Travis County Commissioners Court
April 20, 2010,
Item 10
>> item number 10 is to receive briefing and take appropriate action regarding, a is hospital proposals for housing of available star flight aircraft, and b, request to establish working groups to address public policy issues. Good morning.
>> judge, exist--commissioners, thank you for this time. I'm honord to have with me today representative from seaten network as well as the st. David's network. To my right is mark clayton, the senior environment president of st. David's network, as well as rest from the seaten network, greg heartman, ce o. University medical center, and ash ton.
>> ash ton, community relatings for seaten.
>> in your backup, i have provided you information based upon recent meetings that i have had with both mark and greg. I was instructed and directed by the court to go and work with both networks in regards to placement of star flight aircraft. Before i did that, i decided to meet with staff one more time and to allow them in the star flight program to look all the various options which we had discussed together in previous weeks, as well as other options that way had not discussed. And i had told you, the court, that there was one particular option that i did want the pursue and look at, and i did that. After meeting with staff, it was fairli evident to me that two is in the best interest regarding those options to stay with the current aircraft and stay with the 12-7 aircraft that we have in the air as well as bring in the third aircraft which should be here in june, an as the backup rotation aircraft for the active aircraft. It would not be in the the best ent for the hospitals or for the program to try to add to that at this particular time. Meaning that if i were to, and that was one of the options. And both were willing to discuss it. And that is add staffing to the third aircraft. But in looking at that, it was not finally feasible --financially feasible for you to do that and i don't think in the long run for both networks. A lot of people have indicated that i'm in an unusual circumstance in that i am in between two great networks that are here providing lots and lots of medical services to our community. I'm also in a good position because they are both willing to come and work with the star flight program in regards to what we do. And that is think we provide good service to our community as well. But i actually got slanted one direction by meeting with these two gentleman. And that is even though it's important we talk about aircraft and they think it's important to talk about aircraft, and i want to continue to talk about the aircraft at their hospitals, is that we found that we also talked about other issues that are associated with the hospitals and the aircraft that are public policy issues of which, are common to both of us. It's not just common to air. It's also involving ground. We are involved in a service delivery that basically i have in the past not associated myself directly with the hospitals. So as i began talking with mark and greg, we discussed those particular common issues that we have together. And what is happening in our community in regards to them, mental health. The homeless. The uninsured. Low income. And how does that matter in regards to what i do as far as transport and what they do in regards to crair? --care? Let me first of all say that there are many groups and organizations that are trying to address these issues. But what i found in talking to these two gentlemen is that i basically have left them out of my world. I'm in the prehospital world. But yet we are directly connected because what i bring to them affects them. And so it's important, and i told them both that i would like to attempt, if they are willing to, as two networks, come together and use their authority. Belief me, we are at the cream of the crop here. I mean, i'd love to have a picture to take of these two gentlemen because how often does a person like me get to be with two people like this? And to be able to sit with them and have constructive productive discussions not only on aircraft but also on other issues that affect our community. I was just, i left both of them with gratitude and thankfulness for the fact that i have an opportunity here. And we have an opportunity here. And this community has an opportunity here to bring two networks together. Not that i'm going utilize all their time because i can't. I mean, they are running big operations here. But if i can have a little bit of their time, and if i can use a little bit of their resources, and i if i can connect to those other links out there. And i have already connected to several that are doing some good things. And their comments to me were, you got two hospitals willing to come together and discuss that?. I said, you bet. So i'm not going to overdo this today or not going to underdo this today. I'm just saying that we have an opportunity here to take advantage of an opportunity to come together and see if we can't work together towards some same issues and common goals. Now, in regards to the aircraft, we will be receiving that third aircraft in june. And i think it's important for us to continue that path. They are dedicated to that path. They are also wanting to work toward where we are going with that. Now, in regards to that, if i can bring the aircraft in in june and have a testing period of how that actually does work, and i lay that out clearly, i hope, in the memo, and that is we need to look at availability. Does it indeed, the third aircraft, does it indeed, all the indicators are that it will, allow both aircraft to stay in the sky? Which allows them better service and allows the program better service, meaning more trans ports and less missed calls. Right now with the two aircraft, i can serve both of these networks in a manner that i think will be pleasing to them. But i would like the use that opportunity and that time to test that aircraft and look at all the variables and the operational costs, revenue and trans ports. As both have indicated to me, look at other criteria if we need to in regards to what makes better sense when we do make that decision. So what i have for you today, and i'd like for both greg and mark to come in on this as well because, again, my impressions of my meetings with them, i hope are the same that i have just mentioned here, but i think it's important for you to hear from them. But i have basically three action items for you today. Number one is an i prove staying with the current staffing of star flight aircraft, staying with the current housing of the 12-7 aircraft at the star flight hangar and use the third as spare aircraft for two existing star flight aircraft. By the way, this is not a surprise to either greg or mark. This has been shared with them. Number two is is an i prove delaying the decision on the hospital proposals until october 1, 2010 so an overall assessment can be made regarding the percentage availability of the 24 x 7 aircraft and 12 x 7 aircraft, call volume, missed calls, operational impact, expenditure and revenue performance, and others may be added to this. Number 3, approving coordinating with local hospital representtivities to establish working groups to address public policy issues. Now, i provided for you of those particular working groups. Some of them already exist. The advisory board exists, ms subcommittee exists. The two that we wish to hone in on would be the clinical working group and hospital advisory council. So we have not together met to decide exactly how that will be formed, or those two groups would be formed. That would be our next step if the court is willing to go further with that. And my understanding from both mark and greg is that both networks are willing to do that. But i'll let them now say a few words, if you don't mind. So mark.
>> sure. Thank you and good morning again. And thank you, danny. Somebody once said life is a tuxedo and i feel like a pair of brown shoes. So that comment about being sandwiched here, i don't know that i necessarily agree with, at least on this part here. Really wanted to just endorse from our perspective, st. David's healthcare perspective, the recommendation that danny is making. I want to express my appreciation to him personally as well as you, to allow us to go through this dialogue. You know, the process that we have gone through the last couple of months in terms of discussions about star flight operation. We appreciate that. I wanted to really make three points. Really sort of call out at least from our perspective three commitments. One them is our commitment that we share with star flight and with the patients that they serve. And we jointly serve. Really a commitment to exceptional care for every one of those patients every day. That is our mission at st. David's healthcare and a mission that we hold in common. And to that end, we are also committed to a process of engagement. The this i that danny referenced in terms of the way that we could encage over the next several hospital in a meaningful and sustained dialogue about improving care and addressing the issues in the community that we both face, we embrace that so we are committed to participating in that in that engagement. And the third thing is that we feel very strongly that we would offer our commitment, and we would encourage a participation in a process between now and october, october 1, using this window of opportunity to gather, develop the objecttive criteria that would drive, could drive the decision making about where and when subsequent stations should be located. If expansion is needed, where should that be. I think this window of opportunity that we have is time that would allow that thoughtful process without sort of the heat of an immediate decision that needs to be made. Potentially without an auction type of process. It would be, think, worthwhile for us to begin now to go about that. So we would be committed to participating in that. So we're committed to exceptional care, committed to process of engagement with danny and the team here, and we're also committed to an objecttive process that would serve us all and the patients we serve. So thank you again.
>> thank you.
>> judge, members of the court, thank you for this opportunities to be here again. We appreciate that. And i also want to echo mark and say thanks to danny for the bood work he did and kudos for the discussions which i think were really useful discussions. The one thing i disagree with danny on is that while he implied that i'm an important person, the real big dog are the seaten daughters of charity who really run the place over there. One of the things the daughters enforce upon us is that we are really a community service organization first and foremost, a hospital system but ultimately a community service organization. I think the kind of work we are talking about here, which is looking at best way the utilize public assets and get people to work together, is an important part of being a community service organization. So we really do welcome this process. Think this is the right way to go. The other thing i think it's important to say too, while st. David's and seaten may have had a different viewpoint on where the helicopter should be located the two systems collaborate actually quite a bit. If you look at a lot of hospital or healthcare markets around the country, a lot would say this is probably somewhat un, the level of cap--cooperation and collaboration you have between the two system. On the icc we work together well and mark and i meet and talk about things, children's optimal health we started at seaten and st. David's stepped up and became a supporter of fairly quickly. A lot of opportunities for us to collaborate. I think it's important for the court and public to recognize the two hospital systems work together quite a bit. I don't think we could meet the safety net needs of this community without both hospitals doing what they do right now because it is a challenge and continues to grow to be a challenge. I know we appreciate all that st. David's does to step up to the plate and look at those things. This is one more opportunity for us to talk together. And i think, the only other thing i want to says, the reasonable i think this is a good process that we whole heart thely support and believe it's a continuation of a lot of good work already been doing and we can take further is what you guys are really deciding is where is the location of public assets. And those assets are critical not only to hospital operations which both mark and i will attest to but in terms of where you put aircraft, ground transportation, how you lo e indicate ems, a whole series of--locate ems, an err sue is of issues, how to deal with homeless patients who come to the hospital and are returned to the community. A whole range of issues that we can talk about. We work with the healthcare district and other groups. But having this exercise to think about prehospital care in those contexts i think is going to be critical. When danny and i had our first conversations, a lot of this has been going on. When we started to think about how to ec can the dots between primary care, clinic care, hospital care, when you look at some of the work we have done to identify the most vulnerable in the community, tends to be homeless, those with mental health behavior issues, seniors homeless. Critical populations out there that not only deserve attention and help but also are the largest cost to our system. When you have few individuals who have a significant cost at the healthcare system it make it tougher to expand the network to everybody. I think if we can collaborate, work out ways to become efficient and effective at caring for the most vulnerable pop s while meeting the healthcare of everyone it's going to be better for the community in terms of safety net and hakehere infrastructure overall. With thaten go, thank you for the opportunity to come back together and kudos to danny for the good work he did here. We look forward to coming back to you with hopefully innovative ideas as well as continuation and collaboration of the work we are doing together already.
>> i am impressed that y'all are coming together and working as a team. When you really look at this effort it really is a team effort. Even from this point of coming from the commissioners court. We also are a part of this team. I look at this, listen to both of your comments, listen to the comments that danny has made. I look at this, it is a window of opportunity to provide service. You both mentioned the different issues, community issues that you face and the level of care that you have to provide, you should provide to this existing community. Saying all of this and looking at the window as far as some of the recommendations that we are coming back with hopefully, doing what we do and then coming back in october of this year, looking at that window of opportunity i have a couple of questions that i'd maybe like to get an answer to. One question is, this is just not a one-time thing. Whatever we do here today as far as laying out the ground work to deal with both of you is not just a one-time thing. Both of you mentioned to some degree expansion. So i'm beginning to wonder how will you be able to collect the necessary data in some time frame. How will that data be collected and designated to the right category to even do not only current service level, using the star flight services and the network that both of you have, not only the current level, future level that even may suggest expansion purposes. There has to be not only a one had ever -time event you--a one had ever time event but also ongoing. Meeping to --meaning to me as the community grows the services are going to grow. How will that data be collected and shared with the decision makers here involved in this room today. How will it be shared? And how will it be collected?. Think those are very components of some of the decision driving factors that need to be made not only today but in the years to come, whatever level of service there is. You mentioned a few, homeless, mental, but also the generally welfare of the public. In your assess ments, when you collect the working teams, working groups, what part will they play a role in collecting data, but not only collecting data for this event here that we are dealing currently, but also future data collection that will suggest expanding maybe services depending on how growth and services are magnified. Can someone answer those questions, thank you.
>> that is a very good question and in fact has to be part of this, commissioner. You don't just have people together and just have discussions.
>> right.
>> what people bring with them are their resources. So i think mark and greg will tell you, like i will tell you, is that we all have our own rms systems, record management systems, data systems. Right now what is interesting about that is that.
>> coming together.
>> yes, each one has their independent systems. And that would be a way of discussion, to see how we could collaborate in sharing information.
>> exactly.
>> that is one of the things i realized in talking to both networks. Name my little silo and collect all my information. They have bitsand pieces of it and have been trying to make heads or tails out of it. I have a network where i get all my information but that is part of this, is seeing what all these other stakeholders as well are doing and what they have as far as data. Being able to share that, that is part of the working groups.
>> okay. From an its standpoint of view, information that is shared collectively has to be a common, in my opinion, has to be a common type of format where you will understand each other as far as the data collection process. I'm just saying, whatever that is.
>> perhaps a good way to address this and to address your question within a broader context is maybe one of the first things we should do is actually determine the agenda of mutual interest. One of them we talked a lot about in the last couple months had is the expansion, one item. We look at current operations, clearly there are mutual interests where collaborating together we could work an agenda together that would have a big impact on current care. In terms of the future agenda, i think there is a plethora of data, the gap may be information. Taking that data and sharing it and coming out of that sharing would be an interpretation. And what do these data mean to us. Pulling in the clen --clinical experts, medical directors and others across systems and with danny's lerds ship with the county, and also reference point to data that may be available, information that may be available from other communities that have addressed similar current operational challenges as well as future challenges. I think there are less --lessons to be learned in pulling that outside knowledge in as well. Those are just some thoughts i had about your question.
>> thank you.
>> if i could just add. I agree. I don't think it's a lack of data. I think it's bringing it together and looking at it in a different context as well. Data sources, i know st. David's has a lot and we do and we do some data sharing in a lot of areas. We have the icc, independent gent care club ration, which is a--indigent care collaboration. There's a great resource there. I think it's more what glasses do you wear to look a the data and how we look at this and what we are looking for. That is the interesting thing, looking at prehospital care and county assets, looking at how to best utilize the data to maximize the investment you are making. The other thing, healthcare reform is going to change things. We don't know what it is going to look like. If anybody tells you they know they are probably lying because it's too different. Even in the best circumstances if everything works the best way possible you are still going to are probably ten percent or more of the population that doesn't have good healthcare coverage because of either they have their own homeless populations, the population with mental health issues, still significant. In a perfect world. We are not sure what the states are going to do in terms of funding. It could be larger. The most vulnerable populations can cost the most money to the system. It's provide that we provide high level and consistent level of care for everybody and recognize how do we best utilize assets to make sure the safety net is viable and working well and in the assume federal healthcare reform is going to take care of it. Think it's in some ways to make et more complicated to work with those folks.
>> thank you.
>> any other questions or comments from the court? Mr. Referseed.
>> thank you, sir. I just wanted to point out to our fellow citizens here that these fine gentlemen obviously know a whole lot. Though when one speaks of an agenda, i'm here to reveal to everybody, there's a secret agenda here. And greg, the gentleman named greg, he happened to mention blatantly in saying that the problem is the few individuals who cost a whole lot of money so that we have to cut services for everybody else. That is death panels people. They are picking and choosing who is going to get the treatment and how much it's going to cost because some people cost more than others. Well, that is inherent. Might seem unfair, but the fact is some people cost more money to treat them. Some people takes longer. Some people get old. Some people get real old and that costs them a whole lot and costs us a lot of money. Hey, we are supposed to live in a compassion at cutch that takes care of people. Do we care for everybody or start cutting them off because a few individuals cost a little too much to fit into this obama med medicare scam. It's taking money from all of us and passing off to less care. That is why the read of the --rest of the world that has this kind of care system come here. The rich people, presidents and people who can afford it. They come to our country and use our doctors and very costly and advanced, those kind of procedures that can be obtained here because we, up to now, we have been willing to pay the money to do that. And do that for the research and all these universities that we have here doing this kind of stuff. But now it's going to be cut down and we're going to have just like england. If you pay attention--
>> thank you, mr. Referseed for your input.
>> england is falling apart.
>> two questions. One is do we think that recommendation number two is achievable by october 1, 2010. Mr. Hobby?
>> yes, sir, i do.
>> okay. This started out as search for $3.2 million. Where that?
>> well, at this particular moment, i have $3.2 from each network. And when i left here the last time, it was to look at $3.2 million from either one network or $3.2 from both networks. That is when i looked at the third aircraft possibility. As i told both networks, i'm not after their money. I'm after what is best for aunt molly out there. I found out from both of these gentlemen, they are in the same business. I still want them to support the program so there's not going to be a situation where i am saying everything goes away in regards to aircraft and aircraft at hospital locations and their willingness to support the star flight program. What i am saying is that i'm not interested in pursuing money for the sake of money and increasing the program for the sake of increasing the program. That hurts the hospitals. That hurts aunt molly. So this thing is now turned into a more positive direction of where we are now going to establish the third aircraft, we're four going to see how that works with the existing two aircraft. And it's going to ultimately, i think, end up in a greater and better decision for everybody concerned.
>> but the money is still part of our discussion.
>> the money is still part of the discussion. I think both hospitals are where they are with that.
>> okay.
>> . Therefore, i move that we approve recommendations one, two and three.
>> second.
>> any discussion of the motion?
>> judge, again, i'd like to applaud the gentlemen at the table that have comfort --come forth with this. Especially when they left the money on the table. I was glad to hear that. I didn't see anything to indicate that the money still wouldn't be available, $3.2 million. Really glad to hear that and just thank them for the good work they have done.
>> all in favor. That passes by unanimous vote. Thank you all very much.
>> thank you.
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Last Modified:
Tuesday, April 20, 2010 1:53 PM
