Travis County Commssioners Court
June 8, 2004
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Item 21
Now, we did leave a little time for us to discuss the hospital district item.
>> sandy, we waited until you got back.
>> now, there will be a lot of documents that will be circulating at the last minute. In my view, a couple of them are a little more important than others because in order for us to stay with the time line we have discussed and probably need to keep, some action is required today. If we could pull up the little application process and time line matrix, what we did there really was to start on July 15th, and I understand that the county and the city would like to get this board appointed by that date if possible. And we will need [inaudible] today.
>> in terms of what folks will be looking at, I think it's marked agenda 21-a. The front sheet says qualifications and where he's at is on the third page that has the time line on it.
>> to the left there are dates. In the middle there is [inaudible]. On the right there are new complete tasks. And I think the first two batches are probably more important than the third because we can later include whatever we want to. I do indicate 6 and 8 there to be we would share whatever we act on with the city of Austin and others as appropriate. And there have been others who have indicated an interest in the process and so what I would do is just encourage us to be open and free with sharing this with whoever wants to see it. What I indicate there too is this will be back on the court's agenda on the 15th for final action. That's why in my view if we can move on it today rather than Thursday, we give ourselves a few more workdays to get it done. What we do basically is to post, receive applications, draft interview questions, interview as a court, and make our appointment on July 13th. I do not address the joint appointment. It seems to me that we can work that out with the city council at a later date. This would help us get our [indiscernible] and if we finish before the city does, they will have an opportunity to see who we appoint. If we finish the -- if they finish before we do, we'll see who they appoint. And in terms of trying to achieve diversity and the other things we think are critical, I think whoever makes the second set of appointments would be in a much better position to do that although both of us ought to think about doing it up front.
>> judge -- go ahead.
>> go ahead, Commissioner.
>> a question related to our advisory group. Was there someplace that they ought to be acknowledged in this third column in someplace? And my thought was related to the evaluation of the applications, were we going to roll them into the evaluations in the short listing or not? I don't really recall where we went with that discussion. More to immediate in case [inaudible].
>> I think we ought to include them as much as we can. I certainly had them in mind up there under the first task where we share the information with city council and others.
>> yeah, I know here they are reviewing the process. When we get to that piece, they review the process.
>> I think today the three things we ought to try to get done if we can is the process in time line, the qualifications, because I think they are basic, and if we add to those, that's fine. I think they are general enough to be real good. And the other thing that I think would be the charge to the hospital district transition advisory committee, mr. Williams' little one-pager. What I would do is delete the charge to internal team. As a committee we did not deal with that on Monday, but we did deal with the other part and sort of and he advised a draft that we were working with, and I have a few changes to recommend, but I don't think steven picked up on that. So but we do get those three done today, I think we're in good shape. Then on Thursday the other things that we don't address, and there will be two or three of them, we can discuss them real briefly to lay illegal -- to lay them out before we leave.
>> and I know I took a whack at something that's also titled 21-a as well, related to its almost like the main body in terms of also not only the cofa nominations but some kind of i'll call them special circumstances in terms of the unique role of Travis County and the Commissioners court during this whole process and it kind of leaves the slots for these various other things to be brought in. We don't need to act on that today. That was just a first draft. I do need more time is on the conflict of interest. I tried my darnedest over lunch, barbara, but I need more time on conflict of interest. To kind of understand the choices we've got there.
>> and the process and time line, I tried to put the major activities over the next few days or weeks with the other things that we need to do that aren't necessarily to put on this one. This was a -- really the time line for selecting the board of managers. And I know we gave some discussion to milestones, time lines, et cetera in our meeting, and what I was going to do was come up with a draft summary of that, share it with some committee members, share it with the court, maybe have that back on the court's agenda next Tuesday. Part of that really is really more a matter of information, but we probably ought to be mindful of the differences. But in terms of this process and time line, anything we need to add, do you think?
>> I just bring this to everybody's attention because this is slightly different than in the r.m.a., On July 13th, that is a Tuesday, not Thursday, when we want to do our interviews in a work session slot. And I think the judge mentioned during the subcommittee that we would try and have a shorter meeting so that we could devote our time when we already know that the five of us are going to be here.
>> but the actual application packet is on for next week.
>> to finalize.
>> right, to finalize. Right. Right.
>> hopefully between today, Thursday, that by next Tuesday we will have a packet so anybody saying I want to apply, the answer is here is the packet or here is the electronic packet. We can get it out and in the community.
>> right. This is kind of tight, but in my view it's important to try to get this done by mid-july. And really I don't know that it would be fatal if this were to slip one week, I just think we ought to try as best we can to adhere to it.
>> I move to set a goal.
>> and the reality we talked about this morning on 1445, the city council I believe only has one regularly scheduled meeting in July. If we're intending to act by then, even if it slid by one week, we would still be beating the council to their last meeting.
>> is there a way we can get the -- [multiple voices]
>> council or the mayor?
>> I told them we would send them this. They were meeting on Thursday. Bet dunkerley said she would try to get this to them if we approved this today.
>> they have two items posted on their swrepbd for Thursday related -- agenda related to the charge for the advisory committee and also talking about the process, but as of noon when I pulled up the backup, there was no backup. It's just the shell item. There's no backup yet. Ms. Dunkerley has these top two documents because I sent them to her yesterday at the same time I sent them to the court. And I shared them with clyde. If we change these documents, i'll get you the revised version. So if there are no recommendations to change the application process and time line, I move approval.
>> second.
>> anything from the audience? Changes for the process and time line? These are the major steps. Discussion? All in favor? That passes by unanimous vote. Qualifications. The whole committee spent a little time looking at those. We tried to be general and inclusive and we also followed what we had done with the r.m.a. We had left off with that draft we worked from the two bullets on the front page, ability to collaborate with public officials and staff and a resident of Travis County. I think the law requires Travis County residency, right? And everything else we had kind of mentioned that and we didn't -- it was not on our qualifications.
>> it's not in the statute, but I think if you looked at the case law, likely if you serve in a district, then you should live in that district. I think the case law would reveal that.
>> and I think it's real important, I think it's also limited to Travis County residency. And when the time comes that we are a lot more regional in outlook and function, then we certainly can expand that. And funding.
>> we are going to be regional. [indiscernible].
>> I think there was thought the board would expand. It's not like some of our slots would tphreub to somebody else. There would be new slots added. As campo has also gotten bigger as the jurisdiction -- judge, are you making a motion related to the qualifications and the personal characteristics page as well?
>> I was about to unless Commissioner Davis had --
>> no, I was just wondering about that comment. I think this is probably a good direction that we're going in. I'm kind of concerned though also with the possibility of expansion. I think the regional deal is something we have to look to as far as the future is concerned and I think the residency requirements is something that we really did hinge and focus on when we did deal with the r.m.a. As far as [indiscernible]. We wanted to make sure the person that we appointed to the board as far as the c.t.r. From Travis County that they reside understand Travis County. This is basically following some of the dictates of what we deal with as far as the r.m.a. Is concerned. However, I'm still concerned about the expansion of this and maybe hopefully, hopefully if things this next legislative session that comes up of course as we look for other counties participating in this with us, maybe there can be legislation that will be introduced again to the legislature support I offer of those persons who want to participate in the district of course would be able to allow to do that. Hopefully we can get a law passed to do just that. But of course we're thought there yet, but it doesn't mean that I don't think we can visit -- we can't revisit that when the state legislature convenes. Because there will be a lot of persons that will be coming here using the Travis County hospital district as it gets started and that do not reside here in Travis County. And of course that is a regional concept and a regional [indiscernible]. I think this whole expansion process would be very, very appropriate and maybe we can get the legislature to bless it and make to it pass.
>> some of the major urban hospitals are receiving overload pressure from resident outside of their area, [indiscernible] sent us an e-mail yesterday regarding several hospitals complaining that issue. I think the more attention it receives, the easier it will be for the legislature to get some relief. Now, we did on the charge to the advisory committee, we did add a final one. That would have him assisting also in Travis County developing a needs analysis and strategy to promote a regional partnership for the delivery and funding to be -- to the delivery and funding of health care. But on the qualifications, we tried to be general, but not too restrictive. And what we have in mind is not that one person would necessarily possess all of these qualities, but you would possess a majority of them.
>> and judge, does this include page 2, which has to do with the four personal characteristics, which matches identically with what we did on the r.m.a.
>> Commissioner Davis has mentioned -- I don't think there will be a problem of getting a bill passed that would allow out lying communities or counties, Commissioner, come into this thing. That's not the problem. The problem is what bexar county has suffered. Since 1955, no one has come into it. The way you get people into this district is that you have stipulations about whenever we receive people from out of our county that we have a big enough stick that says we are somehow going to charge you. I mean you are not going to send your people here and have our people continue to pay for it. Now, then you have an opportunity, I think, to go to these other counties, but under this sort of kind of like why buy the cow when you get the milk free. I mean that's the reason the out lying counties don't want to participate. That's the reason that this vote that we had was not a multi-county vote. Because they knew that they couldn't get it passed if it was multi-county. I mean one of the things that I'm going to be, you know, very concerned over is will our appointment is to say let's come up with something where we have the opportunity that if you come in to our health care district and you are from outside, we are going to find a way to bill you. Somebody is going to pay for it. I mean if it's a caldwell county resident, then I think the Commissioners court ought to go to the caldwell county Commissioners court and say here's a bill. I think we're going to have to be hard line with that because if we don't we'll never get what we need out of this thing.
>> anybody that pops up related to emergency care law is quite clear, you have to serve that person.
>> absolutely.
>> but the interim step is one of the state legislature. The state legislature in its unbounding wisdom has decided that the definition of poverty is 21% of the federal guideline. It used to be a whopping 17 or 18%. The problem is that counties don't have much of a requirement that if you sent them a bill they would actually have to pay it. If somebody simply happens to be uninsured but doesn't meet 21% of federal poverty guidelines, those Commissioners courts legally are not bound to pay those bills. In the discussions i've had with surrounding courts, every bill that has been legally presented to them that meets with the state legislature says is your mandated duty to provide, they have paid. So unless they change that designation of what is the mandated legal requirement, we're not going to get anywhere.
>> that is specifically what I'm talking about. We have to work on a lot more legislation. [multiple voices]
>> you can't make caldwell county pay a bill they are not required to pay.
>> absolutely. But I think that will be the essence of what we're trying to get done in this thing, otherwise we will continue to pay for outside --
>> if you saw the debate going on with c.u.c. In terms of what testimony was before the state legislature just a matter of weeks ago during the interim here, there are believe it or not counties that are not even doing the minimum effort. We don't see that because we are doing more than the minimum and go far beyond what state law requires. But there are counties that aren't even meeting that lousy 21% and what percentage of their budget that they have to dedicate to indigent health care. They are not meeting it. It seems like we need to bracket some of these solutions because obviously the urban counties are in a far different place than some of the other 254 counties.
>> move approval of the qualifications.
>> second.
>> I think we need to keep talking with jim collins to help us with those [indiscernible] that we can pay or not pay. How far we can push the envelope.
>> james is on the back seat writing down that recommendation.
>> qualifications.
>> qualification, that's the full page and the four bell let's on the second page -- bullets on the second page under preference will be given to those who demonstrate the personal characteristics. Discussion? Was there a second?
>> I think Commissioner Sonleitner seconded that, I believe.
>> discussion? I think we're pretty comprehensive on the list. All in favor? That passes by unanimous vote. If we could get you to pull up the charge to the hospital transition advisory committee. The two or three changes that I did note was in 6 there, the third sentence, which facility. [indiscernible] a list of facilities. And the one under that which facilities should be a list of the facilities that should. And I just think that it's better to indicate we are looking for lists, basically. And an appropriate inventory in the fourth part. And in 7, regarding the creation of a hospital district, that second line, and in 9, delivery -- of the delivery and funding of health care. Eye didn't get the one in 7, judge. What was that?
>> it was just regarding the creation.
>> and also that same sentence right above that, to ensure consistency, it says and with. It should be just consistency with promises.
>> delete "and."
>> and I found a little one on number 4, it needs to be adopt a transitional budget.
>> okay.
>> just some wordsmithing stuff.
>> we love to do that. My mother loved it when I used my editing. If that's a motion, judge, I would move --
>> any additions or deletions? Now the changes. This is what we would ask the advisory committee to do and if this passes today, we send it to the city and ask them to consider doing the same thing. Send it to clark and have him share it with the members of the advisory committee. The other thing is let's keep this in the back of our minds. If in fact we want to reach out and bring some regional partners in to start looking at this, I think an appropriate place on the advisory committee would be a good place for them to be. That way they can see how it works and if they have ideas about how we can make it work better for the region, that's how to get get the input to the council and the court and the board, I believe. Now, have the other members of the committee seen this thing? This is what the working group worked on on Monday morning. These are the changes that we discussed except for the last part that was added about promoting regional for the delivery and funding. I think I sent an e-mail to everybody in the meeting, so -- any suggestions, recommendations? [indiscernible] means agreement. Commissioner Sonleitner moved approval a minute ago.
>> second.
>> any more discussion? All in favor? That passes by unanimous vote. This is so easy to just go through the others instead of taking action on today indicate exactly where we are on them. There are two or three other documents. [indiscernible] gave us one which is color coded. First we need to know how to read it. It's the Travis County hospital district board of managers member [indiscernible] affidavit. We would expect the court to land on either the red, the blue or the green.
>> actually you could -- one would expect that you would either land on red or red and green or all four. If you land on red, that indicates that there would be no conflict -- that the person who is applying for the position would have no conflict personally in relation to each of the areas that are addressed. If you land on red and green, it would mean the person who is applying and his spouse and in some cases minor children, things like holding real estate, which you could do for tax planning purposes, do not have any aspect of their financial or political involvement that would result in a conflict of interest with the district. If you chose to go with a more of a disclosure approach, like we recognize that if we said that you could have no income from health care-related -- providing health care-related services, that would probably mean that you couldn't have any doctor who was practicing medicine and therefore you might not want to do that. In that case, you would want to have disclosure where you are saying this is where I could have conflicts of interest. These are the aspects of my life or my posessions or whatever the topic is for each of the items where there could be a potential conflict of interest. And the reason I say that you could have all of them in there if you go with a disclosure approach is that you would anticipate that the person who is preparing the affidavit would, like in number 2 -- I'm sorry, 2 is a bad example. It doesn't have a disclosure. In number 6, if the person is not employed, then they would leave that in and scratch out the second alternative which says I am employed. And give us two lines for putting in the disclosure of where they are employed or how they are employed. And if they are employed, of course they would scratch out the first alternative. Now, I say scratch out. If you are going to give them paper forms, they can do that. If you are going to give them electronic forms, they can just delete the alternative that is inappropriate.
>> it was the intention for the court at some point and my recommendation would be on Thursday to decide whether our approach would be like the personable addition, the disclosure or the [indiscernible] family.
>> yes.
>> once we decide that, the form we sent out would be exactly that one. We send out a form where individuals can choose one of the three.
>> I would think that if you chose either personal prohibition or personal and family prohibition, you would have one form and it would go out and everybody gets the same thing. I would think that it would make some sense if you decided to go with disclosure to tell them to cross out the thing that didn't apply rather than having them say as a part of the affidavit I am employed at the following and say none. You could take out the alternative at the other part and just have them fill in the word "none" in their disclosure, whichever the court feels is the appropriate way.
>> I'm ready to spend more time and it seems like we're going through southwest surgical. We want this to be simple, concise, but absolutely have transparency on conflict of interest. And so we need to get down to something that's also a reasonable length. We got it down I think to one full package on the r.m.a. That would be my --
>> this came from r.m.a.
>> well, I'm happy to spend some quality time with you, barbara, over the next day to see if we can plan someplace, say cheese, steven, go to see you here.
>> but did expectation is for the court hopefully on Thursday to decide from a eligibility standard whether we are looking for the -- like the personal prohibition, the person and family, or whether we simply want to leave disclose various information.
>> I think disclose is simpler. Because then it's tailored.
>> but I think some -- I'm not sure -- on the disclosure, I assume that it's disclosing enough information it really depends on how personal the party filling out the questionnaire thinks it is.
>> I think necessary for a oepbt at this time like this.
>> well, I know for example on the r.m.a. They didn't have to give us financial disclosure statements like we have to do on an annual basis, but they did have to basically swear to the fact there was nothing there and that means something. And to me that's -- on this kind of a board, if we -- i'll just leave it at that. I think that was the appropriate way to go. And I think barbara and I also had good discussions about this should not be something somebody has to swear or affirm they are married or not married and we get into a definition of what the marriage. It is really about, you know, the spouse and not the space of the institution.
>> hopefully we'll be able to look at that one Thursday, decide one way or the other, then start sending out the information. That's pretty important because for those interested in being appointed, we would expect them to complete the eligibility statement there as well as an application. Speaking of applications, we did have a draft application. Did the court get that?
>> should have. It's called call for nominations to [indiscernible].
>> call for nominations.
>> and this was largely format based on what we did for the regional mobility authority, obviously making the appropriate changes. I don't expect everybody to sign off on it today, but please pay attention to paragraph number 2. It came out of discussions that we had during the committee on Monday talking about the unique role of Travis County. We thought that was very important to kind of lay it out there that the involvement of Travis County doesn't end simply with us naming people. That there are just some things related to that. So I would hope the people take a close look at this, offer suggestions, whatever. It left [indiscernible] for the qualifications already done and judge we had had on here did you note there was a specific person that we are going to put attention to to get this stuff electronically. We had that in the r.m.a., There was a specific person at t.n.r. That was kind of a contact person, even though all the applications were sent to you. So that's down there underneath the address that has your name in terms of by e-mailing whomever, you can get the electronic copy. We have to set some compact tpoeupbt get the electronic copy.
>> let's do that then. And designate a person. Now, on the call for nomination, are we going to do that today or Thursday?
>> Thursday.
>> Thursday.
>> wordsmith to your heart's delight. And we'll see if we can get it done. Those who have not received a copy of the call for nominations and the three pages, let me know and i'll get it to you today. Thank you committee members and -- [indiscernible]. As soon as there was also to take our old application form, take it back to --
>> I haven't done that.
>> we will get that to you today also. I know I have a copy of it.
>> [inaudible].
>> I don't have a copy.
>> we can do that Thursday.
>> we wanted to absorb any kind of concern we were trying to inundate you with too much paper so we probably held that back. [indiscernible] or early tomorrow morning? Anything else we need to do today? This will be back on the court's agenda next week. What we don't get done on Thursday, we'll get done next week. I do think we made a lot of progress as far as being able to notify anybody inquiring about what we're doing, here is how we plan to proceed, here are the qualifications and in a couple days will you be able to pick up the applications as well as conflict eligibility standards. Yes, sir.
>> has there been any consideration of putting someone from purchasing and i.t.s. On the -- isn't that-purchasing especially.
>> we did talk about that at the time of the naming of the transition team. You were here. And the thought was is that for the day in, day out, we are literally meeting every Monday morning at 9:00 a.m. It wasn't necessary. But as we got to those features it absolutely would involve, that's what they would be brought in. Otherwise it is not a good use of their time while we're working on qualifications to have --
>> [inaudible].
>> absolutely. I wouldn't move on inventory without purchasing being there.
>> I wouldn't either.
>> I do think we ought to do that at the appropriate time.
>> yeah, at the appropriate time.
>> for those who insist on meeting with us who are county folk, we do meet every Monday at 9:00. Anything further today? We are making progress. This comes up first Thursday at 1:30.
>> are we doing it first? That's okay, I'm just asking.
>> I think the council is meeting on Thursday. To the extent we can [indiscernible] whatever we have done, I want to get it to ms. Dunkerley and [inaudible] and let them proceed at the city. Move adjourn. All in favor? That passes by unanimous vote. Thank you all very much.
Last Modified: Wednesday, June 9, 2004 7:25 AM