Travis County Commissioners Court
November 29, 2005
Item 8
Alicia, since we have you there, number 8 is to consider and take appropriate action on the following requests regarding the Travis County forensic center, a, cancellation of the Travis County forensic center addition project. B, direction of facilities management to begin the search for a new site for the forensic center. And c, reallocation of current funding of the Travis County forensic center project to planning and design of a new center.
>> thank you. Two weeks ago we met with our subcommittee made up of judge Biscoe#jfuó?i and Commissioner Margaret Gomez. We met with all three, the medical examiner and the two deputy medical examiners. And all the managers at the forensic center. One of the items that we've discussed was the current project that is -- was an expansion at the existing facility on sabine treat. And that -- street. And that project [ññj;ñççó $318,000. The actual construction was about 278 and then you added moving and ff and e and it went a little bit over 300,000. In looking at the broader scope of the needs of the facility, not into five years, but into 10 and 15 years, we determined that perhaps it was the best and most prudent step for us to take another look at long-term planning for the facility. And this meant not moving forward with the temporary expansion, which would probably be obsolete or not give us enough room, we'd need more expansion at the time that we finished the particular project. So what we've come here to ask, and I think the judge and Margaret can -- were present during the discussion as we put it to the staff, is it better to do this now or do more planning and look at possibly another site so that you will have room enough to expand and also to prepare for accreditation. The national association of medical examiners has standards for facilities also in terms of the ability of the operation to function at best practices. So what we would like from the court, there's three items, approve the cancellation of the medical examiner's forensic center addition project, direct fm to begin search for a new site, and also they should be added to conduct a feasibility analysis of the current site. We do not believe right now that that footprint is large enough to allow us to expand for the needs of the operation for 10 years, maybe for five, but not for 10. And as opposed to putting a lot of money, half a million dollars into it, perhaps we need to look at another site. There are some issues that we would need to work out on a warranty deed that we have with the city of Austin, but working with the county attorney perhaps we can address that and he can advise the court in closed session. We would also like to have the funding reallocated to allow us to do planning and design and search for a new site, but also use any of that money with approval of the court for any interim needs that we would bring to the court for approval.
>> since I first heard the plan, it makes sense to me to sort of do number one, but instead of cancellation, I would use delay implementation or hold, because I do think that this matter ought to be further studied. When I looked -- when I thought about this yesterday when my head was much clearer than at the meeting down at the forensic center, I think that we need to take a real good looks at the standards in terms of number of autopsies, professional staffing required as well as the related staffing. The other thing is that at some point we really need to land on how many autopsies we plan to do for other counties. And I don't know that it makes sense to go out and build a new forensic center before we make that determination. Now we have contracts with about 40 other counties, many of them only send one or two cadavers annually, but some send a whole lot more. At some point, though, if the law requires that we deal with the Travis County autopsies, whether we like it or not, then we've got that number. And I think we have to figure out some sort of projection for increases over the next five to 10 years, look at the accreditation on staffing, number of tables, etcetera. In other words, sort of work out all the specifics and then determine whether it makes sense to try to expand where we are or try to find another location. Now, the last time we discussed what fee we charge, we concluded that we probably charge what the other counties do, maybe even a little bit more, but before we build a new facility, if we build it with other counties in mind, we need to go to them and say either you will have to do our own autopsies or we can continue to do them for you, but if we do, here's your contribution to the effort. I mean, I think that's fair. But if we're serious about nams's accreditation and meeting those standards, they are real specific about the number of autopsies per pathologist, what kind of stations to have and the labs, investigators, all the other stuff. The other thing is that at some point we need to touch base with those who may be interested in acquiring the present location about what kind of price we think we may be able to get for it. We invested a little bit less than three million dollars in it. It does have some parking issues, wasn't it 2.9 million that it cost us? It does have some parking issues, but if we just meet -- if we just have Travis County autopsies, it's big enough right now. But if you factor in all the other counties, it's too small. I just think we ought to land on how we'll run it, how we comply with the nams accreditation if we want to get that, what other counties are on board, do they know what the costs will be? And proceed that way. But I do think that holding off on the renovations that we funded makes all the sense in the world, just hold that money there. And if we need to use some of it at the current location, we just address those issues as they come up, those will be drought bureaucrat to court, we'll act on them, do you see what I’m saying? And to the extent we need to use the money to do some planning, then I have no problem with that. But when I looked at the others here, I know there were probably a whole lot more specifically than we need them to because what we're saying really is don't spend this money, let's do more planning, come back too the court, try to land on this. So I’m together on that, but I think a motion just to delay implementation of the renovations or it place that money on hold until further notice from the court and further planning by us. The other thing is that real soon, later January, early February, we probably need a work session discussion because when you look at those issues there's probably eight to 10 real important ones. And I think that each of them probably requires a bit of additional research between now and then. So we're saying the same thing. I guess what I’m saying, though, is that there are some major pieces that really turn on how many other counties we continue to do autopsies for, how many pathologists we end up with, some of the changes that have been recommended to us. The other thing is that we're continuing to study the situation, and it looks like every two, three, four months there's a major recommendation that comes forth that makes all the sense in the world, but unfortunately each one of them has a price tag with it. So if we could gather all of them, and at some point land on them, then it seems to me that we look like we're doing more comprehensive planning than we've been able to do so far.
>> judge, I like the idea of the word delay. We really need to do a whole lot more due diligence because I have not landed on do we go with the expansion, do we just cut off the flow coming in on the front side, do we need to go someplace else. I remember when this project first came up, we did have to do -- there were requirements that I am vaguely remembering related to where's the best location for this, does it need to be near a hospital, does it need to be -- there are some operational issues that we need to go through because it took a lot for us to land on this particular location, and it wasn't just because it was across the street from where the old place was. There were requirements related to those that use the facility. The second thing is I would like to see us have a fence around this money. It's cancelled, delayed, I would like to keep this money established as we had money, a catch for this project so that if it's 30 days from now, 60 days from now, and we decide this is the way we need to go, we've already got that money still identified. And whether it's going into due diligence on a new site, making improvements to the current site, I don't know where we're going to land, but we need to thoughtfully think this through. And I know where mr. La sarj coming on board, one of the things that he is tasked to do is go through that major review of all our other contracts. Because you're correct, judge, if this is about Travis County, we're big enough right now, but the question is whether we can, should or will do anything about all those other counties that are looking to us to medical examiner's issues.
>> rather than terminating those contracts overnight, I do think we ought to give them as much notice as possible. The other thing is when you look at what the forensic center costs itself, the capital cost, it's great. And when you look at what it costs to operate it, you're even more amazed. And if we comply with the accreditation and standards, the costs really go up because we've had pathologists performing a whole lot more autopsies than the nams standards recommend. So if we come back to their recommendation, they will do half as many as they do right now, which means either they have to do less each year or we have to have more certified pathologists there doing them, so you're not only looking at operational cost, but at expansion or completely new facility. And I think that you let the other counties know here's what the cost is and here's what we have to charge per autopsy and what you've got in mind, are you still with us or are you going to look elsewhere? And if they say they want some time, then I think we ought to be able to give them three, four months for it rather than three,ñc! Weeks. This is the kind of service that you really can't just go anywhere and get. Most of the urban counties do it, most of the small counties contract it out.
>> and judge, I think this project also screams for us to take a second look at what are our planning windows. If you go through the numbers on this, this thing was planned in 1992. It was constructedn
>> they moved in in January of '97.
>> January of nefn. So -- '97. So we're coming up on nine years that we've occupied that. So it's for the space plus size, well, sometimes that is exactly when you occupy the building and what window you have for expansion and future needs are eaten up by the very time it takes to plan something, get it built, and we're running into the same problem at the cjc. That building by the time it finally got finished was used up in terms of any space for the future. And it's like we just can't do five-year windows on major capital projects because they are very complicated, they are very expensive. We've got to have a longer planning window on some of these things. The building has to last for 10 years from the date of completion, not 10 years from the first time we start thinking about it because this is -- this is just not helpful because we've got a lot of stuff that it's all of a sudden starting to pile on us at the same time in space of spaition needs for civil courts, criminal courts, all the departments associated with all those things over in the cjc. Now the medical examiner's office. It can't be five years from the moment of planning, it needs to be five or 10 years from the time of completion, and those are quite different windows.
>> where are we today?
>> I’m finished, thank you.
>> where are we today as far as the staffing of the medical examiner's office? We did look at some staffings that we wanted to make sure happened with investigators and some things there. Where are we currently?
>> we have been able to do some hirings. We have also unfortunately had some resignations, so we have two investigator vacancies and a forensic nurse vacancy. All the others have been hired. We hired two path techs, pathology techs, and two investigators.
>> so outstanding --
>> three.
>> the reason why I pose that question is because of the fact that I’m in agreement with what the judge and Commissioner Sonleitner has brought up. In fact, during the session that we discussed before the Commissioners court with the consultant that we had brought in to give us an overview of what we need to do, I think we are in step and according to a lot of these things, especially in the arena of accreditation. I think it's very important and it just may be the fact that we will not fulfill the adjacent county's request to deal with autopsies. Right now we may be out of their realm. I think they need to be revisited to see, number one, to go along with the staffing request that we have on board now and fill those vacancies, but also number two is that to give -- as they suggested, to give an overview of what 6j are far as autopsies are concerned. And I guess to let them know, as I think the judge suggested, that we may be where we are now. We may not need to go anywhere just to satisfy Travis County. And if the work load is going to be to the point where we're overworked for the staffing that we hq?vwe??Ze additional staffing that we're going to bring in, that that goes outside of accreditation in my mind. What I’m trying to make sure is we stay within the accreditation arena with the proper staffing and maybe looking at ways to look at this. But the money itself, is there going to be an additional need for money to address the outstanding concerns that we have that's been discussed here today, especially if we need to start looking at the other counties as far as looking their autopsies coming into Travis County. So I’m trying to match the money with the outstanding shortfalls that we have on the table today. So if there is a need for expenditures to address these shortcomings, then we will be funding accordingly. I know we mentioned putting a fence around some things, but I don't want to put a fence around something and we need money to make sure these shortcomings that we have existing right now, that we can address and also come within the realm of accreditation. That's my concern. Can somebody answer that for me?
>> yes, sir. I think what the suggestion was is that this is capital improvement money out of car. That if we maintain this money and if there is an immediate need we would come back to the court to draw from this pot of money just to take us through the planning period. I think the suggestion by judge Biscoe for a work session in early February is a good one.
>> late January or early February. The first available opportunity.
>> the first available opportunity is a good issue. A lot of these issues are dynamic. Mr. Lasarge started yesterday and his part of the task is to look at the 45 contracts and see where they're at and what we need to do. There's another possibility of creating a medical examiner's district. That's allowed by state statute. So I think there are -- what you do with the contracts will determine what you do with the facility and the staffing. But I think all that is very dynamic because what you do with the contracts has to do with also your relationship with other counties, the need, -- the area need. And a lot of you are involved in regional issues.
>> the hospital district experience does not bode well for the medical examiner, by the way.
>> the bottom line is that we need to do some analysis on what your options are on the contracts. And then you will determine what your public obligation is on a regional area.
>> let me just ask this, and I’m going to shut up here in a little bit. But what -- let's say we have a county that does not have the -- an me of someone there that can do autopsies and things of that nature as Travis County do. And we have them under contract, for example. What have other counties done that may have discontinued that type of service for autopsies? What do those counties do if that service is discontinue snd are they just left out in the cold or do they hook up with someone else offering that type of service? What happens to them?
>> that's the sort of research that we're doing now. There are private -- we know of at least three private autopsy centers -- not medical examiners because that has to be done by a government, but autopsy centers for private autopsies. The responsibility for any investigation of a suspicious death is with the particular county. They contract. If a county is unable to provide the service, for example, lubbock about a month ago lost two of their medical examiners to el paso overnight. Two of them left and they went to the county of el paso. They literally had to shut down all out of county autopsy services. And so we got one case here, and then the other ones went to look wherever they could because there are only 11 of them in the whole state of Texas. So they're very limited. And most of them are in larger metropolitan areas, tarrant, harris, dallas, san antonio, Austin, el paso, down in the valley and then lubbock, but there's only about 11 of them in the whole state. But those are the sorts of policy issues that we're looking at.
>> okay.
>> and one thing related to the hospital district, and totally different, is that while we may have counties that choose not to join the hospital district, they still have the right to send their patients in an emergency mode to brackenridge er. We have discretion about whether somebody can send us cadavers or not. That is something. They can't just say, ha, you must do this. And I think so the review of the contracts are extraordinarily important as to what's our capacity and who comes first here in terms of whether it's Travis County and whether we can, should or could perform these services for everybody else and whether they pay their proportionate share on this thing. It's not fair to put this thing on Travis County residents. I think that's one thing we really need to see. If all we did were Travis County cadavers, that's it, whether it's on a private basis or because there's some question about that person's death, what is the staffing that is needed for just that purpose? What would we need? And then you look at, okay, what's the add-on if we can, should, would, could, take on a more regional function or a more limited regional function? But we need to know what it's going to take and that we have to pay for no matter what related to what's going on here in Travis County and see what the differential is and go from there.
>> good questions. Mine is what is the best and cheapest way for us to get like an informal appraisal of the forensic center?
>> informal appraisal for the facility. I think we ought to do that, bow spending a lot of money we ought to have an idea of what the appraised value: we ought to informally inquire as to whether or not some of our neighbors are interested in owning that tract. The other thing would be that somebody needs to kind of look around and try to identify other available tracts that we think would be useful. Now, last time we had a real bad experience in that we came up with multiple potential sites and we eliminated them one but one, and the last one was next to a graveyard, and I thought that we would enhance that area, but the neighborhood association came unglued and they thought that was the most negative thing in the world. So it is not easy to find a location for a forensic center once people understand exactly what the intended purpose is. And the other question would be, if we were to expand at the current location, how much expansion is available? How would we go about doing it and what's the approximate cost? It seems to me that when we have a work session, in order for us to really kind of land on some of these key issues, we would have to have the answer to these issues as well as specifically what are the nams accreditation standards and how would we go about meeting them? What would they cost? How do we change how we currently do business? And based on what I know, you're looking at fairly dramatic changes for us.
>> that's what that line of question of replace be. And as opposed to doing what it says in b, you would like to have those questions sort of answered.
>> yeah. When you pull the nams list, you probably come up with 20, 25 key issues. They don't deal with our current location, whether we need a new one, etcetera, so I was trying to ask that. There's no way for us to get around looking at the financial side. And the nams accreditation standards do not deal with money, right? They deal with how you ought to manage your autopsy office from an operational perspective, money aside. As far as I know, right? But there's no way for us to make an informed decision without factoring in cost. And so my goal is to put us in the best position for the January or February work session by at least having a pretty good idea about the answers to some of the basic questions.
>> judge, part of this due diligence that I think we need to think about is welrkñie moving a good chunk of their property, children's, over to the airport site, and I don't know -- I know we're going to have a need for I’ll call it a sally port for lack of a better expression for where certain vehicles need to come in and make deliveries, but I don't know if there's any portion of8rt'çóçóuñ seton property that -- in terms of a lot of the stuff that we do need to do are things that are consistent with what goes on in an operating room, lab areas, administrative areas, about whether there is a piece of that that could be utilized and maybe it's a swap because we have land that is right next to where their footprint is as well. I don't know if there's something that could work. I don't know because of the delivery situation whether that's even a possibility but we could have some conversations about what are the plans for the vacated children's. Certainly they need to move a lot of the regular brack into that area. They some expansion needs themselves. But I would think that some of that on the first floor that is accessible through the first floor, whether that is something that could be compatible because of the operations that are going on over there right now in terms of people coming over, police coming over, the situation. I just remember that a lot of this was absolutely tied to proximity to the er and to the Austin police department and to investigators. That there was a proximity situation. And certainly they are set up related to all the different gases, chemicals, all that kind of stuff because that's the stuff already going on in a hospital. So I think a conversation with jesus would be suggested here as well on due diligence.
>> move that we delay I am implementation of the approved renovations to the forensic center and that we authorize staff to move on the other due diligence efforts that we outlined today.
>> second.
>> any more discussion? Any other experts here on forensic centers besides the court? All in favor of the motion? That passes by unanimous vote. Thank y'all very much.
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Last Modified:
Tuesday, November 30, 2005 9:31 AM