OPTION D i. Establish the broad objectives ‘As in Options A, B and C but with atied emphasis on early detection and treatment ot all significant diseases. This option offers unequivocable evidence of the true concern of the U.:.‘for the comprehensive health care of t': peoples of the islands contaminated by the testing program. ��� fn addition, such a program would aiiow us to develop a mucn more signi- f'sant "health profile" of the inorshallese to assist in the deter- a mination of petential radiation tzLated pathological conditions. II. Constraints LII. Present levels of care Translation Restatement of refined objectives in consideration of restraints. As in Options A, B and C — This opticn exceeds the mandates of our present pregram and would be impossible withouc an appreciable increase in funding. As in Options A, B and C, the restatement af objectives will be dependent upon: Existing Policy As in Options A, B and € ~ In additior in light of the recent (Gece. 12, 1978) ° DOE/DOI/DOD meeting on the status of the peoples of Eniwetok and Bikini, it appears that this option is the one favored by the Under Secretary of the Interior Mr. Joseph. , 1. The definitions of the role (moral/fiscal) of the administrators of DOI and ‘ DOE to carry through on che statements of principal made at the Oct. 12, 1978 - DOI/DOE/ Existing needs and demands This option most closely meets the needs and demauds of the Marshallese people and their leaders. DOD meeting in Washington, D.C. concerning the status of the peoples of Bikini and Eniwetok. 2. %I£ full health care responsibility is assumed - Option D Projected needs and demands Since this option provides adequate health care for all currently and potentially involved Marshallese, it 3. If limited health care responsibility is the choice ~ some compromise between Options C and D is indicated. should meet all projected needs and déenaads Planning at other levels As in Options A, B and € Existing facilities As in Options A, B and C - A major expansion of existing facilities would be necessary to Support a medical program more than twice: the needs no restatement. . (aed ee) Who: With the expansion of the the medical staff - work medical officers and the patient population, it would be wise ta set up (2) field medical teams; (A) the BNL- acute exposure study team (covering vecples of Rongelap ' Utirik) and (B) the “low level" study group - under contract ~ both supported by adequate-1° =20 care at Ebeye and Majuro- Where: Research based upo’ a £ system will provide opti population of the Marsha] of these only about 2,00( The remaining Option D. the general improvement primary centers, - but tl As in Option C. When: As in Options A, B and C. As in Option C - plus Total cost Really impossible to d However, based upon our C) with a cumulative bud to Option D shoul cost . Flexibility This option gives us t examinations in the fiel medical and transportati Avoidance of untoward co This option offers the ment to the people. Thi image of U.S. in ail of In addition, with the ne might decide to fill the physicians (with the goo nuciear MD's might becom 1 Cost/effectiveness As in Options A,B and Timnin This is the optimun t* reasons: A} The movemel the Marshall Islands in the health care deliver) in this period of gener: of Bikini and Eniwetok i - to their very legitimats Timing The time is now optimum for DOE :- lisit of DOI and Narshaliese scatements of needs. iy Full directed data base, What: Screening and follow-up of pertinent findings in population defined under “Objectives” Risk Least risk of a11 opti then not honored. IV Analysis of "dow" for manpower requirements. + Performance or resuits trained physicians at Majuro and Manpower (13) As in Options A, B and C. = Please see Section opt bon Set forth the criteria fo terms of: Ebeye - supported by paramedical personnel, Physician Assistants and nurse practitioners. A cost study would need to be instituted as soon as possible to determing the curren: and future costs of such a program (please sve section V Selection Criteria) -— under "Total Costs". DemocrannicPooularion Characteristics VY. Selection Criteri Develop possible approaches to attaining the objectives, with each approach being stated in teams plus at least 2 U.S. Financial Wry ona ean ee “S$ i Optio: boanmd C - The ary vie cavere: .tLL be cuch mare than devi? 2 4. this Analysis added manpower to support 2 Field present effort. 9052228 Ty. How: Tie ne emu ree aor t ALL radiation related diseases in the exposed and control por ulations plus full screening of all inhabitants now living (er scheduled to be repatriated to} Marshall Islands contaminated by ato n ic fallout | 9052228 052228