Travis County Commissioners Court
May 9, 2006
Item 2
2. Consider and take appropriate action on budget amendments, transfers and discussion items.
>> judge, I don't have any problem with any of them -- it's not even a problem, I have every intention of voting for the medical item related to the sheriff's office, I think it would be worth taking a couple of minutes to kind of lay out because this is the first of many transfers to come and the numbers are pretty big. So I don't want anything big just kind of for the record tell people what's going on here.
>> okay. Commissioners, my name is bill [indiscernible] with planning and budget. At the present time and we may have a better idea later on this afternoon after the end of the year is done, we are expecting the sheriff's office budget will be about $1,400,000 over budget. A large portion of that is related to the medical services budget. That alone is -- expected to be about a million -- almost a million-two over budget. Also pharmaceuticals which I think bill will need to address a little bit, also, expected to be somewhere in the range of half a million over the amended budget. We are requesting with this amendment that we fund with $300,000 in salary savings in nursing vacation ceabses a on -- vacancies a than if her for medical services and a new line item called nursing services, where we will be ability identify things more quickly than in the past. Additionally $145,000 from the roughly $800,000 jail reserve that we need about $600,000 in that reserve. We are hopeful, I believe the sheriff's office is also, that a million-four can be contained within that dollar amount, hopefully less.
>> I think it's, I mean, really appropriate to bring this up because whenever as an elected official we are out on the street talking about what do you get for county government given the fact that you pay most of the people in Travis County do pay municipal taxes, I mean, being in incorporated areas. That this is a pretty eye-opening experience and we are talking about the jail here and it's $100 million. Whenever I tell people that medical services for the people that we incarcerate in this -- in this -- in Travis County, medical alone is $2.7 million. The pharmaceuticals for the people that we have in the jail is $1.5 million. I mean, people are just like wow, we -- we paid for those kind of things. Now, all of us that are in county government know that this is the case. But this is -- this is pretty eye opening. And, you know, it's easy to read your backup, you have done a good job, real easy to understand. Hey, I mean, this overage, a million and a half dollar over, about a million dollar over on just medical alone I guess we are to accept the fact that this is due strictly to the numbers that we have in our jail, although the numbers that we have in our jail this year is not any greater than we had last year. So it is pretty amazing to think that we are either locking up more diabetics or people that need more attention but it does kind of cause you to question what exactly is going on. Because this is a -- this is a pretty disturbing number that's moving quickly in a direction that I don't think that any of us want to try to take on. So I’m glad that Commissioner Sonleitner brought it up, I do think that it's something for the few people that do watch channel 17, this is a pretty eye opening number.
>> we budgeted it at what level.
>> about a million-six for medical services.
>> we budgeted what jail population? Level?
>> 2675. We are currently projecting a population for the whole year of about 2580, 2600.
>> so we are under the number that we projected but extremely over in, you know, our medical --
>> there are some things bill can certainly help me on, there let me say that much of the work that has been done on this has been done by bill and his staff and the folks in the sheriff's office. A lot of this has to have been a painful process, we are as timely as I think we could have been at this point. A portion of this is related to stuff from before, from years back, '03, '04, '05. Some of that will not come back on us, so to speak. But a portion of it is related to the nursing services issue, and the phasing in of that problem and some robs to a certain extent of working at the timing of that. The rest of it I do n that we had about 16% more hospital days in the first five or six months of the year than we did in the same time last year. Of course the population the first part of this year was much, much higher than it was the rest of the -- of -- than it was last year at that time. So I can -- that's a portion of the explanation. Bill can perhaps address a little more.
>> I can amplify on that a little bit. We discovered a backlog of processing in our medical section at del valle. And when we discovered that, we are talking a little bit above $200,000 as it turned out. We took all of that processing or as much of that as we could. Back into downtown financial division. Which is where we are laboring now. To try to work with it. Some of that went all the way back to 2003. Where medical providers would send a bill, there would be a problem with it, wouldn't pay it, they would send it back, we would send it back. That is more or less a one-time event. We discovered probably in November that it looked like we were going over and began tracking our costs a whole lot closer than we ever had before. We found that -- that our nursing contract labor, we had kept hiring at the same rate that we had last year, even though we had begun filling our regular nursing slots. So we have a bit of a cost overrun there. In reaction to that we have set up this new account that will contain only money for contract nurses. So we will be able to look at it immediately and know exactly where we stand if we are -- if we are overspending on the contract nursing budget. So we have reacted I think fairly well if a month or two behind the curve to try to put some controls into place to hold it down. We are seeing some higher medical costs, we've had a few inmates come in with gunshot wound that did use up some hospital days that were more than we have had in the past years. When we run 2800 inmates, part of what we have is we have a higher probability of somebody in that 2800 simply having a -- a series illness and -- than if we are down around 2500. It's just a -- just a law of probabilities that if we have more people, we have a bigger chance of someone being seriously ill and we have to take care of them. So it is a combination of circumstances. We may also be seeing some increases in costs. And that is the kind of thing that's just terribly difficult to budget for -- from one year to the next on what we predict the medical providers are going to go up in terms of costs.
>> we actually -- were you through?
>> I will take your question any time, Commissioner.
>> okay. Have we in the past combined our pharmaceutical purchases with other parties? An example, maybe there's another county jail or pop planning commission that needs similar pharmaceuticals as the inmates have in Travis County. Have we combined the purchases overall to get a discount, maybe in a major purchase of pharmaceuticals? Is that something that's been experienced in the past?
>> well, no, sir, we have a contract with a -- with a drug provider. And as -- as bill referred to, we are working hard next on -- on analyzing the pharmacy and pharmaceuticals because it looks like we are going to be short there.
>> yeah.
>> it's a little premature. We have a contract with the drug supplier that is our primary source. For pharmaceutical, it is not combined with any other county right now.
>> we are a stand alone at this point.
>> yes, sir.
>> okay. It may be good to know if there are savings of entities such as other counties that may combine their purchases as far as pharmaceuticals, I don't know if it an advantage or disadvantage, but it may be good to know if there is an effort, if so what would be the savings be to a similar population as Travis County has.
>> Commissioner, we are working with the auditor's office and with purchasing. So try to find answers to that question and others like it. We are right in the middle of it. I mean it will be two or three weeks before we bring pharmacy and pharmaceuticals back before you.
>> we will have the answer before the next budget, though.
>> yes, sir.
>> specificallies for vehicles, sometimes we buy off the state contract, sometimes we buy off our own, sometimes we buy off of the harris county cob contract because some of those larger entities have better prices.
>> exactly.
>> so that's -- we ought to pursue that.
>> research it.
>> the other thing that I think is real important for the public toed this, though. If you got 2500 people in your custody, then you have a great medical liability issue to add. Add -- to address. If the inmates have medical need, our responsibility is to add them. If they get to the hospital too late and die we are looking at a major lawsuit unfortunately we could have our share of those for medical and other reasons. The other thing is that when an inmate goes through brackenridge hospital his or her bill is the same that mine would be for the same treatment, we are not given any kind of discounted rate. But we have a committee in place that's looking at attendance, trying to make sure that we do all that we can to keep that number as low as possible. We normally keep about four or five initiatives in place to try to do that. I think compared to last year really three or four years ago, we are doing a good job of keeping the number down. It's a constant struggle.
>> judge, we are reducing some of the billings because most of our people are indigent and we are allowed under federal rules to reduce billings to what an indigent should be charged. We are doing that and saving a pretty good amount of money off the face value of what the invoices come in at. So we are scrutinizing what we are billed and paying what we believe is proper. Under the rules and regulations that exist for indigents.
>> the bills, are we also having conversations with the hospital district, one thing positive that did occur within the last year is that mhmr, which was not getting a very good deal on their pharmaceuticals, a lot of those things got shifted over and the pricing power of the Travis County hospital district soon to be the Travis County health care district, they were able to take advantage of the huge pricing because of brackenridge hospital. We work with the hospital district rather than looking at do we combine with another county, I would say are there some things that we can be doing to leverage our situation with the hospital district in term of the purchase of some of these [indiscernible]
>> the answer is yes. But only one initial meeting for about an hour and a half. Just to explore where they were, where we were, see if we could continue that exploration. They are working on some answers to some questions we had. They wanted us to answer a few questions, we are trying to find answers for them. It's very preliminary. The answer is yes we have started.
>> I would continue to go on there also related to try to find medicaid eligibility, et cetera, a very heavy duty effort was made on behalf of the Travis County and city of Austin clinics as well and so I would just see if there's some -- some leveraging or -- or buying additional licenses of owe over the kinds of very sophisticated software that they are doing that basically searches through all sorts of programs that we -- could never even image. So I would hope that the conversations with the hospital district get beyond preliminary and very seriously. It all the same money. All coming from Travis County taxpayers. It's just on a different line item of the tax bill.
>> I’m not sure we are ahead of you. That is one of the questions that's on the table about the software licenses on the clinic's software. We are also pursuing software internally in the sheriff's office. That would automate a good bit of what right now is manual on reducing the billings. Based on medicaid and medicare rates. We are pursuing several items.
>> one other thing is that we did set aside on the chance that we would have to be sending folk out of county, is this correct that we still have about $100,000 plus -- $800,000 plus in that account that likely is not going to have to be tapped?
>> well, actually we are using a portion of that for part of this appropriation. And we will probably need to tap all of it quite frankly with this situation.
>> I figured it would be zeroed out by the time we left. Just so that people are not thinking there's a million-four, there are not strategies that are being explored on how we are going to cover every single one of those --
>> certainly are. Right now the possibility of sending folks out [indiscernible] given current trends relative to last year, is that we will not need to do that this summer.
>> but if we approve this recommendation that will leave 650,000 in the jail reserve.
>> yes, sir, that's correct.
>> what's the 1.4 million now.
>> that is inside the sheriff's separating budget right now. Operating budget.
>> wait. That's inside the sheriff's operating budget for jail related expendtures.
>> yes.
>> all expenditures.
>> our current projection for the end of our 100 million-dollar sheriff budget is a million -- a million and a one, 400,000. We are projecting a total overage at this point of 1.4 million.
>> the good news is $1.4 million has been discovered somewhere.
>> it's the [indiscernible]
>> yeah.
>> it's got the parentheses around it.
>> move approval. [multiple voices]
>> I don't know that any of you all can answer this. Do we have the ability to -- to in the interlocal agreement to have the city participate in any of these kind of overages with the medical and the pharmaceutical? Is there -- in the formula that we have, bill, is there --
>> no. That's outside of central booking. Central booking does have some nursing staff in it and it is -- those are included in the costs related to the city. But the costs for medical services are strictly --
>> okay.
>> behind that wall basically.
>> thanks.
>> let me just mention one thing for you all. That is we will need -- we will need to come back probably in the July time frame for further proposals for this purpose. And we also will probably have -- have to have an appropriation related pharmaceuticals. We are not out of money in that area, yet, but we will be probably in the next couple or three months.
>> it would also be good to have some answers to some very important questions that was illustrated here from the court as far as pharmaceutical and other cost savings that may could be at hand if we -- if we do certain things. So I just think all that need to come together, in my opinion.
>> shouldn't we get a 15 or 20 minute work session overview of the -- of the jail budget. Within the next 30 days with projections through the end of the fiscal year. If we -- if we -- if we are thinking that we will need an amount over and above the jail reserve, the sooner that we know that the better, if there are steps that we can take to reduce the -- the -- expenditure then the sooner we know, the better.
>> I would also be interested, you could only look at a snapshot of any given moment in time, it changes one day before, one day after, of kind of drilling down beneath some of these numbers. Are these folks that are primarily there on pretrial? Are these folks that are spending quality time with us because they have been given a -- a county jail sentence? Are these folks that have been racking it up since the day they got there, at some point they get transferred over to tdcj, it's just trying to drill down just a bit, knowing that it is just a snapshot in time trying to give us a sense. I’m real interested in knowing a little bit more about what kinds of things are we seeing, is it diabetes, are we seeing certain kinds of illnesses that tells us that there ought to be screening things going on in our community at our clinics, et cetera, that are -- that are dealing with folks that are perhaps -- are we just not getting people in? Are there screaming things that can occur so it does not trigger something much more expensive, much [indiscernible]
>> we try to work it into everything else that we have got. It's pretty well manual at this point but we will get started on it and have it for you. The sheriff's office will be happy to take the lead on a work session. We can work with p.b.o. As you would like on -- on what you will like to see.
>> not only the current situation, but also projections through the end of the fiscal year. Would be helpful.
>> certainly.
>> mr. Nellis, closing comments?
>> one short correction on a 2. The -- the -- the department under the second entry there says t.n.r., should be facilities. The account number is correct. But -- but the -- the description --
>> motion includes that correction?
>> yes.
>> any more discussion of the motion?
>> huh-uh.
>> all in favor? That passes by unanimous vote.
>> thank you all very much.
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Last Modified:
Wednesday, May 10, 2006 1:15 PM