Travis County Commissioners Court
August 10, 2004
Item 26
26, consider and take appropriate action on the following for the Travis County hospital district. A, a list of out standing issues recommended for consideration by the board of managers. The internal working committee did discuss this list on Monday and ms. Flecking put that together. I think there were a couple of changes incorporated into the draft before you. If you've had a chance to look at it.
>> that's correct, and if the court does not have the most recent draft, I do have copies available for you.
>> could I get one of those? I've got so many versions of this I want to make sure I知 on the correct one.
>> our goal was to sort of send these unsolicited recommendations to the board of managers thinking that they would positive receive them and in due time given consideration. Some of these are short term, others are long term. I do think that there are some here that I really had not given a whole lot of thought myself, but when you think of a comprehensive list of issues to be on the plate short and long term, I think this represents a pretty good effort in that direction. I guess the question is whether we need to take more time for individual members to look at it. I guess if we were to do this list next week, serious harm would not be done, right?
>> the board is meeting next Monday, Tuesday, Wednesday and even Thursday.
>> yes, I know for sure they are posted to meet on Monday, and I did hear that Tuesday and Wednesday may be also included in the posting.
>> so if we didn't act on this until next Tuesday, they are still going to have --
>> let's put it first on Tuesday then. That will give us a week to look at it. There may be additions, or if you feel strongly be deleting some of these, we're all flexible, right?
>> that's correct, judge.
>> thank you.
>> b, issues related to independent audit required by health and safety code section 281.122. We did meet with representatives from the maxwell ritter accounting firm yesterday. It was a very good meeting. They said they would give us by tomorrow proposed contract, proposed agreed --
>> procedures.
>> agreed procedures and a contract, yes.
>> proposed fee. And we said if they got this to us, we would get it to the Commissioners court and staff, review it ourselves and take formal action next Tuesday. And if we do that, then they believe that by, what, mid-september, I think christian was throwing out September 10th, they would be able to get their work done, but a lot depends on the assistance they receive from Travis County staff and city of Austin staff. And so it looks like both of us have committed to work cooperatively with them and get them to meet that deadline. Anything else on b regarding the independent audit? Or verification audit we are now calling it? C, other matters regarding the implementation of the district.
>> I have no other matters.
>> the hospital board of managers is, as you know, in the process of negotiating a contract with the city of Austin to operate indigent health care programs on behalf of the district to meet their requirements under the indigent health care and treatment act. As a part of that contracting process, the issue has come up to what extent it would be beneficial to contract for some of the administrative services with the city. And when I talk about administrative services, I知 not talking about the administrative services in connection with operating the clinics or the m.a.p. Program that's the base part of the contract, but administrative services that may be necessary for the district itself. The very limited district. Payroll, purchasing, the sorts of administrative things that will need to be done basically to run the administrator's office and the offices of the district itself. Under the statute that creates a hospital district, the Commissioners court has the authority to simply designate that county officials and employees will perform services for the district in the areas of purchasing and expenditures and accounting and control. Tp-rgs initially that looks like the purchasing agent and her office, the treasurer and her office. My mind has gone blank at this second if there are others. But it would be useful to the district to know whether or not the Commissioners court intends to implement that obligation on those county officers to provide them services in that area. If you do, then the district repays the county on a reimbursement of salary and expenses basis. But the district is sort of at the point where they need to have some idea what the court's thinking is with regard to provision of services by county staff so that they know what they need to look for in other places.
>> can we have cyd come down?
>> I think that would be a substantive meeting, wouldn't it? If we know the list of services that we may want to consider, that we go ahead and meet with those officials between now and next week. See what I知 saying? Rather than doing it right now. I would think there would be some pros and cons. Some of those things it's kind of obvious to me that if there's an interlocal to perform services, then the subservices fall out from that. But something like purchasing, it may be easier, but I would think we would want to sit down with the purchasing agent, get her input and make the decision that way. But purchasing comes to mind. What else?
>> the county treasurer with regard to payroll services. And john, I知 sorry, I mentioned one other. Can you -- the county auditor is not a county official so you can't -- oh, I知 sorry, the budget officer in terms of control procedures and expenditure procedures.
>> okay, now, we sent that memo regarding control procedures.
>> yes. Have you exercised your authority to determine what the purchasing and expenditure and accounting and control policies will be for the district. And you had told them that the policies you have adopted for Travis County are the policies you swr- now adopted for them. And all of this is in the process of making the revisions to those policies so that where it says Travis County Commissioners court and it ought to say board of managers, we're making those kind of changes and will bring that to you for your approval so that you have a complete package. But they have the county policies that you have imposed on them. So in these areas where you can provide services to them at your decision solely, you have already decided that the county policies will apply to them. The question is whether or not you want the officials who implement those policies for you to also be assisting them in implementing those policies in their administrative-type business.
>> I mean this is just the precinct 3 Commissioner's thing because I haven't asked. But, you know, there is a little issue that's on the table in this community that has not gotten any closer to my being very comfortable with it, and I have a hard time thinking that I知 going to want to continue some relationship that is presently being done by, you know, that party even though we find ourselves up against the wall with this thing because we're not really in the hospital business and we don't really know how to do that. But, you know, the law says we got to know how to do it, so I guess we better huddle up with the best minds we got and figure out how to get it done because I知 not going to be very supportive at least until that issue gets resolved, however it gets resolved so that I know that I知 dealing with somebody that I want to be dealing with. Because that's real what I we're asking, isn't it, jim? We've got services, we've got things that have to be done to continue the runnings of our clinics and our hospital. And right now the only people that we can rely on administratively to do this, I mean because obviously seton takes care of the hospital and that, but of the administration is really the city of Austin. Isn't it?
>> no, sir. Actually that's what I知 trying to explain is that is resizely not the case. -- precisely not the case. I am not talking here and it wouldn't be within the purview of this court to make this decision. I知 not suggesting that this court can decide that the county purchasing agent will buy medicine for brackenridge hospital or will buy furniture or equipment for any of the clinics that are going to be operated by the city. But there is a very small piece of the district operation which will not be contracted out. It will be the operation of the district offices itself. So when the district administrator needs a telephone or a computer or a pencil or a piece of paper, you have said the district has to follow county purchasing policies when they buy that whatever thing it is for the -- for the district itself. So the question then is do you want to provide the services of the same county officials who perform those functions for Travis County for the district, for those limited number of things that the district will be doing directly. It seems to me there are -- there are some pretty significant cost efficiencies in doing that. The amount of work is initially going to be very limited because the amount that's not contracted out is going to be very small. As well as the fact your own officials are the folks most familiar with those policies. But there may be other issues that aren't encompassing what i've just discussed and the court needs to think about those and be aware of those. But it is a decision that the court needs to make, and if the court does not choose to have the county officials and employees provide those services, then the district has got to find another way to get those services provided to it. It may do so by hiring its own employee to be a purchasing agent. That seems unlikely. It may do so by contracting with some private firm to provide these sorts of administrative services. Or it can do so and what's on the table right now is contracting with the city to provide those kinds of administrative services to the district -- basically the district offices.
>> well, I am right in assuming that the people that are doing it right now is the city.
>> no one is doing this for the district right now or has ever done it for the district.
>> jump in here --
>> let me describe it and I知 going to say in essence a similar thing that jim just said, but in a different way. Imagine a budget that has won item that says contracted services, $70 million. The contract with the provider called the city of Austin. Then imagine the rest of that budget having about six or seven line items. Payroll for the district administrator. Tax collection. A bill once a year from the tax collector. Appraisal district services. A bill from the asprays sal district. -- appraisal district. Paper, computers, travel, et cetera. That budget then will incur -- will result in expenditures. Who processes those expenditures? The workload is fairly diminimus. This is not going to be a lot of complex transactions for those kinds of things. Certainly that one line item is extraordinary and the programs are considerable. But the district office as an entity needs someone to help them keep track of the invoices, keep track of the payroll, buy things for them outside of that 70 million or however many millions of dollars it's going to be to run the clinic. That's the question, and the district can get it done, they can do it themselves, they can get the city, county toeutd, you can tell them use the county or say let them decide. And that's -- that's, I think, the question on the table.
>> but I知 not off what I知 -- [inaudible].
>> and it doesn't have to be decided today, by any means. But it's an issue fast approaching that point where the district is going to have to make some decision and they will need to make it in the absence of knowing what the Commissioners court is deciding if the court doesn't make that decision within at least a couple weeks.
>> then it sounds like that meeting needs to take place to decide those issues. Between here and next week.
>> judge, Commissioners, on direction of judge Biscoe, I did contact mr. Young who I know is a part of the board of managers budget committee to request any information that they had about what services were being proposed. And they were anticipating a proposal for these services from the city of Austin. And so they already are aware of our interest in what services they might be looking at and so there is the potential to maybe have more information on this item by next week.
>> but even that would be a purchase of services, wouldn't it?
>> yes.
>> yes.
>> if the district contracts with anyone else to provide these services, they are going to have to pay them to provide these services. Or else they will have to hire their own employees to provide these services. That does not seem cost efficient simply because the services are fairly small. If the county chooses to require county officials to provide the services, then the county will be reimbursed by the district for the time and expenses of those employees that provide the services to the district.
>> so we can autonomously ask ourselves to do that or we can ask the board of managers and get their opinion, but we could step to the plate and say this is something that we insist that we do ourselves?
>> you have -- underist statute, it is your -- under the statute, it is your choice, the Commissioners court's choice, it does not require anyone else's agreement, to provide county officials to provide services in those areas. And if you make that requirement, if you tell a county official you will provide services to the hospital district in those four areas, then the hospital district reimburses the county not -- I mean there would be some sort of interlocal agreement that will formalize it, but not by interlocal agreement, by operation of the statute the hospital district reimburses for the salary and expenses of the employees providing those services.
>> okay.
>> anything further under the hodz item?ospital district item?
>> next week.
>> we just circulated the e another week toy and we're mull over them and act on them next week. Okay?
The Closed Caption log for this Commissioners Court agenda item is provided by Travis County Internet Services. Since this file is derived from the Closed Captions created during live cablecasts, there are occasional spelling and grammatical errors. This Closed Caption log is not an official record the Commissioners Court Meeting and cannot be relied on for official purposes. For official records please contact the County Clerk at (512) 854-4722.
Last Modified:
Friday, October 28, 2005 9:10 AM