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as a bill in the 1973 legislature. The
bill has been prepared by the Solid
Waste Section of the Montana Depart-
ment of Health and Environmental
Sciences, as a result of citizen con-
cern and in consultation with the
Committee of the State Chamber of
Commerce, the Montana Automobile
Wrecking Association, and various
county commissioners.

Terry Carmody, Coordinator of the
Solid Waste Section, points to two
sets of figures to illustrate the need
for such a program in Montana:

- State Office of Motor Vehicle Re-
gistration figures show 25,000 to
30,000 motor vehicles entering dis-
posal channels each year, many of
them being left on city streets and on
countryside since sanitary landfills
do not accept car bodies and wreck-
ing yards only a selected few.

— A Montana Highway Department
survey revealed the number of auto-
mobile graveyard and junkyard sites
increased from 129 to 401 between
1966 and 1970, with the number of
car-covered acres from 466 to 1402.

Carmody says the program, if in-
corporated by the next legislature,
would probably be financed by a $2
addition to the annual c&r registration
fee. About hall of the money would
go to counties for the establishment
of free graveyards and possible re-
trieval of some car litter from the
countryside. The rest of the funds
would be used to help pay for flatten-
ing vehicles and transportation to
shredder mills for recycling.

The $2 fee is computed from figures
showing the average car lasting sev-
en and one-half years. Compacting
and transporting car bodies costs ab-
out $25, with the body being worth
about $10 on the recycling market.
No burning of car bodies would be
allowed,

Carmody expects recycling values
may go up in the future. "Anytime



private enterprise 'We can take over
this job,' ", he says, "the state will
sure step out of it."

The proposed plan also calls for
requiring all auto wrecking yards to
obtain licenses, screen and maintain
their property in a manner compatible
with surrounding areas and to keep
records on every vehicle they handle.

Carmody hopes the proposed legis-
lation, which was killed in legislative
committees last session, will be
passed by the 1973 legislature, as
the increasing backlog of junked cars
constitute a serious blight on Monta-
na's landscape. "The situation will
get worse before it gets better, un-
less appropriate action is forthcom-
ing," the official pointed out.

Areawide Council
Elects New Officers

by Jim Toner, Billings

The South Central Regional Health
Planning Council, Inc., held its an-
nual meeting in the Hospitality Room
of the Security Federal Savings and
Loan Association (Billings) on Octo-
ber 26, 1972. The major items on the
agenda were election of officers and
Board of Directors members and sev-
eral reports of major concern for the
areawide council.

The following persons were elected
as officers of the Council: Miriam
Sample, President; Colvin Agnew,
M.D., Vice-President; John Manley,
Vice-President; Beatrice Kaasch,
R.M., Secretary; and Arthur Lamey,
Jr., Treasurer.

Gary Coltrin, Social Worker at Dea-
coness Hospital, and Al Littler, Bill-
ings C.A.P. Director, were elected
as new members of the Board of Dir-
ectors.

Sidney Pratt, M.C., Director of the
Montana Division, Mountain States
Regional Medical Program, talked to
the group about the Health Training
Network agreement that is presently
being negotiated between MSRMP and
SCRHPC. Dr. Pratt briefly discussed
the activities that led up to the pre-
sent program agreement negotiations.
There followed an open discussion
on the content and wording contained
in the proposed agreement. SCRHPC
is to be responsible only for the
planning state of the Health Training
Network,



Robert Quam, representing the Em-
ergency Medical Services Unit of the
State Department of Health and Envi-
ronmental Sciences, talked to the
group about the State Plan for Emer-
gency Medical Services. The plan is
to form local Emergency Medical Ser-
vices organizations as well as Area-
wide Emergency Medical Services
Committees. There is already in ex-
istence a State Emergency Medical
Services Advisory Council. The Em-
ergency Medical Services Committees
will be tied in with SCRHPC and the
local CHP units, but the form this
will take is still in the discussion
stage. At the present time, it looks
as though there will be an Emergency
Medical Services Committee or Task
Force responsible to the SCRHPC
board, once the developmental acti-
vities have taken place.

Ted Clack, State CHP Health Plan-
ner, discussed the feasibility of need
legislation and the possible impact
the passage of the Social Security
Amendments would have on SCRHPC
fiealth Facilities planning. Mr. Clack
informed the group that the State CHP
Advisory Council was awaiting input
from the areawides before it took any
further action on the feasibility issue
of certificate of need legislation.

Jim Toner, SCRHPC's new Execut-
ive-Director, informed the group of
his activities since assuming his new
position. The possibility of losing
Treasure County and gaining Petro-
leum, Fergus, and Judith Basin Court-
ties due to the Governor's new dis-
tricting plan was discussed at some
length.




PAGE ELEVEN



What Now?




Saint Vincent s Hospital, Billings, is looking for a health-related use for Marillac
H^l. which has housed the School of Nursing. The School will close in June of
1973, and the building will be available for use at that time.
Marillac was completed in 1947, with remodeling in 1970, 1971, and 1972. This
IS a four-story building with partial basement. The facility has 68 bedrooms and
four large classrooms; in addition, a first floor auditorium seats 250. There is a
well-stocked nursing library on the first floor, also.

Ideal uses for the building would include health education, nursing education,
patient services, and allied health fields. The committee to evaluate alternative
suggestions includes Charles Kaczmarek, Sister Therese Zimmemian, Beatrice
Kaasch, Bill Aldrich, Dr. Perry Berg, and Paul O'Hare.

Requests for additional information, or suggestions for utilization should be sub-
mitted in writing by January 15 to Charles Kaczmarek, Administrator, Saint Vin-
cent's Hospital, Box 2505, Billings, Montana 59103.

For Monday Mor ning Quarterbacks

by Ted Clack



One of the big complainfs about
CUP, and similar programs, seems to
be 'But what have you really done?'
This naturally becomes annoying, not
to mention worrisome. The complaint
also affects those volunteers serving
on councils and committees. Perhaps
the following will help - a bit -

Think of a football team, and the
game it plays. The goals, intermedi-
ate and long-range, are all set, well
defined, and shared by all. The equi-
pment used in the game is standard.
The rules are all established (al-



though subject to revision), and spe-
cify the appropriate role of each
player. The scene of action is well-
marked and of limited size. The var-
ious plays are limited in number and
many have been in use for years. Ev-
eryone is accountable; everyone
knows exactly what he is supposed
to do. Players get immediate know-
ledge of results during or after the
play, and certainly after the game.
Beyond that, the game lasts only a
short time.

Did anyone ever figure out how long
it takes to play a winning season?



Seminar- Workshop
Scheduled for
January 22 - 23

by Warren Brass, Areawide Coordinat
or

You and several other concerned
citizens have met to discuss health
care in your community. As you look
around the table you know that the
man on your left is there because he
wants to recruit a physician, the wo»
an next to him sees a nursing home
as the most needed health service,
the woman across the table thinks
drug education in the schools should
be the group's first project, and the
man to your right is interested in
working out some way to utilize the
three unemployed R.N.'s in the town.
Where do you start' How do you set
priorities for several pressing prob-
lems? How can you most effectively
structure a committee to begin work-
ing on solutions?

These and related topics will be
addressed at a selninar-workshop to
be held in Helena on January 22-23.
Instructors for the sessions, entitled
'The Program Planning Model in
Comprehensive Health Planning,'
will include Dr. David Gustafson iknd
Dr. Roberta Wallace from the U^'iw^
sity of Wisconsin.

Financial assistance to cover meab
and lodging is available to a limited
number of persons. If you are interes-
ted in attending, please contact War-
ren Brass, Areawide Coordinator,
Comprehensive Health Planning,
State Department of Health and Eb-
vironmental Sciences, Helena, Monta-
na 59601.

This is the third in a series of con-
tinuing education programs sponsored
by the five graduate schools of public
health in the West, State CHP, and
the Southwestern Areawide Health
Platming Council.




PAGE TWELVE

Seeley Facility Applies
for Revenue Sharing

by Anita Richards, Chaiman CHP
Manpower Committee

The antiial meeting of the Seeley
Lake, Ovando, Swan Medicine Center
was held in Seeley Lake, November
10th at Rose's Cafe.

Chainnan Rev. C. Robert Border
conducted the meeting with about 105
corporation members present.

Members of the Board of Directors
present were: Marion Haasch, Swan
Lake; Margurete Wilhelm, Swan Lake;
Anita Richards, Seeley Lake; Nels
Newgard, Seeley Lake; Leonard
Swanson, Seeley Lake; Ann Murphy,
Ovando.

Welcome and introduction made by
Chairm an Border — introduced Miss
Elsie Toavs, State Nursing Consult-
ant and the first nurse of the project.
Miss Toavs was here ten months.
Nurse Wilma Nicholson, clerk Sandi
Doucette, and Anita Richards gave
statistics and budget report.

The Development report was given
by Chairman Border. He briefly ran
down what has been done the past
18 months. Land donated to the cen-
ter from Thelma Caines, money to
operate from CHP and RMP. He stat-
ed that we have applied for moneys
from Catholic foundation and have
applied for Revenue sharing from
Missoula County.

Discussion followed concerning
future funding through fonnation of a
special hospital district.

Nurse Wilma Nicholson stated how
the Rural Nurse was being evaluated
throughout seven states. Question
was asked; since services rendered
could not support the budget, did
Nurse Nicholson feel it was a worth-
while project? She replied, 'Yes, it
is. We still believe in giving service
to humanity.'

The election of directors was by
casting a unanimous ballot for pres-
ented State officers. They are as fol-
lows:

3 year - Anita Richards, Bob Border,
Marion Haasch, Ann Muiphy -
2 year - Leonard Swanson, Agnes
Mantio, Marion Matthew, Francis
Davis —

1 year - Roa Johnson, Ruth Rahl,
Lotti Schlopp - Alternates June Un-
derwood, Laura Kilbum,

* Ms. Mary Jane Crigler, Health Plan-
ner with CHP, and Ms. Mary Mmger,
Nursing Consultant with the Bureau
of Nursing, spent two days in Seeley
Lake collecting data to help evaluate



Idten^ U iJte Sdli^



To the Editor:

/ read with great interest the article on the S.O.S. Health Center that appeared
in the November Montana Comprehensive Health Planning News,

Nebraska Comprehensive Health Planning is currently working on a National
Health Service Corps project to provide health care to rural areas in Nebraska ex-
periencing a health manpower shortage. The nurse practitioner program interests
us greatly.

Since it is apparent that your efforts in this area have proven successful, we
would appreciate any helpful information you could provide us in this area. Some
of the information we are most interested in is the following:

1. What legislation if any does Montana have concerning nurse practitioners?

2. What is the distance between Ms. Nicholson and her supervising physician?

3. Is there a telecommunication system between Ms. Nicholson and her supervis-
ing physician?

4. Where were the nurse practitioner courses taken?

5. What problems did you encounter with this project and how were they solved?
These are just a few of the areas of interest to us; as I mentioned earlier, any

available information would be extremely helpful.

Thank you in advance.
Karen Pickering
Nebraska CHP Agency

* Editor's Note:

Your questions indicate that you have in mind a different model of practice than
that which is operating here. The nurse practitioner at the SOS Health Center is
employed by a corporation whose members are area residents, rather than her be-
ing employed by one or a group of physicians. She relates to many physicians and
other health care personnel in Missoula, some 55 miles away, as well as to others
in Kalispell, some 90 miles away.

Two distinct advantages of this model are 1) flexibility to respond to community
needs as determined by the lay advisory board of the Center and 2) freedom of
choice for community residents to select their own physicians and specialists.
One of the greatest disadvantages since the fees she charges do not cover the

Center's expenses, and subsidization is necessary.

A community's location with regard to available physicians would no doubt be
one determinant of which model is chosen. For example, if there is one overwork-
ed physician serving a large area, the model whereby a nurse could serve in an
outpost capacity might be preferable. However, if the community has traditionally
utilized a number of physicians in a distant but accessible town, the model which
enables them to continue with their own physician would be preferable.

In regard to legislation, several groups including the Montana Nurses Associa-
tion have discussed this question, and it is generally agreed that the Montana
Nursing Practice Act does not restrict expansion of the nursing role as is being
demonstrated at Seeley Lake.

Part of the purpose of this demonstration project was to determine what type of
training nurses need to function in this capacity. The State Bureau of Nursing is
looking at this now. Ms. Nicholson was a fortunate choice for this position (she
was selected by the personnel committee of the lay advisory board) as she had
grown up in the kind of experience that has suited her admirably. Her background
includes many years of clinical experience in a variety of settings. It could be
said that, combined with an ideal curriculum which will be determined by looking
at this and similar projects, the person selected should be imbued with a pioneer-
ing spirit and a tolerance for adventure and the unexpected, because the job is
not routine.

You asked about a telecommunication system between Ms. Nicholson and the
physicians. The project does not presently have such a set-up, although efforts
are being made to provide a two-way radio system in the ambulance which she
regularly accompanies on runs.



the impact of the SOS Health Center
on the community. The evaluation
which is to be completed early in
January will enable CHP to assist
other communities which are contem-
plating similar programs in their
areas.

Much interesting material was gath-
ered which attests to the community's
enthusiasm for the project. State-
ments such as, 'We couldn't do with-



out it' and 'It would be a sad day if
we were to lose her' were heard time
and again during interviews with area
residents. Ah unusual display of sup-
port is provided by one couple who
take out insurance every time they
travel, naming the Center as the ben-
eficiary.



SUGGESTION BOX:



PAGE THIRTEEN



I am a resident of a small town (pop. 672) with no physician and no medical faci-
lities. We are 43 miles from the nearest doctor and 68 miles from the nearest hos-
pital. I am sure that we are only one of many communities in Montana which suffer
from a lack of good health care.

I was talking with a friend the other day and we had an idea about a possible
solution to this problem. We have two nurses in our town who are housewives and
have not worked for several years. They are not interested in working full-time
but might agree to be 'on call' if they had some support. This might include a
small 'retainer' ($1,000 a year?), some equipment (stethoscope, blood pressure
equipment, etc.), and maybe some courses or other educztion to up-date their
training. It would sure help if we could feel free to look to them for help and even
to have them discuss with the doctor our symptoms. 1 know I can't take a trip 43
miles everytime one of my children has an accident on his sled or james a finger
playing ball, but it bothers me that I might cause permanent injury by not taking
one of these trips.

Our town can't even support a full-time doctor or nurse, but I think if someone
helped us to get started, that our community and others like us would pay for a
'community health representative' like this nurse would be.

I'd like to hear comments from others who think this is a good idea and might
want to work on it.

* Mary Jane Crigler, our Health Manpower Planner, would be most interested in
hearing from interested citizens. You can contact her at our CHP office.

Another suggestion: Often people who are not ambulatory are victims in house
and apartment building fires. These people might include invalids, elderly, hand-
icapped or persons recuperating from a recent illness. Local firemen might well
be aided by a signal to evacuate them first. This could be accomplished by prov-
iding to anyone wishing them and to persons leaving hospitals, a 3Vi' sticker
which can be easily removed upon recovery — in order that the sticker might be
placed upon the front entrance, front window or some other conspicuous place.
Firemen then would have been warned that their first duty must be to remove the
person from the premises. The sticker should be printed in a bright color, probab-
ly orange and say merely, 'EMERGENCY EVACULATION REQUIRED.'.



Study Prepared




Shirley Isgar discusses her summer's work with Dr. Roy Huffman. Associate
Professor in Research Administration at Montana State University in Bozeman.
Miss Isgar, one of IS WICHE students in Montana this summer, worked in a pro-
gram sponsored by CHP. The 23-year old Durango. Colorado medical student at
the University of Colorado Medical School in Denver, studied the relationship bet-
ween CHP and three main provider groups in Montana - The Montana Hospital
Association, The Montana Medical Association and The Montana Nursing Associ-
ation. Miss Isgar conducted a series of interviews over a 12 week period. The re-
sults of her study have now been published under the title 'Health Organization
Relationships in Montana.' Copies of Miss Isgar's candid study are available by
writing CHP In Helena.



South West Report:



by Jim Foley, Executive Director,
Southwestern Areawide Health Plan-
ning Council

The SWAHPC continued its 'Action
Oriented' philosophy during the last
month.

We held a Head, Neck and Oral
Cancer project in Butte. The conti-
nuing education cancer review ses-
sion was attended by sixty local doc-
tors and dentists, in spite of temper-
atures of -25 the day of the clinic.
Some 330 local residents participated
in the screening, with approximately
25 referred to their own doctor for ad-
ditional tests.

Helena doctors and dentists select-
ed members of their organization to
meet with hospital administrators and
plan a Head, Neck and Oral Cancer
screening for the Capitol City. The
advisory committee selected late
January for the program.

Currently we're developing a Com-
prehensive Health Plan for the 12
county area served by SWAHPC.
Staff members are organizing health
planning councils in each of the 12
counties to identify all health res-
ources in the counties and all health
rieeds or problems. After a CHP plan
IS developed for each county the
SWAHPC will develop long range
goals for the entire area. Needs of
local communities hopefully will be
taken care of immediately through the
help of Mountain States Regional Me-
dical Program and Intermountain Re-
gional Medical Program who have re-
sources to solve many of these prob-
lems.




PAGE FOURTEEN



"We Need a SUPER PLANNER!"



George Fenner, Director of the Div-
ision of Hospital and Medical Facili-
ties for the Department of Health and
Environmental Sciences, told a meet-
ing of state small- hospital adminis-
trators in Lewistown, how small faci-
lities could cope with the expanded
role of government.

Fenner told the gathering, "It would
be nice if I could provide you with
a method by which you could confront
the system with all its tangled rela-
tionships at various levels of govern-
ment and their rules and regulations.
We need a SUPER ADMINISTRATOR,
like Superman, who is able to leap
over tall bureaucrats at a single
bound and thread through red tape at
breakneck speed, plow under prob-
lems at a single pass and cultivate
change at a mind boggling pace."

He said the Medicare program had
more impact on total health care de-
livery systems, "and was the most
oversold government program to come
down the pike." He added, "industry
enrolled at breathtaking speed to
grab federal dollars — taking little
or no time to read and assimilate the
fine print in the agreements they
signed."

Fenner told the group "Facility ad-
ministratots accepted the State De-
partment of Health survey — black
hat and all — as a necessary evil to
get that Medicate dollar. After all,

Health
Delivery

Systems:
A new

conceptual



he continued, "it only involved part
of a day and the necessity of answer-
ing a deficiency letter — correction
wasn't necessary because the inspec-
tor wouldn't be back for another year
or so."

In 1967 and 68, he told the group,
"the federal government began pres-
suring state agencies to shape up —
things began to change with stricter
interpretation of standards. Written
policies and procedures became more
evident and the term 'paper compli-
ance' was bom."

Fennei referred to the 'terrible TO's*
— five years had passed and in num-
erous instances, many of you sitting
in this room did little or nothing to
correct deficiencies and I further
submit that some of you still have
the same deficiencies you had in
1965. In fact, the only positive thing
you did was rally together to resist
the system."

The director said facilities must
now furnish detailed plans of correc-
tion in answer to deficiency letters.
"Some terminations have actually
begun in this state. HR 1, just signed
by the president, wiU bring six-
month provider agreements to hospi-
tals just as in nursing homes."

Fenner concluded, "Occupancy,
although not a Condition of Partici-
pation, is a problem. I concede that



possibly we may now have too many
small hospitals built with Federal
funds. Some of these are destined to
close in the future but not because
of Medicare standards — because I
believe you will meet the compliance
issues. In my opinion, they will close

because of physician attrition and
inability to recruit replacements in
the Montana rural setting with its ex-
treme weather conditions, plus the
Hill-Burton free care requirements
which will be imposed on many of
these facilities in the near future.
Comprehensive health planning on a
state-wide basis and implementation
of a system which will provide qua-
lity care in a safe environment to all
of our citizens is in my eyes most
important now. In closing, I submit
that the piece-meal planning and
short-range thinking and over-concern
about existing regulations that many
of us are involved in really threaten
to jeopardize the potential of the
health care system to meet the chal-
lenge it faces and if we don't get
with it the federal government will."



model




For thT^a^ who has every thinq!





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Online LibraryMontana. Division of Comprehensive Health PlanningMontana comprehensive health planning news (Volume 1972 VOL 4 NO 5) → online text (page 3 of 3)