Travis County Commissioners Court
September 16, 2008
Item 27
27 is to consider and take appropriate action on the following: a, Travis County health care district's 2008 tax rate, and 27 b Travis County health care district's fiscal year 2009 budget. Good morning.
>> good morning. We have -- I'm trish young, president and ceo of Travis County health care district and we're here to speak about our budget. We have the chair of our budget and finance committee and very involved putting together this budget and mr. Clark and carolyn, our chief financial officer. You have in your package the preliminary budget that was submitted to you earlier in August. We have taken this budget through a public hearing process, we've conducted two public hearings and received feedback. That feedback is in documents in your package. Through the hearing process, no -- no information was received that indicated we would change our budget. In other words, no line items have been changed. What you have in front of you is the preliminary budget adopted by the board inner August which has been adopted by our board last Thursday on November 11th. What you have in front of you is a proposed budget with a tax rate of .0679 cents per hundred dollars of valuation. A total revenue and expenditure budget of 95.1 million, almost 95.2. A capital budget of almost 21.5 million. This budget represents a 6.1% increase over the fiscal year 2008 budget that you approved last year. The budget includes a property tax increase of 5.1 million, which is reflective of the tax rate applied to the current valued -- apraised values, which includes new property that was added to the rolls this past year. Our total budget increase of 6.1% includes a substantial portion of increased funding for service capacity. Of the total increase of 5.5 million, 4.2 million in our-he we have budgeted 4.2 million in service expansion which represents almost the entirety of the tax increase from year to year. I will remind the court that, again, our budget, we roughly receive about two-thirds of our budget through our tax support and then the remainder comes through other sources of funds including federal dollars, tobacco settlement and interest. We have budgeted those items to be relatively constant from the federal and other items to be relatively constant from year to year. I'm happy to entertain any questions that you might have.
>> any questions from the court in.
>> trish, when you say that out of the 5.5 million increase over last year, the 4.2 million of it is four direct services.
>> yes. We have budgeted 4.2 million.
>> that means that your 1.1 whatever it is, is that administrative, is that -- what --
>> it would be a combination of administrative. It also would include transition costs incurred related to the transfer of the health center operations to district support and would reflect our natural cost increases from year to year.
>> would you be able to just basically quantify the number of people that you think that the 4.2 -- what would that be? Would that be an additional 270 people? I realize that number might be hard to identify, but give me some sort of a ballpark.
>> I don't know that I could give you numbers, but I could give you categories. It would reflect increases in payment for specialty care services so that there would be an increased number of visits related to specialty care.
>> special care might be mental health?
>> actually mental health is a separate category, but specialty care could include services for cardiology, dermatology, things of that nature when folks need services beyond primary care. That increase also does include amounts to support additional primary care services. Again, additional encounters which could relate to people already in the system as well as additional folks served over time.
>> would you be able to identify the numbers that perhaps -- in the mental health -- I can give you examples.
>> obviously you know I'm trying to get to that spot because that is something that continues to be asked about how are we -- what are we doing with that part of the community knowing that everybody -- or that a lot of people thought -- at least one of the reasons why there was such a large push for the health care district was some additional funding in that particular arena.
>> that's true. We began funding in-patient mental health services in 2006, continued that through 2008 and 2007. Where we're ending up in 2008 is budget of a little under -- I would say a little over 2 million. We are budgeted to increase that to -- in fiscal year 2009 should you approve this budget today to a total of 5 million. And we will have -- we will have funded a total of 18 beds total. Right now the funding that's currently approved is roughly 10, yes, which is a substantial increase from where we started in 2006. If you recall back then I think we started at half a million. And again, we continue to fund and support the ongoing integrated behavioral health program which is in excess of a million dollars a year. Those total expenditures include the support of the integrated behavioral health program as well as medications to fund patients that we share between the community health care system and the Austin-Travis County mental health and mental retardation system.
>> let me ask you, if somebody were to really push you on, okay, if you wanted to go down -- if you want the budget to go down a little, but you want to keep the $4.2 million in for kind of things we all know that we quite frankly need to spend because the needs continue to grow, would that be possible? I mean if you said, okay, well, that means that, okay, I'm not going to have this person and I'm not going to have that person, but if you didn't have that person would it create a situation where
>> [inaudible] deliver the $4.2 million of extra services?
>> this budget -- I think it's important to point out that the budget as it's currently before you includes us taking $7.5 million out of reserves to fund this budget. Which would include the expansion. So I think it's -- I think it's fair to say if the tax revenue that's currently projected were not to come about, then we would need to reach into those reserves to pay for services. Again, at 7.5 million, that's a couple million more than we budgeted from prior years. And remember also that we're in a year -- years of successive evolving of the district in terms of expansion of its responsibilitier it maturing into what it needs to be to support of the community health operations ab the medical assistance program. Over time we have been using those reserves to pay for the one time costs related to the building of infrastructure as well as the transition of 450-some employees and over 14 locations. So I believe that over in the next couple of years we will also continue to utilize those reserves to fund those transition costs and those one time costs, and then we will level out to a new -- a new sort of base budget in terms of what our operating structure will need to be. I think it's important also to point out that our tax rate, the district started at .07 -- I think it was 3. Back when we started. And we each year --
>> I remember that number.
>> you remember that number. Which was the consolidated rate that was transferred from the city and the county to the district. And every year since then our rate has in fact declined and that is due to a combination of new appraisal values added to the rolls as well as increased appraisal value. The rate continues to be lower from year to year. And I guess the thing that we're all concerned about moving -- looking to the mute is what is the stability of that tax base and should our tax base level out and we remain essentially at an effective tax rate, then we will have to look further and further to those less stable sources of funds, federal dollars, et cetera, to help continue to fund a budget, a current budgeted level of service to the community. Which we already know is insufficient and was part of the reason why the district was created was to attempt to solve some -- and close some of that service delivery gap.
>> how many health care districts are there in the state of Texas? Roughly?
>> oh, my gosh --
>> 50?
>> yeah.
>> and would you venture a guess as to what the tax rate would be if you were to average those 50? It's way beyond, you know, our seven cents.
>> the ones I'm familiar are is major urban districts. Our rate is substantially lower than any other urban district. Dallas is north of 25 cents. Houston is north of 24, 23, 24. Bexar county is --
>> 23, 25.
>> in the 20s.
>> so clearly it's above 20, especially for the urban areas.
>> absolutely. We are roughly -- our district, if you look at, say, the top 10 metropolitan districts, we are probably half of the smaller -- of the larger districts. Does that make sense? And then about a third of the larger districts, of the large metropolitan districts.
>> so the tax rate we're looking at is .0679. Right?
>> yes, sir.
>> and the budget for 2009 would be 95,188,806?
>> yes, sir.
>> okay. Now, has anyone come to give comments on the health care district if if you would come forward. We may need two or three of these seats. We have two available already. If you would come forward we'll be happy to take your testimony.
>> if you would hand awful those to Commissioner Davis, he will pass them down.
>> and we need a copy for the clerk as well.
>> I'll have to make extra copies.
>> would you like me to start, judge?
>> yes, sir.
>> thank you, sir. Good morning, Commissioners.
>> good morning.
>> is this the same thing I received? Because I can give my copy to the clerk because I have a copy.
>> yes, Commissioner. Thank you. Good morning, my name is walt esquivel, here to speak on behalf of the neighborhood association. We are located just northwest of the intersection of braker lane and north lamar in north Austin. We are immediately adjacent to the proposed site of the clinic. I'll try and be as brief as possible. How much time do I have, judge?
>> be as brief as possible.
>> [laughter]
>> walt, let me ask you a question.
>> yes, sir.
>> are you going to address us with budget as to how it relates -- I mean because I think there are a number of people in this community that understand the resistance that the neighborhood has to the health care district, at least the transition of this clinic. Is -- is your testimony -- should I be listening to the testimony questioning the budget or should I be lending an ear to the budget as to how it relates to y'all's opposition to the site location of this clinic?
>> that's an excellent question, Commissioner. I think that the two are inex trickably linked. The reason we're here before the county Commissioners is because there are line items in the health care district's proposed f.y. 2009 budget that includes items specifically for the clinic on braker lane. We are here specifically to address issues that deal with the clinic. However, obviously because you are deciding today presumably on the health care district's budget, those line items are attached. Does that answer your question?
>> I think so. Thanks, paul.
>> [one moment, please, for change in captioners] subject to approval by the Travis County Commissioner kwort court. Strip out funding from the tchd's f combrshgs -- fy 09 budget. To strik out and decline the budget because of sflagship until such time of a more detailed process north side clin clinic has been constructed. Likewise more detailed analysis regarding the most health care clinic at 7112. Hub and flagship are words used to provide both community care services department or the city of Austin while in various meetings on August 26th. We had previously not heard it as a hub and -- there is some back of material toerl my let hear the comes from the federal government and they do include the area around the northeast Austin clinic at 183 and mainer as east Austin. So this includes area that's basically east of I 35 when I say east Austin. This project is in the wrong location to service the Austin community. It's inappropriate for residential area. Tchd staff's original recommendation and we short started the open record's review process, there were many sights south of 183. They did have one recommendation and it was the 18301 commercial site which we feel is more appropriate. This new comprehensive neighborhood and redevelopment plan includes appropriate within one mile of the proposed side. Includes north bar net gateway project on the proposed site. It is your responsibility not to rubber stamp them without detailed analysis. Otherwise why even have tccc approve tchd's prujt? Here are a few more detailed reason toosz why we are opposed to line items. Now, obviously based on today's clarification t entire budget tchd's budget which includings funding for clinic. Number one lack of due process. No community input into the site selection criteria. The health care district might lead lade you to believe that has been input, but that's only for things like the fence. What height do you want the fence to be, what color do you want the fence to be; do you want entrancings and exits on Austin park or parkfield lane. These are all things dealing specifically with the sight that they already chose without any input from the community. Our neighborhoods as well as the northeast community tshg site of the current clinic that the slated to close sometime after the clinic on breaker lane opens were not engage witness stand a reasonable amount of time to provide feedback on the closing of the existing clinic the Commissioner Davis' durs diction. Neighborhood opposed to the closure of the northeast clinic. This is a disstoefrs that community and has had no process in the process. Underrepresented families of northeast Austin will have to travel additional miles. I'd like to ad that we have met with the university hills neighborhood association and the north east clinic is within their boundaries. One of their resolution is that they would like a detailed analysis that they would like to get their hands on before any decisions are made for their clinic to be closed. The contact, you can speak with is president al weber. The sight collection selection process was done without oversight of any social service agencies or the public. We're the public, we pay for the health care district. We deserve a little bit of respect in that regard. This lack of accountability is inexcusable and quite frankly disappointing. Number four, the tct-h d-day ta is flawed and the statistics were slanted to win approval. The graph presented were deceptive and did not present the whole truth. If the federal and state government use census tracts why is it that t drshgs hd chose to use zip codes? Well census tracks as provided in the attachment clearly showed 1210 wooes breaker lane is not central. Anyone who believes otherwise is either naive or has a hidden motive. Tchd has lost its credibility and will need to invite the public and and independent third party to do evaluation of the data before it will be accept bid the public. Number five, part of the attachment. It clearly identified five areas in Travis County under served by primary care. East Austin that is slated for closure, east Austin is identified while interestingly, north Austin is not. Why take health care access away from an underserved area and spend $18 million on an area that isn't underserved? Number six, sit clear from the attachment that the census track from the provide proposed site at 1210 west breaker lane is not health shortage area. While the clinic identified for closure is. So here we have north Austin clinic, an asian that is not a hipsa and northeast identified as hpsi based on current data from the federal government using census track. Number ashth funding an $18 million building project without citizen input and independent review is irresponsibility and suspicious. Tchd needs to be trance parent on the selection cry tier and others impacting a project of this mag any constitute. The Commissionerer's court should direct the district to restart this process with an open agenda or at the very least, I'm going to omit that comment because you cannot strip fy 09 funding. Number eight with $70 million reserves in the fy 09 budget, by the way that's about 75% the way I understand it of the revenues and Commissioner Gomez --
>> (indiscernible).
>> and I believe that you mentioned that's you're understanding as to the reserves bag so high was because of understandably things that allow the health care district to receive favorable bond ratings and things of that nature.
>> well if they get to that point, but I think the other reason was that they're on the Travis County's balance sheet so they needed to have reserves in this to make sure if an emergency came up then that emergency would be handled.
>> yes, ma'am. I believe the percentage you sited was 11%.
>> I think that maybe what we recommend to the hospital district, but I think they can, you know, change that number, add a little bit more or certainly, I think what we would recommend is 11%.
>> yes, ma'am. I believe the health care district, Travis County, operates on I believe 150 days. I'm not a financial expert but if they're proposed fy 09 budget is $95 million, I think would that $50 million but cover any operating reserve that a health care district likes to operate under. I could be wrong but we're going to need clarification as to why they have -- it's north of $70 million in the fy 09 proposed budget. Their revenues submitted at $75 million. I have people coming and asking if the surpluses of this site continue can we expect a tax rebate? It's like when you pay for to the federal government, should we be getting back money from the health care district. It's our money after all. Number nine the volters are looking to you to each of you, all five of you collectively to provide leadership in a long-term vision for this entity. The closure of the northeast clinic and the inadequate site selection process does not need mete our expectation of leadership we need from a taxing entity and a health care provider. Please direct tchd to restart the process and save the northeast clinic. You probably don't have authority to redirect the health care district to restart the process which is what we've been asking for, but you do have authority to send the budget back to them so that they can rework it and take out the line items that do pertain specifically to the health care clinic and that's what we're asking here today. I'd like to close by saying that there isn't a single person I've talked to no n north and east Austin that doesn't support the health care clinic. I voted for the creation of the clinic the 2004 and I strongly support their mission which is to provide indigent health care services. As a hispanic, I hope that that mission continues. Ki assure that if that if any of you take a drive to north Austin where I'll be happy to give you a tour of my neighborhood, the majority of us are not going to be able to benefit from the services that the health care district provides. Commissioner eckhardt you have sent various e-mails to people that live in my neighborhood or in north Austin stating that the proposed site is central to the community of patients that the health care district will be serving, and I beg to differ, man ma'am. I have given you data, you asked for data, I've gifsh it to you. If you look at the enclosures, you will see that there is clear evidence that shows the proposed site is not ken central to Travis County's indigent needs to north Austin, far from it.
>> the data you've provided me, I've taken a look at it and it's by census tract which is much more finely pavrjed than zip code and it's been helpful. Do find that it actually corroborates with the zip code information was indicating that there are upwards of 10,000 people who are within a two-mile radius of that location who, um, would be patients of this clinic.
>> so why not put the clinic where the patients are?
>> within two miles of 10,000 people in the 78758 and 78753 zip code by census track according to your data.
>> but you're forgetting east Austin. We're putting a clinic, ma'am, where --
>> we're trying to site a clinic to aid individuals in accessing health care, and I think that if you're siting a clinic that has the potential to serve 10,000 people that live within a two mile radius of it, that that's fairly appropriate siting.
>> I'd like to remind the court that there are three city of Austin housing authority complexing locating close to north la mar and 183. If, if you were to believe that 1210 waste breaker lane is an appropriate location, Commissioner eckhardt, I'd still beg to differ. The data clearly shows at 1210 waste breaker lane is not central, based on the census track information which I kept asking the health care driblg district for more detailed data. I had to find it on my own. I don't get paid. Another issue that we have, quite frankly with the health care district's budget is some of the salary information that we've come across. It's come to our attention that the city manager gets paid approximately $242,000 for a $2.5 billion budget while the president ceo of the health care district makes $245,000 a year for a $95 million revenues in budget. There seems to be discrepancies there. I know city council members make 55-57 thousand dollars, mayor somewhere in the 60s, so, you know, am bring frankly very aware of the months of waiting time because I've talked to patients at the northeast Austin clinic. They have to wait months for an appointment, and yet we have these terms being thrown about, a flagship clinic at the 1210 waste breaker lane location, and I think from what I've been told from many people, we have excessive salaries in the proposed fy 09 budget. I did little research. I found out that county Commissioners don't make that much either. I think in the proposaled budget it's considerably under$100,000. I know the judge make a little bit more, but it's nowhere near the amount that we're paying the salaries of the health care clinic. There's all kinds of issues. I'd like just like the close and say I appreciate your time and consideration. We have made a diligent effort to bring to the attention of the court the reason why is we're opposed. And I think they're still valid. I think that there are lots of properties closer to 183 and north lamar that we would be very happy to work in the health care district in identifying for future clinic needs and we'd also like to work closely with the health care district in identifying what to do about east Austin because that really is an area that is going to be left behind. We're going to have people in east Austin without health care having to drive eight miles or more, it's eight miles roughly from the clinic at 183 and mainer to the proposed sight. Eight miles. And the northeast Austin clinic presumably serves east Austin. So we have people that are without cars, having to get on buses and make multiple transfers and we've been told that a large percentage of the health care clinic's clientele being hispanic myself, they're hispanic women. They're probably receiving prenatal, post natal care, they probably have children, and I am appalled that we're going make these people who have little to no voice before you, before the health care district or before the city council, we're going to make those people have to drive all these miles and/or take multiple bus transfers. So thank you very much for your time. If you have any questions I'd be happy --
>> thanks so much.
>> any comments?
>> yes. Good morning, my name is (indiscernible), I am a Travis County resident. I'm a taxpayer, I'm a voter, I'm hispanic, I'm a single mother, and I live within 200 feet of the proposed site. And I'd like to say that I support the mission of the Travis County health district. I also support the vision and the mission of the community care services department which will soon be part of the county, and part per their web site they state that their vision is to work with the community as peers with open eyes and a responsible attitude to provide the right care at the right time at the right place. The project at breaker lane is not the right place. I oppose the funding for the proposed clinic at breaker lane for several reasons. First, the lack of due process. Also the lack of accountability to our representatives and the lack of transparency through this process. I oppose the project because sit not in line with the vision that the voters had when they approved the health care district which was a network of neighborhood clinics designed to serve specific areas of the county. Much like our library system or our neighborhood recreational centers. Not a regional complex as propose bid Travis County's health district for the breaker lane site. I oppose this project because it continuers the expense of the northeast Austin community. I believe that the closing of the spring deal clinic is an injustice to the northeast Austin community, especially the to hispanic and minority community in that area which buy bithe way has not been properly informed of the closure of the clinic. Just last Wednesday I personally called the nurses, the school nurses at lbj high school, which is across the street from the clinic (indiscernible) middle school and elementary school. I spoke to them and asked them do, you know about the northeast clinic. They told me they did and they referred many patient, families around children to those clinic. When I informed them that it was scheduled to be closed, they were surprised. They said why. I said exactly is what we want to know, why? The proposed location at breaker lane is grossly inconvenient for patients traveling by buses who will have to transfer twice to get to that location. Patients traveling by car will have to travel eight additional miles. I also oppose the complex at breaker because it's not the in best location to serve the central Austin community, especially minority community of that area, which is located closer to lamar and run berg and 183. The da that that was used to select this site was incomplete. The assumptions were flawed and conclusions to select this site was prong wrong. A properer analysis would have blot plotted all the map, residents and found the sight closest to the epicenter for tor closest place near the spot. Instead they started with the closest site and drew circles around that site to see how many patients would be in that tachment area. The true need of the community is better access to health care, not to create barriers. Currently the patients wait weeks for payments. Patientses call many times before getting an appointment and some have personally told me the only way they can get an appointment is to personally go to a clinic to request the appointment and then come back for that appointment at later date. In is not right. Our tax dollars should be spent for health care, for provider services to the people that need it. So provide staff to care for these people, not for new buildings. So I implore you not to fund this. Instead, please take a step back, hire an independent third party consultant. Do an analysis. Please take into consideration the other pressures to the area, for example t north burnett gateway in our consideration to select an appropriate site for this clinic. Finally, I just want to say that as a resident of gray is I woods neighborhood association within 200 feet of this site t first time that the district approached me directly to inform me that they would be neighbors was on September 3rd, when I received a letter from an inany viation only meeting to talk to the property owners who would be affect bid this site. Tonight, at the zoning commission's hearing is when it was scheduled to be heard. I would have have even been invited or contacted by the health district had it not been for the fact that they needed zoning approval to get this project done. The lack of due process and community input is shameful. This project should have been brought to the citizens of Travis County a year ago, and we should have had time to all explore reasonable solutions to finding the proper location for a new site and the best use of the northeast site.
>> any questions?
>> I just have -- no not of her. Thank you so much.
>> you're welcome.
>> I guess one thing that just comes to mind is the no matter who it is that we if we're a public entity that we would address due process. And we've grappled here at the county with notification of everyone who's involve sod that we can bring all of the parties to the table and be fully informed. Um, so those two concerns seem to kind of come of the surface, um, and I'm wondering, the other thing that is bother some is a wait period. Um, I think our folks who will depend on the health care district, I think it's just purely, um, respect for their dignity that a wait period not be so long, and if that can be addressed some how, that's going to be important to me. And these are not new issues that around Travis County, we've dealt with these issues for a long, long time. And I wonder if there is a possibility of voluntarily considering or concerning the process at which we arrive at the need for a clinic. I've been getting a lot of e-mails about this, and while I can't strip any or put on hold any of those expenditures, it seems to me like we would all benefit from voluntarily going through a process where we can say, let's start over. Is that possible?
>> I think we'd like to if you would allow us Commissioner to respond some of the entire presentation.
>> sure.
>> I know ms. Young will have the details, but I think we take issue with several of the facts. We think stopping and restarting would be irresponsible from the standpoint of our mission. There are delays in our being able to take care of patients, that's what the new clinic is all about and is intended to address. Ms. Young can address the details, but I want you to know that do not believe that process has been abused. I believe there's been ample opportunity, which you'll hear about for us to receive input from the neighborhood. We have been consistently willing to try to address that input. I believe that the siting of the clinic was extremely responsible, that the process of siting it was part of an evaluation of every potential site that was on the market. We can't just go out and grab a bees piece of property, we have to look at what pieces of property are available, and we, in fact, did look at another piece of property and make an offer on it and we were not able to buy it. We need to move forward with the project, and I think the board is of the view that the staff has conducted itself appropriately and that the site selection has been appropriate. And I think what you're here haring from these people and I respect their view is really not about east Austin, it's about the fact that they do not want this project at this particular location, and I think it has to do with the mission that we have and that they do not want the people that come to that clinic to be in their neighborhood. It's not about east Austin. I think ms. Young can talk to you about why we selected the site that we did.
>> well, it is about east Austin. Was Commissioner Davis brought into the process of finding a new site or maybe improving the surnt site.
>> if you will allow me an opportunity to maybe start from the beginning and remember that we have been before you discussing this matter over the years. Let's start with the discussion of the northeast Austin clinic as one large health center in a 14 clinic system. We have been talking with you for several years, since the creation of the district about wait times. This is nothing new. That was why we were created. How were we going to address the gaps in services? We have been talking specifically about northeast because it is in fact the largest health center receiving the largest demand in terms of patients trying to access that center. That facility has outgrown its size. That facility is inadequate from both its layout as well as construction and operations. You've been made aware of issues about the facility, issues with heating, air-conditioning, gas leaks etc. Those matters have been addressed over the year bis the city of Austin as beast best they can under the lease they have for thar that property. That lease renewal came up several years ago. That began the process of, do we stay in that community health center? Do we attempt to gut it and rebuild? Can it be expanded because we've already said it's too small. It does not have enough providers to take care of the patients that are seeks services there. That evaluation showed it would not be economically feasible nor from a stewardship perspective to invest millions of dollars to gut it, rebuild it, try to expand it as much as could be expanded into a property that the district does not own. After however many years have already been invested in that property through rental taiment payments. So the decision was made to find a new facility. And from the beginning, that process has been based on data. We first thing we do is look ns
>> [%so!ed9no carrierringconnectb we have been working with Travis County representatives to expand the space that's available there so that we can put more providers there. Two years ago a new health center was opened at the ak black location just east of I 35 in the saint john's area just south of 183. That was in direct response so the additional demand that's being placed in the north center, northeast Austin corridor. We're in thes of expand panding that building and adding more providers. We're talking about relocation of health center. We're not closing northeast, we're relocating the services. We're doubling the size. Patient wait times are unacceptable. We cannot put more bodies into a building that than that building is laid out to handle. You cannot put doctors on top of each other or nurses on opentop of each other. They have to have exam rooms and offices. We cannot squeeze more doctors in the facilities. We need to expand the physical facilities. The data analysis showed and want to address the census analysis issue. If you're trying to figure out where you might want to place a new clinic, where you're looking to start a new service in a community, census tracts are important. We're a community health care system that's fwhn existence since the 70s. We know our patients, we know where they live and we know what the change of the demand and where that's been occurring over the years. This is not the first expansion that the district has undertake ton support the community health center's service delivery. We're about to open a clinic in south oust at I 35 at the end of this month that meed metes the growing demand that's taking place in south Austin, southwest and southeast Austin. We're about to take over a location located adjacent to the the brackenridge hospital or university center brackenridge, that location will provide additional access. The north central community health center is a relocation project and an expansion of services that are available currently in order east, but now severing north central.
>> let me ask you something. Did I hear you say that you're not closing the northeast clinic?
>> we are relocating that clinic. Y the services? But you are closing.
>> the location will not be there once the new location is built and expanded and over a period of transition which will occur over 6 montes to a year t providers will be transitioned into the new facility.
>> t patients that go to northeast Austin have in fact been notified. They will continue. This project will not be completed until probable 2010. There's a long lead time in terms of building the building and working with patients to understand what their options are no terms of where they would like to receive services in this system. They have access to any community health system in our system. We have patients because of the command in various geographic air glas this county, because a person lives in northeast Austin or south Austin doesn't mean that's necessarily where they get services. Optimally, that's where we want them to get services. For example, we have folks that live in north central Austin that come to the south Austin clinic because there happens to be a provider that could take a patient on that particular cay.
>> we have people that live in jones town that come.
>> that's correct. We have need all over the community. I think it's fair to say since these facilities have been in place for so long and many of these community health centers were sited decades ago and built decades ago that that does not necessarily reflect where the people live and work in this community today. So part of our responsibility as we move forward and we build new community health center locations such as you did when you built the new flugerville health center, you looked to see where the growth was happening and where the and in would be in the future, you matched that. We have that same responsibility and we will continue do that. In this is only one part of expansion. There are multiple areas of expansion. . The district is contracting with other providers in the community to have increase access. We are working with other providers who are willing to open additional offices, physician offices, so we can funnel patients in that direction, so we can address the issue of wait times. If we cannot create the capacity within the community health center we're con tracking it outside. We have a long lee time on this project and you know today's wait times are long. We have to do something. We cannot sit back and wait and let this community health center stay there in its current capacity and not address the and in for growth that we are facing. There are a couple of things I also want to notify or to mention tonight in terms of there have been several references made to the fact that there are no patients to be serve fwhid location in these neighbor hootds. This community health center is designed to sever an area. It is not designed to serve north park estates alone, lacey woods alone. It is designed to serve an area. If 60% of the patients live wan radius of this location, they're already traveling seven to eight miles to get their health care. We've surveyed our patients. We know 70% of them have their own private transportation and roughly 30% use public transportation or they use their own network to access care in our community health centers. We know that this new location is a major touch point far north, south and east/west location. There are few locations in this community where you have intersection of two routs. Both of those routes then also have koe knickss with two other major routes the 1 l and 1 m. This is a more ideally location for bus roupts than the current location is. So there's an improvement. We also have ability the work with cap metro to further improve that if possible. We have the ability to work with cap metro on location of bus stops, etc. I want to address the issue of reserves because Commissioner, you did bring up the discussion that's been had with the court with the district over time. The district's reserve policies were established in the initial year of the district operations by the board of managers. It is set per policy, it is reviewed annually by both budget and finance committee and the board itself and that policy is tu stu died here. Our policy requires that we have 150 days cash on hand to address any loss of federal funding that might occur which is a third of our budget and also any other emergencies that would occur. We do have great benefit of reserves that are around $70 million that point in time. Those reserves are not made up of just tax dollars. Those represent federal funds that the district received in its second year of operations by virtue of reconciliation of a prior year. That was a one-time fund in excess of $36 million was received in one year as a payment of prior year services under disproportionate share. That was wonderful gift to us, but it represents one-time money. If we spend it all in one year and we increase our service levels and rely on that money to fund those service level, then we don't have funds in the following year to pay for them. Those funds have been considered one-time and we have been using these jew dirsly to pay for one-time cost. This community center is a perfect example. So we have been very judicious in the use of those one-time reserves and know full well they'll be expended over time. This is only one clinic replacement over time. We're inheriting building that are decades old. Commissioner Daugherty you mentioned the jones clinic which was closed due to its condition. Dell valley is on our list. We know our providers are delivering health care out of mobile units. We have this need all over the community. You built the community health center in oak hill in the recent years. You built that facility with expansion capability and we're using that. We have needings over this entire community, this north central location, and want to speak to mr. Eskavel. It's not a negative connotation. . The term hub refers to the concept which we have today that we have larger facilities in the larger concentrations of people and we've had smaller facilities in the smaller areas. Hub refers to a grouping of facilities. For example, the northeast Austin community health center has historically had close relationships with the mainer cliner and flugerville clinic. When a patient can't get into wurn, it can be referred to another. So that is a term that's how we operate, that's how we utilize the resources we have to meet the needs of the patients. When we use the term flagship, we use that in a very proud way to tell you that we are building a clinic that will be state-of-the-art. Sit new. Other than the flugerville community health senor -- center, our facilities are old, they are aging and not necessarily in the right location. We intend to build a facility that takes advantage of current technology, that takes advantage of current building standards to allow us to build a facility that will serve well into the future. If this northeast community health center was built, I think over 15 years ago and it's outgrown the demand for it. We have to build a fail fa silt that's going meet the needs of the future and not just of today. I twoobt speak to the notification process. The first time this lady was referred to was September 3rd. This property is not part of a register's neighborhood plan through the city of Austin registered neighborhood plan process. Therefore it is not part of a register'd neighborhood plan. The zoning process that takes place because it's not part of the a registered plan it goes through the zoning and platting commission for a request to change the zoning, which we have requested. The city zoning staff is responsible for notifying property owners, they notify everyone within 500 feet thap that note tie kwags tack lace on June 17th. We have conducted four community meetings, two meetings were held at the district's location, our officers on 11 caesar cha vez. One was in June and one in July. We held two large community meetings situated in the saint john's episcopal church across the street from this property and there was a wider dris bugs among easy those meetings. Mr. Eskavel wanted to host a meeting between four neighborhood associations, walnut creek, north park estate, gray is I woods and naka. Mayor protem agreed to facility and set thaup meeting, which he did. Mayor protem, council member moreson and council member coal listened to the meeting. Representatives from north park estates, wall net nut greek and gray is I woods did attend. Representatives of naka did not attend the meeting. We were invited to speak to the naka association in late August which we did. We made a presentation to their membership. Ms. Linda, messia attended that meeting an voiced their opposition to the project. A vote was take and a neighborhood voted 16 for and 13 against the project. My understanding, we understood that naka was going to be originally at the meeting that was fa sl dated by mayor protem but they dpid not attend that meeting. We have invited the neighborhood associations to meet with us individually. There was discussion with mr. Eskovel, he indicated he would prefer to meet with us after the zoning hearing tomorrow. Our zoning case is actually a request has been made to postpone it and we'll be discussing that with the zenning commission tonight. It's possible that after that then maybe there can be further discussions with the neighborhood. I need to make clear that we have been trying to engage these neighborhoods in cushion about the project. What we have been encountering from those who have been very vocal publicly is that they wish that the location be placed else with. They believe our process was flawed. We believe a process over 18 months to two years in which we had numerous meetings of our committees, of the fqhc board, of the discussions that we had hear at Commissioner's court about our plan toss replace that combli clinic. We've had numerous public meetings where there this has been discussed. We, in fact, did attempt to purchase a property, um, in as a first round of property location. That process did not result in a successful sale. The property owner chose not to accept our offer. That caused us to go back out and look at an additional set of properties. The first set that we looked at, I think, were somewhere, I don't have it in front of me, but probably somewhere in excess of eight to nine different locations that resulted in a recommendation to purchase this albertson's at 183 and olon. We did attempt, it fell through. We went back through a process that resulted in us looking at 17 additional sites. We looked at numerous sites and with numerous criteria in terms of whether that was tlavs sfalt there that could be purchased and renovated at appropriate cost and manner. We looked at sites that were land only. We had criteria that involved size, location, condition, and facility. That ultimately resulted in the selection of this property. We did not select this problem property and then work the numbers around it. This was selected as a result of the process we undertook over a very extended period of time. Um, I think it's -- I think also I think it's probably not fair to be talking to other members of the community about the ro closing of the northeast clinic in term ofgs informing them of that when those are relationships that the community health centers have with those entities in the community. We are not closing northeast health center and we will be relocating it. There will be a notification process over the next coming years with patients thp. There will be with our community partners that we work with on a continual basis. So that there's sufficient lee lade time in understanding where the new services will be and how we'll connect with them. I'm going stop there.
>> I think that serves my point in asking the questions just to make sure we had the information on the table while the two parties who are raising questions about it are here. And, um, I haven't been involved in the process and normally, I think I get communicated with by you and other members of the board when it concerns something in my precinct because it's essential that we know what's going on. We're going get the e-mails and calls and they're going to be all kinds of things and it's hard to, um, respond to questions about a process that I know nothing about. I'm not a member of the board of managers or of the health care district. The budget has to come through here. Mainly because of the legislation creating or even making it possible for us to have an election on this, and so I don't understand that part of the process, but, you know, it's there and we deal with it. But, you know, that's why I thought it was important to also ask you if you had had, you know, some, all of this business is about relationships. We have to have communicate, we have to coordinate and collaborate because it just simply makes for a better process. And so, um, and then you have the question, you have the answers to some of the questions that the members of the public will raise, and certainly don't, I'm not there with you. The only thing i, you know, rely on are phone calls and what I read in the paper and I try to be careful to evaluate what I read in the paper with reality, and because it's, I don't want to get in into the political evaluations of an issue, and when it's much more important for us to all communicate, coordinate and collaborate with each other when we make these kinds of decisions that we know this community is very, um, very alert about. And so my understanding then is that the process down at the zoning board has been postponed tonight?
>> no, there is a discussion tonight to postpone the zoning hearing to alater date.
>> okay. So what does that do? Does that give you additional time to continue talking about your reasoning for arrive at this decision?
>> well Commissioner, the zoning process is a land use and exactability process. The zoning and platting commission will only be looking at the merits of the zoning request. They'll not be looking at the merits of whether the clinic is in this right location or not. They're simply at zoning and platting commission who will make a recommendation to the city council as to whether a change in the zoning is appropriate. We have already received a recommendation from the city zoning staff for a zoning recommendation change of neighborhood office to limited office which would then address the use of our of this property for our purposes. Um, the process that's handled by the city if there are both the applicant, who's requesting the zoning change, which is the district, as well as anyone who is opposed to the zoning change, they have the ability to request a postponement, at least one time. The district, in fact, we were scheduled to have our zoning case heard in August. We requested that it be postponed a month so that we would have additional time to engage the members of the community who are directly surrounding this property so we could have dialogue about our project. The only dialogue we've been able to have is reopen the process and go find another location. We continue, we persist in trying to have dialogue with individuals about this project. And I would like to also mention that we do have individuals contacting us telling us they in fact support of this product. They do believe that there is need in their community and surrounding communities, particularly, we receive comments from individuals who are medicare eligible, have difficult with doctors that will not take care of them or accept their medicare coverage. That's a huge and growing need in our community. We've already identified people in these surrounding neighborhoods that we have placed into service in our community health centers because thekdz not get access to a doctor today. So we know there's need there, we know there are people that are in support of this project and they tell us they're in support of this project. And so it's not just, it's been represented that this entire community is against this and I think that is not a fair representation of all the people that live in is surrounding areas. There are people that discuss with us their support. Those folks have came to our first public hearing, it was not reported in the newspaper, but they came tour first public hearing and spoke in support of the community health center. Folks that came to our second hearing and spoke against it were quoted if the newspaper. But I think it's important to know that both have come forwand and spoke for both.
>> the s the purchase of the property predicated on the zoning being okayed, so you all do have the ability to pull out of this deal without any monetary reprodiscussion kugss.
>> there would be a penalty. There's aerns money on this contract.
>> and what kind of earnest money is subject?
>> I think it's probably 21, $25,000, something of that nature.
>> where are you in terms of the (indiscernible) legal requirements as to advertising tax rate?
>> yes, sir. We have all of our notices have gone out according to the prescribed process. The hearing have been held t board took action last Thursday, so the process has been followed. All notifications have gone out.
>> okay. Any other questions?
>> I had a quick comment. Ms. Brown said public hearings, I don't think it was a public hearing. Public hearings usually are advertised in advance and priored to initiation of a project, not to rubber stamp it or to rally the neighborhood to support them. The meetings that ms. Brown mentioned earlier did in fact happen but they were at the y q of the folks that came from the community asking for more information. So the district actually asked us, where would you like to meet because they were so far out of touch with where they were planning to put this neighborhood. Now I think it's interesting that their original location on 183 and olon. Some how they did analysis to arrive at that location and place a bid on that property. That location is two to three miles south of the location they're talking about today. So the four miles that ms. Trish young mentioned, that's centered around their original location t 183, olon. That's the site. I personally shop at the heb at the lamar and run berg. That's lo t location that's needed. I took the bus at lamar at lung burg, I maed mean 183 and lamar. That's the community that needs your services and with $18 million on the table I don't understand why we can't have two clinics. One in the northeast area to serve that location and one in a centrally located area that's familiar to the people that are going to use it near the 183/lamar area. I think that there's been a lot of misrepresentation in this discussion here. For example, the flugerville, my children go to that school district, so it standing to reason that my community and my neighbors would be serviced at the flugerville clinic, not at the northeast clinic. There has a lot of travel from clinic to clinic because people go to wherever they can get the first appointment, so there's a great need. But the solution is to put clinics or open small offices like ms. Brown as mentioned before in specific areas of the town to help people get the care they need. The other thing that I think that was kind of misrepresented is that according to city data, the fastest growing zip codes are the 7853 zip code which is is east of 35. Palmer, breaker, east. So I think there's still a lot of room for study and dialogue, ms. Gomez, and I think a time out is appropriate. Matter of fact, the district does not have to exercise their land contract, I think, until December. So there is more time, and they currently have a lease on the northeast building for at least five years, I believe. So it's not this urgency to make the decision today. We're talking $18 billion here of our tax dollars. I think we can take a --
>> but it is urgent for us to move on the budget. That time is not unlimited. Now I don't know that it's possible for us to get unanimity on this. District proposed is 27 a a tax rate of.7609 and my motion is to approve it.
>> second.
>> is it too late to offer a few additional comments?
>> the reason it is is we have four residents who have come down on another item that we said we'd call up on 11:00. We've received e-mails, comments, there's nothing new and different. Either we approve this or we don't.
>> I just wanted to state for the record that there are comments that have been made here today by the health care district which are misleading.
>> that doesn't surprise me at all. Y'all have not been able to get together on it and I don't know we could say anything magical to make that happen.
>> well judge -- Commissioner Davis.
>> I'm going o to have to ob stain on the vote with relationship of my wife. I'm gloing to have so to ob stain because of those reasons but I'd like to say this. I did receive I think an e-mail from you -- how do you say your name, and I think also you ms. Lucas, did y'all both? The point is I did receive those two e-mails, and I northeast Austin clinic is in precinct one, and I looked as far as phone calls and I had my staff do all the research, and there is no trail of phone logs nor e-mails opposing this regional clinic. And, of course it appears that the folks that live adjacent to this, you got university hills, university bluff, pecan springs lbj neighborhood association, collin park, craigwood and the list goes on and on. All around the proximity of this particular clinic, vi not received from those neighborhood association leaders suggesting that this regional clinic wouldn't be something appropriate. Now of course I'm going to abtan and I stated the reasons why I'm doing that, but I want to make sure the record shows that what I'm saying here is what it is, and of course just receiving e-mails from you and not the others that in the area that I represent, it says a lot.
>> yes, sir.
>> and I'm going the end it right there.
>> on that issue --
>> Commissioner Gomez.
>> I think it's fair to say that the tax rate is a reasonable tax rate, and that the mission of the health care district is one that, that a lot of people voted for. So it became a reality, but there's no doubt that this is a public entity. It collects taxes from all of the homeowners and renters in this area. So it is a public entity and you're going to have input from various members of our citizens, and I think that's to be expected. And I think it needs to be dealt with, and so I think the adoption of the tax rate and the budget is one issue, but I think we can also continue addressing those issues that are raised by citizens because you are a public entity and all of us have to go through this process of public hearings, meeting with neighborhoods, sometimes, I mean we're grappling with it as well. We have to meet with citizens even if we don't have to notify them, and it is just part of the public process.
>> judge, may i? I'll be very brief, I'm sorry. Just in response so y'all having come here today, all of you having come here today, we all, every single one of us and in all of the e-mail correspondence I've had both with members of the in the health community as well as members in the neighborhood, everyone down to the last man and woman has said we support the goals of the health care district and we recognize the, um, urgency of providing health care in our community considering that we as a state have one of the highest uninsured rates, very high underinsured rate, an aging population and an economic downturn which is also exerting pressure on what we all recognize as our goal here. So as elected representatives, we have to weed in their environment and on these kinds of decisions, some people will not be happy with where we're leading. But I have reviewed the process and I have reviewed the data, and I've reviewed outside data provided to me, and to satisfy myself that there was no gross negligence on the part of our board members that we appoint that this body appoints, I have found no gross negligence, reasonable minds can differ on the data, but at base the census data that you provided to me from the icc corroborates the zip code data that was provided to me by the health care district that this is an appropriate location. I have also reviewed the external process, and I agree with the neighbors that it was not as transparent as it could have been, and that the external process of engaging the neighbors was late. It has been ro bust since it was initiated, but it was late. However, ki not allow the perfect to be the enemy of the good here. This is a good process and it has been, it is a good proposed location. I do wish that it had been more transparent and the neighborhood conversation had been more robust earlier, but the process in what has come out of the process is good, and does serve what we all recognize as our goal.
>> motion is to approve the proposed tax rate of.0679. All in favor. Commissioner eckhardt, commission Commissioner Daugherty, Commissioner Gomez goes voting Commissioner. -- I prove approval.
>> second.
>> discussion?
>> all in favor? Commissioners goes measure, Daugherty, eckhardt truly vote in favor, Commissioner daifrs abstains. Thank y'all very much for coming down.
>> judge --
>> we've already approved 21.
>> as opposed to pulling up 23 right now, which I know probably was your intention, I have spoken with the applicants, and I think, I mean I don't want to try to do this in 20 minutes because I want there to be enough time for there to be -- I want there to be enough time for there to be a good explanation of what's going on with this because I think that this is important enough in its detailed enough that we're going to need more than 20 minutes, and I know that y'all, we will break at noon and I don't want you to have to feel like that staff's got to get up there quickly to do it that you all have to quickly do it. We'd mention that if that's okay with y'all, we'd bring that back after lunch. Is that okay with y'all?
>> that's fine with me. I did asset to jp.
>> is that fine? I want you to have your time and we can't do this ampfully 20 minutes.
>> (inaudible).
>> thank you judge. Judge, could we let them know that we would try to do it say at like 2 when we get back if they were going to leave? I think we may need 30 to 45 minutes to do this.
>> and I think they're looking at more like 2:15 that would be a whole lot better.
>> so 23?
>> 23.
>> 2 is is take appropriate action.
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Last Modified:
Tuesday, September 16, 2008 2:37 AM