‘United States Departmer Attachment C OFFICE OF THE SECReriaky WASHINGTON, D.C. 20240 APR 16 1984 Honorable Alex G. Fremling Acting Assistant Secretary for Environmental Protection, Safety, and Emergency Preparedness Department of Energy Washington, D.C. 20585 Dear Mr. Fremling: Thank you for your letter of March 27, 1981, on the matter of medical costs associated with non-radiation related medical conditions among the Rongelap and Utirik people. We realize that this matter has been the subject of several discussions in the past, but unfortunately circumstances are such that resolution to the satisfaction of all concerned does not appear possible until the adoption of a health plan pursuant to Public Law 96-205. We understand the reasons why the visiting Brookhaven National Laboratory and contractor physicians on the Rongelap and Utirik medical surveys have felt it necessary in the past refer non-radiation related medical cases to Honolulu. times there have undoubtediv been emergency conditions th warranted such action. Additionally, the Majuro Hospital obviously did not have the capability to treat certain petients. The fact remains, however, that the Marshall Islands Government has the responsibility for providing reguler medical care tc its citizens. The Marshall Islands Government receives approximately $2 million a year in Federal funds specifically for health services, as part of its annual grant-in-aid from the Office of the High Commissioner. In the FY 82 budget year, the health operation allocation for the Marshall Islands is set at $2,075,000. Of this amount, $378,000 is earmarked for outside referral costs. Additionally, the Government of the Marshall Islands appropriates funds from local revenues for medical referral costs, since for the last several years these referrai costs often have exceeded $500,000. There also has been local criticism of the use of the medical referral program, and this led to the establishment