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issued written notice of amendment as provided in Section VII or
termination as provided in Section VIII.

Section VII. Amendments

Amendments to this Memorandum may be proposed by either party at the
time of the annual review or at any other time. The party proposing
an amendment will provide a written statement of the proposal not less
than 60 days prior to the date the amendment is to be discussed.
Amendments will become effective when approved by the Service Unit
and the NPSHC.

Section VIII. Termination

This Memorandum may be terminated by either party on 90 days' written
notice to the other party. When such a notice of intent to terminate
is sent, the parties agree to meet not less than 45 days from the
proposed date of termination in an attempt to work out whatever
problems led to the notice of intent to terminate.

Section IX. Agreement

The undersigned parties agree to be bound by this Memorandum of
Understanding, which shall be effective when it has been approved by
the Board of the NPSHC, the Northwest Service Unit Indian Health
Board, and the Board of Directors or Executive Committee of the HSA.

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I have recently been contacted by Charles P. McJunkin, Executive Director of the Appalachian Georgia Health Systems Agency, Inc., regarding a letter he sent to you in rebuttal to testimony presented to your Subcommittee by the Atlanta Legal Aid Society. For your immediate reference, I am enclosing a copy of this matter.

I would certainly appreciate your Subcommittee's careful review of this rebuttal statement so that your members can objectively judge the health planning activities in Georgia prior to the mark-up of the health planning amendments.

Sincerely,

Sam

Sam Nunn

Enclosure

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On February 2, 1978, representatives of the Atlanta
Legal Aid Society and the Georgia Legal Services Program
appeared before Senator Kennedy's Subcommittee on Health
and Scientific Research. The testimony given to that Sub-
committee by Mr. Wayne Pressel of Atlanta is full of in-
accurate information and factual distortions regarding the
implementation of the National Health Planning and Resources
Development Act in Georgia.

Attached you will find copies of letters I have written
to both Senators Kennedy and Schweiker pointing out the in-
accuracies of this testimony and attempting to present a
more balanced picture of health planning developments in the
State of Georgia. We would appreciate any assistance that
you can give us in seeing that Senator Kennedy's Subcommittee
receives an objective view of health planning activities in
Georgia.

We are most appreciative of your consideration of this matter, and if we can be of assistance to you, please call upon us.

Sincerely,

Charles P. Mifunt

Charles P. McJunkin
Executive Director

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Enclosures

P. O. Box 829 101 N. Erwin Street Cartersville, Georgia 30120 Phone: (404) 386-2431

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The Honorable Edward M. Kennedy
United States Senate

431 Russell Senate Office Bldg.
Washington, D.C. 20510

Dear Senator Kennedy:

I was not privileged to be present at the Hearings your Subcommittee recently held on Senate Bill 2410, but I have read with dismay and frustration the testimony given at those Hearings by Mr. Wayne Pressel regarding the implementation of the National Health Planning and Resources Development Act in Georgia. It is shocking to me to learn that an attorney would flagrantly and knowingly provide the Senate of the United States with inaccurate information and factual distortions regarding the implementation of a Congressional Act. For this reason I must make an effort to provide you and your Subcommittee with a balanced presentation of what has occurred in Georgia Health Service Area II.

Mr. Pressel stated in his testimony to your Subcommittee that ". the Georgia HSAS were designed to exclude institutionally those interests (consumers) from being heard much less represented." The truth of the matter is that the Appalachian Georgia HSA was designed strictly in accordance with the requirements of P.L. 93-641 and federal regulations. Contrary to the allegation that consumers were excluded, the Bylaws of this Agency guarantee consumer representation, particularly low income consumer representation through a provision which gives all of the Economic Opportunity Agencies, Associations of Retired Persons, and the NAACP direct appointive power to the Agency's Board of Directors. These persons are appointed without review by the Board, and the Board has no power to reject an appointee unless he or she does not meet the require-ments of the law or federal regulations. Mr. Pressel, as an

attorney with Georgia Legal Services, has had copies of this Agency's Bylaws for more than six months and should know that consumers and women have not been institutionally excluded from participation on this Agency's Board of Directors.

Mr. Pressel is correct in his statement that the Medical Association of Georgia has been deeply involved in the evolution of health planning in the State. Of course, what he did not say is that Georgia Planning and Development Commissions, the Georgia Municipal Association, the Georgia Association of Counties, the NAACP, the AARP, the EOA, the 314-b agencies, the 314-a agency and all of the provider groups were also deeply involved in the evolution of health planning in the State.

P. O. Box 829 101 N. Erwin Street Cartersville, Georgia 30120 Phone: (404) 386-2431

25-122 O 78 pt. 2 36

The Honorable Edward M. Kennedy
February 17, 1978

Page 2

His statements that five of the six original HSA directors were immediate former employees of GRMP, and that agency staffs were enlisted from provider organizations is a falsehood. As the original director of the AG-HSA, I came from the associate directorship of Three Rivers HSA in Columbia, S.C. and prior to that was employed as director of the 314-b agency in Rock Hill, S.C. The original director of the Southwest Georgia HSA was also a former 314-b director. No staff member of this Agency was previously employed by a provider organization to which he or she can return for employment.

The allegation that GRMP orchestrated formation of steering committees which, in turn, became HSAs was not true of the Appalachian Georgia HSA. The steering committee which helped to form this HSA was geographically balanced and formed with strong input from existing 314-b agencies, area planning and development commissions, and GRMP. Public hearings conducted across the health service area prior to the establishment of the Agency Board of Directors were well advertised and attended. Consumer input to the selection process was strong and the Steering Committee and Agency Bylaws reflect responsiveness to this input. Agency records document the openess of the selection and Board formation process.

Mr. Pressel's statement that public hearings are advertised by miniscule announcements buried in the legal notices section of newspapers is another calculated misrepresentation of what actually occurs, at least in this health service area. (Please see the attached example of our public notices.) We have made every effort both through paid newspaper advertisements and radio announcements to inform the public of this Agency's activities. Nowhere in state and local government or other quasi-governmental agencies in Georgia is there more public accountability or public involvement in agency processes.

Finally, the statement is made that no HSA established subarea councils, despite a clearly expressed desire for them. This may be true of some Georgia HSAs, but I have not discerned a public desire in this health service area for subarea councils. Even if there had been such a desire, Mr. Pressel completely overlooks the fact that no HSA in Georgia, save North Central Georgia HSA, has the financial resources necessary to staff subarea councils.

It seems evident to me that this testimony is so misleading and factually incorrect, that I would hope the Subcommittee would view it with great caution. As I have stated earlier, there are no governmental or quasi-governmental agencies in

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