Travis County Commissioners Court
July 20, 2004
Health Facilities Development Corporation
Travis County health facilities corporation, one item, consider and take appropriate action on request from people's community clinic for financial assistance to defray the cost to expand facilities located at 2909 north ih-35 in Austin, Texas.
>> again...
>> judge, put this on basically because a representative from the people's community clinic has come by and asked us to go through this, and I hope everyone had an opportunity to hear what the representative of -- from the people's clinic had to say. Of course there's a lot of associated backup and I guess at this time if mr. Dave son go ahead and start this particular process as far as what they're requesting, why they're requesting it and the cost of what they're requesting and the gain out of what has actually been requested, and I guess at any point a representative can step in and intercede into this conversation it would be appropriate.
>> I'm harvey Davis, manager for the corporation and I'm here with regina, the executive director of people's community clinic. They have made a request for $5,000 to assist in remodelling of their clinic located at 2909 north ih-35, on the east side of ih-35 directly across from st. David's hospital. The -- they had in their budget a $250,000 amount for this remodeling project. It ends up that it's going to cost at least $335,000. Per your suggestion, director Davis, I did go out to the clinic yesterday and observed what they are doing. The remodelling work is a four-month project. They are keeping the clinic open while they're doing this construction project. Had they chosen to close the clinic it would have taken four weeks instead of four months. And during my visit I observed the following things that they are doing to -- and the purpose of the remodelling is to enhance the efficiency of providing the services that they're providing to their patients and to be able to serve more patients. So what I observed when I went out to the clinic yesterday was that they are adding three new examination rooms. They are replacing the furniture for the offices of the medical staff to have modular furniture so that more of the medical staff can use each of the rooms and they can use the room in a more efficient manner. They are enhancing their hippa requirements by providing space where they can screen patients in privacy. They are enhancing the security for their medical records. Right now they have a room that has several doors where people can access the medical room and so they are preventing so many doors to be accessed those records. They are decentralizing the nurse's station. They have one nurse's station now and they're eliminating that nurse's station and constructing two new nurse's stations and that way the nurses can more efficiently monitor the examination rooms. They are expanding their small pharmacy. They are reorganizing their lab rooms so that they have two draw stationings instead of one draw station, which means they can take blood out of two people at one time instead of one person at one time. They're adding three alcove stations and expanding one and again this provides efficiency for the nurses to better monitor the examination rooms. They -- they had two conference -- this building is on two stories and they had two conference rooms -- two conference classrooms and they've combined this into one conference classroom on the second floor and again this has provided more space for medical work. They -- they've been able to add one office by eliminating a copier -- a copy and printer room, and finally they've redesigned the front entrance so that, again, they are able to provide privacy for people when they come in to register for the clinic, also cut down on the noise because they -- right now the front entrance has sort of a waiting room and then people also coming in to register. So they're making this whole front end a more efficient space, and more appealing to the patients. So with that, the executive director is here to answer any questions regarding this request.
>> okay. Thank you. Would you like to add to what...
>> I would like to thank mr. Davis for coming to see what we were doing and Commissioner Sonleitner has been out to see the clinic as well. Our goal of the remodel is not to pretty it up but to really make the facility more efficient in the delivery of health care. It's part of our strategic plan that the plan has adopted last year and it's designed to increase over three years our capacity by 20%. Using the space more efficiently, we own the building outright, so this is a good investment from that regard, and we -- we don't have space to add onto the building, however, because we are definitely land locked where we are and our best efforts are to make the space we have as efficient as we possibly can and I think if you're there you'll know that the space is very, very well utilized. This will increase the patient flow, smooth things out in the clinic, add examination rooms, we're trying to keep the cost very low and we're keeping the clinic open throughout the remodel so that patients aren't being turned away, so we would greatly appreciate any assistance. We've asked for the $85,000 difference between the budgeted amount and the actual costs incurred. I've shared with you the additional wish list for items that we have not incurred expenses for but would be beneficial as well, that include a new ac unit, security system, irrigation system, repaving and restriping the parking lot, and we were all a little surprised. We thought that the upstairs was going to get painted and recarported but that was not included either. We have a new conference room that is painted and rerecarpeted. But what we're doing down stairs is what makes a difference in terms of the patient care and your help would be appreciated.
>> how many Travis County residents -- what's the advantage for them?
>> well, they're coming to a much more efficient operation. We anticipate using these dollars -- the equivalent of these dollars that are going toward construction that otherwise would go toward patient care averages out to about 680 patient visits that we could be paying for.
>> and your patients come from what category of residence?
>> they're all low income. By definition we do not have health insurance. Only people who are low income and lack health insurance.
>> these improvements are intended to help you serve more in a given time?
>> yes.
>> from the financial end, I know you're requesting $85,000, and it came into discussion I guess earlier and discussion is that you could maybe look at this $85,000 at a later time -- harvey, can you explain that as far as this year's budget compared to the next budget coming in?
>> all right. In my opinion, the corporation would not be able to fund this request at this time. I would expect what the corporation would have sufficient funds after November 1, because at that time we are scheduled to receive an annual fee payment of approximately $250,000. And that's related to the ascension bonds. So my recommendation is that it -- the board chose to fund this request, that it be contingent on receiving the money and that the payment would be made after November 2004.
>> okay. And with those kind of conditions of possibility -- I don't really know what the board is going to do, but is that a condition that you proceed and continue based on what harvey Davis just stated?
>> I didn't, absolutely.
>> you could go with that?
>> yes.
>> okay. And of course continue to see the clients because there has definitely been an increase as far as the participants that are coming to the clinic, there's definitely been a significant increase and it appears there may be even further growth.
>> yes.
>> for the...
>> we turn away about 200 requests for care a week and during the remodel, for acute care a week, people who need to be seen by someone and can't -- we can't give them an appointment, and our goal -- the board has raised the bar, we want to be able to increase our capacity by 20% over three years and the remodel is the first step in accomplishing that.
>> other questions? Yes, sir.
>> harvey, does this fit the Travis County health facilities corporation's missions/purpose? I mean is this the applicable use for these dollars? I mean I guess take these dollars and they probably are examples of all over...
>> well, in my opinion, yes. I mean it is certainly a health-related payment or service that the corporation would be purchasing.
>> and do we have some history that shows that we've done something like this? In some aspect?
>> yes, the corporation has -- has made other grants or contracts in the past.
>> okay.
>> yes, sir.
>> regina, tell me what the hours or operation of people's clinic is.
>> we're open 8 to 8 Monday through Thursday and 8 to 5 on Friday.
>> 8 to 5... What sort of emergency capabilities do y'all -- I mean do y'all have? I mean obviously you probably have a number of people that come over there and say this is the only place we've ever gone, so we're here again. You all say well, that's beyond our capabilities, and fortunately, I mean it's less than a mile to [... We're directly across the highway with st. David's, we have an agreement with the emergency department can directly make appointments for up to 6 patients a day who show up at the emergency department inappropriately and can be routed over to people's directly from the emergency department. We are a primary care facility so that we have, you know, family practice physicians, pediatricians. We do not provide specialty carry and like everyone else who need to make specialty referrals rely on the brackenridge specialty clinics. We have some specialists who volunteer at the clinic and accept referrals from our providers directly.
>> what percentage of your employees -- I mean give me a breakdown as to county people versus -- I mean, knowing that most of the county residents are also city of Austin residents, I mean do y'all have any kind of a breakdown like that from zip code.
>> only 10% of our patients are from outside of Travis County.
>> but outside of the city...
>> I don't have that breakdown.
>> okay.
>> but many come from --
>> and not that big of deal because, you know, those city people pay county taxes as well.
>> we see many patients from Pflugerville -- not Pflugerville, sorry, manor, it alluded me right there. We have a relationship with the manor independent school district. Many people who need care, need specialty, particularly care around behavior issues get referred to us. We have patients from out at Jonestown and lago vista. Patients come in from all over.
>> I guess, regina, the next couple of questions I'm going to have are going to be somewhat -- perhaps uncomfortable for you given that there's going to be some speculation involved, but we don't -- we're trying to figure out exactly what the health district is going to take on in this community. I mean I don't know whether it's going to take on the ut health center. I've heard everything all over the board. But given that we know that it's going to definitely take care of brack, what do you see y'all -- y'all's asking of the health care district with regards to -- I mean is there a line of money? Is there a line of scs asking what the clinic is going to be asking for out of this health care district? And let me just get to the point. Would it be prudent on this court's part to wait and see exactly what all is going to be under the umbrella of the Travis County hospital district to see whether or not y'all are going to be part of that? And if you are going to be part of it, is this one of those expenses that ought to be taken on by the health care district.
>> i'll start with the last one first and say that I think not. It's my understanding that your health facilities corporation isn't going to transfer to the hospital district some of the that even after the -- so that even after the hospital district is up and running, I would assume if there's an appropriate need in the community that was related to health facilities financing, it would still be appropriate to come back to this body to seek support for that. In terms of what the people's community clinic directly will seek from the hospital district, we are now contractors with both the city and the county through the human services department, and so we assume, I hope, that those dollars will be transferred to the -- be administered by the hospital district and we would continue to be a contractor in much the same way that we contract with, you know, the county now for human services funds. In terms of the more exploratory, expansive issue, I hope -- I know that there are many demands that will be placed on the hospital district. There are many competing interests, who supported it, and who expect to see some return for their particular interest, whether it's mental health or emergency departments, we certainly think that primary care is a -- an important enough issue and it impacts the use of the emergency department significantly enough that it would be a wise investment for the hospital district to strengthen and bolster the primary care system. One thought we have had is that right now people who have map cards or who are map eligible have a great deal of difficulty getting appointments within the city/county clinic system and that if the map eligibility -- if a map card was a portable benefit and the patient could take that with them to whichever indigent care clinics they sought care at, that would be one way of benefitting clinics such as people's community clinic, and others like oblane, we are not the only ones in this situation, but in terms of expecting to see any direct financial support, I think that that would be a little presumptuous on our part. They're going to have a lot of challenges ahead of them and a lot of demands on them and I think that as much as we would love to believe that's on the horizon, I'm not that optimistic.
>> well, I'm -- I mean I'm as much as I know of people's clinic, I mean I'm impressed with bang for the buck that you get, you know, when you come and use y'all's services. I mean a number of people that i've known over the years have always spoke highly of it and I know that that is...
>> thank you.
>> ... Very worth while entity to have, and, you know, there are these questions that, who knows, you know, I -- what's going to happen. You know, given that you're going to be there, given that you provide, you know, an exemplary service in the community, I think that it's -- you know, that it's only reasonable that since we have a health facility development corporation, you know, for these kind of things, I mean I want that to be made a motion, judge, or I don't know what your intent -- do you need time or whatever?
>> I think Commissioner Davis has a comment.
>> I move that we...
>> [inaudible]
>> I'm sorry. I thought the discussion was over.
>> i've been very cautious in terms of...
>> everybody will have an opportunity to speak [laughter]
>> do I have the floor?
>> you do.
>> thank you very much. In terms of how I'm going on this, how do I talk to regina about this, this was, I think, my second stop on the tour of americas related to social service contracts and i've now hit 27 of them. These folks do not have health insurance and they have a way to access primary health care that if this were not available and the same good things that are happening out that way, they would wind up in the emergency room at the most expensive point of payment related to either the city of Austin or to Travis County. I think the people's contract, as regina laid out, is indeed going to shift over related to direct indigent health care services that are being provided. But this is different. This is not for direct services. This is related to a construction project. I think quite frankly if you made that request to the hospital district of fund concrete as opposed to direct services, it would be inappropriate and it would need to be taken in the context of a full capital outlay plan that I would hope they could do systemically and not a situation that has arisen at this particular moment in time. The harris county has many timings towle them we don't want you to look at concrete, think about expanding your clinic hours. Use the building that you have got. This is a way for you all to use the building that you got in a much more efficient way and at this point it would take away -- it is absolutely needed in terms of if you get a chance to gone go out and visit them, they are so crammed in there, they are land locked. It's something and for them to be able to do what is necessary to take care of the clients they got, it would take away from direct services. So I look forward to yielding the floor and whatever motion is made. In fact be very, very happy...
>> like to move approval and contingent that the money be granted and awarded to the people's community clinic in November of 2004 when it's -- becomes available through this particular corporation, and so I have no problem with that and again I'm very, very delighted that you have brought this to our attention and keep up the good work. You're doing a real good job over there at that clinic and thanks for coming to Travis County for this assistance. Thank you.
>> can I ask a friendly -- that we would need to come up with the same appropriate contract that we have come up with for meals on wheels, everyone else in terms of what the expected deliverable is, and that is a construction project, and that...
>> i'll accept.
>> to bring forward an appropriate contract, sign so that everybody knows what the expectation.
>> absolutely.
>> yes.
>> absolutely.
>> as we did...
>> right. That's for $85,000?
>> $85,000.
>> seconded by director Gomez? Anymore discussion? All in favor? That passes by unanimous vote. Thank you very much.
>> thank you very much.
>> ann kitchen had hoped to be here.
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Last Modified:
Friday, October 28, 2005 12:35 PM