Travis County Commissioners Court
September 12, 2006
Item 28
Representatives from the sheriff as office have been very patient today. Rather than test their patience further let's call up item 28. Item is to consider and take appropriate action on transfer of funding in the preliminary budget from the pharmacy reserve to the Travis County sheriff's office budget for an internal pharmacy.
>> judge, Commissioners, I'm bill campbell with the sheriff as office and major dalasia corrections bureau, mike summers is our medical director, and a a few other resource folks here including some from gardener bets who use this contract. We are requesting that the court consider when it meets again next Tuesday on the 19 19th that you allow a change in the preliminary budget. We have checked with pbo on our numbers. This is cost neutral in terms of the money in the budget and a reserve that is in the budget for the pharmacy. We have calculated what we believe to be the best estimate of the lowest cost to run our familiar . We believe that is to-- to--pharmacy. We believe that is to bring it back in house. Our package in the preliminary budget that we submitted contains one pharmacist and another one- one-half pharmacist slot. We have two pharmacy technician slots. We have requested 50,000 in software for the pharmacy pharmacypharmacy to provide data -- for the pharmacy to provide data that we have had difficulty getting on the prescriptions that we have written. And we have another eight, eight,800 for telephones-- telephones--eight--elr 800 for telephones and computers computers. This would be a substitution for money that is in the preliminary budget already. It will allow us by bringing the pharmacy back in house with the perform pharmacy-- pharmacy--with the appropriate pharmacy license classes, to aveil ourselves of recycling of unopened medications which we have found we were unable to do with utm b. And that is the largest cost saver in bringing it back in. In addition, we have found in using utmb that we first put nursing personnel into the job of opening the packages with the prescriptions in them and distributing them. That proved to be pretty costly with nurses at nursing salaries. We have now gone to using contract pharmacy technicians temporarily as the better alternative to do that. If we were to continue with utmb we would request one or possibly two pharmacy tech positions to allow us to open the packages that come in and to properly distribute those to the units where they are needed so that, I believe, coupled with the fact that utmb does not have the pharmacy board board's permission to recycle unopened medications means that should we choose to continue utmb, that we are choosing a higher cost alternative than we believe we have if we bring it back internally.
>> can you be more precise. What's in the budget, I was hoping, are you mr. Enberg is this.
>> this is his alter egoi need to get some precision as to what do we have in the budget in terms of dollars. Because the follow question is going to be if you think this is going to cost less, why would we not budget the lesser number to encourage success in that direction?
>> we have a pharmacy reserve in the preliminary budget of 248,000.
>> for?
>> and that reserve was put in by pbo to cover either the continuation of the current contract or bringing it in house . And at the time of the preliminary budget, the decision had not been made yet as to which way the sheriff's department was going to recommend. We have no problem with the sheriff bringing it inside.
>> okay.
>> bill is not able to be here right now. But I have been in the discussions with the sheriff sheriff's office with bill. And I think they have made a case that we can support for bringing it back in . Now, as to additional savings from bringing it back no, I don't know that number.
>> I'm just making sure I understand the numbers. So we had a reserve already as a placeholder in the budget, already in there, in the event we went with what we was the more expensive, but that the where we were at. Utmb version of doing this. So is the suggestion that we do back in house and that that reserve can be liquidated?
>> yes. But I think the recommendation from the sheriff's office is that they would need to use some or all of that reserve in order to fund the internal staffing. Right, bill?
>> yes.
>> does it need the 248?
>> we need the 248. In addition, we have a line item in the preliminary budget for contract pharmacist that that. It would be the combination of those two that would funds our request. The calculation is still, I think, bill, is not finished with it. If there are savings, we're happy to but those back into the kitty. I personally, and I think bill and I believe leroy, are confident that there are funds in that figure that are more than sufficient to cover our request.
>> I'm hearing one-time costs which of course you would have to do for the pharmacy management software am you don't have that right now so you have get it. Certainly for any kind of computers and . But anything related to pharmacist and techs, that would be ongoing. That ought to be offset by what you are contracting out to utmb in terms of dollars. I am not hearing--
>> that's the hundred thousand I'm talking about for a pharmacist.
>> I'm not hearing the offset.
>> that will be a part.
>> we need an apples to apples comparison.
>> it may be right there. I'm just not seeing it.
>> when is our contract with utmb up?
>> it expires with this fiscal year . Purchasing is--
>> September 30 is the answer.
>> yes, sir.
>> we need an apples to apples comparison next week. That deals with the money.
>> the other question is what about the programmatic perspective? We have heard how difficult it is to get healthcare professionals hired to work in the jail. Right?
>> yes, sir.
>> the question is, how do doable is it for us to do this in house and can we do it that quickly? Or would we phase in, phase out utmb and phase in doing it in house? If you terminate the contract September 30, that presumes that we have the right personnel.
>> we would phase it in, judge. It's almost certain we would phase it in.
>> we need to see that next week also.
>> okay.
>> that's my point. We need to put the money in a place where we can reach it after the conversion. But it does seem to me that from, there is some programmatic question. The other thing, is it a good practice to recycle these drugs. That makes all the sense in the world to me. As long as the drugs are un untainted, medications instead of drugs, let's use that word. As long as the medication is untainted, then it makes sense to me to be able to use it. But from a health perspective or a jail house health perspective, is that a good thing to do. The other thing, in the ought urban counties, how do do the same function? Not that it drivers us but we can get some input from them. Since I have been here we have not done this this house, right?
>> yes, we have. A class a pharmacy for years and years understand a contract. And when the pharmacy board changed their rules that required a full-time pharmacist on bored, you know, on site, rather, we didn't have that.
>> when was that?
>> just recently when we took over--
>> months ago.
>> this was may and June, judge, of this year.
>> oh, okay. I thought the one, the pharmacist or the vendor that we had the issues with, I thought they were here a long time.
>> they were, judge. They were operating our internal pharmacy.
>> on contract.
>> on contract. They were a contract pharmacist.
>> we are going that? I thought we were--going that? I thought -- back to that? I thought we were gag to us.
>> we are going back to a hundred percent operated by employeeswhen have we--
>> when have we had that?
>> never.
>> all right. We had a pharmacy on site that was run under a contract not by our own fte. Sorry, I didn't understand the question.
>> it was the contractor.
>> correct. The pharmacy was on site.
>> aren't various heads going in different directions here? Clearly we can't flip a switch on September 30. Our purchasing agent is saying no, you can't do that.
>> sure.
>> there's going a transition period. My biggest question is going to be like the judge's. It's difficult to hire professionals to work in the jail because would you rather work at cbs or work at the hilton? You know.
>> we're graduating our residents as quick as we can also. I with like to, because your point is absolutely well taken. I would like to commit us to a couple of different analyses for you all, one though shows fte and one that shows contract and the difference in the prices. You're right, if we have our own fte but can't hire anyone, we have a pharmacy sitting there that goes un unattended. Right now, my biggest concern, I'm sure mike's also and jeff sitting behind me, is that the quick delivery of medications to our population, and that's not always occurring right now. So we really do need the pharmacy on site. What's the best way to go, f fte's or contract. I'd like to to commit us to doing both of these analyses to show you the cost difference and the better way to go hopefully.
>> okay. How in fact it operates, not hopefully, but it has to be consistent with rules of the pharmacy board, I guess.
>> yes, sir.
>> and we need to make sure that all that is in place. If so, no problem with me. We can put the money into reserve where we can gradually transition or we can do it overnight. I'm just saying, I'm thinking we need to make sure we're ready to dispense medication ourselves before we cut off our contract.
>> absolutely.
>> which is what you all are saying.
>> I agree.
>> I'm in the saying less delay but--not saying let's delay but I am saying let's take our time and work our way through and at the appropriate time do what's necessary. What you are saying is over overlook the cost savings of $26 4 ,000 on the second page of this memo that I'm looking at. We're looking at basically a break even, we spend roughly the same amount of money. If we do save a little, we'll see it at the end of year.
>> yes, sir.
>> yes, sir. We'll see it not in the operation of the pharmacy itself, but in our savings on the cost to the pharmaceuticals by recycling.
>> okay.
>> the question, and maybe mike, you know this, we all realize how difficult it is to hire nurses and medical people I don't know if the pharmacy world is in that same class. I don't know. I know the dean of the school pharmacy, I bet we can find out real quick > is that profession in as big a shortage? There are a fair number of pharmacist graduating. One of the things that's happened with pharmacy in particular is you rarely are going to be able to just find the old neighborhood pharmacist anymore. There are many different spectrums that the pharmacy folks go into. There's research, nuclear medicine,, retail supply and distribution. There are many avenues open for pharmacists. Right now they are at a premium. The salaries are way up there for a new graduate. The other thing, that would be one of the things that we would really need to look at because with the pharmacy inside the jail, with the new stipulations that just passed recently with the pharmacy board, if we only have one pharmacist and that pharmacist goes on vacation, we essentially have to shut the pharmacy down during that period of time. And during that period of time we have no mechanism to get any medications out to the inmates because the pharmacist must be on site.
>> before you bring us something like this, then, I mean, I sure hope that that is all factored in. Because that may be the deal killer.
>> that's why--
>> we have to find a way do that, but the last thing we need is to find ourselves with not having the professional. That's kind of how we got in trouble the last time. That's why we asked for the one and a half fte for relief when the sift did need--pharmacist did need to go on vacation or training.
>> is this seven days a week week?
>> no.
>> it doesn't need to be run 24--
>> at least five days a week hopefully 12 hours during that period to be able the handle the volume of prescriptions that are written.
>> would you anticipate that most likely the weekends would be the times that you would not have the pharmacist in there?
>> they would not be on site but they--
>> that might be a great selling point to a pharmacist.
>> right.
>> somebody that says, I mean, why would I want to go with this.
>> but they would need to on call. We would need to have the pharmacist on call.
>> which I'm sure they would love to do.
>> eight or nine key items.
>> yeah.
>> I think we need the apple apples to apples cost comparison. It would help me to see a little bit on this recycling of medication, that it's all right if you do it a certain way . We would do it that way. I mean, it would help. I guess I feel a little bit more comfortable if other urban county jails do this themselves and have been able to overcome of what problems surface.
>> sure, even utmb do that at their own facilities and the ones they operate through, they recycle their own medications in the process. We did that here for ten years, the recycling of the medication . And it involves usually medications in blister packs that are not touched by anybody.
>> okay. We're talking about unopened medication.
>> right, yes, sir.
>> and it's all legal.
>> yes, sir.
>> according to Texas pharmacy board.
>> yes, sir.
>> the rx, that's the reason we had them because you could do that if huh somebody on staff.
>> yeah.
>> andly contact the other large jail administrators this my circle and get you some example of what the done in other places.
>> I love the Texasment of corrections--texas department of corrections but hi an urban county jail in mind.
>> since we do have one in our backyard can we check with the warden at the state jail to see their policy? I'd be interested in their policy. Doesn't mean it's the best practice.
>> policy in terms of?
>> do they have a farm out--
>> no--farm out--
>> no, they are -- pharmacist.
>> no, they are provided but utmb, all the utmb facility. The big difference between a jail and prison is that at the state jail, they have what the called a pill window. Everybody in that whole facility comes to that pill window to provide the medications. The other issue has to do with the technology that's at the end d the medications that come from utmb pharmacy is all bar coded with all the information, the inmate name, the name of the medication, everything. At the stale jail, they have a bar code reader that reads that, [po-pbs] it up on the screen, reduce--pops it up on the screen, reduces medication errors. What has been expected of us we receive that information and then we take a computer system and have to break it down to pencil and paper to add minister. Which has been a big problem problem. And that's very time consuming issue right now.
>> it's the lookinging of a bar code reader?
>> and the computer and the technology system.
>> okay, one more thing for us to take a look at.
>> right. A big difference between us and the state jail, they know how long they are going to have their people. Have I no idea how long we're going to have our folks.
>> too long.
>> well, in some cases you're right.
>> we'll have it on next week.
>> thank you all.
>> thank you.
>> thank you.
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Last Modified:
Wednesday, September 13, 2006 10:11 AM