Travis County Commissioners Court
September 28, 2004
Item 10
Number 10 is consider and take appropriate action on interlocal agreement
between Travis County hospital district and city of Austin and brackenridge
hospital and other appropriate medical facilities for the provision of health
care services. We do have --
>> uncle clark.
>> -- several members of the board of managers with us. And
just for the record, some members of the board met with the Travis County
internal working committee on the hospital district yesterday for I guess
the better part of two and a half hours, and most of their time was spent
looking at the proposed interlocal between the hospital district and city
of Austin. And during that meeting basically it was decided that someone would
try to put together some bullets or highlights of the agreement, and we do
have a three-pager that the court has, and it has [indiscernible] care programs,
et cetera, other highlights. Does somebody plan just to walk us through that?
Okay, that will be good.
>> the board needs to -- [inaudible].
>> judge Biscoe, members of court, thanks for letting us
come back. We're back. [laughter] since we have a quorum present, we asked
our counsel and administrator to post the meeting of the hospital district
board of managers at the same time this morning. And so we will call that
meeting to order so that we're meeting simultaneously with you here.
>> okay.
>> and we appreciate your being here. Since the meeting-what
we handed out yesterday at the transition team meeting was a markup that was
current as of 10:00 Sunday night, I guess. Yesterday there were two or three
changes to the document that I知 going to hand you a marked version of. And
tom young, who is chair of our budget committee, is the author of the bullet
points that you have before you. And if it's appropriate, I would ask tom
if he would walk through the bullet points with you while I hand you the --
the final markup here.
>> okay. We did get this morning another discussion draft
that I received a little after 8:00 a.m. Does the whole court have that document?
>> that's actually the draft that has been approved by the
[inaudible]. That's the approved draft.
>> so this is not the same one that -- [multiple voices]
>> this shows the markup and what -- [multiple voices]
>> okay. All right.
>> so I can recycle my other throw or four drafts -- three
or four drafts?
>> there are [inaudible].
>> what we're seeing is this different from what the subcommittee
went through yesterday or does it incorporate any --
>> there are some changes --
>> very minor things.
>> that you've been handed out shows that the markup changes
from the draft [inaudible].
>> got it. Thanks, jim.
>> got it a little after 8:00 this morning and [inaudible]
by the hospital district board last night.
>> and I know before this discussion is over, media will
ask you to sit a little closer to the microphone. Sorry about that interruption,
mr. Young.
>> okay. No problem. The bullet point summary that you got
last night, i'll review that briefly, but essentially as background and context,
the scope of this agreement covers services that the city will be providing
for and on behalf of the hospital district. It covers assets that the city
will transfer to the hospital district, and it also provides for facilities
that -- that are owned or controlled by the city that will be provided in
various ways to the district. Term of the agreement and the services portion
of the agreement anyway is for one year. There is a provision for four renewals,
one-year renewals of the agreement by mutual consent. The agreement -- in
the agreement, the district adopts the map and rural map program as its indigent
care program, and the district formally assumes responsibility tore those
programs and setting policies for those programs and setting policies regarding
the operation of the city and county clinic system going forward pretty much
beginning October 1. It also provides for the city to manage the district
indigent care program in the clinic system. The city and county employees
currently staffing the clinic and the m.a.p. Programs will continue to do
so. They will continue as employees of the city and county respectively. The
city -- or the district will pay the city $41,752,392 in equal monthly stphaupltsz
for operating the m.a.p. Program and clinic system. The major portion of those
monthly payments will be deferred for the months of October through January
until the district gets the cash that it needs to make those payments from
the collection of taxes. The district's financial obligation is capped at
that approximately $42 million level. If the costs that the city is experiencing
for operating clinics and the m.a.p. Program are exceeding -- are on a projectory
to exceed the budgeted amount, it has an obligation to come back to the district
to seek either an agreement to adjust the services accordingly or if the district
feels that the programs are that important, then we would have to do some
sort of a budget amendment to -- to add additional funding to it. As far as
the year-end balance as a result of these activities, if there is a positive
balance at the end of a year, one of two things happens. If we have agreed
that the city will continue to manage the -- the indigent care program, then
that year-end balance will roll forward and will be one of the sources that
funds the next year's activity. If we have terminated that and we have --
and the city will no longer be managing the program, then the year-end balance
is paid to the district. On the other hand, if there's a negative balance
at the end of the year and the city continues to operate the clinic system,
that year-end negative balance rolls forward and it adds to the financial
obligations that the district has to fund. If the city is not going to continue
as our manager of these programs, then the city has to absorb the loss. The
district does not have an obligation to fund that.
>>
>> [one moment, please, for change in captioners]
>>
>> ... And the brackenridge hospital to seton. These have
transferred to the -- to the district effective October 1. The city will continue
to provide direction -- provide day-to-day management under the direction
for the board of managers. The city will also act as paying agents for charity
care payments due to utmb and seton and contract payments to the people's
community clinic at least until the end of January, again, when we expect
to have the cash available from the tax collections to do it ourselves. The
city will contribute some significant assets in this arrangement. It will
contribute the $10.7 million that we discussed when we presented the budget
a couple of weeks ago and that will be used as a foundation of the district's
reserves. Along with the -- a similar amount that will be transferred from
the county. The city will also transfer title and ownership to an approximately
16,000 square foot building on cesar chavez street that is currently used
as the map administrative building and for certain other uses. That transfer
will take place in early December and subsequently the city will move the
nonmap personnel and functions out of that building making it fully available
to the district for our purposes. We expect that will become our headquarters
building. And finally the agreement involves a waiver of claims. There are
a number of issues that could give rise to claims between the parties and
the agreement establishes that the transfer of assets and the services agreement
are a waiver -- a mutual waiver of claims by both parties of any claims that
they might have as of October 1.
>> so for the record, how did y'all arrive at the sum of
$41,752,000 to operate the clinic system?
>> it was extensive rounding. No. [laughter]. We received
budgets -- the budget information that were prepared by the city and county
personnel for the operation of those respective clinic and map programs. As
both the expense side of it and the revenue side and we reviewed those budget
amounts and we agreed to a program and a cost of a program that -- that going
forward.
>> okay. Couple of questions. Based on an e-mail that I saw
this morning that was sent yesterday from the Travis County auditor's office,
there's still the matter of county contract language to be worked out. Any
work on that since the e-mail was sent to the county.
>> yes, your honor, I went to the meeting you all were in
yesterday and yesterday afternoon, talked with the city about the concerns
that were raised by the county auditor's office and some of the changed language
in section 3-1-1 c 3 3-1-1 -- c 3 that you see there was responsive to their
concerns and diana, did you think we've addressed your issues in the right
way in the contract?
>> a big yes. A very important yes.
>> the issue was to be sure that we could hire any independent
auditing firm that we wanted to and have that firm have appropriate access
to city books and records and that was a good comment and one and that the
city aceded too. Aceded.
>> [multiple voices]
>> right, but to have independence.
>> where does the city stand as to approval of the interlocal
before us?
>> the city has approved all aspects of this document but
one, which is the map building which did not get in their ordinance approval
because we had not told them on the day they adopted it that we were prepared
to accept the map building. We didn't want to do that until our friends at
the county, ms. Grimes department inspected the building, which they have
now done and advised that it's in an appropriate condition for us to accept
t city plans to act on that part of the interlocal agreement. The transfer,
the map building, Thursday, September 30, and I know that one of the discussions
we had yesterday was the city -- and one of the drafts of the agreement had
a provision in there that said if the council approves, then the map building
transferred. What I understood the consensus view to be yesterday is that
if we couldn't have it both ways, then we would present the contract -- we
would authorize the contract and hopefully you all would approve it without
that "subject to" language in it. The contract now reads they will transfer
the map building.
>> okay.
>> and they will then I guess approve the agreement over
again or at least the map piece before they sign this agreement so that when
the thing is signed maybe on the evening of the 30th by the city we would
have an enforceable obligation on the part of the city to transfer the map
building.
>> and if there's an issue it would be brought back to us
next week, I guess.
>> right. I don't anticipate an issue. The staff has indicated
that they visited with the council and that -- you know, there's not opposition
to that. That is a deal point that has been in the deal for some time.
>> I did hear the auditor as to I guess section 3. Any other
issues, though, of concern to the Travis County auditor?
>> no, the other area was in the restriction on reserves
and I just spoke with clark on that area, too, and he said what is not in
there.
>> okay.
>> and just one issue as when you get to adopting the budget
once again, that the cost of depreciation, that will probably be coming from
reserves if it's not budgeted aspirate items.
>> okay, we need to hear you again if we do adopt a budget.
>> just so you know that.
>> okay. Questions from the court or comments on the interlocal.
>> a couple of questions.
>> okay.
>> on page 14 c where it looks like that we have -- -- the
district may have an independent public accounting firm audit the books and
records of the city relevant to the year-end balance report for compliance
with this agreement. Do we anticipate that the district is going to have the
ability to go back and look at the citys records? As far back as you all would
want? I mean can we go back and audit the city's books and ask the questions
two, three, four years back? I mean I知 -- I still want to know where and
why we don't have $30 million of reserves in this thing. I mean can we do
that? I mean are we -- do you all have the ability to do that with this? Or
is this only the -- is this only for once this thing starts or begins which
I guess is really October 1, 2004? What do you think?
>> I don't think the agreement gives us the right, doesn't
expressly provide that we can ask for an audit of historical records of the
city and it does contain language, it's not really a release, but it is language
that says you're accepting what we are conveying to you as satisfaction and
many obligations that we have. Now, it may be that there is a legal right
under the public information act or other ways to get at that information.
I知 just not sure based on this agreement that it would be likely to lead
to us getting any more money because this agreement says this is all we're
getting.
>> anything else from the court?
>> i'll just say this is all very consistent with what we
all talked about yesterday and I was amazed in terms of when we would get
to certain sections we would get either tom or clark saying well, actually,
we spent about four hours talking about this particular paragraph over the
weekend. I don't know if there's a full appreciation for the amount of time
that has been put in by everyone on this board, but some folks in particular
in terms of getting this whipped into shape and what I would consider to be
impossible deadlines and it's like every time I see folks on a social basis
we're asking questions and talking about the hospital district and I see tom
-- the two toms and donald at the symphony, that's what they're always talking
about, so I just want to say thank you again to agreeing to be a part of this
process. Has it been perfect? No, do we all wish we had more time? Yes. And
I won't say that the questions that the county asked over and over and over
again made this a better document, and by us being the ones asking those questions,
it allowed you all to come in as the independent neutral third party in this
thing to kind of pull it all together and say, "how do we move forward as
a community? And I think we do need to move forward as a community. There
are so many other issues that we need to get working on and I fully respect
and look forward to you all knowing that we care about reserves and you're
going to do everything you can to build up those healthy balances while still
trying to listen to the community in terms of all the demands that are being
made on the system. So I just want to say publicly thank you. The work is
not over. It's just beginning and I appreciate you all being in the trenches
because it's amazing the amount of work that has gone into this.
>> thank you.
>> y'all are working here until 9, almost 10:00 is what sandy
was telling me. It's just amazing the hours you all have put in.
>> we're enjoying each other's companying and... [laughter]...
And I want to thank the court for their courtesy and for all the support that
they have extended to us. I particularly like to thank several people at the
county, jim collins and tom knuckles who work so hard on the legal aspects
of this. Sid grimes has now spent two two weekends with us and I知 hoping
with therapy she'll recover from that [laughter]. We appreciate her spending
the weekends with us the last couple of weekends christian smith, susan, diana,
all the people who the auditor's office who helped us to set up books and
who has been over this agreement. Barbara silly who facilitated lots of work.
There's many others on the county staff who have worked hard. I would like
to thank my colleague, particularly those on the budget committee, who spent
a lot of time meeting with the city and working real hard on this. A lot of
these issues were very difficult to work through, and this is an agreement
that I think for everybody doesn't have everything that everybody would like
to have in it, but it has ended up with what we think is a serviceable and
responsible agreement from the standpoint of the district and we appreciate
your working with us on it.
>> thanks very much to everybody. I appreciate the time that's
been spent on this very important issue. And I think it's going to be reflected.
Thanks to everybody.
>> let me move approval of interlocal, see if clark has to
take those expressions of appreciation back. [laughter]
>> this is number 10.
>> this is number 10.
>> not a problem.
>> and I would like to also say that this -- I know this
has been a arduous task. Folks, really, working number of hours and the number
of times -- the length of time that you have had to work on this thing, you
really make it a lot closer to the issue. If folks really knew how hard you
have worked, you came here a couple of weeks ago and you asked for more time
to work out a lot of differences that you had before you a couple of weeks
ago and now you have brought something that have resolved a lot of those questions
that were not resolved at that time, so even on the fast track you have done
a remarkable job, and I guess the bottom line now is the services that will
be rented to this community as far as taking care of our energy who continually
need the service and of course I think the wise decision by this court and
also by the city of Austin to appoint the caliber of persons to take this
issue as far as dealing with health care needs here in Travis County, I mean
it's just -- it's above words. The end result is that there will be someone
out there that will benefit from this even though they don't know the inner
workings of what it took to get here, and so, again, I applaud each and every
last one of you with that second, judge. It's a big deal.
>> that's all right. Any discussion? Any comments?
>> well, I hate to be the one that continues to beat this
dead horse. I am -- I mean I just can't get comfortable or signing off on
this interlocal agreement. I mean we've had a September 12th, a September
17th, a September 24th, and one delivered to my office this morning. I haven't
had a conversation with john hilly, which I guess is really our attorney to
go over, you know, this thing, I -- I know how hard y'all have worked. I mean
this is not dogging y'all. I mean, my gosh, you signed up for something that
has been thankless. Important. But -- I mean I hate to be put in a spot where
we've got to do something because it's the time to get it done versus really
being comfortable with reading something. I don't think that y'all -- I mean
if y'all weren't on this board that you would want an elected official to
just say you need to do this because this is what we need to do. I mean I
don't -- I知 not comfortable that people in this community think that's what
we need to be doing. And I知 not trying to be ob stein senate, I mean I知
nervous as heck to sign off on this thing because I think once we sign off
on it then the city says we got exactly what we wanted. We got them to sign
off on this knowing that there are still major issues with regards to do we
have enough money in the reserves, are these -- are these really things that
we need to be signing off on? And i've said it before, we are at a very --
or in a very unfortunate spot. The only people that can do this, apparently,銛
is the cityf Austin. If the hospital district board of managers said, you
know what, we're not going to sign up for this thing, I don't think there's
another place for us to go and get the services delivered to us, and -- and
that's not y'all's fault. I guess that is not anybody's fault. I guess that
is how things have been, you know, with health care in the Austin area. I
would ask -- I mean from the county attorney's office and, barbara, I don't
know if you have worked on this as much or whether it is john hilly, but,
I mean I知 going to ask can the county attorney's office from our side, the
count side, give me a thumb's up on, yes, Commissioner Daugherty, you aught
to sign this, and I知 going to ask pbo to give me a thumb's up, yes, you need
to sign this. I think the auditor has basically said, yes, I think you ought
to sign the deal. Hhs, yes. Because those are the major folks that we've got
to have if there's an issue -- it's not like I知 going to be able to come
to y'all, I think we can talk to you about it. I think you're going to be
very sympathetic to, well, we didn't really know that that might -- that that
was going to happen, and I realize that whenever you sign a contract that
there are all sorts of things that can happen to you. I don't want to vote
against the thing because I want us to move forward, but I am nervous as heck
doing what we're fixing to do this morning. Especially when I got the latest
this morning at 8:00. John, so I guess i'll start with you. Is this something
that you would have me, Commissioner Daugherty, I知 fine with this, give it
a thumb's up.
>> I don't think I could phrase it exactly like that, Commissioner,
from the standpoint of there are some certain deal points that you may be
interested in that I cannot give you advice on, but I can tell you that tom
knuckles, and in fact jim collins, trading hats occasionally back and forth,
providing legal analysis on this as well, to say that it is a legally sufficient
document and it took a great deal of effort drafting it and it is concise,
well-drafted dock, so from that standpoint there's legal authority to enter
into this document.
>> okay.
>> and for the Commissioner's court to approve it.
>> okay. And pbo, christian, are you pleased with... Signing
off on this?
>> I handed a hand-written note to clark hydrich which said
you should get a very big fat star in Travis County heaven. You said at one
time if somebody told me to get over the 33 million, maybe that's what i'll
do. You've got to get over the 33 million. So I知 telling you that. If you
can't get over the 33 million, you should vote against this. Aside from that,
this has got an essence, I think, that business deal that makes the most amount
of sense under the circumstances in recognition of the roles that exist, so
it's a matter of -- it's practical, it will work and it is a year-long deal.
It doesn't contain a variety of elements that in a perfect world one would
want to have it contain. But it's doable and if I were in your seat, I probably
would say some of the same things you're saying but I would get over it. Because
it is a dead horse, I think.
>> I think some of the things that i've learned that kind
of helps a little bit is that there isn't anything perfect and you can lay
it all out on paper and as soon as human beings get their hands on it, it
changes. So I think if we keep that in mind that it isn't the panacea, it's
not to answer to -- it's not utopian, but I think if all of us pay attention
to what we're doing and approach it carefully, I think that we will carry
out what the voters wanted. But I don't, for a minute, think that any of us
are perfect and we all have to kind of take those steps, careful steps, that
make sure that we work together and that we have checks and balances on each
other and make the best of what the voters have asked us to do. But I don't
for a minute think that it is the answer to everything, and so that in itself
tells me we have to be very careful in how we approach our decision-making.
And this interlocal simply lays out some guidelines for us as to how we will
approach the job. Now, what I heard at the meeting last week is that all hospital
districts are going broke and that they're going back to the county and the
city for money. Well, knowing that, don't we think that here in Travis County
we can approach this in a different manner so that we don't have the way side
of other districts? And -- and I just have tremendous confidence in us that
we can get over this and that we can meet the challenges and it's replete
with challenges, but I think we can do it if we kind of all help each other
out here as we go along and let's not, you know, cut each other up, let's
work together an accept each other's humanity and let's work together on these
issues that come up.
>> maybe a couple of more words about the working together,
because I can't say that I attended 100% of the meetings that the judge had
with the transition team 100% of the time, but I was there for a good portion
of it. In addition to the folks that clark singled out. Let me tell you another,
barbara sully, your proxy, your assistant was in those meetings and very vigorous
in terms of asking questions not only on policy but details. Valerie spent
a amazing amount of time in terms of gathering of information. Shirley fleming
with health and human services, along with a full team over at hhs, they were
looking at it from the patient point of view, from the clinic, while we're
trying to get these technical things done, there are real people who are going
to show up in our clinics on October 1 expecting business to be as usual.
They weren't supposed to be impacted in this. I知 seeing kimberly walton and
mike wicker also from the auditor's office. All these picky technical questions,
they have spent unbelievable hours along with leroy and christian smith and
what the judge did in terms of running all of these meetings and all of the
meetings that occurred not within our Travis County family, but this board
started meeting soon after they gotten named to these posts and they have
been meeting for countless hours in subcommittees, in full meetings and those
have been attended by your assistant, by my assistant, unbelievable hours
in term of trying to pull this all together, and I think we're going to be
better off in some of those hospital districts even though we're starting
from scratch because some of those other places, houston for one, they don't
have the hqfc status. We do. They don't have the people's community clinic
partnership. We do. They don't have this amazing thing called Austin Travis
County e.m.s. And starflight, we do. And what I have really learned to appreciate
is the amazing medical community in Austin and Travis County. They are amazing
from the medical society, they're the ones that brought forward that great
idea about project access. How can we leverage what our own doctors are doing
in this community. So we have partnerships that other people can only dream
about. Again it's not perfection, but we have to move forward, and this budget
is a way for us to say we are moving forward.
>> ms. Warner?
>> I just wanted to clarify for Commissioner Daugherty that
as far as when you said the auditor signed off on the interlocal. What we
looked at is to make sure that the district is getting the information they
need to keep their financial records new orleans with generally accepted accounting
principles approximatelies so they can be audited and an opinion rendered.
That's what we looked at and that's why we worked very closely with mr. Young
and mr. Hydrich on those issues so that -- because they wind up on our books.
They are going to be a component unit of Travis County, so they will be on
our financials, so we had a vested interest in making sure they do maintain
their books new orleans with gaap. We didn't say write or wrong on however
it was written.
>> okay. Thank you. Anymore discussion on the motion? All
in favor? Show Commissioners Gomez, Davis, Sonleitner, yours truly voting
in favor. Voting against Commissioner Daugherty.
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Last Modified: Thursday, October 27, 2005 9:26 AM