riit:tl                for  training  (-fir(Ilo-lotiltiii)iiitry  te(-Iiiiicinii.9   to   1)er-
                                                 form  noncritical  fiiii(,tion   !it   (!oroiiary   care   tiii]tA   ,iii(I   free   ))Iiy,,4iciiin,4   for   other
                                                 (litti(,,,4.    Four     larger     g(@iieral     hospitals     in     @'poliiii(,-Defteon(@ss,     Iloly     Iramily,
                                                 Stei-ed    Ileart,,    iii(I    St    Liike's-will     participate     in     tli,is     training     program     with
                                                 SI)olt4iic- Coiiiiiiiinity College.
                                                 5. Tico-tcay Iludio C(Ynfcrcnce an(l, Sli(7c Pi,cse)z.fation: Direct Cost, $S,,@115
                                                                                                                  -trolcc,    tol)icq    to    be    transmitted    via
                                                    Six pilot programs on heart, caiie(!r and
                                                 two-way radiotelephone slide conferences, to                        pliysi(!i,,tiis   and    hospital    staff.9    on
                                                 topics  s(@lecte(i   by   ptnel   of   1.)Iiysiciins,   ;tirtiiig   with   20   lio@,;I)Itftls   in   Niltisliiiigton.
                                                 To    explore    potential    for    continuing    network    scrie.,4    with    local    and     remote     regions.
                                                 6. A lail,-,alfcdical Lib@-arll Facilities: Direct Co.Rt, $21,754
                                                   To   (I(@v(,Iop   a   community   medical    Iii.)rnry    for    Alaska    at    the    PI-IS    Ala.,ilca    Native
                                                                         Aii(-Iioriige  for  Alitsi@it   1)liysiciiin,4   and   health   r(@Iiit(,(]   t4(@arfs   and
                                                               to   have   (!lose   ties   Wallis    community    agejicie,4,    Arctic    II(@altli    Res(@itreli,
                                                 lliiiversity    at;    Fairbanks    niid    to    4111)plelll(@nt     colktliiultig     education     I)rojcvt     for
                                                 Soiit,ii(,ai4t   Alaska   and   the    Anchorage    ciiiicer    l@rojc(!t.








                                                                                                                                                               7






                                                                                                                                  83


                                                                                                            iNl,'@W YOliK ItLP(41ONAL Ilti@I)ICAL I-RO(litANt
                                                                    Itotli of tlit@ l@rogr.,iiiis in tli(@ Western New York- region                                          direct      (@IT.(@t      upon
                                                                                 liekltll  I)rof"sioii@ils,   and                          in tli(@ rural areas.  Ilarticiiljir  eitil)litt-
                                                                sis will be                     111)4111 involving community liosl)itrtl,.4 and  On  training  nurses
                                                                from community li(osl)ititl,4 In  rural                                 The liro e(!t,.4 are listed ii.4 follows:



                                                                                      (,Ioiitiotl(?)i(-fltioti.4   N(-t                                 $170,;#     /!I
                                                                    A                                              Di@t%V(@rIC Will link                            Of                  N(-w           York
                                                                                (country, I't@illisylvtiiiii to tlit,, Continuing                                       I   it,l)iirtiiii,iits   of   tli(@
                                                                                              ol'           Yoj-l@ at ltiifi':iico ,iiid tli(@                                 iNt(,iiioi-ijil                                  I
                                                                                 fietAl-ol-Ic will S,(,I.V(@                    iiiii-liose,,4, @itclk as (,obtaining                                   for
                                                                                   end  the                                                       Ikill)li(!                        I(Iljlilli'413-sttiv(.'
                                                                coiiilililiii(.@itiol),      (-oll',Iiltlltioll      Nvii,ll                said                    among     lp:liilis.      It      xvill
                                                                           both    tiit,    I)Iiysi(,j:kii    and    (-oiiiiiiiiiiit..v    lio@I)itil    in    4,.itli4,r    the    rural    or     urliill
                                                                ('11vir(tilill(@iit:  in  living at tlieii-                               t@li(!             advances  in  the
                                                                                          of heart (Iiqease, st'rol@c@, and                               particular      eitililitisis       will       be
                                                                            Upon      iii),olN,Iiig      rural      liosl@it.,ils      in      this      I)rogrttiji      thereby      improving       both
                                                                their                  an(] restorative function.
                                                                2.  Coi-o@iai-y Ca?-c P2-(@i,at)t: I)ii-ect Co.4t,
                                                                    This     project      will      test      i      training      technique      for      providing      (Iiialitie(I      nurses      who
                                                                will     be     required     to     --taIT-      developing      coronary      care      units      in      the      Region.      AI)proxi-
                                                                iuttely     @     nurses     will     be     selected     from     -ill     parts     of      the      Region      for      a      combined
                                                                academic     and     clinical     course.     It     Is     planned      that      the      iiiirzes      receiving      tlii,,      train-
                                                                iiig     will     return     to     both     rural     and     urban     hospitals     for     the     purpose     of      providing      a
                                                                (Iiigno.,;tic     and     didactic     function.     While     the      program      will      be      housed      at      the      iiiedi-
                                                                cal     center,     the     conii)iAiiiity     hospitals     of     this     region     will     be     the     benefactors     of      the
                                                                project.     Since     there     are     few     nurses     trained     to     work     in      coroii,,try      care      units,      par-
                                                                ticularly      in      the      rural      environment,      special      attention      will       be       paid       to       attracting
                                                                nurses who will return to the community hospital.

                                                                                                   WISCONSIN           R@,GIONAL           AIFE)ICAL            PROGRAM
                                                                       I-otir       of       the       Wisconsin       projects       have       relevance       to        the        Improvement        of
                                                                            care      fit      a      rural      setting,      through      the      provision      Of      education      and       infor-
                                                                iiititioii.       Pliysl(-Iitiiq       and       jilli(-(l       health       personnel       in       community       hospitals       will
                                                                I)eti(,Ilt     front      the      following      projec(t3:

                                                                                                                   01)(-rti(@loiiiil  Projects
                                                                J. A. pilot (letti(ni8ii,atioi@ program for pittittoitai-It throtktbocittboli.,tiib:                                                 tiost,
                                                                       $811,1;00
                                                                    In    tlii,4    project    it    center    1.4     being                     tit     Mitr.,;))Ilel(l     Ilospital     In      Mairsli-
                                                                fl(@1(i,       Wisconsin,       for       demonstration        (li@igiio.4tic        te(!Iiiii(iiies        and        the        available
                                                                therapy  for  pulmonary                                                     rl'ii(@      project      has      a      continuing      edii-
                                                                (-atioii     component     which     will     r(@2ielk      1)liyqi(-i:tiiq      from      many      lu)si)ltjtls      In      the      Re-
                                                                                                                                         't:ttioii  ,
                                                                gioii.  This  Nvill  iiivolv(,  it  24-hoiir  cotiitii                                 ;(@rvice,      the      preparation       of       a
                                                                ni(ivi(, on the t@ol)ie, and sl)(@(:Jal training s(@s,,ioits for groups of physicians.
                                                                    The      lirt)j(-et      will      (leiii(@iistriit@      a      (-oznl)reli(-iisivt,      program       which       will       elicom-
                                                                I)a.,;.-4       diagnostic,       pi-eveiitiv(@,       therapeutic,       laid       rehabilitation        procedures        for        pa-
                                                                ti(,iits,      p(wtgra(Iiia@tion      education,      a      rapid       txtngportittlon       syst@ein       for       patients       from
                                                                Northern     s(,(!tioiis      of      this      Fititte,      iiik(l      cooperation      between      the      clinic      and      other
                                                                Ito,,41@itil8 and medical schools in the @9tii t4!.
                                                                2.                     (li(?l     acccqs     t(lpe     recording     lil)rat-11     air,     the     a)-ca-9     of     heart      diRease,
                                                                                     stroke,      and      related      discaics:      direct       cost,       $18,950
                                                                    9'liis    feftsil)ility    study    will     be     ettrrl(@(I     out     by     the     Uiilvt@rsity     of     Wiscoiiqill     which
                                                                will                  kiiii Store short, 4-6 initial(!, tiil)(,.H on  various  aspects  of  treating
                                                                I):it lt@ni s   ivil@ii  (@li(!  tlir(T                     ADV     I)Iiysl(,Iitii     ntiywli(!rt)      fit      the      Region      cttn
                                                                dial    iii(-    liliriiry    at    tiny    time    and    request    a     tape     relevitnt     to     a     I)rol)leui     In     which
                                                                lie Is
                                                                S.     Nitrsi)ig     tclcpltonc     dial     access      tape      rc(,ortlit?g      library      in      the      areas      of      heart
                                                                        (iiscut?c, c(i,)ircr, sti-o7co atilt retorted diseases: direct cost, $18,800
                                                                    This     f(@iisil)tllty     rtii(ly,     similar     to     the     one     above,     will     e@blIF;li      a      central      tape
                                                                library       with       Information       recorded       on       nursing       care        tit        emergencies,        new        Rro.





                                                                                                         84

                                                Ce,(Iiire,g -iiid equipment, and recent (Iovelol)iiient.9 in nursing. Nurses from any-
                                                hospital   in   the   region   will   be   able   to   call    at    any    tiirie    to    have    a    tape    I)Iayed
                                                to t@liciii.
                                                  D(,il-c,7ol)iit(.,iit   of   tii(,(Iir-al   a?i(I   hc(ilth   t-(!I(ttcd   ,?i?igle   coizeept   fittit   Program   in
                                                                       lioipital8:     direct     cost,      $33,250
                                                                           f(-asii)ility    l@roj(@ct    involves    t(@ii    (!oiiiiiiiiiilty    hospitals    in    its
                                                                 loift(,Vll films On                        nii(I  t(,,eliiii(Iiie,,4   iis(!(l   In   treating   heart,
                                                         and               will  be  (levelol)e(].  Ilro.jector.9  iiii(i  f@lie  llliii.4  will  lw,  inst@fille(I  III
                                                                    foi-  iise by                                       health    1)(@rsoiin(,.l    at    their     con-
                                                            418  11  ('Olit@iiiiiiii,  e(Iii(-Itlloii  (I(-vi(l@e.   Al'i@(-r   four   to   six   months   tile   tritt-
                                                                                 in t(@ii it(](Iitioiijil lit)sl)it@ills.                                                                 I  i
                                                                        Wli(@,ii    do    you    expect-,    to    li;tve    yt)ili.-    first     evitlitittioll     of
                                                                                               ?
                                                                                                                                         11,    ],'(@gioll     tl)[)]iCs
                                                fol'.t                       .111(l NV('               tll :1,111111,,Ll I)roLrl.(",3,4
                                                                                                                                     I   ig to      g(@,t-,  lip  to   L
                                                  III oll(@, of            r(,Lriolis. Is  the  fill                was
                                                                                               tt ii -t([(Iitiol t,l)  tli(@,se  liot-iiitl  reviews  tilt
                                                Nv(. 81,011](I Illollili-, 11 sl)ecitl site           visit     :tll(l     evtllll,to     the     reffioll's      status
                                                from    t'lic    still(li)oillt    of    the    i)roLri-,titi.    We     now     tre     (toiii@     this     all     of
                                                I-,]IC   tillic,   I)icl@iii.,,r    out    times           grlm  niOvelTI(lilt  i)arficul,,trl                       the
                                                                                                                                                             y
                                                Iiift fr(;iii I)],,tiiiiing                                      I grtiit and            Pon     rece     t     of     a
                                                s                                                                                      u                lp
                                                supplemental  request                                              activity. we           go      back      and      re-
                                                VICNV
                                                       tli(@ entire Iiistoi-_V
                                                         rOGrIZS. Wll,.Lf                                       oi-t ?
                                                  I)r.      MARSTON.       The       first       four       operational       l@rograms       were       funded       at
                                                al)])roximttely        the        same        time,        Interiiiouiittin,        Kansas,        Missouri,         and
                                                All):iiiv,       N.Y.
                                                  Mr.                   Could   you   let   us   have    your    evaluation    of    how    effOctiVe
                                                these liai,(,- I)ecn, for the record.
                                                  (The followiii(, iiiforiiiittioii w,,i,-, received by the committee:)

                                                DF,I-AILTMI-,'NT Or Illi;AUrli, li,'I)UCATION, ANI) WIPf,l@Aill@ @T@t'rl-NiENT ON 10,lelTCTIVENESS
                                                                                 or ItF(;rONAL NIFI)TCAL ll[LOGItA?618

                                                                           of  Ftegiotial  'infe(licill   Ilrogrtiiis   is   (let(!riiiiiie(l   !II   tllf-@   following
                                                ways:
                                                U,    valuation,    of    tile    effectiveness    of    each    Regioiiil     Medical     Program     is     a     con-
                                                tiiiiioii.s    process    NN,Iii(-Ii    Involves    review    by    the     li'e(ler.11     Government,     its     non-
                                                          advisors,    said    the    griijitee    itself.    Tlii-,,;(-@    review    activities    are    specifically
                                                           to d(-(@eriiiiiie the extent lo %vl)i(,Ii l@lic r(tgioii liti,-4                                      I)ro(!-
                                                ess  of  r(@,ioiiiliv@itioii  wlile.1                                              (!Ielllellts:     illv(.)Lv(@iliciit,
                                                identification     of     needs     and     opportunities,     asstssinejit     of     resources,     definition      of
                                                ol)j(@(:Ilives,,    setting    of    prlorities,     implementation     of     program     activities,     and     self.
                                                evaluation.
                                                li,iiis             of i-(,gi4)ii:ilizatioii is tli(@              1).v    wl@i(-Ik    the    region    moves     toward
                                                its     ultimate     ol)jective-tlic     assurance     of     easily                 improved        patient        care
                                                for heart                cancer, stroke, tncl related
                                                A          systematic       coinl)rt!heiisive      review      of      the      scientiflc      and       administrative
                                                        of   (@,icli    lt(,.gionil    Medical    Ilrogritin    has    been    tlesigiled    in    order    to    deter-
                                                illilit, the          to  wIli(.Il   (.Rell   liegloii,,it             I.lr4)gi-:iiii    implements    tlii.'4     proc-
                                                                                               -lio.@   of   a(-Iiievii);,,   its   go@il    of    improved    p@itieiit
                                                e.14.4  of  regi(pjiiliz@itioii  for  the   I)ui

                                                        revie%v I)roc(,q,4                                       at    the,     regional     in(]     Federal     level,
                                                all(] is (,on(lileted )).I, both itt)ti-Fe.(It!rjtl and F(@(](-r.,il                    Ity     law     eacli     opera-
                                                tioiiiii  ii(!tivilly  iiiiist  1)(,@   approved by    the.    Regional    Advisory     Groiii)     prior     to     Its
                                                siiioiiii,,4sioii lo fli(@                               for    review    and     ,ipprovjtl.     Irripquent.],v     the
                                                r(-glori.,4                naive     elaborated     oil     this     requirement     by      est@ablishiiig      loefil,
                                                in    ii(iolitioii    to    regional,    n(lvlsorv    I)o(liet4    and/or    scientific     review     bodies     whiell
                                                til.140 (Carefully examine I)rol)osed tietivltleti,





                                                                                                                    85

                                                                                                                               )Inittee      and      t@ti(,      National       Advisory
                                                            A ;Ite visit I)y iii(,,iiiiiers of tli(I lzevi(!w               Col                       ,,(led  114  all  ilit,(!gral
                                                        @"oilll(.Il oil lt(@,iollill                  13rogr,,iiiis to t@)@c r(@gioii 114 ili(,'l
                                                        1)411.t of III),),.Ovillg all oli(,i-at@ioiial I)r4)gritlll foi, II r(,aioii. A.4 t@1)(@ OI)el-ltt@            l(@iiitl     I)ro-
                                                        gr@ii)l  (](@vt@lol)s @111(i  is exl)ltlided  additional  site  visit's are                               li'ijiitlly       (@ach
                                                                                    1'rogr:tjii    Is    rf@qiiir(@d    to    f4iil)i)iit    tin    annual     I)r(@gv(.-sf4     r(!I)ort
                                                                                  in  (I(@titil  tile  r(@gioTi's 1)rogriiin.
                                                            Any j@i-iol)osi@d iiio(lifi(,itti4)jk in I)ro,,i-iiiii (lir(,(.(@io])    I)Y iii(@  gr3iljte(.  latest  ])O  JI)Still(@(I
                                                        III NVI-it@ilig @111(i                  to tli(,s(! review pro(-(!dtir(@,.4.
                                                            Iviil)ill tll(@ (!olitlext of this (@oitipreliciisiv(@ i-evicav I)ro(-egs it Is                              to       d(@ter-
                                                        iiiiiit-,   Nvlieflicr   or    not    a    rekioii.,tl    I)rograiii    is    !II    filet    evolving    a    regional    system
                                                                       to   iiiil)rove   1):iti(@i)t   (-are.
                                                                                              All)jiny, Ne@v York, ikii(I Intermountain Itegioiiiil
                                                        I)j-ograiiis  were the  first to  enter  the  ol)ei-lLt@iOll:ti                              Of      (I(@velt)l)itient.       The
                                                        tl(!t(!rjtiiii,itioii of tli(-ir                    t:o   begin    ol)(,ration.,4    AN,a,;    a    resnlt    of    the    review
                                                        I)roe(@ss    (les(-ril)e(l    tl)ove,    including    a    sit(,    visit    by    ilicilil)ers    of    the    Nqtlon,,il    Ad-
                                                        vi,@ry    Council    and     inciiil)(!rr4     of     lie     staff     of     the     I)ivisloii     of     Regional     Medical
                                                                            ie  I)rogress  of                                                                       tted           during
                                                        Prograiii,4.       TI                        these  regions  has  been  further  evalu,
                                                        'the    review     of supplemental      rant       requests       which       have       been       received       from       all
                                                                                                     9
                                                        four   re,;,ioi),-tl   ])rogrini.,4.   Fiirtl)er   ,4ife   visits   by   C(oiiii(,il   -iiid/or   sttiff.    to    review    tile
                                                        first    y(@iir's    I)i-ogress    have    either    just    been    carried     out     or     are     scheduled     for     the
                                                                    it@t@ fiitur(!. The results
                                                                                                        or   t'll(@so   reviews   e:irri(41   out.   to   (Ifite   iii(li(,itte    tliitt
                                                                                'Nlcdic,,il     Prograiiis     ire      iiiii]@i
                                                        these lt(@gioii:tl      i                                              ng 8111)',                            towartl         tile
                                                        goal,,; set forth       a    year     ago     as     the     I)a,-js     for     the     operational     grant     award.     The
                                                        Ditjor      prol)lezii,4      encountered      have      been      difficulties      in      recruiting       personnel       and
                                                        slowii"s     in     the     (I(!Iivery     of     important     equipments.     These     factors      have      caused      some
                                                                    in implementing
                                                                                             I)itrticular projects.
                                                            In audition to this evaluation ,it the national level, the regi
                                                                                                                                                         onal        programs         are
                                                        <Ievelol)illg  their  own           capabilities       for       self-evaluition.       .9pecial       staff       has       been
                                                        a(l(](@(I to 1,11(@ (-eill@ral staff of the regional 1)i-ogi,;ijns with ,4))eeifi(!                                            in
                                                        cvaliiiitioii                       Tlie,,4e,     te(!Iiiiiqiies     tire      being      further      developed      and      a@
                                                        pili-41  to  the operational  activities.
                                                                    :P@0(ii,@its. Tll                    is Kiiiisis City                             Hospital          involved
                                                            T)r.            -i,oN@. Tii                       City,     l@li(@re     is     a     ioil)t      COIIII-nitt-.eo      froiii
                                                        ]Kansas               '.Nfissoiiri     to     work     to(,retli(@t-     in     tll(,,     ICtilsIS      City      area,      and
                                                        tllt,,              City                    TTosl)it-,il li.,ts I)OOll involve(I               yes.
                                                                                                            I                  Wli-it e,@
                                                                            1?,i.@Oll](IYOIII(@ti,,;kiiowto                               xtent9,
                                                                                    Yes, Sir.
                                                            ('rile followiiitr iliforili@ition was received by I-,lie comnlittee:)
                                                        I)F.i,Ait'r,.%tl".NT OF I-I[?ATTll, l@,DTJCA,rTo,.q, AND Wlvr.rAltlP @@TANPMENT ON TnF                                 INVOT.VF.
                                                                       OF     TITIP     IICANSAS     CITY     GrN@,ItAL     I.IOSPITAL     IN     TITE     MISSOURI     RFAITONAL

                                                            The Kansas City                         Hospit@:tl    is    directly    involve.(]    In     the     planning     for     ind
                                                        fl(,veloliineiit of the        'A-lissoiiri     Regional     Medical     Pr4)griiiii.      The      MI,4@oiii-I      II(,,-Ioyial
                                                        Me(licil    Ilro,-r@im    has    allo(!-ited    $9'-),'.)2C)    for    pi.,iniiiTI9    ill    ICan.,;as    Citv    with    li(-ad
                                                                                  at  t@ll(,   Kansas   City   Cw(-iieral   ITosl)it:tl.    qev(,rii]    ftiift.    ,liar(,    re.-41)on-
                                                        @il)ilit.14-      for             City                   Iloil)itiil     ol)(@i-titloiis     and     Mim,,;oiiri      R(@gioliril
                                                                       Ili,t)"I,lljll ])Iailllillg, Ill(.,Ill(lllig tli(@                  I)ir(,ct@or  of  t@ii(@  Kiiii,4ii.4  City
                                                                                                                 r(!Iiit.(@(I to        I<iiii,,Ilq City                     llosl)it@ill
                                                                                          I)y t@11(@ Missouri Iti,gioiiiil M(-(]I(!411 rrt)gl,fllll l@(O ill(@
                                                                                                                               )  I)i-ogi-iiiiiiii(,(l  coliil)i,t@li(-iisivt,  ejlr(lin-
                                                                            for review. A                     i@o      (I(@velol
                                                                               at Nitn.,;@is (,if@y C,(@iieriil                       Is    pending    finite     review     I)y     tile
                                                                       Coillillit.t(,c  nii(i  (11(@  Niti@loiitil  Advisory                         oil     lt(,gloiinl     T%I(@(lieftl
                                                                          Illaiiiiiilg     fitil(lie.,4     are     underway     oil     iiiiiiiiiowei,     training      and      liost,
                                                        grit(iiijitt,              (,(Iii(-atloii la heart                               and st@rolce.
                                                            Afl-.                  TTow      do      yoii      evaluate      yoiir      1.e(-fiolllll       inedi(!,iil       T)i,oarain?
                                                            ',Olllql Yoll let-, its ]Below tlle, (@ritel-iit used f4)r"ev.A.Illittion? I                               tli   ratio    tbe
                                                        c,ol I I II I i     woll I (,I 1)(@ i
                                                            'I)     @Af
                                                                                     Yes, Sir.
                                                                       following information w,,t,; received by the committee:)




                                                                                                                                  7






                                                                                                      86

                                                Dj,,iAi@ThtlPNT OP IlleAl,'rlf, 14',I)IJCATION,  ANI)                  @,i,A,ripNIENT  ON  TJII@   CR['I'lrRIA
                                                                l@Olt T]IF, l@,VAI,IJAI-ION Ole                   1%11,-,I)ICAL I'ItO(,.AMS
                                                          I)I:iiiiiiiig :iii(I ol)(@ratioiiii activity of it I't(@gioll, as well  as  tll(,'  Overall
                                                IZ(@gioii,,it llrogr:kjii,  receives  (!OlltiT)11011s,  qti;tiit@itlitiv(@  4111(i  (lititlil@iif,lve  (Evolution
                                                                                          is in            (if  iti@t@:iitiint@iit  of  interim  OI)J(!ir-tivtls,
                                                              of r(,,ioi):iliz:itioji, qi)(I tii(,- (,oiii of Itegioiijil iNl(-@(liviil Ilrogriiiiis,
                                                             ilill)rov(,(l patient (!.,ir(@ for li(,jil't                                             r4,lltt(-(l
                                                                               for jti(Igiiig                     of it r(!gioii fit                          the
                                                         of  regioi@,iliz,,It,joll  is  tlit!  (I(@gr(,c  to  Nvlii(-])  It  ciii  be   demonstrated   that   the
                                                li(@gioll@ll    1'rogriiii     iinl)](@iii(-@nte(I tl@(@       (Essential elements of that
                                                ill%.olvejli(@iit,                   of needs and ol)l)(@rtiiiiiti4@,4,                      or i-@.
                                                (I(@lil)il@ioll  of ol),e(.tivc.,i, setting of priorities,  it)il)leiti(@ntatioii, and
                                                Ultilli,it(@ly, the            of   any   Itegioil,,il   @me(lic@il   III-ogr;iin   must   be   judged   by   the
                                                (@,,t(,jit  to  ivlii(,Ii  it   call   be   demonstrated   that   t@lic   It(,giojial   Ilrogram   has   assisted
                                                the   l@i-ovi(l(!r.;   of   health    services    !II    developing    a    system    which    makes    available
                                                to   everyone   in   t@lie   Itegion    Improved    care    for    heart    disease,    cancer,    stroke,    and
                                                relited diseases.
                                                     It   is   ,ilso   important   to   note   that    each    Regional    Medical    Program    is    encouraged
                                                to    build    self-evaltiation     methodologies     Into     its     ongoing     program.     These     evalua-
                                                tioji   niethodologies    then    form    an    integral    part    of    the    total    evaluation    of    the
                                                Rc,,ion's         program.
                                                     A    fuller    description    of    the    process    of    regionalization    Is    contained    In     the
                                                Progi,esy Itepoi-t o)t Regional Ofcdical                          (see   1).   13)    which    was    ,;ubmitte(I
                                                for  l,h(t  Itecor(I   during   the   hearings   on   II.R.   I;-i7@-)8   and   is   the   process   upon   which
                                                interim evaluations of eael) pro,7r@iiii are bitse(l.
                                                                         .1 ]Below oil            2, s(@(,I-ioii tO.@1), it, is
                                                to   :i.ilow   flio   Dist-i-i(@t,   ol'   (Ioltiiiil)i;t,   (loillilloilinleliltli   o.1'   l-ii(,rl@o    Pi(-o,
                                                all(I so  l'ol,,tll,  ill.                            I)III)]iC,            Itw itself.
                                                     I)o(@il't (.,])is  (ro  tIo tll(@, Battle I(.,t"l
                                                     ])I-.            Yes.
                                                     All..               So          trilis Wotil(I :11re(!t every ])I-Ogrllll of the
                                                                           yott    ctn    alir(@    II,;    I'll(,    information.
                                                     Ml'.    l@Altf,    )()I@I)Y        )@ity                   ]?(@gioiitl        Modict]        1'ro(rr,,tiiis,
                                                                                            t                                   in ti)e     Piiblic      Ifeitltli
                                                Act,            (loes  i@ot,   iii(-,Iii(le                                      tdditioiis       have       been
                                                     (I(, t-o cori-,ti II other I)i-ogi-aitis iii                 This    is     I)riiigiiig     the     regional
                                                            I)rogi-,i,iii,, into Iiii(,, oil I
                                                                                                                                                         sti
                                                     Mr.                 Tliiiilc yoii. I am (leli(rlite(i to @e, the D
                                                I)ort    this    pro-i,am    for    ii-iigrtilt    lie,,tlt,li,    Ni,liicli    I    have    b'een     interested
                                                ill lt7l(l  Helped  to  ivrite  tl)e  origiiii.]  ltw.  Aiid  I  tool<  a  ver  active  1),,trt
                                                                                                                                           y
                                                Sinc(i then      ill fo]]Owill(,r fliis program.
                                                     I   have   b(@eii    ver_)r             with    it@,    Aliss    Joliiist-oii.    I    think    Yoll    have
                                                (.IOTIO :t  goo(,l  @iol),        I            it-, is very CSS(@lit@i@ll           we I-ecogilize
                                                is t I)ro(ri,:i.ii@i ili:tt slioiild I)e, coiit,iiiii("(l rii(@lici- tli:iii let-,ting it get.               into
                                                                             Y(@,t-,,               doii't think t@,liis has I)eeii well
                                                                     -)f   1,11o   Slittks.
                                                foi. ill litilliv
                                                                         -Sell]) fol,-                                           w        ill,  I,Iiis  NN'oill(l
                                                                                                             Ili)  I'oi,   re%,io,  ilgit
                                                     10 111) f(@r    I.(@vi(@,w @tt-, (]la            iii 11 (@. All(I we %Vote]    (I  1)0. Table to  I.Itell
                                                ("Oil
                                                11(5(@oillifloll(l. Valid Von woll](I 1)(t able t@o                        @VII(@tll(,r it,  sliotild     (,-oil-
                                                tiiiii(@ as .t                  sl)eei,-tl ])rogri,iii or wli(@ill)er it@, c(ilil(l, ill fact!,  I)c
                                                iiieorp(.)rate(I  within  the  ftl)ric  of  t,])e  partiiersliip-f-or-l@ie.,tltli   I)rogriiii.
                                                     Ml'.                IV]ieii yott too]( over 11  1),t  -I  iiei-sliij)  print  from  t  Stsite,
                                                will tll() I)el),trt-iiieiit. -.ice tli,,tt, this ])]:Ill has in  it-,  the  necessary  gitide-
                                                line,s to carry oiit this type of health pro-rain?





                                                                                                             87

                                                                                    (IC@'elol),        ',Lllcl as tllo         (I(,velol)   t.lie    (,al-).il)ility
                                                       I)I@ll)]!illg,        !]lo        ])Ilrl)o"@.        of   of 111(@                  Iiij)     fo@
                                                                                                                                        rs

                                                                                                             L
                                                                        to    I)o    to    create
                                                                    to @et, their oiA-li 1)"Iorilli(@,;. )N'(@                 I-evi(@NV          ill   -olttioll
                                                                                                                                         in(I
                                                           ])I-i("J-ii              ji:lve                   s(@ll %@,i( Iiiii Si ',it (@s ; ,         iLi])IY   ill
                                                           of                           :1,11(l  li;ttlioilll,l  ])I.iorit,i("S,   t-,Iiosu@   are   also   loolic(l
                                                                    1,(@l:tto      to                  st:11(3
                                                            A1.0  IN@,ilit,  to  li:ive,   illie,   Stl:k,f(@s          illi(@ls(@                             Aii(I
                                                        of'                                         III)i(ille        IN-iiii  (']lo
                                                I i@(@.y (io itiove from @St:tte to                          tii(I  it  is   difriciilt   to   (@,neoilip@iss   that
                                                                                    St:i,t o ])la ]I.
                                                              O(;I.Illl@. @)III, I ]Ill(, I
                                                       ii   oil   tl)o,   iiiigriiit,           1)rogriiiis,    wheat    is     beiiiL'     doiie,,
                                                                    beiiig     tffected     Ii@(I     ]low     really     people     ft@     involl
                                                                    of the couiiti-y.
                                                                    lowili(v iiifoniittion was received I)y the

                                                                    OF I-Il@Al,'rlr, It' I)IUCATION, AN I) WIPLI-AltIP @STAT                           MIGICA
                                                                                    P,AT,Tli IROGItA?,f STATUS, MAItOll I()68
                                                                                    ic health statii.-4 of inigratits tl)rough                         their
                                                                                    ervices and a healthful environment.
                                                   Gitid,
                                                                                    help              himself.
                                                                                    t-s              recognize fill(]  assume                  for         lncludin;
                                                       iiiigr@iiitsizitotiilc   iiutiiiityhealtlil)14iiiiiii)g.
                                                         IlroiiioLe        itdztl)tii                        iiity  servi                           needs        an(
                                                       situation.
                                                                              contain                        pie move.
                                                       13t, ilive    fully    all    ar
                                                       Get  migrants  metric                                 er                        Mullity     life.
                                                   @tatit-v    (se(@    also    itt:i                                                (the   111-18    report,    ci*
                                                                                                             re                    nd      Additional       Ne
                                                titled       ".Illgriiit       Health
                                                has   been   i)liced    in    committee    files)
                                                                       or         niiilti-cotiiity         I)r cis it              li   migrant    health    g
                                                                     in      36       Statesiii(I       Iluert i(:
                                                         28;-)     project     counties     offer      iiiigra )ersorial    health    and    sanitation     serv
                                                               t(l(litioiial     project      counties      11 !(le    sanitation    services     only.
                                                         More       than        200        family        healt er c clinics operate seasonally or
                                                       round.
                                                         1,000     physicians     provide      M./rants      m                 In   the   clinics,   in   their   ow
                                                       offic(,@,,tiid in hospitals.
                                                         300,000              migrant                        Italy 4           were    in    counties    served    b
                                                       projects    for    at     lea@                        licy I
                                                                    215,000        n@
                                                                    2.1,000      (le@
                                                         12:'o,000      visits      v                         t@o 11) gr:      caitips,       other farm       labor
                                                       lioii.,4iii,,  @iii(I   iiiigr                        Ire   centcr.,i.
                                                         12.@),OOO      visits      w                        e( iiit.,irlaiis i                     c    and    work
                                                                                    itiio
                                                         $7.2 iiiillioji-           io      t,otiil      funds iil)l)roi)ri@tl'e(l foi              I)Iigate(I    In
                                                             and t(,                vo   coitiiiill@iii(@iit.4 for (!oiit,iiii)(@(I g               re    made    at
                                                       Ill(!                                                                                        r (4oiit@iiiii(-(l
                                                                                    lii!.qe                  eotil(I not, li(@ iii(@t s             I)rol@riiitioii
                                                              1,11(@                i.4 l,iiiit in 11)(;7. ]it  y(!iir   sale(-(   c   rt)      tin Started      the
                                                       total              tiviilljtlil(@ for gi-ititi@.-4 Iiii-i liceii oi)ligit   find ill
                                                       littv(!Ii;A t@ol)c(!tirrte(I
                                                                                    (As       of       January
                                                                    l,iii@       llr)                            IIILVO     IIOE  ill SORV
                                                               I)i-ojt@t-ts    tire     located     la     2i)
                                                           (;2 liosl)lijilti have signed agreements with projects to 1)
























                                                                                                                 DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ESTIMATED NEW OBLIGATION AUTHORITY REQUIRED                                                              U'IDER H.R. 15753 FOR FISCAL YEARS 1969 77
                                                                                                                   New obligation authority                                  Fiscal year        Fiscal year         Fiscal year         Fiscal year         Fiscal y  'ar       Fiscal year         Fiscal year        Fiscal year         Fiscal year
                                                                                                                                                                                                                                                                     a
                                                                                                                                                                                1969                1970                1971                1972                1973               1974                197  5               1976               1977

                                                                                              1. Regional niedic3i programs        ----     -     --      ----------------  565, D,30. 000    3140,000,000  $200,000,000  $275,000,000  $350,000,010                        --------        -         -----------------------          ---------------------
                                                                                                 Special grants for h-3-@ith of trigratory workers         -------      --     9,030,000                15,000,OOU -----------------------         ------------------------------------  -------                 ----------------------------
                                                                                                 Alcoholic and na,col;c addict rehabilitation          ------------------------           --------------------------                        --------------------------------------------------------------------------------------                         -
                                                                                                       A. Constructioi grants and staffing, operation, and
                                                                                                              maintenance        grants --  -  ----------------               15,CGO,000                25,000,000 ------------------------          -------------------------------------------------------------------               -                ----
                                                                                                                 1. Alco"l;c rehabilitation        -------        --------    (7,000,GOO)             (15,000,000) ------------------------------------------------------------                       -----------------          ---         ---------------
                                                                                                                 2. N3rcoti@ addict rehabilitation       ---------            (8,000,000)             (10,000,000) -------------------------                                ------------------------------------------------- ---------        -     -------
                                                                                                       B. Continuation  costs for  staffing,  operation,  and
                                                                                                              maintenance        @rants ------------------------------------------------------                       15,309,000          13,276,000          11, 242, O@              $10.176,000  @10,176,000         $10,176.000                $5,330,000
                                                                                                                 1. Alcoholic relmbilit3tion                         ---------------------------------------------  (10,424.000)         (9 050,009)         (71 675. 0-@@))         (6,877,C@10)    (6 877,000)         (6,877,000)        (3,  9@,  C@-,O)
                                                                                                                 2. Narcotic addict rehabilitation      ------------------------------------                   ---   (4,885,000)         (4:226,000)         (3. 567, 0,J?))         (3,299,0-,O)   (3,'299, 0,30)       (3,299,000)          1, 3 @2,  @-0)
                                                                                                                       Total NOA required               ------------------   89,000,000                180,000,000 215,309,000         283,276,000         361,242,0.',O         10,   176,    %G    10,176,000          10,176,000                5,330,000
                                                                                                  Note:  The  projections  contained  in  this  table  represent   departmental   predictions   and   do   not   represent   the   administration   position   or,.   the   future   program   or budget      requirements.      Personae]       requirements
                                                                                            will be dependent 6n program de,e@opmen',s and budget factors which at this time cannot be fully predicted.







                                                                         coyiipr(,Ii(,iisivL@ progr.,iiti ill the city of I)es klloiiies-r(@lyizig
                                                              vollitil@it'.1'                          "tir(@:t(IY               in sigilifiettlitly
                                                                rate @iiiii)ijg  Sliltl  Ito%v                   It               I)ossil)lc to J)Ill(@(@ 'I
                                                 iiii(I-@lit iiiiiii'lit,r of these             ill I)o.,itioll.,; of ('llil)lo@@'llielit Ill(l to illo(lify t])
                                                                                    ,o tli@it they ,ire no longer ,Irrested for
                                                 I(""         ,)4 el,itit, I(,@ oft cost to the coiiiililiiiity.
                                                     (c)  C(itifrii-)tia.-At the '.Nleii(lo(-irio State Nletital IloSI)itill t]                                  a.
                                                 tioll all                  iirge treatment I)rogr,,iiii for alcoholics. All                                     (I-
                                                 iiiitt(@tl to trip pi-ogrtin on a voliijit:iry basis tiid tre free to IC                                        at
                                                 groiiii(@- ,it@        tiiiie. A sizeable prof)ortioji of the patients in I                                     re
                                                 Sl@i(I ItoNv ileoli@4ie@ froiii the city of Saii l,riiicis(,o. Tilroiigli th                                    se
                                                 of I)rofessioiiitl a.@NN,ell as iioiiprofessiori@il st@iff, it has been I                              creite     a
                                                 strl)llg           of lll()il@i.le and (ledi(-ation  III  the  treiitiii(,Iit  iiiiit                  nuitil)cr.9
                                                 (of liolit(@(..Ss ql(!olioli@114 i-eiiiiiiii for a siil)sti,,iiii'lal 1)(-rio(I of ti                  rticil)itte
                                                 ill            rii)ge (Of (4,4!r(,iit treiltiii(!iit                             This                  also
                                                                            tIleRkereotyl)etliatitl(-oliolic,,i     will     liotii.,3                  agencies,
                                                                             I)CI  i(@\,e  You  WOIII(L   also   lltV(','   coiv         actions @ol)e@l-lit-ilig
                                                  I)(] St @iiii II(,                          Ill([ t iv@tt iiielit feel lit i(@,/f
                                                                                              iis is iiier(@,ly l(t coiitii@flttioti,of-t-lie l@)ro ritin
                                                     I)i-.               Yes,  sit.  N                                                                      (r
                                                           "e(@t    ioii    4(@-)    of     the                ill              I)ilit-,tt,io  i   AcC   oFi966
                                                   I)III)I i(! f,,Iiv
                                                                                              t]                 C,           ililillit-,y
                                                                         No,   I    Nvotl,                                     )lot be iii'ever
                                                                                                                                                        y center,
                                                                           117]i:it does  the  liii)                      Narcotics   -estimate    is    the
                                                 I)ol)itl-,t,tio)i of our litr(I lit
                                                     I)r.     YoLl,]",,g.     Tlio      ostiiil                           are      62,000       liti-d       narcotics
                                                          ill   tells                                                     ilinto   tliese,    fiL).ures    tre    only
                                                                    ITnitecl            Stites,
                                                                                                               117
                                                                       r(@eiit      of      the                    e II    e   no   true   figure,   so   it   iii,,ty
                                                                      100,000           li,,i@d                Cs  'id([  i
                                                                      s.      I'doii@t      kii                lit to a(@t           -t    bi-@     buildin
                                                                                                          Id be inco
                                                                       -,eeilis     to      IVI I
                                                                          You             iiv(v need ci  tiiii ,t,-tffill                                          you
                                                                                                  I)Url)oSe of        tIlo   effort
                                                                                                i les   wherein        this     is                          ill.    It
                                                                                                c fears it, -,N,.ts I)etter to
                                                                                                Halt gyr:tiit-,           woii]                           States.
                                                                           I                         siil,)jiiit    soiii(,
                                                           out. t/ii(@ is lit). iNl(          1)(-,rs of  i,lic  coiiiiiiittee  ii
                                                        II (I ily(tioi s i it -writ@i iig. We very                    i    Y)i)rcc                        I          is
                                                 t iol I,
                                                                           it           i-,i,in Iil(l   I   Islamic   we    are    off
                                                     illo"t,/Ill)ol'('Il       T)i-oL         ) ,                                                                                          ,    1:  ;@@@
                                                                      solli(.,(Iet,@ils    and    I    tliiiik    the     coliiiliitt(
                                                     f@.(@ W("            Ict.ioll.
                                                                           l@'011](I         be          to ])]..()Vi(le IVII11tever y
                                                                                                                                               111,111,   dealt    'of
                                                                                                                                             or    tlic    A.ssocilli-
                                                                                                                                                                 by
                                                                                                                                            itsliville,          Tenn.
                                                                                                                                                                  your
                                                 glviii,,         ill    I  t,@ so tll-,It the comiriittee 1  ay be)iefit fr                        your       testi-,
                                                 iiioiiy.









                                                                                              '7





                                                                                              123

                                             STATEMENT  OF  DR.  CARLETON                          B.          CHAPMAN,           REPRESENTING
                                                THE      ASSOCIATION      OF      AMERICAN       MEDICAL       COLLE@GES;       ACCOM-
                                                PANIED BY DR. LLOYD ELAM
                                                Dr.  ClIAI',AIAN.,rii:tiiic  yoti,  Alr.  Cliiiii-intji.  ltm  C,,irleton  B.  Cliftp-
                                                     (lo@iii of                               Scliool,  and  on  my  right   is   Dr.   Llo@d
                                                       who is                    of AI(@ii:i.i-ry iNle(ii(!Itl  College.  We  are  on  this
                                             Decision ,pol.:(@siyieii for illi(3 Asso(@i:Ll ion of Airiei-ic,,ti@ MediciLl Colle,,es.
                                             Our association  represents  the  88  iii(@(lic:Ll  s(-,Iiools  in  the,  United  Stites
                                             ;Is il@s@@itittiolls, it. I-,ii,g(,, I)rol)oi-tioii of  t@lio  N,,tlioji's   medical   educators
                                                                   -tiid 3'  -Iiajo   r tetcliillL,. liosl)it-,tls.
                                             ,is ii)dividuils,
                                                '.\fr.  ('Ilia-irmin  I   WOUI(I-Iii(e   to   point   oi@it,   that   we   would   lilce   to   spetk
                                             to  flio                iiiedicil                                 medical     schools     are      inti-
                                             iii;it(@l.y   involved   in    these    programs,    and    while    we    favor    in    general    the
                                             other   provisions    of    the    bill,    we    c:tii    claim    special    experti@se    in    these
                                                AVe    spol@o before Litis grotil) in favor of the ,tdol)tioli of the                             art
                                             (liseise,    cancer,    ,iiid    strolic    amendments    in    Febru,,.tr_y    196@'),     but     eni-
                                             I)Iizisized    that    flie,,\-,ition    did    not    then    possess    enough    trained    personnel
                                             to          out   the   provisions    of    the    propostl.    At    the    tilyie,    our    spokesman
                                             noted   that   our   m-   edical   schools,   originally   set   U])    soleli    to    train    pliysi-
                                             ci,iiis,    were    already    develo-pinz    into    medical     service     centers     with     c(>n-
                                                                                     s"bifl
                                             st@ iitly expanding respon i                 ties in the health          field.   He    went    on    to
                                             say:
                                                                       -ikes  it  clear  that  the  I)rofes,.,ioiial  and   institutional   relations
                                                "his exi)eri(@iiee ni,
                                             ire  coii)l)lex  and  delicate.  It  also  makes  it  clear  tliftt  it  is   painfully   difficult   to
                                             proeiire   and    maintain    an    adequate    supply    of    trained    manpower.    A    functioning
                                             re;,ioiial   complex   ...   would   make   the   etrorts   of    the    practicing    physician    more
                                             effective,   but   the   development   and   ol)erii@tion   ...    will    require    a    marked    In-
                                             cre.i se in trai ncd manpower.
                                                1.1p,   tlso   noted   trait    the    success    of    t    regional    coi-nl)lex    is    lietvily
                                             (I(@p(-iid(,.iit@    oil    the    continued    laid    growiiiy     @rectiveness'of     the     medicil
                                             school iii-id the medical center.
                                                At   this   tinie@   3   years   later,    we    consider    these    observations    still    highly
                                             pertinent.
                                                litit    ill              we     I)eliev(@,                        eirects     of     Public      Law
                                             81)--2,",!)  to                                         It li@i,;              it )lle(.,Ilttllislll  by
                                             ]items       of           file   \',itioll@.,i             s(@llool" liitv(@ 'begun to
                                                                                                                                    with inti)
                                             to coll)lllllllity ill(l (..Oll"llll,icr 11(@:tltli               :I'll([ to ivol
                                             liiv  tll(l  Pi-of,o"%Sioiiil  zi-oiti),,   in                ii(!NN,   methods    of    coping    witT,
                                                      needs. It has ii@itiaie(i the                                of   the   Natioii    into    ilc-
                                             (Y:  I I S, for the purpose of d  el  i  N,e  i-y  o  f  I  I  eil  [II  servi  ces,  very  effectively.
                                             Aii4l    although    this    oi.-ganizttioiitl     process     ]iu     not     Yet     T)roceeded     to
                                             completion, the  results to ditp,  more  than  jiistifi tli()                          Plislillt(re   Of
                                             tli(@, I aw.
                                                AVe    %re    well    lware    that    efforts    to     implement     the     legislation     ha-%lo
                                             been    associated    with    iiiiiiv    i)rol-)Iems.    Reziont]     orbital     @,,Ltioiial     struc-
                                             ttii-es         for tiliftt matter tlie defiiiii-,i(ii@'of re(-rioi@tLl;boujidtries,                ,tre
                                             in soiiie installed initially coiiip](@x iii(  cliiin-,.y. Some                               I)rofe--,-
                                             .sioii@tls complain tl)ttt@ t,liey do not, iiii( ei.-Stit,ii(I the intent of (-,lie                  law
                                             Ill)(]         ,Ai-o Suspicious OT. it. I.,,'LY ill)(] I)I-of(,@Sioillll grotil)s Ni'llieli, Ill
                                             SOI)IO i.-eglolII4, tire ittteinl)t;ing to reach joint deoisi6im for the                          first





                                                                                  124
                                      time, iro li.,Ivi   lig some dililetilties.      Aii(I   oceisioii@illy    one    heal-s    the
                                      of (,Lillillo-collti.-oloft-,IieNitilioti'slie:titlic:tl.L@, ',YSL(kiTi.
                                          131it ill'-Olll. viewl these difliciilties were  to  ,iii.  extent-,  1.)i-edicttl)le  tiid
                                                            iiilpoi-titiit point is tliit  t,])e            by iti(ybiliziiiv  local
                                                                    @,t (,ool)@-i-ittiv(@, @tt,t:lclc oil       proI)I(@ills"Wlli(,]I,
                                      ,.,Llt,lloll"ll Iii,@-lily necessary,         not          01)(@.I.@itivo 1)(,.I,or(@. III olir
                                      view  ilie  (yellertl  consensus  lty   ,tiid   I)i-ofessioii@tl   is   Iiiglily   ftvoi-,tl)lo
                                      to t,lic,  IILNV.
                                          The iii(@dic:tl scliools tli(@ilISCIVeS           ll:l(l  (,Iiffi(@LiltiV@S  ill
                                      tli(,ir oblio-,ttiojis iiii(ler tlip, Iiw. A.L:tiiy of                When Llie ].tNv  wall
                                                laid   no   tdii)iiiistr:tt,ive                      wi,,,      -),-tble of
                                      witli  t,lies(,  new   rc@sl)oiisibilities.   Ill   soiil(,   instances
                                      ill,,  iiiiclc@r  trip,  ]'INV-  involved   coniliiitli)ont   of   prol
                                      that   is   tlretdy   ftilly   committed.   Far    fi-oi-n    -ttt(@,m]                    over
                                      coilt,rol  of  t-lie  1)1,ogriii-i  nitliy,  .tn(I   pei-li:tps   nio.9                   iools
                                      naive,   b(@ii    slow    to    become    involved    1,11.g(;fy    owi                      of
                                          This  li:is  beeii  especially  -icute  I,,  t,])c  SCI)OO]"  move   to
                                                                                                                   e"'in to      meet
                                      tll(-           shortage  of  pllvsicitlis.  Y(,@t  there   is   ]lo   (I.Oub@i-n-our   iyiinds
                                                       icil selloo
                                      tliitl oiir ille(i            Is  wisli  to   be   involved   as   effectively   as   possible,
                                      ]lot, to grain control I)Ilt,, ill ]@OCl)illg         l@lle, illi@elit@ of the law, to i-n,,tke
                                      their                                 more,                      to,,tll   who    need    them.
                                          lit,it@ t.iiis  viil:tl  iiittter,  ,tii(I  the  cqit:tlly  vital  mutter  of  illiprovii)g
                                            ex,j):I,ll(@liiig out-                                          (constitute  ,Ill  ol)li-
                                      Lrttioll tlliitt, c,.ui iiiot-, 1)(3 iriet ol)ti iii:tlly iii. t few. ifiontlis. or even 1)erli s
                                      fair  2  or  il  -years.  The  medical  schools  swlc   no   sl)ccitf   privile&y-c   uli@lle)r
                                      til(I r(,,giolltl iiie(lic-@ti  pro)4_,i-:tin  I:tw  but,  ivisli,  on  the  contrary,  to  as-
                                      Si
                                                         ill
                                          AVo                 the ori,,,iiiil I:tw        ol)ei,;i;(,ed ("XceediiiLrlv,,iiiiootlil
                                                                           li(@ I)Itiiiiiiig T)roe(@,,i(@s it  ]I  ?                y
                                                                                                                Its  initiated.   IVe
                                                        li(3          of t                                      I
                                      also   b(@liev                   i:it  Clio                   e       been   or    soon    will
                                      b(i                               few   ill                   tl  :tltei,,Itiolis.   When   the
                                      I.tw  first  b                     leiiieii:l
                                                                                                     110   .4)"Clloltlly   applicable
                                      Protot@pe@                                                                types       specined.
                                      A       number                            have    now     em              e   more    effective
                                      tli,,tii others.    m,,Li,,  in  our  view,   soon   b(                     r  ii-iore  defini-
                                      tive org,,tiii@     on,@l'guidelines    to    be    pro                    ivision    or     Re
                                      gioiial   !NIcdicil   Programs.   It   will   ,,Is   b(                   in  the   future   to
                                                                                        0
                                      reconsider   critic,,tlly   the   geo(,Yi                                 ai-ious      regions.
                                      The    responsibility     and     autlioi                                         of      which
                                                                                                 IT  gi-ou  ps@
                                      are too
                                                     (11  to  function   effezt                  cletrer     (lei        And      the
                                      iii:tiji t@lirLiSt@ of the                            in  our  view,   to   be   restated   and
                                                   I)e(@ii frequently iiotkd  that,  its  central  focus  Of.  the  Itw  is  the
                                      p:tt@ieiit-, ',tied his        '.Vliis is iiii(Itiestiol1ql)lv ti-ii(,. ]@itt -.t iliore  role-
                                      VLlli@ NV,@y of s;tvi))Lr t.,Ilo ;.tillo                          t@litt t@,lie litw  proposes
                                      to"*
                                      of tll(@, Nll,i,ioll,           (,o(>I)",ttivo                        t@lle opi-)or(-,tiiiity of
                                                              t@o                                               ill the  (littAIlosis
                                                         of t'lit@ (Iise:tses ll!tlrlt)(I ill the, law.,,
                                          III  o(-,Ii(,r  woi-(Is,  the  litw  provides  us  wall  the          and   authority    to
                                                                            t3icittiis   and   otlier   health   workers   to    pro-
                                      fill(@l wtys of tssisting plly





                                                                                             125
                                              vi(it)  Aiiioi.-ic@iii                              111(@v    iiitv    1)0,    with    better     health
                                              cli-O itii(t to  1)1-ovide  tlitt  care  iiii@re
                                                                                lily ,ill(l I)rof,(",iiioll:tl
                                              not-,  iiivi,riably  L)c(,.ii  idea].   food  I':til,ii  iiid                                    between
                                              sll(,Il ',VI-ottl)S Cannot 1)(@,                                  0110    of    the    m@'t    stril@ing
                                                              )Iellts  of  tll(3  ori@in-,-tl  ltw  is  tli@tt,  it  has  set  the        for      the
                                              develol)ii-ieiit of effective c7ool)er,,itioii between these grou
                                                                                                                                   p
                                                 Tiie   ori(yintl   ],%-%v   is   ,tceon@l-)Iisliilig   iwhat   it   set   out   to   do    but    the
                                                     It    which    such    develo    meiits    call    ])i-ocec(l    must     be     viewed     retl-
                                                          AVe    are    not    in                       I those, who s,          tll(tt,   the    PLce
                                                                                                                             Ity
                                              is unsatisfactory;  oil til                             ie  rtte     tt      which i@laiiiiii1cr- li  as
                                              proceeded  has,  to  drive,                                     sive,    owing     in     no     siiiall
                                                          to the uii.derst,.t                                 which        litvo         characterized
                                              tllo,t(iiiiiiii,@t-,r-,itioii of the law.
                                                 J,Iio next 3 years will          1)(3    critical    ones    in    that    whit      been        done
                                                                                                                                      itiust,     then
                                              @,ill  I, ve to 1)  el-itict]ly evtlli@ite(l; tlllbt wlii@Oll is successful
                                                                     that   which   is   iiielyeetiv(@    disc,.trded.    At    this    sti-tze.    as
                                              ill  til(3  1)1,'Ljiiiiiiz  i)li,,tsc,,,   the   iiiedictl   schools   ctii   ,tiid   no   doub@   @viii
                                              r(@,ii(ler sigiitl se vice.
                                                 Wc@             Mr.   (,',Iitii-iiian,   file   ltw   should   continue   to    operate    for    the
                                              I)res(@,iit, WiLliolitcitil)stllltive               but    that    the     results                    ig
                                                                                                                               it is pro(Iiicii
                                              iliusL Soon            to  be  el-iticd]V  eN7,,@l  i-iai  e(i  tii(I  set-iit@inized.  The   Nitilion's
                                                         @(,,IioOls   -,ti-c   now   iiiv@lve(   foi- t@-lie iyio,,(@          to      extent       of
                                                                        )lo(-, ill @ill (@il'ol-il to (r:i,ili (!outlets but-,        to  11(@ll)   to
                                                         (lie N;t(,ioii,,t              service.   Aii(I   its   we   go   'I,I)ollt,   meeting    our
                                              ol)li'-',Itioll'4 header the Itw, we                t-ii(@,  iiii(lei'st@i'lidijiL,  of   our   (francs;
                                              those  Nvlio  feel  tliitt,   we   ire   r(@acliijig   for   @loiyiiiitiice,   no   less   thin   tlioso
                                                                                             fist  oi,  viL,,orouslv   (@,iioii,
                                              who feel (-,I itt -sveii-c not moving                                            gli  oil   the   other.
                                              We,,tro-,AIr.CliairiTi,,tii                l-,tced@quti-el                i@tlieni@(ldlel)utwerecogiiizc
                                                                              II)            -       y
                                              that  the  essence   of   the   re,,-,ioiitl   ii-iodictl   I)rogrtin   activity   is   vittl   io   the
                                              welftir(i   of   the   Natioii.   It'is   oil(,   of   several   iytajor   obligdiioli.,i    which    wo
                                                 Mr.                   ftiilc you, Dr. (11 itl)ii i;tii, -for ftii (,,xcolleii (-, start eni(,,ii t,.
                                                 T iiii,rlit@ sity, tot), t,ii:Lt,   11(@("itil talent. ]letter   (If y@ii@                       wero
                                              i(II(@(tl)i,(@(II)YI,Ili',(-.olilillitl(t@.(@iiii,ii(@wi-it,iii,,o@i@          col-igililtl'i@NV.YOUWCVC
                                                            (111(@tioltill", if NVO eotil4.1              it                   froin    ])v.     Lloyd
                                                 I 1'. l@, f,A rf. A@f 1'. Cl 1:1, i i'l I I it it, I I I y 11 it I I Iis ]',I o y (I I",] 11 I I 1. T final 1) I-esi4iolit 0 f
                                              I)osii,ioi@, I Nv@is clittirjyiti'l of tlit,,                    of    Psycliiitt@ry     at     Meliirry
                                              ai)(I for a I)t@ief            (I(@;lii of III(" S(@'llool of
                                                 I  SI)e:tl< to(l,,ty ts     iii   ofl'teiii   rel)i-es(@iit,,tt,ive   of   the    A-,-,ociition    of
                                                      'c,tii              Colleges  tii(I   -svisli   to   coiiii-neiit   si)ecificall   oil   rel,,t-
                                                                                                                                       y
                                              tiolisilil)s between re(,ioii:tl                     I)i,ogi,.iins ,tiid medical schools.
                                                 I  (loans,  before  You   to(lty   ,ts   olle   Who   has   ]it(l   direct   OXI)CI-iclice   with   I
                                              re,("ioll,tl I'lle(lic.,Il pi-ogr.Liii, t pi,oLri-,tiii ivliieli is itlre,,tdy entering             tlio
                                                                                                                       p
                                              ol)er.tt,ioii,il I)Iiase  ,tf  t@et                                        ro_"ress     in      bringing
                                              to(-,,Ptlier    various    liciltli              in  tl)e'@Nf  idsoutli  are,@(Iiiriiiz  its   T)I-,iii-
                                              nii@ig   pliise.   I   liavet   deep   concern   ,tboiit    the    ,tvail-,ibility    and'iiialfty    of
                                              health    care    among    the    poor,    especially    in    our    cities;    I    am    particularly








                                                                                                                                                 critical
                                                                                                                      call (10 ill (Claim
                                              area.
                                                                          f@i(!t tliaL.  iiiv  iiist,itiit'oii,  -..Nlell@irry  -.Nfc(licil  Coll(@,,(',,
                                                                                                     Illo\@'S   )Ile   to   Clill)lllsizL@   the    J)olllt
                                                                                   Nvf"
                                                                        ;I,        Oll OLII' fillilll"('S 01- 0111-                            .LS   NN'e
                                                                                                                                              of      our
                                              i@(@(,ioll, l'o                                                          ll(,:Il.t
                                              '1114'  "I
                                              ,   I   ,      -,  \\'(t        (14) ',o N\'itlli)ilt  j(,ol):Il.(Iiz,li" our                       (Iticl.
                                              tioll:tl  ol)li"@it,ioll.
                                                                                                         Ill(l  tll(,'  otli(@r   111(@(licil   @,11001'i
                                              of tll(@ N,@t,tioll Nvi--Ji lo                it st@l,ollfr         of   i,(@,I)oii,;il)ilit@y   for   tile
                                                                      of' ill)(',                           stii-rotiii(i  II,,.  ],'(@,(,@ioiial  iii@i-
                                                                 oti'L@r:i.ix ol)l)ort,uriity for sii(,Ii iiivolveiiic,.ikt,.
                                              ill          file, I)o','Sil)ilitv  for                           our    (,@olleg(@    to     ctr@y     out
                                              tlielr iiiii(Illo                   ill colliliiiiliity               esl)ecitlly    ill    tile    devi3l-
                                              o  )Illellt,  of  [)Of  i@(,,r  wtys  to  al)r)ly  iiew  -.tii(I  a(lv,,iiiee(I   proce(litres   tiid   im-
                                              pro@,ed ways of ediic,-ttiiig li6,tli@li I)crsoiiiiel for this taslc.
                                                 I-A@,t, ii-ic            briefly    liow    tlie'Peiiiiessee,    Nfidsotitli    re(,,ioii:il     medical
                                                                                                                                  i  I  ill   tile   next
                                                 i,oiri:,tiii ciiii(@,  nt,o I)eiii- niid Nvli:it we exl)(@ct to,,tccoliipi sl
                                                                                 tn
                                              It?(" w  A@(111irl.4.  Tli'(3           wis    iiiiti@tlly    estil)li,,Iied    fliroii,,-Ii    the     Co-
                                              01)(?r,ll,iv(@   ell(le:lxors   of   ,t   wide    VI,riet,y    of    iiitei-estk@d    -rotips    in    Ten-
                                                                                                                                tn
                                                 'rlie                    involved Afeli:ii-i-,y                  Colle-C,       Vanderbilt        Ui-ii-
                                                         @("1104)]  of A                 lfoSI)it.11  Ill(l                                        Council
                                              of'                     LNasliviii(,,, I)riv:kt,(@ lio.@l  ')i(:t.ls,                            1)1.11)lic
                                                                       I'll(] Volillit..il,y            oi-g,,t,iiiz;ifiotis.    A    re-ioii,@il',,tdvi-
                                                      ,-i-olll)  w;ts                      itil(I    I)I:lli)liiiig     funds     NN,er(3     received     in

                                                  11     our
                                                           or,                       for I)I:tlllllll(r                ]la,, I.(,Islllt@(,(l ill -,til (,II-
                                                                                of ll('llk.1111  l@l,ol)l(tilis  of  1,11(@  re"ioll  iiii(I  of  I)(.,%v
                                                                                                                                   -ess by I l(l@ II i II,),
                                              ways to Solve talent. I cin ilidi(,iititlio extent of our I)i-ogi
                                              voti tli@it, in             19C)71              liloi,(@  t-,Ii:tii  10  iiioiiiiis  litei-,  it   request,
                                                                                              foi-:11 pr(>.i(@(-,t,s to be               out,   in   tile
                                                                              V:kl.i(@(I wi(tely in                  :iii(I in s,@ol)(@, but-,
                                                                    Nvitll solving It
                                                                     oil st i-ol@(@  Nviii(@li  li@i(i  been  i(leiii  iii(@d  (iiii-ifi(r  ties  I)Iaii-
                                                 ()II(!, ])I.Ojet-t, IVI)i(,Il typifies ill(',                                iii(I   allows   film    to
                                              sl)e:llc to  ,-t  P@i,i-(;i(',UIIV  PROI)ICITI  t-liit.  we  at,infeliirry  ai-c@,.tddressiti(,,  is  tll)o
                                                                       progi,,i    in    I)i-oject    concerned    witit    ]on,,-teriii     CN,aluttioil
                                              of IIll(-"  liezl,ltli   -,ttiiis   of   @',O,000   underl,)rivile(re(I   persons   iii   all   urban   pov-
                                              ert\y aretkiiowi-i.L,3 nortJi N,,tsliville.
                                                 Oi r del),irt.-neiit of famil)r and               community       licall@h,        in        conjunction
                                              Avitli tile Office of Eco                              uiiity,    is-est,.tblisliiiia     a     nei,-Iibor-
                                              lioo(I li(Ntltli c(@,iitor for                         iieeay    peol)le.    Tliis'@,3,    as    you    can
                                                              I:tl"o-,o iijide,                     no   iviiieli   re(Iiiir(!,g   ,t   grott   deal   of
                                                                 ii'lid eifoi-                                           s  is  to  (Iot(,rniiiit,,   ex-
                                              ;it,-t,ly NVIIlt;  ,;.Yl)o  of,         (,fLi-o is 21                    Ile,(] by tlies(@
                                              Allotll(,,],, or (!olil.s(@, is lo 111(@:I,slli@o (,]                     (,.iti,o  and  to   iiii(i   out,
                                              i I' it is                             Avian, it-, so                       ]i(@   ro,,ioiiil    iiioclictl





                                                                                                      127


                                                                issilp
                                                 i(@ii of I'an(i
                                                ']:tl)ori,toi--v i.,; .iii adiiiiiet to the nei(-YIil)orliood liealtli ceii@r. Tllo co-
                                                                                             iiivolve,,i     cojisiilt-,,Ltioii     ftzid coinptiter          serv.
                                                lees  ii(,t,(I(@d  for  tlio  autonitt,ed  laboratory  procediir(@s  and  recordlceep-
                                                iii,,                   inedictl i)ro@i-.ti-n supl)o@t, @vill                         ii-,  iineovor  I)ctrt
                                                                                  stil-ok@-in     this      I)OI)iili-ttiozi      in-tlio earliest         stftges,
                                                              (lo(-,iiin(!iit:ttioii of t-lie                          type of illiese disor(l(@rs,  as-
                                                                                          ce
                                                      in tli(@ initiation of iie   ssaiy treatment, and aid in eV.
                                                ti,f@;itn@i(!iit, tli(,,se, I-):tticiits rece.,ive,,it, the ii(,iffliborltood lie,,tlth centei.-
                                                   'I'lle   ])Otelit-i@ll   of    t    coopci,,itll@e    al,i,@tligeiii(,,iit    1)(,twe,(Iln    a    miiltipliasic
                                                S(,i-(,t@iiiiig ],,il)orator
                                                                                _y      for the identification of need for ii-iedicil
                                                t])]-oii@rli   (@,li-lv   (Iiigii-osis   aii(I   of   t    n(@iglil)orlioo(I    lie,,tltli-ccxitei-    for    meet-
                                                ill-       flat         is    @ry    great.    Tlii-i     wiivity     would     hive     been     difficult,     if
                                                                          0       u,,(,crt@
                                                not                      t                     wit-lioiit.   t,lie   lielp    of    rooioiiil    nic(lic,%l    pro-
                                                (rilli@ill.@.  @11--tiiy  of i-lic                   ,iiid     iiiij)oi,laiit     clei-noiit-,     of     rexi6iiil
                                                ill(II(Iic:tl I)roLI.;Lllls           Present ill this olto I)rolec                                      Ig to
                                                                                                                                  t: Tlie,
                                                           ot-    1)i:@,i,ioiisly    di.;I)a,i-ate    elei)ieiits    of     ilie'iiiedica],                 @stein-
                                                I)jlovi(iiiiLy of iii:Lllpowei- 'I'Llid funds t@                   tliiiiL,@,    (loiic-iiiid    the     coniiil(,Y
                                                to            l@itli the i-ei@lly si,@iiific,,tn;t,                   is -@ies of our i-caion.
                                                   'I II(,.  involvement  in  rarrioii@il                            I)t-o,,,ri-aiiis   (if                     and
                                                                   ll)e(lic:tl   qcliools   i.ii(I   of   iiiiiiy   ofli(@r   inedi@e,,tl   schools    I'll    this
                                                coiiiiti-y,  is fair fi-oin siil)erficiil. ljiolee(l, iii. iiittiy                                        iriedict]
                                                S(@llool                                  in tlii3 P-stLl                   of ilic  regioiii.1  iyiedici]
                                                I)rof,)-i,,tiii  ;aid  tli(@so  institutions                   leiit tli(@ir expert                             ill
                                                                t,ii is i-nt
                                                                             jor      ne,-sv      proariiii.      Tlievti,o      itceOI)tilia      responsibilities
                                                1)(,Nroii(I tli(@ traditional ones (y@                            iiiedic-,t]     students     ii-ii(I     conduct-
                                                                        Tl)(@,v    li.-Lv(3    I)ef,,tiii    new    1)1-ogi-,iiiii    to    ti-iiiisltte     iiiore
                                                                t'll(@    fi-iiiifs    of    n-tedi-c,,tl    research    into     improved     ctre     for     the
                                                1)(@i      wit  ]I  ill   t@lle   I-eaiolis   that   t])@y   serve.
                                                                lil@("                        y   by       (serving iriy                -.iiid        entliu@siutic
                                                support;      to      the                                         iis pyo,-rani               -rcer(,
                                                                                                                                        I sii         ly       hope
                                                tli,%t      you will     1                           estiiii,,ttion of its grett importance.
                                                   Thank       you                                   of speaking before you today.
                                                                                                    lani.
                                                   .Nfr. RoGFR,-,.'
                                                   Are     tliero,,qny      qiies      ions
                                                   @lir. I-Zi-ros. I have oil]
                                                                                      .v    a.    few    questions.
                                                   Dr.    Cli,%I)iii,,iii    tnd    Dr.    Elani,    I    want    to     welcome     you     here     %nd     thank
                                                         r your statements.
                                                Yo@froCIiapiiiaii,    gn    @@cre    2    of     your     st,-(itenient     you     include     in     your     re-
                                                inai-ks that, @c,%sion,-tiiy              one    lie,,trs    the    view    tfi,,tt    the     medic,%f     Schools
                                                                                                 ioii-,tl     medical     pro(,Yrtin      for      the      purpose
                                                of                                               n slie,,tltli cii-e,-,ystein.
                                                                                                  i   illiit,   ,L   little   @it?   What    is    the    prol)lein
                                                tli                                                )loin
                                                                                                              t'li.,tt        lirgelv      bcztin      to      dis-
                                                                                                                       @t]   when   tile   ],,i@v    was    Cti-.st
                                                IPI)(Vill,    I illiililc. We hefted this a froo(I (IC,
                                                p,Lss(@,cl.   lit    ti(](Iitioii,    we    ]ttv(3     heard     fears     expressed     tliitt     the     medical
                                                              lliig]   I-,   siixil)ly   like   !fluids   fill(,    were    tvitilit))Io    iiiid(@r    this    law
                                                itii(I use then, for                         ongoing                     school
                                                   Of colii-.@l this -is not I)ossible                         tire   litw,   aiiil   I   think   I   call    sblto
                                                with    Laurance    that     no     ),nedical     school     is     doing     that.     Most     of     us     have







                                                                                    128

                                                                                                 ;III-iotllli"s  of  fluids   in   order
                                                                    I)rovi(lo(I til(@,               tii:tl-, we tieed(@,(l to  cli@ible
                                      to
                                      us  tl)  be  ilivolve(-l  effectively  in  this   I)rogj,,iin,   but   I   don't   think,   Mr.
                                      Kyl-os, tli:tt tlies(, critlicisiyi,;.,tre at the iiioiiielit V(31-Y ,(,,rious.
                                              l@A-IOS. .1.11 the, ,3t,:Lte, Of            1.  IliLV(@      tol(.'l   by    doctors    that
                                      one of tlie, i@,tliitbli3 b(@,iiofiti of tlii.,i  I)i-oLr,.Lin  is  tl),tt  in  @,,t  Stat-,e  where
                                      you (loil@t, li@LN-0 I. ]lie(] ictl school, ,is in                     I  iin,,tirine  there,   are
                                      other @'t,at@es in i@lio United                 tljLt   -don't   )i,,tve   ,t   me(Ti.ea.1   school-
                                      you    serve    t,ii    educational     function     by     disseminating     vital     and     cur-
                                      reiit,   iiifori@nitioji   to   doctors   who   iioriii,,tlly   would   ii@t    have    that    kind
                                      Of I'liforilil,t.ioll.
                                          3)1'. CIIAI.IIfA@N. YINS Sir;  and  n-I'Lily  of  us  ivlio,,tre  (le;tns  regt!-(l  niliiy
                                      of t-li(@, iiio,3(@  i)iil)orttnt  %sl)ects  of  tliii  tctivit;y  to  be  the  colitiiiiiation
                                      education f(@,.ttui-e for       physicians)    and    in    our     own     northern     tier     of
                                                       Kyi-os-of course, we                        three    regi    ns    there     Mtiiie
                                      @ittid"  Verii)oiit  are   septi-ate   re,,,,ioiis,   and   Al.,tiiie   is   tioed   in   with   Now
                                          IN,'o   trc,   inm@iiig   regularly   with    the    Mtiliciiid    (-,lie    Vermont    regional
                                      ine(li@1.1  program  otlici,.tls,  ;iid  one   of   the   i-ntiii   things   is   this:   ti@   con-
                                      tiiiii,,ttioii of ine(lictl education.
                                          -Nfr.  Kyi@@os.  Oil  pige  4,  you   talk   about   t@l
                                          i                                                      ic   desire,   perhaps,   in   the    act
                                      to   obtain   ,t    more    definitive    orginizatioii,,tl    guideline    ,tnd    to    reconsider
                                      critically the                      str@ctur(3    of    the    various    regions.     What     spe-
                                      cificlllv,.tre Von s i@-g@sting?,
                                                                           L 'Llld is a good cLso in point
                                          1)1'. @]fAl@31AN. New l@,ii I,                                              As     you      well
                                      ]@iiow,  sir,  New  Eii(,rltnd   @r   a   long   time   Was   b(,,(,@ii   working   if,,Clf   ts   I
                                      re(,rioii   with   the    northern    tier    of    St,,,ttes    focusing    for    many    purposes
                                      oil 13ostoii  and to -come extent oil                               Albany ts well.
                                          Our    present     regioiitl     structure,     will     undoubtedly     have     to     undergo
                                      modification.   Ill   i,@t,   I   would   sty   it    alre@Ldv    is    in-a    functional    sense.
                                      The northern t@ier of States is a -,finiltr                      ill    terms     of     population$
                                                 ('00("]'.tl)liy,,.tiid ineclictl licilth problems.
                                          Mr. ].:Yltos. 0                       11
                                                             ri page 4 ,tg,,i'                     ol)erttion    between    I.,ty     and-
                                                                               !   I   you,sfty   co
                                                        aroul)s,iii   desiLriiiiiL-.gucit   iii(lillo(Is-tl)!,It   is   of   setting   the
                                                                                                                   in@,,tetion         for
                                      t@lic            )live   been   most   iml)r@-sive,    but    the    bitlttnce    has    not    been

                                                                                                 (VI-olil@s              iiev(3r
                                          1)1'. Cl     l-,IrAN. I think it is i             of
                                                                                                                      I   said    earlier,
                                                          tlicr I)e@foi-(3,ire itoNv li:tviii,, to (lo so,,tii([,,t
                                                  ill  tll(@   State,   sonic   such   clifl'iculty   was   inevitable   and   indeed
                                      I)reetict,@ible.
                                          In  our  own  area,  the  bil.,tnce   is   coiiiiny   ,ti-oiind   very   iiicolv,   as   I   see
                                                                                                                      ("liz      'togetli@
                                      the operating in the advisory  (rioup, ivliicil has brou,                                          r
                                      POOI)IC     who     Tiftd     certainly     never     ,tpproaclied     any     serious     proposals
                                      tog@,tlier ioiiitlv.
                                          Alr.   IC@os.   !)o   I    understand    your    testimony    this    morning    to    be    en-
                                      tirely   in   favor   of   the   program   that   is   set    forth    in    the    acicbefore    us
                                      today 9
                                          Dr.    CI-IAPMAN.    Yes,    Sir.    We    would    consider    it    verv    distressing    in-
                                      deed   if   it   were   not   continued.   It   is   at   the    point    now    where    we    Will
                                      begin to obtain the critical information we                      need    in    order    to     bring
                                      forth   a   program   that   will   really   do   the   job,   and    will    really    carry    out
                                      the intent of the original act.





                                                                                                                7               7





                                                                        129
                                    iN[i,. l@ytzos. Are  you  satisfied  with  the  $6,-)  million  provided  for
                                    1)1'. CIIAI-TIAN-. I aiii really in iio position to spetk to that. I  believe
                                  under the circumstances it will take us the next step.
                                      I      -1@                                                               -ii n
                                    @Ali-. l@) os. ])I-.         I understand your iiiiili,ipliti,sic screci
                                  till-li('(l 111) iitei,iiio cancer III I)iiticiits that would not otherwise litiv(3
                                                 Yes@ @ir; Valid the, results of the sci-(,@eiiing will be sent to
                                  t (lo(@tor in the ;anticipation of turning up such things.
                                                            you.
                                         @ARTI@,']I. No questions.
                                    iNIr.  IZOGEIZS.  It  has  been  helpful  to  have  your  testimony,   Lnd   -,Vo
                                  ,tpl)r(T,i,,ite -your sharing your  l@iioivled(,Ye  with  the  comynitfee.  I  hope
                                  that                          @,our  uzze          or   ,tTiy   improvement    thtt
                                                            Ive        s     sel6n f
                                       -you 'vill lot us 11@
                                  you  tliiilc ih@, pro,,rtiij  -,Iiould @idert,-,ilce.  Ptrficul,,t-rly  I  am  con-
                                          @tl)out  bringing  in  more  hospittl  people.   I   think   maybe   tl-iis
                                  balance tli@it you are  tallcina  tbout  the  p(,,ople  in  tl-ic  pro(yram,  along
                                  with  the  ii-iedicil  I)eoplc-l  think  it  lia@  g6t  to  involve  more   people,
                                  and I would lilce t@  g6t  more  dettils  if  you  could  submit  that  to  us,  on
                                  your c@x,,iiiiiiittioii prorrrtm. I  think  this  could  be  most  helpful  to  the
                                  coniii-iittee.
                                    !)r. C.IIAP.-,rAN,. Tli,,tnlc you, Mr. Chairman.
                                    I\Tr. r@,ooi,,Rs. Thank you.
                                    The committee stands ,idjourned.
                                    (IA'Iiereupoii, at, I'-)i:,IO p.m., the coiiii-nitt'ec ,tdjotirned, to  reconvene
                                  :at 10      Wednesday, March 27, 1968.)






                                               ITEGIONAI, IIE@DICAL PROGIZAilIS; ALCOHOLICS AND
                                                    NARCOTICS ADDICTS FACILITIES; IlriALTII SERV-
                                                    ICES FOR DOMESTIC AGRICULTURAL MIGRATORY
                                                    WORKERS

                                                                           WEDNESDAY, MARCH 27, 1968

                                                                                         I-lousn or Rrl'RE,,4ENTATIVIS,
                                                               SUBco@Nf               ON P'UBTIC I-IFATTll AWD Wr@,irA'RIO,
                                                                  CO@t,Nfl'l-rFF, ON INTFRST@,@TF AND FORPIGN CO.@IrRrr,
                                                                                                                          Was7bington, D.C.
                                                    The subcommittee iyiet it 10                       piirstiaiit    to    notice.    in    room     2322,
                                                    Ra3,burii   I-louse    Office    Iiiiil(ling,    Iloii.    Ptul    G.    Rogers    presidiiig    (Flon.
                                                    Toliii
                                                                                  I r
                                                                    ntii-iiie licariii(_,s oli 11                          dticed I
                                                                                  -ii:,,4;rs of V                        ,tnd ol-ir
                                                                         oi         @ieliarcl I)iLley,
                                                                    lit   wllo.,;o    statement    W:
                                                    Nvllo is tl         it-,i%-O(Iir(,ctor  of   Clii
                                                    Al,,() i,i   d                       ve   you   w       s Miss Siiyd                      will       be
                                                    I)l eii s(@d I11                     io iiiayor's sttt-,eii,ictit.
                                                    STATEMEN                             CHARD J, DALEY, MAY                                  0,      ILL.,
                                                    PRESEN                                IS  K.  SNYDER.  EXEF,                                  DIRECTOR,
                                                    MAYOR'S                     COMMISSION  R THE                           TION         OF         PERSONS
                                                    AND          CHICAGO'S          ALCOHI
                                                             SN-I-I)]-'.R. 1',Alr. Cli,.Ii
                                                    this    opportunity    to    add     m
                                                    for   i)assaae   of   fitle   111,   p                                           t
                                                    Reli,,LbiliCatioii   Act   of    1968.
                                                             n ellici,,o ]live long I,                                           in      adequate      Pro-
                                                    grain Of -,tlcoliolisn-L care ,tnd,                                     y      =of       the       fine
                                                    roI.
                                                    '%N  Ic   beinz   done   tt   C                                                         a      muni.ci-
                                                    )'tl y   Sill)];,Orte(I   ficili                    11                      72   rn,,iles   and    out-
                                                    ll),,Itlieiit services tA)  In(                    II.                   has       been       operating
                                                    since 1957.
                                                     4".\fy Collilli@                           lit  ioll,                    22   very    :ibl(,,    dedi-
                                                                                                                                                is    alco-
                                                                                          citizens,     11
                                                    liolic  1)                       needs     to     Come                                     55.      Our
                                                    tl,e,ttirii                       rect result of their re
                                                                         of this commission ll,,tvo eoiifii-nie,                                     within
                                                    oill, fi,,               to ii-nplei-nent the lcincl of coi                                        am
                                                                       cess,,try. Inasmuch as Chicago and
                                                                         00 alcoholics, more tliaii oiie-hftlf of tlii
                                                                                                    131





                                                                                       133

                                                                                               III(I sill                                   n-
                                                              iII13 coiilinitt(',(. if  you  (,O                  c     ver.)r      interested
                                                                                                                types      if      tr(@a,iment

                                                                                                                                             t


                                                                                                   this coinni ttee,     I)r.          Michael
                                                                                               (,,iit   of    Surgery,    13,tylor    Uiiiver-
                                                  s                                   ii,   Tex.
                                                                                               as    oil    the    President's    Coi-nmission
                                                                                                  was    really    the    (,rui(lincy    force
                                                  f,
                                                                                                       9
                                                                                                                             to        receive
                                                                                                  @nd we vre pleased
                                                  youi t i-iiony,.ttthistime.
                                                  STATEMENT     OF      DI[t      MICHAEL      De      BAKEY,      CHAIRMAN,      DEPAIELTMENT
                                                  OF  SURGERY,                                 SITY        COLLEGE        OF         MEDICINE,
                                                                     BAYLOR               UNIVER
                                                  HOUSTON, TE@ X.
                                                                                YOII.      :iiii, irriti,o@fiil  for  t@ii(@  I)I)oi@i,illiity  t
                                                                                                                       0
                                                  tr:tlll 11 I)f)o,:tr -ol-o i@iiis            ii@ @l@ (li(I oil Tilly 7, il,!(I)5  ill  slip-
                                                                                                 ii i(I to          oil i@ii(@ir
                                                  Avoill(i lilce, I()       iiiy thinks -foi, @%,l Iiti@
                                                  (@lli)il,o CoillilliLt.,eo oil                                          Iiitvc   doii(@   to
                                                  develop this I)ro4yrtiii, ti I)rogl.:Ljll wili(..,Il is ,ilrctdy  Sot.i-,ill("  -,I  pattern
                                                  el II' ,i@] I
                                                  fol                      "ti-O
                                                  I coiiie, before you ill -,t-,rOD(,r Fill@t)pOrt', of      I   of   II.R.   15758,    intro-
                                                                                                              Mr. St,,(i,g
                                                        y  t-,Ii(3  chairman  of  your  fill]  c                          g(@ i@-.
                                                                                 " f tli(i Nttioii,,il, Advisory Coiin(,ii        oil      Re-
                                                   li:tv(@ ])taii t iyierribcr 0
                                                                           ,tms siiim,  its  creation,  -,iii(I  1,  tli.cre,for(l,  have  had
                                                                                                                           ises,  ,tiid    see
                                                                                    pro,,)  ni iTi it-,  pit  iiiiig ph,
                                                                                         ry ts IV6 1-toped it would.
                                                                                        I     b,                                 n
                                                                                               tve  been  @uilty   of   imj),,ttic   co,   but
                                                                                                          I thi@k, at a
                                                                                                                           normal         pace
                                                                                     bqs developed
                                                  and in a very soun   way.
                                                  Now  we  are  at  ,b  r  oint  where  I  think  we   will   be(-rin   to   see   the   first
                                                  fruits  of  this  pro,-r,,tm  in  ternis   of   its   original   obj@iive   which   was   to
                                                  provide  the  best  possible  care,  for  the  T),,tti@nt  at.,ill  levels'of  our  society,
                                                  ,in(-.I  to  extend  this  Iciiid  of  care  to  every  eitizen.  This   was   a   need   we
                                                  have              but were not -,il)lo fully to tcliiove ill the past.
                                                    1)(@lio,v@  this  progr.,tni  will  achieve  its   initial   objective-".,   ceit-,Iil-kly
                                                  ill tll(i    of   I)CILI-T          citii(,,er  itii(I  stroke,  and  liope-ftilly  ill  all
                                                  the          trets.
                                                  At@ tliis I-.iii-io      iti-t)                     f the  let-"i-,Ititioli  I  would  lilce
                                                  to dis(I'li,,s in moro,,pecific t(,rins. You  will  recall,  Mr.  CIiiiii-i-nftTl,  ill  the
                                                  01@llalll,tl. @'Stiii-ioiiy, ,tii(I  in  the  ori  in:tl  bill  there  was  much  discussion
                                                                                               9
                                                  of milsi,,i-iiction authority.
                                                  I   think   the   committee   was   Nvise    in    pointin    out    that    without    this
                                                                                                        I"Il'
                                                  type    of    autliorizittion    for    now    consti-tiction-tiiere    was    authorization





                                                                                 134

                                    for   1-ciio%,;tt.ioii-tliit   the   program   would    not    1)(3    jeopardized    in    the
                                                            we  are  iii  the  ti-eit  of  a(.-,tiitl  operation,  tiid  tli,e@ld
                                       \,ow,
                                            ,ii,()  II  1)ro-i,-,tins  fiiiictioiiiii,,.  I  would  say  bv   the   next   several,
                                    itiolit-llq,          40 or r)O percent of the                    wiil   be   in   some   Phase
                                    of ol)er;ttioii. So we, tro morning, you see               ite  I-'tT)idly.
                                                                                           qii
                                       -,ks we movie into this               (!oiisi i-ii(@tioii
                                    iilgly illol.(@              'tire[ tlreit(ly we ll:tN,e               Of tl)iS IteANI.
                                                                is ftirly    sl)ccifi(, iii          i-L)i(I f:tit-ly lityiited  iii
                                                is ]lot-, oil tile s:tiil(,                  existiii4r                 n  c    l'i
                                                                                                         co)isti-ii(!tio  n
                                    Nvitiiiii tile iii(@dictl  e(,,ii@r.,@eoilstli-itetioit  for  wliicfl'the  c(,@nt(,,i-stlt-etdy
                                    Iiiti-o tile, ittitlioi,iz-.ttioii if not, the i-noii(@y.
                                       NoNv, the (-oiisti-ii(-tioii itiitliori(-,v we           for t@lic
                                    I)rogi.,-Ll-ns ;tl)l)lies I)I-illl'tl-i]Y to the  (@011111111i)ity             and    to    the
                                    lliol.(@              units,  where  tile  I),Ist  (@olistriief,'Ion  has  xiot..tnticil),,tted
                                    this t@   @ of  )roLy-riiii.
                                       11    lo                                            is (lo(-iiiii(@iitittioii and  oiitliii-
                                         Of tile, A-It],Iolis t,
                                                   I           -VI)es  of  e-oiiqti-iietioii   needed.
                                               I    slloiildlik-@to    do,Mr.     Chairman,     i,;itliertlitnt,,il@e     yoiirtime
                                    now,  is  to  subi-nit  ,t  formal  -,tateiiieiit   for   the   record   within-   t]-ie   next
                                    few  d-,tNs.  I  had  liol)ed   to   have   this   reidv   for   voti   tod.%y,   but   I   got
                                    ini-oli-eA  iii  t  series  'of  emergencies   over   tl@,   weell-eiid.
                                             roGF.R,%.    IVe    understand,    and    without     objections     your     form,,tl
                                    statement   will   be   made   t   p,%it   of   the   record,   following   v6u'r    testimony.
                                       Dr.   T)El3Ai,,ry.   This    is-tlie    limited    but    well-defii@d    need    for    new
                                    coiisti-ii(@tioii.  I  leave  to  the  coniniittee's  jtid(,iiieiit,  ts  to  how   this   best
                                    slioii](I be
                                       ',]lo-%v me, to I)oiiii@ out tli,-ii- it- is       i:il for t ]to future <) f t])        ro-
                                    cri.,l II I t,o f i 11 (I )I IC,,I )I,, o f II I(,(@t i I II liese ll(,e(Is o l@ tile Coll III) 11 11 i I-,y lios )i tS.
                                                                                                                         I     :11                     I;    @ :   ,
                                                                                         -Y          of
                                                                             ]:Ll)ol.:It ol
                                            of
                                                         ].(@,ti ill,,- to ]lo List (list,@           all([                    out-
                                            II           siiiil)ly  (It)  iiot,      this   t-yl)e   of sl)itce               ,-tnd
                                                   ll:i%,("             of   fii)(Iiii(r 111(@'I'Iiiids to   provide,    I,Iiis'kin(I
                                                y
                                    of (.ol I Si auction.
                                                  Nf t-.                 ivoill(I                          I i:i.ve             the
                                                   s                                                          I    IC el
                                            iii fail  pr<)gi-.tin where we must.       look  to  the  full(  i  ig   v   s   ov   r
                                    tll(,. (,.o..,(, of                 will retcli tile              we    Visualized    in    our
                                    of-igillii coll(!(@I)ts -Ill(i tile ori-iiltl 1)1-01)0,S-,, Is ill the                     Com-
                                    ii Ii,@-ioii',, i-(@l)ort.
                                       )-oil  Ali]]  recill  fliqt  we  (-,xy)ect,  tiara  to  reach  ititliorizatioii  levels   of
                                          over $4.@)O million     by  tli(;eii(:l  of  -)  years.  Now  we  %re  I)e,.yoiid  tli,%t
                                       oint iii our tliiiilciii-   aiid we iio-,N,          better   evidence    of    wliit    the
                                    p
                                    needs ire goiii(,r to be.      I  would   say   they   will   al.)I)roxim,,i,to   $5   or   $10
                                                                 within  tile,  next.  r)   yeirs.   Therefore,,   I   would   hope
                                                                          -its -ititliori  at  ioii  It@iT]s  of  some  $500  in'l-
                                    tile, (.committee will coilt@lyll)],                 z
                                       riiis level ivill' iiot@ ]lo               Soon, r)f coiii-so. .1loNN,Cvor,     I   ivoill(I
                                    their]( 1).Y I f)71. NN'C, Nvolll(l be (,]O'.4) to @tlie $'IOO million level.
                                       I Nvo;il(l Iloilo by their, triple tile ol)l)oi-I iiiiit@i(@s ix) 1)rovi(lo  f  training  at
                                    this level Nvotild 1)@ reform reitdily av'jt-illtl)](3 truth itt"t@Iiis iiioill(@lit.






                                                                                                                          135

                                                                                                                                       :iiiv qlie,,,tiolis @'oll
                                                                                                            iyl;,(l      to
                                                                                                                                                               for  criviiig                 us
                                                                                       Tii-,iiil,: you N,(@ry I'llic@ILI
                                                                your vlel\!])Olllts oil this pi-ogra@ii a@@d its inil)ort,,tiice.
                                                                ('oil]([   3-oit    giN,e    us    all                    ol 01113                     you       ])IIY        be        ',IWtre
                                                                of,   or    iiityl)e    you    would    wiiit    to    do    this    in    your    st-,ttp-iiieiit.
                                                                                                                                                                                       y
                                                                                                                                                                       it,   1(,t    III
                                                                              I)I'ovi(le          this                            -,vo;[](l  lil@e to dis(,ti.,,s @iii
                                                                                                     ily LGUI)tC(l tire  to(,@ll                             of tll(3
                                                                                          )lot      oi
                                                                bi@it  Eric ii@iliziii,,,,        1)rogl--,Ilik ill ;t ))lost                         iN,,ty  to   I)rovi([(.   the
                                                                   cii]@ir tliree eleiiielits tll-,it. I tliiiilc
                                                                            I-),tt,iciit care. 'I     ,Iles(,     tlll.e("     cieliieiit,,i     lylll",t     be     conibiivcl     it      the
                                                                lev(.,Itt   -vnrllicli   tli(,   I)hysiciaii    n)eets    the    i)(,tticiit.
                                                                                                                                                                                tiid          I
                                                                                       This     li-,ts      been      iii@,                 Nvitli the 1)rogi-,,tiii,
                                                                r(@:1-liz(@ it is still very Yolill','. l@lit. I Ilil 1)(@giiiiiijig t@ L,(@t,
                                                                                    is     ]lot,            ,iig  tll(@  1) -.tcti                                yet.      It      is      not
                                                                (-IO"N,Ilt,otlioliospit,il.Itliasstopl)e(                 ,I,,It @t little li'i,,rlier level, iit the (Icaii's
                                                                ollice.
                                                                              IlAici,y. This is                                         ,tt     the     pl,,tiiiiillg     st',I-     -     Only
                                                                .tt the 0I)er,,Ltin,-, staae will they be@,iii to feel the 1)rograin.
                                                                ,rll(@  latest ilill-)Ortl,lit tlii]iL,7 to iiie is tli   fict that t-be i)ro@r,-tiii                            is      l@)pl-
                                                                coiniiig       ]letter       understood       by        the                     i)liisiciaii,       "Iii(I       there       is
                                                                deve,l(;i)iiig tii ciit,litisitsiii for tli(,, I)i-ogriLiii It, tll(@ gr,,tssi-oots level that
                                                                re,,i,lly 'is in striking coiiti-@ist to ,-oiiie. of the earlier experiences.
                                                                       IZo(.i@its. Tlitt is right. I reiii(@iliber very vividly.
                                                                                                                                                                                re        )tlou
                                                                f(tel t I I1) I -og I -,I            lig   (,    .1     ive                 t-o the coiiiiiiiiliity lio.,                     11,
                                                                                       I)eol)](@    iii    the    (-oiiiiiiiiiiiiy    tri,     1,(N-Llly     begiiiiiiii,,,     to     r(keeivo
                                                                t
                                                                                            NN,oiil(t I)(. liell)f ill t@o tll(@ (@ollililli@t,ce,                         to
                                                                                               so that, other, iil.(@@ts (.,Itll "(@,o Whitt, is
                                                                illos(,
                                                                 I )I-. ])I,; li,@             I   evil]   be   very                  to (lo  this  rl)(I  include  it,  ill  the
                                                                                I %%,ill file witlil you.
                                                                         il,t(@(:,,:,,s.,rii;tiiic       you.
                                                                     I-.  l@.v   1-os'?,
                                                                                       Wo:tl.e,     litil)l)y     to      I
                                                                              I:)i@   rt                                      that, You are ttill@ill(-Y' ',I.I)oll(, AN
                                                                still  li,,IV(3 to I)o )Illt,itted ,it                the loc:tl  level  iiid                     @ii     by      the      A(I-
                                                                vi.Sol-Y (@Illicil.
                                                                                               Yes;       Vll(l        they NVoill(I  also  leave  to  '4110W  jll"tiric"ttioli
                                                                                                     in             Yuideli @.,,    ,is    bein,r    essential     to     the     eflicacy     of
                                                                ,is I)eiii(,- within           cert,,t                    11
                                                                this progr.
                                                                              ,Else "Ill   l@iii(Is     of     construct     ioii     needs,     but     -%v(3     have     various      tvi)es
                                                                of colist@rtl(,tioii       ai-itliorities,           ,tiicl I     -,i-otild      think      the      important      thing      is
                                                                that    we    liii-iit    t;lie,    coiistri-ictioii    to    the    neec.Is    of    this    progr,,tl-n    -     that     is,
                                                                wlierc@,      it      can      be      deiiioiisti-ate(I      unequivocally      that       without       the       C'Oiistruc-
                                                                tioii      sli,@e      the      proarLiii      couldn't      be      effective,       eoiildD.'t       be       inil)lemente(l.
                                                                  -.,Nfr.-Kyllos. I                   know   ]low   familiar   you   are,   sir,   -%with   the    money
                                                                re(iiiii-eiiients      of      the      I)rograiii;      but      the      fi(_rures      Yesterday      were      that      it
                                                                Avoill(I 1)0 II)Ollt $,Oo million (@;irryover from tRe last -fiscal year, Iiid
                                                                tl I(" I)i II this ye,%rc,,vrries$(;5 ]Ili II ioll.
                                                                          you think $05 -million -%vill be                       enough   for   this   kind   of    plftiiiiing
                                                                this  c4)iniiig   year?,









                                                                                                                                                                  I .                @  r@     :      TiI:,:
                                                                                                                                                    I  @                                      r                           ,;






                                                                                 136

                                                             lArelli if I read tli(@,             ion   within   the    next,    year
                                                    -%N'oill(l sly NN'O WOIII(-L (,Olllo (-,Io',.O tl() tll@it) Certainly;         I
                                   (Io] l't IIII II lz i I.@is (,-()i
                                                                       -.ii)oiit, is wl)(@-,ii  @@e  get  into  the  ol)oi-,ttioiiftl
                                   I)II:I,@o NN'it'llill the               6,t@V  by  11)71.  1  would  sly,%vitliiii  this   2-   to
                                                 -io(I          "Oill" to         real
                                                                                                  ioii ill .t(@tivity and,
                                                                         i,liill]CYOII very much.
                                                        Ali-. Nc,].@ii?
                                      @Nfr.             I have 110 (IlleStiOlIS.
                                                        It iSIll 1101IOr  7 Dr.  Do  Bil-:(,y,  to  ]live,   you   ])ere.   You   are
                                   so  well  luioA%,ii  to  Ti-i,,tiiy  of  us  ts  being   @bsoIutely   dedicated   to   the   serv-
                                   ice of liuiiiiiiity. Wo,,tre lioiiored to litvo you here.
                                      I -%voiild  I  am  to  -tsli:  ,tl)out  bow  the  funds  that  you  wiiit-ftro  tli  ey  to  be
                                   for something similar to intensive care units in ditroreiit, lio,-,plt@LIS?
                                      Dr.   Di7   BAIIEY.   Yes.   Well,   some   of   tlieiii   would   be   used   in   tliit,\vay.
                                   For   example,   let   us   take   the   community   hospittl   that   is   ill   ,t    pFO(rrlin.
                                   'They need tnd can use, ,,tnd in L sense m, n                I 11 ill)oi-t@ all i ii tensi i,p- care
                                   unit;  but  the  hospital  is   built   in   such   t   wty   tilit   they   can't   even   reiio-
                                      Youaref,Lii,iiliarfroiiiyoiirownexperience,I,tiiisure                               ijiyotirown
                                   area   of    Keiituclqr,    where    hospitals,    even    those    built    with    Itill-Biirton
                                   funds,.ii-c  now  so  jai-nined  treat  it  would  be   dei-iyin-   the   use   of   tlip,   space
                                   for some    VCI-N-             purpose.
                                      So they licc@'d tdditioiit'l space. To I)iiil(-,l this,             they   late   to    Iiitv(,
                                   i-iioii(-.y.  It  may  be  t  relatively  sii-itll.  siiiii.  It  iniy  amount   110   t   hundred
                                   thousand   (Ioll:trs,   but   it   is   still   money   tlitt   is   hard   to   find   for   this
                                   Pli@ll)oi,,(,,.
                                           I  tciisii,o  care  unit  would  be   one   wiii(,r.   Ajiot@lier   would   I)e-I   liol)o
                                   my  colle,,ttrlio  will  point  this   out   in   his   testiii-ioiiv   to   voii-iii   terms   of
                                   aciitle  strolc(3  units.  Thei@o  will  be   dii,(Yliostic   facilities   ;f   certain   specific
                                      We  I)oii-it,   out   in   the   Surgeon   Geiier,-tl's   report,   which   the   Council   had
                                   the oi)i)oi-tiliiii-,.y to review, the tyl)p-,3 of spice                    They     will     need
                                   Classroom                   This is the ]@ind  of  Space  that  is  essc@iiti,-tl.  to  c:k.i-i-y-
                                   ing out the, I)roartin.
                                                                       We  ]live  SC(@ll  illiit-,  many  of  our  11(@Sf)itltls  ill
                                   ill)(@, siii:tll(,r      'I-ii(i T@ im sili@-0 it-, is I,I-Ilo ill    1-111.1@t, ill the       few
                                   ye:l@i-S             has                    but, still it is
                                            I)i,, ]iA)II,,Y. Coii-il)let(,Iy                              it,  doesn't  t,,Ll@e  into
                                   coii,,,ider@itioii   these   ]finds   of   needs.   They   didn't    even    visliftlize,    these
                                   ]acres   in   tli(3   early   pliiis.   Their   concern   wis   with   imi-nediate   n@d,,3   that
                                   they had to nit,,et.
                                      ,Af r. CAltl-11,R. I SOO the ll('P-Cl of tliese thinas.
                                      Dr.  DI@',  BAIZl@,Y.  Ally   I   say   to   you,   Dr.   Otrter,   that   it   wts   part   of
                                   your   un(ler@t,,tn(-Iillgy   t,@iLt   helped   produce   this   program,   and    I    want    to
                                                      ,tin for your insi,,,I-if into this whole pro-ram.
                                   think you a,r,
                                      Mr.               Tlii,iilc you, ;ir.
                                      .Dr. 1)1,' ]@AICIOY. It. wi,; i, tremendous help -to us.
                                      Mr.               infi-. 13]cul)itz?
                                      Mr. Sicljiii.,i,,7. Tliftnlc you, Mr. Cliitirinitn.





                                                                                                       137
                                                                                          r. I)o lit]@ey, I)itt I want to jo in my
                                                         liti,@re iio                 D
                                                                         yoii liere  today.  I  tiil  lool@ii)g  forward  to  receiving  your
                                                             J)].,,             I want to                     my  itl)l@recitltioii  to  t'lie  commit-
                                                                                         ]@ill(lilp-"s:iiid g(@i                tl)ey  liav(,@  iliown,  and
                                                         tee, -for tlio ivi,,(Ioiii t,iid                          i
                                                         it, is roo([ i(@ lilio%v 111(@l-o are I)III)Iic,                  Iii(o Yotil-,Solv(",i.
                                                                                                                     l'ollo@vs:)
                                                                   Ole ;'%IICIIAII:Y,                             I'l@ole],,Ht4OlL   ANI)    CIIAI[t,%fAN,    1.)I-;I'A[Vr-
                                                                                                                         Ole MI@;1)1(;JNIJ;, I iotlf4,j,4),4, 'I, @;x.
                                                         NE[-:NT 01@ Stilt(jl,:itY, BAYIi)lt UNIVII:Itl@31'rY (@ol,l,l
                                                         ,\II-. ('Iiiiiriiitiii :iii(I members of the                        I sun                   1)(@    ft;tk(!y,
                                                         l'i-of(@,4.@or ,iii(i ciiiiriii:iii Or the I)ei)iii-ti@i(,iit of Surgery, Baylor IJiiiv(,i-,.,ity        Cot-
                                                         l(@ge of )Iediciike, in Iloustoii,           I had tii(,@ iiozior  or  i)(,iiig  xitiiii(-@(i  ))y  President
                                                         Jolii)soii a,,; the Chairman of the Coiiiiiii.,isioii on Ifetirt                         Cancer,          and
                                                         Stroke,  whose  report  led  to  the   initial   re(!oiiiiiieii(lat@io)li   of   the   Regional   'i\le(lical
                                                         Programs )(Coalition which tl)i,4 coiniiiii@le(@ (I(,@velol@(@(I and passed in                          Since
                                                         it,, (,i-(,,,ition, I have   a    member    of    the    Natioiiit    Adi,isory    Council    on     Regional
                                                         @Nledleil   Programs   and   im   also   a   member   of   the   Itegioii;tl   Advisory    Group    of    the
                                                         Texas lt(-@gioiiii Me(ii(,al Ilro,-rim.
                                                         I  testify   today   in   ,4troiig   support   of   Title   I   of   II.R.   157@-)8   introduced   I)y   the
                                                         distinguished   Chairman   of   your   full   committee,   -iN[r.   Staggers.    If    enacted,    Title    I
                                                         world   extend   the   authorizing   legislation   for   Itegiorial   Me(licil    Prog    'Iliis    for    an
                                                                                                                                                   r
                                                         additional   five   years   as   well   -as   clarify   certain   technical   aspects   of    P.L.    89-239.
                                                         I   would   like   briefly   to   reiterate    the    basic    concept    of    the    Regional    'infedical
                                                         rrogriiiis, the future of which this subcommittee is presently considering.
                                                         The     Regional     Medicil     Programs     comprise     a     group      of      units      added-wherever
                                                         I)o.@,,ible-to    already    existing    medical    centers    in    regions    throughout    the    country.
                                                         The   units   are   part   of   the   overall   research,   teaching,   and    medical    care    going    on
                                                         within the medical centers in regard to heart disease, cancer, and stroke.
                                                                units together iii:tlie nl) t national n(,hvorlc for
                                                                                                                                     research,      for       teaching
                                                         lieNv  (levelol@nieiit,4  to  doctors  iii(I  nurses,   itid   for   care   of   patients   under   iiivcsti-
                                                         g.,itioii.   Thus   ci(-Ii   physician   served   by   this    network    has,    readily    accessible    to
                                                         him for his patient.,;, LI)e full range of                     knowledge      and      skills       developed
                                                         tliroii,,Ii nntioii-wi(Ic              At   tli(@   s@iiiie   time   the   doctor    contributes    to    re-
                                                                   his ol),,ervitt,ioii,4 add to the total ](Yiowle(ige.
                                                         search, for
                                                         14'  a(,Ii  of  these  units  we  trc@  discii,,,ii  a,,  has  its   own   facilities   and   staff,   though
                                                         they   function   as   part   of   the   existing   medical   work    force,    to    pull    together    and
                                                                                        otirces now in existence.
                                                                   the medical res
                                                         The    Regional    Medical    Programs    as    initially    aiil@.liori/e(l,    placed     principal     em-
                                                         pli:isis   on   regional   voltiiittrism,   as    the    means    by    which    their    goal    might    be
                                                         achieved.   To(lty   I   can   rel,)ort   that    your    confidence    In    this    approach    has    been
                                                         well   priced.   Within   the   last   three   years   r)4    Regional    Medical    Programs    have    been
                                                         brought   into    being.    By    this    summer    approximately    one-hfllf    of    these    will    have
                                                         elitA.r(.(l    tLe    operational    phase.    The    remaining    regional     programs     will     shortly
                                                         thereafter begin operation.
                                                         With     its     emphasis     on     voluntary     cooperation     the     Regional      Medical      Program
                                                                  n has managed to birness the creative energies                   of      practicing      physicians,
                                                         niecliatilsi
                                                         pitnl,.4, iiie(li tl school.-;            -tary, state and local h
                                                         he,,            c.              , voltin                                   eiltli    agencies.    All     too
                                                                                         e   creative   energies    have    been    isolated    from    one    another
                                                         frequently in the past tlies
                                                         or,   even   wor.@,   in    competition.    Regional    Medical    Programs    make    it    I)orsible    for
                                                         ill   providers   of   health   ,,erviecs   to   combine   their    strengths    to    improve    the    care
                                                         of   patients   with   lictrt   disease,   cancer,   or   stroke.    Thus    our    aspirations    of    1065
                                                         today are worl@ing entities.
                                                         One    of    the    most    important    developments    is    the    large    and    increasing     involve-
                                                         merit   of   the   medical   profession.   In   a    recent    speech    the    Ilresident-elect    of    the
                                                         American   Ale(liciil   Asso(,iiitioii   said,   "As   a   ivhole,   the   medical    profession    at    the
                                                         beginning   of   the   year    li)68    is    probably    more    deeply    involved    In    the    planning
                                                         I)rocesFi   to   (lel@eriiiin(-   tlic,nitiire   of   the   Itegloi)al   Medical   Programs   than   It   has
                                                         be(tzi in the planning of any previous 10e(lerill i)rogritiii.11
                                                         Now    in    considering    t@lle    future    of    tlie.4e    Ilrograins,    Mr.    Chairman,    I    would
                                                                                                                    committee.     I     was      disappointed      to
                                                         like to discuss the legislation before your








                                                            tlifit Till(@ I of tli(@ ])ill (lo(,@ not I)i,oi)(@(@             to I)ro@t(](-Il tli(@ (-ojistriiet'loii  tititliority
                                                        for lt(@gioititl                   Ili-ogr.-tilis. I)iii-iiig tli(@  iiiit,i:il  li(,iiriz)g8  before  tlk(@  Iiiter-
                                                        :ite nii(I 1,701,(,jll Coiiiiiieree Coiiiiilitte(,@ oil lt(,gioll.'il '@k
                                                        .,t                                                                                       Ie(lic.,tl Ili-ograiiis Ili
                                                              i%-:ts     iiiu(-Ii     testimony     t)i.,it     coiistructiori     iiitlioi-ity     NA,oii](I      be      iiecessarv      if
                                                        ti)(,  re(itilr@,iiieiits  of  tlif,  legislation  @v(@re  fiiIIN,  to  be  iii(@t.  The                                           in
                                                                              ])ill    (](-It@ted    (110.    authority    for    iiew    coti.,41@rtiction.     In     its     report     on
                                                        ill(-    bill    file    e<)iiiiiiii@tee    reasoned    that    the.    1)rogi-.iiii    N%,oul(I    not     be     jeopardized     by
                                                        the ]Seek of site])  @tiit@lloi-it,Y ill its itiili:il                                                 Ftirth(,,rinore,    the
                                                                                                               Ili     which     new     coii.,;trii(,-tion     iniglit      be      required
                                                        for     lt(,gioilil     Ale(lical     I)ro,-r:iins,      ot'li(,r  F(!(Ier.,il                 of       funding       should       be
                                                        S<)Iigllt. Filially the coiillalitcec ill it4 rel)ort indicated its Intention to revlew
                                                        thin,; (1110.@tioli fit the time of the legislations (.Xtell,-ioll.
                                                                                    I  NN,oiil(l  lilie  ti)                       Ilit@    (,oiniiiitte(,,'t4     wi,,;doin     oil     this
                                                                    Ili  f@ict,  tire.  lt(@,ioli@il                      Ili-ogr@iiiis   Iiitv(,@   not;   been   jeol@tir(liz(@d
                                                        (Iiii-ilig          I):Ist     three     y(@,,Irs,     during     ivlii(-Ii     Ili(-y     lk:i%,e     organized      tliei)iselv(@s,

                                                                         tlii,,  sitti:ttioii  is  r4ijoi(Ily  (-Iiiitigiiig.                         -12     of fli(@    1)4    lt(@gloiisil
                                                        Ilrogrttiti,,   are   ol)(@r@it@ioiiil   ;iii(I   wit,liiii   tli(-   iio@xt   y(-itr   or   so   fill   of   tlieiii    will    have
                                                        l@(@giiii   ol)(-riiiotis.   i@(-(,()r(Iiiigly,    t.ii(@ir           for     st(I(IiLloli:il     ftt(!Ilities      will      rapidly

                                                               Stirg(@o-,i                     ltel)ori@ to the Ilresi(](@iit find                      Congress        oil        Itegiotiil
                                                             -:II  1,1,(igi-tiii)s                       I    IC    ("tse    for    Iiiiiit(-(l    liegioijitl    inle(liciil     Ilrogr@iiii
                                                        coiisl@1-11(@tioll  'Itilliorit.Y.   IL  is      ext@r(@iii(@ly      iiiil)ort;iiit       t,o       understand       that       these
                                                        facilities NN,otild I)riticipally  be            locat(@d     Ili     coiiiiiiiiiiity     hospitals,      not      our      ine(lical
                                                        schools.
                                                        ],,xaziil)l(!s of                  cozi)jiiiiiiity      hospital      (,oii,,tru(-tioii      described      Ili      the       report
                                                                 (-Itss iii(I                         r(joins        for        regional        continuing        education         programs,
                                                        space     for               (](@niot).,4tr.,itioiis       of       coiiiiiiiiiiity       patient       care,       and       expanded
                                                        diagnostic ]Laboratory f:iciliti(!s.
                                                        These     i)(@(@(Is     ii-c     not     now     being     iiiet     under      exi.'4tilig      Federal      construction      I)ro-
                                                        raiii,4. Tli(,r(! are t%@,o interrelated i,eisoiis for t,liis:
                                                        9
                                                               (i              (.oitil)etitioii     for      l,'e(lei-al      fuii(l@      for      the      construction      of      health
                                                          fa(.Ilities             grown (!jioriiiously as it r(@siilt of                  fill     overNylicIiiiing     (I(@iiiaii(i      for
                                                          such facilities.
                                                                      133,     definition,     tii(@     iitture      of      Regioti:tl      Ale(li(-al      Prograiii      constrii(-ti4)ii
                                                          needs goes beyond tli(@                          of    .1    sillgle    institution    to    tl)e    needs    of    the     region.
                                                          Accordingly,     it      is      unreasonable      to      as,,uiiie      that      any      .4itigle      institution      ,N-ould
                                                          be    willing    to    (Iii-ert     its     soiree     funds     for     iiiitt.(@Iiii)g     purposes     when     the     benefits
                                                          of the ft(-ilitv are intended for nearly ii)sfitiiti(@iis.
                                                        lsil)CC    it    j,14    C.@elltill    tll,'It    tiler(@    be    no    substantial    distillation    of    the    coii(,el)t    of
                                                        ]Regional                  Ilrogriins,     I      coii(-ur      that      ritlier      stri(-t      Iiiiiitations      should      be
                                                                oil  this  virility                     (-oiist@i-tt4-tioii  :iii(.Iiority.              Iciii(Is     of      Iiiiiitiitioiis
                                                        0114) finds ill ill(. Surgeon                         I-(@llol-t,   lllIN-ilig   to   (10   @N@itli    the    material    of    funds
                                                        fLvllil.,Il)l(@ fol,                                                                                     iii(@.
                                                                                                lililltlktil@lls,  wil@if@  loan([  of  Itt@gifill,,Il  Ill-(@gl-,ilii
                                                                                                                    s
                                                        claim ANI(@ %Nlol-l@ilig lo                  Iti)Ni, il4)(-  sti(-Ik it                  N%,oi-)(?   Ali   exiiiiil)l(@   (if   1-110
                                                                                               of   ill(!    I)I,ogi.@illi    ill%-f)]Vitlg    (,ojlllllllllillv                 Is    I)I-o-

                                                                                                                            Iii-(igt,;iiii Ili Ili(@
                                                                                     is                      (](@sigii(41 tf) iiii,(,t                       or
                                                        1)1(@ (I(tliv(@rv of                                        (-Ill-(! It) 11)(@                          Oil(-                  %%-Ill
                                                                                                                               for
                                                        iiisls %%']lo                                                                NVI)iO-ll itilik(' fill @Jils I-(@gi(Oll.
                                                                           (retailing                      X%'ill 1)(@              1;4) !IS 14) 114'81             Ili(!                   I
                                                              ol,                                     Nviil                                  I)rogi.@illi IS 1)(@iilg
                                                                                   to Ili(-                      or                   roi. this              of                       otie
                                                        I)II:ls(, (it this ])).ogl."Iln                   vi.'4i(lilioll.4 I-o                       lios1ii1illm    by    tile,     efir(li-
                                                        ologisis %%,]lo %Vill ])I-ol'i(it! f,iiis                                                                               will       be
                                                                                                 hospital', for C(Olilillll('(]                 Ill, file 10(-ftl I)Ilysi(@qlill.
                                                        A                                                      iiiteiisivi- lateral']) long
                                                                                                                                                               .s   to   I)reli,,ire   I)i-o-
                                                                    iiiirs(@,;    Ili    the    iiialiigeiiioiit    of    (!oronary    care     units.     I'lip,     groatii     fit     the
                                                        number of coroii,,ii-y care units which l@rovi(le                                          iik(hlical      care      during       the
                                                        acute I)li,,tses of cardiic                     hfis     created     all     urgent     need     for     an     increased     liuiii-
                                                        her     of      well      trained      nur.%s;      the      latest      advances      In      nursing      techniquesand      modern
                                                        life-saving       equipment       demands       specialized       Instruction       In       the       nursing       skills       re-








                                                                                                                                                                            @77





                                                                                                        139
                                                                              tli(@ region have Ilrc-IdY                       their   i,iteiit   to    have    iiilrsc.9
                                                        I)arti(,-il)ate in this I)rogrllll as Soon      as it is                    The     (Objectives      of      this
                                                                                                         1)(@  i:illy  tr@iiiii@  I  iiiirses   for   coroii@try   c@irc-
                                                        progrtiui go beyond that of sul)l)lyii)g        .;  e
                                                        units in general                every effort will be         made     to     train     coronary     care     unit
                                                        nurses   from   the    smaller    coluiiiuility    hospitals    as    %@'ell,    eveil    though    they    iiiay
                                                        iiot:is yet h@ive such a unit.
                                                        Tlii-(!o a(l(litioii-,il iet,ivities will also be                           -Lliis    ii)ltiil    ol)eritit)ii:it
                                                        I)i-ogritlit.  A  ri@@ioii:tl  laboratory   will   be   estal)lisite(I   for   e(lue@itioii   8114LI   trliiiil)9
                                                        of        1)(!rsollncl   in   LI)(!   care   of   1):tii(@iits   NN,iitli   lliroitil)oti(!    and    hemorrhagic
                                                        klisoi-(Iers. Tiii-, is t-li(@ first sll(.Ik fil(-.ilit.V ill 11)(@ 1.4,gioll  and  will  1)(@  I),I@,d  ill  one
                                                        of ill(!        llo.Sllit:ils 1).Irti(,ilyttiiig in the                     lt(,gloiiiil     @l%ledical      Pro-
                                                                                                                               -itr(Iiiil
                                                            A  i-f-gioii-wi(le r(-gi@ti,y  of                    %%@iiii iiin,o(          iiifiirelloii      will      be
                                                                                %Vill  g.,tt.lier  iiiiifi)riii  itifoi-iiiii(@ioii  from the corollary
                                                        units of                   liosj)itikis ,iilil jol'Ol'i4ll@                 Its  NN'4'11  118  10119itil4lill@ll
                                                                                                                  t, or 1:11II(Is ]ills 1)(@ell iiiii(le  -giviiii;ki)l(@
                                                        (Illt,:l for         A r(@iiitiv(@ly siiiiill :alumina
                                                        t,() train I'(@gioll t@4) (It@V4'i 11) the first. li-:ti-iiiiig     in l,ii(@ i@i@gloii                        of
                                                                         I)ri)gr.:.iis lit li(!itrt             e@iik4!4,r, iAii4l L;Ilroic(@ fully I)L@
                                                            first  Year  Lwiirtl  for   this   iiiiili.ifiie(@t(!(l   I)rogriiiii   in   (@,,kr(liology   Is   $:343,749.
                                                                d(-s(,i-ii)ed  tit  exiiiiil)l(@  of  ivliiit  we  ,tr(@  I)iiil(liiig,  Mr.  Clitiriiiiiii,   J   should
                                                        lil@e liiifilly to say fL Aord or two 11)4)llt the      I(.Vel   of   fLill(iiil;,   I   believe   essential   if
                                                                                                                                        ii(@v(,- their goal.
                                                        lte-,ioii@il Nlvtlictl 1'rogrtin,; ,ire to have a  f@iii-  cli,,iii(-o  to  tl(!l
                                                        We   :ill   rt@-ilize    tliit    the    maiixt(!ijajice    of    health    is    assuming    all    increasingly
                                                        important role in our socioeconomic trea                of     concern     and     activities,     The     health
                                                        industry   today    accounts    for    an    expenditure    of    $50    billioii    but    it    is    scheduled
                                                        sooii  to  iiicr(@ase  to   all   expenditure   of   $75   billion.
                                                        If   the   Regional   Medical   Program   is    to    fulfill    its    function    as    the    Interface    be-
                                                        tweeii   the   moving   pirts    of    this    health    care    mechanism,    it    must    continue    to    be
                                                        il)le    to    influence    that    increasingly    expensive    device.
                                                        We    would     be     short-sighted     engineers,     Indeed,     to     derive     authorization     ceilizigs
                                                        for   the   next   live   years   of   this   program   by   looking   backward   at   the    cost    of    these
                                                        prograi-n,3    at    the    time    they    were    being    planned.     The     cautious     development     of
                                                        those   programs    has    iiiileased    a    chain    reaction    of    operational    activity    which    will
                                                                                                ised    funding    levels.    It    is    already    clear    that    oil
                                                        lie(,       substantially inere,
                                                        the  ity(@rtige  these  I)rogi-;iiiis   will   be   ol)(@rittiilg   It   11   level   of   between   $5   million
                                                        find $10 million each within the next five                    tirs. It    Is,     therefore,     necessary     that
                                                                                                                ye
                                                        tiii   iittli(@rizatioit   level   of    roughly    @)OO    million be   u.4;(,d    iLs    the    yardstick    with
                                                        Which Oilk@                the    funding     levels     of     the program       contemplated       by        this
                                                        extel)sioll.
                                                        Mr.   Cli@iiriyian,   I   am          I)rivileg(-(]     to     noun have    the    opl)ort@iiiiitv    to    present
                                                        lily views to the cojtiinitlt(@(,.  %vliicii         (]()a(,  so  iiiu(-Ii  to   sli.,tl)(!   health   legi.,ila-
                                                        tioii in general and the Regional Medical Programs In particular.
                                                        Mr.    RoGi,,.jts.    Our    next     -%vitiiess     is     Si(Iney F,,irber,      director       of       research
                                                        Clxil(lreii's        Cancer        Researeli        Foiiiidit@1011, Bost@oli, Mass.
                                                        Dr.    Farber    is    also    an    old    friend    of     the     committee     tnd     he     was     helpful
                                                        in     the     formulation     of     the     original     lelislatioli,     having     served     as     cliair-
                                                        mail of the Cancer Panel of the Presiclent's Commission.
                                                        Welcome back, Dr. Farber.
                                                        STATEMENT  OF DR.  SIDNEY  FARBER,  DIRECTOR  OF                                                        RESEARCH,
                                                        CHILDRE,          N'S           CANCER           RESEARCH           FOUNDATION,           BOSTON,           MASS.
                                                        Dr.    FANBLR.    Thank    you.    It    is    t     Lrreat     lionor     to     be     once     more     before
                                                        this coiiiii-tittm, wli(@re my iiion@loi-ie,,i                :Is   11(@,,irtwiiriiiina    as    ,iiiy    iiiein-
                                                        ori(,,s I  liive                                                                joiti'!)r.               T)eBakey
                                                        ,,i,ii(I ,t]] our c,                       priNgs1iig      ar,%titiide      to      this      committee       and
                                                                     for                                                  the        most        important        program
                                                               fic](I o@                                                                  ry
                                                                                                                          f    our    count    that      is       applied
                                                        dil-L@ct@Iv  to  the  care  of  tl,,
                                                        I SI)Z@:IIC strongly in favo                                           the     urpose      of      which      is,
                                                        railcar other things, to ameiid the                             ubl  I-Ieolt@i     Service     Act     so      as



                                                                                                                                                              71






                                             to ()xtell(I "'(I ',,I)Provo the provisions relating to re oiiil  ifi(',dicil
                                                I join Illy                                              ill st@i-oi)(r                               l'or
                                             coilstriietio;i funds, and I will ,ive one                                   of this     later,   which
                                             will illustrate the                  need   for   construction   funds   in    this    pro(ri.-,ti-n.
                                                          NN,o                  l@o(l@t.y is                         -for i,lie, next, 5 ye,,),i-s  for
                                                     l'iiiitl@s) Nvitll t,jl(,"jlol)o         fill)(ts NN-Ill 1)(, -:iv.,i;ii:tl)](@)                 from
                                             Other sources, NN'lliell  wiii                    the ',Ill)l)ol,i., of t,])'
                                                                                                                            Is  ])I-Ogt.,Illl  and   so
                                             ii):iiiy ot.li(,i- ,N,ortliy                  1)('fol-C the (Congress I)OS.,iil)le.
                                                I would lil@o to sav iiisL L few woi-(Is ibout tli(,@se pro-rtms.
                                                There li@is been ,t iiii(rnificeiit begiiiiiin- tlre,,tdy.  I want                            to      giv6
                                             evidence  that  (;Ii(,   @i(IiiiiiiiLs(,i,,(i,tioii   I.,i   excellent,   under   Dr.   -iN,Itrst,oii   i@the
                                             division     of     re,"ioii@tl     medical     I)ro,),ranis,     and     tli@it     the     Council     ,Ind
                                             advisory    boards    are     composed     of     wise     and     courageous     men     who     Ire     not
                                             ,ifriid   to   s,,t   no,   nor   are   they   not   afraid   to   say   yes,    in    -the    approval    of
                                                              y
                                             I)roo,r,tnis tli at deserve approval.
                                                I    have    the    I)rivilege,    as    a    member     of     the     N(itional     Advisory     @iincil
                                             to    represent    (,hit    -.ouiicil    to    the    r@gioii,,tl    M,    dic,,tl     Progrtins     Council;
                                             this   is    lily    second    year    of                 tn(I    ]is    @enin    with    gre,.tt    api-)re-
                                                                                     I                               l@1),                       L    ions
                                                         :iii(I              were    i I   tii-i   islced   for   i(,@    in the doliber  t
                                             of   t,@ie-so    tdvisory    L)o,,i,i-ds.
                                                Ylio                                 ])].ogi.@illi                                    trial(',  ill  tll(',
                                             history of                     medicine Nvliere all                          of soeiciy
                                                                                                             1,
                                             ivilli the,            of our I)eol)](@ liav(@,               t@o-o,(ttlict-    to    tcliieva    t    common
                                             t(roal of
                                             I                                 I)r(@S(']'VLtioii 'Of live,,,       tiid the I)rolongttioii              of
                                             4VOO(I life l@or I)eol)lo Nvlio @tifror from t'li@,3                 dread   dis'(@,:tses.   Tliiq    is    a
                                             -to@it,  Li-iiii)il)li  in  itsel@f,  ti)d   would   1)(',   Wol't]IY   of   the           cost.   of    this
                                             pi-o(,ra;iii if this ive,].-(,, the only sl)iii-ofr of -,vii:tt has been done.
                                                'I'lle               iiie(lic@tl     programs     quite)     simply,     ,tre,     coiie,(,riied      with
                                             I)riii,viliz   to   (@v("I-v    net,    Nvonitii    and    child    siiff(@    ing    from    tlieso    dread
                                                                 o-v@iitiiii]@y,    I    hope,    from    ,tll     dise@ises,      that is         l(nowii
                                                       hit                     lives    or    1)roloiity    (,Ood    life.    This    is     tccomplislied
                                             to(
                                             ill     sli li'll)lest terms ill tnvo Ways.
                                                lve'be(,,in     with     the     community     liospittl     tnd     the     doctor      in      practice.
                                             We    -ive,    added    streiitrtli     first     i@     man     ower     in     trained     personnel     in
                                                                                                        p
                                             those     community     hospitals,     and,     second,     technical      facilities      for      -,vli,,Lt
                                             is  Itcl;:ing.  And  we         link       these       community       hospitals        with        so-called
                                             centers."
                                                These centers ire           not   buildings    in    oil(,    I)],-tce.    They    are    not    in    one
                                             buildiii(,,,   but   they   rel)l-eseiit   -t   I)ortioii   of   t   given   region    wlier(,    there    is
                                                                    or expertise ill                    s(-,Iiools,     telcliiii-     hospitals      ,Lnd
                                                                                                    tr(@,      facilities      and      manpower       and

                                                If   we    ctii                   two         i-noiii's of tli(,                 co]l-illiiiliity      to-
                                             "ethical., t'll(@ eolilliiiillit   110SI)it:i,ls and  tli(@se                                             and
                                                                              y
                                             Nvit,lk   "oo(I   iiie:tils   of   (@,oiiiiiiiiiiic:tt-ioi)   in   the   modern    idiom    l'or    rendering
                                                              Issisl-,ill(@o .In(]  tilt',Vtl)Olltic                 NV(',    will    ,icliieN,o     Some-
                                                     that    in    the    liel(I    of            and     other     Cie](1s,     will     bring     ("reat
                                                T   Nvtiit   to   mention   rigilt-(,s   that   I   had   the   priN,ile,,-e   of    inciitioiiing    once
                                             before before this committee.




                                                                                      14i].
                                                                                                                 and       child        every-
                                                 In cancer, if  we  coiild  I)rill(-Y.  to  every  )iiai)@  woman
                                                                                                         today,      there      would      I)c
                                                                                       'vii(I
                                                                                                            to    il"e    of    ccncer    this
                                                 @,,tviiig of 100)000 to ')OO,i)i)o %veto :ti-e d    i
                                                 ill tile  fi(,Id   of                                   of    st@rol<e?    this    can     be
                                                                      200,000  of  tlle:,)Oo  ()OO  for  wll()Il-l  W(3   litve   riot@'llilig
                                                         l@0(l@,iy Ill(t NV]lo Nvill (lie of'         IV(,    require    rese-,tr(@li.    The-
                                                 great         J)rogi-:i,iiis of tlk(@ N:Itio)l:tl              Ilistitiito      and       the
                                                                   Societv tll(.1          ]holy   I)rlvlt,(@   iii,,i@itiitiolis    of    the
                                                                      tile  res(@.ti-cli  i  ]I  tile  colirs(@  of  time  which  will   bring
                                                 -Cottiitry NN,.ill J)rovi(l(,
                                                     to the Problems %N'Ilicll C',tilliot                    today.
                                                 Biit if we, call foctis oiir ttteiitioii f)ii those, %vbo can        be    s,,tved    -,vital
                                                 l@iio-vvledge preselitlytv,,tii,,tl)le, tells go@ll is wol.tlly enough..
                                                 I       to  I-)Oillt  Olit  One  extilil)le  ill  reg,,trd   to   construction.   Yoii   ,ire
                                                 .f:ii-nili,tr witii tile gr@,  t  retrials  f  roiii  the  prii,t,,to  sector  to  the  Hill-
                                                           -tii(I  to   the   ITeiltli   Facilities   (')onstiuction   Act,   ,tiid   so   on.
                                                 Illirtoii Act
                                                 liltllose  tli(@reliasl)ceiiiii  otitl)ouriilg  of   I)rivaternoiiey.   Tliit   Nvill   liap-
                                                                  those  ]),trt,,;  of  tile  colit@ti-y   where   the   I)i.,i%rztte   sector
                                                 poll here, too, ill
                                                 call  iid.  In  those  wliere  the  1)riv,,iW  ,cctor  is   uii,
                                                                                                                tble,      iliis       pro,ram
                                                 .-,I)oiild   shoulder   the   entire   burden,   I)cciiise    human    life    is    precious
                                                 'I'liere is one                                .il)oiit    just    before    comina     here.
                                                 rii(, community of Aii(,Iior:ige,                     in response to        the         needs
                                                         by   tile W@i-,Iiiiigi@oii-AIL,,Ict                            I)rogi-,tii-i,     for
                                                                                 litit@,i Closer i,iiitn              W,,tsll.,     is     now
                                                 coll(litet@il),rtetyiil)ltl(,rll   to   build   tile   ftcilitv.   Sol'icit@"(I   private   funds
                                                         s
                                                 will  1)(,  ii  ed  to  construct  t@lle  Housing  for   the   equipment,   which   is   very
                                                 -('X
                                                 @iisivel.
                                                 @)r(lie C(iiiij)llleilt., will  be  I)iireli@ise(I  by  tile  regional  medical  proar,.ii-n.
                                                 Tile               center    -,Vill  1)0   Ol,)PI-,tted   ,is   ,t   regional   resource   by
                                                 tile  Providence  lio-,I)ittI,   ts   planned   ,tiid   ,tpprovecl   by   the   local   ,tn(I
                                                 ,laid r(,ffiojial advisory ffroul)s.
                                                 The   decision    to    sul)porCt-,Iie    -,actively    involves    cooperative    ,trrtnge.-
                                                 iiielits .it ,Iiiotlier level ilso, and  of  this  I  ai-n  very
                                                                                                                proud.    The     Ntt,ioii,,il
                                                 (','.tiieer Tii,,titii(-,e, conducted tile site visit, IVIlicli  (-Y,,tve  assurance  of  the
                                                                  ,,end p                   -tsis of this protect. Here is ,t
                                                 'Sol    iciitific        rofessioiial b,
                                                 -ln,d  SC
                                                 tifiil exaiyiple of two segments of        the    Nttion,,tl     Institutes     of     Health
                                                 -cooper,itiDa.
                                                 1    have     heard    that    file    Aiieliori(-Y(,    Construction     Trades     Council,
                                                 -coiyi !-,i)sii 14  utiioiis,,   have   taken   oil   @lic%   construction   of   the   building,
                                                 e   t@
                                                 on  11  I                    ot         of tile
                                                         i(,ii@g more than   i                    t@ot@,11    cost from    tliis    one    source
                                                 Orion(".        lie,,ti-t-w:tl-iyiiiig,  iii(l(@ed,  to  see  it  community  a-,   't   whole
                                                            -,Ii          -tl program are
                                                         @vit   i.                            Italian      ople    suffering    from     ciii-

                                                          country.
                                                         ill(" let,, colli(@. now to                 grotter   support.    for    this    pro-
                                                 -,fallen                tliefiiieprog
                                                 @oii li @ive, tl read y heard f roiii
                                                                                          Dr.                in   response    to    question-,
                                                 for     qriioiiiit  which   is   recoiiiiii(@iidecl   for   This   y@r.   City   I   mentioii
                                                 two otlie-1,@
                                                               @i,,   pro(yritlyl   ;Iiolll(l   be   supported       n    amount    no    less
                                                 Ily l,f)71 t@,l                                                by a
                                                 all          -n                                      -Uction.
                                                 .tile   .100 i  illioii, ']lot counting eoiisCr                And   we     should      reach






                                                                                                                            142

                                                         the                   of  $.-)OO  illilliol)  witllijl  5                                time  if  NNe
                                                         to            fill]    iii(@    sli-eii--,tli    of     Nvli:til     li:ts     1)(,eii     iiiobiliz(!d     iii     the     various
                                                                        of I  Ikk!  (.,()Illlt  I-
                                                               I  (.,lose  lll(,So  I,eiii:ii-lis,  Ill'.                                    itil(I
                                                         t.ll(,. 1)(@,] i(. I' tll:ttl    i,lic    It@:I(Iel'Sllil)    to    t'll(@    (,'Oll'rL'@4    ()Ir(@r(@d    b    votii-     (@oiii-
                                                                                                                                                                            y
                                                                          @N-ill                                   I-O"Iolltl                   ])]-Ogl.,Llyls  to ill@ll<e             t       ti,tily
                                                         gr(@,,,it,   coiit-i-il)iitioii   to   the   li(@altli   of   ill   of    iiq.
                                                               'I'liltl II( Iroll.
                                                                                                            st.,,tteiiieiit follows:)

                                                                               Ol-'     I)IC.     SII)NRY      PAIIBI-'It,
                                                                                           Itl@81,AltClI  i;,OUNI)A'FION,  IIOS'I'ON',  @)IASS.


                                                         it   is   Aviiii   gi",Ititll(l(@   that,    I                        tiiis   ol,)I)oz,t@iiiiity   to   fii)ri(,.ir   I)efor(@.voii   in
                                                         ,troiig                    of    11.1t.    157--@,    the    piirpo,-,e    of    wlii(-Ii     is.     iinoiig     otlier     tliiiigs,     "to
                                                         ;iiii(tiitl ill(,, I)iil)lie li(@itltli service ,ict so a.,; to ext(,i)(I iiii(I                                   the   proN,i.,,-ioii.,,-
                                                         i-(,Iittiiig   to                                       Progriin.,i."
                                                                                 @@i(Iii(@y                  I ftiii toiiii(i(,r iiii(i                     of tile
                                                                          11'4)iiii(littion Ili Ilostoii, iii(I ('Ii@tiriiiiiii of tilt- St@fiff. of the alliliit(@il                           iiiil-
                                                                    llt)sjoitit                       C(!iiter. l@or aliiiost 44                     I   liavt@    been    isso(@iitte(I    %vital
                                                                                        @(@llool 4is @i sttl(](@lit ,Ill(]  ilioiiiil(,r of fil(@ li'@iclilty,                               I   @illi
                                                         11011%, tli(, S. Iiiii-tl                    Ilror(@"orof lltilioli),y. '.\Iy                                              iiii(I
                                                         ilig                              1)(-I!ll  (I(@\@ote(i  to eliil(li-(,ii  @iii(I  to  Ili(,, 11(@](I  of                              tike
                                                         I)r(,.@tit tijit(@ I @iiii                                 of ili(@ A.jki(@ri(-iiii                                 Nvlii(-Ii
                                                         its              st@l-('Ilgtll    in     its     ql.tigLje     to                             frojii   iiioi-(@    t@Iiiiii    2    iiiii1ioll
                                                                            ill Ill              of    tilt'    ('olllllll-Y.                  I Hill ii                  of        the        National
                                                         A(I%,i,,oi-y                                 (if tlt(@ N;itioijitl Iii,.,Iitkil(N (ir 11(@jill@ii, aii(I
                                                                       It) i,li(@ Nittio)ii@il A41visoi-,N, (",oiiii(-il oil  lt4-gioii:il                             Ili-ogrii)iiH.       It  was
                                                         ]fly                  to   serve    ;).q    it                  (@r tli(@                                           oil                I)is-
                                                                               lilitl  St'l-oli(@, its ('Ii:iii-jii:iii of' l.ii(@ llziii(@l (in                        It i%,jis this       ('oiii-
                                                         itil@l"ioll                                                                                       wili4,.ll                       ill    1111!
                                                                              of         81)-2,t), t,lit,                                              @Lli4i   St,i-(olie    Aiii(@it(Iiiii-iit@    of
                                                         11)1;5.   II:   Nv;ts   iiiv    I)i-ii,ileg(@,        to                            tlii,4                     Ili   siipi)(@rt:   of    Ili(!
                                                         ol-i"illttl                   I(.gisl;ltioll.
                                                               ,l,o4lll3, I           I)t,fol.(@ V(Ill     Ili  siijilit)i,t. (@l' ill(,                     of    tlii4     I)i-ogr4iiii     \vlii(-Ik

                                                                                                                         $Ili(I   to   I)I'olt)lig   gilo(i   iiii(I   118(@Ckil   life   fill'    olit
                                                         I)eol)l(.. ;)I@ly I Stillillili-iZ(@ I)]-i(-Ily at few lhoiiiis (-oii(@(,riiiiig t:li(! program at it

                                                               (1)  A                        beginning in I)Iiiiiiiijg, laid Io i                                  ext(@iit     in      op(@i-.,ttioiis
                                                         li:i,4                been in.,t(](,@ ill this,; vti,y ,Iiort 1)ei-io(i of tjxiie. The 11(@giotitil
                                                         Ilroqi,;iziis       :iire,,i@ly       show        convincing                   that   for   the    first    tiiyie    in    Aiiitri(-,iii
                                                         history    the     v@trious     coiiipojieiit-;     of     i               region    of     tli(-.     country     coiieenic-(l     with
                                                         the    health    of    oiir    pf,ople    call    iii(i     will     worl(     to,-etbor     I:ownr(I     the     aclileveiiielit     of     a
                                                         goal    which    li@is    never     been     j--o     I)ro,,i(ilv
                                                               (2)  Tli(@ go@il  of the Regional                                                     in    a    few    words,    is     tli(,     I)ro.
                                                         N,isioi) for every                      woznnii  iiid (!Iiil(l siiff(,t-iiig front  :Jay (if these                                     iii(I
                                                         rel:ite(I                    of all fliit. is ]@llowil -,is IV(-II 11'4 all
                                                         (I       for        the             ioii (of (]I'll t 11 fk ii(I t be J)I.olollgll t il)ll of goo(I life.                        )li(-)it ,@ I
                                                         t 4) 1 1)(@                      of t ll('S(- g4):l  Is  it  I'(!            Intent s i 11 (1:1 I:ii (!ol feet  iolt  11  ii(I  1)14-
                                                         fi,(!Iioij  (d better iii(,Ilio(Is of                              of                 4-@lli,(@, I.'4  IV(-II  as  iiiijoi-o%'(-Ili('Ilts
                                                         Ili coi@iiiiiiijig (-(Iii(,iiijoii  for tll('                              all(]                     or t,lif@
                                                               of,                                                       ill(,   IZ(@,,ioiiiii                 Ili-ogi-iiiii,'4,  in   1-ii(@   (,iisf@
                                                         of                       1)(.giillilllg to                      ii)(,@itilligrill
                                                                                                                      I.(,gltpli             lll'(@              1:11(,.  Ill(.(Iieitl
                                                                                            Jiliti
                                                                                                                    ill.4t@ilillioll.'4                      \Vit'li                'I'lle      (@oill-
                                                                                         itills,(.  I)i@                        by  iii(-i,(@isitig  t,lie   iiiiiiii)(@r   of   iiit@iiil)l-l.S
                                                                                                      ll-lkill(@(i  ill   ill(',   Vill-i(@iiq              (if (liligilosi.-4 stil(I
                                                         talent of t,lli@ nearly                                            wt@ (.1111                  itil(I   t-lie.   ll(l(litioll   to   their
                                                         t4,(,Iiiii(-jil                              of   sij(-Ii   sli(!eitl                   ti(@NIceH    its    ritdiotli(,riil)y    iitiits,
                                                         :iiiil o(li(,r (Iiilgjios@i(!,iii(I tli(,riil)eiitle cqiiiiiiii(,jit.
                                                               Ili  tll(@   ?))(,(]!Carl   seli0ol                tilf@l,e \\'iii i@(@                             of    SI)OCIIIIIsts    Ill     l@lie
                                                         nearly ,)),,,sea or                                    diagnosi,,4   nine   ti-(@iitiii(@iit    to    give    expert    ftsk;tmtiiiiee









         0                                                                                                                                                                            I





                                                                                                      143

                                                   to ,ijiy doctor lit the region lit I)eli,,Ilr  or iii.,4           it,                       where        a
                                                   (,i-itic-itl iiiiiss of (@xl)ertis(- is to ))(@ foiiii(l, I)riiiiiry   reSI)onsii)ilities    will    include
                                                   ('(Illtifillilig C(lileatioli with tll(' 11(@lp of                          lit the  iiio(l(@rii  i(lioixt,
                                                   (14,111olistriltiolis of 114,Nv             for (liligilo.S[4  of  tr(@iitiiiclit,  and  (!O)I.Sllltfttlion
                                                           to lit(, (!olllllltililt..v liosi)ii@jils and @til (14)(-toi-,g lit tli(@ ro@gi@)ii, lit :t(](Iitioii to
                                                   tlit, (-oii(iii(@t of          (](,,,4igii(@d  to  1)rovi(li@  solutions  for   I)rol)l(@ins   ]it   cancer
                                                              not be sitisr:i(-torily               on tli(@ I)itsis of            Iciiowl(@(Ige.
                                                        It li;i.9 ))(,i@n             I)y            that, if we t!oiii(I iiiiik(! aviiiliii)l(@ to  (@v(@ry
                                                   Iltti('Ilt N%'Illi      lit tli(@ 4,otiiiti-y to(l:ty 4i]l likat 1.4 l@i)owii (@ii(!eriiiiig, diagnosis
                                                                     we (-oitl(l  save  100,(X)f)  of  tli(-  itioi-e  than  'IOO,O(X)  who  will  (lie  of
                                                         title year. 'riiis is %vitliotit new kiiowi@@(lg(- (,iii:iii@itiiig front                  litl)orit-
                                                   tol.14..,;. It is .1 goal tl).It l@e             1).V the fall                   of    tli(@se    Regional
                                                           Progriiiiis in the field of              fll4)n(@.
                                                   (-I)  A,;  was  the  ease  with  the  llill-lliii-toti  pi-ogriiiii,  and   tilso   the   Ileqltli   Fa-
                                                   f-ititi(@s          Coiistrii(,tioii Ilrogriiiii  of  tli(@  N;itionitl  Iiistitut(@  of  Ileitlth,  In-
                                                             of            iiioit(@y  will  be  sul-(@  to  (-:ill  foi-tli  Investment  front  the   I)rlvqte
                                                   s(,(,t(ir. -Joel will be iiit(!re.,4t(-d I iiii siii,e lit (iii@-        III  a  pirt  of  oiir   Cotintry
                                                          -is s(@rioiis need for ii)iprovei)ieiits in tli(- field of cancer.
                                                   'I'll(, (-ojiiiiin(lity of Ati(-Iior:ig(-, Alaska, in             to  the   needs   identified   by   the
                                                                           Tl(,gioiial             llrogr.,iiii  for   high   cii(!r,-y   radiation   treat-
                                                        f,,i(,ility (,Io,,,(@r tl)in         Washington,   is    TIOAV    Conducting    it    fiind    raising
                                                               Soli(-it(-41 priviit(@  final],,  will  b(,         to  (-oiistrii(,t  lioti,4ing   for   the
                                                               Nvlii(!h will ))(@ I)iircli:if3e(I I,)y t,li(@ Itegioiial ',Nfedictil Program.  The  tr(@at-
                                                   iii(@i)t      ivill be ol)(@rate(I it,; it regionil  i-@.-otirce  I)y  the  Ilrovi(lonce  ITo%l)ital,  as
                                                            ni)(I  ill@I)r(ivetl  by   local   and   regional   ii4ii-iqory   groups.   The   decision   to
                                                   siil)l@ort  the  ictivity  iiivol%,es   cool)(,ritive                       at    another    level    also,
                                                   f4)i- tli(@ Nitioni] Ciin(@er Institiiti@                a   site   Visit   which   gave   assurance    of
                                                   tll(,  @olin(I  @(,ielitific  and  I)I-Ofessioii:tl  1)@isis  of  this  project.  I  heard  just  before
                                                   (,i)iiiiiig lit-r(@ tliit the  Anclioi-iig(@  Iiiiil(liiig  said  ConNtruction  Trades  Coiiiieil,  com-
                                                           soiiie  14  nations  liav(@  tgikeii  oil  (-Ii(@  coiistrii(-tioti  of  the  building   its   a
                                                   lirt').Iect,  contributing  iikore  than  oii(-  half  of  tli(@  total  cost  from  this   one   source
                                                   tlone.

                                                          tiiiie for Increasing lli(@ "il)l)f)rt  for  tli".(@  ft(,gloiiiil  Ilrogriiiii,4  lit  I-It!iirt
                                                                       fill(] Strol((@ has i-i)iiiit oil than I)ii,41.4 of tli(t  triily  sl)l(@ti(lid  ittirt
                                                   tli:it@ has                       upward   trend   of   ii(@(,(Is--iiliiio,4t   (loillole,   en(@li   year-
                                                   Is            il,4 iiiol,, I rogriiiii,4 r(titelt l.ii(@ stjig(i of ii(@t@iiiii operation. lit fiscal 11)(47
                                                                        were    ill)(,
                                                        -1 Ill                       rating; la            '-IO        will r(@ii(,Ii that  f4t@ng(@.  l@,ve?i
                                                   to iiiiih(@ i)os,4ii)l(@ iii(@ iiiiivi@rqitl               of sti(-Ii a  f4ittil,)Io  find  emtiit)lislied
                                                               ft)t-              of           of    till!             tilt@ lllifillill(-ollloll
                                                                                         (011(@ limit %Vill Ill. folloNv(@(I by  t@11(@  Having  of  ttioll-
                                                   fill
                                                                     (le wi@iiii,it               NN,4. qllol[14] i@irtloiiiitizt,, too, t'li4it. Utility N4.g-
                                                   Italian of 4iiii,                gli4-ftt)H, rural            Or  i)lii-ilgi@  liojii(,H  among   otli(@rs.
                                                                               to itio4l(@i-ii
                                                    I%'I, iii-i@ linvilt.t. final, l@ill-iii-tilill']Y lit 1)11'4 fields 111-11)1-1(14'H filli@tt@ 1)41
                                                                                      11, 1.14 0111-         to4lilv  merely  to  balling  oill,   til(@   gi,t@@it
                                                                      (,ollle           is -@411101lol.l: of ballerinas %vliii-ii Travel  already  elf-illoll-
                                                                                                           I
                                                            their maturity to                    g(@jil.,4 4 eliii(@(i I)y Ilit@ Pr(,.si(letit't4 (commission
                                                   (lit lif,@irt           Ciiii(@er  and  Strol((@  and  put  Into  law  by  the  Cozigr(,,.9F4   of   our
                                                   Cciiiiitry oil the  recoininej)diitioli  of  tills  Committee.  li'roiii  ill(,  tiitie  of  the  i(len-
                                                   tific.ttion   of   these   goals   in   P.L.   89-231),   the   lte,,,Ional   Medical   Programs    have
                                                   eipttir(@d   the   imagination   and   raiv(l   the   expe(!tatioiis   of   the   generil   public   and
                                                   the  )laterite  provisions   n.lil@e.   Those   who   have   studied   the   needs   of   this   program
                                                   mount  carefully  reeoz)iiiien(I  that  the  (,(@ilitig  for   the   national   program   as   a   whole
                                                   should  reach  the   level   of   more   than   l,')OO   iiiillion   dollars   within   5   years,   and
                                                   should  (-entirely  not  be  lower  tbii)i  @300  million  dollars  for  1071  If  we  are  to   utilize
                                                   to  the  full  the  strength  which   has   been   niol)ilize(I   In   the   varous   regions   of   the
                                                   c(oiiiitry in belinif of the health of our own people.
                                                    I  close  these  remarks  eotifl(lent  lit   tli(,.           tlint  the,  lead(,rshil)   to   the   Con-
                                                   gress   off(-re(i   by   your   Committee   will   permit   tlles(,    ll(,glonal    Medical    Programs
                                                   to iiifilce a truly great contribution to tb(, hAl.'Lltll Of lill Of 1114.
                                                     ',\Tr.              'I'li-,tiilc yoii v(@i-y iiiiie-li, T)I-.  l@'ftrl)er. We   fti-c   izidc4-,te(l   to
                                                   yoii for I)cijigliere aii(I giving its yotir opinion oil tlii,; progriti-a.





                                         I,(,(, iii(, ,tslc you, for instance, witli    the                 Ctncer       Res(,,,trch@
                                         Foiill(l:lt,ioll,  call  y@)II  give  us  any  (@xiiiiple  ivlier(@  II,  new  treiitineiit,
                                                has i)eoii                    tlii,oii,,-Iit r(@gioii:tl in(@,(Iict] pro,,,,i-,ti@n?
                                                          I,(,s  ,A,fr.                                                  ltcse,,Lreli
                                         ollil(llt..iol), if I Italy         of  soilietliiilig  Nvi(,Ii  IvIii(-.Il  I  have  I)Cell
                                                   for the         '-)I y(@,irs is re,,xlly t        @o(.,Vt)(@  of  the  ltegiolitil
                                                                         It-, is  t I)riv:lt(,,                                 froin
                                                             li(',ll) i@l-olli ilt(@                      Society.   It   is    silp-
                                                                  cirt3 ,iil(l (ii:I(Yllosis  itil(I              for        children
                                         witli eiilce, ilia     tit         of                     :i,iiy (,Iii]41 9(@,nt, I)y t (loctor
                                                                  '11(@ (lo(.,Ior             (or t.lio           at lioin(@,  itii(I
                                                                                                               reqliil-(@(I  ))Y   ti
                                               foilil(l,,It.,iol-t    provides    the    teclil)iqlles    and     equipment     which
                                         Ili-e, iiiticli            i@o I)c in ,t do(-,tloi-s ofrLee. It  carries  out  all  I-,Iiese
                                         expensive     services     without     professional     ell                     ent;      at
                                                                                                   ,  (, lo tl-,(,@)"tli
                                                                                                   ""g
                                         liolyle  the  I),Uiellt  is   the   I)rivate   patient   of ,is privfttp,   octor.
                                         In   21   yitrs,   Mr.   Ch,,tillillin,   I   have    never had  a,  complaint   f   real   It
                                         single doctor in this region.        NVe      have      had remarkable           cooperation,.
                                         and:   the   community   -,is   @wliole,   has    cooperated    to    supl,)ort    something
                                         which   they   considered   absolutely   necessary    for    the    comfort,    the    welr-
                                         being,  an(I  the  mental  peace  of  the  family,-  as  well   as   for   the   health   of
                                         the child.
                                         Mr.  r,.OC.ER4.   1-1,,tvo   we   btd   tiiy   retl   breakthroughs   in   this   area,   in
                                         tlit,, t) I    of I ("11 ]c(@] II i II, i II cl I il (I ].(@ii
                                                          Afr. Chairman  there ]),is
                                                                                                     very greit@ pi-ogi-es,;.
                                         was   20   yeirs   :tLo   last   Noveiyib(@,r   when    the    chemical    that     (.011](I
                                         coi-ii,i,ol      la,  ttt  least  temporarily,  was  a(liniiiist@ered   to   a   child   for
                                         Tli(@i,(@ is  no       for iieut-,o lelliceiliili., I)ILL         live  @),ood   lives   for
                                         so),C]..Ll Year", instead of :1 ft@,-vv  ive(@ics  ol..  t  -few  months.  @-nd  there  ftre
                                         itliv(3 ,t few Iiiii)di-e,(l          ft(iiill@s aii(-l eliildr(@ii,  itbout  I  percent,  I
                                                   of ,tll t-,Iio i):tili(,Illg,wit,li             treat@@,d,   who    liave    lived
                                         (yo()('[ Iiv'es for 10 t@o Jr)      Wit'liotil-,            of 4-,Iio disease.
                                         '.I'Ilis is ]lot-, a Caere          iiiioii, I)tit I-,Iiis is very  lie,,trt@witrmiiig  evi-
                                                                                  election ill I-,II(3 1,18(@ of chemical       iiii(I
                                                                                   'Its            ti,@t,iisfitsions itil(I so -iortli.
                                         li@ N%,o call                                      11(@,xi-, forwitrd   st(@p    in    research
                                         iliqy (',OIII(3I no  f(@
                                         1,Ve, li:tvo otlicr t-,iiiyiors in a:(-Iiilts is Nvell a,-, children,  w)iicli  li,,tvo  re-
                                         s )Oll(@i("(l i@o ,II 4r(@,rv, radio         -tii(I (-,Iiciflot@liel'ill)Y. Ill one cits(3 of
                                         0              Ici(Iii@@ in              we  ,ire  iioiv  ii)ov(3  80  I)erceni-,  in  long-
                                         cancer  of   the
                                         toriii siirvivtli I)ectuso of  the  addition  of  cliciiiieftl,  in  this  Case  all  aiiti-
                                         I)iot@ic,, to            of siirg(@i,.y, and radio 1,11(,]"t@y. W(3@ll-i-Ve,
                                                   White,         iinl)ossibl'o  20  years  i-O.  Once  spro,,t(L  to  I-,lie  Itings
                                                        ill illisl@il)(I of ti.ilylol., t,ll(,]
                                                                                          .(@      I,          of  3  to   6   month,
                                         of life ,tliead. We are iioiv             iii  tl)oiit,  C)O  1)ereent   of   the   children
                                         ivlio litvo lift(I -,pi-ctd of this  c,,tnwr  t@o  l@,ho  lung-,,  we  are  able  to  liftve
                                         complete d@-t-,riiet,ion of tlio  t-,iiinor  using  si,ii,%Il ftdlounts   of   radio   tlier-
                                         a,py  and  tn  antibiotic.  Lift)  lia,4  continued  in  t-,Iie  longest  patient   for   13
                                         years Nvit-,Ii no evidence of the return of the ttimor.





                                                                                        145
                                               There    %ro    many     examples        could   be   aiveii   from    the    splendid    in-
                                           stit,utiods  in   the   country   and   in   other   trt,7i   of   the   world   where   great-
                                                                                                  p
                                                                                    riie, wo      igc:tii(@,rll  does  not  ,tpply   to   0,
                                           est,            litve,    been    made.             I'd
                                           SiD'-IlC  (IiSO',IS(@.  It  includes  miiiy   (lifYoreiit   diseases,   which   may   be   tin-
                                           rol"k@te(l, ,III of which            called               ;o   %N,o   may   iitvo   to   tii,,iwer
                                           3,oiii.- qi'i(,,slioii instance by instance is we         record success.
                                               Afi-.          T. tliiiil@ tli,                                t Iii file it-, is well for no;
                                                        oil thirty          some of                            so   Nvllero   you   have    a
                                                        t,il:lt@ is                     (!;III 1)(',                         -oligli t r
                                                                                                                 ici@ly  tlll                e
                                                                                                                                    (Y
                                           gioiiiil                               least, i@ii:tt is t lie,                 it   can   let   to
                                           tl)o loo@tl             -@@id hospital,). Ati(I ,tlilioiic-rli we n-i,,,v not                    the
                                                                       t-,Iiere,'it   can   be   trralj(,Ye(l   for   ,tn(@the    treatment
                                               DI'.  FAItl@l,,ft.  We   liol)o   these   regional   prograriis   will   provide   for   the
                                           colril,yi1lility  liosl)itt]  tiie  exl)(@,rt@iso  tti(I  t-,Ii()  equipment  which  will  take
                                                                    tjorit@ ol- patients with ciiiwr,                       foi-   the   eeii-
                                           care  of   the vaic m@
                                           @i-s   the   iieNv   problems   which   require    far    @e,.tter    outlay    in    equipment
                                           and i)itiir)o,,v(@r.
                                               Mr.  ]'OGI@Tts.  Tli,,tnlc   you.
                                               Are I-,here tiiy
                                                              _       questions?
                                               -%fr. K-i-no
                                                           s. 1. want,  to   join   NNitli   you   in   -,velcoining   Dr.   Farbor   here.
                                               ',Nlr.   NLLSPN.   I   was   iiiter@Wd   in   -   our   statement   that    many    patients
                                                                                           y
                                           have   (,Yoiie    long ts 13 years with no evidence of recurrence.
                                               Is   there   ai-iv   specific   number   of   years   thrift    the    medical    profession
                                                                 ,t the danger Point III                      treatment   of    ,t    tutiior?
                                           ac,gitfn(@s t4) be pL
                                               Dr. JeA]ZBI'lt. T.Iiis v-,tri@ f roTri t-,iiiiior to tumor.
                                               III tll(@ ease of ili(@            t-,iiiiior I' iii(@titioiie(l, I litLvo  experieii(-c  for
                                           more  trillion  d:O  years  wit,it  this  I<itl(l  of  tumor.  If  there   is   no   recurrence
                                           or              of rather I-) Y(@it,i-s           initiation  of  iliei,-Il,PYl  W(@   ]Yltty   lki-
                                                                                                 t@li:tt t,11(3       t@ will 1-0,11'1@illi  III
                                           stliil(" Nvif.,Il II, High           of
                                               0
                                           go  (@i           I'll til(@      of    other     Illinois,          Of t@lle           foi-    ex-
                                                                  most; J)Itl,ielit.,i will I.(kiii:iiii well if they ]live               NVCII
                                           foi- l@) yei@i-S, all of               CtrtA@t', too,  @l@  am  sill..e-llavc  S(IILNII  I)I.Ltiellt,3
                                           "N,llo have ll-lt(t                  IS to 20 ye,:tt-s liti-,or.
                                               Si) Av(@ ii)tist@ giv(, t ('IiiTor(,@iit          for each kind of tumor.
                                                 r.        I,      I.I(l i I I I I I i I I([ :t (.,:) s(@ 1, I I I Lt, I' ,I I 1) AV (@, I I iI-Avit ll'(@ o f , t] at,  11,11).
                                           1)(@iis to be my son who lift('[ fL               tumor. It is now .1) yell,]-s ,i      nm      the
                                                                        iv.,ts  Lriveii,  and  lie  has  been   in   very   goo('.   health

                                                           -Lvs Nvtteliill
                                               I i,lti itlw,                    of (,x)tii-so. 'I'Iiis wits  5  years  tire,  and  it  would
                                           sle,(@ift 11(@, is ill v(@i-v Lroo(I     ftttliis   tiin(@.
                                                                                                                           it[     experience,
                                               Dr. FAltill"llt. f @in sorry to le(,trii you have this person.
                                                                                                                         iiiz.  If  there   is
                                                 Nelseri. I would sity'tli(,, story yoit.give is oncourag
                                           no ovi(leiic() of tiin-ior tfter 5 years, this looks very liopei-@i.
                                               iNIr.  CAICI-I,,R.  I  want  to  sty  think  you   for   ,tn   iiiterestina   and   informa-
                                           tiv@.iiid I started to sty           4@ persuasive"   presentation,    but'i'nstea,(l    of    that,
                                           I  ,ii-n  goiiiz  to  s,,tv  tliit  so  flr  is  I  am   concerned,   I   am,a   believer   end
                                           am fully Porsu,%d@d in -,vlitt you say.
                                               T]i    iilc
                                                  a     _Von.
                                               Dr. FAitii,,,R. Tli-.inlc you very much, Dr. Carter.
                                               ,Afr. SI-:UIIITZ. Doctor, I have one stttement.





                                                                                                     14,C)

                                                                    the,                                       til,'It if We, ('OUI(l Dlt],[(' !tV',Lil-
                                             ,11)le to                                                       evidence,  that  w(,,  iitv(@  oil   (-,,tticer,
                                             I('io.000  lives   Nvollld   I)e,              this year or tiiy                   Is this correct?,

                                                                                                               the isle we, have III t,l,yllltr  to
                                                   to (,N,ol,y

                                                                              \v(@ (lo,
                                                                                   So('i(@(.Y,                   I)I-ol)l(@iii  is
                                             iiii,ilt'loll @i f(@Nv of  ('11(@  (.ollll)l(,Xlt  i(@s'?
                                                                                    io 1): I i (, I I0 I I I  o I I i,, (I o(- f.() I- (t:t I-] y, 'I'l I i,  i s N
                                                                                               I)ai-i i(@iil:tj-ly ]).Its had t                          ioll;  I
                                                             for ]finally Y(@;I,i-s ]II tll(@, :Iit(@illl)t to li:tv(,
                                                         t@li:kll is ]lot%, tlit@,           I f \V(" (Gould apply til(@ cytologic
                                             ti(,-, fe,@t, fol.(,X:Illllle, to ever          NN'()Iii:ill                 (-,Olil(l ,;,,Ive i,liollsll)(is  of
                                             live--,,   lifel-@ill                                      lici-(,   is   a   foi-iii   of   cancer   of    the
                                                                  y
                                                                                       b    siii-get,y, ori@@i(liol Iier:il)y.
                                                                                         y

                                                                I ives.
                                                I'lic,)-e is t further I)oiiit,            t,li;tt should I)c                   It is that       there  is  t
                                             lici@ of facilities         ill lii',Illy Of tilO  ('0111]Dllllity  IIOSI)it(IlS  Of  tl)O,  (!Olltltry
                                                        there   are   -oo(I   ii-ieii   iiid   well   trLiiied   ii-ic,,ii    and    devoted    doctors,
                                             ]),it     "-itliout     e-xpei)sive     facilities      -tnd      without      Ill      of      tl-io      supportive
                                             therapy     that     is     extreiiielv      costly,      one      cannot      do      as      much      for      the
                                             I):ttit@iit    as    iv(,    hope    to     (lo     wlieii     these     regional     medical     programs     brill-
                                                           to     ever.),     coiiiniiiiiity      liosl)ittl      that      is      connected      with      every
                                             center-, @iii(i every center (connected with every other center.
                                                                  if).Illy  ].(@;lsolls of this Iciii(l, bitC if this (!oiiiitry
                                                                  Nvls N%.ortliNN'llll(, Saville 11)(@0100,000
                                                                          'end    ill(,    ii(Iiiiii)isti-,,LtivL,    relationship.,;    that    i\,oii](I     I)e
                                                            t II ' 'e. I i N,(,s could 1)(@,  sive,(I.
                                                                        Af:l,yl)e I                             yoti. I ilioii,,Ilt, yoii                     sty-
                                             ill,-, Drift  olic@ of olir first, 1)1-01)1(@ilis is                     to I)I.il)qr ;11)ollt, all

                                                                                area           to tilL@                          for    I)I'ol)el.
                                                                                1)(@ s:t\-(@(l. Aiii I i-i(,Iit ?,
                                                                                is point, '\'o. 1.                of   it, is            ill(,,    iii(li\,i(Iiial
                                                          ik-ill  (lo,  mile  1):Il.i  of  it,  is  I\']I:li  ill('  (lo(.iol.   Will   (lo.   Illil-   if   these
                                                            (,olll(@  to hospitals                     (lo  not,             facilities,        the        doctor,
                                                      is                  ti@(@iii(,,ii(loiisly                             with     ill(',      tr(,i-rivii(loiis
                                             :Ilt)oillll  ot   l@-( )ill[       lie is (loill(r ill                                  IN'ill  I)C  marble,   to
                                                     tli(@ ol)liiii,,t] t,r(@:tliiieiit,                 the   :facilities    (,lie    I:tcl@iii,r,    I)ec,,tiise
                                             of ill('                  of Sill)])()rtive therapy,                            of   ill(',   litlilll)er   of    ex-
                                                      in iii;iiiv               of    medicine,     siii,-ery,     ,iiid     I:tl)or:ttol-y     s(qel-ice,     tre
                                             .not :t-":k il:il)lefoi- tlie,
                                                l@itt,  if  L                              receive     enrervtliin(r      tlittt,      is      Icilown      today,
                                             1)(,  %N.,]] slitil(i it fti.I f@i,r                               ill    iucli    a    place    than    lie    (-all
                                             ot
                                                                       'I'li:Liilcyoii,])octor.
                                                                                  yoii very iiiiieli, Di-.                         for      yoiir       excell(@nt





                                                                                        147
                                                                                         (loiigi-@,siii,,tn    ]@iiyl(eiidill,     will     in-
                                             Our  (listil)giiislied coll(@,,tguP,,
                                                                                                                    colle,,,iglie    with    us
                                             ti-odii(!o the  nex
                                                               t witliess. Wo.,ti,(! pleased to have our
                                             It   the   comniittee   bore   ind   are   d   li(y   ited   that,   you   will   introduce    our
                                                                                        e
                                             next witness.
                                             STATEMENT       OF       IION.       DAN       KUYKENDAL-L,       A       REPRESENTATIVE        IN
                                                          CONGRESS FROM THE STATE OF TENNESSEE
                                                                        Tli,,ttik you, Ali-.                   It,   is,,t    real    Privilege
                                             to 1)(@, with   the                     for :1 ],CAV liloilicilts) ,tlld ,t             particular
                                             privilege to introduce a rrvtii wlio for s(@v(,rtl  rc&tsolls,                 I-    think,     is
                                                                      to f(@stify Oil tlli@                   bit of legislation.
                                                         li'(, is qiitlifie,(l for several (lilrel,ellt,
                                                First,, if not, f@r(@,iiiost is the fact           our city          area     of     Mciiipilis
                                             i,4  very  much  t  re,@oii.,tl   city,   I)rol),Ll)lv   more   so   thin   any   i-riitjor   city
                                             o@itsi(lo  of  the  crow(le(Itre-,i,  of   Llie   e@tsforii   sett)oird,   where   wit,liiii   125
                                             )Hill.  of  oili-  city  we,  ]live  five  States.   A   ii(I   we   leave   run   into   problems
                                             of   Ilill-Btirtoii,   because    of    implicittioiis    of    not    getting    benefits    from
                                             ,t re-ion,.tl concept.
                                                We,    proudly    announce    that    i\feml)liis    is    ,t     major     medical.     center
                                             around   our    fine    -Liniversity.    And    Dr.    Cannon    himself    is    one    of    the
                                             outstanding     -,urg@ns     and,     maybe     more     particularly     P@,inent     to     this
                                             )Hearing. one of the major contributors to medical                      education      in      the
                                             whole   Nttion   having   been   one   of    the    leaders    in    the    field    of    medical
                                             edii(,,ition for quite some vears.
                                                So                ileac   to   irntro(Iiiec,   my   f   ellow   Memphi,,tn,   a   good   friend
                                             ,tn(I a                    or, Dr. Bland Ciiiiiion, of Memphis.
                                                                          to leave now, itiid go to my committee.
                                                M. r                    jiderst,,,tll(l.
                                                Dr.  (,,tiiiion  we    fire 1)1(@,,,tsed to   litvo   you   ,tii(I   welcortie   you   to   tlic
                                                Dr. CANNON. -YIN3. I Would like to 'nslc Dr. Riilie, D
                                                                                                                      r.   Brill,    and    Mr.
                                             Il:trrison to accoinpitnv me to the wit-nes.,3
                                                Mr. IZ(xill,]ZF;. We,  WPICOMC   all   of   you   to   t,])e   Committee   -,ill(l   will    be
                                                (@iis(@d to rece,'             testimony.    It    is    my    understanding,    Dr.     Ciiii-
                                                                 lv(3 you]
                                             iion, t,liitt, voii      reprosentiti(r    t-lie    Aii,iericaii    Medical     Association     in
                                             giving yoii'r i@est@iinoii'
                                                                         Y.
                                                                                                                    -R    OF     COUNCIL     ON
                                             STATEMENTS OF DR. BLAND W. CANNON, MEMBE
                                                MEDICAL      EDUCATION,      AND      DR.      HENRY      BRILL,      MEMBER      or       com-
                                                MITTEE        ON        ALCOHOLISM        AND         DRUG         DEPENDENCE,         AMERICAN
                                                MEDICAL         ASSOCIATIOX;         ACCOMPANIED         BY          BERNARD          HARRISON,
                                                DIRECTOR,         LEGISLATIVE          1),BPAItTMENT,          AND          DR.          WIUIAM
                                                RUH-E, DIRECTOR, DIVISION OF MEDICAL EDUCATION
                                                Dr. CANNON. That is correct, Mr. Chairman.
                                                I   ,tin   it   pr,,tcticing   neurological   -,uracon   and   a   member   of    the    Ameri-
                                             ciii      Medical       Association7s Council oil Medical Edu(-,ittion.
                                                With  me,   to   T)i-@sent   t.ll(,   views   of   t,lic   Aiiierieivii   Medical   Association
                                             oil 11.1t.  I  r)7t)8  I's  Dr.  Ilenry  Iii-ill,  of  Ilreiit-wood,  N.Y.  Dr.  Brill  is  chair.
                                             mine   of    Llic    AMA's    Coit-iiiiittee    oil    Alcolioli,3ii-i'alid    Drug    Dependence.





                                                                                          149

                                            .Afr.              lltri-isoii is director of AATA's Legislittiv(@ D(,ptr(-,i-neil
                                                                                                                "J)ivisioii of Me(licilli
                                                Dr. Willi:tin l'iilio is director               of  AMA's                                     I
                                         Fdiie.,ii ioii.
                                            'I'I)o  tlii@-co             of         I.")758             t@l i i-ce, 1)ro@,rr;trns of
                                                     Io                        M(,,di(@,i,l   Associiti,ioii.   I will  (@oiyiii-iciit@   On   the
                                                        @VI)iC]l             to (,II(- (-,Xt(',Ilsioll of i@llo 1,@("giollt] 111(3ttic:tl  pro-
                                                                                            (@xi(@iisioti of t,liv, I)t-orrii,i-ii for
                                                                                                                         t,
                                         for lit@:ilili              for iiiiL).I.,Ll,orv
                                                             fol..                                                                         'llrill
                                         will I)roN,i(le         siibcoininittee Nvit'li I'lie -,isso(,iitioii's views oii the  latter
                                         two subjects.

                                                             STATEMENT OF DIL BLAND W,  CANNON
                                            Dr. ('AN-NON. OJle, llllti(li-cd  tiid  t@v(!iii  v-oiie,,vo@ti-s  It'-"Oi  I'll-S  ;t  II(ISII]t,  of
                                         the coll(t4,,l.ll of the profession willi I)i,ol)](@itis                       fo,tlio, (Ilillli,(-,y  of
                                         iiiedi(!,tl                  11-Lil(I               t-lie   AI,fk   NN,,Ls   @iiiided.   giii(@c   tll@it
                                         day   ii-i   18-,17,   or,();,tiiized    medicine    his    ciicoiii-(i.1-red    in("tllo(lol@ogies    of
                                         health    cire    ivliieli    it    believes    will    best     provide,'iiril)roved     health     care
                                            Tllo    increased    longevity    which    the,     Aiiiei-icaii     people     enjoy     todty     is
                                         a   tribute   to   i-nedic,,il   td@ranCeS   and    their    applicttioii    to    the    hetitli    cire
                                         of    the    American     people.     The     Ainerictn     i)fiysicitii     today     is     pr(@y)@ired
                                         to  reiider  the  best   lyiedic,,il   care   in   the   -Nvorld   because   lie   is,,%   p@o(l@iet   of
                                         1%   colist@.-tiitly   ilill)rovinz   T),ttterli   of   the   fiiie,,t   inalic,,ti    education    ,tiid
                                                                   his   oi@p@rtiiiiities   for    -pos(gi.-:i(Iiiite    ediic,,ttioiiti-c    tin-
                                         cxc,(,]I("(l :tiiyw           -.tild 1)  Cause  lie  ]):Is  1)(!(@ii  II,ille(l   with   iii,,,itclil(,Ss
                                         and ever-"L(IVILI                         tic, find
                                            I         iiiad(@
                                         be                 IV                             sti-ivo                            So 1)11.:tt, NVII'tt
                                         we ]five t,(,)(]"Ly    will     be        I. t'l):Lll                iiii(I Nvll"tt., we             Io-
                                         illol.l.o%v will silill 1)(,             I.Ii:lli (Today, NV(.,          )lot., lose           of   fli(@
                                                                                                                       ill         I           I)Y
                                         our
                                            Ill                                           Z.   Al)l)(d,    iN,Iio                               of
                                                                                          I'llo I'lill                                     ("olik-
                                                                                  oil I'll(- I)ill

                                         Actions of iTil(@, iyifl                                                           of
                                                                      coillillittee, )brief) of oliv                  wii,s
                                                                             siii(,,o  that  tili'le,  coiltiliti(@,s  to  I)rojn-ise,,t   hopeful
                                            ]3ti-t, tli(@re ,i,rp, still soine, -%vlko would lilc(@ to            the       regional       medical
                                            r@(,Yr,tin  %s  -tii  iiistrtiii-ieiit  by  lvliicli  tlip,  Oil(-Ylltllizi;tioii   ,tnd   deliv@   of
                                         ille,tltji   care   to   t-)Iie   American-people   could   l')'C    cli,.tnged    in    sorne    revolu-
                                         tioiitry   )n:i,nner.   inipor@t@,tntIV,   this   does   not,,tl)i)etr    to    be    tli(3    view    of
                                         those  i'll  tlit,   .,tdi-ninistm,   tion   cli'arged   with   @tlic   im-   -plementation   of   Public
                                         Law 89-239.
                                                  :D%vi(,rlit    L.    Wilbur    presi(leiit-cle,(,t,    or    -ille    AAIA,    in    vddressiilg
                                                                                                                                          Y
                                         19(;S, ]Joined t@llfLt-. oil  ,@ll                                                      director       of
                                         of                                                                     wi,@lliotitex(@rcisiiigFo(](-,@itl





                                                                                                                                          'r7l,-,"  @-7 7






                                                                                                                     149
                                                                                          iit,,tl control over              current  p,,tttc@,riis   of   hettltli   activ-
                                                           'or Sil@ito
                                                           it,i(,s. Dr. Wilt)tii, tiic@ii gfLid:
                                                                                                                                                          find to                        the
                                                           If tlio I)rogr@iiii ill              is (,]CIrly one (lesigil(@(I to Ctitll]Yze
                                                           tl(,Yeloliiii(@iit   of   ))Ptter   I)i-ogr.,iiiis   tit@iii   i)t)w   exist   to   merve   1)ittleiits   iiii(I   tli(,Ir    physi-
                                                                it  @v!IL                         r(,c(,ive     etktlitislii.st.ic     cool)(@rittloi)     from     the     nic(Ileal     liro-
                                                                  iiii(i              groul)s.
                                                           Sli(,Ii   Sill)l)ol-t@        is                   I)N' tile                               ill     l@MI-@     by      SODle,      Of
                                                                                                           ltlt;,[ by                                                           of        illic
                                                                    I II live ol@ 1.11(@ 5 1                                                                                     1)1-4)gl.ltll
                                                                                     :1.1-o                  ilio  I   )i,,Ili-](- I
                                                           lie@()t it ;i,ll(t                             Ill )unity  or           iii(@, ot,li(,,r                      I)rogl':i,ili,4,
                                                           A\lo    \,i(,w  \Vii II. ]':Ivor tile (":II.ly                             ol'                it,@'     LI-)ility      to      build
                                                           oil (kxi"t)ill..,                   of                                                                   liew               features
                                                           or   changinL,   old   ones   as   local   demands   and   resources    make,    possible,)
                                                           '111(l tile lo(@,ti   11(@xil)iiity Nvlii(@,ii tilows the program                            to     iiitke     t     real      coii-
                                                           tril)ittioi-i to tli(,,          ill    care     of     our     iittioii.
                                                           @Vt, tile SLlyle, times we  recognize  t,lf@it  tile,  concept  of  the  regional  n-le(li-
                                                           cil proffrim is still iii its very  early  sti&ye  of  exi,,tencetiid  fAi@tt  it  is  dif-
                                                           ficult to     11)1)rtise  the  I)rog@,iiii.   IVe   do                    not   know,    for    exaii-il)le,    how
                                                           much this                         ,td@ls  to   the   sti-ess   on   an   alre-,td   overtaxed   supply
                                                                                                                                                       y
                                                           of                   n@edic,,tl nitiil)ower. TlierL,, is some concern that the
                                                                                                                                                                                        pro-
                                                           liferatioii   of   Federal   health   prograi-ns   substantially   contributes   to    tile
                                                           rise  in   health   care   costs.   For   this   reason,   we   are   pleased   that   H.R.
                                                           I        provides      for      tii      eirtluttion      of       t,       le       program.       We       Would       sll(,r,@@st
                                                                          t,,  It     title     oAr"tlll,,Ltion     begin     J     ily     1,     1968,     rather      than      July      1,
                                                           Ilowe'l           i,
                                                           1970              ev,-tliiti-,ioti     ,Iiotild     be     ,in      iii          part       of        the        planning.        We
                                                           t I -.,, osii,ro-est      that      tli(3      si.il)coiyii-nittee      co      isider       further       ,Im       ndilig       section
                                                           102 to      I)rovitlo      tliit      the      eviiiittioii      sli,,tll      be      nii(l(,@      by      a      liongovvriimeiit
                                                           a4r
                                                                                                                       tiii provisions w
                                                                et@ioiis 103, 104, ,iiid 106 cotit,.                                                 Iiich      we      believe      to      be
                                                                                          103     provides     for      the,      iii(-Iiision      of      tile      territories      uii(1,3r
                                                           r,,,'@N,[P; section 104                         c()ITII)iiittt-,ioii       of        re,@rioiial        medical        I)rogi-.i,i-a
                                                                                          for                                                    gl-,tlit-@s; tll(l  Section  106
                                                                                                                                           -oil]([ ))a                 to                     or
                                                           ll()Ill)olii,                  -iii,4it,iit.ioiis @foi-                                    by,     ol.-     ,vlkioli     will     be
                                                           of    sili)"t:lliiii:t,l     li'4(@     t4),!Il,liy     two     or     iiiol,(@     1,(,(rioiiil     ino(licil     pro-rains.     We
                                                           re(@oiiiiiloll(i           ll,(Iol)(@i( )II o I' .1 I I i I        (-,I
                                                            A.s  to                                               ivo                                       ilia                   subcommittee
                                                                     tile, ol)eii-t@iid                                       foi-           foi.-    tile.    4    lis(iil     yeii-s     end-                 t
                                                           nice :ift-.or Ititio '10, 1969. In vi(@w of                                fact-,      that      we      are      still      darling
                                                           with ,t                        uiii,ried                        we     believe     it     would     be     wis(,,     to     liliiit
                                                           t,ile .iiii'lioriz,,ttlioii to  sii(,,Ii                    @t,,          -subcommittee               iyity                determine
                                                           to     be     reasonable,     rather      tlitii      to      I)rovi(le      for      "such      siii-n,,;      ,is      may      be
                                                           necessary        for        the'         4      fiseil      yell,@-s.      Ftij@,tlier,      with      (lie,      same      concern,
                                                           we      'a the, subootiiiiiitteo -to e'x'(-,eiid the 1)i@oartm fare                                             of      3      years
                                                           rather     than      tile      r)-yetr      extension      provided      i@      the      bill.      Both      of      the      pro-
                                                           vioiis     ivitiiesso,,i     litvc     i-neiitioiied     1971     as     ft      Iiiiidmark      in      the      activation      of
                                                             l@inftlly,  we  note                        qc@,et-,ioii      105      provides      -for      ,Lii      increase      in      the
                                                                                          -ory,Coiiii(@,'il         mambo         -s
                                                                                                                                 1    froiyi    li3    t,o    17.    As     this     cli,,ti)go
                                                           number         of          Advi,
                                                           is iii@-,tdo by tlio subcommittee,  we  would                                                 @tlie         further          a-mend-





                                                                                           1 50

                                                                   tiivt four iiieiiil)(,,i-s of flie cc)i-tiicil sh.,tll be
                                         I)li     @iciai-is. Tii(3 current           requires    that    only    two    be     practicing     phy-
                                         sic,iiiii,;. In view of  iiiediciiie's                          witli   RAII')    ,ve    believe,tii,il@t
                                                       I  iiiiiiiiiiiiiii  of   foill.   practicing   I)li   ,iicl,,in.9   would   be   liell)ftil
                                                                                                         y
                                         tot ie A(Ivisoi-                                               -o  i
                                                              i, ('oiijicil.,tji(I to tli(t
                                                                        (-,oll(-,]Ilsioll, l(@t, ilic say         IZMP      has      stimiilttt@ed
                                                                i<)Ii fi-oiil til(@,                               Soiyi(,,  of   oiii-   distiji-
                                         giiislic(l  ille(li(@@Ll  l(@11(lel's  ,tj,,e                     iii        re,  ioii@t@  pr@gi,<,.tii-i
                                                                                                                         9
                                         ,iii(i   iiiiiiiy   St,@ilo   iiid   coiiiity                          ii-e    cooperatiiiir    in    the
                                         Pltililiti@r   of   tlle,-Lctivity.   Oil   the   whole,    we    feel    that    tlie-progriins    hol(I
                                         iiilicli hopeful i)roinise.
                                            Ilrith     -your      -peri-nission5Air.    Cliairin.,,tn,    I    would    now    ask    Dr.    Brill
                                         to    continue    the    -,tssociation's     stateiyient     with     comments     on     the     remain-
                                         in   rr   provisions   of    I-I.R.    15758.
                                            iAir.   Roopits.   Tli,,ink    yoti,    Dr.    Ciiiiioii.    Dr.    Brill,    the    committee    will
                                         be I)Ieased to                       itiliioiiy.
                                                                    )roiir   t@

                                                                 STATEMENT OF              DR. HENRY BRILL
                                             Dr. Bnl,LL. ilfr.       Chairman tiid          iiieiiil)c@i-s   of    the    subcoiiii-nitee:    Tlle
                                         .LNIedical Association, oxi.LNIircli 4,             1965,    t@t,if-ying    before    the    fill]    In-
                                         ,terst,vto -,q.-nd l[ioreic,-Il Coiiiiiiei-ce      Coj)iniit(te   on   -,t   bill    -to    extend    the
                                         program  for lletlth services to                  iiii(,i-,ttoi-y  workers, s,,tid:
                                            INIP T(@-<)giiiz(@ fli,,tt ii)igr@iii,t f,,tiiiiiie,4 earn Aiii(I (li)  I)ul)lie li(@,,iltb lyr4@iiii@lil.4
                                         which tire I)eyoii(I the cnj)iicity of F;ojne Small communities to handle  efficiently.
                                         iii)(I  we  r(@(!oiiiiiieiid  that  the  Coitiiiiittee  fiivoi-ail)ly  (Consider  the  rcqiierit  to  ex-
                                         t(-ii(l,tlie I)j-ogilti iii lor iiv(@ y(,:i rs.
                                                       IT of  If.]Z.  ];')7;-)8   ivoii](I  no%%,  1)i-oi,i(](@  :in   it(l(litioli:tl   2-y(@ill,
                                         (,Xl(,Isioll of This                        @ks N%.(@ (ii(I
                                         tlli,,                         f;lvol.211)1(" ll(,Iioll. l@'itli  oill.                                of
                                                                           I(](] this liol(@.
                                                 Ill(-, I),ISI,         ]its          .1                      lle('(l   ilil'ol@,e(I   will)   the
                                         I)e:tlt,li        of     iiii,,riloi,y               ll,'Iiile tlies(@ I)eol)](,, il-(l  (101TIllioill.@-
                                         of t@lle, IONV-ill(.,olll(@ gi-oi3i), tll(@il- )liability li:l.,;          it, (lini(-Iilt fol-
                                         to   ol)t,.Iill              iti(i    fi,oill                                                 Ifow(.I,el.
                                         Ill('  ilili)lelll(@llf;tlioll  of  the  lit](@  XIX  J)I.o,rl.@iliis                   tll(@    So(!i:il
                                                       A(tt   %%coal([   ]fell)         tltis  1)rol)l(@iii,  its  it  moves  t-()   tll(,   ro:ll
                                         of@                :111  the 111(t(li(.;Illv             ill  the    Sliti@e.  11T(11 1)(@ (1@v(,   meet
                                                            (@,X((@lisioll   of   ill(@    migratory    woi-l@et-s'    program    to    2    years
                                         is                      ,it wlii(-.Ii tiin(@, their 110(ril;llll   (,all be evaluated in             tiie
                                         li(rlit  of  it.,;   I)rol)er   "pliisiil(,r   olit),   ],to   t,lie,   title   XIX   medical   assi@;t@-
                                         ,ince 1)i-ori-,trns.
                                            Now, Mr.                        we would lilie to (Learn our attention to the                      one
                                         remaining  part          of  I-I.rx..  157,@)8-fitle  111,  entitled  "Alcoholic                    ,tiid
                                         Narcotic AZIdict          Rehabilitation.''    Part    A    of    the    title    refers     to     alco-
                                         holic     rehabilitation,     and     part     B     to     ii,,trcotic     addiction.     Both     would
                                         ameiid     the Community ialentii ITe.%It'li Centers Act.
                                            Part    A    would    I)]-ovi(le    graiits    for    coli9tl.lletioii,     stifling,     ol)eritioi),
                                         and    mtiiiteiitiiec-of     f.-teilities     for     flie     prevention     and     treiti-neiit     of
                                         ,alcoholism under t-,Iic coniiiiiiiiiky iiiei)tal Health cent                    rs
                                                                                                                        e     program.         It,
                                         also    I)rovi(les    rritnt-,-,    to    help    communities    develop    facilities     and     Sci-v-






                                                                                                                          71@





                                                                        151

                                       for the liollieless al(@oliolic, CNCll Wli(@l-L' ]lo Colilllllilli(y  inciiiil
                                         celit(,r
                                         are iii fiill ite.@,oi-(l with the ])I'ol-i,;io]IS of this se(.fioll
                                         to tli(,, ftiti(iiii,, for coiisti-iietioii of          'I'lic      AATA       has

                                 of  :111           of tile lietltli I)i-oftssi(@iis." At its cliiiietl iri(@etiiig in
                                 NoN-eiiiber if)("i, tli(3 Ilotise of I)el(-!,,ates  of  tli(@  A.NIA  resolved  that
                                 I lie @kill(@i,icili Afe(iic:il Associttioti '@ideiitify ileoliolism -ts it  complex
                                 (lis(,as(,, aiid sii(,Ili          that  the  iiiedi(!al  components  of  this   Lre
                                              I,csl)ol),3ibility.
                                   It may be ;f interest to the gtil)eoiiii-nitte(-k to i-evienv  briefly  the
                                 A--\I@'i's   iiiei-etsiii@,ly   ictive   interest   in    tlip,    fie](I    of    alcoholism    over    the
                                 past yeLr :
                                         We    have    iSSIIC(I    a    new    Dl',Illtlttl    on    -,ileoliolism     for     physicians,
                                       suiiiniariziii,-    the     esslntitil     considerations     in     the     causes,     diign(l'iis,
                                       tnd treatment of this illiiess;
                                         We are I)Iaiinincr ,tli e,-,Iiibit, based on this           for           showing
                                       lit J)rofclssioiial i-Tiectiilgs;
                                         II'(,,   issiie   new   matei-itl    for    the    public    on    tlcoliolisni    tnd    problem
                                         We    have    published    ,t    (rui(ic     foi-     iii(Itisti-i@il     physicians     concern-
                                       iiiff tli(,ii- role iiitlcoliolisiii pro,rriiiis for employees;
                                                  eiicolll.,I.ill,"   more    extensive    ttjid    (-oilll)l.(@lielisive    iiist,l-lic-
                                       tioii   in   iii(@di(-,,il   schools   in   tl)e   nature   iii(I   problems    of    itleoliolisiti;
                                       aii(I
                                         We  :11.(3   ili.Lriiiz   that   llioi,e   Ill(l   iiioi-e   g(@11(@i-;Il   hospitals   fl(lillit
                                                   its            recognizing    that-,    Ill(.oliolislll    is    it    (lisellse
                                       tllztt-   sliotild   iiot    1)(@    netted    in    isolation    but,    one    that    needs    the
                                       .011C(Illtl of
                                          I.')7,'-)8  !@iVeS  Stl-olll)-   eliCotIt-,I(r   talent   to   tll(@   integration   of   sei,v-


                                   It,               t-lic   complexity   of   t-,Iio    (lisciiseiiid    correctly    r(,,co,,iiize.-,
                                 I I  let it ,Iioiild iiot@ 1)(@ ti-etit-e(i is an isolit(!d (Condition.
                                   Tii   t(lditioii,   by   ii@alciii,,r   I)i-ovisioii   foi,   the    Itoiiieless    ,tl(,oliolic,    ii--
                                              of tile Cxl,,,tell(.e of it col,@-iiiiiiliit.,y 11(t:kltll  it,      wisely
                                 'Itteilil  ts  to   COI)V   with   wiltt   promises   to   be   ,t   ;,Yrowiiiz   1)robleii-i   in   t   lie
                                 view of recent court decisions. These decisions litve reW-
                                                                                                 ,i@ded     the      public
                                 (li@iiiilcoiiiie,,s   of   ,tn   %Icoliolic   ,i,s   t    symptom    of    his    disease,    rather    than
                                 an otTei)%, I)uiiislitl)le by jailiiil-.
                                   'I'lie pi-el)oil(ler:tiit, number of persons    qri-ested    for     this     olTeiise     have
                                 li:t(I ]lo :k(lc(lll@itti     let,   itlol)e   ifiedi@il    attention.    Very    often,    t,lit,,y
                                 It)(@k iil)oii it i@til (,(dl it,, it     root over ili(@ir li(-ii4ls. NoNv, t,
                                         I  iiii(i it illol,.(@         ()no, Talked NN,itli it(le(Iii:i,to
                                  t i ti

                                                                       will 1)(@ fol-tileolliill,r, no(, olll.,;   l@-
                                 1).@-    the          of (.lie national  I)oli(-,Y         this bill              NVL@
                                 ll(,(!Ojlllll("Il(i yoliv       foi- illi(@             great      I)I.ovisioll.      TioNv-
                                         \N'(' li@IV(@ lolig treaty ftill(IS for St-;itliiig itil(i ol)(@l-lit,ioll iti-C
                                 (,)-ly t@lio                of t-.Iio community,, oil(..o the iiiitjor             of
                                 (,,oii,,triietioii has been met witli lPodertil "assistance.






                                                                                             152

                                              Pi,ri 11 N%-oti I (II-) i-ovi (To ,t siiiii III I- ]))-o'Y III IIf<-)]-
                                                                                                       s t,ltiit, I)ot,ilioii of         Nti-(-.oili(,

                                                    in                   of                   It, 11,111(@ll(IS i'lle Coll-lil)illlitl
                                                                                                                                      y
                                          iii("Ilt,  and  i-eliibilititio'n   s(,i,vi(@es.   A(_ri,iii,   N@e,   -,i@pl)],tiid   the   move   to   in-
                                                                        i.ii(I                 foil                           group      of      sielc
                                                                                   of coli'lirlittlit,.Y                We                    however,
                                          t,liIL          is 110 I)I'Ovisioll for i'll(@ lioiiit@l(""s                  ,illiil@Ll.  to   Ili('   pro-
                                          vision   for   liolli(@,1(3,,s   tlcoliolic,-,.   We   believe    tlitt    (-oi-riinuiiities,    iri-esl)cc-
                                          tive    of    Nvliether    they    hive    coiiil)reliciisive    mciitil.    lictltll    centers,     should
                                          be    eii(,oiir.Lgecl    to    iiiike    -tdcqiitte    shelter    facilities     tvtilable     for     iitr-
                                          cot@ictddici-,.-s   -,tii(I   we   recommend    to    this    sul)coit)iiiittee    tli@it    ,t    provision
                                                          for this purpose be included.
                                          fo
                                                   we    hive    stifed    -with    respect    to    the    provision    for     @,i,lcoliolic     re-
                                                s
                                          Iiitl)ilitttion,    we    support    Federal     assistance     in     arints     -for     the     construc-
                                          tion of the necessary facilities, but would iiri@ that. funds for
                                          tioiiiiid    st,,iffin(v    be    t,)ie    responsibility    of    tlit)     P,@@ticiptting     communities.
                                              FiliftlIv. we suggest that the SUI)CO11-1111ittee SI)CCifv the SUM,-3 to  be,
                                                                   tn                                             -
                                          "In              under hour   ro-raiii.9,
                                              t@lioi-iz@d                                      ri.tlier      than      the      ;pen-ciid      author-
                                                                              p
                                          izatioii is stated in ptrt C.
                                              Mr.    Chairman,    with    re(rird    to    both     tliotlcobolic     ,Iiid     nl,]-cotic     ,tddict
                                          rehabilitation    aii-lendnients,    we    ,ti,o     liopeftil     tliit     this     leirislatioii     will
                                          reinforce   the   determined   eiTorts    of    all    of    the,    lietltli    professions    to    I)i-e-
                                          veiitl   to   control   and   to   treit   ill    ,ispects    of    drii,-,    dependence,    of    lvliicli
                                          .ticoliolisi-n .tnd narcotic tddictioii ,tre,,,t ])art.   'n
                                              -kf                    both   Dr.   Ctiiiion   ,ind   I   tliii-ilz   voii   tiid    the    me)-nl-)ei-s
                                          of     your     subcommittee      on      belitlf      of      the      Aniericin'Ale(lical      Association
                                          for     this     opportunity     to      comment      oil      this      important      legislation.      We
                                          will    be    pleased    to     aiteiiipt     to     answer     any     questions     the     subcommittees.
                                          may ]lave.
                                              Mr.    RoGrns.    Thaiilc     you     very     much,     Dr.     Brill,     for     your     statement-,
                                          too,    and    these    statements    that     have     been     presented     on     behalf     of     the.
                                          American Medical Associttion.
                                              As   I   reciil,    too,    Dr.    Brill,    didn't    you    help    us    oil    the    Drug    Abuse.
                                          Control Act?
                                              Dr. BRILL. Yes, Sir. I remember we] I.
                                              Mr. ROGEIZS. We appreciate your coming back to help us again.
                                              Mr. Kyros?
                                              Mr. K)L-ms. Thiiilc you, Mr. Cli.,.tirmiii.
                                              Dr. ("-,tiiiion, oil              3   of   your   st-,,ttciTieilt,    Sir,    you    -,ay    that    anv
                                          evaluation    that    %Vill    be    made    of    l@ll("    eirects    of    the    r(@frioii:tl    medical
                                                       you               ,Iioii](I be made by a iioll-ovel.l)ln("Ilt@,11

                                              '1)1'. (ANNON.                ;11'(@              t@iliti-, (lo ovilliiittioll,,i of
                                          'I'li(@l-o is       Slii,lifol.(l 'Iiisl.iiiii-,o. 'I (@llifilc         i,lio                             of
                                          the ])).og).,I.Irl Would want, I,()                   it  114)114@rovtrlllllellt   litlr(@licy   itliyx%,ilv
                                              I  (Ginnie ol)it@(@,i@ivity or sti(@li all (@%7:iliiatioii     wotil(I ])(I of     i-nore     1)(@lloCit
                                          to tli(,iyi.   tlii     -]fee real izo that,.
                                              Mr.               What is there so far in the                  ol)(@i-atioii of     this    iet,     e@-
                                          pecially   t-,Ixe   section    on    evaluation,    that    concerns    you    at    all    about    flat,,;




                                                                                 153
                                     objectinily?   Is   tiler   iiiy   question   tli@it   t@licy   ivoiildn't   be   looking   for
                                     tile fillt           of lioNv to iii:tlcc   Cli(@  I)roLri-@iiii            and     (-o@i(.In't
                                     tll(@y        tile              elY(%t of                                while     they     are
                                        I)r. (J',@N'NON. No (Iolli)t,  but I  t,liiiilc  they  could  i)-yiprov(@  it  by  liftviiig


                                        Mr.               I NVIllt, 10 ('Ollgrt(@LilttO, tile dis(Iiiigiii,,,Il(,,(l geii(;Ieyii(,,ii
                                     oil ('11(@,ir I)rcstllt:,ttioii,, liero- CO(ity. '@Uliere is ill tll(@, I)Iltllllill- stta(. now,
                                     ivitliiii this colniyliltcc, on tile i(ivice  of  oiii-  cliaii-in,@iii,  a  1).Ii,n  tyevalu-'
                                        IV(, (lo have L V(-,]'Y             oi-g@tiliz:tt@ioll  in   tli(,   General   Accouiitiii(Y
                                     oflic("                                        for  us,  :tii(i  it  is  responsible  Only   t
                                                                                                                                   0
                                     tile Congress, ,Liid      not   to the                 del),tr(ryieiitl    which    does     do
                                     ex(-el lent txiditi for at, and his done them in tile, I)"Lst.
                                        This is  :-6  very  good  ILciiev  Nviiicli  is  ]-(',S])Ollsil)lc  to  us  ,tnd  does  work
                                     for' us. I doii't@ name it               do you, Mr. Cliiirm,,iii?
                                        Mr. ]'ZOGLIIS. We liol)e not.
                                        Mr.  C,kirri@R.  It  litsjilt  been  in  soii-ie,   iN-orlc   they   have   done   for   me.
                                     But   certainly   we   would   consider,   or    I    would    cons    der,    a    noiigovern-
                                                                                                                  Generttl       Ae-
                                     illefita             lloweaer  we do have confidence in the
                                     Coliiitlillg         I)ectuse they usually
                                        Dr.                Di-. Ctr@r, I did         not  ii-iein   that   there   was   bi,.ts   in
                                     evaluation   of   the   program.   I   (,hiiilc   that    there    are    institutions    avail
                                     ltl)lo  tbtt  can   give   exl)@   analysis   that   nity   be   of   great   value   to   this
                                     program.
                                        @ll r.          Yes, sir.
                                        Dr.   ('@AN@NON.   And   Iiiiowiiig   those   who   ti.O   tdiriiiiiste'ring    this    pro-
                                              I  lilLve  tile  iitliilo"t,  confidence  that  they   will   s(,@oic   such   advice.
                                     9
                                        @iiis (loi@lsii't  mean   that   you   should   not   littve someone      else      evaluating
                                     it, too.
                                                                      in (-,v:tliitt@ioii  to  see where   we   are   and   to   see
                                     if                      0111- lylolley Wi,.,(@l V.
                                        1)1'.   (',AN',NON.                            objectivity didn't imply bias.
                                                                  You, sii-.
                                        Now, so far a,,                    ftiitllol,iz",Lt.,iol)s al- concerned,    as    a     usual
                                     thing  they  just  don't  happen   in   tliii   coiiiinit(,eo.   lJstiall.y   it   is   limited
                                     to;@ years. Am I not correct in tlitt,, Mr. Cli,,tirmiii V,
                                             1'0(,],,RS. Yes.
                                        Mr.  CAIZ'i'l!',R.  In  t  genertl   rule   that   hts   been   followed   in   the   coiii-
                                     mittee   it   is   usually   fimited   to   3   years   in   authorizations.   So    I    think
                                     tli,,ttit'isiiiigreenientwitliyourp,,tpcr.
                                        Our  bill,  I  believe,   is   in   agreement   with   Dr.   Brill   also,   in   that   the
                                           ram   concerning   mi,,rat6ry   workers   is   for   2   _years,   as    he    suggested,
                                     @ll,,O(Crwe do         i great    many    problems    with    ilcoh6lism)     and     we     do
                                     relcoallize itist disease.
                                        it is regrettable that         some of our goneriimcnt,,tl           agencies        haven't
                                     ttk(,@ii  to   falls   idea,   however,   because   it   is   very,   very'aifficult   for   us
                                     to  ol)ttiji  tdiiiissioii  to  it  veterans   liosi)it:tl   for   an   alcoliolie-vel'y   dif-
                                                              'Lllllost, impossible it@  t@illies.
                                        I should life  to  see  this  (@liftiiged  soiii(@wliitt,.





                                                                                                         1;54

                                                         I                                    iii ill(,  (-oti@ti-ii(@tioii    of    facilities    foi,    care     of
                                                                                        ((,rt@iijily, I ,till III                        %vitli          Ilere      is
                                                         tile li:il,(l ])III't, tll(', (lifli('Illt      foi- soitic              of   our   eotiiii   i-y.   If   @ve
                                                             fi,(-)iii .,I weiltliy             it is easy for  the  aret  to  provid@  fluids  for
                                                         OT)e,@,,itioii. 13111., if -%,oil Jlal)r)(!Ii to (,,oi-ne l@i-oin all iinpoverislictl
                                                                                          ye      very   (-Iifliciilt,,    donvii    in    Appalacliit,    to    @,-et
                                                         Is it, ll',Ippells I (10, it is I
                                                         t II (@ fi II) (Isfoi. i-t IIIII i II,, sll(-,Il ,III i II@liti I i,i oil.
                                                            tli(,  s@III)e  inner   A%-c   lltN,e   tll(.,   s@1,11le   problems   there   Wlli(-Il   fli(@,y   ]leave
                                                         ill            communities,  ind  I  would  hope  that  we  would  be  'It   little
                                                         bit cli,-ti-it@tl)lotoourlessfortiiiiatebrotliers.
                                                                  yoii,'lNfr. Cliairinin.
                                                         Nf r. I' ociits. Thiiilc you, Di-. Carter.
                                                         %fr. CArrl']'.]I. I -,VIllt to COI-f)l)liniellt, YOU, Igain, gentlemen, on your

                                                         Afr. I'tOGFRs. Mr. Skiibitz?
                                                         Nfr. Siz-ui@irz. Dr. Cirter             raised  ,L  question  that  I  had   intended   to
                                                         I iiii woiideriiig whether we ,Iioiil(liilt  limit  these  Ilitliorizations  to
                                                         Iv(,:ti-. Illlit@ii we tiitliorize for 3 iii(i 4 y(@irs, the departments (lo not
                                                         ]liver t@o          before    us    ,tnd    Justify    tficir    i)'roL),r(im     or     tell     Us     what
                                                         t,li(-,I,   have    done.    They    are    tliro@gli    W'Itli    us.    @Vo@ld    you    oppose    1-ye,,Ir
                                                         tlitlioi-izttions?
                                                         1)1'. C,KNNON.       I      think      that      1-yeir       commitments       could       create       dif-
                                                         Afl-. SIIUIIITZ.    This     doesn't     stop     the     ,tvjieies     froi-n     PI-,inning      for      4
                                                         oi-  ')  ye,(trs.   It   means   they   are   to   come   bicli   and   report   t-0   its   and-   tell   us
                                                         wli@it they are doing.
                                                         Dr.     CAN'NO-,v.     There     inty     be     difficulti(!s     in     ofTecting     the      T)roLri,aini
                                                         in    hiring    I)Prsoyinel,    ,tnd    iiitiiy    other    things,    but    we    woiildr;'t     ]@     op-
                                                         I)o.@(@d to your anniiil evaluations ,in(I -,ipl)roprittions. I                                    tli,,it-is
                                                         (lecisiol-                        ttee.
                                                                I for you r comi-n I
                                                         'Nf   I'.   SIZUI'ITZ.   I   don't    think    the    coi-ninittee    wants    to    abandon    tile    I)ro-
                                                         gi@-,iiii. But this is the committee that listeiis to the testimony-
                                                         I    thin](    it    is    important    for    the    Lgeiicies    to    come    baclc    and    I-.ell    us
                                                         what    they    I-ttve    done    and    justifv     the     monev     they     need     for     the     next
                                                         yei-i' .     Otl@rwise,     the     departments,     are     on     tliei@owii.-AVe,      have      no      control.
                                                         Dr.        CANivoN.'We        are        tremendously        pleased        and        have         commended
                                                                                                                                   this      Program      into       a
                                                         this coi-ni-nittee for its -perceptivity in organizing
                                                         meaningful    piece    of     legislation.     We     stilf     have     that     coifid@'nee     in     your
                                                         (intent.
                                                         ]lid,
                                                         r.   Si[,,-cTpii,z.   I   notice,   for   ext)-nple,   in   tl   is    p,%rtictil,,tr    bill    there    was
                                                         all tiitliorizition      for      $100      inillion'in'1967.      Tfiis      makes      it      appear      that
                                                         I   ]IC,,   I)ro-rtin   is   startin   to   level   off   at   this   time.   It    doesn't    malce    sense
                                                                                      9
                                                         to ]lie,.
                                                         name you, Ikir. Clinii-iii,ttii.
                                                            Ito(li@,as. Tl),iiilc you very i-niieli.
                                                         Di-.    C@ti)rioii    I    -notice,    To!i    @till    express    some    concern    that     this     -pro-
                                                         gi-@ill@l ]flight-, be, Ilse(] tl()   )',Y-    ltl)oll(-,    Some     cliailao     in     a     revolutionary

                                                         1)1'. CA'Nxo-g. I think thin-, tlic)@o still                        an     aitrit     of     concern,     be-
                                                         c:illls(" Some I)li(-rlit              the legislation to            mean    that     it     call     eIT(,ct
                                                         the  stttndtrdiz@t;ion   of   I-ie,,tltli   care.







                                                                                                                                             7





                                                                                             155

                                                                  I tlioti(@lit  we  lia(l  di.,il)cll(,(l  Clitt  in  Nvi'it,ilig  tlle  bill.
                                                                  @itiollli)t to ill illis                                                      Wil(til
                                               ])ill           olit,  of  (,lie  s(@iittte.  It,  N%,oitld  li:tN,e  I)iit   iij)                 coiti-
                                                              1):Lt@i('Ilts (-olil(l to(-               aii(I so             l@tit, @N,(!
                                          llie. (@olic.(@I)tof tllL) I)rf)gl.lllll ill tlii,,ieoiiiliiit,teL", fi',Yoll )11:ly                  .11)(1,
                                                      (lisl)ellt@(i this i(let. Aii(i I N%-oit](I liol)e,                Aiiiet@citit
                                                            (',olil(t (list)(@l t.iiit, vieWI)oilit.
                                                                   I  tllilllC  tilO  @III)ell(illi(@lits  ll,'Ive  been  very  gi-,ttifyilig,
                                          I)Ilt tlio "Iloc-Ic Nvlv(@, iiiii@iilly N%,;ts r@it liei- gi-t@@tt@. Ali([, is yoii lciioAv, t,liis
                                          is                  ttitit Nv(,, I)a%,e lii(I  to  -,i-,-tdiitlly  ovel-coliie.
                                              'All'. IIAIZI,,isoN. Al:ty I coiiiiiieiit, iN[i-.                        tli@it  ts  iii(li(!ated   by
                                          I)r. ("11111011 in Iiis statement, tliit                            of  the  iiiieii(Iiileiit,s   ilii(to
                                          by  this  coiyiinitt,ce  ,it  the  tiiiie  it  I)a&,3ed   oil   this   bill,   tlie   feirs   ttid
                                          concern   of   the    tssoci.,ttioii    were    soiiiewliat    qtiieted.    And    wliile    there
                                          still reiiiiiiis soiiie concern, -,vp, liave seen mucli liol)eftil promise.
                                              117o   liL-%,o   been   very   i-iiiieli   ,tpl)reciative   of   the   work   done   by   tl)is
                                          coii-ii-nittee in tlie, adol;tion of the initial program.
                                              lAir.              'I'litliil@ yoti.
                                              I notice you express concern oil                             ,,-yoti    don't,    know    yet    ]low
                                          iiiiieli this i)rozrain  iii,.iy  td(I  to  the  stress  of  all  -.ili-eidy  ovel-t-.Ixed  stil)-
                                          1)lv   of                  iiie(licil
                                              Jt-, W',I.-, lily Colle'el)t ill  the  (>I-igiil:tl  legislation,  ,tii(I  fi-ozii  li(,;irijig
                                                                                tliiiii i.(Id ,l, I)iii-(Ieii to i  iiiil)ower,                 woill(i
                                                        sei-vo  Is  all  C.ISill-  of   1   ilill)ower   I)OOftilA,   tlle   tll(@(                1%"IS
                                          tlilt. yoti (-,oiil(,l qiii(,.Iily -(@t to the (.Io(,,tor  in  Iiis  own  ](Wtl,ity  til(l@llitest
                                                             tlio ilifol-iiiitioll of t-lio latest            ti-e@it@111(@litsi Ill(l  so  fol-tli.
                                          "kii(i teityis coill(I 1)(@ I)].oll,yiit, in froiii tl)e,          iiiii%,vt,,,itv              to    woi-ic
                                          i\-itit ili(,iii in t                                wliert@ it    (lidiit            til(@@ till)e, of tlit@
                                          lo(.@itl  iiitii  to  liztv(@   to   go                 foi, 2              ill  the   stillijil(-r   to   (lo
                                                                                                      oil  ]lo\\'.   ('()Itlllltllli(.:ttiolis   Wolil(I
                                                                     t Iiis was, I tll(kll"lli@) :1 lio)l)(@fiil N%.Ilv of  liell)ilig  to  ease

                                              IVII:lt-, is yoiiv                Oil t.li:tt,?
                                                                            t-
                                              I)r. (IAN'No.4. .1 tliii)lc  yotii-  1)oiiit  is  iv(,]]  taken.  I'lie  tv(@i-,iLre
                                          iiig lyliysiciaii is  soiiienvliat  in  -t  box  for  tiiiie.  ITe  I)oiiiiees  l@io@ii(I  -.iii(I
                                               it
                                          CIL)I   tiny                 ,iway froin ,tii educ,,ition@il experience.
                                              Tfowover, niaiiy iiieii, is yoti ]@iioiv-I -\would -sty iiiost                           of        tliem-
                                          tire (lodic.,tted to C'oiibiiiiiinz self-imliicition.
                                              Wli(,tt,  I  lit(l  reference  to  li(@r()  Ni!,ts  t,lie  iiiiiiil)er  of  I)ei-soiiilel,  the
                                                        oil tll                 ,w,,tree  coiiiiiio(lity  li@is  been  iiiet@eitsed,  aii(i  the
                                          lti-,iliz-1t@-ioli of those 1)(,ol)le, Nvlko lease                  in  iii(@di(-al  care   to
                                                   1)1-0,riltilis  to                     ill            to             to  set  ill)   Units.   Ilre
                                                   li@l,v(@ @ti'ly                         bill. W(' ill'(@
                                              !Nfi,.              I ,till                  ill liltl,ill(r ilifol-illjltioll illoll(r illi,,i lill(@
                                                       I wolil(I see it,                      jilst. tll(@, ol)])osite,  itil(I   1.   %\.oil]([   llol)e
                                              1)1'. (ANr,,oNr. Nf:tv I' isli I)i-.         I'lille,  I%'Iio  is  (Iil-(!('tol'  of  oill'   T)iN.-isioll
                                          oil                                   to

                                                               I I)VIieNe IN-lilit-@ yoii      Said   will   liltililli.(@l   1)(@   the    case.    Ill
                                                                                ol)el.lltiolll,l st@l(rils, lioni,evel" it,     ])as b(@vii
                                                                                                      .1
                                          S;i ry local of the regions to iceiiiiiiilitte                             large   stairs   of    1)rofes-
                                                                                                                          ot it.
                                           ioiiil 1)eopl(,., to adiiiii)ister the I)rogriiii-i ,iiid to dire'





                                                                                                     156
                                                     As I recall, and I am not certain this is the exact number, but  I
                                                rwOl     one     of     t@lie     larger     regions     estimated     that     it     would     -need     tpl)roxi-
                                                iii,itely 90 professio-ntl people.
                                                     Alr.               All  doctors",
                                                     I)i.-.   ltujii@,.   Not   iiece-,isitrily   A,'[.D.'S,   but,   I)ersoli.9   ,tt   that    coiiij-)artl)lo
                                                                     in    order    to    cirry     oil     tli(@     a(fiiiinist'rtt-,ive     work     and     tile
                                                               of   tile   I)i-ograiii.   T]IIIS,   one,   of   the    iii;llile,(Iitte    oir("Cts    lifts    been
                                                                                                 ill   t   he    (-oiiii-)ct,it,ioti    for-tilit    isn't    ])ell-
                                                               ri(,'Iit    iNor(I-I)tit    in    t.lic    ,ivitil:tl)le    ol)])ol-tiiiiit@,ics     foi,     employ-
                                                ill(' it, of 1)1-0.fessiolitl people It the I,(Ilniiiisil.lLtivc level.
                                                     I
                                                     Alle    ]live    noticed    t]Cis    alret(ly.    I    tliitik    it    has    been    noticed    iii     t-lio
                                                             s(,Iiools     which     li.-Lve      been      ictivoly      involved      in      the      r(@gioil:ll
                                                Ict,ivit-,ies. It Ill-, been iieem,;ivry for                          to      it(l(l       additional       facility
                                                iii(I      administrative      personnel      ii-i      order      to      discharge      their      respoii-,ibill-
                                                ties under the program.
                                                     These  1)eol)le  have to            coiyip,  f roin  -,oil-iewlipre.  The
                                                                                                                                         _y    were     not,     ill
                                                gre@it     stil;l)li     before.     A     number     of     then,     have     come     ;iit     of      I)ractice,
                                                and    while     we     feel     ultimately     this     may     result     in     more     effiGiolle     iitiliza-
                                                tioii     of     health     care     sales,      we      think      there      is      an      immediate      effect
                                                here ill                             e     competition     for     manpower      in      the      health      field.
                                                     This                            basis-for this statement.
                                                     Afr.                            now,      what      I      wondered      was      this:      For      instance,
                                                I    envisioned     the     feet     tlizt     you     would     ctri-y     oil     a     continuing     educ4itioii
                                                                p(@rlit@,    tlii-otigl@    television    wlierv-    you    li,%ve    I.II     expert     ill     It
                                                )i-iedic,,tl ekiitor giviiia ii@trtictioii to your                             liospittLIS    in    a     coi-t@tili
                                                                their,  Ill,,IV   l@,'tve   just   COIII(',   out,;   so   thirty   you   (ton't   litve   to   send
                                                iii,,t rll(",tol-, out, to                           oi-    have    ci(-Ii    doctor    come    in     and     talic
                                                that,   i,iii1o   'to   ('@oll)(@   to til(@                          131it    tile    irollilli.iiiiielitioll    is
                                                olle of tli(@ iii(@ll,l)S that, You 1.1-0 goill(r to Out, (lo'NNll oil tile use of
                                                            'I  Woll](I  I         (11
                                                        t.Iiis   eli%,isiolill(    'i,
                                                     ])I-.             Yes;        it, is.
                                                     iNfi-.             So there,             so    iii:iny    t-Iiii)as    -,vliei,o    I    think    you     Would
                                                be   @@.Lvill(,   t,lie   time   of   tile,   locil   doctor;   -o   'on   don't   Iiitvo   -t-,o   littv(@   fi\,(,
                                                              t,                                                      y
                                                do(,,t4)rs     wli(@re     one     doetK)r     may     (lo     t.])c     waste     of     two     (I(@l@-for     in-
                                                           ivliere    lie    J)erfoii-ns    liis'exaiii    find    wtnts    a    rettdiii.@r    oil    an     X-ray,
                                                .11-L(I ]IC         manicuring   that   is    wrong,    but    lie    eatii    get    it    in    the    iiiedie4-ll
                                                center     where      it      carries'       iiyiiiie(lifttcly     with     i     coim-nuiiicat@ioii     on      the
                                                dii
                                                     'nl'osltsliat      going       to save  Iiiii-i  time  and  enable
                                                     I,,n t                                                                           him      to      see      more
                                                patients?
                                                     Di-. r,,.ujiF,. I think ill time it will.
                                                     'Nlr. P-tcx,,El                                                                                              ng
                                                                    is.       Ri(,rht; -,tiid this is wb at we ire concerned with, getti
                                                the    lielt@Itli    to    the    people,    ,tnd    this    is    the    reason    this     program     was     en-
                                                visioi-ie(l,-tnd adol-)@,-I think.
                                                     @Nll'. CA'R'I'l@it. Mr. Cliviiiiian, will the -Plitlemin yield?
                                                     Afr.   'CAlt'r]'P,.    I    WLllt    t@,O    Say    something    in    bL-Iitlf    of    the    general    rac-
                                                tit-ioii@i-    in    this    case,,    if    Xo@.I)Itse.     I     don't     think     we     sli@uld     sel?liiiii
                                                too  short.  I   fe   is   t   mail   wlio   is   j@iiowii   by   the,   f   fault,-,   of   his   labor.   If   lie
                                                (lo(@il't   1)rodu@,   certainly    his    prlct-,ice    i;.    (Yoiii,-r    to    fall    off,    iiid    he    doe
                                                                                                                                                                   s
                                                t.11@o         tin                                   s    a    iin(@    ber    of    the    Apa(felily    of    Gen-
                                                                      %(School-,. 110 goes  a                   ni
                                                er.-LI    i-.tktice. I-To is required re(,rultirly to go to school.






                                                                                                                                              777@T@





                                                                                                157
                                                                            too, in cooT)erttioii witl,  tli(,  iiiedi          Ical      asso(,i,,it.ioii.,;,
                                                                aid t I                 t5
                                                     (lo        ,       I (I Vi"itill(y                       who     Come     to     our     Iii),.,I)itals-
                                                     t@lli-oll',"Ilovlt rural Aiii(@i-ic:t to tc,@i(,,Ii us, ijid we         lzl-,id foi-
                                                                     )r-,tetitioiier in most cases           if   lie   is   (@flic"ient   and   efT(,c@tivel
                                                     lie,     liis"(Ievp,]oT)ed     cliiiinels     of     communication     with      universities,      ,tnd
                                                     sur@oiis   and   dignost-iciaiis   who   ciii   be   of   help    to    him.
                                                     @,NI'ost    of-    otir    community    hospitals,    I    would     s,.tv,     hire     I     qualified
                                                     1,:i.(tiolo,,rist  %N,Iio  read  their  films  fi-oiTi  time,  to   time.  So    we,    II-,tve     Most
                                                     of  tli@                ,tlretdy.      They       have       alreidy       @i-L       developed       by
                                                     private   illitit@tive,   forced    by    t@lic    iimessity    of    d@ing    the    best    type    of
                                                     worl@.
                                                     And I should say tli@tt most                 iieril    I)ri(@titioiiei-s     do     these     tliiilffs.
                                                                   tin  ,Is I see it  is       to  Collil)](!Illcllt      the      pi-ogrititi      wliich"is
                                                     .11 I -,, y  i n clr
                                                     Alr.    RoGiits.    I    am    not    trying    to    run     down     the     general     practitioner.
                                                     I  tliiiil,:  lie  li@is  done  ,t  (rr,,ind  job.  We  -,vaiit  to  help   him   to-   do   ,t   better
                                                     jobfoi-t.lie   iiieric,,tnpeol)le.
                                                     I  agree  ivitli  --Von.  1   tliinii   lie   his   done   a   great   job.   We   Nv,,iiit   to   lielp
                                                     Ili    t    I)ett@    job    with    tl-iis    I)roor,,iiii.    This    is    a    program     re,(iliv.
                                                     In (10 ,                                                                                 I
                                                     foi- the doctors     so     I     would      understand      kvll      the,      Americiii      'infedic@i
                                                                      I                                              y
                                                     As-,oci,-Lt,ioii would siii@)port it. It is r(@,illy I)Ilsictlly for the                 doctors,
                                                     to 1)(?, lie] I)fU] to talent ill "iViDg good ti-e@itiiieiit.
                                                     1)1-. CA.N@NoN-. ivfr. Chairman may I comment oii your stateil'ieiit?
                                                     Di-. CANNON. This is, in essence  i%-Iiy we                     believe      in      the       expansion
                                                     of    the    A(IN,isol-Y    Council.    We    bc@iievc@,    it    is    wise    to    tike    two    new
                                                     ilieiyibei,,, f real tliepi-,icticilig Pi-of@ssioll.
                                                     -.\fr.   ROGIMS.   I   think   it   is   it   good   sugLr(,,stioii.   -1   think   we    should    have
                                                     practicing    pwple,    and    I    don't    tIliDk-    We     ,il-c     getting     enough     hospital
                                                     ople ill there, either, Dr. C,,iniion. I
                                                     Pe                                                    think    we    are    ('rettiiig    too     )fully
                                                     C(iticttors.  This  is  natural  at   first,   -,laid   we   need   them.
                                                     13ut we have overlool@d in this pro(,r@,.im, @o d,.i                       I      think,      briiiginr,
                                                     in   ,t   more   active    pai-ticipttion    by    pricticii)g    pitysicia)is    find    by    hospital
                                                     ,tdministr@   tors,   -,Ind   soi   c   of   them,   people   who    are    actually    involved    with
                                                     provi(Iiii-  sonic   of   tlies(@   services   ,tnd   wli(-,re   tli(@   critical   units   should   be.
                                                     IV(@        ,t    more    1)i-itcticitl    iti)])I-Oltcll    in    file    implementation    of    wliit
                                                     .i,i @t "oo(I program in t,li(ioi,y,            I            your       suggestion       is        good.
                                                                                                   oilly gi@oill) tliltt,                            filing
                                                      ]flight-, settle flat(, I 1,I)ililc the
                                                                1'4 Your gi-olli) of                                            (I()(@@13  it,  110(,?,  Your
                                                                                     (-oiitillititi(r  e(iii(-iitioji.   ]lei-Iiitl)s   iii(@y   will.   This
                                                     w i    V()o(t.
                                                     1)1'. (",ANNOX. Ily 0111- li(;triti@ivo i-(@Aviii-d                     ili(@y re(iiiii-t@ i(,..
                                                                       I full stil'o  ill           (lo(.to)",  t,[,y  to  l@(@op  111)  its   best,   I'lley
                                                       (!:Ill           )'oil t,lli,,;                 is not, goiii(,r to go       for       ol)t@ii-eii(led
                                                     fitil(lill". w(@ ll,,Lv(@ ]radio it it                   as ll:ts                            by       in
                                                                                                                                                            y
                                                                         l@r(3 will sit ,t                  ,tiiii    to     be     authorized, and       our
                                                     1101                     ts beeii,,t 3-yeti-
                                                                     litroli,
                                                     I,(@,t Ili(., just tslc ,L couple of questions quickly,  since  our  time                              i s
                                                     run ii iiig out.
                                                     Doctor, I     wonder if, oii the alcliolic and                  the     narcotic      provisions      of
                                                     this legislation, you endorsed building the
                                                                                                                se    residential    areas,    the     qtiar-
                                                     s f6@ hoii-iele'ss alcoholics and bonieress narcotic addicts.
                                                     ter





                                                                                                    158

                                                                    Yes, Sir.
                                                                       I)o )'oil clivisioll this ,Is                   of t,lie  (',Olylllilliiity  II)Cllttl
                                                                                                                                                        it     ctii
                                                                     It (-,Ill                         f:t(.ility.               it, is
                                                I)o 1)@tri, of' the                 I)Iltl it,  (.,Ill  also  1)(.,  associated  witli  the  iiieiittl

                                                     ,N II-, I-,'      IIo NV (..III NV(.,
                                                                                                                            or 1)('I'Soll',, of  tliii  tyl)(@
                                                NN,ll()  NN-ill  "ti1v  N'oillllt:tl-ii      if    sil(@lt(.r    is
                                                                                                                                    ft(@,ility into  it  Coill-
                                                                                If          1.11(@y(,olliefl-olliit


                                                     I )I-.          Yes.
                                                                        'I'll(@y Wolil(I St-,ill ll:tk,e t@o go to @l tr(@,,Itiiieiit center                      or
                                                to
                                                     I)r.             This ctii 1.)e ii.,ied iii t flexible               NN@@ty. It (@,111 I)c     IISC(I     for
                                                tIlo,@               ii't fiiid their way blit iiec(l slieitei-ed care for                          a       period
                                                         NN,Iio
                                                of ti III(,.
                                                                                                                         -%%r iiiaiiy i
                                                     il[r.              Are fliere -,illy est-iiii@Ltes oil ]Io                         ieed   this   type    of
                                                             I   would   tppreciati;it   if   yoti   coiild   provide   that   for   the    con-i-
                                                     (Tlie follo-,N,iii(,r letter wis received I)Y tlle coi-riiiiittee:)
                                                                                                          A,-tip@,itICA,-, 'INfF.I)T(!Af, ASSOCIATION,
                                                                                                                           (,'I(ic(igo, Ill., A 1)),il 3, 1968.
                                                11011, T(@tiN TAI(NIA',,
                                                                                     oit Ilitbli(.@ lt(,filfh@  (t;i(l,  II'(,-If(ii-C,  (Iotill)tittrc 02?
                                                                                                                                    ,cs,
                                                                                                  flot(SC of
                                                     $lift(!        ],'oi                                                    )ttaiii,         @hitigtolt,       D.('.
                                                     I)i@,AI4 Alit. FAIC,-,IAN' : I)iiritig t(@stilliol).V oil 11.1t.         oil Afitr(-Ii '2-i, 1(X')S,
                                                              of like Aiii(,i-it-iiii                A."oi-i:itioil                      1).V                                                      :: @    I
                                                                  to stil@l@ly itifol-ill:iti4)lk ll.'4 to t]14@         for   iiiiir-wity   iiotises    for    aico-
                                                              lit                                  l(@ I I I of tli(t I)i 11.
                                                                                  of til(t iiiiiiiim-r of it](-t)lioli(-s %%-]IO  @N,oul(I  I)Pnefit,  frt)iii  tit(@
                                                II%-:iilliloilily of liillf-Nvly llolls(!s riiiig4@s                  1.@jO,000  iiii(I  200,(X)O.  'I'li(,ir   (Its-
                                                trillilti(@ii is go,ii(,r:tlly tliroiigliotit  the  Iiiiite(i  St,,tt@(@s,  wit@ii  the  gr(,ftttst  ii(@(-d  I)eitig
                                                iii            of I)oi)tiiatt@loii.
                                                         e,.,tiiiilite of iiir(-otle                wilo   wolil(i   1)(@iielit   froiii   the   ivailitl)ility    of
                                                                                                                                    iii(lividiiiiis ;ii-c  Io(-at(-(l
                                                iii  Ni-w Y4)t-k (.,ity, Nvitli tit(, r(-iiiiiiii(l(,r Io(,iiig                     tliroitgliotit   tlit@   ctiiters
                                                of            ioll.
                                                     lit slii(-i-r(-Iy liol)t@  lliat  tli(@  tiliov(,-  iiiforiniiiioii  will  prove  il,4efitl  to  yoiir  Sulwoin-
                                                ii@it t(,e iii its            ioiis oii'l.'itic III of 11.1t. I,-)-i 58.
                                                                                                                           10. J. Ti. 111,Af4lN(IANti@:,

                                                                                                               ii,.,(Ts?,  Are   there   tibotit   00,0()O?
                                                     ,Nfr.               IVII,
                                                     ])I-. I,)Izli.l,.(iO,000kiiowjiones.
                                                                                                                                    ly I
                                                     I)r.             The iiir("Ot.ics prol)leiii is in h,%If a doze,, @;g cities.
                                                       r.                  Yoii   don't   envisioi-i   doiii(v   this   in   evel-Y    coini-aiiility
                                                                                       -Cry 9,
                                                                       No.   I   don't    tliiiilc    tl)"I,t    is
                                                                          f  w ,I I)oA I t :1 I (,ol lo] i@s ?,
                                                                               is di  fritsed.
                                                                            ,Ill            (VO, ill(,@y            -)50,000
                                                                       'A'fI,Y  I  say   llilti-, (1)(@  total  I)IIIIII)(@v  or  111(@olioli(','4,   of   (-olir.,4o,
                                                                it            iiiiiiii)(,r    ol, 1)(@ol-)Io   NN'Ilo    Nvotll(lll,t,    need    tells    sort    of






                                                                       Iit ii(I(@rstiiii(I itis (@l 'III I;II (.41 i II t II   (@oti IIti-Y I 'I ltt, t I
                                               '-)()(),()Oo t 0 "I(X),Ooo.
                                                                   :L                                           fl.i)lil Illilloi',, wlio )III            ]Below
                                                                                                                                                     y
                                                                                                                                                     oiir      dis-
                                                                  iiiilioi,it,y               Oil  til(@,   Colillililtee,   :III([   11(@,   itiiy   ,tve   sol)le
                                                                                  011(@ or twol Alr. Cli,,iiriiiiii.
                                                  I)oct@<)i-,    were    you    any    part    of    the     ik@AfA     structure     Lt     the     tinier     WPI
                                                            the      I)eait,      otrolce,,              bill?
                                                  I)r.    CANION.    If    ".,,tru(!tiire"    is    iii    ill-iiicliisive    to@i-iii,    T     certainly     wts.
                                               litit,  1.  i@-,is  iiot  one  of  the  spol@e.,;iiicii   it,   t:liat,   tiiiie,.   I   aill   ,twi,re   of   t@lle

                                                  -Art-.                                      will I               tlie    lestiriioiiv     of     invoiie     wlio
                                               (-o)ii(,s 1)(,foi@(@ tlii,; coii)iiiit,tee, is all                      oil  2t  I)roll;r,,Illl   ii@itil   I   full


                                                                                                                 t:]):It., tiiiie. It-,           ovei-     ]lease,
                                               fi-olit tli(@               witli oil(" ,Iil(l it ]);III'             of                  tt    $970     iiiii1ioll,
                                               '11111OSt                                  stii-t a, 1)i-o4ri-,
                                                          ;I  I)illiOll   dollars   t4-)                        1,111,                  never    se(@ll     Sil(lit
                                               :111 :11,1"ly  I ill(@(I 111) -for transit,  I)]            @iiiiio,,t,,%vti]oNved    it-,,     until     I     went
                                                                             about-, it.. 'I'licii I ]list-, I)e,-, III to lii,,Ll(e soiiie
                                                  @Ill(I (I(@I)it-0 all  tlle 11)(@ill t@ilifigs           1'r]llt  Nv(,I.e,  .said   about,   t.110   diqiii-
                                               (riiis I(,([                    front  l@lorida,   -,,i.iid   )lie,   too,   diiri)ig   tli,,tt   tiin(,,   tli,,tt,
                                               W(l,  W(,I.e  I((',(@I)illg   trial,   bill   f   roin   Collins   to   the   floor,   we   finally   got   it   out
                                               at,   ,@'120   million.   We    didn't    let    it    out    ui@til    they    agreed    in    the    other    body
                                               trial   tli(,@y   woii](I   pass    our    bill.
                                                  If   lily   fi@'lli-esire    correct,    weireilinost    at    tli(@,    end    of    .3    years,    tend    out
                                               of           tli(@y              t    piddly    little    $,320    million,    I-liey    line    been    able     to
                                               sl)(tild 1,)851200)000 to dite.
                                                  liiii eoziiii)gbt(-Ic to this foi- one.                         Oll]Y,  .111(l   fruit   is   that   you   'll.-e
                                               iionv  asiciti,,  for  $(').,-)  iiiillioji   fol.   tilt-,   fisc:ll   Y(@:11-   190,0,   tii(I   iiotlil)ig   lias
                                                Ce!l Sli(l, f     tilce it, Nfi-.                         Nvitli                   to   ikily   I)ossil)l(!    i.c-
                                                                        It,  ]its  1)0(@ii  Said,  :III(]  t@11(@y  ;ti-e  .9111)lliit@(ilig   tll(-,   figiil,(!S.
                                                  I  (@oill(@            i,rilili to       lily               III  s:iyill(,r  tlitlft,  lit"  t'lic   little   You
                                                                       oil t.iji.,4             yolii-               (Iolll)t-(@(I tariff-, t,])i-.,
                                                                                              W("Iit,  oil  ;iii(l  I)oil)l('(l  Out,  wily,  ill   't(@l-@)IS   of
                                                                                          y
                                                                                     so    oil.
                                                  I' :till         t]l.Lt., %Vlilt, You s:ti(I and                  I   s@ii(I   tti(i   Mr.    Itogei-s    sai(],,
                                               ,ill(l  ;t  few  ot'll(@i-s  oil  tlki.,;  Coilllllit,t(@e,,  1)@is  C(Ylll(@   true.   Oil   y   it   liis   colll(
                                                       )Iloilo ti-ii(@ tliiii NN.0                          'I'Iiis    is    about,    tlio    oil]    little    we
                                                                                                                                                  y
                                                  'I'llis  w@is  'L  1)1-(   I-,till   that   I Sill)l)ol-t(@(i                          once     I     tlloll,rllt
                                                                                                                                                          t
                                               it, was @%@itlliii Sol)](,.                      111(@alls.  Iiii@t,  I   11)(@l-(@ly   point   tells   out   li:it.
                                                                                          of   .111yollo   wlio   (-ollles@    before    11.4    witli    ligiii-es
                                                        t@11(@v    cli@    be    justified.
                                                  'I'llis wis, 1-11:iy I sty,                 I   considered   to   be,   II)c   best    f,egtiinoiiy    in    ilic
                                               (-ottiit-i-.y.   litit   you    oiiglit    to    go    back    and    see    tliit    t@t-iinoiiv.    fioiii    I)r.
                                               I)eBttl,((,@y oil down. It wis priN@iite(I before t,iiis cojiiiiilttee. to iustif
                                                                                                                                                                  y
                                               t prog                                             wllicli    turned    out    3    yctrs    later    @o     liilv(l
                                                       ,raD'I-Fortbilliondollars,,
                                               spent $8,5 ii-iillion.





                                                                                                                              77            177                       7






                                                                                      160
                                          I ii",( IN'@ilit t@o II)iit, t@liit on the r(-,eorcl@  I)M.,tuse  I  tliirilc  it,  ought  to  be
                                      I)Vollgllt,  out,  11(ve,  that,  wlitit"  we  Lrt"t  ill  the   way   of   landslide   t,ullitiniony
                                             is :L             jol) and  siiow  job  cli),iiiiiiig  tlitit  s(omiu@tliiiig  c4tii  be  done
                                          Mr.    Si@IJI@ITZ.   Mr. Cliairiii,,tii, will my colleague yield?
                                          @l[r.                Yes.                                                                                     I
                                          Mr.        Sj,:uBi.Tz. IVis   $320   inillioli    authorized    and    $320    i-nillion    itppro-
                                                               14'ifty-iiine and 200.
                                          -Nf   r.    SKLTIIITZ. Bllt
                                                                     liow niuch i-noney was appropri@?
                                                               $85,200,000.
                                          -Nf 1'. @
                                                    S.lill]tITZ. Tliit is all   busy    spent.    1-low    could    they    spend     [lily
                                                               'I'I)o         is   they   di(Iii@t   spend   till    tlittt,w&s    tippi-o-
                                                 Tli(,,)rtl)l)rol)riited iiiore thin $8@1) million.
                                          'I'li;tiilc yo@t, Mr. Cliiit-ziian.
                                          Nfi-. I'@o(,iits. Tlitiilc you.
                                          I  (lo  think  it,  iiiif,)-lit,  be  I)roii-lit  out  it  this  point   that   I   would   coin-
                                      iiieii(I  the  idiiiiii@@ti-atioii  of       the    progriii-I    in    the    fact     that     they
                                                 iiist.  zone  out-,  and   spent   iiioiiey.   So   I   think   this   is   rather   coin-
                                      lliell(l,ll)fe,,  tl@,@t.  they  have  held  iij)   soiiie   8   million   on   last   year   @,%iise
                                      they felt, they were iiotit a stage to spend it.
                                          So  this  is  coliiiiieiid-,ible,  and   I   would   wijit   to   put   that   on   the   record,
                                      too,  that,  we  don't,  want,   tlie)ii,   just   I)e,(@ause   we   iiii-y   authorize   somet,liidg
                                      oil   it   iiiay   be   ippropriited,   tliit   expect   tliein   t@)   go   ot-it   and   spend   it
                                      liiile,,.,3s they ti-e at that point where it could be do@i'e effectively:
                                          So  I   tliiiili   whether   we   reach   goals   that   we   inty   have   set   is   not   ne@-
                                               the   det,eriiiiii@itioii   on   fli@    spending    of    the    money.    We    want    to
                                      iiiake    sure    that    it    is    appropriately    spent    and    even    though    the    goals
                                      illav 1),ive             above tliit.
                                          @o   I   think   the   adiiiiiiistrtitioii   of   it   his   not   been   in   error   in   tliit
                                          i)i-. IZI-ifi@. iNfty I coilkiiieiit Oil tlltt?,
                                          I   tliiii]@   %ve   would    support    this    ftct.    We    ]live    been    reassured    and
                                      eii(-otii-,ig(,,d by the @viy'fliis                    has    I)m-ii    administered.    I     thin]<
                                      ill (lefeli.@("   of   the,   program,   oiie,   thing   call   be   said,   that   in   the    etrly
                                      stages,  eery  ctrefiil   @itteiitioii   has   been   given   to   the   1)1,,tiiiiiiia   ,iiid   the
                                      preparation   for   the   ol)ei,.tt.ioiiil   stage   of   tli(,,   i)t-oardiii.   Tliis"lia-,    been
                                      one  of   the   trials   which   has   kept   the   exl)ciidit,l-li-c@s'@(.Iowii   at   the   present
                                      t
                                                        1)1'00'1',,Illl gets ])loving iii(o t@lle ol)er@itioilt]                I
                                                               to exl)t@(@t tliit the costs would
                                          AVe  feel  tliit,  (lie  I)i-ogi-iiiii  his  been  [tdiiiiiiist(',l-Cd  very   wcll,,Iiid   witli
                                      rf--sti-.tiiit Ljid good ludgiiieiit.
                                                                     you.
                                          @Afl'.   SlitYllITZ.   TlitC   ])rings   me   back   to   the   question   I   riise(I   t    few
                                      illol)lellt,s (Igo, the ll(-C@sit.Y of Iiiilitiii&,r  tlie.,.,e,,tiii@lioi-izttioiis  and  lifLVill,r
                                      t@lio  itgreneics  coii-ic       and I)reiciit tliei r case and prove their Y>oiiit.
                                          If   -%vetiitliorize   for   3   years,   they   don't   litN,o   to   come   back.   From   that
                                      moment oil they go before the Appropriations Committee
                                          Mr. Pt,@ERS. This is ri o@lit,.
                                          Dr.   RuiiF.   There   is   oi@   problem   in   that)   if   I   may.   That   is,   from    the
                                      standpoint    of    the    region    @Nliieh    is    attempting    to    recruit    personnel,    if





                                                                                                      161
                                                          is   @iiiv   qiit@t-ioii   %%-Iiet,lier   tl)(@   I)r(   I-,till   is   goilig   (.4@   i)o   eoiiti[iiie(I
                                                                                                              )91
                                                 rot.                                      it %N'olll(l 11)(@ oxt,roil)(@ly                    to      get       good

                                                                          I)o(.t )I,      )II
                                                        tlio                             t-illio 11,11(i            we lilli,,t lilLvo iL          or        4-y(@:tr
                                                                01, %%,o (,,. it     (rt@,t, tli(@ 1)(@ol)lt). ]@tit l'or soiiio                    t'lio       (iov-
                                                                          .11, ili:iy 1)(k tllt@                                    Nviii@t, ]ijtly                to
                                                                       oii only t -)-yeir                          III)([ lie   is (Iisltl)l)oilitt@(l.
                                                                             I would lilce          to     coijiiii(@iit,     oil     Mr.     Sltibitz'     question,
                                                                            Nvoiild generally                           if   it    ivit.-,    the    comill.it)tec,.@
                                                 good                       'Lll    alitliorizitioii    for    ,t    siii@ri(,@     yetr     while     would     rp,-
                                                 quite, t.lko pr                                                       tila
                                                                     o&-r,iiii    l@eople     to     come     btck     ,     (_;ive      the      cominitt@       all
                                                 ol)l),L)I.t.tilitiy     to     examine     the     pro,-r,-,tm            If     that      was      your      judge,
                                                 iiieiit,     and     we     would     sul)])Olt,     that     movement.
                                                    Mr.     SK-UltITZ.     YOU     ll"td     @better     st.ay     wit-II     the     chairman.     I     am      the
                                                 low ii-lan On the toteni pole.
                                                    Mr.                   As    t    matter    of    filet?    Nfr.    Sl@ttl)itz,    you    MiL'Ilt    be    iliter-
                                                 ested    to    ]@iioNx-    tlitt    we    did    a    speciil    s(iidy    oil    IIEW    ttiid    i'Wojiiiii(3iided
                                                 yt,-:il.],v Llltllol.izttiolis.
                                                                          I:iin  gl,,t@d  to  li.e,:ir   tliat.
                                                    @@Nl v. lz(xll",IL,;. w(@                                 t.o iliov(3 it ill colli,illitt(@ Yet,.
                                                                yoll V(NI-Y                Your    t,('%Stilliolly    lil),S         most helpful.
                                                          (@@@-;NON.                  You,      Mr.       Clitiriiiitii.
                                                    Nf  I-.               Oil I- ll(,Xt, .vitiiess is ])I-. Ivillil-ill l'ili(yfr, illilll('Alil@to I)IIst
                                                                  Aiiieri(-.,tii  (,oil(--c of                                -froiii,  fietliesda,  Md.
                                                                I                            r,                           Y)
                                                                V(-@1-Y              to liltl%le you with us, I)V. liilcofr.
                                                 STATEMENT         OF         WILLIAM         LIKOFF,         M.D.,          IMMEDIATE          PAST          PILESI-
                                                    DENT,         AMERICAN         COLLE,         GE         OF          CARDIOLOGY;          ACCOMPANIED          BY
                                                    WILLIAM D. N-ELLIGAN, EXECUTIVE DIRECTOR
                                                    I)i-.                    .1111              to      iiitt.(Kltlco      Williltiii      NelligiLii,      executive
                                                 di reactor of tlieeolloge.
                                                    1 tl)l)recitte the privilege of                                       before       this       committee        to
                                                              the      views      of      the      Aiiierical-I      Colle(r'o      of      Cardiology      regarding
                                                 bill           15758.
                                                                                                                                        '19,      (lie      I)rogress
                                                    '.I'Iio  goals  :tiid  1)liilo,,iol)liy  of                        T,.tw  89
                                                 ileeor(l(,.(l   by    tJic              iii6dic:tl   I)i-ogi-:tiii   ditriii,,   it   sli   rt    li@f    and    the
                                                 fitt,itro I)roiiiises (@itibodic(l iii (liis-eii(l(@:tvor itre                                        our       cur-
                                                          (,-olisid(@rttioii-,              tlierefoi-e-,  I)IO)III)t til
                                                                   s@iciiec in tells Country i   f,                    'red I
                                                                                                            S        tvo                                       coili-
                                                                tii(i tbuiidttit resources.  This coiyiini
                                                 t@ictil-,trly  t\vtre that the distribution  of  these
                                                 te,riiis of                 ctre,, is sliai-nefully uneven. 'riie   as c ily-ott
                                                 I,,tNv     89-1-139,     the     itiithority     for     the     regional      medical      program,      is      to
                                                 bridL,-e       this       Unequal       between                   itiiclservice     and     to      I)rovide      an
                                                 (4liciellit     liealt@ll     care     system     which     will     assiire     the     transmission     of     the
                                                 best   in   scientific   Iciio@lcd&re    to    all    peol)le    of    this    couiitrv    sufferin(-,    f    roiii
                                                 heart  diseue,  caneeri  and  stroke   or  struggling 'to  ovoi&                                               these
                                                 c,,tt-.tstrophies.






                                                                                                                                                           @77.1





                                                                                                    I (i2

                                                                                          tile                                 I)i,o(,i-ary)  is
                                                :11)1 v s i ii i 1) I e i I i (I i ii t I I c best tj-:i (I i I i oil o f t I I i s (@ol I I I t ry's geii ills for effee-
                                                                                            iiio(ici,ii                                                    ii,i,,ide
                                                              to ,III I)eoi)le wlit@                                                        c
                                                                                            ]I            ili,(@  i(lelitifi(@(I  It,  it   I-   giollil   level
                                                    iii(liN,i(iii,,tls   i-ii,,,olNed    ill    rei,ioii:il    til'iiirs    @i-ii(i    wlieti    ttvtilal)l(@    rul-
                                                soiii,@,,,,,     ii)(I     ii-iaiil)owcr     trc,     i)i-ol)(@i-lv     oxl)loite(I     tliroiigli     cool)er,,ttive
                                                                      lilif@ill','  (Iis(,ovel..y  wit@ll
                                                                  iii;llysis of tile :I(@t-@ivit-,ies of the I.(,(rioll:tl                               ])I,ogI."Iln
                                                             all lliitisii:il ].(@(.ol.(l   of                               tonviii-(l      that      goal      over
                                                                  sl)oi-t I)ei-io(i of                                          li:tv("                          tile
                                                I)Iitillliii@,- -foil I lie:iltii (.:Il.e, sysi(@iii iii                            r)O     r(,glolls     (,ncoyll-
                                                            'tll)ollt )O                  or-     tliii      (.olill(].Y",      I)ol)lll:ttioIl.      Oper@ttioll,,Il
                                                  'Solicitillii)lls -]'or I)IIII)Ilillg ,til(I                           gi,@ilit',    fol-    areas    iiot     yet@
                                                Ilivolve(I     Alto           (tolist:lilt,ly                                           Tile                    witli
                                                iviii(,Il I'iil)lic T,,,tw 81)-2'))9 lias exei,(,ise(i its iiiir)a(@t-,                    tire  Ivi(le      itill&lt
                                                of  its  iii@ittiriilg                       is     iiiost     iriil)i.-essive     tliiio.,,-t     dellyiilg     tile
                                                coliij-)Ioxitie-,i    of    estiblisliiii,,    t    ii(@,w    a(Iiiiiiiisteritig    or    ,ttiiz-,it,ioji     iiii(,l
                                                                                           l@                                    'I     9
                                                ,3ttj]'Nvitliii)   the   I'til)lic   Ilei   tli   Service   aii(I    the    difficulties    ill    -isseml)l    iii(r
                                                foi- I)I:lllliillg .tii(I t(-tioii rel)i-eseiit(itiv(@,,i of diverse scieiitift(, iiii(I   o
                                                siiiiier ,roiil)s iiii iiiyi.-iid of local coiiiiiiiiiiities.
                                                  'I'lle   lii-st   (IYIIIll)l(-,   (@ll',,:Igeitieiits   iN-itli   t   tie   1)i-ol)leiiis   of    or(rtiilz@ttioii,
                                                (]('iillil)g I-egioll.11 ll(-(@(IS ill 11(@:iltli            :111(l il)l el.rk@llit@ill;z 10(-,Vi  I - Pq 0 1 1 I- (.'. c s
                                                -foi. t II (@ I i@      i oil                  II t@(I :1 IIIIII                                    lose   NV]    Io

                                                                                                                 t
                                                -ilillost. witliolit
                                                                        exeel)tioll se)li(" tlllt itisti I           tioll'i     Iil(l     meii     I-el)].eselltillg
                                                                                    ,iiid     coiistiiiier     iiit(-i,(@ts     Nvelcoiiie     t,he      cliillell(re
                                                aii(I    ol)l)oi-tiiiiity    to    serve.    They    ,ii-P    i,I)I)Iyillg    I    liciriselves    ilii.,iti)lt,ingly
                                                to    tlic@    @ai-eli     for     soiiii(I     adiniiiisti-atiN,e,     sti-iietiires     ,tiid     for     efTective
                                                V()Iiiiitai-y      coopei-;itive.      ti-raiiaeiiieiits      wlii(-Ii      will      ,tssiire      the       success
                                                of the ])],ogi.,            @I'lipy    sli,,Il-o    I    I)OSitil@e    view    al)oiit    t,lie    likelilioo(I    of
                                                ol)litet-atiiig the void iiow                                the      coiiver,,ioii      of      l(iiowledre,      to
                                                            'I'lik"                    local             ,ill(l ti)(@y                      iii
                                                to Ili(               l@i                                                                      tll('      ftill(lillY
                                                I)I-o@-isiol)Sof (]I(!                                @111(i tli:lt tlli@             ITLNItItli  S(@l-vi(!e   is
                                                                  til(@S(-, ftill(is jil(li(!iolisly :111(l ill                    witli    tile    iieeds     iiii(i
                                                sol)llisti(@'Itioll   of    tli(@ill)l)lic:ttiolis    fl-()Ill    tll(@l)etilioIllllfr    I-CIrlolls.
                                                                    :Ill(]  ill  (.0111         to "olli(@, of fli(@                         in:l(le    to    tlii,,,
                                                I)oi I I I  i(@ (.4)11 1 1 1 ill (y i s ('N I I-(@ilie-ly S(@iisi I i N@ t 4) i I 10 1 ill) it'llt,i oils  ilill)o,;(@(i
                                                I)v file f:l(.t I liilt. tile, I)I,ogl.;Illl ]its ]lot I)V(@ii estiil)lisll(@(,l O)i          ,I      (Iolitillilitig
                                                ]):Isis.          I)III.,I(Iox   of   (.olliestillg   witli   lolig-t(@i-ill   11(@(@(.1s    Ill(l    lolig-i-@ilig("
                                                                  itil(It'l- tllt@               of' it Silol-t-i(,i-iii :let- is
                                                I(,               tile liai,liessiii,-r of                          it, (@oli'Ati-iCt.S                  to      tile
                                                                    (le(ii(.:ItioIl  is (iiiiiiiiisil(@(i                       ii                  potential
                                                                                                                   of                    Piil)lic'T,itN%,     89-
                                                2.'@!) Ills (@vol@(!(l tile tVI)e of 1-ol)ilst 1-esi)ollse, tli@tt
                                                of   (.olltiiiilil)trstl   )I)oi@f:ltl(l   iilclilsioll   ()if   lo@"i(.:Il   :11-eit-,of   involveil-iclit-.   ]lot,
                                                        0
                                                liol,et  fol      (@ii      ce(l.  @;kt  least  it  I)oi-t  ioii   of   t   lie,,c   ,ire,   recognized   iii   TT.R.
                                                           ('ei-tiitily    the    provisions    to    ii)volveii-eas    ()iitsi(le     of     the     @")O     States
                                                is coii,,istelit,    ,vitli   otill-    ti-,t.(Iit,iollll    ol)ligitioiis,    tllose    iml)lovlllg    IIIP     f,@-
                                                iii(@iitatioii      tlll.olgll      ilifel-le!rioylal      cooperitive,       those       se(.I,.iiig       involve-'
                                                ]Heart of Fe(ler@i           lio,,I)ittils     aiid     I)rovi@Iiiig     for      coiistructioii      fuiids      are
                                                                  lo(risti -,illy aiid fliiietioill]]Y.






                                                                                       163

                                                   @kiiloi,i(@iii           of Ctl'(Iiol()Oy                                           ilie
                                         ol)jv(.IiN'('S :11)(I  I)Ililo.-iol)]IY of tlie,  regional  l)IC(Iie"ll   rogr-,ttii
                                                                                                                l'o
                                         ol)IY 1-t@l(,:is(l itil(I (@ool-(Iill@@ioii.  IVe  siil)port,  t-lic  I)Itiiiiiii(r  tii(I  opera-
                                         tioii  of every                   I)ro(yraiyi  wlici-o we possess manpower                     and
                                            The  colle,re,  is   cert,,tiii   the I)ro(,,rLiii will cIcN,,tte the     lieiltli of      tile
                                                   It I)let(ls for a l@,tvor@il)le it(-,tioii oil bill  I.I.R.  157.-)8.  This  aii-icii(l-
                                         iiietit,  to  the  liil)lic   Ife,-tltli Service Act extends ,xnd expiiids                     the
                                         iiie(lic,tl  i,(,gioii@il  I)ro,-riiii  to  it  new  and  ,tiiiplified  I)oteiititl   and   liope-
                                         fi@lly  to  (II(-,  -,t-,Ittls  of  tlle   i-nost   distil@(,ruislied   i-ncaical   program   con-
                                         ceived
                                               :iiii           l'oi-tli(@opl)orttiiiityof expi-@,;iiigtlieseviews.
                                            @Nf  I..          I'liitilc you very       i-nueli, Doctor.      NVe      appreciate       your
                                         test illioiiy.
                                            Did yoiiv                Iiii-ve any st-,iteii-ieiit?
                                            iAf   r.            No, sir.
                                                   Izo("]@its.  Doctor  C,,trter.
                                            "\I     r. !A Iti'l@R. No q tiesti oiis.
                                            '\fr.
                                                   toGi,,its. Mr. Skiibitz?
                                            @\[r. S KIT]IITZ. No questions.
                                            -@\I'r.           I  iiii,,rlit  siy  tli,.tt  tl-ic  con-iiiiittee,  in  adopting   t   3-year
                                         1)i-o-i-aiii i-:ttlier tliiiit 5- or 10-       r   program,   feels   that   this   is   one   way
                                         l'ol.,(-Iiis  coiiiii-iittee,  to  carry  oittyites,  responsibilities  to   the   Congress   iiid
                                         tli(-,   Aiii(@riciii   I)eople,   because   otliernvise   we   leave    no    review    of    the
                                         pi-o(rraii-i.
                                            Dr.   LIKOFF.   I   understand   trust   I)Ililosoplly,.k\lr.   Cli,,,Liriiiaii,   but   I   do
                                         wisli  to   tell   the   coiiiiiiittee,   ,tnd   particularly   Mr.   Sktil)itz,   tliit   we   in
                                         the field   naive found it diflicult          to coiist riiet   long-range,                  orga-
                                         ilization@tl   progr-.-ciiis   and   planning    iii    view    of    the    uncertainty    froi-n
                                         tilll(,@ to tilli-e of the funding i.-efliiired to support these ventures.
                                            Soiiie,,tiiiii- we. I)Ian for v decide                  cannot, be                           on
                                         2                               Ifow   you   -@t   (,-xoveri)iiieiit,    workers    under    these
                                         C()Il(litiolis l(loii'tkiio,,v.1@'otroli,,tN,iiigdifficiilty.
                                                              t iiiii       it,  would  be  (tesiritl)le  to  set   progi-iiiiis   for   is
                                                   tilli(@, I,, NN't" wtiit(.(l witli .is iiili(.Il iiioll(,y as  wits  witiite(l,  but  we
                                                   to         i,li(@ C(,ollol tiy of (@ii(% Nittioii. li@it. this is  the  coiiiiiiit-,t(le,@8
                                         fi III(.Iiol),!I II (it Ii:lt. isWI) II i@ II(to.
                                                       gl-:ttt@i'lil for Y4)(11.  t(.Si,iiii4@lly.iii  slil)l)ort,  of  this-  legislation.
                                                   I)() I I (@, I 1) 1, t I I t o I I s i I II - c o I I s i
                                                   ll(,Xl, Nvi(ll(";,i is            Milliliitillo.f tlio'Nl'ityo             wlio     will
                                                          gi%,o
                                            Dr. Millil@:tii,             (refigured to IiitN-e you             an([  Nvill  be   I)](-,t.@d
                                         t o I 1: I N'e y ot I I- I- (@@s I I 1 o I I Y.
                                            if  you  Nvoiii(I  like.  to  put,  your  statements  in   tli(,,   record   and   just   sliin
                                         III) for lisi it would be                       oi- if you prefer, reitd it.
                                         STATEMENT       OF       DR.       CLARK       MILLIKAN,        CHAIRMAN,        COUNCIL        ON
                                            CEREBROVASCULAR DISEASE, AMERICAN HEART ASSOCIATION
                                            Dr.   AliLiiicAN.   Mr.   Roaers   ,tnd   iiieiiibers    of    the    subcommittee,    it    is
                                         not   only   an   hoiior,   but   a   responsibility,   to   tal,-e   part   in   the    construe-






                                                                                                     164
                                               tioll  of  the  colitiniiin,-r  legislation.  I  would  prefer,  actually,  to   ill,   t   malc
                                               soine        comments.
                                                 'Nfl           its.    "rhit    will    be    done.    Without    ob-cetioii,     Dr.     Milliki              8
                                                        r',OGF
                                               st@itelliciit will be placed its part of the record                         following     his      reinirks.
                                                                           I                   the Aiii(@,ri(!.iii lf(@,ui-t A-.,;ovittion,  I)ILtill'r
                                               (711"til.lll:tll of t,'Iio                     colill(.il oil
                                                                                              oii,t to  I)e  t
                                                              1.e(!ogiiizable  eiii,it,y   for   cool)eil:ttlive   uiid   colltl)oi-,tt.ive   tr-
                                                                  )lot, only                                              (,eiit,(,,i-s    find    1)rt(,,ticiiig
                                                               but I)et-we(@ii                                                                                  III(]
                                                       Jf(@irt     Asso(-i,,ttioi), -for                       has               iii      extraoi-(Iiiiii-il
                                               -let ivo I)iti-L fll ovei- the N-.ttio I, not, only tt, the                         of   r(@Ariojitl    i(ii,    y
                                               .1@,A)I.y coitilTlitt,,@.  but ill slii,,Iller coiiiniiiiiit,.y                      Last   -,veelc   tliej.(,
                                               iv:tst  meeting  in   New   Yoi.-k.,tt   Ni,liieli   over   400   voltii)teers   were   present,
                                               Itil(I one of tile fii-jii (I(@ci-,ioiis -arrived i,t it tli,%t iiie(It-ilig                          to     Clik-
                                               cotii-ii(,re  further  the  1),ii-ticil),,ttioil  of  Ifeai-t.  As.@iitioii
                                               which ciii t)i-iiiz (i                        to the ii)ipleiiieiltation and t@lle
                                               This exemplifies the ]Third of feeling Ilid the                                            for   iii,-,taii(-e,
                                               tll,,                                l@y   the   very   wise   provisions    of    this    ict,    and
                                               we                       rse, the coiitiiiiittioii of t-li@e basic prilicil)]P-g,,
                                                                             of oi-i!,,iiiivtiiiz ideas fit,  the  @-11  level  ttiid  li-.ii,iii,y
                                               ad]
                         4.
                                               (,ollllll("]Itilig 'LI)OIlt t,lie iiiittel- of tile           filiill("(,,S, $C)r) ]million is  it  sii,,-
                                               est-ioii for fi-x..Ll  1961), Iti)(I its is brought Out, there is to be
                                               9
                                               liol(IoNrer.
                                               You                                            iionv i,(-tiiitlly iJ)oiit I 1.                              I))-o-
                         3                             I,ll(l NN-it,iiiii, t'll(@, next. few ]Health.,;                 will  1)(,  'L  lot..I]  of   @(')   110
                                                                                     ft     is     extraordinarily     ilill)ol-ill,lll@      to      Co])Si(lel,
                                                        iii-o t-li@itilciti(,r Ili lt@i-i!is @)f t               of (-4)iitiiiii-ity             A)i(I       -I@
                                                                                                                  loll)(@litillil  it   is   lill),]I(I:Ito   -Y
                                               filing I%,o     ])lit,  it          ill  front, of it            filly    offer    ill    t@iiiie    with     tile
                         f                     'I'liis NN'.Ilo]O I)I-o"l-lllll               t.@) 1)('ol)lo,                  at   t,lio
                                               %-(I (.,Il(l of. t'll@                                        oi- fit, tii(-, I)iLti(@itt         A    Ili]     if
                                               Nvo (lo -,oinet.Iiii     l@'11]Cll Clit,'@3         the   IIIOI]Ielltlllli   ill   1',Ilo   y(@lLr    19(;8    to
                                               19(;9, we ]live             iiioi-e,   than   1   yetr   of   I)i-o,-i-ess,   and   '30   1   WO[l](I
                                                           tli@,   ii(@(I    for    the,    colitil)tlity    of    fise;ll    Support    for    tells    wll()](@
                                               business.
                                               Noiv, oil I-.]IC                 of  (.ollst,l.llctioii  money,  t-liit  has   Colll(-,   li@1)   ill
                                                           scelyl Iii(,rllly,illlpol.tilit, t'litit tlieI.L" 1)(',Ilitllorizttioii  foi-  this-.
                                                                        inciitioii(A    @id    Di-.    Ftiil)er    added,    there    are    trei.@
                                               As Dr. I)e]Ltl@ey
                                               of    ictivity    for    which    i)ew    construction    fluids    will'ijiicloiil)tedly     be
                                                          ii-,  tile,  level  of  2,  I,  or   4   yoii-s   froin   now,   which   sitolif@l   be
                                               evaluated  at  trait  point  iii'tinie.  It   does   not,   iiewl   to   be   cloiie   now   ill
                                                   of   .i.&,iiziiing   ,in   amowit   of   inoiiey.   But   it    should    be    loolcel    at
                                               l@lit                    iiltellsive   care   unit,   or   a   sti-olce   unit,    or    a    matrix
                                               wliieli            spite@tliat   is   not   the   issue   at   the    iiioiliciit,.    Iiiit    for
                                               t(leqlltlte   'planning   ii-i    the    future    there    should    be    the    authorization






                                            for the I)oteiititil of including            new     construction     soniewlier(@     ill     the
                                            course of tii-ne.
                                               NoNv, ti (,-oinmeiit in the area of strolic,                     this  is  t-lic  area  of  iiiy
                                            pti-ticillitr interest.
                                               'I'lic Ani(@riciii Iletrt Associtt-ioii             been                           in   ,,,troke
                                                        @fol-ille(i ,t colill(@.ii oil                         (liseise,   itzi(I   lias    been
                                                                                                          tjie lvol.(l  ill  Collitillilliti@-.
                                               I            that            oil'(trs  its  iiii  ol)l)oil-iiiiit,,v  tx)  produce  t  ,i-eittA-r
                                            iii@trix where we are really ,,,oillg to (to sonletfliiig :tl)oiit ,itroice,.
                                               '@oii ire aware of the need foi-                          in teriiis of            fl(.il it i(@,,i
                                            for r(,,Iial)ilit,ttiOD, I'(',,OIltry of  the  ]),itieiit  iiit4)  the  COIIITIAUllity,  but  we
                                            i.re iionv beginning to                                wlii(@ii,  if  we   ct   act   the   iiifor-
                                            illtt-ioll to til(3 I)OI)Ultt,ioll and to tll(@,                  -%Vill Siglli@fl(',ILIII@ly itIT(!4,t
                                            stroke,  prevent  ioii.  And  this  is  the  Ic@ii(I  of  thing  t,litt  l@MI)   is   d'esigneal
                                            to (lo,,tnioiigotliertliiii(-r-,.
                                               One of the inost iiite@(,,stiii(-r it,eiiis t,liat is Coillilig  oil  t.lif,@  -,I(reiid-,i  i)ow
                                                                                 )7                                            LI
                                            is  the  word  '@liyp@,rt@iis!Oll,.  or  high  blood  I)r(@slir(",  'Ill(l   -,V("   ]low   have
                                            defiiiiw    epideiniolo,-,icaL    evidence    through    I,)rogi-aiiis    which    have     been
                                            -,iil)l)ot-t-@d  and  ori-@rinite(I  b  you  I-)eople   that,   hypertension   is   -.is   iiii-
                                                                                   y
                                                       in  stroke  is  it  is  in   heart   disease,,   certain   i&,tte(-rories   of   heart
                                                      in   particular,   ,ilid   that   via   t,lic    detection    -land    treatment    of
                                            hypertension,   we   may   @ut   -,i@nificantly   down   on   t-lie   incidence   of   strol,-e.
                                               The   I-Icait   Association   is   (resigning   DroErraii)s   to   interrelate    to    R'@NIP
                                            and   provide   screeiiina   and   detection   ii-iecf@-iiiisins   to   find    there    people.
                                            Soiiie   20   perCODt   Of   li7yperteiisives   are   not   even   detected   at   this'   point
                                                                     to   the,   very    i)nportaiit    subject    of    hypertension,    the
                                            J-(@@)-ioll:l,l medical               oirer all (NCellt-,Ilt D),Itt-ix for t,li(@  en-itliiit-ioii
                                                                            to, . As pi,oo),raiiis for                     (Ioti,(@tioii   iiid
                                                         I)OI-t,(@lisive ;irt s
                                            0              f IiiLll blood 1)ressiirc.,tre
                                            li ,,iloslso                                                        f        should I         %,Ili]-
                                            itt)]o fee.. ()Vltlll@iioll fti)(f coitil),,ti-iiiive t@ritis of drug ii(,r(@iits;
                                            (1111ILrs  IL]i-e,,,tdv  known  tii(I  those  wliielt  will  coyiie  out  of   develol)iiieiittl
                                               Tlies(@,i,ro si,iiil)],y stiiiiiii@ti-i(,,s of soi-yi(, of the coi-niii(@,tits that .tre in ill(-
                                            foi-iii.11 accord. I (ioll't -%want, to belabor tlies(,,                  but  to  )iie,,  we  ti-c
                                            de,.tliii,r Nvit.li t.lie ii,-ttioiiii]            the   lietltli   of   our   people,   and    we
                                            couldn't 1)(" (liscll"k,;ilirt iiiore important ciubject.
                                               I  colirl-,tttilitte  and  codiine-iid  you  oil  all  Of  the  thrillers  tliat,   you   have
                                            (1011(',, -.111(l in tli.is particular fr,-ti-no of ref-c@reiiec your wl"
                                                                                                                        "(Ioiii  i  I  giiidinz
                                            RMI) lits been unique.
                                               (I)r.Millikan's -reparedstawment follows:)
                                                                     p
                                                                             I%IILLIXAlq, CirAIRlfA-;, COTT-,CIL ON CrItEBROVASCITI.AR
                                            STATEMENT or DR. (',T.ARX
                                                                    DISEASE, AMERICAN IIEART ASSOCIATION
                                               I  am  Dr.   Clark   Millikan,   Chairman   of   the   American   I-leart   Association's   Coun-
                                            cil   oil   Cerei)rovascular   Disease.   Representing   the   Aq@iation   I    welcome    the    o@
                                            I)ortiiiiity  Of  testifying  in  support  of  IT.R.  15758,  the   five-year   extension   of   the
                                            Itegiolial  Medical  Program  (11.   r,.   89-231)).   As   one   of   the   organizations   instru-
                                            mental   in   promotiiig   the   original   Regional   Medical   Program   In   l..061,    we    are
                                            pleased  with  tli(t  signifleant  contribution  it   has   made   to   the   application   of   new
                                            medical  knowledge   to   the   diagnosis   and   treatment   of   heart   (liseaF;e   and   stroke.
                                            We  ii-e,  I)atrticulitrly  piezi@tl   that   the   Regional   Medical   Program   has   I)rovitled,
                                            as   intended,    an    effective    vehicle    for    governmental    and    nongovernmental    co-
                                            operation  in  combatting   the   three   diseases   taking   the   greatest   toll   of   life   in










                                                                                                                                                    oil  lo(.,Il  I(,

                                                                                                                          liliv(,           ll(!Iiv(@ oil ,Ililio.,4t  ')III    It(.giol),'Il
                                                                                                                              gilll(.I.illg  (111(ii  oil                     lli;ilil)oNvl.r
                                                                             @iii(i  :iiiiilyziiig ti-ilil4il)l(@ 11(@illtli                        iiii(I    S(!rvi(.(@,4.    We
                                                                                              4]iiriiig  the  flv(@  yt@,11-s  of  t'lle  1)1,01)osecl  r(@ii(!wttl  am  the   (@iii-
                                                     I)li:i,,js (if t)ie l@rogi-@ti)i sliifl,4 front the 1))@iiiiiijkg to the ol)(@i-jitioiiiil I)Iiiise.
                                                                            in N(@w Yorl@ City 100 An)(@i-iciii llf!art As,,;oci.,ttii)ii voliiiii                           'cer,,4  aii(I
                                                     Stiff fi-oiii ,L(,ro,,s t@lic                      1)1.,iiiiie(I  wiiys   in   Nvlii(-Ii   %ve   (@an   ii)il)rove   oiir   I)ro-
                                                     gr@iiii. Ot)(@                 (li.,4cii.4s!oii   groxil)   was   (levote(I   to   tli(@    iiit(!rr(!Iatiolislilp    of    the
                                                     IZ(@.iotial                    Ili,ogriiii    -,iii(I    the     Aiii(@ri(,:iii     ll(,@ii-t     Asso(!iitioii.     We     (lisciisse(I
                                                     tli(@ w:iys in                   tli(@,    relillioiisiiij).,;    1)(.qwt@(,ii    Ileii-t    As,,,o(@iiitioiis    in    the    vftriotis
                                                                                                                                              (!otil(l   1)(,.   reinforce]    It    wits
                                                                     @it (Iiis 114itioll:li II)(.(,t,iiig  (li:il               (@f  oitr  rtil.iir(@  lirt)gr@iiii  woii](I   I)(-   to
                                                                                                                                                           (@flt(-gioliiil        AI(@olle@il
                                                                       (Pill-                     to ti
                                                     1'rogi-iiiii.,;, @o tli:tt,                                       %voiil(l   Ile   1)14tyiiig   their   iiiaxiiiiiiiii   role   to

                                                                               Ii%v                   over it                                                      gi-itil(is    of     front
                                                     $50,000.00t) It) $20(1,(K)0.00()  for llii@ fis(-iii  v(@iir (,iiqli)ig Jtiiie,                                 INI(@    not(,     th@tt
                                                     11. Ik.             slit,(-ili(,s $(;;-P,000,00f) for fis(,@il I!)(;9 @iii(I                     ,iiiiiis ii.4  iii;iy  1)(@
                                                                                                                                                                        7
                                                     s:ii-3,   for   tit(@   ii(,xt@   ft)iir                        NV(@ tire                 tli:il ' ii(@;trly    $2,     ),000,000     of
                                                                          filli(ig          iivliilil)le   ill   I(I(Iit,ioii    to    Ili(!    $(,).-),O()O,000    I)rovid(,(]    in    this
                                                     bill  for  file  ]text  tiw@il   y(-,Iir.   lIoNi-ev(@r,   we   %%@oiil(l   pref(@r   tliit   sp(,(@ific   ftiji(lijig   for
                                                              y(@14ir.,;   I!)70   tliroiigii   ]S)7.'i   ]it(]   been   iiieltid(@d   in    tliis@I)ill    to    as.,;tire    the    iiiixi-
                                                     iiiiiiii gron%,tli of this                             1)i,t)graiii.
                                                        If    tli(@    $(;5,000,000    for    fis(!.il    1961)     is                        aii4l   iiiitliorized,   Nv(@    iiii(l(-r-
                                                     st.,iii(i  30  of  the  5-1  Regioikal                            Ilrograiiis      will      Ile      receiving      their       initial
                                                     olo(@i-:itioii.ii   griiits   iiii(I   14    will    Ile    in    their    s(!eoji(I    or    tlilr(I    ye:tr    of    ol)(,i-iitioiial
                                                     gi-iiiit-I I(-til'ity. It, is to fie                        talent  Ili   file   following   toiii-   y(,itrg   ol)(,r,,itioji,,tl
                                                     r(,(Iiiii-eiiieiit.,; will                      Net    the    legislation    iiii(ler    eoiisi(loratioii    li(@r(@    tocl.,ty
                                                                tii(! l@rogr;iiii to the iiiii@iiown qti.,tntity of                               Congressional                  tipprol)ria-
                                                     tiozis   ift.(,r   fi@(-iil   1901).    We    li;ive    soine    res(,rvqtlioiis    is    to    the    wisdom    of    this    .1    r)-
                                                     I)ro,,icli           li)z)g-rizige    1)1.,iiining    is    P.,Aseiitiil    to    the    ,4iiecesq    of     this     progriiii.     One
                                                     fiiiql NN-4)r(I -.I.,; to               we   ,f@res,,    the    niiniin.,Il    iiec(@ssity    of    the    ftill    $65,000,006
                                                     re(Iii(,sted in 11. R. 15758 for 11)60.
                                                        Aiii(@iig     the     I)rojiii.,;ing     development,;     in     the     R(-gioixil     ',Nle(lical     Prograiii      of      I)ar-
                                                     ti(!til-ir    interest    to    ii.,4    has     been     the     recent     eiiipl)asis     oil     exteii(ling,tbe     develol)tiieiit
                                                     of                 (,,ii-c    iiiiits    tnd     the     necessary     tr.,iiiie(I     p(@i-sotinel     to     hospitals     not     now
                                                     having these                                            It is (@iir i)ii.(Ier.,4t:tii(ling thitt the                             %Ie(li-
                                                     e:il  Pi-ogriin has iii,-iiiy il)l)lientions for fiii)(Is for this joiji-I)o.4p, We                                       tIlol-oliglily
                                                                     tll(@                        of   tli@,o   lif(,-qiivitig    fi(,ilLti<!@    Ili    ev(-vv    lit),41)ital    (,iii-itig
                                                     for<@orozi,,irv   iit(@ry   I)rol)l<,in,.q   iii(I   liol)(@   t@iiitt   Ili   file   fiviiire   ev(@ii   more   ftiiid,4   will   I)k-,
                                                                     for (-oi,(@iiary            iiiiits.
                                                        As   file    (ili:iiriii:iii    (if    file    Aiii(@i-i(-iiii                                                 i)ii      (it@rt-liro-
                                                                                            ,;Ix-jik Ivan                                           of the                             I)ilr-
                                                     loo.,41.8 til(@ It(.Kiolilll Aft@(ii(-Iil Ilri@gt-;iiii Ji:i@, iiii4i NN-111                      to   g(@rv(,    Ili    ilit@I)ilizlllg
                                                                         lit!t(@illif)li hall fiiii(ls for (,otiiiiiiiiiiii--wi(l(@
                                                                                                               lkllilly   111(4]i('411    N('114001,q                   ll"'Ily      fl-4)111
                                                                          Will)  I'll(, 811-ol@t!                    As  I)iii't.  of  (ii(@   I)I@iiiijitig   laid   olm-i-till()iliil
                                                     gi-,Iillt             lt4.gio)[1111  Al(-(Iil-lll Ili-togi-iiiii,                           fit l@lil,4 I)rol)l(@iii has
                                                     Hiiiiiiil:il(,(l  ill  it                          way.                I)I'oillisllig                                      i)(@    (-II-
                                                                     ill  1,11(, II(.Xtl five             of  till<@  lt4.Ki(olllki  INI4,(li4.4ll   111-ogi-itill   tkf)41   it(14-illlllt(@
                                                     fiiiifl,4              for I lii.4
                                                                     IO.@   or   fill.   bill              II)(. Itt-gloilill                   Ili-ogi-ttl)i  to  nrt-ii,.4  (@tilsifi(!
                                                     file   lTilii(,Oi                        slioiii(I   1)(@    file                    (or     tlkl,4     program.     We     Pilliol..,4e
                                                     ill(, 1114-111sioll (if Illl(,I.to ni(.o, fit(. i,ii-git, rsi,iii(i,4,                      Aiii(@i-!(-nii  qllllloa  :Ili(]   til(@
                                                                                  v)f flit, llii(-Ifi(- lt4l:kii4ls.  Vnlii(, to (,Itiz(,ti,; of the                            ia,itlifil
                                                           ['-ilit.e(I             sli(kill(i not. I)(- lifojtr(l(-(l  I)ii-L  sli:tr(@l  Ni,itli  tir(@as  not  li4ii,t  of,  I)iit
                                                     Iii.-4tori(,iilly eotizica(-fl to, the ITiiit(!(l States.
                                                        A(I(Iitioii.,illy, the. A;iiieii(-nii lle,.trt AK,;oeiii.tioti (,ii(lors(,.g the                       of    gr,,ititq     for,t@wo
                                                     fir    more    R(@gional     )Ie(lieRl     Prograni.,4,     as     prol)ose(I     in     S(@,tioii     ()10.     'I'his     I)rovi4if)ii
                                                     will      permit      the      economical      (levclopment      of      reaching      filni,4.       videotapes       aii(I       other
                                                     t,(Itie@itioii.-il     materials     for     rise     by     ,zeveral     regions     on     a     national     basis.     This     pro-
                                                     vision     al.@o     I)erniits      the      kind      of      flexibility      the      American      I-leart      Association      has
                                                     always envisioned for this program.





                                                                                                               I (i7

                                                               lll(,Ill.@ioli (@f rer(@l-iiiq to IZ(@;"ioli:il                                  fll('iliti(@s I)Y
                                                                                                         11)7  is   of'
                                                              Aill ilill4pl.(:Itlf; r4ll(! III  I)r4@v(-iit.iiig  if,,!                   or
                                                                                        if            of  t@)iis   (ii)]ooriiiiiiti,.           iii(!Iiisioji    nioiig    wltli
                                                                     iii this                  is                (@f                    to  file  iiil(@vi@itioll  of'   Soij)i@

                                                        ]it                      ti) flit! N,t@j-.Nl ij)ijK)r(:iiit                of                                lt(@gionitl
                                                                                                             iii:iti-ix   for   t'li(@
                                                              (ii-tiks,  As                                                         'Ill(l  (iiigi)(Isi4  of   lilgli   l@lo4#(l
                                                                                                         ,41iotil4l   I)e.   qviiliiiil(!   for   eviiliint.loti   all(]   coin-
                                                                  tri!Ll,'4 Of                       iii(,Iii(iiiig (it-ilgs  @iii-i@ii(ly  lino"-ii  iiii(I  tlios(,-  wiii(,Il

                                                        li'iiiitlly,  tlic- Ail)eri(-.iii  11(@.irt                                       the   iii(-Iiisloii   of   f(@(I(-r4il
                                                                                 107)  iit  file  l,ot,@il  oi@(@i,ittion  (PI'  file

                                                                                        tli(@ 1)til)lic                         ill  tlit@ ol-igiiiii),               of   ti)(t
                                                              iki.
                                                                   oiie, r"trN@.itioii                     :it tli(@                of t@Iiis t@(,stiitioriy, tlie
                                                           ll(,.irt A.K,,4rx.-ijition strongly r(@(!oiiiiii(@iitls tit(@ eii4i(-tji)(@itt of II.IT.
                                                        ,Ali-.                  'I'li:ililz yoil A-(tl-.Y                    1)1-. IN[illil@.111. We
                                                    yoiii-    testill](@))Y,     :111(i     -1     Woll](I            with Yoti, that st.l'ol<() is- -1111
                                                    Nvlie,i-c we              t@o (lo Defeat                         iiiit(!Ii needs to be done  to  illll)]-OVO
                                                    the    health     of     the     I)eol)le     in     this     area.     I     think     @it     )Its     been     overlooked
                                                    ,t gi-ett, deil from the testimony I have heard.

                                                        @Nfi,.                No question,,.
                                                        @\fi-.               Mr. @l.:ul)itz ?
                                                        .Ali-. Sj<tjj@ii,z. Doctoi-, the              point    I    ,tiyi    tryiii,-    to    get    across    is,    I    have
                                                    no 0I)j(@-(@ioli to ,t Colit@illililig I)rogl.,Ilyi. halt I Want, the  "Lg!elley  to  come
                                                                        year,
                                                                                             v  -*Nliat  they  have,  done  tn(I  prove   lionv   i)iucli
                                                    a(l(litioi-iil tyioii@v is needed.
                                                        ,Af,tyl)(3    $65    million    is    sufli(-iejit    foi-    1969,    biit    who    is    to    say    how    lylu(!Il
                                                    IN'c      ii(yd      in      1970      or      1971      without      the      Department       coming       before       us
                                                    ,iiid      i-eviewi      g      the      Drozrain.      Maybe      we      need      $200      million      next       year,
                                                    in    l@)70.    And    iii,,tyl)@    t];@    year    f-ollowiti(r    we     inty     n@Al     $ilOo     iylillio-ii     iii-
                                                              or$1001liillioll.
                                                                      IctloAv. What. I ivtllt; is l'ol.               tll(@                              coill(k    ill    find
                                                    Illst'i ly it,,;                 I'l-oll) Y(@,iir to Y(@:i I-.  I  f  it,              just ify i               then       I
                                                    S(t(I  110                                       -ogri.@illi                                                                                            I@i      .       I
                                                                                   Afity   I   ii,slc    L                   Ai-(@,      you       itd(ll-(@siiig       Yourself
                                                    to:illst,            tli(@ftlitll(;I-iztt.ions,             'ol-t@lio:tiliollilt?
                                                                                        :1111olilit.
                                                                                                                                                                              It
                                                    111(t(I'llis  t4)  iii(@  tliit  tile  i-(@(@,oi-d   is   ]low   I)Oill(-'  wi-it-t@eli      Oil      the      justification
                                                                                                                                                                 , ill  t
                                                    of this  t)i-oLri-aiii,  til(I  that  we are S(ICIII(R sigiiifickilit CI)allge,                                       II
                                                    ijit,(@i-i-elitioi@sliii)s         between         the                      an
                                                                                                                    laboratory      d   tetelici-q,   on   oi   o    ]I    ii(l,
                                                    'Ll)(I        tile        1)1-,,Lcticin-         physician         community, oil     the     other      Intel(      wIli(.,Il
                                                    ti-e   goiii(,   to,,t(,-criie    to    the    I)en(@fit    of    1);ttie@iis   11 ov  I- t i     Natio i.
                                                               Iil@iljii,i,z. I (1011@t thin]( there' is much doubt about that,.                                     I        am
                                                    sold  oil  tile  I)ro(,ruyi.
                                                                                                 to iTio tli,,tt-if I-li(5 (iii(wtioii is ]low  much  money
                                                    is    to    be    ii.Iloct@d    per    year,    that    is    i-eilly    ill    the     T)l.ovin(,e     of     the     coin-
                                                    iiiit,t,c@e,      Ls      you      deliberate      how      you      establish      mechanisms       to       find       out
                                                    ,tboxit
                                                        ,Nf    r.    SiiuBIT7,.    iNfy    point    is,    thouzll,    that    if    we    authorize    $200    million
                                                    for     1070     and     $300-m-illion      for      19@l,'the      Department      does      not      have      to






                                                                                              168

                                                               this coiiiiiiittee aiiviiiorc,. it g(@ to the  Appropriations

                                                                           l@Yi-oS?
                                               ,\[I-. l@ylzos. I)r. Alillilclli, I fo[iiid your I-(,,,tiiiiotiy most,
                                           iiot,   oiily   in   support   of   tile    I)ro(@l,;Illl    but    I)-.tt-ticulirly    wli@tt    vou    say
                                           -tl)oiit,  iiioiiey.   third,   :igaiii   -is   .i   nitn   wlio   ]it's   just   come,   to   Congress   in
                                           tll(@  1.1.,it.  A-("IV  or   Sol   it,   Surprises   me   to   see   doctors   come   before   tllis   min-
                                           iilitte(,   ii.ii(I     for    fears    money    tii(i    for    tile    continuation    of    I)ro(-rrtrns.
                                               I          to    tliiiilz     tliit     doctors     in     the     American     Me(licAl     As,@lttioli
                                           too]( t (lifr("I.Vllt i,,iew.
                                                  iiii  iii   full                  Nvitli  your  I)ositioii  t,,   it   is   expres.,i(@,(l   II(-i.e.
                                                                       'rli:ililc you.
                                               ,\II-.  l@o(;]"IZ8. 'I'lililll.Z You very ]article.
                                               It is III.), iiiiderst.-tii(Iiiia tliit one of           our witnesses                a 3
                                                     to   (..Itcll         to    C.@lif-oriiit,    tii(I    if     the     corrimit@     would     bear
                                           wit'li us, if we could lik,.ir Iiis testimony now, it would be Helpful.
                                               I)r.    T,(-st(,r    Bi-@'low,    ))Voi.essor    of    lieltltli    ,tdiyiinistr,-ttion    and    cliief
                                           of   the   (livisioi-i   of   licaltli    sc@ri-ices,    Scliool    of    Public    I-lealtli,    University
                                           of (laliforiii,,i., Los Angeles.
                                                     l@i-e.-,Iow, we                       your     Helping     the      committee,      -,wild      we
                                           will   be   I)leise<l   to   receiN7e,   your   tinstiinoiiy.   If    you    would    likoto    file    your
                                                           for    tile    i-(@coi-(l    tii(i     nitice     appropriate     comments,     we     would
                                           be I)leLsed to follow tli,,it procedure.

                                                STATEMENT OF DR. LESTER BRESLOW, PRESIDENT-ELECT,
                                                              AMERICAN PUBLIC HEALTH ASSOCIATION
                                               I)r.   BRESi,ow.   Tli-,tiilc   voti.   I    ,tm    ,tT)I)e-,triiig    before    you    ts    president-
                                           elect   of   the   Aii-iericaii    P@iblic    Iletltll    Association.    I    w-ould    li]Ze    to    mtke
                                           some    rpiii,,irks    based    on    the    written    statement     wliicli     has     been     submitted
                                           foi-    the     record.
                                               'i\ift-. Ro(,.i.,,izs. Yi)iir   st,.tteiiieiit   will   be   made   ,t   part    of    the    record    fol-
                                           lowiii,, )7otir roiii,,trlcs.
                                               I)r.    l@.it",;[A)w.   '.I'Iio            or,,riiiiz,(tt-,ioii   tiicl   utilization   of    the    re-
                                           solli.(.(,s  I  ]let,  we  ]low  ]live,  itil(I  t   11(@   iiiii(itic   contribution   of   Clie   original
                                           (@ool)ei-.itivo                           ii-c i-nttd(i I)-o,,qil)lc by t,liis I)rogi-itiii.
                                                     Hindu(' (..oll@l-il)lltiol;s:tl.etoext(ul(I                                    t'llo  iliedi(@,.tl
                                                        out, ilito (II(% (..olliiiiiiiiiiies, all([ to                     tile    I)i-ogress     ilkit
                                                  finally  it,                                                                             (lo      not
                                           ).(.:lliz(., tile
                                                             1,11(l ili(t looill(@ of t@iiis program is to                        1)rogi-e@-.
                                                  St l'ol@(@, 1
                                                                                                                             t@inelit,s, it-, is  iiii.
                                                                                                                           9
                                           I)ol-(@till,  to   lioto   that-,                                  as ,I, t@wo-w,@y       St.i-eot,.  'I'lic
                                                              (,,Xl)oi-tisoisiiot,(@Tily froiiitli@'           c(licLl   eoii(43r.,4   out   into   the
                                           Colillillillit-Y but tlso from tli(@ Joint of view                   of     the      practicing      doctor,
                                           f  1-oilL  tlio  eol)llllllllity   lios                 to    the    medical    C-Cliters.    Tlioy    tlien
                                           begin   to   ',II)   )recalls   the   r                      iysicians    are    up    against    in     the
                                           day-to-dty    @iti-L@dling     of     i
                                               This   is   t    truly    c-oopet.@                     ent    and    a     two-way     street,     with
                                           motion in both directions.
                                               I    would    like    to    say    a    few    words    about    the    progress    that    is     being
                                                                           -From the outset, the California
                                           made       in       Californi,.v.                                                      program           has





                                                                                                169

                                             soiio-lit  to  elYvet,  cool)er,@ttioii  I)etw(@,P-ii  the  hospital   tssociatioiis,   the
                                                         -,Is,-,ociitiolls, the  ni(@(lical  schools,              the  St,,ttc  liealtIL  depti-t-
                                             iii(,iit, Cancer Society, and Ileirt Association. Tlicre liq,,i been
                                             I islic(l L iiet.woi-Ic of  @oo(I  communications,  i-iow,  tlirolifrIi  Ire-,t  eolniliit-
                                             e(@s troiiii(I every iiiedi(-,it] school and  ext(@ii(lin(-,,  into  ot'very  area  of  the
                                                                              elective      wol-kiilf,,,       bodies       around       many       of       the

                                             .111(@ lit,([ ill wi til 11)(@1(ii(.Itl
                                                               of                                                             li@,, t-,@k ',Ill)lliit,  oil
                                             AI)i-i I I :iiid 2, for (@oiiii(lerttioii          1)                   .1   site, I-evi(@,w, 14  I)t-o-
                                             I)os:lls  fol-                                ill                                  these    will    I)e    a
                                             1)i-ol)o@:il  to                                        unit,     service     in     the     consl@iL]     trelis
                                                                                of so'N,et.ltl hundred ]it
                                                 ('iili            t St                                          ii(@s of slii@tll (.tklrllllllli  ities.
                                             II'    this    l@Vogrllli    is     Lpl)l.oved     these     unit,,     will     work     with     the,     University
                                             iii(@(li(,al (,enter in San                       ill     order     to     extend     this      whole      program
                                             out to tlic,, I)ei-ipliei-y of the State.
                                                 In    the    southern    pti-t    of     the     State     tl-ier()     is     it     proposal     trial     ivould
                                             I)I.iii(y    to@@ctlier    the     medic,,LI     factilties     of     tNvo     of     our     universities     there.
                                             ritis'l)ro,l)ose(I     I)ro,-t-.tm     ,tlso     would     bring     the     medical     factilties      of      these
                                             schools     in     contract     with     the     i)r,.icticinz     pliysici@tiis      ill      the      watts-WilloNv-
                                             I)roolc    area    in     the     center     of@     Los     An@eles-ft     scene     of     1)mt     violence     and
                                             serious I)rol)leiiis. The iiiedic-.tl                          of      these       schools       would       work
                                             -tioii,,     with     the     county     iiid     hospital     -,administrators      of      the      revioii      who
                                             N%-otild     then      (lenelop      .t      Po.-,t,(-rrtdu,-tte      iiieclicLl      education      program      with
                                             coii(viitrit,ioii on heart disease, c-(tncer, and strolte.
                                                   )mention     these     two     proi(wts     iiiei-(!l     t.o     enil)litsize     to      the      coi-nniittee
                                                                                                      y
                                             tIL:lt.   this   pI.o(rl."I,lll   is   goiliL;t:o   briiiLy   I)ett@er   care,   to    I)ersoiis    not    only    iii
                                             tIlo medical centers litit                                     -trts    of    the     Stitte     which     II.LVC
                                                                                  I,]'.,O  into   those,   1),
                                                                                    ill the             such    its    the    ali(!tto    areas    iii     the
                                             cities    iii(I    the    viii-4il    iti-eas    over    the    gr(@tt    stretches    like    iii    C-.Ilifollillil.
                                                 rii;iiii@ yoii, iNIr. Chairman.
                                                 (.I)I-. l@l-(!SloNVIS                 ,itttLilfLelit follows:)
                                             S'fATF@Nfi@NT 01@ I)IC.             ]@]tFSf,.OW,  I'Rol@i,@8014  Ol;'  Illi.Ai.,rii   Si-,uvicFs   ADNIINIS-
                                             TitATIO,-i,  SOIIOOL  OF  l'UI3[,IU  lll@ALTII,   IJI;IVFltlilTY   Oto   CALIFORNIA   AT   ]'()B   AN(iFL@.8
                                                 )ir. Cii.,iii-iiiiiii and iii(@iti!lk@r.4 of tii(@           I aiii TA,.,4t(-r ltre,.4]v)w,
                                                 11@@iltli  Servi(.-(,s A(Iiiiiiii,,4t,rittj4)ii  iii  ill(!  School eye i,iiloi(-         at      17(ll,A.
                                             I iiitv(@ i)revioij4ly          tli(.@        ii(-itit)i Oill(,(-r for t.lio@         or    (California.     I
                                             li:lv(@ Could t(i(lty to 41)(@iik In i4til)l)(@rt (yf 11.1t. Ir)7;-)8 and ly:irtl(!tiliki-ly tli2t,t
                                             of the I)ilL          w(@111(i  (.Xt(.Il(l  interlinearly  for  tli(@  iti,gioiiiii  iNI(4]i(,iii   Ilro,,rililk.-4.
                                                 In i)iy i@rof@.,;i(@niti            I )i:tV() relief 1)(@4@lk              With  -tllo  ii(-(,(l  for  a
                                             iiiii,i-t@         organization of our  va.,;t.  lit@altli  t,,ild(,41vor,  and  I  view  tlio  It(@giotiitl
                                                 (Iieiil  Prograiii.,4  as   liiiviii-   gr(@tit   I)ot   it@tial   for   making   a   very   iiiilm)rtaiit   (-oil-
                                             t@ril)tition  to  tlli"4  OI)J@-lvc,.  It'i  re(,vtit  yeari  tl)is  C(Yiiiiiiittee  lia,.4  heard   a   great   (](ml
                                             of  di.,4cussioii  til)out  the   current   difficulties   of   our   116alth-cire   systeiii.   rior   this
                                             Natiozi,   these   prol@leiiis   are   not   always   the   lack   of   health    resources    but    rather
                                             the   effective   organization   and   utilization   of    the    inany    resources    with    svbich    we
                                             are             including   our   @our@.    of    talent    and    knowledge    as    well    as    capital,
                                             equipment, and personnel.
                                                 In  pissing  this   legislation   three   years   ago,   the   Coii@gre,"   expre@l   a   public   feel-
                                             ilig   tliit   the   I)ellefits   of   me(lival    science    were    notbeing,appli@    uniformly    enough
                                             to  till   segments   of   our   population.   This   expression   was   part   of   a   growing   i-ecogni-
                                             tioii   within   the   health   flel(I   that   the    present    complexity    and    apeciali7a,tion    of
                                             health  c.,tr(@  r"ulres  exploration  of   iiiil)rov(xl   I)attenis   of   organization.   Tli('.   legit;-
                                             Iitioii  carried  through  with  train  concern   I)y,I)I-acijig   emphasis   oil   the   dev(@l(PI)ni(.-zit
                                             through    the    Regional    MiLdical     Prograiiis     of     "regional     cooperative     arrangements"





                                                                                                                           170

                                                        'lillo@ig t@lit, lie@litli pi@l'.'401111('l iiii(I iii.@t.itittiol)S -<@ll @l  ).(,gitoll:ll                      'I.4 it
                                                                              to                                 (il)j(,(,Lives of                                                           frf)lil

                                                                                                                                              @ill                11(@,.v    N'('Ilttlrl@     !II     file
                                                                               of  :111                                                                                                         (-II-
                                                                                                                              tilioii the gr(,iii,                        of    otir    existing
                                                              it.iit
                                                                                 of      1)41si,           Ill,                :I

                                                        %%,ill  1)@@ (Iiiii(.Illt, 4@ilit                  lit.            %%,ill
                                                                                                                                             ill  N'lit-iolis             or           lll(!4-4)llllfl'Y,
                                                                                                                 ])Y    l,iiis                   in    ill(,     ri@im)i,t     oil     Lili(@     ot-igiii@il
                                                                                               :Igo.      N4)%V      t,lkt-                   @ill                        i-oll)]Olf'X
                                                                           Iii(i    Ill(.    I-:Ilji(i                                              iiii(i  ((@(.111iology
                                                           (Ifliisiili-i-ll,l)l(@                t4t)   1114!          fall,                            ill   ill(.   II(.Illtll   notice   If    oill-
                                                        ])(-OIOI(' ill-(' Ito                flill.1'     I'l-40111                                                                     ,fly    tilt!
                                                        i,;il)i(I  1-is(@  or                        (-osl,.,4    Ill)(]                           ill-loililizlkti(PIL  of  (@ILI'
                                                        ii4l(l to I lii.@ iirg(-ii(-y.
                                                                                   of   t'll(@                   ill)                                 lt(.tllvit@i(.s    of    ill(,     lt(@tioll:il
                                                                                                                 t(o    (I(-Iiiitt    tli(@    ol)l)f)rtiiiiiti(@s    for    iztii)r@)viijg    t@ll(!
                                                                           of tli(@ ]i(nltli sfrvi(,(@ Nvit@Iiiii (,ii(-Il  region  @iii(I  the  (!oiitril)titioii.,;  tli-it
                                                        e4l(@li                 of tll(@                   health                        (-.in iiiilie to that                                  The
                                                        I)ro,-r.,Illls    are    est.,tl)li,,Iiiiig     ,L     1)(-riiinii(-iit     fj-.iiii(,%xlork     within     the     regions     that     I)e-
                                                        contes      a      tivo-way      street      where'4y      the      expertise      in      tllf-,      greit      iii(xlictl       ceiiter.,i
                                                        beconie.,,4     iiiore     rei(lily     nvailil)le     to     the     prietitioii(-r     and     iii,.gtittitioii     at      the      coiii-
                                                        iilunit,,y     level,     while     -,it     the     ,g@tine     tinie     the     d(@fiilition     of     ecanniuiii-ty     health     needs
                                                        ,tii(I the involvement of coiiiintinity resourec-.4 is niide iiiore relevant to the
                                                        citilized     cal@ibilities     of      the      large      centers.
                                                            I    I    -ive    f4eeii    this    I)roce,.@    -,it    work    in    California     where     we     face     a     @inore     coniplex
                                                        task    thin    nio.,;t    of     tl)e     regions     I)t-cause     of     the     great     size     of     the     region.     This     is
                                                        the     ltrgest     region     with      an@iit      20      million      I)eol)le,      aii(I      the      (leveloj).uient      of      the
                                                        It(-,Ion.il '.%I(4]ical Pro,-riiii is following a somewhat (liffercqit pattern                                           than           other
                                                        regional,                                                          flexibility      of      tlit,      l(@gi,;I,-ition      in      allonving
                                                                                                   to    flev(-I(@1)     it-coi-(Iiiig     to     the     I)firtleliliir     I),,itt-(-rn     iii(@-t
                                                                       for      that      rtgioii.         ,ijilt@iiiit    of    4-o(@I)i!i-:itioii    involving    all    of     the     iii(-dicii]
                                                                                                                                                                     health                     all(i
                                                        ilit(@l-(.Stcil                ill <'@ilifol-iiiii  li@is @itir(-;i(ly                   all    iiivjiliiitl)le    (.,i)iitril@titioii     to
                                                                                      of the (Ns(.Ilt,i:il  I)II";is  fol,                                             14"v(,Il                   the
                                                                            lt(,giol)Nl    Ale(liesil    l'i-ogi-:iiik    has    rc-(-(@iv(,(l     any     (ilx@i-;iti(yrial     ftij)(1.14,     tIlP
                                                                        (kf til(@ I)r(@gi-alli  (1111-itig  tiara                                      iiiiil    tlie.    e..,4tablisliii)eiit     of
                                                                    iiiii)roN-(@il  Iiiie.4  (@f                                  Union"      111(@       family       ttl(-Illellt,;       involve(]
                                                                                               lortort,.".     Ili     Ili(-             of tijii(,, I w(oiii(i like to                            to
                                                                                    II   @ftill(-r                     (pf  the                                    to    (hit('     iiii(l(@r     the
                                                           'llifol.ilill ll(.gioll.    Nle(li(
                                                                                                     -Ili   Ili-ogriiii.   (See   itttsi(-Iiiii(,iit   A.)   I   tliiiilt    tli(,,r(-    is    still
                                                        .1 ]Long way to go             ill (](@V(@1014lig ill(- I)rogi-;ijn  in                                when    Ili(-    @progr(,s4.,;    j.,4
                                                                                                                 of    I-lie          l@y that saine                          however,             we
                                                        Ili ('.,tliforiki,,t are          very                   that    the    ii(,(-@,.4iry    initial    stol)q    in    the     d(@v(-Iol)jiieilt
                                                        of    ill(,    I)il(@li-,iiii,,ire    now    well     iiii(l(@rwiiy.
                                                            I  believe  tliit, tjle, liegiolial  I%fe(lic.,tl  I.Ii-ogi-;iiiis  for li(@art,                                   caii(@er,         an(I
                                                                     ire    ,t    very    iiiil)oi-Uiiit    coiiij)oneiit:    of    Ili(-    ii(@v(@lopiiieiit    of    health     care     oil     a
                                                        regional basis in              tlii-.4 country.  With  l@li(-ir eiiil)lia,,@4,4  oil  iiie(li(-al                                         the
                                                        iiivoll@(@iiiejit or in@licil 4-(@ziter.,4, the pr,,icti(-Izig                                        4in(I      the       hospitals,       the
                                                        iii-ogt-.,iiiis ire a                                                   -t   to   bring    the    best    in    lieiltli    care    to    the
                                                                                                     Hart of the effoi
                                                                          I"Ijle. Regional                             Ilrogriyii.,i,    however,     (@aii     only     iil,,,ike     their     fall
                                                        e,oiitril)iit@ion     in     concert     with     the     iiiaiiy     other     ii(@tivities     (I(,vote(I     to     that     goal.     The
                                                                  of 111(@ (,-Il.'Illelige is too I)ronfl to 1)(@ tol iilly                                      by     any     one     -pr(@gr;iiii.
                                                        q,ll(.      (Iovelol)ltl(!Ikt.      of                                                   filliolig  tll(@  Ri,,g@iotiii@l
                                                        Ili,t)gr.,iiii4,                              Health    llliiiiiiirig,    iiii(I    ill(-    %A,ifle    variety    of    other     lt(,filtli
                                                                                                           iiii(I                       be                                          that.         the
                                                                               or    e(iorx,ra-liv4@    ri-Ijiti(insli,il).,;     ,iiiiong     iiiiiiiy     (liv(@rse     li)ter(,.qtg     qtli-ently
                                                                           tilroiigli    the    11(@;rlniijil    NT(411(,.iil    IlrogriklilM    is    it    I)iiA].4    for    li(@I)e    lllftt    tIllf4
                                                        eool)(@riiii(iii  (,an  1)(@                             to    a    I)roa(](,r    level     find     that     the     ttft-(,tlve     ititer-
                                                                                -,Vill      be.                  In ways  tilol)rol)ri;it-.O,  to  S(-rve  tells  iliversities  of
                                                        tli(@ vii                     of  the  (-otiii-try.





                                                                                                                    171

                                                                                  collljiol)t@lit  of  this  I)roi(l        (,ff4)rt, the                    for tlit, R(-,gioii.,il
                                                                   llr(igriiiii.,; sli(@iii(I be                         qii(i slllp[)ort slioiil4l be ])rovi(](41 for tl)(@ir
                                                           'I'll4killi Vt)ll V(-I-Y llilt(.Il for tlii,,4 @)lvl)oriiiiiity to lkill@(@tir before yoii tofliiy.

                                                                                                                                 A]

                                                                             ot,                                Al.i)., ON              ('Al.li@'()ItNiA                       ().N




                                                           Visible (11' gi-l,:illy                                                        lif-ill't.
                                                           Iii.@t    this         it @til(IY N\'IIS                    loy ill(' (';Ilifol-iii4i 11(@;iitii  I)iit;t
                                                              i(o              l]lr4)1.111;ilii)ll 4111  Ill(.              of (,V(.],y                 114111111((.(i     (III]-ifig      the
                                                                                                       III                            stii(ly, ii(,ver                      iiiitl(,I-tilk(@il
                                                           ozi so large t ,4ciiie, will slio%A, %\-Ii(@re                   1):iti(-iit (-tixiie           what; his
                                                           iv;t.s i\,Iieii  li(@ Nvis                    fi-4)tii   tlit,                .iii(i     otliei-     iilf()riiiatioii.     NVI)il(!
                                                                   iii@ky        little iiiore tli@iii it set of (ii-y                            the i-esiilts
                                                           Nvit-11  great                 11)(@   kiii(is   of    iiitqli(-,tl             ii(@e(le(I    for     (1:@ilif(@i-iiiaiis     aii(I
                                                           (@iliers    car(-(I    for    iii    the    St:ite.    Other    (iit4i    gitliL@rijig    .ttidie.,;,    which     are     exl@te(I
                                                           to      very @@I)ortly to 4)1)ei,-.itioiiil I)rogriiiis, will be (lescribe(I liter.
                                                           Froiii the v(@ry  b(@giiiiiiiig, 1)1,iiiiiiiig foi- the Ciilif(oi-nia  Itegii)iiil                                           Ili-o-
                                                           griiii   einl)r,-i(-cd   ill   the   iiikjor   iiie(lical   @iii(I   li(@,iltli   interests    Ili    the    State.    The    Cili-
                                                           fi)i-iiii            Ass(o(-iiti(kii,                            for tli(@              23,000        I)ra(!ti(-iiig         physi-
                                                                   tti(-,    (.itiforiiia    11(i.,;I)ititl    Asso(-iiiti4)ii,    rel)reseiit,iiig    virtiitiliy    ill    of    the    (;OO
                                                                  -teriii   -iite    geii(-i-iil    I)o,,I)itil@    Ili    the    regioii    ;    the    Ciliforilia     State     1)el),,Irt-
                                                           iii(,iit of           Ile@iltli     ;     the     (-Iliforiiia     Ile@irt     A@sociitioiis;      t-lie      Califoriiia      I)i-
                                                           vi,;ioll  of the Ainericitik  (laii(-(-i-  '4o(-i(,-ty;  the (Ic-iiii,; of till  of the eight
                                                           @(.1lools  ilk                   iiii(i  tl)e   (le-Iiiks   4if   t@lic   tNN,o   iiiiijor   s(-h(@ols   of   joiit)lic   lie@,tith
                                                           were  j4)iii(,(l  by  (-ilit  I)iii)li(!   r(-Iii-e@t,iitittiv(-s   (if   the   (-oiisiiiii(-r.   ll'ogeiii(!i-   t)lc'.N,   (-oil-
                                                           st@ititio till. l(@giil sl(lvi";or@y                      ft)i,  tit(,   i-(-gi4iii   iiii(I   are   kiionvii   f4)i,iii@illy   Its
                                                           tll(@  (1:11ifol-iiiii                  (ill    lt(,gi4vii3il                Ill-iigl-atiils.                                 )ills
                                                           iiii-i@ reality          has   giiill(41   sil,(,Iiglll,    gl.o%vll    gl-iitifyiiigly    Iki4ll'('    C4)1111(1('Ilt    of    it-
                                                           S(.[I, @is all (,Iitily @111(i lilts iii4.l.(,iksiii,,Iy i)(-(,ii :il)14, to
                                                           A.,4   foi-   (oiH@i-@iti4iii:il                  NN'e           10411(ilig                i4o   II   I,-.Vo-4111Y   Site    Vioilt
                                                           ilk  (itilf4ii-iiiii  oii  Alit-ii  I  tii(i  2   by   II   i,evi(,%v   (,iiiiiljlitte(@   of   ili(@   Niii.ioiiiil   A(Ivi-,f)i-y
                                                                        for   It(,gif)lllil               llr(igriiiii.,;.  'I'li(@y  %vill                    tile    iii(,i,its    of    1.1
                                                           OI)t-l-lltil)lllli                               by  lo(-itt   (-ojiiiikiiiiity   liit4@r(@si.   iii   live   of   tit(,   Stlite's
                                                           (@iglk(l I)IIiiiiiiiij" ili-elis,  itil4l by  lii4@ (:iliroriiiii  Ileiirt                              Tli(@,,(@    lirst    (ilo-
                                                                                                li(@;tvily      w(@iglit.(-(l


                                                                        (-ol,(oiksit-y (-iir(@ ililits,                     II  gi-q@N%,illg  i-olIK4@lisiis  tlii-t@iiglioiit,   ill(-   Nii-
                                                           ti(oll  their:      tillit,,, property                      giii(I %with lilglilv-sliill(@cl (loot,ors iiii(I
                                                            riiii tli(-iii, (-all             iiii4itit   a    (1r;iiiiiiti4-                Ili   ii(@;itlls   (Ill(-   to   illyot-lir(Iiiii
                                                           iiifi-ii(-Iloiis @iii(i (@lli(@r                                            of         I'l                 ill-:II  %%,illi   till!
                                                           ti-iiiiiiilg (@r                                     IIII(I tile (@411111)1)1119 01' ('01-4)illk)'Y
                                                                                                                                                              flirt@iiglioiit         N4@rili.
                                                                                          sti-(@t(,Iiiiig  rr4)jii   the   Itiiy   Art@it   it)   tli(@   Ot-egoii   I)or(ler   ikloiig   tile
                                                                                itil4l  Nvolll(l                 iiiteiisiv(,   triiiiiizig   for    ))Iiysiciazi.,4    lit    tli(@    Siiii
                                                           ler@iii(,is(-o              Ilosl)iljil,   harder   the    ttit(@]@ige    of    lliiivt-rsity    of    (,.klif4)ruiji    (-iir(li-
                                                           ologisti.4.  Siiiiil:tr   i@rol)ositis   Ni,()iil(l   Ill-   ofT4,i-(@(I   t)ii-oiigli   .4(-v(,riil   lif).,;Iiitils   III   tli(@
                                                           highly                         l,o.4 Angeles bitsiil ali@l ill(-ITL41(" tried 1)(-(@iliig lip of the
                                                           c(ii-oiiitry (early Hart lit till, l'os                   (',Ollllty (,eiiertil lIo@I)itii),
                                                               joitit  1)r(@I)o,,.tl  I)y  (lie   Uitiv(,i-si-t@   of   @'oiitlii,rii   (iiilif(@i-iiiii   iiii(I   tli(@   ITiiiv(@rsity   of
                                                                          lit   l,o,,   Aiig(,I(@s   %%-oii)(I    joiii    with    tile    Cliirl(@    It.    I)rew    Nle(li(,:kl    Soci(@ty
                                                           ;tii(I   otli(@rs   to   (@,t:tliiisli   it   Im)sigi,,t(ltiitle    iii(,(Iie;tl    school    iii    t-lic    Witt,.,-Willtiwl)rook
                                                           gli(@t to i i,(-ii  (if  f,os  Aiigele,,.  Itit@(,riislill@  all(]                 lorogriiiiis    NN,ou](I    be     g(!iieriite(I
                                                           ii](@iig with                     laid   I)o.,4grit(Iiiiit(,   triiiiiiiig    foi-    (lo(!tors,    riiir.,4t,s    laid    ailli(41
                                                           114@.iltli   1)1-(If(,Ssiollik1s,   (!lose   r(-Iiit-ioii.41iij),4    with    tile    faculti(@    lit    138(,'    ikii(i    UCT,A
                                                           Hall               I)IIIIII11tig to 111(@(@t li4@iirt,                 caii(-er   niid   strolt(!   ii".(Is   lit   the    iirt@ii.
                                                            At-. Itos(-vill(@, it (-oiiiiiiiiiiily of '.10,000 t-itiv(-iis IS iiiil(-14 iiortli(-ust of
                                                           (lie    lliiiv(-i-.,;ity    of    Cjiliforiiitt    I)IIVIH    Me(lieiil     School     lilts     ciieouragtd     local     I)Iiysi-





                                                                                                                  172


                                                                                                                     iiivoix,iiig    the    NN-liole    (-oziiiiiittlity.    coiititi-
                                                                               tr@iiiiiii;,,  for                  vi)(-iitii)tiiil              iiii(I  otli(@r
                                                                                                    1):tll(lliilg of
                                                                                :t    ttiiii(or                                                              JIFI(I   (@oillizilillily

                                                                                                                                                     (@XI)Iili.41(kil or its sue-
                              '@4                                                                           I)rillgilig liiglily                                                   into
                                                                                                            ill  lifigit)gl@lililly   -111(@   visiiitlizittioii   of   tll(@   I)lo(@(I
                                                                                          4ii(I of rii(ijoii(!tive                                               for

                                                                                          for tile                         Vitil('Y,  tll(@              for     the     lower     S@iii
                                                                                          IIS(@ of Vi(]('Otll]K@                       lillits              WOIII(L    I)(-    illov(,(l
                                                    fr(tiii oil(,                 to the next, coi-eriiig si@v(@iil                        lio.,I@ittils.    The    units    Nv(pti](I
                                                                               I)Y   itle(licill    tel(@visloii          for iiisti-ii(!tioii of e:t(!Ix                        ,;tiff
                                                                    411)(I           lo(',tl Ktiti'f                        its   own   griiii(I    roiiii(I.,.;,    le-&ures    ari(I
                                                                                       by I)I:Iyiiig the l(@;;soii 1):t(-k, iiiil)rov(@ its own                                skill,,4.
                                                       Tile    C;iliforiii@i    Ileiirt    Assoeiii(ioii    pi-ol)(i.@s    it     siil)stiifitiitl     expansion     of     its     suc-
                                                             ill tli(@           wotilil be (@xl).iii(it@d to otlier r(,glozis.
                                                           The                       of   siiiil)le    le,,xrziiiig    liiigtitjA(@,s    in    t    (-oiiiptiter    program    available
                                                                                     grt(ltiii-te     iiii(I     lw)stgi,@iilti@ite     instruction      to      several      regloiiftl
                                                                 1)i-(igr@iiii :ti-et,4 would be eticoui-iig(,(l ill iiii(@tli(@r I)r(jl)osil.
                                                               l,oiii:t              lljiiv(@r-,4ity S(,Iiool of                       )its   it    Iiiglily    iiitrigiiiiig    pilot
                                                                          4)11  ,I  tliird-g(-ripi-:i(iozi  (-oiiijoiitt@r,  iiii(I  I)j-oj)ose.,4  to   (@xj)4tii(i   it's   III)rtry
                                                    si@ilvi(,es to                     I)Iiy.,4i(!iaiis ilirt)iigli4)tit its vist                      ni-eii. Tli(@
                                                                               w(iiil(l    t(@t    the    f(!asil)ility    of     xisli)g     a     r(@iiiot(,@     disl@lity,     Yt-ry
                                                                                          :4et-,
                                                    iiiiit,,4 fr(piii ill(- @(.11(iol colil(l, by I)i(-Iiiiig 111) (,]I(@                        I)oi)li   into   tli(@   (@iiijoiii(@r
                                                                         -Iii@@tlyz(@ the                                    I.e4l(lillg"4  11(@llig  ttil@('11  oil  tile  I)fltl('Ilt
                                                    ;iii(I @t:4k it. to
                                                             IO.V  111(@  I)IIY$ieillll,fi          'I'lie  eoiiil)t)tt@i-  iiiiitly.,4is  w(@iil(l   be   (loii(@   in   rciil-tiiiie,
                                                                                                                                       'iieli    rt     project     iiiiglit     provide
                                                    aii(I l@lie.               would   return   in   2    or    :1    iiiiiiiit(,s.    S
                                                               s(,r%-i(-cs to sxii@ill, remotely lociit(@d                             niitl    (-oixiiiiiiniti(@s    now     Iii(@kiiig
                                                                   14     OIK@r@itio)i;tl      lirol)4)s:il:4       under                         coti.,-4tl(,ratloyi.        Sey(@rtil
                                                                                                               iiii:irl4-r,  %%,ill  I)i@  I)i,l(-Ily  detailed  Ili  a  itioiii(!iit.
                                                    All  li@ii,t,  lo4,4@n                    following    planning    ii(-t,ivily     Nviii(@li     1)(@giiii     in     Ijiiiiiiirv,
                                                    II)f;7.          first  y(@;ir'.,4  l@laiiiiiiig iii,l.ivit,y  li)volv(@41,  unions other                             l@li(@   Iiiy-
                                                    !II,,  il(@Nvii  of  ,i  (1@it;t  li;ise  front   %vlii(@ii   ol)(@i-itt@it)iifil   lwi@l)i),.4itis   iirq   being   I)roje(@tied.
                                                    (loiist i-tt(-t i(@ii of t lt(@ (]it t;i             gone flir4)iigli t %i,o
                                                             1.11(@ lii-.@t          Sillil)le,                iivitiliti)l(- (litt.it          iii,i,iiiig(@(I  Ili  foi-Aii!4   illost
                                                               fol-  l@l:iiiiiiiig   ilk          of   than   Amiga[   jir(,iis   of    (,4klif4)1,11111.    1)(,@itiogi-elpilic    data
                                                    iv(-i-c                    front  the  St;kt(@  Dt@I)artin(@iit  of                             Ifoi-talitil       (]ilia       were
                                                                   front  tli(@  @ttte  1)(@I)tirtiiieiit  of  iltit)li(!                           Also      froiii      the      Yatc
                                                    Il(,,iiiii    I)el).irtiii(@iit,     %vith     added     iiiforiii:itioii     froiii     tile     California     Ilo,,14tixl     As-
                                                                               illitteriitl    for    a    cokt?l)lctc    lif@.qpitat    i-ovtci,    for    each    of    the    Call-
                                                    foriii.t    ]t(,gioiiil    '.Nle(lie:il    Prograiii    areas.    Finally,    tike     first     phase     of     data     acqiiist-
                                                    tioti     (entitled     iiialy,,is     of     les,@     readily     avallilkle      types      of      information      involving,
                                i                   for                  transportation aii(.1 the n),iny viii-iotic.4 of i)iorl)i(lity data.
                                                       T)tirizig     the     second     half     of     the     first     planning     year,     six     plai)iiing     studies     were
                                                                       oil  i region-wi(Ic                     All     were     approved     by     a     data     needs     ;iil)coiii-
                                                    li)ite(-     oil     Avliieli     each     of     tile     C:illforiiia     Regional     Ale(li(,jil     Progriin     areas      was
                                                                                  study     aini(@d     at     relfttively     deel)(-r     penetration     into      soiiie      aspect
                                                                                                                                            tiiiie      each      pointed       clearly
                                                    of    the    (1@itit    base              for planning.  At tli(@
                                                    to                 of     4)IH@i-@itiotiiii                fit tlif- ranking.
                                                    of    Iiiis                     will             iiiii)oi-tiiiit iiiiit(@i-i:il  for  iiioi-iii(lity   tizitily,-414,   l@iirt@ic-
                                                    reality It' III(' siiri,t@y I'lill left                 $it, Interval(,. At            siitiiii (Cities-, t'lle  mtii-%IeV  Ili  1.4


                                                       7';-tlioiiiifl    fti('ilitit-s                                of  iii(@               for  4)1@(@i-ittioiitil
                                                    %Vlli(-Il  1)1-,Ikli  l@(i  (111((@  Slili)h@  Ill  Ili()  first I)IIIIIIIII)G  1)(-]-Io(l,
                                                    liet@(18  and  1.110                           of     training     lirograiii@4     for     k(@y     lieiill;lk     services,      In
                                                    titillation  to                       servi(-(,,4. It was found, though, that, little liiforiiiiii@ioii
                                                    Iiii(I )letter                                                       of wlifit training  facilities  now  exist.
                                                                                     oil tlii@ sljiil)le clti(,,stioii




                                                                                                                      173


                                                                                                                                                                witii       file       sitrv(@y
                                                                                                                    kill  41lililyl,i(!                     ,4iirv(-y      of       (-xi-4t!tlg
                                                                                                                         lll)o%v(.r of all So'l't,!4. I'])(! sllrv(,Y,
                                                                                         for                    -c iii.,i
                                                            1)(,i;ig kill ill%-('Iltol-Y of f:l(!ilitil@s,                                          is    tlo
                                                                                NI),,Itlsiozi    )o,4,.,i
                                                                              (I.                       i)i iti(@,4, (,iiri                                          it   wiii   ;crve
                                                                          for    s(@(,@oii(i-geiieratiot,    stuiies    ttji(i    ol)eriti.ioiiiii    i)roi)osais     in     tilt,     iiiiiii-
                                                              II I lie                                                     is   (,()Iill)l(,tiiig   iiit,(,rvi(@ws    Nvitli    a    riiii(loin
                                                                     of f@llysici@tii,,; tliroligliout t,ll(! Stilt(! ol        I 111(@   Sill@J('Ct   of   r(@f(-rritl    ii;ttt(@rilli    for
                                                                                                        e:iii(-er @iii(I  sti-ol@(,.              t.0o,   iiiiit,(!riiil    ll(,v(@r    g:ttil-
                                                                       witli    ])(!art     (Ii.14(1:lsel                                                       (!ollt@'lill        VIIIUIII)le
                                                                            ii 1)(@iiig I('(Iiiired. Qtl(@stiolkiiixir(!s                        coil
                                                                        of    two    kinds.    As    a    1).tsis    for    iiiil)rove(I    (I(-Iiv(@ry    of
                                                                   of    ii(@iirt               cancer and strolit@, referral                               I)otli  a.,;   to   I)II.V,;ici@ins
                                                                   fteilit                                                         t@(is    seen    I)Y    flllllily     pIlysicialls,     itnd
                                                                         -ic@,    are     I)eiilg                And, tli(@ ri(@                                         or      the      first
                                                                                                                                                            alyzed f
                                                            (ktli(@r                 of    first    reference,    are     being     re(!or(led     and     an
                                                            time    ill    tllis    context.
                                                                                      cooper.,Ltive        undertaking        involving         tile         Iiyt4ti@in         Develol)iiieiit
                                                            ('orl).   of   @;iiita   '.Nfoiiie4i   and    the    UCI,A    S(-Iiool    of    iltil)lic    1,1(@tilth    is    doing    feasibil-
                                                            ity   t('Sti)lg   for               registric.4     in     ,troke     and     lieait     disease.     -California     lias     ill-
                                                                                                @iiee     ill     the     (ICV(-IOI)lllellt     of     a     tuinor     registry,      covering
                                                            re4k(l.v   li@i(I   rieli   exl)cri(.
                                                            ri)tiglily   @i   tlilr(I   of   t.])e   bosl)it@il    bells    in    the    Sttit(@    itiid    providing    ciin(,cr    incidence
                                                            (1@lt,t   of    urli(file    ,igilific,,iilce
                                                                                                        The     Sy,,t,(,zii      Develol)iiiezit      (@rp.      study      is,      therefore,
                                                            iiio%@iiig    oil    io     t     I)r(@Iiiiiiii,,try     examination     of     registry     construction     in     stroke     and
                                                            ii(@411-t            At    the    ,aiiie    t,iiiie,    the    I)ire(-tor    of    tii(-     C@iliforiiia     Tiiiiior     Registry
                                                                     -1,;Il,iiig   %vitli   tilt,   (,',itlifi)riiiii   lt(!gioiiiil   ivl(,(I!(!iil   llr(igi-ain   fit   connection   %%,Itli
                                                            liiz;l  I  it@114  ill  llir(,(@  (,iilif4)j-iiljt  (-earnings  ikr(@   (-ool)(,r@ititig   wit@li   tile   Illusional   M(@(11(@:tl
                                                            Ilro@r@iiii t,o (li@t(@ri@iiiie tli(@ viiliii@ of lo(-iti                        r(@vi(@w
                                                                           witli                rq!view !it li(,4ilt-li lii,4iirikii(!(@ 1)i-o@riiiii@:   for (@lLse
                                                            tioti  Iii-lirt                ciiiiet-r     and     stroller     revi(!w     of     I)revjtlliiig     coiiiiiiuiiity     @tiiiiil-
                                                                   and                     in   iiiiiiilkgellieiit   of   @Nll(!Il    cases,    till(]    I)o,;sible    dev(@lol)iii(@iit    of
                                                                                                dii(!Ittioil     find     otlic@r     programs.     In     eacli     case,      the      county
                                                            postgraduate       ineclical       (,                                                                                                               I  I
                                                                        groiij)     Iiii.4     agreed     to     cool)(@ritte     Nvitli     the     iil)l)ropriate     University      medical
                                                                     in    the     r(,Yit@w.
                                                              .@p(@cialize(l.    ?Icxoltllccs    ill    liospilalx.-Tlic     ,,,ixtli     find     last     of     tli(@     flrst-geiieratioii
                                                            Cgilifcpriii@t      i)l@iiinil)g studies    is 1).'IS(-(l oil                           ,eiit   to   all   the   ;lt!llt(-,   geli-
                                                            eril   lio@l)!tAlls   ill   tile,    ,.Allies through    the    c(pol)(@rsitioii    of     tlie     (',iiliforiiiii     Ilo,,I-)itlil
                                                            As,;o(-iitioii. The                         are   r(@l@orilitig   wli(@tli(,r   or    not    tli(,y    liftvc    various    iteiiis
                                                            oil    it    detailed     rost(!r     of     slwcialize(I     resotir(,es     or     f.,t(@ilities     needed     for     treatment
                                                                                                        pati(@iits %@,itli li(!;irt                   cancer     and     str4)lce.      Tlii.,4
                                                            .iii(I      overall      arrangement       of
                                                                                    -is    not     been     g:ttli(@r(@(I     before,     iiid     Ill     exlwted     to     highlight     ma-
                                                                           too,  If.
                                                                                                        r   in-,tl(listril)iit@i4)zk,4.   At    the    saine    tiiiic,    the    study    will
                                                            teri@il    Iiiclc,;,    oversxil)r,)Iies    o
                                                                                                                                      -Iiitrl)er    focu
                                                            l@rii)g manpower           training  reqtiireiiieiit.,3  to  it  s                              s     as      C@lifornia's      Re-
                                                            gioii,ll               Progranis       enter       their       operational        I)hase.
                                                              All     these     data     gathering     .4tu(Iies     liave     been      integrated      Into      the      14      operational
                                                            l@rol)o,qil.,;    de,,eril)(@d     earlier.     They     1);ive     also     been     incorporated     into     the     five     o@
                                                            erittioji@ql     I)rol)osal.,4     and     the      two      additional      requests      for      funds      especially      ear-
                                                            itiarl@(@(I    by    Congre,,q,     sxii)mil7te(I     by     tii(@     California     Coiiiiiiittec     on     Regional     Medical
                                                            Ilrogriiiii,, during the Alar(!Ii, 19(;8 (juiirt(@r.
                                                              ll'liis -,(!(-oti(I set of liri)l)o,,itl@ iii(!Iii(le.4 ili(@ exi)@iiisioii of (@xistiiig                              c.-iii(@er
                                                                           ;Ill(l   tr(,:iliiki-iit,   so(-i:tl   ,;ervi(!P,    c(iiisilltittioi),    radiological    I)Iiysic,,,    iitt(,Ienr
                                                            iiit-(Ii -iiie fiii(l (-(jtiiiiiit(@r rt-tri(@vitl of                      (litlit   to    2Ci    liogl)ltaig    fit    jiortlierri
                                                                              a (,ooi                   yeitr-r(iiiiid g(,ii(,rtil                  residency,         Intensive          coro-
                                                            n:ii,   <,fir(,,               I                                                                                                                    I  I    @:i
                                                                   V               tritium,, for  I)IIysi(.Ilillt4  ill  "II)IIII  lio.,41iit@111'4,   and   tile   estiti)lisllllltllt   of   ft
                                                                         library :tiid likforiiiiitioii s(-rvi(,(-
                                                                       first    Of     Ill(- lol'OJ4@(-t-@.14 S(@(-Iillig flill-liliirlce(l  fiiik(Is  ltiv(olvc4 it  sixtii                  fix
                                                                                             (-"ollllty,   ti)(@    I)IIII11lilig    for    W111(.Il    lilts       assigned       to       the
                                                            IJiiiversit,y of C:tliC(iriiiit n,t Irvin(--joi-ol)osijig it                                    I)AI]tv)oiirtry  (14!iiioii-4,trii-
                                                            tioll               It would 1)(, Only t,lie f()iirtli of lt,.,i l@iii(I  In tlit@ Ntitt(oii. The
                                                            I)roj(@t-1; Would                   iiii@t    iiiil)rove    fill    existing    liyl)erteii,41oii    program    of    tli(i     IJC
                                                                                                  Ceiit(@r.
                                                               Taiii(@ii   fill    U)gi,tlier,    tli(!8c    tlrt4t    ol)eriLtioiiiil    PrOI)OHR1.4    call be   fAceii   am    t,lie    begin-
                                                            ning     broad     outlines     In     tiie     development     of     a     rcgion-wide      coinprolictisive      biti(-,I)riiit,





                                                                                          174



                                                                   f)ll it (Illy-I)Y-(I:iy  )@:isis,
                                                                    iiie,               1', Yolli-                 (V(@ttiliir to t'lie  (,.Ileti@o
                                      az-i,;IS? (,otll(t you (rive list                   1-iiii(IoNN-1) oil tlk:lt"@,
                                      slioll](I liot.                  tile i siie-is tile I)rol)oS@ll                     li@is been
                                      01)(,(l by T@S(, aii(I 17(@T.,A. faciilti(@s. It, i%-oi.il(i ti-:iiisf(@,r the
                                                                      I)v t,,Iiese two (-(@iiiers. iii flic field of lietrt  disease,
                                                         sti-oiie, to    tile   IV-,itts-117i]lowl)i-ool@   tre,.t.   It   is   iii   this   ai-et
                                      tl)at,  the   (-oiiii(y   1)laiis   to   build   t   iiew   liosl)ital   -%vitli   the   ,tid   of   TTill-
                                      lliii-toii     siil)l)ort,.
                                                :tilii of@  this  ])I.o(rl."Illl  is  to  build  :ii-oiiii(I  tliit  lio,;I)it-al,  bringing  ill
                                                                                                                         '1111   of    postgi-@l(l-
                                           A@o lliiiil@ tlii,,will li:tv(@it ll(!Ill@ti-icil)]P,(@fl'(@(,t@ ill mobilizing      tile       services
                                      o   f  II   1) o IIo I I o f Los      I I   (!S t 0 1) rf) v (I  I)e t t e I t 1-0.
                                                             "I'll@ililz you, :111(l I ;till              (.(I to      '.You ])live            I  s
                                                         oil tli(@ C,,tl'iforiii;i I)rori-.tiii, Nvliicli eve will go into ill
                                           ,Nfl-. ICY]-oS?
                                                             No questions.
                                                              I)i,. Cirt-er?
                                                                                                 y
                                      ltil.ii]:Il)](@,  fol.  tile  IVatts,,tre,-t.  I  wonder   wli:tt   you   :ire   doing   for   tlie.,ii-e,,is
                                      ii-otiiid W,,ttt,s.
                                           I)i-.                 Our   I)rogi-,tiiis   exteii(I   iiito   t@lic   W@it,ts    tre@t    all(]    also
                                      :ii-otiiid    tile,    Ilrtits    area,    not    oil]    t-liroiiglioiit    tile     metropolitan     region
                                                                                       y
                                      of Los                     but    in    flic     mountainous     areas,     tiid     so     fortli.     Other
                                      project.%-
                                           @\fr.   CAlYr]'IZ.   I    believe    in    those    stirroun(linz    ,Lreas    we    are    liable    to
                                              iiiot-e, li(@,,trt atticks and strol@es.
                                           'Afr.     l@o(.ieps.     Th,,tiik     you     very     much,     Dr.     Breslow.     We      appreciate
                                      vei-     n
                                           y i  iicli your comina here.
                                           I   understand   I-.1itt    wY    will    try    to    he,,,tr    one    more    witness    here.
                                           1'ev(@re,ii(I 'vVoi.- cs                                   I     understood,     wore     zoiiiz      to
                                                                      -you tii(I Di. Price,
                                      )life to                       ()iil(l   you   come   forwiti-(I,   than   ?   I've'   will   b@,    ple@-,ed
                                      il()         yoiii- l@(@@t,iiiiony.
                                                                    yoii@      (,oiigi-eq-3inftii,             to (!oitit)   aii(I   i)ii-,ro(Itico
                                      your   I)tit,   t@lio   (@oiriiiiii.teo   ]allow-,   (-)f   yotii,   worlc,   fti)(I   we   itre   delisted
                                      I    o       y(-)ti   lier(@ with          iiid T)r.
                                           Aiiii if you Nvoii](I lilce,, w(@ will mile(,, your                                   1).,trt-, of  tile
                                                                 0I)j(q!t.ioll  @ll)(I  tll(',Y                      follt)Wil)L'    Voill-    i-e-
                                      iii:l I.I(S. Ali(] if Noii (!oii](I t-li(@ii                        I,()]. II,, 1110 I)OIllics i,']I:it,  You
                                      fliil)lc NN-0111(l I)o,llrll)ol.t:llif-, loans Would 1)(', li('Il)flil to t-ll("

                                                                                       A. WORKS,          EXECUTIVE VICE PR@
                                                              NORTH  CONWAY INSTITUTE,  BOST                                                      D
                                           REV.  THOIYI                  RICE,         DIRECTOR          01                          PARTMENT    OF
                                           ALCOHOL  PROBLI                                                E,          GENERAL          BOARD     OF
                                           CHRISTIAN SOCII                                                                                 CH

                                           Dr.     WoltKS.     T]i
                                           'Nfy       name
                                                                                                                                             Nortli
                                      Co                         ,tn  Epiwopal  cl(                                                    ve      vice





                                                                                                                                7@






                                                                Silolll(,l      Nv(@    I provision ill tlip- I.Iw tli-,it if the!
                                                             ('(I, it  iiiiist  1)0, :It, I 11(@        of  i.ii(',   ])el.soil
                                                                        I  NNIolli(I S:ky lli:lt. We. (lo ]),IV(-,            III %V.S fA
                                                                  oi.  t  I),I@is   ill        ilic (.,I.isis coll](I 1)0
                                                                                 to t,li(@,  ,,(@rvi(.e.  IN,(.  (lo  li:tve  olir         roill-
                                            lliit,lkl II     s  Nvll       lllo%v  iis  ]low  to            it
                                            (101)llliit-11   oi- IlisoNN.1
                                                                IN'l);It, I v                  of   Nv:l",         Soil   Igl.e(@(I to
                                                                                            iid  iii  ti
                                            I                til@it  .11o I   list,  t                                        (-ollilllitlll('Iltl
                                                     to tll(@ Coll(
                                                    I)I-,NIAS.   I    woll](I    S,,Iy                  1-(@e  to   stay   to   its   (!Ollcltl"ioll.
                                            If It(,   does    iiot,    soiiie,    other  Ill              lw ttlceii.
                                               iNfr.            IN70111(l       Yoll   "i
                                            be  iiicoi-I)oi--ttecl   iii   what   we.   ai,
                                               Alr.             I  tliiiili:   the                                           iit    nearly    ')I
                                            Pe-reciit    of    these     Clients/,   pt   the   ti-   tn'
                                            toxiticqtioll ti-e,,itilleltt@
                                                 r. 1)'                 Id      be interested   iii   seeing   lioNv   ii-iiiiy

                                                                        Ic  this  ;ift-(@i-iioii  or  toiiioi-rox@-  yoii  Nv
                                                   I)i                    lio is tli(-  foiii)d(@r  of  (li(@  l,'ii'lt(@d  S
                                            t ox i I'l (@tf



                                                                                                                                  ideiit      for
                                            ol)ei-.ttions, I-lallin-.ti-k ('@trds, Iiic.,                   ty,    o.
                                                STATEMENT OF NATHAN 1. STARK, CHAIRMAN, MISSOURI
                                                                     REGIONAL MEDICAL PROGRAM
                                                    S,r,%iti.:.'Aly operations litve, nothing to do with Medicine.
                                               '\fi,.            I  -title  iiot  ,o  siire,.   Doii't   yoii   give   get,--,iT]l   O,'trds   or

                                               ll!rl.. S.I,JkltK. I ]live                 of that.
                                               1. :i.tii           to 'li:i,ve this opport,iiiiiLy to be it this                               on
                                                                                                                                         LI
                                            regional illedi(@,t]  I)ro(-r-,iiiis.  I  tii-ii,,.ts  yoli  iioto  frolyl  the  title,,  -,I  11011-
                                                     iii tlio           field.
                                               @IL bii,                                                                               r
                                                                     iiiter(@ste(i  iii   lieiltli   I)rogrims   is   illy   c,,vte(,,o   y.   As
                                            I        to.1.11  iii("4e  OXI)el-ts,  ]Italy  of  whom  I  li.IN-e  lie:lr(I  of,,-tll(l  sevei--,tl
                                            of whom f ]),I.v(.. ]Known, I               itiysel f t,li(,,  question,  "l@7]i:tt  @Aiii  T  doiiig
                                            liore?"  l@tit,  I)ci,liil)s  this  is  the  iiew  loolc   in   the   jioiil)i-ofessioli,,Il's   view
                                            of tile,
                                               I t,liiiilc that, (1)(" ii(T(I for              1),trt-,icit)ation   lifts   been   rather    iin-
                                            T,,Iiiiiliit-to  iiiostof  those  III  iiiaiiy  I)tti-ts  of  the   health   field,bitt   I   believe
                                            it is fii,st, I)ecoiyiiiii), (,oiisitiiie,r
                                                                     ill t-11(@ 11(@.iltil field tl-o I@'i                  of   the   l@alis.,is
                                            (,ity               Tfo,;I)iti:i,l  @iiid  Afe(lic.-cl  (enter,  -mind  is   clittiniil,ii   of   the
                                            Mill"olll.i                           I)I-Ogl-,tiii,  iii(i  it  is  to  this   letter   role   that,
                                            I wisli to itd(I i-(,,ss III
                                               My                        be    restricted     to     tlieafissouri     proaram,     sinm     this
                                            is  tllo  011(@,  I  Hill  latest,  fiiililiii-  with,  -,tied  it,  niay  be-typ'ical,  or  mty   be
                                            typical of  what  ot@lier  progi,-,iiiis  are.





                                                                                           194

                                                'I'll(i illi@ll      of olit,                 I,, oil       coo@l)ei-.ttive     (lelivei      ,tiid
                                                                                                                                        'Y
                                          1)]@iiiliiil(r of (lie best,                  1)(@:tltli C,:Il.(@,  to   T).it@ienti   sitiferiiig   front
                                                       t'
                                                                                                                              rerr:ir(liess      of
                                          (,(Iollolll]C, educational, or ge@,,Yra,pliic,,ti status.
                                                    1)ro,.Yriiii   iii,ilizes   inaxiintini   local]   I)Iaiiiiiiia   ,iii(,l    initiative    with
                                                ioiia,l   (@i@il)liisis   upon   coordiiitioii   of   eiroits   and    review    of    the    qual-
                                                                                                                           ve   of    the    p@blic
                                                of  cii(,Ietvor,-,.   Policy   is   set   by   ,t   coiiiicil   repr@sentiti
                                                professional leadersliil) ivitli
                                                                                                      f  roiii  ,ill  (,rroups  in   the   reolioll
                                          who  litve  a  I)oii,,t  fi(le  interest   in   ti)(@,   delivery   of   li@,i,lth care.
                                                Because of the, ,ttted intent of the                            which    Ni,,,is     to     improve
                                          c,,ii-   by                tii(,,                   of                     ,,elTls Ittention    ]II     the
                                          @vissoill-I                 iN,.ts              to   early   (Ictectll)ii   of   disease,   ry)(,,tlio(l-
                                          olo(ry for                   to ])I.ovi(l(.@ iii:ixlllllllll economy i.ii(I
                                          :Ili([   initially   -i   siii:ill   member   of   models   of   (I(@liv(@,ry   systems,    ])].'Lllniilg
                                          for 'I @(@ilvice 10 ,I                J)ol)llltt,ioll  of  J)Vol)](@  NN,ii.,Ilollt  re(,,,a@d   to   the
                                                           in ethical                       iiii(,@lit be                  but  witli   eiiipli.,t-
                                          sis oil                  t )e             (-,Ios(@ t@o t@ii(@, I):ttient's  ]ionic  as  is  coll"ist(@,nt
                                          )%-i Ili (@(-@olloilly 'Lli(I            III otli(@,r words, we tre, pcol)le oriented.
                                                P@iiiii)-y                                      Oil   tile   (I(,Velol)in(@,iit,   of    Supportive
                                          Services    iN-Iiicli    titilize    the    nenve"st    iiigei(,,iitific    technology.    Tliisi'neludes
                                          ,I  v@  ri(,I@.y  of  serA,ices  which  c,,Lii  be  fiii-iii,,Iie(I  both  to  the   physician   ',Illd,-
                                          to   4,-lie,   piticiit   qtiiclzly   .tiid   ecoiioiiiietlly   it   any   tiii-ic   anywhere    ill    the
                                          I-(' (r] on.
                                                                 t@estiiig   of   coiii))titerize(I   iiit-(@i-prot,,ttion   of   14,'ICCI's    for
                                          I)Iiysi(-,iaii-,   in   i-tirti   ti-e,.ts   is   .t   pre@ise    example.    For    screening    p,,rp@,
                                          Itil(i  for   tli(,   first,   time   in   Iii,,toiT,   the   privite   I)i-,t(,tii,ioner   participating
                                          I                                                                                   -ilyinic,@lintely
                                          ill    the    model    system     has     consultation     for     licirt     disease
                                          ;Iilltil'il)le,   Io   him   ,tt,   every   hour,   168   hours   ft   week,   at   an   estimated   cost
                                          of less thin $3 I)er interpret-@tt,.ion.
                                                Etcli    iiiterp-retitioii-eliii    be,    backed    up    by     a     dial-a-T.)Iione     lecture
                                          reference    sources    recorded    oil    tile     wid     ,tlso     ,tutomaticalfy     available     at
                                          ,ill hours tt tli(, cost, of i. plioiie
                                                ']'])Ps(@         ](Pictures   will   (levelol)   oil   t   demand   I)&-,is   in    accord    with
                                                            A   iiio(l(@l    of    delivery    systems    is    found    in    the,    Sinitliville
                                                                                ollaii@xi@tiiigrurtlsvst                   mftxlmum          ciTort
                                          has                     by tilo            :I(Ivlsol..y                   flags,  @itl;it@i3  University
                                                       i("Ilool   lll)oll   9.SOI)Ilisi-lic@tte-d   coii,,iilt-,,-Ltion,,tnd   referral    proaram.
                                                Ili  Sliii(liville,   tile   -,vstem   extends   into   lioi-ne   care   utilizint-r   all   Unveil
                                          .11)lo                :tll(l aii'xiliftr                    Fictiltl,    member-,    i4     the     iini-
                                          v(,i-,.,it..y             consiilt, wiib the @,:il st-,tff.
                                                Financial    issi@t.Lnce    was    given    init.li    i,    ipecific    terminal     date,     ,it
                                          is-Iii(,Ii   tiivi(@   tile,   system   of   care   is   projected   to    be    self-supporting.    'nie
                                                        I)rovi(l(@s -for                           of   quality   of   care   as   a   result    of
                                          ]DI elisifl(,,(l slll)l)ort,.
                                                Tt@ is the I-)!.Cii of        Missouri.     Program     to      est.%blisli      and      terminate
                                          final  ',Iil)l)ol.t;   for   t]]   (IVIIIOIIStlrtt@ioii   I)i-oje(,-,ts   in   this   mining   in   order
                                          to   l@rov"(]('   t'lle,   OI)T)ortiiiiii-,y   for   cool)erittive   pro(,riins   witli    a    mttximiim
                                          of                      in tile region.
                                                Sitl)l)oi-t,iiig   service,-,   -,iiid   later   innovations   will    Continue    to    be    made
                                                              ,t                   self-supporting       I)n@si-,to       tlitse        cooperating
                                          coiyiiyiiiiiitics so long as those are found to be mutually helpful.
                                                       ,II   facet    of    the    pro--ram    is    the    interdisciplinar                  -grou
                                                A   fin,                                                                   -v research            p
                                                                          0-                                               doli
                                          in    the      University      wb      a@o      studying      intensively      the    very         system





                                                                                                                              F





                                                                                                           105
                                                                                                                                             needed      biit       ]IC](-
                                                         for           ill  t'l                                                                                Id       I)e
                                                                                            iiiiiiiiiii(.,:It,ioll f,  'ilit,y  vlli.cli  Po,  il))Y  cou
                                                                                            of t-lit)
                                                                    fol. I)rll                                                                                 (11 law
                                                                                                                                            4    wlijell    can    (,,on,
                                                                                               of -,Ill ililivells          (liselp
                                                                                                                                                     lil@o   to    iiiell-
                                                             f t lio 21                                               @v                                   ('111"  of   ft
                                                                                            of    this
                                                                                               ,iiill)liile"   tllo   t,ii,l@iiiil of it
                                                                                                            for   ,
                                                                                                                   tll  II,, I @ or f roly,            20
                                                                    Illces the time rc@Iiiire(i
                                                                                                                                                               rs       and
                                                                                            Of @quipitient                  developed
                                                         to    less.     Another     piece                                                                   icb      h,(ts
                                                                                                     ge   er is     (Ill    ele(,tro
                                                                                                       t I                                                             body
                                                                                                     in      ;P@dilig      the.he,@
                                                                                                                                                                  periods,
                                                                                                     t,je Its Nvllo D'Itiit bp-  11
                                                                                                     n   be    tal<eii    home.
                                                                                                                            which       i.-ei-ninds     the      P,ktient
                                                                                                                    @y,t("Tl
                                                         to ice(,p the b,,t                 proper   dam@n@d.
                                                                                                                            d,Ls   the,   design   Of    Diore,    model
                                                             Fiiti-ii,e I)ro                1-1 CO           ill@illize                                        )rof    e-s-
                                                                                                               %Vitii  the  T)iiblic  -,laid  Ike,,',Itll  I
                                                         delivery s@st@                     Ill (@'                                                                                            ; .    I
                                                                                                              II(ILY-1011   Colit,iiiiied      concentrated      steady
                                                                                                                                            ii Z. the
                                                                              C'  'se  .  N. s (lesi(,,i)(,,d  to  I)e                        I  ,                                                           I
                                                         of                                          t,                                                                 tion
                                                                                                     for     tl-ettillellt      of
                                                                          s    Ill     I)rovl
                                                         to I)I-Ogl@-,Ilyl                                       c;tt(ILYO"Ies  Of-  (Iis(,,%S(',
                                                         of                    sIliT(Irillil,                                                 Ile    patient    or    the
                                                                                                     into action o@ behalf of- t
                                                         tr,i,llsll,ttion  Of            II(,
                                                                                            ,w i(
                                                                                                                                                   be      involved       in
                                                         1)otenti,         tt            ent-                                         time     to
                                                             I'llis     ii     indeed     ,Lll     excitillg,      though      wmri]19,             .  (1,    offers     one
                                                                                                                                      to   I-ay    1111n
                                                         hetitli        tfT,,iirs.        Til reai0il"tl IYIC  I)till@,ti Health for              people,      who       are
                                                         of the best means for Ieliievilig o@
                                                                                                 i,,Lries of r("!Yioll,-tl medical                     tills.
                                                         ill (Street the                    bc,,iiefic,
                                                                                                     the      Support      'all(,      the      ("=atioii      of       this
                                                             I      wotild       (certainly       urge
                                                         program.                                                                     r     tire)     Missoiiri     regional
                                                                                            Ile Itil org,,tiiiz:ii-,ioll            o@
                                                             Now       I revive           IleI                                                                                                         I   . I
                                                                                            III(I lil@e to OfTer for the record.
                                                         pro(Yrii.m     -,vliicli   ',[    wo
                                                                                            Committee   WOIIld   l@)e,   -%,(,,ry   pleiLli(,(l   to   bcLve    that,    and
                                                             lvfr.                          Tli
                                                         it will be iiia@l(@ a p,%It of- tlit) ],(K@ol.(l -it tlis point.
                                                                       document        ref(@rre,(l        to        follows:)
                                                                                            llr,010-iAl,               PIIOCIR-k"f OltOANIZATION
                                                                                                        1. COAT,         gIrT'rING
                                                                                                                                          the       practicing       Profeqslon
                                                                                            c-I)r@-eiitativ(-14 of tli(l I)iil)lic aiid
                                                             (a)  iloii(!y  Is  @,(!t  lY   r
                                                                                        fr4)iii
                                                                                 S("Ilool.,4.
                                                                                               r(,Ill((,Il to ll(lllltil.

                                                                                            1)1-4)f4.ssiollill
                                                                   All               raising]
                                                             (A   i(                                                        (-oil I
                                                                    @ilil ol'                        14'4)111(                   I               items   of   wli(!re    tll(,Y
                                                                                                             ),),ill, I Ile,, oil        r(,goi-;
                                                                                            is ri)r 11     I)'                   I                                        it
                                                                                                                                 illit-,Ilvkilln  risen  4)r  (@oilil)llllll(.  tioll

                                                                                                 t
                                                                                                 2. Ott(;ANIZA'rlO,4Ar, rkjlrvItN
                                                             lilho,                         (lolillilItt(.(,  coliQlf4t,4  of  tll(@  114'11(1  or  IIIR   (lelegitt(%   froili   ill(,.
                                                             S(.Iiools  of  osteopathy  itil4l  medical)(.,   tll(.@   Divisioli   f)f   I-Teiiltli,   Director   (yr   welfare
                                                             niid       I)ir(@(!tor       4)f-meiitfii  I)Igestseq.   This   committee   server4   ag   an   advisory   body   to
                                                             the   Coutiell   oil   RII   PrOI)OSal.4.






                                                                                                                                                                                              7'@








                                                                                                                                                       lilliittl('(@    till(]     ;II)-
                                                                                         llotiiili:llt,(l I)Y III('                               (,Ol
                                                                                                                                                     12
                                                                                                             Ili'   gi)vtll,l 'iII9
                                                                                                                                flix
                                                                                                                                                               iiillY     'lot      10(,

                                                                                                                                4,41 01-  ,)I)IlOili
                                                                                                                                                                                     (41
                                                                                                                                                     Wlil(.Il liltq lipl)]i
                                                                                           Vollifit;ti'Y                                                    r(@actioll          1)@in(,l
                                                                                      I)Y tll(@ (-@oill
                                                                            r(w ('Olllli'il.                                         for              for         the         Mis,,oiirl
                                                                                  of

                                                                                                       AT,  UltilAN   0)@(;ANIZATIO@l;
                                                                                        J.        si,FCT
                                                                                                  it               \Ii,tl.ol@illit:iii                              11:19
                                                                                                                                I i,Nv                            frf)jii       (,Il(!Ii
                                                                                              of  111(@  (@Nv(w                                                             'I([Vi!"Oi'Y
                                                                                                                                                                                    six
                                                                            i\Vo     Iti@;!iq)llitl (Iollli(!ils    for    all    I
                                                                                  of              'ity                               (,(I to            (@'14@y   I)Y   t,lie    IN[ili-
                                                        A
                                                                                                                     ullill,@lt(,Iy    it    Illllst.,    ilitei-act    wit],    Otll('r
                                                                            ,w   t   r(@giolk    is                                                         d(,Velol)e(l           Wit,'
                                                        No  iii;il@t,ol'  II(                                                            ]live 1)("(@
                                                   r(,gi(ills. '@NIO(lifleltiOll" (If t                                                ,4iiililtr     plans     are     uiid(@r     dis-
                                                                                  ,.,(Ijoillili-, regional                                                                                                     I        I
                                                                            ot@lier                    --                       -                     4souri.
                                                            of t@11(@                                  3-e"-iolls Wili(-il .1i,@o a(ijoill ,\II.
                                                                Nviill   i   1111111I)er    Of    Ot'ICr
                                                                                                                                                        T)Ilblic@%tions       of
                                                                                                                                            Of    cooi)ei-ative     (,,fTortS
                                                                                 of
                                                                                                  y    iv(.,tillose,      for
                                                                                  we,
                                                                   o(" f@, I Zs
                                                        'I'lizilil@       you
                                                                                                       It    to    (@Olill)lilll(@lit.                             iii)oil
                                                                                                                   today,    Ill(l    t-o     Sqy     tllllt,                          is
                                                                                                                                                                        it          such
                                                                                                                                                              part I
                                                                                                       ilieii of iii-, c%,ideiit

                                                    PI.(
                                                                                                          to       @(,(.Oll(l
                                                                                                                                                                  tliiiilc     it     is
                                                                                                                                              to ilivollv,
                                                                                                                            0
                                                                                      otilt@i- trivial     east tile, S(@i('] tifi(- (!oliillltlllit@y,           Ill(l     I     -,Von-
                                                                                                                            oil SON' t,l)(@                 ()@f   iliol@(@   itio(.I(,]
                                                                                                  is xoill. trial               t
                                                                                                       'I
                                                                     I,               \.o   tli;it.
                                                                                                  lo(..:It(@(I  ill  A,   11-111','tl          xl)ollt;      1.5      mile,,;       from
                                                                                                                                tt   proffrairi  for   the   first   tiln(3
                                                        to alvo comploW continuity of                                      @frolii   1,11o          tl)(3   I)ILtiolit, is
                                                        in      l,'I)o       diagnostic           Lliroli(,rll 4111(@,                     stii;g(@ Lll@l than iiit@o
                                                          Ili Ili I 11 Ill iol)
                                                          Aiiotli(,,r     olit@.     is           t:tl@iiig pla(@(',  ill                              Mo.,           l@ll(I  Coill-
                                                        lliiillit-,v                  Z@ cir(liov,
                                                                              ci;rdi-.ic                             il@o tri.ini       I I "Y illirges       in(I       doctors       in
                                                        tllc            tl.C:Ltillelit,      ,iii(I      relitl)ilit,,,It,joll      of               1),itientS.  'I'Iiis  is  a
                                                                (-)f   tll,(@                          itiolial     f,yriiit     ,tnd     is     -\vorkiiig     out     very     -\vell.
                                                        Part                ,   cii rreiit           ol)er
                                                                       ,ti,o      ,ix      or      "eNCll      I)ro(,rr,,tins      iTi      operation      or       being       proposed
                                                        now, ill (01niiiiiiiity hosl)it,.tls.
                                                           '.\fr.      r"oGrRs.      Th,,tiik      you      very      much.      We       ,tppreciate       your       bein(r       here
                                                        tod      @y.
                                                                 Our next     witness     who     has     a     4     o'clock      plane,      I      believe,      is      Dr.      Amos
                                                                                   appreci@          your          prmnce          here          today.          Your          Congress.
                                                        Bratrude.                We






                                                                                                            197

                                                                       Ti(@lov,    ,I)ol@e    to    me    oii     the     floor               li(3    wanted     to     be
                                                             to 1)(@i-Soll@illy                      yoii to tlio committee tjid re,,-rets lie  4nii-
                                                    not, 1)(". I I    is ill (.ollllll ittce, Iiiiiiself.

                                                    STATEMENT            OF            DR.            AMOS            EP@ATRUDE,            WASIIINGTON            MEDICAL
                                                        ASSOCIATION. AND ASSOCIATION OF GENERAL PRACTITIONERS
                                                         I)i-.                     T    was    ;ent    liere    to(la-v    by     i-,Iic     W-,ishiiigrtoii     Ale(licil
                                                    Asso(@iitioll,          Ill(l  I     line     the     I)Iessing     ;f     File     Associ.Ltioii     of     Geiier@il
                                                        f         ])I-. Ai-,io,, 1).                              -irn   in   geiiel.,.tl   I)rftcti(-,P,   in    Oiiitic,
                                                                I               (common          fiiliil(ywltll.,Lll          ])C(.)Plowlloll,,tvemolye(I           Ivest"
                                                                        ()@ll- @i(lol)t(@tl lioiii(@                          very   iiiil)ort,,,tiii-,   to   us,   iii(I
                                                    S()                             if] giveyotit
                                                                                Coillililliiitv ol@.il)oiit, 4-,r)Oo I)OC@I)IC
                                                           10(rgj
                                                                                                                                           Si  11  (,'IO  event,  of   the
                                                                   lie   01)1,1,1c   "til)llp(@(I(',   witli    NVIIII(-,    1%'O    colisi(l(@r,    11    World-f;iinotis
                                                             1', t
                                                    sili(.i(le            It    is    IL    ]lie("    community    and    my    ()    vei,i-s    tliere,     have     been
                                                                                   ltin   iii,,iri-ic(l   tii(I   have    loi@r    clill(Iren,,,tii(I    as    a    father
                                                           was    r@iise(l(iii    tire,    ilfid(Ile    Ilrest.    Afy    father    was    ,t     )-ciieral     pri.(-t@i-
                                                    tioiier in  a si)iill  to-,%-ri bv the )time of Antioch, 111.                              TJI)oli          deeidiiic,
                                                    wliere to                      there     %@ere     several      tliiia(,Y-s         Sure.     that      I      wanted.
                                                        1.   %v,,i@iited   ,t   coiiiii-iiiiiity   witli   I   hospital   i@   it.   I   have    -always    ])veil    very
                                                    illter("Ste(I   ill    ('relier.11    I)rlctice    but    could    See    no    reisoii    to    clioose    L    coin-
                                                    liiiiliit.il    tii,,It    was    lar(-,c@,    eiioiilyli    to    litvp,    ,i    well    established     sl)eciilist
                                                    (rl,olll).    I    -%vtiite(I    to    choose    ,t    coiiiii-iiiiiity    that    I    felt    bad    some    promise
                                                    of   -,rowt-li   so   tliit   I    coii](I    ei-eiitiitily    li,.tve    the    type    of    1-nedic-,il    @ractiee
                                                    til@t,t,   I   NN-.is   interested    iii.    This;    n.,tmelv.    is    ,t    zroiip    of    three,    four,    or.
                                                    five    (lo(-toi-s    iN-lio    ,ire    quite     interested     ill'tlic     l@.tctice     of     medicine,     bi.it
                                                    also    want    to    Ile    free     to     pursue,     -tctcleinic     -,and     recreational     ,tctivities.     I
                                                    "tiTt  alone,   the   q,(,i)ioi-         of    @i.    foiir-iiiiii    groiij),    tnd    the    rei,soii    that     I
                                                          I)e   Here    to(lay    is    tliit    I    have    tliree    excellent    partners    tli,,tt    ,ire    cover-
                                                       'I'I)o,,c)  Nv(@i,o  tlio  I)i-a(-t  ie,,tl  i,(@@isoiis  roi-   clioosiii(,r   Oiyi:ik.   I'lic   ciiiot   ioii;tl
                                                    olies   are   tliiit@   tli(,.   (@oiiii@try   just,    iiiiiii(@(li:ti-elv                (.,o    ine.    I     enjoy
                                                    Ili]                                                            (til(I ',ill I
                                                             Ivo ]file               1,5 lyloill-lis ill :1 new ])orbital witl) 3@i                           :11)(I    ,t
                                                                                                                         of tl)(@so          o-1,   our    gi-oill).    It
                                                                                              Of
                                                    is qiiii-(i                     t@o 11)(@, to go I,o                                  fill(]
                                                         r 1)(@ol)lo (Ii.@tiss tli(,,                      of 11, Sill@i
                                                                                                                         .11 lio,"Pii,:Ll. lilv,,tt@i,,Ll)ly
                                                                                Lily(.liiiig :front 100 to 1r)O 1)(@,(IS I-,() 1)(I :@ 8111.111
                                                                            Ili(-il-  (lis(ttissio)18  (@l'        Pi-ol)]Ctiis          II)iglit-,              1,1101-ti
                                                    lilv(@ lio                  ill  Ili  oil  xvli@ti,
                                                                                                                          in -it                 of    32    I)e(ls.     I
                                                                                                          iii   1,11(3   I)rotd(@i-   I)rol)](@iiis    of    jyie(liciiie,
                                                                           ol)])ol-i.itilit. 'V           I..o    111(@,    fi-olyl    i,li('3    Wii.,,Iiiiigtoti-Alisict
                                                    r(@(,,ioii,il               program f.                        it,.
                                                      1.  wol.11(l   1)(@   i-lio        to   I(lliiit,   that   I    bid    ,L                              vi.ei%,poiiit
                                                                                            ol
                                                    wll(,nl               oill(@(ItlieII7;1.sllill                t,oll-@kl@,tslc,tre(rionilinc(licitll)rogz,.tnibo,,ir(l.
                                                    I        b(vll              of    ftirly     coii,,,(@rvttive     1),,treyit-.itae     an(I     riid',,t     decidedly
                                                    jaundiced     opinion     of      the      role      I      t-liou(,,@t      Government      was      pl,%ying      in
                                                    medicine.    It    is    quite     suiTrisiiig     to     find     out     at     tlie     first     advisory     com-





                                     iliit-tee iiie(,tiii@ that most 0  us                 fcTIiiig. Tli(@ii it Nvk-S  inter-
                                     Cst,ili@ to see the clitiigo  in  ever)@oiie  its  tli(,@  iiie,(-tiiig  progressed.  It
                                     secii@d  tli,,bt  most  of  us  had  very  definite,  but  very  erroneous  i(le,,is  of
                                                                                           e,-tiwl    how     it     would     work.
                                     what the regional medical program Donald b
                                     It wis  explained  in  the  first  session  in  relay  of  19C)6  tlitt  the  region,,tf
                                     iiiedicil pro@t-,iiii wis not, froin,, to be t v(-,Ii ](-Io to tr@itisl)ort the I' )-ationt
                                     to @si                but  rttlier  Wts  ;,,oiiig  to  be  ,t  veliicl(3  to   transport
                                     Itnowlj,,d"e,, technique,, t7i(I                to  llli(@  local  level  to  iiiif)rove
                                     patient,   cti-O   ill   I)Iwes   sii(,Ii   is   Oyiiak.   1,   of   course,   was    Very    suspicious
                                     that this Nvl@s ilist,   the   I)iiit   to   lure   us   into   the   trip.   I   have    nonv    wmr
                                     pleted,%I)I)roxiiii:t,t..e]V   20   months   oil    this    committee,    ',Illd    I    am    convinced
                                       at -,it, least tl
                                     tli,            io   W,@-Iiiiigton-A],L-,](,t   T)rograii-i   li-@   not   altered    f    rom    this
                                     icleztl;   that   is,   to   ,tt-.@mpt,   to   improve   the   level   of   care    for    victims    of
                                     lie,,vit'dise,,ise'ealickr
                                                               cCiid    stro@    ,tiid    related    diseases    into     local     com-
                                     iiiiiiiities.   I   wts   tlso    prejudiced    in    another    aret    as    I    %ppro,,tcbecl    the
                                     work   oil   the   i-egi                                            -i                                  .., !il.      :@t
                                                         oii.Ll  iii(,(Iicil   proar.,tiii.   I   ilii   ill   t   very   tirtl   coininu-
                                     nity. I think it. is wonderful       to    !Volvo    -,reat    research    projects     and     a
                                     Iirao tiiioiiiit of wl),tt we ctll    ivory     tower     medicine.     iiiit-I     tlso     feel
                                     tli   '-r,e   is   t   tremendous;   %inoiitit   of   molecule   that   has   to   be   practiced    oil
                                     a day-to-day basis to help tiio                re(,eivo prol)er care.
                                       I false lia(i 111,Lll-Y                       tbout     I)fiysiciaii      education      I)ro-
                                       -a                 w
                                     gi  ;i-fis tlitt-I f   @ro    ftii-ly    Worthless.    I    have     ialcen     these     prejudices
                                     '111(l COIIA'(',YV          -,o                                                     have
                                                              iiit       4 for   our   groUl),    ',Ill(l tni ,tf rai(I
                                             to
                                                           -,l.iid -%villioiit-, tli(@i-ri injury of  the       W(3     enjoy
                                     0(1:1,)- NN-oll](I  not, licio. ]Hit I -fee,],  ,Is  tlio   only   fYellertl   I)rt(-.tit-,ioiier
                                     !)ii    life    Advisory Co)niiiit.t(T,, that l@    N%I:I.I;to(I Very    little    time    .tr-
                                     gllill4-r for            of iiieiii(,-,illo       lli;i,iiytt)out rno,,tre. In
                                     to                  problems   were present iii. the                of   iriedicille    'In
                                     iioilt li-ceiitr@tl @V.,i:sliiii-ton       soi)ie.
                                       Tliore @re corti,@inly Treasury other                  wlii(-,Ii    deal     with     rural
                                            and       nearly          N@oti](I fail  in the                 areits    of     the
                                                          of these.
                                                           stroke               @l'   ii-e    ](>ol@iiig    foi-Nvtrd    to    taking
                                                  Of the (!Ori)iit.ry (,,,tro unit, ti-@iiiiiito-          that    are     etir-
                                     ix@,ilt,]Y Find estftl)lislic(l @1.)y our                     i@kiiia       forward       to
                                     many   otlie@-be-ilefit,-,   from   it.   I   think   t,lie,   Point   tlllt    f    would    like    to
                                     airline.  so  strongly  is  trill   flags,   r-t'.LNIP   ]its   offered   t@lic   first   ol)l)ortutiity
                                     for   local   medical    communities    to    feel    that    it    is    worthwhile    @    get    iii-
                                     volvedind    iii@r@tecl     in     @:).,us(@     their     ol)iiiioiisi-nd     problems     ar'e-'beiiig
                                                certainly   has    I)eeii    t    coiisidei-.tl)l(,    clitiiae    in of      the
                                                                r(@,@rird to Gov(@i-iiiiiiiit, ill            Tli.,;t  it.  few
                                       i, -s a,ao  no  (X)ol)("I-:1-tioll  would  be  ofl'c%i.(@d,  -tii(I  if  I)i-ef-eril)lo  no  in(  er-
                                                                                   we  Find  t@llo-ii:vorlg(@  I)II.Vsicil,ll
                                                              the                  will  .1)(@  involved   ill   @ille(li(-Iiie   and
                                                                      of  sollio  kill(]  N%,Oill(l  be  l@ll'ost       'I'll(i
                                            witfl  it,,,  (@ililyliltsii  on  i-(,,(,Yioiinlizatioti   has,   Iciiii(-Ylit t@lie
                                                                                                         -(@s. As  1.  t-riiv(!]
                                     faii(Iy  of  tli(,,  iiie(li'et]  cori)iiii  iiiii(-s  of  the  ITiiit(@(I   Stii(
                                     t@o V:Ll.iolis Tn(@-,i@intrs with           who    iti,o    scattered    across    tlio    coun-
                                     try,  T  find   tllltt,    Of(A)I'l      1111VO  Ill'.1,liv  fiLvort@I)IO   colylilielit-s   eon-
                                     (!C.I  fair  ti)(@  final and  "rf)llls  of  this  PI-O"llltl"ll.  I  think   t,@llitt   if   this   pro-






                                                                    to be siaiijfl(,.Iilltlv cllrt'llilt,(l ol-                (irol).I)ed, you
                                                                                        Sti-ollt-"                          Itill@p    is    going    to    oi)'Lll
                                                      most of us feel tli(,i,e is a
                                                                                                                             f        tii(5         Goveriiiii(@lit
                                                      :III of us liell) .911(i  COOI)(,I.zlti
                                                      oil  otir loc@il iiiedical-I)rol)](,,i@is.  I  tlliiilc  tl)at-, if it                  I)Ossible.to'
                                                                                                                  I,,Ilo   II.Alp   could   t@   i(@,ii   do   sig-
                                                                @t loi)g I)erio(l, sitell
                                                                         I                     tl)(3              (-ollltntlnity       would       ki)ow       that
                                                              flitiii-o )flLllllillg
                                                                     NVIS I I(. I.(,, t4) ,t:t Y.
                                                                                                                     ol!    coillilig     to     Wii,,,Iiiiif,,ton,
                                                      f ]),Lv(@ eel-t:iiiily e)ljoIye(l the, ex

                                                                                                  0
                                                                                                    pl)oi
                                                                         '.I'li:lliic you Very
                                                      is telex tyl)e I tliiiilc l@-lic colnitiittt.(,                to   licir,   froirl    :1
                                                      plivsici,-tii. We ire, (I(@,li(,rlited that you tooli            ti file to pres(@,lit t] I  i  s  t  (@st  i
                                                      IYI@iiy to the committee.                                                                                                   F
                                                      'Dr. C-,irter?
                                                      Mr. CARfl@Il. I e-ert--iiiilv -%Naiit to                                  the           eiiiliil      III)OII
                                                      I-IiST)rcseiit,,Ltion.1-leisoii             oftliei-neiiwi@oal)pliest]14&EOO"Itslwllieli              II-,Ive
                                                                                            e
                                                      bee ziven    him,    and    in    ,tddition    will    e
                                                                                                                                 use     what     other     tool.-,
                                                                                            ionol     groups.     I     am     impressed     by     his      paper,
                                                      are    given    him    by    our    reg
                                                      an(l,t]le depth of what he says.                  i  am     happy     to     ]lave     such      a      young
                                                      li),siai,,Ln    @fore     us     today.
                                                      p
                                                      Mr. Roe.Eizs.       let   iyie   -,i-,k  if   -   You   say   you   .tre   the,    only    general.    p!-ac-
                                                      titioiier     oi-i     the     Advisory                                         0                           'IL
                                                                                            Ycooiiiiiiittee    for     your     i-egi     n,     or     is     this
                                                      subre-,ion?
                                                      I)r.@-1111ATIIUDI-'. I I,Iii the, only off(,, for tli(@                                                 meet-
                                                         We litve six pr-,i.eticiiig SI)CCi:xlists  from vtti-igii,, disciplines;                                 in
                                                      ',I(I(Iit-,ioll, of coiii,- e, to many I-)@lysi(,ialis ill tll(@ ililiv(@r.-,ities.
                                                                             s
                                                      Afr.                 lliit   tlic@re   are   ,ix   Out    of    @,O    Whom    you    Would    (-,I',I@-,Sify

                                                                           How many hospital tdiiiiiiist.i,ators do you liav(@?
                                                      Dr. BiiATRUD-P!,. Two.
                                                                   ,',RS.
                                                                                -voii tl
                                                      -',\fr. IZOO]       Do            iir)lctliis is -.i,rood ratio?
                                                      Dr. BIA,rjttTDI-'. It is difficult to put eN,er)il)odv tliere. We                             ]lave         six
                                                      or.@,ven   I,,Ly   people,   -%ve   have   two   nurses,   we    live    'I    dentist;    tii(I    by    the
                                                      time you           done, we        really               li(!:tvily ltdeii witli t,lit-             iiieclieal
                                                      School I-)eople.
                                                      Mr. 11'6ocl-i@iis. Woiil(-l       it    be    more    of ,t problem                     -,iwiy     if     you
                                                      were not in T),Lrtiici-sllil)?
                                                                       uj              III(I  lil@e   to   SI)
                                                      Dr. Bizjkln   )I.,. I "vo                              e,,,tlc   about   this   a   bit.    I    think    the
                                                                0                                                                                                 ire
                                                                  f the practicing physician is changed ,oinewli,,Lt,. As we
                                                      train    today,    we    -.ire    tot-,illy    convinced     tliai'we     ]lave     to     Stay     current,;
                                                      Liid   I    think,'    as    we    set    ourselves    into    pi-.i(,tice,    many    of    my    colleagues
                                                      in    our    couiiiv    ,ire    in    independent    practice,    such    as    -Bill    Henry,    one,    of
                                                      t                                                             -nt enou(rh
                                                      lie doctors there. He feels it is imports                                       -Lild     has      ediin-ited
                                                      his   ptticiits   enough   thtt   he    gets    aw,,t-v    for    wurses@.    I    believe    that    grotil)
                                                            -rrolIT),tl-lis @-,tliewq,-v if-is goiii(,;tobe in the future.
                                                      or 110 <,
                                                             no(;r,,rts.    You    don'    think    it    call    be    brought    down     to     the     hospital
                                                      Dr.    BIIAntui)it,,.     I     don't     mean     that.     We     bftvo     hospital     staff     meetings
                                                      find    visiting     professors     -,vlio     come     for     gcmiiiars,     and     the     rciitlcil-Lail





                                                                                                    200

                                                   fi-A)III 'Alissolil'i, ',olil(@ of  ]its                 ,;olll)(Ie,(i    olitst@111(iiii".    IVII(@,11     You
                                                   tiiiiilc itiloll(, 11(@ll)     You                   is                 iii       iiioriiiiil,    iiiil     voij
                                                                                                                                   you I
                                                   to     you sollie,               It                 like this                 of his                         wts
                                                                       'I'li;tiik you so                                           t,ii(@            of    Yolli-


                                                                          is 1'roiiL iiiy owii lioiyie, (-ottiity of lliiiii B(@,teli Cotilit
                                                                     lolls kll                     jol),   ',tll(l         y soille of t-li(,@ pilot
                                                   It     II @tl     car 1)("fol.(@, tlk(@ (@ollill)it,t(,T             I)Cctuse you
                                                   ]II  I)rev     o    legislative li(m,
                                                          nity    p

                                                                                          L L.     BRUMBACK. IVIEMBER,
                                                          BOAR                                PUBLIC         HEALTH          ASSOC            ION

                                                   I)r.        Bitu.Nt
                                                   Tlip,  Auto:            Publi          le,,ilth Associatioii            apprSs   tes        this        oppor-
                                                   tiiiiity  to  pi-eseiit  our  vie-,  of  I-I.R.  157,)S.  I  iiii  lkre,  as   tii   executive
                                                   I)oird  iiieinber   of   thisissoc          ioii    -which    now     haAver     20,000     inenibers.
                                                   I liaie,.i prep-,tre(I st.-ttenie    which has been/lriveii to the                                        ',Ind
                                                                                                                                                    -Irlcs.
                                                   I%voti](I lilce to li@tvc your poi-i                                        ize these reiyi,
                                                   Mr.                 C(@,i-li,iiily, tii(I                                  iteiiieiit.  will  be   rilt(le
                                                      ol@ tit(,,            fol]onvill(r Y(
                                                                             My                                                                          I)ol.tioll
                                                   or the bill.      -11, is                                                                   that
                                                                                                                           I([ II 1)4)ii III i,rritiit, labor to
                                                                     (-.I-o[)S. We:ill                       II    I       I. -rol. liiiit,,Ii of our  Coo(].
                                                                              iiiillioll  )11(tli              @ii                          ilii,,i,,ttc
                                                                         to I,Ikis
                                                   All   lioii@,ii          1)(@,ol)l(@                                                                iii(,,oiiie,
                                                                       1)(@l, Wol-i@et                                                  to   rise    itl)ove    the
                                                                level.
                                                   Fiirtli(,i-iiioi,e, (ii(@                         ii(.,Ii   tli                      live     Ill.(,     Usually
                                                   [,:Ll@            Treat) soitl-(@.,,- ol@ Health                   1)(I (still       :11.(A   IISIIK,]IY    held
                                                   it. :1 tilli(@ Nvll(@ii til(@v      wol-Iiill(,',  :Lll(t   tll                 (I    I i l'y  till(IOV  NV(-,I-
                                                        i-esid(@ii,                     is fol,             fol-I
                                                   "ri-e-,xtnieii                         -,oiiies difli(-u   it.  Actually,  the  I   gi-.-iiits'   ii(@ed
                                                   or   health   c                        tli-,tii tliit of the  rest  of  tl
                                                   -treatments                            e(liSI)OSO  them  to  il@Iiiess  ,t                             el.:  of
                                                   diic,.ttioii  a                        of  where  to  tiirii   for   liell                             t
                                                   roblems.      S     isties  4  I  rin  the   fact   tliit   iiiigriiits                                   earth
                                                   I)rol)lems          the rest of the I)opulitioii.
                                                   Iiif,.Ili@-lort(llity wts over 30 I)er thousand live births iii I()()4.1
                                                   i-,Iie illiRi.,Illts, C.Oini),i.re(I with less tli.-tii 2r) for the ii:itit)ii,.il qi-era
                                                                     fl.-Olli                                                                    wis
                                                   tltoy',tiid,                 -%Nrit@ii 10 -1@ot,tlii(, @N:tt-,ioii itsL wliol(@.
                                                                                                                                                         y






                                                                                                  208

                                                                                          ilililzli(@,, ()I' oill' lli('@

                                                                                           o,                                                of
                                                                                                                      of W(@St  Vii-,,iiii:i  ,ti-e

                                                                                              )v t.iii,,,
                                                                                                                  i-V  for  tlie,   Niti(iii.
                                                                                                                                (I giviii,,,  lis  tll(,-
                                                                   'I'li:illlc  volt   i,er




                                                 I                      to           yoii           'Ill(] NVO l@llo1v of yoli,illl..()Iio"ll Yolit-
                                            (r )Ofl
                                                                                                                      gi@t.
                                                                                                                                j(r)ll:r]);Il @fol.  tile
                                                                        I woiil(l like, -to                it (.()I)y of
                                                      Izo(;I.lls. Alri't-liolit, 0I)j(@etioii, IV(' NN'ill               Tile,  joili'llil   for   t@lie
                                            files.
                                                         I)III)li(-,Itioii                t,,o,   "Joiii-iiil   of   tii(@    AT(@dic:il    Associatioii
                                            of                   A I)i-il 11)67, w:is pla(-(-(l it) t li(@ (,oiiiiiiittee files.)
                                                 ,A,fr.            Yoti i)iiy                    Di-.
                                                 STATEMENT OF DR. S. W. CHAMBERS, REPRESENTING THE
                                                                    MEDICAL ASSOCIATION OF GEORGIA

                                                 Di-.                                           :Hill               of the (-oiiiiiiit,tee, I      aiii
                                                             I?r:t(,,tice of iiiedi(@iii(, ill T,,i Cxi,,Iiit(nye, Gll., ,issociiited Ni-itli t
                                                                                                                    isiisili@ill (.itv  of,-).@).OOO
                                            pol)itla,tioii                            )0,000 ',)ol)llliltioll.              is  011(@  I)oSl)it@ll   ill
                                                              ill t              of
                                            olir coiiiiiiiiiiity;  it@  lits  approxiiiiitely  220  I)e(ls  tiifl  is  ,tii  tc(@i-e(lite(I
                                            liospit,,Il.
                                                 I      reei.,Lt(, Ili(- (-oiii-t(ry of!tliis (,c)tiiii@iittee, ill lie@li-ili,.r ,I Voi(.e fi-oill
                                                 0                    siil)l)oi-t,17  of TI.I@.                l,t@ ii iiiy I)elicf  I-li:it  tile-
                                            tli
                                                       ])I-Ofes"ioll,-Ils ill  oiir                 (.()Ilsidei- tile oi-igiii:tl logi,;].ttioil.,
                                            Ptii)li(, Tj;iNi, 89-2'))(), Its                     its ;iiiN, lli;tt. II-,is                   I)Y title

                                                 Olli-
                                                                                Is WI
                                                            of ill("
                                                 Iiool of                                                                        oi@  ('(V()I.giii   i;l
                                                           ilit@ (,(4 i-gii                                             (x(          I)i%,isioii   of
                                                                                        Y.
                                                    to itl(.Itlll(@ tile                            I'l-olli 111(@                             kqso-
                                                                                                                                               As,,,o-
                                            ei:ttiol    (,(@ol. i,;I. 1)(@,iital Asso(-,i;:ttit)]), (,'(!ol.gill
                                            tioll,                 I)ivisioil of \rocitlioll@ll  I,k(@llll)ilittitioii,                        State
                                            in,iii-ses
                                            1-i,li@tiiie,iit, of F,,i@,,iiily aiid Cliildi-eli SC]-Vi(TS, (",ollllflllllity  Colli@(-il  of
                                            Atl,t.ii,t@.t  Are,,L              ii,jid t@li(,, ll']:iiiiiiiig Cotiiieil. oi-  'Af(@,ti-opolitaii
                                                 In,,tdditioii, tli(, Georgia iNiii-siii,-, Iloi-ne A@-,ociatioii and kiiowled"
                                            able -tii(I     interested    Iiiymen    Were    inelti(led.     From     such     discusgloi'is,






                                                                                                           209

                                                   ilivoIN-ilig        iii(@Sk@                           L  1)1,111   N\',IS                fol.    ill(@     ol.".Illlzil-
                                                   tioll    of    :I.                :I(Ivi@oi-                                                                        12r)
                                                                                                 y
                                                                                                          I)c@iisoiis I)ro:t(tly                              of       oiir
                                                                    zn
                                                   roo,ioii.
                                                                                                                             of                  if)  11(@
                                                                       of     t'lic,            (if i 114@ I)IIY
                                                                     ()I@   t@lio jotii-ii:il   of   t,l)(@               Asso(@i:i,tioii      of      (leo)-gi:l      'was
                                                   (ICN,ol          t otII
                                                           I is          joll 1-11:1 I I  11         o 1)(@ I)II         II i(@
                                                        Alt,lioti,,li  i   lie                 li:t,(]   -oi)ly   ofii(-i@iliv          oil   .):tiiii:ii-y   1,    If)(;7,
                                                   ilie   1-(@,,I)oii,,ibility    l'oi-                   I)v  I
                                                   III  fktct,, t'llo                                      of                          iiii-iiiiiiioli,,Iy
                                                   I)v  11 lio                  i(lvisf@r   gi-oiii) t4)
                                                                                                                     ll\,el :I.-i                    tiie        Geol,,,-It
                                                                                           y
                                                        ilfay       Iqiiot(,,        I)i-ieHy fi-oiii     ,t)i            entitled "A 1-iiiqiie,                     Oppor-
                                                           -y     for
                                                                                              AN                          iii tli(@ AI)ril joiii-iial.
                                                        The    regional    iiie(iic:tl     program     f(pi-     (..(@orgii I)rovi4l(@s  the  iii(-iiili(,rsliip  (@f   i,lie
                                                                    Avso(,,!;ttioii  of  (.vorgit   t   iiiii4iiii@   olil)ortiiiiit,y   for   le@i(It-rsliiii   in   "pro-
                                                   illolilig     11)(@          till(]  al.(   of            @ill(I    tII4,              (4  tli(@   I)IIIIIie   lieiltli."
                                                                    tll(@ ]-oil, of                                     loo                          ;is   pily.,;iciliii.4

                                                        'I'lie ](,gisl:klioll %Vlli(,Il                   this  i)rogi-.iiii  w;i,,;  the  r(,siilt   of   tli(@   r(,Ikort
                                                   or t.lie llrt,siilelii's (@ollitilissioti (@ii                                        all(]   @(t-ok(!,   (,oiiiiiioiily
                                                                                                              (!oiigi-(-"@  giiv(@  tii4@tiglitfiil
                                                        iii:iiiy                           -iii(I  oi-g@iiiiz:iiitpii,,                                 I,.iw      8f)-2119
                                                                              A,,  a,  r(@siiii.  t.ikis  ]nNN,  )irovi(l(@,,  foi-           iii4@(liciil   I)ro,,r.,ii@is
                                                             (.@iii ilik(l ivill 1)4,                lay ]i(@ol)lt@ iii  tii(@         iiiv(olv(,(l  for  tl)(@   ))(@ol)le
                                                        tli(@ :tr4@jis li@ 1)(, ,erv(@41. 'I'Iiis is                      iii   ](-,isi@itioii   iiii,4)xigii   talk   iin-
                                                   gll:lg(@        or                                         ;@lill  "Williolit@                            tll('    lint-
                                                   t(,i-iis, or tliL, iii(@lliotl,4 of liii:iii(,iiig. of                       or                                       or
                                                                            of
                                                                                           I)I-f)gi-:tiii  for  G(@i)i-gi:i  li:is  1)(@eii            cai-efiilly      liy
                                                                           ill  it   II-iily                                    (Iiii-iiig the           15     ik)(@ntlis.
                                                                         l@t@ Iii(lg(@(I liy tli(@                        of tl)(@ I)i-ogi-iiiii's              lifivis4)ry
                                                   gi,4@iii).       I)i-(ogr:itii is               @iii(I iN-ill I)i-ovi4l(, the  f(iols  f(@r  i@N-(,j-y  I)i-netiti(piier
                                                   to               liol@   olity ])IS  (Own  111(@ili(-Itl                  I)iit@ itls(@  to  iiiil)i-oN,c  the  qiiality
                                                   of                                      ftyi-          @ill(I every ()lie of Ilis
                                                        'I'Iiis is it                    for                    of    t@lie            Asso(-Iiitioii      of      Ceoi-gia
                                                   .911(l           Well 11(@ oill'             o]il)oj-iiiitily  !it   i)iir   tiiiie   for   exliil)ii.ii)g   responsible

                                                        Aiiotli(@i-      i';it,t<)r             Nve.  f(,el                          tll(@    (@xt(@lisioll    of     tll(,
                                                                                                   is fill('
                                                                                                          :111(l  ([alone).,  lio@  o]IIV  Illloll(r
                                                                    "(.Ilools,   'Ill(l                              1)@it, :11.,o  .11)loll"  ;ill   of   tll(,   11(@:lltli

                                                   toI)(@

                                                                                  ])];Ill   f(@l-                            io])           ilifo   :I(!(@oillit   fligil-,
                                                           ]@lioNVIO(ig(,,    I'l-4)lil    i@lie                             iiiii,,t  flo\\. to C\.el.y                 of
                                                                       iiii(I    ('(Ill;llly                                                ;Ill(l   11(@(@(IS   of   (110.
                                                            it ioii(@i- all(] ot.lit@i,s iii t.,]I(@ Sill.111  t.o\N'll', little  fl(@NV  to ill(',

                                                                                                           fol.   111(@   (Extension   of    tliii    ])I.ogl.:I.Ill,    we
                                                                    li@is  1)(@eli  the                                             fol.                             1)1-0-
                                                   (rl,:Alll       Of I)III)L i(-,         ioli to stilliiilitte lily I)et)i)le to what               iii)(I  to       seek
                                                    roo(I                 care. Tlieie are iiitny (@c
                                                                                                                  olloiiii(@illy        (Iisttdviiiitared         I)C()I)le





                                                                                                       210

                                                                 liol)13 to                  to   NVLIIL    :I(le
                                                   lii:IN  1)(@  list is 111,111Y illcl(lictllv                       I)eople     totally     itilrelit(@(I      to
                                                   e(lolloillic  cir(,@iiiiistiiie(@s.  Iiielt@ie(,l  ill  tliii  gi-oi.il)   tre   intiiv   of   our   iiio-lit
                                                                                                                               seek     mcitical      care      that
                                                          ("(I                     citizens who Silill)IY (10 iiot,
                                                   (Iolild b(, classified as,,i(le(iiiit(@,.
                                                    l@iiiillv.     Mr.      Cliiiriii..ti.i, Nv(@ I)Cli(,Ve @liit, tli(@, l@ey to the                    of        the
                                                               lyie,(Iicll   I)rogl.,Ilyl    iii    Geor(,@i,(t    is    the    involveiiieiit    of    coiliiiiuiiity
                                                                                                                       re,-Y-ion    in    the     country     to     a
                                                                 This, iio doiti)[, is true iii every
                                                             or   lesse'   exteiit.   Very   early   iii   t   li@   (.t(@v@fol@)ji-ient   of   pl,,tiis    for    the
                                                                                                                          p        arlize(I     thitt     the     vast
                                                   ilil,ij<)rlty   ot   ptiysiciaiis,   iiurses,,tii(i    ot:))ers    iii@-olve(I    Ill    the    regioii,,il    pro-
                                                                                      to    olie    or    iiiore     liosl-)itils.     Therefore,             Ikosl)i-
                                                   tell  ill  tile  re(yi0ii  lii,,  :I   vit,,tl   role   ill   the              Lil(l   ill   the,   f   iiture   of
                                                   iie(ii(@iiie. TI)i,@ iiiclll(les the ],Lrtrv                         i@ii(@ siii:tll                 aiid     tli(3
                                                    -,I)it;tl  iii  t@lto   iiiedi(@,tl   cc        It                          -(@inote   to   t@l   c
                                                                                           later      ii(I tli(@ liosf)it:tl    I                     I lli(,(Iicll
                                                             At   title   I)i-esciit   tiiiie   [here   :line    11)ollt@    -I.(),500    liosl)it@,'Il ])C(:k     ill
                                                                 (tisi            @iiyioiig 178                    @ill(I   lilllit-(@(I   S('I-Vic(@s   liosl)il@IIIS
                                                   of @ilf siz(@s. ONr(@r @,000                                    oil  1,11("   ,t,:tfr@   of   tll(@e   liosl)itils.
                                                                                                                                         t is
                                                          lio.,;I)it:il  will  1)(!('olil(" I            I-;II    f                 tlll-Ollo,'Il   Wili(@ll    tll(3
                                                                  of,    the    J-e,,ioil;tl                                    1)(@   (!Itrri("(l   ()tit.   l@,@-ery
                                                   ]Joe )it;tl -%N-ill                t t(@:tcllii      liosl)@till.   'I'liis   (loe.,;   liot,   illil)]Y    tl),'It
                                                   ille(li@-:11 St-iitl(kilts -,iiid lioii,,P, star            to be Pr("Seiit; but, it  do'CS'imply
                                                   t It ])I     i(@  i                ,    dentists,    1)li.,ti-in,      I -L(l                      I                                      l@ @   :,
                                                                     ;ilis, iitirses                               L("isl@s     ,      ministi-ators      iiieitibei-s
                                                   of tl@(!              ttid   ftll    of    [lie    :Illie'(1    I)eitltli    professionals    Sliall oi-@,,Iiiize
                                                   i  lieliiselviN-3   iiito   -ttii   edii@,   tioiitl   I)rogriiii.   li,acli   hospital   ]la.-,   I)ceii   @tslced
                                                   to   siil)irlit   the   names   of   a   group   of   1)er.4;oiis   to    serve    ,ts    %    local advisory
                                                                                                                                         ted     that     a     physi-
                                                   ,youl@)   to    the    regional    me(fictl    pro,,,-i-,.iii-i.    It    wis    suzzes
                                                   clean -(a-, cliiirma                                                   r,
                                                                             n),    a     ho@pit,,tl     a(Iiiiiiiistr,,tto   a    iwirse,    tnd     a niember
                                                   of     the     public     be     the      i-iiiiiimuiii      number      to      comprise      each      designated
                                                   arou
                                                     I'llis  locLl advisory group                In,,iy be is large           ts     the     local     hospital     or
                                                   Colillillillity desires, but it must be named by                          and          through           acceptable
                                                   ,I(Illl iiiistritive mechanisms.
                                                     These    L,,rotips    of    loci,l    hospi    t,,il     representatives     are     f     iinctioiiing     well.
                                                   Of Geor(,rl"t,s 178 hospitals, !I-)l                        tl)I)Oilltecl      local      advi
                                                               m                                                                                ",Oly gro'l
                                                                     -(,,iit,           -iiy                               t
                                                   This                    fii)i)i-o-,   I:lt(@,lv ()O                 or   -II(,,   goiiertl   I
                                                                                                                                                Cliff  ,,I'll,  oil
                                                       lo(,,t]@,t(lvi,-.o@y gi-oiii),, iiiet in                       oil     Siiii(Ifty,     March     2        1968,
                                                   for.It  (i@l@v   of                                         According to                                  n      87
                                                                              t-ti@.ives w(@i-o present,. Sin-iilii,r iiie,(                                       ved
                                                                              )itlis @fol, (,T(@ol.gl:L 1.(,ifloll. '%Nllll be                                  twic(3
                                                   (1111                        @ir                                                      lo(,,itl   dii-(@,etioii   at
                                                   the                         II the ov(-rtil                       of   I)e.Llt,li   I)Iitliiiill(y   isi   in   our
                                                   OI)i                        id     ell'cctive      itl)l)i-oaeli.
                                                     Altlio          I hear      pli,nning    ]la%    been    goil)g    oil    ill     our     region     for     many
                                                   Y(!Ill-S, t,      is tli     first     time     trials     ro])resciiL:ttiv(@,s     froi-fi     ill] interested
                                                   (,,,rou 's  ]live     deliberated     tog(@,tlier     in'     an     ,ttteirii)t     to     coordiyiftte      their
                                                         p
                                                   health     car     I)Itni-iiiig     into     a     unified     plan     for      T)roaress.      Both      interest
                                                   ,tii(I -P,,trticiTi,,ition of the prap-ti(-in_" physi                      -s,      local      hospitals,       and
                                                                   se]                        excellent.           ose      comm      inicttion       with       other
                                                   medical           iools have been                           01                  I
                                                   agencies,         oro,,anizations,         institutions,         and         Government         programs         is





                                                                                                                                       77             !@r7




                                                                                                                                                                          I   @   I          ii  I    .





                                                                                                          211
                                                                  complete coordination                Of Lll activities in tile area of lie, t I
                                                                                          and tile purposes of Public L@tw  89-23@)                            ai,
                                                     ill tli(3 Geoi-git refrioll,                                                                                     e
                                                     bear         i
                                                                                 11, Air.                     for this ol.)portunity.
                                                                                                           collent statement.
                                                       I  liotic(3    tlitt                         o'il)il@ll    i-(@,present,,ttives     were     pi-c.,;eiit,     It
                                                     yoi I- Iiist@
                                                                                               ly 178. 0 r t liit, ii iiii il)er 1.21 littv(@ iL]
                                                     111) tllo loctl Idvisory groups.                     ones wlio ]leave not                I)x-ii-viti,rily     tlle
                                                     (,xt reii (,Iy siiiill hospitals, Mr. Cli-,tiriiiari, ii'llllyl)e as f                       -,is   15    to    20
                                                             I                                                                                w
                                                                                         feel, tlieill:tjoi@ lioSI)it@tls ill t@,lie St@ttell,.tvc?
                                                              r-to(3iits. But you
                                                                                 We                                                   0
                                                                                                                 of the I)O(ls      c vei-c(l.
                                                       ,Air.                E%,eii   tlioii(,Il   tliey   (I()Il,t   it@t(!Ild   tile    inectiii,,    tliev    I)tti-c
                                                               lip  @fol-   tllis?
                                                                                 Yes. These s@i)n(@, oii(@s ti-C not the, ones                  wlio      were      at,
                                                     previous ilic(@tiiigs, @ieces@;.trily, t)tit, t,liis I)erceiitag(,, is a                    pretty            good
                                                     atteiid:LiiccA,for,,iregioiiour,,ize.
                                                       Dr.   CIIA-,NfprRs.   No,   we    do    liot@@    tliiiik    so.    We    (tre    beginning    to    get    sub-
                                                     re@ion,,iliz,ttion now. This is what we, hope to accomplish.
                                                       !'Jr.  P%,oGi,@is. How long have you -,ictu,,illy ]'aid the region foriiied
                                                       Dr. CIT.A@1113ERS. Our                  grain, Mr. Chairman, act7uilly began                             J,,iii-
                                                                                          pro
                                                     u,            C)7, so we,,ti-e only tbotit 15 month,, old.
                                                            I  1 0
                                                        -N r. RocipRs. You prese                                 ur
                                                        i,.t                               i-it a very eiico                      otiire.
                                                        I)r.CIIA-@NI:BIt',IZS.W(3fee,lwellavcA,lc(@01)'T)Iislie                              tlotini.5ii-ioiitlio,,sir.
                                                        1-1@ iii(@, coiiiiiiiit(@o wolil(i I)e                         sir,    I    would    be    (wild    to    leave
                                                        @Nl I-. I,ko(Ili,],,s, 'I Nx-oill(I lil@(@ i@ei-v           to           tli:tt  -for   (lie   colylillit.te(,@


                                                                            of AI(@oliolisi)i,                      Tells.
                                                                           OF THOMAS P.  CARPENTER,                          PRE@                              NATIONAL
                                                                                 ALCOHOLISM,  INC.;  ACCOM11AI                                                  WILLIAM
                                                                           E            L-       DI        @TOR
                                                                                                                                                        comes        to
                                                                                                                                      fe-,ti-t, Asso(@,i@itioii.
                                                            I'@liow   tll(@,  I)].(@vi                                                 Illy  ,i.Sl')ect@-,   of   tlie,
                                                       roi,)](,Ill.  Al,(,  leave  i                                                    ourselves       Ill(l       our

                                                                             You)yitypr@
                                                                (I.@ICI-I,;,NTEn. T                    ,II    C                     oholisiii    is    the     i-oluii-
                                                      ary liciltli t                                       with                            82   ,tflili,,ttes   ser%,--
                                                     bit,. tll(l iiitic                                 (yroii,                          alle,],     coiiiiiiiiliitiels
                                                                                                       Ea(     I tlril tte  ias i              iiteer     board      of
                                                     (Iil.(,                             n                         ']:Iiese I)oards, li             lie iittt-ioii,,il
                                                     I)o"ll               e(,tors, iti-(@  rel)r(@,seiititt-i@,es of the legal, 111(@                         ediie-,t-
                                                                                                              -,Ili(i  iiidtist-Iriitl  iiiteres s  NV







                                                                                    %7is(@r    wolil(I    1)(,       -tilllt@. Tii @l(l(litioll tlicre  slioi
                                                                                                               f till
                                                            title I-ilti.-iilti;ig ,t4iff olle                                                                    olic@     l@sY(']]
                                                                                           es(, I ).,I I't-I !III e C(Il I', I'll t: III t,S N@-ol II (II)(! (Ii@lgilt),S I IC Wo I' I'
                                                                                             t,r(@:ttineiit.    All    I)ersoiiiiel     wiist     I)c     equil.)I.)cd     Nvi
                                                                                     the                       of tlit@                   @liotil(I  I)e   lylii(T(i   on   e:i.si   ig  tlif!   lit(lill-
                                                                                              r)rOt(@('t.Cfl Sitll@it,ioll ill t,l)(! COIIIIIIIIIlit.Y.
                                                                                             Iiiiiited to !,IO (lays.                    I-,    iLe)t    all    irl)itrii,@fig
                                                                                                               that  3  iiioiitlis  is  ill  ill@iiiy  NN-,Iy"  ll(,@   ol'
                                                            ol,            It is II stil@l)le perio(I for tile iiiiijoriiv ; it @lvoi(                                 xec.,4sil
                                                                                                                                                                    I)olllt     o
                                                                     foi- i                        iNotiiit of tiii,jiov(@.
                                                                                                   -        Jeff
                                                                               (]('Pt'll(lilig (Yll                                           iii(li,,Yltl(i@il              Ali
                                                                                    for  tlt(@ ii,,(!
                                                                     i@N,;Iil4tl)l(t to                                             of 111   C-i'lpi,(Igl.;Itfl, -@f) t@lill
                                                                                    l@il)(I of                                                                 (kri(,itt@it
                                                                        lt@ is it filli(@ Of                   1111(i               lt@nl@ilig,               I)ossil)l(@
                                                                            to  ltv(.I.(,  r:lillll.i..   l@,@fl
                                                            slii-iillt II(.                 at, filitlilig 11(@lisill@.                                  family,     r(@ligii)ti.4,      till(]      iotlii
                                                                                                               111141 t,!Y(I"ilglflN)Iifig all                      (ff      r(,Illt(Igrittioll      ill

                                                                                                                             N(@l
                                                                                               for                          r-%v                                                                giii(i
                                                            II)i@.,;t,,.  T,(j4-jil                                          ive,
                                                                                                                                                                                         t@ioll      I)(. t
                                                                                                                                                                                         ('rill      gi); I
                                                            fit:-It  NN,o   (@ollillit@iicl   PK   iily   Ilillf-wily   1101                                                                      Il]-olig


                                                                       r(,-li:,@liilitiLtion.  ']'hroiigli  fill,,,                      tli(,y    gi,.
                                                                                                                        Aitli                    ;file
                                                                                                                     pre(!Iii(le    the    ii,,(@    of    :11(,oll(@l.     rli(,@reby
                                                                                                                     dignity,  1 @'4tore         their          ii,@fuli
                                                                                                                     I)s tii(I eveiituilly       (-.a.,;e   the   lietvy    btire,
                                                                                                                     I,, is ne                                    ti.@,?aeh,,ble.,,
                                                                                                                     t.ness todty is Eii@iie Siber-v.
                                                                 '@Nfty   I   say   we   will   make   your   stiteinciit   t   @ait   of    the    record,    follow-,
                                                            iiiLt   your   reniarks.   Noiv,   if    you    would    give    us    your    comnionts,    it    would,
                                                            1)@h@lpf ul.
                                                                                         OF         D.          EUGENE          SIBERY,          EXECUTIVE          DIRECTOR,
                                                            STATEMENT
                                                                                GREATER        DE-        TROIT        AREA        HOSPITAL         COUNCIL
                                                                 @lfl-. sill)"Ity. I sliall                                                                                 go  tli@it  T.  sli@tll
                                                                                 t                             ct)iitiii(,iit.;Ii.-v oil it 7-illilitit,O 'fol-I)Iltl
                                                                                                                                                                       I       am
                                                                                                                                                               Ai-'t        Ifo-                  -)iiii-
                                                            Si )('I-       executive dii-(,cl-,or of t,@li() (I i-t@:i tei- I)et I                                   0,@             I-)Ititl CA
                                                            (,,i].      Llso servo -
                                                                                              ts ch,,iii-iyi.,tii of tlio                                  'llosi)itil     A,,so(-,ii,tioii'si
                                                            (!oiiiii,-,il on                          -,tn(I ll'litiini ilr, and ]':ill) tlla                                        of   the   ik,-;-
                                                            sedation    of     lfe,,tlth     Pliii                   !z A                     I                                      (-,ool.(,Iill@,itor
                                                                                                                     In
                                                                                                               l@
                                                                        'Nf                        regional          ;IC
                                                                                                                                                  (111riii -,  it,,
                                                            of tli(,, i                                        me,        'I                                 L
                                                                          1.)el.io(l,   -,Lll(l    now         servo (ii.tllltt                                                                I(Ivisov
                                                                                                                                                                                                          y
                                                                 I tni here today to sl)etlc in supl)oi-t@ of title T,                                                   15758,     to      extend
                                                            the ,tutliori                                                                          -o(yrims    for     he,,t
                                                                                   z,-ttio;i for re(,ion,,vl ine(lictl.  I)i                                                         rt       disease,
                                                            cliiicei-, and stroke.
                                                                 As a       health     planner     -involved      with      tlie      coordinated      i)lanninLy      ae
                                                                                  -a hit                                                     of     the     Nation's      inost      h@Vily
                                                            tivities        of              ndred hospitals, in- one





                                                                                                                                                                  :@77





                                                                                             219

                                                                                                  (,I  I)y  l@lie  potential  of   ret,n,iojial
                                                                            ill) )i-essed 1)     I li(@ii- I)t-ogr(@ss.
                                                                                               y
                                                ]to st,i-eiigtli of t,lies(@ 1)i-ogri,iiis steiii,;   from    the    spirit     of     voluntary
                                           cooI)(@i-iit-ioii           underlies them, and            ivliicli   ivas   written   into    t@lic

                                             Tlii,; @-oliiiiitry,                                      lo I)i,ol.)Ieiii  ,;olviii,,-  isiil(,  as
                                                       :I. illol.(3                                            to 1)07 but, l@   llol)C,     that
                                                                                it, is -fi,i- iiioi-(',
                                                                                          Lr(@
                                                              ;Ociety                                      ti
                                           fol.("(@s ill oitr                                                i(@ ifig(,Iillity of   the      par-
                                                         Tlie,.y ti-o be(-oiytiii,-, st;i-oiiL,,:kii(I                 forces   in    ()Ill,    so-
                                                              t 11(@y exist@ t,i                     lo(!:Il                liol@,
                                                                              s                     ito i,o,l)(i           li,,tt@ioll;tl   I)I-ob-
                                           ](Calls. @vii(I fliitllyz                                              I)ecoi-riixig    strong    tjid
                                                         fol@(,e"i ill our ,w,                     they                  iiT)on    I)Itiis    and
                                           (leci,.4ioiis ii,itdo by those 1                            out the plans       and         decisions,
                                           ,I II (I 1)3, t,l lose who wil I be @,,tfrected by them.
                                              'rlic@,     last     poiiit-bro,,td-bised     iiivol@7eiiient,     for     CO<)I)erLtiie      plin-
                                           iiiiig     and      tction-is      title      paramount      reason      regional      medical      proffraii-is
                                           ii-ilt ultimately succeed in the inner cities of America.                     It   is    -,t-l)ro(rraiii
                                           that    lietltli     planners     hire     lon(r     ,tw,,iited,     ,t     program     to     draw     together
                                           the     hospitals,     physicians     public     health     ,iffenci@s.     ,tnd     all      of      the'-other
                                           elements      necessary      to      provide      efficient      elYective,      -tnd      economic       health
                                           services.
                                              It  is  %]so  t  T)rozram         which           must incorporate        the        opinions         and
                                           tlioil(,rjlts   of   the   pii@iie   to   be   served    by    tli(@@ge    lictlth    resources,    tn(I    this
                                           too ist. terribly iliflictilt             'Plie   1)oi)ii],@itioii   of   our   inner   cities   is    (lo-
                                                       in iiiiii(I  tiid                                 -by   l@telc   of   c(lii('Iltioll   .Ill(l
                                           opportunity, in(I ill but                              by I)ovei-ty           lived.   'I'liis   II)ll"t
                                           not, ('[(@ter us. Without the cooperation @iii(I tl)(.) support of ill                             )lo
                                                                                                                                C'@se 1)(!Ol
                                           110 1)1.-Oiyl."Illl ci ii succeed.
                                                                        ol'              iii(,di(-.,tl   I-)i-ogt,;tiiis   has   s(@eiiie(I   slow   in
                                                                                                             It"s    not     unlike     the     con-
                                           st@i-il(..tioll of ,I, I)IIi](Iiii(ly. TT]itil t'lle,              is      ]Gloriously      diig      and
                                           I)iiilt, find t-ii(, iiiiiii               beffiiis to          I)ro(-Y).-CSS is not,
                                                                                                               ti@ir      foiiiidtiti;@s      wit@li
                                           ,t 1) 1-o(!(,S.,; o f    I I 1) Ii ii ii i i i fr, ai i d tli c st i- i e tti i,(!s I)ogi nii i n L, to mei,-
                                                                                          be all          sounder-      itiid      stronger       for
                                           this   ("N-Ol-Y    (@lYoz-t.    li@ielly    Stated,    l'i-oin    ill(,    iittioliitl    view,,tlie    progress
                                           ol@ teetotal] 111(t(tic:ll                   has been                     Less     than     2      years
                                           t,yo, flici-e w(@i-e no                    iyiedict]  proo'i-,iiyi,-,;  today     there     tre      53
                                                         and at ivoi-Ic.
                                                        is olle fi@il,i-,Iier reason wl)y 1. view         the     period     of     planning      ,is
                                                                                                                            wish to .;fre
                                           so esseitt i]. Tiie experience                      in  this  I)i-oL                                Ss
                                                 I)oijif,-f-oi- lie,,-trt disease,                    @;t@rok@,-Lii   serve   as   1%   g@ii(le    to
                                                                                                                   p
                                                   it, far easier for ot,l)er liciltli I)i-o(ri-@iins to in          C"t the   needs   of   oi    ir
                                           coilliti@v's (Ilitii-o I)OI)IIIItioll, ill(-,Ill(liil(r out,  ilill)"I.ll
                                                                                                                                re    must    I)L)
                                                    s   ill                       jr)(@illo(is     of                        CT

                                                                                                            will I)rovi(I.0 t@lic
                                           isle  l'ol.  ilk(@           ]))-o(,Vssioll:tls      to              illipt-ov(3 the  I)fttteriis
                                           Of ol-t@,@i@liz"ktioll






                                                                                                       220
                                                                                                                                                   I   (lo    t@llilll(
                                                                       0111-                     ill                  i@           I    .
                                                                                                              .I                           ol@   1,11(@   I)I,ogl"llil
                                                    it is                  l'ol' 11', to ill
                                                                                                           9
                                                                                             !Ill of, tile I)III[illilig ll(-(ivitli(@@s ill  t,l)(@  foul)(1-1-
                                                                                                                              @it, tills I)oilit-, ill tiirl(,.
                                                    tioll  fol- ill(, 1)1.(14rl.,Illl          is i)(@i
                                                                                                    ivol  (I
                                                                           1)1-0",I,;  ils,
                                                    of                                        oil tll(, lie(.(I  fol. (1)(@.
                                                                                                                            4@ool)(@i,ittiV(l        regional         a]--
                                                                                                             @111(i t                                     Act      t    0
                                                                                      lill(lel.,tlle,                     Ate(lie'ti  pl.0'r.alll
                                                    be                  @iiid in (@oiifo"),Iit,Y.
                                                                                                             itll               to   L,,o,,ils    and    ,i(,tiviti",
                                                                                                    -il'y -\N'
                                                    I  t@llilil@  they     11-0 Coilll)l(-Illellt@                   10    evel'y@l'i,,Lr    possible     to     be
                                                                        it. the- local level we           ]"list
                                                          think         ,  ,                                                  t    do    cooperate     and     siip-
                                                                           ,e are not ill conflict, but in fac
                                                    eel.tlill tliit,  the
                                                    i-t, e,,i(,Ii  other.
                                                    Po
                                                    I   do   I)Oieve   there   is   t   real   iieed,,,is   the   statement   indicates,    for    limited
                                                    C()ilstrii(@  ioii  funds,  ,tii(I  I  would  liol)e  tliit,  ,is  ,t  p,,trt  of   the   intro(lu(-,-
                                                             t
                                                    tioii  (  f  illy  follri,,tl  statement,   in   the   record   that   you   -%voiild   also   include
                                                    tile   I   )])e;@de,(l   a@i-ticle   entitled    "I-lo-,I)it;ils    and    Reaional    Medical    Pro-
                                                            ,t I'le:i, for (Coordinated Action,"                                  wis     in      the      Dexei-nber
                                                                                                                                                    0
                                                         ssiie, of Tl'osl)it;tlsiiiig,                   This    wis    written    by    my    g    od     friend,
                                                      IZol)(@,t-t.  T@,vliis,  and  T  thin](  4.tiiil)lifies  elo(illel)tlv   Oil   tile   I)Oillt   that
                                                    I -,would iiii'ke,                    is:t real              foi-     Iiiiiite(I     (Instruction      dollars.
                                                                              I    eel-t:i,'iilv     liol)o     tlitt     this     I)ill     Nvill     l@)t)     supported     by
                                                    yolli                    Ill(l  -%Vill) 1)@,                  I      think       the       I)rogi-e@.-so       far       is
                                                    Sound,                 W(@ li:lv(@ gone (,-,'Illtloilsly. I                      tile                            pro-
                                                                   Sl)(@(@(I    tli('    (Illy    tll@it,    %Vt,    %Vill    (Y-et    to    every    %rP,,t    ill     Miellik@ll,
                                                    t? e%,t@i-y  (!It lzell  ill                    tile     I)CII(@fits     t]),it-,     this     progrttii-i     wits     (IC-
                                                    I        o   ].)I-il)
                                                    .1     should     1)(@            to @ll)SWCI- any (itiestioiis you iiiig@it                             It      has
                                                                                                                  follows:)
                                                    STATIINIFN'R  (@F  1).  litl(ll',NIP   SilillitY,                                (',It)-'AT]rit     DFTITOIT     AitrA
                                                                                  Ili)si-i,rA],   COTINCII,,   ])]--,TltOt'r,
                                                                                               of til(@                           fill) 1). li'iig(@ne
                                                                           of t-li(! (,r(-jit(-r 1)(, r(@it Ar(,it  llo,.,])itil                 1   ill'.40   ,4el-ve    as
                                                                                                     t
                                                    ebiiriii,,iii  of  the              hospital A.,;so(-i@itiotil,.,                 oil   Re,,,t,.nreli   aiitl    I'litil-
                                                    iling,  -,in(I  I  an-i   t@lie   I)r(,@i(l(@nt:   of   tli(@   Aqso(-intioii   of   11(@iiltli   1114iiiiiiiig   Agt@ncies.   I
                                                    Nv.,Is file @i(-tilig (coordinator of tile @kii(-Iiigiiii it(,gii)iliti                 Prog@raiii      dtiriiig      its
                                                    initial,    (?rgiiiiizatioll.11    i)erioti,    ati(i    now    serN-c     oil     tliitt     1'rograni's     Rf-gloiinl     Ad-
                                                    T :fail it(@r(@ to(]:iy to             iii   sliiii)oi-t   (@f   Tjtl(@   1,   11.1t.   lr,758,   to   (Extend   tlit,   oil-
                                                    Clioriz:ttioii for iti-gioii,,ti                i,-r(Igriiiiif4 for                                 iiii(I   4ti,olce.
                                                    A,; it health 1)14iiiii(@r iiivoli,t-(]  wait  ,III,  (.ool.(Iillllt(-Il  1)1;17@iiiiig  ft(,tivitit@q  of  a  liiiii-
                                                                        iii oil(, of tli(@ Nitioll's lilost, II(.Zivilv                              I     iiiii     strongly
                                                    Ili        i)y  iii(-   I,oot.(@iii'lill of lt(,gioli;il M(@(li(-Itl Ili-ogrjilvis iiii(I                by    tli(@ir
                                                    Pt 11
                                                           it I.,. legal)   of   tll('S(@   111-ogi-allis   ',t('Iiis   fi-oiii   tli(@   similarly   of   voluntary   cool)(-rntioii
                                                                                   iii)(I wlii
                                                                                                    %vit-,             litto   iii(@   ift%v   largely   by    Yoiir    (-oiii-
                                                                             ilgo.
                                                             %,(limitary                     -  il)l)roiii-li  to               solviiig   isti't   as    sN%,Ift.    As    a
                                                                             (.ool)(@r;itiv(
                                                                                       illegal  lii)l)(Nir  to   1)(,,   I)ilt   I   liol)c   That   yoii   Ai-ill   I)t@   lier-
                                                    ]:Iil(,Ol  third   lt@ is f;ii
                                                                                                    t, l@('(-olllillg Stl-i)llg filter                fol-(-(',4  !II   oiir
                                                                           til(@y              tile ilig(,Iillit@y (of  tll(@                    Tii(ly iir(@
                                                    llig  ;tl.ollg  .111(i             for(-es iii oitr so(-i(@t@y                 tlicy   exist   to   I)IC('t   specific
                                                    local   protil(@ins,   not   I)rol)l(@nis   tlint   Iiiiv(@-    beeii    reii(l(,r(,(]    siifli(!ieiitly    Ytig@ie    to    be




                                                                                                                                                                                   7






                                                                                                                        221

                                                                St I-olig                              s  ill  (plir                                     :11.(t   1)@IS(-(l   111)(Pil    Julius
                                                                                                                               y
                                                                                  iiili(l(@ I)Y tlio@'(@ NN-lio ilill"t, (,;Ilry olit, ill(,- lillifis
                                                                                  NV)lo NN-ill 1)(@       I)Y tli('Iil.
                                                                                                             iiivolv(@i@i(,i@t     for                    I)Iiiiniiig       itti(I        ,tction-
                                                                                  ii)oiitit r(@.isoti lt(@gioiiiil                                  will iiltiixi@it,(']Y                      ill
                                        r                       tli(@      iiiii(@r iti(,s  of              It   is   :t   I)i-4)gi,;iiii   tli@it   li(@@ilth   1)1,,tnii(,rs    lx;tve    lonf,,
                                                                iwiit(@(1,   @l   I)ro,,riiii   to   (Ir,,iw   tog(-tll(!r   Ili(@   liosi@it:ils,   lpliysiviitji.,,-,    lptil)lie    li(@tiltli
                                                                                  4111(l   ill   of   the   otlier   eleiiieiits    ii(@c(@sstry    to    I)rovi(le    effi(,,ieiit,    effective,
                                                                it   is   @ilso   ,t   I)r(;grim   wilicli   iiiii,,t   illeol.l)oratt(-   tll(@   ol)illioll.4   Ill(l   tlloiiglits   of   tlie,
                                                                       to         1)(@ zerv(@d I)y tll(@                                        tlii,
                                                                                                      ,4e li(,,,Lltli                                 too     is     ;t     terribly     difficult
                                                                t;isic.                       of oxir iiiii(@r 4-iti(,s 1,;                         in   iiiiii(I   aii(I    41)irit,    litti(li-
                                                                       I)y        i@t(-k of (!(Iu(,-iitioii aii(I olol)oj-tliiiity, ijitl iill ])tit                         I)y        Igiv(,@rty
                                                                           lie(.(I.   must,   not   (](@ter   iis.   IVitli4)iit    ill(,,    cool)eriitioii    find    stilol)ort    of    tlicso
                                                                l@t-ol)l(,,      no liro;4riiiii c:iii
                                                                                            of lz(,giotiil                   Ilrogriin,,    li@i,4     seciiie(I     slow     in     the     inner
                                                                (-iti(@s,     I)Iit   hill;   be(@ll   I)rogress.   lt's   not    iiiilil(c    tli(@    coti.,;triietioii.    of    a    building.
                                                                ITiit,il      Lli(@ foundation   is   lil)orioiisly    dtig    tii(I    Iiiiilt,    iiid    the    main    sti-ii(-ture    1)(,giiis
                                                                to rise. I)i-ogi-ess is ii(it i)l)l).ir(,iit. ll(,gioii@il                     Ilrograiii,;       havc,       1)(@n       (ligging
                                                                tlit,ir      follil unions with a  loroc(@ss of                      ]wl@itiiiiiig,    tiid    the    ,,trtictliir(-s    1)(,giii-
                                                                      t@o                     ol)er;ttioti;tl I)rogriiiis            vi)l 1)(@ ill the @',,Oi
                                                                for this     (Daily     effort.     ltrielly     stito-(I,     from     the     national      view,      the      I)rogress      of
                                                                                                                                                                in(ler        and         stronger
                                                                lt(,gi4)ii;tl             Ilro,.,rii@i,, ]la,;                              I,t,ss    thin    two    y(@,ir,.A             tli(@re
                                                                NV(4'(@ it@) lt(@gioll@ll              1rogi-@iiiis; to(lity                 ;ii-(@    ri:@    organized    and    lit     Wol-IC.
                                                                                  is  oii(@  ftirtli(@  j-(!ilsoll  wily  I  Vi(!N%'  the  1)(@riod  of  jolitililitig  11'4  so   t-s,,@erititil.
                                                                                      gained in this program for lit-tirt                                 call(,      and      strolc(@      (!all
                                                                                                                                                                 (,r,
                                                                Serve "is It giii(i(- to )fill<(! it far                      for    otliei-     health     l@rogriiiis     to     iiie(@t     the
                                                                ll(,e(Is  of  our  (-()iiiit@ry's   (@iitire   1)(   I)III;ti   role,   i:l(.llltlillg   our   ur@iiii   tireit,4.   Sigikifiefint
                                                                (.11:11ig(@   ill   the    tl..14iitioll:tl    iii(@tl:o(Is    of    (14@liveriiig    health    cire    must    I)(.    eff(@te(l.
                                                                I   1)(@lieve   %vitli   @i(.tive    @ill(I    ill(.,illiiigftil    ini@(plveiiieiit    of    all    lieilth    I)rofes.,;Ionil,4,
                                                                the    lt(@gioiiil    ',\Iedical    Ilrogrtiii,4    will    i)i,ovide    the    ill(,Til.,Ililsiii    for    the    health    pro-
                                                                fe.ssioli'Lls to markedly improve the 1)                                              nation       and       distribution       of
                                                                                                                         -itteriis of orgiiiiz

                                                                                  ,I re.
                                                                I)e:tltli        c.
                                                                 I                o@ir    exrwrience    in    '.\Iicliigaii    is    not    a    typical.    With     the     $1,294,449     grant
                                                                -twar(led     the     \iichigaii     ne,.,iontil     -,Nl(-dical     Program     almost     a     year     ago,     the      Fecl-
                                                                (-ral     Government     has     essentially     I)ougl)t      a      blueprint      for      the      initial      stages      of
                                                                ,ictioii.     Most     tangibly,     this     initial     blueprint     is      a      504-page      document,      our      first
                                                                operational        grant         reques
                                                                                                      t,     which     defines     wliit     we     must     do     and     commits     its     to
                                                                                                                             (,(I     in     some     ivory     tower.     It     represents     a
                                                                (14)illg it.  it; is not a  sterile ))hill (levi@
                                                                r(-,tliz.itioll    tji:lt    lir(@Viollily    frilgnieitt(@d    lit@,,iltli     resources     call     uilite     to     I)rovi(le
                                                                                                           c for li(!fkrt                               and stroke  a relli7
                                                                                  lw)ssil)l(@ I)ixt.it@iit. cttl'                                                                ,       AltiOll
                                                                                                                                lo    live    ill    the    real    world    ;Iii(I    who    have
                                                                                  l@ii(@ 4(,or(,s of iii(@ii mail wolii(-" wl
                                                                                  :kii(I %vill                Lo(.4)lit,ril)lltt,   to    this    I)IIIII]Iillgtnsk.    It    rel)reFA@tits    our
                                                                (.111 I i-t@ Al i(,Ii lgii II (-(iiiiitrysitit@.
                                                                                                                                 iiiiii(,r                   with     tli(,      total      health
                                                                  lil-olit  I  iy  ll,)illt,  of   Vi(-
                                                                                                      %%, its it
                                                                li@.(@(is                               :ir(,;i, oil(, of tli(-  most.   iltll)ol,t;tiil@   fll('('I,H   of   this   Ali(-Iiigiiii
                                                                                  .v ilit
                                                                                  J,I-o,,riiiik Is iii(@ series (if litil@@ig(.s NN'Iii(.Il travel                iii:i(Itt   will%   it   gr(!ttt
                                                                iiiiiii)@(-r   or   gri@tilo.,4   and   installations    (.11glig(,(l    Ill    11(@illt.li    I)I:iiinitig    and    lorovi(litig
                                                                                                                                            'tilfrs
                                                                lit@illi@ii      S(     Ili our lt(@gioli, I  hill)(' tl);It  than                  and    A(tvi.,;ory     Grotil)s     of     all
                                                                                                                       IIIY z4@,,ii for    (,oot-(IiiiittioIl    of  ilct@iviti(@s   ill   tlii.,i
                                                                                                                                               Ili-ogi,:iiii,,i and
                                                                11(@;tltli     emitting     lir(igr:tiils,     I)otit                   try  l(@gi"4111t,ioll                I)Y            8f)tll
                                                                                                                          film     maturity      siil)l)ort,ive      of      their      activities
                                                                (,oligll(@ll" ill't@ 4jilit(!
                                                                                  )",Very erl'ot.11 siloill@i 1)(@ iiiII41(@ ))Y tli(@ stllffg of tll(!S(! t%V() I)rogriiiii.4,  at
                                                                                                '11,     -   iiii,.   (!Ooi)t@1-:Iti(itl    and    (,oor(Iiiiittioii    (@ist.
                                                                tlii@  lot-ill  li@v(@ls,  to  (   ;Iil.(                                                                                                                        :
                                                                                                                    itior(!
                                                                                                                                             I iii,g(@ your                     of               1,
                                                                                                                                     lt(@gi4)11.11                  llrt)gritiiii     Iiiiiitt@(I
                                                                ]lit       lr,-458,                                                                                          tll(
                                                                @liltliot-ity      fi)r                      to             ri,,,ioii:il  ii(@t,41,'4
                                                                                  l@,ri)(irt on                                                 to th,e    l,rcsitl(,tit    aii(l,    the    (!on-
                                                                                      (-Io(Ilit-litly                 lit ili ilrti(,Ie (@tititle(l,      I'llo.'41@itill-.4    and    lteglol)lll
                                                                                                              for   ('o(ir(liii,,tt(@(I    A(,I'Ioii".    This    iirti(!le    npl)(,iire(I    Ili
                                                                                  Ilrogr:tiiis :  A
                                                                                                      Issue of flospit(its iiiiglivll)e,. It              was     written     I)y     my      good
                                                                friell(l@    Dr.    Rol)ert    L.    liviiiis,    I)irect4)r    of    '@\letliciil    E(,Itication    at    the    York     (Penn-
                                                                                                                                 president      of      the      Association      of      Hospital
                                                                Sylvania) Hospital, and Immediate I)a.,it





                                                                                                                     222

                                                      I)ir(,c',Ors    of     Ile(lical     l@,(Iucttioii.     Dr.     Evans     issiste(I     nic     in     prepitrilig     iny     testi-
                                                      iiioiiy    for    t(@day,    Nlr.    Chairiiiaii,    iii)(I    I    would    like    to     re(iiie,4t     that     his     tirti(@le
                                                                        in   the    record    of    till,,    hearing.    I    I)ope,    geiitleiii(@n,    that    Dr.    Evans'    trticle
                                                      NN,iii      eoiiviii(.c      yoii      of      the      need      for       Itegional       Medical       Prograin       construction
                                                      ,tiitILority.
                                                         Tll:tiili you       that concludes iiiy 8t,at(-iiieiit.


                                                                             I li@, J4111riiiii of I lit,           II ]fosipiliti Ast4i@(,iii tl(jii,              Iti(IT I
                                                                       AN[)      Itl@,(;IOXAI,      I\fl,,I)ICAL                   A    1'1,1,,A    l@Olt    (',OO]tl)INA'I't@1)     ACTION
                                                                                               (Ily  Itol)(-j-t T,.  l@,viiiis,
                                                         I,o         third ill till' last till-(-(- y(I.Ill's OlIr                     eftl.(@             his
                                                                                                           fill([  iiii                               fililLiiLity   of   I(]Vi(-(-    I.,;
                                                      l@(@tli  tritt!   ;iii(I   iii-siiiiiel(@ilt,   Siti(@e   early         otir                 (";tl.o   sy,,iti@iri   likes    existed
                                                      ill    .1    lioloc@ilist    of    ;iiggestioll,    I)ressitr(@,.4    for    (!Iiaitge,    ii)d    iiit(@riiil    and     c-\terjiiil
                                                      examination,    Nvliieli    li;i,,4    involved    tlx(!    1'resi(leiit    of    our    nation    oil     oi)c     li,-iii(I     and
                                                                                   of  our  n(@iglil)orli4)oti  ambulance  ciiil),-4  of)  (,lie  Otli(@r.

                                                      ilk oill. Ntollilll.,I]..v               ;Ran Initially every
                                                      our    national,     ,tite,     and     lwat     A@overiiiiieiit.,4     liav(,,     had     their     ,;;ty-@iti(I     are.     still
                                                      t@:Llkiii-.     Begiiiiiin@,     with     the     C(iggesliall     rtport     in     I(,)65      iii(I      I)ro,@@sitig      through
                                                      the    DcBil@ev    coiiinii@on,     the     A'I%IA     task     forces     (-Pii     education     and     (-.ire,     the     Millis
                                                                         tli(,    lieii(lin-    report;,;    of    the    Ntt,ioiiil     Advisory     Coniiiii,,;,@ion     oil     Ileiltli
                                                      %Ti    iil)ower    and    a    siniilar    Coziiinissioii    on    the    Cost    of    Me(licii    Care,     our     system,     its
                                                      voluntary       hospitals,      organized      medicine,      medical      colleges,      Illd      the       role       of       our
                                                      federal    iii(I     state     governments     have     been     stiidictl     by     so     niaiiy     groulis     and     in(bvi(l-
                                                      iial.,;    that    often    i@liere    have    seeiiie(I    to    be    niore    b-,tctoriolo,-,ists     than     bacteria     (-oin-
                                                      1)oqiii,-     the     culture.     There     are     no     indication,,     that     this,     trend     will     st(@1).     TI)ere
                                                                be    no    desire    for    the    cessation    of    these    Letivities     unless     they     are     t@lireateriiL,(l
                                                      witi) till,, iiiuiiil)s of iiiiiii..,wulity, froni wlii(-Ii they iiiiy enierge sterile.
                                                         (.oo(I    health    is    ]low    a    fliil(lall)(,.iitil    right,     together     wiilk     life,     liberty,     and     the
                                                      lotirsiiit of                       lixiiiiiinal,ioii    of    t@lic    sygteiii    that    ensures    this    heitltii    Is     now
                                                      ilk till- I)Ilblic (Iolll,'klli.
                                                                                                      I.F(IISI,ATIVIe  ACTIVITY

                                                                                          Stil(ii(@s                                                   'I  liost, of l@ills
                                                                                                    ill                              oiir nation
                                                                                                                                  ]residual  iiii(i  iii(,tli(-iki   (-Sir('   f(@i-   tile
                                                      kgt,(l ;Iiiil                 f,o]140\v(,(l loy          yarding li(@ilitli (,tir(4ti- training                      III)(]   iiioi-e
                                                                                          ii)(@   program,,,   for    1)12ti)tiiiig    oil    it    regional    iiojil@olit@iviil    I)Rqt,
                                                      Ill(l OIL .1
                                                                                   4@ilsiiiiglit; is Iillle(i ill@ I)ro4lll(.ing                                       tile
                                                                                                                                                                                     Nvitli
                                                                                 ,Iiotglill        (,s.  No oji(@ state I)rq@(11(-t Nvii'li, any (I(@gr(4@ t@r
                                                      tl)4!                          (if,   tile II(             of till! liiiti-11)(,PO"4 oil our Volume(.                    I
                                                                                             fill intelligent iti@I)i-;iis:il is i .,,14igg(-riiig :III(]
                                                      Hill)()                             is                   W'il 'II only It S'lil.'Ill :Ili(I                                1yol-tioll
                                                      Of t I I St I I (I i f@s--t It (@ 1)1:111 I I I lig I(,gi.'41,1 ti (II 1--il I:Lt, ])()I' l@i oil I(-(I wi (I I t I I(- I t(,gii 01111 I
                                                                   Ill'ol'I."Illli of til(i National Iii.,4tittili,,s (If 11(@tilt,li, colit-likililig                                  ill
                                                                                                       to  (our                             iii(,fli(-jll                          t,ll(-ir

                                                         ]",(,gaining  ill  tile.                bill                        I)ro(Iii(.!tiv(@ly     ]iy     World     War      II,      two
                                                                  goN,(,rlllli(@lit.11 funding          F;Yst(-Ills ])live liLil 11 vital 11111@lit@t Oil
                                                                                       billions   Of    dollars    of    federal    siil)l)ort    tin(I    qtl(lil-.ioiiil    iii[liloii,'4
                                                      of     tenantry     foilli(laticliq     sill@liort      have      gone      into      basic      biomedical      research,      all(]
                                                      (2)  ,i(l(litioliftl I)illions have gone into hospital and ficility construction.
                                                         Wliilo                           for                  were l@i-o(lti(-iiig iiliiit)st                               qiiniitifie.'4
                                                      of  ll(.Nv  ]@lir)wle(igi,                     to be I)ro(itictivk- !it t@lic  I)reveiit@1(iii,
                                                      treatment  of                       ot@li(@r    iiionic,,4    in     oiiiili(@r     quantity     were     (levclopli)-     a     vol-
                                                      literary     syst(,iii     of     hospitals     and     ot@lLor     cojiiiiiiinity     facilities     that     are     Rtrii@turtilly

                                                         I   ltotiort   r,.   l@yniiq,   M.1).,   is   riti-ectf)r   of   iiie(lic.,tl    education,    York    (Pa.)    Ilospital,    an(]
                                                      pr(,,,,I(Ieiit of tlit,,  Association  of IloFtpital Directors of Me(llcfil 10(lileation.





                                                                                                                    223


                                                                    @111(l IISII:Illy VOI)IJK@l@(-Ilt. ',\('W
                                                        tiit@ iii;l.iol,ity (@f II(.:Iltlk           I),'Is                       (@(p ipiir            tliroiigli IL  (IiStillCtlY
                                                                                of (!(ollillillitil@y iii(!(Iical iiistil,iltioils.
                                                                                     betnvecii ine(lical ediic,,ition tDd research ceiiters  tiiid  coiii-
                                                        iiiiiiiity  li(@:iltli  e:ir(@  (delivery                    b(@;,ali    to    (let(-i-iorat(@     l@efore     iiii(I     tliiriiig
                                                        Nvol.l(l   NN'@ir   It.   It   li.,is    I)CCoille    iller(,,isiiigly    iii(@ffective    tll-roiigli    the    I,!)i-)Os    Ill(l
                                                        I ")Oos.
                                                                                                                                                          is     becii     I)r(i(ltlctliv(@
                                                           IJII(lll(@stiol)"Il)ly, the fe(It@ril system of                                support h,
                                                        iii  t@eriiis  of  IciioNvlt-(Ige,  ])lit,  it  lizis                    Llirougli    the    teii(l(,r     ti,,il)     of     "soft
                                                        itioii(-.v,"    to              gr(-.itly ill(! (lifli(@tilty iii coi-niiiiiiiicatioii betweeii  the
                                                        iii,- iiii(I r(@seiir(!Ii c(@iiter,-, iiid  the coiiiiiiiiiiity liosl)itiils.  P@,itterns of                                   I)e-
                                                        li@ll-iol.             llint att iii4livi(Iiiql                     witli     ilie     virus     of      fli,,w4)i-ory-%viii-t@lier
                                                        I ltritii;,,Ii              or                    siitsioll--;Ill(l                jol)    iiii(I    faiiiily    @ill)l)ort    tire
                                                        fl)ll4.tioll.,4 of (!olltiiiiiiiig                  iii                   ivill  lo.,4i@   iiit(@rest   at   .1   r:llpi(I   :ill(]
                                                                                       tli(@   iiiore   iiiiiii(laii(@   full(.i,ioll@ll                   of    lii.'A     (Iis(.Overiv,4,
                                                                   :is                              iiiiglit fiii-tlit@r               Ilis              Ulk(lerst@,iii(litl)ly,       .1.4
                                                        tli(@ Ifi(i:is  toii(,Ii  of rest@.ir(-Ii @iil)l)ort I)i,o(iii(,(,(l iiiore fiill-tiiiie ficiill@y
                                                                              tll(.ir    iii;ljor               fi,oiii   iikv(,Illlig@itioii   rit.lier    tlitiii    teilelijiig,    less
                                                                                                           ;iv:ill:tl)le   to   tr@iiisiiiit,   iiii(I    v,,iii(Iiite    iiifi)riti:itioll
                                                        fri)lll tll(@ iiie(li(@@il              to tli(, fiiii(,-tioii:il iiriii of Clic iiie(liefil care systeiii.
                                                        :i t t i         tre botli   ijit@vititl)l(!  an(I  (I(,feiisil)le  t(,-ith  in  tli  c  sy,,?tciii  tllitt-  li:l-,  I)ro(lllc(@ll
                                                        tlietli.
                                                                                                                                       -ioi,@ttiiig  l@ipeliiic-   of   (-oiiiiiiiiii   -a-
                                                           At'  ilt(@ i-(,(,,eivin,-  eii(I   of    this    @(@ler(iti(-:illy    (let(,i                                           i(
                                                        tioll                 (@(Illeitioll"il                aii(i (@,ire                 4)tli(!r     disrtil)t@ive      forces      were
                                                        4it           '.Nlost of the goveriiii-teiit.,il                     to   oiii-   Noliiiitjiry    iii(,(Iical    o,,iire    system,
                                                                                 I)Y   olli-   CO)IIIIIII11ity   11081)itill,   is   (iii,e(!t(,(l   nt:   I)ed    iie(@(is.    Ilroval)l(,
                                                                                            lel(lillg  to  111(lielit(@(I                       in     I)e(l     cal),icity,      pi-odtice
                                                                         't@ 1) -iol-it,y of fill)(Ii                                               Very    little    Sill)l)ort,     li;is
                                                        goii(@   iiiio   ili(@   er(@iitioii   (yf   (lingiiosIA(-   or   tr(-@itineiit   ft(@ilities    iiiile,,o    ilipy    ire    iiii-
                                                                                          ])Y   I)C(t   vitlo4t(-ity.    Aliiioqt    no    siij@l-K)rt,    bas    gone    into    iioiilyi-
                                                        ti(@lit  ("II.()  @tii(I  siilil)ortive  fiteilitie,,4 of  iii                              evaltiitive,        or         analytic
                                                                    A(-(-t-(!(Iitiiig loo(lies                in   IN)ii(](@rotis    iii,,inii(,r    t,lie    necessity    for    siiiootll
                                                                         iiii(I   reeoi-(Iiiig   of   t'lic                            tiid               functions     of     a      tios-
                                                        01)
                                                        !)itill  fill(]   its   iii(,(Iieil   staff,   I)tit   lwiy   tiliiio,,t   no   iitt@eiition   to   the   tctll@ll   qlllllity   of
                                                        tli(@   st@iff,   or   to   tiny   ;yst(@ni   of   as.,;uriiig   t@lie   contiriii(@(I   quality   of   the   staff   In    teriiiq
                                                        of 111)(littilig of kilowle(l,-e iiid t(-cliiiiques.
                                                          Tli(@     (-xeel)tions     to     this     in,;isteiiee     oil      I(Iliiiiiistriitive      itiid      (lirective      function
                                                                 o(-(,iiri-(@(I  In r(@Iiit' ioii    to    two    ,tct@ive    forces    :    (1)    incidental     to     apl)roviil     of
                                                                         Itrogl".Illl.4  (ilitei-ii.,4]iii) aii(I                      Lli(@ Aiiiericiiii
                                                                              oil M(@ili(-al l@,ilii(-ittit)ii does insist oil iiiiiiiiii.,it                          of        gra(Itiate
                                                                         :1.11(i   oil    evi(l(@liec    of                                                           ill  Ill(yw
                                                                                                            101-ogriiiiis;    all(]    ('-')    llie    Aiiierictiii    A(@iiii(@iiiy    of
                                                                                                for its iii(@iiiiii-i-sitili, %Vlii(.Ii tlit,                   itself


                                                                                          lily I)O:li-(Is iii)il lily                            or    oiir     voluntary     lio.,;I)i(ill
                                                                                                                                                                                     iiiitl
                                                                                                :I                       iii(livi4ill;ll ii(isi)itltl                               Nvilo
                                                                             ill    (.orl)oritt(!                  fail                                 eilil)linsi.4   Oil    (@olitlilil-
                                                                                                                             I)sy(-Iiology,  all(]                         fol-     111(@ir
                                                        lll:iil;ig(,jll4,]it@                   iii-illi(!r  lii4ist@  iii)(iii.   iioi-                     toward.    tlii-     .4iiiii(@
                                                        (@iiil)li:isi@4 oil  (,ojiiii4iriill(, (-ollt:iliilil)g P(lil(-Iktio)i  @l(-tivitly  ill  tile ille(lic;)l                       of
                                                                              iiiiit tire (ii(!ir (-(iiiiiiiiiiiily (-Ii:ii-g(-.            (I(@v(,Iol)ilktnt   of   tili.4    ol.i(@iitit-
                                                        ti(@ll  is :igliti  I)otli  lill(l(@rstiilitial)lc  and                             it@ithiib   the   silqfct)t,    tlifit    Iiiis
                                                                                 t(-ii(I to r(@giir(I liol).sit.,ils as                       and   lo   slr(@.ss   tlivir    Iiiisili(!s.4
                                                        fiiii(@tion    to    the    n(iiiiiiii,.,tr;ttiye    groiij).    Gov(@i-iiiii(,iit    and    it(!cr(!dltlii@    I)o(II(@s    under-
                                                        sti@in(l@il)ly     li:ive      been      reluctant      to      lini@ose      (-maintains      education      requirement,,      on
                                                        ill(,               profession.     Many     exiiiiijkles     jiroiiii(I     the     country     sl)o%i,     tlxat     when     the
                                                        ii(-ces,4ity     for     continuing     education     and     Its     basi(!     purposes     In      relation      to      medical
                                                        practice     are     explained      in      a      clear      and      knowledgeable      manner,      most      board      members
                                                        and      administrators      are      quick      to      recognize      its      Import,      but      still       may       assign






                                                                                                                                    224




                                                                          illol-ti

                                                                                                           A'r,ri,i,tji)i.,s   op
                                                                                                                        I)V(!Il I)otli [(-tiv(@ @iti(I                     III @141(lilig                            to
                                                                     I)oNN-(,r         to  (,-oiiiiiie  their                         tlioiiglit to tli(@ (!:ir(@ t,,islcs at                                Wili(-Il
                                                                     :ir(@ ill too tiiii(-., coi)suiiiiiig. llhy,,ici:iii,, ]iitv(@                              to     regard     the     ni(@(li(-@il     (!ol-
                                                                                       si),twiied    titeiii,    as    sol)liisti(-@ttetl    joiirv(,yors    of    it    tyrie     of     intell(-(-tuil
                                                                     exercise that  is itlipra(,tical in teriiis of t(,iiil)or:il,  I)Iiysi(-jil, aii(I                             eiiiotioiiil             I)res-
                                                                     stires ill  the (@(@ilillitillity setting.  Nvitli  Soljie jii,,tili(-,ttioTi,  they                          look       oil       iii(@diciii
                                                                                            .111(l ftiiictioiis q." coii,,;tiiiiiii,, iiioi-(Iii),tt(@ly ],irg(@                   iitittil)ei-s     of      I)Iiy-
                                                                            la  1)(@tli  iiit(-rii ,tii(I ri-sid(@iit I)rogr;tiii.,; @iii(i st@ifj' I)OSitioil,;,                                   1)1(!tt        to
                                                                     tli(@             (@oll(,g(@s too fr(,(Itieiitly lilts 1)0(@ll I)IIS('(l  on What tli(-y                                       i@o      bf!      t
                                                                     (-I(,iii-ly                     iiet,(] for                    ,t:tfi'  ill   tli(-   olo4@r@itiozi   of   tii(-ir   liosi@it@ils   iii(i
                                                                     foi-              @]II)oll-f(@(1,       till]('-Collslllllillg        (-olltiliuillg        ('(Ill(-Ittioll        1)t-ogriiiii.,4.        'I'hiit
                                                                     tllo'.'40   I)IC:ls       f:iil(@ii  oil   (I(@:if   :111(l                                 (-@irs  is                                        ill
                                                                     VI(, NV   of   tll(@   (.ollt@4,11t   of   tll(@   ))Iezl."   lead   tll(!   ii;lt,iil,e   of   l@lic   iiistitutiolis   itil(I   III-
                                                                                t(i   Nylioiii    tli(-y    tire
                                                                     Altlioii;,,Ix     iii.,iz)y    otli(@r    f@i(,tors    have    (-oiitril)iit(@(I    l@o    II                 of         eff(@ctive          Coal-
                                                                     iiiiiiii(,atioli I)etl%vecti  the  soiir(-,(!s  of  oiir                           Valid   the   iiistit,litioll,4   of    Its    ltl)l)ll-
                                                                                  those,                 wolil(I     -Weill     to     1)(!     the     iiiost     livil)(ortaiit     and     relevant      to      the
                                                                     effe(...ts   of   f(@4leril   sul)l)(irt   oil   the    individuals    and    iii,4titittions    at    ekicti    end    of    the
                                                                     "l@iio@N,le(Ige to fil)l)li(,;ition" transport systeitt.
                                                                     Su(](Iellly,  iii,t@o,  this  J)o(IX)tlrl.i  of                                             iiiisliii(ler.,ititiidiiig,                  Internet,
                                                                     -iii(I                hit.,;              a                      for(-i@  foi- iii(ol ivtt,iiig (,-bititg(@. Aft(@r
                                                                     (If  I)rovi(litig  iii.,ijor  fiiii(i  ,;itl)l)ort  for  I)otli                             r(@s(-iireli  and                                (-are
                                                                     ilis',.itiiti(@lis,  tll(,@               govi-i-illil(@lit,                                  of      thr      coiisiiitt(,rs       of       otii-
                                                                                                                         thirty  [ill](.])  of  its  iitv(-St  riient   in   r@,   ai-i-li   )la.,;   1)(-en
                                                                                                         the       iliff)l-llllt,i4)11,                          field     sliills     l@ro(Iii(-(,d      !it      the.
                                                                                               have        not                                                         to  the                                  itriii
                                                                     of tll(@ ii@c@(ii(:@ll                systeiii-t,l I(- Colllllitlliity lio,,,I)ii@il said its                            stirfs.
                                                                     Wli(@t.ii(@r @tlic failtir(, of Cff('Cti'17C                                       I;    (111('    t@(@    @iliil)le    lick    (if    ltiforiiii-
                                                                                                   11   tO   St@l'iOll.'4                           tlioiigii   it.   is   it    coiiveiii(@iit    tli(4)reiii.
                                                                     tioii triiisft,r is ol)e
                                                                     C,aiiil)))(-It             iiinli(-al  director  of tli(@ Aiii(,ri(-,tii  ll(,Iirt
                                                                          -.tl   piolkl(,Ill   .19   V:Ili(littil)ll   (@f   l@nowl(@i,-(-tli:tt   is,   iiull)ility    of    the    I)r;i(,-titi(>tier
                                                                     t lie. r(
                                                                     to                itii(I    i@lol)t    new    liiowlf,.4g(,     or                  iiiit    !I    lie    Ilia     litL(I     the     (@xlxrieitee
                                                                                                                                                 ioii.        llerhal)s        the        "iiiform@itioll         gal)"
                                                                     of "seeing" it used and ii.4ing it under direct
                                                                     is    r(@@illy    t     "V.Ili(litioll     gltt),"     l@iit     I)ripl@iil)ly     it     I.,;     I)otIL-certitinly     the     tlieralty     for
                                                                                       thin   gtkv(-riiiiieiil   ilso   are   iK,,iiii@iiig   to    r(-<,()gillvA.    trial;    iiiii(@li    (of    tile
                                                                     For(!es         wi@
                                                                                                                   Irii(-tioii i)f (,oiiiiiiiiiiil,y                                                lilts
                                                                     sii))Ix)rt                to tli(,- (-4oii,41
                                                                     I(." thin  t4@titily                         ilk    l@l-o(itil.-ilig    t.jli4.i4.llt     and                             dt@iivt,n,            of
                                                                                (-tLre.       Intending       iii.@lvii4i                                                                 illi)41ti(@ll.t.       (,art!
                                                                                                                  ;tii(I a(likiiiii.,;t:rittioii. 14) tti(@ d(@ti-iiii(,tit (if it
                                                                     sysl,(!iii   of   1-git.ii,iit   (-itr(-   iiiv4)lvitig    logical    (livisi4)ti    (of    ililmittelit    and    olitilati(@lit
                                                                                       3iii(i to t'lit-                     t@f      the      (.containing      ll.l)dltt.Ltig      of      I)IIYHI(-Inii       kiiowl-
                                                                     NN'it;li   tile    r(,.<.Oglliti(@ll    of    it.,4    I("-tikitil                 sii(-(-(,,;s    !it    tlio    lmt[4t,    tile     consiiiii(!r
                                                                     grt)iii),                       by       (110        Itegloylill               Ill.()grtms,         the         Nittioiial         Iiistititt(,,,4-
                                                                     of     Ilimil,tti,     and     tli(-ir     Imireiht     I)o(Lv,     tti(@     D4@l@,,Lrt@ttt(,iit     of     lltitlth,     FAIii(-tttloti,     and
                                                                     W(-.Ifitr(t,   li@ive    (-(niie    Ill)    with    it    v(@t-y                hall      aliii(mt      (*rtain      to       be       effe,(-tive
                                                                                       to,     c(>rrtw-t                (@f    tile           itill(l(-(Jllllcie.,4.

                                                                                                                        A  "[411(nGUI;
                                                                                       Silill)]Y,    1110(li(-.tl    (-,ir(-    nik(l                   t,(Iii(!itlioit,     tii(@     two     (,Ii(I-4     (If     our
                                                                                       I)il)(,Iiiie  for   tlio,.ti,aiislitis@ioii   (of   l(tiowl(,41g(-   and   uit(ler.,4Uttidiiig,   are   ttl)4oiit
                                                                     t,()     be     sili)j(,Ct,(,(l     to     one     of     our      ni(@re      (foliation      ,oc-ial      rel:ttioiislill@@tli(@      Inevitable
                                                                          r@i(@ii        froin         the                 pi,(@po,,iti(yii,  to  the                            to         the         engtig(,iileiit
                                                                     jirt)iz                                                                                                                                          I                                            ]@
                                                                     and    finally     to     the     marriage.     Coiisi(It-@riiig     tli(,     (livi,;Iv(-     ffictors     above,     tlii,;     I,,     cvrtaiii
                                                                                       rrny    jtuictioii,    I)tit    it    is    just    as     (!ertiiii     that     it     will     be     coiistunnintext     and
                                                                     t(-)  be   :i   sto
                                                                     I)ro(luctive,     for     it     i,.4     a     "shotgun      weddiiig."      The      I)eol)le      of      our      nation      are      holding
                                                                     the      k;liotgtui.      It      is      loaded      with      cak;li-the      g-reat@t      motivittor       in       our       weietv.       Of





                                                                                                                                                         225


                                                                                              1)44,t, III     t II(, l@i III I lv,  I II l,i' I.(      -(I,  I III                 (-I Y  fil- III,  fi             J'I IIII (-I-- III-I  II  NV.
                                                                                        1)('    iii;lv                                                                                                (I(@IX-11(lifig    111HPI)     the
                                                                                       iiiiiiiiil(,Iit                        ii Collil)lit-llLi-(l Joy tll(@  f:l(-I.  tlii@t  1%,(!  iii,4!  I)ot  (little
                                                                                    is  tile                    ;Ill(l   NN'll(k  is  tltq,  gl.(H)lll.   If                                         :Ll)iiily,        I':i(-iiity,        iiii(i
                                                                                                                                   or N-1 I'll il,.V,  t li(!It  I 114@                         ('Oll(,-gtt  1,Y,t('111  ilill.'41.  11(@
                                                                          t    II all (@ I I I.   II @  is  (14 0111 )tell II  t II:( t  t II (-  f:t            @V I II  Iilt 4@ II  f4k I'  I(Yi)g  to  III iy  (I
                                                                          4)f  @II)ilit@v  (of  tli(@  gri@ipill  to                                  siilil@(irt tli(@ I)ri(li@ NN,Ittiotit ftirtii(@r
                                                                          4)1'                   to ll('Il) NN-iiii                            It  itis4k I,, (if@iilptf@il tiiit aliy                                             oil  II)(,-
                                                                          l@:ii-t of tilt,                    (1114-                                                                     11.4  to   IL(@r   il)ility   to
                                                                                                  or   ;tjlklyti(-   (ilitii-s   !II   tile   11(olls(,Ill)l(l   H(-riotisly   %vill-affe(!t   the   ftiture   of
                                                                          tli(@ iii:Lrriig(-.
                                                                               'Niiiiil(-,4                 for  Ili(@  iii4)iiiviit,,  let  iis                                     tili,4   iii1ioll    1)(@tweeii    111(@(li(.al
                                                                                                iiiti                      iiii(I                     cilr(@ ;tij(l                         tile    factors    ii(!(!es,;itry     for
                                                                          its                                                r(@(iiiir(-               s(-riitijiy           (1)  the                     of   the    (ititility,    the
                                                                          tl)il!tY,  .111(l  the p(@rsoiiiiel  of otir e(Iiie:ttioik.,tl and                                                             faeilitie.,i;      (2)       the
                                                                          .sol)])istic,itioii,        the        qiiility,        the        ability,        the        ik@rsoiiiiel,         and         the         functional         I)attern
                                                                          of  (@iir                      (,are        institution,,;        and        (3)        the        (Itiestioll        of        facilities        stil)port         and
                                                                          ct)ii.,;tru(-tion        stib,-&quexit        to        a        liro(Iii(@t,ive        iiiiioii        of        tilt,        educational         and         research
                                                                          iii,,titiitioii,.-,          tiid          the          iiie(lical          care           iiistitiitioii,@l)erlitips           recognizable           as           the
                                                                          eventual  trringeiiieiits  for  lioiisiiig  tlke  finally.
                                                                                                          college    systeiii    sit    I)r(,s(-iit    I,,    rich    la    all    three    areas,     Over     the
                                                                                   f(-)Ilr                       it Iiik,, I)iiilt Ill) It  large ciidre                        of     (@(Iticiitiojitllly     oriented     iii(li-
                                                                          N-i(Iiii@ls,   III   ,51)ite   of   r"i,itreli   (@iiil)liiisis.    Tli(!    N,(,ry    iiittiir(@    and    I)riiii:try    task    of
                                                                          tli(@                     college syst(-iii  I)ro%,i(les  it  with                                                  classroom,             ati(lio-vi.,iiial,
                                                                          iiistrii(-tioii.il, iiitl otli(-r                                      -.ii(Is   to   c(Iii(@iitioii.   Its    liosi@ital.,i    are    t4ltiipl)(xl
                                                                          for   tl)(@    iiiost    ,;olpliisticiLte(I    ear(@                 II   sigiiifi(-iiiit   1)(@rtioii   of   it   oil   a    research    or    re-
                                                                          se,ireli-(!onnect(@d                                          tire      largely      iii(xl(@riL      and      relatively      well       staffed.
                                                                          Altlioiigli    the    medical    college     certainly     will     need     soiki(@     a(Itlitioiiiil     sul)l)ort     to     help
                                                                          it      ill      its      new      role       is       the       rcsoiitce       of       both       coiit(@iit       and       sonie       instructional       ability
                                                                          for        the        transmission        and        vaii(l@itioii        of        kiionvle(lgc,        it        is        relatively         well         equipl)c@d
                                                                          to        (-ol)e        with        its        role        as        (@(Iiieational        I)rea@twiiiner.        The         (listafe         side-tlie         coiii-
                                                                          iiiiiiiity         liosr)ittl,         wlii(,Ii         will         (,oiisiiiiie         and         titiliz(,,         the         educational          I)ayelieck-is
                                                                          iiiii(@ii          less          adequately          I)rel).tred.

                                                                                                                                 NO,NUNIVFRSITY  iiospi,rAT,S
                                                                                                             -ity                                       iiito tlio,',-(',  tllsl
                                                                               Tli(@  iioiiiiiiiv(@r@                                                                                t@  have                graduate                 educational
                                                                          1)rogr;ii@i.s      and      tlio,4e      that      (to      not.      A       rc(,eiit       ,,,iir%,(!y       (conducted       by       the       Association       of
                                                                          Ilosl)ii,@il         Dir(@(@tc)rs         of          inf(,dictl          Education          show,,          that          although          graduate          teaching
                                                                          hospitals ire iiiiLi(!Ii siiitill(@r Ili                                        t@litir        total        bell        capacity        and        total        nuniber
                                                                          of       stiff       I)hysi(,iaii-,       are       approxiiiiitt(,Iy       equal        to        the        total        I)ed        capacity        and        total
                                                                          iikeflical        ,;taff        physicians        of        the        hospitals        tlllt        (lo        not        conduct         teaching         I)rogranis.
                                                                                                                                                                      tliw,              hospitals              conducting               graduate
                                                                          ,file saine survey iii(licate,4 that even aiiioiig
                                                                          I)rogr-inis,        less        than        50        per        cent        have        -nti*iiiialtil        adequate         teaching         facilities         and
                                                                          less        than        10        per        cent        have         the         services         of         trained         educators,         evaluators,         or
                                                                          z(wiologists                                  even  by  consultation.
                                                                               'I'liere  is little (liff(--reiice  between  the two                                    types          of          nonuiiiversity           hospitals           in
                                                                          inost of the important paraiii(@ter,.; we sliill                                                             The          inajor          difrereiiee          se.(.Ins
                                                                          to   Ile   that   tlio.,4e    hospitals    condu(,tiiig    grii4ltitit(,    I)rogrtzii,4    inay    1)(@    a    little    further
                                                                                              Ili                             lilill,).,;opliy.    Tli(@ir    stairs,     I)owever,     frniiiently     are     (-oxii-
                                                                          1)0',e(I  Iirg(-Iy  of I)Iiysici@iii,.4  who do not ll(.t@iv(,Iy                                                             Ili        the        teaching        pro-
                                                                                         iii(I tli(,ir e(lil("Itl(@lial  fil(-ilitit,s,  witl)  at  few                                             exc(@I)tioii.,4,      t(-ti(l      to      be
                                                                          little       (IiIT(@ri-tit       front        tiios(@                 Ili      hospitals      That      (lo      not      (-oit(Iii(!t       gi,ii(iiittt4@       I)ro-
                                                                          gl-:Iiiis.                                  fol- lit(-                           of tilis                                title   two   t@yix,s   (Of   ])oil-
                                                                          lltlivi,i-,,iity llosi)it4ils 11121Y 1)(@                                     its it (,duration (,tititv.                         fact:   r(@iiiiiiii,4    that
                                                                          tli(! (-alleging stri4li,iii.                                     for     tli4-      ii4piiiiiiiv@,j-sity      IIOSI)Itltl      1.4      tllltt      It      ORqll)llOl
                                                                                                                                   of      (!o)iti)tllillfl      f,dti(!atio)t      foi-       the       I)hll.Nioians       aii(i       alli(,(l
                                                                          Tallith                            of iti
                                                                               ,Alto.,4t ii(@iiiii@iv4,r,.,ity liosl)illll.,4 Ili.(, illo(l(@rii,                                                                  and       rt@littiv(,Iy
                                                                                                       to                   iii4-(Ii(-ail (-area.                    oiii,   (-oiiil)are4   t@li(@in   Nvitli    the
                                                                          college liosloitii, t@114@                                      Ili ill(.              of                     (Fair(, 1,4 a                           1)(,Ilw(@(In
                                                                                                                              oil   tit(@   fruit   of   iiit)st   iioiiiit)lv(-rsitv   liosl)itjilh    and    I)rolK@r
                                                                                                                 t@ll     tli(-     part     of     tile     iii4-(Ii(,iil     (,ollt@ge     lioslilttils.     This      Is      a      tolerable
                                                                          and al)l)ropriat(, (Ilft(.,reikcc.





                                                                                                                     22C)


                                                                                                   INTOLEITABLE DIFFETTE,NCE


                                                                                                         so gj,(@itt         to i)(@

                                                                                  tli(@ii-    tiltiiii:it(,    (lirv(,tioii              in  tji(,-  iitii(is   of   boards   A.   II(]
                                                                                         ill IL I)rol)(@r iiii(I                                                       the           of
                                                                                          01)(@i.;itioii  or  it@.,4                                                 fi,%v   of   Ill(!
                                                                              @11141                                                                                             liliv4@
                                                               :11)1(@  to                        1114'!V                                                      ov(,I.I.Iolljig    ]Ill-
                                                                    ('r (-(Illlilillillg (@4111('Ill,ioll  14) ill('                      iiii(i    Hill-vivill    of    oiit@
                                                                                 ill)(] it@@ lio.,41oil@il,4.         or  fli(@  I)Iiiiyj(@  for  t-Iii8  fjijliii-(@  t@o
                                                                                 iiiii.,;t          ill 111(@                          l@'llo ))live not                 II    ('Ool'(Ii-
                                                                                            ,ill(]                           (-])able(! Ill I)ie                         1)(.Iiiivior

                                                                                                                                   is,@ W(-Ii Its
                                                                        I(,jl(,Iiillg  llosl)il,;il.,4  liiivt!                  lool@    iil)oit    grti(Iiiiite    (iiitel-ii    find
                                                                                                                                                                            fil)l)egir
                                                      t,o          like level of iii6lical c;tre,  iii(i                             they      provide      n(l(litioiial      liai)(Is
                                                      Nvitli    wIli(.Il    to    stilol)ly    that    iiie(lic@il    care.    Ilowever,    even    in     rotation     to     graduate
                                                                        it   )I@is   been    (lifll(!Illt    to    bring    I)o@ir(lq    tii(I    ii(li)iini-strators    to    spending
                                                      l@:iti(,iit    e:ir(@    income    oil    educational     facilities,;,     or     to     supply     within     the     hospitals
                                                      I-)]).Vlli(!Iatls     whose     base     purpose     is      graduate      or      continuing      education      as      opposed
                                                      to   l@lic (](@livery     of     medical     care.     With     the     rapidly     rising      cost      of      hospitalization,
                                                      iii(I    the    clamor    this     rise     has     produced,     oiic,     certainly     must     have     @,iyinpatliy     with
                                                      our      hospital      boards      and      administrators      in      their      reluctance      to       utilize       pttlent
                                                      ctre      funds      for      educational      facilities      and      personnel,      even       though       the       dollars
                                                      s@t     on     education     are     the     best      purchase      the      patient      might      make.      The      concept
                                                      is     stifhciently     abstract     to     make     direct     continuity     of     purpose     and     decision      difficult
                                                      to achieve.
                                                                                             PROPOSAR,S  AND  I'RAC'RICALITIES
                                                        III     addition     to     being     the      stibje6t      of      studies      and      recommendations      by      various
                                                      commissions     iiid     individuals,     our     me(li(,al     care      ,iii(i      education      system      his      1)(@eli
                                                      exposed     to     many      (lifft-reiit      proposals      in      relation      to      continuing      education.      ()lie
                                                               of    universities    with     ,iii(i     without     wiillg,     iiatioiiNN,i(le     closed     circuit     television,
                                                      ill)lplieation    of    tile    national    edilelitiODal    telei,i,,ioii     network     to     iiie(li(,-iiie,     tNvo-,.viiy
                                                      ri(lio, television  tape, and a ]lost of ot)ier novelty approaches.  When  One
                                                                  the vexicer, lie is forced to l@lic                                 (-Oll(-lllsion   tlllt,   ill   Spite   of    all
                                                      of           I)rol@os,,tlg izk(l                       the      otily                I)Iacc    to    editeate    the     I)i-(ic-
                                                      tici,,)ig l@ltyviclaii air a containing atz(l, p)-odii(,,tive                            is in the                 ill.   ?vhirlt
                                                      he i(@oi-k8, I)-c(ttv 7iiq 1)(iticiits, a)td                      hii                   hospital.   IVIiil(@    it,    is    true
                                                      trials  ill  It@,I(lillg  I  )lot-SC  to  Water,  oil(!  Italy   i)()I:   foi-(,(,   I)iiii   to   drink,   the   horse   is   it
                                                      gi-t@@it                   lik(@ly   to   drink   if   the   %i,;it(,r   is   iiii4l(@r   his   i)ose    coii-,ttiitly.
                                                         NN'Iiile         iiitii,(@rsiti@- iii(I  fl)(@ir                                iiiiiy 1)(@ I' ]i(@   (!(@iitrtil
                                                                                                                                                       ill  I.Irogi,.,iiii.,i,  tli(T(@
                                                                 ()Ill  Continuing                         all(] (of ill(@  lt(@giollil  MC(lic
                                                                 lo(- iiiiist doubt  that t@lic iloiliiillv(,I..,;ity ('01@illitillity                              will    1)0   til(@@
                                                                 of   tli(-s(!   programs.   N@4)   portion   of   l,ii(@   Iciio%vl(@ilg(@   pr(o(lii(-(@(i   I)y   the    1)[Iti(@iis
                                                      for             sl)t@iit in li;i@i(!                  III ill(! Iii.'4t: 10 y<,iti,,4 (,all be    I)ro(lit(@tiv(,   iiiitil   11;
                                                      is  in  the                of   tlj(@   individuals   who   c;ir(@   for   tli(@    )majority    of    t.li(,    1)('olpl(-    of
                                                      (1111. ii@llioll--tlie                     (if   our   (-oiiiiiiiiiill@y                                       ']'lie   I)POIPI(-
                                                      of (Pill- ii@itioii--oiir                               tile form (if (,ollgl.es,4, ])live                         ill 11  loll(I

                                                                                      of I lie lt(,gioti:il                  Ilro,,i-zti)is is to                             knowledge
                                                      into                            Cliff]              into                             in   a    (-ool)(-rjitiv(',    i-(@gioit:il,                       ;@,@ : i
                                                      tii(I               murder. 'I'Iiils, tile                    :Ill(]  initial  form  of  l@114@                       of    fill,
                                                                                  llr(igr:iiiis nitrate 1)(@ r(@ii:ii-ative (@(iii(-gitioli in
                                                                                             i(;Il:tls   lip   to   (late.   'I'liis   iiiii,.,t    be    followed    ])Y    continuing
                                                      e(III(@ittioll   to
                                                        Oi@(.(@    i@(iii(.;IiioTi      Well               Avily,   'Itt(-Iltioll  lately  lie             to       providing       the
                                                      I'@ti-ilitit-s ill Ni'lli(.Il tile liewly                           I<iioNvl(-(Ig(.,                    and   ,4kill..(    iii@iy
                                                                            it eool-(Iiilllt(@(I                  It     18               to   I)IIII(I   tile   fll(-Illt@ICS    until
                                                      tll(@             of (Adulation that will                           their ))i,ol)(@i, transit is
                                                      fiiil(.tiol)illg, Willi til(,                  I)iiri)o.,4e   or   manlike   1)1(@   lilllioll4   of   dollars    tlieN,    linve
                                                               in                                 fit   the   care   of    our











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                                                                                                                                  227


                                                                                                                 I(OL41-ITAI,g NFI:D
                                                                     t.        t i       III(, e(i II(.: I Iio II: II I I        (If         II oi I II Iiiv                                       is   Si)
                                                                         tli:il  it  is  (Iiiii(.Illt  (IV  iiiii@ossil)ie  fol.  it@  to  ii:kil(llt!  its  I)ri-si-litly   :].';sigill-it
                                                               in                       11'  it  is  t,t)  1)(@(,ollle  t@lic                                                                  (of     tilo!
                                                                                              Ilrogi,:titi,  tlik@ii  tli(@ iioiiiii)iV(-I-Sii,Y                                        ;"r(,Ilt  il(!:@l
                                                               of           Tlii,@ ll('11)                  twofold:  (1)  D.,, illfol.Illitioll;ll
                                                               tlit,  iiiiloort:ili(-t@  (of  an  (,(Iticittionitl  foliii(l;itioil  to                                                         core
                                                                            so tli4it tlle                      t(liiiiiiisti-ator.,i, @iii(I iiieili(,,il stiffs of our
                                                                                                                                                                                            of     tli(@ir
                                                               :Issigii    lit-oli@,r     r(@(-o.,,iiitioli     ,tii(I     iitil)ortqiici@     to     the     c(lilettioll.11     activities
                                                               iii.,;titxitioii;             (2)  (lire4,t liii:iiiei@il stil)l)ort  t(@ estalilisli  tile                                     fr@iiiie-
                                                                         of                   and   ll,(,.I.soiiiitil   ilccesstry   to   stil)ljort   tile   p(lil(-,atioiial   fiiil(.tiolls.
                                                                          li3'.@t. of the reqliir(@iiieiits for li(-Ili to the noikulilversity                                             in
                                                                                                                                                                                             tin     flivi
                                                               tioii   is          iiii(l(,r way. Tllk-, I)III)li(,,Itiol)s of tile lt(,,ioll,,Il M(-(Ii(-.tl Ilrogr,
                                                               "ioll  or  tile  Nitioti@il  iii,,tlitlit(@s  (If  lieilt,ii                                            str(@.'N     on     this     .;ir(@a.
                                                               Ili,ogi-iiiiis  iyiiliiii                 1)oi-tioi),,;       of        gov(@riiiiik.-lit  ,Ire                       to        ;titnill.-tte
                                                               tli(. ill(,Ili4.:ll  (,oll(.g(.s  :ill(l  ()rg:tiiiz(@(i                           to  it   iiiol-i@   L(-tivt@   re(-ogiiiti4ill   of
                                                               (.k)lllilillillL,  e(iii(l@itioli  @is  iiii(Iii(@tioiial)ly  tli4@  iii(@st  iiiii)()rtitit  I;ortioll  of  tile   SI)(-(--
                                                               ti,iiiii of                                                    iiii(i (.olitilllli)lg 11(@;lltli  111-ofe4.@ioll
                                                                  A(,i,(,(Iititig  oi,@iiiiiziitioiis  and  institutional  gioiil)s,                                       it,,    the    Aiii(,i-i(-;tn
                                                                               Asso(-!;iti4)i),  slioii](I  I)I:iy  II  iiioi-(@ iiiil)ort@,ilit role !II                        stiliiillati4)11       of
                                                                                   tile                         flill(.tioll  of                          they    are     just     I)egiiinitig     to
                                                                                interest      in      t-Iiis      ietivity.      The      A@,4ocizitioii       if       lIosl)itil       Dire(-tors       of
                                                               Al(.(Iic.ll      ]Function,      (X)Iill)oge(l      of      l@(@y      iii(livi(iiiils      ill      stljiiiilitiiig      and      directitig
                                                               (@(ititiiiiiitig    (-(lu4@:ition,    contains    to    increase     its     voi(-P,     eoinl)Ctencc,     and     activity.
                                                                                       and   exl),,iii,,ioii   of   t.lie@e   initial   ii(-tivities   oil    the    liart    of    all    the                                   L
                                                               ijitere.;t(@l  groiil)s  ,inil  i)rg,,ttiiz@itif)n,4   NN,ill   assiii-c   prol)er   ciiil)lii,,4is   to   ft   fiiii(-tioli
                                                               tli;it will                     iiiore    food    I)aticiit    care    in    the    futtire    than    any     other     single
                                                                           --e(-oii(i              that-,   of   fiiiidizk,-   ,;iipl)ort,   I)e(-oiiies    Iiiereii,4!iigly    iiiii)()rtiLiit
                                                               its    illol-C    ('Ilil)llasis    Is    lylllc(!(l    Oil    eoiitliniiiii.,    (-(Illc.,ttion.    The    itiiti:il     (lir(-(@tiori     of
                                                               fliti(lilig     in     tlit@     Itegioiijil     @Nictlic:il      I)r@)griiii-4      and      irk      the      coiill)relkellqive      (.Om-                     t
                                                               iiiiiiiit.N,   ))Itiiiiing   Itrogriii)ig   pr(@I)erly   Ill.,;   I)e(@ii   tr)wnr(I   the   comiiiitineiit    of    inonies
                                                               f(pi,  iiitt,,-r;ite(I  I)Iiiiiiiiiig  of  fill   -al@pi-ot(@li   to   th(@   I)rolvlein   (if   opening   tile   ('Om-
                                                               iiiiiiii(.;Itioll"  Pil)('Iille  I)CtIN,eeii                            (,@(Iticatioii    and     research     and     iiie(lic.11
                                                               etre.   On(@e   these   group,,,   have   I)Iaiiii(@<1   to    coiiiiylxiiiieate    effectively,    we    .4till    are
                                                               fa(-P(l   with   tlie    1)rol)lein    of    a    bride    .iiid    gr<)om    who    are    geographically    separate,
                                                               .tii(i            therefore,     iniist     be     provided     with     the     means     to     coininunicate     appro-
                                                               1)riiite to their (It,.sire ti) (lo ,,o.

                                                                                                              FA(:ILITIlrS  AN[) IeQXJII'@NfENT
                                                                                iiiii.4t   It(!   1)1-01,i(Icel   for   c(lite(itioii(il   fficiilties   an(I   cqiiipnicnt   in   tio?t-
                                                                                                    l@iielliti(@s                    llko,.,I: ilnl)ol.L:iiitly,  nil(litlol-illill  find  (.oil-
                                                                                                            tili'll-                              -Iiiii-iii-y                   find   iii@ileri,,ils,
                                                                                     iii:tl(,ri:its ;iti(I                             2iii4i   iii,(@iig   si)4,(-iii(-Ily   (li@sigitt-il    for    e(iii-
                                                                              (](,Itlollsll,@ilioli'4 ill  1);Ili4,llt,                                                                   fill(]
                                                                         rilli(l@,  NV]Iii-ll  llkio4t-.                      4iiiij@ly   4-:tiiiit)il   stii)l)ly   fi-oiii   iiii)iii(-s    i-iii-r(,Iitly
                                                                                ill    tll(,iv    colillikilliitl(,S,    till,     ]]ill-illit-i-is                 or Its II                      t,ii(@ill
                                                                                                                      tile  N.(,I.y  lilisi(-                     (hill,   fill   Iiiisloitiils    leftist
                                                                             llfl(,(lllllt4,lv                    tll('!I- t;tslc  in                                 stiill's fill(]
                                                                                                                                                                                           4'(Ill(-Iiliotk
                                                                              ll(,;Iltlk                                      11'41)lkysi(-Ilkll.S.
                                                                                                                                                       it                                          titil(@
                                                               tliii.,4,  Ill(.il, l'illi(Illig  ,@lloill(I  Ill.  (Pr                l@t-loi-ily.
                                                                                                                                                         lltilizlkt,loit4@f,             (,(Illi.lltit)ll:ll
                                                                                'I'ii fairly(,              )few  fll(.ilil!4,s  ],t,illly   ftiiiel.ioiiiil   wlij                        two    ii(](Ii-
                                                                                                                                                            ()   ii."iii-e
                                                               tioii:tl                    (1)  iiivesi@igittioii :tii(i                                   t
                                                               tivt@  (.ollt(@lit  (If  till,.  lirogr@iiii4  tll(@y  will  liolls(@;  final   (2)   it(lequiite   iiilitil)tr,.,   of
                                                               (@(111(.Ilti4ill;llly Colkill(ACIlt                            to  -i.,4stire  tills  I)ro(lu(!t@ive   al@Pli(-Iltioil   or   the
                                                               1(1(@iit,ille(I ciirri(!@iluiik ei)ii,teiit and the fii(-ilitif"s.
                                                                  Tw4)     of     the     greatest     problems     for     individuals     with     practical     experience      ill
                                                               continuing     education     are     etirriculum     design     and     content     and     the      motivation      of
                                                                                                                                                                     etors      -are      inextricably
                                                               the practicing physician who is the student. These two fa
                                                               inter%voven    with    a    need    to    know    patterns     of     medica-1     care     and     physician     fune-





                                                                                                                 228

                                                       tioli.  The  are@t  wliere  ii(,(,d  for  iiiforiiiiti(iii  qii(I   tlic,                    r)f iiii,,Iiiforiiiatioii       is
                                                       ii)ost    il)lk4treiit    is    ill    ilic    ile](I    of    flitictioll-(Iie             (if  I)IIY.Sicigilis     ill     til(t
                                                       d(,Iiv(@i-y of               i@4ire nii(I the i(lezititi(-,itioii of tli(@ir                     iiii(I    iiiotiv@itioii    Ili
                                                                        colitilltlil)ge(lll(..,Itil)ll.
                                                       Tli(,r(@ issore iie(@(I for siil)l)ort witliiii the                                      s(@ttjiig for the
                                                             '11141  (@villi;ilit)ll  of (.O)Illillllitlg                      t4)              Its                  311141
                                                                                                        to 111(@                                i@i,iiiiiii1ioll or Ill('
                                                                                                                            lo 114-4-(Plllo' iii(Ol-l'             1111(i
                                                                                     of
                                                                  ii@hitt \\,t, sljt)iil4l              iiiiii it@h(it                iii  bt,h(ti@ioi-  \%'(I  Ill-(!  ti,yiiig  11)
                                                       loi-iii,, Bilotti till-4)llgll



                                                                              I)(. iii)(@ ol.                                                            riiii(is to
                                                       ii)(I  st@iff  iiiiits  to                                                                                        11 11(i     its
                                                                   llill', to 41ssi"t ill     (I(@t(@riiiii)g            (,oiil(,iii,   @iii(I   iiiotivitioii    Ili    (@()iitililiil)g
                                                                                                        r(@gioii   l@y   (](,Iiliitioii   is   ,iiigtilitr   !it   qii@ility,    it    is
                                                       joi-ol)@ii)le  tliiit,   (!ii(,Ii   r(@gioii   will   liave   siiili(-i(,iiily   (liffei-eiit   iie(@(Is   to   re(iiiii-e   (lif-
                                                                                      iiii(I iiieisiireiii(@iit                        To   (@stal)li@li   jiist   oti(@   or    tAvo
                                                       ii,,itioii:tl iz)stitiitioii.,; or niiit.s iiivolv(-(l it) tlijs ti,l)(@ of                     wotil(I  I)e   iii(@ili(-If-lit
                                                                               rllis                        filii(-tioii (-iiiiiiot I)c (-,irric(l oil iii till!            uiiiv(-rsity
                                                       settiii;r, forN%,efirestii(lyijigit iioiiiiiiiNer.,;Ity oi-gikiiisiii.
                                                                                       1141"            I)Cgllll of            Collt(')It,  'Ill(l   1)(@l-tilieilee   ill   I-('Illtioll
                                                       to (,Olltilitillig                  it will I)e iiec(@,.,s@iry to                  tIlAlt '31]ffleiellt
                                                                            411)(I  illotivlt(@(I   iii(livi(iiiii,-4   .11-(!                  ivitllill               Collillilillity
                                                                                        14) it   to (,iisiir(- I)i-oilti(,t iv(@ ils.,ig(@ or tli(@ iiiforiiiiitio)ii
                                                                                                                ill   t)i(@    fol,l)l of   ti-:iitl(,Il   1)(@rsoiliiel,    iiilglitviti-y
                                                                                                                                     f4)1-11111lly  ti-ilill(41
                                                                      @iii(i  iiior(@                   lio-.41)it@ils,  t(o  iii(iii@i4ltiiil                        ivlio       li:lv(@
                                                           I'lie ol)lx@i,t.iiiiity to re(-(-ii,e ll(l(litioitill                             ill    (.(Ill(,.Rtiolial    liliilos()I)lly,
                                                                                                        -r    liosl@it:tls     iik(l                     Oii4@   iiiiglit   1-(@g3ti-41
                                                       tli(,se iii(]iN,i(Iii:ils its the  "iiittrl-iig(@                             of (iiir              Tli(,y     iii-(@     vit3illy
                                                       iiiil)oi-t@iiiit to it                  tii@it   lists   litt)(@   ,;olj(l   foiiii(litioii   Ili   I)r(!vioti.,tiy    (-xist(,iit
                                                       love or iiiiitwitil                              its  I)ilrtii(-rs.
                                                                                                                               of                                                  (-oil-
                                                                                                                 siijolioi-t.                                           't
                                                                                    l@rogi-iiiiig   Sli(ilil(I   lift(@iitiolk    1)(!             lo
                                                                                                 Nvliil(.         (li@V(PtiOll    it)                                            4@4111-
                                                       (.11t.ioll, ori(,Tlt4ltioll, '1111(l ltl)ility Wolil(i                        (I(.I;@y  ill(,  (-Ollstl.ll(.tioil   of   II(-tllal
                                                                                    for  iiioi,(@  01111@lex  iiii(I  8i)])Ilistil-at(@(I  patient                     tll(@     (14@liiy
                                                                                                                                            I)I-ol)(@rly litiliz(@(I I)Y
                                                       wtpiil(l s(@rvo to                 t)iiit Ili(,s(@                   Nvoiil(l 1)(
                                                       (-iiiiis.  Soiiii@  I)rogi-iiiiis  eg)iii(I   I)(-                                              Ciii,lilg     for     1);Itit-lits
                                                       j.,4,  :tfi(,r ,ill,  Ili(, l@riiiiitry                for    Ili(-                 of otir ClitiV(x

                                                                                                        A  ill,IIA  ]-'OIL   A(@'I'TON'
                                                          Ili                  this  1)1-(@Si'llilitit)ll  Is  it   li](@ll   for   it            till(]  logi(@iil   I)i'i)gl-(,,,gsioll
                                                          @t(-tiN-ity  Ili                 Ili  lt(@gi4)ii:ll                                                til(@            illilliol.-
                                                                          ol, t@ll(" so(.i@illy                                      t]14it ligs              Ili
                                                       II.N,           it is it rt-(Iiiest for goo(], soiiii(I I)r(,Illlii-itill
                                                       I)y tlio grooiti iii(I ili(-. fzitli(@r-in-law to                             tliit  tli('         of     otir     "iiiiirrizigt!"
                                                       lots  the  kiio%vle(lgc  aii(I  the  necessary  apl)liiii(.@es                             (,oull.S(@l    to    ke(.I)     liou,,w
                                                       propel-]Y.
                                                          (,(@iiiiiiiiility liosl)itals ind their lieiiltli                                  iiiiist I)e prol)trly
                                                       to              ID(I  rise  tilt,,  ].;iiowl(41ge tb.,it will  potir front  the I)eiviotisly
                                                       COIII)lilini(.,ttiolis    pilxliiie.    The    iiie(licnl    (-,ire     syotein     iiiiist     h,.Ive     initial     fiiil(lill"
                                                       ,.,iil)l)ort    for     id(,ntific@itioti     of     educational     need     iii(i     provision     of     educational     space
                                                       .iii(I    p(,r.,4oniiel.     @Sti(qi     funding     will     prepare     it     for     the     proper     niid     pi-o(iiietive
                                                       Utilization    Of    the    liealtli    care    system    iiii(I     facilities;     to     1)0,     estal)lislle(I     in     the
                                                       fiitiir(@   -,is   ilic    r(,,,4iiit    of    eoor(Iiiinted    regional    an(I    coiiiiiiiiiiity    l@laiiiiiiig    for    tl)e
                                                       (I(-]iV(@ry  Of Tll('(Ii('Ill  car(,.
                                                          To                       NViii,.,toii   flitir(@Iiill,   "We   ii-e   not   nt   tli(@   encl.   nor   ill('    ))PL'Illll@iiig
                                                       of  t@lie  (,till,  biit@  lipi,li:ips  iv(@  fire  nt  life  el)(1  of  the   1)(,giiiiiiiig,"   It   Is   of   vitnl   iiiil)or-
                                                       tliili,(,  t]).,It   W(,   b(@   siii-e   tlint   i-Iiig   111)(,gliiiiiiig"   rt@pr@-eiits   a   solid   fouti(littloji   for   a
                                                                         laid  fiinetioii,,il  fiitiii-e.






                                                                                                     22!)


                                                          N%.(@ Y(@tti II,,(1110114ri                It:lt iol I I'l-ol IIII( SI)
                                                                           il]Voi@         %'it]) (11(@
                                                                        l@l-olil illy                             I   (.:Illllot
                                               ,4:ty tli:ii@                                                           ksso(.i:llioll         1-0-SI)ollsil)illty,
                                                                          Nl.(@ (lo lio(            (@ilol1q,.Ii                                         0(ii(@i-S
                                                                       y
                                               s:l
                                                      i t is (file.   Ilo',I)it:tls                                            lo
                                                                                                               livil(@(i      to                  so   I   (1011@t
                                                                                                        "ly  i
                                                                                     Io]'  ll]oS(!  N%-,,o   say   111(@y   11.1%,e   ]lot,   lit(l   III    Oil-
                                                      tilil;l@  llk;it, oill.                            l[i(dii,r@iii  iiii@rlit.             Noll    lo    se,(,
                                               tli:it, this is ]lot just, -,I      Colitilillill(r    C(Ill(-,Itioll                   fol.   oil)-   ille(lie'll
                                               seliools, I)Ilt, ill     fl(.t is    a                                                 to      develop      ti,iily
                                                                                                           @iiid    it    toolc ils iiiiily     iiioiitlis     to
                                               deN,(Illol)  ,i,  ivoi-iiiii,,-                      foi-  tli(,,           iii(@(lical    seliools     to     co-
                                                              tli(-ir efl'oi-ti    aiid      cojiiiiiiiiiie:ite      b(@cziiise they liad      ii(,@ver    (loiie
                                                  I tliiiilc tli(@ NTi-y fact, tli:tt, I as (,x(,(-tiiive                                 of    :t ]lo-SI)it-,il
                                               (101111(lil  N%,,ts            to            III(,                  ill    ti-viii,-,     to     draw     together
                                               ill(,,                :iiid (](@v(,Iol) Ili(,,               tl)l)li(-iitioll  Is    ft good         iii(licitioli
                                               tli:it  iii ()III- Stil(, ;tt@ 14@;tst, ili(@,    liosi)i(:tl  I-ol(,, i%-@is w(@] 'i(lelitilied.
                                                  'I'li:tiik yoii -%@(@i-y
                                                                                    Yoll.    ),()Iir    testijiioiiy     ])a,,,        iiio,,t@ li(@II)ftil.
                                                                                                 for to(l@t  . The                        for          toinol-IIOW
                                                                                                              y
                                               will I)e lic](17 1                          i@l' t@lic ]III) ill                1-00111,  wllicli  is   oil   tll("
                                                      flooi-, i-ooiii 2112;),, Ill([ so the                           will        liow'st@aiid        adjoiiriied
                                               iiiii ii 11) o'clo(,tlc tomorrow 11101-11111g.
                                                                         -.tt    4:1.r)    1).iii.    flic    coiiiiiiittee    a(Ijouriied,    to     recoiiveiia
                                                                          ,iy, i  -    c
                                               it IOi.iii. Tliiii-sd,               ti, li 28, 19GS.)






                                                                                                              (-ollll)il]S'oll, or 'I-, ilii,, Ill]                 %'olllllill'Y
                                                                                                            i,.,,  ol'                                                                                  is
                                                                                                                                                                                                        'o-
                                                                                          .]I  ol, iil;illN,                                                                    Nr.,",y                 -ily
                                                    gi Miller                          N%
                                                    to g(,t, II                                         (11(ill@t, Ili.,;                  Nv:ts -,oin@o" Io  (livoi            .(@-c    Iiiiii.
                                                                                   ill@   I   v       l@l-, of
                                                                                   II)        lef"ll                                       li@tlf%irty  liotise,.@  iii   operation
                                                    (10 iiotl II',('                               to l@VI) @ll                        residpjlcc.  At-,  trip,  proseyit  tiiyie
                                                    ivo,    liaN-(,    ]amid     iio
                                                                                                 you   very   little])   wave                                       your   help   to    tlio
                                                    coiiiinittee.
                                                       T te. r(,cor@l niiv Stay ol)c@ii  f(@i- 5 (I;t.@,s for ,tliyo                                               1,41         t  St       ll('Il    t,.

                                                                            lio        otli(,I.




                                                                                                                                                                 ANll@lti(;AN                 Nxiit.,;Es'
                                                                                                             ASSO(@IA-l'ION,  IN(!.
                                                                                                                                          lo              II,,,    Sillil)ol.t     of
                                                             of ii.it. -1.7i75-S wlii(-Ii Nvill 4,xli,ii(i ;iiiti                                                               tll('       Itt@,@ioll;ll
                                                                                                                                    l'ol- Iit-:III 11 or, liiigi,ittol-Y                                iiii(I

                                                                                               lt(,gioil;il                                                                     is   011(@    (@    111(@
                                                    V(@1-y                                                          I)y tli(@                       ill   111(@   ]:Isl@    I'('W                       It is
                                                                               til.,It   it    ]],'Is    great    liot'i-liti:il    for    ill;[](Illg    illol-(@    1.(,:I@lily                       to
                                                    t,ii(@ 11(@ol@l(! of this (,-ollllll-Y  tile                          ol' tll(@ liitesi@                        ill     111(@                       of
                                                                                              tji(i      ,;troke      aii(i                                                                             :iii(i
                                                    other  lic:iltli                            ]lave     tli('      ol)l)( 11-tilility     tIlroll"il     t)ie     lit-opl.:Ilyls      to      1)(@eol))L'
                                                    familiar  N\@ill@li                                     all(]  to  Iii)(iiite.                stairs     it)      c@iriiig      for      I)qti(@iits.
                                                    The     I)ro@l,r,,inis     leave     fiirtlierstliziul,.ited     cool)ei-atioii      I)et@i\-ceii      iiicliil)ers      of      tli(!      lie@iltli
                                                                                                                                                  lit-.y       (If       servi(,-e       to       people.
                                                         ft,vsioxis     ii     they     prepare     to     give     t@lic      Iiigli(!st      qiia
                                                    pro
                                                       Tile     legislatioll     iva.-     devised     as     a     incaiis     of     re(iii(@iiig     tli(@     gap     1)(,4twceli     care      I)os-
                                                    sible In ft i-ne(liefil center 'and tbit available to I)er,,4t)iis r(,iii(oL4, froii)  th(-
                                                    'I'o                  this  end W(.  ]lave encouraged  iietiiv(,                                                    of       the       regi.@t(@i,(,d
                                                    iiilrq(,    ig    a    itic?iil)er    of    the    licaltli    teiin    III     botli     tli(!     planning     and     tile
                                                    tioll (if tile ],,i@v.
                                                                                                                                                                        gi-iillt,4  lot-  11(@:i  11   11
                                                    orIII!gi-111(@l@y \VI                     NV4@ II I.g(, t I II II, ti Iis(-Nt4@iisi A)II 4) I'II i4@              I great II  l.4  for  ll('41]i  II



                                                                    Ill  1)('  1111'4'4@  lilil(@q  fruit,  ot
                                                                                              Billions                                                      lit  Initial                   rill1iiii(@s
                                                                  III)                            oi.  tell(.             Ill              4@r            ;Is                       @villi              Ill
                                                             .41                fliiliilit,.,4.                                        lo Ill,
                                                                          ill  (11(@                      or.  114,111111  Haiti
                                                    fl-4@il ItII                   goN.(@V                                III. i%l:l I lv St II (4'S III( II I (,II
                                                                                        "(, of ill,
                                                    sll(.Ii                                          .411111,.i(,Ikl                       Also, (,Iigil)ili(@y i(@                        iit<41ii-itl
                                                    ,@11141  ]until                                                                   l@y     ill(,                                                     (of it
                                                                            [Digital,  i'iiriii                        iiiov(!       fi-oiii            Ilo    N(iit(,,     (,4t@iil)lisltiiig     r4@si-
                                                    (]('Il(-Y is                        ]lot  J)o'.ASII)le.
                                                                 Ag,.,o(@i.,itii)i)              sii)il)orts     'I'it'le      Ill      of      11.1t.      157.7)8      wlileli      proposes      coti-
                                                    st,i-it(,t@ioii gi,njits and Shifting, operation and                                                        91,4111t@,'4 for                        for
                                                    [II(,     tr(@:@1(iiierit     and     r(@liil)illtiitit)ii      of      iilcolioli(,      all(]                       fl@l(licts.
                                                                                                                     orably on II.R. 157'j&.
                                                        We ur,-e the Cominitteeto act fitv










                                                                                                                        of   Sll(-Il                    N%,oii](I I)rt)iijot(@ t,)j(!
                                                                                        I ioll of iiii@4ii(.:Il                       @111(i sl@IIJ.,i I ]it-oligliol
                                                                                                                                             ill                                          of
                                                                           I)f I[(,                                                                                                            ill t
                                                                                                                                                                              4)f        tlii"q is
                                                                                                                                                                                            of      Aiiii-i-i-

                                                                         ill(, fol't@gOilIg                                                                            IO.@   1.)c   retiiiied   in   tile
                                                                         r(, tit.,It I,,                 out by N?
                                                                 It   is                     tlkiit t         jo@t@
                                                                                                        Ills          r be iiieliitli-(l  Ili  t@ii(@                                  rig.4     Oil     ii.n.

                                                                   lol)@L qll(l I)i@st

                                                                                                                                                         SPAITIC. Ill. ATATSUNAGA,
                                                                                                                                                                    jlfcntbcr of Congi-i


                                                                                                                                    A@ll-@lttCAil  I.-IOSI@ITAL ARSOCIATION,
                                                                                                                                              IV(zghingto?t, D.C., Marclt 26, .1968.
                                                            11011,     IIAII.1,LIY     0.
                                                                                Itit(!)-st(ite aiid le'oi-eig?t Coi)@))ierce Coi@iltlittce,
                                                            House of I?cl)rc.3ciif(itii)cs, IV(iihinflion, ]).C.
                                                                                                                                                                    flip    views    of     tile     All)(@rl-
                                                            (-:Ili Ilt@sl)ili@il                          oil 11.1t. .11-)7i-@8 wlii(-Ii ,tiii(,iiiis t'lie Iltil@li(!                              S(@rvi(.,e
                                                            !%4.t @o ;Iq to 4@xt(!]I(l :II)(]  ilillirov(t 1,11(!                                                 to I-egiolial                          Pl'o-
                                                                           to  CXI,(-Il(l  ill('.  :11]tll(kriziition  of  graiit@,;  f(@t-                            of      illigrilt,ory       agrl(,,iil-
                                                                       w(-i-lc(@rs,  to  I)i-oN,i(le  for                                                  f(oi-   ltl(!ollolics    iii)(I    iitire(otic
                                                                           @ilitl for oi:ll(,r


                                                                                                           It[,,'(iIONAI,

                                                                                               st@i-oiigly                                                       (If  t@110  l(@,iS'IlltiOll  WIliCli
                                                                                                        W(@
                                                            Nv(, felt  ivt!r(,                        lo  tile  mount                                                  of  1114@
                                                                                   Ili Ili(! Iiiw. We li,']V(@ (-olllillll(@(I to J'ollo%V                                  @ill(I   %vit@ll    gl,elt    Ili-
                                                                              1)r(@gi-(@s of (@ii(@ Iii-f)gr;kiil-.                 1):ist@ INVO                            to   ligiv(@   1)('Oll    ',P(@lit
                                                            ifi llit@ iti@iii@ Ili t@ii(!                              (if j-(-gioii@il                      @iii(i   Ili    tlieii-    T)l@iiiiiiii,@.    The
                                                                             siig(i  of  the   1)rogi-@iiii   is   j-(@4i]iy                      1)(.giliiiiiig ivi(@ii  si  Iiiiiit.(@(I  iiiiiiil)er
                                                            of                 Iiitviiig   b(@(@ii   :il)i,ro@'(,Ii    to    (]:It(@.              gtlf)(I joi@ilillitig is Ili 'Illy
                                                            if-  j,,@  t4)  11(@  liol@(@(I  tll@it  111(@  I)rogr:iin  will  iijoN,(!  f(ii-w:tt-([  r:il)i(ily   Ili   !Is   ,il)l)lie;ition.
                                                                                                          tli(@                  of file, ]file  is to                                              I)etwc(,Il
                                                            tllt,, scit-ile(@  of lll(!(Iieille  iiii(I  it,,  full                                   tl() tile             .111(l   ti-4@,,itillelit   of
                                                            ]).'itielits.  Ill  tile (@oillilig lll()Iitlis, therefore, it'                    is to 1)(! liol)e(I  tliiit,  the
                                                                              will b(@ fell'       by the public Ili t(@riiis of t                                     ,i@l)l)licatioii     of     kiiowl-
                                                            (@(Ige Ili the tr(@.,itiii(-@jit of tli(,@e                             covei,(@(I    iiii(lei-    the     t)i-ogr4iiii.     We     iii-ge     the
                                                            Cojjiiiiitte(@     to     ,iiit@liorize     the      full      iiiioiiiit                  for    the     I)i-ogriiiii     foi,     the     fiscal

                                                                         As,,oci,,Ltioii  li@is  coiit@iiiil(,(]  to                    tli;[(@  iiiil)](,I)I(@lit@ilioll  4)f  111(@   ]lit@(@lit   of
                                                            '1114" ]@l@V W4)til(l                           .1  ]'Ill]  ilivolv(@iiii,iiii  oil  Title   l@@irt   of   I)oSl)it:lls   iiiiil   their
                                                                                                  will                           liot@ ()Illy  111(@  1):Il.t@i(-Il)lltioll  of  ill(!
                                                                                                                                                                              Nitlillf(,r     lio.'Zllilltl.'i
                                                                                                                  NV]ii(-Ii                  @l  f(@(-Jll  114)iltl,                                    ilik(l
                                                            li,i@;itiiit,iii  Ili  .4ii@;iilt@r                                W(,                                                  ill(@    (@xt(,Ilt@     of
                                                                                   or  11(i@I)iillls  @illil  IPIII-ti(-Illlil.iy  t,ll(-  illillilillif

                                                                                                                                                                            4                             ioll
                                                                                                                                              lloi)4'(l  %%,ill               Ili   11   tillit-11    %V](I(@V
                                                                                  or. ll(OSl)ilill-4. I%'(@ lllkv(! also 11(@it.41  lli:it, I'(-I.y lit,il(@                                1111H
                                                            9!vt-ti  thus  Pill,  l@4k                                      Ill)(]                                          iiii(i    NV4@    llll4,llql    to
                                                                                                  oil  fill'  I)III-T  of'   1114@   lit)ql)ii@iti   li(-Iil   Ili   I'l@Sit'i'llig   Sll(!Il   11   I)I'ollll
                                                            ill)l)i-oli(-Il  to  flat,                                                       IVI@  will                        to    %v4)1-1(    (-Io@(@ly
                                                            iviiii    auto                             of I'll(! jol-41gi-iiiii ill)(]  to  Will,](  l'or  1,11(!                     1):Il.t,l(@ll)lltlojl
                                                                      lii),;I)itlil ii(.)(I.





                                                                                                            300

                                                                     fully  tll(!  I)lC'I-it  of  tilol'4)11;"Il  I)I@tililil'9  :1.1,  II  I)II@@is  fill.  tile
                                              iiiesit of re@joii:il                                                               of             ilill'.tl    illvoiv(@    tile
                                                                                                                     to   ill(@   illil(@"SI"4
                                                           ]low(wer,  tli(-  C(@iigr(,s,.                                S!) 711)  iijiti:lt(-(l
                                                        to  1)(@  llivt)lve(l  ilk  ov(,I.-:111   11(@:iitll          III)(]   iii
                                                                          qli(l                    It  i.@ (ilivioll',
                                                                   Illtililill, lioNv i-xi!;t"4                                                   4111(i fi-I)III  r(.I)ol@t,,,
                                                                                    just, IiI-.,illliilig t4)                     1114, l,iiiil'iisillil  I.(@silitill,
                                              1,; to 114,                 ilk  :III   ol-(I('I-ly               :Illy                               (@olilli(.I,   ii@11!4t   1)4@
                                                           At@                like                  iii-ovi@ii)li,;   4)    fill-
                                                                        rol,4]ojllill:llioll     of      tile
                                                                                                                          "I(.Iioll     to
                                                                                                1.4,111iii-ili@ 111:1(,  llit,  4-1
                                                                                                            ,iii(i tli(@  rt,siilll ., of  tll(!  I)IIIIIii,ifig
                                                                            ill
                                                                                 to                     111(@                     of 111(@                Coilll(-il       fl-ol)l
                                              t"-I.lv(@  to                                                 -to                   filrtil(@l.  tll(,
                                                                 I)Ltw(@(@ll tlii,, ilrogriiiii .11141 tile                                                                 I)ro-
                                                        NN-t@  ivoill4l   III-go,   til.'It   @k(l(iitiol]411                            of
                                                          to ill(-Ill(le iii(livi(lii:lls directly elig:ig(,(l !II                       @ll)(I  @t@tte   WI(IO
                                                        :tr(,@           to  pole  that  tli(@  ))III,  as  ill  tile  ori,,,iii@il  A<-t,   (lot-s   iiot@                      to
                                              fiiitliorize fiiii(Is to l@t@                              for                                     The    i@ro@aiii     i@     o@
                                              sii(-Ii  niigiiit@ii(le  that  w(@  1)(!Iieve  the  fiiii(il,  llioill(i  1)(@                    'for   tlke    ol)Or:ttiozi,,ti
                                              Pll:ls(,s   of   til4@   bill.   Furtlier,   we   feel   it   wolil(I   be   iiiiwise   to   (Ilil)li(@ate   the    coiistriic-
                                              tioii  qiitliority  n(@w  T)rovi(li,.(l   fi)r   lit   otlier
                                                        I)ill r(@(Iii(@,,;ts  cl,,irif'j(,atioii  so  tliit  griii)ts  i)iiiy  1)4'                  t@4)
                                              iil.,4!t,iitioiis  for  ,icrvi(.es  -,Vllj(,Il   will   be                 to  ll%%,o  o),            r4,gioiliil
                                                                              v;irioiis                     wili(.Ik (.;Ill 11(@ (14.v(,Iol)('(l llio'.,t, (.
                                                              fol- liirgi-r areas tliiiii @v4)ii](I II(,                                           slilgi(@                 lv(,.
                                                                          tile t tile II 111,11(ol-i t y I o Hill li(@ gi-ii      II



                                                                                                                                                                            Slill-
                                                                                                                                                                                 zis
                                              14)  l@l'i'lilit@                   liolilitili.'4  f(ii                            iliigl.:Itol-.N.               itil(i    till'il'
                                                                                                             lii:14i(. ;Irt(,I. :I 4til(ly (11, (11(@  1)1.41101(.Ili  (11,
                                                                                                                            l'otill@]   -likill   l@oS]Iillii,4    Ill    @-iii-ifilis
                                                        of  1114@                                Iii-OV141ilig
                                              i\-iiii very @iziiiiii, (-o@(,, foi-                          iiii(I for            ill)                          Nv@is
                                                                                            Very              treat, tl)4@                   I)I.ovi(l('(i fittLitS
                                                                                      for
                                                  'iiq@  iii@ijol. liol-tioll  of  111(@  filli(IS                                                              go   i'l)l-    lit('
                                                                                                                                                          it
                                                                                                lo  rely  foi,  iiii@:iti(@tit@  Iii)@l@it:il          We iirg(@,
                                                                                                            I(](.l. tile ])ill I)(.               lo   lit
                                                             $;-),(X)41,00oof. fli'is:tillolillt-,                                fol.
                                              l@rovi@Iiitg                    care.
                                                               of liii1it(@(I fill)(18, ill(' :I(Illlilli@tl-:itor,, of  tll(@  I)].ogi-iliki  liliv(@
                                                                                                                                                                                 'III
                                                           piiiolic                I)r(oriiiii  f(pi- iiiii-iiiit.,4.                        110 l@l-oviqioll has
                                                        for                     to  migratory  -,vori@(,r,,-   la   [riiisit   I)r   III   areas   of   t-lie,   colilitry
                                              \Vlli(.Il    li@l(I    no    over-all    pill)lie             livogi-.iiii   for   iiiigriitts.    ']'he    Jiier(@a.-@d    ,Ill-
                                              tIloi-izttion  wlti(-Ii  we  liav(@  rccoiiiinell(](@(I  -lioll](I  eii;il)l(t  tl)4@  11(li1iiiiisi@rators   of   tli(,,
                                                             to I)roviti(@ iiii),,itieiit hospital eni-e to iiiigi-4iiit'.,4                                 l@t,  is  n(@(le(l.
                                                             we   rf,(-oiiiiii(,Il(l   tliit   the   1)rogriiiii   be   aiitlioriz(-(l   foi-   a   1)(,-rio(I    of    flair
                                                                 (I of Lli(@ two  years  (-.II  I  l,@(I  forin  the  I  II  II.
                                                  ll,(@ ll:lv(! )ko (.olnni(,iit at this tiiiie oii otlierprovisioiis oftlic ))III.
                                                  NVP,   Nvoiil(I   nl)l)reciikto   your   making   this   4(itteiiiciit   a   1)art   of   4@lic   reeor(I    of    tli(@sc,

                                                                                                                                  l@i-,NNI,','rll  Wlt,T,TAWTSO,';,












                                                                  11011. I[Alti,l@:Y  0.
                                                                                                    (III(I  l'ol
                                                                           of                                117(ish i)itito)i, I).('.
                                         0                                    Ilit.  S-i,.k(;(;i,;i:s:           N:tti(@ii;il                            :tll(l      lt(@pll-;Itol-Y
                                                                                                   to            its              1,4)1,    (.oltliflll@ttioll    of     lt(@gioll:ll               111-0-
                                                                            :is                     for  iii ill,.               All,liotigli  l'i'ogj':tiiis liiiv("
                                                                  vt,l(o]@iiietit:il,   r(,I)orts  t)l'                      tlirt)iiglioiit   tli(,@  coiiiitry                          tij@tt       tli(@
                                                                  lil;lj(@rity  Nvill  Silol'tly  l@(@       iiiiti@tt@iiig    ol)(,i-:illioti@il     ;i(-Iliviti(,,,.     R(!I)t)rt@                  @ill
                                                                                          oil   tll('            of                                      witli   this    Fi@(I(@riLl                   to
                                                                  fiilfill tli(-, I)lirl)ose.,4 of tli(@                                         t@li,,it [lie Aii)ericiii I)iiiolic
                                                                  iiiil)roN-(!(l    iiie,(Ii(--.al    ,;(@rvices     tliroiigii     coor(iiiiited     aiid     inore     (@trici(,iit     (I(,Iivci-y     of
                                                                    Aiitlioriv,@iti(iii for fill)(Is iiili,,,t lie                             to     ilit@('t     Ilic     growing            of     tllo-
                                                                                  ill til(@ 11(@-,t few ye@ti-S if tll(@y lir(@ to                           l.iieir   goal.   ']'lie   iiioiii(@iifiiiii
                                                                  of'   this   F(!(](@r,,il    I)rograiii,    wliicli    illvolv(,.,;    rel;it@iolislill@s    Nvitl@    ]Italy                     Bell(]
                                                                  gr@)iil).,4,   is   :i(@eeleritiiig   ,is   operitioii@il   4i(@tiN,jti(s   ,ire   (Iiie    to    1)(,giii.    Itea(iiiies,;    to
                                                                  I)erforiii will  I                        I)Y   tlie   qiiioiiiit'   of   F(@(ler,,il    fiiii(l,,    ivall@il)le.    Tli(@i-(,for(@
                                                                  tl)e  Col)lllliti(,(,  @I)OIll(I   (.oll.@i(](@r   wli(,(Ii(-r   or   iiol   tl)(@   gititlioriz:itioii   of   $(;:,)   iiiillioii
                                                                  for lis(,iil l')(;9 is l@irge ciiougli to I)eriiiit iiiil)](-iii(!iittitioli of tile exteiisii,(@
                                                                                  ov(-r tile I)a.,;t few ye4irs.
                                                                                                    ilito ol)el.:Iiiolk@ll ll('(iN'iti(,s                  of tile gl,(,@it,            t@o     iiiiljrit%-e
                                                                         .(,s foi- efiroiiie I)iiliiioii:iry                                             At tiiki(@ of                    iilg     ftiii(I.9
                                                                                                                            tii:tt                       oil(' iiii(I  I,A-%-o  ])Iillioll  (11)11"11.s  I)c
                                                                  Iii(@ itiNIll ,il)l)rol@ri:itit)ii for tli@it )T:ir 1)(,                               to   (,Iii-oiiie   ri@sliii-ittory   (li@(@;ts(!
                                                                     riii@     N'I'Itl).@     li,,itl                 sll(.Il               I)Y  (,ollgr(@,,s                       of  the
                                                                  ,,it tl;l t ioli                  -is 'Lll(l                  4):,
                                                                                 ill       fli@igilos
                                                                                  of                        till", so                        11141t@  it,  li@is  l@(@colike  111(@
                                                                                                  for                         jll.(@  gi,@iiit(-tl   14)                Nvlio   iii-(@   j-(-Iireti    for
                                                                  (Ii,;iil@ilit,y l@i,loi, to  ig(,.  4;5,  ilt@  fill  liflilll:ll  (.osl,  (IC  :11)olll'$Im@,1)00,000. 01 II(-I-                    of,
                                                                  I)IIII@iol@ill-Y                         Sll(-Ii ITS                                                              iiii(i    r(,sl)()iisi -
                                                                  1)1(@ flir iiilicii               iiii(i                                                fi-olit (-llil)IIYS(-Ill:t                II(.ell
                                                                  (loiil)liii@,,iii)l)roxiiii,it.(@ly (!v(@ry fi%@e y(@@ii-s iii ill(!                     1)@ist  aii4l  ,ii(@i)g   witli   @i,,tliii)it
                                                                  .Ill(]   (!Iiroiiic    bi-oiicliit:is    iiow                     ill(!      f(,itt@li
                                                                                                                                                                 of   (lei(ji   ill    tile    IJI)it(.(l

                                                                                                    of  tll(@  (.11rollic                                               -,itil@itioll                  the
                                                                  llill)lie lle:tilli  @ervi(-c all(]  tli(i N:itioi):il
                                                                  As,,o(!]@,itioii to  coiiv(@iie  ii  11'2islc  li'oi-(@(!  iii  tlit,  l@Aill  of  I()Gf)  to  (lisciiss  lioN-,r  t.lic  coiitrol
                                                                  of   tlie,,,e   dise@iies   coii)(I   1)(!   iiiij)rov(,(I.    Tile    crit@i(!,,il              Ill   iiie(li(,,ii                  for
                                                                  I)atieiit-,,  -I)e(,@aine  i   fociis   for   iiiii(,Ii   of   the   (lis4!us,.4ioii   tnd   tell   to   oiie   of   the   q',q@Ic
                                                                  1,7orce's   iiiiijor    recoiiiiiieii(littloiis;    n:iiiiely,    tli@it,    I)t-ovi,,;ii)li    1)(,    iyi,,i(le    for    I)tziiiioiiary
                                                                                                    .    ,    re,,I)iritory-cire    iiiiit,    ,     Iii)i
                                                                  fiiiietioii          Iiik@oratori@                                       14            tic-ciire,   nii(i   reliiiloilititioii    I)ro-

                                                                                             t,liat  tli(,   li@ck   of   stieli   i-esoiir(-(N   !,.,   wi4lcsl)rea(l.   Al@iziy   ctjii)iiiiiii@,ty
                                                                  I)oS])it4ils :11-0                \Vil@llout. the                      ill)l):Ii."Itlls ti) tilk(@                of  S(@l-iollsl.,v   ill
                                                                                                                                                            I)I-Ogrill)is     exist     ill     ol)IY     it
                                           A                      small                             of  (@ill-  g4@11(@1-111                 Nvllil(@  Olltl)llli(',Ili;
                                                                  I)III,V  '(  flill  role  ill  I-(']Iil)ilitillioll  .111(l   colijis(@iiiig   t)l'                                          1):kti(,iiis
                                                                       N,irtiiitlly
                                                                                    (.otillllllllil@y                   is                               11    108.q    to    ili@ll)               NVii1l
                                                                                                                                                                lio','I)itliliziltioll                 ill(-
                                                                                                                                    K('iiei-iii                                     vi(-tiiii   of    ill-
                                                                                                 ioli              (if Ill(!                  !it  111(@  rise of til(-S(@
                                                                  il)(@          of stil@(@rN,ist(iii                                     iiiii.i(@ikl@s  froiii  ii(,@iite  itil'i@(,Lioiis  iiii(I  to

                                                                      It;  is  0I)N,iolis  Ilisit  (lirt-(-tioi)  iiii(I  ,,iil)t,i-visioti  oj'  Iii'gli  (Iiitilit.y  eiii-oiiif!  i-esl)irittoi-y
                                                                                1))-ogi-iiiiis  iiiiist  Ill!  lirovi(le(I  I)y                          s(,Iiool.4  iiii(I
                                                                  1)(-iiioiisti-@ttloiis  of  pat.i(@tit  (lisigiio,,,iH  iiii(i  tr(,iitiii(,i)t  iyiii,,4t  Ile  I)rotiglit,  i@o  tli4@   (,oiii-
                                                                  iiiiiiiit.y  I)rit(!titiojier  (@lirotigli  cojil.iiiiiiiig  e(iii(-@tt@ioii  (-oiirs(@s  otl'(@i,(41  I)y
                                                                  institiitlojis        antl        facilities.             Iti,gioiiiil     M(,(Iicitl     Ilrograilit4      Offer      the      ]post








                                                                                                                                 ill       illil)l.ovili;,,               fol-

                                                                                                             of

                                                 I                               of'                     ill     I)I-ollloiillg                li@ili('Ikl                     lill@
                                                             @ls@o(.illtiolis                                                (@4111(.:Itioll  ill  iiiiiiiioll@il-.)7
                                                                                   tli(@              for

                                                                                                                                                              for llilt)IY                ill
                                                                    iii(Ol'o'                                                                                 )it  ill(@                I%Iityl
                                                                                         ill  ,I  1)()"ilioll  to                  (II(- (I(-ilt-lli ol' 11(@ll) f(ii-
                                                 ;tiiil                                    li:ltii-llts     to(l:ly     Zill(I                 (if   fill,,,   111(@y    \Vill    1)(!    goo4l
                                                                                     i(O lii(@ It@1111 la                             tli(!    iii,gi@jit            of       r(,sl)ir4itol-y

                                                                                                                                    ,4(,(,Iioii of l,li(@ N:it'loiiftl

                                                 st:iii(iiii-(Is ,tji(I                                                                                                                   of
                                                 ("11,   i)]",@lliiz;ltioll   will   coiiliiitie   to   Avol-l@   closely   N@@itli    111(@    I)iN'i,@ioll    of    lt(,giciii:il
                                                                  lli,ot,,r@iiiis   to   proi)iote   Iiigli   stiii(l@tr(Is   of   (1i;ii)osis   @iii(I    (!;ire    for    cliroiiic

                                                                                                         I:h(@                  ill  11.1t.  1,57.,-Pq  to  eNp,,tii(l   the   iiiiiiil)er
                                                 of                                                   froiji     tNvelve     to               At tl)(, tiiii(@ Coii,,ress
                                                         ili;@t Iti(,Iltlioll 1)(,, I),,Li(i la Itegioii.,il                         Ilro.,r@iiiis     t@o      cliroiiie      respiratory
                                                                  it :also                       thrift   oiie   of    tli(@                    of    fli(@    N,,itioii,,il     A(l@ri@ory
                                                 Coliti.-il ll:lNre coillioct(,Ilee ill tliis 1),trtietil:tr iii(,(Iic@il                                 10xpiiisioil     of      Cotiiicil
                                                 2iii-iiii)(-rsliij@   NN,Ill   provide   iiiorf--   ,4eol)e   for   cii.@ilriyig   i-t@I)res(@iitiitioii   of    the    varioii.,4
                                                                                                                                                                         I(,tlivities      of
                                                                of                 AN,Iiieh  are  of  necessity  iiivolv(@(I  la  tli(@ iiiiiiiy
                                                                                 Ilro,,rgiiis.
                                                     AV(' IIU(-Stioll if@ CN,:tli'iitioii             of     Progrqiiis,     as                   ill  S(,(-.Iioii  102  of   tli(@   Ijill,
                                                 Slioill(I   1)(@                                I)Y tli(@                          %voti](1              iiiore     sittisf:icti)ry     for
                                                                                       of 1114,W ,ii)(I the I)til)lic, t,o                                    sti(!Ii  (@v;iliiittioit   I)e
                                                          i)N- olit8i(l(- gi-oll))S.
                                                             ;ij,(@                  la  siil)l)ort  of  (@xt(@iisioii  of  gi-@iiii,,;  fol. lit,lil@li
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                                                                                                                             Aifl@it[CAN I )I@,N,rAy. ASSO(,'IA'VION,
                                                                                                                                                          D.C.,   Jfa?,(!7i,    27,.1968.
                                                 1101). JOFIN JAI@NIAN,
                                                                                              o?i, flitblic                         lVi!7f(tt-c, Coikt,,)n,ittce oil
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                                                                  ,iiid   Strok(t   Aiiientlyneiii@8   of   11)65   filed   the   Aligrttiit   ll(,jilt@li   Act   of   l@1)()2,   as
                                                     As  ])art (@f  It's (@oltililitilit@lit l@o  il)kl)l.oviiig tli(@ lojitl  Ileititli  of oiir                                         tile
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                                                             vi(,@vs    oil     t@Iiis     legislitioti     iiiid     respectfully     requests     that     tlii,3     It@tt(,r     t)e
                                                             the     re(,oi-fl     of      liearii),-s.
                                                                        Sli)cer(!Iy            your.,4,

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