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Foley, Thomas
PHOTOCOPY
PRESERVATION
To Speaker Foley
with gratitude for your balaship and counsel-
Hillary Rodhan Clinton 1993
THE WHITE HOUSE
April 9, 1993
Mrs. Thomas S. Foley
The Speakers Rooms
U.S. House of Representatives
Washington, D.C. 20515
Dear Heather:
Thank you for your note and for your
thorough report on the interest groups
involved in health care. It has proven very
useful to the task force in determining the
possible issues we may confront in
implementing our policies.
Best regards.
Sincerely,
Hillary
(no)
EB/MV
The Speaker
United States House of Representatives Melamic
Mashington, D. 4. 20515
May 18, 1993
Dear Hillary:
Enclosed please find information on the Malden Hospital
Family Practice Residency Program which is being established
by the Malden Hospital and the Boston University's School of
Medicine.
It is my understanding that this program is a one of a
kind for the greater Boston area and its main purpose is to
attract, train and retain within the community doctors who will
become family physicians. The goals of this program are very
impressive and appear to be similar to some of the proposals
you may be considering.
The Malden Hospital and the Boston University's School of
Medicine would like to extend to you an invitation to attend
their September dedication of this Program. I will be in touch
with you soon with more detailed information on this event.
With best regards.
R
Sincerely,
Thomas S. Foley
Speaker
Mrs. William Clinton
The White House
Washington, D.C. 20500
TSF: hfm
THE MALDEN HOSPITAL
FAMILY PRACTICE RESIDENCY PROGRAM
The Program
A serious shortage of family practitioners/primary care physicians in the New England
area is increasingly considered a primary factor in the region's rapidly escalating health
care costs and growing inaccessibility of health care for many residents.
In response, The Malden Hospital, in partnership with Boston University's School of
Medicine, will establish the only Family Practice Residency Program in the greater Boston
area this summer. This program hopes to attract, train, and retain within the community,
doctors who will become family physicians. It will be one of only two such programs in
the entire state.
Based at The Malden Hospital, the residency's program goals are:
To attract family physicians to a region where they are urgently needed.
To improve access to health care for working families and the elderly.
To address the critical shortage of adequate prenatal care.
To assist graduates of the program in establishing family medicine practices in the
Malden area and eastern Massachusetts.
When fully operational, The Malden Hospital Family Practice Residency Program will have
12 residents in rotation. The first class of residents will arrive in July of 1993; four new
family physicians eligible for board certification will graduate each year beginning in 1996.
To be eligible for board certification as a Family Medicine Physician, residents must
undergo three years of intensive training in several sub-specialty areas including
pediatrics, obstetrics and gynecology, internal medicine, surgery, geriatrics, psychiatry,
dermatology, human behavior, community medicine and emergency medicine. Their
training will take place at The Malden Hospital, a community teaching hospital, and at
Boston University Hospital.
Unlike traditional medical residency programs, the Family Practice Residency requires
residents to treat patients (under the supervision of family physicians and other
specialists) in a typical outpatient setting and provide community outreach services. The
Malden Hospital will establish a Family Health Center on the hospital campus in order to
fulfill this requirement and provide community ambulatory care services.
Community outreach services provided by the residents will include home visits and care
for nursing home patients, health education presentations to community groups,
resources on a range of health issues including smoking cessation, CPR training, teen
pregnancy, substance abuse, and coordination and performance of on-site health
screenings at organizations such as Head Start and senior centers.
Boston University's School of Medicine is working closely with The Malden Hospital to
develop this new program. The University provides planning support and teaching faculty
to the residency and guidance in the design of the curriculum.
The Need
Health care reform has been determined by President Clinton to be the single most
important national issue to be addressed immediately. Driven by the need to curb health
costs and improve access to basic medical care, health policy experts and the medical
community itself are seeking ways to reorient health care away from specialization toward
a less expensive style of medical practice.
Studies show that even among patients with comparable symptoms, specialists practice
a more expensive brand of medicine than family physicians. One in four patients who
visit specialists have no chronic disease, and many of the rest have mild disease. Yet
specialists use far more resources -- hospitalizing patients more frequently, prescribing
24 percent more medications and ordering 20 percent more diagnostic tests -- than family
practitioners.
Family practitioners' multi-disciplinary training underscores their value as highly cost
effective health care providers. Their broad-based training, in comprehensive and
preventive care for all ages, enables family physicians to care for 85 percent of a patient's
medical needs. They are also trained to know when to refer a patient to a specialist and
to oversee and coordinate specialist care.
Recently, both the American Medical Association and a special Massachusetts Legislative
Commission on Physician Supply recognized that "family medicine specialists" --
practitioners of a medical discipline defined by its emphasis on community health
preservation -- was one way to reduce costs and increase access.
However, medical schools have been producing more specialists and fewer generalists
during the last decade. In Massachusetts particularly, there are not enough established
family physicians, or medical students choosing to pursue that specialty, to meet
demand.
Since 1976, the number of family physicians has decreased more than 42 percent in
Massachusetts. In Malden during the 1950s and 1960s, there were about 40 family or
general physicians who served the general health needs of both young and old in the
family and made house calls. By 1990, there were none in the city.
A nationally recognized standard established by the U.S. Department of Health and
Human Services, recommends a ratio of 40 family physicians to a population of 100,000.
Applying this formula to the greater Malden area, which includes six communities with a
population of 240,000, there should be 96 family practice/primary care physicians to
provide for community health care needs. Currently there are but 30 such physicians.
Due to the inadequate supply of family physicians in the area, hundreds of people seek
costly care at hospital emergency rooms to treat problems such as sore throats, viruses,
muscle sprains and ear infections all which would be better, and less expensively,
addressed by a family physician.
The Malden Hospital Family Practice Residency Program hopes to attract and train new
family physicians who will choose upon graduation to establish private practices in the
Malden area. In addition, faculty at the program are also expected to establish their own
practices within the community. Expectations are that this increase in the number of local
family physicians, and the program's Family Health Center, will dramatically improve
access to cost effective health care within Malden and the six surrounding communities.
The Benefits of Family Medicine
Family physicians are the "new breed" of the old-time general practitioners. They inherit
the kindliness of yesterday's general practitioner and combine it with the expertise and
knowledge of today's medicine, including modern technology, continuing medical
education and up-to-date training.
By their nature and training, family physicians represent a grassroots approach to
community health care. Early preventive intervention delivered through the teaching and
treatment of generations of family members helps decrease the need later in life for high-
cost health care services.
Family physicians are trained to treat 85 to 90 percent of a patient's medical needs. Their
practice is based on a philosophy which combines the principles of preventive health care
and trusting patient-doctor communication through the course of the patient's life and
extending to every member of the family unit.
The American Academy of Family Physicians was the first medical group to require a
minimum of 150 hours of approved continuing education every three years to retain
membership. Such requirement has become a standard for an increasing number of
other medical groups through the years.
Administration
Dr. Jean Arnold, director of The Malden Hospital Family Practice Residency Program and
Dr. Peter Jeffries, associate director, are husband and wife who have practiced together
and have extensive experience in family medicine.
Dr. Arnold most recently served as director of the Southern Wisconsin Family Practice
Residency in Janesville, WI. Previously, she was the associate director of the St.
Elizabeth Hospital Family Practice Residency Program in Utica, NY and associate chairman
of the Department of Community and Family Medicine at Dartmouth Medical School in
Hanover, NH. She is a graduate of Boston University School of Medicine.
Dr. Jeffries most recently served as associate director of Southern Wisconsin Family
Practice Center in Janesville, WI. Previously, he was director of the Family Practice
Center at St. Elizabeth Hospital in Utica, NY and associate director for the Family Medical
Institute of the Maine-Dartmouth Family Practice Residency Program in Augusta, Maine.
He is a graduate of Boston University School of Medicine.
?
Both doctors have a special interest in the medical community's approach to domestic
violence. Together they authored a chapter on spouse abuse in "Family Medicine
Principles and Practices," a leading medical textbook.
/
Dr. Arnold is a well-known speaker on the subject of domestic violence and has given
more than 100 lectures to groups of physicians. She is an advisor to medical students,
particularly women, and is available on a hot line to talk to female medical students
experiencing sexual harassment.
February 23, 1993
Dear Mr. Speaker:
I want to thank you for arranging and
hosting my visit with the Members of the
Health Care Reform Work Group. The
comments you made on my behalf were most
generous.
The Administration values your
counsel on how best to move a complex
health reform package through Congress. I
have shared your thoughts about
legislative, budgeting, and timing
strategies with the President.
This expertise that you and your
impressive staff will bring to the
legislative development process will be
invaluable. I look forward to working
with you in this effort and to building on
the strong and impressive foundation that
you have laid over the years.
Sincerely,
Honorable Thomas S. Foley
Speaker of the U. S. House
of Representatives
Washington, D. C. 20515
THE WHITE HOUSE
February 18, 1993
Dear Heather:
I know you made an extra effort to
accommodate our guests last evening, and I am
grateful. Also, I appreciate your
willingness to join us in the Executive
Gallery. I think it speaks loudly about the
cooperation between the White House and the
House of Representatives, as well as
affirming a friendship that is important to
me personally.
With appreciation and best regards,
Sincerely,
Hilary
Mrs. Thomas S. Foley
U.S. Capitol
Washington, D.C. 20515
I
The Speaker's Rooms
United States House of Representatives
Washington, D. 4. 20515
March 1, 1993
Dear Hillary:
As promised attached is an extensive discussion of the
various interest groups involved in health care.
If you need any more information, please give me a call.
With warm regards.
Sincerely,
deather
Mrs. Thomas S. Foley
Mrs. William Clinton
The White House
Washington, D.C.
20500
HSF: mc
To Heather Foley from -
Hillary
Tom Foley
best wishes, and thanks for your leadership-
Hillary Rodban
THE WHITE HOUSE
September 1, 1993
Honorable Thomas S. Foley
Speaker
United States House of Representatives
Washington, D.C. 20515
Dear Speaker Foley:
Thank you for forwarding me Ms. Ruthie
Dearing's resume for consideration. She certainly
has impressive credentials as a consultant in health
care. As you know, the Health Care Task Force and
the health care reform working groups terminated at
the end of May. The Task Force benefitted from the
expertise of hundreds of individuals -- including
many doctors, nurses, hospital administrators and
other health care providers -- who served on our
working groups.
After considering the recommendations of the
Task Force, the President will submit a proposal to
Congress. However, this is just the first step
toward implementation of a new health care system in
which every American has the security of quality,
affordable health care. We will need the sound
advice of people like Ms. Dearing at many points
during this process. If we are able to meet with
Ms. Dearing, we will contact her directly.
Again, thank you for contacting me.
Sincerely,
Hillary Hilary Rodham Clinton
flinley
The Speaker
United States Couse of Representatives
Mashington, D. 4. 20515
June 10, 1993
Hillary
Dear Mrs Clinton:
I have been asked to forward to you the enclosed
resume of Ruthie H. Dearing who is from my district in
Spokane, Washington. Ms. Dearing is the President of
Dearing & Associates, a women-owned healthcare consult-
ing firm specializing in women's and children's
healthcare programs.
While I realize that your task force has likely
completed much of its review of the health care indus-
try by now, I imagine a great deal still remains to be
done even after you announce your panel's recommenda-
tions.
To this end, Ms. Dearing would be honored to
provide information and support in furtherance of your
efforts to address national healthcare problems and
reform. Her firm works with many different hospitals,
including administrators, physicians, nurses, archi-
tects and support staff. According to Ms. Dearing, her
firm has designed practical solutions for the provision
of care in hospitals of all sizes and has a very suc-
cessful track record.
Thank you for your consideration of Ruthie H.
Dearing. For your convenience, I am also enclosing
copies of her past correspondence to you.
With warmest regards, I am,
Sincerely,
Thomas S. Foley
Speaker
Mrs. Hillary Rodham Clinton
The White House
Washington, D.C. 20500
folegine
RUTHIE H. DEARING
Gonzaga University School of Law
1984
J.D. Degree
Arizona State University
1978
Masters of Health Services Administration
Marketing consultant and program designer for women's and children's healthcare
services In hospitals or free-standing facilities throughout the country: frequent lecturer
on women's and children's healthcare programming and Internal/external marketing
programs and their execution.
Chief Executive Officer of a multi-faceted business organization providing corporate
management services and marketing services to both healthcare and non-healthcare
businesses.
Co-developed innovative cost-effective system for providing single-room maternity
care: provided consulting services for The Cybele Society, Spokane, Washington on
the implementation of this concept.
Extensive experience in healthcare administration and management working primarily
with corporate officers, healthcare administrators, physicians and nurse managers.
PUBLICATIONS: Dearing R: "How to Clinch Patient Loyalty in Your Waiting Room,"
Medical Economics, February 29, 1989.
Dearing R: "Women's Healthcare Moves Beyond the Trappings."
Healthcare Executive. March/April 1988.
Dearing R, Gordon H. Sohner D, Weidel L: Marketing Women's
Healthcare, Aspen Publishers Inc., 1987.
Dearing R, Weidel L: "Marketing to Attract Women," Health
Progress. Jan/Feb. 1987.
Dearing R: "On Being Memorable - Personally and Professionally."
Aspen's Advisor for Nurse Executives. Vol. 2. No. 1, October 1986.
Dearing R: "Managerial Clout." Aspen's Advisor for Nurse
Executives, Vol. I. No. 11, August 1986.
06/03/93
09:44
004
DEARING
& ASSOCIATES
5/18
May 20, 1993
Hillary Clinton
First Lady
The White House
1600 Pennsylvania Ave.
Washington, D.C. 20500
Dear Hillary:
I am writing again to express my strong interest in becoming Involved in the work
being done on healthcare reform. I realize many people are interested in
becoming involved with the healthcare initiative you are leading. However,
because of my work, as a national healthcare consultant for the pas ten years, I
believe I have special expertise and knowledge about the many Issues hospitals
are addressing regarding women's and children's healthcare. Much of the work
we do with hospitals involves implementation of innovative and cost-conscious
programs that replace outdated and costly traditional services.
I am very Interested in serving on a national committee to help reduce healthcare
costs, without compromising care or services. As I stated in previous
correspondence, 1 believe can make a major contribution to your considerable
challenge. We have designed practical solutions for the provision of care in
hospitals of all sizes and have a very successful track record.
I am frequently in the Washington D.C. area and would welcome an opportunity
to talk with you or one of your staff. For information, a resume and our brochure
are enclosed. Thank you for your time.
Cordially,
Ruthie RETAILL H. Dearing, Does
President
RHD:ljc
Enclosure
(500) 747 0713
800 553 33++
FAX 1500) 7472050
SOUTH 1414 BLRNARD SPOKANE WASHINGTON 00303
JUN 3 '93 12:34
PAGE. 004
DEARING
& ASSOCIATES
February 2, 1993
3/18
Hilliary Clinton, First Lady
The White House
1600 Pennsylvania Avenue N.W.
Washington, DC 20500
Dear Hilliary:
This letter is written with great enthusiasm for both you and President Clinton. The
purpose of my writing is to bring to your attention the work of our firm, and to offer
information and support to your efforts addressing our national healthcare problems.
Dearing & Associates is a women-owned healthcare consulting firm specializing In
women's and children's healthcare programs. Although we are cognizant of government
and Washington, DC activities, we operate in the wider arena of "real-life" problems
faced by healthcare providers nationwide. Since we often work in as many as three
different hospitals each week, we are acutely aware of not only the problems in
delivering quality and cost-conscious healthcare, but also many remedies which are not
utilized. in fact, healthcare providers often seem to overlook pragmatic and less costly
solutions, in favor of traditional, We've always done it this way" thinking.
Through our consulting efforts. we work with administrators, physicians, nurses,
architects, and support staff to develop innovative healthcare programs for women and
children. Our efforts are focused on the development and implementation of
programming that is not only supportive to families, but also cost-effective. With 75
years of combined experience in the healthcare industry and 10 years of specialized
consulting work, Dearing & Associates is recognized by the AHA and others as the
leading consultant firm specializing in women's and children's healthcare programs.
We have an active database compiled over the past seven years, reflecting information
gathered from nearly 40,000 women. This database provides information on general
trends about women and their healthcare choices in communities across the country.
Our research data base identifies differences among communities and also details
demographic trends and socioeconomic factors.