nM

een

l

=O

|

iy
  

Le,

   

> |

Lakes Area Regional Medical Program

VOL. VII, NO. 4

HSA’s - What's It All About?

This newsletter is distributed to a par-
ticularly devoted constituency who have
in many ways contributed to the program
as we have known it since 1967. The way
we have worked is less appreciated than
the outcome of this industry.

Brief anecdotes of achievement and il-
lustrations thereof can be satisfying and
are simple to prepare. More difficult,
however, than showing impact of efforts
is to portray these efforts in succinct and
attractive dimensions. We are all familiar
with the newspaper as printed, but the
mechanism that underlies its production
and distribution efforts that enable its
appearance are seldom considered.

One is still asked, what is RMP? The
brief answer is ‘“‘an enabler,” a
mechanism comparable to that which
puts the printed word before the reader
—- the essential vehicle between the
author and: his target.

The list of projects which come to frui-
tion in heart disease, cancer, emergency
medical services, tele-education and
many others are the result of two things:
the Regional Medical Program enabling
function and money.

Some have described this as the
“greasing factor and the coercive com-
ponent.” Shortly the question will be ask-
ed, “what is an HSA?” — and concom-
mitantly where is the RMP? All these
acronyms are irritating to the uninitiated.
They are used with arrogance by many to
imply their own vast comprehension of a
difficult subject. Knowledge of the HSA
and its potential power and impact is
preferable now than when it is a fait ac-
compli. It will affect everyone nationwide.

FROM THE DIRECTOR'S DESK
John R.F. Ingall, M.D.

HSA or Health Systems Agency is a
difficult subject. It is also a confusing
acronym for it also stands for the
geographic area that has to be ad-
ministered by a Health Systems Agency
—— namely a Health Service Area.

The Health Systems Agency of
Western New York is intended, by Public
Law 93-641, to assume the functions of
the Regional Medical Program currently
known as the Lakes Area Regional
Medical Program and Comprehensive
Health Planning, respectively known (or
heard of) as LARMP and CHP. Both
these agencies have specific functions to
discharge. The intent of the new law is to
enclose the functions of both LARMP
and CHP into the new super agency
known as the Health Systems Agency.

Once constructed, the power of the
HSA extends to the approval or disap-
proval of all federal monies applied for
under the Public Health Service Act, the
Community Mental Health Center Act
and the Comprehensive Alcohol Abuse
Act. The dimensions of this power have
yet to be appreciated fully. To list the
areas subject to the HSA authority would
require a detailed listing of the Acts
listed above. In brief, monies for heart,
cancer, stroke, sickle cell, manpower
training, family planning, alcoholism,
narcotic addiction, construction and ex-
pansion of medical service facilities,
training of retarded children and many
other purposes will be subject to HSA
approval or disapproval. The potential
authority for the HSA is therefore great.

How will it come into existence?

(Cont'd on Page 2)

$855,928 Grant Awarded to LARMP

A grant of $855,928 was awarded to
the Lakes Area Regional Medical
Program, inc. on June 24 by the US.
Department of Health, Education and
Welfare to continue its operation.

In a meeting of the LARMP Regional
Advisory Group on June 26, the Board
provisionally approved a budget of $1,-
035,532 to continue operation of eight
health related projects and program staff
from July 1, 1975 to June 30, 1976.

The budget includes the $855,928
award plus carryover funds of $179,594
from the 1975 budget. The budget is
subject to re-evaluation. The Board also
recommended that project directors be
advised that all project budgets will be
reviewed on a monthly basis and may be
subject to revision, expansion or reduc-
tion, based on the overall availability of

funds.
(Cont'd on Page 4)

JULY-SEPTEMBER, 1975

Media Campaign
Launched To
Explain HSA

The Lakes Area Regional Medical
Program, Inc. has initiated an informa-
tion campaign designed to provide infor-
mation to the public about what a Health
Systems Agency is and how it is ex-
pected to work.

Utilizing the communication media the
LARMP Department of Communications
has arranged for newspaper stories and
radio and television interviews which
attempt to explain in understandable
terms how the HSA is being developed
and structured and the tremendous
effect it will have on the health care
systems of the region. Another reason
for bringing this information to the public
is to dispel any rumors that the HSA
development in this area is being done
“undercover” with no attempt made to
inform the public about its existence or
composition.

Dr. John Ingail, Executive Director,
LARMP, appeared on WGR-TV;s inter-
view program “Magazine” on June 27
and spoke on HSA’s; WBEN-TV’s “By the
People” on August 3, again on WBEN-TV
on August 15 for a short news interview,
and on September 21 appeared on
WKBW-TV's “Here and Now” along with
Erie County Executive Edward Regan
and Eugene Wilczewski, Director, Com-
prehensive Health Planning Council of
Western New York, Inc. Dr. Ingail was
also interviewed on August 17 by radio
station WADV-FM for its community ser-
vice program “issues and Views.”

He has appeared on all major televi-
sion stations in the region explaining
what HSA’s are and provisions in the law
that established it.

in This Issue

—HSAs—What's It All About?Directors Desk
—Media Campaign on HSA Launched
—$855,928 LARMP Grant

—Where Has All The LARMP Money Gone?
—-$375,000 EMS Grant

—-Emergency Nurses Course

—Continuing Education Programs
—Asphasia Center Aids Victims

—-Piant A Seed—Watch It Grow
Lakes Area Regional Medical Program
Continuing Education Programs—1975

TOPIC
Emergency Care Course for Physicians

Emergency Care Course for Physicians
Emergency Care Course for Physicians
Emergency Care Course for Physicians
Cancer Teaching Day

“Current Status of Cancer Therapy”
Interpersonal Relationships

Cancer Teaching Day

Cancer Teaching Day

“Lumphomas and Hodgkin's Disease”
Emergency Care Course for Physicians
Emergency Care Course for Physicians
Emergency Care Course for Physicians
Emergency Care Course for Physicians

Medical Genetics Program

Program On Aging

If interested in attending any of these programs call
Mrs. Patricia ‘Hoff, R.N. at 835-0728.

DATE LOCATION
September 17 Ramada inn

Niagara Falls, New York
September 18 Holiday Inn

Olean, New York
September 24 Treadway Inn

Niagara Falls, New York
September 25 Holiday Inn

Olean, New York
September 30 Sheraton East

Buffalo, New York
October 2 Holiday inn

Olean, New York
October 9 Moonwinks Restaurant

Cuba, New York
October 16 Holiday Inn

Fredonia, New York
October 22 Ramda inn

Niagara Falls, New York
October 23 Holiday Inn

Olean, New York
October 29 Ramada Inn

Niagara Fails, New York
October 30 Holiday inn

Olean, New York
November 4 Holiday Inn

Batavia, New York
December 4 - Sheraton East

Buffalo, New York

HSA’s...

(Cont'd from Page 1)

Currently the agencies that it is
designed to take over are studying op-
tions available and recommendations as
to structure. The provider-dominated
Regional Medical Program, CHP and the
legislators of the eight counties of
Western New York are exploring struc-
tures possible for the HSA. In other
words, the provider agency, the elected
officials and the consumer-dominated
agency are working in concert to inter-
prete the law and its portents. These ef-
forts are being made preparatory to a
review by the advisory bodies that
currently exist and direct policy in this
area as they relate to RMP and CHP. This
being done, the law directs that a series
of public meetings must be held to ex-
plain the law and to record recommen-
dations on the options feasible for the
HSA Board of Directors in this area.
Those responsible for the administration
of his law have to produce regulations
and interpretations that will answer
questions relating to the HSA. These
were due August 15th but are delayed in
their development by the complexity of
the law itself.

The structure of the Board of the HSA
has to respond to regional requirements.
The commitment required of HSA board
members will have to take precedence

over any others. The onerous decision-
making will require a measure of study
and familiarity with regional concepts
dictated by population needs. A position
on the board will be no sinecure nor will
it be tenable if used to perpetuate the
status quo.

There’s a great amount of work to be
done. The staffs of both agencies
designated for assimilation are available
to explain and present the substance of
the law. Please Ask.

EMS Project Gets
$375,000 Grant

The Emergency Medical Services
System, a project of the Lakes Area
Regional Medical Program, Inc., receiv-
ed a grant of $375,000 from the U.S.
Public Health Service on July 1, 1975.
The grant covers the period July 1, 1975
to June 30, 1975.

The original Section 1203 Grant re-
quest submitted on April 1, 1975 sought
$1,053,594 from the PHS for the
purchase of communications equipment
and systems, hospital and ambulance
equipment and training programs for
Emergency Medical Technicians,
firernen, police, rescuers, and others in
Western New York and Northwestern
Pennsylvania counties.

Plant A Seed—
Watch It Grow

It is always gratifying to LARMP of-
ficials to learn about LARMP funded
projects that are able to generate ad-
ditional funds on their own based on the
strength of the project's success.

One project director, Sara Marie Cic-
carelli, recently reported that her project
received a special improvement grant for
allied health professions amounting to
$85,946 from the U.S. Public Health Ser-
vice, Department of Health, Education
and Welfare. These funds will augment
the project ‘Improving Medical
Laboratory Services in Rural and Small
Hospital,” which LARMP initially provid-
ed with a $30,556 grant in 1973. Ms. Cic-
carelli is Associate Chairman, Depart-
ment of Medical Technology, State
University of New York at Buffalo.

A ssed grant of $13,744 made to the
SUNYAB School of Nursing in 1974 by
LARMP set the stage for a $282,110
award from the PHS, Dept. HEW, for the
project “Faculty Development Program
in the Enhancement of Expanded Role
Skills.” This project involved participa-
tion by nurse faculty from three regional
university schools of nursing whose pur-
pose is to implement and evaluate a
faculty development program to prepare
nurse faculty members in the expanded
role of the nurse with emphasis on the
enhancement of assessment and in-
tervention skills.

Project Director is Rita Boucher,
Ed.D., of the SUNYAB School of Nursing.

The “Cattaraugus County Household
Survey of the Elderly” received a one
year grant of $18,168 from LARMP to
determine the health needs of the coun-
ty’s rural, elderly population.

Project Director, Marilyn Gibbin,
reported that the survey prompted the
Cattaraugus County Legislature to es-
tablish a County Department for the Ag-
ing.

Other LARMP projects are finding
their way into additional support from a
variety of sources as they continue to
develop and produce positive results.

Free Heaith Tests

Free testing for hypertension, sickle
cell anemia, hearing problems, lead
poisoning, and diabetes was provided
for residents of all ages during a special
Community Health Day held September
4th at the North Jefferson Public Library,
332 East Utica Street, Buffalo, New York.

Buffalo radio station WUFO helped get
the word to the people by broadcasting
live from the library during the day’s
testing program. The event was spon-
sored by the Lakes Area Regional
Medical Program, Inc., Erie County
Health Department and the North Jeffer-
son Public Library as a public service.
 

| Where Has All the LARMP Money Gone?

Since its inception in 1966, the Lakes
Area Regional Medical Program, Inc.
had dispensed over $6,941,228 in
federal tax dollars for a variety of health
related projects designed to improve the
quality and accessibility of good health
care for all the residents of the nine
counties it serves throughout Western
New York and Northwestern Penn-
sylvania.

Every county within the LARMP region
has received some benefit from project
activities and staff involvement. The
Rural Externship Program, for example,
has over the past five years placed 244
health science students in the rural areas
of all nine counties for a summer ex-
perience. The purpose is to encourage
these students to live and set up practice
in these areas after they graduate. These
are areas where health manpower is
usually in short supply, and where there
is a need for these new health
professionals. Although it may be too
early to determine its success, it is work-
ing. Some of the participating “externs”
have already settled in rural parts of this
and other regions.

The Allegany County Mobile Health
Unit, funded in 1972, was in response to
the county’s documented health needs
to provide access to medical care for
many people who live in this rural county
of 46,400 people. The unit makes weekly
visits to the rural towns and provides
health assessments for those desiring
them. In 1974, project officials reported
that over 445 new adults sought the ser-
vices of the unit. A referral rate of 90.3%
for further treatment was reported. The
increase in referral rate was attributed to
the fact that oral examinations produced
many referrals to dentists for treatment
of dental caries. In addition, several
more electrocardiograms were taken
than before. Well-child Conferences ac-
counted for 113 new child examinations
producing a referral rate of 19%. County
residents are thankful for this much
needed health service.

A $25,000 grant to conduct a Survey
of the Needs of Elderly Persons in Cat-
taraugus County uncovered the fact that
the county is in desperate need of a
county department for the aging. This
project generated enough interest in the
Cattaraugus County Legislature to
enable the establishment, by law, of a
county department for the aging. Ad-
ditional funding was obtained from the
New York State Office for the Aging.

Continuing education programs, are
provided on a “circuit rider’ approach
and have attracted thousands of in-
terested health professionals throughout
the region. Program topics have includ-
ed cancer, hypertension, stroke, nutri-
tion, problems of the elderly, and a
number of other heaith subjects. Bring-
ing the program complete with speakers,
sound equipment, registration personnel

and provisions for a meal, right to each
county has provided an easier and less
costly access to continuing education for
many appreciative persons.

The Telephone Lecture Network,
which became self-supporting on July 1,
1975, is another project that has
successfully gone from LARMP support
to paying its own way. Over 40 hospitals
and other institutions are connected ina
network similar to an old fashioned
party-line. Lectures by prominent ex-
perts in their field are presented over the
TLN to its listening posts. A two-way
communication, whereby anyone on the
system can ask a question and the
answer is heard by everyone on the
hookup, is a unique feature of this
network. it provides access to high quali-
ty education programs for all health
professions, and other groups, without
the high cost of travel, lodging and time
spent going to and from a distant city for
this educational material. The network
has provided this service to all counties
in the region and has enjoyed great
success in the rural areas where in many
cases, they provide the only continuing
education programs available.

The sharing of a nutritionist by two
counties, Chautauqua and Cattaraugus,
proved so successful that upon termina-
tion of LARMP funding, the nutritionist
was retained and the funding of her ser-
vices shared by both counties.

The Information Dissemination Ser-
vice, funded initially by the LARMP,
provided health professionals
throughout the region with a number of
library services such as photocopies of
journals, articles, loan of books,
preparation of subject bibliographies in
the user’s area of interest, current
awareness system for those engaged in
long-term research, and medical
reference service. The project has, since
termination of LARMP funding, been
taken over by the Health Sciences
Library, State University of New York at
Buffalo.

Among the first projects supported by
LARMP funding was the Coronary Care
Training Program for nurses. Nurses
from throughout the region who par-
ticipated in the courses brought back to
their hospital Coronary Care Units new
expertise in caring for coronary patients.
The concentrated course provides
classroom instruction and clinical ex-
perience in a number of Buffalo area
hospitals. The program has been ab-
sorbed by the School of Nursing, State
University of New York at Buffalo since
LARMP funding ceased.

The Lakes Area Emergency Medical
Services project was designed to
research the need and activate solutions
for an improved and expanded system of
emergency medical services within the
nine county region. Over 5000 Emergen-
cy Medical Technicians or “first

responders” for emergency care have
been trained through this project. About
$150,000 in radio communication equip-
ment for hospitals and ambulances and
emergency vehicles in Erie County, New
York, was purchased with funds from
this project.

OTHER PROJECTS

A number of other projects initiated in
the early days of LARMP and since com-
pleted or funded through other sources
upon termination of LARMP funding in-
clude — Health Manpower Survey,
which determined the number and dis-
tribution of regional health care per-
sonnel in the region; Stroke Survey,
which was intended to describe the
epidemiology and patterns of medical
care of stroke patients as they occur in
the region as a whole; Chronic
Respiratory Disease Program, a many
faceted comprehensive project featuring
screening, training of hospital personnel,
a home care program, and an Associate
Arts Degree program in Inhalation
Therapy; Nuclear Medicine Center In A
Rural Hospital, a Gamma Camera was
purchased for Wyoming County Com-
munity Hospital, Warsaw, to be used as a
model for diagnostic procedures in a
rural community; Immunofluorescent
Diagnostic Procedures Project, a ser-
vice to assist hospital laboratories in the
development of their own fluorescent an-
tibody testing program, plus the offering
of a cost-free testing service for regional
physicians; Tumor Service Registry, a
centralized, computerized registry that
supplies physicians with confidential
cummulative data on cancer patients (to
date the registry’s data base includes
13,500 cases and serves 24 hospitals
throughout the region. The Registry is
now funded by Rosweil Park Memorial
Institute; Topleal Chemotherapy Treat-
ment for Precancerous Lestons and
Cancer of the Skin, this project involved
the use of an anti-cancer drug, 5+
fluorouracil for patients with skin cancer
or lesions.

All LARMP funded projects provided
direct benefits to residents of all the nine
county LARMP region at one point or
another. The cooperative contributions
made in terms of time and effort expend-
ed by the many people who are involved
with LARMP demonstrates the signifi-
cant role they play in the successful
progress of the program. If the con-
tributions made by volunteers in time
and effort were expressed in dollars and
cents we wouid find that their financial
contributions would match approximate-
ly 45 cents for every tax dollar received,
perhaps even more considering today’s
rate of inflation.

The role of an “enabler” has been one
well played by LARMP. On many oc-
casions LARMP has acted as a catalyst
to help the community realize its own
powerful resources.
Aphasia Center Aids Stroke, Other Victims

Stroke victims and others who may
have suffered a traumatic injury to the
brain causing impairment or joss of
speech can take heart in a locally based
service: that can possibly help you to
regain that valuable gift of speech and
hearing.

The service is being provided by the
Aphasia Center, located within the
Department of Speech and Hearing,
W.C.A. Hospital, Jamestown, New York.
Generally, the facility. deals with com-
rnunication disorders. caused by hearing,
mental retardation, cerebral palsy, cleft
palate, brain damage, laryngectomy, and
stuttering.

in October, 1974 the Aphasia Program
obtained a grant of $31,000 from the
Lakes Area Regional Medical Program,
Inc. which was used to purchase new
equipment for the center and to hire ad-
ditional staff to provide expanded ser-
vices.

R. James Buck, a graduate of Ohio
University at Athens. and a certified
professional in Speech and Audiology,
became the first director of the W.C.A.
Hospital’s Department of Speech and
Hearing in December, 1967.

During a recent site visit, it was
pointed. out to the Regional Medical
Program Staff that although the Program
is in full swing and some individuals are
receiving excellent benefit, there are
many other stroke victims who are not
even aware such help is available.
“Perhaps our biggest problem,” says Mr.
Buck, “is that we have these valuable
resources and services available, yet
many people who could utilize them
don’t know. about it.”

“Another problem is that of patient
lodging and transportation. Many poten-
tial users of our service are deterred
because they lack the money for lodging
and transportation. If we can’t get them
here, we can’t help them.” Mr. Buck said.

“A referral to the center by a physician
is not necessary. Anyone can refer a
patient to us,” Mr. Buck notes. “Even
members of the family or the patients
themselves can contact us for an ap-
pointment. Once the referral is made,
however, the physician will be contacted
by us and some form of communication
and reporting established.”

“As longevity increases,” Mr. Buck
continued, ‘so do the problems
associated with aphasia. Treating
aphasia is one of our newer frontiers,
and nationally very little has been done
to pursue it compared with some other
disorders. Older people get set in a slot
called “maturity” and don’t push for
anything better.” Mr. Buck added that
aphasia treatment someday will become
a field of its own rather than a part of
speech and hearing.

Services Offered

The Aphasia Center operates from
9:00 a.m.-1:00 p.m. daily and provides
an average of six weeks of intensive
therapy for the stroke or injured victim.
This can include individual, group, or oc-
cupational therapy plus drill time in the
language laboratory. This consists of ear
training, which involves learning to dis-
tinguish one sound from another sound,
and correct production of the sound in
syllables, words and phrases. The type
of therapy varies according to the needs
of each individual person.

Currently, records show that more
men than women are using the services.
This may be because more men suffer
strokes than women according to center
officials.

The new approach in the treatment of
aphasics at W.C.A. Hospital is patterned
after the Highland View Hospital
program in Cleveland, Ohio which
pioneered the new therapy plan under
the direction of William Pitts. The W.C.A.
Hospital unit becomes the second one in

the country to use this mode of therapy.

Aphasia patients receiving treatment
and rehabilitation at the unit have an
average age of 58-60. However, persons
of any age group having communication
problems are treated by the Speech and
Hearing Clinic. A breakdown of services
offered shows that the patient load con-
sists of one-third children and two-thirds
adults. In order to get an appointment
simply telephone. the Hospital at 487-
0141 and ask for the Speech and Hear-
ing Center. Mr. Buck notes that aphasia
treatment is covered by health in-
surance, Medicare and Medicaid.

The services of the center are
available to anyone wishing to utilize
them from throughout Western New
York and Pennsylvania.

Emergency Care Course

Twenty-two nurses from Western New
York and Northwestern Pennsylvania
completed a special Emergency Care
Program for Nurses on June 26, 1975.

Sponsored by the Lakes Area
Emergency Medical Services Program, a
project of the Lakes Area Regional
Medical Program, Inc., in cooperation
with the School of Nursing, State Univer-
sity of New York at Buffalo, the five week
course included three weeks of
classroom instruction plus two weeks of
clinical experience in five Buffalo
hospitals. These include the E.J. Meyer
Memorial, Deaconess, South Buffalo
Mercy, Sisters of Charity and Kenmore
Mercy hospitals.

$855,928 Grant...

(Cont'd from Page 1)

The projects involved include: Smali
Rural Laboratories, Regional Hyperten-
sion, Ambulatory Care, Domiciliary In-
Service Training, Medical Genetics,
Minority Health Education Delivery
System, and the Emergency Medical
Services System.

 

 

Lakes Area Regional Medical Program, Inc.

2929 Maln Street
Buffalo, New York 14214

FORUM is published by the
Lakes Area Regional Medical
Program, inc.

2929 Main Street
Buffalo, New York 14214

John R.F. Ingall, M.D.
Executive Director

Anthony Zerbo, Jr., Editor
Hugo Unger, Photography

ine $4 Pant 2 Savty Ononina

J TNGEAaLL MA
ZK om PR APL ST
SutTP ALD ad

 

Non Profit Org.
U.S. Postage
PAID
Buffalo, N.Y.
Permit No. 271

 

 

 

jury?

TIME VALUE