Travis County Commssioners Court
October 21, 2003
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Item 18
That brings us to item number 18. Which is consider and take appropriate action on strategic strategy to improve the following major interlocals: a is Austin-Travis County central booking; b, Austin-Travis County emergency medical services; c is Austin-Travis County social services contracts; and d of number 18 is Austin-Travis County health care services contracts. And my short memo indicates the purpose of this item and that is to give us an opportunity in '04 to deal with some of the issues that we have talked about over the last few years. These major interlocals have caused problems for us. Each year it seems that the contracts emerge at the 11th hour of our budget process, and so this is to give us an early '04 start. In response to an e-mail, I did get recommended names of persons who work on the different -- work for the Austin-Travis County central booking committee. I indicated that I thought that p.b.o. Should be on that. The sheriff's office, the auditor, and justice and public safety. And yesterday mr. Tremble sent me an e-mail that indicated from the sheriff's office emily trevino is recommended. Major emily trevino, along with robin osborne and kelly paige. So that's three people from the sheriff's office. If there is formal voting, they will all vote as one. And justice and public safety, michael trumble with kimberly pierce serving as backup. And susan, anybody from the auditor's office?
>> [no microphone on]
>> okay. Any other discussion of the central booking agreement? By the way, I do recommend -- I recommend in my memo and I do today recommend that we have some in-house meetings to put together what we think would be model standards. That those be brought to the Commissioners court for feedback from us before we send them to negotiations with the city of Austin. Most of these contracts have been around for years and it's been a while since we considered "-.
>> georgia, hi a chance to -- judge, I had a chance to speak with the city manager this past weekend, and I think she seemed to show some interest in our rlocal agreements also. So I think the interest is being shown on both sides, the county as well as the county.
>> good timing.
>> I appreciate this being brought forward. There is a cobbling of our relationships and it's caused problems and not made it easy for the county attorney to keep track of all these things. The purchasing department, the auditor's department. We've never in many of these things been able to say truly what is the cost of these services, whether we're the ones providing it for the city of Austin or whomever, or vice versa. And there's also in terms of how do you document it in terms of what's fair, if terms of [inaudible] [inaudible] why aren't they doing it that way and the e.m.s. Really they have some continuity. On the e.m.s. We're work through this and getting close to having it. There is a total rewriting of that contract because it contemplated this united system. Well, we got that now so it needs to reflect reality. Central booking was kind of the same thing, it was happening at the same time we were moving and shifting responsibilities. Judge, I really appreciate this everyday of effort and I'm just wondering related to central booking and the two ones related to health and human services whether there needs to be somebody from the court I want to say -- I don't want to say being a mentor, but somebody keeping an eye on it or committee structure to bounce back feedback the way that we're running through the [indiscernible] to kind of help ride herd and be the sponsors once it gets to the Commissioners court. I'm open to that, judge.
>> I was interested in helping with the central booking committee and the -- both of the social service, h.h.s. Contracts.
>> I would like to mention one more thing. I know the county attorney's office obviously is going to be involved, but if we want to see them assigning somebody to the committee now or if there is going to have involvement as we go along.
>> on central booking, [indiscernible] provided to the county attorney's office. So maybe [indiscernible] if you are listening, we could get that person's name.
>> he's sitting on the front row over there.
>> hidden in my short memo --
>> and that would be jim connally.
>> and I was going to say jim connally who has background and experience with this.
>> jim, are you the one?
>> I believe so, judge.
>> everybody is putting you on this committee.
>> judge, I think that would probably be true of the others, wouldn't it? County attorney's office --
>> yes.
>> absolutely.
>> hidden in my memo is a recommendation that members of this committee have the time to commit to this effort. We know a full commitment of time, in my view, we are probably looking at five to six months of serious work.
>> oh, yeah.
>> uh-huh.
>> if it's done.
>> I know on e.m.s. We're a little further down the line because the work has -- so I think we're aiming for December, January to get it to the court in terms of the full mega thing.
>> anything else for central booking?
>> judge? Yes, is there any attempt in this to [indiscernible] with the city of Austin or anybody else we are doing an interlocal with on these particular efforts, a point person or something like that, because I don't know -- I know what we're doing here as far as what we're trying to do, but I'm still listening to what the city manager was saying, but of course that wasn't a point person as far as the city of Austin, I'm just wondering who that would be. That direction, do we need to strive for as far as what we're doing, but then have a point person on the city's side that can also --
>> well, it's a city-county committee.
>> we ought to get our house in order first and then meet with the city as a sort of second stage.
>> okay. I think that's fine. I don't have any problem wit. I just wanted to know if we were going this n. That direction.
>> after we come up with what we think the model ought to be, then we'll meet with the city and I'm sure they will have opinions, thoughts. Our goal would be to reach an agreement that is satisfactory to boast us.
>> okay.
>> anything else on central booking?
>> judge, do we just -- do we send something to the city letting them know that we have put or is that just assumed that --
>> I'm assuming they've been listening to us this year.
>> if they listen to us any more than I listen to them, they are never going to know it.
>> in terms of [indiscernible] putting together and try to work on the interlocal, surely they know that.
>> I wouldn't mind making a call or sending an e-mail or something.
>> I think the county committee is one forum that we can let them know what we're doing.
>> that would be great.
>> is it too formal to send a letter to them to say, hi, we're devoting a lot of time and attention to work on major things. Here's what we're do, we look forward to meeting your counter parts as we work through them.
>> I would just tell them. [laughter]
>> can I make a comment just in general, judge? On all of them. You know, we could see the financial side, we don't see the operating side. But these four agreements that you've picked are certainly not the only interlocals, but they are the big ones. Just to give you a feel, in '03, the amount we got from the city -- we made $7.5 million to the city for e.m.s. The soerpl service contracts were 7.2, taken health care between the general fund and fqhc was $10.7 million. What's happened over the years is the size of the contracts have increased significantly. And I think that one of the things that we should keep in mind as we're looking at these is perhaps not necessarily just the approach we had before because although many of these are with the city of Austin, we have other interlocals as well. And we of course are the large government. We're the ones that represent every single taxpayer in Travis County. And in some cases, you know, you set up an agreement and see how it operates and whreuts an internal agreement or external, sometimes it just doesn't work out the way you thought it would. Things turn out differently. But I think we need to look at these and make sure that the quantity and quality of services that you contracted for you are still getting. And that you are comfortable with that. When we provide the service, which is the central booking, we need to make sure that we're getting reimbursement that covers the cost that the city of Austin in fact is incurring. The other thing is I think we need to be sure that there is no erosion of full access to the information that you all need to evaluate the services, both operationally and financially. And sometimes that erodes because in some of these interlocals what has happened is when we manage the services here, we have financial people. But then when we enter into the interlocal, we eliminated those positions because the city was going to run them. So then with a what happens is if we need financial information, the question is who provides that to Travis County since we gave up, we, Travis County, those financial positions ran assuming we're getting that kind of analysis. And that perhaps needs to be clarified. And then the last -- you know, which is kind of the obvious, is these interlocals are in fact the most cost effective way to provide services to all citizens of Travis County whether they live in one of the 21 cities in the county or if they live in the unincorporated area. So there's a specific kind of grinding out the details of each contract, but I think these are overriding issues that we also need to make sure that we look at. And as we're doing that think, you know, is there a better way to handle this, should we continue with them, should we revise the contract or might there be a better way. And there may not be. We may look at these contracts and say this is the best way to handle this. But I think it's -- I agree with you, judge, it is time to really look at those contracts from an operational and a financial perspective.
>> yes, sir.
>> my suggestion was the social services contracts, the health care services contracts would be that we combine them, but also include public health. When we were in an agenda meeting last Wednesday, we got about the general public health interlocal, which covers the public health clinics that are in Austin-Travis County health and human services. I believe that internally if we're able to agree on certain principles to meet the spw-sz of all the parties, with one work group we will be able to feret out the appropriate tracking system once we establish that bench mark or threshold internally. For me I have essentially the same people that would be working on each one of these in different areas, so therefore I think if we had representatives from purchasing, auditor's office, p.b.o. And the county attorney's office working with my staff, and at an appropriate time there would be appropriate city of Austin staff which would vary in each one of these categories, I think we can get through the work just as sufficiently than having three committees dealing with these issues. The services are different, but the principles will mainly be the same. I think once we agree on them, we can move forward with them.
>> e.m.s.
>> regarding e.m.s., Carroll is not here due to a death in the family, but i'll speak on her behalf and hopefully the committee that has been working on this and as Commissioner Sonleitner has mentioned, this has been a working committee for some time.
>> ms. Coburn has been on the committee.
>> I would put her as the lead and me as backup. I would put both Commissioners as wall representative from the auditor's office and p.b.o. Alan miller has been working with us and christian is shaking his head the positive way so alan will continue. Add, if you would, the county attorney's office because we've had two attorneys working with us on this agreement and that is julie joe, unless you change it, john or david, and barbara wilson. And so we would like to make that the working group that -- for e.m.s.
>> now, it seems to me that part of this strategy should be for us to generate what we think the material facts are. What I have noticed is that if you chat with five county employees or managers, you really run into five sets of facts.
>> Commissioner?
>> and so -- I mean I think we would do ourselves a great favor if we generate what we think the material facts are in each category. And I really think it's difficult to come up with a specific and reasonable terms and conditions without know whag the facts are, and we really ought to know the facts, I think.
>> a good jumping off, judge, for the discussions on e.m.s. Is the work session -- work session or agenda item of when the emergency service districts came to visit with the full court and kind of lay out their concerns. I'm sorry, I'm having a brain freeze. Was that just you and me?
>> yes.
>> or was it the --
>> just you and me.
>> I apologize, there's been so many. But the e.s.d.s really laid out what their issues were that they wanted to make sure were covered, and it seemed to be resonating the same kinds of things that each of us individually had heard with our e.s.d.s. They pulled it all together. So those conversations have been previously occurring with the city trying to take a two-part relationship and bring in a third. I apologize for misstating.
>> and what I just handed out, judge, is a real good example of what you just said, and that is -- and this was a communication between shawn o'neal from my office and carol coburn saying from the financial end these are some of the facts that we need to know. And I think that's the kind of thing that's the bye cyst for making -- basis for making good decisions and one of I think our challenges will be who did we contemplate would calculator gather that kind of data, those material facts. So shawn o'neal will be the person from our office on e.m.s.
>> shawn o'neal.
>> [one moment, please, for change in captioners]
>>
>> ... Part of the scheme of a remedy for where we're trying to head as far as these contracts are concerned and I know that is something that we're still looking to overcome is the monitoring and the whole nine yards which was a void as far as what we could see with some of the things that was happening on the city's end, from what I heard testimony last week. But I just want to ensure that we're continuing that effort to narrow that window to ensure that we continue to strive in that direction some of the whatever rerecommend in here, and I know that was just one of the ones that was discussed last week, that windows narrowed to the best interest of Travis County, dealing with the city of Austin for example. And I guess what you're suggesting that will be part of that.
>> yes, I think that is the essence of what I'm saying. We're looking at tracking the total systems from the point of service to the point of payment and looking at what levels of accountability we have built in also assigning responsibility, and more specifically in answer to your question about who we involved or who our contact would be from the city of Austin, just looking at the issue regarding the social services contract since last week, i've had contact not only with the department director, assistant city manager, but also staff in trying to ensure that there is some level of accountability at each point during this process.
>> okay.
>> what county employees will be on there?
>> specifically?
>> yes, sir.
>> am I limited to number? [laughter] because I'm going to name a team. I want an internal team looking at it.
>> he's thinking jose palace and mr. Bacon from our office, and kimberly walton may step in on that one. We did have Commissioner, really, I thought fruitful discussion with stephen and his staff last week after the Commissioner's court session starting to address some of these issues and bringing them to the forefront so, I mean stephen is right, we need to work these out, but I think we have taken some steps of understanding what we need to work out, not worked out but...
>> the group that you're trying to put together, that is internal to hhs...
>> yes.
>> ... And then they bring their work to this committee?
>> well, basically...
>> [inaudible]
>> just in following up to what susan was saying in our meeting follow-up last -- in follow-up to last Tuesday's meeting, we had a meeting on Thursday looking at a specific contract. I was important for me to hear the details of how, you know, the process worked and what the expectations from the auditor's office were, because it was very concrete. With that I was able to go back and look at the process itself to really perform some quality checks myself. There's some things that we're going to have to do internally as well as in our relationship with the city of Austin. Just as an example, and discussing the issue of social services contracts with the city of Austin department director and assistant city manager an issue we discussed to some extent was the level of staffing within the monitoring unit to ensure that site-to-site visits occur. It's that level of detail that I believe I have to deal with when we're talking about specifically the social services contract, but it's going to be a little bit different from each area.
>> so it sounds like the departmental internal and then when you go to the organizational, internal?
>> yes.
>> okay.
>> we're going to be doing it all at once. What susan and I had agreed to do was in April jose would sit down with my team and we -- along with the county attorney's office as well as purchasing and we would look at how we're currently purchasing services and we would come up with a desire to how we believe a more efficient way of purchasing services is, and more importantly how to ensure there's a line of accountability to provide efficient details so that I will be comfortable as well as meeting the auditor's interest.
>> okay. I just want to -- I think it sounds good. I would expand it a little bit and say I'm in agreement with everything you said, the financial accountability, but I think I want to know the impact of the dollars which will be programmatic accountability and I really want to think -- I think this being my nineth year here, I really want to see the programmatic accountability.
>> I agree with that. I think it all has to be integrated and next week what you will see are outcomes as well as productivity for each contract that we have. I'm actually reviewing the draft right now. More specifically judge you want names, it will be me, arlene 'tilman, fulmer, kathleen haass, and maybe lisa [inaudible] that is two, four five of us.
>> five?
>> can you repeat those? Williams, 'tilman...
>> fulmer, haass, senderman.
>> you indicated a desire to be on this...
>> yeah. Are you still talking about combining these two?
>> yeah, because the same people handle...
>> okay.
>> ... And process the payment.
>> all right.
>> you're talking about combining both services contract and... Jie thought we had less issues with public health.
>> and I want to be a part of that also. Add my name to that list. Social services.
>> environmental health, those related -- you wanted a total on that?
>> [inaudible - no mic]
>> okay. So health care services would include our map, fqhc...
>> and I added an area, public health, which would be the general health and the local, several years...
>> would that include the town lake animal...
>> yes.
>> I'm just trying to think.
>> all of that.
>> doesn't do that.
>> those are distinctly different services.
>> yes, they are. And the reimbursement method for every one of these different categories is different.
>> you've got the same committee working on all of them?
>> yes, I think we should be in agreement with them. Once we settle on principals and interest I think the rest would be easy.
>> it does seem to me that we ought to have agreement on what the specific issues are in each of these areas. And I wonder if the committee could put that together for us in two to three weeks.
>> yeah.
>> and let's have, say, sessions where we look at that.
>> okay.
>> did you assign an attorney to this?
>> yeah.
>> who?
>> today is what? November the 11th?
>> have we decided on f we're meeting on the Mondaytor Wednesday?
>> I think we ought to do that in just a few moments.
>> not a problem, thank you. Normally we have a limited of a light schedule on the day preceding or following. Yeah, do we want to meet on Monday or Wednesday?
>> I prefer Wednesday.
>> Wednesday.
>> in terms of paying invoices, does it matter?
>> this is before which holiday?
>> veteran's day.
>> no, it just -- you know, a long time ago we kind of got -- the Commissioner's court's got in the habit of skipping for a holiday, and the vendors can't go a week without payment, as long as we pay them each week we can accommodate your schedule.
>> we can do it on Wednesday.
>> yeah, that is just fine.
>> so that would be when, November 12th.
>> November 12th.
>> so if we could look at those issues on November 12th.
>> okay.
>> it's not really consent agenda but it will be a court light day. I'm just marking down for things.
>> if we get the backup in a timely manner, holiday won't matter. It really gives us an additional day to review the issues. I do think if we sign off we'll know what the committee is working on and if we want to add something to this, we'll have an opportunity to do so. Anything else on this item, number 18?
>> and did commercial district -- comisher Davis get added to this one?
>> I'm assuming valerie is the analyst under her...
>> that's what christian recommends.
>> yeah, yeah.
>> and susan -- okay, yeah, I got her. Okay.
>> anything else? I guess in the health care area it would help to have a listing of the specific contracts you're working on?
>> yeah.
>> in addition to the... Then we'll bring this item back up on November 12th.
>> very good.
Last Modified: Tuesday, October 21, 2003 7:52 PM