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OFFICE OF THE SECRLi AK I Honorable Alex C. Fremlinz Acting Assistant Secretar~ for Safety, and Emergency Department of Energy Thank you for your letter of }Iarch 27, 1981, on the matter of medical costs associated with non-radiation rela~ed medical conditions among the Rongelap and l’cirik 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 i:ationzl Laborator~mand contractor physicians on the Rongelap and refer non-radiation related medical cases to Honolulu. >.E tines there have undoubted; been emergency conditions thee obviously did nor F.ave the capability to treat certai~, The fact rer.sins, however, that the Iqarshall Islands ~o~’ern~.e~.t has the responsibility for providing regula~ medical care tc its citizens. ?he llarshall Islands Go\’ern~ent receives approximately $2 million a year ir.Federal funds specificall:.- for health services, as part of its annual grant-in-aid fron. 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 }Iarshall Islands appropriates funds frcn local revenues for medical referral costs, since for the last several years these referral costs often ha~~’eexceeded $500,000. There also has been local criticism of the use of the medical referral program, and this led to the establish~.er.t
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of a Medical Rafcrral Board that now screens and approves all refermls. But the point of xjor, currant importance raflrzal em t8. If aaargancy sftuatixms remit and the fund fa exhzustod, addftfcmal funds could be made lvailable to this aocmat by reprogramming m by special lppmpriati.ons of the Marshall Islands Legislature, the Nitijela. The Ma uro Hcmpital nuw is run by a medial care contractor. iPart o the contract calls for up-grading of medical staff lt the Xajuro Hospital, -d spacialfied staff Lc being made available. Conditions are imp- at the Majuro Empital. surgery would have to be referred to Honolulu, but this llso wuld be the case for any Marshallese individual in l stmilcr cundition regardless of residence. The Bikini situation you cite is mi.que in that the lgreemmt to provide special medical care was connected with the emaxgency evacuation of tha ~OUp of 144 Biktiians from Biklxd Island in August of 1978. The#e hdfvi.duds believed that thay had received contml.nation by lS- on Bikini Islmd, and the agreemant was made under these nry special cfrcumstances. It d{d not protide for special medical comrage for Biktiians who were Ifting on lUli Island or llsewhere in the MarahaU Islands. Until a special ccmxprehensivehealth care program is In lffect pursuant to P.L. 96-205, non-radiation related medical cases that requfre trea?mmt should be refereed to the lppropriate medical authorities in Majuro. The Medical Ketim Board there has the authority to refer c-es t~t ~t be treated locally to Honolulu. Billy Lee Hart Acting Dqwty Assistant Temltorial and International Affairs