Travis County Commissioners Court
February 23, 2010,
Item 5
Number 5 is to receive presentations and take appropriate action regarding hospital proposals for housing of available star flight aircraft at they're locations.
number a, seat seton family of house and b st.
david hospitals and foundation.
we did have a presentation from mr.
hobby.
if he would like to have opening remarks we'll give him that opportunity right now.
>> judge, I promise I'll be short.
i think today is the time for the two hospitals to come in and really make comments they wish to make.
i gave a presentation last week and I think I'm just going to leave that one the way it is and I'm here to respond to any questions or make comments as you desire.
so I'm going to turn it over if I can to the seton network and allow them an opportunity to speak to you the court.
>> members of the court, thanks for this opportunity to come speak with you on our proposal.
my name is greg hart man.
i have two mean here, dr.
carlos brown, our drama trek tor for the entire network.
and dr.
bob bonor, the president and ce o.
our threel of us will quickly cover a few items and be available for questions you may have.
we're here to hopefully continue the relationship that the county star flight and the hospital has had since the fall of 1985.
danny talked to you last week regarding star flight's location at brak ridge and the curt use of the medical centers.
seton wants to continue the relationship to build better healthcare in central Texas, all the hospitals, the healthcare district, city and so forth.
you have seen our proposal for some time, an unrestricted gift of $3.2 million over five years with first payment of $640,000 upon execution of the contract.
in addition reproposed in the package we gave you to work with star flight to mutually agree upon enhance , remodeling, new construction at both university medical center, the crew quarters and as well as a new facility to help house crews.
bob will talk more about that soon.
i think this is really about our continued work with Travis County about the patients in this region, the type of care we therefore.
we have been able to collaborate before with the Commissioners court and the hark district, which of course reports to you, and it is one of the reasons that we are a level one trauma center today.
you may have heard and we talked with some of you before about Austin was the last metropolitan or largest in the country not to have level one trauma center until recently.
because of significant investments by the seton hospitals and millions of dollars continuing in capital and operations we now have two level one trauma centers.
bob will talk more about the uniqueness of our pediatric level one tralk certain.
but the university medical center remains the fourth busiest tralk center in Texas right now.
as you know, we are building an academic presence here in central Texas.
you also probably heard we are the second largest community in the country without a medical school.
we have begun moving in the direction of fixing that situation with a relationship with ut southwestern, seton is going to invest over $100 million over the neck five years to build up the residency, faculty programs, and with the goal of eventually having a medical school there near the university of medical center and close to dell children's.
the healthcare district with your approval and their budget has had a key role in many of these developments in terms of us bringing academic medicine as well as a level one trauma centers.
you cannot have a level one trauma center unless you can digit reattachment surgeries.
and we needed plastic microsurgeries clinic.
we created the institute of microsurgery, plastic microsurgery institute through the help of the healthcare district which helped with some of the original capital investment to build the clinic.
we now instead of the 60-plus folks in Austin who after an accident where they lost a finger or arm had to be transported to houston, dallas or san antonio, are now doing those surge rigs at the university medical center.
that kind of investment is one of the things the hospital with the healthcare district and the support of the of of local government are giving us the level of care the city deserves to have.
we think the investment in the helicopter which we want to work with you on will continue that.
the university medical center currently gets about 2500 trauma admissions a year.
in 2009.
54 percent were insured, 47 percent uninsured.
fortunately at the university medical center we're part of the hospital where we are proud to provide care to the most vulnerable in the community.
over two-thirds of the hospital care according to the american hospital association of charity care is provided from seton care and 40 percent is at the university medical center.
we have a large percentage of trauma patients often unfunded, it makes sense to have them at this has hospital where we are able to provide care.
i do hope you consider our offer of investment a continuation of our partnership that we hopefully will continue to work on to improve the level of the hark we are able to provide the community.
bob.
>> ladies and gentlemen, thank you so much for allowing us to come and talk about this important issue.
while today I'm president and ceo of dell children's medical center, I started 30 years ago as flight par meda.
those are the old days with single engine aircraft, I'm ashamed to admit I probably couldn't meet weight restriction.
but that experience gave me more than casual knowledge regarding issues of air medical transport of the ill and injured.
as I approach this issue in terms of trying to think about what the best thing, the right thing to do would be, I think if we put the patient in the middle of this, the wise thing to do for a second aircraft would be to place it at the region's only level one pediatric trauma center.
we worked hard to achieve that certification by the state of Texas and american college of surgeons on ferd upon us last July.
a lot of folks don't know there were only 16 level one in the united states, we were the 17th.
the only pediatric fee strangstanding children's trauma center in central Travis County, the other one children's medical center up in dallas.
currently what we struggle with with a single aircraft in service, which is based university medical center, a situation where we have a pediatric enter hospital transport, the aircraft has to fly to dell, put the pediatric equipment on, switch out the crew and put the medical staff on, fly to the patient, bring them back to dell children's, reverse all of that and fly to braken ridge.
i have been talking to the folks at star flight about the wisdom of placing a second aircraft at the region trauma center seems the make sense.
if we place the aircraft at off-site facility you are constantly making the shuttle runs, putting the patient in the middle of the issue lengthens the response time, especially if you are in hospital critical transport.
for scene responses, our colleagues at star flight can answer this, the aircraft flies directly from the dell facility.
it is going out and may pick up a child with no pediatric medical team and no pediatric equipment.
we have toured the space at dell children's medical center with star flight team a few weeks ago.
we have designated space for the construction of appropriate crew quarters.
at the time we designed and built dell children's medical center, we had always thought and hoped that we would be a level one pediatric trauma centers although we knew it was difficult.
we did design a double heli pad so we have a pad there now that is so large you could have one aircraft based there and another could come and go and you wouldn't have to move any aircraft because it's a double size pad.
so in terms of what we think the best thing is for children, in terms of decreasing the response time to get to them, my interest certainly would be, and this is driving this to put the kids in the middle of this debate, have the aircraft stationed at the only pediatric level one trauma center in the region.
so we would ask for your consideration on that.
of course when the time is appropriate, at your leisure, we would be happy to answer questions about our operation that you may have.
dr.
brown.
>> thanks, bob.
good morning, a real pleasure to be here, like greg said.
my name is carlos brown, I'm the chief of trauma in critical care at the university medical centers and director of the university training program for southwestern Austin, a brand new residency program, as well as the director of trauma for the seton family of hospitals.
i'm here to speak to the importance of having the helicopter assets in central Texas at the two level one trauma centers.
if you look at the breakdown of patients star flight picks up, the most frequent calls are going to be 20 percent trauma and 30 percent of pediatric calls are going to be trauma.
the most frequent reason they are deployed to the field is to pick up trauma s --patients which in our region will be brought to level one trauma centers.
in addition, if you see where star flight takes patients, last year about 45 percent were brought to university medical center and 54 percent of pediatric patients brought to dell children's.
the two level one trauma centers.
so if the crews are based in a hospital other than one of these to get the patient in the field, bring them back to the trauma centers and fly back to another institution.
and that is an additional take off and landing that in about half the time would be unnecessary.
that is really where the safety of the crew is going to come into play.
their most dangerous time is take off and landing.
if we can avoid one additional takoff and handing by having them housed at the level one trauma centers I think it will be better for the community as well as the flight program.
in addition, I think it is important as the medical education in central Texas grows to have the star flight crews associated with the two educational hubs for central tex the majority of the residenties will be housed at the university medical centers with exception of pediatric at dell.
that sorts of educational environment allows the flight crews to interact with the trainees as well as train on site at university medical center or dell and have them teach us, the prehospital world and the in hospital world and share skills and knowledge.
the trauma scene in central Travis County has change with two new hospital in pursuit of level two trauma center status.
one is seton Williamson county and the second being st.
david in Round Rock.
we are changing the scheme based on severity of injury and nearest facility.
we have decided for both locations, for the region all helicopter trans ports are going to come to university medical centers and take the few extra minutes to fly the level two to get to the level one with the understanding that level one is going to provide the liest level of most complex care for trauma patients in our lege--in our region.
think the take-home is housing these helicopters at the two level one trauma centers makes the most sense for the star flight program and most importantly for the citizens of central Texas.
thank you.
>> I will have a series of questions.
how many people does st.
david have to speak?
>> we have two at the table.
>> okay.
doctor, we will have one of you sit on the end here.
then if we could just let st.
david have an uninterrupted presentation.
same as seeton.
then we can ask our questions and express concerns.
>> I'll speak for the team.
>> okay, st.
david, don't be shy.
>> media, is the presentation loaded and ready?
should we ask them to show it if it is?.
>> yes.
>> if so, play it .
.
.
.
.
.
>> will I advance by verbal queue?
>> you have control on the laptop.
>> shall I sit over there?
>> there is help right there.
>> let me know when you see the presentation.
i'm assuming I will see it here.
>> there we go.
>> this is a hard copy of exactly what we have on the screen?
>> no.
>> close to it?
>> yes.
that is just a brief outline.
i have a full hard copy which I will leave at the end if that is all right.
>> how is your visualization there?
pretty good?
>> you had you.
>> you can see it?.
>> good morning, I'm mark clayton.
thank you for the time to speak with each of you this morning .
.
along with me from st.
david is malcolm blue.
he is the laptop operator.
we know him as the administrator of facilities and administrative services for st.
david healthcare.
he has responsibility for facility expansion and construction projects and has intimate knowledge of the station that we would like to build at the st.
david north Austin medical centers.
to my immediate left is earl max.
may be known to you as the ceo of the st.
david foundation which is our sponsor for st.
david healthcare.
and appreciate earl being here as well.
i'd like to take you through the presentation.
thought I would put the facts right up front.
really just hit on our poll, a little bit about st.
david's healthcare.
then the con gruence that st.
david's healthcare proposal, most importantly, the needs of star flight, the needs of the people of Travis County.
hitting the proposal first, the project as you may be aware, if you have read, which I think you have, the proposal that we submitted previously.
just to highlight that.
the value of 1.6 million in constructinging the 2000 square foot air ambulance support station and heli pad at north Austin medical center.
the and construction of the fuel addition pension station and underground fuel storage is part of that.
the planning for this began more than 18 months ago.
in consultation with mr.
hobby and mr.
ping.
we have in numerous meetings, about every quarter.
finalizing these plans.
we laid open to the staff any of our campuses as an opportunity for facility expansion.
that was verbalized to us as a need to have a state of the art station, which they did not currently have.
we offered any of our campuses.
the staff really pushed us toward this north Austin location as the preferred site.
which think was referenced in a previous letter that I quoted mr.
hobby from.
the donation for the acquisition of a third aircraft for star flight, this is a lump sum, one-time payment upon, again, the consideration of our agreement.
total value of $3.2 million.
the next slide goes over the site location.
this is one of the reasons why the staff and willie and the team felt that this was an excellent location.
the safety factors, the geography at the st.
david north aur stin facility provides great advantages for helicopter coming there, landing, the campus being so expansive there.
no neighborhoods in immediate proximity there that would encumber that flight path.
so the site location seemed to be ideal from a pilot and patient safety standpoint and also distributing the second station, the current station, a lot of logic there, but the second station to be located outside the city core in an area unencouple --unencumbered by existing flight paths, where you would be several miles away from the one loi case that --location that could be hurt by tornado or other disaser.
those were the key drivers that seemed to resonate with staff.
the next slide touches on population.
there's logic in looking at placing second station outside of the core where the major trauma center is and actually closer to where the patient volume is.
referenced later in the presentation is where is all the volume coming from.
it's coming from the north predominantly.
greater than 50 percent of the volume of the area and traffic is coming from the northern areas.
that slide just shows where that population is and is going to be in the future.
next slide looks at the serious traffic accidents and a heat map that shows again, if you are looking at just the trauma aspects, where the trauma is occurring.
again, logic along the 35 corridor but clearly in the northern area, again echoing most of the volume is in the north.
next slide looks at the proposal itself.
again, very well thought out.
the specifications were from staff.
we hired a third party firm to design the space.
in accordance with their specifications.
three dorm rooms, locker room, flight center office.
again, we would equip this and construct it in accordance with the architecturel standards there at north Austin, a show place medical center.
next slide transitions to st.
david healthcare.
a bit of an overview that, again organizing principles of st.
david's healthcare are guided by our mission that really provide that exceptional care to every patient every day in had the spirit of with a, friendliness and personal pride.
most importantly, I think, our values guide us in everything we do, even the presentation, with integrity, compassion, accountability, respect and excellence.
of course, the goals that we all share of providing that care exceptionally.
customer loyalty, that people will want our services and want to come back to us because they trust us.
fan we do those things well, then financially, the operation is supported.
those are the principles that really guide our partnership.
our partnership as I mentioned is composed of several parties with our major sponsor being the st.
david's foundation.
that partnership allows us to operate not for profit hospitals the each of our hospitals or operations not for profit.
and it's allowed us to become a real destination healthcare .
i mentioned a few aspects that I think line up particularly well with an air ambulance operation.
the thack that --fact that we are a leader in neonatal care, the most intensive care units beds of any system, we are the world leader in heart rhythm treatment.
that is not just a phrase that I claim.
we truly are.
we have excellence in brain spine and nerve disorders.
we are the regional leader in rehabilitation.
and we are the first and still the only system with certified chest pain centers which means the time it takes to have an intervention for chest pain disorders is really worked on in our facilities and accredited and certified nationally.
rapid growth in emergency department volume.
it maybe is not known to everyone there's relative parity between the two major systems in central Texas in terms of patient volume, emergency department volume, roughly equivalent.
you can see where our facilities are.
in the next slide looks at our history of collaboration with ems.
.
interesting enough, the tax except revenue bonds that were placed to support the construction at st.
david's medical center, the fees thrown off of that actually were the fees that fund the first helicopter here for the operations.
interesting parallel that we have been collaborating for many years.
the other things I mentioned there really speak to this legacy of collaboration that we have had, a very transparent relationship.
we have had.
very fulfilling relationship I think for patients with ems, and it is in that spirit of transparency and that legacy of working together that came the idea of a station at north Austin medical center.
the expansion of a third aircraft which we are offering to support and really with both systems here for the community.
let me speak to the con gruence between st.
david's healthcare and the services we provide and the star flight needs.
on this next slide, I'll let you get to that.
the next slide kind of lines up, if you really look at the data, if you look at the star flight data, which we did, and broke it down into its key compolents, you see that 85 percent of star flight patients are adult and neonatal, that is nonpediatric.
85 percent are nonpediatric adult and neonatal.
72 percent star flight adult patients are nontrauma.
72 percent are nontrauma.
the origin, as I referenced before, most of the star flight patients are north of Travis County.
if you break those down and line those up with st.
david's healthcare, I think the alignment with the system in terms of the placement of the station is an important consideration.
at least I'm offering that as one person's opinion.
we are the regional leader in adult care.
if you look at I think we are roughly equal, but there is a 15 percent leadership role that we have in terms of emergency admissions.
admissions that come through the emergency department at st.
david's versus any other system in central Texas.
we are providing 60 percent of the neonatal care, delivering 67 percent of the babies in Austin.
we have 119 nicu beds.
we have invested heavily at the north Austin medical center this past year.
we have seen a number of practices moved to that campus, which will then be resulting in a lot of neonatal volume at that facility.
of course the legacy at our st.
david's medical centers.
in terms of the second points, 72 percent of star flight adult patients being nontrauma, an important consideration for the overall financial state of this program that we look at nontrauma flights are really a key driver to program viability.
nontrauma flights are.
hospitals profit rather well off of trauma.
air ambulances live off of nontrauma.
the transfers, interfacility transfers, to my knowledge, having been a part of another air ambulance service in another state, that is where you live.
and that kind of service allows to you provide service to, as was referenced before, many unfunded nontrauma patients from an air ambulance standpoint.
hospitals get additional fees for trauma services.
so the issue of overall financial viability and the alignment with a nontrauma destination system is an important consideration for the program over time to be sustainable.
north aur stin medical center being the most comprehensive facility in that area.
if you have driven by that, you can see that it's quite a significant facility.
so in summary, the last slide, sort of lines up, itrying to think what would be the most important consideration.
for you.
i think it comes down to geographic and points of access.
the points I mentioned regarding dispersion of the two stations in the areas I think speaks to that.
the geographic access I reference in terms of volume.
where is the volume coming from.
where is the volume likely to be.
safety.
the issues brought up by the pilots, the staff, the other considerations that we talked about advantages of that location.
two or three points here.
the time value of money, the net present value.
is important consideration.
a dollar today is worth more than a dollar tomorrow.
the alignment with the system positioned for nontrauma transfers I think is an important consideration.
that should be analyzed.
you should ask staff to assess that.
just for your own information.
the fewest takoffs and landing was referenced.
if most of the volume is nontrauma, if most of the volume is nonpediatric, then that is an important consideration to make.
you ought to ask staff to do an assessment of the takoff and landings implications and the costs there to.
factor that into the overall picture in items of fiscal responsibility.
so why are we here?
st.
david's is here because we are interested in the well being of patients in Travis County and beyond.
we are interested in also in seeing that the best decision be made that is really prudent from that patient standpoint but also from the county's fiscal standpoint.
and we're here because we have a history of collaborating with you and with the ems staff and because this idea of a station at north Austin medical center and a third aircraft was their idea.
we are here and have been for the last 18 months to work with staff to build that station where they wanted it and how they wanted it.
so, again, we appreciate the opportunity.
we would welcome questions to myself or malcolm or mr.
maxwell.
thank you.
>> thank you.
questions from court members.
>> I have a question.
actually it would be posed to both st.
david's and seton.
with regard to the origin of many of our nontrauma calls, interfacility trans ports being north of Travis County line, I would ask both hospitals, to what degree are you all willing to throw in your clout to suggest to surrounding counties to participate in our air emergency facilities and the healthcare district?
because that is abundantly clear that our healthcare needs are regional.
they don't know county boundaries.
at this point Travis County residents are sub si dieding air emergency at 50 cents on the dollar.
we are sub si dieding half of the air emergency service.
we are attempting to provide a, the most robust prehospital emergency transport system, both ground and air, that we possibly can.
and we are providing it regionwide.
we are not looking at county boundaries.
to what extents will both of those hospitals be willing to prevail upon the regions in which you all are operating to participate financially.
i think our interests are aligned.
i think it makes sense.
both systems operate facilities, seton is referenced to operate trauma facilities in both counties.
we obviously at Round Rock, so I think our interests are aligned.
i would want to explore that.
whatever we feel together would be the best approach for our region I think makes sense, particularly since this aircraft is programmed for services in those same areas.
i would concur with your suggestion.
>> thank you.
>> Commissioner, I'd like to ask if I could, to address some questions regarding pediatric hospital.
Commissioner Eckhardt, you are exactly right.
a very high priority for the family hospitals is to regionalize the healthcare district or some system.
right now you may be aware, we have opened up a new hospital recently in kyle.
we went down before the hoping of that hospital and helped to create with the Commissioners court and with other local leaders down there a fqhc system we are working on to create which we think may be a first step to getting them to look at a full healthcare district system.
>> [(standing by for change in captioners, please ]
>> we have tried to make the argument that when you regionalize health care it is a win win for everyone, when you look at the economics of it and the ability to draw down health care and dallas in a different way if we start to regionalize and we think it is a possibility going for a multidistrict wide -- politically, we are trying to make the argument county by county for the needs to help develop the own health care district, and the best will be in hayes county or bastrop.
>> I think the key is you elaborate on that.
you can't be doing this unilaterally, we need to work together to address the issues and if we work a lot, we will accomplish more than as individuals.
>> to that extent, which is the two hospital systems which of course aren't the only hospital systems in our central Texas region, to what extent are these two hospital systems willing to collaborate with one another with regard to prehospital air medical?
>> well, I guess -- we thought we were and we were suggesting in our proposal, in our discussions with staff that the third aircraft that it be something that both systems participate in, and station to station was brought in as a staff input, if you look at the third input, the need for aircraft, we thought it would be a proposal for both systems to share in that.
so from our perspective, we have been collaborating from -- you know, from the beginning on that.
clearly in terms of prehospital work, admission lifeline and other efforts throughout the region in terms of working together with prehospital and hospital teams that is something we are very, very actively doing clinically, if you are rooking at air ambulance, we thought the opportunity was through this third aircraft.
>> and I think the two networks collaborate a bit, the icc and oh collaboration, quite a bit, we collaborate off and on.
this conversation actually, we were brought in terms of late in final collaboration and mr.
bonar was involved more than I was when we first came to start talking about this and we believe collaboration is important and we work well together for two health care systems and two level I trauma hospitals here that we believe that the aircraft location is critical to -- in terms of long term growth of the hospitals, and what we are trying with trauma network and the academic piece that is critical for this and the delivery of the services and the center population, too, one thing mark mentioned was northern growth and there is a lot outside of the counties but if you look outside the trauma region, it is actually right off of 38 strategic off of see to be medical center and close to del's children hospital and brackenridge center as well.
we want to collaborate and think it is important but we need to recognize two level I trauma centers and north@is snot leffingwell one trauma system, it is level ii stroke system, there is a difference in terms of the type of care being provided on the facilities, the helicopter location is critical to that so I think that's why staff decided to go with the seton's proposal, too even though they talked st.
david's, too, the proposal, side by side, the staff recommended the seton opposed.
any questions?
>> let me understand the monetary contribution of each.
part of it is for facility for personnel, the other is called a monetary contribution for aircraft or something similar to, if it is unrestricted I guess the county will decide how to use it but for seton, we are talking 3.2 million payable over four or fy years at 6,140,000 a year and what would be the -- and 64,000 a year, what would be the department of that.
>> we have talked to folks about the need to remodel and upgrade the university medical center brackenridge facility which we will do in terms of making it more compliant with what the star flight crew wants us to do and dell's childrens, and bob may want to talk about this, there is brand new quarters and other facilities, we haven't priced this out but that would be close to 2.2 million once we agree to the build out you want at both of the sites.
>> yes, we toured dell's children a couple -- two or three weeks ago from casey and folks from star flight and identified space that they would like to use, the space is available.
my initial early estimate from our construction team would be that that would cost about $175,000 to build that out at dell's children medical center and then we would make a couple of additional storage areas available for them, one down by their offices and then one right up on the helipad that is already there, for them to store them, you know, their equipment and so forth, so that's roughly what the costs would be at children's.
>> okay.
st.
david's is looking at 1.6 -- what I call cash --
>> yes.
>> lump sum?
>> that's correct.
>> and construction of a -- of housing facilities?
>> correct.
>> and we estimated that in the proposal 1.6.
again, that was with the systems, was third party and we have had considerable time to price that out.
>> so what would st.
david's expect from Travis County in return?
>> well, the expectation was that the -- the twelve-hour aircraft, once the facility was available, would shift there, and then when a third aircraft was entered into the mix and assuming that that purchase was -- was committed to and achieved, a third aircraft in the mix would then enable a 24-hour presence there for that 24-hour crew.
>> at the northwest location?
>> yes.
that's correct.
>> what other expectation?
other than continue to be an outstanding partner.
>> the -- really, that -- that was the goal, I think to have quarters, to have a safe area.
we thought the proposal achieved that goal, and, you know, for us having that -- that northernmost location made sense in terms of reaching those patients.
so we -- frankly, we are -- we sort of bought into the vision that, hey, that location really is great and a third aircraft would be -- would be great.
so we reached into our pockets to come up with st.
david's money for that, we thought it would be of community benefit, so the expectations from st.
david's, I would say it is more of what the public expectation was and the expectation was for that -- for that site to be used.
no other contingencies.
>> okay.
seton's expectations?
>> we believe, judge, it is critical we have helicopter aircraft at both level I trauma centers, we hope with this contribution and it is in our letter that two aircraft would be located at university medical center brackenridge and one located at dell family medical center.
and a cost question, the 1.6 st.
david's includes a construction of helipad and we have two of those at our landing sites, too, so we don't need to informs in new heli pad destructions and we have invested in the level I trauma center, so they aren't in the current estimates.
we are talking about doing crew quarters and additional safety and other models as well, too.
>> now, so both of you are of the opinion that if we acquire a third helicopter, you would like it at your location, basically?
my problem is that it's difficult to locate one new helicopter at two places 24 hours a day.
so have we given up on sitting down and trying to work -- pardon me -- trying to work out a way for us to get a win win win with a third helicopter?
and the reason I ask that question, it seems to me that this court should take an opportunity and do that, basically call the parties together with two members of the Commissioner's court and staff and talk through these issues and try to reach a decision that, you know, hopefully works for all of us.
now, there is a -- there is a background that I guess we should be familiar with.
I asked mr.
hobby yesterday to call eurocopter and see how long the appriss they have been holding for us will be intact and they said at the close of today's meeting, they denied the two-week extension that he requested on our behalf, which I made for us.
however, if we have two partners, each of which is asking for the helicopter on a full-time basis, I guess we would want to know whether your commitment remains as set out in your proposals if we cannot reach what I would call an appropriate compromise settlement.
because if your proposal remains intact, then it seems to me that our question is, do we make the decision today to purchase the third helicopter and decide during the next 2-3 weeks how we would use it.
there are some facts, I think, that we don't have that we need to get.
my guess is that staff could generate them for us in a couple of days, but it seems fair to me to look at them.
now, you know, when we have three helicopters, I guess what we all know is that you are looking at probably having close to two because one will probably be down in maintenance, for maintenance.
so how that you would that sound?
and many hobby is coming forth now to either give an opinion or explain why he will not.
>> [laughter]
>> yes, I want to be clear on -- on something that I think both networks are -- is clear on but I also want to make sure the court is, as well.
that is, currently we have one 24/7 aircraft and one aircraft that is operating twelve hours.
that's all we have the funding for.
when we buy the third -- if we were -- if you were to approve a third aircraft, we are not proposing that we add staff to that aircraft.
we would be proposing that initially -- and it is only because of our economic situation, our transports and revenue, that we would bring the third aircraft in and we would be able to rotate that aircraft among the two existing aircraft.
however, we would, which we anticipate will happen, the economy will rebound, and we will have the number of transports and hopefully our goal where we could staff the secondary craft from -- second aircraft from 12 to 24 and we can't do that, so we are talking 24/7 aircraft and another one to start out -- doesn't make a difference where it is located -- I think both networks understand that.
the twelve hour air kraft is what we are talking about right now but the advantage of a third aircraft allows a certainty of at least 24/7 and a 12/7 and then we would grow that that secondary craft, the 24/6, once we go back to our financial forecast model so I want the make sure we are clear we are not talking about purchase of third aircraft, that automatically makes the second aircraft 24/7.
>>
>> [indiscernible] brought up something that --
>> I my question I guess is did both parties understand that?
st.
david's and seton?
>> okay.
>> yes, we did.
>> so what you are saying you have three aircraft but we will staff those aircraft as the caseload dictates?
>> that is correct.
now, the advantage of having -- and I will get to that when I get to the aircraft -- but as I mentioned last week in my presentation, the advantage of a third aircraft -- and that is what is an advantage for the networks, is that it enables us to, again, have availability of the two existing aircraft as they are in a better mode because you are now rotating among the three, so if one is down for scheduled maintenance you still have the 12/7 working and the other advantage is timing.
that is, we don't have to wait 18-24 months to get an aircraft in here.
right now we have an aircraft ready to come in here and -- along with the completion of the contracts today if you approve these, and so that's another -- there is a time element.
even though they could build, you know, your -- their helipads and their living quarters, they could build them but if we delay on the aircraft, then you are looking at a long period of time the aircraft can be here.
>> on the aircraft, irunderstand they want our commitment to purchase or not and if we said -- we indicate that we want to purchase, they want us to execute a purchase contract.
and they have the aircraft available?
>> that's correct.
>> so that is two kind of big deals.
they reduce the price and the availability of aircraft right now.
but it seems to me, though, that whether we make the decision on this item today or two or three weeks from now, sort of becomes immaterial if the commitments remain intact.
now, if we choose one of you today, the implication is that we will purchase a third helicopter, right?
and if we indicate -- let's purchase a third helicopter, we will either reach a compromise agreement that satisfies all of us, or that we would choose one of the two proposals before us.
and the way we purchase these any way would be to issue debt, wouldn't we?
>> that's correct.
>> and I am not sure that today's decision in item number 5 impacts that much.
in fact, having that cash available to use as we see fit, you know, may be better anyway, meaning issue of debt, purchaser, aircraft and whatever cash becomes available goes to the general fund for use or just apply toward the indebtedness or, I understand that there are consequences if you apply directly towards the purchase of aircraft and we need legal advice on those consequences before making that decision.
but, I mean, I guess my question about us putting our heads together, it's a little different than if you have both parties in the room, two members of the networks, Commissioner's court and the staff, you want a place that atcy phys all of us and if that is not I achieved then we -- that is not achieved, we simply choose one of the two choices before us.
>> speaking of st.
david's, that request, or that idea, I think nothing is lost in pursuing that at all.
we would -- we would be there.
and I -- I think that, you know, getting us together to pursue that, that would be fine.
certainly our proposal stands as is, to answer that question, but also to answer the question, would we engage in a discussion with you to pursue what you suggested?
we certainly would.
>> well, if this goes and to three of us, three partieses would get together, seton's, st.
david's and Travis County.
and it seems to me that our commitment would be to move as expeditiously as possible so I am looking at 2-4 weeks.
i know government is viewed by some as being incredibly slow so we would press to make a decision, you know, I will say in 2-4 weeks, but there needs to be a commitment of time necessary to do this.
and in the past, you know, often we will reach conclusions that I thought were impossible at the beginning but not all of them have been successful and I am saying that I think the court would feel a lot better if we at least try to reach what I call a compromise agreement that benefits all of us.
>> judge, and the court, if I could, if the court wants us to sit down and talk some more, I want to talk some more but I want to make sure our position is clear here.
we invested in this community to bring this community two level I trauma centers, the investment to getting to level I is significant.
it is a multi million dollar investment to be level I trauma.
we believe to have a level I trauma center operating at the level it needs to have, particularly with the academic presence that we are bringing to this community which also a significant investment require that is we have a helicopter at both of our level I trauma centers, so, again we are willing to talk but it is a requirement we feel for our level I trauma centers to have aircraft at those sites and we have made a significant cash proposal here.
we have it significantly higher than the other proposal, both in terms of the number and the investments we have made and in terms of level I trauma center and the helipads and those things, too,s but we want to talk but we want it to be clear that we feel strongly and trauma partners as well including doctors and ore folk who is have worked strongly, that we need aircraft for level up trauma centers, so that will be a significant point for us.
>> I hear what you are saying, also.
my concern, I guess two or threefold.
of course if we end up -- and I think what the judge is suggesting is a pretty good suggestion, for getting both parties together, maybe members of the Commissioner's court could get our head together and make this a win win situation, but even in that event, I think -- I am concerned the money that has been put on the table, as far as the offers, 3.2mil from seton, as well as 1.6 from st.
david's, will that jeopardize or will that money be taken off the table if there is a win win solution that comes forth?
i am very concerned about that, because that money is 640,000 for a five-year period, for an example, seton, will that be taken off?
and then another concern is whether or not if there is a delay and of course if we do not act today, danny, I guess first I need to find out from staff, how much increase would that be probably for delay of delivery of the month but also maybe it increases in cost.
i would like to know what that increase in costs per se, would be for a urocopter, the dc145 we are talking about, so if that helicopter is not in the actions taken today, what would increase of that helicopter be opposed to what we have on the table now?
>> Commissioner, the answers are as follows, if you make the decision to connect the purchase of the aircraft to the decision-making of the hospitals and it is delayed based upon that, then you, as the judge mentioned ago, in regards to urocopter which is offering us 2009 pricing but won't do that four weeks from today and you are looking at 2010 price and looking at over $400,000.
>> that is the difference, $400,000.
that wasn't on the table for that amount of money.
so an increase from the 6.2 plus 400,000 on top of that, and so --
>> and --
>> and plus the medical package that goes again the package stuff that goes with this stuff, 800 something thousand dollars, so we are looking at this from that angle.
but, again, I -- I mean, both proposals appear to be good proposals, and again, both networks are good hospital networks here in Travis County and of course I wouldn't want to lose the opportunity or not maybe using both, but then again, what -- how would that really affect the money that they put on the table today?
and that's what my concern is, will that money not maybe available as we look at it tonight.
>> I would like to address if I may.
i think greg would echo this.
i don't see a scenario where st.
david's is going to pull this off the table during this, you know, few weeks we are talking about this.
i can't imagine that seton would pull their proposal off the table because you want to discuss a collaboration.
i don't know.
>> like I said, we will be more than happy to talk.
>> [indiscernible] we need a helicopter both at our level I trauma centers, so at the outcome, seton ultimately feels it is critical, we will -- is there a negotiation where we have a larger offer and we share the helicopter with sites, I am not sure, I don't know if that will work, because I think we are offering more money, more resources to have these helicopters across the county and we do believe for investment and level I trauma and everything else we are are investing in right now we have made a good off here and we need the two helicopters that are two level I centers.
>> but I don't know if we are in a position to make a decision today myself.
it seems to me I need a lot more information than I have.
but if we are going to purchase a helicopter it does not make sense to wait if save $400,000 by making a decision today.
if we are undecided about the third helicopter, though, we shouldn't rush into it.
that is a big deal, because if you get a third helicopter, not only are you looking at the purchase price but you are also looking at operating it at some point, and just staffing it is a substantial investment, and maintenance has to follow.
but if we are ready to go on a third helicopter, I mean, I don't know that we have to act on number 5 to do that.
if we are not ready to go on a third helicopter, then we ought not do it.
danny is right.
we detective the third helicopter during I guess a couple of budgets.
the revenue from transports has not been what we projected, you know, two years ago because of the economic downturn, but the need is there probably.
and that need continues to grow because of faces that feed to be brought to Austin for trauma care, other life threatening injuries, and it schemes so me that we can clearly justify getting one and I think utilization will help us justify that in the years ahead.
but I think on how the third helicopter is used, it would help me to spend a little more time talking with parties to to make sure I understand and typically as a governmental entity we would try to reach a conclusion that benefits all, at the same time, though, you can't force that, so if it's not there, I can accept that and we can choose one.
but I would hate to buy a third helicopter and come in one day and both of you have withdrawn your proposals.
>> that's what I
>> [indiscernible] I want to make sure what they offer today is still available and I want to hear from them personally to make sure that they are -- their opportunity of what they say will still be available in the future, as far as st.
david's and also seton's proposal, so very concerned about that.
>> judge, what I hear.
>> so --
>> so --
>> I think there were chances that, as long as people are sit down and talk about what the possibilities, and even -- even with your position, what of what you feel, you know, is required, I think there is still possibilities here and I think you have a good idea to spend a little bit more time with both parties.
>> and, judge, on item 7 and 8, which is part of the debt and a lot of things we are looking at today, I know I am going to request that 7 and 8 go to executive session for things that I need to get out under the legal and real estate.
>> okay.
>> so that is part of where the financing mechanism, even though there are other agenda items that address this issue, such as 9, 10, a1, 22, 23, and and b, there are several items we -- a and b, there are other items that address this issue today, however, under the debt model, item 7 and 8, some -- I need to -- some legal and also on the real estate on some stuff, for those two items, so I will be requesting that 7 and 8 go to executive session this morning.
>> okay.
>> may I ask a couple of questions of staff, so if you could make space for staff.
for pbo, danny, casey and willie, and I am asking these questions just to set the -- you know, set the framework within which this future -- this continued discussion occurs.
i noticed in the backup -- I want to make this clear, that irrespective of which of these two proposals we go with or if we go with some sort of collaborative proposal that's developed over the next couple of weeks, backup states that star flight in any event remains a community asset serving the residents without bias related to ability to pay for the services, type of insurance coverage, or hospital destination or affiliation.
i want to perhaps, willie or casey to elucidate ha on that, that is not about the use of any particular hospital in one star flight system.
that's correct?
>> yes.
>> so in any case, the distribution of services will still be done based on medical need and proximity, am I correct about that?
>> yes, Commissioner,
>> [indiscernible] aviation director of star flight, that is correct as you stated it.
>> now, one thing that st.
david's raises is the issue of a -- an analysis of trauma versus nontrauma performance with regard to the location.
is there -- have you all done analysis to determine if there is a programmatic benefit to one location or the other?
with regard to trauma and nontrauma.
>> casey payton program director, I would like to add what willie said as far as backing up, inner facility transfers is a facility and physician arrangement.
we are not involved in that at all.
so when we do interfacility transfer, it is request at transferring or receiving facility and a relationship that they have and where that patient needs to go.
so the program is really not involved in those decisions, other than the dispatch matrix that you approved and we expanded in the last month to include all of the Austin hospitals.
and so literally if a hospital had a helipad and is able to receive patients with your approval we are able to transport to them.
>> so with regard to requests for air taxi between facilities, take that off the table for a moment.
just emergency medical prehospital.
is there a difference from a service perspective whether we are -- whether we choose one helipad as the base versus another hospital's helipad as the base g.
>> we have data that defines where our patients went historically and I think that has been provided to both of the networks, that was the information they were using in their presentation.
on a scene call perspective, the first thing that we do is make sure that the patient is going to a facility that can meet their needs.
time sensitive of those is usually trauma or stroke or stemi, or -- patients having strokes an those patients are defined outside of our realm, in other words the Travis County medical society or state defines meeting those criteria a as meeting the capability.
we have a transport guideline, first where the patient will be cared for and where to go.
the second thing patient preference, so if we were to ask a patient in Travis County having a stroke and they say they want to go to this facility, as long as it is a stroke center and can receive a patient by helicopter, then we transport the patient there.
>> okay.
so wrapping that all up, is it safe to say that there will be -- with regard to any kind of exclusivity with regard to the home base, the protocols for the distribution of clients will not change?
>> no.
we -- we -- we plan to continue to serve the community and the hospitals in the community, regardless of affility.
>> and the question I had perhaps for danny or casey or willie, spending on who is the most appropriate to understand to it, is there a programmatic difference with regard to the capital assets or improvements between the proproposals that are before us today?
is one -- does one offer more capital improvement assets than the other?
because we haven't -- there is no value placed on the seton opposed so I am asking for -- from our perspective, star flight's value, which is the more valuable proposal from a capital resources perspective.
or are they equivalent?
>> what is the value of two helipads?
>> that was one of our requirements for any hospital, when initially we did the business plan we met with our stakeholders and talked about if there was going to be attentionpansion, where they would go, one of the requirements is there had to be two helipads at a fillcy because otherwise we have to move -- any time another helicopter was coming in, every time we would have to move it and that was one of the requirements, it needed to be two-place helipad at the minimum.
>> what is the value of two helipads, approximately?
what does it cost to construct two good ones?
like the two at dell?
s dell children's hospital, right?
you have two new helipads at dell's children's hospital?
>> yes, sir.
>> so what did it cost to build them, I guess is --
>> the engineer designed designd that into the project in the first place.
>> right.
>> those helipads are built to with stand the landing of shumuk234 for hayne relief and so forth and that helipad, the double one was roughly in order of $10 million, but, again, it's huge and it's a double and it's made to take a helicopter that is heavier than what we would usually land there unless we had some kind of a military evaluation, so most pads built on ground level probably wouldn't be that expensive.
>> a whole lot of money, though.
>> yes, sir, it is.
>> and then I had a question in planning and budget office with regard to the time value of the seton offer as opposed to the one-time current value of the st.
david's off.
have we done that calculation?
>> yes, base on the interest rate we did today, if we were to have five co's, based on the acevedo five year period, the value of 3.2 I believe is being offered is equivalent to about 2.9 million.
>> thanks, I appreciate that.
>> and we did have a break-out on the -- the costs of the second helipad, 300,000 was that number.
>> okay.
thank you.
>> so do we -- we have data showing basically where star flight has delivered patients?
>> yes, sir.
that's correct.
>> and we can pull it up?
i guess matter of days, look at it, analyze it and whatever it shows we would be able to reach conclusions about that, make findings and reach conclusions about it?
>> yes, sir.
>> you don't know that on the tip of your tongue, do you?
>> I have the fy '09 patients by hospital data in front of me.
>> okay.
>> brackenridge 303, dell children's 104, heart hospital 34, north Austin 18, scott and white Round Rock 1 seton main 83, st.
david's downtown 120, and then there is another 112 is other.
those are probably patients that are either leaving Austin and I would have to pull that to see what those other 112 are.
>> so what totals did you reach for st.
david's and seton?
>> well, I would have to -- I would want to break out the other -- 112 other to make sure there could be, as an example, south Austin or other things that we just recently started serving in the last maybe twelve months.
it was captured differently in our database, so I would -- in order to be accurate I would want to pull that data of the 112 and we can get that number to you, though, probably today.
>> okay.
if we get a third new helicopter, but we are still staffed for the two that we have to be operationsal 24-7 on one and 12 on the other, what do we do with the third one?
locate it at one of the facilities?
>> it would remain at our hanger.
the managed facility, as danny talked about, it would be used as a rotational vehicle so that when one aircraft was down, we were able to maintain that twelve-hour staffing.
the benefit of that, we currently estimate we lose about 85 days a year with the secondary craft staffing because it is down for maintenance, so for scheduled maintenance, that number should drop to 0 with a third aircraft.
>> Commissioner.
>> it was mentioned earlier that there was a different resources needed for pediatric as opposed to adult care in star flight.
can you elaborate on that from operational standpoint for the helicopters.
>> the helicopters are staff and equipped to take care of the general population of pediatric patients including pediatric trauma patients.
we, by state law, have to have equipment from all ranges of patients for the missions that we do and so -- but because the pediatric specialty team has capabilities that is beyond the skill set of our crews, for specific patients, ventilators may be a bit different and some of the equipment and medications that they carry is different.
so when we go pick up the pediatric specialty team, we do take some of our equipment off to make room for theirs, but for a scene-call response, we carry both adult and pediatric care equipment and capabilities.
>> what seems clear to me is that if we base the decision solely based on monetary contribution,s I mean, one is better than the other.
if we look at some of the other factors, though, then I guess that's a question mark that I have, and I don't know that we have all of the facts necessary to look at the other factors.
i feel a whole lot better about making an informed decision if we had an opportunity really to contact, communicate with both hospitals and staff a bit more myself.
but at the same time, unless I am hearing differently, we seem inclining to ahead and acquire the third one.
so I mean, that's why I don't know.
>> inclined --
>> I don't know that we absolutely are required to make a decision today, but I know we are required not to diddly dadly around with it.
staff, how does that sound?
>> I think the -- you will hear from me in just a few moments when we talk about this agenda item that talks about the third aircraft and, again, the issue is, in regards to the third aircraft, not the hospital's -- although it does affect the hospital's, and that is that whatever decision is made in regard to the third aircraft has impact, I think, on their proposals and I think it has impact in regards to the availability of current aircraft, and so there is a realtiming issue, both -- a real timing issue both for your helicopter and metro aviation, those that complete the aircraft and I will get into that in my next bit of presentation.
that is, we do have a timing concern here if we want to be able to have the discounts and be able to maintain the 2009 pricing, we also have a timing issue now with Austin -- with metro aviation and that is they now have several aircraft that are ready for them to also complete and so if we delay on that, then we get pushed back, which means we don't get the aircraft until much later, and so I think that's the only bind that I feel like we are in, that when it comes to the aircraft, there are some timing issues and some financial issues, implications in regards to that.
again, it ties into the hospital but it doesn't tie into the hospital.
but, again, it's important that we discuss that as we discuss the third aircraft.
>> we own two aircraft already.
>> we own two already.
>> if we acquire a third one, what flexibility do we have as to where to locate those two?
now I know if one is down for maintenance, it is at the hanger.
but what flexibility do we have as to the location of aircraft one and two, which we already own?
>> I think we can place them wherever you direct us to place them.
we can provide to you, respond to information about where -- where it needs to be.
you know, the main thing within Travis County, most of our responses within Travis County are east and west -- I mean, that doesn't make -- we just don't go to Pflugerville a lot because the way the county is structured.
it is also more of urban area where we have additional ambulances.
that doesn't mean we don't respond there but if you look our incounty response which is one of the thingsesly provide to you is where are we doing our responses, it is mainly east and west.
>> when you say east and west for the listening public, we know you are excluding the incorporated areas but when you talk about east and west, you are talking about east of the incorporated area of the city of Austin and west of the incorporated area of the city of Austin.
right?
>> correct.
and that's also where our geography problems are.
>> lakeses?
>> yes.
>> low transportation grid.
>> yes, our geography problems comes the benefit of the helicopter but we can certainly provide you by esp what our responses and transports look like, so one of our -- one of our focus points was to try to make sure that we were aligned along the center of the county which allowed us to serve east and west constituents equally.
if we were to put the aircraft in logo vista and the brackenridge aircraft was out, it will take us longer to get to the eastern population, so being in the central corridor of the city allows us to serve the county constituents equally.
>> but also, judge, in regards to flexibility, we don't have the luxury of simply putting that aircraft anywhere we want to put it.
that's why they come forward with proposals, there is three basic almosts, two helipads and living quarters and also a fuel station which they haven't mentioned, which is expensive.
>> you are talking about aircraft number 3?
>> well I am talking about placement of secondary craft, if we bring in a third aircraft, again, if we end up staffing to where we have 24/7, you are still going to have two judge, aircraft that are active.
that's the thing we are getting at here.
right now we have one 24/7, one twelve and we bring in third aircraft, we would not staff that aircraft full time, again, until we have the resources to do that.
>> judge.
>> yes, sir.
>> I am going to request that I withdraw my proposal earlier to take this into executive session under item 7 and 8.
i got an answer from legal that will -- that can be discussed in open court.
so the things I was going to ask, so I will not have to take it to an executive session or item, 7 and 6 when it comes up.
>> we are still on 5, right?
>> right.
>> yes, sir.
>> which will affect this, also.
>> anything else on item 5?
then I move the Biscoe proposal.
do we have two members of the court who are willing to serve?
>> [laughter] I guess this is my idea.
i am bold enough to volunteer.
>> I will be useful to you.
>> that will be good and our -- I was seconded by Commissioner Gomez, our intention would be to sit down with the two proposing parties, maybe separately at first and then together.
and then staff either before the first meeting or between them and I will generate a list of additional information that I think the court needs to see for us to have have from staff and so when we chat with the hospitals, we will be able to do that, okay.
and so danny will know who to contact from different hospitals, right?
and so we will move on that within the next few days and try to set up some meetings and our attention will be to report back to the court in a month or earlier.
is that okay?
>> okay.
>> and that's subject to the availability of different parties, but hopefully we can -- if we can set up a couple of dates within the next 30 days, then I he that will facilitate our meetings.
is that okay?
any more discussion of the motion?
all those in favor?
>> I am able to vote on this one, my wife is no longer affiliated with seton hospital.
so I am actually going to be able to vote.
>> Commissioner you don't know how big a deal that is for us.
>> [laughter]
>> ms.
porter, highlight that for us in the minutes.
this passes by unanimous vote.
>> thank you very much.
we appreciate your interest and willingness to work with us on this.
The Closed Caption log for this Commissioners Court agenda item is provided by Travis County Internet Services. Since this file is derived from the Closed Captions created during live cablecasts, there are occasional spelling and grammatical errors. This Closed Caption log is not an official record the Commissioners Court Meeting and cannot be relied on for official purposes. For official records please contact the County Clerk at (512) 854-4722.
Last Modified:
Tuesday, February 23, 2010 2:15 PM
