w I A %u B&B lt4@Rm^,riom & IMAGE MANAMEME@ 300 @eftcz M=nu@s aoulzv UP-golen M@$tL=Ono, MAR Pto Z077Z 6 USA 0 (201) 24@l 10 HISMFff OF REGIONAL MEDICAL P (Public Law 89-239) Prepared As Requested for President Johnson Library August 289 1968 INDEX HISTORY @e Backgromd . . . . . . . . . . . . . 0 # . . 0 . . 0 1 Conferences (Regional Medical Prograin) . . . . . . . . . . . . . 10, 11 Divisim of Regional Medical Programs . . . . . 0 0 0 . . . . . 6, 7, 18 Fiscal Information . . . . . . . . . . . . . . . . . . . . . . . 6, 8 Guidelines . . . . . . . . . 0 & 0 0 0 0 0 0 70 10 Legislation, see Public Law 89-239 Legislation (prior), see Backgromd Marston, Robert Q. . . . . . . . . . . . . . . . . . . . 0 . . 0 6., 12 National Advisory Council on Regional Medical Programs . . . . . 72 14, 24 Olsm, Stanley W . . . . . . . * e * 0 0 0 * . 0 . 0 0 6 . . . * 11 Operational Grants . . . . . . . . . . . . . . . 0 . * 0 . 0 . 0 8, 31 Planning Grants . . . . . . . . . . . . . . . . . . . . . . . . 7, 8, 31 President's Commissim on Heart Disease, Cancer and Stroke . . . 3g, 4 Program Coordinators . . .. . . . . . . . . . . . . . ... . . . . 27, 31 Public Law 89-239 . . . . . 0 . . . 0 * * . 0 . 0 . 6 6 . 0 1, 4, 6 Regional Advisory Groups . o . . . . . .. . . . . . . . . . . . . 8,' 9, 2S Regional Medical Program Review Comdttee . . . o . . . ... . . 7, 24 Regional Medical Program Staffs . . . . . . . . . . .. . . . . . 9,, 31 Regional Medical Programs . 0 0 0 . * 0 * 9 0 . 0 0 0 6 0 . 0 *1 23, 27, 31 Regionalization (concept) . 0 * 0 . . 0 0 e * 0 0 0 0 0 0 . . 0 11, 5 Regions (geographical) . . . . . . . . o 0 0 0 a 0 6 a 0 0 0 0 6 9 Report to the President . . . . . . . . . . 0 * 6 0 0 0 0 0 0 109 11 INDBX, continued APPENDICES Page 1. Public Law 89-239 . . . . . . . . . . . . . . . . . . . . . 14 2. Directory of Divisim of Regional Medical Programs . . . . . 18 3. Listing of National Advisory Council and Review Committee . . . . . . . . . . . * . 21 4. Chronology of Regional Medical Programs . . . . . . . . . . 23 S. Regional Medical Prograrns Regional Advisory Groups . . . . . 25 6. Map of Regional Medical Programs and Listing of Program Coordinators . . . . . . . . . . . . . . . . . . . . 27 7. Directory of Regional Medical Programs . . . . . . . . . . . 31 8. Excerpts of Testimony and Materials (H.R. 15758) . . . . . . 47 . Report on funded projects and activities in first 12 Operating Programs . . . . .. . . . . . . . 48 . Televisim, radio and telephme networks for continuing education . . . . . . 61 0 Statement m efforts directed against the health problems of the inner city . 62 e Statement m operational projects affecting rural areas . . . . . . . . . . . . . . . . 64 . Statemnt m effectiveness of Programs . . . . . ... . 71 HISTORY OF REGIONAL NEDICAL PROGRAMS (Public Law 89-239) On October 6, 1965, the President signed'Public Law 89-239. It authorizes the establishment and maintenance of Regional Medical Programs to assist the Natim's health resources in making available the best possible patient care for heart disease, cancer, stroke and related diseases. This legislation, which will be referred to in this History as The Act, was shaped by the interaction of at least four antecedents: the.historical thrust toward regionalization of health resources; the development of a national biomedical research c ty of unprece- dented size and productivity; the changing needs of society; and finally, the particular legislative process leading to The Act itself. The concept of regionalization as a means to meet health needs effectively and economically was not new. During the 1930's, Assistant Surgeon General Joseph W. Mountin was one of the earliest pioneers urging this approach for the delivery of health services. Ihe Na- tional Comihittee on the Costs of Medical Care also called attention in 1932 to the potential benefits of regionalization. In that same year, the Bingham Associates PLmd of Maine initiated the first comprehensive regional effort to improve patient care in the United States. This program linked the hospitals and programs for continuing education of physicians in the State of Maine with ;Mfts University School of @cine and, through that school., to the other university centers of Boston. Advocates of regionalization next, gained national attention more,than -2- a decade later in the report of the Comission on Hospital Care and in the Hospital Survey and Construction (Hill-Burton) Act of 1946. Other proposals and attempts to introduce regionalization of health resources can be chronicled, but a strong national mvement toward regionalization had to await the convergence of other factors which occurred in 1964 and 1965. One of these factors was the creation of a national biomedical research effort unprecedented in history and unequaled anywhere else in the world. The effec-C-of this activity was and continues to be intensified by the swiftness of its creation and expansion: at the beginning of World War II the national expenditure for medical research totaled $45 million; by 1947 it was $87 million; and in 1967 the total was $2.257 billion -- a 5,000 percent increase in 27 years,. The mst significant characteristic of this research effort is the tremendous rate at which it is producing new knowledge in the medical science, an outpouring which only recently began and which shows no signs of decline. As a result, changes in health care have been dramatic. Today, there are cures where none existed before, a number of diseases have all but disappeared with the application of new vaccines, and patient care generally is far more effective than even a decade ago. It had become apparent in the last few years, however, that new and better means must also be found to convey the ever-increasing volume of applicable research results to the day-to-day use of the practicing physician as well as to the growing complexities in medical and hospital care. Included in this latter group are physician specialization,, increasingly intricate and expensive types of diagnosis and treatment,, and the most effective distribution of scarce health manpower, facilities, and other related resources. The -3- degree of urgency attached to the need to cope with these issues is heightened by an increasing public demand that the latest and best health care be made available to everyone. This public demand, in turn, is largely an expression of expectations aroused by awareness of the results and promise of biomedical research. In a sense, the national comitment to biomedical investigation is one manifestation of the third factor which contributed to the creation of Regional Medical Programs: the changing needs of society in this case, health needs. The decisions by various private and public institutions to support biomedical research were responses to this societal need perceived and interpreted by these institutions. In addition to the support of research, the same interpretive process led the Federal Goverment to develop a broad range of other programs to improve the quality and avail- ability of health care in the Nation. The Hill-Burton Program which began with the passage of previously mentioned Hospital Survey and Construction Act of 1946, together with the National Mental Health ,Act of 1946, was the first in a series of post-World Wa-i II legislative actions having major impact on health affairs. When the 89th Congress adjourned in 1966, 25 health-related bills had been enacted into law. Among these were Ntdicare and Medicaid to pay for hospital and physician services for the Nation's aged and poor; the Comprehensive Health Planning Act to provide funds to each state for non-categorical health planning and to support services rendered through state and other health activities; and Public Law 89-239 authorizing Regional Medical Programs. For the text of Public Law 89-239, see Appendix.l. The Report.of the'President's Cofinission on Heiirt-Disease-,, Cancer, and Stroke, issued in December 1964, focused attention m societal needs and led directly to the introduction of the legislation -4- authorizing Regional Medical Programs. Many of the Commission's recommendations were significantly altered by the Congress in the legislative process but The Act was clearly passed to meet needs and problems identified and given national recognition in the Commission report and in the Congressional hearings preceding passage in The Act. Some of these needs'and problems were expressed as follows: * A Program is ne.eded to focus the Nation's health resources for research, teaching and patient care on heart disease, cancer,, stroke and related diseases because together they cause 70 per- cent of the deaths'in the United States. * A significant number of Americans with these diseases die or are disabled because the benefits of present knowledge in the medical sciences are not uniformly available throughout the country. * There is not enough trained @awer to meet the health needs of the American people withing the present system for the delivery of health services. * Pressures threatening the Nation's health resources are building because demands for health services are rapidly increasing at a time when increasing costs are posing obstacles for many who require these preventive, diagnostic, therapeutic and rehabilitative services. * A creative partnership must be forged the Nation's medical scientists practicing physicians, and all of the Nation's other health resources so that new knowledge can be translated more rapidly into better patient care. This partnership should make it possible for every ty's practicing physicians to share in the diagnostic., therapeutic and consultative resources of major medical institutions. They should similarly be provided the Op- portunity to participate in the academic enviornment of research,, teaching and patient care which stimulates and supports medical practice of the highest quality. Institutions with high quality research program in heart disease, cancer, stroke, and related diseases are too few, given the magni- tude of the prqblems, and are not uniformly distributed through- out the country. There is a need to educate the public regarding health affairs. Education in many cases will permit people to extend their own lives by changing personal habits to prevent heart disease, cancer,, stroke and related disease. Such education will enable individmls to recognize the need for diagnostic, therapeutic or rehabilitative services, and to know where to find these services, and it will motivate them to seek such services when needed. During the Congressional hearings on this bill, representatives of major groups and institutions with an interest in the American health system were heard, particularly spokesmen for practicing physicians and co ty hospitals of the Nation. The Act which emerged turned away from the idea of a detailed Federal blueprint for action. Specifically, the network of "regional centers" recommended earlier by the President's Commission was replaced by a concept of "regional cooperative arrangements" among existing health resources. The Act established a system of grants to enable representatives of health resources to exercise initiative to identify and meet local needs within the area of the categorical diseases through a broadly defined process. Recognition of geographical and societal diversities within the United States was the main reason for -6- this approach, and spokesmen for the Nation's health resources who testified during the hearings strengthened the case for local initiative. Thus the degree to which the various Regional Wdical Prograw meet the objectives of The Act will provide a measure of how well local health resources can take the initiative and work together to improve patient care for heart disease, cancer, stroke and related diseases at the local level. The Act was intended to provide the mans for conveying to the mdical institutions and health professions of the Nation the latest advances in medical scienr-e for diagnosis, treatrwnt, and rehabilitation of patients afflicted with heart disease, cancer, stroke, or related diseases--and to prevent these diseases. The grants authorized by The Act.are to encourage and assist in the establishment of regional coopera- tive arrangements among medical schools,, research institutions, hospitals,, and other medical institutions and agencies to achieve these ends by research, education, and demonstrations of patient care. Through these mans, the prograus authorized by The Act are also intended to improve generally the health manpower and facilities of the Nation. The Supplemental Appropriation Act of 1966 provided initial ftmding for the program, making available $24 million for grants and $1 million for the Division for fiscal year 1966. The Department of Health, Educatim, and Welfare Appropriation Act of 1967 provided $42 million for grants and $2 million for the Division for fiscal year 1967. Shortly after the Law was signed by President Johnson on October 6, 1965, the Division of Regional Nbdical Program was established at the National Institutes of Health. To direct its activities, Dr. Robert Q. Marstm accepted the invitation to leave his post as Dean of NL-dicine and Vice Chancellor of the University.of Nfississippi and become Associate -7- Director of the National Institutes of Health. Prior to the arrival of Dr. Niarston, Dr. Stuart Sessoms, Deputy Director of the National Institutes of Health, was -responsible for the development of plans and policies for the new program. 7he Division of Regional Medical Program was established in February 1966. A listing of the chief staff of the Division in the spring of 1968 is Appendix 2 of this History. The National Advisory Comcil m Regional Medical Progrars, established by the Law, was named from outstanding expert s in heart disease, cancer and stroke and from the leaders in medical practice, hospital and health care a&dnistration and public affairs. The Comcil met with Dr. Marston for the first time in Deceinber 1965 to advise m plans and policies. In early February 1966, the Council met again to review and approve the first issue of the Program Guidelines. Quickly printed, this publication was given its initial distribution the follow- ing month. Members of the National Advisory Council as well as the renbers of the Review Ccmittee who do thorough review of projects and make reconmndations to the Comcil prior to Council consideration and action are listed in Appendix 3. During the spring of 1966, some 20 applications for planning grants were received and reviewed first by initial review groups selected from ammg the comtry's health leaders, and then by the National Advisory Council. By July 1, the first 10 planning grants were recommnded for approval, and inmdiately awarded. Between July and DeceTnber 1966, another 40 applications were reviewed. Many of these were returned for revision or additional information to conform with the requirements of The Act. Twenty-four of these were approved and funded -8- so that when 1966 ended, a total of 34 Regional Nbdical Prograns had received awards for planning programs. These Regions represented areas that included som 60 percent of the population of the country. The first applications for operational grants had also been submitted by that date. In February 1967, the first four operational and 10 additional planning applications had been through the review process and were -reconwnded for approval by the National Advisory Comcil. At the Comcil meeting in May,-five additional planning applications were recommended for approval. In June, the first continuation grants were awarded to 10 Regions for the second year of planning. By the end of 1967, the total of Program in the planning state had increased to 53 and included the entire country with the exception of Puerto Rico. Also, by that time four more operational grants had been made for a total of eight. By July 7, 1968 Puerto Rico had its planning grant bringing the total Regional Medical Programs to 54 of which 23 had become operational. In terms of dollars expended these activities represented gome $75 million--$41 million in planning funds and $34 million to support operational activities. A chronology has been developed to show the time sequence in the developmnt of the Program . It is Appendix 4 of this History. I In terms of people, Regional Advisory Groups are comprised of hospital administrators,, public health officials, practicing physicians, voluntary health agency representatives, medical center and medical school officials and other members of the public. A pie chart was developed to show the overall distribution and numbers of these categorical Groups in April 1968 and is included as Appendix S. In July of 1968 the overall total of individuals m Regional Advisory Groups had risen to 2,034. Subcommittees of-these Groups involved another 3,132 persons. On the staffs of the 54 Regional Wdical Programs in July there was also a total of 1,539 full and part-time people involved in planning activities and another 908 involved in operational activities throughout the country. Appendix 6 lists the 54 Regions and the Program Coordinator or Director of each. It also gives a visual representation of the approximate geographical locations of the Regions. Appendix 7 is a Directory of Regional Nbdical Programs compiled in April 1968 which gives more detailed information m each Regional Nbdical Program, including preliminary planning area, estimated population covered, coordinating headquarters, Program Coordinators and Directors, Chairmen of the Regional Advisory Groups, and amounts of planning a!id operational grants and their effective starting dates. The 54 Regions encompassing the Natim's population had been formed,by organizing groups using functional as well as geographic criteria. These Regions now include combinations of entire states (e.g. the Washingtm- Alaska Region), portions of several states (e.g. the Intemountain Region which includes Utah and sections of Colorado, Idaho, Montana, Nevada and Wyoming), single states (e.g. Georgia), and portions of states around a metropolitan center (e.g. the Rochester Region which includes that city and 11 surromding counties). Within these Regional Programs, a wide variety of organization structures have been developed, including execu- tive and planning c@ttees, categorical disease task forces, and ity and other types of sub-regional advisor)r conidttees. -10- In accordance with The Act, Regions first received planning grants from the Division of Regional Wdical Progrars, and then a growing number were awarded operational grants to fund activities planned with initial and subsequent planning funds. 'Ihese operational activities provide the direct means for Regional Wdical Prograns to accomplish their objectives. Planning not only moves a Region toward operational activity, but is a continuing mans for assuring the relevancy and appropriateness of operational activity, It is the effects of the operational activities, however, which are beginning to produce results by which Regional Medical Progr @ are being judged. In July of 1966 there was a second printing of the Guidelines. These were up-dated in July of 1967, and revised again in Nlay of 1968. Two significant events during the first two years of the Program's existence were the National Conference held January 15-17, 1967, and the Conference-Workshcp of January 17-19, 1968. .The first meeting had been called by the Division of Regional' Nbdical Programs to obtain information frm a representative- group of knowledgeable individuals, which could be used in the preparation of the required Report on Regional Medical Programs to the Cmgress (PHS Publication No. 1690), and further to provide an interchange of informa- tim m the planning of the Programs. Devoted principally to the problems of definition and elaboration of,,the concepts of cooperative arrangements local initiative, and evaluation, that first meeting as reported in its Proceedings: Conference m Regional Nbdical Prograins (PHS Publication No. 1682) did much to characterize the Pmgram in their early stages. The January 1968 Conference-Workshop grew out of a specific request of the Program Coordinators at their meeting of June 1967. Planned by the Program Coordinators themselves, it was significant in content and purpose, and marked a milestone in the development of Regional Medical Programs. Its stated purpose was to provide those directly involved in developing Regional Medical Programs with the opportunity of exchanging ideas and information w@ich would be of benefit in the further implementation of the Programs at the regional level. The focus was m on-going activities in the Regions, particularly as they related to quality and availability of health care for heart disease, cancer, stroke, and related diseases. All Regions were invited to present papers on their activities and ideas;' to submit exhibits which reflected their activities, and to participate actively in panel discussions. The invitation resulted in the presentation of 60 representative-papers and some 40 exhibits and virtually every invited speaker accepted the opportunity to discuss the major issues of the Conference- Workshop. All of this material was reproduced in the Proceedings: Conference- Workshop on Regional Medical Programs, (PHS Publication No. 1774). A key figure in the development of both meetings was Dr. Stanley W. Olson,, fomer Dean of Baylor University Medical School. In 1967, as a consultant to the Division of Regional Medical Programs, he organized the Conference and acted as its chairman. In 1968, as Coordinator of the Temessee Mid-South Regional Medical Program and Chairman of the Coordinators' Steering Comittee, he worked closely with Dr. John A. Gronvall of the Nississippi I&dical Center in developing the Conference-Workshop. It was this extensive experience with Regional Medical Programs that was a strong factor in his subsequent selection by the Secretary of Health, Education, and Welfare and President Johnson as -12. successor to Dr. Robert Q. Marston when Dr. Marston was named to head the new Health Services and Mental Health Administratim created as part of the 1968 reorganization of the Department of Health, Education, and Welfare. The previously mentioned Report on Regional Medical Programs to the President and Congress,was another landmark in the History of Regional Wdical Programs. Required by Section 908 of Public Law 89-239 this publication was noteworthy as it records the accomplishments of the Program from its begimink until June of 1968 and it reconmnddd the further develop- ment of the Program and extension of it beyond the June 30, 1968 limit set in The Act. In addition to its value together with both Conference Proceedings as a source of reference and history it served an important. legislative function. Prepared by the Surgeon General of the Public Health Service, it was submitted to the President through the Secretary of the Department of Health, Education and Welfare, and was transmitted by the President to the Congress on November 9, 1967. His letter transmitting the Report to the Congress was at once encouraging and exhortative when it said, in part : "Because the law and the idea behind it are new, and the -problem is so vast, the program is just emerging from the planning state. But this report gives encouraging evidence of progress -- and it promises great advances in speeding research knowledge to the patient's bedside." Thus in the final seven words of the President's message, the objective of Regional Medical Programs is clearly emphasized. As this History is being written, the legislation extending Regional Medical Programs is in conference between the House and the Senate. Infor- matim m the.Programs, developed as part of the testimmy of the hearings, provided the Congress with a @ understanding of the progress of the Programs both specifically and in selected areas. This information is -13- contained in Appendix 8. With a series of minor amendments developed to meet the needs of the growing Programs, it is expected that the legislation will be passed to permit the continued development of the Regimal Medical Programs as part of the comtry's forward movement toward providing the highest possible quality of medical care to all of its citizens. APPENDIX 1 PUBLIC LAW 89-239 ail m ts to -4 0 t, a t3 PV to, tIr S. ts 'r Cs o OE 2 .10.Z 1.11 0 ts 0rr 0 m " m . ;, t, Po 0 t, is Cs -MO. -P- tr 0 -0 IV to ts OR a -00 a. C6 0 CL 93 J4 t, 00 W4 eq ts a'o0t$ C, ti " "9 oqo 0 ts 0 0 cb .0 ts t3 'C' C6 C, to, CY, tr r.-r V; !I - a k @ .3 ts rr a 9. 19 CM-6 F:l .0 g fo 04 S. rz 5L eb co 34 'I C-1 Ig 0 Po no 0 'o " - , 9. @, C tr SL t-r ,40 tr' m It al gI , 1 @ -, 'o, 2, 1 ,- , .; g . a @ m0 0@. to el# M El t.1' td ts tb 0. com CL. 0 ti a M rr !,4 4 r ; @ to cl 04 ts t2 CL s - C: -,M D.4 . i , - 11 IC:, ir t:r @ i" . S- 1; ot Cs tr 0. c i;c, IM ; - I .- I to a m2 y I E; 13 m 0 m I ft " ae, tms 14, 10 I., pa c (tm 0 IR 0 tr r-r 0 Cs (D 0 10 0spar -1 C3. t-I rr 0 cr I ci .0 aq cb C in t, oar 0 0. 0 n CL i; Ir to P!to@i CC39 0 -- -0 Oa - to It m i -- :i 00- Pr- ti-C$ - , ml --a 0 - aZ @ Is r. cps' o- C.@r 0 A 0, - aim tr 0 1, ck, ti 0 - 0 C6 oOa z - n .2 ;. OH Om ;L mtr F @ - 0 0 o trl a- 1 @ t-r -. ;. , - tr a - 11 D = 0 tb I., 1--i R 13 e5 CD aa 0 C46 0"7 0 n tr 0C, ri 0 , , a i t, ir Cs ta 2 @:9 C.: t., to M to, o CL, c't n n - I r, P- ti 0 Pr 0 ts o Pr is iv tr rr 0 lp_ td t4 a t, C, 019, tr 0 Oa Logi*Wive History: House Report No. 968 accompanying H.R. 3140 (Comm. on Interstate and Foreign Commerce). Senate Report No. 868 (ComnL on LiLbor and Public Welfare). Congressional Record, Vol. 111 (1965): June 25: Considered In Senate. June 28: Considered and pan" Senate. Sept. 23: H.R. 3140 considered In House. Sept. 24: Considered and passed Room amended. in lien of R.R. 8140. Sept 29: Senate Concubine In House ameadmentL APPENDIX 2 DIRECMRY OF THE DIVISION OF REGIONAL MMICAL PROGRAM 0 0 tE EE EOE 0 0 u =i co Z: .0.0 E3 cn 0 0 0 x rj .:g .9 z F4 eol- 0 0 cn io cn > .09 B,.g ew, I 04 -be,) Pk irk 0 ]logo @l @i 1 II -20- OFFICE OF ASSOCIATE DIRECTOR FOR PROGRAM DEVELOPMENT AND RESEARCH Richard F. Manegold, M.D ....... Associate Director for Program Development and Research. Continuing Education and Training Branch: Alexander M. SchrrLidt, M.D ...... Chief. Phyllis E. Carnes, Ph. D .......... Education Specialist. Veronica L. Conley, Ph. D ........ Education Specialist. Cecilia C. Conrath ................ Assistant to Chief. David W. Goldc, M.D ........... Training Consultant. Frank L. Husted, Ph.'D .......... Head, Education Research Group. Elsa J.'Nclson ................... Health Services Officer. Herbert 0. Mathewson, M.D ...... Training Consultant. Marjorie L. Morrill .............. Public Health Adv@. Rebecca R. Sadin ............... Public Health Adv@. Sarah J. Silsbee .................. Public Health Adv@. Jack J. Schneider, M.D .......... Training Consultant. John C. Tapp, M.D .............. Training Consultant. Charlotte F. Turner .............. Education stnd Training S@isL Regional Health @es Brawk: Philip A. Kli@, M.D...,.. Head, @cal hWamB Seetkm. -21- APPENDIX 3 LISTING OF NATICNAL ADVISORY COTJNCIL AND REVIEW CMWTTEE .22- NATIONAL ADVISORY COUNCEL E. L CROSBY, M.D. J. R. IIOGNESS, M.D. E. D. PELLEGRINO, M.D. Director Dean, School of Med. Director of ti3c Med. Ctr. American Hosp. Aum U. of Washington State U. of New York Chicago, 111. Seattle, Wash. Stony Brook, N.Y. M. E. DEBAKEY, M.D. J. T. HOWELL, M.D. A. M. POPMA. M.D. Prof. and Chairman Executive Director R(-gional Director Dept. of Surgery Henry Ford Hosp. Mountain States Regional Baylor U. Detroit, Mich. Medical Program Houston, Tex. Boise, Idaho C H. MILLIKAN, M.D. 11. G. EDMONDS, Ph.D Consultant in Neurology M. 1. SHANHOLT7, KD. Dean, Graduate SCIL Mayo Clinic State Hlth. ComnL No. Carolina CoBege Rochester, Minn. State Dept. of Hlth. Durham, N.C. __ G. F. MOORE, M.D. Richmond, Va. B. W. EVERIST, JR., BLD. Director, Roswell Park W. H.'STEWART, M.D. Chief of Pediatrics Memorial Institute (Chairman) Green (3inic Buffalo, N.Y. Surgeon General Ruston, La. Public Health REVMW COMMRME G. JAMES, M.D. P. M. MORSE, Ph.D. D. E. ROGERS, M.D. (Chairman) Director, Operations Prof. and Chairman Dean, Mount Sinai Research Ctr. Dept. of ?*led. School of Med. Mass. Inst. of Tech. School of Med. New York, N.Y. Cambridge, Mas& Vanderbilt U. H. W. KENNEY, M.D. A. PASCASIO, Ph.D. Nashville, Tenn. Medical Director Assoc. Research Prof. C. H. W. RUHE, M.D. John A. Andrew Memorial Nur,,in Assistant SecretarY, pitt.t School, U. of Hosp. urgh Council on Ated. Ed. Tuskegee Institute Pittsburgh, Pa. American Med. As@ Tuskegee, Ala. Chicago, 111. S. H. PROGER, M.D. F- J. KOWALEWSKL M.D. Prof. and Chairman R. J. SLATER, M.D. Chairman, Dept. of Med. and Executive Director Committee of Environ. Med. Physician-in-Chief The As@ for the Aid of Acad. of Gen. Practice Tufts N.F. Me& Ctr. Crippled Children Akron, Pa. Pre#., Bingham Fund New York, N.Y. G. E MILLER, M.D. Bostot4 Mae& J. D. THOMPSON Director, Off. of Research Prof. of Public HIDL in Med. Educ. Yale U. Med. School ColL of Med U. of IIL New Haven, Conn. C6icam IIL April 1968 -23- APPEMIX 4 CHROMLOGY OF REGia"MMICAL PROGRABS -24- ACNON EVENTS I Report of the President's 1964 DECEMIIEI Commission on Heart Disease, Cancer, and Stroke 1965 FEBRUARY TO JULY Congressional hearings @ODER Enactment of P.L 89-239 DECEMBER National Advisory Council meeting Initial policies and Guidelines reviewed Establishment of Division 19,66 FEBRUARY- Publication of preliminary Guidelines National Advisory Council meeting l'olicy for review proc- ess and Division activities set APRIL Review Committee meeting National Advisory Council meeting 7 planning grants awarded JUNE Review Committee meeting National Advisory Council meeting 3 planning grants JULY' Publication of Guidelines awarded Review Committee meeting AUGUST National Advisory Council meeting 8 planning grants awarded SEPTEMBER First of 5 meetings of 4d Hoc Report material Committee for Report to the discussed President and Congress OCTOBER Review Committee meeting NOVEMBER National Advisory Council meeting 16 planning grants awarded 1967 JANUARY Review Committee meeting National Conference National views & information for Report provided ]FEBRUARY National Advisory Council meeting 10 planning and 4 opera- tional grants awarded APRIL Review Committee meeting MAY National Advisory Council meeting 5 planning and I opera- tional grant awarded JUNE Report to the President & Congress JULY Review Committee meeting AUGUST National Advisory Council meeting 2 planning grants awarded OCTOBER Review Committee meeting NOVEMBER Natibnal Advisory Council meeting 2 planning and 3 opera. tional grants awarded 1968 JANUARY Conference Workshop Regional activities and Review Committee meeting ideas presented FEBRUARY National Advisory Council meeting 5 operational grants -25- APPENDIX 5 REGIONAL MEDICAL REGIML ADVISORY GEM .26- REGIONAL ADVISORY GROUPS The activities of Regional Medical Programs arc directed by fulitime Co. ordinators working together with Regional Advisory Groups which are broadly representative of the medical and health resources oi the Regions. Membership on these groups nationally is: Hospital Administrator cing Public He ysicians Officials 22 Other Health Workers 16(Yo Voluntary Medical Cente Health Age 157o r. &hool Officia6 Total: 1929 Members of the Public -27- APPENDIX 6 MAP OF REGIONAL MMICAL PROGRAYS AND LISTING OF PROGRAM OOORDINA7M -28- .-29- REGIONS AND PROGRAM COORDINATORS OR DIRECTORS I ALABAMA 10 FLORIDA 19 LOUISIANA B. B. Wells, M.D. S. P. Martin, M.D. J. A. Sahatier, M.D. U. of Ala. Med. Ctr. Provost, J. Hillis Claiborne Towers Roof 1919 7th Ave. S. Miller Med. Ctr. 119 S. Claiborne Ave. Birmingham, Ala. 35233 U. of Florida New Orleans, La. 70112 Gainesville, Fla. 32601 2 ALBANY, N.Y. 11 GEORGIA 20 MAINE F. M. Woolsey, Jr., M.D. M. Chatterjee, M.D. Assoc. Dean J. G. Barrow, M.D. 295 Water St. Albany Aledj, Coll. Med. Assoc. of Ga. Augusta, Me. 04332 47 New Scotland Aye. 938 Peachtree St. N.K Albany, N.Y. 12208 Atlanta, Ga. 30309 21 MARY'LAND 12 GREATER W. S. Spicer, Jr., M.D. 3 ARIZONA DELAWARE 550 N. Broadway D. W. Melick, M.D. Baltimore, Md. 21205 VALLEY Coll. of Med. W. e Spring, Jr., BLD. 22 MEMPHIS U. of Arizona Wynnewood House MEDICAL Tucson, Ariz. 85721 300 E. Lancaster Ave- REGION 4 ARKANSAS Wynnewood, Pa. 19096 J. W. Culbertson, M.D. W. K. Shorey, M.D. 13 HAWAH Coll. of Med. Dean, Sch. of Med. U. of Tennessee W. C. Cutting, M.D. 858 Madison Ave. U. of Arkansas 4301 W. Markham S Dean, Sch. of Med. Memphis, Tenn. 38103 L U. of Hawaii Little Rock, Ark. 722011 2538 The Mall 23 METROPOLITAN Honolulu, Ha. 96822 WASHINGTON, D.C. 5 BI-STATE T. W. Mattingly', M.D. W. H. Danforth, M.D. 14 ILLINOIS D.C Medical Society V. Chan. for Med. Affairs Wright Adams, M.D. 2007 Eye St. N.W. Washington U. 112 S. Michigan Ave. Washington, D.C 20006 660 S. Euclid Ave. Chicago, M. 60603 SL Louis, Mo. 63110 24 MICHIGAN 15 INDIANA A. E. Heustis, M.D. 6 CALIFORNIA R. B. Stonehill, M.D. 1111 Michigan Ave. Paul D. Ward Indiana U. Sch. of Med. East Lansing, Mich. 48823 655 Sutter SL #302 1100 W. Michigan Street San Francisco, CaliE 94102 Indianapolis, Ind. 46207 25 MISSISSIPPI G. D. Campbell, M.D. 7 CENTRAL 16 INTERMOUNTAIN U. of Miss. Med. Ctr. NEW YORK 2500 N. State CL R. H. Lyons, M.D. C. U. Castle, M.D. Jackson, Mis& 39216 Assoc. Dean State U. of N.Y. 750 E. Adams SL U. of Utah Syracuse, N.Y. 13210 Salt Lake City, UL 84112 26 MISSOURI V. E. Wilson, M.D. 17 IOWA Executive Director 8 COLORADO. WYOMING W. A. Krehl, M.D., Ph.D. for Health Affairs 308 Melrose Ave- U. of Missouri P. R. Hildebrand, M.D. U. of Iowa Columbia, Mo. 65201 U. of Col. Med. Ctr. Iowa City, la. 52240 4200 E. 9th Ave. 27 MOUNTAIN STATES Denver, Col. 80220 18 KANSAS K. P. Bunnell, Ed.D. C. E. Lewis, M.D. As@ Director 9 CONNECTICUT Chairman Western Interstate H. T. Clark, Jr., M.D. DepL of Preventive Med. Comm- for Higher Ed. 272 George St. U. of Kann& Univ. E Campus New Ha@ Conn. 06510 Kansas City, Kan. 66103 Boulder, CoL 800 -30- 28 NEBRASKA- 37 NORTHWESTERN 46 TENNESSEE SOUTH DAKOTA OHIO MID-SOUTH H. Morgan, M.D. C. R. Tittle, Jr., M.D. S. W. Olson, M.D. 1408 Sharp Bldg. 2313 Madison Avenue 110 Baker Bldg. Lincoln, Neb. 68508 Toledo, Ohio 43624 110 21st Ave. S. 29 NEW JERSEY 38 OHIO STATE Nashville, Tenn. 37203 A. A. Florin, M.D. R. L Meiling, M.D. 47 TEXAS N. J. State Dept. of lUth. Dean, Coll. of Med. *S. G. Thornpaon, M.D. 88 Ross St. Ohio State U. Suite 724 E. Orange, N.J. 07018 410 W. 10th Ave. Sealy-Smith Prof. Bldg. 30 NEW MEXICO Columbus, Ohio 43210 Galveston, Tex. 77550 1. E. liend4son, M.D. 39 01110 VALLEY 48 TR[-ST,4TE U. of New Mexico W. H. McBeath, M.D. N. Stearns, M.D. 900 Stanford Dr. N.E. 1718 Alexandria Dr. Albuquerque, New Mex. Lexington, Ky. 40504 22 The Fenway Boston, Mass. 02115 31 - NEW YORK 40 OKLAHOMA METR.AREA K. M. West; M.D. 49 VIRGINIA V. deP. Larkin, M.D. U. of Ok. Med. Ctr. E. R. Perez, M.D. N.Y. Academy of Med. 800 N.E. 13th SL Richmond Acad. of Med. 2 I- 103d St. Oldahoma City, Ok. 73104. 1200 E. 4May SL New York, N.Y. 10029 Richmond, Va. 23219 32 NORTH CAROLINA 41 OREGON 50 WASHINGTON- M. R. Grover, M.D. ALASKA M. J. Musser, M.D. Director, Cont. Med. Ed. Teer House Sch. of Med. D. R. Sparkman, M.D. 4019 N. Roxboro Rd. U. of Oregon Sch. of Med. Durham, N. C. 27704 U. of Washington 3181 S.W. Sam Jackson Portland, Ore. 97201 Seattle, Wash. 98105 33 NORTH DAKOTA T. H. Harwood, M.D. 42 PUERTO RICO 51 WEST VIRGINIA Dean, Sch. of Med. U. of North Dakota A. Nigaglioni, M.D. C. L Wilbar, Jr., M.D. Chancellor, Sch. of Med. W. Va. Univ. Med. Ctr. Grand Forks, N.D. 58201 U. of Puerto Rico Morgantown, W. Va. 26506 34 NORTHEASTERN San Juan, P.R. 00905 OHIO 52 WESTERN F. C. Robbins, M.D. 43 ROCHESTER, N.Y. NEW YORK Dean, Sch. of Med. R. C. Parker, Jr., M.D. J. R. F. Ingall, M.D. Western Reserve U. Sch. of Med. and Dent. Sch. of Med. State U. of N.Y. at Buffalo 2107 Adelbert Rd. U. of Rochester Cleveland, Ohio 44106 Rochester, N.Y. 14620 Buffalo, N.Y. 14214 35 NORTHERN 44 SOUTH CAROLINA 53 WESTERN NEW ENGLAND C- P. Summerall, III, MD PENNSYLVANIA Dept. of Med. F. S. Cheever, M.D. J. E. Wennberg, M.D. Med. Coll. Hospital Dean, Sch. of Med. U. of VL Coll. of Me& 55 Doughty SL U. of Pittsburgh 25 Colchester Ave. Charleston, S.C 29403 3530 Forbes Ave. Burlington, VL 05401 Pittsburgh, Pa. 15213 45 SUSQUEHANNA 36 NORTBLANDS IVALLEY 54 WISCONSIN R. D. PdcKenzie J. S. lenchboeck. M.D. W. R Miller, BLD. 3906 Market St. Wisconsin RMP, @ 375 Ja@kson SL P.O. BO S41 110 F. Wisconsin Ave. St. Pa@ Minn. 55101 C&mp @0a. 17011 Milwaukee, wiw- SM @@ator -31- APPENDIX 7 DIRECRW OF REGICNAL-NEDICAL PROGRANS -32- DIRECTORY, OF REGIONAL MEDICAL PROGRAMS The Directory lists Regional Medical Programs for which planning or opera- tional gmnts have been awarded or which are in earlier stages of development. Regions were defined for planning pur- poses in the planning applications. State designations do not necessarily indicate that the regions arc coterminous with State boundaries. The original definitions of the regions may be modified on the basis of experience. Region Pago Awarded as of April 26, 1968. NEW JERSEY (see also Greater Delaware ............... 410 INDEX NEW ........... N ov@, Region "'an@ Central A' YORK sea Id Pogo EW N. Yrk M. -itita. ALABAMA N Y rk Y.'k r (son also Tennessee M 0,0,.,. R NEW YORK -1-IR ;I.E South) ................................ : -v ALASKA, see Washington-Alaska. NORTH CAROLINA .................. 4(* ALBANY ................................. i NORTH DAKOTA ................... li NORTHEASTERN OHIO ......... ARIZONA a ARKANSA@*iie'o"iis;;M,o,m,.p,h,i.s,),.,.."-.", 35, NORTHERN NEW ENGLAND....:::..:.. BI-STATE ................................ NORTHLANDS ........................... IALIIORNIA,, NORTHWESTERN OHIO ........... CENTRAL N OHIO STATE (see also Northo@i"",- COLORADO.WYOMING .................. Ohio; Northweitem Ohio; Ohio Valley).. YA CONNECTICUT.. OHIO VALLEY ........................... DELAWARE VALEtY."i"'ij#4iiir"biiii' OKLAHOMA ............................. OREGON ....................... iiii war Valley. ijo6@ @ FLOR'I'DA ................................ PENNSYLVANIA. see Greater GEORGIA. ............... il@ Valley; Susquithanne Valley; Western GREATER '6ifCAWXAt VALLEY ........... IS- Pennsylvania. HAWAII. PUERTO RICO .......................... ft IDAHO, RHODE ISLAND, see Tri-State. States. ROCHESTER ......................... . SOUTH CAROLINA ...................... ILLINOIS esalsoBi-stafe)... INDIANA a SOUTH DAKOTA, see Nbraska-South I T Mo@as tso Ohio Valley) N ER NTAIN ....................... Dakota. IOWA .................................... 3-7 SUS@UEHANNA VALLEY .......... KANSAS. TEN ESSEEMID-SOUTH(sooa-.Im--nkii;;.. KENTUCki(.. i@ i;iiiii" 57 Phis) .................. Tonnesseei Mid-South. TEXAS .................. LOUISIANA ...................... TRI-STATE .............................. UTAHbseTe Intermountain. MAINE .......................... ::,:: -:: N MARYLAND VERM see Northern Now England. MASSACHU@'tfti;"s,e, 'o"T'ri'-'S't'a'f'e .......... VIRGINIA ................................ lw MEMPHIS of WASHINGTON-ALASKA ....... METROPOi:iyAi4,wAiii4iiidy6i4, 6 c WASHINGTON, D.C., see Me' I MICHIGAN ..................... Washington. D.C. MINNES( WEST VIRGINIA Ohio Valle mississ is) ........ WESTERN INTEPS"ToAaT'E-commlssflti missoui FOR HIGHER EDUCATION (WICHE), MONTAH see Mountain States. States. WESTERN NEW YORK .................. *4lr MOUNTAIN STATES... WESTERN PENNSYLVANIA ............. NEBRASKA-SOUTH DAkt WISCONSIN NEVADA sea lntermountal WYOMING NEW HAIAPSHIRE, "a Tr -33- c c re4 c c orb-10 C214 :Z@:;z 0 0 tuc it! -b 0, c C 2 fe4 0 f.) a c m C;d 0 c , !-7 U DC a WCr c -0 in co 0 0 U 0 w ch In In -C c c ;3,4 oite c in 0 N c C CO a 0 .2 c c 0 ,co c ci E c >0:c rL I.c'.c 0 zoi U c 6-2 lop I . 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