OPTLON C ALE gadivtion rebated diseases in the exposed and control groups on Rungelap and Uticth plus all iow level radiation exposed pattents who have already yone through full screening - irrespective of 1, findings of disease Establish che broad objectives As in Options A and & bue adding all patients, exposed to low level Il. Existing Potlcy As in Options A and B, Thia option refleces exis¢ ing sereening will be modifted as derailed de facto fleld policy. Hobbins and tall. Existing needs and demands As in Option A and B. Adding a for the "Wirected data base - risk hazard appraisal" approach of portion of the Bikint populetion wl)l probably not fulfith the Marshallese demands or needs. Projected needs and demands As in Option A and & It scems probable that we will be unable co separate, for medical purpases, the Bikini people who returned to Bikini from the remainder on Kilé. The Eniwetok people will probably alse demand equal treatmenc. Planning ar ather levels 43 in Option A and 8. U.S. Powerful congressional groups (Yates Committee - on appropriations, etc.) are interested in and investigating the well-being of the Marshallese. Existing facilities As in Option A and 8. A redesign and construction of o flexible, mobile screening and treatment support facility - would in che long run increase efficiency and reduce cost/patient. Flnanciat As in option A and B. The signifi- cant variable will be the (7) addition of the people of Bikint and Enlwecok. Manpower As in Option A and 8B. Aguin the additLon of Bikini and Enivetok would more than double the outpatient load. However, the staif could probably handle the increased load wich che addition of a Physician Assistant ead a nurse praccitioner. Timing DemographicPopulut lon As in Uption ASB. sere nd. As [6 Oprion A and &, oractyriatics No further constraines (optimum timing). Plus 41! patients (exposed ta lew lovel cuddatio) previously Adding Bikans (450) 4 Poiwetuk (450). I¥. ILI, Tranalations As in Gptions A and B. rudiation, who have already yone through the BNL screening procedures. This represencgs the current level of uperation. In the future, the Constraince Present levels of care Restatement: of reflned objectives in constderacton of restraints. As in Options A and B - Since this {3 our present level of operation with existing funds - no significant Cranskation of objectives fs necded. Analysis V. Develop possible approaches tu attaining the objectives, with each approach being stated in terma of: What: AS in Options A and Bb. Whe: As in Options A and B, - Selection Criteria Set forth che criteria for the selection of an approach: _ Performance or results As in Options A and B. Totalcost As in Options A and B. Ser - low: for discussion of costs. ay TW, plus all patlents, exposed to low level radiation who huve already gone through BNL Flexibility sctatuy of Blkinl and Eniwetok will change requirements. and manpower} + permits betrer acheduling, screening procedure - again Where: As in Options A and B plus Kili, Jaluic, 7? Enivetok ? Ujelang. Whea: As in Optiona A and B. How: Tf the patient loud Ls doubled and increased, primary care la expected. There will need to be upproxi- mately a doubling of the operat ing budgec with a 66% Increase in personnel and a ship assigned specifically to the medical program. Ic would de prudent ta separate the idencify of rhe BikiniEniwetok group from BNL We could retain administrative concrei and function as advisors, but a subconmtractor might alleviate some of the unxtety of the new study group that would arise from the “radiation” oriented BNL group. We would suggest the University of Hauwali as the most suitable and interested party. Funding for this increase in primary care might be obtained hy pass~ through funding from DOI. As in Options A and & - Increasing EFlexibllicy due ro larger responsibility for care and betcer support (logistic Avofdance of untoward congcquences As in Opetons A and B - plus added credit tor more comprehensive care, Risk As in Options A and & - With increasing volume of patient care che pussibility of ut. -loor poor performance may increase - 7?) Gverc. vente - thls cun be offsec by adequate planning audi iugistie supporr - Expanded operations withour these elements should not be attempted. Lost/effectéivenusas As in Oprions A and B. Timtag As in Options A and B. This Ls the optimum rime, in Lighe of the political and soctologle situation in the Marshalls to enlarge the progrum and to make a positive effurt to change the image of the study.