Travis County Commissioners Court
November 28, 2006
Item 23
23 is to consider and take appropriate action on options for providing pharmaceutical services to Travis County inmates including, but not limited to, creation of an internal pharmacy or contracting with outside vendor. We talked about these two possibilities in the past. Didn't act on it during those discussions, but promised to bring the issue back to court and here it is.
>> good afternoon, jamie bail l.b.j. I can't from the -- balagia from the sheriff's office,
>> [indiscernible] are with us, one of our nursing supervisors hiding back there. The judge is correct. What we want to do is plate an internal pharmacy within our health services building that would be able to dispense medications to all of our inmate population. We want to just continue the mail order business of receiving pharmaceuticals and operate in house. Now the question is do you contract this service out or do you operate it with f.t.e.'s? There's advantages and disadvantages of course to both. I'll -- I'm going to cover what I believe to be the two most critical in each of those and -- jeff is welcome to come up here and give us his professional opinion. He is in the business. I'm merely trying to repeat what my staff tell me. And bill can talk about the money part. To me the biggest advantage of contracting the service out, even though you have the pharmacy inside the facility is the burden of retained the staff is that of the contractor. You write a very good contract that -- that doesn't include for -- for vacancies for any -- any real length of time. And so the burden is on the contractor. To ensure that the appropriate staff are on site providing the service and so you have -- you have uninterrupted service for your inmate population. That's -- that's the best solution. The disadvantage, the largest disadvantage with that is that it costs a lot more and bill can speak to those numbers. When you contract out, the figures that I have heard are anywhere from 25 to 30% increase in costs because you are contracting it. If we go with f.t.e.'s, the obvious advantage is that it's less expensive. To me the disadvantage is being able to hire and retain pharmacists. Now, there are other agencies out there -- out there that -- that have f.t.e.'s, harris county wrote us back when I had written to a number of different counties across the -- across the country asking them how to do it or how they did it, actually I didn't get a lot of response. I only got response from five or six different places. Harris county does do it in house with f.t.e.'s. In fact I think they have six I think pharmacists, of course harris county is huge. They have their almost at 10,000 inmates. I think their number right now number 3 in the nation in inmate population. So it's a big, big business with them. They write, you know, probably upwards of 200,000 scripts a year. Seattle, kent county does it in house with f.t.e.'s. El paso contracts it out. Their pharmacies contract it out. There's another one that contracts it out and that escapes me. It may be collin county. I don't remember right now off the top of my head. So different agencies do it different ways. And they report each being successful. They are not having -- the people that do it in house with f.t.e.'s, at least in the writings that I saw, didn't seem to have a huge problem with hiring their pharmacists, I don't believe. Do you remember what harris county said about theirs, bill?
>> harris county said they were able to hire in their market. But hiring pharmacists is by all accounts a local market. And not necessarily even a state-wide market. A lot of it depends on the number of pharmacy schools. That are local. We happen to have one here.
>> bill, I thought the last time that this came up, we talked about you all kind of potentially testing the market. Did you all do that?
>> now, we did not.
>> there's no point in saying we ought to go with the strategy that talks about hiring people if those people aren't there. So I'm wondering why we never tested the market when that was what we last asked you all to do.
>> we need the slots created, before we can advertise them. And --
>> let's create the slots now because that's exactly what we need to do. I thought that was being done.
>> [multiple voices]
>> there's no point in even having this conversation.
>> until we see what kind of response we get.
>> we have not crossed the bridge to creating the slots. It's my understanding that we can do that without assigning a budget for those slots. We had also discussed simultaneously or concurrently issuing an rf whatever to -- to see if we could attract contractors. And then compare the costs of the two alternatives.
>> I would say being a third alternative, that is we keep what it is that we've got, because there are drugs being disspenced as we speak over in the jail, correct? At some point there is a comparison that gets made to the status quo even with the loss of efficiency related to the recycling. Help me out. Because I had heard that we might have gotten the recycling issue with utmb adjusted in which case that may not be the problem that it once was. So to me I'm not ready to say forget about utmb. To me all three options need to be looked at simultaneously. Did we get any help on the recycling issue?
>> a little bit. But it's still not to the points where it saves money.
>> okay.
>> we get recycled posters that have not been issued, but if we pop one pill out after blister, they will not recycle it.
>> to me there are three options. As opposed to what two options do you want us to look at? To me it's three options, the status quo, even understanding there are loss of efficiencies related to recycling, which can get to can we even find people to take these jobs, which would be compared to -- to what is that additional cost on contract folk and what's the differential between that and the utmb proposal?
>> is utmb willing to continue the status quo?
>> yes, sir, I spoke to dick caisson with utmb yesterday on the telephone. They are -- I told him that cyd grimes group would be contacting them officially. But that unofficially over the telephone they are and we are certainly until we get our decision made --
>> there's no way for us to get with utmb and go to the state and get an authorization to recycle in the same way that utmb recycles for the state?
>> there is another alternative there. We may have an additional alternative there.
>> we have to have a pharmacist on staff. You can't -- to mail order and recycle.
>>
>> [indiscernible]
>> hello?
>> get the law changed.
>> the state system has a pharmacy --
>> right. It is my understanding that the stated system has pharmacists on site. So they can be recycling. But you cannot return the medication to be recycled unless you have a pharmacist on site.
>> state board is here in Austin?
>> yes, sir.
>> I mean it's too easy for us to go over there one day and spend an hour. Crying and complaining reaching out for help. There's no telling what we may walk out with. But what I think we ought to give them the opportunity to assist us if they can. The biggest problem with utmb right now is our inability to recycle with them in there without us having a pharmacist on board.
>> that's the biggest financial issue. There are some operational issues that jeff may want to speak to.
>> [one moment please for change in captioners]
>> I think right now we have seven vacancies in our nursing staff. And if it's under contract, then again, the responsibility is on them to quickly make those replacements as opposed to if we have a familiar cyst that -- pharmacist that quits, then we have the burden to go out and hire another one and what do we do in the interim? Before we sat down I was asking jeff about local temp agencies, do they have pharmacists that we could use on a temporary basis and they do not. So if -- that would be my answer.
>> so the least attractive aspect of that option is that we're looking at an additional cost of from 25 to 30 percent, we think.
>> yes, sir.
>> compared to what we could do it for in-house?
>> yes, sir.
>> now, would we be able to recycle if we contracted out to a third-party vendor?
>> yes, sir, we can. Under the current rule we could be recycling.
>> because we'll have a pharmacist on site.
>> what would be the savings of that? Or is that factored already for the increase of 25 to 30 percent.
>> we have -- no, that cost aligned into the cost of the drugs, and we have not factored that in.
>> so there would be some additional savings and you could knock off 25 or 30 percent.
>> the recycling can occur whether we have employees or whether we contract for pharmacy services.
>> as long as there's a pharmacist on board.
>> yes, sir.
>> from what time to what time?
>> I think the board doesn't say -- give specific times. They just have to be on site. It kind of uses vague language, four days a week or something like that.
>> they have to supervise the recycling. If we have a blister bag we have to guarantee that the penicillin is being returned to another penicillin. Another layperson can't make that decision.
>> so however many hours that takes with the day to do those thingsment.
>> do we think we would get competition for the contracting out of pharmacy services? Because it seemed like we were down to the same firm and there was no competition, that just was the firm and that to me is not the spirit of contracting out.
>> I think there was no competition because we never advertised.
>> well, that would also help.
>> there would nobody ad in the paper to say we're turning out a contract to bid. There's been three --
>> it was advertised on
>> [ inaudible ].
>> not in the statesman. That's where everybody looks. That's where local pharmacists look. I've had three pharmacy groups contact us about a contract.
>> you're telling me you're willing to tolerate us taking another two, three, four months to work through this if necessary.
>> yes, sir, we believe so.
>> as long as we keep the monthly checks coming to them.
>> yes, sir, we got some invoices in. In.
>> yes, sir.
>> what we need to do is the creation of slots and let's make a motion and do that because the first thing that we have got to determine with all that we have talked about to date, and -- I haven't been in the last month or six weeks, but for two or three weeks I was very involved in this. And it is clear, regardless of what we know about houston, every pharmaceutical person will tell you how difficult it is to hire these people. I mean, that's irrelevant refutable -- irrefutable. Unless we do these slots, we put the a. Out and see what we get. If we get eight people I'm willing to go to these people who said they're really hard to get and say we've got seven or eight people. But until we create the slots and put the ad out, then we don't know because I think what we're looking for is, listen, let's mark some things off the list of choices. And I mean, so we'll at least do that. There are people that will come in and contract -- I've been told that there's somebody else that will do it as well. But I think part of what happened in the past is it was also told don't bother. We ain't changing. I mean, that was on the street.
>> not from us.
>> so thrp all sorts of things going on, but if we need to move the ball forward and with this language we have action the motion can be to create -- to set up creation of the spots so that we can move forward with that, then let's do that and then let's get the advertisement out to see whether or not we're going to have any interest in coming in and talking to us about being an in-house familiar cyst. Pharmacist.
>> Gerald, I don't disagree at all. My point is this, though. With all of these moving parts in trying to land on whatever situation we end up dealing with, is there adequate money set aside to deal with utmb as we go through the process? Because again those pharmacists are in high demand. Everybody want them. And it's a shortage of them. It doesn't mean we'll get a good response. I'm kind of looking at this overall as having enough money set aside to get us where we need to go, especially if we have to use utmb as the way we use them now. And still trying to satisfy what we're trying to do here even if it is to get the advertisement of these vacancies and saying, yes, we are look being for somebody, are you interested, all these kind of things. So is there enough money set aside to carry us how far in this process. And I need to find that out.
>> okay. Commissioner, this is bill derryberry with plank and budget. There was appropriated by you all in the budget process this year inside the sheriff's office $100,000, which is basically what they've been spending or has been appropriated for quite a number of years for the pharmacist services. And that amount is being used right now. We have about one month left for that purpose inside their budget. However, outside the budget there is a reserve of $248,000 which is also budgeted and can be drawn upon for either one of these purposes.
>> how far will that take us?
>> it will finish the year, either way. Because -- it will finish the year either way because 248,000 plus the 100,000 inside was sufficient to cover for fy '07 the cost of either the usmb which is, which is around $24,000 a month, or the cost of one and a half pharmacist positions plus two pharmacy tech positions and some related costs associated with that. So there is 348,000. 248 is not in the budget at this point. And it will be necessary next month to come and appropriate some portion of that reserve into the sheriff's intowjt that they can continue to contract. But there is $248,000 there. That 248 will have to continue as ongoing under either circumstance in the future under fy '08.
>> but hearing that, we're going to have to be as close on target as possible with the amount of money we have available. And Gerald, I don't have any objection to what you said about the advertising andanything else ass the advertising to make sthawr we have at least the right mixture of all three of those components as far as the situation that we're looking at.
>> there is sufficient resources right now inside the fy 2007 budget to go and continue either option and pull the plug wherever you want to on where to go.
>> is utmb interested in a permanent relationship or do they see themselves as coming in, helping us out for a finite period, then going back to whaf they were doing before?
>> no. I think they would like to have a contract.
>> they make decent money.
>> so the motion is to create slots. You have to approve the posting. That would have to be salaries and you're looking at a pharmacist plus pharmacist technician. Whatever it is, we need to create the whole ball of wax with the job postings and whatever we need on that. That will require some putting together, I think, because we might as well go out with the realistic expectations. The other thing is to rsp for a vendor interested in doing this and so we'll have to describe the service that we want. And I guess it's similar to what the other vendor was doing except in full compliance with the law at this time. Those words are not mine. I got those from Commissioner Daugherty. The other thing is for utmb we might as well do due diligence with state and fit out how best to go with them and in the end we will know what we have and plus what the cost of each option is. Is that your motion?
>> is that an rfs? Office st a request for services that we would put out, cyd?
>>
>> [inaudible - no mic].
>> okay. So either way. We know what wee after. You put the letters to it.
>> we also want a description of services we would get plus the cost, right? Rsf would get us the cost also?
>> but judge action my understanding of this memo is really to preserve all three options. That is action that we have an ongoing relationship with utmb and we're financially covered for this fiscal year if that's wait it turns out, but to see if there's any flexibility related to the recycling issue and anything else. At the same time looking at an rfs in terms of an independent contractor coming in and providing the same service and simultaneously saying let's test the market and see if this can be done in-house and when we get information for all three, the court, not me, can decide which way they want to go.
>> and -- well, forget it. That ain't going to happen on your watch.
>> I know. That's why the huge smile on my face.
>> what I'd also like to have with this is let's put a date on this when we're going to get this done. I mean, can we do this in 60 days?
>> I don't think we can do it in 60 days.
>> can we do it in 90?
>>
>> [inaudible - no mic].
>> let's get it done so we're talking about the end of February. December, January, February. That's 90 days.
>> we had a motion that was summarized three times. Do we have a second?
>> I've already seconded it, judge.
>> any more discussion, explanation, description? All in favor? That passes by unanimous vote. Good work, fellows.
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Last Modified:
Wednesday, November 29, 2006 07:48 AM