VI. Trade-off or Synthesis We realize that options A and B would, in fact, represent a reduction in the level of health care delivery currently available. A review of 2 most recent "189" for F¥'79 and FY'80 reveals that in February 1977, DOE agreed "to assist the TT in an expanded health care program for the people living at Rongelap and Utirik. This included complete medical and laboratory examinations of ...all Marshallese living on these atolls." The problems inherent in that agreement were the inability of the TT to follow-up on the diseases discovered in this expanded screening. The BNL field team has limited resources to adequately diagnose and treat primary medical problems. As a result of intensified screening, a large number of "abnormal" findings have been identified. These demand further study and resolution if we are to meet the basic tenets of screening: 1. Do NOT screen unless: You are prepared to follow-up and resolve false positive and false neg- ative findings. 2. The screening process will result in some benefit for the patient. From a moral and medicolegal standpoint, we should insure adequate follow-up and treatment of all treatable conditions. To identify disease, inform the patient of the disease and then fail to treat it, would run the risk of a serious loss of credibility for the medical team; and more importantly, a disservice to the patient. For example; if a patient is told he is hypertnesive (e.g., diastolic over 105 mmHg), 1. and is not treated, he can assume that: the findings are of little importance because... "the doctors did noth- ing about it." oe