w B&B ImF-oRm^-riom & imAmE M,&MAGEMENT moo @epocz @ROL-8 mou ^no Utoomen MARLMORM, Magt No zo-ITZ 0 USA 0 (20-1) Z,*@l -10 i DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE NATIONAL ADVISORY COUNCIL ON REGIONAL MEDICAL PROGRAMS Minutes of lst Meeting-LI December 21-22, 1965 The National Advisory Council on Regional Medical Programs convened for its first meeting at 9:40 a.m., Tuesday, December 21, 1965, in Conference Room A, Stone House, National Institutes of Health, Bethesda, Maryland. Dr. William H. Stewart, Surgeon General, Public Health Service, and Chairman, ex offi-cio, presided. The Council members present were: Dr. Leonidas H. Berry Dr. Clark H. Millikan Mr. Gordon R. Cumming Dr. George E. Moore Dr. Michael E. DeBakey Dr. William J. Peeples Dr. Bruce W. Everist Dr. Robert J. Slater Dr. James T. Howell Dr. Cornelius H. Traeger Dr. John W. Hurst The Council member absent was: Dr. Mary I. Bunting Public Health Service members attending some of the sessions included: Dr. Leo J. Gehrig, Deputy Surgeon General, PHS Dr. Ernest M. Allen, Grants Policy Officer, OSG, PHS Dr. Bert Cole, Deputy Grants Policy Officer, OSG, PHS Dr. James A. Shannon, Director, NIH Dr. Stuart M. Sessoms, Deputy Director, NIH Dr. Robert Q. Marston, Consultant, OD-NIH Mr. Karl D. Yordy, Chief, Legislative Reference, and Liaison Branch, OPP-OD-NIH 1/ 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. 2 Liaison members: Dr. Edward W. Dempsey, NIGMS Council Dr. Sidney Farber, NCI Council Dr. John B. Hickam, NHI Council (Dr. John S. Meyer, NINDB Council--absent) Others present were: Dr. F. A. Arnold, Jr., Director, NIDR Dr. Kenneth M. Endicott, Director, NCI Dr. Richard L. Masland, Director, NINDB Dr. Frederick L. Stone, Director, NIGMS Dr. William J. Zukel, Acting Director, NHI Dr. Samuel Fox, BSS Dr. Murray Goldstein, NINDB Dr. Eugene A. Confrey, Chief, DRG Dr. Jerome Green, NHI Dr. Henry T. Clark, Jr., Consultant, OD-NIH Dr. R. B. Stephenson, OD-NIH Mr. Stephen J. Ackerman, PHS-BSS Mr. Charles Hilsenroth, PHS-BMS Dr. Carl Brewer, NIH Consultant Mr. Ralph R. Mueller, BOB 1. OPENING REMARKS Dr. William H. Stewart, Surgeon General, Public Health Service, and Chairman, ex officio, called the meeting to order at 9:40 a.m. This was the first meeting of the Council, and Dr. Stewart swore them in simultaneously. (brs. Bunting and Peeples were absent and will be sworn in later.) Dr. Stewart said the Council will have two principal functions. One is to advise us on policies and planning as this program is initiated and matures. Secondly, it will be necessary for the Council to recommend appropriate action on the applications because the law requires an affirma- tive recommendation from this Council before the Surgeon General can make a grant. The Public Health Service, and the NIH staff were then introduced to the Council. Dr. Stewart gave a brief summary of the legislative history of the Bill up on which this program is based. Most of the changes occurred in the House Committee. An area given considerable attention by the House was local initiative in the implementation of this program. The Act requires that there be a local advisory group, and the law spells out a great deal about the membership of this group. This group must be in existence as one of the 4 VI. BACKGROUND REPORT, THE PRESIDENT'S COMMISSION ON HEART DISEASE, CANCER, AND STROKE Dr. Edward W. Dempsey, Consultant to the Secretary, DHEW, gave a brief history on the background of this Commission. This was supplemented by presentations by Dr. Michael E. DeBakey, Professor and Chairman, Department of Surgery, College of Medicine, Baylor University, and Dr. Sidney Farber, Director of Research, Children's Cancer Research Foundation, Boston. The Commission made 35 specific recommendations which included provisions for the establishment of new programs and strengthening already existing proarams. Reaional Medical Programs reflect the first three recommendations made by the Commission. Other parts have been implemented by other legis- lation, i.e., the Health Professions Educational Assistance Act and the Library Act, or proposed by providing support under existing authorities. Dr. Farber stated that this is the most important challenge which has been presented to the medical community. He expressed pleasure at the increased opportunity which the Cancer Council and the Cancer Institute will have in working with those responsible for the-regional centers. This will add real meaning to many of the programs of the Cancer Institute as well as the the Heart and the Neurological Diseases Institutes. The Commission as a whole was concerned with the establishment of certain principles which, while new, were really very old in their basis. The main goal of the Cancer Subcommittee on the Commission was the bringing to every patient in the country, through his doctor, everything that can be obtained from any laboratory, any hospital, or any medical school, or any source of knowledge in behalf of that patient. Only a small percentage of the total population is able to receive the benefit of everything that is known in the prevention of cancer, in the early diagnosis of cancer, and in the utilization of all of the knowledge that is available today. One reason for this is the lack of resources. In the presently established cancer institutes around the country there is a greater fund of knowledge concerning cancer than in any university department. This is due to the magnitude of the task that has been given to the medical schools of this country. At the present time, so far as is known, there is no cancer institute in the country which has a completely satisfactory relationship with the medical schools. This is one of the challenges that this Council will have to consider when the applications are reviewed. During the Commission's study, thought was given not to the name of an institution but of the problem of the patient, and every patient in a given region. 6 IX. REVIEW OF APPLICATIO@NS, LIAISON, AND CONNA@ICATIO@NS-- Dr. Sessoms We are planning a dual review system for applications in this program. The initial review will be done by a committee, either standing or ad hoc, similar to a Study Section. Regardina liaison and communication, we do have Ccuncil liaison representation from the four Councils concerned with this program. These individuals will meet with this Council and will be in a position to brina to this Council views or recom- mendations from their Councils and will be able to take back to their own categorical Councils the reports, recommendations, or inquiries that may come up here. Dr. Sessoms introduced Dr. Marston who will become Associate Director, NIH, for Regional Niedical Prourams. Dr. Marston will enter on dirty February 1, 1966. Dr. Nlarston gave general comments concerning this program. X. PLANNING FOR A REGIONAL @,'@EDICAL PROGRAM: S@IARY OF I-NT@ST SHOWN Each Council member presented a brief report on what is developing in their part of the country on this program. Dr. Sessoms introduced Dr. Henry Clark who has been serving in a consulting capacity with NIH for several months and has been focusing his attention on the re-ional type of medical activities that have been going on in some parts of this country for several years. Dr. Clark gave the background of his involvement in this program, and will send a copy of his report to the Council members when it is completed. XI. PRESENTATION AND DISCUSSION- OF DRAFT REGULATIONS FOR REGIONAL MEDICAL PROGRP.14S--Dr. Sessoms The Council members had received a copy of the or to the meeting. Dr. Sessoms pointed out the changes which have been made and then the aroup-was asked to raise any specific questions that they might have. The only change made by the Council concerned Section 667.2, page 2, "Definition," Item (g). It was unanimously agreed that the phrase, "who is primarily engaged in the diagnosis and treatment of patients" be deleted. There was general consensus among the Council members that it was desirable to avoid undue specificity in the regulations. Premature specifics might serve to restrict, in an unforeseen manner, desirable de- velopments in regional medical programs. 7 Copies of the Regulations, as published in the Federal Register, will be sent to the Council members when published. XII. ADJOURNMENT The meeting was adjourned at 12:30 p.m., December 22, 1965. I hereby certify that, to the best of my knowledge, the foregoing minutes and, attachments are accurate and complete. Stuart M. Sess6ms, M. D. Deputy Director, NIH Eva M. Handal, Recording Secretary Secretary to Deputy Director, NIH REGIONAL MEDICAL PROGRAMS COUNCIL MEMBERS 1/7/66 Dr. Leonidas H. Berry Dr. John Willis Hurst Professor, Cook County Graduate Professor and Chai =an, School of Medicine, and Department of Medicine, Senior Attending Physician, Emory University School Michael Reese Hospital of Medicine 412 E. 47th Street Atlanta, Georgia 30303 Chicago, Illinois 60653 Dr. Clark H. Millikan Dr. Mary I. Bunting Consultant in Neurology President, . Mayo Clinic Radcliffe College Rochester, Minnesota Cambridge, Massachusetts Dr. George E. Moore Mr. Gordon R. Cumming Director, Administrator, Roswell Park Memorial Institute Sacramento County Hospital 666 Elm Street 2315 Stockton Boulevard Buffalo 3, New York Sacramento, California Dr. William J. Peeples Dr. Michael E. DeBake), Commissioner of Health Professor and Chairman State Department of Health Department of Surgery State Office Building College of Medicine 301 West Preston Street Baylor University Baltimore, Maryland 21201 Houston, Texas 77025 Dr. Robert J. Slater Dr. Bruce W. Everist Dean, College of Medicine Green Clinic University of Vermont 709 South Vienna Street Burlington, Vermont Ruston, Louisiana 71270 Dr. Cornelius H. Traeger Dr. James T. Howell 799 Park Avenue Executive Director, New York, New York Henry Ford Hospital Detroit, Michigan Ex Officio Member Dr. William H. Stewart (Chairman) Surgeon General Public Health Service Washington, D. C. 20201 NATIO@IAL AR@-TSORY C;)UNCt@- 01-T REr,:[Otl/-.L mErict.,, pRoCR.A_iLg Decembel- '-11-22, 1965 Conference Room A, Stone House Dr. Cornelius H, Traeger (67) Dr. James H.-,.ll (68) 799 Park Avenue Executive Director New York, New York Heary.Ford Hospital Detroit, Michigan Dr. Robert J. Slater (66) Dean, College of Medicine Dr. Bruce Everist (67) IJuiversity of Vermont Green Clinic Burlington, Vermont 709 South Vienna Street Ruston, Louisiana 71270 Dr. William Peeples (66) Comissioner of Health Dr. Michael E. DeBakey (68) State Department of Health Professor and Chairman State Office Building Department of Surgery .301 Weat'Preston Street College of Medicine $altimore, Maryland 21201 Baylor University Houston, Texas 7702,5 Dr. George E. Moore (68) Irector Mr. Gordon Cumming (66) itoswell Park @rial Institute Administrator 666'Elm Street Sacramento County Hospital Buffalo 3, New York 2315 Stockton Boulevard Sacra @ to, California Dr. Clark B. Millikan (68) Consultant in Neurology Dr. Leonidas H. Berry, (67) Mayo Clinic President Rochester, Minnesota National Medical Association 412 East 47th Street -Dr. John Willis Hurst (66) Chicago, Illinois Professor and Chairman Department of Medicine Emory Uaiversity,., Sdhool of Medicine Atlanta, Georgia 30303 Reporter Mr. Office of Yordy the Secretary Dr. Marston Dr. Sessoms Surgeon General D.-. Sha@-#x RWIONAL MMICAL PROGRAMS COUNCIL Dr: Leonidas R. Berry (67) Dr.'John Willis Hurst (66) President Professor and Chairman National Medical Association Department of Medicine 4,P East 4Tth Street -Enory University School Chicago., nlinois 60653 of Medicine Dr. Mary I,, Bunting (67) Atlanta, Georgia 30303 President Dr. Clark H. Millikan (68) Radcliffe College Consultant in Neurology Cambridge, Massachusetts Mayo Clinic Rochester) Minnesota Mr. Gordon Cumning (66) Administrator Dr. George E. Moore (68) Sacramento County Hospital Director 2315 Stockton Boulevard Roswell Park Memorial Institute Sacramento., California 666 Mm Street Buffalo 3, New York Dr. Michael Eo DeBakey (68) Professor and Chairman Dr. William Peeples (66) Department of Surgery Commissioner of Health College of Medicine State Department of Healt,4 ]3aylor University State Office Building Houston., Texas 77025 301 West Preston Street Baltimore., Maryland 21.201 Dr. Bruce @riat (6T) Green Clinic Dr4 Robert J. Slater (66) 709 South Vie=a Street, Dean., College of Medicine Ruston University of Vexmont ., Louisiana 7IP70 James To Have3.1 (68) BLix@ont Verniont Qa Executive Director Cornelius H. Traeger (67) @-ieeA- -Ma-e@@ (Retired) Henry Ford Hospital 799 Park Avenue Detroit,$ Mi:chigan New York., New York Officio,Member Dr, William H. Stewart (aaa Surgeon General Public Health Service Washington.$ D*C, 20201 11/30/ 65 DEP Cr Olf.. AIO WWARE hati@ @itutes of Realth sft,, mm rr@ AIMOZA@-N AG@MA P-irat @ing or the. NPMCKAL ADVISORY COUIQCIL On RMIOIQAL MMICAL PRoGRAmS * Rom Aj, Stone House 9:30 or 21-22., 1965 MO 496-5881 CALL TO CFMM AM) @r@e Comoil @ers and SWf n. On TWAM TM PMRZC MM MM=-- Dr. WIIU= R. ft in. R=cm XMICM PROMUM M MM NMOM III ApyTTFIT cIr --Dr. Jams A. DiLrootarj, NM Anno=c e: Dr. St-umrt- M. Senscms @y Director., 1. -A Service Deal, is located,in the ban to pr@de ce. , It you h"eany queaticns travel. or re-imburs of expenses., ve bav-- ed for 1-im. Ha el to be here b 32-00 and :L*.OP pm. t to give you o- day 2.' Coffee Br 4-wrn and gdd-aftemoon 3*' eon (12.-30 2:00) Cafeterias are located: Bu,'-lding 31 first floor Build:Lng I third floor Clini@ Center B-I'C-13 Bus p@ce@ approx. on the rt ha= qua _pp_ ,4, re will bik, a di=c-.r to@t at 6:3o at the charcoal Hearth,, 2001 Wisomain Avenue. cost'vill be $6.00 per 17-@VersOn and t@ will be- a cash bar aval@le. 2 of 7Lnterc- f@m-ing fr= t-ae D rt of H@th FAt@,ation, and Welfare aene-mi p-&inistraz:Lo Wmue n is @led t@Ao -4s,-he Of -"Lb a F-ealth SerN-ic-c- o@-@l, ant a ?tAtlvise--s and ccrsult-, -@t%s ;3m-v@, -z Others !Df pub-l@c shoul4.nc(t -oaetdf-ipw,:e in S;-tuat-i-ons i-n 'v@@T L,, -i-olrz-bio-m of conflict of in- -rc-s+ loss ead re@s-v,- or@ is likely to oce-Lir ,L L -L LTc-f4ds of B=@is end Di-vigi-ons sholald establish proo@res and controls to insure that a c@@ttee @eer is c3lsqit@fiea from p--rfomirg duties or a,-qvice iejaich vill havc- a di-1,Let and Pred-"ctable. effect on the ir-terests of an or or w@th -a -@li he is ass@,iate,,l az ar" emplo-jee o::@ consultant or in which he 1--es a fimme-@ @erest. In particle., Bottom med,)c-rs should not @ticipate in the equation of contract or grant propos@ whitt wi3.l direat'll,,' eLf@. the interests of au4vh organization or inatit-u-Uon.11 ty Of I%fti cmn,denti@ Re@t:Lons of PM Se@ce prcrride tbat discussions 'Of adv-ir-o*- coumile s@ be -held confidential except as d-l-selosiwe :@:s authorized by the @eon Gmneral. lWi3letive @es (under lIC-J TVb "@S]Ation") ye Pictures will be taken the meeting as ve3l as h&N@ a group pictIL-e taken in fro,.it of Stone House d=IM the firwb coffee break. Oa the table before you is a _uaper entitled "Appoiiatwnt Affi&--Its". Plesse -@ad P. thr@ D @ sign on the Une si@iu-e of P-p,-Vointee". On t4e rupees side,, only item 7 should be ered. @,,o,, For-a W-4 -Portion Certi-Ficatell should be c@,leted and al4ped by you. 3 @ee Break IV. c(wsimmon oF =mNG DATFZ (1966 cale@ behind this agenda.) V. BAM=A= THE FMIDENTIS CMCSSION ON Di. TAB I CANCER.. AND SMOU--Dr. Mi@l E. De@y (Professor and TAB II ,, De nt of Surgery., CoUege of Medicine,, @lor University); Dr. W. DeMsey (Cmaultant to the Secretary,, DHEW); and Dr. Sidney I?az-ber (Director of Research., Children's Cancer @earch F tion,, Boston). Luncheon VI. UCGIBLATIVE HISTORY OF P.L. 89-239,, THE DI 9 CANCBRs AnD mm s oF i965--mr. Yarl D. Yordy., Chief,, Legislative Reference and Liaison Branch,, NIH Coffee ]3reak Vil. PLAIGNING FOR A RWIONAL MEDICAL PROMM: olr TAB III SHMS AND ACTION TAKEN BY, INSTITTITI(SO AND ONO--Dr. M. Soisscas od Mr. Tordy 6:30 D@r DeceWnr 22, 1965, 9:30 a.m. Viii. ATION AND DWMSSION OF MM ion FM MGIOM To IV MMIML PR 12:00 noon adjourment 00, 1966 JANUARY JULY S M T W T F S S M T W T F S I I 2 2 3 4 5 6 7 8 3 4 5 6 7 8 9 9 10 11 12 13 14 15 10 11 12 13 14 13 16 16 17 is 19 20 21 Z2 17 18 19 20 21 22 23 23 24 23 26 27 28 29 24 Z5 26 27 28 29 30 30 31 31 FE;BRUARY ATIOUST s M T W T F 5 @t T W T F -8 1 2 3 4 5 I Z 3 4 3 6 6 7 8 9 10 It 12 7 0 9 10 I I I 213 0 14 13 10 l@19 14 13 16 17 1 8 1 9;O to 11 n 13 as 21 22 23 24 13 20 17 27 28 28 29 30 31 MARCII SEPTEMBER S M T W T F 5 5 M T W T F S 1 2 3 4 5 1 2 3 6 7 8 9 10 11 12 -4 3 6 7 ' 8 9 10 13 14 13 16 17 18 19 11 12 13 14 15 16 17 20 21 22 23 24 23 26 18 19 20 21 22 23 24 27 28 29 30 31 23 26 27 28 29 30 APRIL OCTOBER i' m 5 M T W T F S T W T F-S 1 2 3 4 5 6 7 8 9 2 3 4 5 6 7 8 10 It 12 13 14 15 16 1) 10 11 12 13 14 15 17 18 19 20 21 22 23 16 17 18 19 ZD 21 22 24 25 26 27 28 29 30 23 24 25 26 27 28 29 30 31 MAY NOVEMBER S M T W T F 6 5 m T W T F S 1 2 3 4 5 6 7 1 2 3 4 5 8 9 10 11 12 J3 14 6 7 8 9 10 11 12 15 16 17 18 19 20 21 13 14 15 16 17 18 19 22 23 Z4 23 26 27 28 20 21 Z2 23 24 Z5 26 29 30 31 27 28 29 30 JUNE DECEMBER 9 m T W T F 5 6 M T W@T F S I 2 3 4 1 2 3 5 6 7 & 9 in 11 4 5 6 7 8 9 10 12 13 14 13 16 17 19 ti 12 13 14 15 16 17 19 20 21 22 23 24 25 18 19 20 21 22 23 24 go $I 28 39 .10 is 24 27 Zs 29 30 31