Travis County Commissioners Court
June 26, 2007
Item 26
>> let's call up 26. 26. Receive briefing and take appropriate action regarding the provision of psychiatrist services for inmates in Travis County. Let's just go ahead and call up item no. A 1 related. Approve interlocal agreement with Austin Travis County mental health and mental retardation for psychiatric services.
>> okay.
>>judge, bill cable with the sheriff's office. The court's speed left me without support. I trust backup will arrive shortly. What we have for the court today is a situation where we have provided psychiatric services for jail inmates using a contractor. That contractor gave us notice of June 30th, he had been on the month-to-month basis. He proposed an amount of $264,000 to continue his services. We have investigated a number of different methods to provide psychiatric services, and we have been negotiating with ms. Grimes help with Austin Travis County mhmr to provide these same psychiatric services for an amount of $240,000 per year. We have the money available for the rest of this fiscal year in our budget, so there's no impact immediately. We will need $46,000 that is not in our preliminary budget request for -- for fiscal year 2008 and obviously with all of the budget pending that -- that is a matter for some negotiation. And further discussion. Our concern in proposing this is the -- is the number of inmates who may need psychiatric assessment. And occur and services. For that reason, we will propose to court as the budget comes up an earmark on a reserve in the amount of about $100,000 to cover an additional psychiatrist for one-half of the year for the last half of fiscal year 2008 if the workload measures show that that is appropriate. We have been working hand in hand with purchasing on the interlocal. Do we have that yet.
>> no, sir, we don't. Good morning, assistant purchasing agent. I apologize for just now getting down here. I have been working with my staff. Mike long has been in touch, is in touch as we speak with mhmr. At present they are unable to find anyone in their staff to man this position, so we are still working with them, they hope to have something back to us by the end of the day, maybe early tomorrow. We were unable to ascertain what the problem is, basically they have told us -- excuse me, they are unable to find anyone on staff to man it. I have asked mike on my staff to get in touch with mike summers of the sheriff's office and talk with dr. Ford to see if he would be willing to extend his report for 30 days, that way we don't have a lapse in service.
>> did he agree to do it.
>> no, sir, we are in contact with him as we speak. Trying to work this right now. It's been a last minute thing here. We have been in a rush mode.
>> don't we have a -- an answer so whatever you need to do to do it.
>> that's a good question, comirk. We are working this as we speak. Mike along with my staff is in touch with mhmr, as an alternative solution or suggestion as a backup ask him to get in touch with the sheriff's office to talk with dr. Ford to see if he would be willing to extend this contract for another 30 days for us. Just in case we can't get the interlocal agreement executed with mhmr.
>> when do we get notice from dr. Long?
>> dr. Ford.
>> dr. Ford.
>> he gave us notice in may. By contract he has 30 days. Either party can terminate with 30 days notice. He gave us 30 days notice in may. Since then we have been diligently working towards trying to find an alternate solution. Just doesn't seem to be anyone out here, any psychiatrist that's interested in taking on these services.
>> not for a certain cost?
>> yes, sir.
>>and that -- the work environment as well.
>> well, judge, and Commissioners, I've -- I've gotten pretty interested in this subject matter. I mean it was interesting talking to dr. Ford about how his world works and this kind of employment. One of the tough things is that psychiatry, I mean, you have a huge amount of liability, I mean, whenever you come in and take on a position like this. I mean, malpractice insurance alone is staggering. It's easy to see why we can find ours in a spot -- ourselves in a spot where we have been paying -- bill tell us, I mean, we are going to have basically a $240,000 tab, you know, working this thing with mhmr. What -- what did we pay everything included benefits and everything with -- with dr. Ford? Was it -- was it somewhere in the -- below 200,000.
>> it was below 200,000. It was 190 -- 194 whispered in my ear.
>> okay so, you know, we can -- we're a little bit here like we were with pharmacy, you know, we get -- I mean this world of -- of medical care, drugs, I mean especially when you start talking about psychiatry is really tough to get your arms around, I mean,, you know, fortunately we have a spot where mhmr can come along and do this, but I think union contract-wise -- you know, cart-wise it's the best deal that we can get. You are going to have a psychiatrist come along it's going to be some sort of a fee -- I don't know that dr. Ford necessarily tried to stick it to us so to speak. It's just that, you know, if I'm going to do this and the number of people, folks that you see, I mean, in our program and the drugs that we have to administer because of the issues that we have got in the jail, I mean, it's really a pretty daunting task for a physician. So I -- I think that it's -- it's good for all of us to understand kind of how this thing is working so I can see where we have gotten ourselves into -- into this spot, but I'm not very hopeful that we are going to number one that we are going to find anybody to come along and wants to do it as part of the staff, number 2 that we feel like that we could, you know, have a better fee if you will than we could with mhmr. Obviously the thing that you have got to have is this kind of position in place, the administering of drugs that the psychiatrist has to write for our inmate population. It's not something that we can go oh, well we can just deal with it later. Meanwhile if we don't do something like that, then our corrections people, it's hard really -- really hard to take control and deal with some of our jail population if we don't have this going. Isn't that right?
>> we have no choice but to provide these services. They are required.
>>I know it's a big demand. What are some of the county doing with Travis County, are they having confrontational situations where they have these services and -- immediate and -- how are they retaining the folks? Did we look at that comparable level of service that other counties are providing in the same arena?
>> yes, we have. Jamie balagia is here to fully answer that question.
>> our situation is not confrontational in any sense with dr. Ford. It was simply a matter of his contract expiring. And we certainly have no indication with dr. -- no problems with dr. Ford, he has served us long and well. The larger counties tend to have people on staff, psychiatrists do command very high salaries. And finding psychiatrists who wish to practice in the jail environment is -- is -- is somewhat similar to finding nurses who wish to practice nursing in a jail environment. It is a difficult situation, commanding very high pay for what they do. Some counties do contracts, some work through their hospital district, some have staff.
>> harris county has like four or five or six on staff, but they have also got 10,000 people in their -- isn't it true?
>> here is where I have got to have major balagia, because I don't have the facts down on the corrections part of it.
>> there are a number of them in harris county, but of course there are 10,000 inmates in harris county compared to our 2600, you know,, I mean, but they do have, you know, a large staff for that.
>>this is not the --
>> judge, if I may our alternatives, I believe, are to see if dr. Ford will extend and he has -- in discussions already indicated that he would prefer not to. It is to get this --
>> repeat that last statement I'm sorry.
>> dr. Ford has indicated that he preferred not to extend.
>> not to extend?
>>yes, sir.
>>okay.
>> this is the 30 day option, not to extend for 30 days?
>> our prior discussions have indicated with dr. Ford he has declined to extend for another 30 days. We will revisit the issue. We have this contract which we believe is very close to being ready to sign. To the extent that this item had come up later today we might have had it or we believe it will be ready later in the week. If the court wishes to allow the judge to sign that as it comes forward, that is an alternative. If nothing else works, we will provide psychiatric services using day by day psychiatrists, which we have available, the cost will be about $1,100 per day. So we will take a budget hit if we have to do that. And we will work the budget out accordingly.
>> [multiple voices]
>> if we work out everything with mhmr, we could easily sign the contract next Tuesday.
>> yes.
>> it's another at quasi governmental entity. Okay the psychiatrist nurse practitioner is filled.
>> yes, sir.
>> and the county will keep providing that support.
>>yes, sir.
>> we will.
>>in addition to a contract with mhmr or some other entity if we can get one.
>> yes, sir, absolutely correct.
>> okay.
>>that's what I think -- we are negotiating -- if things come through with the -- with mhmr we can simply execute this next Tuesday. That's the easy part. We need them to start working July 1, I take it.
>> yes, sir. We very much would like that.
>> the amount -- I assume we agreed to the amount if we can get the contract --
>> two issues that we are looking at here judge. Number one being them having as I said the difficulty finding someone on mhmr staff step up to the plate and perform these services. Second issue which relates to that may be salary. As I said the reason that I was late I was with my staff working this issue while you guys were discussing it. He was on the phone with mhmr at the time. So we are diligently pursuing this. I would probably have additional information when I go back upstairs. We hope to hear something back from them by the end of the day.
>> if we want the -- doctor ford to extend his contract one month, why wouldn't we pay him his requested amount? For that one month. See what I'm saying?
>>yes, sir.
>> instead of being the rate of the current contract, if he will agree to a one month extension, we will sweeten it by paying him whatever the new contract would have been broken down monthly. I mean, I can understand his position. The amount that we are paying him now has been in place for five years.
>> I think that's correct.
>> since the '02 contract.
>> yes.
>> was the '02 contract the first one that we've had with him.
>> to my knowledge, yes. I think there have been some increases along the years, but it is essentially the same thing.
>> if you do that, I mean if you are looking at 260, 264,000.
>> so that's what 20, 22 grand -- the doctor would do that. But if you are able to do mhmr I guess the -- his contract, dr. Ford's contract goes to the 30th, technically through Saturday. If we are not -- if we don't -- if we wait today to sign up mhmr, next Tuesday, then we have got Sunday and Monday where we technically.
>> if we cut the deal with them, we would expect them to start the contract July 1. The government entity, dealing with a governmental entity is not like us dealing with john doe. We have numerous other contracts with mhmr, that should be easy. Getting a two or three day early start on it. But what marvin is saying is that there are two outstanding issues and probably more important than money is availability of a psychiatrist who can fill the contract.
>> exactly.
>> so, you know, I'm sure dr. Ford has other plans. But if to the extent that money matters, it seems to me that it would make sense for him and us to go ahead and pay him that -- the monthly amount that he would receive under a new contract at the salary that he requests. Our problem is we need at least a psychiatrist available because based on the backup, we have a whole lot of inmates in need of the services. And that won't go away whether we have the psychiatrist or not. Not.
>> judge, do you know something that some of us don't? Have you talked to ford? Is there -- let's just ask the question. It's there more of an issue here than the money? I mean, in your -- whoever has got the -- the best shot at answering that there I mean --
>> I have not talked to dr. Ford about anything except his payments. And I don't know.
>> marvin, your shop is talking to him, though?
>> yes, sir. I have requested that we put in a call to the sheriff's office to talk to dr. Ford.
>> it would be good to hear the conversation, just maybe something that --
>> on ford I would be -- I will ask you a question. I don't know anything that you all don't know. I have not spoken with dr. Ford. This is just back on -- I assume that the strategy in the backup had basically been -- been perfected and -- just a matter of us implementing it. In fact I would like to -- I was about to put it on the consent motion except that I thought it would be good for us to discuss it in open court. But I'm just, you know, human nature and money. He's been here five years, it's not like a death sentence to take 30 more days, but at the same time I don't know what arrangements he has made in his personal life. But to the extent that our needing him matters and our willingness to pay the higher amount for as long as he agrees to stay on, and really to give us an opportunity to try to get the alternative strategy in place, and if mhmr falls through, then it seems to me unless there's something that I don't know, if dr. Ford is still willing to negotiate, we may have to sit down and chat with him a bit further. And if that is the case, the request is whether it would help for a member of the court to help. Whether we would hinder. We don't have to answer that right now. Just think about it. What we can do is call this item up at 3:00 this afternoon. And see if there is more information than we have right now. Who I have in mind is us making as many telephone calls as we can between now and then and if there's new information to be shared with the court, I'm pretty sure we will be here by 3:00. 3:05 I don't know. But 3:00 we will be here.
>> we will try to be here at 2:58.
>> but Dr. Ford if he is listening, we need him another 30 days at least is what we are hearing, right?
>> yes, sir.
>> give it your best shot, marvin.
>> yes, sir, I will.
>>thank you all.
>> and --
>>yeah, I don't know him. You have a relationship with him?
>> I mean I have met him, I feel like I could call him -- the reason that I asked that is because I felt like that there might be something more here than just the salary. If that's the case, well then let's just --
>>we need to know.
>> we will know at 3:00.
>> salary and amount of work. Because when I look at the number of inmates that have to be seen almost daily, it really is a labor intensive position. And -- and the more inmates that we have, probably the more of them that need to see a psychiatrist, right?
>> yes, I think that's a -- that's a pretty clear statement.
>> yeah, I knew the number was big, but I really didn't know it was this big. This is two or three times the number I had in mind. But the number that I had in mind was I just pulled from the air. 3:00, ms. Porter, if you would remind this court of the 3:00 obligation. That's 26 and A1. Rather than just formally re-- formally recessing this one item, we will call it back up at 3:00.
>> okay. So -- so what item are you here on?
>>[one moment please for change in captioners]
Let's get the update on item number 26 he, which is to receive briefing and take appropriate action rargd the provision of psychiatric services for inmates in Travis County. The companion item is a-1, which is approve interlocal agreement with Austin-Travis County mental health. And probably we don't need a-1 today. We know that one is not ready. And actually looking at the wording of -- it's probably all right. The wording is probably broad enough in 26.
>> I brought in reinforcements.
>> good afternoon, judge, Commissioners. As bill said, we've got some reinforcements with us. We have members from the sheriff's office who I'm sure you know. We also have mr. Abraham and menerez who is with mr marnd he's here to dwreas the court concerning mhmr's endeavors here. Before I let him talk with you guys eye like to give a brief update. At the court's direction we did contact our current contractor, dr. Ford, and we inquired of him as to whether he would be willing to extend his termination, which would take us through July, the end of July of this year. I spoke with bill and we had a little discussion. I took the liberty of also inquiewfing of dr. Ford if he would be willing to rescind his termination and perhaps go with his full contract term to the end of the 30th September. Asked him and also to see what cost. I did inform him that the court had directed us just the one month, but also I took the liberty of seeing about three months as well. Dr. Ford was in my opinion, seemed receptive to the one month extension at a cost of $18,000 per month, which is which is above where we're at right now. We're currently at 15,000 per month. The same amount would hold true for the three month extension. We faxed him overdraft modifications for him to take a look at. He said he would have to look at those. I feel fairly confident with the one month extension. He he said he would entertain the three month as well.
>> [ inaudible ].
>> I think that's a very valid presentation of it. Dr. Ford reconsidered and indicated he was positive in his outlook on the 30-day. He did want to review and consider anything beyond that.
>> so 30 days for sure. Maybe 90.
>> maybe 90. And as I said, mr. Menerez is here to address the court. After hearing from him, the court may decide you just want to go with the 30 days, but to be safe we tried to cover all bases.
>> hello, Commissioners. Good to be in front of you again. I'm really speaking for our medical director. He and I met with Travis County purchasing department and some staff from the sheriff's office to discuss the possibility of mhmr being able to provide psychiatric services. We as an agency were very glad to have that discussion and are willing to provide that. We think that it is the right move when it comes to care. As many of you probably heard over the last couple of years, I've been up here talking to other agencies in Travis County. In our efforts to try to get individuals out of jail, one of the stumbling blocks that we run up against is the medication issue. The medicined that they're on in jail and then they get switched. That never plays itself out well. That's one of the reason that we thought if we could get a psychiatrist from mhmr in there, we could continue the same me indications or work with the jail on the medications as we get them into mhmr. It will be a smoother transition. So we're very glad to have this discussion. One of the things we did discuss at the time that dr. Van norman entered up is there is a national shortage of psychiatrists and Austin is not immune to that. We are all trying to get psychiatrists either that are in the community, to work in the community mental health system or from outside of the community. And again, we knew that our fall back position would be to hire a local (indiscernible). And for the most part that's basically doctors that we hire through a staffing agency. It's a very expensive proposition, but in the past that's always been our fall back. So as we move forward with this, with the interlocal, we thought that we could always have that as plan b. In my discussions with dr. Van norman today, we had talked about the fact that the locum 10 dense in the last two weeks had not responded. One of the two thanks dr. Van norman had done was extend an offer to the current psychiatrists to see if any of them were interested in providing services through the jail. There were one or two doctors that expressed some interest, but over the last two weeks had not followed up with with that and it looked like they weren't willing to move from where they were at. This is of course that we as a system needed a couple of psychiatrists. I bring that up because the doctor is very committed to getting a doctor, even if it meant moving a doctor from our current system into the jail. My last discussion with him about two hours ago, he brought up two options that we have right now. The first option which he thinks is a good option for several reasons, and I'll explain, is to try to recruit (indiscernible) psychiatrist that's currently doing a fellowship at shoal creek and try to do a forensic fellowship at the jail so this person would then provide services there. He was wanting to do this for two reasons. One is that it's extremely difficult to get a psychiatrist in the area, but it's even more difficult to get an actual (indiscernible) psychiatrist. When you're specializing in adolescent psychiatry, you're also first certified in adult psychiatry. Dr. Van norman wanted to create that fellowship. The last he heard from this person, be he was interested in doing it, but we didn't have any firm commitments yet. The second comment was with the locum 10 dis. Those are the two options. I can't say that we have a particular person in place right now this is going to start on this date. We are very close and we're still committed to it, and I was glad to hear that the doctor was willing to extend his contract.
>> you might want to start massaging the 90 day deal into 180 days.
>> [ laughter ] I mean, this is consistent with what I've heard. It's just like the pharmacists. Although I think we were pleasantly surprised, I think we got a lot more response in the pharmacy because we were told in the industry that this is a tough deal, but this psychiatry thing really is. Even if you do, you've got to scwlus pay more. That's what it takes to get this service.
>> most new psychiatrists coming out they're looking at a private practice. It's hard to get somebody to come into mental health. And again, forensics is again just another one of those environments that you're looking for somebody that's really invested in doing work in that area.
>> I don't know. I guess my motion would be two fold in the alternative, with the county judge authorized to sign on behalf of the court if any one of these is achieved. One would be the one month extension with an additional $2,859. The alternative would be a three month contract where we increase that to 5,000 a month. We sweeten the deal for 90 days.
>> increase above and beyond the 18?
>> right.
>> one month we're paying just under three thousand dollars more. We'll add two thousand a month to that to get 90 days or three months.
>> so 20,000 a month.
>> so is it 18,000 now?
>> it's 18,000 now.
>> so it would be 23,000 with the additional five.
>> currently he's at 15,000, 141. He was willing to go with us for an additional 30 days for an additional 15,000 a month. And after discussing the additional 90 days he would still do that at 18,000 a month.
>> he's still undecided about the 90 days. My feeling is for the 90 days it would increase to 2200.
>> 20 grand.
>> 22,000.
>> no, 20,000.
>> so $20,000 a month.
>> yeah. So the way we understood y'all, he's favorably inclined for 90 days, has a few more questions -- favor of being inclined 30 days, a few more questions about 90. So I'm saying to give us a little bit more leeway to try to work out an alternative or find out whether there is an alternative, then we would pay an additional amount to get a three-month deal in place.
>> will the court have any objections if I approached him at the $18,000 per month for three months and then just use the additional 2,000 just as another incentive, another negotiating tool?
>> I thought you had already done that?
>> [overlapping speakers].
>> let's say the 90 days is up too.
>> let's say he's watching us.
>> [ laughter ] when you call him he's going to say, I'll go ahead and take that 20.
>> [ laughter ]
>> he's with patients now.
>> or his friends are watching us.
>> I better get out of here and get on the phone.
>> [ laughter ]
>> I've got a way thaw and I can cut two thousand dollars.
>> I second that, be judge.
>> I do think it would be good for us to have a written contract to cover the next 30 days beginning -- the current lerlt of resignation is for the end of this month. And the 30th is Saturday. So if we could have it signed by Friday. So 30 days, if that's all we can get. 90 days preferably. And if the court would authorize me to sign whichever one is available on Friday so we can go ahead and get it in place.
>> but judge, we're not lacking at a situation where we call him and he says give me that five grand for this month and I'll let you know another couple, three weeks. If he's going to sign up for 90, be he needs to tell us now if he wants the five thousand.
>> if he says I'm undecided about the -- after the next 30 days, then I understand what y'all have cut is pretty much an 18,000-dollar deal, which is 2859 more than the current contract has been.
>> right.
>> we're kind of in the situation where we need to get whatever one we can get. And was that a second? No discussion, I take it? All in favor? That passes by unanimous vote. With Commissioner Davis temporarily off the dais. That will take care of item number 26 for us, right? And abraham, you will keep working on the mhmr. David, anything we leave uncovered?
>> no, judge. We appreciate your support.
>> [inaudible - no mic].
>> thank y'all. Appreciate your hard work today. I can't vouch for the other days of the weerks but you worked real hard for us today.
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Last Modified:
Wednesday, June 27, 2007 3:46 PM