Travis County Commissioners Court
September 26, 2006
Item 25
Number 25 is is to consider request to reconsider the pilot program for bariatric surgery and take appropriate action. A couple of presentations, discussion license. Discussion...
>> good morning. Alicia perez, executive manager for administrative operations. You have a letter before you from the employee benefits committee. The committee felt it important that people were aware that the recommendation for the bariatric surgery came from an employee benefits committee. And it was not initiated by court as has been reported. It was a recommendation from employee benefits committee that is set up by the court to look at the health care for employees. This recommendation was brought forth after about a year of discussion, much debate and study of the issue. We reviewed medical data reports, we had testimony from employees. We looked at cost benefits. We looked at what other counties or programs had been successful in this area. And like I said, we have also a presentation from employees and there was significant debate on the issue. The item was voted on and then put forward to the court, but it came from an employee benefits committee. Travis County is self-insured for health care, which means that the county is its own insurance. We are on our fifth year --
>> that means really we provide insurance for employees, retirees, their dependents are covered by the plan.
>> yes, sir. We have an administrator, but it is our money and our plan, our program. Okay? And the employee benefits committee also is involved on an annual basis in putting together the plans that will be be offered to the employees and the benefits and also the premiums. And those recommendations also come forward to the court. We looked at the issue of morbid obesity as an item that we had heard from employees who were having also other medical conditions that are associated with morbid obesity on page 2 of the letter it goes through some of those items that are major cost drivers for the plan. The proposal was to do a pilot project. Again, we'll try it out and if it doesn't work we won't continue it. There are -- there were -- there is a very rigid one-year presurgery program that an employee would have to go through, and it includes screening. Applicants in order to accept them into the program, specific individual guidelines that must be met for the people to remain with the program. They must be under medical care for one year. They must try other weight loss programs before they're eligible for surgery. They also have to pay a thousand dollars, kind of a deposit to make sure that they were serious about sticking with the program. After the surgery there's three years of continued counseling and support groups. There was -- would also be an agreement to adhere to a doctor's instruction with diet and exercise and comply with supervised and closely monitored diet. And then if an individual was still not able to reduce their weight after completing the one-year program, under medical supervision, then the bar bariatric surgery would be a last resort in reducing weight and controlling morbid obesity and that would be a decision between the patient and the doctor. So the committee recommended bariatric surgery only in those cases where morbid obesity was a clinical condition that failed to respond to any other forms of treatment. And the goals were set up to improve health care of employees and reduce long-term cost.
>> by the way, I shared with staff yesterday my reading of the tea leaves, but I did think that some of the information that I had asked for during the previous week should be shared with the court. And I can dan to see if he could gather additional information regarding cost effectiveness. Now, since last week I have learned that harris county basically covers this kind of surgery and harris county does self-insure. And the city of Austin apparently used to, but termiated it because some of their employees got the surgery and then moved on to other things, I hear. But anyway, in terms of cost effectiveness, dan?
>> the cost effectiveness of the surgery is long-term. It's not a short-term program. The cost effectiveness can be measured in a number of ways. The best illustration is when you have someone who is diabetic and is obese and diabetes is out of control, that lends itself to kidney favor and that -- failure and that requires treatment with renal dialysis. That costs 15 to $1,800 a session and there can be anywhere from two to four sessions a week depending on the severity of the kidney failure. With that type of treatment it can cost $25,000 a month for dialysis for an n individual. So as alicia said, as a last resort to treat morbid obesity, bariatric surgery was looked at as a last resort to prevent a person going into kidney failure because that's a cost savings to the plan. The other cost savings comes from better attendance rltd more productivity. It can be measured in number of different ways, but to sit here and tell you that we're going to save x thousands or hundreds of thousands or millions of dollars, we can't do that. The studies toor new yet to project out what that savings eventually could become. I think cindy did a study on our plan and I think you have a copy of this. It's on renal hemodialysis. For plan year 2004 we spent $533,000 for dialysis. Plan year 2,005,400,000 and so far this year we have $347,597. After I believe it's two years, medicare picks up the cost of dialysis, so this will really within the first two years of diagnosis requiring renal dialysis. As you said, judge, hairkt has offered the surgery as any other illness. There's no criteria other than medical necessity. We understand --
>> how long?
>> I believe that --
>> as long as they've had their current plan they've offered it as any other illness. They aye just their carriers, isn't as aetna standard guidelines.
>> and aetna standard guidelines are very close to what we're proposing in the pilot project. I don't believe that they've done a study or analysis on cost savings. They have -- we know how many surgeries they had.
>> they weren't even aware of how many of these they've performed. It's not something they're fak tracking maybe as closely as we would be.
>> we did have a questionnaire that went out to our government benefits association, and the responses got from around the country from yes we offer it to no, we don't and we wouldn't consider it to we're looking at it and we're looking at what you're doing so we can maybe model ours after yours. So it's all over the board as to who's covering it and who's not covering it, what the purposes are. I think back to what Travis County is trying to do, we've done education, we've done weight loss programs, dr. Turner is here and he can address what those programs are. We've brought disease management into place. What we're looking at now is how to treat a root caw of a lot of -- cause of a lot of complications that drive costs up. As alicia said, bariatric surgery wasn't the first step. It's the step when all the other treatment has failed. Behavioral change and life-style change is essential if this is going to be a successful surgery. And that's what that one-year program is designed to do. It's to begin the process of life-style change and behavioral change that leads to weight loss. That's a lot of preemptive activity that takes place with the hope that someone loses weight during this one year period and realize they don't need the surgery. They can lose weight if their committed and they have a structured plan to go by. The three-year period if surgery is is done was to assure that that person didn't slip back into the old behavioral habits. So would you like to talk about the weight loss programs we've given?
>> sure. I'll say a few things. The weight loss program owe my name is trent turner. I'm a physician at the wellness clinic here. The weight loss program or the surgery that we put fortsz that has been voted on, the whole purpose of that is a last resort for people who are morbidly obese, have an treemly difficult time -- extremely difficult time controlling their obesity and losing weight. And as a last resort we're trying many other ways to help the employees of Travis County, the people in the Travis County health plan lose weight and become as healthy as possible. We have many class oz it, on weight loss and nutrition and exercise and diet downtown as well as outlying offices of Travis County. And we're trying to develop exercise groups in each office. We're also trying to develop -- we have an exercise -- we're trying to build -- develop an exercise facility here in the downtown clinic. Hopefully we'll get one at the airport clinic as well.
>> [one moment, please, for change in captioners]
>> a lot of costs come from a small number of patients. If we can help control that, that's the intent is to hopefully reduce costs in that way. The weight loss we have spoken to, the studies that are out there, within five years of the surgery, typically it's the -- typically it's a cost effective measure.
>> I think that you are going to hear in just a moment about a -- a policy that's available to cover complications because I know that's an issue, a -- the degree of complications, the number of complications. Those complications, the rate of complications, mortality rates have come down with the refinement of surgeries. Basically we talked to a doctor yesterday. Basically two surgeries that are done, the other are done, the other ruled as -- the others are ruled as not as effective. That's probably where the complications most arose. Now physicians know post how to treat, post surgery patients to help prevent the complications. There is a program that I think roger is going to talk about that addresses the -- covering the cost of those complications.
>> we saw a report yesterday that addressed the number of deaths that resulted to those that had surgery. Compared to the number of deaths that resulted from those that needed the surgery but did not have it.
>> that was a study done through [indiscernible] university in quebec, canada, that showed that patients that had the surgery versus patient that did not have the surgery, the ones that did not have the weight loss surgery the death rate was nine fold over the ones that were provided the weight loss surgery.
>> > your name.
>> any name is sandy rodgers, I am a supervisor for the transportation natural resource road and bridge division. I am also seven years post on gastric bypass. I have lost approximately 140 pounds. A little background about myself. Prior to having a weight loss surgery, I was disabled for three years. Unable to work, pretty much unable to even maintain my home. And my children. I was told by several doctors that if I did not address any weight because of my health issues, that my life span would be very short and by very short they meant three to five years. So I started researching doctors recommended that I had the weight loss surgery. I met with the weight loss surgery. It took me three years of fighting insurance companies because of the lack of education on morbid obesity to finally gain my approval. I am now seven years without. Within one week of having the weight loss surgery I was off of 90% of my medications of which I was on seven a day. Within three months I was off of 100% of my medications. During the time when I was disabled, I was seeing up to five doctors throughout the year, some of them up to 24 times a year. Within the first year of providing the weight loss surgery, my insurance company had already saved up towards ward's of approximately nine thousand dollars. Back then, the surgery was a little bit cheaper because I am seven years out. Within two years they had already saved the money that they had spent to provide me the surgery.
>> you were not employed in Travis County in 1998.
>> no, sir. I was not employed period, I was disabled. Since that time I've been able to become employable, thank god. A lot of the public is stating this is simply a cosmetic procedure, having a little bit of an uproar. I'm here to educate that this is no the a cosmetic procedure. While the physical attributes of someone who is provided weight loss surgery does change, that of course is an added benefit of the surgery, the main study on this is that it is simply for health issues. Through the national institute of health it's a documented disease as is coronary problems, asthma, diabetes, any other disease, cancer. Through the national americans with disabilities act, morbid obesity is deemed a protected disability. This is done threw numerous studies. Fortunately the american society is uneducated on the disease of morbid obesity, it going to take a long time to get that education out there. I understand that the Commissioners court voted recently to sponsor this pilot program and I feel that if you have done that, through the risk management groups recommendation, but also through research and education on your own. I really am hoping that you uphold that decision. But yesterday I met with the judge and the risk management committee and we also had a weight loss surgeon who conferenced in, made us aware of new program that is becoming available for self pay and also self-insured entities. This program is called bliss care. And the premiums would not come from the self insured insurance company. It would come out of the surgeon's fees, so there's no out of pocket fees for the self insured policy holder. It would cover a portion of the surgery and it would also cover for one year post on coverage should there be through complications. This is a new program. The -- the president of the company would be available to come and give a presentation if needed to give more information on it. Also yesterday during this meeting I provided a study, which I mentioned earlier, it was from the mcgill university out of quebec, canada, where the conclusion was not only was weight loss surgery medically conclusive, but also cost effective. During this meeting I also provided some documentation from the medicare and medicaid coverage. They did a study on their own. They now cover weight lost surgery because they do find it to be, you know, medically necessary and cost effective. I also went around to each Commissioner's office and dropped this packet off so that you could could review this as well. As -- as we were already told, harris county already covers it. They are a self funded county as is Travis County. Now, when -- when we were researching and when I was asked to speak to the risk management can he, the risk management committee also talked to surgeons. That's how they came through numerous educational processes and through speaking to the weight loss surgeons, finding out what the benefits of morbid obesity was. Realizing this is a disease not just a cosmetic procedure or the fault of the person who has morbid obesity. Realizing it is not just a simple act of pushing away from the table or taking a fork out of your mouth as I read on several websites. I also have two weight loss patients in the back here, janice page and stephanie parent. Ms. Page here was actually on a walker when I met her. She was told by numerous doctors that she would not ever walk at least without a cane. As you can see, this beautiful woman behind me is very healthy. Is without a cane today thanks to the benefit ofs weight loss surgery. I'm home that I can stand here as an attestment to Travis County that this surgery is medically beneficial and cost effective. /?Txuknow. I have provide -- I have provided all of you a cost analysis on my personal medical history that does show that it is cost effect I have to provide the surgery versus paying for the co-morbidities that the wait caused.
>> we appreciate you sharing your stories with us. She came to our public hearing.
>> I passed around some pictures of myself prior to surgery.
>> it's a dramatic -- democratic difference. And 1999 that was a few years back.
>> 7 years, yes, sir, I'm picture of health today. I would urge you to uphold your decision to cover the pilot program, if you decide that is not a decision that you like to make, I would request that you delay your vote to get more ed commission and more research in before you make a final decision.
>> what year did you have your surgery? Would you like to have a word? Can you tell us how many medications you were on before you had surgery.
>> I had about eight medications, now I'm down to two, which is good. And I had a back problem, I have what's called spiend respod spolylthesis, a degenerative disease. I was born obese, I had a lot of problems being overweight. Went through a lot of dieting. Knew how to lose weight, didn't know how to keep it off. Whenever I had this surgery back in 2000, it was the first time that I ever had felt satiated, I was always hung gee. I think it's a genetic problem in my own mind, in my family there's a lot of obey best community. I was saved through dr. John pilcher in san antonio, a gastric bypass surgeon, bariatric surgeon. I was on a walker and a cane, my orthopedic surgeon said you have got to lose the weight. I said okay, genius, I do know how to do that. He sent me through several programs again. I have probably lost in my lifetime four to 500 pounds. On and off. Gained and lost. When they finally did do the bariatric surgery, they found out that my gallbladder was inflamed. Ready to burst, that's a sign of too many diets. But navy I was teased as a child and put through a lot of stuff. I was on the verge of having diabetes and I had a back problem, my skeletal problem in the back. I was a size 22, 24, I'm now a size 4. I've had no surgeries to lift or do anything, but I'm healthy. And that's why I'm here.
>> about how much did you weigh at the time of surgery.
>> 230 pounds.
>> 5'1".
>> how many years have you battled with this weight problem before surgery?
>> since I was 12 years old. 12 years old. I weighed over 200 pounds at 12 years old. And I had lost a lot of weight and fought it and fought it, and been on all kinds of diets. Low carbohydrate, you know, just started with that back in the 70s. And atkins. Water. Don't eat. Don't -- you know, all of that.
>> what you will find with the morbid obesity person he is that most of them have tried every diet supplement, program that's available. With success in losing weight, unable to keep it off. I myself have been dieting since I was 13 years old. I always teased that I dieted myself up to morbid obesity because of yo-yo dieting, when you regain that weight back, it usually rebounds with 10, 20, 30 pounds more. My gallbladder was gangrening, the doctor said it was because of the yo-yo dieting it affected my gallbladder as stuff. One of the pictures I'm actually yellowing in it, because it was poisoning my system.
>> one of the things that's really interested here, janice that you brought up, is a little bit of the issue that we have with the public. When somebody says I've lost weight but I gained it, lost weight but gained it, I couldn't keep it off, y'all from the e-mails that I have gotten that is exactly the argument that we need to put this in a spot that it's almost indefensible. People are really saying you can do it, you have done it. And it is amazing to me how many people -- I don't mean just a few, something that I'm going to ask dan to do, you know, with our 4400 employees is I would really like to know how our employees feel about this. But I will tell you that the average everyday person on the street, really thinks that if you want to do it you can do it. We all know that there are -- once you get to a certain weight doing that just by not having the bag of potato chips or the french fries is probably not going to result in -- in what, you know, you want. But is almost -- what I have realized in this last week, it is almost unsellable to the public. And y'all as elected officials we do have a fiduciary responsibility to act on things when we have information information. The reason that I voted for it last week is because I was convinced that we could see some savings. Now, what's happened to me in the last week, because of all of the e-mails, the phone calls and people that I quite frankly I've been blown away how agitated, how exercised this subject matter -- exercised is not -- maybe it is the word to use here. But y'all I am really -- I have really been surprised. What it forced me to do, the reason that I will reverse my vote today, is because I have gone from would to could thinking that I thought that this would really show that we really will be able to save money on our plan because my whole deal last week was really predicated on, I thought it was something that we, you know, would be able to witness and show. But the more you read, the expression all over the board that dan used, that is the problem with this. It is all over the board with experts. With physicians. I mean, they will tell you, some people this is probably the last resort that they have. But quite frankly we at any time tell you that there aren't more complications that can happen and so that's what's moved in. I mean, I'm -- quite frankly I really was willing to go on the employee benefits committee. I know this is not something they did overnight. I was told it was the first time it was brought to them it was rejected. We don't want to do that. The more we found out. Let me tell you I have found out in this spot that the public you are right is not always manned with all of the information that they have. Or that they need. That being said, as precinct 3 Commissioner, I will tell you that I don't have the resources to go out, up and down the street, to get in front of groups of 100 at a time and show people that here's the reason that we are looking at doing this. But the fact that I have read so much about for every one that we can show you, there is something that could happen, the could is the thing that's moving me. I do think that the surgery is a lot more successful. I, too, had a number of family members that have had weight issues their whole life. As a matter of fact I think actually the staples or the stomach stapling back in the 70s and 80s that I had a couple of aunts that used that. One of them kept her weight off. One of them, you know, didn't happen.
>> that surgery back that was in the 70s and 80s was a procedure that the doctors were trying to tweak. They have since come around to the original surgery which they have found to be the most successful with the least amount of malnutrition. The negative comments that you are finding from the public, I'm sure if there was a poll done asking them have they ever suffered from morbid obesity or had a family member that suffered from morbid obesity what was their education on this disease. I stress the word disease. .you would find that the majority of them have never suffered from the disease of morbid obesity and have never had a reason to educate themselves on this disease. And so therefore they don't see the benefits of it. Now, you say yes we have been able to lose the weight and unable to keep it off. And the general person off of the street may be able to. But they don't have the genetic makeup that the average morbid obesity does. Also with the morbid obese person. The majority of them have a trigger in their brain that doesn't function properly telling them when their body is full. So they continue to eat. This --
>> doctor, is there a medical explanation for why certain people really can lose a whole lot of weight but with keep it off.
>> you said all over the board in a way. It's hard to find -- there's not one real good explanation for it. But it is obvious that there's genetic differences in people and their ability to -- you know, to inherent -- obesity can be inherited -- there's genetic factors involved. You see it in families. There's not -- as of yet there's not a certain bio chemical reason that we have pinpointed as to why person x has a more difficult time losing weight than person y. But --
>> these two have kept it off for a long time. You see stories people follow different diets, lose 45, 50, pounds, months later not only gone the 35 or 40 back, but --
>> that could also fall back on the type of surgery, when the surgery was actually performed. Were they doing some experimental surgeries during that time or were they doing the gold standard surgery that's they have come back around to be completing.
>> whenever I was growing up, I was always chubby, heavy, I had a sister-in-law who weighed about 80 or 90 pounds, she told me -- she's now obese, unfortunately. But anyway, she told me she said back in the day I thought that you were lazy. You didn't do the right thing. You didn't need properly. One thing that I have learned having this surgery is -- is eating properly is eating just about whatever you want. In moderation. Walking. Moderation. Everything is about moderation. To lose weight before, I had to go to the extreme. Now my life is moderation.
>> I have smeffed e-mails from across the country, various other options, like the weight patch, a lot of these folks indicate a willingness to send medical personnel down to chat with us. Now, I know a whole lot more about morbid obesity than I ever thought that I would but the -- kind of fascinating area in that there arrest lot of pilot -- there are a lot of pilot programs in place, even ones doing it for years have not been collecting the data that she can share with others with the cost effectiveness. Whether we like it or not, using public dollars at this point, you have to be able to show them that they can achieve their goal. The benefits committee recommended it as a long-term way to -- of cost avoidance or a way to reduce the increase in medical expenses for employees and -- and our retirees covered by our plan. So, you know, in trying to gather information from entities that have provided this surgery or -- for three or four or five years, I guess they have been getting information to satisfy themselves, but they are not able to send that information to us so we can kind of look at it. There are various reports, they show you the negative side fortunately and also the positive side and doctors kind of level with you, so it seems to me appropriate, even if we reverse the decision, which I think the majority is inclined to do, we really ought to keep studying this issue. We ought to take a close leer at the other options that arable and make sure our -- available and make sure that our employees know about them. If the employees know about them, have tried them, doesn't make sense for us to do. But if they don't know about them, we think they may be helpful, at least the employees should know that they are available. The weight patch, every other kind of patch exists. I don't know about that apparently marketed nationwide. They will come here free of charge, they didn't mention anything about expenses, we ought to take them up on that. Another assignment for the employee benefits committee by the way. Other things that we ought to look at over the next few months.
>> may I say something. Last statement is I have gone to different groups down in san antonio where I had my weight loss surgery done, I have known of several people that waited until the last to get their surgery done, they passed away on the table. So I would say be expedient in your search. Because I have seen people that -- you know, they wait so long that that option is for longer available, they die before they get out of the hospital.
>> I think that -- what we really need to do is educate ourselves better on the issue. Certainly the public I think you are correct. I got several e-mails, I did have some telephone conversations with people. Some were very thoughtful in their remarks about the surgery and some were very helpful in trying to help me understand the issue better. But one of the things that I think was lacking was that research, that data that really says -- addresses the complications and regaining of the weight. Because that can also add to complications once you've had the surgery and unable to keep the weight off. I did not buy into any of the stereotypes about people who are obese anymore than I would buy into stereotypes about white males or any other group. So that's -- I didn't give any thought to that. The thing that I did remind people was that county employees are taxpayers, too. And that -- that county employees do contribute to their coverage of health insurance, health coverage. And so -- so, you know, but -- that just told me that we need to do some additional education of the public and of ourselves to make sure that whatever program we have in place really meets everybody's needs. I am concerned about -- about the welfare of county employees, especially if they have the surgery. And I do -- I do feel like I need some additional information so that I can make a really informed decision about it. And of course I am -- this is a really bad time for allergies. The other thing that I do have to say, I really -- it's kind of good in a way to see taxpayers aware of what's going on in their government. Then it's up to us to kind of look through, not buy into stereotypes, try to explain why the benefits committee made the recommendation and it is to save taxpayers money as well. So we don't keep doing the wrong thing over and over again and don't keep coming up with the new outcome. I think that we need to give ourselves more time to study the issue and make sure that we know exactly what to expect and I don't think that we are in a big rush to do this. I think we need to give ourselves some additional time to think about this.
>> if I could say --
>> let's give you an opportunity to make any kind of final statements that you would like to make. If others come here on this, give them an opportunity. Court members can have their say and we will take the action.
>> I think it's great to wait and make sure that's what everybody wants to do. I know that I was told when I had the surgery the people who benefited the best from the surgery had been on a diet before and knew how to diet and all it was it was just that you couldn't keep it off. I think if you keep researching, I did two years before my surgery. That would be a good thing.
>> we were trying to cover those who were morbid obesity plus had another serious illness.
>> correct.
>> so the combination we were told is deadly. Especially the longer that you wait.
>> that's correct. I have seen that with my eyes.
>> we almost were that ourselves.
>> okay. Thank you for sharing your personal life with us.
>> good thing about both of you all is that you have become advocates for morbidly obese people who need assistance. There are folk like me who haven't give then this matter a great deal of thought up the last couple of weeks.
>> if I could just say.
>> I was trying not to listen to much of the uproar this week, but it's hard to help it. I can completely understand people being upset if they think they are paying for something because somebody or a procedure -- because people aren't willing to make the effort to lose weight. The truth of the matter is number one this whole effort to try to pass this is -- is in the savings costs on the health play. No one -- it's totally a cost savings attempt and with the best information that we have received from -- from surgeons and the studies that they -- hopefully we will give you copies of the studies that they are referring to. Can show you know the cost savings. The other thing that I wanted to say is when we think about morbid obesity, we really need to keep in mind we are very, very different genetically in many ways, not just in the area of morbid obesity. For example, like high cholesterol. I have some patients, many people in the county who are on the big bell curve of people in the middle they can control their close roll problem with the right kind of -- cholesterol diet on the right kind of diet. There are people who are genetically hell bent on having that cholesterol. I can put them on the lowest diet they can ever be on, vegan diet, they still have 300 at the end of that. Those people are in need of a medical assistance at that point. I've seen in it diabetes, hypertension, obesity as well. People, the extent that they would have to see owe to keep the weight off, to lose weight and keep it off, the kind of diet that they would have to adhere is not really realistic. For some people. You feltly those people end up being extremely overweight, the which I indications we get from -- from that drive our health care costs up. Quite a bit. That's you why this was driven up in the first place. It might sound like a big expenditure right after the bat. In the long term, hopefully we can give you some studies that can maybe shed some lights on instead of could this, or would this save costs will it or not. You know?
>> ms. Smith any parting words?
>> rogers?
>> ms. Rodgers. [laughter]
>> yes.
>> you look so much like ms. Smith to me. [laughter]
>> I know that Travis County puts a strong emphasis on their employees' health. I am simply here to ask of you to make an informed educated decision. Don't give in to public neglect activity. It will take years to educate the public the way they need to be -- the way they need to be educated. Unfortunately the employees that you have on staff that do suffer from morbid obesity and the secondary co-morbidities do not have the time for that public awareness to be out there the way it does need to be. But they do have a lot of you that can educate yourselves and make an informed educated decision on this agenda item today. That's simply what we are asking, don't make a hasty decision. Make an informed decision. If that does preclude you putting this decision off for a while, please do so and get that education. I will do everything possible to make sure that you get the information needed in order to make that decision and make a correct one.
>> we think that about 10% of our population in general suffers from this disease. Is that accurate? It looks like in Travis County looks like 8 to 10% of our workforce.
>> yes.
>> would fall into this category, is that reflective of the general population, do you think? Okay. Anybody else here on this item? Who would like to address the court? If so, please come forward at this time. There are five seats available. Please come forward at this time.
>> thank you, ms. Rodgers.
>> good morning. I will be real brief. I am a Travis County employee. I work upstairs on the fourth floor. And I started here a year ago on July the 18th. At that point in time I weighed 416 pounds. As you can see now I don't weigh that. But I was before that a state employee. And in 1998 I was diagnosed with congest stiff heart failure which took a toll on me. But I decided to join a gym, try to do the right things and do it on my own. And I had some ups and downs, weight loss, other medical issues. I also have high blood pressure. Degenerative disc disease in my back. No legments barely left in my -- ligaments in my feet and legs because of the weight. Last year I decided to quit my job at the state. Withdrew all of my retirement because health insurance wouldn't cover anything that I needed to help me and I paid for myself to lose weight. I paid a weight management doctor, I went on a diet and exercise. And I have lost 160 pounds. And I'm now 50 pounds away from my goal and continue to do diet and exercise. But I would -- the main reason for me to come was to say if it at all possible for some people, they aren't as strict as I am. I'm one of these people that's black and white you either do it or you don't. There's no in between for me. So I took the strictest measures on myself and took everything into my own hands and just took that measure and just walked with it and decided -- I have now probably paid about -- about 5,000, 6,000, $7,000 out of my own pocket to see my doctor every week, to be monitored, to make sure that everything was in check. I have gone from paying $145 in co-payments for medicine down to $10 a month for hypertension medicine. That's it. The only other thing that I suffer from is allergies, which we all know is a given in Austin, that costs me $25. But I don't even attribute any of that to a part of the medical costs that I incurred. But I used to have to go to the doctor every four to six months to be monitoringed, checked make sure. Last year when I interviewed for this job I was on a cane and I currently now -- I work three jobs now in order to stay afloat and to get myself out of debt, of course, but it was worthwhile for me. But for those people that can for the do what I did, it would be very helpful for them for it to be covered under health insurance. And that was my main statement that I wanted to make.
>> when you were at your heaviest, how many medications were on you?
>> I took about 10 a day to survive.
>> it amazes me how many medications some people are on.
>> for every person it's different. I had to take one to help this, one to replace that, because when you take one, you lose something else. So you have got to -- you have got to do it, or you have no choice. You will be in pain. Along the way you go through a lot of ups and downs. It's not easy. But my main thing is everybody is not like me. There's -- everybody cannot be disciplined. I'm one of these people that for me like I said it's either black or white. There's no in between. If you can't do that, if it's going to be a help for someone that really needs the help, I mean, I even had to have another medical procedure done while I was still mosh bidly obey -- morbidly obese, I had to be halfway asleep, they had a fear that I would not wake up. There are other issues. You have to weigh the pros and cons.
>> what's your name.
>> Margaret sufficient sufentes.
>> congratulations, ths for sharing that with us.
>> Margaret and I had some good discussions because we share the same doctors. And some of the things that we have discovered, too, is that those of us who in the struggle category, of which there are many of us, there are a lot of things that are not covered by our insurance in terms of things before you get to that point of being morbid obesity, using our own flexible spending accounts for wait lost. We found that a weight loss. We found a lot of our expenditures were not covered. Having to do out of pocket for things that we were even having things taken out of our own paychecks for flex dollars, we couldn't that for this kind of area. That's something that needs to be taken a look at. I hope as we finish off today that people also take note of item 22 on our agenda. We are approving for the third year in a row getting involved in the Travis County wellness fair out at the expo center and we will once again be starting up the walking clinics in the fall to be training on behalf of the brown santa program. For those that wrote in or called in saying why aren't you doing more in the wellness arena, the answer is we are. We are working with paul carozza in terms of the kinds of things to get people walking. The first year only dan mansour was slower than I was on the brown santa 5 k. Sorry I outed you. Through the training we were amongst the first people through on the walking program in terms of doing the brown santa program the second year. So I'm looking forward to that. I was the no vote last week. I have not changed my mind on that. It really comes down to public policy in terms of there's a very high bar for me in terms of what is the appropriate use of taxpayer dollars. I know that we have all been very inspired by some of the stories like ms. Rodgers and others of the success stories. But I also got an earful of folks who wrote in saying the surgeries of their loved ones were disasters. That it didn't work on the well and not only were three complications that were very serious, but a lot of folks gained the weight back. You didn't get the benefits that you hoped were going to happen. The other thing that I would hike to say, I don't think there's been enough of a track record for us to know truly what the long-term impacts are. Not two, 3, 4, 5 years, sometimes it can take 15 and 20 years for you to truly know what is going on with a particular kind of medical procedure. In the old days everybody did rk surgery, the really invasive stuff on your eyes to be able to change your eyesight. Nobody does rk surgery anymore. It's been replaced by a much less invasive kind of surgery that I had lasik. It continues to get better and to improve. In the old days everyone got hard contact lenses, I was among those. They found after 15 or 20 careers that you seriously warped your corneas. I was out of them almost a year to try to get my lenses, corneas back to normal because no one knew at the time that was considered the conventional wisdom and no one knew until much later. It was replaced by the semi soft lenses and then soft lenses, et cetera. I'm also thinking in terms of breast cancer. The old way to do it was always a radical mastectomy. Nobody gets that anymore thank goodness. Now replaced no, ma'am by less invasive lumpectomies to still deal with it, but a lot of great strides represented to radiation and different kinds of drugs that can really make an impact and save lives. With that said I'm looking forward because there is a crisis in this nation related to obesity, it is serious. Not only for our children, but it is something that is going to cost us a lot. Now, with all of that said, most of the feedback that I got was on point. I appreciate that. But I have to tell you that I also got a lot of stuff that was not on point. And some of that has been in print, some said in public. The things that I would like to add to the discussion is that some things were said about our workforce that were derogatory in my opinion. Somehow equated heaviness with laziness. And some things were said about our employees that somehow our employees were not good employees and somehow they needed to leave here or whatever. I am here to stand up for our workforce. And in terms that I did not appreciate those comments and I could not say fineer things about the 4500 people that I work with day in, day out as imperfect as we all are. Those are the kinds of comments that really did disstress me that somehow that this is still a topic that people think they can just say anything. I would encourage more people to reread your e-mails before you hit the send button and perhaps what you need to do is either edit it or delete it. But on behalf of our workforce, they are hard working folks, day in, day out, giving you the best on behalf of your tax dollars. I want to make sure that their honor is not dishonored in this process.
>> nobody else? To give comments, right? Then let's hear from the rest of the court. Maybe your motion would be appropriate at this time.
>> I have said everything that I need to say. I'm willing to make a motion. My motion would be the reverse the pilot program on the bariatric surgery that we voted on last week. I do think that we have given clear direction that all of the folks that are really involved in this to continue to work on this issue, but that would simply be my motion.
>> I second that because I think that we need to allow ourselves more time to do a little bit more thorough research on all of the issues and the outcomes.
>> yeah. I will support the motion but I would like to make the following observations and hopefully be brief. The three or 400 county employees who fall into the came category that we have discussed, who are medically morbidly obese, suffer some other serious illness do not go away. And basically I think that part of our responsibility to taxpayers is to try to reduce the costs of medical insurance that we provide as cost effectively as possible. And I think that -- that since this problem has surfaced, and I certainly have a better appreciation for it, then we are duty bound to try to figure out what short of bariatric surgery are variable, what options are available, and I really was pleased with the number of e-mails that I got from other individuals, many of whom are medical professionals, who were saying here's what we have done in this state, here's how it worked out, I would be happy to come down there to share that with you. I think at some point the court ought to get with our benefits committee and put together a program that systematically see what they have. What I suggested was sending us one hard copy of whatever it is. I assured them that I would make multiple copies, distribute them to the right people of Travis County. Afterwards maybe try to get them an audience with the committee. I think we ought to follow up on that. There is new information being made available, if not daily, then certainly weekly, I thought we ought to keep pulling that, studying it. Various medical studies have become available, some are a bit dated. So if some of them have been updated, we ought to try to get them and look at them. So for the three or 400 employees who have been looking at this, whether they wanted the surgery or not, the word that I would like to leave is that we are not abandoning them, we are reversing the vote. There's more work to be done. Whether or not we collect sufficient data to show that this is cost effective remains to be seen. We ought to put forth the good effort. Maybe try to pressure those who offer this kind of surgery to develop, help us develop data so we can justify it. A lot of people have been working on it, which is good. I think we ought to try to benefit from the fruits much their efforts to the -- of their efforts to the extent that we can.
>> [indiscernible]
>> we are here to serve the public as best we can. We sometimes make decisions to come back and reconsider those decisions that we have made collectively as a court, majority rules. There have been several times, well not several, but occasions where we have had to bring things back to be reconsidered. This is another one of those type of occasions. For that I just wanted the public to know there are those times that we have to bring forth reconsideration to the court. This is definitely one of those times.
>> thank you to those who opened up their personal histories for our benefits. Courageous individual, we wish you well. Any more discussion? Thanks to staff for -- for -- mr. Mansour? Just getting your stuff. I thought that you were about to stop this vote. All in favor? That passes by unanimous vote. Tooo t t t t t t t t t too sas ggututututimim ay'sanancococococococo g g grero wait and make sure that's what everybody wants to do. I know that I was told whennnnnn dts wryryat ss teemamama a ait atatthth ilweweththth akt t ininininin g g g gisis th. I think we need to give ourselves some additional time to think about this. - - - sldouououf f -
>>
>>
>>
>> I i I if f f f ouou s s -
>> let's give you an opportunity to make any kind of final statements that you would like to make. If others come here on this, give them an opportunity. Court members can have their say and we will take the action.
>> I think it's great to wait and make sure that's what everybody wants to do. I know that I was told when I had the surgery the people who benefited the best from the surgery had been on a diet before and knew how to diet and all it was it was just that you couldn't keep it off. I think if you keep researching, I did two years before my surgery. That would be a good thing.
>> we were trying to cover those who were morbid obesity plus had another serious illness.
>> correct.
>> so the combination we were told is deadly. Especially the longer that you wait.
>> that's correct. I have seen that with my eyes.
>> we almost were that ourselves.
>> okay. Thank you for sharing your personal life with us.
>> good thing about both of you all is that you have become advocates for morbidly obese people who need assistance. There are folk like me who haven't give then this matter a great deal of thought up the last couple of weeks.
>> if I could just say.
>> I was trying not to listen to much of the uproar this week, but it's hard to help it. I can completely understand people being upset if they think they are paying for something because somebody or a procedure -- because people aren't willing to make the effort to lose weight. The truth of the matter is number one this whole effort to try to pass this is -- is in the savings costs on the health play. No one -- it's totally a cost savings attempt and with the best information that we have received from -- from surgeons and the studies that they -- hopefully we will give you copies of the studies that they are referring to. Can show you know the cost savings. The other thing that I wanted to say is when we think about morbid obesity, we really need to keep in mind we are very, very different genetically in many ways, not just in the area of morbid obesity. For example, like high cholesterol. I have some patients, many people in the county who are on the big bell curve of people in the middle they can control their close roll problem with the right kind of -- cholesterol diet on the right kind of diet. There are people who are genetically hell bent on having that cholesterol. I can put them on the lowest diet they can ever be on, vegan diet, they still have 300 at the end of that. Those people are in need of a medical assistance at that point. I've seen in it diabetes, hypertension, obesity as well. People, the extent that they would have to see owe to keep the weight off, to lose weight and keep it off, the kind of diet that they would have to adhere is not really realistic. For some people. You feltly those people end up being extremely overweight, the which I indications we get from -- from that drive our health care costs up. Quite a bit. That's you why this was driven up in the first place. It might sound like a big expenditure right after the bat. In the long term, hopefully we can give you some studies that can maybe shed some lights on instead of could this, or would this save costs will it or not. You know?
>> ms. Smith any parting words?
>> rogers?
>> ms. Rodgers. [laughter]
>> yes.
>> you look so much like ms. Smith to me. [laughter]
>> I know that Travis County puts a strong emphasis on their employees' health. I am simply here to ask of you to make an informed educated decision. Don't give in to public neglect activity. It will take years to educate the public the way they need to be -- the way they need to be educated. Unfortunately the employees that you have on staff that do suffer from morbid obesity and the secondary co-morbidities do not have the time for that public awareness to be out there the way it does need to be. But they do have a lot of you that can educate yourselves and make an informed educated decision on this agenda item today. That's simply what we are asking, don't make a hasty decision. Make an informed decision. If that does preclude you putting this decision off for a while, please do so and get that education. I will do everything possible to make sure that you get the information needed in order to make that decision and make a correct one.
>> we think that about 10% of our population in general suffers from this disease. Is that accurate? It looks like in Travis County looks like 8 to 10% of our workforce.
>> yes.
>> would fall into this category, is that reflective of the general population, do you think? Okay. Anybody else here on this item? Who would like to address the court? If so, please come forward at this time. There are five seats available. Please come forward at this time.
>> thank you, ms. Rodgers.
>> good morning. I will be real brief. I am a Travis County employee. I work upstairs on the fourth floor. And I started here a year ago on July the 18th. At that point in time I weighed 416 pounds. As you can see now I don't weigh that. But I was before that a state employee. And in 1998 I was diagnosed with congest stiff heart failure which took a toll on me. But I decided to join a gym, try to do the right things and do it on my own. And I had some ups and downs, weight loss, other medical issues. I also have high blood pressure. Degenerative disc disease in my back. No legments barely left in my -- ligaments in my feet and legs because of the weight. Last year I decided to quit my job at the state. Withdrew all of my retirement because health insurance wouldn't cover anything that I needed to help me and I paid for myself to lose weight. I paid a weight management doctor, I went on a diet and exercise. And I have lost 160 pounds. And I'm now 50 pounds away from my goal and continue to do diet and exercise. But I would -- the main reason for me to come was to say if it at all possible for some people, they aren't as strict as I am. I'm one of these people that's black and white you either do it or you don't. There's no in between for me. So I took the strictest measures on myself and took everything into my own hands and just took that measure and just walked with it and decided -- I have now probably paid about -- about 5,000, 6,000, $7,000 out of my own pocket to see my doctor every week, to be monitored, to make sure that everything was in check. I have gone from paying $145 in co-payments for medicine down to $10 a month for hypertension medicine. That's it. The only other thing that I suffer from is allergies, which we all know is a given in Austin, that costs me $25. But I don't even attribute any of that to a part of the medical costs that I incurred. But I used to have to go to the doctor every four to six months to be monitoringed, checked make sure. Last year when I interviewed for this job I was on a cane and I currently now -- I work three jobs now in order to stay afloat and to get myself out of debt, of course, but it was worthwhile for me. But for those people that can for the do what I did, it would be very helpful for them for it to be covered under health insurance. And that was my main statement that I wanted to make.
>> when you were at your heaviest, how many medications were on you?
>> I took about 10 a day to survive.
>> it amazes me how many medications some people are on.
>> for every person it's different. I had to take one to help this, one to replace that, because when you take one, you lose something else. So you have got to -- you have got to do it, or you have no choice. You will be in pain. Along the way you go through a lot of ups and downs. It's not easy. But my main thing is everybody is not like me. There's -- everybody cannot be disciplined. I'm one of these people that for me like I said it's either black or white. There's no in between. If you can't do that, if it's going to be a help for someone that really needs the help, I mean, I even had to have another medical procedure done while I was still mosh bidly obey -- morbidly obese, I had to be halfway asleep, they had a fear that I would not wake up. There are other issues. You have to weigh the pros and cons.
>> what's your name.
>> Margaret sufficient sufentes.
>> congratulations, ths for sharing that with us.
>> Margaret and I had some good discussions because we share the same doctors. And some of the things that we have discovered, too, is that those of us who in the struggle category, of which there are many of us, there are a lot of things that are not covered by our insurance in terms of things before you get to that point of being morbid obesity, using our own flexible spending accounts for wait lost. We found that a weight loss. We found a lot of our expenditures were not covered. Having to do out of pocket for things that we were even having things taken out of our own paychecks for flex dollars, we couldn't that for this kind of area. That's something that needs to be taken a look at. I hope as we finish off today that people also take note of item 22 on our agenda. We are approving for the third year in a row getting involved in the Travis County wellness fair out at the expo center and we will once again be starting up the walking clinics in the fall to be training on behalf of the brown santa program. For those that wrote in or called in saying why aren't you doing more in the wellness arena, the answer is we are. We are working with paul carozza in terms of the kinds of things to get people walking. The first year only dan mansour was slower than I was on the brown santa 5 k. Sorry I outed you. Through the training we were amongst the first people through on the walking program in terms of doing the brown santa program the second year. So I'm looking forward to that. I was the no vote last week. I have not changed my mind on that. It really comes down to public policy in terms of there's a very high bar for me in terms of what is the appropriate use of taxpayer dollars. I know that we have all been very inspired by some of the stories like ms. Rodgers and others of the success stories. But I also got an earful of folks who wrote in saying the surgeries of their loved ones were disasters. That it didn't work on the well and not only were three complications that were very serious, but a lot of folks gained the weight back. You didn't get the benefits that you hoped were going to happen. The other thing that I would hike to say, I don't think there's been enough of a track record for us to know truly what the long-term impacts are. Not two, 3, 4, 5 years, sometimes it can take 15 and 20 years for you to truly know what is going on with a particular kind of medical procedure. In the old days everybody did rk surgery, the really invasive stuff on your eyes to be able to change your eyesight. Nobody does rk surgery anymore. It's been replaced by a much less invasive kind of surgery that I had lasik. It continues to get better and to improve. In the old days everyone got hard contact lenses, I was among those. They found after 15 or 20 careers that you seriously warped your corneas. I was out of them almost a year to try to get my lenses, corneas back to normal because no one knew at the time that was considered the conventional wisdom and no one knew until much later. It was replaced by the semi soft lenses and then soft lenses, et cetera. I'm also thinking in terms of breast cancer. The old way to do it was always a radical mastectomy. Nobody gets that anymore thank goodness. Now replaced no, ma'am by less invasive lumpectomies to still deal with it, but a lot of great strides represented to radiation and different kinds of drugs that can really make an impact and save lives. With that said I'm looking forward because there is a crisis in this nation related to obesity, it is serious. Not only for our children, but it is something that is going to cost us a lot. Now, with all of that said, most of the feedback that I got was on point. I appreciate that. But I have to tell you that I also got a lot of stuff that was not on point. And some of that has been in print, some said in public. The things that I would like to add to the discussion is that some things were said about our workforce that were derogatory in my opinion. Somehow equated heaviness with laziness. And some things were said about our employees that somehow our employees were not good employees and somehow they needed to leave here or whatever. I am here to stand up for our workforce. And in terms that I did not appreciate those comments and I could not say fineer things about the 4500 people that I work with day in, day out as imperfect as we all are. Those are the kinds of comments that really did disstress me that somehow that this is still a topic that people think they can just say anything. I would encourage more people to reread your e-mails before you hit the send button and perhaps what you need to do is either edit it or delete it. But on behalf of our workforce, they are hard working folks, day in, day out, giving you the best on behalf of your tax dollars. I want to make sure that their honor is not dishonored in this process.
>> nobody else? To give comments, right? Then let's hear from the rest of the court. Maybe your motion would be appropriate at this time.
>> I have said everything that I need to say. I'm willing to make a motion. My motion would be the reverse the pilot program on the bariatric surgery that we voted on last week. I do think that we have given clear direction that all of the folks that are really involved in this to continue to work on this issue, but that would simply be my motion.
>> I second that because I think that we need to allow ourselves more time to do a little bit more thorough research on all of the issues and the outcomes.
>> yeah. I will support the motion but I would like to make the following observations and hopefully be brief. The three or 400 county employees who fall into the came category that we have discussed, who are medically morbidly obese, suffer some other serious illness do not go away. And basically I think that part of our responsibility to taxpayers is to try to reduce the costs of medical insurance that we provide as cost effectively as possible. And I think that -- that since this problem has surfaced, and I certainly have a better appreciation for it, then we are duty bound to try to figure out what short of bariatric surgery are variable, what options are available, and I really was pleased with the number of e-mails that I got from other individuals, many of whom are medical professionals, who were saying here's what we have done in this state, here's how it worked out, I would be happy to come down there to share that with you. I think at some point the court ought to get with our benefits committee and put together a program that systematically see what they have. What I suggested was sending us one hard copy of whatever it is. I assured them that I would make multiple copies, distribute them to the right people of Travis County. Afterwards maybe try to get them an audience with the committee. I think we ought to follow up on that. There is new information being made available, if not daily, then certainly weekly, I thought we ought to keep pulling that, studying it. Various medical studies have become available, some are a bit dated. So if some of them have been updated, we ought to try to get them and look at them. So for the three or 400 employees who have been looking at this, whether they wanted the surgery or not, the word that I would like to leave is that we are not abandoning them, we are reversing the vote. There's more work to be done. Whether or not we collect sufficient data to show that this is cost effective remains to be seen. We ought to put forth the good effort. Maybe try to pressure those who offer this kind of surgery to develop, help us develop data so we can justify it. A lot of people have been working on it, which is good. I think we ought to try to benefit from the fruits much their efforts to the -- of their efforts to the extent that we can.
>> [indiscernible]
>> we are here to serve the public as best we can. We sometimes make decisions to come back and reconsider those decisions that we have made collectively as a court, majority rules. There have been several times, well not several, but occasions where we have had to bring things back to be reconsidered. This is another one of those type of occasions. For that I just wanted the public to know there are those times that we have to bring forth reconsideration to the court. This is definitely one of those times.
>> thank you to those who opened up their personal histories for our benefits. Courageous individual, we wish you well. Any more discussion? Thanks to staff for -- for -- mr. Mansour? Just getting your stuff. I thought that you were about to stop this vote. All in favor? That passes by unanimous vote.
The Closed Caption log for this Commissioners Court agenda item is provided by Travis County Internet Services. Since this file is derived from the Closed Captions created during live cablecasts, there are occasional spelling and grammatical errors. This Closed Caption log is not an official record the Commissioners Court Meeting and cannot be relied on for official purposes. For official records please contact the County Clerk at (512) 854-4722.
Last Modified:
Tuesday, September 27, 2006 9:54 AM