AV

    

Lakes Area Regional Medical Program

VOL. Vill, NO. 2

NARMP Conference at San Diego Says —

New Health Law Has Many Problems, Critics,

But Efforts Must Be Made to Make It Work

it’s not a particularly good law, it will
be difficult and cumbersome to imple-
ment and may not be as effective as we
want it to be, but we have to do our best
to make it work.

This was the consensus of over 400
health care officials attending the se-
cond Annual Meeting of the National
Association of Regional Medical
Programs, Inc., September 23-25 in San
Diego, California.

The law being referred to is P.L. 93-
641, the National Health Planning and
Resources Development Act of 1974,
which was signed into law by President
Ford on January 4, 1975.

The new law has been a primary topic
of criticism by health planners and of-
ficials since before its enactment in
January. It scraps three federally funded
health care programs in favor of a
national network of Health Systems
Agencies which will function across the
country. Regional Medical Programs,
Comprehensive Health Planning and the
Hill-Burton hospital construction
programs will be phased out under the

new law. Virtually every convention
speaker, including Kenneth Endicott,
M.D., administrator of the Health
Resources Administration, freely ad-
mitted that the law is not a “good” piece
of legislation, that it is ambiguous, con-
tradictory and may take three years
before it can be fully implemented.

lowa Governor, Robert D. Ray, a
severe critic of the law lashed out
stating, “| was outraged when the law
passed and | am still outraged. The
Midwestern Governors recently voted to
ask to have this law repealed. | think
most governors would like to reverse it
and start all over. But it (the law) is here
and it’s unrealistic to think that it’s not
going to be here, so the real questions
are, how can it be improved and how
can we make it work.” In amending the
law Gov. Ray would place emphasis on
complete health service care instead of
arbitrary population limits, change
membership requirements of agency
governing boards to avoid vested in-
terest pressure groups and provide
public accountability to the people.

(Cont’d on Page 6)

 

WHO IS THE COMMUNITY?

A report from a consulting firm on the
east coast begins with the observation
that Western New York, in particular
Buffalo, has “no sense of community.”
The comment itself is an indictment to
which some will immediately take issue.
There are others whose response to this
provocative statement will respond with
the inevitable “so what's new?”

One of our leading citizens observed
that it is safer for a consulting firm to
speak the truth, especially one from out
of state, than for one of us.

A consulting firm is defined as a body
paid excessively to tell us what we
already know and unable to implement
the theoretical solutions to the problems
defined.

Community is a nebulous term at
best. One dictionary definition is that of
“a social group sharing common
characteristics or interests and perceiv-
ed or perceiving itself as distinct from
the larger society within which it exists.”
It follows that community can be a
group of three or three million.

We are currently assailed by the
terms “consumers” and “providers”
both seen as labels to communities.
Furthermore current legislation,
specifically separates the two groups in
fairly rigid terms. An attempt is made to
define two areas of vested interest
wherein one, the consumer in his
demands has fractional ascendency

(Cont'd on Page 2)

OCTOBER, 1975

Options Noted
For Possible HSA
Governing Board

A specially appointed Ad Hoc Steer-
ing Committee, working on the develop-
ment of a Health Systems Agency (HSA)
for the Western New York area, met on
October 7 in the Lakes Area Regional
Medical Program, Inc. conference room
to review a number of possible
organizational models for the HSA
governing board.

Earlier this year Steering Committee
Co-Chairmen—Theodore T. Bronk, M.D.
(LARMP) and Kenneth Eckhert, M.D.
(CHP/WNY) appointed Robert M.
Whitrock, M.D. of the Veterans Ad-
ministration Hospital, Batavia, New York
as chairman of a Special Task Force
whose function was to draft a number of
options for organizing the proposed
HSA governing body. The task force in-
cludes three representatives from each
of the eight Western New York counties.
The Task Force drafted four options and
added a fifth option at the suggestion of
the Ad Hoc Committee. This fifth option
is referred to as a mixed model. All five
options are described below. They are:

Option I: Limiting governing board
size to a maximum of 30 persons.
Names of governing board members
would be submitted by the subarea or
County Committees.

Option Il: Same as Option |, except that
names would be submitted
by county governments.

Option III: Governing board size would
be greater than 30 members.
In addition, an executive
committee of the governing
body would be created.
Nominations to the govern-

(Cont'd on Page 5)

In This Issue

~-NARMP Annual Meeting — San Diego
—LARMP Quatity Assurance Programs
—Rural Extern Program Best Ever
—~Health Systems Agency Facts.
--Options on HSA Governing Board
Arthritis Plan Public Hearings

~—New HEW Secretary

--Who ts The Community?

~-Federal Regulations Printed

~—Public Hearings on Health issues
WHO IS THE COMMUNITY

(Cont'd from Page 1)

over the smaller group, the provider.
The contention is that “health care” is at
stake!

The issue is the avallability of
medical services, the equity of access
thereto and the cost thereof.

It seems that we are unable to dis-
tinguish between health which is
dominantly, but not exclusively, the
province of the individual, the disease
which is the province of those taught to
manage it.

Good organization comes out of dis-
cipline and unless we can apply this to
the words we use, we shall remain un-
able to communicate. Inability to do this
will not bring about the cooperation
needed and we will remain unable to
refute the accusation recorded in the
first paragraph of this communication
namely that we have no sense of com-
munity.

What is a community and how is it
structured? Where professions and
business interests are concerned the ti-
tle to community is qualified by a
specific, well-defined communal cause.

The consumer community as an entity
is much more difficult to define. So dif-
ficult is this, that the new National Health
Planning and Resources Development
Act (P.L. 93-641) avoids it altogether as
do the regulations for the implementa-
tion of the law.

In 1967, the Regional Medical
Program set out to establish county
committees that would speak to medical
service needs, the priorities of these,
and the manner in which they would ad-
dress Western New York as a communi-
ty. The justification for RMP expenditure
of money had to relate not to in-
stitutional but to “people,’ or “popula-
tion needs.” When established, these
committees were not restricted in
membership for the simple reason that
involvement in a decision-making
process on a regional or large com-
munity basis required the greatest
possible input irrespective of provider
or consumer fabel. We were short of
people. Subsequently these groups or
committees became more formal en-
tities and now serve the needs of the
current Regional Medical Program and
Comprehensive Health Planning.

In the future, involvement in the plan-
ning, data collection, project deveilop-
ment process, all of which will be
coalesced in one agency, will require
much more time from the volunteer.

We require a consortium of interested
parties.

in the early days of the Regional
Medical Program, we were instructed to
define the area needs, document them
and come up with projects to respond to
them. This we did to the extent per-
mitted by the funds available.

We did, however, learn some painful
lessons about community and the need

to define it. We found that there were
two types in the area — those built from
a group of strong individual interests
and the second a constituency
developed by one leader.

in the first type there needed to be,
without doubt, an individual or small
group of organizing people with suf-
ficient feeling and momentum about
certain problems to get under way —
i.e. develop a voice representative of a
body of people and sophisticated
enough to develop a structure of
leadership.

The second type was the community
developed uniquely around one in-
dividual without whose obsessive drive
in developing a support to his concepts
would never have convened or unified.
One became very chary about the in-
dividual using the royal “We” especially
the activist able to window-dress and
co-opt heads as evidence of support to
his opinion, but in no sense partners or
participants in the content of his ideas.
This we saw as unreliable and invalid as
a measure of success, just as a large
audience at a medical seminar is no in-
dex of the impact of the teaching
mechanism.

Whichever way a community evolves
however, has to have a cause. The
problem that we are currently facing is
the existence of many communities both
‘provider’ and ‘consumer’ who are seen
as in conflict, whereas they have some
basic inalienable human aspirations in
common. A body of people irrespective
of label who are placed in rivairy by
their label; whose allegiance to the in-
dividual (or group) with which they have
aligned themselves results in a
belligerence in territorial prerogative —
such as for the birds!

Can we not examine what is feasible
in Western New York by examining what
we need in common rather than
perpetuating the scenario of a
fragmented society?

In the present economic climate we
need to use our resources to the full —
a process which cannot come about
without cooperation. Furthermore,
money to develop projects such as
those of the Regional Medical Program
will not be forthcoming for several
years, and when they do, they will be
subject to a decision-making process
that has to involve “the entire com-
munity” — a group that can see the
whole canvas rather than a particular
segment.

it would seem that the public meetings
soon to be held for the establishment of
a Health Systems Agency for the eight
counties of Western New York have to
be responsibly structured. It is to be
hoped that not only will we be able to
conduct ourselves with dignity and
responsibility but that we shall acquire a
discipline of terminology, and a base of
common objectives that will justify the
term community. Furthermore, those

that become involved in the Heaith
Systems Agency should have opportuni-
ty to be instructed in a systemmatic
fashion on the principles inherent in
responsible planning and the economic
feasibility of various services demand-
ed.

Familiarity with jargon, glib in-
dulgence in acronyms and creation of a
mystique by a diarrhea of technical
terms is a major hindrance to
cooperative multi-interest involvement.
It frustrates the development of com-
munity.

Public Hearings
on Health Issues
Slated In State

Seven public hearings have been scheduled throughout
New York State by the State Assembly's Standing Com-
mittee on Health. Persons wishing to present pertinent
testimony to the Committee at one of these hearings should
get in touch with the contact person listed with each meeting
notice. Oral testimony will be limited to ten minutes duration.
The hearing dates and their subjects are as follows:

QUEENS
November 13, 1975 -— 10:00 a.m., Sloman Lowenstein
Building Auditorium, 2nd Floor, Long Island Jewish Hospital.
Hillside Division, 263rd Street and 76th Avenue, Glen Oaks,
Queens.

SYRACUSE
November 19, 1975 — 10:00 a.m., Auditorium - Public Safe-
ty Building, 511 South State Street.
Subjects: 1. Should the Legislature enact Assembly Bill
7841-B, the Committee's bill to stimulate the expansion of
home heaith care services in New York State.

2. What will be the effect of the recent Federal Medicaid
regulations relating to home health services {45CFR-249)?

3. Hospitat Costs and Care for Convalescence - a com-
parison of operating costs for maintaining a patient in a
hospital and costs for at-home care.

Purpose: To consider appropriate action by the 1976
Legislature to stimulate the expansion of home health care,
Contact Person - Florine Levin, Executive Administrator,
Assembly Committee on Health, New York State Office
Bidg., Room 1103, 270 Broadway, New York, N.Y. 10007,
Phone - (212) 488-5734.

QUEENS
November 17, 1975 — 10:00 a.m., Second Floor,
Auditorium, City Hospital Ctr. at Elmhurst 79-01 Broadway,
Elmhurst.
Subject: Physicians peer review.
Purpose: 1. To consider whether the Legislature should
enact Assembly Bill 7662.

2, To consider the most appropriate means of implemen-

ting the Federal professional standards review organization
(PSRO) legislation in New York State.
Contact person - Florine Levin, Executive Administrator,
Assembly Committee on Health, New York State Office
Bldg., Room 1103, 270 Broadway, New York, N.Y, 10007,
Phone (212) 488-5734.

NEW YORK CITY
December 4, 1975 — 10:00 a.m., Hearing ROOM G, 6th
Floor, New York State Office Building, 270 Broadway. New
York City.
Subject: is there a need for a statutory determination of
death?
Purpose: To determine whether the Legislature should enact
Assembly Bill 9860-4 and what amendments, if any, should
be made prior to the bill's considerations.
Contact person - Lawrence A. DeLong, Staff Director.
Assembly Committee on Health, Legislative Building, Room
831, Albany, N.Y. 12224, Phone (518) 472-3540.

NEW YORK CITY
December 10, 1975 — 10:00 a.m., Hearing Room G, 6th
floor, New York State Office Bldg., 270 Broadway, New York
City.
Subject: Is the “Rhode Island Plan” to deal with catastrophic
illness appropriate for New York State?
Purpose: To determine whether the Legislature should enact
a statute regarding the above subject, and how that statute
should be framed to be appropriate for application in New
York State.
Contact person - Lawrence A. DeLong, Staff Director.
Assembly Committee on Health, Legislative Bldg. Room
831, Albany, N.Y. 12224, Phone (518) 472-3540.

(Cont'd on Page 6)
Record Number 67 Students Participated

Best Ever Rural Externship Program

Held This Summer

Another Rural Externship Program
was completed on August 8, 1975.
Sixty-seven health science students
representing many health disciplines
participated in the eight-week summer
experience. Sponsored by the Lakes
Area Regional Medical Program, Inc.,
students were assigned to preceptors in
several rural locations around Western
New York and Northwestern Penn-
sylvania. Each student received a sti-
pend of $75.00 per week. The intent of
the program is to expose students to
rural health delivery and to encourage
them to consider settling down and set-
ting up their practices in these areas
after they complete their education.

Some typical comments from
students who took part in the program
this past summer are: Medical student
Jay Brachfeld, “I’ve been in surgery, the
delivery room, and the emergency
room. My experience has been in-
valuable. | find it easier talking to
patients now. | never had an opportunity
like this before.” Physical Therapy stu-
dent Michael Margolies, “living in a rural
area has given me a broad view of

 
  
 
 
 
 
 
 
  
 
 
 
  
  

York, looks on.

Pharmacy
student Elaine
Carr checks
over drug
prescriptions
with hospital
pharmacist
Gary
Mittlefehidt at
St. Francis
Hospital,
Olean, New
York.

Medical
technology
student Janet
Sproizer (r}
runs a
laboratory test
f as Lab
Director Doris
Weigan, Olean
General
Hospital
observes.

health care delivery. It has changed my
opinion of rural practice favorably.”
Medical student Lois Polatnick, “some
patients come to this Medical Center
from as far as 30-40 miles away. They
like the personalized and professional
attention they receive. I’ve learned to
talk to patients, that’s an experience in
itself.” Dietetics student Mary Jane
Olivieri, “being able to relate my plan-
ning of patients’ menus directly with the
patient is the kind of experience you
don’t get at school. I've learned more in
the last two months than | have since |
began my college course.” Respiratory
technician student Mary Beth Nichols, “I
feel so much more at ease with patients
now and I’ve done treatments, blood
gases, and so many other things. It's
one of the greatest things that’s ever
happened to me.” Medical technology
student Robert Zercie, “I’m surprised at
the sophistication of the laboratory
procedures used here. They are up to
date and very adequate. I've learned a
lot here.” The complimentary comments
go on and on from students and
preceptors alike. Since the rural ex-

Nursing student Michelle Forquer (extreme right)
listens as (I-r) Mary Blume, R.N. and Mary Chipola,
R.N., nursing director discuss patient chart at St.

Francis Hospital, Olean, New York.

Dietetics student M. Joanne Lang (center) talks with
|i: a patient about a special diet as Mary Kehoe, assis-
Jai tant dietitian at St Francis Hospital, Olean, New

   
 

 

a Phe
Physical therapy. student Judith Bailey (center

prepares to work with a patient as Olean General
Hospital Administrator Theodore W. Gundlah and
Evelyn J. Schoonover, a physical therapy assistant,
watch.

Dr. Joseph D. Lee, a radiologist at St. Francis
Hospital, Olean, New York discusses a patient’s x-
ray with Medical Students (!-r) David Silverstein and

 

ternship was established by LARMP in
1970 some 244 students have par-
ticipated in the program. Although it is
too soon to assess the degree of
success of this project, a recent
telephone survey of health science
students who participated in the
program since 1970 showed that of the
61 students reached, 55 are now in
practice. Of this number 55% or 30 of
them are now in rural practice. The sur-
vey was on a limited basis and will be
continued with a more complete report
due later on.

Of particular interest is the fact that a
number of local legislative bodies and
individuals when contacted for financial
support of the program last Spring,
thought enough of the project to actually
provide funds to help pay some of the
students’ stipends. They supported the
concept and proved it with their con-
tributions.

Contributors include:

Theodore T. Bronk, M.D., Buffalo, N.Y.
Brooks Memorial Hospital, Dunkirk, N.Y.
Cattaraugus County Legislature
Chautauqua County Legislature

City of Dunkirk, New York

City of Jamestown, New York
Genesee County Legislature

McKean County (Pa.) Medical Society
New York State Podiatry Society
Niagara County Legislature

Qlean Medical Group

Welch Food, Inc., Westfield, N.Y.

 

Medical
students Jay
Brachteld (1)
and Mark
Kramer
receive some
emergency
room tips fro:
. Mrs. Barbara
Budniewski,
ALN. at Brook
Hospital,
Dunkirk, New
York.

Medical
student Lois
Polatnick
observes as
her preceptor
Dr. Duncan
Wormer of
Portville, New
York conducts
a patient
examination.

 
Facts You Should Know About Health Systems Agencies (HSA’s)

The National Health Planning and
Resource Development Act of 1974 (P.L.
93-641) is an important piece of health
legislation that was signed into law on
January 4, 1975 by President Ford.

It calls for the development of a
network of Health Systems Agencies
{HSA) across the country which are in-
tended to assume the functions of
Regional Medical Programs and Com-
prehensive Health Planning under one
umbrella. super agency in_ individual
localities. Once fully organized the new
HSA will have control over millions of
federal tax dollars coming into a pre-
approved Health Service Area.

The National Act is designed to im-
prove the quality and accessibility of
health services, restrain skyrocketing
health care costs, and prevent un-
necessary duplication of health
resources.

Below are some of the most common-
ly asked questions about the new law.

|. What Is A Health Service Area?

A Health Service Area is a
geographical portion of the State con-
sisting of a group of counties that have
been joined together to plan better
health care for all persons living in the
area.

ll. What Is A Health Systems Agency
(HSA)?

A Health Systems Agency is a new
type of local health planning agency.
One Health Systems Agency will be es-
tablished in each Health Service Area of
the State. This agency must develop a
Health Service Plan for its area that
pays equal attention to the unmet health
needs of the many different kinds of
consumers that live in the different part
of the area.

ii. Why is There Talk Now About
Health Systems Agencies?

A Federal Law is now in effect that
requires Health Systems Agencies
HSA’s) to be established in every area
of the nation. It is called the “National
Health Planning and Resource Develop-
ment Act of 1974,” Public Law 93-641. It
was passed by. the Congress in late
December, 1974, and was signed by the
President in early January, 1975.

Vv. Can The Health Systems agency
Really Change Anything Important?

Yes. This law mandates stronger
authority and more control over in-
vestments of Federal and State health
dollars than has ever been given to a
jocal health planning agency. In addi-
tion, this law mandates that a majority
(51% to 60%) of consumers must be
members of the agency policy board.
These consumers must represent as
many special consumer interests as ex-
ist in the area. When these consumer
representatives sit on the board they
can vote in the best interests of special
consumer problems.

V. What Is Meant By Special Consumer
Interests?

Special consumer interests are social,
economic, linguistic, racial, and employ-
ment circumstances that create
problems for consumers when they
need health care.

VI. What Other Interests Will Be
Represented On The Agency Policy
Board?

The flaw mandates that special in-
terest of different geographic areas in
the Health Service Area, major
purchasers of health care, providers of
health care, and local government must
also be represented.

Vil. Will The Health Systems Agency
Provide Health Services?

No. The agency will not own or
operate hospitals or clinics, nor will it
employ doctors, nurses and other per-
sonnel to give health care.

Vill. WIH the Health Systems Agency
Have Any Effect On Doctors In Private
Practice?

Yes. They will be encouraged to do
work that answers the community
needs.

IX. WHE The Health Systems Agency
Affect Hospitals and Nursing Homes?

Yes. They will control construction
and purchase of equipment costing
more than $100,000. Any such project
must be reviewed and approved by the
HSA in that specific area. In addition,
the HSA will be reviewing costs and
charges for institutional health care in
their areas. This information, in turn, will
be forwarded for Federal review. It is the
intent of the Act to improve institutional
management and prevent unnecessarily
high costs.

X. What Are The Functions Of A Health

Systems Agency?

Improve the health of residents.

2 Increase accessibility, acceptability,
continuity and quality of health ser-
vices.

3. Restrain increases in cost of

providing health services.

Prevent unnecessary duplication.

Assume responsibility for effective

health planning.

Reduce documented inefficiencies.

Implement the health plans of the

agency.

The agency shall assemble and

analyze data concerning:

A. The status and conditions of the
residents of the health service
area.

B. The status of the health care
delivery system in the area — and
the use of that system by the
residents in that area.

C. The effect of the delivery system
on the health of the residents of
the area.

D. The number, type, and location of
the area's health resources

NO OS

oo

(including health services, man-
power, and facilities).

£. How the area’s health resources
are being used.

XL. Aren’t These Functions Being Done
Now?

These functions are now the respon-
sibility of several different agencies in
each area. In the future, only one Health
Systems Agency will receive Federal ap- -
proval to operate in each health service
area. All these functions will now be per-
formed by one single agency that will
have enough authority to enforce the
new Act. (P.L. 93-641)

XII. How Can One Health System Agen-
cy Represent and Give Equal Treatment
to the Many Different Communities In a
Large Health Service Area?

A Health Systems Agency can es-
tablish “Sub-Area” Advisory Councils to
represent each part of its health service
area that has special and different
health planning and health resource
problems. The special part may be a
geographic section or a group of people
with special needs. Consumers who
represent a special geographic part or
group of people in the Health Service
Area should get together and work
towards organizing a Sub-Area Health
Planning and Resource Council to
represent them. An agency that files
application to become an HSA must
show in its application how it will
guarantee equal representation to all
such “Sub-Area” Councils on its agency
governing board. Before any HSA
application is sent to Washington, it is
planned to have each reviewed at the
State level to insure all area consumer
interests have been given fair and equal
consideration.

XI. Will There Be Jobs (Paid And/Or
Volunteer) Within The Heaith Systems
Agency For Consumers Who Want To
Participate?

This will depend on how effective
consumers are in:

1. Organizing and maintaining active in-
terest in establishing Sub-Area
Councils.

2. Contacting and recruiting other con-
sumers and consumer organizations
to support strong and regular ex-
pression of the consumer point of
view.

3. Participating as working members on

the governing board of the agency.

4. Working with the agency on sub-
committees to: secure special infor-
mation; collect data; and contact
other consumers; consumer
organizations, churches, labor
groups, ethnic groups, all language
groups, age groups, economic
groups and any other special group
necessary for democratic decision
making.
OPTIONS (conra trom Page 1)
ing board would come from
county government.

Option IV: Same as Option Il! except
that nominations would come
from subarea or county com-
mittees.

Option V: Mixed Model. Nominations to
the governing board come
from both.county government
and the subarea or county
committees.

Rather than approving a single op-
tion, the Steering Committee voted to
invite county organizations of RMP, CHP
and government to form unified county
HSA organizations and to convene
pubiic meetings within each county for
the purpose of reviewing provisions of
the law and to examine the five options.
It is hoped that consensus within the
community will identify the best option.

Staffs from LARMP, CHP/WNY and
county government will be available to
assist county organizations in conduc-
ting public meetings.

Meanwhile the Steering Committee
will continue to function on an expanded
basis. In addition to the current
membership consisting of three persons
from each county (representing LARMP,
CHP WNY, and county government)
three more consumers from each coun-
ty will be added. This will expand the
Steering Committee from 26 to 50
members.

Members of the Steering Committee
include — Co-Chairmen: Drs. Bronk,
Eckhert: Allegany County—Virginia
Barker, Ed.D., R.N., Alfred University
School of Nursing, Irwin Felsen, M.D.,
Wellsville physician, Paul Taylor,
legislator, Belmont, New York; Cat-
taraugus County—Marilyn J. Gibbin,
County Division of Nursing Homes,
Olean, Fred A. Printz, Allegany, William
E. McHiwaine, public health ad-
ministrator, Olean; Chautauqua Coun-
ty—Murray Marsh, WCA Hospital Ad-
ministrator, Jamestown, Joseph Gerace,
county executive, Doris Mitchell, county
health department, Mayville; Erie Coun-
ty—Clifford M. Carpenter, Human Ser-
vices Planning, Buffalo, Paul G. Rohr-
danz, Buffalo, Gerald L. Schofield,
deputy director for administration,
Roswell Park Memorial institute, Buf-
falo: Genesee County—J. Albert
Bausch, county legislature, Batavia,
Sidney Sherwin Jr., Batavia, Robert M.
Whitrick, M.D., V.A. Hospital, Batavia;
Niagara County—Francis J. Clifford,
M.D., County Health Commissioner,
Lockport, Cortland Van Deusan, M.D.,
Niagara Falls, Joan Wolfgang,
Youngstown; Orleans County—George
Bane, Lyndonville, Betty Hassall,
Medina, John Staeble, Administrator,
county health department, Albion;
Wyoming County—Charles Grider, Jr.,
Arcade and Patricia Stopen, R.N., public
health administrator, Couunty health
department, Warsaw.

 

 

LARMP Quality
Assurance Programs
Attract Thousands

The need for continuing education
programs for all levels of heaith
professionals is well known. The Lakes
Area Regional Medical Program, inc.
has developed a successful format for
providing these continuing education
programs on a “circuit rider” approach,
whereby high quality programs are
brought to and staged in rural com-
munities upon request. Heaith
professionals from the community
decide what topics they would like
presented and then the LARMP
machinery goes into gear.
Arrangements are made, speakers ob-
tained, brochures mailed out and the
program is publicized. The response
has been overwhelming. Since these
programs first started in 1968, over 20,-
300 persons have participated. Evalua-
tion sheets returned after the program
have shown that the programs are well-
received and of tremendous value to
education-hungry health workers.
Programs on an interdisciplinary level
have been emphasized. The series of
Cancer Teaching Days conducted
throughout the region, featuring
specialists from Roswell Park Memorial
Institute and other famous health in-
stitutions has proven to be very popular
and successful. The range of cancer

topics is varied and interesting. Other -

programs have included subjects such
as hypertension, nutrition, aging,
medical genetics, interpersonal
relationships, pacemakers, emergency
medical services, crisis death in the
hospital and many others.

Many grateful participants have
attested to the fact that the LARMP con-
tinuing education programs are most

 

 

Niagara Gazette Photo

EMERGENCY CARE SEMINAR—Drs. John Border,
(left) and Melvin Dyster, demonstrate cardio-
pulmonary massage on a model during a teaching
day probrem held September 17 in Niagara Falls,
New York.

welcome and valuable, and perhaps the
only link to professional education
available in many of the rural com-
munities served by the program.

LARMP Qualtity Assurance Coor-
dinator, Patricia Hoff, R.N.,M.A. says, “l
think that the key is to involve the com-
munity in planning. The community has
to tell us what they need and we have to
give and take. a little; even though we
may perceive the need to be more ex-
tensive. We, after several planning
sessions, develop a program which is
‘their’ program. We are able to offer
programs more economically than most
as we operate on a narrow margin and
keep the price within reach of all health
workers.”

The system seems to be working well
and benefiting thousands of education
conscious health professionals
throughout the region.

 

PROPOSED FEDERAL
REGULATION PRINTED

Proposed Federal regulations for
designating and funding of Health
Systems Agencies (HSA’s) have been
printed in the October 17, 1975 issue of
the Federal Register. The regulations
set forth the eligibility and operational
requirements for HSAs and describe
Federal grants to help support their
operation. HEW will consider comments
received in the next 30 days before
publishing final regulations.

The jaw requires the Secretary of
HEW to consult with the governors in
the HSA designation process, and HEW
has invited governors to play a major
role.in the process. HEW plans to give
considerable weight to recommen-
dations of the governors in designating
the HSAs. ,

Applications for designation and fun-
ding may be submitted prior to publica-

tion of final regulations in accordance
with application requirements included
in the notice of Proposed Rulemaking.
For further information contact Dept.
HEW, Rockville, Maryland 20852.

NEW HEW SECRETARY

David Mathews, Ph.D., 39-year old
president of the University of Alabama
has been named the new Secretary of
the U.S. Department of Health, Educa-
tion and Welfare, replacing Caspar
Weinberger.

Dr. Mathews, reportedly overwhelmed
by the enormous complexities of ad-
ministering the largest budget in the
President's Cabinet, is for the moment
shunning confrontations on health or
welfare policy with organization
representatives, congressional com-
mittees or the specialized press.

Described as a “tough administrator,”
Dr. Mathews is supportive of the con-
cept of preventive medicine and the
team approach to health care delivery.

 
SAN DIEGO MEETING

(Cont'd from Page 1)

The threat of a lawsuit came from
Joseph F. Boyle, M.D. of Los Angeles
who said the American Medical
Association would carry through on its
previous declaration to take the govern-
ment to court as promised if the law is
implemented. The AMA will claim the
law is unconstitutional, usurping states
rights. _He stressed, however, that
physicians must be prepared to stay on
the scene to be aware of developments
in Health Systems Agencies and lend
advice where needed.

Optimism

Nathaniel Polster urged the associa-
tion to maintain its information lines
both to and from Congress. He detailed
the priorities in which Congress is
seemingly interested and for which
funds may be likely appropriated.
Among the health activities attracting
Congressional attention are public
education in preventive health, almost
any health program that promises
results that are measurable,
developmental activities in mental dis-
abilities, research in health services,
emergency medical services and rural
health activities.

He suggested that if RMPs would
focus on the priority programs and
demonstrate effectiveness, the im-
pressive record thus established would
leap to RMP leadership in rewriting the
law when the time comes.

Paul Ward, executive director of the
California Regional Medical Programs,
opined that the law must be amended
for a variety of reasons among them: 1)
HSAs are not immediately organized
and productive; 2) their funding will be
low, unequal even to that of the CHP,(b)
agencies; 3( developmental activities
(projects) are at feast three years away;
4) while HSAs by law must look to other
sources such as local governments for
supplements, there is no present

evidence that they are doing this or that,
if they do so in the future, they will be
successful. The reason is that county
governments and other sources are
pinched for money; 5) since the law
gives “unusual powers to the HEW
Secretary,” the threat of law suit will
probably slow down HSA development;
6) development of standards for delivery
of health care services, as well as un-
iform systems for cost accounting and
rate settings will also delay HSA es-
tablishment and operation.

Ward also listed as serious problems
the HEW Secretary’s regulatory power
and the continuing inflation which
makes Congress less eager to fund any
health activities. “Eventuaily the curve in
congressional appropriations for health
will turn up,” he said, and “we must be
prepared to provide the leadership and
to keep current and aware of the handl-
ing of extensive legislation when the
time arrives, which is expected to be
about the first of the year.”

Eugene Rubell, acting director,
Bureau of Health Planning and
Resources Development conceded that
technical changes in the law are needed
and noted they could not be expected to
be made until after the law was im-
plemented and a number of the HSAs
established.

PUBLIC HEARINGS

(Cont'd from Page 2)

ROCHESTER
November 14, 1975 — 10:00 am., City Hall Council
Chambers, 30 Broad Street.

ALBANY
November 20, 1975 — 10:00 a.m., Assembly Parlor Room
306, New York State Capitol.
Subject: To consider the significant aspects of proposed
Federal action to establish a system of national health in-
surance.
Purpose: To determine the appropriate response by New
York State, and by the Legislature in particular in anticipa-
tion of Federal action.
Contact person - Nancy Barrett, Staff Assistant, Assembly
Program Subcommittee on the Impact of National Health In-
surance. Legislature Bldg., Room 125, Albany, New York,
Phone (518) 472-8150.

Public Hearings
Set to Discuss
Arthritis Plan

The National Commission on Arthritis
and Related Musculoskeletal Diseases
has scheduled a series of public
hearings around the country to receive
testimony from the public and interested
individuals regarding the development
of a long-range Arthritis Plan. Some of
the hearing locations are noted below.
For those interested persons who are
unable to attend one of these hearings
and would like to express their view-
point on such matters as specific
recommendations for new programs of
professional and public education, basic
and clinical investigation,
demonstrations of patient care at the
community level, and the creation of a
national data system to support arthritis
control, send your written comments to
Ephraim P. Engleman, M.D., National
Commission on Arthritis and Related
Musculoskeletal Diseases, University of
California-San Francisco, 1356 Third
Avenue, San Francisco, California
94143.

Meetings will be held
10—Milwaukee, Wisconsin;
11—St. Louis, Missouri;
12—Little Rock, Arkansas;
8—St. Petersburg, Florida; December
9—Atlanta, Georgia; December
10—Houston, Texas. Meetings will be
held from 9:00. a.m. to 1:30 p.m. For
further details contact the Commission
Chairman at.San Francisco.

Petition for Incorporation Filed

On September 19, 1975, a petition for
charter of incorporation for Hawaii
Health Systems Agency, Inc. was filed
with the Department of Regulatory
Agencies. The petitioners were Gerald
Payne, George H. Mills, Edward Bryan
and Satoru Izatsu.

November
November
November
December

 

Lakes Area Regional Medical Program, Inc.

2929 Main Street
Buffalo, New York 14214

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

2929 Main Street
Buffalo, New York 14214

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

Anthony Zerbo, Jr., Editor
Hugo Unger, Photography

5 TNGALL
34 N PEARL ST
RUFFALO NY

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