Travis County Commissioners Court
September 19, 2006
Item 15
15 is to discuss and take appropriate action on a pilot project for bearia trick surgery.
>> good afternoon, judge and Commissioners. The item that you have before you as you stated, judge, is a pilot project for the baria trick surgery. The item had been brought to the cort before. It's just an addition to the plan that when we discussed it, we thought it would be better to go ahead and pilot this particular program. It was recommended by the committee that deals with employee benefits. We had much debate and discussion on the viability of adding this to our program. It provides an option for bearia trick surgery for individuals who are more bid bidly obese. This particular pilot limits the number of surgeries that would be done to 15. And over a five-year period. And structured aspecific criteria. The criteria is on page 2 of your memorandum. It includes a bmi of over 40 40. And with at least one comore bid ty. What that would mean in practical terms, an individual, I think five food four, would be about a hundred pounds or so over overweight and have one co comorbidity which would include either diabetes, high blood pressure, heart problems, skeletal, muscular issues having to do with the obesity. Documented attempts at weight loss for over one period. The individual participating in the program would be required to work either with our clinic doctors or their own doctor to show and document that they have indeed established a program that for weight lost, that they have taken every effort possible to lose weight and for whatever reason that is clinical in nature they would not be able to do that that. We we would also require cycle call counseling preand post surgery, documented membership and attendance in a support group post and pre presurgery. They would have to agree to monitoring both preand postsurgery at the clinic or at their perge fist who must must--personal physician, who must provide medical information to the county. Prior to surgery, the employee would have to pay $ $1,000 as a deposit that would be refunded within three years postsurgery just to make sure that indeed their efforts are successful and they have done everything they can to comply with the requirements of the program. I want to also clarify that along with the $1,000, the employee, depending on the plan that they are in, would have to mete their calendar deductible, for example. If they are on the ppo it would be $200. If they are on the coinsured ppo, it would be $400. And their out of pocket would take that to a maximum of $1500. So if the surgery costs about $25,000 or so, they would be required to pay $15 $1500 out of pocket plus the $1,000 and $100 for admittance into the hospital hospital. Like I said, it is a pilot program. We're here to answer any questions that you might have.
>> I have a couple of them, if you don't mind. Can you tell me exactly what type of preparation a person would have to get themselves ready for for preparing for such type of bariatric surgery? Is there some type of requirement? A person may say I'd like to have the bariatric ry if the court decides to go this route, but is there any re rerequisite as far as conditioning that the person must be in prior to that kind of surgery being performed, not to monitor, I think you just went into that as far as the thousand dollars deposit which will be refunded at some later date. But other type of conditions that must be met prior to having such type surgery.
>> yes, sir, for one year prior to the surgery, the individual must be under medical care and participate in a program for weight loss loss. And those efforts must be documented. Within that, then the particular physician would assure that the person was in the condition and good enough health to have the surgery in the first place. But the efforts must take place for one year of weight loss under the supervision of a medical doctor before gastric by pass surgery.
>> is there anyone else in the state of Texas using this particular type of procedure under an insurance plan, speaking basically of public entities, that we are aware of?
>> none that we're aware of, Commissioner. We implemented the one-year presurgical program to assure that employees who did participate were serious about and could abide by the physician directives on diet nutrition, exercise, both preand post surgical. We don't know of any other public entity that is using this structure am we do know of a couple of public entities that have added the surgery to their benefit planplan.
>> which ones?
>> the teacher's retirement system. And I forgot.
>> it was teacher's retirement system. I read recently medicare medicaremedicare has approved--
>> medicare has approved this for a benefit, it's been about two years.
>> we know medicare has or we think?
>> we know medicare has for two years.
>> okay.
>> you mention the bmi, body mass index, of 40. That equates into how many pounds of excess body fat that you have? What's the range? In other words, if you have so many, if I weigh a certain amount, a certain height, how many pounds beyond that would be considered a possibility for and the other conditions that are with it, looking at bariatric type surgery? You mentioned diabetes, high blood pressure, a lot of things, but the weight match itself, how many pounds are we talking about?
>> the body mass index changes by height and build and so there's some variables there. But generally a person five foot four who has a body mass index of 35 is going to be about 80 to 100 pounds overweight. A more bidly obese person at that height with a body mass index of 40 would be about 150 pounds overweight . The comore bid ty we talk aboutcious what we're talking about with bm ix of 35 with can comorbity, they are the cost drivers that we recognize in our health plan plan. So that's the attempt we're making to bring those costs under control and that's why we're using that as one of the criteria.
>> so being overweight and with those type of conditions, there are certain affects and cost drivers, cost driving affect affects within our plan that would suggest substantial expenditure to address those particular cost drivers as far as medical is concerned. Can you just identify what they may be.
>> for instance, diabetes. If we can prevent one intern from going on reason kidney dialysis, and someone having three sessions a week can wos the plan 25,000 a month. You can see the comparable.
>> didn't catch that. Sorry, 25,000 per what?
>> dialysis can cost 25,000 a month. To the health plan.
>> a month.
>> cardiovascular disease, a stroke, can cost the health plan 300 to 400,000. So there's some cost that are associated with the disease that we're talking about. And our expectation is to in pilot project, to study if bariatric surgery does in fact reduce the exposure that we have in the health plan to these disease categories.
>> now, when an individual is to, say, well, I don't want to deal with this per se, of course, it's a voluntary type thing, they are still, the risk factor, I guess that has to be looked at and considered and possible symptoms and remedies to those symptoms that you just stated, that would be something that we would still have to bear the cost of providing. And we are a self funded insurance, per se, we're self funded, rather. And that's something that we have to consider as far as dealing with our premiums and things like that. So can you maybe give me some background on some of the things that we have done in place such as an example, a wellness clinic, for example, along with the other type of things that we are trying to end up doing here. As far as looking at some of this preventive maintenance and health delivery that is vital I think to all our employees. Can you give me some type of breakdown on what type of savings that we have realiz realized, number one, becoming self funded, number two, with the wellness clinic and all the other wellness attributes in place with this, and this is still a possible part of the network of benefits that we are offering as far as being look at, as total benefits for employees.
>> well, when we went, when the county was self funded, the court direct that had we develop a wellness program to address the high cost of healthcare and the rising cost which we're running about 25 to 30 percent a year. We developed a wellness program that the court approved and an offshoot was the Travis County wellness and helts clinic, staffed by a physician and nurse, and the purpose is to conduct health education among all employees throughout the county, to help in the disease management, to bring costs for treating disees under control, and for acued care treatment. The court recently voted to expand staff at the clinic. We're now seeing additional patients where we have two clinics open, one open twon day a week--one day a week, there will be a third clinic opening. Those programs have proven to be very effective this last year. Our premium increases were three percent compared to the 25 or 30 percent prior years. So these programs are paying off. We have partnered with run techs for walking education classes, preparing for various events, 5 k race that's sponsored. We've partners with glaxosmithkline on various studies. All of these have come together to help reduce and control healthcare costs. Bariatric is within program that we're bringing before the court to determine if it's something that you would like the see added to our health plan. For the same reason, we expect there would be some savings but this is a long-term proper significant significant. You're not going to realize savings or see savings right away. The costs of healthcare for those individuals undergoing surgery will take time to come down. So this is not an immediate return on any investment. And that needs to be stated up front. It's also not a pan seea for employees to lose weight. The surgery is more like a transplant than append death a. There's constant treatment and following doctor's direct shu. Complications have come down over the last few years as surgery has improve in technique but it's still a surgery and you have to be aware of that whether you're a candidate for bariatric surgery because you can't lose weight for any number of reasons, but it's important that employees understand that and that we state up front to the court that this is a long-term proposition, that savings are thought going to show up as quick--not going to show up as quickly as they have with the other programs.
>> thank you, staff.
>> let me ask a couple questions. I understand what the private benefit is for the individual participant, but what would you say the public benefits are?
>> I think that the first benefit is the cost control of healthcare. We have worked to bring that under control. I think that bariatric surgery is worth study under pilot project to see if it adds to the savings, contributes to those savings savings. Again, long-term, because we will take several years before we see the results, but I think that the primary savings. I think the productivity of the person who maybe is missing work because of morb morbid obesity and complications, if those can be reduced I think you see productivity and attendance improvement. The use of prescription drugs I think is one of the biggest areas that individual sees and that translates to savings in the health plan. Those are the primary areas that I see a benefit to taxpayers.
>> okay. Do you, let's say for an individual who has a weight problem today and a comore bid ty, about what does that individual cost the plan today? Is there a way to estimate that?
>> cindy did an excellent job.
>> okay.
>> cindy peer at human resources. I did just a kind of an estimation. I got with dr. Stewart and we sat down and decided that a fairly health thing person that was obese would probably end up costing the plan about 3300 a year, maybe a little by more. That's someone that was on high cholesterol medication, hypertension and diabetes medication with just a quarterly visit to their doctor. Now, that same person could then as they are either, as they are age or as their condition deteriorates, could go down the road of maybe having cardiac disease disease. If someone goes down the road of adding cardiac disease to that $3300, we say that the potential could be anywhere where another two or three--000 a year, up up--thousand a year, up to 50 or 200,000 if the person has a stroke or cardiac event. Severe complications like stroke, heart attack, even death can occur not to mention total disability. Also, if you went the kidney disease route, we have a lot of di betic, people over overweight have a tendency to develop if they didn't have it to begin w as dan mentioned, reasonable dialysis can cost 20, 25,000 a month. If your kidney disease progresses, you can go into total failure where your only option can be a kidney transplant or death. So those costs could go to 40 to 350,000 a year. Someone with maybe not that quite far advanced kidney disease we're saying would be probably under 2 had you been ,000 a year but it would be--200,000 a year but it would be significant. Those are for example we prepared for you.
>> I did ask the question yesterday because I thought about it. What we are trying to do really, if you seem to be in a category that unless reversed, it's headed sort of in the direction of needing more serious treatment, and you have the determination and will power to make changes immediately, then the plan ought to cover you because the plan will ultimately pick up the dig willing s anyway unless you leave county employment without retiring.
>> right. A lot of this is reversible. If you're heading down the path now you can stop and turn around and go back the other way and get rid of the lot of the medical issues that have come up. It's amazing what the weight loss can do for your medical condition.
>> okay. Yesterday I did prepare a little sort of pre vision that I think is appropriate. I did share this with all three of you allrb right, yesterday. And what it says is Commissioners court reserves the right to terminate the pilot program at the end of each fiscal year based on any of the following criteria, failure to achieve the expected public benefit, unavailability of funds, lack of employee interest, or failure to mete expected or desired employee health results. To be honest, if we approve this, and I do think this would be reasonable, you would be looking at the end of the second year because the first year would be the due diligence period. And the first surgery would be the second year. And really, it's a year or two after that surgery where we really see the employees who have taken the surgery actually follow through with the counseling and the other post surgery treatment that is necessary in order for employees to receive the full benefit. I must say that I have gotten e-mails from several employees who have indicate that had they have been trying the lose weight for years, have not been able to do so permanently. They all indicate benefits during a few months and they relapse and kind of gain the weight back and go to a diet or are religious about exercising for a short time and see the benefits, and only to see those benefits reversed. But if we do this, I think that it does require sort of annual monitoring. Employees would have to release to Travis County enough of the information about their health status for us to make a determination about their eligibility for the surgery. This language is really intended to put us in had a position to where we conclude the program is not doing as we expected, we have a opportunity to jet son without being permanent permanently forced to do it. There's always subject to the availability of funds that frees governmental entities from doing what they can afford to do. I think this kind of language broadens that for us. Thank you.
>> judge.
>> after you.
>> all right. How many claims did we have in excess of the stop loss coverage?
>> we're sitting at nine right now to date this we're.
>> what have we been averaging?
>> nine to seventeen. Looks like we're down a little bit this year.
>> okay.
>> which we did increase our stop loss last year from 15 to 150.
>> right. But in terms of those, whether it's 19 or 17, in terms of those claims, because we are self-insured and can look at our own data how many of those were folks who were morbidly obese?
>> I don't really know since we don't track our data that way at this point. I can't tell you unless we went back to do research with individuals themselves because there's nothing I get that shows their weight weightthis is one of those things, believe me, I have struggled with me weight my entire life. I bet if we took a look at those that didn't hit ston stonstop loss but came close I bet if we look at issue of whether that person smoked or not, probably plays into a whole lot more things than we have going on here. That's not only the health of that individual but their spouse, partner, children, whatever. Yet we don't have anything like that going for this. I think, I just, if we were joining the pack in term of everybody else is doing this and this is a pretty standard governmental benefit, but I think we have to be extra careful because we are government, to have to justify. Because these are taxpayer dollars paying for health insurance coverage. To take a pause for a second there are a quarter of the people in this county who have no health insurance. So I'm very cautious when this kind of thing is talked about and added, are we in sync with what's going on out there, whether it is our peers at the city, other counties, state of Texas, the university of Texas, school dids, I just-- just--districts, I just don't see this one being the norm yet. This could be revisited five years from now and all of a sudden everyone is doing it, you have a lot of good data, but some of the numbers right now in terms of complications and what we haven't talk about, if you have complications, lost workdays. And the kinds of numbers you're going to have to put in your account to kind of save up for in the only being out because of the surgery, but if there are complications. To me this is one that there could be a time where it's appropriateit's-- but to me this is not appropriate when we are talking about taxpayer dollars and having to be very cautious with how our dollars are being used. I think that there are other programs for example, with stopping smoking, really more advances on the well wellness clinic. This is so the last stage of it. There have been way too many stories of people with very serious complications where they don't understand the psychological impacts of this, to them or to their families. It isn't the be all or end all. And to me, I just think as a governmental entity, it's too far out there for me to feel comfortable that this is a good investment of taxpayer dollars. If this were my own budget, or if this were a private corporation, people can make their own decisions. To me, I just think it's something whose time has not quite come yet. And so I will not be able to support this.
>> what is the source of funding, since we're talking budget?
>> the health fund.
>> and what is the health fund?
>> it's the fund that, our self-insured health fund that we play claims and administrative fees for health insurance.
>> how much will that change based on this program?
>> the cost of the surgery is going to be about between one and one and a half percent of the budgeted claims. The cost of the surgery, physician, hospital. That would not include, that figure doesn't include complications, if there were complications, it would be more like two to three percent of the budget.
>> the '07 budget remains the same whether this program is adopted or not.
>> yes.
>> so we think that the stop loss claims average 9-17 annually.
>> uh-huh.
>> and the new standard for that is at least 150,000.
>> uh-huh.
>> the county pays 150,000 and we buy insurance to cover any amount over 150 150,000 is what that means.
>> correct.
>> I think the time has come and we limit ourselves to 15 after the second year we see how many in fact have the surgery. We monitor their progress. If it is not h?mming, we don't do--helping, we don't do it. These are inclined to be the same folk who will, who make us need stop loss coverage. Nothing personal about it. But insurance costs are not going down. And unfortunately, if you have serious weight issues and have not been able to address them, and have one of the morbidity diseases, I don't know why they call them that, that just means diseases inclined to result in death unless you deal with them? Yes, yes, sir.
>> real--
>> yes.
>> real serious he will stuff. We have their narrows this down to the ones most likely to cost us the most money. I don't know that the law allows us to wake up one morning and come down and vote not to cover those with serious illnesses or injuries. Can we?
>> I have never viewed that as an option. I guess not.
>> I will refer that to our lawyer.
>> nor can we let somebody go because they have weight problems.
>> [one moment please for change in captioners]
>> and in the connectivity they have to the tai payers is another that will be explained. Travis County is not just another entity that has money, we set the tax rate and collect money from the taxpayers every year, and that is the source of our health funds,; is that correct?
>> that is right.
>> okay, well, I guess what gives me a little bit of feeling that the employee most of all and the family needs to understand the issue is that year of preparation for it. All of the things that have to be followed -- the other thing we all learned when we go to the doctor to get some -- to get treatment for whatever ales -- ailes us is we need to follow the doctor's orders when it's over. And it's not just I can now continue my life or diet the way it used to be. It's going to call for a huge change and we need to makesthose changes or our health issue will not get better. We just go back to where we were before and that increases the risk to the person. So doctor's orders must be followed.
>> it's going to require a life-change equipment on the part of any employee that does this. It's not a short--term thing. And you have to go into it with that mindset.
>> and in this case with serious problems, maybe not even that unless you follow doctor's orders.
>> as is the case with any surgery.
>> if we pass this today we'll try to reduce to writing a policy that covers this pilot program.
>> yes.
>> now, most of the criteria have been reduced to writing and by the way, this recommendation came from the benefits committee when?
>> back in June I believe.
>> I know we discussed it a few times and it's not new today, but it was new this year from the economy.
>> we've been looking at and revirtuing this for -- researching this for about a year.
>> did you have something else --
>> on the care for the whole,4400 employees that we have.
>> it comes to about $54 million and you end up with about $22, $23 million in reserve.
>> so if you look at 375,000 with a $60 million plus spending on health care you're talking about like I said somewhere in the 1, 2, or 2.5%. The most important thing here is for people to get the message because all of us are getting e-mails and it's like are you nuts? Why are you spending money on people who are overweight? It's a personal responsibility thing and that can get out on the street really easily. But that is not what this is about. It's about a cost benefit to the county, and given the account that we just can't fire someone because they are fat. Now, do we want to take people who have weight issues and try to get them to a wealthier state because of what we are having to do with them or just working quo travis county? That is the message I certainly need to get to the folks who are talking to me. Because the you know lying theme gets back to government should thought be in the business of taking on people's inability to curb what they eat. Now, most people know that all weight is not just a property of what you eat. I mean, a lot of people have a lot of medical issues, and I think that most people understand that. You know, I am comfortable with a pilot program. I think that we have good enough measures in place that if something -- and quiet frankly, somebody has to be really serious about doing this in order to take the next step, which I think is going to probably curb an awful a lot of folks that may think that they want to do this. But y'all -- I mean, there's no question. I was the hardest probably on the court, to drag across the lines with regard to the wellness clinic and after seeing the results that we have witnessed with regards to, you know, less visits to the folks, the doctors that are even on our program, I mean, obviously we were witnessing you know, some pretty, you know, amazing stats. Now, the unfortunately about this is it takes a little bit longer before you see whether it's something that is really going to work. It is not an unusually large number compared to what we are spending on our health care, given the fact that we are self-insured. My gosh, every year health care is one of those line items that we go right to to see what we can do noshd to help -- in order to help Travis County. The citizens needs to understand if this court passes this it's not because we want to help somebody wear a size 6 verse as size 10. I really don't carry about that. What I'm more concerned about is the cost we take on to take care of people that we employee and given that we cannot fire people because they are overweight or because their weight is an issue and they, you know, start missing a lot of work, but even then, I mean, you've got your challenges. So I do think that we are being very judicious about what we are doing. And you're always questioned good, with well, why are y'all doing this and others are not? Well, I think we are pretty innovative with what we try and try to get our arms around some of the costs of health care. And I think it could prove to be a wise decision, but I mean I think that the judges e-mail us all about let's get these four things in, and if any of these four things happen that we have the ability to back out of this deal. I am nervous about the fact that the more you read about this, the cost could get more than 25,000, and if it goes 25,000, whose nickel is on on?
>> it's a heart attack nickel just like if a heart attack cost more than you thought or if you have a complication with a pregnancy. It's a complication. One thing we haven't talked about that is going to be an issue, when someone has the surgery, sometimes they are left with folds of skin that are quite unattractive and this is not intended to take care of that. That would be on the employee's own dime or exercise. And if it becomes a health issue, then it's covered under the plan, but that is something that people need to think about, once you get all of the weight out of you, you may need to cope with the folds of fat, but we consider that cosmetic, unless it's a health issue.
>> I'm just going back to a lot of things here. I can remember when we were not self-funded and we were not a self-funded insurance. And we had someone overseeing u and I don't mean to call no names but we got in a contract with them, and when I came on I wanted to terminate the contract because I didn't think this was the best approach for the travis county employees for maximize health care delivery, and we did become self-insured which I think is one of the greatest things we've done as far as health care is concerned, but on top of that we did come up with a wellness clinic which I think has really curbed a lot of outside -- well, like this, includes a lot of persons into looking at their health issues and bringing them here to this travis county's own health care clinic, a wellness clinic to address this. And that is very unique in itself. I don't know if anyone else has a wellness clinic like Travis County but he do know it's hat positive results. My question to you now is this. Of the percentage of persons that may qualify for bariatric surgery, have these actually visited physicians and have really been routine participants in our wewellness clinic as it exists now? And it's going to expand, also, we are looking at taking it out to the airport site, for example. How many persons that we know that would qualify are actually using our wellness clinic that is designed to take care of --
>> well we can do is provide a sample, and we took one January through July '06 and we had the number of people that sift f visited the clinic, of those, 112 were morbidly obese with a b.m.i. Greater than 45.5 and 335 were considered obese with a b.m.i. Of 34. So the 112 people out of the 976, almost a thousand is really that 10% you're looking at as the people that would need some assistance that would not be required by one that was just 20 or 30 pounds overweight and used exercise and went under a doctor's care for a year and was able to take the weight off. This is a serious obesity.
>> and Commissioner Gomez brought up a good point, by following doctor's orders trying to deal with the situation as far as being overweight, I don't know how many of these out of the 112, how many of those have ended up reducing weight by following doctor 's orders.
>> we would have to research that through the clinic and get them to conduct a --
>> how many were following a doctor's program?
>> of the 112, it's my understanding that they have come back to the clinic for routine screenings. They get diet and nutrition counseling when they do come back, but we are not following them as we would with this program. So some of the questions you're asking, we don't have answers to.
>> would it be a good idea for us -- to try to, for all employees, come up with a Travis County intensive weight loss program for those interested in participating. And whether you're interested in this or not, if you want to lose weight, you may be 25, 30 pounds overweight and hey, we dug this up and it's working world-wide and we urge you to work with them, and it all starlts with exercise and diet, nothing magical about it --
>> in January just after new years we started a four-part program on weight loss and dieting and exercise, and we've had good results there. Just yesterday I heard of an individual who has reduced their insulin need by almost 100%. They are down to the very lowest amount at this time and with more exercise and weight loss they expect to be off of insulin. And this person works very hard and shows up every afternoon at the clinic to exercise. That is a success story, and there are others out there as well. We have those success program, but doctors tell us that individuals hit a wall at some point in life trying to diet and exercise, and at the point they become morbidly obese it becomes harder to exercise and about the only thing they can do is swimming or waiting in a pool. And those are the individuals that you can't do much with as far as exercise and they are the ones that are candidates for bariatric surgery.
>> I sit on the committee, are you interested in why the committee recommended this? When it was brought up most members of the committee didn't think it was something that we would consider but went politely to the meeting to see the doctors and the search and talk to people who have had this. After we heard that presentation, I talked to a couple of physicians outside because I thought, well, if this is your business, you might suggest it, but what does another person -- another physician think? I was primarily interested because we are a government and that is is this really in the realm of a medical necessity? Or is this akin to cosmetic surgery. In other words you really don't want to go through what it takes and you want an easy way out. And the data that the committee saw and that I got from the physicians that I talked to is once people become morbidly obese it does become a medical necessity. The body changes to the point where normal weight loss doesn't work anymore. Like dan said, they are not able to exercise. The amount it would take to lose that kind of weight. People who are that heavy have serious medical problems that we are already paying for, and any kind of surgery or medical procedures that people who are morbidly obese have are at greater risk than average. Doesn't matter, gallbladder, apendectomy. The data we looked at just from the cost of the plan that after five years you're recovering your money, and people are off of the medications they have to take if in fact they follow this. The plan the committee suggested you're looking at is really much more disciplined than would be normally followed under a plan. Because first of all, the person for one year has to go to a weight loss management health program either at our clinic or with a doctor. It was the committee's hope that after a year of intensely working on that, if in fact the person was able to regain their health or loss the weight that they would do that and wouldn't have to have the surgery. If after a full year they coontd, then they could -- coontd, then they could participate in the plan. These are not things that people undergo lightly. It's not like I really want to continue eating potato chips and so why don't I go and have bariatric surgery. These are serious surgeries, and one of them cannot be reversed. So even if you wanted to go back to your old ways, you cannot. The people we talked to who had this, basic will it changed everything about their lives. Their ability to work and to be a functioning member of society. So I believe that speaking for the committee that we concluded that it was a medical necessity that was worth looking at and seeing if in fact this program that we've designed works in concert with the health program and our medical insurance. Morbidlymorbidly obese ti is a problem that is just in this county, it's across the county, a serious problem, and it's look like it's just a problem that is here and not other places. The other thing when we talk about the private versus the public sector and the salaries that people make and the jobs they have here, many of our employees do not have the kind of money and time to join a health club or a spa and don't have the money or the means to talk to a dye dietitian or eat the foods that might not have gotten them to that place. So I don't think it's fair to say that those people who are morbidly obese have really done something wrong to get there and could have prevented it. I don't think we know that from the data. It's a hard decision for you to make and I realize some of the radio stations were taking pot shots this morning, but I just wanted you to though what the committee thought and why they voted to support this for what it's worth.
>> thank you.
>> okay, thanks.
>> I just remembered it's the state of louisiana who has a study going and who has proved that the bariatric surgery on a pilot project is the state of louisiana.
>> what I'm hearing, also, is there are repeat performances, in other words, the effects after where the person ends up putting back on weight -- do you know what the results and how long they've been active? Is there any way to acquire information on what their results are as far as any type of measurement to maybe suggest and are they several funded as we are?
>> they are self-funded and are going into their third year, dat ta is not available yet --
>> it would be good to have that data.
>> they said they would give it to us as soon as it's published.
>> let me try a motion. It's in three parts. The first part is to approve the pilot program with the stated conditions including employees only, a limit to 15 annually, after one year of due diligence, second part is for us to authorize staff to come up with a policy or plan, I guess -- plan description? -- that sets forth all of the specific details, and by the way, we would look at those and approve them before it's in place, but hopefully bet that done in a couple of weeks and then incorporate the Biscoe grounds for termination, the four that I distributed to you yesterday and gave to the court today. That is the motion.
>> I'll second, that. Would it be friendly to say that we would do as much as possible to make sure that people understand the risks and the responsibilities that they have to not have complications? I guess I just can't stress enough that we need to follow the doctor's orders and there is a reason for a doctor giving you orders. I would even say that after we reach a certain age we need to change our diets permanently and we can't eat like we used to when we were kids, but anyway.
>> that is friendly. Let's work toward including language that picks up that idea. How is that? Any discussion of the motion? All in favor, Commissioners Gomez, and Daugherty, you're voting in favor, and voting against Commissioner son lighten and --
>> I abstain, judge. I would like to get more of the information out of louisiana, I would like to have more information on what kind of impact it would have and so I would like to abstain at this time, thank you.
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Last Modified:
Wednesday, September 20, 2006 10:25 AM