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The California Regional Medical Program, therefore, contracted with the Survey Research Center at UCLA to make an analytic region-wide survey of existing training facilities for health service manpower of all sorts. The survey, besides being an inventory of facilities, includes analytic details as to capacities, present enrollments, expansion possibilities, curricula and new programs. It will serve as a basis for second-generation studies and operational proposals in the manpower field.

Physician referral patterns.—The Stanford Research Institute, in cooperation with the California Medical Association, is completing interviews with a random sample of physicians throughout the State on the subject of referral patterns for patients with heart disease, cancer and stroke. Here, too, material never gathered before is being acquired. Questionnaires already completed contain valuable material of two kinds. As a basis for improved delivery of medical service in cases of heart disease, cancer and stroke, referral patterns, both as to physicians and facilities, are being discussed. And, the needs seen by family physicians, and other physicians of first reference, are being recorded and analyzed for the first time in this context.

Registries.-A cooperative undertaking involving the System Development Corp. of Santa Monica and the UCLA School of Public Health is doing feasibility testing for possible registries in stroke and heart disease. California has already had rich experience in the development of a tumor registry, covering roughly a third of the hospital beds in the State and providing cancer incidence data of unique significance. The System Development Corp. study is, therefore, moving on to a preliminary examination of registry construction in stroke and heart disease. At the same time, the Director of the California Tumor Registry is cooperating with the California Regional Medical Program in connection with cancer registration and follow-up.

Use of medical scoiety review mechanisms.—On a trial basis, local medical organizations in three California counties are cooperating with the Regional Medical Program to determine the value of local medical review mechanismsgenerally associated with claims review in health insurance programs for case identification heart disease, cancer and stroke, review of prevailing community standards and practices in management of such cases, and possible development of postgraduate medical education and other programs. In each case, the county medical group has agreed to cooperate with the appropriate university medical center in the review.

Specialized resources in hospitals.The sixth and last of the first-generation California planning studies is based on questionnaires sent to all the acute, general hospitals in the State, through the cooperation of the California Hospital Association. The hospitals are reporting whether or not they have various items on a detailed roster of specialized resources or facilities needed for treatment and overall management of patients with heart disease, cancer and stroke. This material, too, has not been gathered before, and is expected to highlight material lacks, oversupplies or maldistributions. At the same time, the study will bring manpower training requirements to a sharper focus as California's Regional Medical Programs enter their operational phase.

All these data gathering studies have been integrated into the 14 operational proposals described earlier. They have also been incorporated into the five operational proposals and the two additional requests for funds especially earmarked by Congress, submitted by the California Committee on Regional Medical Programs during the March, 1968 quarter.

This second set of proposals includes the expansion of existing clinical cancer diagnosis and treatment, social service consultation, radiological physics, nuclear medicine and computer retrieval of pertinent data to 26 hospitals in northern California, a coordinated year-round general practice residency, intensive coronary care training for physicians in small hospitals, and the establishment of a medical library and information service network.

The first of the projects seeking earmarked funds involves a sixth area in California—Orange County, the planning for which has been assigned to the University of California at Irvine proposing a pediatric pulmonary demonstration center. It would be only the fourth of its kind in the Nation. The second project would expand and improve an existing hypertension program of the UC San Francisco Medical Center.

Taken all together, these first operational proposals can be seen as the beginning broad outlines in the development of a region-wide comprehensive blueprint, whose cohesion and effective potential for vastly improved health care services are emerging, almost on a day-by-day basis, ever more clearly.

Mr. Rogers. Let me ask this. Is your program getting to the ghetto areas? Could you give us a quick rundown on that?

Dr. BRESLOW. One program that is being considered—I perhaps should not prejudge the issue—is the proposal which has been developed by USC and UCLA faculties. It would transfer the medical expertise developed by these two centers, in the field of heart disease, cancer, and stroke, to the Watts-Willowbrook area. It is in this area that the county plans to build a new hospital with the aid of HillBurton support.

The aim of this program is to build around that hospital, bringing in the practicing physicians in the community, a program of postgraduate education, emphasizing heart disease, cancer, and stroke.

We think this will have a remarkable effect in mobilizing the services of that portion of Los Angeles to provide better care.

Mr. Rogers. Thank you, and I am delighted to see you have given us a statement on the California program, which we will go into in deta .

Mr. Kyros?
Mr. KYROS. No questions.
Mr. ROGERS. Dr. Carter?

Mr. CARTER. I am delighted to know you are making all these services available for the Watts area. I wonder what you are doing for the areas around Watts.

Dr. BRESLOW. Our programs extend into the Watts area and also around the Watts area, not only throughout the metropolitan region of Los Angeles, but in the mountainous areas, and so forth. Other projects

Mr. CARTER. I believe in those surrounding areas we are liable to have more heart attacks and strokes. (Laughter.]

Mr. Rogers. Thank you very much, Dr. Breslow. We appreciate very much your coming here.

I understand that we will try to hear one more witness here.

Reverend Works, you and Dr. Price, I understood, were going to have to get away. Could you come forward, then? We will be pleased to hear your testimony.

Mr. Macdonald, your Congressman, wanted to come and introduce you, but the committee knows of your work, and we are delighted to have you here with us, and Dr. Price.

And if you would like, we will make your statements part of the record, without objection and they will appear following your remarks. And if you could then summarize for us the points that you think wolud be important, this would be helpful to the committee.

STATEMENTS OF REV. DAVID A. WORKS, EXECUTIVE VICE PRESI

DENT, THE NORTH CONWAY INSTITUTE, BOSTON, MASS, AND REV. THOMAS E. PRICE, DIRECTOR OF THE DEPARTMENT OF ALCOHOL PROBLEMS AND DRUG ABUSE, GENERAL BOARD OF CHRISTIAN SOCIAL CONCERNS OF THE METHODIST CHURCH

Dr. WORKS. Thank you, Mr. Chairman.

My name is Rev. David Works, of Topsfield, Mass., and North Conway, N.H., an opal clergyman. I am the executive vice president of the North Conway Institute, an interfaith, totally ecumenical fellowship of lay people and clergymen.

We have been studying, praying, working, and waiting for a new or more effective way for the churches and synagogues of the United States to help all people prevent alcohol problems.

In addition to my responsibilities with the North Conway Institute, which is now permanently located in Boston, Mass., I am also a member of the newly created task force on alcohol problems of the National Council of Churches, which was created to do two things:

(A) Study the report of the federally financed cooperative commission on alcohol problems with special emphasis on Dr. Thomas Plaut's Book, “Alcohol Problems: A Report to the Nation,” and

(B) To recommend to the National Council of Churches and through the National Council of Churches of Christ, United States of America, to its constituent members, a broad, comprehensive program to prevent problem drinking.

In addition to my role as a member of the Protestant Episcopal Church and a full-time professional worker in our Lords' vineyard, I am also a very grateful recovered alcoholic who, along with my wife and children and other members of my family—especially my mother and brothers and sisters—wish to express our deep gratitude to this distinguished committee and to you, Mr. Rogers, Mr. Kyros, and other members of this committee, and to the other Members of the 99th Congress and to the present administration for the privilege of adding my words of strong support for H.R. 15758.

Starting in 1951, in a small mountain village in the White Mountains of northern New Hampshire, an ever-increasing group of competent and dedicated church people have been planning out a church program. After 10 years in New Hampshire and the neighboring State of Maine, and in Congressman Peter Kyros' neighboring State of Maine, His Eminence Richard Cardinal Cushing of Boston asked the religious leaders of the Greater Boston area to help sponsor our North Conway Institute program. We plan to do four things:

I will quote from "Alcohol and the American Churches,” published by the North Conway Institute in 1967.

We call upon the people of God to join efforts in an ecumenical spirit to attack this major social problem by action

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four areas:

A. THE PASTORAL CARE OF ALCOHOLICS AND THEIR FAMILIES IN THE COMMUNITY

WHERE THEY LIVE

Each congregation must bring to the alcoholic and his family a redemptive ministry based on compassionate understanding and loving concern which seeks to help them withstand the stress, tension and anxiety of modern life by providing hope, acceptance, and spiritual guidance to a reliance upon God.

B. ALCOHOL EDUCATION OF THE ECUMENICAL COMMUNITY'S OWN CONSTITUENT

MEMBERS

We urge all religious bodies to place a new emphasis on the importance of educating their constituents with regard to the personal and social issues involved in drinking.

C. ALCOHOL EDUCATION FOR THE PUBLIC WITHIN THE COMMUNITY

The ecumenical community should take the initiative in seeking the cooperation of other community organizations in the sponsorship of educational activ

ities designed to acquaint the total community with objective facts about the role of alcohol in the life of the community, the several problems that grow out of it, and the responsibility of the community to deal with these problems.

D. SOCIAL AND LEGAL CONTROLS

We urge the people of God to work constructively for the creation of attitudes which will constitute a social control over the drinking customs of the populace by establishing high values on the virtue of sobriety and strong sanctions against the irresponsible use of alcohol including drunkenness.

We urge the appropriate public agencies to enforce the present legal regulations on the distribution and consumption of alcoholic beverages and urge the general public to obey these regulations in the interest of public welfare. At the same time, we urge that new forms of legal control based on scientific understanding be developed.

In particular, we urge the courts to expand practices under which chronic offenders for drunkenness may elect to receive treatment in lieu of jail sentences. We note the special need for constructive controls over the increasing problem of alcohol-related traffic accidents.

The churches then, to sum up, are helping people to prevent alcohol problems through three major avenues of concern:

First, we have a department of research and development headed by David Barton.

Second, we have a department of pastoral services and training which is headed by a native son of Oklahoma, the Reverend William Sprague.

Third, we have a department of communications which is headed by Simons L. Roof, and which is responsible for issuing our various publications.

All of us work at therapy or helping folks and communities who are already afflicted with not only alcoholism but many other types of alcohol problems.

The average Episcopal minister spends 75 percent of his pastoral time with parishioners who have alcohol-related problems.

What we need are facilities such as will eventually grow out of the Alcoholic Rehabilitation Act of 1968.

The responsible churches of America will evidence our long-time continuing interest by giving members of this committee our strong support in your attempts to achieve a new enlightened concept.

The North Conway Institute is a product of the ecumenical movement, which is sweeping the religious community. It is both interfaith and interdisciplinary. The institute has serving on its board of trustees individuals representative of the three major faiths—Protestant, Catholic, Jewish-and the health, education, and welfare professions and volunteer service groups. A wide spectrum of religious opinion from liberal to conservative is represented by the membership of the board of trustees.

One of the notable achievements of the institute was the endorsement of a statement by prominent church leaders of Metropolitan Boston in 1966. The statement was drafted by the Ecumenical Council on Alcohol Programs and was endorsed by leaders from 16 different churches ranging from Roman Catholic to Salvation Army. The key paragraphs read as follows:

We believe that alcoholism and alcohol-related problems are a serious threat to the health, happiness, and welfare of many people and to the stability of families and communities.

Among other consequences of excessive drinking which call for remedial action are the breakup of family life, the stimulation of crime and juvenile delinquency, the mounting of welfare costs, and the loss to industry through absenteeism and inefficiency.

These problems are not new, but they are acute and are made more so by an attitude of complacency and irresponsibility on the part of the general public in whose hands the final determination of social policy lies. It is urgent that churchmen and others concerned with human needs and the moral foundations of our society endeavor to create a more responsible public attitude toward drinking.

We believe that we may all unite on the ground of the virtue of sobriety. This can be practiced in two ways. One is by total abstinence from beverage alcohol for religious motives. The other is by true moderation in the use of alcohol, also for religious motives. On this common ground the virtue of sobriety may be practiced both by abstainers as well as by those who drink moderately.

Although differences of conscientious conviction in relation to certain current drinking customs exist among us, the area of our agreement with regard to drunkenness and alcoholism is sufficiently large and significant as to enable us to unite our best efforts for the alleviation and ultimate solution of these alcohol-related problems.

As churches move closer to one another and understanding increases, Congress will find more and more support among their constituents for health measures to help communities help the alcoholic and his family. H.R. 15758 is a major step in that direction.

In conclusion, may I strongly urge you to recommend the passage of a comprehensive national program to deal with the health problems of families and communities dealing with chronic alcoholism.

The Alcoholic Rehabilitation Act of 1968 represents a real step forward in the beginning of such a program. Again, I commend the Democratic administration for proposing this legislation, for Congressman Staggers of West Virginia for sponsoring it. And I hope you, Congressman Jarman, will get your subcommittee to approve this bill so the Congress can pass it shortly so our President can sign it into law.

Thank you very much, Mr. Chairman, for your gracious courtesy in allowing me to testify.

(Dr. Works' prepared statement follows:)

STATEMENT OF REV. DAVID A. WORKS, EXECUTIVE VICE PRESIDENT, THE NORTH

CONWAY INSTITUTE, Boston, MASS. My name is The Reverend David A. Works of Topsfield, Massachusetts and North Conway, New Hampshire, and Episcopal clergyman, who is the Executive Vice President of the North Conway Institute, an inter-faith, totally ecumenical fellowship of lay people (men and women) and clergymen (Roman Catholic, Protestant and Jewish) who have been studying, praying, working, and waiting for a new or more effective way for the Churches and Synagogues of the United States to help all people prevent alcohol problems.

In addition to my responsibilities with the North Conway Institute, which is now permanently located in Boston, Massachusetts, I am also a member of the newly created Task Force on Alcohol Problems of the National Council of Churches which was created to do two things :

(a) Study the report of the Federally financed Cooperative Commission on Alcohol Problems with special emphasis on Dr. Thomas Plaut's book, Alcohol Problems: A Report to the Nation.

(6) To recommend to the National Council of Churches and through the National Council of Churches of Christ, United States of America, to its constituent members a broad, comprehensive program to prevent problem drinking.

In addition to my role as a member of the Protestant Episcopal Church and a full-time professional worker in our Lords' vineyard, I am also a very grateful recovered alcoholic who, along with my wife and children and other members

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