D E P A R T M E N T   0 F   H E A L T H,   E D U C A T I 0 N

                                       A N D  W B L F A R E

                                    National Institutes of Health

                                Division of Regional Medica I Programs











                                    National Advisory Council on
                                      Regional Medical Programs








                                          Minutes of Meeting

                                          August 28-29, 1967




                                   ..Iiational Institutes of Health
                                           Conference Room 4
                                              tuilding 31







                             DEPARTMENT OF !IEALTI-1, El:,UC@,.T-J.ON AND WELFARE
                                        rul:3LIC HEZ@LTli SERVICE
                        NATIONAL ADVISORY CON.'CIL 01@ REGIONAL MEDICAL PROGRAMS
                                   Minutes of Nintli Meeting I/  2/
                                         August 28-29., 1967

                   The National Advisory Council on Regional Medical Programs convened
                   for its ninth meeting at 8:35 a.m., on Monday, August 28, 1967o
                   in Conference Room 4, Building 31, National Institutes of Health#
                   Bethesda, Maryland.  Dr. Robert Q. Marston, Associate Director,
                   NIH, and Director, Division of Regional Medical Programs, presided
                   for Dr. William H. Stewart, Surgeon General, who was unable to
                   be present at the meeting.

                   The Council members present were:
                     Dr. Leonidas H. Berry                    Dr. Clark H. Millikan
                     Dr, Michael E. DeBakey                   Dr. George E. Moore
                     Dr. Bruce W. Everist                     Dr. Edmund  D.  Pellegrino
                     Dr. John R. Hogness                      Dr. Maclt 1. Shanholtz
                     Dr. James T. Howell


                   The Council members absent were:
                     Mr. Charles J. Hitch     Dr. Alfred M.  Popma  Dr. Cornelius H. Traeger
                   Public Health Service members attending some of the sessions included:

                     Dr4 Gilbert R. Barnhart, Bureau of Health Services
                     Dr. Ronald G. Basalyga, National Center for Chronic Disease Control
                      Bureau of Disease Prevention and Environmental Control
                     Dr. Lionel Bernstein, Veterans Administration
                     Dr. Burnet M. Davis, National Library of Medicine
                     Dr. Gerald Escovitz, Bureau of Health 'manpower
                     Dr. Frank Freeman, Bureau of Health  Services
                     Dr. M. H. Gordon, Office of the Surgeon General
                     Dr. E. P. Offutt, Office of the Surgeon General
                     Dr. James A.,Shannon., Director, NIH


                    Proceedings of meetings are restricted unless cleared by the  Office
                    of the Surgeon General.  The restriction relates to all material
                    submitted for discussion at the meetings, the agenda for the meetings
                    the supplemental material, and all other official documents.
                    For the record, it is noted that members absent themselves from  the
                    meeting when the Courc-'-.l is discussing applications: (a)-from  their
                     r i.,
                    only when the application is under individual discussion.




                                                                                 -2-

                        Liaison irc-mL@ers attending
                        Dr. Murray M. Copeland, NCI Council
                        Dr* Edward W. Dempsey, NICT@,S Council
                        Dr. John B. Hick@iia, Nill Council   (absent)
                        Dr. A. Earl Walker, NINDB Council
                        Others Attending-
                        Dr. Philip Anderson, NIH-OD
                        Dr. J. H. U. Br@,,7n, NIH-NIGTI.S
                        Dr. D. C. Murphy, NIII-DRG/GA
                        Dr. R. L. Ringler, NIH-Nill
                        Dr. Mathilde Soloway, NIH-NIIIDB
                        Miss Pauline Stephan, NIH-NCI
                        Dr. Richard Stephenson., NIH-OD
                        DRMP Staff-

                        Mr. Stephan J. Acke  an
                                         rm  $ Chief, Planning & Evaluation Branch
                        Yiro James Beattie, Chief, Grants Management Branch
                        Dr. Robert 11. Bucher, Office of the Director
                        Mr. E. M. Friedlander, Asst. to the Director for Communications
                        and Public Information
                        Mr. Charles Hilsenrothp E%ecutive Officer
                        Mrs- Eva M. Handal., Committee Management Officer
                        Mr. James Lawrence, Financial Management Officer.'
                        Mr. Maurice Odoroffp Assistant to the Director for Systems and
                        Statistics
                        Mrs. Martha Phillipst Chief, Grants Review Branch
                        Mr. Robert L. Quave, Administrative Officer
                        Dr. A. M. Schmidt, chief, Continuing Education & Training Branch
                        Dr. Margaret H. Sloan, Chief, Program Development & Assistance
                        Branch
                        Mr. Karl D. Yordys Assistant Director
                        Miss Rhoda Abrams,'Planning & Evaluation Branch
                        Mr.'Ira Alpert$ Program Development & Assistance Branch
                        Miss Sheila Beach, Committee Management Office
                        Mrs. Marilyn Buell, Grants Review Branch
                        Mr. Peter Clepper, Grant-s Review Branch
                        Dr. D. J. Corollo, Program Development & Assistance Branch
                        Mrs. Elizabeth Fuller,  Office of the Director
                        Mrs. lq. V. Geisbertf Resource Support Section
                        Dr. David W. Golde, Continuing Education Branch
                        Dr. J. H. Hall, Office of the Director
                        Mr. Lauren Hellickson, Resource Support Section
                        Mr. Arthur Hiatt, Planning & Evaluation Branch
                        Dr. Frank Husted,-Continuing Education Branch
                        Mr. Robert Jones, Gra
                                         nts Review Branch
                        Mr. J. S. Kakalil-1, P'.aniiing & PNralti,)ti..on Branch
                           Kooatz,
                        Mr. Ro G. Lindee, Office of the Director





                                                                                 -3-



                      Miss Elsa Nelson, Continuing TOucation Branch
                      Dr. R. F. Manegold, Office of the Director
                      Mrs. Erii.ly 14acAfee, Continuing Education  Branch
                      Dr. Hurl)ert Mathewson, Continuing Education Branch
                      Mrs. Patty McDonald, Grants Review Branch
                      Dr. Ian A. Mitchell, Proaram Development & Assistance Branch
                      Miss 11. L. Morrill,  Continuing  Education  Branch
                      Dr. R. M. O'Bryan, Program Development & Assistance Branch
                      Mrs. Suzanne Pau.1, Planning  &  Evaluation  Branch
                      Miss Leah -@nick, Systems & Statistics Branch
                      Mrs. Rebecca  Sadin,  Continuing  Education  Branch
                      Mrs. Jessie F. Salazar, Grants Review Branch
                      Dr. J. Schneider, Continuing Education Branch
                      Mr. J. T. Simeone, Grants Ilanagement Branch
                      Mrs. Judy Silsbee, Continuing Education Branch
                      Mr. A. Strachocki, Program Development & Assistance Branch
                      Miss Charlotte Turner, Continuing Education Branch
                      Mr. Stephan Walsh,  Planning  &  Evaluation  Branch

              1.  CALL TO ORDER AND OPENING REYIARKS

                   Doctor Marston called the meeting to order at 8:35 a.m.

             II.   ANNOUNCEIENTS

                   Doctor Marston made general announcements about the Service Desk
                   and called attention to the  statements  on,  "Conflict  of  Interest,"
                   and "Confidentiality of Ileetings."  He  announced  that  there  would
                   be an Executive meeting of the Council at  noon  on  Monday  when  the
                   Council would be joined by Doctor  Shannon,  Director,  NIH,  and  the
                   liaison members.

                   Doctor Marston then discussed the reorganization of the Division
                   of Regional Medical Programs, and introduced additional staff
                   recently recruited to the'Division, including Dr. Richard F. Manegold,
                   Associate Director for Program Development and Research;
                   Dr. Alexander M. Schmidt, Chief, Continuing Education and
                   Training Branch; Dr. Richard B.  Stepit@nson,  Associate  Director  for
                   Operations. Doctor Marston  also  introduced  Drs.  Robert  M.  Bucher
                   and Jack H. Hall who have joined the  Division  to  work-in  the  areas
                   of operations research and systems analysis; and Mr. Robert G.Lindee
                   who will spend several months with the staff focusing on the revision
                   of the "Guidelines."  Dr. Lionel M. Bernstein, Director of Research
                   Service, Veterans'Administration, was introduced as the new
                   Veterans Administration liaison representative.  Dr. George 9. Moore
                   was congratulated on his appointment as Director of Research for
                   the New York State Health Department.  Doctor Mdore's  office remains
                   at Roswell Park.

                   The Surg@on General'-- P-@,ort to ti-,,-                 Cop-r-,res,,i T,7as







             111.    CONSIDER-,ATION OF FUTURE
                     The Council reaffirmed the following-dates for future meetings:

                                          November 20-21, 1967
                                          8:30 a.m.
                                          NOTE LOCA-ilOlq:  Conference Room "C"  Stone House

                                          February 26-27, 1968
                                          May 27-28, 1968
                                          August'26-27,    1968
                                          November 25-26, 1968

                                          All of the above will be held in
                                          Conference Ro
                                          beginning at 8:30 a.m.

               IV.  CONSIDEIUTION OF MINUTES OF MAY 1967 MEETING

                     The Council unanimously recommended approval of the Minutes
                     of the May 22-23, 1967, meeting as written.

               V.    COI-IFiEi\rfS FROM LIAISON ATIZERS

                     None of the liaison members had comments to make.

               VI.  REPORT ON APPLICATIONS WHICH WERE COI%TSIDERED AT THE MAY COUNCIL
                     14EETING

                       APPLICATION   NO.                            REGION
                                                 .AWARDED


                     3 S03 RII 00015-OIS1                     Intermountain
                     3 S02 RM  00019-OlS2                     California
                     1 S03 Pd4 00037-01                       Wisconsin
                     1 S02 @l  00042-OIR                      New Jersey
                     I S02 RM  00057-OIR                      Mississippi
                     1 S02 RM  00059-01                       Susquenhanna Valley
                     I S02 114 00060-01                       North Da ota
                     I S02 101 00061-01,                      Illinois
                                        RETURN   FOR   REVISION

                     3 S02 PM  00006-02SI                     North Carolina
                     l.SO2 Pkl 00062-01                       Massachusetts New Hampshire
                                                               and Rhode Island
                                              DEFERRED

                     3 S02 Pd@i 00003-OIS2                    Northern New England
                     1 S03 RM  00003-01                       Northern New England
                                             DISAPPROVED






                                                                                  -5o



           VII.  PROPOSED COtq,',CIL DELEC@KTION TO DRMP STAFF FOR
                   AD14INISTLRATIVE CIIJ@NGES IN ON-COING GIUNTS


                   DeleRati.on for Administrative ChaLi  -, in Amoti ts of On-G,,l  rants

                   After discussion  the  Council  unanimously  approved  the  following
                   delegations of authority:
                 "It is proposed that the Council delegate authority to the Division
                   staff to approve increases in amounts for active grants  for  the
                   following purposes:
                   1. Iiistitution-uide salary  increases,  social  security  and  other
                   mandatory employer contribution adjustments.

                   2. Extension of grant period with  additional  funds,  at  a  rate
                   not to exceed the current rate of support, for  a  period  not  to
                   exceed six months--in order  to  prevent  hardship  to  personnel  or
                   loss of investment already made under the grant, to provide
                   additional time for preparation, review, and approval of a renewal
                   application, or to provide for orderly  termination  of  t  e  grant.
                   Such extension would be reported to the Council.

                   3. Increases of an  administrative  nature  which  do  not  represent
                   an expansion of the program  or  change  in  any  significant  manner
                   the nature of the program, such as increased costs for equipment,
                   personnel, travel,  rental,  and  alterations  and  renovations.  Sue
                   increases would be limited to 15 per cent for any budget category
                   and all increases would be reported to the Council.

                   4.  Rebudgeting of allowable indirect costs to direct costs
                   expenditures with an-equiva,lent  reduction  in  the  indirect  costs
                   allowance (an increase in direct  costs  only,  not  in  total  grant
                   amount).
                   In requesting such increases,  grantees  would  have  to  include  in
                   their justification reasons why the  increased  costs  could  not  be
                   covered through rebudgeti.ng within the current grant.
                   DeleRation for  AdministrLLivq_4TIp;@@l  of  Minor  Expansions  in
                   Activities U der A_p2r@v-@@er4t_L       Re  ional  Medical   Procrams

                   Staff may approve reques4.-s for  expansion  of  approved  activities
                   or initiation of activities  ancillary  to  the  Regional  Medical
                   Programs--up to 5 percent of  the  total  direct  costs  awarded  for
                   the current budget period, but  not  greater  than  $50,000  (plus
                   indirect costs). This annual  limit  would  apply  whether  it  is
                   reached in one or more individual requests.


                   each Cou-acj.'t acL-1011           approval of an  operational
                   grant application.   Requests must be  approved  by  the  Regional




                                                                                -6-


                   Advisory Group and should justify  why  the  increased  costs  cannot
                   be covered through rebudgeting within the current grant.

          VIII.    PROGRESS REPOIIT ON CONTP@ACTS FOR  TRAINING  OF  EDUCATION  RESEARCH
                   PERSONliEL . . . . . . . .Doctor Schmidt

                   At the November Council meeting, it was agreed that it was
                   necessary to document as precisely as possible the beneficial
                   results of educational  efforts  of  the  Regional  Medical  Programs
                   by producing data concerning improved levels of patient care,
                   improved levels of knowledge of health workers, etc.  Also, it
                   has been necessary to insist that the regions produce data for
                   themselves on their  various  educ'ational needs,  goals,  and  methods
                   for achieving the goals, results  of  pilot  projects,  etc.  Without
                   this information, successful  regional programs cannot be
                   designed.

                   It has become evident that the person who can ask the proper
                   questions, design training methods  that  will  allow  the  answering
                   of these questions at the end of the training  effort,  is  in  short
                   supply.

                   Doctor Husted  of the Division staff, has had requests from regions
                   for more than  11,000  man-days  of  consultation  regarding  methods
                   concerning evaluation procedures.  In addition, this past Janqary,
                   when planning and operational proposals were examined, it was
                   found that there were 95 unfilled Regional Medical Programst
                   staff positions for medical educators.  Also, 55 senior staff
                   positions were identified for educational media people, these also
                   being unfilled at that time.  The consensus last November was
                   that the need for these people was critical,  and  that  it  was  not
                   being met.

                   A modest beginning had been made  in  this  area  when  the  contract
                   was made to Dr. George Miller and  his  group  at  the.University  of
                   Illinois  which provides for training of physicians as medical
                   educators. This  contract  has  been  expanded  to  include  training
                   physicians to the level of a Master's degree in education.
                   The University of Southern California  will  soon  be  involved  with
                   the training of physicians in  educational  techniques,  as  well  as
                   involving  professional  educators  in  medical  education.   Another
                   contract is being negotiated with Ohio State which will bring
                   educators into medical education.  Beginning in September 1.967 the
                   Medical College of Georgia, Michigan State) aiid Albany Medical
                   College will have programs to which  the  Regional  Medical  Programs
                   can turn for their.needec-I educational specialists.

                   The various inputs into these programs  deal  with  the  bringing  in
                   of.both  physicians  and  professional  educators.  Physicians   will
                   learn about education, and  the  professional  educators.viill  learn
                   S r@_.,,                                                     Ti-    c





                                                                             -7  -



                  for more programs is evident.

                  The Division has now committed $534,000 for contracts for these
                  purposes, and expects this to be increased to about $750,000 during
                  the next fiscal year.  This stl,-a will support six excellent programs,
                  well distributed, and producing a commodity which the  Regional
                  Medical Programs cannot do without.

             IX.  SALARIES OF PROG@-M COORDIN-KTORS

                  Doctor Marston reported that the Division is encountering problems
                  concerning salaries of program coordinators, and  are  checking
                  carefully on the salaries requesting niore than $35 3' 000.  The
                  Division has not issued specific guidelines on this,  but  have
                  requested the Office of the Director, NIH, for advice.  A
                  ceiling on salaries has not been considered to  be  appropriate
                  since,it might give the impression that all Program  Coordinators
                  should receive the same salary.  The Division hopes that a policy
                  can be reached on this matter in the near future.

              Xs  CRITERIA FOR REGIONikL DA@A . . . . . . . . .Doctor Howell

                  Doctor Howell read a statement on the  quantitative  evaluation
                  of the effectiveness of regional medical programs.  His presentation
                  covered the following essential points:

                  "*,,to document statements of progress quantitatively ... the Council
                  must have available to it reliable data. To establish  the  proof
                  that the effort did in fact close the gap...the council ... needs
                  the support of hard data. We shall try to make it  clear  that.
                  each region must be prepared to quantify and to evaluate its  own
                  efforts...."

                  "Each region should know from the National Advisory Council, soon,
                  that we require in the operation phase, quantitative evaluation of
                  its effort. The intent of the law is to foster  local  initiative
                  in developing programs that fit local needs.  Hence the evaluation.
                  process too must fit the regional

                  "It seems mandatory, therefore, that each regional operational
                  program have the capability of measuring its activity.  At  first
                  this may be quantitative or,.I@ iii.form of counts and in the form
                  of records kept of regional activities, but there must  be  the
                  potential of furthering the measurement of qualitative factors
                  which are difficult to quantify."

                  "If acceptable as a preliminary objective, the Council, through
                  the review mechanism, can require each region to avail itself  of
                  quantitation competence including systems analytical and operations
                  research capability.  It is upon competence in quantifying, especially
                  Systems Analyses (SA.) rri Oper@,.tion-,                       in







                 reliability of regional. data and, in turn, for proper evaluation...
                 SA and OR people have the knowledge and the techniques for studying
                 effectiveness and the means of developin- the requirements for
                 records and data.  There are other benefits which will accrue fiom
                 SA and OR professionals, not the least of which will be a clear
                 definition of the purposes and objectives of the regional medical
                 program,
                     tliere are two main objectives of-, the RIIP which may be  termed
                 outputs of the local system:
                 1.  To improve the gamut of health manpower.  This may be measured
                     by:

                     a.  training programs conducted or participated in;

                     b. practical testing  to  ascertain  that  the  skills  taught
                         can indeed be performed; and

                     c.  records of the  utilization  of  the  developed  manpower.

                 2.  To afford the physician the  latest  advances  in  diagnosis  and
                     treatment in the care of  his  patients.  This  may  be  measured
                     in many ways:

                     a.  the number of patients managed in the program;

                     b.  the number of technical procedures used in the program
                         including the frequency of observations, and

                     c.  the management of the patient, including correctly
                         referring patients to proper medical points and other signs
                         of cooperativ6.arrangements.

                 The inputs for a RMP may be assumed   to be two  in  number  also:

                 1.  The region presents  a  series  of  cooperative  arrangements;

                 2.  There is an input of dollars  from  Federal  and  local  sources.

                 Evaluation may then be defined as the  amounts  of  the  two  outputs
                 obtained for the expended amounts of the two inputs.

                 "The different quantitative approaches in the several regions will
                 be developed locally and may well be innovative.  Compardbility
                 will grow out of demonstrations rather than being set at the
                 National Advisory Council or NIH level.  Two other important factors
                 would be realized:

                 1.  National Advisory Council perception of the progress of the


                 2.  The evaluation process   would re=in in the core of each R@LP
                     and not suffer  from delegation.





                                                                               -9-


                  A sample listin- of measurements which riigtit be employed  would
                                 0
                  perhaps be helpful in initiating regional evaluation:

                  1.  The number and types of cooperative arrangements;

                  2.  The changes that have occurred in health manpower;

                  3.  The expenses related to training programs, laboratory
                      developments,, etc.-,

                  4.  The rates of contacts of the program with patients hospitals,
                      diagnostic and treatment units, etc.;

                  5.  The penetration of the program:  geographical location of
                      doctors involved; geographical location of patients, of
                      hospitals particpating, of training, and degree of depth
                      of penetration in these areas.it

                  "This list could be augmented by each MIP.  Records  would   thus
                  begin with the operational phase.  One can surmise that such
                  records would contain important sociological,  financial,  medical
                  information and feasibly be transmissible within or  even  without
                  the region.  Time, experience, and technical growth would logically
                  give rise to a more complete medical record giving better indices
                  of the health status of persons in the region.

                  "To prescribe a fixed medical record is probably to stultify
                  regional development; thus it would seem that  record  development
                  ought to remain an investigational project  within  the  program.

                  "The quantitation. or SA and OR capability in each operational
                  region would insure the maintenance of proper records, guiding the
                  effort of the RIIP, and anchor the responsibilities of the National
                  Advisory Council to evaluate the progress of a program."

                                            RECOIZIENDATIO',\'S


                  "In view of certain capability and willingness exhibited  in  some
                  site visits, such as, Utah, Wisconsin, and Vermont regions:

                  1.  @Te should ask these regional programs to develop analytical
                      projects to measure quantitatively the effects of their programs
                      in terms of the intent of P.L. 89-239;

                  2.  These should represent experimental  programs  in  evaluation
                      and should be funded for SA and OR people to  carry  out  the
                      projects;

                  3.  The staff should visit with these programs encouraging them to
                      do so;


                      si-iould @i v E,, o pLit@ ii: SA an(i Ok, capability in conjunction with
                      the University  staff with which they are affiliated."









            XI. E):ECUTIVE !,IPETING

                                                                               me t in
                                  -4ison Council members,  and  Director,  NIH,
                   The Council, Li@
                   Executive session with Doctor '@iarston from  12-00-2:00  on August
                   2'0 to discuss the transition of  individual  Programs  from    planning
                   to operational. stages; and, the concern  of  Regional  Medical  Programs
                   with metropolitan areas and the related urban health problems.

          XII.     CONSIDERATIC,'-@q C        LICATIO@TS'
                   I S02 Pd4 00024-Olr,2. Flor                      ProRram
                   The Council felt that the  medical  schools  should  be  more  actively
                   involved in the development of the program.  They noticed that
                   the Regional Advisory Council is largely composed of people.from
                   the applicant organization and, as a  result,  might  not  be  able  to
                   function freely in.reviE@-,ii,ng the proposed  activities.  The  adequate
                   representation of minority  groups  is  still  only  very  minimal.  The
                   organization of the program was criticized for being overly complicated.
                   The mechanism for planning  seems  much  too  decentralized  and  vaguely
                   presented.  Finally, there was considerable question regarding
                   the justification of the budget.
                   The Council recowended  that  some  support  for  pre-planning  be  given
                   to the Florida region to assist them in formulation of a more
                   reasonable approach to planning  for  a  Regional  Medical  Program  and
                   eventual submission of a true planning proposal.
                   The Council reccalnends approval in the amount of $200,000 for direct
                   costs for each of two years provided that:  (1) the Regional Advisory
                   Council is made more representative and functional; (2) a more
                   definitive planning approach is  developed;  and  (3)  a  more  realistic
                   budget is submitted.
                   The amountsrequested'vera: $639,753, first year; and $412,525,
                   second year, plus appropriate indirect costs.
                   1 S02 Pll 0006                                                         d
                   Medical Care
                   The Council recommends conditional approval of an award not to
                   exceed $3000000 for each of tv7o years contingent upon a satisfactory
                   site visit to resolve  questions  on  the  structure  and  function  of
                   the applicant organization, as well as the degree of active
                   involvement and representation of regional organizations and
                   institutions.
                   Although this  revised application shows improvement       the   program
                   does not show  community support or adequate representation of those
                   'eateft,orical ilriDtitutinn.s i@-liase supi)()rt i.s essential.. O., the otbe

                                                Ca L
                                                                    staii  may   encourage.







                The Council specifically rec(x.-,,.nendz:, t@at the site visit include
                representatives, not only of the Trustees and the  group  officially
                involved in the present application, but also of the organization
                named which is not effectively -'Lnl.7i-.)Ived.
                The amounts requested were: $80'/,599, first year;  and  $1,870,276,
                second year.  Indirect costs were not requested.

                3 S02 Rll 00003 02SI, Northern New Eri'@,land Re 1-onal @ledicLI  ram

                The Council recommends conditional approval in line with the
                recommendation of the Review Con@mittee. Support is to  be  extended
                with the deletion of the following:

                    1.  Subcontracts for special studies;
                    2.  Four staff positions;
                    3.  Renovations and alterations (not allowable in
                        a planning grant).

                The Council also recommends providing additional support  up to
                $50,000 for extension of the Professional Activity Study  (PAS)
                coverage if, after negotiation with staff, such extension is feasible
                and desirable. The PAS proposal was considered to  be  an  excellent
                opportunity for this system to demonstrate its fullest capability
                at a moderate investment.
                The amount,, to be negotiated by staff and based on the  Councills
                recommendations will be approximately $267,000; plus  the  additional
                amount for PAS; plus appropriate indirect costs.

                3 S02 RM 00006-02SlR. North Carolirli Rep-ional l@4edical P am

                Council recommends approval in the amount and time (one year)
                requested. The additional core staff positions  Are  well  justified,
                with clearly defined functions and responsibilities.  Recent
                information concerning readiness to submit an application  for  an
                application for an operational grant made it clear  that  planning
                activities are meeting their objectives.

                The approved amount is: $253.,976, plus appropriate  indirect  costs.

                3 S02 al 0001.,@,-02SI, Tennessee llid-South

                Council recor-miends approval (one year), subject to an amended
                award date, because it believes that the added core  staff  requested
                in the application are well justified and are an appropriate increase
                for a region about to assume large  operational  responsibilities.

                The requested amount is:  @106,000, plus appropriate indirect costs.



                The Council recommends approval in the reduced amount after their
                concerns are communicated to the applicant.  As in previous requests,






                                                                                -12-



                 it was felt that the development of the new medical school
                 concurrently with the regio--t;,,l medical program is.a real  strength
                 upon which to build  mutual  interests.  There  was  the  consensus
                 that the request is "pre-planning" rather than planning; and approval
                 in a reduced amount will enable this area  to  acquire  staff  and  to
                 develop a program.
                 The amounts requested were: $125,000 for  each  of  two  years.,  plus
                 appropriate indirect costs.

                 lir. Lindee absented himself.

                 3 S02-RM-.-OQQ!9-OlS4.. California-Stanford

                 Council recommends approval in the amount and time requested.
                 Although this area was somewhat late in requesting active participation
                 in the California Region, it appears they are now ready to go
                 forward.  They have the organizational framework for planning, and
                 plans for developing programs in manpower, education, and evaluation
                 of medical services.

                 The amounts requested were:  $223,545, first-year; and $217,673,
                 second year, plus appropriate indirect costs6

                 @Ir. Lindee absented himself.


                 3 S02 Pl@l 00035-OISI, South Carolina

                 The Council recommends approval in the time and amount (the remaining
                 four months of the calendar year) and agreed that the applicant
                 should be encouraged to acquire competent assistance with the design
                 and implementation of the proposed sociologic studies.

                 The amount requested it:  $51,683, plus appropriate indirect costs.

                 3 S02 Rl!l 0003" 02Sl. lJashington-Alasla
                             @q-

                 The Council recorimcnds conditional approval for two years in an
                 amount to be determined which will  include  not  more  than  $250,000
                 direct costs per year for additional core staff, plus the    I full
                 amount requested for the myocardial infarction registry.  Indirect
                 costs will be added. Sinc,-  certain  new  positions  would  relate
                 primarily to operational p-@ojects, it was suggested that such
                 positions not funded under this recommendation could be included
                 in a subsequent operational grant application.

                 The amounts requested were:  $79UO,412, first year; and $700,418,
                 second year, plus appropriate indirect costs.

                 Doctor liogness absented himself.






                                                                             -13-



                3 S03-R).','r,. 00037-OISI, v7i.scor)sill

                It was the consensus of the Counci.1 that this proposal is consistent
                with the objectives of the Regional lied:';-cal Program, and that
                it merits support.  The request for funds to support the purchase
                of urokirkase x,,as deleted at the request of the applicant.
                The amounts requested were:  $75,067, first year; and $55,404, second
                year, plus appropriate indirect costs'.

                Doctor liogness abstained.

         Xllli  ADJOTJPL@TIIENT

                The meeting was adjourned at 12:05 p.m. on August 29, 1967.












                                                       I hereby certify that, to the best
                                                       of niy knowledge, the foregoing
                                                       iiii.riutes and attachment are accurate
                                                       and complete.






                                                       Robert Q. Marston, Yi.D.
                                                       Associate Director, NIH,'and Director,
                                                       Divir>icpm of Regional Medical Programs
















                  Eva 161. I-landal, Recording Secretary
                  Council Assistant, DPDIP









                                           N @TION A L ADVISORY COUI%TCIL ON
                                             PEGION'KL IIEDIC,@L PROGR-V..S


                   Lo-on,tdas H. Berry, M. D. (67)                    J'.mes T. Howell, M. D.   (68)
                   Professor, Cook County Graduate                    Executive    Direct or
                   School of 1,1,,dicine, and                         Hcnry Ford Hospit'il
                   Senior   Attending    Physici.in                   D!-!tro,.t, Michigan  48202
                   Michael Reese Hospital
                   Chicago, Illinois  60653                           Clirk H. l@lillik n, M. D.    (68)
                                                                      Consultint in Neurology
                    Mailing address.                                  M yo Clinic
                                                                      Rochester, Minnesota  55902
                   412 East 47th Street
                   Chicago, Illinois  60653                           G(iorge E. Moore, M. D      (68)
                                                                      Director of Ro-sea-ech for the
                   @lichael E. D@-Bik@-y, M.D. (68)                   New York Stite H-2alth D@pirtment
                   Professor ind Chai-tmln                            Roswell Park Ilic@moriii Institute
                   Department of Surgery                              666 Elm Str@,et
                   College of @ledici-nc,                             Buffalo, N,,,117 York  14203
                   Baylor University
                   Houston, To),,is  77025                            Edmund D. P@llegrino, 11. D. (70)
                                                                      Director of the Medical Cent-@r
                   Bruce @l. Evf--rist, 1,1. D. (71)                  Stat-- University of N--xq. York
                   Chief of Pediatrics                                Stony 'Brook, New York  11790
                   Green Clinic
                   709 South Vienna Street                            Alfred M. Popma, M. D.   (70)
                   Ruston,   Louisiin-3.   71270                      R@gional Director
                                                                      R@gional I-,i.?dical Progrim
                   Mr.  Charles   J.   Hitch   (71)                   525 1,7@st Jefferson Straet
                   Vice Prcsident of the University                   Boise, Idaho  83702
                    for Administration
                   University   of    California                      Mick I. Sh,-anholt;?, M. D.   (70)
                   2200 Univ@rsity .,Ivcnue                           State Hf-l-ilth Commissioner,
                   Berkeley, California  94720                        St,-ate D@@,p,:Irtment of Hc2nith
                                                                      Richmond, Virginia  23219
                   John R. Hogness, M. D.   (70)
                   D2,in,  School  of  Yiedicine                      Cornelius H. Tracger, M..D. (67)
                   Univorsity  of   W-tsliington                      799     Pnrk,Avenue
                   Sc2ittle,   @l@shington    98105                   New York, Now York  .1002-1


                                                          Ex Off ic io Member

                                                  Dr Williim   H.   St@@wart   (Chairmin)
                                                  ;Urgeon Cr,@neril
                                                  Public H.-@,,iltli S:.@rvic(,
                                                  10000 Rockville Pike
                                                  Bethcsdi, Yilryl-ind  20014





                                                                                              7-24-67