Travis County Commissioners Court
July 10, 2007
Item 23
23, receive update on the implementation of the mobile crisis outreach team and related issues. Do we need to get set up?
>> I think we're ready to go. Good morning, judge, Commissioners.
>> good morning. Let's just -- can we just wait a couple minutes here.
>> good morning. During last year's budget that e heal dtric look at the gaps in services in the mental health community. In services for the community in the area of mental health. And one of the projects that you were asked to invest in was the mobile crisis outreach team. And so we have staff with us today from the Austin-Travis County mental health, mental retardation center to give you an update on the implementation of the mobile crisis outreach center so I'll let staff introduce themselves and they will be making the presentation today.
>> judge, Commissioners, on behalf of the Austin-Travis County mhmr board and its executive director mr. David evans, I would like to thank you for the opportunity to come and present to you on our mobile outreach team. One of my roles is to serve as liaison in the inter cooperation agreement we have. Today we've brought dr. Debbie webb and I think -- she was with us awhile ago. Both these folks are on the ground every day on the mobile crisis outreach activity so they have a brief presentation to give you today. And then we can answer any questions that you might have. Thank you.
>> good morning.
>> good morning. How are you all today? Thank you for letting us be here. It's a pleasure to be here. The mobile crisis outreach team is one of the most exciting projects that I've got to work with in I don't know how many years, 22 years with the center. I really believe this is very important for our community and I can't thank you enough for your support of this project because it brings the services where they need to be, which is in the community and in the homes of people that are in crisis. Charles is going to take care of me on the slides so here we go. Okay. So, first of all, the integral part of crisis services is the mobile crisis outreach team for the residents of Travis County. And the emcot is in close cord nays with the c.i.t. Or the crisis intervention teams of both the sheriff's office as well as the a.p.d. The reason ms. Back stepped out is because sergeant hicks wanted to come up here and smile and tell you her feelings about this today, but she was in a place and didn't know what time it would come up. Don't know if she will be able to come, but if not sergeant hicks is a pleasure to work with. I can't say enough things -- good things about her and her team. And we also very much appreciate working with the Austin police department and sergeant mike turner and their c.i.t. So they helped us design the emcot, and I think that's very important. And they are good people. They know what they are doing and we have really enjoyed that collaboration and continue to. The emcot is dispatched out of the psychiatric emergency services that we run. So one call does it all. And when a person calls in, they get a licensed professional who answers that phone and assesses their need and dispatches this team. In case you want to know that number, it's 472-help. And it's also 454-3521. Either of those numbers goes straight to that team where they can come out and check out what's going on in that community and help the person in need. The families in need as well. The mobile crisis outreach team specializes in outreach going into the community to help individuals experiencing psychiatric crisis by providing several things, among those would be crisis counseling, of course, psychiatric assessment, psychiatric medical care, and referrals to community resources. Of all of these things, to be able to get psychiatric medical care in your home is an amazing and wonderful thing. So we're going to go over who the people are that a providing these services so that you will understand how that's possible. So the emcot is professionally staffed by two registered nurses, three licensed therapists and a half-time advanced nurse practitioner. So we are able to administer medications on site including shots and to supervise the effect of those medications and to work with the families and work with the individual and determine what they need. We are able to respond to crisis calls 10:00 a.m. To 8:00 p.m. Seven days a week: now, that is a wonderful thing to be able to cover seven days a week. I wish we could cover 24/7, 24 hours a day. But what we did to expedite the good use of that money is we studied the highest utilization hours and determined them to be 10:00 to 8:00 seven days a week. I was in houston last week and heard them presenting about their crisis team and I think they work like 9:00 to 7:00, it's very close to our hours, and so that pleased me because that kind of validated those are the right hours for us to start with this ability.
>> is that driven more by what -- I'm sorry, by what you can really get people to work or is that really driven by you find that between 10:00 and 8:00 is when the need is because, I mean, your information would be at night, late at night, I mean, because some of this stuff is probably oftentimes alcohol induced.
>> that's certainly the case sometimes. Actually we are able to find people that are willing to work any hours, and we do have full coverage at p.e.s. 24/7. And so if we have a person that needs help at an hour when mobile crisis outreach team is unavailable, we have cab vouchers if they don't have transportation. And we also have people on call that can go out and pick them up if necessary.
>> thank you.
>> you bet. That's a good question. The operating budget, here's how we totaled that 400,000. I think we did a good job of it. And ms. Fleming, of course, is always of good help to us and support and so is jim. Computer hardware 11,000. Those are really nice too. That's all mobile air card driven electronic records realtime. Vehicle costs is $17,000. Telecommunications 13. And other operating 1500.
>> where does the --
>> sir?
>> where is the medication that's administered, what -- as far as cost is concerned, is that embedded anywhere in here?
>> actually we have what we call patients assistance program, and we also have samples. The center works very hard to leverage the cost of medications, and since most of these people are eligible for our other services, they can also receive g.r. Funded meds through dshs. It depends. There are some medications under other operating if it's something that we don't have access to any other way. But we do a really good job of leveraging those meds, and dr. Jim van norman as well as the health clinics here in town in the health district should be definitely noted for their work because it has turned and and made it possible for us to be able to leverage that. So we haven't had any problem with not having enough medications or the cost. The ongoing cost, Commissioner Davis, would be picked up by our regular services. So as those people then engage in the services or maybe they are already in services, we would go ahead and pick up that with our regular operating costs and it wouldn't be part of emcot.
>> so it's outside of this particular break down as far as the cost of the particular medications that's administered.
>> yes.
>> okay. Thank you.
>> you bet. Okay. The priorities for the imcot services, first of all we have people in psychiatric crisis who call the crisis line at p.e.s., and, of course, many times they need immediate, quick access to services in their home. And before we didn't have that capability as we do now. And that's exactly the most important reason I think that imcot exists. We have requests from law enforcement, both a.p.d. And sheriff's offers, asking us to co-respond to calls and that's an exciting thing to do and it's also good that we do cross-training that way where we go with them and they go with us to find out better how to service those kind of calls.
>> how does that particularly work? Can you give me an example of that?
>> sure.
>> especially with the law enforcement end. Because sometimes we have situations where a person's behavior may not be detected, and how does it really work, you know, dealing with that?
>> you know, it is a long time in the coming to be able to determine what behaviors a person might exhibit and
>> [inaudible] they might have. And over time the fact that Austin has trained so many officers, both sheriff and police, in c.i.t. And the specialized services of mental illness, over time that has really helped, I think, in helping officers be able to determine what they are looking at. The training that is offered, two officers in training about mental health is very expensive slide show. I don't know if you have seen their presentation, but it's really good. It's about 350 slides. We also have staff members, including sherry blythe and david Gomez who train on a consistent basis because you have to keep that going so over time that helps. As far as in the field with those folks, if they see -- they ask us to design it whereas if they were in the field and they saw that they needed us to come out immediately, that we would make sure we did that. And the other thing though that's really cool is the next bullet down, which is -- and this is the one that's really going to save money. This is the one that is pertinent to our presentation today and that is that many times the officers go out, but their hands are tied because the person doesn't quite meet criteria for being picked up for, let's say, poec, police officer's mercy commitment. What is nice is they do not want to leave that family or person in that situation, they can tell they are in trouble, but they don't meet criteria for picking them up. With one call they can call us and we'll go out there and pick it up at that point. We do the follow-up, and that doesn't mean days later, I'm talking same day, hopefully the same hour, get out there and talk to them, help them and start working on what is the appropriate treatment plan, what are the services in our community, how can this family be helped, how can we -- how can we make referrals to any service in our community and et cetera, et cetera. So that is the heart of it to me. I'm very, very happy that we're not only able to work with the person that may be experiencing a problem, but the people that support them. Whether they are kin to them or not.
>> can I ask you to elaborate on these people. I'm going to throw you a softball here because I think it's important for our millions of viewers out there to get this, that the service isn't an overlap with the sheriff's department. What the sheriff's department does, I am so grateful that they took on this mandate, and at the same time I'm very angry that they even had to. Because we do have such poor availability for psychiatric services in the state of Texas. That the sheriff's department and our region stepped into the breach and emcot is a much more serving of the individuals. Not everyone meets the criteria for poec. These two bull let's, like I said, let me throw you the softball.
>> I'm glad you are talking about it, because you are right. Mistakes can be made in any field. You wouldn't want me to be doing police work. It wouldn't be the same caliber in that field and the same goes for mental health. I've got 30-something years of experience. Each of us brings our own experience and that makes the quality of what we're able to see and how fast can we expedite what we do and the people we know and how we can link people up and the fact we can motivate people that are perhaps not even engaged in services to engage in services. Those are all by experience. And I don't expect the sheriff's office or the police department to be able to -- to perform exactly the same as a person who has devoted their life to that. So it's a collaboration, a necessary collaboration, though, I think. Because the first responders are the police and the sheriff and people need to be able to call 911 and get some help so I think it's a beautiful collaboration. I agree with you, we are so underfunded, Texas is ranked last or next to last in funding, and per capita Travis County is one of the low necessary the state of Texas. So I think all of us, all of you, all of us are doing a marvelous job with the a money we have to work with.
>> we are at the state level. At the state level we are expected only to respond to the mentally ill when they do become a risk to themselves or others. But that is a travesty. Just because someone is not a risk to themselves or others, they should be able to get help, they should be able to ask their community for support and we're committed to that.
>> that's right. And this says that we are. And I appreciate that. And I also appreciate your advocacy on behalf of the homeless and many of these people are homeless as well so they really are disadvantaged and need help, multiple kinds of help. Okay. And we do a lot of referrals for follow-up. And sometimes people, even p.e.s., even, it's not a lock-downward and people can come and decide they don't want to be there and they leave. If we think they are in terrible crisis, we can send mobile crisis outreach team and we will do whatever it takes to help those people. Okay. Well, what tifertsz have been going on -- activities have been going on since our funding? First of all, we're pleased to have hired all the staff and that they are all trained. And the full-time deployment, and what I mean by that is the seven days per week deployment started mid-april. We started rolling out pieces of this in February as soon as we could. And about six weeks ago so far we have served 35 individuals in crisis and their families. Since that time, as we're rolling, the steam is starting to build and we're doing a lot of education and advocacy so people will know this exists. And so through June 30th we have provided 359 services to 218 unduplicated individuals. Many of these people we see three to four times is the average to link them and successfully hook them into other services and whatnot. So those are many more calls than 218, but it really helps. And then we have our brochures that have been developed and we've been handing those out and we will be providing you with bawnch of brochures. And anybody in the community that wants those bro showers, if you will call the 454-3521 number at p.e.s. And ask for the brochures, we will certainly provide those to you.
>> repeat that number.
>> 454-3521.
>> okay. Let me ask this question. There's a significant high number of veterans here in this community that are homeless. Is there any connect with the federal government that also may be providing the services to maybe collide with what we're doing since we do also have veterans services attached under h.h.s., do we see a relationship with those veterans that we know that are here within Travis County that are homeless?
>> our veterans officers continue to serve many veterans who have mental health challenges and we do refer them to local services. In some cases they may be able to receive services through the veterans administration offices here or the veterans services clinic, but we find we also have to take advantage of the services provided by p.e.s. And even emcot in torms termsof persons who present at r offices that may be having mental health challenges during the time they may be doing business with us. We try to provide the interventions that are necessary. In terms of those that are homeless, I think the veterans in addition to other persons in our community who are homeless, they find challenges with appropriate housing and I think a part of the plan that the stakeholder group made, I think the city of Austin is looking at some of its housing initiatives I think with the recent bond election, it's probably not recent, it was last year, but some of those, the housing that will be developed in conjunction with that I think a portion will be set aside for residents with mental health challenges and debbie may know more about that.
>> Commissioner Davis, I would like to add to that. Something we're going to face in this community and every community across Texas is the fact if you are a veteran or if you are in the army, air force, marines, one of those branches, there's a place for services for you. But if you are in the national guard or if you are in the reserves, some of the reserve activities, oftentimes there may not be as much a place for u and if we see indeed that we come to a time that some of the people returning from the theater in the middle east come back and they may have post-traumatic stress disorder, that's not one of the covered diagnoses that we do. We treat under our contract so we have possibly a disconnect to meeting those people in their crisis.
>> and also the criteria for meeting post-traumatic stress disorder is
>> [inaudible].
>> so we have -- a lot of returning veterans.
>> thank you.
>> I'm going to call a sherry, the associate director of crisis services. These are composite, examples of people that might use mcot.
>> I have a letter written by the mother of a young woman the crisis center has been serving and sheriff's she wanted to talk about the usefulness of that team has been for her daughter. It speaks to the broader issue of the lack of resources for the people in psychiatric need. And to the particular benefits of having a mobile team. The examples I'm going to talk about are hypothetical but they are in keeping with the kinds of cases that the mobile team is going out to see. The first example is an adult sister who called mcot asking for help for her 20-year-old brother, this is very frequent, 42% of the people who call the mobile team are either a family member or the client themselves. That's the largest referral resource. He had become very suspicious, religious and guarded. He was refusing to go see a psychiatrist. This is typical for the mobile team. These are people who will not seek out services themselves. The mobile doctor -- or in this case our advanced practice nurse went out and he has full prescribing capability, and they made several home visits and the young man began taking his medication as prescribed and his symptoms abated at the same time. We were able to provide education to the young man and to his family about his illness and now he is linked to ongoing crisis services, ongoing psychiatric services.es. This is a very common scenario for the mobile team. The second example is the mother of an adult son with schizophrenia because her son would not come out of his bedroom and was not eating. He had lost a lot of weight. The team went to the son and talked to the son through closed doors for five consecutive days. This has happened in several instances where literally we're talking the person is closeted in their room. Over time he was willing to meet with staff and discuss what was going on. The mobile home team and the son discussed his questions. Help a lot of symptoms of schizophrenia and they helped gain insight into what was happening to them and were in turn able to link him with services and connect the family because the family suffers a great deal also with the national alliance for the mentally ill who is a great resource support for people with mental illness.
>> thank you, sherri.
>> I think you brought some good examples in the letter where people actually are experiencing needing this particular service. How does that person know who to get in touch with? There are examples all over the city and county of persons that have these type of conditions or whatever and they need a referral. How do we deal with that? How is that done to say yes, we do have a service available and yes, we can help you? How do they -- how is that done?
>> well, the mobile team is at least once a week going out and talking to groups like national alliance for the mentally ill. These are groups we've actually met with, distributed brochures, tried to get the information out. Child and family planning partnership. The Austin suicide prevention coalition. We're going to be -- we're slated to go with the city health clinic soon. Let's see. Of course, our services, we've been over to the arch, we've been to access to make sure we are in touch with the people serving homeless and individuals. And also we've been meeting with the police officers and providing information for them about how to contact mcot because, again, they are a first r r r r r r r r r r r r rd somebody to pass off to.
>> exactly.
>> the child and family partnership, in turn, was attended by representatives of the school district, juvenile court, the whole array of kind of who is out there providing services for children. And I don't want to leave out that we are providing services for children. These examples are adults, but we are also providing services for children. Does that answer your question?
>> yes, but I guess my question was this person end up calling you, how do they know who to call? That's what I'm trying to -- the who part of it.
>> they might call 211 and be referred.
>> okay.
>> for example, they might call 911 and be referred. We get referrals. The point you are making, Commissioner Davis, is very important, and that is this is a new service.
>> it is new.
>> that's one reason we're glad you allowed us to take your precious time today, we know how busy you are, but we want people in the community to know about this service.
>> exactly.
>> every venue that we can talk about this in we want to. The
>> [inaudible] partnerships of the c.a.n. Are talking about this.
>> is it on the Travis County website?
>> now he, I don't know if it is.
>> we are not linked to mhmr from our website, but we can do that pretty quickly.
>> I think it's something that's necessary as far as exposure to concerned because of what this young lady is saying and what I heard this morning. It's more of an outreach type and we are here for you. This is brand new, but we're here for you.
>> that's a great idea. We'll take care of that.
>> 472-help. The phone number.
>> frequently calls do come in through that phone number. These are people who call, they don't know really if they are asking for the mobile team, they need help and we decide what is the best response given that their situation is.
>> that's correct.
>> well, the next steps are for us to refine the program operational procedures, and that's an ongoing, continuous quality improvement thing that you do for the rest of the life of the program to ensure that it's as good as we can possibly make it. One of the things that we did was we studied all of the published data about mobile crisis outreach teams in the united states and we also had one of our staff members go and ride along with a mobile crisis outreach team that's been functioning well in the northeast in January, February time period. We've also consulted with the people in houston and other places and we'll continue to do that and we will -- we're considering bringing in some consultants at any time either on phone or in person to give us information and ideas because, you know, we don't want to re-create the wheel, we want to know what they've discovered already and implement what they have discovered that works the best. So we promise you that we will continue to make this the best service possible and we have very good staff, they are very dedicated. They were hand selected and they are the right people for the job. We're going to do what Commissioner Davis is talking about which is continue the advertisement out there so that people know about this. And we also will continue to collect data so that we can evaluate the program and improve it and, of course, since you all know me, you know that's something I have a passion for, and I promise you that any way we can figure out how we can better help these aaaaaaaatatatatatatatatatatatatt that we collect, we will implement. That concludes our presentation formally, but we're here for questions and thank you for your time. I'm sorry. I didn't know sergeant hicks had arrived. Sergeant hicks? Hi there. We're so glad that you are here. Would you like to say a couple words about mcot?
>>
>> [inaudible].
>> we need to get you on the mic, sergeant.
>> I'm on the c.i.t. People and mcot has been a very valuable program for us. We are able to meet the criteria where we can take them and put them in a hospital but they need help. We're able to refer knees people to mcot and they can come out and a lot of these people are willing to accept the help, they just don't want to go get it themselves. This is where the mcot team has been a very valuable. And just a side note, back in '93 through 2000 and we had a team similar to this, p.e.s. Did, and it worked wonderful. We worked hand in hand together and it took -- it met a lot of clients' needs. So it's really a good program.
>> thank you so much for the sheriff's department commitment to this. This isn't strictly part of your mandate and you all have taken this on willingly.
>> she helped us design it. That's for sure.
>> we thank you.
>> I have three questions. First one is made to the doctor who is no, sir listed on the page containing the professionals. So the mcot doctor is paid for -- from another source?
>> uh-huh.
>> but part of the mcot team?
>> yes. We originally.
>> > advanced nurse practitioners can do the same thing and we have had a psychiatrist on the mcot who resigned, but what we have are we have the psychiatrists at p.e.s. So the advanced nurse practitioner works hand in hand with the kris. Right now we're very pleased with the advanced nurse practitioner that we have in the field, but there is always, always medical supervision provided through dr. Norman and his team.
>> the mcot is Travis County's contribution to a multi-part strategy. And how are the other parts coming?
>> they are coming well. It's wonderful to have the beds we can access at seton shoal creek hospital. That is coming along well. Austin-Travis County mhmr we've added a lot of staff to the crisis services at p.e.s. And that whole plethora of services has been pumped up and more people serving on shifts and whatnot and with more advanced training. And the state has recently stepped up and, you know, the $82 million were approved for crisis services and we will be receiving some of that money so that's going to help a lot. And there are just so many other avenues that are working in this plan, this long-term plan. The city is working diligently with us, paul hilgers and his team, to create the assisted living facility we think will help abate some of the bed days and that's in design right now and I'm on that team and it's a good project. Charlie, would you like to speak to this?
>> I think that the state of Texas did, judge, advance a six-program design on crisis redesign for the state of Texas, and Travis County I can proudly say is right out there on the cutting edge of that because we have many of those components either in their infancy or are being developed as we speak right now. And so we do have an issue, we utilize the state hospital heavily in this county, we don't understand why but there's a lot of presentation at our state hospital facility. And so this mobile crisis outreach team is one component that can sit there and literally engage the citizen in their home and hopefully stabilize them with the various treatment sherry and her team will bring forth. So we're very pleased with the development with the seton family as well as the health care district to have the shoal creek facility now vainl available to us so we can sit and divert some of the people from the state hospital into that particular facility that we anticipate might be going home fairly quickly. So it becomes kind of a crisis stabilization process, if you would. And so we're very pleased and we thank you very much, the entire court, for all your support on this because this is a key piece of the entire activity. One thing that we are rolling out and will be training on that -- their crisis redesign will be this hotline with certification and suicidology as well as mobile crisis outreach team. That speaks to some of the leadership that you've taken in this matter.
>> the state invited some of the local leaders to a meeting at which they gave us a fairly stern warning about exceeding our allocation of state beds and they weren't concerned we were doing enough to stay below our allocation. Other communities apparently were doing a better job. Part of our goal is I guess is to try to use our beds and not exceed that amount.
>> we work on that every day. There is a team of professionals there at the center as well as we're working with, for example, one of the things that we like to think that we are doing to help move people through the process and not stay as long in the hospital, we have extended our electronic health record to the physicians at the state facility so they can see what kind of treatment protocols during the in-patient stai. We have ensured their billing departments can understand what third-party payers are out there so that allocation would not have to be utilized so they do find -- and Commissioner Davis, you raised the question about the veterans administration. We're working closely with them to ensure they pay their fair share.
>> I was hoping it would come to that. There needs to be a connect somewhere.
>> and that's part of this whole process is identifying and extending to make it somewhat seams if you would. The in-patient, out-patient, engaging the citizen wherever they need, whether it be on the streets or our various law enforcement agencies or in their homes. I mean I think we have the right blend of things and let's hope this cake bakes up and makes a nice serving at the end of the day.
>> let me taste even to add and I have one more question. We did remind the state that the Travis County allocation had been reduced from 200 down to, like, 57. The population was increasing.
>> thank you for doing that.
>> my last question.
>> yes, sir.
>> is on the summary of activities since funding. There's reference made to 35 individuals in crisis and their families. But you gave us other numbers.
>> this presentation, judge, is prepared by the end of may and since then we have been able to update that statistics and I think dr. Webb and sherri have new numbers for you. Knowing you might want that information.
>> that's good. I appreciate it. So the updated numbers are much larger than 35. 59 and --
>> 359 services to 218 persons through June 30th. And every month that climbs and, of course, that's exactly what we want it to do. It's on a steep incline.
>> so mcot is achieving exactly what we hoped it would.
>> absolutely.
>> judge, I guess it really is good to hear that because, you know, I guess spending a lot of time in committee work really does pay off. And especially when we all get on the same page and with the different entities that were working on this issue. I guess I became familiar with the issue in the early '80s as a constable. I had one of my duties was to go and respond to some of these calls. We weren't trained for that. And so I think the first time the mental health unit was created in Travis County, each of the constables gave up a half position so that we could set up a team that then operated out of the sheriff's office. But we've come a long way. And this is truly, truly a much better way of dealing with the issue. And the other thing that's really good is you go to the people. You don't expect the people to come to you. And that's important. As we deliver this kind of service. Thank you.
>> it truly is. Thank you so much. Appreciate it.
>> [one moment, please, for change in captioners]
>> in terms of one of the challenges I think we face in Travis County and statewide is that I don't know if you recall the recent article in the Austin american-statesman that it discussed the long delay in getting licensure activities for various specialties including psychiatry. I think they had an example of a practice here, a private practice here in Travis County that it took them -- they have been waiting eight months for two of their comrades they want to join them from south carolina, they could not get through the state licensing. Beyond that when you go into some of the various medicare, medicaid type of activities, there's a lot of initiatives going on at the national level, the national provider identification number, different kinds of activities that have taken priority over doing certain legs in that process. So we see sometimes the inability to sit there and build these funding sources for 11 to 12 months. This creates a disconnect and disincentive, if you would, to expand your practice to reach out to the poor or the very rich. I mean if you have a need to present with child psychiatry today, we're told you can't find a place at the door. It's a very difficult activity and so --
>> parents are sending their children as far as utah to get residential placement because there is nothing available here.
>> and if I can answer your question on the pharmaceutical issue and some of the encouraging signs that we see here in the county on that, we were all very pleased at the net result of the medicare part d rollout that came out from the federal government. In that particular initiative it was able to sit there and pick up a lot of the cost of some of the ant -- the the atypicals. Extremely expensive. Upwards of $5.50 for one pill and that's at our cost. You can just imagine what it would cost going to a financial si just as a -- pharmacy as a private citizen. But the medicare part did did allow for a lot of those costs to be sent to that particular pay source and so we have for many years, sherry's staff does a lot of consumer benefits screen to go ensure that our citizens that do present themselves for services we can find out whether they are eligible for medicare or medicaid or any other kinds of pay sources. If we did find that a lot of people that fell into the medicare spectrum were extremely complicated cases and they had a lot of use of those atypicals so we were able to see a large gain there. Additionally the health care district has worked out and extended their long arms to help embrace some of this issue and they have those maishtsz that are joint patients of the clinics and ourselves, we can sit there and piggyback on some of their pricing which is a veterans administration pricing which is extremely beneficial. That's helped tremendously. And then, of course, as dr. Webb mentioned the patients assistance program to those large pharmaceutical companies will indeed allow us to sit there and apply for free medications for many of our patients. And those combination of those three elements seem to have control for right now the pharmaceutical duties. Those costs which had run so rampantly at one time, I think we did an analysis for our board and it is a little over $17 million is being committed just for financial suit cals. We're a $36 million operation on an annual basis that gives perspective of the magnitude of what medications can, but they are critical as these good folks right here to my right would tell you. People will remain in crisis so these are very critical.
>> I would like to do whatever I can to be helpful to see interface between the hospital district, the sheriff's department and other major purchasers of pharmaceuticals within the county to see if we can get coordination to maximize our considerable buying power to run our costs down.
>> thank you very much.
>> thank you all for coming.
>>
>> [inaudible].
>> we need you on the mic, please.
>> when we were going through our process with the pharmacy, that is one of things the consultant is going to help us with and the new pharmacist is look at our buying power for pharmaceuticals.
>> that's wonderful.
>> thanks again.
>> thank you. Appreciate it.
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.
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Wednesday, July 11, 2007, 11:00 AM