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Maternal and Child Health

nursing education opportunities for individuals from
minority and disadvantaged backgrounds.

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The Maternal and Child Health Block Grant Program allocates funds to States to provide a wide range of health services to mothers, infants and children, particularly those with low income or limited availability of health services, including preventive and primary care and rehabilitative services which help alleviate infant mortality problems and provide better access to health care. 1992 request of $554 million is the same as the 1991 current estimate. The request includes:


$471 million for State Block grants; and

$83 million for special projects of regional and national significance (SPRANS) in the categories of research, training, hemophilia, genetic diseases, and maternal and child health improvement. The FY 1992 request includes $9 million of SPRANS set-aside to be directed to the Targeted Infant Mortality Initiative.

National Health Service Corps (NHSC)

The NHSC program is designed to improve the capacity to provide health services in Health Professional Shortage Areas (HPSAs) and improve access to health care in these areas through the placement and support of health professionals. The NHSC, and the related recruitment effort, play a critical role in the attempt to reduce shortages of physicians and other primary care providers such as nurse practitioners and midwives and physicians assistants in the most difficult to staff areas throughout the country. The budget request of $42 million will continue the program at approximately the 1991 level. It will support a field strength of 1,030.

National Health Service Corps Recruitment

The FY 1992 budget request of $54 million for NHSC recruitment includes an increase of $5 million above the FY 1991 level to support 495 new scholarships and 285 federal loan repayments to health professionals and health professions students and increase the supply of obligated health practitioners in exchange for service in a HPSA. This will also support 30 State loan repayment



The FY 1992 budget request of $63 million, includes an increase of $12 million above the FY 1991 level for health care to the homeless. This request will support a broad range of primary care, alcohol and substance abuse, and mental health services to approximately 420,000 homeless individuals in approximately 130 centers. This is an increase from 350,000 individuals and 109 centers in FY 1991. Emphasis will be placed on providing preventive as well as curative services to a broad sector of the homeless including runaway adolescents, homeless pregnant women and children, and individuals with chronic substance abuse and mental health problems. Grants will be made to applicants demonstrating broad community participation and linkages with other community providers of

critical support needs of the homeless and effective and efficient provision of care.

Health Professions

At the end of FY 1991 the cumulative Federal investment in Health Professions totaled nearly $9 billion and has increased the supply of health professionals. Beginning in the late 1970's and through the 1980's, more targeted objectives such as primary care, disadvantaged assistance, and improvement in advanced and specialized nurse training have been our priorities.

In recognition of these successes, the Administration proposes to shift the emphasis from broad-based health professions training to other targeted HRSA priorities which target minorities and underserved populations such as reducing infant mortality, increasing the number of minority health professionals, providing health services to underserved populations, and supporting AIDS HIV programs.

National Practitioner Data Bank

The FY 1992 Budget request proposes to expand the collection of user fees to cover the full cost of operations of the National

Practitioner Data Bank. User fees collected in 1992 will fund the operating costs of receipt, storage and dissemination of information on medical malpractice sanctions taken against physicians and dentists. The total cost of operating the Data Bank is expected to be approximately $5 million in FY 1992.

Organ Transplantation

We believe that the allocation of organs for transplantation is more fair and equitable since the establishment of the national Organ Procurement and Transplantation Network. For example, the number of organs procured but not transplanted has decreased markedly from 10 percent in 1985 to 5 percent in 1989. Also, fewer organs are being shipped overseas and, as a result, more U.S. residents, nation-wide, are receiving transplants. The 1992 budget request includes $3 million to continue support of the Network as well as the Scientific Registry, which is used to track the scientific and clinical status of organ recipients. In addition, the request includes funds to continue support of the agency's Organ Transplantation staff and funds for grants and contacts to improve organ donation, especially among minorities.

Rural Health

The budget request includes $4 million for the Office of Rural Health Policy to fund a total of seven Rural Health Policy/Research Centers. These centers will provide an information base and a policy research capability on a wide range of rural health concerns including access to care, financing systems, alternative delivery systems, and occupational health issues. The request provides funding for a national rural health information center and to staff the National Advisory Committee on Rural Health.


This budget continues programs authorized by the Ryan White Comprehensive AIDS Resources Emergency Act of 1990. The funds will be used as follows:


$88 million for HIV Emergency Relief Grants providing grants to an estimated 21 metropolitan areas with very high numbers and/or rates of AIDS cases for coordinated outpatient and ambulatory health and social support services;

$88 million for HIV Care Grants providing grants to all
States and territories for the operation of HIV service
delivery consortia in the localities most affected by
the epidemic, and for the provision of home and
community-based care, continuation of insurance coverage
for infected people, and HIV treatments that prolong
life and prevent serious deterioration of health; and
$45 million for Early Intervention Services providing
grants to community and migrant health centers, health
care for the homeless grantees, family planning
grantees, comprehensive hemophilia diagnostic and
treatment centers, and other federally qualified health
centers, and nonprofit private entities that provide
comprehensive primary care services to populations at
risk of HIV disease.

In addition, HRSA is requesting categorical funding of the following programs:


$17 million for Education and Training Centers to continue 16 projects providing training of health care personnel who care for AIDS patients;

$20 million to fund approximately 43 projects for Pediatric AIDS Health Care Demonstration Grants which demonstrate strategies and innovative models of intervention in pediatric AIDS; and

$4 million for AIDS Facilities Renovation providing grants for the renovation or construction of non-acute care intermediate and long term care facilities for patient with AIDS.

Vaccine Injury Compensation Program

The National Childhood Vaccine Injury Act of 1986 established a program to provide compensation for vaccine-related injury or death. The HRSA maintains the fiscal records of the claims trust fund, provides medical advice to the court, and pays claims. The FY 1992 budget request of such sums as necessary for the post 1988 claims is estimated at $87 million, and $2 million is requested for administrative costs. No funds are requested for payment of the pre-1988 claims. Due to the high influx of petitions received, and preliminary budget estimates which far exceed the original design of the program, the Administration is currently looking into policy options for handling the payment of pre-1988 claims.

In conclusion, I can assure the members of the committee that we at HRSA see the coming year as one with many opportunities and numerous

challenges, and are looking forward to working with you in moving the public health agenda forward.

Mr. Chairman and members of the Committee, my associates and I will be pleased to receive any questions or comments you may have on the specifics of this budget request.




Birthplace and Date:


Post Graduate


Administrator and Assistant Surgeon General Health
Resources and Services Administration

U.S. Public Health Service

Department of Health and Human Services

Director, Missouri Dept. of Health, Jefferson
City, Mo. January 1986-January 1990.

Clinical Professor, Dept. of Family and Community
Medicine. University of Missouri/Columbia School
of Medicine. July 1986-January 1990.

Barnsdall, Oklahoma, March 20, 1944


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1962-66, Washington University, St. Louis,

M.D. 1966-70, Washington University School of
Medicine, St. Louis, MO


M.P.H. 1975-77, School of Hygiene and Public
Health, John Hopkins University, Baltimore,


Internship and residency internal medicine,
University of Colorado Medical Center,
Denver, CO. 1970-73

Certificate, Program for Senior Executives in
State and Local Government, Harvard
University, John F. Kennedy School of
Government. July, 1988.

Medical Officer in PSRO program, Division of
Peer Review, Bureau of Quality Assurance,
Health Services Administration, U.S. Public
Service, Department of HEW, Rockville, MD.
August 1974 - January 1988.

Director, MEDEX Northwest Division and Assistant
Professor, Dept. of Health Services, School
of public Health and Community Medicine;
Adjunct Assistant Professor, Dept. of
Medicine, School of Medicine; University of
Washington, Seattle, WA. August 1977 -

November 1980.

Deputy Director of Public Health, Maricopa

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Director of Public Health and Health Officer,
Maricopa County Dept. of Health Services,
Phoenix, AZ, November 1982 December 1985.
Chairman, Department of Community Medicine,
Maricopa Medical Center, Phoenix, AZ.
December 1980 - December 1985.

Adjunct Associate Professor, Dept. of Family
and Community Medicine, University of
Arizona School of Medicine, Tucson, AZ.

General Preventive Medicine, 1979.

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Internal Medicine, 1973.

Association of State and Territorial Health
Officials; Executive Committee, 1987-1990.
National Association of County Health Officials;
President, July 1983 December 1985.
Physicians National Housestaff Association;

President, 1974-76.

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