COUNCIL of TEACHING HOSPITALS ASSOCIATION of AMERICAN MEDICAL COLLEGES 1346 Connecticut Avenue, N.W

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COUNCIL OF TEACHING HOSPITALS ASSOCIATION OF AMERICAN MEDICAL COLLEGES 1346 Connecticut Avenue, N.W. Washington, D.C. 20036 202/223-5364

AGENDA

COTH COMMITTEE ON CONSTRUCTION AND MODERNIZATION FUNDS FOR TEACHING HOSPITALS Monday, February 19, 1968 The Potomac Room The Mayflower Hotel 1127 Connecticut Avenue, N.W. Washington, D. C. 10:00 a.m. - 4:00 p.m.

I. Call to Order and Call of Roll: 10:00 a.m.

/II. Welcome to John W. Kauffman, Chairman, ABA Council on Government Relations

/III. Welcome to Thomas J. Campbell, Assistant Director, AAMC Division of Operational Studies

IV. Approval of Minutes - Meeting of December 12, 1967 - TAB 1

V. Report on Action Items From Last Committee Meeting and Other Out- standing Action Items From Previous Meetings - TAB 2

VI. Recent Statement of Definitions By American Hospital Association - TAB 3

VII. Report: Meeting of Society of University Health Administrators (January 20-22, 1968) - Lewis H. Rohrbaugh, Ph.D. - TAB 4

VIII. Report by Committee Members and Discussion - Individual contact with members of the President's Advisory Commission on Health Facilities - TAB 5

( IX. Discussion of Proposed "White Paper" on Need for Modernization and Construction Funds for Teaching Hospitals

. Review: Proposed Study of Need of Funds for Expansion of Teaching Hospitals

XI. Other Business

XII. Date of Next Meeting

Adjournment: 4:00 p.m.

At 12:30, the Committee will be joined for lunch by William L. Kissick, M.D., Executive Director, President's Advisory Commission on Health Facilities in the Concord Room. 2

MEMBERSHIP OF COMMITTEES

Committee on Modernization COTH Representatives and Constructions Funds on AAMC Committee on for Teaching Hospitals Federal Health Programs

Richard T. Viguers, Chairman Charles H. Frenzel Lewis H. Rohrbaugh, Ph.D., Vice Chairman Harold H. Hixson Robert C. Hardy J. Theodore Howell, M.D. John H. Knowles, M.D. David Littauer, M.D. John H. Westerman Richard D. Vanderwarker

AHA Representatives

John W. Kauffman

Staff

Matthew F. McNulty, Jr. Fletcher H. Bingham, Ph.D. Grace W. Beirne William G. Reidy Thomas J. Campbell Document from the collections of the AAMC Not to be reproduced without permission ACTION II. #1 Present: Staff: I. Absent: Robert Richard Harold Lewis David John Fletcher Elizabeth Matthew Charles Thomas James Programs Grace Committee PRESENTED. Richard J. John DR. The Approval Call At. Burton sequent of Theodore events meeting Mr. ROHRBAUGH H. H. to H. Littauer, W. H. H. C. G. Amendment T. H. F. Westerman D. Knowles, Order: to Viguers' Rohrbaugh, Beirne, H. Cavanaugh, of Hixson, Hardy Moore, A. was relative Frenzel, Viguers, McNulty, Vanderwarker the THE Bingham, Howell, was Minutes Burgoyne, joined MOVED MOTION October M.D. called COMMITTEE Staff Jr., M.D. suggestion, Legislation COTH --Meeting to Ph.D., Chairman COTH Jr., Ph.D., M.D., THAT Ph.D., at Director, WAS the Member Secretary Assistant, to 10 COUNCIL 12:30 FUNDS Member Director, THE Washington SECONDED COTH order subject meeting. ON Vice Director 10:00 Assistant December Mr. MINUTES of but CONSTRUCTION on p.m. FOR -Chairman Member MINUTES OF on Office October at AAMC to McNulty that a.m. COTH of TEACHING TEACHING AAMC for COTH 10:00 BY He the of Hilton OF modernization 12, Director, Committee on MR. noted no to lunch Comprehensive of Director, Committee 10, THE AAMC a.m. used hearings 1967 4:00 Legislation HIXSON AND HOSPITALS Hotel HOSPITALS 1967: OCTOBER the by: by Committee the p.m. MODERNIZATION on COTH committee AND Chairman on COTH minutes had Federal and 10 Planning, Federal PASSED USPHS been MEETING construction on Viguers had as Health Federal scheduled UNANIMOUSLY. Health a endorsed HEW BE base Programs APPROVED and Health Programs funds for as Hill review yet. sub- - AS Document from the collections of the AAMC Not to be reproduced without permission Mr. reported on for would Advisory nothing than ties National in disagreement might slated With meeting, COTH Action Action Action the fall McNulty the productivity. of these staff curtail be Cost for 1 2 3 innovative first pursuit of that: Commission Advisory dependent -- -- as -- 1968. completion in developments also of follows: The stage A recommendation On Facilities has comments state to direct within the time follow-up implementing Health the what 1) of results indicated He cost Commission and any beyond At on He modernization on advice its on the said the have the December Care said the by will position for Health energies Department in on of Commission that next request the report been of Facilities a modernization the mind, the the the be to not definite on Boisfeuillet Facilities, concept it October. the completed. 11, chief modernization actions received original been until Health -- funds. is of Mr. of National with of and decides highly the prepared. Secretary emphasis McNulty it that governmental was HEW Facilities, enacted then the He Commission's survey expressing was and held chaired on Jones limiting further likely Advisory to emphasis known to construction, what summarized questionnaire by Mr. do. Gardener which at have tailor to COTH, by that will the Jones where trend should reported

Mr. appreciation. the been Commission Boisfeuillet seemed on recommendations, October any in happen action McNulty, a number organization the the cautioned toward distributed be National early COTH 2) is to that actions Commission on The to on 10 in of present on recommendation economy. the stages a there Hill Hill the committee hospitals Jones, National statement Health COTH Conference priori- of rather -Burton -Burton and design which is of the not would met He many the great to is of -3-

• Action 4 -- COTH has voiced its support of S. 2251 and it will extend to the second session of the current congress.

Action 5 -- In relation to the package "Health Manpower Legislation", Mr.

McNulty directed the Committee's attention to the report of the

National Advisory Commission on Health Manpower, which covers

more than just manpower, including support for facility moderni-

zation. Specifically, it was noted that the Report recommended: permission (1) Federal assistance in the form of grants or loans (or loan without guarantees ) be provided to obsolete hospitals in those areas

where modernization needs are so extensive that nongovernment reproduced sources of capital funds will be closely insufficient. be to

Not (2) Before any decision is made to finance modernization, on a • large scale, state and Federal Governments should carry out a AAMC careful study to determine criteria for de"Ciding

the between moderni- of zation and replacement.

collections III. Executive Committee Action of Monday, October 30, 1967, that the Subcommittee the be made a Full Committee: from Dr. Bingham reported that at the October 30 meeting of the COTH Executive

Committee, subsequent to the combination of the COTH Government Relations Document Committee and the AAMC Committee on Federal Health Programs, the Subcommittee

on Construction and Modernization Funds for Teaching Hospitals was made into a

full committee of COTH. In relation to this, Mr. Frenzel outlined some of the

events at the November 21 meeting of the AAMC Committee on Federal Health Pro-

grams, of which he is one of the COTH representatives. Mr. Frenzel indicated • that they met with Ralph K. Huitt, (Assistant Secretary, Legislation) and Philip R. Lee, (Assistant Secretary, Health and Scientific Affairs). The Document from the collections of the AAMC Not to be reproduced without permission ACTION IV. #2 meeting Frenzel were that ticism and let Health to working Frenzel Mr. IT PROGRAMS, AAMC Problem DISCRETION REPORT Mr. WITH a on increasingly contact of Committee. very report WAS Financial Massachusetts the Frenzel not Viguers, forced cutsin the Committee THE Program's from FIRST AGREED important presented indicated matter education. relationship and of with AAMC AAMC to WITH IN Inadequate The the then others the TO who Principles the difficult should THAT REPORTING FOR rest originate EACH Committee representative. THE said request COTH topic, had Bureau General that no THE He felt THE funding, as COTH COTH specific action, make between requested that said Executive TOTAL Overhead the saying COTH to that FOR it for of that from EXECUTIVE MEMBER Hospital members officially resolve that Committee one the could BENEFIT. COMMITTEE COTH Teaching they the committees, the anything COTH crucial this Budget on the Committee ON prime TO be all should COTH Direct who and as THE COMMITTEE Committee THE item more ' had to Hospitals. recognized being ON a is if on responsibility area could Committee AAMC the whole. AAMC expressed come and MODERNIZATION Research properly this on there a and member "Fountain primarily for the COMMITTEE bring the WHICH COMMITTEE out then also subject, was COTH He that agenda, report AAMC of handled Grants of the let discussed another COULD said any to research the this Report" organizational. PARTICIPATING Committee of belief AND ON any as information consider directly that recognized the THEN Financial and FEDERAL by had problem barrage report CONSTRUCTION any the Committee Training he that USE activities and Lawrence on had to was reaction COTH to ITS decided HEALTH was Federal if of that Principles they them. FULLY established the the there Mr. cri- OWN Grants: Committee becoming was E. FUNDS although could to Mr. Martin • • • • Document from the collections of the AAMC Not to be reproduced without permission ACTION ACTION #3 #4 V. VI. supply so. IT OVERHEAD the ON MODERNIZATION Report This health studying stressing ceive local to This National William conferences Director be IT exposed one FUNDS COMMISSION WAS FINANCIAL review more WAS opinion of item item any and FOR to AGREED on services, the AGREED L. to comprehensive. ON current Advisory of the HEW had kind the state was the TEACHING Kissick, members as MEMBERS DIRECT that and the PRINCIPLES Committee TO been REMAINING Conference need discussed composition many THAT of levels commissions Commission. REFER there so problems tangible Commission RESEARCH for covered points of MEMBERS HOSPITALS TO many of the SOUND THE were each the as on FOR AVAILABLE under in on in this of Commission, of Financial AGENDA earlier results. Public OF GRANTS TEACHING fact hospital Cost countless will Mr. THEM the the on view ESTABLISH Item THE is Health Hardy field of that most Commission. OUT ITEM TO the Health as COMMITTEE AND by II, Health Mr. Principles, HOSPITALS, BE to possible AND Mr. they level likely commissions, that said TRAINING CONCERNING but of Care INFORMAL, OF McNulty involve Service APPRISE McNulty. health HELP. were Care the that they Facilities: at ON be Mr. in which Committee MODERNIZATION WITH GRANTS Facilities: hard echoed someone implemented. he were they care McNulty would order INDIVIDUAL THEM THE Many conferences, understood THE to the extremely PROBLEM would and OF TO their serve that Committee on delineate COMMITTEE results took reported THE THE the the be their LIAISON sentiments, as AND COTH OF COTH delivery the from glad staff eager and Executive INADEQUATE of CONSTRUCTION members and that opportunity study POINT COMMITTEE ON Dr. to such committees WITH of to to do of Dr. Dennis, the be could OF per- voiced Document from the collections of the AAMC Not to be reproduced without permission VIII. VII. TX. VIEW "Hospital This Consideration of position McNulty 1967 Discussion nursing "Fund been Mr. Hill since added Mr. mentioning said In be dollars that pitals, that Dr. Bureau difficulty withheld, response -Burton Viguers Viguers Frank PRIOR (H.R. item defeated, that such programs there that Freeze" of suggested as previously in at was Educational while McKee, a Health TO well Regarding he that all and the 12080): said was as confirmed to possibility Mr. ISSUING mainly thought for for however, it likelihood, Dr. that October as still the it AHA that (Director, McNulty Manpower that HEW: is. the the has mentioned Rohrbaugh's impact the Position informational Selected A Facilities" this the state that development the paramedical now FORMAL 10 he existed. Health said matter are meeting. phrase item this considered been has it and Division be Provisions on that will doing POSITION not question Education was territorial was suggested withheld Proposed of Mr. under was of since Mr. educational be yet the The more of handling the worse. Westerman of new in that very reached policy STATEMENT Item only present Physician as reference of from medical Assistance Hill that the to soon. He Social health historic 6 Kenneth question depreciation -Burton this was whether interpreted function. of issue some an referred situation, schools TO the amount not Manpower) Security to officials point medical Acts THE Williamson interest was Amendments: MIA was diploma that approved to COMMISSION. not forward. over would projects the position. funding. Dr. with the definitive, Amendments schools in totally would meaning since schools the McKee's testimony grants which run had Mr. Mr. 2.7 of favor Mr. into read Mr. it McNulty and dead he the of of billion would Viguers McNulty had of but hos- stated great the of • Document from the collections of the AAMC• Not to be reproduced without permission ACTION #5 X. tablished statements have In George appropriations to up Campus), amount into could Committee DeCesare. had Pediatric IT vestigator appeared indicated. letter optimistic. AHA Mr. have definition funds relation absorb WAS established Proposed Viguers a GCRC two use low T. released if AGREED had that there organizations in Harrell, the its on appropriations. Miss possible GCRC, as priority. to between to When noted which experienced Financial Definition meaning have discretion cost. him TO had this Beirne would because contact Mr. Mr. REFER that saying M.D., new been already since COTH topic, He McNulty Mr. be Hixson that said schools, Principles also there THIS defining made of with no of and McNulty in a at that it Mr. hold-up a been Mr. that congressional problem Teaching the said administering ISSUE was stated asked the priority there the should McNulty the Hixson Pennsylvania even promised at the almost AHA confirmed investigation Acting look Mr. government TO would of that this a Hospital: because probably same though approved meeting THE funds. schedule raised said Hixson at the Director year he probably action, as thing. COTH the the this that had reverse many there State Miss the with to said on be "fund cuts. COMMITTEE would by a Miss funding comment forward some Mr. places of possibility although letter that Beirne be to him can University of the freeze" Littauer for Beirne have a remove coordination he what be 10 Committee by expect GCRC to from and ON grants, said advised difficulty to percent each stating him Dr. FINANCIAL problem and funding seemed be Branch, the of commented (Hershey that the department DeCesare a es- Dr. having that would could Chief copy cut for that hospital it quite Bingham of for when Dr. PRINCIPLES. in although of a the holding In- check that had his the that you Document from the collections of the AAMC Not to be reproduced without permission ACTION #6 XI. "TEACHING the IT Mr. Discussion Committee Mr. ANY maintaining establish CUSSION priority. maintained. to definitive elaborated what costs. In definition this necessity government diminishes position suggested designed WAS the line proposed McNulty POSSIBLY' Viguers beds information 'COTH AGREED While AND with paper to HOSPITAL" at priorities Mr. are of that and the action is the seems noted REFERRAL said Dr. a questionnaire. cover its definition, CONFLICT knowing none the THAT McNulty contact necessary, needed, term, Committee need the defining Littauer next that to foregoing would that may has hospital THE Committee BE for think "teaching for AS the meeting.. BETWEEN -- under with not yet why the PRESENTED QUESTION be was THEY inpatient what Proposals future then as perhaps reason be been that they incorporated AHA the Mr. discussion, needs. two this well SAY possible draw we THE raised definition Boisfeuillet hospital" in written, Frenzel the are steps OF action. for want FIT TO item as getting the AHA centers. up After for THE needed, growing THE other the AND the several and away it AND immediately PROPOSED Future reiterated in Mr. He COTH it number discussion was THAT Question why will THE members the from said was when The Frenzel number Jones terms EXECUTIVE necessary information we pieces ALL Activities: AAMC. COTH be agreed group of final that AHA they want -- discussed it COTH that Commission of of beds. of follow-up suggested of DEFINITION of the is whether agreed, construction outpatient are it, also approval that the to COMMITTEE there COMMITTEES proposed Crucial Mr. assignment from needed and consider stressed possibilities a by McNulty was saying is or the documented Dr. questionnaire. the the within OF that not because a centers legislation FOR the need Rohrbaugh WATCH THE follow-up and need Executive and the that regarding COTH said DIS- first a the TERM operating for liaison to FOR the in has although that AHA. show a be • • • Document from the collections of the AAMC• Not to be reproduced without permission S ACTION #7 XIII. XII. XIV. these paper THE would THE OF A AND The There Other New Adjournment: The CERTAIN THE TERM WITH COMMITTEE Business: date meeting suggestions, with serve Old was TEACHING TEACHING AN ADDITION of Business: AMOUNT no an to the was other addition AGREED crystalize HOSPITAL next adjourned OF HOSPITAL Mr. old DOCUMENTATION THAT OF meeting McNulty business. of SEVERAL IN three ir THE by AND TERMS for was Chairman COTH BACKING agreed or LEGISLATIVE the set OF OF STAFF four THE Committee. for CONSTRUCTION to Viguers UP legislative the PREPARE NEED, February A POSSIBILITIES DEFINITION need at THE A 4:00 for AND 19, POSITION CAUSE possibilities OPERATING p.m. a 1967. WITH definitive FOR TO PAPER A RESOLVE THE PRESENTATION COSTS, NEED, DEFINING since position THE ETC., WITH it NEED. SUMMARY OF ACTIONS OF DECEMBER 10 MEETING OF COMMITTEE • ON MODERNIZATION AND CONSTRUCTION FUNDS FOR TEACHING HOSPITALS

ACTION #2 - It was agreed that the COTH Committee on Modernization and Construction Funds report first to the COTH Executive Committee which could then use its own discretion in reporting for COTH to the AAMC Committee on Federal Health Programs, with each COTH member on the AAMC Committee participating fully with the AAMC for the total benefit.

ACTION #3 - It was agreed to refer the agenda item concerning the problem of inadequate overhead on direct research grants and training grants to permission the COTH Committee on Financial Principles for Teaching Hospitals, with the Committee on Modernization remaining available to be of help. without

ACTION #4- It was agreed that members of the Committee on Modernization and Construction Funds for Teaching Hospitals establish informal, individual liaison with commission members to sound them out and apprise reproduced them of the COTH point of view prior to issuing a formal position state- be ment to the commission. (National Advisory Commission on Health Facilities) to Not ACTION #5 - It was agreed to refer the HEW "Fund Freeze" issue to the COTH Committee on Financial Principles. AAMC the

of ACTION #6 - It was agreed that the question of the proposed AHA definition of the term "teaching hospital" be presented to the COTH Executive Com- mittee for discussion and referral as they saw fit and that all COTH Committees watch* for any possible conflict between the AGA and the AAMC. collections the ACTION #7 - The Committee agreed that the COTH staff prepare a position

from paper defining the term teaching hospital and backing up a definition with a presentation of the teaching hospital in terms of construction and operating costs, with a certain amount of documentation of the need, the cause for the need, etc., and with an addition of several legisla-

Document tive possibilities to resolve the need. Document from the collections of the AAMC Not to be reproduced without permission • .degrees, Definition 3. 2. A 1. Interpretation is mal in plines hospital a its 'established for Educational approving during capability exclusive program(s) or agrees upon Certificates, study national educational be The teaching on-the-job that adequate own the allocation published or and to, the that name that lead support educational authorities. authority have hospital. to term meets the or to or allocates program(s) programs are Approved to degrees, training provide , faculty demonstrate of or appointment agreed in of and the standards DEFINITION required formal resources recorded agreements therefor. granting high or agencies, to services. a by or arrangements or qualification November courses This substantial association quality by American -course(s) diplomas for generally the curricula of the in OF implies of faculty that professional facilities, discharge A of hospital. professional recognized 15-17, of Further, TEACHING Hospital give must instruction that teaching of part and that covering with recognized and 1967 instruction a be of student primarily of the college selection a the HOSPITAL certificates, certification They recognized personnel, Association corporate college its qualifying programs. course(s) hospital Specified are are in resources admission or the "formal" augment in of or not medical and the responsibility And controls, students health university, work or bodies,. periods diplomas, or funds must accepted to health the educational requirements when -and licensure, school conduct, field. hospital's of or except -learn or disci- based for- state or by Document from the collections of the AAMC Not to be reproduced without permission 1. Tp" 3. 2. 4.. 'Long eral Modernization facility.programing Modernization tion Where Diagnostic The Rehabilitation B. ters, C. funded The General the cilities specifically The The participation should A. ifically ities in group concept changed t.,11 , 4th% carrying language Hospital language language following: Regional otherwise -Term Acute definition facilities hospitals. planning for practice, and from be merican to Hospitals of should permitted TELEPHOP4 the psychiatric considered as considered Care should REVISED "ambulatory the and -based new out of of include of hospital of and be care Facilities law Treatment of also Facilities the the be the that the construction may Approved be other provided "general replacement STATEMENT related to is home of for Hill Hill Hill amended indicates be program extended are service inpatients broadened. ambulatory inpatient than included. care 2 the a -Burton -Burton -Burton care 64: Facilities health by part by to November - hospitals" ,• future. facilities," so of completely 940o American ON facilities. money. hospitals; the are community centers care the of as HILL legislation legislation legislation facilities related s patients as the to the The need The facilities hospital, 15-17, -BURTON well CAJIE Modernization provide Hospital first definition incorporating use modernization should for comprehensive needs should and so as by of 1967 additional in AMENDMENTS great that should should outpatients. should that the including be members Association determined general developed Association be amended facilities other methods of included only needs be and continue be facilities project, services rehabilitation cen- of 6, beds, amended hospitals; amended 1\4110114' (S.2251) replacement those such in the so as by terms in as a to these good medical systems should but rehabilita- that part the to so so provide should and that should of planning. include as beds program. might of facil- be of staff to health as gen- fa- the be spec- be Hill-Burton Aiilend 2

6. Hospital Educational Facilities

It is recommended that the Hill-,Burton legislation be amended so as; to establish a special category for educational'facilities developed in, or in connection with, general hospitals. The sum of 20 million dollars would be suggested as an appropriate amount in this category.

7. State Allotments

A. It. is recommended that the Hill-Burton legislation provide for allocation offunds for new construction on the basis Of per capita income permission permission and need.

B. It is recommended that the squaring factor in the present formula be without without eliminated.

C. It is recommended that funds be alloted for modernization on the basis

of per capita income and population.

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be 8. Priorities to to Hill-Burton legislation be amended to remove Not Not A. It is recommended'that the the required first priority for rural areas. -The need for facilities

should ,be determined by the states. AAMC AAMC

B. In order to assist both new construction and modernization in an order- the the

ly manner, two separate priority systems,are'required. of of

9._ Coordination with Regional'Eianning

in accordance with'long-standing Association policy,

collections collections It is recommended, that the federal government require that the development of health care the the program under the Office of Economic Opportunity, the Department of Hous-

ing and Urban Development, and any other agencies, be coordinated with from from regional planning activities.

10. Loans Document Document It is recommended that the present 25-year loan Provision for modernization be lengthened to 4o Years

• merican ita sociation

TF LE IA N 7,I7 CADLF•AD DRESS : M 14. OSD

AMERICAN HOSPITAL ASSOCIATION PROGRAM IN COMPREHENSIVE HEALTH PLANNING

Approved by American Hospital Association .November 15-17, 1967

Until recently, the primary emphasis in the nation's attempt to provide adequate health care for all the people has been upon specific programs intended to meet specific needs (e.g., Medicare, Title 19, community mental health centers, categorical disease programs, mental retardation centers, etc.). In an effort to meet urgent needs as rapidly as possible, many of these programs have developed relatively independently of one another.

Now, however, there is a growing social awareness of the need for comprehensive health planning and for coordination of the aims and efforts of individual programs, if the most .imaginative and effective use is to , be made of scarce facilities, manpower, and funds, This awareness is reflected in current federal legislation dealing with comprehensive health planning, the regional medical programs, state mental health and • mental retardation plans, etc. The accelerated timetable for implementation of these planning efforts and the clamor for early results calls attention both to the urgency of this problem and to the need for the American Hospital Association to provide broad leadership for planning as rapidly as possible at national, regional, state, and local levels.

Particularly, the Association should be able to take the initiative in the development of planning and planning concepts for health rather than acting only in response to the proposals made by other agencies and groups. The implications of this level of involvement in planning are not entirely clear; certainly the commitment will have to be at a much higher level than at present.

The American Hospital Association expresses its intention to exercise its leadership efforts in the following directions:

1. To serve as a national focal point in relating to the several federal agencies involved in health planning and also to other national organizations so involved, including the American Medical Associa- tion, American Public Health Association, United Community Funds and Councils of America, National Health Council, etc. The Associa- tion's staff would serve as a point of contact for federal agencies and private health planning organizations, would represent Associa- tion views and concerns to these other agencies, and would participate in defining national program goals, through initiation of and • participation in national meetings and conferences that include governmental agencies and other national organizations. Comp RealthTln/2

To pro-Vide the membership of the Association and its allied associations with basic information and leadership toward enthusiastic support of and active participation in the process of planning for health at all levels, •

Mechanisms forCarrying out the vigorous program in promoting under- Standing of and involvement in planning at many levels should have the following objectives, subject to the availability of staff and funds:

1. To develop an active task force to complete early in 1968 the work of bringing together natibnal interests in planning, both governmental and nongovernmental;

permission 2' TO stimulate and take part actively in formation of the National Resource Facility outlined in the report of the Community Action without Studies PrOjeCt of the National Commission on Community Health.Ser- vice6.on "Action-Planning for Community Health Services;"

3. To distribute to the field regular bulletins similar to the Medicare reproduced bulletins on implementation Of Public Law 89-749 and other health be _planning programs;

to A+. To expand and promote a vigorous counseling Not service for planning for communities, hospital.asseciations, and health,planning agencies;

TO greatly increa'se the activity AAMC 5. of the Association in Washington . related to comprehensive health planning and its implementation, as the well as to other health planning sponsored by any governmental

of agenCyj tO inClude both initiation of and response to legislative proposals regarding planning by technical planning personnel possibly located in the Washington Office;

collections . To encouragedevelopment Of educational programs for planning per- the sonnel by appropriate institutions;

from ▪ TO develop, as soon as passible, manuals on comprehensive planning, covering both personal health services and environmental health services; •

Document 8. To conduct regional meetings to inform voluntary state health leadership groups regarding specific. implementation of comprehensive planning and to train them in appropriate techniques;

9. 'To assiSt:statewide health organizations in training leaders and implementing meetings within the individual states .for health institutions and'health associations, including particularly the county xiedical societies; • Comp Health Plan/3

10. To appoint advisory panels to existing AMA committees that would involve full-time planners in health care institutions and planners who are on staffs of state and metropolitan hospital associations; and

11. To contact state hospital associations to suggest revision of annual meeting programs to include strong and urgent emphasis on comprehensive health planning.

The American Hospital Association and its allied and member associations must play an active and vital role in future planning efforts at all levels — national, regional, and local — if the voluntary role of hospitals as community health centers is to be maintained permission and if future planning is to provide for the most effective use of health services, manpower, and facilities in broad community health efforts. The program outlined above is a without response to the extreme urgency of the hour.

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• Document from the collections of the AAMC Not to be reproduced without permission • • Accordingly, of and As Association States manpower, The a providing provide areawide avoid ity is recognizes planning responsible the a necessary construction American health result unnecessary relationship Public for mericanr agencies planning and for "T that planning believes of review to the Hospital facilities. construction Health STATEMENT OF participant F more bring orderly Approved Association PROPOSED by for duplication is procedures N agencies. than of a that Service essential. comprehensive about Association health 5 proposed involvement ON --- two by 6 mandatory HEALTH in November •1 or MANDATORY 1 orderly American - - ;s decades and the recommends services, of involving renovation 4 0 health CI facilities, other CARE partnership affirms 15-17, development areawide of review of Hospital PLANNING CABLE FACILITY itaf federal comprehensive programs manpower, that, cooperation organized of its 1967 of hospital ADDRFSS: and to health henceforth Association continuing ASSOciation proposed AGENCY and CONSTRUCTION to of achieve assure and comprehensive existing state needed with planning facilities, and areawide REVIEW AMROSP health proper comprehensive medical the agencies, policy all health health agency United care legislation health assessment health of facilities programs, and facil- services, the being now care Document from the collections of the AAMC Not to be reproduced without permission • 4 The ment - a and nizing mental Displaced hospital advances experiencing of parties the in historically personnel Strong personnel federal, education, For In ing time Originally all vate lack ity. ing point previously.established interests cally characteristics, been necessary hospitals Currently, information, fortuitous a hospital seeking STATEMENT education employer numbers programs. find programs, example, in move foundations. under of ventures mericanr followed The for the leaders, in any concerned, TE- understanding employment. in new state, to industrial the becomes in hospital are delays have coordinated LEP need hospitals solutions development approved efforts organization. -relocations medical of care a development overdue, keep the ground in which ON and professional hospitals proceed. geared RONG shortage They persons come the Approved for are and industry, THE has supportive do and training current more and field, Because pattern to is more also care. are local 31? together, in not by COORDINATION workers have to cumbersome strained to -- These are the programs. by educate are acute, needed for each within Council of their even the have as 1 by recently: and being have all November now employees — long levels, training governmental hallmark of Leaders Programs personnel fields to of in a 30 American programs, 400 or other's sharing better are more received group parties personnel caused going be there and the to most problems apprenticeship governmental years. and used s lacked nonprofessional on difficulties. now considered provide OF of from capacities the burdened Administration, train 15-17, CABLE in of cases fit of itaf At of personnel forward to in operations is of at EDUCATION Hospital unemployment the nursing, concerned. the organized designed assistance need technological Hospitals, professionalism a upgrade retraining step of a voluntary agencies, research into all is hospital object time the this pervasive 1967 hospital initiating an today to and Association levels, laudable. as with many . of increasingly

programs, training when essential Association paramedical, train is AND a by present fields. and educational This of training existing data the joint as from government agencies, and the of because personnel It and in educators March TRAINING and training the environments element technological the the the personnel is is many rapidly and first private and upgrading, and programs, hospital health hospital effort some undoubtedly also element The unemployed shortage classical 10-11, programs hospital expanding of experimental industries. complex the and of time and agencies. meet PROGRAMS* and programs increase of their due changing foundations, field, by unfamiliar- has starting medical from which 1966. of field govern- personnel these as with to of all although have at train- for changes patterns classi- unique patterns manage- grows. train- first- due a trained the pri- for recog- in have lack un- seen is But to Document from the collections of the AAMC Not to be reproduced without permission of most agencies full all have The Naturally,.all scope coordination need such meaningful caught cooperation for, for and efforts variation hospitals training the plans of and of various in government leaders the from productive should programs in hospital one plan a crossfire be in community 6 agencies. all programs. tempered now in and the appropriate under health in hospital to many by way Competition the local field, under communities. next. and agencies needs; governmentsponsorship so health This among as there to to requires field Ed governmental help produce and should coordinate is Trng/2' the urgent. the be • • Document from the collections of the AAMC Not to be reproduced without permission S -Jlanning • •and :facility :Centers, jectives •to :health ioower jr:the *ervice. struction facilities ity Of Community extremely Although tip A the Capable the tance Unfortunately and tance The than vices tration, cords, hospital, At hospital hospital. interests 'T. ospitai small reasonable the personal the predict. supply . basis community services. hospital business its on Plant, of of needed, community physical occupations, same - merican hands the community, instances community surrounding ' . for Patients and nursing that, nursing, there can planning, competent organizations, of may iSnot limited. of the Thus The has time, community's and . the policies laundry, office experience, be the care Competition distance if plan will and is concern need Approved received, belief is an and no community frequently development in homes, is the public. STATEMENT CONSTRUCTION laboratory, to requires the to widespread orderly the and to attract exhibiting therefore, better will personnel the usually occupational as trade it travel hospital secure that construct have is the housekeeping, supply results is - well will by rehabilitation best ability be public as November likely during with a than pattern area. area, pride 5. American been a a trained Available. small price ON overemphasized; given are have and as probably .interest 1400 and expansion hospital of public physician to a nearby is x-ray, must of PLANNING IN the the recent agencies, developed, a natural to frequently to trained personnel retain and effective and programs therapy, to such 15-17, SMALL as new of .focus and produce quality service include Hospital function interest. and of acceptance the towns, anesthesia, be health will hospital in study to, centers, a years, experienced Meanwhile, all to FOR COMMUNITIES enthusiasm many maintenance, LE 1967 on primary competent recruitment for and and service pay of or of reevaluated, used the improve departments, adjacent careful HOSPITAL availability at community will care 1) Association effectively years coordination retain increasing interested citizens. hospitals, other its for The even best scope of and as E reason dietetics, facilities bring 3 for personnel. recognition the is high for desire the justification. personnel hospital before study this related though specialized hospital a and must of essential AMHOSP sociation pride, the fact -quality physician having economic about for and including young of public attention quality and is of to also health numbers of such that building adjusted difficult health medical beds staff. the may provide and in economically. service subordination facilities its High-qual- of people be in hospital status con- health adminis- services. community traveling be of in, rather reluc- field the own the in the adequate from care planned Ob- A re- ser- on a a for impor- areas. best is Document from the collections of the AAMC Not to be reproduced without permission f. • , 111V7P S 1. 2. 3. Hospital bers. The they qualified, ries of and by able ical dent this b. a. to b. It e. provided a. assumed d. c. c. their all the is mericanr dentists. services for tence, They They Privileges through They by They Applications ence, They The be and within staff. for of psychologists, carry practitioners, obligation, TELEPHONE the of a required governing health each by privileges. medical medical patient skills for exercise record member perform participate write the and obligation and the out the members the AND Approved of individual, in following demonstrated STATEMENT licensed Patients their professionals ultimate orders should scope and certain of reports the staff same of STATUS AS staff care the for authority consultations - if? independent the of members - STAFF the eligible podiatrists, medical 4;s 64 activities following directly of of appointment channels by as to these be should November 5 membership medical OF -04 allied doctors should responsibility their scope the criteria: and ON American medical the based considered AFFILIATES 00 ALLIED the of competency. MEDICAL progress allied medical staff include, professionals extent determine of licenses judgment in each as be health professionals staff. on extent procedures upon 15-17, of as CABLE their staff the and those ital and Hospital HEALTH should admitted request bylaws: medicine, hospital category health STAFF established staff and his IN radiation notes management privileges for of 1967 lawful for . affiliates within for and the ADPRESS: HOSPITALS professional specified PROFESSIONALS

be responsibility MEMBERSHIP example, if of should professions. Association only are patient on applicable general medical limited employees of doctors the authorized their practice. patients' physicists. identified allied by of by should be hospital AMP-40SP within sedation by medical audiologists, the care patients. qualifications staff to may areas established of the medical training, or statutes. professionals. competent, medical be be osteopathy, being by records. that To the as These membership of in to processed made staff the carry Whether indepen- limits general compe- recommend may shared catego- staff medical experi- avail- and mem- clin- be out staff to Document from the collections of the AAMC Not to be reproduced without permission 4. Members lish signed policies should should this to carry not of and an procedure these be procedures. out appropriate established their allied and professional health relationship. clinical The as an bylaws professions organizational department activities of An the affiliate should medical as entity. subject staff be staff or individually Medical affiliates to adjunct must departmental Staff/2 estab- staff and as- • • merican 1 os.utnLA$SQcU.ftQi1,,

TELE rHONE 3I2 45-‘4400 CABLE ADDRESS: AMROSP

. STATEMENT ON COT,LECTIVE BARGAINING IN HEALTH CARE INSTITUTIONS*

Approved by American Hospital Association August 24, 1959 Revised by American Hospital Association November 15-17, 1967

permission

Voluntary nonprofit hospitals are exempted from coverage under the Labor- without Management Relations (Taft-Hartley) Act of 1947 in this country. The American Hospital Association has consistently supported such exclusion and reaffirms that support at this time.

reproduced Meanwhile, some health care institutions have faced aggressive efforts by be employee professional groups and labor unions to organize groups of their to employees and to represent them in collective bargaining negotiations with management. Although some of Not these activities have been conducted peace- fully, in other instances such activities as strikes, mass resignations, and other • occurrences have impeded the proper dare of the sick. .

AAMC The position of the American Hospital Association concerning the collective bargaining in health care institutions is of as follows:

- 1. The American Hospital Association believes that voluntary nonprofit health care institutions should be exempt from the provisions of the Labor-Management Relations (Taft collections -Hartley) Act. the . 2. The American Hospital Association further believes that such institutions .should be exempt from all legislative acts, federal from or state, requiring health care institutions to bargain collectively with any .unions or professional groups of their employees.

The American Hospital Association Document reaffirms its advocacy of strong and positive personnel policies in health care institutions that "strive to provide for all employees compensation, working conditions, and personnel practices at least at the levels prevailing for equivalent work in the community.-"*

*Revision of Statement of American Hospital Association Concerning Collec- tive Bargaining in Hospitals, approved by House of Delegates, August 24, 1959 **Statement on Management-Employee Relations in Health Care Institutions, approved by American Hospital Association, May 8-10, 1967 January 25, 1968

ASSOCIATION OF AMERICAN MEDICAL COLLEGES (21:,--• 0,0 tu MEETING OF THE #GCTErilY OF UNIVERSITY HEALTH/ADMINISTRATORS

January 20 - 22, 1968 New Orleans, Louisiana

Present:

Lewis Rohrbaugh, Vice President for Medical Affairs, Boston University, since 1960 William Willard, Vice President for Medical Affairs, University of Kentucky, 0 • since 1966

• Joseph Volker, Vice President for Health Affairs, University of Alabama, since 1962 Robert Carter, Director and Dean of Medical Center, University of Iowa, since 1967 sD, Adan Nigaglioni, Chancellor for Medical Sciences campus, University of Puerto Rico, 0 . since. 1965 Lloyd Elam, President, Meharry Medical College, effective April 1968 - George Wolf, Provost and "CSu Dean, University of Kansas, since 1966 John Patterson, Executive Director and Dean of Medicine, University of Connecticut, since 1964 Peter Herbut, President, Jefferson Medical College, since 1966 Randolph Batson, Director of Medical Center and Dean, II Vanderbilt University, 0 1 since 1963. o John Sheehan, Vice President and Dean, Loyola University, since 1950 Robert Cadmus, President, New Jersey Medical College, since 1966 Robert Smith, President, Medical College of Virginia, since 1956 Clement St. John, Vice President and Director of Medical Center, University of Cincinnati, since 1961

the William McCord, President, Medical College of South Carolina, since 1965 of William Knisely, Director, Institute Biology and Medicine, Michigan State Univer- sity, since 1964 Samuel Martin, Provost, University of Florida, since 1961 Joseph S. Begando, Chancellor, Medical Center Campus, University of Illinois,

collections since 1966

the James Dennis, Director, Vice President and Dean, University of Oklahoma,

m ' since 1965 Alvin Kuhn, Chancellor, University of Maryland, since 1958 William Frye, Chancellor of the Medical Center, Louisiana State University, since 1965 ou Carlyle Jacobsen, President, Upstate Medical Center, until 1967 Gordon Scott, Vice President, Wayne State University, since 1965 Wilfred Westerfeld, Acting President, Upstate Medical Center, since 1967 Robert C. Berson, Executive Director, AAMC Joseph Webster, Dean of the School of Pharmacy, University of Illinois

Carlyle Jacobsen presided. The attached agenda was distributed but not followed, and no precisely-worded alternative agenda was developed.

. The AAMC Task Force on Allied Health Professions.

Dr. George A. Wolf, Jr. gave a rather complete verbal review of the activities ofthis task force, particularly its meeting on December.7, and plans for a meeting in March. There was considerable interest in this development and a good bit of discussion. A number of those present expressed interest in being actively helpful but no clear suggestions were made as to how the SUHA as such could play a helpfUl role. - B. Federal Support for Health Education - Possibilities for 1968.

Robert C. Berson reviewed the recent activities of the AAMC Committee on Federal Health Programs and the main points he believes will be contained in the Administration's proposal this year with some additional comments by Dr. Sam Martin. There was a good bit of interest and discussion and a number of questions about the support of nursing education and education in the allied health professions. All of the men present were keenly interested and would like to learn about the details of the Administration's proposals as soon as possible. •Most of them seemed to be in a position to be fairly influential to members of the Congress from their states.

C. Further Development of the AAMC.

Robert C. Berson reviewed the decisions reached at the Annual Meeting of the AAMC, the action of the Executive Council in asking its Committee on Ways and Means to make specific proposals about the reorganization of the AAMC and the 0 plans of the Council to review those proposals at its next meeting. He did not describe the details of the Committee's recommendations. 3 There was a, great deal of discussion of many of the services and programs of the AAMC and its evolution in the recent past. There was a high level of interest 0 in what further evolution will take place. A few people expressed the opinion that the AAMC would not broaden itself to such an extend—that educators, in the other health professions would actively participate in its 0 affairs.

Although Berson and Wolf repeatedly suggested that the AAMC would be keenly interested in suggestions from the SUHA as to what it might do, no clear suggestions were offered.

D. Funds for the Construction and Renovation of Teaching Hospitals. 0 Dr. Rohrbaugh 0 summarized the Study of present and anticipated needs of teaching hospitals for construction funds which has been conducted by a corn-, mitteesof the Council of -5 Teaching Hospitals largely stimulated. by individuals in Boston and urged that this group support efforts to get legislation and -- appropriations to meet these needs. There was general agreement that the .problems are urgent and highly important to all of health education as well as.to the care of substantial. numbers of patients. The discussion was in rio entire agreement with .Dr. Rohrbaugh's viewpoint. No specific strategy or tactics were* proposed or decided upon.

• E. The Future Role and Composition of SUHA.

A good bit more than half of the discussion on both Saturday and Sunday was devoted to discussion of the future composition, name, organizational pattern and mission of the group itself. Rather early in the discussion, the group elected Dr. Kenneth Penrod as its next chairman. He and the others elected to an Executive Committee met during two periods when the entire group was not in session and then presented fairly specific proposals to the group as a whole. •

In the extended,discussion, it was clear that a few of the members felt the group should be • formally organized and seek an initial foundation grant to develop staff and an action program and attempt to become the • spok6Man for health education. ,Most of the members disagreed with' this in whole Or, in part and the eventual decisionsreached are summarized in the attached memorandum prepared.,,by Dr. Penrod. '-- -b(QA-// 6-kw, -2- nk4N,(N PRESIDENT'S ADVISORY COMMISSION ON HEALTH FACILITIES

COTH Committee Member to Contact Members of Commission Commission Member

Boisfeuillet Jones, Chairman Mr. McNulty National Advisory Commission on Health Facilities, & President, Emily and Ernest Woodruff Foundation Atlanta, Georgia

Dr. Samuel L. Andelman, Commissioner of Health Mr. McNulty Chicago Board of Health (Mr. C. Goulet) Chicago, Illinois

Dr. James Z. •Appel, Past President Mr. McNulty

permission American Medical Association (H. R. Cathcart) Lancaster, Pennsylvania

without

Mrs. Angie E. Ballif, Director Mr. McNulty Utah Division of Public Health and Welfare (V. L. Harris) Provo, Utah

reproduced George. E. Cartmill, Jr., Director

be Mr. McNulty Harper Hospital and Past President

to American Hospital Association

Not Detroit, Michigan

•Dr. Leonides G. Cigaroa Mr. McNulty

AAMC Laredo, Texas (H. Swicegood)

the

of Charles E. DeAngelis, Vice President. Mr. Vanderwarker Walter Kidde Constructors, Inc. New York, New York

collections • Dr. James L. Dennis, Vice President for Mr. Hardy the Medical Affairs and Dean School of Medicine from University of Oklahoma Oklahoma City, Oklahoma

Honorable Conrad M. Fowler, Probate Judge and Mr. McNulty Document Chairman, Shelby County Board of Revenue Columbiana, Alabama

Honorable William L. Guy Mr. Westerman Governor of North Dakota

Very Reverend Monsignor Harrold A. Murray Mr. McNulty Director, Bureau of Health and Hospitals United States Catholic Conference Washington, D.C.

Howard N. NemerOvski, Attorney Mr. Hixson San Francisco, California COTH Committee Member to Contact Members of Commission Commission Member

Dr. David E. Rosengard, Medical Director Mr. Viguers The Rosengard Clinic South Boston, Massachusetts

David Sullivan, General President Mr. Vanderwarker Building Service Employees International Union ------•New York, New York

Mrs. Fay O. Wilson, Professor and Chairman Dr. Littauer Nursing Department Los Angeles City College

Los Angeles, California permission permission

William L. Kissick, M.D. Mr. McNulty

Executive Director' without without National Advisory Commission on Health Facilities

Washington, D.C.

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