DEPARTMENT 0O F HEALTH, £ DUCATION AND BELFARE Jealth Services and Mental Health Administration Division of Regional Medical Programs National Advisory Council on Regional Medical Programs Minutes of Meeting August 26-27, 1968 National Institutes of Health Conference Room 4 Building 31 DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE _ HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION NATIONAL ADVISORY COUNCIL ON REGIONAL MEDICAL PROGRAMS Minutes of Thirteenth Meeting L/ 2/ August 26-27, 1968 “——~"~“The National Advisory Council on Regional Medical Programs convened for its thirteenth meeting at 8:30 a.m. on Monday, August 26, 1968, in Conference Room 4, Building 31, National Institutes of Health, Bethesda, Maryland, Dr. Stanley W. Olson, Director, Division of Regional Medical Programs, presided for Dr. Robert Q. Marston, Administrator, Health Services and Mental Health Administration, who was unable to be present for all of thé meeting, The Council” members present were: Dr. Edwin L. Crosby Dr. George E, Moore (8/26 only) Dr, Michael E. DeBakey Dr. Edmund D, Pellegrino Dr. Bruce W. Everist ' Dr. Alfred M. Popma Dr. John R. Hogness Dr. Mack I. Shanholtz ‘ Dr. Clark H. Millikan The Council members absent were: Dr. Helen G. Edmonds Dr, James T. Howell Yr. Curtis Treen Public Health Service members attending some of the sessions included: Dr. Samuel M. Fox, National Center for Chronic Disease Control Dr. George E. Goodman, National Center for Chronic Disease Control Dr. Daniel Horn, National Center for Chronic Disease Control Dr. O.W. Maddrey, National Ceater for Chronic Disease Control Dr. Robert Q. Marston, Administrator, Health Services and Meatal Health Administration Dr. Frank W. Mount, National Center for Chronic Disease Control Mr. John L. Pendleton, National Center for Chronic Disease Control Mr. Donald Riedesel, National Center for Chronic Disease Control Dr. W.eH. Ross, National Ceater for Chronic Disease Control 1/ Proceedings of meetings are restricted unless cleared by the Office of the Administrator, HSMHA, The restriction relates to all material submitted for discussion at the meetings, the agenda for the meetings, the supple- mental material, and all other official documents. © oF Tee oS ee ys . . Se te te be met Pee ee Seen thay menos Pro oie ke bt WeRLEL Ga Gk bet a ee ve . G pds yee Rakes baie i Ex] institutions, or (b) in whica a conflict of interest might occur. This procedure does not, of cours, apply to en bloc actions=-only when the application is under individcual discussion. Liaison members attending: Dr. Sidney Farber, NCI Council Dr. A. Earl Walker, NIND Council (8/26 only) Others Attending: Dr. J.H.U. Brown, NIGMS Dr. William D. Mayer, University of Missouri Dr, Mathilde Solowey, NIN Miss Pauline Stephan, NCI DRMP Staff: Mr. Stephen Ackerman, Associate Director for Planning and Evaluation Mr. Nicolas Cavarrochi, Financial Management Officer Dr. Donald R. Chadwick, Deputy Director, DRMP Mr. Cleveland R. Chambliss, Assistant Associate Director for Operations Mr. Edward M. Friedlander, Associate Director for Communications and Public Information Mrs. Eva M, Handal, Committee Management Officer Mr. Charles Hilse enroth, Executive Officer, DRMP Dr, Charles A. Imboden, Assistant Associate Director for Organizational Liaison Mr. Gregory Lewis, Chief, Grants Management Branch Dr. Richard Manegold, Associate Director for Program Development and Research Mr. Maurice E, Odoroff, Assistant to the Director for Health Data Mr. Roland Peterson, Assistant Associate Director for Planning and Evaluation Mrs. Martha L. Phillips, Chief, Grants Review Branch Dr. Alexander Schmidt, Chief, Continuing Education and Training Branch Dr. Margaret Sloan, Associate Director for Organizational Liaison Dr. Richard Stephenson, Associate Director for Operations Miss Cecilia Conrath, Continuing Education and Training Branch Mr. Arthur Curry, Grants Management Branch Miss Joyce Finnegan, Grants Management Branch Mrs, Mary V. Geisbert, Office of Planning and Evaluation Dr. Louis Gerber, Operations Officer Mr. Sam O. Gilmer, Jr., Operations Officer Mrs. Sheila B. Gould, Committee Management Office’ Mr. George Hinkle, Grants Management Branch Mr. Bryant Jones, Operations Officer Mr. Robert Jones, Grants Review Branch Dr. Anthony Komaroff, Operations Officer Mr. Glean Lamson, Operations Officer Mr. Robert Lawton, Consultant to DRMP Mrs. Emily Macafee, Continuing Education and Training Branch Mrs. Patricia McDonald, Grants Review Branch | Peto Sahn fre . Rte Miss ‘set’ noomia visas and Evaluation Branch Mr. Richard Russell, Grants Review Branch IV. -~3- Mrs, Rebecca Sadin, Continuing Education and Training Branch Mrs. Jessie Salazar, Grants Review Branch . Mrs. Ella R, Scates, Planning and Evaluation Branch Mr. Alphonse Strachocki, Operations Officer Mr. Lee Teets, Grants Management Branch Mrs. Mary A. Teller, Planning and Evaluation Branch Mr. Francis L. Van Hee, Continuing Education and Training Branch CALL TO ORDER AND OPENING REMARKS Doctor Olson called the meeting to order at 8:30 aom. ANNOUNCEMENTS Doctor Olson made general announcements about the Service Desk, and called attention to the statements on, "Conflict of Interest," and “Confidentiality of Meetings." CONSIDERATION OF FUTURE MERTING DATES The Council reaffirmed the following date: November 25-26, 1968 (Monday~Tuesday) These dates for 1969 were tentatively approved: February 20-21, 1969 (Thursday-Friday) May 26-27, 1969 (Monday~Tuesday ) August 18-19, 1969 (Monday~Tuesday ) November 20-21, 1969 (Thursday~Friday) CONSIDERATION OF MINUTES OF MAY 1968 MEETING The Council unanimously recommended approval of the Minutes of the May 27~28, 1968, meeting as written, LEGISLATIVE DEVELOPMENTS 1. Budgetary Status Doctor Olson presented the current status of the budget situation for Fiscal Year 1969. There are carry-over funds from Fiscal Year 1968 in the amount of approximately $35 million. The total amount which will be available for Fiscal Year 1969 will depend on whether the Senate or the House version of the authorization Bill is finally approved. The Senate Bill would result in approximately $63 million for a total (with carry~over) of $98 million, whereas the House Bill would permit $50 million for a total of $85 million. With continuation reauirements for Fiscal Year 1969 of approximately oa oh da kr ee Year, The Senate Appropriations Committee has earmarked at least $5 million em mee Lt pm RD A ee ee fp) tot! © VIL. VIII. 2. RMP Legislation Different versions of the authorization Bill for RMP have been passed by the Senate and the Hovse. It remains for these differences to be resolved in conference. The significant differences are: (1) a three-year extension in the Senate Bill and a two~year extension in the House Bill; and (2) $65 miliion for Fiscal Year 4969 and $140 million for Fiscal Year 1970 in the Senate Bill, and $50.million in Fiscal Year 1969 and $100 million in Fiscal Year 1970 in the House version, REORGANIZATION OF HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION Doctor Olson introduced Dr. Donald R. Chadwick, Deputy Director of the Division of Regional Medical Programs, who, prior to this appointment, was Director of the National Center for Chronic Disease Control. Doctor Olson discussed the organization of the new Health Services and Mental Health Adninistration (HSMHA), He also discussed the relationship of the Division of Regional Medical Programs to the Division of Chronic Disease; Comprehensive Health Planning; and the National Center for Health Services Research and Development. GRANTS REVIEW AND MANAGEMENT WORKLOAD The Council reviewed only supplemental requests at this meeting in the amount of approximately $10.8 million. Staff presented the expected workload in the grants review process for the next review cycle, All regions are expected to have operational activities by the end of the Fiscal Year. It would be desirable, not only in order to reduce the workload of the Council but also to carry out a more effective review, for each Region to have a single anniversary date and, therefore, submit one application per year. STATUS OF THE 54 REGIONAL MEDICAL PROGRAMS Doctor Manegold presented a brief report of the current developmental status of the individual regional medical programms. He briefly described the individual strengths and weaknesses of each region, characterizing strengths és: 1. The existence of a strong coordinator and adequate central program staff able to provide positive leadership to the program and the region; 2. A regional advisory group truly representative of the region and which knows its role znd accomplishes it in an effective manner; 2 The aetohanca fe tte getee oS etemet fal ors eon imrolyed in the 4. The formulatinn by the region of a valid planning and eperational concept consistent with regional medical program philosophy’ Ix, XI, -~ 5 = 5, Involvement of the critical elements of the region, most often the medical echool(s), private practitioners and the medical society, hospitals of all types, and allied health interests; 6. Sound and workable cooperative arrangements established among the above; 7, Grant: proposals well presented and reflecting activities within the strategic concepts of the region, adequate evaluation of the activities, and a good balance of activities among the categorical areas; | 8, Sound relationships with comprehensive health planning; 9, Balance between health service and continuing education activities, and attention being paid to particular regional problems, such as the urban ghetto, migrant field laborers, etc. Characteristics that seem to impede regional development are: (a) an inability to express thoughts and ideas via grant requests or during a site visit, (b) difficulty in recruiting adequate staff and establishing a regional advisory group, (c) the region being awkwardly constituted, (d) the region enmeshed in a difficult political situation, and (e) the program has become deeply involved with cae particular institution or interest. The issues raised by this summary suggest possible means of Regional Medical Programs achieving better the programs’ goals. SUMMARY OF ACTIVITIES OF THE DIVISION OF CHRONLC DISEASE Doctor Chadwick discussed the organization and function of the Division of Chronic Disease (DCD). The functions of DCD are to carry out applied research, to promote the development of improved health servises, and to support the training of health personnel in chronic disease prevention and control, Staff from the Division of Chronic Disease was introduced, and presentations were then made by Dr. Samuel M. Fox, I11, Chief, Heart Disease and Stroke Control Program; Dr. George E. Goodman, Chief, Kidney Disease Control Program; and Dr. William L. Ross, Chief, Cancer Control Program. COORDINATORS CONFERENCE O'{ SEPTEMBER 30~CCTOBER 1, 1968 The second meeting of the Program Coordinztors will be held at the Marriott Twin Bridges Motel, Arlington, Virginia, on September 30- October 1, 1968. EXECUTIVE SESSION The Council met in Executive Session the afternoon of August 26 with ail. AIT. SITE VISIT REPORTS epumanra Council received summaries of all of the site visits which were made as a result of Council action at the May 1968 meeting. CONSIDERATION OF GRANT APPLICATIONS APPROVED IN TIME AND AMOUNT REQUESTED 3 GO2 RM 00019-0251, California RMP The Council recommended approval in the time and amount requested with the provision that the region clarify and document the program's relevance to the categorical diseases. The Council viewed the proposal more favorably than the Review Committee, while essentially agreeing with its concerns, The consensus was that its shortcomings were insignificant and remediable by clarification and documentation of the relevance to heart, cancer, and stroke, The amount requested for a three year period beginning July 1, 1968, through June 30, 1972, is $418,243, plus appropriate indirect costs. 3 GO2 RM 00028-0283, Alabama RMP The Council concurred in general with the recommendations of the Review Committee and recommended approval in the time and amount requested, It was noted that the previous successes of this Region tend to substantiate its ability to accomplish a reasonable portion of the proposed activities. The amount requested for a ten-month period beginning September 1, 1968, through June 30, 1969, is $273,509, plus appropriate indfrect costs. 3 GO2 RM 00062~02RS2, TrieState RMP The Council recommended approval in the time and amount requested. The Council requested that staff advise the Region that in preparing future applications, special attention should be given to clearly describing the relationship of the proposal to the objectives of the Regional Medical Program, Also, unusual budget requests such as limousine service and automobile rental should be thoroughly justified. The amount wquested for « fifteen-month period beginning September l, 1968, through November 3C, 1969,is $198,439. No indirect costs were requested, 3 GO2 RM 00051-0251, Memphis RMP The Council recommended epproval in the time and amount requested. A minor concern was expressed regarding the relationship of the Regional Medical Procram to tha MideSosth Madical Center. Council noted the The amount requested for a one year period beginning July 1, 1968, through June 30, 1969, is $248,184, plus appropriate indirect costs. ~7J- APPROVED WITH CONDITIONS 1 G03 PM O0001-01, Hawaii RMP The Council concurred with the Review Committee's recommendation for conditional approval of the core planning and administration component in the amount of $334, 123 plus appropriate indirect costs for one year, with a site visit and reconsideration of requested future years of support at the next Council meeting. _ The amount requested for a five year period beginning September 1, 1968, through August 31, 1971, is $2,503,417, plus appropriate indirect costs. 3 GO3 RM 06032-0181, WICHE (Mountain States) RMP {he Council recommended approval of the Core Administration , Advanced Planning and Evaluation portion subject to the findings of, and at a levelto be recommended by, the site visit team for a period not to exceed one year; site visitors to consider reduced staffing and funding commensurate with the viability and appropriateness of the region. The amount requested for a five year period beginning November 1, 1968, through October 31, 1973, is $8,123,165, plus appropriate indirect costs. 3 G03 RM 00037-0281, Wisconsin RMP The Council recommended conditional approval of the core program component for one year in the amount requested, $438,974, plus appropriate indirect costs, with a site visit and reconsideration of future years of support at the next Council meeting. The amount requested for a five year period beginning August 1, 1968, through July 31, 1973, is $4,488,182, plus appropriate indirect costs. 2 G03 RM 00026-02, Greater Delaware Valley RMP The Council recommended conditional approval in principle at the present level of monthly obligation, with a site visit to assist the Region in a reasonabie revision of the present application and with delegation of authority to the visitors to set the appropriate level of funding. ~ The amount requested for a three year period beginning September 1, 1968, through August 31, 1971, is $7,846,690, plus appropriate indirect costs, DEFERRED 3 GO2 RM 00024-0251, Fiorida RMP The Council recommended deferral of this application with a site tia anmvonsinte unoklioated The amount requested for a three year period beginning November 1, 1968, through October 31, 1971, is $658,200, plus appropriate indirect: costse -~8- 3 G02 RM 00040-0282, Coloradofilyominz The Council recommended deferral for a site visit for additional information and clarification. Further, the Councii delegated authority for staff to amend the current planning grant by increasing the funds awarded for personnel in an amount not to exceed $14,500 provided there is a sound basis and justification for additional funds. The amount requested for a one year period beginning July 1, 1968, through June 30, 1969, is $281,527, plus appropriate indirect costs. 1 C03 RM 00008-01, Connecticut RMP The Council recommended deferral pending satisfactory confirmation of cooperative arrangments required by law, and of support for the proposed operational program by the groups upon which implementation would depend, specifically the practicing physicians. Message conveyed to Region should emphasize that Council is impressed with the progress to date “of the Regional Medical Program developing in Connecticut, that the deferral action was taken to facilitate the rapprochment between the CRMP and the Connecticut State Medical Society, and that a site visit of Council and staff will be made to help if the parties at issue request it. The amount requested for a five year period beginning July 1, 1968, through Jyne 30, 1973, is $21,237,593, plus appropriate indirect costs. rs Mr, Robert Lawton absented himself. DISAPPROVED 3 GO2 RM 00069-0281 North Dakota The Council recommended disapproval of this application. Among other things, the North Dakota RMP not only has to determine the incidence of the categorical diseases, but aleo determine the available facilities and care. SPECIAL ACTIONS The Council approved the Special Actions on the following: 5 G02 RM 00013-02, Western New york (Buffalo) RMP The Council reconmmanded approval in principle of the proposed planning study on stroke but without a commitment of additional funds beyond the current grant award period. 5 G03 RM 00037~02, Wisconsin RMP ao oh feawe non aie BCU File Rb hee up to $94,006 in direct costs provided it can be demonstrated that the computer costs involved cannot otherwise be met. - 9. 5 GO2 RM 00058-02, New York Metropolitan Ri? The Council recommended approval of the request to provide interim support in order to continue the Memorial Hospital Feasibility Study in cancer for the six months period beginning January 1, 1969. 3 GO2 RM 00061-902S1, Illinois RM® The Council recommended approval of the request for $32,000 for direct «. costs. Mr. Friedlander commented on the Conference which was held ‘recently by the American Hospital Association. The proceedings have been edited by Mr. Friedlander, and these should be ready in about two months. XIV, DELEGATION OF AULHORITY BY NATIOVAL ADVISORY COUNCIL ON REGIONAL MEDICAL PROGRAMS TO THE DIVISION OF REGLONAL MEDICAL PROGRAMS STAFF FOR ADMINISTRATIVE CHANGES IN AMOUNTS OF ON-GOING GRANTS On August 28, 1967, the Council approved the delegation of authority ‘ to the Division staff to approve increases in amounts for active grants for four general purposes. The second of these was: "(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 applicetion, or to provide for orderly termin- ation of the grant. Such extension would be reported to the Council." On August 27, 1968, Council approved the further use of this authority in the following circumstances: . "In the case of grants which included commitments for a final budget period of 12 full months but which were arbitrarily shortened (and amounts concomitantly reduced) by the Division's decision to extend commitments Ro longer than 12 months beyond the life of P,L. 89-239 (June 30, 1969)." + XV. ADJOURNMENT ~ JO = The meeting was adjourned at 1:00 p.m., August 27, 1968. Eva M, Handal Committee Management Council Secretary Officer I hereby certify that, to the best of my knowledge, the foregoing minutes are accurate and complete. . * x ie ee A oN eo "PONS * , . Stanley W. Olson, M.D. Director Division of Regional Medical Programs NATIONAL ADVISGRY COUNCIL ON RESTONAL MEDICAL PROGRAMS Edwin L. Crosby, M.D. (71) Director American Hospital Association Chicago, Illinois 60611 Michael E, DeBakey, M.D. (68) Vice President for Medical Affairs of Baylor University Professor and Ghairman Department of Surgery College of Medicine Houston, Texas 77025 Helen G. Edmonds, Ph.D. (71). Dean, Graduate School North Carolina College Durham, North Curolina 27707 MATLING ADDRESS P.O, Box 432 *Wurham, North Carolina 27707 Bruce W. Everist, M.D. (71) Chief of Pediatrics Green Clinic 709 South Vienna Street Ruston, Louisiana 71270 John R. Hogness, M.D. (70) Dean, School of Medicine _ University of Washington Seattle, Washington 98105 James T. Howell, M.D. (68) Executive Director Henry Ford Hospital Detroit, Michigan 48202 Clack H. Millikan, M.D. (68) Consultant in Neurology Mayo Clinic Rochester, Minnesota 55902 George E. Moore, M.D., Ph.D. (68) Director, Public Health Research New York State Department of Health Roswell Park Memorial Institute 666 Elm Street Buffalo, New York 14203 Edmund D, Pellegrino, M.D. (70) Vice President for the Health Sciences Director of the Center State University of New York Stony Brook, New York 11790 Alfred M, Popma, M.D. (70) Regional Director Regional Medical Program 525 West Jefferson Street Boise, Idaho 83702 Mack I. Shanholtz, M.D. (70) State Health Commissioner State Department of Health Richmond, Virginia 23219 Mr. Curtis Treen (71) Director Pension and Insurance Department United Rubber, Cork, Linoleum and Plastic Workers of America 87 S. High Street Akron, Ohio 44308 Robert Q, Marston, M.D. (Chairman) Director Health Services and Mental Health Administration 9000 Rockville Pike Bethesda, Maryland 20014 DRMP/CMO July. 1968