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The original documents are located in Box 9, folder "Health (3)" of the Theodore C. Marrs
Files at the Gerald R. Ford Presidential Library.
Copyright Notice
The copyright law of the United States (Title 17, United States Code) governs the making of
photocopies or other reproductions of copyrighted material. Gerald Ford donated to the United
States of America his copyrights in all of his unpublished writings in National Archives collections.
Works prepared by U.S. Government employees as part of their official duties are in the public
domain. The copyrights to materials written by other individuals or organizations are presumed to
remain with them. If you think any of the information displayed in the PDF is subject to a valid
copyright claim, please contact the Gerald R. Ford Presidential Library.
sell
THE WHITE HOUSE
WASHINGTON
SCF
July 29, 1975
MEMORANDUM FOR:
PAUL O'NEIDI
FORD & LIBRARY 038470
FROM:
TED MARRS
This is a valid need which I would like to
see us support if there is a mechanism.
Any suggestions?
Enclosure
RECEIVED
Digitized from Box 9 of the Theodore C. Marrs Files at the Gerald R. Ford Presidential Library
GEORGETOWN UNIVERSITY
WASHINGTON. D. C. 20007
OFFICE OF THE PRESIDENT
SPECIAL ASSISTANT FOR
FEDERAL RELATIONS
July 1, 1975
The Honorable Theodore C. Marrs
Special Assistant to the President
Human Resources
The White House
Washington, D.C.
Dear Dr. Marrs:
This is a follow up on our meeting on June 23rd, when you
graciously reviewed our letter to you of June 13, 1975 concerning
the $16,000,000 for Children's Hospital National Medical Center and
the $6,000,000 for the Concentrated Care Center at Georgetown Uni-
versity Medical Center contained in the Second Supplemental Appro-
priation Act of 1975.
The specifics of the financial needs of the Children's
Hospital National Medical Center were reviewed by Mr. Edgar N. Duncan,
Assistant Surgeon General and Acting Director of Hospital and Medi-
cal Facilities, on July 1. We presented to him the need for author-
ity to accept $10,000,000 in bids before July 11, 1975. Mr. Duncan
agreed to the need but stated that the apportionment of the $16,000,000
to the Secretary of the Department of Health, Education and Welfare
for this project must be made before he can authorize the acceptance
of these bids.
At our meeting with Mr. Duncan the requirements of the add-
itional construction at the Concentrated Care Center were also re-
viewed. Mr. Duncan again pointed out that the apportionment of the
$6,000,000 grant funds for this project must be made before it can
proceed.
On the same day (June 23rd) that we visited you, Judge Ely
and we two met briefly with Mr. Paul O'Neill, Deputy Director of
the Office of Management and Budget and presented our plea to him.
If there is anythingelse you believe we should do, we stand
ready. We are praying.
We are deeply grateful for your counsel and interest.
T.Byron Collin sg.
Sincerely,
T. Byron Collins, S.J.
John
John H. Sharon H. Sharon
Special Assistant to the President
Chairman, Children's Hospital
Georgetown University
National Medical Center
CC: Mr. Paul O'Neill, Judge Ely
ohysician physician
FORD è LIBRARY
The
Children's
Grusade
\
Oo
105 0. E. 0. B.
Washington, DC 20500
Change due to official orders.
AUGUST 1975 1975
05104700693
JOHN JOS MAHONEY MD
102 THORNELL
SAN ANTONIO TX 78235
Some items in this folder were not digitized because it contains copyrighted
materials. Please contact the Gerald R. Ford Presidential Library for access to
these materials.
File Georgatown and
DESUCATION DEARTMENT AND WELFARE
HEALTH.
OF
D.C. childrens Hospitals
DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
OFFICE OF THE SECRETARY
U.S.A.
WASHINGTON, D.C. 20201
GERALD R. FORE
11 AUG 1975
MEMORANDUM FOR HONORABLE THEODORE C. MARRS
This is in response to your requests of June 19 and 26 on behalf of Mr.
John H. Sharon, Chairman, Children's Hospital, and Reverend T. Byron
Collins, S.J., Special Assistant to the President, Georgetown University.
Please excuse the delay in replying. Father Collins and Mr. Sharon's
letter to you requested your intercession with the Department to seek
immediate release of the $22,000,000 provided in the fiscal year 1975
Second Supplemental Appropriation Act for Children's Hospital and the
Georgetown University Concentrated Care Center.
The funds were appropriated June 12 in the Second Supplemental Appropria-
tions Act, 1975 (P.L. 94-32) to support ongoing construction projects at
the Children's National Medical Center and the Georgetown University
Concentrated Care Center. These funds were directly allocated and made
available for obligation. In order to minimize the size of a growing
budget deficit, the Office of Management and Budget advised the Depart-
ment that it was considering proposing a rescission to Congress.
Accordingly, the funds were withdrawn and placed into reserve. After a
thorough review of the purposes and need for these funds, the Office of
Management and Budget decided not to submit a rescission to Congress,
and funds were released on July 25. The funds were again allocated and
made available for obligation.
In accordance with standard procedures, Georgetown University was notified
by the Department of the release of these funds. Since your request has
been overtaken by events, we are not enclosing a draft reply.
David nat Lissy
Executive Secretary
to the Department
Ted - & you w of this
+ that this note is just for therecoud
my
HEALTH.
EDUCATION:
DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
OFFICE OF THE SECRETARY
U.S.A.
WASHINGTON, D.C. 20201
11 AUG 1975
MEMORANDUM FOR HONORABLE THEODORE C. MARRS
This is in response to your requests of June 19 and 26 on behalf of Mr.
John H. Sharon, Chairman, Children's Hospital, and Reverend T. Byron
Collins, S.J., Special Assistant to the President, Georgetown University.
Please excuse the delay in replying. Father Collins and Mr. Sharon's
letter to you requested your intercession with the Department to seek
immediate release of the $22,000,000 provided in the fiscal year 1975
Second Supplemental Appropriation Act for Children's Hospital and the
Georgetown University Concentrated Care Center.
The funds were appropriated June 12 in the Second Supplemental Appropria-
tions Act, 1975 (P.L. 94-32) to support ongoing construction projects at
the Children's National Medical Center and the Georgetown University
Concentrated Care Center. These funds were directly allocated and made
available for obligation. In order to minimize the size of a growing
budget deficit, the Office of Management and Budget advised the Depart-
ment that it was considering proposing a rescission to Congress.
Accordingly, the funds were withdrawn and placed into reserve. After a
thorough review of the purposes and need for these funds, the Office of
Management and Budget decided not to submit a rescission to Congress,
and funds were released on July 25. The funds were again allocated and
made available for obligation.
In accordance with standard procedures, Georgetown University was notified
by the Department of the release of these funds. Since your request has
been overtaken by events, we are not enclosing a draft reply.
/2/ DavidH Lissy
David H. Lissy
Executive Secretary
to the Department
HEALTH.
of
DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
OFFICE OF THE SECRETARY
U.S.A.
WASHINGTON, D.C. 20201
11 AUG 1975
MEMORANDUM FOR HONORABLE THEODORE C. MARRS
This is in response to your requests of June 19 and 26 on behalf of Mr.
John H. Sharon, Chairman, Children's Hospital, and Reverend T. Byron
Collins, S.J., Special Assistant to the President, Georgetown University.
Please excuse the delay in replying. Father Collins and Mr. Sharon's
letter to you requested your intercession with the Department to seek
immediate release of the $22,000,000 provided in the fiscal year 1975
Second Supplemental Appropriation Act for Children's Hospital and the
Georgetown University Concentrated Care Center.
The funds were appropriated June 12 in the Second Supplemental Appropria-
tions Act, 1975 (P.L. 94-32) to support ongoing construction projects at
the Children's National Medical Center and the Georgetown University
Concentrated Care Center. These funds were directly allocated and made
available for obligation. In order to minimize the size of a growing
budget deficit, the Office of Management and Budget advised the Depart-
ment that it was considering proposing a rescission to Congress.
Accordingly, the funds were withdrawn and placed into reserve. After a
thorough review of the purposes and need for these funds, the Office of
Management and Budget decided not to submit a rescission to Congress,
and funds were released on July 25. The funds were again allocated and
made available for obligation.
In accordance with standard procedures, Georgetown University was notified
by the Department of the release of these funds. Since your request has
been overtaken by events, we are not enclosing a draft reply.
/s/ David H. Lissy
David H. Liasy
Executive Secretary
to the Department
THE WHITE HOUSE OFFICE
REFERRAL
To: SECRETARY, HEW
Date: June 19, 1975
ACTION REQUESTED
Draft reply for:
President's signature.
Undersigned's signature.
NOTE
Memorandum for use as enclosure to
reply.
Prompt action is essential.
X
Direct reply.
If more than 72 hours' delay is encountered,
X
Furnish information copy.
please telephone the undersigned immediately,
Code 1450.
Suitable acknowledgment or other
appropriate handling.
Basic correspondence should be returned when
Furnish copy of reply, if any.
draft reply, memorandum, or comment is re-
quested.
For your information.
For comment.
REMARKS:
EXEC SEC EXEC' 2EC'
ARH
A
7506240111
21° M9 Es A M9 ES A asnum as num
BECEINED
Description:
X
Letter:
Telegram: Other:
To: Dr. T. C. Marrs
From: John H. Sharon
7506240112
Date: June 13, 1975
Subject: Children's Hospital National Medical Center
By direction of the President:
Theodax l mans
Theodore C. Marrs
TRACER/3916
Special Assistant to the President
(Copy to remain with correspondence)
AM 389
DIRECTOR'S
CORRESPONDENCE
RECE VED
THE WHITE HOUSE
Action to: Hanna
JUN 30 10 16 All '75
Vic Zafra
WASHINGTON
Reply for: Dir
Dep
June 26, 1975
D
MANAGEMENT&BUDGET
Control No:
Due Date:
0100
7/14
Info Copies:
MEMORANDUM FOR
SECRETARY, HEALTH, EDUCATION, AND WELFARE
THRU: OFFICE OF MANAGEMENT AND BUDGET (PAUL O'NEILL) UV
An evaluation of the attached and an appropriate draft
response will be appreciated (see page 1.)
Jhudon Theodore C. Marrs
Than
Special Assistant to the President
Enclosure
EXEC'2EC
HUV
7507090010
for 10 6H.12
BECEINED
TRACER R/4628
CONTENTS
Page
Letter dated June 13, 1975, Fr. Cellins and Mr. Sharon
to the Hon. Theodore C. Marrs
1
Letter dated March 10, 1975 - Fr. Collins and Mr.
Sharon to The Hon. Warren Magnuson and The Hon.
Edward W. Brooke
2 & 3
Letter dated March 26, 1975, Mr. Sharon to Fr. Collins
4
Statement titled 'Georgetown University Hospital -
Concentrated Care Center Phase II - Parking Structure'
dated March 26, 1975
5
House of Representatives Report No. 94-141 on Second
Supplemental Appropriations Bill (P. 27 & 28)
6 & 7
Senate Report No. 94-137 on Second Supplemental Appro-
priations Bill (P.
36)
8, 9,
Conference Report No. 94-239 Making Supplemental Appro-
priations Fiscal Year 1975 (P.10)
10 11
GEORGETOWN UNIVERSITY
WASHINGTON, D. C. 20007
OFFICE OF THE PRESIDENT
SPECIAL ASSISTANT FOR
FEDERAL RELATIONS
June 13, 1975
The Honorable Theodore C. Marrs
Special Assistant - Human Resources
The White House
Washington D.C. 20500
Dear Mr. Marrs:
As you know, the Second Supplemental Appropriations Bill
contained additional funds towards the completion of the Children's
Hospital National Medical Center ($16,000,000) and the Concentrated
Care Center at Georgetown University ($6,000,000).
It is critical for the Children's Hospital project that these
funds be made available immediately to enable them to receive bids
on the project in sequential order. The dedication ceremony for this
facility is scheduled for July 4, 1976, and as you know, President
Ford has been invited to attend (cf enclosed correspondence).
The Concentrated Care Center at Georgetown University is also
in critical need of the appropriated funds so that the work on their
project may not be delayed.
May we ask you intercession with the Office of the Secretary
of the Department of Health, Education and Welfare for the immediate
release of these funds to the HEW Regional Office in Philadelphia so
both of these projects may be kept in steady progress towards com-
pletion in accordance with the intent of the Appropriations bill.
On behalf of Children's Hospital National Medical Center and
Georgetown University we thank you for your interest and counsel.
Sincerely,
T.Byon T. Byron Collins, Collens S.J. 5.9
phn H. Sharon
John H. Sharon
Special Assistant to the President
Chairman, Children's Hospital
Georgetown University
National Medical Center
1.
GEORGETOWN UNIVERSITY
WASHINGTON. D. C. 20007
FFICE OF THE PRESIDENT
SPECIAL ASSISTANT FOR
FEDERAL RELATIONS
March 10, 1975
The Honorable Warren Magnuson
The Honorable Edward W. Brooke
Committee on Appropriations
Subcommittee on Labor and Health, Education and Welfare
U.S. Senate
Washington D.C. 20510
Dear Senator Magnuson and Senator Brooke:
We thank you for having given us the opportunity to testify be-
fore your Committee on our desperate need for final phase grant funds
to complete our national experimental research projects - Children's
Hospital National Medical Center and the Concentrated Care Center at
Georgetown University.
We are pleased to furnish you with additional information to
clarify point mentioned in the hearing.
Children's Hospital Fund Drive and loan program had hoped to
bring in $27,058,000. In the just completed Fund Drive analysis we
find that the present pace of the economy has slowed the expected com-
mitments to the Fund Drive. However, we are certain we can obtain the
matching one-third of the project cost, $23,485,354, to enable us to
finish on schedule, provided the Senate will give favorable considera-
tion to our deep need for this final request for $21,575,000 grant funds
for Children's Hospital.
Georgetown University can also meet its matching one-third of
the project cost, $11,800,000, provided the Senate will give favorable
consideration to the request for $8,000,000 for the Concentrated Care
Center.
The request for these essential final phase funds would be for
a total of $29,575,000 grant funds.
We thank you for your help in our final plea for funds.
Sincerely,
T. Byron Collins, S.J. 5.9-
John Sharon
John H. Sharon
Special Assistant to the President
President, Children's Hospital
Georgetown University
National Medical Center
2.
Enc: Method of Funding
March 10, 1975
1975 SUPPLEMENTAL APPROPRIATIONS GRANT REQUEST - CONCENTRATED CARE
CENTER $8,000,000, CHILDREN'S HOSPITAL NATIONAL MEDICAL CENTER
$21,575,000.
Concentrated Care Center Experimental Project, Total Cost Estimate
$35,000,000
Method of Funding
Phase I - - Cost $23,000,000
Grant HEW Appropriations 1969-70 $ 6,900,000
Grant P.L. 92-80
8,300,000
Loan P.L. 92-80
6,700,000
Private Resources
1,100,000 $23,000,000
Phase II - Cost $12,000,000
1975 Supplemental Appropriation
Grant Request
8,000,000
From Existing Federal Loan Programs
4,000,000
12,000,000
$35,000,000
Summary of Financing of Phases I and II
Federal Grants Phases I & II
$23,200,000
(two-thirds)
Private Resources and Loan Phases
I and II
11,800,000
(one-third)
Total cost of Project
- -
$35,000,000
Children's Hospital National Medical Center Experimental Project
Total Cost Estimate
$70,459,933
Method of Funding
Phase I - - Cost $44,884,933
Grant - P.L. 90-457
$13,399,574
Grant - P.L. 93-50
12,000,000
Federal Loan - - P.L. 90-457
13,399,579
Fund Drive
6,085,780 $44,884,933
Phase II - Cost $25,575,000
Grant Request in HEW Supplemental
1975
21,575,000
Federal Loan (from existing programs) 4,000,000 25,575,000
$70,459,933
Financial Summary
Grants Phases I and II
$46,974,579 (two-thirds)
Private Resources and loans
Phases I and II
23,485,354 (one-third)
$70,459,933
3.
CHILDREN'S HOSPITAL
NATIONAL MEDICAL CENTER 2125 Thirteenth St., N.W., Washington, D.C. 20009 (202) 835-4000
CHILD HEALTH CENTER CHILDREN'S HEARING AND SPEECH CENTER HILLCREST CHILDREN'S CENTER RESEARCH FOUN-
DATION OF CHILDREN'S HOSPITAL
DEPARTMENT OF CHILD HEALTH AND DEVELOPMENT, GEORGE WASHINGTON UNIVERSITY
March 26, 1975
Father T. Byron Collins
Georgetown University
Healy Building
Third Floor
Washington, D. C. 20007
Dear Father Collins:
As you know, we carry on our Statement of Resources our
land and buildings in the amount of $3,000,000, even though all
of our premises have been officially appraised at a higher figure.
The book value figure of $3,000,000 is both reasonable and con-
servative, but I have been informed that it will be impossible for
us to realize at this time a sale of the premises at $3,000,000.
The District of Columbia government is anxious to purchase
our land and buildings for different uses, but I have been informed
that the District of Columbia at this time does not have the required
$3,000,000 to purchase our facility.
With best wishes.
Sincerely,
John 4 Sharin
John H. Sharon
4
JOHN H. SHARON
ROBERT H. P ARROTT, M.D.
NOEL E. KRONCKE
BEALE H. ONG, M.D.
Prestdent
Director
Admini strator
Charman of Medical stay
March 26, 1975
GEORGETOWN UNIVERSITY HOSPITAL
Concentrated Care Center Phase II
Parking Structure
Estimated Cost:
$4,000,000
666 automobiles
Capacity:
Reservoir Road entrance # 3
Location:
west of Concentrated Care Center
Site:
Presently occupied by 93 auto-
mobile capacity ground level
parking lot.
Parking Consultant:
Stephen G. Petersen, P.E.
Perkins and Will
Architect:
Purpose:
To provide parking for patients,
visitors attending Staff and
employees of the 160 Bed Concen-
trated Care Center, now under con-
struction (Peak population of over
1000 persons).
Combination of Federal Grants and
Funding:
Commercial loans.
Schedule:
Completion approximately 18 months,
to coincide with opening of CCC.
Pro Ration of Cost:
62.5 % of this facility is required
for the Concentrated Care Center.
62.5% X $4,000,000 = $2,500,000.
5
P.27
94TH CONGRESS
}
HOUSE OF REPRESENTATIVES
REPORT
1st Session
No. 94-141
SECOND SUPPLEMENTAL APPROPRIATIONS BILL, 1975
APRIL 10, 1975.-Committed to the Committee of the Whole House on the State
of the Union and ordered to be printed
Mr. MAHON, from the Committee on Appropriations,
submitted the following
REPORT
together with
SEPARATE VIEWS
[To accompany H.R. 5899]
The Committee on Appropriations submits the following report in
explanation of the accompanying bill making further supplemental
appropriations for the fiscal year ending June 30, 1975, and for other
purposes.
INDEX TO BILL AND REPORT
Page number
Bill Report
Narrative summary of bill
2
Tabular summary of bill
5
Title I-General Supplementals
2
Chapter I-Agriculture
2
8
Chapter II-Defense
2
10
Chapter III-Housing and Urban Development-Independent
Agencies
3
16
Chapter IV-Interior and Related Agencies
4
19
Chapter V-Labor. and Health. Education, and Welfare
5
24
Chapter VI-Legislative Branch
11
40
Chapter VII-Public Works
14
46
Chapter VIII-State, Justice, Commerce, and Judiciary
14
53
Chapter IX-Transportation
19
62
Chapter X-Treasury, Postal Service, and General Govern-
ment
22
69
Chapter XI-Claims and judgments
24
76
Title II-Increased pay costs
25
76
Title III-General Provisions
50
108
6
27
ment Assistance Act of
HEALTH RESOURCES ADMINISTRATION
advanced to this appro-
ayment of such compensation
HEALTH RESOURCES
ment necessitates this appro-
The bill provides $127,600,000, an increase of $61,100.000 over the
licient funds will be available
budget request. This is in addition to the $159,443,000 appropriated to
nefits. To the extent that these
date for health resources. The bill further includes authority to spend
three accounts, they will be
$8,500,000 from the Social Security trust funds to support the review
conomic situation is so uncer-
of capital expenditures prescribed in section 1122 of the Social Security
timate contained in the budget
Act.
de until September 30, 1976,
This appropriation supports the implementation of the National
sted in the budget.
Health Planning and Resources Development Act of 1974 (P.L.
ge in the bill to preclude the
93-641). This legislation adds two new titles to the Public Health
istance benefits during the up-
Service Act. The first, a new Title IV. is designed to replace existing
o have contracts for the next
health planning programs such as Comprehensive Health Planning.
ar to that contained in the
Regional Medical Programs and the Experimental Health Services
1970, in which the Congress
Delivery Systems. The second. a new Title XVI, is designed to
ent insurance coverage to em-
replace the existing Hill-Burton program for the construction and
education and provided that
modernization of health care facilities. In addition. P.L. 93-641
and certain other individuals
authorizes an appropriation of such sums as may be necessary to
demic years if the individuals
support the transition operations of the Comprehensive Health
Emergency Jobs and Unem-
Planning Agencies, Regional Medical Programs, and the Experi-
contain a similar prohibition,
mental Health Services Delivery Systems. The Committee approved
ion that some States are con-
100 of the 150 new positions requested and reduced the amount
ers this summer.
budgeted for new positions by $100,000. The total positions available
for this new program will be 369.
AGEMENT
The bill provides $50,000,000. an increase of $38,000,000 over the
ENSES
request for Regional Medical Programs in order that on-going projects
may complete their work and thus provide for a smooth and orderiy
of $400,000 from the budget
transition from the old to the new program. The appropriation of
are ; out the Department
transition funds for Comprehensive Health Planning. Regional
le of 1974. The amount
Medical Programs. and the Experimental Health Services Delivery
stead of S0 as requested in
stems is intended to establish the level of funding for these programs
in fiscal year 1975.
increased responsibilities in
In recognition of the timing of this appropriation, the Committee
ions, trade adjustment as-
has extended the availability of $18,700.000 until December 31, 1975
and trade-related economic
in order that these funds may be available to support the initiation
roved in the bill are for the
of the new State agencies for Health Planning and Development, and
the Office of the Solicitor.
the local Health Systems Agencies. These funds are also available to
new positions are required
support the establishment of procedures. guidelines, and regulations
sufficient funds to finance
to further the rapid development and efficient functioning of these
fiscal year, instead of three
new agencies.
udget request assumed an
Included in the bill is $1,200,000 for nursing research projects. No
budget request was submitted for this activity. Nursing research
TION, AND WELFARE
project funds support projects dealing with all aspects of patient care.
nursing as an occupation. nursing education, expanded or extended
EALTH ADMINISTRATION
roles for nurse practitioners and communication of research findings.
There have been no new projects started in the past two fiscal years.
TAL
The Committee believes this is a modest amount which would fund
int as the budget request.
approximately 15 new projects.
00 currently available for
The bill includes $22.000.000 for D.C. Medical Facilities to com-
rs the increased Federal
plete construction of Children's Hospital and a Concentrated Care
benefits. The government
Center at Georgetown University Medical Center. No budget request
e benefits increased from
was submitted for this item.
The total cost of Children's Hospital is estimated at $70,458,933.
To date, $40,458.933 has been appropriated by Congress, and an
additional appropriation of $16,000,000 is needed to complete the
7
28
project. The facility will provide specialized hospital research and
has denied this
patient treatment and services in units which will serve as models for
accordance with
delivery of health services to children in a more economical and
The Committee
effective way. In view of the overwhelming support that has been
gram level becaus
indicated for this project, this Committee feels that the requested
emergency program
Federal assistance should be provided to complete this hospital.
as a whole. is
The total cost of the Concentrated Care Center is estimated at
existed a few years
$32,500,000. To date, $21,900,000 has been appropriated for this
Committee believ
project and an additional appropriation of $6,000.000 is needed to
with the problem
complete construction. The Concentrated Care Center is a model for
program is forwar
renovation of over 7,000 hospitals throughout the nation. Many
in school year
features of the Concentrated Care Center have been initiated by over
The Committ
50 hospitals to date.
funds from this
authorized by
OFFICE OF EDUCATION
matics" or "Pro
The Commit
ELEMENTARY AND SECONDARY EDUCATION
of the most
racial isolation
The bill includes $4,000,000 for carrying out the Alcohol and Drug
speaking child
Abuse Education Act, for which there was no budget request. The
sufficient funds
amount in the bill is $1,700,000 less than the fiscal year 1974 appro-
for the continue
priation. The Committee deferred consideration of this program in the
regular bill for 1975 due to lack of authorizing legislation.
The drug abuse education program is primarily a training program
for groups such as teachers. counselors, and law enforcement personnel:
The bill inclu
and a community education program for parents and other people
for the Guaran's
interested in the problems of drug abuse. Although there is no budget
to $315 miiiion
request from the Administration, the Committee believes that there
This is, in etfe
should not be an abrupt termination of the program. The amount in-
loans are mac
cluded in the bill is sufficient to continue existing projects.
government
students. The
EMERGENCY SCHOOL AID
profit agencies
outstanding
The bill includes $125,000,000 to carry out the Emergency School
students. This
Aid Act, an increase of $50,000,000 over the budget request and a
students who
decrease of $109,000,000 from the fiscal year 1974 appropriation. The
a special allowan
program provides funds to local education agencies and certain public
on all loans
and private nonprofit organizations in order to meet special needs
The additio:
related to school desegregation. Funds are apportioned among the
of $4,400.000
States in accordance with the distribution among the States of minority
larger than
group children aged 5-17. There are also several setasides in the basic
in the average
law for various categorical programs. Some of the activities eligible for
in the specia:
assistance under the Act are teacher aides, supplemental staff, reme-
rates currently
dial services, teacher training, guidance and counseling, and curriculum
was based
development. Two of the principal categorical setasides in the Act are
now estimat
for bilingual education and educational television programming for
maximum 3'
children.
The Committee has deferred consideration of the program until
now because the Office of Education informed the Committee that
efforts were being made by the Administration to amend the Act.
The bill in
Since the program is forward-funded and virtually all of the money
to pay for in
is obligated in the fourth quarter of the fiscal year, deferral of con-
Government.
sideration by the Committee has had no adverse impact on the pro-
in the regular
gram. As a result of the Administration's failure to have the basic
This Fund
law amended through the legislative process, the budget proposes, in
Higher Edu
effect, to do the same thing in the appropriation bill. The Committee
ing expenses
8.
Calendar No. 132
94TH CONGRESS
~
SENATE
REPORT
1st Session
No. 94-137
SECOND SUPPLEMENTAL APPROPRIATIONS BILL, 1975
MAY 14 (legislative day, APRIL 21), 1975.-Ordered to be printed
Mr. McCLELLAN, from the Committee on Appropriations, submitted
the following
REPORT
[To accompany H.R. 5S99]
The Committee on Appropriations, to which was referred the bill
(H.R. 5899) making supplemental appropriations for the fiscal year
ending June 30, 1975, and for other purposes. reports the same to the
Senate with various amendments and presents herewith information
relative to the changes recommended.
INDEX TO BILL AND REPORT
Page number-
Bill
Report
Narrative summary of bill
2
Tabular summary of bill
4
Title I-General Supplementals
2
Chapter I-Agriculture
2
7
Chapter II-Defense
3
10
Chapter III-District of Columbia
4
14
Chapter IV-Housing and Urban Development-Inde-
pendent Agencies
5
19
Chapter V-Interior and Related Agencies
6
24
Chapter VI-Labor. Health, Education, and Welfare
10
32
Chapter VII-Legislative Branch
18
60
Chapter VIII-Public Works
26
70
Chapter IX-State, Justice, Commerce, and Judiciary
28
80
Chapter X-Transportation
36
96
Chapter XI-Treasury, Postal Service, and General
Government
40
105
Chapter XII-Claims and Judgments
43
114
Title II-Increased pay costs
44
115
Title III-General Provisions
72
(1)
9
36
with all aspects of patient care, nursing education, and expanded
however, that
roles of clinical specialists, nurse practitioners, and the communication
tration (ADAME
of research findings. The Committee notes that there have been no
devastating pr.
new projects started in this important area in the last two years.
of the research
The Committee has also provided $29,575,000 for D.C. Medical
in this field. I:
Facilities to complete construction of the Children's Hospital National
be more effectiv
Medical Center and the Concentrated Care Center at Georgetown
already exists
University. These funds shall remain available until expended. This is
cultural proble
$7,575,000 over the House allowance. This level of funding will provide
and communit
$21,575,000 for Children's Hospital, which, when completed, will
current knowled
serve as a national model. specializing in hospital research, patient
harm than
treatment. and service in units which will serve as models for research
will serve as
health delivery systems to children. The Committee is pleased that
The Committee
Children's Hospital has appointed a person to have specific responsibil-
for that agency
ity for its new day-care center. In light of the Committee's continued
The Commit:
strong support of the hospital in all its efforts, the Committee requests
program. A
the hospital administration to report back within 90 days of enactment
Current estima
of this bill on the status of the day-care center.
to fund a full
The Concentrated Care Center is a model for renovation of 7,000
sites. Given Foll
hospitals throughout the Nation. The concentration of modules of
enrolled in
concentrated high-cost services in the acute facility could effect
reduction in
substantial savings in the Nation's expenditures for hospital renova-
with respect
tions and patient care.
would indicate
Further, the Secretary of HEW is directed to provide the Com-
funds, an estimar
mittee with a report on the availability of loan funds to complete
1975-76.
these projects.
OFFICE OF EDUCATION
1975 presently
1975 proposed
ELEMENTARY AND SECONDARY EDUCATION
House allowanc
Committee
1975 presently available
$2,255,675,000
1975 proposed supplemental
The Commit
House allowance
4,000,000
000 over the II
Committee recommendation
9,000,000
quest. The Congr
The Committee concurs with the House in providing $4,000,000 for
item pending the
alcohol and drug abuse education activities. The Congress deferred
basic law. Failing
consideration of this item in the regular 1975 bill, pending enactment
gency School Aid
of authorizing legislation. Authorized by the Alcohol and Drug Abuse
The Committee
Education Act, this program is designed to help schools and com-
directs that the
munities respond to drug and alcohol abuse problems among school
restoring this
children. Emphasis is placed on assisting local communities, school
Committee is no:
districts, and State agencies in dealing with these problems. The
lessened to any
amount recommended includes: $2,040,000 to support five regional
commitment to
training resource centers; $1,410,000 for training 200 school-based
fair and equitabi
nities. such as
alcohol and drug abuse prevention teams; $400.000 for six preservice
assistance under
demonstration projects: and $150,000 for technical assistance.
that sufficient
The Committee is deeply concerned over the serious and continuing
these urgent
growth in alcohol and drug abuse among this nation's youth. Recent
estimates indicate that the proportion of youth who drink has
The Emergency
increased to the point where nearly all children and teenagers are
non-profit
school
involved. With respect to drugs. it is expected that the abuse of
aiding school
opiates and nonopiates alike will remain a national health problem,
with evidence of their use increasing in some areas of the country. The
minority group
funds in the
problem is further intensified when added to the social and economic
costs related to the abuse of these substances. The Committee believes,
the States on
(aged 5
10
P.10.41
94TH CONGRESS
HOUSE OF REPRESENTATIVES
REPORT
1st Session
No. 94-239
MAKING SUPPLEMENTAL APPROPRIATIONS,
FISCAL YEAR 1975
MAY 21, 1975.-Ordered to be printed
Mr. MAHON, from the committee of conference,
submitted the following
CONFERENCE REPORT
[To accompany H.R. 5899]
The committee of conference on the disagreeing votes of the two
Houses on the amendments of the Senate to the bill (H.R. 5899)
"making supplemental appropriations for the fiscal year ending
June 30, 1975, and for other purposes," having met. after full and free
conference, have agreed to recommend and do recommend to their
respective Houses as follows:
That the Senate recede from its amendments numbered 33, 41. 57. 61.
94, 122, and 172.
That the House recede from its disagreement to the amendments of
the Senate numbered 1. 2. 4.5. 6.8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 21.
22, 34, 37, 38. 39. 50. 52. 54. 55. 65, 79. SO. S2. S4. S5. 86. 87. SP. 90. 101.
102, 109, 110. 111. 112. 113. 114. 115. 116. 118. 110. 120, 123. 124. 125. 126.
127, 135, 136. 137, 138. 139. 140. 145. 146. 147. 148. 149. 150, 151. 152. 133.
154, 155, 156. 157. 158. 159. 160. 161, 162, 163, 10+, 165, 166, 167, 105, 169,
and 170, and agree to the same.
Amendment numbered 7:
state
That the House recede from its disagreement to the amendment of
the Senate numbered 7. and agree to the same with an amendment.
as follows:
In lieu of the sum named in said amendment insert $5,000,000; and
the Senate agree to the same.
Amendment numbered 26:
That the House recede from its disagreement to the amendment of
the Senate numbered 26, and agree to the same with an amenciment.
as follows:
In lieu of the sum named by said amendment insert $200,000; and
the Senate agree to the same.
Amendment numbered 25:
That the House recede from its disagreement to the amendment of
the Senate numbered 25, and agree to the same with an amendment.
as follows:
In lieu of the sum proposed by said amendment insert $6,800,000:
and the Senate agree to the same.
38-006 0
11
10
HEALTH RESOURCES ADMINISTRATION
Amen
tion"
Amendment No. 40: Reported in technical disagreement. The man-
$7,500
agers on the part of the House will offer a motion to recede and concur
000,00
in the Senate amendment with an amendment which will appropriate
Amen
$118,900,000 for "Health resources" instead of $127,600,000 as proposed
relating
by the House and $126.475,000 as proposed by the Senate. and will ear-
Amen
mark $10,000.000 for carrying out section 3 of the National Health
agers
Planning and Resources Development Act of 1974. as proposed by the
in the
Senate, instead of $18,700,000 as proposed bv the House. The funds for
in the
carrying out section 3 shall remain available until December 31. 1975.
93-305)
as proposed by the House. The managers on the part of the Senate will
Higher
move to concur in the amendment of the House to the amendment of
Higher
the Senate.
June
Amendment No. 41: Earmarks $22,000.000 of the appropriation for
"Health resources" for carrying out section 305 (b) (3) of the Public
Health Service Act. as proposed by the House, instead of $29,575,000
Amer
as proposed by the Senate.
of the R
Amer
OFFICE OF EDUCATION
services
the Hous
Amendment No. 42: Appropriates $6,500,000 for "Elementary and
Amer
secondary education" instead of $4,000.000 as proposed by the House
agers
and $9,000,000 as proposed by the Senate. The increase over the
cur in
amount proposed by the House is for Part B of the Head Start-Follow
availa
Through Act.
(93rd C
The intent of the conferees is that. with respect to the entering class.
per child costs and enrollment levels in all ongoing Follow Through
projects be maintained at levels provided in previous years.
Amendments Nos. 43 through +7: Reported in technical disagree-
ment. The managers on the part of the House will offer motions to
security
recede and concur in the amendments of the Senate with amendments
The
which will earmark $185,588,000 for section 705 instead of $204,131.000
tions
as proposed by the Senate. $11.309.000 for section 708(a) instead of
ment
$12,447,000 as proposed by the Senate. $9,052.000 for section 708(c)
plicated
instead of $9,958.000 as proposed by the Senate, $6,794,000 for section
supplement
711 instead of $7,468,000 as proposed by the Senate. and $2.257.000 for
section, 713 instead of $2,489,000 as proposed bv the Senate.
The managers on the part of the Senate will move to recede and
concur in the amendments of the House to the amendments of the
Amer
Senate.
opment
Amendment No. 48: Appropriates $215,000.000 for "Emergency
000.0
school aid" instead of $125,000,000 as proposed by the House and
The
by the
$236,493,000 as proposed by the Senate.
Heads:
Amendment No. to: Reported in technical disagreement. The man-
ices for
agers on the part of the House will offer a motion to recede and concur
in the amendment of the Senate with an amendment extending the
Amer
availability of funds in the bill for "Emergency school aid" until
agers
cur in
September 30. 1975. instead of August 15. 1975, as proposed by the
that ST.
Senate.
shall
The managers on the part of the Senate will move to concur in the
000
amendment of the House to the amendment of the Senate.
The
Amendment No. 50: Appropriates $250,000 for "Education for the
amend:
handicapped" as proposed by the Senate.
12
White House.
July 91,1975
Dr mars:
File - Genegetown and
D.C. children Assistals
/. Paul D'Neill hassent the n iemo to
Tres Ford - sointing out that the project:
Children's 4 Serrgetown -DC.
Hansuman, Phila
Water Works - Dertuth
are not budget requests
I. mr. O'Neill also suggested we
notify mr. Inax Friedensdoof. Paul
senla copy afout letter to Pres. tord to
mr as her Indersday
was unable to see us.
mo Freedersdof in out behalf
Hogefully you would talk to
Byron 655-4411 Collin, (Gtn) John Thank 333-4000 Shon + ouidrance Mate
Ely
GEORGETOWN UNIVERSITY
WASHINGTON, D. C. 20007
OFFICE OF THE PRESIDENT
SPECIAL ASSISTANT FOR
FEDERAL RELATIONS
July 21, 1975
The President
The White House
Washington D.C. 20500
Dear Mr. President:
This is a request for the immediate release of $22,000,000 contain-
ed in the Second Supplemental Appropriations for 1975, P.L. 94-32, for two
national experimental hospital construction projects.
The first project is Children's Hospital National Medical Center
in the District of Columbia. This facility, which is under construction (cf.
attached photograph), will provide a combination of specialized care with
research components for children from all over the United States and, in-
deed, the world. This projectwas started in 1966 and is designated as an
experimental research facility in this particular field through a peer
review process.
The need for these additional funds is extremely acute. The con-
struction has been on a phased basis, which was approved by GAO. The total
cost of the facility is $70,457,000. It is scheduled for dedication on
July 4, 1976. We hope you will accept our invitation to attend the ceremony.
The federal grant participation is two-thirds, the remaining one-
third coming from the hospital fund drive and loans in accordance with the
enabling legislation. The particular time crunch lies in this: The funds
in the Second Supplemental were designed to meet a construction phased
bidding process. We have over $10,000,000 of construction bids which were
supposed to have been acted upon by July 11, 1975. A portion of the funds
are from the $16,000,000 provided in the Second Supplemental Appropriation.
The first phase of the project, at a cost of $54,000,000, is nearly com-
plete. The final phase, with bids ready to be awarded, awaits your decision.
Georgetown University's Concentrated Care Center has a ten year
history. It was approved by peer review both in concept and design as a
national experimental project. This project is also on a phased construc-
tion basis similar to Children's Hospital. Its purpose is to provide a
model of health care that is replicable by the 7000 hospitals throughout
the country. This model differentiates between two kinds of hospital care -
the patient who needs constant care and attention by physicians and nurses,
which is concentrated care, and the patient who needs occasional daily
physician and nurse treatment. The purpose of this national experimental
hospital is to demonstrate how these kinds of care can be given and cost
accounted so that patients will be charged a total lower per diem costs.
The $6,000,000 provided in the Second Supplemental Appropriation will
enable the construction of the second phase of this project, which is
to provide for special laboratories and treatment spaces. These funds
are immediately needed so that the construction schedule of the second
phase will be completed to make the first phase function, (cf. attach-
ed photograph). The funds for this $35,000,000 project are made up of
two-thirds federal grant and one-third from Georgetown University re-
sources of gifts and loans.
We believe that the federal investment in these projects will be
repaid many times by the innovative services and cost savings for child
and adult patients.
We point out that these funds are in the fiscal 1975 appropria-
tion and are not within the budget limit for fiscal 1976.
We thank you for considering our plea on behalf of the people of
the United States whom our institutions serve directly and in affil-
iation with the National Institutes of Health. We pray for you and that
you will, in your wisdom, allow our projects to continue.
TByon Collins S.J.
Sincerely yours,
John H Sharan John H. Sharon
Special Assistant to the President
Chairman, Children's Hospital
Georgetown University
National Medical Center
NATIONAL ARCHIVES AND RECORDS ADMINISTRATION
Presidential Libraries Transfer/Disposal Sheet
ITEM ID 00115
DESCRIPTION OF ITEM MOVED
One black and white 8" X 10" black and
white photograph of the Concentrated
Care Center at Georgetown University
and one color 8" X 10" photograph of
the Children's Hospital National
Medical Center.
COLLECTION/SERIES/FOLDER ID 016400086
COLLECTION TITLE
Theodore C. Marrs Files
BOX NUMBER
9
FOLDER TITLE
Health (2)-(3)
ACCESSION NUMBER
70-NLF-221
MOVEMENT DATE
10/19/1989
TYPE OF MATERIAL
Photographs
NEW LOCATION
Audiovisual Collection
ARCHIVIST'S
William H. McNitt
189 VAVAV
CONCENTRATED CARE CENTER
Georgetown University
Photo No. 49, March 25, 1975
Architect-Metcalf - and Assoc.
General View-Rear.
Contractor-The George Hyman Co.
February 26, 1975
GEORGETOWN UNIVERSITY HOSPITAL
CONCENTRATED CARE CENTER
CONSTRUCTION BUDGET
PHASE I
PHASE II
TOTAL
Budget
Budget
Budget
Construction including util-
1/
ities and fixed equipment
$17,761,339
$ 9,958,661
$27,520,000
A/E Fees
1,860,416
609,584
2,470,000
Inspection & Supervision
160,000
125,000
285,000
Consultant Fees
228,485
46,515
275,000
Miscellaneous, fees, permits, etc.
431,403
108,597
540,000
Research coordination & development
378,000
32,000
410,000
Moveable Equipment
2,180,357
1,119,643
3,300,000
TOTAL
$23,000,000
$12,000,000
$35,000,000
1/ Includes $2.5 million for approximately 65% of a $4 million parking facility
at the site. The rest is for automated, clinical laboratories, treatment and
office space.
CHILDREN'S NATIONAL MEDICAL CENTER
COSTS:
Construction
$46,214,248
$8,880,000
$55,094,248
Equipment
267,000
6,610,685
6,877,685
Désign, Consultants and
Administration
5,025,000
962,000
5,987,000
Contingency
952,685
1,547,415
2,500,100
TOTAL
$52,459,933
$18,000,000
$70,459,933
March 10, 1975
1975 SUPPLEMENTAL APPROPRIATIONS GRANT REQUEST - CONCENTRATED CARE
CENTER $8,000,000, CHILDREN'S HOSPITAL NATIONAL MEDICAL CENTER
$21,575,000.
Concentrated Care Center Experimental Project, Total Cost Estimate
$35,000,000
Method of Funding
Phase I - Cost $23,000,000
Grant HEW Appropriations 1969-70
$ 6,900,000
Grant P.L. 92-80
8,300,000
Loan P.L. 92-80
6,700,000
Private Resources
1,100,000 $23,000,000
Phase II - Cost $12,000,000
1975 Supplemental Appropriation
Grant Request
8,000,000
From Existing Federal Loan Programs
4,000,000
12,000,000
$35,000,000
Summary of Financing of Phases I and II
Federal Grants Phases I & II
$23.200,000 (two-thirds)
Private Resources and Loan Phases
I and II
11,800,000 (one-third)
Total cost of Project
$35,000,000
Children's Hospital National Medical Center Experimental Project
Total Cost Estimate
$70,459,933
Method of Funding
Phase I - Cost $44,884,933
Grant - P.L. 90-457
$13,399,574
Grant - P.L. 93-50
12,000,000
Federal Loan - P.L. 90-457
13,399,579
Fund Drive
6,085,780 $44,884,933
Phase II - Cost $25,575,000
Grant Request in HEW Supplemental
1975
21,575,000
Federal Loan (from existing programs) 4,000,000 25,575,000
$70,459,933
Financial Summary
Grants Phases I and II
$46,974,579 (two-thirds)
Private Resources and loans
Phases I and II
23,485,354 (one-third)
$70,459,933
acr
Jill
AMERICAN COLLEGE OF RADIOLOGY: 20 NORTH WACKER DRIVE CHICAGO, ILLINOIS 60606 (312) 236-4983
WASHINGTON OFFICE: 6900 WISCONSIN AVENUE CHEVY CHASE, MARYLAND 20015 (301) 654-6900
August 27, 1975
Guy Newell, M. D.
Deputy Director
GERALD FORD LIBRARY
National Cancer Institute
National Institutes of Health
Bethesda, Maryland 20014
Dear Doctor Newell:
Thank you very much for the opportunity of sitting down and
discussing with you the many ramifications of radiology's involvement
in the current and future status of NCI.
Your guidance and wisdom is greatly valued, for it aids in the
eventual opening of doors with chiefs of various divisions. This
"entrance" is extremely important and necessary for the accomplishment
of future activities.
Your advice in handling the Breast Conference grant is most appreciated.
We have, with all the grace we can, withdrawn the application. There
are many opportunities of involvement between Cancer Control and
the College which can enhance the NCI, as well as, the private sector.
Therefore, the grant will not be pursued any further.
Your wisdom and forsight demonstrates your genuine interested in
doing something for the American patient for whom we all serve.
I look forward to every future meeting we have and hope that there will
be many. Please do not hesitate to call me to make any arrangements,
as I also will be calling you.
With the kindest of personal regards.
Sincerely,
Bin William K. Melton
Deputy Executive Director
WKM:d
acr
200
AMERICAN COLLEGE OF RADIOLOGY
28 AUG
AUG2
1975
6900 WISCONSIN AVENUE
-
MD. 629649
CHEVY CHASE, MARYLAND 20015
Theodore C. Marrs
Special Assistant to the President
The White House
Washington, D.C. 20500
THE WHITE HOUSE
Jempil GL
WASHINGTON
September 3, 1975
MEMORANDUM FOR:
FROM:
JACK
The President saw and appreciated together
TED Janes
with your memo, in reference to Hospital the
concentrated Care Center at Georgetown.
FORD LIBRARY & GERALD
MEMORANDUM
DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
Public Health Service
Shiprock Service Unit
TO
DATE: 9-4-75
:
All Physicians
FROM :
FORD i LIBRARY DERALD
SUD-Shiprock Service Unit
SUBJECT: Nursing Shortage
Due to the acute shortage of nursing personnel, we will not
admit any elective patients for the coming two weeks.
Luverne A. Husen, M.D.
Service Unit Director
Shiprock Service Unit
14 Revell Street
Annapolis, Maryland 21401
November 20, 1975
Sylvia Rhodes
Acting Chief of Nursing
Indian Health Service
Dear Ms. Rhodes,
I am in receipt of your letter of November 4, 1975, in which you again refuse
to refer my application for employment to Shiprock Hospital. Since you still
fail to give any reasons for this refusal I must necessarily consider your action
prejudicial, discriminatory and a violation of my civil rights.
You may not be aware that in my previous employment at Shiprock I received
excellent ratings from Mrs. Beverly Smith, Director of Nursing and Dr. Luvern
Husen, Service Unit Director. A copy of these ratings is available if you
desire them. Further, as a result of my ability and professionalism I was
promoted to Head Nurse, Pediatric Ward, at Shiprock. I would also like to
point out that Dr.. Emery Johnson, Director, Indian Health Service, wrote to
Congressman Edward Mezvinsky on October 28, 1975, saying that the Indian Health
Service is in need of good registered nurses and that I could reapply for
employment without prejudice.
You may not be aware that the Service Unit Director, as recently as September,
found it necessary to publish a memo addressed to all physicians in Shiprock
Hospital concerning the acute shortage of nursing personnel at the hospital.
A copy of that memo is attached for your information.
My application for employment at Shiprock Hospital is herewith resubmitted
for the third time.
Sincerely yours,
Sandra I Kramer
Sandra J. Kramer
file
THE WHITE HOUSE
WASHINGTON
September 12, 19
LIBRARY GERNED R. FORD
MEMORANDUM FOR
RON KIENLEN
FROM:
JUDY JOHNSTON
SUBJECT:
Emergency Medical
Services Week Proclamation
Attached is a request from the American Association
of Trauma Specialists urging the President to issue
a proclamation designating the week of November 3
as Emergency Medical Services Week. The proclamation
was issued last year.
Could you please give me your recommendations on
issuing such a proclamation.
CC: Sarah Massengale
Ted Marrs
June
American Association
EMERGENCY
of
MEDICAL SERVICES
Trauma Specialists
180 N. LaSalle St.
Suite 2201
Chicago, ILLinois 60601
utive Director
(312)
September 9, 1975
bert G Rich
rthbrook. Illinois
The Honorable Gerald R. Ford
President of the United States
The White House
ident Pro Tem
1600 Pennsylvania Avenue N. W.
chael E Hochfelder
Washington, D. C. 20500
is Plaines. Illinois
Dear Mr. President,
cation Director
The concern of the Congress in passing the Emergency Medical
sterE Ascher
Services Systems Act of 1973 and the efforts of the Departments of
cago. Illinois
Transportation and Health, Education, & Welfare have done much to
improve the level of emergency medical care in these United States.
On November 5, 1974 you kindly issued a proclamation designating
bership Director the week of November 3, 1974 as Emergency Medical Services Week. We
10 S Tanenbaum R. Phwould like once again to prevail upon your good services and ask that
Okie. Illinois
you issue a similar proclamation for the week of November 2, 1975,
We have asked the co-operation of the Governors of all fifty states
and the Virgin Islands, and the mayors of the fifty largest cities
eral Counsel
to issue similar proclamations. Several have agreed to do so, and we
would be pleased to have this become an annual event.
R Denkewalter
190. Illinois
We have reviewed the proclamation you issued in 1974 and ask
that you include an additional paragraph similar to the following:
"As a tribute to those engaged in Emergency Medical Services,
and to inform our citizens of their contributions to the
nation's health and welfare, I, Gerald R. Ford, President
of the United States of America, therefore proclaim the
week of November 2, 1975 as Emergency Medical Services Week."
Your kind considerations in the past have given much needed
support for our profession. We would be pleased to participate or
co-operate in any ceremonies honoring our profession. We would
also appreciate any credit given to our Association in connection
with the issuance of a proclamation, and would like to receive
copies of the proclamation and of any photographs taken at
ceremonies in connection with Emergency Medical Services Week.
Sincerely,
Michael E. Hochrelder
President Tem
meh/bs
September 22, 1975
FORD is 076830 LIBRARY
Dear Pete:
Please ask your medical people to review and
see if this has any potential exhibit value.
Thank you.
Sincerely,
Theodore C. Marrs
Special Assistant to the President
General Duwart L. Crow
Associate Deputy Administrator
NASA Headquarters
400 Maryland Avenue, sw.
Washington, D.C. 20546
Enclosure
TCM:pft
JACKSON
HOSPITAL
AND CLINIC INCORPORATED
1235 FOREST AVENUE
MONTGOMERY, ALABAMA 36106
DOUGLAS GOODE, ADMINISTRATOR
August 1, 1975
Dr. Ted Marrs
QERALD FORD GBRARD
Special Assistant to the President on Human Resources
The White House
Washington 25, D. C.
Dear Ted,
Please note from the enclosures, (1) A study by Dr. Burt Edelson of Consat-
a suggested outline of an international Tele-Health Communications network with
projected costs for a year's operation linking Auburn and the Medical University
of South Carolina with Costa Rica, Iran, Egypt, South Africa and Queen Charlotte
Islands, B.C. Canada.
(2) a letter endorsing our project by the Secretary-General of Habitat
(United Nations Conference on Human Settlements, Vancouver 1976).
Vince Moseley reports that the Lister Hill Center of the National Library
of Medicine in Bethesda has also endorsed our project and suggests that
Dr. Kenneth Endicott, director of the Health Resources Administration has funds
available that might be applied to such an undertaking. A Dr. Herbert Tahl is
the liason person between the Lister Hill group and Dr. Ken Endicott's Health
Resources Administration.
Since you manage so well the implantation of projects, I hope that the fore-
going information may be useful in bringing together leaders in these different
agencies, that might resolve our funding problems.
We look upon the Habitat Conference on Human Settlements of the United Nations
as an ideal opportunity to initiate a permanent operational Tele-Health network.
before 5,000 delegates from the worldwide membership of the United Nations.
The Consat budget is slightly less than $500,000, noting that some of the
costs are necessarily estimates at this time. The cost estimates on south stations
at the various sites have not been included, nor has the cost of peripheral communi-
cations equipment and medical instrumentation been estimated. A reasonable guessti-
mate of $250,000 per installation to include personnel for a year's operation is
probably conservative.
In order to establish a definitive budget, our preliminary proposal requested
$50,000 for a feasability study. There is some urgency now to take action if we
are to complete the study in time to marshal the forces necessary to have our project
ready for the May 1976 deadline of the Vancouver Habitat Conference.
Please call me for any additional information. All or any of us will be available
to meet with you whenever necessary.
Respectfully yours,
Hugh MacGuire, this M.D.
Habitat
United Nations Conference on Human Settlements
Conférence des Nations Unies sur les établissements humains
Vancouver 1976
S0-147/1
Enrique Peñalosa
Secretary-General/Secrétaire général
24 July 1975
Dear Dr. McGuire:
I would like to say how extremely pleased I am at your plan for
an international tele-health programme tied to the Habitat Conference.
Although actual installation of the facility will be up to the host country
authorities, I feel certain they will agree with me that this is an extremely
useful example of international co-operation which is closely related to a
central goal of the Conference. That is, to bring modern services to rural
settlements, with medical care and training at the very top of the list.
Budgetary restrictions as well as general policy for conference
secretariats make it impossible for this organization to offer you direct
financial support. However, we feel that the tele-health project closely
parallels the interests of at least three UN specialized agencies ---
World Health, FAO and UNESCO -- and your proposal has been sent to appropriate
divisions of each. I also think the project should be worth support from
private foundations and industries, and perhaps governments as well.
A central goal of Habitat is to show practical examples of how
problems of human settlements -- in villages as well as major cities --
can be solved through new ideas and techniques. But more than that,
we feel that successful "pilot projects" must be followed by broad and
permanent implementation. As I have heard of pilot projects before on
satellite health transmissions, I hope you are including in your project
provisions for the mounting of a permanent system.
Yours sincerely
Dr. Hugh McGuire
International Tele-Health Planning Group
112 Coliseum Boulevard
Montgomery, Alabama 36109
485 Lexington Avenue, New York, N.Y. 10017 (212) 754-1234
Cable: UNATIONS Telex: 236185
COMMUNICATIONS SATELLITE CORPORATION
B.I. EDELSON
Director
Comsat Laboratories
July 10, 1975
Dr. Chester C. Carroll
Vice President for Research
Auburn University
Auburn, Alabama 36830
Dear Dr. Carroll:
The attached study describes an international communications
network for medical and health services. that might be established
to serve five countries using voice grade circuits in the INTELSAT
system. We have tried to give an example of how this might be
accomplished using a reasonable mix of satellite services and
terrestrial extensions. We have also attempted to estimate the
operating cost for establishing a system, plus two options: one
for the use of a small earth terminal, and another for possible
provision of television services. I hope you find this study of
interest.
Please understand that the attached study is for "planning
purposes only." It does not in any way represent a commitment on
the part of the Communications Satellite Corporation to provide
the services described. The cost estimates are based upon our
knowledge of U.S. charges. Foreign charges which are not well
established will be different and probably considerably higher.
It was very nice meeting with you. Please give our regards
to your colleagues.
Sincerely,
BlEdelian B. I. Edelson
BlEdelson
Attachment
cc: W. M. McCord, M.D.
V. Moseley, M.D.
H. C. MacGuire, M.D.
COMSAT LABORATORIES
BOX 115
CLARKSBURG, MD. 20734
TELEPHONE 301-428-4422
INTERNATIONAL MEDICAL AND HEALTH SERVICES NETWORK
Prepared for
Medical University of South Carolina
by
Communications Satellite Corporation
July 1975
INTERNATIONAL MEDICAL AND HEALTH SERVICES NETWORK
I. INTRODUCTION
THis plan was prepared by COMSAT as a result of a re-
quest by the Medical University of South Carolina for information
on the feasibility of an international communications network via
satellite for the transfer and exchange of information on medicine
and health care delivery.
The plan describes a baseline network which utilizes the
space segment of INTELSAT plus existing earth stations in several
countries connected to medical centers by terrestrial interconnec-
tions. The baseline network provides voice-band communications.
In addition, the plan includes some technical and cost information
on two options: the use of small, customer-premises earth stations,
and the provision of television service.
II. BACKGROUND
Previous experience has indicated that useful medical
services can be provided with voice-grade circuits, a good example
being the COMSAT-HOPE experiment held in 1973. In that case, a
small terminal using a 2.4 meter (8-ft) reflector was placed on the
hospital ship HOPE, which was anchored in the port of Maceio, Brazil.
The object of this experiment was to evaluate the use of the sat-
ellite link in support of a complete teaching and operating medi-
cal facility located in a remote area and equipped with only a
low-cost unsophisticated earth terminal. The satellite link be-
tween the ship and project HOPE headquarters is shown in Figure 1.
The three voice grade circuits were used to transmit
voice, full-duplex teletype, facsimile, data, and slow-scan tele-
vision pictures. All of these modes were used in various combina-
tions for the individual experiments and demonstrations with
excellent results.
Teletype was used in a full-duplex mode to support the
administrative needs of the hospital, which were supplied from
HOPE headquarters. The voice link was used to permit the physi-
cians serving on the HOPE to consult with colleagues and experts
in the U.S. Facsimile was especially useful for transmitting med-
ical information and sketches of dental restoration work, for
instance.
Slow-scan television was used in a variety of ways. The
system allowed a picture to be "frozen," i.e., put on a local mem-
ory, and then transmitted to the distant television monitor in
30 seconds. A "live" scan of a stationary subject could be trans-
mitted in 60 seconds to provide a picture with higher resolution
on the receive monitor.
During the five months of the experiment a number of in-
teresting demonstrations were made to evaluate the combined modes
2
INTELSAT IV
BRAZILIAN
HOSPITAL
Figure 1. 1
LOCAL TELEPHONE LINE
PROJECT HOPE HQ
WASH. D.C.
3
HOPE
LABS 'RET'
COMPUTER
ANALYSIS EKG
TELEPHONE
TELETYPE
TELSERV EKG
SLOW-SCAN TV
FACSIMILE
RCA SLOW-
XEROX 400
TELETYPE
TELECOPIER
SCAN TV
TELECOPIER
P15 12/74
of communications in support of a remote medical facility. Medical
consultations were held by sending the patient's medical history
and medication and treatment records in advance by teletype and
facsimile. The condition of the patient was monitored during the
consultation session either by having the patient present, or by
taking polaroid pictures of the patient and sending these via slow-
scan television. Other information transmitted included X-rays and
a Pitood sample on a microscope slide. The latter was accomplished
by Toplacing the microscope eyepiece with the television camera.
A lecture on tropical diseases was delivered via satel-
His DY a Brazilian specialist aboard the HOPE to physicians at
the Mayo clinic in Rochester, Minnesota. For this lecture, 35-mm
coller slides were sent by mail to Rochester to be projected on cue
from the lecturer in Brazil. Otherwise, the lecture was live, and
20way voice was available for questions. This mode of operation
was found to be very effective.
It should be noted that all of the above was accomplished
Dyy. using only three voice channels. As will be shown later, the
cost of satellite service depends on the channel capacity required,
and voice channels require signficantly less satellite resources
Than full-quality television. However, the carriers for the exper-
-ment used about 25 percent of the available capacity of one
global-beam transponder of the INTELSAT satellite due to the small
size of the HOPE antenna. An INTELSAT IV transponder has an annual
rental cost of about $3 million.
4
III. A PROPOSED BASELINE MEDICAL NETWORK
The baseline network is designed to provide inter-con-
nections between the Medical University of South Carolina and
five remote hospitals. This network, to consist of leased voice
circuits, could provide voice, analog and digital data (24-9600
bps) , facsimile, and slow-scan television to be used for the ex-
change of medical information, diagnosis, and evaluation.
The center of the network would be the Medical University
of South Carolina, which would be connected to the INTELSAT system
(Etam, West Virginia) via land line. Satellite communications
could be provided to the following locations:
a. a hospital in Costa Rica via the Nicaraguan earth
station,
b. a hospital in South Africa via their earth station near
Pretoria,
C. a hospital in Iran via their earth station in Asadabad,
and
d. a hospital in Egypt via their non-standard earth station*
near Cairo.
In addition, terrestrial interconnections could be provided to the
following:
a. a hospital on Queen Charlotte Island, Canada; and
b. other universities and medical centers in the U.S.
Egypt has announced plans to build a standard earth station in
1976.
5
Figure 2 indicates the network which has been envisioned.
The communications capability required to support this network will
be uncertain until the system begins to function effectively. The
network capability is indicated in Table 1.
Table 1. Network Capability
Link
Capability
From the Medical University
1 duplex voice circuit to
of South Carolina
each of the five hospitals
From the individual hospitals
1 duplex voice circuit to
the Medical University of
South Carolina
A. COSTS
The costs associated with this communications network
have been estimated on the basis of available information and
should be considered to be at best an approximation. The costs
indicated here are only those associated with the long-haul commu-
nications services and exclude termination costs (probably minor)
and local terminal equipment costs (probably significant).
1. U.S. Extension Costs
For these costs an AT&T rate of $2.63/mile/month or
$31.56/mile/year was used.
6
AN INTERNATIONAL COMMUNICATION NETWORK FOR THE
MEDICAL UNIVERSITY OF SOUTH CAROLINA
- using THE INTELSAT SYSTEM
and LANDLINES
QUEEN CHARLOTTE HOSPITAL
CONNECTED TO MEDICAL
UNIVERSITY or SOUTH CAROLINA
Figure 2. 2
MEDICAL UNIVERSITY
or
SOUTS CAROLINA
HOSPITAL
DI
TRAM
HOSPITAL IN
BGYPT
t
COSTA RICA HOSPITAL
CONNECTED TO
BICARAGUAN
SARTS STATION
SOSPITAL IV
SOUTS AFRICA
2. Foreign Extension Costs
Since exact costs will vary from country to country, the
U.S. costs cited above have been used throughout for foreign
estimates.
3. U.S. Satellite Service
A current COMSAT tariff applicable to common carriers in
the Atlantic area, $34,200 per half-circuit per year, has been used.
4. Foreign Satellite Service
The costs of foreign satellite service are generally dif-
ferent from (higher than) the costs of U.S. service. However, for
estimation purposes the U.S. costs have been used throughout. The
costs charged by INTELSAT for the space segment are a part of the
satellite service costs. These space segment costs are presently
$18,000 per year. The remainder of the costs are earth station
and international common carrier costs, which are $16,200 for the
U.S., but may vary for other countries.
Table 2 is an estimate of the annual communications
costs of a baseline system. A single time-shared circuit between
South Carolina and the other satellite-linked countries would re-
duce the U.S. satellite and extension costs by $154,650, and re-
sult in a network total of $256,150.
8
Table 2. Annual Communications Costs for a Baseline System
Paths from the Medical University
Annual Leased
of South Carolina (to and from)
Costs
A hospital in Iran (near Teheran)
Iranian satellite link*
$34,200
Iranian extension to Teheran (300 miles)
9,500
U.S. satellite link
34,200
U.S. extension (550 miles)
17,350
$95,250
A hospital in South Africa (near Pretoria)
South African satellite link*
$34,200
South African extension (50 miles)
1,600
U.S. satellite link
34,200
U.S. extension
17,350
$87,350
A hospital in Egypt (near Cairo)
Egyptian satellite link*
$34,200
Egyptian extension (100 miles)
3,150
U.S. satellite link
34,200
U.S. extension
17,350
$88,900
A hospital in Costa Rica
Nicaraguan satellite link*
$34,200
Costa Rican extension (225 miles)
7,100
U.S. satellite link
34,200
U.S. extension
17,350
$92,850
A hospital on Queen Charlotte Island
U.S. land lines to Vancouver using special
$27,500
"lo" rate (2,575 miles across the U.S.)
Canadian land lines
18,950
$46,450
TOTAL:
$410,800
*The term "link" indicates the half satellite circuit end termi-
nating in Iran or other country. A current COMSAT tariff has
been used to estimate rates. Foreign rates will differ, and
may be considerably higher.
9
IV. SMALL TERMINAL FOR MEDICAL COMMUNICATIONS
A. OPTION 1
A small terminal for use with an INTELSAT IV satellite
can be placed virtually anywhere on the user's premises. Such a
terminal in the U.S. is subject to FCC regulations regarding oper-
ation and possibly interference considerations. Similar internal
governmental regulations will apply to earth stations located in
other countries. However, in the past clearances and permits have
been obtained in virtually all cases.
The standard earth stations within the INTELSAT system
are required to have a figure of merit of G/T = 41 dB/K. Such a
station would have an antenna with a diameter between 85 and 100
ft. Smaller antennas with a figure of merit less than 41 dB/K are
permitted to operate within the INTELSAT system; however, the
charges for the space segment, i.e., the use of the satellite, incur
a penalty for the smaller G/T figure.
A small terminal to operate in the INTELSAT system might
have a G/T of 31 dB/K. Such a terminal will have an antenna with
a diameter of 32 ft and a parametric amplifier with a noise temper-
ature of 55 K. The following is a description and cost estimate
for this type of terminal, which is assumed to be installed at the
Medical University of South Carolina.
The station equipment and its associated cost are shown
in Table 3. The price of the antenna includes a step track system
10
that automatically tracks the satellite. A licensed operator must
be in attendance to operate the station.
Table 3. Small Terminal Cost Estimate
10-m-diameter antenna (RSI)
$90,000
Receiver (55-K paramp)
25,000
50-W transmitter and driver
12,000
Up/down-conversion, cabling
10,000
FM modulator/demodulator (1 channel)
2,000
Station test equipment
10,000
Baseband interface including echo
suppressors
2,000
Frequency clearance, site preparation,
installation of power, and operating
space in a suitable building to be sup-
plied by the builder
6,000
TOTAL:
$157,000
The station described in Table 3 can operate with a
standard INTELSAT station or with one or more similar stations in
a small terminal network. The space segment rate adjustment factor
for such a small station is 2.5; i.e., INTELSAT's charges are 2.5
times the rate applicable to a standard station.
To develop some tentative cost estimates for a system
with one small earth terminal located, for example, at the Medical
University of South Carolina, the following cost considerations
should be included.
Assume the amortization of the earth station cost of
Table 2 over 5 years at 6-percent interest. This would yield a
11
yearly earth station cost of about $37,000. For a station to han-
dle more than one channel, a multiplex unit (MUX) would be required.
The cost of this unit is estimated as $2,500 per channel per year.
An accurate estimate of the cost of the space segment for
a small station is not possible. However, on the basis of the
INTELSAT space segment charge of $18,000 for a standard station
link times the 2.5 small terminal penalty, the small station space
segment cost per link is $45,000 per year. With these estimates,
the cost of option 1 using one small terminal in the U.S. is
$427,600, as shown in Table 4. This cost does not include the
operation of the small station. In addition, it should be noted
that the above network would have one circuit between the Medical
University of South Carolina and each of four other hospitals, but
would not have circuits linking the hospitals to each other.
B. Option 2
If television is desired, the costs increase considerably.
If it is assumed that the small terminal has a television transmit
and receive capability, the additional earth station costs listed
in Table 5 will be applicable.
12
Table 4. Annual Costs of Option 1, One Small Terminal
Paths from the Medical University Annual Leased
of South Carolina (to and from)
Costs
A hospital in Iran
Iranian satellite link
$34,200
Iranian extension
9,500
U.S. satellite link
47,500
$90,200
A hospital in South Africa
South African satellite link
$34,200
South African extension
1,600
U.S. satellite link
47,500
$82,300
A hospital in Costa Rica
Costa Rican satellite link
$34,200
Costa Rican extension
7,100
U.S. satellite link
47,500
$87,800
A hospital in Egypt
Egyptian satellite link
$34,200
Egyptian extension
3,100
U.S. satellite link
47,500
$83,800
Small earth station in North
Carolina
$37,000
A hospital on Queen Charlotte
Island
U.S. land lines
$27,500
Canadian land lines
19,000
$46,500
TOTAL:
$427,600
13
Table 5. Additional Costs of Small Terminal for
Option 2, Television
High-power transmitter
$60,000
TV picture up-link equipment
52,000
TV picture down-link equipment
52,000
Miscellaneous waveguide parts
and cooling
6,000
Transmitter shelter with air
conditioning
6,000
TOTAL:
$176,000
The television studio must be within a relatively short
distance of the earth station for cable connection; otherwise, a
terrestrial microwave link must be included in the station. Power
requirements for the full TV transmit station are 3 kW. The re-
sulting TV picture quality is about 49-dB S/N, which is quite good,
but not of standard broadcast quality.
The television link would occupy almost the entire trans-
ponder in an INTELSAT satellite so that the space segment charges
would increase accordingly. As mentioned earlier, an INTELSAT IV
transponder has an annual leased cost of $3 million.
The cost estimates for the television channel for the
small terminal are given here primarily to obtain an indication of
their magnitude. The number of stations with television capability
and network arrangements would have to be considered in some de-
tail if this mode of transmission were desired.
14
V. SUMMARY
A proposed baseline network with two options has been
presented for planning purposes. A 5-station satellite network
has been described, with one station (Queen Charlotte Island) con-
nected via terrestrial lines. This network should provide an es-
timate of the basic costs associated with the establishment of a
communications system for providing international health care and
tele-medicine service. Since there are no existing international
tele-medicine networks available for comparison, care should be
exercised in extrapolating from the cost estimates proposed in
this study to actual operational networking costs.
15
October 6, 1975
FORD is LIBRARY 071835
Dear Dr. Toomey:
It was a pleasure to talk with you and I
shall look forward to seeing you when
you are next in this area. We are sorry
the President could not go to Boston for
the meeting.
As we discussed, two proclamations are
enclosed. Thank you for your thoughtful
consideration.
Sincerely,
Theodore C. Marrs
Special Assistant to the President
Edward G. Toomay, M.D.
Concord Medical Center
Old Road to Nine Acre Corner
Concord, Massachusetts 01742
Enclosure
pft
October 6, 1975
Dear Dr. Toomey:
It was a pleasure to talk with you and I
shall look forward to seeing you when
you are next in this area. We are sorry
the President could not go to Boston for
the meeting.
As we discussed, two proclamations are
enclosed. Thank you for your thoughtful
consideration.
Sincerely,
Theodore C. Marrs
Special Assistant to the President
Edward G. Toomay, M.D.
Concord Medical Center
Old Road to Nine Acre Corner
Concord, Massachusetts 01742
Enclosure
pft
October 6, 1975
Dear Dr. Toomey:
It was a pleasure to talk with you and I
shall look forward to seeing you when
you are next in this area. We are sorry
the President could not go to Boston for
the meeting.
As we discussed, two proclamations are
enclosed. Thank you for your thoughtful
consideration.
Sincerely,
Theodore C. Marrs
Special Assistant to the President
Edward G. Toomay, M.D.
Concord Medical Center
old Road to Nine Acre Corner
Concord, Massachusetts 01742
Enclosure
pft
October 6, 1975
Dear Marge:
For your information, I agree with the
nice things.
Sincerely,
Theodore C. Marrs
Special Assistant to the President
Ms. Marjorie Lynch
Deputy Administrator
American Revolution Bicentennial
Administration
2401 E Street, NW.
Washington, D.C. 20276
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WASHINGTON DC
12
AT THE SUGGESTION OF JACK A. MACDONALD WE ARE SENDING YOU THIS
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14
TELEGRAM TO LET YOU KNOW THAT THE MEMBERS OF THE WASHINGTON STATE
15
HEALTH FACILITIES ASSOCIATION REPRESENTING 22,000 LONG TERM CARE
16
17
BEDS IN THIS STATE ENDORSE AND SUPPORT THE NOMINATION OF MARJORIE
18
LYNCH FOR THE POSITION OF UNDERSECRETARY OF HEALTH EDUCATION AND
19
20
WELFARE. HER ADMINISTRATIVE ABILITY COMBINED WITH CONCERN FOR PEOPLE
FORM 0805 PRINTED BY THE STANDARD REGISTER COMPANY, U.S.A.
21
MAKE HER AN EXCELLENT CHOICE
22
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24
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OCT 8 1975
LIBRARY BERALD R. FORD
Ms. Barbara Adams
Member, Eastern Pennsylvania
Comprehensive Health Planning Board
Technical Assistance Office
Schuylkill County Court House
Pottsville, Pennsylvania 17901
Dear Ms. Adams:
Thank you for your letter of September 16 addressed to Dr. Theodore
C. Marrs, Special Assistant to the President, in which you express
your view regarding the placement of Schuylkill County with the
northeastern counties making up Pennsylvania Health Service Area
3, designated by the Department as requested by Governor Shapp.
The designated area was found to meet the requirements of the
National Health Planning and Resources Development Act of 1974
(P.L. 93-641) as proposed. Governor Shapp's plan did alter the
service areas of existing 314(b) Comprehensive Health Planning
Agencies in this and other instances. However, the Department
found that a public process of hearings were conducted by the
Governor's designated officials in the development of the Pennsylvania
health service area plan and discussions around this issue were
considered.
All health service areas designated have been officially announced
through the publication of the September 2 Federal Register notice.
Please be assured that the Department will, as required by the Act,
examine the experience of the future designated Health Systems
Agency in serving their designated area. Should an area prove not
to present a viable and reasonable service area, the Covernor or
Health Systems Agency, with the Department, may consider the re-
designation of the area boundaries.
I trust that your valued volunteer services will be available in
the structuring of an agency that would most successfully serve
Page 2 - Ms. Barbare Adams
Area 3 in providing sound health planning and resource development
for its residents.
Your continued interest will be most appreciated.
IS Sincerely, Kennuh Baum
for
Bugene J. Rubel
Acting Director
ee: HRA Official
ES/PHS
ES/HRA
Reading Board
Ms. Morrill
Mr. Theodore c. Marrs
BHPRD:MLMORRILL:ear:10/7/75
DEPARTMENT OF
HEALTH, EDUCATION, AND WELFARE
OFFICE OF THE SECRETARY
EXECUTIVE SECRETARIAT
TO: ASH
SUBJECT: WHITE HOUSE REFERRALS
ASSIGNED FOR DIRECT REPLY
BE SURE TO SEND THE WHITE HOUSE A
COPY OF YOUR RESPONSE WITH THE
ORIGINAL INCOMING DOCUMENT.
THE WHITE HOUSE HAS MADE US AWARE
THAT THEY ARE NOT RECEIVING COPIES
OF THIS DEPARTMENT'S DIRECT-REPLY
RESPONSES TO THEIR REFERRALS.
THE WHITE HOUSE
WASHINGTON
September 22, 1975
MEMORANDUM FOR
SECRETARY, HEALTH, EDUCATION, AND WELFARE
Please respond directly with copy for our files.
Thank you.
Therslow I, March
Theodore C. Marrs
Special Assistant to the President
Enclosure
7509240112
TRACEBON
TRAC
E
SEAL OF SCHUYLKILL
SCHUYLKILL COUNTY
AREA CODE 717'
622-5570
TECHNICAL ASSISTANCE OFFICE
EXT. 301
SCHUYLKILL COUNTY COURT HOUSE
OR 622-6695
POTTSVILLE, PA. 17901
*
THE
*
PENNSYLVANIA
JAMES R. KEENAN
DIRECTOR
September 16, 1975
Dr. Theodore C. Marrs
Special Assistant to the President
Executive Office Building
Washington, D.C.
Dear Dr. Marrs:
Thank you for having sent the pictures of President Ford to members of
the Railroad Task Force for Northeast Region, Inc. John Cosgrove
delivered them to us last week while we were in Washington to testify
on the United States Railway Association Final System Plan. Will you
also accept my personal, and belated, appreciation for a most informative
and delightful meeting July 22nd with the Task Force Officers.
Like you, sir, I have responsibilities whose relationships are not always
clear. Aside from my railroad work, I sit as a member of the Eastern
Pennsylvania Comprehensive Health Planning Board with a committee assign-
ment on the Project Review Committee. Schuylkill County has spent the
past 2½ years in the Eastern Pennsylvania Comprehensive Health Planning
Board area, has habits of health consumption concurrent with this area,
and thus desires to continue health planning with an agency whose proce-
dures are developed and operational. Unfortunately, and for no apparent
reason, Schuylkill County has been transferred to the Northeastern
Pennsylvania region where, among other drawbacks, there is no consensus
about the appropriate agency to form the Health Systems Agency.
I am approaching you on this matter because of the frustration deriving
from the "shuttlecock" method of regional designation responsibility. As
the attached correspondence indicates, the Federal government claims this
decision must be appealed through the Governor's Office; the state main-
tains the matter is now one for the Secretary of HEW. While adroit,
neither answer is addressing the health planning considerations involved.
Dr: Theodore C. Marrs
Page Two
September 16, 1975
Any assistance you might provide in assisting Schuylkill County in its
attempt to remain with the Eastern Pennsylvania Comprehensive Health
Planning Board will be deeply appreciated. Thank you very much for
your attention.
Sincerely,
Berbara Cdams
Barbara Adams
Member
EASTERN PENNSYLVANIA
COMPREHENSIVE HEALTH PLANNING BOARD
BA:mas
Enclosures
cc: Mr. Peter Whittier
Senator Hugh Scott
Senator Richard Schweiker
Congressman Gus Yatron
Chris Owens
Leonard Bachman
November 28, 1975
FORD & QERALD LIBRARY
MEMORANDUM FOR
THE SECRETARY OF STATE
SUBJECT:
International Blood Denors Exchanges
It is my understanding that you have been contacted by Senator John G.
Tower on this matter. I would approciate a copy of your reply to
him and any additional comments which will enable us to be most
responsive to Senator Tower's interest.
Thank you.
Theodore c. Marro
Special Assistant to the President
Attachment
TCM/vhs
BCC: John Vickerman
the
Bennett Cloup/
Health Services
407 N Street, S.W.
Washington, DC. 20024
202/484-3344
FORD & LIBRARY 01RALD
March 25, 1976
Honorable Theodore C. Marrs
Special Assistant to the President
Old Executive Office Building - Room 103
The White House
Washington, D. C. 20500
Dear Ted:
This may seem like a lot of background about the final
Medicaid Home Health Regulations presently awaiting the
Secretary's signature, but I will try to highlight those
areas germaine to the proprietary issue. We could fill
volumes about the need for home health agencies, the cost
effectiveness, and the numbers of needy recipients not
being served. For right now, though, I'll just give you
the most recent history and the rather inconclusive ar-
guments that certain members of Congress are foisting on
the Secretary.
1. SRS/MSA developed several drafts of the regula-
tions over the past two years. There has been only one
Medicaid regulation (Section 249.10) on home health (copy
attached) since passage of the law. Since 1965, there
has been only a Policy Information Memo issued to the
states (copy attached), which cannot even be called a
guideline, since it is marked "For Internal Use Only"
and, therefore, carries no weight.
2. On June 9, 1975, SSA issued proposed regs, under
mandate from the Federal Courts, (finalized December 4,
1975) to allow non-profit agencies to subcontract for
services with proprietary agencies. Otherwise, proprie-
taries can participate in Medicare only in those fifteen
states that license home health agencies. Why all states
don't license is beyond me.
Dr. Marrs
Page 2
March 25, 1976
3. On July 2, 1975, Secretary Weinberger sent
his 1975 Medicare proposals to Congress in letter form
(copy attached). These included a statutory change to
include proprietaries, but were never put into bill form.
4. On August 8, 1975, Secretary Weinberger signed
the proposed Medicaid regs and they were published in the
Federal Register on August 21.
5. Some time after the publication, two eager Con-
gressional Committee staff members decided, on their own,
that the new regs were a "change in HEW policy", which is
a Congressional prerogative.
6. On October 28, a joint hearing was held by the
Senate Special Committee on Aging, Subcommittee on Long
Term Care and the House Select Committee on Aging, Sub-
committee on Health of the Elderly and Long Term Care.
The issues were aired. (MSA Commissioner Dr. M. Keith
Weikel's remarks are enclosed.)
7. On November 17, Commissioner Weikel called a
meeting of all interested parties (Congress, non-profit
home health association, state Medicaid directors, and
proprietary home health agencies) to further discuss the
proposed regs. MSA revised the proposed regs as a result
of a number of suggestions put forth at the meeting.
8. On December 12, Senator Moss and Congressman
Pepper sent a letter to the Secretary opposing the regs
(copy attached).
The facts are clear to us, Ted, that the Secretary has
all of the authority needed to issue these regs (see Intent
of Congress in original Social Security Amendments). It
was not, and never has been, Federal policy to keep out pro-
prietaries.
In addition, the Moss/Pepper letter stated that the "regs
would have a deleterious effect on the quality" if pro-
prietaries were to be included as providers. In fact,
testimony by the National Association of Home Health Agencies
on February 24 before the Pepper Committee stated that there
Dr. Marrs
Page 3
March 25, 1976
was no difference in the quality of care provided whether
for-profit or not-for-profit.
Statements of this type seem emotional, and not based on
fact. The facts are that home health has not been a viable
mode of health delivery, yet it offers one of the most viable
means of keeping the patient in the appropriate setting while
saving untold dollars of government money. There are 30,000
home health personnel in the currently certified 2,209 home
health agencies. One of the proprietaries has 52,000; another
proprietary has over 30,000. This manpower resource would be
injected into the Medicaid program with no injection of federal
funds for training and startup.
SRS and the Assistant Secretary for Health, Dr. Cooper, are
100% behind the regs. We feel the Secretary needs some re-
assurance, and your ideas on this subject could be most
helpful. We have additional figures on the unmet need, studies
concluding that proprietaries are necessary, favorable comments
on the proposed regs and client kudos, if you need them.
Best regards,
Backeley Berkeley V. Bennett
President
BVB:sg
Attachments: (1) Alabama & Washington Participation
(2) Medicare Regulations
(3) Policy Memo
(4) Secretary Weinberger's Medicare Proposal
(5) Proposed Regulations
(6) Dr. Weikel's Comments
(7) Moss/Pepper Letter
(8) Intent of Statute
(9) Chart of Medicaid Expenditures
HEALTH.
OF
DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
AMERICA
SOCIAL SECURITY ADMINISTRATION
U.S.A.
BALTIMORE, MARYLAND 21235
May 5 1976
OFFICE OF THE COMMISSIONER
REFER TO:
INI-411
Honorable Bob Dole
United States Senate
LIBRARY GERALD R. FORD
Washington, D.C. 20510
Dear Senator Dole:
In your letter of January 12, 1976, you raised the point of whether
administrative action might better serve to make recomended changes
in the Medicare program than legislative action. The delay in our
response was occasioned by our desire to determine the most current
status of several projects va are undertaking which impact on areas
under consideration for legislative action. We understand that of the
four recommendations cited in your letter, only the fourth item cencerning
data precessing is still contained in the proposed legislation. However,
we have reviewed all four proposals and thought you might be interested
in our thoughts with respect to each of the concepts outlined in the
enclosure to your letter.
1. Single agent for carrier and intermediary responsibilities. The
separation of the administrative structure for Part A and Part B was
dictated by the characteristics of the original statutory provisions and,
to some extent, was an accident of legislative history. Under section 1816
of the act, providers of services for Part A (hospitals, skilled nursing
facilities, and home health agencies) are permitted to nominate the inter-
mediary they wish to deal with subject to the Secretary's approval whereas
the Part B carriers are selected by the Secretary. Some long term economies
would be effected by providing for a single Part A/Part B contractor agent
but the transition to such an arrangement could cause serious operational
problems.
Legislation would be required to effect a shift to the single agent concept
because of the authority in present law given to the Part A providers to
nominate their own intermediaries. We are not prepared at this time to
recomend legislation to change the nomination procedure, but we are con-
sidering various approaches to how the Secretary, through legislation, could
be authorized to select intermediaries.
2. Realignment of Part A and Part B geographic areas. As a general
premise, we would agree to the need for some consolidation of contractor
territory and reduction from the 125 contractors that we have new. To
carry out such a consolidation, we think it would be necessary to give the
Secretary authority to select intermediaries which, as indicated above, would
require legislation.
2
With respect to the possible advantages of utilizing regional data
processing centers, we have moved forward in exploring this alternative.
A request for proposal (RFF) was issued in late fall and a review of the
bids submitted by consultant fines is in process. We are hopeful that
the results of this study can be used as a determining factor in our
decisions on the merits of this approach.
3. Establishment of an objective and competitive precess for the
selection of carriers and intermediaries. There is a need, which we are
addressing, to formulate standards of performence which would spell out
minimum acceptable levels of performance. When complete, such comparative
standards could form part of the base for an objective selection process
for carriers and intermediaries.
We have been utilizing a number of measures, indicators, and reports which
get at the quality and efficiency of a contractor's operation. The
measurements have been primarily historical data and are detailed with
respect to administrative cost experience, claims processing activity,
audit activity, etc. We are achieving significant progress in developing
these measures into "pass or fail" standards for minimum levels of per-
formance. For the most critical factors in Part B of the program, we hope
to have measurements in place within the next year or so. Part A would be
implemented shortly thereafter. As a result of recommendations by the HEW
Advisory Committee, we will shortly be contracting with a consultant firm
for assistance in order to accelerate the work on performance standards.
It would be necessary to revise the existing Medicare statute to permit
us to select contractors on a competitive fixed price contract basis
because existing law specifies reimbursement of contractors' administra-
tive expenses on a reasonable cost basis. We do have authority under
present law to experiment with the letting of 6 fixed price contract on
a competitive basis and will plan to do so if an existing carrier either
leaves the program or has his territory reduced.
4. Determination of proper site for data processing activities. There
has been much concern expressed with respect to the electronic data
processing (EDP) activities of Medicare contractors, primarily in Part B
of Medicare. In early years, significant problems were encountered by
a number of carriers in handling their EDP workloads, and some carriers
subcontracted the KDP services in order to operate more effectively.
Although only a single company offered data processing services originally,
there are several companies in the Medicare field presently. As the
original subcontracts expire, we are requiring the carriers to follow
competitive processes in order to enter into new subcontracts. We are
also sharpening our procurement procedures with the aim of creating an
environment for more competition in the private sector.
FORD & GERALD LIBRARY
3
There is a trend by many of our carriers to shift back from subcontracted
EDP to in-house operations. Our basic position has been that a contractor
has the right to change from a subcontract arrangement to an in-house
operation, if the move "in-house" is more sconemical than the prior sub-
contract arrangement. The Bureau of Health Insurance reviews these decisions
to move in-house to assure that the cost analysis is sound and I think they
should continue to do so.
In conclusion, I hope we have been responsive to your concerns and if
there is any additional information that you would like, let us know.
Sincerely yours,
James B. Cardwell
Commissioner of Social Security
cc:
Mr. Theodore Marrs
Mr. George Kelley
Regional Representative, HI, Kansas City
GERALD LIBRARY R. FORD